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Objectives. We assessed changes in cardiovascular disease--related health outcomes and risk factors among American Indians and Alaska Natives by age and gender. Methods. We used cross-sectional data from the 1995 to 1996 and the 2005 to 2006 Behavioral Risk Factor Surveillance System. The respondents were 2548 American Indian and Alaska Native women and men aged 18 years or older in 1995-1996 and 11 104 women and men in 2005-2006. We analyzed the prevalence of type 2 diabetes, obesity, hypertension, cigarette smoking, sedentary behavior, and low vegetable or fruit intake. Results. From 1995-1996 to 2005-2006, the adjusted prevalence of diabetes among American Indians and Alaska Natives increased by 26.9%, from 6.7% to 8.5%, and obesity increased by 25.3%, from 24.9% to 31.2%. Hypertension increased by 5%, from 28.1% to 29.5%. Multiple logistic models showed no meaningful changes in smoking, sedentary behavior, or intake of fruits or vegetables. In 2005-2006, 79% of the population had 1 or more of the 6 risk factors, and 46% had 2 or more. Conclusions. Diabetes, obesity, and hypertension and their associated risk factors should be studied further among urban, rural, and reservation American Indian and Alaska Native populations, and effective primary and secondary prevention efforts are critical. (Am J Public Health. 2010;100:677-683. doi: 10.2105/AJPH.2009.164285)

Objectives. We assessed the impact of education level on the association between self-rated health and cardiovascular risk factors (blood pressure, glycosylated hemoglobin level, and total cholesterol and triglyceride levels). Methods. We used data from the National Health and Nutrition Examination Survey for the years 2001 through 2004 (4015 men and 4066 women). Multivariate analyses were performed with a logistic regression model. Results. After adjustment for age and ethnicity, among women with high glycosylated hemoglobin levels, the most-educated women had poorer self-rated health compared with the least-educated women (odds ratio [OR] =4.61; 95% confidence interval [CI]=2.90, 7.34 vs OR=2.59; 95% CI=1.60, 4.20, respectively; interaction test, P=0.06). The same was true among women with high cholesterol levels (OR=2.23; 95% CI=1.40, 3.56 vs OR=1.13; 95% CI=0.85, 1.49, respectively; interaction test, P=0.06). Among men, the impact of education level on the association between self-rated health and any cardiovascular risk factors (measured or self-reported) was not significant. Conclusions. The impact of cardiovascular risk factors on self-rated health was higher for highly educated women, which could lead to underestimation of health inequalities between socioeconomic groups when self-rated health is used as an indicator of objective health. (doi:10.2105/AJPH.2008.147934)

We analyzed cardiovascular disease mortality risks associated with obesity using participant-level meta-analysis of data from the Black Pooling Project for Black and White individuals. The adjusted relative risks (ARRs) were stronger among White participants than among Black participants for coronary heart disease AAR = 1.21 (95% confidence interval [CI]=1.07, 1.36) versus 0.87 (95% CI=0.69, 1.09), respectively, and cardiovascular disease ARR=1.18 (95% CI=1.07, 1.29) versus 0.91 (95% CI=0.77, 1.05), repectively. The results suggest that obesity is an independent risk factor in White people, and additional study of body size and disease progression is necessary in the assessment of racial disparities. (Am J Public Health. 2008;98:63-66. doi:10. 2105/AJPH.2006.093781)

Objectives. This study examines the relationship between birthplace and mortality from circulatory diseases among American Blacks. Methods. All Black deaths from circulatory diseases (International Classification of Diseases, 9th Revision, codes 390 through 459) were extracted from the National Center for Health Statistics mortality detail files for 1979 through 1991. Age-specific and age-adjusted mortality rates with 95% confidence intervals were calculated for males and females for combinations of five regions of residence at birth and four regions of residence at death. Results. Males had higher mortality rates from circulatory diseases than females in every regional combination of birthplace and residence at death. For both genders, the highest rates were for those who were born in the South but died in the Midwest; the lowest rates were for those who were born in the West but died in the South. Excess mortality for both Southern-born males and females begins at ages 25 through 44. Conclusions. There is a region-of-birth component that affects mortality risk from circulatory diseases regardless of gender or residence at time of death. We must examine how early life experiences affect the development of circulatory disorders. (Am J Public Health. 1997;87:800-804)

Objectives. The purpose of this study was to review cardiovascular mortality, morbidity, and risk factors in the multiethnic population of the Northwest Territories, Canada. Methods. We analyzed death certificates and hospital records, and used a community health and examination survey. Results. The age-standardized mortality rate for ischemic heart disease but not for other heart diseases or stroke) among the Northwest Territories population was lower than among the Canadian population. Among the indigenous Inuit/Eskimos and Indians, the age-standardized mortality rate for all circulatory diseases was lower than Canadians. Among Indian women, the rate approached the Canadian rate and exceeded that of Inuit and non-Natives. Compared with residents of Manitoba, Northwest Territories Inuit adults had a higher prevalence of smoking in all age-sex groups. Obesity was prevalent among older Inuit women and hypertension among young Inuit men. Except for women aged 25 to 44, the total cholesterol and triglyceride levels among Inuit were lower than or not different from Manitoba residents. Relatively high levels of high-density lipoprotein were found in older Inuits. Conclusions. The epidemiologic pattern of cardiovascular diseases in Arctic Canada differs from that among non-Native, southern Canadians. Rapid sociocultural changes may alter the situation, and health agencies must anticipate such transitions and intensity culturally appropriate control programs. (Am J Public Health. 1993;83:881-887), Native peoples of northern Canada may have a lower risk of cardiovascular diseases than that of non-native, southern Canadians. The population of the Northwest Territories includes 35% Inuit (Eskimos) and 15% Dene Indians. Researchers used mortality statistics, hospital records and data from a community health survey to determine risk factors and prevalence of cardiovascular diseases among this population. Among Inuit and Indian men, the mortality rate from all cardiovascular diseases was approximately 40% lower than that of other Canadians. Among Inuit women and other women in the Northwest Territories the cardiovascular disease mortality rate was somewhat lower than that of other Canadian women, but the Indian women had a rate comparable to the rest of Canada. Data for cardiovascular risk factors such as blood pressure, cholesterol levels, weight and smoking are also presented.

Objectives: This study investigated cardiovascular risk factors among male transport workers in Bulgaria. Methods. Comparisons were made of data from independent surveys conducted among male transport workers aged 30 to 59 years in Sofia, Bulgaria. during 1986 (n=1146) and 1996-1997 (n=638). Results. Smoking prevalence increased from 49% to 59% between 1986 and 1996-1997. Among current smokers, the percentage smoking 15 or more cigarettes per day decreased. The prevalence of elevated body mass index, hypertension, or angina pectoris did not change. Conclusions. Smoking prevalence rates increased during the study period; the prevalence of other risk factors remained high. (Am J Public Health 2001; 91:455-457)