Biomedical subjects

J M Sprafka

Publications and source records attributed to J M Sprafka.

At least 37 records · Page 2Linked to original sources

PubMed1993

HLA-associated susceptibility to type 2 (non-insulin-dependent) diabetes mellitus: the Wadena City Health Study.

Epidemiologic data suggest that a parental history of Type 2 (non-insulin-dependent) diabetes mellitus increases the risk of Type 1 (insulin-dependent) diabetes in siblings of a Type 1 diabetes proband. This increase in risk is consistent with a shared genetic susceptibility between Type 1 and Type 2 diabetes. We have previously reported evidence that HLA-DR4-linked factors may represent a homogeneous subset of diabetes susceptibility. First, HLA-DR4 frequency was higher in Type 1 diabetic study subjects with a Type 2 diabetic parent than in Type 1 diabetic subjects whose parents were not diabetic. Second, a DR4-haplotype was transmitted from the Type 2 diabetic parent to the Type 1 offspring more often than expected. These data are consistent with the hypothesis that families with a Type 2 diabetic parent and Type 1 diabetic child, heavily determined by HLA-DR4 linked factors, may represent a homogeneous subset of diabetes susceptibility. In this report, we further explore the relationship between the high-risk HLA antigen (HLA-DR4) in study subjects with differing glycaemic status (National Diabetes Data Group criteria). In this community-based study, we find evidence that HLA-DR4 is increased in study subjects with Type 2 diabetes and may be a marker for Type 2 diabetes susceptibility.

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PubMed1993

Contribution of dietary lipid change to falling serum cholesterol levels between 1980 to 1982 and 1985 to 1987 in an urban population. The Minnesota Heart Survey.

We assessed dietary intake and serum total cholesterol trends during the 1980s, in the Minneapolis-St. Paul (Twin Cities) metropolitan area. Twin Cities residents 25 to 74 years old participated in independent, cross-sectional, population-based surveys of risk factors for cardiovascular disease in 1980 to 1982 (n = 1611) and 1985 to 1987 (n = 2231). Age-adjusted total energy intake was similar in 1980 to 1982 and 1985 to 1987: 2528 kcal (10.6 MJ) versus 2574 kcal (10.8 MJ) for men and 1683 kcal (7.1 MJ) versus 1689 kcal (7.1 MJ) for women. However, significant changes were observed in macronutrient intake. The percent of energy from total fat intake decreased from 39.3 to 38.1% in men and 38.9 to 36.6% in women (both P < 0.01). The composition of fat consumed changed, such that the Keys score, an index of dietary fat and cholesterol, decreased by 3.3 units in both sexes (both P < 0.01). The predicted changes in serum total cholesterol (Keys score) were generally consistent with observed declines of 5.4 mg/dL (0.1 mmol/L) in men and 5.8 mg/dL (0.15 mmol/L) in women during this time period. These data suggest that members of this community are on average modifying their fat consumption and that these dietary changes are resulting in more favorable serum total cholesterol levels.

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PubMed1993

The role of stroke attack rate and case fatality in the decline of stroke mortality. The Minnesota Heart Survey.

The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors in the Minneapolis-St. Paul (Twin Cities) metropolitan area. Trends in stroke mortality were examined from 1960 to 1991; stroke morbidity trends were examined in 50% samples of patients discharged with an acute stroke diagnosis in 1970, 1980, and 1985. Stroke mortality in Twin Cities residents aged 30 to 74 years declined by more than 70% from 1960 to 1991 in both men and women. The decline occurred at a rate of 2.5% per year until 1972, accelerated between 1972 and 1984 (7.9% per year), and slowed considerably thereafter (1.8% per year). Hospitalized acute-stroke discharge rates among those aged 30 to 74 years declined substantially between 1970 and 1985 in both sexes (P < 0.01), but there was no change in definite stroke rates defined by standardized clinical criteria. Both short-term (28 days) and long-term (5 years) survival of definite-stroke patients improved significantly between 1970 and 1985. These improvements, however, were not found in the entire samples of unverified acute-stroke discharges. The proportion of hospitalized acute-stroke patients who had computed tomography performed increased from 0% in 1970 to 75% in 1985. There were also improvements in hospital records pertaining to the documentation of stroke symptoms and signs. These data indicate that the impressive declines in stroke mortality observed in the 1970s and early 1980s have slowed dramatically in the latter half of the 1980s. The decline in stroke mortality likely reflects both a decline in attack rate and improved survival after stroke.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1993

Sex differences in coronary heart disease mortality trends: the Minnesota Heart Survey, 1970-1988.

Recent U.S. national statistics indicate a slowing of the rate of decline in coronary heart disease (CHD) deaths among women. To examine recent sex-specific rates of mortality decline in the Minnesota Heart Survey, we computed the average annual percentage change in age-adjusted CHD death rate for the periods 1970-1978 and 1979-1988. We fit a log-linear regression model to the yearly CHD death rates, with separate sex-specific slopes estimated simultaneously for the two calendar periods. The average annual percentage decline in age-adjusted CHD death rate among men was slightly greater in the period 1979-1988 [4.8%; 95% confidence interval (CI) = 5.2-4.3] than in the period 1970-1978 (3.9%; 95% CI = 4.6-3.1). In contrast, among women, the rate of decline was less in the period 1979-1988 (3.6%; 95% CI = 4.8-2.3) than in 1970-1978 (4.8%; 95% CI = 5.6-4.0). We found a slowing of the rate of decline in out-of-hospital CHD deaths in both men and women. We observed a large increase in the rate of decline in the CHD death rate in hospital among men in the period 1979-1988 (8.3%; 95% CI = 9.3-7.2), compared with the period 1970-1978 (2.4%; 95% CI = 3.2-1.7). This increase did not occur among women (4.1%; 95% CI = 5.7-2.5 in 1970-1980 vs 3.8%; 95% CI = 4.9-2.7 in 1970-1978); this difference is a major factor in the steeper recent decline in overall CHD mortality among men compared with women.

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PubMed1993

Socioeconomic status and coronary heart disease risk factor trends. The Minnesota Heart Survey.

BACKGROUND: Socioeconomic status (SES) indicators including education, income, and occupation are associated with coronary heart disease (CHD) risk factors, morbidity, and mortality. In most industrialized nations, individuals with less education, lower income, and blue collar occupations have the highest CHD rates. It is suggested by some that these differences by SES are increasing even as age-adjusted CHD mortality declines. METHODS AND RESULTS: The Minnesota Heart Survey includes measurement of CHD risk factors and behaviors in population-based samples of Minneapolis-St. Paul adults aged 25 to 74 years in 1980 to 1982 (N = 3243) and 1985 to 1987 (N = 4538). Education was significantly and inversely related to blood pressure, cigarette smoking, body mass index, and a summary risk score for both men and women. Serum cholesterol was inversely related to education in women but not in men. Education was positively associated with leisure physical activity and health knowledge. Associations with household income were less consistent in magnitude and direction. Risk characteristics improved significantly between the 1980 to 1982 and 1985 to 1987 surveys. These changes were similar across education and household income levels. CONCLUSIONS: Improvement in CHD risk factors over time unrelated to education or income suggests that population-wide factors such as improved health knowledge, availability of healthy food items, hypertension treatment, and restrictions on cigarette smoking are operating beneficially in all SES groups. Although the SES gradient in risk factors is not increasing, it remains substantial and indicates directions for future prevention efforts.

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PubMed1993

Trends in survival of hospitalized stroke patients between 1970 and 1985. The Minnesota Heart Survey.

BACKGROUND AND PURPOSE: Age-adjusted stroke mortality rates declined approximately 50% between 1970 and 1990 in both the United States and Minnesota, but the reasons for this decline are not clear. This report examines possible improvements in short- and long-term survival of hospitalized definite stroke patients in the Minneapolis-St Paul (the Twin Cities) metropolitan area during this period. METHODS: Fifty percent random samples of patients discharged with an acute stroke diagnosis from area hospitals were selected in 1970 (n = 1200), 1980 (n = 1040), and 1985 (n = 896). Trained nurses abstracted pertinent clinical data from the hospital charts. By standardized clinical criteria similar to World Health Organization criteria (without computed tomography data), 376, 442, and 453 definite strokes were established for 1970, 1980, and 1985, respectively. RESULTS: Age- and sex-adjusted 28-day case fatality of definite stroke improved significantly from 1970 to 1985; the odds ratio (OR) of death within 28 days in 1985 (versus 1970) patients was 0.55 (95% confidence interval [CI], [0.39, 0.77]). Substantial improvements in 28-day mortality were observed both from 1970 to 1980 and from 1980 to 1985, although the latter change was not statistically significant. Further adjustment for predictors of early stroke mortality (such as level of consciousness) somewhat attenuated these results. Age- and sex-adjusted 5-year survival of definite stroke also improved significantly from 1970 to 1985 (OR, 0.72; 95% CI, [0.54, 0.96]), although the improvement was restricted to the 1970 to 1980 time period (OR, 0.76; 95% CI, [0.57, 1.01]). None of the survival trends differed significantly between men and women. CONCLUSIONS: There were marked improvements in survival from 1970 to 1985 among hospitalized stroke patients in the Twin Cities. These improvements occurred almost exclusively in the acute hospitalization phase. Although the advent of computed tomography and improvements in hospital record-keeping during this period prevent an unequivocal conclusion, improved medical care and decreased severity of stroke probably contributed to gains in survival.

Age Factors↗

PubMed1993

The smoking habits of Minnesota physicians.

The prevalence of smoking among physicians has gradually declined over the past 25 years. Few recent studies have examined specific smoking habits. Of 393 physicians in the Minnesota Medical Association who responded to a survey (response rate of 83%), 9% reported smoking any form of tobacco. The prevalence of cigarette smoking was 4.9%, while 5.1% smoked a pipe and 2.1% smoked cigars. The prevalence estimates of current and former smokers were greater among men than women and among older than younger physicians. Cigarette and overall smoking prevalence among physicians continues to be well below levels reported for the general population.

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PubMed1992

Trends in mortality, morbidity, and risk factor levels for stroke from 1960 through 1990. The Minnesota Heart Survey.

OBJECTIVE: The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors. DESIGN: Surveillance time-trends study. METHODS: The following trends were examined among men and women aged 25 to 74 years living in Minneapolis-St Paul, Minn: (1) stroke mortality from 1960 through 1990; (2) risk factors in population-based surveys conducted in 1973 through 1974, 1980 through 1982, and 1985 through 1987; and (3) morbidity in a 50% sample of hospitalized discharges for acute-stroke in 1970, 1980, and 1985. RESULTS: Stroke mortality in Minneapolis-St Paul declined slowly from 1960 through 1972 (average fall, 2.4% per year), dropped sharply from 1972 through 1984 (average fall, 6.5% per year), but exhibited little change thereafter (average fall, 1.5% per year). The average level of cardiovascular disease risk factors fell from 1973-1974 to 1985-1987, with the exception of body mass index. In particular, hypertension diagnosis, treatment, and control levels improved substantially between 1973-1974 and 1980-1982, although there was little improvement after 1980-1982. While discharge rates for hospital-coded acute stroke declined substantially between 1970 and 1985 in both sexes, no clear trend was observed in definite stroke rates as validated using standard clinical criteria. Twenty-eight-day case fatality rates of definite stroke improved significantly from 1970 to 1985. CONCLUSIONS: The substantial decline in stroke mortality of more than 50% from 1960 through 1990 appears to have been attributable to both primary and secondary prevention. These data suggest that the long decline in stroke mortality and morbidity in Minneapolis-St Paul has plateaued, although improved detection of stroke with computed tomography prevents an unequivocal conclusion.

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PubMed1992

Menopause and serum cholesterol: differences between blacks and whites. The Minnesota Heart Survey.

The relation between menopause and serum total and high-density-lipoprotein cholesterol was examined by the Minnesota Heart Survey in a cross-sectional, population-based study of 344 black women and 474 white women aged 35-54 years from the Twin Cities metropolitan area in 1985-1986. Analysis of covariance was used to examine differences in serum total and high-density-lipoprotein cholesterol in black women and white women by menopausal status, adjusting for the effects of age, educational level, cigarette smoking, body mass index, exercise, alcohol consumption, diabetes mellitus, sex hormone, beta blocker, and diuretic use. Among whites, adjusted serum total cholesterol was 13 mg/dl higher in postmenopausal than in premenopausal women (p less than 0.002). Black postmenopausal women had slightly higher serum total cholesterol than did their premenopausal counterparts (5.4 mg/dl). However, this was not statistically significant. An interaction term in a linear regression model confirmed a racial difference in the total cholesterol association with menopause (p less than 0.02). The higher total cholesterol levels observed in white postmenopausal women were mainly among those with natural menopause (20.7 mg/dl higher than premenopausal, p less than 0.0003) and those with a hysterectomy and at least one intact ovary (11.0 mg/dl higher, p = 0.05). Among black women, only the subgroup with a hysterectomy and a bilateral oophorectomy had a significantly higher serum total cholesterol (19.9 mg/dl higher than premenopausal, p less than 0.05). There was no significant association between high-density-lipoprotein cholesterol and any type of menopause in either black women or white women. Our findings may reflect a true physiologic difference in the relation between menopause and serum total cholesterol between American blacks and whites. The lack of a significant association between menopause and high-density-lipoprotein cholesterol in either race raises the possibility that menopause may not affect atherosclerosis risk via reduced high-density-lipoprotein cholesterol.

Adrenergic beta-Antagonists↗

PubMed1992

Genetic markers associated with high density lipoprotein cholesterol levels in a biracial population sample.

An explanation for the consistently documented finding of higher levels of high density lipoprotein-cholesterol in black men relative to white men was sought by comparing the frequency of restriction fragment length polymorphism markers present in blacks and in whites at the gene loci coding for the two major apolipoprotein constituents of high density lipoprotein, apolipoproteins AI and AII. The measurements were made in population-based samples of 45 to 54-year-old black (n = 190) and white (n = 370) subjects from the Minnesota Heart Survey for whom lipoprotein levels were available. The mean high density lipoprotein-cholesterol level for black men in the sample (47 +/- 1.5 mg/dl) was higher (P less than 0.05) than that for white men (42 +/- 0.9 mg/dl), while levels in women were not different between races. While the SacI and MspI markers at the apolipoprotein AI-CIII-AIV gene locus showed similar frequencies in blacks compared to whites, the degree of the linkage disequilibrium previously noted between these markers in white subjects was altered in blacks and the minor allele of the PstI marker at this locus was virtually absent in the black subjects (P less than 0.005 vs whites). For black men, there were significant associations of the M2 allele and the S2M2 haplotype at the apolipoprotein AI locus with lower high density lipoprotein-cholesterol levels. The results are consistent with the hypothesis that DNA sequence variations in the vicinity of the apolipoprotein AI-CIII-AIV gene locus are associated with the difference in high density lipoprotein-cholesterol levels between blacks and whites.

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PubMed1992

Physical activity in Minnesota physicians.

METHODS: A survey inquiring about physical activity was mailed to a random sample of 500 physicians who were current members of the Minnesota Medical Association. RESULTS: Overall, 65.6% of the 393 respondents reported performing regular exercise, while 38.2% participated in exercise vigorous enough to be of cardiovascular benefit (at least three times per week, at least 15-30 min per session, and strenuous enough to cause sweating or shortness of breath). Men reported a significantly higher prevalence of regular exercise and cardiovascular exercise than did women. There was no significant relationship between the prevalence of either regular exercise or cardiovascular exercise and age, specialty, the percentage of primary care performed, the number of patients seen per day, or the number of hours worked per week. CONCLUSIONS: The prevalence of physical activity was higher among physicians in this survey compared with levels reported for the general population.

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PubMed1992

Cardiovascular disease risk factors and glucose tolerance. The Wadena City Health Study.

Cardiovascular risk factors were examined in 453 subjects participating in the Wadena City Health Study, a population-based study to assess the relationship between diabetes and glucose intolerance with age. Each subject was classified as either having non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), or normoglycemia, using WHO criteria. Age- and body-mass-adjusted levels of systolic and diastolic blood pressure were lowest for those with normoglycemia, intermediate for those with IGT, and highest for those with NIDDM. Age- and body-mass-adjusted levels of high-density lipoprotein cholesterol were lowest for those with NIDDM, intermediate for those with IGT, and highest for those with normoglycemia, while triglyceride levels were highest for those with NIDDM, intermediate for those with IGT, and lowest for those with normoglycemia in women but not in men. Low-density lipoprotein cholesterol levels were lowest for those with NIDDM, intermediate for those with IGT, and highest for those with normoglycemia. With the exception of men with IGT, no differences by glycemic strata were observed for plasma total cholesterol. The prevalence of smoking showed no consistent pattern by glycemic status. These findings suggest that individuals with IGT have an atherogenic risk factor pattern that may put them at greater risk for coronary heart disease than those with normoglycemia. Intervention strategies such as diet, exercise, and/or drug therapy should be tested to evaluate whether these are effective in preventing conversion to overt diabetes and normalizing cardiovascular disease risk factors.

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PubMed1992

Community trends in CPR training and use: the Minnesota Heart Survey.

STUDY OBJECTIVE: To examine community changes in self-reported CPR training and use from 1980-82 to 1985-87 using data obtained from the Minnesota Heart Survey. A comparative investigation of CPR training among blacks and whites in 1985-86 also was completed. DESIGN: Data were obtained in 1980-81, 1981-82, 1985-86, and 1986-87 from four population-based samples drawn from the seven-county Minneapolis-St Paul metropolitan area. To increase sample sizes and to compare prevalences of CPR training and use in the early 1980s with prevalences in the mid-1980s, the four Minnesota Heart Survey surveys were combined into two time periods, 1980-82 and 1985-87. A separate survey of black individuals was conducted in 1985, and these data were used in the comparisons between blacks and whites in 1985-86. RESULTS: The prevalence of whites trained in CPR increased significantly between 1980-82 and 1985-87 in both nonhealth professionals (18.5% vs 30.9%) and health professionals (71.9% vs 86.8%). No significant change was observed between the two periods in the percentage of nonhealth professionals who had ever used their CPR skills (9.7% vs 10.7%), whereas use among health professionals increased significantly (40.2% vs 53.4%). Training within the prior two or three years decreased from 1980-82 to 1985-87 among nonhealth professionals, but increases in recent training were observed among health professionals. There were no significant differences between black and white nonhealth professionals in the prevalence of CPR training. Black trainees, however, reported a higher percentage of ever using CPR skills than white trainees (15.4% vs 9.8%, respectively). Black trainees also had higher rates of recent CPR training than white trainees. No differences were observed between black and white health professionals regarding CPR training and use, or recency of certification. CONCLUSION: These results suggest that the percentage of individuals trained in CPR is increasing. Improvement is needed, however, in the rates of recent certification among nonhealth professionals.

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PubMed1992

Life-style factors do not explain racial differences in high-density lipoprotein cholesterol: the Minnesota Heart Survey.

We analyzed data from a population-based survey to determine whether serum high-density lipoprotein cholesterol (HDL-C) concentrations are different in blacks and whites after controlling for life-style characteristics. We studied a total of 741 white men, 453 black men, 786 white women, and 572 black women age 35-74 years. Age-adjusted HDL-C concentrations were higher in black than white men (48.6 vs 40.8 mg/dl) and in black than white women (56.1 vs 54.0 mg/dl). Life-style characteristics associated with HDL-C in women were exogenous hormone use, average number of cigarettes smoked per day, average ounces of alcohol consumed per week, body mass index, and use of beta-blockers. Life-style characteristics associated with HDL-C levels in men included age, average number of cigarettes smoked per day, average ounces of alcohol consumed per week, body mass index, and a self-reported history of diabetes. After adjustment for life-style characteristics, black men and women had HDL-C levels 7.0 and 5.3 mg/dl higher, respectively, than whites. Body mass index was a negative confounder in women; after adjusting for body mass and age, black women had HDL-C levels 4.6 mg/dl higher than white women. These data indicate that the measured life-style factors cannot fully explain the observed differences in HDL-C between blacks and whites. These findings, which are consistent with other reports, may reflect an inability to assess life-style factors accurately and/or genetic or cultural factors yet to be determined.

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PubMed1992

Association between stimulated plasma C-peptide and age: the Wadena City Health Study.

OBJECTIVE: To assess age-related changes in stimulated plasma C-peptide in a population-based sample of adults. DESIGN: Cross-sectional study. SETTING: Wadena, Minnesota, a city of 4,699 residents (1980 census) in west central Minnesota, approximately 150 miles from Minneapolis/St. Paul. STUDY SUBJECTS: 344 non-diabetic subjects (NDDG standards) from a stratified random sample of the total adult population of Wadena, MN. The six-study strata were men and women from three age groups: young, 20-39 years of age; middle-aged, 40-59; and older, greater than 60 years of age. MEASUREMENTS: During a liquid meal of Ensure-Plus (Ensure-Plus challenge test; EPCT; Ross Laboratories), blood samples were taken for glucose, free fatty acids, creatinine, and C-peptide. Plasma C-peptide taken 90 minutes after the EPCT was used as a surrogate measure for insulin. Clinical tests included one-time samples for hemoglobin, glycosylated hemoglobin, plasma cholesterol, triglycerides, and lipoproteins. Physical measurements included height, weight, and blood pressure. Urine was assayed for C-peptide and creatinine. Assays of urine and plasma C-peptide used antibody M1221 (from Novo; Copenhagen, Denmark). MAIN RESULTS: No differences were observed for the relationship between age and C-peptide within each of the three age groups for men and the three age groups for women. However, the levels of plasma C-peptide for older men or women were statistically significantly higher than levels for the young age groups of the same sex; fasting plasma glucose also was higher for older groups of both sexes, and postmeal glucose was significantly higher for older women. There were decreases with age in urine C-peptide clearance for women and men; the decline for women was statistically significant. In multiple regression models for men alone and women alone, that controlled for age, post-meal plasma glucose best explained plasma C-peptide levels. For young men, plasma glucose alone provided the best prediction of plasma C-peptide levels; body mass index (BMI) and plasma glucose provided the best prediction for young women. For older men and both middle-aged and older women, a combination of urine C-peptide clearance and plasma glucose best predicted plasma C-peptide levels; for middle-aged men, BMI also contributed to the prediction. CONCLUSIONS: Secretion of insulin in response to an orally administered mixed meal is undiminished with age in non-diabetic adults.

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PubMed1992

Morbidity from congestive and hypertrophic cardiomyopathy in the Minneapolis-St. Paul metropolitan area: 1979-1984.

In order to develop an epidemiologic profile of congestive and hypertrophic cardiomyopathy, we reviewed hospital discharge diagnosis data for the Minneapolis-St. Paul metropolitan area from 1979 to 1984. For congestive cardiomyopathy, we found statistically significant increases in the age-adjusted hospital discharge diagnosis rate for both men (from 63 to 125/100,000 population/year) and women (from 35 to 58/100,000 population/year). We also found that the age-specific rates increased significantly among older men (55-64 years of age, from 86 to 198/100,000 population/year; 65-74 years of age, from 182 to 322/100,000 population/year) and older women (65-74 years of age, from 106 to 196/100,000 population/year). The rates increased with advancing age for both genders. Men had greater rates than women. For hypertrophic cardiomyopathy, no temporal trends could be discerned. Women were observed to have greater age-specific rates than men; the age-adjusted rates were, however, approximately the same for men and women. The hospital discharge diagnosis rate increased with advancing age among both men and women. The possible reasons for these observed patterns, including the major impact of improvements in diagnosis during the observation period, are discussed. Additional research into these disorders is needed.

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PubMed1992

Trends in survival of hospitalized myocardial infarction patients between 1970 and 1985. The Minnesota Heart Survey.

BACKGROUND: The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors. As part of this effort, a 50% sample of patients hospitalized for myocardial infarction (MI) in the seven-county Twin Cities (Minneapolis and St. Paul) metropolitan area was reviewed in 1970, 1980, and 1985. Those with a validated definite MI were followed for 4-year mortality. The purpose was to determine whether the improved survival observed between 1970 and 1980 was extended to the 1980-1985 period. METHODS AND RESULTS: Crude 28-day mortality in men changed from 18% in 1970 to 12% in 1980 to 13% in 1985; in women it changed from 27% in 1970 to 22% in 1980 to 18% in 1985. After adjustment for severity factors (e.g., age, previous MI, and admission heart rate and systolic blood pressure), 28-day mortality was significantly lower in 1980 than in 1970 in men (RR, 0.66; 95% CI, 0.47, 0.92) and in women (RR, 0.69; 95% CI, 0.46, 1.04), but no change occurred from from 1980 to 1985 (p greater than 0.25). After adjustment for severity indicators, 4-year survival was better in 1980 than in 1970 for men (RR, 0.67; 95% CI, 0.54, 0.83) and for women (RR, 0.72; 95% CI, 0.54, 0.98), but there was no significant change from 1980 to 1985 (p greater than 0.25). CONCLUSIONS: These results suggest that improvements in survival among hospitalized MI patients contributed to the overall decline in coronary heart disease mortality in the Twin Cities area between 1970 and 1980 but not between 1980 and 1985.

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PubMed1992

Antibiotic use in urban whites and blacks: the Minnesota Heart Survey.

OBJECTIVE: To assess racial differences in the use of antibiotics, including penicillins, erythromycins, tetracyclines, sulfas, and cephalosporins. DESIGN: Population-based surveys, conducted from 1985 to 1987. SETTING: The seven-county metropolitan area of Minneapolis-St. Paul, MN. PARTICIPANTS: 3127 whites (response rate 68 percent) and 1047 blacks (response rate 65 percent), aged 35-74 years. RESULTS: White women (26 percent of 1625) were more likely to report having taken an antibiotic in the past year than were white men (18 percent of 1502), black women (18 percent of 590), or black men (15 percent of 457). Reported antibiotic usage decreased with increasing age. Black men were more likely than white men to report the use of tetracyclines or sulfas; otherwise, white men reported higher usage prevalences. White women reported higher usage prevalences of all drug classes than black women. CONCLUSIONS: Significant independent predictors of antibiotic use were younger age, white race, and female gender. Potential explanations for these differences include differences in patient access, physician-prescribing behaviors, or both.

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