Biomedical subjects

K L Ebi-Kryston

Publications and source records attributed to K L Ebi-Kryston.

7 recordsLinked to original sources

PubMed1990

Predicting death from coronary heart disease using a questionnaire.

The ten-year coronary heart disease (CHD) mortality is reported for 18,322 male civil servants aged 40 to 64 according to questionnaire responses at entry into the Whitehall study. In all 1714 died, 723 from CHD. The predictive power of the questionnaire was examined with a view to its use as a screening tool in population studies. In predicting death from coronary heart disease the greatest specificity (true negative rate) was achieved with men reporting both angina (A) and a history of severe chest pain (possible myocardial infarction, PMI). This strategy (A plus PMI) achieved a specificity of 99% but a sensitivity (true positive rate) of only 7%. In contrast, in men reporting angina and/or PMI, specificity was 90% and sensitivity 29%. If this 'and/or' algorithm was extended to include the report of dyspnoea, diabetes, and/or attending a primary care physician with heart disease or hypertension, then specificity was still 85%, but sensitivity increased to 44%. This combination (11 questions in all) is therefore recommended for screening purposes. Identifying and excluding those who favour positive answers ('yes-set' responders), using questions such as the effect of weather on breathing, led to small increases in specificity but relatively large falls in sensitivity. Among subjects reporting chest pain, those who also complained of non-specific symptoms experienced only half the mortality of those with none of these additional complaints.

Adult↗

PubMed1990

Health and other characteristics of employed women and homemakers in Tecumseh, 1959-1978. I. Demographic characteristics, smoking habits, alcohol consumption, and pregnancy outcomes and conditions.

Using data collected in 1959-60 and 1978-79 in the Tecumseh Community Health Study, characteristics of 866 women aged 20-44 years at baseline were analyzed according to employment status at baseline and follow-up (employed/employed, homemaker/employed, employed/homemaker and homemaker/homemaker). To avoid the bias of including unhealthy women with homemakers, disabled and retired women were excluded. Women employed at both exams more frequently reported current alcohol consumption than other women, and the association persisted after controlling for covariables. Smoking habits, rates of reported pregnancy outcomes and conditions, and rates of gynecological problems did not differ significantly among employment groups.

Adult↗

PubMed1990

Health and other characteristics of employed women and homemakers in Tecumseh, 1959-1978. II. Prevalence of respiratory and cardiovascular symptoms and illnesses, mortality rates and physical and physiological measurements.

Using data collected in 1959-60 and 1978-79 in the Tecumseh Community Health Study, characteristics of 866 women aged 20-44 years at baseline were analyzed according to employment status, at baseline and follow-up (employed/employed, homemaker/employed, employed/homemaker, and homemaker/homemaker). To avoid the bias of including unhealthy women with homemakers, disabled and retired women were excluded. There were few significant differences in health among the groups. Prevalence rates of respiratory conditions were slightly higher at follow-up for women employed at both exams, while prevalence rates of cardiovascular conditions were slightly higher for homemakers at follow-up. The rate of reporting heart attacks was significantly higher for homemakers at both exams, although rates of diagnosed coronary heart disease were similar among employment groups.

Adult↗

PubMed1989

Respiratory symptoms as predictors of 27 year mortality in a representative sample of British adults.

OBJECTIVE: To examine associations between reported respiratory symptoms (as elicited by questionnaire) and subsequent mortality. DESIGN: Prospective cohort study. SETTING: 92 General practices in Great Britain. PARTICIPANTS: A nationally representative sample of 1532 British men and women aged between 40 and 64. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular disease, lung cancer, and chronic bronchitis. RESULTS: Subjects were interviewed in 1958 regarding various respiratory symptoms (including cough, phlegm, breathlessness, and wheeze) by using a questionnaire which formed the basis of the Medical Research Council's questionnaire on respiratory symptoms. By the end of 1985, 889 deaths had been reported, including 51 in men due to chronic bronchitis. After adjustment for differences in age and smoking habits death rates from chronic bronchitis in men who reported symptoms were greater than those in men who did not for each of the symptoms examined. The adjusted mortality ratios were 3.4 (95% confidence interval 1.8 to 6.5) for morning cough, 3.7 (2.0 to 6.9) for morning phlegm, 6.4 (3.0 to 13.8) for breathlessness when walking on the level, and 10.5 (4.4 to 24.6) for wheeze most days or nights. Mortality ratios were also significantly raised for four episodic symptoms not usually included in more recent respiratory symptom questionnaires--namely, occasional wheeze (mortality ratio 6.0; 95% confidence interval, 2.4 to 15.1), weather affects chest (5.7; 3.1 to 10.3), breathing different in summer (4.9; 2.8 to 8.6), and cold usually goes to chest (3.7; 2.0 to 6.8). The excess mortality associated with these symptoms remained significant after further adjustment for breathlessness or phlegm. Ratios for all cause mortality in men and women were also significantly raised for most respiratory symptoms, death rates being some 20-50% higher in people reporting symptoms after adjustment for age, sex, and smoking. Breathlessness was the only symptom significantly associated with excess mortality from cardiovascular disease (mortality ratio 1.4 (95% confidence interval 1.0 to 1.9) for breathlessness when walking on the level). Ratios were generally around unity and not significant for mortality due to lung cancer. CONCLUSIONS: The results suggest that episodic symptoms, which often do not appear in standard respiratory questionnaires, predict subsequent mortality from chronic obstructive airways disease. This supports the hypothesis that reversible airflow obstruction may be a precursor of progressive and irreversible decline in ventilatory function.

Adult↗

PubMed1989

Breathlessness, chronic bronchitis and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland and the United States.

Relationships between cardiovascular disease (CVD) mortality and breathlessness, a definition of chronic bronchitis, and pulmonary function are investigated among men in two employed populations (17,717 London civil servants and 4904 Scottish workers) and in two communities (844 men in Tecumseh, Michigan and 6859 men in Renfrew and Paisley Burghs, Scotland). Men are aged 40-64 years at entry in all studies except Renfrew-Paisley, where they are aged 45-64 years. Length of follow-up ranges from 6 to 16 years. Age and smoking habits were controlled for in all analyses. Chronic phlegm production is not significantly associated with CVD mortality, and 'chronic bronchitis' is significantly associated with mortality only in the employed populations. Low FEV1 is significantly associated with CVD mortality only in the Whitehall study; however, the rate ratios are above one in all studies. Breathlessness is significantly associated with CVD mortality in all studies. These associations between CVD mortality and 'chronic bronchitis', low FEV1, and breathlessness persist after also controlling for employment grade, systolic blood pressure, antihypertensive medication, ECG changes, plasma cholesterol level, body mass index and diabetes. Only the associations between breathlessness and mortality persist after further controlling for low FEV1 and myocardial ischaemia. The rate ratios between breathlessness and mortality are about two for all studies. It is concluded that in these populations, breathlessness is an independent and major predictor of CVD mortality.

Adult↗

PubMed1989

Predicting 15 year chronic bronchitis mortality in the Whitehall Study.

Fifteen year chronic bronchitis mortality was investigated among 17,717 male civil servants aged 40-64 years participating in the Whitehall Study. Associations were assessed between mortality and Medical Research Council standardised questions about chronic phlegm production and breathlessness, and a measure of lung function. Low FEV1 was the most powerful single predictor of mortality; controlling for age, smoking habits and employment grade, the relative hazards ratio (RHR) was 20. Using mortality rates standardised for age and smoking, the proportion of mortality in the total population statistically attributable to low FEV1 (population excess fraction) was 57%. Breathlessness while walking on the level was the best predictor among the questions and combinations of questions; the relative hazards ratio was 12 and the population excess fraction, 39%. A Medical Research Council definition of chronic bronchitis including chronic phlegm production and breathlessness was also strongly associated with chronic bronchitis mortality (RHR = 13); however, the population excess fraction was only 20%. This definition identified only 30% of the 64 deaths, and added almost nothing to prediction by FEV1 alone. The results suggest that although the combination of chronic phlegm production and chronic airflow limitation is strongly associated with mortality from chronic bronchitis, the presence of chronic phlegm production alone is not associated with mortality.

Adult↗

PubMed1988

Respiratory symptoms and pulmonary function as predictors of 10-year mortality from respiratory disease, cardiovascular disease, and all causes in the Whitehall Study.

Relationships between various measures of respiratory impairment and 10-year mortality from chronic respiratory diseases, cardiovascular disease and all causes have been investigated in 17,717 male London civil servants aged 40-64 years. Controlling for age and smoking habits, chronic phlegm production was significantly associated with all-causes and respiratory disease mortality. These associations did not persist after controlling for breathlessness or FEV1 percent predicted. Breathlessness was significantly associated with mortality from respiratory and cardiovascular diseases, and all causes. The associations persisted after controlling for age, smoking habits, employment grade, blood pressure, antihypertensive medication, plasma cholesterol level, diabetes, ECG changes, myocardial ischemia, and FEV1 percent predicted. Anti-hypertensive medication, myocardial ischemia and breathlessness showed the strongest associations with cardiovascular disease mortality. FEV1 less than 65% predicted was significantly associated with mortality from respiratory and cardiovascular diseases, and all causes; for the latter two, the rate ratios were not as high as those for breathlessness.

Adult↗