Biomedical subjects

Karen Bandeen-Roche

Publications and source records attributed to Karen Bandeen-Roche.

At least 19 recordsLinked to original sources

PubMed2006

Towards patient-centered health services in India--a scale to measure patient perceptions of quality.

OBJECTIVE: . (i) To develop a reliable and valid scale to measure in-patient and outpatient perceptions of quality in India and (ii) to identify aspects of perceived quality which have large effects on patient satisfaction. DESIGN: Cross-sectional survey of health facilities and patients at clinics. SETTING: Primary health centers, community health centers, district hospitals, and female district hospitals in the state of Uttar Pradesh in north India. MAIN OUTCOME MEASURES: Internal consistency, validity, and factor structure of the scale are evaluated. The association between patient satisfaction and perceived quality dimensions is examined. RESULTS: A 16-item scale having good reliability and validity is developed. Five dimensions of perceived quality are identified-medicine availability, medical information, staff behavior, doctor behavior, and hospital infrastructure. Patient perceptions of quality at public health facilities are slightly better than neutral. Multivariate regression analysis results indicate that for outpatients, doctor behavior has the largest effect on general patient satisfaction followed by medicine availability, hospital infrastructure, staff behavior, and medical information. For in-patients, staff behavior has the largest effect followed by doctor behavior, medicine availability, medical information, and hospital infrastructure. CONCLUSIONS: The scale developed can be used to measure perceived quality at a range of facility types for outpatients and in-patients. Perceived quality at public facilities is only marginally favorable, leaving much scope for improvement. Better staff and physician interpersonal skills, facility infrastructure, and availability of drugs have the largest effect in improving patient satisfaction at public health facilities.

Adult↗

PubMed2006

Transitions to mobility difficulty associated with lower extremity osteoarthritis in high functioning older women: longitudinal data from the Women's Health and Aging Study II.

OBJECTIVE: To assess the impact of lower extremity osteoarthritis (OA) on transitions to mobility difficulty, and to assess the influence of pain, excess weight, and quadriceps strength on these transitions. METHODS: We analyzed longitudinal data acquired from 199 participants in the Women's Health and Aging Study II (ages 70-79 years) who initially reported no lower extremity limitation (e.g., difficulty walking one-quarter mile) or difficulty in activities of daily living (ADL; e.g., transferring). Prevalent lower extremity OA was determined from validated algorithms encompassing multiple data sources. Markov transition models were created to analyze the first transition from no difficulty at baseline to lower extremity limitations, ADL difficulty, or both 18, 36, and 72 months later. RESULTS: Compared with women without OA (n = 140), a higher proportion of women with lower extremity OA (n = 59) initially reported pain on most days and more severe pain while walking (P < 0.05). Women with OA were also heavier, with a higher proportion being obese or overweight (P < 0.001). Lower extremity OA, higher body mass index, and lower knee extensor strength independently increased the risk of transition to combined lower extremity and ADL difficulty first over 72 months. CONCLUSION: Lower extremity OA increased the likelihood of developing difficulty in both lower extremity tasks and ADL over 72 months in a cohort of initially high functioning older women. Two modifiable factors, higher relative weight and lower knee extensor strength, substantially impacted these transitions, and therefore warrant increased attention in the management of lower extremity OA.

Activities of Daily Living↗

PubMed2006

Central corneal thickness and corneal hysteresis associated with glaucoma damage.

PURPOSE: We sought to measure the impact of central corneal thickness (CCT), a possible risk factor for glaucoma damage, and corneal hysteresis, a proposed measure of corneal resistance to deformation, on various indicators of glaucoma damage. DESIGN: Observational study. METHODS: Adult patients of the Wilmer Glaucoma Service underwent measurement of hysteresis on the Reichert Ocular Response Analyzer and measurement of CCT by ultrasonic pachymetry. Two glaucoma specialists (H.A.Q., N.G.C.) reviewed the chart to determine highest known intraocular pressure (IOP), target IOP, diagnosis, years with glaucoma, cup-to-disk ratio (CDR), mean defect (MD), pattern standard deviation (PSD), glaucoma hemifield test (GHT), and presence or absence of visual field progression. RESULTS: Among 230 subjects, the mean age was 65 +/- 14 years, 127 (55%) were female, 161 (70%) were white, and 194 (85%) had a diagnosis of primary open-angle glaucoma (POAG) or suspected POAG. In multivariate generalized estimating equation models, lower corneal hysteresis value (P = .03), but not CCT, was associated with visual field progression. When axial length was included in the model, hysteresis was not a significant risk factor (P = .09). A thinner CCT (P = .02), but not hysteresis, was associated with a higher CDR at the most recent examination. Neither CCT nor hysteresis was associated with MD, PSD, or GHT "outside normal limits." CONCLUSIONS: Thinner CCT was associated with the state of glaucoma damage as indicated by CDR. Axial length and corneal hysteresis were associated with progressive field worsening.

Adult↗

PubMed2006

Association of blood lead and tibia lead with blood pressure and hypertension in a community sample of older adults.

Few studies have compared associations of blood lead and tibia lead with blood pressure and hypertension, and associations have differed in samples with occupational exposure compared with those with mainly environmental lead exposure. African Americans have been underrepresented in prior studies. The authors performed a cross-sectional analysis of 2001-2002 data from a community-based cohort in Baltimore, Maryland, of 964 men and women aged 50-70 years (40% African American, 55% White, 5% other race/ethnicity) to evaluate associations of blood lead and tibia lead with systolic and diastolic blood pressure and hypertension while adjusting for a large set of potential confounding variables. Blood lead was a strong and consistent predictor of both systolic and diastolic blood pressure in models adjusted and not adjusted for race/ethnicity and socioeconomic status. Tibia lead was associated with hypertension status before adjustment for race/ethnicity and socioeconomic status (p = 0.01); after such adjustment, the association was borderline significant (p = 0.09). Propensity score analysis suggested that standard regression analysis may have exaggerated the attenuation. These findings are discussed in the context of complex causal pathways. The data suggest that lead has an acute effect on blood pressure via recent dose and a chronic effect on hypertension risk via cumulative dose.

Black or African American↗

PubMed2006

Phenotype of frailty: characterization in the women's health and aging studies.

BACKGROUND: "Frailty" is an adverse, primarily gerontologic, health condition regarded as frequent with aging and having severe consequences. Although clinicians claim that the extremes of frailty can be easily recognized, a standardized definition of frailty has proved elusive until recently. This article evaluates the cross-validity, criterion validity, and internal validity in the Women's Health and Aging Studies (WHAS) of a discrete measure of frailty recently validated in the Cardiovascular Health Study (CHS). METHODS: The frailty measure developed in CHS was delineated in the WHAS data sets. Using latent class analysis, we evaluated whether criteria composing the measure aggregate into a syndrome. We verified the criterion validity of the measure by testing whether participants defined as frail were more likely than others to develop adverse geriatric outcomes or to die. RESULTS: The distributions of frailty in the WHAS and CHS were comparable. In latent class analyses, the measures demonstrated strong internal validity vis à vis stated theory characterizing frailty as a medical syndrome. In proportional hazards models, frail women had a higher risk of developing activities of daily living (ADL) and/or instrumental ADL disability, institutionalization, and death, independently of multiple potentially confounding factors. CONCLUSIONS: The findings of this study are consistent with the widely held theory that conceptualizes frailty as a syndrome. The frailty definition developed in the CHS is applicable across diverse population samples and identifies a profile of high risk of multiple adverse outcomes.

Aged↗

PubMed2006

Changes in systolic blood pressure associated with lead in blood and bone.

BACKGROUND: Several studies have examined longitudinal associations of blood pressure change or hypertension incidence with lead concentration in blood or bone. It is not clear whether the observed associations reflect an immediate response to lead as a consequence of recent dose or rather are a persistent effect of cumulative dose over a lifetime. METHODS: We followed 575 subjects in a lead-exposed occupational cohort in South Korea between October 1997 and June 2001. We used generalized estimating equation models to evaluate blood pressure change between study visits in relation to tibia lead concentrations at each prior visit and concurrent changes in blood lead. The modeling strategy summarized the longitudinal association of blood pressure with cumulative lead dose or changes in recent lead dose. RESULTS: On average, participants were 41 years old at baseline and had worked 8.5 years in lead-exposed jobs. At baseline, the average +/- standard deviation for blood lead was 31.4 +/- 14.2 microg/dL, and for tibia lead, it was 38.4 +/- 42.9 microg/g bone mineral. Change in systolic blood pressure during the study was associated with concurrent blood lead change, with an average annual increase of 0.9 (95% confidence interval = 0.1 to 1.6) mm Hg for every 10-microg/dL increase in blood lead per year. CONCLUSION: The findings in this relatively young population of current and former lead workers suggest that systolic blood pressure responds to lead dose through acute pathways in addition to the effects of cumulative injury.

Adolescent↗

PubMed2006

Measures of visual function and percentage of preferred walking speed in older adults: the Salisbury Eye Evaluation Project.

PURPOSE: The purpose of this study was to determine the association of static (visual acuity, visual fields, and contrast sensitivity) and dynamic (dynamic visual acuity and motion threshold) measures of vision with mobility performance on a mobility course with obstacles. METHODS: A cross-sectional population-based study of 1504 persons aged 72 to 92 years enrolled in the third round of the Salisbury Eye Evaluation Project. Standardized examinations were used to test binocular visual acuity, better eye-contrast sensitivity, visual fields, dynamic visual acuity, and motion threshold. Cognitive status was assessed by using the standardized Mini-Mental State Examination. Participants were timed when walking a straight 4-m distance and when walking through a mobility course seeded with obstacles. The percentage of preferred walking speed (PPWS) for each subject was calculated as the ratio of mobility course speed to a 4-m walking speed expressed as a percentage. RESULTS: The mean age of the participants was 78.2 years. The mean 4-m walking speed was 0.82 m/s, whereas the mean mobility course speed was 0.47 m/s. The mean PPWS was 57.1%. All vision variables except visual acuity were associated with PPWS in univariate analyses. Multivariate models found visual fields and the cognitive state to be associated with PPWS. There was no association with dynamic measures of vision. CONCLUSIONS: The mobility performance, as measured by PPWS, was associated with visual fields but not with visual acuity, contrast sensitivity, or dynamic vision measures. Deficits in cognition also play an important role in predicting mobility performance.

Aged↗

PubMed2006

Short stature and the risk of adiposity, insulin resistance, and type 2 diabetes in middle age: the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994.

OBJECTIVE: To investigate the association between stature-related measurements (height, leg length, and leg length-to-height ratio) and adiposity, insulin resistance, and glucose intolerance. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional analysis of a nationally representative sample of 7,424 adults aged 40-74 years, from the Third National Health and Nutrition Examination Survey (1988-1994). The main outcome measures were percent body fat, homeostasis model assessment of insulin resistance (HOMA-IR), and glucose intolerance based on the World Health Organization's 1985 criteria for an oral glucose tolerance test. RESULTS: Shorter height and leg length, and lower leg length-to-height ratio, were associated with higher percent body fat, especially in women. Lower leg length-to-height ratio was associated with greater insulin resistance estimated by HOMA-IR. In multinomial regression models adjusting for potential confounders, including percent body fat, the relative prevalence of type 2 diabetes per 1-SD lower values in height, leg length, and leg length-to-height ratio were 1.10 (95% CI 0.94-0.29), 1.17 (0.98-1.39), and 1.19 (1.02-1.39), respectively. CONCLUSIONS: Our study supports the hypothesis that adult markers of prepubertal growth, especially leg length-to-height ratio, are associated with adiposity, insulin resistance, and type 2 diabetes in the general U.S. population.

Adipose Tissue↗

PubMed2005

Compensatory strategy use identifies risk of incident disability for the visually impaired.

BACKGROUND: Use of compensatory strategies may be a marker for preclinical disability. OBJECTIVE: To determine, among persons who did not report mobility disability, if the reported use of compensatory strategies was a predictor of subsequent disability at 2 years in those who did and did not have visual impairment at baseline. METHODS: Within a population-based sample of 2520 persons aged 65 to 84 years, those who reported no difficulty walking or stair-climbing at baseline (not disabled) were studied. Visual impairment was defined as a visual acuity worse than 20/40, log contrast sensitivity less than 1.5, or more than 30 points missing in the visual field. Use of compensatory strategies at baseline was reported as changing the frequency or method used to walk or climb stairs. Incident disability was defined as report of new difficulty in mobility at 2 years. RESULTS: Those using compensatory strategies at baseline were 3 times more likely to report incident disability in walking and stair-climbing, compared with persons who did not use compensatory strategies. Visual field impairment was the most significant predictor of incident mobility disability of all the vision measures studied. Among those with visual field impairment, users of compensatory strategies were 3 times more likely to report incident walking disability (95% confidence interval, 1.87-5.58) and incident stair-climbing disability (95% confidence interval, 1.86-4.83) compared with those who did not use compensatory strategies. CONCLUSION: Preclinical disability, characterized by use of compensatory strategies in those with no disability, is a predictor for subsequent disability and may help identify patients with visual impairment for whom mobility interventions are warranted.

Activities of Daily Living↗

PubMed2005

A diagnostic for association in bivariate survival models.

We propose exploratory, easily implemented methods for diagnosing the appropriateness of an underlying copula model for bivariate failure time data, allowing censoring in either or both failure times. It is found that the proposed approach effectively distinguishes gamma from positive stable copula models when the sample is moderately large or the association is strong. Data from the Women's Health and Aging Study (WHAS, Guralnik et al., The Womens's Health and Aging Study: Health and Social Characterisitics of Older Women with Disability. National Institute on Aging: Bethesda, Mayland, 1995) are analyzed to demonstrate the proposed diagnostic methodology. The positive stable model gives a better overall fit to these data than the gamma frailty model, but it tends to underestimate association at the later time points. The finding is consistent with recent theory differentiating 'catastrophic' from 'progressive' disability onset in older adults. The proposed methods supply an interpretable quantity for copula diagnosis. We hope that they will usefully inform practitioners as to the reasonableness of their modeling choices.

Aged↗

PubMed2005

Autonomy-related behaviors of patient companions and their effect on decision-making activity in geriatric primary care visits.

The objective of this study, undertaken in the USA, was to investigate the consequences of autonomy-related companion behaviors on patient decision-making activity during geriatric primary care visits. Videotapes were analyzed to characterize patient and companion decision-making activity and related companion behaviors. These behaviors were coded throughout the visit using an autonomy-based framework that included both autonomy enhancing (i.e. facilitating patient understanding, patient involvement, and doctor understanding) and detracting behaviors, (i.e. controlling the patient and building alliances with the physician). Patients (N = 93) in this cross-sectional sample range in age from 65 to 95 years and are mostly white (n = 73, 79%) and female (n = 67, 72%). Companions are spouses (n = 42, 46%), adult children (n = 33, 36%), or other relatives and friends (n = 15, 16%) of patients. Companions are active participants in medical visits and engage in more autonomy enhancing than detracting behaviors. Companions of sicker (compared with less sick) patients were more likely to facilitate patient understanding, p < .05; doctor understanding, p < .01; and patient involvement, p = .06, in care. Patients whose companions facilitated their involvement in the medical visit by asking the patient questions, prompting the patient to talk, and asking for the patient's opinion were more than four times as likely to be active in decision-making as patients whose companions did not assist in this manner (unadjusted OR 3.5, CI 1.4-8.7, p < .01; adjusted OR 4.5, CI 1.6-12.4, p < .01). Companions can play an important role in the visits of geriatric patients by facilitating communication throughout the visit as well as patient activity in decision-making.

Aged↗

PubMed2005

Total and differential white blood cell counts and their associations with circulating interleukin-6 levels in community-dwelling older women.

BACKGROUND: Interleukin-6 (IL-6) is an inflammatory biomediator, and age-related increases in IL-6 levels are associated with osteoporosis, sarcopenia, disability, and mortality in older adults. Although white blood cells (WBC), or leukocytes, are known to produce IL-6 in vitro, their in vivo relationship with circulating IL-6 levels is not well established. METHODS: In this cross-sectional analysis of data from the Women's Health and Aging Study I, the authors evaluated the relationships of total WBC and WBC differential (neutrophil, monocyte, lymphocyte, eosinophil, and basophil) counts to circulating IL-6 levels in 619 community-dwelling older women. Potential associations of age, race, and cigarette smoking with total and differential WBC counts and IL-6 levels were also assessed. RESULTS: Except for lymphocyte and basophil counts, significant associations of total WBC, neutrophil, monocyte, and eosinophil counts with IL-6 levels were identified. These associations remained highly significant after adjustment for age, race, and smoking status. Total WBC, neutrophil, monocyte, and eosinophil counts had significant stepwise increases in four escalating quartiles of IL-6 levels. In addition, age, race, and cigarette smoking were differentially associated with total and differential WBC counts and IL-6 levels. CONCLUSIONS: Positive in vivo associations of total WBC and its specific subpopulations were identified, including neutrophils, monocytes, and eosinophils, with circulating IL-6 levels in community-dwelling older women. These findings suggest significant contributions of WBC and its subpopulations to circulating IL-6 levels and potential effects from chronic elevation of IL-6 levels to the function of these circulating immune cells that warrant further investigation.

Age Factors↗

PubMed2005

Change in self-rated health and mortality among community-dwelling disabled older women.

PURPOSE: Our study assessed whether change in self-rated health is a stronger predictor of mortality than baseline self-rated health and the most recent self-rated health (prior to death or loss to follow-up) among disabled older women. DESIGN AND METHODS: The Women's Health and Aging Study examined disabled older women at baseline and every 6 months for 3 years. During the follow-up period, 253 out of the 905 examined participants died. Cox regression models with time-dependent covariates were used. RESULTS: After baseline characteristics were adjusted for, baseline self-rated health was not related to mortality. After covariates at the most recent observation and covariates measured only at baseline were controlled for, the most recent self-rated health was not associated with mortality either. After time-dependent covariates and covariates measured only at baseline were adjusted for, decline in self-rated health was significantly associated with increased mortality. IMPLICATIONS: Change in self-rated health is a stronger predictor of mortality than self-rated health at baseline and at the most recent observation. Older women with "fair" health are worse off if they are on a declining health trajectory than if their "fair" health is stable. Family caregivers and clinicians need to closely monitor change in self-rated health among disabled older women.

Aged↗

PubMed2005

Occupational lead exposure and longitudinal decline in neurobehavioral test scores.

BACKGROUND: No previous longitudinal studies have compared and contrasted associations of blood lead and tibia lead with declines in cognitive function over the course of time in a large sample of subjects with current and past occupational exposure to inorganic lead. METHODS: From 1997 through 2001, we conducted a longitudinal study of 803 current and former lead workers in South Korea to evaluate effects on the central and peripheral nervous systems. Three study visits occurred during a mean follow-up duration of 2.20 years. Neurobehavioral test scores, peripheral nervous system function, and blood lead were measured at each of the 3 study visits, whereas tibia lead was measured by x-ray fluorescence at the first and second visits. We limited our analysis to the 576 lead workers who completed testing at all 3 visits. We performed regression analyses using generalized estimating equations. RESULTS: There were consistent associations of blood lead with test scores at baseline and of tibia lead with declines in test scores over the next year, mainly in executive abilities, manual dexterity, and peripheral vibration threshold. CONCLUSIONS: The results support the inference that occupational lead exposure can cause declines in cognitive function over the course of time. Lead likely has an acute effect on neurobehavioral test scores as a function of recent dose and a longer-term (possibly progressive) effect on cognitive decline as a function of cumulative dose.

Adult↗

PubMed2005

Visual acuity change and mortality in older adults.

PURPOSE: Several studies indicate an increased mortality rate in older adults who have visual impairment, but few have attempted to address a potential causal mechanism. The goals of this study are to determine whether visual acuity loss increases the risk of dying and to examine whether depressive symptoms act as a mediator in this relationship. METHODS: Data were derived from the 2520 older adults who participated in the Salisbury Eye Evaluation project, a population-based prospective 8-year cohort study. Presenting binocular visual acuity was measured with the Early Treatment Diabetic Retinopathy Study [ETDRS] eye chart and depressive symptoms with the General Health Questionnaire Part D subscale. Mortality data were collected by staff follow-up. Analyses were performed with the Cox proportional hazards regression. RESULTS: Worse baseline acuity was associated with a higher mortality rate (hazard ratio [HR] = 1.05; 95% confidence interval [CI], 1.01-1.09). Also, those who gained two or more lines of visual acuity over 2 years had a lower adjusted risk of dying (HR = 0.47; 95% CI, 0.23-0.95). An interaction was detected, in that women who lost > or =3 lines of visual acuity over a 2-year period had a higher adjusted risk of dying (HR = 3.97; 95% CI, 2.21-7.15), whereas men did not (HR = 1.32; 95% CI, 0.66-2.63). Depressive symptoms did not mediate these relationships. CONCLUSIONS: If the relationship between visual acuity and mortality is indeed causal, it most likely acts via numerous pathways through a variety of intervening variables. The identification of these intervening variables could give additional targets for intervention if acuity cannot be restored.

Aged↗

PubMed2004

Association of visual field loss and mobility performance in older adults: Salisbury Eye Evaluation Study.

PURPOSE: To determine the association between visual field loss and orientation and mobility (O&M) performance in a population-based sample of older adults and to identify the specific regions of the visual field that are most strongly associated with O&M performance. METHODS: A population-based sample of 1504 persons between the ages of 72 to 92 was enrolled in the third round of Salisbury Eye Evaluation. Monocular visual fields (60 degrees radius) were tested with the 81-point, single intensity (24 dB) screening test strategy on the Humphrey Field Analyzer. Binocular visual fields were estimated from a combination of the monocular fields. The number of points missed was calculated for the overall visual field and for 3 non-overlapping regions: central (< or = 20 degrees radius), upper- and lower-peripheral visual fields. Orientation and mobility performance was evaluated by walking speed, number of bumps, and number of orientation errors on a circuitous, 32.8-m course seeded with obstacles. Log-linear regressions and linear regressions, adjusting for age, gender, body mass, height, cognitive and general health status, were performed. RESULTS: Loss in the overall visual field was associated with an increase in the number of bumps and decrease in walking speed. Visual field loss was not associated with the number of orientation errors. Out of the three visual field sub-regions that we tested, in terms of percentage of loss, the central and lower peripheral regions showed comparable decrements in walking speed and the central region was most strongly associated with number of bumps. CONCLUSIONS: The loss in visual field, which occurs with aging, is associated with a decline in mobility performance. Walking speed decreases, and the number of bumps into obstacles increases, with decreases in the visual field. The number of orientation errors is not associated with the loss in visual field that occurs with aging.

Aged↗

PubMed2004

Divided visual attention as a predictor of bumping while walking: the Salisbury Eye Evaluation.

PURPOSE: The purpose of this study was to determine the association between bumping while walking and divided visual attention, as measured by the useful field of view (UFOV). METHODS: The Salisbury Eye Evaluation is a population-based study of community-dwelling adults, aged 72 to 92 at the third round of data collection. Participants walked a circuitous 32.8-m course, seeded with obstacles, and the number of bumps made while traversing the course was counted. UFOV divided attention score was based on processing speed: the time taken to identify a central target, and the location of a peripheral target simultaneously. Association between number of bumps and UFOV score was assessed in a generalized linear model, with adjustment for vision and attention measures that might explain the UFOV score. RESULTS: Of the 1504 participants in this study, 10.1% did not attempt the mobility course. In a model adjusting for demographic, physical, cognitive and attention, and vision measures, a decrease of 50 ms in processing speed for the divided-attention task was associated with a 4.9% increase (P = 0.004) in number of bumps made over the course. Receiver operating characteristic curves were created for the UFOV and visual field tests, to determine accuracy in detecting those with a high number of bumps. The visual field test had slightly higher area under the curve, but positive predictive value for both tests was low. CONCLUSIONS: The UFOV test of divided attention, as measured by processing speed, independently predicted bumping while walking. These data suggest that poor visual attention is a significant risk factor for bumping while walking.

Aged↗

PubMed2004

Disparities in cognitive functioning by race/ethnicity in the Baltimore Memory Study.

The Baltimore Memory Study is a cohort study of the multilevel determinants of cognitive decline in 50-70-year-old randomly selected residents of specific city neighborhoods. Prior studies have demonstrated that cognitive function differs by race/ethnicity, with lower scores in minorities than in whites, but the underlying basis for these differences is not understood. Studies have differed in the rigor with which they evaluated and controlled for such important confounding variables as socioeconomic status (SES), health-related behaviors, comorbid illnesses, and factors in the physical environment. The goal of this study was to describe differences in neurobehavioral test scores by race/ethnicity, before and after control for a four-dimensional measure of SES and health-related behaviors and health conditions, in a cross-sectional analysis of first visit data. Random samples of households in the study area were selected until enrollment goals were reached. Among the 2,351 persons on whom eligibility was determined, 60.8% were scheduled for an enrollment visit; of these, 1,140 (81.3%) were enrolled and tested. These study participants were 34.3% male and 65.7% female and were from 65 Baltimore, Maryland, neighborhoods. After adjustment for age, sex, and testing technician, there were large and statistically significant differences in neurobehavioral test scores by race/ethnicity, with African-American scores lower than those for whites, for both men and women. After adjustment for individual SES (educational status, household income, household assets, and occupational status), the average difference declined by 25.8%. After additional adjustment for SES, health-related behaviors and health conditions, and blood lead, the average difference declined another 10%, but large differences persisted; African Americans had test scores that averaged 0.43 standard deviation lower than those for whites across all neurobehavioral tests. These differences were present in all cognitive domains, including tests that would not be characterized as susceptible to differential item functioning by race/ethnicity, suggesting that the results are not due to race/ethnicity-associated measurement error.

Black or African American↗