PubMed Health⌕ Search

Biomedical subjects

N Krieger

Publications and source records attributed to N Krieger.

At least 73 records · Page 4Linked to original sources
PubMed1996

Accounting for the public's health: an introduction to selected papers from a U.S. conference on "measuring social inequalities in health".

Accounting for, and being accountable to, the public's health requires carefully documenting and analyzing social inequalities in health. Controversies abound over which measures of socioeconomic position to use, at which points in time, and at what level-e.g., individual, household, and neighborhood. Important debates also concern how to analyze these data and relate them to inequalities involving race/ethnicity and gender. Addressing these complex issues is particularly timely in the light of persistent- and even widening- social inequalities in health. To improve tools for evaluating socioeconomic gradients in health, in 1994 the U.S. Public Health Service and National Institutes of Health sponsored a conference on Measuring Social Inequalities in Health. This introduction to the Section on Social Inequalities in Health introduces five articles presented by participants at the conference. Topics include: a historical review of efforts to measure socioeconomic inequalities in health in the U.S. between 1990 and 1950; income dynamics and health; measuring inequalities in health among nonemployed persons; analyzing links between racial/ethnic and socioeconomic disparities in health; and using neighborhood-based socioeconomic data in public health research. Together, these five articles point to a new emphasis on refining methodologies to assess relationships between social position and health and their expression in population patterns of social inequalities in health.

Ethnicity↗
PubMed1996

Poverty and death in the United States.

The authors conducted a survival analysis to determine the effect of poverty on mortality in a national sample of blacks and whites, 25 to 74 years of age (the first National Health and Nutrition Examination Survey (NHANES-1) and NHANES-1 Epidemiologic Follow up Study). They estimated the proportion of mortality associated with poverty during 1971-1984 and in 1991 by calculating population attributable risk and assessed confounding by major known risk factors (e.g., smoking, cholesterol levels, and physical inactivity). In 1973, 6.0 percent of U.S. mortality among black and white persons 25 to 74 years of age was attributable to poverty; in 1991, the proportion was 5.9 percent. In 1991, rates of mortality attributable to poverty were lowest for white women, 2.2 times as high for white men, 8.6 times as high for black men, and 3.6 times as high for black women. Adjustment for all these potential confounders combined had little effect on the hazard ratio among men, but reduced the effect of poverty on mortality among women by 42 percent. The proportion of mortality attributable to poverty among U.S. black and white adults has changed only minimally in recent decades. The effect of poverty on mortality must be largely explained by conditions other than commonly recognized risk factors.

Adult↗
PubMed1996

Measuring social inequalities in health in the United States: a historical review, 1900-1950.

For over two centuries, U.S. vital statistics routinely have been stratified by age, sex, and race, but not by social class. The usual explanation is that U.S. government officials have not considered social class relevant to health. During the first third of the 20th century, however, questions of socio-economic inequalities in morbidity and mortality ranked high on the agenda of federal and other public health agencies, and routine reporting of U.S. vital statistics and health survey data by socioeconomic measures was nearly institutionalized. This history has largely been lost. In this article, the authors focus on the period from 1900 to 1950 and examine how public health researchers and agencies conceptualized and analyzed socioeconomic inequalities in health. Highlights include production, for 1930, of the first U.S. national death rates stratified by social class, in work sponsored by the National Tuberculosis Association and Bureau of the Census, and the Public Health Service's 1935-1936 National Health Survey, which reported morbidity data stratified by socioeconomic measures. Efforts like these were cut short by the onset of World War II and their legacy erased by the Cold War. Recovering this rich history can help inform current debates about collecting and evaluating data on social inequalities in health.

Health Status↗
PubMed1995

Socioeconomic differences in sexually transmitted disease rates among black and white adolescents, San Francisco, 1990 to 1992.

This paper examines the effect of socioeconomic position on the differences in the 3-year rates (1990 to 1992) of reported cases of gonorrhea and chlamydia between Black and White adolescents, aged 12 to 20 years, residing in San Francisco. The crude relative risks for Blacks were 23.4 (95% confidence interval [CI] = 20.4, 27.8) for gonorrhea and 9.3 (95% CI = 8.3, 10.3) for chlamydia. Adjusting for poverty and occupational status, the relative risks were 28.7 (95% CI = 22.5, 36.1) for gonorrhea and 8.9 (95% CI = 7.4, 10.6) for chlamydia. This study demonstrates that factors other than poverty and occupational status account for the racial/ethnic differences in the rates of gonorrhea and chlamydia among adolescents in San Francisco.

Adolescent↗
PubMed1995

Poverty and death in the United States--1973 and 1991.

We conducted a survival analysis to determine the effect of poverty on mortality in a national sample of blacks and whites 25-74 years of age (in the First National Health and Nutrition Examination Survey and National Health Examination Follow-up Survey). We estimated the proportion of mortality associated with poverty from 1973 through 1984 and in 1991 by calculating the population attributable risk. We assessed confounding by major known risk factors, such as smoking, serum total cholesterol, and inactivity. In 1973, 16.1% of U.S. mortality among black and white persons 25-74 years of age was attributable to poverty; in 1991, the proportion increased to 17.7%. In 1991, the population attributable risk of poverty on mortality was lowest for white women, 1.7 times higher for white men, 2.6 times higher for black women, and 3.6 times higher for black men. Potential confounders explained 40% of the effect of poverty on mortality among women. The proportion of mortality attributable to poverty among U.S. black and white adults has increased in recent decades and is comparable to that attributable to cigarette smoking. The effect of poverty on mortality must be explained by conditions other than commonly recognized risk factors.

Adult↗
PubMed1994

Breast cancer and serum organochlorines: a prospective study among white, black, and Asian women.

BACKGROUND: Five small case-control studies have examined the relationship between exposure to organochlorines and the risk of breast cancer and have found inconsistent results. In these studies, organochlorine levels in breast cancer patients were measured after (or at most 6 months before) diagnosis. PURPOSE: We tested the hypothesis that organochlorines are a risk factor for breast cancer, using prospectively gathered data on serum levels of DDE [1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] (the main metabolite of the pesticide DDT [2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane]) and polychlorinated biphenyls (PCBs). METHODS: Study subjects belonged to a cohort of 57,040 women (46,629 white, 8123 black, and 2288 Asian) from the San Francisco Bay Area who took a multiphasic health examination, independent of concern about risk of breast cancer, in the late 1960s. At that time, a sample of blood was obtained, then frozen and stored. Follow-up was through December 31, 1990. We conducted a nested case-control study of 150 case patients and 150 matched control subjects. A random sample of 50 women per racial/ethnic group who had been diagnosed with breast cancer more than 6 months after the multiphasic examination (mean follow-up = 14.2 years) was selected, and each case patient was matched to a cancer-free control subject. RESULTS: Matched analyses found no differences in the case patients' and control subjects' serum levels of DDE (mean difference = 0.2 parts per billion [ppb]; 95% confidence interval [CI] = -6.7, 7.2) or PCBs (mean difference = -0.4 ppb; 95% CI = -0.8, 0.1). DDE levels, however, tended to be higher among black case patients compared with black controls (mean difference = 5.7 ppb; 95% CI = -3.3, 14.8), and PCBs were lower among white case patients compared with white controls (mean difference = -0.6 ppb; 95% CI = -1.2, -0.1). Organochlorine levels were significantly higher among black and Asian women compared with white women. The mean difference for DDE was 11.0 ppb for black women (95% CI = 4.3, 17.6) and 12.6 ppb for Asian women (95% CI = 6.0, 19.2); for PCBs, the respective differences were 0.8 ppb for black women (95% CI = 0.2, 1.4) and 1.4 ppb for Asian women (95% CI = 0.8, 1.9). The results were not altered by adjusting for relevant confounders, and the lack of association between exposure to organochlorines and breast cancer was present regardless of length of follow-up, year of diagnosis, or the case patient's menopausal and estrogen-receptor status. CONCLUSION: The data do not support the hypothesis that exposure to DDE and PCBs increases risk of breast cancer. IMPLICATIONS: Future investigations must consider the biologic mechanisms involved and variations in exposure to chemical pollutants and of breast cancer incidence rates among diverse groups of women.

Adult↗
PubMed1994

Lipase from a Brazilian strain of Penicillium citrinum.

A lipases (glycerol ester hydrolases E. C. 3.1.1.3) from a brazilian strain of Penicillium citrinum has been investigated. When the microorganism was cultured in the simple medium (1.0% olive oil and 0.5% yeast extract), using olive oil in as carbon source in the inocula, the enzyme extracted showed maximum activity (409 IU/mL). In addition, decrease of yeast extract concentration also reduces the lipase activity. Nevertheless, when yeast extract was replaced by ammonium sulfate, no activity was detected. Purification by precipitation with ammonium sulfate showed best activity in the 40-60% fraction. The optimum temperature for enzyme activity was found in the range of 34-37 degrees C. However, after 30 min at 60 degrees C, the enzyme was completely inactivated. The enzyme showed optimum at pH 8.0. The dried concentrated fraction (after dialysis and lyophilization) maintained its lipase activity at room temperature (28 degrees C) for 8 mo. This result in lipase stability suggests an application of lipases from P. citrinum in detergents and other products that require a high stability at room temperature.

Brazil↗
PubMed1994

Epidemiology and the web of causation: has anyone seen the spider?

'Multiple causation' is the canon of contemporary epidemiology, and its metaphor and model is the 'web of causation.' First articulated in a 1960 U.S. epidemiology textbook, the 'web' remains a widely accepted but poorly elaborated model, reflecting in part the contemporary stress on epidemiologic methods over epidemiologic theories of disease causation. This essay discusses the origins, features, and problems of the 'web,' including its hidden reliance upon the framework of biomedical individualism to guide the choice of factors incorporated in the 'web.' Posing the question of the whereabouts of the putative 'spider,' the author examines several contemporary approaches to epidemiologic theory, including those which stress biological evolution and adaptation and those which emphasize the social production of disease. To better integrate biologic and social understandings of current and changing population patterns of health and disease, the essay proposes an ecosocial framework for developing epidemiologic theory. Features of this alternative approach are discussed, a preliminary image is offered, and debate is encouraged.

Causality↗
PubMed1994

Inter-observer variability among pathologists' evaluation of malignant melanoma: effects upon an analytic study.

This study examined whether inter-observer variability in rating tumor characteristics affected results of an investigation of surveillance bias and malignant melanoma at the Lawrence Livermore National Laboratory. The 20 cases from the Laboratory and their 36 non-Laboratory controls belonged to the same pre-paid health plan and were diagnosed with melanoma between 1970 and 1984. Tumors were independently and then jointly rated by three dermatopathologists blind to the subjects' Laboratory status. The mean difference between the reviewers and the consensus reading for tumor thickness was small, ranging from -0.06 mm (95% confidence interval [CI]--0.12, 0.00) to 0.00 mm (95% CI--0.07, 0.07). Agreement was much lower for histologic type (kappa = 0.48, 95% CI 0.37, 0.58). Because the inter-observer variability, the study's hypothesis was rejected by analyses based on data from the consensus reading and two reviewers, but not on data from the third reviewer. These findings suggest that epidemiologists using data subject to inter-observer variability may want to employ consensus instead of individual ratings.

Dermatology↗
PubMed1994

Social class: the missing link in U.S. health data.

National vital statistics in the United States are unique among those of advanced capitalist countries in reporting data only by race, sex, and age--not by class and income. This article reviews the limited U.S. data resources that may be used to document social class inequalities in health. Summarizing the strengths and weaknesses of the British approach to gathering data on social class and health, the authors discuss possible approaches to collecting data that could be feasible in the U.S. context. They argue that educational level is an insufficient marker for socioeconomic position and contend that appropriate measures must take into account not only individual but also household and neighborhood markers of social class. These additional types of social class data are especially important for accurately describing and understanding social class inequalities in health among women and across diverse racial/ethnic groups.

Adolescent↗
PubMed1994

Man-made medicine and women's health: the biopolitics of sex/gender and race/ethnicity.

National vital statistics in the United States present data in terms of race, sex, and age, treated as biological variables. Some races are clearly of more interest than others: data are usually available for whites and blacks, and increasingly for Hispanics, but seldom for Native Americans or Asians and Pacific Islanders. These data indicate that white men and women generally have the best health and that men and women, within each racial/ethnic group, have different patterns of disease. Obviously, the health status of men and women differs for conditions related to reproduction, but it differs for many nonreproductive conditions as well. In national health data, patterns of disease by race and sex are emphasized while social class differences are ignored. This article discusses how race and sex became such all-important, self-evident categories in 19th and 20th century biomedical thought and practice. It examines the consequences of these categories for knowledge about health and for the provision of health care. It then presents alternative approaches to understanding the relationship between race/ethnicity, gender, and health, with reference to the neglected category of social class.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Surveillance bias and the excess risk of malignant melanoma among employees of the Lawrence Livermore National Laboratory.

To assess the role of surveillance bias in the observed three-fold excess of cutaneous malignant melanoma (CMM) at the Lawrence Livermore National Laboratory (LLNL) in California, we examined the thickness of CMMs among all 20 laboratory employees who were members of a large prepaid health plan and whose CMM was diagnosed from 1970 through 1984. For comparison, we reviewed slides of 36 other members of the same health plan matched (usually 2:1) to the laboratory case by age, sex, facility, and year of diagnosis. Three expert dermatopathologists read the slides using a multiheaded microscope to reach a consensus; they were blind to the laboratory employment status of the subjects. We found that from 1970 to 1976, before there was widespread publicity about the excess incidence of CMM at LLNL, lesion thickness was greater for non-LLNL employees (mean difference = 1.5 mm; 95% confidence interval 0.1-2.9). From 1977 through 1984, however, there was no appreciable difference [mean difference = -0.3 mm; 95% confidence limits (CL) = -1.4, 0.9]. Dropping the matching to adjust for histologic type of melanoma as well as gender, year, and age at diagnosis yielded substantially the same results. These data are compatible with an effect of surveillance bias up to around 1976, but in this health plan population, they do not support a role for surveillance bias in the continuing excess incidence observed since that time.

Bias↗
PubMed1993

Understanding AIDS: historical interpretations and the limits of biomedical individualism.

The popular and scientific understanding of acquired immunodeficiency syndrome (AIDS) in the United States has been shaped by successive historical constructions or paradigms of disease. In the first paradigm, AIDS was conceived of as a "gay plague," by analogy with the sudden, devastating epidemics of the past. In the second, AIDS was normalized as a chronic disease to be managed medically over the long term. By examining and extending critiques of both paradigms, it is possible to discern the emergence of an alternative paradigm of AIDS as a collective chronic infectious disease and persistent pandemic. Each of these constructions of AIDS incorporates distinct views of the etiology, prevention, pathology, and treatment of disease; each tacitly promotes different conceptions of the proper allocation of individual and social responsibility for AIDS. This paper focuses on individualistic vs collective, and biomedical vs social and historical, understandings of disease. It analyzes the use of individualism as methodology and as ideology, criticizes some basic assumptions of the biomedical model, and discusses alternative strategies for scientific research, health policy, and disease prevention.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Thinking and rethinking AIDS: implications for health policy.

In the United States, we see three main phases in the construction of the history of AIDS, with each having very different implications for health and social policy. In the first, AIDS was conceived of as an epidemic disease, a "gay plague," by analogy to the sudden, devastating epidemics of the past. In the second, it was normalized as a chronic disease, similar in many ways to diseases such as cancer. In the third, the authors propose a new historical model of a slow-moving, long-lasting pandemic, a chronic infectious ailment manifested through myriad specific HIV-related diseases. The new paradigm of AIDS incorporates the positive aspects of both earlier conceptions. It emphasizes, like the plague model, the etiology, transmission, and prevention of disease but rejects its assumption of a time-limited crisis. It takes from the chronic disease model an appropriate time frame and concern with the clinical management of protracted illness but insists on the primacy of prevention. The authors criticize both infectious and chronic disease models for their individualistic conceptions of disease and their narrow strategies for disease prevention. They further argue that the traditional distinction between, and approaches to, infectious and chronic diseases need to be rethought for other diseases as well as for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The emerging histories of AIDS: three successive paradigms.

Thinking of AIDS as an 'emerging disease' inevitably raises questions of comparison. In the United States, we see three main phases in understanding AIDS, with each having very different implications for health and social policy. In the first, AIDS was conceived of as an epidemic disease, a 'gay plague', by analogy to the sudden, devastating epidemics of the past. In the second, it was normalized as a chronic disease, similar in many ways to diseases such as cancer. In the third, we outline a new understanding of AIDS a slow-moving, long-lasting pandemic, a chronic infectious ailment manifested through myriad specific HIV-related diseases. This new paradigm emphasizes, like the plague model, the etiology, transmission, and prevention of disease; like the chronic disease model, it is concerned with the clinical management of protracted illness. We do criticize, however, both the infectious and chronic disease models for their individualistic conceptions of disease and their narrow strategies for disease prevention. We further suggest that the traditional distinction between, and approaches to, infectious and chronic diseases are problematic and need to be rethought for AIDS and other diseases.

Acquired Immunodeficiency Syndrome↗