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Biomedical subjects

Nancy Krieger

Publications and source records attributed to Nancy Krieger.

At least 37 records · Page 2Linked to original sources
PubMed2005

Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts.

OBJECTIVES: We analyzed neighborhood heterogeneity in associations among mortality, race/ethnicity, and area poverty. METHODS: We performed a multilevel statistical analysis of Massachusetts all-cause mortality data for the period 1989 through 1991 (n=142836 deaths), modeled as 79813 cells (deaths and denominators cross-tabulated by age, gender, and race/ethnicity) at level 1 nested within 5532 block groups at level 2 within 1307 census tracts (CTs) at level 3. We also characterized CTs by percentage of the population living below poverty level. RESULTS: Neighborhood variation in mortality across CTs and block groups was not accounted for by these areas' age, gender, and racial/ethnic composition. Neighborhood variation in mortality was much greater for the Black population than for the White population, largely because of CT-level variation in poverty rates. CONCLUSIONS: Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty.

Adolescent↗
PubMed2005

Class matters: U.S. versus U.K. measures of occupational disparities in access to health services and health status in the 2000 U.S. National Health Interview Survey.

To inform current debates over whether occupational class is causally linked to health inequities, the authors used data from the 2000 U.S. National Health Interview Survey to compare occupational disparities in access to health services, socioeconomic resources, and health status, using (1) the United Kingdom's new National Statistics Socio-Economic Classification (NS-SEC), premised on type of labor contract (salaried vs. hourly wage) and class position (employer, self-employed, supervisory and non-supervisory employee), and (2) the conventional U.S. occupational categories, premised on status and skill. Analyses included all working-age adults (age 25 to 64) for whom data on occupation and race/ethnicity were available (N = 22,500). Risk of inadequate access to health services, poverty, and low education were two times greater for persons in NS-SEC class 5 versus class 1, compared with blue-collar versus white-collar, and for both measures persons with the worst health status were in jobs that afforded the least access to health care. Controlling for earned income and workplace health insurance markedly reduced health service disparities, especially for the NS-SEC measure, thereby implying structural characteristics of jobs are causally relevant for resources and benefits necessary to address health inequities in the United States.

Adult↗
PubMed2004

Liver transplantation for neuroendocrine tumors.

Liver transplantation for the treatment of metastatic neuroendocrine tumors (NETs) is radical. Although cure is not impossible, it is improbable. The reported experience with transplantation for NETs is limited to less than 150 cases with widely varying results and few 5-year disease-free survivors. We reviewed our experience with transplantation for patients with NETs. Fourteen symptomatic patients with unresectable NET liver metastases who had failed medical management were listed for transplantation. Two patients listed for transplantation underwent prior right lobectomies. Three patients were listed but did not undergo transplantation: one was lost to follow-up, one died 14 months after listing, and one remains waiting over 4 years. Eleven patients underwent liver transplantation, three with living donor grafts. There were four men (36.4%) and seven women (63.6%) who had a mean age of 51.2+/-6.3 years. Three patients had distal pancreatectomies and one patient had a Whipple procedure at the time of transplantation. There were six nonfunctioning tumors (54.6%), three carcinoid tumors (27.3%), and two (18.2%) Vipomas. In one patient, with fulminant hepatic failure, the NET was an incidental finding in the explant. The 1- and 5-year survival among transplanted patients is 73% and 36%, respectively, with a mean follow-up of 34+/-40 months (range 0 to 119 months). Of the three patients surviving more than 5 years, only one was disease free. In carefully selected patients with metastatic NETs, liver transplantation may be an appropriate option.

Adult↗
PubMed2004

Post-liver transplant acute renal failure: factors predicting development of end-stage renal disease.

BACKGROUND: Acute renal failure (ARF) occurs in 5-50% of patients undergoing orthotopic liver transplantation (OLT). The aim of this study was to determine factors that might predict the development of end stage renal disease (ESRD) in patients who had ARF after OLT. METHODS: We studied all OLT recipients between 9/1/1988 through 12/31/2000. RESULTS: A total of 1602 patients underwent OLT during the study period. About 350 patients (22%) developed ARF requiring dialysis post-operatively. One hundred and twenty-three (39.8%) died within a year after OLT. Median follow up was 5.8 yr (range 1-12 yr). Forty-three patients (23%) developed ESRD over median of 3.79 yr (range 1-8 yr). Multivariate logistic regression analysis revealed creatinine levels > 1.7 mg/dL at 1 yr (p < 0.001), cyclosporine as immunosuppression (p = 0.026), and the presence of diabetes pre-OLT (p < 0.001) to be associated with the development of ESRD. The development of ESRD did not decrease patient survival (p = 0.111). ESRD patients who received subsequent kidney transplantation had significantly improved survival rates (p = 0.005). CONCLUSIONS: Serum creatinine levels at 1 yr, cyclosporine as immunosuppression, and the presence of diabetes pre-OLT are independent predictive factors for the development of ESRD. ESRD patients who received kidney transplantation had higher 10-yr survival rates when compared with patients maintained on dialysis.

Acute Kidney Injury↗
PubMed2004

Longitudinal study of the inception of perimenopause in relation to lifetime history of sexual or physical violence.

STUDY OBJECTIVE: To investigate of the extent to which violence over the life course accelerates the onset of perimenopause, as measured by menstrual changes. DESIGN: Prospective cohort study. SETTING: Boston, Massachusetts. PARTICIPANTS: 603 premenopausal women aged 36-45 years at baseline who completed a cross sectional survey on childhood and adult violence history. MAIN OUTCOME MEASURE: Time to perimenopause, defined as time in months from baseline interview to a woman's report of (1) an absolute change of at least seven days in menstrual cycle length from baseline or subjective report of menstrual irregularity; (2) a change in menstrual flow amount or duration; or (3) cessation of periods for at least three months, whichever came first. MAIN RESULTS: Experience of abuse was associated with delayed onset of menstrual changes indicative of onset of perimenopause. Women reporting childhood or adolescent abuse entered perimenopause about 35% slower than women who reported no abuse (IRR(adj) = 0.65, 95% CI 0.45 to 0.95) after adjusting for age, age at menarche, ever live birth, ability to maintain living standard, smoking, BMI, and depression. There was a similar association among women who reported first abuse during adulthood (IRR(adj) = 0.72, 95% CI 0.28 to 1.80). These findings persisted when the cohort was restricted to non-depressed women (childhood/adolescent IRR(adj) = 0.57, 95% CI 0.36 to 0.90; adulthood IRR(adj) = 0.63, 95% CI 0.23 to 1.77). CONCLUSIONS: This study is the first longitudinal analysis of the timing of perimenopause to show an association with a history of physical or sexual abuse. Further study of the relation between violence and reproductive aging is needed.

Adult↗
PubMed2004

Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birthweight deliveries: the CARDIA Study.

OBJECTIVES: We examined the effects of self-reported experiences of racial discrimination on Black-White differences in preterm (less than 37 weeks gestation) and low-birthweight (less than 2500 g) deliveries. METHODS: Using logistic regression models, we analyzed data on 352 births among women enrolled in the Coronary Artery Risk Development in Young Adults Study. RESULTS: Among Black women, 50% of those with preterm deliveries and 61% of those with low-birthweight infants reported having experienced racial discrimination in at least 3 situations; among White women, the corresponding percentages were 5% and 0%. The unadjusted odds ratio for preterm delivery among Black versus White women was 2.54 (95% confidence interval [CI]=1.33, 4.85), but this value decreased to 1.88 (95% CI=0.85, 4.12) after adjustment for experiences of racial discrimination and to 1.11 (95% CI=0.51, 2.41) after additional adjustment for alcohol and tobacco use, depression, education, and income. The corresponding odds ratios for low birthweight were 4.24 (95% CI=1.31, 13.67), 2.11 (95% CI=0.75, 5.93), and 2.43 (95% CI=0.79, 7.42). CONCLUSIONS: Self-reported experiences of racial discrimination were associated with preterm and low-birthweight deliveries, and such experiences may contribute to Black-White disparities in perinatal outcomes.

Adolescent↗
PubMed2004

Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000.

OBJECTIVES: We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures. METHODS: We analyzed data from the 2000 National Health Interview Survey. RESULTS: Overall, the prevalence of current smoking was greatest among persons in--and independently associated with--working class jobs, low educational level, and low income. Attempts to quit showed no socioeconomic gradient, while success in quitting was greatest among those with the most socioeconomic resources. These patterns held in most but not all race/ethnicity-gender groups. Finer resolution of smoking patterns was obtained using a relational UK occupational measure, compared to the skill-based measure commonly used in US studies. CONCLUSIONS: Reducing social disparities in smoking requires attention to the complexities of class along with race/ethnicity and gender.

Adult↗
PubMed2004

Characterizing perceived police violence: implications for public health.

Despite growing recognition of violence's health consequences and the World Health Organization's recent classification of police officers' excessive use of force as a form of violence, public health investigators have produced scant research characterizing police-perpetrated abuse. Using qualitative data from a study of a police drug crackdown in 2000 in 1 New York City police precinct, we explored 40 injection drug using and 25 non-drug using precinct residents' perceptions of and experiences with police-perpetrated abuse. Participants, particularly injection drug users and non-drug using men, reported police physical, psychological, and sexual violence and neglect; they often associated this abuse with crackdown-related tactics and perceived officer prejudice. We recommend that public health research address the prevalence, nature, and public health implications of police violence.

Adult↗
PubMed2003

Genders, sexes, and health: what are the connections--and why does it matter?

Open up any biomedical or public health journal prior to the 1970s, and one term will be glaringly absent: gender. Open up any recent biomedical or public health journal, and two terms will be used either: (1) interchangeably, or (2) as distinct constructs: gender and sex. Why the change? Why the confusion?-and why does it matter? After briefly reviewing conceptual debates leading to distinctions between 'sex' and 'gender' as biological and social constructs, respectively, the paper draws on ecosocial theory to present 12 case examples in which gender relations and sex-linked biology are singly, neither, or both relevant as independent or synergistic determinants of the selected outcomes. Spanning from birth defects to mortality, these outcomes include: chromosomal disorders, infectious and non-infectious disease, occupational and environmental disease, trauma, pregnancy, menopause, and access to health services. As these examples highlight, not only can gender relations influence expression-and interpretation-of biological traits, but also sex-linked biological characteristics can, in some cases, contribute to or amplify gender differentials in health. Because our science will only be as clear and error-free as our thinking, greater precision about whether and when gender relations, sex-linked biology, both, or neither matter for health is warranted.

Bias↗
PubMed2003

Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures--the public health disparities geocoding project.

Use of multilevel frameworks and area-based socioeconomic measures (ABSMs) for public health monitoring can potentially overcome the absence of socioeconomic data in most US public health surveillance systems. To assess whether ABSMs can meaningfully be used for diverse race/ethnicity-gender groups, we geocoded and linked public health surveillance data from Massachusetts and Rhode Island to 1990 block group, tract, and zip code ABSMs. Outcomes comprised death, birth, cancer incidence, tuberculosis, sexually transmitted infections, childhood lead poisoning, and nonfatal weapons-related injuries. Among White, Black, and Hispanic women and men, measures of economic deprivation (e.g., percentage below poverty) were most sensitive to expected socioeconomic gradients in health, with the most consistent results and maximal geocoding linkage evident for tract-level analyses.

Adolescent↗
PubMed2003

Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective.

Research on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the "battered child syndrome" dramatically increased attention to-and prompted new research on-the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health.

Attitude to Health↗
PubMed2003

Breast cancer, birth cohorts, and Epstein-Barr virus: methodological issues in exploring the "hygiene hypothesis" in relation to breast cancer, Hodgkin's disease, and stomach cancer.

To address methodological issues in exploring a variant of the "hygiene hypothesis" that posits delayed infection by Epstein-Barr virus contributes to rising rates of breast cancer and Hodgkin's disease, we examined birth cohort trends in the incidence of both cancers plus stomach cancer, building on previously reported year-of-diagnosis cross-sectional associations of age-standardized rates. Using published data from the United States Connecticut state cancer registry (1935-1998) for women for each cancer site, we obtained age-specific incidence rates by birth cohort (1870-1874 to 1970-1974), along with age-standardized incidence rates for selected calendar years (1935-1939, 1940-1944,., 1990-1994, 1995-1998). Clear secular trends in incidence rates, in the opposite direction, were evident for: (a) breast cancer and for Hodgkin's disease in young adults (increasing), and (b) stomach cancer (decreasing). Correlations between the incidence of breast cancer among women ages 50-54 and Hodgkin's disease among young adults (ages 20-24) were stronger for birth cohort (Pearson correlation, 0.85) than for cross-sectional analyses (Pearson correlation, 0.68). Stronger associations between the incidence of breast cancer and non-Hodgkin's disease were evident for birth cohort compared with cross-sectional analyses, findings consonant with (but not "proof" of) the hygiene hypothesis. One methodological implication is that tests of the hygiene hypothesis must take into account birth cohort effects and age at incidence of the outcomes under study; age-standardized cross-sectional analyses may be misleading.

Adolescent↗
PubMed2002

Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project.

Despite the promise of geocoding and use of area-based socioeconomic measures to overcome the paucity of socioeconomic data in US public health surveillance systems, no consensus exists as to which measures should be used or at which level of geography. The authors generated diverse single-variable and composite area-based socioeconomic measures at the census tract, block group, and zip code level for Massachusetts (1990 population: 6,016,425) and Rhode Island (1990 population: 1,003,464) to investigate their associations with mortality rates (1989-1991: 156,366 resident deaths in Massachusetts and 27,291 in Rhode Island) and incidence of primary invasive cancer (1988-1992: 140,610 resident cases in Massachusetts; 1989-1992: 19,808 resident cases in Rhode Island). Analyses of all-cause and cause-specific mortality rates and all-cause and site-specific cancer incidence rates indicated that: 1) block group and tract socioeconomic measures performed comparably within and across both states, but zip code measures for several outcomes detected no gradients or gradients contrary to those observed with tract and block group measures; 2) similar gradients were detected with categories generated by quintiles and by a priori categorical cutpoints; and 3) measures including data on economic poverty were most robust and detected gradients that were unobserved using measures of only education and wealth.

Adolescent↗