Coronary artery disease is not associated with the E298-->D variant of the constitutive, endothelial nitric oxide synthase gene.
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Aspartic Acid↗
Biomedical subjects
Y Friedlander
Publications and source records attributed to Y Friedlander.
Hypoglycemia in hospitalized nondiabetic older patients.
OBJECTIVES: To analyze the clinical characteristics, associated risk factors, and outcome of hypoglycemia in nondiabetic hospitalized older patients. DESIGN: A retrospective case control study. PARTICIPANTS: Sixty patients, aged 65 years and older, in the acute medical and geriatric wards who developed hypoglycemia. A control group was composed of 83 older patients, sex and age matched, in orthopedic and surgery wards who were undergoing corrective surgery for hip fracture or hernioplasty. MEASUREMENTS: For all patients, data for the following variables were abstracted from the charts: age, sex, degree of hypoglycemia, clinical presentation of hypoglycemia, number and duration of hypoglycemia episodes, nutritional state, and blood chemistry analysis. Risk factors were defined as nutritional state, heart failure, renal or liver disease, malignancy, and infection or sepsis. RESULTS: Mean blood glucose in hypoglycemic cases was 38.9 +/- 7 mg/dL. Symptoms and signs of hypoglycemia were noted in only 38.4% (23/60) of patients. All identified risk factors except cachexia were found significantly more frequently in the hypoglycemic patients than in the control group. Mean total number of risk factors was greater in the hypoglycemic group than in the control group, 2.97 +/- 1.1 versus 1.64 +/- .8, respectively (P < .001). In a multivariant logistic model, low plasma albumin level, liver disease, malignancy, and congestive heart failure were significant predictors of hypoglycemia. In-hospital mortality rate was higher among the hypoglycemic patients, 48% versus 18.1% (P < .001), and was independent of the degree of hypoglycemia or the number of hypoglycemic episodes. Mortality was correlated significantly with the number of risk factors (3.4 +/- 1.1 vs 2.5 +/- 1.1; P = .006). Hypoglycemia remained a significant predictor of mortality (OR = 3.67; 95% CI, 1.2-11.2) even after the adjustment for other risk factors. CONCLUSIONS: Hypoglycemic episodes occur even among nondiabetic hospitalized older patients. Symptoms and signs of hypoglycemia were noted in only two-fifths of the patients. Albumin less than 3.0 g%, liver disease, renal insufficiency, malignancy, congestive heart failure, and sepsis were statistically significant predictors of developing hypoglycemia. The overall mortality rate was significantly higher among the hypoglycemic patients and was independent of hypoglycemia levels. Mean total number of risk factors was significantly higher among those who died compared with hypoglycemic patients who survived. Based on the present study, the estimated odds of mortality in an older patient with hypoglycemia were 3.67 times higher than in those without hypoglycemia.
Age Factors↗
Five minute recordings of heart rate variability for population studies: repeatability and age-sex characteristics.
OBJECTIVE: To evaluate the stability of short recordings of heart rate variability (HRV) with time, and the association of HRV with age and sex. DESIGN: Five minute Holter recordings were made twice over a two month interval (tracking study). In addition, HRV was measured in a cross sectional study. SETTING: Residents of 11 Israeli kibbutzim were examined in their settlements. SUBJECTS: 32 men and 38 women (aged 31-67) participated in the tracking study and 294 (aged 35-65) were involved in the cross sectional study. MAIN OUTCOME MEASURES: Time and frequency domain analyses on Holter recordings were undertaken in two breathing conditions: spontaneous and controlled breathing (15 respirations per minute). Regression was used to assess the relations of sex, age, heart rate, and logarithmically transformed HRV indices. RESULTS: HRV measures were highly consistent with time with correlations of 0.76-0.80 for high frequency and total power. Geometric mean total power declined with age by 45% in men and 32% in women, and was lower by 24% among women than among men (all p < or = 0.005). Men had a 34% higher very low and low frequency power and a higher ratio of low to high frequency power (p < 0.001). Conversely, high frequency power in women represents a greater proportion of total power than in men. CONCLUSION: Short recordings of HRV in a non-laboratory setting are stable over months and therefore characteristic of an individual. Strong age and sex effects were evident. HRV derived from short recordings can be informative in population based studies.
Adult↗
Risk factors for ischemic stroke: Dubbo Study of the elderly.
BACKGROUND AND PURPOSE: One in 10 deaths in Australia is due to stroke. The predictors of ischemic stroke have not been well defined, although hypertension, atrial fibrillation, and previous stroke have been consistently reported. We report on 98 months' follow-up in a prospective study of cardiovascular disease in the Australian elderly, the Dubbo Study. METHODS: The cohort, first examined in 1988, was composed of 2805 men and women 60 years and older. The prediction of ischemic stroke by potential risk factors was examined in a Cox proportional hazards model, after linkage to hospital and death records. RESULTS: Three hundred six men and women manifested an ischemic stroke event (ICD-9-CM 433 to 437), and 95 subjects suffered a fatal stroke event. In the multivariate model, the significant independent predictors of stroke were advancing age, female sex (48% lower risk), being married (30% lower risk), prior history of stroke (227% higher risk), use of antihypertensive drugs (37% higher risk), belonging to the highest category of blood pressure reading (67% higher risk), presence of atrial fibrillation (58% higher risk), HDL cholesterol (36% lower risk for each 1-mmol/L increment), impaired peak expiratory flow (77% higher risk for tertile I than for tertile III), physical disability (59% higher risk), and depression score (41% higher risk for tertile III than for tertile I). CONCLUSIONS: These findings suggest that morbidity and mortality associated with ischemic stroke can be predicted by various clinical indicators, some of which may be amenable to intervention. The matters of impaired peak expiratory flow, depression score, and ischemic stroke require further study.
Aged↗
Association of the ADH2*2 allele with reduced ethanol consumption in Jewish men in Israel: a pilot study.
OBJECTIVE: This study provides preliminary evidence on the associations between alcohol consumption patterns and polymorphisms of the alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) enzymes in a Jewish population. METHOD: Two groups of Jewish men were studied--one group (n = 92) representative of the free-living population of Jerusalem and generally light consumers of ethanol and the other group (n = 53) composed of treatment-enrolled heroin dependent individuals in the same city, most with a history of heavy daily drinking. All participants were interviewed regarding sociodemographic background, present and past alcohol consumption patterns, and familial characteristics including alcohol problems among first-degree relatives. Polymorphisms of the ADH2, ADH3 and ALDH loci were determined for all participants. RESULTS: The less common allele of the ADH2 locus (ADH2*2 allele frequency approximately 20% in Ashkenazic and non-Ashkenazic members of both groups) was related to a reduced mean level of peak weekly alcohol intake in the two groups. In multiple regression models adjusting for family history of alcohol problems and other factors, the ADH2*2 allele accounted for 20% and 30% of the explained alcohol intake variance in these two groups, respectively. Results from a logistic regression indicated that the ADH2*2 allele was also related to infrequent drinking in both groups. Evidence for an independent association between the ADH3 polymorphism and alcohol consumption patterns was not found. The ALDH gene was not polymorphic in this population. CONCLUSIONS: This report describes for the first time an association between alcohol consumption patterns and a polymorphism at the ADH2 locus in a Jewish population. The relatively high frequency of the ADH2*2 allele may contribute to the seemingly lower levels of alcohol consumption and heightened sensitivity to alcohol observed among Jews.
Adult↗
Relationship of peak expiratory flow rate with mortality and ischaemic heart disease in elderly Australians.
OBJECTIVE: To evaluate the relationships of mortality and ischaemic heart disease (IHD) with peak expiratory flow rate (PEF) in the elderly. DESIGN: Prospective study with median follow-up of 83 months. SETTING: Dubbo, a New South Wales country town (population, 30500). SUBJECTS: Non-institutionalised residents born before 1930 (i.e., aged 60 years and over at study entry). Participation rate was 73% (1235 men and 1570 women). MAIN OUTCOME MEASURES: Baseline demographic, psychosocial and standard cardiovascular risk factors, including PEF; all-causes mortality, IHD mortality and IHD events (hospitalisations with any manifestation of IHD) by tertile of PEF. RESULTS: More subjects with PEF in the lowest tertile (I) had a past history of respiratory disease, were current cigarette smokers and were taking antihypertensive drugs. During follow-up, 321 men (26%) and 252 women (16%) died. All-causes mortality was three (men) to four (women) times higher for those in PEF tertile I than for those in tertile III. IHD mortality and IHD events showed similar trends. In a proportional hazards model adjusted for age, height, smoking status and other risk factors or confounders, the hazard ratios (95% confidence interval) for men in PEF tertile I versus tertile III were: all-causes mortality, 1.62 (1.14-2.30); IHD mortality, 1.75 (0.96-3.20); and IHD events, 1.12 (0.82-1.53). For women, respective hazard ratios were 1.92 (1.23-3.00), 2.58 (1.24-5.39), and 1.16 (0.83-1.63). CONCLUSIONS: We confirm an independent, inverse relationship between PEF and all-causes and IHD mortality. The data suggest a potential benefit for coronary risk factor management in subjects with existing airways disease and further support the case for antismoking programs.
Aged↗
Scavenger receptor activity and expression of apolipoprotein E mRNA in monocyte-derived macrophages of young and old healthy men.
The aim of this study was to compare some aspects of lipid metabolism in monocyte-derived macrophages isolated from young males, aged 18-24 years, and old males, aged 74-90 years, who were found healthy in accordance with the Senieur protocol. The parameters tested were metabolism of 125I-acetylated low-density lipoproteins (LDL) and oxidized LDL, incorporation of [3H]cholesterol into cholesteryl ester and expression of apolipoprotein E (apo E) mRNA. Cell association and degradation of 125I-acetylated LDL by macrophages of old and young subjects, respectively, was 15,978 +/- 2492 and 9300 +/- 1416 ng/mg cell protein per 24 h. Incorporation of [3H]cholesterol into cellular [3H]cholesteryl ester in the presence of acetylated LDL in cells isolated from old subjects was twice that in cells from young subjects. The macrophages from both age groups metabolized less 125I-oxidized LDL than 125I-acetylated LDL. Cell association and degradation of 125I-oxidized LDL in cells from old and young subjects, respectively, was 6779 +/- 1398 and 3219 +/- 643 ng/mg cell protein per 24 h. Expression of apo E mRNA was determined by reverse transcriptase polymerase chain reaction. In the basal state, it was 5.8 +/- 0.4 and 2.4 +/- 0.2 photo-stimulated luminescence (PSL) units in cells from the old and young subjects, respectively, and increased after exposure to acetylated LDL. In conclusion, these findings suggest that a combination of higher scavenger receptor activity and increased expression of apo E mRNA in macrophages could contribute to (a) enhanced metabolism of modified LDL and (b) more efficient removal of cholesterol from arteries, thus leading to healthy old age.
Acetylation↗
Genetic influences on changes in body mass index: a longitudinal analysis of women twins.
Numerous studies have demonstrated genetic influences on body fat, but there also may be genetic effects on its intraindividual variation over time. This study examined changes in body mass index (BMI) using longitudinal data from two examinations of the Kaiser Permanente Women Twins Study, performed a decade apart. The analysis included 630 women, 185 monozygotic and 130 dizygotic twin pairs, with average ages of 41 years and 51 years at the two examinations, respectively. Age-adjusted heritability estimates for the change in BMI over the decade ranged from 0.57 to 0.86 (all p < or = 0.001) using three different statistical analysis approaches, indicating that at least half and possibly as much as 85%+, of the variance in the change in BMI is attributable to genetic influences under a polygenic model. These estimates remained statistically significant after adjusting for environmental factors (ranging from 0.57 to 0.78) and with additional adjustment for BMI at baseline (ranging from 0.41 to 0.79), although dizygotic intraclass correlations were low after these adjustments. Thus, in addition to known environmental and behavioral influences, these results provide evidence for genetic influences on changes in BMI over a decade in women.
Adolescent↗
Heritability of longitudinal changes in coronary-heart-disease risk factors in women twins.
Numerous studies have demonstrated genetic influences on levels of coronary heart disease (CHD) risk factors, but there also may be genetic effects on the intraindividual variation in these risk factors over time. Changes in risk factors are likely to reflect genetic-environmental interactions and may have important implications for understanding CHD risk. The present study examines the heritability of changes in CHD risk factors, using data from the two examinations by the Kaiser Permanente Women Twins Study, performed a decade apart. The sample consisted of 348 pairs of women twins who participated in both examinations, including 203 MZ pairs and 145 DZ pairs. Average ages at the two examinations were 41 and 51 years, respectively. By means of three different statistical analytic approaches, moderate heritability estimates were demonstrated for changes in LDL cholesterol (h2 = .25-.36) and in HDL cholesterol (h2 = .23-.58), some of which were statistically significant. Although small to moderate heritability estimates were found for systolic blood pressure (.18-.37; P < .05 for some estimates), no genetic influence on changes in diastolic blood pressure was detected. Based on longitudinal twin data in women, this study demonstrates a genetic influence on changes in both lipoprotein risk factors and systolic blood pressure over a decade. In addition to environmental factors, which clearly are operating, the effect of various "variability genes" may be acting independently of the genetic influences on the absolute levels of these risk factors. Both mapping the gene(s) underlying intraindividual variations in these CHD risk factors and understanding their function(s) could lead to targeted intervention strategies to reduce CHD risk among genetically susceptible individuals.
Adult↗
Chronic bronchitis and risk of coronary heart disease.
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Aged↗
Influence of apolipoprotein E genotypes on plasma lipid and lipoprotein concentrations: results from a segregation analysis in pedigrees with molecularly defined familial hypercholesterolemia.
Familial hypercholesterolemia (FH) is a monogenic disorder caused by mutations in the low-density lipoprotein (LDL) receptor gene. Large variations in plasma lipids and lipoprotein levels have been observed in FH families. These may be caused by other environmental and genetic factors of which apolipoprotein E (apo E) is a candidate. The possible influence of apo E polymorphism on components of variation in plasma LDL-C, triglycerides, high-density lipoprotein cholesterol (HDL-C), and lipoprotein(a) (Lp(a)) levels was investigated in 235 members of 14 families with FH. Sex-and age-adjusted mean LDL-C was influenced significantly by the apo E genotype in non-FH subjects (P <or= .01), and a similar trend was observed in FH cases. Mean plasma levels of triglyceride, HDL-C, and Lp(a) were not significantly different across the apo E genotypes in FH and in non-FH family members. Complex segregation analysis was first applied to these sex- and age-adjusted data. In addition to the major gene involved in LDL-C levels (i.e., the LDL receptor gene), there was evidence for a non-transmitted environmental major factor in addition to polygenic effect that explained the mixture of distributions in TG and a major effect in addition to polygenic loci which influenced Lp(a) levels. There was no evidence for a single major factor controlling HDL-C levels in these pedigrees. When the segregation models allowed apo E regression coefficients to be ousiotype (class) specific, the results suggested that apo E genotypes have a significant effect on LDL-C, TG, and Lp(a) levels. In conclusion, the analysis presented here supports the concept that the apo E gene has an important role in the regulation of plasma lipid and lipoproteins in FH.
Adolescent↗
The modulation of plasma lipids and lipoproteins during bone marrow transplantation is unrelated to exogenously administered recombinant human granulocyte-monocyte colony-stimulating factor (rHu GM-CSF).
We evaluated the effect of exogenously administered recombinant human granulocyte-macrophage colony stimulating factor (rHu GM-CSF) on plasma lipid and lipoprotein concentrations in 28 patients undergoing bone marrow transplantation (BMT). Twenty-one received rHu GM-CSF during the immediate post transplantation period (group 1) and seven did not (group 2). All patients received intravenous hyperalimentation starting at the immediate post-transplantation period until 3-5 days post engraftment. Plasma lipids and lipoproteins, liver and renal function tests and blood counts were determined prior to BMT (baseline levels) and during the immediate and late post transplantation periods. In both groups, marked changes of plasma total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) concentrations were observed. During the immediate post transplantation period, TC levels decreased by 22.2% and 26.2% in groups 1 and 2, respectively. During the same period, HDL-C levels decreased by 41.4% and 37.5% in these two groups. At the late recovery phase TC and HDL-C resumed pre-treatment levels. These changes were in parallel to the fluctuations in total WBC counts. We conclude, therefore, that BMT has a significant transient effect on plasma lipids and lipoproteins. Although this response is unrelated to the exogenous administration of rHu GM-CSF it may be causally related to endogenous cytokines or other, yet unidentified, factors.
Adult↗
M235-->T polymorphism of the angiotensinogen gene predicts hypertension in the elderly.
OBJECTIVE: To determine whether the M235-->T polymorphism (exon 2) of the angiotensinogen gene is associated with hypertension in elderly patients with isolated systolic hypertension [ISH: systolic blood pressure (SBP) > or = 160 mmHg, diastolic blood pressure (DBP) < 90 mmHg) or systolic-diastolic hypertension (SDH: DBP > or = 90 mmHg, SBP > or = 160 mmHg) compared with normotensive controls (SBP < 160 mmHg, DBP < 90 mmHg). DESIGN: A case-control study in 769 non-institutionalized, elderly (aged > or = 60 years; female:male ratio 0.85) residents of Dubbo, New South Wales. METHODS: Individuals were classified as having ISH (n = 171), having SDH (n = 218) and being normotensive controls (n = 366) with age and sex matching. MM, TT and MT genotypes were determined by a nested polymerase chain reaction strategy using DNA extracted from serum. The prediction of ISH or SDH by genotype or allele was examined in a multiple-logistic regression model that controlled for various confounders. RESULTS: SBP (mean +/- SD, mmHg)/DBP (mean +/- SD, mmHg) was 176 +/- 16/79 +/- 8 in the ISH group, 167 +/- 23/97 +/- 7 in the SDH group and 134 +/- 14/74 +/- 9 in the normotensive control group. The frequencies of M and T alleles in the normal population (0.69 and 0.31, respectively) were altered significantly in the ISH group (0.61 and 0.39, respectively; chi 2 = 6.0, P < 0.02) and the SDH group (0.62 and 0.38, respectively; chi 2 = 6.0, P < 0.02). The presence of the TT genotype predicted both ISH (odds ratio 1.9, 95% confidence interval 1.1-3.3) and SDH (1.7, 1.0-3.0) as did that of the T allele (ISH: 1.3, 1.0-1.7; SDH: 1.3, 1.0-1.7). CONCLUSIONS: The M235-->T polymorphism may be a marker for both forms of hypertension in the elderly. Whether the TT genotype represents a genetic risk factor for the development of hypertension in later life requires confirmation.
Aged↗
Genetic contributions to LDL-C, Apo-B and LDL-C/Apo-B ratio in a sample of Israeli offspring with a parental history of myocardial infarction.
One hundred and forty sibships consisting of 280 brothers and 256 sisters with a family history of myocardial infarction were investigated for the possible involvement of a major gene in the determination of LDL-C, Apo-B and LDL-C/ Apo-B ratio (as a surrogate for LDL subclasses). The mean ages were 29.5 years (range 15-48) and 29.2 years (range 15-47), for brothers and sisters, respectively, and values were initially adjusted for age effects through multiple regression analysis. Results from commingling analysis indicated that for LDL-C a single normal distribution fitted the data as well as a mixture of two distributions. For Apo-B, a mixture of two normal distributions fitted the data significantly better than a single distribution (chi 2 = 7.8, df = 2, p = 0.02). For LDL-C/ Apo-B ratio a mixture of three normal distributions fitted the data significantly better than two distributions (chi 2 = 9.2, df = 2, p = 0.01). A regression analysis applied to the logarithm of the sex- and age-adjusted mean and variance within sibship, showed no indication of a major gene involvement for LDL-C. For Apo-B and LDL-C/Apo-B ratio, there existed, however, significant linear relationships between the logarithmically transformed means and within sibship variances which support the involvement of major genes. In addition, the Bartlett test applied to the data of within-sibship variances also rejected the null hypothesis of multifactorial transmission for Apo-B and LDL-C/Apo-B ratio (p < 0.0001). Lastly, the results from sib-pair linkage analyses provided significantly positive evidence for linkage between ApoB levels and the Apo-B XbaI restriction site.
Adolescent↗
Predictors of mortality in the prospective Dubbo study of Australian elderly.
BACKGROUND: A prospective study in non-institutionalised Australian elderly 60 years and over commenced in Dubbo, NSW in 1988. AIM: To examine clinical and socio-demographic predictors of all-causes mortality. METHODS: The data were derived from a community-based sample comprising 1236 men and 1569 women followed for a median period of 62 months. RESULTS: Two hundred and thirty five men (19%) and 184 women (12%) died, 46% of male and 53% of female deaths respectively related to cardiovascular disease. In a proportional hazards model, the significant predictors of mortality were: older age, being married (relative risk [RR] = 0.71 for men, 0.74 for women), current smoking for men (RR = 3.11), taking more than three alcoholic drinks per day for men (RR = 0.37), prior coronary heart disease for men (RR = 1.36), severe hypertension for women (RR = 1.99), use of anti-hypertensive medication for men (RR = 1.74), diabetes for men (RR = 1.62), poor-fair self-rated health for women (RR = 1.74) and physical disability for men (RR = 1.72). Serum cholesterol was associated with mortality in a 'J-shaped' relationship in men and in a reciprocal relationship in women. Blood pressure predicted mortality in an incremental fashion below 75 years, but in older subjects lower pressure was associated with excess mortality. CONCLUSION: Some predictors of mortality in the well elderly have been identified and a more extended period of follow-up will possibly resolve contradictory findings in some areas.
Aged↗
Diabetes, mortality and coronary heart disease in the prospective Dubbo study of Australian elderly.
BACKGROUND: A prospective study of Australian elderly living in Dubbo has shown that diabetes is a significant predictor of all-causes mortality and coronary heart disease (CHD). AIM: To examine and contrast clinical and socio-demographic predictors of these outcomes in those with and without diabetes. METHODS: The data are derived from a community-based sample of subjects 60 years and older followed over 62 months since 1988. Of 1155 men and 1472 women, 9.2% and 6.9% respectively manifested diabetes at baseline, based on history or fasting hyperglycaemia. RESULTS: In the presence of diabetes, all-causes mortality was increased twofold in both sexes, CHD incidence was increased twofold in men and threefold in women, stroke incidence was increased twofold in women but little changed in men. Proportional hazards models were derived separately for persons with and without diabetes and risk factors differentially predictive in diabetes were sought. Significant predictors of death in diabetes were old age and current smoking. Those factors differentially predictive were 'being married' (Relative Risk [RR] 1.60 with diabetes and 0.69 without diabetes) and higher body mass index (BMI) (RR 1.03 with diabetes and 0.79 without diabetes). Significant predictors of CHD in diabetes were old age, prior CHD, severe hypertension, low HDL cholesterol and self-rated health. Those factors differentially predictive were higher body mass index (RR 1.14 vs 0.83) and physical disability (RR 0.69 vs 1.55). Differential predictions with regard to BMI may relate in part to excess CHD and mortality at low BMI in non-diabetic subjects. CONCLUSION: The vascular disease burden of diabetes in the elderly has been confirmed, especially in women. A number of conventional risk factors are contributing to this burden and may be amenable to treatment.
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Alcohol intake and survival in the elderly: a 77 month follow-up in the Dubbo study.
BACKGROUND: A prospective study in non-institutionalised Australian elderly aged 60 years and over commenced in Dubbo, NSW in 1988. AIM: To examine the relationship between all-causes mortality and alcohol intake. METHODS: The data were derived from a community-based sample comprising 1236 men and 1569 women followed for a median period of 77 months. Regular alcohol intake was reported by 78% of men and 52% of women. Eighty-seven per cent of men and 44% of women primarily drank beer. RESULTS: Death occurred in 305 men and 236 women, 34% and 39% respectively from coronary heart disease (CHD). In a proportional hazards model, the hazard ratio (HR) for all-causes mortality in male drinkers, compared with abstainers, was 0.75 at one-seven drinks/week, 0.76 at eight-14 drinks/week, 0.69 at 15-28 drinks/week and 0.49 at > 28 drinks/week (p < 0.04), an inverse relationship. In female drinkers, HR was 0.78 at one-seven drinks/week, 0.49 at eight-14 drinks/week (p < 0.04) and 0.62 at 15-28 drinks/weeks, potentially a U shaped relationship. The effect on all-causes mortality could not be attributed to a differential effect of beer versus wine/spirit intake. Although the mortality rate was lower in those taking any alcohol compared with abstainers, those taking any alcohol exhibited an increased proportion of deaths due to cancer at the expense of a reduced proportion of CHD and stroke deaths. CONCLUSIONS: Alcohol intake in the Dubbo elderly appears to be independently associated with a significant increase in life expectancy. Mechanisms underlying the effect may emerge at a longer interval of follow-up.
Aged↗
Does religious observance promote health? mortality in secular vs religious kibbutzim in Israel.
OBJECTIVES: This study assessed the association of Jewish religious observance with mortality by comparing religious and secular kibbutzim. These collectives are highly similar in social structure and economic function and are cohesive and supportive communities. METHODS: In a 16-year (1970 through 1985) historical prospective study of mortality in 11 religious and 11 matched secular kibbutzim in Israel, 268 deaths occurred among 3900 men and women 35 years of age and older during 41347 person-years of observation. RESULTS: Mortality was considerably higher in secular kibbutzim. Cox proportional hazards analysis was used to adjust for age and the matched design; rate ratios were 1.67 (95% confidence interval [CI]=1.17, 2.39) for men, 2.67 (95% CI=1.55, 4.60) for women, and 1.93 (95% CI=1.44, 2.59) overall. Kaplan-Meier survival analysis of birth cohorts confirmed the association. The lower mortality in religious kibbutzim was consistent for all major causes of death. CONCLUSIONS: Belonging to a religious collective was associated with a strong protective effect not attributable to confounding by sociodemographic factors. Elucidation of mechanisms mediating this effect may provide etiologic insights and leads for intervention.
Adult↗