bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial Segregation and Longevity among African Americans: An Individual‐Level Analysis
Authors: Laveist Thomas A. 
Published: December 2003

Objective To test the relationship between racial segregation and mortality using a multidimensional questionnaire‐based measure of exposure to segregation.Data Sources Data for this analysis come from the National Survey of Black Americans (NSBA), a national multistage probability sample of 2,107 African Americans (aged 18–101). The NSBA was conducted as a household survey. The NSBA was matched with the National Death Index (NDI).Study Design Prospective cohort study, where Cox regression analysis was used to examine the effect of baseline variables on time to death over a 13‐year period.Principal Findings Respondents who were exposed to racial segregation were significantly less likely to survive the study period after controls for age, health status, and other predictors of mortality.Conclusion The results support previous studies linking segregation with health outcomes.
Distributional Issues in the Analysis of Preventable Hospitalizations
Authors: Delia Derek 
Published: December 2003

Objective. To describe patterns in ambulatory care sensitive (ACS) admissions at the zip code level based on zip code demographic and other characteristics. These patterns include trends over time, persistence within zip codes over time, and variation between and within socioeconomic strata.Data Sources. New York State hospital discharge data 1990–1998, U.S. census data 1990, and New York State birth records 1990.Study Design. Age‐ and sex‐adjusted rates and volumes of ACS admissions are calculated at the zip code level. Descriptive statistics are analyzed cross‐sectionally and over time. Kernel density functions are estimated across income strata. Ordinary and quantile regression techniques are used to determine the impact of socioeconomic variables on average and extreme values of the distribution of ACS admission rates.Principal Findings. Ambulatory care sensitive admissions rates declined during the study period but in conjunction with a greater decline in overall admission rates. Thus, as a percentage of total admissions, they actually rose by 4 percent. Ambulatory care sensitive admissions are geographically concentrated and rates are highly persistent within zip codes over time. Even on a log scale ACS admissions are typically greater and exhibit more variability among low‐income zip codes. Other variables positively associated with ACS admissions are total population, births to unwed mothers (a proxy for family structure), black population, Hispanic population, and the number of non‐ACS admissions. Births to immigrant mothers (a proxy for immigrant population) are negatively associated with ACS admissions.Conclusions. The concentration and persistence of ACS admissions point to a chronic, geographically limited deficiency of primary ambulatory care in the most underserved neighborhoods. Much of the difference in preventable hospitalization levels between high‐ and low‐income areas is driven by very high volumes in the low‐income areas unrelated to population density. New York data suggest that most costs from preventable hospitalizations could be saved by focusing on targeted neighborhoods. Socioeconomic and area utilization variables play a role in both average and extreme values of the rate of preventable hospitalizations at the zip code level. Since variables that affect the average volume of preventable hospitalizations can change the distribution of that volume, analysis based on averages alone may be inadequate. The findings on area demographics and non‐ACS admissions point to the need to better understand social and cultural issues as well as local admitting practice patterns to encourage appropriate and efficient use of the health care delivery system.
Nonlinearity in Demographic and Behavioral Determinants of Morbidity
Authors: Norris Jean C. , Van der laan Mark J. , Lane Sylvia , Anderson James N. , Block Gladys 
Published: December 2003

Objective. To examine nonlinearity of determinants of morbidity in the United StatesData Sources. A secondary analysis of data on individuals with dietary data from the Cancer Epidemiology Supplement and National Health Interview Survey (NHIS) 1987, a cross‐sectional, stratified random sample of the U.S. population (n=22,080).Study Design. A statistical exploration using additive multiple regression models.Methods. A Morbidity Index (0–30 points), derived from 1987 National Health Interview Survey data, combines number of conditions, hospitalizations, sick days, doctor visits, and degree of disability. Behavioral (health habits) variables were added to multivariate models containing demographic terms, with Morbidity Index and Self‐assessed Health outcomes (n=17,612). Tables and graphs compare models of morbidity with self‐assessed health models, with and without behavioral terms. Graphs illustrate curvilinear relationships.Principal Findings. Morbidity and health are associated nonlinearly with age, race, education, and income, as well as alcohol, diet change, vitamin supplement use, body mass index (BMI), marital status/living arrangement, and smoking. Diet change and supplement use, education, income, race/ethnicity, and age relate differently to self‐assessed health status than to morbidity. Morbidity is strongly associated with income up to about $15,000 above poverty. Additional income predicts no further reduction in morbidity. Better health is strongly related to both higher income and education. After controlling for income, black race does not predict morbidity, but remains associated with lower self‐assessed health.Conclusions. Good health habits, as captured in these models, are associated with a 10–20‐year delay in onset and progression of morbidity.
Socioeconomic Gradients and Low Birth‐Weight: Empirical and Policy Considerations
Authors: Finch Brian Karl 
Published: December 2003

Objective.To examine whether socioeconomic status (SES) gradients emerge in health outcomes as early as birth and to examine the magnitude, potential sources, and explanations of any observed SES gradients.Data Sources.The National Maternal and Infant Health Survey conducted in 1988.Study Design.A multinomial logistic regression of trichotomized birth‐weight categories was conducted for normal birth‐weight (2,500–5,500 grams), low birth‐weight (LBWT; <2,500 grams), and heavy birth‐weight (>5,500 grams). Key variables included income, education, occupational grade, state‐level income inequality, and length of participation in Women‐Infants‐Children (WIC) for pregnant mothers.Principal Findings.A socioeconomic gradient for low birth‐weight was discovered for an adjusted household income measure, net of all covariates in the unrestricted models. A gross effect of maternal education was explained by maternal smoking behaviors, while no effect of occupational grade was observed, net of household income. There were no significant state‐level income inequality effects (Gini coefficient) for any of the models. In addition, participation in WIC was discovered to substantially flatten income gradients for short‐term participants and virtually eliminate an income gradient among long‐term participants.Conclusions.Although a materialist explanation for early‐life SES gradients seems the most plausible (vis‐à‐vis psychosocial and occupational explanations), more research is needed to discover potential interventions. In addition, the notion of a monotonic gradient in which income is salutary across the full range of the distribution is challenged by these data such that income may cease to be beneficial after a given threshold. Finally, the success of WIC participation in flattening SES gradients argues for either: (a) the experimental efficacy of WIC, or (b) the biasing selection characteristics of WIC participants; either conclusion suggests that interventions or characteristics of participants deserves further study as a potential remedy for socioeconomic disparities in early‐life health outcomes such as LBWT.
Social Determinants of Tooth Loss
Authors: Gilbert Gregg H. , Paul duncan R. , Shelton Brent J. 
Published: December 2003

Objectives. To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities.Data Sources/Study Setting. The Florida Dental Care Study, comprising African Americans (AAs) and non‐Hispanic whites 45 years old or older who had at least one tooth.Study Design. We used a prospective cohort design. Relevant population characteristics were grouped by predisposing, enabling, and need variables. The key outcome was tooth loss, a leading measure of a population's oral health, looked at before and after entering the dental care system. Tooth‐specific data were used to increase inferential power by relating the loss of individual teeth to the disease level on those teeth.Data Collection Methods. In‐person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months.Principal Findings. African Americans and persons of lower SES reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them. At the first stage of analysis, differences in disease severity and new symptoms explained tooth loss disparities. Racial and SES differences in attitudes toward tooth loss and dental care were not contributory. Because almost all tooth loss occurs by means of dental extraction, the total effects of race and SES on tooth loss were artificially minimized unless disparities in dental care use were taken into account.Conclusions. Race and SES are strong determinants of tooth loss. African Americans and lower SES persons had fewer teeth at baseline and still lost more teeth after baseline. Tooth‐specific case‐mix adjustment appears, statistically, to explain social disparity variation in tooth loss. However, when social disparities in dental care use are taken into account, social disparities in tooth loss that are not directly due to clinical circumstance become evident. This is because AAs and lower SES persons are more likely to receive a dental extraction once they enter the dental care system, given the same disease extent and severity. This phenomenon underscores the importance of understanding how disparities in health care use, dental insurance coverage, and service receipt contribute to disparities in health. Absent such understanding, the total effects of race and SES on health can be underestimated.
County‐Level Income Inequality and Depression among Older Americans
Authors: Muramatsu Naoko 
Published: December 2003

Objectives. To examine (1) whether county‐level income inequality is associated with depression among Americans aged 70 and older, taking into consideration county‐level mean household income and individual‐level socioeconomic status (SES), demographic characteristics, and physical health, and (2) whether income inequality effects are stronger among people with lower SES and physical health.Data Sources. The individual‐level data from the first wave of the Assets and Health Dynamics among the Oldest Old survey (1993–1994) were linked with the county‐level income inequality and mean household income data from the 1990 Census.Study Design. Multilevel analysis was conducted to examine the association between income inequality (the Gini coefficient) and depression.Principal Findings. Income inequality was significantly associated with depression among older Americans. Those living in counties with higher income inequality were more depressed, independent of their demographic characteristics, SES, and physical health. The association was stronger among those with more illnesses.Conclusions. While previous empirical research on income inequality and physical health is equivocal, evidence for income inequality effects on mental health seems to be strong.
Racial Differences in the Receipt of Bowel Surveillance Following Potentially Curative Colorectal Cancer Surgery
Authors: Ellison Gary L. , Warren Joan L. , Knopf Kevin B. , Brown Martin L. 
Published: December 2003

Objective. To investigate racial differences in posttreatment bowel surveillance after colorectal cancer surgery in a large population of Medicare patients.Data Sources. We used a large population‐based dataset: Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data.Study Design. This is a retrospective cohort study. We analyzed data from 44,768 non‐Hispanic white, 2,921 black, and 4,416 patients from other racial/ethnic groups, aged 65 and older at diagnosis, who had a diagnosis of local or regional colorectal cancer between 1986 and 1996, and were followed through December 31, 1998. Cox Proportional Hazards models were used to investigate the relation of race and receipt of posttreatment bowel surveillance.Data Collection. Sociodemographic, hospital, and clinical characteristics were collected at the time of diagnosis for all members of the cohort. Surgery and bowel surveillance with colonoscopy, sigmoidoscopy, and barium enema were obtained from Medicare claims using ICD‐9‐CM and CPT‐4 codes.Principal Findings. The chance of surveillance within 18 months of surgery was 57 percent, 48 percent, and 45 percent for non‐Hispanic whites, blacks, and others, respectively. After adjusting for sociodemographic, hospital, and clinical characteristics, blacks were 25 percent less likely than whites to receive surveillance if diagnosed between 1991 and 1996 (RR=0.75, 95 percent CI=0.70–0.81).Conclusions.Elderly blacks were less likely than non‐Hispanic whites to receive posttreatment bowel surveillance and this result was not explained by measured racial differences in sociodemographic, hospital, and clinical characteristics. More research is needed to explore the influences of patient‐ and provider‐level factors on racial differences in posttreatment bowel surveillance.
Tackling Health Inequalities in the United Kingdom: The Progress and Pitfalls of Policy
Authors: Exworthy Mark , Blane David , Marmot Michael 
Published: December 2003

Goal.Assess the progress and pitfalls of current United Kingdom (U.K.) policies to reduce health inequalities.Objectives.(1) Describe the context enabling health inequalities to get onto the policy agenda in the United Kingdom. (2) Categorize and assess selected current U.K. policies that may affect health inequalities. (3) Apply the “policy windows” model to understand the issues faced in formulating and implementing such policies. (4) Examine the emerging policy challenges in the U.K. and elsewhere.Data Sources.Official documents, secondary analyses, and interviews with policymakers.Study Design.Qualitative, policy analysis.Data Collection.2001–2002. The methods were divided into two stages. The first identified policies which were connected with individual inquiry recommendations. The second involved case‐studies of three policies areas which were thought to be crucial in tackling health inequalities. Both stages involved interviews with policy‐makers and documentary analysis.Principal Findings.(1) The current U.K. government stated a commitment to reducing health inequalities. (2) The government has begun to implement policies that address the wider determinants. (3) Some progress is evident but many indicators remain stubborn. (4) Difficulties remain in terms of coordinating policies across government and measuring progress. (5) The “policy windows” model explains the limited extent of progress and highlights current and possible future pitfalls. (6) The U.K.'s experience has lessons for other governments involved in tackling health inequalities.Conclusions.Health inequalities are on the agenda of U.K. government policy and steps have been made to address them. There are some signs of progress but much remains to be done including overcoming some of the perverse incentives at the national level, improving joint working, ensuring appropriate measures of performance/progress, and improving monitoring arrangements. A conceptual policy model aids understanding and points to ways of sustaining and extending the recent progress and overcoming pitfalls.
What New Knowledge Would Help Policymakers Better Balance Investments for Optimal Health Outcomes?
Authors: Kindig David , Day Patricia , Fox Daniel M. , Gibson Mark , Knickman James , Lomas Jonathan , Stoddart Gregory 
Published: December 2003

Objective:Review the limitations in cross‐sectoral health outcomes research and suggest a future research agenda.Data Sources, Study Design, Data Collection:Literature review and workshop discussion.Principal Findings:The research evidence that would aid public and private policy makers in answering the question the title poses is quite limited.Conclusions:Much more evidence from diverse disciplines is needed, and key areas are suggested. Criteria for progress by 2010 are proposed.
Effects of sub‐antimicrobial dose doxycycline therapy on crevicular fluid MMP‐8, and gingival tissue MMP‐9, TIMP‐1 and IL‐6 levels in chronic periodontitis
Authors: Choi Dong‐Hoon , Moon Ik‐Sang , Choi Bong‐Kyu , Paik Jeong‐Won , Kim Yoon‐Sik , Choi Seong‐Ho , Kim Chong‐Kwan 
Published: December 2003

Objective:  To investigate whether sub‐antimicrobial dose doxycycline (SDD) therapy for 120 d in chronic adult periodontitis patients had significant effects on gingival crevicular fluid (GCF) matrix metalloproteinase‐8 (MMP‐8) levels, and on gingival tissue MMP‐9, tissue inhibitor of matrix metalloproteinases‐1 (TIMP‐1) and interleukin‐6 (IL‐6) levels.Background:  Tetracycline can significantly inhibit MMP activity in GCF and in gingival tissue, even in much lower dosage then a traditional antimicrobial dosage used in conventional therapy. Sub‐antimicrobial dose doxycycline (SDD) therapy has been shown to reduce periodontal disease activity to control MMP and pro‐inflammatory cytokines.Methods:  A total of 32 patients with incipient to moderate (probing pocket depth ≈ 4–7 mm) chronic adult periodontitis were included in the study. Subjects were randomly assigned to two groups. After scaling and root planning (SRP), the SRP + SDD group received SDD, 20 mg bid, whereas the SRP + placebo group received placebo, 20 mg bid. In the follow‐up, efficacy measures included the change in probing pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP) and gingival crevicular fluid MMP‐8 levels, gingival tissue MMP‐9, TIMP‐1 and IL‐6 levels from baseline to 120 d.Results:  After 120 d, PD and CAL improved significantly in the SRP + SDD group. Initial MMP‐8 levels for the SRP + SDD group and the SRP + placebo group were 407.13 ± 114.45 ng/ml and 378.71 ± 189.39 ng/ml, respectively, with no statistical difference between the two groups. MMP‐8 levels for the SRP + SDD group and the SRP + placebo group were: 235.35 ± 134.58 ng/ml and 364.04 ± 219.27 ng/ml at 30 d; 157.50 ± 95.95 ng/ml and 236.60 ± 186.16 ng/ml at 60 d; 102.70 ± 67.64 ng/ml and 208.56 ± 124.54 ng/ml at 90 d; and 63.77 ± 53.33 ng/ml and 229.13 ± 168.09 ng/ml at 120 d, respectively. The amount of decrease in MMP‐8 levels for the SRP + SDD group was statistically significant compared to that for the SRP + placebo group, especially apparent at 120 d (p < 0.05). TIMP‐1 levels in both groups increased from the baseline to 120 d with statistical significance (p‐value < 0.05), but there was no significant difference between the two groups. Changes in MMP‐9 and IL‐6 levels were not statistically significant.Conclusion:  Adjunctive SDD therapy can improve the clinical parameters and this clinical improvement is reflected by controlled level of MMP‐8 in chronic adult periodontitis after the therapy.
Interaction of Porphyromonas gingivalis with low‐density lipoproteins: implications for a role for periodontitis in atherosclerosis
Authors: Miyakawa Hiroshi , Honma Kiyonobu , Qi Mingshan , Kuramitsu Howard K. 
Published: December 2003

Objective:  The association of periodontitis with atherosclerosis has been suggested from epidemiological studies. Recently, we have reported that macrophages stimulated by Porphyromonas gingivalis formed foam cells in the presence of low‐density lipoproteins (LDL). In this study, we examined the direct interactions between LDL and P. gingivalis.Methods:  We investigated the aggregation of LDL with P. gingivalis and its outer membrane vesicles (OMVs), degradation of the apo B‐100 protein of LDL by sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS–PAGE) and western blot analyses, as well as the effects of protease inhibitors or activators on the mobility of LDL by agarose gel shift assays. The binding of P. gingivalis or its OMVs with LDL was demonstrated by western blot analysis. We also examined whether or not the aggregated LDL induced foam cell formation from murine macrophages.Results:  LDL was aggregated in a dose‐dependent manner with P. gingivalis and its OMVs. Moreover, degradation of the apo B‐100 protein of LDL was directly demonstrated in the presence of P. gingivalis or its OMVs. Furthermore, the gel shift assays indicated that the mobility of LDL was increased in the presence of P. gingivalis. This alteration was attenuated in the presence of the protease inhibitors TLCK and leupeptin and increased in the presence of reducing agents. Moreover, LDL was bound to specific proteins of P. gingivalis suggesting that these proteins may also play a role in aggregation. Finally, the aggregated LDL induced murine macrophages to form foam cells.Conclusions:  These results suggest that P. gingivalis may stimulate foam cell formation, in part, by aggregating LDL by proteolysis of apo B‐100.
Expression of CD73/ecto‐5′‐nucleotidase on human gingival fibroblasts and contribution to the inhibition of interleukin‐1α‐induced granulocyte‐macrophage colony stimulating factor production
Authors: Nemoto Eiji , Kunii Ryotaro , Tada Hiroyuki , Tsubahara Taisuke , Ishihata Hiroshi , Shimauchi Hidetoshi 
Published: December 2003

Background and objectives:  CD73/5′‐nucleotidase (5′‐NT) is an ectoenzyme that participates in immune/inflammatory reactions. We examined the possible expression of CD73/5′‐NT on human gingival fibroblasts (hGF), which are important to the immune/inflammatory system in periodontal tissue.Methods and results:  We demonstrated that CD73/5′‐NT was expressed on hGF by flow cytometry. We found that pre‐treatment of hGF with 5′‐AMP induced marked inhibition of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) production from hGF upon stimulation with interleukin‐1α (IL‐1α) by enzyme‐linked immunosorbent assay (ELISA). A specific inhibitor of 5′‐NT, adenosine 5′‐[α,β‐methylene] diphosphate blocked the inhibition of GM‐CSF production, suggesting that adenosine converted from 5′‐AMP acts on the inhibitory effects. The GM‐CSF inhibition suggested that A3 receptor might be involved. The rank order of agonists was found to be (N6‐benzyl‐5′‐N‐ethylcarboxamidoadenosine) A3 receptor agonist ≥ (2‐chloroadenosine) non‐selective agonist > (CGS‐21680) A2A receptor agonist > adenosine ≥ (N6‐cyclohexyladenosine) A1 agonist. Further support for the main role of A3 receptor was the binding A3 antagonist [9‐chloro‐2‐(2‐furanyl)‐5‐([phenylacetyl]amino)[1,2,4]‐triazolo[1,5‐c]quinazdine] reversed the effect of adenosine, but no significant reverse was observed by A1 (1,3‐dipropyl‐8‐cyclopentylxanthine), A2 [3,7‐dimethyl‐1‐(2‐propargyl)xanthine], A2A[8‐(3‐chlorostyryl)caffeine], and A2B (alloxazine) antagonists. The CD73/5′‐NT expression was increased upon stimulation with gamma‐interferon, but not other stimulants such as tumor necrosis factor‐alpha, IL‐4, lipopolysaccharide from Porphyromonas gingivalis and Escherichia coli, and fimbriae from P. gingivalis, and this increase was correlated with the enhanced GM‐CSF inhibition by 5′‐AMP but not adenosine.Conclusions:  These findings suggested that CD73/5′‐NT on hGF exerts an anti‐inflammatory effects in periodontal disease by conversion from 5′‐AMP to adenosine.