Logistic model estimation of death attributable to risk factors for cardiovascular disease in Evans County, Georgia

The use of epidemiologic data for personal risk assessment in health hazard/health risk appraisal programs

Health Hazard/Health Risk Appraisal (HHA/HRA) programs employ personal risk assessment as an educational and motivational technique to encourage the adoption of healthier lifestyles by health education clients. We have reviewed the scientific basis of of the risk assessments provided in HHA/HRA. There are severe limitations in both the data and the risk estimation procedures. Various undocumented assumptions enter into the projections; several key aspects are arbitrary. Proposals for improvement of the procedure generally require data that are not available. Attention has largely focused on increasing mathematical sophistication (e.g. adjustment for competing risks) while ignoring problems in accuracy of the client data from which projections are calculated and serious questions about the health education messages implicit in the appraisal results. Health Hazard/Health Risk Appraisal programs should be candid about the limitations of the technique. Use of appraisal results for evaluation purposes is questionable. The health education messages produced by such programs deserve attention, since their appropriateness, especially for clients who are not white, middle class and middle-aged, has not been established.

The impact of elevated blood pressure upon 10-year mortality among Japanese men in Hawaii: the Honolulu Heart Program

The impact of blood pressure upon total and cause-specific mortality during 10 years of follow-up was studied for 7610 Japanese men in Hawaii, aged 45-68 at baseline examination. The age adjusted rate of total mortality for men with definite hypertension (WHO criteria) was twice that for normotensive men. The relative risk of mortality was five for all cardiovascular diseases (CVD), four for coronary heart disease (CHD), and six for stroke. Men with borderline hypertension also had significantly high mortality rates intermediate between the definite hypertensives and the normotensives. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were the most important independent predictors of total, CVD, CHD and stroke mortality in multivariate analysis, taking account of 11 other known risk factors. However, SBP was more strongly related to total, CVD and CHD mortality than was DBP, whereas the reverse was true for stroke mortality. There was no significant association of either SBP or DBP with cancer and other non-cardiovascular mortality in multivariate analysis. Men who were receiving antihypertensive medication at baseline examination had a higher mortality from CVD, CHD and stroke as compared to untreated men in every category of blood pressure status. This apparently paradoxical finding probably reflects more advanced status of hypertension existing before treatment rather than adverse effects of drugs per se; however, this latter possibility cannot be dismissed.