Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples

OBJECTIVE

The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes.

METHODS

We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates.

RESULTS

Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey.

CONCLUSIONS

Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.

Racial/ethnic disparities in the association between fine particles and respiratory hospital admissions in San Diego county, CA

Ambient air pollution exposure is associated with exacerbating respiratory illnesses. Race/ethnicity (R/E) have been shown to influence an individual's vulnerability to environmental health risks such as fine particles (PM 2.5). This study aims to assess the R/E disparities in vulnerability to air pollution with regards to respiratory hospital admissions in San Diego County, California where most days fall below National Ambient Air Quality Standards (NAAQS) for daily PM 2.5 concentrations. Daily PM 2.5 levels were estimated at the zip code level using a spatial interpolation using inverse-distance weighting from monitor networks. The association between daily PM 2.5 levels and respiratory hospital admissions in San Diego County over a 15-year period from 1999 to 2013 was assessed with a time-series analysis using a multi-level Poisson regression model. Cochran Q tests were used to assess the effect modification of race/ethnicity on this association. Daily fine particle levels varied greatly from 1 μg/m³ to 75.86 μg/m³ (SD = 6.08 μg/m³) with the majority of days falling below 24-hour NAAQS for PM 2.5 of 35 μg/m³. For every 10 μg/m³ increase in PM 2.5 levels, Black and White individuals had higher rates (8.6% and 6.2%, respectively) of hospitalization for respiratory admissions than observed in the county as a whole (4.1%). Increases in PM 2.5 levels drive an overall increase in respiratory hospital admissions with a disparate burden of health effects by R/E group. These findings suggest an opportunity to design interventions that address the unequal burden of air pollution among vulnerable communities in San Diego County that exist even below NAAQS for daily PM 2.5 concentrations.

Differences in Febrile and Respiratory Illnesses in Minority Children: The Sociodemographic Context of Restrictive Parenting

OBJECTIVE

To examine the moderating role of restrictive parenting on the relation of socioeconomic status (SES) to febrile illnesses (FIs) and upper respiratory illnesses (URIs) among ethnic minority and non-minority children.

METHODS

Children from diverse ethnic backgrounds (Caucasian, African American, Asian, Latino, other, or multiethnic) were followed across the course of the kindergarten year. Parents reported on SES and parenting. A nurse completed 13 physical exams per child over the year to assess FIs and URIs.

RESULTS

During the school year, 28% of children (n = 199, 56% ethnic minority) exhibited one or more FIs (range, 0-6) and 90% exhibited one or more URIs (range, 0-10). No main or moderating effects of SES or restrictive parenting on FIs or URIs were found among Caucasian children; however, among ethnic minority children, the relation of SES to FIs was conditional upon restrictive parenting (β = .66; P = .02), as the fewest FIs were found for lower SES minority children whose parents reported more restrictive practices. Additionally, among minority children, more restrictive parenting was marginally associated with fewer URIs (β = -.21; P = .05).

CONCLUSIONS

Unexpectedly, among minority children the fewest illnesses occurred among lower SES children whose parents endorsed more restrictive parenting. This may be due to unique appraisals of this rearing style among minority children in lower SES environments and its potential to influence immune functioning. Results suggest variability in the effects of parenting on offspring health and support context-specific evaluations of parenting in efforts to ameliorate early health disparities.

Prognostic Significance of Large Airway Dimensions on Computed Tomography in the General Population. The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study

RATIONALE

Large airway dimensions on computed tomography (CT) have been associated with lung function, symptoms, and exacerbations in chronic obstructive pulmonary disease (COPD), as well as with symptoms in smokers with preserved spirometry. Their prognostic significance in persons without lung disease remains undefined.

OBJECTIVES

To examine associations between large airway dimensions on CT and respiratory outcomes in a population-based cohort of adults without prevalent lung disease.

METHODS

The Multi-Ethnic Study of Atherosclerosis recruited participants ages 45-84 years without cardiovascular disease in 2000-2002; we excluded participants with prevalent chronic lower respiratory disease (CLRD). Spirometry was measured in 2004-2006 and 2010-2012. CLRD hospitalizations and deaths were classified by validated criteria through 2014. The average wall thickness for a hypothetical airway of 10-mm lumen perimeter on CT (Pi10) was calculated using measures of airway wall thickness and lumen diameter. Models were adjusted for age, sex, principal components of ancestry, body mass index, smoking, pack-years, scanner, percent emphysema, genetic risk score, and initial forced expiratory volume in 1 second (FEV1) percent predicted.

RESULTS

Greater Pi10 was associated with 9% faster FEV1 decline (95% confidence interval [CI], 2 to 15%; P = 0.012) and increased incident COPD (odds ratio, 2.22; 95% CI, 1.43-3.45; P = 0.0004) per standard deviation among 1,830 participants. Over 78,147 person-years, higher Pi10 was associated with a 57% higher risk of first CLRD hospitalization or mortality (P = 0.0496) per standard deviation. Of Pi10's component measures, both greater airway wall thickness and narrower lumen predicted incident COPD and CLRD clinical events.

CONCLUSIONS

In adults without CLRD, large airway dimensions on CT were prospectively associated with accelerated lung function decline and increased risks of COPD and CLRD hospitalization and mortality.

Contributions of individual acculturation and neighborhood ethnic density to variations in Hispanic children's respiratory health in a US-Mexican border metropolis

BACKGROUND

We used an expanded conceptualization of ethnic density at the neighborhood level, tailored to Hispanic majority communities in the USA, and a robust measure of children's acculturation at the individual level, to predict Hispanic children's respiratory health.

METHODS

We conducted a cross-sectional survey of 1904 children in 2012 in El Paso, TX, USA. One thousand one hundred and seven Hispanic children nested within 72 census tracts were analyzed. Multilevel logistic regression models with cross-level interactions were used to predict bronchitis, asthma and wheezing during sleep.

RESULTS

A neighborhood-level ethnic density factor was a non-significant risk factor while individual-level acculturation was a significant risk factor for the three outcomes. Pest troubles and not having been breastfed as an infant intensified the positive association between ethnic density and bronchitis. Increases in ethnic density intensified the odds of wheezing in sleep if the child was not low birth weight or was not economically deprived.

CONCLUSIONS

Results suggest that increasing individual-level acculturation is detrimental for US Hispanic children's respiratory health in this Hispanic majority setting, while high ethnic density neighborhoods are mildly risky and pose more significant threats when other individual-level factors are present.

Chronic disease and chronic disease risk factors among First Nations, Inuit and Métis populations of northern Canada

INTRODUCTION

Aboriginal populations in northern Canada are experiencing rapid changes in their environments, which may negatively impact on health status. The purpose of our study was to compare chronic conditions and risk factors in northern Aboriginal populations, including First Nations (FN), Inuit and Métis populations, and northern non-Aboriginal populations.

METHODS

Data were from the Canadian Community Health Survey for the period from 2005 to 2008. Weighted multiple logistic regression models tested the association between ethnic groups and health outcomes. Model covariates were age, sex, territory of residence, education and income. Odds ratios (ORs) are reported and a bootstrap method calculated 95% confidence intervals (CIs) and p values.

RESULTS

Odds of having at least one chronic condition was significantly lower for the Inuit (OR = 0.59; 95% CI: 0.43-0.81) than for non-Aboriginal population, but similar among FN, Métis and non-Aboriginal populations. Prevalence of many risk factors was significantly different for Inuit, FN and Métis populations.

CONCLUSION

Aboriginal populations in Canada's north have heterogeneous health status. Continued chronic disease and risk factor surveillance will be important to monitor changes over time and to evaluate the impact of public health interventions.

Disaggregating race and ethnicity in chronic health conditions: implications for public health social work

This study examines the ethnic subgroup variation in chronic health by comparing self-reports of chronic conditions across diverse ethnic subgroups of Asian American (Vietnamese, Filipino, Chinese), Latino American (Cuban, Portuguese, Mexican), and African Caribbean (Haitian, Jamaican, Trinidadian/Tobagonian) respondents. This analysis utilizes linked data from the Collaborative Psychiatric Epidemiology Surveys (CPES). Logistic regression revealed significant subgroup differences in reports of chronic respiratory, cardiovascular, and pain conditions across nine ethnic subgroups masked by racial categorization. Findings suggest that precautions must be taken by public health social workers as there may be far more ethnic heterogeneity than is apparent among broad racial categories.

Psychosocial and health impacts of uranium mining and milling on Navajo lands

The uranium industry in the American Southwest has had profoundly negative impacts on American Indian communities. Navajo workers experienced significant health problems, including lung cancer and nonmalignant respiratory diseases, and psychosocial problems, such as depression and anxiety. There were four uranium processing mills and approximately 1,200 uranium mines on the Navajo Nation's over 27,000 square miles. In this paper, a chronology is presented of how uranium mining and milling impacted the lives of Navajo workers and their families. Local community leaders organized meetings across the reservation to inform workers and their families about the relationship between worker exposures and possible health problems. A reservation-wide effort resulted in activists working with political leaders and attorneys to write radiation compensation legislation, which was passed in 1990 as the Radiation Exposure Compensation Act (RECA) and included underground uranium miners, atomic downwinders, and nuclear test-site workers. Later efforts resulted in the inclusion of surface miners, ore truck haulers, and millworkers in the RECA Amendments of 2000. On the Navajo Nation, the Office of Navajo Uranium Workers was created to assist workers and their families to apply for RECA funds. Present issues concerning the Navajo and other uranium-impacted groups include those who worked in mining and milling after 1971 and are excluded from RECA. Perceptions about uranium health impacts have contributed recently to the Navajo people rejecting a resumption of uranium mining and milling on Navajo lands.

Comorbidity among patients with colon cancer in New Zealand

AIMS

To identify patient factors that are associated with a higher risk of comorbidity, and to assess the impact of comorbidity on risk of in-hospital death, length of stay and 5-year all-cause survival among a large cohort of patients with colon cancer in New Zealand.

METHODS

Comorbidity data were collected from patients who were diagnosed with colon cancer and admitted to public hospitals during 1996-2003. The comorbidity measures included all conditions listed in the Charlson Comorbidity Index, as well as a predetermined list of additional conditions. We examined predictors of higher comorbidity scores. We also measured the impact of comorbidity on in-hospital death, length of stay and 5-year all-cause survival using logistic, linear and Cox proportional hazard regression models to adjust for confounding by sex, age, ethnicity, extent of disease and area level deprivation.

RESULTS

There were 11,524 patients included in the study. 7.5% of females and 10.3% of men had Charlson scores of three or more. Higher comorbidity scores were associated with increasing age, and were more common among males, Māori and Pacific people, those with unknown extent of disease and those living in the most deprived quintile of New Zealand. Those with Charlson scores ≥ 3 had a higher risk of in-hospital death (OR=4.8; 95% CI 3.5-6.6), longer lengths of hospital stay (0.14 days 95% CI 0.08-0.2) and lower 5-year survival HR=2.0; 95%CI=1.8-2.3) compared with those with a score of 0.

CONCLUSION

This study confirms that comorbidity is common among colon cancer patients in New Zealand, and has an adverse and independent effect on outcomes related to mortality and length of hospital stay.

Association of depression, psycho-social stress and acculturation with respiratory disease among Puerto Rican adults in Massachusetts

To assess associations between acculturation, depression, and self-reported stress score with reported diagnosis of respiratory disease (RD) in Puerto Rican adults, participants (N = 1,168) were identified from areas of high Hispanic density in the Boston, MA metropolitan area. Eligible participants were interviewed in the home by bilingual interviewers in either Spanish or English. Scales included topics ranging from general background to depressive symptomatology. Respiratory disease was self-reported and checked against prescribed medication. More than one-third (37.8%) of subjects reported doctor-diagnosed RD. A final binary logistical regression model (N = 850), which was adjusted for potential confounders (sex, age, education, poverty) showed that RD was significantly associated with psychological acculturation (OR = 1.97, P = 0.005), depressive symptomatology (OR = 1.52, P = 0.03) high perceived stress score (OR = 1.97, P = 0.009), and current smoking (OR = 1.61, P = 0.03). Significant inverse associations included a high level of language acculturation (OR = 0.65, P = 0.03), light (OR = 0.67, P = 0.01) and moderate to heavy physical activity versus sedentary physical activity (OR = 0.40, P = 0.03). We found self reported physician diagnosed RD was associated with high perceived stress and depression, as well as higher levels of psychological acculturation. Longitudinal research is needed to determine if there is a causal pathway for these associations.

Deaths: leading causes for 2004

OBJECTIVES

This report presents final 2004 data on the 10 leading causes of death in the United States by age, race, sex, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the annual report of final mortality statistics.

METHODS

Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2004. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes.

RESULTS

In 2004, the 10 leading causes of death were (in rank order) Diseases of heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Alzheimer's disease; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Septicemia and accounted for about 78 percent of all deaths occurring in the United States. Differences in the ranking are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2004 were (in rank order) Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Respiratory distress of newborn; Bacterial sepsis of newborn; Neonatal hemorrhage; and Diseases of the circulatory system. Important variation in the leading causes of infant death is noted for the neonatal and postneonatal periods.

Ambient biomass smoke and cardio-respiratory hospital admissions in Darwin, Australia

BACKGROUND

Increasing severe vegetation fires worldwide has been attributed to both global environmental change and land management practices. However there is little evidence concerning the population health effects of outdoor air pollution derived from biomass fires. Frequent seasonal bushfires near Darwin, Australia provide an opportunity to examine this issue. We examined the relationship between atmospheric particle loadings <10 microns in diameter (PM10), and emergency hospital admissions for cardio-respiratory conditions over the three fire seasons of 2000, 2004 and 2005. In addition we examined the differential impacts on Indigenous Australians, a high risk population subgroup.

METHODS

We conducted a case-crossover analysis of emergency hospital admissions with principal ICD10 diagnosis codes J00-J99 and I00-I99. Conditional logistic regression models were used to calculate odds ratios for admission with 10 microg/m3 rises in PM10. These were adjusted for weekly influenza rates, same day mean temperature and humidity, the mean temperature and humidity of the previous three days, days with rainfall > 5 mm, public holidays and holiday periods.

RESULTS

PM10 ranged from 6.4 - 70.0 microg/m3 (mean 19.1). 2466 admissions were examined of which 23% were for Indigenous people. There was a positive relationship between PM10 and admissions for all respiratory conditions (OR 1.08 95%CI 0.98-1.18) with a larger magnitude in the Indigenous subpopulation (OR1.17 95% CI 0.98-1.40). While there was no relationship between PM10 and cardiovascular admissions overall, there was a positive association with ischaemic heart disease in Indigenous people, greatest at a lag of 3 days (OR 1.71 95%CI 1.14-2.55).

CONCLUSION

PM10 derived from vegetation fires was predominantly associated with respiratory rather than cardiovascular admissions. This outcome is consistent with the few available studies of ambient biomass smoke pollution. Indigenous people appear to be at higher risk of cardio-respiratory hospital admissions associated with exposure to PM10.

Ambient biomass smoke and cardio-respiratory hospital admissions in Darwin, Australia

BACKGROUND

Increasing severe vegetation fires worldwide has been attributed to both global environmental change and land management practices. However there is little evidence concerning the population health effects of outdoor air pollution derived from biomass fires. Frequent seasonal bushfires near Darwin, Australia provide an opportunity to examine this issue. We examined the relationship between atmospheric particle loadings <10 microns in diameter (PM10), and emergency hospital admissions for cardio-respiratory conditions over the three fire seasons of 2000, 2004 and 2005. In addition we examined the differential impacts on Indigenous Australians, a high risk population subgroup.

METHODS

We conducted a case-crossover analysis of emergency hospital admissions with principal ICD10 diagnosis codes J00-J99 and I00-I99. Conditional logistic regression models were used to calculate odds ratios for admission with 10 microg/m3 rises in PM10. These were adjusted for weekly influenza rates, same day mean temperature and humidity, the mean temperature and humidity of the previous three days, days with rainfall > 5 mm, public holidays and holiday periods.

RESULTS

PM10 ranged from 6.4 - 70.0 microg/m3 (mean 19.1). 2466 admissions were examined of which 23% were for Indigenous people. There was a positive relationship between PM10 and admissions for all respiratory conditions (OR 1.08 95%CI 0.98-1.18) with a larger magnitude in the Indigenous subpopulation (OR1.17 95% CI 0.98-1.40). While there was no relationship between PM10 and cardiovascular admissions overall, there was a positive association with ischaemic heart disease in Indigenous people, greatest at a lag of 3 days (OR 1.71 95%CI 1.14-2.55).

CONCLUSION

PM10 derived from vegetation fires was predominantly associated with respiratory rather than cardiovascular admissions. This outcome is consistent with the few available studies of ambient biomass smoke pollution. Indigenous people appear to be at higher risk of cardio-respiratory hospital admissions associated with exposure to PM10.

Identifying students with self-report of asthma and respiratory symptoms in an urban, high school setting

Strategies for identifying urban youth with asthma have not been described for high school settings. African-American high school students are rarely included in asthma studies, despite a high risk of asthma mortality when compared to other age and race groups. Identification and follow-up of children with uncontrolled respiratory symptoms are necessary to reduce the burden of asthma morbidity and mortality, especially in underserved areas. We describe a process used to identify high school students who could benefit from intervention based on self-report of asthma and/or respiratory symptoms, and the costs associated with symptom-identification. Letters announcing a survey were mailed to parents of 9th-11th graders by an authorized vendor managing student data for the school district. Scan sheets with student identifiers were distributed to English teachers at participating schools who administered the survey during a scheduled class. Forms were completed by 5,967 of the 7,446 students assigned an English class (80% response). Although prevalence of lifetime asthma was 15.8%, about 11% of students met program criteria for enrollment through report of an asthma diagnosis and recent symptoms, medication use, or health care utilization. Another 9.2% met criteria by reported symptoms only. Cost of symptom-identification was $5.23/student or $32.29/program-eligible student. There is a need for school-based asthma programs targeting urban adolescents, and program initiation will likely require identification of students with uncontrolled symptoms. The approach described was successfully implemented with a relatively high response rate. Itemized expenses are presented to facilitate modifications to reduce costs. This information may benefit providers, researchers, or administrators targeting similar populations.

Experiences of Maori families accessing health care for their unwell children: a pilot study

The aim of this study was to explore with a small number of Maori families their experiences of accessing health care when their children were unwell with a respiratory condition. Although there is a wide variety of literature exploring Maori and their ability to access health care, there is a very limited amount that describes the experience of individual Maori families in accessing health care for their children. A qualitative research methodology was used in the study. Participating families were among those experiencing an admission to a children's ward between July and December 2003. Four families were interviewed. They discussed in depth their experience of accessing health care for their unwell children. Data were analysed using thematic analysis, and three common themes were evident: family resources, choice of health service provider and parents' feelings of vulnerability. The findings highlight that while socio-economic status plays a large part in determining the ease with which families can access the needed health care, there are other barriers within the health system which also pose difficulties for Maori.

Damaged goods: return to sender. A review of the historical medical records of repatriated Chinese miners

After the Anglo-Boer (South African) War (1899-1902), there was a shortage of unskilled labor on the South African gold mines. Chinese men were imported to make up for the deficit. This article reviews the records of indentured Chinese mine workers examined for repatriation in 1905. The records tell of high proportions of social disorders, respiratory diseases, musculoskeletal disorders, opium addiction, and injury. These reflect the social and physical conditions to which these men were exposed in the mines.

Childhood exposure to environmental tobacco smoke and chronic respiratory symptoms in non-smoking adults: the Singapore Chinese Health Study

BACKGROUND

Childhood exposure to environmental tobacco smoke has been extensively associated with childhood respiratory illness; fewer studies have addressed the effects on adults.

METHODS

Childhood environmental tobacco smoke exposure in relation to chronic cough, phlegm, and asthma diagnosis was studied in never smokers from a cohort of Singaporeans of Chinese ethnicity aged 45-74 years at enrollment from 1993 to 1998. From 1999 to 2004 subjects were interviewed regarding environmental tobacco smoke exposure before and after the age of 18 and the presence and duration of current symptoms of chronic cough and phlegm production and asthma diagnosis.

RESULTS

Among 35,000 never smokers, fewer had smoking mothers (19%) than fathers (48%). Although few subjects currently lived (20%) or worked (4%) with smokers, 65% reported living with a daily smoker before the age of 18 years. Living with a smoker before the age of 18 increased the odds of chronic dry cough (149 cases, odds ratio 2.1, 95% CI 1.4 to 3.3) and, to a lesser extent, phlegm, after adjustment for age, sex, dialect group, and current and past exposure to smokers at home and at work after the age of 18. Associations strengthened with higher numbers of smokers in childhood. There was no association with asthma or chronic bronchitis. There was evidence to suggest a stronger association among subjects with a lower adult intake of fibre which has previously been found to be protective for respiratory symptoms.

CONCLUSIONS

In this large study of non-smokers, living with a smoker in childhood was associated with chronic dry cough and phlegm in adulthood, independent of later exposures to environmental tobacco smoke.

Respiratory morbidity in hospitalized Bedouins residing near an industrial park

The residents' concern about exposure to a chemical industrial park (IP), which includes the national toxic industrial waste site, prompted the authors to initiate this ecological study on the association between residing near the IP and being hospitalized for respiratory ailments in the local Bedouin population. The population was stratified by sex, age, and locality type (permanent settlements and traditional tribal settlements). The distance and wind direction from the IP were used as exposure indicators. Hospitalization data were obtained from the regional medical center. Increased hospitalization rates for chronic obstructive pulmonary disease and all respiratory diseases were found to be associated with residential proximity to the IP. Attributable risk for chronic obstructive pulmonary disease was 34.2% in male members of the traditional tribal settlements and 49.3% in female members of the permanent settlements.

Mortality and causes of death in persons with Down syndrome in California

This study investigated mortality and causes of death between 1988 and 1999 in 14781 persons (6702 female) with Down syndrome in California, comparing age, sex, ethnicity, and other factors. Mean age at the start of follow-up was 14 years 8 months (SD 14y 10mo). During the study period 600 persons died. The standardized mortality ratio (SMR) for the population was 5.5. Blacks were at greater risk than whites, Hispanics, or Asians (relative risk = 1.5). Mortality declined during the period, especially for children with congenital heart defects. Leukemia (SMR = 17), respiratory illnesses (SMR = 27), congenital anomalies (SMR = 72), and circulatory diseases (SMR = 5.3) accounted for most of the excess mortality. With the exception of leukemia, cancer mortality was not different from that of the general population.

Nitric oxide levels and ciliary beat frequency in indigenous New Zealand children

New Zealand children's morbidity from respiratory disease is high. This study examines whether subclinical ciliary abnormalities underlie the increased prevalence of respiratory disease in indigenous New Zealand children. A prospective study enrolled a group of healthy children who were screened for respiratory disease by questionnaire and lung function. Skin-prick tests were performed to control for atopy. Exhaled and nasal NO was measured online by a single-breath technique using chemiluminescence. Ciliary specimens were obtained by nasal brushings for assessment of structure and function. The ciliary beat frequency (CBF) (median CBF, 12.5 Hz; range, 10.4-16.8 Hz) and NO values (median exhaled NO, 5.6 ppb; range, 2.3-87.7 ppb; median nasal NO, 403 ppb; range, 34-1,120 ppb) for healthy New Zealand European (n=58), Pacific Island (n=61), and Maori (n=16) children were comparable with levels reported internationally. No ethnic differences in NO, atopy, or CBF were demonstrated. Despite an apparently normal ciliary beat, the percentage of ciliary structural defects was 3 times higher than reported controls (9%; range, 3.6-31.3%), with no difference across ethnic groups. In conclusion, it is unlikely that subclinical ciliary abnormalities underlie the increased prevalence of respiratory disease in indigenous New Zealand children. The high percentage of secondary ciliary defects suggests ongoing environmental or infective damage.

Health problems and hospitalizations among Asian-American ethnic groups

OBJECTIVES

To study health status and hospitalization risk among Asian Americans.

DESIGN

Cross-sectional analyses and cohort study.

SETTING

Comprehensive prepaid health care program in Northern California.

PATIENTS

Adult Asian Americans (N=13,592), self-classified at health examinations as 6050 (44.5%) Chinese, 1707 (12.6%) Japanese, 4232 (31.1%) Filipinos, 714 (5.3%) South Asians, and 889 (6.5%) Other Asians.

INTERVENTIONS

None except data analysis.

OUTCOME MEASURES

With Chinese and Whites (n=72,019) as referents, comparison of symptom composites by logistic regression and hospitalization risk by Cox proportional hazards models.

RESULTS

Compared to Chinese, Filipinos, South Asians, and other Asians more frequently reported coronary, respiratory, gastrointestinal, and emotional problems. Chinese and Japanese generally had the lowest hospitalization risk. Compared to Chinese, hospitalization risk was higher (P<.05) among Filipinos for circulatory (men or women), respiratory (men), and digestive (women) conditions (relative risks [RR] range from 1.5 to 1.7) and among South Asian men for cardiovascular conditions (RR=2.2). While Asian groups generally had similar or lower hospitalization risk than Whites, risks were higher for asthma (Filipino and South Asian men, RRs >3.0), peptic ulcer (Chinese men, Filipino men and women, other Asian women [RRs 1.9-5.6]), and coronary disease (South Asian men (RR=2.3) and Filipino women (RR=1.5).

CONCLUSIONS

Variations in risk of hospitalization and frequency of reported health problems point out differences in health problems and health needs among subgroups of Asian Americans. This diversity shows the need to study Asian ethnic groups separately.

Spirometric findings among school-aged First Nations children on a reserve: a pilot study

BACKGROUND

Asthma and chronic obstructive pulmonary disease (COPD) are increasing concerns for First Nations peoples in Canada. Although hospital utilization for asthma and COPD among First Nations peoples has been increasing, the prevalence of asthma or wheezing is comparable to national averages.

OBJECTIVES

A pilot study was conducted to determine the prevalence of impaired lung function in school-aged First Nations children.

PATIENTS AND METHODS

A First Nations community in northern Alberta was selected to participate. Consent forms and a school health survey were completed by parents or guardians. Children with consent completed spirometry at school, and results were compared with predicted values.

RESULTS

A total of 36 children participated (response rate 70.6%). Of these, 19.4% of parents reported that their child had received a physician diagnosis of asthma at some point in their life; only 28.6% had a parental report of still having asthma. Parents smoked in 73.1% of the children's homes. The mean (+/- SD) percentage of forced expiratory volume in 1 s (FEV1) over forced vital capacity (FVC) was 82.6%+/-6.9% (94.4%+/-0.08% of predicted). Evidence of airflow obstruction was found in 25% of the children. Parental report of the child ever having asthma was associated with impaired lung function (OR 3.20; P=0.033). Children in a home with reported mold exposure were less likely to have impaired lung function (OR 0.68; P=0.030).

CONCLUSIONS

Many children in this study already have established airflow obstruction and may be at increased risk for asthma or COPD. Exposure to mold appeared to be protective. Further research is needed to evaluate the lung health concerns of this population.

Respiratory symptoms and exposure to wood smoke in an isolated northern community

BACKGROUND

Wood smoke has been associated with respiratory symptoms. This study examined the prevalence of respiratory symptoms and health effects of wood smoke exposures (from home heating, curing meat, and tanning hides) among residents of Deline, Northwest Territories (NWT).

METHODS

A survey was conducted of all residents. Relationships between wood smoke and respiratory symptoms were examined.

RESULTS

The response rate was 70.2% (n=402). 71% of people at least 18 years old were current smokers. Prevalence of symptoms was higher for women (odds ratios (ORs) 1.3-3.1). Women who smoked were more likely to be exposed to indoor smoke from curing and tanning. ORs for respiratory symptoms were higher for females, increased with age, and were strongly affected by smoking. Among those at least 18 years old, phlegm on winter mornings (6.5 (95% CI: 2.3-18.1)), dyspnoea (5.1 (95% CI: 1.9-13.2)), and watery or itchy eyes (3.6 (95% CI: 1.4-9.0)) were significantly related to self-reported outdoor wood smoke and smoke curing. Home heating was marginally associated with wheeze. No significant associations were found for males.

CONCLUSIONS

Women engaged in curing/tanning demonstrated increased prevalence of respiratory symptoms. The cultural importance of these activities precludes abandoning them. Smoking cessation, limiting wood smoke exposure times, and process modifications in curing and tanning could reduce risk of adverse health effects.

Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities

OBJECTIVES

To describe the short-term outcomes in Aboriginal children admitted to hospital with radiological alveolar lobar changes; and determine whether predischarge chest radiography can predict respiratory morbidity found at follow-up. DESIGN, PARTICIPANTS, SETTING: Prospective cohort study of Aboriginal children admitted to Alice Springs Hospital between October 2000 and April 2001 with alveolar lobar abnormalities (area of consolidation, > or = 1 cm) on chest radiographs. Participants were to have a predischarge radiograph and be followed up for 12 months.

MAIN OUTCOME MEASURES

Comorbidities, follow-up rate, and new respiratory disease found at follow-up.

RESULTS

Of 113 children hospitalised with radiological alveolar lobar changes, 109 were Aboriginal. Their median age was 1.8 years (range, 0.2 months-13.3 years), and 124 episodes were recorded. Comorbidities were common in these children (anaemia, 51.5%; suppurative otitis media, 37.3%). The follow-up rate one year after admission was 83.1% of episodes. New treatable chronic respiratory morbidity was found in 20 (25.6%) of the 78 children with completed follow-up. Predischarge chest radiographs were predictive of all chronic respiratory morbidity when they showed no or minimal resolution (0-20% resolution) (relative risk, 7.43; 95% CI, 2.07-26.60).

CONCLUSIONS

Central Australian Aboriginal children admitted to hospital with alveolar changes on chest radiographs have a substantial burden of chronic respiratory illness, and should be clinically followed up for early detection and management of chronic respiratory morbidity. A predischarge radiograph is useful, and patients whose radiograph shows no or minimal resolution should have a follow-up x-ray film.

The burden of air pollution: impacts among racial minorities

Various epidemiologic investigations have shown that ambient air pollution levels are associated with acute increases in hospital admissions and mortality in the United States and abroad. The objectives of this investigation were a) to determine if racial minorities are more adversely affected by ambient air pollution than their white counterparts and b) to assess the contribution of socioeconomic status to any observed racial differences in pollution effect. Time-series regression methods were conducted to investigate these hypotheses for daily respiratory hospital admissions in New York City, New York. Pollutants considered included mean daily levels of particulate matter with a mass median aerodynamic diameter less than 10 microm (PM(10), ozone (O3), strong aerosol acidity (H+), and sulfates (SO4(2). The relative risk for respiratory hospital admission was calculated for each pollutant for a maximum minus mean increment in mean daily pollutant concentration. The greatest difference between the white and nonwhite subgroups was observed for O(3), where the white relative risk (RR) was 1.032 [95% confidence interval (CI): 0.977-1.089] and the nonwhite RR was 1.122 (95%CI: 1.074-1.172). Although not statistically different from each other, the various pollutants' RR estimates for the Hispanic nonwhite category in New York City were generally larger in magnitude than those for the non-Hispanic white group. When these analyses incorporated differences in the underlying respiratory hospitalization rates across races (that for nonwhites, was roughly twice that for whites), the disparities in attributable risks from pollution (in terms of excess admissions per day per million persons) were even larger for nonwhites versus whites. However, when insurance status was used as an indicator of socioeconomic/health coverage status, higher RRs were indicated for the poor/working poor (i.e., those on Medicaid and the uninsured) than for those who were economically better off (i.e., the privately insured), even among non-Hispanic whites. Thus, although potential racial differences in pollution exposures could not be explored as a factor, within-race analyses suggested that most of the apparent differences in air pollutant effects found across races were explained by socioeconomic and/or health care disparities.

Hospial admission among Pacific children Auckland 1992-97

AIMS

To describe the reasons for, and rates of, hospital admissions for Pacific children, compared with Maori and 'Other' (non Maori, non Pacific) children in Auckland over the six year period 1992 to 1997.

METHOD

Analysis was carried out of the New Zealand National Health Information Service database for Auckland domiciled children to show diagnostic codes and hospital admission rates for 0-14 year old children, using the 1996 Census population as the denominator population. Age standardised rates were calculated using the 'Other' group of children as the standard population.

RESULTS

All-cause admission rates were higher among Pacific Children, compared with Maori and 'Other' children. Pacific Children were over-represented in admissions for acute respiratory infections, pneumonia and asthma/chronic obstructive pulmonary diseases, compared with both Maori and 'Other' children.

CONCLUSION

Pacific children had the highest hospital admission rates, the main reason being preventable respiratory tract conditions. These findings suggest that Pacific children should be a priority group for intervention at various levels. Improvements in socio-economic circumstances, access to early primary health care and community education supported by comprehensive ambulatory paediatric services (particularly with respect to respiratory conditions) need to be implemented urgently. Qualitative research is needed to determine why ethnic differences exist and to identify effective interventions for Pacific children.

Hospitalization of aboriginal and non-aboriginal patients for respiratory tract diseases in Western Australia, 1988-1993

BACKGROUND

Aboriginal people have lower health standards than other Australians. Respiratory tract diseases are prominent causes of high morbidity and mortality rates in the Aboriginal population. However, very little is known about the patterns of respiratory illnesses which affect these people.

METHOD

This paper compares Aboriginal and non-Aboriginal age-specific hospitalization patterns for respiratory tract diseases from 1988 to 1993 in Western Australia (WA).

RESULTS

Aboriginal people were admitted for respiratory diseases 2-16 times more frequently than non-Aboriginals of the same age with considerable discrepancies in hospitalization rates particularly in infants, young children and older adults. High admission rates for acute respiratory tract infections, pneumonia and asthma occurred in Aboriginal infants. Pneumonia was a disproportionately frequent cause of admissions in Aboriginal infants, children and adults. Pneumonia is a more frequent cause of admission among non-metropolitan compared to metropolitan Aboriginals. Asthma was a frequent cause of admissions of Aboriginal children and hospitalization rates for this disease were higher in non-metropolitan than metropolitan areas. Chronic obstructive airway disease and respiratory tract carcinoma were important uses of hospitalization in older Aboriginals.

CONCLUSIONS

Admission rates for respiratory conditions were consistently higher among the Aboriginal population and in non-metropolitan areas. The overwhelming importance of infections among Aboriginal admissions has significant implications for the prevention and management of respiratory diseases among Aboriginal people.

Ethnic differences in the prevalence of nonmalignant respiratory disease among uranium miners

OBJECTIVES

This study (1) investigates the relationship of nonmalignant respiratory disease to underground uranium mining and to cigarette smoking in Native American, Hispanic, and non-Hispanic White miners in the Southwest and (2) evaluates the criteria for compensation of ethnic minorities.

METHODS

Risk for mining-related lung disease was analyzed by stratified analysis, multiple linear regression, and logistic regression with data on 1359 miners.

RESULTS

Uranium mining is more strongly associated with obstructive lung disease and radiographic pnuemoconiosis in Native Americans than in Hispanics and non-Hispanic Whites. Obstructive lung disease in Hispanic and non-Hispanic White miners is mostly related to cigarette smoking. Current compensation criteria excluded 24% of Native Americans who, by ethnic-specific standards, had restrictive lung disease and 4.8% who had obstructive lung disease. Native Americans have the highest prevalence of radiographic pneumoconiosis, but are less likely to meet spirometry criteria for compensation.

CONCLUSIONS

Native American miners have more nonmalignant respiratory disease from underground uranium mining, and less disease from smoking, than the other groups, but are less likely to receive compensation for mining-related disease.

Current prevalence of asthma-related symptoms in San Diego's predominantly Hispanic inner-city children

Ethnic minorities of low socioeconomic status are disproportionately represented in the trends of increasing asthma prevalence, morbidity, and mortality. We surveyed a cohort of 998 fourth-grade students in an impoverished area of southeast San Diego with a high percentage of Hispanic Mexican-Americans. Of the 654 Hispanic 9-12-year-olds, 14.4% were categorized as probable current asthma (within the past year), based on symptom of wheezing or physician diagnosis of asthma [with respiratory symptom(s) or medication]. An additional 13.5% had respiratory symptoms indicating possible asthma. Differences by ethnic group in the percentage of probable asthma or related symptoms were highly significant (p < 0.0001). Among Hispanics with a category of probable asthma, only 57.4% had a physician diagnosis versus 80.6% of black and 85.7% of white students. The frequency of health insurance coverage differed significantly between ethnic groups (p < 0.0001), with Hispanics among the lowest (37.2%).

The ageing of lung function: cross-sectional and longitudinal studies of an Inuit community

Three surveys (1969/1970, 1979/1980 and 1989/1990) have examined the impact of acculturation to a sedentary lifestyle on the pulmonary function of a circumpolar native Inuit community. The sample comprised more than 50% of those aged 20-60 yrs, most recently 119 males and 92 females. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and maximal mid-expiratory flow (MMEF) were measured by standard spirometric techniques, and information was obtained on smoking habits and health. Multiple regression equations showed that lung function was affected by height and age, but usually not by age squared. Cross-sectional age coefficients for FVC and FEV1 increased over the period 1969/1970 to 1989/1990. Parallel longitudinal trends were seen in FEV1 (males only). Multiple analysis of variance (MANOVA) showed age-decade*cohort effects for FVC and FEV1 (males but not females). Almost all of the population now smoke (mean +/- SD males 13 +/- 8 cigarettes.day-1; females 11 +/- 7 cigarettes.day-1). However, smoking bears little relationship to lung function perhaps due to limited variance in consumption. About a third of the community have physician-diagnosed and/or radiographically visible chest disease, but with little effect upon pulmonary function. We conclude that an apparent secular trend to a faster ageing of lung function in men is not explained by disease or domestic air pollution. Possible factors include increased lung volumes in young adults, greater pack-years of cigarette exposure, nonspecific respiratory disease, increased inspiration of cold air or altered chest mechanics due to operation of high-speed snowmobiles, and loss of physical fitness.

Respiratory symptoms, bronchial responsiveness, and atopy in Fijian and Indian children

Hospital admission rates for asthma in the 5 to 14 yr age group are three times higher in Fiji Indians than in Melanesian Fijians. Conversely, admission rates for pneumonia are three times higher for Fijians than Indians. To determine the prevalence of respiratory symptoms, bronchial hyperresponsiveness, and atopy, a questionnaire in three languages was distributed to 2,173 Suva City school children (mean age 9.6 yr), half of whom were sampled for histamine inhalation and skin-prick allergen tests. Prevalence of wheeze in the previous 12 mo was identical in both ethnic groups (20.6%). Productive cough was more common in Fijians (29%) than Indians (17%, p < 0.0001). Bronchial hyperresponsiveness was twice as common in Indians (30%) as Fijians (15%), relative risk 2.1 (95% confidence interval [CI]: 1.5 to 2.8), p < 0.0001. The combination of current wheeze and bronchial hyperresponsiveness was found in nearly three times as many Indian children (11.3%) as Fijians (4.0%), and the mean bronchial dose-response slope to histamine was steeper in Indians than Fijians. Prevalence of atopy was similar in Fijians (36%) and Indians (38%). Wheeze was significantly associated with atopy and a steeper dose-response slope to histamine, but productive cough was not. Indians may have more severe asthma than Fijians due to genetic or environmental factors acting independently of atopy. The higher prevalence of productive cough in Fijians is consistent with a greater burden of respiratory infection, and is associated with domestic crowding.

A practical intervention to address ear and lung disease in Aboriginal primary school children of central Australia

Australian Aboriginal populations have an extremely high prevalence of lung disease and ear disease. In addition to an improvement in socio-economic conditions, implementation of strategies to address the problem, within the limitations of present conditions, is needed. A 5 month trial was conducted to investigate the effectiveness of a school-based intervention programme involving nose blowing, deep breathing and coughing combined with exercise performed daily. This was a community-based trial, designed to give priority to cultural and ethical considerations, to be non-intrusive and to utilize local skills and resources. Results of the trial showed that signs of upper and lower respiratory tract disease and pulmonary function measurements were statistically significantly improved. Hearing levels showed no statistically significant change. The programme met with a good response from children and teachers. This study does suggest that this strategy may help address the existing problems of lung and ear disease in Aboriginal primary school children, providing some immediate benefits within the limitations of the present socio-economic conditions.

Disease profiles in Chinese in Hong Kong: an analysis of the primary diagnoses in 561 acute hospital medical admissions

Little is known about the disease profiles in Chinese living in an urbanized community like Hong Kong. Accordingly, the discharge summaries of 561 acute hospital medical admissions were reviewed and the primary diagnoses (the main reason for admission or the most important clinical problem) were coded according to the International Classification of Diseases. Our data indicate that cardiovascular diseases are the most important cause of acute medical admissions and mortality and that gastrointestinal hemorrhage is very common amongst the Chinese in Hong Kong.

Respiratory conditions, including asthma, and height in primary school

The National Study of Health and Growth (NSHG) of primary school children has examined the relationships between height and each of six separate respiratory conditions, one of which was asthma, in children aged 5-11 years, allowing for a number of genetic and environmental confounding factors, in particular for parental height. The relationships were investigated in a 'representative' sample of 4974 Caucasian English children in 1984 and in an 'ethnic/inner city' sample of 3419 Afro-Caribbean/Indian and Pakistani/Caucasian English children in 1985. None of the respiratory conditions was found to be related to height except for 'wheeze most days', whether or not it was accompanied by an asthma attack in the last 12 months. The Caucasian children in the 'representative' sample who had 'wheeze most days', were 0.17 height standard deviation score (95% confidence interval 0.03 to 0.31) less (approximately 1 cm) than those with no wheeze. Comparisons with previous results for NSHG 'representative' Caucasian English children in 1973 showed good agreement except for children with three or more asthma attacks who were found to be shorter in 1973, but not in 1984, which may reflect improved treatment, or milder asthma being reported in 1984. It was concluded that, in the 1980s, the respiratory conditions were not related to height. The exception was 'wheeze most days'. It is suggested that this is an indicator of sickness, most likely asthma, which is being experienced with sufficient severity to affect growth slightly.

Smoking, respiratory symptoms, and pulmonary function among a population of Hispanic farmworkers

We conducted a cross-sectional study in the agricultural Central Valley to evaluate the prevalence of respiratory symptoms, smoking status, and pulmonary function in Hispanic California farmworkers. Of 759 farmworkers completing questionnaires and spirometry, 747 were Hispanic. The prevalences of current, former, and never smokers (29, 17, and 54 percent, respectively) were comparable to rates in other studies of Hispanics, but daily cigarette consumption (median-five for men and three for women) was lower than in comparison populations. Prevalences of chronic cough, chronic phlegm, and persistent wheeze were low (1.6, 5.1, and 2.8 percent, respectively). Current smoking, increased age, female sex, and working greater than or equal to 8 months per year in agriculture were associated with increased prevalence of respiratory symptoms. Adjusted lung function was higher than for reference populations. Hispanic California farmworkers have a similar smoking prevalence to other Hispanic populations, but lower respiratory symptom prevalences and higher pulmonary function are consistent with lower daily cigarette consumption and the "healthy worker effect."

Quantifying health aspects of passive smoking in British children aged 5-11 years

STUDY OBJECTIVE

The aim was to estimate the dose-response relations of height and respiratory symptoms to passive smoking in children aged 5-11 years.

DESIGN

The study was an analysis of existing observational studies, comprising three samples: English representative; English inner city; Scottish representative.

SETTING

Primary schools (children aged 5-11 years).

PARTICIPANTS

The study population included 5002 English children from the representative sample (69.1% of total eligible), 2903 English inner city children (42.0%), and 3319 representative Scottish children (75.6%).

MEASUREMENTS AND MAIN RESULTS

No significant relation was found between child's height and total parental smoking in the home. Relative risk for persistent wheeze on exposure to 20 cigarettes per day was 1.35, compared to no exposure. Risk of at least one respiratory condition attributable to passive smoking reached 8.1% in white English inner city children.

CONCLUSIONS

The relation of child's height to passive smoking was not substantiated. The risk of respiratory conditions resulting from passive smoking, although small, is not negligible.

The major respiratory diseases of American Indians

The most prominent respiratory diseases of American Indian adults are pneumonia, cancer of the lung, chronic obstructive pulmonary disease (COPD), and tuberculosis. Mortality and hospitalization rates of these diseases were compared with those for the rest of the U.S. population and between Indian groups in the various Indian Health Service Areas. Pneumonia and influenza constitute the sixth leading cause of death among Indians and the fifth leading cause of death among the U.S. All Races population. Chronic obstructive pulmonary disease is the fourth leading cause of death among U.S. All Races, but only the tenth leading cause of death among Indians. Pneumonia and tuberculosis are more significant causes of death and disability for Indians than are COPD and cancer of the lung. The explanation for these differences in mortality rates between Indians and the general population are not known. Respiratory system diseases are responsible for 10.6% of Indian hospitalizations. The most frequent is pneumonia, which accounts for approximately 4% of all Indian hospitalizations. Differences in respiratory diseases between Indian groups are sometimes striking, with a sharp increase in mortality and hospitalization in the Areas across the northern border of the lower 48 states. There is also a much higher prevalence of cigarette smoking in those same Areas.

Reference equations used to predict pulmonary function. Survey at institutions with respiratory disease training programs in the United States and Canada

Adult respiratory disease training programs in the United States and Canada were surveyed to determine which reference equations were used to predict normal pulmonary function and how ethnic differences were approached. Replies from 139 of the 180 (77.2 percent) institutions surveyed were received and evaluated. Surprisingly few studies account for most of the equations in use: three studies account for 85 percent of the spirometric equations, two for 83 percent of the lung volume equations and five for 84 percent of the diffusing capacity equations. Although there are no definite data, the form of many of the replies suggests that equipment default settings may influence the selection process. Of those responding to the ethnic difference question, 53 percent of institutions applied no correction for ethnic differences. There was no consistent pattern to the method of correction among those who did.

Respiratory symptoms and functional impairment from acute (cross-shift) exposure to welding gases and fumes

One hundred forty-five male welders from a West Coast shipyard were studied cross-sectionally and across a Monday work shift by pulmonary function tests and a questionnaire. Ten years of welding was associated with chronic bronchitis in 23.3% of nonsmokers compared to 3.3% in male controls, shortness of breath in 31.5% of nonsmokers compared to 1.5% in controls, and chest pain or heaviness in 38.4% compared to 4.4% in controls. Men who welded aluminum but had never smoked had more frequent wheezing, chest tightness, phlegm, feverishness and fatigue than those welding mild (black) or stainless steel. There were no significant cross-shift effects from welding exposure on measurements of pulmonary function. Although baseline expiratory flows were reduced slightly when compared to Caucasian-predicted values, ethnic specific comparisons for the largest subgroup showed only that FEF25-75 was reduced to 92.9 percentage of predicted values. Diffusing capacities for carbon monoxide were significantly reduced as compared to referents. The pulmonary function values of 25 current smokers were indistinguishable from the 41 who had never smoked, which probably reflects their low consumption of cigarettes.

An analysis of the seasonal variation of coronary heart disease and respiratory disease mortality in New Zealand

The seasonal variation of coronary heart disease mortality rates in New Zealand is analysed by age, sex and race using monthly national mortality data for the period 1970-83. A 35% variation from the winter peak to summer low is found in the crude mortality rate, but the size of the seasonal variation is age-dependent, being more pronounced in the elderly, and more so in males than in females. The hypothesis that respiratory infections are linked to coronary heart disease, and that their seasonal occurrence explains the seasonal variation in coronary rates, is examined by an analysis of the association between coronary disease and respiratory disease mortality rates. By partial correlation analysis and by examining the residual correlation after filtering the seasonal variation from both series, it is suggested that the season acts as a confounding factor to cause an apparent association between the two rates. After controlling for season there is a tenuous relationship, but it is apparent only in the elderly.

Respiratory diseases and cigarette smoking in a Hispanic population in New Mexico

We have conducted a cross-sectional study of Hispanic residents of a community in New Mexico. A total of 2,111 subjects were recruited from 733 households; the overall participation rates were 68.1% for males and 78.9% for females. For all subjects, a standardized respiratory symptoms questionnaire was completed, spirometric testing was performed, and saliva and end-tidal breath samples were obtained. As in other populations, chronic respiratory symptoms were uncommon in children, and asthma was more prevalent in boys than in girls. In adults, physician-diagnosed chronic bronchitis and emphysema were less prevalent in this population than in a previously studied sample of non-Hispanic whites in New Mexico. Spirometric testing was confirmatory; less than 1% of the Hispanic males and females had chronic air-flow obstruction. The prevalence of cigarette usage in the Hispanics was comparable to data from non-Hispanic whites in New Mexico and from nationwide surveys. However, daily cigarette consumption by the Hispanics in this sample tended to be low, as found in previous studies in New Mexico and elsewhere.

Ethnic variation in respiratory morbidity and lung function in childhood

In a population of 5689 primary schoolchildren there were few important differences between children of European (n = 5287), African (n = 198), and Indian origin (n = 204) in the prevalence of a history of past respiratory illnesses or current respiratory symptoms. The reported 12 month period prevalence of the symptom "ever wheezy" was 15%, 18%, and 17% respectively in the three ethnic groups (differences not significant). In a subsample of 973 European, 47 African, and 40 Indian children forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were significantly lower by 12% and 13% in Africans and by 8% and 9% in Indians than in Europeans after adjustment to the group mean height of 128 cm. No significant ethnic variation was found for forced mid expiratory flow, FEV1/FVC, or mean transit time. Since the lung function studies were performed on a sample from a large population with little variation in respiratory morbidity, the differences are likely to reflect human biological differences. Separate prediction equations need to be developed for the different ethnic groups in childhood.

Pulmonary functions and respiratory symptoms and diseases among adult Israelis. Variations by country of origin

A study group of 1,299 adult Israelis aged 30 to 65 years was chosen from persons referred for evaluation of possible pulmonary diseases in two outpatient chest clinics. They were interviewed using the ATS-NHLI (American Thoracic Society-National Heart and Lung Institute) health questionnaire and underwent the pulmonary function test (PFT), which included the following parameters: forced vital capacity (FVC), forced expiratory volume in 1st sec (FEV1), FEV1/FVC, peak expiratory flow (PEF), FEF50 and FEF25 (forced expiratory flow at 50 and 25% of FVC, respectively). The effect of the country of origin of the subjects on the distribution of respiratory symptoms, pulmonary diseases and PFT was analyzed. The lowest PFT values and an excess of reported respiratory symptoms and chronic obstructive airways diseases--especially asthma--among subjects and their parents were found among immigrants from Iraq-Iran. In immigrants from Morocco, reported respiratory symptoms, pulmonary diseases and impaired PFT were relatively uncommon. The different distribution of reported respiratory symptoms, pulmonary diseases and impaired PFT by country of origin could not be explained by environmental factors, such as smoking habits and socioeconomic background. The high prevalence of reported asthma among immigrants from Iraq-Iran is most probably due to a genetic factor.