Purpose To evaluate the association of self-reported type 2 diabetes, anthropometric factors, alcohol consumption, and cigarette smoking with risk of primary open-angle glaucoma (POAG) in a ...prospective cohort study of African-American women. Methods From 1995 through 2007, 32,570 Black Women’s Health Study participants aged 21 to 69 years at baseline were followed for incident POAG. Questionnaires were mailed biennially to update exposures and identify incident cases of POAG. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were derived from Cox regression models. Results During 416,171 person-years of follow-up, 366 incident POAG cases were confirmed by physician report. After adjustment for potential confounders, the IRR comparing women with and without type 2 diabetes was 1.58 (95% CI, 1.17–2.13), and the IRR comparing current with never alcohol consumers was 1.35 (95% CI, 1.05–1.73). Among women younger than 50, associations with diabetes and alcohol consumption were stronger, and POAG was significantly associated with body mass index, waist circumference, waist-to-hip ratio, and both long-duration and high-intensity current smoking. Conclusions These results suggest that type 2 diabetes and current alcohol consumption are independent risk factors for POAG among African-American women, and that in addition to those factors, overall and central adiposity and smoking may be associated with increased risk of early-onset POAG.
Neighborhood socioeconomic status (SES) is associated with adverse health outcomes, but longitudinal data among Black Americans, who tend to live in more deprived neighborhoods, is lacking.
We ...prospectively assessed the relation of neighborhood SES to mortality in the Black Women's Health Study.
A prospective cohort of 59,000 Black women was followed from 1995-2011. Participant addresses were geocoded and US Census block group was identified. Neighborhood SES was measured by a score based on US Census block group data for six indicators of income, education and wealth.
Deaths were identified through the National Death Index. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs with control for covariates.
Based on 2,598 deaths during 1995-2011, lower neighborhood SES was associated with increased all-cause and cancer mortality irrespective of individual education: among those with 16 or more years of education, HRs for lowest relative to highest neighborhood SES quartile were 1.42 (95% CI 1.18-1.71) for all-cause and 1.54 (95% CI 1.14-2.07) for cancer mortality. Neighborhood SES was associated with cardiovascular mortality among less-educated women.
Lower neighborhood SES is associated with greater risk of mortality among Black women. The presence of the association even among women with high levels of education suggests that individual SES may not overcome the unfavorable influence of neighborhood deprivation.
To assess the association of birth weight with incident type 2 diabetes, and the possible mediating influence of obesity, in a large cohort of U.S. black women.
The Black Women's Health Study is an ...ongoing prospective study. We used Cox proportional hazards models to estimate incidence rate ratios (IRRs) and 95% CI for categories of birth weight (very low birth weight <1,500 g, low birth weight 1,500-2,499 g, and high birth weight ≥4,000 g) in reference to normal birth weight (2,500-3,999 g). Models were adjusted for age, questionnaire cycle, family history of diabetes, caloric intake, preterm birth, physical activity, years of education, and neighborhood socioeconomic status with and without inclusion of terms for adult BMI.
We followed 21,624 women over 16 years of follow-up. There were 2,388 cases of incident diabetes. Women with very low birth weight had a 40% higher risk of disease (IRR 1.40 95% CI 1.08-1.82) than women with normal birth weight; women with low birth weight had a 13% higher risk (IRR 1.13 95% CI 1.02-1.25). Adjustment for BMI did not appreciably change the estimates.
Very low birth weight and low birth weight appear to be associated with increased risk of type 2 diabetes in African American women, and the association does not seem to be mediated through BMI. The prevalence of low birth weight is especially high in African American populations, and this may explain in part the higher occurrence of type 2 diabetes.
BACKGROUND: No studies have examined dietary patterns and breast cancer risk in a large cohort of African American women. OBJECTIVE: We investigated the association between dietary patterns and ...breast cancer risk in the Black Women's Health Study. DESIGN: This is a prospective cohort study of 50,778 participants followed biennially from 1995 through 2007. During 443,742 person-years of follow-up, 1094 incident cases of breast cancer were identified. Factor analysis was used to derive food patterns based on 69 food variables. We used Cox regression models to obtain incident rate ratios (IRRs) for breast cancer in relation to quintiles of each of the 2 dietary patterns, with adjustment for other breast cancer risk factors. RESULTS: Through factor analysis, we identified 2 dietary patterns: Western (refined grains, processed meat, and sweets) and prudent (whole grains, vegetables, fruit, and fish). The prudent diet was weakly associated with lower breast cancer risk overall; P for trend = 0.06. In analyses stratified by body mass index (BMI; in kg/m²), the prudent dietary pattern was associated with a significantly lower risk of breast cancer in women with a BMI <25 (IRR: 0.64; 95% CI: 0.43, 0.93; P for trend = 0.01). The prudent dietary pattern was also associated with a significantly lower risk of breast cancer in premenopausal women (IRR: 0.70; 95% CI: 0.52, 0.96; P for trend = 0.01), and we found a significant inverse association for the prudent dietary pattern and estrogen receptor-negative breast cancer (IRR: 0.52; 95% CI: 0.28, 0.94; P for trend <0.01). CONCLUSION: Our findings suggest that the prudent dietary pattern may protect against breast cancer in some black women.
OBJECTIVE:--Inverse associations between magnesium and calcium intakes and risk of type 2 diabetes have been reported for studies in predominantly white populations. We examined magnesium, calcium, ...and major food sources in relation to type 2 diabetes in African-American women. RESEARCH DESIGN AND METHODS--This is a prospective cohort study including 41,186 participants of the Black Women's Health Study without a history of diabetes who completed validated food frequency questionnaires at baseline. During 8 years of follow-up (1995-2003), we documented 1,964 newly diagnosed cases of type 2 diabetes. RESULTS:--The multivariate-adjusted hazard ratio of type 2 diabetes for the highest compared with the lowest quintile of intake was 0.69 (95% CI 0.59-0.81; P trend <0.0001) for dietary magnesium and 0.86 (0.74-1.00; P trend = 0.01) for dietary calcium. After mutual adjustment, the association for calcium disappeared (hazard ratio 1.04 95% CI 0.88-1.24; P trend = 0.88), whereas the association for magnesium remained. Daily consumption of low-fat dairy (0.87 0.76-1.00; P trend = 0.04) and whole grains (0.69 0.60-0.79; P trend <0.0001) were associated with a lower risk of type 2 diabetes compared with a consumption less than once a week. After mutual adjustment, the hazard ratio was 0.81 (0.68-0.97; P trend = 0.02) for magnesium and 0.73 (0.63-0.85; P trend <0.0001) for whole grains. CONCLUSIONS:--These findings indicate that a diet high in magnesium-rich foods, particularly whole grains, is associated with a substantially lower risk of type 2 diabetes in U.S. black women.
Purpose Obesity is more common in black women than in white women. Racial discrimination is a form of chronic stress that may influence weight. Methods We assessed the association of perceived racism ...with weight change between 1997 and 2005 in 43,103 women from the Black Women's Health Study, a prospective follow-up of U.S. black women aged 21–69 years at entry in 1995. Eight questions about perceptions and experiences of racism were asked in 1997 from which two summary variables were created: everyday racism (e.g., how often do people act “as if you are not intelligent?”), and lifetime racism (e.g., unfair treatment due to race “on the job”). Mixed linear regression models were used to calculate the multivariate adjusted means for changes in body weight across categories of perceived racism. Results Weight gain increased as levels of everyday and lifetime racism increased. The mean multivariable-adjusted difference in weight change between the highest and the lowest quartile of everyday racism was 0.56 kg. The mean difference comparing the highest category of lifetime racism to the lowest was 0.48 kg. Conclusion These prospective data suggest that experiences of racism may contribute to the excess burden of obesity in U.S. black women.
Background Chronic stress resulting from experiences of racism may increase the incidence of adult-onset asthma through effects on the immune system and the airways. We conducted prospective analyses ...of the relation of experiences of racism with asthma incidence in the Black Women's Health Study, a prospective cohort of black women in the United States followed since 1995 with mailed biennial questionnaires. Methods Among 38,142 participants followed from 1997 to 2011, 1,068 reported incident asthma. An everyday racism score was created based on five questions asked in 1997 and 2009 about the frequency in daily life of experiences of racism (eg, poor service in stores), and a lifetime racism score was based on questions about racism on the job, in housing, and by police. We used Cox regression models to derive multivariable incidence rate ratios (IRRs) and 95% CIs for categories of each racism score in relation to incident asthma. Results The IRRs were 1.45 (95% CI, 1.19-1.78) for the highest compared with the lowest quartile of the 1997 everyday racism score ( P for trend <.0001) and 1.44 (95% CI, 1.18-1.75) for the highest compared with the lowest category of 1997 lifetime racism. Among women who reported the same levels of racism in 1997 and 2009, the IRRs for the highest categories of everyday and lifetime racism were 2.12 (95% CI, 1.55-2.91) and 1.66 (95% CI, 1.20-2.30), respectively. Conclusions Given the high prevalence of experiences of racism and asthma in black women in the United States, a positive association between racism and asthma is of public health importance.
Objective Uterine leiomyomata (UL) are a major contributor to gynecologic morbidity and medical costs, and black women are disproportionately affected by the condition. Previous studies have linked ...UL to psychosocial stress, including child abuse. We assessed the association between lifetime abuse victimization and UL among 9910 premenopausal women. Study Design Data were derived from the Black Women's Health Study, a prospective cohort study. In 2005, participants reported their experiences of physical and sexual abuse within each life stage (childhood, adolescence, adulthood). Biennial follow-up questionnaires from 2005 through 2011 ascertained new UL diagnoses. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Results There were 1506 incident UL cases diagnosed by ultrasound or surgery. UL incidence was higher among women who reported child abuse, particularly sexual abuse. Relative to no abuse across the life span, RRs were 1.16 (95% CI, 1.02−1.33) for physical abuse only, 1.34 (95% CI, 1.09−1.66) for sexual abuse only, and 1.17 (95% CI, 0.99−1.39) for both physical and sexual abuse in childhood. RRs for 1-3 and 4 or more incidents of child sexual abuse were 1.29 (95% CI, 1.04−1.61) and 1.41 (95% CI, 1.07−1.85), respectively, whereas the RRs for low, intermediate, and high frequencies of child physical abuse were 1.19, 1.04, and 1.23, respectively. The association was strongest for the highest category of child abuse severity (RR, 1.57; 95% CI, 1.19−2.07). No associations were found for teen or adult abuse. Conclusion In the present study, child sexual abuse was an independent risk factor for UL, supporting the hypothesis that childhood adversity increases UL risk.
Genome wide association studies have identified ~100 loci associated with body mass index (BMI). Persons with low birth weight have an increased risk of metabolic disorders. We postulate that normal ...mechanisms of body weight regulation are disrupted in subjects with low birth weight. The present analyses included 2215 African American women from the Black Women's Health Study, and were based on genotype data on 20 BMI-associated loci and self-reported data on birth weight, weight at age 18 and adult weight. We used general linear models to assess the association of individual single-nucleotide polymorphisms (SNPs) with BMI at age 18 and later in adulthood within strata of birth weight (above and below the median, 3200 g). Three SNPs (rs1320330 near TMEM18, rs261967 near PCSK1 and rs17817964 in FTO), and a genetic score combining these three variants, showed significant interactions with birth weight in relation to BMI. Among women with birth weight <3200 g, there was an inverse association between genetic score and BMI; beta-coefficient=-0.045 (95% confidence intervals (CI) -0.104, 0.013) for BMI at age 18, and -0.055 (95% CI -0.112, 0.002) for adult BMI. Among women with birth weight ⩾3200 g, genetic score was positively associated with BMI: beta-coefficient=0.110 (95% CI 0.051, 0.169) for BMI at age 18 (P for interaction=0.0002), and 0.112 (95% CI 0.054, 0.170) for adult BMI (P for interaction<0.0001). Because TMEM18, PCSK1 and FTO are highly expressed in the central nervous system (CNS), our results suggest that low-birth weight may disrupt mechanisms of CNS body weight regulation.
Introduction Substantial research has been dedicated to understanding the reasons for the dramatic rise in obesity rates in the U.S. in the last 2 decades. Animal studies and epidemiologic studies in ...children have suggested that air pollution might contribute to weight gain. This study investigates the association between ambient air pollution and weight gain over 16 years of follow-up (1995−2011) in a large cohort of African-American women in the U.S. Methods This study assessed associations of fine particulate matter, ozone, and nitrogen dioxide with weight gain using a linear random effects model. All analyses were conducted in 2015. Results There was no statistically significant association between weight change and fine particulate matter (mean weight change over 16 years per interquartile range 2.9 μg/m3 , 0.12 kg; 95% CI=−0.10, 0.35) and ozone (0.16 kg per interquartile range 6.7 ppb; 95% CI=−0.11, 0.43). There was a small decrease in weight associated with nitrogen dioxide (−0.50 per interquartile range 9.7 ppb; 95% CI=−0.77, −0.23). Conclusions The results do not provide support for an association of air pollution with weight gain in African-American adult women.
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