Rosemarie Hirsch

Centers for Disease Control and Prevention, Atlanta, MI, United States

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Publications (35)151.95 Total impact

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    ABSTRACT: Data from the National Health and Nutrition Examination Survey, 1976-1980, 1988-1994, 2001-2004, and 2007-2010 The prevalence of high low-density lipoprotein cholesterol, or LDL-C, decreased from 59% to 27% from the late 1970s through 2007-2010. The percentage of adults using cholesterol-lowering medication increased from 5% to 23% from the late 1980s through 2007-2010. The percentage of adults consuming a diet low in saturated fat increased from 25% to 41% from the late 1970s through 1988-1994. No significant changes in the percentage of adults consuming a diet low in saturated fat were observed from 1988-1994 through 2007-2010.
    NCHS data brief 03/2013;
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    ABSTRACT: BACKGROUND: Data collection for the National Health and Nutrition Examination Survey (NHANES) comprises three levels: a household screener, an interview, and a physical examination. The primary objective of the screener is to determine whether any household members are eligible for the interview and examination. Eligibility is determined by the preset selection probabilities for the desired demographic subdomains. After selection as an eligible sample person, the interview collects person-level demographic, health, and nutrition information as well as information about the household. The examination includes physical measurements, tests such as eye and dental examinations, and the collection of blood and urine specimens for laboratory testing. OBJECTIVES: This report will first describe the broad design specifications for the 1999-2006 survey including survey objectives, domain and precision specifications, operational requirements, sample design, and estimations procedures. Details of the sample design are divided into two sections. The first section (NHANES 1999-2001 Sample Design) broadly describes the sample design and various design changes during the first three years of the continuous NHANES (1999-2001). The second section (NHANES 2002-2006 Sample Design) describes the final sample design developed and applied for 2002-2006. Weighting and variance estimation procedures are presented in the same manner; however, to correspond to the public data release cycles, the weighting and variance sections are separated into those used for 1999-2002, and those used for 2003-2006. Much of this report is based on survey operations documents and sample design reports prepared by Westat. Documentation of the survey content, procedures, and methods to assess nonsampling errors are reported elsewhere.
    Vital and health statistics. Series 2, Data evaluation and methods research 05/2012;
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    ABSTRACT: To carry out the first large-scale population study of the prevalence of HLA-B27 in the US, which is needed for public health planning purposes because of recent improvements in medical therapy and diagnostic testing for ankylosing spondylitis (AS). The national prevalence of HLA-B27 was determined as part of the 2009 US National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey monitoring the health and nutritional status of the US civilian, noninstitutionalized population. DNA polymerase chain reaction analysis was conducted in samples from 2,320 adults ages 20-69 years from this nationally representative sample. The age-adjusted US prevalence of B27 was 6.1% (95% confidence interval [95% CI] 4.6-8.2). By race/ethnicity, the prevalence of B27 was 7.5% (95% CI 5.3-10.4) among non-Hispanic whites and 3.5% (95% CI 2.5-4.8) among all other US races/ethnicities combined. In Mexican Americans, the prevalence was 4.6% (95% CI 3.4-6.1). The prevalence of B27 could not be reliably estimated for other US racial/ethnic groups because of the low number of B27-positive individuals in those groups. For adults 50-69 years of age, the prevalence of B27 was 3.6% (95% CI 2.2-5.8), which suggested a decrease in B27 with age. These prevalence estimates took into account the NHANES survey design and are reviewed with respect to data from the medical literature. Our findings provide the first US national prevalence estimates for HLA-B27. A decline in the prevalence of HLA-B27 with age is suggested by these data but must be confirmed by additional studies.
    Arthritis & Rheumatology 12/2011; 64(5):1407-11. DOI:10.1002/art.33503 · 7.48 Impact Factor
  • Charles F Dillon, Rosemarie Hirsch
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    ABSTRACT: Currently available U.S. population-based data for ankylosing spondylitis (AS), spondyloarthritis and inflammatory back pain (IBP) from the nationally representative U.S. National Health and Nutrition Examination Survey (NHANES) include both NHANES I (1971-1975) and NHANES II (1976-1980) surveys. The pelvic radiographs obtained in NHANES I provided U.S. prevalence estimates for radiographic sacroiliitis, an important component of the AS case definition. AS and spondyloarthritis prevalences cannot readily be calculated from NHANES I survey data; however, IBP prevalence (Rudwaleit et al Criteria 7b) can be estimated from NHANES II. The NHANES II estimate for IBP is 0.8% of the adult population ages 25 to 49 years. The prevalence of IBP in the subset of persons with a history of a back pain episode lasting 2 or more weeks was 6.7%. The 2009-2010 NHANES U.S. Inflammatory Back Pain/Spondyloarthritis survey is currently fielded.
    The American Journal of the Medical Sciences 02/2011; 341(4):281-3. DOI:10.1097/MAJ.0b013e31820f8c83 · 1.52 Impact Factor
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    ABSTRACT: To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by arthritis overall, rheumatoid arthritis, juvenile arthritis, the spondylarthritides, systemic lupus erythematosus, systemic sclerosis, and Sjögren's syndrome. A companion article (part II) addresses additional conditions. The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey (NHIS). For analysis of overall arthritis, we used the NHIS. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition. More than 21% of US adults (46.4 million persons) were found to have self-reported doctor-diagnosed arthritis. We estimated that rheumatoid arthritis affects 1.3 million adults (down from the estimate of 2.1 million for 1995), juvenile arthritis affects 294,000 children, spondylarthritides affect from 0.6 million to 2.4 million adults, systemic lupus erythematosus affects from 161,000 to 322,000 adults, systemic sclerosis affects 49,000 adults, and primary Sjögren's syndrome affects from 0.4 million to 3.1 million adults. Arthritis and other rheumatic conditions continue to be a large and growing public health problem. Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions, more studies generalizable to the US or addressing understudied populations are needed.
    Arthritis & Rheumatology 01/2008; 58(1):15-25. DOI:10.1002/art.23177 · 7.87 Impact Factor
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    ABSTRACT: To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions. The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition. We estimated that among US adults, nearly 27 million have clinical osteoarthritis (up from the estimate of 21 million for 1995), 711,000 have polymyalgia rheumatica, 228,000 have giant cell arteritis, up to 3.0 million have had self-reported gout in the past year (up from the estimate of 2.1 million for 1995), 5.0 million have fibromyalgia, 4-10 million have carpal tunnel syndrome, 59 million have had low back pain in the past 3 months, and 30.1 million have had neck pain in the past 3 months. Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions more studies generalizable to the US or addressing understudied populations are needed.
    Arthritis & Rheumatology 01/2008; 58(1):26-35. DOI:10.1002/art.23176 · 7.87 Impact Factor
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    ABSTRACT: Elevated serum total cholesterol is a major and modifiable risk factor for heart disease, the lead-ing cause of death in the United States (1,2). Reducing mean total serum cholesterol levels among adults to less than 200 mg/dL and reducing the proportion who have levels of 240 mg/dL or higher to less than 17% are national Healthy People 2010 objectives (3). Age-adjusted mean serum cholesterol levels among adults aged 20-74 years declined from 222 mg/dL in 1960-1962 to 203 mg/dL in 1999-2002 (4). Among adults aged 20 years and older, the percent of the population with high serum total cholesterol levels (240 mg/dL or higher) declined from 20% during 1988-1994 to 17% during 1999-2002 (4). In individual patients, a high serum total cholesterol level indicates a potential increased risk for heart disease, but further evaluation of other risk factors and the specific components of cholesterol provide the basis for determining the need for initiating therapeutic lifestyle changes or treatment with medication (5). Low-density-lipoprotein (LDL) is the cholesterol component associated with arterial blockage, and it is the primary clinical target for cholesterol management. High-density-lipoprotein (HDL) may help to protect individuals from developing heart disease. In populations, comparisons of total cholesterol levels over time can show if population groups are experiencing improvement in cholesterol levels, and knowledge of trends in levels of total cholesterol can help identify subgroups where additional prevention efforts may be needed.
    NCHS data brief 01/2008;
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    The Journal of Rheumatology 06/2007; 34(5):1118-24. · 3.17 Impact Factor
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    ABSTRACT: To estimate the United States prevalence of symptomatic hand osteoarthritis using American College of Rheumatology (ACR) physical examination criteria. The Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative cross-sectional health examination survey, performed upper-extremity physical examinations on a sample of United States adults age 60+ yrs. Data for demographics, pain history, analgesic use, and activity limitations were obtained by interview. Among United States adults, 58% had Heberden's nodes, 29.9% had Bouchard's nodes, and 18.2% had first carpal-metacarpal deformities. Women had significantly more first carpal-metacarpal deformities (24.3%) than men (10.3%). Symptomatic osteoarthritis prevalence at these sites was 5.4, 4.7, and 1.9%, respectively. Overall, symptomatic hand osteoarthritis prevalence by ACR criteria was 8% (95% CI 6.5-9.5%), or 2.9 million persons. Symptomatic hand osteoarthritis significantly increased with age and was decreased among non-Hispanic blacks, but there were no gender differences. Symptomatic hand osteoarthritis was associated with self-reported difficulty lifting 10 lbs (OR 2.31; 95% CI 1.23-4.33), dressing (OR 3.77; 95% CI 1.99-7.13), and eating (OR 3.44; 95% CI 1.76-6.73). Frequent monthly use was significantly increased for analgesics, especially acetaminophen, but not nonsteroidal antiinflammatory drugs. Symptomatic hand osteoarthritis affects 1 in 12 older United States adults. NHANES III data provide a population-based assessment of the impact and associated functional impairments of symptomatic hand osteoarthritis.
    American Journal of Physical Medicine & Rehabilitation 02/2007; 86(1):12-21. · 2.01 Impact Factor
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    ABSTRACT: To estimate the US national prevalence of tibiofemoral radiographic knee osteoarthritis (RKOA) with and without symptoms, and its influence on functional tasks. Radiographic and interview data from the National Health and Nutrition Examination Survey (NHANES III), a nationally representative cross-sectional health examination survey, were used to estimate lifetime RKOA prevalence in adults age 60 years and older. Demographic trends, self-reported activity limitations, physical performance test results, and patterns of recent analgesic use were analyzed. Among US adults, the prevalence of RKOA and symptomatic RKOA was 37.4% and 12.1%, respectively. RKOA prevalence was greater among women than men (42.1% vs 31.2%). Women had significantly more Kellgren-Lawrence Grade 3-4 changes (12.9% vs 6.5% in men). However, symptomatic RKOA prevalence did not differ by sex. Additionally, some 1.6% of US adults had knee joint replacement. Multivariable analysis showed significantly higher odds of both RKOA and symptomatic RKOA with greater body mass index (BMI > or = 30), greater age, non-Hispanic Black race/ethnicity, and among men with manual labor occupations. Only symptomatic RKOA was significantly associated with self-reported activity limitations: difficulty walking, stooping, standing from a seated position, and stair climbing. Adults with symptomatic RKOA used significantly more assistive walking devices, had slower measured gait velocities, and used significantly more prescription nonsteroidal antiinflammatory drugs and prescription narcotics, and nonprescription acetaminophen. NHANES III data provide an overall national assessment of the prevalence, demographic distributions, and functional impact of symptomatic knee OA, which affects more than 1 in 10, or 4.3 million older US adults.
    The Journal of Rheumatology 11/2006; 33(11):2271-9. · 3.17 Impact Factor
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    ABSTRACT: PurposeAnalgesics offer many benefits, however, chronic, long-term use may pose risks of adverse drug events. The objective of this study was to estimate frequent monthly non-narcotic analgesic use among U.S. adults, identifying socio-demographic trends and potentially at-risk groups.Methods Analysis of adult medication use data from the 1999–2000 National Health and Nutrition Examination Survey household interview (n = 4880).ResultsSome 20% of U.S. adults used non-prescription or prescription non-narcotic analgesics on a frequent basis, that is nearly every day for a month, at some point during their lifetime. Also, 14% of U.S. adults were currently using analgesics frequently. Aspirin was most commonly used (8%), followed by non-aspirin non-steroidal anti-inflammatory drugs (NANSAID, 3%) and acetaminophen (3%). Three-quarters of aspirin, 46% of NANSAID and 63% of acetaminophen users were long-term frequent monthly users (1+ years). Seven percent of frequent monthly analgesic users reported using two or more analgesics nearly every day during the month. Frequent analgesic use was most common among older adults and non-Hispanic whites with no differences by gender or education. Use patterns, however, varied by analgesic subgroups.Conclusions Frequent monthly non-narcotic analgesic use, especially of over-the-counter analgesics, is widely prevalent among U.S. adults. Health-care providers should heighten their awareness of this trend, and routinely monitor both non-prescription and prescription analgesic use in their patients to prevent adverse drug effects and inappropriate use. Published in 2004 by John Wiley & Sons, Ltd.
    Pharmacoepidemiology and Drug Safety 04/2005; 14(4):257 - 266. DOI:10.1002/pds.983 · 2.90 Impact Factor
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    ABSTRACT: Population-based cross-sectional prevalence survey. To define muscle relaxant use patterns in the United States. Despite a long history of use for back pain and musculoskeletal disorders, national prevalence patterns of prescription muscle relaxant use have not been defined. NHANES III (1988-1994) is an in-person health examination survey of the U.S. civilian population, based on a complex, multistage probability sample design. An estimated 2 million American adults reported muscle relaxant use (1-month period prevalence 1.0%; 95% confidence interval 0.8-1.3%). While virtually all (94%) used individual muscle relaxants rather than fixed combination muscle relaxant analgesics, two thirds took an additional prescription analgesic. Men and women had similar usage. Median user age was 42 years, but 16% of users were older than 60 years. Eighty-five percent of users took muscle relaxants for back pain or muscle disorders. Two thirds of muscle relaxant users had histories of recent back pain; however, only 4% of all those with a recent history of back pain reported any muscle relaxant use. Mean length of use was 2.1 years (95% confidence interval 1.6-2.6), with 44.5% taking medication longer than a year (95% confidence interval 35.7-53.3). Muscle relaxant use in the elderly, among older persons with ambulatory impairments, and in chronic obstructive pulmonary disease appeared undiminished compared with general population use. Although typically recommended for short-term treatment of back pain, muscle relaxants are often used chronically and are prescribed to subpopulations potentially at risk for adverse effects.
    Spine 05/2004; 29(8):892-6. DOI:10.1097/00007632-200404150-00014 · 2.45 Impact Factor
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    ABSTRACT: To estimate prescription and non-prescription analgesic use in a nationally representative sample of US adults. Data collected during the third National Health and Nutrition Examination Survey (1988-1994), for persons 17 years and older were analyzed (n = 20,050). During the household interview, respondents reported use, in the last month, of prescription and non-prescription analgesics. An estimated 147 million adults reported monthly analgesic use, Prescription analgesic use was 9% while non-prescription use was 76%. Females were more likely than males to use prescription (11 vs. 7%, p < 0.001) and non-prescription (81 vs. 71%, p < 0.001) analgesics. Across race-ethnicity groups, males (approximately 8%) and females (11-13%) had similar age-adjusted prescription analgesic use. Non-prescription analgesic use was higher among non-Hispanic whites than non-Hispanic blacks and Mexican-Americans for males (76 vs. 53% (p < 0.001) and 59% (p < 0.001), respectively) and females (85 vs. 68% (p < 0.001) and 71% (p < 0.001), respectively). With increasing age, prescription analgesic use increased whereas non-prescription use decreased. Approximately 30% of adults used multiple analgesics during a 1-month period. This was more common among females (35%) than males (25%, p < 0.001) and among younger (17-44 years, 33%) rather than older age groups (45+ years, 26%, p < 0.001). Analgesic use among US adults is extremely high, specifically of non-prescription analgesics. Given this, health care providers and consumers should be aware of potential adverse effects and monitor use closely.
    Pharmacoepidemiology and Drug Safety 06/2003; 12(4):315-26. DOI:10.1002/pds.755 · 3.17 Impact Factor
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    ABSTRACT: To determine prevalence estimates for rheumatoid arthritis (RA) in noninstitutionalized older adults in the US. Prevalence estimates were compared using 3 different classification methods based on current classification criteria for RA. Data from the Third National Health and Nutrition Examination Survey (NHANES-III) were used to generate prevalence estimates by 3 classification methods in persons 60 years of age and older (n = 5,302). Method 1 applied the "n of k" rule, such that subjects who met 3 of 6 of the American College of Rheumatology (ACR) 1987 criteria were classified as having RA (data from hand radiographs were not available). In method 2, the ACR classification tree algorithm was applied. For method 3, medication data were used to augment case identification via method 2. Population prevalence estimates and 95% confidence intervals (95% CIs) were determined using the 3 methods on data stratified by sex, race/ethnicity, age, and education. Overall prevalence estimates using the 3 classification methods were 2.03% (95% CI 1.30-2.76), 2.15% (95% CI 1.43-2.87), and 2.34% (95% CI 1.66-3.02), respectively. The prevalence of RA was generally greater in the following groups: women, Mexican Americans, respondents with less education, and respondents who were 70 years of age and older. The prevalence of RA in persons 60 years of age and older is approximately 2%, representing the proportion of the US elderly population who will most likely require medical intervention because of disease activity. Different classification methods yielded similar prevalence estimates, although detection of RA was enhanced by incorporation of data on use of prescription medications, an important consideration in large population surveys.
    Arthritis & Rheumatology 01/2003; 48(4):917-26. DOI:10.1002/art.10897 · 7.87 Impact Factor
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    ABSTRACT: To better understand disablement and transitions from impairment to disability, discrete valid measures of functional limitation are needed. This study reports the development and criterion-related validity of scales that quantify severity of upper and lower extremity functional limitation. Data are from 3,635 cognitively intact community-dwelling women aged 65 years and older and 1,002 moderately to severely disabled participants in the Women's Health and Aging Study. Scales assessing severity of upper and lower extremity functional limitation were constructed from commonly available questions on functional difficulty. Criterion-related validity was evaluated with self-report and performance-based measures. The upper and lower extremity scales range from 0 to 6 and 0 to 9, respectively. Scale scores were well distributed in the disabled group and discriminated limitations in the broader community. For both scales, rates of difficulty for all ADL and IADL increased (p<.001) with increasing severity score, and percent able and mean performance on respective upper and lower extremity tasks decreased (p<.01). These scales, constructed from commonly used self-report measures of function, provide discrete measures of upper and lower functional limitation. Because these scales are distinct from measures of disability and impairment, their use should facilitate increased understanding of the disablement process.
    The Journals of Gerontology Series B Psychological Sciences and Social Sciences 01/2001; 56(1):S10-9. DOI:10.1093/geronb/56.1.S10 · 2.85 Impact Factor
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    ABSTRACT: Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weight-bearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability.
    Annals of internal medicine 11/2000; 133(8):635-46. · 16.10 Impact Factor
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    ABSTRACT: To describe the prevalence of hand osteoarthritis (OA) by joint site, joint count and severity in a representative population of older disabled women. 1,002 moderately to severely disabled women aged > or = 65 years were selected from a representative population of community-dwelling women. Hand OA was established using a reproducible algorithm based on self-reported pain, standardized physical examinations, hand photographs, and physician questionnaire responses. OA was categorized as either symptomatic disease, intermittently symptomatic/ asymptomatic disease, possible disease, or no disease. Symptomatic OA, requiring the presence of hand pain on most days for at least 1 month, occurred in approximately 23% of disabled older women in each age group, and most reported pain in the moderate to severe range. The prevalence of intermittently symptomatic/ asymptomatic OA was higher with increasing age. Finally, the most commonly affected hand OA sites were the distal interphalangeal (DIP) and the first carpometacarpal (CMC1) joint groups. These findings demonstrate the very high prevalence of clinical hand OA in disabled older women and show that a large proportion of hand OA results in substantial symptoms.
    Osteoarthritis and Cartilage 11/2000; 8 Suppl A:S16-21. DOI:10.1053/joca.2000.0330 · 4.66 Impact Factor
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    ABSTRACT: This report provides reliability and prevalence estimates by sex, age, and race/ethnicity of an observed physical performance examination (PPE) assessing mobility and balance. The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994. A cross-sectional nationally representative survey. All persons aged 60 and older (n = 5,403) who performed the PPE either in the mobile examination center (MEC) or in the home during NHANES III (conducted 1988-1994). The PPE included timed chair stand, full tandem stand, and timed 8-foot walk. Timed chair stand and 8-foot timed walk were reliable measurements (Intraclass Correlations > 0.5). Women were significantly slower (P < .001) than men for both timed chair stands and timed walk. Non-Hispanic white men and women did the maneuvers in significantly less time than non-Hispanic black men and women and Mexican Americans women (P < .001). Lower extremity functions measured by timed chair stand and walk are reliable. Women at every age group were more physically limited than men.
    Journal of the American Geriatrics Society 09/2000; 48(9):1136-41. · 4.22 Impact Factor
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    ABSTRACT: To provide estimates by sex and age and by sex and race/ethnicity of the proportion of older Americans who have difficulty with functional limitations and daily activities. The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994. A cross-sectional nationally representative survey. All persons aged 60 and older who completed a household interview (N = 6,866) during NHANES III (conducted 1988-1994). The self-reported physical and functional disability questions from NHANES III included: lower-extremity function, instrumental activities of daily living, basic activities of daily living, needing help with personal and routine daily activities, and use of assistive devices for walking. Non-Hispanic black and Mexican-American men and women generally reported significantly (P < .01) more disability than did non-Hispanic white men and women. Disability was greater for minority women than for men. For both men and women, the prevalence in disability increased significantly (P < .01) with age for each measure. These sex-age and sex-race/ethnicity national estimates of disability indicate that minority women may represent a vulnerable subpopulation.
    Journal of the American Geriatrics Society 09/2000; 48(9):1132-5. · 4.22 Impact Factor

Publication Stats

5k Citations
151.95 Total Impact Points

Institutions

  • 1998–2013
    • Centers for Disease Control and Prevention
      • • National Center for Chronic Disease Prevention and Health Promotion
      • • National Center for Health Statistics
      • • Division of Health and Nutrition Examination Surveys
      Atlanta, MI, United States
    • National Institutes of Health
      • Laboratory of Epidemiology, Demography, and Biometry (LEDB)
      Bethesda, MD, United States
  • 1997–2001
    • National Institute on Aging
      • Laboratory of Epidemiology, Demography and Biometry (LEDB)
      Baltimore, Maryland, United States
  • 2000
    • Johns Hopkins University
      • Division of Geriatric Medicine and Gerontology
      Baltimore, MD, United States
  • 1996–1999
    • National Institute of Arthritis and Musculoskeletal and Skin Diseases
      Maryland, United States