D M Makuc

Centers for Disease Control and Prevention, Druid Hills, GA, United States

Are you D M Makuc?

Claim your profile

Publications (27)133.65 Total impact

  • Source
    D D Ingram, D M Makuc, J J Feldman
    American Journal of Epidemiology 10/1997; 146(6):528-9. · 4.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several studies have examined relatively large body iron stores and the risk of coronary heart disease with conflicting results. No reports of studies that associated body iron stores with stroke were found. To test the hypothesis that relatively high transferrin saturation is associated with increased stroke incidence and mortality in women and men, data from a follow-up study of a national cohort were examined. A total of 5,033 women and men aged 45-74 years from the First National Health and Nutrition Examination Survey Epidemiologic Followup Study who were free of stroke at baseline were followed an average of 12 years. Transferrin saturation (serum iron concentration divided by total iron binding capacity) was used as a measure of the amount of circulating iron available to tissues. In white women aged 45-74, after adjusting for age or for age and other risk variables, the authors observed a significant U-shaped association of transferrin saturation with risk of incident stroke (> 44% vs. 30-36%, relative risk = 1.96, 95% confidence interval 1.15-3.36; < 20% vs. 30-36%, relative risk = 1.80, 95% confidence interval 1.20-2.71). However, no significant associations were found in white men aged 45-74 after adjusting for other risk variables. Similar findings were observed for stroke mortality in whites, but no significant associations were seen in blacks. The significantly increased risk of stroke that was seen at both high and low levels of transferrin saturation in white women should be confirmed in other cohorts of women and men.
    American Journal of Epidemiology 07/1996; 144(1):59-68. · 4.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Erythrocyte sedimentation rate (ESR) is a simple and relatively inexpensive laboratory test. Data were examined to determine whether elevated ESR was a predictor of CHD incidence and death in a large U.S. national sample of persons aged 45-74 at baseline. In the NHANES I Epidemiologic Follow-up Study cohort, white men aged 45-64 years with ESR in the upper quintile at baseline had increased incidence of CHD (RR = 1.73, 95% CL 1.12, 2.68) over a 15 year follow-up after controlling multiple risk factors compared to white men with ESR in the lowest quintile. Furthermore, men aged 45-64 with ESR in the upper quintile had more than twice the risk of CHD death (RR = 2.73, 95% CL 1.21, 6.15) of men with ESR in the lowest quintile after adjusting other risk factors. No significant associations were seen in white women. The mechanism of this association is unclear. Further studies are needed to replicate this finding and elucidate the mechanism for this association in longitudinal studies in which plasma fibrinogen, HDL cholesterol, as well as ESR are measured.
    Journal of Clinical Epidemiology 04/1995; 48(3):353-61. · 5.33 Impact Factor
  • R F Gillum, D D Ingram, D M Makuc
    [Show abstract] [Hide abstract]
    ABSTRACT: Relatively high serum albumin levels have been associated with reduced cardiovascular mortality and coronary heart disease incidence. No prospective studies have examined serum albumin and stroke mortality and incidence. Therefore, data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study were examined to assess serum albumin level as a risk factor for stroke. White men aged 65-74 years with serum albumin concentrations of > 4.4 g/dl had a risk of stroke incidence over a follow-up period of 9-16 years of only about two-thirds that of men with serum albumin concentrations of < 4.2 g/dl. This effect persisted after controlling for multiple stroke risk variables (relative risk = 0.61, 95% confidence interval 0.41-0.89). A similar association with stroke death was found in white men aged 65-74 years. Serum albumin was not associated with stroke risk in white women aged 65-74 years. In blacks aged 45-74 years, serum albumin concentrations of > 4.4 g/dl were associated with a risk of stroke incidence only one-half and a risk of stroke death only one-fourth that seen at levels < 4.2 g/dl after controlling other risk variables. Further studies are needed to confirm these findings and to elucidate mechanisms for the effect of serum albumin on stroke incidence and death.
    American Journal of Epidemiology 11/1994; 140(10):876-88. · 4.78 Impact Factor
  • D D Ingram, D M Makuc
    [Show abstract] [Hide abstract]
    ABSTRACT: This report presents alternative strategies for analysis of data from the NHANES I Epidemiologic Followup Study (NHEFS) using Cox proportional hazards and person-time logistic regression models. Analytic issues related to the complex survey design of the NHANES I and the variable length of followup of NHEFS participants are discussed.
    Vital and health statistics. Series 2, Data evaluation and methods research 06/1994;
  • R F Gillum, D D Ingram, D M Makuc
    [Show abstract] [Hide abstract]
    ABSTRACT: A 1982 report (J Chronic Dis 1982;35:703-14) that a relatively high white blood cell (WBC) count predicted increased incidence of cerebral thrombosis could not establish whether this association was independent of smoking. Therefore, the authors examined data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, conducted in 1971-1987, to assess WBC count as a risk factor for stroke in a sample of the US population. White men with a WBC count of > 8,100 cells/mm3 had a 39% increase in age-adjusted stroke incidence compared with those with a WBC count of < 6,600 cells/mm3. However, controlling for cigarette smoking reduced the association and rendered it statistically nonsignificant (relative risk = 1.26, 95% confidence interval 0.93-1.70). No significant associations of WBC count with stroke incidence were seen in white women or in blacks. In white men, elevated WBC count may be a mediator of cardiovascular effects of smoking, an indicator of smoking exposure, or both. Further studies are needed to confirm these findings and to elucidate mechanisms for the effect of smoking and WBC count on stroke incidence and death.
    American Journal of Epidemiology 05/1994; 139(9):894-902. · 4.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Recent studies have suggested an association between higher body iron stores and the risk of coronary heart disease. To assess these findings, we examined the association between transferrin saturation and the risk of coronary heart disease, myocardial infarction, overall mortality, and mortality from cardiovascular causes in a large population. We studied a total of 4518 men and women from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, using a multivariate Cox proportional-hazards model. Base-line data were collected from 1971 to 1974, with follow-up through 1987. Transferrin saturation (serum iron concentration divided by total iron-binding capacity) was used as a measure of the amount of circulating iron available to tissues. The risk of coronary heart disease was not related to transferrin-saturation levels in white men or women. Estimates of the relative risk of coronary heart disease for the fifth quintile of transferrin saturation as compared with the first quintile were 0.72 (95 percent confidence interval, 0.51 to 1.00) for men and 0.85 (95 percent confidence interval, 0.60 to 1.21) for women. The results were similar for myocardial infarction. A significant inverse association with transferrin saturation was found for overall mortality and for mortality from cardiovascular causes in white men and women. Transferrin saturation was not associated with any of the clinical outcomes in blacks, possibly owing to the small sample. Higher transferrin-saturation levels were not associated with an increased risk of coronary heart disease or myocardial infarction. On the contrary, the results indicate that there may be an inverse association of iron stores with overall mortality and with mortality from cardiovascular causes.
    New England Journal of Medicine 05/1994; 330(16):1119-24. · 51.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about the relation of overweight to risk of coronary heart disease in older women. In this paper, the authors used measured weight for 1,259 white women aged 65-74 years from the Epidemiologic Follow-up Study of the First National Health and Nutrition Examination Survey to examine the effect of overweight on coronary heart disease incidence (mean length of follow-up, 14 years). They also used reported lifetime maximum weight to examine the effect of weight loss on this association. Women with a Quetelet index (weight (kg)/height (m)2) of 29 or more showed an increased risk of coronary heart disease (relative risk (RR) = 1.5, 95% confidence interval (CI) 1.1-2.1) after adjustment for age and smoking in comparison with those with a Quetelet index of less than 21, while women with a Quetelet index of 23-24 had a lower risk of coronary heart disease (RR = 0.6, 95% CI 0.4-0.9). However, the pattern of risk associated with measured weight was modified by weight loss. Among heavier women whose weight was relatively stable, those with a Quetelet index of 29 or more had an increased risk of heart disease (RR = 2.7, 95% CI 1.7-4.4). Among those with greater weight loss, the relation between Quetelet index and risk of coronary heart disease was J-shaped. Overweight is an independent risk factor for coronary heart disease in older women, a finding strengthened after previous weight loss is accounted for. Reasons for the unexpected increase in risk of coronary heart disease in thinner women who lost weight are unclear, and further investigation is warranted.
    American Journal of Epidemiology 07/1993; 137(12):1318-27. · 4.78 Impact Factor
  • R F Gillum, D D Ingram, D M Makuc
    [Show abstract] [Hide abstract]
    ABSTRACT: To confirm the reported association of elevated WBC count with increased risk of CHD incidence and death in white men and to determine whether such associations exist for CHD incidence and death in women and blacks, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 7 to 16 years, WBC counts > 8100 cells/mm3 compared with WBC counts < 6600 cells/mm3 were associated with increased risk of CHD incidence in white men (RR = 1.31; 95% CL 1.07, 1.61) and in white women (RR = 1.31; 1.05, 1.63) aged 45 to 74 after adjustment for baseline risk factors. The association was found in white female but not in white male subjects who had never smoked. Increases in risk of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also seen in all white men in the sample. RRs for death for all causes at ages 45 to 74, which compared the upper and lower strata of WBC counts, were 1.43 (95% CL 1.22, 1.68) in all white men and 1.33 (95% CL 1.00, 1.78) in subjects who had never smoked after adjustment for baseline risk factors. Similar increases in risk of death from all causes were seen in blacks aged 45 to 64 despite small sample size. Thus this analysis failed to clearly establish an increased risk of CHD incidence in white men with relatively elevated WBC counts who never smoked cigarettes, although such an association was evident in white women. The increased risk of death from all causes in men appeared to be only partially due to effects of smoking.(ABSTRACT TRUNCATED AT 250 WORDS)
    American Heart Journal 03/1993; 125(3):855-63. · 4.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The relationship of low serum cholesterol and mortality was examined in data from the NHANES I Epidemiologic Followup Study (NHEFS) for 10,295 persons aged 35-74, 5833 women with 1281 deaths and 4462 men with 1748 deaths (mean (followup = 14.1 years). Serum cholesterol below 4.1 mmol/l was associated with increased risk of death in comparison with serum cholesterol of 4.1-5.1 mmol/l (relative risk (RR) for women = 1.7, 95% confidence interval (CI) = (1.2, 2.3); for men RR = 1.4, CI = (1.1, 1.7)). However, the low serum cholesterol-mortality relationship was modified by time, age, and among older persons, activity level. The low serum cholesterol-mortality association was strongest in the first 10 years of followup. Moreover, this relationship occurred primarily among older persons (RR for low serum cholesterol for women 35-59 = 1.0 (0.6, 1.8), for women 70-74, RR = 2.1 (1.2, 3.7); RR for low serum cholesterol for men 35-59 = 1.2 (0.8, 2.0), for men 70-74, RR = 1.9 (1.3, 2.7)). Among older persons, however, the low serum cholesterol-mortality association was confined only to those with low activity at baseline. Factors related to underlying health status, rather than a mortality-enhancing effect of low cholesterol, likely accounts for the excess risk of death among persons with low cholesterol. The observed low cholesterol-mortality association therefore should not discourage public health programs directed at lowering serum cholesterol.
    Journal of Clinical Epidemiology 07/1992; 45(6):595-601. · 5.33 Impact Factor
  • R F Gillum, D M Makuc
    [Show abstract] [Hide abstract]
    ABSTRACT: To confirm a reported association between elevated serum albumin concentrations and reduced risk of death in middle-aged white men and to determine whether such associations exist for CHD incidence in white men and CHD and death in white women and black men and women, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 9 to 16 years, serum albumin concentrations of 4.5 gm/dl or more were associated with reduced risk of CHD incidence in white men aged 45 to 64 years (RR = 0.51; 95% CL = 0.36, 0.73) and in white women aged 45 to 74 years (RR = 0.70; 95% CL = 0.55, 0.88), independent of baseline risk factors. Independent reductions in risk of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also seen in white men and women. Relative risk of death from all causes at ages 45 to 74 years in the white population was 0.73 (95% CL = 0.62, 0.85) for men and 0.71 (95% CL = 0.59, 0.85) for women. Similar reductions in risk of death from all causes and cardiovascular diseases were seen in black men and women, despite the small numbers. Further studies are needed to confirm these findings for women and black persons and to elucidate mechanisms for the effect of serum albumin.
    American Heart Journal 03/1992; 123(2):507-13. · 4.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The relationship between cholesterol and 14-year incidence of coronary heart disease was compared for men and women of two age groups, 25 to 64 years and 65 to 74 years. While cholesterol levels of 6.2 mmol/L or higher were associated with a risk of coronary heart disease in the younger group, this was not true for either men or women aged 65 to 74. Further analyses for older persons showed that weight loss modified the cholesterol-heart disease relationship. Those with stable weight showed a positive relationship between cholesterol and coronary heart disease, similar to the younger age group (relative risk [RR] = 1.8 [95% confidence interval: 1.1, 2.9] for men; RR = 1.6 [.7, 3.4] for women). Among those with a weight loss of 10% or more, the relationship of cholesterol to heart disease was inverse (RR = .8 [.5, 1.2] for men; RR = .6 [.3, 1.0] for women). These data suggest that the relationship of cholesterol to coronary disease in healthier older persons may be similar to that in younger persons, and that health status should be considered in analyses of cholesterol risk in old age.
    Annals of Epidemiology 01/1992; 2(1-2):35-41. · 2.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objectives of this report are to document methods used to identify health service areas for the United States and to describe and evaluate these areas. A health service area is defined as one or more counties that are relatively self-contained with respect to the provision of routine hospital care. Service areas that include more than one county are characterized by travel between the counties for routine hospital care.
    Vital and health statistics. Series 2, Data evaluation and methods research 12/1991;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although coronary heart disease remains a leading cause of death and disability in old age, the relationship of serum cholesterol level to risk of coronary heart disease in old age is controversial. Data for 2,388 white persons aged 65-74 who participated in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS) were examined to determine the relationship of serum cholesterol level to coronary heart disease incidence and whether activity level would modify this relationship. While there was no overall relationship between serum cholesterol level and coronary heart disease risk in either men or women, the relationship between serum cholesterol level and coronary heart disease differed within activity groups. For persons who were more active, serum cholesterol level was associated with a graded increase in risk of coronary heart disease, from 1.3 (95% CI 0.7, 2.3) in those with serum cholesterol level of 4.7-5.1 to 1.7 in those with serum cholesterol level of 6.2 mmol/L or more (95% CI 1.0, 2.7), when compared with those with serum cholesterol level below 4.7. For the least active persons, all levels of cholesterol were associated with a significant inverse relative risk, including cholesterol of 6.2 mmol/L or more (Relative risk = 0.4 (95% CI 0.2, 0.7]. These data suggest that factors such as activity level may modify the serum cholesterol-coronary heart disease association in old age. The serum cholesterol-coronary heart disease association in more active older persons resembles that seen in younger populations, whereas the association in less active persons is that of serum cholesterol level and risk of cancer or death. The modification of the serum cholesterol-coronary heart disease association by activity level may have implications for appropriate clinical management as well as appropriate design of research studies of this association.
    Journal of the American Geriatrics Society 09/1991; 39(8):747-54. · 3.98 Impact Factor
  • R F Gillum, D M Makuc, J J Feldman
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine whether associations of elevated resting pulse rate with CHD incidence or death in white men are independent of other risk factors and whether such associations exist for women and blacks, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 6 to 13 years, elevated RR for CHD incidence were found for older white men with baseline pulse greater than 84 beats/min compared with less than 74 beats/min after controlling multiple risk factors (RR = 1.37, 95% CL 1.02, 1.84). Risks of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also elevated for white men with elevated pulse rate independent of other risk factors. CHD incidence was increased in white women with elevated pulse rate. Risks of death from all causes, cardiovascular diseases, and noncardiovascular diseases, were also elevated for white men with elevated pulse rate independent of other risk factors. CHD incidence was increased in white women with elevated pulse rate. Risk of death from all causes and cardiovascular diseases was elevated in black men and women with elevated pulse rate. Risk of death from noncardiovascular disease was elevated in black men with elevated pulse rate. The association with cardiovascular death was particularly striking in black women, even after adjusting for baseline risk factors (RR 3.03, 95% CL 1.46, 6.28). Further studies are needed to assess associations of pulse rate with CHD in blacks and to elucidate mechanisms in all groups.
    American Heart Journal 02/1991; 121(1 Pt 1):172-7. · 4.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Measurement of the availability of health care providers in a geographic area is a useful component in assessing access to health care. One of the problems associated with the county provider-to-population ratio as a measure of availability is that patients frequently travel outside their counties of residence for health care, especially those residing in nonmetropolitan counties. Thus, in measuring the number of providers per capita, it is important that the geographic unit of analysis be a health service area. We have defined health care service areas for the coterminous United States, based on 1988 Medicare data on travel patterns between counties for routine hospital care. We used hierarchical cluster analysis to group counties into 802 service areas. More than one half of the service areas include only nonmetropolitan counties. The service areas vary substantially in the availability of health care resources as measured by physicians and hospital beds per 100,000 population. For almost all of the service areas, the majority of hospital stays by area residents occur within the service area. In contrast, for 39 percent of counties, the majority of hospital stays by county residents occur outside the county. Thus, the service areas are a more appropriate geographic unit than the county for measuring the availability of health care.
    The Journal of Rural Health 01/1991; 7(4 Suppl):347-56. · 1.44 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The authors examined national changes in socioeconomic differentials in mortality for middle-aged and older white men and women in the United States with the use of 1960 data from the Matched Records Study and 1971-1984 data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). In 1960, there was little difference in mortality by educational level among middle-aged and older men. Since 1960, death rates among men declined more rapidly for the more educated than the less educated, which resulted in substantial educational differentials in mortality in 1971-1984. In contrast, among women, death rates declined at about the same rate regardless of educational attainment, so that a strong inverse relation between education and mortality in 1960 remained about the same magnitude during 1971-1984. Trends in educational differentials for heart disease mortality are responsible for much of the change for all causes of death. Relative risk estimates based on the NHEFS indicate that after taking into account selected baseline risk factors the least educated are still at substantially elevated risk of death from heart disease, ranging from a relative risk of 1.38 for men aged 65-74 years at baseline to 2.27 for men aged 45-64 years. Reasons for the observed educational differentials and their changes over time are not easily explained and are likely to be multifactorial.
    American Journal of Epidemiology 06/1989; 129(5):919-33. · 4.78 Impact Factor
  • Source
    D M Makuc, V M Freid, J C Kleinman
    [Show abstract] [Hide abstract]
    ABSTRACT: This study investigates national changes between 1973-74 and 1985 in women's use of three preventive health services based on data from the National Health Interview Survey. Smoothed proportions of women with recent preventive care were estimated using weighted least squares for subgroups categorized by age (20-39, 40-59, 60-79), race (White, Black), income (poor, nonpoor), and year of interview. Older women and Black women experienced the largest increases in recent use of clinical breast examinations and Pap tests. Between 1973 and 1985 changes in recent breast examination ranged from zero for White women ages 20-39 years to a 23 percentage point increase (95% CI = 17,30) for Black women ages 60-79 years. A similar pattern was found for Pap testing. Changes between 1974 and 1985 in recent blood pressure testing ranged from zero for women ages 20-39 years to an 8 percentage point increase (95% CI = 6, 10) for women ages 60-79 years. Despite the increases among older women, in 1985 recent use of breast exams and Pap tests remained lower among older women. Further, the poor remained less likely than the nonpoor to have recent preventive care (except blood pressure testing among older women). Most women without recent cancer screening tests had a recent physician contact, highlighting the need for greater emphasis on cancer prevention by health care providers.
    American Journal of Public Health 02/1989; 79(1):21-6. · 3.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Using birth certificate data, national trends in prenatal care use are examined for White and Black mothers overall, as well as for 10 separate subgroups defined by marital status, maternal age, and educational attainment. The per cent of Black mothers with early prenatal care increased each year during the 1970s but the average annual percentage point increase for 1976-80 (1.2) was smaller than that for 1970-75 (2.3). Furthermore, the per cent of Black mothers with early care declined from 62.6 in 1980 to 61.4 in 1982 and remained at this lower level in 1983. Similar changes in trends were observed for all of the 10 Black subgroups despite substantial variation among the subgroups in the level of early prenatal care use. Analyses of state trends provide further evidence of a change in trend for Black mothers. For White mothers, average annual increases in the per cent with early care were similar for 1970-75 and 1976-80 (0.8 and 0.6 percentage points). In addition, the per cent with early care has remained stable since 1980.
    American Journal of Public Health 05/1986; 76(4):415-23. · 3.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This article evaluates three alternative definitions of physician service areas using data from the 1978 National Health Interview Survey. The three types of areas are county aggregations based on different data sources: the Bureau of Economic Analysis Economic Areas (BEAAs), Ranally Basic Trading Areas (RBTAs), and Health Care Commuting Areas (HCCAs). The three types of areas differ substantially in size, population, urbanization, and the availability of physicians. The overall percentage of physician visits outside each of the three areas was small, ranging from 3 percent for BEAAs to 5 percent for RBTAs and HCCAs. Visits by nonmetropolitan residents were about four times as likely as those by metropolitan residents to occur outside of each area. The results suggest that HCCAs are the most appropriate primary care physician service areas because they are the smallest in size and population and have the greatest variability in physician supply, yet they exhibit an amount of outside-area travel for care similar to that of the two larger types of areas.
    Health Services Research 05/1985; 20(1):1-18. · 2.29 Impact Factor