HICN244 News Part 1/2 
Author Message
 HICN244 News Part 1/2

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Volume  2, Number 44                                      November 29, 1989

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                         Editor: David Dodell, D.M.D.
                   St. Joseph's Hospital and Medical Center
    10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA
                           Telephone (602) 860-1121
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   Copyright 1989 - Distribution on Commercial/Pay Systems Prohibited without
                              Prior Authorization

             International Distribution Coordinator: Robert Klotz
                            Nova Research Institute
            217 South Flood Street, Norman, Oklahoma 73069-5462 USA
                           Telephone (405) 366-3898

The Health Info-Com Network Newsletter is distributed weekly.  Articles  on  a
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                       T A B L E   O F   C O N T E N T S

1.  Medical News
     Medical News for Week Ending November 26, 1989 ........................  1

2.  Center for Disease Control Reports
     [MMWR 11-22-89] Eosinophilia-Myalgia Syndrome and L-Tryptophan ........  5
     Comorbidity of Chronic Conditions and Disability among Older Persons ..  9
     Chronic Disease Reports: Deaths from Chronic Liver Disease ............ 11
     Apparent Per Capita Ethanol Consumption ............................... 13

3.  Articles
     Anatomy of Elbow Pain ................................................. 15

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                                 Medical News
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                Medical News for Week Ending November 26, 1989
        Copyright 1989: USA TODAY/Gannett National Information Network
                          Reproduced with Permission

                                      ---
                                 Nov. 20, 1989
                                      ---

                            FDA SEEKS DRUG RECALL:

   The cooking.net">food and Drug Administration said Saturday it is seeking  a  nationwide
recall  of  all over-the-counter dietary supplements that contain L-tryptophan
as their sole or major component.  Reason:  Because of its  possible  link  to
eosinophilia-myalgia syndrome, a rare {*filter*} disorder. (From the USA TODAY Life
section.)

                           PARENTS MISTAKE SYMPTOMS:

   Parents  aren't  likely  to  notice "internalized" symptoms that indicate a
child is contemplating suicide, reports a study at the University of Missouri-
Columbia School of Medicine.  Suggestions: Parents should talk frequently with
their  children about things that bother them,  perceptions about other people
and the world.

                        EXPOSURE DOESN'T INCREASE RISK:

   {*filter*}-agers who are exposed to other {*filter*} suicides will be no more likely to
take their own lives, reports the Nov. 17 issue of the Journal of the American
Medical Association.  A study of suicide clusters found that youths who killed
themselves didn't have increased direct or indirect exposure to previous {*filter*}-
age suicides.

                          DOCTORS RESEARCH {*filter*}HIV:

   The  National  Institute  of  Dental  Research has launched a epidemiologic
study on the {*filter*}effects of the human immunodeficiency virus (HIV).  Why:  To
document  the  prevalence  and incidence of {*filter*}conditions that appear during
various stages of HIV infection and define risk factors  associated  with  the
conditions.

                         GROUP ISSUES CPR GUIDELINES:

   Because  of  the  hepatitis  B and human immunodeficiency virus scare,  the
Emergency Cardiac Care Committee of the American Heart Association has revised
its guidelines, reports the Journal of the American Medical Association's Nov.
17  issue.   Changes:   CPR  rescuers  can  begin  chest  compressions  before
ventilating a victim.

                         DENTISTRY EXPECTED TO CHANGE:

   The  1990s  signals a new era in the dental industry,  reports the American

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Dental  Association.   Expectations:   Breakthroughs  in  periodontal  disease
control;  dramatic  gains  in  the control of decay around old fillings and on
tooth roots in {*filter*}s;  popular use of dental implants to replace real  teeth;
expanded use of lasers and computers in dental care.

                         DENTAL IMPLANTS COME OF AGE:

   Dental  implants  are  gaining in popularity,  said Dr.  Paul Kaufmann,  an
associate professor or {*filter*}and  maxillo{*filter*}  surgery  at  both  N.Y.  State
University  School  of  Dental  Medicine and NYU School of Dentistry.  Reason:
Recent advances in implant devices and techniques have led to a higher success
rate and significant increase in use.

                         PREVENTIVE CARE HAS CHANGED:

   New methods of tooth decay prevention are being added  to  the  regimen  of
brushing,  flossing  and  fluoride use and regular dental visits,  reports the
American Dental Association.  Development: Sealants that can offer 100 percent
protection  against  tooth  decay  on  the chewing surfaces of children's back
teeth.  Made of a clear or shaded  plastic  material,  sealants  coat  against
plaque and acids.

                             SWALLOWING MEDICINE:

   Taking medicine can be fun. At least that's what comic forces hope to teach
children.  It's  in  the free D-C Comic book Super Heroes Good Health Activity
Book, starring Batman and Robin, Wonder Woman and Superman.  The booklet, from
DuPont,  in cooperation with the National Association of Retail Druggists.  It
features puzzles with safety messages. Call (800) 341-4004

                                      ---
                                 Nov. 21, 1989
                                      ---

                         HEALTH PREDICTIONS FOR 1990:

   Major advances will be made in cancer and AIDS research in  1990,  predicts
Maximilian  de  Clara,  a  well-known  biotechnology  venture  capitalist  and
president of Cel-Sci Corp.,  Alexandria,  Va.  Predictions:  Researchers  will
learn to mix anti-cancer "cocktails" of immune system modulators; AIDS vaccine
may appear sooner than expected.

                            SO FAR, NO LINK FOUND:

   Since the recent outbreak of the rare {*filter*} disorder,  eosinophilia-myalgia
syndrome,  the U.S.  Food and Drug Administration has been conducting tests to
find  out  if L-tryptophan products are linked to the disorder.  Why:  Because
many people with the illness have reported using  the  product.  Findings:  To
date, no medical evidence of a cause and effect association.

                        {*filter*} NOT GOOD FOR CHILD:

   Yelling, yanking, slapping and verbally debasing a child in public are very
stressful to a child,  said Kaoru Yamamoto, Ph.D., a University of Colorado at
Denver psychologist.  Study:  {*filter*} is  considerably  more  painful  for

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children than other kinds of crises such as the arrival of a new sibling.

                                      ---
                                 Nov. 22, 1989
                                      ---
                         ASTRONAUTS WILL SEE FLASHES:

   Astronauts on the next few shuttle flights will see bright flashes, streaks
and pops with their eyes.  Why: Subatomic particles from solar explosions will
penetrate the shuttle and finally, through the astronauts' eyes. The energized
particles travel at close to the speed of light,  pass through the  liquid  of
the eyeball and convert to light energy.

                           X-RAY HOLOGRAMS ADVANCE:

   Laser  scientists  at Lawrence Livermore National said they have achieved a
key advance toward developing an X-ray laser  source  suitable  to  eventually
produce  three  dimensional  views  of  living  cells.  How:  By achieving the
shortest X-ray laser wavelength ever - to 44.8 angstroms.  Use:  The holograms
would assist in learning about and fighting diseases.

                            BEWARE OLD PACEMAKERS:

   Health  officials  are  cautioning  hospitals  to dispose of old pacemakers
carefully.  Presently,  they are  trying  to  locate  a  pacemaker  containing
radioactive  plutonium that was mistakenly left inside the body of an Iowa man
cremated last month.  Why:  It contains plutonium 238,  a powerful radioactive
material that has been known to cause cancer.

                         CANCER STUDY AT A STALEMATE:

   Despite  advances  in  cell biology and related fields,  finding a cure for
cancer is at a stalemate, experts in the field said.  Facts: Overall incidence
of cancer and the cancer death rate still are rising.  One in  four  Americans
still  develops  cancer  and one in six dies of the disease.  Results:  Cancer
remains the leading cause of death in the U.S. after heart disease.

                          USAF TO STUDY CHOLESTEROL:

   Wilford Hall Air Force Medical Center will launch a cholesterol study. Why:
As part of an effort to reduce heart disease.  Study:  Center will screen more
than 100,000 people in South Texas who are eligible for military medical care.
Those  with  symptoms  or  high cholesterol will be followed up with a program
that could include diet, exercise and medicine.

                                      ---
                               Nov. 24-26, 1989
                                      ---

                           FOLIC ACID HELPS UNBORN:

   Pregnant women who take multivitamins  containing  folic  acid  during  the
first  weeks  of pregnancy reduce the risk of having a baby born with a spinal
cord defect, a study shows.  Results of study:  In relation to other research,

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it  should end the multivitamin-neural tube defect controversy.  (From the USA
TODAY Life section.)

                          CANCER DRUG SHOWS PROMISE:

   Camptothecin,  a compound derived from plants,  is showing  dramatic  anti-
cancer  potential  in  a  laboratory study,  reports Science's Nov.  24 issue.
Study:  Genetically engineered mice were given human colon cancers and treated
with the drug. Results: Complete remissions in some cases and very little side
effects.  (From the USA TODAY Life section.)

                         MANY AIDS CASES NOT REPORTED:

   In South Carolina between 1986 and 1987, only 59 percent of AIDS cases were
reported, reports Journal of the American Medical Association's Nov. 24 issue.
Why:  Cases  among  whites and Midwesterners are not reported probably because
doctors  want  to   protect   confidentiality,   insurance   coverage.   Fear:
Underreporting could be across the U.S. (From the USA TODAY Life section.)

                        STUDY: FILTERED BREW HEALTHIER:

   Filtered coffee,  not boiled, may be the healthier for the heart, reports a
study in New England Journal of Medicine's Nov.  23  issue.  Why:  People  who
drink  percolated  coffee  risk  a  10 percent rise in cholesterol levels over
those who drink filtered coffee. (From the USA TODAY Life section.)

                        {*filter*} TRANSMITS {*filter*} DISEASE:

   Two new reports  documented  the  first  cases  of  Chagas  disease  to  be
transmitted  via  {*filter*}  transfusions  in  the  U.S.  and Canada.  Facts:  The
disease,  caused by a parasite found mostly in Latin America,  was  contracted
from  the  {*filter*}  of Bolivian and Paraguayan immigrants.  Symptoms:  Prolonged
fever and enlargement of the spleen, liver and lymph nodes.

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                      Center for Disease Control Reports
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

                     Morbidity and Mortality Weekly Report
                          Wednesday November 22, 1989

                        Epidemiologic Notes and Reports
     Eosinophilia-Myalgia Syndrome and L-Tryptophan-Containing Products --
               New Mexico, Minnesota, Oregon, and New York, 1989

    As of November 21,  360 cases of eosinophilia-myalgia syndrome  (EMS)  had
been  reported  by  state  health  departments  to  CDC.  Studies examining an
association of L-tryptophan-containing products (LTCPs) with the EMS  epidemic
(1) have been completed in New Mexico,  Minnesota, and Oregon.  In addition, a
fatal case in New York has been reported.
    New Mexico.  In a New Mexico case-control study, EMS cases (N=12) were all
persons  for  whom  an  eosinophil  count  of  greater  than  or equal to 2000
cells/mm3 was  recorded  from  May  1  through  November  11,  1989,  in  nine
laboratories  in  Albuquerque,   Santa  Fe,   and  Los  Alamos  and  for  whom
incapacitating myalgia was documented,  either in the  medical  record  or  by
interview  with  the  patient.  Potential  cases were excluded if eosinophilia
could have been caused by any of a  predetermined  list  of  approximately  20
infectious,  neoplastic,  allergic, or other chronic diseases.  EMS cases were
compared with controls (two per case) who had been matched with  case-patients
by  age  (plus  or  minus  5  years),  sex,  and  neighborhood  of  residence.
Comparisons were made for factors such as the use of different vitamins, other
health foods or raw cooking.net">food products,  medications,  and different water sources.
All  case-patients  and  two  (8%)  controls  used  LTCPs (odds ratio (OR) not
calculable) (X2=20;  p=6.9 X 10-6).  There were no  statistically  significant
differences  between  cases  and  controls  on 32 other potential risk factors
studied.
    Minnesota. In Minnesota, potential cases for an initial case-control study
of risk factors for EMS were identified by rheumatologists (who were asked  by
the  Minnesota Department of Health to report patients recently diagnosed with
eosinophilia and either severe myalgia or muscle  weakness)  and  by  clinical
pathologists  and a pediatric neurologist (who were asked to identify patients
with muscle biopsies showing  eosinophilic  perimyositis  or  perivasculitis).
Criteria  necessary  for  these  patients  to  be  considered  as  cases  were
eosinophil count of greater than 1000 cells/mm3, myalgia or muscle weakness of
severity sufficient to affect normal daily activities, and a muscle biopsy (if
done) showing perimyositis,  perivasculitis,  or unspecified fasciitis.  As in
the  New  Mexico  study,  potential cases were excluded if EMS could have been
caused by any of a predetermined list of diseases known to be associated  with
eosinophilia.  Investigators had no prior knowledge of patients' use of LTCPs.
Twelve cases were identified and compared with controls (one per case) matched
by age,  sex,  and telephone exchange.  All case-patients and no controls used
LTCPs  (OR  not  calculable)  (p=8  X  10-4)  during the month before onset of
illness for case-patients  and  during  a  similar  time  period  for  matched
controls.  Nine  (75%)  case-patients and four (33%) controls were taking some
type  of  prescription  medication  (not   statistically   significant   after
adjustment  for use of LTCPs).  Illness was not associated with consumption of
vitamins and  health-food  products,  wild  game,  undercooked  meat  or  fish
products, or nonprescription medications.
    A  follow-up study compared 30 EMS cases fitting the CDC surveillance case

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definition of EMS (1) with 36 asymptomatic users of LTCPs who responded  to  a
public request and contacted the Minnesota Department of Health.  Twenty (67%)
case-patients reported using  brands  of  LTCPs  from  one  particular  tablet
manufacturer,  compared  with  eight  (22%)  asymptomatic  users (OR=7.0;  95%
confidence interval (CI)=1.5-24.6 (p less  than  0.0002)).  Asymptomatic  LTCP
users  were  similar  to case-patients for age,  sex,  and geographic areas of
residence;  additional  population-based  studies  of  LTCP  use  continue  in
Minnesota.
    Oregon.  The  Oregon Health Division studied 29 EMS patients who conformed
with the CDC case definition.  All had eosinophilia  and  myalgia;  four  also
reported  respiratory signs or symptoms.  These patients,  all users of LTCPs,
were compared with users of LTCPs identified by a random telephone  survey  of
Oregon  residents  (control  group  A;  N=32)  and  asymptomatic  LT users who
contacted the Oregon Health Division (control group B;  N=24).  Four{*filter*} (48%)
case-patients  were  exposed  to  LTCPs  from  a  single  lot of 4500 bottles,
compared with two (6%) persons in control group A  and  two  (8%)  persons  in
control  group  B  (ORs=14.0  (95%  CI=2.5-103.0)  and 10.3 (95% CI=1.8-76.8),
respectively) who were so  exposed.  This  association  remains  statistically
significant when controlled for age, sex, or average daily LTCP consumption.
    New  York.  In  New York,  a 58-year-old woman with EMS died September 17,
1989.  The patient, who had become ill in July 1989 with myalgia, fatigue, and
marked  progressive  weakness,  had  been  taking  5-6 g of LT daily.  She had
leukocytosis (19,800 cells/mm3) with 18% eosinophils.  Electromyelographic and
nerve conduction studies were most consistent with axonal neuropathy.  Studies
considered  to be within normal limits included:  cerebrospinal fluid glucose,
protein,  and cell counts and celiac and renal arteriograms.  Serologic  tests
for  a variety of autoimmune diseases were negative.  The patient developed an
ascending  polyneuropathy  with  near-total  quadriplegia   and   a   bi{*filter*}
hemiparesis.  She  failed  to  improve  on corticosteroid and cyclophosphamide
treatment and died following cardiorespiratory arrest.

Reported by:  M Eidson, DVM, R Voorhees, MD, M Tanuz, CM Sewell,  DrPH,  State
Epidemiologist, New Mexico Health and Environment Dept.  SL Glickstein, MD, WE
Muth, MD, Park Nicollet Medical Center, Minneapolis;  MT Osterholm, PhD, State
Epidemiologist, Minnesota Dept of Health. DW Fleming, MD, LR Foster, MD, State
Epidemiologist, Oregon Health Div, Oregon Dept of Human Resources. A Finn, Jr,
MD,  Univ  Medical Center,  Stonybrook;  J Melius,  MD,  DL Morse,  MD,  State
Epidemiologist, New York State Dept of Health. Div of Field Svcs, Epidemiology
Program Office;  Health Studies Br and Surveillance and Programs  Br,  Div  of
Environmental Hazards and Health Effects,  Center for Environmental Health and
Injury Control, CDC.

Editorial Note: The case-control studies in New Mexico and Minnesota establish
a statistically significant association between use of LTCPs  and  development
of  EMS.  The  strength  of this association,  the temp{*filter*}relationship,  the
absence of apparent selection or data-ascertainment biases, and the failure of
different potential confounders to account for this  association  support  the
potential  causal  relationship.  In  addition,  of  the  85 case-patients who
initially called  CDC  before  the  full  implementation  of  the  state-based
reporting system and for whom information on LTCP use was available,  only one
(1%) did not use LTCPs.  However,  the biologic mechanism for the  development
of EMS among LTCP users is unclear.
    The report of an EMS-associated death in New York emphasizes the potential
severity  of  this condition,  and confirmatory data are being sought on other
possible EMS-associated deaths.  In the fatal case,  the severe Guillain-Barre

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syndrome-like  ascending  polyneuropathy  resembles clinical manifestations in
patients with the intermediate and chronic phases of toxic-oil syndrome (TOS),
a disease similar to EMS that was epidemic in  Spain  in  1981  (2--5).  Frank
vasculitis has been reported in some EMS cases. Physicians caring for patients
with  EMS  should  be  alert to the possibility that such patients may develop
clinical manifestations similar to those of chronic TOS,  including peripheral
neuropathy (mononeuritis multiplex), thromboembolic phenomena, sclerodermiform
skin  changes,  joint  contractures,  and  pulmonary hypertension (2-5).  Case
reports received at CDC suggest that, as with TOS, the clinical manifestations
of EMS may not regress immediately on removal of LTCPs.
    The findings of the lot and brand-name studies in  Minnesota  and  Oregon,
suggest multiple interpretations:  some LTCPs could contain a contaminant that
is causally associated with EMS;  or host factors mediating the response to LT
may  be  unique  to  patients  who  use  a  particular  brand or set of brands
associated with  illness.  Studies  under  way  include  identifying  possible
chemical or microbial contaminants in LTCPs, tracing the sources of individual
brands and lots,  identifying host factors related to clinical manifestations,
and determining factors associated with use and purchase of LTCPs.
    On November 17,  the cooking.net">food and  Drug  Administration  (FDA)  announced  its
intention  to seek a nationwide recall of all LTCPs in which LT is the sole or
major component;  this reinforced a November 11 alert to the public to refrain
from  using  LTCPs.  FDA  is  attempting to trace suspect lots of LTCPs and is
evaluating production procedures  at  the  companies  in  Japan  where  LT  is
produced for eventual sale and consumption in the United States.
    CDC's  initial  surveillance  case  definition  for  EMS required specific
serologic testing or muscle biopsy to rule out trichinosis (1). It now appears
the clinical presentation of some EMS patients may  be  sufficiently  distinct
from  that of trichinosis patients that such specific laboratory tests are not
warranted.  Accordingly,  the CDC surveillance definition  of  EMS  no  longer
requires  specific  laboratory  testing  for  trichinella.  CDC now recommends
defining EMS as an illness characterized by 1)  eosinophil  count  of  greater
than  or  equal  to 1000 cells per mm3,  2) generalized myalgia (at some point
during the course of illness) of severity sufficient  to  affect  a  patient's
ability  to  pursue  his or her usual daily activities,  and 3) absence of any
infection or neoplasm that could account for 1 or 2  above.  This  change  has
been communicated to state health departments.
    Epidemiologic  investigations  and  research  studies  of  EMS  should  be
directed toward further defining a causal association between  LTCPs  and  EMS
and  identifying  specific  etiologic factors and possible cofactors tha t may
modify risk.  Additional questions relate to the existence of a possible dose-
response effect, the latent period between exposure and disease, establishment
of  the  beginning  of  the  epidemic,  determination  of the full spectrum of
clinical  manifestations,   elucidation  of   pathogenetic   mechanisms,   and
determination of prognosis and the response to specific therapies.

References

1. CDC. Eosinophilia-myalgia syndrome--New Mexico. MMWR 1989;38:765-7.

2.  Grandjean P, Tarkowski S, eds.  Toxic oil syndrome: mass cooking.net">food poisoning in
Spain--report of a WHO meeting,  Madrid 21-25 March  1983.  Copenhagen:  World
Health Organization Regional Office for Europe, 1984.

3.  Toxic Epidemic Syndrome Study Group. Toxic epidemic syndrome, Spain, 1981.
Lancet 1982;2:697-702.

Health InfoCom Network News                                             Page  7
Volume  2, Number 44                                      November 29, 1989

4. Kilbourne EM, Rigau-Perez JG, Heath CW JR, et al.  Clinical epidemiology of
toxic-oil   syndrome:   manifestations  of  a  new  illness.   N  Engl  J  Med
1983;309:1408-14.

5.  Martinez Tello FJ, Navas Palacios JJ, Ricoy JR, et al.  Pathology of a new
toxic syndrome caused by ingestion of {*filter*}erated oil in Spain.  Virchows Arch
(A) 1982;397:261-85.

*Includes persons reporting they currently had a cataract, had had surgery for
a cataract, or had had a lens implant for a cataract.

**Includes  persons  who  reported  they  had ever had coronary heart disease,
angina pectoris, myocardial infarction, or any other "heart attack."

Health InfoCom Network News                                             Page  8
Volume  2, Number 44                                      November 29, 1989

                                Current Trends
    Comorbidity of Chronic Conditions and Disability among Older Persons --
                              United States, 1984

    Although the coexistence of  chronic  conditions  (i.e.,  comorbidity)  is
considered  common  in the older population,  there has been little systematic
evaluation  of  the  prevalence,  patterns,   and  impact  of  comorbidity  in
representative populations (1). Data from the Supplement on Aging (SOA) to the
1984 National Health Interview Survey were analyzed to evaluate the prevalence
and impact of comorbidity.
    The  National Health Interview Survey,  conducted by CDC's National Center
for  Health   Statistics,   is   a   continuing   survey   of   the   civilian
noninstitutionalized population of the United States. In 1984, all respondents
aged  greater  than  or equal to 65 years and a 50% sample of those aged 55-64
years were asked to also respond to questions on the SOA. The SOA was designed
to collect information about chronic  conditions,  physical  limitations,  and
other  health-related  and  social  information  about  middle-aged  and older
persons (2). In total, 16,148 interviews were conducted.  This report presents
results  for  the  13,807  persons  aged  greater  than  or equal to 60 years,
representing an estimated U.S.  population of 37,256,000 in this age group  in
1984.
    Emphasis  was  placed  on nine common chronic conditions in the population
aged greater than or equal to  60  years,  including:  arthritis,  present  in
49.0%;   hypertension,  41.8%;  cataracts,*  19.9%;  heart  disease,**  14.0%;
varicose veins, 9.9%; diabetes, 9.5%; cancer (except nonmelanoma skin cancer),
6.6%; osteoporosis/hip fracture, 5.5%; and stroke, 5.4%.
    The proportion of the population greater than or equal to 60 years of  age
with  two  or more of the nine chronic conditions increased with age and,  for
each age group, was higher for women than for men (Table 1).  For persons aged
greater than or equal to 80 years, 70% of women and 53% of men had two or more
of the nine conditions.
    Prevalence of comorbidity is directly related to the prevalence of each of
the individual conditions. Hypertension and arthritis, the two conditions with
the highest prevalence,  co-occurred in 24.1% of persons greater than or equal
to 60 years of age; cataract and arthritis were both reported by 11.7% (Figure
1).  The remaining six pairs  of  the  most  common  comorbid  conditions  had
coprevalences that ranged from 5.5% to 9.6%.
    If the prevalences of two conditions are assumed to be independent,  their
expected coprevalence is the product of  their  individual  prevalence  rates.
However,  for each of the eight most common pairs of conditions,  the observed
comorbidity exceeded the expected (Table 2).  Except for  the  comorbidity  of
cataract  with hypertension in men,  each of these increases was statistically
significant (p less than 0.001, adjusted for the complex sampling design).
    Respondents were asked if they received assistance with six activities  of
daily living:  getting in and out of bed or chair,  walking, using the toilet,
bathing or showering,  dressing,  and eating.  The percentage of men and women
receiving  assistance  with one or more of these activities increased directly
with the number of chronic conditions (Table 3).

Reported by:  JM Guralnik,  MD,  AZ LaCroix,  PhD,  DF Everett,  MS,  National
Institute on Aging, National Institutes of Health.  Office of Vital and Health
Statistics Systems,  National Center for  Health  Statistics;  Office  of  the
Director, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note: Analysis of the 1984 SOA data indicates that the prevalence of

Health InfoCom Network News                                             Page  9
Volume  2, Number 44                                      November 29, 1989

comorbidity of chronic conditions in the noninstitutionalized older population
is  substantial.  Comorbidity prevalence rates for the nine chronic conditions
are highest for women,  increasing from 45% in persons aged 60-69 years to 70%
in persons aged greater than or equal to 80 years.
    For  the  most  commonly  reported  pairs  of  conditions,   the  observed
--- end part 1 of 2 cut here ---



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