Notes Washed Up in a Bottle

Don. W. MacCorquodale M.D. M.S.P.H.

Periodic Notes From the Field on Philosophy and Science.

NATIONAL HEALTH INTERVIEW SURVEY, 2004

          The first National Health Interview Survey, NHIS, was conducted in the U. S. in 1957, and a NHIS has been conducted annually ever since.  The NHIS questionnaire has been revised every 10-15 years.  In 1995, the sample design was changed to include oversampling of black and Hispanic persons.  In 1997 a substantially revised instrument was introduced as well as a computer-assisted personal interviewing.  (www.cdc.gov/nchs/)
          The main objective of NHIS is to monitor the health of the U. S. population.  The target population is the civilian, non-institutionalized population of the U. S.  Each year a representative sample of households across the country is selected using a multistage cluster sample design. 
          The interviewed sample for 2004 consisted of more than 36,000 households, which yielded more than 37,000 adults eligible for interview.  Data were collected for more than 31,000 adults 17 years of age and over, a response rate of 73%. 

Selected highlights

Selected circulatory conditions

1. About 12% of adults had been told by a doctor or other health professional that they had heart disease; 6% coronary heart disease.
2. Asian and black adults were less likely to have ever been told that they had heart disease than white adults.  Asian and white adults were less likely to have been told they had hypertension than black adults.
3. Non-Hispanic white men had the highest percentage of heart disease (including coronary heart disease).

Selected respiratory conditions

1. About 2% of adults had been told by a doctor or other health professional that they had emphysema.
2. Ten percent had been told they had asthma.
3. About 14% were told they had sinusitis.
4. Asian adults were less likely than black or white adults to have been told that they had sinusitis.

Selected cancers

1. About 7% of adults had been told by a doctor or other health professional that they had some form of cancer.
2. Eight percent of non-Hispanic white adults had been told they had some form of cancer compared with 4% of non-Hispanic black adults and 4% of Hispanic adults. 

Diabetes, ulcers, kidney disease, liver disease, and arthritis and chronic joint symptoms.

1. About 7% of the adult population had ever been told by a doctor or other health professional they had diabetes.
2. Twenty-two percent had ever been told they had some form of arthritis, gout, fibromyalgia, etc., and 27% had chronic joint symptoms.
3. American Indian and Alaska Native adults and black adults had higher percentages of diabetes compared with the white population.  Asian adults were less likely to have arthritis or chronic joint symptoms than members of other racial/ethnic groups. 

Pain

1. During the 3 months prior to the interview, 15% of adults had experienced a migraine or severe headache.  About 27% had experienced pain in the lower back.
2. Adults 18-44 years of age were less likely to have experienced pain in the lower back during the 3 months prior to interview compared with older adults. 
3. Asian adults were less likely to have migraine or pain in the lower back than members of other racial/ethnic groups. 

Cigarette Smoking

1. 21% of adults 18 years of age and older were current cigarette smokers.  About 21% were former smokers, and 58% had never smoked at least 100 cigarettes in their lifetime.
2. About 11% of Asian adults were current smokers compared with 21% of white adults, 20% of black adults, and 29% of American Indians or Alaska Native adults. 
3. Adults with at least a bachelor’s degree were less likely than other adults to be current smokers. 
4. Eleven percent of Hispanic women compared with 17% of non-Hispanic black women and 21% of non-Hispanic white women were current smokers.

Alcohol Drinking

1. Overall, 47% of adults 18 years of age and over were current regular drinkers, 13% were current infrequent drinkers, 7% were former infrequent drinkers, and 25% were lifetime abstainers.
2. Fifty-seven percent of men were current regular drinkers compared with 38% of women.
3. Asian adults were more likely to be lifetime abstainers compared with other single-race groups.
4. Educational attainment and family income were positively associated with current drinking status and inversely associated with being a lifetime abstainer. 

Body Mass Index

1. Based on BMI, 2% of adults were underweight, 39% were at a health weight, 35% were overweight (but not obese), and 24% were obese.
2. About 60% of Asian adults were at a health weight compared with 39% of white adults, 30% of black adults, and 32% of American Indians and Alaskan Native adults.  White adults were three times as likely as Asian adults to be obese.

Poverty level was inversely associated with all of the diseases noted above.  Adults in families that were poor or near poor were more likely to have been told that had one of the diseases noted above than were adults in families that were not poor.
          Education was inversely associated with all of the diseases noted above.  The percentage of adults with each of the above diseases decreased with increased levels of educational attainment. 

COMMENT:
          Since the diseases and the health behavior reported in this survey are self-reported, there are almost certainly some errors.  I rather suspect however that the errors, largely under-reporting, are not large.
          The most striking aspect of this report for me was the remarkable state of health of Asian-Americans.  Again and again, it was reported that this disease or that condition was less prevalent in the Asian population. 
          The lesser prevalence of disease in the Asian-American population is almost certainly due, at least in part, to their health behavior.  The proportion of Asian-Americans that smoke cigarettes is far less than that of any other racial/ethnic group.  They are less likely to be obese, and they are more likely to be abstainers with regard to alcohol. 
          Of course, it is still widely believed that moderate consumption of alcohol is a plus as far as health is concerned.  Moderate consumption of alcohol is associated with reduced all cause mortality, which is due largely to lower death rates from coronary heart disease.  I am not at all sure that this is true.  I am reminded of that superb study performed a few years ago of alcohol consumption and mortality in which the investigators controlled for practically every known risk factor for heart disease.  The protective effect of alcohol, which was found on uncontrolled analysis of the data, almost disappeared completely when the researchers controlled for age, family history, cigarette smoking, hypertension, diabetes, serum cholesterol, low density cholesterol/high density cholesterol ratios, and a host of other risk factors.  It is certainly entirely possible that abstaining from alcohol completely is associated with reduced risk of all cause mortality.
          In any event, I cannot help but wonder if the better health status of Asian/Americans is due entirely to their health behavior.  Surely, it is quite reasonable to suspect that something else is going on with relation to their better health.