Although screening exercise tolerance testing detects severe coronary artery obstruction in a small proportion of persons screened and can provide independent prognostic information about the risk for coronary heart disease events, the effect of this information on clinical management and disease outcomes in asymptomatic patients is unclear.

Socioeconomic deprivation in childhood was a strong predictor of adulthood obesity in this community sample of African American women. Findings are consistent with both critical period and cumulative burden models of life-course socioeconomic deprivation and long-term risk for obesity in African American women.

BACKGROUND: Many Americans lack health insurance. Despite good evidence that lack of insurance compromises access to care, few prospective studies examine its relationship to health outcomes.OBJECTIVE: To determine the relationship between insurance and cardiovascular outcomes and the relationship between insurance and selected process measures. DESIGN AND PARTICIPANTS:We used data from 15,792 participants in the Atherosclerosis Risk in Communities Study, a prospective cohort study. Participants were enrolled in 1987-1989 and returned for follow-up visits every 3 years, for a total of 4 visits. MAIN OUTCOME MEASURES:We estimated the hazard of myocardial infarction, stroke, and death associated with insurance status using Cox proportional hazard modeling. We used generalized estimating equations to examine the association between insurance status and risk of (1) reporting no routine physical examinations, (2) being unaware of a personal cardiovascular risk condition, and (3) inadequate control of cardiovascular risk conditions. RESULTS: Persons without insurance had higher rates of stroke (adjusted hazard ratio, 95% CI 1.22-2.22) and death (adjusted hazard ratio 1.26, 95% CI 1.03-1.53), but not myocardial infarction, than those who were insured. The uninsured were less likely to report routine physical examinations (adjusted risk ratio 1.13, 95% CI 1.08-1.18); more likely to be unaware of hypertension (adjusted risk ratio 1.12, 95% CI 1.00-1.25) and hyperlipidemia (adjusted risk ratio 1.11, 95% CI 1.03-1.19); and more likely to have poor blood pressure control (adjusted risk ratio 1.23, 95% CI 1.08-1.39). CONCLUSIONS:Lack of health insurance is associated with increased rates of stroke and death and with less awareness and control of cardiovascular risk conditions. Health insurance may improve cardiovascular risk factor awareness, control and outcomes.

Methods study participantsThe Pitt County Study is a community-based, representative prospective cohort study of blacks in eastern North Carolina; participants were 25-50 years old in 1988, the baseline year. The objective of the Pitt County Study was to elucidate psychosocial and behavioral risk factors for hypertension and related disorders in blacks (21). During the study's baseline year (1988), 1,773 male and female residents of Pitt County, North Carolina were interviewed. The baseline interview was conducted in participants' homes by a trained interviewer. The content of the interview included questions about demographic factors, health history, psychosocial factors, diet, and exercise practices. Physical measurements such as blood pressure, height, and weight were also taken.A follow-up interview was sought in 2001 with all living, noninstitutionalized members of the cohort residing within a 100 mile radius of Greenville, the principal city in Pitt County. Of the 1,540 participants meeting these criteria, follow-up data were available for 1,173 (76%). During the follow-up interview, participants' height and weight were again measured. Additional details of the follow-up study design are published elsewhere (22).