J . NORTH CAROLINA STATE LIBRARY
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PHSB STUDIES
A Special Report Series by the N,C. Department of Human Resources, Division of
Health Services, Public Health Statistics Branch, P.0. Box 2091, Raleigh, N.C.
No. 4 May 1977
ASSOCIATIONS BETWEEN NUTRITION AND MORTALITY
IN SIX HEALTH SERVICE AREAS OF NORTH CAROLINA
(An Indirect Study)
In recent years, considerable attention has been given to studies relating
disease processes to various elements of human consumption. These studies have
experimentally implicated a number of products including cyclamates, food dye and
saccharin. In addition, various studies have related basic foodstuffs to disease
processes; for example, the high cholesterol content of eggs has been implicated
as a factor in cardiovascular disease. Still other recent reports point to the
role of diet in various forms of cancer.
A recent PHSB study (1) suggests that occupational distribution contributes
significantly to the explanation of death from acute myocardial infarction, lung
cancer and prostatic cancer; in addition, that income is explanatory for lung cancer;
education for colon-rectum cancer; and elevation for acute myocardial infarction and
prostatic cancer. The question is, what do these variables represent. ... Is diet
an important factor?
Fortunately, North Carolina is in the position of having conducted a survey
that provides dietary data for a representative sample of the household population
(2,3). Although that survey was conducted seven years ago, and time and circumstance
have undoubtedly modified eating behavior to some extent, we believe the data are
still useful indicators of the relative dietary habits of different areas of the
state and, in any event, that they afford us the unique opportunity to examine
associations between prior dietary practice and current mortality in North Carolina.
The present study uses correlation analysis to examine dietary factors that
might be affecting age-race-sex-adjusted mortality in the state's six health service
areas (HSA's), these being the smallest areas for which survey data are available.
In these analyses, intercorrelations among per capita income, a contrived elevation
variable and nutrition factors are also examined. Although the previously cited
study (l) and other investigations tend to support the hypothesis of a protective
effect of altitude upon heart function, dietary factors may be the protective agent
i n North Carol i na.
METHODS AND MATERIALS
Dietary Data
The North Carolina Nutrition Survey (NCNS) was originally designed to provide
dietary data for only three regions of the state--the East, the Piedmont, and the
West (2). However, in terms of the number of households for which dietary data
were obtained, each of the HSA's appears sufficiently represented to allow for the
post-stratification used in this paper. Table 1 compares the percentage distributions
of responding survey households and household members to the corresponding distributions
obtained in the April 1970 Census.
Details concerning the survey design and procedures have been reported (2).
Briefly, the data were collected by trained nutritionist-interviewers from an adult
household member who had responsibility for meal preparation. This person was asked
N. C.
&OC.
JVN 1 5 1978
