Demographic and Dietary Determinants of Constipation
`in the US Population
`ROBERT s. SANDLER, MD, MPH, MATTHEW C. JoRDAN, MS, AND BRENT J. SHELTON, BS
`
`Abstract: We investigated the association between self-reported
`constipation and several demographic and dietary variables in 15,014
`men and women 12-74 years of age examined between 1971-75
`during the first Health and Nutrition Examination Survey. Overall,
`12.8 percent reported constipation. Self-reported constipation cor(cid:173)
`related poorly with stool frequency. Nine percent of those with daily
`stools and 30.6 percent of those with four to six stools/week, reported
`constipation. Constipation was more frequent in Blacks (17.3 per(cid:173)
`cent), women (18.2 percent), and those over age 60 (23.3 percent);
`
`after adjusting for age, sex, and race it was more prevalent in those
`with daily inactivity, little leisure exercise, low income, and poor
`education. Constipated subjects reported lower consumption of
`cheese, dry beans and peas, milk, meat and poultry, beverages
`(sweetened, carbonated and noncarbonated), and fruits and vegeta(cid:173)
`bles. They reported higher consumption of coffee or tea. They
`consumed fewer total calories even after controlling for body mass
`and exercise. (Am J Public Health 1990; 80:185-189.)
`
`Introduction
`
`Constipation is a significant problem in the United States
`with over 330 million dollars spent each year on over(cid:173)
`the-counter laxatives. 1 Our understanding of both the epi(cid:173)
`demiology and pathophysiology is limited.
`Studies of constipation are handicapped by lack of a
`standard definition of the condition. Connell, et ai,2 inquired
`about the bowel habits of 1,055 persons not seeking medical
`advice in an industrial community. They found that 99.4
`percent had three or more bowel movements per week.
`Based on this work, individuals with fewer than three stools
`per week are usually considered to be constipated. While
`physicians and investigators often define constipation by
`stool frequencies that lie below the usual range, healthy
`subjects tend to define constipation in terms of function
`( straining) and stool consistency (hard stools). 3
`Because of the lack of a standard definition, because
`bowel habits change with time, and because constipation
`depends on age and sex, the range of reported prevalence is
`quite broad. In a group of healthy young adults not seeking
`health care, Sandler and Drossman found that 7.3 percent
`reported that they were constipated more than 25 percent of
`the time. 3 When constipation was defined as straining more
`than 25 percent of the time, Thompson and Heaton found that
`10.3 percent of subjects were constipated. 4 In a prospective
`study of 1,064,004 men and women who were surveyed by
`American Cancer Society volunteers, 18.5 percent of men
`and 33. 7 percent of women reported "constipation. " 5
`Sonnenberg and Koch have recently performed detailed
`analyses of constipation using data from the National Hos(cid:173)
`pital Discharge Survey, the National Health Interview Sur(cid:173)
`vey, the National Ambulatory Medical Care Survey, and the
`Vital Statistics of the United States.6 Constipation was the
`most frequent digestive compliant in the United States with
`an estimated four million people complaining of "frequent
`constipation." There were over 92,000 annual hospitaliza(cid:173)
`tions with constipation listed among the hospital discharge
`
`Address reprint requests to Robert S. Sandler, MD, MPH, Associate
`Professor of Medicine and Epidemiology, Division of Digestive Diseases, CB#
`7080, 423 Burnett-Womack Bldg., University of North Carolina, Chapel Hill,
`NC 27599-7080. Mr. Shelton is a doctoral student in Biostatistics at UNC(cid:173)
`Chapel Hill; Mr. Jordan is a research statistician at the Research Triangle
`Institute, Research Triangle Park, NC. This paper, submitted to the Journal
`February 21, 1989, was revised and accepted for publication July 13, 1989.
`
`© 1990 American Journal of Public Health 0090-0036/90$1.50
`
`diagnoses, and 900 deaths from diseases associated with or
`related to constipation. Using data from the National Disease
`and Therapeutic Index, the same authors reported 2.5 million
`physician visits for constipation. 7 The data are limited in
`several ways. Most people with constipation do not visit
`physicians, are not hospitalized, and do not die. The reliabil(cid:173)
`ity of the prevalence estimates for chronic constipation based
`on the National Health Interview Survey are uncertain
`because one member of the household provided health
`information for all members of that household. The published
`reports of constipation have not attempted to link constipa(cid:173)
`tion with dietary and lifestyle factors that might be respon(cid:173)
`sible for this symptom.
`The first National Health and Nutrition Examination
`Survey (NHANES-I) was conducted by the National Center
`for Health Statistics between 1971-1975. 8 The study involved
`a nationwide probability sample of 20,749 persons. In addi(cid:173)
`tion to detailed socio-demographic information, the survey
`included data on dietary intake, exercise, and bowel dys(cid:173)
`function. We took advantage of unique data available from
`the NHANES-I to describe the distribution and determinants
`of constipation in the United States.
`
`Methods
`
`The NHANES-I was a large-scale, multistage probabil(cid:173)
`ity sample designed to closely reflect the US non-institution(cid:173)
`alized civilian population, 1-74 years of age. The design and
`methodology have been described in detail elsewhere.6 The
`analyses reported here involve 15,014 Black and White
`persons older than age 12 at the time of the survey, who
`completed both an examination and a dietary interview.
`Constipation, in the present study, was based on re(cid:173)
`sponses to the question: "Do you have trouble with your
`bowels that makes you constipated or gives you diarrhea?"
`Those who answered "yes-constipated," were defined as
`having self-reported constipation and were compared to
`those who responded negatively to the question. Those with
`diarrhea (621), constipation and diarrhea (73), and those with
`missing information (72) were excluded. Subjects were also
`asked: "How often do you usually have a bowel move(cid:173)
`ment?" Stool frequency was coded by the National Center
`for Health Statistics as less than two stools per week, two to
`three per week, four to six per week, one per day, and two
`or more per day. It was not possible to analyze stool
`frequencies apart from these categories. An alternative
`definition of constipation was fewer than four stools per
`
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`
`185
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`

`

`SANDLER, ET AL.
`
`week. No time period for self-reported constipation or stool
`frequency was specified.
`Height and body weight were obtained through stan(cid:173)
`dardized procedures. 6 Body mass index (BMI) was calcu(cid:173)
`lated using the formula BMI = weight (kg.)/height (m)2 to
`provide an index of weight controlled for height. Daily
`calories were determined using standardized food composi(cid:173)
`tion tables applied to foods in each person's 24-hour dietary
`recall record. Subjects were also asked the frequency with
`which they consumed a variety of foods with categories
`chosen to provide reasonably balanced numbers in each
`category. Race was dichotomized as White or Black.
`Analyses were performed using the Statistical Analysis
`System (SAS Institute, Cary, NC). The SESUDAAN pro(cid:173)
`gram, which takes into account the complex sample design of
`the survey, was used to compute standardized proportions
`and standard errors.9 The RTILOGIT program10 was run
`under SAS to perform logistic regression analyses that took
`account of the sample weights and sample design. Age, body
`mass index, and calories were entered into models as con(cid:173)
`tinuous variables. Categorical variables were coded as de(cid:173)
`scribed in the Tables.
`
`Results
`Overall, 12.8 percent (S.E. 0.48) of the United States
`population reported constipation (Table 1). Self-reported
`constipation was more common in Blacks (17.3 percent),
`women (18.2 percent), and those over age 60 (23.3 percent).
`When we defined constipation as fewer than four stools per
`week, constipation was again more common in Blacks and
`women. The elderly did not consistently report fewer stools.
`There was poor correlation between the reported stool
`frequency and self-reported constipation (Table 2). Only 67 .8
`percent of those with fewer than two stools per week reported
`constipation. Nine percent of those with daily stools, and
`30.6 percent of those with four to six stools per week
`considered themselves constipated. Of the 180 persons with
`less than two stools per week, 137 (76 percent) were women,
`supporting the fact that constipation is more common in
`women.
`Self-reported constipation was most prevalent in those
`with daily inactivity and little recreational exercise with a
`distinct gradient from the most active to the least active at all
`ages (Table 3). Those with low income and education were
`more likely to be constipated within each age category. The
`effect of marital status was inconsistent. Reported constipa-
`
`TABLE 1-Proportlon of Persons with Self-Reported Constipation In the
`US Population
`
`Group
`
`No.
`
`% Constipated'
`
`Overall
`Race
`White
`Black
`Sex
`Men
`Women
`Age (years)
`12--29
`30-59
`60-75
`
`15,014
`
`12,178
`2,836
`
`6,042
`8,972
`
`5,660
`5,470
`3,884
`
`12.8
`
`12.2
`17.3
`
`7.0
`18.2
`
`8.1
`13.9
`23.3
`
`Standard
`Error
`
`0.48
`
`0.48
`1.40
`
`0.50
`0.70
`
`0.54
`0.61
`1.21
`
`·Pen:ents are US population estimates derivad by applying sampHng weights to survey
`data.
`
`TABLE 2-Comparlson of Stool Frequency to Self-Reported Constipation
`
`Stool Frequency"
`
`No.(%)
`
`% Constipated•
`
`<2/Week
`2-3/week
`4-6/week
`1/day
`;,:2fday
`
`180 (1.0)
`1,342 (7.6)
`1,884(10.6)
`12,442 (70.0)
`1,930 (10.9)
`
`67.8
`58.3
`30.6
`9.0
`7.0
`
`""How often do you have a bowel movement?"
`""Do you have trouble with your bowels which makes you oonstipaled?"
`
`TABLE 3-Proportlon of Persons with Self-Reported Constipation In the
`US Population by Age and Personal Characteristics
`
`Age (years)
`
`12--29
`
`30-59
`
`60-75
`
`%$EM•
`
`%$EM•
`
`%SEM•
`
`Nonrecreational Exercise"
`Very active
`Moderately active
`Inactive
`Recreational Exercise0
`Much exercise
`Moderate exercise
`Little exercise
`Income
`$<6,999
`7,000-9,999
`10,000-14,999
`>14,999
`Education (years)
`o-6
`7-11
`12
`13+
`Marital Status
`Never Married
`Married
`Region
`Northeast
`Midwest
`South
`West
`
`6.9 (0.6)
`8.7 (0.7)
`15.9 (3.1)
`
`6.0 (0.6)
`7.5 (0.8)
`14.3 (1.3)
`
`9.6 (1.2)
`8.3 (0.8)
`7.9 (0.9)
`6.4 (0.9)
`
`9.8 (2.6)
`7.0 (0.7)
`8.6 (0.8)
`8.9 (0.9)
`
`6.6 (0.6)
`10.8 (0.8)
`
`7.8 (0.8)
`7.1 (0.9)
`9.6 (1.6)
`8.1 (0.9)
`
`11.7(0.8)
`15.9(0.9)
`17.2(2.3)
`
`8.9(1.0)
`12.7(0.9)
`17.1 (1.1)
`
`20.6 (1.9)
`14.9 (1.3)
`11.5 (1.0)
`9.8 (1.2)
`
`25.6 (3.1)
`15.8 (1.2)
`12.7 (8.9)
`10.7 (0.9)
`
`20.0 (2.3)
`12.8 (0.6)
`
`13.3 (1.1)
`12.7(0.9)
`16.8(1.7)
`13.4(1.2)
`
`17.9(1.2)
`25.8 (1.7)
`29.0 (3.2)
`
`18.0(2.4)
`19.3(1.7)
`27.8 (1.7)
`
`28.8(1.6)
`18.4(2.1)
`17.1 (3.5)
`10.3(1.9)
`
`33.5(2.8)
`28.6 (1.7)
`16.6(2.5)
`15.4(2.1)
`
`23.4 (3.7)
`21.8(1.5)
`
`18.4 (2.1)
`23.5 (1.9)
`28.4(3.2)
`23.0 (2.6)
`
`"Standard error of the mean
`"subjects were asked: "In your usual day, aside trom recreation, how active are you?"
`"Subjects were asked: "Do you get much exercise in things you do for recreation?"
`
`tion was slightly more common in those living in the South.
`When we stratified by race and sex (not shown), all of these
`findings persisted. They also persisted when we compared
`those with fewer than four stools per week (constipated
`group) to those with more than four.
`Table 4 presents data on a number of specific dietary
`constituents. Constipated individuals reported lower con(cid:173)
`sumption of cheese and cheese dishes, dry beans and peas,
`milk, fruits and vegetables, meat and poultry, and sweetened,
`carbonated and non-carbonated beverages, and higher con(cid:173)
`sumption of coffee and tea. There was no consistent re1a(cid:173)
`tionship with cereal or bread. These associations largely
`persisted for White men and women and when we defined
`constipation as fewer than four stools per week. The results
`for Blacks were not as consistent but were based on much
`smaller numbers within individual dietary categories.
`In order to assess the independent effects of these
`variables, we examined them in a logistic regression model
`that also contained terms for age, race, sex, body mass index,
`and total daily calories. Each individual dietary item was
`
`186
`
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`

`CONSTIPATION IN THE US POPULATION
`
`TABLE 4-Proportlon of Persons with Self-Reported Constipation In the US Population by Dietary Constit(cid:173)
`uents Consumed
`
`low
`1
`
`% SEM0
`15.9 (1.3)
`11.9 (0.8)
`20.6 (1.4)
`15.4 (6.0)
`15.3 (1.2)
`2.6 (2.1)
`28.2 (11.1)
`7.9 (0.8)
`18.0 (1.0)
`
`Frequency of Consumption•
`
`2
`
`3
`
`4
`
`%SEM
`14.1 (1.1)
`13.9(0.9)
`12.7(0.7)
`13.4 (3.9)
`14.8 (1.7)
`18.4 (4.1)
`22.1 (6.2)
`10.3 (1.7)
`15.8 (1.0)
`
`% SEM
`12.9 (0.6)
`11.8 (0.6)
`12.6 (0.6)
`13.3(1.0)
`14.2(0.8)
`14.0(1.3)
`15.9(1.3)
`9.6(1.1)
`11.5(0.7)
`
`% SEM
`11.2(0.6)
`16.1 (1.3)
`10.7(0.8)
`12.6 (0.6)
`12.4 (0.6)
`12.3 (0.6)
`12.4 (0.5)
`13.8 (0.6)
`10.2 (0.7)
`
`high
`5
`
`% SEM
`12.6 (1.1)
`11.9 (9.4)
`9.2(1.0)
`12.9 (0.6)
`9.9(0.8)
`13.1 (0.7)
`5.9 (1.3)
`
`Cheese
`Cereal
`Beans
`Bread
`Milk
`Fruit/vegetables
`Meat/poultry
`Coflee/1ea
`Beverages
`
`"Cheese refers to cheese and cheese dishes; beans to dry beans and peas; beverages to sweetened, carbonated and
`non-carbonated. The categories for the following specific Items were: milk: (1) never, (2) less than once a week, (3) 1-6 times a week,
`(4) once a day, (5) more than once a day; meat and poultry, fruits and vegetables, bread: (1) never, (2) less than once a week, (3) 1-6
`times a week, (4) 1-2 times a day, (5) more than twice a day; cheese, beans: (1) never, (2) less than onoe a week, (3) 1-2 times a week,
`(4) 3-6 limes a week, (5) once or more a day; oerea/: (1) never, (2) less than once a week, (3) 1-6 times a week, (4) one or more times
`a day. Beverages (sweetened, carbonated and norH:arbonated) and coffee or tea were ranked in lour cat09ories by the NCHS (1) never,
`(2) less than once a week, (3) 1-6 times a week, (4) once or more a day.
`0SEM ~ Standard error of the mean.
`
`statistically significant (p < 0.001) in the same direction as the
`univariate analyses shown in Table 4.
`Body mass index was similar for those who reported
`constipation and those who did not at every age and in both
`sexes, whereas the constipated group consumed fewer cal(cid:173)
`ories (Table 5). In order to assess the independent effects of
`various demographic and lifestyle factors on reported con(cid:173)
`stipation we performed a logistic regression analysis that
`simultaneously controlled for all variables in the model and
`took into account the sample weights and sample design
`(Table 6). The most important determinant of constipation
`was sex. Women were 2.4 times more likely to report
`constipation after controlling for other factors. The other
`results were in the same direction as the univariate analyses.
`Constipation was more common in Blacks, the elderly, and
`those with less education, low income, and inactivity. Marital
`status and body mass index were not important. Constipated
`subjects consumed fewer calories even after controlling for
`the other variables in the model.
`
`TABLE 5-Age-Speclflc Mean Body Mass Index and Daily Calorie Con(cid:173)
`sumption by Constipation Category"
`
`Age (years)
`
`12-29
`
`30-59
`
`60-75
`
`Women
`Body Mass I ndex0
`Constipated
`Not constipated
`Calories
`Constipated
`Not constipated
`Men
`Body Mass lndex0
`Constipated
`Not constipated
`Calories
`Constipated
`Not constipated
`
`22.7
`22.2
`
`(0.3)
`(0.1)
`
`25.6 (0.2)
`25.5 (0.1)
`
`(0.3)
`27.1
`26.4 (0.2)
`
`1698.9 (48.3)
`1762.7 (27.5)
`
`1493.8(31.1)
`1554.4 (18.8)
`
`1229.4 (33.7)
`1350.5 (23.7)
`
`23.9
`22.8
`
`(0.7)
`(0.1)
`
`26.2 (0.4)
`(0.1)
`26.1
`
`25.3 (0.4)
`25.5 (0.1)
`
`2655.5 (125.9)
`2847.2 (39.7)
`
`2195.0 (84.4)
`2440.2 (34.4)
`
`1789.8 (83.1)
`1944.1 (38.6)
`
`aNumbers in parentheses represent the standard error of the mean.
`•Body mass index ~ weight (kg)/heighl (m)2
`
`Discussion
`
`Our results are representative of the non-instiutionalized
`civilian US population. The large size of the study (15,014
`subjects) permitted us to look at several demographic and
`dietary characteristics in order to present a more complete
`description of constipation. The results confirm other reports
`and indicate that recreational and nonrecreational inactivity
`is associated with self-reported constipation independent of
`dietary intake. Exercise is thought to increase propulsive
`movements in the large intestine'' although there are not
`good studies to support the use of exercise in constipated
`subjects. 12
`The NHANES-1 survey was conducted between 1971
`and 1975. There has been a modest decrease in the prevalence
`of "frequent constipation" between 1%8 and 1986.6 We
`chose the first NHANES-1 because subjects were asked
`about both stool frequency and self-reported constipation.
`There were only 180 subjects with fewer than two stools per
`week, too few to permit detailed analyses. We performed all
`analyses using stool frequency less than four per week (8.6
`percent of the population) as well as self-reported constipa(cid:173)
`tion, and found no major differences in the results for diet and
`demographic features with one exception. The elderly did not
`report consistently fewer stools than the young even though
`they reported more constipation.
`In the absence of an agreed upon definition of constipa(cid:173)
`tion, we believe that self-reports of the symptom of consti(cid:173)
`pation may be preferable to stool frequency since infrequent
`stools may be asymptomatic and simply represent the lower
`end of the continuum. Self-reported constipation may refer to
`several different symptoms including infrequent stools, feel(cid:173)
`ings of incomplete evacuation, straining and hard stools3
`which may, in tum, be the consequence of several discrete
`pathogenetic mechanisms. It is possible that the differences
`that we observed in constipation prevalence by age, sex, and
`race are due to differences in definitions used by respondents.
`The similarity of our age and sex findings to those based on
`physician diagnosis, however, argues against this interpre(cid:173)
`tation.7
`There is value to studying self-reported constipation
`since it is this symptom that distresses patients. Epidemiol-
`
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`
`187
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`SANDLER, ET AL.
`
`TABLE 6--Conatlpatlon In the US Population, Logistic Regreaalon
`Anelyala"
`
`Variables
`
`Beta
`
`S.E.
`
`Odds Ratio
`
`Female sex
`Black race
`Age (10)
`Nonrecreational
`activity
`Recreational
`activity
`Married
`Body mass index
`(10)
`Calories (1,000)
`Income
`Education
`
`0.8803
`0.2849
`0.2063
`
`0.1813
`
`0.1522
`-0.0090
`
`-0.0279
`-0.1391
`-0.1369
`-0.1503
`
`0.0007
`0.0008
`0.0002
`
`0.0004
`
`0.0004
`0.0001
`
`0.0005
`0.0004
`0.0003
`0.0003
`
`2.41
`1.33
`1.23
`
`1.20
`
`1.16
`0.99
`
`0.97
`0.87
`0.87
`0.86
`
`'Adjusting simultaneously for all other variables in model using RTILOGIT10 to take
`account of sample weights and sample design. For education, income, nonrecreational
`activity, and recreational activity, betas (and odds ratios) reflect comparisons belween
`individual categories described in Table 3. Age and body mass index were entered as
`continuous variables with betas calaJlated for intervals of 1 o. Total calorias were entered as
`a continuous variable with the beta reflecting an interval of 1000 calories.
`
`ogists have been reluctant to study conditions for which there
`may not be pathologic, radiologic, or laboratory confirma(cid:173)
`tion. We need to study the epidemiology of symptoms and
`symptom complexes, however, since they represent a large
`part of human morbidity and suffering. 13
`Diet, particularly dietary fiber, has often been regarded as
`an important determinant of constipation, 14•15 although per(cid:173)
`sonality factors may be important as well. 16 The large sample
`size and detailed dietary data available in the NHANES-1
`permitted us to examine the association between diet and
`constipation. We found that those who ate more fruits and
`vegetables had fewer complaints of constipation. In addition,
`however, we found that those who ate more of a number of
`dietary constituents including cheese, dry beans and peas,
`milk, and meat and poultry also had less self-reported consti(cid:173)
`pation. As one might expect, these individuals also had a
`higher caloric intake. When we controlled for caloric intake,
`however, these dietary components were still significant.
`One of the most interesting findings was that constipated
`subjects ate fewer calories. The constipated group was not
`leaner, and their lower calorie consumption was not com(cid:173)
`pletely explained by decreased physical exercise or differ(cid:173)
`ences in other demographic characteristics, although these
`could have been incompletely controlled in the logistic model
`(residual confounding). The inverse association between
`calorie consumption and self-reported constipation may offer
`clues about etiology. Caloric intake is based on body size,
`physical activity, metabolic efficiency, and net energy bal(cid:173)
`ance (i.e., change in body fat or muscle). 17 The mechanisms
`of metabolic efficiency, including differences in absorption
`and thermogenesis, are poorly understood, but individual
`differences must exist since even under controlled conditions
`some subjects will gain more weight than others eating similar
`calories. 18
`One might hypothesize that individuals with constipa(cid:173)
`tion are more efficient at absorbing or utilizing food in their
`small intestines. They eat less, present less to their colons,
`and have more constipation as a consequence. Those free of
`constipation, on the other hand, are less efficient. Food that
`escapes absorption enters the large bowel where fecal flora
`may produce short chain or volatile fatty acids that protect
`against constipation.
`
`The absorption of dietary constituents by the human
`small bowel is known to be incomplete. Kramer, et al, 19
`found that several different dietary components increased the
`ileal effluent in seven colectomized subjects. The starch
`moiety of most staple foods (wheat, com, oats, potatoes) is
`incompletely absorbed by normal subjects,20 and there may
`be considerable variation among individuals. Stephen, et
`a/, 21 found that while some individuals absorbed starch well,
`others failed to absorb 15-20 percent. It is possible that
`functional constipation could be due to overly efficient
`handling of the carbohydrate that normally escapes absorp(cid:173)
`tion in the small bowel. 22
`In summary, we found that self-reported constipation
`was more common in women, Blacks, the poor, the elderly,
`and those with Jess education and little physical exercise.
`Those who ate fewer calories were more constipated even
`after controlling for exercise and body mass index. In order
`to reconcile all of the available information, one might view
`constipation as the end result of both exogenous factors (diet
`and exercise) and endogenous factors (sex hormones, per(cid:173)
`sonality, and metabolic efficiency). Further studies on energy
`balance and absorption in constipated subjects may be
`important in helping us to understand and treat this common
`symptom. Such studies will require large numbers and careful
`consideration of symptom definition.
`
`ACKNOWLEDGMENTS
`Supported in part by a grant from the National Institutes of Health (DK
`3497). The authors acknowledge the National Center for Health Statistics as
`the original source of the data reported here, and accept full responsibility for
`all analyses, interpretations, and conclusions presented.
`
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`
`CONSTIPATION IN THE US POPULATION
`
`Nation's First Medical School Celebrates Its 225th Anniversary
`throughout 1990
`
`The University of Pennsylvania School of Medicine-the first medical school established in the
`United States in 1765-marks its 225th anniversary during 1990, at the same time the University notes
`its 250th anniversary. A year-long celebration is planned to celebrate this landmark in the history of
`American medicine. A blend of history, contemporary scholarship, and a look at the future will be linked
`with festivities to make 1990 a memorable year for alumni, faculty, students, and friends.
`The continuing theme throughout the year will be the evolution of medicine in the United States
`and the critical role the University of Pennsylvania School of Medicine played in the process,
`accentuated by exhibits, lectures, symposia, and exchanges to highlight the major contributions of the
`school. Three peak celebration periods are planned for the year-occurring in January, May and
`October.
`• The January program emphasized frontiers of science in medicine, and centered around the
`dedication of a new clinical research building ·on the site of the former Philadelphia General
`Hospital. Louis Sullivan, MD, US Secretary of Health and Human Services, delivered the
`keynote address which focused on national health policy. Other events in the January program
`included the 27th annual Women in Medicine dinner, and a scientific symposium entitled
`"Molecular Mechanisms of Disease" featuring three of the world's foremost medical scientists:
`Philip Leder, MD, Harvard University; Sydney Brenner, MD, Cambridge, England; and Joshua
`Lederberg, PhD, Rockefeller University.
`• The "May Festival" will take place May 16-20, and will include dedication of the Seymour Gray
`Foundation for Molecular Medicine: Seymour Gray Lecture in Molecular Biology. Keynote
`speaker will be Michael S. Brown, MD, Nobel Laureate and Professor of Molecular Genetics,
`University of Texas-Southwestern Medical School. "Medical Alumni Weekend" a major annual
`event-will be incorporated into the festivities, with numerous social activities, and a scientific
`symposium entitled "Recent Developments in Cancer Research."
`Also in May, continuing medical education credit will be given for a series of faculty-alumni
`exchanges that are part of the Medical School's 225th anniversary.
`• The "Future of Medicine and Health Care" will be the focus of the October festivities, with a
`symposium on October 12 featuring three keynote speakers: Arnold Reiman, MD, Editor, New
`England Journal of Medicine; Samuel 0. Thier, MD, President, Institute of Medicine/National
`Academy of Sciences; and Uwe E. Reinhardt, PhD, Professor of Political Economy, Princeton
`University.
`For further information, contact: Office of the 225th Anniversary Celebration, University of
`Pennsylvania School of Medicine, 196 John Morgan Building, 36th and Hamilton Walk, Philadelphia,
`PA 19104; or the Office of Public Information, University of Pennsylvania Medical Center, 2 Blockley
`Hall, 3400 Spruce Street, Philadelphia, PA 19104-6021. Tel: (215) 662-2560.
`
`AJPH February 1990, Vol. 80, No. 2
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