University of Minnesota

The Epstein-Boas study of New York City Garment Workers

In the early 1950s, some investigators turned to cross-cultural comparisons, seeking diversity and variation among populations. Fred Epstein, to whom this website and book are dedicated, and Ernst Boas, his Mt. Sinai Hospital colleague, asked the following question, quoted from them verbatim: “Did Jews have, indeed, as is always suspected, a predisposition to develop coronary heart disease as compared with other ethnic groups, in our case, mostly people of Italian origin. And, if so, is this predisposition explicable in terms of such factors as dietary habits, serum lipid patterns, and possibly, other atherogenic influences?”

The New York Joint Board of the Association of Clothing Workers of America, a vigorous labor union of the time, gave a grant to Mount Sinai and the Sidney Hillman Health Center to study the question. The workers were first-generation immigrants who had arrived in their teens and were thought to be comparable in social and economic status.

Surprisingly, in this first study to look at the cultural difference in animal and vegetable fat composition of diets, the diets of the Italians and Jews differed little in nutrient composition, though their background youthful experience in the homeland was probably dissimilar. Epstein opined about diet studies in the U.S. in general: “by and large, dietary habits among different groups are too similar in this country to do such studies. For such studies one would seem to have to go abroad as Keys has done and is doing. In this country, on the other hand, conditions are suitable to study possible atherogenic factors other than diet.”

This sage advice reached few at the time, and most CVD epidemiological studies were carried out within homogeneous middle-aged white male populations. Nevertheless, in this comparison, coronary disease was twice as common among the Jewish garment workers, a difference unexplained by current blood pressure or diabetes or diet or hypertension or obesity. Finding no clear risk relationships on this cross-sectional survey, Epstein makes a plea for further epidemiological studies that “reach into areas inaccessible by other approaches. No laboratory situation can exactly duplicate the infinitively complex reactions which result from the impact of environment on the basic constitution of man.”

The Seven Countries Study soon addressed this complexity of environment with combined survey and prospective observations. (Henry Blackburn)

[Ed. Epstein’s was pretty impressive thinking for the early 1950s.]


Fred Epstein’s Keys Lecture called “Cardiovascular Disease Epidemiology: A Journey from the Past into the Future.” Circulation, 1996;93:1755-1764)

Epstein, F.H.; Boas,EP. 1955. The Prevalence of Manifest Atherosclerosis Among Randomly Chosen Italian and Jewish Garment Workers. A Preliminary Report
J Gerontology, 1955, 10, 331-337