Conflict between epidemiological and clinical diagnosis of rheumatoid arthritis in a population sample.
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Biomedical subjects
Publications and source records attributed to E Allander.
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The incidence and mortality rates of cerebrovascular disease (CVD) before age 55 were estimated for the Stockholm county between 1973 and 1977 using community based diagnosis and death statistics registers. Annual validation procedures concluded that less than 5% of hospitalized patients may have escaped registration. During the study period a diagnosis of CVD (initial stroke or TIA) was reported in 2,103 individuals, giving annual average crude incidence rates for stroke and TIA of 34 and 4 respectively per 100,000 inhabitants under age 55. Hemorrhagic lesions were reported in 45.4% of the cases, ischemic lesions in 33.1% and unclassified lesions in 21.5%. For all diagnostic categories a strong correlation to age is found, and for most categories the male:female ratio is high. The mortality rates are high for hemorrhagic lesions and low for ischemic and unclassified lesions. Incidence rates are higher than in Uppsala and Gothenburg, Sweden, but lower than in North Karelia, Finland. Mortality rates are similar to those reported by most other investigators.
Rheumatological diagnosis encountered at 3 levels of the health care system primary care, district hospital and specialized centers, were registered. The prevalence of rheumatic disorders was calculated from a population survey. Back complaints were the predominant diagnosis of primary care physicians, while inflammatory diseases were the major diagnostic group seen in specialized rheumatology centers. Among in-patients at the district hospital level, back disorders and inflammatory diseases each constituted 1/2 of cases. The utilization of primary care for patients over 65 yr of age decreased for back disorders but was higher for all other types of rheumatic disorders. Young and middle aged patients were seen more frequently by specialists than older patients. Awareness of the high frequency of noninflammatory rheumatic disorders in the population and at all levels of care is important in the planning of health services for the rheumatic disorders.
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