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M Feinleib

Publications and source records attributed to M Feinleib.

At least 37 records · Page 2Linked to original sources
PubMed1993

Time trends, cohort effects, and geographic patterns in stroke mortality--United States.

Trends and patterns in cerebrovascular disease mortality from 1940 to 1991 are examined using provisional and final mortality data from the US National Vital Statistics System. Trends are analyzed in terms of both period and cohort effects. Monthly data are examined using a time series regression model. Geographic patterns use maps ranking state mortality relative to the US average. Final 1989 data indicate that cerebrovascular disease remains the third leading cause of death in the United States, accounting for 145,551 deaths, or 6.8% of deaths from all causes. The age-adjusted death rate from stroke declined one-third during 1979 to 1989, more rapidly than the other ten leading causes of death. Overall, stroke mortality declined steadily from 1950 through the mid-1970s, then accelerated. On a cohort basis, each successive birth cohort since 1890 has improved their life-span experience from stroke deaths. Maps of stroke mortality demonstrate a persistent "stroke belt" in the South over the past decade.

Adult↗
PubMed1993

Data needed for improving the health of minorities.

Identified needs for minority health data, obstacles in obtaining the data, and potential solutions are reviewed. Vital statistics for whites and blacks have been available by states for many years. Recent revisions provide data on Hispanics, and new resolutions will provide data on Asian and Pacific Islander subgroups. But limitations persist in providing accurate statistics for minority subgroups. A major obstacle is the inadequacy of census denominator estimates, due to differential undercounts, paucity of postcensal estimates for states and localities, and the validity of the race and ethnicity data. Important issues revolve around quality, comparability, and intraperson variability of self-identification in determining race and ethnicity, versus external assessment. National survey data have oversampled for black and Hispanic minorities, but not others. The Disadvantaged Minority Health Improvement Act of 1990 provides some solutions, including an extramural grants program to strengthen minority statistics, which the National Center for Health Statistics has implemented to improve minority health assessment at all levels.

Adolescent↗
PubMed1992

Increased mortality from brain tumors: a combined outcome of diagnostic technology and change of attitude toward the elderly.

United States national data were used to assess factors responsible for the increase of brain tumor mortality. Between 1968 and 1988, death rates increased 50% among those aged 65-74 years, 200% among those aged 75-84 years, and 800% in the oldest old. Rate of increase and maximum death rate have changed over time. Death rate among the population aged 65-74 years peaked in the mid-1980s, while among those aged 85 years and older it is projected to continue increasing throughout the 1990s. The patterns of rate increases were almost identical in the two sexes, as well as among whites and nonwhites. There was a strong correlation over time of death rates with head diagnostic procedures (r = 0.96) and with the pace of computerized axial tomography installation (r = 0.91). The authors conclude that the reported increase in brain tumor mortality is not genuine, but represents a combination of three factors: availability of more sophisticated, noninvasive diagnostic technology; change in the attitude toward care of the elderly; and introduction of support programs such as Medicare that facilitate diagnostic procedures in the elderly.

Age Factors↗
PubMed1991

The epidemiologist's responsibilities to study participants.

Epidemiologists and health survey statisticians must be aware of their many responsibilities to study participants during all phases of the investigation. Safeguards for the subject's welfare and privacy must be considered during the planning of the study, recruitment of participants, conducting the interviews or examinations, maintaining the records, and analyzing and disseminating the information. In order to achieve maximum participation and candor of study respondents, the importance and purposes of the study and the safeguards for protecting the respondents' privacy and minimizing risks must be clearly explained. All staff must be carefully trained as to their responsibilities for protecting the privacy and safety for the participants. Adherence to these principles will promote the collection and dissemination of quality data while minimizing the risks and burdens to study participants.

Confidentiality↗
PubMed1990

The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community.

The relation between coronary heart disease and disability was examined in 2,576 community-dwelling women and men ages 55-88 years. These Framingham Study participants were originally recruited in 1948-51 for an examination of cardiovascular disease. Twenty-seven years later, remaining members of the cohort were interviewed to ascertain physical abilities, and a score on a disability scale was assigned. Multivariate logistic analyses examined disability in relation to uncomplicated angina pectoris (AP), complicated AP, and coronary heart disease other than AP, controlling for possible confounders. In younger and older women and men, uncomplicated and complicated AP were associated with disability. Coronary heart disease other than AP was associated with disability only in the younger men. Congestive heart failure predicted disability only in the women. These results suggest that onset of AP should be recognized as a critical point in the development of disability and that AP is a better predictor of disability than is myocardial infarction or coronary insufficiency.

Aged↗
PubMed1989

Trends in COPD morbidity and mortality in the United States.

This paper describes patterns and trends in COPD morbidity and mortality based on data from several data systems of the National Center for Health Statistics (NCHS), as follows: mortality data from the National Vital Statistics System; and morbidity data from the National Health Interview Survey, the National Hospital Discharge Survey, and the National Ambulatory Medical Care Survey. The paper focuses on the period 1979 to 1985 and the age groups 55 years old and over. old and over. Data are also presented separately for men and women. In addition to presenting rates for prevalence, hospital discharges, office visits, and deaths on a population basis, the paper also presents rates and analyses on a per case basis, using a "pseudo-natural history model." This paper also describes some of the methodological issues associated with analyzing comparative data from several NCHS data systems.

Age Factors↗
PubMed1989

Coronary heart disease and related procedures. National Hospital Discharge Survey data.

The National Hospital Discharge Survey provides cross-sectional and trend data for analysis of cardiovascular diseases that may require surgery or other procedures. Overall, there was a decline in the hospital discharge rate for all causes since 1983. However, the number of discharges with first-listed coronary artery-related diagnoses increased between 1984 and 1986. For men, the estimated number of these discharges increased from 1,161,000 to 1,323,000. For both sexes, there was a decrease for chronic ischemic heart disease; however, the number of discharges for unstable angina pectoris doubled over this period. It is uncertain whether this reflects an increase in disease or is the result of reimbursement policies affecting diagnosis. For both unstable and stable angina pectoris, there was a reversal of the male-female ratio at older ages, with larger numbers of older women than men discharged with these diagnoses. The discharge rates for all-listed acute myocardial infarction remained relatively constant over the past 7 years. However, the average length of stay decreased. Dysrhythmias and heart failure were the most frequent complications listed. The number of coronary artery bypass graft surgery discharges increased from 114,000 in 1979 to 228,000 in 1986. The increase in coronary angioplasty is noteworthy, rising from 2,000 to 133,000 in the same period. For both procedures, the most frequently associated diagnosis was chronic ischemic heart disease. Further monitoring of hospital discharge trends for coronary heart disease and related procedures is indicated.

Angiography↗
PubMed1988

The Framingham Disability Study: physical disability among community-dwelling survivors of stroke.

The relationship between stroke and physical disability was examined in a cohort of adult, Framingham, Massachusetts, residents who, between 1948 and 1951, were assembled for a longitudinal examination of cardiovascular disease. Multivariate analyses examined the amount of residual disability attributable to stroke among 2540 community-dwelling survivors, 27 years after their initial examination, after controlling for age, cardiovascular risk factors, other cardiovascular diseases, and eight general health conditions related to physical disability. Among men living in the community, a history of stroke explained 12% of the variance in physical disability. Suffering a stroke, however, was not as strongly related to physical disability among women living in the community, accounting for only 3% of the variance. Results suggest that although older men and women die from the same major causes, they may not be disabled by the same conditions.

Activities of Daily Living↗
PubMed1988

Coronary heart disease in the elderly.

In 1984, 435,759 deaths were attributed to CHD among persons greater than or equal to 65 years of age. CHD was the leading cause of death in this group. Death rates rose steeply with age among the elderly. Men had higher death rates than women, but the male-to-female ratio declined with increasing age. Considerable geographic variation in CHD mortality in the elderly was noted. Since 1968, CHD death rates have declined in persons greater than or equal to 65 years of age in each age, sex, and race group. However, prevalence of self-reported CHD in the elderly population has increased. Prevalence rates increased with age except for a slight decrease above age 75 in men. In 1985, 436,000 persons aged greater than or equal to 65 years were discharged with a principal diagnosis of acute MI. The hospital case fatality rate was 21.8%. Since 1970, hospitalization rates for acute MI have generally increased, while hospital fatality rates have decreased for persons greater than or equal to 65 years of age. Since 1979, utilization of coronary artery bypass surgery and coronary arteriography have dramatically increased among the elderly. In 1980 and 1981, elderly persons made six million visits to physicians' offices for chronic CHD. CHD contributed importantly to the 1980 expenditures of 3.3 billion dollars in men and 4.8 billion dollars in women greater than or equal to 65 years of age for heart disease care. Although mortality rates from CHD in the elderly have decreased since 1968, increasing hospitalization rates and utilization of other health care services emphasize the need for more vigorous efforts at prevention.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Biases and weak associations.

Bias is any systematic error in the design, conduct, analysis, or interpretation of a study that tends to produce an incorrect assessment of the nature of the association between an exposure or risk factor and the occurrence of disease. It is evident that a major emphasis in an epidemiologic study should be to minimize any biases that may occur at any stage of the study. Since by definition, biases will produce an incorrect assessment of the nature and magnitude of an association, avoidance of bias will be particularly important when the association under investigation is already presumed to be weak. The major biases important for evaluating weak associations are described in the context of how they may occur and how they may be avoided at each stage of an epidemiologic study.

Data Collection↗
PubMed1987

Considerations in the use of echocardiography in epidemiology. The Framingham Study.

To quantify potential biases in the use of echocardiography in epidemiologic studies, we assessed the relationship of sex, age, vital capacity, body fatness, and overt cardiovascular disease to prevalence of acceptable echocardiograms in 6148 Framingham men and women aged 17 to 90 years. Echocardiograms adequate to assess left ventricular chamber dimensions and wall thickness, aortic root, and left atrial dimensions as well as mitral and aortic valves were obtained in 4947 (80%) of the 6148 subjects. The prevalence of acceptable echocardiograms ranged from less than 50% for those more than 80 years of age to more than 96% for subjects under 30 years of age. A significant learning curve was apparent, particularly in the older subjects (more than 60 years of age) for whom prevalence of acceptable echocardiograms rose from a minimum of 28% during the first 5 months of studies to a maximum of 74 to 81% during studies 2 years later. The likelihood of unacceptable echocardiograms was slightly greater in men. Obesity (in subjects younger than 60 years of age), lower vital capacity, and overt cardiovascular disease were associated with unacceptable echocardiograms, independent of age. Consideration of these biases should aid in the interpretation and planning of epidemiologic and other studies using echocardiography.

Adult↗
PubMed1987

The spectrum of left ventricular hypertrophy in a general population sample: the Framingham Study.

To assess the prevalence, characteristics, and correlates of echocardiographically determined left ventricular hypertrophy (echo LVH) in a free-living population, 510 men and 855 women from the original Framingham cohort (age 59 to 90 years) were studied by M-mode echocardiography. Offspring and offspring spouses (1718 men and 1892 women; age 17 to 75 years) were similarly studied. The severity of echo LVH, as reflected by left ventricular mass indexed to body surface area, ranged from 101 g/m2 (women) and 132 g/m2 (men) to more than 400 g/m2. The prevalence of electrocardiographically assessed LVH increased proportionately with increased echocardiographic left ventricular mass. Women with echocardiographic left ventricular mass indexes exceeding 200 g/m2 were three to four times more likely to have electrocardiographic LVH than men with similar elevations of echocardiographic left ventricular mass index. The prevalence of echo LVH ranged from 6.6% in the younger (offspring study) women to 33% in the older (original cohort) women (8.6% and 23.7%, respectively, for men) and included a spectrum of forms--eccentric-dilated, eccentric-nondilated, concentric, and disproportionate septal thickness--which varied in prevalence in the various age-sex groups. Each of these forms of echo LVH was associated with higher systolic blood pressures at the time of echocardiographic examination and over the previous 30 years when compared with blood pressures of Framingham subjects without echo LVH.

Adult↗