Search PubMed⌕ Search

Biomedical subjects

S J Jacobsen

Publications and source records attributed to S J Jacobsen.

At least 163 records · Page 9Linked to original sources
PubMed1992

Racial and community factors influencing coronary artery bypass graft surgery rates for all 1986 Medicare patients.

OBJECTIVE: This study examines the differences in the rates of coronary artery bypass grafting (CABG) between white and black Medicare patients. DESIGN: This is a cross-sectional study with data from the 1986 Health Care Financing Administration hospital claims records on all Medicare patients, the 1988 update of the Bureau of Health Professions area resource file, and the 1985 Census Bureau's county population estimates file. SETTING: Data are from all Medicare patients in the United States in 1986. MAIN OUTCOME MEASURES: Sex- and age-adjusted CABG rates for whites and blacks over the age of 65 years were computed for each of 50 states and 305 Standard Metropolitan Statistical Areas (SMSAs). RESULTS: Nationally the CABG rate was 27.1 per 10,000 for whites (40.4 for white men and 16.2 for white women), but only 7.6 for blacks (9.3 for black men and 6.4 for black women). Racial differences were greater in the Southeast, particularly in nonmetropolitan areas, than in other regions. Neither white nor black SMSA rates were associated with the rate of admission for acute myocardial infarction (an indication of the amount of coronary artery disease). White rates, but not black rates, were associated with the number of thoracic surgeons per 100,000 people. CONCLUSIONS: For patients insured by Medicare, race is strongly associated with CABG rates, and this association is greater for men than for women and greater in the Southeast than in other parts of the country. Physician supply may relate to the CABG rates for whites.

Black or African American↗
PubMed1992

Framework multipoint map of the long arm of human chromosome 4 and telomeric localization of the gene for FSHD.

Mapping the long arm of Chromosome (Chr) 4 has assumed medical relevance with the establishment of linkage of facioscapulohumeral muscular dystrophy (FSHD) to distal 4q markers. We have constructed a multipoint linkage map using DNA markers that map to the long arm of Chr 4. Segregation data were collected for 17 DNA markers on the multigenerational CEPH mapping families, and data for one marker were taken from the published CEPH database. Genotypic information for six of these markers was also collected from a set of 24 families that exhibited inheritance of FSHD. Multipoint analyses allowed us to construct a map of 12 loci, connecting two previously separate linkage groups. Significant sex-specific differences in recombination were found for some genetic intervals. Four loci from the distal region of this map showed linkage with FSHD. A map using these terminal markers gave the strongest support for FSHD in the most distal position over all other possible positions.

Chromosome Mapping↗
PubMed1992

Monthly variation of hospital admission and mortality of peptic ulcer disease: a reappraisal of ulcer periodicity.

The occurrence of peptic ulcer is characterized by a seasonal variation, the meaning of which is poorly understood. The present study examined the periodicity of hospital admissions and mortality resulting from gastric and duodenal ulcer to determine its etiologic relevance. Ulcer periodicity was studied in the nationwide data sets of the Department of Veterans Affairs, the Health Care Financing Administration, and the Vital Statistics. Both ulcer types were characterized by similar patterns of periodicity. Hospital admissions peaked during the first 3 months of the year, followed by a marked decline during summer and a second smaller peak around October. This pattern occurred independently of age, sex, race, and place of residence. It also pertained to ulcers complicated by hemorrhage or perforation. Although total admissions peaked earlier during the year and showed a less consistent peak in October, there was a close resemblance between the periodicity of all diseases and that of peptic ulcer. Mortality was highest in January and lowest in July for all disease and ulcer diseases alike. The similarity between the periodicity of peptic ulcer and other diseases suggests that the major factors responsible for the cyclic behavior of gastric and duodenal ulcer are not particular to these diseases but affect other unrelated diseases alike.

Hospitalization↗
PubMed1992

Cholesterol and coronary artery disease: age as an effect modifier.

An elevation of serum cholesterol has been one of the more frequently cited risk factors for coronary heart disease, found in both case-control and cohort studies. As a result, this country has undertaken massive screening of adults older than 20 years of age in an attempt to identify those persons with cholesterol levels greater than 200 mg/dl, and follow up with an active approach for intervention. The suggested cutpoints for borderline (200-240 mg/dl), and definite (> or = 240 mg/dl) hypercholesterolemia have been applied to all age groups despite suggestions of a diminution of risk conferred by cholesterol in the elderly. This study of 2544 white men undergoing coronary angiography shows that for all men, aged 25-84 years, plasma cholesterol levels were associated with an increase in coronary artery occlusion (rs = 0.15, p < 0.01). However, when stratified by age, this association held only for the younger men, the association diminishing to near zero in the oldest age group. The negative interaction between cholesterol levels and age in predicting coronary artery disease proved highly significant (p < 0.001) in multivariable linear regression analysis, suggesting that cholesterol levels are much less predictive of coronary artery disease in the elderly as compared to the young. These results point to the need for a more finely tuned set of criteria for the evaluation of hypercholesterolemia, one that takes into account the age of the screenee.

Adult↗
PubMed1992

The association between water fluoridation and hip fracture among white women and men aged 65 years and older. A national ecologic study.

For the past 45 years, there has been a great deal of debate regarding the health issues surrounding the fluoridation of public water supplies. In order to assess the association between fluoridation and hip fracture, we identified 129 counties across the United States considered to be exposed to public water fluoridation and 194 counties without exposure. Data from the Health Care Financing Administration and the Department of Veterans Affairs were used to calculate the incidence of hip fracture among white persons, aged 65 years or older, in fluoridated and nonfluoridated counties. There was a small statistically significant positive association between fracture rates and fluoridation. The relative risk (95% confidence interval) of fracture in fluoridated counties compared to nonfluoridated counties was 1.08 (1.06 to 1.10) for women and 1.17 (1.13 to 1.22) for men. As comparisons were made at the grouped level, it may be inappropriate at this time to draw inferences at the individual level. The relationship observed at the county level needs to be duplicated at the individual level with more precise measures of fluoride exposure.

Aged↗
PubMed1992

Hospitalization with vertebral fracture among the aged: a national population-based study, 1986-1989.

Whereas fractures related to osteoporosis have become a pressing public health concern, relatively few epidemiologic studies have focused on vertebral fractures. To shed further light on the occurrence of this injury, we collected data from the Health Care Financing Administration on 151,986 discharges listing a diagnosis of vertebral fracture over a 4-year period. After adjusting for age, white women experienced the highest rates of discharge, at 17.1 per 10,000 per year, followed by white men (9.9 per 10,000), black women (3.7 per 10,000), and black men (2.5 per 10,000). Among white women, discharge rates rose exponentially from 5.3 discharges per 10,000 population at age 65 to nearly 47.8 per 10,000 at age 90. White men, black women, and black men experienced less dramatic age-related increases in discharge rates. The similarity of these patterns to discharge rates for hip fracture suggests that the race-sex differences in vertebral fracture discharge rates may be due to differences in the incidence of vertebral fracture.

Aged↗
PubMed1992

Race and sex differences in mortality following fracture of the hip.

This paper describes the all-cause mortality experience, following a fracture of the hip, of 712,027 persons covered by the Medicare program from 1984 through 1987. White women experienced the lowest mortality rate (17.2 per 1000 person-months), followed by Black women (22.9 per 1000 person-months), Black men (33.5 per 1000 person-months), and White men (33.7 per 1000 person-months). The observed race-sex differences in survival were found at all ages and regardless of the number of comorbid conditions listed with the discharge diagnosis. While these data demonstrate marked race-sex differences in survival following hip fracture, the cause of these differences is not immediately apparent and demands further investigation.

Aged↗
PubMed1992

Linkage analyses of five chromosome 4 markers localizes the facioscapulohumeral muscular dystrophy (FSHD) gene to distal 4q35.

The genetic locus for facioscapulohumeral muscular dystrophy (FSHD) has been mapped to chromosome 4. We have examined linkage to five chromosome 4q DNA markers in 22 multigenerational FSHD families. Multipoint linkage analyses of the segregation of four markers in the FSHD families and in 40 multigenerational mapping families from the Centre d'Etude du Polymorphisme Humaine enabled these loci and FSHD to be placed in the following order: cen-D4S171-factor XI-D4S163-D4S139-FSHD-qter. One interval, D4S171-FSHD, showed significant sex-specific differences in recombination. Homogeneity tests supported linkage of FSHD to these 4q DNA markers in all of the families we studied. The position of FSHD is consistent with that generated by other groups as members of an international FSHD consortium.

Chromosome Mapping↗
PubMed1991

Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984-1987.

This study uses 44 consecutive months of data from the Health Care Financing Administration to assess seasonal trends in hip fracture incidence among the United States white population aged 65 years and older. The authors studied a total of 621,387 cases of hip fracture which occurred from January 1984 to September 1987. During the study period, hip fracture incidence rates display a distinctive pattern of seasonal periodicity; high rates are found in the winter and low rates in the summer among both males and females. This pattern of seasonal periodicity is consistent at ages 65-74 years, 75-84 years, and greater than or equal to 85 years. When the time series of rates are stratified into five geographic levels, each level covering 5 degrees of latitude, the distinctive pattern of seasonal periodicity is the same for all levels.

Accidental Falls↗
PubMed1991

Geographic variation of inflammatory bowel disease within the United States.

One approach to learn about possible environmental risks in inflammatory bowel disease relates to studying its geographic pattern of occurrence. The geographic variation of inflammatory bowel disease within the United States was analyzed using the accumulated 17.5 million hospital discharges of all U.S. Medicare beneficiaries during two consecutive years. To validate the geographic pattern shown by the Medicare data, hospitalization was compared with mortality from inflammatory bowel disease among different states. Mortality and hospitalization statistics both suggested that the occurrence of inflammatory bowel disease was determined by environmental factors that had a marked geographic variation within the United States. Both Crohn's disease and ulcerative colitis appeared to be more frequent in northern parts of the United States than in southern and in urban more than rural parts. These trends were observed for men and women and for blacks and whites alike. Similar geographic patterns of Crohn's disease and ulcerative colitis suggested the influence of one or more identical risk factors for both diseases.

Aged↗
PubMed1990

Body fat distribution and male/female differences in lipids and lipoproteins.

The role of body fat distribution, as assessed by the ratio of waist-to-hip circumferences (WHR), in statistically explaining differences in levels of lipoproteins between men and women was studied using data collected in 1985-1986 from employed adults (mean age, 40 years). As compared with the 415 women, the 709 men had higher mean levels of triglycerides (+38 mg/dl) and apolipoprotein B (+11 mg/dl) as well as lower mean levels of high density lipoprotein (HDL) cholesterol (-15 mg/dl) and apolipoprotein A-I (-19 mg/dl). Additionally, men were more overweight, consumed more alcohol, and exercised more frequently than women but were less likely to smoke cigarettes. Controlling for these characteristics, however, did not alter the differences in lipoprotein levels between men and women. In contrast, adjustment for WHR (which was greater among men) reduced the sex differences in levels of apolipoprotein B (by 98%), triglycerides (by 94%), HDL cholesterol (by 33%), and apolipoprotein A-I (by 21%). Similar results were obtained using analysis of covariance, stratification, or matching; at comparable levels of WHR, differences in lipid and lipoprotein levels between men and women were greatly reduced. Although these results are based on cross-sectional analyses of employed adults and need to be replicated in other populations, the findings emphasize the relative importance of body fat distribution. Whereas generalized obesity and body fat distribution are associated with lipid levels, fat distribution (or a characteristic influencing fat patterning) can be an important determinant of sex differences in levels of triglycerides, HDL cholesterol, and apolipoproteins B and A-I.

Adipose Tissue↗
PubMed1990

Hip fracture incidence among the old and very old: a population-based study of 745,435 cases.

Data were obtained from the Health Care Financing Administration and the Department of Veterans Affairs (formerly called Veterans Administration) on all hospital discharges among the elderly population from 1984 through 1987 and combined with census estimates to calculate incidence rates of hip fracture for the elderly population of the United States. Rates for White women were the highest, reaching 35.4 per 1,000 per year among 95 year-olds. Comparably, White men, Black women, and Black men experienced similar age-related increases in risk, although of less magnitude and relatively less rate of change, respectively.

Black or African American↗
PubMed1990

A clinically homogeneous group of families with facioscapulohumeral (Landouzy-Déjérine) muscular dystrophy: linkage analysis of six autosomes.

Facioscapulohumeral muscular dystrophy (FSHMD) is a neuromuscular disorder characterized by autosomal dominant inheritance and clinical onset in the muscles of the face and shoulder girdle. Using a set of RFLP markers spaced at approximately 20 centimorgans, we have begun a systematic search for markers linked to the disease. A total of 81 RFLP loci on six autosomes (1, 2, 5, 7, 10, and 16) have been examined for linkage to FSHMD in 13 families. With the computer program CRI-MAP, two-point and multipoint analyses have not resulted in any LOD score indicative of linkage to FSHMD. However, these analyses have allowed us to exclude 909 centimorgans (sex average) of our genetic maps in intervals where the LOD score is less than -2.0. We estimate our data have excluded 23% of the human genome.

Blotting, Southern↗
PubMed1989

Hospital characteristics and mortality rates.

The Health Care Financing Administration (HCFA) publishes hospital mortality rates each year. We undertook a study to identify characteristics of hospitals associated with variations in these rates. To do so, we obtained data on 3100 hospitals from the 1986 HCFA mortality study and the American Hospital Association's 1986 annual survey of hospitals. The mortality rates were adjusted for each hospital's case mix and other characteristics of its patients. The mortality rate for all hospitalizations was 116 per 1000 patients. Adjusted mortality rates were significantly higher for for-profit hospitals (121 per 1000) and public hospitals (120 per 1000) than for private not-for-profit hospitals (114 per 1000; P less than 0.0001 for both comparisons). Osteopathic hospitals also had an adjusted mortality rate that was significantly higher than average (129 per 1000; P less than 0.0001). Private teaching hospitals had a significantly lower adjusted mortality rate (108 per 1000) than private nonteaching hospitals (116 per 1000; P less than 0.0001). Adjusted mortality rates were also compared for hospitals in the upper and lower fourths of the sample in terms of certain hospital characteristics. The mortality rates were 112 and 121 per 1000 for the hospitals in the upper and lower fourths, respectively, in terms of the percentage of physicians who were board-certified specialists (P less than 0.0001), 112 and 120 per 1000 for occupancy rate (P less than 0.0001), 113 and 120 per 1000 for payroll expenses per hospital bed (P less than 0.0001), and 113 and 119 per 1000 for the percentage of nurses who were registered (P less than 0.0001).

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

Risk factors and the anatomic distribution of coronary artery disease.

Differences in the importance of risk factors according to the anatomic location of coronary artery disease (CAD) were assessed in 4722 men and 1069 women who underwent arteriography. Examined characteristics included total and high-density lipoprotein (HDL)-cholesterol, triglycerides, obesity, smoking, alcohol consumption, diabetes, and hypertension. Of these risk factors, the ratio of total to HDL-cholesterol showed the highest correlation with the overall severity of CAD (r = 0.24, men; r = 0.38, women); in contrast, its relation to left main (LM) disease was much lower (r = 0.10, men; r = 0.08 women) than were correlations with stenotic disease in the left anterior descending, circumflex, and right coronary arteries. Other risk factors also showed weaker associations with LM disease than with stenoses in other vessels, and none was related to increased LM disease after controlling for disease in other vessels. For example, as compared with men who had no significant CAD, those with 1-, 2-, and 3-vessel disease had mean increases in total cholesterol of 12, 18, and 19 mg/dl, respectively. In contrast, after adjusting for disease in other vessels, LM disease (present in 293 men) was associated with only a 4 mg/dl increase in mean cholesterol levels (P = 0.20). These results indicate that the relation of risk factors to CAD differs according to the location of the stenotic disease, and that LM disease is poorly predicted by the standard risk factors.

Adult↗