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T J Songer

Publications and source records attributed to T J Songer.

29 records · Page 2Linked to original sources
PubMed1993

Should persons with diabetes be licensed to drive trucks?--Risk management.

How should a regulatory agency interpret a risk analysis that concludes there is a small increase in risk? The agency must decide on behalf of society whether the increased risk is large enough to justify banning the risky activity or taking some other step to lessen the risks. In a companion paper (Songer et al.), we conclude that licensing insulin using persons to drive commercial motor vehicles in interstate commerce would result in 42 additional crashes each year. Here we address risk management issues by interpreting the number of additional crashes and the relative risks of the prospective handicapped drivers. Are the number of additional crashes (42) significant? Is the increase in the annual crash risk (from 0.00785 to 0.032 for non-insulin dependent and 0.048 for insulin dependent persons) significant? Are the relative risks significant for all insulin using drivers (4.7)? For drivers with a history of severe hypoglycemic reactions (19.8)? How should society tradeoff risk increases for increases in opportunity for these handicapped persons? We review other social decisions concerning highway safety: Accepting the increasing risks of letting 16 year olds drive, allowing extremely light cars, allowing some unsafe highways, and allowing extremely unsafe driving conditions at some times of day. We conclude that the additional risks from insulin using persons are well within the current accepted range of risks.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1992

International comparisons of IDDM mortality. Clues to prevention and the role of diabetes care.

A striking difference in all-cause mortality has been noted between individuals with insulin-dependent diabetes mellitus (IDDM) from Finland and Allegheny County, PA. Mortality rates among people 25-37 yr of age from the Allegheny County IDDM Registry were over two times greater than the rates observed from the Finland IDDM Registry. Applying the Finnish rate to the structure of the IDDM population from Allegheny County suggests that about one-half of the deaths in the Allegheny County cohort may be theoretically preventable. Most deaths that might be avoided appear to be caused by the acute complications of diabetes. Deaths from acute-related causes were higher (as a proportion of all deaths) in the Allegheny County cohort than in Finland (46.2 vs. 33.3%). There is some indication that barriers to health care may be present among individuals with IDDM in the United States. Individuals without health insurance from the Children's Hospital IDDM Registry in Pittsburgh had fewer physician visits than those with insurance. Even for those with insurance, out-of-pocket health-care expenses were significant. People with lower household incomes (less than $20,000) spent more, as a percentage of their income, on medical supplies than those with higher incomes and may have been less likely to monitor blood glucose levels and visit an eye doctor because of it. These findings suggest that health system barriers, such as the access to care and the financial burden of diabetes care, in the United States may be affecting the health of adults with IDDM. Further investigation is needed to clarify the extent of barriers to care in IDDM and their contribution to adverse health outcomes.

Adult↗
PubMed1992

Epidemiology of insulin-using commercial motor vehicle drivers. Major variability of state licensing requirements in the U.S.

OBJECTIVE: Licensing agencies in many areas, including the U.S., prohibit insulin-using individuals from driving CMVs or large trucks. This study examined the debate over the risks of licensing insulin-using individuals to drive CMVs as an occupation, and the variations in regulations of different states. RESEARCH DESIGN AND METHODS: As part of an ongoing review of the regulations governing interstate commerce in the U.S., we surveyed all 50 states and Washington, D.C. to determine the regulations concerning intrastate driving. We received responses from 48 states and D.C., representing 95% of the U.S. population. RESULTS: Only 9 states reported preventing insulin users from acquiring a CMV license, whereas 39 states and D.C. permitted licensing within state boundaries. Of the states allowing insulin users to drive, 26 placed special requirements on CMV licensing. CONCLUSIONS: The results indicate that, despite a standardized U.S. federal law for driving across states, enormous variability exists in the policies for driving within states, ranging from no restrictions to a complete ban on CMV driving for insulin users.

Automobile Driving↗
PubMed1991

Health, life, and automobile insurance characteristics in adults with IDDM.

OBJECTIVE: To determine whether people with insulin-dependent diabetes mellitus (IDDM) were compromised in their access to insurance. RESEARCH DESIGN AND METHODS: A case-control study of 158 people with IDDM and 158 nondiabetic siblings matched for age and sex was conducted to evaluate the health, life, and automobile insurance characteristics and history of people with IDDM. RESULTS: Health insurance coverage (yes/no) among the IDDM and sibling control subjects was similar. More than 90% of the IDDM and control respondents had insurance through a private third-party source, and this insurance did not differ by type of plan, coverage, or premium. However, Medicare coverage was more common among the IDDM subjects and was associated with the presence of severe diabetic complications. IDDM subjects were also more likely to have been denied a health insurance policy by an insurer than were the control subjects (23 vs. 1%, P less than 0.001). Similarly, there was no difference between the IDDM and sibling control subjects in the number who had a life or automobile insurance policy. However, life and automobile insurance refusal was much more frequent among the IDDM respondents, more so for life (55 vs. 0%, P less than 0.001) than for automobile (12 vs. 4%, P less than 0.05) insurance. CONCLUSIONS: These results suggest that access to insurance is severely compromised for people with IDDM. Although most of those with IDDM are able to find some form of insurance, it is evident that on average they must go to extra lengths to find it. These data and a changing insurance environment emphasize the need to reexamine, as a society, the importance of insurance for people with chronic disease, particularly IDDM.

Adult↗
PubMed1990

Insulin-dependent diabetes mellitus mortality. The risk of cigarette smoking.

The relation between cigarette smoking and mortality was examined prospectively in a population of adult insulin-dependent diabetes mellitus (IDDM) patients. In 1981, information on smoking history and other health and lifestyle factors was obtained by questionnaire from 93% of the 723 patients included in the Children's Hospital of Pittsburgh IDDM registry who were diagnosed between 1950 and 1964. Vital status as of January 1, 1988 was ascertained for 98% of the 548 patients who participated in the baseline survey and were alive as of January 1, 1982. Fifty-four cases died during the 6-year follow-up (32 male, 22 female). Proportional hazards analysis revealed that heavy smoking was a significant independent predictor of all-cause mortality among females but not males. The excess mortality in female diabetics was explained primarily by a marked excess risk of coronary heart disease mortality in smokers. These data strongly suggest that cigarette smoking, especially among diabetic females, should be avoided in order to improve longevity.

Cause of Death↗
PubMed1989

Employment spectrum of IDDM.

Occupational issues in 158 insulin-dependent diabetes mellitus (IDDM) individuals and 158 matched nondiabetic siblings were examined in a case-control design to evaluate the role of diabetes in the employability of people with IDDM. Overall, the IDDM cases were more likely to report refusal for a job at some point in their lives (56 vs. 42%, P = .02) than were the nondiabetic control siblings. Surprisingly, individuals who told job interviewers about their diabetes were more likely to report job refusal than their siblings (64 vs. 42%, P = .005), whereas individuals who did not mention their diabetes reported rates of refusal similar to their siblings (44 vs. 41%). IDDM cases were also less likely to be employed full time compared with siblings (55 vs. 73%, P = .001). Reduced employment in IDDM respondents was related to work disability. Reported work disability was more than seven times greater in the IDDM than the sibling group. The presence of diabetic complications was the primary factor related to work disability. Although 13% of IDDM respondents were unable to work because of disability, absenteeism among IDDM cases currently working did not differ from that of the nondiabetic siblings. Diabetes was not significantly associated with career levels or household income levels reported by the IDDM group. Disability, however, had a strong detrimental influence on these variables. The results suggest that hiring practices by employers may still be discriminatory toward individuals with IDDM. Once hired, the employment experiences of the IDDM population appear to be similar to the experiences of the nondiabetic population, provided the development of disabling diabetic complications has not taken place.

Absenteeism↗
PubMed1988

Motor vehicle accidents and IDDM.

A case-control study examining the 1-yr motor vehicle accident experiences of 158 insulin-dependent diabetes mellitus (IDDM) cases and 158 nondiabetic siblings was undertaken to evaluate the risk of motor vehicle accidents among drivers with IDDM. In multivariate analyses the overall accident risk of the cases and control subjects did not differ significantly. Female diabetic drivers, however, showed a marked increased risk for motor vehicle accidents. The accident risk among female cases was five times higher than among the female control subjects (P less than .05). Age and marital status were also significantly associated with accident probability in the multivariate model. The results suggest that IDDM could have an effect on the accident rate of diabetic drivers, particularly women. However, the traditional risk factors for automobile accidents, i.e., age and marital status, appear to have an equally strong influence on accident occurrence. Further studies are needed to 1) document the role of IDDM in accidents among representative samples of the IDDM population and 2) properly evaluate the licensing restrictions recommended for diabetic drivers.

Accidents, Traffic↗
PubMed1986

Height at diagnosis of insulin dependent diabetes in patients and their non-diabetic family members.

Height at the onset of insulin dependent diabetes mellitus was evaluated in 200 newly diagnosed children, 187 non-diabetic siblings, and 169 parents. Diabetic children 5-9 years of age at diagnosis were consistently taller than the national average. Non-diabetic siblings of the same age were also tall. Diabetic children aged 14 or over at diagnosis were short, while their siblings and parents were of normal height. Diabetic children positive for islet cell antibodies were taller than those without islet cell antibodies. No association between height and HLA antigens was found. Non-diabetic siblings at high risk for the disease were closer in height to the diabetic children than were the lower risk, non-diabetic siblings. Siblings, particularly those under 10, were also significantly more obese than the general population. Deviations in growth in patients with insulin dependent diabetes mellitus appear to be related to age at diagnosis and a factor(s) not related to parental height.

Adult↗