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PubMed2006

Prescription drug expenditures and population demographics.

OBJECTIVE: To provide detailed demographic profiles of prescription drug utilization and expenditures in order to isolate the impact of demographic change from other factors that affect drug expenditure trends. DATA SOURCES/STUDY SETTING: Demographic information and drug utilization data were extracted for virtually the entire British Columbia (BC) population of 1996 and 2002. All residents had public medical and hospital insurance; however their drug coverage resembled the mix of private and public insurance in the United States. STUDY DESIGN: A series of research variables were constructed to illustrate profiles of drug expenditures and drug utilization across 96 age/sex strata. DATA COLLECTION/EXTRACTION METHODS: Drug use and expenditure information was extracted from the BC PharmaNet, a computer network connecting all pharmacies in the province. PRINCIPAL FINDINGS: Per capita drug expenditures increased at an average annual rate of 10.8 percent between 1996 and 2002. Population aging explained 1.0 points of this annual rate of expenditure growth; the balance was attributable to rising age/sex-specific drug expenditures. CONCLUSIONS: Relatively little of the observed increase in drug expenditures in BC could be attributed to demographic change. Most of the expenditure increase stemmed from the age/sex-specific quantity and type of drugs purchased. The sustainability of drug spending therefore depends not on outside forces but on decisions made by policy makers, prescribers, and patients.

Adolescent↗
PubMed1996

Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive interventions.

OBJECTIVE: To determine the incidence of pressure ulcers in varied populations, and whether demographic characteristics (age, gender, race) and primary diagnosis are factors in pressure ulcer development when the level of risk for developing ulcers is considered. To determine if there is a difference in the type of preventive services prescribed for persons who do or do not develop pressure ulcers when risk is controlled and whether differences can be related to demographic characteristics. DESIGN: Cohort study. SETTING: Two skilled nursing homes, two university operated tertiary care hospitals, and two Veteran's Administration Medical Centers (VAMCs) in Omaha, NE, Durham, NC, and Chicago, IL. PATIENTS: A total of 843 randomly selected patients more than 19 years of age who did not have pressure ulcers on admission to their place of care. Subjects were 63% male, 79% white, and had a mean age of 63 (+/- 16) years. MEASURES: A head-to-toe skin assessment for pressure ulcers recording site and stage of ulcers, scores for the Braden Scale for Predicting Pressure Sore Risk, demographic characteristics (age, sex, race), and primary diagnosis and preventive interventions (turning or repositioning orders and pressure reduction surface) were documented on the patient record. Observations were made every 48 to 72 hours for a minimum of 1 to a maximum of 4 weeks. MAIN OUTCOME MEASURES: Presence/absence and stage of pressure ulcers. MAIN RESULTS: One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care, VAMCs, and nursing homes, respectively. Logistic regression demonstrated that lower Braden Scale scores, older age and white race predicted pressure ulcers; gender was not predictive. Primary diagnoses were not significant predictors of pressure ulcer risk when the Braden Scale score was entered into the regression. Prescription of turning was predicted by Braden Scale scores and by white race, whereas prescription of pressure reduction was predicted by Braden Scale scores, white race, and female sex. CONCLUSIONS: Risk assessment, rather than diagnoses or demographic characteristics, is recommended as the basis for prescriptive decisions. Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers. Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented. The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered.

Adult↗
PubMed1993

Demographic influences on risk perceptions.

Over the past 15 years, psychologists have empirically investigated how people perceive technological, consumer, and natural hazards. The psychometric-attitudes to risk being summarized by three factors: "dread," whether the risk is known, and personal exposure to the risk. The results have been used to suggest that certain types of hazards are viewed very differently from other hazards. The purpose of this paper is somewhat different, in that it investigates whether individual demographic characteristics influence psychometric perceptions of risk. This paper makes use of a large, professionally conducted, survey of a wide cross-section of the residents of metropolitan Chicago. One thousand adults were interviewed in a random-digit dial telephone survey, producing a useable dataset of about 800. Data on the three risk factors mentioned above were obtained on 7-point scales for four common hazards: aviation accidents, fires in the home, automobile accidents, and stomach cancer. The survey also collected demographic data on respondents' age, schooling, income, sex, and race. Regressions were then conducted to relate the demographic characteristics to risk perceptions. Some strong general conclusions can be drawn. The results suggest that women, people with lower levels of schooling and income, younger people, and blacks have more dread of hazards. The exception being age-related illnesses which, not unnaturally, are feared by older people. Unlike previous literature, we cannot substantiate the argument that these groups of people are less informed about hazards and thus less accepting of them. The most likely leading explanation of the relationship between demographic factors and dread of a hazard is the perceived personal exposure to the hazard.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Aviation↗
PubMed1987

A prospective study of postpartum psychoses in a high-risk group. 2. Relationships to demographic and psychiatric history characteristics.

Among 88 reproductions to women with a history of nonorganic psychosis, 25 postpartum episodes (PPPs) occurring during the total 6-month period following the current delivery were not systematically related to the woman's demographic characteristics, to her psychiatric history characteristics surrounding onset of the previous disorder or to a history of PPPs following previous reproductions. PPPs were highly significantly related to greater length of previous psychiatric hospitalization and to active mental disturbance just prior to this pregnancy, and this was true both for PPPs developing within 3 weeks of delivery and for those developing later. Considerable differences were found in the demographic characteristics that were related to development of PPPs within these Early vs. Later Onset cases, suggesting these to represent different disorders not only diagnostically but also demographically. In several diagnostic categories, selected demographic or psychiatric history characteristics identified subgroups with PPP rates as high as 75%.

Adult↗
PubMed1989

Estimating premorbid IQ from demographic variables: regression equations derived from a UK sample.

The purpose of the study reported here was to build regression equations for the estimation of premorbid IQ from demographic variables in a UK population. Subjects (n=151) free of neurological, psychiatric or sensory disability, were administered the Wechsler Adult Intelligence Scale (WAIS) and had their demographic details recorded (age, sex, occupation and education). WAIS Full Scale (FSIQ), Verbal (VIQ), and Performance IQ (PIQ) were regressed on the demographic variables. The regression equations generated by this procedure predicted 50, 50, and 30 percent of the variance in FSIQ, VIQ, and PIQ respectively. These equations should provide a convenient and useful supplement to psychometric estimates of premorbid IQ. Unlike psychometric estimates, demographic estimates are entirely independent of a patient's current cognitive status.

Adolescent↗
PubMed2006

The importance of demographic niches to tree diversity.

Most ecological hypotheses about species coexistence hinge on species differences, but quantifying trait differences across species in diverse communities is often unfeasible. We examined the variation of demographic traits using a global tropical forest data set covering 4500 species in 10 large-scale tree inventories. With a hierarchical Bayesian approach, we quantified the distribution of mortality and growth rates of all tree species at each site. This allowed us to test the prediction that demographic differences facilitate species richness, as suggested by the theory that a tradeoff between high growth and high survival allows species to coexist. Contrary to the prediction, the most diverse forests had the least demographic variation. Although demographic differences may foster coexistence, they do not explain any of the 16-fold variation in tree species richness observed across the tropics.

Africa↗
PubMed1998

Levofloxacin population pharmacokinetics and creation of a demographic model for prediction of individual drug clearance in patients with serious community-acquired infection.

Population pharmacokinetic modeling is a useful approach to obtaining estimates of both population and individual pharmacokinetic parameter values. The potential for relating pharmacokinetic parameters to pharmacodynamic outcome variables, such as efficacy and toxicity, exists. A logistic regression relationship between the probability of a successful clinical and microbiological outcome and the peak concentration-to-MIC ratio (and also the area under the plasma concentration-time curve [AUC]/MIC ratio) has previously been developed for levofloxacin; however, levofloxacin assays for determination of the concentration in plasma are not readily available. We attempted to derive and validate demographic variable models to allow prediction of the peak concentration in plasma and clearance (CL) from plasma for levofloxacin. Two hundred seventy-two patients received levofloxacin intravenously for the treatment of community-acquired infection of the respiratory tract, skin or soft tissue, or urinary tract, and concentrations in plasma, guided by optimal sampling theory, were obtained. Patient data were analyzed by the Non-Parametric Expectation Maximization approach. Maximum a posteriori probability Bayesian estimation was used to generate individual parameter values, including CL. Peak concentrations were simulated from these estimates. The first 172 patients were used to produce demographic models for the prediction of CL and the peak concentration. The remaining 100 patients served as the validation group for the model. A median bias and median precision were calculated. A two-compartment model was used for the population pharmacokinetic analysis. The mean CL and the mean volume of distribution of the central compartment (V1) were 9.27 liters/h and 0.836 liter/kg, respectively. The mean values for the intercompartmental rate constants, the rate constant from the central compartment to the peripheral compartment (Kcp) and the rate constant from the peripheral compartment to the central compartment (Kpc), were 0.487 and 0.647 h(-1), respectively. The mean peak concentration and the mean AUC values normalized to a dosage of 500 mg every 24 h were 8.67 microg/ml and 72.53 microg x h/ml, respectively. The variables included in the final model for the prediction of CL were creatinine clearance (CLCR), race, and age. The median bias and median precision were 0.5 and 18.3%, respectively. Peak concentrations were predicted by using the demographic model-predicted parameters of CL, V1, Kcp and Kpc, in the simulation. The median bias and the median precision were 3.3 and 21.8%, respectively. A population model of the disposition of levofloxacin has been developed. Population demographic models for the prediction of peak concentration and CL from plasma have also been successfully developed. However, the performance of the model for the prediction of peak concentration was likely insufficient to be of adequate clinical utility. The model for the prediction of CL was relatively robust, with acceptable bias and precision, and explained a reasonable amount of the variance in the CL of levofloxacin from plasma in the population (r2 = 0.396). Estimated CLCR, age, and race were the final model covariates, with CLCR explaining most of the population variance in the CL of levofloxacin from plasma. This model can potentially optimize the benefit derived from the pharmacodynamic relationships previously developed for levofloxacin.

Adult↗
PubMed2004

Projecting the demographic consequences of adult HIV prevalence trends: the Spectrum Projection Package.

This paper describes the software package Spectrum, which is a modular program that is used to examine the consequences of current trends and future program interventions in reproductive health. It is used to determine the consequences of the HIV/AIDS epidemic, including the number of people living with HIV/AIDS by age and sex, the number of AIDS deaths, and the number of orphans as a result of AIDS, as well as other demographic indicators of interest, such as life expectancy and <5 mortality. The core of Spectrum is a demographic projection model called DemProj, which projects the population by age and sex. Other modules interact with the demographic projection. The HIV/AIDS projections are added to the demographic projections using a module called AIDS Impact Model. This module uses the projection of adult HIV prevalence over time, which is prepared using the Estimation and Projection Package model or the projection workbook. It also requires assumptions about the epidemiology of HIV, including the ratio of female:male prevalence, the distribution of infection by age, the distribution of the time from infection until AIDS death, and the effect of HIV on fertility.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Relations of left ventricular mass to demographic and hemodynamic variables in American Indians: the Strong Heart Study.

BACKGROUND: Previous studies have identified associations of left ventricular (LV) mass with demographic (body habitus and sex) and hemodynamic variables (blood pressure, stroke volume [SV], and myocardial contractility), but the relative strength and independence of these associations remain unknown. METHODS AND RESULTS: We examined the relations of echocardiographically determined LV mass to demographic variables, blood pressure, Doppler SV, and measures of contractility (end-systolic stress [ESS]/end-systolic volume index and midwall fractional shortening [MFS] as a percentage of predicted for circumferential end-systolic stress [stress-independent shortening]) in 1935 American Indian participants in the Strong Heart Study phase 2 examination without mitral regurgitation or segmental wall motion abnormalities. Weak positive relations of LV mass with systolic and diastolic pressures (r=.22 and r=.20) were exceeded by positive relations with height (r=.30), weight (r=.47), body mass index (r=.31), body surface area (r=.49), and Doppler SV (r=.50) and negative relations with ESS/volume index ratios (r= -.33 and -.29) and stress-independent MFS (r= -.26, all P<.0001). In multivariate analyses that included blood pressure, SV, and a different contractility measure in each model, systolic pressure, stroke volume, and the contractility measure were independent correlates of LV mass (multiple R=.60 to .66, all P<.0001). When demographic variables were added, LV mass was more strongly predicted by higher SV and lower afterload-independent MFS than by greater systolic pressure, height, and body mass index (each P<.00001, multiple R=.71). CONCLUSIONS: Additional characterization of volume load and contractile efficiency improves hemodynamic prediction of LV mass (R(2)=.30 to .44) over the use of systolic blood pressure alone (R(2)=.05), with a further increase in R(2) to .51 when demographic variables are also considered. However, nearly half of the ventricular mass variability remains unexplained.

Aged↗
PubMed2006

Demographic characteristics of individuals who received Project Liberty crisis counseling services.

OBJECTIVES: This article describes demographic characteristics of service recipients and their patterns of use of crisis counseling services provided under Project Liberty during the 27 months after the September 11, 2001, attacks on the World Trade Center. It also examines the extent to which service recipients reflected the demographic characteristics of their home communities. METHODS: A total of 753,015 service encounter logs submitted by 177 providers were analyzed to determine rates of use by different demographic groups and to evaluate patterns of use over time with goodness-of-fit and logistic regression models. RESULTS: A total of 687,848 individual crisis counseling sessions were provided to an estimated 465,428 individuals, including large numbers of persons from racial or ethnic minority groups and non-English-speaking individuals. Most of these services were provided to residents of the five New York City boroughs, with a small percentage of services to residents from the ten surrounding counties. Most services were provided in community settings rather than provider offices. African-American and Hispanic individuals showed the greatest increase in rates of accessing services over time. Follow-up visits were significantly more likely to be by Caucasians than by non-Caucasians, and children were more likely than adults to receive follow-up visits. Demographic characteristics of individuals using Project Liberty crisis counseling services generally were representative of the five boroughs and ten other counties constituting the greater metropolitan region and representative of estimated need. CONCLUSIONS: Project Liberty provided services that were accessible to individuals of diverse racial and ethnic backgrounds.

Adult↗
PubMed1996

Predicting activity and workload in general practice from the demographic structure of the practice population.

OBJECTIVES: The managerial requirements of budget-setting and performance monitoring in general practice (primary care) in the UK require an understanding of the causal relationship between practice activities and the characteristics of both the practice and its patients. This study sought to model the determinants of three major components of general practice activities (consultations, prescribing costs and referrals to secondary care), paying particular attention to the influence of the demographic structure of the patient list. METHODS: Stepwise regression analysis was carried out on data for 98 practices in the county of Lincolnshire using 12 independent variables pertaining to patient and practice characteristics plus 14 statistical measures derived from the demographic structure of the patients registered with the practice. RESULTS: Robust statistical models were estimated for the three dependent variables, of which list size emerged as the most significant independent variable. In addition, six other independent variables, including the patients' unemployment rate, fundholding status and single-handed status, were statistically significant in one or more of the equations. Variables based on the demographic structure of the practice population also appeared in each model. The Jarman score and degree of urbanization did not achieve statistical significance. CONCLUSIONS: Activity and workload in general practice can be predicted from routine data. Such models are of particular value for planning and financial management when demographic change in practice populations is anticipated.

Budgets↗
PubMed2005

Persistent demographic differences in colorectal cancer screening utilization despite Medicare reimbursement.

BACKGROUND: Colorectal cancer screening is widely recommended, but often under-utilized. In addition, significant demographic differences in screening utilization exist. Insurance coverage may be one factor influencing utilization of colorectal cancer screening tests. METHODS: We conducted a retrospective analysis of claims for outpatient services for Washington state Medicare beneficiaries in calendar year 2000. We determined the proportion of beneficiaries utilizing screening fecal occult blood tests, flexible sigmoidoscopy, colonoscopy, or double contrast barium enema in the overall population and various demographic subgroups. Multiple logistic regression analysis was used to determine the relative odds of screening in different demographic groups. RESULTS: Approximately 9.2% of beneficiaries had fecal occult blood tests, 7.2% had any colonoscopy, flexible sigmoidoscopy, or barium enema (invasive) colon tests, and 3.5% had invasive tests for screening indications. Colonoscopy accounted for 41% of all invasive tests for screening indications. Women were more likely to receive fecal occult blood test screening (OR 1.18; 95%CI 1.15, 1.21) and less likely to receive invasive tests for screening indications than men (OR 0.80, 95%CI 0.77, 0.83). Whites were more likely than other racial groups to receive any type of screening. Rural residents were more likely than urban residents to have fecal occult blood tests (OR 1.20, 95%CI 1.17, 1.23) but less likely to receive invasive tests for screening indications (OR 0.89; 95%CI 0.85, 0.93). CONCLUSION: Reported use of fecal occult blood testing remains modest. Overall use of the more invasive tests for screening indications remains essentially unchanged, but there has been a shift toward increased use of screening colonoscopy. Significant demographic differences in screening utilization persist despite consistent insurance coverage.

Age Distribution↗
PubMed2003

Demographic and parasitic infection status of schoolchildren and sanitary conditions of schools in Sanliurfa, Turkey.

BACKGROUND: The design and development of school health programmes will require information at demographic characteristics of schoolchildren and the major health burdens of the school-age group, the opportunities for intervention and the appropriateness of the available infrastructure. This study aims to analyse demographic and parasitic infections status of schoolchildren and sanitary conditions of schools in Sanliurfa province of south-eastern Turkey. METHOD: Three primary schools were randomly selected in the shantytown, apartment and rural districts. A total of 1820 schoolchildren between 7-14 years age were took part to the survey of whom 1120 (61.5%) were boys and 700 (38.4%) were girls. A child form (including child's name, sex, age, school grade and parasitic infections) and school survey form (including condition of water supply, condition of latrines, presence of soaps on the basins and presence of garbage piles around to the schools) were used for demographic, parasitic and sanitary surveys. Stool samples were examined by cellophane thick smear technique for the eggs of intestinal helminths. RESULTS: The demographic survey showed that number of schoolchildren was gradually decreased as their age's increase in shantytown school. The sex ratio was proportional until the second grade, after which the number of females gradually decreased in children in shantytown and rural schools while, in apartment area, schoolchildren was proportionally distributed between age groups and gender even the high-grade students. The prevalence of helminthic infections was %77.1 of the schoolchildren in shantytown, 53.2% in apartment district and 53.1% of rural area. Ascaris lumbricoides was the most prevalent species and followed by Trichuris trichiura, Hymenolepis nana and Taenia species in three schools. Sanitation survey indicated that the tap water was limited in shantytown school, toilet's sanitation was poor, available no soaps on lavatories and garbage piles were accumulated around the schools in shantytown and rural area, while, the school in apartment area was well sanitised. CONCLUSIONS: These results indicated that burden of parasitic infections and poor sanitation conditions constituted public health importance among to the shantytown schoolchildren. School health programmes including deworming and sanitation activities through the health education and improvement of sanitation conditions in the schools have a potential to better health and education for schoolchildren. These programmes also offer the potential to reach significant numbers of population in the shantytown schools with high level of absenteeism.

Adolescent↗
PubMed2004

Attenuating demographic influences on verbal fluency and animal naming in a psychiatric sample.

Measures of verbal fluency are common additions to neuropsychological evaluations. Due to the literature demonstrating the impact of demographic variables on these measures, corrective norms have recently been published. However, these norms have yet to be cross-validated. This study sought to cross-validate these norms in a racially diverse psychiatric sample. In addition, this study sought to evaluate the utility of Wide Range Achievement Test, 3rd Edition (WRAT3) Reading Recognition and Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Vocabulary in attenuating the effect of demographic variables on these measures of verbal fluency. Results supported the utility of Gladsjo et al.'s (1999) norms. Further analysis revealed that both WRAT3 Reading Recognition and WAIS-III Vocabulary scores also attenuated the impact of demographic variables on these measures and accounted for more of the variance. Together, these results suggest that, although the demographically corrected norms adequately attenuate the impact of these variables, norms corrected for WRAT3 Reading Recognition or WAIS-III Vocabulary may account for more of the variance and therefore might be more appropriate and universally applicable.

Adolescent↗
PubMed1998

Effects of psychopathology and demographic characteristics on MMPI-2 scale scores.

Using multiple linear regression analyses, we examined the effects of subject status for 6 demographic variables and the presence of psychopathology on variance in MMPI-2 scale scores. The analyses were designed to measure the incremental contribution of the demographic variables to scale variance beyond that explained by presence of psychopathology. Demographic variables were found to contribute little incremental variance for the validity and clinical scales, but did explain more than 10% of the score variance for 1 clinical scale, 2 content scales, and 5 supplemental scales. For these 8 scales, gender was most often the potent demographic variable and an expected influence. The results are discussed in light of the use of gender-based norms and in terms of other potential factors that might explain MMPI-2 scale score variance.

Adult↗
PubMed2006

Understanding the demographic characteristics of urban men who have sex with men.

We examined migration, closetedness, and family structure explanations of demographic profiles of urban men who have sex with men (MSM) using data from the Urban Men's Health Study and the Public Use Microdata Sample of the U.S. Census. The data suggested that the demographic profiles of urban MSM reflect a large in-migrating white, often young adult, population without children. Closetedness, an oft-cited bias in MSM population studies, did not significantly impact demographic patterns with minor exceptions. MSM urban subpopulations have demographics that differ substantially from the general population of the cities in which they reside.

Adolescent↗
PubMed2001

Estimating premorbid IQ from demographic variables: a comparison of a regression equation vs. clinical judgement.

OBJECTIVES: To assess the accuracy with which clinicians estimate premorbid IQ from demographic variables and compare it with a regression equation which uses the same information. DESIGN: Repeated measures and correlational. METHODS: Sixty participants were administered the WAIS-R and had their demographic variables recorded (age, sex, years of education and occupation). Eight clinical psychologists estimated the participants' IQs from the demographic variables. Estimated IQs were also obtained using a regression equation developed by Crawford and Allan (1997). RESULTS: The correlation between obtained IQ and the equation-based estimate was significantly higher than the correlation between obtained IQ and the clinicians' estimates. Further, mean estimated IQ from the regression equation did not differ significantly from obtained IQ whereas the means for four of the eight clinicians' estimates did differ significantly. CONCLUSIONS: Demographic-based regression equations can provide unbiased and useful estimates of premorbid IQ; these estimates can be modified in the light of the additional qualitative information available to the clinician.

Adolescent↗
PubMed2002

Consanguinity in Spain: socioeconomic, demographic, and geographic influences.

Information on consanguinity in Spain was reanalyzed in order to obtain a more complete picture of consanguinity patterns by considering temporal, geographical, demographic, and economic factors. To obtain data on consanguineous marriages, we reviewed 106 published references. Only populations with homogeneous geographical characteristics, economic activities, transportation facilities, and the like, were considered. Two-way analysis of variance (ANOVA) provided highly significant differences (p < 0.001) for a both for time periods and for urban versus rural patterns, but there was no interaction between the latter two. A regression analysis shows that for rural areas the geographic characteristics, economy, communications, and index of demographic tendency were significant predictors of the inbreeding coefficient. The results obtained indicate that urban and rural patterns differ significantly and that the temporal factor needs to be taken into account before comparing inbreeding coefficients. In urban areas the census size and altitude are included in the regression equation as significant variables, but association was not found between alpha and the index of demographic tendency (population increase or decrease). Instead, the absolute number of inhabitants (census size) was significant. In rural areas geographic characteristics, communications, and index of demographic tendency were significant predictors of the inbreeding coefficient.

Analysis of Variance↗