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PubMed2001

Using census data and birth certificates to reconstruct the early-life socioeconomic environment and the relation to the development of Alzheimer's disease.

The early-life environment and its effect on growth and maturation of children and adolescents are associated with several adult chronic diseases, including Alzheimer's disease. Because it is not feasible to collect information prospectively over the average life span, methods to reconstruct the early-life environment of the aged are necessary to evaluate these associations. In a community-based case-control study conducted in the United States, we collected U.S. census records and birth certificates to reconstruct the early-life socioeconomic environment of each elderly subject. Information was found on 82% of the available Alzheimer's disease cases (239 of 292) and 87% of the available controls (245 of 282). We investigated risk of Alzheimer's disease associated with father's occupation, parental age, household size, sibship size, and birth order. Subjects whose fathers were unskilled manual workers or laborers were at higher risk for Alzheimer's disease (odds ratio = 1.80, 95% confidence interval = 1.19--2.73). The risk of Alzheimer's disease was increased with increasing number of people in the household. We also evaluated whether subjects with the apolipoprotein epsilon 4 allele (APOE epsilon 4), a strong genetic risk factor that is not a necessary cause or a sufficient cause by itself for the development of Alzheimer's disease, were at higher risk than subjects who did not carry this allele. Among subjects with the APOE epsilon 4 allele whose fathers held lower-socioeconomic level occupations, the odds of developing Alzheimer's disease were higher (odds ratio = 2.35, 95% confidence interval = 1.07--5.16) compared with subjects without the allele (odds ratio = 1.40, 95% confidence interval = 0.78--2.52). Subjects carrying the APOE epsilon 4 allele alone have a threefold increased risk of Alzheimer's disease (odds ratio = 3.17, 95% confidence interval = 1.99--5.04). Compared with subjects with neither risk factor, subjects with both the genetic and the environmental risk factors (household size of seven or more and father's occupation being manual) had a relatively high risk of Alzheimer's disease (odds ratio = 14.8, 95% confidence interval = 4.9--46). The data suggest that APOE epsilon 4 may modify the associations between father's occupation, other early-life environmental factors, and development of Alzheimer's disease in late life.

Adolescent↗
PubMed1992

The Israel perinatal census.

A nation-wide perinatal census which included 22,815 deliveries was carried out. The cesarean section rate was 9.6% and the perinatal mortality rate was 13.5/1000. Using a logistic regression analysis the risk factors for cesarean section and for perinatal mortality were ranked. Breech presentation and one uterine scar were found to be the most important risk factors for cesarean section and breech presentation, maternal disease and multiple pregnancy for perinatal mortality. Low birth weight rate was 6.9% with nonsignificant differences between the various ethnic groups. The national cesarean section rate in breech presentation was 57.8%. It was performed mainly at the extremes of birth weight. From those with one previous cesarean section 55.1% delivered vaginally and 44.9% abdominally. The chance for vaginal delivery is higher (67.2%) providing the woman had delivered vaginally in the past. Comparison between primiparae and multiparae showed that preeclampsia, hypertension and diabetes mellitus were all significantly more frequent among older parturients and among primiparae.

Adolescent↗
PubMed1997

Selection bias from sampling frames: telephone directory and electoral roll compared with door-to-door population census: results from the Blue Mountains Eye Study.

Many Australian public health research studies use the telephone directory or the electoral roll as a sampling frame from which to draw study subjects. The sociodemographic, disease-state and risk-factor characteristics of subjects who could be recruited using only the telephone directory or only the electoral roll sampling frames were compared with the characteristics of subjects who would have been missed using only these sampling frames, respectively. In the first phase of the Blue Mountains Eye Study we interviewed and examined 2557 people aged 49 and over living in a defined postcode area, recruited from a door-to-door census. This represented a participation rate of 80.9 per cent and a response rate of 87.9 per cent. The telephone directory was searched for each subject's telephone number and the electoral roll was searched for each subject. Subject characteristics for those who were present in each of these sampling frames were compared with the characteristics of those subjects not included in the sampling frames. The telephone directory listed 2102 (82.2 per cent) of the subjects, and 115 (4.5 per cent) had no telephone connected. The electoral roll contained 2156 (84.3 per cent) of the subjects, and 141 subjects (5.5 per cent) could not be found in either the electoral roll or the telephone directory. Younger subjects, subjects who did not own their own homes and subjects born outside of Australia were significantly less likely to be included in either of these sampling frames. The telephone directory was also more likely to exclude subjects with higher occupational prestige, while the electoral roll was more likely to exclude unmarried persons and males. Researchers using the telephone directory and electoral roll to select subjects for study should be aware of the potential selection bias these sampling frames incur and need to take care when generalising their findings to the wider community.

Aged↗
PubMed1997

A national census of those attending UK accident and emergency departments with asthma. The UK National Asthma Task Force.

OBJECTIVE: To obtain a representative national picture of the type of people with asthma attending accident and emergency (A&E) departments in the UK, the reasons why they attend, and to determine the proportion admitted to hospital. DESIGN: A national census involving questionnaires. SETTING: 100 A&E departments throughout the UK. SUBJECTS: All those with asthma attending because of asthma during a one week period in September 1994. RESULTS: Details were obtained about 1292 attendances. About half of all attendances were by adults and half by children, and 87.8% were previously diagnosed asthmatics; 18.8% of adult attenders were unemployed. Perceived severity of asthma was the reason for attendance in 65.5%, but 11.5% reported non-availability, or perceived non-availability, of the general practitioner (GP) as the reason for attending. One fifth of adults had been kept awake by their asthma for over three nights before attendance. 425 of the 1292 attenders (32.9%) had been admitted to hospital in the previous 12 months and 316 (24.5%) had attended the A&E department in the previous three months. Only 24.6% of attenders had had contact with their general practitioner in the previous 24 h. 61.6% of under-5 attenders (n = 341) were admitted to hospital; the figures for those aged 5-15 and 15+ years and above were 265 (41.4%) and 665 (38.7%). CONCLUSIONS: Many people with asthma attend A&E departments without first having seen their GP. In many adult cases the asthma, while severe, is not acute, but a high proportion of both adults and children are admitted to hospital. Many of these attendances and admissions are repeat attendances. To enhance the quality of care provided to those with asthma may require easier access to primary care, enhanced patient education, or enhanced health professional education. Further study is needed of a variety of potential interventions.

Acute Disease↗
PubMed2003

Random sample (DOPPS) versus census-based (registry) approaches to kidney disease research.

This review describes advantages and limitations of registries that base their analyses on the census of all patients. Registries may utilize the random sample approach to enrich their data for more detailed and informative research. The Dialysis Outcomes and Practice Pattern Study (DOPPS) and its random sample approach is discussed here in detail, with examples on the value of this method. The DOPPS is currently being expanded to allow for even more valuable studies. This methodology can also be applied to large countries that do not have an existing registry, as it is an effective way of collecting detailed information at a relatively low cost that is representative of the country or population as a whole.

Censuses↗
PubMed2006

Is there a "Scottish effect" for self reports of health? Individual level analysis of the 2001 UK census.

BACKGROUND: Scotland's overall health record is comparatively poor for a Western European country, particularly amongst people of working age. A number of previous studies have explored why this might be the case by comparing mortality in Scotland with England and Wales. A study in the 1980s showed that the higher prevalence of deprivation in Scotland accounted for Scotland's excess mortality risk. However, more recent studies suggest that deprivation now explains less of this excess. This has led to the suggestion that there is a yet unidentified "Scottish effect" contributing to Scotland's mortality excess. Recent research has also suggested that there could be an unidentified effect influencing Scotland's higher rate of heart disease. This paper explores whether there is also an unexplained Scottish excess, relative to England, in self reports of poor health. METHODS: Data came from the individual Sample of Anonymised Records, a 3% random sample of the 2001 UK census. Using logistic regression models, self reports of health (limiting illness and general health) from the working age populations (aged 25 to 64) of Scotland and England were compared. Account was taken of people's country of birth. Stratified analysis by employment status allowed further exploration of Scotland's excess. RESULTS: People born and living in Scotland reported higher levels of poor general health and limiting illness compared to people born and living in England. Adjustment for socioeconomic position and employment status largely explained the higher rates. In the stratified analysis a Scottish excess was seen only amongst the economically inactive born and living in Scotland. For those in employment, people born and living in Scotland actually had slightly lower odds of reporting poor general health and limiting illness than people born and living in England. CONCLUSION: This analysis suggests that higher rates of poor self reported health in Scotland can be explained by differences in employment and socioeconomic position and so there is unlikely to be an unidentified "Scottish effect" for self reports of health. Scotland's excess of poor general health and limiting illness amongst the economically inactive is probably attributable to its economic and employment history.

Adult↗
PubMed2006

Longitudinal study of urban malaria in a cohort of Ugandan children: description of study site, census and recruitment.

BACKGROUND: Studies of malaria in well-defined cohorts offer important data about the epidemiology of this complex disease, but few have been done in urban African populations. To generate a sampling frame for a longitudinal study of malaria incidence and treatment in Kampala, Uganda, a census, mapping and survey project was conducted. METHODS: All households in a geographically defined area were enumerated and mapped. Probability sampling was used to recruit a representative sample of children and collect baseline descriptive data for future longitudinal studies. RESULTS: 16,172 residents living in 4931 households in a densely-populated community (18,824 persons/km2) were enumerated. A total of 582 households were approached with at least one child less than 10 years of age in order to recruit 601 children living in 322 households. At enrollment, 19% were parasitaemic, 24% were anaemic, 43% used bednets, and 6% used insecticide-treated nets. Low G6PD activity (OR = 0.33, P = 0.009) and bednet use (OR = 0.64, P = 0.045) were associated with a decreased risk of parasitaemia. Increasing age (OR = 0.62 for each year, P < 0.001) and bednet use (OR = 0.58, P = 0.02) were associated with a decreased risk of anaemia CONCLUSION: Detailed surveys of target populations in urban Africa can provide valuable descriptive data and provide a sampling frame for recruitment of representative cohorts for longitudinal studies. Plans to use a multi-disciplinary approach to improve the understanding of the distribution and determinants of malaria incidence and response to therapy in this population are discussed.

Aging↗
PubMed2004

Are data on the uptake of disability benefits a useful addition to census data in describing population health care needs?

OBJECTIVE: To determine if administrative data relating to the uptake of disability benefits held by government departments in Northern Ireland are fair and unbiased indicators of relative need for health care and therefore a useful addition to census data. METHOD: This is an ecological study of the 566 electoral wards in Northern Ireland. The variation in uptake of a health-related benefit (Disability Living Allowance) was regressed against three other indicators of health (limiting long-term illness, mortality and the numbers of patients admitted to hospital). All the indicators had been indirectly standardised by age and sex. The unstandardised residuals from this model were regressed against the social and geographical factors, namely area deprivation score, religious denominational composition and urban/rural dwelling to see if they influenced benefit uptake above and beyond any association with ill health. RESULTS: The health factors alone explained 77.2% of the variation in benefit uptake, with limiting long-term illness being the major determinant; however, even after controlling for differences in health status, benefit uptake was shown to be higher in more urban areas and in areas that had a greater proportion of Catholics. Area deprivation was not associated with benefit uptake once health differences had been controlled for. CONCLUSION: Administrative data on disability benefits can undoubtedly provide useful additional information for describing the levels of relative disadvantage or ill health of areas. However, because they also reflect variations in uptake, which appears to be confounded by social and geographical factors, we would urge caution when they are used to identify priority areas or to allocate resources.

Adult↗
PubMed2005

[A nationwide wealth score based on the 2000 Brazilian demographic census].

OBJECTIVE: To propose an asset based indicator of wealth for Brazil using variables present in the demographic census. METHODS: The indicator, named IEN (Indicador Econômico Nacional/ National Wealth Score), was developed using 12 assets and the schooling of the household head, through principal component analysis. Data from the 2000 Brazilian Demographic sample was used for deriving the score and for the calculation of decile cut-off points. RESULTS: The indicator, first component obtained from the analysis with the 13 variables, retained 38% of the total variability, and presented a Spearman correlation of 0,74 with total family income and of 0,67 with per capita income. The necessary scores to calculate the indicator are presented, as well as reference distributions for the 27 states and their capitals, the five major regions as for the whole country. An example of use of indicator is presented. CONCLUSIONS: Differently from other economic indicators, the Indicador Econômico Nacional has local reference distributions available, along with the national distribution. It is therefore possible to compare a study sample to the municipal, state or country distribution. The small number of variables allow investigators to calculate the Indicador Econômico Nacional in research studies where economic classification is of interest.

Brazil↗
PubMed2005

Functional limitations among older American Indians and Alaska natives: findings from the census 2000 supplementary survey.

The objectives of this study were to determine the national prevalence and profile of American Indian and Alaska Natives with functional limitations. Data were obtained from 4763 American Indian and Alaska Native respondents aged 45 years or older in the Census 2000 Supplementary Survey. Functional limitations were reported by 28% of American Indian and Alaska Natives aged 45 years or older. These individuals were poorer, older, less educated, and less likely to be married or employed than American Indian and Alaska Natives without such limitations (for all comparisons, P < .001). American Indian and Alaska Natives have high disability rates, and many are not receiving benefits for which they qualify.

Age Factors↗
PubMed2000

Race/ethnicity and the 2000 census: implications for public health.

OBJECTIVES: This article addresses the potential impact of the revised standards for race and ethnicity on data from the 2000 census and public health data sources, policies, and programs. METHODS: The authors examine the relationship between race/ethnicity and health in selected measures, identify the factors that influence race/ethnicity identification, consider past experience in race/ethnicity reporting, and explore the challenges in understanding and managing the effects of new racial/ethnic categories in various data sets. RESULTS: The multiple-race group seems to compose only a small percentage of the US population and may have little impact on data for single-race groups. Actual effects will vary according to a number of factors, including the size, composition, and geographic distribution of the group. CONCLUSIONS: More research is needed to support a thorough understanding of the reporting of multirace data and the development of techniques for analyzing these data. Given the importance of understanding the relationship between race/ethnicity and health, the ability to produce useful, comparable, and meaningful data is essential.

Censuses↗
PubMed2005

Implications of the United States census 2000 in analyzing and reporting new findings of disparities in health.

This paper argues that, when analyzing and reporting new findings of disparities in health, two areas from the recent U.S. Census of 2000 should be considered for those findings to be meaningful. The first is to avoid analyzing and reporting findings of disparity with an emphasis on the term "Hispanic" and instead to specify the particular Hispanic group from which such findings were collected, such as Mexican-American versus Cuban communities. The second point is that such findings should also take into consideration combination of two or more races. For example, reporting would allow for multiple groupings for respondents who consider themselves African American and White, or African American, Asian, and White.

Bias↗
PubMed1996

English language ability and mental health service utilisation: a census.

OBJECTIVE: To explore the relationship between English language proficiency and mental health service utilisation. METHODS: In September 1993, a sample census was conducted of all mental health services in the State of Victoria, including public and private hospital wards, outpatient consultations provided by psychiatrists and clinical psychologists, and primary mental health care provided by general practitioners. Response rates ranged from 37% for monolingual general practitioners (GPs) to 96% for inpatient units. Particular emphasis was placed on patients' English language proficiency and the role played by bilingual clinicians. RESULTS: Over 80% of inpatients received a diagnosis of either dementia or psychosis. This proportion was even greater in the case of patients with English language difficulties. The latter group of patients underutilised specialist outpatient services, and those using these services were less likely to receive psychotherapy than fluent English speakers. They utilised GPs for mental disorder at at least the same rate as other patients. There was a marked preference for bilingual GPs, with 80% of patients with poor English language skills consulting GPs who spoke their native language. CONCLUSION: There appears to be considerable underutilisation of specialist mental health services by patients who are not fluent in English. The liaison-consultation model of psychiatric care may be an effective way of addressing this problem, given the important role already played by billingual GPs in the psychiatric care of those whose native language is not English.

Adolescent↗
PubMed2005

National job-exposure matrix in analyses of census-based estimates of occupational cancer risk.

OBJECTIVES: The aim of this study was to increase the understanding of the alternative exposure metrics and analysis methods in studies applying job-exposure matrices in analyses of health outcomes, the association between crystalline silica and cancer being used as an example. METHODS: Observed and expected numbers of cancer cases during 1971-1995 among Finns born in 1906-1945 were calculated for 393 occupational categories, as defined in the 1970 population census. According to the Finnish Cancer Registry, there were 43 433 lung and 21 444 prostate cancer cases. The Finnish job-exposure matrix (FINJEM) provided estimates of the proportion of exposed persons and the mean level of exposure among the exposed in each occupation. RESULTS: The most comprehensive exposure metric included period- and age-specific estimates of exposure and an estimate of occupational stability, but also remarkably simpler metrics gave significantly elevated estimates of the risk ratio (RR) between 1.36 and 1.50 for lung cancer for occupations with the highest estimated cumulative silica exposure (> or = 10 mg/m3-years), allowing a lag time of 20 years. It proved important to adjust the risk ratios at least for the socioeconomic status and occupational exposure to asbestos. The risk ratios for prostate cancer were close to 1.0 in every model. CONCLUSIONS: The results showed that the FINJEM-based analysis was able to replicate the well-known association between exposure to crystalline silica and lung cancer. The FINJEM-based method gives valid results, and it can be used to analyze large sets of register-based data on health outcomes.

Adult↗
PubMed2000

The meaning and measurement of race in the U.S. census: glimpses into the future.

The 1996 Racial and Ethnic Targeted Test (RAETT) was a "mail-out mail-back" household survey with an experimental design of eight alternative questionnaire formats containing systematic variations in race, instructions, question order, and other aspects of the measurement. The eight different questionnaires were administered to random subsamples of six "targeted" populations: geographic areas with ethnic concentrations of whites, blacks, American Indians, Alaskan natives, Asian and Pacific Islanders, and Hispanics. The major conclusion is that allowing multiple responses to the "race" question in the 2000 census (and other variations in measurement that were considered in RAETT) had only a slight impact on the measured racial composition of the population. Another finding was a dramatic reduction in nonresponse to the combined race/Hispanic-origin question relative to all other questionnaire formats. We conclude that the concept of "origins" may be closer to the popular understanding of American diversity than is the antiquated concept of race.

Censuses↗
PubMedDate not supplied

[Results of the Census of Hemodynamic Services and Interventional Cardiology 2000 in the Mexican Republic].

We present the results from the National Census of cardiac catheterization and interventionist Cardiology Services performed by the Chapter of interventional Cardiology of the Mexican Society of Cardiology up to the year 2000. The present document identifies the total number of existing services, their physical characteristics and available human resources, as well as the number and type of procedures performed in them.

Cardiology Service, Hospital↗
PubMed2002

Unlocking the numerator-denominator bias. II: Adjustments to mortality rates by ethnicity and deprivation during 1991-94. The New Zealand Census-Mortality Study.

AIMS: Maori and Pacific mortality rates are underestimated due to different recording of ethnicity between mortality and census data--the so-called numerator-denominator bias. Ethnicity and deprivation are strongly associated with mortality in New Zealand, but it is unclear what are the independent and overlapping effects of each on health. The objectives of this study were first, to determine the effect of adjusting for numerator-denominator bias on ethnic-specific age-standardised all-cause mortality rates among 0-74 year olds during 1991-94: second, to determine the effect of adjusting for numerator-denominator bias on analyses of the independent associations of ethnic group and small area deprivation with all-cause mortality in New Zealand. METHODS: Direct standardisation methods were used to calculate rates of mortality by ethnic and small area deprivation groupings. RESULTS: Unadjusted for numerator-denominator bias, Maori had a 70% and 101% higher standardised mortality rate than non-Maori non-Pacific for males and females, respectively. Adjusting for numerator-denominator bias, the excess Maori mortality burden increased to 126% and 158%. For Pacific people, excess mortality increased from -5% and -13% (ie apparently lower mortality rates) to 58% and 54% after adjustment, for males and females respectively. Using data adjusted for numerator-denominator bias, about a third of the Maori to non-Maori non-Pacific disparity in mortality among 0-54 year olds was explained by small area deprivation. Conversely, about a quarter of the mortality gradient by deprivation in New Zealand was explained by ethnic group. CONCLUSIONS: Numerator-denominator bias causes a marked underestimate of the ethnic disparities in mortality in New Zealand for the 1991-4 period, both overall and within strata of deprivation. The distribution of small area deprivation by ethnicity explains some of the ethnic disparities in mortality.

Adolescent↗
PubMed2002

Geography for the 2001 Census in England and Wales.

This article provides an overview of 2001 Census geography systems in England and Wales, concentrating primarily on the creation of output geography. It is important to note that there are significant differences between the systems being implemented in England and Wales and those which apply to Northern Ireland and Scotland. The Northern Ireland system is broadly similar to that described here, whereas the entire data infrastructure and output area design process in Scotland are different.

Censuses↗