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PubMed1982

A method of analyzing density-dependent vital rates with an application to the Gainj of Papua New Guinea.

A method of estimating age-specific coefficients of density-dependent variation in fertility and mortality is developed; the method is applicable to longitudinal data on population size and the number of births and deaths classified by age. Given a sufficiently large data set, it is possible to estimate both the sensitivity of each age class to density-dependent damping and the density effect of each age class on every age class in the population. Application of the method to government census data on the Gainj, a small tribal population from highland Papua New Guinea, shows that fertility is density-independent, but that mortality is at least partially density-dependent. This finding suggests that the size of the population is regulated by mortality rather than fertility. Individuals aged less than five years and greater than 50 years are particularly sensitive to density-dependent survival damping; individuals of adolescent and early reproductive age are not themselves damped, but appear to be responsible for the observed damping.

Adolescent↗
PubMed2004

Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975-2000.

BACKGROUND: Temporal cervical cancer incidence and mortality patterns and ethnic disparities in patient survival and stage at diagnosis in relation to socioeconomic deprivation measures have not been well studied in the United States. The current article analyzed temporal area socioeconomic inequalities in U.S. cervical cancer incidence, mortality, stage, and survival. METHODS: County and census tract poverty and education variables from the 1990 census were linked to U.S. mortality and Surveillance, Epidemiology, and End Results cancer incidence data from 1975 to 2000. Age-adjusted incidence and mortality rates and 5-year cause-specific survival rates were calculated for each socioeconomic group and differences in rates were tested for statistical significance at the 0.05 level. RESULTS: Substantial area socioeconomic gradients in both incidence and mortality were observed, with inequalities in cervical cancer persisting against a backdrop of declining rates. Cervical cancer incidence and mortality rates increased with increasing poverty and decreasing education levels for the total population as well as for non-Hispanic white, black, American Indian, Asian/Pacific Islander, and Hispanic women. Patients in lower socioeconomic census tracts had significantly higher rates of late-stage cancer diagnosis and lower rates of cancer survival. Even after controlling for stage, significant differences in survival remained. The 5-year survival rate among women diagnosed with distant-stage cervical cancer was approximately 30% lower in low than in high socioeconomic census tracts. CONCLUSIONS: Census-based socioeconomic measures such as area poverty and education levels could serve as important surveillance tools for monitoring temporal trends in cancer-related health inequalities and targeting interventions.

Education↗
PubMed2005

Racial/ethnic disparities in injection drug use in large US metropolitan areas.

PURPOSE: Because blacks and Latinos bear a disproportionate burden of injection-related health problems compared with whites, we sought to describe black/white and Latino/white disparities in injecting drugs in 94 US metropolitan statistical areas (MSAs) in 1998. METHODS: Using US Census data and three databases documenting injectors' use of different healthcare services (drug treatment, HIV counseling and testing, and AIDS diagnoses), we calculated database-specific black/white and Latino/white disparities in injecting in each MSA and created an index of black/white and Latino/white disparities by averaging data across the three databases. RESULTS: The median black/white injecting disparity in the MSAs ranged from 1.4 to 3.7 across the three databases; corresponding median Latino/white injecting disparities ranged from 1.0 to 1.1. Median black/white and Latino/white index disparity values were 2.6 and 1.0, respectively. CONCLUSIONS: Although whites were the majority of injectors in most MSAs, database-specific and index black/white disparity scores indicate that blacks were more likely to inject than whites. While database-specific and index disparity scores indicate that Latinos and whites had similar injecting rates, they also revealed considerable variation in disparities across MSAs. Future research should investigate these disparities' causes, including racial/ethnic inequality and discrimination, and study their contributions to the disproportionate burden of injection-related health problems borne by blacks and Latinos.

Adult↗
PubMed1999

Typhoid fever in children aged less than 5 years.

BACKGROUND: Calculation of the incidence of typhoid fever during preschool years is important to define the optimum age of immunisation and the choice of vaccines for public-health programmes in developing countries. Hospital-based studies have suggested that children younger than 5 years do not need vaccination against typhoid fever, but this view needs to be re-examined in community-based longitudinal studies. We undertook a prospective follow-up study of residents of a low-income urban area of Delhi, India, with active surveillance for case detection. METHODS: A baseline census was undertaken in 1995. Between Nov 1, 1995, and Oct 31, 1996, we visited 8172 residents of 1820 households in Kalkaji, Delhi, twice weekly to detect febrile cases. Blood samples were obtained from febrile patients, and those who tested positive for Salmonella typhi were treated with ciprofloxacin. FINDINGS: 63 culture-positive typhoid fever cases were detected. Of these, 28 (44%) were in children aged under 5 years. The incidence rate of typhoid per 1000 person-years was 27.3 at age under 5 years, 11.7 at 5-19 years, and 1.1 between 19 and 40 years. The difference in the incidence of typhoid fever between those under 5 years and those aged 5-19 years (15.6 per 1000 person-years [95% CI 4.7-26.5]), and those aged 19-40 years (26.2 [16.0-36.3]) was significant (p<0.001 for both). The difference between the incidence of typhoid at 5-19 years and the incidence at 19-40 years was also significant (10.6 [6.3-14.8], p<0.001). Morbidity in those under 5 and in older people was similar in terms of duration of fever, signs and symptoms, and need for hospital admission. INTERPRETATION: Our findings challenge the common view that typhoid fever is a disorder of school-age children and of adults. Typhoid is a common and significant cause of morbidity between 1 and 5 years of age. The optimum age of typhoid immunisation and the choice of vaccines needs to be reassessed.

Adolescent↗
PubMed2003

Climatic variables are associated with seasonal acute asthma admissions to accident and emergency room facilities in Trinidad, West Indies.

OBJECTIVES: To determine if there is seasonal variation in acute asthmatic visits to accident and emergency (A&E) facilities in Trinidad and to identify the climatic variables associated with such visits. DESIGN AND METHODS: A retrospective census of patients with asthma, defined as those who required emergency bronchodilator nebulization, was taken at two A&E facilities in Trinidad from 1 January 1997 to 31 December 1999. The study included patients aged 64 years and under. Patient demographic data were obtained from the A&E records. Climate variables were taken from the island's sole Meteorological Office. Multiple regression was used to identify climate variables that were independent predictors of A&E asthma visits. RESULTS: There were a total of 45 842 asthma admissions to the two facilities during the study period. Visits exhibited a cyclic pattern over the 3 years that varied according to the island's dry (January-May) and wet (June-December) seasons. There were more visits during the wet season than the dry (40 [SD=2] vs. 32 [SD=2] visits/day; P<0.001). The results of multiple regression indicated that season (P<0.001), barometric pressure (P<0.001), temperature difference (P<0.001), minimum temperature2 (P<0.001) and wind speed2 (P=0.032) were predictors of paediatric visits. Independent predictors of adult visits were season (P<0.001), relative humidity (P<0.001), minimum temperature (P=0.01), temperature difference2 (P<0.001) and minimum temperature2 (P=0.004). Season and climatic variables explained 18% of the variance of the total A&E asthma admissions. CONCLUSION: There is seasonal variation in acute asthma visits to A&E facilities in Trinidad, which remains significant after controlling for climate variables. However, while climate has a role, there are other factors that may also be responsible for increased visits during the wet season. More research is needed to identify these factors.

Acute Disease↗
PubMedDate not supplied

Racial differences in post-neonatal mortality in Chicago: what risk factors explain the black infant's disadvantage?

OBJECTIVES: To investigate the extent to which the place of residence affects the black to white differential in post-neonatal (28-365 days) mortality, we performed a univariate analysis and multivariate logistic regression of the 1982-1983 Illinois vital records. Chicago Police violent crime information and 1980 US Census income data. METHODS: Four environmental predictors of post-neonatal death were examined: a median family income of < $10,000 per year, a poverty prevalence of > 50%, violent crime rates of > 11/1000 and limited community access to primary medical care based on physician supply ratios. RESULTS: The post-neonatal mortality rate of black (n = 50,765) infants was three times that of white (n = 50,690) infants: 10/1000 versus 3/1000, respectively. Thirty-six percent of the white infants had none of the environmental risk factors, whereas only 13% of the black infants had none of the risk factors. For black infants, the presence of any one factor was associated with a slightly increased risk of post-neonatal mortality (9/1000 as compared to 7/1000 with no risk factors), whereas the presence of two or more risk factors was associated with a higher risk (11/1000). When the number of these environmental risk factors were taken into account, the OR for black infants declined from 3.0 (95% CI 2.5-3.6) to 1.7 (95% CI 1.5-1.9). When the differences in maternal age, education, marital status and infant birth weight were also taken into account the odds ratio of post-neonatal death for blacks was 1.5 (95% CI 1.3-1.7). CONCLUSIONS: We conclude that a substantial proportion of the black to white difference in post-neonatal mortality is associated with specific environmental conditions.

Black or African American↗
PubMed2003

A first look at retirement migration trends in 2000.

PURPOSE: This brief report takes a look at the preliminary estimates of the number and proportion of migrants over the age of 60 who moved to and from states between 1995 and 2000 and compares these estimates with those who made the same kind of move one decade earlier. DESIGN AND METHODS: The 2000 census 1-in-100 public-use microdata sample, released in the summer of 2003, and the 1-in-20 sample from the 1990 census, were compared in this analysis. Point estimates of 100% were created for the inflows and outflows for the top 10 states in these two census decades. Net migration was also considered. RESULTS: The total estimated number of older interstate migrants increased to over 2 million during the 1995-2000 migration period. Florida declined slightly in its position as the dominant destination for a second decade, indicating a downward trend for the first time. Arizona became the second largest receiving state, next to Florida, and California approached New York's dominance as a migration origin, or sending, state. Nevada entered the top ranking retirement states for the first time. IMPLICATIONS: Long-term migration dynamics of the older population may reflect perceived shifts in quality of life in destination states. Nonetheless, the next two decades will see a substantial rise in the number of older migrants.

Aged↗
PubMed2003

Estonia 1989-2000: enormous increase in mortality differences by education.

BACKGROUND: Having regained its political autonomy in 1991, Estonia experienced major changes in political, economic, and social realities. We aimed to analyse mortality changes by education from 1989 to 2000 in order to assess the impact of recent changes in Estonia, as well as the delayed effects of pre-transitional developments. METHODS: Two census-based analyses were compared. Individual cause-specific death data for those aged 20+ for 1987-1990 (72 003 deaths) and 1999-2000 (35 477 deaths) came from the national mortality database. Population denominators came from the population censuses of 1989 and 2000. Mortality for all causes combined and for selected causes of death were analysed for high, mid, and low educational groups. The absolute differences in mortality were evaluated through life expectancy at age 25 and age-standardized mortality rates. To assess the relative differences between educational levels, mortality rate ratios with 95% CI were calculated using Poisson regression. RESULTS: Educational differences in mortality increased tremendously from 1989 to 2000: over the 10-year period life expectancy improved considerably for graduates, and worsened for those with the lowest education. In 2000, male graduates aged 25 could expect to live 13.1 years longer than corresponding men with the lowest education; among women the difference was 8.6 years. Large differences were observed in all selected causes of death in 1989 and in 2000 and the trends were invariably much more favourable for the higher educated. Educational differences in total mortality increased in all age groups. CONCLUSIONS: Social disruption and increasing inequalities in wealth can be considered main recent determinants; however, causal processes, shaped decades before recent reforms, also contribute to this widening gap.

Adult↗
PubMed1982

Closure among U.S. community hospitals, 1976-1980: a description and a predictive model.

Closure of U.S. community hospitals during the years 1976-1980 is analyzed by describing the distributional patterns of closings among hospitals classified by certain institutional characteristics: bed size, number of facilities and services, ownership, teaching status, location in a Standard Metropolitan Statistical Area (SMSA) or in a non-SMSA, and location in one of the nine United States Census Divisions. The method of Cox regression analysis is used to show that each of these institutional characteristics is independently, and significantly, associated with closure, and to estimate the strength of the association. On the basis of this analysis, a theoretic model is constructed for estimating the relative probability of closure for any community hospital with a given set of these institutional characteristics.

Health Facilities↗
PubMed2006

The prevalence of phobia and its associated factors in a multiracial aging urban population.

OBJECTIVE: There have been few multiracial epidemiologic community-based studies of phobia in older adults. The aim of this study was to determine the prevalence of phobia and associated factors among older persons living in a northeastern urban area. METHODS: Using 1990 census data for Brooklyn, NY, the authors attempted to interview all persons age 55+ in randomly selected block groups. The final sample consisted of 214 whites and 860 blacks. The authors used an adaptation of George's Social Antecedent Model for examining the association of 18 individual variables and one interactive variable with the presence of a phobia. The dependent variable was derived from the Guy's/Age Concern community survey. The sample was weighted by race and gender. To control for design effects, the authors used SUDAAN for the data analysis. RESULTS: A total of 8.9% of the sample met criteria for a current phobia and 10.2% met phobia criteria at some time during their life. Using logistic regression analysis, the authors found six variables-higher personal income, more depressive symptoms, poorer physical health, use of prayer as a coping strategy, use of spiritualists or their products, and not having been raised by both parents-to be significantly associated with a current phobia. CONCLUSION: The prevalence rate of phobia was comparable to rates for older adults in the urban areas of the Epidemiologic Catchment Area study suggesting that prevalence has remained stable over the past two decades. Consistent with earlier studies, there were significant associations among phobia, depressive symptoms, and physical illness. Many of the demographic and social variables, including race, that had been reported previously to be associated with phobias in younger samples were not significant in this study.

Adaptation, Psychological↗
PubMed2003

Trauma system evaluation using the fatality analysis reporting system.

BACKGROUND: The Fatality Analysis Reporting System (FARS) has recorded detailed data on fatal traffic crashes since 1975. At least three prior studies have used declining mortality rates derived from FARS as evidence of regional trauma system effectiveness. METHODS: FARS and census data were obtained at no cost through the Internet. Previously published studies were replicated graphically including data from additional years before and after the previously reported time periods, and with rates also calculated for control populations. RESULTS: The association of trauma system organization with observed decreases in mortality rates was less convincing when all available data were displayed and other potential factors were considered. Death after traffic crashes, and especially death in hospitals, is becoming less frequent throughout the country. CONCLUSION: FARS is an excellent resource available to all injury researchers, but provides little evidence that some regions have decreased traffic mortality more than others because of trauma systems.

Accidents, Traffic↗
PubMed2002

Predictors of falls in the Melbourne visual impairment project.

OBJECTIVE: To assess factors associated with falls in the past month, including visual acuity and other vision-related variables. METHODS: A household census was used to recruit permanent residents aged 40 years and older for baseline examinations of the Melbourne Visual Impairment Project conducted from 1992-94. At the five-year follow-up examinations, returning participants were asked to recall all falls that they had ever experienced and also how many falls they had experienced in the past month. Falls history was divided into those that occurred at home and away from home. Standardised examination of visual acuity was performed. RESULTS: Of the original cohort of 3,271, 231 (7.1%) were reported to have died, leaving 3,040 eligible. Of these, 2,594 (85%) were examined, 51 (2%) had moved interstate or overseas, 83 (3%) could not be traced, and 312 (10%) refused to participate. A history of having ever fallen at home was reported by 466 (20%) participants, and 406 (17.3%) reported having fallen away from home at least once. Five per cent of the cohort (129/2,343) had fallen in the previous month. Factors significantly related to falls at home in the past month in a multivariate logistic regression model included age (OR=1.56 for 10-year age groups) and nuclear cataract (OR=2.87). CONCLUSIONS: Irrespective of visual acuity, cataract is major risk factor for falls at home. IMPLICATIONS: Interventions aimed at decreasing the incidence of falls in the community should include assessment of both visual acuity and cataract status and referral for treatment if functional impairment is evident.

Accidental Falls↗
PubMed2007

Cancer is overtaking cardiovascular disease as the main driver of socioeconomic inequalities in mortality: New Zealand (1981-99).

BACKGROUND: Relative socioeconomic disparities in cardiovascular mortality have increased in New Zealand, as in many Western countries in Northern Europe, the US and Australia during the late 20th century. However, substantial declines in cardiovascular mortality mean that its absolute contribution to overall mortality has decreased. RESEARCH QUESTIONS: How did the absolute contribution of major causes of death to socioeconomic inequalities in New Zealand change during the 1980s and 90s? METHODS: Linked census-mortality cohorts were used to calculate the contribution of different causes of death to inequalities in mortality, measured with the slope index of inequality, by household income. RESULTS: Between 1981-4 and 1996-9, the contribution of cardiovascular disease (CVD) to total inequality declined from 55% to 28% among women, whereas at the same time the contribution of cancers increased from 14% to 37%. Among men, the contribution of CVD to total inequality peaked at 47% in 1986-9, then declined to 38% in 1996-9. The contribution of cancer increased from 19% to 26% in men. CONCLUSION: CVD mortality has declined at all income levels and so too has the contribution of CVD to mortality inequalities. Concurrently, the contribution of cancer to inequalities in mortality by income has increased and, in women at least, is now greater than the contribution of CVD. It is hypothesised that a similar crossover is occurring in other populations where CVD mortality has declined, although socioeconomic differences in the distribution and effect of the obesity epidemic for CVD may ensure its continuing importance. Prevention efforts aimed at reducing socioeconomic inequalities in mortality will need to increasingly focus on socioeconomic inequalities in cancer mortality.

Adult↗
PubMed2004

Racial differences in paranoid ideation and psychoses in an older urban population.

OBJECTIVE: This study examined whether there are racial differences in the prevalence of paranoid ideation and psychotic symptoms in persons age >/=55 in an urban community. METHOD: Using 1990 census data for Brooklyn, N.Y., the authors attempted to interview all cognitively intact persons age >/=55 in randomly selected blocks. The final group consisted of 206 whites and 821 blacks. The authors used George's Social Antecedent Model for analyzing 21 independent and three dependent variables: paranoid ideation, psychotic symptoms, and psychotic symptoms/paranoid ideation. The group was weighted by race and gender. To control for intrablock clustering effects without replacement sampling, the authors used SUDAAN for data analysis. RESULTS: A significant difference in psychotic symptoms or paranoid ideation was found between blacks and whites (24% versus 10%) that was attenuated but not eliminated with logistic regression analyses. Blacks with psychotic symptoms or paranoid ideation, especially Caribbeans, had significantly lower receipt of mental health services and lower perceived service needs. With logistic regression, psychotic symptoms and paranoid ideation were associated with four variables among blacks and whites, although only one was significant in both groups. CONCLUSIONS: Racial differences in psychotic symptoms and paranoid ideation persist even after control for various clinical, social, and attitudinal effects. Among blacks, response to stressors may be expressed through increased paranoid ideation and psychotic symptoms. Stronger beliefs in spiritualism increase this expression in both races. The high prevalence of psychotic symptoms or paranoid ideation among this aging urban population, especially blacks, highlights a potential public health issue.

Age Factors↗
PubMed2005

Racial differences in syndromal and subsyndromal depression in an older urban population.

OBJECTIVE: The authors explored racial differences in the prevalence of depression and its associated factors among older persons. METHODS: Using 1990 census data for Brooklyn, New York, the authors attempted to interview all cognitively intact persons age 55 years and older in randomly selected block groups. The sample was weighted by ethnicity and gender. The authors adapted George's Social Antecedent Model of Depression to allow examination of 20 independent variables and the nominal dependent variable consisting of three levels of depression. The data were analyzed with SUDAAN. RESULTS: Syndromal depression was found among 8 percent of blacks and 10 percent of whites. Subsyndromal depression was found among 13 percent of blacks and 28 percent of whites. No racial differences were found in rates of syndromal depression, but significant racial differences were found in rates of subsyndromal depression and of any type of depression. Nonlinear effects on both types of depression were found, and higher levels of stress had a greater impact on whites than on blacks. The racial difference in subsyndromal depression was explained by its lower prevalence among French-speaking African Caribbeans. Many racial differences were found in the variables associated with syndromal and subsyndromal depression. CONCLUSIONS: Race had an independent effect on the rate of subsyndromal depression and an interactive effect with stress on the rate of both syndromal and subsyndromal depression. For each racial group, different elements may play a role in the etiology, maintenance, and relief of depression. The findings underscore the importance of recognizing within-group and between-group racial differences in depression.

Aged↗
PubMedDate not supplied

FluSurge--a tool to estimate demand for hospital services during the next pandemic influenza.

PURPOSE: To assess the impact of pandemic influenza on hospital services. METHODS: Based on census data and estimates of hospital resources (non-ICU [intensive care unit] beds, ICU beds, and mechanical ventilators) in a given area, FluSurge software estimates the number of hospital admissions and deaths due to pandemic influenza under variable duration and virulence scenarios and compares hospital resources needed during a pandemic with existing hospital resources. RESULTS: Sample results from Metropolitan Atlanta illustrate how the next influenza pandemic may overwhelm existing hospital resources, given that hospitals increasingly operate at nearly full capacity. CONCLUSIONS: Hospitals need to consider and plan for a surge in demand for hospital services during the next influenza pandemic.

Adolescent↗
PubMed2004

[Regional differences in perinatal mortality rates in Japan--an investigation based on vital statistics].

OBJECTIVE: This study investigated whether regional differences in perinatal mortality rates are related to distances to medical resources for perinatal care, such as the Neonatal Intensive Care Unit (NICU). METHODS: Using the census for Japan in 2000, all municipalities in Japan were classified into four groups based on population size: municipalities of 1,000,000 people or more (Group 1), municipalities between 350,000 and 1,000,000 people (Group 2), municipalities between 10,000 and 350,000 people (Group 3), and municipalities of less than 10,000 people (Group 4). Then, using the vital statistics, perinatal mortality rates for all groups were calculated. In addition, setting the perinatal mortality rate in Group 1 as a referent, we calculated the differences in the rates to detect regional differences in perinatal mortality in Japan. Finally, we compared the distances between the municipality center and the closest NICU among the four groups by one-way ANOVA. RESULTS: The perinatal mortality rates of Groups 1, 2, 3 and 4 were 5.38, 5.58, 5.88 and 6.31, respectively. The perinatal mortality rate ratios (95%CI) were 1.04 (0.96-1.12), 1.09 (1.03-1.16), and 1.17 (1.05-1.31), respectively. The perinatal mortality rate differences (95%CI) were 0.20 (-0.24-0.64), 0.50 (0.15-0.84), and 0.93 (0.23-1.62), respectively. The distances (95%CI) between the center of the municipalities and the closest NICU for Groups 1, 2, 3 and 4 were 2.61 (1.56-3.66) km, 4.23 (2.74-5.72) km, 20.79 (17.68-23.90) km and 38.07 (31.65-44.48) km, respectively. All of the differences among the groups were significant (p < 0.001), except for the difference between Group 1 and Group 2. CONCLUSION: There are regional differences in perinatal mortality rates in Japan. This study suggests that the difference is associated with the uneven distribution of NICUs.

Health Services Accessibility↗
PubMed2005

Policy changes and the methadone maintenance treatment system for opioid dependence in Ontario, 1996 to 2001.

BACKGROUND: Until recently, the availability of methadone treatment in Ontario, Canada was limited. In 1996, policy changes were introduced to increase the availability of treatment. The 5-year impact of these policy changes is assessed. METHODS: For these census data, descriptive statistics were used to examine changes in the patient and provider populations over time using data from the College of Physicians and Surgeons of Ontario Methadone Maintenance Registry of Patients and the Registry of Methadone Prescribing Physicians. RESULTS: Between 1996 and 2001, the total number of clients in treatment increased substantially from: 1595 to 7787. Over this time period, the number of physicians prescribing methadone increased from 60 to 161. INTERPRETATION: Policy changes resulted in substantial increases in the patient and provider populations across Ontario. However, the estimated low proportion of opiate users in treatment indicates that more efforts are needed to address the potential demand for treatment.

Adult↗