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PubMed2004

Spatial risk assessment of herd sero-status of Aujeszky's disease in a county in Hungary.

A Geographic Information System (VetEpiGIS) was used to analyze the ADV (Aujeszky's disease virus) sero-status in large-scale pig units regarding certain geographical features in a county of southern Hungary. The ADV sero-statuses were collected from all swine units in Csongrád county in 1998-2000. The units' coordinates were combined with a vector graphical digital map of the county, with a resolution of 1:100,000. Logistic regression tested the associations between sero-status of large-scale units and presence of topographical features, other units and villages in the neighborhood. "Neighborhood" was defined by circular zones with radius 1-10km around the unit (in 1km increments; one logistic regression for each radius). The following topographical features showed significant positive association with the ADV seropositivity: lake (3km OR: 5.7; 5km OR: 7.5; 6km OR: 6.1; 10km OR: 5.4) and highway (5km OR: 4.2; 6km OR: 5.3). Other features had negative association with ADV seropositivity: forest (3km OR: 0.13; 4km OR: 0.15; 5km OR: 0.15; 6km OR: 0.10; 7km OR: 0.10; 8km OR: 0.23) and uninfected large-scale unit (4km OR: 0.07; 5km OR: 0.27; 6km OR: 0.32; 7km OR: 0.31).

Animal Husbandry↗
PubMed2005

Lead, cadmium, and zinc concentrations in plaster and mortar from structures in Jasper and Newton Counties, Missouri (Tri-State Mining District).

The primary goal of this study was to evaluate anecdotal evidence that within Jasper and Newton Counties, Missouri, two counties within the Tri-State Mining District, granular mine tailings were commonly used in place of river sands in wall plasters and mortar. Interior wall plaster and mortar samples from structures in this mining district were analyzed for lead, cadmium, and zinc, and compared to samples from Springfield, MO (comparison site). The Jasper and Newton County samples showed elevated concentrations of the three elements, consistent with the inclusion of mine tailings, with a number of samples containing lead and cadmium at concentrations greater than EPA remediation targets for yard soil. X-ray diffraction studies showed the presence of the zinc ore minerals, sphalerite and hemimorphite, in high level samples. Thin section optical studies identified the major component of the aggregate as chert, a mineral abundant within the tailing piles. Because dust from crumbling plaster and mortar could represent an avenue for significant heavy metal exposure to building occupants, we suggest that there may be associated health consequences that should be further evaluated.

Air Pollution, Indoor↗
PubMed2006

Facility and county effects on racial differences in nursing home quality indicators.

This study's goal was to examine the effects of nursing home (NH) and county racial mix on quality of care in NHs. We examined quality indicator (QI) outcomes for residents in 408 urban New York NHs in July through September, 1995. The QI outcomes studied were restraint and antipsychotic drug use (for low and high-risk residents), and at study commencement, these QIs were being used by the Centers for Medicare and Medicaid Services to monitor the quality of care in USA Medicare and/or Medicaid-certified NHs. A hierarchical modeling approach was used to properly reflect the nesting of both residents within NHs and NHs within counties. Separate regression models were fit to the two strata of interest (Urban Non-Hispanic Whites and Urban African Americans) to test, for each race group, the effect on quality of residing in NHs and counties with higher proportions of African Americans (than state medians). Descriptive analyses found that, compared to Whites, the unadjusted restraint rate was lower for African Americans while the antipsychotic drug rate was higher. For both race groups, multi-level analyses showed residence in for-profit NHs was associated with higher likelihoods of being restrained, and of receiving antipsychotic drugs. Also, for both race groups, residence in NHs with higher proportions of African-Americans was associated with lower likelihoods of being restrained and with higher, statistically nonsignificant, likelihoods of receiving antipsychotic drugs. Higher NH nurse staffing ratios were associated with higher likelihoods of being restrained and with lower likelihoods of antipsychotic drug use (statistically significant for low-risk African-Americans). Findings support the notion that differential care is provided in USA NHs caring for higher proportions of African-American residents and thereby suggest intervention at the organizational level is warranted to improve QI outcomes for both race groups.

Black or African American↗
PubMed1991

Associations of daily mortality and air pollution in Los Angeles County.

We report results of a multiple regression analysis examining associations between aggregate daily mortality counts and environmental variables in Los Angeles County, California for the period 1970 to 1979. Mortality variable included total deaths not due to accidents and violence (M), deaths due to cardiovascular causes (CV), and deaths due to respiratory causes (Resp). The environmental variables included five pollutants averaged over Los Angeles County--total oxidants (Ox), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and KM (a measure of particulate optical reflectance). Also included were three metereological variables measured at the Los Angeles International Airport--temperature (Temp), relative humidity (RH), and extinction coefficient (Bext), the latter estimated from noontime visual range. To reduce the possibility of spurious correlations arising from the shared seasonal cycles of mortality and environmental variables, seasonal cycles were removed from the data by applying a high-pass filter. Cross-correlation functions were examined to determine the lag structure of the data prior to specifying and fitting the multiple regression models relating mortality and the environmental variables. The results demonstrated significant associations of M (or CV) with Ox at lag 1, temperature, and NO2, CO, or KM. Each of the latter three variables were strongly associated with daily mortality but also were highly correlated with one another in the high-frequency band, making it impossible to uniquely estimate their separate relationships to mortality. The results of this study show that small but significant associations exist in Los Angeles County between daily mortality and three separate environmental factors: temperature, primary motor vehicle-related pollutants (e.g., CO, KM, NO2), and photochemical oxidants.

Air Pollutants↗
PubMed1991

Methylene chloride exposure and birthweight in Monroe County, New York.

This study examined the relationship between birthweight and exposure to emissions of methylene chloride (DCM) from manufacturing processes of the Eastman Kodak Company at Kodak Park in Rochester, Monroe County, New York. County census tracts were categorized as exposed to high, moderate, low or no DCM based on the Kodak Air Monitoring Program (KAMP) model, a theoretical dispersion model of DCM developed by Eastman Kodak Company. Birthweight and information on variables known to influence birthweight were obtained from 91,302 birth certificates of white singleton births to Monroe County residents from 1976 to 1987. No significant adverse effects of exposure to DCM on birthweight were found. Adjusted birthweight in high exposure census tracts was 18.7 g less than in areas with no exposure (95% confidence interval for the difference between high and no exposure - 51.6, 14.2 g). Problems inherent in the method of estimation of exposure, which may decrease power or bias the results, are discussed. Better methods to estimate exposure to emissions from multiple industrial point sources are needed.

Air Pollutants↗
PubMed2001

Public perceptions of environmental quality: a survey study of beach use and perceptions in Los Angeles County.

Despite documented successes in the battle to clean up the coastal waters of Southern California, Los Angeles County residents continue to view the ocean more as a place of pollution than a vibrant and healthy place for bathing and swimming. This study shows that residents of Los Angeles County tend to hold perceptions of marine water quality that are at odds with data on bacteriological measures of water quality collected by local sanitation districts (and reported by not-for-profit Heal the Bay). Summary results of a survey of 400 randomly chosen households in Los Angeles County are given. Respondents were asked about their beach use and perceptions of environmental quality: both coastal water quality and air quality. The results suggest that perceptions of coastal water quality may be influenced less by "current coastal education campaigns" and more by the media and other factors.

Adult↗
PubMed2005

Long-term trends in thyroid carcinoma: a population-based study in Olmsted County, Minnesota, 1935-1999.

OBJECTIVE: To determine whether there was a significant increase in the incidence of thyroid carcinoma in Olmsted County, Minnesota, that may be attributed to the widespread use of therapeutic head and neck irradiation between 1920 and the 1950s or to exposure to atomic fallout at the Nevada Test Site in the 1960s. METHODS: Rochester Epidemiology Project resources were used to identify potential cases of thyroid carcinoma among residents of Olmsted County between 1935 and 1984. We extended this earlier study through 1999. RESULTS: During the study period, thyroid carcinoma was newly diagnosed in 263 residents. In women, the age-adjusted incidence increased from 2.7 per 100,000 person-years (p-y) in 1935-1949 to 9.2 per 100,000 p-y in 1990-1999 (P = .001); In men, the rate increased from 0.8 to 5.0 per 100,000 p-y (P = .007). However, most of the increase occurred before 1965 and remained relatively stable thereafter. Similar trends were observed for papillary carcinoma alone. CONCLUSION: Although the Incidence of thyroid carcinoma increased significantly between 1935 and 1964, no significant Increases have been seen since 1965, suggesting that neither atmospheric atomic fallout from the Nevada Test Site nor use of ionizing radiation to treat conditions of the head and neck significantly affected the incidence of thyroid carcinoma in Olmsted County.

Adolescent↗
PubMed1995

Incidence of sudden infant death syndrome in Olmsted County, Minnesota: 1945 through 1992.

OBJECTIVE: To apply uniform diagnostic criteria for sudden infant death syndrome (SIDS) for an extended period for comparison of incidence rates from 1945 to 1992 in Olmsted County, Minnesota, to investigate the influence of a person-time or live birth denominator on the estimate of incidence, to calculate the proportionate mortality rate for SIDS over time, and to evaluate the accuracy of death certificates for case ascertainment and the role of interobserver variation in case classification. DESIGN: We retrospectively reviewed the autopsy results and complete medical records for all infant death from 1945 through 1992 for residents of Olmsted County, Minnesota. MATERIAL AND METHODS: Cases were identified from a computerized list of all Olmsted County deaths of infants occurring at ages 48 hours to 365 days. All resident cases were categorized as non-SIDS, possible SIDS, SIDS, or incomplete, on the basis of findings from autopsy and clinical history. Incidence rates were calculated for two different SIDS groups and with use of denominators of person-time and live births. RESULTS: For the study period, 82 cases of SIDS were identified (97% white and 3% Asian). The mean age at death was 12.5 weeks; male infants constituted 59% of cases. No significant trend in seasonal distribution was noted; 73% of deaths occurred between midnight and noon. The incidence rate, defined as SIDS definite and possible deaths per 1,000 resident live births, increased from 0.55 in 1950 through 1953 to 1.28 in 1990 through 1992. The secular trend was best described by a linear model with constant positive slope. Similar trends were observed with other definitions of incidence. During the study period, SIDS as a percentage of total infant deaths dramatically increased, ranging from 2.5 in 1950 through 1953 to 17.9 in 1990 through 1992. The death certificate diagnosis correctly predicted 72% of SIDS cases before 1970 and 100% of cases after 1970. CONCLUSION: Since 1945, the incidence of SIDS apparently has increased, although diagnostic transfer from other causes of death probably contributes to the observed trend. The comparison of live births versus person-time as denominators showed no significant difference in incidence rates. Interobserver reliability is modest for SIDS cases diagnosed before 1970 and may contribute to the variability in reported SIDS incidence rates.

Death Certificates↗
PubMed1994

Incidence of leukemia in Olmsted County, Minnesota, 1975 through 1989.

OBJECTIVE: To determine the incidence of leukemia in Olmsted County, Minnesota, for a recent 15-year period and to compare the data with reported rates for the previous 40 years. DESIGN: We conducted a population study of leukemia diagnosed between 1975 and 1989 in residents of Olmsted County by review of medical records identified through diagnostic indexes, death certificates, autopsy files, and histologic preparations. MATERIAL AND METHODS: Diagnoses of leukemia were categorized into various subtypes, and age- and sex-specific incidence rates were calculated for leukemia as a whole and for each subtype. In addition, incidence rates were age- and sex-adjusted to the 1970 US white population for comparison with earlier published rates. Age and annual trends as well as sex differences were assessed with the generalized linear interactive model approach. RESULTS: During 1975 through 1989, the mean annual incidence rate for leukemia was 12.3 per 100,000 population in Olmsted County. When adjusted for age and sex, the rate per 100,000 was 13.6, in comparison with a similarly adjusted rate of 11.8 for the previous decade (1965 through 1974). The rates for chronic myelogenous leukemia and acute lymphocytic leukemia remained stable throughout the entire study period; however, rates for acute myelogenous leukemia and chronic lymphocytic leukemia increased, most prominently in patients 50 years of age or older. This increased rate occurred in both males and females, but the incidence rates for both subtypes began increasing earlier for males than for females. CONCLUSION: Although we cannot rule out an actual increase in incidence rates for these types of leukemia in the elderly population, we believe that the increase in persons older than 50 years of age reflects social change in improved health care and its better utilization by elderly persons, as well as the ability to diagnose leukemia earlier than in the past.

Adolescent↗
PubMed1999

Epidemiology of anaphylaxis in Olmsted County: A population-based study.

BACKGROUND: Awareness of the clinical features of anaphylaxis and its causative triggers is important if recurrent episodes are to be avoided. The incidence of anaphylaxis in the general population is often underreported, and epidemiologic studies are few. Because an accurate profile of anaphylaxis could heighten awareness of this problem, we investigated the epidemiology of anaphylaxis in the general population of Olmsted County, Minn. OBJECTIVE: The purpose of this study was to describe the epidemiology of anaphylaxis in Olmsted County residents from 1983 through 1987. METHODS: This was a retrospective population-based cohort study. The medical records of 1255 Olmsted County residents identified by computer-linked, medical diagnostic indices (the Rochester Epidemiology Study) were reviewed retrospectively to identify residents whose clinical episodes met the criteria for anaphylaxis. We determined the incidence and rate of occurrence of anaphylaxis, rate of recurrence, prevalence of atopy, cause of anaphylaxis, frequency of referral to an allergy specialist, hospital admission rate, and case-fatality rate. RESULTS: There were 133 residents who experienced 154 anaphylactic episodes during the 5-year period: 116 residents had 1 episode of anaphylaxis, 13 residents had 2 episodes, and 4 residents had 3 episodes. The anaphylaxis occurrence rate was 30 per 100,000 person-years (95% confidence interval, 25-35). There were 110 residents who had a first lifetime episode of anaphylaxis (that was medically evaluated) during the years 1983 to 1987. The average annual incidence rate of anaphylaxis was 21 per 100,000 person-years (95% confidence interval, 17-25). Atopy was present in 53% of the cohort, and allergy consultation was obtained in 52%. A suspect allergen was identified in 68% of the cohort, most frequently a food, medication, or insect sting. The hospitalization rate was 7%, and 1 patient died. CONCLUSION: The incidence of anaphylaxis is less than 1%, and death rarely occurs. People with atopy experience anaphylaxis more frequently than people without atopy. Anaphylaxis frequently is not recognized by patients and physicians.

Anaphylaxis↗
PubMed2003

Epidemiology of child homicide in Jefferson County, Alabama.

OBJECTIVE: The purpose of this study was to present the epidemiology of homicide among children younger than 6 years of age in Jefferson County, Alabama. This study focused on obtaining great detail on homicides and suspicious deaths occurring within a fixed population. METHODS: For purposes of this study, cases included Jefferson County deaths attributed to "homicide" or that were "undetermined" as noted in the coroner files among children younger than 6 years of age who were born and died between January 1, 1988 and December, 31, 1998. Victim and offender characteristics were obtained from the Jefferson County Coroner/Medical Examiner Office records. Environmental factors and circumstances surrounding the death were noted as well. RESULTS: The 53 study subjects were mainly female (55%), Black (69%), younger than 2 years of age (85%), had single mothers (38%), and a history of abuse (53%). Offenders were more likely to be male (64%), Black (73%), and a parent of the victim (53%). Homicides primarily resulted from an angry impulse (61%), with hands the most common weapon (61%). CONCLUSIONS: The majority of deaths in this study occurred among children younger than age 2, with a high proportion of fatalities among Black children of unmarried mothers. The offender most often knew the victim, with half of all homicides and two-thirds of all infant homicides involving a parent. More than half of the homicides resulted from an angry impulse, while the most common scenario for deaths with undetermined intent involved the caretaker finding the child unresponsive.

Black or African American↗
PubMed1998

Congenital esotropia in Olmsted County, Minnesota.

OBJECTIVE: To determine the birth prevalence of and risk factors associated with congenital esotropia. DESIGN: Population-based prevalence study with nested case-control study. PARTICIPANTS: All residents of Olmsted County, Minnesota who were diagnosed with congenital esotropia and born between January 1, 1980 and December 31, 1989 (n = 47). Control subjects were chosen by selecting the next two sequential births to parents residing in Olmsted County, Minnesota (n = 94). METHODS: Cases were identified through the Medical Diagnostic Index of Mayo and the Rochester Epidemiology Project. The community medical records were reviewed to confirm case status and ascertain risk factor information. MAIN OUTCOME MEASURE: Birth prevalence of congenital esotropia. RESULTS: Forty-seven cases were identified from 17,536 live births, for a birth prevalence of 27 per 10,000 (95% confidence interval [CI], 20-35). Congenital esotropia was associated with prematurity (odds ratio [OR], 11.5; 95% CI, 3.4-39.2), a birth weight less than 2500 grams (OR, 4.6; 95% CI, 1.7-12.9), a low Apgar score at 1 minute (OR, 4.3; 95% CI, 1.7-11.2) and at 5 minutes (OR, 6.3; 95% CI, 1.3-30.7), and a family history of strabismus (OR, 3.5; 95% CI, 1.5-8.3). CONCLUSIONS: The birth prevalence of congenital esotropia in Olmsted County, Minnesota is lower than previous estimates. Prematurity, low birth weight, low Apgar scores, and a family history of strabismus are significant risk factors for congenital esotropia.

Apgar Score↗
PubMed1999

Association between health insurance and antibiotics prescribing in four counties in rural China.

A cross-sectional study was carried out at county, township and village health care facilities in four counties in rural China in order to describe and compare the effects of health financing systems on antibiotic prescribing in outpatient care. A total of 1232 outpatients at the health care facilities was selected by multi-stage random sampling and were interviewed over 2 weeks. The results showed that health financing systems appeared to influence antibiotic prescribing in outpatient care, both in terms of frequency and of the types prescribed. The insured group had lower prescribing of antibiotics at township and village health care facilities, and for respiratory tract infections, but had higher prescribing of newer antibiotics at county and village health care facilities, for respiratory tract and g-i infections. Because there was a high patient compliance rate (94.3%) in this study the prescribing of antibiotics (supply side behavior) reflected the use of antibiotics (demand side behavior) to a great extent. Thus the results imply that antibiotics prescribing and using might be biased by the patient's health financing systems and antibiotic prescribing was the result of the interaction between physicians and patients.

Anti-Bacterial Agents↗
PubMed2003

A spatial analysis of county-level variation in hospitalization rates for low back problems in North Carolina.

Hospitalization rates for low back problems vary widely. In previous non-spatial analyses, population-level socioeconomic and health resource characteristics have explained little of the variation in rates. This study examines geographic variation in hospitalization rates for low back problems while controlling for spatial dependence in the data. County-level surgical and medical hospitalization rates were calculated using North Carolina hospital (USA) discharge data from 1990-92. Non-spatial and spatial regression models were estimated using socioeconomic and health resource predictors. Both surgical and medical rates varied significantly among the 100 counties. Non-spatial models explained 62% of variation in log-transformed surgical rates and 66% of variation in log-transformed medical rates; however, residuals showed significant spatial dependence. Spatial lag models were therefore applied. Using simple contiguity spatial weights, surgery rates increased with higher percent urban population, primary care physician density, and discharge rate for other causes, and decreased with higher percent college graduates, percent disabled, occupied hospital bed density, and unoccupied hospital bed density. There was a nonlinear relationship between surgery rates and percent employed in heavy lifting/transportation industries. Medical rates increased with higher other-cause discharge rate and with MRI/CT scanner availability, and decreased with higher percent urban population, percent nonwhite population, percent in heavy lifting/transportation industries, and unoccupied hospital bed density. The results show that population-level socioeconomic and health resource characteristics are important determinants of variation in low back hospitalization rates. Independent of these variables, a separate spatial process produces geographic clustering of high-rate counties. Spatial effects are important and should be considered in small area analyses.

Catchment Area, Health↗
PubMed2004

Disability in society-medical and non-medical determinants for disability pension in a Norwegian total county population study.

The objective of this study was to describe sociomedical determinants and developments for the medically based disability pension in Norway by linking individual based data from a county health survey to data on disability from the National Insurance Administration. Two cross-sectional total population health surveys with an approximate 10-year interval were conducted in Nord-Trøndelag county, HUNT I (1984-86) and HUNT II (1995-97), which allows for analyses of changes over time, supplied with official incidence data on disability pension. The large-scale variations and overall increasing incidence rates of disability pension in Norway during the last 20 years also applied to the county of Nord-Trøndelag. The prevalence of disability pension generally increased in the population from the mid-1980s to the mid-1990s. A striking finding was a consistent pattern of increasing prevalence of disability pension with decreasing socio-economic status and education. A geographic pattern for disability pension prevalence on a municipality level suggested that structural and cultural factors were important in determining the level of disability in society. Medical determinants alone cannot explain either the dramatic variations or the overall increased incidence rates of disability pension in the last two decades in Norway. The results demonstrate the importance of social, non-medical and contextual determinants for disability pension, how these determinants result in important prevalence differences by socio-economic status, and their impact on the level of disability in society.

Adult↗
PubMed2001

Subnational sources of toxicology information: state, territorial, tribal, county, municipal, and community resources online.

The rapid assimilation data and information on the Internet and the World Wide Web (WWW) is reflected in the development of these electronic services by state, county, local, and other subnational agencies, departments, offices, bureaus, and intergovernmental bodies. The content of state and territorial, tribal, county, and local government Web pages varies considerably. However, information about health and the environment are among the most frequently posted resources by subnational government bodies. This article describes the environmental health and toxicology-related data and information resources provided by government agencies and representative associations for subnational government bodies. Standard reference sources for identifying subnational government bodies are described with particular reference to those in electronic and digital formats. Means for identifying and locating electronic resources are described for appropriate subnational environmental quality, environmental (public) health agencies, occupational health and safety, toxicology-related agencies and departments, emergency response, fish consumption advisories, and cancer registries are provided. Professional organizations of state, county, municipal (local) governments and intergovernmental bodies are also described.

Environmental Health↗
PubMed1998

Gender differences in use of stress testing and coronary heart disease mortality: a population-based study in Olmsted County, Minnesota.

OBJECTIVES: We sought to examine the utilization of exercise stress testing in relation to age and gender in a population-based setting. BACKGROUND: The utilization of noninvasive procedures has been shown to be associated with the subsequent use of invasive procedures. Yet, there are no population-based data on the utilization of stress testing; in particular, although gender differences in the use of invasive procedures have been reported, the use of noninvasive procedures has not been examined in relation to gender. METHODS: In Olmsted County, Minnesota, passive surveillance of the medical care of the community is provided through the Rochester Epidemiology Project. A population-based cohort of Olmsted County residents undergoing exercise tests was identified. The medical records of residents with prevalent and incident exercise tests in 1987 and 1988 were reviewed. For persons with an initial test (incidence cohort), data on clinical presentation, test indications and results were abstracted. Stress test utilization rates were calculated, and crude rates were directly adjusted to the age distribution of the 1980 U.S. population. To help interpret patterns of use at the population level, coronary heart disease mortality rates (International Classification of Diseases, 9th revision, codes 410 to 414) were calculated (crude and directly adjusted to the overall age distribution of the 1980 U.S. population) and used as an indicator of coronary disease burden. RESULTS: A total of 2,624 tests were performed. The crude utilization rate (per 100,000) was 1,888 for men and 703 for women (rate ratio for men over women 2.7, 95% confidence interval [CI] 2.5 to 2.9); it remained significantly higher in men across all age strata. The crude incidence rate (per 100,000) of initial stress tests was 1,112 for men and 517 for women (rate ratio 2.2, 95% CI 1.9 to 2.4). For both men and women, the incidence increased with age; however, incidence remained lower in women in all age strata. At the time that they underwent an initial test, women were more symptomatic and had poorer exercise performance than men. The rate ratio of men over women for coronary heart disease mortality was 1.1 (95% CI 0.9 to 1.2). The age-adjusted rate ratios for stress test utilization were 2.8 (95% CI 2.5 to 3.0), and that for coronary heart disease mortality was 1.9 (95% CI 1.7 to 2.2). CONCLUSIONS: These population-based data show that during the study period, the utilization of stress testing in Olmsted County was lower in women than in men. Women in the incidence cohort were older and more symptomatic and had poorer exercise performance than men. Such differences should be considered when examining the utilization of subsequent invasive procedures according to gender.

Adult↗
PubMed2001

Time trends in first admissions for schizophrenia and paranoid psychosis in Stockholm County, Sweden.

Several studies have reported decreasing time trends in first diagnosed schizophrenia patients. The aim of this study was to analyze time trends for first admissions with a diagnosis of schizophrenia or a diagnosis of either schizophrenia or paranoid psychosis during 1978-1994 in Stockholm County, Sweden, with a population of around 1.8million. Information about first psychiatric admission with the diagnosis schizophrenia or paranoid psychosis for residents of Stockholm County was obtained from the Swedish population-based psychiatric inpatient register. Age-adjusted average yearly changes in first hospitalization rates were estimated in a Poisson regression model. Time trends in first admission rates were calculated from 1978 to 1994, while admissions during 1971 to 1977 were observed only to eliminate later re-admissions. First admissions for schizophrenia declined by 1.9% annually for females and by 1.3% for males, while first admissions for schizophrenia and paranoid psychosis together were unchanged over the study period for both genders. Our results indicate that the incidence of schizophrenia and paranoid psychosis taken together was essentially the same over the studied time period in Stockholm County, and that the apparent decline in first admission rates for schizophrenia may be an effect of changes in clinical diagnosis over time.

Adolescent↗