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PubMed2007

Alcohol and environmental justice: the density of liquor stores and bars in urban neighborhoods in the United States.

OBJECTIVE: This study had two purposes: (1) to characterize the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and (2) to assess alternative measures of retailer density based on the road network and population. METHOD: We used census data on business counts and sociodemographic characteristics to compute the densities facing individuals in 9,361 urban zip codes. RESULTS: Blacks face higher densities of liquor stores than do whites. The density of liquor stores is greater among nonwhites in lower-income areas than among whites in lower- and higher-income areas and nonwhites in higher-income areas. Nonwhite youths face higher densities of liquor stores than white youths. The density of liquor stores and bars is lower in higher-income areas, especially for nonwhites. CONCLUSIONS: Mismatches between alcohol demand and the supply of liquor stores within urban neighborhoods constitute an environmental injustice for minorities and lower-income persons, with potential adverse consequences for drinking behavior and other social ills. Our results for bars are sensitive to the measure of outlet density as well as population density. Although neither measure is clearly superior, a measure that accounts for roadway miles may reflect proximity to alcohol retailers and thus serve as a useful refinement to the per-capita measure. If so, alcohol policy might also focus on density per roadway mile. Further research on the existence, causes, and consequences of environmental injustice in alcohol retailing is warranted.

Alcohol Drinking↗
PubMed2002

The impact of mother-to-mother support on optimal breast-feeding: a controlled community intervention trial in peri-urban Guatemala City, Guatemala.

OBJECTIVE: To assess the impact that a mother-to-mother support program operated by La Leche League Guatemala had on early initiation of breast-feeding and on exclusive breast-feeding in peri-urban Guatemala City, Guatemala. MATERIALS AND METHODS: A population census was conducted to identify all mothers of infants < 6 months of age, and the mothers were then surveyed on their breast-feeding practices, in two program communities and two control communities. Data collection for this follow-up census and survey was carried out between November 2000 and January 2001, one year after a baseline census and survey had been conducted. RESULTS: At follow-up, 31% of mothers in the program communities indicated that counselors had advised them about breast-feeding, 21% said they had received a home visit, and 16% reported attending a support group. Community wide rates of early initiation of breast-feeding were significantly higher in program areas than in the control communities, at both baseline and follow-up. However, the change over time in early initiation in program communities was not significantly different from the change in control communities. Community wide rates of exclusive breast-feeding were similar in program and control sites and did not change significantly from baseline to follow-up. However, of the mothers in the program communities who both received home visits and attended support groups, 45% of them exclusively breast-fed, compared to 14% of women in program communities who did not participate in those two activities. In addition, women who were exposed to mother-to-mother support activities during the year following the baseline census and survey were more likely than mothers exposed before that period to exclusively breast-feed. This suggests that the program interventions became more effective over time. CONCLUSIONS: This study does not provide evidence of population impact of La Leche League's intervention after one year of implementation. In peri-urban Guatemala, long-term community-based interventions, in partnership with existing health care systems, may be needed to improve community wide exclusive breast-feeding rates.

Adult↗
PubMed1996

Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada.

OBJECTIVES: We compared US and Canadian health administration costs using national medical care employment data for both countries. METHODS: Data from census surveys on hospital, nursing home, and outpatient employment in the United States (1968 to 1993) and Canada (1971 and 1986) were analyzed. RESULTS: Between 1968 and 1993, US medical care employment grew from 3.976 to 10.308 million full-time equivalents. Administration grew from 0.719 to 2.792 million full-time equivalents, or from 18.1% to 27.1% of the total employment. In 1986, the United States deployed 33,666 health care full-time equivalent personnel per million population, and Canada deployed 31,529. The US excess was all administrative; Canada employed more clinical personnel, especially registered nurses. Between 1971 and 1986, hospital employment per capita grew 29% in the United States (mostly because of administrative growth) and fell 14% in Canada. In 1986, Canadian hospitals still employed more clinical staff per million. Outpatient employment was larger and grew faster in the United States. Per capita nursing home employment was substantially higher in Canada. CONCLUSIONS: If US hospitals and outpatient facilities adopted Canada's staffing patterns, 1,407,000 fewer managers and clerks would be necessary. Despite lower medical spending, Canadians receive slightly more nursing and other clinical care than Americans, as measured by labor inputs.

Administrative Personnel↗
PubMed2000

Economic deprivation and AIDS incidence in Massachusetts.

OBJECTIVES: This study quantified AIDS incidence in Massachusetts in relation to economic deprivation. METHODS: Using 1990 census block-group data, 1990 census population counts, and AIDS surveillance registry data for the years 1988 through 1994, we generated yearly and cumulative AIDS incidence data for the state of Massachusetts stratified by sex and by neighborhood measures of economic position for the total, Black, Hispanic, and White populations. RESULTS: Incidence of AIDS increased with economic deprivation, with the magnitude of these trends varying by both race/ethnicity and sex. The cumulative incidence of AIDS in the total population was nearly 7 times higher among persons in block-groups where 40% or more of the population was below the poverty line (362 per 100,000) than among persons in block-groups where less than 2% of the population was below poverty (53 per 100,000). CONCLUSIONS: Observing patterns of disease burden in relation to neighborhood levels of economic well-being elucidates further the role of poverty as a population-level determinant of disease burden. Public health agencies and researchers can use readily available census data to describe neighborhood-level socioeconomic conditions. Such knowledge expands options for disease prevention and increases the visibility of economic inequality as an underlying cause of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Area deprivation and widening inequalities in US mortality, 1969-1998.

OBJECTIVES: This study examined age-, sex-, and race-specific gradients in US mortality by area deprivation between 1969 and 1998. METHODS: A census-based area deprivation index was linked to county mortality data. RESULTS: Area deprivation gradients in US mortality increased substantially during 1969 through 1998. The gradients were steepest for men and women aged 25 to 44 years and those younger than 25 years, with higher mortality rates observed in more deprived areas. Although area gradients were less pronounced for women in each age group, they rose sharply for women aged 25 to 44 and 45 to 64 years. CONCLUSIONS: Areal inequalities in mortality widened because of slower mortality declines in more deprived areas. Future research needs to examine population-level social, behavioral, and medical care factors that may account for the increasing gradient.

Abstracting and Indexing↗
PubMed1997

Underreporting and misclassification of maternal mortality in Taiwan.

BACKGROUND: Underreporting and misclassification of maternal deaths are universal. The purposes of this study were to quantify the level of underestimation of maternal mortality and to analyze possible factors that contribute to underreporting and misclassification of maternal mortality. METHODS: An interview census of all registered deaths that occurred during 1984-1988 in women of reproductive age was undertaken in Taiwan. Pregnancy-related deaths were screened from all collected questionnaires and death certificates by the researchers. The screened pregnancy-related deaths were then reviewed and evaluated by obstetrician-gynecologists; a cause of each death was assigned. RESULTS: For the five years, on average, the rate of underreporting of maternal mortality is 58.38% and the correct/confirmed rate of classification is 53.28%. Underreported and misclassified maternal deaths are more likely for women aged 20-24, with stillbirth and fetal death, care sought for non-obstetric reasons, care received in private hospitals and clinics, occurrence in the home, certification by non-obstetrician-gynecologists and court doctors, and death from non-obstetric causes. CONCLUSIONS: This study shows the limitations of official vital registration and concludes that dependence on death certificates alone to identify maternal deaths is incomplete and incorrect.

Adult↗
PubMed2000

Unemployment and health care utilization.

OBJECTIVES: This study attempted to determine whether prior use of health services predicts a subsequent risk of unemployment and also to describe the acute effects of exposure to unemployment on the use of health care services. MATERIAL AND METHODS: The 1986 census records were linked with comprehensive health care information for the period 1983-1989 for over 44629 randomly selected residents of Manitoba, Canada. All cause and cause-specific rates of hospital admission and ambulatory physician contacts were compared between 1498 unemployed and 18272 employed persons across 4 consecutive time periods related to the onset of unemployment. RESULTS: The adjusted rates of hospital admission and physician contacts were higher among the unemployed across all 4 periods. When persons with a history of mental health treatment were excluded, health care use in the period prior to the onset of unemployment was equivalent among the employed and unemployed. When a history of mental health treatment was controlled for, all-cause and cause-specific health care use was elevated among the unemployed during the unemployment spell. CONCLUSIONS: Unemployed persons had increased hospitalization rates before their current spell of unemployment. Much of this difference was due to the subgroup with prior mental health treatment. For persons without prior mental health care, hospitalization increased after a period of unemployment.

Adolescent↗
PubMed1999

[Immune status against measles and rubella among 4 Chilean groups of different ages].

BACKGROUND: Results of clinical and epidemiological studies confirm that no cases of measles have occurred in Chile since 1993. However, since covering of vaccination programs do not exceed 95%, an immunological surveillance for this disease is warranted. AIM: To know the immune status against measles and rubella in the Chilean population. MATERIAL AND METHODS: A serological census of a representative sample of communities with high (90% or more) or low immunization coverings was performed. Four sub samples along the country were selected: 122 children aged 18 months of age (stratum A), 1,276 children attending the first years of basic school (stratum B), 899 teenagers in their last high school year (stratum C) and 399 women attending a family planning clinic (stratum D). IgG antibodies against measles and rubella were measured using ELISA and hemagglutination inhibition techniques, respectively. RESULTS: Antibodies against measles and rubella were found in 96% and 94% of study subjects. No differences in these titres were found between different strata or communities with high or low vaccination covering. There is a high percentage of positive antibodies against measles among children of 18 months of age and a high percentage of antibodies against rubella among teenagers and women in family planning. Only 3% of the sample had not received any vaccine at the moment of the study. CONCLUSIONS: The high prevalence of antibodies against rubella allows to conclude that it is not necessary to consider this antigen in the next vaccination campaign. Due to the high prevalence of antibodies against measles, only the population older than 20 years old should be affected by the disease if this virus enters the country.

Adolescent↗
PubMed2001

Association between smokeless tobacco use and breast cancer among Native-American women in North Carolina.

BACKGROUND: Cigarette smoking and smokeless tobacco use have been associated with the development of a variety of cancers. While cigarette smoking may be associated with breast cancer, smokeless tobacco use has never been evaluated as a breast cancer risk factor. This study explores such an association. METHODS: A complete census was carried out among Eastern Band Cherokee women aged 18 years and older, residing on tribal lands in western North Carolina. Self-reported alcohol, cigarette and smokeless tobacco use, demographic information, and personal history of breast cancer (stratified by age of onset < 55 years or > or = 55 years) were obtained by questionnaire. RESULTS: 1,070 out of 1,408 (76%) eligible women were interviewed. Current and former smokeless tobacco use was common (6% and 21%, respectively). Five cases of breast cancer were identified in women under the age of 55 years and 3 cases were found in women at > or = 55 years. Only the odds ratio (OR) for younger-onset breast cancer among ever-users of smokeless tobacco was significantly elevated (OR = 7.79, 95% CI = 1.05-66.0). While the ORs for younger onset breast cancer were elevated among ever-smokers or women reporting at least monthly alcohol use, these were not significant (OR 8.49, 95% CI = 0.09-200; and OR = 1.72, 95% CI = 0.19-15.2, respectively). No ORs were significantly elevated for breast cancer among older women. CONCLUSIONS: These preliminary data are the first to document an apparent relationship between smokeless tobacco use and breast cancer risk, but should be confirmed in other studies due to the small number of cases. The nearly 8-fold increase in risk suggests that smokeless tobacco is not a safe alternative to cigarette smoking.

Adolescent↗
PubMed1993

Estimates of net internal migration for Korea, 1985-90.

The authors "estimate the volume and rate of net internal migration in [South] Korea for each five-year age group for the period between 1985 and 1990, adopting the forward census survival ratio method.... Two sets of [estimates] are made: (1) net internal migration for administratively defined provinces and equivalent districts with urban-rural distinction and (2) net internal migration for each of 73 cities in 1990." Extensive tables contain the estimates.

Age Factors↗
PubMed1993

Inter-provincial migration in Pakistan, 1971-1981.

The objectives of this paper are: "(1) To estimate the volume of net inter-provincial migration in Pakistan between 1971-1981 with the use of the census survival ratio method; and (2) to estimate selected demographic characteristics (age and sex) of the migrants."

Age Factors↗
PubMed2003

[Prevalence of pediculus humanus capitis infestation in schoolchildren at Despeñaderos, Córdoba Province].

BACKGROUND: Approximately 80% of Argentine children have pediculosis, making it imperious to detect the defects in the prevention and control actions for this parasitosis. OBJECTIVES: To study the infestation level by P. h. capitis, its temporal variation, and the association between infestation and host characteristics. MATERIALS AND METHODS: A monthly census in children of 6-8 years old from 2 primary schools (state and private) was carried out, recording the parasite stages found, children characteristics (sex, colour and length of hair), and infestation level. Data were analysed by means of contingency tables, difference of proportions, quotient of chances, and rank correlation coefficient. The independence of variables was analysed by c' test. RESULTS: The prevalence and chances of becoming infested were higher at the state school, where also all infestation levels were recorded, which did not occur at the private institute. The frequency of children infested was significantly lower when they had short hair. The correlation among infestation degree and hair length (short-long) was only significant for boys. Pediculosis cases were recorded at the beginning of the school year in both educative institutions, which demonstrated that infestation was acquired not only at school but also at home. CONCLUSIONS: Pediculosis is a social problems and the whole community must participate in preventive and control actions, for which sanitary education is essential, and the myth that the school is the only place of contagion must be eradicated.

Animals↗
PubMed2005

The epidemiology of breast cancer in Maori women in Aotearoa New Zealand: implications for screening and treatment.

AIM: To describe the epidemiology of breast cancer in Maori and non-Maori women in New Zealand, and to identify the implications for breast cancer screening and treatment policy and practice. METHODS: New Zealand Census Mortality Study (NZCMS)-adjusted age-specific incidence and mortality rates for breast cancer in total and sole Maori and non-Maori women were calculated using registration and mortality data obtained from New Zealand Health Information Service for 1996-2000. RESULTS: Despite similar age-specific incidence rates of breast cancer in total Maori and non-Maori women under 50 years of age, total Maori women aged 25-59 years had higher age-specific mortality from breast cancer than non-Maori. A similar pattern is seen for sole Maori age-specific rates; however, the rates are even higher than total Maori rates. DISCUSSION: Possible drivers of ethnic disparities in breast cancer mortality require investigation--particularly the role of access to breast cancer screening and treatment for Maori women compared to non-Maori. Specific initiatives are continually needed to ensure that Maori women are able to access breast cancer screening--otherwise ethnic inequalities in mortality will persist. The interaction between deprivation and ethnicity in breast cancer incidence and mortality analyses should be investigated in future analyses.

Adult↗
PubMed2006

Tuberculosis risks and socio-economic level: a case study of a city in the Brazilian south-east, 1998-2004.

OBJECTIVES: To explore tuberculosis (TB) risks in relation to potential determinants in the city of São José do Rio Preto, São Paulo State, Brazil; to analyse morbidity and mortality indicators in São José do Rio Preto, and to determine the relationship between the risk of TB and socio-economic level (SEL) using a geo-referenced information system (GIS) and the national census for 2000. METHOD: Standardised incidence rates and TB incidence and mortality rates were calculated. Socio-economic variables were determined using the statistical technique of principal component analysis. Data sources were the São Paulo State Data Analysis System (SEADE), the TB Notification Database (EPI-TB), the Information Department of the Brazilian Health Ministry (DATASUS), and the Brazilian Institute of Geography and Statistics (IBGE). New cases reported in 1998-1999 and 2003-2004 in the urban area of the city were geo-referenced and analysed. RESULTS: TB risk in the city is twice as high in areas of lower SEL than in areas with higher SEL. CONCLUSION: The identification of areas with different levels of risk enables the Municipal Health Department to propose innovative interventions to minimise the risk of disease at both individual and population level.

Brazil↗
PubMed1991

Calculation of the underprivileged area score for a practice in inner London.

A study was undertaken in a London inner city practice to determine an underprivileged area score for the practice based on information derived from questionnaires completed by 773 patients. The practice studied was new, had a highly mobile population and operated an 'open door' policy to new registrations--factors which were all considered to be contributing to a high level of workload. This was confirmed by the practice underprivileged area score which at 60.37 was considerably higher than the comparative score of 17.22 obtained for the same patients based on 1981 census information. This method highlights the differing workloads of practices in the same area and provides a means by which to make comparisons between practices.

Catchment Area, Health↗
PubMed1995

Correlation of rates of coronary artery bypass surgery, angioplasty, and cardiac catheterization in 305 large communities for persons age 65 and older.

OBJECTIVE: The rate of coronary artery bypass surgery (CABG) has been shown to vary greatly across geographic regions. This study examined whether these rates were associated with the rate of coronary artery angioplasty (PTCA) and with other community characteristics. DATA SOURCES/STUDY SETTING: The health care financing administration provided the number of Medicare hospitalizations in 1988 for conditions and procedures related to coronary artery disease. Information on physicians and hospitals was obtained from the Area Resource File, and the number of persons in each age, sex, and race category was obtained from US. census data. STATISTICAL METHODS: Age-and sex-adjusted hospitalization rates based on the patient's zip code of residence were calculated at the level of the Metropolitan Statistical Area (MSA) for white patients age 65 or older. Rates were obtained for 305 MSAs for CABG, PTCA, cardiac catheterization, angina, and myocardial infarction. PRINCIPAL FINDINGS: The rate of cardiac catheterization had a correlation of .72 with the CABG rate and .64 with the PTCA rate. The correlation of the PTCA and CABG rates with each other was .49. This correlation was not charged by adjusting for the rates of hospitalization for angina or myocardial infection, but it was reduced to only .05 (ns) after adjusting for the rate of cardiac catheterization. The rates of all three procedures had rank correlations of about .15 with the density of thoracic surgeons and about .30 with the density of hospitals with cardiac catheterization and open heart surgery units. CONCLUSIONS: Community CABG and PTCA rates tend to move in the same direction due to community factors that also affect the rates of cardiac catheterization. These community factors do not appear to include the rate of coronary artery disease, but may include resources or attitudes toward aggressive treatment of coronary artery disease.

Aged↗
PubMed1995

Income and AIDS rates in Los Angeles County.

OBJECTIVE: To examine the relationship between income and AIDS rates in Los Angeles County (LAC) by race/ethnicity. METHODS: 1990 US census data were used to classify LAC postal zones (zip codes) by median household income into low-, middle-, and high-income strata. AIDS rates were calculated for each income stratum based on 15,805 AIDS cases diagnosed from 1987 through 1992 and reported to the county health department. RESULTS: The AIDS rate was highest among residents of low-income areas (252.8 per 100,000), intermediate among residents of middle-income areas (161.2 per 100,000), and lowest among residents of high-income areas (82.0 per 100,000). This trend in rates was present in all racial/ethnic groups examined and was most pronounced among whites (675.1, 226.7, and 88.4 per 100,000, respectively). Residents of low-income areas accounted for 78% of AIDS cases among blacks, 67% among Hispanics, and 47% among whites. CONCLUSIONS: These findings suggest a strong inverse relationship between income and AIDS rates in LAC that is consistent across racial/ethnic groups. Prevention programs and treatment services should be directed most intensively to low-income neighborhoods in this county.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Hospital emergency department surveillance system: a data base for patient care, management, research and teaching.

The Johns Hopkins Health Services Research and Development Center and Emergency Department have developed a processing and feedback mechanism to provide a data base for management planning, allocating available resources, research strategies to evaluate the quality of care and teaching programs to train physicians in emergency medicine. A 10% sample of all emergency department visits is randomly selected each day, and data collected on patient age, sex, race, marital status, mode of arrival, method of payment, census tract of residence, complaint, diagnosis, disposition, date of visit, and times of entry and departure. In addition, process data on nursing care are collected. A sub-sample is selected for telephone or household follow-up aimed at gathering outcome data as part of the surveillance study. Turnaround time from the subject's emergency department visit to provider's feedback is one month. Thus, an ongoing, current description of usage is available. Retrieval of data for longer time periods provides valuable information on daily, monthly and seasonal usage patterns.

Abstracting and Indexing↗