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PubMed1997

Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density.

BACKGROUND: The incidence of insulin-dependent diabetes mellitus (IDDM) incidence varies between and within countries. The origins of this variation are disputed, but they involve both genetic and non-genetic influences. To explore the role of environmental factors in the aetiology of IDDM we have examined the incidence in small geographical areas and related it to variables derived from national censuses. METHODS: This is an ecological analysis of incidence data from a register of children with IDDM covering the counties of West Yorkshire, North Yorkshire and Humberside in the north of England. All children aged < or = 16, diagnosed with IDDM between 1978 and 1990 were eligible for inclusion. Spatial variation in incidence between electoral wards was investigated using Poisson regression, in relation to socioeconomic status, population density, urban-rural status and measures of geographical isolation. Ward child populations varied in size from 84 to 7197 (mean = 1545). RESULTS: Rates were significantly lower in wards of high population density and with many overcrowded houses. The rate ratio for areas in the upper half of the childhood density distribution was 0.88 (95% confidence interval (CI): 0.78-0.99) and for the two upper tertiles of household overcrowding the rate ratios were 0.84 (95% CI: 0.74-0.95) and 0.68 (95% CI: 0.58-0.79) respectively. CONCLUSIONS: The incidence of childhood IDDM was associated with environmental factors including population density and overcrowded homes. A possible inference from these data is that patterns of infection are involved in the occurrence of IDDM. Analytical epidemiological studies will be needed to investigate these ideas further.

Adolescent↗
PubMed1998

The effects of differential unemployment rate increases of occupation groups on changes in mortality.

OBJECTIVES: This study estimated the effects of changes in unemployment rates of occupation groups on changes in mortality in a period of increasing unemployment. METHODS: Census records for all 20- to 64-year-old economically active Finnish men in 1985 were linked to information on unemployment and deaths in 1987 through 1993. RESULTS: Change in mortality was similar in occupation groups in which unemployment rates increased at a different pace. These relationships were similar for all age groups and for mortality from diseases as well as accidents and violence. CONCLUSIONS: Unemployment does not seem to cause mortality in the short term. Excess mortality rates among unemployed individuals observed in previous studies may have been due in part to selection.

Adult↗
PubMed2000

Diminishing educational differences in breast cancer mortality among Finnish women: a register-based 25-year follow-up.

OBJECTIVES: This study examined trends in breast cancer mortality by education, age, and birth cohort. METHODS: Census records of Finnish women 35 years and older were linked with death records for 1971 through 1995. RESULTS: Excess breast cancer mortality of more-educated women has declined rapidly, mainly because of increasing mortality among less-educated women and stable or decreasing mortality among more-educated 35- to 64-year-old women. During the 1990s, mortality among more-educated 50- to 64-year-old women declined particularly fast. CONCLUSIONS: The causes of declining differences by education in breast cancer mortality are difficult to verify, but they may be due in part to narrowing differences in reproductive behavior among the younger birth cohorts and to a period effect possibly associated with the introduction of breast cancer screening in the late 1980s.

Adult↗
PubMed2001

Neighborhood poverty and the resurgence of tuberculosis in New York City, 1984-1992.

OBJECTIVES: The resurgence of tuberculosis (TB) in NewYork City has been attributed to AIDS and immigration; however, the role of poverty in the epidemic is unclear. We assessed the relation between neighborhood poverty and TB at the height of the epidemic and longitudinally from 1984 through 1992. METHODS: Census block groups were used as proxies for neighborhoods. For each neighborhood, we calculated TB and AIDS incidence in 1984 and 1992 with data from the Bureaus of Tuberculosis Control and AIDS Surveillance and obtained poverty rates from the census. RESULTS: For 1992, 3,343 TB cases were mapped to 5,482 neighborhoods, yielding a mean incidence of 46.5 per 100,000. Neighborhood poverty was associated with TB (relative risk = 1.33; 95% confidence interval = 1.30, 1.36 per 10% increase in poverty). This association persisted after adjustment for AIDS, proportion foreign born, and race/ethnicity. Neighborhoods with declining income from 1980 to 1990 had larger increases in TB incidence than did neighborhoods with increasing income. CONCLUSIONS: Leading up to and at the height of the TB epidemic in New York City, neighborhood poverty was strongly associated with TB incidence. Public health interventions should target impoverished areas.

Adult↗
PubMed1998

Mapping and analysing 200 years of the census.

"The 10th of March 2001 will mark the two-hundredth anniversary of the first census of population and should be an opportunity to look back not merely at the history of census-gathering but at the development of the population, economy and society of the British Isles. [We describe] a major university-based project led by ourselves and funded by the Economic and Social Research Council, the Leverhulme Trust and other bodies.... The project is supported by ONS [Office for National Statistics] and one of our central goals is to create an historical social atlas for publication at the bi-centenary."

Censuses↗
PubMedDate not supplied

The U.S. decennial census: an agenda for change.

"The results and experiences of the 1990 [U.S.] census demonstrate that the American population has grown too diverse and dynamic to be accurately counted solely by the traditional 'headcount' approach, and that fundamental changes must be implemented for a successful census in 2000. In the past, each census was more accurate than the preceding one, in part because of increased spending. However, the accuracy of the 1990 census fell below that of the 1980 census, as census costs escalated significantly. The $2.6 billion the nation spent on the 1990 census represented a 65 percent increase in constant dollars over the cost of the 1980 census. Additional cost escalation with the 2000 census is probable unless needed reforms are implemented. Although it is too early to identify the precise design needed for a more cost-effective census in 2000, the General Accounting Office believes that a number of opportunities for reform are worthy of aggressive attention."

Americas↗
PubMed1995

Women in low income groups smoke more: Canterbury 1976-92.

AIM: To examine the relationship between income and levels of smoking in women of child-bearing age. METHODS: Census area units within the Christchurch region were divided into five groups according to average income for each of the census years 1976, 1981 and 1991 respectively. Smoking rates were obtained from census data for 1976 and 1981. For 1992, data from a questionnaire on smoking during pregnancy and obstetric records were used. RESULTS: For all years, higher proportions of women from low income groups smoked. The overall percentage of female smokers in Canterbury fell slightly from 31.6% in 1976 to 27.5% in 1981. There were 27.1% of pregnant women smoking in 1992. There were marked changes by economic groups. The percentage of smokers in the highest income group fell from 24.8% in 1976 to 21.0% in 1981: an 18% fall. Smokers in the lowest income group increased from 36.8% in 1976 to 39.8% in 1981. The same patterns were seen for smoking in pregnancy in the 1992 data. CONCLUSION: While the downward trend for smokers in the high income groups is good news, it is of concern that the proportion of smokers in the lower income groups remains so high. Young women have the highest rates of smoking, which is of special concern when they become pregnant. Smokefree intervention programmes need to be specifically targeted at these groups.

Adolescent↗
PubMed1997

Variable budgeting for staffing. Analysis and evaluation.

A successful resource-management system must be based on variable budgeting principles to account for fluctuation in patient census, methodically prepared through historical analysis of operations, carefully executed and monitored by accountable multidisciplinary managers. Significant attention must be paid to communication, positioning and stability of the patient care organization.

Budgets↗
PubMed1997

Long-term mortality and its predictors in patients with critical leg ischaemia. The I.C.A.I. Group (Gruppo di Studio dell'Ischemia Cronica Critica degli Arti Inferiori). The Study Group of Criticial Chronic Ischemia of the Lower Exremities.

OBJECTIVE: To assess the predictivity of predefined variables with respect to long-term mortality in a cohort of patients with chronic critical leg ischaemia (CLI). DESIGN: Prospective observational study. METHODS: Census offices were asked to release information on survival or death status of 574 patients with CLI 2 years after their recruitment in the study. RESULTS: Of 522 patients with available information, 165 (31.6%) died within 2 years of hospital admission, mostly from vascular causes as expected. Among the variables considered, male sex, current smoking, arterial hypertension, diabetes mellitus, hypercholesterolaemia, obesity, history of myocardial infarction and low ankle systolic pressure showed no univariate association with mortality. The multivariate analysis also excluded revascularisation procedures and the Fontaine stage as prognostic factors in terms of mortality. Besides age > or = 70 years (relative risk, RR 1.94; 95% confidence interval (CI) 1.37-2.70), only a history of stroke (RR 1.82; 95% CI 1.19-2.79) and major amputation (RR 1.90; 95% CI 1.30-2.80) were significantly associated with mortality. CONCLUSIONS: CLI is a clinical condition of such severity that most of the recognised cardiovascular risk factors cannot further influence the fate of the patients, one-third of whom die within 2 years.

Aged↗
PubMed1998

An organizational field approach to resource environments in healthcare: comparing entries of hospitals and home health agencies in the San Francisco Bay region.

OBJECTIVE: To draw together insights from three perspectives (health economics, organizational ecology, and institutional theory) in order to clarify the factors that influence entries of providers into healthcare markets. A model centered on the concept of an organizational field is advanced as the level of analysis best suited to examining the assortment and interdependence of organizational populations and the institutional forces that shape this co-evolution. In particular, the model argues that: (1) different populations of healthcare providers partition fiscal, geographic, and demographic resource environments in order to ameliorate competition and introduce service complementarities; and (2) competitive barriers to entry within populations of providers vary systematically with regulatory regimens. DATA SOURCES: County-level entries of hospitals and home health agencies in the San Francisco Bay Area using data from the American Hospital Association (1945-1991) and California's Office of Statewide Health Planning and Development (1976-1991). Characteristics of the resource environment are derived from the Area Resource File (ARF) and selected government censuses. METHODS OF ANALYSIS: A comparative design is applied to contrast influences on hospital and home health agency entries during the post-World War II period. Empirical estimates are obtained using Poisson and negative binomial regression models. RESULTS: Hospital and HHA markets are partitioned primarily by the age and education of consumers and, to a lesser extent, by urbanization levels and public funding expenditures. Such resource partitioning allows independent HHAs to exist comfortably in concentrated hospital markets. For both hospitals and HHAs, the barriers to entry once generated by oligopolistic concentration have declined noticeably with the market-oriented reforms of the past 15 years. CONCLUSION: A field-level perspective demonstrates that characteristics of local resource environments interact with interdependencies of provider populations and broader regulatory regimes to affect significantly the types of provider organizations likely to enter a given healthcare market.

Catchment Area, Health↗
PubMed1987

A survey of Census Bureau population projection methods.

"Population projections methods of the U.S. Census Bureau draw upon several different traditions of forecasting: demographic accounting, judgmental, time series, deterministic, and explanatory. This paper reviews each of the forecasting traditions in population projections, describes the U.S. Census Bureau's current methods for national and state population projections, and proposes new hybrid approaches such as demographic-time series methods for national fertility projections and economic-demographic methods for state migration projections. Throughout the article, possible parallels with forecasting in other disciplines are noted."

Americas↗
PubMed1986

Probabilistic methods in matching census samples to the National Death Index.

The National Death Index (NDI) of the National Center for Health Statistics is a powerful tool for identifying deaths in epidemiologic studies. The NDI will generate a list of possible matches for every input record according to the NDI matching criteria. The task of determining a true or correct match out of the list of possible matches becomes formidable when a large number of records are being investigated. In the National Longitudinal Mortality Study nearly one million Census records are being matched to the NDI, thus requiring an efficient and accurate method to screen out the false positive matches. In a pilot study to the larger mortality follow-up, Census Bureau files containing 226,000 person records were matched to the 1979 NDI. The results of this match were used to generate a probabilistic method to separate the possible matches into categories of true positives, false positives and those of questionable status requiring manual review of the Census record and the death certificate. Of the 5542 possible matches about one-third were ultimately determined to be true positives and two-thirds false positives. The probabilistic method was validated by replications on subsets of the data and promises to save considerable time in review of records in the large national study of mortality.

Computers↗