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PubMed2004

Secular changes in disability among middle-aged and elderly Finns with and without coronary heart disease from 1978-1980 to 2000-2001.

PURPOSE: To examine time trends in the prevalence of coronary heart disease (CHD) and disability. METHODS: Data were used from two large nationally representative cross-sectional health examination surveys conducted in Finland (1978-1980 and 2000-2001). RESULTS: The prevalence of CHD decreased in men and women aged 45 to 64 years and increased among those aged 75 years or more. In men with and without CHD, and in women without CHD, the prevalence of disability decreased until the age of 75 years, but in women with CHD no statistically significant decrease was observed. CONCLUSIONS: Favorable changes in prevalence of CHD and disability have occurred in people aged 45 to 75 years, but not in older people particularly in women. The proportion of decrease in disability attributable to CHD was estimated to be up to 25%. The causes of unequal development by age and gender should be ascertained.

Age Distribution↗
PubMed2005

Secular trends in outcomes for Fanconi anemia patients who receive transplants: implications for future studies.

Transplantation protocols for patients with Fanconi anemia are being modified continuously. However, it is unclear how outcomes have changed over time. We determined historical adverse event rates from long-term follow-up of 117 Fanconi anemia patients in the Hôpital Saint Louis transplant cohort, who received low-dose cyclophosphamide- and irradiation-based conditioning, in combination with other modalities, between 1976 and October 2002. In high-risk patients with mismatched donors, the peritransplantation mortality rate during 0 to 6 months declined significantly over time (P = .003), from 28%/month (95% confidence interval [CI], 9%-87%/month) during 1985 to 1989 to 3.3%/month (95% CI, 0.8%-13.3%/month) during 2000 to October 2002. The corresponding proportion of patients who developed severe acute graft-versus-host disease also declined significantly over time (P = .003). In low-risk patients with matched sibling donors, the peritransplantation mortality rate was consistently low, 1.4%/month (95% CI, 0.3%-5.3%/month), during 1990 to October 2002. Sample sizes to detect 2-fold reductions from rates and risks observed since the mid-1990s are larger than recently reported case series. To demonstrate further advances in survival, transplant centers may need to coordinate their protocols and engage in multicenter collaborative studies.

Bone Marrow Transplantation↗
PubMed2005

Secular trends in mortality rates for diabetes in Australia, 1907-1998.

AIMS: To characterise long-term mortality trends for diabetes in Australia during the 20th century, and to provide suggestions to health policy-makers. METHODS: A descriptive study was conducted using existing dataset. Deaths due to diabetes, as underlying cause of death, from 1907 to 1998 were tallied, according to the ICD-9. Trends in diabetes mortality (overall population, under-19 and over 40-year-old age groups) by gender were examined. RESULTS: There was a slightly increasing trend in the mortality rate in males over the study period, from 14.38/100,000 in 1907 to 16.05/100,000 in 1998. Among females, it started from 19.6/100,000 in 1907, reached the peak in early 1940s and then decreased to 10.61/100,000 in 1998. There was a reversal sex ratio after late 1960s with mortality rates among males were higher than females after 1969. There was a significant difference in overall mortality between males and females over study period (p<0.001). The mortality trend among the 40 years and over group was similar to the overall population. The death rates for the under-19 group declined significantly over the study period (p<0.001), but no difference between males and females was detected (p>0.05). CONCLUSIONS: The application of insulin played an important role in the reduction of diabetes mortality among the under-19-year-old group. New medical treatment methods to reduce chronic complications and other public health interventions could have made a recent contribution to reducing death rates. It is also probable that over the study period there has been an increase in the likelihood of diabetes being correctly diagnosed.

Adolescent↗
PubMed2004

Secular trends and seasonality in first-time hospitalization for acute myocardial infarction--a Danish population-based study.

BACKGROUND: The incidence of acute myocardial infarction has declined in several Western countries during the last decades. The incidence and mortality of acute myocardial infarction follow a seasonal pattern. We examined if changes in the incidence of acute myocardial infarction were associated with any changes in seasonality. METHODS: The study was based on 17,989 patients hospitalized with first-time acute myocardial infarction identified in the Hospital Discharge Registry of the County of North Jutland, Denmark, from 1 January 1983 to 31 December 1999. The seasonality of acute myocardial infarction was estimated using a Poisson regression model. RESULTS: The incidence rate decreased by 3.2% (95% confidence interval: 2.7-3.3%) annually. Hospitalizations followed different seasonal patterns depending on age, but not on gender. In the <59-year-old group, the seasonal pattern was dominated by a broad spring peak (April/May) and a minor autumn peak. With increasing age, the spring peak decreased while the autumn peak increased and moved towards December. A seasonal pattern dominated by one peak (December) and one trough (August) was found in the > or =80-year-old category. The shape and extent of these seasonal patterns remained stable throughout the study period despite the decline in hospitalizations for acute myocardial infarction. CONCLUSION: Hospitalizations for first-time acute myocardial infarction decreased from 1983 to 1999, but the seasonal pattern remained stable over time.

Denmark↗
PubMed2005

Secular trends in coronary heart disease mortality, hospitalization rates, and major cardiovascular risk factors in Taiwan, 1971-2001.

BACKGROUND: While mortality from coronary heart disease (CHD) has declined substantially in most developed countries in recent decades, discordant rising trends have been observed in many developing and newly developed countries. In this study, we examined the trends of CHD mortality and its hospitalization rate, and correlated the trends with changes in major cardiovascular risk factors in Taiwan. METHODS: Mortality data during the period 1971-2001 were obtained from official vital statistics. Hospitalization rates were calculated using information extracted from the National Health Insurance Database, which was available from 1996 to 2001. Changes in major cardiovascular risk factors were obtained from official statistics and review of previous epidemiologic studies. RESULTS: In 2001, the age-standardized CHD mortality in Taiwan was 28.7 per 100,000 for men and 15.5 per 100,000 for women. For both men and women, age-adjusted CHD mortality increased slowly but steadily from 1971 to 1992, but after that, a downward trend was observed. Hospitalization rates for CHD, however, increased substantially from 1996 to 2001. Levels of per-capita cigarette consumption, dietary fat intake, body mass index, and prevalence of hypertension and diabetes had all increased over the past three decades. CONCLUSIONS: The overall cardiovascular risk profile has worsened in the general population in Taiwan. The decline in CHD mortality observed in recent years was most likely attributable to the improvement in acute cardiac care and medical treatment among patients with CHD. We anticipated that CHD incidence and prevalence would continue to rise in Taiwan.

Body Mass Index↗
PubMed2005

Secular trends in prevalence of diabetes among younger patients admitted with acute myocardial infarction.

BACKGROUND: Diabetes prevalence is increasing in the population, both in the young and the elderly. We assessed the impact of increasing prevalence of diabetes on admissions for acute myocardial infarctions (MI) from 1990 through 1997. METHODS AND RESULTS: We retrospectively identified all patients discharged with the primary diagnosis of MI from any Veteran's Affairs Medical Center (VAMC) in the country between October 1990 and September 1997. Patients were classified as having diabetes from the ICD-9-CM codes and stratified by age. Demographic data were extracted from the patient treatment files. Prevalence of diabetes among MI patients for the years 1990 through 1997 was compared to that in the general population obtained from the Center for Disease Control. We identified 67,889 patients with MI of whom 17,756 (26%) had diabetes. In the age group < or =44 years, the prevalence of diabetes remained at approximately 11.5% from 1991 to 1998. In the age group 45-64 years, the increase was from 23% to 28%--a 23% increase (p<0.001), while in the older age group over 65 years, it increased from 25% to 33.5%--a 34% increase (p<0.001). In the general population, prevalence of diabetes increased by 50%, 63% and 44% in the three age groups. CONCLUSIONS: Despite substantial increase in prevalence of diabetes among the younger population, it does not appear to be predisposing them to increased risk for MI. The prevalence of diabetes among older patients with MI paralleled the increase seen in the general population with the steepest increase seen in the group > or =65 years. These data are important in focusing our resources for preventive measures.

Adult↗
PubMed2005

Secular trends in children's sweetened-beverage consumption (1973 to 1994): the Bogalusa Heart Study.

OBJECTIVE: To determine whether children's sweetened-beverage consumption has changed over a 21-year period (1973 to 1994) in Bogalusa, LA, and whether trends in energy intake, milk consumption, and body mass index (BMI) varied among the sweetened-beverage consumption groups. DESIGN: Information on food and nutrient intake was derived from a single 24-hour dietary recall collected from children who participated in one of seven cross-sectional surveys. SUBJECTS/SETTING: A total of 1,548 10-year-old children (65% white, 35% African American; 51% female, 49% male) were randomly selected to participate in the study. STATISTICAL ANALYSES: The Cochran-Armitage Trend test was applied to examine the trends in sweetened-beverage consumption by 10-year-old children over a 21-year period. A general linear model was used to examine the trend in milk consumption, energy intake, and BMI among the sweetened-beverage consumption groups. RESULTS: The percentage of children consuming sweetened beverages significantly decreased from 83% (1973) to 81% (1994) (P <.05), particularly consumption of soft drinks (P <.01) and coffee with sugar ( P <.0001). However, the mean gram amount of tea with sugar consumed significantly increased (P <.0001), with no changes in the mean gram amount of fruit drinks, soft drinks, and coffee with sugar consumed. When comparing tertiles of sweetened-beverage consumption over time, the mean gram consumption significantly increased from 1973 to 1994 for those children who were in the medium (P <.001) to high (P <.0001) tertiles. The mean BMI significantly increased (P <.001) from 1973 to 1994 in children within all of the sweetened-beverage consumption groups; however, there were no significant differences in total BMI across the sweetened-beverage consumption groups. The total gram amount of milk consumption was significantly lower in the medium to high sweetened-beverage consumption groups compared with the lower to no sweetened-beverage consumption groups. Total energy intake remained unchanged from 1973 to 1994 within all four sweetened-beverage consumption groups. Total energy intake was significantly higher in the high sweetened-beverage consumption group compared with the other three sweetened-beverage consumption groups. CONCLUSIONS: Children's sweetened-beverage consumption has changed over a 21-year period. The percentage of children consuming sweetened beverages decreased from 1973 to 1994, particularly consumption of soft drinks and coffee with sugar. Data suggest that there was no linear relationship between sweetened-beverage consumption and BMI and total energy intake. However, total milk consumption was lower in the medium to high sweetened-beverage consumption groups compared with the low to no consumption groups. More studies are needed to confirm these regional findings, which may not be reflective of national trends.

Animals↗
PubMed2005

Twenty-year secular changes in sex specific lung cancer incidence rates in an urban Chinese population.

The objective of this study was to describe trends in the incidence rates of primary lung cancer in a geographically defined Chinese population. Primary lung cancer cases (N=40,022) diagnosed between 1981 and 2000 were identified by the Tianjin Cancer Registry. Age-specific and age-adjusted incidence rates to the world standard population were examined in both males and females. Age-period-cohort (APC) model and Poisson regression were used to assess the cohort effects and incidence trends. Crude and age-adjusted incidence rates in the study period were: 66.2/100,000 and 45.2/100,000 in males; and 47.7/100,000 and 28.2/100,000 in females, respectively. The major birth cohort effect can be described as for those born before 1940, in every age group lung cancer incidence rate increased as the birth years advanced. For those born after 1940, age specific incidence rates decreased as the birth years advanced. Results from the Poisson regression analyses suggested a statistically significant increasing trend of incidence rates of lung cancer from 1981 to 1990 and changed little afterwards. Through first 10 years of the study period between 1981 and 2000, lung cancer incidence rates increased in both males and females. While the study results suggest that the age-adjusted incidence rates may have reached their peak and may even decline, as the Chinese population ages, and smoking prevalence remains high, the number of new lung cancer cases will continue to increase and overall burden of lung cancer will remain high.

Adult↗
PubMed1999

Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996.

OBJECTIVES: To determine the levels and time trends of blood pressure and body size in a healthy population of youth. STUDY DESIGN: Minneapolis, Minnesota, fifth through eighth grade public school children (aged 10 to 14 years) were surveyed in 1986 and 1996. Blood pressure, height, and weight were measured by technicians trained to the same rigorous protocol at each time period, and comparisons were made between the 2 groups (1986 and 1996). RESULTS: In 1986 and 1996, 8222 and 10,241 children, respectively, were measured with participation rates of over 93%. African American, Hispanic, Native American, Asian, and non-Hispanic white groups were all represented. Systolic blood pressure was significantly higher and diastolic blood pressure lower in 1996 than in 1986 in all ethnic and gender groups. Weight and body mass index (wt/ht2) were significantly higher in all groups in 1996. Adjustment for body size largely eliminated the systolic blood pressure differences but had no effect on measured diastolic blood pressure. CONCLUSIONS: Body size and systolic blood pressure are rising among school children. Weight and body mass index show substantial increases over 10 years (1986-1996). Diastolic blood pressure fell for unclear reasons. These changes may have future health implications for cardiovascular disease, as these youth move into adulthood.

Adolescent↗
PubMed1983

Nosocomial urinary tract infections: secular trends, treatment and economics in a university hospital.

During a 71-month interval 3,024 nosocomial urinary tract infections were identified by prospective surveillance at our hospital. The annual attack rate varied between 2.0 and 3.1 per 100 admissions. Gram-negative bacilli caused 74 per cent of all urinary infections and recurrent infections in the hospital accounted for only 1 per cent. The most frequent pathogens were Escherichia coli (24 per cent), Pseudomonas aeruginosa (8 per cent), Streptococcus faecalis (7 per cent), Klebsiella pneumoniae (6 per cent) and Proteus mirabilis (6 per cent). Candida species caused 10 per cent of the infections and may represent a hospital-acquired pathogen of increasing importance. The burn unit had a significantly higher proportion of Enterobacter infections (21 per cent) than any other service (p less than 0.05). The plastic surgery service had more Serratia infections (24 per cent), whereas obstetrics and gynecology had more Escherichia coli infections (47 per cent) relative to other hospital services. More than 99 per cent of the patients with nosocomial urinary tract infections received antimicrobial drugs; in 63 per cent the chart documented that drug therapy was prescribed specifically for treatment of the urinary infections. Hospital-acquired urinary infections added approximately 1 million dollars to hospital expenses during the study interval. Estimates were made of the economic benefits of successful control programs.

Cross Infection↗