[Basic conclusions from the 1985 population and housing census in the People's Republic of Bulgaria and future tasks after its completion].
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Bulgaria↗
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Measurement of death registration completeness using the growth balance procedure applied to data from India.
"In a previous note...a new method was presented for the simultaneous evaluation of the completeness of death registration and census coverage." In the present article, the method is applied to mortality data for males in Kerala, India, over the period 1961-1971.
Asia↗
[Trends in the mortality from stomach tumors in Italy from 1951 to 1981].
In Italy the mortality rate for gastric cancer is still very high compared to that of other European countries, with marched differences between the regions (age-adjusted rates were much higher in the North than in the South). On the basis of official certifications, gastric cancer ranks as the second cause of death from cancer in both sexes, only surpassed by tumors of respiratory tract in men and breast cancer in women. This note examines the data relative to the official death certifications for stomach cancer in Italy, between 1950-1982, to value quantitatively the trend of the mortality in the last years as regards sex, age and birth year. The absolute values relative to death certifications for gastric cancer between 1950 and 1982 were obtained from the Istituto Centrale di Statistica which gathers all the death certifications issued throughout the whole of Italy. The 1951-1961-1971-1981 census data were used to calculate the rates for 100,000 inhabitants. For the thirty years considered, the following rates were calculated separately for each sex: a)--the age-specific mortality rates for five-year age groups in the three years around the census; b)--the age-adjusted mortality rates (direct methods, using the Italian population of the October 1981 census as standard population) for the total population and for those aged between 35 and 74; c)--the age-specific mortality rates in five-year age group, by cohorts of birth from 1883-85 to 1933-35; d)--the male/female ratio for gastric cancer mortality. Age-standardized death certification rates for the population of all ages decreased from 51.7 to 32.9/100,000 males and from 40.3 to 21.5/100,000 females. Age-standardized death truncated 35-74 years mortality rates showed a more marked declining trend in both sexes: from 92.5 to 50.1/100,000 males and from 57.3 to 23.3/100,000 females. If differences among the age-specific mortality rates between 1951 and 1981 is examined, it can be seen that there is a constant more or less marked decline for all the age groups up to 74, whereas in the higher age groups the rates tend to increase. The analysis of the cohorts of birth reveals that the decline in mortality rates for stomach cancer was already evident in females born at 1894 and in males born at 1904 and this continued regularly in the following decades. Finally, the trend male/female ratio for gastric cancer mortality increased over time from 1.28 in 1951 to 1.53 in 1981.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
[Handling missing data in coverage estimation, with application to the 1986 Test of Adjustment Related Operations].
"This paper discusses methods used to handle missing data in post-enumeration surveys for estimating census coverage error, as illustrated for the 1986 Test of Adjustment Related Operations (Diffendal 1988). The methods include imputation schemes based on hot-deck and logistic regression models as well as weighting adjustments. The sensivity of undercount estimates from the 1986 test to variations in the imputation models is also explored." The test was carried out in Central Los Angeles County, California.
Americas↗
[Risk profile: multivariate cluster analysis of urban small areas based on socioeconomic indicators - census tracts from the Greater Rio de Janeiro Metropolitan Area]
A method based on small area data analysis was developed to build a health risk classification for the Greater Rio de Janeiro Metropolitan Area. The approach uses 1991 census data and studies data pertaining to sanitation, ownership and type of housing, size and occupancy of the household, demography, schooling, and income. Principal component analysis applied over each dimension allowed for the choice of 15 variables, which summarized most of the observed variances. Additional analysis with these variables suggested that just six variables are sufficient for the construction of a classification using k-means method of multivariate cluster analysis. Five classes were obtained: (A) high income; (B) lower income; (C) poor; (D) low schooling and income; (E) low-level access to sanitation. The existing inequality in each of the geopolitical established areas was clearly identified. The proposed method allowed for the construction of compound indices to evaluate quality of life, based on widespread and easily obtained data (the census). Moreover, the method contributed to the detection of socioeconomic inequality, identifying, not only the larger poor regions but also the small excluded areas.
Journal Article↗
Incidence of breast cancer in a Norwegian cohort of women with potential workplace exposure to 50 Hz magnetic fields.
BACKGROUND: The risk of breast cancer was investigated in a large dynamic population-based cohort of all 1.1 million economically active women in Norway with potential exposure to 50 Hz magnetic fields at the censuses of 1960, 1970, and 1980. METHODS: The follow-up period for the cohort was 1961-1992. For each woman, date of birth and census information on occupation and socioeconomic status were ascertained. These data were linked to the breast cancer morbidity information in the Cancer Registry of Norway. Exposure to magnetic fields was assessed a priori using two different approaches. In the first approach, hours per week in a potential magnetic field above background level (0.1 microT) were classified by an expert panel. In the second approach, measured magnetic fields from a separate study of men at work were allocated to the women's census job titles. In both approaches, exposure was cumulated over the years of employment (work hours and microT-years, respectively). RESULTS: The Poisson regression analysis showed a risk ratio (RR) of 1.14 (95% confidence interval (CI) = 1.10-1.19) in the highest exposure category compared to the lowest when using the first approach, and the corresponding RR was 1.08 (95% CI = 1.01-1.16) when using the second approach. For women younger than 50 years, RR was 1.20 (95% CI = 1.11-1.29) and 1.12 (95% CI = 0.98-1.28), respectively. CONCLUSIONS: The results give some support to the hypothesis that exposure to 50 Hz magnetic fields may increase the risk of breast cancer. However, since no direct information on exposure was available, no firm conclusions can be drawn.
Adult↗
Time-weighted nursing demand is a better predictor than midnight census of nursing supply in an intensive care unit.
PURPOSE: Labor costs are the largest fraction of operating costs in an intensive care unit (ICU). Estimation of appropriate nursing supply is frequently based on the midnight census of patients, which is a "snapshot" view of the ICU. We postulated that the midnight census would not correlate as well as time-weighted nursing demand (a calculation of need for nursing staff) with the actual number of nurses who were required to staff the ICU (nursing supply). The purpose of this study was to compare the correlation between midnight census and actual nursing supply with the correlation between time-weighted nursing demand and nursing supply. MATERIALS AND METHODS: We measured nursing activity, midnight census, and actual nursing supply for each of 77 consecutive days in a 14-bed medical-surgical ICU within a 450-bed tertiary care teaching hospital. We calculated time-weighted nursing demand based on 1:1 nursing for ICU patients, 1:2 nursing for step-down patients, 0.5 additional nurse hours for each cardiac arrest, and 0.5 additional nurse hours for each new admission to the ICU. RESULTS: There was a correlation between midnight census and nursing supply (r2 = .42, P<.0001) and between nursing demand and nursing supply (r2 = .83, P<.0001). The correlation coefficient for the relationship between nursing demand and nursing supply was significantly greater than that for the relationship between midnight census and nursing supply (P<.01). CONCLUSIONS: Time-weighted nursing demand is a better predictor than midnight census of nursing supply in an ICU.
British Columbia↗
Geographic variation in the rate of carotid endarterectomy in Canada.
UNLABELLED: Background and Purpose-- Carotid endarterectomy (CEA) is an important method of stroke prevention, but its usage in Canada is not well known. The indications for CEA have been well informed by the recent clinical trials, but the impact of this information on the rate and regional variation in the rate of CEA is unknown. This study sought to determine the rate and the regional variation in the rate of CEA in Canada, its provinces, and census divisions for 1994-1997. METHODS: Discharge data from all hospitals in Canada except Quebec were obtained from the Canadian Institute for Health Information for 1994-1997 and were searched for CEA by residential site. Rates and variations in rates were calculated. RESULTS: The national age- and sex-adjusted rate per 100 000 people of CEA for those aged >/=40 years rose from 31.7 in 1994 to 40.5 in 1997. Provincial rates in 1997 varied from a low of 25.7 in Saskatchewan to high of 82.8 in Prince Edward Island. The census division rates varied even more, from a low of 0 in several divisions to a high of 179. CONCLUSIONS: The recent slight increase in CEA rates may reflect the release of new efficacy results for CEA, especially for asymptomatic carotid stenosis, but the rates are still far below US levels. The marked regional variation in rates may reflect differing views on the appropriateness of indications such as asymptomatic carotid stenosis for CEA and the inconsistency of published clinical practice guidelines.
Adult↗
A controversial census topic: race and ethnicity in the British census.
"This paper examines attempts to collect data on a politically controversial topic, race and ethnicity, in the British Census of Population in the post-war period. It discusses an indirect, proxy method of inferring race or ethnicity by asking for the country of birth of the respondent and of his parents, and a direct question where the respondent is asked to identify his racial or ethnic group. Different versions of the direct question are examined, as is the 1979 Census test, which resulted in considerable public resistance to the question. Following the exclusion of the direct question from the 1981 Census, the subject was reviewed by the Parliamentary Home Affairs Committee, the results of whose report--including practical suggestions as to question wording--are discussed."
Censuses↗
Problems in estimating the number of women in need of subsidized prenatal care.
For effective allocation of resources, public program planners need to know how many women require subsidized prenatal care and where they are located. Because sample surveys are expensive, indirect methods of estimation using secondary data sources are frequently used to arrive at quick annual estimates. Census data on poverty are often incorporated into such methods, but out study of the eight southeast States in Federal Region IV shows that available census data severely underestimate the proportion of pregnant women who are poor. Updated poverty data from the 1990 census will not solve this problem of underestimation. Alternative methods for estimating the number of women in need of subsidized prenatal care services, for measuring unmet need, and for doing estimates on the county level are presented and evaluated. Such considerations are especially important, given the new Title V block grant reporting requirements.
Female↗
Generating social class data in primary care.
The objective of this study was to compare three methods of collecting social class data in general practice. The setting was a rural dispensing practice on the Nottinghamshire/Lincolnshire border. The methods examined were: (a) a self-administered questionnaire to 200 patients to determine their social class based on the occupation of the head of household; (b) members of the practice staff were asked to assign a social class to these households based on their local knowledge; and (c) use of small area statistics from the 1991 census data using modal and weighted methods. It was found that the practice staff were unable reliably to assign a social class to the households. The modal method of using small area statistics to assign social class to households through their postcode and its link to the census data was also inaccurate. While a personal questionnaire will remain the only method for assigning a social class to individual patients for clinical care or most research, the weighted method of small area statistics is shown to be a cost-effective and sufficiently accurate method for health needs assessment in general practice.
Data Collection↗
[Occupational mortality in the population employed at 1991 Census].
BACKGROUND: Despite limitations and problems connected to occupational surveillance systems based on mortality data, mortality from specific causes continues to be a crucial indicator for evaluating the differences in health among various occupations. OBJECTIVES: To evaluate the potential of a surveillance system of occupational mortality based on census and mortality data obtained from ISTAT (Italian Central Statistics Institute). METHODS: By means of record-linkage between Census data and death records from ISTAT, occupational mortality was assessed during the twelve month period following the 1991 census, limited to subjects aged 18-64 years for whom occupational information was available. The study population consisted of deceased subjects, 19,527 of whom were men and 3,547 were women. A cross-sectional model was used to evaluate odds ratios for cause-specific mortality. The risk estimates were then compared to the results obtained in a previous analysis on Census data gathered in the 1981 census. RESULTS: Among the significantly increased risks observed both in 1981 and 1991, of particular interest are the excesses of mortality from liver cirrhosis in caretakers, janitors, and cleaning staff; and the excess of breast cancer in teachers. Mortality from cirrhosis in masons, porters, and waiters, and from violent causes in transport workers and bar and restaurant workers, was instead significantly in excess only in 1991. CONCLUSIONS: The data on mortality by occupation does not permit inferences about occupational risks, though they can be useful to highlight socio-economic differences in premature death in the employed segment of the population and to draw attention to possible trends over time.
Adolescent↗
Death and suicide among former child and adolescent psychiatric patients.
BACKGROUND: Increased mortality rates among previous child and adolescent psychiatry (CAP) patients have been found in Scandinavian studies up to the 1980s. The suicide risk in this group has been estimated to be almost five times higher than expected. This article addresses two questions: Do Swedish CAP patients continue to risk premature death and what kind of information related to psychiatric symptoms and/or behavior problems can predict later suicide? METHODS: Hospital files, Sweden's census databases (including immigration and emigration) and administrative databases (including the Swedish Hospital Discharge register and the Persons Convicted of Offences register), and the Cause of Death register were examined to determine the mortality rate in a group of 1,400 former CAP inpatients and outpatients over a period of 12-33 years. Observed and expected numbers of deceased were calculated with the prospective method and the standardized mortality ratio (SMR) method. The relative risk or the risk ratio (RR) is presented with 95% confidence intervals (CIs). Significance level tests were made using two-by-two tables and chi-square tests. The Cox proportional-hazards regression model was used for survival analysis. RESULTS: Twenty-four males and 14 females died. Compared with the general population, the standardized mortality ratio in this group of CAP patients was significantly higher in both sexes. Behavioral problems, school problems, and co-morbid alcohol or drug abuse and criminality (including alcohol-related crimes) were found to be important predictors. Thirty-two deaths were attributed to suicide, intoxication, drug overdose, or accident; one patient died of an alcohol abuse-related disorder, and five patients died of natural causes. Suicide was the most common cause of death, but only 2 of these 19 cases were initially admitted for attempted suicide. CONCLUSION: We suggest that suicide and death prevention among CAP patients may not be a psychiatric issue per se but a future function of society's juvenile social-welfare investments and juvenile-delinquency prevention programs.
Adolescent↗
Childhood-onset diabetes in the white and South Asian population in Leicestershire, UK.
The prevalence of childhood-onset Type 1 diabetes mellitus is important for determining health care provisions. In Leicestershire 13.5% of the childhood population (0-14 years) is of South Asian origin (census 1991). This study determined the prevalence of Type 1 diabetes in Whites and South Asians in Leicestershire, using a capture/recapture method to coincide with the 1991 Census day. Children (0-14 years) with Type 1 diabetes were captured from the central diabetic register. The health visitor and consultant records were used to recapture the cases. Total ascertainment of cases was 95-100%. The prevalence of Type 1 diabetes in White children (107 cases) was 0.75/1000 children (95% CI 0.61-0.89) compared with the South Asian prevalence (18 cases) of 0.77/1000 (95% CI 0.41-1.13). The overall prevalence in White males was 0.82/1000 (0.61-1.03) compared with 0.68/1000 (0.48-0.87) in females. In South Asian males it was 0.59/1000 (0.15-1.03) compared with 0.96/1000 (0.39-1.53) in females. The prevalence of Type 1 diabetes in children of South Asian migrants to the United Kingdom cannot be said to be different from White children.
Adolescent↗
Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study.
OBJECTIVE: To estimate age- and gender-specific prevalences of ocular hypertension and open-angle glaucoma (OAG) in adult Latinos. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: The study cohort consisted of all self-identified Latinos of primarily Mexican ancestry 40 years and older residing in 6 census tracts in La Puente, California. All participants underwent a complete ophthalmologic examination, including measurement of intraocular pressure (IOP), visual field (VF) testing using an automated field analyzer, and simultaneous stereoscopic fundus photography of the optic disc. Ocular hypertension was defined as IOP of >21 mmHg and the absence of optic disc damage or abnormal VF test results. Open-angle glaucoma was defined as the presence of an open angle and various criteria that included a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. MAIN OUTCOME MEASURES: Prevalence of open-angle glaucoma and ocular hypertension. RESULTS: For the 6142 participants who underwent a complete ophthalmologic examination at the clinical center, the prevalence of OAG was 4.74% (95% confidence interval [CI], 4.22%-5.30%). The prevalence of ocular hypertension was 3.56% (95% CI, 3.12%-4.06%). The prevalences of OAG and ocular hypertension were higher in older Latinos than in younger Latinos (P<0.0001). No gender-related differences in prevalences of OAG and ocular hypertension were present. The mean IOP, mean deviation, and mean vertical cup-disc ratio in persons with OAG were 17 mmHg, -9.6 decibels, and 0.6, respectively. Seventy-five percent of Latinos with OAG and 75% of Latinos with ocular hypertension were previously undiagnosed. Further, 17% of Latinos with OAG and 23% of Latinos with ocular hypertension had received treatment for "glaucoma." CONCLUSION: Our data suggest that the prevalence of OAG is high among Latinos of Mexican ancestry. The higher prevalence of OAG in older Latinos emphasizes the public health importance of providing eye care services for the early diagnosis and management of this condition in Latinos.
Adult↗
Recovering event histories by cubic spline interpolation.
If event data are recorded in discrete intervals of time, errors are introduced when the data are converted from the unit in which they were recorded, such as date, to another unit such as age or duration. The problem is illustrated by the inconsistent age at marriage schedules published by 2 recent US censuses. This paper develops a general method for treating problems of this type using cubic spline interpolation. The method is used to adjust US age at marriage schedules, explaining a substantial part of the discrepancy in the 1960 and 1970 censuses.
Americas↗
Socioeconomic differentials in mortality among men within Great Britain: time trends and contributory causes.
STUDY OBJECTIVE: To assess the size of mortality differentials in men by social class in Scotland as compared with England and Wales, and to analyse the time trends in these differentials. SUBJECTS: Men from England and Wales and Scotland around each census from 1951 to 1981. METHODS: Poisson regression analysis was used to calculate relative indices of inequality for disease specific and all cause mortality as a measure of mortality differentials between social classes. This measure is not dependent on the size of the social class groups, so it can be used to compare the magnitude of differentials over time periods during which the relative sizes of social class groups change. MAIN RESULTS: While overall death rates were higher in Scotland than in England and Wales around the 1951, 1961, and 1971 censuses the relative indices of inequality indicated smaller mortality differences between social classes in Scotland. Inequality, as indexed by the relative index of inequality, increased over time in both Scotland and England and Wales, but to a greater degree in Scotland, resulting in greater social class mortality differentials for Scotland in 1981 (the relative index of inequality increased from 1.40 to 2.43 for England and Wales, and from 1.22 to 2.57 for Scotland between 1951 and 1981). This greater increase in the magnitude of inequalities in all cause mortality in Scotland seemed to result from increasing social class differentials in cardiovascular disease, accidents and external causes, and "all other causes of death". Examining the trends in overall death rates, it seems that the greater increase in social class differences in Scotland occurred because of the greater decrease in death rates among the privileged social groups, in combination with a smaller decrease (or a greater increase) in the death rates in the lower social class groups. CONCLUSIONS: This study has shown that trends in mortality and in inequalities in mortality differ within Great Britain. Although death rates were higher in Scotland than in England and Wales, smaller mortality differentials by social class were found in Scotland over the period 1951 to 1971. By 1981, however, social class mortality differentials were greater in Scotland than in England and Wales. The greater increase in the social class differentials over time in Scotland, may have contributed to the worsening overall mortality profile in Scotland as compared with England and Wales that occurred between 1971 and 1981.
Adolescent↗
Comparison of prognostic and socio-economic factors in screen-detected and symptomatic cases of breast cancer.
BACKGROUND: The relationship between breast cancer and socioeconomic deprivation is complex. Although women from more deprived areas are less likely to get breast cancer, in general they experience poorer survival. A number of reasons have been proposed, including differences in tumour stage and tumour biology, but recent studies suggest that treatment factors or host response are the most important. The introduction of a national health service breast screening programme (NHSBSP) means that an additional factor now has to be taken into account. As deprived women are less likely to attend for screening we set out to determine the nature of the relationship between prognostic factors evident at diagnosis, screening status and socio-economic deprivation, in order to assess the implications for the NHSBSP. METHODS: The NHSBSP computer systems and the Thames Cancer Registry (TCR) database were used to examine breast cancers diagnosed in women aged 50-64 y during the period 1988-1992. Cases had previously been classified into screen-detected, interval cancers, eligible but not yet invited, non-attenders and those not registered with the programme. A prognostic score was assigned to each case using TCR data on the morphology and extent of the disease. Socio-economic comparisons were made from the women's postcodes and census details using the Carstairs method. RESULTS: Screen-detected cases had a significantly better prognosis at diagnosis than those presenting with symptoms, and were less deprived than those who did not comply with the screening programme (by either failure to attend or not being registered). When the relationship between presentation status, deprivation and prognosis was assessed together, screen-detected cases had a better prognosis at diagnosis irrespective of deprivation level. CONCLUSION: The poor survival rate of deprived women with breast cancer due to host or treatment factors is likely to be compounded by poor attendance for screening. Unless the NHSBSP increases its efforts to target these women, the socio-economic gradient in breast cancer survival is likely to increase.
Breast Neoplasms↗