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PubMed2005

High school census tract information predicts practice in rural and minority communities.

PURPOSE: Identify census-derived characteristics of residency graduates' high school communities that predict practice in rural, medically underserved, and high minority-population settings. METHODS: Cohort study of 214 graduates of the University of California, San Francisco-Fresno Family Practice Residency Program (UCSF-Fresno) from its establishment in 1970 through 2000. Rural-urban commuting area code; education, racial, and ethnic distribution; median income; population; and federal designation as a medically underserved area were collected for census tracts of each graduate's (1) high school address and (2) practice location. FINDINGS: Twenty-one percent of graduates practice in rural areas, 28% practice in areas with high proportions of minority population (high minority areas), and 35% practice in federally designated medically underserved areas. Graduation from high school in a rural census tract was associated with rural practice (P < .01), Of those practicing in a rural site, 32% graduated from a rural high school, as compared with 11% of nonrural practitioners. Graduation from high school in a census tract with a higher proportion of minorities was associated with practice in a proportionally high minority community (P = .01). For those practicing in a high-minority setting, the median minority percentage of the high school census tract was 31%, compared with 16% for people not practicing in a high minority area. No characteristics of the high school census tract were predictive of practice in a medically underserved area. CONCLUSION: Census data from the residency graduate's high school predicted rural practice and practice in a proportionally high minority community, but not in a federally designated medically underserved area.

Adolescent↗
PubMed2002

Unlocking the numerator-denominator bias. I: Adjustments ratios by ethnicity for 1991-94 mortality data. The New Zealand Census-Mortality Study.

AIM: To determine the extent of the under-reporting of Mäori and Pacific mortality among 0-74 year olds for the period 1991-94. METHODS: A subset (n=22,578) of highly probable linked 1991 census and 1991-94 mortality records were selected from the 31,635 census-mortality links in the New Zealand Census-Mortality Study. The numbers of decedents assigned as Mäori, Pacific, and non-Mäori non-Pacific were compared between mortality and census data. RESULTS: Compared to the death registration form, 29% more 0-74 year old decedents during 1991-94 had self-identified as sole-Mäori on the 1991 census (46% for prioritised-Mäori). This numerator-denominator bias was greater among the young and those living in central and southern New Zealand. Among 0-14, 15-24, 25-44, 45-64, and 65-74 year old decedents, respectively, 91%, 50%, 41%, 26% and 15% more decedents had self-identified as sole-Mäori on the 1991 census. For Northern, Midland, Central and Southern regional health authority areas, respectively, 14%, 17%, 81% and 102% more decedents had self-identified as sole-Mäori. Among Pacific decedents 68% more 0-74 year old decedents had self-identified as sole-Pacific on the 1991 census (78% for prioritised-Pacific group). This bias for Pacific decedents did not notably vary by age and region. CONCLUSIONS: This study confirms substantial underestimation of Mäori and Pacific mortality rates for the period 1991-94, even using the recommended sole-ethnic group denominator. The results from this study should be used to adjust ethnic-specific mortality rates for the early 1990s. Population-based funding formulas that included region-specific Mäori mortality rates would have particularly disadvantaged central and southern regions.

Adolescent↗
PubMed2003

Unlocking the numerator-denominator bias III: adjustment ratios by ethnicity for 1981-1999 mortality data. The New Zealand Census-Mortality Study.

AIM: Maori and Pacific deaths are under-counted in mortality data relative to census data. This 'numerator-denominator' bias means that routinely calculated mortality rates by ethnicity are incorrect. We used New Zealand Census-Mortality Study data to quantify the bias from 1981 to 1999. METHODS: The 1981, 1986, 1991 and 1996 Censuses were each anonymously and probabilistically linked to three years of subsequent mortality data, allowing a comparison of ethnicity recording. RESULTS: Compared with death registrations, 16% more 0-74 year old decedents during 1981-1984 had self-identified as '1/2 or more Maori' on the 1981 Census, and 32% more during both 1986-1989 and 1991-1994 had self-identified as 'sole Maori' on the 1986 and 1991 Censuses. From September 1995, mortality data have allowed multiple ethnicity to be recorded. During 1996-1999, 7% more decedents identified Maori as one of their ethnic groups on the 1996 Census compared with mortality data. For Pacific decedents, 55%, 76% and 68% more self-identified as 'sole Pacific' on census data compared with data recorded on death registrations for 1981-1984, 1986-1989 and 1991-1994 respectively, but there was no difference for 1996-1999. The bias for Maori (but not for Pacific) was greater among the young and those living in central and southern regions of New Zealand. CONCLUSIONS: The 1995 change to ethnicity recording on mortality data has improved the robustness of ethnicity data collection. These adjustment factors for 1981-1999 allow for more accurate calculations of ethnic-specific mortality rates over the last 20 years.

Adolescent↗
PubMed2005

[Census population vs. registration population: which population denominator should be used to calculate geographical mortality].

OBJECTIVES: Studies on the geographical differences in mortality tend to use a census population, rather than a registration population, as the denominator of mortality rates in South Korea. However, an administratively determined registration population would be the logical denominator, as the geographical areas for death certificates (numerator) have been determined by the administratively registered residence of the deceased, rather than the actual residence at the time of death. The purpose of this study was to examine the differences in the total number of a district population, and the associated district-specific mortality indicators, when two different measures as a population denominator (census and registration) were used. METHODS: Population denominators were obtained from census and registration population data, and the numbers of deaths (numerators) were calculated from raw death certificate data. Sex- and 5-year age-specific numbers for the populations and deaths were used to compute sex- and age-standardized mortality rates (by direct standardization methods) and standardized mortality ratios (by indirect standardization methods). Bland-Altman tests were used to compare district populations and district-specific mortality indicators according to the two different population denominators. RESULTS: In 1995, 9 of 232 (3.9%) districts were not included in the 95% confidence interval (CI) of the population differences. A total of 8 (3.4%) among 234 districts had large differences between their census and registration populations in 2000, which exceeded the 95% CI of the population differences. Most districts (13 of 17) exceeding the 95% CI were rural. The results of the sex- and age-standardized mortality rates showed 15 (6.5%) and 16 (6.8%) districts in 1995 and 2000, respectively, were not included in the 95% CI of the differences in their rates. In addition, the differences in the standardized mortality ratios using the two different population denominators were significantly greater among 14 districts in 1995 and 11 districts in 2002 than the 95% CI. Geographical variations in the mortality indicators, using a registration population, were greater than when using a census population. CONCLUSION: The use of census population denominators may provide biased geographical mortality indicators. The geographical mortality rates when using registration population denominators are logical, but do not necessarily represent the exact mortality rate of a certain district. The removal of districts with large differences between their census and registration populations or associated mortality indicators should be considered to monitor geographical mortality rates in South Korea.

Censuses↗
PubMedDate not supplied

Optimizing census geography: the separation of collection and output geographies.

"This paper reviews the changing way in which census geography has been treated with the increasing automation of census data processing. A four-stage model of modern census geography development is presented. In the context of this model, current practice is reviewed, and new opportunities for automated census geography design presented, culminating in a current prototype for the separation of purpose-designed data collection and output geographies. The narrative is presented primarily from a British perspective, but focuses on internationally relevant issues such as the implementation of census geography design, and the influence of census output geography on data analysis."

Censuses↗
PubMed1993

Accuracy of the 1990 census and undercount adjustments.

"In July 1991 the [U.S.] Census Bureau recommended to its parent agency, the Department of Commerce, that the 1990 census be adjusted for undercount. The Secretary of Commerce decided not to adjust, however. Those decisions relied at least partly on the Census Bureau's analyses of the accuracy of the census and of the proposed undercount adjustments based on the Post-Enumeration Survey (PES).... This article describes the total error analysis and loss function analysis of the Census Bureau. In its decision not to adjust the census, the Department of Commerce cited different criteria than aggregate loss functions. Those criteria are identified and discussed."

Americas↗
PubMed2000

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↗
PubMed1995

Using data from the 1991 census.

The 1991 census for England and Wales provides a substantial amount of data on demography, ethnicity, housing tenure, employment status, and other social factors for geographical areas ranging in size from enumeration districts upwards. Many in the health service and in the academic community are making use of the data in the 1991 census. However, users of census data need to be aware of the problems and limitations of these data, which include the format of the data, data modification and suppression, sampling error, and underenumeration. An important innovation of the 1991 census was that the census form included a question on the postcode of respondents; this allowed the Office of Population Censuses and Surveys to produce a postcode-enumeration district look up table which overcomes many of the problems previously encountered in trying to assign postcodes to enumeration districts. The new look up table also includes the grid reference of postcodes, and this will improve the geographical referencing of census data.

Data Collection↗
PubMed1995

Interpreting the new illness question in the UK census for health research on small areas.

STUDY OBJECTIVE: The study aimed to identify the various factors that seem to influence the average response to the new census question on limiting, long standing illness at the small area level, to assess the extent to which the new questions adds to information already available in the census and elsewhere, and to discuss how useful the data are likely to be for those planning health and social services. DESIGN: This was a cross sectional analysis of the relationship between rates of limiting, long standing illness (standardised for age and sex) and a large number of indicators of health and socioeconomic status at the small area level. SETTING: The study used data relating to 4985 small areas covering the whole of England. The average population was about 10 000. PARTICIPANTS: The 1991 census of population was addressed to the entire population of England. MAIN RESULTS: There are wide variations in the levels of self reported long standing illness between small areas, 70% of which are explained by demographic factors. Variation in age/sex standardised responses to the new census question at the small area level can largely be explained by census data on self reported disability among those of working age, standardised mortality ratio, and by indicators of socioeconomic circumstances relating to social class, ethnicity, and the elderly living alone. These does not seem to be a significant reporting bias due to underemployment. CONCLUSION: Unlike the disability question in the census, the standardised, self reported long standing limiting illness ratio covers the entire population and it is not skewed towards men. Although the variable is a synthesis of the health and social determinants of perceived morbidity, it does not provide much information that was not already available. In addition, it is available every 10 years only and thus may be rather inaccurate as an indicator of relative need towards the end of the decade. Moreover, in future censuses, individuals' answers might be influenced by the knowledge that their responses will affect the volume of resources allocated to the area in which they live.

Adolescent↗
PubMed1992

Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology.

BACKGROUND: Most US medical records lack socioeconomic data, hindering studies of social gradients in health and ascertainment of whether study samples are representative of the general population. This study assessed the validity of a census-based approach in addressing these problems. METHODS: Socioeconomic data from 1980 census tracts and block groups were matched to the 1985 membership records of a large prepaid health plan (n = 1.9 million), with the link provided by each individual's residential address. Among a subset of 14,420 Black and White members, comparisons were made of the association of individual, census tract, and census block-group socioeconomic measures with hypertension, height, smoking, and reproductive history. RESULTS: Census-level and individual-level socioeconomic measures were similarly associated with the selected health outcomes. Census data permitted assessing response bias due to missing individual-level socioeconomic data and also contextual effects involving the interaction of individual- and neighborhood-level socioeconomic traits. On the basis of block-group characteristics, health plan members generally were representative of the total population; persons in impoverished neighborhoods, however, were underrepresented. CONCLUSIONS: This census-based methodology offers a valid and useful approach to overcoming the absence of socioeconomic data in most US medical records.

Adult↗
PubMedDate not supplied

Lost but not forgotten: the U.S. census of 1890.

"The 1990 decennial census of population marked the bicentennial of the United States census enterprise. As we observed and participated in the activities of the 1990 census, it provided the opportunity to reflect on earlier experiences. This article considers the census of 1890, outlines the historical significance of that census, and examines the events surrounding the accidental destruction of the 1890 census records."

Americas↗
PubMed1991

The case for samples of anonymized records from the 1991 census.

"The census of population represents a rich source of social data. Other countries have released samples of anonymized records from their censuses to the research community for secondary analysis. So far this has not been done in Britain. The areas of research which might be expected to benefit from such microdata are outlined, and support is drawn from considering experience overseas. However, it is essential to protect the confidentiality of the data. The paper therefore considers the risks, both real and perceived, of identification of individuals from census microdata. The conclusion of the paper is that the potential benefits from census microdata are large and that the risks in terms of disclosure are very small. The authors therefore argue that the Office of Population Censuses and Surveys and the General Register Office of Scotland should release samples of anonymized records from the 1991 census for secondary analysis."

Censuses↗
PubMed1987

New approaches to the estimation of migration flows from census and administrative data sources.

Census data represent an important source of information about migration flows. However, existing estimation procedures based on intercensal projection are often inconvenient to apply and are sensitive to even quite small changes in enumeration completeness. 2 new estimation procedures applicable to data from 2 censuses are developed and illustrated using US data. The 1st method is essentially a modification of traditional intercensal projection techniques, but as a result of working with age groups rather than cohorts, it is simpler to apply and allows mortality of the migrants to be incorporated over the intercensal period. The 2nd method also uses information from 2 censuses, but also uses independent information on the age pattern of migration from administrative sources or from other census questions. The method uses the fact that the age pattern of recent migration is likely to be different from the age distribution of the overall population to distinguish between intercensal change due to migration and apparent intercensal change due to changes in enumeration completeness. If the method's assumptions are met, it is possible to estimate the relative coverage of the 2 censuses as well as the scale of the independent age pattern of migration relative to the coverage of 1 or other of the censuses. The illustrative applications of the methods to US data suggest that both can work reasonably well.

Age Factors↗
PubMed1992

An overview of demographic analysis as a method for evaluating census coverage in the United States.

"Since the 1950 U.S. census, demographic methods based on the fundamental balancing equation of demography have played an important role in the evaluation of the census net undercount. Application of this set of methods, called demographic analysis, results in national estimates of the net undercount for age-race-sex groups. Although results of demographic analysis are readily available in Bureau of the Census publications, the procedures used to estimate each of the components of population change are less well-known. In this paper we review the historical foundation of demographic analysis, beginning with Coale's 1950 census evaluation project and concluding with the recent evaluation of the 1990 census. We examine each of the components of the method, how their estimation has changed over time, and how they were estimated for the 1990 census."

Americas↗
PubMed1992

The ESRC/UFC-ISC 1991 census of population initiative: delivering the data of the decade.

"This article describes the programme of data purchase, dissemination, training and development support which the Economic and Social Research Council (ESRC) in collaboration with the Information Systems Committee of the Universities Funding Council (UFC-ISC) has put in place to...[inform users about] new products derived from the Census [of the United Kingdom]. As a preliminary some background to the census itself and to the Census Initiative are provided." Topics covered include census outputs, new features of the census, linked datasets, linked software, and Census Initiative datasets, training and development programs, and organization.

Censuses↗
PubMed2001

The use of census data for determining race and education as SES indicators: a validation study.

PURPOSE: Little research has examined the validity of using census data to determine an individual's socio-economic status (SES), as measured by race and educational level. This study assessed the accuracy of using aggregate level data from United States Census Block Groups in determining race and education SES indicators in a cohort of women from North Carolina. METHODS: The study analyzed patient data from the Carolina Mammography Registry and 1990 United States Census in 21 North Carolina counties. Women (n = 39,546) were geocoded to their census block group and their block group characteristics (surrogate measures) were validated with their self-reported values on race and education. An analysis was performed to explore whether using these surrogate measures would affect measured associations with the self-reported values. RESULTS: Whites were accurately identified (84.8%) more consistently than Blacks (14.1%) regardless of their urban/rural status. Women without a high school diploma or equivalent were accurately identified (56.2%) more often than those with higher education levels (45.9%). Analyses using the surrogate measures were significantly different than the true values according to chi-square statistics. CONCLUSIONS: Use of census data to derive SES indicators tends to be more accurate for the majority than the minority population. Researchers must be sensitive to the ecologic fallacy when using aggregate level data such as the census to determine individual level characteristics.

Black or African American↗
PubMed1998

Use of census-based aggregate variables to proxy for socioeconomic group: evidence from national samples.

Increasingly, investigators append census-based socioeconomic characteristics of residential areas to individual records to address the problem of inadequate socioeconomic information on health data sets. Little empirical attention has been given to the validity of this approach. The authors estimate health outcome equations using samples from nationally representative data sets linked to census data. They investigate whether statistical power is sensitive to the timing of census data collection or to the level of aggregation of the census data; whether different census items are conceptually distinct; and whether the use of multiple aggregate measures in health outcome equations improves prediction compared with a single aggregate measure. The authors find little difference in estimates when using 1970 compared with 1980 US Bureau of the Census data or zip code compared with tract level variables. However, aggregate variables are highly multicollinear. Associations of health outcomes with aggregate measures are substantially weaker than with microlevel measures. The authors conclude that aggregate measures can not be interpreted as if they were microlevel variables nor should a specific aggregate measure be interpreted to represent the effects of what it is labeled.

Censuses↗
PubMed2000

Anonymous linkage of New Zealand mortality and Census data.

BACKGROUND: The New Zealand Census-Mortality Study (NZCMS) aims to investigate socio-economic mortality gradients in New Zealand, by anonymously linking Census and mortality records. OBJECTIVES: To describe the record linkage method, and to estimate the magnitude of bias in that linkage by demographic and socio-economic factors. METHODS: Anonymous 1991 Census records, and mortality records for decedents aged 0-74 years on Census night and dying in the three-year period 1991-94, were probabilistically linked using Automatch. Bias in the record linkage was determined by comparing the demographic and socio-economic profile of linked mortality records to unlinked mortality records. RESULTS: 31,635 of 41,310 (76.6%) mortality records were linked to one of 3,373,896 Census records. The percentage of mortality records linked to a Census record was lowest for 20-24 year old decedents (49.0%) and highest for 65-69 year old decedents (81.0%). By ethnic group, 63.4%, 57.7%, and 78.6% of Maori, Pacific, and decedents of other ethnic groups, respectively, were linked. Controlling for demographic factors, decedents from the most deprived decile of small areas were 8% less likely to be linked than decedents from the least deprived decile, and male decedents from the lowest occupational class were 6% less likely to be linked than decedents from the highest occupational class. CONCLUSION: The proportion and accuracy of mortality records linked was satisfactorily high. Future estimates of the relative risk of mortality by socio-economic status will be modestly under-estimated by 5-10%.

Adolescent↗