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PubMed1988

[The 1986 Test of Adjustment Related Operations in Central Los Angeles County].

The author presents the methodology and results of a 1986 test census conducted in Central Los Angeles County, California, to examine the feasibility of adjusting the census for the estimated undercount using a post-enumeration survey. "The results of the dual-system estimates are presented for the test site by the three major race/ethnic groups (Hispanic, Asian, Other) by tenure, by age and by sex. Summaries of the small area adjustments of the census enumeration, by block, are presented and discussed."

Age Factors↗

PubMed1988

[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↗

PubMed1989

[Quebec's 1986 population figure. Comparing the census with Quebec's health insurance file].

The author compares the 1986 population figures obtained through the Canadian census to figures from Quebec's health insurance file. The difference between the two "is very close to the one implied by the estimated rate of undercounting. This paper explains the functioning of the file and how it may be used for demographic purposes, and provides some results by age and sex as well as by region." (SUMMARY IN ENG AND SPA)

Age Factors↗

PubMed2003

Estimating the total number of newly-recognized silicosis cases in the United States.

BACKGROUND: The US employer-based surveillance system for documenting occupational injuries and illnesses undercounts chronic diseases. We suggest a method to estimate the number of individuals who are newly-recognized with silicosis each year in the United States. METHODS: Data from US death certificates, the Michigan state-based surveillance system, and capture-recapture analysis were used to calculate national estimates of silicosis. RESULTS: From 1987 to 1996, 2,787 deaths occurred in the United States where silicosis was mentioned on the death certificates. During the same period, in Michigan 77% of death certificates with a mention of silicosis were confirmed as silicosis-related deaths and the ratio of the number of living to deceased confirmed silicosis cases was 6.44. The proportion of confirmed silicosis deaths, the ratio of the living to deceased silicosis cases and capture-recapture analysis from the Michigan surveillance system, were used to estimate that there were 3,600-7,300 cases per year of silicosis in the United States from 1987 to 1996. CONCLUSIONS: Our estimate of the annual number of newly-recognized silicosis cases is significantly larger than the estimate from the employer-based reporting system used for counting occupational disease in the United States. This employer-based surveillance system is inadequate for determining the frequency of occupational disease. Our analysis which combines a readily-available and relatively inexpensive national administrative database (i.e., death certificates) with a more costly state-based active surveillance system is a cost-effective model that could be used to provide better estimates of a number of different occupational diseases. Accurate estimates of occupational illnesses are essential to both determine temporal trends and evaluate efforts to prevent silicosis.

Death Certificates↗

PubMed2003

Previously undetected silicosis in New Jersey decedents.

BACKGROUND: Despite a reported decline in mortality and hospitalizations associated with silicosis [U.S. Department of Health and Human Services, 1999], this decline may be artifactual, stemming in part from underdiagnosis by physicians. METHODS: This study estimates, through radiological confirmation, the prevalence of unrecognized silicosis in a group of silica-exposed New Jersey decedents whose cause of death was chronic obstructive pulmonary disease (COPD), tuberculosis, or cor pulmonale. Two expert readers re-evaluated the chest X-rays of this group to determine the presence or absence of silicosis. The study population was considered to be presumptively exposed to silica dust by virtue of their usual industry of employment as listed on the death certificate. RESULTS: Radiographic evidence of silicosis was found in 8.5% of this population, and evidence of asbestosis was found in another 10.7%, for a total of 19.2%. CONCLUSIONS: The existence of previously unrecognized silicosis and asbestosis in 19.2% of this study group suggests that occupational lung disease is under-recognized and, hence, undercounted.

Aged↗

PubMed2003

Work-related amputations in Michigan, 1997.

BACKGROUND: Work-related amputations are of concern in Michigan and nationally. This study reports on 1 year of data on work-related amputations, which were treated in Michigan hospital emergency departments (ED) or as in-patients in Michigan. METHODS: Michigan hospitals provided face sheets and discharge summaries of in-patient and ED visits for work-related amputations that occurred in 1997. Information was also obtained about worksite inspections associated with reported amputations from the Michigan Occupational Safety and Health Act (MIOSHA) program. Data from this study and from Michigan workers compensation were used to generate an estimate of the true numbers of work-related amputations in Michigan in 1997. RESULTS: Three hundred thirty-nine work-related amputations were identified by hospitals. Powered saws and power presses were the leading sources of injury. MIOSHA completed 30 enforcement inspections related to these amputations. Our best estimate of the total numbers of work-related amputations in 1997 for Michigan was 693, of which 562 resulted in hospitalization or ED treatment. CONCLUSIONS: In-patient and ED records provided information for identifying high risk groups and problem worksites in Michigan. Estimates generated from these data underscore that data on work-related amputations released by the Bureau of Labor Statistics (BLS), which reported 440 amputations in 1997, are a significant undercount--only 64%--of the true number of cases. Better integration of public health data into OSHA enforcement activity is needed.

Accidents, Occupational↗

PubMed2003

Cancer rates among American Indians and Alaska Natives: is there a national perspective.

BACKGROUND: Two important goals of cancer surveillance are to provide milestones in the effort to reduce the cancer burden and to generate observations that form the basis for cancer research and intervention for cancer prevention and control. Determination of the cancer burden among American Indians and Alaska Natives (AIAN) has been difficult largely due to lack of data collection efforts in many areas of the country and misclassification of racial data that results in undercounting of Native Americans. There is a revitalized commitment to improve data collection among the national agencies and organizations. METHODS: Data on cancer trends from 12 areas covered by the Surveillance, Epidemiology and End Results (SEER) Program were reviewed for incidence and death rates for 1992-2000. AIAN trends were examined and compared with trends among other racial/ethnic population groups. Reference was made to studies of disease-specific survival for nine of the SEER areas for 1988-1997. RESULTS: In SEER areas, cancer incidence rates for AIAN populations appeared to be decreasing significantly for lung and breast cancers among women and for prostate cancer among men. However, death rates rose, although not significantly, over the same period, except for a significant decrease in prostate cancer. Among the cancers with rising death rates were lung cancer (AIAN women) and colorectal cancer (AIAN men). In addition, survival often was lower for AIAN populations. CONCLUSIONS: Although the incidence was stable or decreased among AIAN populations, increased death rates and lower survival rates indicate the need for intensified application of cancer prevention and control measures, including screening and treatment. Difficulties in interpretation of data include small population size and substantial interregional differences in rates.

Alaska↗

PubMedDate not supplied

Probabilistic linkage of large public health data files.

Probabilistic linkage technology makes it feasible and efficient to link large public health databases in a statistically justifiable manner. The problem addressed by the methodology is that of matching two files of individual data under conditions of uncertainty. Each field is subject to error which is measured by the probability that the field agrees given a record pair matches (called the m probability) and probabilities of chance agreement of its value states (called the u probability). Fellegi and Sunter pioneered record linkage theory. Advances in methodology include use of an EM algorithm for parameter estimation, optimization of matches by means of a linear sum assignment program, and more recently, a probability model that addresses both m and u probabilities for all value states of a field. This provides a means for obtaining greater precision from non-uniformly distributed fields, without the theoretical complications arising from frequency-based matching alone. The model includes an iterative parameter estimation procedure that is more robust than pre-match estimation techniques. The methodology was originally developed and tested by the author at the U.S. Census Bureau for census undercount estimation. The more recent advances and a new generalized software system were tested and validated by linking highway crashes to Emergency Medical Service (EMS) reports and to hospital admission records for the National Highway Traffic Safety Administration (NHTSA).

Adult↗

PubMed2001

Costs of occupational injuries and illnesses in California.

OBJECTIVES: The purpose of this study was to estimate the annual incidence, the mortality, and the direct and indirect costs associated with occupational injuries and illnesses in California in 1992. To achieve this, we performed aggregation and analysis of national and California data sets collected by the U.S. Bureau of Labor Statistics, California Workers' Compensation Insurance Rating Bureau, California Division of Industrial Relations, the National Center for Health Statistics, and the U.S. Health Care Financing Administration. METHODS: To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from state and national surveys and applied an attributable risk proportion method. To assess costs, we used the cost-of-illness, human capital, method that decomposes costs into direct categories such as medical expenses and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from California data, whereas others were drawn from a national study but were adjusted to reflect California's differences. Cost estimates for injuries were calculated by multiplying average costs by the number of injuries. For the majority of diseases, cost estimates relied on the attributable risk proportion method. RESULTS: Approximately 660 job-related deaths from injury, 1.645 million nonfatal injuries, 7,079 deaths from diseases, and 0.133 million illnesses are estimated to occur annually in the civilian California workforce. The direct ($7.04 billion, 34%) plus indirect ($13.62 billion, 66%) costs were estimated to be $20.7 billion. Injuries cost $17.8 billion (86%) and illnesses $2.9 billion (14%). These estimates are likely to be low because: (1) they ignore costs associated with pain and suffering, (2) they ignore home care provided by family members, and (3) the numbers of occupational injuries and illnesses are likely to be undercounted. CONCLUSION: Occupational injuries and illnesses are a major contributor to the total cost of health care and lost productivity in California. These costs are on a par with those of all cancers combined and only slightly less than the cost of heart disease and stroke in California. Workers' compensation covers less than one-half of the costs of occupational injury and illness.

California↗

PubMedDate not supplied

Looking at the patient in the mix: is case mix methodology unfair to the hospital outpatient department?

The diagnoses of 431 general internal medicine patients from an urban outpatient department (OPD) were analyzed using two methods of case mix description: 1) a visit-based method which captures a single diagnosis for each visit; 2) a patient-based method which captures multiple diagnoses for a patient over one year. Nine of the top ten diagnoses were the same using either method, but the prevalence of diagnoses was two- to twelvefold higher with the patient-based method. Next the OPD was compared by the visit-based method with a national survey of doctors' private offices. Although the visit-based case mix in the OPD appeared to be the same as that in doctors' private offices, the analysis suggested that differences may be hidden by the method of describing case mix. The authors conclude that a visit-based approach to case mix description makes urban OPDs resemble doctors' private offices because the visit-based method undercounts those patients with chronic diagnoses, co-morbid conditions, and psychosocial problems, so common in the urban OPD. These findings have major implications for ambulatory reimbursement schemes, most of which capture only one diagnosis for each visit.

Diagnosis-Related Groups↗

PubMed1999

International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging.

A cross-national study of hip fracture incidence was carried out in five geographic areas--Beijing, China; Budapest, Hungary; Hong Kong; Porto Alegre, Brazil; and Reykjavik, Iceland--during the years 1990-1992. Cases of hip fracture among women and men of age 20 years and older were identified using hospital discharge data in conjunction with medical records, operating room logs, and radiology logs. Estimated incidence rates varied widely, with Beijing reporting the lowest rates (age-adjusted rate per 100,000 population for men 20 years and older = 45.4; women = 39.6) and Reykjavik the highest rates (man = 141.3; women = 274.1). Rates were higher for women than for men in every area except Beijing. In every area except Budapest, review of the operating room or radiology logs identified additional cases that were not reported in the discharge list, increasing the estimated number of hip fractures by 11% to 62%, depending on the area. Review of medical records identified miscoding of hip fractures (ICD 9820) as 'shaft of femur and other femur fractures' (ICD 9821) in the discharge lists of every area except Budapest, increasing the estimated number of hip fractures by 1% to 30%. The final estimates of hip fracture incidence taking into account all investigated sources of undercount and overcount ranged from 15% lower to 89% higher than an estimate based on the discharge diagnoses alone. Although these results indicate substantial limitations in relying on hospital discharge data alone to estimate hip fracture incidence rates, the extent of errors found in the discharge lists is smaller than the large international variation found here and previously reported in incidence rates. The findings support the conclusion that the differences reported among countries mainly reflect genuine variation in the hip fracture incidence rates.

Adult↗

PubMed2004

Discrepancies in bacterial recovery from dental unit water samples on R2A medium and a commercial sampling device.

Monitoring the number of bacterial colony-forming units is an important step in assuring compliance with the recommendation that water from dental units contain <200 CFU mL(-1). Media that have been used for this purpose include R2A, a standard plate counting medium for water samples, and the Millipore HPC Sampler device, designed to facilitate sampling in dental offices. Discrepancies between the two media have been observed. This study tested the hypothesis that differences in counts on the two media were due to the failure of some bacteria to grow on the HPC sampler or to grow at less efficiency than on R2A. Of four different bacterial colony phenotypes tested in three independent experimental trials, one phenotype did not grow on the HPC device, and another grew inconsistently and at lower efficiency. These results confirmed the hypothesis. From these findings, users of the HPC sampler should be aware that microbial undercounts may occur.

Bacteria↗

PubMed2006

Patterns of disparity: ethnic and socio-economic trends in breast cancer mortality in New Zealand.

OBJECTIVE: To test whether trends in breast cancer mortality varied by ethnicity and socio-economic position during the 1980s and '90s in New Zealand. METHODS: Four cohorts of the entire New Zealand population for 1981-84; 86-89; 91-94 and 96-99 allowed direct determination of socio-economic trends in breast cancer mortality. For ethnicity, unlinked routine census and mortality data were used with adjustment factors for undercounting of Māori and Pacific deaths. RESULTS: Māori and non-Māori non-Pacific mortality rates changed little until mid-1990s with Māori experiencing 25% higher mortality. In 1996-99, Māori rates increased notably to become 68% higher than non-Māori non-Pacific (SRR 1.68; 95% CI: 1.49-1.90). Pacific women experienced an approximate three-fold increase in breast cancer mortality over time. There appeared to be reducing mortality among higher income and education groups but trends within socio-economic groups were not statistically significant. Nevertheless, by 1996-99, there was a significant 22% excess mortality (SRR 1.22; 95% CI: 1.01-1.49) for low compared with high-income groups. CONCLUSIONS: Widening ethnic, and probably, socio-economic disparities in breast cancer mortality are likely due to both underlying incidence and differential survival trends. Disparities are likely to increase once the full differential mortality benefits of screening impact on the population.

Adolescent↗

PubMed1985

Discrepancies in vehicular crash injury reporting: Northeastern Ohio Trauma Study. IV.

People injured in motor vehicle traffic crashes were identified from a population-representative incidence sample of hospital emergency department visits. Matched police reports of crashes were sought in official state records of motor vehicle traffic crashes. Of the emergency department cases, 55% had matched police reports. The frequency of matched reports was highest for drivers (74%), people transported to the hospital by emergency vehicle (69%), and those requiring hospital admission (74%). The frequency was lowest for people younger than 16 years (28%), people injured as occupants of vehicles other than passenger cars (24%), medicaid recipients (33%), and nonresidents of the study region (40%). Motor vehicle traffic injuries are undercounted in police-reported statistics. For many groups, police reporting is less than 50% of the cases identified through emergency departments. The likelihood that a case of motor vehicle traffic injury will have a matched police report depends on demographic, social and crash factors as well as on injury severity.

Accidents, Traffic↗

PubMed1995

Treated injuries in northern Vermont.

OBJECTIVES: To study characteristics of injury events and injuries requiring treatment in a Vermont population. METHOD: A one year 30% prospective sample was studied of persons from 22 communities who received first physician care for injury at the Medical Center Hospital of Vermont. RESULTS: Modal injuries were-superficial involving skin only among children below age 10, overexertion injuries among 10-59 year olds, and fractures among older persons. Among interviewed males ages 20-59, 31% of injuries were work related. Among females 26% were work related. Examining hospitalized cases only would have overemphasized falls, chemical injuries, leg fractures, transportation and nursing home injuries, and undercounted overexertion injuries, especially to the back, arm fractures, and injuries during recreation, work and home activities. Most common products/materials in use when injured were recreational equipment (24%) and motor vehicles (9%). Those most often causing injury were ground (20%) and home structures/construction materials (17%). No product was involved in 39% of injury event initiation and 15% of injury causation. CONCLUSION: In order to adequately reflect the distribution of treated injuries in the community by anatomical area, age, and event type studies must examine both emergency department and hospitalized cases and use a data collection system capable of recording several parameters to describe injury events and products/materials involved.

Accident Prevention↗

PubMed1975

Measurement of the prevalence of respiratory allergies by interview questionnaire.

A recent publication of the National Center for Health Statistics estimated the prevalence of asthma in 1970 to be 30.2 per 1,000 noninstitutionalized population, and of hay fever (without asthma) as 54.2 per 1,000. These and other data on chronic respiratory conditions were obtained by means of a household survey employing lay interviewers and a standardized questionnaire. There may be a gap between the intended meaning of the key question-did the individual have a chronic condition during the past 12 months-and the respondent's understanding of it. As a consequence, some of those who have been asymptomatic in the recent past may have excluded themselves. Even among people with the chronic condition who have seen a physician about it during the prior year, significant numbers fail to report it to the interviewer, according to validation studies. A method is suggested for making rough adjustments for these undercounts. It results in raising the estimated prevalence to 43.0 for asthma and 71.1 for hay fever. These revisions are dependent on necessarily subjective assumptions about the magnitude of the biases involved.

Asthma↗

PubMed1993

Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Abuse Warning Network.

There is no gold standard for determining poisoning incidence. We wished to compare four measures of poisoning incidence: International Classification of Diseases 9th Revision (ICD-9) principal (N-code) and supplemental external cause of injury (E-code) designations, poison control center (PCC) reporting, and detection by the Drug Abuse Warning Network (DAWN). We studied a case series at two urban hospitals. We assigned ICD-9 N-code and E-code classifications, determining whether these matched with medical records. We ascertained PCC and DAWN system reporting. A total of 724 subjects met entry criteria; 533 were studied (74%). We matched poisoning N-codes for 278 patients (52%), E-code by cause in 306 patients (57%), and E-code by intent in 171 patients (32%). A total of 383 patients (72%) received any poisoning N-code or any E-code. We found that PCC and DAWN reporting occurred for 123 of all patients (23%) and 399 of 487 eligible patients (82%), respectively. In multiple logistic regression, factors of age, hospital admission, suicidal intent, principal poisoning or overdose type, and mixed drug overdose were statistically significant predictors of case match or report varying by surveillance measure. Our findings indicate that common surveillance measures of poisoning and drug overdose may systematically undercount morbidity.

Adolescent↗

PubMed1993

Data needed for improving the health of minorities.

Identified needs for minority health data, obstacles in obtaining the data, and potential solutions are reviewed. Vital statistics for whites and blacks have been available by states for many years. Recent revisions provide data on Hispanics, and new resolutions will provide data on Asian and Pacific Islander subgroups. But limitations persist in providing accurate statistics for minority subgroups. A major obstacle is the inadequacy of census denominator estimates, due to differential undercounts, paucity of postcensal estimates for states and localities, and the validity of the race and ethnicity data. Important issues revolve around quality, comparability, and intraperson variability of self-identification in determining race and ethnicity, versus external assessment. National survey data have oversampled for black and Hispanic minorities, but not others. The Disadvantaged Minority Health Improvement Act of 1990 provides some solutions, including an extramural grants program to strengthen minority statistics, which the National Center for Health Statistics has implemented to improve minority health assessment at all levels.

Adolescent↗