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PubMed2004

Syndromic surveillance: the effects of syndrome grouping on model accuracy and outbreak detection.

STUDY OBJECTIVE: Data used by syndromic surveillance systems must be grouped into syndromes or prodromes. Previous studies have examined the accuracy of different methods of syndromic grouping. We seek to study the effects of different syndrome grouping methods on model accuracy, a key factor in the outbreak-detection performance of syndromic surveillance systems. METHODS: Daily emergency department visit rates were analyzed from 2 urban academic tertiary care hospitals for 1,680 consecutive days. During this period, each hospital census totaled approximately 230,000 patient visits. Three methods were used to group the visits into a respiratory-related syndrome category: 1 relying on chief complaint, 1 on diagnostic codes, and 1 on a combination of the two. The different groupings of the syndromic data resulting from these methods were used to build different historical models that were then tested for forecasting accuracy and for sensitivity to detecting simulated outbreaks. RESULTS: For both hospitals, the data grouped according to chief complaints alone yielded the lowest model accuracy and the lowest detection sensitivity. Using diagnostic codes to group the data yielded better results in accuracy and sensitivity. Combining the 2 grouping methods yielded the best results in accuracy and sensitivity. Temporal smoothing of the data was shown to improve sensitivity in all cases, although to various degrees in the different models. CONCLUSION: The methods used to group input data into syndromic categories can have substantial effects on the overall performance of syndromic surveillance systems. The results suggest that incorporating diagnostic data into these systems can improve the modeling accuracy and its detection sensitivity. Furthermore, the best results may be achieved by using a combination of methods to group visits into syndromic categories.

Bioterrorism↗
PubMed1996

Modelling inequality in reported long term illness in the UK: combining individual and area characteristics.

STUDY OBJECTIVE: To assess the nature of the relation between health and social factors at both the aggregated scale of geographical areas and the individual scale. DESIGN AND SETTING: The individual data are derived from the sample of anonymised records (SAR) from the census of 1991 in Great Britain, and are combined with area data from this census. The ecological setting (context) was defined using multivariate methods to classify the 278 districts of residence identifiable in the SAR. The outcome health variable is the 1991 census long-term limiting illness question. Health variations were analysed by multilevel logistic regression to examine the compositional variation (at the level of the individual) and the contextual variation (variability operating at the level of districts) in reported illness. PARTICIPANTS: 10 per cent randomised subsample of the SAR who are aged 16+ and are resident in households. MAIN RESULTS: The multi-level modelling revealed that area factors have a significant association with individual health outcome but their effect is smaller than that of individual attributes. The results show evidence for both compositional and contextual effects in the pattern of variation in propensity to report illness. CONCLUSIONS: The results suggest generally higher levels of ill health for individuals who are older, not married, in a semi/unskilled manual social class, and socioeconomically deprived (as measured by a composite deprivation score). All individuals living in areas with high levels of illness (which tend to be more deprived areas) show greater morbidity, even after allowing for their individual characteristics. However, within affluent areas, where morbidity was generally lower, the health inequality (health gradient) between rich and poor individuals was particularly strong. We consider the implications of these findings for health and resource allocation policy.

Adolescent↗
PubMed1995

Mortality of butchers and cooks identified from the 1961 census of England and Wales.

OBJECTIVES: To explore a suspected hazard of lung cancer in butchers and cooks. METHODS: 4018 male butchers and 2062 male cooks were identified from the 1961 census of England and Wales. 4857 (79.9%) of these men were traced through the National Health Service Central Register, and 3518 deaths were recorded during follow up to the end of 1992. Mortality from lung cancer and other causes was compared with that of the general population by the person-years method. RESULTS: Mortality from all causes was significantly below that of the national population in both butchers (standardized mortality ratio (SMR) 0.94, 95% confidence interval (95% CI) 0.90-0.98) and cooks (SMR 0.89, 95% CI 0.84-0.95). When allowance was made for a latency of 20 years from entry to follow up, the deficit in butchers was reduced, but that in cooks persisted, and was largely explained by a shortfall of deaths from cancer and circulatory disease. Mortality from lung cancer was close to expectation in the butchers (SMR 1.01, 95% CI 0.90-1.13) and below expectation in the cooks (SMR 0.93, 95% CI 0.75-1.13). Cooks had increased mortality from cancers of the oral cavity (SMR 5.57) and pharynx (SMR 2.66). CONCLUSIONS: The findings provide no support for an occupational hazard of lung cancer in either butchers or cooks. The possibility of excess risk in sub-groups of these occupations cannot be discounted. The high rates of oral and pharyngeal cancer in cooks are probably a consequence of high alcohol consumption.

Cause of Death↗
PubMed2006

Levels and trends of demographic indices in southern rural Mozambique: evidence from demographic surveillance in Manhiça district.

BACKGROUND: In Mozambique most of demographic data are obtained using census or sample survey including indirect estimations. A method of collecting longitudinal demographic data was introduced in southern Mozambique since 1996 (DSS -Demographic Surveillance System in Manhiça district, Maputo province), but the extent to which it yields demographic measures that are typical of southern rural Mozambique has not been evaluated yet. METHODS: Data from the DSS were used to estimate the levels and trends of fertility, mortality and migration in Manhiça, between 1998 and 2005. The estimates from Manhiça were compared with estimates from Maputo province using the 1997 National census and 1997 Demographic and Health Survey (DHS). The DHS data were used to estimate levels and trends of adult mortality using the siblings' histories and the orphanhood methods. RESULTS: The populations in Manhiça and in Maputo province are young (44% <15 years in Manhiça and 42% in Maputo); with reduced adult males when compared to females (all ages sex ratio of 78.7 in Manhiça and 89 in Maputo). Fertility in Manhiça is at a similar level as in Maputo province and has remained around 5 children per woman, during the eight years of surveillance in Manhiça. Although the infant mortality rate (IMR) in Mozambique has decreased during the last two decades (from 148 deaths per 1000 live births in 1980 to 101 in 2003), it has remained stable around 80 in Manhiça during the surveillance period. Adult mortality has increased both in Manhiça (probability of dying from ages 15 to 60 increased from 0.4 in 1998 to 0.6 in 2005 in Manhiça, from 0.3 in 1992 to 0.4 in 1997 in Maputo province and from 0.1 in 1980 to 0.6 in 2000 in Mozambique). Consequently, the life expectancy decreased from 53 to 46 in Manhiça and from 42 years in 1997 to 38 in 2004 in Mozambique. Migration is high in Manhiça but tends to stabilise after the movements of resettlement that followed the end of the civil war in 1992. CONCLUSION: The population under demographic surveillance in Manhiça district presents characteristics that are typical of southern rural Mozambique, with predominance of young people and reduction of adult males. Labour migration and excess adult male mortality are the major factors for the reduction of adult males. Mortality is high and only infant mortality has started to stabilise while adult mortality has increased, and as consequence, life expectancy has decreased. The Manhiça DSS is an adequate tool to report demographic measures for southern rural Mozambique.

Adolescent↗
PubMed1988

[Measuring accuracy in a post-enumeration survey].

"The U.S. Bureau of the Census will use a post-enumeration survey to measure the coverage of the 1990 Decennial Census. The Census Bureau has developed and tested new procedures aimed at increasing the accuracy of the survey. This paper describes the new methods. It discusses the categories of error that occur in a post-enumeration survey and means of evaluation to determine that the results are accurate. The new methods and the evaluation of the methods are discussed in the context of a recent test post-enumeration survey."

Americas↗
PubMed2004

The impact of AIDS on adult mortality: evidence from national and regional statistics.

OBJECTIVE: To measure trends in adult mortality in countries with significant levels of HIV prevalence using data sources other than those that collect information on HIV status. DATA AND METHODS: Data sources consisted of national population censuses and sample surveys, Demographic and Health Surveys (DHS), vital registration, and longitudinal surveillance systems. Estimates of adult mortality were derived from censuses using intercensal survival and questions on deaths of household members and orphanhood. From DHS adult mortality was measured from data on survival of siblings and orphanhood. Death registration should be tested for changes in the level of coverage before drawing conclusions on mortality trends. Demographic surveillance systems record trends and age patterns of mortality, but are not nationally representative. RESULTS: Census and survey data from Kenya, Malawi and Zimbabwe showed increasing adult mortality in the 1990s, reversing previous downward trends. DHS data for over 20 sub-Saharan countries showed that most had increasing mortality, which was steepest in eastern and southern Africa, with high HIV prevalences. Death registration in Zimbabwe and South Africa showed increasing adult mortality, as in Thailand and Trinidad, both countries with appreciable levels of HIV. Surveillance systems in Tanzania and South Africa showed radically different age patterns of mortality, with relatively high rates among younger adults compared with data from countries with lower HIV prevalences. CONCLUSION: Adult mortality is increasing in countries with high HIV/AIDS prevalences, although the contribution of the epidemic to this increase is difficult to measure. More data and improved methods of analysis are needed before firm conclusions can be drawn.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Deindustrialisation and the long term decline in fatal occupational injuries.

AIMS: To examine the extent to which deindustrialisation accounts for long term trends in occupational injury risk in the United States. METHODS: Rates of fatal unintentional occupational injury were computed using data from death certificates and the population census. Trends were estimated using Poisson regression. Standardisation and regression methods were used to adjust for the potential effect of structural change in the labour market. RESULTS: The fatal occupational injury rate for all industries declined 45% from 1980 to 1996 (RR (rate ratio) 0.55, 95% CI 0.52 to 0.57). Adjustment for structural changes in the workforce shifted the RR to 0.62 (95% CI 0.60 to 0.65). Expanding industries enjoyed more rapid reduction in risk (-3.43% per year, 95% CI -3.62 to -3.24) than those that contracted (-2.65% per year, 95% CI -2.88 to -2.42). CONCLUSIONS: Deindustrialisation contributed to the decline of fatal occupational injury rates in the United States, but explained only 10-15% of the total change.

Accidents, Occupational↗
PubMed1997

Identifying older people with dementia: the effectiveness of a multiservice census.

A census of all relevant services in an area can be used to identify people with mental impairment suggestive of dementia. Two censuses in Tayside, Scotland, were used to test the effectiveness of this method. False positives accounted for 12% of returns. After excluding false positives, by comparison with expected dementia prevalence based on EURODEM, 66% of all sufferers and 50% of those living in the community were identified by the censuses. By pro-rating for non-response, the proportion of sufferers known to services was estimated as 72%. The characteristics of those not known to services are unclear and further research is needed on this. The cost of a census in an area of 250,000 population is under pounds 3000. A multiservice census offers a simple, inexpensive, practicable method of constructing a sample frame for population needs assessment.

Aged↗
PubMed1983

The epidemiology of admissions to the child and adolescent psychiatric outpatient clinic.

Using the data from the 1970 census of population and housing for the Standard Metropolitan Statistical Area (SMSA) of Milwaukee, Wisconsin (1), demographic information was recorded for each of the approximately 300 census tracts in Milwaukee County pertaining to the population characteristics, marital status, age stratification, and economic and housing characteristics. Also, information was collected on the number of admissions into the child and adolescent outpatient clinic for each census tract. The 300 census tracts were than divided into four categories: very low admission, low admission, high admission, and very high admission. Using a computer method, a demographic analysis of these four groups of census tracts was then carried out to examine the correlation between the census tracts was then carried out to examine the correlation between the density of admissions and various demographic characteristics. During the course of the study, various correlations between high admissions to the child and adolescent psychiatric outpatient clinic and various demographic characteristics emerged. Implications of these findings, in terms of present service and future planning, are discussed.

Adolescent↗
PubMed2005

Mental health differences between rural and urban men living with HIV infection in various age groups.

Despite the disproportionate increase in rural, Southern residents and older persons during the third era of the HIV/AIDS epidemic, no known study has examined whether older, rural men living with HIV infection face a double jeopardy and have poorer psychosocial profiles than other subgroups of men. We investigated whether area of residence (rural, urban), age (young, middle-age, old), and the interaction of residence and age would be related to mental health factors by using two measurement methods to categorize rural and urban residence (US Census Bureau classification and The Office of Rural Health Policy's, Rural Urban Commuting Area Codes [RUCAs]). We conducted 2-3 hour-long, face-to-face interviews with all but 43 patients who met the study criteria and kept their clinic appointments at three different types of healthcare facilities (i.e., VA, university clinic, public health department) over a 20-month period. The sample consisted of 226 men living in the southeastern US. Rural and urban men of various age groups did not differ in socioeconomic factors, travel distance to clinics, use of medications, satisfaction with care, types of severe stressors, and confidentiality concerns. Using two methods to categorize area of residence, we found that rural men as compared to urban men had similar levels of total stress, AIDS-related stress, social support, active coping and avoidance coping, but higher rates of risk for depression. Rural men had higher levels of non-AIDS-related stress only when the US Census Bureau's categorization was used, which highlights the importance of carefully selecting and describing methods to categorize rural versus urban residence.

Adult↗
PubMed2004

Occupational injury mortality surveillance in the United States: an examination of census counts from two different surveillance systems, 1992-1997.

BACKGROUND: The surveillance of occupational injury mortality in the United States has evolved over the last century. Currently there are two different data sources used for the study of occupational injury mortality. Each system varies in methodology, leading to different census counts. We provide an overview and analysis of similarities and differences in these two systems. METHODS: The National Traumatic Occupational Fatalities (NTOF) surveillance system and the Census of Fatal Occupational Injuries (CFOI) were examined for civilian deaths at work in the United States from 1992 to 1997. RESULTS: There were 31,643 occupational injury mortality cases according to NTOF and 37,023 from CFOI for civilian workers 16-years and older in the United States for the 6-year period of analysis. The annual average occupational injury mortality rates were 4.5 per 100,000 full time equivalent workers from NTOF and 5.2 from CFOI. The higher capture rate by CFOI was consistent across each of the 6 years. Similar patterns for demographics, industry, and occupation, and type of incident were seen for both systems. CONCLUSIONS: While NTOF provides more years of data dating back to 1980, CFOI (established in 1992) provides a more comprehensive capture of occupational injury mortality and provides greater detail of the mortality incidents. The overall injury mortality patterns, however, appear to be similar between the systems.

Accidents, Occupational↗
PubMed1988

Monitoring the metropolitanization process.

Alternative approaches have led to different interpretations of the metropolitanization process in the United States. We identify and illustrate several methods and procedures for monitoring metropolitan-nonmetropolitan population change using the 1950-1980 U.S. decennial censuses. Two basic approaches are compared: constant area approaches and component methods. In addition, we assess the effects of changing metropolitan definitions on metropolitan-nonmetropolitan growth. The results clearly reveal that the underlying mechanics of metropolitanization not only are complex but have changed substantially during the 1950-1980 period. We conclude with observations regarding the use of these procedures in future research.

Humans↗
PubMed1984

Life table construction on the basis of two enumerations of a closed population.

The author demonstrates that an accurate detailed life table that represents average mortality experience between two censuses can be constructed if the censuses provide accurate records of the single-year age distribution of a closed population. This life table can begin at age zero if accurate data on the annual number of births during the inter-censal period are available; otherwise the first age in the life table must equal the duration of time between the censuses. "The estimation technique involves the calculation of the number of persons attaining each age during the period between the censuses and the determination of the average rate of increase in the number at each individual age. The success of the technique comes from the use of interpolation to calculate how many in each cohort attain each exact age the cohort passes through between the censuses." The estimation technique is tested using two alternative methods of interpolation. Some illustrations based on data for Sweden and China are included.

Age Distribution↗
PubMedDate not supplied

Recent estimates of adult mortality from widowhood in Bangladesh: a critical comparison.

"The indirect techniques of demographic estimation available at the moment are often inadequate to estimate levels in the presence of trends. The generalised stable population relations have been applied to census and survey data collected in Bangladesh for the estimation of adult mortality. This method combines two sets of widowhood data and yields estimates for the intersurvey period. The generalised stable population relations are based on the assumption that the population is closed to migration between the censuses. The application of the method is simple whatever may be the length of the inter survey period. But the method may be found to be affected by age misreporting and other errors." (SUMMARY IN ITA AND FRE)

Asia↗
PubMed1995

Ethnic differences in contraceptive use in Kuwait: a clinic-based study.

The Arab, Muslim, oil-rich nation of Kuwait has achieved unusually high levels of knowledge and use of contraception for a developing, high fertility country. Almost all women know of contraceptive pills without prompting, and 57-86% report having ever used a method (usually the oral pill or IUD) in recent studies. Based on a survey of six randomly selected clinics the present study compares the knowledge and use levels of two major ethnic groups--the Beduins and non-Beduins. It also analyses preference for various contraceptive methods and probable reasons for this. While Census or Survey data do not provide information about the size of ethnic groups analyzed in this paper, it is estimated that at least one-third of the population of Kuwait is Beduin. There is a significant difference between the levels of knowledge and use of contraception between the Beduin and non-Beduin women; current use being 42% and 65%, respectively. The differentials between the two groups are particularly marked among women of lower socioeconomic status, and tend to reduce notably once variables such as education and income are controlled. Within the subgroup of non-Beduins, socioeconomic differences in contraceptive use have virtually disappeared; the illiterate and relatively less affluent women are as likely to use a contraceptive method as the university educated, and richer women. However, among the Beduins, the usually expected differences by socioeconomic characteristics still persist. The oral pill is the best known and most commonly used method. Male sterilization is the least known and not practiced at all.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Algorithms for reengineering 1991 census geography.

"The availability of GIS [geographic information systems] technology and digital boundaries of census output areas now makes it possible for users to design their own census geography. Three algorithms are described that can be used for this purpose. An Arc/Info implementation is briefly outlined and case studies presented to demonstrate some of the results of explicitly designing zoning systems for use with 1991 [U.K.] census data."

Censuses↗
PubMed1985

[Re-estimation of the population by age and sex and vital rates in postwar Japan].

"In this study Japanese population by age and sex was re-estimated for the postwar years and both fertility and mortality rates were also re-estimated based on these revised populations." Using the cohort component method, the authors analyze data from seven censuses conducted between 1950 and 1980, adjusting for international migration. The revised population figures are then used to re-estimate age- and sex-specific death probabilities and to derive life table functions for the postwar years. Problems with the reliability of the census data are emphasized, in particular the under-enumeration of the total population and of specific subgroups, and the bias in offical birthrate estimates arising from the procedure for estimating mid-year populations. (summary in ENG)

Age Factors↗