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PubMed2006

Ageing of the baby boomer generation: how demographic change will impact on city and rural GP and nursing workforce.

INTRODUCTION OBJECTIVE: To compare the impact of ageing on the GP and nursing rural and city workforce. METHOD: Cohort analysis of Australian Bureau of Statistics census data. The data was used to examine the age distribution of the city and rural GP and nursing workforce; patterns of attrition for those 50 years and over; and the impact of changes in working hours. RESULTS: The rural GP and nursing workforce is significantly older than their city counterparts (p<0.001) with the 'baby boomer' generation making up 52% of city GPs but 59% of rural GPs in 2001. While a large proportion of city and rural GPs continued to work past the age of 65 years, rural GPs left the workforce at a significantly younger age than city doctors (p<0.001). Rural nurses are older than their city peers (p<0.001) but retire at an older age than city nurses (p<0.001). In 1986, a significantly higher proportion of rural GPs in all age cohorts worked more than 41 hours per week compared with their city counterparts (p<0.001). By 2001, rural 'generation X' GPs were no more likely to work long hours than those in the city (p<0.001). However, significantly more rural than city 'baby boomers' continued to work long hours. CONCLUSIONS: Rural GPs are retiring faster than city GPs and strategies to attract rural GPs and nurses will be critical to ensure adequate rural health care and that current rural workforce shortage do not worsen.

Adult↗
PubMed1984

Use of surnames in ethnic research: the case of Kims in the Korean-American population.

This paper introduces a method for estimating the size of the Korean American population in communities in the United States. Since about 22 percent of Korean Americans have the surname Kim and the telephone subscription/listing rate for Korean Americans is extremely high, a fairly simple equation for such estimation can be constructed. The number of Kims listed in the published telephone directory for a community, the mean size of the Kim households, the residence telephone subscription/listing rate, and the proportion of Kims are the factors included in the equation. A specific value for each of the factors has been derived from various "unobtrusive" and nongovernmental sources. Only insignificant differences have been found between estimates made using this method and the enumeration figures from the 1980 census for the Korean American population in the New York metropolitan area and Los Angeles and Orange counties. It appears that the equation is effective in estimating the size of the Korean American population in a community and could be a useful instrument in evaluating the accuracy of the 1980 Census enumeration of Korean Americans. The paper also describes the potential utility of Kims listed in published telephone directories as a sampling frame of Korean Americans in the United States. The ideas and procedures presented here can be extended to other ethnic populations with unique surnames, such as Nguyen for the Vietnamese American population and those starting with "Yama" . . . for the Japanese American population.

Demography↗
PubMed1996

Mortality impact of AIDS in Abidjan, 1986-1992.

OBJECTIVES: To quantify the mortality impact of AIDS in the city of Abidjan (Côte d'Ivoire) by a full scale analysis of mortality trends before and after the onset of the epidemic. DESIGN: Data on deaths registered in the 10 vital registration centers of the city between 1973 and 1992, and data on causes of deaths in the four public hospitals were coded and investigated. Data on deaths were compared with census data in order to compute death rates. METHODS: Life tables were computed for each of the 20 years of the study. The trends in death rates were analysed during the 10 years before the onset of the AIDS epidemic (1973-1982) and compared with the changing death rates in the following 10 years (1983-1992). Deaths attributable to AIDS were defined as those in excess of the original trends. The evolution in the number of deaths in the hospital allowed an analysis by cause of death. RESULTS: There was a marked increase in death rates starting in 1986, date of the first diagnosed AIDS cases in the city. This increase was significant for both sexes, but more pronounced among men. It was concentrated primarily among young adults (aged 25-44 years) and among older children (aged 5-14 years), and most of it was considered to be attributable to AIDS and related infections, tuberculosis in particular. When data were cumulated from 1986 to 1992, approximately 25,000 persons were estimated to have died of AIDS. CONCLUSIONS: The high number of AIDS deaths estimated in Abidjan underlines the heavy toll already paid by African populations, and calls for intensive action.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Effects of health services and socioeconomic factors in spatial differences in mortality in Mexico].

OBJECTIVE: Mortality in Mexico has decreased significantly, however, regional differences persist. The present work analyzes mortality in Mexico, considering how social and economic factors, as well as the presence of medical centers affect these differences. MATERIAL AND METHODS: Data were taken from the XI Population Census, from the statistics published by the Interinstitutional Information Group (Secretaría de Salud) and the publications from the National Statistics, Geography and Informatics Institute. The causal model is defined in terms of the models of covariance structures (LISREL) which allow an estimate of the effect of non-measurable factors affecting the phenomenon. The program used herein was LISREL7. RESULTS: Social and economic status directly affect regional differences in mortality. The effect of medical centers is less important. CONCLUSIONS: Regional differences in mortality can be explained by the interaction between social and economic levels and the presence of medical centers. The higher the social and economic level, the lower the mortality rate. Better medical centers are also more frequently used, which is reflected as a lower mortality rate. The regional distribution of medical centers should be improved.

Adult↗
PubMed1997

Will primary central nervous system lymphoma be the most frequent brain tumor diagnosed in the year 2000?

BACKGROUND: There has been a dramatic increase in the diagnosis of primary lymphoma of the brain during the past decade, prompting speculation that it may become the most frequently diagnosed tumor of the central nervous system by the year 2000. The current analysis drew from the updated Surveillance, Epidemiology, and End Results (SEER) database to establish projections for the incidence of brain lymphoma. The study also attempted to determine whether increased incidence rates are attributable to the increasing incidence of acquired immunodeficiency syndrome (AIDS) and whether there is gender or age dependence. METHODS: Primary brain lymphoma case data and population census data for calculating incidence rates for the period 1973-1992 were obtained from the SEER program. In an attempt to determine the contribution of AIDS to the increasing incidence of the disease, separate analyses were performed with and without the inclusion of never married men (a high risk group for the development of AIDS). Separate analyses were also performed within the San Francisco SEER registry because a higher incidence of AIDS-related cancers has been documented in this geographic region. Finally, a piece-wise linear model (using one regression line until 1982 and another regression line from 1982 onward) was used to predict incidence rates for the year 2000. RESULTS: During the period of study, the incidence rates of brain lymphoma increased more than 10-fold, from 2.5 cases per 10 million population in 1973 to 30 in 1991-1992 (chi-square trend, 17.76: P < 0.0001). These increased incidence rates were independent of age and gender. The incidence rates of primary brain lymphoma did not differ significantly when comparing the San Francisco registry with the remainder of the SEER database for any comparison that excluded never married males. However, when the analysis included never married males, a statistically significantly higher incidence rate of primary central nervous system lymphoma was observed among San Franciscans compared with age-matched controls from the remainder of the SEER database. In the year 2000, the projected incidence rate of brain lymphoma would reach 51.1 per 10 million population and 118.2 per 10 million population, with never married men excluded and included, respectively. These incidence rates would still fall below the corresponding projections for glioma and glioblastoma multiforme. CONCLUSIONS: There continues to be a significantly increasing incidence of brain lymphoma that is independent of age and gender. Indirect evidence implicates the AIDS epidemic as a contributor to this trend. Although the rate of increase in the incidence of non-Hodgkin's lymphoma of the brain is higher than for peripheral non-Hodgkin's lymphoma and other glial tumors, brain lymphoma is not projected to surpass glial tumors as the most frequently diagnosed intracranial malignancy by the year 2000.

Age Factors↗
PubMed2002

Probabilistic record linkage and a method to calculate the positive predictive value.

BACKGROUND: Computerized record linkage is commonly used in cohort studies to ascertain the study outcome, and as such its accuracy classifying the outcome can be described using the standard epidemiological terms of sensitivity and positive predictive value (PPV). METHOD: We describe a 'duplicate method' to calculate the PPV of record linkage when each record can only be involved in one match (e.g. linking population files to death files). The method does not require a validation subset of records from both files with detailed personal information (e.g. name and address), and is therefore ideal for linkage projects using anonymous data. The duplicate method assumes that the number of records from one file with zero, one, two, etc., links from the other file is distributed in a manner predicted by combinatorial probabilities. Having made this assumption, the number of false positive links, and hence the PPV, are estimable. We demonstrate this duplicate method using output from anonymous and probabilistic record linkage of census and mortality records in New Zealand. RESULTS: The PPV estimates conform to the pattern expected based on the underlying theory of probabilistic record linkage, and were robust to sensitivity analyses. We encourage other researchers to further assess the accuracy of this method.

Epidemiologic Methods↗
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↗
PubMed2006

Privacy protection versus cluster detection in spatial epidemiology.

OBJECTIVES: Patient data that includes precise locations can reveal patients' identities, whereas data aggregated into administrative regions may preserve privacy and confidentiality. We investigated the effect of varying degrees of address precision (exact latitude and longitude vs the center points of zip code or census tracts) on detection of spatial clusters of cases. METHODS: We simulated disease outbreaks by adding supplementary spatially clustered emergency department visits to authentic hospital emergency department syndromic surveillance data. We identified clusters with a spatial scan statistic and evaluated detection rate and accuracy. RESULTS: More clusters were identified, and clusters were more accurately detected, when exact locations were used. That is, these clusters contained at least half of the simulated points and involved few additional emergency department visits. These results were especially apparent when the synthetic clustered points crossed administrative boundaries and fell into multiple zip code or census tracts. CONCLUSIONS: The spatial cluster detection algorithm performed better when addresses were analyzed as exact locations than when they were analyzed as center points of zip code or census tracts, particularly when the clustered points crossed administrative boundaries. Use of precise addresses offers improved performance, but this practice must be weighed against privacy concerns in the establishment of public health data exchange policies.

Algorithms↗
PubMed1998

Unmixing aggregate data: estimating the social composition of enumeration districts.

"In this paper the authors address the problem of interpreting and classifying aggregate data sources and draw parallels between tasks commonly encountered in image processing and census analysis. Both of these fields already have a range of standard classification tools which are applied in such situations, but these are hindered by the aggregate nature of the input data. An approach to ¿unmixing' aggregate data, and thus revealing the nature of the subunit variation masked by aggregation, is introduced. This approach has already shown considerable success in Earth Observation applications, and in this paper the authors present the adaptation and application of the approach to Census small area statistics data for Southampton, Hants, [in England] revealing something of the social composition of Southampton's enumeration districts. The unmixing technique utilises an artificial neural network."

Censuses↗
PubMed2000

[Reef fishes community structure in 4 atolls of the San Andrés - Providencia Archipelago (Southwestern Caribbean)].

In 1994 and 1995, 131 visual censuses of reef fishes were made using the stationary sampling method in Courtown, Albuquerque, Serrana and Roncador, four atolls of the Archipelago of San Andrés and Old Providence in the Southwestern Caribbean. Fish species and their abundances were recorded in four geomorphologic zones: lagoon, windward barrier reef, windward terrace and forereef terrace. A total of 98 species were censused; the most abundant were Chromis cyanea (14%), Clepticus parra (14%) and Stegastes partitus (10%). The most abundant families were Pomacentridae (37%), Labridae (28%) and Scaridae (10%). Analysis of similarities showed that differences between zones were greater than differences between atolls, but lagoon and forereef terrace were not significantly different. Cluster and ordination analysis confirmed these results; in addition, the ordination analysis placed the groups according to depth and wave-exposure gradients, suggesting that these two physical variables were responsibles for the clustering. Differences in equitability and species richness appear also due to these variables. Inverse analysis showed in each group few characteristic species, then the differences between zones were due specially to dominance of some species. The dominant trophic categories were planktivorous and herbivorous that were significantly different between zones. In shallow zones (shallow lagoonal patch reefs) and high wave-exposed zones (winward barrier reef) dominated herbivorous fishes, while in deeper zones (terraces and deep lagoonal patch reefs) planktivorous were more abundant.

Animals↗
PubMedDate not supplied

[Financing of health care for the aged].

OBJECTIVE: To determine the direct financial requirements for providing health care to the elderly in Mexico along with an estimation of the current expenditures from services provided to this same population. MATERIAL AND METHODS: Health care needs for the elderly were estimated from the censuses and the database of the National Health Survey II. In addition, service use trends for the aged were obtained from health sector statistical yearbooks. Finally, the amounts of expenditures were estimated by two methods: a) using a formula that considers hospital discharges, daily bed costs and length of stay; and b) inferring hospital expenditures and ambulatory visits from the numbers of hospital discharges. RESULTS: Currently health care needs of the aged outnumber the amount of resources and the capacity of the health care sector to meet these needs. Our estimates for the year 1994 show that 4.9% of the total budget available to public health care institutions was dedicated to hospital services provided to the elderly. CONCLUSIONS: In Mexico, the aged population health needs are already a priority, due to the particular nature of their needs and demand. Taking care of this population demands an important fraction of the resources spent in hospital services. To correctly plan and allocate resources for providing health care to this population developing a research agenda is an important requirement.

Aged↗
PubMed2005

Comparison of farmers in the agricultural health study to the 1992 and the 1997 censuses of agriculture.

CONTEXT: The Agricultural Health Study (AHS) is a large, prospective cohort study in the states of Iowa and North Carolina that has been developed to better understand how pesticides and other agricultural exposures relate to the occurrence of cancer and other diseases. PURPOSE: This report compares the characteristics of AHS farmers to the Census of Agriculture to evaluate the generalizability of AHS findings. METHODS: We restricted the AHS to private pesticide applicators who enrolled in Iowa (n = 31,065) and in North Carolina (n = 17,239) between 1993 and 1997, and who identified themselves as living or working on a farm. We compared their self-reported data with data from the 1992 and 1997 Censuses of Agriculture. FINDINGS: AHS farmers in Iowa are younger; live or work on larger farms; more frequently apply herbicides, insecticides, and fungicides; and are more likely to raise beef cattle and swine, and grow corn, soybeans, hay, and oats. AHS farmers in North Carolina are also younger, live or work on larger farms, more frequently reported growing crops commonly seen in the state, and are more frequent pesticide users. However, animals raised are similar to those in the North Carolina Census of Agriculture. CONCLUSIONS: AHS farmers likely represent the higher end of pesticide usage in both states in part because AHS farmers have larger farms. Since the health effects of pesticides are best ascertained among pesticide users with the greatest exposure, the AHS cohort should prove to be a valuable resource for health effects research.

Adult↗
PubMedDate not supplied

Bridging between two standards for collecting information on race and ethnicity: an application to Census 2000 and vital rates.

OBJECTIVES: The 2000 Census, which provides denominators used in calculating vital statistics and other rates, allowed multiple-race responses. Many other data systems that provide numerators used in calculating rates collect only single-race data. Bridging is needed to make the numerators and denominators comparable. This report describes and evaluates the method used by the National Center for Health Statistics to bridge multiple-race responses obtained from Census 2000 to single-race categories, creating single-race population estimates that are available to the public. METHODS: The authors fitted logistic regression models to multiple-race data from the National Health Interview Survey (NHIS) for 1997-2000. These fitted models, and two bridging methods previously suggested by the Office of Management and Budget, were applied to the public-use Census Modified Race Data Summary file to create single-race population estimates for the U.S. The authors also compared death rates for single-race groups calculated using these three approaches. RESULTS: Parameter estimates differed between the NHIS models for the multiple-race groups. For example, as the percentage of multiple-race respondents in a county increased, the likelihood of stating black as a primary race increased among black/white respondents but decreased among American Indian or Alaska Native/black respondents. The inclusion of county-level contextual variables in the regression models as well as the underlying demographic differences across states led to variation in allocation percentages; for example, the allocation of black/white respondents to single-race white ranged from nearly zero to more than 50% across states. Death rates calculated using bridging via the NHIS models were similar to those calculated using other methods, except for the American Indian/Alaska Native group, which included a large proportion of multiple-race reporters. CONCLUSION: Many data systems do not currently allow multiple-race reporting. When such data systems are used with Census counts to produce race-specific rates, bridging methods that incorporate geographic and demographic factors may lead to better rates than methods that do not consider such factors.

Adolescent↗
PubMed1984

A comparison of population estimation methods: housing unit versus component II, ratio correlation, and administrative records.

The authors present the case for the housing unit (HU) method as a technique for estimating the population of states and local areas in the United States. They "evaluate population estimates produced by the housing unit method and by three other commonly used methods: component II, ratio correlation, and administrative records. Basing [the] analysis on 1980 census data from 67 counties in Florida and testing for precision, bias, and the distribution of errors, [they find that] application of the HU method performs at least as well as the more highly acclaimed methods of local population estimation."

Americas↗
PubMed2002

Genetic effective size is three orders of magnitude smaller than adult census size in an abundant, Estuarine-dependent marine fish (Sciaenops ocellatus).

Using eight microsatellite loci and a variety of analytical methods, we estimated genetic effective size (N(e)) of an abundant and long-lived marine fish species, the red drum (Sciaenops ocellatus), in the northern Gulf of Mexico (Gulf). The ratio N(e)/N, where short-term variance N(e) was estimated via the temporal method from shifts in allele-frequency data over four cohorts and where N reflected a current estimate of adult census size in the northern Gulf, was approximately 0.001. In an idealized population, this ratio should approximate unity. The extraordinarily low value of N(e)/N appears to arise from high variance in individual reproductive success and perhaps more importantly from variance in productivity of critical spawning and nursery habitats located in spatially discrete bays and estuaries throughout the northern Gulf. An estimate of N(e) based on a coalescent approach, which measures long-term, inbreeding effective size, was four orders of magnitude lower than the estimate of current census size, suggesting that factors presently driving N(e)/N to low values among red drum in the northern Gulf may have operated similarly in the past. Models that predict N(e)/N exclusively from demographic and life-history features will seriously overestimate N(e) if variance in reproductive success and variance in productivity among spatially discrete demes is underestimated. Our results indicate that these variances, especially variance in productivity among demes, must be large for red drum. Moreover, our study indicates that vertebrate populations with enormous adult census numbers may still be at risk relative to decline and extinction from genetic factors.

Animals↗
PubMed1996

Comparison of sudden and nonsudden coronary deaths in the United States.

BACKGROUND: The present study was designed to compare risk factor prevalences in coronary heart disease deaths in persons dying within 1 hour of onset of cardiovascular symptoms (sudden coronary death), those dying without such sudden symptoms (nonsudden coronary death), and those with unknown duration of symptoms before death (other coronary death). METHODS AND RESULTS: Data from the 1986 National Mortality Followback Survey and the US Bureau of the Census were examined to assess death rates for sudden, nonsudden, and other coronary deaths. Multivariate logistic regression methods were used to calculate the odds ratio (OR), compared with nonsudden and other coronary deaths, for sudden coronary death associated with socioeconomic status variables, the person's location at death, and coronary heart disease risk factors. Mortality rates for all coronary deaths increased with age, were higher for men than women, and increased with decreasing years of schooling. The rate of sudden coronary death was highest for Hispanics. In 1986, an estimated 251,000 sudden coronary deaths (95% CI = 238,000 to 263,000) occurred in the United States. Sudden coronary deaths were less likely than nonsudden coronary deaths to occur at home (OR = 0.5, 95% CI = 0.4 to 0.6), but individuals who died of sudden coronary death were more likely to have been current cigarette smokers (OR = 1.3, 95% CI = 1.0 to 1.8). No other modifiable risk factors for coronary heart disease distinguished sudden coronary deaths from nonsudden coronary deaths. CONCLUSIONS: Contrary to the commonly held view, coronary deaths in the home are more likely to be nonsudden than sudden. Cigarette smoking more likely results in sudden than nonsudden coronary death, perhaps because of nicotine-induced ventricular arrhythmias.

Adult↗
PubMedDate not supplied

Use of Stone's method in studies of disease risk around point sources of environmental pollution.

The Small Area Health Statistics Unit is a national facility funded by the U.K. government for the analysis of disease risk around sources of environmental pollution. It holds cancer incidence (from 1974) and mortality data (from 1981) for Great Britain. Data retrieval is based on the postcode of residence, relating on average to 14 households. Population data for the calculation of disease rates and small area measures of socioeconomic deprivation are from census small area statistics for 1981 and 1991. Isotonic regression methods first described by Stone are used to test for declines in disease risk with distance from point sources of environmental pollution. This paper describes modifications of the method to include adjustments for socioeconomic confounding, a conditional approach to allow for generally elevated risks near the source, and methods to deal with pooling of data around a number of point sources. Examples from recent studies are given.

Disease Susceptibility↗
PubMed1995

Indexing the census: a by-product of the simulation of whole populations by means of SAS and SAR data.

"Amongst the new output formats adopted for the 1991 [U.K.] census were the Small Area and Local Base Statistics tables and the Samples of Anonymised Records. During an attempt to combine these data sources to estimate whole populations, a need was recognised for a computer algorithm to aggregate SAR data flexibly into LBS and SAS table look-alikes. This paper is a report on progress in the development of such an algorithm, including the concomitant development of a meta-database of census tables and variables required as an input to the algorithm. Out of this work a user-friendly, freely disseminable version of the census meta-database has been created, of interest to all census users."

Censuses↗