Population migration and distribution in China: data from the fourth census.
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Asia↗
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Small-area population estimates: a review of methods used in Britain in the 1990s.
"Population estimates are usually produced by local government administrations in Britain, for each small area within their authority. Increasing interest has been shown by commerce and by central government. Five main methods are identified: apportionment, ratio change, additive change, cohort survival, and local censuses. Estimation strategies also vary according to available data, the detail in which a population is estimated, and the precise combination of elements chosen from one or more of the main methods. The use of methods at the beginning of the 1990s is surveyed in this paper, and examples given. The accuracy of each main method is quantified from empirical data collated by the Estimating with Confidence project. Likely developments towards the end of the 1990s are reviewed."
Developed Countries↗
Race/ethnicity and the 2000 census: implications for public health.
OBJECTIVES: This article addresses the potential impact of the revised standards for race and ethnicity on data from the 2000 census and public health data sources, policies, and programs. METHODS: The authors examine the relationship between race/ethnicity and health in selected measures, identify the factors that influence race/ethnicity identification, consider past experience in race/ethnicity reporting, and explore the challenges in understanding and managing the effects of new racial/ethnic categories in various data sets. RESULTS: The multiple-race group seems to compose only a small percentage of the US population and may have little impact on data for single-race groups. Actual effects will vary according to a number of factors, including the size, composition, and geographic distribution of the group. CONCLUSIONS: More research is needed to support a thorough understanding of the reporting of multirace data and the development of techniques for analyzing these data. Given the importance of understanding the relationship between race/ethnicity and health, the ability to produce useful, comparable, and meaningful data is essential.
Censuses↗
Uses of population census data for monitoring geographical imbalance in the health workforce: snapshots from three developing countries.
BACKGROUND: Imbalance in the distribution of human resources for health (HRH), eventually leading to inequities in health services delivery and population health outcomes, is an issue of social and political concern in many countries. However, the empirical evidence to support decision-making is often fragmented, and many standard data sources that can potentially produce statistics relevant to the issue remain underused, especially in developing countries. This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. METHODS: Population-based indicators of geographical variations among HRH were extracted from census microdata samples for Kenya, Mexico and Viet Nam. Health workforce statistics were matched against international standards of occupational classification to control for cross-national comparability. Summary measures of inequality were calculated to monitor the distribution of health workers across spatial units and by occupational group. RESULTS: Strong inequalities were found in the geographical distribution of the health workforce in all three countries, with the highest densities of HRH tending to be found in the capital areas. Cross-national differences were found in the magnitude of distributional inequality according to occupational group, with health professionals most susceptible to inequitable distribution in Kenya and Viet Nam but less so in Mexico compared to their associate professional counterparts. Some discrepancies were suggested between mappings of occupational information from the raw data with the international system, especially for nursing and midwifery specializations. CONCLUSIONS: The problem of geographical imbalance among HRH across countries in the developing world holds important implications at the local, national and international levels, in terms of constraints for the effective deployment, management and retention of HRH, and ultimately for the equitable delivery of health services. A number of advantages were revealed of using census data in health research, notably the potential for producing detailed statistics on health workforce characteristics at the sub-national level. However, lack of consistency in the compilation and processing of occupational information over time and across countries continues to hamper comparative analyses for HRH policy monitoring and evaluation.
Journal Article↗
Survey of academic pediatric emergency departments regarding use of evaluation and management codes.
OBJECTIVE: The aims of the study were to determine the frequency at which each emergency medicine evaluation and management (E/M) code is used, to identify factors associated with their use by academic pediatric emergency departments (PEDs), and to compare PED E/M code utilization rates with rates reported by Centers for Medicare and Medicaid Services for general emergency departments (EDs). METHOD: A 24-question survey was sent to 42 academic PED medical directors. Questions pertained to PED demographics, physician staff, records/documentation, billing education, and E/M coding data for 1 year. The general ED E/M code utilization rates were obtained from the published Centers for Medicare and Medicaid Services database. Descriptive statistics and odds ratios were used to report and compare the data. RESULTS: Twenty (48%) of the surveys were returned, and 9 (21%) completed the E/M coding data questions. From these 9 departments, the mean PED annual census was 46,065 (range, 23,531-92,910). The methods of PED medical record documentation were template (6), handwritten (2), and dictation/transcription (1). Charge documents were completed by the PED physician (3), professional service coders (4), and hospital coders (2). Coding/documentation in-services were provided to the physicians of 7 PEDs, and billing audits were performed in 5 PEDs. The total number of charges for the 9 PEDs was 325,129, 78.4% of the census. Multiple reasons were given for the discrepancy between census and charges. The percentage of each of the 5 levels of service billed was calculated for each of the 9 PEDs. The 2 lowest levels of service were used 38.3% of the time, whereas the 2 highest were used 19.2% of the time. The range for the highest level of service varied widely from 5.3% to 53.3%. Approximately 65% of E/M codes used by general EDs were for the 2 highest levels of service. The PED with the highest percentage of upper level charges (53.4%) was the only PED that used dictation/transcription for documentation. CONCLUSION: Although the response rate was low, and thus the validity of the results was limited, the findings may serve as a benchmark for E/M code utilization in PEDs. The large variation in use of the E/M codes among the PED in our study and the lower rate of using the highest E/M codes by the PEDs compared with the general EDs suggest potential opportunities for academic PEDs to improve billing practices.
Academic Medical Centers↗
Trends in the risk of death from cardiovascular, cerebrovascular and ischemic diseases in thirteen States of Brazil from 1980 to 1998.
OBJECTIVE: Analyze the trends in the risk of death from circulatory diseases (CD) in thirteen states in Brazil between 1980 and 1998. METHODS: Data on mortality from CD, ischemic heart diseases (IHD), and cerebrovascular diseases (CVD) in thirteen states were obtained from the Ministry of Health data base. Populational estimates from 1980 to 1998 were calculated through interpolation, using the Lagrange method, based on data from the 1970, 1980, 1991 censuses, and 1996 populational count. The trends were analyzed by multiple linear regression model. RESULTS: Mortality due to CD showed a trend towards decrease in most states. In Pernambuco state males presented increase in all age ranges, whereas in Goiás increase was shown from 40 years of age on, and in Bahia and Mato Grosso, from 50 years of age. Females showed increase starting at 30 in Mato Grosso, at 40 in Pernambuco, and in Goiás, in the age ranging from 30 to 49 years of age. In Goiás, increase was discreet in all other age ranges. As for IHD, mortality increase was reported in all age ranges in Mato Grosso and Pernambuco; in Bahia, Goiás and Pará, from 40 on. As for CVD, mortality increase was reported in all age ranges in Mato Grosso and Pernambuco; and from 40 on in Bahia and Goiás. CONCLUSION: Significant increase in the risk of death from circulatory diseases could be observed in less developed states in Brazil.
Adult↗
Mortality in China 1964-2000.
This paper uses data from censuses and surveys to re-estimate mortality levels and trends in China from the 1960s to 2000. We use the General Growth Balance method to evaluate the completeness of death reporting above the youngest ages in three censuses of the People's Republic of China from 1982 to 2000, concluding that reporting quality is quite high, and revisit the completeness of death recording in the 1973-75 Cancer Epidemiology Survey. Estimates of child mortality from a variety of direct and indirect sources are reviewed, and best estimates arrived at. Our estimates show a spectacular improvement in life expectancy in China: from about 60 years in the period 1964-82 to nearly 70 years in the period 1990-2000, with a further improvement to over 71 years by 2000. We discuss why survival rates continue improving in China despite reduced government involvement in and increasing privatization of health services, with little insurance coverage.
Adolescent↗
Some coverage error models for census data.
"Alternative models are presented for representing coverage error in surveys and censuses of human populations. The models are related to the capture-recapture models used in wildlife applications and to the dual-system models employed in the vital events literature. Estimation methodologies are discussed for one of the coverage error models." After a discussion of the theory underlying the methodology, "distinctions are made between two kinds of error: (a) sampling error and (b) error associated with the model. An example involving data from the 1980 U.S. census is presented. The problem of adjusting census and survey data for coverage error is also discussed."
Americas↗
[Fertility and migration: an analysis of women included in the 1981 census in the province of Milan].
The relationship between fertility and migration patterns in the Italian province of Milan is analyzed. "The own-children method is used to obtain retrospective fertility measurements by the linkage of the young children enumerated in the census to their mothers, classified by different mobility characteristics (such as place of birth, present and previous place of residence)." (SUMMARY IN ENG AND FRE)
Birth Rate↗
Impact of the year 2000 Medicare policy change on older patient enrollment to cancer clinical trials.
PURPOSE: A prior analysis by the Southwest Oncology Group (SWOG) showed that women and African American patients were adequately represented on cancer clinical treatment trials but that older patients were substantially underrepresented. Twenty-five percent of patients > or = 65 years old were enrolled onto SWOG trials from 1993 to 1996, whereas 63% of all patients with cancer were > or = 65 years old. Recognition of this under-representation led to a change in Medicare policy in 2000 to include coverage of routine patient care costs of clinical trials. We conducted an updated analysis of accrual trends. METHODS: The proportions of enrollment onto SWOG treatment trials by sex, race/ethnicity, and age (> or = 65 years) were computed for the years 1997 to 2000; corresponding rates in the United States were derived from US Census and National Cancer Institute Surveillance, Epidemiology, and End results data. Additionally, method of payment data were analyzed over time (1993 to 2003) to assess whether patterns in method of payment changed with the new Year 2000 Medicare policy on clinical trials coverage. RESULTS: The results showed continued adequate representation by sex and race/ethnicity. Older patient accrual on SWOG trials increased significantly since 2000, with 31% of patients > or = 65 years old enrolled from 1997 to 2000 and 38% enrolled from 2001 to 2003 (v 25% from 1993 to 1996). The percentage of patients using Medicare plus supplemental insurance also increased beginning in 2000, whereas the percentage of patients using Medicare alone remained the same. CONCLUSION: Method of payment analyses provided evidence that the Year 2000 Medicare policy change had a positive impact, but only for those patients with supplemental private coverage of coinsurance costs. Improvements in the Medicare payment structure could further increase older patient participation in clinical trials.
Aged↗
How should we measure social disadvantage in clinic settings?
BACKGROUND: Despite a large research literature supporting their validity, deprivation indices derived from census data have not been routinely applied to clinic populations. METHOD: A case-note sample of 201 cases was examined, to identify whether such data (Jarman indices) predicted presenting disability separately from diagnostic class (behaviour, emotional, mixed, other, and no diagnosable disorder), or conventional clinic measures of social adversity (ICD-10 psychosocial diagnostic codes). RESULTS: Jarman index scores predicted disability in behaviour disorders or other disorders. Conventional clinic measures of adversity predicted disability in mixed disorders. For emotional disorders, and those cases with no diagnosed disorder, clinically measured adversity and Jarman scores interacted. CONCLUSIONS: Postcode related census data capture information about clinic children's presenting disability that is not available from routine clinic assessment of psychosocial adversity. It should therefore be collected as part of the routine clinical child psychiatry assessment.
Adolescent↗
Breast cancer and occupational exposures in women in Finland.
BACKGROUND: The etiology of breast cancer is not fully understood. Environmental and occupational exposures may contribute to breast cancer risk. METHODS: We linked 324 job titles from the 1970 census of 892,591 Finnish women with incidence of breast cancer (23,638 cases) during 1971-1995. We converted job titles to 31 chemical and two ergonomic agents through a measurement-based, period-specific, national job-exposure matrix. Poisson regression models were fit to the data, with adjustment for birth cohort, follow-up period, socioeconomic status, mean number of children, mean age at first delivery, and turnover rate. RESULTS: For premenopausal breast cancer, medium/high level of occupational exposure to ionizing radiation was associated with a standardized incidence ratio (SIR) of 1.3 (95% confidence interval (CI) 0.7-2.5; trend P = 0.03). For postmenopausal breast cancer, we found on SIR of 1.2 (1.1-1.3) for low level and 1.4 (1.1-1.8) for medium/high level of ionizing radiation (trend P = 0.001); and an SIR 1.3 (1.1-1.7) for medium/high levels of both asbestos and man-made vitreous fibers. Aromatic hydrocarbon solvents showed a significant trend for a modest excess of postmenopausal breast cancer. CONCLUSIONS: Our study indicates that occupational exposure to ionizing radiation may be associated with an increased risk of female breast cancer. High-quality studies on environmental and occupational etiology of breast cancer are needed for further elucidation of risk factors.
Adult↗
Mathematical hazard models of mortality: an alternative to model life tables.
A five-parameter competing hazard model of the age pattern of mortality is described, and methods of fitting it to survivorship, death rate, and age structure data are developed and presented. The methods are then applied to published life table and census data to construct life tables for a Late Woodland population, a Christian period Nubian population, and the Yanomama. The advantage of this approach over the use of model life tables is that the hazard model facilitates life-table construction without imposing a particular age pattern of mortality on the data. This development makes it possible to use anthropological data to extend the study of human variation in mortality patterns to small populations.
Adolescent↗
Factors associated with methadone maintenance treatment retention among street-recruited injection drug users.
This study examined factors associated with methadone maintenance retention, defined as remaining in treatment for a minimum of 90 days, among street recruited injection drug users (IDUs). Targeted sampling methods were used to establish recruitment quotas in Denver census tracks. A total of 577 IDUs were randomly assigned to either a risk reduction intervention, focusing on safer injection and sex behaviors, or motivational interviewing, addressing more sweeping lifestyle changes including drug treatment. All subjects who wanted treatment were provided transportation, rapid intake and a waiver of the intake fee. In addition, 50% were randomly assigned a coupon for 90 days of free treatment. Overall, 33% entered treatment and of these, 60% remained for at least 90 days. Factors associated with retention included higher methadone dose, free treatment, greater contacts with the clinic and counselor rating of patient cooperation. Although desire for treatment, or motivation, was associated in univariate analyses with greater retention, there were no differences observed between the motivational interviewing and risk reduction interventions.
Adult↗
Peripartum stroke and intracranial venous thrombosis in the National Hospital Discharge Survey.
OBJECTIVES: To determine nationally representative estimates of the incidence of peripartum stroke and intracranial venous thrombosis and to identify potential risk factors for these conditions. METHODS: We analyzed National Hospital Discharge Survey data for the period 1979-1991. Nationally representative estimates of risk were calculated by age, race, method of delivery, presence of pregnancy-related hypertension, census region, hospital ownership, and number of hospital beds. Multivariate models were developed using logistic and Poisson regression. RESULTS: There were an estimated 5484 cases of peripartum stroke and 4454 cases of intracranial venous thrombosis in the United States among 50,110,949 deliveries (risk, 10.3 cases of peripartum stroke and 8.9 cases of intracranial venous thrombosis per 100,000 deliveries). In both univariate and multivariate models, peripartum stroke was associated strongly with cesarean delivery, pregnancy-related hypertension, proprietary hospital ownership, and larger hospital size. Intracranial venous thrombosis was strongly associated with cesarean delivery and less strongly with smaller hospital size. CONCLUSIONS: Peripartum stroke and intracranial venous thrombosis are common complications of pregnancy. Although the associations identified in this study are plausible, further studies are required to confirm these associations and elucidate the underlying mechanisms.
Adolescent↗
Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study.
PURPOSE: To examine the prevalence of age-related maculopathy (drusen and retinal pigmentary abnormalities) and end-stage age-related macular degeneration lesions (neovascular maculopathy or geographic atrophy) in a defined older Australian urban population. SUBJECTS: All noninstitutionalized residents 49 years of age or older who were identified in a door-to-door census of two postcode areas west of Sydney, Australia. METHODS: All participants received a detailed eye examination, including stereoscopic photographs of each macula. Two trained graders used the Wisconsin Age-related Maculopathy Grading System to assess the presence and severity of typical lesions. RESULTS: A marked age-related increase in all typical lesions of age-related maculopathy and macular degeneration was observed. End-stage age-related macular degeneration was present in 1.9% of the population, rising from 0% among people younger than 55 years of age to 18.5% among those 85 years of age or older. Soft drusen were found in 13.3% of people, with distinct drusen more frequent than indistinct soft drusen. Retinal pigmentary abnormalities were found in 12.6% of people. For end-stage lesions and soft drusen, females had higher age-specific prevalence rates than males, whereas retinal pigmentary abnormalities were more frequent in males, although most of these differences were not significant. Prevalence rates for all lesions were lower (statistically significant for retinal pigmentary abnormalities and soft drusen) than for the United States Beaver Dam Eye Study which examined a similar population. CONCLUSIONS: These data provide detailed prevalence rates for most components of ARM in an Australian population and reinforce the Beaver Dam Eye Study findings for the relative age-specific frequency of age-related macular degeneration components.
Age Distribution↗
Admissions for critically ill children: where and why?
INTRODUCTION: Planning services for critically ill children requires identification of overall critical care activity as well as an assessment of population needs. METHOD AND OBJECTIVES: This prospective needs assessment took a census approach to estimating population-based admission rates for paediatric critical care irrespective of where care was provided. A survey form was completed for every child in the study population for all of their admissions. CRITERIA: The need for tracheal intubation was used as a proxy for defining need for intensive care in this study. Critical illness was defined by clinical criteria adapted from the Advanced Paediatric Life Support Guidelines. STUDY POPULATION: All children under 17 years resident in south-east England (Thames regions) who required care for a critical illness in any inpatient setting between 1 December 1996 and 30 November 1997. Critical illness was the presence of acute body-system or multi-system failure. RESULTS: A wide variation in the rates of critical care admission to different types of care settings was reported ranging from 1.2 admissions per 1000 resident children per year for PIC units (general and cardiothoracic units) to 0.02 admissions per 1000 children per year for children admitted from the community to neonatal units. The age of children and their rates of admission were directly related to the type of ward or unit where children received care. Tracheal intubation occurred in all care settings. The proportion of intubated children transferred to paediatric intensive care units (PICUs) or paediatric cardiothoracic intensive care units (PCICUs) varied according to the type of referring unit. The proportion of episodes involving tracheal intubation where the child was not transferred to a PICU or PCICU was 52% for children in stand-alone neurosurgical units, 41% for those in adult intensive care units (AICUs), and 4% for those in children's wards. CONCLUSIONS: This baseline study shows a significant number of critically ill children who are never cared for in PIC units. With national changes in UK policy to regionalise care for these children, monitoring care in all locations by cause of admission remains important. While the data were collected in 1997, the findings from this study remain relevant and provide the basis for planning regional critical care services for children. Results are also relevant to other geographical areas in that measuring the use of services for critically ill children must go beyond documenting admission to ICUs for children and adults. All settings for critical care must be identified, the activity documented, and the use of services measured against existing resources. Clear clinical criteria are needed to identify children who can be cared for appropriately on high dependency units.
Adolescent↗
The rise of tamoxifen: temporal and geographical trends of tamoxifen use in Ontario.
PURPOSE: To describe the change in use of tamoxifen over time and across countries in Ontario. METHODS: Data from the Ontario Drug Benefit (ODB) plan, Census Canada, and the Ontario Cancer Registry (OCR) were combined and analysed to determine rates of tamoxifen use for females over 65 for each county and the province overall, by year. Rates were analyzed by repeated measures ANOVA to determine significance of changes over time. Consistency of tamoxifen use across counties was determined by the Spearman rank correlation coefficient, and overall variation between counties was described using three statistical techniques: Chi-square analysis, the extremal quotient (EQ), and the systematic component of variation (SCV). RESULTS: The number of one-month tamoxifen prescriptions per incident case of breast cancer rose significantly from 13.51 in 1985 to 20.54 in 1990 (p < 0.001) and to 34.06 in 1992 (p = 0.001). Viewed differently, the number of women over 65 receiving tamoxifen prescriptions per incident case of breast cancer changed from 1.91 in 1985 to 3.14 in 1990 to 4.54 in 1992. Statistically significant variation in the rate of tamoxifen prescribing was demonstrated between Ontario counties in all three years by Chi Squared analysis (p < 0.0001). Both the EQ and the SCV declined from 1985 to 1990, suggesting more uniform prescribing across the province. Little change in overall variation was seen between 1990 and 1992. All counties over time tended to prescribe generic preparations more often and shifted from 10 mg to 20 mg formulations. CONCLUSIONS: The significant increase in the rate of tamoxifen use and trend towards more uniform prescribing across Ontario between 1985 and 1990 coincided with the publication of two important documents outlining the benefits of tamoxifen in early breast cancer. Despite this trend, variation in tamoxifen use between counties remains. There has been little change in uniformity of prescribing since 1990.
Aged↗