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PubMed1990

Cost-effectiveness perspectives in coronary heart disease.

In the United States there has been a dramatic decrease in age-adjusted coronary heart disease (CHD) mortality during the last 20 years. This article investigates the reasons for this decline and concludes that most of the decline in CHD has been the result of life-style changes, particularly reduction in serum cholesterol and cigarette smoking. The CHD Policy Model is used to compare the effect of a targeted versus a population-wide program of cholesterol reduction. On the basis of these projections, population-wide interventions are considered an important part of cholesterol reduction programs. The article also assesses the cost-effectiveness of selected cardiac interventions, for example, screening exercise tolerance tests, coronary care units, thrombolysis in acute myocardial infarction, and beta-blockers in patients after myocardial infarction. Cost-effectiveness analysis is seen to be crucial as medical costs escalate and the population at risk from CHD increases.

Adrenergic beta-Antagonists↗
PubMed2002

Fracture rates lower in rural than urban communities: the Geelong Osteoporosis Study.

BACKGROUND: Urban and rural communities differ in the incidence of several diseases including coronary heart disease and some cancers. Lower hip fracture rates among rural than urban populations have been reported but few studies have compared rural and urban fractures at sites other than the hip. OBJECTIVE: To compare total and site specific fracture rates among adult residents of rural and urban communities within the same population. DESIGN AND SETTING: This is a population based study on osteoporosis in Australia. All fractures occurring in adult residents over a two year period were ascertained using radiological reports. The rural and urban areas are in close proximity, with the same medical, hospital, and radiological facilities permitting uniform fracture ascertainment. MAIN OUTCOME MEASURES: All fracture rates were age adjusted and sex adjusted to the Australian population according to the 1996 census of the Australian Bureau of Statistics and described as the rate per 10 000 person years. The p values refer to the adjusted rate difference. RESULTS: The hip fracture rate (incidence per 10 000 person years) was 32% lower (39 v 57, p<0.001), and the total fracture rate 15% lower (160 v 188, p=0.004) among rural than urban residents, respectively. The lower fracture rates in the rural population were also apparent for pelvic fractures. CONCLUSION: In the older rural population, lower fracture rates at sites typically associated with osteoporosis suggest environmental factors may have a different impact on bone health in this community. If the national rate of hip fracture could be reduced to that of the rural population, the projected increase in hip fracture number attributable to aging of the population could be prevented.

Adult↗
PubMed2004

Projecting the demographic consequences of adult HIV prevalence trends: the Spectrum Projection Package.

This paper describes the software package Spectrum, which is a modular program that is used to examine the consequences of current trends and future program interventions in reproductive health. It is used to determine the consequences of the HIV/AIDS epidemic, including the number of people living with HIV/AIDS by age and sex, the number of AIDS deaths, and the number of orphans as a result of AIDS, as well as other demographic indicators of interest, such as life expectancy and <5 mortality. The core of Spectrum is a demographic projection model called DemProj, which projects the population by age and sex. Other modules interact with the demographic projection. The HIV/AIDS projections are added to the demographic projections using a module called AIDS Impact Model. This module uses the projection of adult HIV prevalence over time, which is prepared using the Estimation and Projection Package model or the projection workbook. It also requires assumptions about the epidemiology of HIV, including the ratio of female:male prevalence, the distribution of infection by age, the distribution of the time from infection until AIDS death, and the effect of HIV on fertility.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Internal migration in Russia during the economic transition.

"A World Bank demographer analyzes patterns of migration among Russia's regions from shortly before the break-up of the Soviet Union and the onset of economic reforms through the first five years of independence. The analysis focuses on two large migration streams currently occurring in Russia--the return migration of Russians, as well as Russian speakers, to Russia from the other republics of the former Soviet Union and massive out-migration from the Russian North to the western and southern portions of the country. These migration streams are assessed in terms of both their impacts on current population numbers in Russia's regions and as a basis for projections of population change into the early 21st century."

Demography↗
PubMed2000

Utility of predictive equations for estimating the prevalence and incidence of primary open angle glaucoma in the UK.

AIMS: To assess the Tuck-Crick and the Quigley-Vitale predictive regression equations against fresh independent real world data for estimating the prevalence of primary open angle glaucoma (POAG) in the UK. To apply the equations to the elderly population of England and Wales, for which there is sample survey data on glaucoma, and demographic data. METHODS: Directly measured actual prevalence of POAG in a population sample of 1530 people was compared with the predicted prevalence derived by applying the Tuck-Crick and the Quigley-Vitale equations to the sample data. The two equations were applied to the demographic data of the population to project POAG prevalence and to derive 5 year cumulative incidence for the elderly population. These were compared with estimates derived from the local survey data. RESULTS: The actual directly measured prevalence of POAG in the local sample was 3.01%. The Tuck-Crick estimate was 2. 74% (difference 0.27%), and the Quigley-Vitale was 3.50% (difference -0.49%). The three methods-projection from local survey data, Tuck-Crick, and Quigley-Vitale-gave point estimates of 2.85% (228 526 cases), 2.71% (217 375 cases), and 3.50% (280 364 cases) respectively for the prevalence of POAG in the elderly population of England and Wales (8 008 705 people aged 65 or older). Calculation of incidence from age specific prevalence gave the following results: the numbers of new cases of POAG expected (5 year cumulative incidence) in the elderly population were 71 146 and 94 485 for methods 2 and 3 respectively. CONCLUSIONS: The Tuck-Crick predictive equation performed well when applied to fresh (independent) actual data from a local sample survey using a particular definition for POAG, and its usefulness for estimation of prevalence of POAG in England and Wales has been demonstrated. The work on development of predictive equations has been very promising and further refinements could be made when more fresh survey data become available.

Age Distribution↗
PubMed2004

Projecting the United States ESRD population: issues regarding treatment of patients with ESRD.

In 2001, there were 406,081 patients who received treatment for end-stage renal disease (ESRD), increasing by 4.2% since 2000. The number of patients with ESRD has grown consistently over the past decade, with the greatest rate of growth occurring among patients older than 75 years of age, and patients with comorbidities such as diabetes mellitus and hypertension. Current projections indicate that the population of patients with ESRD may reach more than 2 million by 2030. The overall mortality rate has fallen by 10% since 1988, with the greatest decline among patients incident to dialysis, and an increase among patients receiving dialysis for greater than five years. While the rate of hospitalization for ESRD patients has remained relatively constant, recent improvements in mortality are temporally associated with a greater proportion of patients achieving adequate benchmarks of care in dialytic processes, such as anemia correction and dose of dialysis. The ESRD program consumes 6.4% of the Medicare budget. On a per-patient per month basis, Medicare costs have risen between 1991 and 2001. While payments fell slightly during 1998 and 1999 because of changes in Medicare policies, more recent years have seen an upswing in total expenditures, presumably related to use of injectables not included in the composite rate. Continued growth in the number of new patients reaching ESRD, as well as improved mortality rates of ESRD patients, are both contributing to the current rise and projected epidemic of ESRD over the next 25 years. The current public health strategy of identification of patients with early kidney disease to slow their progression to ESRD, in addition to aggressive treatment strategies to minimize the morbidity and mortality of patients with ESRD, is essential toward affecting the growth and health of this population.

Adult↗
PubMed1998

Projecting physician supply at a state level: physicians in Louisiana in 2001 and 2006.

BACKGROUND: Many studies predicting physician supply are based on national statistics, which may not be applicable at the state level. METHODS: To facilitate meaningful planning of future physician supply in our state, we developed a conservative, population-based projection of the total number of generalist and specialist physicians who will practice in Louisiana per 100,000 population in 2001 and 2006. RESULTS: Our projections, which err toward our goal of overestimating physician supply, indicate that the total physician number per 100,000 population in Louisiana will rise from the current level of 139 to 162, then to 186, in 2001 and 2006, respectively. The number of primary care physicians will rise from 52 to 59, then to 67, and specialists from 87 to 103, then to 119, in 2001 and 2006, respectively. These numbers are well within the range of need reported in several widely published demand scenarios used for comparison. CONCLUSION: In planning future policies on physician supply, states should develop their own projections rather than simply extrapolating national data to their individual situations.

Algorithms↗
PubMed2003

The human genome project: opportunities, challenges and consequences for population screening.

It is widely agreed that the Human Genome Project represents one of the most successful international collaborative research efforts of the last millennium. The fruits of the Human Genome Project have paved the way for a revolution in future health care, built on the foundations of an improved understanding of the molecular pathogenesis of human disease, and new and emerging technologies that will allow the rapid throughput of sophisticated gene-based testing. In this review some practical examples of these advances will be outlined, touching on such areas as pharmacogenetics, pharmacogenomics, and microarray technologies. In addition, some of the legal, ethical and social issues that have arisen from the Human Genome Project will be discussed. It is argued that in embracing the new knowledge afforded by the Human Genome Project, we must maintain a cautious approach to help minimise the potential risks in order to reap the potentially enormous benefits to society.

Human Genome Project↗
PubMed1995

Estimation and projections of stomach cancer trends in Italy.

Mortality data from official sources, and survival data from population-based cancer registries, are used for the estimation of incidence and prevalence of stomach cancer. Time trends of morbidity, survival, and mortality during the period 1970-90 are presented and analyzed. Incidence rates were decreasing during the considered period, but the rate of decrease was slowing down during the last decade. Almost stable rates, and even slightly increasing for women, were estimated for the youngest cohorts. Relative survival for stomach cancer was higher for women and for young ages; it was associated positively with period of diagnosis, and presented a significant South-North geographic gradient. Prevalence was estimated as decreasing during the period 1970-80, but increasing during the successive decade, due to both better survival and population aging. Projection of stomach cancer morbidity and mortality to the year 2000 showed that the disease should still be considered in Italy as a major public health problem.

Adult↗
PubMed2000

Impact of polymorphisms of the human beta2-adrenoceptor gene on obesity in a French population.

OBJECTIVE: To investigate the impact of two common polymorphisms in the human beta2-adrenoceptor gene (Gly16Arg and Gln27Glu substitutions) on obesity and anthropometric measurements as well as blood variables in a large sample of a French population. DESIGN AND SUBJECTS: Within the framework of the WHO-MONICA project, a population study composed of 1195 subjects aged 35-64 y was randomly sampled from the electoral rolls of the Urban Community of Lille, in northern France. Subjects without any medical treatment (for hypercholesterolaemia, hypertension or diabetes mellitus) susceptible to interfere with body weight and biological variables were selected (n = 836, 419 men/417 women, age = 49.5+/-8.1 y, body mass index (BMI) = 25.7+/-4.4 kg/m2). Subjects with a body mass index > or = 30 kg/m2 were considered as obese (n = 119, age = 49.5+/-8.2 y, BMI = 33.9+/-3.3 kg/m2 range 30-44). MEASUREMENTS: Genotyping was carried out with allele-specific oligonucleotides hybridization. Association between genotypes and various obesity markers (body weight, body mass index, waist and waist-to-hip ratio), lipid, glucose and insulin variables were studied. RESULTS: The Gly16Arg and Gln27Glu polymorphisms were in complete linkage disequilibrium. Gln27Gln subjects had an increased risk of obesity (odds ratio (OR) = 1.77, 95% CI 1.19-2.62, P = 0.005). This effect was mainly detected in men (OR = 2.40, 95% CI 1.34-4.27, P = 0.003). Men bearing the Gln27Gln genotype had higher body weight, BMI, waist and hip circumferences and waist-to-hip ratio than others. Moreover, if Gln27Gln men carried in addition the Arg16 allele, the increase in body weight, BMI and waist-to-hip ratio was more important. CONCLUSION: Our results suggest that genetic variability of the beta2-adrenoceptor gene is implicated in body weight regulation and in the onset of obesity in French men.

Adult↗
PubMed2006

Conservation of species in dynamic landscapes: divergent fates of Silene tatarica populations in riparian habitats.

In transient environments, where local extinctions occur as a result of destruction or deterioration of the local habitat, the long-term persistence of a species requires successful colonizations at new, suitable sites. This kind of habitat tracking should be associated with the asynchronous dynamics of local populations, and it can be especially important for the conservation of rare plant species in riparian habitats. We determined spatiotemporal variation in the demography of the perennial Silene tatarica (L.) Pers. in 15 populations (1998-2003) located in periodically disturbed riparian habitats. The habitats differed according to their morphology (flat shores, slopes) and the amount of bare ground (open, intermediate, closed) along a successional gradient. We used elasticity and life-table response analyses and stochastic simulations to study the variation in population demography. Finite population growth rate was higher in intermediate habitats than in open and closed habitats. In stochastic simulations population size increased in most cases, but four populations were projected to become extinct within 12-70 years. The viability of local populations depended most on the survival and growth of juvenile individuals and on the fecundity of large fertile individuals. On a regional scale, the persistence of this species will require a viable network of local populations as protection against local extinctions caused by natural disturbances and succession. Accordingly, the long-term persistence of riparian species may depend on habitat changes; thus, their conservation requires maintenance of natural disturbance dynamics. Along regulated rivers, management activities such as the creation of open habitats for new colonization should be implemented. Similarly, these activities can be rather general requirements for the conservation of endangered species dependent on transient habitats along successional gradients.

Computer Simulation↗
PubMed1996

The end of the demographic explosion in the Mediterranean?

"We...compare the UN projections made in 1994 to the previous set in 1992 and to the Blue Plan projections, for [Algeria, Egypt, Morocco, Syria, Tunisia, and Turkey, the] six most populated [developing countries in the Mediterranean region].... We shall also consider more briefly the lesser populated countries. This will enable us to appreciate the changes that have occurred in the UN's perception of population growth in this region."

Africa↗