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PubMed2005

Inequalities in mortality by education and socio-economic transition in Lithuania: equal opportunities?

AIM: The aim of this study was to examine the changes in mortality differentials by level of education during the period of socio-economic transition in Lithuania. METHODS: This analysis was based on routine mortality statistics and census data for 1989 and 2001 for the entire country. RESULTS: Despite a general improvement in the level of education in the Lithuanian population, some negative educational patterns were observed amongst its young members. Increasing inequalities in mortality by education have occurred due to a declining mortality rate in people with higher educational achievements and, conversely, an increasing mortality rate in people with a low level of education. Mortality inequalities by education amongst females exceeded those amongst males in 2001, particularly in middle-aged groups and due to external causes. The results of this survey predict an unfavourable forecast of increasing health inequalities in Lithuania in the near future. CONCLUSIONS: General policies for health promotion and disease prevention should be based on the realities faced by lower educated groups, rather than on experiences that are general for the total population or the class of society that has at least achieved an average education. Inequalities in health by the level of education should plateau as the society-at-large enters into a more stable stage of social and economic development.

Adult↗
PubMed1997

The geographic distribution of Parkinson's disease mortality in the United States.

PURPOSE: This study examines geographic variation in reporting of Parkinson's disease mortality in the U.S. METHODS: National Center for Health Statistics and Bureau of the Census data were used to map age-adjusted, race- and race-gender-specific Parkinson's disease mortality rates in the U.S. for 1988. RESULTS: Among whites, high underlying-cause rates predominated in the North and low rates predominated in the South, whereas high contributing and all-cause rates were concentrated in the northeastern U.S. Strong north-to-south decreasing gradients were present for both underlying- and all-cause rates for whites, regardless of gender, whereas a clear west-to-east gradient could not be demonstrated. Geographic variation in contributing- and all-cause rates was partially explained by variation in tendency to report contributing causes of death. Reported rates among blacks were significantly lower than among whites. There was no latitudinal or longitudinal gradient of underlying-cause rates for blacks, but there was a relatively weak north-to-south decreasing gradient of all-cause rates for blacks, regardless of gender. CONCLUSIONS: The large-scale pattern of underlying-cause Parkinson's disease mortality among whites has persisted for over three decades.

Black or African American↗
PubMed2002

Common mental disorder symptom counts in populations: are there distinct case groups above epidemiological cut-offs?

BACKGROUND: At the lower end of IQ distributions in general populations, there is a clear excess of cases, representing the distinct pathology of severe learning disability. This study aimed to establish whether such a subpopulation exists in distributions of common mental disorder and depression symptom scores, above epidemiological 'case' cut-offs. METHOD: Data from 9556 non-psychotic respondents to the 1993 OPCS (Office of Population Censuses and Surveys) National Household Psychiatric Morbidity Survey were analysed. The distribution of total neurotic symptom and depression scores from the revised Clinical Interview Schedule were examined. Automated least squares methods were used to fit the best single statistical distribution to the data. RESULTS: A single exponential curve provided the best fit for the whole population, but floor effects produced deviations at symptom counts of 0-3. After truncation, exponential distributions fitted excellently. Proportions of the population above conventional cut-offs of > or = 12 symptoms differed by < 12% from expected for a range of low and high prevalence groups. The single exponential model also fitted the depression score. CONCLUSIONS: Symptom counts for the common mental disorders fall within single population distributions, with little apparent numerical excess in the case range. High and low prevalences of these disorders appear to be population characteristics, with shifts in exponential means predicting proportions above case cut-offs.

Adolescent↗
PubMed1998

Secular trends of weight, height and obesity in cohorts of young Portuguese males in the District of Lisbon: 1960-1990.

OBJECTIVE: To examine the secular trend of weight, height and obesity among young Portuguese males at the time of military inspection for national conscription purposes in the region of Lisbon, during the last thirty years. DESIGN: Cross-sectional study, based on the review of military census files. SETTING: Military selection centre of Lisbon. SUBJECTS AND METHODS: In Portugal, military service is obligatory and medical inspections are carried out every year on males at the age of twenty. For study purposes, representative samples were taken from the young male population undergoing inspection for the Armed Forces on a five year basis, between 1960 and 1990 in the region of Lisbon. Weight and height were evaluated by a trained team, using standard measurement instruments and procedures. RESULTS: A progressive and significant increase in weight, height and BMI of the young male population was found between 1960 and 1990. For certain variables the increase was also statistically significant within a five-year period, as it was the case for height between 1965-1980 and for weight between 1985-1990. The increase in BMI experienced some minor fluctuation along the reference period, however, it was statistically significant between 1985-1990. The increase in weight and in BMI was greater in the highest percentiles and particularly noticeable between 1985 and 1990. The percentage of young males with BMI over 25 kg/m2 was of 8.1% in 1960 and of 18.0% in 1990, while those having a BMI over 27 kg/m2 varied between 3.6% and 6.4% in the same period, respectively. The percentage of young adult males with BMI higher than 25 kg/m2 doubled between 1960 and 1990.

Adult↗
PubMed2000

"With the rule" astigmatism is not the rule in the elderly. Reykjavik Eye Study: a population based study of refraction and visual acuity in citizens of Reykjavik 50 years and older. Iceland-Japan Co-Working Study Groups.

PURPOSE: To study refractive state and visual acuity in citizens of Reykjavik 50 years and older. METHODS: 1700 persons were randomly selected from the national population census. 1379 could be located and qualified whereof 1045 participated. Evaluation of refraction was performed using Nidek ARK 900 autorefracto-keratometer. Visual acuity was tested on a Snellen chart. RESULTS: The prevalence of hypermetropia increases with age by 0.3 D in five years. The prevalence of "against the rule" astigmatism increased on average 5.3% and oblique 3.9% in five years. Analysis of corneal astigmatism measured by keratometer shows an "against the rule" change with age. CONCLUSIONS: Hypermetropia increases by age. The prevalence of astigmatism increases and the axis turns to "against the rule". The changes in total astigmatism and corneal astigmatism is almost parallel which might indicate that the "against the rule" change is related to changes in the cornea.

Aged↗
PubMed2002

Insecticide-treated bednet use, anaemia, and malaria parasitaemia in Blantyre District, Malawi.

OBJECTIVE: To evaluate the use of insecticide-treated bednets and the effectiveness of social marketing for their distribution. METHODS: Systematic cluster sample survey of 1080 households in 36 census enumeration areas across Blantyre district, Malawi, in February 2000. RESULTS: A total of 672 households had one or more children under 5. Bednet ownership was low (20.5% of households) overall, and significantly lower in rural areas than urban areas (6.4 vs. 29.8%, P=0.001). Only 3.3% of rural children under 5 had slept under a net the previous night, compared with 24.0% of urban children (P < 0.001). When asked why they did not own a net, nearly all (94.9%) caretakers in households without nets stated they had no money to buy them. In multivariate statistical models that controlled for the influence of house structure, urban vs. rural location, gender of the head of household, and the primary caretaker's education, rural children under 5 in households without nets experienced a statistically significant higher prevalence of malaria parasitaemia [RR (risk ratio) 4.9, 95% CI (confidence interval) 2.3-10.5] than children in households with at least one bednet. This was also true for urban children under 5 (RR 2.1, 95% CI 1.0-4.2, P=0.04). CONCLUSION: Social marketing approaches to promoting insecticide-treated nets in Blantyre District may have produced measurable health benefits for children in those households in which residents bought and used the products. Market-based approaches may take years to achieve high levels of coverage and may exaggerate inequities between urban and rural populations.

Adolescent↗
PubMed2000

Hip fracture rates in South Australia: into the next century.

BACKGROUND: Fractures of the femoral neck already represent a major public health problem in Australia. This situation is set to worsen as the population ages. The present study estimates the number of patients over 50 years of age with femoral neck fractures that is expected to impact on the South Australian healthcare service into the next century. METHODS: Population projections from the Australian Bureau of Statistics 1996 census were combined with age- and gender-specific incidence rates for fractures of the femoral neck for persons over the age of 50 in South Australia. Projections for the expected number of hip fractures in this State were then calculated. RESULTS: Assuming there are no changes in the age- and gender-specific incidence of fracture rates, the number of fractures in South Australia is estimated to increase by approximately 66% by the year 2021 and 190% by 2051. CONCLUSION: Based on the population projections and the assumption that conditions contributing to hip fractures remain constant, the number of fractured neck of femurs will increase in far greater proportion than the overall population in the next century. The results of the present study indicate the serious implications for the South Australian healthcare system if there is no reduction in incidence rates.

Age Factors↗
PubMed1999

Survival advantage in Asian American end-stage renal disease patients.

UNLABELLED: Survival advantage in Asian American end-stage renal disease patients. BACKGROUND: An earlier study documented a lower mortality risk for end-stage renal disease (ESRD) patients in Japan compared with the United States. We compared the mortality of Caucasian (white) and Asian American dialysis patients in the United States to evaluate whether Asian ancestry was associated with lower mortality in the United States. METHODS: The study sample from the U.S. Renal Data System census of ESRD patients treated in the United States included 84,192 white or Asian patients starting dialysis during May 1995 to April 1997, of whom 18,435 died by April 30, 1997. Patient characteristics were described by race. Relative mortality risks (RRs) for Asian Americans relative to whites were analyzed by Cox proportional hazards regression models adjusting for characteristics and comorbidities. Population death rates were derived from vital statistics for the United States and Japan by age and sex. RESULTS: Adjusting for demographics, diabetes, comorbidities, and nutritional factors, the RR for Asian Americans was 0.75 (P = 0.0001). Race-specific background population death rates accounted for over half of the race-related mortality difference. For whites, mortality decreased as the body mass index (BMI) increased. For Asians, the relationship between BMI and survival was u-shaped. The ratio of Asian American/white dialysis death rates and the ratio of Asian American/white general population death rates both varied by age in a similar pattern. The population death rates of Asian American and Japanese were also similar. CONCLUSION: Among dialysis patients, Asian Americans had a markedly lower adjusted RR than whites. The effect of BMI on survival differed by race. Compared with the respective general population, dialysis patients had the same relative increase in death rates for both races. The difference in death rates between the United States and Japan does not appear to be primarily treatment related, but rather is related to background death rates.

Adult↗
PubMed1995

Regional variation across the United States in the management of acute myocardial infarction. GUSTO-1 Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.

BACKGROUND: Differences in the management of acute myocardial infarction have been reported among countries, but few studies have investigated this issue in regions of the United States. METHODS: We compared the management of acute myocardial infarction among census regions across the United States, using data from the first Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries trial (GUSTO-1) comprising 21,772 patients, and from the American Hospital Association. RESULTS: We found substantial regional variation in the management of acute myocardial infarction in the United States. Beta-blockers (prescribed for a range of 55 to 81 percent of patients in the various regions), nitrates (prescribed for 61 to 77 percent), and angiotensin-converting-enzyme inhibitors (prescribed for 18 to 23 percent) were used most often in New England, whereas calcium-channel blockers (31 to 42 percent) and lidocaine (14 to 43 percent) were used least often there. Similarly, the proportion of patients undergoing various cardiac procedures differed among regions (range for angiography, 52 to 81 percent of patients; angioplasty, 22 to 35 percent; and coronary-artery bypass surgery, 9 to 17 percent) and was lowest in New England. The regional use of cardiac procedures was closely related to their availability, except in New England. After the analysis was adjusted for clinical and hospital variables, patients in New England were found to be less likely to undergo angiography than patients in the other regions (odds ratio, 0.37; 95 percent confidence interval, 0.32 to 0.42). There was no apparent relation between the use of cardiac procedures and rates of recurrent infarction or death at 30 days or 1 year. CONCLUSIONS: There is substantial regional variation in the use of cardiac medications and procedures to manage acute myocardial infarction in the United States. The use and availability of cardiac procedures are closely related. The management of acute myocardial infarction in New England is atypical in that the relatively limited availability of cardiac procedures does not account for their relatively low use in that region.

Angioplasty↗
PubMed1996

Excess mortality among blacks and whites in the United States.

BACKGROUND: Although the general relations between race, socioeconomic status, and mortality in the United States are well known, specific patterns of excess mortality are not well understood. METHODS: Using standard demographic techniques, we analyzed death certificates and census data and made sex-specific population-level estimates of the 1990 death rates for people 15 to 64 years of age. We studied mortality among blacks in selected areas of New York City, Detroit, Los Angeles, and Alabama (in one area of persistent poverty and one higher-income area each) and among whites in areas of New York City, metropolitan Detroit, Kentucky, and Alabama (one area of poverty and one higher-income area each). Sixteen areas were studied in all. RESULTS: When they were compared with the nationwide age-standardized annual death rate for whites, the death rates for both sexes in each of the poverty areas were excessive, especially among blacks (standardized mortality ratios for men and women in Harlem, 4.11 and 3.38; in Watts, 2.92 and 2.60; in central Detroit, 2.79 and 2.58; and in the Black Belt area of Alabama, 1.81 and 1.89). Boys in Harlem who reached the age of 15 had a 37 percent chance of surviving to the age of 65; for girls, the likelihood was 65 percent. Of the higher-income black areas studied, Queens--Bronx had the income level most similar to that of whites and the lowest standardized mortality ratio (men, 1.18; women, 1.08). Of the areas where poor whites were studied, Detroit had the highest standardized mortality ratios (men, 2.01; women, 1.90). On the Lower East Side of Manhattan, in Appalachia, and in Northeast Alabama, the ratios for whites were below the national average for blacks (men, 1.90; women, 1.95). CONCLUSIONS: Although differences in mortality rates before the age of 65 between advantaged and disadvantaged groups in the United States are sometimes vast, there are important differences among impoverished communities in patterns of excess mortality.

Adolescent↗
PubMed2006

Estimating density dependence from time series of population age structure.

Population fluctuations are caused by demographic and environmental stochasticity, time lags due to life history, and density dependence. We model a general life history allowing density dependence within and among age or stage classes in a population undergoing small or moderate fluctuations around a stable equilibrium. We develop a method for estimating the overall strength of density dependence measured by the rate of return toward equilibrium, and we also consider a simplified population description and forecasting using the density-dependent reproductive value. This generality comes at the cost of requiring a time series of the population age or stage structure instead of a univariate time series of adult or total population size. The method is illustrated by analyzing the dynamics of a fully censused population of red deer (Cervus elaphus) based on annual fluctuations of age structure through 21 years.

Age Distribution↗
PubMed2004

Lack of change in birthweights of infants by generational status among Indian, Pakistani, Bangladeshi, Black Caribbean, and Black African mothers in a British cohort study.

AIM: To test the hypothesis that an intergenerational increase would occur in birthweights of babies born to UK-born compared with overseas-born (migrant) minority women. METHOD: Live singleton births to mothers present at the 1991 Census in a national longitudinal study were classified by mother's country of birth and ethnic origin as reported in the census. During 1983-2000, 52,554 White, 1788 Indian, 1538 Pakistani, 995 Bangladeshi, 300 Black Caribbean, and 299 Black African live singleton births were identified. Mean birthweights were adjusted for maternal age, socio-economic circumstances, gender, year of birth, and birth order. RESULTS: Adjusted mean birthweights were: 3400 g (95% CI: 3395, 3405) for infants of UK-born White mothers; 3033 g (95% CI: 2980, 3087) of UK-born Indian mothers and 3066 g (95% CI: 3034, 3097) of migrant Indian mothers; 3110 g (95% CI: 3049, 3172) of UK-born Pakistani mothers and 3123 g (95% CI: 3087, 3159) of migrant Pakistani mothers; 3026 g (95% CI: 2922, 3130) of UK-born Bangladeshi mothers and 3110 g (95% CI: 3076, 3145) of migrant Bangladeshi mothers; 3268 g (95% CI: 3177, 3359) of UK-born Black Caribbean mothers and 3238 g (95% CI: 3089, 3388) of migrant Black Caribbean mothers; and 3167 g (95% CI: 3004, 3330) of UK-born Black African mothers and 3302 g (95% CI: 3208, 3395) of migrant Black African mothers. The proportions of low birthweight infants (<2500 g), generally greater among migrant mothers than White UK-born mothers, were similar by generational status within the ethnic groups. CONCLUSION: There are no significant differences in mean birthweights of infants by generational status among mothers from these main ethnic minority groups in the UK.

Africa↗
PubMed2005

The contribution of smoking to inequalities in mortality by education varies over time and by sex: two national cohort studies, 1981-84 and 1996-99.

BACKGROUND: The contributions of tobacco smoking to overall mortality and socioeconomic inequalities in mortality vary between populations and over time. We determined how these contributions varied by sex and over time in two national New Zealand cohort studies. METHODS: Poisson regression and modelling were conducted on linked census-mortality cohorts for people aged 45-74 years in 1981-84 and 1996-99 (2.0 and 2.7 million person-years, respectively). RESULTS: Contribution to socioeconomic inequalities in mortality. Adjusting for current and former smoking reduced the all-cause mortality rate ratios for men with nil educational qualifications compared with men with post-school qualifications from 1.34 to 1.29 in 1981-84 and from 1.31 to 1.25 in 1996-99, or 16 and 21% reductions in relative inequalities. Equivalent results for women were 1.42-1.41 in 1981-84 and 1.42-1.37 in 1996-99, or 3 and 11% reductions in relative inequalities. Contribution to overall mortality. Using 1996-99 data, we estimated that if all current smokers quit and became ex-smokers, mortality rates would reduce by 11% for men and 5% for women. If everyone was a never smoker (i.e. a historically smoke-free society), mortality rates would have been 26% lower for men and 25% lower for women. CONCLUSIONS: The contribution of smoking to educational inequalities in mortality was greater for males, and increased over time for both males and females, reflecting the historically differential phasing of the tobacco epidemic by sex and socioeconomic position. Complete cessation of smoking in contemporary New Zealand would reduce both overall mortality and educational inequalities in mortality.

Aged↗
PubMed2006

Patient characteristics and hospital quality for colorectal cancer surgery.

OBJECTIVE: To assess associations of patient characteristics with quality-related characteristics of the hospitals where they were treated for colorectal cancer and the role of these associations in disparities in treatment quality affecting vulnerable patient groups or variations across health plans. SETTING: Population-based cancer registry in California. PARTICIPANTS: A total of 38 237 patients diagnosed with stage I-III (non-metastatic) colorectal cancer in California between 1994 and 1998. METHODS: Registry data were linked with hospital discharge abstracts, US census data, and Medicare enrollment data. The associations of patients' sociodemographic, clinical, and geographic covariates with treatment at high-volume institutions were assessed with logistic regression. The associations of patients' covariates with the risk-adjusted 30-day mortality rates of the hospitals where they received surgery were tested with linear regression. RESULTS: Patients with more advanced tumor stage or more extensive comorbidity, those of Hispanic or Asian race/ethnicity, and those from less affluent communities were less likely to undergo surgery at high-volume institutions and were treated at hospitals with higher risk-adjusted 30-day postoperative mortality rates than those who were less severely ill, white, or more affluent, respectively (all P < 0.05). Black patients also received surgery at hospitals with above-average mortality. Among patients 65 years and older, Medicare managed-care enrollees underwent surgery in higher-volume hospitals than Medicare fee-for-service enrollees, and there was substantial variation in hospital volume and adjusted hospital mortality among Medicare managed-care plans. CONCLUSION: Improving access of sicker, poorer, and minority patients to high-quality hospitals for cancer surgery may improve their outcomes. Further study of processes affecting hospital referral is warranted.

Adult↗
PubMed1990

Assigning race to occupational cohorts using census block statistics.

Race is an important determinant of disease frequency, yet the race of subjects in retrospective epidemiologic studies is frequently unknown. If addresses are available, the race of study subjects may be estimated from the racial composition of the blocks on which they have resided. Such information can be obtained from census block statistics for Standard Metropolitan Statistical Areas and, with the 1990 Census, probably for the entire United States. The authors assigned black race to persons on blocks with greater than 60% black residents and white race to those residing on blocks containing less than 40% blacks. The validity of the procedure was tested on 341 decedents of known race who resided at the time of death within the Detroit, Michigan, Standard Metropolitan Statistical Area. Thirteen individuals who lived on blocks with 40-60% blacks were excluded from analysis, as well as 18 others for whom racial composition of blocks could not be ascertained. In 293 (94%) of the remaining 310 persons, race assigned on the basis of census information agreed with race obtained from death certificates. This method should prove useful for assigning race to study subjects lacking racial identification.

Black or African American↗
PubMed2002

South Asian ethnicity and risk of childhood accidents: an ecological study at enumeration district level in Leicester.

BACKGROUND: Surveys of 'self-reported' accidents suggest that South Asian children in the United Kingdom may have lower rates of childhood accidents, but little is known about their susceptibility to severe accidents compared with white children. METHODS: We conducted an ecological study at the level of Census enumeration districts to compare hospital utilization as a result of childhood accidents according to White, South Asian, Black or 'Other' ethnic grouping and Townsend deprivation score in Leicester. Enumeration districts were assigned to postcoded data for fracture clinic attendances between 1997 and 1999 and in-patient admissions and in-patient stays of longer than 3 days as a result of accidents between 1995 and 1999 in children under 16 years. RESULTS: South Asian children were less likely than white children to attend fracture clinic, be admitted or to have a prolonged stay as a result of an accident. Having adjusted for deprivation score, for a 10 per cent increase in the proportion of South Asian residents in an enumeration district, the odds ratio for an in-patient stay of longer than 3 days was 0.95 (95 per cent confidence interval (CI) 0.91-1.00, p = 0.035), for an accident admission the odds ratio was 0.93 (95 per cent CI 0.92-0.94, p < 0.001) and for attendance at fracture clinic the odds ratio was 0.94 (95 per cent CI 0.92-0.96, p < 0.001). For a district with 70 per cent of its children from South Asian groups (as observed in one-fifth of Leicester's enumeration districts), this represents a 40 per cent lower rate of accident admissions. CONCLUSIONS: South Asian children were significantly less likely to utilize hospital services as a result of an accident. This may well be explained by differential exposure to accident hazards across ethnic groups, rather than by different thresholds of hospital attendance, given that hospital utilization was also lower for serious accidents in South Asian children.

Accidents↗
PubMed1997

Child and adolescent psychiatry residency training: current issues and controversies.

OBJECTIVE: To examine major current influences on child and adolescent psychiatry (CAP) residency training, highlighting the most common problems. Potential solutions and unresolved dilemmas are presented. METHOD: Data were gathered from empirical studies, review articles, national census data, and discussions over the past decade at national meetings on recruitment of residents and faculty; clinical, didactic, and research training; the impact of managed care and changes in graduate medical education funding; and the professional development of CAP residents. RESULTS: Overall there are significant problems recruiting U.S. medical students and attracting faculty into CAP training programs. Economic forces, including decreased reimbursements from managed care and the federal government, are threatening the survival and vitality of training programs. Managed care is harmful for sound residency training and identity formation of the child and adolescent psychiatrist. CONCLUSIONS: The integrity of CAP residency training in the future will depend on increased efforts of teaching hospitals and programs to develop fiscally viable systems of care integrated with residency training; seek new sources of training subsidies; modify traditional models of clinical and didactic curricula; and foster greater collaboration between training programs locally and nationally.

Adolescent Psychiatry↗
PubMed1999

The geography of sexual partnerships in Baltimore: applications of core theory dynamics using a geographic information system.

OBJECTIVE: Gonorrhea has a focused geographic distribution characterized by high incidence rates in defined "core" areas and decreased incidence as the radial distance from the central core increases. Dense cor group transmission has long been hypothesized. METHODS: We have previously mapped sexually transmitted disease (STD) rates in Baltimore census tracts using STD morbidity data interfaced with a geographic information system. Core areas were defined using a standard definition based on gonorrhea distribution. We studied spatial distance patterns between sexual partners, using the residential addresses of 572 individuals, representing 286 dyad partnerships recruited as part of an epidemiology and behavioral study. To determine if partners lived closer together than would be expected, a modified bootstrap algorithm using Monte Carlo models was developed to compare the distances between partners' residences and all other possible residences. RESULTS: Two distinct (east and west) core areas were previously identified. Compared with randomly selected Baltimore addresses, partners tended to reside closer to one another than would be expected by chance (z = -1.8), with a median distance of 1.7 kilometers. Within the core areas, women resided a median of 547 meters from their partner, and men resided a median of 339 meters from their reported partners. When all partnerships were considered, the median distance was 1,699 meters. Of the 500 simulation models, the minimum median distance was 4,889 meters. CONCLUSIONS: Partners of patients in core areas in Baltimore live remarkably close to one another, and the partner selection patterns in general indicate nonrandom distribution. Geographic information system-determined patterns of STD patients residing in hyperendemic census tracts support the core theory of disease transmission. In these areas, targeted geographically based interventions may be warranted.

Adult↗