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PubMed1999

Analysis of geographical heterogeneity in live-birth ratio in Thailand.

BACKGROUND: Live-birth (male-female) ratios are a standard measure used in demography. Recently, live-birth ratios have been considered as a potential indicator for various environmental hazards. In this paper, mixture modeling is applied to analyse the geographic heterogeneity of live-births in their composition of male and female proportions (live-birth ratio) in the Kingdom of Thailand. METHODS: Live-birth data are taken from the 1990 census of the Kingdom of Thailand. The level of aggregation is the province, of which there are 73 in Thailand. The analysis is based on the simple observation that a logical equivalent to the live-birth ratio is available, namely the proportion of male live-births. Based on this measure a simple and exact statistical model is easily derived: conditional on the number of live-births, the number of male live-births forms a binomial distribution, with parameter lambda. If there is homogeneity in the proportion of male live-births, then all provinces can be described by means of a single binomial distribution. However, if there is heterogeneity in the proportion parameter lambda, then a mixture of binomial distributions will occur. RESULTS: For the 1990 census data, three groups could be identified: a majority group containing 84% of the provinces and a proportion parameter of lambda = 0.513, a group of five provinces having a reduced proportion parameter of lambda = 0.500 (fewer male live-births), and a group of four provinces having an increased proportion parameter of lambda = 0.525. CONCLUSIONS: It is unclear how this can be explained, although some potential explanations are offered. The stability of these groups in time should be confirmed and regularly monitored.

Bias↗

PubMedDate not supplied

[Behavioural disorders in Alzheimer's disease. Data from a populational study].

AIMS: The purpose of this work was to study the characteristics of the behavioural disorders (non-cognitive or neuropsychiatric symptoms) presented by subjects with Alzheimer's disease from a sample of the population together with their relation to the cognitive and functional impairment suffered by these patients. PATIENTS AND METHODS: NEDICES is a longitudinal populational study based on the census of neurological diseases in subjects above the age of 64. In 2001, a study was conducted of the situation of 83 subjects who had started suffering from Alzheimer's disease between 1994 and 1997. Due to death and a number of other reasons, only 32 of them could be examined. Patients were administered a structured interview with scales referring to the cognitive state, functional capacity, severity of the dementia and the presence and severity of neuropsychiatric disorders. RESULTS: All the patients studied presented some non-cognitive symptom. Apathy was the most frequent (93.8%), followed by irritability (81.1%), anxiety (75.0%), dysphoria (71.8%) and agitation-aggressiveness (56.2%). The least frequent were deliria (50.2%), altered nocturnal behaviour and aberrant motor activity (37.6%), altered appetite and eating, and hallucinations (24.9%), disinhibition (21.8%) and euphoria (21.6%). The degree of cognitive impairment and the presence of non-cognitive symptoms exerted a similar and independent effect on functional capacity. Only 56.3% of the patients were treated with some kind of anticholinesterase or psychotropic medication. CONCLUSIONS: Our census-based populational study confirmed the high prevalence rate of non-cognitive symptoms in patients with Alzheimer's disease. These data confirm the notion that these symptoms are intrinsic manifestations of the disease.

Aged↗

PubMed2005

The contribution of causes of death to socioeconomic inequalities in child mortality: New Zealand 1981-1999.

BACKGROUND: Socioeconomic inequalities in all-cause child mortality exist in New Zealand; however the inequalities in cause-specific mortality have not been examined. This study examines child mortality inequality by household income between 1981 and 1999, by cause of death. METHODS: Data was used from a record linkage study of census and mortality records of all New Zealand children aged 0-14 years on census night 1981, 1986, 1991, 1996 followed up for 3 years for specific causes of mortality between ages 1-14 years. All cohorts were combined to calculate mortality rates, rate ratios, and rates differences for each cause of death. RESULTS: Socioeconomic differences in child mortality (low income compared to high income) were observed for injury (non road traffic) (RR 1.87, 1.35 to 2.58), road traffic injury (RR 1.36, 1.01 to 1.82), and 'other' causes of death (RR 1.81, 1.32 to 2.47). 'Other' and non-road traffic injury deaths together contributed 70% of the total gap in child mortality between the rich and the poor. CONCLUSIONS: Socioeconomic differences existed across most broad causes of child death. The major contributors to mortality inequality are diverse, suggesting that the similar distal causes of inequality (e.g. poverty) play out through a myriad of proximal causes. Fortunately there appears to be some scope for policymakers to modify some of the proximal and distal causes of these inequalities.

Accidents, Traffic↗

PubMed1990

Breast cancer stage, social class and the impact of screening.

Two studies were carried out to examine socio-economic factors in breast cancer: a random sample of all new cases in Edinburgh in 1979 was reviewed, and the control population of the Edinburgh randomized trial of breast screening was used to determine stage and survival in relation to social class. Small area statistics from census data were used as measures of social class, the method being now well accepted. More than one-third of women still present with obviously advanced or metastatic breast cancer, but both studies showed this has no association with socio-economic status. Late stage at presentation is a serious problem, and although mass screening is likely to cause an improvement in those who are screened, it cannot in those who do not attend for screening. As attendance is related to social class, less affluent women are less likely to benefit and will continue to be diagnosed with advanced disease.

Adult↗

PubMed1988

Estimating vaccination coverage: routine information or sample survey?

The manager of a district immunization programme needs to regularly assess vaccination coverage. This case study from Zimbabwe describes how routine information can be used for this purpose. The number of children and their location in the district was estimated from several sources using a variety of methods. This suggested that under-enumeration at the 1982 census was probably as high as a third and was a particular problem among children aged under 1 year. Routinely collected figures of the number of vaccinations were then used to calculate coverage levels for different health unit catchment areas within the district. These levels varied considerably and were lowest in areas with significant numbers of Apostolics, a group who often reject immunization on religious grounds. Comparisons between estimates of coverage obtained from routine information and a sample cluster survey raised several issues. These included accuracy of routine information, precision of sample surveys, estimating differential coverage in the district, management uses of estimates and the cost of data collection.

Adolescent↗

PubMed1997

Age-related trends (1986-1993) in the use of thrombolytic agents in patients with acute myocardial infarction. The Worcester Heart Attack Study.

OBJECTIVE: To examine age-related differences and temporal trends in the use of thrombolytic therapy in a community-wide study of patients hospitalized with acute myocardial infarction (AMI) between 1986 and 1993. METHODS: All hospitals in the Worcester, Mass, metropolitan area (1990 census population, 4370000) were included. A total of 3824 patients with validated AMI categorized according to age comprised the study sample: younger than 55 years (n = 577), 55 to 64 years (n = 758), 65 to 74 years (n = 1143), and 75 years or older (n = 1346). RESULTS: Use of thrombolytic therapy increased during the period under study in all patients hospitalized with AMI (9% in 1986; 26% in 1993). In 1986, the majority of treated patients received streptokinase; while increases over time in the use of tissue-type plasminogen activator were noted, streptokinase remained the thrombolytic agent of choice in 1993. Marked age-related trends in the use of thrombolytic therapy were observed, with the most striking increases in the use of thrombolytic therapy over time seen in those aged 65 years or older. Between 1986 and 1993 the relative increases in the use of thrombolytic therapy were observed in the following age groups: younger than 55 years (106%), 55 to 64 years (85%), 65 to 74 years (694%), and 75 years or older (571%). Despite these encouraging trends in the use of thrombolytic therapy in older patients, after controlling for a variety of potential confounding variables elderly patients were significantly less likely to receive thrombolytic therapy during hospitalization for AMI. Compared with patients aged 75 years or older, patients younger than 55 years were 6.4 times (95% confidence interval [CI], 4.8-8.5), patients aged 55 to 64 years were 4.9 times (95% CI, 3.8-6.4), and patients aged 65 to 74 years were 3.0 times (95% CI, 2.3-3.9) significantly more likely to receive thrombolytic therapy. These differences were in part related to the proportion of patients with myocardial infarction satisfying eligibility criteria for the receipt of thrombolytic therapy; patients aged 75 years or older were significantly less likely to meet these criteria (19%) than were those younger than 55 years (49%), those aged 55 to 64 years (38%), and those aged 65 to 74 years (28%). CONCLUSIONS: The present results show that while there have been substantial increases over time in the use of thrombolytic therapy in patients with AMI, most particularly in older individuals, the elderly remain appreciably less likely to receive these agents during hospitalization for AMI. These differences may be due to the smaller percentage of elderly patients satisfying criteria for the use of these agents compared with younger patients with coronary heart disease, as well as to a reluctance by physicians to use these agents in older patients. Continued monitoring of these trends remains important for examining changes in physicians' practice patterns regarding the use of thrombolytic therapy in this vulnerable population.

Age Factors↗

PubMedDate not supplied

Effect of Medicaid expansions on preterm birth.

OBJECTIVES: Inadequate prenatal care is thought to be a major modifiable risk factor for preterm birth, the leading cause of neonatal mortality. To improve high-risk women's financial access to prenatal care, the U.S. Medicaid program underwent major expansions during the 1980s. We evaluated these expansions over the nine-year period 1983 to 1991 in Tennessee to determine their effects on Medicaid enrollment, use of prenatal care, and preterm birth. METHODS: We used linked birth certificates, Medicaid data, and U.S. Census files to identify 610,056 singleton births to African-American or Caucasian women in Tennessee whose last menstrual period was between 1983 and 1991. These were classified by maternal characteristics to identify groups with the greatest postexpansion increases in Medicaid enrollment, which should have benefited most from the policy changes. Study outcomes were Medicaid enrollment by delivery, enrollment in the first trimester, inadequate prenatal care (modified Kessner index), and preterm (< 37 weeks) birth. We calculated the changes (delta expressed as births per 100) between 1983 and 1991 in percentages of births with each of these outcomes. RESULTS: The expansions led to pronounced increases in maternal Medicaid enrollment by delivery (21% of births in 1983 to 51% by 1991) and in the first trimester (from 10% to 37%). Married women with < 12 years of education, < 25 years of age, and < $12,500 mean neighborhood incomes (group 1) had the greatest increase, where enrollment and first-trimester enrollment increased from 24% to 86% and 7% to 68%, respectively. In group 1, the percentages of births with inadequate maternal use of prenatal care decreased substantially, from 12.8% in 1983 to 6.4% in 1991, a reduction of 6.4 births per 100 (95% confidence intervals [CI] = -7.6, -5.3). However, the preterm birth rate did not decrease (9.1% in 1983, 9.4% in 1991, change of 0.3[-0.7 to 1.2] births per 100). For other births, there were lesser increases in Medicaid enrollment, correspondingly lesser decreases in inadequate use of prenatal care, but no reductions in preterm birth rates. CONCLUSIONS: In Tennessee, the Medicaid expansions materially increased enrollment and use of prenatal care among high-risk women, but did not reduce the likelihood of preterm birth.

Adult↗

PubMed2003

Race, socioeconomic status and stage at diagnosis for five common malignancies.

BACKGROUND: African-Americans are more likely than Caucasians to be diagnosed at an advanced stage of colorectal, lung, breast, cervical, and prostate cancers. This study explores if racial differences in stage at diagnosis can be explained by socioeconomic status (SES) differences. Previous studies investigating this association have used aggregate SES indicators from census tract of residence; we used census block-group data, representing a smaller, potentially more homogenous group. METHODS: We included all African-American and Caucasian invasive cancers of the colon and rectum, lung and bronchus, female breast, cervix uteri, and prostate that were diagnosed between January 1, 1988 and December 31, 1992 in the Detroit area. Stage of disease at diagnosis was grouped as local or non-local. An SES value was calculated for each case using aggregate 1990 US Census data for education, poverty status, and occupation specific to each case's census block-group. Logistic regression analysis was used to model the probability of non-local stage using SES, race, age group, and sex as covariates. RESULTS: SES was an independent predictor of stage at diagnosis for each cancer site, with cases from the highest SES block-group more likely to present with local stage disease than those from the lowest SES group. Race independently predicted stage only for breast and prostate cancers; African-Americans presented with more advanced stage than Caucasians. CONCLUSIONS: Based on census block-group aggregate data, SES is an important predictor of stage at diagnosis, most likely accounting for much of the disparity in stage between African-Americans and Caucasians for colorectal, lung, and cervical cancers. Biological factors may play a role in racial disparities for breast and prostate cancer stage at diagnosis.

Black or African American↗

PubMed1996

Asian American and Pacific Islander Provider and Community Concerns with Rapid Managed Care Growth.

BACKGROUND: Minority communities are becoming increasingly concerned that the rapid growth of managed care activities will lead to a deterioration of their limited health care services and of the diminution of the primary health care providers. A generally expressed opinion among Asian and Pacific Islander Americans (APIAs) is that where there are underrepresented physicians groups, especially those who are culturally competent and ethnically sensitive, any health care reform strategy to control cost by cutting program funds is likely to compound the problem of underrepresentation of the provider community, and would result in greater medically underserviced areas and populations. In contrast, where there are culturally competent and ethnically sensitive physicians serving their communities, health care is more accessible and of better quality. Physicians and other health care providers working in underserved APIA areas are concerned with the loss of their patients to newly formed health maintenance organizations, the increased hassle of paperwork, the increased levels of patient care activities, and the disincentives and erosion of their financial base. In California, the number of managed care programs leads the nations. Moreover, in seventeen California counties, the Medicaid program is being streamlined under a managed care delivery system. The concern among API communities is the loss of access, availability and acceptability of care. Research and data collection on these issues need to be conducted to assess and evaluate the impact of managed care delivery on the health of these populations. METHODS: Information from literature reviews, data from community health centers, 1990 Census data compiled and analyzed by the Asian and Pacific Islander Center for Census Information and Services (ACCIS) program at the Asian and Pacific Islander American Health Forum, and personal communications were the sources of information for this presentation. FINDINGS: The provision of health care services will be more difficult as the managed care movement grows. The supply of physicians providing primary care to the APIA communities is expected to become more acute. The number of primary care physicians is not sufficient to meet the needs of the APIA communities. CONCLUSIONS: The delivery of medical services must be culturally competent and ethnically sensitive. Special interventions are suggested to improve access, acceptability, and appropriateness of health services for the APIA populations. A mentorship program, beginning in the states with the largest numbers of APIAs targeting high school, college, and post-graduate students is suggested as a method to heighten students' sense of social responsibility, and to create the desire and incentive to work in underserved APIA communities.

Journal Article↗

PubMed2005

A profile of home care workers from the 2000 census: how it changes what we know.

PURPOSE: The goal of our study was to identify a representative sample of direct care aides to generate an accurate profile of the long-term-care workforce, with a special focus on home care workers. DESIGN AND METHODS: Data were taken from the 5% Public Use Microdata Sample (PUMS) of the 2000 Census. RESULTS: Variable coding in the 2000 Census data allowed for a more detailed identification of long-term-care workers than was available in previous studies. On the basis of this new sample, the estimated size of the home care workforce is much larger than that in previous estimates, and it is more heterogeneous. In addition, our analyses revealed more self-employed workers, higher salaries than previously reported, and greater ethnic diversity, with Hispanics or Latinos comprising a significant proportion of the home care workforce. IMPLICATIONS: Numerous state and federal programs are currently underway to increase the capacity of the long-term-care workforce. A more comprehensive understanding of the characteristics of the long-term-care workforce will facilitate more effective development of programs designed to enhance recruitment and retention of these workers to meet the increasing demands of future years.

Adult↗

PubMed2004

The New Zealand Socio-economic Index of Occupational Status: methodological revision and imputation for missing data.

OBJECTIVES: To revise and update the New Zealand Socio-economic Index (NZSEI) in the light of methodological issues in its construction, and to develop an imputation method for use where occupational information is not available. METHODS: Data were drawn from the following New Zealand national surveys: 1996 Population Census; 1996/97 and 1997/98 Household Economic Surveys; 1996/97 Household Health Survey. Three sets of statistical analyses were applied: alternating least squares to generate socio-economic scores; cluster and discriminant function analyses to identify cut-points; and regression and logistic regression to develop and test imputation methods. RESULTS: Socio-economic scores for the full-time workforce in 1996 showed a different distribution, but much the same occupational ordering, as in 1991. The introduction of part-time workers and income adjustment multipliers for self-employed workers significantly affected scores for management and agricultural titles. The application of cluster and discriminant function analyses generated six groupings that were relatively distinct occupationally. An imputation method based on an averaging of scores within age/qualification categories was found to achieve acceptable results. CONCLUSIONS: Methodological improvements in the construction of the NZSEI have enhanced its empirical robustness, while a simple imputation technique has widened the potential application of the scale.

Data Collection↗

PubMed1980

Statistical analysis of comparative field trials of acute rodenticides.

The present method of analysis of data from comparative field trials of acute rodenticides was compared with two alternative methods of analysis, using computer simulation techniques. One of the proposed alternative analyses, the use of post-treatment census takes as a percentage of pre-treatment census takes in an analysis of variance, was found to be more accurate, to avoid a theoretical difficulty associated with the present method, and is computationally much simpler.

Animals↗

PubMed1994

Basic characteristics of radiology groups in the United States: results of a 1991-1992 census.

OBJECTIVE: The American College of Radiology (ACR), the principal professional organization of United States radiologists, receives numerous requests for information on the characteristics of radiology groups. This report describes the basic characteristics of radiology groups in the United States. We defined radiology groups as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. MATERIALS AND METHODS: To collect basic information on radiology groups, the ACR conducted a mail census of all identified radiology groups in the United States during late 1991 and early 1992. Follow-up was conducted by mail and telephone. To make the responses accurately representative of all radiology groups, we weighted the approximately 2000 responses to correspond to known control totals for the number of groups of each of seven size categories in each of the four census regions (Northeast, Midwest, South, and West). These control totals were obtained from the ACR's 1990 Manpower Survey, which showed a total of approximately 3200 radiology groups. RESULTS: Approximately one fourth of all groups have two radiologists, one fourth have three or four radiologists, one fourth have five to seven radiologists, and one fourth have eight or more radiologists. Academic groups were relatively large; almost 50% had 11 or more radiologists. Nonmetropolitan areas had very few large groups, and metropolitan center cities had relatively few small groups. Ninety-two percent of all groups practiced at hospitals, and 73% of all groups practiced at nonhospital offices or centers. The median number of practice sites for all groups was three, including both hospital and nonhospital sites. Eighty-eight percent of all groups provided diagnostic radiology services, 23% provided radiation oncology, 12% offered both, and 11% were oncology-only groups. Relatively many academic groups (25%) were oncology-only groups; very few radiology groups (2%) in multispecialty practices were oncology-only groups. The diagnostic radiology techniques available from the largest percentages of groups were general radiography (plain film), sonography, mammography, and CT. One eighth of academic groups that provided diagnostic services did not report providing mammography, compared with only a few percent of all groups in the United States that provided diagnostic services. CONCLUSION: Half of all groups have two to four radiologists, and this has not changed since at least 1986. A substantial percentage of groups that perform diagnostic radiology do not provide MR, interventional, or nuclear medicine services. This is particularly true of relatively small groups. These characteristics may become the source of some problems as managed care becomes more prominent and larger groups, offering a full range of services and practicing at several sites, are favored by managed care organizations that seek to contract with one group for all their radiology services.

Data Collection↗

PubMed1996

Use of the Nottingham Health Profile to test the validity of census variables to proxy the need for health care.

BACKGROUND: Data on health or health service use are invariably used to test the validity of proxy measures of need, for use in resource allocation formulae. Perceived health state is a good measure to use in this respect, as it is closely linked to perceived need and the decision to consult health services. This being the case, a large community based study was undertaken which collected data on perceived health, using the Nottingham Health Profile (NHP), with the aim of testing the validity of a variety of Census based measures as proxy measures of the need for health care. METHOD: A postal questionnaire survey of 9565 people living in the former South East Thames Regional Health Authority was conducted and the relationship between their perceived health state and the socio-economic characteristics of their electoral ward of residence analysed. RESULTS: A relatively low response rate (59 per cent) weakened any conclusions to be drawn from the results. However, significant correlations between perceived health and a variety of the Census based indicators were found. The highly skewed distribution of responses to the NHP statements made the results difficult to analyse and interpret. CONCLUSIONS: Although the study gave an indication of those variables that might be incorporated into resource allocation formulae, the NHP is not a particularly efficient instrument to use in a community setting. It is argued that the appropriateness of an approach to determining appropriate needs weights in allocation formulae, which attempts to find one indicator of all health care needs at the District Health Authority level, must be questioned.

Adolescent↗

PubMed1995

[Epidemiology of bovine hypodermyiasis in canton Vaud: comparison of two methods of mapping the infestation with a view to strategic treatment].

The geographic distribution of bovine hypodermyiasis in the canton Vaud/Switzerland has been investigated in two ways: By direct examination of the animals by the livestock officers at the 1993 annual census and by ELISA on bulk milk sampled in January 1994. The efficacy of the two methods is compared and the distribution of hypodermyiasis presented on a map. The serological analyses have revealed a highly satisfactory degree of sensitivity and specificity (92.1% and 98.1%, resp.). The epidemiological interpretation however, is rather difficult, partly because quite often the animals are not infested on their farms but rather while being on alpine pastures. A monitoring of the herds with a view to an efficient control of hypodermyiasis could thus in a first instance be based on the indications provided by the livestock officers, whereas a serological monitoring in a second place would allow to detect the last and remaining foci of infestation.

Animals↗

PubMed2005

National job-exposure matrix in analyses of census-based estimates of occupational cancer risk.

OBJECTIVES: The aim of this study was to increase the understanding of the alternative exposure metrics and analysis methods in studies applying job-exposure matrices in analyses of health outcomes, the association between crystalline silica and cancer being used as an example. METHODS: Observed and expected numbers of cancer cases during 1971-1995 among Finns born in 1906-1945 were calculated for 393 occupational categories, as defined in the 1970 population census. According to the Finnish Cancer Registry, there were 43 433 lung and 21 444 prostate cancer cases. The Finnish job-exposure matrix (FINJEM) provided estimates of the proportion of exposed persons and the mean level of exposure among the exposed in each occupation. RESULTS: The most comprehensive exposure metric included period- and age-specific estimates of exposure and an estimate of occupational stability, but also remarkably simpler metrics gave significantly elevated estimates of the risk ratio (RR) between 1.36 and 1.50 for lung cancer for occupations with the highest estimated cumulative silica exposure (> or = 10 mg/m3-years), allowing a lag time of 20 years. It proved important to adjust the risk ratios at least for the socioeconomic status and occupational exposure to asbestos. The risk ratios for prostate cancer were close to 1.0 in every model. CONCLUSIONS: The results showed that the FINJEM-based analysis was able to replicate the well-known association between exposure to crystalline silica and lung cancer. The FINJEM-based method gives valid results, and it can be used to analyze large sets of register-based data on health outcomes.

Adult↗

PubMed2005

Associations between income inequality and mortality among US states: the importance of time period and source of income data.

OBJECTIVES: We used census data to examine associations between income inequality and mortality among US states for each decade from 1949 to 1999 and tax return income data to estimate associations for 1989. METHODS: Cross-sectional correlation analyses were used to assess income inequality-mortality relationships. RESULTS: Census income analyses revealed little association between income inequality and mortality for 1949, 1959, or 1969. An association emerged for 1979 and strengthened for 1989 but weakened for 1999. When income inequality was based on tax return data, associations were weaker for both 1989 and 1999. CONCLUSIONS: The strong association between income inequality and mortality observed among US states for 1989 was not observed for other periods from 1949 through 1999. In addition, when tax return rather than census data were used, the association was weaker for 1989 and 1999. The potential for distal social determinants of population health (e.g., income inequality) to affect mortality is contingent on how such determinants influence levels of proximal risk factors and the time lags between exposure to those risk factors and effects on specific health outcomes.

Censuses↗

PubMed2003

Survival of Californian women with epithelial ovarian cancer, 1994-1996: a population-based study.

OBJECTIVE: The objective was to identify demographic, clinical, and provider characteristics that might influence cancer survival in a cohort of Northern California women using a population-based cancer registry. METHODS: We used California Cancer Registry data to evaluate survival in 1051 Northern California women who were diagnosed with epithelial ovarian cancer between 1994 and 1996 and underwent a surgical procedure for their cancer. Chemotherapy data from the cancer registry were supplemented with a physician survey and medical record review. Database linkages with census and hospital discharge data provided socioeconomic and comorbidity measures. Kaplan-Meier method was used to generate survival curves and multivariate Cox proportional hazard models were used to evaluate the effect of different factors on survival. RESULTS: Crude 5-year survival was 82, 57, 28, and 10% for women with FIGO stage IC, II, III, and IV disease, respectively. Adverse survival was most strongly influenced by advanced stages III and IV with a hazards ratio ranging from 8 to 11.8 compared to stage IC disease. Multivariate analysis also identified other adverse factors including high grade and other adverse histologies, age over 45, and rural location. Chemotherapy decreased the risk of death by 50% if the patient had advanced-stage disease. Medical comorbidity increased the risk of death by 40%. Survival was not influenced by race/ethnicity, socioeconomic status, physician specialty, or hospital characteristics. CONCLUSION: Advanced age remains an adverse prognostic factor even after adjustment for treatment and comorbidity factors. These results also suggest that there may be important regional differences in ovarian cancer survival.

Adult↗