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PubMed1992

A population-based, multivariate analysis of the association between 911 access and per-capita county trauma death rates.

STUDY OBJECTIVE: Decreased response times for injury should decrease the morbidity and mortality of trauma. The 911 telephone access is designed to improve the response time for emergencies. The purpose of this study was to analyze the association between county 911 access and per-capita county trauma death rates. METHODS: Data on all trauma deaths from 1986 through 1988 were obtained from the North Carolina Medical Examiner's data base. Counties were divided into those that had 911 access during the entire study period (15), those that never had 911 access (62), and those that installed 911 during 1987 (ten). Counties obtaining 911 access in 1986 or 1988 were excluded (13). RESULTS: The per-capita trauma death rate in counties that had 911 access throughout the study was 4.3 +/- 0.8 versus 5.0 +/- 1.1 per 10,000 population in counties that never had 911 access (P less than .01). Compared with counties with 911 access, counties without 911 were more rural, were less likely to have a trauma center, and were less likely to have advanced life support certification (P less than .03 for all). Controlling for these other factors, multivariate analysis demonstrated that 911 access had no significant independent association with per-capita county trauma death rates. In the ten counties that implemented 911 access in 1987, no significant change occurred in per-capita county trauma death rates after implementation of 911. CONCLUSION: Although counties with 911 access had lower trauma death rates by t-test, multivariate analysis showed no significant independent association of 911 access with per-capita county trauma death rates. In the ten counties that implemented 911 access in 1987, no significant changes in trauma death rates occurred after implementation. Although other factors may explain these findings, this study showed no significant independent impact of 911 access on per-capita county trauma death rates.

Emergency Medical Service Communication Systems↗
PubMed2003

Cancer mortality in counties near two former nuclear materials processing facilities in Pennsylvania, 1950-1995.

There has been concern that living near nuclear installations might increase the risk of cancer, including childhood leukemia, in surrounding communities. Such concern has been voiced by residents in Armstrong and Westmoreland Counties in Western Pennsylvania in conjunction with the operation of two former nuclear materials processing facilities located in the Apollo borough and the Parks township, just three miles apart. These facilities began operating in 1957 and 1960 and processed uranium and plutonium for commercial and naval applications. To evaluate the possibility of increased cancer rates in communities around the Apollo-Parks nuclear facilities, a cancer incidence and a cancer mortality survey were conducted. The county mortality findings are reported here. Nearly 40,000 cancer deaths occurred in the population residing in Armstrong and Westmoreland Counties from 1950 through 1995. Each of these two study counties was matched for comparison to three control counties in the same region on the basis of age, race, urbanization, and socioeconomic factors available from the 1990 U.S. Census. There were over 77,000 cancer deaths in the 6 control counties during the 45 y studied. Following similar methods used by the National Cancer Institute, Standardized Mortality Ratios (SMRs) were computed as the ratio of observed numbers of cancers in the study and control counties compared to the expected number derived from general population rates of the United States. Relative risks (RR) were computed as the ratios of the SMRs for the study and the control counties. There were no significant increases in the study counties for any cancer when comparisons were made with either the U.S. population or the control counties. In particular, deaths due to cancers of the lung, bone, liver, and kidney were not more frequent in the study counties than in the control counties. These are the cancers of a priori interest given that uranium and/or plutonium might be expected to concentrate in these tissues. Deaths from all cancers combined also were not increased in the study counties, and the RRs of cancer mortality before the facilities operated (1950-1964), during plant operations (1965-1980) and after plant closure (1980-1995) were similar: 0.96, 0.95 and 0.98, respectively. For childhood leukemia mortality, the relative risk comparing the study counties with their controls before plant start-up was 1.02, while during operations (RR 0.81) and after closure (RR 0.57) the relative risks were lower. The study is limited by the correlational approach and the relatively large size of the geographic areas of the counties studied.

Adolescent↗
PubMed2005

Using local data to monitor obesity rates in Wisconsin counties, 1994-2003.

INTRODUCTION: Although county-level obesity estimates are necessary for planning and evaluating community-based interventions, the quality of these data has never been examined. OBJECTIVES: To evaluate the reliability of the county-level obesity prevalence estimates from Wisconsin's 72 counties and to highlight the variation of obesity among Wisconsin counties. METHODS: Obesity prevalence data for each county in Wisconsin were obtained from the Wisconsin Behavioral Risk Factor Surveys (BRFS) from 1994 to 2003. During this 10-year period, 26,635 residents were interviewed by telephone, with sample sizes ranging from 6586 in Milwaukee County to 15 in Menominee County. The number of counties with reportable and reliable estimates, using criteria of sample sizes > or = 50 and > or = 300, respectively, was determined. RESULTS: The 10-year obesity prevalence was reportable for 68 of Wisconsin's 72 counties, ranging from 9.7% in Bayfield County to 29% in Langlade County. By pooling data from the BRFS for 5-, 3-, and 1-year periods, estimates are reportable for 43, 24, and 4 counties, respectively. A sample size of at least 300 provides a more reliable estimate, but is available for only 5 counties for a 5-year period. CONCLUSIONS: By pooling 10 years of survey data, obesity rates can be estimated for most of Wisconsin's 72 counties, demonstrating marked variation in rates across the state. This surveillance system provides valuable data for larger counties for planning and program evaluation. Supplemental surveys can be conducted to provide more reliable and timely estimates.

Humans↗
PubMed1992

Firearm homicide among black teenage males in metropolitan counties. Comparison of death rates in two periods, 1983 through 1985 and 1987 through 1989.

OBJECTIVE: To identify US counties (1) that had either significantly high or significantly low firearm homicide rates among black males 15 through 19 years of age in 1983 through 1985 and in 1987 through 1989, and/or (2) that experienced a significant increase in the firearm homicide rate between 1983 through 1985 and 1987 through 1989. DESIGN: Using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, county-level firearm homicide rates are analyzed. SETTING: Eighty counties with a population of at least 10,000 black males 15 through 19 years of age in 1987 through 1989. SUBJECTS: Black males 15 through 19 years of age whose underlying cause of death was classified as firearm homicide (E965.0 through E965.4, or E970) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURE: County-specific firearm homicide rate. RESULTS: In 1983 through 1985 and in 1987 through 1989, seven and 13 counties, respectively, were identified that had significantly high firearm homicide rates. Firearm homicide rates were significantly high in both time periods in the following counties: Los Angeles, California; Wayne, Michigan; Kings, New York; St Louis City, Missouri; and Baltimore City, Maryland. Firearm homicide rates increased significantly between 1983 through 1985 and 1987 through 1989 in 34 of the 80 counties. Twenty counties had significantly low rates in both time periods. Several counties with low rates in 1983 through 1985 experienced significant increases and by 1987 through 1989 were among those with high rates. CONCLUSIONS: Surveillance of firearm homicide rates at the county levels in counties with high and with low rates is a necessary first step in the development of successful violence prevention programs. Those counties where rates are high and increasing are the counties that are in greatest need for intervention strategies. Knowledge of the incidence of nonfatal firearm injuries is also needed.

Adolescent↗
PubMed2006

Identification of case clusters and counties with high infective connectivity in the 2001 epidemic of foot-and-mouth disease in Uruguay.

OBJECTIVE: To evaluate the influence of individual spatial units (ie, counties) on the epidemic spread of foot-and-mouth disease (FMD) virus. SAMPLE POPULATION: 163 counties in Uruguay where there was an outbreak of FMD between April 23 and July 11, 2001. PROCEDURE: A geographically referenced database was created, and the distance between counties (13,203 county pairs), road density of counties (163 counties), and time when cases were reported in those counties (11 weeks of the epidemic) were considered to assess global spatial and spatial-temporal autocorrelation, determine the contribution of links connecting pairs of counties with infected animals, and allow us to hypothesize the influence for spread during the epidemic for counties with greater than the mean infective link contributions. RESULTS: Case clusters were indicated by the Moran Iand Mantel tests during the first 6 weeks of the epidemic. Spatial lags between pairs of counties with infected animals revealed case clustering before and after vaccination was implemented. Temporal lags predicted autocorrelation for up to 3 weeks. Link indices identified counties expected to facilitate epidemic spread. If control measures had been implemented in counties with a high index link (identifiable as early as week 1 of the epidemic), they could have prevented (by week 11 of the epidemic) at least 2.5 times as many cases per square kilometer than the same measures implemented in counties with average link indices. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of spatial autocorrelation and infective link indices may identify network conditions that facilitate (or prevent) disease spread.

Animals↗
PubMedDate not supplied

Trends in cancer incidence in Allegheny County, Pennsylvania, 1937-71.

Cancer incidence rates by race, sex, and cancer site were obtained from the Third National Cancer Survey for the years 1969-71 for residents of Allegheny County, Pennsylvania. When the sex-site-specific rates for 1969-71, as well as incidence rates from surveys in the county in 1937, 1947, and 1957-58, were compared with U.S. rates for 1937, 1947, and 1969-71, a number of significant changes in incidence were observed. Male incidence of cancers of the lung, bronchus, and trachea increased steadily between 1937 and 1969-71 both in Allegheny County and the United States. In the county, female incidence rates for these cancers decreased in the period 1947 to 1957-58 but showed an average annual increased of 9.2 percent in the interval 1957-58 to 1969-71. Incidence rates for county males increased by an average of 4.4 percent per year from 1957-58 to 1969-71. For stomach cancer, incidence rates for both sexes have decreased sharply in the county and in the United States. In the county, stomach cancer rates for females declined by an annual average of 4 percent from 1957-58 to 1969-71, while those formales dropped 2.1 percent. There appears to have been a steady decline over time in cervical cancer in Allegheny County, although the average annual rate of decrease of 2.8 percent for the latest interval (1957-58 to 1969-71) is not as large as the decrease of 3.9 percent per year from 1947 to 1957-58. Breast cancer rates for the county appear to have been steadily, although slowly, increasing at an average rate of about 0.6 percent per year, in contrast to almost constant U.S. rates. The county's breast cancer incidence rate for 1969-71 almost equals the U.S rate. There have been steady increases in prostate cancer incidence in both Allegheny County and the United States since 1937. For all sites combined, male cancer incidence rates increased, while those for females slowly decreased in both Allegheny County and the United States during the interval 1937 to 1969-71. In the county, male rates for the interval 1937 to 1969-71 increased an average of 1 percent per year, while female rates declined approximately 0.3 percent annually.

Black People↗
PubMed2005

Primary care, social inequalities and all-cause, heart disease and cancer mortality in US counties: a comparison between urban and non-urban areas.

OBJECTIVE: The objective of this study was to test whether the association between primary care and income inequality on all-cause, heart disease and cancer mortality at county level differs in urban (Metropolitan Statistical Area-MSA) compared with non-urban (non-MSA) areas. STUDY DESIGN: The study consisted of a cross-sectional analysis of county-level data stratified by MSA and non-MSA areas in 1990. Dependent variables included age and sex-standardized (per 100,000) all-cause, heart disease and cancer mortality. Independent variables included primary care resources, income inequality, education levels, unemployment, racial/ethnic composition and income levels. METHODS: One-way analysis of variance and multivariate ordinary least squares regression were employed for each health outcome. RESULTS: Among non-MSA counties, those in the highest income inequality category experienced 11% higher all-cause mortality, 9% higher heart disease mortality, and 9% higher cancer mortality than counties in the lowest income inequality quartile, while controlling for other health determinants. Non-MSA counties with higher primary care experienced 2% lower all-cause mortality, 4% lower heart disease mortality, and 3% lower cancer mortality than non-MSA counties with lower primary care. MSA counties with median levels of income inequality experienced approximately 6% higher all-cause mortality, 7% higher heart disease mortality, and 7% higher cancer mortality than counties in the lowest income inequality quartile. MSA counties with low primary care (less than 75th percentile) had significantly lower levels of all-cause, heart disease and cancer mortality than those counties with high primary care. CONCLUSIONS: In non-MSA counties, increasing primary physician supply could be one way to address the health needs of rural populations. In MSA counties, the association between primary care and health outcomes appears to be more complex and is likely to require intervention that focuses on multiple fronts.

Analysis of Variance↗
PubMedDate not supplied

The association between sulfate air pollution and mortality at the county scale: an exploration of the impact of scale on a long-term exposure study.

The American Cancer Society (ACS) Study and its reanalysis are built upon in order to examine the impact of scale on the observed relationship between sulfates and mortality. The limitations of the original ACS Study (Pope et al., 1995) and the reanalysis of this study (Krewski et al., 2000) are discussed; while the latter dealt with some issues in using ecological data, it did not address scale. Next, the article outlines the county-scale study, the methods used to aggregate data, and the two-stage analysis used to derive relative risk (RR). Finally, the results of working at the county scale are compared with those obtained by the reanalysis team using larger metropolitan areas. Less than half of the cohort used in the metropolitan study were used at the county scale because of the limited availability of sulfate monitors and because five-digit ZIP codes more accurately assigned individuals to geographical areas. Therefore, the county data should be considered as new and not as a reorganization of the original data set. The reanalysis and the county studies should be considered as two separate studies that took different scales as their basic organizing principle. The RR of all-cause mortality from sulfate exposure at the county scale was 1.50 (1.30, 1.73) compared with 1.25 (1.13, 1.37) at the metropolitan scale; for cardiopulmonary mortality, the RR was 1.75 (1.48, 2.08) at the county scale compared with 1.29 (1.15, 1.46) at the metropolitan scale. Because lung cancer mortality was low in some counties, the two-stage random effects model became unstable. At the county scale, the RR from sulfates was more robust to the inclusion of ecologic covariates. Other place-specific ecologic covariates were either insignificant or barely significant (with a lower 95% confidence limit near 0.99 or 1.00) when included in the two-stage regression model for all-cause mortality with sulfates. Moreover, no ecologic covariate changed the RR of all-cause mortality from sulfates by 25% or more. Both population change and unemployment rate affected the RR for cardiopulmonary mortality from sulfate exposure by 25% or more in the county-scale analysis. However, when these two variables were entered into a multiple covariate analysis, the RR from sulfates decreased but remained strongly significant. Sulfur dioxide was not an important covariate at the county scale. Thus, at the county scale, long-term exposure to sulfates appears to be more strongly associated with increased risk of all-cause and cardiopulmonary mortality than previously indicated by the ACS study and its reanalysis.

Air Pollution↗
PubMed1996

Bayesian prediction of mean indoor radon concentrations for Minnesota counties.

Past efforts to identify areas with higher than average indoor radon concentrations by examining the statistical relationship between local mean concentrations and physical parameters such as the soil radium concentration have been hampered by the variation in local means caused by the small number of homes monitored in most areas. In this paper, indoor radon data from a survey in Minnesota are analyzed to minimize the effect of finite sample size within counties, to determine the true county-to-county variation of indoor radon concentrations in the state, and to find the extent to which this variation is explained by the variation in surficial radium concentration among counties. The analysis uses hierarchical modeling, in which some parameters of interest (such as county geometric mean radon concentrations) are assumed to be drawn from a single population, for which the distributional parameters are estimated from the data. Extensions of this technique, known as random effects regression and mixed effects regression, are used to determine the relationship between predictive variables and indoor radon concentrations; the results are used to refine the predictions of each county's radon levels, resulting in a great decrease in uncertainty. The true county-to-county variation of geometric mean radon levels is found to be substantially less than the county-to-county variation of the observed geometric means, much of which is due to the small sample size in each county. The variation in the logarithm of surficial radium content is shown to explain approximately 80% of the variation of the logarithm of geometric mean radon concentration among counties. The influences of housing and measurement factors, such as whether the monitored home has a basement and whether the measurement was made in a basement, are also discussed. The statistical method can be used to predict mean radon concentrations, or applied to other geographically distributed environmental parameters.

Air Pollution, Indoor↗
PubMed1980

[Guizhou County censured for poor planned parenthood work].

According to Guizhou Ribao, Zhijin County has done a very poor job of planned parenthood work. The county's natural population growth rate in the more than 10 years before the gang of 4 were smashed was over 30/1000. The work was grasped in 1977, and the growth rate that year fell to 18.1/1000. However the rate rose again to 26.64/1000 in 1979, 120% more than the planned target. The general office of the Guizhou Provinical CCP Committee has issued a circular criticizing the county's renewed high population growth in 1979. The situation remains very unsatisfactory this year. Why are the planned parenthood problems so serious in this county? The main reason is that the county CCP committee has failed to gain a sufficient understanding of the importance of the work, and has not grasped it as a major affair. For a long time the committee has gone no further than issuing general calls. Many leading cadres do not like planned parenthood. Many leading cadres in the provincial organs have taken the lead in producing an excessive number of children. A deputy secretary of the county CCP committee who already had 4 children had a 5th last year. The wife of the director of the county CCP committee's organization department works in the county planned parenthood office. She had her 5th child in 1977. The director of the Public Health Bureau, who already had 7 children, remarried last year and has now produced an 8th. In addition, the county CCP committee has failed to commend and reward certain people who have practiced planned parenthood. The county has not issued a single 1 child pledge certificate. On the contrary, cadres who have an excess number of children have actually been promoted. The problems in planned parenthood work in Zhijin County have yet to be solved. It is hoped that the county CCP committee and the departments concerned will rapidly organize forces and take decisive action to put things right and do a good job of planned parenthood work.

Asia↗
PubMed2003

[Creating the model county to promote the prevention of blindness in Zhejiang Province].

OBJECTIVE: To develop a system of enhancing work efficiency in prevention of blindness in Zhejiang province by creating the Model County in prevention of blindness. METHODS: Twenty counties were selected in the whole Zhejiang province to serve as the candidates of the Model County in prevention of blindness in 1996 - 1998. The activities for prevention of blindness were conducted in these counties according to the five standards of the Model County in prevention of blindness established by the National Committee for Prevention of Blindness. The Model County in prevention of blindness was awarded only after checking and accepting by the authorities in county, provincial and national levels. RESULTS: The effective way for creating the Model County in prevention was as follows: the local government put the prevention of blindness in the list of the priorities, the local committee for prevention of blindness was established, the three level network for prevention of blindness was established, the eye care workers were trained, the necessary equipment was provided. After the efforts for three years, seven counties were awarded as the Model County in prevention of blindness. In addition, Shaoxing Prefecture city became Model City in prevention of blindness. A strong effort was made to promote the activities for prevention of blindness during 1996 to 1998 in the other thirteen counties. The number of eye doctors increased from 602 into 1 850. There were two folds increase in the number of equipment availability, for example, slit lamp and ophthalmic microscope. The annual number of cataract surgeries was about 20 000. CONCLUSION: It appears to be a good approach to create the Model County to promote the prevention of blindness.

Blindness↗
PubMed1994

Indications for cesarean section in singleton pregnancies in two Danish counties with different cesarean section rates.

OBJECTIVE: To compare the clinical indications for delivery by cesarean section (CS) in singleton pregnancies in two Danish counties with different CS rates, and to describe the relation between CS in the two counties and parity, mother's age, type of delivery department, gestational age at birth, and birthweight. DESIGN: A population-based, follow-up study based on antecedent data. SETTING: Two Danish counties, where women deliver in obstetric as well as surgical departments, with a CS rate of 8.3% and 15.2%, respectively. SUBJECTS: All pregnant women in the two counties who delivered in 1989. MAIN OUTCOME MEASURES: Comparison of the rates of CS in the two counties carried out for five well-defined clinical indications: Previous cesarean section, breech presentation, dystocia, fetal distress, and other. SECONDARY MEASURES: Neonatal and maternal outcomes. RESULTS: In the county with the higher frequency of CS, all indications for CS were used significantly more often, except from 'fetal distress' in primiparous women. In this county 'breech presentation' was the commonest indication among primiparous women, whereas 'fetal distress' was the most common in the county with the lower CS rate. For multiparous women the highest CS rates in both counties were found among women who had had a previous CS. The major difference between the two counties was the threefold greater risk of CS indicated by 'dystocia' among multiparous women in the county with the higher CS rate. CONCLUSION: The regional differences in CS could not be explained by differences between the two populations or by an increased rate of a single indication, but could be due to differences in obstetric practice or expectations or demands from the pregnant women.

Adolescent↗
PubMed2002

Use of medical resources, complications and long-term outcome in patients hospitalized with acute chest pain. A comparison between a city university hospital and a county hospital.

OBJECTIVE: The primary aim was to test the hypothesis that there is a difference in long-term outcome after hospital discharge among patients hospitalized with acute chest pain in a university hospital and a county hospital. Secondary aims were to compare these two hospitals with regard to use of medical resources, occurrence of complications and risk indicators for death. PATIENTS: All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km(2)) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km(2)) due to symptoms of acute chest pain during a period of 6 months. RESULTS: Complications, use of medical resources and mortality during the subsequent 2 years after discharge were compared among 1,592 hospitalizations in a city hospital and 822 in a county hospital due to acute chest pain. Angina pectoris after the first event, congestive heart failure and various arrhythmias were more frequently reported in the county hospital. The use of medical resources differed. Thus, the use of betablockers, heparin, antiarrhythmics, diuretics and nipride was more frequent in the county hospital, whereas the use of nitrates, digitalis, coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was more frequent in the city hospital. Despite these differences, the mortality 2 years after hospital discharge was similar (14.7% in the city hospital and 12.8% in the county hospital, P=0.26). Two factors, intravenous digitalis in hospital and a prescription of insulin at discharge, were significantly more associated with death in the county hospital compared with the city hospital. CONCLUSIONS: When comparing a city university hospital with a county hospital with regard to patients admitted with chest pain, major differences in terms of complications and use of medical resources were found. Thus, various complications were reported more frequently in the county hospital. The use of medical resources varied, some being used more frequently in the county hospital, whereas others were used more frequently in the university hospital. Despite these differences the mortality 2 years after hospital discharge was similar in the two cohorts.

Acute Disease↗
PubMed2006

Associations of subsite-specific colorectal cancer incidence rates and stage of disease at diagnosis with county-level poverty, by race and sex.

BACKGROUND: This study examined associations of subsite-specific colorectal cancer incidence rates and stage of the disease with county-level poverty. METHODS: The 1998-2001 colorectal cancer incidence data, covering 75% of the United States population, were from 38 states and metropolitan areas. The county-level poverty data were categorized into 3 groups according to the percentage of the population below the poverty level in 1999: <10% (low-poverty), 10%-19% (middle-poverty), and >or=20% (high-poverty). Age-adjusted subsite-specific incidence rates (for all ages) and stage-specific incidence rates (for ages >or=50) were examined by race (whites and blacks), sex, and the county's poverty level. The differences in the incidence rates were examined using the 2-tailed z-statistic. RESULTS: The incidence rates of proximal colon cancer were higher among white males (11% higher) and white females (15% higher) in the low-poverty than in the high-poverty counties. No differences across county poverty levels were observed among whites for distal colon and rectal cancers or among blacks for all the subsites. The late-to-early stage incidence rate ratios were higher in the high-poverty than in the low-poverty counties among white and black males for distal colon and rectal cancers, among white females for distal colon cancer, and among black females for rectal cancer. For proximal colon cancer, however, the late-to-early stage rate ratios were similar across all county poverty levels. CONCLUSIONS: Higher incidence rates of proximal cancer were observed among white males and females in the low-poverty counties relative to the high-poverty counties. The higher late-to-early stage rate ratios in high-poverty than in low-poverty counties is observed for distal colon and rectal cancers, but not for proximal colon cancer.

Age Factors↗
PubMed2005

The relationship between the location of pediatric intensive care unit facilities and child death from trauma: a county-level ecologic study.

OBJECTIVES: To describe the relationship between the location of Pediatric Intensive Care Unit (PICU) facilities and county-level child death from trauma in the contiguous USA. STUDY DESIGN: We conducted a cross-sectional ecologic study using county-level data on death due to trauma in children 0 to 14 years of age from 1996 to 1998. These data were linked to 1997 county-level data on availability of PICU facilities. RESULTS: In 1997, PICU facilities were present in 9% of USA counties. There were 18,337 childhood deaths from trauma in the study period. The presence of PICU facilities in a county was associated with lower mortality from trauma (incidence rate ratio [IRR] = 0.72; 95% CI 0.67-0.78) compared to counties without PICU facilities. After controlling for residence in rural and low-income counties, and the presence of adult medicosurgical intensive care units, the presence of PICU facilities in a county remained associated with lower rates of death from trauma (IRR = 0.82; 95% CI 0.75-0.89). CONCLUSION: The presence of PICU facilities is related to lower mortality rates due to traumatic injuries at the county level. This finding may reflect the concentration of pediatric subspecialty care in counties with PICUs. This association merits further study with individual-level observations.

Adolescent↗
PubMed2003

Comparison of road crashes incidence and severity between some French counties.

Our aim is to compare traffic safety among several counties in France, and explore whether observed differences can be explained by differences in road types distribution and by differences in socio-economic characteristics between counties. Traffic safety is measured by incidence and severity, where incidence is defined by the ratio of counts of injury accidents and exposure, measured by the amount of kilometres driven. Severity is measured by the ratio between fatal and injury accidents. These indexes are analysed in the framework of Generalised Linear Models: counts of injury accidents are analysed with a Negative Binomial regression, which accounts for over-dispersion. Severity being the proportion of fatal accidents among injury accidents corresponds to the probability of a Binomial setting and this is modelled by a logistic regression. This modelling provides an easy way to adjust for covariates such as road type, environment (urban/rural) and evolution over time, and to test their possible interactions. We find that the time trend of each indice (incidence and severity) is the same across counties and across road types. There is a significant interaction between county and road type, meaning that, first, differences in traffic safety between counties are not fully explained by different road type distributions, and second, that the "ranking" of counties in term of incidence or severity varies according to the road type considered, and vice-versa. It was planned to explore global characteristics of the counties (driving and socio-economic data) as possible explanatory factors of differences between counties, but the existence of an interaction of county with road types shows the necessity of collecting and exploring characteristics of the sub-levels of road type within county.

Accidents, Traffic↗
PubMedDate not supplied

Age and smoking-adjusted lung cancer incidence in a Utah county with a steel mill.

In a recent study of urban air pollution, a Utah county with a steel mill was compared with a county without a steel mill. The result was that 38% of respiratory cancer deaths could be attributed to the air pollution emanating from the mill. Rates for smoking in this previous study were not adjusted, but assumed rats were similar in both counties. We used smoking information obtained from an ongoing radon and lung cancer case-control study to adjust for smoking, and no difference was found in incidence rates of respiratory cancer in the county with the steel mill, compared with the other urban counties and the rural counties among male and female nonsmokers and male smokers. There was a slight excess of lung cancer among female smokers in the county with the steel mill when compared with the other urban counties (rate ratio [RR] = 1.3, 95% confidence interval [95% CI] = 1.0-1.6), but there was no effect in nonsmoking women. We conclude that the findings of the previous study can be explained by differences in smoking rates between the county with the steel mill and the other counties.

Adult↗
PubMed2002

Genotype-specific carriage of Neisseria meningitidis in Georgia counties with hyper- and hyposporadic rates of meningococcal disease.

Carriage of Neisseria meningitidis in a Georgia county with hypersporadic incidence of meningococcal disease ("hypersporadic county") and in a county with no cases of meningococcal disease was determined by a cross-sectional pharyngeal culture study of high school students. Among 2730 students from whom culture samples were obtained, meningococcal carriage was 7.7% (140/1818) in the hypersporadic county and 6.1% (56/912) in the comparison county. Carriage rates by serogroup and genetic type (i.e., electrophoretic type [ET]) did not differ significantly between counties, but apartment or mobile home residency was a risk factor for carriage in the hypersporadic county. Although most cases of meningococcal disease in the hypersporadic county were caused by members of the serogroup C ET-37 clonal group, no ET-37 meningococcal isolates were recovered from carriers in this county. However, 38% of all meningococcal isolates recovered from carriers in both counties were members of the serogroup Y ET-508 clonal group, an emerging cause of meningococcal disease in Georgia and throughout the United States during 1996-2001. Shifts in carriage and transmission of meningococcal strains with different pathogenic potential are important determinants of meningococcal disease incidence.

Adolescent↗