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PubMed1999

Geographical differences of cancer incidence in Costa Rica in relation to environmental and occupational pesticide exposure.

BACKGROUND: This study describes geographical differences in cancer incidence in Costa Rica, and investigates if some of these differences may be related to pesticides. METHODS: Data were combined from the cancer registry (1981-1993), the 1984 population census, the 1984 agricultural census, and a national pesticide data set. The 81 counties of Costa Rica were the units for the ecological analyses. Adjacent counties were grouped into 14 regions (3 urban and 11 rural) with relatively similar socioeconomic characteristics. County indices for population density and agricultural variables were constructed and categorized. Differences across regions and categories were assessed by comparing observed numbers of incident cases to expected values derived from national rates. Within the tertile of most rural counties, rate ratios between categories of high and low pesticide use were calculated. RESULTS: In urban regions, excesses were observed for lung, colorectal, breast, uterus, ovary, prostate, testis, kidney, and bladder cancers; and in rural regions for gastric, cervical, penile, and skin cancers. Skin cancers (lip, melanoma, non-melanocytic skin and penile cancer) occurred in excess in coffee growing areas with extensive use of paraquat and lead arsenate. In the most rural subset, heavy pesticide use was associated with an increase of cancer incidence overall and at a considerable number of specific sites, including lung cancer (relative risk [RR] 2.0 for men and 2.6 for women) and all female hormone-related cancers (RR between 1.3 and 1.8). CONCLUSIONS: Regions and populations at high risk for specific cancers were identified. Several hypotheses for associations between pesticides and cancer emerged. The findings call for studies at the individual level.

Confidence Intervals↗
PubMed2001

Motor vehicle crash fatalities in the elderly: rural versus urban.

BACKGROUND: The elderly contribute disproportionately to hospital trauma mortality and expense. This population and its traffic fatality rate are increasing. The purpose of this study was to determine how the effect of age on vehicle-related mortality is modified by population density. METHODS: FARS data for vehicle drivers and passengers were analyzed after linkage to census age-specific county population and area estimates. Characteristics of crash fatalities in the elderly (> or =65 years old) were compared with younger victims, for each quartile of county population density. RESULTS: There were 5905 fatalities among the elderly, and 26,159 among the younger population, yielding annual rates (per 100,000) of 17.6 and 11.4. Rates were higher in counties with lower population density, but always higher among the elderly. Elderly fatal crash victims in all county quartiles were less likely to be male, unrestrained, riding with an intoxicated driver, or traveling over 60 MPH; all these risk factors were more frequent at lower population densities, regardless of age. Fatal crashes at intersections were more likely in the elderly, especially at higher population densities. CONCLUSION: Older age and lower population density independently increase vehicle-related mortality. Differing characteristics in each category suggest different preventive strategies.

Accidents, Traffic↗
PubMed2006

Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: using multilevel modeling in geriatric psychiatry.

OBJECTIVE: Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressive symptomatology in older adults in a diverse geographic region of central North Carolina. METHODS: The sample included 2,998 adults 65 or older residing in 91 census tracts. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Neighborhoods were characterized by five census-based characteristics: socioeconomic disadvantage, socioeconomic advantage, racial/ethnic heterogeneity, residential stability, and age structure. RESULTS: In ecologic level analyses, level of census tract socioeconomic disadvantage was associated with increased depressive symptoms. To determine whether neighborhood context was associated with depressive symptoms independently of individual characteristics, the authors used multilevel modeling. The authors examined the ability of each of five neighborhood (level 2) characteristics to predict a level 1 outcome (CES-D symptoms) controlling for the effects of individual (level 1) characteristics. Younger age, being widowed, lower income, and having some functional limitations were associated with increased depression symptoms conditional on census tract random effects. However, none of the neighborhood characteristics was significantly associated with depression symptoms, conditional on census tract random effects, either unadjusted or adjusted for individual characteristics. CONCLUSION: Any observed association between neighborhood sociodemographic characteristics and individual depressive symptoms in our sample may reflect the characteristics of the individuals who reside in the neighborhood rather than the neighborhood characteristics themselves. The use of multilevel modeling is important to separate these effects.

Aged↗
PubMed1995

Geographic variation in reporting of stroke deaths to underlying or contributing causes in the United States.

BACKGROUND AND PURPOSE: This study examines the geographic variation in the reporting of deaths with stroke as the underlying or contributing cause in the United States. METHODS: Data from the National Center for Health Statistics and Bureau of the Census were used to map the geographic distribution of race- and race/sex-specific, underlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates in the United States by state for 1979 through 1981. RESULTS: Underlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates were significantly clustered for both whites and blacks. However, the spatial distributions of underlying- and contributing-cause rates differed; there was no association between underlying- and contributing-cause rates for either racial group or for the various race/sex groups. There was no association between nonstroke mortality and stroke mortality rates. There was also very little spatial variation and no spatial clustering of the median number of contributing causes reported. CONCLUSIONS: The overall large-scale spatial distribution of resident underlying-cause stroke mortality rates cannot be explained by geographic variation in the selection of the underlying cause of death from among all causes reported on the death certificate, by different area-dependent tendencies for mortality generally, or by different tendencies to consider stroke as the cause of death when death occurs. Geographic variation in contributing-cause rates is not explained by variation in tendency to report contributing causes of death.

Age Factors↗
PubMed2005

Impact of intercensal population projections and error of closure on breast cancer surveillance: examples from 10 California counties.

INTRODUCTION: In 2001, data from the California Cancer Registry suggested that breast cancer incidence rates among non-Hispanic white (nHW) women in Marin County, California, had increased almost 60% between 1991 and 1999. This analysis examines the extent to which these and other breast cancer incidence trends could have been impacted by bias in intercensal population projections. METHOD: We obtained population projections for the year 2000 projected from the 1990 census from the California Department of Finance (DOF) and population counts from the 2000 US Census for nHW women living in 10 California counties and quantified age-specific differences in counts. We also computed age-adjusted incidence rates of invasive breast cancer in order to examine and quantify the impact of differences between the population data sources. RESULTS: Differences between year 2000 DOF projections and year 2000 census counts varied by county and age and ranged from underestimates of 60% to overestimates of 64%. For Marin County, the DOF underestimated the number of nHW women aged 45 to 64 years by 32% compared to the 2000 US census. This difference produced a significant 22% discrepancy between breast cancer incidence rates calculated using the two population data sources. In Los Angeles and Santa Clara counties, DOF-based incidence rates were significantly lower than rates based on census data. Rates did not differ significantly by population data source in the remaining seven counties examined. CONCLUSION: Although year 2000 population estimates from the DOF did not differ markedly from census counts at the state or county levels, greater discrepancies were observed for race-stratified, age-specific groups within counties. Because breast cancer incidence rates must be calculated with age-specific data, differences between population data sources at the age-race level may lead to mis-estimation of breast cancer incidence rates in county populations affected by these differences, as was observed in Marin County. Although intercensal rates based on population projections are important for timely breast cancer surveillance, these rates are prone to bias due to the error of closure between population projections and decennial census population counts. Intercensal rates should be interpreted with this potential bias in mind.

Breast Neoplasms↗
PubMed2006

Assessing household solid fuel use: multiple implications for the Millennium Development Goals.

OBJECTIVE: The World Health Organization is the agency responsible for reporting the Millennium Development Goal (MDG) indicator "percentage of population using solid fuels." In this article, we present the results of a comprehensive assessment of solid fuel use, conducted in 2005, and discuss the implications of our findings in the context of achieving the MDGs. METHODS: For 93 countries, solid fuel use data were compiled from recent national censuses or household surveys. For the 36 countries where no data were available, the indicator was modeled. For 52 upper-middle or high-income countries, the indicator was assumed to be < 5%. RESULTS: According to our assessment, 52% of the world's population uses solid fuels. This percentage varies widely between countries and regions, ranging from 77%, 74%, and 74% in Sub-Saharan Africa, Southeast Asia, and the Western Pacific Region, respectively, to 36% in the Eastern Mediterranean Region, 16% in Latin America and the Caribbean and in Central and Eastern Europe. In most industrialized countries, solid fuel use falls to the < 5% mark. DISCUSSION: Although the "percentage of population using solid fuels" is classified as an indicator to measure progress towards MDG 7, reliance on traditional household energy practices has distinct implications for most of the MDGs, notably MDGs 4 and 5. There is an urgent need for development agendas to recognize the fundamental role that household energy plays in improving child and maternal health and fostering economic and social development.

Air Pollution, Indoor↗
PubMed2006

Modeling of the temporal patterns of fluoxetine prescriptions and suicide rates in the United States.

BACKGROUND: To study the potential association of antidepressant use and suicide at a population level, we analyzed the associations between suicide rates and dispensing of the prototypic SSRI antidepressant fluoxetine in the United States during the period 1960-2002. METHODS AND FINDINGS: Sources of data included Centers of Disease Control and US Census Bureau age-adjusted suicide rates since 1960 and numbers of fluoxetine sales in the US, since its introduction in 1988. We conducted statistical analysis of age-adjusted population data and prescription numbers. Suicide rates fluctuated between 12.2 and 13.7 per 100,000 for the entire population from the early 1960s until 1988. Since then, suicide rates have gradually declined, with the lowest value of 10.4 per 100,000 in 2000. This steady decline is significantly associated with increased numbers of fluoxetine prescriptions dispensed from 2,469,000 in 1988 to 33,320,000 in 2002 (r(s) = -0.92; p < 0.001). Mathematical modeling of what suicide rates would have been during the 1988-2002 period based on pre-1988 data indicates that since the introduction of fluoxetine in 1988 through 2002 there has been a cumulative decrease in expected suicide mortality of 33,600 individuals (posterior median, 95% Bayesian credible interval 22,400-45,000). CONCLUSIONS: The introduction of SSRIs in 1988 has been temporally associated with a substantial reduction in the number of suicides. This effect may have been more apparent in the female population, whom we postulate might have particularly benefited from SSRI treatment. While these types of data cannot lead to conclusions on causality, we suggest here that in the context of untreated depression being the major cause of suicide, antidepressant treatment could have had a contributory role in the reduction of suicide rates in the period 1988-2002.

Antidepressive Agents, Second-Generation↗
PubMed1991

Regression-adjusted small area estimates of functional dependency in the noninstitutionalized American population age 65 and over.

Health planning efforts for the population age 65 and over have been hampered continually by the lack of reliable estimates of the noninstitutionalized long-term care population. Until recently national estimates were virtually nonexistent, and reliable small area estimates remain unavailable. However, with the recent publication of several national surveys and the 1990 Census, synthetic estimates can be made for states and counties by using multivariate methods to model functional dependency at the national level, and then applying the predicted probabilities to corresponding state and county data. Using the 1984 National Health Interview Survey's Supplement on Aging and the 1986 Area Health Resources File System, we have produced log-linear regression models that include demographic and contextual variables as predictors of functional dependency among the noninstitutionalized population age 65 and over. Age, sex, race, and the percent of the 65 and over population who reside in poverty were found to be significant predictors of functional dependency. Applying these models to 1986 Medicare Enrollment Statistics, regression-adjusted synthetic estimates of two levels of functional dependency were produced for all states and--as examples of how the rates can be used to produce additional synthetic estimates--the largest county in each state. We also produced point estimates and standard errors for the national prevalence of functional dependency among the noninstitutionalized population age 65 and over.

Activities of Daily Living↗
PubMed2003

Disparities in trends of hospitalization for potentially preventable chronic conditions among African Americans during the 1990s: implications and benchmarks.

OBJECTIVES: We compared trends in prevalence rates of preventable cardiovascular- and diabetes-related hospitalizations between African Americans and members of other major US racial/ethnic groups. METHODS: Standardized rates for 1991 to 1998 were derived from hospital and US census data for California. RESULTS: African Americans had significantly higher hospitalization rates in 1991, and discrepancies in rates continued to widen through 1998. Overall male and female rates were approximately 3 times higher for angina, 7 times higher for hypertension, between 7 and 8 times higher for congestive heart failure, and 10 times higher for diabetes. CONCLUSIONS: Widening disparities in cardiovascular- and diabetes-related health conditions were observed in this study, possibly owing to racial inequalities in provision of effective primary care.

Adult↗
PubMed2000

Epidemiology 1, 2, 3: study and sample design.

Bad sample designs and selection bias have plagued studies on schistosomiasis, and as a result some believe that schistosomiasis is too focal, making it difficult to draw reliable samples. The Epidemiology 1, 2, 3 (EPI 1, 2, 3) sample design, although complex, demonstrates that sampling theory is readily applicable to epidemiologic studies of schistosomiasis. The EPI 1, 2, 3 sampling scheme was designed to achieve the smallest feasible standard errors given EPI 1, 2, 3 objectives and certain logistical constraints. The sample design is a multi-stage selection of villages (ezbas, which were stratified by size) and households within each of 9 purposely selected Egyptian governorates. Villages and households were systemically selected from census frames. The sampling of ezbas was especially difficult because of the lack of complete sampling frames and their wide variation in population size. Ultimately, ezbas were stratified by size and then randomly selected from each stratum. Sample sizes for villages and ezbas and individuals within ezbas were calculated based on EPI 1 and 2 objectives, respectively. No re-selection was made for non-respondents. A 20% subsample of the full sample was drawn for clinical and ultrasonographic examinations. The sample selected from individual governorates closely parallel the age structure of the 1986 census of the respective rural populations. Details of the study design and related methods are given below.

Egypt↗
PubMed2006

Educational inequalities in life expectancy in German speaking part of Switzerland 1990-1997: Swiss National Cohort.

STUDY OBJECTIVE: Switzerland belongs to the group of nations with the highest life expectancy. However, it is unclear to what extent life expectancy varies across socio-economic groups. We used data from a large longitudinal study to quantify differentials in life expectancy across educational groups for men and women of different ages. DESIGN: The Swiss National Cohort linked the records from the December 4th, 1990 census with death certificate data up to 1997, using a probabilistic record linkage method. The current analysis was restricted to Swiss nationals resident in the German speaking part of the country. Life expectancy was calculated for four educational categories ("compulsory schooling or less", "vocational training", "upper secondary education", "university education") by constructing abridged life tables for men and women aged 30 or older. RESULTS: The study was based on 3.06 million persons and 262,552 deaths recorded during 19.01 million person-years of follow up. The educational level was lower in women than in men. In most age groups vocational training was the dominant educational category. At ages 30, 50, 65 and 80 men with university education lived 7.1, 5.4, 3.5 and 1.6 years longer than their counterparts with compulsory education or less. In women the corresponding differences were 3.6, 3.1, 2.7 and 2.2 years. CONCLUSIONS: In Switzerland educational gradients in life expectancy are substantial, particularly among young and middle-aged men. Social policies and public health strategies should address this situation.

Adult↗
PubMed2000

Attributable risk estimates for cataract to prioritize medical and public health action.

PURPOSE: Cataract is the most common cause of blindness in the world. The purpose of this study was to estimate the population attributable risk associated with identified risk factors for cortical, nuclear, and posterior subcapsular (PSC) cataract in a representative sample of the Victorian population aged 40 years and older. METHODS: Cluster, stratified sampling was used and participants were recruited through a household census. At locally established test sites, standardized clinical examinations were performed to assess cataract and personal interviews were conducted to quantify potential risk factors. Multivariate logistic regression was used to determine the independent risk factors associated with the three types of cataract, and the population attributable risk was calculated. RESULTS: A total of 3271 (83% of eligible) of the urban residents and 1473 (92%) rural residents participated. The urban residents ranged in age from 40 to 98 years (mean, 59 years), and 1511 (46%) were men. The rural residents ranged in age from 40 to 103 years (mean, 60 years), and 701 (48%) were men. The overall prevalence of cortical cataract was 12.1% (95% CL 10.5, 13.8), nuclear cataract 12.6% (95% CL 9.61, 15.7), and PSC cataract 4.93% (95% CL 3.68, 6.17). Significant risk factors for cortical cataract included age, female gender, diabetes for greater than 5 years, gout for greater than 20 years, arthritis, myopia, average annual ocular UV-B exposure, and family history of cataract (parents or siblings). Significant risk factors for nuclear cataract included age, female gender, rural residence, age-related maculopathy, diabetes for greater than 5 years, smoker for greater than 30 years, and myopia. The significant risk factors for PSC cataract were age, rural residence, thiazide diuretic use, and myopia. Of the modifiable risk factors, ocular UV-B exposure explains 10% of the cortical cataract in the community, and cigarette smoking accounts for 17% of the nuclear cataract. CONCLUSIONS: Because of the near universal exposure to UV-B in the environment, ocular protection has one of the highest modifiable attributable risks for cortical cataract and would therefore be an ideal target for public health intervention. Quit smoking campaigns can be expanded to incorporate information about the excess cataract in the community associated with long-term smoking. Nonmodifiable risk factors such as age, gender, and long-term medication use have implications for the timely referral and treatment for those at higher risk of cataract.

Adult↗
PubMed2002

Implications of changes in the UK social and occupational classifications in 2001 for vital statistics.

In 2001, three simultaneous changes were introduced which influence the reporting of vital statistics by socio-economic status. Registrar General's Social Class was replaced by the new National Statistics Socio-Economic Status (NS SEC); the Standard Occupational Classification (SOC) was updated from SOC90 to SOC2000; and the coding of employment status on vital statistics changed to stay in line with census coding and SOC2000. This article reports on these changes and describes a method for coding data prior to 2001 to NS SEC (named NS SEC90) in order to facilitate the analysis of health inequalities over time. NS SEC90 allocates 90 per cent of deaths to the same analytical category as NS SEC. This figure varies according to sub group.

Data Collection↗
PubMed2002

[Mortality in Oslo by inequalities in occupational class].

BACKGROUND: We know very little about social inequalities in mortality in Norway. The "Urban Health" project opens up the possibility of studying this issue for the whole population of Oslo. MATERIAL AND METHODS: In a linked file of all deaths in 1990-94 and the census of 1980 for all inhabitants in Oslo we have calculated death rates across five occupational classes in the age group 50-69 years. In order to compare with class-specific mortality in England and Wales we obtained similar data from National Statistics. RESULTS: Unskilled workers had considerably higher mortality rates than high-ranked employees in this population, 1.60 times higher for women and 1.92 times higher for men. In the three strata in between, mortality showed a smooth stepwise pattern which was steepest for age groups 35-69 for men and 50-69 for women. INTERPRETATION: Social inequalities in mortality are distinct in Oslo. For men the results were strikingly similar in Oslo and Britain; for women the inequality was smaller in Oslo. Comparing a city with a whole country is of limited interest, but the results are remarkable and call for further research. Some possible explanations of these similarities and dissimilarities in mortality in the two areas are discussed.

Aged↗
PubMed2003

Revised pregnancy rates, 1990-97, and new rates for 1998-99: United States.

OBJECTIVES: This report presents detailed pregnancy rates for 1990-99. Rates for 1991-97 are revised using populations consistent with the April 1, 2000, census; the revised populations are also used for the new 1998-99 rates. METHODS: Tabular and graphic data on pregnancy rates by age, race, and Hispanic origin, and by marital status are presented and described. RESULTS: In 1999, an estimated 6.23 million pregnancies resulted in 3.96 million live births, 1.31 million induced abortions, and 1.0 million fetal losses. The pregnancy rate in 1999 was 102.1 pregnancies per 1,000 women aged 15-44 years. The 1999 rate was similar to the rates since the mid 1990s, but it was 12 percent below the peak rate in 1990 (115.6). These data extend a consistent series of pregnancy rates from 1976 through 1999. The teenage pregnancy rate dropped steadily through the 1990s, reaching a record low of 86.7 per 1,000 aged 15-19 years in 1999, 25 percent lower than the 1990 peak (116.3). Rates fell more for younger than for older teenagers. The declines reflect reductions in births and abortions.

Abortion, Induced↗
PubMed2005

Race, ethnicity, and linguistic isolation as determinants of participation in public health surveillance surveys.

INTRODUCTION: To plan, implement, and evaluate programs designed to improve health conditions among racial and ethnic minority populations in the United States, public health officials and researchers require valid and reliable health surveillance data. Monitoring chronic disease and behavioral risk factors among such populations, however, is challenging. This study assesses the effects of race, ethnicity, and linguistic isolation on rates of participation in the Behavioral Risk Factor Surveillance System (BRFSS). METHODS: County-level data from the 2003 BRFSS survey and 2000 U.S. census were used to examine the effects of race, ethnicity, and linguistic isolation on six measures of survey participation (i.e., rates of resolution, screening, cooperation, response, language barriers, and refusal). RESULTS: Participation rates were significantly lower in counties with higher percentages of black people and people who did not speak English. Response rates decreased by 4.6% in counties with the highest concentration of black residents compared with counties with few black residents. Likewise, response rates decreased by approximately 7% in counties in which a larger percentage of the population spoke only Spanish or another Indo-European language compared with counties in which all residents spoke English. CONCLUSION: The negative relationship between the percentage of Spanish-only-speaking households and participation rates is troubling given that the BRFSS is conducted in both Spanish and English. The findings also indicate that more needs to be done to improve participation among other minorities. Researchers are investigating several ways of addressing disparities in participation rates, such as using postsurvey adjustments, developing more culturally appropriate data-collection procedures, and offering surveys in multiple languages.

Adolescent↗
PubMedDate not supplied

A census of mammal populations in Punta Leona Private Wildlife Refuge, Costa Rica.

Population sizes of six mammal species were estimated using the King method during the late dry season (March) of 1996 in the Punta Leona Private Wildlife Refuge, Costa Rica. The white-faced monkey (Cebus capucinus), coati (Nasua narica) and nine-banded armadillo (Dasypus novemcinctus) with 148, 46, and 8 sighted individuals, respectively, demonstrated the largest populations in the refuge. The Central American spider monkey (Ateles geoffroyi), tamandua anteater (Tamandua mexicana), and variegated squirrel (Sciurus variegatoides) were also included in the census. Population densities are calculated, habitat types are described, and habitat use and activity periods are discussed.

Animals↗
PubMed1986

Functional forms and the relevance of contiguous migration in the study of migration and employment growth.

The authors examine internal migration in the United States and emphasize the importance of decomposing total migration into contiguous and noncontiguous migration flows when analyzing employment change. "In this study, a simultaneous-equation model containing two equations, one for migration and the other for employment growth, has been specified in a general form and estimated by the 2SLS method for total, contiguous and noncontiguous migration flows. Results obtained from the use of 1970 Census data show that noncontiguous migration behaves significantly [differently] from contiguous migration, and that noncontiguous migration, rather than total migration, should be used for the study of factors affecting interstate migration. Results also indicate that the log-linear functional form commonly used in empirical studies cannot be accepted statistically."

Americas↗