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PubMed2006

[Estimation of emergency department activity and its relationship with inhospital bed disposition].

BACKGROUND AND OBJECTIVE: To find out if the daily emergency department (ED) census and daily ED admittances can accurately be foreseen based on the number of visits arrived on ED within the first shift hours. PATIENTS AND METHOD: For 6 consecutively months, the number of ED visits from 6 AM to 10 AM (early visits), and from 10 AM to next day 6 AM (daily ED census) was recorded, along with the number of both daily hospital and ED admittances from 6 AM to 6 AM. The analysis was performed for the ED as a whole, and for each one of its sections. RESULTS: A significant direct correlation was seen between the early visits and daily ED census. This relationship was even greater as considered the ED as a whole (R2 = 0.25; p < 0.001). A direct correlation was also found between daily ED census and daily admittances (R2 = 0.19; p < 0.001). CONCLUSIONS: The number of early ED visits is an important tool to accurately predict the daily ED census and the number of in-hospital beds needed for ED patients.

Emergency Service, Hospital↗
PubMed2004

Deaths: preliminary data for 2002.

OBJECTIVES: This report presents preliminary data on deaths for the year 2002 in the United States. U.S. data on deaths are shown by age, sex, race, and Hispanic origin. Death rates for 2002 are based on population estimates consistent with the April 1, 2000, census. Data on life expectancy, leading causes of death, and infant mortality are also presented. METHODS: Data in this report are based on a large number of deaths comprising approximately 97 percent of the demographic file and 93 percent of the medical file for all deaths in the United States in 2002. The records are weighted to independent control counts of infant deaths and deaths 1 year of age and over received in State vital statistics offices for 2002. Unless otherwise indicated, comparisons are made with final data for 2001. For certain causes of death, preliminary data differ from final data because of the truncated nature of the preliminary file. These are, in particular, unintentional injuries, homicides, suicides, and respiratory diseases. Populations were produced for the Centers for Disease Control and Prevention's National Center for Health Statistics under a collaborative arrangement with the U.S. Census Bureau. The populations reflect the results of the 2000 census. This census allowed people to report more than one race for themselves and their household members and also separated the category for Asian or Pacific Islander persons into two groups (Asian and Native Hawaiian or Other Pacific Islander). These changes reflected the Office of Management and Budget's (OMB) 1997 revisions to the standards for the classification of Federal data on race and ethnicity. Because only one race is currently reported in death certificate data, the 2000 census populations were "bridged" to the single race categories specified in OMB's 1977 guidelines for race and ethnic statistics in Federal reporting, which are still in use in the collection of vital statistics data. RESULTS: The age-adjusted death rate in 2002 for the United States decreased from 854.5 deaths per 100,000 population in 2001 to 846.8 in 2002. Declines in age-adjusted death rates occurred for Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Accidents (unintentional injuries), Chronic liver disease and cirrhosis, and Assault (homicide). The decrease in homicide reflects the effect of the terrorist attacks of September 11, 2001, on the rates for that year. Age-adjusted death rates also decreased for alcohol-induced deaths between 2001 and 2002. Age-adjusted death rates increased between 2001 and 2002 for the following causes: Alzheimer's disease, Influenza and pneumonia, Essential (primary) hypertension and hypertensive renal disease, Septicemia, and Nephritis, nephrotic syndrome and nephrosis. Life expectancy at birth rose by 0.2 years to a record high of 77.4 years. The infant mortality rate increased between 2001 and 2002, the first numerical increase in the infant mortality rate since 1957-58. However, supplemental analyses of fetal death records indicate that the perinatal mortality rate remained stable between 2001 and 2002.

Adolescent↗
PubMed2001

A genetic analogue of 'mark-recapture' methods for estimating population size: an approach based on molecular parentage assessments.

Molecular polymorphisms have been used in a variety of ways to estimate both effective and local census population sizes in nature. A related approach for estimating the current size of a breeding population, explored here for the first time, is the use of genetic 'marks' reconstructed for otherwise unknown parents in paternity or maternity analyses of progeny arrays. This method provides interesting similarities and contrasts to traditional mark-recapture methods based on physical tags. To illustrate, this genetic method is applied to a population of painted turtles on the Mississippi River to estimate the number of successfully breeding males. Non-genetic mark-recapture approaches were also applied to animals trapped at this location. Results demonstrate that such genetic data on parentage can be helpful not only in estimating contemporary population sizes, but also in providing additional information, not present in customary mark-recapture data, about possible extended movements of breeding individuals and the size of the pool of mates which they encounter.

Animals↗
PubMed2004

Comparison of spatial interpolation methods for the estimation of air quality data.

We recognized that many health outcomes are associated with air pollution, but in this project launched by the US EPA, the intent was to assess the role of exposure to ambient air pollutants as risk factors only for respiratory effects in children. The NHANES-III database is a valuable resource for assessing children's respiratory health and certain risk factors, but lacks monitoring data to estimate subjects' exposures to ambient air pollutants. Since the 1970s, EPA has regularly monitored levels of several ambient air pollutants across the country and these data may be used to estimate NHANES subject's exposure to ambient air pollutants. The first stage of the project eventually evolved into assessing different estimation methods before adopting the estimates to evaluate respiratory health. Specifically, this paper describes an effort using EPA's AIRS monitoring data to estimate ozone and PM10 levels at census block groups. We limited those block groups to counties visited by NHANES-III to make the project more manageable and apply four different interpolation methods to the monitoring data to derive air concentration levels. Then we examine method-specific differences in concentration levels and determine conditions under which different methods produce significantly different concentration values. We find that different interpolation methods do not produce dramatically different estimations in most parts of the US where monitor density was relatively low. However, in areas where monitor density was relatively high (i.e., California), we find substantial differences in exposure estimates across the interpolation methods. Our results offer some insights into terms of using the EPA monitoring data for the chosen spatial interpolation methods.

Air Pollutants↗
PubMed2004

The fertility contribution of Mexican immigration to the United States.

Crucial to the long-term contribution of immigration to a receiving country's population is the extent to which the immigrants reproduce themselves in subsequent, native-born generations. Using conventional projection methodologies, this fertility contribution may be poorly estimated primarily because of problems in projecting the number of immigrants who are at risk of childbearing. We propose an alternative method that obviates the need to project the number of immigrants by using the full sending-country birth cohort as the risk group to project their receiving-country childbearing. This "sending-country birth cohort" method is found to perform dramatically better than conventional methods when projecting to 1999 from base years both before and after the large increase in inflows of Mexican immigrants to the United States in the late 1980s. Projecting forward from 1999, we estimate a cumulative contribution of Mexican immigrant fertility from the 1980s to 2040 of 36 million births, including 25% to 50% more births after 1995 than are projected using conventional methods.

Birth Rate↗
PubMed1993

Identification and characterization of populations living near high-voltage transmission lines: a pilot study.

Populations living close to high-voltage transmission lines often have residential magnetic field exposures in excess of 1 microT, and sometimes over 2 microT. Yet, populations studied in most epidemiologic investigations of the association between residential magnetic field exposure and cancer typically have exposures below 1 microT and frequently below 0.5 microT. To improve statistical power and precision, it would be useful to compare high exposure populations with low exposure populations rather than only studying small differences within low exposure populations. Toward this end, we have developed an automated method for identifying populations living near high-voltage transmission lines. These populations likely have more highly exposed individuals than the population at large. The method uses a geographic information system (GIS) to superimpose digitized transmission line locations on U.S. Census block location data and then extract relevant demographic data. Analysis of data from a pilot study of the populations residing within 100 m of a 29-km segment of one 230-kV line in New Jersey shows that when compared to populations in the surrounding census blocks farther than 100 m from this line, those populations close to the line have similar demographics but differ in terms of perceived housing value variables. We believe that the approach we have developed will enable investigators to rapidly identify and characterize populations living near high-voltage transmission lines on a statewide basis for considering the impact of exposures and for public policy and that these populations also can be used for epidemiologic study.

Demography↗
PubMed2003

Blindness: how to assess numbers and causes?

BACKGROUND: Traditionally, blindness surveys have modelled themselves on the "gold standard" of a census and examination of a whole population. Blindness, however, is a relatively rare condition even in badly affected communities; hence, large sample sizes are required to gain adequate estimates of prevalence, particularly by cause. METHODS: Three assessments of blindness prevalence and aetiology in the same communities are reported. One involved asking individuals questions concerning their visual status during a census (perceived visual status, PVD), one involved examination of all ostensibly visually disabled people presenting to a central point within each community (examination of the visually disabled, EVD), and the final assessment involved a gold standard examination of the whole population (whole community examination, WCE). RESULTS: In a population of 8139 the blindness prevalence was 2.7% PVS, 3.6% EVD, and 3.1% WCE. Attributed causes of blindness were not representative in the PVS except for cataract. The END yielded cause specific estimates not far from those found at WE except for a relative under-representation of glaucoma and optic atrophy. CONCLUSION: Since cataract is, by a significant margin, the most common cause of blindness in the world such a simple method as asking individuals if they are blind and what they believe to be the cause may yield adequate estimates of the problem for planning eye care strategies for this condition. Alternatively, an ophthalmologist visiting villages and examining allcomers for visual disability may provide reasonably accurate cause specific prevalence estimates without the expense of a major blindness survey.

Adolescent↗
PubMed1994

Sample survey methods as a quality assurance tool in a general practice immunisation audit.

AIMS: In a multidoctor family practice there are often just too many sets of patients records to make it practical to repeat an audit by census of even an age band of the practice on a regular basis. This paper attempts to demonstrate how sample survey methodology can be incorporated into the quality assurance cycle. METHODS: A simple random sample (with replacement) of 120 from 580 children with permanent records who were aged between 6 weeks and 2 years old from an Auckland general practice was performed, with sample size selected to give a predetermined precision. The survey was then repeated after 4 weeks. RESULTS: Both surveys were able to be completed within the course of a normal working day. An unexpectedly low level of under 2 years olds that were recorded as not overdue for any immunisations was found (22.5%) with only a modest improvement after a standard telephone/letter catch up campaign. Seventy-two percent of the sample held a group one community services card. CONCLUSIONS: The advantages of properly conducted sample surveys in producing useful estimates of known precision without disrupting office routines excessively were demonstrated. Through some attention to methodology, the trauma of a practice census can be avoided.

Child, Preschool↗
PubMed1994

Using census and mortality data to target small areas for breast, colorectal, and cervical cancer screening.

OBJECTIVES: The goal of this study was to develop and validate quantitative models for estimating cancer incidence in small areas. METHODS: The outcome for each cancer site was the incidence of disease that had reached a late stage at the time of diagnosis. Two sets of predictors were used: (1) census-based demographic variables and (2) census-based demographic variables together with the cancer-specific mortality rate. RESULTS: The best models accounted for a substantial percentage of between area variability in late-stage rates for cancer of the breast (46%), cervix (61%), and colon/rectum (58%). A validation procedure indicated that correct identification of small areas with high rates of late-stage disease was two to three times more likely when model-based estimates were used than when areas were selected at random. CONCLUSIONS: Additional testing is needed to establish the generality of the geographic targeting methodology developed in this paper. However, there are strong indications that small-area estimation models will be useful in many regions where planners wish to target cancer screening programs on a geographic basis.

Breast Neoplasms↗
PubMed1993

Interfacing U.S. census map files with statistical graphics software: application and use in epidemiology.

In 1990, the United States Bureau of the Census released detailed geographic map files known as TIGER/Line (Topologically Integrated Geographic Encoding and Referencing). The TIGER files, accessible through purchase or federal repository libraries, contain 24 billion characters of data describing various geographic features including coastlines, hydrography, transportation networks, political boundaries, etc. for the entire United States. Many of these physical features are of potential interest in epidemiological case studies. Unfortunately, the TIGER data base only provides raw alphanumeric data; no utility software, graphical or otherwise, is included. Recently, the S statistical software package has been extended to include a map display function. The map function augments S's high-level approach towards statistical analysis and graphical display of data. Coupling this statistical software with the map data base developed for U.S. Census data collection will facilitate epidemiological research. We discuss the technical background necessary to utilize the TIGER data base for mapping with S. Two types of S maps, segment-based and polygon-based, are discussed along with methods to construct them from TIGER data. Polygon-based maps are useful for displaying regional statistical data, such as disease rates or incidence at the census tract level. Segment-based maps are easier to assemble and are appropriate when the data are not regionalized. Census tract data of AIDS incidence in San Francisco and lung cancer case locations relative to petrochemical refinery sites in Contra Costa County are used to illustrate the methods and potential uses of interfacing the TIGER data base with S.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Decades of disparity: widening ethnic mortality gaps from 1980 to 1999.

BACKGROUND: Maori and Pacific deaths were severely undercounted in the mid-1980s and first half of 1990s, resulting in numerator-denominator bias when calculating mortality rates by ethnicity. We used the New Zealand Census-Mortality Study to adjust for this bias and calculate corrected ethnic-specific mortality rates from 1980 to 1999. METHODS: Age-specific adjusters were calculated for the period 1980-99. They were applied to mortality data to obtain a corrected number of deaths. Mortality rates (by age and gender) were calculated by dividing the total number of adjusted deaths by the respective census counts. RESULTS: Contrary to unadjusted rates, corrected Maori and Pacific mortality rates were clearly higher than non- Maori non-Pacific rates during the 1980s and early 1990s. From 1980-84 (1361 per 100,000 for males and 965 per 100,000 for females) to 1996-99 (1258 and 894), there was only a modest decrease in Maori 1 to 74 year old mortality rates. Pacific mortality rates changed little from 1980-84 (1264 and 672) to 1996-99 (1144 and 696 per 100,000 for males and females respectively). Non-Maori non-Pacific mortality rates, however, decreased by about 30% from 1980-84 (919 and 553) to 1996-99 (641 and 407 per 100,000 for males and females, respectively). Cancer (lung, prostate, breast, colorectal) mortality rates tended to increase over time among Maori compared to steadily decreasing among non-Maori non-Pacific. Of note, Pacific colorectal cancer mortality rates have increased by about ten-fold during the 1980s and 1990s. All ethnic groups experienced falls in cardiovascular disease mortality rates, but the decreases were much greater among non-Maori non-Pacific. CONCLUSION: The gaps between Maori and non-Maori non-Pacific mortality widened over the 1980s and 1990s mainly due to steadily declining non-Maori non-Pacific mortality rates and stagnant Maori mortality rates. Likewise, the gaps between Pacific and non-Maori non-Pacific mortality also widened during that period.

Adolescent↗
PubMed1998

Spatial clustering of childhood leukaemia: summary results from the EUROCLUS project.

The interpretation of reports of clusters of childhood leukaemia is difficult, first because little is known about the causes of the disease, and second because there is insufficient information on whether cases show a generalized tendency to cluster geographically. The EUROCLUS project is a European collaborative study whose primary objective is to determine whether the residence locations of cases at diagnosis show a general tendency towards spatial clustering. The second objective is to interpret any patterns observed and, in particular, to see if clustering can be explained in terms of either infectious agents or environmental hazards as aetiological agents. The spatial distribution of 13351 cases of childhood leukaemia diagnosed in 17 countries between 1980 and 1989 has been analysed using the Potthoff-Whittinghill method. The overall results show statistically significant evidence of clustering of total childhood leukaemia within small census areas (P=0.03) but the magnitude of the clustering is small (extra-Poisson component of variance (%) = 1.7 with 90% confidence interval 0.2-3.1). The clustering is most marked in areas that have intermediate population density (150-499 persons km[-2]). It cannot be attributed to any specific age group at diagnosis or cell type and involves spatial aggregation of cases of different ages and cell types. The results indicate that intense clusters are a rare phenomenon that merit careful investigation, although aetiological insights are more likely to come from investigation of large numbers of cases. We present a method for detecting clustering that is simple and readily available to cancer registries and similar groups.

Adolescent↗
PubMed2004

The colour of noise in short ecological time series data.

The statistical properties of ecological time series data and general trends therein have historically been of great interest to ecologists. In recent years, there has been a focus on establishing the relative importance of 'memory' in these data. The classic study by Pimm & Redfearn (1988 Nature, 334, 613-614) has been extremely important in establishing within the ecological community the idea that population time series are generally 'red-shifted' (dominated by long-term trends). This conclusion was reached by exploring the relationship between observed variability and census length in ecological data and comparing them with those for artificially generated data. Here, we highlight some subtle problems with this approach and suggest possible alternative methods of analysis, especially when the time series of interest are short.

Censuses↗
PubMed1999

Socioeconomic status and birth weight: comparison of an area-based measure with the Registrar General's social class.

OBJECTIVE: To compare the relation of birth weight with socioeconomic status measured by an area-based measure of material deprivation and by the Registrar General's social class. SETTING: West Midlands Health Region 1991-93. STUDY DESIGN: Retrospective cohort study. METHOD: Birthweight data by enumeration district deciles ranked by Townsend Deprivation Index based on 1991 census data for all live births in the West Midlands Health Region were studied in three consecutive whole year birth cohorts, 1991 to 1993 and by Registrar General's social class in a 10% sample of live births (within marriage and jointly registered, provided by the Office of National Statistics) in the same region for the same period. Estimated proportions of births < 2500 g and < 3500 g "attributable" to social inequalities were compared for both socioeconomic status measures. The proportion of infants in each birthweight group were calculated for both measures. Relative risk (95% confidence intervals) of birth in each birthweight group for lowest versus highest socioeconomic status groups were calculated. RESULTS: The estimated proportions of births < 2500 g "attributable" to social inequalities were 30% using the area-based measure and 27% using the Registrar General's social class. For births < 3500 g, the estimated proportions were 12% for the area-based measure and 7% for social class. There was a positive linear relation between the proportion of babies weighing > or = 3500 g and increasing socio-economic status measured by either method. Gradients in the opposite direction were noted for the proportion of babies born in the other birth weight groups. Relative risk of birth weight < 3500 g was 1.30 (95% CIs 1.28, 1.32) for most versus least deprived decile and 1.17 (95% CIs 1.10, 1.25) for social class V versus I. For birth weight < 2500 g the risks were 1.99 (95% CIs 1.85, 2.18) and 2.04 (95% CIs 1.53, 2.73) respectively and for birth weight < 1500 g, 2.11 (95% CIs 1.73, 2.57) for most versus least deprived decile (numbers too small for analysis in the Office of National Statistics sample). CONCLUSION: A substantial proportion of births < 2500 g and < 1500 g are statistically "attributable" to social inequality. The results demonstrate that, using either socioeconomic measure, the likelihood of being born weighing > or = 3500 g, the most advantageous group, is substantially greater in the socially advantaged. Using the area-based measure, an estimated 12% of births < 3500 g could be ascribed to social inequalities whereas the same figure using social class was 7%. These findings suggest that this proxy measure of socioeconomic status may be a better discriminator in the study of pregnancy outcomes in this population than classification by occupational social class. Another advantage is its almost universal availability in routine records and its universal population coverage.

Birth Weight↗
PubMed1997

Epidemiology of adult rheumatoid arthritis in northwest Greece 1987-1995.

OBJECTIVE: Rheumatoid arthritis (RA) in Greece differs in its clinical, serological, and genetic aspects from that of Northern European countries. We investigated the incidence and prevalence of RA in the district of Ioannina in northwest Greece for the period 1987-1995. METHODS: We investigated records of patients at rheumatology clinics of university and general hospitals and private clinics in Ioannnina. Diagnosis was by 1987 ACR criteria, and the population data were based on the 1991 national census. Crude and age specific rates were calculated as number of cases per 1000 inhabitants. Age adjusted rates were obtained by the direct method using the European standard population. RESULTS: A total of 428 cases of RA were identified during the study period. Total prevalence of RA was for men 2.05 and for women 4.78 cases/1000 inhabitants, and the total women/men ratio was 2.33. Annual incidence rates fluctuated between 0.15 and 0.36/1000 inhabitants. CONCLUSION: Our findings suggest a low prevalence and low incidence of RA in northwest Greece. Environmental and/or genetic factors may explain this low frequency of the disease in the population studied.

Adolescent↗
PubMed2000

Lost human capital from early-onset chronic depression.

OBJECTIVE: Chronic depression starts at an early age for many individuals and could affect their accumulation of "human capital" (i.e., education, higher amounts of which can broaden occupational choice and increase earnings potential). The authors examined the impact, by gender, of early- (before age 22) versus late-onset major depressive disorder on educational attainment. They also determined whether the efficacy and sustainability of antidepressant treatments and psychosocial outcomes vary by age at onset and quantified the impact of early- versus late-onset, as well as never-occurring, major depressive disorder on expected lifetime earnings. METHOD: The authors used logistic and multivariate regression methods to analyze data from a three-phase, multicenter, double-blind, randomized trial that compared sertraline and imipramine treatment of 531 patients with chronic depression aged 30 years and older. These data were integrated with U.S. Census Bureau data on 1995 earnings by age, educational attainment, and gender. RESULTS: Early-onset major depressive disorder adversely affected the educational attainment of women but not of men. No significant difference in treatment responsiveness by age at onset was observed after 12 weeks of acute treatment or, for subjects rated as having responded, after 76 weeks of maintenance treatment. A randomly selected 21-year-old woman with early-onset major depressive disorder in 1995 could expect future annual earnings that were 12%-18% lower than those of a randomly selected 21-year-old woman whose onset of major depressive disorder occurred after age 21 or not at all. CONCLUSIONS: Early-onset major depressive disorder causes substantial human capital loss, particularly for women. Detection and effective treatment of early-onset major depressive disorder may have substantial economic benefits.

Adult↗
PubMed1998

A regression analysis estimating the number of drug-using arrestees in 185 US cities.

OBJECTIVES: This study sought to provide population-based estimates of drug-using arrestees in the 185 largest US cities. METHODS: A prevalence model for drug-using arrestees was developed by relating selected social indicators (from 1990 census data) and drug use rates (from Drug Use Forecasting program data) via logistic regression analysis. RESULTS: It was estimated that in 1990, across the 185 cities, about 925,000 arrestees used cocaine, 317,000 used opiates, 213,000 used amphetamines, 389,000 were drug injectors, and 1,296,000 used an illicit drug. CONCLUSIONS: This approach represents a cost-efficient method for prevalence estimation based on empirically demonstrable relationships between social indicators and drug use rates.

Adolescent↗
PubMed2005

Neighborhood composition and incidence of cancer among Hispanics in the United States.

BACKGROUND: Hispanics in the United States have a 33% lower age-adjusted incidence of cancer and a 38% lower cancer mortality rate compared with non-Hispanic whites. This may be secondary to health behaviors that vary with residential and economic assimilation. The authors investigated whether cancer incidence among Hispanics increased with residential and economic assimilation into mainstream culture. METHODS: Data from the Surveillance, Epidemiology, and End Results program (SEER) and the U.S. Census Bureau were used to compare cancer incidence rates and rate ratios as a function of percentage of Hispanics and income of Hispanics in a census tract. Type of cancer was identified with a site recode variable in the SEER data set. Cases with in situ prostate and cervical carcinoma were excluded. Hispanic ethnicity in SEER was identified by medical record review and Hispanic surname lists. The study also used income of Hispanics living in the census tract, age at diagnosis, and stratification by gender. RESULTS: The incidence of breast, colorectal, and lung carcinoma among Hispanics increased as the percentage of Hispanics in the census tract decreased and as tract Hispanic income increased. For example, there was a 39% reduction in breast carcinoma and a 38% reduction in male colorectal carcinoma when the Hispanic population in high-density Hispanic neighborhoods in the lowest income quartile was contrasted to Hispanics living in tracts with the lowest total percentage of Hispanics in the highest income quartile. CONCLUSIONS: The lower cancer rates among Hispanics relative to non-Hispanic whites in the United States may dissipate as Hispanics become more assimilated into the mainstream society.

Acculturation↗