Statistical aspects of physician payment systems. A report of the National Committee on Vital and Health Statistics.
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Ambulatory Care↗
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Recommendations to avoid the prone sleeping position and recent statistics for sudden infant death syndrome in the United States.
OBJECTIVE: To determine whether two recent, nonsynchronized recommendations to avoid the prone position for sleeping infants were each followed by a decline in the incidence or expected number of cases of sudden infant death syndrome (SIDS). DATA SOURCES: Data were collected from SIDS counseling programs, state vital statistics, and medical examiner records of 44 states and the city of Los Angeles, Calif. Data for a state were excluded because of either incompleteness or nonresponsiveness to request. DATA SYNTHESIS: In the 8 months following an article in the Seattle Times advising against the use of the prone position for sleeping infants, the incidence of SIDS fell by 52.0% in King County (where 32 households in every 100 receive the Seattle Times) and by 19.9% in Snohomish County (16 in 100 households). In the remaining 37 counties of Washington State (on average, < 1 in 100 households are subscribers), the incidence rose 3.4%. Examination of medical examiner records for King County and Snohomish County revealed no compensatory increase in other causes of death and no cases attributed to aspiration. In the 12 months following the initial 8 months, the number of SIDS cases in King County remained at approximately half the previous annual average (25 vs 49 cases). At the national level, the American Academy of Pediatrics' recommendation on April 15, 1992, was followed in the next 6 months by a decrease of 12.0% in the number of SIDS cases compared with the previous year. CONCLUSIONS: The results are consistent with those of intervention programs in other countries. A national campaign to inform parents of the risk of the prone position in early infancy should be given serious consideration.
Cause of Death↗
[AIDS--the leading cause of death among young adult men in Copenhagen and Frederiksberg].
The objective was to describe the extent to which HIV infection has become a major cause of death among young adults in Denmark. The design used was retrospective review of underlying causes of death recorded in the National Danish Register of Causes of Death on the basis of submitted death certificates. Analysis of mortality statistics revealed, that from 1980 to 1993 AIDS became the 5th leading cause of death among men 25 to 49 years of age in Denmark after cancer, accidents, suicide and heart disease. AIDS among women had little impact on the vital statistics in the period. In the municipalities of the City of Copenhagen AIDS was the major cause of death among men already from 1990 and in 1993 death from AIDS comprised 25% of all causes (n = 107, death rate = 88/100,000). The rising rates of deaths attributed to AIDS among younger men show no sign of decreasing neither in the capital nor in the country as a whole.
Acquired Immunodeficiency Syndrome↗
Registration of cancer mortality data in a developing area: Chennai (Madras, India) experience.
OBJECTIVES: This study was carried out to evolve a method to improve the registration of cancer mortality data in Chennai (Madras, India). METHODS: Data on cancer deaths have been collected from the Vital Statistics Department (VSD) by a population-based cancer registry (PBCR) in Chennai only since 1982. The low mortality-to-incidence ratio during 1982-84 suggested under-registration of mortality data. Since 1985, the PBCR has taken special effort to ascertain the vital status of cancer cases by sending reply-paid postcards and/or making house visits. The data on all deaths occurring in Chennai, irrespective of stated cause of death in the death certificate, have been collected from the VSD since 1992. RESULTS: Deaths that occurred in Chennai and obtained by sending reply-paid postcards and/or making house visits were registered in VSD as non-cancer causes of death; hence, these data were not collected from VSD. The sensitivity and positive predictive values of death certificates on cancer diagnosis based on 1992 and 1993 mortality data were 57 percent and 99.5 percent, respectively. CONCLUSION: Since the accuracy of death certificate information on cancer diagnosis is relatively low in a developing country such as in India, collecting data on all deaths will improve the mortality data registration in PBCRs.
Cause of Death↗
Changing asthma mortality.
BACKGROUND: Rates of death from asthma in the United States have increased progressively since 1978. OBJECTIVE: To identify recent trends in asthma mortality. METHODS: The National Center for Health Statistics supplied asthma mortality data (ICD 493), and the Bureau of the Census supplied population data that permitted calculation and graphing of mortality data by age group, race, sex, and region and calculation and tabulation of mortality rates by state. The Departments of Health and Vital Statistics of Australia, Canada, Great Britain, and New Zealand provided data that permitted calculation and graphing of rates of death from asthma (ICD 493) in those countries. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 in 1977 and 1978 to 2.0 in 1989, fell to 1.9 in 1990 and then increased again to 2.0 in 1991. Rates have been much higher for blacks than whites; age-adjusted rates for blacks increased from 1.5 in 1977 and 1978 to 3.5 in 1991; those for whites, from 0.5 in 1977 to 1.2 in 1991. Rates of death from asthma have increased with age and across time have increased in almost all age groups. The greatest proportional increase has occurred at 10 to 14 years of age with rates of 0.1 in 1979, 0.5 in 1987, and 0.4 in 1991. Rates of death at 5 through 34 years of age have increased for both blacks and whites in all regions of the country. Increases in rates of death from asthma have also occurred in other countries, but rates have been falling in New Zealand since the peak of 8.1 in 1980 and in Australia since the peak of 5.7 in 1989. CONCLUSIONS: The recent plateau in increases in rates of death from asthma in the United States may suggest effectiveness of improved management of asthma that may have followed increased awareness of the importance of optimal management.
Adolescent↗
Prevalence of and risk factors for sudden infant death syndrome in Canada.
OBJECTIVE: To analyse and describe the prevalence of sudden infant death syndrome (SIDS) in the Canadian population in relation to the distribution of known risk factors for the syndrome. To explain the observed interprovincial variation in SIDS rates. DESIGN: Retrospective population-based case-control study. SETTING: All the provinces and territories of Canada except Quebec. SUBJECTS: The birth and infant death records of singleton births for 1986-88 were linked. The linkage was successful in matching 904 (86%) of the 1053 deaths attributed to SIDS to the birth file for the infant. For each SIDS case three control babies who survived infancy were chosen at random, matched by province of birth. MAIN OUTCOME MEASURES: Infant death classified as a "sudden infant death." Independent variables included infant's sex, birth weight and gestational age, being small for gestational age, mother's age, marital status and parity, and father's age. RESULTS: The risk of SIDS was greater for boys (odds ratio [OR] 1.47, 95% confidence limits [CLs] 1.26 and 1.70) than for girls and was greater for the infants of unmarried women (OR 3.48, 95% CLs 2.94 and 4.11) than for those of married women. The risk of SIDS was inversely related to birth weight (p < 0.001), duration of pregnancy (p < 0.001) and mother's age (up to age 35) (p < 0.001) and was directly related to parity (up to four) (p < 0.001). The available information on birth and death registrations enabled about 30% of deaths from SIDS to be predicted. CONCLUSIONS: Logistic regression equations based on the risk factors available in vital statistics data have low power to predict provincial differences in rates of SIDS. Consequently, there may be additional factors that may explain provincial variation. There is a need for a well-designed case-control study that examines more variables than are available through vital registration systems.
Canada↗
Chronic obstructive pulmonary disease surveillance--United States, 1971-2000.
PROBLEM/CONDITION: Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema but has been defined recently as the physiologic finding of nonreversible pulmonary function impairment. This surveillance summary reports trends in different measures of COPD during 1971-2000. REPORTING PERIOD COVERED: This report presents national data regarding objectively determined COPD (1971-1994); COPD-associated activity and functional limitations (1980-1996); self-reported COPD prevalence, COPD physician office and hospital outpatient department visits, COPD hospitalizations, and COPD deaths (1980-2000); and COPD emergency department visits (1992-2000). DESCRIPTION OF SYSTEMS: The Centers for Disease Control's National Center for Health Statistics conducts the National Health Interview Survey annually, which includes questions concerning COPD and activity limitations. The National Center for Health Statistics collects physician office-visit data in the National Ambulatory Medical Care Survey, emergency department and hospital outpatient department data in the National Hospital Ambulatory Medical Care Survey, hospitalization data in the National Hospital Discharge Survey, and death data in the Mortality Component of the National Vital Statistics System. Data regarding pulmonary function were obtained from the National Health and Nutrition Examination Surveys (NHANES) I (1971-1975) and III (1988-1994), and data regarding functional limitation were obtained from NHANES III, Phase 2 (1991-1994). RESULTS: During 2000, an estimated 10 million U.S. adults reported physician-diagnosed COPD. However, data from NHANES III estimate that approximately 24 million United States adults have evidence of impaired lung function, indicating that COPD is underdiagnosed. During 2000, COPD was responsible for 8 million physician office and hospital outpatient visits, 1.5 million emergency department visits, 726,000 hospitalizations, and 119,000 deaths. During the period analyzed, the most substantial change was the increase in the COPD death rate for women, from 20.1/100,000 in 1980 to 56.7/100,000 in 2000, compared with the more modest increase in the death rate for men, from 73.0/100,000 in 1980 to 82.6/100,000 in 2000. In 2000, for the first time, the number of women dying from COPD surpassed the number of men dying from COPD (59,936 vs 59,118). Another substantial change observed is that the proportion of the population aged < 55 years with mild or moderate COPD, on the basis of pulmonary function testing, decreased from 1971-1975 to 1988-1994, possibly indicating that the upward trends in COPD hospitalizations and mortality might not continue. INTERPRETATION: COPD is a major cause of morbidity, mortality, and disability in the U.S. Despite its ease of diagnosis, COPD remains an underdiagnosed disease, chiefly in its milder and more treatable form.
Activities of Daily Living↗
Demographic characteristics of the rural population of Ethiopia.
"In the field of population studies, Ethiopia has neither carried out even a single population census nor established a vital statistics registration system. But with the available scanty and defective data, attempts are made here to examine the demographic situation of rural Ethiopia. Since only about 13% of the total population of the country are estimated to reside in agglomerations of 2,000 and above, Ethiopia is predominantly rural. According to the estimates of the vital rates, Ethiopia has been experiencing high levels of fertility and mortality conditions. "The low average life expectancy at birth, together with the high birth and death rates can indicate the low level of living which has been prevalent in the country."
Africa↗
[The Chinese demographic challenge].
Recent official vital statistics data from China are used to emphasize the seriousness of the demographic situation in China, and to highlight the continued pressure on limited resources exerted by a growing population that is struggling to achieve socioeconomic development. The authors conclude that "the pessimistic scenarios of evolution of Chinese vital factors justify the pursuit, or even the intensification, of the birth control programme. New educational programmes should focus on the necessity to develop new solidarities, to achieve a [reasonable] vital growth at least during the next five decades, which could lead to a better balanced...development of the economy." (SUMMARY IN ENG)
Asia↗
Secular trends in coronary heart disease mortality in Norway, 1966-1986.
In most countries of the western world, the health statistics demonstrate similar secular trends in coronary heart disease mortality. There was a relatively marked increase in the mortality rates until the 1970s, followed by a decline. A cohort analysis was performed to examine these trends. Poisson regression with models that included the effects of age, period, and cohort was applied to Norwegian vital statistics. The results demonstrate that cohort effects explain the secular variations in coronary heart disease mortality in Norway from 1966 to 1986. The author relates these findings to the development of primary and secondary preventive means of coronary heart disease mortality.
Age Factors↗
Cancer on Guam, especially among Micronesians.
The Guam Cancer Registry (GCR) collects data on cases of cancer in Guam residents whether their initial diagnosis is made on Guam or as a result of a referral to an off-island medical facility. It also collects data on cancer of non-residents diagnosed on Guam. Although including non-Guam resident cancer cases in statistical tables will have the effect of raising local cancer rates, this probably only partially compensates for the number of Guam-resident cancer cases that are diagnosed off-island and not reported to the registry. Cases are also collected by a periodic review of death certificates filed with the Guam Office of Vital Statistics. To test this hypothesis GCR records were reviewed to determine the number of reported cancer cases for each ethnic group that claimed to be Guam residents. Since a high proportion of cancers seen among Micronesians on Guam represent cases referred from their home islands, it may also be that these cases only represent those cancers most likely to be referred to Guam rather than being representative of the cancers most commonly occurring within these ethnic groups in their home islands.
Death Certificates↗
Vital and health statistics: Russian Federation and United States, selected years 1985-2000 with an overview of Russian mortality in the 1990s.
This report provides comparative vital and health statistics data for recent years for the Russian Federation and the United States. Statistical data for Russia and from the Ministry of Health of Russia and from Goskomstat, the central statistical organization of Russia. Information for the United States comes from various data systems of the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) as well as other parts of the Department of Health and Human Services. The initial section of the report summarizes information on recent mortality trends in the Russian Federation. During the 1990s, Russia experienced a major increase in mortality from 1990 to 1994, a substantial reduction in mortality from 1994 to 1998, and another major increase from 1998 to 2000. The mortality overview uses tables and figures to describe mortality changes by age group, sex, and cause of death, and to determine the contribution of each of these to changes in life expectancy. The overview also considers risk factors and other issues underlying these trends, in an attempt to understand the impact of major mortality determinants on changes in life expectancy. The section on vital and health statistics uses tables, figures, and commentary to present information on many different health measures for the populations of the two countries. Topics covered include population size, fertility, life expectancy, infant mortality, death rates, communicable diseases, and various health personnel and health resource measures. The commentary includes a discussion of data quality issues that affect the accuracy and comparability of the information presented. Data are provided for selected years from 1985 to 2000. In addition to national data, mortality information on urban and rural subgroups in Russia is provided. A glossary of terms at the end of the report provides additional information on definitions and data sources and limitations.
Adolescent↗
[Population statistics of Triatoma rubrovaria in laboratory].
OBJECTIVE: To obtain T. rubrovaria population parameters in order to describe its demographic characteristics. METHODS: The study was carried out in the laboratory of Arthropods, Corrientes, Argentina, from October 2000 to February 2003. Eggs were grouped to form five 100-egg cohorts. Insects were fed on chickens (Gallus domesticus). The cohorts were monitored weekly and kept under controlled temperature (28 +/- 3 degrees C) and relative humidity (63 +/- 10%). A life table was constructed and other vital statistics were calculated and recorded. RESULTS: Higher mortality was recorded in the first through the fourth nymphal stadium. A constant decrease was seen from the fifth nymphal instar. Life expectancy dropped linearly after overcoming the critical stages. Adults mean survival was 50.2 weeks. The first oviposition was after 40.6 weeks. The fecundity was 859.6 eggs with an average 22.8 eggs per female. The reproductive period was 37.7 weeks. The generation time was 55.3 weeks and the net reproduction rate was 133.7. The intrinsic rate of weekly increment was 0.088. In a stable age distribution the population would be composed of 25.3% eggs, 72.3% nymphs and 2.4% adults. Adults accounted for more than 70% of the total reproductive value. CONCLUSIONS: Triatoma rubrovaria had a long survival as imago, a late first reproduction and a low intrinsic rate of natural increase.
Animals↗
The Danish Fertility Database.
BACKGROUND: The Fertility Database (FTDB) in Statistics Denmark is solely based on data from other registers, which comprise data on a different number of birth cohorts and different time spans. The FTDB was established during 1989-1992 in order to provide a better tool for socio-demographic research on the developments in fertility. The variables included also make the register a valuable tool in medical research regarding reproductive outcome and characterization of parents. RESULTS: Based on the Register of Population Statistics, the FTDB comprises at present annual information on any woman and man in the fertile age in Denmark for the period 1980-1993, approximately 1.2 and 1.4 million persons, respectively. Their children are identified through various registers and for all children born 1973-1993 specific information on the birth was available from the Medical Register of Vital Statistics. The adult populations are described annually as regards education, occupation, income, social benefit and housing conditions. CONCLUSION: The FTDB has been used in a number of research projects; in some cases data from the FTDB have been linked with data from other registers. The FTDB is a valuable tool in demographic as well as medical research.
Adolescent↗
Trends in childhood asthma: prevalence, health care utilization, and mortality.
OBJECTIVES: Our objective was to use national data to produce a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality to assess changes in the disease burden among US children. METHODS: Five data sources from the National Center for Health Statistics were used to describe trends in asthma for children aged 0 to 17 years from 1980 to the most recent year for which data were available. These included the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics System. RESULTS: Asthma prevalence increased by an average of 4.3% per year from 1980 to 1996, from 3.6% to 6.2%. The peak prevalence was 7.5% in 1995. In 1997, asthma attack prevalence was 5.4%, but changes in the NHIS design in 1997 preclude comparison to previous estimates. Asthma attack prevalence remained level from 1997 to 2000. After a decrease between 1980 and 1989, the asthma office visit rate increased by an average of 3.8% per year from 1989 to 1999. The asthma hospitalization rate grew by 1.4% per year from 1980 to 1999. Although childhood asthma deaths are rare, the asthma death rate increased by 3.4% per year from 1980 to 1998. Children aged 0 to 4 years had the largest increase in prevalence and had greater health care use, but adolescents had the highest mortality. The asthma burden was borne disproportionately by black children throughout the period. Racial disparities were largest for asthma hospitalizations and mortality: compared with white children, in 1998-1999, black children were >3 times as likely to be hospitalized and in 1997-1998 >4 times as likely to die from asthma. CONCLUSIONS: Recent data suggest that the burden from childhood asthma may have recently plateaued after several years of increasing, although additional years of data collection are necessary to confirm a change in trend. Racial and ethnic disparities remain large for asthma health care utilization and mortality.
Adolescent↗
Deaths in World Trade Center terrorist attacks--New York City, 2001.
On September 11, 2001, terrorists flew two hijacked airplanes into the World Trade Center (WTC) in lower Manhattan in New York City (NYC), destroying both towers of the WTC. This report presents preliminary vital statistics on the deaths caused by the terrorist attacks and describes the procedures developed by the New York City Department of Health and Mental Hygiene (NYCDOHMH) to issue death certificates in response to the attacks. These data underscore the need for legal mechanisms to expedite the issuance of death certificates in the absence of human remains and the need for vital registration systems that can be relocated in case of emergency.
Adolescent↗
Trends in birth rates: New York City 1970-1995.
Traditional means of assessing the problem of teen pregnancy have relied on national or state statistics. By using large geographic areas, usually comprised of a heterogeneous population, it is impossible to tell which subareas have more of a problem than others. This study focused on trends in teen birth rates at the health district level in New York City over a 25-year period to illustrate variations among ethnic groups. Teen birth rates were calculated based on vital statistics published by the New York City Department of Health. They were calculated as the number of births per 1,000 females in each of three age groups: under age 15, 15-17, and 18-19. Rates were calculated for the entire City, for four boroughs, and for selected health center districts. The decline in the birth rate among New York City teens is most significant in health districts populated by blacks. An exception is the noted increases in birth rates in districts populated predominantly by Hispanics. Data show substantial decreases among older teens compared to younger teens. Birth trends in small areas of New York City mirror trends seen nationwide. As migration changes the ethnic composition of small areas, it is important to monitor trends so that policies and programs can be targeted to those in need.
Adolescent↗
Simplifying record linkage: software and strategy.
Although the methodology of record linkage is fairly well developed, there is a need for less expensive methods and simpler software to facilitate trying out different tactics to generate good linkages. The present work has built on a fourth generation language SAS (Statistical Analysis System) with accompanying macroprocessor, to develop a user-friendly and flexible system for both exact and probabilistic matching. The major features of the LINKS system are presented and illustrated using 1979-1984 information from the Manitoba Health Services Commission (MHSC) registry file with the Canadian Mortality Data Base. Initial runs with exact, then probabilistic, matching linked approximately 91% of the Vital Statistics records to corresponding MHSC records. Subsequent modification of parameters improved the linkage to 95%.
Database Management Systems↗