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PubMedDate not supplied

Disease cluster statistics for imprecise space-time locations.

Health professionals are investigating an increasing number of possible disease clusters, and statistical tests play an important role in cluster description and analysis. Existing cluster statistics assume precise data, when in reality health events are often imprecise (for example, place of residence is known only to the census district or zip code) and uncertain (for example, 'I first became ill sometime in 1985'). This incompatibility--precise methods used to analyse imprecise data--is largely ignored, resulting in test statistics of unknown accuracy. Most cluster statistics can be written as the cross-product of two matrices where one matrix reflects nearest-neighbour, distance or adjacency relationships and the second matrix is health related (for example, case-control identities). This paper explores a general approach to clustering, which incorporates uncertainty regarding space-time locations into these nearest neighbour, distance or adjacency relationships. Because the approach is general it can be used with almost all existing cluster tests, and, because it accounts for imprecise location data, it is suited to the 'real-world' nature of disease cluster investigations.

Bias↗
PubMedDate not supplied

Methodological issues in the development of the Canadian Cancer Incidence Atlas.

The Canadian Cancer Incidence Atlas is among recent national atlases using incidence rather than mortality data. Methods used to assess the significance and spatial correlation of the age-standardized rates (ASIRs) for the 290 census divisions are described. The expected number of cases by area was used to determine cancer sites with sufficient cases to be mapped. ASIR significance was assessed using a simulation based on a Poisson distribution. The consistency of the observed case distributions with the Poisson distribution was examined. The bootstrap confidence interval (CI) for the ASIR developed by Swift was used in the atlas. Spatial correlation was assessed with Moran's I/I(max) and the significance determined by a simulation in order to allow for area population variation. Data quality indicators typically used for cancer registries were presented, supplemented by a registry questionnaire.

Atlases as Topic↗
PubMed1996

Demographic composition of farm households and its effect on time allocation.

"This study demonstrates the effects of the existence of family members of various age groups on the time allocation decisions of farm operators and their spouses, by modelling the couple's joint farm and off-farm labor participation decisions. Specifically, two participation equations of the probit type are estimated for each person (one for farm participation and one for off-farm participation), using data from the 1981 Census of Agriculture in Israel. The resulting four-equation probit model is estimated by quasi maximum likelihood (QML) methods, allowing for village-specific fixed effects."

Age Factors↗
PubMed2006

LXIII Edward Jackson Memorial Lecture: Eye care: dollars and sense.

PURPOSE: The development of health economic data for vision loss and eye disease is described. DESIGN: Data from population-based epidemiologic studies of eye disease, studies of the impact of vision loss on daily living, Australian national health-care costs, census, and demographic projections were combined to develop a model of the economic impact of vision loss in Australia. METHODS: Data were considered to assess the current magnitude and costs of vision loss and to make projections as to future costs. Further analysis investigated the costs and economic benefits of various interventions to address avoidable vision loss. RESULTS: The amount of vision loss increases three-fold and the number with vision loss will double in 20 years. Vision loss cost Australia a total of AU $9.85 billion in 2004. Vision loss ranks seventh in causes of loss of well-being. An intervention package to address avoidable vision loss would cost AU $190 million or AU $5,591/Quality Adjusted Life Year (QALY) and give lifetime savings of AU $911 million. CONCLUSIONS: Although specific for Australia, these data can help guide health care policy debate and the priority given to eye care in other developed economies. For each dollar spent on the prevention of vision loss and eye care, there is a 5 dollar return to the community.

Activities of Daily Living↗
PubMed1999

The magnitude of the effect of smaller family sizes on the increase in the prevalence of asthma and hay fever in the United Kingdom and New Zealand.

BACKGROUND: Declining family size is one factor that has been proposed to contribute to increasing asthma and hay fever prevalence, but its relative importance has not been quantified. OBJECTIVE: Our purpose was to determine the change in asthma and hay fever prevalence that would be expected from the reduction in family size that has occurred in England/Wales and New Zealand over recent decades. METHODS: The relative change in family size between 1961 and 1991 in England/Wales and New Zealand was determined from census data for these years. Summary weighted odds ratios were calculated for the associations among birth order, family size, and asthma and hay fever prevalence. The expected increase in the prevalence of asthma and hay fever between 1961 and 1991 resulting from changes in family size was then calculated. RESULTS: The expected relative increase in the prevalence of asthma between 1961 and 1991 as a result of the smaller family size was 1% and 5% for England/Wales and New Zealand, respectively; smaller family size would be expected to increase the prevalence of hay fever prevalence in England/Wales by 4%. CONCLUSIONS: Changes in family size over the last 30 years do not appear to explain much of the reported increase in asthma or hay fever prevalence. The contribution that other risk factors have made to these increases could be assessed with use of a similar approach.

Asthma↗
PubMed2002

Exploring the effect of the environment on physical activity: a study examining walking to work.

BACKGROUND: Research on physical activity and the physical environment is at the correlates stage, so it is premature to attribute causal effects. This paper provides a conceptual approach to understanding how the physical design of neighborhoods may influence behavior by disentangling the potential effects of income, university education, poverty, and degree of urbanization on the relationship between walking to work and neighborhood design characteristics. METHODS: The study merges Canadian data from 27 neighborhood observations with information on walking to work from the 1996 census. Hierarchical linear modeling was used to create a latent environment score based on 18 neighborhood characteristics (e.g., variety of destinations, visual aesthetics, and traffic). The relationship between the environment score and walking to work was modeled at the second level, controlling for income, university education, poverty, and degree of urbanization. RESULTS: With the exceptions of visual interest and aesthetics, each neighborhood characteristic contributed significantly to the environment score. The environment score was positively associated with walking to work, both with and without adjustment for degree of urbanization. Controlling for university education, income, and poverty did not influence these relationships. CONCLUSIONS: The positive association between the environment score and walking to work, controlling for degree of urbanization supports the current movement toward the development of integrated communities for housing, shops, workplaces, schools, and public spaces. Given the need for research to guide environmental interventions, collaboration among public health practitioners, urban planners, and transportation researchers is essential to integrate knowledge across sectors.

Adult↗
PubMed2005

Is education associated with mortality for breast cancer and cardiovascular disease among black and white women?

BACKGROUND: Although low socioeconomic status (SES) has been found to be an important risk factor for all-cause mortality in women, the association is inconsistent across specific causes of death. SES appears to have different associations with 2 common causes of mortality in women: low SES is associated with greater cardiovascular disease (CVD) mortality in women but may also be associated with lower breast cancer mortality. OBJECTIVE: We examined the association between SES and CVD and breast cancer mortality among black and white women. METHODS: Our analysis sample included black and white women participating in the National Longitudinal Mortality Study, which links US Census Bureau Current Population Surveys with the National Death Index between 1979 and 1989. Education and income were used as SES indicators. For each cause of death, we used multivariate logistic regression to estimate variation in mortality risk across SES levels within each racial group. RESULTS: The sample included 21,303 black women and 186,322 white women. Unadjusted cumulative incidence (over a mean follow-up period of 8.7 years) of CVD mortality was 4.2% among black women and 2.3% among white women, and of breast cancer mortality was 0.3% among black women and 0.4% among white women. After adjustment for age, marital status, and urban or rural residence, less education was still associated with greater CVD mortality among black women (odds ratio [OR], 1.8; 95% Cl, 1.03-3.0) and white women (OR, 1.4; 95% Cl, 1.3-1.6). However, less than a high school education was associated with lower breast cancer mortality among white women (OR, 0.73; 95% CI, 0.6-0.9) but not among black women (OR, 1.1; 95% Cl, 0.5-2.3). Similar ORs were obtained when income was examined. CONCLUSIONS: The association between SES and cause-specific mortality may differ between black and white women for breast cancer death but not CVD death. Better understanding of these inter actions could guide the targeting of more effective interventions.

Adult↗
PubMed2001

Capitation registration and social deprivation in England. An inverse 'dental' care law?

OBJECTIVE: To examine associations between NHS child dental registration data and area deprivation scores of English Health Authorities (N= 100) in 1996/97 and 1997/98. METHOD: The Department of the Environment index of local conditions and the Jarman Underpriviledge Area Score from the 1991 census were used to measure deprivation. Prior to September 1997, children got free dental treatment under a capitation scheme with an NHS dentist. If they did not attend within 24 months their registration lapsed on the last day of December of the second registration year and they were deleted from the capitation list. After September 1997 the registration period was reduced to 15 months. OUTCOME: Curve-linear regression of the Health Authority (HA) percentage of children registered, lapses in capitation registrations and deprivation scores. RESULTS: In England 68% of children were registered in December 1996. The percentage registered in each Health Authority was associated with deprivation (DoE, r2=0.33, Jarman, r2=0.27 p<0.01). In January 1997, 17.8% (1,345,142) of children registered lapsed (HA range 12.8% to 30.3%) and this was also significantly associated with deprivation (DoE r2=0.66, Jarman, r2=0.51 p<0.01). Similar results were found in 1997/98. CONCLUSIONS: Registration and lapse rates were significantly associated with social deprivation confirming that there is an inverse 'dental' care law for children in England. NHS capitation may widen dental health inequalities.

Adolescent↗
PubMed1998

Sex differences in symptom presentation associated with acute myocardial infarction: a population-based perspective.

OBJECTIVES: To describe sex differences in symptom presentation after acute myocardial infarction (AMI) while controlling for differences in age and other potentially confounding factors. BACKGROUND: Although several studies have examined sex differences in diagnosis, management, and survival after AMI, limited data exist about possible sex differences in symptom presentation in the setting of AMI. METHODS: Community-based study of patients hospitalized with confirmed AMI in all 16 metropolitan Worcester, Mass., hospitals (1990 census population = 437,000). Men (n = 810) and women (n = 550) hospitalized with validated AMI in 1986 and 1988 comprised the study sample. RESULTS: After simultaneously controlling for age, medical history, and AMI characteristics through regression modeling, men were significantly less likely to complain of neck pain (adjusted odds ratio (OR) = 0.52; 95% CI: 0.35, 0.78), back pain (OR = 0.38; 95% CI: 0.26, 0.56), jaw pain (OR = 0.50; 95% CI: 0.31, 0.81), and nausea (O.R. = 0.58; 95% CI: 0.45, 0.75) than women. Conversely, men were significantly more likely to report diaphoresis (OR = 1.27; 95% CI: 1.00, 1.61) than women. There were no statistically significant sex differences in complaints of chest pain though men were more likely to complain of this symptom. CONCLUSIONS: The results of this population-based observational study suggest differences in symptom presentation in men and women hospitalized with AMI. These findings have implications for public and health care provider education concerning recognition of sex differences in AMI-related symptoms and health care seeking behaviors.

Aged↗
PubMed2003

Prescribing for inpatients with schizophrenia: an international multi-center comparative study.

BACKGROUND: This study compares prescription practices for acute inpatients with schizophrenia among six academic departments located in China, Japan, Hungary, and the U.S. METHODS: Prescription data for a sample of 429 inpatients from six academic departments were collected on a randomly chosen census day. All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years. RESULTS: While patients at the different centers varied in their demographic and clinical characteristics, i. e., age, sex, and length of illness, a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied (i. e., number and dose antipsychotics, atypical and depot antipsychotics, other psychotropic drugs, multiple antipsychotics, and daily dose) except antidepressant use. In most cases these differences persisted even after adjusting for demographic and clinical characteristics (age, sex, and length of illness) of the subjects. Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs, including anticholinergics, anticonvulsants, benzodiazepines, and non-benzodiazepine hypnotics. Anticholinergic use was more common with typical antipsychotics. Rates of atypical antipsychotic drug use were lowest in the Japanese center. The Japanese center had by far the highest mean daily dose of antipsychotics. CONCLUSIONS: The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia. The results also confirm previous findings that prescribing practices for schizophrenia vary greatly among centers and countries. A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs, such as anticholinergics, hypnotics, anticonvulsants, and benzodiazepines, administered in multiple daily doses.

Adult↗
PubMed1991

Board-certified physicians in the United States, 1971-1986.

BACKGROUND: This is our third report covering the census of U.S. physicians over a 15-year period. The present report updates the information for 1980 to 1986. METHODS: Most of our data are based on published information from the Association of American Medical Colleges, the Educational Council for Foreign Medical Graduates, the American Board of Medical Specialties, and the National Resident Matching Program. Data on board-certified physicians were obtained from the Division of Survey and Data Resources of the American Medical Association and are not published elsewhere. RESULTS: After a steep rise in the 1970s, the annual number of physicians receiving licenses increased at a slower rate. The numbers of new board diplomas in medicine and primary care continued to grow. In other non-surgical clinical specialties there was less growth, and in certain fields of surgery the numbers declined. The board-certified percentage of all practitioners increased slightly (74 to 79 percent). About 14 to 16 percent of all active physicians are still in their residency and fellowship years. The percentage of all practitioners under the age of 35 who are women has increased from 8.4 percent in 1967 to 25.2 percent in 1986. The enrollment of some residency programs is currently more than 50 percent women. CONCLUSIONS: The work force of physicians did not grow as rapidly in the 1980s as in the 1970s. This nonlinearity of growth and massive changes in the epidemiology and treatment of disease render predictions about the need for or the numbers of physicians a decade hence unreliable.

Certification↗
PubMedDate not supplied

Alcohol consumption among school adolescents in Palma de Mallorca.

AIMS: To describe alcohol consumption of adolescent boys and girls in Palma de Mallorca, and its relationship with physical activity and socio-demographic factors. METHODS: Four hundred and forty five adolescents (171 boys, 274 girls; 14-18 years old) selected from the school census (participation 96%), using two-stage probability sampling were studied. A semi-quantitative food frequency questionnaire was administered and alcohol intake was analysed. Physical activity was computed as a ratio of energy expended in basal metabolic rate. Socio-demographic data were collected, and categorized as gender, mother's level of education, parental occupational status, and mother's region of origin. RESULTS: About 60% of adolescents, 53% of boys and 65% of girls, reported alcohol consumption, which increased with age in boys (91% when they were 18 years old), but remained constant in girls. The adolescents consumed alcohol mainly on weekends; average consumption was four drinks per drinking day, and the most consumed drinks were mild distilled spirits. The mother's educational level and adolescents' physical activity were negatively and significantly related to alcohol consumption, whereas the adolescents from occupational upper-class parents and non Majorcan/Balearic mothers were positively and significantly related to alcohol consumption. CONCLUSIONS: The increased penetration of alcohol into the adolescents' environment may result in misuse of consumption. To give more information to parents and adolescents on considering alcohol to be a drug, and to promote physical activity among adolescents may be contributing factors towards decreased alcohol consumption among the latter age group.

Adolescent↗
PubMed2003

Child mortality, socioeconomic position, and one-parent families: independent associations and variation by age and cause of death.

BACKGROUND: Although the association between child mortality and socioeconomic status is well established, it is unclear whether child mortality differences by socioeconomic position are present at all ages. The association of one-parent families with mortality, and whether any such association is due to associated low socioeconomic position, is also not clear. METHODS: In all, 480 of 693 (69%) 0-14 year old deaths during 1991-1994 were linked to 1991 census records. Analyses were weighted to adjust for potential linkage bias. RESULTS: There was approximately twofold higher mortality among the lowest compared with the highest socioeconomic categories of education, income, car access, and neighbourhood deprivation. Occupational class differences were weaker. These socioeconomic differences in mortality were strongest among infants (particularly sudden infant death syndrome [SIDS] mortality), but similar across other age groups (1-4, 5-9, and 10-14 years). The socioeconomic differences were of a similar magnitude for unintentional injury, cancer, congenital, and other deaths. Multivariable analyses demonstrated persistent independent associations of education, income, car access, and neighbourhood deprivation with mortality. Rate ratios (adjusted for age and ethnicity) for one-parent families compared with two-parent or other families were 1.2 (95% CI: 1.0, 1.5) and 1.8 (95% CI: 1.2, 2.5) for all-cause and unintentional injury mortality, respectively. Further adjustment for socioeconomic factors reduced these associations to 0.8 (95% CI: 0.6, 1.2) and 1.2 (95% CI: 0.7, 2.2), respectively. CONCLUSIONS: There does not appear to be notable variation in relative risk terms of socioeconomic differences in child mortality by age or cause of death. Any association of one-parent families with child mortality is due to associated low socioeconomic position.

Adolescent↗
PubMed2005

Rising incidence and prevalence of orphanhood in Manicaland, Zimbabwe, 1998 to 2003.

OBJECTIVE: To quantify and describe orphan incidence in Manicaland, eastern Zimbabwe. DESIGN: Open cohort study. METHODS: Statistical analysis of data on 13,740 and 10,308 children, aged 0-14 years, enumerated in household censuses in four socio-economic strata, 1998-2000 and 2001-2003, and 10,184 children seen in both censuses (74% follow-up). RESULTS: Prevalence of all forms of orphanhood increased. The overall rate of losing a parent amongst non-orphans was 27.5 per 1000 person-years (py). Paternal orphan incidence (20.2 per 1000 py) was higher than maternal orphan incidence (9.1 per 1000 py) and maternal orphans lost their fathers at a faster rate than paternal orphans lost their mothers. Paternal and maternal orphan incidence increased with age. Incidence of maternal orphanhood and double orphanhood amongst paternal orphans rose at 20% per annum [incidence rate ratio (IRR) = 1.20; 95% CI, 1.06-1.35] and 71% per annum (IRR = 1.71; 95% CI, 1.25-2.33), respectively, 1998-2003, but incidence of paternal orphanhood and double orphanhood amongst maternal orphans were unchanged. For 82% of children with a parent who died, the parent was HIV-positive at baseline. More new paternal and double orphans--but not new maternal orphans--than non-orphans had left their baseline household. Mortality was higher in orphans than non-orphans with the highest death rates observed amongst maternal orphans. CONCLUSIONS: Orphan incidence and prevalence are high and increasing due to HIV in eastern Zimbabwe. Orphan incidence patterns differ from orphan prevalence patterns and need to be understood if support programmes are to assist children during periods of high vulnerability.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Genetic diversity, population structure, effective population size and demographic history of the Finnish wolf population.

The Finnish wolf population (Canis lupus) was sampled during three different periods (1996-1998, 1999-2001 and 2002-2004), and 118 individuals were genotyped with 10 microsatellite markers. Large genetic variation was found in the population despite a recent demographic bottleneck. No spatial population subdivision was found even though a significant negative relationship between genetic relatedness and geographic distance suggested isolation by distance. Very few individuals did not belong to the local wolf population as determined by assignment analyses, suggesting a low level of immigration in the population. We used the temporal approach and several statistical methods to estimate the variance effective size of the population. All methods gave similar estimates of effective population size, approximately 40 wolves. These estimates were slightly larger than the estimated census size of breeding individuals. A Bayesian model based on Markov chain Monte Carlo simulations indicated strong evidence for a long-term population decline. These results suggest that the contemporary wolf population size is roughly 8% of its historical size, and that the population decline dates back to late 19th century or early 20th century. Despite an increase of over 50% in the census size of the population during the whole study period, there was only weak evidence that the effective population size during the last period was higher than during the first. This may be caused by increased inbreeding, diminished dispersal within the population, and decreased immigration to the population during the last study period.

Animal Migration↗
PubMed1996

Prevalence of urolithiasis in Kaizuka City, Japan--an epidemiologic study of urinary stones.

BACKGROUND: According to the results of nationwide surveys, the prevalence of urolithiasis has been steadily increasing in Japan. However, these surveys relied on hospital statistics, and there has been no survey of the prevalence of urolithiasis in Japan utilizing postal questionnaires. We surveyed the prevalence of urolithiasis among the inhabitants of Kaizuka City. METHODS: A total of 3,000 inhabitants ranging from 20 to 59 years old were randomly selected from the census register in numbers consistent with the population distribution of each district and sex by municipal computerized system. RESULTS: A total of 1,975 postal questionnaires were returned, and 1,972 (65.7%) were considered valid. Of the respondents, 137 (6.95%) had a history of stones (men; 9.64%, women; 4.51%). The annual incidence of urolithiasis for Kaizuka citizens aged from 20 to 59 years old in 1991 was 0.97%, and the lifetime prevalence of urolithiasis increased linearly with age, and it was 10.3% for respondents in their 50s. In the total survey population of 7,568, which included the respondents and their family members, 342 (4.52%) had a history of stones. Male administrative workers had a significantly higher prevalence than any other occupational group. The monthly expenditure on food by the families of stone formers was significantly greater than that by the families of non-stone formers. CONCLUSION: Extrapolation of the findings suggests that > 10% of the general population (> 13% of men and > 7% of women) can be expected to suffer from urolithiasis at least once in their lifetime.

Adult↗
PubMed1999

Prevalence of smokers and nicotine-addicted patients in a suburban emergency department.

OBJECTIVE: To define the prevalence of smokers and nicotine-addicted patients in a suburban, community ED. METHODS: This was a prospective survey of consecutive ED patients seen in a suburban ED with an annual patient census of 48,000. Medically stable patients aged 18 years or older were eligible for inclusion. Patients were excluded if they had predominantly psychiatric complaints or were critically ill. Patients were queried about their smoking habits by a closed-question survey, which included the previously validated Fagerstrom Test for Nicotine Dependence. The study was conducted during a six-week period, only at times when there were dedicated research associates available to ensure consecutive patient entry. Continuous variables were analyzed by Student's t-tests. Clinical variables were analyzed by chi-square tests. All tests were two-tailed with alpha at 0.05. RESULTS: 1,515 patients comprised the study group. The mean age (+/-SD) was 45.6 (+/-18.9) years; 52% were female, 25% were nonwhite, and 47% were college graduates. There were 317 (21%) smokers. Patients having private physicians were less likely to smoke (18% vs 29%, p = 0.001). Of all smokers, 46% were moderately to severely nicotine-dependent, 69% wanted to quit, and 30% expressed an interest in joining a smoking cessation program. CONCLUSION: A substantial percentage of ED patients smoke, many of them are nicotine-addicted, and the majority would like to quit. Randomized, controlled trials are needed to determine whether interventions by physicians in the ED can have an impact on the smoking habits of these patients.

Adult↗
PubMed1994

Clinical features and race-specific incidence/prevalence rates of systemic lupus erythematosus in a geographically complete cohort of patients.

OBJECTIVES: To assess race-specific incidence and prevalence rates for systemic lupus erythematosus (SLE) using 1991 National Census data and to ascertain the frequency of clinical/laboratory features of a geographically complete cohort of patients with SLE. METHODS: Multiple methods of retrieval were used to ascertain SLE patients including screening request cards for immunology investigations. Patients were classified according to the revised ARA criteria. Multiple logistic regression analysis was used to study the effects of age at diagnosis on the frequency of clinical/laboratory SLE features. RESULTS: The overall one year period prevalence rate for SLE was 24.7 (age adjusted, 95% CI: 20.7-28.8)/100,000. Highest rates were seen in Afro-Caribbeans (207 (111-302)/100,000), followed by Asians (48.8 (10.5-87.1)/100,000), and then Whites (20.3 (16.6-24.0)/100,000). The mean age at diagnosis of SLE was 40.9 years (range: 11-83) with a mean interval between first definite SLE symptom and diagnosis of 61 months (0-518). In 85% of patients the first definite lupus feature was musculoskeletal and/or cutaneous. In this SLE cohort renal disease (22%) was observed less commonly than in previous studies and the 'classic' butterfly rash was present in only 30% of patients. Malar rash, thrombocytopaenia, positive anti-dsDNA antibodies, hypocomplementaemia (C4), and positive IgG anticardiolipin antibodies were all seen less commonly with increasing age at diagnosis. CONCLUSIONS: A closer estimate of the true frequency of clinical/laboratory SLE manifestations is likely from this geographically complete cohort of patients compared with studies that may be skewed by referral patterns.

Adolescent↗