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PubMed1991

Multiple imputation in health-care databases: an overview and some applications.

Multiple imputation for non-response replaces each missing value by two or more plausible values. The values can be chosen to represent both uncertainty about the reasons for non-response and uncertainty about which values to impute assuming the reasons for non-response are known. This paper provides an overview of methods for creating and analysing multiply-imputed data sets, and illustrates the dramatic improvements possible when using multiple rather than single imputation. A major application of multiple imputation to public-use files from the 1970 census is discussed, and several exploratory studies related to health care that have used multiple imputation are described.

Databases, Factual↗
PubMedDate not supplied

[A method for projecting the population according to size of locality. (Application to the case of Mexico's urban population in 1990)].

"In this article, a restricted components method is presented (because sex and age are not taken into account) to project the population classified according to the size of the locality.... The application is presented for urban centers (15,000 or more inhabitants) of Mexico in 1990, utilizing the trend in demographic growth for the 1960-1980 period." Data are from Mexican censuses conducted in 1960, 1970, and 1980. (SUMMARY IN ENG)

Americas↗
PubMed2002

Unemployment and health: contextual-level influences on the production of health in populations.

While there is a large and growing literature investigating the relationship between an individual's employment status and health, considerably less is known about the effect on this relationship of the context in which unemployment occurs. The aim of this paper is test for the presence and nature of contextual effects in the ways unemployment and health are related, based on a simple underlying model of stress, social support and health using a large population health survey. An individual's health can be influenced directly by own exposure to unemployment and by exposure to unemployment in the individual's context, and indirectly by the effects these exposures have on the relationship between other health determinants and health. Based on this conceptualization an empirical model, using multi-level analysis, is formulated that identifies a five-stage process for exploring these complex pathways through which unemployment affects health. Results showed that the association of individual unemployment with perceived health is statistically significant. Nevertheless, this study did not provide evidence to support the hypothesis that the association of unemployment with health status depends upon whether the experience of unemployment is shared with people living in the same environment. Above all, this study demonstrates both the subtlety and complexity of individual- and contextual-level influences on the health of individuals. Our results caution against simplistic interpretations of the unemployment-health relationship and reinforce the importance of using multi-level statistical methods for investigation of it.

Adult↗
PubMed2004

From The Cover: Diffusion-based method for producing density-equalizing maps.

Map makers have for many years searched for a way to construct cartograms, maps in which the sizes of geographic regions such as countries or provinces appear in proportion to their population or some other analogous property. Such maps are invaluable for the representation of census results, election returns, disease incidence, and many other kinds of human data. Unfortunately, to scale regions and still have them fit together, one is normally forced to distort the regions' shapes, potentially resulting in maps that are difficult to read. Many methods for making cartograms have been proposed, some of them are extremely complex, but all suffer either from this lack of readability or from other pathologies, like overlapping regions or strong dependence on the choice of coordinate axes. Here, we present a technique based on ideas borrowed from elementary physics that suffers none of these drawbacks. Our method is conceptually simple and produces useful, elegant, and easily readable maps. We illustrate the method with applications to the results of the 2000 U.S. presidential election, lung cancer cases in the State of New York, and the geographical distribution of stories appearing in the news.

Data Interpretation, Statistical↗
PubMed1995

Intravenous chlorpromazine vs intravenous metoclopramide in acute migraine headache.

OBJECTIVE: To compare the efficacy of IV chlorpromazine with that of IV metoclopramide in the treatment for acute migraine headache in the ED. METHODS: A prospective randomized double-blind trial was undertaken at two university-affiliated urban EDs with a combined annual census of more than 85,000 patients. Included in the study were patients presenting to the ED with a diagnosis of migraine headache. The subjects were randomized to receive 0.1 mg/kg/dose IV of either chlorpromazine (CPZ) or metoclopramide (MC), up to a total of three doses. RESULTS: Ninety-one patients completed the protocol; 44 received MC and 47 received CPZ. The demographics of the two groups were similar. Both drugs provided, for the majority of patients, adequate pain relief as measured on a visual analog scale (VAS) completed every 15 minutes from T = 0 minutes to T = 45 minutes. The average pain relief over 45 minutes (delta VAS) for CPZ was 4.87 cm, vs 4.34 cm for MC (p = 0.35). There also was no statistically significant difference in blood pressure (BP) changes (delta BP < 2 mm Hg for both systolic and diastolic BPs, p = 0.47 and 0.33) or numbers of patients reporting adverse effects (AEs) (CPZ: 16 of 35; MC: 13 of 29, p = 0.43). There was no severe AE with either study drug. CONCLUSIONS: Metoclopramide and chlorpromazine administered IV are both effective in the management of acute migraine headache. They are associated with similar minor side-effect profiles.

Acute Disease↗
PubMed2005

A population-based study of the waiting times for prostatectomy in Ontario.

INTRODUCTION AND OBJECTIVE: Despite the high incidence of prostate cancer in Canada, there is currently limited information describing how these patients are being managed. The aim of this study was to review the surgical waiting times for radical prostatectomy in Ontario, utilizing existing population-based cancer databases, and to describe factors associated with prolonged waiting times. METHODS: This is a retrospective, population-based, observational study of men diagnosed with prostate cancer in Ontario between 1980 and 2000. The sources of data include the Ontario Cancer Registry linked to hospital discharge data, as well as census data from Statistics Canada. Study variables include age, county of residence, teaching hospital status, hospital surgical volume, area-level median household income and cause-specific survival. Waiting times were compared across study variables using univariate and graphical methods. Survival was compared across geographic regions with differing average wait times. RESULTS: We identified 9524 men treated with radical prostatectomy in Ontario over the study period and found the percentage of all patients with the disease who were treated surgically increasing from 3% to 20% over the last 2 decades. The overall time to prostatectomy has almost doubled with a median waiting time of 55 days in earlier eras to 91 days in 1996-2000. A few counties had significantly different wait times, whereas age and socio-economic factors were not associated with wait times across most eras. In the most recent eras, acute care hospitals and hospitals with higher surgical volumes had significantly higher waiting times (up to 20 days longer in 1996-2000, p<0.0001). Patients living in regions with the shortest wait times had statistically significant worse survival (p=0.02), implying that triaging has a greater impact than the potential effect of prolonged waits. CONCLUSIONS: The observed increases in waiting times for radical prostatectomy from this study are similar to the known increases in waiting times for radiotherapy. This increased time to treatment is an illustration of the stress on the health care system in Ontario.

Aged↗
PubMed2004

Incorporating group-level exposure information in case-control studies with missing data on dichotomous exposures.

In case-control studies with exposure data obtained from interviews, participation is an issue of concern. Use of external group-level exposure information, available for all cases and controls (including nonparticipants), can reduce participation bias and improve precision of effect estimates. Our methodologic investigation was motivated by a population-based case-control study on occupational exposures and leukemia. We assessed exposure using dichotomous data collected in interviews, and also using census data on past and current occupational groups for all subjects. Based on information from a job-exposure database, a group-level probability of exposure was assigned to each subject. We studied the performance of the iterative expectation-maximization method for estimating the odds ratio (OR) by using the individual-level exposure data on the interviewed participants together with the assigned group-level exposure probabilities for the nonparticipants. In each iteration, the expected numbers of exposed and unexposed among the nonparticipating cases and controls were calculated from their assigned exposure probabilities and, for the cases only, from the current OR estimate. We then estimated the OR based on the total (observed plus expected) numbers and repeated the procedure until convergence. The expectation-maximization method eliminated participation bias and improved precision for scenarios with error-free group-level exposures and individual-level exposure data missing at random conditional on disease status and group affiliation. We specifically addressed consequences of assigning erroneous exposure probabilities to the nonparticipating subjects. In such situations, the expectation-maximization method can produce biased estimates if the participation rates among the cases and controls differ substantially.

Bias↗
PubMed2001

Ancestral kinship and cancer in Lastovo Island, Croatia.

The aim of this study was to compute the average kinship coefficient of cancer cases in an extreme isolate (Lastovo Island, Croatia) and to compare it to the corresponding value for the island's unaffected population. Kinship estimates were obtained by Wright's path method (phi) based on pedigree reconstruction and Lasker's coefficient of relationship by isonymy (Ri) based on surname distribution. A total of 76 cancer cases were recorded on the island between 1971 and 1995. The unaffected control population of 1144 persons was obtained from the population census in 1971. The data on five ancestral generations were collected from parish registries preserved in the local church, and included 5484 persons born on the island between 1750 and 1970. Both Wright's path method and Lasker's isonymy method indicated significantly greater kinship of female cancer cases than of the unaffected population. Cancer cases with increased values of Ri among them and Ri among their ancestors included cancers of the ovary, colon, brain, breast, and prostate and leukemias. This study confirms the role of heredity and common ancestry in the development of cancer, providing a rough insight into their relative importance for specific cancer sites.

Case-Control Studies↗
PubMed2003

Predicting smoking behaviour in census output areas across Scotland.

Spatially disaggregated surveys of smoking behaviour are rare and hence estimating the geography of the incidence of smoking is difficult. The main aim of this study is to develop a technique for estimating smoking probability for different age/sex groups in small areas across the whole of Scotland using information on smoking behaviour from the Scottish Household Survey. This is useful not only in its own right, but as an aid to studies of geographical variations in diseases such as lung cancer that, as a first step, need to control for smoking behaviour. The method developed uses individual-level characteristics from the Scottish Household Survey combined with a set of output area and pseudo-postcode sector measures from the 1991 census to model the probability of smoking. The parameters from this model are then used to make smoking predictions by age and sex for output areas across Scotland. This is the first time that such geographically detailed estimates of smoking have been made available.

Adolescent↗
PubMed1983

Sectorized psychiatry. A methodological study of the effects of reorganization on patients treated at a mental hospital.

The aim of the study was to find relevant methods and use them to investigate the effects of sectorized psychiatry on former mental hospital patients. Seventeen hypotheses were formulated, concerning both positive and negative effects of sectorized psychiatry. Relevance and expected availability decided the variables, which were based on information from medical registers, case records, death certificates, social authorities, courts of law, public health insurance, census office and personal interviews. The hypotheses were tested by the use of two groups of patients, 377 in one experimental group, and 377 in one control group. A matched control method was used. The study patients were domiciled in the catchment area for the first complete trial of sectorized psychiatric service in the Stockholm area. The control patients were domiciled in the catchment area for the remaining divisions of Beckomberga Mental Hospital. During the actual years, an experimental situation was at hand. Comparisons in each pair were performed, regarding the experimental year 1980. A methodological description of variables for measurement of the effects and changes in psychiatric care is presented. The comparison showed no significant differences in the analyses, regarding utilization of inpatient care at Beckomberga Hospital in 1980. Study patients had significantly more outpatient visits and day-care days compared to controls. Study patients reported significantly shorter time of public transportation between home and psychiatric service. Study patients were significantly more often discharged to the division's own agencies compared to controls. Study patients reported significantly less satisfaction with ward staff than controls. No significant differences in direct cost of treatment during the experimental year were registered. The conclusion is, that there are no consistent tendencies proving the new organization superior to the traditional one for these former mental hospital patients.

Adult↗
PubMed2004

Pulmonary thromboembolism in American Indians and Alaskan Natives.

BACKGROUND: The rate of diagnosis of deep venous thrombosis and/or pulmonary embolism (collectively, venous thromboembolism: VTE) among patients discharged from Indian Health Service hospital care from 1980 through 1996 was considerably lower than rates reported in African Americans or whites. Expansion of the national census in 1990 to include American Indians and Alaskan Natives permits a more in-depth examination of this issue. METHODS: Combined data from the National Hospital Discharge Survey (nonfederal hospitals) and the Indian Health Service (federal hospitals) from 1996 through 2001 were used to evaluate the rate of diagnosis of VTE in American Indians and Alaskan Natives. RESULTS: The diagnosis of VTE in American Indians and Alaskan Natives, based on combined data from the National Hospital Discharge Survey and the Indian Health Service was 71 per 100,000 per year compared with 155 per 100,000 per year in African Americans (P<.001) and 131 per 100,000 per year in whites (P<.001). The rate ratio comparing the rate of diagnosis of VTE in American Indians and Alaskan Natives with African Americans was 0.46 (95% confidence interval, 0.45-0.47) and comparing American Indians and Alaskan Natives with whites it was 0.54 (95% confidence interval, 0.53-0.55). CONCLUSIONS: The observed relatively low incidence of VTE in American Indians and Alaskan Natives would seem to be due to as yet undetermined genetic factors. The possibility that American Indians and Alaskan Natives have different lifestyles that affect the rate of diagnosis of VTE cannot be excluded.

Alaska↗
PubMed1994

Delays in childhood immunizations in public and private settings.

BACKGROUND: As the costs of childhood immunizations have increased over the past 10 years, patients have increasingly turned to public health departments for this service. This study compares reasons for delays in immunization among patients who obtained their immunizations at health departments and those who continued to utilize private physicians or clinics. METHODS: A birth certificate survey of all children born between September 1, 1988, and August 31, 1989, in four urban census tracts and two rural counties in Kentucky was performed in late 1991, when all children were over age 2 years. The percentage of patients whose immunizations had been delayed and the reasons for delay were noted. RESULTS: Children who utilized public health departments or a combination of health departments and private sources for their immunizations were more likely to have experienced delays than those who obtained immunizations from private providers (56% vs 34%, P = .002). In particular, patients in the public provider group were more likely than those in the private provider group to have missed immunizations for invalid contraindications (34% vs 8%, P = .02), missed appointments (22% vs 9%, P = .02), or failure to receive immunizations when at the health department for another visit (23% vs 11%, P = .04). CONCLUSIONS: While a large number of patients in both the private and public provider groups experienced delays in immunizations, patients who received immunizations from public sources were more likely to experience delays related to missed opportunities.

Birth Certificates↗
PubMed1984

Leukemia incidence by occupation in the Portland-Vancouver metropolitan area.

During a 15-year period in an urban area with over a million inhabitants, we identified 1,678 cases of leukemia among residents aged 16 or older. Case finding was done according to the methods of the National Cancer Institute (NCI) SEER program. Usual occupation was coded by a system based on the U.S. Census Bureau classification. According to age-standardized incidence rates for persons aged 16-67, significant excess leukemia risks were found for 14 male and 8 female occupation categories, with the larger number of male excess risk situations due to nonlymphatic leukemia. Lymphatic leukemia risks were significantly elevated among dentists, school teachers of both sexes, auto mechanics, gas station attendants, female assembly workers, and female laundry and dry cleaning workers. Nonlymphatic leukemia risks were significantly elevated among machinists, other metal tradesmen, heavy equipment operators, textile operatives, meat cutters, cannery workers, construction laborers, freight and stock handlers, policemen, and firemen. Risks of both types of leukemia were significantly elevated among registered and practical nurses and lumber mill workers. This study has not identified specific etiologic agents and exposures, but applied investigations aimed at disease control by prevention of cases are now possible in this community. Nationwide surveillance and control are recommended.

Adolescent↗
PubMed1992

Adjustment for smoking, alcohol consumption, and socioeconomic status in the California Occupational Mortality Study.

This paper presents methods for adjusting for smoking, alcohol, and socioeconomic status in death certificate-based occupational mortality surveillance. The methods were applied in the California Occupational Mortality Study, a statewide study of rates based on 180,000 deaths and census estimates of occupations. For each occupation, levels of smoking, alcohol consumption, and socioeconomic status were estimated using National Health Interview Survey and U.S. Census data, and an empirical Bayes procedure was used to improve the stability of smoking and alcohol estimates for small occupations. Expected death rates for occupations were calculated by modeling rates as a function of age, smoking, alcohol, and socioeconomic status with Poisson regression. The effect of adjustment was usually moderate and in the expected direction, and the adjusted mortality ratios were generally closer to 1.0. Full data on agricultural occupations are presented for illustration.

Adolescent↗
PubMed2005

Software for tabular data protection.

In order for national statistical offices to maintain the trust of the public to collect data and publish statistics of importance to society and decision-making, it is imperative that respondents (persons or establishments) be guaranteed privacy and confidentiality in return for providing requested confidential data. Consequently, for most survey and census data, disclosure limitation techniques must be applied before the data are ready for public release. For microdata, examples of methods that can be used to identify respondents include directly extracting identifying information from microdata files or indirectly identifying respondents by matching a given file with an external file. For tabular data, respondents may be identified directly from small cell counts or respondent contributions to heavily concentrated cells of magnitude data may be closely approximated by the cell value. Indirect disclosure is possible in tables through manipulation of additive tabular relationships between cell values and totals, e.g. manipulating rows and column totals in a two-dimensional table. Two-dimensional statistical tables are a staple of official statistics. This paper describes a desktop software system that for the first time implements within a single framework four standard disclosure limitation techniques for protecting tabular data in two-dimensional tables: complementary cell suppression, minimum-distance controlled rounding, unbiased controlled rounding, and controlled rounding subject to subtotals constraints, and a fifth, new method: controlled tabular adjustment, and summarizes the five methods.

Computer Security↗
PubMed2001

Availability of medicines in the European Union: results from the EURO-Medicines project.

OBJECTIVE: There is at present no comprehensive directory of medicines available in European countries. Such a directory would be valuable to policy analysts, clinicians, regulatory agencies, pharmaceutical companies and consumer groups. The aim of this project was to compile such a directory of all medicines marketed in each of the European Union member countries. METHODS: Lists of medicines for each country, compiled from several national sources, classified by Anatomical-Chemical-Therapeutic (ATC) code. Census date was late 1998. RESULTS: A comprehensive directory was created using data from 14 of the 15 European Union countries. Numbers of trade names and of active ingredients varied widely, from Germany with 18,554 and 1,973, respectively, to Denmark with 1,915 and 1,016, respectively. In individual therapeutic areas, there were variations in the numbers of active ingredients available: the least variation between countries was in antineoplastic medicines (ATC code L, maximum number available in any country 101, minimum 60) and wider variation in alimentary (ATC code A, maximum 256. minimum 103) or cardiovascular (ATC code C, maximum 269, minimum 112). Only 7% of all the active ingredients were available in all the countries studied. The Scandinavian countries had the greatest proportion of active ingredients (60%) available in all other countries. Each country had a number of active ingredients available only in that country Italy had the largest number of these. CONCLUSIONS: The directory illustrates the wide variations in the availability of medicines across the European Union. The range of drugs available in each country represents differences in regulatory and market policies, as well as cultural and historic differences. This directory lends itself to many further analyses.

Data Collection↗
PubMed1998

Window Sensitivity Functions for Line Transect Sampling

/ The estimation of animal or plant abundance by the line or belt transect sampling method has been investigated by many authors, including biologists, statisticians, biometricians, wildlife scientists, and fisheries and forestry specialists. The method has reached wide acceptance over the last 30 years, and the theoretical development has continued to expand, both from a parametric and a nonparametric point of view. This article examines the line transect sampling method from a slightly different perspective. If the line transect region is regarded as a rectangle with length L and width 2w, then by a selection of viewing window is meant a choice of w, with the intent being to search for optimal viewing windows, with the goal in mind of improving variances of estimators of population density, reducing sampling effort, while maintaining the property of unbiasedness. The notions of increasing window sensitivity (IWS) and decreasing window sensitivity (DWS) are introduced, and a method of deriving confidence intervals is discussed.KEY WORDS: Line transection sampling; Population estimation; Probability detection function; Window sensitivity function; Strip census.

Journal Article↗
PubMed2005

Neighborhood crime, deprivation, and preterm birth.

PURPOSE: Significant racial disparity in preterm birth (PTB; birth at <37 weeks' gestation) exists, poorly explained by Individual-level factors. This research explores whether neighborhood crime contributes to the racial disparity in PTB. METHODS: Geocoded Wake County, NC, birth records and crime-report data for 1999 to 2001 were merged with US Census data (2000). Race-stratified logistic and multilevel logistic models produced odds ratios (ORs) and 95% confidence intervals (CIs) for block-group violent, theft, property, and vice crime rates and singleton PTB. RESULTS: A total of 13,960 women resided in a 114-block-group crime area. Non-Hispanic black women were more likely than non-Hispanic white women to deliver preterm (12.8% versus 6.7%), live in economically deprived block groups (42.2% versus 19.3% in the highest deprivation quartile), and experience more crime (32.0% versus 3.8% in the highest violent-crime-rate quartile). Quartiles of violent, theft, property, and vice crimes were associated with PTB in unadjusted models. Living in very high violent-crime-rate block-group quartiles was suggestive of increased odds of PTB for white and black non-Hispanic women (OR = 1.5; 95% CI, 0.9-2.6; and OR = 1.4; 95% CI, 1.0-2.1, respectively) in adjusted models. Other crime effects were attenuated after adjustment. CONCLUSIONS: Differential neighborhood exposures may contribute to racial disparity in PTB.

Adolescent↗