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PubMed1991

Birth outcomes and infant mortality by income in urban Canada, 1986.

For 1986, 219,470 live births were reported for residents of Canada's 25 Census Metropolitan Areas (CMAs). For each of these births, street address information as shown on the birth registration was used to code the census tract where the mother lived. Data by census tract were obtained for 1,650 infant deaths in 1986, and from the 1986 census for the population of 4,727,770 women aged 10-49 in 1986. Births, infant deaths and census population data (adjusted for undercount) were then used to calculate rates of infant mortality, low birth weight (LBW), very low birth weight (VLBW), prematurity, small for gestational age (SGA), and total fertility. The results are presented by neighborhood income quintile group (based on percentage of low income), and by the mother's age, parity (number of live births), marital status and country of birth, as well as by CMA.

Adolescent↗
PubMed1987

Comments on HCFA hospital death rate statistical outliers. Health Care Financing Administration.

In March 1986, the Health Care Financing Administration (HCFA) released ten lists of death-rate "outlier" hospitals, one for all 1984 Medicare discharges and nine for specific DRGs. Recent Medicare hospital discharge abstracts have substantially undercounted in-hospital deaths, with large variations by state. Apart from the proportion of a hospital's cases in 80 DRGs, the predictive models had no measures of case severity based on diagnosis or procedure. Having DRG 123 (all deaths from acute myocardial infarction) as an independent variable in the all-death regression model probably accounted for much of its high r2. Inclusion of an independent variable for average length of stay (ALOS) favored hospitals in higher ALOS states by higher predicted death rates. Model bias also favored lower-risk hospitals. Small numbers of predicted deaths for specific DRGs limited low-volume hospitals on these outlier lists to those with high ratios of actual to predicted deaths. On six of the nine DRG-specific outlier lists, a total 1,222 hospitals had unfavorable residuals, while only 8 were favorable. Ten recommendations are given to increase reliability of future outcome analyses.

Aged↗
PubMed1985

The nominative technique: a new method of estimating heroin prevalence.

Over the years, nominative estimates of heroin prevalence have been consistently higher than self-reports of heroin use. During this time, nominative data have generally followed mainstream patterns of drug use: nominative estimates for young adults and for males are higher than nominative estimates for older persons, youth, and females; moreover, the recent downward trends in drug use have been replicated by the nominative heroin data. Thus, the overall picture presented by the nominative data--similar patterns but higher levels of prevalence--seems to support the validity of the new approach. Nevertheless, considerable caution should be exercised in interpreting nominative data. This is chiefly because a substantial minority of nominators cannot report the number of other close friends of the heroin user who also "know." While missing data has been handled by a conservative imputation rule, the fact that so many persons are unable to provide an answer to this key question casts doubt on the accuracy of the answers that were given. In fact, the nominative approach might tend to produce over-estimates, because of the potential for undercounts of the numbers of others who "know." Additional tests of validity should be performed, such as application of the nominative approach to nonsensitive behaviors or minimally sensitive behaviors, such as marijuana use or perhaps cocaine use. Certainly, the overall validity of the nominative heroin data would be supported if in future surveys new nominative heroin estimates for relatively unstigmatized forms of drug use proved to be similar to self-reported levels of use, thus pointing to the unique difference in estimates that might be observed for heroin. Finally, in interpreting the heroin estimates presented here, it should be remembered that both the nominative and self-report estimates refer to heroin use in the household population of the United States. Thus, many heroin addicts and other users who reside in various unconventional living arrangements would not be included in the counts presented here. Among the excluded groups are transients residing in rooming houses or "crashing" in the home of one "friend" after another or who are incarcerated in jails or confined to residential drug treatment centers. This is a caution for interpreting the estimates presented in this paper, not a criticism of the nominative technique itself.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

New midyear age-sex-color-specific estimates of the U.S. population for the 1940s and 1950s: including a revision of coverage estimates for the 1940 and 1950 censuses.

This paper describes new midyear (July 1) estimates of the "true" population of the United States by age, sex, and color (white, nonwhite) for the 1940s and 1950s. It also presents the corresponding implied coverage estimates for the 1940 and 1950 censuses. The new population estimates are calculated by combining the most recent figures on the 1960 population with estimates of the demographic components of change for the 1950s and 1940s in an iterative reverse cohort-component projection algorithm. Among the principal findings of the new estimates are: (a) existing midyear estimates of the "true" population in the 1950s are 450,000 to 500,000 too high; (b) existing age-specific estimates for the 1950s tend to underestimate the population at the older ages (55 years and over) and overestimate the population in the young and middle adult years (15 to 54 years); (c) estimates of the "true" population in the 1940s were too low except for nonwhites at ages 65 and over; (d) existing estimates of percentage net undercount and underenumeration for the 1950 and 1940 censuses tend to be too high, substantially so for nonwhites in the 1940 Census; and (e) nonwhites were more completely enumerated in 1940 than in 1950. Thus, in addition to being methodologically and temporally consistent with post-1960 estimates, the new population estimates described here imply some substantial revisions in demographic, social, and economic statistics for the two decades prior to 1960.

Adolescent↗
PubMedDate not supplied

Sensitivity of hospitals' E-coded data in identifying causes of children's violence-related injuries.

E codes classify causes of injury as unintentional, intentional, and undetermined. E-coded discharge data from hospitals provide an opportunity to use this source of morbidity data for planning, implementation, and evaluation of injury and violence prevention activities. This study explores the extent to which E-coded data from hospitals identify injuries that result from violent acts. Cases were identified through a multihospital population-based surveillance system of pediatric injuries. Those cases with injury as a result of violence, designated by study criteria, were compared with those with E codes that were classified as intentional. The analysis indicated that 25 percent of injuries to children resulting from violence may not be accounted for through the use of E codes. The majority of the undetected injury cases resulting from violence involved child abuse. Researchers and other persons who design and conduct injury and violence prevention programs should be aware of the undercount and associated issues when using E-coded hospital discharge data for surveillance of injuries resulting from violence.

Adolescent↗
PubMed1995

Estimates of early twentieth-century U.S. homicide rates: an econometric forecasting approach.

Bureau of the Census death registration records, as reported in Mortality Statistics, are a primary source for early twentieth-century U.S. homicide statistics. Those data appear to show a massive rise in homicide during the first decade of the century, with a continuing increase through 1933. This increase is quite at variance with the trend away from violence in other industrialized societies. During the first one-third of the century, however, death registration was incomplete; it occurred only in an expanding "registration area" that was composed, in the earlier years, primarily of states with typically low rates of homicide. Further, in the first decade of the century homicides within the registration area often were reported as accidental deaths. As a result, apparent increases in rates of homicide in the United States between 1900 and 1933 may be illusory. I use a two-step process to address these problems. Drawing on internal evidence and commentaries in early volumes of Mortality Statistics, I use GLS regression to estimate the prevalence of undercounts. Then I create a series of GLS models that use registration area data to estimate early twentieth-century national rates. These estimates call into question the extent of homicide change early in the century.

Bias↗
PubMed1993

Available epidemiologic data on New York's Latino population: a critical review of the literature.

The increasing diversity of New York's Latino population creates complex challenges for the health care provider and planner, such as how to plan for divergent health risks, disease patterns, and health behaviors. However, most research on Latinos has been done in the southwestern United States. This paper reviews the epidemiologic data published since 1980 on Latino groups in New York State. The review covers the following areas: maternal and child health, infectious diseases, depression, tobacco and substance use, chronic diseases, neoplasms, and mortality statistics. We compare New York data with studies done in other areas of the United States. We identify serious methodological shortcomings in the epidemiological assessment of New York's Latino population, including (1) imprecise definition of "Latino," (2) misclassification, (3) census undercount of minority groups, and (4) lack of data on socioeconomic status. We argue that the epidemiological and cultural diversity of Latino groups demands the inclusion of such variables as place of birth, length of stay, and language preference in research and service statistics. This would facilitate targeted program planning and help to determine environmental, sociopolitical, behavioral, and genetic influences on diseases.

Adult↗
PubMedDate not supplied

Evaluation of computer-assisted semen analysis (CASA) with IDENT stain to determine sperm concentration.

This study was undertaken to compare a new fluorescent stain-based computer-assisted semen analysis (CASA) system (IDENT) for determining human sperm concentration to the manual hemacytometric method and to conventional CASA (CASA-CONV). Normal healthy semen donors as well as patients provided samples that were evaluated for sperm concentration with the CASA-IDENT method, the hemacytometer method, and CASA-CONV. Each field was examined visually to determine the sources of overcounting and undercounting for the two CASA methods. Four ranges of sperm concentration were examined: 0-10, > 10-30, > 30-100, and > 100 x 10(6)/ml. The main outcome measures were sperm concentration, debris counted as sperm, and missed sperm. Our results showed that significantly more debris was counted as sperm and more sperm were missed with CASA-CONV than CASA-IDENT. As the sperm density increased, so did the number of counting errors for the CASA-CONV system. The error rate was much greater using CASA-CONV (12.1 +/- 42.2%) than with CASA-IDENT (0.4 +/- 0.7%) when compared to hemacytometer counts (P = 0.068). We conclude that the CASA-IDENT method of sperm counting is highly accurate and less time-consuming when compared to the hemacytometer method. There are significant differences in the amount of debris counted as sperm and number of missed sperm between CASA-CONV and CASA-IDENT with varying sperm density. With both parameters, the counts are more accurate using the CASA-IDENT method.

Benzimidazoles↗
PubMedDate not supplied

A new coincidence model for single particle counters, part III: realization of single particle counting accuracy.

U.S.P. objective tests for particle contamination in injectable fluids are based on counts of single particles in a specified test volume. Accuracy standards for these tests must therefore be based on single particle count accuracy. A definitive analysis for this purpose is described whose results can be used during a counting experiment. To improve the accuracy of particle counter data, U.S.P.XXIII has added a particle counter accuracy requirement defined in terms of a maximum particle concentration for 10 microns particles at which there is a 10% ratio of coincident occurrences. The 10% coincident count ratio cannot be directly measured: it must be calculated from experimental results using a model of the counting process. The U.S.P.XXIII count accuracy specification relies on vendor statements without definition of the methodology or model to be employed. The model of particle counting described in the literature is the Geometric Poisson model due to Jaenicke (4) and extended by Lieberman (5). Recent publications (1, 2) have shown that calculations based on this model do not agree with experimental data. This conclusion is supported and extended in this paper. The single particle counting error estimate for U.S.P.XXIII (788) SVI (3), using Jaenicke's Geometric model to evaluate a good commercial laser sourced detector, is 9.32%; the single particle count error estimate for this detector using the experimentally validated Particle-Triggered Poisson model is 19%. The count error for the concentration calculated with the Jaenicke Geometric model for the same detector is 40.5% when calculated with the validated Particle-Triggered Poisson model. The estimated count error increases for particles larger than 10 microns. Light extinction particle counters are well behaved instruments fully capable of the workhorse task of making accurate, routine single particle contamination measurements in injectable products. In principle, any particle counter instrument now in use, operated within calculated particle size and concentration contours, can deliver accurate single particle counting data. Operation within these limits both within and below the U.S.P.XXIII (788) (3) size range will assure single particle count accuracy without the injection of false counts or undercounts. These count limits vary with particle size and are determined by the capability of the counter. No single particle test can characterize the complex particle size and concentration response of a detector. In practice, selection of a counter with sufficient capability to provide the desired accuracy without constant dilution is an important consideration. When particle concentration exceeds the selected count accuracy contour, dilution and a repeat of the assay provide a practical solution.

Drug Contamination↗
PubMed1997

Occupational injury and illness in the United States. Estimates of costs, morbidity, and mortality.

OBJECTIVE: To estimate the annual incidence, the mortality and the direct and indirect costs associated with occupational injuries and illnesses in the United States in 1992. DESIGN: Aggregation and analysis of national and large regional data sets collected by the Bureau of Labor Statistics, the National Council on Compensation Insurance, the National Center for Health Statistics, the Health Care Financing Administration, and other governmental bureaus and private firms. METHODS: To assess incidence of and mortality from occupational injuries and illnesses, we reviewed data from national surveys and applied an attributable risk proportion method. To assess costs, we used the human capital method that decomposes costs into direct categories such as medical and insurance administration expenses as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Some cost estimates were drawn from the literature while others were generated within this study. Total costs were calculated by multiplying average costs by the number of injuries and illnesses in each diagnostic category. RESULTS: Approximately 6500 job-related deaths from injury, 13.2 million nonfatal injuries, 60,300 deaths from disease, and 862,200 illnesses are estimated to occur annually in the civilian American workforce. The total direct ($65 billion) plus indirect ($106 billion) costs were estimated to be $171 billion. Injuries cost $145 billion and illnesses $26 billion. These estimates are likely to be low, because they ignore costs associated with pain and suffering as well as those of within-home care provided by family members, and because the numbers of occupational injuries and illnesses are likely to be undercounted. CONCLUSIONS: The costs of occupational injuries and illnesses are high, in sharp contrast to the limited public attention and societal resources devoted to their prevention and amelioration. Occupational injuries and illnesses are an insufficiently appreciated contributor to the total burden of health care costs in the United States.

Accidents, Occupational↗
PubMed1997

1991 population estimates for areas smaller than districts.

This article describes the construction of population estimates for mid-1991 for electoral wards in England and Wales and postal sectors in Scotland. It shows how earlier work adjusting 1991 census figures at national and local authority level for undercount and other factors has been extended to smaller areas in a way that produces estimates which are consistent with the estimates for larger areas. Estimates for smaller areas are needed to calculate employment, health and other indices, and as a starting point for population estimates between census years.

Adolescent↗
PubMed1998

Reconstructing the size of the African American population by age and sex, 1930-1990.

We estimate the size of the African American population in five-year age groups at census dates from 1930 to 1990 using a three-part strategy. For cohorts born after 1935, we follow the U.S. Census Bureau in using classical demographic analysis. To estimate the size of cohorts born before 1895, we use extinct-generation estimates. For remaining cohorts, we implement an age/period/cohort model of census counts. All approaches are applied to a data set in which the age distribution of deaths has been corrected for age misreporting. Results provide strong confirmation of the basic validity of Census Bureau estimates of census undercounts for African Americans while extending estimates to new cohorts and periods. Our estimates are less consistent with an historical series prepared by Coale and Rives (1973).

Adolescent↗
PubMed1998

Trends in single mothers' living arrangements from 1970 to 1995: correcting the current population survey.

I examine trends in single mothers' living arrangements using data from the 1970-1995 Current Population Surveys. I create a consistent trend by correcting a coding problem that stemmed from the misidentification of children living in multigenerational households before 1984. Revised estimates show that the number of single mothers in each of these years was undercounted by 200,000-300,000. All of these women were subfamily heads living with their parents, and the problem occurred disproportionately among teens and black women. The uncorrected trend falsely indicates a large increase in the share of single mothers living with their parents. In reality, there was little change in the percentage of single mothers living in this arrangement over the time period. However, the data indicate a large increase in the rate of cohabitation and a comparable decline in the rate of living independently among this population.

Adolescent↗
PubMed1976

Provisional evaluation of the 1970 census count of American Indians.

Estimates of the American Indian population under 20 years of age on April 1, 1970, based on birth and death statistics for a 20-year period, show a possible net undercount of 6.9 percent for this age group in the 1970 census. However, for some particular ages the estimates indicate net overcounts in the census. Likewise, the net increase of the entire American Indian population as measured by the difference between the 1960 and 1970 censuses is 67,000 greater than the natural increase for the decade. Detailed analysis of cohort data with respect to the possible causes of the differences between the estimates and the census figures indicate that a portion of the estimated net overcounts can be attributed to classification, as well as coverage, problems. The estimated net overcounts offer support for the hypothesis that many individuals who were registered as white at birth and who were counted as white in the 1960 census shifted their racial self-identification from white to American Indian during the 1960's.

Adolescent↗
PubMed1998

The burden of rheumatoid arthritis: facts and figures.

In the most recent comprehensive economic study in the United States, the cost of arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA), was $64.8 billion US in 1992. Of the total costs of these diseases, about half were due to expenditures for medical care (direct costs) and about half were due to lost wages (indirect costs). Studies of the cost of RA undercount the true costs of this illness. Overall, costing methods create a bias against illnesses that occur disproportionately among women. The bias arises because the women with these conditions have historically had much lower labor force participation rates than men, and because women earn lower wages than men for similar work. In addition, there are many effects of RA that cannot be easily priced in the marketplace, although they are vital to the person and family affected by this disease. New approaches to therapy, which include earlier and more aggressive intervention, new drugs, and combinations of drugs, appear necessary to provide adequate control of inflammation, so that the longterm damage of RA might be prevented and the considerable costs reduced. The incremental costs, side effects, and benefits of therapies, compared to the average costs of disease, become much more relevant in policy discussions and clinical decision making. The possible adverse effects and costs of treatment must be balanced against the adverse effects and underestimated costs of RA.

Arthritis, Rheumatoid↗
PubMed1996

Ethnographic perspectives on the enumertion of aboriginal people in remote Australia.

"This paper compares population counts and age distributions from the last two Australian Bureau of Statistics (ABS) enumerations of the Aboriginal population of Aurukun, Cape York Peninsula, with the results of detailed ethnographic surveys of the same population at similar points in time. This reveals substantially lower numbers for the ABS counts, particularly of young adults and children. Reasons for this discrepancy are sought in the ethnographic realities of remote indigenous communities and an alternative methodology for Aboriginal enumeration in remote regions is suggested."

Age Distribution↗
PubMed1998

Making sense of Census data: a components analysis of employment change among indigenous Australians.

"The 1996 Census count of indigenous Australians included a substantial number of individuals who were not recorded as indigenous by the previous census. This paper considers the implications of this for interpreting change in employment numbers. Two adjustments are made to employment change data. First, reverse survival of the 1996 population is applied to reconstruct 1991 employment figures. Second, administrative data are used to discount employment generated by participation in labour market programs. The effect is to substantially deflate the strong intercensal employment growth apparent from census counts with the conclusion that the rate of indigenous employment in the mainstream labour market has fallen."

Australia↗
PubMed1993

Aboriginal population prospects.

The authors examine data from the 1986 and 1991 Australian censuses to assess discrepancies between the census data and past projections of the size and structure of the Aboriginal population. They also "comment on ways in which determinants of Aboriginal population change are diverging from the parameters used for previous projections. We pay particular attention to mortality prospects.... We note the evidence for under-enumeration of the Aboriginal population in particular age groups in the 1991 Census as in previous censuses, and estimate the size of adjustments necessary to correct for some, but not all, of these deficiencies. The analysis shows that Aboriginal fertility increased in the second half of the 1980s."

Age Distribution↗