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Occupational fatalities in emergency medical services: a hidden crisis.

STUDY OBJECTIVE: We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States. METHODS: We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). These rates were compared with the occupational fatality rates of police and firefighters and with the rate of all employed persons in the United States. RESULTS: The Census of Fatal Occupational Injuries database documented 91 EMS provider occupational fatalities. The National EMS Memorial Service database contained 70 fatalities, and the Fatality Analysis Reporting System identified 8 ground-transportation EMS occupational fatalities. There was also wide variation in fatality counts by cause of injury. Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period. CONCLUSION: This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers.

Accidents, Occupational↗

Neighborhood effects on the self-rated health of elders: uncovering the relative importance of structural and service-related neighborhood environments.

OBJECTIVES: The purpose of this study was to investigate the independent relationship between neighborhood context (characterized through age structure, economic conditions, service provision, and residential stability) and self-reported health among elders in one U.S. city. METHODS: By using multilevel statistical models, we examined the cross-sectional relationships between markers of neighborhood environment (derived from the 1980 U.S. Census and the Yellow Pages of the 1985 New Haven, Connecticut, telephone book) and self-rated health among elders. We used survey data from the 1985 New Haven Established Populations for Epidemiologic Studies of the Elderly, which comprised 1,926 elders nested within 28 census tracts. RESULTS: When controlled for individual age, gender, race, marital status, education, and income, neighborhood measures of percent poverty were positively associated with poor self-rated health (odds ratio [OR] = 1.09; 95% confidence interval [CI] = 1.02-1.17), whereas residential stability (OR = 0.90; 95% CI = 0.84-0.96) and concentration of elders (OR = 0.82; 95% CI = 0.72-0.94) were inversely associated with poor self-rated health. Neighborhood service density was not associated with self-rated health. DISCUSSION: We found support for the role of neighborhood structural context (reflected through measures of poverty, residential stability, and age-based demographic concentration) in predicting the health of elders. Density of neighborhood services did not appear to have an independent effect on the self-rated health of elders.

Aged↗

Mortality among seamen with special reference to work on tankers.

BACKGROUND: Several studies demonstrate a high mortality among seamen but this has not been related to different types of work on board. This study examined a possible relationship between work on tankers and mortality. Tankers differ from other ships by carrying different types of oil, oil products and other chemicals. METHODS: Mortality was studied in 1687 men who were captains and mates during the period 1970-1987, and were registered by a Norwegian census in 1970. The data were linked to the Norwegian Register of Death Certificates. In all 181 deaths were found. Each case was age-matched at time of death to three individuals from the rest of the population alive at this date. Information about the seamen's work on different ships was obtained for cases and controls. The data were analysed using multivariate conditional logistic regression. RESULTS: Seamen working on tankers had a higher mortality rate ratio (RR = 2.43, 95% confidence interval [CI]: 1.65-3.60) than seamen who had not been working on tankers. The increased risk was especially related to death from cancer and from accidents, while no significantly increased mortality due to cardiovascular diseases was found. Employment as a mate on tankers showed the highest all-causes risk of death (RR = 3.14, 95% CI: 2.04-4.82) as well as for cancer (RR = 4.24, 95% CI: 2.02-8.88) and accidents (RR = 5.85, 95% CI: 1.66-20.60). Employment as a captain on tankers showed no significantly increased mortality. CONCLUSION: Exposure to chemicals on tankers may be related to the increased mortality, as this is the major difference between tankers and other ships and mates are exposed to chemical agents, while captains are not.

Accidents, Occupational↗

Alcohol and HIV: a study among sexually active adults in rural southwest Uganda.

OBJECTIVE: To investigate the association between alcohol consumption and HIV sero-positivity in a rural Ugandan population. METHODS: The adult population residing in a cluster of 15 neighbouring villages has been kept under epidemiological surveillance for HIV infection using annual censuses and sero-surveys since 1989. At the eighth annual survey all respondents were asked about their history of alcohol consumption, the sale of alcohol in their household, and other socio-demographic information. After informed consent, blood was drawn for HIV serology. RESULTS: Of the total adult population 3279 (60%) were interviewed; 48% were males; 905 (27%) had not started sexual activity and were excluded from further analysis. Of the remaining 2374, 8% were HIV infected, 57% had ever drunk alcohol, and 4% lived in households where alcohol was sold. Living in a household where alcohol was sold was associated with a history of having ever drunk alcohol (OR 2.9, 95% CI : 1.7-4.8). HIV prevalence among adults living in households selling alcohol was 15% compared with 8% among those living in households not selling alcohol (OR 2.0, 95% CI : 1.1-3.6). Individuals who had ever drunk alcohol experienced an HIV prevalence twice that of those who had never drunk, 10% versus 5% (OR 2.0, 95% CI : 1.5-2.8). This association remained after adjusting for potential confounders including sale of alcohol in the household and Muslim religion (OR 1.8, 95% CI : 1.2-2.7). Only age, marital status and having ever drunk alcohol independently predicted HIV sero-positivity in a logistic regression model. CONCLUSIONS: We have demonstrated an association between a history of alcohol consumption and being HIV sero-positive. This unexplored factor may explain in part the observed lower prevalence of HIV infection among Muslims. Public health campaigns need to stress the relationship between HIV and alcohol.

Adolescent↗

Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study.

BACKGROUND: This study investigates the relationship between neighbourhood characteristics and mortality (all-cause, cardiovascular disease [CVD], and cancer) in the Atherosclerosis Risk in Communities Study (ARIC). METHODS: Analysis was limited to African-American and white participants 45-64 years of age at baseline whose records were linked to census data. Deaths ascertained through 31 December 1999 were included in the analysis. Individual-level characteristics were obtained from the baseline interview. A composite index was used to characterize the neighbourhood socioeconomic environment. Proportional hazards regression was used to estimate the effect of neighbourhood socioeconomic status (SES) index and family income on the survival time. RESULTS: The rate of mortality adjusted for age and gender was highest among those who lived in disadvantaged neighbourhoods and were of lower SES. In general, all-cause and CVD mortality rates decreased with increasing neighbourhood SES advantage and family income in all race-gender groups. Although this pattern generally persisted after adjustment for individual socioeconomic factors, statistically significant associations persisted for CVD mortality in whites only (hazard ratio = 1.4, 95% CI: 1.0, 2.0) for most disadvantaged versus most advantaged tertile). When compared with the most affluent participants living in the most advantaged neighbourhoods, the increased risk of all-cause and CVD mortality associated with being poor and living in the most disadvantaged neighbourhoods was equivalent to being 11 and 13 years older at baseline for whites and African Americans, respectively. CONCLUSION: Our findings indicate that neighbourhood socioeconomic characteristics are associated with modest increases in CVD mortality in white adults. The lack of neighbourhood effects in African Americans needs to be interpreted with caution due to the limited range in the characteristics of the neighbourhood from which these participants were drawn.

Black or African American↗

Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer.

BACKGROUND: Prostate cancer mortality is higher among black American men than among white American men. We investigated whether racial disparities in outcomes of clinically localized prostate cancer vary by treatment (surgery, radiation therapy, or nonaggressive treatment). METHODS: Merged Surveillance, Epidemiology, and End Results Program (SEER) and Medicare files provided data (on treatment modality, age, race, cancer stage, tumor grade, census tract socioeconomic status, and date of death) on 5747 black and 38 242 white patients diagnosed at age 65-84 years with clinically localized prostate cancer between 1986 and 1996 in five SEER sites. Patients were followed through 1998. Racial differences in survival outcomes were assessed using Kaplan-Meier survival curves and Cox regression models. RESULTS: The median survival time for black patients was 1.7 years (95% confidence interval [CI] = 1.6 to 1.9 years) less than that for white patients. Median survival in black patients relative to white patients was 1.8 years (95% CI = 1.5 to 2.0 years) less among those who had surgery, 0.7 years (95% CI = 0.5 to 1.0 years) less among those who had radiation therapy, and 1.0 years (95% CI = 0.7 to 1.1 years) less among those who had nonaggressive treatment. Racial disparities were evident both in overall survival and in prostate cancer-specific survival, before and after statistical adjustment for covariates. CONCLUSIONS: Black patients' poorer overall survival from localized prostate cancer varies by initial treatment, with the survival gap being largest among patients undergoing surgery. Investigating these treatment-specific differences may clarify the mechanisms underlying worse outcomes for black patients in the health care system.

Aged↗

A statistical profile of physical therapists, 1980 and 1990.

BACKGROUND AND PURPOSE: To plan for future needs, human resource analysts require demographic data. In this research, US census data were used to develop a profile of physical therapists. SUBJECTS: Data were extracted from the Public Use Microdata Samples of the US censuses of population from 1980 and 1990. Samples of 3,112 physical therapists from 1990 and 1,530 therapists from 1980 were obtained. METHODS: A profile was generated by use of descriptive statistics to examine geographic distribution, social characteristics, employment characteristics, and income. Linear regression was used to determine factors that influence income. RESULTS: During the 1980s, physical therapy demonstrated remarkable growth, with trends in physical therapist location, gender, age, and place of employment. Even as the profession aged, it stayed an occupation composed predominantly of women, but one less concentrated in hospitals. Geographically, physical therapists remained clustered in the Northeast and along the Pacific Coast. Income generated by physical therapists was predicted by social and geographic characteristics. CONCLUSION AND DISCUSSION: This study presents a new data source to examine physical therapist characteristics. It provides information necessary for health care planners and analysts to better understand the nature of the profession and those who practice.

Adult↗

Urban-rural differences in self-reported limiting long-term illness in Scotland.

BACKGROUND: Previous research suggests that there are significant differences in health between urban and rural areas. The aim of this study is to describe the pattern and magnitude of urban-rural variation in health in Scotland and to examine the factors associated with health inequalities in urban and rural areas. METHODS: The data used in this study were limiting long-term illness (LLTI) and socio-economic data collected by the 1991 Census. A rurality indicator was created using Scottish Household Survey rurality classifications. Multilevel Poisson regression modelling was carried out with LLTI as a health indicator for each type of rurality within Scotland. A variety of socio-economic factors were investigated for each rurality. RESULTS: Areas with the highest Standardized Illness Ratios (SIRs) (>125) are predominantly urban whereas the lowest SIRs (<75) are found in both urban and rural areas. Rural communities are more heterogeneous than urban areas in terms of their social make-up with relation to health; however, when these areas are split according to minor road length and different socio-economic factors are added, the model fit for each new model is improved and the reduction in total variation is comparable with that of the urban models. CONCLUSION: These findings suggest that rural areas should not be treated as a homogeneous group but should be subdivided into rural types.

Chronic Disease↗

Organic solvents and the risk of multiple sclerosis.

BACKGROUND: Epidemiologic studies suggest that environmental factors may be part of the yet unknown causation of multiple sclerosis (MS). Several case-control studies have shown a history of elevated exposure to organic solvents among cases. METHODS: Three cohorts of 11,542 painters, 36,899 construction workers and 9,314 food-processing workers were identified by the 1970 census in Norway. The cohorts were followed until the end of 1986 for registration of disability pensions. RESULTS: A total of nine painters, 12 construction workers and six food workers had received a disability pension because of MS. The relative risk for painters compared with workers not exposed to organic solvents was 2.0 (95% confidence inter-val = 0.9-4.5) for MS. CONCLUSIONS: These results are compatible with the hypothesis of organic solvents being a possible risk factor for MS.

Adult↗

Demographic differences in injuries among the elderly: an analysis of emergency department visits.

BACKGROUND: An understanding of demographic differences in injury types among the elderly will help in targeting interventions. METHODS: Rates were calculated from the 1997 to 1999 National Hospital Ambulatory Medical Care Surveys by dividing the estimated number of visits by census population estimates. Age-adjusted standardized morbidity ratios were calculated to facilitate comparison between genders and between races. RESULTS: Although men had fewer fractures than expected on the basis of the rate for women (standardized morbidity ratio = 0.57), they had more open wounds (standardized morbidity ratio = 1.785, p < 0.001). Blacks had fewer fractures than expected, based on the rates for whites (standardized morbidity ratio = 0.601, p = 0.004) but had higher visit rates than expected for less severe injuries such as contusions, strains, and sprains. CONCLUSION: The trends noted in the present analysis suggest interventions for improved machinery safety targeted at elderly men and a continuing focus on access to primary care for minority elderly.

Age Factors↗

Hospitalizations for pelvic inflammatory disease and tuboovarian abscess.

OBJECTIVE: To describe the demographic characteristics of and procedures for patients hospitalized for pelvic inflammatory disease (PID) and tuboovarian abscess in California from 1991 to 2001. METHODS: We used the International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes in the California Patient Discharge Database and census data to calculate hospitalization rates for PID and tuboovarian abscess by age and race/ethnicity. We estimated the proportion of PID and tuboovarian abscess hospitalizations associated with procedures and estimated average length of hospital stay, readmission rates, and mortality. RESULTS: From 1991 to 2001, the California hospitalization rate for PID decreased by 61.5% (from 2.6 to 1.0 per 10,000 women). Tuboovarian abscess hospitalization rates declined by 33.3% during the same time period (from 0.6 to 0.4). Pelvic inflammatory disease hospitalization rates were highest among 20-39 year olds compared with other age categories. Black women aged 20-39 had the highest PID hospitalization rates compared with other racial/ethnic groups. The proportion of hospitalizations associated with hysterectomy was lowest for blacks. CONCLUSION: In California, the hospitalization rate for PID has declined between 1991 and 2001. Black women, 20-39 years of age, had the highest PID hospitalization rates. LEVEL OF EVIDENCE: III.

Abscess↗

Diabetes prevalence in England, 2001--estimates from an epidemiological model.

AIMS: To estimate the total prevalence of diabetes mellitus (diagnosed and undiagnosed) at national, regional and local level in England to support health-care planning and delivery. METHODS: An epidemiological model was constructed by applying age-sex-ethnic-specific reference prevalence rates from epidemiological studies to resident populations (2001 census) of England at national, regional, and local authority/Primary Care Trust levels. RESULTS: Estimated prevalence of total diabetes for all persons in England was 4.41% in 2001, equating to 2 168 000 persons. Type 2 diabetes was estimated to affect 2 002 000 persons (92.3%) and Type 1 diabetes 166 000 persons (7.7%). Diabetes prevalence was estimated to be higher in women (5.17%) than men (3.61%). People from ethnic minority groups had higher crude prevalence than White Europeans (4.29, 5.69, 6.63 and 2.13% among White Europeans, Black African/Caribbeans, South Asians and 'other' groups, respectively). Prevalence increased sharply with age (0.33, 3.37 and 13.92%, respectively, in those aged 0-29, 30-59 and 60+ years). The model allows use of user-defined population denominator estimates to derive numbers and prevalence of people with diabetes for a given local population group, such as at ward or general practice level. CONCLUSIONS: Self-reported diabetes prevalence estimates from community surveys underestimate the true burden of diabetes. The model can be used to derive the expected total prevalence of diabetes in health areas that lack reliable data to facilitate the implementation of the National Service Framework for diabetes. It will also allow estimates of future diabetes prevalence to be derived, and can potentially be used for prevalence estimates in all of the UK.

Adolescent↗

Opposing trends in incidence of esophageal squamous cell carcinoma and adenocarcinoma in a multi-ethnic Asian country.

OBJECTIVES: To describe the incidence trends in esophageal squamous cell carcinoma (SCC) and adenocarcinoma among the three major ethnic groups in Singapore from 1968 to 2002. METHODS: Esophageal cancer cases in Singapore citizens and permanent residents obtained from the Singapore Cancer Registry and population data derived from the national census were used to calculate the incidence rates from 1968 to 2002. RESULTS: The age-standardized incidence rates (ASRs) for SCC decreased progressively from 8.31 to 3.85 per 100,000 men (p = 0.017) and from 3.43 to 0.81 per 100,000 women (p = 0.027). The rates fell for all three ethnic groups. The ASR for adenocarcinoma rose from 0 to 0.54 per 100,000 men and from 0.03 to 0.13 per 100,000 women, although these time trends did not achieve statistical significance. The frequency of regular smoking in the population decreased from 23% in 1966/1977 to 12.6% in 2004. The percentage of obesity in adults rose from 4.3% in 1982-1985 to 6.9% in 2004. The frequency of esophagitis in Singapore based on endoscopic findings increased from 3.9% in 1992 to 9.8% in 2001. CONCLUSIONS: The decline in the incidence of SCC is likely to be associated with the known decrease in the frequency of smoking among Singaporeans. In contrast, there appears to be a trend toward an increase in the incidence of adenocarcinoma in Singapore, although the absolute incidence remains relatively low. This may be due to the associated rise in the frequency of reflux esophagitis and obesity in Singapore.

Adenocarcinoma↗

Economic disparity in bicycle helmet use by children six years after the introduction of legislation.

BACKGROUND: Studies evaluating the effectiveness of bicycle helmet legislation often focus on short term outcomes. The long term effect of helmet legislation on bicycle helmet use is unknown. OBJECTIVE: To examine bicycle helmet use by children six years after the introduction of the law, and the influence of area level family income on helmet use. METHODS: The East York (Toronto) health district (population 107,822) was divided into income areas (designated as low, mid, and high) based on census tract data from Statistics Canada. Child cyclists were observed at 111 preselected sites (schools, parks, residential streets, and major intersections) from April to October in the years 1995-1997, 1999, and 2001. The frequency of helmet use was determined by year, income area, location, and sex. Stratified analysis was used to quantify the relation between income area and helmet use, after controlling for sex and bicycling location. RESULTS: Bicycle helmet use in the study population increased from a pre-legislation level of 45% in 1995 to 68% in 1997, then decreased to 46% by 2001. Helmet use increased in all three income areas from 1995 to 1997, and remained above pre-legislation rates in high income areas (85% in 2001). In 2001, six years post-legislation, the proportion of helmeted cyclists in mid and low income areas had returned to pre-legislation levels (50% and 33%, respectively). After adjusting for sex and location, children riding in high income areas were significantly more likely to ride helmeted than children in low income areas across all years (relative risk = 3.4 (95% confidence interval, 2.7 to 4.3)). CONCLUSION: Over the long term, the effectiveness of bicycle helmet legislation varies by income area. Alternative, concurrent, or ongoing strategies may be necessary to sustain bicycle helmet use among children in mid and low income areas following legislation.

Adolescent↗

Do inaccuracies in small area deprivation analyses matter?

OBJECTIVE: To assess the accuracy of computerised matching of postcode to enumeration district (ED) and to determine whether any mismatching reduces the validity of methods to distinguish socioeconomic differences in "small area" deprivation studies. DESIGN: Computerised and manual matching of postcodes to EDs were compared and the census based Townsend deprivation score was compared with socioeconomic data on individual families. SETTING: County of Northumberland, England, 1989. SUBJECTS: Random sample of 301 families with a child aged less than 15 months. MAIN RESULTS: With computerised matching only 47% of postcodes were matched to the correct ED. Eighty per cent of the deprivation scores of the computer matched EDs, however, approximated (+/- 2) to the deprivation score of the actual ED. When EDs were divided into quintiles according to the deprivation score, accurate manual matching showed that 75% of families in the most deprived EDs were classed as deprived compared with 4% in the most affluent EDs. With the inaccuracies introduced by computer matching of postcodes, the corresponding figures were 56% and 12% respectively. CONCLUSIONS: Computerised matching of postcodes to EDs is highly inaccurate, but this has little effect on the allocation of deprivation scores. The socioeconomic inequalities shown by the deprivation score are blunted, but not eradicated, by this mismatching.

Computers↗

The prevalence of Parkinson's disease in an area of North Tyneside in the North-East of England.

OBJECTIVES: UK prevalence studies have demonstrated prevalence rates for Parkinson's disease (PD) of 108 to 164 cases per 100,000. we aimed to calculate the prevalence of PD in an area of the North-East of England. MATERIAL AND METHODS: A case finding methodology was used to identify cases in North Tyneside with a population of 108,597 at the 2001 UK census. RESULTS: 161 cases were identified giving crude and age-adjusted prevalence estimates of 148 cases (95% CI 124-174) and 139 cases (95% CI 116-162) per 100,000, respectively. The mean age was 74.1 years (range 44-96 years) with mean disease duration of 5.6 years. CONCLUSIONS: The prevalence of PD in North Tyneside is comparable with that of the rest of the UK. The prevalence of PD in the UK appears not to have changed greatly over the last 30 years.

Adult↗

The New York Islands AVM Study: design, study progress, and initial results.

BACKGROUND AND PURPOSE: Prospective population-based data on the incidence of brain arteriovenous malformation (AVM) hemorrhage are scarce. We studied lifetime detection rates of brain AVM and incident AVM hemorrhage in a defined population. METHODS: The New York islands (ie, Manhattan Island, Staten Island, and Long Island) comprise a 9,429,541 population according to the 2000 census. Since March 15, 2000, all major New York islands hospitals have prospectively reported data on consecutive patients living in the study area with a diagnosis of brain AVM and whether the patient had suffered AVM hemorrhage. Patients living outside the ZIP code-defined study area were excluded from the study population. RESULTS: As of June 14, 2002, 284 prospective AVM patients (mean+/-SD age, 35+/-18 years; 49% women) were encountered during 21,216,467 person-years of observation, leading to an average annual AVM detection rate of 1.34 per 100,000 person-years (95% CI, 1.18 to 1.49). The incidence of first-ever AVM hemorrhage (n=108; mean age, 31+/-19 years; 45% women) was 0.51 per 100,000 person-years (95% CI, 0.41 to 0.61). The estimated prevalence of AVM hemorrhage among detected cases (n=144; mean age, 33+/-19 years; 50% women) was 0.68 per 100,000 (95% CI, 0.57 to 0.79). CONCLUSIONS: Our prospective data, spanning 27 months, suggest stable rates for AVM detection and incident AVM hemorrhage. Approximately half of AVM patients may suffer intracranial hemorrhage.

Adolescent↗

Driving times and distances to hospitals with percutaneous coronary intervention in the United States: implications for prehospital triage of patients with ST-elevation myocardial infarction.

BACKGROUND: The success of prehospital triage protocols for patients with ST-elevation myocardial infarction (STEMI) will depend, in part, on how patients are geographically distributed around hospitals that perform percutaneous coronary intervention (PCI). Accordingly, we determined the proportion of the adult population in the United States with timely access to PCI hospitals using driving times and distances. METHODS AND RESULTS: We performed a cross-sectional study using hospital-level data from the American Hospital Association Annual Survey and Census tract-level data on adults 18 years of age or older from the 2000 United States Census. Our aims were to determine the proportion of the adult population who (1) lived within 60 minutes of a PCI hospital and (2) had additional transport times within 30 minutes if directly referred to a PCI hospital as opposed to a closer, non-PCI hospital. Median times and distances to the closest PCI hospital were 11.3 (interquartile range [IQR] 5.7 to 28.5) minutes and 7.9 (IQR 3.5 to 22.4) miles, respectively. A total of 79.0% of the adult population lived within 60 minutes of a PCI hospital. Among those with a non-PCI hospital as their closest facility, 74.0% required additional transport times of <30 minutes if directly referred to a PCI hospital as opposed to the non-PCI hospital. These estimates varied substantially across regions and urban, suburban, and rural Census tracts. CONCLUSIONS: Nearly 80% of the adult population in the United States lived within 60 minutes of a PCI hospital in 2000. Even among those living closer to non-PCI hospitals, almost three fourths would experience <30 minutes of additional delay with direct referral to a PCI hospital, which suggests that such a strategy might be feasible for these individuals.

Angioplasty, Balloon, Coronary↗