Group-specific Rates Research Articles

Seroprevalence of transfusion transmissible infections (TTI), in first time blood donors in Abeokuta, Nigeria.

Transfusion transmissible infections, such as HIV, HBV, HCV and syphilis are on the rise and pose a threat to blood safety. To determine prevalence and demographic profiles of TTI's among first time blood donors in Abeokuta, Nigeria. The study was conducted between February to November 2013; 130 first time blood donors were tested for the presence of HIV, HBsAg, HCV antibodies and Treponema palidium antibodies using EIA based rapid immunochromatographic kits. Data analysis was done using SPSS with a level of significance of p<0.05. Prevalence rates to HIV, HBsAg, HCV antibody, were 6.2% (n=8), 10% (n=13) and 1.5% (n=2), there was 0% prevalence to Treponema palidium antibodies. Group specific prevalence rates revealed that educational status was associated with HBsAg positivity (p = 0.028), donors with a history of previous blood transfusion was also statistically associated with HIV sero-reactivity (p = 0.013). High levels of HBsAg and HIV were observed, there is need to revise the donor testing algorithm in Nigeria in line with the prevalence of TTI's. We also advocate that a National surveillance system for TTI's be established through our National blood transfusion service (NBTS) program, a second serological test is also suggested to reduce the risk of occult HBV infection in Nigeria.

Ethnic group variations in alcohol-related hospital admissions in England: does place matter?

Objectives. The health burden of alcohol use is socially and geographically patterned in many countries. Less is known about variations in this burden between ethnic groups and whether this differs across place of residence.Methods. National cross-sectional study using hospital admission data in England. Alcohol-related admission rates, where an alcohol-related condition was either the primary diagnosis (considered as the reason for admission) or a comorbidity, were calculated using ethnic group specific rates for English regions.Results. In 2010/11 there were a total of 264,870 alcohol-related admissions in England. Admission rates were higher in the North of England than elsewhere (e.g. for primary diagnosis 161 per 100,000 population in the North vs. 62 per 100,000 in the South). These patterns were not uniform across ethnic groups however. For example, admission rates for alcohol-related comorbidity were four times higher among White Irish in London compared with those in the South of England (306 to 76 per 100,000) and four times higher in Indians living in the Midlands compared with those in the South of England (128 to 29 per 100,000). These patterns were similar for admissions with a comorbid alcohol-related condition.Conclusions. Geographical location may be an important determinant of within and between ethnic group variations in alcohol-related hospital admissions in England. While a number of factors were not examined here, this descriptive analysis suggests that this heterogeneity should be taken into account when planning interventions and services for the prevention and management of alcohol misuse.

Trends in acute myocardial infarction hospitalization rates in Norway during 1994-2009; a CVDNOR project

Purpose: AMI hospitalizations account for almost 90% of all AMI occurrences. They encompass incident and recurrent events; the first reflecting primary prevention and the second in-hospital care and secondary prevention. Our aim was to examine AMI hospitalization trends during 1994-2009 in Norway. Methods: All AMI hospitalizations during 1994-2009 were extracted from Cardiovascular disease in - CVDNOR, a research project including information on all patients hospitalized for a CVD event 1994-2009. First and recurrent hospitalizations were included. Overall age-standardized and age group specific hospitalization rates were calculated. Trends over time were explored by Poisson regression analyses, computing hospitalization rate ratios (HRR). Changes are reported separately for 1994-2000 and 2001-2009, to minimize the effect of changes in AMI diagnostic criteria (troponin introduction) around 2000-2001. Results: 241 207 AMI hospitalizations (39% women) were included. Overall, age-standardized hospitalization rates declined during 2001-2009 (HRR=0.93; 95% CI 0.92-0.95). In young adults (< 45 years) rates increased during 1994-2009; not significantly during 1994-2000 and significantly thereafter (HRR=1.11; 95% CI 1.01-1.21). In age group 85+ years, rates increased during 1994-2000 (HRR=1.53; 95% CI 1.45-1.62) but not thereafter. A decline was observed in age group 45-64 years only during 1994-2000 (HRR=0.90; 95% CI 0.87-0.94). In age group 65-84 years there was a decline both for 1994-2000 (HRR=0.96; 95% CI 0.93-0.98) and 2001-2009 (HRR=0.85; 95% CI 0.84-0.87) ![Figure][1] Age-standardized hospitalization rates Conclusion: Overall AMI hospitalizations rates in Norway declined after 2000, due to declining rates among patients 45-84 years. Increasing trends were observed in young adults and elderly over 85 years. [1]: pending:yes

Sex difference in the incidence of nasopharyngeal carcinoma in Hong Kong 1983–2008: Suggestion of a potential protective role of oestrogen

BackgroundNasopharyngeal carcinoma (NPC) shows a male predominance in incidence while the underlying reasons have rarely been explored. MethodsWe analysed incident cases of NPC recorded in Hong Kong Cancer Registry during the period 1983–2008. All cases were divided into 5-year age groups. Age group specific incidence rates of NPC by sex and male to female ratios in incidence rate by age group were calculated. A curve fitting approach was taken to quantitatively describe the age-specific incidence rates of NPC using non-linear regressions. ResultsDuring the period 1983–2008, a total of 27,579 new cases of NPC were identified (20,060 males and 7519 females) in Hong Kong. The overall male to female ratio of the annual age-standardised incidence rates of NPC ranged 2.2–3.1. The male to female ratio of NPC incidence increased with age until peaking at ages 55–59years and showed a decline thereafter. An additional minor increase at ages 15–19years was also observed. Modelling of the age-specific incidence curves suggested divergent slopes for men and women and a delay in increasing incidence with age among females, by around 5–10years before menopause ages. ConclusionThe age-dependent pattern of the sex difference in the incidence of NPC could not be completely explained by known risk factors for NPC. The contributions of intrinsic exposures, such as sex hormones, merit consideration and further investigations.

Health, employment, and economic change, 1973-2009: repeated cross sectional study

The paper Health, employment, and economic change, 1973-2009: repeated cross sectional study by Jonathan William Minton and colleagues ( BMJ 2012;344:e2316, doi:10.1136/bmj.e2316) Abstract Objective —To see whether adverse relations between social class, health, and economic activity, observed between 1973 and 1993 and previously identified in a 1996 BMJ paper, were still apparent between 1994 and 2009 despite improvements in the general economic climate and overall population health. Design —Replication of repeated cross sectional analysis from the original paper, using the same source (the General Household Survey) and occupation coding scheme, but extended from the period 1973-93 to 1973-2009, and including women as well as men. Participants —Men and women aged 20-59 years in each annual survey between 1973 and 2009. Main outcome measures —Change over time in class specific rates of employment, unemployment, and economic inactivity within subgroups of respondents. Results —Overall employment rates have decreased for men of working age while increasing for working age women. For men in particular, the gradient of these changes seems to depend on occupational group. Over 37 years, the difference in occupational group specific economic inactivity and employment rates between people reporting and those not reporting a limiting long term illness has increased substantially. Conclusion —Between 1973 and 2009, the relation between good health and securing and sustaining employment has strengthened for men and women. For men, this has been caused by employment rates decreasing and economic inactivity rates increasing among men with poor health. For women, this has largely been because of a general trend of increased employment and reduced economic inactivity occurring among healthier women, but not in women of poorer health. Some evidence suggests that, since 2005, the relation between health, employment, and economic inactivity for women in the top two occupational groups has become more like that for …

Health, employment, and economic change, 1973-2009: repeated cross sectional study

Objective To see whether adverse relations between social class, health, and economic activity, observed between 1973 and 1993 and previously identified in a 1996 BMJ paper, were still apparent between...

Reference priors for constrained rate models of count data

We derive reference priors for constrained rate models of count data using the sequential algorithm of Berger and Bernardo (1992b). The event counts for various groups of subjects are modeled as discrete random variables (Poisson, binomial, or negative binomial) with group specific rates. We consider situations in which the groups can be completely ordered according to one covariate. The priors enforce monotonicity (or monotonicity and convexity) of the rates with respect to the ordering. We use the priors to model a data set on mortality rates for men in different age groups assuming that the mortality rates increase with respect to age. We also consider the situation in which the parameter space is augmented to include rates corresponding to unobserved age groups, and the case of a random upper bound on the mortality rates. In addition, we provide an evaluation of the out-of-sample predictive performance of the proposed methods.

Single Regression Estimates of Voting Choices When Turnout is Unknown

This paper demonstrates that conventional single regression estimators of voting preferences for groups within the electorate are unreliable when group-specific turnout rates are unknown. In this context, the relationship between voting choices and the composition of the electorate is defined by two applications of Goodman’s Identity. Several methods appear in the scholarly and litigation literature which attempt to estimate characteristics of this relationship with variants of “Goodman’s regression”, including “correlation analysis” and “homogeneous precinct analysis”. Most of these methods are inconsistent with the Identities. For all methods, the expected values and variances of the dependent variables and of all regression statistics are unknown. None of these methods are capable of identifying any of the underlying parameters, much less the statistical significance of any estimators. Consequently, none has any scientific validity.

Fluoride in drinking water and osteosarcoma incidence rates in the continental United States among children and adolescents

IntroductionIt has been suggested that fluoride in drinking water may increase the risk of osteosarcoma in children and adolescents, although the evidence is inconclusive. We investigated the association between community water fluoridation (CWF) and osteosarcoma in childhood and adolescence in the continental U.S. MethodsWe used the cumulative osteosarcoma incidence rate data from the CDC Wonder database for 1999–2006, categorized by age group, sex and states. States were categorized as low (≤30%) or high (≥85%) according to the percentage of the population receiving CWF between 1992 and 2006. Confidence intervals for the incidence rates were calculated using the Gamma distribution and the incidence rates were compared between groups using Poisson regression models. ResultsWe found no sex-specific statistical differences in the national incidence rates in the younger groups (5–9, 10–14), although 15–19 males were at higher risk to osteosarcoma than females in the same age group (p<0.001). Sex and age group specific incidence rates were similar in both CWF state categories. The higher incidence rates among 15–19 year old males vs females was not associated with the state fluoridation status. We also compared sex and age specific osteosarcoma incidence rates cumulated from 1973 to 2007 from the SEER 9 Cancer Registries for single age groups from 5 to 19. There were no statistical differences between sexes for 5–14 year old children although incidence rates for single age groups for 15–19 year old males were significantly higher than for females. ConclusionOur ecological analysis suggests that the water fluoridation status in the continental U.S. has no influence on osteosarcoma incidence rates during childhood and adolescence.

Ambulatory Visit Rates and Antibiotic Prescribing for Children With Pneumonia, 1994–2007

The incidence of pediatric hospitalizations for community-acquired pneumonia (CAP) has declined after the widespread use of the heptavalent pneumococcal conjugate vaccine. The national incidence of outpatient visits for CAP, however, is not well established. Although no pediatric CAP treatment guidelines are available, current data support narrow-spectrum antibiotics as the first-line treatment for most patients with CAP. To estimate the incidence rates of outpatient CAP, examine time trends in antibiotics prescribed for CAP, and determine factors associated with broad-spectrum antibiotic prescribing for CAP. The National Ambulatory and National Hospital Ambulatory Medical Care Surveys (1994-2007) were used to identify children aged 1 to 18 years with CAP using a validated algorithm. We determined age group-specific rates of outpatient CAP and examined trends in antibiotic prescribing for CAP. Data from 2006-2007 were used to study factors associated with broad-spectrum antibiotic prescribing. Overall, annual CAP visit rates ranged from 16.9 to 22.4 per 1000 population, with the highest rates occurring in children aged 1 to 5 years (range: 32.3-49.6 per 1000). Ambulatory CAP visit rates did not change between 1994 and 2007. Antibiotics commonly prescribed for CAP included macrolides (34% of patients overall), cephalosporins (22% overall), and penicillins (14% overall). Cephalosporin use increased significantly between 2000 and 2007 (P = .002). Increasing age, a visit to a nonemergency department office, and obtaining a radiograph or complete blood count were associated with broad-spectrum antibiotic prescribing. The incidence of pediatric ambulatory CAP visits has not changed significantly between 1994 and 2007, despite the introduction of heptavalent pneumococcal conjugate vaccine in 2000. Broad-spectrum antibiotics, particularly macrolides, were frequently prescribed despite evidence that they provide little benefit over penicillins.

Hispanic Poverty: A County Contrast

&lt;p class="MsoNormal" style="text-align: justify; margin: 0in 34.2pt 0pt 0.5in;"&gt;&lt;span style="font-size: 10pt;"&gt;&lt;span style="font-family: Times New Roman;"&gt;This study examines Hispanic ethnic poverty rates at the county level.&lt;span style="mso-spacerun: yes;"&gt;&amp;nbsp; &lt;/span&gt;The specific ethnic groups examined are Cubans, Mexicans and Puerto Ricans as well as Other Hispanics and the counties include the Bronx, Los Angeles and Miami-Dade.&lt;span style="mso-spacerun: yes;"&gt;&amp;nbsp; &lt;/span&gt;The primary goal is to separate high Hispanic poverty into an ethnicity factor and a geographic/economic factor.&lt;span style="mso-spacerun: yes;"&gt;&amp;nbsp; &lt;/span&gt;The evidence is clear.&lt;span style="mso-spacerun: yes;"&gt;&amp;nbsp; &lt;/span&gt;Although ethnicity has some influence on the group specific poverty rates of Hispanic-Americans, it is overshadowed by local economies.&lt;span style="mso-spacerun: yes;"&gt;&amp;nbsp; &lt;/span&gt;Location is far more influential than cultural lineage in affecting group poverty rates.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

A Comparative Analysis of Tuberculosis Treatment Success between Hunan Province of China and Eastern Ghana

Objective: To assess the differences in tuberculosis (TB) treatment success between Hunan and Eastern Ghana. Subjects and Methods: The study was a retrospective comparative study using 2005–2006 surveillance data from the Hunan province of China and the Eastern region of Ghana. Data analyzed were from the provincial/regional capital and a randomly selected city of lower economic status. χ² test and Fisher’s exact test were used to do general and stratified comparison of treatment success rates within/between the two areas. Multivariate logistic regression was used to analyze the independent effect of explanatory variables on treatment success. Results: Generally, the treatment success rate was significantly higher in Hunan (93.1 vs. 60.7%, p = 0.000). Stratified analyses showed a similar pattern for almost all the group-specific rates. Key predictors of TB treatment success in Hunan were gender, age group, and type of city of residence whilst in Eastern Ghana treatment success was associated with only age group. Odds ratios for treatment success in Hunan were significantly lower for males (OR = 0.78; 95% CI = 0.63, 0.97), and higher for patients resident in the provincial capital (OR = 1.35; 95% CI = 1.12, 1.62). In both countries treatment success rates decreased with increasing age. Conclusion: TB treatment success in Hunan was comparatively better than that in Eastern Ghana. Gender, age group, and type of city of residence were the key predictors of treatment success in Hunan whilst in Eastern Ghana age group was the key predictor.

Practice Patterns in Benign Prostatic Hyperplasia Surgical Therapy: The Dramatic Increase in Minimally Invasive Technologies

We describe the trends in transurethral prostatectomy and minimally invasive surgical treatments for benign prostate hyperplasia from 1999 through 2005 among elderly male Medicare beneficiaries. Benign prostatic hyperplasia surgeries were identified using the annual 100% Medicare carrier files which contain physician claims for services reimbursed under Medicare Part B. The annual age group specific procedure rates as well as the age adjusted rates by race and percent of each procedure performed in different clinical settings were calculated. The total number of benign prostatic hyperplasia procedures increased 44% from 88,868 in 1999 to 127,786 in 2005. The minimally invasive surgical treatment procedure counts increased 529% from 11,582 to 72,887 and the rates increased 439% from 136 to 678 per 100,000 males during that period. The transurethral prostate resection rate decreased approximately 5% per year. By 2005 minimally invasive surgical treatment procedures accounted for 57% of total benign prostatic hyperplasia surgeries, while transurethral prostate resection accounted for only 39%. Almost all transurethral microwave thermotherapy, 86% of transurethral needle ablation and 54% of laser coagulation procedures were performed in office clinics, and 78% of laser vaporization procedures were performed in hospital outpatient clinics. Black beneficiaries were 17% less likely to receive minimally invasive surgical treatment than whites in 2005. The increase of total benign prostatic hyperplasia procedure rate was driven by a marked increase in minimally invasive surgical treatment and a continuing decrease of transurethral prostate resection. Differences in the use of minimally invasive surgical treatment across age and racial groups persisted. This dramatic change in the pattern of benign prostatic hyperplasia surgical treatment may have a profound impact on health care expenditures and outcomes, and requires further investigation.

Increasing thyroid cancer incidence in Lithuania in 1978–2003

BackgroundThe aim of this paper is to analyze changes in thyroid cancer incidence trends in Lithuania during the period 1978–2003 using joinpoint regression models, with special attention to the period 1993–2003.MethodsThe study was based on all cases of thyroid cancer reported to the Lithuanian Cancer Registry between 1978 and 2003. Age group-specific rates and standardized rates were calculated for each gender, using the direct method (world standard population). The joinpoint regression model was used to provide estimated annual percentage change and to detect points in time where significant changes in the trends occur.ResultsDuring the study period the age-standardized incidence rates increased in males from 0.7 to 2.5 cases per 100 000 and in females from 1.5 to 11.4 per 100 000. Annual percentage changes during this period in the age-standardized rates were 4.6% and 7.1% for males and females, respectively. Joinpoint analysis showed two time periods with joinpoint in the year 2000. A change in the trend occurred in which a significant increase changed to a dramatic increase in thyroid cancer incidence rates. Papillary carcinoma and stage I thyroid cancer increases over this period were mainly responsible for the pattern of changes in trend in recent years.ConclusionA moderate increase in thyroid cancer incidence has been observed in Lithuania between the years 1978 and 2000. An accelerated increase in thyroid cancer incidence rates took place in the period 2000–2003. It seems that the increase in thyroid cancer incidence can be attributed mainly to the changes in the management of non palpable thyroid nodules with growing applications of ultrasound-guided fine needle aspiration biopsy in clinical practice.

Cancer incidence in the Swedish leather tanning industry: updated findings 1958–99

Aims: To assess how a 10 year extension of the follow up period affected cancer incidence in the Swedish leather tanning cohort. Methods: A cohort of 2027 tannery workers (of...

Comparing the Context of Immigrant Homicides in Miami: Haitians, Jamaicans and Mariels

We contribute to the field of immigration and crime research by conducting one of the first contemporary examinations of Afro-Caribbean homicides. Despite the growth of immigration across urban America, social scientists lack an understanding of both the extent and severity of immigrant violent crime. Several important findings emerge from our unique data set on Haitian, Jamaican and Mariel Cuban homicides in the city of Miami. Most notably, Miami's homicide rate led the country at various points throughout the 1980s, but immigrant group-specific rates rarely exceeded the city total. By 1990, immigrant Caribbean victim and violator rates had declined to a level and rate far below the city average. Compared to other cities, Miami has a more diverse population and a greater potential for intergroup contact, yet most killings were between ethnic group members. In addition, while the “criminal alien problem” is a prominent image fueling contemporary attempts to restrict immigration, our findings undermine this conventional wisdom. We conclude with suggestions for future elaboration on the causes and consequences of immigration and homicide.

Inferring capitation rates from aggregate health plans' costs.

Setting risk-adjusted capitation rates in health systems with centralized financing and decentralized delivery is one of the most intriguing policy issues. The common practice to set capitation group rates is based on individual data collected from either population surveys or medical records, using a single-and in most cases arbitrary-set of relative unit costs of services. This paper presents a method for estimating group-specific mean costs and capitation rates using a panel of aggregate cost data of the competing health plans and the composition of their populations. This method is used to estimate mean costs and capitation rates for the Israeli health care system. The limited data available severely constrains the range of estimable models, however, the results evoke some questions with regards to reimbursement and rates presently used, as well as to the methodology used to estimate them.

Use of laboratory testing for genital chlamydial infection in Norway.

To assess the use of laboratory tests for genital chlamydial infection in Norway. Questionnaire survey of general practitioners' practice in chlamydial testing, retrospective survey of laboratory records, 1986-91, and prospective study of testing in one laboratory during four weeks. All 18 microbiological laboratories in Norway (4.2 million population), including one serving all doctors in Vestfold county (0.2 million population). 302 general practitioners. GPs' routine practice, methods used for testing, 1986-91, and sex specific and age group specific testing in 1991. 201(69%) GPs replied to the questionnaire: 101(51%) would test all women younger than 25 years at routine pelvic examination, 107(54%) all girls at first pelvic examination, 131(66%) all pregnant women, and 106(54%) all men whose female partner had urogenital complaints. Nationwide in 1986, 122,000 tests were performed (2.9 per 100 population); 10% were positive and 51% were cell culture tests. In 1991, 341,000 tests were performed (8.0 per 100 population); 4.5% were positive and 15% were cell culture tests. 13,184 tests were performed in Vestfold in 1991 (6.6 per 100 population). The age group specific rates (per 100 population) among women were: age 15-19 years, 22.0(95% confidence interval 18.2 to 25.8); 20-24 years, 47.2(42.1 to 52.3); 25-29 years, 42.3(37.1 to 47.5); 30-34 years, 29.8(25.4 to 34.2); and 35-39 years, 12.5(9.5 to 15.5). GPs use liberal indications for testing. The dramatic increase in testing, especially by enzyme immunoassays, in populations with a low prevalence of infection results in low cost effectiveness and low predictive value of positive tests, which in women over 29 years is estimated as 17-36%. Doctors should be educated about the limitations of enzyme immunoassays in screening low prevalence populations, and laboratories should apply a confirmatory test to specimens testing positive with such assays.

Do group-specific or national unemployment rates influence perceptions?

We show that disaggregated social preference functions between inflation and unemployment may be modelled using the national unemployment rate rather than group-specific rates. We reach this conclusion by fitting presidential popularity functions to groups classified by age, region, sex and race.

Down's syndrome and maternal age in British Columbia, 1972--75.

The occurrence of Down's syndrome in British Columbia during the period 1972-75 is analyzed with respect to maternal age distribution. This period is compared with previously studied periods. No marked trends are evident in the various age group-specific rates studied. The significance of these findings is discussed in connection with a possible role of environmental nutagens in induction of Down's syndrome and the maternal age effect.