Israeli Central Bureau Research Articles

P3.218 Increasing Trend of HIV/AIDS Among Arab and Jewish Males in Israel, 1986–2010

<h3>Background</h3> HIV/AIDS-burden in Israel is low (∼6 cases:100,000 population), while sub-populations characterised by high-risk behaviours are affected disproportionally. This study aims to compare HIV/AIDS-burden in males between Israeli Jews and Arabs, which are the biggest monitory in Israel. <h3>Methods</h3> The National HIV/AIDS Registry (NHAR) was the source for HIV/AIDS-infection records, while the Israeli Central Bureau of Statistics was used to determine groups-specific disease rates. <h3>Results</h3> Between 1986 and 2010, 3,499 HIV/AIDS-infected males were reported: 3,369 (96.3%) Jews and 130 (3.7%) Arabs, in an average annual incidence of 5.5 and 0.8 per 100,000 populations, respectively, p = 0.05. Of all Jews, 1,018 (29.9%) were born in Ethiopia, while 2,389 were Jews who were not Ethiopian-born (JNE). Most Arabs (N = 99, 74.8%) were Muslims, followed by 21 (16.2%) Christians and 13 (10%) Druze. AIDS rather than HIV upon reporting was diagnosed in 568 (23.8%) of JNE and 31 (23.8%) of the Arabs, p = 1. The most affected age-group among JNE was 25–34 and in Arabs 20–24, and the respective cumulative death rates were 24.9% (N = 594) and 32.5% (N = 40), p = 0.1. The point-prevalence in 2010 was 58.4 and 11.4 per 100,000 for JNE and Arabs, and in adults aged 15–49, was 98.0 and 20.4 per 100,000, respectively. In Muslims, Christians and Druze, the point-prevalence was 4.2, 11.2 and 7.1 per 100,000; and in adults aged 15–49 was 20.4, 52.6 and 21.6, respectively. The most common risk-groups among JNE was MSM (N = 1,223, 51.2%), followed by IVDU (N = 661, 27.7%); while among Arabs was MSM (N = 63, 48.1%), followed by heterosexuals (N = 36, 27.3%). <h3>Conclusions</h3> HIV/AIDS-burden in Arab males was significantly lower than in Jews. Among Arab-males, HIV/AIDS-burden was highest in Christians than in Druze and Muslims. The proportion of MSM of all males, regardless of their religion is increasing. Interventions aiming to prevent further HIV-transmission should address cultural, linguistic and behavioural characteristics.

Socioeconomic status and gender affects utilization of Medical Nutrition Therapy

AimsTo identify socioeconomic status and gender inequalities in long and short-term Medical Nutrition Therapy among Israeli adult patients with diabetes. MethodsAn analysis of data was performed on 90,900 patients over the age of 18 who were registered as patients with diabetes mellitus in Maccabi Healthcare Service Register which is the second largest health maintenance organization in Israel. Socioeconomic Rank for each patient was determined from the Israel Central Bureau of Statistics by geographical area of residence. Medical Nutrition Therapy was defined by the number of visits with registered dietitians. Short-term therapy was defined as one visit and long term therapy as two or more visits during the previous two years. Newly diagnosed patients were compared with veteran patients. ResultsOnly 25.8% of the patients with diabetes received nutrition therapy during the previous two years. Newly diagnosed patients received therapy more frequently than veterans. We found that long term therapy was positively dependent on socioeconomic rank. Women under the age of seventy five had a higher chance of receiving therapy compared to men. ConclusionsA nationwide nutritional counseling service is available and accessible to all patients with diabetes. However, the patients with higher socioeconomic rank have a higher rate of persistence with long-term nutritional therapy.

The Increasing Prevalence of Inflammatory Bowel Diseases Among Jewish Adolescents and the Sociodemographic Factors Associated with Diagnosis

We investigated the prevalence and sociodemographic factors associated with diagnosis of inflammatory bowel diseases (IBD) among Jewish Israeli adolescents. A total of 953,684 Jewish Israeli adolescents (57.8% men) who underwent a general health examination at mean age 17.3 ± 0.5 years from 1998 to 2010 were included. A definite diagnosis of IBD was based on laboratory, endoscopy, and pathology reports. Covariate data included socioeconomic status (SES) as defined by the Israel Central Bureau Statistics, and origin and number of children in household. A total of 2021 patients with IBD were identified (0.21%) in 13 annual cohorts. The prevalence of IBD increased from 149.4 cases per 100,000 to 301.0 cases per 100,000 in the first and last cohort (Ptrend = 0.003). Independent factors associated with occurrence of IBD were SES (high: odds ratio [OR] = 1.84, 95% confidence interval [CI]: 1.60-2.1, P < 0.001; medium: OR = 1.47, 95% CI: 1.3-1.69, P < 0.001; low: reference), Western origin (OR = 1.71, 95% CI: 1.53-1.90, P < 0.001; Asia Africa: reference), and male gender (OR = 1.21, 95% CI: 1.10-1.33, P < 0.001; female: reference). Four or more children in the household were associated with reduced OR for IBD [N ≥ 4: OR = 0.70, 95% CI: 0.62-0.72, P < 0.001, N = 1-3: reference]. The OR among adolescents of Western origin-high SES was 2.95 times higher compared with adolescents of Asia-African origin with low SES. The prevalence of IBD doubled during the 13 years of the study period. Among this large cohort of Jewish adolescents, for each origin, higher SES was associated with increased occurrence of IBD.

The Cost Of More Accessible Higher Education: What Is The Monetary Value Of The Various Academic Degrees?

One of the main reasons for acquiring a Bachelor's Degree is the perception of higher education as a means of improving graduates' financial status. In light of the increased accessibility of higher education, a growing number of students hope to use their studies as a financial springboard. In the current study we sought to examine this perception and to check whether and to what degree baccalaureate degrees indeed improve graduates' financial situation. In cooperation with Israel's Central Bureau of Statistics we gathered data on 6,091 graduates who completed their studies at the Ariel University Center during 2000-2008. Data analysis included exploring graduates' rate of employment and monthly salary from the day they began their academic studies until eight years later. We divided and distinguished between graduates by discipline and gender. The findings show that graduates earn almost three times the national average salary (and five times the median salary) and indicate employment rates of nearly 100%. Analysis of findings by discipline indicates that the most profitable fields are computer sciences and mathematics, engineering, and architecture. Salaries in the natural and social sciences and in the humanities are significantly lower both compared to the former fields and to the national average salary, at least for this eight year span. Analysis of the data by sex showed that the rate of employment among men is 12% higher than among women and that there is a disparity in employment within each discipline as well. Research conclusions show that academic degrees per se are not a guarantee of financial or occupational security. Employees with degrees in the social sciences and the humanities may find that their pay is no higher than those with no degree. One of the implications of this issue, already evident at this stage is that students are attempting to attain higher degrees in the hope of improving their financial status. The equation of a higher education with a higher income seems to involve other components as well, such as graduates' field of study, seniority on the job, and field of occupation.

Increasing trend of HIV/AIDS among Arab and Jewish male persons in Israel, 1986–2010

The aim of the study was to compare the HIV/AIDS burdens in Jewish and Arab Israeli males, as HIV/AIDS affects different population groups disproportionally. The National HIV/AIDS Registry (NHAR) was used as the source of HIV/AIDS infection records, while the Israeli Central Bureau of Statistics was used to determine group-specific disease rates. Between 1986 and 2010, 3499 HIV/AIDS-infected male Israelis were reported to the NHAR: 3369 (96.3%) Jews and 130 (3.7%) Arabs, with an average annual incidence of 5.5 and 0.8 per 100 000 of the population, respectively (P = 0.05). Of the Jews, 1018 (29.9%) were born in Ethiopia, while 2389 were Jews who were not Ethiopian-born (JNE). Most of the Arabs (n = 99; 74.8%) were Muslims, followed by Christians (21; 16.2%) and Druze (13; 10%). AIDS rather than HIV infection at the time of reporting was diagnosed in 568 (23.8%) of the JNE and 31 (23.8%) of the Arabs (p = 1). The most affected age group was those aged 25-34 years among the JNE and those aged 20-24 years among the Arabs, and the respective cumulative death rates were 24.9% (n = 594) and 32.5% (n = 40) (P = 0.1). The point prevalences in 2010 were 58.4 and 11.4 per 100 000 for JNE and Arabs, and in adults aged 15-59 years they were 71.5 and 26.3 per 100 000, respectively. In Muslims, Christians and Druze, the point prevalences were 4.2, 11.2 and 7.1 per 100 000, and in adults aged 15-59 years they were 22.6, 42.9 and 29.4, respectively. The most common risk group among JNE was men who have sex with men (MSM; n = 1223; 51.2%), followed by injecting drug users (n = 661; 27.7%), while among Arabs it was MSM (n = 63; 48.1%), followed by heterosexuals (n = 36; 27.3%). The HIV/AIDS burden in Israeli Arab males was significantly lower than that in Jews, and in both populations the most common risk group was MSM, with the proportion of MSM increasing with time.

Socioeconomic environment and recurrent coronary events after initial myocardial infarction

PurposeLongitudinal data linking area-level socioeconomic status (SES) to repeated acute coronary syndrome (ACS) events are limited. Using multiple failure-time data, we examined the association between neighborhood SES and ACS in a community-based cohort of myocardial infarction (MI) survivors. MethodsConsecutive patients aged 65 years or younger discharged from eight hospitals in central Israel after first MI in 1992–1993 were followed through 2005. Recurrent MI and unstable angina pectoris (UAP) leading to hospitalization were recorded. Neighborhood SES was assessed through a composite census-derived index developed by the Israel Central Bureau of Statistics. Different variance-corrected proportional hazards models were used to account for multiple recurrent events: Andersen-Gill, Wei-Lin-Weissfeld (WLW), and Prentice-Williams-Peterson. ResultsDuring follow-up, 531 recurrent MIs and 1584 UAP episodes occurred among 1164 patients. Adjusting for known prognostic factors and individual SES using the Andersen-Gill model, higher estimated hazards were associated with poor neighborhood SES (hazard ratio, 1.55; 95% confidence interval [CI], 1.13–2.14 for recurrent MI; and hazard ratio, 1.48; 95% CI, 1.22–1.79 for UAP; in the 5th vs. 95th percentiles). The WLW and Prentice-Williams-Peterson models yielded similar results. When the two outcomes were combined, the WLW-derived hazard ratio was 1.64 (95% CI, 1.39–1.93). ConclusionsMI survivors living in a deprived neighborhood are at higher risk of repeated hospital admissions because of ACS. Secondary prevention initiatives should incorporate multilevel approaches to increase effectiveness and reduce geographic health disparities.

Poor Neighborhood Socioeconomic Status and Risk of Ischemic Stroke After Myocardial Infarction

Data linking neighborhood socioeconomic status (SES) to stroke risk are scarce. We examined long-term stroke incidence according to neighborhood SES in a population-based cohort of patients hospitalized with first myocardial infarction (MI). Consecutive patients aged 65 years or less, discharged from 8 hospitals in central Israel after incident MI in 1992-1993, were followed for stroke through 2005. Individual demographic, socioeconomic, and clinical data were obtained at study entry. We estimated neighborhood SES through a composite census-derived index developed by the Israel Central Bureau of Statistics. During a median follow-up of 13 years, 196 incident ischemic strokes occurred in 1410 patients. Accounting for death as a competing risk, patients residing in disadvantaged neighborhoods had higher rates of ischemic stroke (cumulative survival estimates: 81%, 88%, and 89% in increasing tertiles of neighborhood SES). Upon multivariable adjustment for individual SES measures (including income, education, and employment), cardiovascular risk factors, MI characteristics and severity indices, and acute management, the overall hazard ratio for stroke in the lower versus upper tertile of neighborhood SES was 1.5 (95% confidence interval [CI] = 1.0-2.3); after 13 years, the adjusted absolute risk difference was 7.9 incident stroke cases per 100 participants with MI (95% CI = 1.7-14.1). Poor neighborhood SES is associated with increased risk of ischemic stroke post-MI. The association is only partly attributable to individual SES and other baseline characteristics. The potential mechanisms for this association require further study.

Elaboration on the association between immigration and schizophrenia: a population-based national study disaggregating annual trends, country of origin and sex over 15 years

Generally, immigrant status and male sex are separately documented to increase the risk of schizophrenia; although population-based risk trends by sex and immigration over time have not been examined. This study aims to examine the extent to which immigration acts as a risk factor for schizophrenia, delineated by origin, sex and year, using national population-based data over 15 years. Data on all first psychiatric admissions from 1978 to 1992 (n = 10,892) from the National Psychiatric Hospitalization Case Registry of the State of Israel were merged with aggregate national data from the Israeli Central Bureau of Statistics. Compared to native-born Israelis, people who migrated prior to the age of 15 (n = 2,335) were at a greater risk of schizophrenia (n = 8,557; RR = 1.6, 95% CI = 1.53; 1.68), particularly those from Far Eastern (RR = 2.43, 95% CI = 1.91; 3.1) and Caribbean and South American (RR = 1.94, 95% CI = 1.51; 2.51) countries. Aggregate risk was higher among female than male immigrants and over the 15-year study immigration-related risk declined across the sexes. The current findings replicate past research showing that immigrants, particularly from a social minority, as suggested by the social defeat-hypothesis, are at an increased risk of schizophrenia, and extend past findings to show that risk at least in Israel has decreased with time irrespective of sex.

Using space–time visual analytic methods for exploring the dynamics of ethnic groups' residential patterns

In this article, we present a methodological framework, based on georeferenced house-level socio-demographic and infrastructure data, for investigating minority (or ethnic) group residential pattern dynamics in cities. This methodology, which uses visual analytical tools, is meant to help researchers examine how local land-use configurations shape minorities' residential dynamics and, thereby, affect the level of minority–majority segregation. This methodology responds to the need to refer to the relationship between local land-use configurations and the identity of a building's residents, without simultaneously revealing sensitive house-related details. The research was instantiated on the residential patterns exhibited by the Arab community in Jaffa, Israel. The residential data were collected for over 40 years at four different moments, each associated with the population and housing censuses conducted by Israel's Central Bureau of Statistics and the Ministry of the Interior. Using this methodology enabled us to remain on the level of the individual building when identifying the relationships between spatial land-use configurations and rates of change in ethnic composition and the Arab community's residence pattern dynamics at different geographical scales. It likewise allowed us to identify the qualitative changes in the population's residential preferences during the pattern's development.

Relationship between socio‐economic position and general, maxillofacial and dental trauma: A National Trauma Registry Study

Trauma, a major public health problem, has been extensively studied. However, characteristics of maxillofacial and dental injuries and their association with socio-economic position (SEP) have not been thoroughly documented. This study retrospectively investigated the occurrence of maxillofacial, dental and general trauma in Israel, and examined the relationship between socio-economic status and trauma-related hospitalizations. Records were obtained for all trauma patients hospitalized and recorded in the National Israel Trauma Registry (ITR) between January 1, 2003 and December 31, 2005. Maxillofacial and dental injuries were separated and further analyzed by residence locality and SEP. The socio-economic index, developed by the Israel Central Bureau of Statistics, was used to determine the socio-economic status of 50 selected localities. During the study period, 77 072 trauma patients were hospitalized, of whom 3972 (5%) were diagnosed with maxillofacial or dental injuries. Among the selected localities, 42 303 hospitalizations were recorded, of which 1886 (4.5%) involved maxillofacial or dental injuries. For all traumas, lower injury rates were found among residents living in high socio-economic localities. The difference in hospitalization rates for maxillofacial and dental injuries was not significant. The cause of injury differed by age, SEP and category of injury. A fall (35%) or road crash (33%) caused most of the maxillofacial injuries, with 50% of dental injuries because of a road crash. Intentional injuries constituted 22% of the maxillofacial-related hospitalizations and were more prevalent among adults living in low SEP localities. These data should be used to promote injury prevention programs with emphasis directed at high risk populations.

A population-based study of selected demographic characteristics of Israeli-Jewish women with cervical squamous cell carcinoma

The age-standardized incidence rate (ASR) of invasive cervical cancer in Israeli-Jewish women is persistently low compared to many other countries. The aim of the present study was to assess selected demographic characteristics of Israeli-Jewish women with cervical squamous cell carcinoma (SCC) in an attempt to identify current selected risk factors. Included were all histologically confirmed SCC patients diagnosed during 2002-2004 according to the Israel National Cancer Registry. Demographic and population data were obtained from the Central Population Registry and from the Israel Central Bureau of Statistics annual abstract reports. The ASR and incidence rate for each demographic category were computed. During the study period, 350 SCC patients (mean age 50.3 years) were diagnosed (ASR of 3.8/100,000). High SCC incidence rates of single women 40+, of married women 30+ years old and of divorced and widowed women in the 40-49 age group were found. The mean number of children was 2.1 (range 0-9). Compared to the population the rate of childless patients in the 50+ age group, that of patients with 1-2 children in the 40-49 age group and that of North-African-born patients was significantly higher. No excess rate was found for multiparity and low socioeconomic status. High incidence rates of SCC were observed for some age groups of single and married women, for women without children or 1-2 children and for North-Africa-born women. Great differences between age groups within each demographic category were observed.

Trends in the gap in life expectancy between Arabs and Jews in Israel between 1975 and 2004

To examine trends in the Arab-Jew life expectancy gap in Israel during 1975-2004 and to determine the contribution of age groups and causes of death to changes in the gap. Data on life expectancy and mortality rates by cause of death, for Arabs and Jews, were obtained from the Israel Central Bureau of Statistics. Standard life table techniques were used for decomposition analysis to explore the contribution to changes in the life expectancy gap. While life expectancy of Arabs was lower than Jews during 1975-2004, there was a decline in this gap during 1975-98. However, during the following years the gap increased and the difference in 2004 was 3.2 years for men and 4 years for women. During 2000-04, the main causes of death contributing to the gap in life expectancy were chronic diseases, mainly heart disease and diabetes. Heart disease mortality contributed mostly to the overall life expectancy gap for males and females, accounting for 0.89 and 1.17 years, respectively. The age group >65 years contributed most to the gap (1.33 years among males, and 2.42 years among females). Following a period of reduction, the gap in life expectancy at birth between Arabs and Jews in Israel has started to widen. These findings indicate the need for increased attention to primary prevention and disease management in the Arab population. Reducing social and individual risk factors for major causes of death should be a national priority.

Association between socioeconomic status and the prevalence of asthma

The finding in some recent studies that the prevalence of asthma is higher in poor populations contradicts the hygiene theory, which claims that improved quality of life removes protective factors that prevent atopy. To determine whether socioeconomic status (SES) is associated with the prevalence of asthma in adolescents in Israel. The study sample consisted of 159,243 consecutive 17-year-old military recruits examined in the Israel Defense Forces. Relevant medical data were collected from the army's computerized database. The SES of the recruits was assessed according to the socioeconomic grade (by quintiles) assigned to their city or town of residence by the Israel Central Bureau of Statistics and by the number of children in the family. Asthma was documented in 8.5% of the male recruits and in 6.7% of the female recruits. The prevalence of asthma increased with an increase in socioeconomic grade, from 3.7% for the lowest quintile to 8.8% for the highest (P < .001). Separate analysis of individuals from the Tel Aviv area showed that the prevalence of asthma ranged from 3.4% to 13.7% from the lowest to the highest socioeconomic quintiles (P < .001). In Israel, having a higher number of children in the family is associated with lower SES. There was an inverse relationship between number of children in the family and the prevalence of asthma: 8.7% in families with 1 or 2 children and 1.9% in families with 9 or more children. High SES is associated with a relatively high prevalence of asthma in adolescents in Israel.

Patients with Pandemic (H1N1) 2009 in Intensive Care Units, Israel

To the Editor: We report results of an active surveillance system established by the Tel Aviv District Health Office in Israel. This surveillance system monitors the daily status of patients with laboratory-confirmed pandemic (H1N1) 2009 virus infection in each of the district’s intensive care units (ICUs), including pediatric ICUs. Follow-up is maintained by daily phone conversations with medical staff until disease outcome is concluded by discharge, transfer to a long-term rehabilitation facility, or death. Medical records, as well as daily laboratory reports, are collected to confirm or to rule out pandemic (H1N1) 2009 infection. During July 10–October 10, 2009, our prospective cohort included 17 patients with pandemic (H1N1) 2009 laboratory-confirmed infection who were residents of the district; 12 (70.6%) were male patients. The median age was 44 years (interquartile range 13–72 years). By October 10, 2009, six patients had been discharged, 7 had died, 2 had been transferred to long-term rehabilitation facilities, and 2 remained hospitalized. Twelve (70.6%) patients had an underlying medical condition, mainly chronic lung disease (6 patients) or chronic cardiovascular disease (5 patients). Two patients were morbidly obese (body mass index >35), and 1 patient was pregnant. Additionally, 3 patients (17.6%) were infected while hospitalized. Thirteen patients (76.5%) had acute respiratory distress syndrome caused by diffuse viral pneumonitis. Other notable manifestations were acute renal failure (6 patients), sepsis/septic shock (5 patients), and neurologic complications such as Guillain-Barre syndrome, encephalitis, and seizures (3 patients). Documented nosocomial sepsis, often of multiple gram-negative bacteria (9 patients), was the most frequent complication during the course of the disease. Other frequent characteristics were the use of high positive end-expiratory pressure during mechanical ventilation (4 patients) and the need for tracheostomy (5 patients). Average time from disease onset to hospital admission was 3 days. Time from hospital admission to ICU admission for those patients who died was longer than for those who survived, with a median of 2 days compared with 0.5 day, respectively, albeit not significant (p = 0.26). Average hospitalization was 23.4 days; average length of stay in the ICU was 16.7 days (71.4% of the average hospitalization time). As mentioned previously, 7 patients (41.2%) died; 5 (71.4%) were male, similar to their cohort’s proportion. One significant difference (p = 0.02) was found between the age of survivors (mean 26.0 years, 95% confidence interval 7.6–44.3) and the age of nonsurvivors (mean 59.3 years, 95% confidence interval 39.6–79.0). The most prominent case–fatality rate was for elderly patients, >65 years of age (3 of 4 patients) followed by patients between 20 and 64 years of age (4 of 9 patients); these subgroups constituted 23.5% and 52.9% of the cohort, respectively. Estimated incidence rate was 13.8 patients and 5.7 deaths in ICUs per million residents in the Tel Aviv district. Again, the elderly subgroup was dominant, with the highest estimated rate of illness (23.1 per million residents) and death rate (17.3 per million residents). The denominator of these rates was calculated from the population data published by the Israeli Central Bureau of Statistics for 2007 and 2008. Upon that basis, the population data for the end of the third quarter of 2009 was estimated. During the described surveillance period, 5.7% of ICU beds in the district were, on average, continuously occupied by patients infected with pandemic (H1N1) 2009. The occupancy peak was 6.5 of 53.8 standardized ICU beds (12.1%) per million residents during the week ending August 28, 2009 (Figure). Figure Number of intensive care unit (ICU) beds occupied by patients with pandemic (H1N1) 2009 infection in district ICUs during the described surveillance period, Tel Aviv, Israel. During this period, 5.7% of ICU beds, on average, were continuously occupied ... In conclusion, our analysis of patients having the most severe pandemic (H1N1) 2009 infection indicates a need for prolonged periods of hospitalizations, especially in ICUs, for young adults and elderly patients. Death or prolonged adverse complications were frequent outcomes. We found that the impact of patients with pandemic (H1N1) 2009 on the ICUs in our district during the summer wave was surprisingly similar in length and intensity to the impact that was recently reported in Australia and New Zealand during the winter wave (1). The maximum number of ICU beds occupied per million residents, reported for all regions of Australia and New Zealand combined, was 7.4 during the week ending July 27, 2009 (vs. 6.5 as described above). We also found that the mean age of those who died was older than that in previous reports (2–6).This finding may present a need for policymakers to reconsider current vaccination priorities (7) while facing the winter wave of influenza in the Northern Hemisphere.

Selected demographic characteristics of Israeli Jewish women with high-grade cervical intraepithelial neoplasia (CIN3): a population-based study

A population-based study of cervical intraepithelial neoplasia grade 3 (CIN3) has hitherto not been performed in Israel. The aim of the present study was to assess selected demographic characteristics of Israeli Jewish CIN3 patients in an attempt to identify the risk factors in this population. All CIN3 patients diagnosed during 2002-2004 according to the Israel National Cancer Registry were included. Demographic and population data were obtained from the Central Population Registry and from the Israel Central Bureau of Statistics annual abstract reports. The age-standardized incidence rate (ASR) and rate ratios (RR) for each demographic category were calculated. The study comprised 1,108 CIN3 patients (mean age 38.4 years) yielding an ASR of 13.9/100.000. A significantly greater number of CIN3 in the 30-39-year (RR = 2.16) and 40-49-year (RR = 1.74) age groups were observed. The overall rate of single and married women was similar, that in widowed women significantly lower and divorced women significantly higher (RR = 2.37) than in the general population. The mean number of children was 1.7. The rate of patients with 5 + children was significantly higher only in the 30-39-year age group. RR varied with age within each demographic category. The rate of Israeli born was higher and that of other ethnic origins was similar to the population rates. No association between CIN3 and socioeconomic status was found. Greater CIN3 rates were observed in women of 30-49 years, divorced women and Israeli-born women. Great differences in RR between age groups within the demographic categories were observed.

Broadening Our Understanding of Survival After Myocardial Infarction

As clinicians and scientists, it is common to presume that clinical outcomes after myocardial infarction (MI) are most profoundly influenced by the pathogenesis of the disease itself, including genetics, cardiovascular risk factors, inflammatory state, disease severity (eg, the number and severity of obstructed coronary arteries), and the treatments that we offer. Consequently, our efforts to optimize the outcomes of our patients are aimed at following clinical guidelines in care for individual patients.1–3 When our profession seeks to influence systems of care and public policy, our focus has been on increasing access to lifesaving therapies.4 Because they appear outside of physicians’ locus of control, risk factors related to patients’ socioeconomic status are often not considered targets for intervention. Article see p 375 Although numerous studies have defined an adverse association between lower socioeconomic status and post-MI treatment5 and outcomes,6–8 little work has been done to develop interventions to overcome these disparities. We also have not sought to systematically understand mediating factors that may influence the prognostic associations of socioeconomic risk factors with outcomes. The reasons there have been such little progress in overcoming socioeconomic status barriers, despite the national priorities to create equity in health care,9–11 are multifactorial and include both the difficulties in measuring socioeconomic status and the challenges in overcoming them. In a critical review of the science linking socioeconomic status to health outcomes, Braveman and colleagues12 demonstrated that different measures of socioeconomic status are not interchangeable, …

Neighborhood Socioeconomic Context and Long-Term Survival After Myocardial Infarction

Neighborhood of residence has been suggested to affect cardiovascular risk above and beyond personal socioeconomic status (SES). However, such data are currently lacking for patients with myocardial infarction (MI). We examined all-cause and cardiac mortality according to neighborhood SES in a cohort of MI patients. Consecutive patients < or =65 years of age discharged from 8 hospitals in central Israel after incident MI in 1992 to 1993 were followed up through 2005. Individual data were obtained at study entry, including education, income, and employment. Neighborhood SES was estimated through a composite census-derived index developed by the Israel Central Bureau of Statistics. During follow-up, 326 deaths occurred in 1179 patients. Patients residing in disadvantaged neighborhoods had higher mortality rates, with 13-year survival estimates of 61%, 74%, and 82% in increasing tertiles (P(trend)<0.001). After adjustment for sociodemographic variables, traditional risk factors, MI severity indexes, and individual SES measures, the hazard ratios for death associated with neighborhood SES were 1.47 (95% confidence interval, 1.05 to 2.06) in the lower and 1.19 (95% confidence interval, 0.86 to 1.63) in the middle tertiles compared with the upper tertile (P(trend)=0.02). The respective hazard ratios were even stronger for cardiac death (1.63; 95% confidence interval, 1.09 to 2.25; and 1.41; 95% confidence interval, 0.96 to 2.07). In the final models, neighborhood context and several individual SES measures were concurrently associated with all-cause and cardiac mortality. Neighborhood SES is strongly associated with long-term survival after MI. The association is partly, but not entirely, attributable to individual SES and clinical characteristics. These data support a multidimensional relationship between SES and MI outcome.

A Dynamic Brain Drain in the Core-Periphery Model

The aim of this research is to explore the effect of a lower return on education in peripheral regions of a country compared to core regions on the decision of individuals in each region to acquire human capital by advancing their education. In addition, the study examines how these decisions may endogenously increase the income gap between the core region and the peripheral region. We first build a theoretical model that explains the individual's decisions regarding the acquisition of human capital using different production functions in each region. Thereafter, we conduct a simulation, using data from Israel's Central Bureau of Statistics, to evaluate the main parameters of the model.

Patterns of Psychiatric Hospitalization Among Ethiopian and Former Soviet Union Immigrants and Persons Born in Israel

Patterns of Psychiatric Hospitalization Among Ethiopian and Former Soviet Union Immigrants and Persons Born in Israel

Is Transition from Nomadic to Sedentary Lifestyle an Important Social Determinant of Child Health?

ISEE-0680 Background and Objectives: Nomadic communities – one of the types of underprivileged populations – still lags the furthest behind in every field of progress. We were able to monitor changes in the health status of Bedouin children over a 25 year period of transition from a semi-nomadic life style to sedentarism in desert area of southern Israel. Methods: Systematic review of articles published on the health of Bedouin children in the Negev as well as summarizing data routinely collected by the Israeli Central Bureau of Statistics and the Regional Medical Office of the Ministry of Health. Results: Among the Bedouin Arab population of the Negev Infant Mortality Rates have decreased from 30.9 per 1000 live births in 1979 to 8.5 per 1000 in 2008. A striking decrease in vaccine-preventable infectious diseases in the Bedouin population was found. The data show marked decrease in the proportion of Bedouin children who born with low birth weight from 15% in 1980–1981 to 8.9% in 2006. In 1986 the proportion of 1 year old children with short stature was 38.2% but this decreased to 19% in 1999. In 2006, 17.5% of Bedouin women were exclusively breast-feeding their infants at 6 months of age while another 61.4% were still breast-feeding with supplements. All theses changes were temporally associated with the transition of over 60% of Bedouin the population from a semi-nomadic life style to permanent settlements which was started in 1978 and is continuing up to the present. Conclusions: The results have implications for the inclusion of transition from nomadism to a sedentary existence as social determinant of health which leads to improving in child health.