Percentile Ratio Research Articles

Geographic variation of life expectancy and all-cause mortality in Beijing

BACKGROUND AND AIM: Life expectancy may vary substantially within Beijing, a globalized city with highly heterogenous physical and social environment. Small-area analysis helps reveal geographical variation. We aim to investigate geographic variation of life expectancy and all-cause mortality at the township level in Beijing. METHODS: All cause death counts in 2017 and 2018 by 5-year age group, sex and township were obtained from Beijing Center for Disease Control and Prevention. Population data for each township were from Beijing statistical yearbook, with weights for age and sex obtained from district-level population. We used a Bayesian spatial models to estimate age-specific mortality and life expectancy for 309 townships in Beijing, separately for men and women. RESULTS:The median of age-standardized all-cause mortality at township level was 445.3/10 0000 (interquartile range [IQR], 217.5/10 0000) for men and 329.5/10 0000 (IQR, 186.3/10 0000) for women in Beijing in 2017-2018. The relative geographic gap defined as 80th-to-20th percentile ratio of mortality was higher in women than in men (2.0 vs. 1.8). Townships with high mortality were primarily found in the northern and southwestern outskirts for both genders. The median of township life expectancies at birth in Beijing was 80.6 years (95% credible interval [Crl]: 79.1–82.0) for men and 85.3 years (Crl: 82.7–87.9) for women. The inequality across townships, measured as the difference between the 20th and 80th percentiles of township life expectancies, was 8.5 years for men and 8.8 years for women, respectively. The geographic pattern of life expectancy was similar in men and women and townships with high life expectancy were concentrated in central urban areas for both genders. CONCLUSIONS:Life expectancy and all-cause mortality varied substantially across townships in Beijing. Studies by small area may aid the development of local policies to reduce health inequalities. KEYWORDS: Life expectancy, Health inequalities, Bayesian spatial analysis, Small-area analysis

Potentially inappropriate medications (PIMs): frequency and extent of GP-related variation in PIMs: a register-based cohort study

ObjectivesPotentially inappropriate medications (PIMs) pose an increasing challenge in the ageing population. We aimed to assess the extent of PIMs and the prescriber-related variation in PIM prevalence.DesignNationwide register-based cohort study.SettingGeneral...

The impact of platelet indices on clinical outcome in heart failure: results from the MyoVasc study.

AimsPlatelet indices have been associated with traditional cardiovascular risk factors, cardiovascular diseases and all‐cause mortality. This study aimed to investigate the role of platelet count, mean platelet volume (MPV) and platelet‐to‐leukocyte ratio, including platelet‐to‐monocyte and platelet‐to‐lymphocyte ratio with cardiac function, heart failure (HF) phenotypes and clinical outcome, worsening of HF.Methods and resultsUnivariate and multivariable linear and Cox regression analyses were used to investigate the associations between platelet indices, cardiac function and worsening of HF in 3250 subjects enrolled in the MyoVasc study. Higher MPV, lower platelet count, lower platelet‐to‐leukocyte and platelet‐to‐monocyte ratios have been associated with reduced left ventricular ejection fraction (beta estimate [β]MPV [fL] = −0.05 [−0.09; −0.02], βplatelet count (× 10 /L) 9 = 3.4 [1.2; 5.6], βplatelet‐to‐leukocyte ratio = 1.4 [1.1; 1.8], βplatelet‐to‐monocyte ratio = 28 [20; 36]) and increased E/E' ratio (β MPV [fL] = 0.04 [0.003; 0.07], βplatelet count (× 10 /L) 9 = −3.1 [−5.3; −0.92], βplatelet‐to‐leukocyte ratio = −0.83 [−1.2; −0.46], βplatelet‐to‐monocyte ratio = −20 [−28; −12]), independent of age and sex. Cox regression demonstrated an increased risk for worsening of HF in subjects with MPV > 75th percentile (hazard ratio [HR] = 1.47 [1.16; 1.87]), platelet count < 25th percentile (HR = 1.36 [1.07; 1.74]), platelet‐to‐leukocyte < 25th percentile (HR = 1.53 [1.20; 1.95]), platelet‐to‐monocyte < 25th percentile (HR = 1.38 [1.08; 1.77]) and platelet‐to‐lymphocyte > 75th percentile (HR = 1.50 [1.17; 1.93]) ratios, independent of potential confounders. MPV > 75th percentile and platelet count < 25th percentile were strongly related to outcome in HFpEF vs. HFrEF (P for difference = 0.040). Platelet‐to‐leukocyte ratios were associated with worse outcome in both HF phenotypes, without a significant difference between HFpEF and HFrEF.ConclusionsPlatelet indices are linked with worse cardiac function and adverse clinical outcome, independent of subjects' underlying cardiovascular profile. This study emphasizes their important value to provide additional information on pathophysiology and risk stratification in HF syndrome.

Labor Market Experience and Falling Earnings Inequality in Brazil: 1995–2012

Abstract The Gini coefficient of labor earnings in Brazil fell by nearly a fifth between 1995 and 2012, from 0.50 to 0.41. The decline in other measures of earnings inequality was even larger, with the 90-10 percentile ratio falling by almost 40 percent. Applying micro-econometric decomposition techniques, this study parses out the proximate determinants of this substantial reduction in earnings inequality. Although a falling education premium did play a role, in line with received wisdom, this study finds that a reduction in the returns to labor market experience was a much more important factor driving lower wage disparities. It accounted for 53 percent of the observed decline in the Gini index during the period. Reductions in horizontal inequalities – the gender, race, regional and urban-rural wage gaps, conditional on human capital and institutional variables – also contributed. Two main factors operated against the decline: a greater disparity in wage premia to different sectors of economic activity, and the “paradox of progress”: the mechanical inequality-increasing effect of a more educated labor force when returns to education are convex.

Uncertainties in short term prediction of atmospheric dispersion of radionuclides. A case study of a hypothetical accident in a nuclear floating power plant off the West coast of Norway

Short-term predictions for dispersion of radionuclides in the atmosphere following releases from nuclear incidents are associated with uncertainties originating from meteorology, source term and parameterization. Characterization of these uncertainties is of key importance for preparedness, decision making during an accident and for the further uncertainty propagation in the subsequent modelling of human and ecosystem exposures. Increased traffic of nuclear-propulsion vessels in Norwegian territorial waters gives rise to growing concern of a potential nuclear accident along the coast of Norway. In the present study, we have quantified and inter-compared the uncertainties associated with the model outputs for a hypothetical loss of coolant accident with an ensuing fire in a nuclear vessel situated along the Norwegian coastline, applying two different atmospheric dispersion models: the SNAP Lagrangian particle model (SNAP-Severe Nuclear Accident Program) and the DIPCOT Lagrangian puff model (DIPCOT – Dispersion over Complex Terrain). The case highlights a situation with atmospheric transport from the offshore area to the coast of Western Norway, combined with large wet deposition in inland mountainous terrain, i.e. a common weather situation in this region. The meteorological data include an Ensemble Prediction System with nine ensemble members in addition to a deterministic base run. Five different 7 h emission scenarios with the same total released activity were considered. Hourly wind data at 10 m above ground for a 24 h period, showed that 36% of the wind direction and 41% of the wind speed data were outside the spread of the meteorological ensemble. About 55% and 13% of the measured values fell outside the ensemble for hourly 2 m above ground temperatures and 3 hourly accumulated precipitation, respectively, indicating that the ensemble did not cover all uncertainties in the meteorological fields. The maps of accumulated concentrations and depositions were qualitatively similar for the two models, but SNAP predicted higher accumulated concentration levels compared to DIPCOT for quite large areas, while DIPCOT yielded larger total depositions in the same areas. Furthermore, the direction, speed of movement and spatial extension of the radioactive plume from the accident varied considerably from one model to the other. The spread in the dispersion of the radionuclides ranged from a factor of about 1–3 in the source area to a factor of about 2–5 further away. The spreads due to meteorology and emission scenarios were of similar magnitude. Considering the ratio of the 50th percentiles of the two models, the spread varied by a factor of about 1–9, indicating that uncertainties arising from the formulation of the dispersion model could be as important or even larger than those associated with meteorology and emissions. Thus, it is recommended to include the uncertainty originating from the choice of the dispersion model into the overall uncertainty of short-term prediction of the dispersion of radionuclides and to exploit this further by generating an ensemble of several dispersion models.

Factors associated with difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases: A nationwide population-based observational study.

Although it is essential to shorten the interval to initial treatment in the care of acute ischemic stroke, some hospitals in Japan reject requests for hospital acceptance from on-scene emergency medical service personnel because of limited resources, which can cause delays in care. We aimed to assess the risk factors for difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases. We conducted a retrospective analysis of the national ambulance records of the Fire and Disaster Management Agency in Japan in 2016. Multivariable logistic regression analysis was used to assess the association between difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases and prehospital factors. During the study period, a total of 222,926 patients were included, and 5283 patients (2.4%) experienced difficulties in hospital acceptance. In multivariable analysis, nights (adjusted odds ratio [AOR] 1.54, 95% confidence interval [CI] 1.45-1.64), weekends (AOR 1.32, 95% CI 1.24-1.40), <25 percentile ratio of emergency physicians and neurosurgeons to all physicians (AOR 1.13, 95% CI 1.03-1.23) (AOR 1.36, 95% CI 1.25-1.48), and mean age of physicians (AOR 1.06, 95% CI 1.05-1.07) were significantly associated with difficulties of hospital acceptance of patients suspected to have cerebrovascular disease. There was a marked regional variation in the difficulties of hospital acceptance. Among the national ambulance records of patients suspected to have cerebrovascular diseases, certain prehospital factors such as weekends were positively associated with difficulty of hospital acceptance. A comprehensive strategy for hospital acceptance of patients with cerebrovascular diseases considering regional variation is required.

Economic design of repetitive group sampling plan based on truncated life test under exponentiated half logistic distribution

In this paper, we propose repetitive group sampling plan based on time truncated life test under exponentiated half logistic distribution by considering percentile lifetime of the product as its quality characteristic when shape parameter value of exponentiated half logistic distribution is known. In this research, the design parameters are determined for various percentile ratios using the method of two points on the operating characteristic curve. Tables are constructed for various values of shape parameters to choose optimal parameters. The sampling procedure of proposed repetitive group sampling plan is illustrated with real time data and the consequence of misspecification of shape parameter on lot acceptance probability is also investigated. The proposed plan is also compared with single and double sampling plans in terms of discriminating power and average sample number under two other lifetime distributions. Moreover, an economic design of the proposed repetitive group sampling plan is discussed and optimal plan is selected to fulfill both producer’s and consumer’s risks with minimum cost.

Multidimensional Heterogeneity and Matching in a Frictional Labor Market – An Application to Polarization

The role of technological change in labor market polarization is a debated issue and has been subject to recent critique. This paper finds that RBTC can account for wage and job polarization in the US from the 1980s to the 2010s. It also demonstrates that RBTC is consistent with the timing of labor market polarization in the US, including the stagnation of the 50/10 wage percentile ratio and the slowdown of employment growth in high-wage jobs from the 2000s. The paper does so using a model with two key ingredients: 1) directed search and 2) two-sided multidimensional heterogeneity. Estimation results show that the complementarity between cognitive skill and task increased while that between manual skill and task did not. The model can fully account for the rise and fall of the 90/50 and 50/10 wage percentile ratios respectively. It also generates 72.6 percent of the rise in employment share of high-paying jobs relative to middling jobs and 69 percent of the fall in employment share of middling jobs relative to low-paying jobs. The paper suggests that the stagnation of the 50/10 wage ratio may be due to rank-switching between workers across the wage distribution from the 2000s, while the slowdown of employment growth in high-wage jobs may result from the tradeoff between the returns to applying for high-wage jobs and the likelihood of unemployment.

Association of Maternal Folate and Vitamin B12 in Early Pregnancy With Gestational Diabetes Mellitus: A Prospective Cohort Study.

OBJECTIVETo investigate the association of folate and vitamin B12 in early pregnancy with gestational diabetes mellitus (GDM) risk.RESEARCH DESIGN AND METHODSThe data of this study were from a subcohort within the Shanghai Preconception Cohort Study. We included pregnancies with red blood cell (RBC) folate and vitamin B12 measurements at recruitment (between 9 and 13 gestational weeks) and those with three samples available for glucose measurements under an oral glucose tolerance test. GDM was diagnosed between 24 and 28 weeks’ gestation. Odds ratio (OR) and 95% CI of having GDM was used to quantify the association.RESULTSA total of 1,058 pregnant women were included, and GDM occurred in 180 (17.01%). RBC folate and vitamin B12 were significantly higher in pregnancies with GDM than those without GDM (P values were 0.045 and 0.002, respectively) and positively correlated with 1-h and 2-h serum glucose. Daily folic acid supplementation in early pregnancy increases the risk of GDM; OR (95% CI) was 1.73 (1.19–2.53) (P = 0.004). Compared with RBC folate <400 ng/mL, pregnancies with RBC folate ≥600 ng/mL were associated with ∼1.60-fold higher odds of GDM; the adjusted OR (95% CI) was 1.58 (1.03–2.41) (P = 0.033). A significant trend of risk effect on GDM risk across categories of RBC folate was observed (Ptrend = 0.021). Vitamin B12 was significantly associated with GDM risk (OR 1.14 per 100 pg/mL; P = 0.002). No significant association of serum folate and percentile ratio of RBC folate/vitamin B12 with GDM was observed.CONCLUSIONSHigher maternal RBC folate and vitamin B12 levels in early pregnancy are significantly associated with GDM risk, while the balance of folate/vitamin B12 is not significantly associated with GDM.

Uncertainty analysis in internal dose calculations for cerium considering the uncertainties of biokinetic parameters and S values

Radioactive cerium and other lanthanides can be transported through the aquatic system into foodstuffs and then be incorporated by humans. Information on the uncertainty of reported dose coefficients for exposed members of the public is then needed for risk analysis. In this study, uncertainties of dose coefficients due to the ingestion of the radionuclides 141Ce and 144Ce were estimated. According to the schema of internal dose calculation, a general statistical method based on the propagation of uncertainty was developed. The method takes into account the uncertainties contributed by the biokinetic models and by the so-called S values. These S-values were derived by using Monte Carlo radiation transport simulations with five adult non-reference voxel computational phantoms that have been developed at Helmholtz Zentrum München, Germany. Random and Latin hypercube sampling techniques were applied to sample parameters of biokinetic models and S values. The uncertainty factors, expressed as the square root of the 97.5th and 2.5th percentile ratios, for organ equivalent dose coefficients of 141Ce were found to be in the range of 1.2–5.1 and for 144Ce in the range of 1.2–7.4. The uncertainty factor of the detriment-weighted dose coefficient for 141Ce is 2.5 and for 144Ce 3.9. It is concluded that a general statistical method for calculating the uncertainty of dose coefficients was developed and applied to the lanthanide cerium. The dose uncertainties obtained provide improved dose coefficients for radiation risk analysis of humans. Furthermore, these uncertainties can be used to identify those parameters most important in internal dose calculations by applying sensitivity analyses.

Application of a unified probabilistic framework to the dose-response assessment of acrolein

BackgroundIn quantitative chemical risk assessment, a reference value is an estimate of an exposure to a chemical that is “likely to be without appreciable risk.” Because current “deterministic” approaches do not quantitatively characterize the likelihood or severity of harm, the National Academies has recommended using reference values derived from a risk-specific dose that are treated as random variables, with probability distributions characterizing uncertainty and variability. ObjectivesIn order to build familiarity and address issues needed for routine and standardized derivation of probabilistic risk-specific dose distributions, a case example applying the unified probabilistic framework presented in Chiu and Slob (2015) is developed for acrolein. This case study is based on an updated systematic evidence map of literature (Keshava et al., 2020) identifying nasal lesions reported in Dorman et al. (2008) as the most appropriate endpoint and study for reference value derivation. MethodsThe probability distribution was calculated for the risk-specific dose, which in this implementation of the approach was calculated for the dose at which 1% of the human population is estimated to experience minimal lesions, and a probabilistic reference value was computed as the 5th percentile of this distribution. A deterministic reference value was also derived for comparison, and a sensitivity analysis of the probabilistic reference value was conducted investigating alternative assumptions for the point of departure type and exposure duration. ResultsThe probabilistic reference value of 6 × 10−4 mg/m3 was slightly lower than the deterministic reference value of 8 × 10−4 mg/m3, and the risk-specific dose distribution had an uncertainty spanning a factor of 137 (95th-5th percentile ratio). Sensitivity analysis yielded slightly higher probabilistic reference values ranging between 9 × 10−4 mg/m3 and 2 × 10−3 mg/m3. ConclusionsUsing a probabilistic approach for deriving a reference value allows quantitative characterization of the severity, incidence, and uncertainty of effects at a given dose. The results can be used to inform risk management decisions and improve risk communication.

Degrees of ‘eliteness’ in higher education systems: A comparison between Germany and France

AbstractEducation systems worldwide differ in their degree of eliteness. They range from being non‐elitist with dominant patterns of horizontal differentiation (e.g., Germany) to being strongly elitist and having established elite education sectors (e.g., France). Quantitatively, it remains relatively unclear how the eliteness of education systems can be assessed and evaluated. We identify several theoretical mechanisms that are assumed to increase or decrease vertical differentiation between education institutions. For the analyses, we use two large secondary datasets of student beginners’ higher education choices in Germany and France and test different measures of inequality and concentration (Gini index, Duncan’s D, inverse Pareto coefficient, percentile ratios) to describe the degree of eliteness. We estimated the shares of students from higher status groups (high achievers, upper‐tier service class academic milieu) in higher education institutions and fields of study and compared their distribution. Our findings indicate that analyses of percentiles, percentile ratios and inverse Pareto coefficient confirm an expected stronger concentration of high achieving students in the top of the distribution of higher education institutions and fields of study in France than in Germany. In comparison to students’ achievement, social origin proved to be less important for country‐specific differences in concentration.

Percentile Study of χ Distribution. Application to Response Time Data

As a continuation of our previous work, where a Maxwell–Boltzmann distribution was found to model a collective’s reaction times, in this work we will carry out a percentile study of the χ distribution for some freedom ranging from k = 2 to k = 10. The most commonly used percentiles in the biomedical and behavioral sciences have been included in the analysis. We seek to provide a look-up table with percentile ratios, taken symmetrically about the median, such that this distribution can be identified in practice in an easy way. We have proven that these ratios do not depend upon the variance chosen for the k generating Gaussians. In general, the χ probability density, generalized to take any value of the variance, represents an ideal gas in a k-dimensional space. We also derive an approximate expression for the median of the generalized χ distribution. In the second part of the results, we will focus on the practical case of k = 3, which represents the ideal gas in physics, and models quite well the reaction times of a human collective. Accurately, we will perform a more detailed scrutiny of the percentiles for the reaction time distribution of a sample of 50 school-aged children (7200 reaction times).

Discordance between Estimate Glomerular Filtration Rate with Creatinine and Cystatin is Associated with Inflammation and Worsened Survival in Heart Failure

Introduction Glomerular filtration rate (GFR) can be estimated using serum creatinine or cystatin C. At the population level, these equations predict GFR with similar accuracy but can give substantially different results at the level of an individual patient. These within-patient differences may be explained by factors such as inflammation, as cystatin C is associated with higher levels of established inflammatory markers. We sought to determine if the discordance between the two GFR estimates could be attributed to inflammation, and furthermore to examine if this information held prognostic value. Hypothesis Discordance of estimated GFR (eGFR) using creatinine vs. cystatin C will be affected by inflammation and patients with greater discordance will have worsened survival. Methods We analyzed an outpatient cohort of patients with chronic stable heart failure (n= 162). CKDEPI-Creatinine and CKDEPI-Cystatin C equations were used to estimate GFR. Discordance of eGFR was calculated as the ratio of eGFRcreatinine to eGFRcystatin. (values higher than 1 represent eGFRcreatinine > eGFRcystatin and lower than 1 represent eGFRcystatin > eGFRcreatinine). Results In the overall population eGFRcreatinine was 54±28mL/min/m2 and the eGFRcystatin was 43±25mL/min/m2, resulting in an average ratio of 1.3±0.4. There were, however, substantial differences in individual patients with the 10th percentile ratio at 0.9 and 90th percentile a ratio of 1.7. Notably, the ratio was correlated with plasma interleukin-6 (r= 0.24), C-reactive protein (r= 0.23), and ST2 (r= 0.26); p Conclusion The discordance of eGFR with creatinine and cystatin C was associated with markers of inflammation and holds powerful independent prognostic information. Additional study into the drivers of the discordance in GFR estimates by cystatin C and creatinine is warranted.

A Bayesian control chart for monitoring the ratio of Weibull percentiles

AbstractThis paper introduces a new Bayesian control chart to compare two processes by monitoring the ratio of percentiles of two quality characteristics that are assumed to be independent Weibull distributed random variables with the same and stable shape parameter larger than one. The chart analyses the sampling data directly, instead of transforming them in order to comply with the usual normality assumption, as many charts do. A real application in the wood industry and a wide simulation illustrate the features of the chart and its performance, depending on the number of training data, the quality of prior information, and the magnitude of the shift.

Is Single-Photon Emission Computed Tomography/Computed Tomography Superior to Single-Photon Emission Computed Tomography in Assessing Unilateral Condylar Hyperplasia?

Single-photon emission computed tomography (SPECT) with technetium-99m diphosphates plays an important role in assessing unilateral condylar hyperplasia (UCH). The aim of this study was to evaluate whether quantification methods of SPECT plus CT (SPECT/CT) based on precise region-of-interest (ROI) drawings made under the guide of CT images were more accurate than conventional SPECT methods in the assessment of UCH growth. This study is a nonblinded retrospective case series. Patients with UCH who had undergone SPECT/CT were enrolled. CT images were used to guide ROI drawings around the anatomic contour of the affected and contralateral condyles on SPECT/CT images versus fixed ROIs on conventional SPECT images. Mean and maximum values within the ROIs were recorded to compute percentile ratios. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves were calculated separately for SPECT-based methods (SPECTaver, SPECTmax) and SPECT/CT methods (SPECTCTaver, SPECTCTmax). The area under the ROC curve of each method was calculated and compared pairwise. Fifty-six patients (30 patients with progressive and 26 patients with nonprogressive mandibular asymmetry) were evaluated. SPECTmax had the highest sensitivity of 83.3%, followed by SPECTCTmax, SPECTaver, and SPECTCTaver. In contrast, SPECTaver, SPECTCTmax, and SPECTmax had similar specificities, PPVs, and NPVs. Nonetheless, SPECTCTaver had the lowest specificity, PPV, and NPV among all methods. ROC analysis also showed similar diagnostic performances among SPECTaver, SPECTmax, and SPECTCTmax (P>.05) and poorer diagnostic performance of SPECTCTaver compared with the other 3 methods (P<.05). The method of using ROIs drawn around the contour of the condyle on SPECT/CT images does not show improved accuracy over conventional SPECT-fixed ROI methods in assessing UCH.

Analysis of Physician Variation in Provision of Low-Value Services

Facing new financial incentives to reduce unnecessary spending, health care organizations may attempt to reduce wasteful care by influencing physician practices or selecting more cost-effective physicians. However, physicians' role in determining the use of low-value services has not been well described. To quantify variation in provision of low-value health care services among primary care physicians and to estimate the proportion of variation attributable to physician characteristics that may be used to predict performance. This retrospective analysis included national Medicare fee-for-service claims of 3 159 834 beneficiaries served by 41 773 generalist physicians from January 1, 2008, through December 31, 2013 (data were analyzed in 2016 through 2018). Multilevel modeling was used to estimate the extent of variation in service use across physicians within their region and provider organization, adjusted for patient clinical and sociodemographic characteristics and sampling variation. The proportion of variation attributable to physician characteristics that may be used to predict performance (age, sex, academic degree, professorship, publication record, trial investigation, grant receipt, pharmaceutical or device manufacturer payment, and panel size) was estimated via additional regression analysis. Annual count per beneficiary of 17 primary care-associated services that provide minimal clinical benefit. Among the 3 159 834 beneficiaries (58.3% women; mean [SD] age, 73.2 [11.0] years) served by 41 773 physicians (74.9% men; mean [SD] age, 48.0 [10.1] years), the mean annual rate of low-value services was 33.1 services per 100 beneficiaries. Considerable variation across physicians within the same region was found (SD, 8.8 [95% CI, 8.7-8.9]; 90th:10th percentile ratio, 2.03 [95% CI, 2.01-2.06]) and across physicians within the same organization (SD, 6.1 [95% CI, 6.0-6.2]; 90th:10th percentile ratio, 1.61 [95% CI, 1.60-1.63]). The corresponding rates at the 10th percentile of physicians within region and within organization respectively were 21.8 and 25.3 services per 100 beneficiaries. Observable physician characteristics accounted for only 4.4% of physician variation within region and 1.4% of physician variation within organization. Physician practices may substantially contribute to low-value service use, which is prevalent even among the least wasteful physicians. Because little variation is predicted by measured physician characteristics, direct measures of low-value care provision may aid organizational efforts to encourage high-value practices.

Changes in Wage Trends and Earnings Differences in Kerala

In this article, the weekly earnings gap between men and women in Kerala is examined by a number of inequality indices such as the percentile ratio and the Gini coefficient. The entropy measures of inequality are used to decompose wage inequality into within-group and between-group inequalities. The earnings inequality between men and women has been increasing, even though their wage grows faster than men’s wage. The indices of inequality suggest the growing wage disparity in the regular and casual labour market. The result reveals that the levels of education and earnings are positively correlated, but women with the same level of education earn much less than men in regular salaried work. The rising wage inequality of men and women during 2004–2009 were associated with the growth rate of wages in the same period. That is, the wage rates of both regular and casual workers have increased more than four per cent during the period that experienced the highest inequality.

An algorithm for quantitatively estimating non-occupational pesticide exposure intensity for spouses in the Agricultural Health Study.

Residents of agricultural areas experience pesticide exposures from sources other than direct agricultural work. We developed a quantitative, active ingredient specific algorithm for cumulative (adult, married lifetime) non occupational pesticide exposure intensity for spouses of farmers who applied pesticides in the Agricultural Health Study (AHS). The algorithm addressed three exposure pathways: take home, agricultural drift, and residential pesticide use. Pathway-specific equations combined (i) weights derived from previous meta analyses of published pesticide exposure data and (ii) information from the questionnaire on frequency and duration of pesticide use by applicators, home proximity to treated fields, residential pesticide usage (e.g., termite treatments), and spouse’s off farm employment (proxy for time at home). The residential use equation also incorporated a published probability matrix that documented the likelihood active ingredients were used in home pest treatment products. We illustrate use of these equations by calculating exposure intensities for the insecticide chlorpyrifos and herbicide atrazine for 19,959 spouses. Non zero estimates for ≥1 pathway were found for 78% and 77% of spouses for chlorpyrifos and atrazine, respectively. Variability in exposed spouses’ intensity estimates was observed for both pesticides, with 75th to 25th percentile ratios ranging from 7.1−7.3 for take home, 6.5−8.5 for drift, 2.4−2.8 for residential use, and 3.8−7.0 for the summed pathways. Take home and drift estimates were highly correlated (≥0.98), but were not correlated with residential use (0.01−0.02). This algorithm represents an important advancement in quantifying non occupational pesticide relative exposure differences and will facilitate improved etiologic analyses in the AHS spouses. The algorithm could be adapted to studies with similar information.

Job-exposure matrices addressing lifestyle to be applied in register-based occupational health studies

ObjectivesInformation about lifestyle factors in register-based occupational health studies is often not available. The objective of this study was therefore to develop gender, age and calendar-time specific job-exposure matrices (JEMs)...