Substantial Regional Differences Research Articles

Diabetes screening after gestational diabetes in England: a quantitative retrospective cohort study

The National Institute for Health and Care Excellence (NICE) recommends postpartum and annual monitoring for diabetes for females who have had a diagnosis of gestational diabetes mellitus (GDM). To describe the current state of follow-up after GDM in primary care, in England. A retrospective cohort study in 127 primary care practices. The total population analysed comprised 473 772 females, of whom 2016 had a diagnosis of GDM. Two subgroups of females were analysed using electronic general practice records. In the first group of females (n = 788) the quality of postpartum follow-up was assessed during a 6-month period. The quality of long-term annual follow-up was assessed in a second group of females (n = 718), over a 5-year period. The two outcome measures were blood glucose testing performed within 6 months postpartum (first group) and blood glucose testing performed annually (second group). Postpartum follow-up was performed in 146 (18.5%) females within 6 months of delivery. Annual rates of long-term follow-up stayed consistently around 20% a year. Publication of the Diabetes in Pregnancy NICE guidelines, in 2008, had no effect on long-term screening rates. Substantial regional differences were identified among rates of follow-up. Monitoring of females after GDM is markedly suboptimal despite current recommendations.

Low Prevalence of Liver Disease but Regional Differences in HBV Treatment Characteristics Mark HIV/HBV Co-Infection in a South African HIV Clinical Trial

BackgroundHepatitis B virus (HBV) infection is endemic in South Africa however, there is limited data on the degree of liver disease and geographic variation in HIV/HBV coinfected individuals. In this study, we analysed data from the CIPRA-SA ‘Safeguard the household study’ in order to assess baseline HBV characteristics in HIV/HBV co-infection participants prior to antiretroviral therapy (ART) initiation.Methods812 participants from two South African townships Soweto and Masiphumelele were enrolled in a randomized trial of ART (CIPRA-SA). Participants were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and HBV DNA. FIB-4 scores were calculated at baseline.ResultsForty-eight (5.9%) were HBsAg positive, of whom 28 (58.3%) were HBeAg positive. Of those with HBV, 29.8% had an HBV DNA<2000 IU/ml and ALT<40 IU/ml ; 83.0% had a FIB-4 score <1.45, consistent with absent or minimal liver disease. HBV prevalence was 8.5% in Masiphumelele compared to 3.8% in Soweto (relative risk 2.3; 95% CI: 1.3–4.0). More participants in Masiphumelele had HBeAg-negative disease (58% vs. 12%, p = 0.002) and HBV DNA levels ≤2000 IU/ml, (43% vs. 6% p<0.007).ConclusionOne third of HIV/HBV co-infected subjects had low HBV DNA levels and ALT while the majority had indicators of only mild liver disease. There were substantial regional differences in HBsAg and HbeAg prevalence in HIV/HBV co-infection between two regions in South Africa. This study highlights the absence of severe liver disease and the marked regional differences in HIV/HBV co-infection in South Africa and will inform treatment decisions in these populations.

FRUIT AND VEGETABLE CONSUMPTION FREQUENCY BY URBAN HOUSEHOLDS IN GHANA - IMPLICATIONS FOR POSTHARVEST HANDLING

The paper examines the frequency of eating fruits and vegetables in three major cities in Ghana applying survey data collected by authors in 2011. Results based on responses provided by over 1,000 households indicate that tomato and orange were the most often eaten vegetable and fruit, respectively. However, there are substantial regional differences implying the importance of climatic differences and availability of specific types of produce. The paper also reports differences in purchased fruits and vegetables between those spending below or above the sample average on these two food categories and reports on differences in the selection of retail outlet type in shopping for fruits and vegetables. Knowledge of the identified differences has direct implications for the suppliers and distributors of fresh fruits and vegetables in Ghana.

Off‐label use of second generation antipsychotics for post‐traumatic stress disorder in the Department of Veterans Affairs: time trends and sociodemographic, comorbidity, and regional correlates

Second generation antipsychotics (SGAs) are widely used for post-traumatic stress disorder (PTSD), although without strong evidence base. With substantial numbers of veterans returning from Iraq/Afghanistan conflicts with PTSD, it is important to characterize the extent of SGA use and identify associated factors. We determined time trends and patient characteristics associated with the use of SGAs in veterans with PTSD, without comorbid schizophrenia or bipolar disorders, using the Department of Veterans Affairs national administrative data 2003-2010. Among 732,085 veterans with PTSD, 27.6% received an intentional trial of an SGA in 2003-2010. The annual number treated with SGAs almost doubled (45,268 to 84,197, p < 0.001), while prescribing rates decreased (28.6% to 21.5%, p < 0.001). In multivariate analyses, African Americans (odds ratio (OR) = 1.07, 95%confidence interval (CI) = 1.06-1.09) and Hispanics (OR = 1.13, 95%CI = 1.10-1.17) were more likely to receive SGAs than Whites. Strongest clinical associations were with prior diagnosis of depression (OR = 1.96; 95%CI = 1.94-1.99), substance use disorders (OR = 1.86; 95%CI = 1.84-1.88), and other anxiety disorders (OR = 1.27; 95%CI = 1.26-1.29) (all p - < 0.0001) as well as cardiovascular risk factors. Veterans previously deployed to Iraq/Afghanistan had lower likelihood of SGA receipt. Substantial regional differences were demonstrated (South > Northeast; Midwest and West < Northeast; p < 0.0001); regional administrative units (veterans integrated service networks) contributed minimally to regional differences. Post-traumatic stress disorder population growth is driving substantial increases in SGA use. Decreasing rates of the Department of Veterans Affairs prescribing may be due to integrated system-wide mechanisms (e.g., national practice guidelines), although regional variations remain prominent. These analyses provide foundational steps for identifying modifiable provider-level and organization-level determinants of SGA prescription in this growing population.

Near‐surface air temperature lapse rates in the mainland China during 1962–2011

Land surface hydrological modeling is sensitive to near‐surface air temperature, which is especially true for the cryosphere. The lapse rate of near‐surface air temperature is a critical parameter when interpolating air temperature from station data to gridded cells. To obtain spatially distributed, fine‐resolution near‐surface (2 m) air temperature in the mainland China, monthly air temperature from 553 Chinese national meteorological stations (with continuous data from 1962 to 2011) are divided into 24 regional groups to analyze spatiotemporal variations of lapse rate in relation to surface air temperature and relative humidity. The results are as follows: (1) Evaluation of estimated lapse rate shows that the estimates are reasonable and useful for temperature‐related analyses and modeling studies. (2) Lapse rates generally have a banded spatial distribution from southeast to northwest, with relatively large values on the Tibetan Plateau and in northeast China. The greatest spatial variability is in winter with a range of 0.3°C–0.9°C · 100 m−1, accompanied by an inversion phenomenon in the northern Xinjiang Province. In addition, the lapse rates show a clear seasonal cycle. (3) The lapse rates maintain a consistently positive correlation with temperature in all seasons, and these correlations are more prevalent in the north and east. The lapse rates exhibit a negative relationship with relative humidity in all seasons, especially in the east. (4) Substantial regional differences in temporal lapse rate trends over the study period are identified. Increasing lapse rates are more pronounced in northern China, and decreasing trends are found in southwest China, which are more notable in winter. An overall increase of air temperature and regional variation of relative humidity together influenced the change of lapse rate.

Absence of E coli O157:H7 in sheep and cattle faeces in North Wales

Escherichia coli O157:H7 is a human pathogen associated with haemolytic uraemic syndrome and haemorrhagic colitis cases throughout the developed world (Garcia and others 2010). The faeces of ruminant animals, in...

Large differences between patients with acute myocardial infarction included in two Swedish health registers

Acute myocardial infarction (MI) is a leading cause for morbidity and mortality in Sweden. We aimed to compare patients with an acute MI included in the Register of information and knowledge about Swedish heart intensive care admissions (RIKS-HIA, now included in the register Swedeheart) and in the Swedish statistics of acute myocardial infarctions (S-AMI). Population based register study including RIKS-HIA, S-AMI, the National patient register and the Cause of death register. Odds ratios were determined by logistic regression analysis. From 2001 to 2007, 114,311 cases in RIKS-HIA and 198,693 cases in S-AMI were included with a discharge diagnosis of an acute MI. Linkage was possible for 110,958 cases. These cases were younger, more often males, had fewer concomitant diseases and were more often treated with invasive coronary artery procedures than patients included in S-AMI only. There were substantial regional differences in proportions of patients reported to RIKS-HIA. Approximately half of all patients with an acute MI were included in RIKS-HIA. They represented a relatively more healthy population than patients included in S-AMI only. S-AMI covered almost all patients with an acute MI but had limited information about the patients. Used in combination, these two registers can give better prerequisites for improved quality of care of all patients with acute coronary syndromes.

Where Does the Irrigation Water Go? An Estimate of the Contribution of Irrigation to Precipitation Using MERRA

Abstract Irrigation is an important human activity that may impact local and regional climate, but current climate model simulations and data assimilation systems generally do not explicitly include it. The European Centre for Medium-Range Weather Forecasts (ECMWF) Interim Re-Analysis (ERA-Interim) shows more irrigation signal in surface evapotranspiration (ET) than the Modern-Era Retrospective Analysis for Research and Applications (MERRA) because ERA-Interim adjusts soil moisture according to the observed surface temperature and humidity while MERRA has no explicit consideration of irrigation at the surface. But, when compared with the results from a hydrological model with detailed considerations of agriculture, the ET from both reanalyses show large deficiencies in capturing the impact of irrigation. Here, a back-trajectory method is used to estimate the contribution of irrigation to precipitation over local and surrounding regions, using MERRA with observation-based corrections and added irrigation-caused ET increase from the hydrological model. Results show substantial contributions of irrigation to precipitation over heavily irrigated regions in Asia, but the precipitation increase is much less than the ET increase over most areas, indicating that irrigation could lead to water deficits over these regions. For the same increase in ET, precipitation increases are larger over wetter areas where convection is more easily triggered, but the percentage increase in precipitation is similar for different areas. There are substantial regional differences in the patterns of irrigation impact, but, for all the studied regions, the highest percentage contribution to precipitation is over local land.

Clearfell controversies and alternative timber harvest designs: How acceptability perceptions vary between Tasmania and the U.S. Pacific Northwest

Perceptions of the acceptability of alternative “variable retention” timber harvests, that keep trees standing in harvested areas, were compared between regions beset by major forestry conflicts. Data from similar studies of similar harvest systems were compared between Oregon and Tasmania. These comparisons were related to attitudes and to differences in ecosystems, silvicultural prescriptions, forestry outcomes, aesthetics, and social-political context. Findings showed that perceptions measured in one region cannot be assumed valid in another. Substantial regional differences arose not from general sociological differences but from differences in local forestry outcomes. These largely arose from different regeneration requirements of commercial tree species and consequent differences in the design of otherwise analogous harvests. Comparisons of perceptions by people with similar attitudes yielded substantial regional differences. Those prioritizing ecological conservation were mainly influenced by habitat outcomes, and consequently preferred harvests with aggregated tree retention patterns in Tasmania but not in Oregon. People sympathetic to timber industry interests in both regions showed little association between forestry outcomes and acceptability and favoured more intensive harvests. Tasmanian harvest advocates perceived harvests that keep more standing trees as less acceptable than those in Oregon. This may be due to sampling differences or to greater risk perceptions towards new harvest designs in Tasmania. Tasmanians generally disliked clearfelling more than Oregonians, likely due to different political narratives framing these perceptions or to higher aesthetic impacts in Tasmania due to burning. Dispersed retention was perceived as more acceptable in Oregon than in Tasmania, likely because Oregon had much higher post-harvest tree densities. Regional differences in wildfire-risk and logger-safety were not strongly associated with different acceptability perceptions because these were confounded by other more influential concerns. More and better cross-regional studies of environmental perceptions are needed and would benefit from more standardized or coordinated methods.

Regional variation in survival after metastatic prostate cancer diagnosis.

4666 Background: Survival after diagnosis of metastatic prostate cancer (mPC) averages 2-3 years. Substantial regional differences in survival have been documented for PC prior to 2000. We investigated the extent to which regional variation exists in survival for mPC patients during 2000-2007. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare claims, we identified men (mean age, 77.6 years) continuously enrolled in Medicare Parts A/B who were diagnosed with mPC between 2000 and 2007 and not diagnosed with another malignancy. The base-case model was limited to hospital service areas with &gt;50 patients. A Cox proportional hazards model was used to estimate hazard ratios (HR) for overall survival (OS), adjusting for year of diagnosis, age, marital status, poverty and education covariates, Gleason score, comorbidities, and region covariates. Sensitivity of results was tested by limiting the analysis to patients surviving at least 6 months after diagnosis and by removing regional sample size limits. We report HRs for covariates, results of a Wald test of joint significance for region effects, and percentage difference from the mean for each region’s HR for death. Results: A total of 2696 patients with mPC met the inclusion criteria. OS was 37% at 3 years and mean HR for death was 4.8 (sd 2.1). HRs for death were positively correlated with age (HR=1.96, 95% CI: 1.6-2.3 for &gt;80 years), PC-specific comorbidity index (HR=1.2, 95% CI: 1.1-1.3), and Gleason score (HR=6.6, 95% CI: 2.4-17.8 for poorly differentiated). Year of diagnosis, race, and socioeconomic status were not significantly associated with mortality. Wald test of joint significance for survival across regions of P=.019 indicated significant differences in survival across regions and was robust in sensitivity analyses. Patients living in regions with the worst survival rates had HRs for death that were 20% higher than the mean (HR=5.8) and those living in regions with the best survival rates had HRs 30% lower than the mean (HR=3.4). Conclusions: There are significant regional differences in survival for mPC patients in the 2000s. Further research is needed to determine if treatment differences play a role in this disparity.

Myocardial Revascularization in New York State: Variations in the PCI-to-CABG Ratio and Their Implications.

BackgroundDuring the past 2 decades, percutaneous coronary intervention (PCI) has increased dramatically compared with coronary artery bypass grafting (CABG) for patients with coronary artery disease. However, although the evidence available to all practitioners is similar, the relative distribution of PCI and CABG appears to differ among hospitals and regions.Methods and ResultsWe reviewed the published data from the mandatory New York State Department of Health annual cardiac procedure reports issued from 1994 through 2008 to define trends in PCI and CABG utilization in New York and to compare the PCI/CABG ratios in the metropolitan area to the remainder of the State. During this 15-year interval, the procedure volume changes for CABG, for all cardiac surgeries, for non-CABG cardiac surgeries, and for PCI for New York State were −40%, −20%, +17.5%, and +253%, respectively; for the Manhattan programs, the changes were similar as follows: −61%, −23%, +14%, and +284%. The average PCI/CABG ratio in New York State increased from 1.12 in 1994 to 5.14 in 2008; however, in Manhattan, the average PCI/CABG ratio increased from 1.19 to 8.04 (2008 range: 3.78 to 16.2). The 2008 PCI/CABG ratios of the Manhattan programs were higher than the ratios for New York City programs outside Manhattan, in Long Island, in the northern counties contiguous to New York City, and in the rest of New York State; their averages were 5.84, 5.38, 3.31, and 3.24, respectively. In Manhattan, a patient had a 56% greater chance of receiving PCI than CABG as compared with the rest of New York State; in one Manhattan program, the likelihood was 215% higher.ConclusionsThere are substantial regional and statewide differences in the utilization of PCI versus CABG among cardiac centers in New York, possibly related to patient characteristics, physician biases, and hospital culture. Understanding these disparities may facilitate the selection of the most appropriate, effective, and evidence-based revascularization strategy. (J Am Heart Assoc. 2012;1:e001446 doi: 10.1161/JAHA.112.001446.)

Regional Variations and Trends in the Prevalence of Diagnosed Glaucoma in the Medicare Population

To determine the prevalence of diagnosed glaucoma in the Medicare population and to assess regional variations and trends. Retrospective, cross-sectional study. A 5% random sample of Medicare beneficiaries aged ≥ 65 years, excluding those in health maintenance organizations. All claims with a glaucoma diagnosis code submitted by ophthalmologists, optometrists, or ambulatory surgery centers were used to estimate prevalence of the diagnosis of glaucoma for each year from 2002 to 2008. Regional variation in diagnosed glaucoma was examined in 9 large geographic regions and in 179 smaller subregions, controlling for patient characteristics and provider supply. The prevalence of diagnosed open-angle glaucoma suspect (OAG-s), open-angle glaucoma (OAG), angle-closure glaucoma suspect (ACG-s), and angle-closure glaucoma (ACG), trends over time, and regional variations in prevalence. The overall prevalence increased from 10.4% in 2002 to 11.9% by 2008, largely owing to increase in diagnosed OAG-s (from 3.2% to 4.5%; P<0.001). The relative prevalence of diagnosed OAG compared with diagnosed ACG was 32:1. In 2008, multivariable models showed that the New England and Mid-Atlantic regions had 1.7 times more diagnosed OAG-s than the reference region (East South Central; New England: odds ratio [OR], 1.66; 95% confidence interval [CI], 1.58-1.75; Mid-Atlantic: OR, 1.66; 95% CI, 1.59-1.73). The odds of diagnosed OAG was 36% higher in New England (OR, 1.36; 95% CI, 1.30-1.42) and 31% higher in the Mid-Atlantic (OR, 1.31; 95% CI, 1.26-1.36) than in the reference region. The New England and Mid-Atlantic regions had the highest odds of diagnosed ACG-s and the Mid-Atlantic region had the highest odds of diagnosed ACG. Among 179 subregions, the New York area had high diagnosis rates of all glaucoma types. The relative prevalence of diagnosed ACG compared with diagnosed OAG was lower than expected from population-based data, possibly owing to failure to perform gonioscopy. Substantial regional differences in diagnosed rates existed for all types of glaucoma, even after adjusting for patient characteristics and provider concentration, suggesting possible overdiagnosis in some areas and/or underdiagnosis in other areas. Regionally higher diagnosis rates in the New York area deserve further study.

Prevalence and trends of non-medical opioid and other drug use histories among federal correctional inmates in methadone maintenance treatment in Canada

BackgroundThe prevalence of illicit drug use among correctional populations is high, and associated with high levels of drug related morbidity risks and harms. The purpose of this study was to examine temporal and regional patterns of illicit drug use among a sample of Canadian federal correctional inmates participating in correctional methadone maintenance treatment (MMT). MethodsSocio-demographic and drug use data collected from 1272 male federal offenders admitted to Correctional Service Canada's (CSC) MMT program between 2003 and 2008 were examined. Univariate analyses were conducted on inmates’ key demographic and correctional characteristics, pre-MMT opioid use and other problematic drug use, and opioid and injecting use while incarcerated. Bivariate associations on drug use measures across regions and over time were computed. ResultsPrevalence of heroin use decreased, and prevalence of prescription opioid (PO) use increased over the study period. Significant regional differences existed for PO use, specifically for morphine/hydromorphone and oxycodone use. The majority used opioids and injected while incarcerated, with overall downward trends over time and regional variations. Approximately half the sample indicated a history of lifetime non-opioid problematic drug use, most commonly cocaine (72%) for which substantial regional differences were found. ConclusionsPre-MMT opioid and other problematic non-opioid drug use in the sample was high. Temporal and regional patterns of drug use observed may reflect developments in the general population, e.g. increasing PO misuse. The observed drug use patterns underscore the need for targeted drug specific prevention/treatment measures in correctional environments beyond existing interventions.

Optimization of the Land Offices organisation in the Czech Republic

&amp;nbsp; The land consolidation is a significant instrument for the ownership relations issue and for ensuring the maintenance of land functions and the increase of the ecological stability. Despite of the demonstrable arguments, this activity is not fully valued by the society, which is retroactively reflected from the long term point of view into the processes and structures of land consolidation in countryside. The analysis of the current organisation and management of the Land Offices pointed at substantial regional differences in the process management effectiveness, the utilisation of expert capacities during the land consolidation realisation and further administration actions. There is proposed an optimisation of the institutional structure that will be sufficiently flexible towards the changes of the demanded actions. The need for change of organisation and activities requires also the agro-environmental policies of the European Union.

P1-134 Delays in accessing HIV/AIDS health services persist in Salvador, Brazil

IntroductionEven though Brazil was the first country to provide universal and free access to ARVs, substantial regional differences exist in the timing that services and care are accessed. Studies among...

Mergers and acquisitions in the global food processing industry in 1986–2006

Food systems around the world experienced increased merger and acquisition (M&A) activity over the past decades. Based on a sample of 13,911M&A attempts worldwide during 1986–2006, this study provides an analysis of major determinants of M&A completion in the food processing industry. Friendly attitude, cash payment and experience with M&As emerge as strong deal facilitators. Bidding competition, pursuit of parallel transactions, target subsidiary status and acquirer public status are the most important deal breakers. Unlike the lenient antitrust approach of the Reagan administration, the 1998 UK Competition Act and various directives and regulations on food safety and quality associated with the completion of the internal European market in 1992 facilitated M&A completion. In contrast, the beginning of the Economic and Monetary Union, as marked by the introduction of the Euro in 1999, had a strong negative effect on completion likelihood. This study identifies substantial regional differences. Completion of M&As that involve Asian firms depends on distinct factors. Results for NAFTA are mostly in line with predictions derived from general economic theory, compared to other regions.

Growth, Inequality, and Poverty Reduction in Developing Countries: Recent Global Evidence

The study presents recent global evidence on the transformation of economic growth to poverty reduction in developing countries, with emphasis on the role of income inequality. The focus is on the period since the early-mid-1990s when growth in these countries as a group has been relatively strong, surpassing that of the advanced economies. Both regional and country-specific data are analysed for the $1.25 and $2.50-level poverty headcount ratios, using the most recent World Bank data. The study finds that on average income growth has been the major driving force behind both the declines and increases in poverty. The study, however, documents substantial regional and country differences that are masked by this ‘average’ dominant-growth story. While in the majority of countries, growth was the major factor behind falling or increasing poverty, inequality, nevertheless, played the crucial role in poverty behaviour in a large number of countries. And, even in those countries where growth has been the main driver of poverty reduction, further progress could have occurred under relatively favourable income distribution. For more efficient policymaking, therefore, idiosyncratic attributes of countries should be emphasised. In general, high initial levels of inequality limit the effectiveness of growth in reducing poverty, while growing inequality reduces poverty directly for a given level of growth. It would seem judicious, therefore, to accord special attention to reducing inequality in certain countries where income distribution is especially unfavourable. Unfortunately, the present study also points to the limited effects of growth and inequality-reducing policies in low-income countries.

Getting cancer prevalence right: using state cancer registry data to estimate cancer survivors.

Cancer incidence and mortality statistics provide limited insight regarding the cancer survivor population and its needs. Cancer prevalence statistics enumerate cancer survivors--those currently living with cancer. Commonly used limited-duration prevalence (LDP) methods yield biased estimates of the number of survivors. National estimates may not allow sufficient granularity to inform local survivorship programs. In this study, complete prevalence (CP) methods are applied to actual North Carolina Central Cancer Registry (NCCCR) data to generate better, more informative prevalence estimates than previous methods. Data included all incident cases for 1995-2007 from the NCCCR and US Census population data. SEER*Stat software was used to calculate 13-year LDP. ComPrev software was used to estimate CP for each cancer site, gender, and race combination. CP methods estimated 362,810 survivors in North Carolina on January 1, 2008, 40% more than LDP estimates of 258,556, with substantial racial, regional, and gender differences in prevalence rankings of several cancers. CP estimates are substantially higher than previous prevalence estimates. This study found previously unrecognized racial, regional, and gender differences. State and local programs may apply these methods using their own data to develop better, more detailed estimates to improve planning for their specific survivor populations' needs.

Prostate cancer screening and incidence among men younger than age 50.

183 Background: Prostate cancer has long been considered as a disease of older men. However, age at diagnosis with prostate cancer has continued to decline. Since the introduction of prostate-specific antigen (PSA) test in 1986, the prostate cancer incidence rate has steadily and dramatically increased in men under age 50. This study aims to better understand demographic variations in prostate cancer screening and incidence, and clinical characteristics of prostate cancers in men under age 50. Methods: We examined prostate cancer testing data from the Behavioral Risk Factor Surveillance System (2002, 2004, 2006, and 2008) and prostate cancer incidence data from the CDC's National Program of Cancer Registries and the NCI's Surveillance, Epidemiology, and End Results programs (2001-2006). We estimated the weighted percentage of self-reported cancer testing using SUDAAN and age-adjusted cancer incidence rates and trends using SEER-STAT. Statistical significance for trends was determined by the annual percentage change (APC) differing form zero. Results: A total of 29,176 prostate cancer cases were identified from 2001-2006 among men under age 50. Of these, 551 (1.9%) were among men under age 40. Incidence rates remained stable from 2001-2006; however the incidence of well-differentiated tumors decreased significantly (APC=−24.7) during this time period. About 44% of men aged 40-49 years old reported having a prostate cancer test in the past two years. Prostate cancer testing and incidence rates were highest among men who were black, non-Hispanic, or lived in the northeast. Black men had more than a 2-fold increase in cancer incidence than white men. Conclusions: The magnitude of prostate cancer testing and incidence in men under age 50 reveals significant health/public health problems in this younger population. This study demonstrates substantial regional differences in prostate cancer testing and incidence in men under age 50. It also confirms that prostate cancer testing and incidence varies by race and ethnicity. We observed a large disparity in prostate cancer incidence between blacks and whites. The incidence rate remained stable over time; the dramatic decrease occurred in well-differentiated cancers. No significant financial relationships to disclose.

Childhood leukemia incidence in Brazil according to different geographical regions

Resource-rich countries tend to have a higher incidence of childhood acute lymphoblastic leukemia (ALL), whereas lower rates are seen in more deprived countries. This study describes the incidence of childhood acute leukemia in Brazil, an upper middle-income country, based on data from 16 population-based cancer registries (PBCRs). Data were examined from 16 PBCRs in Brazilian cities located in five geographical regions during the period from 1997 to 2004. Incidence rates were analyzed according to gender, age, and type of leukemia. The Wilcoxon test was performed to evaluate for gender-age based difference between by leukemia type. The median age-adjusted incidence rate (AAIR) of leukemia in children aged 0-14 years old was 53.3 per million. A different AAIR was found regarding ALL and myeloproliferative disorders (MPD) that ranged from 24.8 to 76.84 per 1,000,000 children. Manaus, although located in a poor area of Brazil, exhibited the highest AAIR (56.6 per million) of ALL. Goiania had the highest AAIR (24.5 per million) of MPD. The median age-specific incidence rate (ASIR) for the 16 Brazilian PBCRs demonstrated a marked peak in incidence of ALL at age 3 years old, in both genders. This population-based study of childhood leukemia demonstrates that substantial regional differences exist regarding the incidence of acute leukemia in Brazil, which warrants further ecological study.