Variations In Time Trends Research Articles

Time trends in losses from major tornadoes in the United States

Damage from tornadoes imposes substantial costs on society. This study provides an analysis of time trends in the severity of losses from tornadoes in the United States for the period 1954–2018. Based on information provided by the Storm Prediction Centre (SPC) of the U.S. National Weather Service, we create a dataset of normalized losses from tornadoes spanning 65 years. We then analyse patterns and trends in the total annual losses from tornadoes as well as distributional properties of the damage from individual tornadoes. Our approach allows us to combine observations from the period 1954–1996, when losses from tornadoes were typically reported in a range (e.g. $500,000–$5,000,000) with observations from 1997 onwards when an actual estimate of the damage for an event is provided. Our findings suggest an overall national significant decline in normalized losses from tornado events. At the country level, both the severity of damage from individual events and the total annual losses from tornadoes are seen to have reduced over time. We also find spatial variations in time trends for the damage from tornadoes: while for most U.S. states the declining trend in severity is confirmed, an increasing trend of total annual losses from tornadoes is observed for Alabama.

Regional variation and rising costs of groin hernia repairs in Australia: is there an urgent need for clinical consensus guidelines?

Regional variation and rising costs of groin hernia repairs in Australia: is there an urgent need for clinical consensus guidelines?

Dispersion of contraceptive access policies across the United States from 2006 to 2021

Person-centered contraceptive access benefits reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health. However, contraceptive access varies by social and geographic position, with policies either perpetuating or alleviating health inequities. We describe geographic and time-trend variation in an index from fewer (less expansive) to greater (more expansive) aggregation of U.S. state-level contraceptive access policies across 50 states and Washington, D.C. (collectively, states) from 2006 to 2021. We collected data from primary and secondary sources on 23 policies regulating contraceptive education, insurance coverage, minor’s rights, provider authority, and more. As of 2021, the most enacted policies expanded contraceptive access through: 1) prescribing authority for nurse practitioners, certified nurse-midwives (n = 50, 98 % of states), and clinical nurse specialists (n = 38, 75 %); 2) Medicaid expansion (n = 38, 75 %); 3) prescription method insurance coverage (n = 30, 59 %); and 4) dispensing authority for nurse practitioners and certified nurse-midwives (n = 29, 57 %). The average overall U.S. policy index value increased in expansiveness from 6.9 in 2006 to 8.6 in 2021. States in the West and Northeast regions had the most expansive contraceptive access landscapes (average index values of 9.0 and 8.2, respectively) and grew more expansive over time (increased by 4–5 policies). The Midwest and South had least expansive landscapes (average index values of 5.0 and 6.1, respectively). Regions with more expansive sexual and reproductive health policy environments further expanded access, whereas least expansive environments were maintained. More nuanced understanding of how contraceptive policy diffusion affects health outcomes and equity is needed to inform public health advocacy and law making.

Assessing the effect of a regional integrated care model over ten years using quality indicators based on claims data \u2013 the basic statistical methodology of the INTEGRAL project

BackgroundThe regional integrated health care model “Healthy Kinzigtal” started in 2006 with the goal of optimizing health care and economic efficiency. The INTEGRAL project aimed at evaluating the effect of this model on the quality of care over the first 10 years.MethodsThis methodological protocol supplements the study protocol and the main publication of the project. Comparing quality indicators based on claims data between the intervention region and 13 structurally similar control regions constitutes the basic scientific approach. Methodological key issues in performing such a comparison are identified and solutions are presented.ResultsA key step in the analysis is the assessment of a potential trend in prevalence for a single quality indicator over time in the intervention region compared to the corresponding trends in the control regions. This step has to take into account that there may be a common - not necessarily linear - trend in the indicator over time and that trends can also appear by chance. Conceptual and statistical approaches were developed to handle this key step and to assess in addition the overall evidence for an intervention effect across all indicators. The methodology can be extended in several directions of interest.ConclusionsWe believe that our approach can handle the major statistical challenges: population differences are addressed by standardization; we offer transparency with respect to the derivation of the key figures; global time trends and structural changes do not invalidate the analyses; the regional variation in time trends is taken into account. Overall, the project demanded substantial efforts to ensure adequateness, validity and transparency.

POSTER ABSTRACTS: P73 DISPERSION OF CONTRACEPTIVE ACCESS POLICIES ACROSS THE US FROM 2007 TO 2017

Objectives: Person-centered access to contraceptive methods benefits reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health. However, contraceptive access varies by social and geographic position, with policies potentially perpetuating or alleviating health inequities. We describe geographic and time-trend variation in state-level contraceptive access policies over a recent decade in the US.

Impact of low-dose computed tomography for lung cancer screening on lung cancer surgical volume: The urgent need in health workforce education and training.

This study aimed to investigate the time trend variation in the surgical volume and prognostic outcome of patients with lung cancer after the gradual prolonged implementation of a low-dose computed tomography (LDCT) lung cancer screening program.Using the hospital-based cancer registry data on number of patients with lung cancer and deaths from 2008 to 2017, we conducted a retrospective study using a hospital-based cohort to investigate the relationship between changes in lung cancer surgical volume, the proportion of lung-sparing surgery, and prolonged prognostic outcomes after the gradual implementation of the LDCT lung cancer screening program in recent years.From 2008 to 2017, 3251 patients were diagnosed with lung cancer according to the hospital-based cancer registry. The 5-year mortality rate decreased gradually from 83.54% to 69.44% between 2008 and 2017. The volume of total lung cancer surgical procedures and proportion of lung-sparing surgery performed gradually increased significantly from 2008 to 2017, especially from 2014 to 2017 after implementation of a large volume of LDCT lung cancer screening examinations. In conclusion, our real-world data suggest that there will be an increase in cases of operable early-stage lung cancers, which in turn will increase the surgical volume and proportion of lung-sparing surgery, after the gradual implementation of the LDCT lung cancer screening program in recent years. These findings suggest the importance of a successful national policy regarding LDCT screening programs, regulation of shortage of thoracic surgeons, thoracic radiologist workforce training positions, and education programs.

Time trends of perfluoroalkyl substances in blood in 30-year old Norwegian men and women in the period 1986\u20132007

Biomonitoring studies are helpful tools and can increase our knowledge on time trends in human blood concentrations of PFASs: how they relate to emission trends and the potential prenatal exposure for future generations. In this study, serum was sampled in cross-sections of men and women who were 30 years old in each of the years 1986, 1994, 2001, and 2007 in Northern Norway and analyzed for 23 PFASs. Differences in serum concentrations across sampling years were investigated graphically and with significance testing and compared with those observed in our previous longitudinal study using repeated individual measurements in older men in the same years. The results demonstrate overall increasing blood burdens of PFASs in men and women in reproductively active ages during 1986–2001 and decreases until 2007. However, longer chained PFASs were still increasing in 2007 indicating divergent time trends between the different PFASs, underlining the importance of continued biomonitoring. Comparisons between 30-year-old men and older men within the same population demonstrated variation in time trends in the exact same years, underlining that biomonitoring studies must regard historic exposures and birth cohort effects.

Geographical variations of socioeconomic status and prostate cancer mortality in Taiwan

A population-wide study was conducted to determine the association between area-level socioeconomic status and prostate cancer mortality in Taiwan. Age-period-cohort analysis was performed to adjust the time-trend variation. The area-level socioeconomic factors included proportion with a higher education, average income tax, population density, and clinical workload. After adjustment for time-trend variations in age, period, and cohort, prostate cancer mortality was significantly lower in the groups with the highest higher education proportion (rate ratio 0.88; 95% Confidence Intervals 0.83-0.93), average income tax (RR 0.90; 95% CIs 0.86-0.94), and population density (RR 0.88; 95% CI 0.83-0.93). When all variables were incorporated into one model, the rate ratio of prostate cancer mortality was 0.92 (95% CIs 0.88-0.97) in the region with the highest average income tax level compared with that with the lowest level, but differences in the other socioeconomic factors were not significant. This study revealed a significantly lower prostate cancer mortality rate in areas with a high higher education proportion, average income tax level, and population density compared with areas of low socioeconomic status in Taiwan.

Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis

ObjectivesTo summarise treatment success rate (TSR) among adult bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients in sub-Saharan Africa (SSA).DesignWe searched MEDLINE, EMBASE, Google Scholar and Web of Science electronic databases for...

Regional variation in coronary heart disease mortality trends in Portugal, 1981–2012

BackgroundInformation is scarce about the geographic variation in time trends of mortality from coronary heart disease (CHD). We aimed to describe trends in death rates, absolute number of deaths and years of life lost (YLL) due to CHD among men and women in Portugal, by region, from 1981 to 2012. MethodsThe age-standardized mortality rates from CHD were estimated by sex and region. We used joinpoint regression analysis to calculate the annual percent change (APC) in mortality and to identify points of significant change in the trend. The YLL due to premature mortality for CHD were computed using the Global Burden of Disease method. ResultsThe age-adjusted mortality from CHD decreased between 1981 and 2012, both in men and women, but with significantly different APC by region. Smaller declines in rates were observed in Alentejo (men: APC 1993–2012: −2.4%; women: APC 1991–2012: −2.4%). The greatest decline was observed in Madeira between 2003 and 2012, in men (APC: −7.6%) and women (APC: −9.7%). The decline in rates in Algarve started only after 2003, whereas it was consistent from 1981 in the North and started in the 1990s in most other regions. A decrease in the number of deaths was only observed after 2000. The YLL from CHD decreased from 1981 to 2012, mainly after 2000. ConclusionsIn Portugal, between 1981 and 2012, relative declines of CHD mortality indicators were different by geographic region. Consistent decreases in mortality rates were only observed in the Centre, Lisbon and North, the most populated and urbanized regions.

Seasonal and Time-Trend Variation by Gender of Alcohol-Impaired Drivers at Preventive Sobriety Checkpoints.

We aimed to analyze the evolution over time and the seasonality of outcomes of nonrandom alcohol concentration breath tests performed on drivers at sobriety checkpoints in Catalonia (Spain) from 2005 to 2012. Differences by gender are also explored. This study was a time-series analysis of the monthly prevalence of drunk drivers by gender. The sample consisted of all drivers tested at nonrandom sobriety checkpoints in Catalonia (N = 3,985,000). Our outcome variable was the monthly prevalence of drivers with a breath alcohol concentration at or above the legal limit. The driver's gender was also registered. A decreasing trend in alcohol-impaired driving over time was found. The gender gap diminished after 2008 and disappeared in 2012. After adjusting for the trend, the lowest monthly coefficient for men was recorded in January (3.91, p < .001) and the highest in July (4.72, p < .001) and September (4.75, p < .001). The lowest monthly coefficient for women was also recorded in January (3.05, p < .001) but the highest in October (4.12, p < .001). After seasonal aggregation, the lowest coefficient was recorded in winter for both men and women, whereas a peak was found for men in spring and for women in autumn. Seasonal patterns for male and female drivers testing positive at nonrandom sobriety checkpoints indicate that the prevalence of alcohol-impaired driving peaks in spring for males and in autumn for females. We recommend that the authorities enforce campaigns that target male and female drinkers accordingly.

Time Trends in Incidence of Pathological and Etiological Stroke Subtypes during 16 Years: The Erlangen Stroke Project

Background: Population-based data, which continuously monitors time trends in stroke epidemiology are limited. We investigated the incidence of pathological and etiological stroke subtypes over a 16 year time period. Methods: Data were collected within the Erlangen Stroke Project (ESPro), a prospective, population-based stroke register in Germany covering a total study population of 105,164 inhabitants (2010). Etiology of ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results: Between January 1995 and December 2010, 3,243 patients with first-ever stroke were documented. The median age was 75 and 55% were females. The total stroke incidence decreased over the 16 year study period in men (Incidence Rate Ratio 1995-1996 vs. 2009-2010 (IRR) 0.78; 95% CI 0.58-0.90) but not in women. Among stroke subtypes, a decrease in ischemic stroke incidence (IRR 0.73; 95% CI 0.57-0.93) and of large artery atherosclerotic stroke (IRR 0.27; 95% CI 0.12-0.59) was found in men and an increase of stroke due to small artery occlusion in women (IRR 2.33; 95% CI 1.39-3.90). Conclusions: Variations in time trends of pathological and etiological stroke subtypes were found between men and women that might be linked to gender differences in the development of major vascular risk factors in the study population.

State-specific, racial and ethnic heterogeneity in trends of firearm-related fatality rates in the USA from 2000 to 2010

ObjectivesTo document overall, racial, ethnic and intent-specific spatiotemporal trends of firearm-related fatality rates (FRF rates) in the USA.DesignCross-sectional study per year from 2000 to 2010.SettingUSA.ParticipantsAggregate count of all people in...

The impact of hospital and surgeon volume on the 30-day mortality of lung cancer surgery: A nation-based reappraisal

Our objective was to analyze the time trend variation of 30-day mortality after lung cancer surgery, and to quantify the impact of surgeon and hospital volumes over a 5-year period in France. We used Epithor, the French national thoracic database and benchmark tool, which catalogues more than 180,000 procedures of 89 private and public hospitals in France. From January 2005 to December 2010, 19,556 patients who underwent major lung resection (lobectomy, bilobectomy, pneumonectomy) were included in our study. Multilevel logistic models were designed to investigate the relationship between 30-day mortality and surgeon (model 1) or hospital (model 2) volumes. The 3 levels considered were the patient, the surgeon, and the hospital. From 2005 to 2007, the 30-day mortality of patients who underwent major lung resection averaged 10%, and then decreased until it reached 3.8% in 2010 (P < .0001). A significant decrease in 30-day mortality was observed over time (P = .0046). During the study period, the mean annual number of procedures per surgeon was 46.1 (standard deviation [SD] = 23.6) and per hospital was 97.9 (SD = 50.8). Model 1 showed that surgeon volume had a significant impact on 30-day mortality (P = .03), whereas model 2 failed to show that hospital volume influenced 30-day mortality (P = .75). Since 2007, when France's first National Cancer Plan became effective, 30-day mortality of primary lung cancer surgery has decreased and currently measures 3.8%. Low mortality was correlated with higher surgeon volume but was not influenced by hospital volume, which cannot be considered a proxy measure for determining the safety of lung cancer surgery.

Trends in incidence of primary cutaneous malignancies in children, adolescents, and young adults: A population-based study

Skin cancer incidence among young adults is rising; however, the epidemiological characteristics of primary cutaneous lymphomas and cutaneous soft tissue sarcomas (CSTS) in individuals <30 years old has not been investigated. We analyzed the incidence and time-trends of primary cutaneous malignancies in children and adolescents/young adults (AYA). SEER-17 and -13 data were used to assess the descriptive epidemiology and time-trends in incidence of primary cutaneous malignancies in children and AYA. SEERStat and Joinpoint softwares were utilized to estimate annual percent changes (APC) in incidence. In total, 7,814 cases (ASR = 25.66/1,000,000 habitants) of primary skin cancers in <30 years old were diagnosed in 2000-2008. Females had a higher incidence of melanoma (risk ratio (RR) = 1.95; P < 0.001) and a lower risk of developing CSTS (RR = 0.64, P < 0.001). Compared to whites, blacks have a lower incidence of melanoma (RR = 0.03, P < 0.001), and higher risk of CSTS (RR = 2.28, P < 0.001). Melanoma increased in females over a 15-year period (1992-2006) (APC = 2.5, 95%CI = 1.8; 3.2), and the incidence of cutaneous T-cell lymphomas increased over the period 1992-2008 (APC = 9.5, 95% CI = 6.7; 12.4). CSTS incidence decreased among males over the period 1992-1999 (APC = -21.4, 95% CI -27.2; -15.1), particularly due to a decrease in Kaposi sarcoma incidence (AAPC 1992-2008 = -13.6, 95% CI = -22.4;-3.8), although with a notable racial disparity (whites, AAPC = -15.2, 95% CI = -23.2;-6.4; blacks, AAPC = -10.6, 95% CI = -13.2;-7.9). Non-melanoma skin cancer is very rare in children and AYA. We have shown variation in time-trends in incidence as well as in incidence patterns by race, sex, age, and histologic type, highlighting the importance of descriptive epidemiology to better understand the characteristics of these malignancies.

The Evangelismos hospital central nervous system tumor registry: Analysis of 1414 cases (1998-2009)

Background:The Evangelismos Hospital central nervous system (CNS) Tumor Registry represents the current effort of the Departments of Neurosurgery and Pathology to collect data for primary and metastatic CNS tumor patients. In the present study, 12-year hospital data (1998-2009) were reviewed and analyzed.Methods:Patients that underwent surgery for CNS tumors for the first time were identified. Histologically confirmed tumor rates by age and gender were compared. Time trends in annual rates for specific tumor types were investigated. In-hospital mortality rates and length of hospital stay were analyzed by age and gender and their putative variations across the study period investigated.Results:A total of 1414 patients (age 15-89 years) were identified. The most frequently encountered histologies were gliomas and meningiomas, accounting for, respectively, 32.8% and 29.1% of the total sample. A greater proportion of meningiomas was found in women; the proportion of glioblastomas and metastatic tumors, as well as of mixed gliomas, were greater in men. Increased rates of glioblastoma and meningioma with advancing age at diagnosis were also apparent. There were no significant variations in time trends for specific tumor types. In-hospital mortality was significantly higher for older patients (≥70 years). An increase in the length of hospital stay was apparent between the first and middle third of the study period.Conclusions:Analysis of tumor rates in relation to age at diagnosis and gender showed significant bias in accordance with salient literature. Available data indicated no significant variations in time trends for specific tumor types across the study period, while an adverse effect of advanced age on in-hospital mortality was shown. The present findings can guide the formulation of future treatment programs and preventive strategies and provide the basis for further intra- and/or interdepartmental research.

State Disparities in Time Trends of Adolescent Body Mass Index Percentile and Weight-Related Behaviors in the United States

Evidence is conflicting as to whether youth obesity prevalence has reached a plateau in the United States overall. Trends vary by state, and experts recommend exploring whether trends in weight-related behaviors are associated with changes in weight status trends. Thus, our objective was to estimate between-state variation in time trends of adolescent body mass index (BMI) percentile and weight-related behaviors from 2001 to 2007. A time series design combined cross-sectional Youth Risk Behavior Survey data from 272,044 adolescents in 29 states from 2001 to 2007. Self-reported height, weight, sports participation, physical education, television viewing, and daily consumption of 100% fruit juice, milk, and fruits and vegetables were collected. Linear mixed models estimated state variance in time trends of behaviors and BMI percentile. Across states, BMI percentile trends were consistent despite differences in behavioral trends. Boys experienced a modest linear increase in BMI percentile (ß=0.18, 95% CI: 0.07, 0.30); girls experienced a non-linear increase, as the rate of increase declined over time from 1.02 units in 2001-2002 (95% CI: 0.68, 1.36) to 0.23 units in 2006-2007 (95% CI: -0.09, 0.56). States in which BMI percentile decreased experienced a greater decrease in TV viewing than states where BMI percentile increased. Otherwise, states with disparate BMI percentile trends did not differ with respect to behaviors. Future research should explore the role of other behaviors (e.g., soda consumption), measurement units (e.g., portion size), and societal trends (e.g., urban sprawl) on state and national adiposity trends.

Spatio-temporal analysis of mortality among children under the age of five in Manhiça (Mozambique) during the period 1997-2005

BackgroundReducing childhood mortality is the fourth goal of the Millennium Development Goals agreed at the United Nations Millennium Summit in September 2000. However, childhood mortality in developing countries remains high. Providing an accurate picture of space and time-trend variations in child mortality in a region might generate further ideas for health planning actions to achieve such a reduction. The purpose of this study was to examine the spatio-temporal variation for child mortality rates in Manhiça, a district within the Maputo province of southern rural Mozambique during the period 1997-2005 using a proper generalized linear mixed model.ResultsThe results showed that childhood mortality in all the area was modified from year to year describing a convex time-trend but the spatial pattern described by the neighbourhood-specific underlying mortality rates did not change during the entire period from 1997 to 2005, where neighbourhoods with highest risks are situated in the peripheral side of the district. The spatial distribution, though more blurred here, was similar to the spatial distribution of child malaria incidence in the same area. The peak in mortality rates observed in 2001 could have been caused by the precipitation system that started in early February 2000, following which heavy rains flooded parts of Mozambique's southern provinces. However, the mortality rates at the end of the period returned to initial values.ConclusionsThe results of this study suggest that the health intervention programmes established in Manhiça to alleviate the effects of flooding on child mortality should cover a period of around five years and that special attention might be focused on eradicating malaria transmission. These outcomes also suggest the utility of suitably modelling space-time trend variations in a region when a point effect of an environmental factor affects all the study area.

Absence of disparities in anthropometric measures among Chilean indigenous and non-indigenous newborns

BackgroundStudies throughout North America and Europe have documented adverse perinatal outcomes for racial/ethnic minorities. Nonetheless, the contrast in newborn characteristics between indigenous and non-indigenous populations in Latin America has been poorly characterized. This is due to many challenges, including a lack of vital registration information on ethnicity. The objective of this study was to analyze trends in anthropometric measures at birth in Chilean indigenous (Mapuche) and non-indigenous children over a 5-year period.MethodsWe examined weight and length at birth using information available through a national data base of all birth records for the years 2000 through 2004 (n = 1,166.513). Newborns were classified ethnically according to the origins of the parents' last names.ResultThe average birthweight was stable over the 5 year period with variations of less than 20 g in each group, and with mean values trivially higher in indigenous newborns. The proportion weighing less than 2500 g at birth increased modestly from 5.2% to 5.6% in non-indigenous newborns whereas the indigenous births remained constant at 5.2%. In multiple regression analyses, adjusting flexibly for gestational age and maternal characteristics, the occurrence of an indigenous surname added only 14 g to an average infant's birthweight while holding other factors constant. Results for length at birth were similar, and adjusted time trend variation in both outcomes was trivially small after adjustment. Anthropometric indexes at birth in Chile are quite favorable by international standards.ConclusionThere is only a trivial degree of ethnic disparity in these values, in contrast to conditions for ethnic minorities in other countries. Moreover, these values remained roughly constant over the 5 years of observation in this study.

EXPOSURE TO ENVIRONMENTAL RISK FACTORS AND RESPIRATORY DISORDERS IN CHILDREN

Rationale A survey was conducted in 10 areas of Northern-Central Italy in the period 1994/1995, to provide data on the prevalence of respiratory disorders in children, and to identify possible risk factors for these conditions (SIDRIA- Italian Studies on Respiratory Disorders in Children and the Environment). Smoking habits of parents was found to be associated with wheezing in children (1); high frequency of lorry traffic in the street of residence was associated with increased risks for many adverse respiratory outcomes (2). Objective In the year 2002, a second population based survey has been conducted in 13 italian areas, including 3 centers of South Italy, in order to improve national estimates of the prevalence of respiratory disorders and of the exposure to risk factors, as well as to evaluate variations in time trends of the respiratory disorders in children and to identify environmental factors that may relate to these possible variations. Methods The sample include 13380 adolescents (13–14 yrs) and 19394 children (6–7 yrs), living in 13 areas varying in size, latitude, climate and level of urbanisation. Information on several health outcomes (including the complete set of ISAAC modules regarding asthma, rhinitis and eczema) and on many environmental risk factors (including smoking and traffic indicators in the area of residence) have been collected with questionnaires completed by parents and also from adolescents themselves (respiratory disorders and active smoke). Results Preliminary results show that more than 19% of subjects report a high traffic density in the zone of residence; frequency of lorry traffic in the street of residence is reported as very frequent by more than 20% of subjects. Smoking habit among parents and adolescents shows a slight reduction compared to 1995 survey. Analysis of the data are on-going and detailed results of the association between environmental factors and respiratory disorders will be presented at the conference. The study is partially funded by the Italian Ministry of Health.