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The prevalence of age-related maculopathy by geographic region and ethnicity

PROGRESS IN RETINAL AND EYE RESEARCH 1999年第3期18卷 371-389页

作者： Klein, R Klein, BEK Cruickshanks, KJ Univ Wisconsin Dept Ophthalmol & Visual Sci Madison WI 53705 USA

The prevalence of age-related maculopathy (ARM) varies considerably in different locations and racial/ethnic groups around the world. At present there are insufficient data to determine whether it is likely that these differences in prevalence, especially for the early forms of ARM are due to variations in genetic and environmental factors or due to variations in age of the cohorts and methods used to ascertain and define ARM. In three population-based studies of whites living in Beaver Dam, Wisconsin, Blue Mountains, Australia, and Rotterdam. The Netherlands, in which similar methods of ascertainment and classification were used to detect and define ARM, late ARM was present in 1.2%, 1.4% and 1.2% of the population less than 86 years or age, respectively. While data from clinical studies suggest that late ARM associated with choroidal neovascularization is rare in blacks compared with whites, some epidemiological studies suggest that late ARM may be similar in blacks and whites. There are still too few data from various ethnic racial groups around the world and too few population-based data in older Hispanic and Asian populations to make meaningful comparisons. There is a need for further research into the distribution of ARM and its possible causes using similar methodologies to ascertain and define the disease. Further insights will be gained when genotypes associated with ARM are discovered. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：人口统计学人种群/统计学和数值数据黄斑变性/流行病学黄斑变性/人种学患病率世界卫生人类

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Dental services: Use, expenditures and sources of payment, 1987

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第4期130卷 500-508页

作者： Manski, RJ Moeller, JF Maas, WR Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA

Background This article pro rides per capita estimates of dental care utilization, expenditures mix of services and sources of payment for each of several socioeconomic and demographic categories. Methods. The focus of the analyses presented here is on dental cafe utilization by the U.S, population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. Results. During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. Conclusions. These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. Practice Implications. Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses. practitioners will be better positioned to meet the dental needs of all Americans.

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Attrition in graduate surgical education: An analysis of the 1993 entering cohort of surgical residents

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第6期189卷 602-610页

作者： Kwakwa, F Jonasson, O Amer Coll Surg Chicago IL 60611 USA

Background: Pyramidal surgical residency programs, in which more residents are enrolled than can complete the program, have gradually declined in number in recent years. In 1996, the Residency Review Committee for Surgery established a policy that the number of residents appointed to a program must be consistent with the number who will complete the program. Even so, there is still attrition in the ranks of surgical residents, some of whom hold undesignated preliminary positions and have no guarantee of a position that will lead to completion of the program. This study examined the 1993 entering cohort of surgical residents to determine the rate of attrition as of 1998. Study Design: Data were collected from the AMA's Medical Education Research Information Database, the American College of Surgeons Resident Masterfile, and the Association of American Medical Colleges GME Tracking Census database. The data were examined by specialty, gender, ethnic background, and type of medical school attended. Results: The overall attrition rate from surgical GME was 12%;the rate for international medical graduates was 33%;and the rate for osteopathic residents was 28%. African-American United States and Canadian graduates had attrition rates of 16% for men and 8% for women, and Hispanic United States and Canadian graduates had attrition rates of 14% for men and 15% for women. General surgery residents had an attrition rate of 26%, which included residents in undesignated preliminary positions. Gender was not a risk factor except for the significantly higher attrition rate of African-American men. Most (81%) of the residents who dropped out of surgical GME enrolled in GME in other specialties. Conclusions: The attrition rate from surgical GME is low, and most residents who drop out reenter GME in another specialty. Of concern is the high rate of attrition of African-American men who are United States or Canadian graduates. The highest rate of attrition, by far, is in the group of

关键词：职业选择队列研究人种群/统计学和数值数据实习医师和住院医师职务/人力实习医师和住院医师职务/统计学和数值数据退学/统计学和数值数据外科学/教育外科学/人力美国女(雌)性人类男(雄)性

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Cancer incidences in Europe related to mortalities, and ethnohistoric, genetic, and geographic distances

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PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA 2000年第11期97卷 6067-6072页

作者： Sokal, RR Oden, NL Rosenberg, MS Thomson, BA SUNY Stony Brook Dept Ecol & Evolut Stony Brook NY 11794 USA EMMES Corp Potomac MD 20854 USA

We have previously shown that geographic differences in cancer mortalities in Europe are related to tin order of importance): geographic distances (reflecting environmental differences), ethnohistoric distances (encompassing cultural and genetic attributes), and genetic distances of the populations in the areas studied. In this study, we analyzed the relations of the same three factors to European incidences of 45 male and 47 female cancers. Differences in cancer incidences are correlated moderately, first with geographic distances, and then with genetic distances, but not at all with ethnohistoric distances. Comparing these findings to the earlier ones for cancer mortalities, we note the reversal in the importance of ethnohistory and genetics, and the generally lower correlations of incidence differences with the three putatively causal distance matrices. A path diagram combining both studies demonstrates the lack of cultural carcinogenic effects, but suggests cultural influences on procedures such as the registration of deaths in different political entities. Additionally, the relatively large correlation between ethnohistoric distances and mortality differences is caused by common factors behind the correlation of ethnohistoric and geographic distances. Geographic proximity results in similar ethnohistories. The direct effects of genetic distances are negligible and only their common effects with geographic distances play a role, accounting for the weak to negligible influence of genetics on incidence and mortality differences. Apparently, the genetic systems available to us do not substantially affect cancer incidence or mortality. We present indirect evidence that international differences in the quality of cancer rate data are greater in mortalities than in incidences.

关键词：聚类分析数据收集数据库事实型人种群/统计学和数值数据欧洲/流行病学疾病遗传易感性发病率国际机构肿瘤/流行病学肿瘤/人种学肿瘤/遗传学肿瘤/死亡率肿瘤综合征遗传性/流行病学肿瘤综合征遗传性/遗传学女(雌)性人类男(雄)性

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Report of the task force on residency training information (2000-2001), American Board of Emergency Medicine

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ANNALS OF EMERGENCY MEDICINE 2001年第5期37卷 515-532页

作者： Hoffman, GL Bock, BF Gallagher, EJ Ham, HP Reinhart, MA Amer Board Emergency Med Task Force Residency Training Informat E Lansing MI 48823 USA

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residents and the programs in which they train. We present the fourth annual report on the status of US emergency... 详细信息

关键词：聘任鉴定/统计学和数值数据年龄分布课程教育医学研究生/统计学和数值数据教育医学研究生/发展趋势急救医学/教育人种群/统计学和数值数据助学金和奖学金/组织和管理实习医师和住院医师职务/统计学和数值数据实习医师和住院医师职务/发展趋势许可证医学居住特征/统计学和数值数据时间因素美国成年人女(雌)性人类男(雄)性中年人

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Ethnic minority suicide: a small area geographical study in south London

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PSYCHOLOGICAL MEDICINE 1999年第2期29卷 429-436页

作者： Neeleman, J Wessely, S Univ Groningen Dept Social Psychiat NL-9700 RB Groningen Netherlands Inst Psychiat Dept Psychol Med London England

Background. The relationship between ethnicity and suicide risk is ill-understood. It is unclear whether, and if so, how, the ethnic mix of local areas affects risk in local individuals. Methods. Coroners' records of 329 suicides were used to obtain ethnic (White, Afro-Caribbean, Asian) suicide rates in South London (population 902008) for 1991-3. Geographical variation and associations of ethnic suicide rates with small area (mean population 8274) ethnic densities (proportion of residents of given ethnic groups) and deprivation, were examined with random effects Poisson regression. Results. Adjusted for deprivation, age and gender, suicide rates in wards with larger minority groups were higher among Whites (relative rate (RR) per standard deviation (S.D.) increase in minority density 1.18;95 % CI 1.02-1.37) but lower among minority groups (RR 0.75 (0.59-0.96)) (LR-test for interaction chi(2) = 9.2 (df = 1);P = 0.003). Similar patterns were also apparent for Afro-Caribbeans and Asians separately. With White suicide rates as baseline, ethnic minority status is a risk factor for suicide in wards with small, but a protective factor in neighbourhoods with large minority populations. The RR of minority versus White suicide declines with a factor (relative RR) 0.67 (0.51-0.87) per S.D. increase in local minority density. Conclusions. Minority suicide rates are higher in areas where minority groups are smaller. This effect is ethnic-specific and not due to confounding by gender, age, deprivation or unbalanced migration. Dependent on address, a suicide risk factor for a White individual may protect an ethnic minority individual and vice versa. This has implications for research and prevention.

关键词：年龄分布人种群/心理学人种群/统计学和数值数据伦敦/流行病学少数民族/心理学少数民族/统计学和数值数据人口密度性别分布自杀/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

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Are diagnostic testing and admission rates higher in non-English-speaking versus English-speaking patients in the emergency department?

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ANNALS OF EMERGENCY MEDICINE 2000年第5期36卷 456-461页

作者： Waxman, MA Levitt, MA Alameda Cty Med Ctr Dept Emergency Med Oakland CA 94609 USA Albany Med Coll Albany NY 12208 USA

Study objective: To determine whether non-English-speaking patients who present to an emergency department have more diagnostic tests ordered, higher admission rate, and longer length of stay in the ED than English-speaking patients for 2 common complaints, chest pain and abdominal pain. Methods: This prospective, comparative, observational study was conducted at a public hospital ED. The study group was composed of 324 patients (172 non-English-speaking and 152 English-speaking) presenting with nontraumatic abdominal pain (148) or chest pain(176). The main outcome measures were admission rates, length of stay in the ED, and diagnostic test and procedure ordering. Results: The mean age for the total sample was 45.8+/-15.5 years (range 14 to 87 years);45.4% (147/324) of the patients were male. For the non-English-speaking patients, the language distribution was Spanish (31.0%), other (9.0%), Cantonese (5.9%), Hindi (2.5%), Mien (1.5%), Arabic (1.9%), Russian (0.9%), Mandarin (0.6%), and Korean (0.3%). The admission rate was 37.8% for English-speaking patients versus 42.8% for non-English-speaking patients in the total sample (mean difference in proportions 5%, 95% confidence interval [CI] -6% to 16%;34.2% for English-speaking versus 9.1% for non-English-speaking patients presenting with abdominal pain, mean difference in proportions 5%, 95% CI -11% to 21%) and 40.9% for English-speaking versus 45.8% for non-English-speaking patients presenting with chest pain (mean difference in proportions 5%, 95% CI -10% to 20%). Power was 80% to detect a 15% difference in admission rates at an alpha value of .05. There was no statistically significant difference in ordering of diagnostic tests between the non-English-speaking and English-speaking patients with chest pain. Non-English-speaking patients with abdominal pain had 5 tests ordered more often than English-speaking patients. The mean difference in proportions (with 95% CIs) for these tests were CBC count 18.4% (5.1% to 31.

关键词：腹痛/诊断腹痛/流行病学腹痛/病因学加利福尼亚胸痛/诊断胸痛/流行病学胸痛/病因学决策诊断试验常规/利用急诊室医院/利用人种群/统计学和数值数据语言住院时间/统计学和数值数据病人入院/统计学和数值数据青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Epidemiology of cervical spine injury victims

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ANNALS OF EMERGENCY MEDICINE 2001年第1期38卷 12-16页

作者： Lowery, DW Wald, MM Browne, BJ Tigges, S Hoffman, JR Mower, WR Emory Univ Sch Med Dept Emergency Med Atlanta GA USA Emory Univ Sch Med Dept Radiol Atlanta GA 30322 USA Univ Calif Los Angeles Ctr Emergency Med Sch Med Los Angeles CA 90024 USA Univ Calif Los Angeles Dept Med Sch Med Los Angeles CA 90024 USA

Study objective: We sought to characterize demographics and injury patterns among patients undergoing emergency department cervical spine radiography for blunt traumatic injury. Methods: All patients with blunt trauma undergoing cervical spine radiography at 21 centers were enrolled in this prospective, observational study. Patients' date of birth, age, sex, and ethnicity were noted before cervical spine radiography. Results: Demographic factors associated with cervical spine injury, present in 818 of 33,922 patients, included the following: age of 65 years or older (relative risk [RR] 2.09;95% confidence interval [CI] 1.77 to 2.59);"other" ethnicity (RR 1.79, 95% CI 1.46 to 2.19), male sex (RR 1.72, 95% CI 1.48 to 2.00);and white ethnicity (RR 1.50, 95% CI 1.31 to 1.72). Hispanic ethnicity (RR 0.64, 95% CI 0.51 to 0.79), female sex (RR 0.58, 95% CI 0.50 to 0.67), black ethnicity (RR 0.55, 95% CI 0.45 to 0.66), and age of less than 18 years (RR 0.39, 95% CI 0.27 to 0.55) were associated with reduced risk of cervical spine injury. Conclusion: Among patients undergoing ED cervical spine radiography, cervical spine injury is more common among the elderly, male subjects, and patients of white or "other" ethnicity. Because cervical spine injury occurs in patients in ail demographic categories, however, this information cannot be used to select individual patients who should or should not undergo imaging.

关键词：年龄分布颈椎/损伤急诊处理人种群/统计学和数值数据人群监测患病率前瞻性研究性别分布美国/流行病学创伤非贯通性/流行病学创伤非贯通性/病因学创伤非贯通性/放射摄影术青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Cardiovascular mortality of Chinese in New York City

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JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE 1999年第1期76卷 51-61页

作者： Fang, J Madhavan, S Alderman, MH Yeshiva Univ Albert Einstein Coll Med Dept Epidemiol & Social Med Bronx NY 10461 USA

To determine cardiovascular disease mortality among Chinese migrants in New York City and compare it to both that of residents in China and whites in New York City, mortality records for 1988 through 1992 for New York City and the 1990 US census data for New York City were linked. Age-specific death rates for urban China, reported by the World Health Organization, were used for comparison. The results show that male and female Chinese residents in New York City had lower mortality rates for all causes and total cardiovascular disease than did either New York City whites or Chinese in China. Coronary heart disease deaths among New York City Chinese were intermediate between Chinese in China (lowest) and New York City whites (highest). Stroke death rates for New York City Chinese were substantially lower than those in China and, in general, were similar to those for New York City whites. However, New York City Chinese had higher death rates for hemorrhagic stroke and lower for atherosclerotic stroke than did New York City whites. In conclusion, cardiovascular mortality rates among Chinese migrants in New York City fall below those of both Chinese in China and whites in New York City.

关键词：年龄因素亚洲大陆世系人群心血管疾病/人种学心血管疾病/死亡率脑出血/死亡率脑血管障碍/死亡率中国/人种学冠心病/死亡率人种群/统计学和数值数据欧洲大陆世系人群/统计学和数值数据颅内动脉硬化/死亡率纽约市/流行病学登记性别因素美国/流行病学城市卫生/统计学和数值数据世界卫生组织成年人老年人女(雌)性人类男(雄)性中年人

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OPHTHALMOLOGY 1999年第6期106卷 1056-1065页

作者： Klein, R Klein, BEK Jensen, SC Mares-Perlman, JA Cruickshanks, KJ Palta, M Univ Wisconsin Sch Med Dept Ophthalmol & Visual Sci Madison WI 53705 USA Univ Wisconsin Sch Med Dept Prevent Med Madison WI USA

Objective: To investigate the prevalence of and risk factors for age-related maculopathy (ARM) in three racial/ethnic groups: non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans. Design: A nationally representative population-based, cross-sectional study. Participants: A total of 8270 persons 40 years of age or older, a sample of the Third National Health and Nutrition Examination Survey. Main Outcome Measures: Age-related maculopathy was determined by the grading of fundus photographs using a standardized protocol. Results: The prevalence of any ARM in the civilian noninstitutionalized United States population including those 40 years of age or older was 9.4% (95% confidence interval [CI], 8.2, 10.6) as estimated from the sample. After adjusting for age, there was no difference in the prevalence of early ARM (defined largely by the presence of soft drusen) by ethnic/racial group. However, for the less frequent component lesions of early ARM (increased retinal pigment and retinal pigment epithelial depigmentation), the odds ratios (95% Cls) comparing non-Hispanic blacks to non-Hispanic whites were 0.47 (0.31, 0.74) and 0.59 (0.33, 1.04), respectively, and for comparing Mexican-Americans to non-Hispanic whites, they were 0.41 (0.21, 0.81) and 0.72 (0.44, 1.19), respectively. For late ARM, the odds ratio (95% CI) for non-Hispanic blacks compared to non-Hispanic whites was 0.34 (0.10, 1.18) and for Mexican-Americans compared to non-Hispanic whites, it was 0.25 (0.07, 0.90). Other than age, none of the personal, medical, or physiologic variables studied were statistically significantly associated with any of the ARM endpoints in any of the three races/ethnic groups. Conclusion: Overall, rates of any ARM (including all early and late lesions) ave not significantly different among non-Hispanic blacks, Mexican-Americans, and non-Hispanic whites. However, the rates of individual lesions suggest that non-Hispanic whites and Mexican-Americans may be protected agai

关键词：非洲大陆世系人群横断面研究人种群/统计学和数值数据欧洲大陆世系人群黄斑变性/人种学黄斑变性/病因学墨西哥裔美国人/统计学和数值数据营养调查比值比人群监测患病率危险因素美国/流行病学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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