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Assessing heterogeneity and correlation of paired failure times with the bivariate frailty model

STATISTICS IN MEDICINE 1999年第8期18卷 907-918页

作者： Xue, XN Ding, Y NYU Med Ctr Dept Environm Med Div Epidemiol & Biostat New York NY 10010 USA New York State Dept Hlth Wadsworth Ctr Albany NY 12201 USA

We consider bivariate survival times for heterogeneous populations, where heterogeneity induces deviations in an individual's risk of an event as well as associations between survival times. The heterogeneity is characterized by a bivariate frailty model. We measure the heterogeneity effects through deviations associated with hazard functions and an association function defined through the conditional hazard functions: the cross-ratio function proposed by Oakes. We show how the deviation and association measures are determined by the frailty distribution. A Gibbs sampling method is developed for Bayesian inferences on regression coefficients, frailty parameters and the heterogeneity measures. The method is applied to a mental health care data set. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：算法贝叶斯定理计算机模拟数据收集卫生政策住院/统计学和数值数据保险索赔审核/统计学和数值数据住院时间/统计学和数值数据精神障碍/治疗模型生物学蒙特卡罗法危险人类

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Impact of availability of hospital-based invasive cardiac services on racial differences in the use of these services

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AMERICAN HEART JOURNAL 1999年第3期138卷 507-517页

作者： Gregory, PM Rhoads, GG Wilson, AC O'Dowd, KJ Kostis, JB UMDNJ Robert Wood Johnson Med Sch Dept Family Med Hlth Serv Res Program New Brunswick NJ 08903 USA Univ Med & Dent New Jersey Robert Wood Johnson Med Sch Dept Med New Brunswick NJ 08903 USA Rutgers State Univ New Jersey Grad Program Publ Hlth Piscataway NJ USA NJDHSS Trenton NJ USA

Background Reports indicate thai black patients ore less likely than white patients to receive invasive cardiac services after hospitalization for acute myocardial infarction (AMI). There is still uncertainty as to why racial differences exist and how they affect patient outcomes. This is the first study to focus on the availability of invasive cardiac services and racial differences in procedure use. Study objectives were to (1) document whether racial differences existed in the use of invasive cardiac procedures, (2) study whether these racial differences were related to availability of hospital-based invasive cardiac services at First admission for AMI, and (3) determine whether there were racial differences in long-term mortality rates. Methods A historical cohort study was conducted with discharge records from all acute care hospitals in New Jersey For 1993 linked to death certificate records for 1993 and 1994. There were 13,690 black and white New Jersey residents hospitalized with primary diagnosis of AMI. Use of cardiac catheterization within 90 days, revascularization within 90 days (percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass graft surgery [CABG]), and death within 1 year after admission for AMI were the main outcome measures. Patterns for PTCA and CABG as separate outcomes were also studied. Hospital-based cardiac services available were described as no invasive cardiac services, catheterization only, or PTCA/CABG. To account for payer status and comorbidity differences, patients 65 years and older with Medicare coverage were analyzed separately from those younger than 65 years. Results slack patients aged 65 and older were generally less likely to receive catheterization and revascularization than white patients, regardless of facilities available at first admission. For patients younger than 65 years, the greatest differences between black and white patients in catheterization and PTCA/CABG use within 90 days after AM

关键词：非洲裔美国人/统计学和数值数据非洲大陆世系人群血管成形术经腔经皮冠状动脉/利用队列研究冠状动脉分流术/利用欧洲大陆世系人群/统计学和数值数据卫生服务易得程度心脏导管插入术/利用住院/统计学和数值数据心肌梗死/人种学心肌梗死/死亡率心肌梗死/外科学新泽西/流行病学回顾性研究老年人女(雌)性人类男(雄)性中年人

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Reasons for hospitalization due to abortion and pregnancy termination

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JOURNAL OF TROPICAL PEDIATRICS 1999年第1期45卷 31-36页

作者： de Souza, AI Cecatti, JG Ferreira, LOC Santos, LC Womens & Childrens Hosp IMIP Recife PE Brazil UNICAMP Sao Paulo Brazil Univ Fed Pernambuco FESP Recife PE Brazil

The aim of this study was to identify the reasons for hospitalization associated with abortion and pregnancy termination among women attending the Maternity Unit of IMIP, Recife, Brazil. In a case-control study, 230 women who were hospitalized consecutively between August 1994 and June 1995 due to causes related to pregnancy termination or abortion were chosen as cases, Four controls per case were selected randomly out of a total of 920 women who delivered at the same hospital. For each potential cause consider-ed, the odds ratio (OR) and respective 95 per cent confidence interval (CI) were calculated. Multiple logistic regression analysis was then used to control for confounders. Among all potential causes studied, those that showed significant association with pregnancy termination or abortion were: being single, absence of emotional support from partner, being a working woman, literacy up to the fourth year of school, failure of contraceptive method employed, and experience of previous pregnancies, children, and abortions.

关键词：流产人工/副作用流产人工/心理学流产人工/统计学和数值数据巴西病例对照研究住院/统计学和数值数据 Logistic模型比值比危险因素青少年成年人女(雌)性人类中年人妊娠

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Use of telemonitoring to decrease the rate of hospitalization in patients with severe congestive heart failure

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第7期84卷 860-+页

作者： Cordisco, ME Beniaminovitz, A Hammond, K Mancini, D Columbia Presbyterian Med Ctr Div Circulatory Physiol New York NY 10032 USA

We investigated whether the application of a homebased telemonitoring system could decrease hospital admissions and emergency room visits in 30 patients with severe congestive heart failure compared with 51 patients with congestive heart failure who received standard therapy. Emergency room visits (1 vs 11) and hospitalizations (13 vs 36) were decreased in the telemonitored group (both p < 0.05).

关键词：方差分析体重卡方分布住院/统计学和数值数据监测便携式/方法电话女(雌)性人类男(雄)性中年人

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A population-based study on the incidence of severe ocular trauma in Singapore

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第3期128卷 345-351页

作者： Wong, TY Tielsch, JM Natl Univ Singapore Dept Ophthalmol Singapore Natl Eye Ctr Singapore 168751 Singapore Natl Univ Singapore Dept Ophthalmol Singapore Eye Res Inst Singapore 168751 Singapore Johns Hopkins Univ Sch Hyg & Publ Hlth Dept Epidemiol Baltimore MD USA Johns Hopkins Univ Sch Hyg & Publ Hlth Dept Int Hlth Baltimore MD USA Johns Hopkins Univ Sch Med Wilmer Ophthalmol Inst Dana Ctr Prevent Ophthalmol Baltimore MD 21205 USA

PURPOSE: To define the epidemiology of severe ocular trauma in Singapore. METHODS: A population-based incidence study involving all Singapore citizens and residents. Two government-administered databases were used to capture information on severe ocular trauma in Singapore. The national hospital discharge database provided information on incident episodes of hospitalized ocular injury, defined as any ocular injury requiring hospitalization. The national medical savings database provided information on incident episodes of open globe injury, defined as any open globe injury requiring acute ophthalmic surgery. The 1990 Singapore Census was used as denominator data. RESULTS: From 1991 to 1996, the overall annual incidence rate of hospitalized ocular injury was 12.6 per 100,000, and the annual incidence rate of open globe injury was 3.7 per 100,000. Nearly 15% of open globe injury was associated with an intraocular foreign body. Although a 20% decline in the rate of hospitalization over this 6-year period was observed, no distinct time trend in the rate of open globe injury was seen. Men had fourfold higher rates of injury than women. A. bimodal age pattern of ocular injury was observed, with a peak in injury rates in young adults and another in people over 70 years, Racial variation in rates of injury was seen in men but not in women (with Indian men having twice the risks than either Chinese or Malay men). CONCLUSIONS: Severe ocular trauma in Singapore varied with age (highest in young adults and elderly), gender, and race (highest in Indian men), suggesting demographic-specific differences in exposure to high-risk injury settings. (Am J Ophthalmol 1999;128: 345-351, (C) 1999 by Elsevier Science Inc. All rights reserved.)

关键词：年龄分布数据库事实型/统计学和数值数据眼异物/流行病学眼损伤穿透性/流行病学卫生保健调查/统计学和数值数据住院/统计学和数值数据发病率医疗储蓄存款帐户/统计学和数值数据性别分布新加坡/流行病学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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Natural disaster plus wake-up time: A deadly combination of triggers

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AMERICAN HEART JOURNAL 1999年第5期137卷 779-781页

作者： Kloner, RA Leor, J Hosp Good Samaritan Inst Heart Los Angeles CA 90017 USA Univ So Calif Cardiol Sect Los Angeles CA 90089 USA Ben Gurion Univ Negev Soroka Med Ctr Dept Cardiol IL-84105 Beer Sheva Israel

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Outpatient parenteral antimicrobial therapy for central nervous system infections

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CLINICAL INFECTIOUS DISEASES 1999年第6期29卷 1394-1399页

作者： Tice, AD Strait, K Ramey, R Hoaglund, PA Infect Ltd PS Tacoma WA 98402 USA

Patients with central nervous system (CNS) infections are increasingly treated with intravenous antimicrobials outside the hospital, but the safety and problems associated with this therapy have not been well defined. To examine this issue, we reviewed 68 cases in which outpatient intravenous antimicrobial therapy (OPAT) was received through our physician office-based infusion clinic. All infections were cured, and no deaths occurred during therapy. Seizures occurred in 2 patients but without significant injury and apparently were unrelated to antimicrobial therapy Eleven patients (16%) were hospitalized after starting OPAT, 5 for procedures and 6 for medical reasons. The antimicrobial used was changed in 13 cases (19%) because of an adverse effect or clinical failure. OPAT can be safe and effective for patients with CNS infections, but patients must be carefully selected and monitored closely.

关键词：抗菌药/治疗应用抗感染药/治疗应用抗病毒药/治疗应用脑脓肿/药物疗法脑脓肿/微生物学中枢神经系统感染/药物疗法中枢神经系统感染/微生物学中枢神经系统感染/病毒学药物评价/统计学和数值数据脑炎/药物疗法脑炎/病毒学住院/统计学和数值数据输注静脉内脑膜炎/药物疗法脑膜炎/微生物学门诊病人发作/化学诱导青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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Using administrative data to assess health care outcomes

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EUROPEAN HEART JOURNAL 1999年第23期20卷 1689-1691页

作者： Ayanian, JZ Brigham & Womens Hosp Div Gen Med Boston MA 02115 USA Harvard Univ Sch Med Dept Hlth Care Policy Boston MA 02115 USA

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Hospitalization and Alzheimer's disease: Results from a community-based study

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JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES 1999年第5期54卷 M267-M271页

作者： Albert, SM Costa, R Merchant, C Small, S Jenders, RA Stern, Y Columbia Univ Gertrude H Sergievsky Ctr New York NY 10032 USA Columbia Univ Dept Med Informat New York NY 10032 USA

Background. Prior studies offer conflicting findings on whether Alzheimer's disease (AD) is associated with an increased risk of hospitalization. Methods. We investigated AD and hospitalization in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based study of 2,334 elders in New York City. In 1996, an electronic medical records system was established that allows an e-mail alert to be sent to the research team whenever WHICAP subjects are admitted to Columbia-Presbyterian Medical Center (CPMC), the site of hospital care for the majority of subjects. Results. Of the WHICAP cohort, 13.1% was admitted to CPMC in 21 months of follow-up;17.5% of AD patients and 11.9% of unaffected subjects were admitted (p < .01). Multivariate logistic regression models showed that more advanced AD (Clinical Dementia Rating scale 3+) was a significant risk factor for hospitalization independently of age, gender, education, comorbid medical conditions, and death in the follow-up period (OR 2.3;95% CI: 1.1, 4.6);subjects with mild or moderate AD did not show a significantly elevated risk. The prevalence of psychiatric symptoms did not differ between AD subjects who were hospitalized in the reporting period and AD subjects who were not hospitalized. Infectious disease was a more common discharge diagnosis for subjects with AD (p < .05). Conclusions. In this community-based cohort, subjects with severe AD were more likely to be hospitalized than unaffected subjects. The increased use of hospital care by these AD patients appears to be specific to AD but is not a result of psychiatric morbidity or end-of-life care. Rather, a greater risk of medical complications that require hospital care, especially infections, appears to be characteristic of severe AD.

关键词：年龄因素阿尔茨海默病/分类阿尔茨海默病/流行病学死亡原因队列研究传染病/流行病学共病现象计算机通信网络教育程度随访研究医院记录住院/统计学和数值数据 Logistic模型多元分析纽约市/流行病学患病率危险因素性别因素城市卫生/统计学和数值数据老年人老年人 80以上女(雌)性人类男(雄)性

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The health and economic benefits of influenza vaccination for healthy and at-risk persons aged 65 to 74 years

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PHARMACOECONOMICS 1999年第1-Sup期16卷 63-71页

作者： Nichol, KL Goodman, M Vet Adm Med Ctr Minneapolis MN 55417 USA Univ Minnesota Minneapolis MN USA Healthpartners Res Fdn Bloomington MN USA

Objective: The objective of this study was to assess the health and economic benefits of influenza vaccination in both healthy and at-risk seniors aged 65 to 74 years. Design and setting: We used administrative claims data from 6 consecutive serial cohorts spanning the years 1990 to 1991 through 1995 to 1996. All members of a Twin-Cities managed care organisation who were greater than or equal to 65 years of age for the respective study year were included in each cohort. Other information obtained included demographic characteristics, baseline comorbidities, prior resource utilisation, and influenza vaccination status. Study outcomes included hospitalisations for pneumonia and influenza and for all respiratory conditions and death. Economic analyses assumed the societal perspective and included both direct and indirect costs. Main outcome measures and results: During the 6 study seasons, there were 100 195 person-periods of observation for persons aged 65 to 74 years. Of these, two-thirds were healthy and one-third had at least one major baseline comorbidity. Influenza vaccination was associated with reductions in hospitalisations for pneumonia and influenza and for all respiratory conditions in both healthy and at-risk groups, although the results did not reach statistical significance among the healthy individuals. Vaccination was also associated with significant reductions in the risk of death for both groups. The economic analysis demonstrated that vaccination against influenza in the base case was associated with direct and total cost savings for both healthy and at-risk seniors aged 65 to 74 years. Conclusion: Influenza vaccination of healthy and at-risk seniors aged 65 to 74 years is associated with substantial health benefits and is cost saving. These findings support age-based vaccination strategies for all persons greater than or equal to 65 years of age.

关键词：队列研究共病现象直接服务费用欧洲/流行病学住院/统计学和数值数据流感疫苗流感人/经济学流感人/流行病学流感人/预防和控制明尼苏达/流行病学肺炎病毒性/经济学肺炎病毒性/流行病学肺炎病毒性/预防和控制危险因素接种/经济学老年人女(雌)性人类男(雄)性

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