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Cardiovascular mortality of Chinese in New York City

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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Prevalence of self-reported heart failure among US adults: Results from the 1999 National Health Interview Survey

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AMERICAN HEART JOURNAL 2003年第1期146卷 121-128页

作者： Ni, H CDCP Div Hlth Interview Stat Natl Ctr Hlth Stat Hyattsville MD 20782 USA

Objective The objective of the present study was to determine the prevalence of self-reported heart failure among US adults. Methods Data from the 1999 National Health Interview Survey were analyzed. A total of 30,801 sampled adults aged 18 years were given a list of major medical conditions, which included heart failure (HF), and asked if they had ever been told by a doctor or other health professional that they had any of the conditions. Analyses were conducted with the use of SUDAAN software to account for the complex sample design. Results An estimated 2.4 million adults had been told by a doctor or other health professional that they had HF. The prevalence of self-reported HF for age groups 18 to 39, 40 to 64, 65 to 74, and 75 to 105 years were 0.1%, 1.1%, 3.6%, and 5.5%, respectively. HF was most prevalent among ever-smokers, obese persons, and persons aged 65 years. No difference was found in the prevalence of self-reported HF between black and white persons. The most common comorbid conditions for those with HF were hypertension, coronary heart disease, and diabetes. Compared with those without HF, the elderly persons with HF were 8 times as likely to have severe mobility difficulties and 2 to 3 times as likely to have severe depression. Half of the elderly persons with HF had been hospitalized, visited an emergency room, or had > 10 clinic visits in the past year. Black patients were more likely than white patients to have been unable to pay for prescription medicine and to have seen a medical specialist during the past year. Conclusions This nationally representative survey indicates that an estimated 2.4 million adults had been told by a doctor or other health professional that they had heart failure. Black patients with HF were less likely than white patients to have received the needed care.

关键词：非洲裔美国人/统计学和数值数据年龄分布心排血量低/流行病学心排血量低/人种学欧洲大陆世系人群/统计学和数值数据卫生服务易得程度/统计学和数值数据卫生服务需求/统计学和数值数据健康调查患病率性别分布统计数据美国/流行病学成年人老年人老年人 80以上人类中年人

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Prediction of hospital readmission for heart failure: Development of a simple risk score based on administrative data

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1560-1566页

作者： Philbin, EF DiSalvo, TG Henry Ford Hosp Sect Heart Failure & Cardiac Transplantat Div Cardiovasc Med Detroit MI 48202 USA Massachusetts Gen Hosp Cardiac Unit Heart Failure & Transplantat Boston MA 02114 USA Harvard Univ Sch Med Boston MA 02115 USA

OBJECTIVES The purpose of this study waste develop a convenient and inexpensive method for identifying an individual's risk for hospital readmission for congestive heart failure (CHF) using information derived exclusively from administrative data sources and available at the time of an index hospital discharge. BACKGROUND Rates of readmission are high after hospitalization for CHF. The significant determinants of rehospitalization are debated. METHODS Administrative information on all 1995 hospital discharges in New York State which were. assigned International Classification of Diseases-9-Clinical Modification codes indicative of CHF in the principal diagnosis position were obtained. The following were compared among hospital survivors who did and did not experience readmission: demographics, comorbid illness, hospital type and location, processes of care, length of stay and hospital charges. RESULTS A total of 42,731 black or white Patients were identified. The subgroup of 9,112 patients (21.3%) who were readmitted were distinguished by a greater proportion of blacks, a higher prevalence of Medicare and Medicaid insurance, more comorbid illnesses and the use of telemetry monitoring during their index hospitalization. Patients treated at rural hospitals, those discharged to skilled nursing facilities and those having echocardiograms or cardiac catheterization were less likely to be readmitted. Using multiple regression methods, a simple methodology was devised that segregated patients into low, intermediate and high risk for readmission. CONCLUSION Patient characteristics, hospital features, processes of care and clinical outcomes may be used to estimate the risk of hospital readmission for CHF. However, some of the variation in rehospitalization risk remains unexplained and may be the result of discretionary behavior by physicians and patients. (C) 1999 by the American College of Cardiology.

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共病现象欧洲大陆世系人群/统计学和数值数据心力衰竭/流行病学心力衰竭/人种学心力衰竭/康复 Medicaid/统计学和数值数据 Medicare/统计学和数值数据纽约/流行病学结果与过程评价(卫生保健) 病人再入院/统计学和数值数据危险疾病严重程度指数美国老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Prevalence of premature ventricular contractions in a population of African American and white men and women: The Atherosclerosis Risk in Communities (ARIC) Study

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AMERICAN HEART JOURNAL 2002年第3期143卷 535-540页

作者： Simpson, RJ Cascio, WE Schreiner, PJ Crow, RS Rautaharju, PM Heiss, G Univ N Carolina Div Cardiol Dept Med Chapel Hill NC 27599 USA Univ N Carolina Dept Epidemiol Chapel Hill NC 27599 USA EPICARE Ctr Chapel Hill NC USA Univ Minnesota Sch Publ Hlth Div Epidemiol St Paul MN 55108 USA

Background The distribution or the causes of premature ventricular contractions (PVCs) in diverse populations are not fully known. We describe the prevalence of PVCs on a 2-minute electrocardiogram (ECG) in adults to determine whether hypertension has an important association with such PVCs. Methods A cross-sectional analysis of the 15,792 individuals (aged 45-65 years) from the four US communities participating at visit 1 of the Atherosclerosis Risk In Communities (ARIC) study was performed. Multiple logistic regression was used to determine the association of PVCs with potential causal predictors of PVCs. Results Based on a 2-minute ECG, PVCs are present in >6% of middle-aged adults. Increasing age, the presence of heart disease, faster sinus rates, African American ethnicity, male sex, lower educational attainment, and lower serum magnesium or potassium levels are directly related to PVC prevalence. Independently of these factors, hypertension is associated with a 23% increase in the prevalence of PVCs. Conclusions The prevalence of PVCs on a 2-minute ECG differs by age, ethnicity, and sex and is associated with hypertension, heart disease, faster sinus rates, electrolyte abnormalities, and lower educational attainment. Hypertension is likely to be a major cause of PVCs in adults.

关键词：非洲裔美国人/统计学和数值数据队列研究横断面研究教育程度心电描记术欧洲大陆世系人群/统计学和数值数据高血压/并发症似然函数 Logistic模型患病率性别分布室性早搏复合征/流行病学室性早搏复合征/人种学室性早搏复合征/病因学女(雌)性人类男(雄)性中年人

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Motor vehicle crash fatalities: A comparison of Hispanic and non-Hispanic motorists in Colorado

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ANNALS OF EMERGENCY MEDICINE 2000年第6期36卷 589-596页

作者： Harper, JS Marine, WM Garrett, CJ Lezotte, D Lowenstein, SR Univ Colorado Hlth Sci Ctr Div Emergency Med Dept Surg Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Dept Med Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO USA Univ Colorado Hlth Sci Ctr Dept Publ Hlth & Environm Denver CO USA

Study objectives: We compare the population-based death rates from traffic crashes in the Hispanic and non-Hispanic white populations in a single state, and compare fatally injured Hispanic and non-Hispanic drivers with respect to safety belt use, alcohol involvement, speeding, vehicle age, valid licensure, and urban-rural location. Methods: Hispanic and non-Hispanic white motorists killed in traffic crashes in 1991-1995 were studied (n=2,272). Data from death certificates (age, sex, education, race, and ethnicity) and the Fatality Analysis Reporting System (FARS;driver, vehicle, and crash information) were merged. Average annual age-adjusted fatality rates were calculated;to compare Hispanic and non-Hispanic white motorists, rate ratios (RR) and 95% confidence intervals (CIs) were calculated, Odds ratios (ORs), adjusted for age, sex, and rural locale, were calculated to measure the association between Hispanic ethnicity and driver and crash characteristics. Results: Eighty-five percent of EARS records were matched to death certificates. Compared with non-Hispanic white motorists, Hispanics had higher crash-related fatality rates overall (RR 1.75, 95% Cl 1.60 to 1.92) and for drivers only (RR 1.62, 95% CI 1.41 to 1.85). After adjustment for age, sex, and rural locale, Hispanic drivers had higher rates of safety belt nonuse (OR 1.81, 95% CI 1.20 to 2.72), legal alcohol intoxication (OR 2.73, 95% CI 1.97 to 3.79), speeding (OR 1.36, 95% CI 0.99 to 1.88), and invalid licensure (OR 2.58, 95% CI 1.78 to 3.75). The average vehicle age for Hispanic drivers (10.1 years, 95% CI 9.3 to 11.0) was greater than for non-Hispanic white motorists (8.8 years, 95% CI 8.4 to 9.2). Conclusion: Compared with non-Hispanic whites, Hispanic drivers have higher rates of safety belt nonuse, speeding, invalid licensure and alcohol involvement, with correspondingly higher rates of death in traffic crashes. As traffic safety emerges as a public health priority in Hispanic communities, these dat

关键词：事故交通/死亡率年龄分布科罗拉多/流行病学置信区间欧洲大陆世系人群/统计学和数值数据西班牙裔美国人/统计学和数值数据发病率 Logistic模型死亡率/发展趋势比值比登记危险因素性别分布青少年成年人老年人儿童儿童学龄前女(雌)性人类男(雄)性中年人

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Trends in untreated caries in permanent teeth of children 6 to 18 years old

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第11期130卷 1637-1644页

作者： Brown, LJ Wall, TP Lazar, V Amer Dent Assoc Hlth Policy Resources Ctr Chicago IL 60611 USA

Background. This article is the first in a series of three that focus on recent changes in the caries status of children and adolescents in the United States. Methods. This study is based on analyses of data regarding untreated carious permanent teeth among children 6 to 18 years of age from the first and third National Health and Nutrition Examination Surveys, or NHANES I and NHANES III. The NHANES is periodically conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Results. Overall, the number of carious permanent teeth among children 6 to 18 years old decreased from 1.43, as measured in NHANES I, to 0.33, as measured in NHANES III. The number of carious permanent teeth in children 6 to 18 years old also decreased across four demographic variables: age, sex, race and poverty level. Conclusions. The number of untreated carious permanent teeth among children has declined dramatically. Since the 1970s, the absolute difference in untreated caries between disadvantaged children and the rest of the child population has narrowed substantially. Practice Implications, The reduction in untreated caries, the major oral disease among children, has been dramatic in all subgroups of children. This may reinforce the already apparent shift from restorative to preventive dental services.

关键词：非洲裔美国人/统计学和数值数据年龄分布龋失补指数龋齿/流行病学牙列恒欧洲大陆世系人群/统计学和数值数据贫困/统计学和数值数据性别分布美国/流行病学青少年儿童女(雌)性人类男(雄)性

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Cancer surveillance series: Interpreting trends in prostate cancer - Part III: Quantifying the link between population prostate-specific antigen testing and recent declines in prostate cancer mortality

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JOURNAL OF THE NATIONAL CANCER INSTITUTE 1999年第12期91卷 1033-1039页

作者： Etzioni, R Legler, JM Feuer, EJ Merrill, RM Cronin, KA Hankey, BF Fred Hutchinson Canc Res Ctr Seattle WA 98109 USA NCI Div Canc Control & Populat Sci Bethesda MD 20892 USA Brigham Young Univ Dept Hlth Sci Provo UT 84602 USA

Background: The objective of this study was to investigate the circumstances under which dissemination of prostate-specific antigen (PSA) testing, beginning in 1988, could plausibly explain the declines in prostate cancer mortality observed from 1992 through 1994. Methods: We developed a computer simulation model by use of information on population-based PSA testing patterns, cancer detection rates, average lead time (the time by which diagnosis is advanced by screening), and projected decreased risk of death associated with early diagnosis of prostate cancer through PSA testing. The model provides estimates of the number of deaths prevented by PSA testing for the 7-year period from 1988 through 1994 and projects what prostate cancer mortality for these years would have been in the absence of PSA testing, Results: Results were generated by assuming a level of screening efficacy similar to that hypothesized for the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Under this assumption, the projected mortality in the absence of PSA testing continued the increasing trend observed before 1991 only when it was assumed that the mean lead time was 3 years or less. Projected mortality trends in the absence of PSA screening were not consistent with pre-1991 increasing trends for lead times of 5 gears and 7 years, Conclusions: When screening is assumed to be at least as efficacious as hypothesized in the PLCO trial, it is unlikely that the entire decline in prostate cancer mortality can be explained by PSA testing based on current beliefs concerning lead time. Only very short lead times would produce a decline in mortality of the magnitude that has been observed.

关键词：非洲裔美国人/统计学和数值数据计算机模拟欧洲大陆世系人群/统计学和数值数据普查/方法模型统计学死亡率/发展趋势人群监测前列腺特异抗原/血液前列腺肿瘤/诊断前列腺肿瘤/人种学前列腺肿瘤/免疫学前列腺肿瘤/死亡率存活率美国/流行病学老年人老年人 80以上人类男(雄)性

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Racial variation in the use of laparoscopic cholecystectomy in the Department of Veterans Affairs Medical System

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第6期188卷 604-622页

作者： Arozullah, AM Ferreira, MR Bennett, RL Gilman, S Henderson, WG Daley, J Khuri, S Bennett, CL Vet Affairs Med Ctr Cooperat Studies Program Coordinating Ctr 151K Hines IL 60141 USA Brockton W Roxbury Vet Affairs Med Ctr W Roxbury MA USA Northwestern Univ Sch Med Dept Med Chicago IL 60611 USA Univ Chicago Robert Wood Johnson Clin Scholars Program Chicago IL 60637 USA VA Employee Educ Syst Long Beach CA USA Harvard Univ Sch Med Boston MA USA Beth Israel Deaconess Med Ctr Div Gen Med & Primary Care Boston MA USA Brigham & Womens Hosp Boston MA 02115 USA Northwestern Univ Sch Med VA Chicago Hlth Care Syst Lakeside Div Chicago IL USA

Background: While studies have found racial differences in the rates of use of established invasive cardiac and cerebrovascular procedures, no study has evaluated racial variation in the rates of adoption of new surgical procedures. For patients undergoing laparoscopic cholecystectomy, the procedure represents a new and safe option that shortens the duration of postoperative hospitalization by almost one week. In this study, we evaluated whether, in the equal access Veterans Affairs (VA) medical system, the rate of adoption of this procedure and improvements in the duration of postoperative hospitalization differed between African-American and Caucasian patients. Study Design: Data were obtained from two sources-administrative claims fries and prospectively compiled clinical data from medical records and patient interviews. In both data sets, frequency of use, length of stay, and outcomes for African-American and Caucasian patients undergoing minimally invasive and open gallbladder surgery were analyzed for the first four years of use of the procedure in the VA system (1992 to 1995). Results: Analyses based on claims files indicated that, after adjustment for potentially confounding variables, African-American patients who underwent cholecystectomy in VA medical centers were 25% less likely to undergo a minimally invasive cholecystectomy during the first 4 years of use of the new procedure (adjusted odds ratio, 0.74;95% confidence interval, 0.66-0.83). Shortening of the average postoperative length of stay from 9 days or more in the prelaparoscopic era to less than 4.5 days for patients undergoing the laparoscopic procedure occurred in the first year for Caucasian patients, but did not occur until the fourth year for African-American patients (p < 0.001). The overall difference in postoperative length of stay between African-American and Caucasian patients more than doubled from 1.7 days before introduction of laparoscopic cholecystectomy to 3.8 days in the fourth y

关键词：非洲裔美国人/统计学和数值数据胆囊切除术/死亡率胆囊切除术/利用胆囊切除术腹腔镜/死亡率胆囊切除术腹腔镜/利用共病现象欧洲大陆世系人群/统计学和数值数据医院死亡率医院退伍军人/统计学和数值数据住院时间比值比美国美国退伍军人事务部成年人老年人女(雌)性人类男(雄)性中年人

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Racial disparity in long-term mortality rate after hospitalization for myocardial infarction: The Atherosclerosis Risk in Communities study

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AMERICAN HEART JOURNAL 2003年第3期146卷 459-464页

作者： Ding, JZ Roux, AVD Nieto, FJ McNamara, RL Hetmanski, JB Taylor, HA Tyroler, HA Johns Hopkins Univ Bloomberg Sch Publ Hlth Dept Epidemiol Baltimore MD 21205 USA Columbia Univ Coll Phys & Surg Div Gen Med New York NY USA Columbia Univ Dept Epidemiol Mailman Sch Publ Hlth New York NY USA Univ Wisconsin Sch Med Dept Populat Hlth Sci Madison WI USA Chinle Comprehens Healthcare Facil Dept Internal Med Chinle AZ USA Univ Mississippi Med Ctr Dept Med Jackson MS 39216 USA Univ N Carolina Sch Publ Hlth Dept Epidemiol Chapel Hill NC USA

Background The underlying reasons why African American patients have a significantly higher mortality rate than European American patients after a myocardial infarction (MI) remain unclear. This study examined the racial disparity in mortality rates after MI and possible explanatory factors. Methods A prospective analysis was conducted within the Atherosclerosis Risk in Communities (ARIC) study, a community-based study of 15,792 middle-aged adults. From 1987 to 1998, 642 patients (471 European American and 171 African American) hospitalized for MI without prior history of MI were identified. Of these 642 patients, 129 (82 European American and 47 African American) died during follow-up. Results Cox proportional hazard models were used to analyze the racial difference in mortality rate after MI. After adjusting for age and sex, the relative hazard (RH) comparing African American patients to European American patients was 1.80 (95% Cl, 1.24-2.61). The RH decreased after adjusting for vascular risk factors (1.29;95% Cl, 0.83-2.00), socioeconomic position (1.31;95% CI, 0.83-2.09), severity of MI (1.60;95% Cl, 1.05-2.45), and treatment (1.36;95% Cl, 0.92-2.00). In the final model, which included all factors aforementioned, the RH for race was 1.00 (95% Cl, 0.56-1.77). Conclusions Our findings suggested that vascular risk factors, socioeconomic position, and treatment play major roles in the racial disparity in mortality rate after MI.

关键词：非洲裔美国人/统计学和数值数据年龄因素欧洲大陆世系人群/统计学和数值数据住院发病率心肌梗死/流行病学心肌梗死/人种学心肌梗死/死亡率比例危险度模型前瞻性研究危险因素性别因素社会经济因素美国/流行病学女(雌)性人类男(雄)性中年人

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Cancer surveillance series: Interpreting trends in prostate cancer - Part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates

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JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE 1999年第12期91卷 1017-1024页

作者： Hankey, BF Feuer, EJ Clegg, LX Hayes, RB Legler, JM Prorok, PC Ries, LA Merrill, RM Kaplan, RS NCI Div Canc Control & Populat Sci Bethesda MD 20892 USA NCI Div Canc Epidemiol & Genet Bethesda MD 20892 USA NCI Div Canc Prevent Bethesda MD 20892 USA NCI Div Canc Treatment Bethesda MD 20892 USA Brigham Young Univ Dept Hlth Sci Provo UT 84602 USA

Background: The prostate-specific antigen test was approved by the U.S. Food and Drug Administration in 1986 to monitor the disease status in patients with prostate cancer and, in 1994, to aid in prostate cancer detection. However, after 1986, the test was performed on many men who had not been previously diagnosed with prostate cancer, apparently resulting in the diagnosis of a substantial number of early tumors. Our purpose is to provide insight into the effect of screening on prostate cancer rates, Detailed data are presented for whites because the size of the population allows for calculating statistically reliable rates;however, similar overall trends are seen for African-Americans and other races. Methods: Prostate cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and mortality data from the National Center for Health Statistics were analyzed, Results/Conclusions: The following findings are consistent with a screening effect: 1) the recent decrease since 1991 in the incidence of distant stage disease, after not having been perturbed by screening;2) the decline in the incidence of earlier stage disease beginning the following year (i.e,, 1992);3) the recent increases and decreases in prostate cancer incidence and mortality by age that appear to indicate a calendar period effect;and 4) trends in the incidence of distant stage disease by tumor grade and trends in the survival of patients,vith distant stage disease by calendar year that provide suggestive evidence of the tendency of screening to detect slower growing tumors, Implications: The decline in the incidence of distant stage disease holds the promise that testing for prostate-specific antigen may lead to a sustained decline in prostate cancer mortality. However, population data are complex, and it is difficult to confidently attribute relatively small changes in mortality to any one cause.

关键词：非洲裔美国人/统计学和数值数据年龄分布欧洲大陆世系人群/统计学和数值数据发病率普查/方法死亡率/发展趋势肿瘤分期人群监测前列腺特异抗原/血液前列腺肿瘤/流行病学前列腺肿瘤/人种学前列腺肿瘤/免疫学前列腺肿瘤/死亡率前列腺肿瘤/病理学 SEER规划存活率美国/流行病学老年人老年人 80以上人类男(雄)性中年人

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