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Biomedical subjects

D Makuc

Publications and source records attributed to D Makuc.

12 recordsLinked to original sources
PubMed2001

State-level income inequality and individual mortality risk: a prospective, multilevel study.

OBJECTIVES: Previous studies have linked state-level income inequality to mortality rates. However, it has been questioned whether the relationship is independent of individual-level income. The present study tests whether state-level income inequality is related to individual mortality risk, after adjustment for individual-level characteristics. METHODS: In this prospective, multilevel study design, the vital status of National Health Interview Survey (NHIS) respondents was ascertained by linkage to the National Death Index, with additional linkage of state-level data to individuals in the NHIS. The analysis included data for 546,888 persons, with 19,379 deaths over the 8-year follow-up period. The Gini coefficient was used as the measure of income inequality. RESULTS: Individuals living in high-income-inequality states were at increased risk of mortality (relative risk = 1.12; 95% confidence interval = 1.04, 1.19) compared with individuals living in low-income-inequality states. In stratified analyses, significant effects of state income inequality on mortality risk were found, primarily for near-poor Whites. CONCLUSIONS: State-level income inequality appears to exert a contextual effect on mortality risk, after income is adjusted for, providing further evidence that the distribution of income is important for health.

Adolescent↗
PubMed1986

National and state trends in use of prenatal care, 1970-83.

Using birth certificate data, national trends in prenatal care use are examined for White and Black mothers overall, as well as for 10 separate subgroups defined by marital status, maternal age, and educational attainment. The per cent of Black mothers with early prenatal care increased each year during the 1970s but the average annual percentage point increase for 1976-80 (1.2) was smaller than that for 1970-75 (2.3). Furthermore, the per cent of Black mothers with early care declined from 62.6 in 1980 to 61.4 in 1982 and remained at this lower level in 1983. Similar changes in trends were observed for all of the 10 Black subgroups despite substantial variation among the subgroups in the level of early prenatal care use. Analyses of state trends provide further evidence of a change in trend for Black mothers. For White mothers, average annual increases in the per cent with early care were similar for 1970-75 and 1976-80 (0.8 and 0.6 percentage points). In addition, the per cent with early care has remained stable since 1980.

Adolescent↗
PubMed1985

Service areas for ambulatory medical care.

This article evaluates three alternative definitions of physician service areas using data from the 1978 National Health Interview Survey. The three types of areas are county aggregations based on different data sources: the Bureau of Economic Analysis Economic Areas (BEAAs), Ranally Basic Trading Areas (RBTAs), and Health Care Commuting Areas (HCCAs). The three types of areas differ substantially in size, population, urbanization, and the availability of physicians. The overall percentage of physician visits outside each of the three areas was small, ranging from 3 percent for BEAAs to 5 percent for RBTAs and HCCAs. Visits by nonmetropolitan residents were about four times as likely as those by metropolitan residents to occur outside of each area. The results suggest that HCCAs are the most appropriate primary care physician service areas because they are the smallest in size and population and have the greatest variability in physician supply, yet they exhibit an amount of outside-area travel for care similar to that of the two larger types of areas.

Ambulatory Care↗
PubMed1983

Chronological trend in blood lead levels between 1976 and 1980.

Analysis of a chronological trend in data from the second National Health and Nutrition Examination Survey indicated that average blood lead levels in the United States dropped approximately 37 per cent (5.4 micrograms per deciliter) from February 1976 through February 1980. There was no evidence that this trend was due to errors in laboratory measurement or to the design of the survey. The trend was present even after accounting for differences in race, sex, age, region of the country, season, income, and degree of urbanization. Changes in exposure to lead in paint or in the diet are unlikely explanations of the trend. However, the correlation of blood lead levels with the lead level in gasoline was highly significant (P less than 0.001) overall and in population subgroups defined by race, sex, and age. Although strong correlation does not prove cause and effect, the most likely explanation for the fall in blood lead levels is a reduction in the lead content of gasoline during this period.

Adolescent↗
PubMed1983

Travel for ambulatory medical care.

This article describes travel patterns for ambulatory care based on the 1978 National Health Interview Survey. The county where a physician visit occurs has been compared with the county of patient's residence. Nearly 20 per cent of physician visits occur outside the county of residence, with substantial variation according to metropolitan status and proximity to an SMSA. Visits by nonmetropolitan residents are twice as likely to occur in another county as visits by metropolitan residents. The proportion of visits that occur outside the county of residence increases with decreasing population density, both among metropolitan and nonmetropolitan areas. Travel patterns for the usual source of care are similar to those for primary care physician visits. The results are used to estimate adjusted physician-population ratios by allocating physicians to each county type in proportion to their use by residents. These adjusted ratios exhibit substantially less variation than the unadjusted ratios.

Adolescent↗
PubMed1983

Changing practice in the surgical treatment of breast cancer. The national perspective.

This study documents changes in surgical treatment of breast cancer using data from the National Hospital Discharge Survey. All discharge records for women aged 25 years and older who received a mastectomy and had a diagnosis of breast cancer were selected for analysis. The proportion of such women discharged who received a radical mastectomy declined precipitously from 49% in 1972-1974 to 14% in 1978-1980. The proportion of women discharged who received modified radical mastectomies increased concomitantly from 29% in 1972-1974 to 64% in 1979-1980. Further, these changes in surgical practice were observed in all regions of the United States and for both small and large hospitals. The average length of hospital stay for discharged women treated surgically for breast cancer declined from 11.8 to 10.3 days between 1972-1974 and 1978-1980. About one third of this decline can be attributed to the shift toward less extensive operations.

Adult↗
PubMed1981

Use of ambulatory medical care by the poor: another look at equity.

Access to health services by the poor and other disadvantaged groups has improved considerably over the past 15 years. These circumstances have led some to question whether the poor now have equal access to health care. This article presents recent evidence from the 1976-78 National Health Interview Surveys (NHIS) comparing utilization among age, race, and income groups. Without adjustment for health status, the poor have more physician visits than those with higher incomes. After adjusting for age and health status, however, these differences are reversed. Depending on which measure is used, the poor have between 7 per cent and 44 per cent fewer visits than those with income above twice the poverty level. Furthermore, the age- and health-adjusted data show blacks have significantly fewer visits than their white counterparts. In addition, there are large differences among race and income groups in the characteristics of the ambulatory care obtained. Blacks and the poor are much more likely to use hospital clinics and less likely to use private physician offices or telephone consultations. The poor also receive less preventive care. It would appear from the present evidence that still further progress is required to achieve the goal of equity in the distribution of medical care services.

Adolescent↗
PubMed1981

Analysis of interrupted time series mortality trends: an example to evaluate regionalized perinatal care.

Interrupted time series designs are frequently employed to evaluate program impact. Analysis strategies to determine if shifts have occurred are not well known. The case where statistical fluctuations (errors) may be assumed independent is considered, and a segmented regression methodology presented. The method discussed ia applied to the assessment of changes in local and state perinatal postneonatal mortality to identify historical trends and will be used to evaluate the impact of the North Carolina Regionalized Perinatal Care Program when seven years of post-program mortality data become available. The perinatal program region is contrasted with a control region to provide a basis for interpretation of differences noted. Relevant segmented regression models provided good fits to the data and highlighted mortality trends over the last 30 years. Considerable racial differences in these trends were identified, particularly for postneonatal mortality. Segmented regression is considered relevant for the analysis of interrupted time series designs in other applications when errors can be taken to be independent. Thus, the methodology may be regarded as a general statistical tool for evaluation purposes.

Evaluation Studies as Topic↗
PubMed1978

Hand structure and function in an industrial setting.

The influence of patterns of usage on the structure and function of the hands was formally tested. Three groups of female textile workers, each employed in a distinct and defined, atraumatic, repetitive, stereotyped manual task for at least 20 years, were identified in a single rural mill. Replicate data were obtained for the following measures of structure and function: range of motion, a score for the degree of radiographic degenerative changes at each hand joint, malalignment at digital joints determined radiographically, and a quantitative measure of osteophyte formation. Significant and consistent differences in the right hand when compared to the left were detected. Furthermore, highly significant task-related differences were demonstrated. These task-related differences in the structure and function of the hands were consistent with the pattern of usage. Therefore these three patterns of usage influence hand structure and function in the population studied.

Female↗
PubMedDate not supplied

10 years after NHANES I: mortality experience at initial followup, 1982-84.

The NHANES I Epidemiologic Followup Study (NHEFS) was initiated jointly by the National Center for Health Statistics and the National Institute on Aging in collaboration with other National Institutes of Health and Public Health Service agencies. The goal of NHEFS is to examine the relationship of baseline clinical, nutritional, and behavioral factors assessed in the first National Health and Nutrition Examination Survey (NHANES I-1971-75) to subsequent morbidity and mortality. Tracing for the initial followup began in 1981 and ended in 1984. This article compares the mortality experience of the NHEFS cohort with survival probabilities and cause-of-death distributions derived from U.S. vital statistics data. The analysis was done for 28 age-race-sex specific subgroups. The survival of each group of the NHEFS cohort corresponds quite closely to that expected on the basis of the U.S. life table survival probabilities. Mortality differentials by age, race, and sex are also quite similar between NHEFS and U.S. vital statistics. In addition, the cause-of-death distributions among NHEFS participants are quite similar to those expected based on national vital statistics. Thus, there do not seem to be any serious biases in the mortality data. The NHEFS, therefore, provides a unique resource for assessing the effects of baseline sociodemographic, health, and nutritional factors on future mortality in a large, heterogeneous sample that is representative of the nation's population.

Actuarial Analysis↗