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Biomedical subjects

L M Koonin

Publications and source records attributed to L M Koonin.

At least 37 records · Page 2Linked to original sources
PubMed1995

Vasectomy in the United States, 1991.

OBJECTIVES: Recent conflicting findings on possible health risks related to vasectomy have underscored the need for reliable and representative estimates of numbers and rates of vasectomies in the United States. The purpose of this study was to estimate the annual US number, rate, and characteristics of vasectomies in 1991. METHODS: A national survey of urology, general surgery, and family practice physician practices was conducted with probability sampling methods (n = 1685 physicians). RESULTS: An estimated 493,487 (95% confidence interval = 450,480, 536,494) vasectomies were performed in 1991, for a rate of 10.3 procedures per 1000 men aged 25 through 49 years. Most vasectomies were performed by urologists, and most were done in physicians' offices with local anesthesia and ligation as the method of occlusion. The rate of vasectomies was highest in the Midwest. CONCLUSIONS: This survey provides the first national estimates of the number and rate of vasectomies in the United States, as well as the first estimates of occlusion method used. Results confirm previous findings that urologists perform most vasectomies and that most vasectomies are performed with local anesthesia. Recommendations include the monitoring of vasectomy numbers and rates as well as demographic studies of men obtaining vasectomies.

Adult↗
PubMed1994

Hysterectomy in the United States, 1988-1990.

OBJECTIVE: To describe patient characteristics and diagnoses associated with hysterectomy in the United States from 1988-1990 using data from the National Hospital Discharge Survey. METHODS: We analyzed data from the National Hospital Discharge Survey, an annual probability sample of discharges from nonfederal, short-stay hospitals in the United States. A population-based sample of all women aged 15 years or older in the United States civilian population who had a hysterectomy during 1988-1990 was examined to characterize factors associated with hysterectomy: patients' age and race, diagnoses, surgical approach, and oophorectomy. RESULTS: Approximately 1.7 million women had a hysterectomy during 1988-1990. The highest rates--100.5 hysterectomies per 10,000 women--were for women aged 30-54 years. Total rates of hysterectomy for black women were similar to those for white women (61.7 and 56.5 per 10,000 women, respectively); uterine leiomyoma ("fibroid tumor") was reported as the primary diagnosis for 61% of black women and 29% of white women. Abdominal surgery was used for 75% of all hysterectomies. Concomitant bilateral oophorectomy was done for 37% of the women under 45 years old and 68% of the women 45 years or older. CONCLUSIONS: Two-thirds of all hysterectomies for noncancerous conditions were performed for uterine leiomyoma or endometriosis--conditions that are most common before the age of menopause. Future assessments of the appropriateness of hysterectomy will require better understanding of these disorders. Continued monitoring of hysterectomy rates is critical to understanding the appropriate use of hysterectomy, alternative therapies for uterine disorders, and future trends in women's health care.

Adolescent↗
PubMed1993

Surveillance for pregnancy and birth rates among teenagers, by state--United States, 1980 and 1990.

PROBLEM/CONDITION: In the United States in 1990, there were an estimated 1 million pregnancies and 521,826 births among women ages 15-19 years. Rates of teenage pregnancy and birth rates by state in 1990 exceeded those in most developed countries. An estimated 95% of teenage pregnancies are unintended (i.e., they occur sooner than desired or are not wanted at any time). REPORTING PERIOD COVERED: This report summarizes and reviews surveillance data for pregnancies, abortions, and births among women ages 15-19, 15-17, and 18-19 years reported by CDC for 1980 and 1990. DESCRIPTION OF SYSTEM: Data for births and abortions were reported to state health departments and other health agencies and sent to CDC. The data from each state included the total number of births and abortions by age and race/ethnicity. RESULTS: Data in this report indicate that pregnancy rates by state among U.S. teenagers ages 15-19 years have changed little since 1980. Moreover, many states have reported increases in birth rates that are probably related to concurrent decreases in abortion rates. Pregnancy rates range from 25 to 75 per 1,000 for 15- to 17-year-olds and from 92 to 165 per 1,000 for 18- to 19-year-olds. INTERPRETATION: States with low rates of teenage pregnancy or birth may have developed and used prevention strategies directed at the needs of both younger and older teenagers; these programs may serve as models for other states where birth rates have remained high or have increased since 1980. ACTIONS TAKEN: CDC will continue to conduct surveillance of and analyze data for pregnancies, abortions, and births among teenagers to monitor progress toward national goals and to assist in targeting program efforts for reducing teenage pregnancy.

Abortion, Legal↗
PubMed1993

Abortion surveillance--United States, 1990.

CONDITION: Since 1980, the number of legal induced abortions reported to CDC has remained fairly stable, varying each year by < or = 5%. REPORTING PERIOD COVERED: This report summarizes and reviews data received by CDC for legal induced abortions obtained in 1990. DESCRIPTION OF SYSTEM: For each year, CDC compiles abortion data received from 52 reporting areas: 50 states, New York City, and the District of Columbia. RESULTS: In 1990, 1,429,577 abortions were reported--a 2.4% increase from 1989. The abortion ratio for 1990 was 345 legal induced abortions per 1,000 live births, and the abortion rate was 24 per 1,000 women ages 15-44 years. Most women undergoing abortions were young, white, and unmarried; most had had no previous live births and were having the procedure for the first time. Approximately half of all abortions were performed before the 8th week of gestation, and 87% were before the 13th week of gestation. Younger women were more likely to obtain abortions later in pregnancy than were older women. INTERPRETATION: Since 1980, the national number (and rate) of abortions has remained relatively stable, with only small (< or = 5%) year-to-year fluctuations. However, since 1984, the national abortion ratio has declined; in 1990, the abortion ratio was the lowest recorded since 1977. Increasing rates of childbearing may account for some of this decline. ACTIONS TAKEN: The number and characteristics of women having abortions are needed from all states to furnish an accurate characterization of legal induced abortion in the United States and to assist efforts to identify and reduce preventable causes of morbidity and mortality associated with abortions.

Abortion, Legal↗
PubMed1993

The epidemiology of placenta previa in the United States, 1979 through 1987.

OBJECTIVE: Placenta previa can cause serious, occasionally fatal complications for fetuses and mothers; however, data on its national incidence and sociodemographic risk factors have not been available. STUDY DESIGN: We analyzed data from the National Hospital Discharge Survey for the years 1979 through 1987 and from the Retrospective Maternal Mortality Study (1979 through 1986). RESULTS: We found that placenta previa complicated 4.8 per 1000 deliveries annually and was fatal in 0.03% of cases. Incidence rates remained stable among white women but increased among black and other minority women (p < 0.1). In addition, the risk of placenta previa was higher for black and other minority women than for white women (rate ratio 1.3, 95% confidence interval 1.0 to 1.7), and it was higher for women > or = 35 years old than for women <20 years old (rate ratio 4.7, 95% confidence interval 3.3 to 7.0). Women with placenta previa were at an increased risk of abruptio placentae (rate ratio 13.8), cesarean delivery (rate ratio 3.9), fetal malpresentation (rate ratio 2.8), and postpartum hemorrhage (rate ratio 1.7). CONCLUSION: Our findings support the need for improved prenatal and intrapartum care to reduce the serious complications and deaths associated with placenta previa.

Adult↗
PubMed1992

Abortion surveillance--United States, 1989.

Since 1980, the number of legal induced abortions reported to CDC has remained stable, varying each year by < 5%. In 1989, 1,396,658 abortions were reported--a 1.9% increase from 1988. The abortion ratio for 1989 was 346 legal induced abortions/1,000 live births, and the abortion rate was 24/1,000 women ages 15-44 years. The abortion ratio was highest for black women and women of other minority racial groups and for women < 15 years of age. Overall, women undergoing abortions tended to be young, white, and unmarried; to have had no previous live births; and to be having the procedure for the first time. Approximately half of all abortions were performed before the eighth week of gestation, and 87% were before the thirteenth week of gestation. Younger women tended to obtain abortions later in pregnancy than older women. This report also includes newly reported abortion-related deaths for 1986 and 1987, as well as an update on abortion-related deaths for the period 1978-1985. Ten deaths in 1986 and six deaths in 1987 were associated with legal induced abortion. The case-fatality rate in 1986 was 0.8 abortion-related deaths/100,000 legal induced abortions and 0.4/100,000 in 1987.

Abortion, Legal↗
PubMed1991

Maternal mortality surveillance, United States, 1979-1986.

To understand further the epidemiology and causes of maternal death, the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, reviewed all identified maternal deaths in the United States, including Puerto Rico, for the period from 1979 through 1986. The maternal mortality ratio for the period was 9.1 deaths/100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups, particularly for women ages greater than or equal to 40 years. Unmarried women had a higher risk of death than married women. Women who had received any prenatal care had a lower risk of dying than women who had received no care (RR = 0.19, 95% confidence limits (CL) 0.15, 0.23). Women who received no prenatal care had a gestational age-adjusted risk of maternal death 5.7 times that of women receiving care defined as "adequate." The risk of maternal death increased with decreasing levels of education for all age groups, particularly among women ages greater than or equal to 35 years. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death following the delivery of a live birth. Future studies aimed at developing strategies to reduce the risk of maternal deaths in the United States should use enhanced surveillance and collect more information about each death, which would allow for better understanding of factors associated with maternal mortality.

Adult↗
PubMed1991

Abortion surveillance, United States, 1988.

Since 1980, the number of legal abortions reported to CDC has remained fairly stable, varying each year by less than 3%. In 1988, 1,371,285 abortions were reported--a 1.3% increase from 1987. The abortion ratio for 1988 was 352 legally induced abortions/1,000 live births, and the abortion rate was 24/1,000 women ages 15-44 years. The abortion ratio was higher for black women and women of other minority races and for women less than 15 years of age. However, the abortion ratio for women less than 15 years was lower in 1988 than in any previous year since 1972. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to live in a metropolitan area, 3) to have had no previous live births, and 4) to be having the procedure for the first time. Approximately half of all abortions were performed before the eighth week of gestation, and greater than 85% were performed during the first trimester of pregnancy (less than 13 weeks of gestation). Black women and women of other minority races tended to obtain abortions later in pregnancy than did white women; however, age was a more dominant influence than race. Younger women tended to obtain abortions later than older women. Educational level strongly influenced when an abortion was performed; better educated women had an abortion earlier in gestation.

Abortion, Legal↗
PubMed1990

Abortion surveillance, 1986-1987.

Since 1980, the number of legal abortions reported to CDC has remained fairly stable, varying each year by less than 3%. In 1986, 1,328,112 abortions were reported; in 1987, that number increased by approximately 2% to 1,353,671. The abortion ratio for 1986 was 354 legally induced abortions per 1,000 live births; the ratio for 1987 was 356 per 1,000. The national abortion rate was 23/1,000 females ages 15-44 years for 1986 and 24/1,000 females ages 15-44 years in 1987. Abortion ratios were higher among women of black and other minority races and among women less than 15 years of age. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to have had no previous live births, and 3) to be having the procedure for the first time. In 1987, approximately half of all abortions were performed before the eighth week of gestation, and greater than 85% were performed during the first trimester of pregnancy (less than 13 weeks of gestation).

Abortion, Legal↗
PubMed1990

Maternal mortality in the United States, 1979-1986.

To understand better the epidemiology and to describe the causes of maternal death, we reviewed all identified maternal deaths in the United States and Puerto Rico for 1979-1986. The overall maternal mortality ratio for the period was 9.1 deaths per 100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death after a live birth. Unmarried women had a higher risk of death than married women. The risk of death increased with increasing live-birth order, except for primiparas. In order to develop strategies to reduce the risk of maternal death in the United States, future studies should include expanded information about each death, which will allow better understanding of factors associated with maternal mortality.

Abortion, Spontaneous↗
PubMed1989

Pregnancy-associated deaths due to AIDS in the United States.

From 1981 to 1988, eighty percent of all women with the acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control were of reproductive age. Six pregnancy-associated deaths due to AIDS in this country have been reported in the medical literature. We identified 20 unpublished cases of women who died of AIDS during or within one year after termination of pregnancy. Analysis showed that these women were mostly black or Hispanic, half were intravenous drug abusers, and most died of Pneumocystis carinii pneumonia. Each pregnancy had an obstetric complication, primarily preterm delivery. The interval between diagnosis of AIDS and the death of these women ranged from one day to 15 months, with a mean interval of 113 days. Multiple reporting sources increased case detection and should be used for future investigations. Prospective case-control studies are needed to determine any further relationship between pregnancy complications and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Abortion surveillance, United States, 1984-1985.

Since 1983, the number of legal abortions reported to CDC increased by 5% to 1,333,521 in 1984; in 1985, that number decreased by less than 1% to 1,328,570. The national abortion rate was the same for both years-24 per 1,000 females ages 15-44 years. The abortion ratio for 1984 was 364 legally induced abortions per 1,000 live births; the ratio for 1985 was 354 per 1,000. Abortion ratios were higher among women of black and other minority races and among women younger than 15 years of age. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to have had no previous live births, and 3) to be having the procedure for the first time. Curettage was the procedure used in 96% of the reported cases. Eleven deaths were associated with legally induced abortions in 1984, and six in 1985. The case-fatality rate in 1985 was 0.5 deaths per 100,000 legally induced abortions, down from the 0.8 per 100,000 reported in 1983 and 1984. Overall, since 1980, the numbers and rates of abortion have had only slight year-to-year fluctuations. The steady increase in the percentage of repeat abortions since 1972 reflects the ongoing availability of legal abortions. Since the beginning of CDC's abortion mortality surveillance, the number of deaths related to legal abortions has decreased 75%, from 24 deaths in 1972 to six deaths in 1985.

Abortion, Legal↗
PubMed1988

Maternal mortality surveillance, United States, 1980-1985.

To better define the incidence, causes, and risk factors associated with maternal deaths, the Division of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, CDC, coordinated a study by the Maternal Mortality Collaborative, a Special Interest Group of the American College of Obstetricians and Gynecologists (ACOG). In 1983, this group established voluntary surveillance of maternal deaths for the years 1980-1985. The Maternal Mortality Collaborative reported 601 maternal deaths from 19 reporting areas for 1980-1985, representing a maternal mortality ratio of 14.1 per 100,000 live births. Overall, 39% more maternal deaths were reported by the Maternal Mortality Collaborative than by the National Center for Health Statistics for these reporting areas. Overall, women over 30 years of age had a higher risk of dying than did younger women. For each age group, women of black and other races who were 30 years and older having the highest risk. The leading causes of maternal deaths were embolism, hypertension in pregnancy, sequelae from ectopic pregnancy, hemorrhage, cerebrovascular accidents, and anesthesia complications. Of the 111 nonmaternal deaths, 90 (82%) were attributed to unintentional or intentional injuries. As a result of the success of this voluntary reporting system, the Division of Reproductive Health initiated National Pregnancy Mortality Surveillance in January 1988.

Adult↗
PubMed1988

Maternal mortality in the United States: report from the Maternal Mortality Collaborative.

To better define the incidence, causes, and risk factors associated with maternal deaths, the Maternal Mortality Collaborative in 1983 initiated national voluntary surveillance of maternal mortality. The Maternal Mortality Collaborative reported 601 maternal deaths from 19 reporting areas for 1980-1985, representing a maternal mortality ratio of 14.1 per 100,000 live births. Overall, 37% more maternal deaths were reported by the Maternal Mortality Collaborative than by the National Center for Health Statistics for these reporting areas. Older women and women of black and other races continued to have higher mortality than younger women and white women. The five most common causes of death for all reported cases were embolism, nonobstetric injuries, hypertensive disease of pregnancy, ectopic pregnancy, and obstetric hemorrhage. Compared with national maternal mortality for 1974-1978, ratios were lower for all causes except for indirect causes, anesthesia, and cerebrovascular accidents. Fatal injuries among pregnant women are not commonly reported to maternal mortality committees. As maternal mortality from direct obstetric causes continues to decline, clinicians will need to emphasize preventing deaths from nonobstetric causes.

Black or African American↗
PubMedDate not supplied

Tubal sterilization in the United States, 1994-1996.

CONTEXT: Although the number and rate of tubal sterilizations, the settings in which they are performed and the characteristics of women obtaining sterilization procedures provide important information on contraceptive practice and trends in the United States, such data have not been collected and tabulated for manyyears. METHODS: Information on tubal sterilizations from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery was analyzed to estimate the number and characteristics of women having a tubal sterilization procedure in the United States during the period 1994-1996 and the resulting rates of tubal sterilization. These results were compared with those of previous studies to examine trends in clinical setting, in the timing of the procedure and in patient characteristics. RESULTS: In 1994-1996, more than two million tubal sterilizations were performed, for an average annual rate of 1 1.5 per 1,000 women; half were performed postpartum and half were interval procedures (i. e., were unrelated by timing to a pregnancy). All postpartum procedures were performed during inpatient hospital stays, while 96% of interval procedures were outpatient procedures. Postpartum sterilization rates were higher than interval sterilization rates among women 20-29 years of age; interval sterilization procedures were more common than postpartum procedures at ages 35-49. Sterilization rates were highest in the South. For postpartum procedures, private insurance was the expectedprimary source of payment for 48% and Medicaid was expected to pay for 41 %; for interval sterilization procedures, private insurance was the expected primary source of payment for 68% and Medicaid for 24%. CONCLUSIONS: Outpatient tubal sterilizations andprocedures using laparoscopy have increased substantially since the last comprehensive analysis of tubal sterilization in 1987, an indication of the effect of technical advances on the provision of this service. Continued surveillance of both inpatient and outpatient procedures is necessary to monitor the role of tubal sterilization in contraceptive practice.

Adult↗