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Biomedical subjects

M G Kovar

Publications and source records attributed to M G Kovar.

At least 19 recordsLinked to original sources
PubMed1996

Risk indicators for hospitalization during the last year of life.

OBJECTIVE: High levels of hospital expenditures for older people during their last year of life are widely documented. However, evidence of the association between prospectively measured indicators and subsequent hospitalization is sparse. This article investigates the pattern of hospitalization for a sample of Medicare enrollees during their last year of life. DATA SOURCES: Data from the Longitudinal Study of Aging, a national study of persons age 70 and older, are used. Only data on decedents are used. STUDY DESIGN: We determine individual characteristics (including functional status, evidence of disease, living arrangement, and prior hospitalization) shortly before the last year of life. A distinction is made between terminal and nonterminal admissions. National estimates and regression analyses using survey weights are conducted. PRINCIPAL FINDINGS: The likelihood of any use is high regardless of age, functional status, or the presence of major diseases. Although only a few indicators are associated with having a terminal stay, a number of indicators are associated with nonterminal use. Nonterminal stays and total nights hospitalized are positively associated with prior evidence of disease, prior hospitalization, and age, although the probability of nonterminal use decreases with age for persons over 82 years old. The relationship between use and functional status depends on whether persons lived alone, were institutionalized, or had private health insurance. CONCLUSIONS: This study demonstrates that while it is difficult to predict who will be admitted to the hospital at the time of death, a number of characteristics existing before the last year of life are associated with nonterminal hospitalization and total nights hospitalized during the last year of life.

Age Factors↗
PubMed1995

Disability among older people: United States and Canada.

Data from two national surveys of community-dwelling people 55 years of age and over are the basis of tables presenting 25 measures of disability for each country. The report includes discussions of similarity and differences between the countries, methods used to make the data comparable, and limitations on interpretation of the data.

Age Factors↗
PubMed1993

Trends in medical care and survival from stroke.

Using data from two national surveys in the United States, the National Hospital Discharge Survey and the National Health Interview Survey, we examined whether the incidence of stroke (based on hospitalization rates), the prevalence of stroke, and disability due to stroke had changed. Discharge rates remained virtually constant from 1970 through 1990. At the same time, the proportion of patients who were treated with surgery or other diagnostic procedures increased from 15 to 57% and the proportion who were discharged dead decreased from 20 to 8%. The data suggest that the incidence has not decreased. Hospitalization rates for stroke have changed very little over the past 20 years. Further, neither the prevalence nor the burden of stroke appear to have increased.

Adult↗
PubMed1991

Functional ability and the need for care: issues for measurement research.

Measuring the prevalence of functional disability among older people is extremely important. The number of older people is projected to increase in both the developed and the developing countries. The incidence and prevalence of functional disability are high among older people, and they are higher at older ages. Many countries plan to care for their impaired older populations. They need good information to plan for their care. The available data are soft. They are often fragmentary and based on research done 20 or 30 years ago when conditions were different. Data may not take into account the differences among people living in widely varying cultures. Nevertheless, the available data, including data from longitudinal studies, have started to yield useful information. Cross-national studies can only increase the value of the information that many people have devoted enormous resources to obtain. People should devote their time to cross-national comparisons, with the respect for the careful study of survey design, question wording, and tabulation that has been addressed in this paper. Researchers should also devote time to considering whether questions appropriate in one culture are equally appropriate in another. Investigating such issues is one of the purposes of this conference.

Activities of Daily Living↗
PubMed1990

Slowdown in the decline of stroke mortality in the United States, 1978-1986.

The gradual decline in stroke mortality rates observed in the United States since 1900 accelerated markedly around 1973 for whites and around 1968 for blacks. During the next decade stroke mortality rates decreased by almost 50% so that the United States now experiences one of the lowest stroke mortality rates in the world. Beginning in 1979, however the annual rate of decline in stroke mortality began to slow considerably. Comparing the period 1979-1986 with the previous decade, a 57% slowing in the absolute rate of decline (as estimated by the slope of the linear portion of the mortality curve) was observed for white men; the corresponding slowdowns in the rate of decline were 58% for white women, 44% for black men, and 62% for black women. If the decline during the 1980s had continued at the rate observed for the period 1968/73-1978, there would have been 131,000 fewer stroke deaths during the period 1979-1986, 28,000 fewer in 1986 alone. This slowdown in the rate of decline in stroke mortality is occurring while mortality rates for both coronary heart disease and all causes are leveling off. The reasons for this change in the mortality trend remain unknown, and corresponding trends in the treatment and control of hypertension do not provide an entirely satisfactory explanation.

Age Factors↗
PubMed1989

Longitudinal study of physical ability in the oldest-old.

Based on 1984 data from the Longitudinal Study on Aging, one-third of White persons aged 80 or older living in the community (N = 1,791) were defined as having no difficulty in walking 1/4 of a mile, in lifting 10 pounds, in climbing 10 steps without resting, or in stooping, crouching or kneeling. Physical ability was associated with lower risk of death over two years mean follow-up; Relative odds (RO) = .4 (95 percent confidence interval = .4, .6) and in survivors, lower utilization of hospitals RO = .4 (CI = .3, .7), physicians RO = .6 (CI = .5, .8) and nursing homes RO = .3 (CI = .2, .5) compared with those having difficulty on any of the four functional measures included in the definition of physical ability. Fifty percent of the women and 42 percent of the men physically able at the time of the baseline survey in 1984 remained physically able at follow-up. Continued physical ability in this group was associated with never having had cardiovascular disease RO = 2.1, (CI = 1.2, 3.7), never having had arthritic complaints RO = 1.9 (CI = 1.2, 2.7), a body mass index less than the 75th percentile RO = 1.8 (CI = 1.2, 2.9), younger age (for each decade of age, RO = 2.0 (CI = 1.1, 3.6), and higher level of education (greater than 13 years versus 0-6 years) RO = 2.4 (CI = 1.2, 4.7). These correlates include factors amenable to preventive measures and highlight the need to consider the heterogeneity of the oldest-old in formulating programs aimed at prevention and postponement of disability.

Activities of Daily Living↗
PubMed1988

Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States.

Since 1976 there has been a leveling off or slowdown in the rate of decline in coronary heart disease (CHD) mortality. The age-adjusted absolute annual rate of decline in CHD mortality rates during 1968-75 (delta rate/100,000 population/year) was virtually identical for White males (-7.54), Black males (-7.85), and Black females (-7.20), and somewhat lower for White females (-4.25). During 1976-85, however, the secular trends diverged considerably. Age-adjusted rates continued to decline at the same annual rate for White males, while the decline was approximately half as steep for the other three race-sex groups. During 1976-85 there was also a leveling off in the average annual per cent change in age-adjusted CHD mortality for Black males and females and White females when compared to 1968-75, while there was no change for White males. As a result, more than 40,000 White and Black females and Black males died of CHD in 1985 than would have died if CHD rates would have continued to decline at the 1968-75 trends. All comparisons were based on a reclassification of cause-of-death codes to maximize comparability between the 8th and 9th Revisions of the International Classification of Disease. These results suggest that the factors which have led to the continued decline in coronary heart disease may not have influenced all the demographic groups in this country equally over the last decade.

Adult↗
PubMed1987

The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey.

Immediate hypersensitivity skin tests to eight select allergens were performed on a sample (N = 16,204) of the civilian noninstitutional population of the United States, 6 to 74 years of age, in the second National Health and Nutrition Examination Survey (NHANES II). The eight allergens were house dust, cat, dog, Alternaria, mixed giant/short ragweed, oak, perennial ryegrass, and Bermuda grass. Skin test reactivity was defined as a mean erythema diameter greater than or equal to 10.5 mm at the 20-minute reading. Overall, 20.2% of the participants reacted to at least one allergen. Peak reactivity occurred in the 12 to 24-year-old age group. Reactivity was higher in blacks versus whites, but the difference did not reach statistical significance (23.2% versus 19.8%; p greater than 0.05). Male participants had an increased prevalence of reactivity versus female participants in whites (22.0% versus 17.6%), but not in blacks (23.2% versus 23.3%). Skin test reactivity increased in both whites and blacks with increasing income and education. The prevalence of skin test reactivity was higher in urban versus rural areas, but the difference was statistically significant only for whites (whites, 21.6% versus 16.4%; blacks, 23.8% versus 18.4%; p greater than 0.05). With logistic regression, the most important predictors of skin test reactivity in whites were age, sex, urban residence, and poverty status. In blacks, the most important predictors were age, urban residence, and poverty status.

Adolescent↗