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PubMed2002

Long-term and recent time trends in the prevalence of obesity among Dutch men and women.

OBJECTIVE: To describe long-term and recent time trends in the prevalence of obesity by age and educational level. DESIGN: :Repeated cross-sectional population based monitoring studies. SETTING: Consultation Bureau Heart Project 1976-1980, Monitoring Project on Cardiovascular Diseases 1987-1991 and Monitoring project on risk factors for chronic diseases (MORGEN-) project 1993-1997. SUBJECTS: A total of 29 141 men and women aged 37-43 y (1976-1997); and 21 926 men and women aged 20-59 y (1993-1997). MEASUREMENTS: Body mass index, ie weight divided by height squared. RESULTS: Between 1976 and 1997 the prevalence of obesity increased from 4.9 to 8.5% among men and from 6.2 to 9.3% among women aged 37-43 y. Between 1993 and 1997, the prevalence of obesity among men aged 20-59 y was 8.5% and increased by 0.54 percentage points per year (P<0.01). The prevalence of obesity among women was 9.6% and increased by 0.35 percentage points per year (P=0.07). The increase in the prevalence of obesity in the period 1993-1997 was strongest in men with a relatively low educational level and in women with a high educational level. CONCLUSIONS: There has been a steady increase in the prevalence of obesity in the last quarter of the 20th century. Also, a recent increase in the prevalence of obesity has been seen. To stop the increase in the prevalence of obesity, effective strategies for the management and prevention of obesity need to be developed.

Adult↗

PubMed2006

Official marital status, cohabiting, and self-rated health-time trends in Finland, 1978-2001.

BACKGROUND: Married persons are healthier and live longer than single, divorced, and widowed persons. Time trends in self-rated health (SRH) by marital status and cohabitation have remained largely unstudied. We aim to assess the levels and trends of SRH by official marital status and cohabitation, and to study the causes of these differences. METHODS: Two nationally representative cross-sectional surveys were conducted 20 years apart in Finland. Data on self-reported marital status, SRH, education, smoking, and long-standing illness were collected from Finns aged 30-64 years in 1978-80 (Mini-Finland Health Survey, N = 6102, response rate 96%) and 2000-01 (Health 2000 Survey, N = 5871, response rate 92%). RESULTS: SRH has improved in the last 20 years, but differences between marital status groups have not reduced. In 2000-01, non-married persons reported worse SRH than married persons. Among men, single [cumulative odds ratio (COR) = 1.55; 95% confidence interval (95% CI) 1.22-1.99] and divorced (COR = 1.55; 95% CI 1.17-2.05) persons showed the poorest SRH, while among women widows (1.53; 95% CI 1.04-2.26) were the most disadvantaged group. The SRH of cohabiting persons did not significantly differ from that of married persons. Differences in educational structure, smoking, and the prevalence of long-term illness explain part of the marital status differences in SRH among men, but less so among women. Among both single men and women as well as among widowed women, SRH had improved slightly less than in the other groups. CONCLUSION: The challenges on public health posed by growing numbers of currently not married people are likely to increase.

Adult↗

PubMed2002

Time trends and seasonal patterns of asthma deaths and hospitalisations among Maori and non-Maori.

AIM: To examine the time trends and seasonal patterns in asthma mortality and hospitalisations in Maori and non-Maori. METHODS: We studied asthma deaths in Maori and non-Maori during 1962-1998 and asthma hospitalisations during 1976-1998 in the 5-34 and 35-74 year age-groups. Average monthly mortality and hospital discharge rates were calculated for 1978-1998 to observe the seasonal patterns. RESULTS: The two asthma mortality epidemics of the 1960s and 1970s affected Maori disproportionately, with the peak rates in 1979 being twice that of non-Maori (7.4 vs 3.7 per 100 000) although the rates are now similar. Hospitalisation rates for Maori were consistently higher than non-Maori with the rates remaining elevated until 1987. The most recent hospitalisation figures show a fall of 61.2% from the 1987 rate. For Maori in the 5-34 year age-group, deaths were highest in spring while hospitalisations peaked in the winter month of May. CONCLUSION: Although asthma mortality and hospitalisation rates for Maori have declined over the period under study, Maori continue to experience more severe asthma and have a higher number of hospital admissions for asthma than non-Maori.

Adolescent↗

PubMed1992

Time trends of non-Hodgkin's lymphoma: are they real? What do they mean?

Factors that need to be considered in the analysis of time trends in disease incidence are age, year of diagnosis, and birth cohort. When these are included in a log-linear model, a nonidentifiability problem arises from the linear dependence among these three time factors so that only specified functions of the parameters can be unambiguously determined. One of these invariant functions is the drift or the sum of the period and cohort trend. Non-Hodgkin's lymphoma incidence rates from Connecticut for the period 1935-1989 were analyzed for males and females. In addition to an age effect, both period and cohort significantly improved the fit of the model. The estimated drift shows that there has been a 10.3% increase in risk every 5 years since 1965 for females and 9.2% for males. It is unlikely that a trend of this magnitude can be attributed entirely to data artifact.

Adult↗

PubMed1989

Time trends in occupational risks of lung cancer among Swedish men from 1961-1979.

Using data from the Swedish Cancer-Environment Register, time trends in the standardized incidence ratio (SIR) for lung cancer 1961-1979 were studied in different occupations. After adjustments for differences in the SIR with respect to year of birth, only the decreasing trends for blacksmiths and members of the armed forces as well as increasing trends for foundry workers and construction machine operators were significant (p less than 0.05). For bakers and pastry cooks, there was a significant interaction between year of birth and observation period in relation to SIR. Data on smoking habits, obtained from a sample of the population, did not seem to explain the trends.

Adult↗

PubMed2006

[Time trends in the prevalence of asthma and allergic diseases over 7 years among adolescents in Guangzhou city].

OBJECTIVE: To assess time trends in the prevalence of asthma, allergic rhinitis and eczema in Guangzhou urban adolescents. METHODS: A cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III protocol was conducted in 2001. Cluster randomized samples of 3516 schoolchildren aged 13 - 14 from 10 secondary schools of four central districts were recruited for the study in Guangzhou city. The results were compared with those obtained in ISAAC Phase I Study (1994 - 1995), which used the identical and validated core questionnaires. Each subject was given an ISAAC Phase III written questionnaire to complete, followed by the video questionnaire about asthma at the same session in school. RESULTS: The prevalence rate of physicians' diagnosis of asthma in Phase III was 4.6%, which was similar to that of 3.9% in Phase I (P > 0.05). But the prevalence rates of wheeze and exercise-induced wheeze in the past 12 months by written questionnaire have increased from 3.4% and 17.4% in Phase I to 4.8% and 23.4% in Phase III respectively (all P < 0.01). By the video questionnaire, the 12-months prevalence rates of wheeze at rest and exercise-induced wheeze were also significantly higher in Phase III (3.8% and 11.3%) compared with those in Phase I (2.0% and 6.9%) (P < 0.01). The 12-months prevalence rates of nasal symptoms without common cold, both related to rhinitis and rhinoconjunctivitis had also increased from 39.5% and 8.7% in Phase I to 45.5% and 11.1% in Phase III, respectively (both P < 0.01). Meanwhile, the prevalence rates of physicians' diagnosis of hayfever and allergic rhinitis in Phase III were 4.1% and 22.7%, which were significantly higher than that of 2.9% and 17.4% in Phase I (both P < 0.05). The 12-months prevalence rate of flexural eczema symptoms had increased from 1.3% in Phase I to 2.2% in Phase III (P < 0.01). However, the prevalence rates of physicians' diagnosis of eczema were similar in both surveys (P > 0.05). The absolute percentage changes in 12-months prevalence rate related to symptoms and physicians' diagnosis for asthma, allergic rhinitis and eczema were more in males than those in females. CONCLUSION: There is a general tendency towards an increase in the prevalence of asthma, allergic rhinitis and eczema over 7 years among adolescents in Guangzhou city, remarkably more so among males than females.

Adolescent↗

PubMed1992

Time trends in high-risk injection practices in a multi-site study in Massachusetts: effects of enrollment site and residence.

Time trends in needle sharing and bleach use were examined among needle users enrolled at drug abuse treatment and nontreatment sites in greater Worcester, MA, from 1987 through 1989. Substantial declines in high-risk behavior were found, with different trends at drug treatment versus nontreatment sites. The percentage of individuals sharing needles declined at treatment facilities but not at nontreatment sites. Among those sharing, the proportion using bleach increased at both drug treatment and nontreatment sites. The bleach distribution program in Worcester appears to be associated with increased bleach use among residents. Bleach use was associated with residence in Worcester, after controlling for age, gender, race, enrollment site, time period, and frequency of sharing. Risk reduction in the subpopulation of needle users entering treatment was greater than that among those not in treatment. As avoidance of sharing is likely to be more effective than bleaching for the prevention of human immunodeficiency virus (HIV) transmission, the subpopulation not in treatment should be targeted for prevention programs.

Adolescent↗

PubMed1996

Sex differences in time trends of colorectal cancer in England and Wales: the possible effect of female hormonal factors.

Differences between the sexes in time trends of colorectal cancer incidence 1962-87 and mortality 1960-91 in England and Wales are examined in relation to changes in female hormonal factors. There was a trend in the sex ratio of this tumour, particularly marked for the descending colon, whereby the female excess in risk at young ages has almost disappeared but the male excess at older ages has increased. This trend started for cohorts born since the 1920s and coincided with the increase in the use of oral contraceptives and, to a lesser extent, with increases in fertility. The decline has been particularly pronounced for women at young ages born since 1935-39, coinciding with the spread of oral contraceptive use to younger age groups. These results are consistent with the hypothesis that female hormonal factors may play a role in the aetiology of colorectal cancer and with the possibility that oral contraceptive use might exert a protective effect in the descending colon.

Adolescent↗

PubMed2006

Time trends in allergic disorders in the UK.

BACKGROUND: Allergic disorders are common in the UK. This study reviews recent UK time trends in the prevalence, morbidity and mortality for allergic disorders, excluding asthma. METHODS: A trend analysis was performed over recent decades of national, representative or repeat surveys, primary care consultations, prescriptions, hospital admissions, and mortality. RESULTS: Serial surveys showed that the prevalence of diagnosed allergic rhinitis and eczema in children have both trebled over the last three decades. While these long term trends were paralleled by the prevalence of disease symptoms, more recent symptom prevalence data suggest a decline. Similarly, GP consultation rates rose by 260% for hay fever and by 150% for eczema overall during the period 1971-91, but rates have stabilised over the past decade. Hospital admissions for eczema have been stable since 1995, and hospital admissions for allergic rhinitis have fallen to about 40% of their 1990 levels. Since 1990, admissions for anaphylaxis have increased by 700%, for food allergy by 500%, for urticaria by 100%, and for angio-oedema by 40%. Prescriptions issued for all types of allergy have increased since 1991. CONCLUSIONS: The prevalence and healthcare usage for eczema and hay fever have increased substantially over recent decades, but may now be stabilising or even falling. In contrast, admissions for some systemic allergic diseases have risen sharply in the last decade which may indicate a rising incidence of these conditions. Although changes in treatment and other healthcare factors may have contributed to these trends, there may also be a change in the aetiology of allergic disease in the UK.

Adolescent↗

PubMed1988

Time trends in peptic ulcer surgery in Sweden. A preliminary report of a nation-wide survey.

In order to establish time trends in surgical rates for peptic ulcer disease, we sent a questionnaire to every surgical department in Sweden. Eighty-two per cent of the departments responded. Since 1956 there was a marked and steady decline in elective procedures (-83%) and to a much lesser extent also in emergency procedures for perforations (-30%). The decline was most pronounced for duodenal ulcer in men. In 1986, the incidence was 1.2 and 0.65 operations per 10,000 inhabitants for elective and emergency operations, respectively. In the future, the few patients needing elective surgery for peptic ulcer may have to be served by a small number of specialized centers.

Cross-Sectional Studies↗

PubMed1979

Time trends in the association of a rural or urban background with physician location.

The association of rural or urban background with choice of practice location was investigated in two time periods, 1950--1955 and 1963--1968, using the alumni of Marquette School of Medicine (now the Medical College of Wisconsin) in Milwaukee, Wisconsin. Background included size of communities of birth, high school, college, and internship. Small communities were screened to distinguish suburban from rural settings. It was found that in the 1950s the percentage of physicians from rural schools who chose to practice in rural areas was 2.2 times as great as this percentage for physicians from nonrural high schools (26 percent versus 12 percent). In the 1960s the ratio increased to 3.5, (35 percent versus 10 percent). This time trend was reversed for physicians more than 28 years old at the time of graduation from medical school. Place of birth and place of internship also were significantly associated with practice location; place of college showed a significant association with practice location only in the 1950s; and class rank was not associated with place of practice.

Age Factors↗

PubMed2003

Time trends and demography of mortality after fractured neck of femur in an English population, 1968-98: database study.

OBJECTIVES: To investigate time trends in mortality after admission to hospital for fractured neck of femur from 1968 to 1998, and to report on the effects of demographic factors on mortality. DESIGN: Analysis of hospital inpatient statistics for fractured neck of femur, incorporating linkage to death certificates. SETTING: Four counties in southern England. SUBJECTS: 32 590 people aged 65 years or over admitted to hospital with fractured neck of femur between 1968 and 1998. MAIN OUTCOME MEASURES: Case fatality rates at 30, 90, and 365 days after admission, and standardised mortality ratios at monthly intervals up to one year after admission. RESULTS: Case fatality rates declined between the 1960s and the early 1980s, but there was no appreciable fall thereafter. They increased sharply with increasing age: for example, fatality rates at 30 days in 1984-98 increased from 4% in men aged 64-69 years to 31% in those aged > or = 90. They were higher in men than women, and in social classes IV and V than in classes I and II. In the first month after fracture, standardised mortality ratios in women were 16 times higher, and those in men 12 times higher, than mortality in the same age group in the general population. CONCLUSIONS: The high mortality rates, and the fact that they have not fallen over the past 20 years, reinforce the need for measures to prevent osteoporosis and falls and their consequences in elderly people. Whether post-fracture mortality has fallen to an irreducible minimum, or whether further decline is possible, is unclear.

Aged↗

PubMed1981

Time trends in lung cancer mortality among nonsmokers and a note on passive smoking.

Lung cancer mortality rates were computed for nonsmokers in the American Cancer Society's prospective study for three 4-year periods from 1960 to 1972 and in the Dorn study of veterans for three 5-year periods from 1954 to 1969. There was no evidence of any trend in these rates by 5-year age groups or for the total groups. No time trend was observed in nonsmokers for cancers of other selected sites except for a decrease in cancer of the uterus. Compared to nonsmoking women married to nonsmoking husbands, nonsmokers married to smoking husbands showed very little, if any, increased risk of lung cancer.

Adult↗

PubMed1987

Time trends of the prevalences of hepatitis B e antigen positives among hepatitis B virus carriers in Japan.

In order to examine time trends of the prevalences of HBeAg positives among HBV carriers in Japan, we analysed data on HBeAg of HBsAg positive voluntary blood donors (23,560 males, and 8659 females) at the Osaka Red Cross Blood Centre between January 1977 and March 1984. Age-specific prevalences of HBeAg positives decreased year by year for both sexes, especially for those in their teens and twenties. The prevalences of HBeAg positives decreased with age, but at any given age it was lower for the later than for the earlier birth cohorts. Although reasons for the secular declines are unknown, the findings suggest that the prevalence of HBeAg positives among HBV carriers will continue to decrease in Japan. This, together with the immunization programme implemented this year, may lead to a future reduction in the risk of HBV related liver diseases in Japan.

Adolescent↗

PubMed1991

Time trends in incidence rates of acute, non-traumatic extremity ischaemia: a population-based study during a 19-year period.

Time trends in the occurrence of acute limb ischaemia were studied from 1965 to 1983 in a defined geographical area in Sweden. Data were obtained from a computerized register which covers all instances of inpatient care for a population of 1.3 million. Analysis based on 5394 first admissions for acute arterial occlusion revealed that the annual number increased by 2.7 per cent yearly in women and 3.9 per cent in men whereas the age-adjusted incidence remained stable for women and increased by 2.6 per cent yearly for men. A study of 1189 patients who underwent surgical procedures showed that the annual number of embolectomy procedures increased 7.6 per cent for females and 8.6 per cent for males. The corresponding age-adjusted incidence rose annually by 3.0 per cent for women and by 7.5 per cent for men. The introduction of the Fogarty catheter and an increasing interest in vascular surgery may have contributed to the increasing rates of operations during the period of study.

Adult↗

PubMed2002

Time trends in lipid lowering drug use in The Netherlands. Has the backlog of candidates for treatment been eliminated?

AIMS: To assess time trends in lipid lowering drug use in The Netherlands. METHODS: Data were obtained from the PHARMO-database, comprising pharmacy records of approximately 300 000 people in The Netherlands. In the period from 1991-98, we estimated prevalence of lipid lowering drug use on the first Wednesday of October. A patient was defined as incident user if (s)he filled a prescription for lipid lowering medication after a 360 days lipid lowering drug free interval. Both prevalence and incidence estimates were weighted for the sex and age distribution of the general Dutch population. RESULTS: From 1991 to 1998, the prevalence of lipid lowering drug use increased from 0.5% (95% confidence interval (CI): 0.5, 0.6) to 2.3% (95% CI: 2.2, 2.4) in women and from 0.6% (95% CI: 0.6, 0.6) to 2.9% (95% CI: 2.8, 3.0) in men. Prevalence increased with increasing age and was highest in the age category 60-69 years (in 1998: 9.9% (95% CI: 9.4, 10.4) in women and 11.6% (95% CI: 11.0, 12.1) in men). In 1992, the estimated incidence of lipid lowering drug use was 251(95% CI: 226, 277)/100,000 person years in women and 251(95% CI: 225, 276)/100,000 person years in men. The largest incidence estimates were observed in 1996 (685(95% CI: 644, 726)/100,000 person years in women and 881(95% CI: 834, 928)/100,000 person years in men). After 1996, incidence stabilized in 1997 and decreased in 1998 to 599(561, 637)/100,000 person years in women and 731(688, 773)/100,000 person years in men. Most of the patients (approximately 95%) were treated with one lipid lowering agent. Statins were used by over 90% of patients from 1996 onwards. In 1998, 35% of the patients started with a statin that was not a first choice drug (mainly atorvastatin). CONCLUSIONS: In the period from 1991-98, prevalence of lipid lowering drug use significantly increased in The Netherlands. However, incidence stabilized and decreased after 1996 which may be explained by the fact that the number of patients eligible for treatment was reached. The question remains whether lipid lowering medication was targeted to the appropriate patients.

Age Factors↗

PubMed2003

Time trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998, and predictors for death.

BACKGROUND: We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors for death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time. METHODS: We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Göteborg, Sweden, from 1980 to 1998 and divided the data into 2 time periods, 1980 to 1991 and 1991 to1998, with an equal number of patients. RESULTS: A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with time. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time; the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio [RR] 1.06, 95% CI 1.05-1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51-2.72), history of smoking (RR 1.77, 95% CI 1.29-2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44-2.02). The prescription of beta-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95% CI 0.46-0.85). CONCLUSION: The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of beta-blockers were independent predictors of outcome.

Adolescent↗

PubMed1998

Time trends in distal colorectal cancer subsite location related to age and how it affects choice of screening modality.

BACKGROUND AND OBJECTIVES: A time trend analysis of colorectal cancer (CRC) incidence in the distal colorectum as a proportion of total CRC is presented for the period 1977-1994 as a function of age, to determine the age at which Americans might best be served by screening fiberoptic sigmoidoscopy. METHODS: CRC incidence rates were obtained for each anatomic subsite from SEER Public Use Files for 1977, 1986, and 1994. The colorectum was divided anatomically for these analyses at the junction of the descending colon and sigmoid colon. Incidence in the distal colorectum was divided by total CRC incidence to determine the proportion of CRC in that age/race/gender/year cohort located in the distal colorectum. RESULTS: The proportion of distal CRC among African Americans was without a clear trend as they grew older in each of the years of observation and in both genders. However, in whites, with increasing age, the proportion of distal disease declined progressively in both genders, with the greatest decline in 1994. Distal CRC became less prevalent than proximal at about age 72 years in white women and at age 82 in white men in 1994. CONCLUSIONS: As the white population becomes older, and for African Americans of all ages, more total colon screening modalities are needed, although at the onset of recommended screening, among 50- to 60-year-olds, fiberoptic sigmoidoscopy would appear efficacious.

Age Factors↗