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The U.S. decennial census: an agenda for change.

"The results and experiences of the 1990 [U.S.] census demonstrate that the American population has grown too diverse and dynamic to be accurately counted solely by the traditional 'headcount' approach, and that fundamental changes must be implemented for a successful census in 2000. In the past, each census was more accurate than the preceding one, in part because of increased spending. However, the accuracy of the 1990 census fell below that of the 1980 census, as census costs escalated significantly. The $2.6 billion the nation spent on the 1990 census represented a 65 percent increase in constant dollars over the cost of the 1980 census. Additional cost escalation with the 2000 census is probable unless needed reforms are implemented. Although it is too early to identify the precise design needed for a more cost-effective census in 2000, the General Accounting Office believes that a number of opportunities for reform are worthy of aggressive attention."

Americas↗

An estimate of the annual direct cost of treating cutaneous melanoma.

BACKGROUND: Although the survival benefits of early stage melanoma have been clearly documented, the potential economic impact of early versus late stage disease has not been assessed. OBJECTIVE: Our purpose was to estimate the annual direct cost of diagnosing and treating melanoma, based on the number of projected cases of melanoma entering each stage in 1997. METHODS: A model was constructed with assumptions derived from the literature and clinical experience at the Massachusetts General Hospital Melanoma Center and the Boston University Medical Center. Cost estimates were based on 1997 Boston area Medicare reimbursements. RESULTS: The annual direct cost of treating newly diagnosed melanoma in 1997 was estimated to be $563 million. Stage I and II disease each comprised about 5% of the total cost; stage III and stage IV disease consumed 34% and 55% of the total cost, respectively. About 90% of the total annual direct cost of treating melanoma in 1997 was attributable to less than 20% of patients (those patients with advanced disease, that is, stage III and stage IV). CONCLUSION: In addition to the potential survival advantages, aggressive primary prevention through sun protection and intensive screening to enhance earlier detection should reduce the economic burden of melanoma care.

Biopsy↗

Contributions of social context to inequalities in years of life lost to heart disease in Texas, USA.

Several recent articles have pointed to the effect of social context on heart disease mortality after adjusting for individual level indicators. This study investigates the contributions of individual socioeconomic factors (sex, race, and education) and social context at the neighborhood level (wealth, education, social capital, and racial/ethnic composition), and the county level (social inequality, human and social capital, economic and demographic characteristics) on premature cardiovascular mortality. Death certificate information was obtained for all those who died of heart disease in Texas, USA, in 1991. Deaths were geocoded to obtain block-group, census tract, and county social context from the census. Multilevel hierarchical models quantified the contributions of individual characteristics and block-group, tract, and county social context on years of potential life lost to heart disease. Cross-level analyses investigated the interaction between individual and contextual factors. Being female, having more education, and residing in areas with higher median house value were associated with less premature mortality. Although blacks and Hispanics lost more years of life to heart disease than whites, blacks and Hispanics living in tracts with higher own racial/ethnic group density lost fewer years of life than their peers living in less homogenous tracts. At the county level, premature mortality was negatively associated with social capital. The tract and county level variances were statistically significant indicating the importance of social context to premature heart disease mortality. Plausible mechanisms through which these effects operate are explored. Social context at the block-group, tract, and county level played an important role, though a smaller role than individual factors, in explaining years of life lost to heart disease.

Black or African American↗

Costs of schizophrenia and other psychoses in urban Australia: findings from the Low Prevalence (Psychotic) Disorders Study.

OBJECTIVE: To estimate the costs associated with the treatment and care of persons with psychosis in Australia based on data from the Low Prevalence Disorders Study (LPDS), and to identify areas where there is potential for more efficient use of existing health care resources. METHOD: The LPDS was a one-month census-based survey of people with psychotic disorders in contact with mental health services, which was conducted in four metropolitan regions in 1997-1998. Mental health and service utilization data from 980 interviews were used to estimate the economic costs associated with psychotic disorders. A prevalence-based, 'bottom-up' approach was adopted to calculate the government and societal costs associated with psychosis, including treatment and non-treatment related costs. RESULTS: Annual societal costs for the average patient with psychosis are of the order of 46,200 Australian dollars , comprising 27,500 Australian dollars in lost productivity, 13,800 Australian dollars in inpatient mental health care costs and 4900 Australian dollars in other mental health and community services costs. Psychosis costs the Australian government at least 1.45 billion Australian dollars per annum, while societal costs are at least 2.25 billion Australian dollars per annum (including 1.44 billion Australian dollars for schizophrenia). We also report relationships between societal costs and demographic factors, diagnosis, disability and participation in employment. CONCLUSIONS: Current expenditure on psychosis in Australia is probably inefficient. There may be substantial opportunity costs in not delivering effective treatments in sufficient volume to people with psychotic disorders, not intervening early, and not improving access to rehabilitation and supported accommodation.

Adolescent↗

On the wrong side of the tracts? Evaluating the accuracy of geocoding in public health research.

OBJECTIVES: This study sought to determine the accuracy of geocoding for public health databases. METHODS: A test file of 70 addresses, 50 of which involved errors, was generated, and the file was geocoded to the census tract and block group levels by 4 commercial geocoding firms. Also, the "real world" accuracy of the best-performing firm was evaluated. RESULTS: Accuracy rates in regard to geocoding of the test file ranged from 44% (95% confidence interval [CI] = 32%, 56%) to 84% (95% CI = 73%, 92%). The geocoding firm identified as having the best accuracy rate correctly geocoded 96% of the addresses obtained from the public health databases. CONCLUSIONS: Public health studies involving geocoded databases should evaluate and report on methods used to verify accuracy.

Abstracting and Indexing↗

[Population censuses and their costs].

This is a summary of a report from an international project involving France, Hungary, Sweden, and the United Kingdom on the cost of taking censuses. "The author...shows...the most important parts of the summary report, pointing out the main characteristics of the recent censuses of the participating countries, the comparisons of costs converted to the price level of 1991, and the explanatory notes necessary to understand the differences." (SUMMARY IN ENG AND RUS)

Censuses↗