Trends in Lung Cancer Incidence Rates,Oklahoma 2005–2010

Purpose

Lung cancer is the second most frequently diagnosed cancer among men and women in the United States. With cigarette smoking causing the majority of cases, patterns in lung cancer are often monitored to understand the impact of anti-tobacco efforts. The purpose of this research was to investigate trends in lung cancer incidence rates for the period 2005–2010 in Oklahoma.

Methods

Data on Oklahoma’s incident cases of lung cancer (2005–2010) were obtained from the Centers for Disease Control and Prevention WONDER system. Annual percent change (APC) was calculated by linear regression to characterize trends in lung cancer incidence rates over time for the overall population, by gender, by age group, and by age group within gender. Rates were considered to increase or decrease if the p-value for trend was <0.05.

Results

From 2005 through 2010, lung cancer incidence rates declined from 81.96 to 68.19 per 100,000 population, with an APC of -3.58% (p-value: 0.0220). When subgroups were examined, declines were observed among all males (APC: -4.25%; p-value: 0.0270), males <65 years (APC: -5.32%; p-value: 0.0008), females <65 years (APC: -4.85%; p-value: 0.0044), and persons aged 55–64 years (APC: -6.38%; p-value: 0.0017).

Conclusions

Declines in lung cancer incidence rates occurred during 2005–2010 among the overall population and within select demographic groups in Oklahoma. Although trends were stable for several demographic groups, rates of lung cancer incidence were lower in 2010 compared to 2005. Continued evidence-based tobacco control efforts are needed to ensure further reductions in lung cancer incidence rates in the state of Oklahoma.     

Trends in childlessness in the United States, 1910–1975

Abstract

This paper examines trends in childlessness for ever‐married women in the United States. Data assembled from assorted census materials permit cohort and period investigations for a number of time periods, from 1910 to 1975, for various color and ethnic groups. Whether examined at the period or cohort level, the incidences in percentage rates of childlessness have varied irregularly over time. We focus particularly on the younger cohorts of white women (those beginning fecundity after 1965); they show higher rates of childlessness at each age than any of the older cohorts at similar ages in the reproductive cycle. We suggest that a major portion of the increasing rates of these younger cohorts may be attributed to increases in voluntary childlessness, which in turn may be linked to broader changes in the fabric of society regarding fertility control, contraceptive technology, female work preferences and patterns, and sexual and family norms.     

Trends in educational attainment by race/ethnicity,nativity, and sex in the United States, 1989–2005

Despite the importance of education for shaping individuals’ life chances, little research has examined trends and differences in educational attainment for detailed demographic subpopulations in the United States. We use labour market segmentation and cohort replacement theories, linear regression methods, and data from the National Health Interview Survey to understand educational attainment by race/ethnicity, nativity, birth cohort, and sex between 1989 and 2005 in the United States. There have been significant changes in educational attainment over time. In support of the cohort replacement theory, we find that across cohorts, females have enjoyed greater gains in education than men, and for some race/ethnic groups, recent cohorts of women average more years of education than comparable men. And in support of labour market segmentation theories, foreign-born Mexican Americans continue to possess relatively low levels of educational attainment. Our results can aid policymakers in identifying vulnerable populations, and form the base from which to better understand changing disparities in education.     

Trends in Cancer Incidence in Maputo,Mozambique, 1991–2008

Background

Very limited information is available regarding the incidence of cancer in sub-Saharan Africa. We analyzed changes in cancer patterns from 1991 to 2008 in Maputo (Mozambique).

Methods

We calculated the rates of incidence of different cancer sites by sex in the 5-year age-group of the population of Maputo city as well as age-standardized rates (ASRs) and average annual percentage changes (AAPC).

Results

Over the 18-year study period a total of 12,674 cases of cancer (56.9% females) were registered with an overall increase in the risk of cancer in both sexes. In males, the most common cancers were those of the prostate, Kaposi sarcoma (KS) and the liver. Prostate cancer showed the most dramatic increase over the whole study period (AAPC +11.3%; 95% CI: 9.7–13.0), with an ASR of 61.7 per 10⁵ in 2003–2008. In females, the most frequent cancers were of the uterine cervix, the breast and KS, with the former increasing along the whole study period (AAPC + 4.7%; 95% CI: 3.4–6) with an ASR of 62.0 per 10⁵ in 2003–2008 as well as breast cancer (AAPC +6.5%; 95%CI: 4.3–8.7).

Conclusions

Overall, the risk of cancer rose in both sexes during the study period, particularly among cancers associated with westernization of lifestyles (prostate, breast), combined with increasingly rising incidences or limited changes in cancers associated with infection and poverty (uterine cervix, liver). Moreover, the burden of AIDS-associated cancers has shown a marked increase.     

Suburbanization and segregation in the United States: 1970–2010

Analysis of trends in the suburbanization of whites, blacks, Asians, and Hispanics reveal that all groups are becoming more suburbanized, though the gap between whites and minorities remains large. Although central cities have made the transition to a majority-minority configuration, suburbs are still overwhelmingly white. Levels of minority-white segregation are nonetheless lower in suburbs than in cities. Blacks remain the most segregated group at both locations. Black segregation and isolation levels are declining in cities and suburbs; however, while Hispanic and Asian segregation levels have remained stable, spatial isolation levels have risen. Multivariate analyses suggest that Hispanics achieve desegregation indirectly by using socio-economic achievements to gain access to less-segregated suburban communities and directly by translating their status attainments into residence in white neighbourhoods. Blacks do not achieve desegregation indirectly through suburbanization and they are much less able than Hispanics to use their socio-economic attainments directly to enter white neighbourhoods.     

Regional Variations in Esophageal Cancer Rates by Census Region in the United States, 1999–2008

Background

Assessment of cancer incidence trends within the U.S. have mostly relied upon Surveillance, Epidemiology, and End Results (SEER) data, with implicit inference that such is representative of the general population. However, many cancer policy decisions are based at a more granular level. To help inform such, analyses of regional cancer incidence data are needed. Leveraging the unique resource of National Program of Cancer Registries (NPCR)-SEER, we assessed whether regional rates and trends of esophageal cancer significantly deviated from national estimates.

Methods

From NPCR-SEER, we extracted cancer case counts and populations for whites aged 45–84 years by calendar year, histology, sex, and census region for the period 1999–2008. We calculated age-standardized incidence rates (ASRs), annual percent changes (APCs), and male-to-female incidence rate ratios (IRRs).

Results

This analysis included 65,823 esophageal adenocarcinomas and 27,094 esophageal squamous cell carcinomas diagnosed during 778 million person-years. We observed significant geographic variability in incidence rates and trends, especially for esophageal adenocarcinomas in males: ASRs were highest in the Northeast (17.7 per 100,000) and Midwest (18.1). Both were significantly higher than the national estimate (16.0). In addition, the Northeast APC was 62% higher than the national estimate (3.19% vs. 1.97%). Lastly, IRRs remained fairly constant across calendar time, despite changes in incidence rates.

Conclusion

Significant regional variations in esophageal cancer incidence trends exist in the U.S. Stable IRRs may indicate the predominant factors affecting incidence rates are similar in men and women.     

Trends in Breast Cancer Stage and Mortality in Michigan (1992–2009) by Race,Socioeconomic Status,and Area Healthcare Resources

The long-term effect of socioeconomic status (SES) and healthcare resources availability (HCA) on breast cancer stage of presentation and mortality rates among patients in Michigan is unclear. Using data from the Michigan Department of Community Health (MDCH) between 1992 and 2009, we calculated annual proportions of late-stage diagnosis and age-adjusted breast cancer mortality rates by race and zip code in Michigan. SES and HCA were defined at the zip-code level. Joinpoint regression was used to compare the Average Annual Percent Change (AAPC) in the median zip-code level percent late stage diagnosis and mortality rate for blacks and whites and for each level of SES and HCA. Between 1992 and 2009, the proportion of late stage diagnosis increased among white women [AAPC = 1.0 (0.4, 1.6)], but was statistically unchanged among black women [AAPC = −0.5 (−1.9, 0.8)]. The breast cancer mortality rate declined among whites [AAPC = −1.3% (−1.8,−0.8)], but remained statistically unchanged among blacks [AAPC = −0.3% (−0.3, 1.0)]. In all SES and HCA area types, disparities in percent late stage between blacks and whites appeared to narrow over time, while the differences in breast cancer mortality rates between blacks and whites appeared to increase over time.     

Influenza Illness and Hospitalizations Averted by Influenza Vaccination in the United States, 2005–2011

Context

The goal of influenza vaccination programs is to reduce influenza-associated disease outcomes. Therefore, estimating the reduced burden of influenza as a result of vaccination over time and by age group would allow for a clear understanding of the value of influenza vaccines in the US, and of areas where improvements could lead to greatest benefits.

Objective

To estimate the direct effect of influenza vaccination in the US in terms of averted number of cases, medically-attended cases, and hospitalizations over six recent influenza seasons.

Design

Using existing surveillance data, we present a method for assessing the impact of influenza vaccination where impact is defined as either the number of averted outcomes or as the prevented disease fraction (the number of cases estimated to have been averted relative to the number of cases that would have occurred in the absence of vaccination).

Results

We estimated that during our 6-year study period, the number of influenza illnesses averted by vaccination ranged from a low of approximately 1.1 million (95% confidence interval (CI) 0.6–1.7 million) during the 2006–2007 season to a high of 5 million (CI 2.9–8.6 million) during the 2010–2011 season while the number of averted hospitalizations ranged from a low of 7,700 (CI 3,700–14,100) in 2009–2010 to a high of 40,400 (CI 20,800–73,000) in 2010–2011. Prevented fractions varied across age groups and over time. The highest prevented fraction in the study period was observed in 2010–2011, reflecting the post-pandemic expansion of vaccination coverage.

Conclusions

Influenza vaccination programs in the US produce a substantial health benefit in terms of averted cases, clinic visits and hospitalizations. Our results underscore the potential for additional disease prevention through increased vaccination coverage, particularly among nonelderly adults, and increased vaccine effectiveness, particularly among the elderly.     

Temporal Trends in Incidence of Myocardial Infarction and Ischemic Stroke by Socioeconomic Position in Sweden 1987–2010

Background

We analyzed temporal trends in the incidence of myocardial infarction and ischemic stroke in Sweden by socioeconomic position and investigated whether social inequalities in incidence of these diseases changed over time.

Materials and Methods

We studied a cohort of almost three million Swedish residents born between 1932 and 1960 followed from 1987 until 2010. Incident cases of myocardial infarction and ischemic stroke were identified in the Swedish National Inpatient Register and Cause of Death Register. Socioeconomic position was retrieved from the Population and Housing Censuses. Incidence rates of myocardial infarction and ischemic stroke and incidence rate ratios comparing levels of socioeconomic position were estimated using flexible parametric survival models adjusted for calendar year, attained age, sex, and birth country.

Results

The overall incidences of myocardial infarction and ischemic stroke decreased over time among men, but were stable over time among women. With regard to ischemic stroke incidence, socioeconomic inequality increased over time in the age group 55 to 59: the incidence rate ratios for low manual compared to high non-manual increased from 1.3 (95% CI: 1.2–1.4) in 1997 to 1.5 (1.4–1.7) in 2010 among men, and from 1.4 (1.3–1.6) in 1997 to 2.1 (1.8–2.5) in 2010 among women. The socioeconomic inequality in incidence of myocardial infarction was stable over time for both men and women.

Conclusion

There was a decrease in myocardial infarction and ischemic stroke incidence over time among men but no significant change for women. Our study highlights existing, and in some cases increasing, social inequalities in the incidence of cardiovascular diseases.     

Short‐term fluctuations in death by cause,temperature, and income in the United States, 1930–1985

Abstract

Disclosures that this decade has had the five hottest years ever recorded globally raise concern that extreme temperatures might be associated with higher mortality. An analysis of fluctuations in annual cause‐specific deaths, seasonal temperatures, and annual income per capita in Massachusetts, Michigan, Washington, Utah, North Carolina, and Mississippi, 1930 to 1985, suggests that, on the contrary, a temperature increase throughout the year was associated with fewer deaths from all causes combined, including deaths from infectious diseases, heart diseases, cerebrovascular diseases, pneumonia, and influenza. An average temperature increase of one degree Fahrenheit was associated with a more than 2 per cent decline in deaths from pneumonia and influenza. The only category of deaths showing no significant association was death from malignant neoplasms. Compared to spring, summer, and fall temperature fluctuations, unusually cold winter temperatures had the strongest fatal effects, but only in North Carolina and Mississippi. The greatest cumulative temperature effects on mortality were found in the same two states. Controlling for annual fluctuations in income per capita did not influence the relationship between temperature and mortality. There was evidence suggesting that the level of wealth ameliorated the fatal effects of extreme temperatures. In conclusion, unusually warm weather was followed by fewer deaths; unusually cold weather, by more deaths.     

The Diarrhea of Travelers—Incidence in Foreign Students in the United States

To ascertain whether foreign visitors to the United States experience the diarrhea of travelers, 215 foreign students matriculating at the University of California, Los Angeles, were interviewed. The attack rate of diarrhea was 14.0 per cent during the first month after arrival in the United States. In a comparison group of 238 U.S. students, the attack rate of diarrhea in one month was 8.4 per cent. The difference in attack rate was not statistically significant.The diarrheal episodes reported by the foreign students were less abrupt in onset, less severe and of longer duration than the usual diarrhea of travelers. The typical severe explosive diarrhea of short duration usually described as “diarrhea of travelers” was not encountered among the foreign students in this study.The occurrence of diarrhea was not associated with the age, sex or race of the students, with the location of eating places, with the geographic area from which the foreign students came or with any characteristics of the trip to the United States. In the group of U.S. students there was an increased incidence of diarrhea among students who came from outside California to Los Angeles.     

Height and standard of living in Puerto Rico from the Spanish enlightenment to annexation by the United States, 1770–1924

This preliminary work presents a first series of heights of male adults in Puerto Rico. The sample, made up of 6000 prisoner records. the estimates were systematically assessed for selectivity, and we find that selectivity is quite negligible for the main results. The text studies the extreme dependence of the standard of living on the evolution of the price of sugar, a dependence which caused the progressive deterioration of material well-being in the country. Only between 1860 and 1880 did Puerto Ricans enjoy some improvement and a higher level of height. We measures the negative short-term effects of the 1898 annexation Puerto Rico by the United States.     

“Culling the Herd”: Eugenics and the Conservation Movement in the United States, 1900–1940

While from a late twentieth- and early twenty-first century perspective, the ideologies of eugenics (controlled reproduction to eliminate the genetically unfit and promote the reproduction of the genetically fit) and environmental conservation and preservation, may seem incompatible, they were promoted simultaneously by a number of figures in the progressive era in the decades between 1900 and 1950. Common to the two movements were the desire to preserve the “best” in both the germ plasm of the human population and natural environments (including not only natural resources, but also undisturbed nature preserves such as state and national parks and forests). In both cases advocates sought to use the latest advances in science to bolster and promote their plans, which in good progressive style, involved governmental planning and social control. This article explores the interaction of eugenic and conservationist ideologies in the careers of Sacramento banker and developer Charles M. Goethe and his friend and mentor, wealthy New York lawyer Madison Grant. In particular, the article suggests how metaphors of nature supported active work in both arenas.     

Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997–2012

BackgroundRespiratory syncytial virus (RSV) causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspecified bronchiolitis (UB) hospitalization rates from 1997‒2012 among US high-risk infants.MethodsThe Kids’ Inpatient Database (KID) infant annual RSV (ICD-9 079.6, 466.11, 480.1) and UB (ICD-9 466.19, 466.1) hospitalization rates were estimated using weighted counts. Denominators were based on birth hospitalizations with conditions associated with high-risk for RSV: chronic perinatal respiratory disease (chronic lung disease [CLD]); congenital airway anomalies (CAA); congenital heart disease (CHD); Down syndrome (DS); and other genetic, metabolic, musculoskeletal, and immunodeficiency conditions. Preterm infants could not be identified. Hospitalizations were characterized by mechanical ventilation, inpatient mortality, length of stay, and total cost (2015$). Poisson and linear regression were used to test statistical significance of trends.ResultsRSV and UB hospitalization rates were substantially elevated for infants with higher-risk CHD, CLD, CAA and DS without CHD compared with all infants. RSV rates declined by 47.0% in CLD and 49.7% in higher-risk CHD infants; no other declines in high-risk groups were observed. UB rates increased in all high-risk groups except for a 22.5% decrease among higher-risk CHD. Among high-risk infants, mechanical ventilation increased through 2012 to 20.4% and 13.5% of RSV and UB hospitalizations; geometric mean cost increased to $31,742 and $25,962, respectively, and RSV mortality declined to 0.9%.ConclusionsAmong high-risk infants between 1997 and 2012, RSV hospitalization rates declined among CLD and higher-risk CHD infants, coincident with widespread RSV immunoprophylaxis use in these populations. UB hospitalization rates increased in all high-risk groups except higher-risk CHD, suggesting improvement in the health status of higher-risk CHD infants, potentially due to enhanced surgical interventions. Mechanical ventilation use and RSV and UB hospitalization costs increased while RSV mortality declined.     

Dietary Sources of Methylated Arsenic Species in Urine of the United States Population,NHANES 2003–2010

Background

Arsenic is an ubiquitous element linked to carcinogenicity, neurotoxicity, as well as adverse respiratory, gastrointestinal, hepatic, and dermal health effects.

Objective

Identify dietary sources of speciated arsenic: monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA).

Methods

Age-stratified, sample-weighted regression of NHANES (National Health and Nutrition Examination Survey) 2003–2010 data (∼8,300 participants ≥6 years old) characterized the association between urinary arsenic species and the additional mass consumed of USDA-standardized food groups (24-hour dietary recall data), controlling for potential confounders.

Results

For all arsenic species, the rank-order of age strata for median urinary molar concentration was children 6–11 years > adults 20–84 years > adolescents 12–19 years, and for all age strata, the rank-order was DMA > MMA. Median urinary molar concentrations of methylated arsenic species ranged from 0.56 to 3.52 µmol/mol creatinine. Statistically significant increases in urinary arsenic species were associated with increased consumption of: fish (DMA); fruits (DMA, MMA); grain products (DMA, MMA); legumes, nuts, seeds (DMA); meat, poultry (DMA); rice (DMA, MMA); rice cakes/crackers (DMA, MMA); and sugars, sweets, beverages (MMA). And, for adults, rice beverage/milk (DMA, MMA). In addition, based on US (United States) median and 90th percentile consumption rates of each food group, exposure from the following food groups was highlighted: fish; fruits; grain products; legumes, nuts, seeds; meat, poultry; and sugars, sweets, beverages.

Conclusions

In a nationally representative sample of the US civilian, noninstitutionalized population, fish (adults), rice (children), and rice cakes/crackers (adolescents) had the largest associations with urinary DMA. For MMA, rice beverage/milk (adults) and rice cakes/crackers (children, adolescents) had the largest associations.     

Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates

BackgroundReductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states.ConclusionsChanges in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment.