Population density is an indicator in many studies, but often with only a cursory explanation of why. Unfortunately, elected officials and the media draw misleading conclusions about population ...density and public health. After providing three reasons why population density is linked to human health outcomes, using state, county, municipal and neighborhood scale data, we show that population density serves as a surrogate for explaining the geographical distribution of life expectancy and broadband access. However, population density loses its unique contribution when other factors influencing health are included. We urge authors to explain why they include population density in their studies.
Studies of racial/ethnic variations in stroke rarely consider the South Asian population, one of the fastest growing sub-groups in the United States. This study compared risk factors for stroke among ...South Asians with those for whites, African-Americans, and Hispanics.
Data on 3290 stroke patients were analyzed to examine risk differences among the four racial/ethnic groups. Data on 3290 patients admitted to a regional stroke center were analyzed to examine risk differences for ischemic stroke (including subtypes of small and large vessel disease) among South Asians, whites, African Americans and Hispanics.
South Asians were younger and had higher rates of diabetes mellitus, blood pressure, and fasting blood glucose levels than other race/ethnicities. Prevalence of diabetic and antiplatelet medication use, as well as the incidence of small-artery occlusion ischemic stroke was also higher among South Asians. South Asians were almost a decade younger and had comparable socioeconomic levels as whites; however, their stroke risk factors were comparable to that of African Americans and Hispanics.
Observed differences in stroke may be explained by dietary and life style choices of South Asian-Americans, risk factors that are potentially modifiable. Future population and epidemiologic studies should consider growing ethnic minority groups in the examination of the nature, outcome, and medical care profiles of stroke.
Background:
The most common reason for hospitalization in the United States is childbirth. The costs of childbirth are substantial.
Materials and Methods:
This was a retrospective cohort study of ...hospital deliveries identified in the MarketScan
®
Commercial and Medicaid health insurance claim databases. Women with an inpatient birth in the calendar year 2016 were included. Severe maternal morbidity (SMM) was identified using the Centers for Disease Control and Prevention algorithm of 21 International Classification of Diseases-10 codes. Mean costs and cost ratios for women with and without SMM were reported. Generalized linear models were used to analyze demographic and clinical variables influencing delivery costs.
Results:
We identified 1,486 women in the Commercial population, who had a birth in 2016 and met the criteria for SMM. The total mean per-patient costs of care for women with and without SMM were $50,212 and $23,795, respectively. In the Medicaid population there were 29,763 births, of which 342 met the criteria for SMM. The total mean per-patient costs of care for women with and without SMM were $26,513 and $9,652, respectively. A multifetal gestation, a cesarean delivery, maternal age, and pregnancy-related complications were independently predictive of increased delivery costs in both Commercial and Medicaid populations.
Conclusions:
The occurrence of SMM was associated with an increase in maternity-related costs of 111% in the Commercial and 175% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs could be treated or avoided.
This study compared public health and environmental justice indicators between the 50 U.S. state capitol cities and their host states, to similarly-sized cities in the same state, and 1-mile circular ...zones around the capitol complexes. Overall, capitol cities mirrored other cities of similar population sizes but were marked by more public health and environmental justice challenges, especially in the areas close to capitol domes where access to space is contested. These findings might be ameliorated if capitol cities provide more affordable housing, better food environments, stronger public schools, and other assets for their residents.
•This study measures the extent to which U.S. state capitol cities, especially in the spaces near their capitol complexes, demonstrate public health and environmental justice issues.•All data used in this study can be obtained without charge from publicly-available databases.•The software used to identify areas for comparison in this study is freely available from the U.S. Environmental Protection Agency (EPA) EJScreen tool.•The majority of U.S. state capitol cities presented more evidence of public health and environmental justice issues than their host states.•The areas immediately surrounding capitol complexes had larger proportions of low-income and unemployed residents, as well as higher environmental exposures than their host cities.
Purpose Since many children with lower urinary tract symptoms are treated based on history and physical, it is important to know which symptom survey correlates best with the physician clinical ...impression. We evaluated 3 tools that have been demonstrated to predict severity of lower urinary tract symptoms, the Dysfunctional Voiding Symptom Score, the Akbal survey and the Nelson survey. Total scores from each survey were compared to clinical impression. Materials and Methods Participants consisted of 36 males and 35 females referred to our pediatric urology center for lower urinary tract symptoms. A total of 37 children 4 to 10 years old completed the Dysfunctional Voiding Symptom Score with the help of their parents, and 34 of these parents completed the Akbal survey. A total of 35 children 11 to 17 years old completed the Nelson survey. Scores from the 3 instruments were compared to the clinical impression of a pediatric urologist using rank correlation (Kendall's tau-b test). Results Mean total symptom scores were increased relative to physician rating for all 3 surveys. Symptoms reported by younger children using the Dysfunctional Voiding Symptom Score correlated better with physician rating of symptom severity (tau-b 0.43) compared to symptoms reported by parents using the Akbal survey (tau-b 0.41). Older children reporting symptoms using the Nelson survey had the strongest correlation with physician clinical impression (tau-b 0.48). Conclusions All 3 surveys were statistically significantly correlated with the physician impression of severity for lower urinary tract symptoms, with the Nelson survey being the most accurate.
Public Health Schneider, Dona; Lilienfeld, David; Lilienfeld, David E
08/2011
eBook
Published in 2008, the first volume of Public Health focused on issues from the dawn of western civilization through the Progressive era. Volume 2 defines the public health challenges of the ...twentieth century--this important reference covers not only how the discipline addressed the problems of disease, but how it responded to economic, environmental, occupational, and social factors that impacted public health on a global scale. Major illnesses such as cancer, HIV, and tuberculosis are addressed, along with lifestyle concerns, such as tobacco and nutrition. Chapters also explore maternal-child and women's health, dental public health, health economics and ethics, and the role of philanthropy. Each chapter begins with an in-depth introduction, followed by three original articles that illustrate the problem. The volume is enhanced with a detailed chronology of public health events, as well as appendices that contain many of the original documents that ushered public health into the new millennium.
Abstract We examined hazard and risk‐related metrics of the highest‐ and lowest‐income counties and municipalities in each U.S. state. Indicators of natural and anthropogenic hazards, health ...outcomes, location of locally unwanted land uses, food insecurity, and other metrics were used to measure social and environmental justice. As expected, the highest‐income places have better health outcomes, access to assets that protect health, and high municipal ratings of place quality compared with their poorest counterparts. Yet, they also have higher natural hazard risks and are more likely to live near concentrations of anthropogenic hazards. That is, high‐income places have a lot to lose. Although the poorest jurisdictions demonstrate cumulative disadvantages, those in rural areas are exposed to less dense motor vehicle traffic and other hazards and risks associated with urban life. Relationships between income and the geography of hazards and risks are not simple. Even the highest‐income areas face challenges. We suggest improvements in databases and tools to increase the focus on and monitoring of the breadth of risks people face in all areas.
We examined the spatial concentration of public housing, demographic indicators of low socioeconomic status, and environmental locally unwanted land uses (LULUs) in eight populous U.S. cities. Using ...the updated EJScreen database and its geographic information systems capabilities, we, as expected, found subsidized housing to be disproportionately colocated in areas with poor and underserved residents. Underground storage tanks and high traffic density were consistently associated with the location of public housing, whereas Superfund sites were located near public housing in only half of the cities in the study. Increasing our understanding of the variables typically used to measure environmental and social justice is important to expand the discussion around a broader set of environmental measures that might be more relevant to the communities that live near them without ignoring the traditional ones that have marked the early legacy of the environmental justice movement.
Background To examine the differences in risk factors and length of hospital stay (LOS) between the insured and uninsured stroke patients, identifying the root causes of increasing hospital stay. ...Methods Retrospective analysis of stroke registry data of acute stroke patients (N = 19,255) was analyzed to compare risk factors, severity, outcome, and LOS by insurance status. Chart review of patients from a comprehensive stroke center (N = 3290) was studied in greater detail for causes of extended length of stay. Results The uninsured patients had poorer control of risk factors and statistically significantly ( P < .0001) higher initial stroke severity, mortality, and LOS as compared with insured patients (3.8 versus 4.5 days, respectively). The increased length of stay was largely accounted for by the inability to transfer uninsured patients to inpatient rehabilitation settings. Conclusion This study highlights the need for public policies that provide funding for both primary stroke prevention and poststroke rehabilitation.
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