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This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure. [ABSTRACT FROM AUTHOR]

The paper describes SIPP data elements pertaining to health and disability, examines broad policy needs for health and disability issues from the perspective of the Department of Health and Human Services, and contains recommendations for future SIPP design. Specific health and disability items described include health insurance, health care utilization, participation in Federal disability programs, functional disability (i.e. ADLs and IADLs), work disability, and children's disability. The paper contains recommendations to more consistently collect health and disability data in SIPP. Although the goals of SIPP are to study the dynamics of Federal program participation and describe the income distribution of the population, since program participation and income are so closely influenced by health and disability, SIPP's goals cannot be fully met until health and disability data are collected more consistently. [ABSTRACT FROM AUTHOR]

Objectives. This paper analyzes the impact of seven chronic conditions (three nonfatal: arthritis, visual impairment, hearing impairment; four fatal: ischemic heart disease, chronic obstructive pulmonary disease, diabetes mellitus, malignant neoplasms) on US adults aged 18 and older. Impact refers to how readily a condition prompts activity limitations, physician visits, and hospital stays. Methods. Data come from three national health surveys and vital statistics. For comparability, a single disease classification scheme was applied, and new rates were estimated. Frequency, impact, and prominence of the target conditions are studied via rates, ratios of rates, and ranks, respectively. Results. In young adulthood, the nonfatal conditions prompt limitations less readily than do the fatal ones, but by older ages, arthritis and visual impairment have a limiting impact equivalent to that of fatal conditions. Despite high prevalence and limitations, nonfatal conditions stand well below fatal conditions for health services use. Conclusions. Although statistics on frequency, impact, and prominence all indicate conditions' "importance," they give only weak clues about specific service needs of affected persons. The persistent finding that nonfatal conditions do not receive health services care commensurate with their prevalence and impact reflects long-standing imbalanced attention on fatal conditions in research and medical care. [ABSTRACT FROM AUTHOR]

Purpose: To assess the equivalence of self-reports of physical functioning between pediatric respondents to the English- and Spanish-language patient-reported outcomes measurement information system (PROMIS®) physical functioning item banks.Methods: The PROMIS pediatric physical functioning item banks include 29 upper extremity items and 23 mobility items. A sample of 5091 children and adolescents (mean age = 12 years, range 8-17; 49% male) completed the English-language version of the items. A sample of 605 children and adolescents (mean age = 12 years, range 8-17; 55% male; 96% Hispanic) completed the Spanish-language version of the items.Results: We found language (English versus Spanish) differential item functioning (DIF) for 4 upper extremity items and 7 mobility items. Product-moment correlations between estimated upper extremity and mobility scores using the English versus the equated Spanish item parameters for Spanish-language respondents were 0.98 and 0.99, respectively. After excluding cases with significant person misfit, we found DIF for the same 4 upper extremity items that had DIF in the full sample and for 12 mobility items (including the same 7 mobility items that had DIF in the full sample). The identification of DIF items between English- and Spanish-language respondents was affected slightly by excluding respondents displaying person misfit.Conclusions: The results of this study provide support for measurement equivalence of self-reports of physical functioning by children and adolescents who completed the English- and Spanish-language surveys. Future analyses are needed to replicate the results of this study in other samples. [ABSTRACT FROM AUTHOR]

Background: Ideally, the distribution of research funding for different types of cancer should be equitable with respect to the societal burden each type of cancer imposes. These burdens can be estimated in a variety of ways; "Years of Life Lost" (YLL) measures the severity of death in regard to the age it occurs, "Disability-Adjusted Life-Years" (DALY) estimates the effects of non-lethal disabilities incurred by disease and economic metrics focus on the losses to tax revenue, productivity or direct medical expenses. We compared research funding from the National Cancer Institute (NCI) to a variety of burden metrics for the most common types of cancer to identify mismatches between spending and societal burden. Methods: Research funding levels were obtained from the NCI website and information for societal health and economic burdens were collected from government databases and published reports. We calculated the funding levels per unit burden for a wide range of different cancers and burden metrics and compared these values to identify discrepancies. Results: Our analysis reveals a considerable mismatch between funding levels and burden. Some cancers are funded at levels far higher than their relative burden suggests (breast cancer, prostate cancer, and leukemia) while other cancers appear underfunded (bladder, esophageal, liver, oral, pancreatic, stomach, and uterine cancers). Conclusions: These discrepancies indicate that an improved method of health care research funding allocation should be investigated to better match funding levels to societal burden. [ABSTRACT FROM AUTHOR]

An examination of aggregate out-of-pocket health care expenditures from the CE, MEPS, and the NHEA for the 1996-2006 period indicates that methodological differences account for the lack of agreement among estimates [ABSTRACT FROM AUTHOR]

Background: Evidence-based public health requires the existence of reliable information systems for priority setting and evaluation of interventions. Existing data systems in the United States are either too crude (e.g., vital statistics), rely on administrative data (e.g., Medicare) or, because of their national scope (e.g., NHANES), lack the discriminatory power to assess specific needs and to evaluate community health activities at the state and local level. This manuscript describes the rationale and methods of the Survey of the Health of Wisconsin (SHOW), a novel infrastructure for population health research. Methods/Design: The program consists of a series of independent annual surveys gathering health-related data on representative samples of state residents and communities. Two-stage cluster sampling is used to select households and recruit approximately 800-1,000 adult participants (21-74 years old) each year. Recruitment and initial interviews are done at the household; additional interviews and physical exams are conducted at permanent or mobile examination centers. Individual survey data include physical, mental, and oral health history, health literacy, demographics, behavioral, lifestyle, occupational, and household characteristics as well as health care access and utilization. The physical exam includes blood pressure, anthropometry, bioimpedance, spirometry, urine collection and blood draws. Serum, plasma, and buffy coats (for DNA extraction) are stored in a biorepository for future studies. Every household is geocoded for linkage with existing contextual data including community level measures of the social and physical environment; local neighborhood characteristics are also recorded using an audit tool. Participants are re-contacted bi-annually by phone for health history updates. Discussion: SHOW generates data to assess health disparities across state communities as well as trends on prevalence of health outcomes and determinants. SHOW also serves as a platform for ancillary epidemiologic studies and for studies to evaluate the effect of community-specific interventions. It addresses key gaps in our current data resources and increases capacity for etiologic, applied and translational population health research. It is hoped that this program will serve as a model to better support evidence-based public health, facilitate intervention evaluation research, and ultimately help improve health throughout the state and nation. [ABSTRACT FROM AUTHOR]

In the USA cancer as a whole is the second leading cause of death and a major burden to health care; thus medical progress against cancer is a major public health goal. There are many individual studies to suggest that cancer treatment breakthroughs and early diagnosis have significantly improved the prognosis of cancer patients. To understand better the relationship between medical improvements and the survival experience for the patient population at large, it is useful to evaluate cancer survival trends on the population level, e.g. to find out when and how much the cancer survival rates changed. We analyse population-based grouped cancer survival data by incorporating join points into the survival models. A join point survival model facilitates the identification of trends with significant change-points in cancer survival, when related to cancer treatments or interventions. The Bayesian information criterion is used to select the number of join points. The performance of the join point survival models is evaluated with respect to cancer prognosis, join point locations, annual percentage changes in death rates by year of diagnosis and sample sizes through intensive simulation studies. The model is then applied to grouped relative survival data for several major cancer sites from the ‘Surveillance, epidemiology and end results’ programme of the National Cancer Institute. The change-points in the survival trends for several major cancer sites are identified and the potential driving forces behind such change-points are discussed. [ABSTRACT FROM AUTHOR]

The article compares demographic characteristics of adults and adolescents who received an AIDS diagnosis in one state and died in a different state. AIDS cases surveillance is conducted in all states and territories in the United States. The distribution of migrants by sex, age at diagnosis of AIDS, race/ethnicity, mode of transmission, region of AIDS diagnosis, size of metropolitan area of residence at AIDS diagnosis, and time between AIDS diagnosis and death are examined. 251,441 deaths among adults and adolescents with AIDS were reported to the Centers for Disease Control and Prevention from January 1993 through December 2001. 13,860 were migrants among them. Analysis of data revealed that among persons who died with AIDS, a small proportion migrated between time of AIDS diagnosis and death. Whites, regardless of region, were more likely than blacks to move to a different state after AIDS diagnosis. Differences were found in the relationship between migration and HIV exposure category by region of residence at AIDS diagnosis.

The article presents a position paper from the American Public Health Association relative to the availability of nutrition status data to local health agencies in the U.S. The association encourages that there be adequate personnel and funding to make surveillance data collected by the Center for Disease Control available to all the states and territories of the U.S. It also encourages that there be enough funding and manpower to enable the administrators of the Health and Nutrition Examination Survey of the National Center for Health Statistics to formulate a method to make data available and more useful to local communities and develop future surveys to accomplish the purpose.

Abstract: In October 1983, a retrospective survey was initiated to determine if patients reported to the Centers for Disease Control as having recurrent tuberculosis truly had recurrent disease and, if so, why they had developed tuberculosis again. Twenty-three health jurisdictions provided information on 800 patients diagnosed as having recurrent tuberculosis during 1981 and 1982. We found that 199 (25 per ¢) of the cases did not meet the criteria for recurrent disease. Of the remaining 601 recurrent cases, 20 per ¢ had no chemotherapy prescribed for their previous episodes of tuberculosis, 20 per ¢ were prescribed inadequate or inappropriate therapy, and 33 per ¢ were not compliant with their prescribed therapy regimens. Patients who, during their original episode of tuberculosis, received the major portion of their medical care from physicians in private practice were more compliant than those treated by other health care providers. However, those same patients were more likely to have received inappropriate therapy than patients treated by other providers. Better patient and physician education, closer monitoring, and greater use of preventive therapy and directly observed therapy are necessary to resolve these problems. [ABSTRACT FROM AUTHOR]

Abstract: In a nationwide survey we found 72 PKU (phenylketonuria) patients who had terminated diet but later returned to diet. Sixty-one patients resumed diet due to clinical problems. Age at initial diet discontinuation ranged from three to 20 years. The most prevalent problems reported were poor school performance, and mood and/or behavior changes. Following diet reinstitution, only positive changes were noted for 42 patients, no changes for 19 patients, and 11 had one or more negative changes. Improvements and blood phenylalanine levels were not significantly correlated, but only Il patients maintained levels < 10 mg/dl. The number of improvements was significantly correlated with length of time on diet (p < 0.001 ). After a median of 10 months on diet. 22 patients had again discontinued due 10 poor diet control, lack of motivation, poor formula tolerance, lack of apparent benefits and/or changes [or the worse, Median time on diet for the 50 second-time continuers was two years nine months. [ABSTRACT FROM AUTHOR]

Abstract: Personal and telephone interview surveys were conducted simultaneously during 1981 in the same area (four counties on the area of Tampa Bay, Florida and utilizing the same interview schedule. Following completion of the surveys, validity checks were made with the medical providers reported by a subsample of respondents to each mode. The telephone survey yielded a lower response rate but cost less than half the personal interview. There was some evidence of nonresponse bias in the telephone survey, and some relatively minor differences in responses were found between the two modes, but there was no conclusive evidence that the response differences resulted from mode effects. Telephone respondents appeared to be somewhat more accurate in their reporting of visits to medical provides, although accuracy comparisons must be interpreted with caution in view of the disparate success experienced for the two modes in securing permission forms for the release of medical record information. [ABSTRACT FROM AUTHOR]

In 1977 the National Center for Health Services Research, US Department of Health and Human Services, undertook a survey of 40,000 individuals in the United States, soliciting information on expenditures and sources of payment for health services including prescribed medicines. Differences in the use of prescribed medicines by age, sex, ethnic/racial background, family income, and perceived health status were found across and within therapeutic categories. More than one-fifth of expenditures were for cardiovascular-renal agents. Sources of payment were similar in all but a few therapeutic categories. [ABSTRACT FROM AUTHOR]

Abstract: The method of data collection in household health surveys can be a major determinant of cost and data quality. A survey strategy can comprise mail. telephone, or home interview methods, individually or in combination to follow up non-respondents. The purpose of this study in Montreal was to compare cost and data quality of various strategies. Strategies which began with mail or telephone contact, followed by the two other methods, provided response rates as high as a home interview strategy (all between 80 and 90 percent), for one-half the cost of home interviews when used as the sole method. The telephone response rate was higher than the mail response rate. Comparing different follow-up approaches to strategies beginning with mail or telephone, it proved less costly, and equally effective, to use home interviewing as a last resort for persistent non-respondents. Validity of response (comparing individual responses with records of a government health insurance data bank) and willingness to answer sensitive questions were greatest in mail strategy. [ABSTRACT FROM AUTHOR]

A set propositions is offered to provide a frame of reference for proposed strategies to improve healthful behavior by placing personal choice-making in the context of societal option-setting. The health status of populations at a given point in time is seen as a result of customary personal choice-making. These choices in turn are limited by both the perceived and actual options available to individuals, depending on their personal and their community's resources, from which to make choices, Most people, most of the time will make the easiest choices, i.e., will do the things, develop the patterns or life-styles, which seem to cost them less and/or from which they will gain more of what they value in tangible and/or intangible terms. The range of options available to them, and the ease with which they may choose certain ones over others, is typically set by organizations, public and private, formal and informal. The more powerful the organization, i.e., the more effective it is in carrying out its policies, the more it affects the populations, whether or not these effects are immediately perceived by individuals in their day-by-day choicemaking. Implications for health education strategies are noted. [ABSTRACT FROM AUTHOR]

The Survey of Income and Program Participation (SIPP) has been used to provide descriptive estimates of the health and disability status of the U.S. population. Comparisons are drawn between SIPP estimates and independent estimates of disability including data from Canada and Britain which shows evidence of the reliability and weaknesses of certain measurements. SIPP is found to substantially underestimate participation in special education programs and fails to measure enrollment of children with disabilities in SSI. It is found that at least 1 million adults with severe functional limitations who are unable to work receive in Social Security disability benefits. It is argued that SIPP could be employed more effectively to see why this situation occurs and to more effectively examine the adequacy of benefits provided to persons with work disabilities. SIPP also provides a unique resource for studying changes in disability status and their socioeconomic impact which has been underutilized. Several recommendations for improving SIPP are provided. [ABSTRACT FROM AUTHOR]

We surveyed 1196 Black health and political leaders on their perceptions about the US Department of Health and Human Services' Healthy People 2000 public health goals. Respondents identified reducing the incidence of acquired immunodeficiency syndrome, improving maternal and infant health, and controlling sexually transmitted diseases as the three most important public health goals for Black Americans that are amenable to intervention. The leaders assigned nearly all responsibility for prevention efforts to the federal government and the individual. With the American health care system now in flux, Black leaders need to organize to see that these priority issues are addressed. [ABSTRACT FROM AUTHOR]

Of the 47 states that participated in a 1983 survey of State Health Departments, 30 were found to have public health standards in place or started. Most states' standards emphasize the range of services to be provided, but substantial variations were found in how standards are formulated, adopted, and used by state and local agencies. (Am J Public Health 1985; 75:649-650) [ABSTRACT FROM AUTHOR]