Search

Purpose: We address how the national prevalence of cognitive impairment can be estimated from two nationally representative surveys. Design and Methods: Data are from the 1999-2001 National Health Interview Survey (NHIS) and the 1999 National Nursing Home Survey (NNHS). The NHIS represents all community-dwelling people living in the United States, and the NNHS is representative of all nursing home residents. Results: NHIS data show that there are approximately 800,000 community-based elders aged 65 and older with reported confusion or memory loss, and 2.3 million elders with reported limitation of activity caused by senility or dementia. There are an estimated 632,000 nursing home residents aged 65 and older with a reported diagnosis of dementia. Implications: Estimates of the prevalence of cognitive impairment that are based on nationally representative data are rare, because comprehensively evaluating a national sample by using standard, validated cognitive-impairment assessment methods is difficult and expensive, and because most national surveys are broad based and designed to cover a wide variety of topics. Crude measures of cognitive impairment, such as the presence of confusion or memory loss or limitations caused by senility or dementia, that are included in these multipurpose surveys may be only rough proxies for clinically evaluated cognitive impairment, but they do appear to produce prevalence estimates that are similar to estimates found with the use of more precise case-ascertainment methods. These nationally representative data sets may be used to generate hypotheses related to the prevalence, epidemiology, and health care utilization patterns of people with cognitive impairment that can be tested in studies using more specific case-ascertainment criteria.

Cancer of the cervix, the opening of the uterus, can be cured if detected and treated at an early stage. The Papanicolaou test, also referred to as the Pap smear, is used to detect cancer cells in the cervix. Tissue from the vagina and cervix are obtained during a routine pelvic examination, and the cells are stained and examined using a microscope. Survival from cervical cancer has not improved, possibly due to late diagnosis of women with a poorer chance of survival, or to the large proportion of women who do not undergo Pap smear screening. Studies have shown that the prevalence of screening was greater among patients with health insurance, a higher level of education, and who were employed; it is also more common among blacks than whites or Hispanics. Patients with cervical cancer tended to have fewer Pap smears or their first Pap smear at an older age. Some reasons for women not having the Pap smear included the opinion that the test was not a high priority, they had incorrect information about the test, or they harbored strong objections to the test. The prevalence of Pap smear screening, attitudes about the intervals between screening, and factors affecting screening were assessed. The prevalence of screening was lowest among Hispanics who spoke mainly or only Spanish. Eighty percent of women who saw a medical practitioner within the past two years and more than 90 percent of women who sought medical attention within the past five years had either never been screened or never informed about the Pap smear. Most women did not have a recent Pap smear because they had put off testing or believed it unnecessary. The improvement of screening for cervical cancer should focus on Hispanics and emphasize the importance of routine Pap smears for the detection of cervical cancer in patients without symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

The article discusses the ethical, legal, policy, and regulatory issues related to public health surveillance data. Topics discussed include the utilization of the data for understanding the disease burden and guiding the public health action, the blockage of data sharing through the storage of data in incompatible formats, and the need for the data-use agreements to be shared and promoted by developing supportive funding mechanisms.

Background: Data from the CDC's National Health Care Survey (NHCS) can assist researchers studying women's healthcare utilization. Methods: Using data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), component surveys of the NHCS, this paper presents prescribing trends from 1995 to 2000 for the 10 therapeutic drug classes of medications mentioned most often during women's ambulatory care visits. Results: Antidepressants top the list as the most frequently mentioned therapeutic class in 1999-2000, followed by estrogens and progestins, antiarthritics, and drugs for acid/peptic disorders. The number of medications prescribed increased by about 13% during visits by women to physicians' offices and hospital outpatient departments between 1995-1996 and 1999-2000, from 144 to 162 mentions per 100 visits, respectively. Conclusions: Researchers can use the NHCS to track changes in use over time and to target potential issues related to access to care, quality of care, or cost that warrant further, in-depth study. [ABSTRACT FROM AUTHOR]

The article focuses on the effects of competition on health care outcomes. Studying competition in health care in a meaningful way, is far easier made a goal than a reality. While there has been a substantial amount of research conducted on the possible effects of competition among hospitals in market areas on prices, research on effects of hospital competition on quality of care is considerably more limited. For many researchers, policy analysts, managed care and other industry representatives, and federal and state officials, several issues affect the feasibility of conducting informative studies of competition.

In the United States, data systems are created by the ongoing, systematic collection of health, demographic, and other information through federally funded national surveys, vital statistics, public and private administrative and claims data, regulatory data, and medical records data. Certain data systems are designed to support public health surveillance and have used well-defined protocols and standard analytic methods for assessing specific health outcomes, exposures, or other endpoints. However, other data systems have been designed for a different purpose but can be used by public health programs for surveillance. Several public health surveillance programs rely substantially on others' data systems. An example of data used for surveillance purposes but collected for another reason is vital statistics data. CDC's National Center for Health Statistics (NCHS) purchases, aggregates, and disseminates vital statistics (birth and death rates) that are collected at the state level. These data are used to understand disease burden, monitor trends, and guide public health action. Administrative data also can be used for surveillance purposes (e.g., Medicare and Social Security Disability data that have been linked to survey data to monitor changes in health and health-care use over time).

Key Findings: The percentage of physician office and hospital outpatient department (OPD) visits during which an MRI/CT/PET scan was ordered doubled, to 4%, and the percentage of hospital emergency department visits with an MRI/CT scan more than tripled, to 16%. The percentage of physician office and OPD visits with at least five drugs prescribed more than doubled, to 25%. Inpatient hospitalization rates were similar in 2006 and 1996, but the types of procedures and surgeries performed have changed. Hospitalization rates for coronary artery stent insertions, hip replacements, and knee replacements rose sharply, while rates for some other procedures declined. Ambulatory surgery visit rates were almost twice as high in 2006 as in 1994-1996, and for some types of ambulatory procedures, such as colonoscopies, the increase was even greater.

Objectives: This report presents long-term trends in the number and percentage of persons under age 65 years with different types of health insurance coverage and with no coverage. It documents changes in how the National Health Interview Survey (NHIS) has collected information about coverage over almost 50 years. It also compares recent trends in coverage estimates based on the NHIS and the U.S. Census Bureau's Current Population Survey (CPS)., Methods: Estimates were derived from 32 years of the NHIS, from 1959 to 2007. The types of estimates available differ over these years, reflecting changes in the availability of different types of coverage and changes in the NHIS questions. Joinpoint regression was used to estimate average annual percent change over time and to identify statistically significant changes in trends., Results: The percentage of persons under age 65 years with private coverage rose between 1959 and 1968, to 79%, remained stable until 1980, and then declined to 67% by 2007. During the 1980s, the percentage of persons with no coverage increased, while the percentage with private coverage declined and the percentage with Medicaid remained stable. Since 1990, the percentage of nonelderly persons without coverage has remained stable, but the number has increased by more than 6 million persons, to 43.3 million in 2007. During this period, the percentage with private coverage has continued to decline, while the percentage with Medicaid has increased. Recent trends in coverage based on the NHIS and CPS are similar.