Abstract:
OBJECTIVE:To determine, for abdominal aortic aneurysm surgery, whether a previously reported relationship between hospital case volume and mortality rate was observed in Ontario hospitals and to assess the potential impact of age on the mortality rate for elective surgery. DESIGN:Population based observational study using administrative data. SETTING:All Ontario hospitals where repair of abdominal aortic aneurysm as a primary procedure was performed during 1988-92. PATIENTS:These comprised 5492 patients with unruptured abdominal aortic aneurysms and 1203 patients with ruptured abdominal aortic aneurysms admitted to hospital between 1988-92 for repair of abdominal aortic aneurysm as a primary procedure. MAIN OUTCOMES:In-hospital death and length of in-hospital stay. RESULTS:The case fatality rate was 3.8% for unruptured abdominal aortic aneurysms and 40.0% for ruptured abdominal aortic aneurysms. For unruptured cases, after adjustment for patient and hospital covariates, each 10 case per year increase in hospital volume was related to a 6% reduction in relative odds of death (odds ratio (OR) 0.94, 95% confidence intervals 0.88, 0.99) and 0.29 days reduction (95% CI -0.22, -0.35) in postoperative in-hospital stay. Female sex (OR 1.53, 95% CI 1.08, 2.18) and transfer from another acute care hospital (OR 4.37, 95% CI 2.62, 7.29) were associated with increased case fatality rates among patients in the unruptured category. For ruptured cases, neither the case fatality rate nor postoperative in-hospital stay were significantly related to hospital volume. The case fatality rates increased linearly and substantially with advancing age both for unruptured and ruptured aneurysms, and the excess risk of postoperative death in ruptured as compared to unruptured aneurysms was substantially higher in older patients. CONCLUSION:The relationship between hospital volume and mortality or morbidity was very modest and observed only for elective surgery. Case fatality rates in patients with ruptured abdominal aortic aneurysms remained 10 times higher than for patients with unruptured abdominal aortic aneurysms, despite improvements in overall mortality in comparison to previously published data. More effective detection of aneurysms, including elective repair for those once considered "high risk" older patients, might further reduce the toll from ruptured aortic aneurysms.
journal_name
J Epidemiol Community Healthjournal_title
Journal of epidemiology and community healthauthors
Wen SW,Simunovic M,Williams JI,Johnston KW,Naylor CDdoi
10.1136/jech.50.2.207subject
Has Abstractpub_date
1996-04-01 00:00:00pages
207-13issue
2eissn
0143-005Xissn
1470-2738journal_volume
50pub_type
杂志文章abstract::A case-control study of cancers of the upper alimentary tract was conducted in a hospital to assess the role of several risk factors, including alcohol consumption, which is reported here. Male patients from one community with cancers of the oral cavity (n = 278), pharynx (n = 225), and oesophagus (n = 236) formed the...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.42.2.187
更新日期:1988-06-01 00:00:00
abstract:BACKGROUND:Lower blood folate levels have been associated with depression in cross-sectional surveys, but no studies have examined the relationship prospectively to determine whether the relationship is causal. A follow-up study was designed to examine whether lower blood folate levels predict incident depressive sympt...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章,多中心研究
doi:10.1136/jech.2007.069765
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:To assess the impact of childhood and adulthood socioeconomic position (SEP) across 20 causes of death in a large population-wide sample of Norwegian men and women. METHODS:Census data on parental occupational class from 1960 and data from the tax register on household income in 1990 were linked to the death...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2006.052811
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:Research on inequalities in health has shown a strong association between the lack of standard of living (defined as material deprivation) and self-rated health (SRH). In this study, we sought to further examine this association in a trend analysis of relative and absolute inequalities in SRH as defined by m...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech-2015-205948
更新日期:2016-01-01 00:00:00
abstract::A random sample of 617 primiparas was identified from birth notifications over a 12 month period and 534 of these were interviewed four weeks after confinement. Those breast feeding at the time of interview were contacted again at four months and those still breast feeding then were contacted at six and a half months....
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.37.2.89
更新日期:1983-06-01 00:00:00
abstract:BACKGROUNDS:The debate on health selection which describes the influence of health on subsequent social mobility is highly contested. The authors set out to examine the effect of health selection by looking at the effect of previous health status on changes in socio-economic position (SEP) over two time periods. METHO...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2009.107995
更新日期:2011-12-01 00:00:00
abstract:STUDY OBJECTIVE:This study aimed to examine whether the high mortality in lower salaried men in Norway was related to an inflow into this group of unskilled workers with high mortality. DESIGN:Individual information on occupation was derived from the 1970 and the 1980 censuses and linked to mortality data for the peri...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.47.3.192
更新日期:1993-06-01 00:00:00
abstract:BACKGROUND:In India, excess female under-5 mortality is well documented. Under-5 mortality is also known to be patterned by socioeconomic factors. This study examines sex differentials and sex-specific wealth gradients in neonatal, postneonatal and child mortality in India. METHODS:Repeated cross-sectional study of na...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech-2018-211569
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVES:To assess the effect on fruit and vegetable consumption, self reported, and psychological health of a "natural experiment"-the introduction of large scale food retailing in a deprived Scottish community. DESIGN:Prospective quasi-experimental design comparing baseline and follow up data in an "intervention" ...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2004.029843
更新日期:2005-12-01 00:00:00
abstract:STUDY OBJECTIVES:To assess the extent to which poorer self assessed health in men in whom an abdominal aortic aneurysm (AAA) is detected at screening is a consequence or a predictor of screening outcome. DESIGN:Prospective study. SETTING:Community based screening. PARTICIPANTS:23 654 men who attended for AAA screeni...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章,多中心研究
doi:10.1136/jech.2003.019307
更新日期:2004-12-01 00:00:00
abstract:BACKGROUND:There are few longitudinal data on physical activity patterns from mid-life into older age. The authors examined associations of self-reported physical activity, adiposity and socio-demographic factors in mid-life with objectively assessed measures of activity in older age. METHODS:Participants were 394 hea...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech-2011-200505
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Nerve, nerve root and plexus disorders are common diseases, but little is known about familial clustering in these diseases. This is, to our knowledge, the first systematic family study carried out on these diseases. METHODS:Familial risks for siblings who were hospitalised for nerve, nerve root and plexus ...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2006.046615
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:Antiretroviral therapy (ART) initiation is now recommended irrespective of CD4 count. However data on the relationship between CD4 count at ART initiation and loss to follow-up (LTFU) are limited and conflicting. METHODS:We conducted a cohort analysis including all adults initiating ART (2008-2012) at three...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章,多中心研究
doi:10.1136/jech-2015-206629
更新日期:2016-06-01 00:00:00
abstract::Prompted by my participation in the People's Climate March held in New York City on 21 September 2014, as part of the 'Harvard Divest' contingent, in this brief essay I reflect on the late 20th century development of--and debates over--the necessity of ecological thinking in epidemiology, and also the still limited en...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech-2014-205027
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:With the exception of key 'proven successes' in global health, the current regime of global health governance can be understood as transnational and national actors pursuing their own interests under a rational actor model of international cooperation, which fails to provide sufficient justification for an o...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2009.101097
更新日期:2012-07-01 00:00:00
abstract:OBJECTIVE:To raise compliance in a general practice based colorectal cancer screening programme by the use of a simple health educational leaflet. DESIGN:A randomised controlled trial of the leaflet's effect on completion of faecal occult blood tests. The leaflet explained the high frequency of colorectal cancer, the ...
journal_title:Journal of epidemiology and community health
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/jech.51.2.187
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:To establish the relation between socioeconomic status and the age-sex specific prevalence of type 1 and type 2 diabetes mellitus. The hypothesis was that prevalence of type 2 diabetes would be inversely related to socioeconomic status but there would be no association with the prevalence of type 1 diabetes a...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.54.3.173
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND:The adverse health and environmental effects of poor housing quality are well established. A central requirement for evidence-based policies and programmes to improve housing standards is a valid, reliable and practical way of measuring housing quality that is supported by policy agencies, the housing sector...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2009.100701
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:In Italy the law on industrial risk has emphasised the necessity of building a local information process to answer people's questions on safety and provide greater community participation in risk management. The aim of this research is to analyse the local population's ideas and expectations of a participator...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2005.043513
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVES:To measure the geographical variation in prevalence of cardiovascular disease, risk factors, and their control in a nationally representative sample of older British women. METHODS:Baseline survey using general practitioner record review, a self completed questionnaire, research nurse interview, and physica...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.57.2.134
更新日期:2003-02-01 00:00:00
abstract:STUDY OBJECTIVE:The aim was to assess the differences in suicide data obtained from different database sources. DESIGN:Death certificate based data on suicidal deaths were compared with the information obtained from the non-natural death investigation files at the Public Prosecutor's Office. SETTING:The study was con...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.47.1.73
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:Differences in health, lifestyles, and use of health care between groups of varying ethnic origin can have important implications for preventive and curative health care. This paper studies whether socioeconomic factors explain ethnic differences in these outcomes. DESIGN:Data on health status, lifestyles, a...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.52.5.298
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:To assess the effect of the Demerit Point System (DPS), introduced in Spain on 1 July 2006, on the number of fatalities due to road traffic accidents, using a methodology that controls for the seasonal variation and trend in the data series. METHODS:Time-series analysis by ARIMA models of 29 113 fatalities ...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2008.082461
更新日期:2010-03-01 00:00:00
abstract:STUDY OBJECTIVE:The purpose of this paper is to give an overview and comparison of different easily applicable statistical techniques to analyse recurrent event data. SETTING:These techniques include naive techniques and longitudinal techniques such as Cox regression for recurrent events, generalised estimating equati...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2004.030759
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:The Home Office has recently published estimates which, for the first time, provide a "robust national estimate" of the number of problematic drug users in England. The 2004/05 and 2005/06 estimates are the highest estimates ever produced for England and coincide with the highest ever government annual expen...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2008.076844
更新日期:2009-01-01 00:00:00
abstract:STUDY OBJECTIVE:To explore the relationship between self reported environmental tobacco smoke exposure (or passive smoking), the serum cotinine concentration, and evidence of respiratory or coronary disease in men and women who have never smoked. DESIGN:Cross sectional random population survey identifying disease mark...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.49.2.139
更新日期:1995-04-01 00:00:00
abstract:STUDY OBJECTIVE:To investigate and evaluate published data on cost effectiveness of cholesterol lowering interventions, and how this information could be interpreted in a rational approach of cholesterol management in general practice. DESIGN:A systematic review of the literature. SETTING:No restriction on setting. ...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章,评审
doi:10.1136/jech.52.9.586
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Age-specific death from cardiovascular disease among Australian Aboriginals is estimated to be four to seven times that of general population, and the major cause of premature death. There is little reliable information on the incidence of coronary heart disease (CHD). This study compares CHD event rates in ...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech.2009.098343
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Patients with diabetes mellitus (DM) have a markedly higher overall mortality from coronary heart disease (CHD), as well as many other causes of death like cancer. Since diabetes is a multisystem disease, this fact together with the increased lifespan among individuals with diabetes may also lead to the emer...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech-2019-213602
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:The use of validated multivariate cardiovascular predictive models in a population setting is of interest for public health policy makers. We aimed to validate the estimations of the CASSANDRA model (coronary heart disease (CHD) incidence and CHD risk distribution), considering the population changes in age,...
journal_title:Journal of epidemiology and community health
pub_type: 杂志文章
doi:10.1136/jech-2013-203516
更新日期:2014-11-01 00:00:00