OBJECTIVE: To facilitate the quantitative comparison of AIDS incidence statistics between countries and with other diseases using statistics based on age-standardized incidence rates instead of absolute number of cases. DESIGN: AIDS incidence rates for 19 countries belonging to the World Health Organization (WHO) European region, and for comparative purposes, the United States. METHODS: Incidence rates were standardized using the world standard population for all ages, from 1985 to 1992. The data were derived from the WHO European Non-Aggregate AIDS Dataset and the Centers for Disease Control and Prevention (CDC) AIDS Public Information Dataset, adjusted for reporting delays in each country. RESULTS: The AIDS incidence rate for men (81 in 1,000,000) in the United States was fourfold higher than the highest rate in a European country (Switzerland) in 1985; incidence rates in all other European countries, except France and Denmark, were below 10 in 1,000,000. Subsequently, AIDS incidence has increased more rapidly in southern Europe than in the rest of the continent. The estimated incidence rate for men in Spain (243 in 1,000,000) approached that in the United States (304 in 1,000,000) in 1992, and three additional countries (France, Switzerland and Italy) showed rates above 100 per million. The spread of the AIDS epidemic among women in some southern European countries was faster than in the United States. In Switzerland and Spain the standardized incidence rates in women were higher than in the United States by 1988 and 1992, respectively. CONCLUSIONS: Analysis trends in incidence rates avoids some weaknesses of AIDS statistics based on absolute numbers, and should become one of the standard tools for AIDS surveillance.
This paper examines the effect of banning broadcast advertising of alcoholic beverages. The data used in this study are a pooled time series from 17 countries for the period 1970 to 1983. The empirical results show that countries with bans on spirits advertising have about 16% lower alcohol consumption than countries with no bans and that countries with bans on beer and wine advertising have about 11% lower alcohol consumption than countries with bans only on spirits advertising.
Comment In: J Health Econ. 1993 Jul;12(2):213-2810127781
Persons age 65 years and older bear the greater burden of cancer in the United States and other industrial nations. A cross-national perspective using data from several population-based resources (eg, the NCI Surveillance, Epidemiology, and End Results Program; US Bureau of Census; World Health Organization; and International Association for Research on Cancer) illustrates current and future demographic transitions in America in comparison with six industrial nations, and profiles cancer mortality in older persons across the selected nations--Denmark, France, Italy, Japan, Sweden, and United Kingdom. Mortality rates, age-standardized to the world population, are presented for major tumors. US aging and cancer profiles are highlighted. Demographic projections portend a substantial increase in numbers of older persons, and thus, imply resultant increases in cancer incidence and mortality in the elderly. By 2030, there will be larger proportions of persons in the age group most vulnerable to cancer. Information is needed on how age-related health problems affect cancer prevention, detection, prognosis, and treatment. A knowledge base as guidance in management of cancer in the elderly is lacking. Planning for effective prevention measures and improvement of treatment for the elderly is imperative to meet current and future quality cancer care needs.
The present paper reviews the American epidemic of West Nile Fever (WNF), which is the largest recorded outbreak ever. The epidemiological consequences of introducing a novel and immunologically unknown pathogen in a previously unexposed population and the possible evolution of a more pathogenic viral strain are discussed. In view of recent reports of imported cases in Denmark the issue of possible disease spread to Scandinavia is likewise addressed. However, the main scope of the article is to provide the clinician with an overview of the natural history, epidemiology and clinical characteristics of the disease.
BACKGROUND: The Domestic/International Gastroenterology Surveillance Study (DIGEST) was designed to examine the 3-month prevalence of upper gastrointestinal (GI) symptoms internationally and the impact of these symptoms on healthcare usage and quality of life. METHODS: The study sample was derived from the urban, adult (> or = 18 years) population of Canada, Italy, Japan, The Netherlands, Switzerland, the USA and the Nordic countries (Denmark, Finland, Norway and Sweden). Subjects were randomly recruited on a house-to-house basis in all countries except the USA and Italy, where telephone recruitment was carried out. Participants were interviewed in their own homes (house-to-house recruitment) or at a central location (telephone recruitment). The DIGEST questionnaire consisted of two sections. The first was a newly developed questionnaire consisting of 27 questions examining the prevalence, frequency and severity of upper GI symptoms, and their impact on healthcare use and daily activities. It also examined a number of demographic and socioeconomic variables. This part of the questionnaire was evaluated and pilot-tested before commencement of the survey. The second part of the questionnaire consisted of the local language version of the Psychological General Well-Being Index (PGWBI), a validated generic quality-of-life scale. Following completion of the survey, subjects with upper GI symptoms were classified on the basis of their most bothersome symptom into three symptom groups: gastro-oesophageal reflux-like, ulcer-like or dysmotility-like. CONCLUSIONS: Rigorous design, standardization of interview techniques and prior evaluation of the DIGEST questionnaire, provided a firm foundation for reliable data collection, analysis and interpretation.
In assessing the economic impact of diabetes for a population, several factors should be considered, including the incidence and prevalence of the disease, the level of development of the health care system, and the population's overall level of economic development. Two different approaches have been used to address the economic impact of an increasing incidence of diabetes. The first approach uses disability-adjusted life-years (DALYs) to measure intangible costs associated with diabetes. It combines the number of healthy life-years lost as a result of early mortality with those lost because of disability. The second approach, which has been used more frequently, is the cost-of-illness approach, which includes the concepts of direct, indirect, and intangible costs. A study conducted by the World Bank found that of the 1,362 million DALYs lost to all illnesses in 1990, 7.97 million DALYs were lost because of diabetes. In a 1992 study that assessed the direct costs of treating diabetes in the U.S., the American Diabetes Association used the cost-of-illness approach and found that the estimated total expenditure for 1 year was $45.2 billion. The 1994 epidemiological studies by Zimmet and the World Health Organization include estimates of increased prevalence of diabetes resulting from an increase in population. Estimates of the global cost of diabetes based on these studies reveal that diabetes accounts for 2-3% of the total health care budget in every country; therefore, an increase in diabetes incidence and prevalence translates into a significant economic impact.
PURPOSE: To review the epidemiology of age-related macular degeneration (AMD). DESIGN: Evidence from epidemiologic data regarding the natural history of AMD and its risk factors are presented. RESULTS: Large, soft drusen associated with pigmentary abnormalities increase the risk of progression to advanced AMD. Large soft drusen may fade over time. Advanced AMD is more likely to be present in whites than blacks, despite the similar prevalence of soft drusen in both groups. Neovascular AMD is more frequent than geographic atrophy in most population-based studies in whites in America, Australia, and the Netherlands than in similar population-based studies in Iceland and Norway. After age and family history, there are few consistent relationships of risk factors to AMD. Of these, the relationship of smoking, hypertension, and cataract surgery to advanced AMD have been most consistent. CONCLUSIONS: Long-term epidemiologic studies have provided information on the distribution and the natural history of AMD and its associated risk factors. It is not known what effect reduction of blood pressure and the cessation of smoking might have on the incidence and progression of AMD.
Vaccines present perhaps the most attractive solution to the worldwide problem of diarrhoeal disease. Epidemiological evidence has important implications for the development and use of such vaccines, and results of studies on diarrhoeal diseases in developing and developed countries, in particular among children, and travellers' diarrhoea are reviewed. The virulence and pathogenicity of various enteropathogens are discussed, and the extent to which immunity may be acquired. It is concluded that the development of appropriate vaccines may be a complex task.
The prevalence of neural tube defect (NTD)-affected pregnancies ranges between 0.4 and 2/1000 pregnancies in EU. NTDs result in severe malformations and sometimes miscarriages. Children born with NTD suffer for the rest of their life of disability and chronic healthcare issues, and many women therefore choose termination of pregnancy if NTD is diagnosed prenatally. Women planning for pregnancy are recommended to eat 400 µg folic acid/d, whereas average figures across Europe indicate intakes of ~250 µg/d for women of fertile age, a gap that could be bridged by implementation of folic acid fortification. The results of mandatory folic acid fortifications introduced in USA and Canada are a decrease between 25 and 45% of NTD pregnancies.
Evidence-based NTD prophylaxis is now practised in more than 60 countries worldwide. EU countries worry over possible cancer risks, but ignore a wealth of studies reporting decreasing cancer risks with folate intakes at recommended levels. Currently, there are indications of a U-shaped relationship, that is, higher cancer risks at low folate intakes (1 mg/day), respectively. However neither the global World Cancer Research review nor EU's European Food Safety Authority report present data on increased cancer risk at physiological folate intake levels. Therefore, EU should act to implement folic acid fortification as NTD prophylaxis as soon as possible.