David E. Lilienfeld

Hospitalization and case fatality for pulmonary embolism in the twin cities: 1979–1984

To better characterize the morbidity from pulmonary embolism, we examined hospital discharge data for all acute care facilities (except for the Veterans Administration Medical Center) in the Minneapolis-St. Paul metropolitan area in each year from 1979 to 1984 for persons aged 30 to 74 years. For each person in whom the discharge diagnoses included pulmonary embolism, the age, sex, year of admission, and vital status at discharge were recorded. Annual age-sex-specific and age-adjusted sex-specific hospitalization rates were calculated. Similar analyses were undertaken for case fatality. With the exception of men younger than 55 years of age, all groups experienced significant decline in the pulmonary embolism discharge rate. No significant temporal changes were observed in any of the case fatality rates. These data suggest that changes in pulmonary embolism mortality in the United States from 1979 to 1984 may reflect declining occurrence of the disease and are likely not the result of changes in case fatality. Further studies in this area are needed.

Disposal-related sharps injuries at a New York City Teaching Hospital

OBJECTIVE To characterize disposal-related sharps injuries. DESIGN A three-part study including (a) descriptive analysis of disposal-related injuries in a 1-year period, (b) 4:1 matched case-control study of nurses injured while using sharps disposal containers, and (c) survey to solicit opinions of users of containers. SETTING An 1,181-bed teaching hospital in New York City. PARTICIPANTS For epidemiologic analyses, persons with self-reported injuries identified via New York State and Occupational Safety and Health Administration forms and control nurses without self-reported injuries. For survey, convenience sample of hospital nurses, laboratory workers, and maintenance workers. MAIN OUTCOME MEASURES Circumstances of injuries determined by study questionnaires. Employee opinions obtained by questionnaires and discussions during small group sessions. RESULTS Three hundred sixty-one persons reported sharps injuries, of whom 72 (20%) had disposal-related injuries. Persons with disposal-related injuries included four hospital visitors and one patient. Of 67 disposal-related injuries among employees, 25 (37%) directly involved use of a sharps disposal container. Significant risk factors for injury included container height greater than 4 ft above the floor, distance less than 5 ft from site of sharp object use to nearest container, and lack of attendance at universal precautions inservice classes. Survey groups involved 69 employees who identified a variety of preferred features for sharps disposal containers. CONCLUSIONS Disposal of sharp objects is an important cause of sharps injuries. Ergonomic factors, worker education, and appropriate container design should be considered in injury prevention strategies. Relevant guidelines and regulations are lacking and are needed.

Increased Mortality in African Americans with Idiopathic Pulmonary Arterial Hypertension

BACKGROUND Idiopathic pulmonary arterial hypertension (IPAH) is a progressive disorder that usually culminates in right ventricular failure and death without treatment. OBJECTIVE To assess mortality trends by race and gender for idiopathic pulmonary arterial hypertension in the United States from 1994-1998. METHODS The U.S. National Center for Health Statistics data for the years 1994-1998 was reviewed for deaths in which the underlying cause was primary pulmonary hypertension (ICD-9 code 416.0), now known as IPAH. The age, gender, race and state of residence of the deceased were abstracted from the Centers for Disease Control Wonder System (http://wonder.cdc.gov). Average annual age-adjusted region-, race- and gender-specific rates were then calculated. RESULTS African-American women demonstrated the highest mortality rates for IPAH across all age groups compared to other racial and gender groups. No geographical differences in mortality rates were noted. An increase in mortality rates with advancing age was observed in all racial and gender groups, with the highest mortality rates for IPAH noted in the elderly. DISCUSSION African Americans with IPAH exhibit a substantially increased mortality compared with Caucasians, particularly African-American women.

Parkinsonism Death Rates by Race, Sex and Geography: A 1980s Update

To evaluate temporal changes in the geographic distribution of Parkinsons disease (PD) mortality in the United States, we reviewed death rates for PD in the nine regions of the United States for 1980-1984. Age-adjusted mortality for all ages and for the elderly (65 years of age and older) was analyzed. Variation in PD mortality was observed among the regions for all demographic groups. The patterns were different from those reported during 1959-1961. Changing geographic patterns in mortality provide evidence for an environmental etiology for PD.

Geographic distribution of pulmonary embolism mortality rates in the United States, 1980 to 1984

The identification of individuals who are at high risk for developing PE has focused on clinically identified groups. Epidemiologic characterization of high-risk populations has been less successful. To provide a demographic basis for further epidemiologic inquiry into groups at high risk for PE, we investigated the geographic distribution of PE mortality rates in the United States from 1980 to 1984. We found that for most sections of the United States, PE mortality rate patterns mirrored those that were observed previously for the nation. Men had greater PE mortality rates than women in most regions, and nonwhites had greater PE mortality rates than did whites. The exception to this pattern was the Pacific region, where the PE mortality rate was lower than rates in other parts of the country, particularly among nonwhites. This pattern probably reflects the different racial compositions in the regional populations of the United States, with corresponding PE risk factor differences. However, the specific risk factors that are responsible for these patterns have not been identified. Further inquiry into these geographic patterns may provide a means for the prevention of high PE morbidity and mortality rates.

Parkinson's and Motoneuron Disease Morbidity in the Twin Cities Metropolitan Area: 1979–1984

To better characterize the morbidity from Parkinsons disease and motoneuron disease, we examined hospital discharge diagnosis data for all acute care facilities (except for the Veterans Administration Medical Center) in the Minneapolis-St. Paul area in each year from 1979 to 1984 for persons aged 30-74 years. For each person in whom the discharge diagnosis included either Parkinsons disease or motoneuron disease, the age, gender, and year of admission were recorded. Annual age-gender-specific and age-adjusted gender-specific hospital discharge diagnosis rates were calculated. For Parkinsons disease, for both, men and women, the age-adjusted hospital discharge diagnosis rate declined by 26-27%. Component age-specific data for Parkinsons disease showed more variable temporal changes. For motoneuron disease, no temporal changes were observed, although the number of observations was small. These data suggest that Parkinsons disease is declining in prevalence in the hospitalized population. The implications for motoneuron disease are less clear. Further studies in this area are needed.