Frances M. Murphy

On the production of neurologists in the United States : an update

Based primarily on a survey of all neurology residency training programs in the United States conducted in 1985–1986, the average annual production (incidence) of general neurologists for 1980–1986 was 363.6 and of child neurologists for 1982–1986,53.8. About ¼ of these general neurologists and ⅓ of child neurologists are women; about ¼ of either are foreign medical graduates, predominantly foreign-born. Data routinely published by the AMA well match the questionnaire information. First postgraduate year of training was in internal medicine for ⅔ of general neurologists. Board certifications have recently averaged 290.9 (general) and 37.1 (child) per annum. From life-table calculations, prevalence of general neurologists in 1990 is estimated at 7,500 fully-trained and 5,500 board-certified, and of child neurologists near 1,100 trained and over 600 certified. The number of neurologists is predicted to plateau near the year 2020 at some 13,700 trained, including 1,700 child neurologists, and 9,800 certified (1,100 child). The maximal prevalence rate for all neurologists will be 4.75 per 100,000 population in 2010, declining then to 4.42 by 2050; those rates provide shortfalls of 30% and 35%, respectively, compared with previously calculated needs for neurologists.

Epidemiology of Multiple Sclerosis in US Veterans

Previously, we studied the effect of population ancestry on the risk of multiple sclerosis (MS) in US veterans of World War II, comparing by state 1980 US census ancestry data with MS case/control rat

The changing patterns of death rates in parkinsonism

Annual crude death rates due to parkinsonism in Denmark, 1956 to 1985, and the United States, 1950 to 1984, showed a consistent hierarchy, with white male rates greater than white female than black male than black female. Rates rose sharply in both lands and sexes between 1976 and 1984. Age-specific death rate curves for whites in the 1960s and 1980s were very similar between the countries with a regular male excess. Both countries drastically changed the configuration of all the death rate age curves in parallel fashion between the 2 periods: rates were now nearly twice those of the earlier interval for each sex, age, and race, and were then maximal at age 82 or 85 + as opposed to the prior peak at age 77 or 80. Age-adjusted rates did not consistently reflect this change, being markedly lower for US white females despite their age-specific rate increases. This discrepancy appears to be an artifact of changing population distributions which increasingly differ by age between sexes and countries over time. When the recent age-specific death rates were recalculated with the thesis that all deaths had occurred at ages 5 years younger, all the 1980s death rate configurations returned to those of the 1960s, with but modest increases at most ages. This is evidence that age at death, and thus survival, has increased at all ages by about 5 years since the introduction of levodopa, released in the US in 1970 and in Denmark in 1971. The increase in the annual death rates is also taken as an indirect result of therapy, with proportionately more parkinsonians now diagnosed and under continued treatment, and thus now more likely to have the disorder listed on a death certificate.

Death rates from Parkinson's disease in Norway reflect increased survival

Age-specific death-rate curves for Parkinsons disease in Norway for 1970 to 1974 and 1980 to 1985 were very similar in configuration to those at like periods in the United States and Denmark. As with the United States and Denmark, the pattern of a steady, progressive increase with age in the 1980s reverted to the earlier configurations, which showed maximal rates near ages 80, when the Norwegian rates were recalculated by attributing all deaths to ages 5 years younger.