John J. Hisnanick

Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.

OBJECTIVES This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.

Assessing a disaggregated energy input: Using confidence intervals around translog elasticity estimates☆

The role of energy in the production of manufacturing output has been debated extensively in the literature, particularly its relationship with capital and labor. In an attempt to provide some clarification in this debate, a two-step methodology was used. First, under the assumption of a five-factor production function specification, we distinguished between electric and non-electric energy and assessed each components relationship with capital and labor. Second, we calculated both the Allen and price elasticities and constructed 95% confidence intervals around these values. Our approach led to the following conclusions: that the disaggregation of the energy input into electric and non-electric energy is justified; that capital and electric energy and capital and non-electric energy are substitutes, while labor and electric energy and labor and non-electric energy are complements in production; and that capital and energy are substitutes, while labor and energy are complements.

Modeling economies of scale : the case of US electric power companies

Modeling and validating the existence of technical progress within the neoclassical production function specification has been facilitated through the translog functional form. However, attempts to separate out the effects of technical progress and returns to scale has been limited. This study develops and presents a model for testing the existence of these two separate effects using data from a sample of US electric power companies. The analysis found that for these electric utilities there existed increasing returns to scale and technical progress that was energy using but capital-neutral. However, scale effects were found to be a dominant factor in lessening the impact of declining average productivity.

Hospital Resource Utilization by American Indians/Alaska Natives for Alcoholism and Alcohol Abuse

Previous work examining the issue of alcoholism and alcohol abuse among American Indians and Alaska Natives can be broadly categorized as either descriptions of the consumption patterns and behaviors of specific tribes or mortality studies, focusing on deaths due to alcoholism, alcohol abuse, chronic liver disease, or cirrhosis. A major shortcoming of previous studies has been that they have not looked at the burden this problem has imposed upon the system of health care delivery for this minority population. By using an International Classification of Diseases, Ninth Revision, Clinical Modification taxonomy of diagnostic codes developed by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and the national Indian Health Service (IHS) inpatient database for direct and contract admissions, utilization patterns for 43 IHS facilities were investigated. The period of study was 1980-1988, and our case definition included any individual 14 years and older who had any mention upon discharge of an alcohol-related diagnosis (ARD). For the 9-year period under investigation, 43,302 adult inpatient admissions occurred at the 43 IHS facilities for ARD. These admissions accounted for an overall estimated per annum rate of 13.7% of the adult inpatient days. In addition, age and gender specific discharge rates for ARD were estimated and compared to reported ARD discharge rates of the United States civilian population prepared by the NIAAA using the National Hospital Discharge Survey over the period 1979-1988. In contrast, the IHS discharge rates for ARD were three times greater than reported ARD discharge rates for the United States civilian population.

A Great Place to Start: The Role of Military Service on Human Capital Formation

The earnings of African-American males have increased over the past 50 years, but differences remain in their economic progress relative to either white or Asian Americans. Labor market disadvantages in the past were the result of overt discrimination; however, the earnings gap experienced over the last four decades has been linked to human capital differences. It is hypothesized that military service provides a buffer for adverse labor market characteristics for young African-American males and this paper discusses the returns from military service as reflected in their post-service wages. Copyright Fondazione Giacomo Brodolini and Blackwell Publishing Ltd 2003.

The Earnings of Tied-Migrant Military Husbands

Identifying the earnings penalty associated with being a tied mover has focused on the working wives of servicemen. However, the number of women serving in the armed forces now makes it feasible to study the earnings losses of a group of tied-mover males, the husbands of servicewomen. Using data from the 2000 U.S. Census, the authors identified a sample of such men and compare their earnings to civilian husbands of working civilian wives to extend and generalize on tied-mover earnings effects. Multivariate analysis accounting for selection bias and controlling for migration, demographic, household, and labor market characteristics shows that military husbands earn about 70 percent of civilian husbands, whereas military wives earned about 50 percent of civilian wives. Since different estimation procedures provide comparable outcomes regardless of gender, these results reveal a detrimental earnings effect for military husbands similar to earlier estimates for military wives.

Forecasting the demand for inpatient services for specific chronic conditions

While the proposed forecasting methodology has a well-established record in evaluating economic time-series, there is minimal, if any, use of this technique in projecting hospitalizations for specific chronic conditions. Using an established taxonomy of disease codes for alcoholism and alcohol abuse in a national inpatient database, a monthly time-series of hospitalizations was modeled. The model derived is both statistically adequate and accurate in forecasting future monthly demand for inpatient hospitalizations. This type of model specifications could be used by hospital planners and policy makers in evaluating monthly resources for specific chronic conditions.

The impact of disaggregated energy on productivity: A study of the US manufacturing sector, 1958–1985

Abstract The issue of the productivity slowdown of the 1970s and 1980s has received considerable analysis in the literature. However, the issue of the impact of energy on productivity is still debated. This study contributes to the debate, with the hope that some sight could be provided through disaggregating the factor input energy into two components; a petroleum component and a non-petroleum component. By analysing labour productivity growth, total factor productivity growth and labour intensity ratios, the disaggregated energy component can be viewed as a major influence in explaining the productivity decline.

Comparative analysis of violent deaths in American Indians and Alaska Natives

Accidents, injuries, and outcomes from adverse effects have been identified as the second leading cause of death for American Indians and Alaska Natives (AI/AN). However, no studies have been done which analyze violent deaths (homicides, suicides, and other accidents) for this population with a focus on time trends. For this study, overall and gender-specific mortality rates due to violent deaths were computed for 1973-88. The results indicate that overall and gender-specific mortality rates for violent deaths in AI/AN have been decreasing on average per year: homicide, 4.3%; suicide, 2.7%; other accidents, 5.6%. Similarly, age-adjusted rates have been declining, and at faster rates than those of the U.S. general population: homicide, 4.5% vs. 1.4%; suicide, 2.5% vs. 0.6%; other accidents, 6.2% vs. 2.6%. However, the male-female ratio for homicides and other accidents has remained unchanged, and the ratio for suicide has been increasing. While the gap between age-adjusted rates have been narrowing, the age-adjusted rates for AI/AN have remained consistently above those of the U.S. general population.

An alternative safety net to patient dumping

Hospitals adjusted their admitting practices and treatment protocols in response to the prospective payment system (PPS) enacted by the Health Care Financing Agency over a decade ago. Under PPS it is often not profitable for a hospital to admit and treat chronically ill individuals, with Medicare coverage, who may require extended periods of in‐patient care. It has been suggested in the literature that hospitals engage in “patient dumping”, or shifting high‐cost Medicare patients to public hospitals, to minimize loses. Institutional factors and market deficiencies result in discriminatory practices towards poor, elderly and disabled patients with limited or no health insurance coverage in the provision of health care. US Department of Veteran Affairs medical centers, however, provide an alternative, or safety net, for poor, elderly and disabled veterans who would be prime Medicare candidates for patient dumping.