Tanja Srebotnjak

Cigarette smoking prevalence in US counties: 1996-2012

BackgroundCigarette smoking is a leading risk factor for morbidity and premature mortality in the United States, yet information about smoking prevalence and trends is not routinely available below the state level, impeding local-level action.MethodsWe used data on 4.7 million adults age 18 and older from the Behavioral Risk Factor Surveillance System (BRFSS) from 1996 to 2012. We derived cigarette smoking status from self-reported data in the BRFSS and applied validated small area estimation methods to generate estimates of current total cigarette smoking prevalence and current daily cigarette smoking prevalence for 3,127 counties and county equivalents annually from 1996 to 2012. We applied a novel method to correct for bias resulting from the exclusion of the wireless-only population in the BRFSS prior to 2011.ResultsTotal cigarette smoking prevalence varies dramatically between counties, even within states, ranging from 9.9% to 41.5% for males and from 5.8% to 40.8% for females in 2012. Counties in the South, particularly in Kentucky, Tennessee, and West Virginia, as well as those with large Native American populations, have the highest rates of total cigarette smoking, while counties in Utah and other Western states have the lowest. Overall, total cigarette smoking prevalence declined between 1996 and 2012 with a median decline across counties of 0.9% per year for males and 0.6% per year for females, and rates of decline for males and females in some counties exceeded 3% per year. Statistically significant declines were concentrated in a relatively small number of counties, however, and more counties saw statistically significant declines in male cigarette smoking prevalence (39.8% of counties) than in female cigarette smoking prevalence (16.2%). Rates of decline varied by income level: counties in the top quintile in terms of income experienced noticeably faster declines than those in the bottom quintile.ConclusionsCounty-level estimates of cigarette smoking prevalence provide a unique opportunity to assess where prevalence remains high and where progress has been slow. These estimates provide the data needed to better develop and implement strategies at a local and at a state level to further reduce the burden imposed by cigarette smoking.

How Much Will I Get Charged for This? Patient Charges for Top Ten Diagnoses in the Emergency Department

Objectives We examined the charges, their variability, and respective payer group for diagnosis and treatment of the ten most common outpatient conditions presenting to the Emergency department (ED). Methods We conducted a cross-sectional study of the 2006–2008 Medical Expenditure Panel Survey. Analysis was limited to outpatient visits with non-elderly, adult (years 18–64) patients with a single discharge diagnosis. Results We studied 8,303 ED encounters, representing 76.6 million visits. Median charges ranged from

Health Care as a “Market Good”? Appendicitis as a Case Study

740 (95% CI

Migration and risk: net migration in marginal ecosystems and hazardous areas

651–

Emergency Department Charges for Asthma-Related Outpatient Visits by Insurance Status

817) for an upper respiratory infection to

The association of trauma center closures with increased inpatient mortality for injured patients

3437 (95% CI

Is emergency department closure resulting in increased distance to the nearest emergency department associated with increased inpatient mortality

2917–

A global Water Quality Index and hot-deck imputation of missing data

3877) for a kidney stone. The median charge for all ten outpatient conditions in the ED was

System-level health disparities in California emergency departments: minorities and Medicaid patients are at higher risk of losing their emergency departments.

1233 (95% CI

Key drivers for unsustainable resource use – categories, effects and policy pointers

1199–