Is the high ischemic heart disease mortality rate in New York State just an urban effect?

To determine whether New York State''s high ischemic heart disease mortality rate was due primarily to an urban effect, rates for regions in the State were compared with each other and with national data. New York State mortality rates for the period 1980-87 were highest for New York City (344.5 per 100,000 residents), followed by upstate urban and rural areas (267.1-285.1), and New York City suburbs (272.5). However, the overall 1986 age-adjusted rate for the New York State region with the lowest mortality rate (265.7) exceeded that of 42 States. New York State''s number one ischemic heart disease mortality ranking reflects the need for statewide intervention programs, because even regions with relatively low mortality rates are high when they are compared with national rates.     

Mycobacterium tuberculosis transmission in a newborn nursery and maternity ward--New York City, 2003

Evaluating young children recently exposed to airborne Mycobacterium tuberculosis is a public health priority. If infected, children aged <2 years are at high risk for severe tuberculosis (TB) disease (e.g., TB meningitis). In December 2003, infectious pulmonary TB disease was diagnosed in a foreign-born nurse working in the newborn nursery and maternity ward of a New York City hospital (hospital A); the nurse had declined treatment for latent TB infection (LTBI) after testing positive 11 years earlier. An investigation including medical evaluation of contacts in the nursery and maternity ward was conducted by the Bureau of TB Control (BTBC) at the New York City Department of Health and Mental Hygiene, hospital A, and CDC. This report summarizes the results of that investigation, which determined that approximately 1,500 patients had been exposed to the nurse but the majority could not be located for evaluation. Among those who were tested, four infants had positive tuberculin skin test (TST) results, likely attributable to recent transmission of M. tuberculosis. The findings emphasize the difficulty of conducting contact investigations in certain settings and the importance of effective LTBI testing and treatment programs for health-care workers (HCWs) to prevent TB disease and subsequent health-care--associated transmission.     

Commentary: tuberculosis in New York City--the consequences and lessons of failure.

The resurgent tuberculosis epidemic represents--especially in New York City--a failure to maintain a public health infrastructure that was focused on preventing active disease in high-risk populations (i.e., individuals with the human immunodeficiency virus [HIV]) and on treating active tuberculosis patients until cured. Although the tuberculosis problem in New York City and other localities is worsened by homelessness, poverty, and substance abuse, it is possible to bring tuberculosis under control by directing public health resources into targeted programs that enhance compliance with tuberculosis treatment regimen and expand chemoprophylaxis efforts among HIV-infected individuals. These two avenues will decrease, respectively, the number of cases of multidrug-resistant tuberculosis and the total number of new cases.     

2010年郑州市儿童医院轻重症手足口病患儿流行病学分析

目的了解郑州及周边地区住院轻重症手足口病病例流行病学特征及其对比情况,掌握其流行规律,为防治提供依据。方法应用描述性流行病学方法及卡方检验进行分析。结果住院轻症手足口病病例以5～7月份发病率最高,郑州市各县(市)区病例数占66.4%,以4岁以下发病率最高,男女比1.57∶1;住院重症病例以3～8月份发病率最高,男女比1.73∶1,郑州市各县(市)区病例数占71.4%,以3岁以下发病率最高,PE和EV71混合阳性率最高为66.3%,占总阳性数的82.8%。住院手足口病病例1～2岁年龄组发病数最多为615例,占44.4%。结论住院重症病例发病高峰年龄较轻症患儿普遍小1岁左右,发病季节较轻症患儿较早,且持续时间长,男孩发病多于女孩,其中1～2岁年龄段是轻重症手足口病病例共同发病高峰。住院重症手足口病病例主要病原体是EV71型,且多与PE型病原体混合性感染。     

Targeting tuberculosis testing: the yield of source case investigations for young children with reactive tuberculin skin tests

OBJECTIVE: This study was designed to determine the yield of investigations whose aim is to identify a source case for tuberculosis infection among tuberculin reactors 3 years of age or younger. METHODS: The authors describe the results of associate investigations conducted for child tuberculin reactors reported from January 1, 1996, through June 30, 1998. Associates were defined as individuals who live with or spend significant time with a child reactor. An associate investigation was defined as evaluation of at least one associate. A source case was an associate older than 10 years of age who had culture-positive, pulmonary tuberculosis during a period when the child could have been exposed. RESULTS: Two hundred seven children had an associate investigation performed with a median of four associates investigated per child (range 1-21). Birthplace was known for 187 (90%); 128 were U.S.-born. Of 1,222 associates identified, 980 (80%) were evaluated. Among 452 (46%) associates for whom birthplace was known, 250 (55%) were non-U.S.-born. Of 980 associates, 668 were household contacts; 198 (30%) were infected, three had prior tuberculosis disease, and three had active tuberculosis. Two active cases met source case criteria; the yield was 0.9 (2 of 207) source cases per 100 children investigated. Of 312 non-household contacts, 57 (18%) were infected and none had the disease. CONCLUSIONS: Although few source cases were identified for young tuberculin skin test reactors in New York City, investigations identified a proportion of cases and infection in associates similar to that identified among contacts to pulmonary tuberculosis cases. Such investigations may be identifying a high-risk group and should be considered, depending on program resources.     

Legionnaires’ Disease Incidence and Risk Factors,New York,New York,USA, 2002–2011

Incidence of Legionnaires’ disease in the United States is increasing. We reviewed case records to determine the the epidemiology of and risk factors for the 1,449 cases reported to the New York City Department of Health and Mental Hygiene, New York, New York, USA, during 2002–2011. The highest incidence (2.74 cases/100,000 population) occurred in 2009; this incidence was higher than national incidence for that year (1.15 cases/100,000 population). Overall, incidence of Legionnaires’ disease in the city of New York increased 230% from 2002 to 2009 and followed a socioeconomic gradient, with highest incidence occurring in the highest poverty areas. Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires’ disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease.     

Molecular epidemiology of tuberculosis after declining incidence, New York City, 2001-2003

Tuberculosis incidence in New York City (NYC) declined between 1992 and 2000 from 51.1 to 16.6 cases per 100,000 population. In January 2001, universal real-time genotyping of TB cases was implemented in NYC. Isolates from culture-confirmed tuberculosis cases from 2001 to 2003 were genotyped using IS6110 and spoligotype to describe the extent and factors associated with genotype clustering after declining TB incidence. Of 2408 (91.8%) genotyped case isolates, 873 (36.2%) had a pattern indistinguishable from that of another study period case, forming 212 clusters; 248 (28.4%) of the clustered cases had strains believed to have been widely transmitted during the epidemic years in the early 1990s in NYC. An estimated 27.4% (873 minus 212) of the 2408 cases were due to recent infection that progressed to active disease during the study period. Younger age, birth in the United States, homelessness, substance abuse and presence of TB symptoms were independently associated with greater odds of clustering.     

Impact of the AIDS epidemic on morbidity and mortality among intravenous drug users in a New York City methadone maintenance program.

To examine the impact of the AIDS epidemic on morbidity and mortality in a defined population of intravenous drug users, we analyzed overall and cause-specific death rates, AIDS incidence, and acute medical hospitalizations among patients in a long-term methadone maintenance program in New York City for the years 1984 through 1987 (midyear population for each year 828 to 891; demographic characteristics did not differ). The number of deaths while in treatment increased from 11 (13.3/1000) in 1984 to 39 (44.2/1000) in 1987. Deaths from AIDS increased from 3.6/1000 to 14.7/1000, deaths due to bacterial pneumonia/sepsis from 3.6/1000 to 13.6/1000; deaths from cirrhosis, drug overdose, trauma, and other causes remained relatively stable. AIDS incidence rose from six cases/1000 in 1984 to 20.4.1000 in 1987. Hospitalizations for AIDS, pneumonia, tuberculosis, and endocarditis/sepsis increased from 84.9/1000 in 1986 to 144.8/1000 in 1987. These data suggest that the AIDS epidemic has had a profound effect on patterns of morbidity and mortality among intravenous drug users in this methadone program population. Drug treatment programs may be important sites for targeting clinical services for drug users with AIDS, although the increasing burden of AIDS-related disease will require expansion of existing funding and treatment resources.     

2014—2018年江苏宜兴市学生肺结核疫情分析

目的通过对2014—2018年宜兴市学生肺结核病例的处置分析,为学生肺结核防控提供依据。方法对宜兴市2014—2018年发生的学生肺结核病例采用描述流行病学进行分析。结果宜兴市2014—2018年共发生肺结核患者1614人,其中学生肺结核患者135人,占8.36%,卡方趋势分析这几年来存在升高趋势(χ2=3.46,P<0.001),年均发病率2.27/10万,男性多于女性,年龄分布以16~18岁为主,职业以高中生为主,发病高峰主要受聚集性疫情影响集中在6月与12月。结论宜兴市肺结核疫情总体而言已呈现下降趋势,但学生肺结核病例近几年曾现上升趋势,主要由于暴发疫情引起,后期要加强卫生与教育部门的合作,对病例的早发现有重要意义。     

Varicella-related deaths--United States, January 2003-June 2004

During 2003 and the first half of 2004, CDC received reports of eight varicella-related deaths. The age of the decedents ranged from 1 to 40 years. Six of the eight deaths occurred among children and adolescents aged <20 years. The cases were reported from Arizona (two), Maryland (two), Arkansas (one), New Hampshire (one), Ohio (one), and New York City (one). Six deaths occurred in unvaccinated persons. Vaccination status of the remaining two persons could not be determined. This report describes clinical data for three of the fatal varicella cases in children, reported from Arizona, Arkansas, and New York City; all three patients were susceptible and unvaccinated, but otherwise healthy. The three other children and adolescents, not described in detail in this report, were immunocompromised as a result of at least one preexisting condition. The findings in this report underscore 1) the importance of timely routine vaccination of children aged 12--18 months and catch-up vaccination of older susceptible children and adolescents according to current recommendations and 2) the need for timely and complete national varicella death surveillance.     

New York City's tuberculosis control efforts: the historical limitations of the "war on consumption".

New York City began America's first campaign to control tuberculosis in 1893, and the disease declined until the 1970s. Throughout the 20th century, New York relied on three control strategies: screening, supervised therapy, and detention of noncompliant persons. Officials consistently identified the persistent foci of tuberculosis to be minorities and the poor, and they concentrated efforts among these populations. Recently, however, in the setting of rising human immunodeficiency virus infection and homelessness, tuberculosis--including multidrug-resistant strains--has returned to New York with a vengeance. Tuberculosis control in the city has been limited by two problems that hamper many public health programs: (1) antituberculosis measures, while appropriately targeting the poor, have been inconsistently funded and poorly coordinated; and (2) efforts have emphasized detection and treatment of individual cases rather than improvement of underlying social conditions. Renewed efforts by New York and other cities must address these limitations.     

2019-2021年我国4省份报告儿童肺结核病例特征分析

目的 分析北京市、湖北省、重庆市和四川省（4省份）报告的0~14岁儿童肺结核的情况,为儿童结核病防治政策提供依据。方法 利用中国疾病预防控制信息系统传染病报告信息管理系统和结核病信息管理系统收集儿童肺结核病例报告资料,采用描述流行病学方法,分析儿童肺结核病例的就诊流向、流行特征及纳入管理等情况。利用Excel 2015、R 4.1.2及Echart 4.7.0软件进行统计学和数据可视化分析。结果 2019-2021年4省份共报告6 811例儿童肺结核病例,其中,临床诊断病例4 741例（69.6%）,确诊病例2 070例（30.4%）。共有526家不同类型的医疗卫生机构报告儿童肺结核病例,其中综合医院356家（67.7%,356/526）,共报告4 706例;传染病医院11家（2.1%,11/526）,共报告836例;儿童医院5家（1.0%,5/526）,共报告542例。报告的本地病例6 249例（91.7%）,外地病例562例（8.3%）;2019-2021年本地病例报告发病率分别为6.20/10万、7.10/10万和7.20/10万,呈逐年上升趋势。男女性别比为0.98∶1（3 373∶3 438）;年龄分布以10~14岁组为主,共4 887例（71.8%）;人群分类以学生为主,共5 167例（75.9%）。本地病例和外地病例的纳入管理率分别为20.60%和2.67%。结论 2019-2021年4省份儿童肺结核病例的主要就诊医疗机构为儿童医院、传染病医院和结核病专科医院,四川省儿童结核病疫情较严重,2020年外省病例跨省就医的比例明显降低。男性发病数低于女性,10~14岁学生是儿童肺结核高发人群。外地病例的纳入管理率低于本地病例。     

A mortality analysis of Native American in New York State, 1980-86

This investigation examined the mortality experience of Native Americans in New York State, exclusive of New York City, between 1980 and 1986. Compared to the general population of New York State, exclusive of New York City, deaths among Native Americans occurred an average of nine years earlier. Among Native males, elevated risk of death was noted for tuberculosis, diabetes mellitus, pneumonia and cirrhosis. Native females demonstrated an excess of deaths due to diabetes mellitus and cirrhosis. Fewer than expected malignant neoplasm deaths occurred among both Native males and females. A deficit of deaths was observed for colon and lung cancer deaths among Native males and for colon and breast cancer deaths among Native females. While these results are generally in agreement with previous reports, this study did not identify an excess of deaths due to accident-related mortality. Findings from this study, while limited, do serve as crude indicators of the overall health status of Native Americans in New York State and may prove useful in the context of planning and evaluating future health care services among this population.     

The Homeless Child Health Care Inventory: assessing the efficacy of linkages to primary care.

Each year, the New York City homeless family shelter system provides transitional housing for nearly 20,000 homeless children. While the health care needs of these children are substantial, there is currently no system-wide mechanism for ensuring that they have access to appropriate medical care. This report analyzes information from the Homeless Child Health Care Inventory, a survey conducted by Montefiore Medical Center''s Division of Community Pediatrics, to examine the adequacy of health care resources available to the homeless children in New York City. Results showed that available health care resources varied considerably throughout the shelter system and that nearly 50% of homeless children in New York City did not have access to appropriate medical care.     

英德市2009—2016年手足口病流行特征分析

目的 分析英德市2009—2016年手足口病流行特征,为制定防控策略提供科学依据。方法 收集“中国疾病预防控制信息管理系统”中英德市的手足口病例数据,采用描述流行病学方法对英德市2009—2016年手足口病疫情报告资料进行统计分析。结果 英德市2009—2016年共报告手足口病 15 126例,年均报告发病率为170.64/10万,其中重症54例,死亡6例;男性9 734例,女性5 392例,男女性别比为1.81：1;发病年龄最小2天,最大69岁,发病以5岁以下儿童为主,占报告发病总数的96.07%,重症与死亡病例多发生于3岁以下儿童;职业以散居儿童为主,占发病总数的81.92%;全年各月份均有发病,发病高峰集中在5~7月份,占发病总数的60.96%。结论 英德市手足口病发病呈高发态势,其发生具有时间、性别、年龄和职业差异,低龄、男性儿童是手足口病的高发人群,今后应采取持续开展健康教育宣传、加强日常监测工作、有效处理疫情和进行疫情风险分析等综合性防治措施,切实预防和控制英德市手足口病暴发流行。     

基于传染病监测系统的肺结核疫情和流行特征

目的探讨2011—2020年长沙市肺结核发病趋势和流行特征。方法采用回顾性分析方法,从中国疾病预防控制信息系统的传染病监测系统中导出长沙市2011—2020年肺结核报告发病信息,对肺结核病例在时间、地区、年龄、性别和职业等方面的分布特征及流行趋势进行描述性分析。结果2011—2020年间,长沙市肺结核报告发病人数共48587例,年均报告发病率为62.94/10万(56.44/10万~84.34/10万);报告病原学阳性肺结核共18455例,年均报告发病率23.91/10万(19.91/10万~28.88/10万);2017—2020年报告利福平耐药共251例,年均利福平耐药发病率0.81/10万(0.61/10万~0.85/10万)。长沙市2011—2020年肺结核报告发病率总体呈下降趋势(Z=32.4355,P=0.0001),年递降率为4.36%。地区分布位居前三位的分布是浏阳市、宁乡市和望城区,年均发病率分别为79.98/10万、79.31/10万和67.80/10万;性别分布以男性为主,年均报告发病率男性和女性分别为87.92/10万和39.71/10万,男性和女性年均递减率分别为5.38%和2.47%。年龄分布中,<15岁年龄组、15~岁组和65岁及以上组的年均肺结核报告发病率分别为2.38/10万、62.31/10万和150.19/10万。职业分布中以农民为主,其次是家务及待业人员和离退人员;学生的发病数及占比都有明显升高,2020年占比达第四位(5.64%)。结论2011—2020年长沙市肺结核报告发病总体呈稳定下降趋势,应进一步加强对农村人口、学生和65岁以上老年人等重点人群的结核病防控工作。     

Tuberculosis surveillance using death certificate data,New York City, 1992.

OBJECTIVE. To determine the accuracy and frequency of reporting tuberculosis as either the contributing or underlying cause of death on death certificates in New York City during 1992. METHODS. Death certificates from 1992 that listed tuberculosis were matched with the New York City tuberculosis registry. For those persons who had tuberculosis listed as a cause of death, but who were not listed in the registry, medical records were reviewed. The frequency of reporting tuberculosis on death certificates in patients who died with active tuberculosis was evaluated in the second part of this study. Death certificates of patients with active tuberculosis (persons who died within six months of starting anti-tuberculosis medications) in 1992 were reviewed. RESULTS. Tuberculosis was listed on 635 death certificates; 377 (59%) were confirmed cases based on registry data. Reviews of medical records were possible for 230 (89%) of the remaining 258 patients and confirmed only two additional tuberculosis cases. Of 310 persons who died with active tuberculosis in 1992 (second part of the study), only 104 (34%) had tuberculosis listed on their death certificates. CONCLUSIONS. In New York City, a diagnosis of tuberculosis on death certificates is an inaccurate measure of tuberculosis burden.     

Peer Reviewed: Overreporting of Deaths From Coronary Heart Disease in New York City Hospitals, 2003

Introduction

New York City has one of the highest reported death rates from coronary heart disease in the United States. We sought to measure the accuracy of this rate by examining death certificates.

Methods

We conducted a cross-sectional validation study by using a random sample of death certificates that recorded in-hospital deaths in New York City from January through June 2003, stratified by neighborhoods with low, medium, and high coronary heart disease death rates. We abstracted data from hospital records, and an independent, blinded medical team reviewed these data to validate cause of death. We computed a comparability ratio (coronary heart disease deaths recorded on death certificates divided by validated coronary heart disease deaths) to quantify agreement between death certificate determination and clinical judgment.

Results

Of 491 sampled death certificates for in-hospital deaths, medical charts were abstracted and reviewed by the expert panel for 444 (90%). The comparability ratio for coronary heart disease deaths among decedents aged 35 to 74 years was 1.51, indicating that death certificates overestimated coronary heart disease deaths in this age group by 51%. The comparability ratio increased with age to 1.94 for decedents aged 75 to 84 years and to 2.37 for decedents aged 85 years or older.

Conclusion

Coronary heart disease appears to be substantially overreported as a cause of death in New York City among in-hospital deaths.     

2008 - 2017年湖北省水痘流行病学分析

目的 全面分析湖北省2008 - 2017年水痘流行病学特征,为控制水痘的暴发和流行提供科学依据。方法 通过中国疾病控制信息系统,收集水痘个案和暴发疫情信息,运用描述性流行病学方法对湖北省10年间水痘报告病例进行分析。结果 10年间湖北省共报告水痘病例218 426例,年平均发病率为37.83/10万,水痘发病时间高峰期分别为5 - 6月,11 - 12月至次年的1月。湖北省各地市以神农架林区发病最高,年平均发病率为200.84/10万、其次是恩施州（71.92/10万)、十堰市（67.63/10万）,水痘报告病例中男女比例为1.34∶1,主要发病年龄为20岁以下的人群,其中3～14岁发病率较高,职业分布主要为学生、幼托儿童、散居儿童;暴发疫情以小学为主,占80.93%。结论 发病人群主体是学生,发病地区以山区发病率较高,应加强山区经济欠发达地区人群的健康教育及疾病监测和处置。发病主要场所是学校,应提高学校监测的敏感性,做到早发现、早诊疗、早隔离。     

2009-2014年许昌市0～6岁儿童传染病流行病学分析

摘要:目的　分析2009-2014年许昌市0～6岁儿童法定报告传染病流行特征,为预防控制传染病提供科学依据。方法　采用描述流行病学方法进行数据分析。结果　2009-2014年共报告许昌市0～6岁儿童法定传染病28种42229例,年均发病率为1683.96/10万。前5位的病种为手足口病、流行性腮腺炎、其它感染性腹泻、细菌性痢疾和麻疹。不同年龄发病情况和疾病谱构成不同,手足口病、细菌性痢疾、其它感染性腹泻、麻疹发病率随年龄增长下降,流行性腮腺炎发病率随年龄增长上升;0～岁组儿童新生儿破伤风、梅毒、丙肝、肺结核发病率高于其他年龄组。肠道传染病发病最高峰出现在4-5月（占45.28%）,呼吸道传染病发病最高峰出现在4-6月（占42.52%）,虫媒及自然疫源性疾病发病高峰期为7-9月（占87.50%）,血源及性传播疾病无明显发病高峰。结论　许昌市0～6岁儿童传染病发病率高,是传染病预防控制工作的重点针对人群,应根据疾病谱、流行特征采取有效措施减少疫情发生。