Trends in cancer mortality among Puerto Rican-born migrants to New York City

Age-standardized cancer death rates in Puerto Rican-born males and females residing in New York City have been calculated for 1979-81, and compared with those for white non-Puerto Rican-born people. For all population groups the rates in 1979-81 have been compared with rates in 1969-71. For some cancer sites, in particular cancers of the lung, breast and ovary, the Puerto Rican migrant population exhibited rates well below those of other residents of New York at both time periods. For other sites, most notably colon cancer (and to a lesser extent, prostate and bladder cancer), the rates for Puerto Ricans were somewhat lower than those of other New Yorkers in 1979-81, but had very markedly increased from levels shown in the earlier period. The Puerto Rican-born population at each time period had considerably higher rates of stomach cancer and cervical cancer than did 'other' white New Yorkers. Although substantial reductions in risk for these sites occurred among Puerto Ricans during the intercensal period examined, these corresponded to the reductions among 'other' white New York residents. The trends are discussed with reference to differences in lifestyle patterns, especially diet.     

Income inequality and infant mortality in New York City

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6–29.6/1,000 live births: range in income inequality: 12.7–27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P<.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions. Data collection and initial analyses for this project were supported in part by an Investigator Award in Health Policy Research from The Robert Wood Johnson Foundation. The views expressed are those of the authors and do not imply endorsement by The Robert Wood Johnson Foundation.     

Active surveillance of maternal mortality in New York City

OBJECTIVES: This study examined the usefulness of computer-assisted active surveillance in identifying maternal deaths in New York City. METHODS: Computerized searches of hospital discharge and autopsy record databases were conducted for maternal deaths occurring in 1997. RESULTS: Active surveillance revealed 14 new maternal deaths not previously reported, an 88% increase. Nine of these deaths were found through the hospital discharge database search, 1 was found through the autopsy record search, and 4 were found in both searches. Overall maternal mortality ratios associated with active surveillance and routine surveillance were 24.3 and 13.0 deaths per 100 000 live births, respectively. CONCLUSIONS: Active surveillance of maternal mortality is useful in identifying new maternal deaths. Existing databases can be used relatively easily to augment routine surveillance of maternal mortality.     

Decrease in infant mortality in New York City after 1989.

OBJECTIVES: This study identified factors contributing to the rapid decline in infant mortality in New York City from 1989 to 1992. METHODS: Changes in birthweight distributions and in birthweight/age-, cause-, and birthweight/age/cause-specific mortality rates from 1988/89 (before the mortality reduction) to 1990/91 were identified from New York City vital statistics data. RESULTS: Infant, neonatal, and postneonatal mortality of very-low-birthweight (< 1500 g) and normal-birthweight infants decreased significantly. The declines were almost entirely due to decreases in birthweight-specific mortality rates, rather than increased birthweights. All races experienced most of these reductions. Mortality decreased significantly for 6 causes of death. These decreases were consistent with the birthweight/age groups experiencing mortality declines. CONCLUSIONS: Widespread, multiple perinatal and postnatal factors contributed to the decline in infant mortality.     

Cancer mortality among Puerto Rican-born residents in New York City

More than half the 800,000 Puerto Rican migrants living in the United States resided in New York City in 1970. Mortality statistics from 1969-1971 indicate that Puerto Rican natives in the metropolis have a standardized mortality ratio for cancer which is 77% of that of non-Puerto Rican white males and 81% of that of non-Puerto Rican white females. The age-adjusted death rates of the Puerto Rican-born residing in New York City for cancers of the lung, prostate, bladder, ovary, and rectum are low, ranging from 43-70% of those of non-Puerto Rican whites; rates for breast cancer and colon cancer are somewhat lower relative to those for non-Puerto Rican whites. As is true for Puerto Ricans on the island, migrants to New York City have excessive levels of cancer of the cervix and esophagus (each roughly three times that of non-Puerto Rican whites) and cancer of the stomach (almost twice that of non-Puerto Rican whites).     

Trends in intravenous drug abuse as reflected in national hepatitis reporting.

A procedure for obtaining an indicator of trends in illicit intravenous (I.V.) drug use-a form of drug use which is very harmful and difficult to measure-has been developed using national hepatitis surveillance data. Hepatitis reports are separated into two groups: one containing mostly cases related to transmission via I.V. drug use and the other containing cases related to transmission via personal contact and blood transfusion. The analysis of ten years of national hepatitis reporting (1966 to 1975) shows an almost ten-fold rise in drug-related hepatitis cases from 1966 to 1972. In the last three years the number of cases has declined but remains substantially greater than the pre-epidemic levels. The rise in I.V. drug-related cases began in the 1960's among minority groups living in the center cities of the East and West Coasts and spread during the 1970's into the suburbs of these cities and into metropolitan areas throughout the United States. Limitations of this indicator of I.V. drug use relate to the characteristics of the surveillance system and to the underlying relationship of hepatitis to I.V. drug use.     

Tuberculosis knowledge among New York City injection drug users.

Structured interviews measuring tuberculosis knowledge were administered to 494 New York City injection drug users, 31% of whom reported a history of having a reactive tuberculin skin test. Medical records review of a subsample confirmed the validity of self-reported data. Most respondents understood the mechanisms of tuberculosis transmission. Three fourths of the subjects did not fully understand the distinction between a reactive skin test and active tuberculosis, but those who reported a history of skin test reactivity were twice as likely to understand this distinction. Forty percent of subjects did not understand the importance of medication adherence. Misunderstandings, based on a recent lack of tuberculosis education, may contribute to the fear and confusion that interfere with efforts to control tuberculosis.     

Completeness of pediatric TB reporting in New York City

OBJECTIVE: Accurate surveillance of tuberculosis (TB) in children is critical because such cases represent recent transmission, but surveillance is difficult as only 10% to 50% of cases are culture-confirmed. Hospital-based sources were used to develop alternative surveillance to assess completeness of reporting for pediatric TB in northern Manhattan and Harlem from 1993 through 1995. METHODS: Alternative surveillance sources included ICD-9-CM hospital discharge codes for active TB and gastric aspirate reports. Cases identified by alternative surveillance were compared with cases previously reported to the New York City Department of Health (NYC DOH). RESULTS: Alternative surveillance detected 25 cases of possible pediatric TB, of which four (16%) had never been reported to the NYC DOH and three (12%) had been reported as suspect cases, but had not fulfilled the criteria for a reportable case of pediatric TB. Of these seven newly counted cases, three were detected by ICD-9-CM codes, three by a gastric aspirate log book, and one by both. In contrast, 13 other cases had been reported to the NYC DOH, but were undetected by our alternative surveillance; eight of these could be verified with available medical records. Thus, the demographic and clinical characteristics of the 25 detected and the eight undetected cases with available medical records were evaluated in this study. CONCLUSION: Alternative surveillance proved effective, was complementary to the NYC DOH surveillance efforts, and increased the number of pediatric TB cases identified during the study period by 21%.     

Trends in the AIDS epidemic among New York City’s injection drug users: Localized or citywide?

The New York City injection drug user acquired immunodeficiency syndrome (IDU AIDS)epidemic accounts for almost one quarter of AIDS cases in IDUs in the United States. Recent studies have reported declines in seroprevalence and risk behaviors among IDUs in New York City during the 1990s. These trends, however, are based on studies primarily conducted in the city’s central borough of Manhattan. This article analyzes data from all five boroughs of New York City to examine trends over phases of the epidemic and to determine the level of prevention services available; an exploratory qualitative study was also conducted to assess access to prevention services and injection practices in areas in the “outer boroughs”. Findings indicated that (1)borough differences in services and behaviors existed from early in the epidemic; (2)services have been concentrated in Manhattan; and (3)declines in seroprevalence were greatest among Manhattan-recruited IDUs. Enhancing access to services for IDUs in the boroughs outside Manhattan may be needed to continue the positive trends in all areas of New York City.     

Cardiovascular mortality of Chinese in New York City

To determine cardiovascular disease mortality among Chinese migrants in New York City and compare it to both that of residents in China and whites in New York City, mortality records for 1988 through 1992 for New York City and the 1990 US census data for New York City were linked. Age-specific death rates for urban China, reported by the World Health Organization, were used for comparison. The results show that male and female Chinese residents in New York City had lower mortality rates for all causes and total cardiovascular disease than did either New York City whites or Chinese in China. Coronary heart disease deaths among New York City Chinese were intermediate between Chinese in China (lowest) and New York City whites (highest). Stroke death rates for New York City Chinese were substantially lower than those in China and, in general, were similar to those for New York City whites. However, New York City Chinese had higher death rates for hemorrhagic stroke and lower for atherosclerotic stroke than did New York City whites. In conclusion, cardiovascular mortality rates among Chinese migrants in New York City fall below those of both Chinese in China and whites in New York City.     

Acceptance and completion of hepatitis B vaccination among drug users in New York City

Hepatitis B (HBV) vaccination rates remain low among drug users. We examined correlates of vaccine acceptance and completion in two ongoing prospective studies of young injecting and non-injecting drug users in New York City. Street recruited drug users were enrolled at one of two neighbourhood locations (Harlem and the Bronx) between 2000 and 2004 and completed risk behaviour questionnaires and HBV testing. Free HBV vaccination was offered. Among 1117 participants, 26.1% (275) had a previous HBV infection, 57.9% (610) were susceptible to HBV, and 16.0% (169) had serological evidence of previous vaccination. Of the 610 participants susceptible to HBV, 466 (76.4%) returned for their results and were offered vaccination; 53.9% (251) received at least one dose of the vaccine (acceptors). Correlates of vaccine acceptance included older age, public assistance as main income source, and being recruited in the Bronx. Daily crack users were significantly less likely to initiate the vaccine series. Among 240 vaccine acceptors, 98 (40.8%) completed all three doses. Daily injectors, Hispanics, and those recruited in Harlem were less likely to complete the vaccination series. HBV vaccination acceptance among drug users seems likely in programmes that are convenient and offer remuneration; however, extended efforts are needed to improve series completion.     

Ascertainment of maternal deaths in New York City.

Maternal deaths in New York City are defined as deaths from any cause in a woman while pregnant or within six months of pregnancy termination. Pilot studies seeking to improve maternal death ascertainment found that selected medical examiner reports contributed an additional 10.5 percent of the total maternal deaths, vital statistics review contributed 6.3 percent, linkage of death tapes of women of reproductive age to live birth and fetal death tapes contributed 1.0 percent. Medical examiner cases should be incorporated into surveillance data for accurate ascertainment of pregnancy associated deaths.