Hip fracture rates in Hong Kong and the United States, 1988 through 1989.

OBJECTIVES. Prior studies have suggested that hip fracture rates are substantially lower in Asian countries than in the United States. However, comparisons have been limited by unavailability of recent data, differences in case definition, lack of data from similar time periods, and small sample sizes. This study sought to examine trends by age and sex, with separate statistics for those aged 85 or older. METHODS. Hospital discharge data were used to obtain hip fracture incidence in Hong Kong and the United States from 1988 through 1989. RESULTS. Within each population, women had higher hip fracture rates than men. Fracture rates in the United States were significantly higher for both sexes than rates in Hong Kong. For persons over the age of 80, rates of hip fracture among White US males exceeded those for Hong Kong women. Inclusion of transferred cases in hip fracture rates minimized differences between the countries. CONCLUSIONS. Despite increasing hip fracture rates in Hong Kong, those rates are still substantially lower than the rates in the United States. Identifying factors responsible for this variation may prove useful in the search for preventive strategies.     

Hip fracture in Hong Kong and Britain

Hip fractures in elderly people are an important public health problem in many Western populations. Little is known of their epidemiology in Oriental populations. A comparative study of hip fracture incidence in Hong Kong and Southampton showed similar incidence rates by age and sex. In the last two decades hip fracture incidence in Hong Kong has increased, particularly among men. This can be partly explained by reduction in the levels of activity among the elderly Chinese population.     

Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden, 1965-1983

Time trends from 1965 through 1983 for age-specific and age-standardized rates of first hospital admission for a proximal femur fracture were studied in the Uppsala Health Care Region, Sweden, using a centralized register for inpatient care. During the 19-year study period, 29,277 hospital admissions for a first hip fracture were recorded in this population of about 1.5 million persons. The total number of first hip fracture admissions per year increased for both sexes. Age-standardized admission rates for both cervical and trochanteric fractures increased in men (average change per year of 1.8% and 2.6%, respectively) in contrast to the decreased admission rate for cervical fractures (-1.6% per year) and a stable rate for trochanteric fractures (0.4% per year) in women. The cumulative rate of cervical or trochanteric fracture at ages 30-79 years increased 46% in men (from 42/1,000 population in 1965 to 61.5/1,000 population in 1983) in contrast to a 24% decrease in women (from 134/1,000 population in 1965 to 101.5/1,000 population in 1983). The female:male ratio of age-standardized incidence rates decreased for both types of fracture during the study period. This finding of stable or decreasing rates of hip fracture in women contrasts with the findings of most previous studies.     

Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study

OBJECTIVES: This study examined the effect of birth cohort on incidence rates of hip fracture among women and men in the Framingham Study. METHODS: Age-specific incidence rates of first hip fracture were presented according to tertile of year of birth for 5209 participants of the Framingham Study, a population-based cohort followed since 1948. Sex-specific incidence rate ratios were calculated by Cox regression to assess the relation between birth cohort and hip fracture incidence. RESULTS: An increasing trend in hip fracture incidence rates was observed with year of birth for women (trend, P =.05) and men (trend, P =.03). Relative to those born from 1887 to 1900 (incidence rate ratio [IRR] = 1.0), age-specific incidence rates were greatest in the most recent birth cohort, born from 1911 to 1921 (IRR = 1.4 for women, IRR = 2.0 for men), and intermediate in those born from 1901 to 1910 (IRR = 1.2 for women, IRR = 1.5 for men). CONCLUSIONS: Results suggest risk of hip fracture is increasing for successive birth cohorts. Projections that fail to account for the increase in rates associated with birth cohort underestimate the future public health impact of hip fracture in the United States.     

Increased hip-fracture incidence in the county of Osterg?tland, Sweden, 1940-1986, with forecasts up to the year 2000: an epidemiological study.

The incidence of hip fractures in the county of Osterg?tland in Sweden has increased dramatically from 1940 to 1986, mainly due to an increase in age-specific incidence of trochanteric fractures. The increase is most pronounced in people over 80 but is present even in age groups down to 50 years. If the age-specific incidence rates continue to increase, and the population of the elderly grows in accordance with the forecast, there will be 70% more hip fractures in the year 2000 than in 1985.     

Sex-specific and race-specific hip fracture rates.

Sex-, race- and age-specific hip fracture rates were determined using Health Care Financing Administration data for Medicare-reimbursed hip fracture hospitalizations from 1980 to 1982. Rates were highest in White women, lowest in Black men, and intermediate in White men and Black women. Proportions of hip fracture patients dying during hospitalization and those discharged to nursing homes, respectively, were: White men (10.5%; 49%); Black men (9.3%; 32%); White women (5.0%; 54%); and Black women (8.2%; 30%).     

Differences in all-cause, cardiovascular and cancer mortality between Hong Kong and Singapore: Role of nutrition

BACKGROUND: The majority of inhabitants in Hong Kong and Singapore are ethnic Chinese, but all-cause and cardiovascular mortality rates in these two regions are markedly different. This study describes differences in the magnitude and trends in mortality and attempts to explain these differences. METHODS: Data of mortality rates in 1963-1965 and 1993-1995 in the age class of 45-74 years, dietary habits and other factors were compared between Hong Kong and Singapore using Japan, Spain and the USA as reference countries. Mortality and food consumption data were obtained from WHO and FAO, respectively. RESULTS: Large differences in all-cause and cardiovascular mortality exist between Hong Kong and Singapore. The difference in total cancer mortality was less consistent and smaller. The most pronounced finding was that ischemic heart disease mortality in 1993-1995 was 2.98 and 3.14 times higher in Singapore than in Hong Kong in men and women, respectively. Of the five countries considered, Singapore has the highest all-cause mortality in both sexes in the period of 1960-1995. The ratio of animal to vegetal fat was higher in Singapore (2.24) than in Hong Kong (1.08). Singapore had higher serum concentrations of total cholesterol and low-density lipoprotein cholesterol than Hong Kong, but the opposite result was observed for high-density lipoprotein cholesterol. CONCLUSIONS: There are striking differences in all-cause and cardiovascular mortality between Hong Kong and Singapore. These differences can be most reasonably and plausibly explained by their differences in dietary habits, for example, a higher consumption of coconut and palm oil, mainly containing saturated fat, in Singapore.     

Effects of long-term fluoride in drinking water on risks of hip fracture of the elderly: an ecologic study based on database of hospitalization episodes]

OBJECTIVES: Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. METHODS: Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. RESULTS: The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (p<0.01). The relative risk of hip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the nonfluoridated cities. CONCLUSIONS: We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.     

Nasopharyngeal carcinoma in Chinese—Salted fish or inhaled smoke?

The role of two proposed risk factors for nasopharyngeal carcinoma (NPC) in Chinese was examined by comparing incidence rates (1974–1975) of NPC among Chinese in Hong Kong with those in Los Angeles County (1972–1976) by age, sex, birthplace, and occupation. In Hong Kong, incidence rates for NPC were highest for persons born outside of the Chiu Chau region in Kwangtung Province. In Los Angeles County, the highest rates were observed for immigrant Chinese followed by indigenous Chinese. The high rates in Hong Kong-born Chinese and in Hong Kong boat people and the much higher rates in men compared with women do not support an inhaled carcinogen as the major risk factor for NPC in southern Chinese. The incidence data coupled with available experimental evidence are most consistent with consumption of Cantonese salted fish as the major etiologic factor.     

Global tuberculosis incidence and mortality during 1990-2000.

Forecasts of tuberculosis morbidity and mortality are presented for the decade 1990-99. An estimated 88 million new cases of tuberculosis, of which 8 million will be attributable to HIV infection, will occur in the world during the decade; 30 million people are predicted to die of tuberculosis in the same period, including 2.9 million attributable to HIV infection. The number of new tuberculosis cases occurring each year is predicted to increase from 7.5 million (143 cases per 100,000) in 1990 to 8.8 million (152 per 100,000) in 1995 and 10.2 million (163 per 100,000) in the year 2000. In 1990, 2.5 million persons were estimated to have died of tuberculosis; at the same level of availability of treatment, it is predicted that 3.0 million tuberculosis deaths will occur in 1995 and 3.5 million in 2000. Demographic factors, such as population growth and changes in the age structure of populations, will account for 79.5% of the predicted increases in new cases. Age-specific incidence rates in sub-Saharan Africa are increasing due to the HIV epidemic and will account for the remaining 20.5% of the forecast increase in new cases. In WHO''s South-East Asian Region and in Central and South America the age-specific incidence rates are expected to fall during 1990-2000, but at a slower rate than in previous years because of the expected increase in HIV seroprevalence.(ABSTRACT TRUNCATED AT 250 WORDS)     

An audit of current clinical practice in the management of osteoporosis in Nottingham

BACKGROUND: Osteoporosis is now recognized by the World Health Organization and the Department of Health as a major public health problem. In 1994, the Advisory Group on Osteoporosis (AGO), set up by the Department of Health, recommended that Health Authorities and general practitioner fundholders should purchase bone densitometry services for the management of osteoporosis. The aims of this study were to assess the criteria for requests for bone densitometry from primary care in comparison with the AGO recommendations and to compare the numbers of patients referred with a low-trauma osteoporotic fracture with the expected number of fractures in the Nottingham area. METHODS: Patient referral data and requests for bone densitometry were collected by case note review of all new patients referred to the Nottingham Osteoporosis Clinic over a 12 month period and then compared with the AGO recommendations. The patients referred with a history of a low-trauma fracture were then compared with the expected incidence of fractures, calculated using age-sex-specific fracture incidence data applied to the Nottingham population Census statistics. RESULTS: A total of 413 patients were referred to the Osteoporosis Clinic for bone densitometry. Almost two-thirds of the patients had no clinical indicators for requests for scanning, in comparison with the AGO recommendations. Seventy-seven patients were referred with vertebral fracture, 12 hip, 20 colles and 26 other fractures. Using age-sex-specific fracture incidence data applied to the Nottingham population Census statistics, it was estimated that the expected incidence of hip fractures would be 812, distal forearm fractures 514 and vertebral fractures presenting to clinical attention 625. This represents 1.5 per cent of the total hip fractures, 3.9 per cent distal forearm and 12.3 per cent vertebral actually presenting to the Osteoporosis Clinic. CONCLUSION: Bone densitometry was requested in up to 60 per cent of the patients with no clinical risk factors to warrant bone densitometry. Osteoporosis-related fractures remain unrecognized in clinical practice. The majority of patients do not receive specialist assessment despite being at high risk of future fracture. Further steps are necessary to educate health care professionals in primary and secondary care, but more importantly, to direct services more proactively in those at high risk of future fracture.     

Incidence rate of Creutzfeldt-Jakob disease in Japan

BACKGROUND: The objective of this study is to clarify the incidence rate of Creutzfeldt-Jakob disease (CJD) during the last decade in Japan. METHODS: A nationwide mail survey was conducted in all hospitals with a minimum bed capacity of 100 and having at least one of three departments: neurology, psychiatry, and neuropathology. The survey required the patient's sex, date of birth, date of diagnosis, diagnostic criteria, medical history and CJD incidence in the family. RESULTS: From 493 hospitals throughout the country, 821 patients with CJD were reported from January 1985 through March 1996. The annual incidence rate was 0.49 per million population for males and 0.68 for females. The age-specific incidence rate was highest among those 70-79 years of age, followed by the 60-69, and 50-59 age groups. The incidence and mortality increased during the observed period; however, the incidence rate among younger generations did not rise. CONCLUSION: A nationwide incidence survey of CJD in Japan revealed the incidence and distribution of the disease over the recent decade. It was found that the incidence and mortality rates had increased during the observed period.     

Respiratory disease in Army recruits: surveillance program overview, 1995-2006

BACKGROUND: Since 1966, the U.S. Army has had in place a comprehensive surveillance system for acute respiratory disease (ARD) because of its continued high incidence in the recruit population. A retrospective review of the program from 1995 to 2006, a continuation of an earlier analysis from 1985-1994, was performed to describe the program and to summarize group A streptococcal (GAS) outbreaks identified through this program. METHODS: Weekly incidence data and daily sentinel case data collected as part of the ARD surveillance program were analyzed in 2007 to report rates of ARD and GAS outbreaks over this 12-year period (1995-2006) for five participating Army sites. RESULTS: Average ARD rates were consistently higher from 2000 to 2006 than from 1995 to 1999. Rate ratios of winter rates to summer rates were greater than 1.0 prior to 2000, but from 2000 to 2006, ratios were consistently near 1.0. Rheumatogenic M types were available for three of five outbreaks. CONCLUSIONS: Continuing high incidence of ARD in the military, re-emerging rheumatogenic M types, and a highly mobile military underscore the need for continued surveillance efforts. The continued employment of interventions with demonstrated effectiveness, such as chemoprophylaxis and basic preventive measures, is essential to reducing the burden of ARD.     

Incidence of hip fracture in Saskatchewan, Canada, 1976-1985

The authors ascertained the incidence of hip fracture in Saskatchewan, Canada, residents aged 65 years or older for the 10 years 1976-1985 from computerized hospital discharge records and compared it with rates for several other populations in Northern Europe and the United States. In Saskatchewan, the average annual incidence was 5.5 per 1,000 person-years. The incidence in women was twice that in men, the incidence in urban areas was 27% greater than that in nonurban areas, and there was no secular trend of increasing rates. The incidence of hip fracture in Saskatchewan was lower than that for populations in Scandinavia and the United States but was comparable to rates in English populations. Further study is needed to elucidate the genetic, environmental, and behavioral factors responsible for this variation.     

Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984-1987

This study uses 44 consecutive months of data from the Health Care Financing Administration to assess seasonal trends in hip fracture incidence among the United States white population aged 65 years and older. The authors studied a total of 621,387 cases of hip fracture which occurred from January 1984 to September 1987. During the study period, hip fracture incidence rates display a distinctive pattern of seasonal periodicity; high rates are found in the winter and low rates in the summer among both males and females. This pattern of seasonal periodicity is consistent at ages 65-74 years, 75-84 years, and greater than or equal to 85 years. When the time series of rates are stratified into five geographic levels, each level covering 5 degrees of latitude, the distinctive pattern of seasonal periodicity is the same for all levels.     

Hip fractures in Norway 1999–2008: time trends in total incidence and second hip fracture rates. A NOREPOS study

Declining incidences of hip fractures are reported from western countries. Norway has among the highest rates in the world. The aim of this study was to investigate trends in total hip fracture rates in Norway between 1999 and 2008 and risk of second hip fractures. All hospitalizations given a hip fracture diagnosis code (International Classification of Diseases (ICD) 9 or ICD 10) (cervical, trochanteric or subtrochanteric) in Norwegian hospitals were retrieved with accompanying surgical procedure codes and additional diagnoses. A total of 93,123 hip fractures were identified between 1999 and 2008 in persons ≥50?years. Annual incidences of hip fractures were calculated and tested for trends. Rates of first and second hip fractures (2006–2008) were compared. The age-standardized total incidence of hip fracture decreased by 13.4?% (95?% confidence interval (CI): 11.0–15.6) in women and 4.8?% (95?% CI: 0.7, 8.7) in men. Age-adjusted rates of second hip fractures did not change in the observation period. In those with a prior hip fracture, the age-standardized risk of a subsequent hip fracture was 2.5-fold (95?% CI: 2.5, 2.6) in women, and 4.6-fold (95?% CI: 4.5, 4.7) in men. Total hip fracture rates declined in both genders during 1999–2008, whereas rates of second hip fractures did not change.     

Time trends and educational differences in the incidence of quitting smoking in Spain (1965-2000)

BACKGROUND: To analyze the pattern in the incidence of quitting smoking in Spain from 1965 to 2000 according to gender, age and educational level. METHODS: We used data from 5 Spanish National Health Interview Surveys including 33532 ever smokers>or=20 years old. We reconstructed the history of smoking and the age at smoking cessation. We calculated the biannual incidence of quitting smoking according to sex, age and educational level. We fitted joinpoint regression to identify significant changes in trends. RESULTS: The incidence of quitting smoking at ages 20-50 years has increased from 0.5% in 1965-1966 to 4.9% in 1999-2000 for males and from 1.1% in 1965-1966 to 5.0% in 1999-2000 in females. For those aged>50 years old, the incidence of quitting smoking has increased from 0.4% in 1965-1966 to 8.7% in 1999-2000 for males and from 7.9% in 1973-1974 to 8.8% in 1999-2000 in females. A level-off in cessation rates is observed both in men and women aged 20-50 years old with lower educational level in the last decade, while cessation among those with higher educational level continue to increase. CONCLUSIONS: The different pattern of smoking cessation according to gender, age, and level of education suggests that health promotion actions and tobacco control policies might have had a different effect among different population subgroups.     

A comparison of hip fracture incidence among native Japanese, Japanese Americans, and American Caucasians

Hip fracture incidence rates among men and women of Japanese ancestry living on Oahu, Hawaii, from 1979 to 1981 were compared with rates for Japanese living on Okinawa, Japan, from 1984 to 1985. Both rates were further compared with those for various American Caucasian populations, including that of Rochester, Minnesota, from 1978 to 1982. Age-specific and cumulative (age 50-84 years) hip fracture rates among persons of Japanese ancestry were approximately half that of Caucasians for both sexes. Although diet and other cultural attributes of the Oahu group have become more westernized than the Okinawan population, there were no detectable differences in hip fracture rates between Oahu and Okinawa Japanese. Additional studies are needed to determine whether the observed differences in fracture rates between Caucasians and Japanese might be related to differences in bone mass, body size, frequency of falls, or other factors.     

北京市中小学生1985～2000年超重和肥胖流行趋势分析

目的 了解北京市7-18岁中小学生1985—2000年超重和肥胖变化趋势，为改善学生营养状况提供依据。方法 利用1985，1991，1995和2000年全国学生体质调研北京市资料，根据体重指数（Body Mass Index，BMI）筛查标准计算不同时期、不同年龄段城乡男女中小学生超重和肥胖检出率。结果城男、城女、乡男、乡女超重和肥胖呈上升趋势，1995．2000年增幅高于1985．1995年平均每5a的增幅；1995～2000年比1985～1995年增速变缓，但7—9岁组城男超重和肥胖，7—9岁组城女和乡女超重，16～18岁乡男和13～15岁城女肥胖的增速高于1985～1995年水平。城区“差”片学生超重和肥胖检出率高于“好”片。结论北京市中小学生超重、肥胖呈现出从散发到流行、从城区向农村、逐渐低龄化的趋势：应从小学低年级开始，将超重和肥胖的防治作为北京市学校卫生的工作重点。