Estimates of pregnancies and pregnancy rates for the United States, 1976-85.

After increasing by 9 per cent in the period 1976-80 in the United States, pregnancy rates declined by 4 per cent between 1980 and 1984 (from 111.9 to 107.3 pregnancies per 1,000 women aged 15-44 years). Between 1984 and 1985, the rate rose by less than 1 per cent to 108.2. More detailed data by age and race, available only through 1983, indicate that the decline in the 1980-83 period was not shared by all age groups. For example, pregnancy rates continued to increase for women in their thirties, and teenage pregnancy remained substantially the same. In 1983, 61 per cent of all pregnancies ended in live birth, 26 per cent in induced abortion, and 13 per cent in fetal loss. Pregnancy rates in that year were two-thirds higher for women of races other than White than for White women, and pregnancies of other-than-White women were more likely to terminate as an induced abortion or fetal loss. However, White teenagers and teenagers of other races were about equally likely to have their pregnancy end in induced abortion or fetal loss.     

Vasectomy in the United States, 1991.

OBJECTIVES. Recent conflicting findings on possible health risks related to vasectomy have underscored the need for reliable and representative estimates of numbers and rates of vasectomies in the United States. The purpose of this study was to estimate the annual US number, rate, and characteristics of vasectomies in 1991. METHODS. A national survey of urology, general surgery, and family practice physician practices was conducted with probability sampling methods (n = 1685 physicians). RESULTS. An estimated 493,487 (95% confidence interval = 450,480, 536,494) vasectomies were performed in 1991, for a rate of 10.3 procedures per 1000 men aged 25 through 49 years. Most vasectomies were performed by urologists, and most were done in physicians' offices with local anesthesia and ligation as the method of occlusion. The rate of vasectomies was highest in the Midwest. CONCLUSIONS. This survey provides the first national estimates of the number and rate of vasectomies in the United States, as well as the first estimates of occlusion method used. Results confirm previous findings that urologists perform most vasectomies and that most vasectomies are performed with local anesthesia. Recommendations include the monitoring of vasectomy numbers and rates as well as demographic studies of men obtaining vasectomies.     

Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998.

OBJECTIVE: To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States. DESIGN: Statistical analysis. METHODS: We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital. RESULTS: The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated. CONCLUSIONS: Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions.     

Trends in AIDS among Hispanics in the United States, 1991-1996.

OBJECTIVES: This article describes recent trends in AIDS among US Hispanics. METHODS: Incidence rates were calculated from AIDS surveillance data for persons diagnosed from 1991 through 1996. Increases in the number of cases among Hispanics were calculated by linear regression. RESULTS: Of the 415,864 persons diagnosed with AIDS from 1991 through 1996, 19% were Hispanic. Among Hispanics with AIDS, 67% were born in the United States or Puerto Rico. The relative risk (RR) of AIDS for Hispanics compared with Whites was highest for women (RR = 7.0), followed by children (RR = 6.2) and men (RR = 2.8). Increases in the number of cases were higher among foreign-born Hispanics. CONCLUSIONS: An understanding of which Hispanic subgroups are at greatest risk for HIV infection is important for prevention efforts.     

Vasectomy in the United States, 1991 and 1995.

OBJECTIVES: This study sought to assess whether the controversy surrounding publications linking vasectomy and prostate cancer has had an effect on vasectomy acceptance and practice in the United States. METHODS: National probability surveys of urology, general surgery, and family practices were undertaken in 1992 and 1996. RESULTS: Estimates of the total number of vasectomies performed, population rate, and proportion of practices performing vasectomy were not significantly different in 1991 and 1995. CONCLUSIONS: This study provides no solid evidence that the recent controversy over prostate cancer has influenced vasectomy acceptance or practice in the United States. However, the use of vasectomy appears to have leveled off in the 1990s.     

Surveillance for dracunculiasis, 1981-1991.

In 1986 the World Health Organization (WHO) designated dracunculiasis (guinea worm disease) as the next disease scheduled to be eradicated (by 1995) after smallpox. Dramatic improvement in national and international surveillance has played a key role in the global eradication campaign, which was initiated at CDC in 1980. About 3 million persons are still affected by the disease annually, with adverse effects on their health as well as on agricultural production and education. Over 100 million persons are at risk of having the disease in more than 20,000 villages in India, Pakistan, and 17 African countries. At least one nationwide, village-by-village search to detect all villages with endemic dracunculiasis and count cases is recommended at the outset of each national campaign, followed by monthly reporting by village-based health workers in the targeted villages during the implementation phase. Rapid dissemination of the results of the surveillance is critical. Intensive case detection and containment--with rewards for reporting of cases--are most appropriate near the end of each campaign. Cameroon, Ghana, India, Nigeria, and Pakistan have pioneered the various surveillance methods for this disease in recent years. Methods for conducting surveillance of dracunculiasis and other important diseases must continue to be developed and improved as countries now believed to be free of dracunculiasis prepare to apply to WHO for certification of elimination of dracunculiasis.     

Norovirus and foodborne disease, United States, 1991-2000

Efforts to prevent foodborne illness target bacterial pathogens, yet noroviruses (NoV) are suspected to be the most common cause of gastroenteritis. New molecular assays allow for better estimation of the role of NoV in foodborne illness. We analyzed 8,271 foodborne outbreaks reported to the Centers for Disease Control and Prevention from 1991 to 2000 and additional data from 6 states. The proportion of NoV-confirmed outbreaks increased from 1% in 1991 to 12% in 2000. However, from 1998 to 2000, 76% of NoV outbreaks were reported by only 11 states. In 2000, an estimated 50% of foodborne outbreaks in 6 states were attributable to NoV. NoV outbreaks were larger than bacterial outbreaks (median persons affected: 25 versus 15), and 10% of affected persons sought medical care; 1% were hospitalized. More widespread use of molecular assays will permit better estimates of the role of NoV illness and help direct efforts to control foodborne illness.     

Chancroid in the United States, 1981-1990: evidence for underreporting of cases.

Chancroid, a bacterial sexually transmitted disease (STD) characterized by genital ulceration, has reemerged in the United States during the last decade. From 1950 to 1980, cases were infrequently reported. After an epidemic in California in 1981, however, the numbers of cases increased, peaking in 1987 at 5,035. Despite a subsequent decline in numbers of reported cases to 4,223 in 1990, new areas continue to report outbreaks. Interpreting chancroid surveillance data is difficult because confirmatory culture media are not commercially available. In addition, states may not require that unconfirmed or even confirmed cases be reported. To determine if chancroid is more widely distributed than surveillance figures indicate, CDC contacted STD clinics in 115 health departments, located in 32 states, the District of Columbia, and Puerto Rico--areas chosen because they had reported five or more cases of chancroid in any single year during 1986-1990--to determine if cases might be occurring but not reported. Only 16 of the 115 clinics had culture media available for Haemophilus ducreyi, and only nine had laboratory facilities complete enough to definitively diagnose chancroid, syphilis, or genital herpes, the most common STDs characterized by genital ulcers. Five or more clinically likely cases occurring in 1990 were identified in 24 states, seven more than surveillance figures indicated. Surveillance can be improved if a) states utilize the definitions for chancroid cases adopted for use in 1990 and b) microbiology laboratories utilize enhanced diagnostic methods.     

Coverage of beverage alcohol issues in the print media in the United States, 1985-1991.

OBJECTIVES: This study assessed the portrayal of alcohol-related issues in the print media in the United States during the 7-year period bracketing implementation of the US alcohol warning label act in November 1988. METHODS: All articles that appeared from 1985 to 1991 in 5 national newspapers and that were indexed as dealing with beverage alcohol were identified. Content analysis of a 15% sample of these articles allowed an in-depth assessment of the conceptualization of alcohol in the US print media. RESULTS: A slight decrease in articles related to alcoholism was offset by an increase in articles about the more general health-related effects of alcohol. The warning label act received little attention. Most articles portrayed alcohol neutrally or negatively, using information from government sources. CONCLUSIONS: Portrayal of alcohol in the US print media has changed in recent decades. A general shift noted as early as the 1960s has increasingly emphasized public health issues and deemphasized clinical aspects of alcoholism. This has been accompanied by a continuing shift away from a biopsychological definition of alcohol-related behavior to a definition stressing external environmental factors.     

Hemophilia-associated AIDS in the United States, 1981 to September 1987.

Between January 1, 1981 and September 4, 1987, 407 cases of hemophilia-associated acquired immunodeficiency syndrome (AIDS) had been reported to the Centers for Disease Control. The number of cases diagnosed each year nearly doubled, except in 1986, when cases increased only 50 per cent. Demographic characteristics of the patients did not change over time. The majority (74 per cent) had severe hemophilia and 97 per cent received commercially produced concentrated clotting factors. The cumulative incidence of AIDS between 1981 and September 1987 for persons with severe hemophilia A was substantially greater than that for persons with severe hemophilia B (4.2 cases vs 1.9 cases per 100 persons).     

Surveillance of Rocky Mountain spotted fever, United States, 1981-1983

The increase in the incidence of RMSF observed in the 1970s appears to have plateaued at a median of 0.49 cases/100,000 for the 6-year period 1978-1983. In 1981-1983, for the first time, Oklahoma had the highest incidence of RMSF in the United States (4.10 cases/100,000/year); increased numbers of cases were also reported from two of the other three West South Central states-Texas and Arkansas. Texas, which reported 217 cases in the 3-year period, had an average incidence of 0.47 cases/100,000/year. This apparent regional increase in RMSF activity may reflect multiple factors, including increased recognition and reporting of cases and environmental factors that may be associated with a true increase in RMSF. Simultaneously, a decrease in the number of cases reported and in the incidence of RMSF have been observed in the South Atlantic states, although these states still account for most (51%) of the cases in the United States. The slight decrease in the case-fatality ratio observed over the last 9 years is unexplained. It may reflect increased awareness of RMSF and result in appropriate and timely treatment. The increasing number and percentage of cases that are laboratory confirmed suggest that the more sensitive and specific laboratory tests now required for serologic confirmation are being more widely used and are contributing to an increased accuracy of reporting of RMSF in this country.(ABSTRACT TRUNCATED AT 250 WORDS)     

Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991

This study presents three estimates--ranging from low to high--of the direct and indirect costs of the AIDS epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Centers for Disease Control (CDC). According to what the authors consider their best estimates, personal medical care costs of AIDS in current dollars will rise from $630 million in 1985 to $1.1 billion in 1986 to $8.5 billion in 1991. Nonpersonal costs (for research, screening, education, and general support services) are estimated to rise from $319 million in 1985 to $542 million in 1986 to $2.3 billion in 1991. Indirect costs attributable to loss of productivity resulting from morbidity and premature mortality are estimated to rise from $3.9 billion in 1985 to $7.0 billion in 1986 to $55.6 billion in 1991. While estimated personal medical care costs of AIDS represent only 0.2 percent in 1985 and 0.3 percent in 1986 of estimated total personal health care expenditures for the U.S. population, they represent 1.4 percent of estimated personal health care expenditures in 1991. Similarly, while estimated indirect costs of AIDS represent 1.2 percent in 1985 and 2.1 percent in 1986 of the estimated indirect costs of all illness, they are estimated to rise to almost 12 percent in 1991. Estimates of personal medical care costs were based on data from various sources around the United States concerning average number of hospitalizations per year, average length of hospital stay, average charge per hospital day, and average outpatient charges of persons with AIDS. For estimating the indirect costs the human capital method was used, and it was assumed that average wages and labor force participation rates of persons with AIDS were the same as those for the general population by age and sex.     

Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991

This study presents three estimates ranging from low to high of the direct and indirect costs of the acquired immunodeficiency syndrome (AIDS) epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Centers for Disease Control (CDC). According to the author's best estimates, personal medical care costs of AIDS in current dollars will rise from $630 million in 1985 and $1.1 billion in 1986 and $8.5 billion in 1991. Nonpersonal costs (for research, screening, education, and general support services) are estimated to rise from $319 million in 1985 to $542 million in 1986 to $2.3 billion in 1991. Indirect costs attributable to loss of productivity resulting from morbidity and premature mortality are estimated to rise from $3.9 billion in 1985 to $7.0 billion in 1986 to $55.6 billion in 1991. While estimated personal medical care costs of AIDS in 1985 and 1986 represent only 0.2% and 0.3%, respectively, of such estimated expenditures for the U.S. population in these 2 years, they represent 1.4% of these estimated costs in 1991. Similarly, while estimated indirect costs of AIDS represent 1.2% in 1985 and 2.1% in 1986 of the estimated indirect costs of all illness, they are projected to rise to almost 12% in 1991. For estimating the indirect costs, the human capital method was used, and it was assumed that average wages and labor force participation rates of persons with AIDS were the same as those for the general population by age and sex.