OBJECTIVES: This report provides detailed information on how the 2000 Centers for Disease Control and Prevention (CDC) growth charts for the United States were developed, expanding upon the report that accompanied the initial release of the charts in 2000. METHODS: The growth charts were developed with data from five national health examination surveys and limited supplemental data. Smoothed percentile curves were developed in two stages. In the first stage, selected empirical percentiles were smoothed with a variety of parametric and nonparametric procedures. In the second stage, parameters were created to obtain the final curves, additional percentiles and z-scores. The revised charts were evaluated using statistical and graphical measures. RESULTS: The 1977 National Center for Health Statistics (NCHS) growth charts were revised for infants (birth to 36 months) and older children (2 to 20 years). New body mass index-for-age (BMI-for-age) charts were created. Use of national data improved the transition from the infant charts to those for older children. The evaluation of the charts found no large or systematic differences between the smoothed percentiles and the empirical data. CONCLUSION: The 2000 CDC growth charts were developed with improved data and statistical procedures. Health care providers now have an instrument for growth screening that better represents the racial-ethnic diversity and combination of breast- and formula-feeding in the United States. It is recommended that these charts replace the 1977 NCHS charts when assessing the size and growth patterns of infants, children, and adolescents.
The authors describe changes proposed for the census scheduled for the year 2000 in Poland. These include changes in coverage, definitions, methods of tabulation, and concepts. Some of these changes concern data on households and families, fertility, and economic activities. (SUMMARY IN ENG AND RUS)
Describing the distribution of disease between different populations and over time has been a highly successful way of devising hypotheses about causation and for quantifying the potential for preventive activities.1 Statistical data are also essential components of disease surveillance programs. These play a critical role in the development and implementation of health policy, through identification of health problems, decisions on priorities for preventive and curative programs and evaluation of outcomes of programs of prevention, early detection/screening and treatment in relation to resource inputs. Over the last 12 years, a series of estimates of the global burden of cancer have been published in the International Journal of Cancer.2-6 The methods have evolved and been refined, but basically they rely upon the best available data on cancer incidence and/or mortality at country level to build up the global picture. The results are more or less accurate for different countries, depending on the extent and accuracy of locally available data. This “data-based” approach is rather different from the modeling method used in other estimates.7-10 Essentially, these use sets of regression models, which predict cause-specific mortality rates of different populations from the corresponding all-cause mortality.11 The constants of the regression equations derive from datasets with different overall mortality rates (often including historic data from western countries). Cancer deaths are then subdivided into the different cancer types, according to the best available information on relative frequencies. GLOBOCAN 2000 updates the previously published data-based global estimates of incidence, mortality and prevalence to the year 2000.12 The data sources that have been used to build up the global estimates are as follows. Incidence, the number of new cases occurring, can be expressed as the annual number of cases (the volume of new patients presenting for treatment) or as a rate per 100,000 persons per year. Incidence data are produced by population-based cancer registries.13 Registries may cover national populations or, more often, certain regions. In developing countries in particular, coverage is often confined to the capital city and its environs. It was estimated that, in 1990, about 18% of the world population were covered by registries, 64% of developed countries and 5% of developing countries, although the situation is improving each year. The most recent volume of “Cancer Incidence in Five Continents” (CI5) contains comparable incidence information from 150 registries in 50 countries, primarily over the period 1988–1992.14 Survival statistics are also produced by cancer registries by the follow-up of registered cancer cases. Population-based figures are published by registries in many developed countries, for example, the SEER program covering 10% of the U.S. population15 and the EUROCARE II project, including 17 countries of Europe.16 Survival data from populations of China, the Philippines, Thailand, India and Cuba have been published by Sankaranarayanan et al.17 Mortality is the number of deaths occurring and the mortality rate the number of deaths per 100,000 persons per year. It is the product of incidence and fatality (the inverse of survival) of a given cancer. Mortality rates measure the average risk to the population of dying from a specific cancer, while fatality (1-survival) represents the probability that an individual with cancer will die from it. Mortality data are derived from vital registration systems, where the fact and “underlying” cause of death are certified, usually by a medical practitioner. Their great advantage is comprehensive coverage and availability. By 1990, about 42% of the world population was covered by vital registration systems producing mortality statistics on cancer. Not all are, however, of the same quality in all countries. National-level statistics are collated and made available by the World Health Organiztion (http://www-dep.iarc.fr/dataava/globocan/who.htm), although for some countries coverage of the population is manifestly incomplete (so that the so-called mortality rates produced are implausibly low) and in others, quality of cause of death information is poor. Frequency data, e.g., case series from hospitals and pathology laboratories, provide an indication of the relative importance of different cancers in a country or region in the absence of a population-based registry and mortality statistics. There are problems in extrapolating the results to the general population, since such series are subject to various forms of selection bias. Such data are generally published locally or in journal articles, although a few compendia are available.18, 19 Prevalence is the proportion of a population that has the disease at a given point in time.20 For many diseases (e.g., hypertension, diabetes), prevalence usefully describes the number of individuals requiring care. For cancer, however, many persons diagnosed in the past have been “cured”—they no longer have an excess risk of death (although some residual disability may be present, for example, following a resective operation). A straightforward comparison of need for cancer services can be made using partial prevalence, cases diagnosed within 1, 3 and 5 years, to indicate the numbers of persons undergoing initial treatment (cases within 1 year of diagnosis), clinical follow-up (within 3 years) or not considered “cured” (before 5 years). Patients alive 5 years after diagnosis are usually considered cured since, for most cancers, the death rates of such patients are similar to those in the general population. The methods used to produce the estimates are summarised in several recent articles.5, 6, 21, 22 The “Help” option of GLOBOCAN 2000 lists the sources of data and methods used for each country. National incidence data from good-quality cancer registries. National mortality data, with estimation of incidence using sets of regression models specific for site, sex and age, derived from local cancer registry data (incidence plus mortality). Local (regional) incidence data from 1 or more regional cancer registries within a country. When there are several cancer registries in the country, their incidence rates must be combined into a common set of values by some weighted average. Local mortality data from some sort of sample survey of deaths, converted to incidence using specific models. Frequency data. For several developing countries, only data on the relative frequency of different cancers (by age and sex) are available. These are applied to an estimated “all sites” incidence rate, derived from existing cancer registry results, in 7 world regions (Eastern Africa, Middle Africa, Northern Africa, Southern Africa, Western Africa, Middle East and Other Oceania). No data. The country-specific rates are those of the corresponding world area (calculated from the other countries for which estimates could be made). There are few large countries that fall into this category. Those with a population greater than 10 million were Morocco, Afghanistan, Nepal, Sri Lanka, Mozambique, Madagascar and Yemen. National mortality rates, with for some countries a correction factor applied to account for known and quantified underreporting of deaths. Rates for missing sites were computed using proportions from mortality files provided by cancer registries. When no national mortality data are available, local (regional) mortality rates derived from the data of 1 or more cancer registries covering a part of a country (state, province, etc.) were used. When mortality data were unavailable or known to be of poor quality, mortality was estimated from incidence, using country/region-specific survival (see prevalence data). In the absence of any data, country-specific rates are calculated from the average of those of neighbouring countries in the same regions. Estimates of partial prevalence in each country were derived by combining the annual number of new cases and the corresponding probability of survival by time. For example, 1-year prevalence at a fixed point in mid-2000 was estimated from the number of new cases in 2000 multiplied by the probability of surviving at least 6 months, and 3-year prevalence sums the numbers alive at 0.5, 1.5 and 2.5 years. Relative survival data were obtained from the sources cited above and converted to observed survival using “normal” mortality probability (derived from the corresponding life tables). The shape of the survival curve from 0 to 5 years postdiagnosis was assumed to follow a Weibull distribution.22 GLOBOCAN 2000 presents incidence, mortality and prevalence data for 5 broad age groups (0–14, 15–44, 45–54, 55–64 and 65 and over) and sex for all countries of the world for 24 different types of cancer. Since cancer data are collected and compiled sometime after the events to which they relate, the most recent statistics available are from periods from 3–10 years earlier. The actual number of cancer cases, deaths and prevalent cases are calculated by applying these rates to the estimated world population for 2000, obtained from the most recent projections prepared by the United Nations Population Division.23 On the CD-ROM are computer programs to analyse and present the cancer database. The database itself may be downloaded from the Internet (http://www-dep.iarc.fr/globocan/globocan.htm). This site contains the most recently available estimates of the incidence and mortality rates in different countries worldwide. GLOBOCAN 2000 can present the statistics described at any level of geographical aggregation and in tabular or graphical format (maps, bar charts, age-specific curves and pie charts). Some examples of these graphical presentations are shown on the cover of this issue. Tabulations of numbers and rates may also be displayed and printed. Incorporation of population projections for 5-year intervals, from 2005 to 2050,23 allows GLOBOCAN 2000 to be used to prepare projections of future burden, assuming current rates of incidence and mortality, or incorporating age/sex-specific rates of change in the rates. Table I shows the most basic summary data of all—the global numbers of cases, deaths and prevalent cancers (within 5 years of diagnosis) by cancer site in males, females and both sexes. There are an estimated 10.1 million new cases, 6.2 million deaths and 22.4 million persons living with cancer in the year 2000. No attempt has been made to estimate incidence or mortality of nonmelanoma skin cancer because of the difficulties of measurement and consequent lack of data. The total “All Cancer” therefore excludes such tumours. The 2000 estimate represents an increase of around 22% in incidence and mortality since our most recent comprehensive estimates (for 1990). Lung cancer is the main cancer in the world today, whether considered in terms of numbers of cases (1.2 million) or deaths (1.1 million), because of the high case fatality (ratio of mortality:incidence = 0.9). However, breast cancer, although it is the second most common cancer overall (1.05 million new cases) ranks much less highly (5th) as a cause of death because of the relatively favourable prognosis (ratio of mortality:incidence = 0.4). Colon plus rectum is third in importance in terms of new cases (945,000 cases, 492,000 deaths), and stomach cancer (876,000 cases, 647,000 deaths) fourth. In terms of prevalence, the most common cancers are breast (3.9 million breast cancer cases), colorectal cancers (2.4 million) and prostate (1.6 million). The ratio between prevalence and incidence is an indicator of prognosis. This explains why breast cancer appears as the most prevalent cancer in the world, despite there being fewer new cases than for lung cancer, for which the outlook is considerably poorer. Table II shows incidence rates for all cancers (excluding skin) by world area and sex. Two indices are used, the age standardized rate per 100,000 (standardized to the world standard population) and the cumulative rate (percent), from birth to age 65. Both of these indicators allow comparisons between populations that are not influenced by differences in their age structures. Age standardized rates in developed countries are about twice those in developing countries; the differential is less for the cumulative rate, which ignores disease rates in the 65 and over age groups. On average, worldwide, there is about a 10% chance of getting a cancer before age 65. Incidence (and mortality) rates are highest in North America, Australia/New Zealand and Western Europe, and lowest in parts of Africa. This overall risk is, of course, dependent upon the contributions of different types of cancer. For example, in West Africa, incidence of almost all cancers is low (except for cervix cancer in women and liver cancer in men). This contrasts with Southern Africa, which has, in addition, high rates of lung and oesophagus cancer, and with East Africa, with high rates of AIDS-related tumours, notably Kaposi's sarcoma. The statistics used to assess the importance (burden) of cancer and of different types of cancer in the population either quantify the disease itself (the “need” for services) or the demand that it places upon them.24 Incidence rates provide a measure of the risk of developing specific cancers in different populations. Changes in incidence are the appropriate indicator of the impact of primary prevention strategies. Mortality rates are sometimes used as a convenient proxy measure of the risk of acquiring the disease (incidence) when comparing different groups, since they may be more generally available. However, this use assumes equal survival in the populations being compared, and this assumption may well be incorrect, for example, there are well-documented differences between countries. Mortality does provide an unambiguous measure of the outcome or impact of cancer and, used in conjunction with data on incidence, is the index of choice for the evaluation of the effects of early diagnosis or treatment. Prevalence, as the number of persons ever diagnosed with cancer (lifetime prevalence), does not have much apparent utility. The data can be derived from cancer registries that have very long-term registration of cases and complete follow-up for vital status over many years.25, 26 Population surveys are another approach, although they underestimate true prevalence.27 In the absence of complete data, an estimate can be prepared using models that incorporate longtime series of incidence and survival.28, 29 Other workers have attempted to define the proportion and timing of “cure” for different cancers, so that only patients not cured are considered prevalent.30 The data needed for such calculations are rarely available, however, and, for international comparisons, a simpler approach is needed. Partial prevalence, as estimated in GLOBOCAN, as well as approximating the numbers of patients under treatment or follow-up, does not require long time series of incidence or survival data (or a further set of assumptions required to estimate them). Compound indicators, which use information on the duration or severity of disease, have a genuine utility in setting priorities within health-care systems. They include person-years of life lost (how many years of normal life span are lost due to deaths from cancer)31 and disability or quality-adjusted life-years lost.32, 33 The latter measures require that a numerical score is given to the years lived with a reduced quality of life between diagnosis and death (where quality = 0) or cure (quality = 1). The problem with such indicators, however, is that there is simply insufficient quantitative information on quality or disability following a cancer diagnosis in different cultures (or countries) worldwide to permit calculation of valid comparative statistics. The GLOBOCAN estimates of incidence, mortality and (5-year) prevalence help to define priorities for cancer control program (prevention and treatment, aided by early detection, if appropriate). For countries with well-established sources of data, changes in the estimates over time indicate progress against cancer. Incidence trends can monitor the success of prevention and the success of treatment (resulting from earlier diagnosis or more effective therapies). In addition, the geographic patterns of cancer internationally serve one of the classic roles of descriptive epidemiology: observing whether the distribution of specific cancers follows the patterns expected from the distribution of known risk factors between populations or whether there are apparent anomalies that merit further investigation. GLOBOCAN 2000 incorporates the best currently available national statistics, but as information systems extend to all countries of the world and improve their coverage and accuracy, we expect that our knowledge of the world cancer burden will improve and so too will our ability to mount effective strategies against it.
BACKGROUND: Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors. METHODS: We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses. RESULTS: From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively). CONCLUSIONS: Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.
PURPOSE: Myopia is a common cause of vision loss, with uncorrected myopia the leading cause of distance vision impairment globally. Individual studies show variations in the prevalence of myopia and high myopia between regions and ethnic groups, and there continues to be uncertainty regarding increasing prevalence of myopia. DESIGN: Systematic review and meta-analysis. METHODS: We performed a systematic review and meta-analysis of the prevalence of myopia and high myopia and estimated temporal trends from 2000 to 2050 using data published since 1995. The primary data were gathered into 5-year age groups from 0 to ≥100, in urban or rural populations in each country, standardized to definitions of myopia of -0.50 diopter (D) or less and of high myopia of -5.00 D or less, projected to the year 2010, then meta-analyzed within Global Burden of Disease (GBD) regions. Any urban or rural age group that lacked data in a GBD region took data from the most similar region. The prevalence data were combined with urbanization data and population data from United Nations Population Department (UNPD) to estimate the prevalence of myopia and high myopia in each country of the world. These estimates were combined with myopia change estimates over time derived from regression analysis of published evidence to project to each decade from 2000 through 2050. RESULTS: We included data from 145 studies covering 2.1 million participants. We estimated 1406 million people with myopia (22.9% of the world population; 95% confidence interval [CI], 932-1932 million [15.2%-31.5%]) and 163 million people with high myopia (2.7% of the world population; 95% CI, 86-387 million [1.4%-6.3%]) in 2000. We predict by 2050 there will be 4758 million people with myopia (49.8% of the world population; 3620-6056 million [95% CI, 43.4%-55.7%]) and 938 million people with high myopia (9.8% of the world population; 479-2104 million [95% CI, 5.7%-19.4%]). CONCLUSIONS: Myopia and high myopia estimates from 2000 to 2050 suggest significant increases in prevalences globally, with implications for planning services, including managing and preventing myopia-related ocular complications and vision loss among almost 1 billion people with high myopia.
Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015, and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542-753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies.
BACKGROUND: Limited data exist on trends in incidence of atrial fibrillation (AF). We assessed the community-based trends in AF incidence for 1980 to 2000 and provided prevalence projections to 2050. METHODS AND RESULTS: The adult residents of Olmsted County, Minnesota, who had ECG-confirmed first AF in the period 1980 to 2000 (n=4618) were identified. Trends in age-adjusted incidence were determined and used to construct model-based prevalence estimates. The age- and sex-adjusted incidence of AF per 1000 person-years was 3.04 (95% CI, 2.78 to 3.31) in 1980 and 3.68 (95% CI, 3.42 to 3.95) in 2000. According to Poisson regression with adjustment for age and sex, incidence of AF increased significantly (P=0.014), with a relative increase of 12.6% (95% CI, 2.1 to 23.1) over 21 years. The increase in age-adjusted AF incidence did not differ between men and women (P=0.84). According to the US population projections by the US Census Bureau, the number of persons with AF is projected to be 12.1 million by 2050, assuming no further increase in age-adjusted incidence of AF, but 15.9 million if the increase in incidence continues. CONCLUSIONS: The age-adjusted incidence of AF increased significantly in Olmsted County during 1980 to 2000. Whether or not this rate of increase continues, the projected number of persons with AF for the United States will exceed 10 million by 2050, underscoring the urgent need for primary prevention strategies against AF development.
Abstract. We present and discuss a new dataset of gridded emissions covering the historical period (1850–2000) in decadal increments at a horizontal resolution of 0.5° in latitude and longitude. The primary purpose of this inventory is to provide consistent gridded emissions of reactive gases and aerosols for use in chemistry model simulations needed by climate models for the Climate Model Intercomparison Program #5 (CMIP5) in support of the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment report (AR5). Our best estimate for the year 2000 inventory represents a combination of existing regional and global inventories to capture the best information available at this point; 40 regions and 12 sectors are used to combine the various sources. The historical reconstruction of each emitted compound, for each region and sector, is then forced to agree with our 2000 estimate, ensuring continuity between past and 2000 emissions. Simulations from two chemistry-climate models are used to test the ability of the emission dataset described here to capture long-term changes in atmospheric ozone, carbon monoxide and aerosol distributions. The simulated long-term change in the Northern mid-latitudes surface and mid-troposphere ozone is not quite as rapid as observed. However, stations outside this latitude band show much better agreement in both present-day and long-term trend. The model simulations indicate that the concentration of carbon monoxide is underestimated at the Mace Head station; however, the long-term trend over the limited observational period seems to be reasonably well captured. The simulated sulfate and black carbon deposition over Greenland is in very good agreement with the ice-core observations spanning the simulation period. Finally, aerosol optical depth and additional aerosol diagnostics are shown to be in good agreement with previously published estimates and observations.
ABSTRACT Aim To map and characterize anthropogenic transformation of the terrestrial biosphere before and during the Industrial Revolution, from 1700 to 2000. Location Global. Methods Anthropogenic biomes (anthromes) were mapped for 1700, 1800, 1900 and 2000 using a rule‐based anthrome classification model applied to gridded global data for human population density and land use. Anthropogenic transformation of terrestrial biomes was then characterized by map comparisons at century intervals. Results In 1700, nearly half of the terrestrial biosphere was wild, without human settlements or substantial land use. Most of the remainder was in a seminatural state (45%) having only minor use for agriculture and settlements. By 2000, the opposite was true, with the majority of the biosphere in agricultural and settled anthromes, less than 20% seminatural and only a quarter left wild. Anthropogenic transformation of the biosphere during the Industrial Revolution resulted about equally from land‐use expansion into wildlands and intensification of land use within seminatural anthromes. Transformation pathways differed strongly between biomes and regions, with some remaining mostly wild but with the majority almost completely transformed into rangelands, croplands and villages. In the process of transforming almost 39% of earth's total ice‐free surface into agricultural land and settlements, an additional 37% of global land without such use has become embedded within agricultural and settled anthromes. Main conclusions Between 1700 and 2000, the terrestrial biosphere made the critical transition from mostly wild to mostly anthropogenic, passing the 50% mark early in the 20th century. At present, and ever more in the future, the form and process of terrestrial ecosystems in most biomes will be predominantly anthropogenic, the product of land use and other direct human interactions with ecosystems. Ecological research and conservation efforts in all but a few biomes would benefit from a primary focus on the novel remnant, recovering and managed ecosystems embedded within used lands.
CONTEXT: The prevalence of obesity and overweight increased in the United States between 1978 and 1991. More recent reports have suggested continued increases but are based on self-reported data. OBJECTIVE: To examine trends and prevalences of overweight (body mass index [BMI] > or = 25) and obesity (BMI > or = 30), using measured height and weight data. DESIGN, SETTING, AND PARTICIPANTS: Survey of 4115 adult men and women conducted in 1999 and 2000 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. MAIN OUTCOME MEASURE: Age-adjusted prevalence of overweight, obesity, and extreme obesity compared with prior surveys, and sex-, age-, and race/ethnicity-specific estimates. RESULTS: The age-adjusted prevalence of obesity was 30.5% in 1999-2000 compared with 22.9% in NHANES III (1988-1994; P<.001). The prevalence of overweight also increased during this period from 55.9% to 64.5% (P<.001). Extreme obesity (BMI > or = 40) also increased significantly in the population, from 2.9% to 4.7% (P =.002). Although not all changes were statistically significant, increases occurred for both men and women in all age groups and for non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Racial/ethnic groups did not differ significantly in the prevalence of obesity or overweight for men. Among women, obesity and overweight prevalences were highest among non-Hispanic black women. More than half of non-Hispanic black women aged 40 years or older were obese and more than 80% were overweight. CONCLUSIONS: The increases in the prevalences of obesity and overweight previously observed continued in 1999-2000. The potential health benefits from reduction in overweight and obesity are of considerable public health importance.
BACKGROUND: Sepsis represents a substantial health care burden, and there is limited epidemiologic information about the demography of sepsis or about the temporal changes in its incidence and outcome. We investigated the epidemiology of sepsis in the United States, with specific examination of race and sex, causative organisms, the disposition of patients, and the incidence and outcome. METHODS: We analyzed the occurrence of sepsis from 1979 through 2000 using a nationally representative sample of all nonfederal acute care hospitals in the United States. Data on new cases were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification. RESULTS: Review of discharge data on approximately 750 million hospitalizations in the United States over the 22-year period identified 10,319,418 cases of sepsis. Sepsis was more common among men than among women (mean annual relative risk, 1.28 [95 percent confidence interval, 1.24 to 1.32]) and among nonwhite persons than among white persons (mean annual relative risk, 1.90 [95 percent confidence interval, 1.81 to 2.00]). Between 1979 and 2000, there was an annualized increase in the incidence of sepsis of 8.7 percent, from about 164,000 cases (82.7 per 100,000 population) to nearly 660,000 cases (240.4 per 100,000 population). The rate of sepsis due to fungal organisms increased by 207 percent, with gram-positive bacteria becoming the predominant pathogens after 1987. The total in-hospital mortality rate fell from 27.8 percent during the period from 1979 through 1984 to 17.9 percent during the period from 1995 through 2000, yet the total number of deaths continued to increase. Mortality was highest among black men. Organ failure contributed cumulatively to mortality, with temporal improvements in survival among patients with fewer than three failing organs. The average length of the hospital stay decreased, and the rate of discharge to nonacute care medical facilities increased. CONCLUSIONS: The incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining. There are also disparities among races and between men and women in the incidence of sepsis. Gram-positive bacteria and fungal organisms are increasingly common causes of sepsis.
CONTEXT: Prior analyses of National Health and Nutrition Examination Survey (NHANES) data through 1991 have suggested that hypertension prevalence is declining, but more recent self-reported rates of hypertension suggest that the rate is increasing. OBJECTIVE: To describe trends in the prevalence, awareness, treatment, and control of hypertension in the United States using NHANES data. DESIGN, SETTING, AND PARTICIPANTS: Survey using a stratified multistage probability sample of the civilian noninstitutionalized population. The most recent NHANES survey, conducted in 1999-2000 (n = 5448), was compared with the 2 phases of NHANES III conducted in 1988-1991 (n = 9901) and 1991-1994 (n = 9717). Individuals aged 18 years or older were included in this analysis. MAIN OUTCOME MEASURES: Hypertension, defined as a measured blood pressure of 140/90 mm Hg or greater or reported use of antihypertensive medications. Hypertension awareness and treatment were assessed with standardized questions. Hypertension control was defined as treatment with antihypertensive medication and a measured blood pressure of less than 140/90 mm Hg. RESULTS: In 1999-2000, 28.7% of NHANES participants had hypertension, an increase of 3.7% (95% confidence interval [CI], 0%-8.3%) from 1988-1991. Hypertension prevalence was highest in non-Hispanic blacks (33.5%), increased with age (65.4% among those aged > or =60 years), and tended to be higher in women (30.1%). In a multiple regression analysis, increasing age, increasing body mass index, and non-Hispanic black race/ethnicity were independently associated with increased rates of hypertension. Overall, in 1999-2000, 68.9% were aware of their hypertension (nonsignificant decline of -0.3%; 95% CI, -4.2% to 3.6%), 58.4% were treated (increase of 6.0%; 95% CI, 1.2%-10.8%), and hypertension was controlled in 31.0% (increase of 6.4%; 95% CI, 1.6%-11.2%). Women, Mexican Americans, and those aged 60 years or older had significantly lower rates of control compared with men, younger individuals, and non-Hispanic whites. CONCLUSIONS: Contrary to earlier reports, hypertension prevalence is increasing in the United States. Hypertension control rates, although improving, continue to be low. Programs targeting hypertension prevention and treatment are of utmost importance.
Agricultural activities have dramatically altered our planet's land surface. To understand the extent and spatial distribution of these changes, we have developed a new global data set of croplands and pastures circa 2000 by combining agricultural inventory data and satellite‐derived land cover data. The agricultural inventory data, with much greater spatial detail than previously available, is used to train a land cover classification data set obtained by merging two different satellite‐derived products (Boston University's MODIS‐derived land cover product and the GLC2000 data set). Our data are presented at 5 min (∼10 km) spatial resolution in longitude by longitude, have greater accuracy than previously available, and for the first time include statistical confidence intervals on the estimates. According to the data, there were 15.0 (90% confidence range of 12.2–17.1) million km 2 of cropland (12% of the Earth's ice‐free land surface) and 28.0 (90% confidence range of 23.6–30.0) million km 2 of pasture (22%) in the year 2000.
CONTEXT: Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities. OBJECTIVES: To identify and quantify the leading causes of mortality in the United States. DESIGN: Comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality. The search was initially restricted to articles published during or after 1990, but we later included relevant articles published in 1980 to December 31, 2002. Prevalence and relative risk were identified during the literature search. We used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data. MAIN OUTCOME MEASURES: Actual causes of death. RESULTS: The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%) [corrected], and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000). CONCLUSIONS: These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.
CONTEXT: The prevalence of overweight among children in the United States increased between 1976-1980 and 1988-1994, but estimates for the current decade are unknown. OBJECTIVE: To determine the prevalence of overweight in US children using the most recent national data with measured weights and heights and to examine trends in overweight prevalence. DESIGN, SETTING, AND PARTICIPANTS: Survey of 4722 children from birth through 19 years of age with weight and height measurements obtained in 1999-2000 as part of the National Health and Nutrition Examination Survey (NHANES), a cross-sectional, stratified, multistage probability sample of the US population. MAIN OUTCOME MEASURE: Prevalence of overweight among US children by sex, age group, and race/ethnicity. Overweight among those aged 2 through 19 years was defined as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts. RESULTS: The prevalence of overweight was 15.5% among 12- through 19-year-olds, 15.3% among 6- through 11-year-olds, and 10.4% among 2- through 5-year-olds, compared with 10.5%, 11.3%, and 7.2%, respectively, in 1988-1994 (NHANES III). The prevalence of overweight among non-Hispanic black and Mexican-American adolescents increased more than 10 percentage points between 1988-1994 and 1999-2000. CONCLUSION: The prevalence of overweight among children in the United States is continuing to increase, especially among Mexican-American and non-Hispanic black adolescents.
The Surveillance Research Program of the American Cancer Society's Department of Epidemiology and Surveillance Research reports its annual compilation of estimated cancer incidence, mortality, and survival data for the United States in the year 2000. After 70 years of increases, the recorded number of total cancer deaths among men in the US declined for the first time from 1996 to 1997. This decrease in overall male mortality is the result of recent down-turns in lung and bronchus cancer deaths, prostate cancer deaths, and colon and rectum cancer deaths. Despite decreasing numbers of deaths from female breast cancer and colon and rectum cancer, mortality associated with lung and bronchus cancer among women continues to increase. Lung cancer is expected to account for 25% of all female cancer deaths in 2000. This report also includes a summary of global cancer mortality rates using data from the World Health Organization.
BACKGROUND: Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000-15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival. METHODS: We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1-59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation. FINDINGS: In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935-1·179]), pneumonia (0·921 million [0·812 -1·117]), and intrapartum-related events (0·691 million [0·598 -0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000-15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR. INTERPRETATION: In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target. FUNDING: Bill & Melinda Gates Foundation, WHO.
One of the aims of the standardization committee has been the development of Part I, which could be used on a royalty- and fee-free basis. This is important for the standard to become widely accepted. The standardization process, which is coordinated by the JTCI/SC29/WG1 of the ISO/IEC has already produced the international standard (IS) for Part I. In this article the structure of Part I of the JPFG 2000 standard is presented and performance comparisons with established standards are reported. This article is intended to serve as a tutorial for the JPEG 2000 standard. The main application areas and their requirements are given. The architecture of the standard follows with the description of the tiling, multicomponent transformations, wavelet transforms, quantization and entropy coding. Some of the most significant features of the standard are presented, such as region-of-interest coding, scalability, visual weighting, error resilience and file format aspects. Finally, some comparative results are reported and the future parts of the standard are discussed.
BACKGROUND: The initial Global Burden of Disease study found that depression was the fourth leading cause of disease burden, accounting for 3.7% of total disability adjusted life years (DALYs) in the world in 1990. AIMS: To present the new estimates of depression burden for the year 2000. METHOD: DALYs for depressive disorders in each world region were calculated, based on new estimates of mortality, prevalence, incidence, average age at onset, duration and disability severity. RESULTS: Depression is the fourth leading cause of disease burden, accounting for 4.4% of total DALYs in the year 2000, and it causes the largest amount of non-fatal burden, accounting for almost 12% of all total years lived with disability worldwide. CONCLUSIONS: These data on the burden of depression worldwide represent a major public health problem that affects patients and society.
To provide the first nationwide reconnaissance of the occurrence of pharmaceuticals, hormones, and other organic wastewater contaminants (OWCs) in water resources, the U.S. Geological Survey used five newly developed analytical methods to measure concentrations of 95 OWCs in water samples from a network of 139 streams across 30 states during 1999 and 2000. The selection of sampling sites was biased toward streams susceptible to contamination (i.e. downstream of intense urbanization and livestock production). OWCs were prevalent during this study, being found in 80% of the streams sampled. The compounds detected represent a wide range of residential, industrial, and agricultural origins and uses with 82 of the 95 OWCs being found during this study. The most frequently detected compounds were coprostanol (fecal steroid), cholesterol (plant and animal steroid), N,N-diethyltoluamide (insect repellant), caffeine (stimulant), triclosan (antimicrobial disinfectant), tri(2-chloroethyl)phosphate (fire retardant), and 4-nonylphenol (nonionic detergent metabolite). Measured concentrations for this study were generally low and rarely exceeded drinking-water guidelines, drinking-water health advisories, or aquatic-life criteria. Many compounds, however, do not have such guidelines established. The detection of multiple OWCs was common for this study, with a median of seven and as many as 38 OWCs being found in a given water sample. Little is known about the potential interactive effects (such as synergistic or antagonistic toxicity) that may occur from complex mixtures of OWCs in the environment. In addition, results of this study demonstrate the importance of obtaining data on metabolites to fully understand not only the fate and transport of OWCs in the hydrologic system but also their ultimate overall effect on human health and the environment.