The burden of disease and injury in the United States 1996

Background: Burden of disease studies have been implemented in many countries using the Disability-Adjusted Life Year (DALY) to assess major health problems. Important objectives of the study were to quantify intra-country differentials in health outcomes and to place the United States situation in the international context. Methods: We applied methods developed for the Global Burden of Disease (GBD) to data specific to the United States to compute Disability-Adjusted Life Years. Estimates are provided by age and gender for the general population of the United States and for each of the four official race groups: White; Black; American Indian or Alaskan Native; and Asian or Pacific Islander. Several adjustments of GBD methods were made: the inclusion of race; a revised list of causes; and a revised algorithm to allocate cardiovascular disease garbage codes to ischaemic heart disease. We compared the results of this analysis to international estimates published by the World Health Organization for developed and developing regions of the world. Results: In the mid-1990s the leading sources of premature death and disability in the United States, as measured by DALYs, were: cardiovascular conditions, breast and lung cancers, depression, osteoarthritis, diabetes mellitus, and alcohol use and abuse. In addition, motor vehicle-related injuries and the HIV epidemic exacted a substantial toll on the health status of the US population, particularly among racial minorities. The major sources of death and disability in these latter populations were more similar to patterns of burden in developing rather than developed countries. Conclusion: Estimating DALYs specifically for the United States provides a comprehensive assessment of health problems for this country compared to what is available using mortality data alone

Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States

BACKGROUND: The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the “eight Americas,” to explore the causes of the disparities that can inform specific public health intervention policies and programs. METHODS AND FINDINGS: The eight Americas were defined based on race, location of the county of residence, population density, race-specific county-level per capita income, and cumulative homicide rate. Data sources for population and mortality figures were the Bureau of the Census and the National Center for Health Statistics. We estimated life expectancy, the risk of mortality from specific diseases, health insurance, and health-care utilization for the eight Americas. The life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001. Within the sexes, the life expectancy gap between the best-off and the worst-off groups was 15.4 y for males (Asians versus high-risk urban blacks) and 12.8 y for females (Asians versus low-income southern rural blacks). Mortality disparities among the eight Americas were largest for young (15–44 y) and middle-aged (45–59 y) adults, especially for men. The disparities were caused primarily by a number of chronic diseases and injuries with well-established risk factors. Between 1982 and 2001, the ordering of life expectancy among the eight Americas and the absolute difference between the advantaged and disadvantaged groups remained largely unchanged. Self-reported health plan coverage was lowest for western Native Americans and low-income southern rural blacks. Crude self-reported health-care utilization, however, was slightly higher for the more disadvantaged populations. CONCLUSIONS: Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries

The Receptivity to Safety-Related Mobile Apps Among Commercial Fishing Captains: Descriptive Exploratory Study

BackgroundMobile apps addressing a variety of workplace safety issues have proliferated over the last decade as mobile technology has advanced and smartphone ownership has increased. Workplace safety interventions are often designed for a specific work site. However, some of the most dangerous jobs are ones in which workers frequently change field locations, such as commercial fishing. Mobile apps may be particularly suitable for delivering safety interventions to these workers. ObjectiveWe sought to gauge the potential for using mobile apps to deliver safety interventions to commercial fishing workers. The purpose of this paper is to describe how fishermen use their mobile devices during fishing operations and identify any mobile apps they already use for safety. MethodsParticipants comprised commercial fishing captains who already owned an iOS or Android smartphone or tablet. They completed a questionnaire that asked about their current mobile device use and their use of safety-related mobile apps, in addition to questions about their fishing operations. We performed descriptive analyses of the data. ResultsA total of 61 participants completed the questionnaire. The most common types of mobile devices participants reported owning were iPhones (n=36, 59%) and Android phones (n=24, 39%). Most participants (n=53, 87%) reported using their mobile device for both work and personal purposes, including while out at sea (n=52, 85%). Over half of the participants reported that they had either safety-related apps (n=17, 28%) or apps that help them with their work (n=35, 57%). The types of apps most frequently mentioned were apps for weather, wind, tides, and navigation. ConclusionsThe results of this study indicate that some commercial fishing captains who own a mobile device are receptive to using safety-related apps for work. Apps that help avoid hazards by monitoring environmental conditions and apps optimized for use on smartphones may be most likely to be adopted and used. Overall, these results suggest that mobile apps are a promising avenue for improving safety among workers in commercial fishing and similar occupations

Workplace homicides committed by firearm: recent trends and narrative text analysis

Abstract Background Firearm workplace homicides are a significant problem in the United States. We sought to provide a current, national-level examination of these crimes and examine how perpetrators accessed firearms used in workplace homicides. Methods We abstracted information on all firearm workplace homicides from the Bureau of Labor Statistics’ Census of Fatal Occupational Injuries from 2011 to 2015. We classified deaths by perpetrator’s relationship to the workplace/victim, motive (robbery v. non-robbery), circumstance (argument v. other circumstances), and firearm access points using narrative text fields. Results There were 1553 firearm workplace homicides during the study period. Robbery crime trended downward from 2011 to 2015. In contrast, non-robbery crimes constituted almost 50% of the homicides and trended upward in recent years. Customers and co-workers were the most frequent perpetrators of non-robbery crimes, most after an argument. While customers and co-workers who commit these crimes were often armed at the time of the argument, some were not and retrieved a firearm from an unspecified location before committing a homicide. Thus, immediate and ready firearm access was commonly observed in argumentative workplace deaths. Conclusions Limiting firearm access in the workplace is a possible measure for preventing deadly workplace violence and should be considered as part of a comprehensive strategy for addressing this reemerging public health concern

Malaria-Related Knowledge and Prevention Practices in Four Neighbourhoods in and Around Mumbai, India: A Cross-Sectional Study

Background: India accounts for the highest number of malaria cases outside of Africa. Eighty per cent of India’s population lives in malaria-risk areas, with cases increasing in urban areas. Mumbai, India, one of the most populous cities in the world, has experienced such an increase. To be successful, many malaria control efforts require community participation, which in turn depends on individuals’ knowledge and awareness of the disease. This study assessed the knowledge and prevention practices regarding malaria in residents of four different areas of Mumbai, India, around the time of a malaria outbreak and the start of a widespread awareness campaign. Methods: A cross-sectional comparative study assessed malaria-related knowledge and prevention practices in four geographically and socio-demographically distinct areas of Mumbai, India. A structured interviewer-administered questionnaire was administered to a stratified random sample of 119 households between 16 December 2010 and 30 January 2011. Participant socio-demographic characteristics, malaria knowledge, malaria prevention practices, and household environmental factors were examined overall and compared across the four areas of Mumbai. Results: Overall, respondents had excellent knowledge of the mosquito as the means of transmission of malaria, mosquito biting times and breeding sites, and fever as a symptom of malaria. However, many respondents also held misconceptions about malaria transmission and symptoms. Respondents generally knew that bed nets are an effective prevention strategy, but only 30% used them, and only 4% used insecticide-treated bed nets. Knowledge and prevention practices varied across the four areas of Mumbai. Conclusions: Although most residents know that bed nets are effective in preventing malaria, usage of bed nets is very low, and almost no residents use insecticide-treated bed nets. As the four areas of Mumbai differed in knowledge, prevention practices, and primary sources of information, malaria control campaigns should be tailored according to the knowledge gaps, practices, environments, resources, and preferences in different areas of the city, using the interpersonal and media channels most likely to reach the target audiences. Malaria control efforts involving bed nets should emphasize use of insecticide-treated bed nets

Life Expectancy at Birth in the Eight Americas (1982–2001)

<p>Estimates for Americas 1 and 3 have been adjusted for differential underestimation of population and mortality among Asians (see <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030260#st2" target="_blank">Methods</a>).</p

County Life Expectancies by Race

<div><p>Deaths were averaged for 1997–2001 to reduce sensitivity to small numbers and outliers.</p> <p>(A) Life expectancy at birth for black males and females. Only counties with more than five deaths for any 5-y age group (0–85) were mapped, to avoid unstable results.</p> <p>(B) Life expectancy at birth for white males and females.</p></div