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Re: Cardio disease citation--as promised, was Gofman
The big problem with the data shown below is that they are crude
mortality (or incidence) rates. Unless & until they are adjusted (or
standardized) for age, smoking rates, socio-economic status and any
other obvious confounders, they don't really tell us whether there's a
problem or not. Ms. Smith should know that, and should also know that
hospitalization data and mortality data are not the same.
Mr. Ricciuti, I'm not saying there is no problem in the Niagara Falls
area, I'm saying that there is a reason why studies that hold up under
scrutiny publish adjusted (or standardized) mortality rates, just like
there's a reason why radsafers argue about whether residential radon
studies have dealt with confounders properly. This issue isn't limited
to studies of radiation health effects, but arises in any study where
health effects are correlated with environmental exposures. Unlike
physics problems, epidemiological problems rarely have answers that are
clear cut.
The bottom line is that neither health physics nor epidemiology should
be practiced by amateurs.
Back to work,
Tony Harrison, MSPH
Colorado Dept. of Public Health & Environment
Laboratory Services Division
(303)692-3046
tony.harrison@state.co.us
>>> <NiagaraNet@AOL.COM> 06/06/03 07:17PM >>>
Dear Radsafers:
Here is a letter that I requested from the epidemiologist that was a
part of
the number crunching for the WNY/Niagara cardio stats. Please credit
the
Research Center for Stroke & Heart Disease of The Jacobs Neurological
Institute as
the source of this information when referencing it. The data set, as
described, can be released to approved researchers.
So, I guess we don't have to believe a US Senator, a Mayo trained
cardiologist,
a hospital president, or me :*)
I hope this helps to validate some of what I have posted. Further
research is
being reviewed and more is anticipated.
Regards,
L.H. Ricciuti
NiagaraNet@aol.com
"We're not here for a good time, nor for a long time."
---
Subj: The information you requested
Date: 6/6/2003 5:29:54 PM Eastern Standard Time
From: <A
HREF="mailto:SKSmith@KaleidaHealth.Org";>SKSmith@KaleidaHealth.Org</A>
To: <A HREF="mailto:niagaranet@aol.com";>niagaranet@aol.com</A>
File: Mort&Hospbyregion,countyTABLES.xls (20992 bytes) DL Time (26400
bps):
< 1 minute
Sent from the Internet (Details)
L.H. Ricciuti,
The Research Center for Stroke & Heart Disease of The Jacobs
Neurological
Institute at Kaleida Health (Buffalo General Hospital) collects raw
data files
from several sources in order to sort and analyze them in an effort to
present
epidemiological profiles of stroke and heart disease for Western New
York (WNY)
and other regions of New York State (NYS). Sources of data include: the
Statewide Planning and Research Cooperative System (SPARCS) at the New
York State
Department of Health (NYSDOH) for hospitalization data and the Vital
Statistics
System at the NYSDOH for mortality data. There are also others, but the
data
I will discuss below are from the aforementioned sources.
In the year 2000, Niagara County, New York had the greatest number of
hospitalizations (a measure of prevalence) of any county in the entire
state, be it
Upstate or Downstate New York. Niagara County had 443.947 per 100,000
population cases of hospitalized cerebrovascular disease and 1008.433
per 100,000
population cases of hospitalized cardiovascular disease-- these rates
are 48% and
73% higher than the state aggregate rate, respectively (these rates are
crude
morbidity rates). In some cases, Niagara County residents experienced
nearly
five times as many hospitalizations for cardiovascular disease than
residents of
other areas of NYS. WNY as a region has the worst rate of both
cerebrovascular disease hospitalizations and cardiovascular disease
hospitalizations of any
other region of NYS. These raw data are from SPARCS at the NYSDOH. This
is NY
State's best source of hospitalization data which we can analyze in
several
ways including by ICD code. As I mentioned earlier on the phone, these
raw
datasets are available to hospitals within NYS and upon request, if
approved, to
other researchers.
As far as mortality, Niagara County fares the worst with regard to
cardiovascular disease mortality when compared to all other WNY
counties as well as the
aggregate state and national rates of mortality (Year 2000 as well).
The
Niagara County rate of cardiovascular disease mortality is 27% higher
than the
aggregate state rate. And, WNY itself fares worse than any other region
of NY
State, and the US as a whole, with regard to cardiovascular disease
mortality.
Niagara County has the fifth highest rate of cardiovascular disease
mortality of
all 62 counties in NYS. The raw data we analyzed here are from the
Vital
Statistics System out of the NYSDOH.
So, as you know, the numbers strongly support the argument that Niagara
County has extraordinarily high rates of heart disease and stroke, in
fact, in many
cases, the worst rates in the whole state. The WNY region, almost
across the
board, has the highest rates of stroke and heart disease mortality and
morbidity of all regions of the entire state as well.
I will attach a Word document with crude death and morbidity rates of
cerebrovascular and cardiovascular disease rates for NYS regions and
counties (the
file has two worksheets in it with labeled tabs). I hope this gives you
quite a
bit to work with. There are many, many ways to present and make
comparisons
with these data. Please credit the Research Center for Stroke & Heart
Disease of
The Jacobs Neurological Institute as the source of this information
when
referencing it. And, kindly send me anything that you do produce. I
would love to
see it. My contact info is below.
* Note: I use the terms stroke and cerebrovascular disease
interchangeably
and I use the terms heart disease and cardiovascular disease
interchangeably.
Shannon Smith
<<Mort & Hosp by region, county TABLES.xls>>
Shannon K. Smith, M.S.
Director of Research
Research Center for Stroke & Heart Disease
The Jacobs Neurological Institute
100 High Street, Suite C319
Buffalo, New York 14203
Phone: (716) 859-3328, Fax: (716) 859-3324
__
Once I've looked at the spread sheet that was sent to me as an
attachment,
I'd be happy to pass it along to those that would wish to see it. I
will need a
week to peruse it myself, so any time after that, a request would be
welcomed.
LHR
Time 21:12
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