Subject(s)
Global Health , Tuberculosis/epidemiology , Humans , Tuberculosis/diagnosis , Tuberculosis/therapyABSTRACT
In 1991, the first epidemic of St. Louis encephalitis (SLE) ever reported in Arkansas resulted in 25 cases in Pine Bluff (attack rate: 44 per 100,000; 95% confidence interval [CI] 28-65). To identify risk factors for SLE viral infection and risk factors for neuroinvasive illness, we conducted a community-based, cross-sectional study of noninfected and asymptomatically infected persons and a case-control study of asymptomatically and symptomatically infected persons. The SLE viral infection rate was similar in all age groups and in all studied census tracts. Risk factors for asymptomatic infection included: living in a low income household (relative risk [RR] = 2.6, 95% CI 1.1-6.0), sitting outside in the evening (RR = 2.1, 95% CI 1.0-4.8), and living in homes with porches (RR = 2.9, 95% CI 0.9-9.3) or near open storm drains (RR = 2.2, 95% CI 1.0-4.9). Compared with asymptomatically infected persons, symptomatic persons were older (odds ratio [OR] for age > or = 55 years = 13.0, 95% CI 1.2-334) and more likely to have a previous history of hypertension (OR = 8.5, 95% CI 1.1-72). Our results indicate that advanced age is the most important risk factor for developing encephalitis after infection with SLE virus. Hypertension and vascular disease may predispose to neuroinvasive disease, but this epidemiologic study has not ruled out the confounding effects of age.
Subject(s)
Disease Outbreaks , Encephalitis, St. Louis/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Animals , Antibodies, Viral/blood , Arkansas/epidemiology , Case-Control Studies , Child , Child, Preschool , Culex/microbiology , Encephalitis Virus, St. Louis/immunology , Encephalitis Virus, St. Louis/isolation & purification , Encephalitis, St. Louis/etiology , Female , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Infant , Insect Vectors/microbiology , Male , Middle Aged , Risk Factors , Socioeconomic FactorsABSTRACT
BACKGROUND: Cancer incidence and cancer survival estimates in American Indians are quite limited. PURPOSE: Our purpose was to estimate cancer incidence and survival in American Indians who were registered for Indian Health Service (IHS) care in Montana. METHODS: We linked databases from the IHS and the Montana Central Tumor Registry (MCTR) to ascertain cases for the time period from January 1, 1982, through December 31, 1987. To calculate survival rates, we used a relative survival method that incorporated age-specific risks for noncancer deaths among American Indians. RESULTS: We identified 344 cases that were compatible with the National Cancer Institute (Surveillance, Epidemiology, and End Results Program) surveillance definition of cancer. Of these cases, 249 (72%) were listed in both the MCTR and the IHS databases; 56 (16%) and 39 (11%) were listed in only the MCTR or the IHS database, respectively. Compared with the overall cancer incidence in U.S. White men, the overall cancer incidence in Montana American Indian men was markedly lower, as was the incidence for colorectal and bladder cancers and for non-Hodgkin's lymphoma. The overall cancer incidence for Montana American Indian women differed less markedly, however, from the overall incidence in U.S. White women. Compared with the cancer incidence in U.S. White women, the incidence in Montana American Indian women was significantly higher for cervical cancer but was significantly lower for colorectal, breast, and uterine cancers. Survival rates from cancer were also examined for the first time in this population. For those sites examined, the survival rates were much lower in Montana American Indians than in U.S. Whites. CONCLUSIONS: We conclude that it is feasible to develop state-specific cancer incidence and survival estimates for American Indians in at least some states in different regions of the United States. Collaboration between the IHS and a state tumor registry is likely to improve the case ascertainment achieved by either agency alone.
Subject(s)
Indians, North American , Neoplasms/epidemiology , Female , Humans , Incidence , Male , Montana/epidemiology , Neoplasms/ethnology , Registries , Survival AnalysisABSTRACT
The first outbreak of St. Louis encephalitis (SLE) in Arkansas occurred in Pine Bluff (Jefferson County) during July-August 1991. Cases of SLE were identified mainly through reporting by physicians in Jefferson and surrounding counties. In addition, testing of stored cerebrospinal fluid specimens, a hospital chart review, and a serosurvey were performed in Pine Bluff. Twenty-eight Arkansas residents, five of whom died, had cases of SLE. Half the case patients were over age 60, and nearly half had hypertension. The serosurvey confirmed that infection with the SLE virus was not new to Pine Bluff, and that most infections in 1991 were asymptomatic. Arkansas physicians may see more cases of SLE in 1992. SLE epidemiology, clinical presentation, diagnosis, and preventive measures are reviewed.
