Acquired immune deficiency syndrome and the increase in non-Hodgkin lymphoma incidence in New Jersey from 1979 to 1996.

BACKGROUND: In New Jersey, the age-adjusted incidence rate of non-Hodgkin lymphoma (NHL) increased more than a third from 1979 to 1996, the largest increase among the major cancers. METHODS: Data from a linkage of New Jersey's population-based cancer and acquired immune deficiency syndrome (AIDS) registries were used to obtain two sets of annual age specific incidence rates and estimated average annual percentage changes in the incidence rates, for each of five adult age groups within each gender, from Poisson regression models that 1) included all the NHL cases and 2) excluded the cases of AIDS-NHL. RESULTS: During 1979-1996, of the NHL cases aged 15 years and older reported to the cancer registry, 687 (6%) of the 11,725 male cases and 139 (1%) of the 10,785 female cases were AIDS-NHL. The highest percentages of AIDS-NHL were in the younger age groups--15-29, 30-39, and 40-49 years. Among both men and women, average annual percentage increases in NHL occurred overall (3.1 and 3.0, respectively), and in each age group, ranging from 1.6 and 1.9, respectively, in the 50-59 years age group to 6.6 and 4.2, respectively, in the 30-39 years age group (P <<0.01). Excluding AIDS-NHL, the estimated average annual percentage increases in NHL were greatest in the 30-39 and the 60 years and older age groups among men, and these two age groups plus the 15-29 years age group among women, ranging between 2.4 and 2.9 (P < 0.05). CONCLUSIONS: As elsewhere, factors in addition to AIDS are involved in the increasing incidence of NHL in New Jersey. Because diagnostic and classification changes probably do not explain the entire increase unrelated to AIDS, other risk factors are likely responsible. Public health interventions to reduce the incidence of NHL not related to AIDS are problematic until more is known about the causes of NHL.

Cancer in people with AIDS in New Jersey.

A total of 2,460 persons with AIDS (PWA) and cancer were identified--2,159 men and 301 women--among 22,382 men and 7,931 women reported with AIDS from 1979-1995 in New Jersey. Of these, 50% were diagnosed with Kaposi's sarcoma (KS), 33% with non-Hodgkin's lymphoma (NHL), and the remainder with other cancers, including lung and bronchus, oral, cervical, Hodgkin's disease, and digestive other than anal. The proportions of PWA who also had cancer, specifically KS and NHL, varied significantly by gender, race, and mode of HIV transmission. These findings are discussed in terms of risk factors in addition to immunosuppression that may account for the higher rates of cancer among PWA than the general population. Cancer prevention and detection measures likely will become more important as PWA survive longer.

Fibrinolytic therapy in young women with acute myocardial infarction.

STUDY OBJECTIVE: Previous studies found that women with acute myocardial infarction (AMI) receive less aggressive therapy compared with men. We sought to determine the percentage of young women (12 hours after symptom onset) were the most common reasons for ineligibility.

Age-related differences in diagnoses within the elderly population.

The most common diagnoses of elderly patients in the emergency department (ED) were compared among three age subgroups: 65 to 74, 75 to 84, and 85 and older. The computerized billing records for patient visits to 10 northern New Jersey hospital EDs for the years 1985 to 1991 were retrospectively analyzed. The most frequently occurring ICD-9-CM codes for elderly patients were compared among the three age subgroups. Elderly persons comprised 174, 146 (14% of the total) patient visits. The 176,146 patient visits were assigned 259,440 ICD-9-CM codes. The most common ICD-9-CM codes for medical diagnoses included chest pain, cardiac dysrhythmias, congestive heart failure, syncope, abdominal pain, and dyspnea. Fractures, particularly of the lower limb and upper limb; contusions; open wounds, particularly of the head, neck, and trunk; and falls were among the most common trauma diagnoses. The proportions in the three age subgroups of each diagnosis were statistically significantly different, except for cardiac arrest and contusions of the trunk and of multiple sites. The diagnoses with clinically significant higher relative risks in older age subgroups were atrial fibrillation, congestive heart failure, syncope, hypovolemia/dehydration, gastrointestinal hemorrhage, dyspnea, pneumonia, pulmonary edema, cerebrovascular accident, septicemia, urinary tract infection, fractures, and open wounds of the head, neck, trunk, particularly the scalp, and falls. Clinically significant lower relative risks were found in older age subgroups for chest pain, acute myocardial infarction, hypertension, angina, chronic airway obstruction not elsewhere classified, epistaxis, contusions of the upper limb, and open wounds of the finger.

Evolution of a state occupational lead exposure registry: 1986-1996.

In the first 11 full years of operation (January 1, 1986, through December 31, 1996) of an adult lead registry in New Jersey, 23,456 reports of occupational lead toxicity (blood lead level > or = 1.21 mumol/L) in 4,011 workers, involving 496 workplaces, were received. The majority of the reports and workers were from the manufacturing and construction industries. Over the 11 years, the annual numbers of reports and workers declined, although the annual numbers of involved workplaces remained stable, as did the number of newly identified workers and workplaces. The decline occurred primarily in the manufacturing industry; the construction industry experienced an increase in reports and reported workers. For all years combined, 36% of reported workers had at least one blood lead level equal to or greater than 1.93 mumol/L, although in the most recent years the percentage dropped overall and in both the manufacturing and construction industries.

Medical management of lead-exposed workers: results of physician interviews in New Jersey.

Between July 1990 and April 1992, a questionnaire was administered to the physicians who saw 62 individuals with a blood lead (PbB) level equal to or higher than 2.40 mumol/liter with occupational inorganic lead exposure, to ascertain the medical management of workers with elevated PbB levels. Most of the 62 cases were seen by their personal physician (50%) or a private physician under contract with the company for which the patient worked (40%). Only eight (13%) patients were seen by a physician in a medical specialty assumed to include training relevant to occupational lead exposure. Fifteen percent of the patients' physicians reported taking no action for the elevated PbB level. Twenty-nine percent did not report retesting the patient (all should have been retested). Twenty-one percent of the 62 patients' physicians reported informing no one, including the patient, of the elevated PbB level. The majority of the physicians did not know the answer or declined to answer a question about what PbB level would prompt them to take six follow-up actions. The results of the physician interviews indicate that medical follow-up on workers with elevated PbB levels may not be adequate to prevent lead poisoning of the workers and their co-workers. Recommendations include methods to increase physician and employer knowledge of the medical management of workers with elevated PbB levels and to increase employer compliance with OSHA standards regarding medical surveillance of lead-exposed workers.

Use of employer illness reports for occupational disease surveillance among public employees in New Jersey.

The New Jersey Department of Health Public Employees Occupational Safety and Health (PEOSH) Program reviewed public employers' "Annual Occupational Injuries and Illness Summary" and "First Report of Accidental Illness or Injury" to determine their usefulness for occupational disease surveillance. More than 1200, 1800, and 1700 cases of illnesses were reported on the annual summaries for 1988, 1989, and 1990, respectively. Skin diseases and respiratory conditions due to toxic agents were the two most reported categories of illness. The most commonly reported illnesses on the First Reports for June 1990 and for January 1991 were insect bites, poison ivy/oak/sumac, skin rash/dermatitis/infection, smoke inhalation, communicable disease, stress reaction, and toxic substance inhalation. Analyses of the age, sex, and occupation of the employees and on the causes of the illnesses are also presented. From the analysis of First Reports for June 1990 and January 1991, the First Reports were determined to be very useful for occupational disease surveillance because of their timeliness and detail on the employer, employee, and illness. Accordingly, First Reports for July 1991 through June 1992 were reviewed to assist in the development of the PEOSH Program's workplan for July 1992 through June 1993.

Smokeless tobacco use among ninth graders in a north-central metropolitan population: cross-sectional and prospective associations with age, gender, race, family structure, and other drug use.

Smokeless tobacco use was analyzed in relation to demographic factors and to past and current use of tobacco, alcohol, and marijuana in 4,249 ninth graders in the Twin Cities metropolitan area. Smokeless tobacco use was found to be more common among males, particularly whites; among whites relative to blacks; among adolescents from one-parent households; and among those who reported current or prior use of cigarettes, alcohol, or marijuana. Smokeless tobacco use was also very common among the Native Americans and Hispanics sampled. The results suggest that smokeless tobacco may be joining the list of common recreational drugs that have potential for both short and long-term danger to the adolescent user.