Analysis of the sociodemography of gonorrhoea in Leeds, 1989-93.

OBJECTIVE: To investigate the epidemiology of gonorrhoea in an urban area in the United Kingdom. DESIGN: Analysis of all cases of gonorrhoea with regard to age, sex, ethnic group, and socioeconomic group with 1991 census data as a denominator. SETTING: Leeds, a comparatively large urban area (population around 700,000) in the United Kingdom. SUBJECTS: All residents of Leeds with culture proved cases of gonorrhoea during 1989-95. MAIN OUTCOME MEASURE: Relative risk of gonorrhoea. RESULTS: Sex, age, race, and socioeconomic group and area of residence were all independently predictive of risk of infection. Young black men aged 20-29 were at highest risk, with incidences of 3-4% per year. Black subjects were 10 times more likely than white subjects to acquire infection, and subjects from the most deprived socioeconomic areas were more than four times more likely than those from the most affluent areas to acquire infection. CONCLUSIONS: Different ethnic and socioeconomic groups vary in their risk of infection with gonorrhoea within an urban area. Targeted interventions and screening to reduce the incidence of sexually transmitted disease are now priorities.

Pathways of coronary care--a computer-simulation model of the potential for health gain.

A computer-simulation model of the need for cardiology services is described. The model simulates the potential for health gain, in terms of a fall in mortality, determining the effect of alterations in prevention and treatment rates. The model was initially developed from a pathways-of-care flow chart, which originated from a working group consisting of a consultant cardiac surgeon, cardiologists, and public-health physicians, together with statisticians and an operational-research analyst. The original purpose of the model was as a communication tool, to help nonclinicians to have a better understanding of how and why doctors work as they do, but it has since been developed for use in setting and meeting health targets. It enables quantification of the effects of changing different combinations of key variables over time. It is designed to answer 'what if?' questions of the type 'What would the effect of a 10% reduction in the incidence of angina be on the number of deaths, angiograms, angioplasties, and coronary-artery bypass grafts. The model has been made available in a form which only requires a Lotus 123 spreadsheet package to enable it to run, and it is designed to be easy to use with the assistance of simple two-key commands throughout. The model has been used by district health authorities to calculate the response required in their own local areas to achieve targets for the year 2000.

Standardized mortality from cervical cancer: a measure of performance?

A retrospective cohort analysis, using data extracted from clinical notes, examined the validity of standardized mortality ratios (SMRs) for cervical cancer as an indicator of the quality of health services by exploring the mortality at five years of patients presenting with cervical cancer, identifying factors associated with survival, and studying the relationship of those factors to SMRs for the disease. The subjects were 1038 women aged 15-64 registered at the Yorkshire Cancer Registry as having invasive cervical cancer between 1979 and 1983. It was found that independent risk factors for mortality within five years of presentation were stage at diagnosis and smoking habit. Method of treatment had an effect that failed to reach statistical significance. Independent risk factors for late stage at presentation were absence of a history of cervical smear and increasing age. Considerable variation remained unexplained in both models. District SMRs were not related to five-year survival, stage at presentation or screening history. SMRs were related to proportions of smokers. It is concluded that SMRs are subject to considerable influence from a range of unidentified factors, as well as identified risk factors. They are too broad an indicator to be a valid measure of health service performance. The health service's ability to reduce case fatality does not outweigh the effects of incidence and severity. Better indicators would be survival to five years of those presenting at stage II or less and distribution of stage at presentation.