The epidemiology of Wegener's granulomatosis. Estimates of the five-year period prevalence, annual mortality, and geographic disease distribution from population-based data sources.

OBJECTIVE: To estimate the prevalence, annual mortality, and geographic distribution of Wegener's granulomatosis. METHODS: Analysis of national vital statistics data and hospitalization data from a national survey and from all New York State inpatient facilities. RESULTS: Between 1979 and 1988, 1,784 death certificates in the United States listed Wegener's granulomatosis as a cause of death. Nationally, an estimated 10,771 hospitalizations included Wegener's granulomatosis among the discharge diagnoses. In New York State, there were 978 hospitalizations among 571 individuals with Wegener's granulomatosis. CONCLUSION: The prevalence of Wegener's granulomatosis in the United States is approximately 3.0 per 100,000 persons. Clear differences in the geographic distribution of Wegener's granulomatosis are apparent when analysis consider rates of disease in individual counties. Contrary to previous reports, associations between disease exacerbations and season were not apparent.

Characteristics of HIV-infected adults in acute care hospitals in New York State, 1984-1986.

The New York State acute care, hospital discharge database was used to create a longitudinal case history file for all adult inpatients infected with the human immunodeficiency virus (HIV). From 1984 through 1986, 12,958 individuals with HIV-related diseases were treated in acute care hospitals throughout the state. Approximately 80% of those people resided in New York City, and nearly half of them were between ages 30 and 39 years. Over the three-year period, the proportion of females increased from 11.8% to 16.6%. The per diem charge increased slightly, although the total length of stay for the first year of HIV illness declined sufficiently to decrease the total charge for the year. Examination of the pattern of inpatient stays and intercurrent days shows the first and last hospital stays to be longer than those in between, although the days between stays decreased as the number of admissions increased. The hospital stay in which a patient died was typically of longer duration than earlier stays. The average charge for HIV-related hospital care among inpatients during their first year of illness was approximately $20,000.

An evaluation of the use of the Statewide Planning and Research Cooperative System of New York State as a resource planning tool for HIV infection.

Hospital discharge records of patients with Pneumocystis carinii pneumonia (PCP) in New York State were studied to determine whether cases of human immunodeficiency virus (HIV) infection were identified. We estimate that as many as 13 percent of hospitalizations of patients with PCP in 1987 and 10 percent of those in 1988 were not appropriately identified as HIV related. Identification of PCP as HIV related was a function of a hospital's volume of PCP admissions.

HIV infected hospital patients in New York State. The development of longitudinal information from a hospital discharge data system.

Abstracted records of all patients discharged from New York State acute care hospitals from January 1, 1983, through October 1, 1987, containing a diagnosis of HIV infection (N = 36,664) were linked into a longitudinal file of 20,005 patient-specific case histories. A validation study utilizing Medicaid patient-specific discharge information for calendar year 1985 showed that, on the average, each case history of the longitudinal file contained 85% (+/- 5%) of the expected discharges. The number of patients present in the longitudinal file was 10% (+/- 4%)--too large a percentage, due to a failure to link all the discharges to the appropriate case histories. The number of patients with a diagnosis of Pneumocystis carinii pneumonia (PCP) found in the longitudinal file was found to be consistent with the number reported to the New York State AIDS Registry. The longitudinal file appears to be sufficiently accurate and complete to use in evaluating HIV-related acute care in hospitals.

Automation of the indirect fluorescent-antibody test for toxoplasmosis.

The feasibility of automating the decision-making tasks of the medical technician in the determination of the results of the indirect fluorescent-antibody test for toxoplasmosis was investigated. Two approaches were studied: (i) macroscopic measurement of fluorescence from a large number of organisms (full-field illumination measurements), and (ii) microscopic measurements of fluorescence and morphology of individual parasites (pattern recognition). The macroscopic approach was studied utilizing an argon-ion laser in incident illumination with a Leitz Ortholux microscope and a phototube mounted so as to measure green fluorescence. Due to similar amounts of fluorescence from negative polar reactions and positive rim reactions, the macroscopic technique was concluded to be not feasible. The microscopic approach was studied utilizing a high resolution optical pattern recognition instrument. The results indicate that an object area measurement is sufficient to distinguish the presence of Toxoplasma gondii organisms from debris and overlapping organisms when studying the red fluorescence (due to Evans blue counterstain). Dark reactions were determined by the absence of green fluorescence. The differentiation of the rim and polar reactions was determined by the measurement of the ratio of green fluorescing area (due to fluorescein isothiocyanate) to red fluorescing area on the same organism. Clinically important titer information was also demonstrated to be obtainable. It was concluded that complete automation of the indirect fluorescent antibody test for toxoplasmosis is feasible with existing technology.