Diane Makuc - Academia.edu (original) (raw)

Papers by Diane Makuc

Med Care, 1983

This study documents changes in surgical treatment of breast cancer using data from the National ... more This study documents changes in surgical treatment of breast cancer using data from the National Hospital Discharge Survey. All discharge records for women aged 25 years and older who received a mastectomy and had a diagnosis of breast cancer were selected for analysis. The proportion of such women discharged who received a radical mastectomy declined precipitously from 49% in 1972-1974 to 14% in 1978-1980. The proportion of women discharged who received modified radical mastectomies increased concomitantly from 29% in 1972-1974 to 64% in 1979-1980. Further, these changes in surgical practice were observed in all regions of the United States and for both small and large hospitals. The average length of hospital stay for discharged women treated surgically for breast cancer declined from 11.8 to 10.3 days between 1972-1974 and 1978-1980. About one third of this decline can be attributed to the shift toward less extensive operations.

American Journal of Epidemiology, Nov 1, 1994

Relatively high serum albumin levels have been associated with reduced cardiovascular mortality a... more Relatively high serum albumin levels have been associated with reduced cardiovascular mortality and coronary heart disease incidence. No prospective studies have examined serum albumin and stroke mortality and incidence. Therefore, data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study were examined to assess serum albumin level as a risk factor for stroke. White men aged 65-74 years with serum albumin concentrations of > 4.4 g/dl had a risk of stroke incidence over a follow-up period of 9-16 years of only about two-thirds that of men with serum albumin concentrations of < 4.2 g/dl. This effect persisted after controlling for multiple stroke risk variables (relative risk = 0.61, 95% confidence interval 0.41-0.89). A similar association with stroke death was found in white men aged 65-74 years. Serum albumin was not associated with stroke risk in white women aged 65-74 years. In blacks aged 45-74 years, serum albumin concentrations of > 4.4 g/dl were associated with a risk of stroke incidence only one-half and a risk of stroke death only one-fourth that seen at levels < 4.2 g/dl after controlling other risk variables. Further studies are needed to confirm these findings and to elucidate mechanisms for the effect of serum albumin on stroke incidence and death.

American Journal of Epidemiology, May 1, 1989

The authors examined national changes in socioeconomic differentials in mortality for middle-aged... more The authors examined national changes in socioeconomic differentials in mortality for middle-aged and older white men and women in the United States with the use of 1960 data from the Matched Records Study and 1971-1984 data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). In 1960, there was little difference in mortality by educational level among middle-aged and older men. Since 1960, death rates among men declined more rapidly for the more educated than the less educated, which resulted in substantial educational differentials in mortality in 1971-1984. In contrast, among women, death rates declined at about the same rate regardless of educational attainment, so that a strong inverse relation between education and mortality in 1960 remained about the same magnitude during 1971-1984. Trends in educational differentials for heart disease mortality are responsible for much of the change for all causes of death. Relative risk estimates based on the NHEFS indicate that after taking into account selected baseline risk factors the least educated are still at substantially elevated risk of death from heart disease, ranging from a relative risk of 1.38 for men aged 65-74 years at baseline to 2.27 for men aged 45-64 years. Reasons for the observed educational differentials and their changes over time are not easily explained and are likely to be multifactorial.

American Journal of Public Health, Sep 20, 2011

American Journal of Public Health, Mar 1, 2001

Measurement of the availability of health care providers in a geographic area is a useful compone... more Measurement of the availability of health care providers in a geographic area is a useful component in assessing access to health care. One of the problems associated with the county provider-to-population ratio as a measure of availability is that patients frequently travel outside their counties of residence for health care, especially those residing in nonmetropolitan counties. Thus, in measuring the number of providers per capita, it is important that the geographic unit of analysis be a health service area. We have defined health care service areas for the coterminous United States, based on 1988 Medicaredata on travel patterns between counties for routine hospital care. We used hierarchical cluster analysis to group counties into 802 service areas. More than one half of the service areas include only nonmetropolitan counties. The service areas vary substantially in theavailability of health care resources as measured by physicians and hospital beds per 100,000 population. For almost all of the service areas, the majority of hospital stays by area residents occur within the service area. In contrast, for 39 percent of counties, the majority of hospital stays by county residents occur outside the county. Thus, the service areas are a more appropriate georgraphic unit than the coun ty for measuring the availability of health care.

American Journal of Public Health, Mar 1, 2008

We sought to establish national data on the prevalence of visual impairment, blindness, and selec... more We sought to establish national data on the prevalence of visual impairment, blindness, and selected eye conditions (cataract, diabetic retinopathy, glaucoma, and macular degeneration) and to characterize these conditions within sociodemographic subgroups. Information on self-reported visual impairment and diagnosed eye diseases was collected from 31,044 adults. We calculated weighted prevalence estimates and odds ratios with logistic regression using SUDAAN. Among noninstitutionalized US adults 18 years and older, the estimated prevalence for visual impairment was 9.3% (19.1 million Americans), including 0.3% (0.7 million) with blindness. Lifetime prevalence of diagnosed diseases was as follows: cataract, 8.6% (17 million); glaucoma, 2.0% (4 million); macular degeneration, 1.1% (2 million); and diabetic retinopathy, 0.7% (1.3 million). The prevalence of diabetic retinopathy among persons with diagnosed diabetes was 9.9%. We present the most recently available national data on self-reported visual impairment and selected eye diseases in the United States. The results of this study provide a baseline for future public health initiatives relating to visual impairment.

American Journal of Epidemiology, Oct 15, 1997

the particular case of serum transferrin saturation and stroke, although a quadratic effect might... more the particular case of serum transferrin saturation and stroke, although a quadratic effect might be biologically plausible, it would be reassuring to see whether this effect still holds when age is taken into account in a nonparametric way. REFERENCES 1. Gillum RF, Sempos CT, Makuc DM, et al. Serum transferrin saturation, stroke incidence, and mortality in women and men. The NHANES I Epidemiologic Followup Study. Am J Epidemiol 1996;144:59-68. 2. Breslow NE, Day NE, eds. Statistical methods in cancer research. Vol 2. The design and analysis of cohort studies.

American Journal of Epidemiology, 1994

A 1982 report (J Chronic Dis 1982;35:703-14) that a relatively high white blood cell (WBC) count ... more A 1982 report (J Chronic Dis 1982;35:703-14) that a relatively high white blood cell (WBC) count predicted increased incidence of cerebral thrombosis could not establish whether this association was independent of smoking. Therefore, the authors examined data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, conducted in 1971-1987, to assess WBC count as a risk factor for stroke in a sample of the US population. White men with a WBC count of > 8,100 cells/mm3 had a 39% increase in age-adjusted stroke incidence compared with those with a WBC count of < 6,600 cells/mm3. However, controlling for cigarette smoking reduced the association and rendered it statistically nonsignificant (relative risk = 1.26, 95% confidence interval 0.93-1.70). No significant associations of WBC count with stroke incidence were seen in white women or in blacks. In white men, elevated WBC count may be a mediator of cardiovascular effects of smoking, an indicator of smoking exposure, or both. Further studies are needed to confirm these findings and to elucidate mechanisms for the effect of smoking and WBC count on stroke incidence and death.

American Journal of Epidemiology, Jul 1, 1996

Several studies have examined relatively large body iron stores and the risk of coronary heart di... more Several studies have examined relatively large body iron stores and the risk of coronary heart disease with conflicting results. No reports of studies that associated body iron stores with stroke were found. To test the hypothesis that relatively high transferrin saturation is associated with increased stroke incidence and mortality in women and men, data from a follow-up study of a national cohort were examined. A total of 5,033 women and men aged 45-74 years from the First National Health and Nutrition Examination Survey Epidemiologic Followup Study who were free of stroke at baseline were followed an average of 12 years. Transferrin saturation (serum iron concentration divided by total iron binding capacity) was used as a measure of the amount of circulating iron available to tissues. In white women aged 45-74, after adjusting for age or for age and other risk variables, the authors observed a significant U-shaped association of transferrin saturation with risk of incident stroke (>44% vs. 30-36%, relative risk = 1.96, 95% confidence interval 1.15-3.36; <20% vs. 30-36%, relative risk = 1.80, 95% confidence interval 1.20-2.71). However, no significant associations were found in white men aged 45-74 after adjusting for other risk variables. Similar findings were observed for stroke mortality in whites, but no significant associations were seen in blacks. The significantly increased risk of stroke that was seen at both high and low levels of transferrin saturation in white women should be confirmed in other cohorts of women and men. Am J Epidemiol 1996; 144:59-68. blacks; cerebral embolism and thrombosis; cerebrovascular disorders; cohort studies; ferritin; free radicals; iron; transferrin Although a number of studies have been published of various measures of iron status and the incidence of acute myocardial infarction, no consensus has emerged as to whether such an association exists (1, 2). No published studies were found of serum ferritin or transferrin saturation and the incidence of stroke, the other leading cause of ischemic mortality in industrialized nations (3). To test the hypothesis that elevated transferrin saturation is associated with increased stroke incidence and mortality in women and men, data from a follow-up study of a national cohort

American Journal of Epidemiology, May 1, 1994

National health statistics reports, 2009

This report presents long-term trends in the number and percentage of persons under age 65 years ... more This report presents long-term trends in the number and percentage of persons under age 65 years with different types of health insurance coverage and with no coverage. It documents changes in how the National Health Interview Survey (NHIS) has collected information about coverage over almost 50 years. It also compares recent trends in coverage estimates based on the NHIS and the U.S. Census Bureau's Current Population Survey (CPS). Estimates were derived from 32 years of the NHIS, from 1959 to 2007. The types of estimates available differ over these years, reflecting changes in the availability of different types of coverage and changes in the NHIS questions. Joinpoint regression was used to estimate average annual percent change over time and to identify statistically significant changes in trends. The percentage of persons under age 65 years with private coverage rose between 1959 and 1968, to 79%, remained stable until 1980, and then declined to 67% by 2007. During the 1980s...

Journal of the American Geriatrics Society, 1991

Although coronary heart disease remains a leading cause of death and disability in old age, the r... more Although coronary heart disease remains a leading cause of death and disability in old age, the relationship of serum cholesterol level to risk of coronary heart disease in old age is controversial. Data for 2,388 white persons aged 65-74 who participated in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS) were examined to determine the relationship of serum cholesterol level to coronary heart disease incidence and whether activity level would modify this relationship. While there was no overall relationship between serum cholesterol level and coronary heart disease risk in either men or women, the relationship between serum cholesterol level and coronary heart disease differed within activity groups. For persons who were more active, serum cholesterol level was associated with a graded increase in risk of coronary heart disease, from 1.3 (95% CI 0.7, 2.3) in those with serum cholesterol level of 4.7-5.1 to 1.7 in those with serum...

NCHS data brief, 2011

Lack of health insurance presents a barrier to obtaining routine preventive care and early diagno... more Lack of health insurance presents a barrier to obtaining routine preventive care and early diagnosis and management of chronic conditions. In 2005-2008, approximately 23% of adults aged 20-64 had no health insurance. Hypercholesterolemia (high total cholesterol or taking medication to lower cholesterol) and hypertension (high blood pressure or taking medication to lower blood pressure) are major risk factors for cardiovascular disease, particularly when untreated and uncontrolled and are common among nonelderly adults. In 2005-2008, 23% of adults aged 20-64 had hypercholesterolemia and 23% had hypertension. The objective of this report is to quantify the association between health insurance coverage and the diagnosis and control of hypercholesterolemia and hypertension among persons with those conditions. The criteria used to define these conditions are provided in the "Definitions" section of the report.

New England Journal of Medicine, 1994

Medical Care, 1983

This article describes travel patterns for ambulatory care based on the 1978 National Health Inte... more This article describes travel patterns for ambulatory care based on the 1978 National Health Interview Survey. The county where a physician visit occurs has been compared with the county of patient's residence. Nearly 20 per cent of physician visits occur outside the county of residence, with substantial variation according to metropolitan status and proximity to an SMSA. Visits by nonmetropolitan residents are twice as likely to occur in another county as visits by metropolitan residents. The proportion of visits that occur outside the county of residence increases with decreasing population density, both among metropolitan and nonmetropolitan areas. Travel patterns for the usual source of care are similar to those for primary care physician visits. The results are used to estimate adjusted physician-population ratios by allocating physicians to each county type in proportion to their use by residents. These adjusted ratios exhibit substantially less variation than the unadjusted ratios.

Medical Care, 1981

Access to health services by the poor and other disadvantaged groups has improved considerably ov... more Access to health services by the poor and other disadvantaged groups has improved considerably over the past 15 years. These circumstances have led some to question whether the poor now have equal access to health care. This article presents recent evidence from the 1976-78 National Health Interview Surveys (NHIS) comparing utilization among age, race, and income groups. Without adjustment for health status, the poor have more physician visits than those with higher incomes. After adjusting for age and health status, however, these differences are reversed. Depending on which measure is used, the poor have between 7 per cent and 44 per cent fewer visits than those with income above twice the poverty level. Furthermore, the age- and health-adjusted data show blacks have significantly fewer visits than their white counterparts. In addition, there are large differences among race and income groups in the characteristics of the ambulatory care obtained. Blacks and the poor are much more likely to use hospital clinics and less likely to use private physician offices or telephone consultations. The poor also receive less preventive care. It would appear from the present evidence that still further progress is required to achieve the goal of equity in the distribution of medical care services.

The Journal of Rural Health, 1991