Patterns of gun deaths across US counties 1999–2013

PurposeWe examined the socio-demographic distribution of gun deaths across 3143 counties in 50 United States’ states to understand the spatial patterns and correlates of high and low gun deaths.MethodsWe used aggregate counts of gun deaths and population in all counties from 1999 to 2013 from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER). We characterized four levels of gun violence, as distinct levels of gun death rates of relatively safe, unsafe, violent, and extremely violent counties, based on quartiles of 15-year county-specific gun death rates per 100,000 and used negative binomial regression models allowing clustering by state to calculate incidence rate ratios and 95% confidence intervals (95% CIs).ResultsMost states had at least one violent or extremely violent county. Extremely violent gun counties were mostly rural, poor, predominantly minority, had high unemployment rate and homicide rate. Overall, homicide rate was significantly associated with gun deaths (incidence rate ratios = 1.08, 95% CI = 1.06–1.09). In relatively safe counties, this risk was 1.09 (95% CI = 1.05–1.13) and in extremely violent gun counties was 1.03 (95% CI = 1.03–1.04).ConclusionsThere are broad differences in gun death rates across the United States representing different levels of gun death rates in each state with distinct socio-demographic profiles.     

Prevalence of physical activity and obesity in US counties, 2001–2011: a road map for action

Background

Obesity and physical inactivity are associated with several chronic conditions, increased medical care costs, and premature death.

Methods

We used the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit telephone survey that covers the majority of United States counties, and the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US civilian noninstitutionalized population. About 3.7 million adults aged 20 years or older participated in the BRFSS from 2000 to 2011, and 30,000 adults aged 20 or older participated in NHANES from 1999 to 2010. We calculated body mass index (BMI) from self-reported weight and height in the BRFSS and adjusted for self-reporting bias using NHANES. We calculated self-reported physical activity—both any physical activity and physical activity meeting recommended levels—from self-reported data in the BRFSS. We used validated small area estimation methods to generate estimates of obesity and physical activity prevalence for each county annually for 2001 to 2011.

Results

Our results showed an increase in the prevalence of sufficient physical activity from 2001 to 2009. Levels were generally higher in men than in women, but increases were greater in women than men. Counties in Kentucky, Florida, Georgia, and California reported the largest gains. This increase in level of activity was matched by an increase in obesity in almost all counties during the same time period. There was a low correlation between level of physical activity and obesity in US counties. From 2001 to 2009, controlling for changes in poverty, unemployment, number of doctors per 100,000 population, percent rural, and baseline levels of obesity, for every 1 percentage point increase in physical activity prevalence, obesity prevalence was 0.11 percentage points lower.

Conclusions

Our study showed that increased physical activity alone has a small impact on obesity prevalence at the county level in the US. Indeed, the rise in physical activity levels will have a positive independent impact on the health of Americans as it will reduce the burden of cardiovascular diseases and diabetes. Other changes such as reduction in caloric intake are likely needed to curb the obesity epidemic and its burden.

     

Cancer mortality in Greece: where are we heading? A 20-year comparative study in four Greek counties

AIM: Comparison of cancer mortality rates in four Greek counties during the decades 1979-1988 and 1989-1998 and drawing out of cause and effect relationships that could lead to organization of prevention programs. METHODS: We used the Wilcoxon-White test to statistically compare data between the two decades as well as between the four counties separately. RESULTS: We found that the total proportional mortality during the decade 1988-1998 significantly increased, compared to 1979-1988, in all counties we studied. We noted a statistically significant increase of the proportional mortality of organs of the gastrointestinal tract and peritoneum (W = 55, p < 0.001 for both decades), of the respiratory system and intrathoracic organs (W = 71, p = 0.009 for 1979-1988 and W = 55, p < 0.001 for 1988-1998) and the skin and breast (W = 136, p = 0.019 for 1979-1988) in Attiki compared to Thessaloniki. As far as Achaia and Trikala are concerned, we found a minor, though statistically significant increase of the proportional mortality of organs of the gastrointestinal tract and peritoneum (W = 78, p = 0.043), of the respiratory system and intrathoracic organs (W = 77, p = 0.035) and the skin and breast (W = 76, p = 0.029) during the decade 1988-1998. CONCLUSIONS: Statistically significant differences were noted concerning the incidence rates between four different counties as well as between two different decades. Although genetic factors might partially explain our results, environmental factors seem to be the main culprits.     

Canine cutaneous and visceral leishmaniasis and Chagas' disease from counties in the Triângulo Mineiro and Alto Paranaíba regions, Minas Gerais State, Brazil

Leishmaniasis and Chagas' disease were surveyed by indirect immunofluorescence with sera from 331 dogs from Uberlandia and Coromandel, two counties in the State of Minas Gerais, Brazil. Leishmania amazonensis and Trypanosoma cruzi antigens were employed. In Uberlandia county, 230 sera were studied, of which 200 were from urban areas and 30 rural: 4.5% of urban samples and 6.6% of rural were positive for L. amazonensis antigen. Of 89 sera from Coromandel, 5.6% were positive for the same test to L. amazonensis antigen. Twelve additional canine sera were obtained from the Veterinary Hospital at the Federal University in Uberlandia, all of which with a pending diagnosis of leishmaniasis: of these, one had a positive immune test to L. amazonensis and another to T. cruzi antigens. The results suggest regional urbanization of both leishmaniasis and Chagas' disease in the canine populations of both communities.