AJPH News Release May 30, 2006 4 PM

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AJPH NEWS Release

EMBARGOED UNTIL May 30, 2006, 4 PM (ET)
CONTACT: For copies of articles, call Natalie Raynor, (202) 777-2511

All articles are online following embargo under First Look at www.ajph.org.

American Journal of Public Health Highlights

· Gastric bypass surgery rates skyrocket in recent years
· Outdoor falls an overlooked health problem for middle-aged and older adults
· Blacks and less educated elderly patients more likely to be placed in poorest-quality nursing homes
· Lack of driving increases risk for long-term care entry among elderly
· Canadians fare better than Americans on health care access

The articles below are published online by the American Journal of Public Health under "First Look," and will appear in the July 2006 print issue of the Journal. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. Following the embargo, articles will appear under "First Look" at www.ajph.org/first_look.shtml. The American Journal of Public Health is published by the American Public Health Association and is available at www.ajph.org.

Gastric bypass surgery rates skyrocket in recent years
Gastric bypass surgery rates have risen exponentially in the United States in recent years, likely due to advances in surgery techniques and improved success among patients.
A study of gastric bypass surgeries found the rate increased from 7.0 per 100,000 U.S. adults in 1998 to 38.6 per 100,000 U.S. adults in 2002. An estimated 14,089 gastric bypass surgeries were performed in the United States in 1998, compared with 82,636 in 2002. The numbers came from data collected as part of the National Hospital Discharge Survey.
One reason researchers say the obesity surgery's popularity may have jumped so dramatically is the Food and Drug Administration's approval in 2001 of the laparoscopic-adjustable gastric banding surgical technique, which is more costly and time intensive than traditional gastric bypass surgery but is less invasive and accompanied by shorter patient recovery times. [From: "Gastric Bypass Surgery in the United States, 1998-2002." Contact: Tonya M. Smoot, PhD, University of Louisville, smootmcmillan@aol.com.]

Outdoor falls an overlooked health problem for middle-aged and older adults
Outdoor falls among adults age 45 and older are a largely preventable and often overlooked health problem.
According to a study of data on 2,193 falls that resulted in injury among adults age 45 and older in California between 1996 and 2001, outdoor falls were far more common than indoor falls. Yet, most education efforts are aimed at preventing indoor falls among the elderly. Also, 73 percent of the outdoor falls were caused by such "environmental factors" as slippery sidewalks, uneven surfaces or objects on sidewalks, curbs or streets. Walking was the most common fall-related activity, accounting for almost 50 percent of the outdoor falls reported.
"With the widespread promotion of active lifestyles for older people, improvements in their outdoor environment are urgently needed," the study's authors said. [From: "Outdoor Falls in Middle-Aged and Older Adults: A Neglected Public Health Problem." Contact: Jennifer L. Kelsey, PhD, University of Massachusetts Medical School, Worcester, Ma., Jennifer.Kelsey@umassmed.eduj]

Blacks and less educated elderly patients more likely to be placed in poorest quality nursing homes
Being poorly educated or black increases a Medicare recipient's odds of being discharged to a low-quality nursing home after hospitalization.
A study of more than 62,000 Medicare nursing home admissions found blacks and patients without a high school degree had the highest likelihood of winding up in a nursing home in the lowest quality quartile.
"Our findings offer evidence that existing ethnic/racial disparities in nursing home care are attributable in part to hospital discharge practices that refer minorities to lower quality nursing homes," the study's authors said. They suggested a need to educate hospital discharge planners about the quality of available nursing home care. [From: "Effect of Educational Level and Minority Status on Nursing Home Choice After Hospital Discharge" Contact: Joseph J. Angelelli, Penn State University, University Park, Pa., joe.angelelli@pioneernetwork.net.]

Lack of driving increases risk for long-term care entry among elderly
Elderly adults who do not drive have a significantly higher risk of entering the long-term care system.
A study based on data from 1,593 adults ages 65-84 found that former drivers and those who had never learned to drive had higher rates of entry into the long-term care system, such as nursing homes and assisted living facilities. Living in a house with no other drivers was also a risk factor for needing long-term care. The results held true even after adjusting for demographic and health variables.
"We expect older adults to make good decisions about when to stop driving, but we fail to recognize the hardships that not driving imposes on an older adult," the study's authors said. "Innovative strategies to improve the transportation options for older adults should be developed." [From: "Driving Status and Risk of Long-Term Care Entry in Older Adults." Contact: Ellen Freeman, PhD, Johns Hopkins University, Baltimore, Md., eefreeman@gmail.com.]

Canadians fare better than Americans on health care access
Americans are less likely than Canadians to have a regular doctor and more likely to forgo needed medical care and skip recommended medication. Moreover,health disparities that cause even larger gaps in care access are more pronounced in the United States.
According to an analysis of population-based data on 3,505 Canadian and 5,103 U.S. adults from the Joint U.S./Canada Survey of Health, the universal health care system in Canada provides better access to care across the board than the American system. Disparities based on race, income and immigrant status were present in both countries but more pronounced in the United States.
For example, U.S. immigrants had less access to care than native-born Americans, and adults with the lowest incomes were less likely to have a regular doctor and to have contacted a physician in the previous 12 months than the most affluent Americans.
[From: "Access to Care, Health Status, and Health Disparities in the US and Canada: Results of a Cross-National Population-Based Survey." Contact: Karen E. Lasser, MD, MPH, The Cambridge Hospital, Cambridge, Ma., klasser@challiance.org.]

The American Journal of Public Health is the monthly journal of the American Public Health Association, the oldest organization of public health professionals in the world. APHA is a leading publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. More information is available at www.apha.org.

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