Despite an overall decline in death rates in the United States since 1960, poor and poorly educated people still die at higher rates than those with higher incomes or better educations, and this disparity increased between 1960 and 1986.
OBJECTIVES: The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS: With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS: An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS: Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.
Results are presented of a study undertaken to explore the reproducibility of the 100 gm. oral glucose tolerance test. Over 400 male volunteers from an institutional population, who were not known to be diabetic, participated in a program which included a series of six tests for each individual over a period of one year. Ten men were tested daily, and each retested at intervals of approximately two months. Bloods were drawnat fasting, one, two and three hours after the administration of a 100-gm. glucose drinkand duplicate determinations were obtained on the Auto- Analyzer. Average blood glucose levels for the total group remained stable over time. However, blood glucose levels for individuals varied considerably. On single tests, some of the men exhibited borderline or diagnostic test readings, but in no case was this consistent over all tests. Some of the factors which contribute to individual variance are considered briefly. Implications of the data on interpretation of the results of oral glucose tolerance tests are presented.
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