Dataset Information

The effects of New York City's coordinated public health programmes on mortality through 2011.

ABSTRACT:

Background

In 2003, New York City (NYC) implemented a series of coordinated policies designed to reduce non-communicable disease.

Methods

We used coarsened exact matching (CEM) of individuals living inside and outside NYC between the years of 1992-2000 and 2002-10 to estimate difference-in-difference survival time models, a quasi-experimental approach. We also fitted age-period-cohort (APC) models to explore mortality impacts by gender, race, age, borough and cause of death over this same time period.

Results

Both CEM and APC models show that survival gains were large in the pre-2003 era of health policy reform relative to the rest of the USA, but small afterwards. There is no clear link between any policy and changes in mortality by age, gender, ethnicity, borough, or cause of death.

Conclusions

NYC's gains in survival relative to the rest of the nation were not linked to the city's innovative and coordinated health policy efforts.

SUBMITTER: Muennig P

PROVIDER: S-EPMC6251557 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Publications

The effects of New York City's coordinated public health programmes on mortality through 2011.

Muennig Peter P Masters Ryan R Vail Daniel D Hakes Jahn J

International journal of epidemiology 20170801 4

<h4>Background</h4>In 2003, New York City (NYC) implemented a series of coordinated policies designed to reduce non-communicable disease.<h4>Methods</h4>We used coarsened exact matching (CEM) of individuals living inside and outside NYC between the years of 1992-2000 and 2002-10 to estimate difference-in-difference survival time models, a quasi-experimental approach. We also fitted age-period-cohort (APC) models to explore mortality impacts by gender, race, age, borough and cause of death over t ...[more]

PMID: 28031310

Similar Datasets

Project description:ImportanceThe spring 2020 surge of COVID-19 unprecedentedly strained ventilator supply in New York City, with many hospitals nearly exhausting available ventilators and subsequently seriously considering enacting crisis standards of care and implementing New York State Ventilator Allocation Guidelines (NYVAG). However, there is little evidence as to how NYVAG would perform if implemented.ObjectivesTo evaluate the performance and potential improvement of NYVAG during a surge of patients with respect to the length of rationing, overall mortality, and worsening health disparities.Design, setting, and participantsThis cohort study included intubated patients in a single health system in New York City from March through July 2020. A total of 20 000 simulations were conducted of ventilator triage (10 000 following NYVAG and 10 000 following a proposed improved NYVAG) during a crisis period, defined as the point at which the prepandemic ventilator supply was 95% utilized.ExposuresThe NYVAG protocol for triage ventilators.Main outcomes and measuresComparison of observed survival rates with simulations of scenarios requiring NYVAG ventilator rationing.ResultsThe total cohort included 1671 patients; of these, 674 intubated patients (mean [SD] age, 63.7 [13.8] years; 465 male [69.9%]) were included in the crisis period, with 571 (84.7%) testing positive for COVID-19. Simulated ventilator rationing occurred for 163.9 patients over 15.0 days, 44.4% (95% CI, 38.3%-50.0%) of whom would have survived if provided a ventilator while only 34.8% (95% CI, 28.5%-40.0%) of those newly intubated patients receiving a reallocated ventilator survived. While triage categorization at the time of intubation exhibited partial prognostic differentiation, 94.8% of all ventilator rationing occurred after a time trial. Within this subset, 43.1% were intubated for 7 or more days with a favorable SOFA score that had not improved. An estimated 60.6% of these patients would have survived if sustained on a ventilator. Revising triage subcategorization, proposed improved NYVAG, would have improved this alarming ventilator allocation inefficiency (25.3% [95% CI, 22.1%-28.4%] of those selected for ventilator rationing would have survived if provided a ventilator). NYVAG ventilator rationing did not exacerbate existing health disparities.Conclusions and relevanceIn this cohort study of intubated patients experiencing simulated ventilator rationing during the apex of the New York City COVID-19 2020 surge, NYVAG diverted ventilators from patients with a higher chance of survival to those with a lower chance of survival. Future efforts should be focused on triage subcategorization, which improved this triage inefficiency, and ventilator rationing after a time trial, when most ventilator rationing occurred.

Dataset Information

The effects of New York City's coordinated public health programmes on mortality through 2011.

Background

Methods

Results

Conclusions

Publications

The effects of New York City's coordinated public health programmes on mortality through 2011.

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