Context. In the private sector, the use of surgery to treat gastroesophageal reflux disease has increased substantially since the development of minimally invasive laparoscopic techniques. However, trends in the use of antireflux surgery in the Veterans Affairs (VA) health care system have not been explored. Objective. To compare secular trends in the use of antireflux surgery in VA hospitals and the private sector. Data Sources. VA data are from the 1991-1999 medical SAS datasets for inpatient care (commonly known as patient treatment files); private sector data are from the 1991-1997 Nationwide Inpatient Sample and the U.S. census. Calculations. We compared secular trends in the use of antireflux surgery in the VA and private sector with each group's baseline rate in 1991. For the VA, we calculated annual rates of antireflux surgery among active users of the VA health care system by dividing the number of procedures (based on the appropriate procedure codes from the International Classification of Diseases, ninth revision, clinical modification) by the number of veterans who had at least two hospital or clinic visits in a given year. For the private sector, we calculated true population rates by dividing procedure counts by the total U.S. population. Results. From 1991 to 1995, the annual rate of antireflux surgery among active users of VA hospitals increased by 64%, then decreased over the next 4 years to almost baseline rates. In contrast, rates of antireflux surgery in the private sector increased 185% from 1991 to 1995, then appeared to reach a plateau thereafter. Among patients undergoing antireflux surgery, those in the VA were less likely than those in the private sector to undergo laparoscopic surgery (29% vs. 65%, respectively, in 1997). Conclusions. With the development of laparoscopic surgery, rates of antireflux surgery in VA hospitals increased only modestly compared with the private sector and have decreased in recent years. Both patient and provider factors may explain the substantially higher use of this procedure in the private sector.

Context. Influenza and its complications result in significant morbidity and mortality each year. Certain groups are at increased risk for influenza and influenza-related complications. They, and others who are in close contact with them, are target groups to receive a yearly influenza immunization according to recommendations from the Advisory Committee on Immunization Practices (ACIP). Objective. To estimate the proportions of adults in selected target groups who received influenza vaccination in 1995 and 1998 and to identify characteristics associated with vaccination receipt. Data Source. The National Health Interview Survey (NHIS), a nationally representative survey of civilian noninstitutionalized persons conducted annually by the Centers for Disease Control's National Center for Health Statistics. We used data for adults (> 18 years of age) from the 1995 and 1998 NHIS. Outcome Measure. Proportions of persons in target groups self-reporting influenza vaccination in the 12 months before the NHIS interview. Results. Between 1995 and 1998, influenza vaccination increased for persons aged 65 and older (58.2% to 63.3%; P<0.05) and for adults under 65 belonging to selected ACIP target groups (27.5% to 30.1%; P<0.05). Examination of 1998 data shows that regardless of age, the likelihood of influenza vaccination is strongly influenced by having health coverage or a regular source of care. For example, 66% of the elderly with private fee- for-service health care coverage were vaccinated, compared with 23% of the elderly with no insurance (adjusted odds ratio [OR], 3.9; 95% CI, 1.6 to 9.3). For persons aged 18 to 64 years belonging to an ACIP target group, the corresponding figures are 32% vs. 16% (adjusted OR, 1.8; CI, 1.4 to 2.3). The likelihood of vaccination also varied by race and ethnicity: For age 65 and older, 66% of non-Hispanic whites were vaccinated compared with 46% of non-Hispanic blacks (adjusted OR, 2; CI, 1.6 to 2.4). Conclusions. The use of influenza vaccination among adults at high risk for influenza and influenza-related complications increased between 1995 and 1998. Younger individuals at high risk, people without insurance or a regular source of care, and nonwhites still have low vaccination rates.