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July 16, 1982

Hospital Use in a Fee-for-Service System-Reply

JAMA. 1982;248(3):307. doi:10.1001/jama.1982.03330030020007

In Reply.—  The influence of disease frequency on hospital utilization is a matter that the authors considered at length. However, our experience in the Rochester-Olmsted County Epidemiologic project for the past 17 years has led us to the conclusion that the incidence of disease is not less in Olmsted County than in the country at large.In fact, the incidence rates for dozens of disorders, including malignancies and other chronic illnesses, that have been studied in Olmsted County for almost two decades have, for the most part, been as high or higher than those noted nationally.1,2 Some relatively infrequent chronic conditions have also been found to be higher than national rates. As an example, the Olmsted County incidence rates for leukemia in the 1930s were three times those of the national rates at that time; the 1970 age-adjusted rates for this disease are higher than those reported by the