Coal-mining and mortality.
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Biomedical subjects
Publications and source records attributed to A L Cochrane.
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Deaths from ischaemic heart-disease in 18 developed countries are not strongly associated with health-service factors such as doctor and nurse density. There is a negative association with gross national product per capita and a positive but inconsistent association with saturated and monounsaturated fat intake. The principal finding is a strong and specific negative association between ischaemic heart-disease deaths and alcohol consumption. This is shown to be wholly attributable to wine consumption.
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A more detailed analysis of material from the 20-year follow-up of men in the Rhondda Fach confirms the similarity between the Standardised Mortality Ratios (SMRs) of miners and exminers with radiological categories 0, 1, 2, 3 and A (120.3, 116.5, 119.0, 115.7, and 120.1 respectively) as well as the difference between these SMRs and that of the non-moners (98.7). The specific death rates show a raised SMR for bronchitis and other respiratory diseases excluding pneumoconiosis for all categories including category 0, but little difference between those for category 0 and those for simple pneumoconiosis. The SMRs for ischaemic heart disease and other circulatory diseases for categories A, B and C combined are lower than those for simple pneumoconiosis and category 0 (84.2 and 85.0, compared with 109.8 and 121.8 for simple pneumoconiosis, and 117.5 and 114.6 for category 0). Fortunately the SMR for leukaemia is low. A comparison between the survival rates of men aged 55-64 in Leigh, Lancashire and those in the Rhondda Fach suggests that nonminers in the two areas have similar survival rates while the survival rates for category 0 and simple pneumoconiosis are lower in the Rhondda Fach.
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The relationship between age-specific mortality rates and some indices of health facilities and some environmental and dietary factors has been studied in 18 developed couuntries. The indices of health care are not negatively associated with mortality, and there is a marked positive association between the prevalence of doctors and mortality in the younger age groups. No explanation of this doctor anomaly has so far been found. Gross national product per head is the principal variable which shows a consistently strong negative association with mortality.
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