Biomedical subjects

R Beaglehole

Publications and source records attributed to R Beaglehole.

At least 145 records · Page 8Linked to original sources

PubMed1986

Accuracy of certification of deaths due to asthma. A national study.

In a two-year study of asthma mortality in New Zealand conducted between August 1981 and July 1983, the certified cause of death and its subsequent statistical coding was compared with the opinion of a panel of respiratory physicians who had made detailed enquiry into the medical history and circumstances surrounding the death of each patient. When the panel's opinion was taken as the reference standard, the national health statistics overestimated asthma mortality for all age groups by 26.0%. For patients aged 15-64 years, the net overestimate was 12.9%, no greater than that found in a similar study in this age group in the United Kingdom. Failure of certifying doctors and coroners to follow appropriate procedures for identification of the primary condition leading to death, or misdiagnosis of other lung disease as asthma, accounted for most inaccuracies in certification. In patients under age 35 years, certification and statistical coding of asthma death was considered accurate in 97.8% of all cases, but accuracy declined with increasing age. The high New Zealand asthma mortality rate, especially in young people, could not be explained by inaccuracies in death certification or statistical coding.

Adolescent↗

PubMed1986

Deaths from asthma in New Zealand.

We report the first complete population based study of childhood deaths due to asthma. All deaths ascribed to asthma in New Zealand children aged 0-14 were investigated as part of a two year national study of mortality from asthma. The 16 children who died from asthma all developed asthma by the age of 4; 15 had a family history of asthma, and 12 had associated atopic disorders. Disturbed pyschosocial relationships were evident in eight families. Seven children died in less than three hours from the onset of their final attack. All children died outside hospital. Mortality from asthma in Maori children (3.14 per 100 000) was five times that of European children. With hindsight, factors which if avoided could have led to a different outcome were identified in eleven cases. The circumstances surrounding these deaths were similar to those described for adults with asthma; this study, however, underlines the importance of parental care and knowledge in the management of children with asthma. Inadequate long term medical care, underassessment of severity by family and doctors, failure of the family to call for help when required, and inadequate responses of medical services contributed to the fatalities. Excess beta2 sympathomimetic dosage or overreliance on home nebulisers were uncommon. Most childhood deaths from asthma should be prevented by increased family awareness, better assessment of severity, improved long term treatment, and rapid access to emergency medical care.

Adolescent↗

PubMed1986

A case-control study of deaths from asthma.

A population based case control-study was initiated in 1981 to identify risk factors for death from asthma. Over a two year period all deaths in the Auckland population possibly due to asthma, in people less than 60 years of age, were investigated. From the 47 people who died from asthma 44 who had useful reversibility of airways obstruction (records showing greater than 20% variability of peak flow or a history indicating equivalent variability of shortness of breath) before death were selected as cases for the study. Both hospital and community based controls were used. The cases were more likely than were the community controls to have had severe disease, a hospital admission or visits to a hospital emergency department in the previous year (odds ratios 4.4, 16.0, 8.5 respectively). The asthmatic patients who died were more likely than either group of controls to have had a previous life threatening asthma attack. Poor management of the disease and poor compliance on the part of the patient increased the risk of death. In addition, use of three or more types of asthma drug within the past year was associated with an increased risk of dying that was independent of disease severity. Of interest was a similarity between asthmatic patients admitted to hospital and those who died. Nevertheless, a history of a previous life threatening attack and a recent admission to hospital identified a group at high risk.

Acute Disease↗

PubMed1985

Asthma mortality in New Zealand: a two year national study.

The epidemic of deaths from bronchial asthma in New Zealand was investigated by a two-year national review of all deaths of persons under 70 years where "asthma" appeared in part I of a death certificate or in a coroner's report of cause of death. Information about the patients, the characteristics and management of their asthma and the circumstances of the fatal episode was obtained by interviewing relatives and general practitioners and perusal of hospital records. The reviewing panel of the asthma task force of the Medical Research Council considered 271 of the 342 deaths studied were due to asthma. A high national asthma mortality rate (5.1 per 100 000) was confirmed, with rates for Maoris (18.9) and Pacific Islanders (9.4) considerably higher than that for Europeans (3.4 per 100 000). After standardising for age and ethnic groups, there remained a threefold variation in mortality rates among health districts suggesting regional differences in prevalence, severity or management of asthma. No single cause for these high mortality rates was found. One-quarter of the deaths occurred in patients who had had previous life threatening attacks. Excessive use of bronchodilator drugs did not account for the high mortality rates, but inappropriate prolonged use of a home nebuliser may have delayed institution of other therapy in a few cases.

Adolescent↗

PubMed1985

Risk factors for coronary heart disease: a case-control study.

Risk factors for myocardial infarction and sudden death have been examined in caucasians using data from a population-based register of coronary disease and an electoral roll sample of adult Aucklanders. The risk factors studied were past history of treatment for hypertension, cigarette smoking, body mass index, serum cholesterol and in men a history of vasectomy. A total of 625 myocardial infarction cases and 185 sudden death cases were compared with 1586 controls aged 35-64 years. In univariate and multivariate analyses in both sexes a history of treatment for hypertension and cigarette smoking were each associated with more than doubling of the risk for myocardial infarction and sudden death. Both men and women with a very high body mass index were at increased risk for myocardial infarction, and serum cholesterol was associated with an increased risk of myocardial infarction in men. Approximately one half of the myocardial infarction events and over half of the sudden death events occurring in this population were attributable to hypertension and smoking.

Adult↗

PubMed1985

Are low cholesterol values associated with excess mortality?

The relation between cholesterol concentration and mortality was studied prospectively over 17 years in 630 New Zealand Maoris aged 25-74. The dead or alive state of each person was determined in 1981. The causes of death were divided into three categories: cancer, cardiovascular disease, and "other." Using univariate and both linear and non-linear multivariate methods of analysis for survivorship data, significant inverse relations with serum cholesterol were found for total mortality in women, for mortality from cancer in men and women, and for other causes of mortality in both men and women. The inverse and non-linear association with total mortality in women remained significant when deaths in the first five years of follow up were excluded. This suggests that the association was not explained by undetected illness causing low cholesterol concentrations at the time of initial examination.

Adult↗

PubMed1985

Secular trends in underreporting of cigarette consumption.

Information on the cigarette smoking habits of all New Zealanders aged 15 years and over was collected in two consecutive national censuses in 1976 and 1981. These data show that the self-reported per capita consumption of cigarettes declined by 9.4 per cent during this five-year period. A comparison of census data with national cigarette sales data for the corresponding years indicated considerable underreporting of cigarette use in the two censuses. However, there was little change in the degree of underreporting between 1976 (28 per cent) and 1981 (30 per cent) and the estimated decline in per capita consumption of cigarettes based on sales data (8.6 per cent) was similar to the census-based estimate. These findings suggest that trends in self-reported consumption are a reliable indicator of national trends in cigarette smoking habits.

Adolescent↗

PubMed1985

Alcohol consumption and blood pressure.

The relationship between alcohol consumption and systolic and diastolic blood pressure was examined in a representative population sample of 1,429 men and women aged 35-64 years in Auckland, New Zealand during 1982. Univariate plots demonstrated a U-shaped relationship between alcohol consumption and systolic and diastolic blood pressures in men and in women aged 50 years and older, with light and moderate drinkers (less than 0-34 g alcohol/day) having lower blood pressure levels than either nondrinkers or heavy drinkers. No clear relationship was seen in younger women. The U-shaped relationship in men, particularly for systolic blood pressure, remained after controlling for potential confounders, whereas in women aged 50 years and older, there appeared to be a threshold level of approximately four drinks per day, below which drinkers had similar blood pressure levels to nondrinkers. In the multivariate analyses, it was calculated that among men, light and moderate drinkers had systolic levels 4.8 mmHg lower and diastolic levels 1.7 mmHg lower than nondrinkers and heavy drinkers, while among women aged 50-64 years, nondrinkers, light drinkers, or moderate drinkers had systolic levels 10.2 mmHg lower and diastolic levels 4.5 mmHg lower than heavy drinkers. These findings suggest that in men and in women aged 50 years and older, there is a nonlinear relationship between blood pressure and alcohol consumption, and that there is a level of alcohol consumption, of approximately four drinks per day, below which drinkers have either similar or lower blood pressure levels compared to nondrinkers.

Adult↗

PubMed1985

Coronary heart disease mortality, morbidity, and risk factor trends in New Zealand.

Coronary heart disease (CHD) mortality rates declined by 22 and 13% for European men and women respectively between 1968 and 1981. Data from two methodologically identical population-based registers indicate that in the period 1974-1981 there was no change in either the event rates or case fatality rates of definite myocardial infarction. In the same period there was a significant 17% decline in the sudden death event rates. These declines have been associated with a decrease in the consumption of dairy products, a reduction in self-reported cigarette smoking habits, improved control of hypertension, and possibly by reductions in serum cholesterol levels and an increase in habitual physical activity in the community. There have also been improvements in the medical management of patients with CHD although this appears to be of secondary importance in contributing to the decline in CHD mortality.

Adolescent↗

PubMed1984

Death from asthma in Auckland: circumstances and validation of causes.

New Zealand has experienced an epidemic of asthma deaths since 1977 with mortality rates of over 3.0/100 000 for people aged 5-34 years, more than three times the rate of comparable countries. To examine the reasons for this high mortality rate all deaths from asthma in people under 70 years in the Auckland region in 1981-82 were investigated. A total of 84 possible cases were studied and the validity of death certificates was found to be excellent for people under the age of 50 years. Fifty-three cases had usefully reversible asthma at the time of death and the mortality rate was almost four times higher in Pacific Islanders than in caucasians, with the Maori rate being intermediate. Sixty-seven percent (35) of the deaths in people with usefully reversible asthma occurred at home. In only 40% of cases had the patient reached some form of medical care. No deaths occurred in the patients admitted to hospital with the diagnosis of asthma during this period.

Adolescent↗

PubMed1984

Myocardial infarction and sudden death in Auckland.

A population-based register of definite myocardial infarction and sudden death was established in Auckland for the twelve months from 1 March 1981. Data were collected on 905 myocardial infarctions and 300 sudden deaths that occurred in people under the age of 70 years. The age standardised event rates were more than three times higher in men than in women. The rates of myocardial infarction were comparable in Maoris and non-Maoris but the sudden death rate was almost three times higher in Maoris than in the other ethnic groups. The age standardised 28 day myocardial infarction case fatality rates were 27% and 21% for men and women respectively. Overall, 42% of patients who reached hospital were transported by a life support unit, and 59% of patients who reached a coronary care unit did so within four hours of onset.

Adult↗

PubMed1984

Trends in survival after myocardial infarction in New Zealand, 1974-81.

Coronary heart disease mortality in New Zealand has declined by 20% in the 13 years since 1968. One possible explanation for this decline is lower case-fatality rates resulting from improvements in the management of myocardial infarction. This paper tests this hypothesis by examining trends in 1-year survival following a definite myocardial infarction for the population aged 35-69 in Auckland. The data were obtained from two methodologically identical population-based registers of myocardial infarction compiled in 1974 and 1981 in Auckland. In both periods the 1-year crude case-fatality rate was 30% and the pattern of survival over 1 year was similar. These data suggest that factors other than the improved care of myocardial infarction patients are responsible for the decline in coronary heart disease mortality rates in New Zealand.

Adrenergic beta-Antagonists↗

PubMed1984

Trends in sales of drugs for asthma in New Zealand, Australia, and the United Kingdom, 1975-81.

As part of an investigation into the recent epidemic of deaths from asthma in New Zealand, trends in the sales of drugs for asthma in New Zealand, Australia, and the United Kingdom during 1975-81 were examined. Data on sales of drugs were obtained from an international pharmaceutical market research organisation. A striking increase in sales of sympathomimetic aerosols, steroid aerosols, and theophylline per caput occurred in all three countries, with the greatest increase occurring in New Zealand. Sales of sodium cromoglycate also increased in New Zealand and the UK but fell in Australia. By 1981 New Zealand had the highest sales of all these drugs per caput. Explanations for the rising mortality from asthma in New Zealand despite large increases in drug sales need to be explored. Although the temporal association between mortality and sales of drugs suggests that direct drug toxicity is unlikely, there may be more subtle adverse effects of drug use.

Adolescent↗

PubMed1984

Trends in coronary heart disease event rates in New Zealand.

To examine the reasons for the recent decline in coronary heart disease death rates in New Zealand, a register of definite myocardial infarction and sudden death was established in the Auckland region (1981 population 829,464). Both routine and nonroutine case finding sources were used and event rates for the 12 months from March 1, 1981, were compared with estimates from an earlier study conducted in 1974. In 1981, 1,093 myocardial infarction and/or sudden death events in people 25-69 years of age were registered. The age standardized event rates for the total of myocardial infarction and sudden death were 506/100,000 and 139/100,000 for men and women, respectively. Over the seven-year period from 1974 there was no change in the event rate or 28-day case fatality of definite myocardial infarction, but a significant decline in the rate of sudden death occurred from 139/100,000 to 117/100,000. The decline in the sudden death rate was particularly marked in people under the age of 50 years and in subjects with a prior history of myocardial infarction.

Adult↗

PubMed1984

Event, incidence and case fatality rates of cerebrovascular disease in Auckland, New Zealand.

Death rates for cerebrovascular disease (stroke) in New Zealand are declining. To investigate the reasons for this decline and to measure the impact of stroke on a defined population, a register of new episodes of stroke was kept in the Auckland region for the year ending March 1982. All cases were followed for one year, with in-depth interviews at onset, one month and six months and a telephone follow-up at one year to establish dead or alive status. A total of 703 episodes were registered for 680 patients, 331 men and 349 women. The crude event rate for all those over 15 years was 228 and 220 per 100,000 for men and women, respectively. Age-adjusted event rates for all strokes were 28% higher for men than women and the age-adjusted event rates for Maoris were 44% higher than for non-Maoris. The case fatality rates were 23.1% at one week, 33.5% at one month, 43.5% at six months and 48.5% at one year. In comparison with other studies, case fatality rates are similar but the incidence rates appear to be lower.

Adolescent↗

PubMed1984

Level, trend, and variability of blood pressure during childhood: the Muscatine study.

On alternate years from 1970 to 1981 blood pressure has been measured in school children living in Muscatine, Iowa. A total of 4313 children beginning at 5 to 14 years of age have been examined on three to six occasions. To compare blood pressures throughout the period of observation, each value was expressed as a percentile rank. For each subject the average percentile rank (level), the trend in rank, and the variability over time were calculated. Values for height, weight, relative weight, and triceps skinfold thickness were expressed in the same fashion. The relationship between average rank of blood pressure and average rank of body size as well as between trend of blood pressure and trend of body size percentiles were significant (p less than .05). These observations indicate the importance of relative rate of growth in the establishment of the rank order of blood pressure. Using the variables of level, trend, and variability, we identified groups of children who appear to be consistently tracking toward future hypertension: 233 (5.4%) children, whose systolic levels were in the upper quintile with either a flat or rising trend and low variability, and 280 (6.0%) children with systolic levels in the lower four quintiles with high trend and low variability. In addition there were 321 (7.4%) children whose mean systolic levels were in the upper quintile with high variability and who thus resemble adults with labile hypertension. There were similar numbers of children with diastolic pressures showing these features.

Adolescent↗

PubMed1983

Blood pressure levels and the treatment of hypertension in Auckland, 1982.

The level of coronary heart disease risk factors in a random sample of 1598 people aged 35-64 years was examined in Auckland in 1982. Blood pressure was measured and the prevalence of treated and untreated hypertension determined. Mean systolic blood pressure increased with age from 124 mmHg (16.49 kPa) in men aged 35-39 years to 144 mmHg (19.15 kPa) in those aged 60-64 years, and from 115 mmHg to 140 mmHg (15.29-18.62 kPa) in women in the same age groups. Compared with previous New Zealand studies blood pressure levels were lower in this study and considerably more people were on antihypertensive treatment. Hypertension is still a major problem in Auckland with 21% of men and 19% of women aged 35-64 years either hypertensive or on antihypertensive treatment. Although half of these people were on treatment, 16% of men and 9% of women in this age group in Auckland were estimated to have a blood pressure level in the hypertensive range.

Adult↗

PubMed1983

The longevity of international rugby players.

The longevity of New Zealand international rugby players (All Blacks) is compared with the New Zealand male population to test the hypothesis that vigorous leisure time physical activity in the form of rugby in early adulthood is associated with an increased longevity. Data on 822 All Blacks since 1884 are compared with information from New Zealand life tables for males. The life expectancy of All Blacks is the same as the general population although non-Maori All Blacks live almost ten years longer than Maori All Blacks.

Adolescent↗