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T J Thom

Publications and source records attributed to T J Thom.

14 recordsLinked to original sources
PubMed1999

Age-adjusted death rates: consequences of the Year 2000 standard.

PURPOSE: For nearly 60 years, official U.S. mortality statistics have been age-adjusted using the age distribution from the U.S. population for the year 1940. A new population standard, the projected Year 2000 U.S. standard, has been approved for use by the Department of Health and Human Services (DHHS). It will be implemented for official U.S. Government statistics published for deaths occurring in 1999. The new standard reflects the older age distribution of the population; 6.8% of the population was age 65 years or more in 1940, as compared to 12.6% projected for 2000. METHODS: This paper investigates the consequences of the new age distribution standard by comparing death rates by time, place, and population characteristics, adjusted to both the 1940 and projected 2000 population standards. RESULTS: The new standard changes the level of the age-adjusted death rate for total mortality and for many causes of death, as compared to the 1940 standard. For example, the 1995 death rate for diseases of the heart is 138 per 100,000 population when adjusted using the 1940 standard, but is 296 per 100,000 using the Year 2000 standard. The new standard may change the comparison of age-adjusted rates if there are substantial differences in the age-specific rates. For example, the ratio of age-adjusted death rates for ischemic heart disease in black relative to white males is 1.07 using the 1940 standard, but is 0.96 using the Year 2000 standard. CONCLUSIONS: The new Year 2000 age standard has the potential to change both levels and comparisons of age-adjusted rates. Age-adjustment is an averaging process, and consequently, has the potential to view the data effectively as a whole while possibly obscuring important age-specific details.

Adolescent↗
PubMed1994

Heart disease, cancer, and stroke mortality trends and their interrelations. An international perspective.

BACKGROUND: Changes in mortality from heart disease, cancer, and stroke over recent decades in many countries have received much attention. However, comprehensive and concurrent analyses of these trends and their effect on total mortality have been lacking. Moreover, the extent to which the trends for one disease may relate to those for another disease is unknown. Concordance of trends for major diseases would suggest that they have common causes and thus may be responsive to the same preventive measures. METHODS AND RESULTS: Age-adjusted death rates for total mortality and mortality from heart disease, stroke, lung cancer, and cancer other than lung cancer were obtained for the years 1950 to 1987 in 27 countries by sex and ages 35 to 74 years from the World Health Organization statistical reports. Concordance of mortality trends was assessed for ages 35 to 74 between 1950 and 1983 through visual inspection and semiquantitative measurements of percentage change over time. The epidemic increase in heart disease mortality ended in the 1960s or 1970s in most industrialized countries; death rates often declined very steeply. Stroke mortality also changed from an increase to a decline or from a modest to a steep decline in the 1960s or 1970s. Lung cancer mortality slopes generally changed from a steep increase to either a modest increase, a flat trend, or a decline; the changes in slope are lagging behind those for heart disease and stroke. These improvements influenced trends for total mortality. Cancer other than lung cancer trends are less distinct than those for the three other causes of mortality. Yet, testing them for concordance with heart disease trends reveals that they are mostly concordant on a time-lag analysis that assumes that heart disease responds more rapidly to a change in lifestyle or environment than cancer. Trends for heart disease and lung cancer in men also tend to be concordant on time-lag analysis. Heart disease and stroke trends have become more concordant with time. CONCLUSIONS: Trends for mortality from heart disease, stroke, lung cancer, and, less distinctly, cancer other than lung cancer, tend to be similar in different countries, leading to a corresponding similarity in total mortality trends. An analysis of trends for pairs of diseases within countries indicates a tendency toward concordance of trends, suggesting the existence of common causes amenable to the same preventive measures. This analysis of international mortality trends is intended to stimulate further research along these lines, as a guide to preventive and therapeutic action.

Adult↗
PubMed1993

Stroke mortality trends. An international perspective.

This article presents death rates for cerebrovascular disease (stroke) by sex for ages 35 to 74 years in 1990 for 52 countries, and trends in rates from 1950 to 1990 for 30 countries. Rates are high in Asia and eastern Europe. In most industrialized countries, large declines occurred, particularly over the last 2 decades. The United States and Canada have low rates. Portugal, Trinidad, Paraguay, Mauritius, China, Korea, and most eastern European countries have the highest rates. Japan, with very high stroke mortality in the 1950s, experienced the largest absolute and percent decline and now ranks above western Europe and North America but below most other countries. In most industrialized countries, except in eastern Europe, stroke death rates declined more than 50% since 1970, somewhat more in women than in men. There is more uniformity in trends since 1970 than in earlier years. In several countries, either a downward slope accelerated in the 1970s, or a rising trend was reversed.

Adult↗
PubMed1990

Mortality from chronic obstructive pulmonary diseases and asthma in France, 1969-1983. Comparisons with the United States and Canada.

This article focuses on international similarities and differences in levels and trends of mortality for chronic obstructive pulmonary disease (COPD) and asthma in the US, Canada and France from 1969 to 1983. Comparisons have been made of national vital statistics data for age groups 55-64 years, 65-74 years and 75-84 years. From 1969 to 1978, under the 8th revision of the International Classification of Diseases (ICD), the COPD and asthma category included the codes 490-493 and, for the US and Canada, a special code 519.3. From 1979, under the 9th revision, COPD and asthma codes 490-493, 496 were in use in all three countries. The analyses of US, Canadian and French data show lower death rates for COPD and asthma in France. The ratio of male to female deaths from COPD increased with age in the US and Canada, but not in France. The proportion of COPD and asthma deaths attributed to bronchitis was higher in France. An increased use of code 496 (under 9th revision) was observed in the US and above all in Canada. In the three countries, death rates increased faster between 1979 and 1983 in women than in men and increases in women were steeper in the US and Canada than in France. Intercountry comparability is better for COPD mortality in the 9th revision than the 8th revision. Some differences observed between the three countries can be partly explained by coding practices and ICD revisions, but, allowing for differences in coding and classifying respiratory causes of death as well as ICD revisions, death rates are obviously higher in the US and Canada than in France. This suggests that the difference is real.

Aged↗
PubMed1989

International comparisons in COPD mortality.

In 31 developed countries, chronic obstructive pulmonary disease (COPD) and allied conditions comprise a major cause of death, but they cause less than 10% of all deaths, even in older persons. COPD mortality is highest in the Eastern European countries and Ireland, Scotland, and England/Wales, and is lowest in southern Europe, Japan, and Israel. That these differences are large and real is a likelihood but not a certainty, due to problems in comparability of cause-of-death statistics. In the past, the trend in COPD mortality has been upwards. Over the short time period of 1980 to 1985, there have been substantial declines in death rates in most countries for the major causes of death, but not for COPD or lung cancer. It is not clear, however, whether COPD mortality is continuing to increase everywhere. In only nine countries is the trend upwards and only in women above age 55 and in men above age 75. In the other 22 countries, trends are not clearly upwards or downwards. Longer time trend statistics are needed to corroborate and explain these patterns and the apparent intercountry differences.

Age Factors↗
PubMed1989

Epidemiology and risk factors for coronary heart disease in women.

The information presented indicates that the risk factors associated with the development of coronary heart disease in women are, for the most part, the same as those identified for men. It is encouraging to note that although the prevalence of hypertension in women has not changed over the past 20 years, the proportion of treated hypertensive women has increased dramatically and the proportion with controlled blood pressure has doubled since 1960. It is also encouraging to note that the number of adult women who smoke cigarettes has decreased since 1960, but the number of young girls who smoke has increased at an alarming rate. Researchers have noted that the number of cigarettes smoked per day by women has increased from the 1950s to the present. The Framingham data reveal that serum cholesterol level increases substantially with age and that women should take steps to eat a healthy, low-saturated fat, low cholesterol diet to maintain a low blood cholesterol level. The Framingham Study data also show that although the same risk factors operate in men and women, the standard risk factors do not explain the marked differences in morbidity and mortality from heart disease between the two sexes. We must continue to study the epidemiology and biology of coronary heart disease in women both to better understand the disease process in women and to understand the large gender differential for CHD in most Westernized countries.

Adult↗
PubMed1989

International mortality from heart disease: rates and trends.

Mortality trends are described for heart disease, its main subgroup coronary heart disease (CHD), and total mortality for men and women 45-64 years of age from 1950 to 1985 in 27 countries. In contrast to the epidemic rise in mortality from CHD prior to the 1960s, the death rate is declining in most industrialized countries except in Eastern Europe where trends remain upward. Mortality from CHD was upwards in 18 countries in the 1970s and in only four countries in the 1980s. Peaks for CHD occurred earlier in women than men. With some exceptions, declines were greater for higher than lower rate countries. In many countries, CHD declines are accompanied by a corresponding downward change in total mortality, which suggests that the declines are real. Although in several countries there is substantial mortality from heart diseases other than CHD, generally there is good correspondence in trends between them over the 35-year period. There is also a trend toward less intercountry variability in death rates and proportionate mortality for CHD. But the North-South high-to-low gradient in Europe continues in 1985, and there remains at least a fourfold difference for men and an eightfold difference for women between the highest and lowest CHD rates. The male/female ratios of the rates, while narrowing in many countries, vary from 3:1 to 6:1 among the 27 countries.

Aged↗
PubMed1985

Potential for altering the natural history of congestive heart failure: need for large clinical trials.

Congestive heart failure (CHF) is a major clinical and public health problem; moreover, its incidence is increasing. Once this syndrome is manifest, the mortality rate is very high. To date, none of the drugs available for its treatment has been shown to reduce mortality. It is theoretically possible that in patients with overt CHF, drug treatment may not alter prognosis. This hypothesis suggests that patients at high risk of heart failure should be treated before CHF becomes manifest. Alternatively, the trials of patients with manifest CHF may have been unpromising, simply because they were too small. These considerations indicate an urgent need for very large studies of both categories of patients--a "prevention" trial in those without overt CHF and a "treatment" trial in those with overt CHF.

Aged↗
PubMed1985

Trends in total mortality and mortality from heart disease in 26 countries from 1950 to 1978.

Death rates for total mortality and for non-rheumatic heart disease and hypertension ('heart disease') are described for men and women ages 45-64 in six time periods during 1950-78 for 26 countries. Rates for men in high-rate countries are three times those in low-rate countries. This variation is more striking for men than women. There were marked increases for heart disease in men in most countries, but in 13 countries there was a slowing or reversal of that trend in the 1960's or 1970's or acceleration of an already downward trend. In 22 countries long-term declines for heart disease occurred in women. There was a widening of the north/south gradient in Europe and of the male/female ratio of heart disease mortality. Countries with high heart disease death rates in men had high ratios of heart disease to total death. Other countries experienced a rise in proportionate mortality. In women, proportionate mortality for heart disease remained flat or declined in most countries. In spite of these changes in rates, each country seems to have a range for heart disease mortality that is characteristic of its population and environmental setting so that profound changes in rates do not substantially alter their relative ranking. Our intent is to stimulate the search for reasons why heart disease mortality recently declined in some countries but not in others (already begun in the WHO-sponsored MONICA programme). Our forthcoming monograph on international mortality trends for the major causes of death will be a next step in this process.

Australia↗
PubMedDate not supplied

Decline of coronary heart disease mortality in the United States.

Annual mortality rates for cardiovascular disease in the U.S. have declined steadily since at least 1968, with an accelerated rate of decline since approximately 1972. Although these trends have been seen in both men and women and in both Blacks and Whites, there have been relative differences in the rate of decline by region and state within the U.S. The relative importance of improved prevention vs. treatment in accounting for this decline has been discussed at length but not resolved, and efforts to gather relevant data are still being undertaken. Nonetheless, important changes have occurred in dietary habits with, for example, lower animal and higher vegetable fat consumption; in cigarette smoking rates, with especially important declines in middle-aged men; and in high blood pressure control, with improved levels in both genders and especially in Blacks, who have the highest rates.

Adult↗
PubMedDate not supplied

Economic costs of neoplasms, arteriosclerosis, and diabetes in the United States.

Substantial economic resources are used for treatment of neoplasms, arteriosclerotic diseases, and diabetes (direct costs), and substantial productivity is lost due to morbidity and mortality (indirect costs). Costs of these disease groups in the U.S. in 1993 are estimated from national health expenditures from the Health Care Financing Administration and survey data from the National Center for Health Statistics. Based on primary diagnosis, direct costs are $37 billion for neoplasms, $126 billion for arteriosclerosis, and $15 billion for diabetes, and indirect costs are $70, $83, and $5 billion respectively. Costs would be higher, particularly for diabetes ($92-138 billion), if based on primary and secondary diagnosis.

Arteriosclerosis↗