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PubMed1987

Comments on HCFA hospital death rate statistical outliers. Health Care Financing Administration.

In March 1986, the Health Care Financing Administration (HCFA) released ten lists of death-rate "outlier" hospitals, one for all 1984 Medicare discharges and nine for specific DRGs. Recent Medicare hospital discharge abstracts have substantially undercounted in-hospital deaths, with large variations by state. Apart from the proportion of a hospital's cases in 80 DRGs, the predictive models had no measures of case severity based on diagnosis or procedure. Having DRG 123 (all deaths from acute myocardial infarction) as an independent variable in the all-death regression model probably accounted for much of its high r2. Inclusion of an independent variable for average length of stay (ALOS) favored hospitals in higher ALOS states by higher predicted death rates. Model bias also favored lower-risk hospitals. Small numbers of predicted deaths for specific DRGs limited low-volume hospitals on these outlier lists to those with high ratios of actual to predicted deaths. On six of the nine DRG-specific outlier lists, a total 1,222 hospitals had unfavorable residuals, while only 8 were favorable. Ten recommendations are given to increase reliability of future outcome analyses.

Aged↗
PubMed2002

Therapeutic application of caspase 1/interleukin-1beta-converting enzyme inhibitor decreases the death rate in severe acute experimental pancreatitis.

OBJECTIVE: To assess the effect of therapeutic inhibition of interleukin 1beta-converting enzyme (ICE) in an experimental model of severe acute pancreatitis (SAP). SUMMARY BACKGROUND DATA: Several lines of evidence suggest that cytokines activated by ICE play an instrumental role in the course of acute pancreatitis. Recent studies have shown that pharmacologic or genetic blockade of ICE significantly ameliorates the overall severity of and the death rate in SAP. METHODS: Severe acute pancreatitis was induced by infusion of 5% sodium taurocholate in Wistar rats. A new, highly selective, irreversible inhibitor of ICE was intraperitoneally applied at a dosage of 0.25 mg every 12 hours. Control animals in group 1 received treatment with saline; in group 2 rats, ICE inhibition was started 6 hours after the onset of pancreatitis; and in group 3 rats, ICE inhibition was started 12 hours after the onset of pancreatitis. After a 7-day observation period, surviving rats were killed and blood, plasma, pancreas, lung, and liver were used for subsequent analysis. RESULTS: Inhibition of ICE decreased the 7-day death rate from 87.5% to 38.9% irrespective whether treatment was started 6 hours or 12 hours after induction of SAP. Morphometric analysis revealed a significant reduction of acinar cell necrosis in both treated groups, whereas pancreatitis-associated pulmonary and hepatic damage was uniformly low and not influenced by ICE inhibition. Tissue myeloperoxidase concentrations were dramatically decreased in the pancreas and the lung after either regimen of ICE inhibitor treatment. In contrast to lung and liver, marked upregulation of interleukin 1beta, tumor necrosis factor alpha, and ICE mRNA was observed in the pancreas, with levels of interleukin 1beta and tumor necrosis factor alpha being reduced in ICE-inhibited animals. Compared with nontreated rats, plasma amylase levels were higher in both treatment groups, whereas lipase and hematocrit showed no difference. Changes of the differential white blood count including neutrophils, lymphocytes, and monocytes were attenuated in both groups after ICE inhibitor treatment. CONCLUSIONS: Pharmacologic inhibition of ICE significantly improves the overall severity of and the death rate in SAP. A substantial reduction of neutrophil-mediated tissue injury in pancreas and lung seems to contribute to the beneficial effects of this approach. Moreover, ICE inhibition is still effective after a therapeutic window of 12 hours. Based on the current findings, future studies on the clinical application of ICE-inhibiting substances in acute pancreatitis seem to be promising.

Acute Disease↗
PubMed1994

Impact of HIV infection and AIDS on death rates in British Columbia and Canada.

OBJECTIVE: To assess the impact of HIV infection and AIDS on death rates in British Columbia and Canada. DESIGN: Descriptive, population-based study. SETTING: British Columbia and Canada. PATIENTS: All people for whom HIV infection or AIDS was listed as the underlying cause of death in Canada and all provinces from 1987 to 1991, as reported to Statistics Canada, and all people for whom HIV infection or AIDS was listed as the underlying or antecedent cause of death in British Columbia and Vancouver from 1987 to 1992, as reported to the Division of Vital Statistics, British Columbia Ministry of Health. MAIN OUTCOME MEASURES: Age- and cause-specific patterns of death, and potential years of life lost (PYLLs) for men. RESULTS: From 1987 to 1991 a total of 4189 deaths from HIV infection and AIDS (in 3941 males and 248 females) in Canada and 686 such deaths (in 671 males and 15 females) in British Columbia were reported to Statistics Canada. The rate of death from HIV infection and AIDS was 1.39 times higher (95% confidence interval [CI] 1.29 to 1.50) in British Columbia than in Canada as a whole and 1.95 times higher (95% CI 1.65 to 2.29) when HIV infection was associated with specified malignant neoplasms than with other related causes. The PYLLs from HIV infection and AIDS for men rose steadily in Canada, from 17,615 in 1987 to 38,735 in 1991; the latter is comparable to the PYLLs from stroke and colorectal cancer. In Vancouver the PYLLs from HIV infection and AIDS for men increased sharply from 1987 to 1992, surpassing the PYLLs from heart disease, malignant neoplasms and accidents. CONCLUSIONS: From 1987 to 1991 the rate of death from HIV infection and AIDS in British Columbia was higher than the national average. In Vancouver HIV infection and AIDS have become the leading causes of premature death in men, exceeding heart disease, malignant neoplasms and accidents.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Sudden and cardiac death rates in hemodialysis patients.

BACKGROUND: Sudden and cardiac death (including death from congestive heart failure, myocardial infarction, and sudden death) are common occurrences in hemodialysis patients. The intermittent nature of hemodialysis may lead to an uneven distribution of sudden and cardiac death throughout the week. The purpose of this study was to assess the septadian rhythm of sudden and cardiac death in hemodialysis patients. METHODS: Data from the United States Renal Data System (USRDS) were obtained to examine the day of death for United States hemodialysis and peritoneal dialysis patients from 1977 through 1997. The days of death were also determined for patients in the Case Mix Adequacy Study of the USRDS. RESULTS: There was an even distribution of sudden and cardiac deaths for patients on peritoneal dialysis, and hemodialysis patients dying of noncardiac deaths also had an even distribution. For all hemodialysis patients, Monday and Tuesday were the most common days of sudden and cardiac death. For patients in the Case Mix Adequacy Study designated as Monday, Wednesday, and Friday dialysis patients, 20.8% of sudden deaths occurred on Monday compared with the 14.3% expected (P = 0.002). Similarly, 20.2% of cardiac deaths occurred on Monday compared with the 14.3% expected (P = 0.0005). Similar trends were found on Tuesday for Tuesday, Thursday, and Saturday dialysis patients. CONCLUSIONS: The intermittent nature of hemodialysis may contribute to an increased sudden and cardiac death rate on Monday and Tuesday for patients enrolled in the USRDS.

Age Factors↗
PubMed1988

Further investigation into the recent increase in asthma death rates: a review of 41 asthma deaths in Oregon in 1982.

Vital statistics indicate increasing mortality from asthma since 1978 in the United States, England and Wales, Australia, and New Zealand. In Oregon and Washington, combined asthma mortality increased by 87% between 1977 and 1983. We reviewed the records of all patients (N = 41) (1) who died in hospitals or nursing homes in Oregon in 1982 and (2) whose death certificates listed asthma as the cause. Patients were 34 to 90 years old and half had been smokers. We found that most young patients who died clearly had asthma and died suddenly during severe attacks. Patients aged 55 and over frequently had bronchitis, emphysema, or chronic obstructive pulmonary disease rather than uncomplicated asthma, and were treated less aggressively than young patients. Their cause of death was often due to multisystem disease rather than reversible airflow obstruction. Reported statistics probably overestimate the true asthma mortality rate in the older population in Oregon.

Acute Disease↗
PubMed2003

Gauging the impact of breast carcinoma screening in terms of tumor size and death rate.

BACKGROUND: While the question of whether the trials of breast cancer screening have resulted in a reduction in breast cancer death has been the subject of much scrutiny, there has been less attention to the reduction in tumor size achieved by screening. METHODS: Size data for invasive breast tumors were assembled from a variety of sources. The health consequences that can be expected from finding tumors of various sizes were determined using a recently developed mathematical method for relating tumor size to death rate. RESULTS: First, in both the Swedish two-country trial and at the MGH Breast Imaging Division, the sizes of the invasive breast cancers in the screening population (those masses seen at screening together with those found as palpable masses after screening examinations) were sufficiently smaller than the cancers found among women who had not used screening to have lead to considerable reductions in death. Second, the lack of reduction in death rates detected in both Canadian National Breast Screening Studies could be ascribed to the small reductions in tumor size achieved in these studies. Third, radiographic density had a small effect, whereas age had a negligible effect, on the capacity of mammographic screening to find breast carcinomas at smaller, and thus less lethal, sizes. CONCLUSIONS: Prompt attendance at annual mammographic screening offers the potential to reduce tumor size and, presumably, breast carcinoma death, in women of all ages and density groups.

Adult↗
PubMed2005

Lower stroke death rates in patients receiving blood pressure lowering therapy before the onset of a stroke.

The objective of this study was to compare stroke death rates among patients with and without blood pressure lowering treatment before the onset of the stroke. During two consecutive years all patients with acute stroke were recorded by 178 Belgian general practitioners of the sentinel network. In total 511 patients with acute stroke were recorded. The death rate after one month was found significantly higher among the untreated patients (33%; n = 84) compared to those receiving blood pressure lowering treatment (23%; n = 61) (p = 0.007). Blood pressure lowering treatment before the onset of stroke had a beneficial effect on survival in a backward stepwise logistic regression (OR 0.38; 95% CI 0.20-0.72). In conclusion, stroke mortality is significantly lower among patients receiving blood pressure lowering treatment before the onset of stroke compared to those without blood pressure lowering treatment.

Aged↗
PubMed1962

Growth, reproduction, and death rates of Escherichia coli at increased hydrostatic pressures.

ZoBell, Claude E. (University of California, La Jolla) and Andre B. Cobet. Growth, reproduction, and death rates of Escherichia coli at increased hydrostatic pressures. J. Bacteriol. 84:1228-1236. 1962.-Pressures ranging from 100 to 500 atm were found to retard the growth and reproduction of Escherichia coli in nutrient medium. Reproduction (as manifested by cell division or an increase in the number of viable cells) was retarded more than was growth (as manifested by increase in cell size or the formation of biomass). When incubated near the threshold of pressure tolerance (about 475 atm at 30 C), some cells of E. coli grew into long slender filaments showing little evidence of fission or cell division. Compression prolonged the lag phase of E. coli in nutrient medium, particularly at pressures higher than 400 atm. The inhibiting effects of pressure on reproduction and growth were found to be less at 30 than at 20 or 40 C. Pressures of 400 to 1,000 atm accelerated the death rate of E. coli cultures in nutrient medium. The lethal effects of pressure were greater at 40 than at 30 C and greater at 30 than at 20 C.

Atmospheric Pressure↗
PubMed1989

Hypertension as a cause of lower than expected death rates from coronary artery disease among blacks.

Coronary risk factors are more prevalent among blacks than whites in the United States. It is therefore paradoxical that age-adjusted death rates for coronary artery disease (CAD) are similar in the two racial groups. The major risk factor for CAD that is more common among blacks than whites is hypertension, which increases the risk of CAD by two- to fourfold, depending on the presence of smoking, hypercholesterolemia, or other factors. Two general hypotheses have been advanced to explain the lower than expected CAD rates among blacks: (1) the presence of some protective factors, such as increased levels of high density lipoprotein cholesterol (HDL); or (2) selective loss of CAD-prone black individuals due to other causes of mortality. Analysis of age-specific death rates from the vital statistics records strongly suggests that differential survival in the black and white populations, i.e., mortality selection, is the primary explanation of this phenomenon. We sought to test this hypothesis by examining an entirely independent data base. Data from the National Hospital Discharge Survey for the years 1973-1984 were evaluated to determine whether there were age-related differences in case-fatality rates between whites and blacks, and whether a crossover pattern in mortality could be discerned. The results demonstrate that in-hospital case-fatality rates for acute myocardial infarction (MI) were 10% to 70% higher for each of the 10-year age groups for blacks up to age 70 years, at which time a crossover occurred. The median age at which death due to MI occurred in blacks was approximately 5 years earlier than in whites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

An epidemic model with a density-dependent death rate.

This paper deals with a mathematical model for a disease where the death rate depends on the number of people in the population. This sort of model would be suitable for diseases in developing countries or for diseases amongst animal and insect populations. We also assume that the population under consideration is regulated by the disease so that there is a mortality induced by the disease. We use a compartmental model and perform an equilibrium and stability analysis to find that there is a threshold condition. If the threshold is exceeded, then there is a unique equilibrium with disease present which is locally stable to small perturbations. We conclude by looking at several specific models and seeing how the results relate to previous work.

Animals↗
PubMed2001

High early death rate in tuberculosis patients in Malawi.

SETTING: Thirty-eight district and mission hospitals in Malawi. OBJECTIVES: In patients registered with all types of tuberculosis (TB) in 1997 to determine 1) treatment outcomes, and 2) when in the course of anti-tuberculosis treatment TB deaths occurred. DESIGN: A retrospective study using information from TB registers, health centre registers, TB treatment cards and TB ward admission books. RESULTS: A total of 16,004 patients were registered with all types of TB, 6471 with smear-positive pulmonary tuberculosis (PTB), 5305 with smear-negative PTB and 4228 with extra-pulmonary tuberculosis (EPTB). Of patients with all types of TB, 3720 (23%) died: death rates were 22% in smear-positive PTB, 26% in smear-negative PTB and 22% in EPTB. Month of death was known in 3371 patients (91% of those who died) and day of death in 3326 patients (89% of those who died). In patients who died, 19% of deaths occurred by day 7 and 41% by the end of the first month of treatment. A higher proportion of early deaths occurred in patients with smear-negative PTB and EPTB and in relation to increasing age. CONCLUSIONS: There was a high overall death rate in TB patients registered in 1997, with 40% of deaths occurring in the first month of treatment. Strategies to combat this problem are needed.

Adolescent↗
PubMed2001

State helmet laws and motorcycle rider death rates.

Motorcycles are the most dangerous form of motorized transportation. Per vehicle miles traveled, motorcyclists are about 3 times as likely as passenger car occupants to be injured in a crash, and 16 times as likely to die. Because the majority of these deaths are caused by head injury, safety advocates have recommended mandatory use of motorcycle helmets. Others contend that state laws mandating helmet use infringe on motorcyclists' rights, and question whether such laws really reduce motorcycle deaths and injury. Scientific evidence cannot address the appropriate balance between personal freedom and public safety, but it can address the effectiveness of mandatory helmet laws. This Issue Brief summarizes a new analysis of the effects of motorcycle helmet laws on death rates, and points out the need to account for other potential factors when comparing death rates across states.

Accidents, Traffic↗
PubMed2004

Using population death rate to predict rate of admissions to the intensive care unit.

OBJECTIVE: To determine whether the intensive care unit (ICU) admission rates of new health plan members can be predicted by the mortality of non-ICU-treated members. DESIGN: Retrospective study of health records. PATIENTS: Five sequential cohorts of new health plan members (298,974 members) seen at any of three tertiary care medical centers of a health maintenance organization in northern California who joined the health plan during the first quarter of 1994, 1995, 1996, 1997, or 1998 and retained membership for > or =1 yr. SETTING: Three medical centers in northern California. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured rates of ICU admission, death, and mechanical ventilation among cohort members. ICU admission rate varied between hospitals and over time but was predicted by non-ICU mortality-ICU admission rate = 0.83 x non-ICU mortality-and was linear throughout its range. In no hospital or time period was a higher mortality associated with fewer ICU admissions. Seventeen percent of population deaths occurred among ICU patients and did not differ among medical centers. CONCLUSIONS: A single linear equation predicted ICU admission rate from death rate of non-ICU-treated patients among cohorts of new members. ICU admission rates can be predicted from a measure of population illness burden, such as the mortality of non-ICU-treated patients. It may be possible to extend this analysis to other hospitals and health care systems to evaluate the adequacy of ICU services provided.

California↗
PubMed1975

Relationships of temperature with death rates from all causes and from certain respiratory and arteriosclerotic diseases in different age groups.

Changes of temperature of short duration (2-10 days) and of longer duration (15 and more days) are associated with inverse changes in death rates in both respiratory infections (pneumonia and bronchitis) and in vascular diseases (myocardial infarction and cerebral vascular accidents). These relationships are less or absent in younger subjects and marked in the elderly. The temperature on the day of death is less relevant to the death rate than that on earlier days and the particular days which are most relevant differ in the different conditions. In the case of myocardial infarcts the temperature 1 to 2 days before death is the most relevant, in strokes 3 to 4 days before death and in the respiratory infections more than 5 days before death is the most relevant.

Age Factors↗
PubMed2004

Birth and death rate estimates of cats and dogs in U.S. households and related factors.

Studies report variable factors associated with dog and cat surpluses in the United States. Estimates of cat and dog birth and death rates help understand the problem. This study collected data through a commercial survey company, distributing questionnaires to 7,399 cat- and dog-owning households (HHs) in 1996. The study used an unequal probability sampling plan and reported estimates of means and variances as weighted averages. The study used estimates of HHs and companion animals for national projections. More than 9 million owned cats and dogs died during 1996-yielding crude death rates of 8.3 cat deaths/100 cats in HHs and 7.9 dog deaths/100 dogs in HHs. The study reported twice as many kitten as puppy litters, with an average litter size of 5.73 and 7.57, respectively. The study reported data on planned versus unplanned litters, reasons caregivers did not spay females, disposition of litters, and sources of animals added to HHs. These first national estimates indicate the magnitude of, and reasons for, animals leaving HHs. The crude birth rate was estimated to be 11.2 kittens/100 cats in HHs and 11.4 puppies/100 dogs in HHs.

Animal Welfare↗
PubMed1994

Perinatal, infant, and child death rates among the Old Order Amish.

The Old Order Amish are a distinct ethnic group with a very high birth rate and patterns of perinatal risk factors quite different from those of the general population. This study reports marital fertility and perinatal, infant, and child death rates for an entire Amish settlement of approximately 10,000 individuals, centered around Geauga County, Ohio. All 6,623 births from 1948 to 1988 listed in a directory of Geauga Settlement Amish households were studied. The childbearing experience of all 475 married women over the age of 44 years was also described. Women aged > 44 years had a median of 8.3 births; 24% of the births were to women aged > 34 years. Despite a higher prevalence of several risk factors for perinatal and infant death among the Amish, neonatal and infant death rates for Geauga Settlement Amish have been very similar to the corresponding rates for white children in rural Ohio and the state as a whole. The beneficial aspects of Amish society that may lessen the impact of perinatal risk factors on mortality merit further study.

Adolescent↗