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PubMed1987

Infant death rates among the poor and nonpoor in Kentucky, 1982 to 1983.

The mortality rates of infants born in Kentucky during 1982 and 1983 were analyzed to determine whether there were differences between poor and nonpoor infants. We used computer matching with the Social Insurance Food Stamp files and with the Aid for Families With Dependent Children files to define poor and nonpoor Kentucky resident families. The crude death rate for poor infants was 13.7/1,000 births, and the nonpoor death rate was 10.8/1,000 births. After adjusting for several important variables, we found that the poor infant was at a significantly greater risk for death than the nonpoor infant but only during the postneonatal period (relative risk 2.04, P = .0003). Some differences by sex and race were noted. Sudden infant death syndrome and infections were largely responsible for the poor infants' higher postneonatal mortality risk.

Black or African American↗
PubMed2003

Two-decade-long trends (1975-1997) in the incidence, hospitalization, and long-term death rates associated with complete heart block complicating acute myocardial infarction: a community-wide perspective.

BACKGROUND: The purpose of this community-wide study was to describe a >2-decade-long experience (1975-97) in the incidence and death rates associated with complete heart block (CHB) in patients with acute myocardial infarction (AMI). Limited population-based data exist describing recent, and changes with time therein, incidence and case-fatality rates associated with CHB complicating AMI. METHODS: We conducted an observational study of 9082 metropolitan Worcester, Mass, residents (1990 census = 437,000) hospitalized with validated AMI in all greater Worcester hospitals during 11 1-year periods between 1975 and 1997. RESULTS: Overall, CHB developed in 5.0% of patients with AMI. The incidence rates of CHB declined in the periods studied (6.0% in 1975/78 vs 3.1% in 1997). Declines in the occurrence of CHB were noted in patients with anterior or inferior/posterior MI. These trends remained after adjustment for other factors that might affect the risk of CHB. Patients in whom CHB developed experienced significantly higher hospital death rates than patients in whom CHB did not develop (46.8% vs 14.6%). However, improving trends in the hospital survival rate of patients with CHB were observed between 1975/78 (47.4% surviving) and 1997 (61.3% surviving). Patients in whom CHB developed during hospitalization were not at increased risk for dying after hospital discharge. CONCLUSIONS: Our findings indicate that the incidence of CHB complicating AMI has declined with time. The hospital prognosis of patients in whom CHB developed has improved, but these patients remain at an increased risk of hospital mortality. The long-term prognosis of patients with inferior MI and CHB is similar to that of patients in whom CHB did not develop. Patients with anterior MI and CHB may be at an increased risk of long-term mortality.

Acute Disease↗
PubMed1991

A comparison of injury death rates in China and the United States, 1986.

BACKGROUND: The importance of injury as a public health problem is not well recognized in many developing countries. Data have recently become available on injury mortality in China. METHOD: We compared Chinese injury data based on a 100 million population segment for 1986 with data for the United States. RESULTS: The age-adjusted death rate from all injuries for China exceeds the rate for the US (69.0 vs 61.3 per 100,000). The US has higher death rates from motor vehicle crashes, fires, and homicide; China has greater mortality from drowning, poisoning, falls, and suicide. Especially noteworthy in China are the high drowning rates among young children and the elderly and the high suicide rates in rural areas among young adults and the elderly. CONCLUSION: Injury is an important public health problem in China, exceeding in many respects the problem in the United States. It is urgent for China to place high priority on injury research and prevention.

Accidents, Traffic↗
PubMed1987

Public release of hospital specific death rates. Guidelines for health care executives.

Recent changes in the regulatory guidelines of the Freedom of Information Act have allowed greater public access to hospital specific data concerning Medicare patients. The result has been a significant increase in media attention to hospital outcomes, particularly death rate data. This article outlines the changes and potential problem areas, discusses how hospitals in Birmingham, Alabama were affected, and how they responded. Proactive strategies for managing the public release of hospital specific death rates are proposed as part of an ongoing quality management program.

Alabama↗
PubMed2006

Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America.

BACKGROUND: There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain. METHODS: The contribution of smoking to adult mortality in a population can be estimated indirectly from disease-specific death rates in that population (using absolute lung cancer rates to indicate proportions due to smoking of mortality from certain other diseases). We applied these methods to 1996 death rates at ages 35-69 years in men in three different social strata in four countries, based on a total of 0.6 million deaths. The highest and lowest social strata were based on social class (professional vs unskilled manual) in England and Wales, neighbourhood income (top vs bottom quintile) in urban Canada, and completed years of education (more than vs less than 12 years) in the USA and Poland. RESULTS: In each country, there was about a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales 21%vs 43%, USA 20%vs 37%, Canada 21%vs 34%, Poland 26%vs 50%: four-country mean 22%vs 41%, four-country mean absolute difference 19%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4%vs 19%, USA 4%vs 15%, Canada 6%vs 13%, Poland 5%vs 22%: four-country mean 5%vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country. CONCLUSION: In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due to the effects of smoking. Widespread cessation of smoking could eventually halve the absolute differences between these social strata in the risk of premature death.

Adult↗
PubMedDate not supplied

[Incidence of proliferative retinopathy and sex-related differences in death rate among patients with diabetes mellitus and sight impairment treated with insulin (according to the data from national diabetic registry)].

The article presents the analysis of the occurrence of diabetes mellitus-linked sight impairment and proliferative retinopathy after data of National Diabetes Population Register among patients receiving insulin therapy. The number of women with above mentioned impairments has been found to prevail significantly over that of men. This tendency is also observed among the patients aged to 50 y. o., although in this age group the number of men with diabetes mellitus prevails over that of women. This discrepancy can be explained through higher death rate linked with diabetes mellitus among men as compared with women. Death rate statistics concerning patients with diabetes mellitus complicated with sight impairment for 2003 y. confirms this supposition.

Adult↗
PubMed1993

Is the death rate from asthma exaggerated? Evidence from west Cumbria.

Although the death rate from asthma in England and Wales is reported to be about 2000 a year, clinical experience suggests that it is much rarer. Doctors in West Cumbria health district could recall only seven cases in 14 years. Examination of case notes of patients officially recorded as dying of asthma showed that many were aged over 60 and cigarette smokers. An alternative cause of death was evident in over half the patients. If the picture is representative of that in the whole of Britain the reported mortality from asthma may be much too high.

Age Factors↗
PubMed2001

Exposure-based death rates for child motor vehicle occupants.

We used reports of additional occupants on trips from the Nationwide Personal Transportation Survey to estimate travel in cars and trucks for children age nine years and younger. For children age five to nine years these indirect estimates were 98% of directly reported travel. Using this travel data, the death rate was 4.0 per billion km of travel for children less than age one year and decreased to 1.7 for children age nine years. Infants have a higher exposure-based death rate for travel in cars and trucks than older children despite greater restraint use.

Accidents, Traffic↗
PubMed1979

Division and death rates of Salmonella typhimurium inside macrophages: use of penicillin as a probe.

In mouse peritoneal macrophages infected in vitro with Salmonella typhimurium the number of viable bacteria and the number of stainable bacteria detected by light microscopy both increased at similar rates with a doubling time of more than 1 h. Antibiotics were not present; instead extracellular bacteria were removed by frequently rinsing the cells. The bacterial doubling time in the same medium in the absence of macrophages was about 20 min. Penicillin added to macrophage monolayers rapidly entered the macrophages, reaching a diffusion equilibrium. The penicillin-induced bacterial death rate appeared to depend on the bacterial division rate as well as on the penicillin concentration. These properties of penicillin were used to monitor intracellular bacterial division and death rates. The results indicated that intracellular killing, with the disappearance of stainable bacteria, did not contribute to the extended doubling time in macrophages. It was concluded that the intracellular environment of the bacteria was probably growth inhibitory but not bactericidal.

Cell Division↗
PubMed1990

Exercise in leisure time: coronary attack and death rates.

Nine thousand three hundred and seventy six male civil servants, aged 45-64 at entry, with no clinical history of coronary heart disease, were followed for a mean period of 9 years and 4 months during which 474 experienced a coronary attack. The 9% of men who reported that they often participated in vigorous sports or did considerable amounts of cycling or rated the pace of their regular walking as fast (over 4 mph, 6.4 km/h) experienced less than half the non-fatal and fatal coronary heart disease of the other men. In addition, entrants aged 55-64 who reported the next lower degree of this vigorous aerobic exercise had rates less than two thirds of the remainder; entrants of 45-54 did not show such an effect. When these forms of exercise were not vigorous they were no protection against the disease, nor were other forms of exercise or high totals of physical activity per se. A history of vigorous sports in the past was not protective. Indications in these men are of protection by specific exercise: vigorous, aerobic, with a threshold of intensity for benefit and "dose response" above this threshold, exercise that has to be habitual, and continuing, which suggests that protection is against the acute phases of the disease. Those men who took vigorous aerobic exercise were demonstrably a favourably "selected" group; they suffered less of the disease, however, whether at low risk or high by the several risk factors that were studied. Men with exercise-related reduction in coronary heart disease also had lower death rates from the total of other causes, and so lower total death rates than the rest of the men.

Coronary Disease↗
PubMed1992

Comparison of individual characteristics and death rates of disabled-worker beneficiaries entitled in 1972 and 1985.

The many changes to the Disability Insurance (DI) program that took place during the early 1980's suggest that there may be significant differences in the characteristics of newly awarded beneficiaries over time. This study compares two cohorts of newly entitled beneficiaries--one from 1972 and the other from 1985--in order to assess changes in individual characteristics and death rates between the pre-1980's and the late 1980's. The 1985 cohort had a greater percentage of beneficiaries with mental impairments and a lower percentage with diseases of the circulatory system. The 1985 cohort was also younger, more educated, had higher primary insurance amount levels, and had greater percentages of women and black beneficiaries. Although the death rates and survival curves for both cohorts were very similar, differences in the curves occurred for some covariate subgroups. When the populations were standardized, the estimated percentages of beneficiaries who survived 5 years after entitlement were 78 percent for the 1972 cohort and 77 percent for the 1985 cohort.

Adolescent↗
PubMed1979

Relation of myocardial metal concentrations to water hardness and death-rates from ischaemic heart disease.

Samples of normal heart muscle from an area with soft drinking-water (Burnley) contained significantly more magnesium and potassium than samples from an area with hard drinking-water (Hull). Females from the soft-water area had significantly more iron and copper. Males from the soft-water area had significantly less manganese and slightly less water in the heart muscle. Males in the soft water areas had significantly lower magnesium/potassium ratios, and both sexes had significantly higher potassium/sodium ratios, than those in hard water areas. The relationship between potassium/sodium ratio and death rates from arteriosclerotic disease suggests that the optimum potassium/sodium ratio is 2.8--3.0, and deviations in both directions are associated with increases in the death-rate from ischaemic heart-disease.

Adolescent↗
PubMed1980

The in vivo division and death rates of Salmonella typhimurium in the spleens of naturally resistant and susceptible mice measured by the superinfecting phage technique of Meynell.

Salmonella typhimurium appears to divide faster in the spleen of naturally susceptible BALB/c than in resistant (B10 x A/J)F1 mice. S. typhimurium M526 is an LT2 derivative lysogenic for a non-excluding P22 mutant which allows superinfection with a second, non-replicating, P22 phage so that the proportion of superinfected organisms halves at each division. The true in vivo division and death rates can be calculated from successive determinations of the proportion of superinfected organisms and the viable count. It was found that the division time was 2.86 h in BALB/c and 5.02 h in (B10 x A/J)F1; the death rate was low and actually greater in the susceptible BALB/c strain. These results suggest that the gene controlling in vivo salmonella net growth rate, which is very important in natural resistance to salmonella infection, acts very early by regulating the division rate, perhaps inside macrophages. The actual mechanism remains unknown.

Animals↗
PubMed2026

Immortal genome assumption significantly underestimates replication and death rates of Mycobacterium tuberculosis in mice and monkeys.

Immune correlates of protection against infection with Mycobacterium tuberculosis (Mtb) or against tuberculosis (TB) remain poorly defined. The ratio of colony forming units (CFUs) to chromosomal equivalents (CEQs), Z = CFUs/CEQs, recovered either from the whole lung (mice) or individual lesions (monkeys or rabbits) of Mtb-infected animals has been used as a metric for how effectively Mtb is killed in vivo. However, the contribution of bacterial killing to changes in the CFU/CEQ ratio during an infection has not been rigorously investigated. We developed alternative mathematical models to study the dynamics of CFUs, CEQs, and their ratio during an Mtb infection. We find that the ratioalone cannot be used to infer the death rate of bacteria, unless the dynamics of CEQs and CFUs are entirely uncoupled, which is biologically unreasonable and inconsistent with the view that CEQs reflect an accumulated burden of both viable and non-viable bacteria. Importantly, we estimate a decay rate of 3.6%/day (a half life of about 20 days) of Mtb H37Rv CEQs in B6 mice that is similar to 4%/day, previously found for Mtb Erdman in cynomolgus macaques. While the estimated Mtb DNA decay rate seems small, we found that estimated rates of Mtb replication and death/killing are still extremely sensitive even to slow decay of Mtb DNA, in part, because Mtb replication and death rates are also small especially during chronic phases of infection. By applying our models to data on Mtb dynamics during the first 3 weeks of infection in macaques, we provide evidence of substantial killing of Mtb bacteria, prior to arrival of adaptive immunity to the site of infection, challenging the previously established notion of non-dying bacteria in the absence of T cell immunity and granuloma formation. We also propose experiments that will allow more accurately to measure the rate of Mtb DNA loss, helping more rigorously quantify impact of immunity on within-host Mtb dynamics.

Mycobacterium tuberculosis↗
PubMed2022

High early death rates, treatment resistance, and short survival of Black adolescents and young adults with AML.

Survival of patients with acute myeloid leukemia (AML) is inversely associated with age, but the impact of race on outcomes of adolescent and young adult (AYA; range, 18-39 years) patients is unknown. We compared survival of 89 non-Hispanic Black and 566 non-Hispanic White AYA patients with AML treated on frontline Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology protocols. Samples of 327 patients (50 Black and 277 White) were analyzed via targeted sequencing. Integrated genomic profiling was performed on select longitudinal samples. Black patients had worse outcomes, especially those aged 18 to 29 years, who had a higher early death rate (16% vs 3%; P=.002), lower complete remission rate (66% vs 83%; P=.01), and decreased overall survival (OS; 5-year rates: 22% vs 51%; P<.001) compared with White patients. Survival disparities persisted across cytogenetic groups: Black patients aged 18 to 29 years with non-core-binding factor (CBF)-AML had worse OS than White patients (5-year rates: 12% vs 44%; P<.001), including patients with cytogenetically normal AML (13% vs 50%; P<.003). Genetic features differed, including lower frequencies of normal karyotypes and NPM1 and biallelic CEBPA mutations, and higher frequencies of CBF rearrangements and ASXL1, BCOR, and KRAS mutations in Black patients. Integrated genomic analysis identified both known and novel somatic variants, and relative clonal stability at relapse. Reduced response rates to induction chemotherapy and leukemic clone persistence suggest a need for different treatment intensities and/or modalities in Black AYA patients with AML. Higher early death rates suggest a delay in diagnosis and treatment, calling for systematic changes to patient care.

Adolescent↗
PubMed2006

Estimating lymphocyte division and death rates from CFSE data.

The division tracking dye, carboxyfluorescin diacetate succinimidyl ester (CFSE) is currently the most informative labeling technique for characterizing the division history of cells in the immune system. Gett and Hodgkin [Nat. Immunol. 1:239-244, 2000] have pioneered the quantitative analysis of CFSE data. We confirm and extend their data analysis approach using simple mathematical models. We employ the extended Gett and Hodgkin [Nat. Immunol. 1:239-244, 2000] method to estimate the time to first division, the fraction of cells recruited into division, the cell cycle time, and the average death rate from CFSE data on T cells stimulated under different concentrations of IL-2. The same data is also fitted with a simple mathematical model that we derived by reformulating the numerical model of Deenick et al. [J. Immunol. 170:4963-4972, 2003]. By a non-linear fitting procedure we estimate parameter values and confidence intervals to identify the parameters that are influenced by the IL-2 concentration. We obtain a significantly better fit to the data when we assume that the T cell death rate depends on the number of divisions cells have completed. We provide an outlook on future work that involves extending the Deenick et al. [J. Immunol. 170:4963-4972, 2003] model into the classical smith-martin model, and into a model with arbitrary probability distributions for death and division through subsequent divisions.

Cell Death↗
PubMed1993

Comparison of death rates from acute myocardial infarction in a single hospital in two different periods (1977-1978 versus 1988-1989).

The in-hospital prognosis of patients with definite acute myocardial infarction (AMI) treated at the University Medical Center in Marburg, Germany, was retrospectively evaluated for the years 1977 to 1978 and 1988 to 1989. Diagnosis of AMI was established in 357 patients (251 men, 106 women) in 1977 to 1978 and in 338 patients (240 men, 98 women) in 1988 to 1989. Overall in-hospital death rate increased from 19.6% (1977 to 1978) to 28.7% (1988 to 1989) (p < 0.01). Median ages of both groups were comparable. Patients treated in 1988 to 1989 had a higher prevalence of arterial hypertension (p < 0.001), hypercholesterolemia (p < 0.0001), reinfarction (p < 0.01), and successful resuscitation before hospital arrival (p < 0.0002). Univariate risk factor evaluation suggested the following unfavorable prognostic variables: age, successful resuscitation before hospital arrival, diabetes mellitus, reinfarction, and female sex. A favorable prognosis was associated with a history of smoking, higher serum cholesterol concentration and thrombolysis. Logistic regression analysis identified age, smoking, serum cholesterol concentration, and the combination of treatment period with either successful resuscitation before hospital arrival, or diabetes mellitus, as independent variables of in-hospital prognosis. In conclusion, the apparent increase of in-hospital death rate between 1977 to 1978 and 1988 to 1989 could mainly be attributed to differences in the 2 study groups.

Age Factors↗
PubMed1998

Iowa record-linkage study: death rates in psychiatric patients.

The Iowa record-linkage study was developed to investigate death rates in psychiatric patients, and involved computer matching of death certificates with a roster of patients. A list of all patients admitted to our hospital from 1972 through 1981 was obtained and after removing duplicate entries the list was pared to 5412 names. The record included multiple identifiers (e.g., name, gender, date-of-birth, hospital number). This information was then linked by computer with all Iowa death certificates for the same period; a total of 331 deaths were identified. Patients were assigned to a single psychiatric diagnostic category based on a computer program that reviewed each patient's clinical diagnoses and picked the one with the highest priority in a hierarchy we had created. Age and sex adjusted mortality tables were constructed, allowing us to compute expected numbers of deaths. Relative risk for premature death was greatest among women, and those under 20 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either gender with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psychophysiological disorders; and men with neuroses. Death from natural causes, especially from heart disease, was significantly excessive among women, while death from accidents and suicides was excessive for both men and women. The overall SMR was 1.65 (P < 0.001). Most importantly, we found that the greatest excess of mortality occurred within the first 2 years following hospital discharge. Thus, we were able to demonstrate that risk of mortality in general, and of suicide specifically, differed according to age, gender, diagnosis, and portion of the follow-up. We have subsequently used this method to investigate specific risk factors associated with mortality in mood disorders, schizophrenia, and antisocial personality disorder. Findings from these studies are reported.

Adult↗