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PubMed1995

Components of small area variation in death rates: a method applied to data from Sweden.

STUDY OBJECTIVES: The study aimed to develop and evaluate a method for small area analysis of different non-random components of the variation in death rates. The method was applied to incidence and mortality data for selected malignant neoplasms in 26 administrative health areas in Sweden. DESIGN: Variation in mortality and incidence rates for malignant neoplasms of the trachea, bronchus, and lung; colon; rectum; and cervix uteri in the 26 health areas were analysed after standardisation for age. In addition, the systematic and random components of variance were estimated. The systematic component of variance in mortality was divided into two additive components-one component was dependent on the variation in the corresponding incidence rates and the other remained after adjustment for incidence. SETTING AND PARTICIPANT: All cases diagnosed between 1972 and 1983 and all deaths between 1974 and 1985 for selected malignant neoplasms in Swedish citizens and other residents in Sweden, aged between 0 and 64 years, were analysed. MAIN RESULTS: Much of the observed variation in mortality was explained by the estimated random variation. For malignant neoplasms of the trachea, bronchus, and lung the systematic variation in mortality was mainly explained by the variation in incidence. For cancer of the cervix uteri, alone, there was significant systematic variation of moderate magnitude that was not explained by the incidence rates. CONCLUSIONS: These methods made it possible to divide the observed variance in mortality into different components. Random effects and variance in incidence rates were found to be of great importance when analysing the variance in death rates between health areas. By studying different systematic components of variation it is possible to identify fields for in depth studies on the quality of prevention and treatment.

Adolescent↗
PubMed1992

[Incidence of autopsies in France. Consequence on the estimation of sudden death rate according to regions. Results from an epidemiologic survey on postneonatal mortality].

In order to assess the actual rate of sudden infant death in France, an epidemiological survey was carried out. All the deaths of the postneonatal period were investigated from September 1986 to December 1987. The parents of the babies and the certifying physicians were involved in the survey, the results of the post mortem investigations were recorded. That material showed a low rate of necropsies among the sudden infant deaths (31% at the national level) and wide variations in the rates between the French regions (from 55 to 7%). Nevertheless the results of the autopsies as well as the clinical aspects allowed to calculate the unexplained sudden infant death rates by region according to the Beckwith's definition. These rates are ranging from 0.8 to 1.9 per thousand live births (mean 1.3).

Asphyxia Neonatorum↗
PubMed2004

Examining differences in death rates for medicaid and non-medicaid nursing home residents.

OBJECTIVES: The purpose of this work was to examine differences in the probability of death for Medicaid and privately funded nursing home residents, controlling for differences in facility, market, and resident characteristics. METHODS: Given that Medicaid residents are more likely to die in nursing facilities, the probability of dying within 1 or 2 years is estimated using a series of probit models, controlling for whether a resident is Medicaid-funded or privately-funded. As resident characteristics, market attributes, facility characteristics, and facility fixed effects are sequentially added to the specifications, the gap in the probability of death between Medicaid and private-pay residents is considered. RESULTS: The overall mortality rate for Medicaid residents was 14.8% points higher than the death rate for privately funded residents. When considering death within 1 year and 2 years, Medicaid resident death rates were 4.2% and 7.8% higher, respectively. The apparent difference in mortality declines as one controls for resident, market, and facility characteristics. Both facility characteristics and facility fixed effects are relatively important in explaining differences in death rates between Medicaid and private-pay residents. CONCLUSIONS: Differences in death rates between Medicaid and private-pay residents are relatively small, suggesting that residents with different payment sources are not treated differently in nursing homes in ways that impact the probability of death. However, policymakers may want to look more closely at whether Medicaid residents are segregated into lower-quality facilities.

Age Factors↗
PubMed2006

Computing exact excess death rates from a published mortality study.

We wish to estimate the associated excess death rate (EDR) or mortality ratio (MR) from a published study of persons with a given medical condition. This requires computation of the expected mortality in the study population. If age- and sex-specific person years of data are available, this task is straightforward. Most often, however, we have only descriptive statistics--percentage male, average and standard deviation of age--at the beginning of follow up. We show here how this limited information can be used to compute an exact EDR or other quantities of interest.

Age Distribution↗
PubMed1992

Death rates of malignant melanoma among white men--United States, 1973-1988.

Since 1973, death rates for malignant melanoma (International Classification of Diseases, Ninth Revision, codes 172.0-172.9) have increased in the United States and other countries; this increase has occurred disproportionately among white men. To develop hypotheses on the etiology of this increase, the Boston University Schools of Medicine and Public Health and CDC reviewed data from the Surveillance, Epidemiology, and End Results (SEER) Program for the National Cancer Institute and other existing databases. This report summarizes patterns of malignant melanoma among whites in the United States from 1973 through 1988 and suggests possible causes for these patterns.

Adult↗
PubMedDate not supplied

[Accident death rate. Some data on its behavior in Cuba].

"An analysis of the behavior of accident death rates in Cuba in the last few years and its distribution by sex, age, place of residence, and different causes, is made [in an attempt] to understand its behavior and implement efficient preventive methods. This analysis demonstrates that accident death risks increase with advanced age. Accident frequency of occurrence varies significantly with sex, but males show rates twice as high. Also some differences are noted concerning the major causes of accident for both sexes. At the same time, the significance of these causes varies for each age group and sex, with younger age brackets showing a prevalence of traffic accidents and advanced age a prevalence in accidental falls." (SUMMARY IN ENG AND FRE)

Age Factors↗
PubMed2006

Florida's weakened motorcycle helmet law: effects on death rates in motorcycle crashes.

OBJECTIVES: Effective July 1, 2000, Florida's universal helmet law was amended to exclude riders ages 21 and older with insurance coverage providing at least 10,000 US dollars in medical benefits for injuries sustained in a motorcycle crash. Observed helmet use in Florida was reported to have declined from nearly 100% in 1998, before the law change, to 53% after. This study examined the effects of the law change on the likelihood of death, given involvement in a motorcycle crash. METHODS: Rates of motorcyclist deaths per crash involvement in Florida for 2001-2002 (after the law change) were compared with those for 1998-1999 (before the law change). Before/after death rate ratios (95% CIs) were examined, and logistic regression models estimated the effect of the helmet law change on the odds of death in a crash, while controlling for rider gender, age, and seating position, and number of vehicles. RESULTS: The motorcyclist death rate increased significantly after the law change, from 30.8 to 38.8 deaths per 1,000 crash involvements. Motorcyclist death rates increased for single- and multiple-vehicle crashes, for male and female operators, and for riders of all ages including those younger than 21. After controlling for gender and age, the likelihood of death given involvement in a motorcycle crash was 25% higher than expected after the law change. It is estimated that 117 motorcyclist deaths could have been avoided during 2001-2002 if Florida's universal helmet law had remained in place. CONCLUSIONS: This study provides evidence of the life-saving benefits of universal helmet laws. The results also suggest that age-specific helmet laws are not effective in protecting the youngest drivers. This is not surprising, as these laws are largely unenforceable.

Accidents, Traffic↗
PubMed2001

Higher colon cancer tumor proliferative index and lower tumor cell death rate in mice undergoing laparotomy versus insufflation.

BACKGROUND: Our laboratory has previously shown that tumors are established more easily and grow larger after laparotomy than after laparoscopy. To characterize these differences in tumor growth further, the tumor cell death rates and tumor proliferation rates were compared in vivo after full sham laparotomy versus carbon dioxide (CO2) insufflation. METHODS: Female Balb/C mice (n = 36) were inoculated intradermally in the dorsal skin with 106 C-26 colon adenocarcinoma cells in 0.1 ml of culture media no more than 1 h before interventions. The mice then were randomized to one of three groups: anesthesia control, CO2 insufflation, or sham laparotomy. The anesthesia control group underwent no procedure. The insufflation group underwent CO2 pneumoperitoneum (4-6 mmHg) for 20 min via a 20-gauge angiocatheter. The laparotomy group underwent a midline incision from xiphoid to pubis, which was closed after 20 min. Tumors were excised from half the mice in each group on postoperative day 7, and from the remaining mice on postoperative day 14. Sections of tumors were made then stained separately for free 3? hydroxyl ends of genomic deoxyribonucleic acid (DNA) using fluorescein-deoxyunidine triphosphate (dUTP), and immunohistochemically for proliferating cell nuclear antigen (PCNA). Apoptosis was measured by quantitating DNA strand breaks in individual cells using fluorescence microscopy. Fluorescein-positive cells in five random high-power fields (x200) were counted in a blinded fashion. The proliferative index of each tumor was determined by averaging PCNA positive cells in five high-power fields (x450) counted in a blinded fashion with the aid of an optical grid. RESULTS: On postoperative day 7, there was no significant difference in the proliferative index or apoptotic rates among the three groups. On postoperative day 14, the proliferative index in the laparotomy group was significantly higher than in either the insufflation or control group (p < 0.001). The proliferative index in the insufflation group also was significantly higher than in the control group (p < 0.05). Inverse differences in apoptotic rates were found. The apoptotic rate in the laparotomy group was significantly lower than in either the insufflation (p < 0.05) or control group (p < 0.001). The apoptotic rate in the insufflation group was significantly lower than in the control group (p < 0.001). CONCLUSIONS: We have demonstrated that there is a significantly higher rate of tumor cell proliferation and a significantly lower rate of tumor cell death with the C-26 colon adenocarcinoma tumor line after laparotomy than after insufflation or anesthesia alone on post-operative day 14. The mechanisms of these phenomena are unclear. It appears that certain factors postoperatively stimulate tumors to proliferate at a higher rate, causing tumor cells to die at a lower rate in the laparotomy group than in the insufflation group.

Adenocarcinoma↗
PubMed1977

Heterogeneity and the modelling of bacterial spore death: the case of continuously decreasing death rate.

Models for the inactivation of bacterial spores for the case of continuously decreasing death rate are reviewed and extended to show that it is not possible to distinguish between one particular model based upon the innate heterogeneity of the population and that based upon the acquisition of heat resistance during the heating process. Two innate heterogeneity models have been fitted to published data.

Adaptation, Physiological↗
PubMed2004

Asian/Pacific Islander American women: age and death rates during hospitalization for breast cancer.

PURPOSE/OBJECTIVES: To investigate whether differences in age and death rates exist between hospitalized Asian/Pacific Islander American (APIA) women and women of other racial groups. DESIGN: Secondary data analysis of a national data set. SETTING: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample, Release 6, was used to obtain hospitalization data on women with breast cancer based on racial status. A total of 20,507 hospitalization records met the study criteria. SAMPLE: All women who were hospitalized with a primary diagnosis of breast cancer, were older than 18, and did not die during hospitalization, plus all women who met the criteria stated above but died during hospitalization. METHODS: Secondary data analysis. Post hoc analysis was used to identify significant differences among racial groups. FINDINGS: Significant differences were found between APIA and Caucasian and Latino women. Significant differences based on race were found between subjects who had died during hospitalization. On average, APIA women were the youngest to die. CONCLUSIONS: APIA women with breast cancer were among the youngest women being hospitalized and the youngest to die during hospitalization. IMPLICATIONS FOR NURSING: Cultural awareness by nurses is critical when discussing methods for prevention and early detection of breast cancer with minority women. Targeting new immigrants is a priority for those who screen and educate women about detection and treatment of breast cancer.

Adult↗
PubMed1981

Rising death rates in the Soviet Union: the impact of coronary heart disease.

Age-adjusted overall death rates in men and women in the Soviet Union began to rise in the mid-1960s; an 18 per cent increase occurred in the entire population from 1964 to 1975. The epidemic of coronary heart disease (CHD) appears to be the primary cause of this trend and has been particularly widespread among middle-aged men. Prospective epidemiologic studies and autopsy reports confirm the high prevalence rates of atherosclerosis and its complications. The major risk factors for CHD occur frequently in the Soviet population. The epidemic nature of the modern chronic diseases is dramatically apparent in the secular trends in Soviet vital statistics. A similar pattern of life style as related to risk of CHD in the Soviet Union and in Western capitalist countries further suggests a similar social basis for this epidemic in both areas.

Adult↗
PubMed1989

Models explaining motor vehicle death rates in the United States.

This paper is a selective survey of models explaining motor vehicle death rates in the United States. First, it reviews Peltzman's 1975 study of the effect of automobile safety regulation and critiques of the study. Then it summarizes several subsequent statistical studies of highway fatalities. The surveyed studies are typically regression analyses of the impact of various factors on motor vehicle deaths. They are categorized in this paper according to which of three types of data they utilized: time-series; cross-sectional; or pooled time-series, cross-sectional. This paper notes what can be inferred collectively from the surveyed studies regarding the impacts of various factors on highway fatalities. It also discusses certain shortcomings of the studies in general along with possible remedies, and makes recommendations regarding future research. Tabular summaries of the statistical studies surveyed in this paper are included in the Appendix.

Accidents, Traffic↗
PubMed2006

Lung cancer: very high death rate with HIV, huge reduction possible with CT screening for early diagnosis.

Lung cancer has a high death rate, especially with HIV in one group of patients studied recently. Researchers are finding that most of the fatalities are due to late diagnosis; as many as 80% of the deaths from lung cancer in the general population might be prevented by CT screening to find the tumors early. The patients with HIV were often relatively healthy, so doctors did not suspect that they had cancer.

Early Diagnosis↗
PubMed2006

Long-term recurrence and death rates after acute pancreatitis.

OBJECTIVE: The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death. MATERIAL AND METHODS: Over a period of 3 years (1995 to 1998), 155 patients admitted with a first attack of acute pancreatitis were included in the study. They followed a specific protocol (ultrasound within 24 h, laboratory tests, Ranson scoring and patients with severe pancreatitis computed tomography scans). In gallstones, pancreatitis, either ERCP or cholecystectomy, was performed at admission or in the case of the latter within 4 weeks. A follow-up was done in January 2002. RESULTS: Forty-one percent of the patients without gallstones were readmitted to hospital during the period of follow-up compared to 10% in the group of patients with gallstones. Using multivariate analysis, no factors were significantly predictive of readmission. CONCLUSIONS: We found an identical mortality rate of 15% in the two groups, the only predictive factor being age.

Adolescent↗