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PubMed2005

Using moving total mortality counts to obtain improved estimates for the effect of air pollution on mortality.

In many cities of the United States, measurements of ambient particulate matter air pollution (PM) are available only once every 6 days. Time-series studies conducted in these cities that investigate the relationship between mortality and PM are restricted to using a single day's PM as the measure of PM exposure. This is undesirable because current evidence suggests that the effects of PM on mortality are spread over multiple days. And studies have shown that using a single day's PM as the measure of PM exposure can result in estimates that have a large negative bias. In this article, I introduce a new model for estimating the mortality effects of PM when only every-sixth-day PM data are available. This new model uses information available in the daily mortality time series to infer otherwise lost information about the effect of PM on mortality over a period of more than a single day. This new model typically offers an increase in both statistical estimation precision and accuracy compared with existing models.

Aged↗
PubMed1995

US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study.

OBJECTIVES: A large US sample was used to estimate the effects of race, employment status, income, education, occupation, marital status, and household size on mortality. METHODS: Approximately 530,000 persons 25 years of age or more were identified from selected Current Population Surveys between 1979 and 1985. These individuals were followed for mortality through use of the National Death Index for the years 1979 through 1989. RESULTS: Higher mortality was found in Blacks than in Whites less than 65 years of age; in persons not in the labor force, with lower incomes, with less education, and in service and other lower level occupations; and in persons not married and living alone. With occasional exceptions, in specific sex and age groups, these relationships were reduced but remained strong and statistically significant when each variable was adjusted for all of the other characteristics. The relationships were generally weaker in individuals 65 years of age or more. CONCLUSIONS: Employment status, income, education, occupation, race, and marital status have substantial net associations with mortality. This study identified segments of the population in need of public health attention and demonstrated the importance of including these variables in morbidity and mortality studies.

Adult↗
PubMed1997

Mortality and work conditions: a retrospective follow-up assessment of the effects of work conditions on the mortality of male employees in the manufacturing industry.

A retrospective follow-up study was conducted to investigate the effects of work conditions on mortality. Mortality rates among male employees aged 40-60 years in the Japanese steel industry were calculated for separate work condition factors, such as job site location (parent company or subsidiary company), job category (white-collar or blue-collar) and work schedule (day work or shift work). Odds ratios were calculated to evaluate the independent effects of work condition factors on mortality using a logistic regression method. Death certificates and demographic statistics, 1991-1995, from the annual personnel reports of the employees which had been compiled and preserved by the company, were utilized. There were 19,642 employees in April, 1991, and 171 deaths and 76,761.7 person-years were observed. No work condition factors were associated with the mortality rates. Selection bias was speculated from the findings. Since there is a thorough medical checkup system at this company, the employees identified with serious health problems would probably already have been excluded as potential candidates for transferring to subsidiaries or for work schedule changes. These findings and the interpretation were consistent with those of other reports which have been conducted in Japanese industrial fields. Mortality was not an appropriate indicator for assessing health risks in the occupational environment, but it reflects the real status of health care management. Through careful interpretation it has been suggested that there is a possibility that past health care work conditions activity can be accessed.

Adult↗
PubMed1995

Differential mortality in New York City (1988-1992). Part One: excess mortality among non-Hispanic blacks.

To determine the distribution of mortality for non-Hispanic blacks and non-Hispanic whites in New York City, death certificates issued in New York City during 1988 through 1992, and the relevant 1990 US census data for New York City, have been examined. Age-adjusted death rates for blacks and whites by gender and cause of death were computed based on the US population in 1940. Also, standard mortality ratios and excess mortality were calculated using the New York City mortality rate as reference. The results showed that New York City blacks had higher age-adjusted death rates than whites regardless of cause, including stroke, AIDS, homicide, and diabetes. The rate for New York City blacks was also higher than the US total for both genders. Using New York City mortality rates as a reference, more than 80% of excess deaths in blacks occurred before age 65. Injury/poisoning was the leading cause of excess death (20.1%) in black males, while in black females, cardiovascular disease was the largest single cause of excess deaths (24.8%). The higher death rates, especially premature death, of blacks in New York City are related to conditions such as violence, substance abuse, and AIDS, for which prevention rather than medical care is the more likely solution, as well as to cardiovascular diseases, where both prevention through behavioral change, and health and medical care, can influence outcome.

Black or African American↗
PubMed2001

The first mortality follow-up study: the 1841 Report of William Farr (physician) on the mortality of lunatics.

BACKGROUND: In the 1830s in England, there was a great cultural interest in the collection and publishing of all kinds of statistics. The Council of the Statistical Society of London (founded in 1834) commissioned one of its Fellows, Dr William Farr, to investigate and prepare a report on the mortality of patients in the county asylums, with the mortality in a large number of proprietary houses that were licensed to care for patients with mental illness (then called lunatics) ordered for confinement because of their mental condition. Committees of Parliament had investigated the condition of the mentally ill confined to the asylums and taken measures in an attempt to improve their treatment and to correct abuses. RESULTS: Farr collected data from Hanwell, the Middlesex County asylum opened in 1831, and other asylums on annual admissions, resident patients, deaths, discharges, derived years of residence (exposure to risk), and annual mortality rates by duration and as an aggregate. He used similar data from a recent report on a large number of licensed houses. For the best estimate of comparative mortality, an assumed age distribution by sex and rates from the English Life Table No. 1 (constructed by Farr for 1841). CONCLUSION: Farr demonstrated that annual mortality rates were higher at durations 0-1.5 years than at durations 1.5-7.5 years, higher in men than in women, higher in paupers than in other patients, higher in licensed houses than in the Hanwell Asylum, and higher in the 4 large licensed houses than in a collection of smaller ones. COMMENT: A brief sketch of Farr's life is given as a memorial tribute to his pioneer work in vital statistics, life table methodology, public health, and life insurance medicine.

Adolescent↗
PubMed1992

[Infant mortality and perinatal mortality in Poland in the eighties].

The dynamics of the changes in the level of infant mortality and perinatal mortality in Poland during 1980-89 by age and cause is presented. The statistical definitions concerning the perinatal period are used according to the World Health Organization's recommendations. There is stronger decline in postneonatal mortality rates then in neonatal rates during the eighties. The level of neonatal mortality rates (14.8 in 1989) and perinatal mortality rates (19.6 in 1989) is high comparing to the developed countries.

Humans↗
PubMed1991

[Problems of codification of cause of death: comparison of the mortality data of the ISTAT and the Regional Mortality Registry of Tuscany].

A two-part study was undertaken to assess the comparability of the coding of underlying cause of death between ISTAT (Central Statistics Office providing "national" mortality statistics) and RMR (Mortality Registry of Tuscany Region providing "local" mortality statistics). In Part I was compared mortality data of the Province of Florence (years 1985-1986) from the files of ISTAT with those of RMR. The source of the cause of death is the same for both systems (ISTAT certificate), but the data collection and coding of RMR are different from those of ISTAT. In Part II was compared a set of 219 Tuscany death certificates (year 1988) coded by ISTAT and RMR. The results showed an high degree of completeness of RMR (only--0.65% vs. ISTAT) and a satisfactory level of correspondence in the number of deaths for circulatory diseases, for neoplasms and for cancers of most important sites (lung, stomach, intestine, pancreas, breast). Discrepancies were found for some other diseases; for some of these causes of death, also age-adjusted mortality rates showed discrepancies (for example ischaemic heart disease). The cause of these differences have been analyzed.

Adolescent↗
PubMed1990

[Infant mortality and mortality in older children in the Czech and Moravian Regions in 1988].

The authors compare the present infant mortality in Czech and Moravian regions with the mortality in comparable areas after the First World War. Attention is drawn to the possibility of a wider, more objective evaluation of reproductive losses by an indicator where in the numerator are infant deaths, stillborn infants and aborted foetuses with a body weight of more than 500 g and in the denominator live born infant. The results of evaluations in regions according to these larger reproductive losses differ considerably from the evaluation according to infant mortality and the order of regions is also different. Finally, bases on the reports of regional specialists, the authors demonstrate interregional differences in the specific neonatal mortality by birth weight and differences in the post-perinatal mortality from some groups of diseases.

Czechoslovakia↗
PubMed1989

[Late mortality among small premature infants. Significance of respiratory distress and bronchopulmonary dysplasia for early and late mortality among infants with birth weights lower than 1,501 g].

We have studied neonatal and late mortality rates among children with a birthweight of less than 1.501 grams. The sample consisted of children admitted to the neonatal intensive care unit at the Dept. of Pediatrics in Trondheim during 1985 and 1986. 58 children were admitted, three of whom had lethal malformations (two triploids, one trisomi 18). Of the remaining 55 children, 12 died in the neonatal period. This gives a neonatal mortality rate of 21.8%, which is comparable with the results reported from other centers. However, six children died after the neonatal period, giving a late mortality rate of 10.9%. This is higher than reported in the literature. Most reports that we have been able to find are six to ten years old, and at that time the neonatal mortality rates were significantly higher. Five of the six children who died late had bronchopulmonary dysplasia. The sixth child suffered a sudden infant death. The incidence of bronchopulmonary dysplasia was 27.2%, which is comparable with the incidence reported in the literature. The present study clearly shows the importance of taking late mortality rates into consideration when evaluating neonatal care.

Birth Weight↗
PubMed1983

Mortality and social class in New Zealand. I: overall male mortality.

Social class differences in New Zealand male mortality are investigated using two different systems of social class classification. In each case it is found that the lower social classes have mortality rates significantly higher than those of the upper social classes with the mortality rate of the lowest class being approximately twice that of the highest class on a six-category scale. The relative risk is higher in the younger age-groups. When the British Registrar-General's scale is used New Zealand exhibits a social class mortality gradient similar to that previously found in England and Wales, but the lowest social class experiences a particularly high mortality rate.

Adolescent↗
PubMed1995

[Mortality of workers in the dye industry. I. Analysis of general mortality].

A mortality study was carried out among workers employed in a plant producing different kinds of dyes using benzidine. The cohort comprised 8,523 males and 2,006 females whose vital status was recorded between Jan 1, 1945 and Dec 31, 1991. They had worked in this plant for, at least, 3 months between Jan 1, 1945 and Dec 31, 1974. The cohort was divided into 4 subcohorts: I. those exposed only to benzidine; II. those exposed to benzidine and to other occupational hazards; III. those involved directly in the dyes production but not exposed to benzidine, and IV. those not involved directly in the dye production-mainly administrative staff. Death risk was estimated on the basis of standardized mortality ratio (SMR), determined by means of the person-years method. The general population of Poland was taken as a reference group. The observed number of deaths in the cohort and each subcohort was compared with expected deaths. The comparison was based on the national rates by adjustment for age, gender and calendar time. An excessive mortality due to mental disorders (SMR = 2.37) was found in the male cohort, and due to atherosclerosis in both cohorts--male (SMR = 1.25) and female (SMR = 1.37). An analysis of mortality in subcohorts showed similar but not the same relationship. Mortality because of malignant neoplasms will be presented in the next paper.

Adult↗
PubMed1988

The infant mortality rate, life expectancy at birth, and a linear index of mortality as measures of general health status.

The infant mortality rate is not a good indicator of overall mortality or health status. Based on new empirical life tables from the UN Population Division, it can only predict life expectancy with 95% confidence to within a 14-year range. Two infant mortality rates must be nearly 80 units apart to be 95% confident that life expectancy in the two communities is different. Life expectancy itself is not an ideal general measure of mortality, because it implicitly weights deaths at different ages in an inconsistent fashion. A measure of potential years of life lost is preferable because it is ethically more consistent.

Adolescent↗
PubMed1985

Mortality in a follow-up of 500 psychiatric outpatients. I. Total mortality.

Total or all-cause mortality data were determined from a prospective study of 500 randomly selected psychiatric outpatients during a mean follow-up period of seven years. With the use of age-, sex-, and race-adjusted methods, a mortality nearly twice that expected from reference population rates was observed. Mortality was excessive among younger, but not older, patients; and among white men and women and black men, but not among black women. Certain psychiatric diagnoses (based on structured personal interviews performed at index and using explicit criteria) were associated with excess mortality: alcoholism, antisocial personality, drug addiction, homosexuality, organic brain syndrome, and schizophrenia. Excess mortality was not observed among patients with primary affective disorders, ie, disorders not antedated by nonaffective psychiatric illness.

Adolescent↗
PubMed2000

Intravenous indomethacin for preventing mortality and morbidity in very low birth weight infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: Indomethacin is used to treat symptomatic patent ductus arteriosus and may prevent or limit intraventricular haemorrhage in the neonatal period. This review examines the effectiveness of prophylactic intravenous indomethacin in reducing the mortality and morbidity associated with these conditions in infants weighing less than 1750 grams at birth. SEARCH STRATEGY: A literature search from January 1980 to October 1994 was made in three computerised data bases: Medline; Embase; and the Oxford Database of Perinatal Trials. The search was updated in February 1997. SELECTION CRITERIA: Strict selection criteria were applied to clinical trials: the population had to be newborn infants of birth weight < 1751 grams; the intervention had to be prophylactic intravenous indomethacin; the trial had to be randomised and controlled; and at least one of several prespecified outcomes had to be reported in the results. DATA COLLECTION AND ANALYSIS: The methodological quality of each study was assessed using explicit criteria. Data on relevant outcome measures were extracted on two separate occasions and, where appropriate, the results of individual trials were combined using meta-analysis techniques to provide a pooled estimate of effect. MAIN RESULTS: There is a trend towards reduced neonatal mortality in infants receiving prophylactic indomethacin, pooled relative risk (RR) = 0. 85 [95% CI 0.66 to 1.09]. The incidence of symptomatic patent ductus arteriosus is significantly reduced in treated infants, pooled RR = 0.35 [0.26 to 0.47] but there is no evidence that treatment affects respiratory outcomes. Prophylactic indomethacin significantly reduces the incidence of Grade 3 and 4 intraventricular haemorrhage in treated infants, pooled RR = 0.60 [0.43 to 0.83]. There is no evidence to suggest prophylactic indomethacin is associated with any long term adverse effect although there is a trend in treated infants towards an increased incidence of necrotizing enterocolitis, and some evidence that treatment may transiently impair renal function. There is no evidence that haemostasis is disturbed. REVIEWER'S CONCLUSIONS: Prophylactic treatment with indomethacin has a number of immediate benefits, in particular a reduction in symptomatic patent ductus arteriosus and severe intraventricular haemorrhage. There is no evidence at present of long-term harm. Further trials are needed to assess more precisely the effects, both beneficial and harmful, on short and long-term outcomes.

Cardiovascular Agents↗
PubMed1991

Longitudinal Gompertzian analysis of stomach cancer mortality in the U.S., 1962-1987: a thermodynamic analogy of its declining mortality.

Age-adjusted mortality rates for stomach cancer (SC) in the United States from 1962 to 1987 were subjected to longitudinal Gompertzian analysis. Age-adjusted SC mortality rate distributions between age 50 and 85 years were highly Gompertzian for each and every year for both men and women. The environmental 'temperature' or intensity factor declined (improved) 1.55-fold for men and 2.04-fold for women in 1987 as compared to 1962. If the environmental 'pressure' or frequency factor had remained constant, the age at the theoretical common intersect point would have been 56.0 years for men and 80.0 years for women and overall SC mortality would have increased. However, between 1962 and 1987, non-age-standardized annual crude SC mortality rates decreased 46.8% for men and 44.0% for women. The thermodynamic analogy for this apparent discrepancy is that the environmental 'pressure' factor has not remained constant, but rather declined 51.7% for men and 60.9% for women between 1962 and 1987. This suggests that the overall frequency of environmental challenges that contribute to SC mortality has become significantly reduced.

Age Factors↗
PubMed1992

Longitudinal Gompertzian analysis of cervical cancer mortality in the US, 1962-1987: a method of quantitatively demonstrating changing environmental influences upon deterministic mortality dynamics.

Age-specific mortality rates for cervical cancer (CC) in the United States from 1962 through 1987 were subjected to longitudinal Gompertzian analysis. Age-specific CC mortality rate distributions for women display two distinct Gompertzian slopes, one between age 20 and 35 years and the other between age 40 and 85 years. These two distinct Gompertzian regions suggest that CC may be clinically and biologically classified into pre- and postmenopausal varieties, similar to breast cancer. Between 1962 and 1987, the annual crude CC mortality rate declined 60.0%. The basis for the decline of CC mortality is shown to be that aggregate environmental (etiopathogenic) influences upon premenopausal CC age-specific mortality rate distributions decreased 57.8%, and upon postmenopausal CC, decreased 28.0%.

Adult↗
PubMed1993

Longitudinal Gompertzian analysis of non-Hodgkin's lymphoma mortality in the US, 1979-1988: demonstration of the environmental basis for rising overall mortality.

Between 1979 and 1988, annual crude non-Hodgkin's lymphoma mortality rates (per 100,000) in the United States increased from 3.43 to 6.34 among men (an 85% increase in only 10 years) and, among women, increased from 2.82 to 5.71 (a 102% increase). Age-specific mortality rates for non-Hodgkin's lymphoma from 1979 through 1988 were subjected to longitudinal Gompertzian analysis, a method that may be able to identify and distinguish among genetic, environmental and competitive influences upon evolving mortality trends. The results of this analysis suggest that the basis for the dramatic rise in non-Hodgkin's lymphoma mortality is due to worsening environmental influences. The capability to distinguish between environmental and competitive influences upon evolving mortality patterns has significant public health policy implications.

Adolescent↗
PubMed1995

A mortality kinetics approach to characterizing the fractionated exposure-mortality response relationship of radon progeny.

The utility of mortality kinetics analysis in evaluating mortality data from fractionated exposure studies was demonstrated using radon-progeny induced extra mortality as an example. Gompertz (log-hazard) functions were used to characterize the mortality of male SPF Wistar rats exposed to radon progeny at 100 WL and 1000 WL for total exposures ranging from 20 to 10,240 WLM. There was an upward parallel displacement of the Gompertz functions following the period of radon exposure. The shape of the Gompertz functions for the exposed animals was consistent with a Gompertz model of toxicity resulting from short-term exposure, resulting in non-repaired injury that summates with natural (aging) injury. The parallel upward displacements (epsilon ss) of the Gompertz functions showed an unexpected non-monotonic pattern for rats exposed at 1000 WL. The parallel upward displacements showed a sharp upward increase from 320 to 640 WLM, fell at 1280 WLM, and thereafter increased linearly to 10,240 WLM. These data suggest that the radon progeny exposure-mortality response is non-linear. In contrast, there was no significant parallel upward displacement of the Gompertz functions for rats exposed at 100 WL for total exposures of 20-1280 WLM, but a large displacement began at 2560 WLM total exposure.

Animals↗