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PubMed2003

Race, Hispanic origin, and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults.

Black and Hispanic adults travel less in motor vehicles than whites but may be at greater risk when they do travel. Passenger vehicle occupant deaths per 10 million trips among persons ages 25-64 were computed by race, Hispanic origin, gender, and socioeconomic status (SES) using 1995 data from the Fatality Analysis Reporting System (FARS) and Nationwide Personal Transportation Survey. Educational level was used as the indicator of SES. Blacks, particularly black men, were at increased risk of dying relative to whites when traveling in motor vehicles (rate ratio (RR) for black men=1.48; 95% confidence interval (CI)=1.42-1.54). Hispanic men, but not Hispanic women, also had elevated occupant death rates, but their risk was less than that of black men (RR=1.26; 95% CI=1.20-1.31). SES was the strongest determinant of occupant deaths per unit of travel; RRs among those who had not completed high school were 3.52 (95% CI=3.39-3.65) for men and 2.79 (95% CI=2.69-2.91) for women, respectively. Whites without high school degrees had the highest death rates per 10 million trips. After adjustment for SES, the elevated risk of occupant fatalities persisted among black men and women, but not among Hispanic men. Seat belt use and alcohol-impaired driving were examined among fatally injured passenger vehicle drivers. Among those with no education beyond high school, higher percentages were reported as having high blood alcohol concentrations (BACs) or having not used belts. Reported belt use rates were lower among black men and women, even after controlling for SES, whereas Hispanic men and women had belt use rates similar to those of whites. High BACs were more common among Hispanic men, which appeared largely to be an effect of SES because most Hispanic men killed in crashes had not completed high school, the education level with the highest percentage that drove while impaired by alcohol. More effective public health efforts are needed to reduce occupant deaths among persons of lower SES, blacks, and Hispanics, including measures to increase use of seat belts and reduce alcohol-impaired driving.

Accidents, Traffic↗
PubMed1992

Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years.

OBJECTIVE: To evaluate the efficacy of annual mammography over and above annual physical examination of the breasts and the teaching of breast self-examination among women aged 50 to 59 on entry. DESIGN: Individually randomized controlled trial. SETTING: Fifteen urban centres in Canada with expertise in the diagnosis and treatment of breast cancer. PARTICIPANTS: Women with no history of breast cancer and no mammography in the previous 12 months were randomly assigned to undergo either annual mammography and physical examination (MP group) or annual physical examination only (PO group). The 39,405 women enrolled from January 1980 through March 1985 were followed for a mean of 8.3 years. DATA COLLECTION: Derived from the participants by initial and annual self-administered questionnaires, from the screening examinations, from the patients' physicians, from the provincial cancer registries and by record linkage to the Canadian National Mortality Data Base. Expert panels evaluated histologic and death data. MAIN OUTCOME MEASURES: Rates of referral from screening, rates of detection of breast cancer from screening and from community care, nodal status, tumour size and rates of death from all causes and from breast cancer. RESULTS: Over 85% of the women in each group attended the screening sessions after screen 1. The characteristics of the women in the two groups were similar. Compared with the Canadian population the participants were more likely to be married, have fewer children, have more education, be in a professional occupation, smoke less and have been born in North America. The rate of screen-detected breast cancer on first examination was 7.20 per 1000 in the MP group and 3.45 per 1000 in the PO group, more node-positive tumours were found in the MP group than in the PO group. At subsequent screens the detection rates were a little less than half the rates at screen 1. During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.28 in the MP group and 1.18 in the PO group. Of the women with invasive breast cancer through to 7 years, 217 in the MP group and 184 in the PO group had no node involvement, 66 and 56 had one to three nodes involved, 32 and 34 had four or more nodes involved, and 55 and 46 had an unknown nodal status. There were 38 deaths from breast cancer in the MP group and 39 in the PO group. The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 0.97 (95% confidence interval 0.62 to 1.52). The survival rates were similar in the two groups. Women whose cancer had been detected by mammography alone had the highest survival rate. CONCLUSION: The study was internally valid, and there was no evidence of randomization bias. Screening with yearly mammography in addition to physical examination of the breasts detected considerably more node-negative, small tumours than screening with physical examination alone, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.

Breast Neoplasms↗
PubMed1998

Trends in ischemic heart disease death rates for blacks and whites--United States, 1981-1995.

During 1995, ischemic heart disease (IHD) caused 21% of all deaths and 65% of deaths attributed to heart disease. Few reports comparing IHD mortality between blacks and whites have presented age-specific rates, and none have compared trends over time. This report examines the trend in age-specific IHD death rates for blacks and whites from 1981 through 1995 (the latest year for which data are available) and indicates that, in the younger age groups (35-64 years), blacks have a higher risk for IHD death than whites.

Adult↗
PubMed1998

Intra-urban differentials in death rates from homicide in the city of São Paulo, Brazil, 1988-1994.

The objective of this research was to analyze the relationship between socioeconomic statistics and homicide mortality rates in the city of São Paulo between 1988 and 1994. City districts were grouped into five geographic areas. A socioeconomic indicator (ISE) was constructed with census information combining average income of the family head, illiteracy rate for the population over 5 yr of age, average number of rooms and number of persons per household. The higher the score, the better the socioeconomic situation (possible values: 4 to 384). Deaths from homicide were grouped by residential areas, and the rates for these areas were calculated. The association between homicide rates and the socioeconomic situation was analyzed with Spearman correlation coefficients. Average ISE scores varied from 291 in the Central area (homicide rate = 27.96 deaths per 100000) to 119.9 in the East area (homicide rate = 40.38). The Spearman coefficient between ISEs and homicide rates was -0.98 (p < 0.05). Due to the heterogeneity inside the areas, the median ISE is a better indicator of the socioeconomic conditions yielding an rs = -1.0. Almost half the population resides in areas with the highest risk of homicide mortality (East and South). Taking the Central area as a reference, we found risks of 1.36 in the Western, 1.37 in the Northern, 1.44 in the Eastern and 2.67 in the Southern areas.

Brazil↗
PubMed2000

Seasonal variation in asthma hospitalizations and death rates in New Zealand.

OBJECTIVE: The aim of this study was to determine if there is a seasonal pattern to asthma hospitalizations and mortality in New Zealand. METHODOLOGY: Data for an 18-20 year period were obtained for the whole of New Zealand regarding the number of asthma deaths and hospital discharges in each month, as well as annual population totals (1978-1995 for asthma hospitalizations, 1976-1995 for asthma deaths). Monthly mortality and hospital discharge rates were calculated for the age groups 5-14, 15-44, and those aged 45 years and older. Variation about the mean monthly rates was plotted along a linear timescale to observe the seasonal trend. RESULTS: In the oldest age group (45+), asthma mortality and hospitalization rates peaked in the winter months (July/August). Among the younger age groups, however, mortality and hospitalizations showed different seasonal patterns; peak hospitalization occurred in the early winter months, with peak mortality in the early summer months. CONCLUSIONS: Seasonal variations in the asthma hospitalization and death rates in New Zealand are similar to those from the Northern Hemisphere. The peak mortality in summer for the younger age groups is paralleled by a reduction in hospitalizations in this period, indicating that the increase in mortality may be due to problems of access to medical care.

Adolescent↗
PubMed2006

Effects of travel distance and the season of the year on death rates of broilers transported to poultry processing plants.

Death losses among broilers transported to processing plants are caused by poor welfare. The number of birds dying during transport and in processing plants shortly after arrival there may serve as an indicator of the quality of welfare during loading and transport. In the Czech Republic, shipments of broilers to processing plants were monitored from 1997 to 2004. It was found that the mortality of broilers during transport was 0.247%, but it varied according to the transport distance to the processing plant from 0.146% (50 km maximum) to 0.862% (>300 km). The broiler mortality in transit was also influenced by the season of the year. The highest mortality was found in summer months, especially in June, July, and August, and in winter months, especially in December, January, and February. A comparison between period 1 (1997 to 2000) and period 2 (2001 to 2004) showed a long-term adverse trend in the number of broilers dying during transport to processing plants for all of the distances monitored (except transport distances <50 km), because the overall number of dead birds on arrival to processing plants increased from 0.224 to 0.265% (index of 1.18). This difference is statistically significant (P = 0.000). The stress caused to broilers by transport to processing plants is reflected in higher transport-related mortality of the birds. Long-term trends point to an increase in death losses of broilers. Longer transport distances and transportation in summer and winter months have led to an increase in death losses among broilers transported to processing plants.

Abattoirs↗
PubMedDate not supplied

Project MotherCare: one hospital's response to the high perinatal death rate in New Haven, CT.

Starling national statistics indicate that New Haven, CT, is the seventh poorest city of its size, in terms of per capita income, in the United States. In 1989, it was reported to have the highest rate of infant mortality--18.5 infant deaths per 1,000 live birth--in the nation for a city with more than 100,000 people. Seventy-five percent of all perinatal deaths are attributed to low birth weight infants. Adequate prenatal care is a proven means of reducing this risk. To further compound the problem, substance abuse among pregnant women has increased dramatically. Census tract data revealed that many of the infant deaths were localized to several well-defined areas of the city. Forty-four percent of the infant deaths were ascribed to extreme immaturity or other causes related to low birth weight. Approximately 21 percent of the pregnant population had either no prenatal care or care was begun late--after the first trimester. The traditional avenues for prenatal care have been ineffective; an innovative approach, one that can be replicated, was initiated. The Hospital of Saint Raphael's "Project MotherCare" embarked on an initiative to address these problems by reducing the access barriers to prenatal care regardless of insurance status or ability to pay. The mission was twofold: (a) to bring prenatal care to underserved neighborhoods of New Haven and (b) to identify the substance-abusing pregnant woman and deliver a continuum of services including prenatal care, counseling, social services, and referral to a drug treatment program. Community need caused the program to expand beyond prenatal services and provide additional primary care services to other residents of these neighborhoods.

Adult↗
PubMed2004

SES discrepancies and Delaware cancer death rates.

Cancer can be monitored fairly effectively by using cancer registry data for site, stage, age, sex, and race. Adding to this the patient's years of education, now only found on death certificates, should not be difficult since it is an easily measured major SES factor. Most comorbidities should also be easy to obtain since hospitals usually code them. Capturing all treatment and response data remains a challenge as more and more cancer diagnosis and management is done in outpatient settings. Current efforts to establish electronic medical records in compliance with the Health Insurance Portability and Accountability Act (HIPAA) may be a blessing if adequate software can be standardized and used similar to that already present in the VA hospital in Delaware. Such information would aid efforts to reduce Delaware's high cancer incidence and mortality rates. A proposed state cancer plan should stimulate improved integration of the state's health resources to focus on the quality of individual health care and to use cost-effective measures to improve the public's health. A plan should (1) stimulate a public awareness to reduce risk factors for all major chronic diseases with a special focus on cancer deaths; (2) use medical office settings to provide simple screens to improve the early detection of a number of chronic diseases depending on such risks as age and sex (such studies might include weight, height, blood pressure, sugar, cholesterol, PSAs, exams of skin, oral cavities, breasts, abdomen, rectum, and vagina with pap smears, all of which can be accomplished in a cost-effective fashion); and (3) offer equitable access to a state's health care system for information, screening, and treatment. Current evidence shows that it is less expensive to manage patients with early cancers than those with advanced cases, which often occur because of ignorance and lack of access to health services, and by socioeconomic, educational, and cultural barriers. Implementing the recommendations in the Governor's Advisory Council's report should go a long way toward reducing both Delaware's cancer incidence and death rates. An increase in taxes on tobacco (one of the Council's recommendations) could provide resources to explore relationships between the environment, occupation, and cancer, and provide early access to competent cancer care for those at risk because of limited education, income, and health insurance.

Delaware↗
PubMed1992

The impact of prenatal care on fetal and neonatal death rates for uninsured patients: a "natural experiment" in West Virginia.

A three-county program in southern West Virginia was developed by an obstetric practice to deliver prenatal care to a population of uninsured patients. Between January 1984 and December 1986, 1331 (29.4%) of 4534 patients were delivered at a level 2 hospital after prenatal care within the clinic program. The hospital-wide fetal death ratio declined from 11.8 to 7.2 per 1000 live births during the years of clinic operation, a statistically significant reduction (P = .02). Uninsured patients experienced a statistically significant reduction in fetal death ratio during the program, from 35.4 to 7.0 per 1000 live births (P = .02), whereas those covered by medical assistance did not experience a reduction. Privately insured patients also had a significant decrease, from 10.0 to 3.1 per 1000 live births (P less than .001). The increasing operating expense, mainly due to rising malpractice insurance premiums, required suspension of the program in December 1986. The fetal death ratio returned to 10.3 deaths per 1000 live births in 1987. Factors that varied significantly during the "clinic" phase included: higher rates of cesarean, diagnosed maternal hypertension, and diabetes mellitus; and lower rates of premature rupture of membranes and non-white population. Other factors, including age over 35 years, postdatism, incidence of twins, incidence of lethal congenital anomalies, and single marital status, did not vary significantly before, during, or after the clinic program. This study identified a high-risk population of patients who did not qualify for medical assistance coverage and were de facto "uninsured." The results suggest that prenatal care for this high-risk population of uninsured patients can reduce the fetal death rate.

Female↗
PubMed1987

Death rates from diabetes mellitus in Ireland 1833-1983: a historical commentary.

A world-wide increase in diabetic deaths and a varying rate of increase between one country and another over the past hundred years has long been recognised. During the nineteenth century, the incidence of diabetes was low in Ireland as measured by mortality. Nevertheless, the rising trend found elsewhere was also apparent in Ireland. Recorded deaths were 0.22/100,000 of the population in 1840, rising to 13.2 by 1972. Most of the increase occurred between the 1880s and 1911, but only 15% of this can be accounted for by an ageing population. It is, therefore, necessary to seek other explanations. During the period, sugar and fat consumption in Ireland rose sharply. It has not been possible precisely to relate dietary causes to the incidence of diabetes, but the Irish experience suggests that such a link may exist.

Diabetes Mellitus↗
PubMed1995

Pneumonia and influenza death rates--United States, 1979-1994.

The combined cause-of-death category pneumonia and influenza (P&I) (International Classification of Diseases, Ninth Revision, codes 480-487) ranks as the sixth leading cause of death in the United States following heart disease, cancer, stroke, unintentional injuries, and chronic obstructive pulmonary disease. Changes in the epidemiology of Streptococcus pneumoniae and other recognized respiratory pathogens, the increasing occurrence of drug-resistant microorganisms, and the detection of new respiratory pathogens have heightened awareness of the public health importance of severe respiratory infections. To characterize the epidemiology of P&I deaths in the United States, CDC further analyzed underlying and multiple cause-of-death mortality files for 1979-1994. This report summarizes the results of this analysis.

Adult↗