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Death rates and causes of death in cohorts of serum hepatitis patients followed up for more than 20 years.

A cohort of 214 drug addicts with serum hepatitis and a cohort of 193 hepatitis patients without drug addiction were examined in respect of death rates, causes of death and a number of risk factors for reduced survival. The death rate was significantly higher among the drug addicts than among non-addicts. The annual mortality rate was 1.5% in the drug addict group and 0.7% in the non-addict group. The highest relative risk of death was 860 for female drug addicts in age group 15-24 compared to females of the same age in the general population. The most prevalent cause of death in the drug addict group was drug overdose (53%), whereas in the other group 66% died from various somatic diseases. Hepatitis or complications of viral hepatitis played no role as cause of death among the drug addicts, and infections as a whole were also responsible for very few deaths. For male drug addicts, imprisonment before admission and leaving hospital without the doctors' permission were risk factors for early death.

Adolescent↗

Adverse mortality experience of a southwestern American Indian community: overall death rates and underlying causes of death in Pima Indians.

As part of an ongoing epidemiologic study, the death rate and causes of death during 1975 through 1984 were determined in Pima Indians who resided in the Gila River Indian Community (GRIC) in 1965 and later. Death certificates were available for 677 of the 681 deaths. In 78% of the deaths, the underlying cause recorded on the death certificate agreed with the cause determined after review of all available relevant records. The age- and sex-adjusted average annual death rate for the GRIC population (1639/100,000) was 1.9 times (95% CI 1.7-2.0) the 1980 rate for the U.S. all races (878/100,000). In Pima males, whose death rate was substantially higher than that of Pima females, the age-adjusted death rate was 2.3 times that in U.S. males, all races. Moreover among males 25-34 years of age, the Pima death rate was 6.6 times that for the U.S. all races. Diseases of the heart and malignant neoplasms caused 59% of U.S. deaths in 1980, but only 19% of GRIC deaths. By contrast, the age- and sex-adjusted mortality rate in the GRIC Pima was 5.9 times the rate of the U.S. all races for accidents, 6.5 times for cirrhosis, 7.4 times for homicide, 4.3 times for suicide, and 11.9 times for diabetes. Tuberculosis and coccidioidomycosis were important causes of death in the Pima, for whom infectious diseases was the tenth leading cause of death. The findings indicate that programs to improve the adverse mortality experience of the GRIC population should emphasize factors related to fatal accidents, alcoholic cirrhosis, homicide, suicide, diabetes mellitus, and infectious diseases. Young Pimas, especially the males, should be the primary focus of such preventive efforts. These findings and recommendations probably apply to many Native American populations.

Accidents↗

Trends in pulmonary embolism death rates for Canada and the United States, 1962-87.

To investigate the effect of advances in the prevention and treatment of pulmonary embolism, we examined the rates of death from pulmonary embolism in Canada for 1965-87 and compared them with those for the United States for 1962-84. The direct method of age standardization was used on sex-specific and age-specific death rates, with the 1960 US population as the standard. In both countries the death rates increased then decreased, although the changes in the Canadian rates occurred later and were less pronounced than those in the US rates. Men and elderly people were at higher risk of death from pulmonary embolism than women and younger people. Prevention strategies, possibly including encouraging a more active lifestyle and targetting high-risk groups, may further reduce pulmonary embolism death rates in both countries.

Adolescent↗

Deaths from injury in children and employment status in family: analysis of trends in class specific death rates.

OBJECTIVE: To examine socioeconomic inequalities in rates of death from injury in children in England and Wales. DESIGN: Analysis of rates of death from injury in children by the eight class version of the National Statistics Socio-Economic Classification (NS-SEC) and by the registrar general's social classification. SETTING: England and Wales during periods of four years around the 1981, 1991, and 2001 censuses. SUBJECTS: Children aged 0-15 years. MAIN OUTCOME MEASURES: Death rates from injury and poisoning. RESULTS: Rates of death from injury in children fell from 11.1 deaths (95% confidence interval 10.8 to 11.5 deaths) per 100,000 children per year around the 1981 census to 4.0 deaths (3.8 to 4.2 deaths) per 100,000 children per year around the 2001 census. Socioeconomic inequalities remain: the death rate from all external causes for children of parents classified as never having worked or as long term unemployed (NS-SEC 8) was 13.1 (10.3 to 16.5) times that for children in NS-SEC 1(higher managerial/professional occupations). For deaths as pedestrians the rate in NS-SEC 8 was 20.6 (10.6 to 39.9) times higher than in NS-SEC 1; for deaths as cyclists it was 27.5 (6.4 to 118.2) times higher; for deaths due to fires it was 37.7 (11.6 to 121.9) times higher; and for deaths of undetermined intent it was 32.6 (15.8 to 67.2) times higher. CONCLUSIONS: Overall rates of death from injury and poisoning in children have fallen in England and Wales over the past 20 years, except for rates in children in families in which no adult is in paid employment. Serious inequalities in injury death rates remain, particularly for pedestrians, cyclists, house fires, and deaths of undetermined intent.

Adolescent↗

Death rates and causes of death among children and youth in Göteborg, Sweden 1971-85. Indicators for public health work in a city.

Among children and youth in Göteborg, Sweden, the death rate per 100,000 children decreased from 32 in 1971-75 to 24 in 1981-85 and in youth from 76 to 54. Accidents and human violence together with tumours and congenital malformations remained the most important causes of death in children, together accounting for 2/3 of all deaths. A marked decrease in traffic accident deaths among children and young people is an encouraging result of prevention. Among young people human violence (mainly suicide) emerged as the most important cause of death relative to other causes of death. Alcohol-related mortality was also a notable cause of death in this age group. Preventive measures directed against human violence and alcohol-related mortality should be the subject of consistent and sustained committment to action comparable to that applied over many years to traffic accidents.

Accidents↗

Helmet laws and motorcycle rider death rates.

We investigated motorcycle rider death rates between states with full motorcycle helmet laws and those without. This was done using both unadjusted bivariate analyses and multivariate random-effects generalized least squares regression models of rider death rates. Multivariate models were adjusted for the competing influences of several explanatory variables, including the existence of a motorcycle helmet law. From 1994 to 1996, states with helmet laws experienced a median death rate of 6.20 riders per 10000 registered motorcycles and states without helmet laws experienced a median death rate of 5.07 riders per 10000 registered motorcycles (P = 0.008). After controlling for other factors that affect motorcycle rider fatalities (most notably population density and temperature), death rates in states with full helmet laws were shown to be lower on average than deaths rates in states without full helmet laws (P = 0.740). Our study weakens the claim that rider death rates are significantly lower in states without full motorcycle helmet laws.

Accidents, Traffic↗

Environment, temperature and death rates.

Analysis of recorded monthly deaths in England and Wales shows a close association of death rates with external temperature in most diseases other than the cancers. Analysis of daily deaths in England and Wales and in New York shows the following relationships between temperature and deaths from myocardial infarction, strokes and pneumonia. Between -10 degrees and +20 degrees C mimimum temperature there is a nearly linear fall in deaths as the temperature rises. Above 20 degrees C deaths rise steeply as the temperature rises and below -10 degrees C rise steeply as temperature falls. These associations of deaths with temperature are much stronger in the elderly than in younger subjects. Detailed analysis of the daily deaths in England and Wales from myocardial infarction, strokes and pneumonia show that short-term (1--2 days) temperature changes have little effect on death rates but medium-term (7--10 days) and longer-term (three or more weeks) changes associated with very significant changes in death rates. The three diseases vary in the time relations between temperature change and change in death rates. In all three there is an interval between the change in temperature and death and this is shortest in the case of myocardial infarction (1--2 days before death), longest in the case of pneumonia (about a week before death) and intermediate in the case of strokes (about 3--4 days before death). At low temperatures death rates increase as the duration of temperature change increases, while at high temperatures (but below +20 degrees C) death rates decrease as the period of temperature change is longer. The implications of these findings are discussed and it is postulated that there is probably causal relationship between temperature change and deaths from a wide variety of diseases. A proximal link in the chain is probably a failure of autonomic control of body temperature in the elderly leading to a change in body temperature and some humoral change which in turn leads to death. It is not appropriate to concentrate on hypothermia as the relationship between temperature and death is seen at all temperatures.

Age Factors↗

The changing patterns of death rates in parkinsonism.

Annual crude death rates due to parkinsonism in Denmark, 1956 to 1985, and the United States, 1950 to 1984, showed a consistent hierarchy, with white male rates greater than white female than black male than black female. Rates rose sharply in both lands and sexes between 1976 and 1984. Age-specific death rate curves for whites in the 1960s and 1980s were very similar between the countries with a regular male excess. Both countries drastically changed the configuration of all the death rate age curves in parallel fashion between the 2 periods: rates were now nearly twice those of the earlier interval for each sex, age, and race, and were then maximal at age 82 or 85+ as opposed to the prior peak at age 77 or 80. Age-adjusted rates did not consistently reflect this change, being markedly lower for US white females despite their age-specific rate increases. This discrepancy appears to be an artifact of changing population distributions which increasingly differ by age between sexes and countries over time. When the recent age-specific death rates were recalculated with the thesis that all deaths had occurred at ages 5 years younger, all the 1980s death rate configurations returned to those of the 1960s, with but modest increases at most ages. This is evidence that age at death, and thus survival, has increased at all ages by about 5 years since the introduction of levodopa, released in the US in 1970 and in Denmark in 1971.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

U.S. congressional district cancer death rates.

BACKGROUND: Geographic patterns of cancer death rates in the U.S. have customarily been presented by county or aggregated into state economic or health service areas. Herein, we present the geographic patterns of cancer death rates in the U.S. by congressional district. Many congressional districts do not follow state or county boundaries. However, counties are the smallest geographical units for which death rates are available. Thus, a method based on the hierarchical relationship of census geographic units was developed to estimate age-adjusted death rates for congressional districts using data obtained at county level. These rates may be useful in communicating to legislators and policy makers about the cancer burden and potential impact of cancer control in their jurisdictions. RESULTS: Mortality data were obtained from the National Center for Health Statistics (NCHS) for 1990-2001 for 50 states, the District of Columbia, and all counties. We computed annual average age-adjusted death rates for all cancer sites combined, the four major cancers (lung and bronchus, prostate, female breast, and colorectal cancer) and cervical cancer. Cancer death rates varied widely across congressional districts for all cancer sites combined, for the four major cancers, and for cervical cancer. When examined at the national level, broad patterns of mortality by sex, race and region were generally similar with those previously observed based on county and state economic area. CONCLUSION: We developed a method to generate cancer death rates by congressional district using county-level mortality data. Characterizing the cancer burden by congressional district may be useful in promoting cancer control and prevention programs, and persuading legislators to enact new cancer control programs and/or strengthening existing ones. The method can be applied to state legislative districts and other analyses that involve data aggregation from different geographic units.

Age Distribution↗

Historical changes in motor vehicle death rates among the elderly.

Motor vehicle death rates among the elderly decreased substantially between 1940 and 1980, while the number of registered motor vehicles in the United States increased fourfold and death rates from motor vehicle injury changed little for the entire population. The annual death rate per 100,000 males aged 75-79 declined from 120 in 1940 to 41 in 1980. Much of the decrease can be attributed to reduced pedestrian deaths. Rates for other elderly age and sex groups showed similar patterns but the rates were lower and the changes smaller. Displaying age-specific motor vehicle death rates by birth cohort provides a graphic demonstration that these death rates have decreased markedly for all age groups 60 and older. Implications and possible causes of this decrease are discussed.

Accidents, Traffic↗

Unintentional injury death rates in rural Appalachia.

Rural unintentional injury (UI) death rates are higher than rates for urban regions. Our trauma center serves 49 rural Appalachian (AP) counties in a 120-county rural state. We investigated the impact of prehospital and hospital resources on UI death rates in our referral area. Age-adjusted and average age- and sex-specific UI death rates from 1979-1985 were compared among 49 rural AP counties, the 71 non-Appalachian (NAP) counties, and the United States. Counties were grouped for comparisons by level of prehospital care (Advanced Life Support [ALS] vs. Basic Life Support [BLS]) and by presence (H) or absence (NH) of a hospital. Death rates were calculated using data from the 1980 population census, the National Center for Health Statistics (NCHS), and state vital statistics. Within AP, all 49 counties have ambulance service. Only 9/49 (18%) have ALS service and 13/49 (26%) have no hospital. Age-specific AP rates were higher than NAP and US rates in the 25-44 and 45-64 year age groups. AP death rates were highest for BLS and NH counties across all age groups. Rural UI death rates in the region remain unacceptably high. The reason(s) that AP death rates exceed the NAP rates is uncertain. ALS service and an available hospital were associated with lower death rates. We propose both educational and epidemiologic programs to better identify and define additional problems.

Adult↗

Lung cancer rates as an index of tobacco smoke exposures: validation against black male approximate non-lung cancer death rates, 1969-2000.

BACKGROUND: Researchers use lung cancer death rates (rates) as an index of the cumulative burdens of smoking. That index lacks direct validation and calibration. So this study directly validates and calibrates that index against annual approximately non-lung (all-sites minus lung and stomach) rates from 1969 to 2000 in United States black men, then estimates their cancer death rate smoking-attributable fractions (SAFs). METHODS: This study uses linear regression, age-adjusted rates from http://www.seer.cancer.gov/canques, and the formula SAF = (1- ((rate in the unexposed) / (rate in the exposed))). Estimated rates in the unexposed range between the 1969 rate and the rate predicted for a population with no smoking-attributable lung cancers. Stomach and lung cancer rate SAFs were based on published cohort studies. RESULTS: Lung cancer death rates predicted 98% and 97% of the variances in approximately non-lung cancer death rates throughout their 1969-1990 34% rise and subsequent declines, respectively (each P < 0.0001). The findings suggest that the SAF of the all-sites cancer death rate in black men peaked at 66% in 1990. CONCLUSIONS: Lung cancer death rates were a good index of smoke exposure for predicting approximately non-lung cancer death rates in black men. Smoking may cause most premature cancer deaths in black men.

Black or African American↗

Infant death rates in Queensland, 1962 to 1972.

Published statistical material has been used to analyse the infant death rate in Queensland. The neonatal death rates, which tend to reflect the level of obstetric care, were approximately twice as high in the Peninsula Division as in Brisbane, and the late infant mortality rate was almost eight times as high in the Peninsula Division as in Brisbane. In the Peninsula there has been no fall in infant death rate over the 11 years studied. One small area had an infant mortality rate of 100 deaths per 1,000 live births. The areas with the highest infant death rates were those with a significant Aboriginal population. The data show that proximity to major health facilities does not ensure low infant death rates and in the Brisbane Metropolitan Division there were threefold differences in late infant death rates. It seems likely that infant death rates are influenced by the economic status and education of parents and by the priority they place on infant care. The study has shown that published statistical data can detect areas within Queensland with high infant death rates, and could therfore be used to direct resources to improve the well-being of infants in these areas.

Australia↗