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PubMed1988

[[Mortality estimation using proportional mortality indicators for developing countries]].

The author extends a technique for the indirect estimation of mortality originally developed by Courbage and Fargues. The technique is applied to national data from 35 developing countries for the year 1975. "Nine families of model life tables constructed by Coale and Demeny and the United Nations were applied to each of the object populations, and the level of mortality corresponding to the value of PMI (proportional mortality indicator: percentage of deaths at the ages 50 years and over) obtained from death registration data, was determined for each family." The author notes that the technique does not require assumptions regarding features of the population in question and is applicable to a non-stable population or an open population without any adjustment. (SUMMARY IN ENG)

Demography↗
PubMed1991

Inverse relationship between risk of SIDS and early neonatal mortality: study of state mortality rates.

It was predicted that at the state level early neonatal (0-6 days) mortality rates and rates for sudden infant death syndrome (SIDS) in the age range 7-364 days would be negatively correlated. Using published data for each of the 50 states and the District of Columbia over the 5-year period 1980-1984, the actual correlation was -0.68 (p less than 0.001). In a breakdown of early neonatal mortality by age at death, rates for infants aged less than 1 hour proved to be the exception; their rates were not found to be negatively correlated with the rates for SIDS (r = +0.20). This finding probably reflects uniformity in the quality of obstetric care. The geographic variation in mortality rates for infants aged 1 hour to 6 days might be explained by variation in the probability of a mother and fetus sharing one or more HLA antigens.

Cause of Death↗
PubMed1990

Postneonatal mortality in Norway: a study of recent trends and comparison with other mortality rates in Norwegian children.

Postneonatal mortality in Norway decreased rapidly from 1956 to 1980 but subsequently remained stable. In recent years the postneonatal death rate appears to be increasing, primarily due to greater numbers of deaths attributed to the Sudden Infant Death Syndrome. During the same period, mortality among older children has also decreased, with the decline evident in all leading causes. Only among people aged 15 to 19 years have recent trends been less than encouraging, with the number of fatal traffic accidents in particular remaining stable or increasing. Although there is room for continued improvement, the widely held belief that the health status of Norwegian children is good is supported by the trends in mortality.

Accidents, Traffic↗
PubMed1984

[Comparison of a cohort mortality with the mortality of a reference population. Principle, necessary number of expected deaths and the given power of the test].

This note derives the power of the test comparing the mortality of a cohort to the mortality of a reference population. The principle of the comparison is recalled i.e. computation of the standardised mortality radio (SMR) and test of the null hypothesis: SMR = 1. It is shown how one can compute the power of the test. A numerical example is given.

Adult↗
PubMed1995

[Maternal mortality and birth distribution: a possible explanation of excess mortality in France].

Maternal mortality is higher in France than in most European countries with the same health standards. The analysis of the French rates shows that the changes, between 1975 and 1991, in the birth distribution according to the age of the mothers, explain 14% of all maternal deaths in 1991. The proportion of livebirths from mothers aged 30 years and over has increased from 21% in 1976 to 37% in 1991 in France and only 32% in England and Wales. For the period 1988-1990, crude maternal mortality was 9.4 per 100,000 livebirths in France and 7.4 in England and Wales. Direct standardization removes differences between birth distributions of each country and allows to calculate a standardized mortality rate of 8.6 for the French data. The variation between the crude and the standardized French rates is explained by the fact that 18 of the 210 deaths for the considered period were associated to the older mother's age distribution than in England and Wales.

Adult↗
PubMed1995

[Frequency analysis for achieving health goals--II: Analysis of mortality tables for cause of death, expected mortality].

The article gives algorithms to calculate mean ages at death for specific causes, based on life table models. Parameters of interest are death due to a specific cause, dying after the "elimination" of the specific cause, or the transition into a "new" structure of mortality when a specific cause of death vanishes. The setbacks of widely used calculations are discussed in this context. These different approaches are demonstrated by means of data pertaining to accident and cardiovascular mortality of the male population of Berlin (West). The estimated impact on life expectancy varies according to both the mathematical model and the specific cause of death: differences are negligible in mortality due to accidents, whereas the results differ considerably in cardiovascular causes of death. The algorithm suggested allows to constrain the calculations to specific age groups. Topics such as "avoidable death" and "health objectives" have to be aware of these different methods.

Accidents, Traffic↗
PubMed1995

A community based investigation of causes of maternal mortality in rural and urban Zimbabwe. Maternal Mortality Study Group.

UNLABELLED: Most data on maternal mortality in Zimbabwe has been urban hospital based. Using a network of informants and sensitized health workers an attempt was made to identify and investigate all maternal deaths in rural Masvingo and urban Harare over a two year period. The present report discusses place of death and the medical causes in both populations. Results gave maternal mortality rates of 168 and 85 per 100,000 live births for Masvingo and Harare respectively. These rates are significantly higher than those from conventional reporting systems especially in the rural area where 27 pc of deaths occurred at home or in transit. The leading medical causes of death were haemorrhage in Masvingo (25 pc of deaths) and eclampsia in Harare (26 pc), with puerperal and post abortal sepsis as the next most common causes in both cases. Malaria featured as the major indirect cause in Masvingo (7.6 pc). There were four suicides committed following unwanted pregnancy. The rural/urban variation in causation of death is discussed and the study results compared with other community based studies internationally. SYNOPSIS: This community based study revealed higher maternal mortality rates (MMR) than conventional statistics, especially in the rural area where deaths occurred at home or in transit. In the rural area the MMR was higher and the leading cause of death was haemorrhage, compared to eclampsia in the urban area. Strategies to reduce maternal deaths should include factors both within and outside health service structures.

Adolescent↗
PubMedDate not supplied

[Maternal mortality in the Huichol area of Jalisco state, Mexico. The Study Group on Maternal Mortality].

With the aim of estimating the level of maternal mortality, a field survey in 349 Huichol families was carried out from August 1990 to August 1991, using an ad-hoc questionnaire. In 208 deliveries, five maternal deaths were recorded, rendering a maternal mortality rate of 2,403.8 per 100,000 live births. This is a considerably higher rate than those reported at the state and national levels, as well as in other municipalities of the region. All five deaths were due to direct maternal causes and took place during the puerperium. None of the patients received medical care. The high maternal mortality rate observed among Huichol groups can be explained by their disadvantageous social conditions, their lack of access to health care, and also their cultural patterns which, in turn, determine their reproductive behaviour. All these elements place Huichol groups among the worst served populations in Mexico.

Adolescent↗
PubMed1997

Nativity, race, and mortality: influence of region of birth on mortality of US-born residents of New York City.

Among non-Hispanic black and white residents of New York City the association between birthplace by region (South, West/ Midwest, and Northeast) within the United States and mortality was determined by linking mortality records for 1988-1992 with the 1990 United States census data for New York City. Age-adjusted death rates computed by birthplace for blacks and whites were examined and also compared with total US data. The results indicate that death rates for New Yorkers generally exceed those of the United States overall, and black rates exceed those of whites. Moreover, Southern-born blacks have substantially higher death rates than do blacks born in the Northeast. The most striking variations are for cancer and diseases of the heart. Deaths from AIDS and homicide are higher among blacks than among whites, but the rates for Southern-born blacks do not exceed those for Northeastern-born blacks. For whites those born in the South have higher death rates overall than those born in the Northeast, but differences in cause-specific mortality are less consistent than for blacks. The results reveal substantial heterogeneity of health status based on nativity, among blacks in particular. To understand the role of the related factors, both genetic and environmental, further population and epidemiologic studies are important.

Adult↗
PubMed1998

Maternal education and fetal and infant mortality in Quebec. Fetal and Infant Mortality Study Group of the Canadian Perinatal Surveillance System.

OBJECTIVES: This article examines differences in fetal and infant mortality by maternal education in the province of Quebec, where the rates are among the lowest in Canada. DATA SOURCE: The data are from linked birth and infant death records (including stillbirths) for the 1990-1991 birth cohorts in Quebec. MAIN RESULTS: Fetal and infant mortality rates were greater for the offspring of mothers with less than 12 years of education, compared with mothers with at least 14 years, even after adjusting for maternal age, parity, marital status and infant's sex. When intermediate factors such as birthweight or both gestational age and fetal growth were taken into account, the differentials in mortality by education diminished. If all education groups had experienced the low rates attained by the higher education group, the number of fetal and infant deaths would have been reduced by approximately 20%.

Adolescent↗
PubMed1975

The effect of maternal demographic factors on infant mortality rates. Summary of the findings of the Louisiana Infant Mortality Study. Part I.

Birth and infant death certificates for Louisiana in 1972 were matched and reviewed to identify groups particularly in need of close medical support and counselling during the identify groups particularly in need of close medical support and counselling during the life phases of preparation for reproduction, gestation, and parenthood. From all recorded birth and infant death certificates for 1972 (69,556 birth and 1,541 death certificates) infant, neonatal, and postneonatal mortality rates were computed for maternal demographic (intrinsic patient physiocal and life-style characteristics) factors including age, race, parity by age cohort, education, and legitimacy. Excessive infant deaths were found among illegitimate offspring, except in mothers less than 15 years of age or nonwhites over 35 years of age; the less educated; those having too many children too soon; those of low birth weight; and whites relying on Charity Hospitals. An increased mortality rate was seen with nonwhites and with the younger and older mothers.

Black or African American↗
PubMed1988

Mortality odds ratio, proportionate mortality ratio, and healthy worker effect.

The standardized proportionate mortality ratio (PMRi) and the mortality odds ratio (MORi) are two statistics used to approximate the cause specific standardized mortality ratio (SMRi) when death data are available but the population at risk is not known. When there is a healthy worker effect, the MORi will always overestimate the SMRi and will always be greater than the PMRi. The PMRi is influenced by the relative frequency of the cause of death. For rare causes, such as brain cancer or leukemia, the PMRi will overestimate the SMRi to essentially the same degree as the MORi. For more common conditions, such as lung cancer, the PMRi will overestimate or underestimate the SMRi depending on the magnitude of the healthy worker effect. When the SMRi = 1 and there is a healthy worker effect, both the PMRi and MORi are in excess of one (1) regardless of the disease rate. As the SMRi increases it is more likely to be bounded by the PMRi (lower) and the MORi (upper). We therefore recommend that each statistic be derived when death certificates are the only source of data used to assess risk due to occupational exposures.

Environmental Exposure↗
PubMed1989

Minnesota highway maintenance worker cohort mortality study: methods and noncancer mortality.

In 1984, the Minnesota Department of Health (MDH) began a cohort mortality study of 4,849 workers to follow up concerns with the health and safety of highway maintenance workers (HMWs). A total of 1,530 deaths had occurred, resulting in a standardized mortality ratio (SMR) of 91 (p less than .01) and an all cancer SMR of 84 (p less than .01). There was a significant elevation in the SMR for chronic renal failure among long-term rural workers (SMR = 676, p less than .05). The SMR was also elevated for transportation injuries. The latter SMR was highest among short-term urban workers (SMR = 280, p less than .01). In addition, the SMR for transportation-related injury deaths tended to increase the later the decade of starting work. The SMRs were 137, 259, 502, and 2,145 for urban workers starting work in the decades 1945-1954, 1955-1964, 1965-1974, and 1975-1984, respectively. This study demonstrates the possible adverse health effects of highway maintenance work and the need to comprehensively evaluate injury mortality among selected occupational cohorts.

Accidents, Traffic↗
PubMed1992

Mortality studies of machining fluid exposure in the automobile industry I: A standardized mortality ratio analysis.

Machining fluids are widely used in a variety of common industrial metalworking operations to lubricate and cool both the tool and the working surfaces. Previous studies have suggested elevated respiratory, digestive, and skin cancers in exposed populations. This cohort study was initiated to assess whether long-term exposure to machining fluids in the course of machining, grinding, and other cutting operations is associated with excess cancer mortality. The cohort includes more than 45,000 automobile production workers from 3 plants, almost 1 million years of follow-up, over 10,000 deaths, and an extensive exposure assessment component. Standardized mortality ratios (SMRs) have been estimated for each of the 3 plants, using both U.S. as well as local populations as reference. Relative risks of 1.2-3.1 have been observed for several specific respiratory and digestive cancers of a priori interest, including cancer of the stomach, large intestine, pancreas, lung, and larynx. In addition, elevated risks for leukemia and asthma were noted. Future exposure-response analyses will provide the opportunity to identify relatively modest excesses in cause-specific mortality risk associated with exposure to specific types (straight, soluble, or synthetic), additives, or components of machining fluids.

Automobiles↗
PubMed1995

The mortality rate of the province of birth as a risk indicator for lung and stomach cancer mortality among Genoa residents born in other Italian provinces.

This study analyses the relationship between migration and mortality for lung and stomach cancer, these diseases being those considered susceptible to changes in environmental conditions and individual habits that usually follow migration. Mortality rate of the province of birth was used as the index of risk related to migration. Data were analysed using the Poisson regression model for grouped data. Results indicate that migration determines modifications in the mortality rates of the migrant populations for the diseases under study. For lung cancer, the analysis showed a greater risk for migrants originating from areas with high rates and that migrants had a reduced risk in comparison with natives of Genoa. With regard to stomach cancer, the study revealed that migrants originating from high risk areas had higher relative risks than the Genoa natives, even if these were lower than expected when compared to the risks of the populations in the regions from which the migrants originated.

Emigration and Immigration↗
PubMed2000

Sequential logistic models for 30 days mortality after CABG: pre-operative, intra-operative and post-operative experience--The Israeli CABG study (ISCAB). Three models for early mortality after CABG.

OBJECTIVES: The goal of this paper was to examine the added effect of operative and post-operative variables on 30 days mortality, in addition to patients' case-mix factors. SETTING AND DESIGN: A prospective study of 4835 patients, 95% of all Israeli patients who underwent coronary artery bypass grafting (CABG) in 1994. Information related to risk of death was collected at admission to hospital (preceding the operation), at time of the operation and in the immediate post-operative period. Deaths were independently ascertained. METHOD: Data collectors followed every patient from admission to discharge. Sequential logistic models were constructed for the 'case-mix', 'operative' and the 'post-operative' periods in chronological order. Each model incorporated and adjusted for the risk estimated at the previous point in time, by forcing individual risk scores. RESULTS: Significant pre-operative risk factors for 30 days mortality, in the case-mix model included mainly severity of illness characteristics, such as, left ventricular dysfunction and emergency admission, (c-statistic 78.8%). Model 2 (the 'operation' model) included in addition to the case-mix score, excessive duration of the operation per graft, bleeding, etc. (c-statistic 85.3%). The post-operative model showed the added effect of the post-operative factors such as low haemoglobin, additional surgery, and excessive time on respirator, (c-statistic 92.4%). CONCLUSIONS: The sequential analysis was an efficient method for updating patients' risk over time, where the number of events was small, relative to the number of risk factors. The addition of peri-operative factors increased significantly the predictive power of the model, adding clinical insights to the role of the hospital experience on 30 days mortality.

Adult↗
PubMed2000

C-reactive protein: relation to total mortality, cardiovascular mortality and cardiovascular risk factors in men.

BACKGROUND: There is much interest in reported associations between serum C-reactive protein and incident ischaemic heart disease. It is uncertain what this association represents. We aimed to assess the effect of confounding from a number of different sources in the Caerphilly Prospective Heart Disease Study and in particular whether the low grade inflammation indicated by C-reactive protein may be the mechanism whereby non-circulating risk factors may influence pathogenesis of ischaemic heart disease. METHODS: Plasma specimens collected during 1979-83 from 1395 men with sufficient sample remaining were assayed for serum C-reactive protein by ELISA. Subsequent mortality and incident ischaemic heart disease events were ascertained from death certificates, hospital records and electrocardiographic changes at 5-yearly follow-up examinations. RESULTS: There was a positive association between C-reactive protein and incident ischaemic heart disease (P<0.005) mainly with fatal disease (P<0.002). There was also a positive association with all-cause mortality (P<0.0001). C-reactive protein was significantly associated with a number of non-circulating risk factors including body mass index (P<0.0001), smoking (P<0.0001), low forced expiratory volume in 1 s (P<0.0001), height (P=0.025), low childhood social class (P=0.014) and age (P=0.036). C-reactive protein was also associated positively with circulating risk factors including viscosity, leukocyte count, fibrinogen (all P<0.0001) and insulin (P=0.0058). After adjustment for non-circulating risk factors the association with all-incident ischaemic heart disease and ischaemic heart disease death became non-significant, but the association with all-cause mortality remained (P=0.033). Further adjustment for fibrinogen however removed any hint of an increasing trend in odds for all three outcomes. CONCLUSION: C-reactive protein levels are raised in association with a variety of established cardiovascular risk factors. Neither C-reactive protein nor the systemic inflammation it represents appears to play a direct role in the development of ischaemic heart disease.

Biomarkers↗
PubMed2001

High plasma nonesterified fatty acids are predictive of cancer mortality but not of coronary heart disease mortality: results from the Paris Prospective Study.

To assess the association of fasting plasma nonesterified fatty acid (NEFA) concentration with the risk of death from coronary heart disease and cancer, the authors computed 15-year mortality rates for the 4,589 working men aged 43-53 years who were included in the Paris Prospective Study between 1967 and 1972. A total of 251 and 126 men died from cancer and coronary heart disease, respectively. For coronary heart disease death, the age- and tobacco-adjusted relative risk for men in the highest 20% of the fasting plasma NEFA concentrations compared with those in the lowest 80% was 1.54 (95% confidence interval (CI): 1.01, 2.34). It became nonsignificant after further adjustment for blood pressure, iliac/thigh ratio, and plasma insulin and cholesterol concentrations. In contrast, a high fasting plasma NEFA concentration exhibited a strong independent relation with cancer mortality (relative risk = 1.66, 95% CI: 1.25, 2.21, after adjustment for age, cigarette consumption, heart rate, and body mass index). Despite pathophysiologic mechanisms linking NEFA metabolism with visceral fat and plasma glucose, insulin, and triglyceride concentrations, the plasma NEFA concentration does not appear to be a good marker for coronary heart disease risk. In contrast, an unexpected association with cancer mortality was found that may point to the need for further investigation.

Adult↗