[A new approach to studies of mortality in countries with a high rate of mortality].
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Delivery of Health Care↗
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[Primary health care and development of the rural regions in the fight against maternal mortality and infant mortality].
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Developing Countries↗
Markedly increased renal disease mortality and incidence of renal replacement therapy among IDDM patients in Japan in contrast to Allegheny County, Pennsylvania, USA. Diabetes Epidemiology Research International (DERI) U.S.-Japan Mortality Study Group.
The aim of this study was to evaluate factors related to the markedly increased risk of dying from diabetic renal disease in Japanese insulin-dependent diabetic patients compared to those in the USA. The study was based on two population-based cohorts consisting of 1374 cases from Japan and 995 cases from Allegheny County, Pennsylvania, USA, who were diagnosed between 1 January 1965 and 31 December 1979. The living status and dialysis experience were determined as of 1 January 1990. The duration-adjusted renal-failure-related mortality rates in the Japanese cohort and the USA cohort were 277.2 and 130.9 per 100,000 person-years, and the duration-adjusted incidence rates of dialysis were 564.9 and 295.6 per 100,000 person-year, respectively. After adjustment for sex, age at onset, calendar year of onset, and duration of diabetes, individuals with insulin-dependent diabetes in the Japanese cohort were still 2.4-fold more likely to receive dialysis compared to those in the USA cohort. Ten of the 36 renal-failure-related deaths in the Japanese cohort had never been treated by dialysis, while all renal-failure-related deaths in the USA cohort had been treated by dialysis. Survival after initiation of dialysis in the Japanese cohort was virtually the same as the USA cohort. These data suggest that a greater frequency of diabetic end-stage renal disease and reduced access to acceptance at dialysis underlie much of the excess of diabetic renal deaths in Japan.
Adolescent↗
Socioeconomic and behavioural risk factors for mortality of individuals with IDDM in Japan: population-based case-control study. Diabetes Epidemiology Research International (DERI) US-Japan Mortality Study Group.
The aim of this population-based, one-to-one matched-pair case-control study was to evaluate the factors concerning the markedly increased risk for dying among Japanese subjects with insulin-dependent diabetes mellitus (IDDM) from a social and behavioural perspective. The study was based on the population-based cohort of IDDM subjects in the Diabetes Epidemiology Research International Mortality Study. We studied 90 cases who died and 90 living control subjects, selected from the rest of the cohort, who were matched for sex, birth year, year of diagnosis and duration of diabetes. Socioeconomic and behavioural status were surveyed through a questionnaire. Conditional logistic regression analyses based on 55 respondent pairs revealed that the better educated patients (year of completing education: odds ratio = 0.66) who kept the same physician (number of times a patient changed physician: odds ratio = 2.77) and who attended a clinic specializing in diabetes (attendance at university hospital clinic: odds ratio = 0.18) injecting insulin several times a day (number of injections, odds ratio = 0.31) and more frequently attending the clinic (> or = 12 times per year, odds ratio = 0.23) were at substantially lower risk of death. The results begin to profile the patients with the highest risk of dying who could be identified earlier and undergo intervention treatment.
Adolescent↗
Cancer mortality correlation studies. II. Regional associations of mortalities with the consumptions of foods and other commodities.
The age-corrected mortalities from cancer at 17 sites were correlated with the consumptions of 12 major food items and the apparent consumptions of alcoholic beverages, cigarettes, beer, coffee, tea and solid fuel, in different countries. Significant direct and inverse correlations with food consumption variables were observed: the results are in essential accord with those of other workers employing different methods of statistical analysis. A modification of the diet in western industrialized nations is proposed as a means of lowering the human cancer risk. For cancers of the mouth and neck, and for liver in males, significant associations with the wine alcohol consumption were observed. Statistical evidence for liver cirrhosis as liver-cancer, and for stomach ulcer as stomach-cancer-predisposing conditions was obtained.
Alcoholic Beverages↗
Reanalysis of lung cancer mortality in a National Cancer Institute Study on "Mortality among industrial workers exposed to formaldehyde".
The analysis of an historical cohort study of mortality among individuals occupationally exposed to formaldehyde by Blair et al. (2) in 1986 failed to allow properly for the Healthy Worker Effect and to evaluate time integrated exposure and length of exposure simultaneously. In our reanalysis of the same data we find a risk for lung cancer, increasing with increasing cumulative exposure to formaldehyde.
Adult↗
Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study.
Limited data are available on the relation between physical fitness and mortality from cardiovascular disease. We examined this question in a study of 4276 men, 30 to 69 years of age, whom we followed for an average of 8.5 years. Examinations at base line included assessment of conventional coronary risk factors and treadmill exercise testing. The heart rate during submaximal exercise (stage 2 of the exercise test) and the duration of exercise were used as measures of physical fitness. Men with incomplete data (n = 308) or who were using cardiovascular drugs (n = 213) were excluded from the analysis. Men who had clinical evidence of cardiovascular disease at base line (n = 649) were analyzed separately. Forty-five deaths from cardiovascular causes occurred among the remaining 3106 men. A lower level of physical fitness was associated with a higher risk of death from cardiovascular and coronary heart disease, after adjustment for age and cardiovascular risk factors. The relative risk of death from cardiovascular causes was 2.7 (95 percent confidence interval, 1.4 to 5.1; P = 0.003) for healthy men with an increment of 35 beats per minute in the heart rate during stage 2, and 3.0 (95 percent confidence interval, 1.6 to 5.5; P = 0.0004) for those with a decrement of 4.4 minutes in the exercise time spent on the treadmill. The corresponding values for death from coronary heart disease were 3.2 (95 percent confidence interval, 1.5 to 6.7; P = 0.003) and 2.8 (95 percent confidence interval, 1.3 to 6.1; P = 0.007), respectively. We conclude that a lower level of physical fitness is associated with a higher risk of death from coronary heart disease and cardiovascular disease in clinically healthy men, independent of conventional coronary risk factors.
Adult↗
Postneonatal mortality, sudden infant death syndrome: factors preventing the decline of infant mortality in France from 1979 to 1985.
The sudden infant death syndrome (SIDS) is known to be associated with a peak in mortality rates at 3 months of age, and a seasonal peak in winter. The aim of this study was to analyse the relationship between the month of death, month of birth and age at death for cohorts of monthly births in France between 1979 and 1985. Statistics concerning the causes of death were collected and used to calculate life-tables firstly from SIDS and secondly from all other causes. They show that the specific age distribution at death was not the same for babies born in late summer or autumn as for other newborns. Total infant death rates were higher for cohorts born in the autumn, because of the peak in deaths from SIDS at about three months of age.
Actuarial Analysis↗
Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991.
OBJECTIVE: To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. DESIGN: Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. SETTING: England and Wales. SUBJECTS: Children aged 0-15 years. MAIN OUTCOME MEASURES: Death rates from injury and poisoning. RESULTS: Death rates from injury and poisoning have fallen for children in all social classes. The decline for children in social classes IV and V (21% and 2% respectively), however, is smaller than that for children in social classes I and II (32% and 37%). As a result of the differential decline in injury death rates, socioeconomic mortality differentials have increased. In the four years 1979-80 and 1982-83 the injury death rate for children in social class V was 3.5 times that of children in social class I. For the four years 1989-92 the injury death rate for children in social class V was 5.0 times that of children in social class I. Poisson regression modelling showed that the trend in the decline in death rates across the social classes was unlikely to have arisen by chance alone. CONCLUSIONS: Socioeconomic inequalities in child injury death rates have increased. If these gradients persist, the Health of the Nation's target is likely to be met for children in the non-manual social classes but not for those in the manual social classes.
Adolescent↗
Mortality and incidence of cancer among oil exposed workers in a Norwegian cable manufacturing company. Part 2. Mortality and cancer incidence 1953-84.
Mortality and incidence of cancer 1953-84 was studied in a cohort of 529 men exposed to mineral oils in a Norwegian cable manufacturing company. Expected numbers of deaths were calculated from national death rates and cases of cancer from regional incidence rates. Among the 195 men who had worked for less than one year, there were statistically significant excesses of deaths from all causes (O/E = 75/39.3) and from malignant neoplasms, ischaemic heart disease, non-malignant respiratory disease, and violence. In a subcohort of all 248 men with known work category and at least one year's employment in oil exposed work statistically significant excesses of deaths from ischaemic heart disease (O/E = 26/16.1) and cases of lung cancer (O/E = 10/3.9) were observed. Nine of the cases of lung cancer had occurred 20 years or more after first employment (2.7 expected; p less than 0.01). In smokers of this subcohort there were 7.06 cases of lung cancer per 1000 person-years compared with 1.30 in smokers of a general population sample. It is concluded that exposure to mineral oils has probably been an important contributing factor in the development of lung cancer among these workers.
Cohort Studies↗
A study of mortality in workers engaged in the mining, smelting, and refining of nickel. II: Mortality from cancer of the respiratory tract and kidney.
This paper describes observed and expected mortality from cancers of the lung, larynx, nose, and kidney in a cohort of 54,509 nickel workers followed for 35 years. For analysis purposes the cohort was subdivided into men with and without service in one of the three high nickel dust areas of the operation: the Sinter Plants at Copper Cliff and Coniston, and the Leaching, Calcining and Sintering (LC&S) department at Port Colborne. At Copper Cliff Sinter Plant workers experienced three times the expected number of lung cancer deaths; the SMR rose steeply with increasing duration of service peaking at 943 with 10 to 15 years. A similar overall excess risk of lung cancer was seen in the smaller Coniston Sinter Plant again with an indication of an exposure risk gradient. Men in the LC&S department at Port Colborne also experienced a dose related excess risk of lung cancer death that rose to an SMR of 806 with 20 to 25 years of service. Nasal cancer deaths were increased at both the Copper Cliff Sinter Plant (6 deaths) and the LC&S department at Port Colborne (19 deaths), representing SMRs of 3,704 and 7,755, respectively, for this rare cancer. Laryngeal cancer and kidney cancer, both previously associated with nickel, were not in excess in these high risk groups. A further exploration of death from these causes in the lower exposure remainder of the cohort revealed an epidemiologically modest elevation in lung cancer death in miners (probably not nickel related) and parts of the Copper Refinery. No evidence of laryngeal cancer excess was found.(ABSTRACT TRUNCATED AT 250 WORDS)
Canada↗
Chronic obstructive pulmonary disease. Mortality and mortality reduction.
Chronic obstructive pulmonary disease (COPD) affects an estimated 15 million Americans and is the fourth most common cause of death in the US. Despite an improved understanding of the disease, treatment has changed little over the past 20 to 30 years and COPD remains a major health problem worldwide. Smoking is the major risk factor for COPD, accounting for some 90% of cases. Therefore, smoking cessation remains the most important intervention. Other available pharmacotherapeutic options include corticosteroids, bronchodilators, antibiotics for the treatment of acute exacerbations, mucokinetic agents, and oxygen for the advanced stages of the disease. Recent data investigating the use of dornase alfa (recombinant human deoxyribonuclease I) in patients with acute exacerbations of COPD were disappointing and failed to demonstrate a mortality benefit. While it is likely that ongoing research will optimise the use of older agents and identify new treatment options for patients with COPD, smoking cessation will probably remain the most important intervention and should be a key focus of future initiatives aimed at controlling this disease.
Anti-Bacterial Agents↗
[Mortality of diabetic patients in Warsaw--22 year prospective observation (1973/74-1995). II. Mortality of patients with type I diabetes (insulin-dependent-diabetes)].
During the follow-up 1973/74-1995 years 171 subjects with type 1 (insulin dependent diabetes) (105 males and 66 females) aged 18-30 years died 31.6% (32.4% males and 30.3% females). The relative risk of mortality for all causes in the compared to the general population was 5.0 (3.5 for men and 7.5 for women). Almost 30% deaths were from renal disease, 17% from ischemic heart disease, and 3 death in women from carcinoma of breast.
Adult↗
Studies of the mortality of atomic bomb survivors. Report 12, part II. Noncancer mortality: 1950-1990.
This report updates the data on noncancer mortality for 86,572 atomic bomb survivors with dose estimates in the Radiation Effects Research Foundation's Life Span Study cohort. The primary analyses are based on more than 27,000 noncancer disease deaths that occurred in the cohort between October 1, 1950, and December 31, 1990, 30% more than in the previous report. The present analyses strengthen earlier findings of a statistically significant increase in noncancer disease death rates with radiation dose. Increasing trends are observed for diseases of the circulatory, digestive and respiratory systems. Rates for those exposed to 1 Sv are elevated about 10%, a relative increase that is considerably smaller than that for cancer. However, estimates of the number of radiation-related noncancer deaths in the cohort to date (140 to 280) are 50 to 100% of the number for solid cancer. The data do not yet clarify the shape of the dose response. There is no significant evidence against linearity, but the data are statistically consistent with curvilinear dose-response functions that posit essentially zero risk for doses below 0.5 Sv. Similarly, while the data are consistent with substantial variation in the excess relative risk with age at exposure or attained age, there is no statistically significant dependence on these factors. In view of the small relative risks and the lack of understanding of biological mechanisms, we emphasize consideration of whether the findings could be explained by misclassification, confounding or selection effects. Based on available data, we conclude that such factors are unlikely to fully explain the observed dose response. A significant dose response is also seen for deaths from blood diseases with an excess relative risk that is several times greater than that seen for solid cancer. Particular attention is paid to the possibility that this apparent effect is a consequence of the attribution of leukemia or other cancer deaths to noncancer blood diseases. We find that misclassification does not explain this excess risk. As in earlier reports, suicide rates tend to decrease with increasing dose.
Cause of Death↗
Poisoning mortality in the United States: comparison of national mortality statistics and poison control center reports.
STUDY OBJECTIVE: To determine whether the distributions of age and poisoning categories for poisoning deaths are similar in death certificates as compiled by the National Center for Health Statistics (NCHS) and US poison control centers as reported by the Toxic Exposure Surveillance System (TESS). METHODS: Data from both databases for 1994 were examined. Mortality data from NCHS were identified by applicable E-codes of the International Classification of Diseases-ninth revision (ICD-9). All fatalities described in the TESS report were coded to conform to the ICD-9 system. RESULTS: A total of 16,527 poisoning deaths were recorded by NCHS; 766 deaths were reported by TESS. For NCHS and TESS, respectively, the age distribution of unintentional drug poisonings (N=7,823; 155) and unintentional non-drug poisonings (N=1,234; 102) differed (P <.001), whereas those for intentional poisonings (N=5,320; 413) did not differ significantly. In the NCHS and TESS data sets, respectively, the relative distribution of death circumstances differed (P <.001) for unintentional drug poisonings (47% versus 20%), unintentional non-drug poisonings (8% versus 14%), intentional poisonings (32% versus 54%), and unknown or other circumstances (13% versus 12%). The distributions of poisoning circumstances and age categories were dependent on the data source (P <.001). There was no statistical agreement between the data sets in rankings of the 12 most frequent ICD-9 codes and toxins associated with poisoning deaths. CONCLUSION: Deaths reported in TESS represent 5% of the poisoning deaths tabulated by NCHS. Differences observed in the 2 data sets may lead to differing health policies to address poisoning hazards.
Accidents↗
Dairy calf mortality rate: the association of daily meteorological factors and calf mortality.
The number of dairy heifer calves born each day, the number of these calves which died prior to 36 days of age and the actual date of death were recorded and analyzed for possible associations with weather factors. The demographic data on dairy calves were supplied by 16 farms in Tulare County, California for the months of July to December 1973. High temperatures in the summer and low temperatures in the winter were associated with an increased risk of death. Calves born during the periods of extreme temperatures had a higher risk of death than those born on more temperate days, while death, when it occurred was temporally related to days of extreme temperatures. Periods of increased risk of death often were associated with large temperature fluctuations irrespective of the absolute temperature. Nonmeteorological factors specific to invidual farms also appeared to influence daily calf mortality rates.
Age Factors↗
Occupational groups potentially exposed to silica dust: a comparative analysis of cancer mortality and incidence based on the Nordic occupational mortality and cancer incidence registers.
We have analysed mortality and cancer incidence data available in census-based record-linkage studies from the Nordic countries for males in occupational groups with potential exposure to silica dust. The study showed an excess lung cancer risk for foundry workers in all the Nordic countries, and also for miners in Sweden. These results are consistent with the findings of previous in-depth epidemiological studies. The lung cancer risk did not differ significantly from that of the respective national populations for males working in glass, porcelain, ceramics and tile manufacture, in excavation, and in stone quarries, sand and gravel pits. Stone cutters, who are probably not exposed to known lung carcinogens at the workplace but in some places to high concentrations of silica dust, showed a significant excess lung cancer risk in both Finland and Denmark.
Adult↗
Maternal mortality. A report of the KMA Maternal Mortality Study Committee.
This maternal mortality report delineates the course of a myocardial infarction subsequent to a cesarean section. A brief discussion of this entity is presented.
Adult↗