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PubMed1992

Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years.

OBJECTIVES: To evaluate the efficacy of the combination of annual screening with mammography, physical examination of the breasts and the teaching of breast self-examination in reducing the rate of death from breast cancer among women aged 40 to 49 years 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 usual care after an initial physical examination (UC group). The 50,430 women enrolled from January 1980 through March 1985 were followed for a mean of 8.5 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 90% of the women in each group attended the screening sessions or returned the annual questionnaires, or both, over years 2 to 5. 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 3.89 per 1000 in the MP group and 2.46 per 1000 in the UC group; more node-positive tumours were found in the MP group than in the UC group. During years 2 through 5 the ratios of observed to expected cases of invasive breast cancer were 1.26 in the MP group and 1.02 in the UC group. Of the women with invasive breast cancer through to 7 years, 191 and 157 women in the MP and UC groups respectively had no node involvement, 55 and 43 had one to three nodes involved, 47 and 23 had four or more nodes involved, and 38 and 49 had an unknown nodal status. There were 38 deaths from breast cancer in the MP group and 28 in the UC group. The ratio of the proportions of death from breast cancer in the MP group compared with those in the UC group was 1.36 (95% confidence interval 0.84 to 2.21). The survival rates were similar in the two groups. The highest survival rate occurred among women whose cancer had been detected by mammography alone. CONCLUSION: The study was internally valid, and there was no evidence of randomization bias. Screening with yearly mammography and physical examination of the breasts detected considerably more node-negative, small tumours than usual care, but it had no impact on the rate of death from breast cancer up to 7 years' follow-up from entry.

Adult↗
PubMedDate not supplied

High death rates in health care workers and teachers in Malawi.

High death rates are reported in health care workers (HCWs) and teachers in urban areas of Malawi. The present study was carried out to determine the annual death rate in HCWs and primary school teachers working in semi-urban and rural areas of Malawi, and to try to ascertain the main causes of death. Forty district and mission hospitals in Malawi were visited. A record was made of the number of clinical and nursing-based HCWs in each hospital in 1999, the number of deaths in that calendar year and reported causes of death. A record was also made of the number of teachers working in 4 primary schools nearest to each hospital in 1999, the number of deaths in that calendar year and reported causes of death. There were 2979 HCWs, of whom 60 (2.0%) died. There were 4367 teachers of whom 101 (2.3%) died. Annual death rates, calculated per 100,000 people, were significantly higher in male HCWs compared with female HCWs (2495 versus 1770, RR 1.17, 95% CI 1.14-1.20, P < 0.001), and significantly higher in female teachers compared with male teachers (2521 versus 1934, RR 1.14, 95% CI 1.11-1.17, P < 0.001). In male HCWs and teachers the highest death rates were in those aged 35-44 years. In female HCWs and teachers, the highest death rates were in those aged 25-34 years and 35-44 years, respectively. Reported causes of death in HCWs were tuberculosis (TB) in 47%, chronic illness in 45% and acute illness in the remainder, while in teachers the causes were TB in 27%, chronic illness in 49% and acute illness in 25%. Chronic illness, thought to be due to AIDS, and TB were the common causes of death. The current high death rates from AIDS and TB will have a crippling toll on the health and education sectors, and effective ways of reducing these death rates must be found.

Acute Disease↗
PubMed1993

[Death rate in acute poisonings].

The analysis of death rate, based on data for the years 1989-1990, obtained from nine regional centres of clinical toxicology, is reported. A high death rate is observed in poisonings with toxic mushroom (Amanita phalloides), ethylene glycol, methyl, alcohol, pesticides, corrosive substances and metabolic compounds. As to pesticides the highest death rate is produced by poisonings with dipyridyl derivatives and organophosphorous compounds. A low death rate is observed in the case of poisonings with drugs.

Humans↗
PubMed2003

Correlation between standardized death rate for area and LA(50).

In order to investigate the relationship between standardized death rate for area and 50% mortality rate for burn area (LA(50)), correlation analysis, curve estimation and linear regression were performed with the variables. The results showed that: (1) there was a similarity in sort order of standardized death rate in control groups of samples, compared with the experimental group; (2) there were significant differences between the sort order from low to high mortality rate of standardized death rate in control groups for burn area, compared with the sort order in the experimental group; (3) there was a similarity (P<0.05) in low to high sort order for standardized death rate compared with high to low sort order for LA(50) in the experimental group; and (4) there was an extraordinarily significant correlation (P<0.0001) between linear regression analysis and curve estimation for the standardized death rate and LA(50) using a Pearson correlation. The observation that there was a significant relation between the sort orders in standardized death rate and LA(50) shows that the standardized death rate for area can reflect accurately mortality in each of samples.

Age Factors↗
PubMed1986

Projection of death rates from ischemic heart disease in Japan, 1985-2000.

Death rates from all forms of ischemic heart disease and acute myocardial infarction were projected between 1985 and 2000 A.D., based on vital statistics from 1973 to 1982 and the estimated population by sex and age groups in Japan. It is predicted that the crude death rate from ischemic heart disease will increase (+1.4% per year for males and +1.8% for females), and that the age-adjusted death rate will decrease (-1.1% per year for males and -1.4% for females). The crude death rate from acute myocardial infarction is predicted to increase steadily (+2.4% per year for males and +2.2% for females), though the age-adjusted rate will decline slightly (-0.5% per year for males and -1.0% for females) throughout this period. The crude death rate from acute myocardial infarction is predicted to increase more than the rate from ischemic heart disease. It is estimated that the total number of deaths will increase from 48,000 (males and females combined) in 1982 to 72,000 in 2000 for ischemic heart disease, and from 29,600 in 1982 to 45,500 in 2000 for acute myocardial infarction.

Adult↗
PubMed2005

Is there evidence for an increase in the death rate from liver-related disease in patients with HIV?

BACKGROUND: Increases in deaths due to liver-related disease (LRD) among HIV-infected individuals have been reported although the influence of combination antiretroviral therapy (cART) on LRD is controversial. AIMS: To determine changes over time in the death rate from LRD and if longer exposure to cART was associated with an increased death rate from LRD in 10 937 patients from EuroSIDA, an observational longitudinal cohort study. RESULTS: A total of 184 (1.7%) died from LRD during 52 236 person-years of follow-up (PYFU). The death rate from LRD declined from 6.9 per 1000 PYFU before 1995 [95% confidence interval (CI), 3.9-9.9] to 2.6 at/after 2004 (95% CI, 1.6-4.0). When the current CD4 cell count and other factors were taken into account, there was a 13% increase in the death rate from LRD per year (95% CI, 5-20%, P = 0.0008). In patients who had started cART, there was a 12% increase in the death rate from LRD per additional year exposure to cART (95% CI, 4-20%, P = 0.022) after adjustment for current CD4 cell count and other factors. CONCLUSIONS: Death rates from LRD appeared to decrease across Europe. However after adjustment for the current CD4 cell count, and therefore increases in CD4 cell counts in patients taking cART, there was a significant increase over time in death rates from LRD. In patients with similar CD4 cell counts, longer exposure to cART was associated with an increased death rate from LRD. This may be due to direct liver toxicity of antiretrovirals, progression of liver disease due to hepatitis B virus or hepatitis C virus over time as patients survive longer, or some other factor.

Adult↗
PubMed1997

Fetal death rate in the United States, 1979-1990: trend and racial disparity.

OBJECTIVE: To examine the impact of changes in birth weight distribution in individual groups and in birth weight-specific fetal death rates on the decline in the crude fetal death rate in the United States. METHODS: Data on live births and fetal deaths in the U.S. for the period 1979-1990 were examined by birth weight group and race using Kitagawa's method for analysis of the crude fetal death rate. RESULTS: In the period 1979-1990, all racial groups had a decrease in the crude fetal death rate, more so in whites and others (about 22%) than in blacks (10%). In the white population, 73.4% of the total reduction in the crude fetal death rate was attributable to the improvement in birth weight-specific fetal death rates, and the remaining portion of the reduction was due to a favorable change in birth weight distribution. In the black population, the reduction in the crude fetal death rate was entirely attributable to the improvement in the birth weight-specific fetal death rates. However, in other groups, a favorable change in the birth weight distribution was the major determinant. Although black births represented 16.5% of all births in the U.S., they accounted for 26-29% of the crude fetal death rate. Disparity in the crude fetal death rates for blacks and whites is explained almost entirely by differences in birth weight distribution. CONCLUSIONS: A further decrease in the crude fetal death rate in the U.S. requires a decrease in low birth weights, particularly in blacks.

Birth Weight↗
PubMedDate not supplied

[Comparability of the data presented in the medical death certificate and the death rate statistics index].

It having been impossible to use the Death Rate Statistics Index for analyzing the death rate in the city of Seville for 1985 and this Index having been substituted by the Medical Death Certificate has lead us to carry out this study to compare the data reflected in these two documents and determine the extent to which the Medical Death Certificate conforms to the Death Rate Statistics Index, used officially, and its validity. The results show that both documents tally to a great degree, the DRSI providing somewhat more information with regard to the process leading up to the deaths, this having led us to decide to make the death rate analysis for 1985 in Seville by using the Medical Death Certificate as the document on which the information will be based.

Cause of Death↗
PubMed2002

Effect of air-pollution control on death rates in Dublin, Ireland: an intervention study.

BACKGROUND: Particulate air pollution episodes have been associated with increased daily death. However, there is little direct evidence that diminished particulate air pollution concentrations would lead to reductions in death rates. We assessed the effect of air pollution controls--ie, the ban on coal sales--on particulate air pollution and death rates in Dublin. METHODS: Concentrations of air pollution and directly-standardised non-trauma, respiratory, and cardiovascular death rates were compared for 72 months before and after the ban of coal sales in Dublin. The effect of the ban on age-standardised death rates was estimated with an interrupted time-series analysis, adjusting for weather, respiratory epidemics, and death rates in the rest of Ireland. FINDINGS: Average black smoke concentrations in Dublin declined by 35.6 mg/m(3) (70%) after the ban on coal sales. Adjusted non-trauma death rates decreased by 5.7% (95% CI 4-7, p<0.0001), respiratory deaths by 15.5% (12-19, p<0.0001), and cardiovascular deaths by 10.3% (8-13, p<0.0001). Respiratory and cardiovascular standardised death rates fell coincident with the ban on coal sales. About 116 fewer respiratory deaths and 243 fewer cardiovascular deaths were seen per year in Dublin after the ban. INTERPRETATION: Reductions in respiratory and cardiovascular death rates in Dublin suggest that control of particulate air pollution could substantially diminish daily death. The net benefit of the reduced death rate was greater than predicted from results of previous time-series studies.

Adolescent↗
PubMed1990

Inherent limitations of hospital death rates to assess quality.

Modeling death rates has been suggested as a potential method to screen hospitals and identify superior and substandard providers. This article begins with a review of one hospital death rate study and focuses upon its findings and limitations. It also explores the inherent limitations in the use of large data sets to assess quality of care.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Multivariate population-based analysis of the association of county trauma centers with per capita county trauma death rates.

UNLABELLED: The purpose of this study was to utilize a large population-based data base to determine the association of trauma centers with per capita county trauma death rates. METHODS: Per capita county trauma death rate, the dependent variable in the model, was obtained from a well-validated state Medical Examiner's data base. Over 200 county demographic, prehospital, and hospital trauma care resource variables were obtained from a variety of sources for multivariate modeling. Bivariate analysis identified candidate variables for multivariate modeling, excluding highly correlated independent variables to avoid problems of collinearity. Multivariate linear regression, logistic regression, and stepwise discriminant analysis were used to determine the relative association of the candidate variables with per capita county trauma death rates. RESULTS: Bivariate analysis identified multiple factors associated with per capita county trauma death rates. These included, among others: county rurality, percentage of unemployment, percentage nonwhite, 911 access, and ALS certified EMS. Per capita trauma death rates were significantly lower in counties with trauma centers compared with counties without trauma centers (4.0 +/- 0.5 and 5.0 +/- 1.1 deaths per 10,000 population, p = 0.0001, respectively). Multivariate analysis demonstrated that the presence of a trauma center in the county and ALS were the best medical system factors predicting decreased per capita county trauma death rates. CONCLUSIONS: This study is unique in utilizing a regional population-based data base of all trauma deaths in a large state to analyze the association of trauma centers and trauma death rates. Multivariate modeling controlling for other county variables demonstrated that the presence of a trauma center and Advanced Life Support training were the best predictors of per capita county trauma death rates. These findings are consistent with the hypothesis that trauma centers decrease trauma death rates.

Adult↗
PubMed2006

Declining death rates from hyperglycemic crisis among adults with diabetes, U.S., 1985-2002.

OBJECTIVE: To examine trends in death rates for hyperglycemic crisis (diabetic ketoacidosis or hyperglycemic hyperosmolar state) among adults with diabetes in the U.S. from 1985 to 2002. RESEARCH DESIGN AND METHODS: Deaths with hyperglycemic crisis as the underlying cause were identified from national mortality data. Death rates were calculated using estimates of adults with diabetes from the National Health Interview Survey as the denominator and age adjusted to the 2000 U.S. population. The trends from 1985 to 2002 were tested using joinpoint regression analysis. RESULTS: Deaths due to hyperglycemic crisis dropped from 2,989 in 1985 to 2,459 in 2002. During the time period, age-adjusted death rates decreased from 42.4 to 23.8 per 100,000 adults with diabetes (4.4% decrease per year, P for trend <0.01). Death rates declined in all age-groups, with the greatest decrease occurring among individuals aged > or =65 years. Age-adjusted death rates fell for all race-sex subgroups, with black men experiencing the smallest decline. About one-fifth of deaths occurred at home or on arrival at the hospital, and the death rates for hyperglycemic crisis occurring at these places declined only modestly over time (2.1% decrease per year, P for trend = 0.049). CONCLUSIONS: Overall death rates due to hyperglycemic crisis among adults with diabetes have declined in the U.S. However, scope for further improvement remains, especially to further reduce death rates among black men and to prevent deaths occurring at home.

Adolescent↗
PubMed1996

Factors associated with the higher traumatic death rate among rural children.

STUDY OBJECTIVE: To examine medical and demographic factors associated with traumatic deaths among children in Kentucky. METHODS: This was a retrospective review and multiple regression analysis of all deaths in children younger than 18 years reported to the Kentucky Office of Vital Statistics from 1988 to 1992. RESULTS: All 1,024 pediatric trauma deaths that occurred from 1988 to 1992 were analyzed. Death rates were calculated for each type of trauma for each county in the state. Motor vehicle accidents accounted for most of the pediatric deaths, but this finding was markedly age dependent. Death rates were higher in rural Kentucky for all forms of trauma and were highest in the Appalachian region. Multiple Poisson regression analysis identified variables associated with the traumatic pediatric death rates. Rural setting was associated with higher traumatic death rates, whereas the availability of a hospital with 24-hour emergency services in the county and the presence of advanced life support prehospital care were associated with lower death rates. Children in Appalachia were at an increased risk compared with other Kentucky children, even when we controlled for the rural nature of Appalachia. CONCLUSION: Demographic and medical system factors are associated with traumatic death rates in Kentucky children. Access to care and advanced prehospital support were both significantly associated with lower pediatric death rates. Increased access to quality care and training of prehospital providers in advanced life support should be priorities in the planning of trauma systems for this state.

Adolescent↗
PubMed1999

Fatality Analysis Reporting System demonstrates association between trauma system initiatives and decreasing death rates.

BACKGROUND: Trauma registries frequently do not include the deaths of patients who do not get to trauma centers (TCs). Thus, complementary methods of monitoring the impact of trauma system initiatives should be considered. The objective of this study is to use National Highway Safety Traffic Administration's Fatality Analysis Reporting System (FARS) and New York State Department of Motor Vehicles data and to study the impact of state and regional initiatives over a 10-year period in the seven-county Hudson Valley New York (HV) region with one regional TC in Westchester County (WC) and to assess its face validity. METHODS: FARS data for the United States (US), New York State (NY), the HV region, and WC were analyzed from 1987 to 1996. Trauma system initiatives included the following. Statewide: (1) TC standards (1989), (2) TC designation and funding (1990), (3) State Trauma Advisory Committee (1991), (4) BLS triage protocol and trauma registry (1993), and (5) quality improvement site surveys (1994). Regional: (1) one regional and two area TCs (1990), (2) helicopter services (1992 and 1994), (3) two additional area TCs, and (4) E 911 in all three counties (1995). The results were presented to the New York State Trauma Advisory Committee. RESULTS: Although nationally motor vehicle crash deaths/100,000 persons have plateaued since 1991, trauma system initiatives have been temporally associated with death rates continuing to diminish in New York, the HV, and WC. From 1987 to 1996, the HV death rate dropped from 17.00 to 9.45, a 44% drop; and the WC rate dropped from 12.51 to 7.05, a 44% drop compared with United States death rate drop of 16% (p < 0.005). The percentage of seriously injured trauma patients going to the trauma centers increased from 53% in 1990 to 72% in 1995 (p < 0.001). The STAC felt that the data reflected in part effects of New York State trauma system initiatives. CONCLUSION: The drops in motor vehicle crash death rates may reflect injury prevention as well as trauma system initiatives. Thus, although FARS and New York State Department of Motor Vehicles data cannot establish cause and effect relationships, it can monitor the aggregated impact of multiple initiatives. Taken together with increasing percentages of seriously injured trauma patients going to trauma centers and comparisons with national FARS data, the association of decreasing deaths with the implementation of a trauma system seems to have face validity.

Accidents, Traffic↗
PubMed1996

Exploring the male-female discrepancy in death rates from bicycling injury: the decomposition method.

The population-based death rate as an important indicator of health status has been widely used in injury research. Generally, the death rate from injury for males is about three times that for females. The importance of the various factors that contribute to this male-female discrepancy, however, has not been well understood. Using the innovative Decomposition Method, data from the Nationwide Personal Transportation Survey, the National Electronic Injury Surveillance System, and the National Center for Health Statistics were analyzed to explore the determinants of the male-female difference in death rates from bicycling injury. The results revealed that males have higher death rate from bicycling injury than females because they have a greater exposure rate and case fatality rate. When exposure measured by number of bicycle trips is taken into account, males are at slightly lower risk of injury than females. The relative contribution of case fatality, exposure, and risk to the 6.4-fold difference in death rates from bicycling injury between men and women is 53%, 51%, and -4%, respectively.

Accidents, Traffic↗
PubMed1987

Adjusted hospital death rates: a potential screen for quality of medical care.

Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist.

Adolescent↗
PubMed2001

Age-adjusted death rates: trend data based on the year 2000 standard population.

Age-adjusted death rates are routine mortality risk measures used to compare rates over time or between groups such as those living in different geographic areas. This type of measure eliminates differences that would be caused because one population is older than another. Beginning with mortality data for 1999, the standard population used by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) to calculate age-adjusted death rates based on the Year 2000 estimated population distribution replacing that of 1940 used previously. Comparisons of 1999 mortality data with that of 1998 and earlier years cannot be made unless age-adjusted death rates are based on the same standard population. Changing the standard population generally changes the magnitude of an age-adjusted death rate and may change the magnitude of the differential between two groups. Typically, the change in standard makes relatively little difference in the mortality trend but it can when age-specific rates have divergent patterns. This publication provides age-adjusted death rates by race and sex based on the year 2000 population standard and directs readers to the NCHS Web site for age-adjusted death rates by selected causes.

Age Distribution↗
PubMedDate not supplied

Recomputation of age-adjusted death rates and age-sex-adjusted birth rates for the United States, 1940-1990.

"Many authors have examined whether the National Center for Health Statistics should continue to use the 1940 U.S. population as the standard for the computation of age-sex-adjusted birth rates and age-adjusted death rates, or replace it by a more recent population. It is shown that standardization by using a single population as the standard leads to internally inconsistent results. The standardization technique suggested in this paper not only generates internally consistent rates, but also puts an end to the continuing debate as to which one of the actual populations should be used as the standard. The technique is applied to the U.S. data to recompute the adjusted birth and death rates for the years 1940-1990." (SUMMARY IN FRE AND ITA)

Americas↗