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Random samples of residents in North Wales, some of whom had been seen in 1976 and others in 1981, were seen again in 1984. Blood lead estimations indicated that there had been a fall of about 5% per year. This is similar to the fall we estimated from two previous studies in Wales and is comparable to changes described in the USA and New Zealand.
In the period 1961-84, the number of deaths in Ireland due to the testis cancer rose by 64%. This was due both to significant male population expansion (25.3%) and to an increased mortality rate. In the 25-34 years age group, one of the groups at highest risk, the mortality rate rose by 123%. In contrast, in England and Wales, although the male population has risen by 8.5% since 1961, the number of deaths has decreased by 17%. This is due to falling mortality rates, for example an 18% decrease in those aged 25-34 years. The highest rate of all occurred in those Irish over 75 years old. The changing Irish trends appear to lag behind those in England and Wales by some decades, and this raises important aetiological considerations.
STUDY OBJECTIVE: The aim was to investigate whether trends in mortality from cancer of the cervix uteri by age, marital status, and social class are compatible with current beliefs about the epidemiology of the disease. DESIGN: Data on mortality from cancer of the cervix for single and married women by age and social class were obtained from the Registrar General's Decennial Supplements on occupational mortality for the years 1950-53, 1959-63, 1970-72, and 1979, 1980, 1982, and 1983. Age standardised mortality rates were calculated directly by social class and marital status. SETTING: The data relate to all cases of carcinoma of the cervix reported in England and Wales in the years studied. MAIN RESULTS: There was a marked convergence of mortality between single and married women over the period within every social class grouping examined. The social class differential, however, remained essentially unchanged for both single and married women considered separately. CONCLUSIONS: Trends in mortality by marital status appear to reflect accurately the changes in the pattern of marriage and sexual behaviour that have taken place in the post-war period, whereas the patterns of other risk and protective factors such as screening explain these trends less well. In contrast, it seems likely that factors other than patterns of sexual behaviour and screening operate to maintain the social class differential in England and Wales.
STUDY OBJECTIVE: To identify and quantify the factors responsible for the differences in mortality between affluent and deprived areas, the north and the south, and urban and rural areas in England and Wales. DESIGN: A multiple Poisson regression analysis of cause specific mortality in the 403 local authority districts, each classified by deprivation (using the Jarman Index), latitude (from 50 degrees to 55 degrees north) and urbanisation, adjusting for age, sex, and proportion of ethnic minorities. SETTING: England and Wales 1992. MAIN RESULTS: All cause mortality was 15% higher in the districts comprising the most compared with the least deprived tenth of the population, 23% higher in the most northern (55 degrees) than in the most southern (50 degrees) districts, and 4% higher in metropolitan (within large cities) than rural districts. Nationally these differences were associated with 40,000, 65,000, and 15,000 excess deaths respectively. More than two thirds of the overall excess mortality with deprivation, latitude, and urbanisation was from three diseases--ischaemic heart disease, lung cancer, and chronic bronchitis and emphysema. The excess mortality from these and other diseases closely matched that predicted from differences according to deprivation and latitude in smoking, heavy alcohol consumption, Helicobacter pylori infection, and temperature, and thus could be attributed to these causes. About 85% of the overall excess mortality with deprivation was attributable to heavier smoking and 6% to heavier alcohol consumption, but diet varied little. Deaths more directly related to deprivation (such as those caused by H pylori infection, drug misuse, psychoses) accounted for an estimated 12% of the excess deaths, but variation in provision and uptake of healthcare services only 1%. The direct effects of deprivation are more strongly related to morbidity than mortality. Of the difference in mortality with latitude, about 45% was attributable to differences in smoking, and 25% to climate (mainly the association of cardiovascular and respiratory disease with cold). The differences with urbanisation were mainly because of smoking. CONCLUSIONS: Differences in the prevalence of smoking account for much of the variation in mortality between areas. Alcohol accounts for some, diet little. The more direct material effect of deprivation contributes to the variation in mortality but is particularly important with respect to differences in morbidity.
STUDY OBJECTIVE: To investigate the suicide risk of doctors in England and Wales, according to gender, seniority and specialty. DESIGN: Retrospective cohort study. Suicide rates calculated by gender, age, specialty, seniority and time period. Standardised mortality ratios calculated for suicide (1991-1995), adjusted for age and sex. SETTING: England and Wales. SUBJECTS: Doctors in the National Health Service who died by suicide between 1979 and 1995, identified by death certificates. Population at risk based on Department of Health manpower data. MAIN RESULTS: Two hundred and twenty three medical practitioners in the National Health Service who died by suicide or undetermined cause were identified. The annual suicide rates in male and female doctors were 19.2 and 18.8 per 100 000 respectively. The suicide rate in female doctors was higher than in the general population (SMR 201.8; 95% CI 99.7, 303.9), whereas the rate in male doctors was less than that of the general population (SMR 66.8; 95% CI 46.6, 87.0). The difference between the mortality ratios of the female and male doctors was statistically significant (p=0.01), although the absolute suicide risk was similar in the two genders. There were significant differences between specialties (p=0.0001), with anaesthetists, community health doctors, general practitioners and psychiatrists having significantly increased rates compared with doctors in general hospital medicine. There were no differences with regard to seniority and time period. CONCLUSIONS: There is an increased risk of suicide in female doctors, but male doctors seem to be at less risk than men in the general population. The excess risk of suicide in female doctors highlights the need to tackle stress and mental health problems in doctors more effectively. The risk requires particular monitoring in the light of the very large increase in the numbers of women entering medicine.
A register of families with Duchenne muscular dystrophy (DMD) in Wales was set up in 1973 and has been regularly maintained ever since. All women at significant risk in these families were offered estimation of their carrier status by creatine kinase and pedigree analysis. A total of 225 of the 512 women tested was assigned a risk of carrying the DMD gene of less than 5%. One hundred and twenty live births from this group were notified to the register and only one was an affected male. This was the expected number and shows that the risks given were largely accurate. Women given a risk of 5% or greater were offered fetal sexing with termination of any male. Amniocentesis was of limited value and chorionic villus sampling, introduced in 1984, was acceptable to more women at risk. The incidence of DMD in Wales dropped from one in 3435 at the beginning of the study to one in 4046 by 1982, and the proportion of recurrent cases from 40% to 22%. Common reasons for recurrence were birth of a second affected boy before diagnosis of the first, and failure of families with affected dead members in previous generations to be notified to the register. Maintaining an accurate register of DMD families is an essential tool in their management.
Mortality rates from motor neuron disease in England and Wales for the years 1959-1979 were studied through death certification data supplied by the Office of Population Censuses and Surveys. The age- and sex-adjusted mortality rate increased over the period from 1.2 per 100 000 per year in 1959-61 to 1.6 in 1977-79, the increase being most apparent in women over age 45 years and men over 60 years. The ratio of the sex-specific mortality rates remained fairly constant at 1.6:1 (male to female). The distribution of motor neuron disease deaths within England and Wales showed more variation between counties and between Hospital Regions than expected, and areas of high motor neuron disease mortality along the south coast and low mortality in the Midlands could be identified. The variation was most marked in those aged over 65 years at death. Examination of occupation, as listed on the death certificates, showed an excess of motor neuron disease deaths in leather workers in all three periods for which data were available (1959-63, 1970-72 and 1975). A small study of the certified cause of death of 56 motor neuron disease patients showed that a high percentage (88%) had motor neuron disease given as the cause of death.
BACKGROUND: Despite the high burden from exposure to both hot and cold weather each year in England and Wales, there has been relatively little investigation on who is most at risk, resulting in uncertainties in informing government interventions. OBJECTIVE: To determine the subgroups of the population that are most vulnerable to heat-related and cold-related mortality. METHODS: Ecological time-series study of daily mortality in all regions of England and Wales between 1993 and 2003, with postcode linkage of individual deaths to a UK database of all care and nursing homes, and 2001 UK census small-area indicators. RESULTS: A risk of mortality was observed for both heat and cold exposure in all regions, with the strongest heat effects in London and strongest cold effects in the Eastern region. For all regions, a mean relative risk of 1.03 (95% confidence interval (CI) 1.02 to 1.03) was estimated per degree increase above the heat threshold, defined as the 95th centile of the temperature distribution in each region, and 1.06 (95% CI 1.05 to 1.06) per degree decrease below the cold threshold (set at the 5th centile). Elderly people, particularly those in nursing and care homes, were most vulnerable. The greatest risk of heat mortality was observed for respiratory and external causes, and in women, which remained after control for age. Vulnerability to either heat or cold was not modified by deprivation, except in rural populations where cold effects were slightly stronger in more deprived areas. CONCLUSIONS: Interventions to reduce vulnerability to both hot and cold weather should target all elderly people. Specific interventions should also be developed for people in nursing and care homes as heat illness is easily preventable.
OBJECTIVES: To study incidence and mortality of leukaemias, cancer of the larynx, and other cancers near the petrochemical plant at Baglan Bay, in response to local concerns of an alleged cluster of cancers in the vicinity. METHODS: This is a small area study of cancer incidence, 1974-84 and of mortality, 1981-91 based on the national postcoded data held by the Small Area Health Statistics Unit and with population and socioeconomic data from the 1981 census. The study is centred on BP Chemicals Ltd, Baglan Bay, Port Talbot, West Glamorgan, South Wales and includes a general population sample of 115,721 people (1981 census) living within 7.5 km of the plant. Cancer incidence and mortality for all cancers, leukaemias, and cancer of the larynx were examined within 7.5 km and 3 km of the plant, and tests for decline in risk of these cancers with distance from the plant were carried out. Mortality from several other cancers possibly associated with the petrochemical industry was also studied. RESULTS: There were 5417 incident cancer cases and 2458 cancer deaths within 7.5 km of the plant during the periods of study. There was an 8% excess incidence of all cancers within 7.5 km, and a 24% excess of cancer of the larynx, consistent with a general excess of these cancers in West Glamorgan, but no apparent decline in incidence with distance from the plant, nor excess mortality. There was also no evidence of decline in leukaemia incidence or mortality with distance, at all ages or in children. Among the other causes included in the mortality study, there was an excess of multiple myeloma within 7.5 km, especially among women, and a significant decline in mortality from non-Hodgkin's lymphomas although there was no excess overall within 7.5 km. CONCLUSIONS: The apparent excess incidence of all cancers and cancer of the larynx within 7.5 km of the BP Chemical Ltd works was consistent with an excess more generally in West Glamorgan, possibly related, at least to some extent, to cancer registration in Wales. There was no excess mortality from these cancers. The results for multiple myeloma and especially non-Hodgkin's lymphomas may have been chance findings in view of the multiple tests of significance carried out in the study. A study of lymphatic and haematopoietic cancers near oil refineries in Great Britain is to be undertaken that will help put the findings of the present study in wider context.
OBJECTIVE: To determine whether there was an increased incidence of leukaemias and lymphomas in young people aged less than 25 years in the locality of a petrochemical plant at Baglan Bay, South Wales. METHODS: Geographical population based study to compare the observed and expected incidence of leukaemia and lymphoma with onset before the age of 25, in the years 1974 to 1991. The population was aged 0-24 years and lived within 1.5 and 3 km of the plant. The observed number of cases in various categories were compared with the expected numbers of cases calculated from the Welsh cancer registration rates. RESULTS: Although the observed numbers were generally greater than would be expected, none of the comparisons showed significant excess of leukaemias or lymphomas for any period of years. CONCLUSIONS: The study shows that the incidence of leukaemias and lymphomas in children and young people in the area around the BP Chemical site at Baglan Bay, South Wales, between the years 1974 and 1991 was not significantly greater than normal.
OBJECTIVES: To examine the mortality patterns of male and female farmers and farmers' wives in England and Wales. METHODS: Information on all deaths in England and Wales at ages 20-74 during the periods 1979-80 and 1982-90 was obtained from the Office of Population Censuses and Surveys. Proportional mortality ratios (PMRs) and proportional cancer mortality ratios (PCMRs) were used to compare the mortality of farmers with that of the general working population, and of farmers' wives with wives of all working men. RESULTS: Farmers and farmers' wives had high mortality from accidents and suicide and from certain respiratory diseases. Mortality from hernia was also raised. Deaths from cancer were generally below expectations, but the PMR for prostatic cancer was 112 (95%CI 106-118). The PMRs and PCMRs for oesophageal cancer were significantly increased in male farmers from two counties where cider is produced. CONCLUSIONS: The occupational hazards of farming continue to be associated with excess mortality, and most of the risks extend also to farmers' wives. Action is needed to reduce deaths, particularly from accidents and suicide.
One thousand and ninety-eight patients from Wales were treated in hospital for Crohn's disease between 1967 and 1976, which gave an overall 'period prevalence' for the disease of 40 cases/10(5) of the total population. The data were analysed for each of the 8 counties and for rural as well as urban populations of different sizes. The disease was significantly more common in the urban counties of Gwent and the 3 parts of Glamorgan compared with the remainder of Wales. The highest prevalence was in South Glamorgan (54 cases/10(5)) and the lowest in Dyfed (30/10(5)). There was a relatively small but highly significant difference in the prevalence for urban populations larger than 10 000 (47/10(5)) compared with smaller communities which were chiefly rural (34/10(5)).
Thirty six patients with hydatid disease have been investigated in the Radiology Departments of Cardiff hospitals between June 1973 and June 1984; thirty two of these patients are likely to have acquired the disease in Wales. There were 16 hepatic cysts, 3 renal cysts, 2 cerebral cysts, 15 pulmonary cysts, 1 pleural cyst, 1 recurrent spinal cyst, and 1 cyst of the broad ligament. The radiological features are discussed. These patients emphasize the higher incidence of hydatid disease in Wales, compared with other regions of the United Kingdom, and the need to consider this diagnosis in Welsh patients from rural areas, who have large pulmonary opacities, or hepatic, renal, or cerebral cystic abnormalities.
OBJECTIVE: To describe the recent epidemiology of genital Chlamydia trachomatis infection in England and Wales. DESIGN: Retrospective study of routinely available surveillance datasets and ad hoc prevalence studies. METHODS: Numbers of new cases of genital C trachomatis infection, obtained from the Department of Health and Welsh Office, were combined with the estimated mid-year resident population of England and Wales. Rates were analysed for trend over time using a log linear age period model in GLIM4. Ad hoc prevalence and case finding studies carried out over the past 20 years were critically assessed in terms of study design and testing methodologies. RESULTS: Attendance rates at genitourinary medicine (GUM) clinics were higher for women than men over the period 1989 to 1994 as were the number of laboratory reports. The highest rate of attendance (GUM clinic data) was for women aged 16 to 19 years. There was an overall significant linear decrease in the attendance rates over time for both men (p = 0.0172) and women (p = 0.0000) between 1989 and 1994. There was considerable variation in the prevalence of genital C trachomatis infection detected within different clinical settings, together with a substantial level of asymptomatic infection. CONCLUSIONS: Genital C trachomatis infection is broadly distributed throughout the sexually active population, with a substantial reservoir of asymptomatic infection among those generally perceived to be at low risk of a sexually transmitted infection. Young people, particularly women aged 16 to 19 years, are at highest risk of genital C trachomatis infection. This is of concern since younger women are more susceptible than older women to developing complications of chlamydial infection, such as pelvic inflammatory disease. The broad distribution of infection across all sexually active health service attenders and the high level of asymptomatic infection suggest that a new, screening based, approach to the control of genital C trachomatis infection is required. Recommendations are made as to the epidemiological research required to guide such work.
OBJECTIVE: To estimate the number of prevalent HIV infections in England and Wales at the end of 1991 and 1993. METHOD: A direct method was used whereby population estimates derived from the National Survey of Sexual Attitudes and Lifestyle (NATSAL) and prevalence data from the Unlinked Anonymous HIV Prevalence Monitoring Programme (UAPMP) were combined to produce estimates of the number of adults infected and alive in the population. RESULTS: In the population of England and Wales the numbers of prevalent infections for defined transmission categories, at the end of 1993, were as follows: 12,600 through sex between men, 2500 through injecting drug use, and 6900 through heterosexual intercourse. The overall estimate was 22,800 HIV seropositive individuals. CONCLUSIONS: The direct method attempts to provide an estimate of the number of HIV infections using population based survey data. These estimates are consistent with other approaches using independent methods. Such methods are essential for inferring recent HIV incidence, projecting future AIDS cases, and for healthcare planning.
OBJECTIVE: To describe the epidemiology of genital warts in England and Wales over the period 1971 to 1994. METHOD: Retrospective study of available statistics. RESULTS: The rate of attendance for genital warts increased by 390% and 594% for men and women respectively between 1971 and 1994. Most of this increase occurred between 1980 and 1986. From 1986 to 1991 virtually no change occurred, but since 1992 the rate of attendance has risen by 15%. The ratio of male to female cases has declined steadily from 1.85 in 1971 to 1.34 in 1994. Rates of attendance for first attack in men were highest in the 20 to 24 year age group whereas for women it peaked in those aged 16 to 24 years. Regional data indicate that the rate of attendance has increased consistently over England and Wales during this period. CONCLUSIONS: Rates of genital warts have risen substantially over the past 25 years. If these are a reflection of changes in sexual behaviour then the rise since 1992 is of considerable concern particularly for the incidence of cervical cancer in the coming decades.
BACKGROUND: The incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated. METHODS: A small area study using distance from source as a proxy for exposure was undertaken in subjects aged 65 or over and children under 5 years within 7.5 km of four coke works (1991 estimated populations 87 760 and 43 932, respectively). The main outcome measures were emergency hospital admissions in 1992/3-1994/5 with a primary diagnosis of coronary heart disease (ICD 410-414), stroke (ICD 431-438), all respiratory diseases (ICD 460-519), chronic obstructive pulmonary disease (ICD 491-492), and asthma (ICD 493) in those aged 65 or over, and all respiratory and asthma admissions in children under 5 years of age. RESULTS: At age 65 or over the combined estimate of relative risk with proximity to coke works (per km) ranged from 0.99 (95% CI 0.90 to 1.09) for chronic obstructive pulmonary disease to 1.03 (95% CI 0.94 to 1.13) for asthma. For children under 5 years the combined estimate of risk was 1.08 (95% CI 0.98 to 1.20) for all respiratory disease and 1.07 (95% CI 0.98 to 1.18) for asthma. There was evidence of significant heterogeneity in risk estimates between coke work groups, especially in children under 5 years (p<0.001 and p=0.004 for respiratory disease and asthma, respectively). For the Teesside coke works in North East England the relative risk with proximity (per km) was 1.09 (95% CI 1.06 to 1.12) for respiratory disease and 1.09 (95% CI 1.04 to 1.15) for asthma. CONCLUSIONS: No evidence overall was found for an association between hospital admissions and living near operational coke works in England and Wales. Trends of a higher risk of hospital admission for respiratory disease and asthma among children with proximity to the Teesside plant require further investigation.
Of the 231 laboratories carrying out sputum cytology in England and Wales, information on the staffing, laboratory procedures, workload, records, and results for the year 1971 was obtained from 228 (98.7%) by means of a questionnaire, which was completed in 1973 in 81% of the laboratories and at the end of 1972 in the remainder. At the time the questionnaire was completed, the number of laboratories per region offering a service ranged from 6 to 25. Most of the processing of specimens was done by technicians and non-medical screeners (technicians without recognized qualifications) and most of the microscopy by pathologists and technicians. Papanicolaou and/or haematoxylin and eosin stains were used in 97% of the laboratories. During 1971, the number of specimens tested per laboratory ranged from 9 to 6000. A median of 381 specimens and 165 patients were tested per laboratory. Almost all specimens were submitted by hospitals and chest clinics and only 1% by general practitioners. An estimated median of 6.5% of all cytological specimens were sputum, most of the remainder being cervical smears. Laboratories varied greatly in their positive (0%-24%) and doubtful positive (0%-27%) rates. An estimated 63 000 patients had their sputum tested in 1971, and about 6300 had positive reports, rather less than one-quarter of all patients diagnosed as having lung cancer in England and Wales in 1971. The cost of the service was estimated to be of the order of pound375 000 at 1974 prices; that is, pound2.50 per specimen or pound6.00 per patient tested. An improved service might best be provided by district general hospital laboratories testing at least 1000 specimens per year so that a high level of accuracy in reporting could be assurred. A large proportion of the microscopy might be done by non-medical graduates and technicians under the supervision of pathologists.