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PubMed1989

A computer program for analyses of vital statistics-based occupational mortality data.

Routinely collected vital statistics mortality data (death certificate data) on occupation and industry are useful for (1) generating hypotheses about potential occupational hazards and (2) identifying occupational mortality differentials possibly associated with socioeconomic and life-style factors. This paper presents a Fortran program that analyzes occupational mortality using vital statistics and census data. The user can form any desired grouping of age, race, occupation (or industry), and cause of death codes for analysis. The program also allows stratification on social class or other user-defined correlates of occupation such as smoking behavior. Furthermore, program output can be used for Poisson regression analysis of mortality rates.

California↗
PubMed1995

Formulas expressing life expectancy, survival probability and death rate in life table at various ages in US adults.

The National Center for Health Statistics (Monthly Vital Statistics Report, 41 (1993) 1-36; Pediatrics, 92 (1993) 743-754) reported the life table for the total population of the United States, 1992, on the basis of vital statistics. The life table shows life expectancy, survival and death rate at various ages. Formulas expressing death rate, survival probability and life expectancy at various ages in US adults are constructed from the data of the National Center for Health Statistics (NCHS). A mathematical model of the 'probacent'-probability equation previously published by the author is employed in this study. Analysis of the computer-assisted predicted values and the data reported by the NCHS indicates that the formulas are accurate and reliable with a close agreement in expressing death rate, survival probability and life expectancy at various ages in US adults of 25 years of age and older. The formulas can determine the relationship between the age and the death rate, the survival probability or the life expectancy and may be of value for epidemiologic evaluation of US adults.

Adult↗
PubMed1977

A vital statistics-based procedure for estimating conception rates.

A method for estimating conception rates, using vital statistics data, is developed and applied to data on five-year age groups of California women for 1971. The approach is deterministic and allocates total exposure time to the known pregnancy outcomes of live birth, spontaneous abortion, and induced abortion. The population at risk is defined to exclude women who are known to be sterile or sexually inactive. Early fetal loss, premarital conception, and contraceptive use are taken into account. Estimates are made of the fecundability which would obtain if no contraception were used.

Abortion, Induced↗
PubMed2000

Biostatistics in the new millennium: a consulting statistician's perspective.

This article attempts to predict the future for biostatistics and biostatisticians in the twenty-first century. Life will certainly be more complex and there will be growth in population, large corporations, and globalization generally. However, there will continue to be problems relating to biology, medicine, health and the environment, so biostatisticians can surely play an important role, if they are willing to adapt to changing circumstances. Personal views are expressed concerning those areas of most recent development that seem likely to be continued in the coming years: applications (clinical trials, epidemiology, vital statistics), philosophies, models, advances in computing, and the profession of biostatistics.

Biometry↗
PubMed1999

What is the leading cause of infant mortality? A note on the interpretation of official statistics.

OBJECTIVES: According to vital statistics reports, congenital malformation is the leading cause of infant death in the United States and accounts for a much greater proportion of infant mortality than does premature birth. The purpose of this study was to examine the potential underestimation of prematurity-related mortality in current vital statistics reports. METHODS: National mortality data from 1985, 1991, and 1996 were analyzed. RESULTS: The official statistics significantly understate the role of prematurity-related mortality. An alternative etiology-based classification designates prematurity as the underlying cause in approximately one third of all infant deaths. CONCLUSIONS: Although no single scheme is suitable for every objective, analysts and policymakers should recognize the degree to which technical classification practices can influence the apparent importance of various causes of death.

Asphyxia↗
PubMed1996

Preliminary data on births and deaths--United States, 1995.

Timely and accurate health data are essential to public health surveillance efforts for monitoring trends in vital events, diseases, injuries, and disabilities. More timely release of accurate vital statistics has been identified as a priority by health agencies at the federal, state, and local levels and in academia and the private sector. In response to the need for faster release of high-quality data, CDC's National Center for Health Statistics (NCHS), in collaboration with state vital statistics offices, has initiated a new system to speed the transmission of vital statistics from states to CDC. This initiative has resulted in the availability of near-final natality and mortality data approximately 1 year before final data usually are released. This report presents the selected findings of an analysis of preliminary birth and death records for 1995. The number of births in the United States declined for the fifth consecutive year to an estimated 3,900,089 in 1995, 1% fewer than the final 1994 total of 3,952,767 (Table 1). In addition, the estimated number of deaths in 1995 totaled 2,312,180 (Table 2), 1% more than the previous record high of 2,278,994 in 1994.

Birth Rate↗
PubMedDate not supplied

Discrepancies in the reported frequency of cocaine-related deaths, United States, 1983 through 1988.

OBJECTIVE: --To assess the validity of cocaine-related mortality data available from the principal federal sources of information about the frequency of drug abuse deaths in the United States: the national vital statistics system and the Drug Abuse Warning Network (DAWN). DESIGN, SETTING, AND PARTICIPANTS: --We compared the number of cocaine-related deaths reported to national vital statistics and DAWN from 25 metropolitan areas during the years 1983 through 1988. We also compared cocaine-related mortality data reported to national vital statistics with data from all published forensic case series of cocaine-related deaths that occurred during the mid-1980s. RESULTS: --During the 6-year study period, 75% more cocaine-related deaths were reported to DAWN (6057) than to national vital statistics (3466) from the 25 metropolitan areas that were studied. For individual metropolitan areas, the discrepancy between DAWN and vital statistics counts of cocaine-related deaths was as large as a sixfold difference. In six of the seven forensic case series identified in our literature search, the number of cocaine-related deaths exceeded the number of these deaths reported to vital statistics. The largest discrepancy was for cocaine-related deaths in New York, NY, during a 10-month period in 1986 for which 151 deaths were reported in a case series and seven deaths were reported to vital statistics. CONCLUSION: --Improvements in existing public health surveillance systems are needed for (1) full and accurate measurements of the lethal impact of drug abuse epidemics and (2) valid and comprehensive assessments of the effectiveness of national programs designed to prevent drug-related morbidity and mortality.

Cause of Death↗
PubMed2006

Death certificates are not reliable: revivification of the autopsy.

BACKGROUND: Medicine assumes that vital statistics are accurate, but they are only as good as the death certificates. OBJECTIVE: To evaluate the accuracy of death certificates in reporting vital statistics with an emphasis on cardiac deaths. DESIGN: A population-based retrospective study within one community hospital. PATIENTS: During the study period, 1,619 patients expired during hospitalization, of which 223 underwent autopsy. INTERVENTIONS: Clinical diagnoses were determined from the death certificate and autopsy results from the final pathology reports. MEASUREMENTS: Concordance of myocardial infarction as the underlying cause of death between the death certificate and the autopsy was measured. New diagnoses uncovered by the autopsy were tabulated. RESULTS: The death certificate missed acute myocardial infarction in 25 of 52 autopsy-proven cases (48% errors of omission). Conversely, it erroneously asserted the presence of an acute myocardial infarction in 9/36 cases (25% errors of commission). Autopsy showed these nine cases actually were pneumonia (5), sepsis with ARDS (2), cerebral hemorrhage (1), and cardiac tamponade (1). Autopsy proved 52 myocardial infarctions causing death, while death certificates accurately reported only 27. Myocardial infarction was more likely to be unsuspected in extreme ages, in women, when found in right ventricle or posterior wall, and in the presence of sepsis or ARDS. Death certificates were frequently inaccurate and in 21.5% of cases were of no value because of an inadequate diagnosis, ie, cardiopulmonary arrest, arrhythmia or respiratory failure. CONCLUSION: Major discrepancies of commission and omission occur frequently between the death certificate and autopsy. 1) Death certificates are often wrong. 2) The time-honored autopsy is more valuable than ever. 3) Physicians need to write better death certificates and correct them. 4) Death certificate-based vital statistics should be corrected with autopsy results. 5) Vital statistics should note deaths confirmed by autopsy. 6) More autopsies would improve vital statistics and the practice of medicine.

Adult↗
PubMed2005

A comparison of two surveillance systems for deaths related to violent injury.

OBJECTIVE: To compare violent injury death reporting by the statewide Medical Examiner and Vital Statistics Office surveillance systems in Oklahoma. METHODS: Using a standard study definition for violent injury death, the sensitivity and predictive value positive (PVP) of the Medical Examiner and Vital Statistics violent injury death reporting systems in Oklahoma in 2001 were evaluated. RESULTS: Altogether 776 violent injury deaths were identified (violent injury death rate: 22.4 per 100 000 population) including 519 (66.9%) suicides, 248 (32.0%) homicides, and nine (1.2%) unintentional firearm deaths. The Medical Examiner system over-reported homicides and the Vital Statistics system under-reported homicides and suicides and over-reported unintentional firearm injury deaths. When compared with the standard, the Medical Examiner and Vital Statistics systems had sensitivities of 99.2% and 90.7% (respectively) and PVPs of 95.0% and 99.1% for homicide, sensitivities of 99.2% and 93.1% and PVPs of 100% and 99.0% for suicide, and sensitivities of 100% and 100% and PVPs of 100% and 31.0% for unintentional firearm deaths. CONCLUSIONS: Both the Vital Statistics and Medical Examiner systems contain valuable data and when combined can work synergistically to provide violent injury death information while also serving as quality control checks for each other. Preventable errors within both systems can be reduced by increasing training, addressing sources of human error, and expanding computer quality assurance programming. A standardized nationwide Medical Examiners' coding system and a national violent death reporting system that merges multiple public health and criminal justice datasets would enhance violent injury surveillance and prevention efforts.

Homicide↗
PubMed2003

Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico.

New Mexico leads the nation in poisoning mortality, which has increased during the 1990s in New Mexico and the United States. Most of this increase has been due to unintentional deaths from illicit drug overdoses. Medical examiner and/or vital statistics data have been used to track poisoning deaths. In this study, the authors linked medical examiner and vital statistics records on underlying cause of death, coded using the International Classification of Diseases, Ninth Revision, to assess the extent to which these data sources agreed with respect to poisoning deaths. The authors used multiple-cause files, which are files with several causes listed for each death, to further assess poisoning deaths involving more than one drug. Using vital statistics or medical examiner records, 94.7% of poisoning deaths were captured by each source alone. For unintentional illicit drug and heroin overdose deaths, each data source alone captured smaller percentages of deaths. Deaths coded as E858.8 (unintentional poisoning due to other drugs) require linkage with medical examiner or multiple-cause records, because this code identifies a significant percentage of illicit drug overdose deaths but obscures the specific drug(s) involved. Surveillance of poisoning death should include the use of medical examiner records and underlying- and multiple-cause vital statistics records.

Adult↗
PubMed1994

Attempt at deriving a formula for setting general practitioner fundholding budgets.

OBJECTIVE: To explore the possibility of using routine Hospital Episode Statistics, census data, and vital statistics to derive weights for an equitable capitation formula for setting general practitioner fundholding budgets for buying acute hospital services. DESIGN: Analysis of a routine dataset of 9 million hospital episodes in 1991-2, extracting elective general practitioner fundholding procedures, combined with 1991 census variables, vital statistics, and data on supply of health care at ward level. Costs were attached to each procedure according to the average cost of the relevant "Mersey" band category. MAIN OUTCOME MEASURES: Variation in age and sex adjusted expenditure per head on fundholding procedures across wards modelled for the impact of health and social needs variables after adjusting for variations in supply. RESULTS: No sensible simple model including determinants of use other than age and sex could be derived. The most parsimonious but statistically acceptable model showed that though standardised mortality ratio and self reported illness and several social class variables were associated with utilisation, the signs and the size of the coefficients were contradictory. The most important explanation of variation was provided by age and sex differences between wards. CONCLUSIONS: An equitable system of setting general practitioner fundholders' budgets is needed. In the short term age and sex weighted capitation should form the principal basis of fundholder budgets. Utilisation data at ward level are inadequate for developing a formula which adequately adjusts for the differences in the health care needs of populations. A capitation formula based on information derived from individual cohort data may be the only means of promoting equity and efficiency and of avoiding discriminating against patients with known high cost health problems.

Adolescent↗
PubMed2000

Teenage childbearing in the United States, 1960-1997.

Teenage childbearing in the United States has declined significantly in the 1990s. Still the U.S. teen birth rate is higher than in other developed countries; in 1997 it was 52.3 births per 1000 women aged 15 to 19. A steep rise in teen birth rates in the late 1980s generated a great deal of public concern and a variety of initiatives targeted to reducing teen births. Data from the National Center for Health Statistics' National Vital Statistics System are used to review and describe trends and variations in births and birth rates for teenagers for the period 1960-1997. Teen birth rates were much higher in the early 1960s than at present; in fact, rates for 18- to 19-year-olds were double what they are currently. In the 1990s, birth rates for teenagers dropped for younger and older teenagers, with greater declines recorded for younger teens. While rates have fallen in all population groups, the greatest declines have been experienced by black teenagers, whose rates have dropped 24% on average. %Trends in teen births and birth rates since 1960 have been affected by a variety of factors. These include wide swings in the number of female teenagers, substantial declines in marriage among older teens, falling birth rates for married teens concurrent with rapidly rising birth rates for unmarried teens, and sharp increases in sexual activity among teens that have abated only recently, according to the National Center for Health Statistics' National Survey of Family Growth. This review article also tracks changes in contraceptive practice and abortion rates.

Adolescent↗
PubMedDate not supplied

Fertility in persons with epilepsy: 1935-1974.

Data from the Rochester-Olmsted County Medical Records Linkage Project were utilized to assess fertility in persons with epilepsy. Population age-specific reproduction rates for Rochester residents for the years 1935-1974 were estimated using the number of live births from the Minnesota Department of Health Statistics and Vital Statistics of the U.S. for comparison with rates in affected persons. Overall, fertility rates were significantly reduced to 80% of expected for affected males and 85% for affected females. Individuals with partial seizures (simple and complex) were disadvantaged, whereas those with generalized onset were not. During the last 20 years of the study period, males were more disadvantaged than females. The male-female difference was greatest during the time of low population fertility (after 1965). Male deficits were more marked after diagnosis; female deficits were more marked before diagnosis. Differences in the proportion of ever-married person-years between the sexes only partially explain the observed differences.

Adolescent↗
PubMed2002

Education, income inequality, and mortality: a multiple regression analysis.

OBJECTIVE: To test whether the relation between income inequality and mortality found in US states is because of different levels of formal education. DESIGN: Cross sectional, multiple regression analysis. SETTING: All US states and the District of Columbia (n=51). DATA SOURCES: US census statistics and vital statistics for the years 1989 and 1990. MAIN OUTCOME MEASURE: Multiple regression analysis with age adjusted mortality from all causes as the dependent variable and 3 independent variables-the Gini coefficient, per capita income, and percentage of people aged >/=18 years without a high school diploma. RESULTS: The income inequality effect disappeared when percentage of people without a high school diploma was added to the regression models. The fit of the regression significantly improved when education was added to the model. CONCLUSIONS: Lack of high school education accounts for the income inequality effect and is a powerful predictor of mortality variation among US states.

Adult↗
PubMed2002

Recent trends in mortality rates for four major cancers, by sex and race/ethnicity--United States, 1990-1998.

In 1998, 53% of all cancer-related deaths in the United States were associated with four sites: lung/bronchus, colon/rectum, prostate, and female breast. Cancer-related death does not affect racial/ethnic populations similarly. In 1996, the National Cancer Institute (NCI) published cancer incidence and death rates during 1988-1992 in 10 categories of race/ethnicity. To examine trends during 1990-1998 in annual death rates for the four major cancers by sex and race/ethnicity (i.e., blacks, whites, Hispanics, American Indians/Alaska Natives [AI/ANs], and Asians/Pacific Islanders [APIs]), CDC analyzed data from the National Center for Health Statistics' National Vital Statistics System. This report summarizes the results of that analysis, which indicated that, except for lung cancer in women and lung, colorectal, and breast cancer in AI/ANs, trends in death rates from these cancers have generally declined. But the rates remained high for blacks, have not decreased equally among all populations, and have increased in certain instances. Continuing research and prevention efforts are needed to reach high-risk and underserved populations and to understand the reasons for differences in cancer mortality among racial/ethnic populations.

Breast Neoplasms↗