Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “causes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 613 records · Page 34Linked to original sources
PubMed2000

[Equivalence between revisions of the International Classification of Diseases: causes of death].

OBJECTIVE: To evaluate the comparability of the underlying cause and multiple causes of death identified according to the ninth and tenth revisions of the International Classification of Diseases. METHODS: Study data was obtained by a random sample of 3,313 death certificates of individuals living in the State of S. Paulo and whose death was registered during the year of 1992. They corresponded to 1.6% of the total deaths of that year. The corresponding file was processed by the Automated Classification of Medical Entities system, and codes were assigned to all mentioned conditions. The underlying cause of death had been evaluated and revised according to the ninth revision. All the conditions mentioned on the medical form of the corresponding death certificates were coded according to the tenth revision and the codes were introduced in the original file in order to assess the causes of death by the Declarações de Obito de S. Paulo system to obtain the underlying cause of death. Multiple causes of death tabulations for both ninth and tenth revisions codes were produced by the respective versions of the Multiple Causes of Death Tabulator software. The comparisons of causes of death are circumscribed to the chapters of both revisions. RESULTS/CONCLUSIONS: The most important changes with the underlying causes of death occurred in chapters I, III and VIII of the ninth revision and the corresponding chapters I, IV and X of the tenth revision of the International Classification of Diseases. They were due to the displacement of deaths related to the human immunodeficiency virus disease and the dismissal of pneumonias as a cause of death. Regarding multiple causes of death, it was observed an increase ofrespiratory diseases and a corresponding reduction of causes included in the chapter of ill-defined affections due to recoding of respiratory failure.

Brazil↗
PubMed2000

High cardiovascular disease mortality in subjects with visual impairment caused by diabetic retinopathy.

OBJECTIVE: The aim of this study was to assess mortality and causes of death in subjects with visual impairment caused by diabetic retinopathy (DR). Only limited data are available concerning the mortality of subjects with DR, and to our knowledge, no data so far have been published on the mortality of subjects with visual impairment caused by DR. RESEARCH DESIGN AND METHODS: We identified 34 men and 73 women living in northern Finland with visual impairment caused by DR on 31 December 1993. The median age of the subjects was 71 years (range 27-88). The mortality of these 107 diabetic subjects was followed up for 4 years, until 31 December 1997, and compared with the mortality rates of 3 age- and sex-matched control groups. The first control group consisted of subjects treated for DR by laser coagulation from 1990 to 1993. The second control group consisted of diabetic subjects who had had fundus photographs taken from 1991 to 1992. The third control group comprised nondiabetic subjects selected from the population register. Information on deaths was obtained from official death certificates. RESULTS: A total of 91 diabetic and 10 nondiabetic subjects died during the follow-up. Of the deaths, 51 occurred in the subjects with visual impairment caused by DR, with a 4-year mortality rate of 477/1,000 (95% CI 382-571/1,000). Mortality rates were 224/1,000 (145-303/1,000) for the diabetic subjects with retinopathy treated by laser coagulation; 150/1,000 (82-217/1,000) for the diabetic subjects who had undergone fundus photography; and 94/1,000 (46-165/1,000) for the nondiabetic subjects. Cardiovascular diseases were the underlying cause of death in 55% of the subjects with visual impairment. Nephropathy was mentioned as the immediate cause of death for only 10% of the subjects. Compared with the nondiabetic control subjects, the odds ratios (ORs) for all-cause mortality were 5.1 (2.6-11) in the diabetic subjects with visual impairment caused by DR, and 5.6 (2.1-19) for mortality caused by diseases of the circulatory system. The ORs for all-cause mortality were 2.4 (1.1-5.6) in the diabetic subjects with retinopathy treated by laser coagulation and 1.6 (0.68-4.0) in the diabetic subjects with fundus photographs taken. CONCLUSIONS: The survival of diabetic subjects with visual impairment caused by DR was poor. The high mortality rate was attributed mainly to cardiovascular diseases. Therefore, severe retinopathy proves to be a risk marker of cardiovascular death in diabetic patients.

Adult↗
PubMed2003

[Causes of death in a cohort of EDF-GDF employees: comparison between occupational medicine and official statistics data].

BACKGROUND: In an epidemiological study, medical causes of death may be obtained from different sources. In a study on French gas and electricity company (EDF-GDF) workers, they were obtained from the national INSERM database. Additionally, the causes collected by the EDF-GDF occupational physicians were available for a subset of 1,330 deaths, which occurred between 1989 and 1994. The data from the two sources were compared with each other, in order to assess whether they were globally equivalent, and the potential impact of their differences on the results of epidemiological analyses. METHODS: Concordance rates between causes of death in the INSERM and EDF-GDF physicians databases were calculated according to the International Classification of Diseases (ICD) ninth revision codes and for various causes groups. Causes of death records were also examined in order to clarify the observed divergences. SMRs were computed in order to evaluate the consequences of using each database in epidemiological analyses. Finally, some SMRs were computed with the two sources and compared with each other. RESULTS: INSERM and EDF-GDF physicians causes belonged to the same causes group in 81% of cases, but the exact cause was different for more than half of them. The concordance rate was high for the deaths by AIDS and by cancer, and low for deaths by respiratory system and digestive system diseases. More causes of death were coded as "unknown" in EDF-GDF physicians data than in INSERM data. The SMRs varied widely depending on whether the INSERM or EDF-GDF physicians causes of death databases were used. CONCLUSIONS: Causes of death recorded in the INSERM and EDF-GDF physicians databases are very different. Therefore, using the national mortality rates computed by INSERM with the EDF-GDF physicians causes of death to calculate SMRs is not valid, and it is observed that they may be very different from those computed with INSERM data. In a general way, it should be better to use the INSERM database, which is a common source, in order to generate results comparable with other studies. However, this database has its own limitations, and it may be better, in particular situations and for internal analyses, to use another source if it seems to be a better one.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Causes and costs of spinal cord injury in the United States.

A cross-sectional multicenter study was conducted to estimate the direct costs for each cause of spinal cord injury in the United States. Random samples of 227 new injuries and 508 persons 2-16 years postinjury were selected. Prospective data were collected during one year on all charges for emergency medical services, hospitalizations, attendant care, equipment, supplies, medications, environmental modifications, physician and outpatient services, nursing homes, household assistance, vocational rehabilitation, and miscellaneous items. In 1995 dollars, first year charges averaged $233,947 for vehicle crashes, $217,868 for violence, $295,643 for sports, $185,019 for falls and $208,762 for other causes. Recurring annual charges for each cause averaged $33,439, $17,275, $27,488, $26,238 and $23,510, respectively. Using average age at time of injury for each cause, a 2% real discount rate, and the most recent survival data from the National Spinal Cord Injury Statistical Center, average lifetime charges for each cause were $969,659, $613,345, $950,973, $630,453 and $673,749, respectively. Given an estimated 10,000 new cases of spinal cord injury occurring each year of which 35.9% are caused by vehicle crashes, 29.5% are caused by violence, 20.3% are caused by falls, 7.3% are caused by sports, and 7% result from other causes, annual aggregate direct costs of traumatic spinal cord injury in the United States are $3.48 billion for vehicle crashes, $1.81 billion for violence, $1.28 billion for falls, $694 million for sports and $472 million for other causes. Total direct costs for all causes of SCI in the United States are $7.736 billion.

Accidental Falls↗
PubMed2000

Cause-specific perinatal death rates, birth weight and deprivation in the West Midlands, 1991-93.

OBJECTIVES: To study the relationship between cause-specific perinatal death rates, material deprivation and birthweight among births in 3 consecutive years in the West Midlands Health Region. STUDY DESIGN: Retrospective cohort study. SETTING: West Midlands Health Region (WMHR). STUDY POPULATION: All births (live and stillbirths) to mothers with addresses in the WMHR in 1991, 1992 and 1993. MAIN OUTCOME MEASURES: Cause-specific perinatal death rates--crude and stratified by birthweight. METHODS: Perinatal deaths in the WMHR in 1991-93, collected as part of the national Confidential Enquiry into Stillbirths and Deaths in Infancy, were classified into causes of death by the extended Wigglesworth classification. Crude rates for cause-specific perinatal deaths and rates stratified by birthweight < 2500 g and > or = 2500 g were calculated for each enumeration district (ED) quintile derived by ranking enumeration districts for the whole of the region by Townsend Deprivation Index. Cause-specific rates of death were investigated for a linear trend across ED quintiles. The relative risk of death (most vs least deprived) from specific causes was calculated. Using rates for the least deprived quintile as the reference, deaths from each cause 'attributable' to social inequality were calculated. RESULTS: Positive linear trends in perinatal deaths were noted with increasing deprivation for each specific cause of death except those classified as 'other causes' (Wigglesworth Class E). Relative risk (most vs least deprived) of perinatal death with a congenital anomaly was 1.98 (confidence interval, CI: 1.36,2.89). For deaths related to antepartum events, intrapartum events and immaturity the risks were 1.81 (CI: 1.39,2.38), 1.48 (CI: 1.10,1.98) and 1.92 (CI 1.45,2.56), respectively. Forty-three (35.7%) perinatal deaths per year were due to congenital anomalies, 63 (29.7%) antepartum events, 36 (21.9%) intrapartum events and 61 (32.7%) immaturity and these were statistically 'attributable' to social inequality. Cause-specific perinatal death rates for babies < 2500 g showed no correlation with deprivation; however, for babies > or = 2500 g the association with deprivation persisted. CONCLUSIONS: All cause-specific rates except those due to 'other causes' showed a positive linear trend with increasing deprivation. These trends were found for infants born > or = 2500 g but were not seen for low birthweight infants (< 2500 g). Almost 30% of deaths were statistically 'attributable' to social inequality. The results of this study suggest that material deprivation plays an important role in the causal pathway leading to perinatal death and needs to be addressed in preventive programmes aimed at the reduction of perinatal deaths.

Birth Weight↗
PubMed2003

Causes of visual impairment in two older population cross-sections: the Blue Mountains Eye Study.

AIMS: To describe the causes of bilateral and unilateral blindness and visual impairment in two cross-sections of an older Australian population 6 years apart. METHODS: The Blue Mountains Eye Study examined 3654 persons aged 49-97 years during 1992-1994 (population cross-section 1). Cohort survivors (2335) and 1174 persons who moved to the area or reached an eligible age were examined during 1997-2000, a total of 3509 persons (population cross-section 2). LogMAR visual acuity was measured after standardized refraction. Blindness and visual impairment were respectively defined by visual acuity <6/60 and <6/12. Causes were determined for the two temporal cross-sections. RESULTS: Age-related macular degeneration (AMD) was the principal cause of bilateral and unilateral non-correctable blindness in both cross-sections. AMD caused 77% of bilateral blindness in Cross-section 1 and 50% in Cross-section 2. Cataract, glaucoma, corneal and neurological disease were next equally frequent causes (6% each) of bilateral blindness in Cross-section 1. In Cross-section 2, cataract ranked as the third most frequent principal cause (10%) after other retinal diseases (40%). The proportion of unilateral blindness with AMD as principal cause was very similar (around one-third of cases) in the two cross-sections; while in Cross-section 2 blindness was less frequently caused by cataract (19% vs. 13%). Cataract was the principal cause of both bilateral and unilateral visual impairment, responsible for 50% of bilateral (better eye) and 35-40% of unilateral (worse eye) impairment, with slightly lower rates found in Cross-section 2 than in Cross-section 1. AMD was consistently the second most frequent cause, causing one-third of bilateral and one-fifth of unilateral visual impairment. CONCLUSIONS: These data indicate a relative stable pattern of causes for blindness and visual impairment, with AMD and cataract, respectively, dominating these two levels.

Aged↗
PubMed1994

Self-reported causes of physical disability in older people: the Cardiovascular Health Study. CHS Collaborative Research Group.

OBJECTIVE: To determine the major conditions and symptoms reported to cause difficulty in 17 physical tasks of daily life and the criterion validity of self-report of diseases given as the causes of the difficulty in functioning, in community-dwelling older people. DESIGN: Cross sectional analyses of data obtained in an observational cohort study. SETTING: Research clinics in four US communities: Winston-Salem, NC, Hagerstown, MD, Pittsburgh, PA, and Sacramento, CA. PARTICIPANTS: 5201 community-dwelling people > or = 65 years old. RESULTS: Arthritis and other musculoskeletal diseases were given as the primary causes of difficulty in performing physical tasks by 49.0% of the participants reporting difficulty in any task, followed by heart disease (13.7%), injury (12.0%), old age (11.7%), lung disease (6.0%), and stroke (2.9%). The self-reports of diseases that caused disability varied by task. Whereas arthritis was given as a cause of difficulty in most of the 17 different tasks, heart and lung disease were more likely to be reported as causing difficulty with activities requiring high aerobic work capacity such as walking one-half mile or doing heavy housework. Stroke was more likely to be reported as causing difficulty with use of the upper extremities and in performing basic activities of daily living. There was a high degree of consistency (91%) between the diseases and symptoms reported to cause disabilities. The percentage of people who reported a disease as the cause of their difficulty performing a task and had independent confirmation of the diagnosis was 85% in men and 71% in women, and varied according to type of disease and the individual's cognitive status and health status. CONCLUSION: These data suggest that age-related chronic diseases are important causes of disability in older people but that the type of disability is dependent on the underlying disease that causes the disability. Also, self-report of the cause of disability appears to be generally accurate but is influenced by gender, health status, and type of disease.

Activities of Daily Living↗
PubMed1995

Geographic variation in reporting of stroke deaths to underlying or contributing causes in the United States.

BACKGROUND AND PURPOSE: This study examines the geographic variation in the reporting of deaths with stroke as the underlying or contributing cause in the United States. METHODS: Data from the National Center for Health Statistics and Bureau of the Census were used to map the geographic distribution of race- and race/sex-specific, underlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates in the United States by state for 1979 through 1981. RESULTS: Underlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates were significantly clustered for both whites and blacks. However, the spatial distributions of underlying- and contributing-cause rates differed; there was no association between underlying- and contributing-cause rates for either racial group or for the various race/sex groups. There was no association between nonstroke mortality and stroke mortality rates. There was also very little spatial variation and no spatial clustering of the median number of contributing causes reported. CONCLUSIONS: The overall large-scale spatial distribution of resident underlying-cause stroke mortality rates cannot be explained by geographic variation in the selection of the underlying cause of death from among all causes reported on the death certificate, by different area-dependent tendencies for mortality generally, or by different tendencies to consider stroke as the cause of death when death occurs. Geographic variation in contributing-cause rates is not explained by variation in tendency to report contributing causes of death.

Age Factors↗
PubMed1982

New dimensions in cause of death statistics.

This article discusses the limitations of traditional national cause of death statistics. These limitations derive from an attempt to conceptualize a multidimensional phenomenon and reduce down to a unidimensional framework. The article outlines the characteristics of a new multidimensional approach which involves the codification and tabulation of all causes (multiple causes) listed on death certificates. Preliminary data are presented which illustrate that multiple cause of death data do indeed represent a major new dimension to cause of death statistics. These data indicate that most major causes of death are contributory factors in many deaths in which they are not the underlying cause of death. For example, in 1976, diabetes mellitus was the underlying cause of approximately 35,000 deaths but was a contributing factor in another 100,000 deaths. This paper also demonstrates the contribution of multiple cause of death data to identifying patterns of association among diseases and the kinds of injuries resulting from various external causes. Finally, data are presented which depict the use of multiple cause data in evaluating the efficacy of the coding rules used to classify the underlying cause of death.

Computers↗
PubMed2003

Prevalence and clinical outcomes of patients with multiple potential causes of syncope.

OBJECTIVE: To determine the prevalence, predictors, and prognosis of patients with multiple potential causes of syncope. PATIENTS AND METHODS: This is a retrospective cohort study with prospective follow-up of consecutive patients with syncope of uncertain cause who were referred to the electrophysiology service for syncope evaluation from January 1, 1996, through December 31, 1998. The main outcome measures were prevalence of multiple potential causes of syncope, survival of patients with multiple potential causes of syncope compared with survival of patients with a single cause, and clinical predictors of multiple potential causes of syncope. RESULTS: A total of 987 patients were studied (mean +/- SD age, 58.0 +/- 21.4 years; male, 550 [55.7%]). Multiple potential causes were present in 182 patients (18.4%). Patients with multiple potential causes of syncope had a lower survival rate at 4 years, 73.1% (95% confidence interval, 64.6%-82.8%), vs those with a single cause, 89.3% (95% confidence interval, 86.4%-92.2%) (P < .001). Multivariate predictors of multiple potential causes were older age, atrial fibrillation, use of cardiac medications, and New York Heart Association classification II, III, and IV. CONCLUSION: Of the patients evaluated for syncope, 18.4% had multiple potential causes. The presence of multiple potential causes was an independent predictor of increased mortality among patients with syncope.

Age Factors↗
PubMed1989

Cause-specific actuarial survival analysis: a useful method for reporting survival data in men with clinically localized carcinoma of the prostate.

The primary objective of this retrospective 15-year survival analysis of 57 men with clinical stage B1 carcinoma of the prostate undergoing radical prostatectomy between 1951 and 1963 is to compute the cause-specific curve for these men and argue why it is a useful method to report survival data in men with clinically localized prostatic cancer. Historically, survival following radical prostatectomy and radiotherapy has been reported using all cause survival analysis. Cause-specific survival focuses on the impact of a disease process on survival, since men dying of causes unrelated to carcinoma of the prostate are considered lost to followup as of date of death of such unrelated causes. Cause-specific survival analysis reduces the impact of age, medical condition and other risk factors on survival rates. The cause-specific 15-year actuarial survival rate in our patients was 86 per cent. The 95 per cent confidence interval for this 15-year survival rate was 76.9 to 90.1 per cent. Based upon this series of patients with clinical stage B1 carcinoma of the prostate who undergo radical prostatectomy one may state that the chance of death of carcinoma of the prostate within 15 years of surgery averages 14 +/- 5 per cent. The cause-specific survival curve reached a plateau at 10 years, indicating that most men who survive 10 years are cured of the disease. With the Cox model regression analysis, mortality in this series was related positively to age at operation when the outcome variable was death of all causes (p equals 0.003) but it was unrelated to age when the outcome variable was prostate cancer mortality (p equals 0.85). Cause-specific survival rates are a more precise indicator of the impact of a therapeutic modality on survival and, therefore, they are useful to report survival data in men with localized carcinoma of the prostate and other disease when death from competing causes is an important consideration.

Actuarial Analysis↗
PubMed1997

National adaptations of the ICD rules for classification--a problem in the evaluation of cause-of-death trends.

In 1981, the registration routines of the Swedish cause-of-death register were adjusted. The aim of this study was to assess what influence these changes in registration practice might have had on the cause-of-death trends after 1981. The Eighth Revision of the International Classification of Diseases (ICD-8) was used throughout the study period (1976-1985). Significant changes in the registered number of cases were found in 13 of the 18 diagnostic groups scrutinized. Four main types of outcomes were observed: (a) the number of underlying causes increased while the number of contributing causes decreased or vice versa; (b) the number of both underlying and contributory causes changed in the same direction, due to the transfer of a diagnostic group from one ICD category to another; (c) the number of both underlying and contributory causes changed in the same direction, but not due to the transfer of a diagnostic group; or (d) the number of either underlying or contributory causes changed, but not both. In general, the altered registration practice led to more conditions that are often considered as terminal complications to other diseases being registered as the underlying cause of death. While most of the 1981 instructions meant a more literal application of the ICD-8, those concerning cardiac valvular diseases deviated substantially from it. We conclude that (a) important changes in registration practice may occur at any point in time, and not only in connection with the implementation of a new version of the ICD; and (b) national adaptations of the ICD coding instructions may amount to a reversal of the instructions included in the ICD manuals. These findings must be considered when comparing cause-of-death statistics from different countries, and both underlying and contributing cause-of-death statistics should be considered in such analyses of cause-of-death trends.

Cause of Death↗
PubMed2001

Effect of misclassification of causes of death in verbal autopsy: can it be adjusted?

BACKGROUND: Verbal autopsy (VA) is an indirect method of ascertaining cause of death from information about symptoms and signs obtained from bereaved relatives. This method has been used in several settings to assess cause-specific mortality. However, cause-specific mortality estimates obtained by VA are susceptible to bias due to misclassification of causes of death. One way of overcoming this limitation of VA is to adjust the crude VA estimate of cause-specific mortality fractions (CSMF) using the sensitivity and specificity of the VA tool. This paper explores the application of sensitivity and specificity of VA data obtained from a hospital-based validation study for adjusting the effect of misclassification error in VA data obtained from a demographic surveillance system. METHOD: Data from a multi-centre validation study of 796 adult VA, conducted in Tanzania, Ethiopia and Ghana, were used to explore the effect of distribution of causes of death in the validation study population and the pattern of misclassification on the sensitivity and specificity of VA. VA estimates of CSMF for six causes (acute febrile illness, diarrhoeal diseases, TB/AIDS, cardiovascular disorders, direct maternal causes and injures) were obtained from a demographic surveillance system in Morogoro Rural District in Tanzania. These were adjusted for misclassification error by using sensitivity and specificity values of VA obtained from the validation study in a model proposed for correcting the effect of misclassification error in morbidity prevalence surveys. RESULTS: Sensitivity and specificity of VA differed between the three validation study sites depending on the distribution of causes of death. These differences were explained by variations in the level and pattern of misclassification between sites. When these estimates of sensitivity and specificity were applied to data from the demographic surveillance system with a comparable structure of causes of death the difference between crude and adjusted VA estimates of CSMF ranged from 3 to 83%. CONCLUSION: Estimates of sensitivity and specificity obtained from hospital-based validation studies must be used cautiously as a de facto 'gold standard' for adjusting the misclassification error in CSMF derived from VA. It is not possible to use sensitivity and specificity estimates derived from a location-specific validation study to adjust for misclassification in VA data from populations with substantially different patterns of cause-specific mortality.

Autopsy↗
PubMed2003

Effects of misclassification of causes of death on the power of a trial to assess the efficacy of a pneumococcal conjugate vaccine in The Gambia.

BACKGROUND: A reduction in cause-specific mortality may be the most important public health measure of the efficacy of a new vaccine. However, in developing countries, assignment of causes of deaths occurring outside hospitals can be assessed often only through the questioning of relatives about the signs and symptoms leading to death ('post-mortem questionnaire'). Causes assigned in this way have poor sensitivity and specificity. We illustrate the effects of this misclassification on the power of a large trial of a pneumococcal polysaccharide/protein conjugate vaccine with a mortality endpoint. METHODS: Required sample sizes to achieve a study with specified power were calculated for all-cause and acute lower respiratory tract infection (ALRI) mortality for different levels of sensitivity and specificity of post-mortem questionnaires. Data from active community-based surveillance and post-mortem questionnaires collected 1989-1993 from the study area were used in the calculations. FINDINGS: The mortality rate among children aged 6-29 months from all causes was 34.2 per 1000 child-years; 19% of deaths were attributable to ALRI. Assuming that pneumococci would be responsible for 50% of ALRI deaths and that the vaccine would cover 70% of disease serotypes and would be 90% effective against these serotypes, the expected efficacy of the vaccine would be 6.0% (19% x 50% x 70% x 90%) against all causes combined and 31.5% (50% x 70% x 90%) against deaths from ALRI. If, as suggested by various reports, the sensitivity and specificity of assigning a death to ALRI by post-mortem questionnaire are about 40% and 90% respectively, then the observed vaccine efficacy against ALRI (as classified using the post-mortem questionnaire) would fall to 20%, and the power to detect this would be reduced by approximately 40%. Furthermore, low sensitivity of diagnosis would lead to a falsely low estimate of the burden of ALRI mortality in the population and the trial might have greater power to detect a reduction in mortality from all causes combined than that estimated at the outset. CONCLUSIONS: Low sensitivity and specificity of diagnosis by post-mortem questionnaire may mean that the power of a trial to detect a reduction in all-cause mortality is similar to that to detect a reduction in ALRI mortality. Since the latter is more susceptible to bias from misclassification of cause of death, all-cause mortality may be the most suitable endpoint. Similar considerations apply to trials of interventions against other diseases for which a cause-specific endpoint is subject to substantial misclassification.

Africa↗
PubMed2000

Causes of death in elderly prostate cancer patients and in a comparison nonprostate cancer cohort.

BACKGROUND: Prostate cancer tends to affect older men and to progress relatively slowly. Since the prevalence of comorbidity increases with advancing age, competing causes of death are important contributors to death rates among prostate cancer patients. Accurate determination of the underlying causes of death in older men dying with prostate cancer may thus also be more difficult. METHODS: We compared the distribution of underlying causes of death in decedents from a population-based cohort of elderly prostate cancer patients to that from a population-based comparison cohort of elderly men without prostate cancer. Among decedents from the prostate cancer patient cohort, we examined associations of patient demographics, disease stage, and initial treatment, with assignment of a prostate cancer underlying cause of death (versus any other cause) by use of multivariable logistic regression. In the subgroup of prostate cancer patient decedents having underlying causes of death other than prostate cancer, the underlying cause distribution was compared with that in nonprostate cancer cohort decedents. RESULTS: Prostate cancer was the underlying cause for 39% (95% confidence interval [CI] = 36.3-41.9) of the decedents in the prostate cancer cohort. Causes of death among prostate cancer patients not dying of prostate cancer were similar to those among the nonprostate cancer cohort decedents. However, in those who were aggressively treated, the adjusted odds of other cancer causes of death were 51% higher (odds ratio [OR] = 1.51; 95% CI = 1.08-2.10) than that in nonprostate cancer patient decedents, while in those treated with watchful waiting the adjusted odds were 34% lower (OR = 0.66; 95% CI = 0.47-0.93). CONCLUSIONS: Initial treatment may influence the underlying cause of death reported in vital statistics for prostate cancer patients.

Aged↗
PubMed2006

Analysis of deaths with an unknown cause in epidemiologic analyses of mortality burden.

OBJECTIVE: To describe options for analysing deaths with an unknown cause, which often occur in community-based studies that are used to estimate disease-specific mortality burden and trends in low-income countries. METHODS: Mathematical formulae were derived that accommodate deaths with an unknown cause for the disease-specific mortality rate, proportion of deaths attributable to the disease and all-cause mortality rate. Seven specific options are presented, including example calculations from a study of childhood malaria mortality in The Gambia. An algorithm is proposed to help make decisions on analysing deaths with an unknown cause. RESULTS: In the Gambian study, 25.2% of deaths had an unknown cause. Three options would result in 23.6% (minimum), 48.8% (maximum) and 28.7% (probably the best estimate) of deaths attributed to malaria. The best analysis option depends on the disease of interest: diseases for which the diagnostic method has high sensitivity and specificity (e.g., measles, neonatal tetanus) are best analysed assuming that deaths with an unknown cause never have this cause, while diseases for which specificity and/or sensitivity is low (e.g., malaria) are likely to account for some proportion of deaths with an unknown cause. CONCLUSIONS: The most important aspects of analysing deaths with unknown cause are choosing appropriate assumptions, describing them explicitly and performing a sensitivity analysis. Studies of causes of death should report several key pieces of information on deaths with unknown cause to aid interpretation.

Algorithms↗
PubMed1999

Trends and patterns of drug-caused mortality in Australia and Western Australia.

OBJECTIVE: To estimate the number of drug-caused deaths and compare patterns and trends of drug-caused mortality in Western Australia (WA) and Australia. METHOD: Aetiologic fractions were applied to mortality data for WA (1985-96) and Australia (1991-96) to estimate the number of deaths due to alcohol, tobacco and other drugs. RESULTS: Age-standardised rates (ASR) for smoking and alcohol-caused deaths fell significantly, while the ASR for deaths caused by other drugs increased significantly. About 85% of drug-caused deaths occurred among people aged 50 years and above. Tobacco-caused deaths mainly occurred among the elderly. Alcohol-caused death rates showed a minor peak in those aged 20-24 years then, from middle age, began to rise steadily, peaking in the oldest age group. However, deaths due to other drugs occurred mainly among young people, particularly those aged 25-34 years. These age differences were reflected in the person years of life lost (PYLL). People who died from other drugs lost, on average, about 31 years of life, twice as many as people who died from alcohol-caused conditions and about six times the average number of PYLL per tobacco-caused death. CONCLUSIONS: Nearly a fifth of all deaths were due to drugs and 80% of drug-caused deaths were due to tobacco smoking. The patterns and trends of drug-caused mortality in WA were similar to those Australia wide. IMPLICATIONS: Strategies highlighting the negative impact of tobacco and alcohol on health need to be maintained as well as programs which target illicit drug use.

Adolescent↗
PubMed2003

Cause of death in patients with end-stage renal disease: assessing concordance of death certificates with registry reports.

OBJECTIVES: To assess concordance in reporting, in two Australian national datasets, of cause of death of patients with end-stage renal disease (ESRD). METHODS: For deaths in 1997-99, we compared 'cause of death' and 'primary renal disease', as coded in the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), with 'underlying' and 'associated' causes of death (based on death certificates), as coded by the Australian Bureau of Statistics (ABS). Dates of birth and death and sex identified the same individuals in the two datasets. Deaths from the three States for which date of birth was not available from death certificates were excluded. Cause of death was compared at the ICD-10 chapter level. RESULTS: Of 1,728 ANZDATA patients from NSW, SA, WA, NT and ACT who died during 1997-99, 1,117 (65%) could be matched to a record in the ABS dataset for the corresponding jurisdictions. The death certificates of 219 (20%) of these 1,117 patients made no mention of chronic renal failure. Overall, agreement on cause of death was poor (kappa = 0.22). Using ANZDATA information on cause of death and ABS underlying cause of death, only 38% of patients had the same cause (at the ICD-10 chapter level) recorded in both datasets. Additional information on primary renal disease (ANZDATA) and up to 12 associated causes of death (ABS) was required to obtain substantial agreement. CONCLUSION AND IMPLICATIONS: Death certificates and ANZDATA records provide differing causes of death for ESRD patients. Information from these sources was not directly comparable. Neither dataset provided a complete picture of renal disease as a cause of death in Australia.

Australia↗