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PubMed1999

Surveillance for morbidity and mortality among older adults--United States, 1995-1996.

PROBLEM/CONDITION: During the twenty first century, growth in the number of older adults (persons aged > or =65 years) in the United States will produce an unprecedented increase in the number of persons at risk for costly age-associated chronic diseases and other health conditions and injuries. REPORTING PERIOD: 1995-1996. DESCRIPTION OF SYSTEMS: This report uses data from CDC's National Center for Health Statistics (NCHS) to report on leading causes of death in 1996 (from the National Vital Statistics System), major causes of hospitalization (1996 National Hospital Discharge Survey [NHDSI), and major chronic conditions (1995 National Health Interview Survey [NHIS]). The National Vital Statistics System compiles information regarding all death certificates filed in the United States. NHDS is an annual probability sample of discharges from nonfederal, short-stay hospitals. NHIS is an ongoing annual cross-sectional household survey of the U.S. civilian, noninstitutionalized population. In addition, health-care expenditures for older adults are examined by using information obtained from published reports from the U.S. Health Care Financing Administration (HCFA) and health-services literature. RESULTS: The leading causes of death among adults aged > or =65 years were heart disease (1,808 deaths/100,000 population), malignant neoplasms (1,131/100,000), and cerebrovascular disease (415/100,000). Several leading causes of mortality among older adults differed by race, with deaths caused by Alzheimer's disease more frequent among whites and deaths caused by diabetes, kidney diseases, septicemia, and hypertension more frequent among blacks. Rates of hospitalization and length of hospital stays increased with age. Hospitalizations for heart disease represented the highest proportion of all discharges among older adults (23%). Discharge rates for malignant neoplasms, stroke, and pneumonia were similar for adults aged > or =65 years and, as with heart disease, were higher for men than for women. However, the rate of hospitalization for fractures among women exceeded the rate among men. Arthritis was the most prevalent chronic condition among adults aged > or =65 years (48.9/100 adults), followed by hypertension (40.3/100) and heart disease (28.6/100). In 1995, adults aged > or =65 years comprised 13% of the population but accounted for 35% of total personal health care dollars spent ($310 billion), and real per capita personal health-care expenditure for this age group increased at an average annual rate of 5.8% during 1985-1995. Projections for future medical expenditures for older adults vary; however, all project substantial increases after the year 2000. Hip fracture, dementia, and urinary incontinence are discussed as examples of prevalent and costly health conditions among older adults that differ in potential for prevention. These conditions were selected because they result in substantial medical and social costs and they differ in potential for prevention. INTERPRETATION: The higher prevalence of serious and costly health conditions among adults aged > or =65 years highlights the importance of implementing preventive health measures in this population. PUBLIC HEALTH ACTIONS: Data regarding causes of morbidity, mortality, and health-care expenditures among older adults provide information for measuring the effectiveness of public health efforts to reduce modifiable risk factors for morbidity and mortality in this population.

Aged↗
PubMed1976

Chilean medicine under social revolution.

During the last decade Chile has experienced a series of social changes under Christian Socialist (1964-1970), Marxist Socialist (1970-1973) and military (1973-1975) governments. These changes grossly affected the evolution of medicine and public health in Chile. Nevertheless, vital statistics show an overall improvement in health indexes, with a short interruption during the Marxist government. During this period medical standards and the quality of medical services declined when revolutionaries disrupted the organization of traditional socialized Chilean medicine founded 50 years ago. The vital statistics of 1974 suggest an overall recovery, but physical and human resources for health, eroded by revolution and the present acute economic crisis, have not yet begun to improve. Nevertheless, Chilean medicine has reasumed the technical character that should never have been abandoned.

Chile↗
PubMed1999

Cancers in children younger than age 16 years in Kenya.

OBJECTIVE: To determine the number of cancers seen in six months in children aged below sixteen years and to look for any associations with breastfeeding, parental ages, smoking, water availability and consanguinity. DESIGN: Prospective case study from June 1997 through December 1997. SETTING: Seven provincial hospitals and Kenyatta National Referral Hospital. SUBJECTS: Both sexes with tissue proven malignancy. INTERVENTIONS: By obtaining clinical information, and laboratory evaluatory results. MAIN OUTCOME MEASURES: Proportions of vital statistics, anatomic site, stage and histology of cancer, vaccination, breastfeeding, congenital abnormality, parental vital statistics, education, smoking, water availability status and consanguinity. RESULTS: One hundred and fifty seven cases were evaluated. Male to female (M:F) ratio was 1.5:1. Mean ages: patients 6.5, fathers 36.6, mothers 31.1 years. Histologic types were: Burkitt's lymphoma (BL) 45%, nephroblastoma 14%, Hodgkin's lymphoma 9.5%, acute lymphocytic leukaemia 7.6%, retinoblastoma 5.7%, acute myeloid leukaemia 5.1%. The age distribution was as follows: 0-5 years, 46.5%, 6-10, 39.5% and 11-16 years 14%. The birth places of the children were as follows: Nyanza 25%, Central 21%, Eastern 16%, Western 13%, Rift Valley 9%, Coast 8%, Nairobi 8% and North Eastern had less than one per cent. The ethnic distribution was; Luo 25%, Kikuyu 22%, Luhya 13%, Kamba 10%, Coastal 6%, Kalenjin 6%, others 19%. Fifty per cent of the cases studied were breastfed for over six months, 34% for 3-6 months, five per cent less than three months and eleven per cent were not breastfed. Eighty five per cent of the cases received complete vaccination. The modal number of siblings was four and only 49% of parents received formal education. No consanguinity was noted in the studied population. The abdomen and jaw were main anatomic sites involved by the tumours. CONCLUSION: This study showed that the commonest childhood tumour is Burkitt's lymphoma and nephroblastoma is the commonest solid tumour. While the results demonstrate geographic and ethnic variations, other factors studied do not appear to influence the characteristics of cancers in the cases investigated.

Adolescent↗
PubMed2003

Deaths: preliminary data for 2001.

OBJECTIVES: This report presents preliminary data on deaths for the year 2001 in the United States. U.S. data on deaths are shown by age, sex, race, and Hispanic origin. Death rates for 2001 are based on population estimates consistent with the April 1, 2000, census. Data on life expectancy, leading causes of death, infant mortality, and deaths resulting from September 11, 2001, terrorist attacks are also presented. For comparison, this report also presents revised final death rates for 2000, based on populations consistent with the April 1, 2000, census. METHODS: Data in this report are based on a large number of deaths comprising approximately 98 percent of the demographic file and 92 percent of the medical file for all deaths in the United States in 2001. The records are weighted to independent control counts of infant deaths and deaths 1 year and over received in State vital statistics offices for 2001. Unless otherwise indicated, comparisons are made with final data for 2000. For certain causes of death, preliminary data differ from final data because of the truncated nature of the preliminary file. These are, in particular, accidents, homicides, suicides, and respiratory diseases. Populations were produced for the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) under a collaborative arrangement with the U.S. Census Bureau. The populations reflect the results of the 2000 census. This census allowed people to report more than one race for themselves and their household members and also separated the category for Asian or Pacific Islander persons into two groups (Asian and Native Hawaiian or Other Pacific Islander). These changes reflect the Office of Management and Budget's (OMB) 1997 revisions to the standards for the classification of Federal data on race and ethnicity. Because only one race is currently reported in death certificate data, the 2000 census populations were "bridged" to the single race categories specified in OMB's 1977 guidelines for race and ethnic statistics in Federal reporting, which are still in use in the collection of vital statistics data. RESULTS: The age-adjusted death rate in 2001 for the United States decreased slightly from 869.0 deaths per 100,000 population in 2000 to 855.0 in 2001. For causes of death, declines in age-adjusted death rates occurred for Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Accidents (unintentional injuries), and Influenza and pneumonia. Age-adjusted death rates also declined for drug-induced deaths between 2000 and 2001. Age-adjusted death rates increased between 2000 and 2001 for the following causes: Alzheimer's disease, Nephritis, nephrotic syndrome and nephrosis, Essential (primary) hypertension and hypertensive renal disease, and Assault (homicide). The increase in homicide was a direct result of the terrorist attacks of September 11, 2001. The infant mortality rate did not change between 2000 and 2001. Life expectancy at birth rose by 0.2 years to a record high of 77.2 years.

Cause of Death↗
PubMed2004

Deaths: preliminary data for 2002.

OBJECTIVES: This report presents preliminary data on deaths for the year 2002 in the United States. U.S. data on deaths are shown by age, sex, race, and Hispanic origin. Death rates for 2002 are based on population estimates consistent with the April 1, 2000, census. Data on life expectancy, leading causes of death, and infant mortality are also presented. METHODS: Data in this report are based on a large number of deaths comprising approximately 97 percent of the demographic file and 93 percent of the medical file for all deaths in the United States in 2002. The records are weighted to independent control counts of infant deaths and deaths 1 year of age and over received in State vital statistics offices for 2002. Unless otherwise indicated, comparisons are made with final data for 2001. For certain causes of death, preliminary data differ from final data because of the truncated nature of the preliminary file. These are, in particular, unintentional injuries, homicides, suicides, and respiratory diseases. Populations were produced for the Centers for Disease Control and Prevention's National Center for Health Statistics under a collaborative arrangement with the U.S. Census Bureau. The populations reflect the results of the 2000 census. This census allowed people to report more than one race for themselves and their household members and also separated the category for Asian or Pacific Islander persons into two groups (Asian and Native Hawaiian or Other Pacific Islander). These changes reflected the Office of Management and Budget's (OMB) 1997 revisions to the standards for the classification of Federal data on race and ethnicity. Because only one race is currently reported in death certificate data, the 2000 census populations were "bridged" to the single race categories specified in OMB's 1977 guidelines for race and ethnic statistics in Federal reporting, which are still in use in the collection of vital statistics data. RESULTS: The age-adjusted death rate in 2002 for the United States decreased from 854.5 deaths per 100,000 population in 2001 to 846.8 in 2002. Declines in age-adjusted death rates occurred for Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Accidents (unintentional injuries), Chronic liver disease and cirrhosis, and Assault (homicide). The decrease in homicide reflects the effect of the terrorist attacks of September 11, 2001, on the rates for that year. Age-adjusted death rates also decreased for alcohol-induced deaths between 2001 and 2002. Age-adjusted death rates increased between 2001 and 2002 for the following causes: Alzheimer's disease, Influenza and pneumonia, Essential (primary) hypertension and hypertensive renal disease, Septicemia, and Nephritis, nephrotic syndrome and nephrosis. Life expectancy at birth rose by 0.2 years to a record high of 77.4 years. The infant mortality rate increased between 2001 and 2002, the first numerical increase in the infant mortality rate since 1957-58. However, supplemental analyses of fetal death records indicate that the perinatal mortality rate remained stable between 2001 and 2002.

Adolescent↗
PubMed2000

The epidemiological study on registered cases of sudden infant death syndrome (SIDS) in Tokyo: examination of the effect of autopsy on diagnosis of SIDS and the mortality statistics in Japan.

In the United States and most of European countries, a diagnosis of sudden infant death syndrome (SIDS) may be given only after an autopsy has been performed. Under the new definition of SIDS in Japan, an autopsy is now mandatory for the diagnosis of SIDS. However, according to the official records on autopsies, the proportion of autopsy for sudden infant death in Japan is still low (less than 30%). If a physician suspects SIDS from a review of the patient's medical history and medical findings, he can write 'suspected SIDS' as the cause of death on the death certificate without performing an autopsy. Such a clinical diagnosis is entered in the Vital Statistics section by the Japanese Ministry of Health and Welfare. In this report, a comparative epidemiological survey of registered cases of SIDS--after autopsy and with no autopsy--was carried out by examining the data from the death certificates registered by the Japanese Ministry of Health and Welfare (vital statistics in Tokyo from January 1979 to December 1996). There were 369 cases of SIDS registered in Tokyo. We found 247 diagnosed after autopsy (66.9%) and 122 with no autopsy (33.1%). The following epidemiological variables were used: address of the deceased (a specific area in Tokyo), sex, year of death, time of death, month of death, age at death, occupation of householders, and place of death. There were epidemiological differences at the 0.05 significance level between registered cases diagnosed after autopsy and those diagnosed without autopsies, as follows: year (P=0.016) and place of death (P=0.037). In addition, there were slight epidemiological differences at the 0.10 significance level between registered cases diagnosed after autopsy and with no autopsy, as follows: month of death (P=0.076) and age at death (P=0.082). This suggests that the quality of diagnosis of SIDS is not completely guaranteed. With respect to the area of residence, the incidence of SIDS is high in those areas where autopsy is performed frequently. In Tokyo, the medical examiner system is enforced only in the urban area and there is a possibility that SIDS is being underdiagnosed in the rural area of the Metropolitan Tokyo. It is likely that the diagnosis of SIDS without autopsy will influence the quality of SIDS diagnoses. The administrative inadequacy in the autopsy system in Japan should be corrected to improve the accuracy of SIDS diagnosis.

Age Factors↗
PubMedDate not supplied

Infant mortality in a Mexican-American community: Laredo, Texas, 1950-1977.

Published infant mortality rates (IMR's) for Mexican-American populations frequently are lower than expected given the socioeconomic status (SES) of these populations. It has been speculated that this is due to bias or incompleteness in Mexican-American vital statistics. In this paper an extensive genealogical data base constructed from Catholic church records and civil records for the border city of Laredo, Texas is used to study this problem. The infant mortality probabilities (IMP's) since 1950 are compared to conventional IMR's, both based strictly on the population at risk defined by baptisms, in which the deaths are a proper subset of the denominator, and these are compared with IMR's calculated in the usual way from aggregate civil records of births and infant deaths for Laredo. We find that when these data are used, the IMR's for the most recent years are about twice the conventional rates computed from registered vital statistics.

Bias↗
PubMed1996

Measuring social inequalities in health in the United States: a historical review, 1900-1950.

For over two centuries, U.S. vital statistics routinely have been stratified by age, sex, and race, but not by social class. The usual explanation is that U.S. government officials have not considered social class relevant to health. During the first third of the 20th century, however, questions of socio-economic inequalities in morbidity and mortality ranked high on the agenda of federal and other public health agencies, and routine reporting of U.S. vital statistics and health survey data by socioeconomic measures was nearly institutionalized. This history has largely been lost. In this article, the authors focus on the period from 1900 to 1950 and examine how public health researchers and agencies conceptualized and analyzed socioeconomic inequalities in health. Highlights include production, for 1930, of the first U.S. national death rates stratified by social class, in work sponsored by the National Tuberculosis Association and Bureau of the Census, and the Public Health Service's 1935-1936 National Health Survey, which reported morbidity data stratified by socioeconomic measures. Efforts like these were cut short by the onset of World War II and their legacy erased by the Cold War. Recovering this rich history can help inform current debates about collecting and evaluating data on social inequalities in health.

Health Status↗
PubMed1995

Prenatal care of HIV-infected women: analysis of a large New York State cohort.

We examined the effect of methadone treatment, duration of Medicaid enrollment during pregnancy, and other maternal characteristics on receipt of prenatal care by 2,254 women infected with human immunodeficiency virus (HIV) delivering a singleton in New York state from 1985 through 1990. Data were obtained from the New York State Medicaid HIV/AIDS Research Data Base and vital statistics records. Adequacy of the number of prenatal visits reported by the mother on vital statistics records was assessed with use of the Kessner Index, which adjusts for gestational age at delivery. Too few visits were reported by 65% of the study population. Illicit drug users had higher odds of having too few visits [1.64, 95% confidence interval (CI) 1.24-2.17] than methadone-treated women but the odds were similar for non-drug users and methadone-treated women (0.79, 95% CI 0.60-1.25). Women with brief Medicaid enrollment (< or = 25% of pregnancy) had 45% higher odds of having too few visits than did longer enrollees. Treatment for drug addiction and longer Medicaid enrollment during pregnancy may offer important interventions to increase prenatal care of HIV-infected women. Approaches to increase prenatal care of HIV-infected women are especially important given trials showing a reduction in vertical transmission from zidovudine treatment during pregnancy.

Adolescent↗
PubMedDate not supplied

Feasibility of a national fatal asthma registry: more evidence of IRB variation in evaluation of a standard protocol.

PURPOSE: Approximately 4,500 Americans die from asthma each year. Our objective was to determine the feasibility of creating a national fatal asthma registry to better understand this problem.Methods. Using a standard questionnaire, 18 state vital statistics departments and 22 medical examiners offices were contacted in 2001 to assess availability of fatal asthma data. Funding was obtained in 2002 to implement a fatal asthma registry. During 2003, the project was put on hold due to uncertainty about the impact of the Health Insurance Portability and Accountability Act (HIPAA). The project was revived in 2004 when a standard protocol was submitted to Institutional Review Boards (IRBs) in four different states. RESULTS: All vital statistics departments reported that they were able to identify the decedent's name and demographic characteristics. Contact information for a relative or doctor was available in all states. Demographic characteristics and autopsy findings were available from 100% of the medical examiners offices. However, IRBs at the four institutions required major protocol modifications, including language and approach for contacting next of kin. CONCLUSION: Availability of demographic and clinical data across states is consistent. The creation of a national fatal asthma registry appears feasible, but different IRB interpretations of what is permissible preclude a standard approach across states.

Asthma↗
PubMed2005

Measurement challenges in developing the national healthcare quality report and the national healthcare disparities report.

OBJECTIVES: The objective of this study was to describe 2 measurement challenges faced in the development of the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR): the use of federal data on race and ethnicity and the selection of measures of socioeconomic status (SES). METHODS: Over 30 federal and nonfederal data systems were examined to identify measures of race, ethnicity, and SES and to evaluate the characteristics and relative quality of the data. RESULTS: The availability and quality of data on race, ethnicity, and SES vary by factors such as the type of data (population or establishment based-survey, administrative/claims data, or vital statistics), the source of information (self, proxy, other, or some combination), and the transition to new federal standards. No single measure of SES could be identified, so a mix of measures is presented, including income, education, and expected source of payment (ESOP). Income relative to federal poverty level was used as the preferred SES measure from person-based surveys. Selected analyses linking hospital discharge data to annual median household income from US census data were presented for data derived from administrative data systems. Educational attainment was the variable used for examining SES using data from the Vital Statistics System. CONCLUSIONS: The first NHQR and NHDR maximized the presentation of data by accommodating the variation among data systems while at the same time imposing some standardization in the coding and classification of data on race, ethnicity, and SES.

Aged↗
PubMed2001

[Risk factors for infant mortality from diseases in Japan 1995-98].

OBJECTIVE: Since 1995, additional information (i.e. birth weight, singleton/multiple births, gestational weeks, maternal age, maternal parity and stillbirth experience) has been required for certificates of infant (less than 1 year of age) death from diseases in Japan. The present study examined the effects of biological, demographic and social variables, as reported on birth and death certificates, on infant, neonatal and postneonatal mortality in Japan. METHODS: Using data from vital statistics between 1995 and 1998, more than 4,787,000 livebirths and 16,000 infant deaths from diseases were analyzed. Univariate and multivariate analyses with the Poisson regression model were employed to assess the effects of variables on infant, neonatal and postneonatal mortality by singleton and multiple livebirths separately. RESULTS: The infant mortality rates from diseases were 3.2/1000 for singleton livebirths and 17.7/1000 for multiple livebirths. In singleton livebirths, low birth weight, infant born in earlier years, being a male infant, employment status as "unemployed or unknown", short gestational weeks, late birth in multiparity and maternal stillbirth experience were all significantly related to increased risk of neonatal and postneonatal deaths. Teenage mother were also at high risk of postneonatal deaths. Regional differences were observed. Compared with singleton livebirths, birthweight-specific mortality rates in multiple livebirths were relatively low among infants weighing under 2500 g. In multiple livebirths, elevated risk of death was associated with low birth weight, infant born in earlier years, employment status as "unemployed or unknown" and short gestational weeks. However, late birth in multiparity was related to a reduced risk of death, and maternal stillbirth experience was not a significant variable. CONCLUSION: This study provided the first quantitative estimate of risk of infant mortality from diseases in Japan. Since a more detailed elucidation of actual conditions and risk factors of infant deaths by vital statistics has become possible, efficient measures for improvement of infant mortality are to be expected.

Female↗
PubMed2001

[The validity of revised death certificates (ICD-10) for ischemic heart disease in Oita City, Japan].

PURPOSE: Mortality statistics have recorded an increased number of deaths from ischemic heart disease (IHD) since death certificates were revised to reflect the International Classification of Diseases, tenth revision (ICD-10) in Japan, in 1995. However, it remains unclear whether the validity of IHD diagnosis improved after this revision. METHODS: We conducted the Oita Cardiac Death Survey to validate IHD certified deaths that occurred among residents aged 25-74 in Oita City, Japan (mean population = 273,000). Of the eligible 342 fatalities, 328 cases (95.0%) were examined by a review of the medical records and/or interviews with physicians. The MONICA criteria were applied and provided a reference standard against which to assess the validity of certified fatal IHD. Sensitivity (Se), positive predictive value (PPV), specificity (Sp) and negative predictive value (NPV) for IHD as the cause of death were analyzed, assuming that all validated IHD deaths were true. Multivariate logistic models were used to determine associations of false positive and false negative cases with sex, age at time of death and place of death. RESULTS: Vital statistics revealed 273 fatalities to be due to cardiac disease, including 143 from acute myocardial infarctions (AMI), 27 from other IHD, 52 from heart failure and 51 from other heart diseases. After validation, 25 'definite fatal AMI' and 71 'possible fatal AMI or IHD death' were identified among all subjects according to the MONICA criteria. In all, Se, PPV, Sp and NPV for IHD certified as the cause of death were 86.5% (95% Cl: 77.6-92.3), 50.3% (42.5-58.1), 64.7% (58.1-70.7), and 92.0% (86.5-95.5), respectively. PPV among persons aged 25-54 years was remarkably decreased. PPV and Sp among out-of-hospital deaths were significantly lower than for in-hospital deaths. Multivariate logistic models revealed out-of-hospital deaths and being aged 25-54 years to be significant predictors of false positive cases (odds ratio (OR) = 2.03, P < 0.001 versus in-hospital deaths and OR = 2.79, P < 0.05 versus ages of 65-74 years, respectively). CONCLUSIONS: Because false positive cases increased among certified IHD deaths after the revision, PPV and Sp percentages decreased. Out-of-hospital deaths and being aged 25-54 years were associated with increased possibility of false positive. Given our findings, IHD deaths in vital statistics may increase due to the tendency of physicians to certify IHD as the cause of death in cases without clear sign suggestive of other causes.

Adult↗
PubMed2002

Trends in postneonatal aspiration deaths and reclassification of sudden infant death syndrome: impact of the "Back to Sleep" program.

OBJECTIVE: The introduction of the "Back to Sleep" campaign for the prevention of sudden infant death syndrome (SIDS) brought with it concern that there might be an increase in the incidence of aspiration-related deaths. The objective of this analysis was to describe the trends in postneonatal mortality and proportionate mortality ratios for the United States for the years 1991 to 1996 for aspiration-related deaths and other causes to which a SIDS death could conceivably be reclassified. METHODS: Linked birth and infant death vital statistic files for the United States were used for the years 1991, 1995, and 1996. US Vital Statistic Mortality files for the years 1992, 1993, and 1994 were used because of the absence of linked files for those years. RESULTS: The overall postneonatal mortality rate between 1991 and 1996 declined 21.9%, whereas the SIDS rate declined 38.9%. The proportion of the postneonatal mortality (PNPMR) contributed by SIDS declined from 37.1% in 1991 to 28.8% in 1996. There was no significant increase in the PNPMR for aspiration, asphyxia, or respiratory failure. There was, however, a significant increase in the PNPMR for suffocation in bed or cradle from 0.9 to 1.3. CONCLUSIONS: These data show no evidence of an increased risk of death from aspiration as a result of the "Back to Sleep" program. Although there has been an increase in the proportion of postneonatal mortality attributable to suffocation, this represents a very small proportion of postneonatal mortality and thus potentially a very small number of SIDS deaths reclassified as suffocation.

Adult↗
PubMed1954

Needs in vital and health statistics in underdeveloped countries.

The author discusses the types of health and vital statistics that would be of the greatest practical value to countries with only slightly developed public-health and vital registration systems and the ways by which these statistics may be obtained.While a regular census is necessary for proper mortality and natality statistics, population estimates may be successfully used until a census can be taken. Natality statistics should include live-births, stillbirths, legitimacy, and age of mother. For morbidity measurement, four sources of information or types of inquiry can be used before complete registration systems are available: sickness surveys by home visits of families; records of notifiable communicable diseases; medical records of sickness in schools; and records of health welfare centres and health visitors, when these exist. The use of infant mortality figures in underdeveloped countries is subject to considerable error, and great effort will be needed to get every living child in the birth register. A useful local index of health is the recording in selected areas of deaths during the first three years of life. Death-rates at higher ages can only be assessed where death registration is fairly complete.It is suggested that reliable information on population changes, child mortality and sickness, and the incidence of disease can be obtained by a continuous study programme in carefully selected model survey and registration districts. Apart from the immediate results from such a programme, it would prepare the ground for the subsequent establishment of a full vital registration system.

Censuses↗
PubMed2005

[Tuberculosis and its control--lessons from the past and future prospect].

Koch R reported the discovery of tubercle bacilli on March 24, 1882, and the numbers of death from phthisis were collected in the vital statistics from the latter half of 1883 in Japan. Tuberculosis death was officially adopted in the Japanese vital statistics from 1899, and there was certain disagreement existed between the numbers of death from TB and phthisis in 1899, the analysis on the trend of TB in Japan was done based on TB death. Trend of TB in Japan in the past 100 years could be divided into five phases. In phase 1 (1899-1918), TB mortality had increased with the first industrialization of Japan with main focus on the weaving industry. During this period, TB mortality of female was higher than that of male and then major victims of TB were young girls born from 1890 to 1925. In phase 2 (1918-1930), TB mortality decreased through excess death of TB cases by the influenza pandemic in 1918. This decline due to influenza pandemic was seen all over the world, and in the European countries and the U.S., the decline continued up to 1945 while in Japan, TB had increased again in the phase 3 (1930-1945) mainly due to second industrialization with main focus on heavy industry and the impact of quasi-war and war conditions. In phase 4 (1945-mid 1970s), TB started to decline fast due to the excess death of TB cases during the World War II and then, the application of modern TB control started from early 1950s. In phase 5 (from mid 1970s until now), decline of TB has showed down. Increase or slowdown of TB decline was seen nearly all countries of the world, however, its causes were different from country to country. In case of Japan, slowdown was caused by the rapid ageing of the population, in developing countries mainly by the impact of HIV epidemic and in industrialized countries, mainly by the migration of the population and partly by the HIV epidemic. Contribution of phthisiology in Japan to the global progress of phthisiology could be summarized as follows: elucidation of the pathogenesis of TB when TB was highly prevalent in Japan by high incidence of TB from primarily infected youth, the development of mass screening for TB using radiophotography technique developed in Japan, completion of the interpretation method of chest X-ray findings, first success in the mass production of freeze-dried BCG vaccine in the world, the first implementation of the TB prevalence survey using random sampling method in 1953, and the development of a new drug for TB, kanamycin. Phthisiology also contributed to the progress of international health. As the objective index to measure the magnitude of TB problem, the concept of annual risk of TB infection (ARTI) was introduced by Sutherland and Styblo, and by using ARTI, the epidemiological situation of TB could be divided into 3 categories; high prevalence country with ARTI above 1%, low prevalence country below 0.05-0.1%, and middle prevalence country inbetween. To reduce the burden of TB in high prevalence countries, so-called DOTS strategy of TB control was introduced and has been applied in most developing countries, and the gap between high and low prevalence countries has reduced in the past decade. Cooperation in global TB control has also been done actively from the government and NGOs of industrialized countries under the strong leadership of WHO. For the success of TB control, the transmission of tubercle bacilli in a community should be cut either infection, onset of TB or the progress of TB. Prevention of TB infection could be achieved by the early detection of TB cases and their cure by the treatment. To encourage early visit to doctors for those with symptoms suggesting TB and adequate examinations at medical institutions for these persons would be a major tool of early detection of TB cases in Japan in the future. In addition, there is no doubt to intensify contacts examinations and source investigations. It is hoped to elucidate recent pathogenesis of TB by applying new technologies such as QFT and RFLP. Prevention of onset of TB will be focused on the preventive use of TB drugs, however, development of new vaccine better than BCG is also encouraged for the developing countries where the risk of TB infection is remained high. TB is now a curable disease, and the duration of treatment has been shortened to 6 months. If new more potent TB drugs were developed, and the total duration of treatment could be shortened, the global TB control could be done much more easily, and also most MDRTB cases could be cured. Otsuka Pharmaceutical Company is now developing a new potent drug which has no cross resistance with existing TB drugs. This new drug is now on the clinical trial phase II, and it is hoped that Japan can make another great contribution to the global TB control. It is my sincere wish that the government continues to assist the research to develop new TB drugs and new technologies used in TB control, and in future, if it is needed to change the current policy of TB control, a new policy should be tried in a pilot area before its introduction on national level. The Japanese Society for TB is a key organization in developing further research and the training of new personnel engaging in TB research and control, and I sincerely hope further development of the Society.

Adolescent↗
PubMed2004

Sanitary medicine and the social body: the case of national civil registration and statistics in Canada, 1855-75.

Civil registration and vital statistics are important elements in the definition of a social body, the primary object whose health and well-being is the aim of social medicine. The failure of the federal government to organize a national system of civil registration in the Confederation era is placed in the context of a variety of sources of pressure for it to do so from doctors, social reformers, and provincial and municipal officials.

Canada↗