Does liberal abortion improve perinatal outcome?
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Deaths from diabetes are under-reported in national mortality statistics.
Subjects with diabetes who attended rural surveys in Western Australia from 1978 to 1982 were followed up to ascertain death rates and the causes of death recorded on death certificates. Cardiovascular disease was assigned as the direct cause of death in 63% of deaths, with equal rates in male and female subjects, and renal disease in 8% of deaths with the proportion in women (12%) being greater than that in men (4%). The diagnosis of diabetes was stated on only 65% of the death certificates, and in only 24% was diabetes recorded as a direct or antecedent cause. In the same cohort the Australian Bureau of Statistics coded diabetes as the underlying cause of death in 24%, while attributing deaths to cardiovascular disease in 50% of the cases. This study suggests that diabetes is considerably underreported both on doctors' death certificates and in the mortality figures of the Australian Bureau of Statistics.
Adolescent↗
Accidental falls and injuries among seniors.
This study analyzes data on accidental falls for those aged 65 and older. The data are based on mortality statistics from 1980 to 1989 and morbidity statistics from 1985 to 1989. These statistics are provided to the Canadian Centre for Health Information by the provincial governments. Mortality rates and hospital separation rates for accidental falls are highest for those aged 65 and older. Accidents are one of the leading causes of death and hospitalization among seniors. In 1989, for those aged 65 and older, accidental falls accounted for 56% of accidental deaths and 65% of accident-related hospital separations. Mortality and hospital separation rates for accidental falls increased with age. For those aged 65 and older, the mortality rates for accidental falls were higher for men than women. However, the accident-related hospital separation rate was higher for women than men. The reason for this difference is not fully understood, but it has been suggested that while more women fall than men, more men seriously injure themselves. For men requiring hospitalization due to accidental falls, the most common injuries, in descending order, were fractures of the hip, ribs, vertebral column, humerus, and pelvis. For women, the most common injuries were fractures of the hip, humerus, radius and ulna, pelvis, and ankle. Of fall-related injuries resulting in hospitalization, hip fractures were the leading cause of death and proportionately more men than women died of hip fractures.
Accidental Falls↗
Premature mortality, Israel 1986.
Mortality statistics serve as the most common tool for health policy planning. However, this method suffers from several shortcomings. The mortality patterns in Israel in 1986 are presented in this article using the measure of years of potential life lost (YPLL), which better expresses premature mortality and the burden of diseases on society. Ischemic heart disease, cancer, and accidents of all types are responsible equally for most premature deaths in males in Israel, whereas cancer is the leading cause of premature mortality in women in Israel. Planning future health policy should rely more heavily on measures such as YPLL.
Adolescent↗
[Mortality from acute respiratory infections and influenza (1976-1980)].
Acute respiratory infections (ARI) and influenza (flu) are extremely common illnesses, which make up the main causes of medical consultation and absence from work. OBJECTIVE. To discover the level of mortality because of ARI and flu in the Health Areas within the Community of Valencia; to analyse their possible relationship with socio-economic factors and also to identify higher-risk groups according to age and sex. DESIGN. Retrospective study. SITE. The Community of Valencia. PATIENTS OR OTHER PARTICIPANTS. Mortality data across the Community were obtained from the mortality statistics published by the Generalitat (Government) of Valencia during the five-year period of 1976 to 1980. MAIN MEASUREMENTS AND RESULTS. The results establish that Health Areas 4, 6, 7, 9-12 and 18 present less mortality because of ARI and flu. These are the better areas, socio-economically speaking, although the data are without statistical significance. A spectacular increase in mortality in the age-group of those over 70 was observed, with no great differences found between the sexes. CONCLUSIONS. Given that the main interventions to prevent these diseases are based on vaccination, it would be useful to carry out vaccination programmes with greater thoroughness in those areas identified as of high risk.
Acute Disease↗
Impact on mortality of a community-based programme to control acute lower respiratory tract infections.
Acute lower respiratory tract infections (ALRIs) are a major cause of death among young children in developing countries. A targeted programme designed to treat children with ALRI was implemented in 1988 in a primary health care project in rural Bangladesh. In the 2 years preceding the introduction of the programme (1986-87), non-ALRI-specific health services were provided, including promotion of oral rehydration therapy, family planning, immunization of children and mothers, distribution of vitamin A, referral of severely sick children to field clinics, and nutritional rehabilitation of malnourished children. The targeted ALRI programme, which was in place in 1988-89, was based on systematic ALRI case detection and management by community health workers, who were linked to a referral system for medical support. These two levels of intervention have been evaluated by comparing the ALRI-specific mortality in the programme area and a neighbouring control area during the two periods. During the first phase (1986-87), the ALRI mortality among under-5-year-olds was 28% lower in the intervention than in the comparison area (P less than 0.01). During the second phase (1988-89), the ALRI mortality was 32% lower in the intervention area than during the preceding phase, while there was no significant difference for the comparison area. These findings suggest that in the study region the combination of specific and nonspecific interventions can reduce ALRI mortality by as much as 50% and the overall mortality among under-5-year-olds by as much as 30%.
Allied Health Personnel↗
Mortality trends in Abidjan, Côte d'Ivoire, 1983-1988.
To assess changes in mortality in Abidjan since the development of the AIDS epidemic, we compared official city mortality statistics and hospital fatality rates in 1983, before AIDS was recognized in Abidjan, with those in 1988. Review of records in the city's major hospitals showed that fatality rates (deaths per 1000 admissions) in adult medical patients increased by 54% between 1983 and 1988, with increases of 106 and 98% in men 20-29 and 30-39 years of age, respectively, and 199 and 42% in women of the same age ranges. Mortality rates in surgical patients showed little change, while in children they declined. Over the same period, official mortality statistics for the city showed reduced mortality rates in children and women 20-29 years of age, but an increase in mortality rates of 54% in men 20 years of age and older, and of 28% in women aged 30 years and older. HIV infection may be a major cause of the increased adult mortality documented in hospital and city records, and jeopardizes improved survival from preventive measures such as maternal and child health services.
Acquired Immunodeficiency Syndrome↗
Infant and child mortality in the Elim District, northern Transvaal, 1976-1986, and a comparison of trends.
Childhood mortality rates among rural blacks in South Africa are currently not based on a reliable registration system. National childhood mortality statistics rely on mortality extrapolations and population estimates. This study attempts to provide further information on infant and child mortality among rural blacks in the northern Transvaal, using a direct method. Currently available obstetric histories from hospital and clinic records of the Elim Hospital Health Ward were reviewed, covering the years 1976-1988 and approximately 28,000 pregnancies. The mean infant mortality rate was 88/1,000 live births, and did not change significantly over 10 years, in contrast to other populations in South Africa with documented decreases. Components of the infant mortality rate were also calculated. There was a 1 in 10 risk of death among children less than 5 years of age over this period, although the risk had declined slightly over 10 years. Mortality among boys was higher than that among girls in all age groups studied. Conclusions include that small but measurable changes have occurred in rural South African black childhood mortality rates, although there has been no discernible change in infant mortality, and that a simple direct method can illustrate levels as well as trends in mortality. This has implications for health policy.
Black or African American↗
Perinatal mortality statistics in Harare 1980-1989.
Perinatal and neonatal mortality rates, in the Greater Harare Maternity Unit, which showed a modest decline from 1980 to 1985, have rise dramatically since then. Half of the rise in neonatal mortality rate is due to increased numbers and an increased mortality rate in babies of birth weight less than 1001g. There is also an increase in the numbers of deaths of large babies. There is a strong case for a broad-based on-going enquiry into the reasons for such changes.
Birth Rate↗
Communicable disease mortality: now you see it, now you don't.
This presentation proposes that cause-specific mortality analyses are greatly enhanced by first examining the cause-specific pattern of the entire mortality structure instead of restricting initial assessments to a limited number of leading causes of death. Six broad cause groups are defined toward this end. The advantage of defining a single category for communicable diseases, both for the structural and the leading-cause approach is also pointed out. Some examples illustrate the potential usefulness of this approach to the study of the cause-specific mortality structure: a few broad all-inclusive cause-groups provide a first rough--but nevertheless quite informative--overview of the mortality profile, while at the same time offering guidance in regard to groups which should be looked into in greater detail.
Adolescent↗
[Problems of codification of cause of death: comparison of the mortality data of the ISTAT and the Regional Mortality Registry of Tuscany].
A two-part study was undertaken to assess the comparability of the coding of underlying cause of death between ISTAT (Central Statistics Office providing "national" mortality statistics) and RMR (Mortality Registry of Tuscany Region providing "local" mortality statistics). In Part I was compared mortality data of the Province of Florence (years 1985-1986) from the files of ISTAT with those of RMR. The source of the cause of death is the same for both systems (ISTAT certificate), but the data collection and coding of RMR are different from those of ISTAT. In Part II was compared a set of 219 Tuscany death certificates (year 1988) coded by ISTAT and RMR. The results showed an high degree of completeness of RMR (only--0.65% vs. ISTAT) and a satisfactory level of correspondence in the number of deaths for circulatory diseases, for neoplasms and for cancers of most important sites (lung, stomach, intestine, pancreas, breast). Discrepancies were found for some other diseases; for some of these causes of death, also age-adjusted mortality rates showed discrepancies (for example ischaemic heart disease). The cause of these differences have been analyzed.
Adolescent↗
Impact of the human immunodeficiency virus epidemic on mortality in children, United States.
To assess the effect of the human immunodeficiency virus (HIV) epidemic on mortality in US children younger than 15 years of age and to identify associated causes of death, the authors examined final national mortality statistics for 1988, the most recent year for which such data are available. In 1988, there were 249 deaths attributed to HIV/acquired immunodeficiency syndrome (AIDS) in children younger than 15 years of age. Associated causes of death listed most frequently on 270 death certificates with any mention of HIV/AIDS included conditions within the AIDS surveillance case definition (30%), pneumonia (excluding Pneumocystis carinii pneumonia) (17%), septicemia (10%), and noninfectious respiratory diseases (8%). The impact of HIV/AIDS as a cause of death was most striking in the 1-through 4-year-old age group and in black and Hispanic children, particularly in the Northeast. By 1988 in New York State, HIV/AIDS was the first and second leading cause of death in Hispanic and black children 1 through 4 years of age, accounting for 15% and 16%, respectively, of all deaths in these age-race groups. With an estimated 1500 to 2000 HIV-infected children born in 1989, the impact of HIV on mortality in children will become more severe.
Acquired Immunodeficiency Syndrome↗
[Current trends in perinatal mortality statistics at the New Jersey Obstetric Center].
The study presents an overview of the changes in perinatal mortality rates at the Statewide Perinatal Center of New Jersey during the past decades. According to the data, the increase in the rate of cesarean sections from 4.5 percent to 17 percent, and the comparable reduction of the rates of manipulative intrapartum and extraction procedures, contributed significantly to the decrease of the perinatal mortality rates from 51/1000 to 17/1000 between 1971 and 1983. Of the new technical tools, those utilized for the evaluation of fetal well-being antepartum appeared to be more useful then those used intrapartum. On account of the high prevalence of genital infections in the population, the recent acceptance in the service of the use of invasive intrapartum technology, appears to have impacted unfavorably upon the perinatal mortality trends. The increased rate of births of premature babies, the widespread abuse of habit forming drugs in the community, and the routine use of procedures requiring artificial rupture of the membranes, probably all contributed to the rapid increase of the perinatal mortality rate in the Center from 15/1000 in 1986 to 28/1000 in 1988. It is concluded that perinatal care is a complex medical and social task. The overall result of the relevant efforts depends to a great extent upon the social environment, and the moral standing, educational level and motivation of the recipients.
Humans↗
Impact of the human immunodeficiency virus epidemic on mortality in women of reproductive age, United States.
To assess the effect of the human immunodeficiency virus (HIV) on mortality in US women 15 to 44 years of age and to identify associated causes of death, we examined final (1980 through 1987) and provisional (1988) national mortality statistics. Between 1985 and 1988, the death rate for HIV/acquired immunodeficiency syndrome (AIDS) quadrupled (0.6 per 100,000 to 2.5 per 100,000), and by 1987, HIV/AIDS had become one of the 10 leading causes of death. In 1988, the death rate for black women (10.3 per 100,000) was nine times the rate for white women (1.2 per 100,000). The majority of deaths in both black and white women occurred in women 25 to 34 years of age, for whom HIV-related deaths accounted for 11% and 3% of all deaths in 1988, respectively. Among 1157 death certificates that included any mention of HIV/AIDS in 1987, other leading diagnoses included drug abuse (27%), Pneumocystis carinii pneumonia (20%), other pneumonias (14%), septicemia (10%), other infections not in the AIDS surveillance definition (7%), nephritis (6%), liver diseases (4%), and anemias (4%). If current mortality trends continue, HIV/AIDS can be expected to become one of the five leading causes of death by 1991 in women of reproductive age. Because women infected with HIV are the major source of infection for infants, these trends in AIDS mortality in women forecast the impact of HIV on mortality in children as well.
Acquired Immunodeficiency Syndrome↗
Causes of death: an assessment of global patterns of mortality around 1985.
Cause-of-death statistics are available for virtually the entire population of the developed world (1.17 billion in 1985) and thus estimates of the mortality pattern in these countries can be made with some confidence, notwithstanding the artefacts which arise due to differences in diagnostic and certification practices between countries. In the developing countries, cause-of-death estimation is much more difficult due to the paucity of mortality statistics. Nonetheless, there are several sources of information on mortality, ranging from surveillance systems and small-scale community studies to complete vital registration, which can be exploited to estimate mortality patterns. Of the 50 million deaths which occur throughout the world each year, roughly 39 million (78%) occur in developing countries. For the developing countries as a whole, infectious and parasitic diseases are estimated to have accounted for almost one-half of all deaths in 1985. Diarrhoeal diseases, acute respiratory diseases (primarily pneumonia) and tuberculosis each claimed about 3-5 million deaths in the developing world in the mid-1980s, with a further 2.6 million due to measles and whooping cough. Perinatal conditions are estimated to have been responsible for a little over 3.2 million deaths in 1985 in developing countries, one-quarter of which were due to neonatal tetanus alone. Maternal causes claimed the lives of about 0.5 million women. At the same time, the chronic diseases are emerging as a leading cause of death in several regions of the developing world, particularly Latin America and East Asia. Circulatory and specific degenerative diseases are estimated to have caused about 6.5 million deaths in 1985. Chronic lung diseases and cancer are each thought to have claimed about 2.5 million lives in 1985. External causes also probably accounted for 2.0-2.5 million deaths.
Australia↗
[Incidence and mortality of malignant lymphomas in the GDR].
Based on data from the cancer register of the German Democratic Republic established in 1952 and on the official mortality statistics, incidence of and mortality from malignant lymphomas (ICD 200-203) in the GDR are analysed. Age-specific incidence and mortality of Hodgkin's disease show a peak in the age group of 25-30 years and rise steadily from 45 years on up to the highest age. Lymphosarcoma and reticulosarcoma increase slowly from infancy to old age, whereas multiple myeloma is a disease of the elderly and extremely rare before the age of 40. The apparent increase of malignant lymphoma may be due to underregistration at the beginning of the cancer register. In the past years mortality from Hodgkin's disease is slowly decreasing, thus reflecting progress in methods of treatment and results.
Adolescent↗
Perinatal and neonatal mortality and morbidity in Lusaka, 1976.
A prospective study of perinatal and neonatal mortality and morbidity at the University Teaching Hospital (UTH), Lusaka for 1976 is presented. The early neonatal mortality of the babies born in hospital was 28.7 per 1000 live-births; it was 239.96 per 1000 admissions of those born outside the hospital. The still-birth rate in the hospital-born babies was 25.2 per 1000 deliveries; the perinatal mortality was 53.3 per 1000 deliveries; and the neonatal mortality in the hospital-born was 31.1 per 1000 live-births. The cause of death were asphyxia, infections could injury, respiratory distress syndrome, congenital malformation and intracranial haemmorrhage. If the perinatal and neonatal mortality and morbidity are to be reduced, much effort and co-operation of all concerned with the health of the expectant mother, and her child are required. Records of birth-weights, stillbirth, and causes of deaths in the University Teaching Hospital (UTH) for the year 1976 have been analysed. The aim is to provide a basis for future comparisons and improvement of the care given to newborns.
Female↗
[Perinatal mortality. Statistics from the Gynecological and Obstetrical Service of the Notre-Dame-de-Bon-Secours Hospital (1961-1975)].
The authors present their statistics for perinatal mortality from 1961 to 1975. In the last 5 years this mortality is less than 15 per 1000, in spite of an increase in the numbers of pathological pregnancies. Over and above progress in obstetrics and neonatology that has occurred, this result can be attributed in part to the quality of supervision carried out by the senior obstetricians and in part to the existence of pathological consultation which takes place between colleagues about the therapy to be carried out in multidisciplinary meetings.
Female↗