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PubMed1990

Unintentional injury death rates in rural Appalachia.

Rural unintentional injury (UI) death rates are higher than rates for urban regions. Our trauma center serves 49 rural Appalachian (AP) counties in a 120-county rural state. We investigated the impact of prehospital and hospital resources on UI death rates in our referral area. Age-adjusted and average age- and sex-specific UI death rates from 1979-1985 were compared among 49 rural AP counties, the 71 non-Appalachian (NAP) counties, and the United States. Counties were grouped for comparisons by level of prehospital care (Advanced Life Support [ALS] vs. Basic Life Support [BLS]) and by presence (H) or absence (NH) of a hospital. Death rates were calculated using data from the 1980 population census, the National Center for Health Statistics (NCHS), and state vital statistics. Within AP, all 49 counties have ambulance service. Only 9/49 (18%) have ALS service and 13/49 (26%) have no hospital. Age-specific AP rates were higher than NAP and US rates in the 25-44 and 45-64 year age groups. AP death rates were highest for BLS and NH counties across all age groups. Rural UI death rates in the region remain unacceptably high. The reason(s) that AP death rates exceed the NAP rates is uncertain. ALS service and an available hospital were associated with lower death rates. We propose both educational and epidemiologic programs to better identify and define additional problems.

Adult↗
PubMed1987

[The registration of deaths in Venezuela: an evaluation of coverage].

"This paper presents six indirect techniques for estimating the degree of death coverage as applied to vital statistics information in Venezuela between 1960 and 1982, collected by two public institutions, namely, the 'Oficina Central de Estadistica e Informatica' (OCEI) and the Ministry of Health and Social Assistance (MSAS).... The results show remarkable improvements in the death registry coverage for both institutions, that amount to 97 or 98 per cent at the beginning of the 80's. Nevertheless, great differences can be observed between them regarding both structure and volume of deaths by sex and age." Among the problems discussed are the impact of immigration and errors in age reporting. (SUMMARY IN ENG)

Age Factors↗
PubMed2004

Deaths: final data for 2002.

OBJECTIVES: This report presents final 2002 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 2002. METHODS: In 2002 a total of 2,443,387 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Funeral directors, attending physicians, medical examiners, and coroners complete death certificates. Original records are filed in the State registration offices. Statistical information is compiled into a national database through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. Causes of death are processed in accordance with the International Classification of Diseases Tenth Revision (ICD-10). RESULTS: The age-adjusted death rate for the United States in 2002 was 845.3 deaths per 100,000 standard population, representing a decrease of 1.1 percent from the 2001 rate and a record-low historical figure. Life expectancy at birth rose by 0.1-year to a record high of 77.3 years. Considering all deaths, age-specific death rates rose only for those under 1 year, and declined for a number of age groups including those 1-4 years, 25-34 years, 55-64 years, 65-74 years, 75-84 years, and 85 years and over. The 15 leading causes of death in 2002 remained the same as in 2001. Heart disease and cancer continued to be the leading and second leading causes of death, together accounting for over half of all deaths. The infant mortality rate in 2002 increased to 7.0 compared with a rate of 6.8 in 2001. CONCLUSIONS: Generally, mortality patterns in 2002 were consistent with long-term trends. Life expectancy in 2002 increased again to a new record level. The age-adjusted death rate declined to a record low historical figure. However, the infant mortality rate increased in 2002. The infant mortality rate has either decreased or remained level each successive year through 2001 since 1958. Trends for homicide and injury at work were interrupted due to the terrorist deaths that occurred September 11, 2001. The homicide rate decreased significantly from 2001 to 2002 and dropped to the 14th leading cause of death. Deaths due to injury at work also declined significantly during this period.

Cause of Death↗
PubMed1991

Ascertainment of maternal deaths in New York City.

Maternal deaths in New York City are defined as deaths from any cause in a woman while pregnant or within six months of pregnancy termination. Pilot studies seeking to improve maternal death ascertainment found that selected medical examiner reports contributed an additional 10.5 percent of the total maternal deaths, vital statistics review contributed 6.3 percent, linkage of death tapes of women of reproductive age to live birth and fetal death tapes contributed 1.0 percent. Medical examiner cases should be incorporated into surveillance data for accurate ascertainment of pregnancy associated deaths.

Adolescent↗
PubMed1999

Deaths: final data for 1997.

OBJECTIVES: This report presents final 1997 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1997. METHODS: In 1997 a total of 2,314,245 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. RESULTS: The 1997 age-adjusted death rate for the United States decreased to an all-time low of 479.1 deaths per 100,000 standard population, and life expectancy at birth increased to a record high of 76.5 years. The 15 leading causes of death remained the same as in 1996, although Human immunodeficiency virus (HIV) infection plummeted from the 8th leading cause of death to the 14th leading cause. Some of the 8th-14th leading causes of death shifted positions. HIV infection remained the leading cause of death for black persons aged 25-44 years. The largest decline in age-adjusted death rates among the leading causes of death was for HIV infection, which dropped 47.7 percent between 1996 and 1997. Mortality declined for all age groups, except for persons aged 85 and over. The infant mortality rate reached a record low of 7.2 infant deaths per 1,000 live births in 1997 although the decline in the rate from 1996 was not statistically significant. CONCLUSIONS: The overall improvements in general mortality and life expectancy in 1997 continue the long-term downward trend in U.S. mortality. The trend in U.S. infant mortality is of steady declines over the past four decades.

Adolescent↗
PubMed2003

Mortality associated with birth defects: influence of successive disease classification revisions.

INTRODUCTION: The National Vital Statistics System is the fundamental source of mortality statistics in the United States. The cause-of-death classification which is used to assign medical terms to a standard taxonomy is revised periodically, and it is necessary to account for these changes when investigating trends. This paper presents birth defects mortality statistics and preliminary information on the most recent transition between revisions of the classification. METHODS: Descriptive statistics are presented using multiple cause and underlying cause counts, rankings of leading causes of death, infant mortality rates, and age-adjusted death rates. Comparability results are based upon records that have been coded using two separate classifications. RESULTS: Birth defects remain the leading cause of death for infants and among the leading causes for younger age groups. The trend for birth defect mortality shows that the risk of dying from birth defects decreased between 1950 and 2000. The effect of implementing successive revisions of the cause-of-death classification was relatively minor until the implementation of the most recent revision. Fewer records are assigned to birth defects in the latest revision than in the previous revision. DISCUSSION: Researchers investigating mortality trends related to birth defects need to be aware that the cause-of-death classification changes periodically. The effect of the changes between two successive classifications can be measured and explained.

Cause of Death↗
PubMed1993

Data needed for improving the health of minorities.

Identified needs for minority health data, obstacles in obtaining the data, and potential solutions are reviewed. Vital statistics for whites and blacks have been available by states for many years. Recent revisions provide data on Hispanics, and new resolutions will provide data on Asian and Pacific Islander subgroups. But limitations persist in providing accurate statistics for minority subgroups. A major obstacle is the inadequacy of census denominator estimates, due to differential undercounts, paucity of postcensal estimates for states and localities, and the validity of the race and ethnicity data. Important issues revolve around quality, comparability, and intraperson variability of self-identification in determining race and ethnicity, versus external assessment. National survey data have oversampled for black and Hispanic minorities, but not others. The Disadvantaged Minority Health Improvement Act of 1990 provides some solutions, including an extramural grants program to strengthen minority statistics, which the National Center for Health Statistics has implemented to improve minority health assessment at all levels.

Adolescent↗
PubMed2006

Transmissibility and mortality impact of epidemic and pandemic influenza, with emphasis on the unusually deadly 1951 epidemic.

There are important gaps in our current understanding of the influenza virus behavior. In particular, it remains unclear why some inter-pandemic seasons are associated with unusually high mortality impact, sometimes comparable to that of pandemics. Here we compare the epidemiological patterns of the unusually deadly 1951 influenza epidemic (A/H1N1) in England and Wales and Canada with those of surrounding epidemic and pandemic seasons, in terms of overall mortality impact and transmissibility. Based on the statistical and mathematical analysis of vital statistics and morbidity epidemic curves in these two countries, we show that the 1951 epidemic was associated with both higher mortality impact and higher transmissibility than the 1957 and 1968 pandemics. Surprisingly in Liverpool, considered the 'epicenter' of the severe 1951 epidemic, the mortality impact and transmissibility even surpassed the 1918 pandemic.

Communicable Disease Control↗
PubMedDate not supplied

Improving data collection strategies.

The authors examined 21 major health data systems of the U.S. Department of Health and Human Services (DHHS) and concluded that data on Hispanics are not included in several Departmental national health data collection systems, and that even when collected, data on Hispanic subpopulations are found in few of the systems. Of the 21 data systems, 6 do not collect Hispanic population data, including the Medicare statistical system. Only the National Vital Statistics System was found to collect data for all major Hispanic subpopulation groups. Seventeen of the 21 data systems do not collect sample sizes adequate for analyzing any one of the four major Hispanic subpopulation groups. To address that lack, Hispanic health leadership agendas have recommended collecting data on Hispanics in all systems, where possible, to provide samples of a size adequate for detailed analysis of Hispanic subpopulation groups, for support of researchers and a Hispanic research infrastructure, and for broad dissemination of data findings, including dissemination in useful formats to Hispanic community-based organizations.

Data Collection↗
PubMed1996

Infant mortality rate inequalities in the Western Cape Province of South Africa.

BACKGROUND: Cape Town is undergoing rapid urbanization. South African vital statistics have routinely been stratified by racial categories but intra-urban and peri-urban geographical variations have been neglected. METHODS: To examine variations in infant mortality rates (IMR) and proportional infant mortality between urban, rural and informally settled areas, stratified by racial category, birth notifications and infant death certifications recorded by a large health authority were analysed. RESULTS: The IMR per 1000 livebirths was as high for coloureds on rural farms (34, 95% confidence interval 29-40) as for blacks in informal settlements (35, 95% CI: 32-37) and an exceptionally high IMR (60, 95% CI: 43-82) was found for coloureds in informal settlements. Inequalities between racial categories (11 (95% CI: 9-14) for whites, 19 (95% CI: 18-21) for coloureds and 33 (95% CI: 31-35) for blacks) were as expected from other South African studies. Of rural farm deaths, 22% were ascribed to ill-defined causes. Low birthweight was the most common defined cause of death in all areas except rural farm areas (14% ascribed to pneumonia), and gastro-enteritis was important in informally settled areas (18%). CONCLUSIONS: Routine mortality data are more informative if stratified by robust and readily available indicators of socio-economic status such as residential area and racial category. Place of residence may distinguish risk strata as well as racial category, but the latter is helpful within socioeconomically heterogeneous residential areas.

Black or African American↗
PubMedDate not supplied

Bridging between two standards for collecting information on race and ethnicity: an application to Census 2000 and vital rates.

OBJECTIVES: The 2000 Census, which provides denominators used in calculating vital statistics and other rates, allowed multiple-race responses. Many other data systems that provide numerators used in calculating rates collect only single-race data. Bridging is needed to make the numerators and denominators comparable. This report describes and evaluates the method used by the National Center for Health Statistics to bridge multiple-race responses obtained from Census 2000 to single-race categories, creating single-race population estimates that are available to the public. METHODS: The authors fitted logistic regression models to multiple-race data from the National Health Interview Survey (NHIS) for 1997-2000. These fitted models, and two bridging methods previously suggested by the Office of Management and Budget, were applied to the public-use Census Modified Race Data Summary file to create single-race population estimates for the U.S. The authors also compared death rates for single-race groups calculated using these three approaches. RESULTS: Parameter estimates differed between the NHIS models for the multiple-race groups. For example, as the percentage of multiple-race respondents in a county increased, the likelihood of stating black as a primary race increased among black/white respondents but decreased among American Indian or Alaska Native/black respondents. The inclusion of county-level contextual variables in the regression models as well as the underlying demographic differences across states led to variation in allocation percentages; for example, the allocation of black/white respondents to single-race white ranged from nearly zero to more than 50% across states. Death rates calculated using bridging via the NHIS models were similar to those calculated using other methods, except for the American Indian/Alaska Native group, which included a large proportion of multiple-race reporters. CONCLUSION: Many data systems do not currently allow multiple-race reporting. When such data systems are used with Census counts to produce race-specific rates, bridging methods that incorporate geographic and demographic factors may lead to better rates than methods that do not consider such factors.

Adolescent↗
PubMedDate not supplied

Causes of mortality in an African city.

Registered deaths from the vital statistics registration system of Lagos City, a system that was judged to be 60% complete, were analysed for the year 1977. Nearly 40% of total registered deaths were from infections, parasitic diseases and motor vehicle accidents. Of the reported deaths, 17.3% were from ill-defined conditions. Deaths from neoplasms, diseases of the nervous and sense organs, diseases of the digestive and genitourinary systems as well as those from congenital anomalies are relatively less frequent. Maternal mortality appears to be very high. The age pattern of mortality is different from that in the developed countries, a high proportion of the deaths in Lagos City being those of children aged under 5 years. Infant mortality is dominated by perinatal causes which constituted a huge 38.4% of deaths of infants under 1 year, the other important causes being dysentery and diarrhoea, pneumonia and tetanus. Among adults, death from motor vehicles accidents is the most important cause accounting for more than 26% of deaths in the age group 15 years and above. Other important causes of adult deaths are cerebrovascular disease, hypertensive disease, heart disease, pneumonia, dysentery and diarrhoea and complications of pregnancy. Well organized health services stressing antenatal care, preventive and health education services are needed to effect a reduction in mortality and bring about a general improvement in the health of the people.

Adolescent↗
PubMed1989

Trends in perinatal and neonatal mortality and morbidity in India.

Although the infant mortality rate (IMR) has reduced by 50% during the past century, it compares poorly with the advanced countries and some developing countries. The observed fall in IMR has been mostly in post-neonatal mortality, with the result that neonatal deaths now account for over 60% of all infant deaths. The overall perinatal mortality rate (PMR) in India is still over 50 per 1000 and has shown virtually no decline during the past decade, However, PMR differs widely in different states, urban/rural areas, different hospitals and so on. PMR is seen to correlate better with social development than economic development of the representative community. The causes of perinatal deaths suggest poor health of mother and poor health facilities and are hence potentially preventable. Various studies have shown that PMR can be significantly reduced within a short span of time. The registration of vital statistics continue to be highly unsatisfactory especially in rural areas.

Cause of Death↗