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PubMed1978

Follow-up methods to trace women treated for pulmonary tuberculosis, 1930-1954.

A retrospective cohort study, designed to examine the relationship between multiple chest fluoroscopies and subsequent breast cancer risk, was conducted in which 93.6% of 1764 former sanatorium patients were successfully located. The methodology used to trace former female patients who were treated for pulmonary tuberculosis between 1930 and 1954 (20-45 years before the study began) is presented. Extensive use of city directories and telephone resulted in locating the majority of study subjects. Outpatient medical records and state vital statistics departments were also of value. Searching for death certificates of parents was helpful as the informant named on the certificate was often the woman being traced or her husband. The Postal Service was of limited use. No difference in the proportion of breast cancer cases was found between the more easily traced patients and the last 9.7% of patients who were difficult to locate. Fewer of the last patients located had died, however, than those located without intense effort. Patients lost to follow-up were younger at the time of sanatorium admission, had a higher proportion of Protestants and non-white women, had shorter lengths of hospitalization and had less severe tuberculosis requiring less aggressive treatment than patients located.

Adolescent↗

PubMedDate not supplied

The management and use of data on maternal and child health and crippled children: a survey.

With the advent of the Maternal and Child Health Services Block Grant, both maternal and child health programs and crippled children's (CC) programs at the State level have assumed greater responsibility for identifying populations in need, planning appropriate services for them, and monitoring progress toward program objectives. To determine the capabilities of eight Southeastern States to produce and apply the data necessary to accomplish those tasks, a survey of data systems available to, and used by, perinatal and CC programs in the Southeast was undertaken. Findings of the survey suggested that the data available to perinatal programs were more useful for planning and evaluation than those available to CC programs, primarily due to the vital statistics data systems in each State. The major data management needs of the region include (a) measuring the health status of populations served by public perinatal programs, (b) measuring services received by population groups considered in need of public perinatal care, (c) estimating the incidence and prevalence of handicapping conditions among children, and (d) measuring the outcomes of CC programs. If these shortcomings are addressed, the programs will be in better positions for effective planning and evaluation. To improve data management and utilization capabilities, the programs may need to engage technical assistance and consultation from sources outside their service-oriented agencies.

Child↗

PubMed1994

Social class: the missing link in U.S. health data.

National vital statistics in the United States are unique among those of advanced capitalist countries in reporting data only by race, sex, and age--not by class and income. This article reviews the limited U.S. data resources that may be used to document social class inequalities in health. Summarizing the strengths and weaknesses of the British approach to gathering data on social class and health, the authors discuss possible approaches to collecting data that could be feasible in the U.S. context. They argue that educational level is an insufficient marker for socioeconomic position and contend that appropriate measures must take into account not only individual but also household and neighborhood markers of social class. These additional types of social class data are especially important for accurately describing and understanding social class inequalities in health among women and across diverse racial/ethnic groups.

Adolescent↗

PubMed2007

Geographic difference of mortality of Creutzfeldt-Jakob disease in Japan.

BACKGROUND: The geographic mortality difference of Creutzfeldt-Jakob disease is still unclear in Japan. METHODS: Using vital statistics of Japan for 6 year period between 1999 and 2004 officially published by the government, we observed the mortality from Creutzfeldt-Jakob disease (ICD-10th: A81.0 and A81.8) by prefecture. Standardized mortality ratios were calculated for the 47 prefectures. RESULTS: For the observed 6 years, a total of 792 deaths from Creutzfeldt-Jakob disease were observed whole in Japan. Two prefectures, Akita and Yamanashi, presented significantly high standardized mortality ratios. In addition, Tochigi, Kochi, and Nagasaki showed standardized mortality rates higher than 1.5 without significance. No prefecture had significantly low standardized mortality ratios. CONCLUSION: Some prefectures with high mortality rate from Creutzfeldt-Jakob disease existed in Japan. Some of them had high incidence rate in a survey conducted in 1996 as well.

Adolescent↗

PubMed2004

Premature mortality in health regions with high aboriginal populations.

OBJECTIVES: Potential years of life lost (PYLL) before age 75 in health regions with a relatively high proportion of Aboriginal residents is compared, by cause of death, with all other health regions. DATA SOURCES: The findings are based on mortality data for 1995 through 1997 from the Canadian Vital Statistics Database, and on population estimates for 1995, 1996 and 1997 at the health region level. ANALYTICAL TECHNIQUES: PYLL was calculated by age and sex for two groups of health regions: the 18 with a high proportion (19% or more) of Aboriginal residents and the remaining 120, which had smaller proportions of Aboriginal residents. PYLL rate differences and rate ratios were used to compare the two groups. MAIN RESULTS: The PYLL rate per 1,000 person-years at risk for all causes of death was about 50% greater in the high-Aboriginal health regions than in the other group. Almost 40% of total PYLL in high-Aboriginal health regions was attributable to injuries, notably, suicide and motor vehicles accidents.

Accidents, Traffic↗

PubMed1988

[Description of a methodology to identify and quantify groups of poor and malnourished families in the Republic of Panama].

The methodology used to identify and quantify existing data on the magnitude of nutrition and health damage in different political-administrative areas and families of Panama, is described. The purpose of the present paper is to orient governmental actions of the social field toward the most affected areas and families facing food and nutrition problems. The existing information sources used were the National Nutrition Survey carried out in 1980, the National Census on School Children's Height, of 1980, and the Vital Statistics of 1982. A score determined according to the expected data reliability was applied, by district, to the preschool height retardation data of the 1980 survey, to the data compiled through the school children's height retardation census of 1982 and to the infant and one-to-four year-old children's mortality data. The districts with the highest health and nutrition damage received the lowest score. Following this procedure, 28 districts, 204 "corregimientos" and six priority family groups were selected for social action. The usefulness of this procedure to orient governmental resources toward the poor and malnourished populations is discussed, as well as the technical possibility of carrying it out, on periodical bases, in order to orient program planning and know the impact they have on health and nutrition of the population.

Adult↗

PubMed1987

Canadian federalism and the Canadian health care program: a comparison of Ontario and Quebec.

The Quebec and Ontario health insurance and health service delivery systems, developed within the parameters of federal regulations and national financial subsidies, provide generally universal and comprehensive basic hospital and medical benefits and increasingly provide for the delivery of long-term care services. Within a framework of cooperative federalism, the health care systems of Ontario and Quebec have developed uniquely. In terms of vital statistics, the health of Ontario and Quebec residents generally is comparable. In viewing expenditures, Quebec has a more clearly articulated plan for providing accessible services to low-income persons and for integrating health and social services, although it has faced some difficulties in seeking to achieve the latter goal. Its plans for decentralized services are counter-balanced by a strong provincial role in health policy decision-making. Quebec's political culture also allows the province to play a stronger role in hospital planning and in the regulation of physician income than one finds in Ontario. These political dynamics allow Quebec an advantage in control of costs. In Ontario, in spite of some recent setbacks, physician interests and hospital sector interests play a more active role in health system bargaining and are usually able to influence remuneration and resource allocation decisions more than physician interests and hospital sector interests in Quebec.

Canada↗

PubMed1992

Marriage markets and nonmarital fertility in the United States.

We merge census microdata with vital statistics data to examine the effect of women's marriage opportunities on nonmarital fertility rates and ratios across 75 U.S. metropolitan areas. Measures of the quantity and "quality" of marriageable men simultaneously specific for women's age, race, education, and place of residence reveal especially poor marriage prospects for highly educated black women. The effect of mate availability on nonmarital fertility is generally modest. Among white women, marriage opportunities are associated inversely with the nonmarital fertility rate, perhaps reflecting an increased likelihood that a premarital conception will be legitimated. Marriage opportunities also reduce nonmarital fertility ratios for young black and white women. The nonmarital fertility rate is lower among women whose marriage pool includes a large percentage of nonemployed males. Only a small proportion of the racial difference in nonmarital fertility appears attributable to differences in the marriage markets of black and of white women.

Black or African American↗

PubMed2003

Birth cohort effect of the mortality rate from congenital heart disease in Japan.

BACKGROUND: The mortality rate from congenital heart disease in Japan had decreased partly because the great improvement of medical treatment and care. Therefore, the patients who would have died of congenital heart disease in younger age in the past may be alive to be adult, and the number of adults with congenital heart disease might increase. If the management of such adults did not improve, the mortality rate from congenital heart disease might increase because of the increased number. METHODS: Using the Japanese vital statistics from 1960 through 1999, we observed the time series of the mortality rate from congenital heart disease by age and sex. The birth cohort consisted of those who were bone in 5-year period starting in 1960. The mortality rate was the sum of the number of death in every five years divided by the population of the center year. RESULTS: The transition of the mortality rate from congenital heart disease for age group 0 to 4 years was decreased since 1973. Other age groups showed decreased mortality rate since late 1960's. The birth cohort analyses showed that the mortality rate of each birth cohort was decreased as time passed, especially the age group 5 to 9 years old and 10 to 14 years old. CONCLUSION: Birth cohort effect of mortality from congenital heart disease exists in Japan.

Adolescent↗

PubMed1995

A comparative study of trends in mortality rates of the ageing population in Norway, Sweden, Denmark, and Finland, 1966-1986.

The populations of Finland and the three Scandinavian countries (Denmark, Norway and Sweden) have experienced relatively marked differences regarding trends in mortality rates since the Second World War. To assess factors that might contribute to these differences, a cohort analysis was performed based upon vital statistics for the age category 45 years to 89 years, from the four countries, for the period 1966-86. The results of log-linear modelling, which included the effects of age, period, and cohort, on mortality rates, revealed differences in the effect of age parameters on mortality between Finland and the three Scandinavian countries. These differences may be related to a genetic component. Differences in patterns of mortality rates over time relating to period and cohort effects indicate a differential development in lifestyle-related risk factors associated with the major causes of death. Based on differences in goodness-of-fit of the log-linear models, it is suggested that the Finnish population has experienced a more heterogeneous development in mortality over time than has the Scandinavian. This may be related to the greater social inequities that have existed in Finland than in Scandinavia during the decades under study.

Aged↗

PubMed1998

A comparative study of twinning and triplet rates in 17 countries, 1972-1996.

Secular changes in twinning and triplet rates were analyzed using vital statistics in Austria, the Czech Republic, the Slovak Republic, England and Wales, Germany, the Netherlands, Switzerland, Denmark, Finland, Norway, Sweden, Canada, Australia, Hong Kong, Israel, Japan, and Singapore during the period from 1972 to 1996. Among those 17 countries, the twinning and triplet rates in the Czech Republic and in the Slovak Republic remained constant from 1972 to 1994, whereas these rates increased significantly year by year in the other 15 countries during the examined period in each country. Twinning rates increased from 1.2-fold in Austria to 2-fold in Denmark from 1972 to 1996. As for triplets, the rate increased from 3-fold in Denmark to 9-fold in Norway during that period. With one exception, that being the Slovak Republic, the triplet rate was highest in the Scandinavian countries, followed by the other European and Asian countries. The rising twinning and triplet rates have been attributed to the higher proportion of mothers treated with ovulation-inducing hormones and partially attributed to IVF.

Asia↗

PubMed1998

Childhood injury in Connecticut.

We reviewed vital statistics (1988-95) and hospital discharge data (1990-94) for Connecticut children and youth to describe the epidemiology of childhood injuries. There are approximately 175 deaths (rate = 21/100,000) and 4,230 hospitalizations (rate = 468/100,000) annually due to injury. Nonfatal injuries resulted in over 94,000 hospital days at a cost of nearly $155 million dollars. Death and hospitalization rates are highest among male children and adolescents 15 to 19 years of age. Geographic analysis of injury revealed significantly higher injury death and hospitalization rates in towns greater than 100,000 population. In addition, a majority of the homicides occurred in large urban areas, and most of the motor vehicle occupant deaths and suicides occurred in suburban and rural areas. Injury is an important cause of mortality and morbidity in youth and is largely preventable. The data presented here allow for the development, implementation, and evaluation of community based injury prevention programs.

Accidents, Traffic↗

PubMed1989

Fatal injuries in Oklahoma: descriptive epidemiology using Medical Examiner data.

To characterize mortality associated with injuries and other health problems in Oklahoma, we examined data from the Office of the Chief Medical Examiner of the State of Oklahoma for the years 1978 through 1984. Each year, approximately 1,500 and 800 deaths resulted from unintentional injury (UI) and intentional injury (ie, suicide and homicide), respectively. The medical examiner (ME) data differed substantially from the state's vital statistics (VS); over the seven years, the ME records showed 2,021 (16%) fewer UI deaths than did the VS, as well as 24 (1%) more cases of suicide and 499 (23%) more cases of homicide. Rates for UI and suicide were highest for young adults and for the elderly; in contrast, rates for homicide were highest for young adults, and then decreased with age. For each of the three categories of injury-related deaths, rates for male subjects were approximately three times those for female subjects; rates also varied by race-ethnic group. Deaths due to UI and homicide occurred more often in the summer and on weekends, though suicides did not vary by month and were slightly more common on weekdays. This study indicates that ME data represent an important source of epidemiologic information for the surveillance and study of injury-related mortality.

Adolescent↗

PubMed2004

Apparent truth about congenital diaphragmatic hernia: a population-based database is needed to establish benchmarking for clinical outcomes for CDH.

BACKGROUND: The authors hypothesize that recent single or multiinstitution-based reports of improved survival of congenital diaphragmatic hernia (CDH) patients are biased by patient selection, practice, and referral patterns. Here the authors report a population-based analysis of the clinical outcomes of CDH in the province of Ontario for 1996. METHODS: A retrospective analysis of cross-sectional data from the Bureau of Vital Statistics of Ontario and all 5 pediatric surgical institutions in Ontario for 1996 was performed. RESULTS: Twenty-four CDH-associated deaths were registered in Canada in 1996. Fourteen of 24 occurred in Ontario (58.3%). Of 30 institutionally identified CDH in Ontario, 8 patients died (26.7%). CDH-associated infant mortality rate was 6.6 of 100,000 live births in Canada compared with 10 of 100,000 live births for Ontario (Relative risk, 1.4; confidence interval, 0.5, 3.7; P >.01). Neonatal death (<28 postnatal days) accounted for the majority, 13 of 14 (92.8%) of deaths. Six of 14 (42.9%) CDH-associated deaths, however, were not accounted by the institutional-based reporting. In addition, institutional-based survival rates for CDH varied from 62.5% to 100%. CONCLUSIONS: Our results indicate the existing bias associated with institution-based reporting and database of CDH. The "hidden mortality" associated with CDH is still present. A population-based database is needed to establish the benchmarking for management of CDH.

Bias↗

PubMed1996

Low birthweight in Germany 1990-92.

The reunification in 1990 of the German Democratic Republic (GDR) and the Federal Republic of Germany (FRG) produced profound social transformations. Changes in the distribution of low birthweight (LBW, < 2500 g) in the two parts of the country between 1990 and 1992 have been studied by analysing vital statistics for the period. In absolute numbers, livebirths in the former FRG remained stable, while those in the former GDR declined by 51%. Numbers of LBW livebirths increased slightly in the former FRG and decreased in the former GDR; those in the category between 500 and 999 g remained stable in the former GDR and increased in the former FRG. However in terms of proportion, livebirths in this category doubled in the former GDR. Migration rates for the same period showed a shifting population from East to West particularly of young people, and maternal age-specific numbers of livebirths decreased in both countries. Psychosocial stress may have contributed to the rise in ELBW, but it is also possible that the improvement and sharing of perinatal management strategies may have led to increased survival of babies < 1000 g. Most importantly, the observed rise in the proportion of ELBW births (except those < 500 g) could be a result of the introduction of the more comprehensive definition of livebirth into the former GDR.

Adult↗

PubMed2000

Teenage pregnancy.

OBJECTIVES: This article examines trends in teenage pregnancy in Canada, focussing on induced abortions, live births and fetal loss among women aged 15 to 19 in 1997. DATA SOURCES: The data come from the Hospital Morbidity Data Base and the Canadian Vital Statistics Data Base at Statistics Canada, and the annual Therapeutic Abortion Survey, conducted by the Canadian Institute for Health Information. Data on abortions performed on Canadian residents in the United States are from an annual survey of selected states. International data are from the Alan Guttmacher Institute. ANALYTICAL TECHNIQUES: Pregnancy rates, abortion rates, live birth rates and fetal loss rates are calculated using population counts of women in the age groups 15 to 17, 18 to 19, and 15 to 19. The percentages of pregnancies that ended in the three outcomes are also calculated for these years. MAIN RESULTS: The teenage pregnancy rate declined from 1994 to 1997, reflecting lower teenage birth and fetal loss rates. Through this period the abortion rate remained stable, with the result that slightly more than half of all teenage pregnancies ended in abortion by 1997. Younger teens are more likely to have an abortion than to give birth. The majority of pregnancies among older teens end in a live birth, although the number of live births is decreasing.

Abortion, Legal↗

PubMed2006

Changes in the timing of SIDS deaths in 1989 and 1999: indirect evidence of low homicide prevalence among reported cases.

An unknown proportion of cases diagnosed as sudden infant death syndrome (SIDS) are misdiagnosed, and in some cases are homicides. Because recent SIDS prevention measures were unlikely to reduce homicides, changes in the reported timing of SIDS cases provide an indirect measure of covert homicides in this group. This paper uses United States vital statistics microdata to explore these questions. The sample includes all reported infant deaths to singletons with birthweight > 500 g in the 1989 and 1999 US birth cohorts. Deaths attributed to SIDS (n = 7708), homicide (n = 597), or object inhalation and mechanical suffocation (n = 860) are specifically examined. If reported SIDS cases were a mixture of 'true' cases and misdiagnosed homicides, it is hypothesised that the age-at-death distribution of SIDS deaths would have changed to reflect greater prevalence of misdiagnosed homicide. We find that the age-at-death distribution of reported SIDS cases was virtually unchanged in the two cohorts, showing no increase during periods of infancy when relative homicide risk is most pronounced. One cannot reject the hypothesis that the timing was drawn from the same distribution (chi2(52)= 62.2, P = 0.157). Analogous results hold for infants born in circumstances associated with high homicide risk (chi2(50) = 61.5, P = 0.12). The stable age-at-death distribution of reported SIDS cases between 1989 and 1999 suggests that covert homicides are a small fraction of reported SIDS cases.

Age Factors↗

PubMed1994

[Main household occupation and mean birth weight in Japan 1984].

By using the 1984 vital statistics released on magnet tapes by the Japanese government, we observed in the present study how the mean birth weight (MBW) varies from one group of mothers who fall under the same category of "main household job" to another. In so doing, we compared the MBWs among different job categories in terms of mother's age, baby's sex, and parity. The obtained results are summarized as follows: 1) The MBW of primiparae and male babies was found to be significantly different among the job categories in the age range of 20-39. In the group of multiparae and male babies, however, all the age ranges older that twenty showed significant differences in the MBW among the job categories. In the group of female babies, the significant difference was found in the age range of 20-39 and all the ranges older than twenty for primiparae and multiparae, respectively. 2) The above results were considered to be caused mainly by the low MBW in the category of "other" for primiparae, and by the high MBW in "part-time farming" and the low MBW in "other" for multiparae.

Adolescent↗