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PubMedDate not supplied

[Trends in mortality in Serbia, excluding the provinces, 1973-1994].

The war and break up of former Yugoslavia began in 1991. In May 1992 the United Nations imposed economic sanctions on Serbia and Montenegro which were suspended only in November 1995. The purpose of this study was to assess the effects of the war and UN sanctions on health of the population of Serbia without the provinces of Vojvodina and Kosovo. The period 1973-1994 was studied. Mortality data were derived from unpublished and published materials of the Federal Institute of Statistics [1]. Refugees, who, because of civil war, came to Serbia and Montenegro from other parts of former Yugoslavia, were not counted as a part of the population when mortality rates were calculated. Mortality rates were standardized directly using the "European population" as the standard [2]. The least square method was used to fit mortality rates to different trend curves. Linear trend was used whenever it significantly (p < 0.05) demonstrated the existing mortality rates. To measure the possible effect of the war and sanctions (WAS) on mortality between 1991 and 1994, dummy variable (variable WAS) consisting of 0's and 1's was made to signify the passage from the period before and the period after the beginning of the war and sanctions [3]. Over the period 1991-1994, characterized by the war and UN sanctions, in women aged 25-34, 35-44 and 75-84, total mortality was significantly higher than expected on the basis of the trend for the preceding period (p = 0.006, p = 0.000 and p = 0.015 respectively). The opposite effect was found in the age group 85+ (p = 0.012)/Table 2. Of major causes of death, in age group 25-34, mortality from endocrine diseases increased more rapidly in both sexes (p = 0.000) and mortality from urogenital diseases in women decreased more slowly than expected (p = 0.006). On the other hand, in age group 85+ mortality was significantly lower for cardiovascular diseases in both sexes (p = 0.035 and p = 0.006), for respiratory diseases in men (p = 0.011) and for neoplasms in women (p = 0.006)/Table 4. In addition, in the years 1991 and 1992 the increase in mortality from injuries and poisoning was evident in men aged 15-24, 25-34 and 85+ years (Graph 5). Our results show that over the period 1991-1994 changes in mortality were present in some age groups and were caused by certain groups of diseases. In men, besides mortality of infectious disease which decreased more slowly during 1991-1993 than expected, [4], the main departures were found in the mortality from injuries and poisoning and in mortality from endocrine diseases. The excess of death due to injuries and poisoning in the age group 15-34 can be explained as a direct consequence of the war. There were no military operations on the territory of Serbia, but young men from Serbia were nevertheless engaged in the war in other republics of former Yugoslavia. The outstanding increase in mortality caused by injuries and poisoning in men aged 85+ has two explanations. The first is the fact that suicide rate which was on an average of 86 per 100,000 over the period 1984-1990 rose to 140 per 100,000 during the period 1991-1993. In the year 1994 it fell to 92 per 100,000. Since there were no great differences in percent distribution of suicides among all deaths caused by injuries and poisoning in the two periods (27% in 1984-1990 and 20% in 1991-1993), it is clear that the rise of suicidal rate cannot be the only explanation for increased mortality from injuries and poisoning. In a situation when medical services were badly overextended (lack of medical equipment and proper maintenance of the existing equipment, lack of drugs and other medical inputs, a large number of wounded coming from Bosnia as well as numerous refugees) [5, 6], priority had to be given to younger age groups. Higher mortality due to endocrine diseases in men and women aged 25-34 years and higher mortality due to urogenital diseases in women of the same ages can be most probably attributed to poor medical supplies. Although formally excluded from the international economic blockade medical supplies were in practice badly affected by the fact that the dinar was rendered almost worthless and the Ministry of Health could no longer pay the medical inputs. In addition, bureaucratic hurdles of getting clearance from the UN added months of delay and made foreign companies unwilling to trade [5, 7]. The supply and distribution of drugs within the country was also irregular because communication lines were cut and local companies were not prepared to risk distributing drugs that nobody could pay for [7]. Higher than expected mortality in women aged 25-44 over the period 1991-1994 could be probably explained by their higher vulnerability (period of fertility) and the fact that the main burden of family survival was on them, so they had no time to think and to take care of their health. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed2005

Bias measuring mortality gradients by occupational class in New Zealand.

BACKGROUND: Socioeconomic differences in mortality in New Zealand have traditionally been measured using occupational class from mortality data (based on usual or last occupation) as the numerator, and class from census data (current occupation on census night) as the denominator. Such analyses are prone to numerator-denominator bias. Record linkage of census and mortality data in the New Zealand Census-Mortality Study (NZCMS) allows analyses of 'linked' data that will avoid numerator-denominator bias, but may be prone to other biases. OBJECTIVES: To determine differences in the assignment of occupational class between census and mortality data; to investigate biases in the observed association of class with mortality using linked census-mortality data; and to compare the class-mortality association using unlinked versus linked census-mortality data. METHODS: Census records for males aged 25-64 years on census night 1991 were anonymously and probabilistically linked to 5,844 out of 8,145 eligible deaths occurring in the second and third years following census night. RESULTS: (by objective) Only 47% of linked deaths had an occupation recorded on census data, compared to 84% on mortality data - a census to mortality ratio of 0.56. Relatively fewer deaths were identified as class 4 on census data (census to mortality ratio of 0.45) compared to other classes (ratios 0.55 to 0.64). Linkage bias: A lower likelihood of 25-44 year old deaths (but not 45-64 year olds) from lower socioeconomic classes being successfully linked to a census record meant that analyses using linked census-mortality data underestimated the class-mortality association. Bias due to exclusion of economically inactive: Analyses on linked-census data (using current occupational class) considerably underestimated the estimated association of usual occupational class with mortality. The strength of the association of class with mortality according to linked census-mortality data (and adjusted for the above two biases) and unlinked data were roughly comparable. CONCLUSION: Differences in the recording of occupational class on census and mortality data in New Zealand mean measuring mortality differences by class is thwart with difficulty. If one assumes that biases for any particular method of analysis are similar over time, or one carefully adjusts where possible for bias, using occupational class to monitor trends in socioeconomic mortality gradients may be valid.

Adult↗
PubMedDate not supplied

[Analysis of mortality in cancer of the large intestine in a cohort group in Serbia from 1971 to 1996].

Colorectal cancer is one of the most frequent malignant neoplasms in both sexes within developed countries. In the Republic of Serbia(Serbia), colorectal cancer mortality in 1971 range 5 in females, and 4 in males; it became the second leading malignancy in 1982 in females (after breast cancer), and in 1992 in males (after lung cancer). The objective of this descriptive-epidemiological study was to examine colorectal cancer mortality in Serbian population, particularly the effect of cohort variations on death rates in defined age groups over the period 1971-1996. Mortality rates were calculated from unpublished national vital statistics data of the Institute of Statistics of the Republic of Serbia. To estimate the age effect on colorectal cancer mortality, specific death rates were computed for cohorts born between 1992-96 and 1972-76, and died at subsequent time periods. The mortality rates were adjusted by direct method, using the world standard population. Confidence intervals (CI) for death rates were assessed with 95% level of probability. In time trend analysis of mortality, Fisher's test was used as a significance test for linear regression coefficient. In the study period (1971-1996), a share of all digestive tumours in cancer mortality has decreased from 42.0% to 32.3%. However, the mortality risk of colorectal cancer and its share in cancer mortality have increased. For example, in men, the share of colorectal cancer in digestive cancer mortality increased from 20.7% (1971) to 32.8% (1996) and in overall cancer mortality from 7.5% to 10.5%. In women, the share of colorectal cancer in digestive cancer mortality increased from 23.0% (1971) to 35.6% (1996), and in overall cancer mortality from 8.5% to 11.6%. The average colorectal cancer age-adjusted death rates (1971-1996) were 11.2 per 100,000 men (95% CI: 10.1-12.3), and 8.3 per 100,000 women (95% CI: 7.7-8.9). The secular linear mortality trends showed significant increase both in males (y = 11.2 + 0.2x; p = 0.000), and females (y = 8.3 + 0.1x; p = 0.000). The highest rise in age-specific death rates, according to linear mortality trends, was observed in males over 65 years (7.8% annually), and females between 60 and 69 years (5.9% annually). In cohort analysis of age-specific rates in males, younger birth cohorts were compared with older ones. The increasing colorectal cancer mortality risk has been observed for ages over 40, with statistical significance in age groups over 45. In ages between 45 and 59, and over 60, the youngest birth cohorts were at 2 and 2.5-fold higher cancer mortality risk than birth cohorts of the oldest generations. For example, the age specific colorectal cancer death rates in a 70-74 year group were 2.5-fold higher in men born between 1922 and 1926 (139.3/100,000) than in cohorts born 25 years earlier (58.7/100,000). In cohort analysis of age-specific rates in females, changes in the age under 50 were not so expressive. In all age groups over 50, women of younger generations were at 2-fold higher cancer mortality risk than the oldest ones. The age specific colorectal cancer death rates in a 65-69 year group were doubled in women born between 1927 and 1931 (61.0/100,000), than in cohorts born 25 years earlier (30.5/100,000). According to the present mortality trends, the further increase in colorectal cancer death rates, especially in the ages over 40, should be expected in future generations. Consistent increase in mortality risk in all younger birth cohorts of older ages, as well as in successive five-year age groups of the observed generations, could reflect the continuous increase in colorectal cancer incidence attributed to predominantly environmental exposures.

Adult↗
PubMed2000

[Mortality socio-economic inequalities for small-areas in Belgium: assessing concentration].

BACKGROUND: The reduction of socio-economic inequality in mortality is an important public health goal. Previous ecological studies aimed at studying the relationship between mortality rate and socio-economic factors have paid little attention to mortality causes avoidable by primary or secondary prevention. Furthermore, these studies do not make the distinction between, on the one hand, the strength of the relationship mortality/socio-economic deprivation and, on the other hand, the significance of the unequal distribution of mortality. The present work is aimed at measuring the strength of this relationship and the concentration of mortality in relation to socio-economic deprivation for both overall mortality and mortality avoidable by primary and secondary prevention. METHOD: Standardised mortality ratios were computed at the community level in Belgium (1985-93 period) for all causes and for 11 mortality causes avoidable by primary and secondary prevention. A deprivation index was elaborated using a factorial principal component analysis on 11 socio-economic indicators. The mortality/deprivation relationship was assessed by way of a standardised regression coefficient (B) while socio-economic concentration of mortality was estimated using the Concentration Illness Index (Cii) and the P90/P10 ratio. RESULTS: A strong positive relationship was found between mortality and deprivation for under 65 years all-causes mortality (B =0.71; CI [0.66; 0.76]), mortality for cirrhosis of the liver (B =0.56; CI [0.51; 0.62]), lung cancer (B =0.49; CI [0.42; 0. 56]), suicide (B =0.35; CI [0.29; 0.42]) and falls (B =0.34; CI [0. 28; 0.41]). However, the concentration of mortality was more limited: 14% (CI [11%-17%]) of cirrhosis of the liver mortality, 7% of fall (CI [5%-10%]) and suicide mortality (CI [4%-9%]), 6% (CI [5%-7%]) of lung cancer mortality is unequally distributed. CONCLUSION: Socio-economic deprivation is positively associated with mortality. This association is more pronounced for tobacco, alcohol and mental health related mortality. However, the strength of the relationship between socio-economic deprivation and mortality is not a good indicator of unequal distribution.

Age Factors↗
PubMed1997

[Decrease in cardiovascular disease mortality in the Czech Republic from 1984 to 1993 and its possible causes].

BACKGROUND: The objective of the investigation was to evaluate the ten-year development of the cardiovascular mortality rate in two population groups in the age bracket from 25 to 64 years, i.e. in subjects living in six districts which participated in the international WHO project MONICA and in the population of the whole Czech Republic. METHODS AND RESULTS: Data on the mortality rate in 1984-1993 for the age group from 25-64 years were provided by the Institute of Health Information and Statistics, information on the prevalence of risk factors was obtained in three cross-sectional studies implemented in six districts as part of the MONICA project in 1985, 1988 and 1992. In the mortality rate per 100,000 population in the six districts the following changes were revealed (in parentheses the values for 1984 and 1993 are given): men - a statistically significant declining trend in the from all caused mortality (849.3-742.5; p < 0.001) and cardiovascular mortality (367.2-280.4; p < 0.001) and cerebrovascular mortality (69.7-44.8; p < 0.001). In the mortality from ischaemic heart disease (215.7-170.6; ns) a declining trend was not recorded. In women aged 25-64 years in the six districts there was a statistically significant decline of the mortality from all caused (359.5-322.1; p < 0.001), the cardiovascular mortality (115.6-100.6; p < 0.001) and cerebrovascular mortality (31.1-23.6; p < 0.001). The mortality from ischaemic heart disease did not change (49.2-48.8; ns). In the population of the Czech Republic in men the following were detected: a drop of the from all caused mortality (907.1-784.8; P < 0.001), the cardiovascular mortality (383.5-308.4; p < 0.001) and cerebrovascular mortality (76.5-55.3; p < 0.001). Also in women of the Czech Republic a decline of the mortality from all caused was recorded (390.1-328.5; p < 0.001), the cardiovascular mortality (135.3-103.8; p < 0.001), ischaemic heart disease (58.0-48.6; p < 0.001) and cerebrovascular mortality (43.5-27.4; p < 0.001). In 1990 an increased cardiovascular mortality was recorded in men different from the trend during 1984-1993, statistically significant in the Czech Republic (p < 0.05) and in the six districts (p < 0.05). The reasons of this trend are not clear. The role of health services in the mortality drop is not clear, although available data indicate their improvement. Favourable changes were found in risk factors: during the period from 1985-1992 the prevalence of hypercholesterolaemia declined significantly in men and women, the prevalence of hypertension in women and the prevalence of smoking in men declined in the six districts. From nationwide data ensues that after 1989 significant changes occurred in the diet of the Czech population. The meat consumption declined by 1993 by 13%, the milk and dairy product consumption by 26.8% the butter consumption by 43.6% the consumption of vegetable fats increased by 16%, of vegetables by 8%, tropical fruit by 43.2%. These changes probably had an impact on the cholesterol level and BMI of the Czech population. CONCLUSIONS: In the declining cardiovascular mortality trend during 1984-1993 the following may have participated: improved medical care, dietary changes, improvement of the risk profile and other, in particular socioeconomic factors. With regard to the close temporal association of the investigated changes it may be assumed that this development is at least partly associated with changes of the political and economic position in the Czech Republic after 1989.

Adult↗
PubMed2000

Determinants of infant and early childhood mortality levels and their decline in the Netherlands in the late nineteenth century.

OBJECTIVE: To study the relative importance of various determinants of total and cause-specific infant and early childhood mortality rates and their decline in The Netherlands in the period 1875-1879 to 1895-1899. DATA AND METHODS: Mortality and population data were derived from Statistics Netherlands for 16 towns and 11 rural areas. Mortality levels and their decline were estimated with a Poisson regression model. The associations of the estimated levels and declines, and determinants of infant and early childhood mortality were analysed using multivariate linear regression analysis. The causes of death studied were major contributors to infant mortality (convulsions, acute digestive disease, acute respiratory disease) and early childhood mortality (encephalitis/meningitis, acute respiratory disease, measles). RESULTS: Infant mortality rates were high in the south-western part of The Netherlands in 1875-1879. Due to a rapid decline in the western regions, this pattern changed to a north-south gradient in 1895-1899. Early childhood mortality showed an urban-rural gradient in 1875-1879 with mortality high in towns. This gradient had largely disappeared by 1895-1899, due to a rapid decline in mortality in towns. Roman Catholicism was significantly associated with infant mortality (particularly from diarrhoeal disease) in 1875-1879 and 1895-1899. The association with Roman Catholicism was stronger in 1895-1899 because mortality declines were less rapid in Roman Catholic areas in 1875-1879 to 1895-1899. Urbanization was significantly associated with early childhood mortality (particularly from respiratory disease) in 1875-1879 and 1895-1899. This association weakened over time, due to the rapid decline in mortality in towns. CONCLUSIONS: Different determinants of mortality (decline) were important in infant and early childhood mortality and they acted on different causes of death. Therefore, infant and childhood mortality should be studied separately. International comparison of the results showed that findings with respect to determinants of mortality (decline) for one country do not necessarily apply to other countries. The results for The Netherlands with respect to infant mortality differed from England and Wales.

Catholicism↗
PubMed2004

Ethnic inequalities in age- and cause-specific mortality in The Netherlands.

BACKGROUND: By describing ethnic differences in age- and cause-specific mortality in The Netherlands we aim to identify factors that determine whether ethnic minority groups have higher or lower mortality than the native population of the host country. METHODS: We used data for 1995-2000 from the municipal population registers and cause of death registry. All inhabitants of The Netherlands were included in the study. The mortality of people who themselves or whose parent(s) were born in Turkey, Morocco, Surinam, or the Dutch Antilles/Aruba was compared with that of the native Dutch population. Mortality differences were estimated by Poisson regression analyses and by directly standardized mortality rates. RESULTS: Compared with native Dutch men, mortality was higher among Turkish (relative risk [RR] = 1.21, 95% CI: 1.16, 1.26), Surinamese (RR = 1.24, 95% CI: 1.19, 1.29), and Antillean/Aruban (RR = 1.25, 95% CI: 1.15, 1.36) males, and lower among Moroccan males (RR = 0.85, 95% CI: 0.81, 0.90). Among females, inequalities in mortality were small. In general, mortality differences were influenced by socio-economic and marital status. Most minority groups had a high mortality at young ages and low mortality at older ages, a high mortality from ill-defined conditions (which is related to mortality abroad) and external causes, and a low mortality from neoplasms. Cardiovascular disease mortality was low among Moroccan males (RR = 0.51, 95% CI: 0.44, 0.59) and high among Surinamese males (RR = 1.13, 95% CI: 1.05, 1.21) and females (RR = 1.14, 95% CI: 1.06, 1.23). Homicide mortality was elevated in all groups. CONCLUSION: Socio-economic factors and marital status were important determinants of ethnic inequalities in mortality in The Netherlands. Mortality from cardiovascular diseases, homicide, and mortality abroad were of particular importance for shifting the balance from high towards low all-cause mortality.

Adolescent↗
PubMed1987

History of black mortality and health before 1940.

This article documents the history of black mortality between 1850 and 1940 and begins the process of placing that history into the context of the more general history of mortality decline in the United States. One aspect of this process has been to discuss the trends in mortality among blacks and whites living in the same general geographic areas--for example, comparing southern rural blacks with southern rural whites. A second part has been to relate black mortality to many of the factors that have been discussed as determinants of general mortality trends--such as water and sanitation, the urban disadvantage in mortality, and child care and feeding practices. During the second half of the nineteenth century, black mortality declined only slightly or not at all. Between 1850 and 1880 there may have been some decline in child mortality, but the trends in adult mortality are indeterminate. Between 1880 and 1900 both child and adult mortality rates were constant. Sometime between 1900 and 1910 mortality rates among blacks began to decline at all ages, especially in urban areas. During the first four decades of this century mortality rates among American blacks declined substantially. Expectation of life at birth increased from about 35 years to about 54 years, which represents a significant improvement in health and living standards. The life expectancy among blacks in 1940, however, was still two years below the value for whites in the death registration area in 1920. (This may exaggerate the difference slightly since the mortality rates for 1919 and 1920 were artificially low following the pandemic of influenza in 1918. In addition, the mortality rates in the DRA may not have been representative of the whole white population.) Throughout the period studied, blacks had substantially higher mortality rates than whites living in the same area. Although the amount of excessive mortality among blacks differed from place to place and period to period, we did not find a single area or time when black mortality rates were close to those of whites. The examination of causes of death among whites and blacks in 1920 showed that racial differences in the amount of tuberculosis explained a substantial part of the mortality differences in New York and North Carolina, but blacks probably had excessive mortality due to all causes.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗
PubMedDate not supplied

Ethnic differences in ischaemic heart disease and stroke mortality in Mauritius between 1989 and 1994.

OBJECTIVE: To measure ethnic differences in overall, cardiovascular, ischaemic heart disease and stroke mortality in the Republic of Mauritius. DESIGN: Analysis of vital registration mortality data from 1989 to 1994 among Hindus, Muslims, Chinese and Creoles, aged 30-64 years, presented as age-standardized mortality rates, proportional mortality ratios and standardized mortality ratios. RESULTS: During the six year period of analysis 10,657 deaths were recorded in men and 5008 in women. Mortality rates from ischaemic heart disease in Mauritian men are above the average of those found elsewhere. Ischaemic heart disease mortality in women and stroke mortality in both sexes are among the highest recorded in the world. Due to large ethnic differences in overall mortality, which could not be explained by the uncertainty about the exact population size by ethnic group, proportional mortality ratios are an inadequate measure of differential mortality between ethnic groups. 'Best' estimates of standardized mortality ratios indicate that in comparison to Hindus as the 'standard' population: (i) Creole women have lower ischaemic heart disease (by 34%) and stroke (by 22%) mortality; (ii) Creole women have lower ischaemic heart disease mortality (by 19%); (iii) Muslim men have lower stroke mortality (by 51%) and similar ischaemic heart disease mortality; (iv) Chinese men and women have markedly lower ischaemic heart disease (by 48% and 70%, respectively) and stroke mortality (by 54% and 48%, respectively). CONCLUSION: The mortality rates of ischaemic heart disease and stroke of all ethnic groups in Mauritius, with the exception of the small Chinese ethnic minority, are very high by international standards. This pleads against differential allocation of resources for prevention strategies despite considerable differences in mortality rates from cardiovascular diseases between ethnic groups.

Adult↗
PubMed1995

Analysis of risk factors for excess mortality after aortic valve replacement.

OBJECTIVES: This study sought to identify risk factors for both late observed and late "excess" mortality after aortic valve replacement and to examine the causes of late mortality. BACKGROUND: Because operative mortality after aortic valve replacement is very low, the timing of surgical intervention should focus on maximizing long-term survival. However, to judge the effect of valve replacement on long-term survival in an elderly population, it is important to separate mortality resulting from extraneous causes (background mortality) from disease-related mortality (excess mortality). Background mortality can be estimated by calculating expected mortality on the basis of age and gender. METHODS: From 1966 to 1986, 643 patients (mean age 59.6 years, 138 [21%] > or = 70 years old) underwent aortic valve replacement, 129 of whom also underwent coronary bypass grafting; 594 patients survived > or = 30 days after the procedure. The overall operative mortality rate for isolated aortic valve replacement decreased over time from 25.5% (1966 to 1972) to 2.6% (1980 to 1986). Cumulative total follow-up after discharge was 3,603 patient-years. Multivariate analysis was performed for both observed and excess mortality. RESULTS: Risk factors for both observed and excess mortality were previous myocardial infarction, coronary artery disease, heart failure and atrial fibrillation. Although age > or = 70 years was a risk factor for observed mortality (hazard rate ratio [HRR] 2.4, 95% confidence interval [CI] 1.6 to 3.7), it was not a risk factor for excess mortality. In contrast, isolated aortic regurgitation was an important risk factor for excess mortality only (HRR 3.8, 95% CI 1.3 to 11.2). Late mortality was valve related in 22% of patients, including sudden death in 7% and cerebral vascular accidents in 7%. Congestive heart failure was an important cause of death (21%) irrespective of the time elapsed since aortic valve replacement. In patients with aortic regurgitation, congestive heart failure was the main cause of death (38%); in patients with aortic regurgitation and preoperative heart failure or severe left ventricular dysfunction, heart failure was the cause of death in 44% and 63%, respectively. CONCLUSIONS: Analysis of excess mortality revealed that older age in itself is not a risk factor for late mortality after aortic valve replacement. Aortic regurgitation carries a high risk, probably associated with left ventricular dysfunction at the time of operation. Earlier operation may be warranted in such patients.

Age Factors↗
PubMed2006

Are mortality rates for different operations related?: implications for measuring the quality of noncardiac surgery.

BACKGROUND: Except in cardiac surgery, measuring quality with procedure-specific mortality rates is unreliable because of small sample sizes at individual hospitals. Statistical power can be improved by combining mortality data from multiple operations. We sought to determine whether this approach would still be useful in understanding performance with individual procedures. METHODS: We studied 11 high-risk operations performed in the national Medicare population (1996-1999). For each operation, we calculated 1) the risk-adjusted mortality rate for the procedure and 2) the mortality rate with up to 10 other operations combined ("other" mortality). To test for an association between these mortality rates, we calculated the correlation coefficient adjusting for random variation. We then collapsed hospitals into quintiles of other mortality and calculated procedure-specific mortality rates within each of these quintiles. RESULTS: Mortality with specific operations was modestly correlated with other mortality: coefficients ranged from 0.14 for pneumonectomy to 0.35 for esophagectomy. Despite small to moderate correlations, other mortality was a good predictor of procedure-specific mortality for 10 of the 11 operations. Pancreatic resection had the strongest relationship, with procedure-specific mortality rates at hospitals in the worst quintile of other mortality 3-fold higher than those in the best quintile (15.2% vs. 6.3%, P < 0.001). Pneumonectomy had the weakest relationship with no significant relationship between other mortality and procedure-specific mortality. CONCLUSIONS: Hospitals with low mortality rates for 1 operation tend to have lower mortality rates for other operations. These relationships suggest that different operations share important structures and processes of care related to performance. Future efforts aimed at predicting procedure-specific performance should consider incorporating data from other operations at that hospital.

Aged↗
PubMed2002

Changing area socioeconomic patterns in U.S. cancer mortality, 1950-1998: Part II--Lung and colorectal cancers.

BACKGROUND: Lung cancer and colorectal cancer are leading causes of U.S. cancer mortality. Because mortality rates for many cancers vary by socioeconomic characteristics, we used area socioeconomic indices to examine patterns in U.S. lung and colorectal cancer mortality between 1950 and 1998. METHODS: A factor-based area socioeconomic index was linked to 1950-1998 county mortality data to generate annual lung and colorectal cancer mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model and identify statistically significant changes in the mortality trends. RESULTS: Area socioeconomic patterns in U.S. lung cancer mortality changed dramatically between 1950 and 1998. Men aged 25-64 years and those aged 65 years or older in higher socioeconomic areas generally had higher lung cancer mortality than did those in lower socioeconomic areas during 1950-1964 and 1950-1980, respectively. Area socioeconomic differences in lung cancer mortality began to reverse and widen by the early 1970s for younger men and by the mid-1980s for older men. In 1998, lung cancer mortality was 56% (95% confidence interval [CI] = 49% to 64%) higher for younger men and 38% higher (95% CI = 34% to 43%) for older men in the lowest area socioeconomic group than for the same age groups in the highest area socioeconomic group. Lung cancer mortality among older women in all socioeconomic groups increased sevenfold to eightfold between 1950 and 1998, with higher mortality in higher area socioeconomic groups. The positive socioeconomic gradient in colorectal cancer mortality diminished substantially over time. Although colorectal cancer mortality among women in all area socioeconomic groups showed a consistent downward trend, colorectal cancer mortality among men in low area socioeconomic groups, but not in high area socioeconomic groups, showed an upward trend. CONCLUSIONS: Socioeconomic gradients in male lung cancer mortality reversed between 1950 and 1998, and those in colorectal cancer mortality narrowed over that time. Area measures may be useful for monitoring socioeconomic disparities in cancer mortality and for identifying areas for potential cancer control interventions.

Adult↗
PubMed1999

Variations in 'avoidable' mortality: a reflection of variations in incidence?

BACKGROUND: Variations in 'avoidable' mortality may reflect variations in the quality of care, but they may also be due to variations in incidence or severity of diseases. We studied the association between regional variations in 'avoidable' mortality and variations in disease incidence. For a selection of conditions we also analysed whether the proportion of in-hospital deaths can explain the regional variations in incidence-adjusted mortality. METHODS: Relative risks for mortality, incidence, incidence-adjusted mortality and in-hospital mortality (1984-1994) were calculated by log-linear regression. Linear regression was used to examine the relationship between mortality and incidence on the one hand, and between incidence-adjusted mortality and in-hospital mortality on the other. RESULTS: Significant regional mortality variations were found for cervical cancer, cancer of the testis, hypertensive and cerebrovascular disease, influenza/pneumonia, cholecystitis/lithiasis, perinatal causes and congenital cardiovascular anomalies. Regional mortality differences in general were only partly accounted for by incidence variations. The only exception was cervical cancer, which no longer showed significant variations after adjustment for incidence. The contribution of inhospital mortality variations to total cause-specific mortality variations varied between conditions: the highest percentage of explained variance was found for mortality from CVA (60.1%) and appendicitis (29.2%). CONCLUSIONS: Incidence data are a worthy addition to studies on 'avoidable' mortality. It is to be expected that the incidence-adjusted mortality rates are more sensitive for quality-of-care variations than the 'crude' mortality variations. Nevertheless, further research at the individual level is needed to identify possible deficiencies in health care delivery.

Adolescent↗
PubMed1997

Birth weight and age-specific analysis of the 1990 US infant mortality drop. Was it surfactant?

OBJECTIVE: To examine birth-weight-specific and age-specific mortality among US infants to determine if the large infant mortality decrease in 1990 was due to surfactant use. DESIGN: Population-based analysis of data from the 1983-1991 National Linked Birth and Infant Death files. Mortality trends from 1983 to 1989 were used to calculate expected infant mortality rates for 1990 to 1991. SETTING: United States. PARTICIPANTS AND STUDY POPULATION: All singleton infants with known birth weight born in the United States from 1983 to 1991. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Mortality at less than 1 day of life, 1 to 6 days, 7 to 27 days, or 28 to 364 days. Observed mortality rates were divided by the expected rates in 250-g birth-weight categories to create mortality ratios. RESULTS: The observed infant mortality rate in 1990 was 8.05, significantly lower than the expected rate of 8.36. Infants weighing 750 to 1749 g had mortality ratios of approximately 0.8 for 1- to 6-day mortality, with ratios significantly less than 1.0 for mortality in all age groups except less than 1 day. Observed mortality among infants weighing less than 750 g or from 1750 to 2499 g was not significantly lower than expected at any age. Postneonatal mortality among infants weighing 2500 g or more was significantly lower than expected. Infants weighing less than 1500 g accounted for almost 700 fewer infant deaths than predicted in 1990. Infants weighing 2500 g or more accounted for approximately 550 fewer deaths than expected. CONCLUSIONS: The hypothesis that surfactant was partially responsible for the overall infant mortality drop in 1990 is supported by the lower than expected mortality among infants weighing 750 to 1749 g. However, the unexpected improvement in postneonatal mortality among infants weighing 2500 g or more was responsible for a substantial portion of the overall decline and suggests that other factors also acted to decrease US infant mortality in 1990.

Age Distribution↗
PubMedDate not supplied

[Inequalities in mortality in Seville [Spain]].

OBJECTIVES: To describe social inequalities in mortality in Seville from 1994 to 1998 according to socioeconomic status. METHODS: Life expectancy, crude and age-adjusted rates of total mortality as well as mortality by causes and potential years of life lost were estimated using the number of deaths and the population of Seville, aggregated by Basic Health Areas (BHA). BHA were divided in three levels according to the unemployment rate among men. The relative risks of total mortality and mortality by causes were estimated for men and women in each of these levels, using Poisson regression. The unemployment rate of each of the BHA was related to total mortality and to some of its causes. RESULTS: Differences in life expectancy of up to 7.9 years for men and 4.6 years for women were found among BHA. Concerning potential years of life lost, the areas with the highest mortality showed 4.1 times greater mortality in men and 2.6 times greater mortality in women than those with the lowest mortality. Total mortality increased with unemployment rate: the BHA with the highest unemployment rate showed a 15% increase in mortality in men and a 6% increase in that in women than those with the lowest unemployment rate. Among causes of mortality, AIDS showed the greatest inequalities in both men and women. CONCLUSIONS: From 1994 to 1998, Seville presented inequalities in total mortality and premature mortality, as well as in mortality by causes per BHA. Inequalities were present in men and women, although they were greater in men. There was a clear association between socioeconomic variables and mortality.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Differences in pediatric ICU mortality risk over time.

OBJECTIVES: To compare pediatric intensive care unit (ICU) mortality risk using models from two distinct time periods; and to discuss the implications of changing mortality risk for severity systems and quality-of-care assessment. DATA SOURCES AND SETTING: Consecutive admissions (n = 10,833) from 16 pediatric ICUs across the United States that participate in the Pediatric Critical Care Study Group were recorded prospectively. Data collection occurred during a 12-mo period beginning in January 1993. METHODS: Data collection for the development and validation of the original Pediatric Risk of Mortality (PRISM) score occurred from 1980 to 1985. The original PRISM coefficients were used to calculate mortality probabilities in the current data set. Updated estimates of mortality probabilities were calculated, using coefficients from a logistic regression analysis using the original PRISM variable set. Quality-of-care tests were performed using standardized mortality ratios. RESULTS: Risk of mortality from pediatric ICU admission improved considerably between the two periods. Overall, the reduction in mortality risk averaged 15% (p < .001). Analysis of mortality risk by age indicated a large improvement for younger infants. The mortality risk for infants <1 mo improved by 39% (p < .001). Mortality risk improved by 28% (p < .001) for infants between 1 and 12 mos. Analysis of mortality risk by principal diagnosis indicated substantial improvement in respiratory diseases, including respiratory diseases developing in the perinatal period. The mortality risk for respiratory diseases improved by 45% (p < .001). The improvement in mortality risk substantially deteriorated the calibration of the original PRISM severity system (p < .001). As a result of changing mortality risk, the standardized mortality ratios across the 16 pediatric ICUs demonstrated substantial disparities, depending on the choice of models. CONCLUSIONS: This study documents differences in pediatric ICU risk of mortality over time that are consistent with a general improvement in the quality of pediatric intensive care. Despite continued widespread use of the original PRISM, recent improvements in pediatric ICU quality of care have negated its usefulness for many intended applications, including quality-of-care assessment.

Age Distribution↗
PubMed2003

Mortality risk after hip fracture.

OBJECTIVE: To determine the mortality risk following hip fracture and identify factors predictive of increased mortality. DESIGN: Retrospective review of prospectively collected data. SETTING: Tertiary care orthopaedic hospital. BACKGROUND: Approximately 250,000 hip fractures occur annually in the United States. The greatest mortality risk following hip fracture has been demonstrated to be within the first 6 months of fracture, and some studies report that the risk approaches expected mortality after 6 months. However, more recent studies have demonstrated that an increased risk of mortality may persist for several years postfracture. The purpose of this study was to assess the excess mortality associated with hip fracture at up to 2 years postinjury. METHODS: All patients with a hip fracture who were admitted to our institution over a 10-year period were evaluated. Criteria for inclusion included: Caucasian, age 65 or older, previously ambulatory, and home dwelling. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a 2-year follow-up period. Mortality was compared to a standardized population and standardized mortality ratios were calculated. RESULTS: Eight hundred thirty-six patients met the inclusion criteria and were included. The mortality risk was highest within the first 3 months following fracture, with standardized mortality ratios approaching that of the control population by two years. Patients age 65-84 had higher mortality risk when compared with patients age > or =85. American Society of Anesthesiologists classification was predictive of increased mortality risk in younger patients, with these patients having triple the mortality risk when compared to the reference population at 2-year follow-up. More elderly patients had minimal excess mortality associated with hip fracture at 1- and 2-year follow-up, regardless of ASA classification. CONCLUSION: The data demonstrate that hip fracture is not associated with significant excess mortality amongst patients older than age 85. Amongst younger patients, however, those with ASA classifications of 3 or 4 have significant excess mortality following hip fracture that persists up to 2 years after injury.

Activities of Daily Living↗
PubMed1998

Excess mortality in working age males in Poland: general patterns.

Since the second World War, excess mortality of males has been steadily growing in Poland. The aim of this paper was to analyze the basic relationships between excess male mortality and some social and economic factors, with special reference to both age and place of residence. Data published in Demographic Yearbooks and included in reports produced by the Government Population Council were used in the analysis. The excess male mortality is expressed in terms of male/female mortality ratio, and also in terms of the difference between the average female and male life expectancy. In the early 1990s the general male mortality rate in Poland was by 23% higher than the general female mortality rate, whereas in males at younger working age (20-44 years) mortality was three times higher, and in the older age (45-64 years) groups 2.7 times higher than the female mortality. Compared with the majority of European countries, Poland is characterised by high rates of excess male mortality, which points to a deteriorated health status of the population. At present, excess mortality of the working age males is much higher than in the 1960s and 1970s. Our analysis of the 1960-1994 trends revealed that the highest excess male mortality occurs in the 20-24 age group. Although recently a falling trend has been observed in the infant, juvenile and post working age groups, a continuous increase is noted in the working age population of Poland. Causes of death were also included in our analysis. Among circulatory diseases, the highest excess mortality was due to acute myocardial infarction (the risk of death from this disease was 8 times higher for males than for females). Accidents, injuries and poisoning constitute another leading group of causes responsible for excess mortality (6/1 male/female death risk ratio). The excess male mortality rates are higher in the rural than in the urban areas. The excess male mortality was also reflected in the indices of average life expectancy. In 1995, the average life expectancy was 67.6 years for males and 76.4 years for females. Thus, in Poland males live 8.6 years shorter than females on average. Increased excess mortality among the working age males, a considerable difference between male and female average life expectancy, disturbed demographic male/female balance, these are at least some of the reasons why further in depth studies of excess male mortality in Poland should continue.

Adult↗