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PubMed1997

Competing risks of mortality in prostate cancer.

PURPOSE: We have observed that in prostate cancer older age, black race, high stage and no treatment are independently associated with higher disease specific and overall mortality. Because disease nonspecific mortality was not examined one cannot reasonably infer that higher overall mortality is largely due to higher disease specific mortality. To understand better the interactions of independent prognostic variables with overall mortality we jointly evaluated their effects on type of death and time to death. MATERIALS AND METHODS: Using the prostate cancer patients of the 1973 to 1990 public use tape of the Surveillance, Epidemiology and End Results program, we performed competing risks analysis with multivariate accelerated failure time model to examine if the prognostic factors were associated with type of death and time to death. RESULTS: Older age, black race and no treatment were independently associated with higher relative risk of disease specific and nonspecific mortality. Localized stage was associated with lower and higher disease specific and nonspecific mortality than regional stage, respectively. The relative risks of disease specific and nonspecific mortality were significantly different from each other for all prognostic factors. CONCLUSIONS: To our knowledge, a competing risks analysis in prostate cancer has not been done previously. While all prognostic factors were associated with disease specific and nonspecific mortality, the relative contribution of disease specific and nonspecific mortality to overall mortality varied by prognostic factor, with some prognostic factors associated with relatively high disease specific mortality while others were associated with relatively high disease nonspecific mortality. The similarity of the associations of age, race and treatment with disease specific and nonspecific mortality suggests that they mark an unidentified factor(s) that affects patient health nonspecifically. Such a factor(s) may partly or completely explain the association of treatment with lower disease specific mortality.

Aged↗
PubMed2007

Cancer mortality trends in the Umbria region of Italy 1978-2004: a joinpoint regression analysis.

BACKGROUND: The aim of the present paper was to analyse cancer mortality in the Umbria region, from 1978 to 2004. Mortality trends depend on a number of factors including exposures, health system interventions, and possibly artefact (e.g. classification change, variations of data completeness). Descriptive data on mortality only allow for generation of hypotheses to explain observed trends. Some clues on the respective role of possible mortality determinants may be found comparing mortality with incidence and survival data. METHODS: Mortality data for the periods 1978-1993 and 1994-2004 were supplied by the National Institute of Statistics (ISTAT) and the Regional Causes of Death Registry (ReNCaM) respectively. Sex and site-specific mortality time trends were analysed by the "joinpoint regression" method. RESULTS: For all sites combined, in both sexes, the standardised rate was first increasing before the end of the eighties and decreasing thereafter. Gastric cancer mortality showed a different trend by gender; that is the rate constantly decreased over the period among females while, for males, it was first increasing up to 1985 and decreasing thereafter. Liver cancer trend showed a pattern similar to gastric cancer. Large bowel cancer showed a gender specific trend, that is it was increasing among males and stable among females. Also lung cancer mortality varied by gender: it started to decline after 1989 among males but was steadily increasing over the study period among women. A decreasing trend for female breast cancer mortality began in 1994. Prostate cancer mortality trend is the only one showing two significant joinpoints: mortality decreased up to 1990, then it increased up to 1998 and, finally, was decreasing. CONCLUSION: Overall cancer mortality was decreasing in both sexes in Umbria and this favourable trend will probably continue and further improve since population screening against breast, cervix, and large bowel cancers were recently introduced. Besides gastric cancer, tobacco-related cancers and prostate cancer mainly contributed to mortality reduction in males, whereas breast cancer mainly contributed to declining mortality in females.

Breast Neoplasms↗
PubMedDate not supplied

Cardiovascular mortality--the hidden peril of heat waves.

OBJECTIVE: Define the mortality associated with extremely hot weather during the 04 July through 14 July, 1993 heat wave that struck the northeastern United States. METHODS: DESIGN--A rapid field assessment was used to compare mortality occurring during the heat wave to mortality occurring during a period in which there was no heat wave using copies of death certificates. The findings of the rapid field assessment were validated, and it was determined whether increases in mortality occurred in other metropolitan east-coast counties also affected by the heat wave, by reviewing computerized mortality files. SETTING--Information was collected on all deaths occurring in Baltimore City, Maryland; Baltimore County, Maryland; Essex County, New Jersey; Newcastle County, Delaware; and Philadelphia County, Pennsylvania; during these specified study periods: 08-18 June (comparison period) and 06-16 July (heat wave study period), 1993. MAIN OUTCOME MEASURES--Ratios for total mortality, cause-specific mortality, and variables such as age, sex, race, residence, and day and place of death, that were available from death certificates were calculated. RESULTS: From the rapid field assessment, the following were observed: a 26% increase in total mortality and a 98% increase in cardiovascular mortality associated with the heat wave in Philadelphia. Data from the computerized mortality files showed an increase in total mortality in four of five counties examined and an increase in cardiovascular mortality in all five counties. The risk for death for those dying from cardiovascular disease increased significantly for people older than 64 years, for both sexes, and all races. CONCLUSION: As initially indicated by the Philadelphia Medical Examiner, there was excess mortality associated with a heat wave in Philadelphia. All other nearby counties examined also experienced excess mortality associated with the heat wave, although this excess was not recognized by the local health officials. The true impact of a heat wave that causes excess preventable mortality must be appropriately and rapidly ascertained. Using a national standard to certify a death as heat-related will provide the needed information rapidly so that public health resources can be more effectively allocated and mobilized to prevent further heat-related illnesses and death.

Adolescent↗
PubMed2004

Geographical variations in post myocardial infarction mortality and their impact on risk selection.

OBJECTIVES: The objective is to assess the impact of geographical variations in mortality on risk selection in patients after acute myocardial infarction. METHOD: Mortality analysis is used with an actuarial methodology applied to follow-up studies based on data from randomized clinical trial and observational cohort studies of acute myocardial infarction patients from different geographic areas. Observed mortality was calculated as geometric average annual rate (q) and compared to the expected geometric average annual mortality (q') mortality calculated from different life tables. This comparison was expressed as mortality ratios (MR). Values of q and MR were averaged within each country grouping. Variance, standard deviation, and variation coefficient (CV) were calculated. RESULTS: Geometric average annual mortality rates varied by country. The lowest rate (2.7%) was observed in Japan, and the highest rates (7.5%) were seen in studies from the United Kingdom and Northern Europe (Denmark, Sweden, Finland). The average annual mortality rate was 4.9%. Mortality ratios averaged within countries vary from 182% to 212%, with an overall average value of 198%. Coefficient of variation (CV) was 36% for geometric average annual mortality rates and 6% for mortality ratios. CONCLUSION: Although annual mortality rates from all causes vary greatly between countries, mortality ratios do not vary and remain relatively constant. This highlights the interest of risk assessment using mortality analysis methodology, which makes the geographic variation in post-myocardial infarction mortality disappear.

Developed Countries↗
PubMed1995

[Regional distribution of stomach and colon cancer mortality in the Dithmarschen and Nordfriesland districts--cartographic presentation].

In two counties (Dithmarschen and Nordfriesland) of the Federal State of Schleswig-Holstein (in the northern part of Germany) the cancer mortality rates, especially those of stomach and colon cancer, were evaluated for the time period 1980-1991. For this purpose the corresponding death certificates collected in these counties were analysed. The counties were subdivided into 16 and 17 smaller areas, respectively. The age-adjusted mortality rates were calculated and the obtained data scaled into eight sections, which were graphically mapped over the smaller areas of the two counties. The frequency of these cancer mortality rates reflects a wide range of distribution pattern in the smaller areas of the two counties, which greatly differ from the cancer mortality values calculated for the two counties as a whole. In comparison with the frequency of stomach cancer mortality for men published in the German Cancer Atlas in 1984 it could be demonstrated that this cancer mortality further decreased in these counties. However, in some smaller areas of these counties, especially in rural areas, the mortality rates of stomach cancer in men were still rather high. The opposite seems to be reflected regarding the frequency of colon cancer mortality. Here higher frequencies of mortality were seen in the small cities of these counties. We suggest that a more subtile cancer mortality mapping can be performed easily without any risk of hurting the requirements of personal data securities, because cancer mortality data are already continuously evaluated by a trained staff at the offices of statistical affairs. These data may be transferred and used for cancer mortality mapping as described in the present paper. In order to guarantee that there will be no violation of personal data secrecy the cancer mortality mapping must be restricted to cancer sites with high frequencies of mortality. All published data should be supervised by an official with special knowledge of the requirements of personal data protection. This study underlines the necessity for higher resolution (smaller areas) in cancer registries as essential prerequisite for systematical exploration of the origins of cancer mortality and as a basis for preventive measures.

Colonic Neoplasms↗
PubMed1996

High mortality from cardiovascular disease and analysis of risk factors in Indian and Melanesian Fijians.

BACKGROUND: In recent years, developing populations such as the Pacific island nation of Fiji, have seen decreases in infectious diseases and increasing frequency of cardiovascular diseases (CVD), diabetes and cancer. However, cohort studies of mortality in these populations are scarce. Here we report 11-year all-cause and cause-specific mortality rates and risk factors for total, CVD and coronary heart disease (CHD) for indigenous Melanesian and Asian Indian people of Fiji. METHODS: Following a baseline risk factor survey in 1980, mortality surveillance continue until 1991 in a representative cohort of 1325 Melanesians and 1221 Indians from urban and rural areas of Fiji. Date and cause of death were recorded and total, CVD and CHD mortality rates calculated. Baseline predictors of mortality were assessed using Cox regression. RESULTS: Total mortality rates in Melanesians were 15.9 and 9.2/1000 person-years, and in Indians were 13.5 and 6.8/1000 person-years, in men and women respectively. Death due to CHD was more common in men than women, and in Indian than Melanesian men, although total CVD deaths were more common in Melanesian men. Deaths due to CHD were more common in the urban than the rural area. After adjusting for other risk factors Indian ethnicity was associated with a significantly reduced risk of total and CVD mortality in men, and total mortality in women. Age and systolic blood pressure were consistently and independently associated with mortality from all causes, as well as CVD and CHD (except in Indian women). In men associations were also identified for total cholesterol with CVD and CHD mortality in Melanesians, and 2-hour plasma glucose with total and CVD mortality in Indians. In women, 2-hour glucose was important for total, CVD and CHD mortality in both ethnic groups as was smoking in Indians. Obesity had inconsistent associations with mortality. CONCLUSION: Cardiovascular disease is now responsible for a large proportion of total mortality in both Indian and Melanesian Fijians. The major risk factors identified in Fijians are similar to those observed in developed populations.

Adult↗
PubMed1998

[Mortality rates in childhood and their causes in Spain. 1991].

OBJECTIVE: The purpose of this study is to present the different pediatric mortality rates in Spain during 1991 and to describe the groups of mortality causes for the different ages in relationship to these rates. PATIENTS AND METHODS: We have used data from the National Institute of Statistics for the year studied. These data were summarized, grouped and simplified. In order to clarify them, causes of death have been expressed in percentage. RESULTS: The different mortality rates were: Infant mortality 7.19; neonatal mortality 4.57; early neonatal mortality rate 3.32; late neonatal mortality rate 1.25; postneonatal mortality 2.62; perinatal mortality 7.24; preschool mortality 1.75; mortality within the age group 5-9 years 1.26. For infantile, neonatal, early neonatal, late neonatal and postneonatal mortality the biggest percentage was due to causes depending upon congenital malformations and perinatal diseases. For preschool and school mortality accidents and tumors were the most frequent causes of death, although causes related to congenital anomalies were also responsible for a large percentage of deaths. CONCLUSIONS: Pediatric mortality rates in our country are more than acceptable and their causes are similar to those of other civilized countries.

Adolescent↗
PubMed1999

Trends in infectious disease mortality in the United States during the 20th century.

CONTEXT: Recent increases in infectious disease mortality and concern about emerging infections warrant an examination of longer-term trends. OBJECTIVE: To describe trends in infectious disease mortality in the United States during the 20th century. DESIGN AND SETTING: Descriptive study of infectious disease mortality in the United States. Deaths due to infectious diseases from 1900 to 1996 were tallied by using mortality tables. Trends in age-specific infectious disease mortality were examined by using age-specific death rates for 9 common infectious causes of death. SUBJECTS: Persons who died in the United States between 1900 and 1996. MAIN OUTCOME MEASURES: Crude and age-adjusted mortality rates. RESULTS: Infectious disease mortality declined during the first 8 decades of the 20th century from 797 deaths per 100000 in 1900 to 36 deaths per 100000 in 1980. From 1981 to 1995, the mortality rate increased to a peak of 63 deaths per 100000 in 1995 and declined to 59 deaths per 100000 in 1996. The decline was interrupted by a sharp spike in mortality caused by the 1918 influenza epidemic. From 1938 to 1952, the decline was particularly rapid, with mortality decreasing 8.2% per year. Pneumonia and influenza were responsible for the largest number of infectious disease deaths throughout the century. Tuberculosis caused almost as many deaths as pneumonia and influenza early in the century, but tuberculosis mortality dropped off sharply after 1945. Infectious disease mortality increased in the 1980s and early 1990s in persons aged 25 years and older and was mainly due to the emergence of the acquired immunodeficiency syndrome (AIDS) in 25- to 64-year-olds and, to a lesser degree, to increases in pneumonia and influenza deaths among persons aged 65 years and older. There was considerable year-to-year variability in infectious disease mortality, especially for the youngest and oldest age groups. CONCLUSIONS: Although most of the 20th century has been marked by declining infectious disease mortality, substantial year-to-year variation as well as recent increases emphasize the dynamic nature of infectious diseases and the need for preparedness to address them.

Adolescent↗
PubMed1999

Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men.

CONTEXT: Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease (CVD) risk factors, but the role of physical inactivity is not prominent in these recommendations. OBJECTIVE: To quantify the influence of low cardiorespiratory fitness, an objective marker of physical inactivity, on CVD and all-cause mortality in normal-weight, overweight, and obese men and compare low fitness with other mortality predictors. DESIGN: Prospective observational data from the Aerobics Center Longitudinal Study. SETTING: Preventive medicine clinic in Dallas, Tex. PARTICIPANTS: A total of 25714 adult men (average age, 43.8 years [SD, 10.1 years]) who received a medical examination during 1970 to 1993, with mortality follow-up to December 31, 1994. MAIN OUTCOME MEASURES: Cardiovascular disease and all-cause mortality based on mortality predictors (baseline CVD, type 2 diabetes mellitus, high serum cholesterol level, hypertension, current cigarette smoking, and low cardiorespiratory fitness) stratified by body mass index. RESULTS: During the study period, there were 1025 deaths (439 due to CVD) during 258781 man-years of follow-up. Overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors. Using normal-weight men without CVD as the referent, the strongest predictor of CVD death in obese men was baseline CVD (age- and examination year-adjusted relative risk [RR], 14.0; 95% confidence interval [CI], 9.4-20.8); RRs for obese men with diabetes mellitus, high cholesterol, hypertension, smoking, and low fitness were similar and ranged from 4.4 (95% CI, 2.7-7.1) for smoking to 5.0 (95% CI, 3.6-7.0) for low fitness. Relative risks for all-cause mortality in obese men ranged from 2.3 (95% CI, 1.7-2.9) for men with hypertension to 4.7 (95% CI, 3.6-6.1) for those with CVD at baseline. Relative risk for all-cause mortality in obese men with low fitness was 3.1 (95% CI, 2.5-3.8) and in obese men with diabetes mellitus 3.1 (95% CI, 2.3-4.2) and as slightly higher than the RRs for obese men who smoked or had high cholesterol levels. Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors. Approximately 50% (n = 1674) of obese men had low fitness, which led to a population-attributable risk of 39% for CVD mortality and 44% for all-cause mortality. Baseline CVD had population attributable risks of 51% and 27% for CVD and all-cause mortality, respectively. CONCLUSIONS: In this analysis, low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors.

Adult↗
PubMed2003

First-year mortality rates for selected birth defects, Hawaii, 1986-1999.

Birth defects have been the leading cause of infant death in the United States for over the last decade. However, there is little population-based data on the first-year mortality rates for many specific birth defects and the factors that may affect these mortality rates. This investigation examined the first-year mortality rates for 54 selected birth defects of various organ systems in Hawaii during 1986-1999 using data from a population-based birth defects registry and evaluated the impact of the presence of chromosomal abnormalities and other structural birth defects and the year of delivery on the mortality rates. Mortality rates varied widely by defect, being highest for anencephaly (100%), trisomy 13 (82%), and trisomy 18 (74%), while no first-year deaths were reported for glaucoma, bladder exstrophy, and persistent cloaca. The majority (36 of 54 or 67%) of the birth defects had a mortality rate of less than 25%. Among the 51 structural birth defects, 38 (75%) had higher first-year mortality rate for cases with chromosomal abnormalities and 42 (82%) had higher first-year mortality rates for cases with other major structural birth defects. The mortality rate among 1986-1992 deliveries was higher than the mortality rate among 1993-1999 deliveries for 37 (69%) of the 54 birth defects. This study indicates that first-year mortality rates vary widely by type of birth defect, although the mortality rate for the majority of birth defects is relatively low. The presence of a chromosomal abnormality or other structural birth defect increases the mortality rate, and mortality rates for the majority of birth defects have declined in Hawaii during the study period.

Congenital Abnormalities↗
PubMed2006

Age stratified, perioperative, and one-year mortality after abdominal aortic aneurysm repair: a statewide experience.

OBJECTIVE: The purpose of this study was to determine the in-hospital, 30-day, and 365-day mortality for the open repair of abdominal aortic aneurysms (AAAs), when stratified by age, in the general population. Age stratification could provide clinicians with information more applicable to an individual patient than overall mortality figures. METHODS: In a retrospective analysis, data were obtained from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1995 to 1999. Out-of-hospital mortality was determined via linkage to the state death registry. All patients undergoing AAA repair as coded by International Classification of Diseases, 9th Revision (ICD-9) procedure code 38.44 and diagnosis codes 441.4 (intact) and 441.3/441.5 (ruptured) in California were identified. Patients <50 years of age were excluded. We determined in-hospital, 30-day, and 365-day mortality, and stratified our findings by patient age. Multivariate logistic regression was used to determine predictors of mortality in the intact and ruptured AAA cohorts. RESULTS: We identified 12,406 patients (9,778 intact, 2,628 ruptured). Mean patient age was 72.4 +/- 7.2 years (intact) and 73.9 +/- 8.2 (ruptured). Men comprised 80.9% of patients, and 90.8% of patients were white. Overall, intact AAA patient mortality was 3.8% in-hospital, 4% at 30 days, and 8.5% at 365 days. There was a steep increase in mortality with increasing age, such that 365-day mortality increased from 2.9% for patients 51 to 60 years old to 15% for patients 81 to 90 years old. Mortality from day 31 to 365 was greater than both in-hospital and 30-day mortality for all but the youngest intact AAA patients. Perioperative (in-hospital and 30-day) mortality for ruptured cases was 45%, and mortality at 1 year was 54%. CONCLUSIONS: There is continued mortality after the open repair of AAAs during postoperative days 31 to 365 that, for many patients, is greater than the perioperative death rate. This mortality increases dramatically with age for both intact and ruptured AAA repair.

Age Distribution↗
PubMed2001

The role of cultural and economic determinants in mortality decline in the Netherlands, 1875/1879-1920/1924: a regional analysis.

The objective of this study was to determine the relative importance of cultural and economic factors in mortality decline in the Netherlands in the periods 1875/1879-1895/1899 and 1895/1899-1920/1924. Mortality data by region, age, sex and cause of death as well as population data were derived from Statistics Netherlands for the years 1875/1879, 1885/1889, 1895/1899, 1910/1914, 1920/1924. Regional mortality declines were estimated on the basis of Poisson regression models. In a multivariate analysis the estimated declines were associated with economic (wealth tax) and cultural variables (% Roman Catholics and secularisation) corrected for confounders (soiltype, urbanisation). In the period from 1875/1879-1895/1899, %Roman Catholics was significantly associated with all-cause mortality decline and with mortality decline from diseases other than infectious diseases. Mortality declined less rapidly in areas with a high percentage of Roman Catholics. Secularisation was significantly associated with infectious-disease mortality decline. In areas with a high percentage population without a religious affiliation, mortality declined more rapidly. In the period from 1895/1899 to 1920/1924, wealth tax was significantly associated with all-cause and infectious-disease mortality decline. Mortality declined more rapidly in wealthy areas. Intermediary factors in the relationship between cultural factors and mortality decline were fertility decline, but more importantly, the number of medical doctors per 100,000 inhabitants. No intermediary factors were found for the association between the economic variable and mortality decline. Cultural and economic factors both played an important role in mortality decline in The Netherlands, albeit in different periods of time. The analysis of intermediary factors suggests that the acceptance of new ideas on hygiene and disease processes was an important factor in the association between culture and mortality decline in the late 19th century.

Confounding Factors, Epidemiologic↗
PubMed2000

The relationship between urban airborne pollution and short-term mortality: quantitative and qualitative aspects.

The influence of airborne pollution on mortality rates has been examined since the well known severe pollution episodes of Pennsylvania (1948) and London (1952). Three main epidemiological approaches are available: transversal studies, time series studies, prospective studies. The most frequently used method is the time series analysis, which retrospectively determines daily mortality rates as compared to daily pollution levels in a defined period. The vast majority of studies applying this approach confirm the existence of a positive correlation between mortality and airborne pollution. The relative risk of death during the most severely polluted days as compared to the least polluted days ranges between 1.02 and 1.13. Airborne pollution affects mortality as related to cardiovascular and chronic obstructive pulmonary diseases mainly in subjects previously affected by these pathologies. The dose-response mortality-pollution curve shows linear increments of mortality at low pollution levels, weak increments at high pollution levels. This phenomenon is attributed to the existence of subjects highly susceptible to pollution induced adverse health effects. These subjects, dying at low pollution levels, are not available to increase mortality rates at high pollution levels. Mortality is mainly related to the concentration of single pollutants, such as suspended particle matter, sulfur oxides, nitric oxides and ozone. Elderly are highly susceptible to pollution-induced mortality increases. Therefore, the study of mortality-pollution correlation is of particular interest in cities characterized by a relative prevalence of the elderly in the population. The latency period between pollution increases and related mortality increases falls in the 1-3 days interval range. The pollution-mortality relationship is influenced by many factors, such as the occurrence of exceedingly high or low environmental temperatures, influenza epidemics, etc. Many hypotheses has been raised to support the causality of the mortality-pollution association, including a direct effect of pollutants on cardiovascular and respiratory apparatus, and the release of inflammatory mediators affecting blood viscosity and pneumocytes homeostasis. On the whole, available data suggest that pollution is able to increase mortality only if associated to other risk factors determining an increased susceptibility in the exposed population.

Air Pollutants↗
PubMed1997

Malaria and mortality: some epidemiological considerations.

Malaria can, a priori, kill on its own ('direct' malaria mortality) or in conjunction with some other cause(s) ('indirect' malaria mortality). There are three distinct approaches to the measurement of malaria mortality: (1) measurement of malaria-specific mortality (based on attributing each death to a single cause) or its surrogate, the admission rate for life-threatening malaria; (2) measurement of the reduction in all-cause mortality after removal (or near removal) of malaria; and (3) the estimation of the malaria mortality required to explain the observed frequency of the HbS gene. There is a strong indication that approaches (2) and (3) yield estimates of total (direct and indirect) malaria mortality which are at least twice as high as those obtained using approach (1), which probably measures mostly direct malaria mortality. There is currently a controversy about the long-term impact on mortality of reducing the intensity of malaria transmission from 'high' to 'intermediate', given the expected loss of immunity. Certain geographical comparisons (of the results of 'nature's experiment') indicate that, when the intensity of transmission is high, the incidence of life-threatening malaria falls. However, the seasonal variation in the intensity of transmission decreases with increases in the intensity; low seasonal variation is probably beneficial, allowing a smoother transition from passive to active immunity, but is unlikely to be reversed by preventive measures. It also seems likely that geographical comparisons produce estimates of predominantly direct mortality, which might not run in parallel with the indirect mortality. A tentative numerical exploration of the problem, using a simple demographic model, indicates that, if indirect malaria mortality is important and the other causes of death are concentrated in early life, the long-term impact on all-cause mortality of reducing exposure (although less than the short-term) will probably always be beneficial, even if there is some increase in direct malaria mortality.

Animals↗
PubMed2004

The introduction of diphtheria-tetanus-pertussis vaccine and child mortality in rural Guinea-Bissau: an observational study.

BACKGROUND: and objective Previous studies from areas with high mortality in West Africa have not found diphtheria-tetanus-pertussis (DTP) vaccine to be associated with the expected reduction in mortality, a few studies suggesting increased mortality. We therefore examined mortality when DTP was first introduced in rural areas of Guinea-Bissau in 1984-1987. Setting Twenty villages in four regions have been followed with bi-annual examinations since 1979. SUBJECTS: In all, 1657 children aged 2-8 months. Design Children were weighed when attending the bi-annual examinations and they were vaccinated whenever vaccines were available. DTP was introduced in the beginning of 1984, oral polio vaccine later that year. We examined mortality for children aged 2-8 months who had received DTP and compared them with children who had not been vaccinated because they were absent, vaccines were not available, or they were sick. MAIN OUTCOME MEASURE: Mortality over the next 6 months from the day of examination for vaccinated and unvaccinated children. RESULTS: Prior to the introduction of vaccines, children who were absent at a village examination had the same mortality as children who were present. During 1984-1987, children receiving DTP at 2-8 months of age had higher mortality over the next 6 months, the mortality rate ratio (MR) being 1.92 (95% CI: 1.04, 3.52) compared with DTP-unvaccinated children, adjusting for age, sex, season, period, BCG, and region. The MR was 1.81 (95% CI: 0.95, 3.45) for the first dose of DTP and 4.36 (95% CI: 1.28, 14.9) for the second and third dose. BCG was associated with slightly lower mortality (MR = 0.63, 95% CI: 0.30, 1.33), the MR for DTP and BCG being significantly inversed. Following subsequent visits and further vaccinations with DTP and measles vaccine, there was no difference in vaccination coverage and subsequent mortality between the DTP-vaccinated group and the initially DTP-unvaccinated group (MR = 1.06, 95% CI: 0.78, 1.44). CONCLUSIONS: In low-income countries with high mortality, DTP as the last vaccine received may be associated with slightly increased mortality. Since the pattern was inversed for BCG, the effect is unlikely to be due to higher-risk children having received vaccination. The role of DTP in high mortality areas needs to be clarified.

BCG Vaccine↗
PubMed1997

Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92.

OBJECTIVE: To compare mortalities for selected groups of immigrants with the national average. DESIGN: Analysis of mortality for adults aged 20-69 in 1970-2 and 1989-92 using population data from 1971 and 1991 censuses. Mortality of Scottish and Irish immigrants aged 25-74 was also compared with mortality in Scotland and Ireland for 1991. SETTING: England and Wales. MAIN OUTCOME MEASURES: Standardised mortality ratios for deaths from all causes, ischaemic heart disease, cerebrovascular disease, lung cancer, and breast cancer. RESULTS: In 1989-92 mortality from all causes was higher than the national average for Scottish immigrants, by 32% for men and 36% for women; for Irish immigrants it was higher by 39% for men and 20% for women; and for Caribbean born men it was lower by 23%. Ischaemic heart disease and lung cancer accounted for 30-40% of the excess mortality in Scottish and Irish immigrants. For south Asians, excess mortality from circulatory disease was balanced by lower mortality from cancer. Standardised mortality ratios for cerebrovascular disease in 1989-92 were highest for west African immigrants (271 for men and 181 for women). CONCLUSIONS: Widening differences in mortality ratios for migrants compared with the general population were not simply due to socioeconomic inequalities. The low mortality from all causes for Caribbean immigrants could largely be attributed to low mortality from ischaemic heart disease, which is unexplained. The excess mortality from cerebrovascular and hypertensive diseases in migrants from both west Africa and the Caribbean suggests that genetic factors underlie the susceptibility to hypertension in people of black African descent.

Adult↗
PubMed1991

Cultural and economic determinants of geographical mortality patterns in The Netherlands.

STUDY OBJECTIVE: The geographical pattern of mortality in The Netherlands is dominated by an area of relatively high mortality in the southern part of the country. The aim was to analyse the background of this geographical mortality pattern in the early 1980s, and its evolution over time since the early 1950s. DESIGN: Mortality data by district (n = 39), cause of death (13 large causes, "symptoms and ill defined conditions", all other causes), and time period (1950-54, 1960-64, 1970-74, 1980-84) were available from the Netherlands Central Bureau of Statistics. Standardised mortality ratios were calculated, and the logarithms of these were related to three sociodemographic characteristics using multiple, ordinary least squares regression analysis. SETTING: This study used data for the whole Dutch population. MAIN RESULTS: Although the geographical mortality pattern has been rather stable over the last decades, a clear tendency towards convergence is also apparent. Approximately 90% of the current excess mortality in the southern part of the country is due to cardiovascular diseases. The results of regression analysis show that the excess mortality is primarily related to the high percentage of Roman Catholics in this part of the country, and additionally to a slightly lower average income. In The Netherlands, a higher percentage of Roman Catholics in the population is linked with higher all cause mortality rates, as well as with higher mortality rates for lung cancer, ischaemic heart disease, cerebrovascular disease, arterial disease, and chronic non-specific lung disease. Survey data show that these associations are partly due to a higher prevalence of smoking among Roman Catholics. As in many other countries, a lower average income is linked with high all cause mortality rates in The Netherlands. Cause specific data show negative associations for stomach cancer, ischaemic heart disease, cerebrovascular disease, chronic non-specific lung disease, and traffic accidents. Since the early 1950s the association between geographical mortality patterns and the percentage of Roman Catholics in the population has gradually become less strongly positive. This suggests that the convergence of the mortality rates in the South towards the national average may be related to a gradual lessening of differences in lifestyle between population groups. CONCLUSIONS: Both cultural and economic factors are important in the explanation of geographical mortality patterns in The Netherlands.

Adolescent↗
PubMed1996

Mortality rates from cryptogenic fibrosing alveolitis in seven countries.

BACKGROUND: Registered mortality from cryptogenic fibrosing alveolitis (CFA) in England and Wales has increased substantially since the specific International Classification of Diseases code for CFA was introduced in 1979. However, since a significant proportion of deaths from CFA are misclassified as post inflammatory fibrosis (PIF), it is possible that the observed rise in CFA mortality is due to diagnostic transfer from this code. To investigate this, and to assess mortality trends in other countries, annual CFA and PIF mortality data from England and Wales, USA, Australia, Scotland, Canada, New Zealand, and Germany were analysed. METHODS: Crude annual mortality rates were calculated and rates standardised by Poisson regression to allow assessment of changes over time and comparison between countries, sexes, and age groups. The relative trends in mortality from CFA and PIF were assessed by calculating the annual ratio of CFA to PIF deaths. RESULTS: Men were more likely than women to die from both CFA and PIF in all countries. The highest standardised CFA mortality rate occurred in England and Wales, and the lowest in Germany. Since 1979 mortality from CFA has increased in England and Wales, Australia, Scotland and Canada, but there was no trend in CFA mortality in New Zealand or Germany. In the USA mortality from CFA was low and has fallen. Mortality from PIF increased in all countries except New Zealand and Germany, and the highest PIF mortality, together with the greatest increase over time, was seen in the USA. Changes over time in the annual ratio of CFA to PIF deaths in all countries were small, implying that diagnostic transfer is not a major cause of the increasing CFA mortality. CONCLUSIONS: Mortality from CFA continues to increase in England and Wales and in many other countries. Diagnostic transfer from PIF does not appear to be a major cause of this.

Adolescent↗