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PubMed2001

Regional differences in stillbirth and neonatal death rate in Sweden with a cause-of-death specific analysis.

UNLABELLED: Regional differences in stillbirth and neonatal death rates in Sweden were studied and a cause-of-death analysis was done in the 4 counties (among 24) with an increased mortality. The study is based on a computerized evaluation of infant cause of death, using a slightly modified Wigglesworth classification and a hierarchical classification (NICE: Neonatal and Intrauterine death Classification according to Etiology). Differences between the identified counties with respect to specific causes of death were demonstrated. CONCLUSION: There are differences between Swedish counties with respect to the risk for stillbirth or neonatal death. The NICE cause-of-death classification can be used for the routine surveillance of stillbirths and neonatal deaths in a population and can help in pinpointing weak elements in antenatal, delivery and neonatal care.

Cause of Death↗
PubMed1982

Assessment of hospital performance by use of death rates. A recent case history.

This article discusses an analytical approach for integrating hospital death rates. A study of patient mortality in four hospitals in a large metropolitan areas demonstrates the principles underlying this approach. One hospital, which experienced an annual crude death rate almost twice that of the other three, was suspected of providing an inferior quality of care. Case-mix differences among the hospitals introduced a serious bias, however, and were later taken into account. The patients' primary diagnosis was found to be the most important case-mix variable, with a potential for biasing death rate comparisons. After readjustment for case mix, the maximum difference in death rates among the four hospitals was reduced from 19 to four deaths per 1,000 patients. Further analysis of diagnosis-specific mortality supported the thesis that the observed mortality excess was largely attributable to patient referral patterns in the community.

Adolescent↗
PubMed1998

Age standardization of death rates: implementation of the year 2000 standard.

This report discusses the rationale for and implications of the implementation of a new population standard for the age standardization (age adjustment) of death rates. The new standard is based on the year 2000 population and beginning with data year 1999, will replace the existing standard based on the 1940 population. This report also includes a technical discussion of direct and indirect standardization and statistical variability in age-adjusted death rates. Currently, at least three different standards are used among Department of Health and Human Services agencies. Implementation of the year 2000 standard will reduce confusion among data users and the burden on State and local agencies. Use of the year 2000 standard will also result in age-adjusted death rates that are substantially larger than those based on the 1940 standard. Further, the new standard will affect trends in age-adjusted death rates for certain causes of death and will narrow race differentials in age-adjusted death rates. Although age standardization is an important and useful tool, it has some limitations. As a result the examination of age-adjusted death rates should be the beginning of an analysis strategy.

Adolescent↗
PubMed1979

Areas with extreme death rates for middle-aged white males.

"Death rates from natural causes and from cardiovascular diseases, age 35-74, age-adjusted, by sex and race, by county and State Economic Area [of the United States] for 1968-1972 have been calculated...." The counties with extremely high or low death rates for white males are identified, and the reasons for the variations in mortality observed are considered

Age Factors↗
PubMedDate not supplied

Primary biliary cirrhosis (PBC) in an European country--a description of death rates in The Netherlands (1979-1992).

BACKGROUND/AIMS: In 1979, separate liver transplantation (LT) and primary biliary cirrhosis (PBC) death rate registration became available in The Netherlands (15 million inhabitants). The objective of this study was to investigate death rates from 1979-1992 and analyse the impact of LT. PATIENTS AND METHODS: PBC was either a primary or secondary cause of death. Rates were expressed as absolute numbers or per million inhabitants in the corresponding age category. Age classes of 5 years were used. The Netherlands was divided in four regions, North, South, East and West. Standardized mortality ratios (SMR) were used for calculation of regional differences. RESULTS: In the 14 year period between 1979-1992, 417 persons died from and 179 persons died with PBC, totaling 596 PBC patients (6.3 per million inhabitants > or = 35 years). No person younger than 35 died. Eighty-two percent were female, with a corresponding female/male ratio of 4.2 per million females/males inhabitants. In region South there were significantly fewer deaths (SMR 66%, p < 0.001) and in region North significantly more (SMR 141%, p < 0.05). The median age class at death was 70-74 (males and females alike). At age 35-59, death from PBC in 1992 per million was 1.2, and for > or = 65 years 15.7. In age class 80-84, the highest death rate from or with PBC was found with 28 deaths per million inhabitants and with a female/male ratio of 3.6. In 1992, with two deaths only, LT appeared to have nearly eliminated death from PBC in the age category 35-59 years. CONCLUSION: Death from PBC mainly occurs in the old and very old, who may never seek a specialized center. This indicates a more specific management and therapy for this particular group is needed.

Adult↗
PubMed1988

Relationship between hepatitis B surface antigen prevalence, per capita alcohol consumption and primary liver cancer death rate in 30 countries.

The relationships between the prevalence of hepatitis B surface antigen (HBsAg), mean annual per capita alcohol consumption and primary liver cancer (PLC) death rates were explored in 30 countries. HBsAg prevalence was associated, significantly, with the logarithm of the primary liver cancer death rate (simple correlation coefficient = 0.44, p less than 0.05). This significant association increased following adjustment for a country's mean annual per capita alcohol consumption (partial correlation coefficient = 0.53, p less than 0.01). A logarithmic linear relationship was also found between per capita alcohol consumption and the primary liver cancer death rate after adjustment for the country's prevalence of HBsAg (partial correlation coefficient = 0.38, p less than 0.05). Results from both correlation and regression analyses showed that prevalence of HBsAg was more significantly associated with PLC death rates than was alcohol consumption. However, these two variables were independently related to the PLC death rate in a stepwise multiple regression model. We could not demonstrate an interaction between the two variables. These findings are consistent with the prevailing view that chronic hepatitis B infection is the major factor in the most common form of primary liver cell cancer, hepatocellular carcinoma. In addition, they support the notion that alcohol consumption contributes significantly and independently, although probably to a lesser extent than hepatitis B, to deaths from that disease.

Alcohol Drinking↗
PubMed1994

[Analysis of foetal death rates in Japan based on legitimacy status of foetus and period of gestation].

The purpose of this study was to analyze spontaneous and artificial foetal death rates from the context of legitimacy status of the foetus and period of gestation. Data over five years, 1985 to 1989, were averaged and mainly used for analysis and compared to reference data for five other years, 1970 to 1974, with the following results. In the latter half of the 1980's, spontaneous foetal death rates for the illegitimate were very high compared to the legitimate. In all periods of gestation, spontaneous foetal death rates of the illegitimate were higher than those of the legitimate. For the 16th to the 31st week of gestation especially, rates of the illegitimate were ten times or more that of the legitimate. Spontaneous foetal deaths before the 24th week of gestation constituted nearly 90% of all spontaneous foetal deaths in the illegitimate. By comparison, the percentage was 66% in the legitimate. This data suggests that some artificial foetal deaths were being notified as spontaneous and this phenomenon caused the differences mentioned above. Artificial foetal death rates of the illegitimate were very high compared to the legitimate. Before the 24th week of gestation, artificial foetal death rates were 50 to 100 times that of the legitimate. These characteristics observed in the latter half of the 1980's, were also seen in the first half of the 1970's. From the comparison of the two observation periods, the registration of foetal deaths appears to be improving, especially in the period of 12 to 15 weeks of gestation.

Abortion, Induced↗
PubMed1989

Excess mortality ratio with reference to the lowest age-sex-specific death rates among countries.

Indicators based on mortality data have long been used to measure the level of health status and to monitor and evaluate the progress and achievements of health programmes. Their usefulness is particularly obvious when dealing with preventable deaths. This article proposes the use of the lowest death rate recorded among industrialized countries for each age/sex group as an achievable target and as a reference for assessing the amount of excess mortality. The resulting indicator, excess mortality ratio (EMR), reveals some features of the mortality pattern which may not be easily noticed by means of other mortality indicators. Two sets of the lowest age-sex-specific death rates are considered, namely one comprising the lowest rates recorded in each calendar year (the current minimum) and the other comprising the lowest rates ever recorded since 1950 (the historical minimum). The former may be used for monitoring whether a country is moving ahead in mortality reduction in pace with low mortality countries, while the latter may be considered as a realistic goal for a country's mortality reduction. In computing the EMR, the lowest death rates are first applied to the age-sex composition of the population of a given country for a given calendar year to obtain the number of deaths which would have been expected under the lowest mortality pattern; the expected number is then subtracted from the actual number of deaths recorded in the country during the calendar year to yield the "excess". The indicator is finally calculated by taking the ratio of the excess to the expected minimum. The historical minimum death rates found from the records maintained in WHO's mortality data base are shown in Table 2 (for country codes used, see Table 1). The minimum rates have themselves declined with time as seen in Table 4, especially in young age groups, and the declining trend has been more marked in females. These trends are seen also in individual countries' data (Table 3). A comparison of the cause-of-death pattern of a country with that of the world's lowest death rate will reveal the causes to which the country's excess mortality is attributable, as seen in Table 5. At the same time, the table also shows that even the lowest rates are made up of causes which are largely preventable. The world's lowest rate therefore may be regarded as conservative targets for mortality reduction.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2002

Variation in death rate after abdominal aortic aneurysmectomy in the United States: impact of hospital volume, gender, and age.

OBJECTIVE: To determine whether high-volume hospitals (HVHs) have lower in-hospital death rates after abdominal aortic aneurysm (AAA) repair compared with low-volume hospitals (LVHs). SUMMARY BACKGROUND DATA: Select statewide studies have shown that HVHs have superior outcomes compared with LVHs for AAA repair, but they may not be representative of the true volume-outcome relationship for the entire United States. METHODS: Patients undergoing repair of intact or ruptured AAAs in the Nationwide Inpatient Sample (NIS) for 1996 and 1997 were included (n = 13,887) for study. The NIS represents a 20% stratified random sample representative of all U.S. hospitals. Unadjusted and case mix-adjusted analyses were performed. RESULTS: The overall death rate was 3.8% for intact AAA repair and 47% for ruptured AAA repair. For repair of intact AAAs, HVHs had a lower death rate than LVHs. The death rate after repair of ruptured AAA was also slightly lower at HVHs. In a multivariate analysis adjusting for case mix, having surgery at an LVH was associated with a 56% increased risk of in-hospital death. Other independent risk factors for in-hospital death included female gender, age older than 65 years, aneurysm rupture, urgent or emergent admission, and comorbid disease. CONCLUSIONS: This study from a representative national database documents that HVHs have a significantly lower death rate than LVHs for repair of both intact and ruptured AAA. These data support the regionalization of patients to HVHs for AAA repair.

Adult↗
PubMed1999

Why is the death rate from lung cancer falling in the Russian Federation?

Age standardised death rates (European standard population) from lung cancer in the Russian Federation, have been rising since at least 1965, levelled out in the late 1980s and have subsequently decreased. The reasons for this decline are not apparent. This study seeks to identify the reasons for the decline in mortality from lung cancer in the Russian Federation in the 1990s. Changes in age-specific mortality from lung cancer in the Russian Federation between 1990 are described and age-cohort analysis, based on age-specific death rates for lung cancer is undertaken for the period 1965 to 1995. As other work has shown that any recent deterioration in coding of cause of death has been confined largely to the elderly, this suggests that the trend is not a coding artefact. Age-period-cohort analysis demonstrates the existence of a marked birth cohort effect, with two major peaks corresponding to those born around 1926 and 1938. These groups would have reached their early teens during the second world war and the period immediately after the death of Stalin, respectively. The present downward trend in death rates from lung cancer in the Russian Federation is partly due to a cohort effect and it is expected that this will soon reverse, with a second peak occurring in about 2003.

Adolescent↗
PubMed2006

Natural background radioactive carbon and the natural death rate of people.

A brief analysis of the known data on the potential danger of radiocarbon incorporation into DNA structure shows that the great genetic importance of transmutational transformations of DNA-incorporated 14C is theoretically and experimentally proved. This effect exists both in huge and small radiation doses (similar to doses of 14C natural background radiation). Therefore, the human death rate can be assumed to be dependent on natural and anthropogenous fluctuations of atmospheric 14C. Calculation methods of the age parameter dynamics of the natural human death rate are offered. It is shown that when calculating the parameters of the natural death rate, the use of Gompertz's formula is reasonable provided that the data on the general death rate are taken for the age interval "60 to 85 years." The ratios reflecting the regular and casual errors of the parameters R and a of Gompertz's equation, caused by people's casual deaths, were determined. A comparison of the historical dynamics of people's natural death rates in the last 150 years with the variations of 14C of the natural background during the same period showed that these are coordinated phenomena, the strong correlation of which indicates the possibility of their functional dependence. The 14C-concentration increase in an organism is the result of its increase in the surrounding biospheric composition, causing an increase in the natural death rate and vice versa: The increase of a person's life expectancy is caused by a decrease of 14C concentration.

Background Radiation↗
PubMedDate not supplied

Why Londoners have low death rates from ischaemic heart disease and stroke.

OBJECTIVE: To explain the low death rates from cardiovascular disease in London. SETTING: London and the other counties of England and Wales. SUBJECTS: Women living in London during 1901-10 and people in London dying during 1968-78. RESULTS: At the beginning of the twentieth century young women aged 15-34 in London had remarkably low death rates, largely because of low rates for tuberculosis and other infectious diseases and low mortality during childbirth. Their low death rates contrasted with the high rates in girls under 15 years. CONCLUSIONS: Large numbers of young women had migrated into London from agricultural counties in southern England and went into domestic service, where the diet was usually very good. Recent findings suggest that a mother's nutrition and health has a major effect on the risk of cardiovascular disease in the next generation. The low cardiovascular mortality in London is consistent with this, and contrasts with the high mortality from other common diseases.

Cause of Death↗
PubMed1994

The descriptive epidemiology of unnatural deaths in Oregon's state institutions: a 25-year (1963-1987) study. IV. The reduction of unnatural death rates during 1988-1992 in three facilities as a result of planned changes.

This paper documents the most recent five-year (1988-1992) analysis of unnatural deaths in Oregon's state mental and correctional institutions. The current findings are compared with those of the preceding five years (1983-1987) within the context of the long term trend in unnatural death rates for the previous 25 years. The unnatural death rates for the institutional clients are also compared with those for the noninstitutionalized citizens of Marion County, Oregon. There are two major findings in these 1988-1992 data: (a) There have been highly significant reductions in unnatural death rates in Oregon State Hospital and in the Forensic Psychiatric Program, which the authors believe are largely due to the implementation of planned changes to reduce the previously very high suicide rates in these two facilities; and (b) There was a dramatic reduction (to zero) of unnatural deaths at the Fairview Training Center. The authors also believe that this was attainable mostly because of large-scale improvements made at that facility, by the Department of Human Resources and the Oregon Legislature, just before and during the present study time frame. Changes in these three facilities which led to the improvement in unnatural death rates of clients are discussed.

Accidents↗
PubMed1978

Effect of fetal monitoring on neonatal death rates.

We analyzed data from 15,846 live-born infants to assess the effect of electronic fetal monitoring on neonatal death rates. The crude neonatal death rate was 1.7 times higher in unmonitored infants than in those monitored. Adjusting for inherent risk and changes in mortality rates and monitoring rates during the years of the study lowered the relative risk to 1.4 (95 per cent confidence interval, 0.85 to 2.45). The estimated yield from monitoring decreased as the inherent risk of the baby declined. Thus, in the highest-risk group 109 lives might be saved for every thousand babies monitored. In the lowest risk group (babies at term with no risk factors) the neonatal death rate is around one per thousand. The absolute benefit for this large group could therefore not exceed one life saved for every thousand babies monitored.

Female↗
PubMed1965

Effect of several environmental conditions on the "thermal death rate" of endospores of aerobic, thermophilic bacteria.

The composition of the recovery medium affected the apparent heat resistance of Bacillus stearothermophilus when the pH of the medium was 7.0 but not when the pH was 6.5. The rate of thermal death at 110 C was exponential. Deviations from exponential rates of thermal death during the initial phases of heating at 96 C were observed with endospores of B. coagulans under different conditions of sporulation. Additionally, the apparent heat resistance was influenced by the composition of the media used for sporulation and recovery and by the composition of the suspending menstruum. The presence of 0.001 m sorbic acid in the suspending menstruum at pH 7.0 and the temperature of incubation of the cultures after heating did not affect the apparent heat resistance of B. coagulans. Several explanations are discussed for the observed deviations from exponential thermal death rates and the effect of the environment on the apparent heat resistance of B. coagulans.

Bacillus↗
PubMed2001

Age- and gender-specific asthma death rates in patients taking long-acting beta2-agonists: prescription event monitoring pharmacosurveillance studies.

OBJECTIVE: Prescription event monitoring is a national drug safety surveillance scheme in which prescribers are prompted to report events and deaths following prescription of newly marketed drugs. This paper presents age- and gender-specific asthma death rates in patients prescribed the long-acting beta2-agonists salmeterol and bambuterol. DESIGN AND SETTING: Pharmacosurveillance cohort study of general practice patients in England. PATIENTS AND PARTICIPANTS: 15 406 patients prescribed salmeterol between December 1990 and May 1991, and 8098 patients prescribed bambuterol between February 1993 and December 1995. METHODS: Patients prescribed these drugs by general practitioners in England were identified using the national pharmacovigilance system of prescription event monitoring, in which details of all dispensed prescriptions were provided in confidence by the Prescription Pricing Authority. Questionnaires were sent to the prescriber asking for details of events occurring after the first prescription. In each study an attempt was made to establish the cause of all deaths reported on the questionnaires, via retrieval of the patients' medical notes or examination of death certificates. OUTCOME MEASURES AND RESULTS: There was little evidence of heterogeneity in the drug-specific death rates and we therefore present the combined age- and gender-specific death rates for the 2 cohorts. Overall, there were 85 asthma deaths among people taking the long-acting beta2-agonists studied (bambuterol and salmeterol cohorts combined). The overall death rate was 2.33 [95% confidence interval (CI) 1.84 to 2.84] per 10000 months of observation. There were 37 asthma deaths among male patients (rate 2.40 per 10000 months of observation; 95% CI 1.74 to 3.40) and 48 asthma deaths among female patients (rate 3.08 per 10000 months of observation; 95% CI 2.21 to 3.98). There was no difference in death rates when male and female patients were compared (rate ratio 0.78; 95% CI 0.49 to 1.22; p = 0.26). CONCLUSION: Prescription event monitoring is a form of prompted surveillance allowing rapid, uniform, national and practical assessment of newly marketed drugs on large cohorts of patients in England. These data provide benchmark rates from which to assess the performance of newly prescribed anti-asthma drugs and generate hypotheses for later analytical investigation in which confounding by indication and asthma severity can be controlled for. Any differences in these rates should be considered as a source of signal generation within the context of a surveillance programme, rather than as robust evidence of any mortality differential between drugs.

Adrenergic beta-Agonists↗
PubMed1992

Some threshold and stability results for epidemic models with a density-dependent death rate.

Most classical models for infectious diseases assume that the birth and death rates of individuals and the meeting rates between susceptible and infected individuals do not depend on the total number of individuals in the population. While these assumptions are valid in some situations they are less valid in others. For example, for diseases in animal an insects populations competition for scarce resources might well mean that the death rate depends on the number of individuals. The present paper examines two epidemic models where the death rate is density dependent. For each model the possible equilibrium levels of disease incidence are determined and the stability of these equilibrium levels to small perturbations is discussed. The biological interpretation of these results is presented together with the results of some numerical simulations.

Birth Rate↗
PubMed2006

Variations of humans' natural death rate and the radiocarbon aging mechanism.

The historical dynamics of the natural death rate have been studied for the populations of 48 European countries from 1970 to 2002, as well as of 191 countries worldwide for 1999, 2000, and 2001. The variations of natural death rate parameters appear to obey the common law in practically all the populations of the planet, and this law follows from the radiocarbon mechanism of aging. The results allow one to imagine the existence of the connection between a person's natural death probability and his or her environmental conditions, brought about by the fact that the environment determines the change of 14C concentration in an organism. Experimental confirmation of such a hypothesis has been considered. As a primary step, it implies the choice of a basic risk factor determining the natural death rate of this or that biologic object, then a comparison of the intensity of the chosen risk factor with radiocarbon content in the whole organism as well as its separate structures.

Carbon Radioisotopes↗