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PubMed1993

Influence of prerandomization (baseline) variables on mortality and on the reduction of mortality by enalapril. Veterans Affairs Cooperative Study on Vasodilator Therapy of Heart Failure (V-HeFT II). V-HeFT VA Cooperative Studies Group.

BACKGROUND: The effects of hydralazine plus isosorbide dinitrate were compared with those of enalapril in 804 men receiving digoxin and diuretic therapy for chronic congestive heart failure (CHF) in the Department of Veterans Affairs Cooperative Vasodilator-Heart Failure Trial (V-HeFT II). METHODS AND RESULTS: Patients were randomly assigned to receive 20 mg of enalapril or 300 mg of hydralazine plus 160 mg of isosorbide dinitrate daily. At 2 years, treatment with enalapril resulted in a significant (28%) reduction in mortality relative to the active control treatment. Baseline variables were examined to determine their impact on risk of mortality and on relative response to treatment. Mortality rates were significantly higher in patients with severe ventricular arrhythmias; in patients with low baseline ejection fractions, low peak oxygen consumption, and low systolic blood pressures; in patients with high cardiothoracic ratios, high scores indicating greater impairment on a quality-of-life questionnaire, and high plasma norepinephrine or renin levels; and in patients in New York Heart Association (NYHA) classes III and IV. Coronary artery disease, duration of CHF, and patient age were not predictive of mortality. Enalapril reduced mortality significantly compared with hydralazine/isosorbide dinitrate in patient subgroups with high plasma renin or norepinephrine levels and in patients with low cardiothoracic ratios. Furthermore, enalapril conferred significantly greater protection from mortality than hydralazine/isosorbide dinitrate in patients in NYHA classes I and II and in patients without arrhythmias or with < or = 10 premature ventricular contractions per hour. CONCLUSIONS: Of the prerandomization characteristics that were predictive of mortality in patients with CHF, only neurohormone measurements, cardiothoracic ratios, arrhythmia severity, and NYHA class identified subgroups of patients who benefited most from treatment with enalapril; a treatment interaction across strata was detected only for plasma norepinephrine and NYHA class. In no patient subgroup was the mortality with enalapril treatment significantly higher than the mortality with hydralazine/isosorbide dinitrate treatment.

Drug Therapy, Combination↗
PubMed2001

Early volume expansion for prevention of morbidity and mortality in very preterm infants.

BACKGROUND: Reduced perfusion of organs such as the brain, heart, kidneys and the gastrointestinal tract may lead to acute dysfunction and be associated with permanent injury. Various strategies have been used to provide cardiovascular support to preterm infants including inotropes, corticosteroids and volume expansion. OBJECTIVES: In very preterm infants, does early volume expansion reduce morbidity and mortality. If volume expansion is effective, what type of volume expansion is most effective. SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. Searches were conducted of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts and conference proceedings. SELECTION CRITERIA: Randomised trials of early volume expansion with normal saline, fresh frozen plasma, albumin, plasma substitutes or blood compared to no treatment or another form of volume expansion in preterm infants < 32 weeks gestation or < 1500g were included. Volume expansion was defined as at least 10 mls/kg given in the first 72 hours of life. DATA COLLECTION AND ANALYSIS: Standard methods of the Neonatal Review Group with use of relative risk (RR), risk difference (RD) and weighted mean difference (WMD). The fixed effects model using RevMan 4.1 was used for meta-analysis. Data from individual studies were only eligible for inclusion if a least 80% of infants were reported for that outcome. MAIN RESULTS: Seven studies were included. Five studies, four with data for mortality, compared volume to no treatment. Most studies enrolled very preterm infants on the basis of gestation or birthweight. Two studies comparing different types of volume expansion enrolled very preterm infants with hypotension. No study enrolled infants on the basis of low blood flow. One study examined the effect of volume expansion on blood flow but in normotensive very preterm infants. Comparing volume and no treatment, 4 studies with a total of 940 very preterm infants reported no significant difference in mortality (RR 1.11, 95% CI 0.88, 1.40). The large NNNI 1996 study reported no significant difference in severe disability (RR 0.80, 95% CI 0.52, 1.23), cerebral palsy (RR 0.76, 95% CI 0.48, 1.20) and combined death or severe disability (RR 1.00, 95% CI 0.80, 1.24). Although one small study (Beverley 1985) reported reduced P/IVH with volume expansion, this was not supported by any other study. No significant difference was reported in grade 3-4 P/IVH and combined death or grade 3-4 P/IVH. One study (NNNI 1996) reported no significant difference in the incidence of hypotension. The finding of decreased necrotising enterocolitis and increased sepsis in infants who received fresh frozen plasma compared to a gelatin-based plasma substitute or no treatment in one study should be treated with caution. No significant differences in mortality or disability were found in this study. In one small study, there were no significant differences in outcomes between hypotensive infants who received colloid (albumin) or crystalloid (saline). REVIEWER'S CONCLUSIONS: There is no evidence from randomised trials to support the routine use of early volume expansion in very preterm infants without cardiovascular compromise. There is insufficient evidence to determine whether infants with cardiovascular compromise would benefit from volume expansion. There is insufficient evidence to determine what type of volume expansion should be used in preterm infants (if at all) or for the use of early red cell transfusions. The trial comparing colloid (albumin) and crystalloid (saline) in hypotensive preterm infants found no benefit in using a more expensive blood product compared to saline, but is insufficiently powered to detect an important clinical difference.

Blood Volume↗
PubMed1995

United States mortality from ill-defined causes, 1968-1988: potential effects on heart disease mortality trends.

BACKGROUND: Deaths are coded to the International Classification of Diseases (ICD) category, 'Symptoms, Signs, and ill-defined Conditions' when there is insufficient information for cause of death determination. Due to difficulties of diagnosis of coronary heart disease (CHD) death and since CHD is the leading cause of death among US adults, CHD is the most likely cause of ill-defined deaths. METHODS: Vital statistics and census data were used to create annual age-adjusted ill-defined rates, unrevised CHD rates, and CHD rates revised to include ill-defined deaths for US African Americans and whites, ages 35-74 years, during 1968-1988. Ill-defined and CHD mortality trend analyses were conducted. RESULTS: In 1968, African American/white ratios of ill-defined mortality were 5 among men and 7 among women; following steep declines in ill-defined mortality among African Americans, ratios were 3 among men and 2 among women in 1988. In 1968, approximately 3% and 1% of all deaths among African Americans and whites, respectively, were certified to ill-defined causes; in 1988, approximately 1.5% of deaths among African Americans were coded ill-defined, with no change among whites. Revised CHD rates showed substantially higher excess CHD mortality among African Americans than whites compared to unrevised CHD rates. Declines in revised CHD mortality steepened throughout the study period among men, and among women began to decelerate after 1978. CONCLUSIONS: Ill-defined mortality was of sufficient magnitude to potentially contribute to substantial underestimation of racial disparities in CHD mortality. Also, temporal changes in ill-defined mortality may have affected CHD trends which are used to evaluate the efficacy of public health interventions.

Adult↗
PubMed1999

Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali.

OBJECTIVE: Few prospective studies have been undertaken of maternal mortality in sub-Saharan Africa. National statistics are inadequate, and data from hospitals are often the only source of information available. Reported maternal mortality ratios may therefore show large variations within the same country, as in Mali. This study was designed to produce an estimate of the maternal mortality ratio for the population of Bamako. DESIGN: Prospective cohort study. SETTING: Bankoni (population 59,000), a district of Bamako (population 700,000). POPULATION: 5782 pregnant women identified during quarterly household visits. METHODS: After enrolment, two follow up visits, at six weeks and one year after delivery, were performed to collect information on the pregnancy, its outcome, the method of delivery, the puerperium and the first year after birth. Detailed inquiries on deaths were undertaken in the community, the maternity units and the reference hospital. MAIN OUTCOME MEASURES: Maternal mortality ratio, late maternal mortality, likely cause of death. RESULTS: Complete data at follow up were available on 4717 women (82%) (4653 single and 64 twin pregnancies). Most of the women had antenatal care were and delivered in a district maternity hospital. There were 4580 live births (96%). Fifteen maternal deaths were recorded, yielding an overall maternal mortality ratio of 327 per 100,000 live births. Hypertensive disorders and haemorrhage were the main causes of death. Five more deaths occurred within 42 days or one year after delivery. CONCLUSIONS: This study gave an estimate of the maternal mortality ratio for the population of Bamako, and stressed the need of better emergency obstetric care and the importance of late maternal mortality.

Adolescent↗
PubMed1977

Mortality and industrial employment. II. Industries with high mortality among young workers based on a social security sample.

Goldsmith and Hirschberg have published a preliminary report on mortality among a sample of social security recipients employed in 1965 and whose mortality experience was available through 1972. Among white males, but not among blacks or white females, mortality was higher among those age 16-20 in 1965 than among those 21-25. Among the industrial populations tabulated, young workers showed in a few cases significantly elevated standard mortality ratios, even when overall mortality was not increased. Accordingly, we have examined mortality for 1960-72 for those employed in 1960 for all the industrial groups (two digit SIC codes) to look for industries in which young workers have high mortality. Only those industries have been considered in which observed deaths at ages 11-30 (in 1960) exceed 10 and population at risk exceeds 200. Young workers appear to have significantly elevated mortality in: agricultural production (white males), metal mining (white males), real estate (white males), military and reserves (white males), miscellaneous business services (white females), and eating and drinking establishments (white females). For such industries, preventive measures should be considered.

Adolescent↗
PubMed2005

Alcohol consumption and increased mortality in Russian men and women: a cohort study based on the mortality of relatives.

OBJECTIVE: To examine the relations between frequency of alcohol consumption and of binge drinking and adult mortality in Russian men and women. METHODS: Using modified indirect demographic techniques, a convenience cohort was constructed based on survey respondents' information about their close relatives. A random sample general population of the Russian Federation of 7172 respondents (response rate 61%) provided information on 10 475 male and 3129 female relatives, including age, vital status, and frequency of alcohol consumption and binge drinking. These relatives formed the cohort analysed in this report. The outcome measure was all-cause mortality after the age of 30 years. FINDINGS: There was a strong linear relation between frequency of drinking and of binge drinking and all-cause mortality in men; after controlling for smoking and calendar period of birth, the relative risk of death in daily drinkers compared to occasional drinkers was 1.52 (95% confidence interval (CI) 1.33-1.75). Male binge drinkers had higher mortality than drinkers who did not binge, which persisted after adjustment for drinking frequency (adjusted relative risk 1.09, 95% CI 1.00-1.19). In women, the increased mortality was confined to a small group of those who binged at least once a month (adjusted relative risk 2.68, 95% CI 1.54-4.66). CONCLUSION: The results suggest a positive association between alcohol and mortality in the Russian Federation. There was no evidence for the protective effect of drinking seen in western populations. Alcohol appears to have contributed to the high long-term mortality rates in Russian men, but it is unlikely to be a major cause of female mortality.

Adult↗
PubMed2004

Breast cancer mortality patterns and time trends in 10 new EU member states: mortality declining in young women, but still increasing in the elderly.

Breast cancer is the cancer diagnosed most frequently in women worldwide. In Europe it is the most common cancer in the female population, with approximately 350,000 new cases diagnosed each year including 130,000 deaths. Incidence rates are increasing in the majority of European countries, whereas a decline in mortality rates has been observed in many West European countries since the late 1980s and early 1990s. Our study examines breast cancer mortality patterns and time trends in the new European Union (EU) member states and compares them with the situation in current EU member states. A Joinpoint regression analysis was used to assess temporal changes in mortality rates and the trends examined in the light of known risk factors, screening programs and advances in treatment. In the majority of the countries analyzed, a deceleration in the increase of mortality rates appeared, followed by a decrease of mortality in many of them in the second half of the 1990s. The declining tendency was visible primarily in young women, and to a lesser extent in middle-aged women, whereas in elderly women a continuing increase of mortality was observed. Analysis of mortality data, information from previous publications, as well as analysis of known factors influencing breast cancer risk suggest that changes observed are due mainly to recent advances in treatment rather than changes in lifestyle risk factors or the result of screening programs. Early detection and a shift toward more favorable stage distribution could have played the leading role for mortality decline in younger patients.

Adolescent↗
PubMed2006

Social inequalities in male mortality, and in male mortality from smoking: indirect estimation from national death rates in England and Wales, Poland, and North America.

BACKGROUND: There are substantial social inequalities in adult male mortality in many countries. Smoking is often more prevalent among men of lower social class, education, or income. The contribution of smoking to these social inequalities in mortality remains uncertain. METHODS: The contribution of smoking to adult mortality in a population can be estimated indirectly from disease-specific death rates in that population (using absolute lung cancer rates to indicate proportions due to smoking of mortality from certain other diseases). We applied these methods to 1996 death rates at ages 35-69 years in men in three different social strata in four countries, based on a total of 0.6 million deaths. The highest and lowest social strata were based on social class (professional vs unskilled manual) in England and Wales, neighbourhood income (top vs bottom quintile) in urban Canada, and completed years of education (more than vs less than 12 years) in the USA and Poland. RESULTS: In each country, there was about a two-fold difference between the highest and the lowest social strata in overall risks of dying among men aged 35-69 years (England and Wales 21%vs 43%, USA 20%vs 37%, Canada 21%vs 34%, Poland 26%vs 50%: four-country mean 22%vs 41%, four-country mean absolute difference 19%). More than half of this difference in mortality between the top and bottom social strata involved differences in risks of being killed at age 35-69 years by smoking (England and Wales 4%vs 19%, USA 4%vs 15%, Canada 6%vs 13%, Poland 5%vs 22%: four-country mean 5%vs 17%, four-country mean absolute difference 12%). Smoking-attributed mortality accounted for nearly half of total male mortality in the lowest social stratum of each country. CONCLUSION: In these populations, most, but not all, of the substantial social inequalities in adult male mortality during the 1990s were due to the effects of smoking. Widespread cessation of smoking could eventually halve the absolute differences between these social strata in the risk of premature death.

Adult↗
PubMed1998

A comparison of mortality rates in three prospective studies from Copenhagen with mortality rates in the central part of the city, and the entire country. Copenhagen Center for Prospective Population Studies.

Valid generalizations of results from population-based epidemiological surveys requires knowledge about how representative the sample is. The Copenhagen Center for Prospective Population Studies have assessed mortality on the basis of pooled data from three research programmes in the region of Copenhagen. In two of the studies, subjects were randomly selected, using the Danish Central Population Registry, within certain age groups and area-restricted sectors of the Greater Copenhagen. In the third study, men employed in 14 companies participated. Participation rates were between 78% and 87% in the three programmes. Standardized mortality rates (SMR) were calculated in relation to mortality rates in the municipality of Copenhagen and in the whole country in three age groups and the two genders. SMR values in the whole sample including non-participants were similar to rates for Copenhagen in the Copenhagen City Heart Study, whereas mortality rates in the Glostrup Population Studies were similar to rates for the whole country. The mortality rates among participants were lower than in the whole sample, and differences existed in relation to region and selection criteria of the cohorts. The Copenhagen Male Study, where only employed men were included, showed the lowest mortality rates, and higher rates were found in the study from the central part of the City (the Copenhagen City Heart Study) compared to the study from the suburbs (the Glostrup Population Studies). The difference between mortality rates in the cohorts and in Copenhagen City decreased with increasing age. The SMR converged towards 1.00 with increasing observation time. In conclusion, high participation rates were found in all three studies, resulting in SMR values for participants only slightly lower than in the source population in the two randomly selected samples, but 30% lower values in the sample of employed men. As mortality rates in the total samples including non-participants were markedly higher than among the participants, generalizations of results for participants to the whole population should be made with caution, especially during the first years of observation.

Adult↗
PubMed1998

Body mass and 26 y risk of mortality among men who never smoked: a re-analysis among men from the Adventist Mortality Study.

OBJECTIVE: To re-analyse the previously reported linear relation between Quetelet's body mass index (BMI) and mortality, among men from the Adventist Mortality Study after accounting for effects due to age at measurement of BMI, smoking history and race. DESIGN: Prospective cohort study. To specifically account for effects due to age at measurement of BMI, smoking history and race, our methodology includes: 1, computing hazard ratios for BMI quintiles from a proportional hazard regression, with 'time on study' as the time variable, and age at baseline as a covariate; 2, conducting separate analyses of middle-aged (age 30-54y) and older (age 55-74y) men; and 3, restriction of the analyses to never-smoking, non-Hispanic white males. SUBJECTS: 5062 men (age: 30-74 y, BMI: 14-44 kg/m2) from the Adventist Mortality Study. MEASUREMENTS: Subjects reported data on anthropometric, demographic, medical, dietary and lifestyle characteristics at baseline and were enrolled in mortality surveillance during a 26y study period (1960-1985). RESULTS: During the early years of follow-up (years 1-8, 9-14), we found some evidence of excess risk among the leanest men that was probably due to the effects of antecedent illness. During the later years of follow-up (years 15-26), effects due to antecedent illness were not apparent and a significant positive, linear relation between BMI and all-cause mortality was consistently found among middle-aged (30-54 y) and older (55-74 y) men. Disease-specific analyses of the later follow-up (years 15-26) revealed that the positive linear trends with all-cause mortality, were primarily due to excess risk of cardiovascular disease and cancer among the heavier men. Among older men, a significant inverse relation between BMI and respiratory disease mortality risk was identified during later follow-up (years 15-26), but this effect attenuated after restriction of the analyses to men with no baseline history of respiratory disease. CONCLUSIONS: The re-analysis confirms the findings of a positive, linear relation between BMI and all-cause mortality, reported in the original study.

Adult↗
PubMed1991

Behavioural risk factors among young adults in small areas with high mortality versus those in low-mortality areas.

A community-based cross-sectional survey of behavioural risk factors for premature mortality was carried out on a group of 354 adults aged 25-44 from previously identified high-mortality 'black-spots' in Dublin who were compared with 333 others from low-mortality areas. In the black-spot areas, 50.9% of respondents were current smokers versus 28.5% in low-mortality areas and 14.6% took 'sufficient' exercise versus 31.4% in low-mortality areas. People living in black spots were also less likely to make 'healthy' dietary choices than those in low-mortality areas. There is a higher prevalence of behavioural risk factors for premature mortality among young adults living in electoral wards/district electoral divisions (DEDs) with high standardized mortality ratios (SMRs) from all causes than among those in areas with low SMRs. A health promotion programme aimed at increasing exercise levels, reducing smoking and encouraging healthy eating should be aimed at young adults in DEDs with high SMRs.

Adult↗
PubMed1990

Mortality by employment status in the National Longitudinal Mortality Study.

A mortality follow-up of 452, 192 persons aged 25 years or more who were characterized with respect to employment status was conducted using the National Death Index for the years 1979 through 1983. The cohort, part of the National Longitudinal Mortality Study, was drawn from Current Population Survey samples representative of the US population using selected months during the years 1979-1983. Employed persons aged 25-64 years were found to have standardized mortality ratios from 61% to 74% of the average, depending upon their sex and race. Unemployed men had standardized mortality ratios slightly above 100, but these values were 1.6 and 2.2 times higher than those for employed white men and black men, respectively. Those classified as unable to work had very high mortality ratios, from two to seven times the average. In the older age groups, 65 years or more, very low mortality ratios were found for those who were still employed. These relations were maintained after adjustment for family income and educational level. These results 1) describe the magnitude of mortality risk for clearly defined employment categories, 2) identify segments of the population with especially high mortality requiring greater public health recognition, and 3) suggest further research into the health consequences of the various employment/nonemployment conditions.

Adult↗
PubMed1993

The predictability of risk factors with respect to incidence and mortality of myocardial infarction and total mortality. A 12-year follow-up of the Oslo Study, Norway.

OBJECTIVES: To study the prognostic value of several risk factors on incidence and mortality of myocardial infarction (MI) and total mortality in men. DESIGN: Prospective cohort study of 12 years' follow-up. SETTING: All men in Oslo aged 40-49 and a 7% sample of men aged 20-39 were invited for screening. SUBJECTS: Of all 30,025 invited men, of whom 25,015 were aged 40-49, a total of 16,209 men aged 40-49 attended the screening and risk factors were recorded for these men. MAIN OUTCOME MEASURES: Incidence of first MI (non-fatal and fatal), mortality of MI, total mortality. RESULTS: When examining the rate ratio of the fifth to the first quintile of risk factors we found that systolic and diastolic blood pressures were stronger predictors for mortality than incidence of MI. The rate ratios (95% confidence interval) of systolic blood pressure were 3.73 (2.56, 5.44) and 2.56 (2.01, 3.25) respectively. For diastolic blood pressure the corresponding rate ratios were 4.14 (2.84, 6.04) and 2.78 (2.18, 3.54). Small differences in the rate ratios for these end-points were found for total serum cholesterol and triglycerides. Daily cigarette smoking versus non-cigarette smoking was a stronger predictor for MI mortality than incidence, with rate ratios of 3.16 (2.45, 4.24) and 2.34 (2.00, 2.79) respectively. The Cox proportional hazards regression analysis confirmed the above results. CONCLUSIONS: Total serum cholesterol and triglycerides predicted incidence and mortality of MI equally well. Whereas blood pressure and daily cigarette smoking predicted mortality of MI more strongly.

Adult↗
PubMed1996

Inequality in income and mortality in the United States: analysis of mortality and potential pathways.

OBJECTIVE: To examine the relation between health outcomes and the equality with which income is distributed in the United States. DESIGN: The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. MAIN OUTCOME MEASURE: Age adjusted mortality from all causes. RESULTS: There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. CONCLUSION: Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.

Adolescent↗
PubMed2004

Shortcomings of the laboratory-derived median lethal concentration for predicting mortality in field populations: exposure duration and latent mortality.

Exposure duration and intensity (concentration or dose) determine lethal effects of toxicants. However, environmental regulators have focused on exposure intensity and have considered duration only peripherally. Conventional testing for toxicology tends to fix exposure time and to use the median lethal concentration (LC50) at that time to quantify mortality. Fixing the exposure duration and selecting the 50% mortality level for reasons of statistical and logistical convenience result in the loss of ecologically relevant information generated at all other times and ignore latent mortality that manifests after the exposure ends. In the present study, we used survival analysis, which is widely employed in other fields, to include both time and concentration as covariates and to quantify latent mortality. This was done with two contrasting toxicants, copper sulfate (CuSO4) and sodium pentachlorophenol (NaPCP). Amphipods (Hyalella azteca) were exposed to different toxicant concentrations, and the percentage mortalities were noted both during and after the exposure ended. For CuSO4 at the conventional 48-h LC50 concentrations, the predicted proportions dead after including latent mortality were 65 to 85%, not 50%. In contrast, only 5% or fewer additional animals died if the latent mortality was included for NaPCP. The data (including exposure time, concentration, and proportion dead at each time) for each toxicant were then successfully fit with survival models. The proportion of organisms dying at any combination of exposure concentration and time can be predicted from such models. Survival models including latent mortality produced predictions of lethal effects that were more meaningful in an ecological or field context than those from conventional LC50 methods.

Amphipoda↗
PubMed1995

Differential mortality in New York City (1988-1992). Part Two: excess mortality in the south Bronx.

To display the extent of variations in mortality according to geographic regions in New York City, we have compared mortality in New York City as a whole with that of the South Bronx. Mortality records for 1988 to 1992 and 1990 US census data for New York City were linked. The 471,000 residents of the South Bronx were younger, less educated, and more likely to lack health insurance than other New Yorkers. Using age- and gender-stratified populations and mortality in New York City as standards, age-adjusted death rates and excess mortality in the South Bronx were determined. All-cause mortality in the South Bronx was 26% higher than the city as a whole. Mortality for AIDS, injury and poisoning, drug and alcohol abuse, and cardiovascular diseases were 50% to 100% higher in the South Bronx than in New York City; years of potential life lost before age 65 in the South Bronx were 41.6% and 44.2% higher for men and women, respectively, than in New York City; AIDS accounted for the largest single share of excess premature deaths (21.8%). In summary, inequalities in health status, reflected by higher mortality rates in the South Bronx, are consistent with, and perhaps caused by, lower socioeconomic status and deficient medical care among residents of this inner-city community.

Cause of Death↗
PubMed2002

Unlocking the numerator-denominator bias. I: Adjustments ratios by ethnicity for 1991-94 mortality data. The New Zealand Census-Mortality Study.

AIM: To determine the extent of the under-reporting of Mäori and Pacific mortality among 0-74 year olds for the period 1991-94. METHODS: A subset (n=22,578) of highly probable linked 1991 census and 1991-94 mortality records were selected from the 31,635 census-mortality links in the New Zealand Census-Mortality Study. The numbers of decedents assigned as Mäori, Pacific, and non-Mäori non-Pacific were compared between mortality and census data. RESULTS: Compared to the death registration form, 29% more 0-74 year old decedents during 1991-94 had self-identified as sole-Mäori on the 1991 census (46% for prioritised-Mäori). This numerator-denominator bias was greater among the young and those living in central and southern New Zealand. Among 0-14, 15-24, 25-44, 45-64, and 65-74 year old decedents, respectively, 91%, 50%, 41%, 26% and 15% more decedents had self-identified as sole-Mäori on the 1991 census. For Northern, Midland, Central and Southern regional health authority areas, respectively, 14%, 17%, 81% and 102% more decedents had self-identified as sole-Mäori. Among Pacific decedents 68% more 0-74 year old decedents had self-identified as sole-Pacific on the 1991 census (78% for prioritised-Pacific group). This bias for Pacific decedents did not notably vary by age and region. CONCLUSIONS: This study confirms substantial underestimation of Mäori and Pacific mortality rates for the period 1991-94, even using the recommended sole-ethnic group denominator. The results from this study should be used to adjust ethnic-specific mortality rates for the early 1990s. Population-based funding formulas that included region-specific Mäori mortality rates would have particularly disadvantaged central and southern regions.

Adolescent↗
PubMed1975

Long-term mortality study of steelworkers. IX. Mortality patterns among sheet and tin mill workers.

As a result of findings of an earlier report in this series, this study examines the updated cause-specific mortality of men employed in the sheet and tin mill areas of the steel industry. In order to investigate possible relationships between occupational responsibilities or exposures and mortality from specific causes, the sheet and tin mills have been subdivided into 13 mutually exclusive work areas. Detailed analysis is limited primarily to white workers due to the small number of nonwhites in these areas. The most important observations are: 1. Increased overall mortality appears for men employed in 1953 in the sheet finishing and shipping area, confirming the findings of Lloyd, et al. The earlier observation of a significant excess in deaths from vascular lesions of the central nervous system does not hold over time. The previously noted excess for this cause may be related to selective factors or an extreme chance observation. The excess in mortality from all causes of death, which occurs over several disease categories, may not be a result of occupational exposures, but rather some selectivity. 2. Significant excesses in mortality from arteriosclerotic heart disease are noted among men employed in batch pickling and sheet dryer operations, which is in agreement with the earlier findings. Increased risks of dying from hypertensive heart disease are seen in the coating area. 3. Cancer of the lymphatic and hematopoietic tissues is found to be a significant source of excess mortality for workers in the heat treating and forging and tin finishing and shipping work areas. 4. Steelworkers employed in the annealing-normalizing work area show an excess in deaths from nonmalignant respiratory diseases, primarily pneumonia. Further study in these areas should attempt to investigate whether factors in the work environment may be responsible for the observed excess mortalities. More specifically, work should be done to find out whether men employed in heat treating and forging and tin finishing and shipping work in close proximity to chemicals or radiation exposure and whether workers employed in the annealing-normalizing area are exposed to any kind of oil, vapor, or chemical which might be irritating or infectious to the respiratory system. A similar analysis for men working in the batch pickling and sheet dryers and coating areas would also be worthwhile. The main emphasis of any future study should lie upon investigating whether the observed excess mortalities are due to any environmental factor, selection for health, or random fluctuation.

Alloys↗