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At least 127 records · Page 7Linked to original sources
PubMed1997

Increasing incidence of and declining mortality from breast carcinoma. Trends in Malmö, Sweden, 1961-1992.

BACKGROUND: The incidence of breast carcinoma is increasing in most populations, whereas mortality caused by this disease is fairly constant. The authors analyzed the incidence of and mortality from invasive breast carcinoma in a population with access to good medical care, into which mammographic screening was introduced in 1976 and adjuvant therapy in 1978. METHODS: In a consecutive series of patients with invasive breast carcinoma from Malmö, 1961-1991, changes in age-adjusted incidence were analyzed and compared with incidence of the disease in the rest of Sweden. Age-adjusted breast carcinoma mortality was studied for the period 1964-1992. RESULTS: The introduction of mammographic screening was associated with an increase in breast carcinoma incidence. This was restricted to the age group that was eligible for screening (age 45-69 years) and to Stage I disease. Between 1977 and 1992, age-adjusted breast carcinoma mortality decreased in Malmö by 43% (95% CI, 26-56%) as compared with 12% (95% CI, 8-16%) in the rest of Sweden. The decrease was statistically significant in both populations and significantly greater in Malmö than in the rest of Sweden (P < 0.001). In Malmö the decrease was seen in two age groups, age 45-69 years and age 70 years and older. In the rest of Sweden the decrease was seen only among women age 70 years and older. In the rest of Sweden the decrease was seen only among women age 70 years and older. There were no changes in incidence or mortality among women younger than 45 years in either population. CONCLUSIONS: Breast carcinoma incidence was strongly related to diagnostic activity, especially mammographic screening. The decrease in mortality occurred in temporal relation to the introduction of screening and adjuvant therapy, making a causal relation likely. The difference in results between Malmö and the rest of Sweden indicates an important role for screening in mortality reduction.

Adult↗
PubMed1989

Sociodemographic indicators of stroke mortality.

Declining mortality from cerebrovascular disease (stroke) has become a hallmark of cause-specific mortality trends nationwide. Analysis of demographic and socioeconomic characteristics of the population in Allegheny County, western Pennsylvania, in 1980 was carried out to explore their utility as indicators of stroke mortality. Percent black population (followed by unemployment) was found to be the best predictor of stroke mortality in different county areas (r = 0.6, P = 0.001) compared with other variables including income or education. Possible implications for community intervention or primary care programs are discussed.

Black or African American↗
PubMed2004

The decline of postnatal mortality from gastrointestinal anomalies with age.

It has been previously shown that mortality from congenital anomalies decreases with the first power of age with the exception of "gastrointestinal anomalies". On the other hand, mortality declines with the second power of age in the category "certain conditions originating in the perinatal period". According to the theory of congenital individual risks, the dying out of more impaired individuals causes these two types of mortality decline. Mortality decline with the first power of age is the most frequent type of mortality decline after birth. This evidence is explained as a consequence of the rule: the higher the individual risk of death, the less frequent the individual risk is at the moment of birth. If all defects (and all individual risks) appear with the same frequency and selection does not occur (e.g. this could be assumed for certain conditions originating in the perinatal period) then mortality declines with the square of age. Here, it is shown that mortality from "gastrointestinal anomalies" (ICD9 codes: 750 and 751) decreases with the second power of age in all five countries within the age interval 1-10 years. This is a consequence of evidence that these defects do not affect vitals important during pregnancy and selection is not significant. These findings demonstrate that the selection of higher individual risks proceeds during pregnancy rather than during previous generations.

Adult↗
PubMed1983

Decline in mortality from coronary heart disease in Finland from 1969 to 1979.

The trends in mortality from coronary heart disease in the 1970s and the differences in trends between counties within Finland were calculated from official mortality statistics among the population aged 35 to 64 years. During this period coronary mortality declined by a mean of 1.1% for men and 2.3% for women annually in the whole of Finland. A community based cardiovascular control programme was started in 1972 in North Karelia, a county in the east of Finland. The decline in coronary mortality in this county between 1969 and 1979 was 24% in men and 51% in women. The decline in the rest of Finland over the same period was 12% in men and 24% in women. The decline in North Karelia was greater than that in other counties of Finland for both men and women and that difference exceeded random variation, with over 95% likelihood for both sexes. Even with adjustment for rates before 1974 with cross-county multiple regression analyses the difference persisted. Although further studies are needed, the changes in coronary mortality in North Karelia suggest that the preventive programme has been effective.

Adult↗
PubMed1999

Cardiovascular disease in the Netherlands, 1975 to 1995: decline in mortality, but increasing numbers of patients with chronic conditions.

OBJECTIVE: To examine the relation between trends over time in mortality and hospital morbidity caused by various cardiovascular diseases in the Netherlands. DESIGN: Trend analysis by Poisson regression of national data on mortality and hospital admissions from 1975 to 1995. SUBJECTS: The Dutch population. RESULTS: All cardiovascular diseases combined were responsible for 39% of all deaths and 16% of all hospital admissions in 1995. From 1975 to 1995, age adjusted cardiovascular mortality declined by an annual change of -2.0% (95% confidence intervals (CI) -2.1% to -1.9%), while in the same period age adjusted discharge rates increased annually by 1. 3% (95% CI 1.1% to 1.5%). Around 60% of the gain in life expectancy in this period was related to lower cardiovascular mortality. For mortality, major reductions were seen in coronary heart disease (annual change -2.9%) and in stroke (-2.1%), whereas the increase in hospital admissions was mainly caused by chronic manifestations of coronary heart disease (5.1%), heart failure (2.1%), and diseases of the arteries (1.8%). In recent years, the gap between men and women at risk of dying from coronary heart disease became smaller for those aged </= 65 years. CONCLUSIONS: Our findings of a decrease in cardiovascular mortality and an increase in admission rates for chronic conditions such as heart failure, chronic coronary syndromes, and diseases of the arteries, support the hypothesis that the longer survival of many patients with heart diseases is leading to a growing pool of patients at increased risk for subsequent cardiovascular complications in Western countries.

Adolescent↗
PubMed1997

Declines in hospital mortality associated with a regional initiative to measure hospital performance.

To determine changes in hospital mortality that occurred in association with the dissemination of data by a regional initiative to profile hospital performance, we conducted a retrospective cohort study of patients admitted before and subsequent to dissemination of comparative data in 1992. The analysis included 101,060 consecutive eligible discharges from 30 hospitals in Northeast Ohio with eight diagnoses: acute myocardial infarction, congestive heart failure (CHF), obstructive airway disease, gastrointestinal hemorrhage, pneumonia, stroke, coronary artery bypass surgery, and lower bowel resection. Baseline (1991, N = 35,629) mortality rates were compared to rates during three subsequent periods (July-December 1992, N = 20,392; January-June 1993, N = 23,070; and July-December 1993, N = 21,969). Mortality rates were risk-adjusted using validated multivariable models based on data abstracted from patient's medical records. For all conditions, risk-adjusted mortality declined from a baseline rate of 7.5% to rates of 6.8%, 6.8%, and 6.5%, respectively, during the three subsequent periods. Using weighted linear regression analysis to estimate trends across periods, declines in mortality rates were significant for CHF (0.50% per period; P = 0.002) and pneumonia (0.38% per period; P = 0.03). We conclude that hospital mortality declined in association with the dissemination of comparative data. Although changes in hospital care were not directly examined, the results suggest that initiatives to examine provider performance may have a beneficial impact on quality of care.

Aged↗
PubMed1995

Role of immunizations in the recent decline in childhood mortality and the changes in the female/male mortality ratio in rural Senegal.

In early 1987, immunizations were introduced to an isolated area of eastern Senegal where there had previously been no regular immunizations. Since immunizations were the only change introduced in the area during this period, this allowed the authors to study the impact of immunizations of mortality in different age groups and the possible interaction with sex differences in mortality. They compared mortality rates for the 6 years before and the 6 years after the introduction of immunization. Neonatal mortality declined 31% (95% confidence interval (CI) 17 to 43); between 1 and 8 months of age, the reduction was 20% (95% CI -2 to 37); and between 9 and 59 months of age, mortality declined 48% (95% CI 39 to 56). Excluding acute measles deaths, the reduction was 16% (95% CI -8 to 35) between 1 and 8 months of age and 32% (95% CI 20 to 43) between 9 and 59 months of age. The decline was stronger in villages that maintained high coverage after the initial national campaign, whereas mortality increased again in the villages where the coverage declined. Since the reduction in mortality was most marked after 9 months of age, measles immunization is likely to have been the most important vaccination. Both female and male mortality declined but not equally quickly. The reduction in mortality in the neonatal period was significantly greater in males than in females, resulting in an increase in the female/male mortality ratio from 0.64 (95% CI 0.50 to 0.83) to 0.96 (95% CI 0.71 to 1.30), p = 0.04. After 9 months of age, the reduction in mortality was somewhat greater in females than in males, resulting in a decrease in the female/male mortality ratio from 1.04 (95% CI 0.85 to 1.28) to 0.79 (95% CI 0.62 to 1.02), p = 0.10.

Age Distribution↗
PubMed1998

Epidemiology of stroke in The Netherlands from 1972 to 1994: the end of the decline in stroke mortality.

In 1994, stroke was responsible for the death of 4,994 men and 7,601 women in the Netherlands, corresponding to 7.5% of all deaths in men and 11.4% in women. Age-adjusted stroke mortality declined by 39% for men and by 45% for women between 1972 and 1994. However, the decline in mortality levelled off after 1987. In contrast to mortality, age-adjusted discharge rates increased by 47% for men and by 28% for women during the study period. The decline in mortality was equally distributed over the age groups, while the increase in the number of hospital admissions was more pronounced in the older age groups. The analyses by diagnostic subgroups of stroke showed the importance of increasing diagnostic capabilities in the hospital setting. The use of diagnostic subgroups in national mortality data was of limited value, illustrated by the fact that 70% of all stroke deaths in 1994 belonged to the ill-defined type of stroke.

Age Distribution↗
PubMedDate not supplied

Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale.

BACKGROUND: A study in Matlab, Bangladesh, has provided evidence favouring a community-based maternity-care delivery system. 3 years of this programme coincided with a significant reduction in direct obstetric mortality compared with the 3 years before the programme. We have examined whether the effects of the programme are sustained over time. METHODS: Using data from the continuing demographic survelliance system and from special investigations into the rates and causes of maternal mortality during 1976-93, we compared the trends in direct obstetric maternal mortality ratios in the Maternal and Child Health and Family Planning (MCH-FP) area (which has received extensive services in health and family planning since 1977) with those in the comparison area (with no such intensive health inputs). We divided the areas and time periods into discrete groups that best represented the effects of the introduction of the maternity-care programme. FINDINGS: Direct obstetric mortality declined by 3% per year (rate ratio 0.97 per year [95% CI 0.95-0.99]); there was no difference between the MCH-FP and comparison areas (1.00 [0.96-1.05]). Direct obstetric mortality halved between 1976-86 and 1987-89 in the northern MCH-FP area, where the maternity-care programme was initiated in 1987 (0.50 [0.22-0.99]), but showed no change in the southern MCH-FP area, which had no such intervention at that time (1.07 [0.64-1.72]). After 1990, when the programme was expanded throughout the MCH-FP area, the southern part showed a downward (non-significant) trend in direct obstetric mortality (0.68 [0.35-1.32]). However, direct obstetric mortality also declined between 1987 and 1989 in the southern comparison area (0.48 [0.26-0.83]) in the absence of an intense maternity-care programme, and remained stable thereafter. In the northern comparison area, there was no such decline in direct obstetric mortality (0.78 [0.40-1.40]). INTERPRETATION: Although the introduction of the maternity-care programme coincided with declining trends in direct obstetric mortality in the areas covered by the programme, a decline also occurred in one of the areas not receiving any such interventions. Caution is required in the interpretation of short-term trends in one indicator in studies designed without random allocation of interventions into treatment and control groups.

Adolescent↗
PubMed2006

The effect of age at immigration and generational status of the mother on infant mortality in ethnic minority populations in The Netherlands.

BACKGROUND: Migrant populations consist of migrants with differences in generational status and length of residence. Several studies suggest that health outcomes differ by generational status and duration of residence. We examined the association of generational status and age at immigration of the mother with infant mortality in migrant populations in The Netherlands. METHODS: Data from Statistics Netherlands were obtained from 1995 through 2000 for infants of mothers with Dutch, Turkish and Surinamese ethnicity. Mothers were categorized by generational status (Dutch-born and foreign-born) and by age at immigration (0-16 and >16 years). The associations of generational status and age at immigration of the mother with total and cause-specific infant mortality were examined. RESULTS: The infant mortality rate in Turkish mothers rose with lower age at immigration (from 5.5 to 6.4 per 1000) and was highest for Dutch-born Turkish mothers (6.8 per 1000). Infant death from perinatal and congenital causes increased with lower age at immigration and was highest in the Dutch-born Turkish women. In contrast, in Surinamese mothers infant mortality declined with lower age at immigration (from 8.0 to 6.3 per 1000) and was lowest for Dutch-born Surinamese mothers (5.5 per 1000). Generational status and lower age at immigration of Surinamese women were associated with declining mortality of congenital causes. CONCLUSIONS: Total and cause-specific infant mortality seem to differ according to generational status and age at immigration of the mother. The direction of these trends however differs between ethnic populations. This may be related to acculturation and selective migration.

Acculturation↗
PubMed2005

Does testing for prostate-specific antigen contribute to declining prostate cancer mortality? Estimating the broader economic influences on aggregate prostate cancer mortality rates.

Key variables associated with prostate cancer mortality were examined using Canadian province level time-series data over the period 1979-1999 in a multiple regression framework. The key variables driving the prostate cancer mortality rate are per capita income, per capita number of family physicians, rate of prostate cancer incidence, real per capita total health spending, and a time trend. As well, provincial dummy variables show that regional differences exist with higher rates of mortality in eastern Canada. Econometric results show a positive and significant relationship between incidence and mortality, suggesting that the increased amount of prostate-specific antigen (PSA) testing may not have been responsible for mortality declines. However, there is also a downward trend in mortality from prostate cancer when all other factors are controlled for that can be attributed partly to the onset of PSA testing given that the benefits should emerge over time. A 1% increase in incidence is associated with a 0.2% increase in mortality. A 1% increase in real per capita income is associated with a 0.5% increase in mortality when real per capita income is below Canadian dollars 20,054. A 1% increase in the per capita number of family physicians reduces the mortality rate by 0.5%. A 1% increase in real per capita total health expenditures is associated with a 0.7% decline in the mortality rate. Finally, by 1999 there were 4.74 fewer deaths per 100,000 population due to the effect of time after controlling for all other factors--a decrease of approx. 15%.

Aged↗