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PubMed1995

Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990.

Coronary heart disease and stroke death rates were compared for six ethnic groups (non-Hispanic white, Hispanic, African-American, Chinese, Japanese, and Asian Indian) by sex and age (25 to 44, 45 to 64, 65 to 84, and 25 to 84 years old) using California census and 1985 to 1990 death data. African-American men and women in all age groups had the highest rates of death from coronary heart disease, stroke, and all causes (except for coronary heart disease in the oldest men). Hispanics, Chinese, and Japanese in all age-sex groups had comparatively low death rates for coronary heart disease and stroke, although stroke was proportionally an important cause of death for Chinese and Japanese groups. Coronary heart disease was an important cause of death for Asian Indians although death rates were generally not higher than those for other ethnic groups. Ethnic differences were most marked for women and younger age groups.

Adult↗
PubMedDate not supplied

Age-specific incidence and prevalence rates of treated epilepsy in an unselected population of 2,052,922 and age-specific fertility rates of women with epilepsy.

BACKGROUND: There are no data on prevalence or incidence of treated epilepsy, and no data on fertility of women with epilepsy from an unselected UK population. METHODS: We used the General Practice Research Database to ascertain the incidence and prevalence of people with treated epilepsy in an unselected population of 2,052,922 people in England and Wales, and also age-specific fertility rates. We defined period prevalence of treated epilepsy as the number of people with epilepsy taking an antiepileptic drug per 100,000 people during 1995. The incidence of treated epilepsy was defined as the number of new cases of treated epilepsy per 100,000 people during the same period. We calculated fertility rates among women with treated epilepsy between 1991 and 1995 and compared these rates with the population rates for England and Wales in 1993. FINDINGS: The period prevalence of treated epilepsy in 1995 was 5.15 per 1000 people (95% CI 5.05-5.25). The prevalence was lower in children (age 5-9 years 3.16 [2.86-3.48]; 10-14 years 4.05 [3.70-4.42]), and higher in older people (65-69 years 6.01 [5.50-6.57]; 70-74 years 6.53 [5.97-7.14]; 75-79 years 7.39 [6.73-8.11]); 80-84 years 7.54 [6.78-8.39]; 85 years and older 7.73 [6.98-8.66]). The incidence of treated epilepsy was 80.8 per 100,000 people (76.9-84.7). The incidence was lower in children (5-9 years 63.2 [50.5-79.1]; 10-14 years 53.8 [42.4-68.3]) and higher in older people (65-69 years 85.9 [68.5-107.3]; 70-74 years 82.8 [65.0-105.2]; 75-79 years 114.5 [116.9-179.2]; 80-84 years 159 [125.2-202.6]; > or = 85 years 135.4 [100.4-178.7]). Fertility was lower among women with treated epilepsy, with an overall rate of 47.1 livebirths per 1000 women aged 15-44 per year (42.3-52.2), compared with a national rate of 62.6 in the same age-group. The standardised fertility ratios were significantly lower between the ages of 25 and 39 years in women with epilepsy (p<0.001). INTERPRETATION: Compared with previous studies, we found that the incidence of epilepsy was higher in elderly people and lower in children. The prevalence rates also increase with age. Women aged 25-39 years with treated epilepsy have significantly lower fertility rates than those in the general population. Research is needed to identify any potentially preventable causes for the low fertility rates.

Adolescent↗
PubMed1998

Socioeconomic status and cancers of the female breast and reproductive organs: a comparison across racial/ethnic populations in Los Angeles County, California (United States).

OBJECTIVES: Despite the fact that socioeconomic status (SES) has been shown to have important implications in health related issues, population-based cancer registries in the United States do not routinely collect SES information. This study presents a model to estimate the SES of cancer patients in the registry database. METHODS: At the Los Angeles Cancer Surveillance Program (CSP), we developed a model to estimate each cancer patient's SES from aggregate measurements of the census tract of residence (n = 1,640) at time of diagnosis. We then applied the SES estimates to observe the relationship between SES and risk of cancers of the female breast and reproductive organs including cancers of the ovary, cervix uteri, and corpus uteri. The analyses were performed on the cumulative records (n = 127,819) of cancer patients diagnosed between 1972 and 1992 in Los Angeles County, California, for the mutually exclusive racial/ethnic groups of non-Hispanic Whites, Hispanic Whites, Blacks, Asians, and persons of other ethnic groups. RESULTS: We found SES is positively associated with female breast cancer, ovarian cancer, and cancer of the corpus uteri, but inversely associated with cervical cancer. These SES trends were quite consistent across age groups among non-Hispanic White women. Variations by race/ethnicity in the SES patterns were also found, with Asians exhibiting little association. CONCLUSIONS: Our model of measuring SES is sufficiently sensitive to capture the trends. Adopting the aggregate approach to measure SES in population-based registry data appears to be useful.

Adolescent↗
PubMed2001

Anorexia nervosa and cancer risk.

OBJECTIVE: Energy restriction reduces the incidence of malignant tumors in experimental animals, but evidence for a similar effect in humans is lacking. To test the hypothesis in humans, we investigated cancer incidence among patients with anorexia nervosa, who have had an extremely low intake of calories for prolonged periods of their lives. METHODS: Patients with anorexia nervosa (2151 women and 186 men) during 1970-1993 were identified in the population-based Danish Psychiatric Case Register and the National Registry of Patients. The cohort was linked to the Danish Cancer Registry, and cancer incidence among cohort members was compared with that of the general population. RESULTS: The overall cancer incidence among women with anorexia nervosa was reduced by a factor of 0.80 (95% confidence interval 0.52-1.18) below that of the general population on the basis of 25 observed and 31.4 expected cases. Among men, two cases of cancer were observed, both confined to the brain, whereas 0.2 cases were expected. CONCLUSIONS: The finding of a slight reduction in cancer risk among women with anorexia nervosa may support the theory that a low-energy diet may decrease tumor development in humans. However, longer follow-up and control for confounding factors are needed to obtain more convincing evidence.

Adolescent↗
PubMed2000

Housing status and health care service utilization among low-income persons with HIV/AIDS.

OBJECTIVE: To examine the impact of housing status on health service utilization patterns in low-income HIV-infected adults. DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York State between April 1996 and March 1997. MAIN RESULTS: Six percent of study participants were homeless, 24.5% were "doubled-up," and 69.5% were stably housed. Compared with the stably housed, doubled-up and homeless participants were less likely to be seeing a physician regularly (P = .0001), and if seeing a physician, they were likely to have been doing so for a significantly shorter time (P = .02). The homeless were also less likely than either stably housed or doubled-up individuals to see the same physician or group of physicians at each ambulatory visit (P = .007). In addition, a higher proportion of the homeless had made one or more hospital visits over the prior 3 months than the nonhomeless. After multivariate adjustment, doubled-up participants were found to make more emergency room visits, the homeless were less likely to be taking prophylaxis for Pneumocystis carinii pneumonia, and both the doubled-up and the homeless were shown to use slightly more outpatient care than the stably housed. CONCLUSION: Our study documents differences in health care utilization patterns across stably housed, doubled-up, and homeless HIV-infected persons after controlling for health insurance coverage. These differences, especially those pertaining to outpatient services, suggest that the unstably housed may be receiving less adequate health care than the stably housed, and hence may be more likely to experience adverse clinical outcomes.

Adult↗
PubMed1999

Effects of husbands' smoking on the incidence of lung cancer in Korean women.

BACKGROUND: Although smoking remains uncommon among Korean women, lung cancer mortality is rapidly escalating. METHODS: We investigated the effects of spousal smoking in 160130 Korean women, aged 40-88, who received health insurance from the Korea Medical Insurance Corporation (KMIC). Exposure data were collected during medical examinations conducted between April 1992 and June 1994. The primary outcome variable was the incidence of lung cancer defined by hospital admissions between July 1994 and December 1997. Standardized rates for the incidence of lung cancer were assessed according to the smoking habits of their husbands. RESULTS: At baseline (n = 160 130), 53.9% of husbands were smokers and 23.3% were ex-smokers, while 1.1% of wives (n = 1756) were current smokers and 0.6% (n = 938) were ex-smokers. During follow-up, 79 cases of lung cancer occurred among non-smoking wives (n = 157436). Wives of heavy smokers were found to have a higher risk of developing lung cancer. The husbands' smoking habits did not affect their wives' risk of developing other cancers such as those of the stomach, liver and cervix, but they did affect breast cancer, which has a significantly higher risk in relation to the longer duration of husbands' smoking. In Poission regression models, adjusting for the age of both husband and wife, socioeconomic status, occupation, residency and vegetable intake, the rate ratio (RR) of lung cancer in non-smoking wives was 1.9 (95% CI: 1.0-3.5) in current smokers and 1.3 (95% CI: 0.6-2.7) in ex-smokers. The RR of lung cancer was 3.1 (95% CI: 1.4-6.6) in wives of husbands who had smoked for 30 years or more compared with wives of non-smoking husbands. CONCLUSION: In Korea, the incidence of lung cancer is higher among non-smoking women whose husbands smoke, and a dose-response relationship seems to exist.

Adolescent↗
PubMed2001

Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985-1987 and 1995-1997.

BACKGROUND: Socioeconomic inequalities in mortality have been repeatedly observed in Britain, the US, and Europe, and in some countries there is evidence that the differentials are widening. This study describes trends in socioeconomic mortality inequality in Australia for males and females aged 0-14, 15-24 and 25-64 years over the period 1985-1987 to 1995-1997. METHODS: Socioeconomic status (SES) was operationalized using the Index of Relative Socioeconomic Disadvantage, an area-based measure developed by the Australian Bureau of Statistics. Mortality differentials were examined using age-standardized rates, and mortality inequality was assessed using rate ratios, gini coefficients, and a measure of excess mortality. RESULTS: For both periods, and for each sex/age subgroup, death rates were highest in the most disadvantaged areas. The extent and nature of socioeconomic mortality inequality differed for males and females and for each age group: both increases and decreases in mortality inequality were observed, and for some causes, the degree of inequality remained unchanged. If it were possible to reduce death rates among the SES areas to a level equivalent to that of the least disadvantaged area, premature all-cause mortality for males in each age group would be lower by 22%, 28% and 26% respectively, and for females, 35%, 70% and 56%. CONCLUSIONS: The mortality burden in the Australian population attributable to socioeconomic inequality is large, and has profound and far-reaching implications in terms of the unnecessary loss of life, the loss of potentially economically productive members of society, and increased costs for the health care system.

Adolescent↗
PubMed2000

Urban-rural differences in total hip replacements: the next stage.

BACKGROUND: The aim of this study was to explore the differences in the incidence of primary elective total hip replacements between urban and rural communities and different age and sex groups in Northern Ireland, and to use this information to develop an equitable method for the allocation of surgical capacity among groups of general practices, in a system where referrals are matched to the contracted capacity. METHODS: A retrospective review was performed of all cases of primary elective total hip replacement between 1 April 1994 and 31 March 1997. Incidence rates were calculated using direct standardization. Age, sex, and urban and rural specific rates for Northern Ireland were calculated and applied to each general practice population giving that practice's annual expected number of total hip replacements. RESULTS: A total of 4,147 cases were analysed. The age and sex standardized incidence of primary elective total hip replacement for the total population was 87.6 per 100,000. The incidence was significantly greater in rural populations (101.3 per 100,000), than in urban ones (77.6 per 100,000), p < 0.001. The overall standardized ratio of males to females was 1:1 although it was 1:1.2 in urban and 1:0.9 in rural populations. Using a 3 year commissioning cycle, commissioning for a population of 130,000 allows a 10 per cent margin of error in the numbers of procedures required. CONCLUSIONS: A system of calculating the expected need for a total hip replacements was developed based on the demography and rurality of individual general practices. This system allowed a method of commissioning to be instituted that could significantly reduce in-patient waiting lists for this procedure.

Adult↗
PubMed1997

The relation of alcohol intake to coronary heart disease and all-cause mortality in a beer-drinking population.

Epidemiologic studies indicate that light to moderate alcohol consumption from beer, wine, or spirits is associated with a reduction in all-cause mortality, owing primarily to a reduced risk of coronary heart disease (CHD). To find out whether this protective effect of small to moderate amounts of alcohol could be confirmed in Germany, where much of the alcohol consumed is taken in the form of beer, we studied the relation between alcohol and CHD and total mortality in a population of southern Germany. We conducted a prospective cohort study from 1984 to 1992 among 1,071 men and 1,013 women, age 45-64 years at baseline, from the Augsburg region. Eighty-seven per cent of men and 56% of women reported drinking alcohol at baseline. Among drinkers, men had an average alcohol intake of 42 gm per day, of which 33 gm per day came from beer. Women who drank had an average alcohol intake of 16 gm per day and derived about half of it from beer and the other half from wine. During the 8 years of follow-up, 96 deaths (all causes) and 62 incident CHD events (nonfatal and fatal) occurred in men, and 45 deaths (all causes) occurred in women. Adjusting for a number of potential confounders, in men the adjusted hazard rate ratio (HRR) of CHD events for drinkers as compared with nondrinkers was 0.51 [95% confidence interval (CI) = 0.27-0.95]; this protective effect starts with the 0.1-19.9 gm per day alcohol category and does not change much with higher intake. In men, the adjusted total mortality HRR for drinkers as compared with nondrinkers was 0.59 (95% CI = 0.36-0.97). The total mortality HRRs for the different alcohol groups compared with nondrinkers show a U-shaped curve, with the lowest HRR of 0.46 (95% CI = 0.20-0.80) for the 20-39.9 gm per day alcohol group and an HRR of 1.04 (95% CI = 0.54-2.00) for the > or = 80 gm per day alcohol group. In women, the total mortality HRR for those drinking up to 19.9 gm per day as compared with nondrinkers was 0.46 (95% CI = 0.22-0.96).

Age Distribution↗
PubMed2005

Kawasaki syndrome in Hawaii.

OBJECTIVE: To describe the incidence and epidemiology of Kawasaki syndrome (KS) in Hawaii. METHODS: Retrospective analysis of the State Inpatient Database for Hawaii residents hospitalized with KS during 1996 through 2001. RESULTS: During 1996 through 2001, 267 persons younger than 18 years of age living in Hawaii were hospitalized with KS; 226 (84.6%) were younger than 5 years of age. The average annual incidence for KS was 45.2 per 100,000 children younger than 5 years of age. The incidence was higher for children younger than 1 year of age than for those 1-4 years of age (74.3 and 37.5 per 100,000). The KS incidence for Asian and Pacific Islander children and for White children was 70.9 and 35.3 per 100,000, respectively. Incidence was highest among Japanese American children living in Hawaii (197.7 per 100,000). Honolulu County had the most KS patients (85.0%) and the highest incidence (53.1 per 100,000) among Hawaii counties. For children younger than 5 years of age hospitalized with KS, the median length of stay was 2 days, and the median hospital charge was $9379. CONCLUSION: During 1996 through 2001, the annual incidence rate for KS among children younger than 5 years of age in Hawaii was the highest in the United States. The incidence among Japanese American children in Hawaii was higher than that among other racial groups in the state and when compared with children living in Japan.

Adolescent↗
PubMed2001

Similarity indices for spatial ecological data.

We present a method for assessing similarity between species maps of presence and absence or abundance that emphasizes global features while ignoring minor local dissimilarities. The method arranges sites into small groups, or cliques, and allows controlled changes to be made within cliques to reduce the influence of local discrepancies. Resulting measures of similarity are visually more satisfactory than traditional indices. We show that the similarity indices are useful for model selection by comparing observed spatial patterns with those predicted by different fitted models. Examples are provided for spatial distributions of oribatid mites (Acari, Oribatei), woodlarks (Lullula arborea), and red deer (Cervus elaphus).

Algorithms↗
PubMed1995

Contact pressure prediction in total knee joint replacements. Part 2: Application to the design of total knee joint replacements.

The general elasticity contact theory for elliptical geometry developed in Part 1 (1) has been applied to the design of current total knee joint replacements. A two-step curve-fitting technique using cubic spline interpolation routines has been adopted to represent the full elasticity solutions. The curve fit results of the maximum contact pressure have been compared with the full elasticity solution for a specified elliptical geometry and different polyethylene thicknesses and good agreement has been demonstrated. The computing time required by the curve-fitting technique is very small compared with the full elasticity solution and therefore can readily be applied to the design of knee joint replacements. Furthermore, reasonable agreement has also been found for the contact area for a typical knee joint design between the present theoretical prediction and the experimental measurement using pressure-sensitive film. Predictions of the maximum contact pressure have been made for an existing knee joint replacement in order to illustrate the present analysis in the design cycle. It has been shown that the effect of the thickness of ultra high molecular weight polyethylene is relatively small on contact stress predictions provided a sufficiently large value is chosen. On the other hand, the effect of conformity has a much greater influence on the contact stress distribution, particularly in the direction of the smaller principal radius.

Elasticity↗
PubMed2002

Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial.

Small-solute clearance targets for peritoneal dialysis (PD) have been based on the tacit assumption that peritoneal and renal clearances are equivalent and therefore additive. Although several studies have established that patient survival is directly correlated with renal clearances, there have been no randomized, controlled, interventional trials examining the effects of increases in peritoneal small-solute clearances on patient survival. A prospective, randomized, controlled, clinical trial was performed to study the effects of increased peritoneal small-solute clearances on clinical outcomes among patients with end-stage renal disease who were being treated with PD. A total of 965 subjects were randomly assigned to the intervention or control group (in a 1:1 ratio). Subjects in the control group continued to receive their preexisting PD prescriptions, which consisted of four daily exchanges with 2 L of standard PD solution. The subjects in the intervention group were treated with a modified prescription, to achieve a peritoneal creatinine clearance (pCrCl) of 60 L/wk per 1.73 m(2). The primary endpoint was death. The minimal follow-up period was 2 yr. The study groups were similar with respect to demographic characteristics, causes of renal disease, prevalence of coexisting conditions, residual renal function, peritoneal clearances before intervention, hematocrit values, and multiple indicators of nutritional status. In the control group, peritoneal creatinine clearance (pCrCl) and peritoneal urea clearance (Kt/V) values remained constant for the duration of the study. In the intervention group, pCrCl and peritoneal Kt/V values predictably increased and remained separated from the values for the control group for the entire duration of the study (P < 0.01). Patient survival was similar for the control and intervention groups in an intent-to-treat analysis, with a relative risk of death (intervention/control) of 1.00 [95% confidence interval (CI), 0.80 to 1.24]. Overall, the control group exhibited a 1-yr survival of 85.5% (CI, 82.2 to 88.7%) and a 2-yr survival of 68.3% (CI, 64.2 to 72.9%). Similarly, the intervention group exhibited a 1-yr survival of 83.9% (CI, 80.6 to 87.2%) and a 2-yr survival of 69.3% (CI, 65.1 to 73.6%). An as-treated analysis revealed similar results (overall relative risk = 0.93; CI, 0.71 to 1.22; P = 0.6121). Mortality rates for the two groups remained similar even after adjustment for factors known to be associated with survival for patients undergoing PD (e.g., age, diabetes mellitus, serum albumin levels, normalized protein equivalent of total nitrogen appearance, and anuria). This study provides evidence that increases in peritoneal small-solute clearances within the range studied have a neutral effect on patient survival, even when the groups are stratified according to a variety of factors (age, diabetes mellitus, serum albumin levels, normalized protein equivalent of total nitrogen appearance, and anuria) known to affect survival. No clear survival advantage was obtained with increases in peritoneal small-solute clearances within the range achieved in this study.

Analysis of Variance↗
PubMed1999

Lung cancer incidence rates by histologic type in high- and low-risk areas; a population-based study in Osaka, Okinawa, and Saku Nagano, Japan.

We investigated lung cancer incidence by histologic type using the data from population-based cancer registries in high-risk (Osaka and Okinawa) and low-risk (Saku Nagano) areas. Since the proportion of cases with histologic types identified was not sufficiently high, sex- and age-specific incidence rates by histologic type were estimated assuming that the distribution of histologic types was the same across the same sex and age groups regardless of reporting status. Compared to Saku in Nagano Prefecture, the cumulative risk of lung cancer incidence rates in Osaka and Okinawa were 1.3 and 1.5 times higher for males and 1.3 and 1.2 times higher for females, respectively. When divided by histologic type, male adenocarcinoma and small cell carcinoma were 1.6-2.1 times higher in Osaka and Okinawa, while squamous cell carcinoma was 1.6 times higher only in Okinawa compared to Saku Nagano. In females, squamous cell carcinoma and small cell carcinoma were 2.5-3.3 times higher in Osaka and Okinawa compared to Saku Nagano, while adenocarcinoma was almost equal in the 3 areas. These results indicate that the pattern of incidence of lung cancer by histologic type may differ between high- and low- risk areas.

Adenocarcinoma↗
PubMed2002

Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994.

BACKGROUND: Evidence indicates that deaths from coronary disease are decreasing less in elderly persons and women. Understanding the determinants of these trends is important for prevention. OBJECTIVE: To test the hypothesis that trends in incidence and survival of hospitalized myocardial infarction differ according to sex and age. DESIGN: Longitudinal observational study. SETTING: Community-dwelling persons in Olmsted County, Minnesota. PATIENTS: 5117 patients who had an estimated 1820 incident myocardial infarctions from 1979 to 1994. MEASUREMENTS: Myocardial infarctions were validated by using epidemiologic criteria. Rates were directly adjusted to the age distribution of the 2000 U.S. population. RESULTS: Of the 1820 incident infarctions, 44% occurred in women and 36% in persons 75 years of age or older. In 1979, the age-adjusted incidence of myocardial infarction was 205 per 100 000 persons (95% CI, 162 to 247 per 100 000 persons). Between 1979 and 1994, the age-adjusted incidence of myocardial infarction decreased by 8% (CI, -23% to 10%) in men but increased by 36% (CI, 9% to 70%) in women. A 31% decrease in the incidence of infarction over time was observed in men 40 years of age compared with a 49% increase in women 80 years of age. Survival improved predominantly in younger persons. CONCLUSIONS: Over time, the incidence of hospitalized infarction decreased in men but increased in women and elderly persons. Survival benefits were clustered among younger persons. These results suggest that both incidence and survival contribute to the contrasting mortality trends by age and sex and that the burden of coronary disease has shifted toward elderly persons, a finding that has public health implications in an aging population.

Age Distribution↗
PubMed1989

On the regression analysis of tumour recurrence rates.

Regression models with mixture (random) components are proposed for the statistical analysis of recurrent events when waiting times between successive events are unknown. These models allow adjustment of parameter estimates for unobserved heterogeneity in the population (due for example to missing covariates) or overdispersion resulting from inexact distributional assumptions. The models are illustrated by a study of recurrence rates of superficial bladder cancer in men.

Carcinoma, Transitional Cell↗
PubMed1999

Identifiability of parameters in the Yakovlev-Polig model of carcinogenesis.

The paper discusses the problem of identifiability for two versions of a two-stage model of carcinogenesis recently introduced by Yakovlev and Polig. In this model, cell killing is allowed to compete with tumor promotion. In the first version of the Yakovlev-Polig model, which is referred to as Model 1, cell killing starts immediately after a carcinogen is administered. In the second version, called Model 2, it is assumed that a cell may be killed only after the process of initiation has been completed. The two versions of the Yakovlev-Polig model suggest explicit formulas for the distribution of time to tumor onset (that is, appearance of the first malignant clonogenic cell) counted from the initial moment of the exposure to a carcinogen. A model of carcinogenesis is identifiable if the set of all model parameters is uniquely determined by the distribution of time to tumor onset. It is shown that, under a natural necessary condition of overlap of supports of the dose-rate function h and the promotion time distributions from a family F, Model 1 is identifiable in the family F for many practically important functions h. In particular, this is the case for a simple model of spontaneous carcinogenesis (h = 1) and for a class of piecewise constant dose-rate functions h with arbitrary family F. Also, this holds for the family of gamma distributions and h supported on an interval and non-vanishing in the interior of this interval. More restrictions need to be imposed on the dose-rate function and the family of promotion time distributions for Model 2 to be identifiable. In particular, for h = 1, Model 2 turns out to be non-identifiable even in the family of gamma distributions.

Animals↗
PubMed2001

Stillbirth and neonatal mortality due to congenital anomalies: temporal trends and variation by small area deprivation scores in England and Wales, 1986-96.

We investigated the variation of stillbirth and neonatal mortality due to congenital anomalies in relation to small-area measures of deprivation in a population-based study in England and Wales, 1986-96. We found 10 954 stillbirths and neonatal deaths from all non-chromosomal and chromosomal anomalies during the study period out of a total of 7 487 007 live and stillbirths. The extended perinatal mortality rate (EPM rate) (defined as babies who were stillborn or died within 28 completed days after birth per 10 000 total live and stillbirths) for all chromosomal and all non-chromosomal anomalies was 1.5/10 000 and 13.2/10 000, respectively, over the whole period. The rate for non-chromosomal anomalies halved over the decade while the rate for chromosomal anomalies remained unchanged. The relative risks of EPM for chromosomal and non-chromosomal anomalies were 0.71 [0.80, 0.95] and 1.17 [95%CI 1.06, 1.30], respectively, in the group of wards with highest deprivation compared with the least deprived group. Increasing gradients of EPM with increasing deprivation were observed for (1) grouped non-chromosomal anomalies including neural tube defects, all renal and urinary anomalies, all musculoskeletal anomalies, and multiple anomalies, and (2) several specific non-chromosomal anomalies including anencephaly, limb reduction defects, diaphragm and abdominal wall defects. This study provides strong evidence that increased deprivation is associated with increased EPM due to most non-chromosomal anomalies; the finding of decreased relative risk for chromosomal anomalies is probably related to differences in maternal age distribution between deprivation groups.

Chromosome Aberrations↗