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PubMed2000

Frailty modelling for adult and old age mortality: the application of a modified DeMoivre hazard function to sex differentials in mortality.

Unobserved differences in individual's susceptibility to death are an important aspect in the analysis of contemporary mortality patterns. However, observed mortality rates at adult ages, which are usually well described by a Gompertz curve, are often perceived inconsistent with frailty models of mortality. The authors therefore propose a modified DeMoivre hazard function that is suitable for the application of frailty models to adult and old ages. The proposed hazard increases faster than exponential, and when combined with unobserved frailty it can capture a broad range of patterns encountered in the analysis of adult mortality. The authors' application to Bulgaria during 1992-93 suggests that the stronger selection process in the male population, caused by an overall higher level of mortality, may constitute a primary mechanism leading to the convergence of male and female mortality at higher ages. Hence, the convergence between male and female mortality is not necessarily caused by differential process of aging across sexes, but is merely a consequence of the different levels of mortality at adult ages.

Adult↗
PubMed2003

Unlocking the numerator-denominator bias III: adjustment ratios by ethnicity for 1981-1999 mortality data. The New Zealand Census-Mortality Study.

AIM: Maori and Pacific deaths are under-counted in mortality data relative to census data. This 'numerator-denominator' bias means that routinely calculated mortality rates by ethnicity are incorrect. We used New Zealand Census-Mortality Study data to quantify the bias from 1981 to 1999. METHODS: The 1981, 1986, 1991 and 1996 Censuses were each anonymously and probabilistically linked to three years of subsequent mortality data, allowing a comparison of ethnicity recording. RESULTS: Compared with death registrations, 16% more 0-74 year old decedents during 1981-1984 had self-identified as '1/2 or more Maori' on the 1981 Census, and 32% more during both 1986-1989 and 1991-1994 had self-identified as 'sole Maori' on the 1986 and 1991 Censuses. From September 1995, mortality data have allowed multiple ethnicity to be recorded. During 1996-1999, 7% more decedents identified Maori as one of their ethnic groups on the 1996 Census compared with mortality data. For Pacific decedents, 55%, 76% and 68% more self-identified as 'sole Pacific' on census data compared with data recorded on death registrations for 1981-1984, 1986-1989 and 1991-1994 respectively, but there was no difference for 1996-1999. The bias for Maori (but not for Pacific) was greater among the young and those living in central and southern regions of New Zealand. CONCLUSIONS: The 1995 change to ethnicity recording on mortality data has improved the robustness of ethnicity data collection. These adjustment factors for 1981-1999 allow for more accurate calculations of ethnic-specific mortality rates over the last 20 years.

Adolescent↗
PubMed2004

Influenza-associated excess mortality from monthly total mortality data for Germany from 1947 to 2000.

OBJECTIVES: Death attributable to influenza is noted under various causes in the mortality statistics. Therefore, excess of total mortality is frequently used for the estimation of the entire impact of influenza on mortality. Various models for the estimation of the expected mortality are in use but are rather complex which hampers their routine use. A simple and hence transparent model was developed and applied to the total mortality in Germany from 1947 to 2000. METHODS: The method is based on the pattern of the distribution of the mortality over the months. Additional trends over the time could be included with simple factors. In this manner the model was applicable over the total observation period. RESULTS: The fit for the months where influenza was not epidemic was good and comparable to other models (R2 = 0.91). The estimated excess mortality is plausible and congruent with estimates based on other models. CONCLUSION: This method is applicable to long time series of any duration and obvious trends could be considered by simple factors in a readily identifiable and plausible way. Possible reductions in precision due to the consideration of a given monthly distribution pattern of the annual mortality seem tolerable with respect to the goodness of fit of the model. The estimation includes the pandemics of 1957/58 and 1968 to 1970.

Germany↗
PubMed1988

Infant mortality increase despite high access to tertiary care: an evolving relationship among infant mortality, health care, and socioeconomic change.

In this study, the determinants of an apparent increase in the infant mortality rate of an urban population with high access to tertiary neonatal care are reviewed. For a 4-year period (1980 to 1983), all infant deaths (n = 422) of the 32,329 births to residents of the City of Boston were analyzed through linked vital statistics data and a review of medical records. A significant increase in the infant mortality rate occurred in 1982 due to increases in three components of the infant mortality rate: the birth rate of very low birth weight infants (less than 1,500 g), the neonatal mortality rate of normal birth weight infants (greater than or equal to 2,500 g), and the mortality rate of infants dying during the postneonatal period (28 to 365 days). These increases were associated with inadequate levels of prenatal care. Although transient, the impact of the observed alterations in these infant mortality rate components was enhanced by a more long-standing phenomenon: the stabilization of mortality rates for low birth weight infants. This stabilization allowed the increases in other component rates to be expressed more fully than in previous years. In this report a mechanism is shown whereby fully regionalized neonatal care ultimately may confer to the infant mortality rate a heightened sensitivity to socioeconomic conditions and levels of adequate prenatal care.

Birth Rate↗
PubMed2003

Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data.

BACKGROUND: Pulmonary thromboembolism (PTE) is a common clinical problem that is associated with substantial morbidity and mortality. Estimates of PTE mortality and predictions of PTE trends have varied widely. These estimates play a role in the planning of national health strategies. The analysis of pulmonary embolism mortality trends and comorbidities may elucidate how well we treat and prevent the disease as well as identify additional risk factors. METHODS: We analyzed PTE (International Classification of Diseases, Ninth Revision code 415.1) as reported on death certificates in the Multiple-Cause Mortality Files compiled by the National Center for Health Statistics from 1979 to 1998. RESULTS: Of all the 42932973 decedents, 572773 (1.3%) had PTE listed on their death certificates and 194389 of these (33.9%) had PTE as the underlying cause of death. The age-adjusted rate of deaths with PTE decreased from 191 per million in 1979 to 94 per million in 1998 overall, decreasing 56% for men and 46% for women. During the study period, the age-adjusted mortality rates for blacks were consistently 50% higher than those for whites, and those for whites were 50% higher than those for people of other races (Asian, American Indian, etc). Within racial strata, mortality rates were consistently 20% to 30% higher among men than among women. Conditions that were of higher likelihood in persons who died with PTE included thrombophlebitis, fractures, trauma, postoperative complications, certain cancers, and the inflammatory bowel diseases. CONCLUSIONS: Mortality with PTE in the United States has decreased during the 20-year period. The mortality rates between men and women and between racial groups vary substantially. These findings may be useful in better directing preventive therapy efforts.

Adolescent↗
PubMed2000

Prophylactic versus selective use of surfactant for preventing morbidity and mortality in preterm infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: To compare the effect of prophylactic surfactant administration to surfactant treatment of established respiratory distress syndrome in premature infants. SEARCH STRATEGY: Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH terms: pulmonary surfactant; limits: age groups, newborn infants), previous reviews including cross-references, abstracts, conference and symposia proceedings, expert informants, and journal handsearching in the English language. SELECTION CRITERIA: Randomized controlled trials which compared the effects of prophylactic surfactant administration to surfactant treatment of established respiratory distress syndrome in premature infants were included in the analysis. DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes including the incidence of pneumothorax, pulmonary interstitial emphysema, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage (any grade and severe intraventricular hemorrhage), bronchopulmonary dysplasia, mortality, bronchopulmonary dysplasia or death, and retinopathy of prematurity were excerpted from the reports of the clinical trials by the reviewers. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group. MAIN RESULTS: The majority of included studies noted an initial improvement in the respiratory status and a decrease in the incidence of respiratory distress syndrome in infants who received prophylactic surfactant. The meta-analysis supports a decrease in the incidence of pneumothorax, a decrease in the incidence of pulmonary interstitial emphysema, a decrease in the incidence of mortality and a decrease in the incidence of bronchopulmonary dysplasia or death associated with prophylactic administration of surfactant. No significant untoward effects of prophylactic surfactant administration are noted. REVIEWER'S CONCLUSIONS: Prophylactic surfactant administration to infants judged to be at risk of developing respiratory distress syndrome (intubated infants less than 30-32 weeks gestation) has been demonstrated to improve clinical outcome. Infants who receive prophylactic surfactant have a decreased incidence of pneumothorax, a decreased incidence of pulmonary interstitial emphysema and a decreased incidence of mortality. However, it remains unclear exactly which criteria should be used to judge "at risk" infants who would require prophylactic surfactant administration.

Humans↗
PubMed2006

How much can current interventions reduce colorectal cancer mortality in the U.S.? Mortality projections for scenarios of risk-factor modification, screening, and treatment.

BACKGROUND: Although colorectal cancer (CRC) is the second leading cause of cancer death in the U.S., available interventions to reduce CRC mortality are disseminated only partially throughout the population. This study assessed the potential reduction in CRC mortality that may be achieved through further dissemination of current interventions for risk-factor modification, screening, and treatment. METHODS: The MISCAN-COLON microsimulation model was used to simulate the 2000 U.S. population with respect to CRC risk-factor prevalence, screening use, and treatment use. The model was used to project age-standardized CRC mortality from 2000 to 2020 for 3 intervention scenarios. RESULTS: Without changes in risk-factor prevalence, screening use, and treatment use after 2000, CRC mortality would decrease by 17% by the Year 2020. If the 1995 to 2000 trends continue, then the projected reduction in mortality would be 36%. However, if trends in the prevalence of risk-factors could be improved above continued trends, if screening use increased to 70% of the target population, and if the use of chemotherapy increased among all age groups, then a 49% reduction would be possible. Screening drove most (23%) of the projected mortality reduction with these optimistic trends; however, decreasing risk-factors (16%) and increasing use of chemotherapy (10%) also contributed substantially. The contribution of risk-factors may have been overestimated, because effect estimates could not be obtained from randomized controlled trials. CONCLUSIONS: Currently available interventions for risk-factor modification, screening, and treatment have the potential to reduce CRC mortality by almost 50% by the Year 2020. However, without action now to further increase the uptake of current effective interventions, the reduction in CRC mortality may be only 17%.

Colorectal Neoplasms↗
PubMed2003

The heritability of cause-specific mortality: a correlated gamma-frailty model applied to mortality due to respiratory diseases in Danish twins born 1870-1930.

The genetic influence on susceptibility to diseases of the respiratory system and all-cause mortality was studied using data for identical (MZ) and fraternal (DZ) twins. Data from the Danish Twin Register include 1344 MZ and 2411 DZ male twin pairs and 1470 MZ and 2730 DZ female twin pairs born between 1870 and 1930, where both individuals were alive on 1 011943. We used the correlated gamma-frailty model. Proportions of variance in frailty attributable to genetic and environmental factors were assessed using the structural equation model approach. For all-cause mortality the correlation coefficients of frailty for MZ twins tend to be higher than for DZ twins. For mortality with respect to respiratory diseases this effect was only seen in females, whereas males showed the opposite effect. Five standard biometric models are fitted to the data to evaluate the magnitude and nature of genetic and environmental factors on mortality. Using the best fitting biometric model heritability for cause of death was found to be 0.58 (0.07) for all-cause mortality (AE-model) and zero for diseases of the respiratory system for males. Heritability was 0.63 (0.11) for all-cause mortality (DE-model) and 0.18 (0.09) for diseases of the respiratory system (DE-model) for females. The analysis confirms the presence of a strong genetic influence on individual frailty associated with all-cause mortality. For respiratory diseases, no genetic influence was found in males and only weak genetic influence in females. The nature of genetic influences on frailty with respect to all-cause mortality is probably additive in males and dominant in females, whereas for frailty with respect to deaths caused by respiratory diseases in females, there are genetic factors present which are caused by dominance. Environmental influences are non-shared with exception of frailty with respect to respiratory diseases in males, where the shared environment plays an important role.

Aged↗
PubMed1991

Longitudinal Gompertzian analysis of pancreatic cancer mortality in the U.S., 1962-1987: distinguishing between competitive and environmental influences upon evolving mortality patterns.

Pancreatic cancer (PanC) is an extraordinarily lethal neoplasm that is currently the fifth leading cause of cancer death in the United States. Annual age-specific mortality rates for PanC in the U.S. from 1962 to 1987 were subjected to longitudinal Gompertzian analysis. Age-specific PanC mortality rate distributions between age 30 and 60 years were determined by a common fixed intersect point and a variable competitive factor. The intersect point for PanC occurred at age 59.5 years and mortality rate 37.4 per 100,000 for men, and at age 53.2 years and mortality rate 7.9 per 100,000 for women. These intersect points are determined by genetic and environmental influences upon mortality. The observation that these points have remained fixed suggests that there has been no significant alteration in environmental etiopathogenic influences upon PanC mortality. Longitudinal Gompertzian analysis suggests that the emergence of PanC in the U.S. as a significant cause of cancer mortality has been the consequence of competitive influences upon PanC mortality dynamics.

Adult↗
PubMed1991

Longitudinal Gompertzian analysis of prostate cancer mortality in the U.S., 1962-1987: a method of demonstrating relative environmental, genetic and competitive influences upon mortality.

Age-specific mortality rates for prostate cancer (PC) in the United States from 1962 to 1987 were subjected to longitudinal Gompertzian analysis. Age-specific PC mortality rate distributions between age 55 and 85 years were determined by a variable competitive factor and a common intersect point. The intersect point for PC occurred at age 61.5 years and mortality rate 27.9 per 100,000 and reflects genetic and environmental influences upon mortality. Between 1962 and 1987, non-age-standardized annual crude PC mortality rates increased 41.6%. Longitudinal Gompertzian analysis suggests that rising PC mortality rates in the United States are the natural consequence of competitive deterministic mortality dynamics. Moreover, longitudinal Gompertzian analysis is a method that demonstrates the relative contribution of environmental, genetic and competitive influences upon disease specific mortality.

Age Factors↗
PubMed1992

Longitudinal Gompertzian analysis of emphysema mortality in the US, 1962-1987: the differing basis for evolving mortality patterns in men and women.

Age-specific mortality rates for emphysema in the United States from 1962 through 1987 were subjected to longitudinal Gompertzian analysis, a method that can be used to identify and distinguish aggregate genetic, environmental, and competitive influences upon mortality. Annual crude emphysema mortality rates (per 100,000) among men increased from 11.77 in 1962 to 20.94 in 1968, and then fell to 7.74 in 1987. The basis for this rise and fall is shown to be the corresponding changes in environmental influences upon emphysema mortality in men. Between 1962 and 1987, the annual crude emphysema mortality rates among women increased from 1.71 to 4.25. The basis for the increase of emphysema mortality in women, on the other hand, is shown to be an enhancement of the competitiveness of emphysema as a cause of mortality in women, and not the result of worsening environmental influences. The capability to distinguish between environmental and competitive influences upon evolving human mortality patterns could have a significant impact upon public health policy.

Adult↗
PubMed2005

Present-at-admission diagnoses improve mortality risk adjustment and allow more accurate assessment of the relationship between volume of lung cancer operations and mortality risk.

BACKGROUND: Mortality risk adjustment is a key component of studies that examine the statistical relationship between hospital lung cancer operation volume and in-hospital mortality. Previous studies of this relationship have used different methods of adjusting for factors that influence mortality risk, but none have adjusted for differences in comorbid disease using only diagnoses identified as present-at-admission. METHODS: This study uses adjustments for conditions identified as present-at-admission to examine the statistical relationship between the volume of lung cancer operations and mortality among 14,456 California hospital patients, and compares these results to other methods of risk adjustment similar to those used in previous studies. RESULTS: Mortality risk adjustment using present-at-admission diagnoses yielded better discrimination and explained more of the variability in observed deaths. Large increases in hospital procedure volume were associated with much smaller decreases in mortality risk than those estimated using comparable risk-adjustment models. CONCLUSIONS: Present-at-admission diagnoses can be used to improve mortality risk adjustment and may allow a more accurate assessment of the relationship between procedure volume and mortality risk.

Comorbidity↗
PubMed1999

Rebound mortality and the cost-effectiveness of malaria control: potential impact of increased mortality in late childhood following the introduction of insecticide treated nets.

The efficacy and relative cost-effectiveness of insecticide-treated nets (ITNs) for the control of malaria in children under 5 years of age have recently been demonstrated by several large-scale trials. However, it has been suggested that long-term use of ITNs in areas of high transmission could lead to mortality rebound in later childhood, which would reduce the cost-effectiveness of the intervention, and at the extreme could lead to negative overall effects. A model is presented in which the cost and disability adjusted life years (DALYs) per child aged 1-119 months were estimated for a sub-Saharan African population with and without an ITN intervention. The rebound rate, defined as the percentage increase in age-specific all-cause mortality and malaria specific-morbidity, was varied to estimate the threshold at which the intervention was no longer cost-effective. Rebound was considered over two possible age ranges: 5-9 years and 3-6 years. With mortality and morbidity reductions due to ITNs in children aged 1-59 months and rebound in the 5-9 years age class, one could be reasonably certain that the cost per DALY averted is below $150 up to a rebound rate of 39%. Up to an 84% rebound rate it is highly likely that the intervention will be DALY-averting, that is the DALYs averted by the intervetion outweigh DALYs incurred through rebound effects. These thresholds are sensitive to the age range over which reductions and rebound in morbidity and mortality occur. With reductions confined to children aged 1-35 months and rebound in the 3-6 years age class, the cost per DALY is highly likely to fall below $150 only up to a 2.5% rebound rate, and with a rate in excess of 11% one can no longer be reasonably certain that the intervention is DALY-averting. These rates apply to the whole population. If there is no rebound amongst children who did not comply with the intervention, the actual increases in morbidity and mortality required to reach these thresholds amongst compliers would be much higher. The age range over which rebound occurs is a critical determinant of the thresholds at which one can no longer be reasonably certain that ITNs remain cost-effective in the long term. Based on empirical estimates of age-specific malaria mortality in sub-Saharan Africa, it appears unlikely that this threshold rate would be reached if rebound occurs over the 5-9 years age range. By contrast, if rebound occurs over the ages of 3-6 years, the increase in mortality rates required to reach this threshold falls within the observed range of malaria-specific mortality rates for this age group. It is essential that long-term surveillance is included as part of ITN interventions, with particular attention to the age range over which rebound may occur.

Africa South of the Sahara↗
PubMed1999

Mortality oscillations induced by periodic starvation alter sex-mortality differentials in Mediterranean fruit flies.

Sex-specific mortality rates of medflies were monitored in cages containing individuals of both sexes and with food (either sugar-only or full diet) removed every 2nd, 3rd, or 4th day (plus ad libitum controls). The general finding is that periodic starvation led to marked oscillations in raw mortality rates. The specific findings are as follows: (i) female medflies live longer than male medflies when they are subjected to periodic starvation; (ii) male medflies maintained on a full diet experience a catastrophic increase in mortality (40%) on the first day food is removed. This mortality surge was not observed for females on either diet or for males maintained on a sugar-only diet; (ii) life expectancy is inversely related to the amplitude of mortality oscillations caused by food deprivation; and (iv) the large perturbations in mortality at younger ages caused by periodic starvation has little effect on the amplitude of mortality at older ages. In general, our data shed new light on the complexity of the mortality response of medflies to both the type and availability of food and thus provide a complimentary perspective to findings from dietary restriction studies on both vertebrate and invertebrate systems.

Adaptation, Physiological↗
PubMed2002

Prospective evaluation of a clinical score for 60-day mortality after transjugular intrahepatic portosystemic stent-shunt: Bonn TIPSS early mortality analysis.

OBJECTIVE: Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is increasingly used to treat complications of portal hypertension, but proven tools for risk assessment of early mortality are lacking. DESIGN: The prospective evaluation of a new 60-day mortality score. PATIENTS AND METHODS: In a tertiary medical centre, 30 consecutive TIPSS patients were analysed for early mortality predictors, such as Child-Pugh score, TIPSS urgency (elective: > or = 36 h or emergency: < 36 h after variceal bleeding), comorbidity (Acute Physiology and Chronic Health Evaluation [APACHE]-II) and clinical data. Main predictors (P< 0.01) in this group (group-1: Child-Pugh score 10A, 10B, 10C) were graded (1, 2 or 3 points representing low, medium and high risk, respectively) and summarized as a Bonn TIPSS early mortality (BOTEM) score. This score was then tested prospectively in the next 73 TIPSS patients (group-2: Child-Pugh score 14A, 42B, 17C). RESULTS: Group 1 early mortality (30%) depended primarily on bilirubin (P< 0.005), APACHE-II (P < 0.001) and TIPSS urgency (P< 0.001). Added risk points (1, 2, 3) for bilirubin (< 3 mg/dl, 3-6 mg/dl, > 6 mg/dl, respectively), APACHE-II (< 10, 10-20, > 20 points, respectively) and urgency (elective, emergency, active bleeding, respectively) represented individual BOTEM score points. BOTEM was the best mortality predictor (P< 0.001); < or = / > 6 score points was the optimal cut-off, with 56% sensitivity, 100% specificity, 100% positive predictive value, 84% negative predictive value and 87% accuracy. In group 2, early mortality (8.2%) was again best predicted by BOTEM (P < 0.01) with the same cut-off and 67% sensitivity, 99% specificity, 80% positive predictive value, 97% negative predictive value and 96% accuracy. CONCLUSION: BOTEM score based on bilirubin, comorbidity and TIPSS-urgency predicts rather reliably post-TIPSS 60-day mortality and might optimize TIPSS treatment.

Aged↗
PubMed2007

All-cause and cardiovascular mortality in diabetic subjects increases significantly with reduced estimated glomerular filtration rate (eGFR): 10 years' data from the South Tees Diabetes Mortality study.

AIMS: To investigate the association between estimated glomerular filtration rate (eGFR) and total and cardiovascular mortality in a population-based cohort of diabetic subjects. METHODS: A longitudinal study using a population-based district diabetes register comprising 3288 subjects in South Tees, UK. The eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) study equation. Patients were stratified by baseline eGFR into five stages as per the National Kidney Foundation guidelines: Stage 1, eGFR > 90; Stage 2, eGFR 60-89; Stage 3, eGFR 30-59; Stage 4, eGFR 15-29; and Stage 5, eGFR < 15 ml/min per 1.73 m(2). Main outcome was all-cause and cardiovascular mortality between 1 January 1994 and 31 July 2004. RESULTS: At baseline, mean age (58.4 years) differed between groups. Persons with lower eGFR were older (P < 0.001). Thirty-six percent (n = 1193, males 56%) had died by 10 years (cardiovascular cause in 60%). Median follow-up was 10.5 years amounting to 28 342 person years. Stages 4 and 5 (eGFR <or= 29 ml/min per 1.73 m(2)) were amalgamated for mortality analysis. Total and cardiovascular mortality increased with reduced eGFR. Adjusted hazard ratios (HR) [95% confidence interval (CI)] for all-cause mortality comparing groups 2 and 3, and 4 and 5 combined with group 1 were 1.28 (1.02, 1.60), 2.58 (2.05, 3.25) and 6.42 (4.25, 9.71), respectively. Adjusted HRs (95% CI) for mortality due to circulatory disease comparing groups 2 and 3, and 4 and 5 combined with group 1 were 1.50 (1.10, 2.06), 3.32 (2.41, 4.58) and 7.99 (4.69, 13.62), respectively. CONCLUSIONS: In diabetic subjects, mortality increases significantly with reduced GFR. Low eGFR identifies patients at high risk of cardiovascular mortality who should be targeted for aggressive risk factor modification.

Diabetes Mellitus, Type 2↗
PubMed1994

Mortality rates and predictors of mortality among late-middle-aged and older substance abuse patients.

This study describes mortality rates and predictors of mortality among late-middle-aged and older (55+) substance abuse inpatients (n = 21,139) in Department of Veterans Affairs (VA) Medical Centers in the 4 years after an index episode of care. A total of 24% of the patients died; this mortality rate was 2.64 times higher than expected. Predictors of earlier mortality included older age and nonmarried status, alcohol psychosis and organic brain disorder diagnoses, and several medical diagnoses, including neoplasms, liver cirrhosis, respiratory, endocrine and metabolic, and blood system disorders. Three proxy indicators of illness severity also predicted mortality: more prior inpatient and outpatient medical care and an index episode in an extended care unit. In contrast, more prior outpatient mental health care and remitted status predicted lower mortality. These diagnostic and treatment indicators can be used to identify patients at heightened risk for premature mortality. Moreover, they show that intensive mental health aftercare and remission of substance abuse may delay mortality, even among older patients who have longstanding substance abuse problems.

Aged↗
PubMed2000

Effect of NHS breast screening programme on mortality from breast cancer in England and Wales, 1990-8: comparison of observed with predicted mortality.

OBJECTIVE: To assess the impact of the NHS breast screening programme on mortality from breast cancer in women aged 55-69 years over the period 1990-8. DESIGN: Age cohort model with data for 1971-89 used to predict mortality for 1990-8 with assumption of no major effect from screening or improvements in treatment until after 1989. Effect of screening and other factors on mortality estimated by comparing three year moving averages of observed mortality with those predicted (by five year age groups from 50-54 to 75-79), the effect of screening being restricted to certain age groups. SETTING: England and Wales. SUBJECTS: Women aged 40 to 79 years. RESULTS: Compared with predicted mortality in the absence of screening or other effects the total reduction in mortality from breast cancer in 1998 in women aged 55-69 was estimated as 21.3%. Direct effect of screening was estimated as 6.4% (range of estimates from 5.4-11.8%). Effect of all other factors (improved treatment with tamoxifen and chemotherapy, and earlier presentation outside the screening programme) was estimated as 14.9% (range 12.2-14.9%). CONCLUSIONS: By 1998 both screening and other factors, including improvements in treatment, had resulted in substantial reductions in mortality from breast cancer. Many deaths in the 1990s will be of women diagnosed in the 1980s and early 1990s, before invitation to screening. Further major effects from screening and treatment are expected, which together with cohort effects should result in further substantial reductions in mortality from breast cancer, particularly for women aged 55-69, over the next 10 years.

Adult↗