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PubMed2003

Mortality and cancer incidence among individuals with Down syndrome.

BACKGROUND: Individuals with Down syndrome (DS) have a predisposition to leukemia and possibly other cancers and excess mortality from other conditions, but information on the magnitude of risk associated with specific cancers or causes of death is sparse. METHODS: Mortality experience and cancer incidence were evaluated in a combined cohort of 4872 individuals with a hospital discharge diagnosis of DS in Sweden (1965-1993) or Denmark (1977-1989) by linkage to national cancer and vital statistics registries. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were estimated by comparison with age, sex, and calendar-year expected values. RESULTS: Individuals with DS had an increased risk of incident acute lymphocytic (SIR, 24.2; 95% confidence interval [CI], 15.2-36.6; n = 22) and acute nonlymphocytic (SIR, 28.2; 95% CI, 15.7-48.3; n = 14) leukemias. Risks of testicular cancer (SIR, 3.7; 95% CI, 1.0-9.4; n = 4) and liver cancer (SIR, 6.0; 95% CI, 1.2-17.5; n = 3) were also elevated. Individuals with DS also experienced elevated mortality attributed to stomach cancer (SMR, 6.4; 95% CI, 1.7-16.4; n = 4), dementia and Alzheimer disease (SMR, 54.1; 95% CI, 27.9-94.4), epilepsy (SMR, 30.4; 95% CI, 13.9-57.7), ischemic heart disease (SMR, 3.9; 95% CI, 2.7-5.4), other heart disease (SMR, 16.5; 95% CI, 11.0-23.7), cerebrovascular disease (SMR, 6.0; 95% CI, 3.5-9.6), infectious diseases (SMR, 12.0; 95% 6.0-21.4), and congenital anomalies (SMR, 25.8; 95% CI, 21.0-31.4). CONCLUSIONS: Individuals with DS have a substantially increased risk of mortality due to specific causes and may have an elevated risk of other incident cancers in addition to leukemia. These results provide clues regarding chromosome 21 gene involvement in diseases that complicate DS and are important for disease detection and care of affected individuals.

Adolescent↗
PubMed2004

Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences.

BACKGROUND: Diabetic ketoacidosis (DKA), once thought to typify type 1 diabetes mellitus, has been reported to affect individuals with type 2 diabetes mellitus. An analysis and overview of the different clinical and biochemical characteristics of DKA that might be predicted between patients with type 1 and type 2 diabetes is needed. METHODS: We reviewed 176 admissions of patients with moderate-to-severe DKA. Patients were classified as having type 1 or type 2 diabetes based on treatment history and/or autoantibody status. Groups were compared for differences in symptoms, precipitants, vital statistics, biochemical profiles at presentation, and response to therapy. RESULTS: Of 138 patients admitted for moderate-to-severe DKA, 30 had type 2 diabetes. A greater proportion of the type 2 diabetes group was Latino American or African American (P<.001). Thirty-five admissions (19.9%) were for newly diagnosed diabetes. A total of 85% of all admissions involved discontinuation of medication use, 69.2% in the type 2 group. Infections were present in 21.6% of the type 1 and 48.4% of the type 2 diabetes admissions. A total of 21% of patients with type 1 diabetes and 70% with type 2 diabetes had a body mass index greater than 27. Although the type 1 diabetes group was more acidotic (arterial pH, 7.21 +/- 0.12 vs 7.27 +/- 0.08; P<.001), type 2 diabetes patients required longer treatment periods (36.0 +/- 11.6 vs 28.9 +/- 8.9 hours, P =.01) to achieve ketone-free urine. Complications from therapy were uncommon. CONCLUSIONS: A significant proportion of DKA occurs in patients with type 2 diabetes. The time-tested therapy for DKA of intravenous insulin with concomitant glucose as the plasma level decreases, sufficient fluid and electrolyte replacement, and attention to associated problems remains the standard of care, irrespective of the type of diabetes.

Adolescent↗
PubMed1999

Early newborn hospital discharge and readmission for mild and severe jaundice.

OBJECTIVES: To further explore the relationship of early newborn hospital discharge and readmission for jaundice, and to determine if early hospital discharge was associated with increased severity of jaundice among those readmitted. METHODS: We performed a population-based case-control study using Washington State vital statistics, birth certificates, and hospital discharge abstracts from 1991 to 1995. Cases included 750 infants readmitted to the hospital for jaundice in the first 2 weeks of life; controls included 3192 infants not readmitted. Infants with severe medical conditions and those delivered by cesarean section were excluded. Early hospital discharge was defined as fewer than 30 hours in the hospital, late hospital discharge, 30 to 78 hours. We assessed the risk for hospital readmission for jaundice, for hospital readmissions classified as brief (< or =2 days) or prolonged (>2 days), and for hospital readmissions classified as uncomplicated or complicated. RESULTS: Infants discharged from the hospital early were at increased risk for jaundice (odds ratio, 1.34 [95% confidence interval, 1.10-1.64] adjusted for birth year, gestational age, maternal race and age, parity, payer, and infant sex). The risk associated with early hospital discharge was similar regardless of whether the hospital readmission was brief or prolonged and complicated or uncomplicated. One hundred twenty-two infants would have to stay for longer than 30 hours to avoid 1 jaundice readmission. CONCLUSIONS: While newborns discharged from the hospital early are at increased risk for hospital readmission for jaundice, the clinical significance is limited. Mandating longer neonatal stays may not be the most effective strategy to prevent hospital readmission for jaundice and its complications.

Case-Control Studies↗
PubMed1999

Sudden infant death syndrome among twins.

BACKGROUND: Sudden infant death syndrome (SIDS) is a major contributor to infant mortality. Previous studies have suggested that infants born of twin pregnancies are at greater risk for SIDS and that a twin who survives after a co-twin dies is at increased risk for SIDS. OBJECTIVE: To attempt to confirm the increased risk of SIDS among and within twin pairs through the use of US vital statistics data. METHODS: We analyzed data from the US-linked birth and infant death certificate tapes for the years 1987 through 1991 to determine the risk of SIDS in twin births compared with singleton births and to describe the characteristics of twin pairs in whom SIDS occurred. The analysis was limited to live births with weights of 500 g or more and gestational ages of 24 weeks or more. We used an algorithm to match co-twins (infants within a twin pair) to measure sex and birth weight concordancy, to identify twin pairs, in which one or both twins died of SIDS; and to examine, when both twins died, whether they died on the same day. RESULTS: There were 23464 singleton SIDS deaths and 1056 twin SIDS deaths during the 5-year period. The crude relative risk for SIDS among twins compared with singleton births was 2.06 (95% confidence interval, 1.94-2.19). The adjusted relative risk independent of birth weight and sociodemographic variables was 1.13 (95% confidence interval, 0.97-1.31). We successfully matched the co-twins of 172029 twin pregnancies. Of these, 767 were twin pregnancies in which one or both twins died of SIDS. Among the 767 twin pregnancies in which one or both twins experienced SIDS, there were only 7 in which both twins died of SIDS (rate ratio, 4.0 per 100000 twin pregnancies). In only 1 of these 7 did both twins die on the same day (rate ratio, 0.58 per 100000 twin pregnancies). The relative risk for a second twin dying of SIDS was 8.17 (90% confidence interval, 1.18-56.67). CONCLUSIONS: Independent of birth weight, twins do not appear to be at greater risk for SIDS compared with singleton births. In addition, the occurrence of both twins dying of SIDS is uncommon, and the occurrence of both twins dying on the same day is extremely uncommon.

Birth Weight↗
PubMed1996

Pediatric firearm-related fatalities. Not just an urban problem.

OBJECTIVE: To examine medical and demographic factors associated with the firearm-related deaths among children in Kentucky. DESIGN: Retrospective review and multiple regression analysis. DATA SOURCE: All firearm-related deaths among children younger than 20 years reported to the Kentucky Office of Vital Statistics, Frankfort, from 1988 to 1993. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All 320 pediatric firearm-related deaths that occurred in Kentucky from 1988 to 1993 were analyzed. Death rates were calculated for each county in the state. While the overall death rate from firearms was not significantly different between African-American and white children (relative risk [RR], 1.39; 95% confidence interval [CI], 0.98-1.98), the pattern of the types of events was markedly different. African American children were much more likely to have been involved in a homicide; suicides were more frequent in white children. Multiple Poisson regression analysis, controlling for age, race, and gender, identified only 1 variable that was significantly associated with deaths due to firearms. Children in rural Kentucky were at significantly more risk for a firearm-related death than children in urban areas (RR, 1.26; 95% CI, 1.01-1.62) even after controlling for medical system variables (availability of a hospital with 24-hour emergency services, availability of prehospital advanced life support, and availability of 911 service). CONCLUSIONS: Children in rural areas of Kentucky are at an increased risk for firearm-related mortality. Prevention and intervention programs that focus only on urban areas may not produce optimum results in the Kentucky setting. Further research is needed to determine factors that are important in rural areas so that interventions specific to them can be planned.

Adolescent↗
PubMed1980

Suicide and age in Alberta, Canada, 1951 to 1977. The changing profile.

The changing contribution of suicide among young persons to the entire suicide profile was examined. Using Alberta Vital Statistics data for the years 1951 to 1977 inclusive, suicide age profiles were constructed for each census year; age-specific changes in rates were compared; suicides by persons aged 15 to 29 years were expressed as a percentage of all suicides 15 years old and older by year and compared to corresponding population figures. Analyses were done for men and women separately and combined. The suicide age profile has shown a significant rise in rates among the young compared with older age groups and the number of suicides by persons between the ages of 15 and 29 has increased to a greater extent than can be explained by shifts in the age structure of the Alberta population.

Accidents↗
PubMed1980

Suicide and age in Alberta, Canada, 1951 to 1977. A cohort analysis.

A cohort analysis was undertaken of the 4,315 deaths by suicide registered in Alberta, Canada, Vital Statistics between the years of 1951 and 1977, inclusive. Age, gender, and year of death were available in all but two instances. Five-year age cohorts were identified and their suicide rates were followed as the cohorts aged. Analyses were done for men and women separately and combined. Suicide rates increased directly with age, regardless of gender for each cohort observed. Once a cohort entered the 15- to 19-year-old age range with a high rate of suicide, the rate for that cohort remained consistently high as it aged.

Adolescent↗
PubMed2005

The relationship between antidepressant medication use and rate of suicide.

BACKGROUND: Approximately 30 000 people die annually by suicide in the United States. Although 60% of suicides occur during a mood disorder, mostly untreated, little is known about the relationship between antidepressant medication use and the rate of suicide in the United States. OBJECTIVE: To examine the association between antidepressant medication prescription and suicide rate by analyzing associations at the county level across the United States. DESIGN: Analysis of National Vital Statistics from the Centers for Disease Control and Prevention. SETTING: All US counties. PARTICIPANTS: All US individuals who committed suicide between 1996 and 1998. MAIN OUTCOME MEASURES: National county-level suicide rate data are broken down by age, sex, income, and race for the period of 1996 to 1998. National county-level antidepressant prescription data are expressed as number of pills prescribed. The primary outcome measure is the suicide rate in each county expressed as the number of suicides for a given population size. RESULTS: The overall relationship between antidepressant medication prescription and suicide rate was not significant. Within individual classes of antidepressants, prescriptions for selective serotonin reuptake inhibitors (SSRIs) and other new-generation non-SSRI antidepressants (eg, nefazodone hydrochloride, mirtazapine, bupropion hydrochloride, and venlafaxine hydrochloride) are associated with lower suicide rates (both within and between counties). A positive association between tricyclic antidepressant (TCA) prescription and suicide rate was observed. Results are adjusted for age, sex, race, income, and county-to-county variability in suicide rates. Higher suicide rates in rural areas are associated with fewer antidepressant prescriptions, lower income, and relatively more prescriptions for TCAs. CONCLUSIONS: The aggregate nature of these observational data preclude a direct causal interpretation of the results. A high number of TCA prescriptions may be a marker for those counties with more limited access to quality mental health care and inadequate treatment and detection of depression, which in turn lead to increased suicide rates. By contrast, increases in prescriptions for SSRIs and other new-generation non-SSRIs are associated with lower suicide rates both between and within counties over time and may reflect antidepressant efficacy, compliance, a better quality of mental health care, and low toxicity in the event of a suicide attempt by overdose.

Adolescent↗
PubMed1998

Causes of declining life expectancy in Russia.

CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.

Adolescent↗
PubMedDate not supplied

Safety of early discharge for Medicaid newborns.

CONTEXT: Neonates are being discharged from the hospital more rapidly, but the risks associated with this practice, especially for low-income populations, are unclear. OBJECTIVE: To determine the impact of decreasing postnatal length of stay on rehospitalization rates in the immediate postdischarge period for Medicaid neonates. DESIGN AND SETTING: Retrospective, population-based cohort study using Ohio Medicaid claims data linked to vital statistics files from July 1, 1991, to June 15, 1995. PARTICIPANTS: A total of 102 678 full-term neonates born to mothers receiving Medicaid for at least 30 days after birth. MAIN OUTCOME MEASURES: Rehospitalization rates within 7 and 14 days of discharge, postdischarge health care use, and regional variations in length of stay and rehospitalization. RESULTS: The proportion of neonates who were discharged following a short stay (less than 1 day after vaginal delivery, less than 2 days after cesarean birth) increased 185%, from 21% to 59.8% (P<.001) and the mean (SD) length of stay decreased 27%, from 2.2 (1.0) to 1.6 (0.9) days (P<.001), over the course of the study. The proportion of neonates who received a primary care visit within 14 days of birth increased 117% (P = .001). Rehospitalization rates within 7 and 14 days of discharge decreased by 23%, from 1.3% to 1.0% (P=.01), and by 19%, from 2.1% to 1.7% (P=.03), respectively. Short stay across the 6 regions of the state varied significantly over time (P<.001). Factors significantly associated with increased likelihood of rehospitalization within both 7 and 14 days of discharge were white race, shorter gestation, primiparity, earlier year of birth, lower 5-minute Apgar score, vaginal delivery, married mother, and region of the state. CONCLUSION: Our data suggest that reductions in length of stay for full-term Medicaid newborns in Ohio have not resulted in an increase in rehospitalization rates in the immediate postnatal period.

Humans↗
PubMed2000

Comprehensive follow-up care and life-threatening illnesses among high-risk infants: A randomized controlled trial.

CONTEXT: Inner-city high-risk infants often receive limited and fragmented care, a problem that may increase serious illness. OBJECTIVE: To assess whether access to comprehensive care in a follow-up clinic is cost-effective in reducing life-threatening illnesses among high-risk, inner-city infants. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: A total of 887 very-low-birth-weight infants born in a Texas county hospital between January 1988 and March 1996 and followed up in a children's hospital clinic. One hundred four infants who became ineligible or died after randomization but before nursery discharge were excluded from the analysis. INTERVENTIONS: Infants were randomly assigned to receive routine follow-up care (well-baby care and care for chronic illnesses; n = 441) or comprehensive care (which included the components of routine care plus care for acute illnesses, with 24-hour access to a primary caregiver; n = 446). MAIN OUTCOME MEASURES: Life-threatening illnesses (ie, causing death or hospital admission for pediatric intensive care) occurring between nursery discharge and age 1 year, assessed by blinded evaluators from inpatient charts and state Medicaid and vital statistics records; and hospital costs (estimated from department-specific cost-to-charge ratios). RESULTS: Comprehensive care resulted in a mean of 3.1 more clinic visits and 6.7 more telephone conversations with clinic staff (P<.001 for both). One-year outcomes were unknown for fewer comprehensive-care infants than routine-care infants (9 vs 28; P =.001). Identified deaths were similar (11 in comprehensive care vs 13 in routine care; P =.68). The comprehensive-care group had 48% fewer life-threatening illnesses (33 vs 63; P<.001), 57% fewer intensive care admissions (23 vs 53; P =.003), and 42% fewer intensive care days (254 vs 440; P =.003). Comprehensive care did not increase the mean estimated cost per infant for all care ($6265 with comprehensive care and $9913 with routine care). CONCLUSION: Comprehensive follow-up care by experienced caregivers can be highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants. JAMA. 2000;284:2070-2076.

Acute Disease↗
PubMed2000

Homicide and suicide rates associated with implementation of the Brady Handgun Violence Prevention Act.

CONTEXT: In February 1994, the Brady Handgun Violence Prevention Act established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales. The effects of this act have not been analyzed. OBJECTIVE: To determine whether implementation of the Brady Act was associated with reductions in homicide and suicide rates. DESIGN AND SETTING: Analysis of vital statistics data in the United States for 1985 through 1997 from the National Center for Health Statistics. MAIN OUTCOME MEASURES: Total and firearm homicide and suicide rates per 100,000 adults (>/=21 years and >/=55 years) and proportion of homicides and suicides resulting from firearms were calculated by state and year. Controlling for population age, race, poverty and income levels, urban residence, and alcohol consumption, the 32 "treatment" states directly affected by the Brady Act requirements were compared with the 18 "control" states and the District of Columbia, which had equivalent legislation already in place. RESULTS: Changes in rates of homicide and suicide for treatment and control states were not significantly different, except for firearm suicides among persons aged 55 years or older (-0.92 per 100,000; 95% confidence interval [CI], -1.43 to -0.42). This reduction in suicides for persons aged 55 years or older was much stronger in states that had instituted both waiting periods and background checks (-1.03 per 100,000; 95% CI, -1.58 to -0.47) than in states that only changed background check requirements (-0.17 per 100,000; 95% CI, -1.09 to 0.75). CONCLUSIONS: Based on the assumption that the greatest reductions in fatal violence would be within states that were required to institute waiting periods and background checks, implementation of the Brady Act appears to have been associated with reductions in the firearm suicide rate for persons aged 55 years or older but not with reductions in homicide rates or overall suicide rates. However, the pattern of implementation of the Brady Act does not permit a reliable analysis of a potential effect of reductions in the flow of guns from treatment-state gun dealers into secondary markets. JAMA. 2000;284:585-591

Adult↗
PubMed2005

Trends in the leading causes of death in the United States, 1970-2002.

CONTEXT: The decrease in overall death rates in the United States may mask changes in death rates from specific conditions. OBJECTIVE: To examine temporal trends in the age-standardized death rates and in the number of deaths from the 6 leading causes of death in the United States. DESIGN AND SETTING: Analyses of vital statistics data on mortality in the United States from 1970 to 2002. MAIN OUTCOME MEASURE: The age-standardized death rate and number of deaths (coded as underlying cause) from each of the 6 leading causes of death: heart disease, stroke, cancer, chronic obstructive pulmonary disease, accidents (ie, related to transportation [motor vehicle, other land vehicles, and water, air, and space] and not related to transportation [falls, fire, and accidental posioning]), and diabetes mellitus. RESULTS: The age-standardized death rate (per 100,000 per year) from all causes combined decreased from 1242 in 1970 to 845 in 2002. The largest percentage decreases were in death rates from stroke (63%), heart disease (52%), and accidents (41%). The largest absolute decreases in death rates were from heart disease (262 deaths per 100,000), stroke (96 deaths per 100,000), and accidents (26 deaths per 100,000).The death rate from all types of cancer combined increased between 1970 and 1990 and then decreased through 2002, yielding a net decline of 2.7%. In contrast, death rates doubled from chronic obstructive pulmonary disease over the entire time interval and increased by 45% for diabetes since 1987. Despite decreases in age-standardized death rates from 4 of the 6 leading causes of death, the absolute number of deaths from these conditions continues to increase, although these deaths occur at older ages. CONCLUSIONS: The absolute number of deaths and age at death continue to increase in the United States. These temporal trends have major implications for health care and health care costs in an aging population.

Cause of Death↗
PubMed2006

Increasing incidence of thyroid cancer in the United States, 1973-2002.

CONTEXT: Increasing cancer incidence is typically interpreted as an increase in the true occurrence of disease but may also reflect changing pathological criteria or increased diagnostic scrutiny. Changes in the diagnostic approach to thyroid nodules may have resulted in an increase in the apparent incidence of thyroid cancer. OBJECTIVE: To examine trends in thyroid cancer incidence, histology, size distribution, and mortality in the United States. METHODS: Retrospective cohort evaluation of patients with thyroid cancer, 1973-2002, using the Surveillance, Epidemiology, and End Results (SEER) program and data on thyroid cancer mortality from the National Vital Statistics System. MAIN OUTCOME MEASURES: Thyroid cancer incidence, histology, size distribution, and mortality. RESULTS: The incidence of thyroid cancer increased from 3.6 per 100,000 in 1973 to 8.7 per 100,000 in 2002-a 2.4-fold increase (95% confidence interval [CI], 2.2-2.6; P<.001 for trend). There was no significant change in the incidence of the less common histological types: follicular, medullary, and anaplastic (P>.20 for trend). Virtually the entire increase is attributable to an increase in incidence of papillary thyroid cancer, which increased from 2.7 to 7.7 per 100,000-a 2.9-fold increase (95% CI, 2.6-3.2; P<.001 for trend). Between 1988 (the first year SEER collected data on tumor size) and 2002, 49% (95% CI, 47%-51%) of the increase consisted of cancers measuring 1 cm or smaller; 87% (95% CI, 85%-89%) consisted of cancers measuring 2 cm or smaller. Mortality from thyroid cancer was stable between 1973 and 2002 (approximately 0.5 deaths per 100,000). CONCLUSIONS: The increasing incidence of thyroid cancer in the United States is predominantly due to the increased detection of small papillary cancers. These trends, combined with the known existence of a substantial reservoir of subclinical cancer and stable overall mortality, suggest that increasing incidence reflects increased detection of subclinical disease, not an increase in the true occurrence of thyroid cancer.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Analytical resources for assessment of clinical genetics services in public health: current status and future prospects.

CONTEXT: Genetics services are not well integrated into the public health programs of most states, nor has there been effective use of clinical and program databases in the design, evaluation, and monitoring of public health genetics services at the state level. OBJECTIVE: To evaluate the availability and current use of population-based clinical genetics databases, including birth defects surveillance programs, in state-level public health genetics programs. DESIGN: Mail survey to state genetics coordinators in 50 states and 3 territories during 1996 with an update in 1997. RESULTS: Thirty states had birth defects surveillance programs; data from these resources were used in public health genetics program planning and management in only 15 states. Thirty states or territories had clinical genetics services databases. Most states had newborn screening program databases; few linked these records to vital statistics for programmatic purposes. Only 24 states had individual record databases for the Children with Special Health Care Needs program; 8 states had databases for maternal serum alpha-fetoprotein screening, and 7 had statewide cytogenetics registries. CONCLUSION: Population-based databases concerning aspects of public health genetics are largely unavailable at the state level. Where these databases exist, they are poorly integrated into state public health genetics program activities. More attention should be paid to the development and use of clinical data programs for the assessment, monitoring, and assurance of genetics issues with relevance to population health.

Child↗
PubMed1996

Cancer mortality at very old ages.

BACKGROUND: Mortality rates of all malignant neoplastic diseases combined and of most individual kinds of cancer increase with age through most of the human life span. What happens to cancer mortality rates near the end of the life span has not been described previously. People age 85 years and older are commonly considered as a single category; however information is available for cancer mortality of patients older than 85 years in 4 age groups, each covering 5-year spans. METHODS: Age-stratified mortality rates of all of the patients with malignant neoplasms combined and of cancers of several sites in 5-year age groups from 50 to more than 100 were calculated from United States vital statistics and Census data from 1990. RESULTS: Mortality rates of all of the patients with malignant neoplastic diseases combined and of cancers of most individual sites peak between ages of 80 and 100 years, and decline after ages older than those. Although mortality rates generally increase with age, the relative frequency of cancer deaths declines with age from nearly 40% of all deaths between ages of 50 and 69 years, to 4% of all deaths in patients older than age 100 years. CONCLUSIONS: People who survive to ages approaching 100 years are relatively resistant to the causes of death, including cancer, of the majority of people who die at younger ages. The basis of this resistance to cancer may be attributable to several recognized genetically controlled steps in the pathogenesis of cancer.

Age Factors↗
PubMed1997

An ecological study on diet/nutrition and cancer in Japan.

Correlation or ecological studies may be useful in identifying cancer risk factors which are distributed relatively homogeneously within a population, but differ greatly between populations or between different periods within a given population. In Japan, the westernization of dietary habits has progressed remarkably in the last few decades and may have resulted in changes of incidence/mortality rates of diet-related diseases, especially cancer. Based on data from the National Nutritional Survey of Japan (1955-1993) and the vital statistics of Japan (1955-1993), we conducted correlation analyses between food/nutrient intake and cancer mortality. The present study on chronological correlations suggests the relationship between westernized dietary habits and mortality by cancers of the colon, breast, ovary and prostate and also the relationship between traditional Japanese dietary habits and mortality by stomach cancer. Our results suggest the importance of diet in the etiology of diet-related cancer. Further observation and analyses are needed to confirm the relationship between food/nutrient intake and cancer mortality, while also considering the consumption of tobacco and alcohol and improvement in cancer diagnostic and therapeutic techniques.

Diet↗
PubMedDate not supplied

The spatial relationship between infant mortality and birth defect rates in a U.S. city.

The spatial patterns of infant mortality and birth defect rates in the Des Moines, Iowa, urban region are described as a contoured surface based on the punctual kriging of address-matched vital statistics records from The Iowa Department of Public Health. Areas defined as having high rates are shown to be sensitive to the size of the spatial filtering units. There is no correlation between infant mortality and birth defect rates in the region. The significance of areas with high rates is determined by a Monte Carlo simulation procedure. One area of high infant mortality is found in the region, which contrasts with many smaller areas with high birth defect rates in the region. The observed birth defect rate pattern is consistent with the hypothesis that each birth was equally likely to result in a birth defect, while the infant mortality pattern is unlikely to be the result of such an equal likelihood process.

Congenital Abnormalities↗