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PubMed1979

Frequency of systemic lupus erythematosus in different ethnic groups in Hawaii.

A survey of systemic lupus erythematosus (SLE) patients was conducted in civilian general hospitals on Oahu, Hawaii for the years 1970-75. One hundred sixty-eight cases were ascertained, of which 107 were considered "definite." Age-adjusted prevalence rates per 100,000 were estimated for definite cases at the end of 1975 as follows: white 5.8, Chinese 24.1, Filipino 19.9, part-Hawaiian 20.4, and Japanese 18.2. There was a heavy preponderance of females in each ethnic group, averaging 90% of the definite cases overall. Review of vital statistics for the United States and Hawaii during this period showed age-adjusted SLE mortality rates per million as follows: U.S. white 3.04, U.S. non-white 8.82, Hawaii white 1.89, Hawaii non-white 14.46. The cause of the very high SLE prevalence and mortality in the Oriental and Polynesian people of Hawaii is not clear.

Adolescent↗
PubMed1996

The epidemiology of Wegener's granulomatosis. Estimates of the five-year period prevalence, annual mortality, and geographic disease distribution from population-based data sources.

OBJECTIVE: To estimate the prevalence, annual mortality, and geographic distribution of Wegener's granulomatosis. METHODS: Analysis of national vital statistics data and hospitalization data from a national survey and from all New York State inpatient facilities. RESULTS: Between 1979 and 1988, 1,784 death certificates in the United States listed Wegener's granulomatosis as a cause of death. Nationally, an estimated 10,771 hospitalizations included Wegener's granulomatosis among the discharge diagnoses. In New York State, there were 978 hospitalizations among 571 individuals with Wegener's granulomatosis. CONCLUSION: The prevalence of Wegener's granulomatosis in the United States is approximately 3.0 per 100,000 persons. Clear differences in the geographic distribution of Wegener's granulomatosis are apparent when analysis consider rates of disease in individual counties. Contrary to previous reports, associations between disease exacerbations and season were not apparent.

Adolescent↗
PubMed2006

Mortality in systemic lupus erythematosus.

OBJECTIVE: To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled. METHODS: Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined. RESULTS: The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration <1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001. CONCLUSION: Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.

Adolescent↗
PubMed1989

Hypertension as a cause of lower than expected death rates from coronary artery disease among blacks.

Coronary risk factors are more prevalent among blacks than whites in the United States. It is therefore paradoxical that age-adjusted death rates for coronary artery disease (CAD) are similar in the two racial groups. The major risk factor for CAD that is more common among blacks than whites is hypertension, which increases the risk of CAD by two- to fourfold, depending on the presence of smoking, hypercholesterolemia, or other factors. Two general hypotheses have been advanced to explain the lower than expected CAD rates among blacks: (1) the presence of some protective factors, such as increased levels of high density lipoprotein cholesterol (HDL); or (2) selective loss of CAD-prone black individuals due to other causes of mortality. Analysis of age-specific death rates from the vital statistics records strongly suggests that differential survival in the black and white populations, i.e., mortality selection, is the primary explanation of this phenomenon. We sought to test this hypothesis by examining an entirely independent data base. Data from the National Hospital Discharge Survey for the years 1973-1984 were evaluated to determine whether there were age-related differences in case-fatality rates between whites and blacks, and whether a crossover pattern in mortality could be discerned. The results demonstrate that in-hospital case-fatality rates for acute myocardial infarction (MI) were 10% to 70% higher for each of the 10-year age groups for blacks up to age 70 years, at which time a crossover occurred. The median age at which death due to MI occurred in blacks was approximately 5 years earlier than in whites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

The mortality rate from anorexia nervosa.

OBJECTIVE: We determined the standardized mortality ratio (SMR) in our anorexia nervosa (AN) patient population. METHOD: We used a cross-sectional design to study an inception cohort (1981-2000) drawn from the provincial tertiary care eating disorders program at St. Paul's Hospital (British Columbia, Canada). All patients who completed their initial assessment for an eating disorder were included in the study. Vital status, date and cause of death from British Columbia Vital Statistics Agency, date of assessment, date of birth, and diagnosis at the time of assessment were collected for each patient. RESULTS: Of 954 patients, 326 diagnosed with AN completed an assessment over the 20 years. The SMR was 10.5 (95% confidence interval [CI] = 5.5-15.5) for AN. DISCUSSION: Some studies in the literature report that AN has the highest mortality rate of any psychiatric disorder in young females. However, others dispute this fact and report an SMR lower than the normal population mortality (SMR = 0.71). Contrary to some reports in the literature, our study confirms a high mortality rate within the AN population.

Adult↗
PubMedDate not supplied

Malignant lymphomas in Japan: epidemiological analysis on adult T-cell leukemia/lymphoma.

According to the Vital Statistics Japan Series in 1950-1981, the age-adjusted death rate for malignant lymphomas (ICDs, 200-202) in Japan has increased in recent years. A geographical clustering of malignant lymphomas in the Kyushu districts was observed both in the period 1969-1971 and more recently in 1979-1981. The excessive rate of malignant lymphomas in Kyushu was due to the high incidence of adult T-cell leukemia/lymphoma (ATLL). The distribution of healthy carriers of ATLV, a human retrovirus which is almost identical to HTLV, was closely related to that of patients with ATLL in Japan. Epidemiological features of the infectious mode of ATLV suggested two main routes of natural transmission, one from mother to child and the other from husband to wife. ATLV is considered to be a main causative agent of ATLL from virological and epidemiological evidence, but infection by this virus alone may not result in ATLL because the incidence of ATLL among ATLV carriers was apparently not very high even in endemic areas of ATLL. Thus, some risk factors other than ATLV, such as environmental and genetic factors, may contribute to the development of ATLL.

Age Factors↗
PubMed2004

Null association between pregnancy termination and breast cancer in a registry-based study of parous women.

Studies suggesting a positive association between pregnancy termination and breast cancer risk have often been of retrospective case-control design, so subject to selection and recall biases. We undertook a registry-based analysis with minimal selection bias and prospective record-based ascertainment of terminations. The source population comprised Massachusetts women with a record of giving birth between 1987 and 1999 in the Massachusetts Vital Statistics Registry. Primary breast cancer cases were 25-55 years old at diagnosis between 1988 and 2000 and had a record of the diagnosis in the Massachusetts Cancer Registry. We matched 3 controls to each case on maternal age, year of giving birth and birth facility. Information on terminations (induced and spontaneous) before the birth of record, the matched factors and potential confounders were collected from the birth certificate. After adjustment for the matched factors, age, parity and maternal and paternal education, the odds ratio associating any termination history with breast cancer risk equaled 0.91 (95% CI = 0.79-1.05). The marginally protective adjusted odds ratio largely derived from a protective effect among women with parity equaled to 1 (OR for any termination = 0.68; 95% CI = 0.45-1.03), suggesting a protective effect of terminated pregnancy among women with one live birth.

Abortion, Induced↗
PubMed1994

Cancer mortality trends in Uruguay 1953-1991.

Cancer mortality trends from 1953 to 1991 were assessed by means of data supplied by the Department of Vital Statistics of the Ministry of Public Health. The population at risk was obtained from the Bureau of Statistics and Censuses. Age-specific and age-adjusted mortality rates were calculated, using the world standard population, for a number of sites or groups of sites. In order to obtain relative risks of death for each period, Poisson regression models were fitted to the data using the GLIM program. The main model included age and period as explanatory variables. Among males, the principal increase was observed for lung cancer, followed by prostatic cancer. The rates were mainly stable in colon cancer and leukaemias, whereas gastric cancer showed a marked decline. Also, a recent decline was seen for oesophageal cancer. In females a steady decline in mortality was observed for all sites combined. Major decreases were seen for oesophageal, gastric, cervical and total uterine cancers. The only cancers showing significant increases were breast cancer, and lung cancer for the most recent period. Providing that there were no changes in death registration or in survival rates, changes in prevalence of risk factors might be responsible for the observed trends.

Adolescent↗
PubMedDate not supplied

Improved surveillance of maternal deaths.

This study explains and verifies an apparent increase in the New Jersey resident maternal mortality rate from 1.7 per 10,000 live births by the state's traditional method to 3.1 per 10,000 live births by a new method of surveillance instituted in late 1974. In 1975, the maternal mortality rate by the traditional method was 1.5 per 10,000 and by the expanded method, 3.0 per 10,000. The traditional method compiled data from death certificates submitted to the State Vital Statistics Office. The expanded method found additional deaths by review of Annual Maternity Services Reports from hospitals and by close follow-up of individual reports of maternal deaths from medical examiners, physicians and hospitals.

Adolescent↗
PubMed2007

Cost-effectiveness of screening for hepatopulmonary syndrome in liver transplant candidates.

The hepatopulmonary syndrome (HPS) is present in 15-20% of patients with cirrhosis undergoing orthotopic liver transplantation (OLT) evaluation. Both preoperative and post-OLT mortality is increased in HPS patients particularly when hypoxemia is severe. Screening for HPS could enhance detection of OLT candidates with sufficient hypoxemia to merit higher priority for transplant and thereby decrease mortality. However, the cost-effectiveness of such an approach has not been assessed. Our objective was to perform a cost-effectiveness analysis from a third-party payer's perspective of screening for HPS in liver OLT candidates. The costs and outcomes of 3 different strategies were compared: (1) no screening, (2) screening patients with a validated dyspnea questionnaire, and (3) screening all patients with pulse oximetry. Arterial blood gas analyses and contrast echocardiography were performed in patients with dyspnea or a pulse oximetry (SpO(2)) < or =97% to define the presence of HPS. A Markov model was constructed simulating the natural history of cirrhosis in a cohort of patients 50 years old over a time horizon of their remaining life expectancy. Transition probabilities were obtained from published data available through Medline and U.S. vital statistics. Costs represented Medicare reimbursement data at our institution. Costs and health effects were discounted at a 3% annual rate. No screening was associated with a total cost of 291,898 dollars and a life expectancy of 11.131 years. Screening with pulse oximetry was associated with a cost of 299,719 dollars and a life expectancy of 12.27 years. Screening patients with the dyspnea-fatigue index was associated with a cost and life expectancy of 300,278 dollars and 12.28 years, respectively. The incremental cost-effectiveness ratio of screening with pulse oximetry (compared to no screening) was 6,867 dollars per life year gained, whereas that of the dyspnea-fatigue index (compared to pulse oximetry) was 55,900 dollars per life year gained. The cost-effectiveness of screening depended on the prevalence and severity of HPS, and the choice of screening strategy was dependent on the sensitivity of the screening modality. In conclusion, screening for HPS, especially with pulse oximetry, is a cost-effective strategy that improves survival in transplant candidates predominantly by targeting the transplant to the subgroup of patients most likely to benefit. The utility of screening depends on the prevalence and severity of HPS in the target population.

Cost-Benefit Analysis↗
PubMed2004

Intrauterine growth retardation in full-term newborn infants with birth weights greater than 2,500 g.

Intrauterine growth retardation (IUGR) is an overlooked problem in full-term infants with birth weights greater than 2,500 g. Birth weight less than the 10th percentile underestimates the presence of IUGR. The purpose of this study was to determine the prevalence of IUGR in full-term infants and to identify sociodemographic and maternal characteristics associated with IUGR. The Ohio Department of Health Vital Statistics database was used to obtain data related to sociodemographic and maternal characteristics. The fetal growth ratio (FGR) was used to determine the presence of IUGR. The sample consisted of 1,569 infants with normal ratios and 1,364 infants classified as IUGR. Infants with IUGR were more often male and African American or Asian American. Maternal characteristics associated with IUGR included history of smoking during pregnancy, lower pre-pregnancy weight, lower weight gain during pregnancy, and inadequate prenatal care. IUGR is present in a significant number of full-term infants with birth weights greater than 2,500 g. The long-term effects of IUGR in these infants remain to be determined.

Black or African American↗
PubMed1992

Applications of crude incidence curves.

Crude incidence curves display the cumulative number of failures of interest as a function of time. With competing causes of failure, they are distinct from cause-specific incidence curves that treat secondary types of failures as censored observations. After briefly reviewing their definition and estimation, we present five applications of crude incidence curves to show their utility in a broad range of studies. In some of these applications it is helpful to model survival-time distributions with use of two different time metameters, for example, time from diagnosis and age of the patient. We describe how one can incorporate published vital statistics into the models when secondary types of failure correspond to common causes of death.

Antineoplastic Agents↗
PubMed1997

Design and analysis of epidemiological studies of excess cancer among children exposed to Chernobyl radionuclides.

Within the last decade, a substantial amount of attention has been devoted to etiological research on the association between exposure to fallout radionuclides from the Chernobyl accident and radiation-induced late effects (cancer) among children. A majority of the studies completed to date have been of the descriptive type, which only correlate average population exposure with average rate of cancer incidence as a function of calendar period. Since individual dosimetry is not performed in descriptive studies, it is unclear whether exposure precedes the development of cancer and a final decision cannot be made regarding the association between radiation exposure and cancer. This paper reviews the background epidemiology and outlines an analytical study design that is needed to clarify the unclear association between Chernobyl fallout exposure and childhood cancer. We discuss the essential elements of an analytical case-control design such as genetic predisposition, vital statistics, sample size and power determinations, ascertainment of cases and controls, and phenomenological dose modeling to establish individual doses. Examples such as cytogenetic biodosimetry, medical radiation dosimetry, and cytogenetic characterization of leukemia to minimize exposure and diagnostic misclassification are provided. We recommend the analytical methods described in this paper for studying the role of Chernobyl radionuclides and development of childhood cancer.

Adolescent↗
PubMed2002

Timing of prenatal care initiation and risk of congenital malformations.

BACKGROUND: Although previous studies provide some evidence that timing of prenatal care initiation is associated with risks of congenital malformation, the issue has not previously been examined in depth. This study uses data from a large population-based registry to explore the association of timing of prenatal care initiation with risks of selected congenital malformation phenotypes. METHODS: Data on cases were grouped according to four-digit malformation codes of the International Classification of Diseases, Ninth Revision (ICD-9). A randomly selected group of 10,000 nonmalformed deliveries served as the comparison group. Information on month of initiation of prenatal care (categorized as during months 1-3 of gestation, months 4-7, or after month 7) and other maternal characteristics were derived from vital statistics data. RESULTS: Among the 176 four-digit ICD groupings, 67 had an adjusted odds ratio for at least one of the two prenatal care categories that was either < or = 0.67 or > or = 1.50. Later prenatal care initiation was associated with risk > or = 1.50 for most groups. Later care was associated with risk < or = 0.67 for only two groups, and the effects were imprecise. Statistical interaction between parity and prenatal care was indicated for 13 groups (P < 0.10). Risks among women with no previous pregnancy tended to increase with later prenatal care initiation; risks among parous women tended to be somewhat weaker. In general, associations applied to a wide range of malformation groups. CONCLUSIONS: This is the first large-scale study of the association of timing of prenatal care initiation and congenital malformation risks. Further defining the phenomena that surround prenatal care as a marker may help clarify the etiologies of a variety of malformations.

Congenital Abnormalities↗
PubMed2002

Regional bias in birth defect prevalence rates for Arkansas: influence of incomplete ascertainment along surveillance system borders.

BACKGROUND: As part of the continuing evaluation of the Arkansas Reproductive Health Monitoring System (ARHMS), we assessed the effects on birth defect prevalence rates introduced by incomplete case ascertainment along surveillance boundaries. METHODS: Using data from ARHMS and Arkansas Vital Statistics for 1993-1998, we determined birth defect prevalence rates (per 10,000 live births), stratified by race, among three geographic comparison groups of counties. These included: (1) the Northeast Group, near the state border at Memphis, Tennessee; (2) the Central Group, surrounding Little Rock, Arkansas; and (3) the Southwest Group, near Texarkana, Texas. These counties have similar socioeconomic measures and proximity to health care facilities, but are differentiated by limitations imposed by ARHMS' surveillance borders. Maternal age-standardized rates from the control groups were used to impute expected rates, for the Northeast Group and statewide, which were compared with reported rates. RESULTS: We found that there were 620 fewer reported birth defect cases than expected for the Northeast Group. The Northeast Group's prevalence rates were approximately half of the control groups' rates (310.6 vs. 529.8, respectively, for Whites, and 240.8 vs. 550.1, respectively, for African-Americans). Incorporating the missed cases into statewide prevalence calculations could increase prevalence rates from 502.6 to 523.2 for Whites and from 527.4 to 590.7 for African-Americans. CONCLUSIONS: This study identified significant regional differences in reported birth defect rates in Arkansas. Case ascertainment might be incomplete in other surveillance systems lacking the means to share data with neighboring systems. Regional inaccuracy can hinder evaluation of localized birth defect trends or targeted prevention efforts.

Black or African American↗
PubMed2001

Declining Minamata male birth ratio associated with increased male fetal death due to heavy methylmercury pollution.

The purpose of this retrospective study was to examine the effect of methylmercury pollution on the sex ratio of offspring at birth and of fetuses at stillbirth in Minamata City, Japan, in the 1950s when severe and widespread methylmercury pollution was experienced. In 4 of 5 years from 1955 to 1959 when methylmercury pollution was most severe, lower numbers of male offspring at birth were observed in the city population. The offspring sex distributions from 1950 to 1969 by 5-year period were calculated in the overall population of Minamata City, in the most prevalent area, in fishermen (most heavily exposed occupation group) and among Minamata disease patients using data from birth certificates. We also similarly calculated the sex ratio of stillborn fetuses in the city population using Kumamoto Prefecture's vital statistics on still-birth. Decreases in male births were observed in offspring in the overall city population, in fishermen, and in maternal Minamata disease patients in the city in 1955-1959, when the methylmercury pollution was most severe. An increase in the proportion of male stillborn fetuses in the city was observed at the time. It is possible that male fetuses were more susceptible to the pollution than their female counterparts, and this could be a cause for the lower numbers of male offspring at birth.

Animals↗
PubMed2001

Coronary heart disease, hypercholesterolemia, and atherosclerosis. I. False premises.

Lipid-rich caseous debris of advanced lesions stimulated interest in the role of cholesterol and lipids in atherosclerosis. Lipid-containing arterial lesions in cholesterol-overfed animals (cholesterolosis) and xanthomatous vascular lesions in subjects with familial hypercholesterolemia were then misrepresented as being atherosclerotic and led to the development of the hypercholesterolemic/lipid hypothesis. It is untenable that cholesterol, an essential multifunctional metabolite, is pathogenic at all blood levels and hypercholesterolemia is not prerequisite for human or experimental atherosclerosis. Serum cholesterol levels display a poor correlation with atherosclerosis at autopsy and with unreliable national coronary heart disease (CHD) mortality in each sex. Atherosclerosis topography and its iatrogenic production in humans and experimentally in herbivores by hemodynamic means both support a biomechanical causation and preclude causality by any circulating humoral factor. CHD, not a specific disease, is a nonspecific complication of many diseases including atherosclerosis and cannot be equated with coronary atherosclerosis due to differences in pathology and pathogenesis. Thus, extrapolations from CHD risk factors or correlations with fallacious vital statistics to atherosclerosis are invalid. It follows that the hypercholesterolemic/lipid hypothesis evolving from false premises, misuse of CHD, scientific misrepresentation, and fallacious data has no legitimate basis.

Animals↗
PubMed2001

Trends in the mortality (1950-1997) and incidence (1975-1993) of malignant ovarian neoplasm among Japanese women: analyses by age, time, and birth cohort.

OBJECTIVE: The purpose of this study was to explore epidemiological features of malignant ovarian neoplasm in Japan. METHODS: The number of deaths from malignant ovarian neoplasm was obtained from the national vital statistics. Estimated incidence rates, based on several cancer registries, were also used for analyses. We divided the subjects into two age groups (0-29 and 30+ years) and examined secular trends in mortality (1950-1997) and incidence (1975-1993) by age, time, and birth cohort. RESULTS: The age-adjusted mortality rate has increased approximately 4-fold (from 0.9 to 3.6 per 100,000 women) from 1950 to 1997. Age-specific mortality rates showed a rising pattern in the elderly, whereas mortality in the younger people tended to increase in the 1950s and 1960s, but then decreased in the 1970s and afterward. In analyses using a mathematical model, the time effect in the population aged 0-29 years increased with advancing period up to 1970, and then decreased. The cohort effects had positive values, which indicate higher than additive influence from age/time effect, for birth cohorts from 1900 to 1935. The age-adjusted incidence rate increased approximately 1.5-fold (from 3.6 to 5.7) from 1975 to 1993. The rate increased in the early 1980s, but has remained stable since the late 1980s. Age-specific incidence rates in older age groups increased steadily up to 1985, and have remained stable since, while the rates in younger women have remained almost unchanged. CONCLUSION: The major effects on malignant ovarian neoplasm in Japan are supposed to be due to declining parity and therapeutic improvements.

Adolescent↗