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PubMed1994

Etiology of low-birthweight birth: a population-based study.

BACKGROUND: Preterm and low-birthweight births remain the major correlates of infant mortality in the United States. The recognition that these births result from varying proximal etiologies is essential to the development of preventive strategies specific to each etiologic group. METHODS: Using vital statistics data tapes provided by the North Carolina Center for Health and Environmental Statistics, mothers in 20 counties who delivered infants with birthweights between 1 pound and 5 pounds, 8 ounces were identified. Maternal hospital records of 4,754 women were reviewed for data about prenatal and intrapartal events. Two perinatologists classified births into four proximal etiology groups: term-lowbirthweight, medically indicated preterm birth, preterm premature rupture of membranes, and idiopathic preterm birth. Information from birth certificate and hospital records was merged to provide an expanded data set. RESULTS: Race, age, education, and marital status are associated with different patterns of proximal etiology. Rates were higher for all etiologies in black women and in young women; however, the absolute number of LBW births was highest among white women. Idiopathic preterm birth was highest in black women and decreased as age increased; medical indications for preterm birth increased with increasing age. CONCLUSIONS: Classification of LBW births by etiologic group provides insights of value to both clinicians and researchers. Studies in which LBW and/or preterm birth are the outcome variables will be enhanced by identifying etiology. Multiple preventive strategies should address varying etiologic groups.

Adolescent↗
PubMed1993

Melanoma: linked temporal and latitude changes in the United States.

The rise in the incidence and mortality from melanoma of the skin is slowing down in younger age groups in the United States. In many White populations, including that of the US, melanoma incidence and mortality rates increase according to proximity of residence to the Equator. Variations with age in this gradient do not seem to have been examined. We examined how the influence of latitude on melanoma rates varied with age. Estimates of age-specific trends by time and by latitude for natural logarithm (Ln) melanoma incidence-rates from the Surveillance, Epidemiology and End Results (SEER) programs, and Ln melanoma mortality rates from the US Vital Statistics were derived from fitted regression equations. Unexpectedly, a decline from old age to youth in the influence of latitude was found for both incidence and mortality from melanoma of the skin in males, and for mortality in females. Further, these changes in the relationship to latitude with age correlated with the changes in time trends with age. The link with exposure suggests that the time trends in melanoma are driven by variations in damage to melanocytes in early life that increases sensitivity to sunlight. This has implications for the general understanding of melanoma etiology and for health education.

Adolescent↗
PubMed1995

An economic analysis of pregnancy resolution in Virginia: specific as to race and residence.

This study analyses an economic model of pregnancy resolution; that is, a model of the choice by a pregnant woman to abort her fetus or carry it to term. This analysis, using an analytical model derived from the household utility framework, adds to previous research by presenting race- and residence-specific estimates of how individual characteristics, history of abortion, and the community-based factors determine women's choices of giving birth vs. aborting. The main data for estimating the model were drawn from the 1984 vital statistics of all induced abortions and live births in the Commonwealth of Virginia. The major findings indicate that low parental education, high maternal age, previous early abortions, and the availability of abortion providers all significantly reduce the probability of choosing the live birth option. Married status and the availability of family planning clinics significantly increase the probability of the live birth option. The findings also suggest that women's choices between abortion and live birth vary substantially with race (White vs. Black) and residential (urban vs. rural) location.

Abortion, Induced↗
PubMed1986

Young adult mortality as an index: associations with income and social indicators.

In an effort to find an indicator for use in studies of the epidemiological impact of drug abuse in California in the late 1960s, we recognized that, for comparative analyses, cause specific mortality was less attractive than total mortality of the population group principally affected, young adults. This paper examines the all cause mortality; and its major components for young adults, age 15-24, (Young Adult Mortality, YAM) for the U.S. as it varied over time and for various countries in relation with income and social indicators. Between 1961 and 1969 in the United States a striking overall increase occurred (40.6%) with motor vehicle accidents a dominant cause which neither accounted for, all the increase, nor for the racial gradients. Male rates are higher than female rates. In the U.K. a steep and persistent social class gradient has been shown. Comparative studies done among countries whose vital statistics are reported to the World Health Organization, were analyzed in relation to international social and economic indicators. Countries with a Per Capita Income (GNP/person) below $3,000 show a striking increase in mortality from diseases with decreasing income, but above $3000 GNP/person "environmental" (non-disease) causes of death begin to increase, so that total mortality increases with increasing income. Two distinct groups of "industrialized countries" can be identified, seven with low mortality, and ten with high mortality. Per capita expenditure on education and ethnic homogeneity appear to be the social indicators which best discriminate between these two groups of countries.

Accidents, Traffic↗
PubMed1987

Software for health care analysts: a modular approach.

The many concerns about the cost and quality of health care suggest the need to facilitate planners' using existing data bases for utilization review, program evaluation, and technology assessment. Despite both the availability of relevant data and widespread improvements in computing power, integrated computer software to permit analyses by nonspecialists has not previously been developed. This paper discusses the features of a health policy information system which aids working with hospital discharge abstracts, medical claims, cancer registries, and vital statistics files. Analyses of small area utilization, length of stay, in-hospital mortality, and readmissions are facilitated by this package. This information system, named the Health Applications System, includes an analysis module, three information management modules, and a set of record linkage modules. The modules were developed using the macroprocessor in the fourth-generation SAS system. Features of the software and their implications for data analysis are discussed.

Data Interpretation, Statistical↗
PubMed1990

The effects of monthly temperature fluctuations on mortality in the United States from 1921 to 1985.

The impact of short-term temperature fluctuations on mortality has been studied mainly on historical populations, thus providing a limited ability to generalize to contemporary conditions, which would be more useful in determining public health policies aimed at reducing mortality. Therefore, this study examined the effects of monthly temperature fluctuations on mortality in the United States from 1921 to 1985. Monthly data about mortality from the Vital Statistics and temperature from the National Oceanic and Atmospheric Administration and the US Department of Agriculture Weather Bureau were used. Six states were selected to be studied (Massachusetts, Michigan, Washington, Utah, North Carolina, and Mississippi). The analysis was carried out using distributed lag models. The analysis showed that warmer than usual temperatures in July and August, and unusually cold temperatures from January to June are linked to higher mortality. From September to December unusually low temperatures are associated with higher mortality in most states, while temperature has no significant effect on mortality in June and September. In January and February mortality is especially affected by unusually cold weather in the southern states of Mississippi and North Carolina. For example, a one degree drop in the mean temperature in 1921 is associated with a more than 3.5% increase in the February crude death rate in Mississippi and North Carolina and a less than 1% increase in the four other states examined. Finally, in the months from January to March the relationship between monthly fluctuations in the crude death rate and temperature declined over time and became relatively weak by 1985.

Humans↗
PubMed1990

Projected impact of the trend toward delayed childbearing on breast cancer incidence in the Saarland/FRG.

The potential impact of the trend toward delayed childbearing or nulliparity on future breast cancer incidence is quantitatively assessed for the Saarland/FRG. Distribution of age at first birth is estimated from vital statistics for seven five-year birth cohorts from 1936-40 to 1966-70. Estimates of the relative risks associated with age at first birth or nulliparity are based on median results of 23 controlled epidemiologic studies conducted in Europe and North America. Compared to the birth cohorts around 1940, a steady increase in incidence up to about +15% is projected for the younger cohorts indicating a substantial public health impact. Using data of the population based cancer registry of the Saarland, the cumulative incidence of breast cancer up to age 50 is calculated as 1.52% for the 1936-40 birth cohort and is projected to rise to 1.75% in the 1966-70 cohort. Similar changes in fertility patterns have been observed in other parts of the FRG. Given the continuing rise in mortality from breast cancer in the FRG this stresses the need for more effective screening procedures.

Adolescent↗
PubMed1995

The epidemiologic transition to chronic diseases in developing countries: cardiovascular mortality, morbidity, and risk factors in Seychelles (Indian Ocean). Investigators of the Seychelles Heart Study.

The occurrence of cardiovascular diseases (CVD) and related risk factors was evaluated in Seychelles, a middle level income country, as accumulating evidence supports increasing rates of CVD in developing countries. CVD mortality was obtained from vital statistics for two periods, 1984-5 and 1991-3. CVD morbidity was estimated by retrospective review of discharge diagnoses for all admissions to medical wards in 1990-1992. Levels of CVD risk factors in the population were assessed in 1989 through a population-based survey. In 1991-93, standardized mortality rates were in males and females respectively, 80.9 and 38.8 for cerebrovascular disease and 92.9 and 47.0 for ischemic heart disease. CVD accounted for 25.2% of all admissions to medical wards. Among the general population aged 35-64, 30% had high blood pressure, 52% of males smoked, and 28% of females were obese. These findings substantiate the current health transition to CVD in Seychelles. More generally, epidemiologic data on CVD mortality, morbidity, and related risk factors, as well as similar indicators for other chronic diseases, should more consistently appear in national and international reports of human development to help emphasize, in the health policy making scene, the current transition to chronic diseases in developing countries and the subsequent need for appropriate control and prevention programs.

Adult↗
PubMedDate not supplied

Copper IUDs, PID, and fertility in nulliparous women.

Some authors have suggested that use of IUDs (intrauterine contraceptive devices) in nulliparous women should be contraindicated because of the risk for PID (pelvic inflammatory disease); others have found nulliparous women to be suitable candidates for IUD use. Clinical studies of copper IUDs in which parous and nulliparous women have been compared with regard to risk of PID often point to young age as a risk factor, regardless of parity. Vital statistics of PID rates also show this trend. An overall PID rate of 1.49/100 woman-years (WY) was calculated from data contained in 28 of the clinical studies reviewed in this paper. These studies included 25,674 women, of whom 42.5% were nulliparous. Studies of fertility following use of copper IUDs indicate that fertility is not impaired by their use.

Adolescent↗
PubMed1989

Mortality rate of Huntington disease in Japan: secular trends, marital status, and geographical variations.

The death rate from Huntington disease (HD) in Japan was analyzed using Japanese vital statistics for 1969-1985. There was no significant change in the HD death rate over the years. The overall death rate per million population was 0.15 for both sexes. As for marital status, a quarter of the HD deaths was the single group for both sexes. There were remarkable differences in the HD death rates for each sex among the four marital categories. The geographical variations in the HD death rate were observed with the highest death rate in Tokushima prefecture (1.03). The excess of observed than expected numbers of HD deaths was obtained in the occupational category VI (other) of the head of household. The mean age at death in HD was nearly constant during the period, and overall mean age at death was 48 years for both sexes, which value was eight years shorter than that in South Wales.

Age Factors↗
PubMed1984

Analysing trends in cardiovascular mortality: some methodological points.

This paper comments on the drop in coronary heart disease mortality observed in Switzerland among middle-aged men since the mid-seventies. Several methodological points are made regarding the consistency of this decline (relationships with mortality from other causes), and the reasons for this drop (possible change in population mix). It is suggested that a more complete use of vital statistics is still possible and that this can provide useful clues for the assessment and the interpretation of mortality trends in the field of cardiovascular epidemiology.

Adult↗
PubMed1997

Descriptive Epidemiology of Male Breast Cancer in Japan.

To examine the characteristics of male breast cancer in Japan, time trends and geographical distribution of the mortality of male breast cancer were analyzed by using " Vital Statistics " over the last four decades, compared with female breast cancer mortality. The male to female sex ratio of the number of deaths from breast cancer over the period between 1950-1994 was 1:103.6. The age-specific death rates of breast cancer in males rose steadily with age while the rates in females having the peak in the latter half of the sixth decade, then decreasing, rising again in the ninth decade for the years 1973-1993. The number of deaths from breast cancer has increased, and while the crude death rate has risen from 1948-1952 to 1988-1992 in both sexes, and the increasing trend in females was larger than that in males in recent years. On the other hand, the age-adjusted death rate from breast cancer has leveled off or decreased in males while the rate in females has increased over the last few decades. Thus, the female to male sex ratios of both the number of deaths and the death rates from breast cancer increased continuously in recent years. The average age at death from breast cancer in males gained 11.7 years during the last 40 years(71.2 years old in 1988-1992 vs 59.5 years in 1948-1952), but only 3.1 years in females(58.6 vs 55.5).

Journal Article↗
PubMed1997

Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study.

OBJECTIVE: To compare the performance of the New Simplified Acute Physiology Score (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE) II in an independent database, using formal statistical assessment. DESIGN: Analysis of the database of a multicentre, prospective study. SETTING: 19 intensive care units (ICUs) in Portugal. PATIENTS: Data for 1094 patients consecutively admitted to the ICUs were collected over a period of 4 months. Following the original SAPS II and APACHE II criteria, the analysis excluded patients younger than 18 years of age, readmissions, acute myocardial infarction, burns, patients in the post-operative period after coronary artery bypass surgery, and patients with a length of stay in the ICU of less than 24 h. The group analysed comprised 982 patients. INTERVENTIONS: Collection of the first 24 h admission data necessary for the calculation of SAPS II, APACHE II, Therapeutic Intervention Scoring System (TISS), Simplified TISS, organ system failure and basic demographic statistics. Vital status at discharge from the hospital was registered. MEASUREMENTS AND RESULTS: In this cohort, discrimination was better for SAPS II than for APACHE II (SAPS II: area under the receiver operating characteristic curve 0.817, standard error 0.015; APACHE II: 0.787, 0.015; p < 0.001); however, both models presented a poor calibration, with significant differences between observed and predicted mortality (Hosmer-Lemeshow goodness-of-fit tests H and C, p < 0.001). In a stratified analysis, this study was unable to demonstrate any definite pattern of association between the poor performance of the models and specific subgroups of patients except for the most severely ill patients, where both models overestimated mortality. CONCLUSIONS: SAPS II performed better than APACHE II in this independent database, but the results do not allow its use, at least without being customised, to analyse quality of care or performance among ICUs in the target population.

APACHE↗
PubMed1997

Gastric cancer mortality and drinking water qualities in Taiwan.

The possible association between the risk of gastric cancer and nitrate and hardness in drinking water from municipal supplies was investigated in a matched case-control study in Taiwan. Data on gastric cancer deaths among eligible residents in Taiwan from 1987 through 1991 (6,766 cases) were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes (6,766 controls) and were matched individually to the cases by sex, year of birth, and year of death. Data on nitrate-nitrogen (NO3-N) and hardness levels in drinking water throughout Taiwan were collected from the Taiwan Water Supply Corporation (TWSC). The municipality of residence for cases and controls was assumed to be the source of the subject's nitrate and hardness exposure via drinking water. There was no difference in gastric cancer rates between the groups with different levels of nitrate. The odds ratios (95% confidence interval) for death from gastric cancer was 0.95 (0.87-1.03) for the group with water nitrate levels between 0.23 and 0.44 mg/L, and 1.02 (0.93-1.11) for the group with nitrate levels greater than 0.45 mg/L. However, the results show a significant negative relationship between drinking water hardness and gastric cancer mortality. Odds ratios were 1.16 (1.07-1.26) and 1.65 (1.52-1.79), respectively, for exposure to moderately hard water and soft water compared with the use of hard water. This is an important finding for the Taiwan water industry and human health risk.

Case-Control Studies↗
PubMed2003

Environmental factors affect colon carcinoma and rectal carcinoma in men and women differently.

BACKGROUND AND AIMS: Colon cancer is thought to be more closely associated with environmental factors than rectal cancer, but evidence is currently insufficient. We examined whether there are differences in the degree of environmental effect on colon cancer and rectal cancer in Japan. METHODS: We performed a birth cohort analysis for colon and rectal cancers using Japanese vital statistics from 1950 to 1998 and analyzed time trends by cancer site and gender. RESULTS: The mean annual increase in age-adjusted mortality rate from colon cancer was greater than that from rectal cancer and was greater in men than in women. In men left colon cancer showed the greatest rate of increase whereas cancer of the right colon showed only a slight change. Although left colon cancer rapidly increased until the middle 1980s and thereafter showed no change, right colon cancer showed no change until the middle 1980s and thereafter rapidly increased in men. However, the rates of increase in left colon cancer were greater than those in right colon cancer until the middle 1980s, after which a reversal in trend was seen in women. Birth cohort analysis indicates that for all cohorts the mortality rates at the same age were higher in the recent cohorts than in the previous ones. This trend was more marked for colon cancer than for rectal cancer and was stronger among men than among women. CONCLUSION: Colon cancer is more closely associated than rectal cancer with environmental factors, and this association is more pronounced in men than in women. Consequently cancers at these two sites should not be combined in studies of the role of lifestyle factors in causing these neoplasms. Furthermore, the causes of these diseases may differ in men and women.

Adolescent↗
PubMed1999

A registry for exposure and population health in the Altai region affected by fallout from the Semipalatinsk nuclear test site.

A registry of the rural population in the Altai region exposed to fallout from nuclear tests at the Semipalatinsk test site (STS) was established more than four decades after the first Soviet nuclear explosion on August 29, 1949. Information about individuals living in an exposed and a control area was collected using all available local sources, such as kolkhoz documentation, school registries, medical treatment records and interviews with residents. As a result, a database comprising an exposed group of 39 179 individuals from 53 Altai region villages, 6769 external and 3303 internal controls was compiled. For several settlements, effective dose estimates reached the level of 1.5 Sv, while the average effective dose estimate in the exposed group was 340 mSv. Dosimetric data, vital status information and health records gathered at rayon and village medical facilities are held in the registry. Cause-of-death information for deceased residents is obtained from death registration forms archived at the Altai region vital statistics office. At present, a follow-up of approximately 40% of the population exposed in 1949 has been done. More will be added by searching for migrants to the larger towns of the Altai region, i.e. Barnaul, Rubtsovsk and Biisk. In order to assess the influence of radiation exposure, analytical studies with a case-control design for stomach and lung cancer are currently being prepared. The number of known cases is sufficient to detect an odds ratio of 1.5 at the 95% confidence level. Epidemiological studies in populations affected by fallout from STS may be equally important to the atomic bomb survivors' study for the direct quantification of radiation effects. The range of exposure rates experienced will extend the acute high-dose-rate findings from Hiroshima/Nagasaki towards acute and protracted lower exposures, which are more relevant for radiation protection issues.

Environmental Exposure↗
PubMed2004

Sudden and unexpected deaths after the administration of hexavalent vaccines (diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, Haemophilius influenzae type b): is there a signal?

UNLABELLED: Deaths in temporal association with vaccination of hexavalent vaccines have been recently reported. The objective of this paper is to assess whether these temporal associations can be attributed to chance. Standardised mortality ratios (SMR) for deaths within 1 to 28 days after administration of either of the two hexavalent vaccines in the 1st and 2nd year of life were determined using the respective annual rates for sudden unexpected deaths (SUDs) from the national vital statistics. The distribution of SUD cases and the vaccination uptake by month were estimated from surveys and sales figures for the individual vaccines. Sensitivity analyses were performed to account for limitations in the data sources. For one of the vaccines, Vaccine B, all SMRs were well below one. For the other, Vaccine A, SMRs exceeded one insignificantly on the 1st day after vaccination in the 1st year of life. In the 2nd year of life, however, the SMRs for SUD cases within 1 day of vaccination with vaccine A were 31.3 (95% CI 3.8-113.1; two cases observed; 0.06 cases expected) and 23.5 (95% CI 4.8-68,6) for within 2 days after vaccination (three cases observed; 0.13 cases expected). Extensive sensitivity analyses could not attribute these findings to limitations of the data sources. CONCLUSION: These findings based on spontaneous reporting do not prove a causal relationship between vaccination and sudden unexpected deaths. However, they constitute a signal for one of the two hexavalent vaccines which should prompt intensified surveillance for unexpected deaths after vaccination.

Age Distribution↗
PubMed1999

Deaths from heat-stroke in Japan: 1968-1994.

Global warming is increasingly recognized as a threat to the survival of human beings, because it could cause a serious increase in the occurrence of diseases due to environmental heat during intermittent hot weather. To assess the direct impact of extremely hot weather on human health, we investigated heat-related deaths in Japan from 1968 through 1994, analyzing the data to determine the distribution of the deaths by age and their correlation to the incidence of hot days in summer. Vital Statistics of Japan, published by the Ministry of Health and Welfare of Japan, was the source of the heat-related mortality data employed in this study. Meteorological data were obtained from the District Meteorological Observatories in Tokyo and Osaka, the two largest cities in Japan. Heat-related deaths were most prone to occur on days with a peak daily temperature above 38 degrees C, and the incidence of these deaths showed an exponential dependence on the number of hot days. Thus, even a small rise in atmospheric temperature may lead to a considerable increase in heat-related mortality, indicating the importance of combating global warming. Furthermore, half (50.1%) of the above-noted deaths occurred in children (4 years and under) and the elderly (70 years and over) irrespective of gender, indicating the vulnerability of these specific age groups to heat. Since a warmer climate is predicted in the future, the incidence of heat waves will increase, and more comprehensive measures, both medical and social, should be adopted for children of 4 years and younger the elderly to prevent heat-related deaths in these age groups.

Adolescent↗