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PubMed1991

Is arteriosclerosis a life prolonging, adaptive process?

Arteriosclerosis is believed by many to represent the aging process of arteries and to be responsible for the cause-specific deaths at any age in industrialized countries. However, the increasing rate of (A) associated with steadily increasing life expectancy invited studies of the average age at death (AAD) of conditions with prominent (A) (ischemic heart disease, myocardial infarction, cerebrovascular disease, "atherosclerosis"). Data were obtained from "Vital Statistics of the U.S.A.", (Vol. II, Mortality), Section 8, Tables VIII-V). Persons above the age of 40 were studied. The (A) groups were compared to the "normals" from whom (in addition to the groups with prominent arteriosclerosis,) accidents, suicides, homicides and other "external" causes of death were deducted. We also excluded malignancies because the AAD would have prejudiced the data in favor of our assumption. In general the (A) groups had significantly higher (AAD's) than the "normals". Exceptions were white males with ischemic heart disease whose (AAD) was lower than that of the "normals". This was also true for white males and females with myocardial infarction. Although (A) may exceed its normal function leading to lesions (e.g., myocardial infarction) in the majority of the cases it seems to be a life prolonging adaptive process which is in line with evolutionary expectations.

Adaptation, Physiological↗
PubMed1983

Homicide death rates in childhood in 23 developed countries: U.S. rates atypically high.

World Health Organization vital statistics data were used to compare U.S. homicide death rates with those in 23 other developed countries. Using rank ordering and comparison with mean and median rates for the other countries, U.S. homicide rates for the general population were found to be exceptionally high among developed countries. Similarly, U.S. homicide death rates for infants and for 1-4-year-olds were atypically high. The U.S. infant homicide rates were also unusual because of a male predominance. After infancy, high female homicide rates in the U.S. were more unusual than the male rates. The atypically high homicide risk in the U.S. apparently begins in early childhood, affecting particularly male infants and females after infancy. The data and other cited information suggest that features of U.S. society may promote homicide in childhood. The scope and nature of the U.S. childhood homicide problem warrants a focused effort to develop specific preventive approaches.

Age Factors↗
PubMedDate not supplied

A typical interdisciplinary topic: questions of the mortality dynamics.

Dynamic characteristics of mortality experience are intensely studied in demography and in experimental gerontology. The classic Gompertz-Makeham function is also a significant starting point of numerous investigations in this topic. By comparative analysis of human vital statistics, one can observe characteristic secular and topological variations of the Gompertz parameters. Some of these findings are reviewed briefly in the article. Some other related questions are also touched upon. For example, the concept of the maximum life span is criticised. A thorough overview of literature data makes it clear that the general male mortality excess is by far not so unambiguous as is widely supposed. Surprisingly simple stochastic models, published by one of us in the recent past, can serve as theoretical background for the Gompertz law. Further studies would be necessary to check the biological relevance of these models.

Journal Article↗
PubMed1994

A computerised cancer registry data and validation system in India--its implications for developing countries.

The cancer registration system in India, and an appropriate computer program to validate the cancer patient data it generates, are described, with the resource inputs, and outputs of research, training, awareness creation and cancer control, in the context of local health care systems. Computer packages already available mostly address the type of data obtainable from western health care systems. The same factors that limit health care systems in India, and probably most other developing countries--inadequate health care facilities, skeletal medical records systems, meagre and unavailable vital statistics, few trained staff, funding and computer facilities--also limit the data sent to the National Cancer Registry Programme. The computer program we developed checks for the reliability and validity of various cancer diagnostic, spread, therapeutic and outcome variables. The program is in HIBASIC for a CPM operating system with a minimum of 64 kB memory, adaptable to MS-DOS systems, population-based cancer registry data, and perhaps to other types of chronic disease registries, with relevant modifications. Since reliable cancer registry data are needed for effective cancer control measures, this program may help in such efforts in developing countries.

Computers↗
PubMed1985

A test of the National Death Index using the Coronary Artery Surgery Study (CASS).

The National Death Index (NDI) is a central, computerized index of death record information compiled from records submitted by the Vital Statistics Office of each state to the National Center for Health Statistics. A selection of 1180 cases, including 370 decedents, from the Coronary Artery Surgery Study was sent to the NDI to test the reliability of the index in identifying decedents. Five possible matching rules are considered: an NDI match with soundex included, an NDI match without soundex matches, an NDI match on social security number, an NDI match on personal data (first name, last name, sex, race, and month, day, and year of birth), and an NDI match on social security number or personal data. In determining death, the greatest positive predictive value was given by a match on social security number, while the greatest negative predictive value was given by an NDI match with soundex included. Further comparisons of sensitivity and specificity, and figures that relate predictive values to the population mortality rate, are given to assist potential users in determining an optimal matching rule.

Coronary Disease↗
PubMed1991

Risk factor changes and mortality changes: a regional perspective on ischaemic heart disease in Norway 1966-85.

This study from Oppland county, Norway, examines risk factor changes in three regions with different mortality time trends among middle-aged males, for ischaemic heart disease, including sudden, unexpected death (IHD/SUD). The study is partly based on vital statistics and on results from two health screening surveys conducted in 1976-78 and in 1981-83. Regional data for the following risk factors are considered: serum cholesterol, systolic blood pressure, body weight and prevalence of smoking. Risk factor data are from the group of men aged 40-49 years in 1976-78. Changes in risk factor levels from 1976-78 to 1981-83 did not differ substantially between regions with widely different mortality time trends. The north-western, rural part of Oppland county experienced 80% IHD/SUD-mortality increase (95% confidence interval 35%-124%) from 1966-70 to 1981-85, among males aged 40-59. The mean serum cholesterol level dropped by 1.7% (P less than 0.001) from 1976-78 to 1981-83, and the prevalence of smoking was also reduced in this region. The north-western rural region experienced a slightly more pronounced increase in mean body weight and in mean systolic blood pressure, compared to the remaining two regions of Oppland county, where the changes in IHD/SUD mortality were not statistically significant. This study has demonstrated that changes in main risk factors are not necessarily accompanied by contemporary IHD/SUD-mortality changes in the same direction. The explanation could be long time-lags before risk factors affect mortality levels. The results could also indicate the presence of other important risk factors, not evenly distributed between the regions.

Adult↗
PubMed1995

Virally induced arteriosclerosis: increased life expectancy?

The average human life expectancy has been increasing constantly since first observed in Roman Times (particularly during our century). This is usually believed to be related to such 'environmental' factors as sanitation and housing and to medical intervention. Data obtained from Vital Statistics of the United States supported the idea that these explanations are insufficient. Studies on persons who had died from conditions associated with advanced stages of arteriosclerosis (ischemic heart disease, cerebrospinal disease) showed the highest life expectancy. The inflammatory nature of arteriosclerosis and studies (by others) indicating 'protective' effects suggested that the developmental stages of arteriosclerosis (in contrast to the final stages) promote increased life expectancy. Inasmuch as certain viruses (especially the human herpes virus) are involved in the development of arteriosclerosis and because nearly everybody gets infected during childhood, this virus may be a factor in the increase of life expectancy. The work on symbiosis and on hormesis has established the fact that small amounts of parasites are often associated with beneficial effects for both the host and the parasites. All of this is in line with evolutionary expectations.

Animals↗
PubMed1995

The hypothetical epidemic of coronary heart disease and atherosclerosis.

Accurate usage of the term 'epidemic' is important scientifically and it should ideally be used to mean only contagious diseases, not used loosely or emotively to mean non-infectious diseases, particularly coronary heart disease, which is a non-specific complication of many diseases. It should not be used as a surrogate term for atherosclerosis of indefinite severity. An epidemic of atherosclerosis is impossible, there being no variation in prevalence because the disease is ubiquitous. Moreover, vital statistics are too unreliable to determine the existence of an increase or decline in coronary heart disease. A coronary heart disease epidemic could be due to an increase in non-atherosclerotic coronary heart disease or increased severity of atherosclerosis. The former has not been studied and the latter would cause a shift to the left in age distribution and is inconsistent with the fall in 'all cause' and stroke mortality rates whilst coronary heart disease mortality allegedly increased alarmingly. A coronary heart disease epidemic, having no scientific basis, negates any reason for the sustained search for a speculative causative environmental factor.

Arteriosclerosis↗
PubMed1994

Echocardiographic correlates of survival in patients with chest pain.

OBJECTIVES: This study sought to identify echocardiographic predictors of survival in patients with chest pain and to assess the utility of qualitative echocardiographic data in the prognostic stratification of this cohort. BACKGROUND: The potential usefulness of echocardiographic data in prognostic stratification of patients with acute chest pain is unclear, in part because of the qualitative nature of routinely available echocardiographic readings. METHODS: The study group comprised 513 patients who underwent transthoracic two-dimensional and Doppler echocardiography within 1 month of emergency department visits for acute chest pain. Clinical and electrocardiographic (ECG) data were recorded for these patients at the time of their initial evaluations, and echocardiographic data were subsequently obtained from the official hospital reports. Follow-up survival rate data were obtained from medical records or the Massachusetts Bureau of Vital Statistics. RESULTS: A mean of 28.5 months after the index visit, 102 patients (20%) had died, including 58 (57%) for whom the primary cause of death was cardiovascular. In analysis of routinely available qualitative echocardiographic data, left ventricular size and function, the presence of regional wall motion abnormalities, mitral regurgitation and structural abnormalities of the mitral valve were significant univariate correlates of both overall mortality and death from cardiovascular causes. Severe left ventricular dysfunction (adjusted rate ratio 3.8, 95% confidence interval [CI] 1.9-7.5) and moderate or severe mitral regurgitation (adjusted rate ratio 2.4, 95% CI 1.5-3.7) were independent predictors of mortality in a multivariate Cox regression analysis that adjusted for clinical and ECG variables. Moderate or severe left ventricular dysfunction and mitral regurgitation were predictors of mortality in the subset of patients without acute myocardial infarction. CONCLUSIONS: Qualitative echocardiographic reports of left ventricular dysfunction and mitral regurgitation were independent correlates of prognosis in patients with acute chest pain, including patients without acute myocardial infarction. Further data are needed to assess the generalizability of these findings and the implications for use of this diagnostic technology.

Acute Disease↗
PubMedDate not supplied

Dynamic model for preventing mental retardation in the population: the importance of poverty and deprivation.

A dynamic simulation model is used to answer the question, "What is the most effective child health policy initiative for the prevention of mental retardation (MR)?" The impact of medical strategies is contrasted with social interventions to see how they affect the prevalence of MR in the general population. The model is based on data from four U.S. Census and California Vital Statistics reports (1960, 1970, 1980, 1990). An interstate comparison (California and South Carolina) uses 1990 data. The results of the simulations reveal that medical interventions to improve the developmental outcome of low birth weight (LBW) infants did not cause a reduction in the rate of MR in the population after a 24-year trial period. In contrast, reducing the proportion of children living in poverty who are exposed to environmental deprivation significantly decreased (10%) MR at the end of the model's time period. This analysis supports the view that long-term reduction in MR prevalence is attainable by modifying public policies that influence children's development. Effective MR prevention calls for public policy committed to multifaceted health and educational services for both affected parents and their young children.

Adolescent↗
PubMed1989

Accuracy of diagnosis on death certificates for underlying causes of death in a long-term autopsy-based population study in Hisayama, Japan; with special reference to cardiovascular diseases.

Major categorical diagnosis by International Classification of Diseases and type-specific diagnosis for cardiovascular diseases in death certificates were compared to the diagnosis made at autopsy in 864 consecutive autopsy cases aged 20 or over, among the Japanese residents in Hisayama town. Cerebral stroke was correctly diagnosed in 84%, malignant neoplasms in 78% and cardiac disease in 66%. Cerebral stroke and cardiac disease tended to be overdiagnosed, while malignant neoplasms were underdiagnosed. The validation of certified diagnosis was less reliable in the aged population, and in type-specific diagnosis of cardiovascular diseases. Cerebral hemorrhage with false negative or false positive diagnoses was usually classified into type unspecified stroke or different categories of cerebral stroke, while those misdiagnosed as cases of cerebral infarction frequently had no significant lesions in the autopsied brain. Finally, the relationship between the validation of diagnosis on the death certificates and the secular trend in cardiovascular disease in the Japanese vital statistics was discussed.

Adult↗
PubMed1995

Decline in mortality from heart disease in Denmark: some methodological problems.

Mortality rates in Denmark from ischemic heart diseases (IHD), other heart diseases and unknown causes are presented for the period 1968-92. In all age groups, mortality from IHD is higher at the beginning of the period than at the end. For other heart disease, the plot of the mortality rate is U-shaped for the age groups 65-84 and > or = 85, but first decreases and is then constant for the age group 30-64. There are an increasing number of deaths from symptomatic heart disease. For the group of unknown causes, the rates are increasing for all sex and age groups. The relationship between deaths from IHD and deaths from unknown causes varies with period, age, sex and region. For women in Copenhagen in the age group 30-64, the mortality rate from unknown cause is higher than the rate for IHD at the end of period. Vital statistics must therefore be used cautiously in analysing trends for IHD, and even the validity of temporal changes within a country must be questioned.

Adult↗
PubMed1996

Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience.

The community surveillance component of the Atherosclerosis Risk in Communities (ARIC) Study is designed to estimate patterns and trends of coronary heart disease (CHD) incidence, case fatality, and mortality in four U.S. communities. Community surveillance involves ongoing review of death certificates and hospital discharge records to identify CHD events in community residents aged 35-74 years. Interviews with next of kin and questionnaires completed by physicians and medical examiners or coroners were used to collect information on deaths, and review and abstraction of hospital records were used to collect information on possible fatal and nonfatal myocardial infarctions (MIs). Events were classified using standardized criteria. The initial 2-years' experience with case ascertainment and availability of information needed for classification of events is described. Average annual age-adjusted attack rates of definite MI and CHD mortality rates for blacks in two communities and whites in the four communities are presented and compared with rates based on unvalidated hospital discharge data and vital statistics. Age-adjusted rates based on ARIC classification of definite MI were lower than those based on hospital discharge diagnosis code 410 (e.g., 5.60/1000 and 11.50/1000 among Forsyth County white men, respectively). Age-adjusted rates of definite fatal CHD based on ARIC classification were similarly lower than rates based on underlying cause of death code 410; for example, Jackson black men had rates of 2.82/1000 and 4.52/1000 for definite fatal CHD and UCOD 410-414 or 429.2, respectively.

Adult↗
PubMed1993

Time trends, cohort effects, and geographic patterns in stroke mortality--United States.

Trends and patterns in cerebrovascular disease mortality from 1940 to 1991 are examined using provisional and final mortality data from the US National Vital Statistics System. Trends are analyzed in terms of both period and cohort effects. Monthly data are examined using a time series regression model. Geographic patterns use maps ranking state mortality relative to the US average. Final 1989 data indicate that cerebrovascular disease remains the third leading cause of death in the United States, accounting for 145,551 deaths, or 6.8% of deaths from all causes. The age-adjusted death rate from stroke declined one-third during 1979 to 1989, more rapidly than the other ten leading causes of death. Overall, stroke mortality declined steadily from 1950 through the mid-1970s, then accelerated. On a cohort basis, each successive birth cohort since 1890 has improved their life-span experience from stroke deaths. Maps of stroke mortality demonstrate a persistent "stroke belt" in the South over the past decade.

Adult↗
PubMed2005

Mathematical models assuming selective recruitment fitted to data for driver mortality and seat belt use in Japan.

Previous research has indicated that unbelted drivers are at higher risk of involvement in fatal crashes than belted drivers, suggesting selective recruitment that high-risk drivers are unlikely to become belt users. However, how the risk of involvement in fatal crashes among unbelted drivers varies according to the level of seat belt use among general drivers has yet to be clearly quantified. We, therefore, developed mathematical models describing the risk of fatal crashes in relation to seat belt use among the general public, and explored how these models fitted to changes in driver mortality and changes in observed seat belt use using Japanese data. Mortality data between 1979 and 1994 were obtained from vital statistics, and mortality data in the daytime and nighttime between 1980 and 2001 and belt use data between 1979 and 2001 were obtained from the National Police Agency. Regardless of the data set analyzed, exponential models, assuming that high-risk drivers would gradually become belt users in order of increasing risk as seat belt use among general motorists reached high levels, showed the best fit. Our models provide an insight into behavioral changes among high-risk drivers and support the selective recruitment hypothesis.

Accidents, Traffic↗
PubMed2005

Suspicion and treatment of the macrosomic fetus: a review.

OBJECTIVE: To review the prevalence of and our ability to identify macrosomic (birthweight >4000 g) fetuses. Additionally, based on the current evidence, propose an algorithm for treatment of suspected macrosomia. STUDY DESIGN: A review. RESULTS: According to the National Vital Statistics, in the United States, the prevalence of newborns weighing at least 4000 g has decreased by 10% in seven years (10.2% in 1996 and 9.2% in 2002) and 19% for newborns with weights >5000 g (0.16% and 0.13%, respectively). Bayesian calculations indicates that the posttest probability of detecting a macrosomic fetus in an uncomplicated pregnancy is variable, ranging from 15% to 79% with sonographic estimates of birth weight, and 40 to 52% with clinical estimates. Among diabetic patients the post-test probability of identifying a newborn weighing >4000 g clinically and sonographically is over 60%. Among uncomplicated pregnancies, there is sufficient evidence that suspected macrosomia is not an indication for induction or for primary cesarean delivery. For pregnancies complicated by diabetes, with a prior cesarean delivery or shoulder dystocia, delivery of a macrosomic fetus increases the rate of complications, but there is insufficient evidence about the threshold of estimated fetal weight that should prompt cesarean delivery. CONCLUSION: Due to the inaccuracies, among uncomplicated pregnancies suspicion of macrosomia is not an indication for induction or for primary cesarean delivery.

Algorithms↗
PubMed2005

Unintentional injuries in the home in the United States Part I: mortality.

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.

Accidental Falls↗
PubMed2006

Health burden and funding at the Centers for Disease Control and Prevention.

BACKGROUND: The relationship between domestic funding for selected conditions to the Centers for Disease Control and Prevention (CDC) and the burden of disease and disability in the United States was assessed systematically. METHODS: Using mortality, years of potential life lost (YPLLs), disability-adjusted life years (DALYs), hospital days, hospital discharges, and direct medical costs of conditions, 34 high-burden conditions addressed by CDC programs were identified, and information was collected about the funds spent on each by CDC during fiscal year (FY) 2003. The 34 conditions were grouped into 15 categorical areas, and the relationship between budget and burden was analyzed using correlation and regression methods for each of the categorical areas and for each measure of burden. RESULTS: Of CDC's total FY 2003 budget of $6.9 billion, 62% ($4.3 billion) of funding was allocated to one of the 34 conditions studied. A positive relationship between budget and burden was identified for all measures of burden, although the correlations varied for the different conditions. CONCLUSIONS: Although examination of the relationship of CDC's budget to burden measures provides insight into the agency's portfolio of investments, this exercise also highlights a number of limitations with this approach and the currently available burden measures. Assessment of key public health functions such as emergency preparedness and the collection of vital statistics require development of metrics different from the burden measures used in this analysis. Investment in the development of such metrics warrants consideration.

Budgets↗