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PubMed2002

Decline in mortality of coronary heart disease among whites and blacks in Wisconsin 1979-1998.

OBJECTIVES: 1) To examine overall trends in Coronary Heart Disease (CHD) mortality in Wisconsin from 1979 to 1998 to assess progress toward Wisconsin's "Public Health Agenda for the Year 2000" goal; and 2) to compare the trends in mortality rates due to CHD by race, gender, and age groups between the periods of 1979-1983 and 1994-1998. METHODS: Mortality data for CHD (ICD codes 410-414, 429.2) were retrieved from the Center for Disease Control and Prevention's WONDER database. Age-specific CHD mortality rates were calculated as averages over the 5-year periods, 1979-1983 and 1994-1998. Both the percentage change in mortality rates between the two periods and the number of lives saved during the 1994-1998 period as a result of change were obtained. To look at racial disparities in mortality, relative rates, that is, ratios between mortality rates of blacks and whites in the 1994-1998 period, were calculated. RESULTS: Between the two time periods (1979-1983 and 1994-1998) there was a 40% reduction of CHD mortality in most age groups for white men and women. The slowest decline in mortality occurred among black men: 11% in the 35-44 age group and less than 30% among those 55 years and older. Although the mortality rate declines for black women over the study period were similar to those for whites overall, in the 1994-1998 period mortality rates among younger black women aged 35 to 54 were 2 to 4 times higher than those for white women in the corresponding age groups. CONCLUSION: Wisconsin achieved its year 2000 objective for CHD mortality reductions in 1998, experiencing a 49% decline in CHD mortality from 1979 to 1998. Despite this overall decline, however, there was a noticeable difference in the trends among demographic groups, suggesting a further focus on racial disparities in CHD mortality.

Adult↗
PubMed2001

Social differentials in the decline of child mortality in nineteenth century Stockholm.

BACKGROUND: Mortality had declined dramatically by the end of the nineteenth century and the early twentieth century. Little is known about the development of social differentials in infant and child mortality in Stockholm at the turn of the century. This study investigates social differentials in child mortality during the years 1885, 1891 and 1910 in one parish in Stockholm. METHODS: Individual entries from computerised records originally collected for civil registration purposes in Stockholm for 1878-1925 (the Roteman Archives) were analysed with respect to social class of the head of household and marital status of the mother for 36,718 children aged 0-14 years. Age- and cause-specific mortality rates were calculated for each year of study. Cox' regression analysis was used to analyse the mortality risk (relative rates (RRs) of mortality) by socioeconomic group and by marital status of the mother. RESULTS: Child mortality rates were nearly halved between 1885 and 1910. Socioeconomic differentials in mortality between the four social classes emerged from 1891 as the overall mortality declined. The decline was sharpest in the upper and middle social classes. Children born out of wedlock had higher mortality rates than children of married mothers in all 3 years studied. CONCLUSION: The social differentials in child mortality risk were substantial and the gradient emerged sharper from 1891 to 1910. The results are in line with studies from England and Wales, Germany and the USA for the same time period. The differentials mostly increased because of a greater decline in mortality among higher socioeconomic groups.

Child, Preschool↗
PubMed2006

Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality.

This study profiles testicular cancer incidence and mortality across Europe, and the effects of age, period and generational influences, using age-period-cohort modeling. Despite a 5-fold variation in incidence rates, there were consistent mean increases in incidence in each of the 12 European countries studied, ranging from around 6% per annum (Spain and Slovenia) to 1-2% (Norway). In contrast, declines in testicular cancer mortality of 3-6% per annum were observed in the 1980s and 1990s for the majority of the 22 countries studied, particularly in Northern and Western Europe. The mortality trends in several European countries were rather stable (Romania and Bulgaria) or increasing (Portugal and Croatia). Short-term attenuations in increasing cohort-specific risk of incidence were indicated among men born between 1940 and 1945 in 7 European countries. In Switzerland, successive generations born from the mid 1960s may have experienced a steadily declining risk of disease occurrence. While the underlying risk factors responsible remain elusive, the temporal and geographical variability in incidence may point to an epidemic in different phases in different countries-the result of country-specific differences in the prevalence of one or several ubiquitous and highly prevalent environmental determinants of the disease. Advances in treatment have led to major declines in mortality in many European countries from the mid 1970s, which has translated to cohorts of men at successively lower risk of death from the disease. Slower progress in the delivery of optimal care is however evident from the mortality trends in several lower-resource countries in Southern and Eastern Europe. The first beneficiaries of therapy in these populations may be those men born--rather than diagnosed--in the era of major breakthrough in testicular cancer care.

Adult↗
PubMed1982

The contribution of medical measures to the decline of mortality from respiratory tuberculosis: an age-period-cohort model.

The decline of mortality in the more developed nations has been related to two major influences, economic development and the introduction of medical measures. The contribution of medical measures has been a source of continuing controversy. Most previous studies employ either a birth cohort or calendar year arrangement of mortality data to address this controversy. The present study applies an age-period-cohort model to mortality from respiratory tuberculosis in England and Wales, Italy, and New Zealand in an attempt to separate economic influences from that of medical measures. The results of the analysis indicate that while the overall contribution of medical measures is small when examined by calendar year, specific birth cohorts both in Italy and in England and Wales benefited substantially from these measures. The environmental conditions in New Zealand, however, were such that the introduction of medical measures barely affected declining mortality levels from respiratory tuberculosis.

Adolescent↗
PubMed1997

Death and taxes: longer life, consumption, and social security.

We analyze in three steps the influence of the projected mortality decline on the long run finances of the Social Security System. First, on a theoretical level, mortality decline adds person years of life which are distributed across the life cycle. The interaction of this distribution with the age distribution of labor earnings minus consumption, or of taxes minus benefits, partially determines the corresponding steady state financial consequences of mortality decline. The effect of mortality decline on population growth rates also matters, but is negligible in low mortality populations. Second, examination of past mortality trends in the United States and of international trends in low mortality populations, suggests that mortality will decline faster than foreseen by the Social Security Administration's forecasts. Third, we combine the work of the first two parts in dynamic simulations to examine the implications of mortality decline and of alternative forecasts of mortality for the finances of the social security system. Also, we use stochastic population forecasts to assess the influence of uncertainty about mortality decline on uncertainty about finances; we find that uncertainty about fertility still has more important implications than uncertainty about mortality, contrary to sensitivity tests in the official forecasts.

Actuarial Analysis↗
PubMed1981

Trends in coronary heart disease mortality and associated risk factors in New Zealand.

Coronary heart disease mortality declined by 17 percent and 14 percent for New Zealand European men and women respectively between 1968 and 1978. The fall occurred in all age groups and in Maoris and cannot be attributed to change in diagnostic fashions. The decline has been associated with a decrease in the consumption of diary products and more recently with a levelling off of cigarette smoking, an increased awareness of the importance of treating hypertension, and an apparent increase in habitual physical activity in the community. There have also been improvements in the medical management of patients with coronary heart disease which may be contributing to the continuing decline in mortality rates. A programme to monitor trends in CHD incidence and case fatality and the level of risk factors in the community is required to elucidate the reasons for the decline in CHD mortality.

Adult↗
PubMed1994

Diarrhoea and mortality in Menoufia, Egypt.

From 1982 the Ministry of Health of Egypt implemented the National Control of Diarrhoeal Diseases Project (NCDDP) which attempted to improve case management of childhood diarrhoea by making oral rehydration salts (ORS) widely available and used, to improve feeding patterns during diarrhoea, and other measures. National data indicate a high level of success in achieving the targets. However, impact evaluation is hampered by weak national baseline information available prior to NCDDP on case management of diarrhoea and causes of infant and childhood mortality. A study in Menoufia Governorate in 1979-80 obtained such information. Consequently, in 1988 the area was revisited to examine subsequent changes. Findings showed marked improvement in case management of diarrhoea and rapid mortality decline, with diarrhoeal mortality apparently declining somewhat faster than mortality from other causes.

Child↗
PubMed2001

Increasing use of inhaled steroids associated with declining asthma mortality.

Increasing worldwide asthma prevalence and mortality has led to greater advocacy of inhaled agents, especially steroids. To determine whether corresponding drug usage trends had ensued locally, wholesale data (expressed as defined daily doses (DDDs)/1000 inhabitants/day) were compared for inclusive periods 1984-1986 and 1992-1994. Whereas absolute usage of anti-asthmatics increased by 79%, proportional inhaled usage increased markedly, especially of steroids (571%) and in hospitals. An odds ratio trend analysis revealed asthma mortality from 1992 onward had declined, particularly in males (p < 0.001). In Hong Kong, despite increasing asthma prevalence, more intensive use of anti-asthmatic drugs (especially inhaled steroids) was associated with declining asthma mortality.

Administration, Inhalation↗
PubMed1983

Changing mortality of peptic ulcer disease in Germany.

This study examines mortality of gastric ulcer and duodenal ulcer in the Federal Republic of Germany during the period 1952-1980. The data originate from tabulations of the German Federal Office of Statistics. In women, mortality due to gastric and duodenal ulcer increased; in men, duodenal ulcer mortality remained constant and gastric ulcer mortality declined. Overall mortality of peptic ulcer declined from 7.0 to 6.0 deaths per 100,000 inhabitants and year. Since 1952, the average age at death has increased for both ulcer types and sexes. This was due to an increase of mortality in the older age groups; in men, mortality concomitantly decreased in the younger age groups. Women died of peptic ulcer older than men. In the 1950s none but the group of women gastric ulcer patients died as old as the nonulcer subjects, all other groups of peptide ulcer (female duodenal ulcer, male gastric ulcer and duodenal ulcer) died younger than the nonulcer subjects. In more recent years, both male and female gastric ulcer and duodenal ulcer patients died at the same age or even older than nonulcer subjects. It is concluded that peptic ulcer has changed from a lethal disease of the mid- and old-age groups to a lethal disease predominantly in the old- and very-old-age groups. The time-course of peptic ulcer mortality is different in the Federal Republic of Germany from what has been described in other Western States, especially in the United States and England. This difference suggests that, similar to healing, mortality of peptic ulcer is characterized by geographic variations, and that the time-course observed in one country does not necessarily hold true for other countries.

Adolescent↗
PubMed1996

Declining cancer mortality in the United States.

BACKGROUND: The overall age-adjusted cancer mortality rate had been increasing in the United States for as long as such statistics have been kept. This trend was reversed and a decline in cancer mortality began in 1991. METHODS: Vital statistics of the United States provided annual age-adjusted mortality rates for all forms of cancer and for lung carcinoma. Information from the Surveillance, Epidemiology, and End Results Program was also used to evaluate the effects on mortality of declining 5-year cancer case fatality. RESULTS: The overall age-adjusted cancer mortality rate declined in each succeeding year from 1990 to 1995 for a total reduction of about 3.1%. A major reduction occurred in lung carcinoma, which declined by 3.9%. Other smoking-related cancers declined by about 2%. The 5-year case fatality declined by approximately 0.5% per year from 1950-1954 to 1986-1991 for forms of cancer for which lead-time bias could be largely excluded. CONCLUSIONS: Both cancer prevention activities, especially those directed against smoking, and improvements in medical care have produced an appreciable reduction in cancer mortality in the United States. The nature of these changes suggests that the now ongoing decline will be sustained for the immediately foreseeable future.

Humans↗
PubMed1999

Declining HIV/AIDS mortality in New York City.

BACKGROUND: New York City has only 3% of the U.S. population but has reported nearly 16% of all AIDS cases. METHODS: This is an observational study using the New York City vital events and AIDS case surveillance registries to describe trends in HIV/AIDS mortality from 1983 through June 30, 1998. RESULTS: Annual HIV/AIDS deaths increased steadily until stabilizing at 7046 in 1995, declined 29% to 4998 in 1996, and declined 47% to 2625 in 1997. Comparing data from 1997 with those from 1995, declines occurred in all demographic groups and in all major HIV transmission categories: 74% in men who have sex with men, 68% in injecting drug users, and 64% in heterosexuals. In the first 6 months of 1998, declines were smaller than they had been in previous 6-month intervals in all demographic groups except Hispanic males and those between 35 and 44 years of age. From 1995 to the first 6 months of 1998, the number of people living with AIDS in New York City increased 22% (from 32,692 to 39,976). CONCLUSIONS: The precipitous 63% decline in HIV/AIDS deaths from 1995 to 1997 occurred at the same time that more effective antiretroviral therapies became widely available. The slowing in the mortality decline observed in 1998, however, suggests that although these new therapies may have a profound effect at the population level, deaths due to AIDS will continue.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Declining perinatal mortality in Finland between 1987 and 1994: contribution of different subgroups.

OBJECTIVE: To examine the extent to which the decline in perinatal mortality is attributable to some subgroups, especially to certain birthweight or gestation groups. STUDY DESIGN: A register study using the Finnish Medical Birth Register for years 1987 to 1994. RESULTS: Of the overall reduction in perinatal mortality from 8.8 to 6.7 per 1000 births, 78% was due to stillbirths, compared with 22% due to early neonatal deaths. The decline in mortality among infants who weighed under 1500 g at birth was the major contributor (62%) to the overall reduction in perinatal mortality. The largest decline in mortality in the stillbirth group occurred among those weighing < 1000 g, while for early neonatal deaths the group most affected weighed 1000-1499 g. A similar pattern emerged when the gestation-week groups were examined. CONCLUSION: The decline in perinatal mortality is attributable to stillbirths of very low birthweight. The most likely explanations for this result are the improved antenatal and neonatal care and the wider use of malformation screening.

Abortion, Spontaneous↗
PubMed1991

Relationship of hospitalized stroke rate and in-hospital mortality to the decline in US stroke mortality.

Data from the National Hospital Discharge Survey was used to estimate the admission rate and in-hospital mortality for US stroke patients from 1970 to 1987. Over this period the hospital admission rate increased from 5.0 per 1,000 population to 5.5 per 1,000, while the in-hospital mortality fell from 18.6 to 10.0% of discharges. When patients experiencing general or late effects or transient ischemic attacks were excluded, the hospital admission rate increased from 2.8 to 4.8 per 1,000 and in-hospital mortality fell from 26 to 12% of discharges. Admission rates increased from 1970 to 1987 for both hemorrhagic strokes and cerebral infarctions, but fell for ill-defined cerebrovascular events, presumably reflecting increased use of computed tomography and magnetic resonance imaging during this period. Mortality for hemorrhagic strokes decreased from 45 to 30% of discharges, mortality for infarctions decreased from 24 to 13% and mortality for ill-defined events fell from 24 to 17%. There are several limitations with the use of the National Hospital Discharge Survey data to estimate changes in hospital admission rates and in-hospital mortality. However, these data suggest a greater role for decreasing case fatality in explaining nationwide declines in stroke mortality rates than has generally been acknowledged.

Acute Disease↗
PubMed2003

[Health economics analysis of breast cancer screening].

INTRODUCTION: The organized breast cancer screening programme has started in Hungary at the end of 2001. AIM: To assess the screening rate, the cost of screening and treatment and to calculate the expected epidemiological and economic gain and cost-effectiveness of mass-screening programme. METHODS: The data derive from the financial database of the National Health Insurance Fund of Hungary from 2001. To assess the screening rate the authors used the code "No. 42400 mammography screening" of outpatient care. The cost of treatment includes the cost of outpatient care, the acute and chronic inpatient care, the subsidies of the prices of medicines and the expenditure on disability to work (including sickness-pay). The expected benefits of the screening programme were modeled with changing mortality decrease for a 10 years interval. RESULTS: The screening rates of women aged 45-65 for 2001 and 2002 were 7% and 21.7%, respectively. The cost of treatment of breast cancer was around 8.6 billion Hungarian forints (29,939,868 USD, 33,426,321 EUR) in 2001. In the age-group 45-65 with 10% mortality decline 509 lives (net present value, NPV: 365), with 20% mortality decline 1.074 (NPV: 772) lives and with 30% mortality decline 1.582 (NPV: 1.139) lives can be saved during a 10 years screening programme. The cost of one life saved varies between 5.7 million forints (19,876 USD, 22,190 EUR)/life saved and 17.8 million forints (62,047 USD, 69,273 EUR)/life saved according to the mortality decline. The cost of one life year saved varies between 271,000 forints (946 USD, 1057 EUR)/life year saved and 847,000 forints (2955 USD, 3299 EUR)/life years saved. CONCLUSION: The implementation of organized breast cancer screening can lead to cost savings in Hungary. The cost-effectiveness of breast cancer screening seems to be acceptable for purchaser.

Breast Neoplasms↗
PubMed2001

Demographers and the study of mortality: scope, perspectives, and theory.

Demographers have for a long time adopted an empirical approach to the study of the levels and trends of mortality, fertility, and population size. They depend for their analyses on data, usually collected until recent times by government and often for other purposes. Modern demography had its origins in Britain in the second half of the seventeenth century. The major focus of demographers has usually been on mortality, although fertility studies predominated in the 1960s and 1970s. Mortality decline in the West only became certain in the late nineteenth century. Until the 1960s the fastest mortality declines were for the young, but an unheralded mortality decline among the old thereafter became important. The world, especially in economically advanced countries, is faced with an increasingly high proportion of old people, explained largely, not by mortality decline, but by fertility decline. Explanations for the mortality transition place different emphases on the role of modern medicine, better nutrition, and behavioral and social change, particularly rising levels of education. Even among the old, at least until 85 years of age, there are wide differentials in mortality by educational level. Analysts have divided the mortality transition into stages: (1) high, pretransitional mortality, (2) early transitional mortality with the decline explained by the conquest of infectious disease, and (3) late transitional mortality largely attributable to degenerative disease. Some have now added stage (4), the reduction or delay in death from degenerative causes. Attempts have been made to effect the convergence of demographic and epidemiological approaches to the analysis of mortality, and they have been more successful in the case of medical demographic than in social demographic approaches.

Adult↗
PubMed1998

Declining severity adjusted mortality: evidence of improving neonatal intensive care.

OBJECTIVES: Declines in neonatal mortality have been attributed to neonatal intensive care. An alternative to the "better care" hypothesis is the "better babies" hypothesis; ie, very low birth weight infants are delivered less ill and therefore have better survival. DESIGN: We ascertained outcomes of all live births <1500 g in two prospective inception cohorts. We estimated mortality risk from birth weight and illness severity on admission and measured therapeutic intensity. We calculated logistic regression models to estimate the changing odds of mortality between cohorts. PATIENTS AND SETTING: Two cohorts in the same two hospitals, 5 years apart (1989-1990 and 1994-1995) (total n = 739). RESULTS: Neonatal intensive care unit mortality declined from 17.1% to 9.5%, and total mortality declined from 31.6% to 18.4%. Cohort 2 had lower risk (higher birth weight, gestational age, and Apgar scores and lower admission illness severity for newborns >/=750 g). Risk-adjusted mortality declined (odds ratio, 0.52; confidence interval, 0.29-0. 96). One third of the decline was attributable to "better babies" and two thirds to "better care." Use of surfactant, mechanical ventilation, and pressors became more aggressive, but decreases in monitoring, procedures, and transfusions resulted in little change in therapeutic intensity. CONCLUSIONS: Mortality decreased nearly 50% for infants <1500 g in 5 years. One third of this decline is attributable to improved condition on admission that reflects improving obstetric and delivery room care. Two thirds of the decline is attributable to more effective newborn intensive care, which was associated with greater aggressiveness of respiratory and cardiovascular treatments. Attribution of improved birth weight specific mortality solely to neonatal intensive care may underestimate the contribution of high-risk obstetric care in providing "better babies."

Hospital Mortality↗
PubMed1995

Infant and child mortality levels and trends in Bangladesh.

Infant and child mortality levels and trends in Bangladesh are examined using data from the 1989 Bangladesh Fertility Survey. Both infant and child mortality declined from the mid 1970s but infant mortality declined more quickly. The level of infant mortality in 1989 was around 100 per 1000 live births while child mortality (5q0) was 200 per 1000 live births. Life table analysis confirms the change in infant and child mortality. The decline in infant mortality is attributed to the introduction of improved public health measures and access to maternal and child health services.

Adolescent↗
PubMed2002

[Mortality of 1880-1980 generations in Switzerland: a rereading of evolution of mortality based on longitudinal data].

OBJECTIVES: Seek to explain the declining mortality rates observed in Switzerland using a different approach from conventional period analyses. METHODS: Analysis of the mortality rates for cohorts born between 1880 and 1980 in Switzerland. RESULTS: While the mortality transition was a constant feature of the 20th century, mortality receded most sharply among the 1900 to 1940 birth cohorts. Life expectancy gains were much lower for the pre-1900 cohorts, while early trends for the post-1940 cohorts point to a slowdown in the rate of mortality decline. These findings may be connected with the social and health conditions in which the different cohorts lived. CONCLUSION: In contrast to the cross-sectional analysis, the longitudinal approach shows that the decline in mortality suddenly stops with the 1940 cohort.

Adolescent↗