Mortality in the Islamic Republic of Iran, 1964-2004

OBJECTIVE: Reliable information on the pattern, level and trend of mortality is essential for evidence-based policy to improve health. Various sources of mortality data in the Islamic Republic of Iran have not been critically assessed. This paper aims to document and evaluate the completeness of the different data sources on mortality and to estimate the level and trends of mortality over the past 40 years according to various mortality indices such as child mortality, adult mortality and life expectancy. METHODS: We undertook a systematic review of all available studies on infant mortality from 1964 to 2004 and estimated the most probable trend in child mortality. Death registration data from between 1992 and 2004 were assessed for completeness to estimate the level of adult mortality. Life tables for 2004 were constructed for the Islamic Republic of Iran based on these data, corrected for under-registration of death. FINDINGS: Infant mortality decreased from an estimated 154 deaths per 1000 live births in 1964 to 26 in 2004. The risk of adult mortality in 2004 was estimated to be 0.124 and 0.175 for females and males respectively. According to adjusted death registration data, life expectancy at birth in 2004 was 71.2 for females and 68.7 for males. The average completeness of death registration for ages 5 years and older across all systems was 76% for the period 2001-2004. CONCLUSION: There has been a general decline in child mortality in the Islamic Republic of Iran over the past three decades. Adult mortality levels also have declined, but less substantially. Mortality information systems have improved, yet serious concerns remain regarding the completeness and quality of data.     

Validation of cause-of-death statistics in urban China

BACKGROUND: National vital registration systems are the principal source of cause specific mortality statistics, and require periodic validation to guide use of their outputs for health policy and programme purposes, and epidemiological research. We report results from a validation of cause of death statistics from health facilities in urban China. METHODS: 2917 deaths from health facilities located in six cities in China constituted the study sample. A reference diagnosis of the underlying cause was derived for each death, based on expert review of available medical records, and compared with that filed at registration. Sensitivity, specificity and positive predictive value were computed for specific causes/cause categories according to the International Classification of Diseases (ICD), including analyses based on quality of evidence scores for each cause. Patterns of misclassification by the registration system were studied for individual causes of death. RESULTS: The registration system had good sensitivity in diagnosing cerebrovascular disease and several site specific cancers (lung, liver, stomach, colorectal, breast and pancreas). Sensitivity was average (50-75%) for some major causes of adult death in China, namely ischaemic heart disease (IHD), chronic obstructive lung disease (COPD), diabetes, and liver and kidney diseases, with compensatory misclassification patterns observed between several of them. Sensitivity was particularly low for hypertensive disease. CONCLUSIONS: Although diagnostic misclassification is not uncommon in urban death registration data, they appear to balance each other at the population level. Compensating misclassification errors suggest that caution is required when drawing conclusions about particular chronic causes of adult death in China. Investment is required to improve the quality of cause attribution for health facility deaths, and to assess the validity of cause attribution for home deaths. Periodic assessments of the quality of cause of death statistics will enhance their usability for health policy and epidemiological research.     

Evaluation of the quality of cause of death statistics in rural China using verbal autopsies

BACKGROUND: Death registration systems in rural China are in a developmental stage. The Disease Surveillance Points (DSP) system provides the only nationally representative information on causes of death. In this system, there are no standard procedures or instruments for ascertaining causes of death; hence available statistics require careful evaluation before use. AIM: To assess the reliability of data from the DSP. METHODS: 14 DSP sites were selected through stratified sampling, enrolling 2482 deaths registered during June-November 2002. Defined verbal autopsy (VA) procedures were used to derive underlying causes of death. kappa Measures of agreement between VA and registered diagnoses were computed. VA diagnoses were used as references to compute sensitivity and positive predictive values. Finally, patterns of cause-specific discordance between the two data sources were studied. RESULTS: kappa Scores indicate only moderate agreement for chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). The results also suggest that COPD is undercounted in registration data. A significant degree of cross attribution of cause was found between the two data sources. Overall, the VA was successful in limiting deaths with ill-defined causes to <10%. CONCLUSIONS: Diagnoses based on structured symptom questionnaires in the VA approach seem plausible and reliable as compared with lay-reported diagnoses in registration data. Concerns with attribution of cause of death due to COPD, IHD and tuberculosis in registration data suggest caution in their use for research and health programme purposes. The VA methods tested in this study offer promise for implementation in the routine registration system.     

Validation of verbal autopsy procedures for adult deaths in China

BACKGROUND: Vital registration of causes of death in China is incomplete with poor coverage of medical certification. Information on the leading causes of mortality will continue to rely on verbal autopsy (VA) methods. A new international VA form is being considered for data collection in China, but it first needs to be validated to determine its operating characteristics. METHODS: Detailed medical records and clinical evidence for 3290 deaths (mostly adults) among residents of six cities representative of the urban Chinese population were reviewed by a panel of physicians and coded by experts to establish a reference underlying cause of death. Independently, families of the deceased were interviewed using a structured symptomatic questionnaire and a separate death certificate was prepared for each matching case (2102). Validity of the VA procedure was assessed using standard measurement criteria of sensitivity, specificity, and positive predictive value. RESULTS: VA methods perform reasonably well in identifying deaths from several leading causes of adult deaths including stroke, several major cancer sites (lung, liver, stomach, oesophagus, and colorectal), and transport accidents. Sensitivity was less satisfactory in detecting deaths from several causes of major public health concern in China including ischaemic heart disease, chronic obstructive pulmonary disease, diabetes, and tuberculosis, and was particularly poor in diagnosing deaths from viral hepatitis, hypertension, and kidney diseases. CONCLUSIONS: VA is an imprecise tool for detecting leading causes of death among adults. However, much of the misclassification generally occurs within broad cause groups (e.g. CVD, respiratory diseases, and liver diseases). Moreover, compensating patterns of misclassification would appear to suggest that, in urban China at least, the method yields population-level cause-specific estimates that are reasonably reliable. These results suggest the possible utility of these methods in rural China, to back up the low coverage of medical certification of cause of death owing to poor access to health facilities there.     

Estimating mortality and causes of death in Turkey: methods, results and policy implications

BACKGROUND: Cause-specific mortality statistics are primary evidence for health policy formulation, programme evaluation, and epidemiological research. In Turkey, a partially functioning vital registration system in urban areas yields fragmentary evidence on levels and causes of mortality. This article discusses the application of innovative methods to develop national mortality estimates in Turkey, and their implications for national health development policies. METHODS: Child mortality levels from the Demography and Health Survey (DHS) were applied to model life tables to estimate age-specific death rates. Reported causes of death from urban areas were adjusted using re-distribution algorithms from the Global Burden of Disease (GBD) Study. Rural cause structure was estimated from epidemiological models. Local epidemiological data was used to adjust model-based estimates. RESULTS: Life expectancy at birth in 2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10 years lower than in Western Europe. Leading causes of death include major vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths, chronic obstructive lung disease and lung cancer in men, but also perinatal causes, lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of deaths, although this may be an underestimate. CONCLUSIONS: Mortality estimates are uncertain in Turkey, given the poor quality of death registration systems. Application of burden of disease methods suggests that there has been progress along the epidemiological transition. Key health development strategies for Turkey include improved access to communicable disease control technologies, and urgent attention to the development of a reliable, nationally representative health information system.     

The Burden of Stroke in Kurdistan Province,Iran From 2011 to 2017

ObjectivesThe aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017.MethodsIncidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs).ResultsThe burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively.ConclusionsThe burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.     

Chronic diseases now a leading cause of death in rural India--mortality data from the Andhra Pradesh Rural Health Initiative

INTRODUCTION: India is undergoing rapid epidemiological transition as a consequence of economic and social change. The pattern of mortality is a key indicator of the consequent health effects but up-to-date, precise, and reliable statistics are few, particularly in rural areas. METHODS: Deaths occurring in 45 villages (population 180 162) were documented during a 12-month period in 2003-04 by multipurpose primary healthcare workers trained in the use of a verbal autopsy tool. Algorithms were used to define causes of death according to a limited list derived from the international classification of disease version 10. Causes were assigned by two independent physicians with disagreements resolved by a third. RESULTS: A total of 1354 deaths were recorded with verbal autopsies completed for 98%. A specific underlying cause of death was assigned for 82% of all verbal autopsies done. The crude death rate was 7.5/1000 (95% confidence interval, 7.1-7.9). Diseases of the circulatory system were the leading causes of mortality (32%), with similar proportions of deaths attributable to ischaemic heart disease and stroke. Second was injury and external causes of mortality (13%) with one-third of these deaths attributable to deliberate self harm. Third were infectious and parasitic diseases (12%). Tuberculosis and intestinal conditions each caused one-third of deaths within this category. HIV was assigned as the cause for 2% of all deaths. The fourth and fifth leading causes of death were neoplasms (7%) and diseases of the respiratory system (5%). CONCLUSION: Non-communicable and chronic diseases are the leading causes of death in this part of rural India. The observed pattern of death is unlikely to be unique to these villages and provides new insight into the rapid progression of epidemiological transition in rural India.     

Estimated causes of death in Thailand, 2005: implications for health policy

Background  

Almost 400,000 deaths are registered each year in Thailand. Their value for public health policy and planning is greatly diminished by incomplete registration of deaths and by concerns about the quality of cause-of-death information. This arises from misclassification of specified causes of death, particularly in hospitals, as well as from extensive use of ill-defined and vague codes to attribute the underlying cause of death. Detailed investigations of a sample of deaths in and out of hospital were carried out to identify misclassification of causes and thus derive a best estimate of national mortality patterns by age, sex, and cause of death.     

Can regional variation in "avoidable" mortality be explained by deaths outside hospital? A study from Sweden, 1987-90.

STUDY OBJECTIVE: This study aimed to calculate the proportion of deaths outside hospital in Sweden for some conditions for which the acute medical management may be important to the outcome and to analyse whether the proportion of deaths outside hospital can explain regional variations in mortality from these causes of death. DESIGN: The place of death was registered on all death certificates in Sweden during the period 1987-90. The proportion of deaths outside hospital was calculated at the national level for selected causes of death. Variation in cause-specific mortality among the 26 administrative health areas in Sweden was analysed. Death rate ratios were calculated with standardisation for age and sex using the national rate as standard. The correlation between the proportion of deaths outside hospital in each health area and the cause specific mortality irrespective of place of death was calculated. For areas with a significantly high death rate the ratios for mortality outside hospital as well as in hospital were analysed in order to decide which component of mortality represented a high mortality risk. SETTING AND PARTICIPANTS: All death registration in Swedish citizens and other residents in Sweden aged under 70 years between 1987 and 1990 which gave diabetes, asthma, ischaemic heart disease, cerebrovascular diseases, or ulcer of the stomach or duodenum as the underlying cause of death. MAIN RESULTS: For asthma (58%) and ischaemic heart disease (54%), most deaths occurred outside hospital. For most causes of death, however, no correlation was found among the health areas between the proportion of deaths outside hospital and the SMR for mortality irrespective of the place of death. A high death rate was associated with a high proportion of deaths outside hospital, for diabetes in one area in the north of Sweden (Norrbotten) and for ulcer of the stomach and duodenum in one large municipality (Göteborg). CONCLUSIONS: The high proportion of deaths outside hospital at the national level for some of the conditions studied suggests that in-depth studies of the process preceding death and the functioning of medical care are needed. In most cases, however, no evidence was found that regional variation in mortality could be explained by death outside hospital. The results for diabetes in Norbotten and ulcer of stomach and duodenum in Göteborg indicate that in-depth studies on the quality of care are required.     

Causes of death of foreign tourists in the county of Istria during the summer holiday season from 2000 to 2004

In this paper, the causes of death are presented of 322 foreign tourists that occured during summer holidays in County of Istria, Croatia, in the period from May to September, during 5 years (from 2000 to 2004). The aim of this study was to evaluate the frequency of the common causes of these deaths. Data about these cases were taken out of the archives of the Institute of Public Health of County of Istria in Pula. RESULTS: During this period of time there were 322 cases of deaths recorded. The rate was 3.2 deaths for 100 000 tourists. Heart attack occured in 126 cases (39%), and it was the leading cause of death. The highest number of deaths by the heart attack (n=31) was registered in 2002. The frequency of heart attack was six times higher in males than in females. The heart attack occurance was between 47% in 2000 to 30% in 2003. Drowning was the second leading cause of death with 10.5% of all cases of deaths recorded. Out of all victims (n=34), there were three times more males then females. Other causes of deaths were chronic ischaemic heart disease (8%), cardiac arrest (4%) and stroke (3.0%). CONCLUSION: Heart attack and drowning were the leading causes of death among foreign tourists in Istria.     

Road-traffic-related mortality in Iran: a descriptive study

Road traffic accidents are considered to be the second highest cause of mortality in Iran. A study was conducted to describe road-traffic-related mortality data in Iran in a given period. All Iranian mortality data on road traffic accidents between March 1999 and 2000 (one complete Iranian calendar year) were obtained. The main variables studied were deceased's gender, age, education level, status (i.e. driver, car occupant, etc.), cause and place of death. A total of 15?482 individuals died from road traffic accidents in Iran in the study period. A disproportionate number of deceased individuals were male (79%), mostly aged 40 years or less (65%), and who were pedestrians or car occupants (62%). Head injury was the most common cause of road-traffic-related mortality (66%) in males and females of all ages. Following road traffic accidents, 57% of deaths occurred pre-hospital. Head injury is the most common single cause of mortality attributable to road traffic accidents in Iran, and since most deaths occur pre-hospital, it seems many are preventable. To overcome this major public health problem, there is an urgent need to develop a comprehensive injury control policy and strategy in Iran.     

Causes of death classified by risk and condition, New Zealand 1997

OBJECTIVE: To classify causes of death in New Zealand by risk factor (in addition to condition) as a planning tool for health promotion. METHOD: Deaths occurring in New Zealand in 1997 were classified by 20 prevalent risk factors using a combination of categorical attribution (rule-based) and counterfactual modelling (population-attributable risk-based) approaches. RESULTS: Approximately 30% of deaths were attributed to the joint effect of dietary factors. Tobacco consumption was responsible for 18% of deaths and insufficient physical activity for almost 10%. Less important behavioural risk factors included alcohol consumption (3%), illicit drug use (0.5%) and unsafe sex (0.5%). Among biological risk factors, higher than optimal total blood cholesterol, systolic blood pressure and body mass index accounted for 17%, 15% and 12% of deaths respectively. Deprivation contributed to 17% of deaths, and adverse in-hospital events to 6%. Among environmental exposures, microbes accounted for 6.5% of deaths, air pollution 3.5% and occupational diseases and injuries 0.5%. Among injury hazards, risk factors related to road traffic were responsible for 2% of deaths, while violence accounted for 2.5% of deaths, mostly through suicide. Cross-classifying deaths by both condition and risk factor, 90% of ischaemic heart disease and 80% of stroke, but only 30% of cancer deaths, could be attributed to specific risk factors. CONCLUSIONS: This is the first comprehensive ranking of causes of death at the level of risk factors available for New Zealand and should prove useful as a planning tool, especially for disease prevention and health promotion.     

Who dies of what? A comparative analysis of mortality conditions in developed countries around 1987

The developed countries are often viewed as being relatively homogeneous in terms of health conditions. This is not the case, however. Whilst the overall level of life expectancy in these countries (73.7 years) is well in excess of that observed in the majority of developing countries, there are nonetheless very substantial differences in health status among and between the developed countries. Female life expectancy is typically 6-8 years longer than that of males. The gap in life expectancy between Japan and some countries of Northern Europe, on the one hand, and the nations of Eastern Europe on the other, is of the same order of magnitude. Of the 11 million deaths reported in the developed countries each year, roughly 5.5 million or almost exactly 50% are attributable to cardiovascular diseases. Of these deaths, 2.4 million are coded to ischaemic heart disease and 1.5 million to stroke (cerebrovascular disease). Cancer (all forms) accounts for 2.3 million deaths (21%), 500,000 of which are due to lung cancer alone. External causes of death claim 750,000 lives each year in the developed countries, with suicide and motor-vehicle accidents each accounting for around 180,000 deaths. This pattern of mortality, when viewed in conjunction with the epidemiological evidence about the principal risk factors associated with these causes of death, strongly suggests that national health-for-all strategies must continue to emphasize individual health consciousness as the primary means of achieving national health goals.     

How many Australian deaths from heart disease and stroke could be avoided by a small reduction in population cholesterol levels?

Aim:  To quantify the number of premature deaths from coronary heart disease and ischaemic stroke that potentially could be avoided annually among the Australian population if a sustained 10% reduction in the mean population level of low-density lipoprotein cholesterol were to be achieved.
Methods:  Data were obtained on the number of deaths from coronary heart disease and stroke in the Australian population, subdivided into age and sex strata, and on the mean population level of low-density lipoprotein cholesterol. Published relative risks (95% CI) from a meta-analysis of lipid-lowering therapy were used to calculate the reduction in the relative risk for coronary heart disease and stroke associated with a 5%, 10% and 15% reduction in low-density lipoprotein cholesterol. The expected number of deaths from coronary heart disease and ischaemic stroke avoidable with a 10% reduction in low-density lipoprotein cholesterol was modelled. Secondary analyses were performed assuming reductions in low-density lipoprotein cholesterol of 5% and 15%.
Results:  A 10% reduction in low-density lipoprotein cholesterol would prevent 2279 deaths from coronary heart disease (95% CI: 2025–2531 deaths) and 641 deaths from ischaemic stroke (95% CI: 440–881 deaths). The projected benefits are greatest among the elderly, although some benefit would be expected in all age and sex groups and among individuals with a broad range of baseline levels of low-density lipoprotein cholesterol.
Conclusions:  A small leftward shift in the low-density lipoprotein cholesterol distribution of the adult Australian population has the potential to save about 3000 lives from coronary heart disease and stroke annually. Achieving this goal will require the active participation of key public health, food industry and government stakeholders.     

Cardiovascular mortality attributable to high blood cholesterol in New Zealand

OBJECTIVE: To estimate mortality attributable to higher-than-optimal blood cholesterol in New Zealand in 1997, and the mortality burden that could be potentially avoided in 2011 if modest reductions in mean population blood cholesterol concentrations were achieved. DESIGN: Comparative risk assessment methodology was used to estimate the attributable and avoidable mortality due to higher-than-optimal total blood cholesterol (> 3.8 mmol/L). Disease outcomes assessed were deaths from ischaemic heart disease (IHD) and ischaemic stroke. RESULTS: Overall, higher-than-optimal blood cholesterol contributed to 4,721 deaths in New Zealand in 1997 (17% of all deaths). This included 4,096 IHD deaths (64%) and 625 ischaemic stroke deaths (38%). Modest reductions in mean population blood cholesterol concentrations (e.g. 0.1 mmol/L) could potentially prevent 300 deaths (261 IHD and 39 ischaemic stroke) each year from 2011. CONCLUSIONS: Higher-than-optimal blood cholesterol concentrations are a leading cause of mortality in New Zealand. Modest reductions in blood cholesterol levels could have a major impact on population health within a decade.     

Trends in chronic disease mortality in the Northern Territory Aboriginal population, 1997‐2004: using underlying and multiple causes of death

Objective: To assess trends in chronic disease mortality in the Aboriginal population of the Northern Territory (NT), using both underlying and multiple causes of death. Method: Death registration data from 1997 to 2004, were used for the analysis of deaths from five chronic diseases; ischaemic heart disease (IHD), diabetes, chronic obstructive pulmonary disease (COPD), renal failure and stroke. Negative binomial regression models were used to estimate the average annual change in mortality rates for each of the five diseases. Chi squared tests were conducted to determine associations between the five diseases. Results: The five chronic diseases contributed to 49.3% of all Aboriginal deaths in the NT. The mortality rate ratio of NT Aboriginal to all Australian death rates from each of the diseases ranged from 4.3 to 13.0, with the lowest rate ratio for stroke and highest for diabetes. There were significant statistical associations between IHD, diabetes, renal failure and stroke. The mortality rates for diabetes, COPD and stroke declined at estimated annual rates for NT Aboriginal males of 3.6%, 1.0% and 11.7% and for Aboriginal females by 3.5%, 6.1% and 7.1% respectively. There were increases in mortality rates for Aboriginal males and females for IHD and a mixed result for renal failure. Conclusion: NT Aboriginal people experience high chronic disease mortality, however, mortality rates appear to be declining for diabetes, COPD and stroke. The impact of chronic disease on mortality is greater than previously reported by using a single underlying cause of death. The results highlight the importance of integrated chronic disease interventions.     

Thailand's national death registration reform: verifying the causes of death between July 1997 and December 1999

A fundamental aspect of public health is the accuracy of death certification. Assessing the death registration system is a step toward improving the quality of death reporting. Thailand implemented a more rigorous and informative pilot death registration system in March 2001 in 18 provinces, followed by nationwide implementation in August 2003. Since Thailand is an industrializing nation, its experiences will be of interest to other developing nations planning similar reforms. The causes of all deaths in the 15 provincial pilot projects (of Thailand's 76 provinces) and a random sampling in Bangkok were investigated between July 1997 and December 1999. Health workers interviewed close relatives and three medical doctors reviewed hospital records to verify the causes of death. We were able to interview 78% of the relatives (i.e. 47,632 in number). Three-quarters (76%) of the deceased had sought prior medical care; 41% died in hospital and 54% at home. The overall agreement between the causes of death in our survey vs. that reported on the death certificate was 29%. The highest agreement was for: 'Ill-defined' causes (33%), 'Cancer and Tumors' (17%), 'External Causes' (16%), and 'Infectious Diseases' (10%). Considering the different patterns among age groups and sex, hypertension with stroke, cancer of the liver and bile duct, and HIV infection, were the highest ranking causes among females. Infectious diseases (especially HIV/AIDS), hypertension with stroke and accidents, were the leading causes of deaths among males. External causes were highest among children and young adults.     

Ethnic differences in ischaemic heart disease and stroke mortality in Mauritius between 1989 and 1994

Objective. To measure ethnic differences in overall, cardiovascular, ischaemic heart disease and stroke mortality in the Republic of Mauritius.

Design. Analysis of vital registration mortality data from 1989 to 1994 among Hindus, Muslims, Chinese and Creoles, aged 30–64 years, presented as age‐standardized mortality rates, proportional mortality ratios and standardized mortality ratios.

Results. During the six year period of analysis 10 657 deaths were recorded in men and 5008 in women. Mortality rates from ischaemic heart disease in Mauritian men are above the average of those found elsewhere. Ischaemic heart disease mortality in women and stroke mortality in both sexes are among the highest recorded in the world. Due to large ethnic differences in overall mortality, which could not be explained by the uncertainty about the exact population size by ethnic group, proportional mortality ratios are an inadequate measure of differential mortality between ethnic groups. ‘Best’ estimates of standardized mortality ratios indicate that in comparison to Hindus as the ‘standard’ population: (i) Creole women have lower ischaemic heart disease (by 34%) and stroke (by 22%) mortality; (ii) Creole women have lower ischaemic heart disease mortality (by 19%); (iii) Muslim men have lower stroke mortality (by 51%) and similar ischaemic heart disease mortality; (iv) Chinese men and women have markedly lower ischaemic heart disease (by 48% and 70%, respectively) and stroke mortality (by 54% and 48%, respectively).

Conclusion. The mortality rates of ischaemic heart disease and stroke of all ethnic groups in Mauritius, with the exception of the small Chinese ethnic minority, are very high by international standards. This pleads against differential allocation of resources for prevention strategies despite considerable differences in mortality rates from cardiovascular diseases between ethnic groups.     

道路交通伤及其他主要死因的减寿对比评估

目的对比评估交通伤及其他主要死因对期望寿命前死亡的影响。方法应用寿命损失年数(YPLL)及有关的期望寿命前死亡评估指标。结果2000年，辽宁省城市居民死亡中男性交通伤死亡仅占2．3％，但其所致的YPLL及潜在工作损失年数(WYPLL)在全死因所致YPLL及WYPLL中的构成比则分别升高至9．2％及7．8％。女性交通伤死亡仅占死因构成的1．1％，但其所致的YPLL及WYPLL在全死因所致YPLL及WYPLL中的构成比分别升高至3．8％及4．6％。脑血管病缺血性心脏病所致的YPLL及WYPLL在全死因所致的YPLL及WYPL中的构成比明显低于其死因构成比。男性人群中肿瘤所致的YPLL及WYPLL在全死因所致的YPLL及WYPLL中的构成比与其死因构成比接近，而女性人群中则高于死因构成比。每一人道路交通伤亡所致的YPLL／d及WYPLL／d均明显超过其他主要死因。每一人道路交通伤死亡所致的VYPLL／d为正值，而其他主要死因的VYPLL／d均为负值。结论交通伤对期望寿命前死亡的影响非常明显地大于脑血管病、缺血性心脏病及肿瘤等，已成为导致人群潜在寿命损失年数的主要原因之一。