National maternal mortality ratio in Egypt halved between 1992-93 and 2000

Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms. The numbers of maternal deaths were determined and interviews conducted. The medical causes of death and avoidable factors were determined. Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100,000 live births). The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt. In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000. Consideration of the intermediate and outcome indicators suggests that the greatest effect of maternal health interventions was on the death-related avoidable factors "substandard care by health providers" and "delays in recognizing problems or seeking medical care". The enormous improvements in these areas are certainly due in part to extensive training, revised curricula, the publication of medical protocols and services standards, the upgrading of facilities, and successful community outreach programmes and media campaigns. The impact on the utilization of antenatal care (ANC) has been less successful. Other areas that remain problematic are inadequate supplies of blood, drugs and equipment. Although the number of maternal deaths linked to haemorrhage has been drastically reduced, it remains the primary cause. The drop in maternal mortality in the 1990s in response to Safe Motherhood programmes was impressive and the ability to tailor interventions based on the data from the NMMS of 1992-93 and 2000 was clearly demonstrated. To ensure the continuing availability of information to guide and evaluate programmes for reducing maternal mortality, an Egyptian national maternal mortality surveillance system is being developed.     

Community-based monitoring of safe motherhood in the United Republic of Tanzania

OBJECTIVE: To examine the progress made towards the Safe Motherhood Initiative goals in three areas of the United Republic of Tanzania during the 1990s. METHODS: Maternal mortality in the United Republic of Tanzania was monitored by sentinel demographic surveillance of more than 77,000 women of reproductive age, and by prospective monitoring of mortality in the following locations; an urban site; a wealthier rural district; and a poor rural district. The observation period for the rural districts was 1992-99 and 1993-99 for the urban site. FINDINGS: During the period of observation, the proportion of deaths of women of reproductive age (15-49 years) due to maternal causes (PMDF) compared with all causes was between 0.063 and 0.095. Maternal mortality ratios (MMRatios) were 591-1099 and maternal mortality rates (MMRates; maternal deaths per 100,000 women aged 15-49 years) were 43.1-123.0. MMRatios in surveillance areas were substantially higher than estimates from official, facility-based statistics. In all areas, the MMRates in 1999 were substantially lower than at the start of surveillance (1992 for rural districts, 1993 for the urban area), although trends during the period were statistically significant at the 90% level only in the urban site. At the community level, an additional year of education for household heads was associated with a 62% lower maternal death rate, after controlling for community-level variables such as the proportion of home births and occupational class. CONCLUSION: Educational level was a major predictor of declining MMRates. Even though rates may be decreasing, they remained high in the study areas. The use of sentinel registration areas may be a cost-effective and accurate way for developing countries to monitor mortality indicators and causes, including for maternal mortality.     

2006—2011年云南省疾病监测点居民恶性肿瘤死因分析

目的了解2006—2011年云南省疾病监测点居民恶性肿瘤死亡水平及其变化趋势,为恶性肿瘤的防治工作提供科学依据。方法应用死亡率、标化死亡率等对2006—2011年云南省疾病监测点死因监测资料进行统计分析。结果 2006—2011年云南省疾病监测点居民恶性肿瘤年均报告死亡率为70.80/10万,标化死亡率78.17/10万,居全死因第4位;男性高于女性,男女死亡率比为1.66;前5位恶性肿瘤死因依次是肺癌、肝癌、胃癌、结直肠癌和白血病。结论恶性肿瘤已成为云南省疾病监测点居民的主要致死疾病之一,且死亡率呈上升趋势,应根据不同人群、不同肿瘤的特点,采取综合性的干预措施,预防或减少恶性肿瘤的发生。     

Urban Health in Tanzania: Questioning the Urban Advantage

How are health inequalities articulated across urban and rural spaces in Tanzania? This research paper explores the variations, differences, and inequalities, in Tanzania’s health outcomes—to question both the idea of an urban advantage in health and the extent of urban–rural inequalities in health. The three research objectives aim to understand: what are the health differences (morbidity and mortality) between Tanzania’s urban and rural areas; how are health inequalities articulated within Tanzania’s urban and rural areas; and how are health inequalities articulated across age groups for rural–urban Tanzania? By analyzing four national datasets of Tanzania (National Census, Household Budget Survey, Demographic Health Survey, and Health Demographic Surveillance System), this paper reflects on the outcomes of key health indicators across these spaces. The datasets include national surveys conducted from 2009 to 2012. The results presented showcase health outcomes in rural and urban areas vary, and are unequal. The risk of disease, life expectancy, and unhealthy behaviors are not the same for urban and rural areas, and across income groups. Urban areas show a disadvantage in life expectancy, HIV prevalence, maternal mortality, children’s morbidity, and women’s BMI. Although a greater level of access to health facilities and medicine is reported, we raise a general concern of quality and availability in health services; what data sources are being used to make decisions on urban–rural services, and the wider determinants of urban health outcomes. The results call for a better understanding of the sociopolitical and economic factors contributing to these inequalities. The urban, and rural, populations are diverse; therefore, we need to look at service quality, and use, in light of inequality: what services are being accessed; by whom; for what reasons?     

Maternal mortality surveillance, United States, 1980-1985

To better define the incidence, causes, and risk factors associated with maternal deaths, the Division of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, CDC, coordinated a study by the Maternal Mortality Collaborative, a Special Interest Group of the American College of Obstetricians and Gynecologists (ACOG). In 1983, this group established voluntary surveillance of maternal deaths for the years 1980-1985. The Maternal Mortality Collaborative reported 601 maternal deaths from 19 reporting areas for 1980-1985, representing a maternal mortality ratio of 14.1 per 100,000 live births. Overall, 39% more maternal deaths were reported by the Maternal Mortality Collaborative than by the National Center for Health Statistics for these reporting areas. Overall, women over 30 years of age had a higher risk of dying than did younger women. For each age group, women of black and other races who were 30 years and older having the highest risk. The leading causes of maternal deaths were embolism, hypertension in pregnancy, sequelae from ectopic pregnancy, hemorrhage, cerebrovascular accidents, and anesthesia complications. Of the 111 nonmaternal deaths, 90 (82%) were attributed to unintentional or intentional injuries. As a result of the success of this voluntary reporting system, the Division of Reproductive Health initiated National Pregnancy Mortality Surveillance in January 1988.     

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.     

Global and regional mortality patterns by cause of death in 1980

Mortality attributable to major causes of death around 1980 has been estimated for different regions in the world. The World Health Organization's mortality data bank has been employed to derive the rates for the developed areas in the world whereas for the developing areas, cause-specific mortality has been estimated on the basis of total mortality using a linear regression method. For the cause grouping chosen, infectious and parasitic diseases claim one third of all deaths in the world. Although diseases of the circulatory system and neoplasms are the two most common causes of death in the developed countries, more than 50% of all deaths in the world due to these causes occur in the developing world. Mortality due to injury and poisoning is--contrary to that due to the other main causes of death--almost independent of the level of development of the area. The results are aimed to assist the information back-up for health policies concerning the developing world.     

Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and Nutrition Examination Survey

This study examined relative hazards for mortality and functional limitations according to poor self-ratings of health using prospective data from the NHANES I Epidemiologic Follow-up Study, a representative sample of US adults aged 25-74 years that has been followed since the First National Health and Nutrition Examination Survey (NHANES I) was conducted in 1971-1975. Follow-up data were taken from death records and from the 1982 and 1992 reinterviews. Respondents (n = 6,913) provided extensive baseline data through physician examinations, laboratory testing, and self-reports of conditions, symptoms, and risk behaviors. Functional limitations were assessed among survivors in 1982 and 1992. Cox regression models accounting for sample design indicated that baseline self-rated health was associated with a significantly reduced hazard of mortality for males but not for females through 1992; adjusted hazards ratios for excellent health as compared with poor health were 0.52 for males (95% confidence interval: 0.36, 0.73) and 0.80 for females (95% confidence interval: 0.51, 1.23). Self-rated health also predicted 1982 and 1992 functional limitation for both men and women and 1992 function net of 1982 function for men only. Self-rated health contributes unique information to epidemiologic studies that is not captured by standard clinical assessments or self-reported histories, but evidence suggests that the effect may be stronger for men than for women.     

Evaluating the Use of an Electronic Death Registration System for Mortality Surveillance During and After Hurricane Sandy: New York City, 2012

Objectives. We evaluated the use of New York City’s (NYC’s) electronic death registration system (EDRS) to conduct mortality surveillance during and after Hurricane Sandy.Methods. We used Centers for Disease Control and Prevention guidelines for surveillance system evaluation to gather evidence on usefulness, flexibility, stability, timeliness, and quality. We assessed system components, interviewed NYC Health Department staff, and analyzed 2010 to 2012 death records.Results. Despite widespread disruptions, NYC’s EDRS was stable and collected timely mortality data that were adapted to provide storm surveillance with minimal additional resources. Direct-injury fatalities and trends in excess all-cause mortality were rapidly identified, providing useful information for response; however, the time and burden of establishing reports, adapting the system, and identifying indirect deaths limited surveillance.Conclusions. The NYC Health Department successfully adapted its EDRS for near real-time disaster-related mortality surveillance. Retrospective assessment of deaths, advanced methods for case identification and analysis, standardized reports, and system enhancements will further improve surveillance. Local, state, and federal partners would benefit from partnering with vital records to develop EDRSs for surveillance and to promote ongoing evaluation.New York City’s (NYC’s) Health Department introduced an electronic death registration system (EDRS) in 2005, allowing medical providers, funeral directors, and Health Department registration staff to voluntarily report deaths and access death records through a Web-based system. Since then, local mandates for EDRS use and timeliness resulted in nearly complete electronic reporting and accelerated the processing of death certificates and the availability of population mortality data.1 Across the United States, 46 of 57 vital event jurisdictions have implemented EDRSs, creating new opportunities to use mortality data for the timely surveillance of emerging public health concerns.2,3 For example, fatalities are a commonly used indicator of the public health impact of natural disasters, including extreme heat events, floods, tornadoes, and hurricanes.4 Recently, lead US health agencies have called for greater research and evaluation of disaster-related systems and processes to address challenges faced by government and public health agencies, hospitals and clinicians, and academic researchers.5 The evaluation of local systems after disasters is therefore critical for identifying and addressing knowledge gaps for future events.On October 29, 2012, posttropical cyclone Sandy (Hurricane Sandy) made landfall approximately 100 miles south of NYC, causing a record-breaking storm surge throughout coastal areas of the city.6 Extensive flooding and wind damage caused widespread power outages, transportation shutdowns, medical facility and residential evacuations, and disruptions to health care access.7 Environmental risks persisted in the days and weeks following the storm, especially in residential buildings with damage to electrical, heating, elevator, and potable water systems. This raised concerns not only for direct-injury–related fatalities but also for all-cause deaths attributable to hazardous conditions. In response, the NYC Health Department used its EDRS to conduct mortality surveillance during and after Hurricane Sandy. Surveillance objectives were to (1) identify and characterize Sandy-related deaths, and (2) examine all-cause mortality during the storm and identify poststorm hazards. To assess performance of the disaster mortality surveillance system, we evaluated key system attributes, identified strengths and limitations, and made recommendations for system improvements.     

2012年青海省疾病监测点死因监测情况分析

目的 掌握青海省2012年死因监测系统报告质量,了解本地区居民的死亡原因和死亡水平,为制定政策提供科学依据.方法 对2012年青海省监测点死因网络报告数据进行分析.结果 2012年青海省疾病监测点居民死亡率为377.05/10万,其中男性为469.31/10万、女性为283.32/10万.根本死因编码不准确率为3.10％.前5位死因为循环系统疾病（205.60/10万）、恶性肿瘤（132.35/10万）、呼吸系统疾病（78.47/10万）、伤害（31.26/10万）及消化系统疾病（24.09/10万）,其中城市、农村前5位死因顺位相同,牧区依次为循环系统疾病、伤害、呼吸系统疾病、恶性肿瘤及消化系统疾病.各级各类医疗机构死亡病例漏报率为9.17％、卡片填写完整率为97.66％、迟报率为7.03％、错填率为16.16％、错录率为5.62％; 2009-2011年漏报率为37.85％,校正死亡率为699.41/10万.结论 通过对各单位定期开展死亡病例的督导和查漏补报工作,掌握本地区死亡水平,并不断完善和提高监测系统工作质量,为相关部门制定政策提供可靠数据.     

The importance of injury as a cause of death in sub-Saharan Africa: results of a community-based study in Tanzania

This paper describes rates and causes of injury deaths among community members in three districts of the United Republic of Tanzania. A population-based study was carried out in two rural districts and one urban area in Tanzania. Deaths occurring in the study areas were monitored prospectively during a period of six years. Censuses were conducted annually in the rural areas and biannually in the urban area to determine the denominator populations. Cause-specific death rates and Years of Life Lost (YLL) due to injury were calculated for the three study areas. During a 6 year period (1992-1998), 5047 deaths were recorded in Dar es Salaam, 9339 in Hai District and 11 155 in Morogoro Rural District. Among all ages, deaths due to injuries accounted for 5% of all deaths in Dar es Salaam, 8% in Hai and 5% in Morogoro. The age-standardised injury death rates among men were approximately three times higher than among women in all study areas. Transport accidents were the commonest cause of mortality in all injury-related deaths in the three project areas, except for females in Hai District, where it ranked second after intentional self-harm. We conclude that injury deaths impose a considerable burden in Tanzania. Strategies should be strengthened in the prevention and control of avoidable premature deaths due to injuries.     

Improving mortality data in Jordan: a 10 year review

Problem

Before 2003 there was substantial underreporting of deaths in Jordan. The death notification form did not comply with World Health Organization (WHO) guidelines and information on the cause of death was often missing, incomplete or inaccurate.

Approach

A new mortality surveillance system to determine the causes of death was implemented in 2003 and a unit for coding causes of death was established at the ministry of health.

Local setting

Jordan is a middle-income country with a population of 6.4 million people. Approximately 20 000 deaths were registered per year between 2005 and 2011.

Relevant changes

In 2001, the ministry of health organized the first meeting on Jordan’s mortality system, which yielded a five-point plan to improve mortality statistics. Using the recommendations produced from this meeting, in 2003 the ministry of health initiated a mortality statistics improvement project in collaboration with international partners. Jordan has continued to improve its mortality reporting system, with annual reporting since 2004. Reports are based on more than 70% of reported deaths. The quality of cause-of-death information has improved, with only about 6% of deaths allocated to symptoms and ill-defined conditions – a substantial decrease from the percentage before 2001 (40%). Mortality information is now submitted to WHO following international standards.

Lessons learnt

After 10 years of mortality surveillance in Jordan, the reporting has improved and the information has been used by various health programmes throughout Jordan.     

奉贤县消化道恶性肿瘤死亡率分析

目的了解奉贤县消化道恶性肿瘤的死亡率情况。方法对奉贤县１９９２～１９９７年消化道恶性肿瘤死亡２８３１例进行分析。结果６年中消化道恶性肿瘤年平均死亡率为９０．７１／１０万,标化死亡率为８６．５７／１０万,死亡率有缓慢上升趋势。死亡总数中肝癌（死亡率为３１．８２／１０万,标化死亡率为２９．９７／１０万）死亡９９３例,占总死亡数的３５．０８％,居首位;其次为胃癌（死亡率为２８．８０／１０万,标化死亡率为２７．９５／１０万）死亡８９９例,占总死亡数的３１．７６％;肠癌（死亡率１３．０１／１０万,标化死亡率为１２．１１／１０万）死亡４０６例,占总死亡数的１４．３４％,其余依次为食道癌、胰腺癌和胆囊癌。男性消化道恶性肿瘤年平均死亡率为１２０．６９／１０万,女性年平均死亡率为６１．８９／１０万,男性消化道恶性肿瘤死亡率高于女性。死亡率随年龄增长而上升,特别是４５岁以上死亡率上升幅度较大。结论消化道恶性肿瘤严重威胁中老年人群健康。     

Recent trends of age-specific pneumoconiosis mortality rates in the United States, 1985-1996: coal workers' pneumoconiosis, asbestosis, and silicosis

The authors examined the temporal trends of age-specific pneumoconiosis mortality from coal worker's pneumoconiosis (CWP), asbestosis, and silicosis in the United States in 1985-1996. Mortality data were derived from the National Center for Health Statistics multiple causes of death files for the period. Age-specific mortality rates were computed for three age groups (15-44, 45-64, and > or = 65 years) among decedents with mention of CWP, asbestosis, or silicosis. Linear regression analysis was performed to examine the annual changes in age-specific mortality rates, by age group, with each specific condition. The CWP mortality rates declined significantly (p = 0.0001) in the groups 45 years old and older, but not in the age group 15-44. Asbestosis mortality rates declined significantly (p = 0.005) for the age group 45-64, while increasing (p = 0.0001) for those aged 65 years and older. However, in the younger age group 15-44, the rates showed no significant trend. Silicosis mortality rates declined significantly (p = 0.0001) for all groups. The continued occurrence of deaths from CWP, asbestosis, and silicosis among young adults may be the result of high levels of exposure to occupational risks. These results suggest that pneumoconiosis surveillance may help to evaluate the temporal pneumoconiosis mortality patterns in the United States.     

Structure and performance of infectious disease surveillance and response, United Republic of Tanzania, 1998

OBJECTIVE: To assess the structure and performance of and support for five infectious disease surveillance systems in the United Republic of Tanzania: Health Management Information System (HMIS); Infectious Disease Week Ending; Tuberculosis/Leprosy; Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome; and Acute Flaccid Paralysis/Poliomyelitis. METHODS: The systems were assessed by analysing the core activities of surveillance and response and support functions (provision of training, supervision, and resources). Data were collected using questionnaires that involved both interviews and observations at regional, district, and health facility levels in three of the 20 regions in the United Republic of Tanzania. FINDINGS: An HMIS was found at 26 of 32 health facilities (81%) surveyed and at all 14 regional and district medical offices. The four other surveillance systems were found at <20% of health facilities and <75% of medical offices. Standardized case definitions were used for only 3 of 21 infectious diseases. Nineteen (73%) health facilities with HMIS had adequate supplies of forms; 9 (35%) reported on time; and 11 (42%) received supervision or feedback. Four (29%) medical offices with HMIS had population denominators to use for data analyses; 12 (86%) were involved in outbreak investigations; and 11 (79%) had conducted community prevention activities. CONCLUSION: While HMIS could serve as the backbone for IDSR in the United Republic of Tanzania, this will require supervision, standardized case definitions, and improvements in the quality of reporting, analysis, and feedback.     

Geographic distribution of deaths due to sentinel health event (occupational) causes

This report describes the Compressed Mortality File available from the National Center for Health Statistics that can be used to easily and efficiently generate annual mortality rates for geographic areas as small as counties for any period from 1968 to 1985. Several ways of presenting geographic variation in mortality rates due to potentially work-related deaths and changes in these rates over time are discussed for the 15-year period from 1969 through 1983. Causes of death that are potentially work-related were identified using the sentinel health events (occupational) [SHE(O)] concept. Data are given for nine diagnostic groups of occupationally related disorders, and maps are presented for bladder cancer, acute myeloid leukemia, and pneumoconioses. Significant changes in age-adjusted mortality rates were noted for pneumoconioses and acute myeloid leukemia that could not be due to changes in the disease coding of death certificates. Racial differences in mortality rates due to pneumoconioses may be due to differences in employment patterns. The use of SHE(O) codes to search the Compressed Mortality File may be helpful in identifying areas for public health concern, even if only as a monitoring signal for subsequent time periods. This file also provides an easy way to generate reference population mortality rates for epidemiologic studies.     

The determinants of infant and child mortality in Tanzania

This paper investigates the determinants of infant and child mortality in Tanzania using the 1991/92 Tanzania Demographic and Health Survey. A hazards model is used to assess the relative effect of the variables hypothesized to influence under-five mortality. Short birth intervals, teenage pregnancies and previous child deaths are associated with increased risk of death. The Government of the United Republic of Tanzania should therefore maintain its commitment to encouraging women to space their births at least two years apart and delay childbearing beyond the teenage years. Further, this study shows that there is a remarkable lack of infant and child mortality differentials by socioeconomic subgroups of the population, which may reflect post-independence health policy and development strategies. Whilst lack of socioeconomic differentials can be considered an achievement of government policies, mortality remains high so there is still a long way to go before Tanzania achieves its stated goal of 'Health for All'.     

Mortality trends among refugees in Honduras, 1984-1987

Mortality data collected from 1984 to 1987 through a routine standardized health information system in the five main refugee populations of Honduras were reviewed. The direct standardized mean annual death rate for all refugees was 5.5 per 1000 population (Honduras population as reference; Honduras mortality rate: 10.1 per 1000). Mortality decreased or remained stable among Salvadoran refugees from 1984 to 1987, but increased among Nicaraguan refugees after 1985. The highest neonatal (56.1 per 1000 livebirths), infant (126.1 per 1000 livebirths) and under-five-year-olds (35.7 per 1000 child less than five years of age) mortality rates were observed in the two Nicaraguan camps. These two camps had the highest rate of newly arriving refugees. Deaths in infants and under-five-year-olds accounted for 42 and 54.1% of all deaths respectively. Of all deaths under five years of age, respiratory infections, diarrhoeal diseases and measles accounted for 21.4%, 22.1% and 4.7%, respectively. Mortality rates, particularly among under-five-year-olds and infants increased when the rate of newly arriving refugees was higher. The importance of adapted health surveillance in refugee settlements is discussed.     

Monitoring and evaluation of integrated disease surveillance and response in selected districts in Tanzania

Integrated Disease Surveillance and Response (IDSR) is a strategy developed by the World Health Organization Regional Office for Africa in 1998. The Ministry of Health, Tanzania has adopted this strategy for strengthening communicable diseases surveillance in the country. In order to improve the effectiveness of the implementation of IDSR monitoring and evaluating the performance of the surveillance system, identifying areas that require strengthening and taking action is important. This paper presents the findings of baseline data collection for the period October-December 2003 in 12 districts representing eight regions of Tanzania. The districts involved were Mbulu, Babati, Dodoma Rural, Mpwapwa, Igunga, Tabora Urban, Mwanza Urban, Muleba, Nkasi, Sumbawanga Rural, Tunduru and Masasi. Results are grouped into three key areas: surveillance reporting, use of surveillance data and management of the IDSR system. In general, reporting systems are weak, both in terms of receiving all reports from all facilities in a timely manner, and in managing those reports at the district level. Routine analysis of surveillance data is not being done at facility or district levels, and districts do not monitor the performance of their surveillance system. There was also good communication and coordination with other sectors in terms of sharing information and resources. It is important that districts' capacity on IDSR is strengthened to enable them monitor and evaluate their own performance using established indicators.     

Use of multiple surveys to estimate mortality among never, current, and former smokers: changes over a 20-year interval.

OBJECTIVES: This study sought to demonstrate how data from publicly available large-scale cross-sectional health surveys can be combined to analyze changes in mortality risks among never, current, and former smokers. METHODS: Data from the 1966/68 and 1986 National Mortality Followback Surveys and the 1970 and 1987 National Health Interview Surveys were used to estimate the distribution of never, current, and former smokers among the US population at risk and decedents. Standardized mortality ratios and quotients of standardized mortality ratios were used to estimate mortality risks. RESULTS: Generally, during the period from 1966 through 1986, mortality rates in the United States for most causes of death declined among all smoking groups. However, mortality rates from respiratory diseases increased for current and former smokers. CONCLUSIONS: The reported changes in never and current smoker mortality risks are similar in magnitude and direction to those reported in a previous study based on longitudinal data. The use of combined data from the National Mortality Followback Survey and the National Health Interview Survey offers several advantages as an epidemiological tool.