ELEVATED CARBOHYDRATE-DEFICIENT TRANSFERRIN PREDICTS PROLONGED INTENSIVE CARE UNIT STAY IN TRAUMATIZED MEN

Carbohydrate-deficient transferrin (CDT) is reported to havea higher specificity in alcoholism than conventional markers.As the morbidity and mortality rates amongst chronic alcoholicsare raised following trauma, the objective was to investigateif CDT could be used to predict prolonged intensive care Unit(ICU) stay and an increased morbidity in patients with multipleinjuries admitted to the ICU. In this prospective double-blindstudy, 66 traumatized male patients were transferred to theICU following admission via the emergency room and operativemanagement. Blood samples for CDT determination were taken uponadmission to the emergency room, the ECU and on days 2 and 4following admission. The patients were allocated a priori totwo groups; high CDT group (CDT > 20 U/I on admission tothe emergency room) and low CDT group (CDT     

Health impacts of family planning

Among the many effects of family planning is the influence ithas on mortality and morbidity in women and children throughthe mechanism of changing the number and spacing of children.There is a complex set of relationships between mother's age,parity, birth spacing and infant and child mortality and morbidity.Much effort has been put into untangling this web in the hopeof identifying clear causal connections, but for the most parton the basis of inadequate data. Rather than attempt to establishthe relative importance of child spacing as a cause of decreasesin mortality, this paper takes as its starting point that thereis a connection, and presents some possible causal mechanismswhich explain how short birth intervals and child mortalitycould be related. In addition the most frequently cited hypotheses-maternaldepletion and sibling competition-a third is examined-birthcrowding which, it is suggested, influences the pattern of thetransmission of infectious diseases and, in turn, mortality. In the field of maternal mortality, the data which could beused to quantify the benefits of family planning are in evenshorter supply; however, the causal connections are rather moreeasily identified. The final section combines parity-specificdata on maternal mortality with evidence of changes in fertilitypatterns brought about by family planning to assess how successfulwe can hope to be in reducing through birth control the numberof women who die in childbirth.     

Investigation of gender heterogeneity in the associations of serum phosphorus with incident coronary artery disease and all-cause mortality

Serum phosphorus levels in the general population have beenreported to be associated with cardiovascular morbidity andmortality and increased carotid intima-media thickness. Theauthors examined gender heterogeneity in the association ofphosphorus with all-cause mortality and incident coronary arterydisease using data from the Atherosclerosis Risk in CommunitiesStudy (1987–2001). Baseline phosphorus levels were higherin women and were associated differently among men and womenwith traditional atherosclerosis risk factors such as age, lowdensity lipoprotein cholesterol, diabetes mellitus, and hypertension.In a multivariable-adjusted model, men in the highest quintileof serum phosphorus level (>3.8 mg/dL) had an increased mortalityrate (hazard ratio = 1.45, 95% confidence interval: 1.12, 1.88),while women did not (hazard ratio = 1.18, 95% confidence interval:0.89, 1.57). The multivariable likelihood ratio test of effectmodification by gender was significant at = 0.1 (P = 0.085)for all-cause mortality. Although the associations of phosphoruswith coronary artery disease also appeared to differ substantiallyby gender, the multivariable test for effect modification suggestedthat the difference was consistent with random variation (P= 0.195). These results suggest the need for further investigationinto gender differences in the contribution of mineral metabolismto cardiovascular disease in the general population. cardiovascular diseases; coronary artery disease; mortality; phosphorus; risk; sex factors     

Mortality Experience at a Hydrometallurgical Nickel Refinery in Fort Saskatchewan, Alberta between 1954 and 1984

The mortality experience of 716 male hydrometallurgical nickelrefinery employees who worked at Sherritt Gordon Limited inFort Saskatchewan, Alberta for at least 12 continuous monthsduring the years 1954 to 1978 was examined. Mortality ascertainmentwas obtained utilizing the Canadian Mortality Data Base maintainedby Statistics Canada and covered the years 1954 through 1984.Cause-specific mortality analyses were accomplished using male,age and calendar-year adjusted death rates for Canada and theprovince of Alberta. Total mortality was significantly belowexpectation (27 observed vs. 47 expected). Statistically significantfewer observed deaths were found for circulatory disease whilemultiple myeloma demonstrated a statistically significant increaseof observed deaths. No deaths due to nasal cavity or paranasalsinus cancer were detected. Only one lung cancer death was foundwith three deaths expected (SMR 33). No association was foundin this study between exposure to nickel concentrate or metallicnickel and the subsequent development of respiratory cancer. Requests for reprints should be addressed to: R. D. Egedahl, MD, FRCPC, 3304-Thornbrook Court, Midland, Michigan 48640, USA     

DANGEROUS JOBS AND HEAVY ALCOHOL USE IN TWO NATIONAL PROBABILITY SAMPLES

Samples of employed persons within the US were drawn from theNational Health and Nutrition Examination Survey II (n = 8477),and the Quality of Employment Survey (n = 1393) to test thehypothesis that a positive association existed between alcoholuse and job hazards. Heavy total alcohol use, or beer or wineor liquor use separately, were the dependent variables. Thekey independent variables included subjects' evaluations ofhazardous nature of the job and fatality rates within occupationsand industries. Models were estimated with logistic regressionscontrolling for age, gender, race and other covariates. Onlyone robust finding emerged: heavy beer use was found to be positivelyand strongly correlated with the fatality rate within occupations.Additional correlations between job hazards and heavy alcoholuse were weak, generated large P values, and some suggestedan inverse association. The lack of robust findings for theadditional correlations may partially be explained by the associationsbetween job categories on the one hand and choice of beverageon the other. Blue-collar jobs are more hazardous than white-collarjobs, on average. Persons in blue-collar jobs were more likelyto drink beer, while those in white-collar jobs were more likelyto drink wine or liquor (spirits). Separate analyses of beer,wine and liquor appeared essential to explaining correlationsbetween dangerous jobs and heavy alcohol use in these data.Limitations of the study included (1) age of the data (fromthe 1970s), (2) alcohol use and some job hazards were measuredby self-report, and (3) data were from only one country     

Effect of Bereavement on the Health of the Remaining Family Members

Van Eijk J, Smits A, Huygen F and van den Hoogen H. Effect ofbereavement on the health of the remaining family members. FamilyPractice 1988; 5: 278–282. This investigation focusses on the effect of the death of afamily member on the number and type of diagnosed illnessesof the remaining members. The data on mortality and morbiditywere obtained from a continuous morbidity register. A totalof 225 cases of death were selected, involving 313 family members.A control group of 4909 people who had not been confronted witha death of a family member were selected. A comparison of morbidityrates for the two groups showed that morbidity rates, both forminor and serious illnesses, were affected by the death of afamily member. Increases in minor illnesses occurred more oftenwhen people had been confronted with death after a chronic illness;increases in serious illnesses were mainly found among peopleconfronted with sudden death. Surprisingly, people with nervousdisorders in their medical history showed fewer diagnoses forminor illnesses after a sudden death of a family member. Anexplanation may be found in the basic principles of family medicine.     

Mortality Rates Among Arab Americans in Michigan

The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.     

Higher mortality rates associated with rheumatoid arthritis in Saskatchewan,Canada, 2001–2019

ObjectivesTo estimate provincial all-cause mortality rates of Saskatchewan people with rheumatoid arthritis (RA) for comparison with the general population over time and between different geographic regions.MethodsSaskatchewan provincial administrative health databases (2001–2019) were utilized as data sources. Two RA case definitions were employed: (1) ≥ 3 physician billing diagnoses, at least 1 from a specialist (rheumatologist, general internist or orthopaedic surgeon) within 2 years; (2) ≥ 1 hospitalization diagnosis (ICD-9 code 714, and ICD-10-CA codes M05, M06). Data from these definitions were combined to create an administrative data RA cohort. All-cause mortality rates across geographic regions, between rural/urban residences and between sexes were examined.ResultsOver an 18-year span, between fiscal-year 2001–2002 and fiscal-year 2018–2019, age- and sex-adjusted mortality rates ranged from 17.10 to 21.04 (95% CI 14.77, 19.44; 18.03, 24.05)/1000 RA person-years, compared with mortality rates for the general Saskatchewan population without RA, which ranged from 9.37 to 10.88 (95% CI 9.23, 9.51; 10.72, 11.05)/1000 person-years. Fiscal-year mortality rate ratios ranged from 1.82 to 2.13 (95% CI 1.56, 2.13; 1.83, 2.46). Provincial mortality rates were higher in men than in women for both general and RA populations. Northern Saskatchewan mortality rates were significantly higher in the general population but did not achieve significance compared with other provincial regions for the RA population. Regression analysis identified age, male sex, RA and geographic region as factors contributing to increased mortality. A trend towards lower mortality rates over time was observed.ConclusionHigher mortality rates were observed in the RA population overall. Men had higher mortality rates, as did residents of Northern Saskatchewan compared with residents of other regions for the general population.     

Race and stroke mortality in Brazil

As stroke mortality rates according to race were not known in Brazil, data on mortality for the year 2010 was collected from the Mortality Information System of the Brazilian Ministry of Health. Cerebrovascular mortality rates adjusted for age (per 100,000) were calculated with a confidence interval of 95% (95%CI) by sex and race/skin color. The differences between races were significant for men with rates of 44.4 (43.5;45.3), 48.2 (47.1;49.3) and 63.3 (60.6;66.6) for white, brown and black, respectively; and for women, with rates of 29.0 (28.3;29.7), 33.7 (32.8;34.6) and 51.0 (48.6;53.4) for white, brown and black, respectively. The burden of stroke mortality is higher among blacks compared to brown and white.     

Epidemiologic evidence for different roles of ultraviolet A and B radiation in melanoma mortality rates

PURPOSE: The action spectrum of ultraviolet radiation mainly responsible for melanoma induction is unknown, but evidence suggests it could be ultraviolet A (UVA), which has a different geographic distribution than ultraviolet B (UVB). This study assessed whether melanoma mortality rates are more closely related to the global distribution of UVA or UVB. METHODS: UVA and UVB radiation and age-adjusted melanoma mortality rates were obtained for all 45 countries reporting cancer data to the World Health Organization. Stratospheric ozone data were obtained from NASA satellites. Average population skin pigmentation was obtained from skin reflectometry measurements. RESULTS: Paradoxically, melanoma mortality rates decreased with increasing UVB in men (r = -0.48, p < 0.001), and women (r = -0.57, p < 0.001), and with increasing UVA in both sexes. By contrast, rates were positively associated with increasing UVA/UVB ratio in men (r = + 0.49, p < 0.001) and women (r = + 0.55, p < 0.001). After multiple adjustment that included controlling for skin pigmentation, only UVA was associated with melanoma mortality rates in men (p < 0.02) with a suggestive but non-significant trend present in women (p = 0.12). CONCLUSIONS: UVA radiation was associated with melanoma mortality rates after controlling for UVB and average pigmentation. The results require confirmation in observational studies.     

Musculoskeletal complaints in lock assemblers, testers and inspectors

The objectives of this study were to determine the prevalenceof musculoskeletal complaints in a population of lock assemblersin the West Midlands; to follow one group over 12 months andto explore the relationship between survey data, sickness absenceinformation and claims experience. An adapted Nordic MusculoskeletalQuestionnaire was used to determine annual and weekly prevalenceand annual disability rates for musculoskeletal complaints.There was no statistically significant difference in complaintsbetween the six companies, apart from an increased reportingof neck (p < 0.001), upper back (p < 0.001) and hip (p< 0.05) symptoms at one company (Site 4) during the weekprior to the study. When the study was repeated at Site 4 oneyear later, new employees had significantly fewer complaintsof neck and elbow discomfort over the previous year and week,but no difference in wrist complaints was reported. This surveyof lock assemblers has highlighted high levels of self-reportedupper limb complaints when compared to other referent groupsof workers.     

Is the high ischemic heart disease mortality rate in New York State just an urban effect?

To determine whether New York State''s high ischemic heart disease mortality rate was due primarily to an urban effect, rates for regions in the State were compared with each other and with national data. New York State mortality rates for the period 1980-87 were highest for New York City (344.5 per 100,000 residents), followed by upstate urban and rural areas (267.1-285.1), and New York City suburbs (272.5). However, the overall 1986 age-adjusted rate for the New York State region with the lowest mortality rate (265.7) exceeded that of 42 States. New York State''s number one ischemic heart disease mortality ranking reflects the need for statewide intervention programs, because even regions with relatively low mortality rates are high when they are compared with national rates.     

A Bayesian approach to assess heart disease mortality among persons with diabetes in the presence of missing data

Some states’ death certificate form includes a diabetes yes/no check box that enables policy makers to investigate the change in heart disease mortality rates by diabetes status. Because the check boxes are sometimes unmarked, a method accounting for missing data is needed when estimating heart disease mortality rates by diabetes status. Using North Dakota’s data (1992–2003), we generate the posterior distribution of diabetes status to estimate diabetes status among those with heart disease and an unmarked check box using Monte Carlo methods. Combining this estimate with the number of death certificates with known diabetes status provides a numerator for heart disease mortality rates. Denominators for rates were estimated from the North Dakota Behavioral Risk Factor Surveillance System. Accounting for missing data, age-adjusted heart disease mortality rates (per 1,000) among women with diabetes were 8.6 during 1992–1998 and 6.7 during 1999–2003. Among men with diabetes, rates were 13.0 during 1992–1998 and 10.0 during 1999–2003. The Bayesian approach accounted for the uncertainty due to missing diabetes status as well as the uncertainty in estimating the populations with diabetes. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of CDC.     

Do inferences about mortality rates and disparities vary by source of mortality information?

PurposeResearchers who study mortality among survey participants have multiple options for obtaining information about which participants died (and when and how they died). Some use public record and commercial databases; others use the National Death Index; some use the Social Security Death Master File; and still others triangulate sources and use Internet searches and genealogic methods. We ask how inferences about mortality rates and disparities depend on the choice of source of mortality information.MethodsUsing data on a large, nationally representative cohort of people who were first interviewed as high school sophomores in 1980 and for whom we have extensive identifying information, we describe mortality rates and disparities through about age 50 using four separate sources of mortality data. We rely on cross-tabular and multivariate logistic regression models.ResultsThese sources of mortality information often disagree about which of our panelists died by about age 50 and also about overall mortality rates. However, differences in mortality rates (i.e., by sex, race/ethnicity, education) are similar across of sources of mortality data.ConclusionResearchers' source of mortality information affects estimates of overall mortality rates but not estimates of differential mortality by sex, race and/or ethnicity, or education.     

The beginning of the end of the lung cancer epidemic among Dutch women

OBJECTIVE: To describe and interpret recent changes in lung cancer mortality and incidence, and changes in smoking prevalence among young and middle-aged women in The Netherlands. DESIGN: Secondary data analysis. METHOD: Mortality data were collected from Statistics Netherlands (CBS; 1960-2006), data on the incidence were obtained from The Netherlands Cancer Registry (NCR; 1989-2003), and data on smoking prevalence were collected from the Dutch Foundation on Smoking and Health (STIVORO; 1988-2007). Mortality and incidence rates were calculated for four age groups (20-44, 45-49, 50-54 and 55-59 years). Changes in trends in mortality and smoking prevalence were examined using joinpoint regression and birth cohort analysis. RESULTS: Since the 1960s, lung cancer mortality and incidence has increased dramatically among women in The Netherlands. In the mid-1990s, lung cancer mortality and incidence rates in young women (aged < 50 years) surpassed those in men. Mortality rates in young women (aged 20-49 years) increased 4-6% annually. However, these rates started to stabilise since 1999. Among women born after 1950, mortality rates and smoking prevalence have decreased. CONCLUSION: An end to the lung cancer epidemic in women in The Netherlands is in sight. The first indications are the recent reduction in mortality and incidence among young women, particularly in women born after 1950. In the future, this reduction is expected to translate into a stabilisation or modest decrease in total lung cancer mortality and incidence.     

Gastrointestinal cancer mortality in New Jersey counties, and the relationship with environmental variables

The State of New Jersey (NJ) USA has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for its 21 counties. This paper presents an analysis of gastrointestinal (GI) cancer mortality rates in New Jersey counties during 1968-1977, a comparison with the 1950-1969 rates, and associations between current GI cancer mortality rates and selected environmental variables. Age-adjusted mortality rates for GI cancers were calculated for the 21 NJ counties during the period 1968-1977, and were compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US, 1973-1977. The county rates were also correlated with: the distribution of chemical toxic waste disposal sites; annual per capita income; the rates of low birth weight, birth defects, and infant mortality; chemical industry distribution; percentage of the population employed in chemical industries; the density of population; and the urbanization index for each of the counties. Some of the major findings are: Age-adjusted GI cancer mortality rates (all sites combined) were higher than national rates in 20 of 21 NJ counties. In comparison with national trends, NJ stomach cancer rates have declined less, oesophageal cancer rates have declined more, and pancreatic cancer mortality rates have followed similar patterns. Cancer mortality rates in NJ during the period 1968-1977 significantly (p less than 0.0001) exceeded national rates for cancer of the oesophagus (white male, non-white male), stomach (men and women), colon (white male, white female, non-white female), and rectum (whites only). In 18 of the 21 NJ counties, the observed number of cancer deaths for at least one GI cancer site was significantly greater than expected at the 0.0001 level for at least one population subgroup. Among white men, a significant (p less than 0.0001) excess of observed over expected cancer deaths was observed for three or more GI cancer sites in seven counties. The environmental variables that were most frequently associated with GI cancer mortality rates (except pancreatic cancer) were degree of urbanization, population density, and chemical toxic waste disposal sites. Some of the implications of the study findings are discussed and recommendations made for future investigations.     

Effect of healthcare on mortality: trends in avoidable mortality in Australia and comparisons with Western Europe

OBJECTIVES: Using the concept of avoidable mortality, international studies suggest that healthcare has been effective in reducing mortality. This paper provides an analysis of avoidable mortality in Australia and compares trends with those of Western Europe. METHODS: Using unit-record mortality data, we calculated avoidable mortality rates in Australia for 1968-2001. We partitioned avoidable causes into three categories: those amenable to medical care; those mainly responsive to health policy; and ischaemic heart disease. We used Poisson regression to model the trends. We compared trends with those of nine European countries using published data. RESULTS: Total avoidable death rates fell by 68% in females and 72% in males. The corresponding non-avoidable death rates fell by 35 and 33%. The annual declines in avoidable mortality rates were: 3.47% [95% confidence intervals (CI) 3.44-3.50%] in males and 3.89% (95% CI 3.86-3.91%) in females. For non-avoidable mortality rates, the annual declines were 1.09% (95% CI 1.05-1.13%) and 0.95% (95% CI 0.92-0.98%), respectively. In females, declines in death rates from causes amenable to medical care contributed 54% to the decline in avoidable mortality rates, ischaemic heart disease contributed 45%, and causes responsive to health policy intervention contributed 1%. In males, the corresponding contributions were 32, 57 and 11%. These rates, and the declines between 1980 and 1998, were comparable with selected European countries, with Australia's ranking improving over the period. CONCLUSION: Trends in avoidable mortality in Australia suggest that the Australian healthcare system has been effective in improving population health. Australia's experience compares favourably with that of Europe.     

Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System

We studied infant mortality rates in Canada within specific gestational age and birthweight categories after using probabilistic techniques to link information in Statistics Canada's live births data base (1985-94) with that in the death data base (1985-95). Gestational age- and birthweight-specific mortality rates in 1992-94 were contrasted with those in 1985-87 with changes expressed in terms of relative risks with 95% confidence intervals [CI]. Statistically significant reductions in infant mortality were observed beginning at 24-25 weeks of gestation and extended across the gestational age range to post-term births. Crude infant mortality rates, infant mortality rates among those > or = 500 g and among those > or = 1000 g decreased by 22%, 25% and 26%, respectively, from 1985-87 to 1992-94. The magnitude of the reductions in infant mortality rates ranged from 14% [95% CI 7, 21%] at 24-25 weeks of gestation to 40% [95% CI 31, 47%] at 28-31 weeks. Almost all reductions in gestational age- and birthweight-specific infant mortality between 1985-87 and 1992-94 were due to approximately equal reductions in neonatal and post-neonatal mortality. Live births > or = 42 weeks of gestation did not follow this rule; post-neonatal mortality rates among such live births decreased significantly by 51% [95% CI 26, 68%], although neonatal mortality rates showed no significant change. The mortality reductions observed across the gestational age and birthweight range are probably a consequence of specific clinical interventions complementing improvements in fetal growth. Temporal changes in the outcome of post-term pregnancies need to be carefully examined, especially in relation to recent changes in the obstetric management of such pregnancies.     

ICD-10 adaptations of the Ontario acute myocardial infarction mortality prediction rules performed as well as the original versions

OBJECTIVE: To derive and validate an International Classification of Diseases-10 (ICD-10) version of the Ontario Acute Myocardial Infarction (AMI) mortality prediction rules, used to adjust for case-mix differences in studies of AMI patients using administrative data. STUDY DESIGN AND SETTING: We linked the records of all Ontario patients admitted with AMI (2002-2004) with mortality data. The original ICD-9 codes were mapped to ICD-10-CA (Canada) codes using both a translation produced by coding experts and a manual search of codes; the final codes were determined by consensus. Comorbidity prevalence and mortality rates were calculated. Multivariable logistic regression models were used to predict 30-day and 1-year mortality and the C-statistic was used to evaluate the discrimination of the models. RESULTS: We identified 37,271 AMI patients. The most common comorbidities were heart failure and dysrhythmias; 30-day and 1-year mortality rates were 12.3% and 21.8%, respectively; and mortality rates were highest among patients with shock, cancer, and acute renal failure. The C-statistics were 0.77 and 0.80, compared with 0.78 and 0.79 in the ICD-9 version, for 30-day and 1-year mortality, respectively. CONCLUSION: An ICD-10 version of the AMI mortality prediction rules predicted 30-day and 1-year mortality as well as the original ICD-9 version.     

Declining child mortality in northern Malawi despite high rates of infection with HIV

Objective

To determine whether routine surveys, such as the Demographic and Health Surveys (DHS), have underestimated child mortality in Malawi.

Methods

Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32 000. After initial census, births and deaths were reported by village informants and updated monthly by project enumerators. Cause of death was established by verbal autopsy whenever possible. The likely impact of human immunodeficiency virus (HIV) infection on child mortality was also estimated from antenatal clinic surveillance data. Overall and age-specific mortality rates were compared with those from the 2004 Malawi DHS.

Findings

Between August 2002 and February 2006, 38 617 person–years of observation were recorded for 20 388 children aged < 15 years. There were 342 deaths. Re-census data, follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births, under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30% lower than those from national estimates as determined by routine surveys.

Conclusion

The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates.