Hepatitis A--related mortality in California, 1989-2000: analysis of multiple cause-coded death data

OBJECTIVES: We estimated the hepatitis A (HA) mortality rate in California, assessed demographic differences in HA-related mortality, and examined comorbidities listed on death certificates in order to provide information for health policy and planning related to HA vaccination. METHODS: We identified HA-related deaths in California from 1989 to 2000 with multiple-cause-of-death files and calculated mortality rates and rate ratios. RESULTS: We identified 402 HA-related deaths between 1989 and 2000; the annual age-adjusted HA-related mortality rate was 1.20 deaths per 1 million persons. Older individuals, men, Latinos, and American Indians/Alaska Natives had elevated mortality rates. Liver conditions and non-A viral hepatitis infections were more common among HA-related deaths than among all other deaths. CONCLUSIONS: Current immunization practices should be reevaluated and the expansion of current vaccination guidelines for groups that have elevated HA-related mortality rates should be considered.     

Pancreatic cancer mortality and organochlorine pesticide exposure in California, 1989-1996

BACKGROUND: Occupational studies have suggested a possible link between organochlorine pesticides and the occurrence of pancreatic cancers. California maintains a death file and a pesticide reporting system that allows examination of this relationship for residents of high use areas. METHODS: We employed a mortality odds ratio design to compare deaths from pancreatic cancer (1989-1996) with a random sample of non-cancer deaths. Using pesticide data for three agricultural counties, we classified 102 ZIP codes in quartiles of pesticide usage for 1972-1989. Using logistic regression we estimated the effect of pesticide applications by ZIP code controlling for possible confounders. RESULTS: Among long-term residents, pancreatic cancer mortality was elevated for those living in ZIP codes with the highest use of four pesticides: 1,3-dichloropropene (1,3-d), captafol, pentachloronitrobenzene (PCNB), and dieldrin. No dose-response relationship was observed. CONCLUSIONS: Our study suggests increased pancreatic cancer mortality among long-term residents in areas of high application rates of 1,3-d (an EPA-classified probable human carcinogen), captafol, pentacholoronitrobenzene (PCNB), and dieldrin.     

Alcohol-related mortality in California, 1980 to 1989.

OBJECTIVES. This study sought to examine the impact of alcohol use and misuse on mortality in California during the 1980s. METHODS. Alcohol-Related Disease Impact estimation software and California vital statistics data were used to calculate alcohol-related mortality, mortality rates, and years of potential life lost. Statistical tests were applied to detect significant differences in death rates by sex and race/ethnicity. Time trends in death rates for a subset of alcohol-defined diagnoses were examined using regression analysis. RESULTS. An estimated 6.2% of all deaths for California residents during 1989 were related to alcohol, making it one of the top 10 leading causes of death. Injury diagnoses were major contributors to the total estimated number of alcohol-related deaths and years of potential life lost before age 65. Alcohol-related mortality rates were significantly higher for men and for Blacks. However, age-adjusted death rates for alcohol-defined diagnoses declined significantly from 1980 to 1989. CONCLUSIONS. A structured data-base approach to analyzing mortality data represents an important advance for alcohol research that has implications for policy and program planning. Future refinements and enhancements to the disease impact estimation methodology will add precision to determining how alcohol use and misuse affect public health in California.     

A proportionate mortality analysis of California agricultural workers, 1978-1979

There are few published reports of epidemiologic studies of the risks of agricultural work. Members of this occupational group have been of special concern because of their exposure to pesticides, some of which are mutagens and animal carcinogens. A previous proportionate mortality study of California agricultural workers was based on deaths recorded among white males of this occupational group during 1959-1961. We have conducted a proportionate mortality analysis of all deaths recorded during 1978-1979 among California farm workers and farm owner/managers. In general, the findings of our study are consistent with those of the previous study. For farm workers, we found proportionate mortality ratios (PMRs) which were consistently elevated for all race and sex categories (in which there were 6 or more decedents) for deaths due to motor vehicle accidents, all respiratory disease, and all infective and parasitic diseases. The PMRs for the former three causes of death were also found to be elevated across several race and sex categories for farm owner/managers. We also found a significant and consistent deficit of deaths among farm workers and farm owner/managers due to arteriosclerotic heart disease. The proportionate cancer mortality ratios (PCMRs) for cancer of the stomach and cancer of other lymphatic tissue were elevated, although not necessarily statistically significantly, for several race and sex categories among farm workers and farm owner/managers. The PCMR for cancer of the cervix was statistically significant for white female farmworkers.     

Spatial distribution of Parkinson's disease mortality in Spain, 1989-1998, as a guide for focused aetiological research or health-care intervention

Background  

Aetiologically, genetic and environmental factors having an uneven spatial distribution may underlie Parkinson's disease (PD). Undiagnosis of PD in selected regions might have limited access to treatment with levodopa and simultaneously, if present at death, determined PD underreporting at the death record. The purpose of this study was to describe and analyse municipal mortality due to PD in Spain in aetiological and interventional perspective.     

Daily mortality and air pollution in Santa Clara County, California: 1989-1996.

Since the last revision of the national particulate standards, there has been a profusion of epidemiologic research showing associations between particulates and health effects--mortality in particular. Supported by this research, the U.S. Environmental Protection Agency promulgated a national standard for particulate matter [less than/equal to] 2.5 microm in aerodynamic diameter (PM(2.5)). Nevertheless, the San Francisco Bay Area of California may meet this new standard. This study investigates the relationship between daily mortality and air pollution in Santa Clara County (a Bay Area county) using techniques similar to those utilized in earlier epidemiologic studies. Statistically significant associations persist in the early 1990s, when the Bay Area met national air pollution standards for every criteria pollutant. Of the various pollutants, the strongest associations occur with particulates, especially ammonium nitrate and PM(2.5). The continuing presence of associations between mortality and air pollutants calls into question the adequacy of national standards for protecting public health.     

Injury mortality among American Indian and Alaska Native children and youth--United States, 1989-1998

Injuries account for 75% of all deaths among American Indian and Alaska Native (AI/AN) children and youth, and AI/ANs have an overall injury-related death rate that is twice the U.S. rate for all racial/ethnic populations. However, rate disparities vary by area and by cause. To help focus prevention efforts, CDC analyzed injury mortality data by Indian Health Service (IHS) administrative area and by race/ethnicity. This report summarizes the results of these analyses, which indicate that although death rates for some causes (e.g. drowning and fire) have shown substantial improvement over time, rates for other causes have increased or remained unchanged (e.g., homicide and suicide, respectively). Prevention strategies should focus on the leading causes of injury-related death in each AI/AN community, such as motor-vehicle crashes, suicides, and violence.     

Estimated effect of pneumococcal conjugate vaccination on invasive pneumococcal disease and associated mortality, Denmark 2000-2005

In order to provide an estimation of the direct and indirect benefits of pneumococcal vaccination with three protein-conjugate pneumococcal vaccines (PCV) we described the epidemiology and mortality from invasive pneumococcal disease (IPD) in Denmark between 2000 and 2005. Approximately 1080 cases were registered annually during the period. The overall incidence of IPD increased significantly, from 15.4 cases per 100,000 population in 2000 to 20.7 cases per 100,000 in 2005 (p<0.01), mainly due to an increase in bacteraemia cases. The serotype coverage in children under 5 years varied from 64% to 91% depending on the PCV used. The mean mortality proportion after IPD was 18%, with approximately 190 deaths annually. One to two deaths among children younger than 5 years and approximately 50 deaths related to IPD caused by vaccine serotypes among older age groups could be prevented annually by introducing a PCV. Approximately 70% of all deaths occurred in adults over 65 years, underlining the need for protection against IPD in this age group.     

Invasive pneumococcal disease in children 5 years after conjugate vaccine introduction--eight states, 1998-2005

Streptococcus pneumoniae (pneumococcus) is a major cause of meningitis, pneumonia, and bacteremia, especially among young children and older adults. Before the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in the United States in 2000, the seven pneumococcal serotypes covered by the vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F) caused 80% of invasive pneumococcal disease (IPD) cases among young children, and the incidence of IPD was relatively stable. In October 2000, the Advisory Committee on Immunization Practices recommended PCV7 for all children aged <2 years and for older children at increased risk for IPD. Introduction of PCV7 in the United States led to substantial reductions in the incidence of IPD among the target population of children aged <5 years. Use of the vaccine also reduced IPD among unvaccinated populations through reductions in nasopharyngeal colonization and transmission of vaccine-type pneumococci from vaccinated children (i.e., indirect, or herd, effects of PCV7). To evaluate the effect of continued PCV7 use on IPD incidence among children aged <5 years in the United States, CDC analyzed population- and laboratory-based surveillance data. Results of that analysis indicated that in 2005, overall IPD rates among children aged <5 years were 77% lower, and an estimated 13,000 fewer cases of IPD occurred, compared with the years preceding vaccine introduction (1998-1999). Although IPD caused by PCV7 serotypes declined through 2005, overall IPD rates leveled off beginning in 2002, primarily because of increases in the incidence of IPD caused by non-PCV7 serotype 19A. Given these trends, use of expanded-valency conjugate vaccines might further reduce IPD incidence. Continued surveillance is needed to guide development of future formulations of conjugate vaccines and to monitor the effects of continued vaccine use.     

Internal migration and distribution of Chagas disease mortality, Brazil, 1981-1998

In Brazil, mortality from Chagas disease occurs even in regions classified as free of vector transmission. Because death rates refer to residents, and considering that a huge migratory movement has occurred inside the country, this study was intended to quantify the contribution of Brazilian internal migration to overall mortality from Chagas disease, from 1981 to 1998. If the PAHO Southern Cone Initiative actually achieved its objectives, one could expect declining death rates and increasing age at death from this cause. The results showed that out of 68,936 deaths in Brazilians with known birthplace, 32,369 (32%) occurred in people born in States other than those of their current residence (range: from 0.3% in Rio Grande do Sul to 100% in Roraima and Amapá). Most (67%) of the deaths in migrants occurred in individuals born in the States of Minas Gerais (51%) and Bahia (16%). Death rates in residents showed a consistent decline in the Southeast, South, and Central West of the country, but not in the Northeast and North, where median age at death was the lowest.     

1989—2004年徐州市区居民脑血管病死亡状况分析

目的了解我市市区居民脑血管病死亡状况及其危害程度。方法对我市市区居民1989—2004年死因资料进行了分析,计算年均增长率和潜在减寿年数(YPLL)。结果 1989—2004年,徐州市市区居民脑血管病死亡率68.01/10万~105.83/10万,标化死亡率在63.42/10万~111.39/10万,居全死因顺位的前3位,16年间,构成比呈上升趋势(χ2=4.41,P<0.05)。男女脑血管病死亡差异有统计学意义(χ2=75.53,P<0.01)。结论应加强脑血管病的预防和控制。     

Alaska native mortality, 1979-1998

OBJECTIVES: This study compares mortality patterns for the Alaska Native population and the U.S. white population for 1989-1998 and examines trends for the 20-year period 1979-1998. METHODS: The authors used death certificate data and Indian Health Service population estimates to calculate mortality rates for the Alaska Native population, age-adjusted to the U.S. 1940 standard million. Data on population and mortality for U.S. whites, aggregated by 10-year age groups and by gender, were obtained from the National Center for Health Statistics, and U.S. white mortality rates were age-adjusted to the U.S. 1940 standard million. RESULTS: Overall, 1989-1998 Alaska Native mortality rates were 60% higher than those for the U.S. white population for the same period. There were significant disparities for eight of 10 leading causes of death, particularly unintentional injury, suicide, and homicide/legal intervention. Although declines in injury rates can be documented for the period 1979-1998, large disparities still exist. Alaska Native death rates for cancer, cerebrovascular disease, chronic obstructive pulmonary disease, and diabetes increased from 1979 to 1998. Given decreases in some cause-specific mortality rates in the U.S. white population, increased rates among Alaska Natives have resulted in new disparities. CONCLUSIONS: These data indicate that improvements in injury mortality rates are offset by marked increases in chronic disease deaths.     

Salmonelloses in the Czech Republic 1989-1998

In the Czech Republic in 1989 a triple increase of the incidence of salmonelloses was recorded: 34,435 cases. Since that year the morbidity trend varies between 400 and 500 cases per 100,000 population. The dominating agent (95% and more) is Salmonella Enteritidis PT8. The epidemic incidence was recorded on the whole territory of the Czech Republic mainly in Moravia and in the East Bohemian region. The specific morbidity is highest in 0 and 1-4 year-old children. The seasonal incidence has two peaks with the exception of 1997. During the period between 1989 and 1996 there was a significant increase of epidemics of salmonellosis in conjunction with food production incl. private confectionery shops, restaurants and the sale of foods in the streets. The most important vehicle are eggs and egg products, in particular confectionery. Salmonella Typhimurium DT104 is found only rarely in the Czech Republic. The first epidemic (15 cases) developed in 1998.     

Variation in homicide risk during infancy--United States, 1989-1998

Homicide is the 15th leading cause of death during the first year of life (i.e., infancy) in the United States. In addition, the risk for homicide is greater in infancy than in any other year of childhood before age 17 years and is greatest during the first 4 months of life. To determine how the risk for homicide varied by week during infancy and by day during the first week of life, CDC analyzed death certificate data for 1989-1998. This report summarizes the results of this analysis, which indicated that risk for infant homicide is greatest on the day of birth. Efforts to prevent infant homicides should focus on early infancy.     

Parkinson's disease mortality and pesticide exposure in California 1984-1994

BACKGROUND: In the last two decades reports from different countries emerged associating pesticide and herbicide use with Parkinson's disease (PD). California growers use approximately 250 million pounds of pesticides annually, about a quarter of all pesticides used in the US. METHODS: We employed a proportional odds mortality design to compare all cases of PD recorded as underlying (1984-1994) or associated causes (1984-1993) of death occurring in California with all deaths from ischaemic heart disease (ICD-9 410-414) during the same period. Based on pesticide use report data we classified California counties into several pesticide use categories. Agricultural census data allowed us to create measures of percentage of land per county treated with pesticides. Employing logistic regression models we estimated the effect of pesticide use controlling for age, gender, race, birthplace, year of deaths, and education. RESULTS: Mortality from PD as the underlying cause of death was higher in agricultural pesticide-use counties than in non-use counties. A dose response was observed for insecticide use per county land treated when using 1982 agricultural census data, but not for amounts of restricted pesticides used or length of residency in a country prior to death. CONCLUSIONS: Our data show an increased PD mortality in California counties using agricultural pesticides. Unless all of our measures of county pesticide use are surrogates for other risk factors more prevalent in pesticide use counties, it seems important to target this prevalent exposure in rural California in future studies that use improved case finding mechanisms and collect pesticide exposure data for individuals.     

Coronary heart disease mortality for six ethnic groups in California, 1990-2000

PURPOSE: To investigate ethnic variations in coronary heart disease death in California, the authors examined total and CHD-specific mortality among non-Hispanic white (white), Hispanic, non-Hispanic black (black), Chinese, Japanese, and Asian Indian Americans. Deaths were identified in the California Mortality Database and population information was derived from the 1990 and 2000 censuses. METHODS: Age-standardized death rates per 100,000 population were calculated for ages 25 to 84 years from 1990 to 2000. Proportional mortality ratios (PMRs) for each sex and age group were calculated by dividing the proportion of deaths due to CHD in each ethnic group by the proportion of deaths due to CHD in the total population. RESULTS: Blacks had the highest all-cause age-standardized death rates among men (1614) and women (1014). Blacks had the highest CHD death rates among men (272) and women (190). PMRs for CHD were highest in Asian Indian men (161) and women (144), reflective of the higher percentage of CHD deaths compared with all cause deaths in this group. All sex-ethnic groups showed a decline in all cause and CHD mortality compared with the period between 1985 and 1990, except Asian Indian women, who experienced a 16% increase in all cause mortality and 5% increase in CHD mortality. CONCLUSIONS: There is considerable heterogeneity in CHD mortality among ethnic subgroups, and additional research is needed to guide treatment and prevention efforts. Blacks and Asian Indians in California are identified as particularly high risk populations.     

Fatal traumatic brain injury, West Virginia, 1989-1998

OBJECTIVE: The objective of this study was to describe fatal cases of traumatic brain injury (TBI) among West Virginia residents. METHODS: The authors analyzed data from the National Center for Health Statistics Multiple Cause of Death tapes for the period 1989-1998. They compared West Virginia's annualized average TBI death rate with the rates of other states and with the rate among U.S. residents for the same period. U.S. Bureau of Census population estimates were used as denominators. RESULTS: A total of 4,416 TBI deaths occurred in West Virginia in 1989-1998, for an annual average death rate of 23.6 per 100,000 population. From 1989 to 1998, TBI death rates declined 5% (p=0.4042). Seventy-five percent (n=3,315) of fatalities occurred among men. Adults > or =65 years of age accounted for the highest percentage of fatal injuries (n=1,135). The leading external causes of fatal TBI were: firearm-related (39% of reported fatalities), motor vehicles-related (34%), and fall-related (10%). Firearm-related TBI became the leading cause of TBI fatalities in 1991, surpassing motor vehicle-related TBI. Seventy-five percent of firearm-related TBI deaths were suicides (n=1,302). West Virginia's TBI death rate (23.6 per 100,000) was higher than the national rate (20.6 per 100,000). In 23 states, the average TBI death rates over the 10-year period were higher than West Virginia's. Whereas modest declines in TBI death rates occurred for motor vehicle-related and firearm-related causes in West Virginia, a concomitant 38% increase occurred in the fall-related TBI death rate during the decade. CONCLUSION: Data presented in this report can be used to develop targeted prevention programs in West Virginia.     

Brain tumors mortality in Brazil, 1980-1998

Brain tumors are rare, but their incidence and mortality have increased in different countries, including Brazil, especially among the elderly. This paper presents the mortality pattern of brain tumors in Brazil, including distribution of mortality rates by gender, age, topography, and tumor staging, from 1980 to 1998. Age-adjusted (by world population) brain cancer mortality rates increased from 2.24/100,000 to 3.35/100,000 inhabitants among the overall population during this period (an increase of 50%). Observed rates were higher during childhood than adolescence and increased with age, reaching the highest levels among the elderly. Among individuals 70 years of age and older, an average annual increase of 6% was observed in the series. Brain and meningeal tumor rates are presented for the entire country and selected State capitals. Further study is needed to elucidate the role of both new diagnostic technologies and environmental exposures potentially associated with the observed changes in brain cancer mortality rates.     

Incidence of invasive pneumococcal disease and distribution of capsular types of pneumococci in Denmark, 1989-94.

During the period 1989-94, 4620 strains of Streptococcus pneumoniae (4063 from blood and 557 from cerebrospinal fluid), from cases of invasive disease in Denmark, were received for capsular typing and penicillin susceptibility testing. During the study period the incidence of bacteraemic pneumococcal disease increased from 10 to 18 cases per 100000 inhabitants per year. The highest rates were seen in the very young, age less than 5 years (23/100000/year, in 1994), and in the elderly, age greater than 60 years (55/100000/year, in 1994). The annual number of cases of meningitis did not vary. Overall, 92% (93% blood, 87% CSF) of isolates and 94% of all childhood isolates belonged to the 23 vaccine types. The capsular types occurring most commonly among the 4123 pneumococcal strains from adults were types 1, 4, 14, 6A + 6B, 7F, 9V, 3, 12F, and 8 (in order of frequency). The ten most frequently occurring types from children (6A + 6B, 18C, 14, 1, 7F, 19F, 9V, 4, and 23F) covered 84% of the cases of bacteraemia and meningitis. Reduced susceptibility to penicillin was rare (< 1%).