Causes of death in Minamata disease: analysis of death certificates

Summary The causes of death in Minamata disease were analyzed and compared with those of control subjects. Of the 1422 Minamata disease patients in the Kumamoto Prefecture, 378 had died by the end of 1980. Of these 378, the first death occurred in 1954 with a peak incidence in 1956 when Minamata disease was officially reported for the first time. The number of deaths increased rapidly after 1972 with a second peak in 1976. The male: female ratio was 1.8: 1 and the mean age-at-death was 67.2 years (SD = ± 18.65). The mean age-at-death was younger in the cases of the initial outbreak than in those recently. There were, on the average, 2.8 causes of death per person. Of these cases, 157 (41.5%) had Minamata disease indicated on the death certificate, though 64 (16.9%) had Minamata disease coded as the underlying cause. Minamata disease and the noninflammatory diseases of the central nervous system (CNS) were the main underlying causes of death between 1954 and 1969, while, in the multiple cause data, pneumonia and non-ischemic heart disease were the most prevalent. Cerebrovascular diseases (18.0%) were the main underlying causes of death followed by malignant neoplasms (14.7%), cardiovascular diseases (14.1%) and Minamata disease (14.1%) in 1970 or later, while cardiovascular diseases (18.6%), Minamata disease (14.5%), cerebrovascular diseases (10.4%) and malignant neoplasms (7.1%) were the major multiple causes of death. As compared with the control, the proportions of deaths due to noninflammatory diseases of CNS and pneumonia were higher in the initial outbreak. Although the difference in the causes of death was less apparent recently, malignant neoplasms and hypertensive diseases tended to be lower. These results suggest that there is a need for a long-term follow-up of Minamata disease patients. The data also show the potential value of multiple causes of death coding in analyses of mortality.     

上海市浦东新区2014年高血压患者死因分析

目的 分析上海市浦东新区2014年高血压患者死亡情况,为制定高血压防治对策提供依据。方法 依照ICD-10对疾病进行编码,应用STATA 11.0软件对2014年户籍高血压患者死亡资料进行分析。结果 2014年浦东新区高血压患者死亡6 853人,占总死亡数的31.72%。脑血管疾病是高血压患者最主要的死亡原因,死亡率达76.51/10万,死亡率随年龄增长迅速增加。死于心脑血管等疾病的高血压病患者在家中、赴院途中死亡比例更高。结论 脑血管疾病是高血压患者最主要的死亡原因,加强患者自我管理,有助于较好控制血压,降低患者心脑血管事件的发生。     

Validity of maternal and perinatal risk factors reported on fetal death certificates

We sought to estimate the accuracy, relative to maternal medical records, of perinatal risk factors recorded on fetal death certificates. We conducted a validation study of fetal death certificates among women who experienced fetal deaths between 1996 and 2001. The number of previous births, established diabetes, chronic hypertension, maternal fever, performance of autopsy, anencephaly, and Down syndrome had very high accuracy, while placental cord conditions and other chromosomal abnormalities were reported inaccurately. Additional population-based studies are needed to identify strategies to improve fetal death certificate data.     

1998年我国生育年龄段人群中自杀的死因分析

目的 了解我国1998年育龄男女人群自杀情况。方法 根据卫生部提供的1998年《全国卫生统计年报资料》中的部分资料以及《中国人口统计年鉴（1999）》中有关1998年相应年龄组人口数进行推算,得出我国农村、城市15－24岁、25－34岁、35－44岁几个年龄组男女最重要疾病的死亡率。结果 自杀是我国1998年15－34岁人群的第1位死因、35－44岁人群的第4位死因。在15－44岁人群中,农村自杀率是城市的3．3倍,占自杀总人数的92％;在农村15－44岁、城市15－34岁人群中女性自杀高于男性;年龄越大,男女自杀率之间的差异越小。结论 15－44岁人群是自杀预防的重点人群,特别是这一年龄组的农村女性。     

Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research

Gay and bisexual men experience numerous health disparities relative to heterosexual men, including high rates of HIV and suicidal behavior. Systematic community health assessments could provide direct comparisons of the burden of mortality across diseases and thus facilitate the prioritization of public health activities; however, such assessments have been precluded by the absence of sexual orientation information in vital statistics records. In this context, we used population attributable fraction to derive and compare indirect estimates of mortality for both HIV and suicide. Assuming that 2% of Canadian men are gay or bisexual, and that these men are 42 times more likely to die from HIV and 4 times more likely to die from suicide, we estimated that in 2011, suicide resulted in 46 deaths per 100,000 gay and bisexual men, while HIV resulted in 30 deaths per 100,000. Based on these estimates, suicide surpassed HIV as a leading cause of premature mortality for gay and bisexual men in 2007. Despite the large burden of suicide among gay and bisexual men, research attending to the issue in biomedical, psychology, and social science literatures is sparse, with at least 10 times fewer citations than for HIV between 2003 and 2012. We urge researchers, practitioners, and community leaders to broaden the scope of gay and bisexual men’s public health priorities to include suicide and other high burden health inequities.     

2015年株洲市居民伤害死亡原因及潜在减寿年数分析

目的 了解2015年株洲市居民伤害死亡水平、特征及潜在寿命损失情况,为伤害的预防和控制提供科学的决策依据。 方法 利用2015年株洲市死因监测资料,通过死亡率、标化死亡率、死因顺位、潜在减寿年数(PYLL)、平均潜在减寿年数(AYLL)等指标分析居民伤害死亡和减寿的主要原因,率的比较采用χ²检验。 结果 2015年株洲市居民伤害死亡率38.85/10万(标化死亡率为36.55/10万),男女标化死亡率分别为30.86/10万和44.70/10万,女性高于男性(χ²=44.51,P=0.000)。因伤害导致的潜在减寿年数是30 058人年,导致的平均潜在减寿年数为26.65年。道路交通事故、意外跌落、溺水、自杀和意外中毒是伤害的主要死因。0~岁年龄段以溺水为主,15~岁、45~岁年龄段以道路交通事故为主, 65~岁年龄段以意外跌落为主。 结论 伤害是2015年株洲市居民最主要死亡原因,疾病负担重,严重影响居民期望寿命的提高,应根据本地实际情况,针对不同人群特征开展伤害防治工作。     

2007-2015年齐齐哈尔市居民死亡原因分析

目的 了解2007-2015年齐齐哈尔市居民死亡情况和疾病负担,为疾病防治和卫生资源配置提供依据。 方法 收集中国疾病预防控制中心发布的2007-2015年齐齐哈尔市人口死亡登记数据,应用人口系数、负担系数、粗死亡率、标化死亡率、潜在减寿年数(potential years of life lost, PYLL)评价居民死亡情况和疾病负担。 结果 2007-2015年齐齐哈尔市居民老年人口系数为7.91%、老年负担系数为10.23%;居民粗死亡率为552.76/10万、标化死亡率为629.39/10万;男女死亡率差异有统计学意义(P=0.001);2007-2015年齐齐哈尔市居民各类疾病PYLL为2 163 230人年,PYLL率前两位为循环系统疾病、恶性肿瘤。 结论 齐齐哈尔市居民整体进入老龄化社会,老年负担有上升趋势;居民标化死亡率呈现先上升后下降的趋势,循环系统疾病和恶性肿瘤是影响齐齐哈尔居民健康的主要疾病。     

Causes of death among persons reported with AIDS.

OBJECTIVES. This study describes causes of death in persons with acquired immunodeficiency syndrome (AIDS) and assesses the completeness of reporting of human immunodeficiency virus (HIV) infection or AIDS on death certificates of persons with AIDS. METHODS. AIDS case reports were linked with death certificates in 11 local/state health departments; underlying and associated causes of death were available for 32,513 persons with AIDS who died. RESULTS. HIV/AIDS was designated as the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987 (the year specific coding procedures were implemented for HIV/AIDS). Most other underlying causes of death were conditions within the AIDS case definition (notably Pneumocystis carinii pneumonia), pneumonia, infections outside the AIDS case definition, and drug abuse. Unintentional injuries, suicide, and homicide were less common. HIV/AIDS was listed as underlying or associated on 88% of death certificates from 1987 to 1989; reporting varied primarily by HIV exposure category and time between diagnosis and death. CONCLUSIONS. Physicians and other health care professionals should realize their critical role in accurately documenting HIV-related mortality on death certificates. Such data can ultimately influence the allocation of health care resources for HIV-infected individuals.     

The accuracy of liver cancer as the underlying cause of death on death certificates

Studies of liver cancer mortality are subject to confusion attributable to the changes in categories by which liver cancer is identified in successive revisions of the International Classification of Diseases. To determine the effects of these changes, diagnoses of 2,388 cases of primary liver cancer in the years 1973-80 were compared to the underlying causes of death recorded on the death certificates, using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Results showed that only 53 percent of the deaths were attributed on death certificates to primary liver cancer. In a reverse comparison of 2,977 death certificates from the years 1973-85 with an underlying cause of death of primary liver cancer, 83 percent had been diagnosed as liver cancer. However, among the certificates that specified cancer of the liver, not specified as primary or secondary, as the cause of death, only 40 percent had been diagnosed originally as liver cancer. The mortality of liver cancer can be either underestimated or overestimated depending on which disease classification categories are used.     

How accurately is euthanasia reported on death certificates in a country with legal euthanasia: a population-based study

Background

Death certificates are the main source of information on the incidence of the direct and underlying causes of death, but may be unsuitable for monitoring the practice of medical assistance in dying, e.g. euthanasia, due to possible underreporting. This study examines the accuracy of certification of euthanasia.

Methods

Mortality follow-back survey using a random sample of death certificates (N?=?6871). For all cases identified as euthanasia we checked whether euthanasia was reported as a cause of death on the death certificate. We used multivariable logistic regression analysis to evaluate whether reporting varied according to patient and decision-making characteristics.

Results

Through the death certificates, 0.7% of all deaths were identified as euthanasia, compared with 4.6% through the mortality follow-back survey. Only 16.2% of the cases identified from the survey were reported on the death certificate. Euthanasia was more likely to be reported on the death certificate where death was from cancer (14% covered), neurological diseases (22%) and stroke (28%) than from cardiovascular disease (7%). Even when the recommended drugs were used or the physician self-labelled the end-of-life decision as euthanasia, euthanasia was only reported on the death certificate in 24% of cases.

Conclusions

Death certificates substantially underestimate the frequency of euthanasia as a cause of death in Belgium. Mortality follow-back studies are essential complementary instruments to examine and monitor the practice of euthanasia more accurately. Death certificate forms may need to be modified and clear guidelines provided to physicians about recording euthanasia to ensure more accurate certification.

     

Misclassification of childhood homicide on death certificates

Suspect classification of homicide deaths of Connecticut residents under 20 years of age was noted for 29 percent of cases examined. Misclassification was attributed to incomplete or erroneous information recorded on the death certificates, rather than errors in the designation of ICD-9 homicide codes. The results have important implications in the interpretation of vital statistics when homicide is listed as the cause of death and underscore the value of record linkage systems.     

2007—2010年南通市儿童青少年死因分析和减寿评估

目的了解南通市儿童青少年死亡情况,为制定防治对策和有效干预措施提供依据。方法对南通市2007—2010年5～19岁儿童青少年死亡资料进行分析。结果 2007—2010年南通市5～19岁儿童青少年年均死亡率19.50/10万,标化死亡率19.95/10万,死因构成和潜在减寿年数(PYLL)、前五位死因顺位皆为损伤中毒、肿瘤、神经系统疾病、先天性疾病、循环系统疾病。结论损伤中毒和肿瘤是南通市5～19岁儿童青少年健康的主要危险因素,应加强预防,促进儿童青少年的身心健康发展。     

贵州1991—2015年5岁儿童死亡率和死亡原因分析

目的 分析1991—2015年贵州省<5岁儿童年龄别死亡率（U5MR）和主要死因别死亡率,评价贵州省《千年发展目标4（MDG 4）》指标的进展情况。方法 采用贵州省<5岁儿童死亡监测网1991—2015年监测资料,计算城市、农村新生儿、婴儿及<5岁儿童死亡率和<5岁儿童主要死因死亡专率。结果 2015年贵州省新生儿死亡率（NMR）、婴儿死亡率（IMR）和U5MR 分别为3.5‰、8.7‰和12.2‰,比1991年分别下降92.9%、86.8%和87.6%,城市、乡村儿童死亡率均呈下降趋势,其中,NMR、IMR和U5MR分别由1991年的25.0‰（城市）和55.3‰（农村）、39.9‰和93.0‰、42.1‰和112.4‰下降至2015年的3.2‰和3.6‰、7.6‰和9.2‰、10.3‰和13.2‰（均P<0.01）。2015年贵州省农村NMR、IMR、U5MR分别为城市的1.13、2.63、1.28倍,而1991年分别为2.21、2.33、2.67倍。贵州省<5岁儿童死亡主要死因中,肺炎、腹泻、出生窒息、早产或低出生体重和脑膜炎死亡专率均呈下降趋势,分别从1991年的3276.1/10万、1501.7/10万、1416.7/10万、689.4/10万和689.4/10万下降到2015年的215.3/10万、61.6/10万、154.4/10万、153.7/10万和4.7/10万（P<0.01）。2015年全省U5MR前4位死因分别为肺炎、出生窒息、早产或低出生体重和先天性心脏病。其中,城市前4位为肺炎、早产或低出生体重、先天性心脏病、出生窒息,农村前4位为肺炎、早产或低出生体重、出生窒息、先天性心脏病。肺炎、出生窒息、早产低出生体重死亡率均逐年下降,而先天性心脏病、溺水和交通意外死亡率呈现反复。结论 2015年贵州省U5MR为12.2‰,已达到国家2020年目标,降低农村U5MR、缩小城乡差距仍是今后工作的重点,但是,基于死因别构成变化,防治重点要进行相应调整。