A population-based analysis of pneumococcal disease mortality in California, 1989-1998

OBJECTIVES: Pneumococcal disease is an important cause of vaccine-preventable mortality. It is important to understand the burden and distribution of mortality so that prevention efforts can be targeted appropriately. This study evaluated pneumococcal disease mortality and its demographic correlates in California from 1989 to 1998. METHODS: Deaths due to pneumococcal disease were identified from statewide vital records data using multiple cause-coded information. Denominator data were obtained from estimates from the California Department of Finance. Crude and age-adjusted mortality rates and 95% confidence intervals were calculated for each age, gender, and racial/ethnic group. RESULTS: The age-adjusted pneumococcal disease mortality rate was 2.05 deaths per 100,000 population. Mortality was highest in elderly individuals (reaching 38.29 deaths per 100,000 population in individuals older than age 85). Age-adjusted mortality rates were elevated in the African American race/ethnicity group (2.96 deaths per 100,000 population) and males (2.67 deaths per 100,000 population). The majority of individuals who died of pneumococcal disease (78.9%) fell into at-risk groups indicated for vaccination. The majority of all pneumococcal deaths were caused by pneumococcal pneumonia. Mortality was seasonal, reaching a peak in the winter months. A decreasing trend in mortality was observed over the 10-year period examined. CONCLUSIONS: Pneumococcal disease remains a significant cause of vaccine-preventable mortality in the California population. Greater efforts must be made to vaccinate at-risk individuals, especially those in demographic groups at highest risk of death.     

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.     

Space-time distribution of suicide in Galicia, Spain [1976-1998]]

Objective: To study the space-time distribution of suicide in Galicia from 1976 to 1998, taking into account gender, age, season and method of suicide.Methods: For each sex crude and age-adjusted rates per province and age-specific rates per period (1978-84, 1985-91, 1992-98) were calculated. To estimate mortality risk and time trends in the municipalities, a Bayesian hierarchical model was used.Results: In the last few years mortality from suicide has increase considerably. Age-adjusted rates of 6 per 105 at the beginning of the study rose to 10 per 105 at the end. The increase was greatest among men. The higher rates were observed in the elderly, although in terms of time trends the highest increase occurred among adolescents and young adults. In both sexes the main method of suicide was hanging. Less common methods were jumping from a height and shooting. The greatest number of suicides took place during the spring and summer months. In terms of spatial distribution, a high number of suicides were committed in the province of Lugo; in the municipalities, mortality risk decreased from North to South and an inverse temporal trend was observed in both sexes. This differed from the space-time patterns of suicides committed using methods other than hanging.Conclusions: Suicide is an important health problem in Galicia not only because to its magnitude but also because of the increasing rates, especially among young people. Geographical and temporal analysis can identify priority areas where preventive policies should be implemented.     

Hospital admissions for pertussis in Spain, 1995-1998

This epidemiological survey was undertaken to estimate the annual burden of hospitalizations for pertussis in Spain during a four-year period 1995–1998. Data were obtained from the national surveillance system for hospital data. All hospital discharges for pertussis (ICD-9- CM 033) were analyzed. The annual incidence of hospitalization for pertussis was 1.7 per 100,000 population. Eighty-nine percent of the cases were <1 year of age (incidence of 78 per 100,000) and 95% were ≤5 years of age (incidence of 28 per 100,000). During the study period, 14 deaths were reported among patients hospitalized by pertussis. Despite of the high inmunization rates, many pertussis cases occur each year, mostly of them among very young children.     

Time trends, cohort effect and spatial distribution of cerebrovascular disease mortality in Spain

Study objective: This study describes mortality due to cerebrovascular disease (CVD) in Spain, based on time-series analysis in the period 1951–1995 by age, sex, and cohort of birth; spatial distribution observed for the five-year period 1991–1995, and time-spatial analysis in the period 1992–1995 vs. 1988–1991. Special attention is paid to risk of medium aged population. Design: Longitudinal and cross-sectional observational study. Setting and participants: Spanish population. All mortality data used were taken from official statistics. Time trends and spatial distribution were analyzed using log-linear Poisson regression models. Main results: CVD mortality declined over the last two decades of the study period (1974–1995) by an annual average of 4.16% (95% CI: 3.95–4.36) and 4.00% (95% CI: 3.77–4.24) in men and women, respectively. The downward trends were accelerated in last decade. An excess of male mortality was in evidence. For all age groups mortality declined with more recent cohorts, but the decline was less marked among ages 35–64. Spatial distribution of CVD mortality revealed a north-south pattern, but this is being difuminated by increasing rates in the lower risk provinces. Internationally, Spain ranks midway to low in terms of its overall CVD mortality. Conclusions: Efforts to reduce CVD incidence and case fatality are the essential prerequisite for any long-term improvement in mortality. Accordingly, further research is called for into current disease morbidity and the risk factors to be targeted at a general population level, nationwide.     

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。     

Trends in ischaemic heart disease mortality and its determinants in Spain, 1940-1988

Trends of ischaemic heart disease (IHD) mortality and of manyof their determinants in Spain from 1940–1988 resemblethose of other Mediterranean countries and some Western countrieswith a lag of 10 years. Mortality from IHD Increased from 1955to 1975 and then declined. This trend affected both sexes andalmost all age groups. Tobacco smoking increased from 3.2 gper capita per day in 1940 to 8 g per capita per day in themid-1970s and then levelled off. The prevalence of smoking hasdecreased in all ages among men but has Increased among womenover the last 15 years. Since 1940 there has been a steady increasein the intake of meat and dairy products and a moderate riseof eggs, fish and sunflower oil. Consumption of olive oil hasremained relatively constant. These trends have been translatedinto an increase of total lipid intake and of saturated, monounsaturatedand polyunsaturated fatty acids and cholesterol over the period1940–1988. The number of physicians, primary health carecentres, cardiac function diagnostic facilities, heart operationsand the consumption of cardiovascular drugs have also Increasedsince the mid- 1970s. The authors conclude that the reductionin smoking among men and the improvement of the health caresystem may have contributed to the decline in IHD mortalityrates in Spain since 1975.     

Changing mortality patterns for major cancers in Spain, 1951-1985

Mortality trends for main cancer sites in Spain from 1951-1985 are presented. Age-standardized mortality rates per 100,000 were computed using the direct method. The Spanish population of 1970 was used as the standard. Age-standardized mortality rates for total cancer showed a marked increase among men throughout the period of study. This can be attributed mainly to the increase in lung cancer mortality (from 8.63 person-years to 44.74 between 1951 and 1985), which was only partially balanced by a reduction in the stomach cancer mortality (from 36.18 to 18.31). Among women the increase in total cancer is lower overall. It occurred mainly during the 1950s and thereafter the trend has remained stable and even declined in recent years. Lung cancer mortality rates among women have remained fairly stable and stomach cancer followed the same pattern as for men. Breast cancer mortality increased constantly during the period (from 7.21 to 19.38) but it was not until 1978 that it became the leading cause of cancer mortality among women.     

Trends in enteric disease as a cause of death in the United States, 1989-1996

The authors examined rates of and trends in enteric disease as a cause of death in the United States. The National Center for Health Statistics Multiple Cause of Death databases for 1989-1996 were analyzed for International Classification of Diseases, Ninth Revision, codes for gastroenteritis due to infectious agents and codes describing illness with other enteric pathogens. The highest rates of death related to enteric diseases were seen among people older than 75 years, followed by children under 1 year of age. Rates increased markedly over time in the 65- to 74-year age group for bacterial enteric pathogens and in the 35- to 44-year age group for viral enteric pathogens. Enteric diseases were the underlying cause of death for an average of 2,740 deaths during each year of this study, and the rate of death due to enteric-related disease is increasing.     

Geographical distribution and time trends in avoidable mortality in Catalonia, Spain (1986-2001)

OBJECTIVES: To analyze time trends and geographical variation in avoidable mortality by health areas in Catalonia. MATERIAL AND METHODS: Avoidable mortality was analyzed according to the classification used by the Health Department of the Regional Government of Catalonia from 1986-2001 for health areas and causes were grouped as treatable and preventable. Standardized mortality rates were calculated by the direct and indirect method and the comparative mortality figures were calculated for the treatable and preventable groups and for the 46 health areas. The mean annual change adjusted for age was also calculated using a Poisson regression of avoidable and general mortality. RESULTS: The total number of avoidable deaths was 61,261 (7.3% of overall deaths). 10,623 cases (17.34%) were classified as treatable and 50,638 (82.65%) as preventable. The mean annual change for avoidable causes was -2.43% (95% CI, -2.60 to -2.26), higher than the -1.57% (95% CI, -1.61 to -1.52) change for general mortality. The rates were higher for preventable causes than for treatable causes, although mortality decreased in both groups. The health area of Segrià was notable for its significantly higher mortality from both treatable and preventable causes in both periods. Four health areas showed a significant increase in mortality from preventable causes but none showed an increase in mortality from treatable causes. CONCLUSIONS: In Catalonia, the decrease in avoidable mortality was greater than that in general mortality from 1986 to 2001. The geographical distribution shows wide dispersion but allows areas requiring preventive interventions to be identified.     

Spatial distribution of tuberculosis mortality in Salvador,Bahia, Brazil

An ecological study was conducted to describe the urban spatial distribution of mortality attributable to tuberculosis in Salvador, Bahia, Brazil in 1991, 1994, and 1997. The unit of analysis was the Health District (HD). The HD with the highest standardized rates was Sub rbio Ferrovi rio in 1991, 1994, and 1997, with 15.7, 10.6, and 10.6/100.000 inhabitants, respectively. Inequalities in mortality between HDs were high. The year 1997 showed the lowest standardized rates. The proportional mortality ratios for tuberculosis when compared with total deaths from infectious diseases were 20.7%, 18.2%, and 16.9% for 1991, 1994, and 1997 respectively. The highest rates were observed in the age group over 65 years. The authors argue the possibilities of using the results for the implementation of equitable local health policies and health surveillance measures, since the methodology identified both the HD with the highest risk and the most heavily affected age groups.     

Social inequalities in ischemic heart disease and cerebrovascular disease mortality in men in Spain and France, 1988-1990

BACKGROUND: To compare socio-economic differences in mortality from ischemic heart disease and cerebrovascular disease in men in Spain and France during the 1988-90 period. METHODS: In Spain, the data were taken from the Eight Provinces Study, and in France the number of deaths was provided by the French National Health Institute(INSERM). The socio-economic differences in mortality have been estimated through the rate ratio. RESULTS: Farmers and manual workers presented higher mortality from ischemic heart disease and cerebrovascular disease than the professional and managerial group, while mortality in service workers showed a different pattern in both countries. CONCLUSIONS: The use of two occupational classes (manual/non manual) in international comparisons limits the interpretation of the results in this kind of studies.     

Trends in mortality and years of life lost related to alcohol in the Canary Islands, Spain [1980-1998]

OBJECTIVE: The aim of this article was to describe death rates and years of life lost prematurely (YLLP) in relation to alcohol consumption in the Canary Islands. The study covered the period between 1980 and 1998. METHODS: Deaths from 1980 to 1998 were classified by age, sex, and cause using data obtained from the National Institute of Statistics (Natural Changes in the Population). The number of alcohol-related deaths was calculated by year, sex, and age group using the attributable population fraction as proposed by the Centers for Disease Control (USA). The YLLP attributed to alcohol consumption were calculated for each cause of death by multiplying deaths by the attributable population fraction in 5-yearly age groups for both sexes (average span of five years), up to the age of 65 years. RESULTS: Between 1980 and 1998, the number of alcohol-related deaths was 12,614, averaging 6.4% per year and with a male-to-female ratio of approximately 2:1. The main causes of death and YLLP in both men and women were malignant neoplasms, diseases of the digestive system, and alcohol-related accidents, although accidents were by far the main cause producing 50.6% of alcohol-related YLLP in men and 55.5% in women. Over the study period, the incidence of cirrhosis of the liver and that of other chronic liver diseases (CIE 571) decreased in men whilst remaining stable in women. CONCLUSIONS: The finding that the percentage of alcohol-related deaths and cirrhosis of the liver remained high in the Islas Canarias between 1980 and 1998 highlights the need for educational strategies on the effects of alcohol, together with policies designed to reduce its consumption, particularly among the young.     

昆明市城区1998-2003年慢性阻塞性肺病早死疾病负担的时间趋势和地理分布

目的 分析昆明市某城区1998-2003年慢性阻塞性肺病（COPD）早死所致疾病负担的时间趋势和地理分布。方法 选择盘龙区作为城区的代表,以早死所致生命损失年（YLL）作为COPD疾病负担的测量单位,采用3%的贴现率但不采用年龄权重按年计算标化每千人口YLL率;并应用地理信息系统分析其地理分布的变化趋势。结果 昆明市盘龙区1998-2003年COPD每千人口YLL率随时间呈逐年下降的趋势,男性的每千人口YLL率均高于女性。从地理分布来看,城区中心街道办事处COPD的每千人口YLL率连续6年处于较高水平,而偏远街道办事处COPD每千人口YLL率呈逐年下降趋势。结论 应重点加强对昆明市城区居民COPD的防治工作。     

Spatial variability of climate effects on ischemic heart disease hospitalization rates for the period 1989-2006 in Quebec,Canada

Background  

Studies have suggested an association between climate variables and circulatory diseases. The short-term effect of climate conditions on the incidence of ischemic heart disease (IHD) over the 1989-2006 period was examined for Quebec's 18 health regions.     

Changes in total serum cholesterol for cardiovascular disease in a Mediterranean area, 1989-1999

This work is about the comparison between two studies performed in southern Italy: Montecorvino Rovella Project (PMR, 1988–1989) and VIP Project (Prevention in the Irno Valley, 1998–1999) to evaluate the trend of cholesterolaemia in an area of the Campania region. These two areas which are near the city of Salerno have similar social and economic conditions and are where the Mediterranean diet originated. In both studies, people between 25 and 74 years were enlisted at random from the electoral rolls and subjected to blood tests. Total serum cholesterol was determined by an enzymatic method in the VIP as in the PMR. In the last 10 years, data show a reduction of mean cholesterolaemia of 5.5 mg/dl for men and of 3.5 mg/dl for women. In 1999, serum cholesterol for men and women is respectively 199.3 and 199.4 mg/100ml. Ten years ago, the values were respectively 204.8 and 202.9 mg/100 ml. Prevalence of age-adjusted cholesterolaemia 240 mg/100 ml decreased from 20.8 to 13.6% for men and from 19.8 to 18.6% for women. The Mediterranean diet protected the population of southern Italy from ischemic heart disease from 1950 to 1960. After this period, the population changed its eating habits, and one of the consequences was an increasing level of cholesterol. During the past decades, a return to the Mediterranean diet and the use of drugs have been responsible for lowering cholesterol.     

Trends in hospital admissions for fractures of the hip and femur in England, 1989-1990 to 1997-1998

BACKGROUND: Fractures of the hip are a major public health issue. Suggestions of a recent stabilization of age-specific admission rates would have implications for health service planning, thus we investigated this using hospital data. METHOD: Hospital episode statistics for England, 1989-1990 to 1997-1998, were examined for admissions and deaths for fractures of the hip and femur in NHS hospitals in patients aged 45 years and over. RESULTS: Age-standardized admission rates increased by 32 per cent between 1989-1990 and 1997-1998 in men, and by 30 per cent in women. The increase in admission rates was almost entirely confined to the period 1989-1990 to 1991-1992, with very little change after this. The proportion of admissions ending in death during the study period decreased in both men (-35 per cent) and women (-40 per cent) but this change was largely confined to the early years of the study. The number of admissions from hip and femoral fractures in people aged 65 years and over is projected to increase from about 57,300 in 1997-1998 to 69,500 by 2021-2022. CONCLUSIONS: Age-specific rates of admission appear to be stabilizing, which is in contrast to previous trends. The lack of any decrease in hospital admission and mortality rates over the last 5 years is of concern. The management of osteoporosis-induced fractures in hospitals, the prevention and treatment of osteoporosis in primary care and the prevention of falls should be seen as priorities for the NHS to help reduce the burden of disease from osteoporosis in the elderly.