Syphilis-associated perinatal and infant mortality in rural Malawi.

In Mangochi District, a rural area of Malawi, the prevalence of active syphilis was 3.6% among 3591 women who had singleton births and who were negative for human immunodeficiency virus (HIV). Compared with non-syphilitic women, those with active syphilis (positive Venereal Disease Research Laboratory/rapid plasmin reagin tests (titre > or = 1:8) and a reactive microhaemagglutination assay) were more likely to experience stillbirths as well as the early and late neonatal deaths and even postneonatal deaths of their children. Characteristics associated with active syphilis were not very useful in targeting women at high risk of having the condition, which makes universal screening in antenatal programmes the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a programme to prevent congenital syphilis in the perinatal, neonatal, and post-neonatal periods is evident. In considering resource allocation to child survival programmes in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system.     

Community-based prevention of perinatal deaths: lessons from nineteenth-century Sweden

BACKGROUND: Perinatal deaths have been more difficult to prevent than infant deaths in low- income countries due to its close relation to poor maternal outcome. The aim of the study was to perform a comprehensive population-based analysis of perinatal mortality in a high mortality setting and to determine the impact of midwifery-assisted home deliveries. METHOD: The study design was a community-based cohort study. In all, 4876 perinatal deaths were recorded among 116 211 newborns in the districts of Sundsvall and Skelleftea in northern Sweden during the years 1831-1899. Relative risks, 95% CI, population attributable proportions and prevented fractions were calculated. RESULTS: The overall perinatal mortality rate was 42.0 per 1000 births. A previous stillbirth represented one of the most important risk factors (RR = 3.25, 95% CI : 2.97-3.56), with a population attributable proportion of 7%. Two or more previous stillbirths gave an RR of 8.50 (95% CI : 7.58-9.53) and a population attributable proportion of 4%. There was an increased risk of perinatal mortality for mothers over 35 years old, the primiparous and the unmarried, while grandparous women had a higher perinatal mortality that was accounted for completely by a poor history of previous stillbirths and infant deaths among these women. The children of crofters, farmers and workers had higher perinatal mortality, but area had no significant impact. During the years 1881-1890 and 1891-1899, the prevented fractions of midwifery were 15% and 32%, respectively. CONCLUSION: Poor reproductive history, particularly previously high perinatal mortality, is associated with high perinatal mortality. Midwifery-assisted at home deliveries successfully reduced perinatal mortality.     

Perinatal mortality in Taiwan

Information on perinatal deaths was obtained from 310 women by collecting detailed obstetric histories dating from marriage to the start of the survey. These histories were compared to those of 688 age matched controls. Potential risk factors, levels and time trends of perinatal mortality in Taiwan were examined and factors underlying stillbirths and early neonatal deaths were also compared using conditional logistic regression analyses. A nearly 56% decline of the perinatal mortality rate during the 35 y, approximately, prior to the survey was observed. Risk of stillbirths was increased among those who had abused illegal drugs during pregnancy, those who reported that the pregnancy was unwanted and those with Thalassemia trait. Body mass index was log-linearly related with stillbirths, with higher body mass associated with higher risk. For early neonatal deaths, those mothers aged 19 y or less, those giving birth to either their first children or to their fifth or later child, those who had their first prenatal care visit after the first three months of pregnancy were associated with increased risk in the logistic model. Those with a birth interval of less than two years and those with less education were associated with increased risk in both perinatal death groups. While some of these factors have already been associated with perinatal deaths, others have not; the new associations provide clues to mechanisms by which the risk of death increases before or after delivery.     

Is there an association between female circumcision and perinatal death?

OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women.     

Perinatal mortality in northern rural Tanzania

The study was conducted to investigate the association between perinatal mortalityand factors relating to nutrition and infections in a rural population in northern Tanzania. A cohort of 3,618 women attending antenatal clinics was registered with background information and the results of antenatal examinations, and followed up after delivery. Stillbirths and neonatal deaths were identified and traced for an interview with the closest relatives. No information on outcome of pregnancy was obtained for seven women, and incomplete information was obtained for 99. The perinatal mortality rate was 27/1,000 births [95% confidence interval (CI) 22/1,000-33/1,000]; 44% were early neonatal deaths; and 56% were stillborn. There was an increased risk of perinatal death among babies with low birth-weight [for babies weighing 2,000-2,499 g, adjusted odds ratio (AOR) 5.8, 95% CI 2.1-15.8, babies below 2,000 g AOR 45.7; 95% CI 18.3-114.1], babies of women with a small arm circumference (below 23 cm, AOR 5.3, 95% CI 1.3-22.2), babies of women with positive VDRL serology (AOR 5.1, 95% CI 1.0-25.7), babies of mothers who had previously lost a baby (AOR 1.9, 95% CI 1.1-3.2), and among babies of nulliparous women (AOR 1.7; 95% CI 1.0-3.0). Infections and nutritional deficiencies should be addressed at antenatal clinics.     

182例围产儿死亡情况分析

目的:探讨近10年北京协和医院作为三甲医院在围产保健方面的特点,以进一步提高保健水平,降低围产儿死亡率。方法:回顾性分析2001～2010年协和医院17 532名围产儿中死亡的个案资料。结果:2001～2005年围产儿死亡率为9.29‰,2006～2010年围产儿死亡率11.03‰,平均10.38‰。孕产妇年龄<25岁者及>35岁者围产儿死亡率明显增高,随孕周增加围产儿死亡率下降。出生体重<2 500 g者围产儿死亡率达8.47%,是正常体重儿的32.8倍。足月新生儿死亡中出生缺陷为最主要的死因,医源性早产中最主要的死因则为重度子痫前期/子痫(占47.8%)。死胎前三位的死因分别为妊娠合并症及并发症、出生缺陷、脐带因素。结论:做好出生缺陷地三级预防,加强对农村地区及城市流动人口孕产妇的健康教育及产前检查是降低围产儿死亡率的关键。     

上海市1999～2008年围产儿死亡情况分析

目的:分析上海市围产儿死亡现状,探讨围产儿死亡原因及相关因素,为改进围产期保健提供科学依据。方法:回顾性分析1999～2008年上海市全部围产儿死亡个案及评审资料。结果:①1999～2008年围产儿平均死亡率为6.0‰,从1999年的7.3‰下降至2008年的4.8‰。其中本市户籍围产儿死亡率从4.9‰下降到2.8‰,非本市户籍者从14.9‰下降至6.3‰。②围产儿死因前5位依次为原因不明(13.8%)、严重畸形(12.8%)、早产儿(6.7%)、宫内窘迫(6.5%)和脐带缠绕(5.7%)。③非本市户籍围产儿死亡者高危孕妇比例高(49.1%)、高龄产妇多(12.0%)、经产妇多(45.7%)、无产前检查者多(47.6%)。④评审结果显示,可以避免死亡占2.6%、创造条件可以避免死亡占16.4%、不可避免死亡占81.0%。结论:上海市围产儿死亡率较低,但仍有下降空间。加强流动人口孕产妇管理、减少畸形和早产是关键。     

妊娠合并梅毒早期治疗的临床意义

目的：探讨妊娠合并梅毒患者早期治疗与妊娠结局的关系。方法：对我院2000年1月至2005年1月间，妊娠合并梅毒患者进行回顾性调查分析，将早期发现早期治疗的妊娠合并梅毒患者分为治疗组，孕20周后发现梅毒及发现后未治疗者为未治疗组。结果：5年期间我院分娩总数12305例，接受梅毒筛查6435例，妊娠合并梅毒56例，发生率8．7‰。治疗组围产儿死亡率为13．5％，先天梅毒为18．2%，未治疗组围产儿死亡率为80．8％，先天梅毒为63．6％。结论：妊娠合并梅毒患者由于症状及体征不明显。容易误诊，因此，孕期常规梅毒筛查特别重要，早期规范的青霉素治疗，能明显降低围产儿死亡率及先天梅毒的发生。     

Challenge of reducing perinatal mortality in rural Congo: findings of a prospective, population-based study

Each year, an estimated six million perinatal deaths occur worldwide, and 98% of these deaths occur in low- and middle-income countries. These estimates are based on surveys in both urban and rural areas, and they may underrepresent the problem in rural areas. This study was conducted to quantify perinatal mortality, to identify the associated risk factors, and to determine the most common causes of early neonatal death in a rural area of the Democratic Republic of the Congo (DRC). Data were collected on 1,892 births. Risk factors associated with perinatal deaths were identified using multivariate analysis with logistic regression models. Causes of early neonatal deaths were determined by physician-review of information describing death. The perinatal mortality rate was 61 per 1,000 births; the stillbirth rate was 30 per 1,000 births; and the early neonatal death rate was 32 per 1,000 livebirths. Clinically-relevant factors independently associated with perinatal death included: low birthweight [odds ratio (OR)=13.51, 95% confidence interval (CI) 7.82-23.35], breech presentation (OR)=12.41; 95% CI 4.62-33.33), lack of prenatal care (OR=2.70, 95% CI 1.81-4.02), and parity greater than 4 (OR=1.93 95% CI 1.11-3.37). Over one-half of early neonatal deaths (n=37) occurred during the first two postnatal days, and the most common causes were low birthweight/prematurity (47%), asphyxia (34%), and infection (8%). The high perinatal mortality rate in rural communities in the DRC, approximately one-half of which is attributable to early neonatal death, may be modifiable. Specifically, deaths due to breech presentation, the second most common risk factor, may be reduced by making available emergency obstetric care. Most neonatal deaths occur soon after birth, and nearly three-quarters are caused by low birthweight/prematurity or asphyxia. Neonatal mortality might be reduced by targeting interventions to improve neonatal resuscitation and care of larger preterm infants.     

Perinatal mortality in Shanghai: 1986-1987.

The incidence of, and risk factors associated with, perinatal mortality in Shanghai during 1986-1987 are examined using data from a multi-site study conducted in 29 hospitals. The overall perinatal mortality rate was 14.96 per 1000 births. The mortality rates of antepartum fetal death, intrapartum fetal death and early neonatal death were 5.97, 2.06 and 6.94 per 1000 births, respectively. The perinatal mortality rates increased in winter and late spring. Male neonates were 1.5 times more likely to die than females. Low birthweight and preterm infants had 15 to 80 times higher risk of perinatal death. Higher parity, multiple pregnancy, and maternal age greater than or equal to 35 years were the risk factors for perinatal mortality. Asphyxia, cord complications, and congenital malformations were found to be the major causes of perinatal deaths. Comparison of mortality rates between Shanghai and the US suggests that the shortage of advanced technology in perinatal care (e.g. neonatal intensive care units) is a major obstacle to the reduction of perinatal mortality in Shanghai.     

Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza Strip

Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15-49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings.     

Labour complications remain the most important risk factors for perinatal mortality in rural Kenya

OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). METHODS: A cross-sectional study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. FINDINGS: The perinatal mortality rate was 118 per 1000 births. Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting.     

Causes of perinatal mortality in Pelotas, RS (Brazil). Use of a simplified classification

The causes of perinatal mortality among 7392 hospital births which occurred in Pelotas, RS, Brazil during 1982, were analyzed using the simplified classification described by Wigglesworth. The main advantage of this classification is that it can be used even in places where postmortems are seldom performed. The perinatal deaths were classified into 5 groups: a) macerated fetuses without malformations; b) congenital malformations; c) immaturity; d) asphyxia, and e) other causes of death. The perinatal mortality rate was 33.7/1000 births, nearly equally divided between fetal and early neonatal deaths, and 8.8% of the babies were of low birthweight. 36% of the perinatal deaths were antepartum stillbirths, and 60% of these weighed 2000 g or more. The 2nd most important cause was immaturity, which accounted for 31% of the deaths. In this latter group, 21% weighed 2000 g or more at birth. These findings, as well as the high birthweight-specific perinatal mortality rates, strongly suggest that there are deficiencies in the antenatal and delivery care in Pelotas that must be corrected promptly. Policies that should be implemented by health planners include: decentralization of antenatal care clinics; utilization in these clinics of the "at-risk" concept to identify women at high risk of delivering low birthweight babies, efforts to increase community participation and home visits in order to attract those pregnant women who do not attend clinics. In addition, it is mandatory that well-trained doctors (obstetricians and pediatricians) should be available 24 hours/day at the maternity hospitals to assist mothers and babies identified as being at high risk. (author's)     

The impact of maternal health improvement on perinatal survival: cost-effective alternatives

Each year, an estimated half million women die from complications related to child birth either during pregnancy, delivery or within 42 days afterwards. When pregnant women have complications, their infants are at greater risk of becoming ill, permanently disabled or dying. For every maternal death, there are at least 20 infant deaths: stillbirths, neonatal or postneonatal deaths. Altogether, an estimated 7 million infants each year die perinatally (stillborn or deaths within the first week of life). Low cost, feasible, and effective intervention strategies include: a) improved family planning and abortion services; b) obstetric care at delivery; and, c) prenatal services. Two hypothetical populations of one million (a low mortality and a high mortality country) are used to illustrate maternal and perinatal program strategies and priorities. In countries with high fertility, major reductions in maternal and infant deaths result both from reductions in the number of pregnancies through family planning and from improved obstetric care. Where fertility is already low, reductions result almost entirely from improved obstetric and prenatal care. The investments required are relatively low, while the potential gains are great. The cost to avert each death in a high mortality population is estimated between $800 and $1,500 or as low as $0.50 per capita per year. The priorities for programs targeting maternal and perinatal health depend on demographic, ecologic and economic factors, and should include the promotion of good health, not merely the avoidance of death. More operational research is required on various aspects of maternal and perinatal health; in particular, on the cost-effectiveness of different service components.     

Smoking and mortality: a 21-year follow-up based on the Swedish Twin Registry

Data on smoking and mortality from the Swedish Twin Registry were analysed as a prospective cohort study and as a co-twin control study. The twin method involves control of genetic and early environmental factors and thereby a general control of the nested factors that may act as confounders, adjustments not obtainable in ordinary study designs. In the cohort analyses the following relative risks for cigarette smokers were found for men and women, respectively: death all causes 1.4 (90% Cl 1.3; 1.5), 1.4 (1.3; 1.5), CHD death 1.4 (1.3; 1.7), 1.6 (1.3; 2.0), lung cancer 19.7 (9.1; 42.7), 5.1 (3.0; 8.7), and other cancers 1.2 (1.0; 1.4), 1.2 (1.0-1.4). The comparison of deaths in cigarette-smoking twins and their non-smoking co-twins gave the following risk estimates for monozygotic (MZ) men: death all causes 1.6 (35 versus 22 first deaths), CHD death 2.8 (11 versus 4). The results for dizygotic (DZ) males and for females were in agreement. Four lung-cancer deaths occurred in MZ and 17 in DZ smoker twins while the non-smoker co-twins showed two such cases (DZ women). Other cancer deaths did not occur more often in the smoker than in the non-smoker twin. The impact of smoking on mortality, CHD death and lung cancer is also valid among smoking discordant twins.     

Risk factors for perinatal death in Cape Verde

Summary.   Risk factors for perinatal death in the Cape Verde islands were assessed among 104 bereaved mothers and 292 mothers of surviving infants in an area-based case–control study in 1992–93. Prospectively gathered information on risk factors was obtained from medical records supplemented with post-partum interviews and anthropometric measurements of mothers and infants. No autopsies were performed. Multiple logistic regression analysis was applied. Out of 23 alleged maternal and two alleged infant risk factors, the following seven proved significantly and independently correlated with perinatal death: first pregnancy (odds ratio [OR] = 2.9); previous hypertensive disease (OR = 4.2); previous perinatal death (OR = 4.6); pre-eclampsia (OR = 7.0); non-cephalic fetal presentation (OR = 17.1); male infant (OR = 2.1) and maternal post-partum fever (OR = 3.1). The perinatal mortality rate was calculated as 37–46/1000 total births. A reduction in the mortality rate warrants antenatal and obstetric care with emphasis on primiparous women; improved detection and treatment of hypertensive disorders and genital infections; and improved intrapartum fetal observation and resuscitation routines.     

Maternal mortality surveillance, United States, 1979-1986

To understand further the epidemiology and causes of maternal death, the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, reviewed all identified maternal deaths in the United States, including Puerto Rico, for the period from 1979 through 1986. The maternal mortality ratio for the period was 9.1 deaths/100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups, particularly for women ages greater than or equal to 40 years. Unmarried women had a higher risk of death than married women. Women who had received any prenatal care had a lower risk of dying than women who had received no care (RR = 0.19, 95% confidence limits (CL) 0.15, 0.23). Women who received no prenatal care had a gestational age-adjusted risk of maternal death 5.7 times that of women receiving care defined as "adequate." The risk of maternal death increased with decreasing levels of education for all age groups, particularly among women ages greater than or equal to 35 years. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death following the delivery of a live birth. Future studies aimed at developing strategies to reduce the risk of maternal deaths in the United States should use enhanced surveillance and collect more information about each death, which would allow for better understanding of factors associated with maternal mortality.     

Searching for socioeconomic risk factors in perinatal mortality in Kuwait: a case control study

The aim of this paper was to investigate whether socioeconomic factors such as parent's education, occupation, and income constitute risk factors in perinatal mortality after controlling for biological variables such as birth weight and length of gestation, and maternal factors such as age, parity and reproductive history. A case-control study covering all perinatal deaths in Kuwait was conducted for one year from 1 October, 1997 to 30 September, 1998. Each case (perinatal death) was matched with a control (live birth). Matching criteria were: father's nationality, place, and date of birth. Information was successfully collected on 463 matched pairs, 274 Kuwaitis and 189 non-Kuwaitis. Only singleton births were included in the analysis. Bivariate analysis showed that several of the socioeconomic variables (e.g. lower education, lower income) increased the risk of a perinatal death. However, none of these variables remained significant in the multivariate analysis in which birth weight and length of gestation emerged as the two major determinants of perinatal deaths among both nationality groups. Among the Kuwaitis, primiparity and high parity, and previous history of miscarriage were also significant risk factors. Among the non-Kuwaitis, none of the socioeconomic factors, or the maternal factors, were significant predictors of perinatal mortality. For Kuwaitis, it appears that the government's policies and programs aimed at reducing social inequalities in the society have been effective in eliminating perinatal mortality differences between socioeconomic groups. Among non-Kuwaitis, the lack of differences is reflective of the fact that this group is relatively homogenous and selective of the more affluent who can bring the family to Kuwait. Both nationality groups benefit from the government's free health services. However, charges for non-Kuwaitis are due to be levied soon which may increase disparities in access to health care.     

Risk factors for perinatal deaths in rural Bangladesh

Perinatal mortality refers to stillbirths and deaths which occur during the first week of life. 7 million such deaths occur annually worldwide, almost all of which are in developing countries. Rates as high as 75-100 deaths/1000 births have been documented in developing countries. The 3 leading causes of perinatal mortality are complications of pre-term birth, birth asphyxia and birth trauma, and bacterial infections. The other causes of perinatal mortality are largely unknown due to difficulties in documenting stillbirths in developing countries. In many developing country societies, it is culturally unacceptable to acknowledge a birth until it has survived its first week of life. This study identified and quantified the risk factors for perinatal deaths in a rural community in Manikganj district, Bangladesh. Cases were mothers whose infants died in the perinatal period, while comparison mothers were those whose infants survived the perinatal period. Of the 186 infant deaths recorded, 130 (69.9%) were in the perinatal period, and included 53 stillbirths. The perinatal death rate was 64.5/1000 births. Logistic regression confirmed that maternal age, parity, and mal-presentation were significantly associated with perinatal deaths. Mal-presentation was independently associated with a increased risk of perinatal death.     

Estimation of the past and future burden of mortality from mesothelioma in France

OBJECTIVES: Firstly to evaluate future mortality from mesothelioma in France with an age-period-cohort approach and evaluate different hypotheses on risk of mesothelioma for the most recent birth cohort. Secondly to compare the results with a British and an American study. Thirdly to study if any trends were detectable on data for women which would be consistent with the consequences of increasing environmental exposure to asbestos. METHODS: Estimates of mortality from mesothelioma among men and women in France from 1950 to 1995 were based on the analysis of the pleural cancer mortality data coded 163 in the ninth revision of the international classification of diseases (ICD-9). Correction factors were used to derive the mortality from mesothelioma from these data, based on two regional registries. The analysis of the past mortality data has been performed by an age-cohort model (with a maximum likelihood technique). Predictions of deaths from mesothelioma over the next 50 years were based on four different assumptions on the risk of death from mesothelioma in future birth cohorts. RESULTS: The predicted lifetime probability of dying from mesothelioma increases until the last birth cohort 1964-8 among men whereas it decreases strongly from the 1954-8 birth cohort among women. The projected numbers of deaths from mesothelioma in France until 2020 are similar, whichever hypothesis is considered: around 20,000 deaths from mesothelioma might occur among men and 2900 among women from 1996 to 2020. CONCLUSIONS: French data show an increasing lifetime probability of death from mesothelioma in the more recent male cohorts. Although the mortality burden can be predicted until 2020, and is intermediate between the United Kingdom and United States estimates, there is still high uncertainty on the figures after 2020. No increase is found in women, and this does not support the hypothesis that current environmental exposure to asbestos could be associated with a detectable risk of death. Specific surveillance should be set up to monitor future trends or their absence.