Trends in age-specific mortality rates for ischaemic heart disease, 1968 - 1977

Age-specific mortality rates (MRs) were calculated for each year of the period 1968 - 1977 for ischaemic heart disease (IHD) in males and females of the USA, Australia, Finland, Scotland, England and Wales, and of South Africa (Whites). The age range studied, in 10-year intervals, was 15 - 64 years. In the younger age groups (15-24, 25-34 and 35-44 years) the MRs of White South Africans were two to three times as high as those of other populations over the whole 10-year period. In the older age groups the differences narrowed. MRs for IHD in the USA decreased markedly in all age groups over the period studied, the decreases varying from 20% to 40%. Decreases in MRs for IHD also occurred among Australians and Finns but were neither as consistent nor as large as those occurring in the USA. No consistent changes were observed in the other three populations.     

Decline in the ischaemic heart disease mortality rates of South Africans, 1968-1985

The age-adjusted ischaemic heart disease (IHD) mortality rates (MRs) of white, Asian and coloured South Africans aged 35-74 years were studied for the period 1968-1985. Asians have the highest IHD MR in the RSA, followed by whites, coloureds and then blacks. Asian female have much higher rates than females in the other groups, especially in the older age groups. Asian males have noticeably higher rates in the younger age groups. Coloured females aged 35-44 years have a surprisingly high rate. Declines of 36.5% (from 482 to 306/100,000) for whites between 1970 and 1985, 27.5% (from 583 to 422/100,000) for Asians between 1973 and 1985, and 19.5% (from 287 to 231/100,000) for coloureds between 1976 and 1985 were observed. Rates declined among both males and females as well as in all the age groups studied. Trends in IHD MRs for black South Africans were studied for 1978-1985. The MRs for IHD among blacks are very much lower than those for South African Asians, coloureds and whites. The age-adjusted IHD MR for all South Africans was 162/100,000 in 1978 and had dropped to 121/100,000 in 1985, a 25.3% decline.     

An interracial study of continuous ambulatory peritoneal dialysis (CAPD) in Natal

This study analyses our experience with continuous ambulatory peritoneal dialysis (CAPD) over a period of 2 1/2 years. Twenty-six patients are continuing on CAPD. Of the 31 Whites, 19 Asians, 5 Coloureds and 3 Blacks who began treatment, 15 Whites, 8 Asians, and 3 Coloureds but no Black patients are continuing treatment. Peritonitis was the most important limiting factor and occurred once in every 28,5 weeks in Coloureds, once in 19,5 weeks in Whites, once every 16 weeks in Asiatics and once every 11 weeks in Blacks. Twenty-eight per cent of the patients had 70% of the episodes of peritonitis. Advantages of CAPD were personal freedom, control of blood pressure and fluid balance, and a greater latitude in acceptance of more patients into a chronic renal dialysis programme. The value of CAPD should be assessed further in time and should not be regarded as the final solution to the management of patients with chronic renal failure.     

Defaecation frequencies in Black, Indian, Coloured and White populations - what do they signify?

Using questionnaires covering a 7-day period, frequencies of defaecation were determined in a total of 2937 Black, Indian. Coloured and White subjects aged from 10 years upwards. It transpired that the overall frequency in rural Blacks was roughly twice that of Whites. Among rural Blacks defaecation frequencies of 5-7 per week were recorded in 16%, and from 1-3 per day in 80%. The corresponding figures among urban Blacks were 25% and 71%, among Indians 58% and 34%, among Coloureds 46% and 39%, and among Whites 59% and 29%. The wide differential in frequencies between Blacks and Whites is consistent with the wide differential prevailing in proneness to noninfective bowel diseases. On the other hand, Indians and Coloureds had defaecation frequencies little different on average from those of Whites, yet the former two populations are far less prone to bowel diseases. Hence caution must be exercised in correlating defaecation frequency with proneness to bowel diseases. Since bowel behaviour includes numerous aspects, defaecation frequency should not be regarded in isolation.     

Leading causes of death among children under 5 years of age in the various population groups of the RSA in 1970

The mortality rates (MRs) of children under 5 years of age in the various population groups of the RSA were calculated as deaths/10(5) for various causes of death and groupings of causes of death as classified by the International Classification of Diseases. In 1970 the ten leading causes of death among Coloured and Black children under 5 years of age in the RSA were similar to those among children in developing countries. The rank order of causes of death (in MRs/10(5] among Coloured children was as follows: gastro-enteritis (1 733), pneumonia (725), immaturity (405), ill-defined causes of death (168), nutritional deficiencies (167), measles (126), anoxia (97), 'other bacterial diseases' (91), inflammatory diseases of the nervous system (55) and tuberculosis (48). The ten leading causes of death among White children in the RSA were characteristic of children in Western developed countries. The rank order (in MRs/10(5] was as follows: immaturity (144), anoxia (94), pneumonia (46), gastro-enteritis (41), congenital heart disease (32), other accidents (19), birth injury (19), ill-defined causes of death (12) and inflammatory diseases of the nervous system (11).     

Deaths from and mortality rates for largely preventable causes of death in whites in the RSA. Comparison of the situations in 1970 and 1980

The numbers of deaths from and age-adjusted mortality rates (MRs) for largely preventable causes of death in white males and females aged 15 - 64 years in 1970 and 1980 were compared. The causes of death considered were lung cancer, ischaemic heart disease (IHD), cerebrovascular disease, chronic lung diseases, cirrhosis of the liver, motor vehicle accidents and suicide. In spite of an increase in the white population in this age group from 2,39 million in 1970 to 2,93 million in 1980, the number of deaths from the above causes decreased, with two exceptions. The exceptions were lung cancer, where the number of deaths increased from 482 in 1970 to 535 in 1980, and suicide--up from 433 to 516. The decreases over the 10-year period were substantial in some cases. For example, the number of deaths from IHD fell from 4000 to 3486. The MRs (those for 1980 were age-adjusted) decreased over the 10-year period in all cases, except in the case of lung cancer where the MR remained at 20/100 000. This seems to indicate that anti-smoking campaigns in RSA have not yet begun to influence the incidence of this disease in the white population.     

Variations in mortality of the coloured white and Asian population groups in the RSA, 1978-1982. Part III. Rheumatic heart disease

An analysis was undertaken of mortality from rheumatic heart disease in the RSA between 1978 and 1982 in whites, coloureds and Asians. This article details the age-specific mortality rates (MRs) for each group and also comparisons between groups based on age-standardised MRs. The rates for Asians and coloureds markedly exceed those for whites, particularly in the lower age groups (under 45 years).     

Deaths in gynaecological wards at Groote Schuur Hospital, Cape Town, 1957 - 1977

During the period 1957 - 1977 there were 421 deaths recorded in the gynaecological wards of Groote Schuur Hospital, Cape Town. Nearly 50% of the patients were Coloureds, 25% were Whites, and 14% were Blacks; in 14% the ethnic group was not stated. Seventy-four per cent were more than 40 years and 25% were more than 70 years of age. The causes of death in order of frequency were: malignant disease of the cervix (30%), malignant disease of the ovary (17%), incomplete abortion (15%), non-gynaecological conditions (11%), malignant disease of the corpus uteri (8%), intra-abdominal malignancy (6%), pulmonary embolism (3%), sepsis not associated with abortion (3%), malignant disease of the vulva (2%), and other conditions (5%). The six commonest causes of death varied in the three ethnic groups.     

Variations in mortality of the coloured, white and Asian population groups in the RSA, 1978-1982. Part IV. Respiratory diseases

Respiratory diseases are major causes of death in South Africa. The reported mortality rates (MRs) for: (i) pneumonia and influenza; (ii) chronic obstructive lung disease and allied conditions; (iii) pulmonary tuberculosis; and (iv) carcinoma of the lung and bronchus over a 5-year period are examined in relation to age, sex, ethnic group and year. Such data have not previously been reported in South Africa. MRs for all respiratory diseases (except lung carcinoma) were substantially higher in coloureds than in whites or Asians. In each ethnic group and for each disease category, MRs for males were higher than for females, especially in those over the age of 24 years. For all, except lung carcinoma, MRs were highest at the extremes of life. Changes in respiratory disease MRs over the 5-year period were examined by calculating the age standardised MRs for each condition in each of the 5 years. There was a clear decline in the MR for pneumonia over this period in all groups. The MR for chronic obstructive pulmonary disease rose in all groups, except Asian females. Similarly, the MR for carcinoma increased in all groups, except white females. The MR for tuberculosis was highest in coloured males (10 times greater than in Asian males and 100 times greater than in white females). The pattern of respiratory disease MRs in white South Africans is very similar to that in the USA, whereas in coloureds MRs for infectious diseases remain high and are added to by the burden of cigarette smoking-related deaths.     

Pulmonary embolism in the Rhodesian Black.

Pulmonary embolism is less frequent in Blacks than in Whites. Deep vein thrombosis is probably not uncommon in Blacks, but relatively few of them develop pulmonary embolism. Postoperative pulmonary embolism in Blacks is probably far less common than in Whites. We are dealing with a relatively young Black population, compared with the White one, and therefore more cases might be expected among the Black population as its life expectancy improves.     

Trends in maternal mortality in Cape Town, 1953-1977

In the period 1953 - 1977 there were 223 maternal deaths among 291 800 patients delivered in hospitals under the aegis of the Department of Obstetrics and Gynaecology of the University of Cape Town. A sudden decrease in the maternal mortality rate to below 100/100,000 deliveries occurred in 1956, largely due to the greater use of the obstetric 'flying squad'. Since 1975 maternal mortality rates have been available for the various ethnic groups. For the period 1975 - 1977 the rates were 69/100,000 for Blacks, 40/100,000 for Coloureds and 27/100000 for Whites. Of the deaths, 48% occurred in women aged 21 - 30 years and 29% in those aged 35 years or more. While 28% of deaths were associated with the first pregnancy, grand multiparity (parity 5 or more) accounted for 39%. Nearly half of the patients who died were unbooked. The 7 commonest causes (grouped) of maternal deaths (obstetric as well as non-obstetric) were, in rank order: proteinuric hypertension, haemorrhage, cardiac disease, pulmonary embolism, sepsis, trauma and anaesthetic complications. Proteinuric hypertension is the most important obstetric problem in Cape Town, in terms of numbers of patients, maternal and perinatal deaths, and socio-economic implications for the community. Slightly more than 33% of the infants whose mothers died also succumbed. Major avoidable factors associated with maternal deaths were booking status, grand multiparity, cardiac disease and late or incorrect use of the 'flying squad'.     

Cause- and age-specific mortality rates from accidents, poisoning and violence

Cause- and age-specific mortality rates (MRs) were calculated for 1980 for all four population groups in the RSA for certain accidents, poisonings and violence as they are grouped in the WHO International Classification of Diseases (ICD). Cause-specific MRs of coloureds, Asians and blacks were age-adjusted to the age-distribution of whites in 1980 in order to judge the relative importance of the various causes of death. This showed that in whites and Asians motor vehicle accidents (MVAs) head the rank order of MRs; furthermore the first three MRs in the rank order, namely for MVAs, suicide and violence, are common in these two populations. A similar situation exists among coloureds and blacks in that the MRs for homicide rank first and the first four causes of death in the rank order of MRs--homicide, MVAs, violence and other accidents--are common to those two population groups. The fact that deaths from MVAs and violence rank so high in the MRs for all four population groups lends support to the contention that the RSA is a 'violent society'.     

Sodium and potassium status, plasma renin and aldosterone profiles in normotensive and hypertensive Johannesburg blacks

Many studies have suggested that there is an association between the sodium status, plasma renin and aldosterone profile and essential hypertension. We measured serum, urine and red blood cell (RBC) sodium and potassium, plasma renin and aldosterone levels in normotensive Whites, normotensive Blacks, mildly hypertensive Blacks, severely hypertensive Blacks and Blacks with malignant hypertension. There were no important differences between the groups studied as regarded the serum sodium, serum potassium and urinary sodium excretion values. However, the urinary potassium excretion was significantly lower in normotensive and hypertensive Blacks than in Whites. RBC sodium concentrations showed no significant differences in the mean values across the range of degrees of hypertension in Blacks, although they tended to be higher in the more severely hypertensive groups. Blacks with mild-to-moderate hypertension as well as the severely hypertensive group had significantly lower plasma renin levels than the normotensive group; only in the malignant hypertensives with advanced renal failure did the plasma renin and aldosterone levels rise.     

Incidence of atherosclerosis by race in the dialysis morbidity and mortality study: a sample of the US ESRD population

White individuals who are on dialysis experience much higher overall and cardiovascular mortality rates than black individuals despite a more favorable risk factor profile, but the incidence of nonfatal cardiovascular disease (CVD) to this racial disparity has not been well studied. A longitudinal study of 16,103 people who had ESRD and were enrolled in the United Renal Data System from 1993 to 1996 was conducted. The incidence of new and recurrent atherosclerotic CVD (ASCVD) events was determined using Medicare claims for hospitalizations and mortality among blacks and whites, stratified by ASCVD at baseline. ASCVD was defined as coronary heart disease, peripheral vascular disease, and cerebrovascular disease. Incidence of new ASCVD in people without ASCVD at baseline was 146.9 per 1000 person-years in whites and 118.7 per 1000 person-years in blacks. Incidence of recurrent ASCVD was 404.1 per 1000 person-years in whites and 317.5 per 1000 person-years in blacks. Whites were 1.35 (95% confidence interval, 1.18 to 1.55) times more likely to develop incident ASCVD compared with blacks and 1.25 (95% confidence interval, 1.14 to 1.36) times more likely to develop recurrent disease after adjusting for traditional CVD and dialysis-related risk factors. Excess risk for recurrent ASCVD in whites compared with blacks was consistently present no matter the duration of dialysis: Hazard ratio 1.42 for 0 to 6 mo and 1.40 for 6 to 12 mo. Whites who are treated with dialysis have a higher incidence of ASCVD than blacks who are on dialysis, both new and recurrent. Although differences in survival before the initiation of dialysis may contribute to the observed difference in ASCVD risk, it is not explained by baseline traditional and dialysis-related ASCVD risk factors.     

Ethnicity and Peripheral Arterial Disease

INTRODUCTION: the prevalence of peripheral arterial disease (PAD) is relatively well defined for the Caucasian population. Given the susceptibility of Asians and Afro-Caribbeans to coronary heart disease and stroke respectively, and the high prevalence of cardiovascular risk factors in both groups, one would expect a high prevalence of peripheral arterial disease. METHODS: a search of MEDLINE (1966-2002) was undertaken for studies on the incidence and prevalence of PAD, abdominal aortic aneurysms (AAA) and cerebrovascular disease in different ethnic groups. RESULTS: there are very few population-based prevalence studies assessing PAD, AAA or cerebrovascular disease in non-Caucasians. A review of hospital-based series demonstrates different patterns of PAD between ethnic groups. Blacks and Asians have a tendency towards more distal occlusive disease and AAA appear to be predominantly a disease of Caucasians. It is not clear whether these studies provide a true representation of the prevalence of arterial disease in various ethnic groups or are the result of an unmet health care need. CONCLUSIONS: further studies are required to establish the prevalence, natural history and response to treatment of PAD, AAA and cerebrovascular disease in non-Caucasians. Only when this has been achieved, can clinically and cost-effective health care be delivered to affected individuals from different ethnic groups.     

Variations in outcomes of hemodialysis vascular access by race/ethnicity in the elderly

Objective

Prevalence of end-stage renal disease, modality of treatment, and type of hemodialysis vascular access used varies widely by race/ethnicity in the United States, but outcomes of hemodialysis vascular access by race/ethnicity are poorly described. The objective of this study is to evaluate variations in outcomes of hemodialysis vascular access in the elderly by race/ethnicity.

Variations in mortality of the coloured, white and Asian population groups in the RSA, 1978-1982. Part VI. Ischaemic heart disease

An analysis of ischaemic heart disease (IHD) mortality for the period 1978-1982 showed markedly different rates for the Asian, white and coloured population groups in the RSA. Age-specific and age-standardised rates for Asians were in general considerably higher than those for whites, and did not show the marked decline with time observed in rates for whites. Although coloureds were seen to have considerably lower age-standardized rates than Asians or whites of the same sex, an increase in the age-standardised rates for coloured males over a 10-year period and a slight decrease among females suggested that rates for coloureds may be in the process of approaching those for the other groups. The observed decline in IHD rates among whites of both sexes suggests that preventable major risk factors may be coming under control, apparently to a greater extent in this group than among Asians or coloureds.     

Trends in the mortality rates for the ten leading causes of death among white, coloured and Asian children under 5 years of age in the RSA, 1968-1977

The mean mortality rates (MRs) for the ten leading causes of death among Coloured children in the RSA over the 10-year period 1968-1977 were consistently higher, and in some instances substantially higher, than the MRs among White children; the MRs among Asians were intermediate between those for the White and Coloured children. For certain causes of death the differences between the MRs of White and Coloured children were large; the MR for gastro-enteritis of Coloured children was 42 times higher than that of White children, the MR for tuberculosis was 64 times higher, the MR for measles was 52 times higher, the MR for nutritional deficiencies was 57 times higher, and the MR for pneumonia was 17 times higher. There were, however, certain important causes of death in Coloured children in which dramatic improvements occurred over the 10-year period. For example, the decrease in the MR for gastro-enteritis was 21 times as fast as the change in the MR among White children. Also, the MR for nutritional deficiencies among Coloured children decreased at a faster rate than the MRs among the other children. Unfortunately there were no improvements over the 10-year period in MRs for tuberculosis, measles and pneumonia in Coloured and White children. This is a cause for concern since these are preventable diseases.     

Nonaggressive management of White and Black prostate cancer patients in the United States

Appropriate treatment for prostate cancer is controversial because of the lack of information from randomized clinical trials indicating the benefits of one treatment over another. Watchful waiting or conservative management remains an alternative for this disease. This paper assesses the extent to which White and Black prostate cancer patients in the USA choose nonaggressive therapy. Nonaggressive therapy is defined as patients not receiving cancer-directed surgery or radiation, or that undergo a transurethral resection of the prostate (TURP)/simple prostatectomy but no radiation. Of 112,445 prostate cancer patients diagnosed in 1992-1996, 40% Whites and 46% Blacks were not aggressively treated. Approximately 28% Whites and 33% Blacks did not receive cancer-directed surgery or radiation, and 12% Whites and 13% Blacks underwent a TURP/simple prostatectomy but no radiation. Stage, histologic grade and age at diagnosis, race (White and Black), and number of cancer primaries each significantly influence how patients are managed. Black patients are more likely than White patients to forego aggressive therapy, even after adjusting for less preferential stage and histologic grade at diagnosis, as well as differences in age and number of cancer primaries. Explanations for this result deserve further consideration. Prostate Cancer and Prostatic Diseases (2000) 3, 94-99     

Geographical distribution of lung and stomach cancers in South Africa, 1968-1972

The geographical distribution of lung and stomach cancer among three races in South Africa (Whites, Coloureds and Asians) has been investigated for the years 1968-1972, and the patterns of the occurrence of cases of cancer have been tested stochastically and mapped both separately and together. Information was not available for the Black population. Distinct differences in the distribution of lung and stomach cancer were found. Possible explanations for these differences are discussed.