Cohort trends in mortality from oral, esophageal, and laryngeal cancers in the United States

Temporal patterns in mortality from 1950 to 1984 in the United States for oral, esophageal, and laryngeal cancers show some similarities but differ markedly by sex and race. Cohort analyses reveal that among white women, rates for all three cancers declined among those born during the latter half of the 1800s, increased among those born between about 1895 and 1920, and decreased thereafter. Rates among nonwhite women generally follow the patterns among white women, with a lag of about five years. Among white men, except for declining oral cancer mortality among those born from the mid- to late 1800s, cohort-specific patterns are much less remarkable, whereas increases for oral, esophageal, and laryngeal cancers among nonwhite male cohorts born since 1900 have been steep and have not yet reversed direction as they have for whites. Gender and racial differences in tobacco and alcohol consumption as well as dietary factors are explored as explanations for these patterns.     

Association between gross domestic product throughout the life course and old-age mortality across birth cohorts: parallel analyses of seven European countries, 1950-1999

Mortality levels of national populations have often been studied in relation to levels of gross domestic product (GDP) at time of death. Following the life course perspective, we assessed whether old-age mortality levels for subsequent cohorts are differentially associated with GDP levels prevailing at different ages of the cohorts. We used all-cause and cause-specific mortality data by sex, age at death (65-99), year at death (1950-1999), and year of birth (1865-1924) for Denmark, England and Wales, Finland, France, the Netherlands, Norway, and Sweden. Trends in national GDP per capita between 1865 and 1999 were reconstructed from historical national accounts data. Through Poisson regression analyses, we determined for each country both univariate and multivariate associations across five-year birth cohorts between mortality and GDP levels prevailing at time of death, and at earlier ages of the cohorts (i.e. 0-5, 6-19, 20-49, and 50-64). For the subsequent cohorts, levels of GDP at time of death were strongly inversely associated with all-cause mortality, especially among women, and among men in England and Wales, Finland, and France. In most countries, stronger associations were observed with GDP levels prevailing at earlier ages of the cohorts. After control for GDP at time of death, these associations remained. An independent association of GDP at earlier ages of the cohort was also observed for cause-specific mortality. The associations were negative for ischaemic heart diseases, cerebrovascular diseases, and stomach cancer. They were positive for prostate cancer, breast cancer, COPD (women), and lung cancer (women). GDP prevailing at ages 20-49 (men) and ages 50-64 (women) had the largest associations with old-age mortality. These findings suggest an independent, mostly negative effect of GDP prevailing at earlier ages of subsequent cohorts on old-age mortality. Socio-economic circumstances during adulthood and middle age seem more important in determining old-age mortality trends than those during infancy or childhood.     

Variations in the pace of mortality decline in elderly in 7 Northwestern European countries between 1950-1999: the impact of smoking

OBJECTIVE: Examination of the variations in the pace of old-age (80+) mortality decline in 7 Northwestern European countries for the period 1950-1999, and the impact of smoking DESIGN: Retrospective. METHOD: The population mortality data of 7 Northwestern European countries were collated according to year of death for a 50 year period (1950-1999), single year of age (60+ and 80+) and sex. Both all-cause and non-smoking-related mortality were analysed. In addition, a comparison was made with the pace of mortality decline at younger age among the same cohorts. Regression and correlation analyses were used. RESULTS: Marked variations in the pace of old-age mortality decline were found between countries, periods and sexes. While mortality declines were constantly strong in France and England and Wales, modest declines or even increases in mortality rate were observed in the 1950s in the Nordic countries, and since the 1980s in Denmark, The Netherlands, and (for men only) Norway. For non-smoking-related mortality, a high and consistent pace ofmortality decline was observed. The declines showed a clear cohort pattern, with the smallest declines or even increases for men born between 1890 and 1899, compared to an increased pace of mortality decline among women born between 1847 and 1937. Among men, but not women, the pace of old-age mortality decline correlated with the pace of mortality decline at ages 60-69 among the same cohorts. CONCLUSIONS: Variations in the pace of old-age mortality decline are strongly influenced by smoking and probably also by other factors originating earlier in life. For future decades, substantial further declines in old-age mortality may be expected, even though rates of change in specific countries and periods would be difficult to predict.     

Trends in reproductive, smoking, and other chronic disease risk factors by birth cohort in a large occupational study

PURPOSE: To illustrate the value of using large cohort studies to identify birth cohort trends in several chronic disease risk factors.METHODS: In collaboration with the American Registry of Radiologic Technologists (ARRT) and the University of Minnesota, the National Cancer Institute (NCI) initiated a cohort study of radiologic technologists who were certified by ARRT for at least two years between 1926 and 1982. Over 90,000 technologists (nearly four-fifths female) from all 50 states responded to a mailed questionnaire on reproductive, medical, work, and lifestyle factors. Ten, mostly five-year, birth cohorts, from before 1920 through 1960 and later, were evaluated.RESULTS: In this population, the mean height of both men and women generally rose in each subsequent birth cohort. The proportion of men who smoked before age 18 fell among those born since the late 1920s. In contrast, the proportion of women smoking before age 18 rose among those born since the early 1950s, reaching 14.2% among those born in 1960 and later. The mean age at menarche fell, until leveling off at 12.5, among those born after 1940. Recent birth cohorts (since 1950) show among the highest mean ages at birth of first child (>26 yeras), highest rates of nulliparity at age 25 (>/=63%), and lowest mean parity levels (相似文献   

High coronary heart disease rates among Dutch women of the baby boom, born 1945-1959: age-cohort analysis and projection

BACKGROUND: After a steep decline in older generations, coronary heart disease mortality is stagnating in female cohorts born after the Second World War. We analysed past trends and predicted future health care needs for coronary heart disease in the Dutch population. METHODS: A loglinear age-cohort model relates numbers of deaths and hospital admissions for coronary heart disease to sex, age, birth cohort and population size, and projects age-cohort changes over the future population. Population size, population forecasts and coronary heart disease mortality (period 1970-1999) are from vital statistics. Numbers of hospitalised acute coronary events are from the nationwide hospital register (period 1980-1999). RESULTS: Among men, the rate ratios of deaths and hospital admissions were, respectively, 0.21 (death) and 0.78 (survivors at discharge) in the cohorts born in the period 1948-1962 compared to the period 1918-1922. Among women, the same rate ratios were 0.41 and 1.89. The projection model predicts 22% less deaths from coronary heart disease and 22% more survivors of an infarction in 2015, among men. Among women, there will be 5% less deaths and 70% more survivors of an infarction, most of these being middle age members of the baby boom cohorts. CONCLUSIONS: Stagnating all-cause mortality is correlated with an upward trend in coronary heart disease risk in the female baby boomers. Heart health care needs among middle-aged women will increase sharply. These changes are correlated to high lung cancer mortality and high smoking rates in these cohorts.     

Trends in lung cancer mortality in Brazil from the 1980s into the early 21st century: age-period-cohort analysis

The aim of this study was to describe the pattern of trends in lung cancer mortality in Brazil and identify the effects of the factors age, period and cohort (APC) on mortality rates. A time series study was conducted using secondary population-based data. Lung cancer mortality rates by sex were calculated for the period 1980 to 2007. APC models were adjusted to identify the influence of age, period and cohort effects on rates. Lung cancer mortality rates are significantly higher among men. Specific rates for men over the age of 64 and for women of all ages are increasing. There was a greater increase of adjusted rates among women. With respect to the age effect, mortality risk increases with age starting with the earliest age groups. With regard to the cohort effect, there is a lesser risk of mortality among men born after 1950 and an increasing risk across all cohorts among women. The results regarding younger generations indicate that present trends are likely to continue. The cohort effect among women suggests an increasing trend in mortality rates, whereas a decrease in rates among men under the age of 65 suggests that this trend will continue. These trends reflect tobacco control measures adopted since 1986.     

Trends in reproductive,smoking, and other chronic disease risk factors by birth cohort and race in a large occupational study population

PURPOSE: To illustrate the value of cohort studies to assess trends in chronic disease risk factors. METHODS: In collaboration with the American Registry of Radiologic Technologists and the University of Minnesota, the National Cancer Institute initiated a cohort study of cancer among radiologic technologists. More than 90,000 technologists who responded to a mailed questionnaire were grouped into ten birth cohorts from before 1920 through 1960 and later, and stratified by self-reported racial/ethnic groups. Trends in height, smoking, and reproductive factors were analyzed. RESULTS: Among the trends observed were that the proportion of young men (< 18 years) smoking generally fell in each birth cohort after 1925, whereas the proportion of young women smoking rose for those born after 1950. Among women born since 1940, the mean age at menarche for white women has remained at 12.5 years, but has declined among black and Asian/Pacific Islander women. Recent birth cohorts (since 1955) show among the highest mean ages at birth of first child (> 26 years), highest rates of nulliparity at age 25 (>/= 63 %), and lowest mean parity levels (< or = 1.7) compared with earlier cohorts. CONCLUSION: Analyses of large cohorts can clarify birth cohort trends in chronic disease risk factors.     

Prevalence of cigarette smoking among subsequent cohorts of Italian males and females

Prevalence of cigarette smoking among successive cohorts of Italian males and females born between 1890 and 1969 was estimated from data of the 1983 National Health Survey (based on 89,765 persons randomly selected within strata of geographical area, size of place of residence, and size of household), opportunely corrected for excess mortality of smokers. The overall participation rate for the original sample was 93.6%; impossibility of tracing or refusal of the interview led to substitution of 2,058 households. Among males, smoking prevalence in the young and middle-aged increased steadily up to the generation born in 1920-1929, which, in its 30s, showed the highest absolute smoking prevalence (68.3% in 1960). Moderate declines followed, chiefly on a calendar-period basis (i.e., between 1970 and 1980 in each birth cohort). These declines occurred later and at a lower rate than in several other Western countries. Among females, cigarette smoking was extremely rare for those generations born at the turn of the century (only about 3% of Italian females born in 1890-1899 ever smoked), but increased steadily in each birth cohort and calendar period to reach a rate only about one-third lower than that of males in the 1960-1969 cohort.     

Bladder cancer mortality in England and Wales in relation to cigarette smoking and saccharin consumption

Cohort analyses of bladder cancer mortality rates in men and women in England and Wales have been compared with figures for the per caput consumption of saccharin and cigarette tobacco and with similar analyses of cigarette smoking habits. The increase in bladder cancer mortality rates in male cohorts born since 1870 can be attributed to cigarette smoking, and there is no evidence of any break in the continuity of the trends in either men or women which corresponds to the introduction of saccharin.     

Interpretation of disease time trends: is cancer on the increase? A simple cohort technique and its relationship to more advanced models.

Analysis of trends in mortality from respiratory cancer among women shows that, contrary to previous interpretation, there is no suggestion of any increase over time which might be due to recent increases in exposures to carcinogens. Although there are upward trends in the number of deaths, the crude death rate, and the age standardised rate, these are shown to be related to the aging of earlier cohorts of women who have experienced high mortality rates. More recent cohorts, born since the middle 1920s, show a decline. A simple technique to identify trends in different cohorts is described, and it is shown to be linked to the age-period-cohort modelling approach to investigating time trends. Dangers inherent in ignoring either period or cohort effects when describing one of these factors are discussed.     

Mortality among non-western migrants in The Netherlands

Mortality among 10 groups of non-western migrants to The Netherlands, observed in the period 1995-2000, is compared with mortality among people who were born in and whose parents were born in The Netherlands. The migrant groups concerned consisted of people who were born in, or whose parents were born in Turkey, Morocco, Surinam, The Netherlands Antilles, Ghana, Somalia, Iraq, Iran, Afghanistan and Vietnam. Differences in mortality were adjusted for age, marital status, region, degree of urbanization, and socioeconomic status. Despite the fact that most migrants originate from countries with a substantially higher mortality rate than The Netherlands, most groups had similar or more favourable total mortality rates than native Dutch people. Men from Turkey and Surinam had slightly elevated mortality rates and men and women from Somalia had a notably higher mortality rate than native Dutch people. The generally favourable mortality rates among migrants are the result of two compensating phenomena: higher mortality among young migrants than among young native Dutch people, and lower mortality among elderly migrants than among elderly native Dutch people. An analysis of cause-of-death patterns revealed relatively low mortality from cardiovascular diseases, cancer and respiratory diseases in most migrant groups, and relatively high mortality from infectious diseases and injuries. These findings are unlikely to have been influenced by incomplete registration of mortality. Selective migration may play a role--some migrant groups have a relatively high level of education for example. Also some of the findings may be explained by a difference in timing between the health benefits and the health risks of migration. Migrant health could be benefiting from the favourable socioeconomic, public health and health-care conditions in The Netherlands, but not yet be affected by the higher risks of cancer and cardiovascular disease associated with prosperity.     

Women's death in Scandinavia — what makes Denmark different?

OBJECTIVE: To compare the mortality for women in Sweden, Norway and Denmark in order to search for clues for the low life expectancy of Danish women. METHODS: Prospective age-period-cohort study covering 40 years for all Swedish, Norwegian and Danish women aged 40-84 during the period 1960-2000, and born 1900-1950. OUTCOME MEASURES: Relative risks and 95% confidence intervals for deaths. RESULTS: The high risk of dying among Danish women was associated with being born between the two World Wars, and that a similar pattern was not found for women in Norway and Sweden. A tendency of a cohort effect was observed for Swedish women born around 1940. CONCLUSIONS: The currently low life expectancy of Danish women compared with that of women in Norway and Sweden is partly a transitional phenomenon caused by excessive death rates for women born between the two World Wars. Data on smoking prevalence by birth cohort and age indicate that a high percentage of Danish women in these cohorts were smokers throughout their adult life.     

Weight at birth and all-cause mortality in adulthood

BACKGROUND: Small size at birth is associated with subsequent cardiovascular disease and diabetes, and large size is associated with obesity and cancer. The overall impact of these opposing effects on mortality throughout the lifespan is unclear because causes of death change with age. METHODS: We investigated the association of birth weight with adult all-cause mortality using a Danish school-based cohort of 216,464 men and women born from 1936 through 1979. The cohort was linked to vital statistic registers. The main outcome was all-cause mortality from ages 25 through 68 years. Associations with death from cancer, circulatory disease, and all other causes were also examined. RESULTS: During 5,205,477 person-years of follow-up, 11,149 deaths occurred among men and 6609 among women. The cumulative hazard ratios of the association between birth weight categories and all-cause mortality was constant for all ages investigated and did not differ between men and women. Compared with subjects having birth weights in the reference category (3251-3750 g), those with the lowest birth weights (2000-2750 g) had 17% higher mortality (95% confidence interval = 1.11-1.22), and those with the highest birth weights (4251-5500 g) had 7% higher mortality (1.01-1.15) from all causes. The association of birth weight with cancer increased linearly, whereas the association of birth weight with circulatory disease and all other causes was U-shaped. CONCLUSIONS: To the degree that the association of birth weight with adult survival is causal, the U-shaped association between birth weight and adult mortality suggests that population increases in birth weight may not necessarily lead to improved health in adulthood.     

Trends in mortality from lung cancer in Mexico, 1980-2000]

OBJECTIVE: To analyze trends in age-adjusted lung cancer mortality rates in Mexico for the period of 1980 through 2000. METHOD: The trends were assessed using the adjusted rates of mortality from lung cancer, year of death, year of birth, age at death, state, and standard population. The standardized mortality rate and the index of potential years of life lost were used to compare incidence and premature deaths. The standardized mortality rate was analyzed by age groups according to the age at death (30-74 years), five-year observation period (1980-1999), and birth cohort (1910-1950). Nonparametric Spearman correlations were calculated for per capita tobacco consumption, social marginalization, and emigration. RESULTS: The adjusted mortality rate from lung cancer declined from 7.91 per 100 000 in 1989 to 5.96 per 100 000 in 2000. This pattern correlated with the reduction in per capita tobacco consumption, from 2.145 kg in 1959 to 0.451 kg in 1982. The latent period for the appearance of lung cancer in Mexico was 30 years. The male:female ratio was 2.4:1. The highest adjusted mortality rate was found in men who were 70-74 years old at the time of death. The adjusted mortality rates were low among the cohorts of persons born in 1945 or later, and those rates declined over the 1980-2000 period. The index of potential years of life lost and the incidence of premature death were greater among men. The mortality rates for the cohorts of men born between 1915 and 1940 showed a slight decline over the 1980-2000 period; beginning with men born in 1944 the rates increased slightly, mainly among men 30-34 and 35-39 years old at the time of death. For women the adjusted mortality rates were highest among those 75 or older; the rates gradually declined among the women born between 1945 and 1960, with the largest decrease among women 30-34 years old. The adjusted mortality rates varied according to the five-year observation period, the year of death, and birth cohort and gender. The correlation coefficient for the adjusted mortality rate by state and social marginalization was -0.70 (P = 0.00). There was no statistically significant correlation with the index of emigration (P = 0.56). CONCLUSIONS: Mortality from lung cancer has declined in Mexico. Morbidity and premature death due to lung cancer are greater in the states of northern Mexico.     

The effects of various factors on cerebrovascular disease mortality rates in the 20th century and future trends in Japan

PURPOSES: To analyze the outcomes of measures designed to decrease cerebrovascular diseases (CVDs) in Japan and to project CVD mortality trends into the 21st century based on an analysis of rates observed in the 20th century. METHODS: The numbers of CVD deaths and population sizes from 1920 to 2003 (excluding 1940 to 1946) by sex, year, and 5-year age group (from 20 to 79 years old) were used and effects of various factors on CVD mortality rates were estimated using Nakamura's Bayesian age-period-cohort model. The numbers of CVD deaths up to the year 2050 were projected based on estimates of age, cohort, and future period effects under three scenarios: (i) values remaining constant after year 2003; (ii) linearly extrapolated values; and (iii) quadratically extrapolated values, we obtained using a regression line for period effects from 1995 to 2003. RESULTS: The age, cohort, and period effects on CVD mortality rates were large and in order of the magnitude of their ranges. There were small differences between males and females. The age effect increased with aging and the period effect started decreasing after 1970. The cohort effect was high for birth cohorts born from the 1840s to the 1890s and low for those born from the 1920s to the 1970s. There were some differences in the cohort effect between males and females for birth cohorts born after 1940s; for females there was a gradual decrease, while for males there was a slight increase, after which it remained almost constant. According to the three scenarios, CVD deaths: (i) had upward trends through the projected period and peaked at around 2025 and 2045; (ii) remained almost constant at the present level for males, and decreased slightly for females; (iii) decreased for both males and females. CONCLUSIONS: The outcomes of measures designed to decrease CVDs were observed as period effects after 1970. Exposure to these measures is associated with prevention of CVD deaths. Nevertheless, in the first half of the 21st century, the number of CVD deaths is projected to increase due to the aging of the baby boomers and upward trends in the cohort effect for males. It would be necessary to adopt and develop both population strategies to decrease future period effects and high-risk strategies to decrease cohort effects for younger males who are currently in their twenties and thirties.     

Diet Quality Index as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort

The Diet Quality Index (DQI) was developed to measure overall dietary patterns and to predict chronic disease risk. This study examined associations between DQI and short-term all-cause, all-circulatory-disease, and all-cancer mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort, a cohort of US adults aged 50-79 years enrolled in a prospective study. After 4 years of follow-up (1992-1996), there were 869 deaths among 63,109 women and 1,736 deaths among 52,724 men. All study participants reported being disease free at baseline in 1992-1993. In age-adjusted Cox models, a higher DQI, which was indicative of a poorer quality diet, was positively related to all-cause and all-circulatory-disease mortality rates in both women and men and to cancer mortality in men only. However, in fully adjusted Cox models, only circulatory disease mortality was clearly positively related to DQI and only in women (medium-low-quality diet vs. highest-quality diet: rate ratio = 1.86, 95% confidence interval: 1.19, 2.89). Although trend tests indicated significant positive relations between DQI and all-cause mortality, effects were small (rate ratios 相似文献   

Body mass index and mortality: results of a cohort of 184,697 adults in Austria

There is still a debate about the role of body mass index (BMI) as a risk factor for all-cause mortality. Most investigations with large sample sizes focused on populations from the United States, studies from Central-European cohorts are not available. We investigated the association between BMI and all-cause mortality and cause-specific mortality within a cohort in Austria. Design of this article is “Cohort study”. The Subjects used were 184,697 men and women (mean age 41.7 ± 15.4 years). Weight and height were measured. Cox proportional hazards models were used to estimate hazard ratios (HR). During a median follow-up of 15.1 years 15,557 deaths (6,077 from cardiovascular disease, 4,443 from cancer and 606 from respiratory disease) were seen. A U-shaped association between BMI and all-cause mortality was observed in men and women. Compared with the reference category (BMI 22.5–24.9 kg/m2) high risks were found both in the highest category of BMI (≥35 kg/m²) with HR of 2.13 (95% CI, 1.82–2.48) in men and 1.60 (95% CI, 1.42–1.81) in women and in the lowest category (<18.5 kg/m2) with HR of 2.57 (95% CI, 2.17–3.05) in men and 1.40 (95% CI, 1.21–1.62) in women. Similar patterns were seen among ever-smokers and non-smokers. Increased mortality with increasing BMI was driven by cardiovascular diseases and to a lesser extent by cancers. Respiratory diseases contributed to mortality in the lowest BMI category independently from smoking status. Underweight and obesity were both associated with higher all-cause mortality in men and women. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Changing patterns of skin melanoma mortality in West Germany from 1968 through 1999

PURPOSE: Skin cancer incidence data from West Germany are available only for the territory of the Federal State of Saarland. We examined time trends in melanocytic and non-melanocytic skin cancer mortality for the territory of West Germany including a population of about 66 million people. METHODS: We analyzed the melanocytic and non-melanocytic skin cancer mortality data (1968-99) from West Germany including West Berlin. We calculated age-specific and age-standardized mortality rates and used Poisson regression to estimate underlying age, cohort, and period effect. RESULTS: The estimated percent annual increase of the skin melanoma mortality rate was 1.0% (95% CI, 0.7-1.3) among men and 0.5% (95% CI, 0.2-0.7) among women. This increase is mainly due to a rate increase in people aged 60 years or more. The skin melanoma mortality trend was best explained by age-, cohort-, and period effects. The risks increased in each successive birth cohort born between 1890 and roughly 1935. Thereafter, the risks declined through the most recent birth cohort born in 1975. CONCLUSIONS: Skin melanoma mortality in West Germany showed an increase from 1968 through 1999 in people aged 60 years or more. The favorable mortality decline by birth cohort in the most recent birth cohort is an important indicator of a likely decline in mortality over the coming years.     

Mortalité des générations 1880-1980 en Suisse une relecture de l'évolution de la mortalité à partir de données longitudinales

Summary.Cohort mortality from 1880-1980 in Switzerland Objectives: Seek to explain the declining mortality rates observed in Switzerland using a different approach from conventional period analyses. Methods: Analysis of the mortality rates for cohorts born between 1880 and 1980 in Switzerland. Results: While the mortality transition was a constant feature of the 20^th century, mortality receded most sharply among the 1900 to 1940 birth cohorts. Life expectancy gains were much lower for the pre-1900 cohorts, while early trends for the post-1940 cohorts point to a slowdown in the rate of mortality decline. These findings may be connected with the social and health conditions in which the different cohorts lived. Conclusion: In contrast to the cross-sectional analysis, the longitudinal approach shows that the decline in mortality suddenly stops with the 1940 cohort.     

A cohort analysis of breast cancer, uterine corpus cancer, and childbearing pattern in Norwegian women.

STUDY OBJECTIVE--The aim was to study the influence of childbearing pattern on the incidence of breast cancer and uterine corpus cancer. DESIGN--This was an ecological study of birth cohorts of women. SETTING--The study was population based, involving the whole of Norway. PARTICIPANTS--The participants were Norwegian women born between 1890 and 1944. MEASUREMENTS AND MAIN RESULTS--Age specific fertility rates and age specific incidence rates for different birth cohorts were analysed by an age-cohort-period model where quantitative indices of the childbearing pattern substituted the cohort component. The 1890-94 birth cohort had the most favourable childbearing pattern with regard to the risk of breast cancer as well as uterine corpus cancer. The least favourable pattern was in the 1910-14 cohort for breast cancer and the 1940-44 cohort for uterine corpus cancer. In the analysis it is estimated that about 15% of the increase in incidence of breast cancer from 1955 to 1984 may be attributed to changes in the childbearing pattern of the cohorts under study. For cancer of the uterine corpus the corresponding fraction is about 27%. CONCLUSIONS--The study reveals that changes in childbearing pattern may explain a certain fraction of the observed increase in breast and uterine corpus cancer in Norway in the last 30 years, but the largest fraction must be accounted for by other factors.