Tuberculosis burden in India and its control from 1990 to 2019: Evidence from global burden of disease study 2019

BackgroundTuberculosis is still a major public health problem in India. This study aims to assess trends in the burden of tuberculosis from 1990 to 2019 for tracking success of tuberculosis control programme in India.MethodsIn this study, the 2019 global burden of disease study data were used to measure the incidence, prevalence, mortality, and disability-adjusted life years lost (DALY)rates of Tuberculosis during 1990–2019 for India and its states. Age and gender-specific rates were also analyzed for India. All rates were age-standardized and 95% uncertainty intervals (UIs) were computed.ResultOverall incidence, prevalence, death and DALY of TB decreased in India from 1990 to 2019. Tuberculosis morbidity and mortality was higher in males as compared to females. Incidence of TB was low in children up to 14 years of age. Prevalence of TB was higher in females as compared to males till 29 years of age, whereas higher prevalence was reported in males as compared to females in adults aged 30 years and more. Death rate of TB was low in children and young adults up to 29 years of age.ConclusionThis study shows that overall incidence, prevalence, death and DALY of tuberculosis decreased from 1990 to 2019 in India. The burden of TB was higher among males as compared to females during study period. TB affects all the age groups but deaths were higher in older age groups.     

Incidence and mortality from thyroid cancer in Brazil

In this study we evaluated the incidence and mortality due to thyroid cancer (TC) in Brazil using incidence data provided by seven Brazilian cancer registries and mortality data from the Brazilian Mortality Information System. Five-year age-adjusted mortality rates were calculated over a 20-year period (1980-1999) for the country as a whole. We have calculated a 3-year age-adjusted incidence rate using data available since 1993. Age-adjusted mortality rates decreased from 0.22/100,000 to 0.28/100,000 (-21%) among males, and from 0.42/100,000 to 0.51/100,000 (-17%) among females. Among males, age-adjusted incidence rates varied from 0.7/100,000 in Belém to 3.0/100,000 in S?o Paulo. These cities also presented the lowest (0.8/100,000) and the highest (10.9/100,000) age-adjusted incidence rates among females. The downward tendency of mortality is probably explained by an improvement in diagnosis and treatment of TC over the study period, whereas geographical variations in incidence are probably related to availability of medical care resources in the different regions and the quality of cancer registers data.     

Increasing trends in HIV and TB rates in Odessa and the Ukraine

Notification rates for HIV and tuberculosis (TB) have increased in the Ukraine and particularly in Odessa. In 1962, the incidence of TB in Odessa region was 178 cases per 100,000 cases, declining to 73.0, 42.0 and 41.6 cases per 100,000 in 1972, 1982 and 1992, respectively. In 2002, TB incidence and prevalence were 80.4 and 330.1/100,000 population, respectively. TB mortality in the port almost doubled from 10.2/100,000 to 21.6/100,000 between 1990 and 2001. In 2002, the HIV incidence and prevalence and AIDS incidence and prevalence were 46.4 and 241.0 cases/100,000 population and 14.5/100,000 and 26.9/100,000, respectively. There are increasing numbers of TB cases co-infected with HIV (200 in 2002), suggesting that the HIV and TB epidemics are converging. Significant effort is needed for the effective control of these two outbreaks to prevent high levels of morbidity and mortality from these diseases.     

The incidence of systemic lupus erythematosus in Baltimore, Maryland, 1970-1977

The incidence of systemic lupus erythematosus, based on first hospital discharge diagnosis, in Baltimore, Maryland for the years 1970 through 1977 was determined for individual sex-race groups and the total population. Age-specific incidence rates were consistently highest among black females and lowest among white males: rates for white females exceeded those for black males through age 54, but then declined for ages greater than or equal to 55. Mean age at diagnosis was significantly lower for black females versus white females (35.5 versus 41.7 years, P = 0.005) and for all females versus all males (37.2 versus 44.2 years, P = 0.012). There were no temporal trends noted in yearly age-adjusted incidence rates during the 8-year study period. The overall population incidence of systemic lupus erythematosus was 4.6 per 100,000 per year, representing a twofold increase over a comparable study done in New York City 15 years ago.     

Increased incidence of adenocarcinomas at the gastro-oesophageal junction in Dutch males since the 1990s

BACKGROUND: Worldwide population-based studies suggest that the incidence of oesophageal and gastric cardia adenocarcinomas has increased since the 1970s. OBJECTIVE AND METHODS: We studied time trends in mortality and incidence rates of oesophageal and gastric carcinomas according to subsite and histology in the south-east Netherlands since 1978. RESULTS: The age-adjusted mortality and incidence rates for oesophageal cancer doubled in males over the entire 19-year study period from 2.7 to 5.6 and from 2.4 to 4.8 per 100,000 person years, respectively. In females, a similar trend for the mortality and incidence rates was seen, but at a lower level. The age-adjusted mortality and incidence rates for gastric cancer decreased with time from 20.7 to 12.8 and from 21.6 to 15.9 per 100,000 person years in males, respectively. In females, age-adjusted mortality and incidence rates for gastric cancer also decreased. Analysis of incidence rates by subsite and subtype showed an increase in adenocarcinomas of the oesophagus and gastric cardia, largely restricted to males. In females, the rise in incidence of squamous cell carcinoma of the oesophagus appeared to be more marked than the rise in adenocarcinomas, whereas the incidence of gastric cardia carcinomas has remained stable over the last 10 years. Neither the decrease in the number of unspecified tumours with time, nor the increase in the use of diagnostic endoscopy and imaging techniques, is likely to explain completely the observed increases. CONCLUSION: The increase in incidence of adenocarcinomas at the gastro-oesophageal junction in the south-eastern Netherlands seems, at least in part, to represent a true underlying increase that is restricted largely to males.     

The incidence of systemic lupus erythematosus in baltimore,maryland, 1970–1977

The incidence of systemic lupus erythematosus, based on first hospital discharge diagnosis, in Baltimore, Maryland for the years 1970 through 1977 was determined for individual sex-race groups and the total population. Age-specific incidence rates were consistently highest among black females and lowest among white males: rates for white females exceeded those for black males through age 54, but then declined for ages ⩽55. Mean age at diagnosis was significantly lower for black females versus white females (35.5 versus 41.7 years, P = 0.005) and for all females versus all males (37.2 versus 44.2 years, P = 0.012). There were no temporal trends noted in yearly age-adjusted incidence rates during the 8-year study period. The overall population incidence of systemic lupus erythematosus was 4.6 per 100,000 per year, representing a twofold increase over a comparable study done in New York City 15 years ago.     

Recent trends in asthma hospitalization and mortality in the United States.

OBJECTIVE: To study the recent trends in asthma hospitalization and mortality rates by age, gender, and race categories in the United States. METHODS: The National Hospital Discharge Survey Database for the years 1995 to 2002 was used to examine trends in asthma hospitalization. An International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) code of 493.0 was used to identify primary hospitalization for asthma. Hospitalization rates were estimated using U.S. Census Bureau population estimates as denominators. Mortality data was obtained from the Center for Disease Control and Prevention Mortality Database. Death from asthma was identified using ICD-9-CM codes (493.0) for the years between 1995 and 1998 and ICD-10 codes (J45-J45.9) for 1999 and afterwards. Asthma hospitalization and mortality rates were estimated per 10,000 and per 100,000 populations, respectively. Crude relative risks (RR) were estimated to compare risks between various groups. RESULTS: During the study period the age-adjusted asthma hospitalization rate decreased by 16.3% among white females (from 13.4/10,000 in 1995-1996 to 11.2/10,000 in 2001-2002), and by 7% (from 8.14/10,000 in 1995-1996 to 7.56/10,000 in 2001-2002) among white males. Among blacks the decrease in hospitalization rate was by 13.9% (from 38.18/10,000 in 1995-1996 to 32.86/10,000 in 2001-2002) in males and by 14.4% (from 40.21/10,000 in 1995-1996 to 34.42/10,000 in 2001-2002) in females. A narrowing of the black to white disparity in asthma hospitalization rate was noted for children younger than 10 years of age. On the other hand, the racial disparity among subjects 10 years and older narrowed until 2000 but has started to widen since then. The overall decrease in asthma mortality rate was evident for the age group=5, but remained unchanged for the age group less than five. The age adjusted asthma mortality rate has also decreased by 22.2% in blacks (from 3.33/100,000 in 1995 to 2.59/100,000 in 2001) and by 38.4% in whites (from 1.26/100,000 in 1995 to 0.78/100,000 in 2001). CONCLUSION: This study confirms that both asthma hospitalization and mortality rates decreased during the study period and the black to white racial disparity in asthma hospitalization has narrowed for children younger than 10 years of age. For those subjects 10 years and older the racial disparity in hospitalizations narrowed until 2000 but started to widen since then. The widening racial gap in adults is disconcerting and needs further observation to assess its persistence.     

Cardiovascular mortality in Korea: a country experiencing epidemiologic transition

BACKGROUND: The pattern of morbidity and mortality of cardiovascular disease (CVD) changes with epidemiologic transition. An understanding of this pattern in rapidly developing countries might provide important clues for the understanding of the epidemiological trends in CVD mortality. The objective of this paper was to address the changing pattern of CVD mortality in Korea during the period 1984-1999, and to examine the significant changes in associated major risk factors for CVD over a similar period. METHODS: For the purpose of this study, three main categories in CVD were reviewed: hypertensive heart disease, ischaemic heart disease, and cerebrovascular disease (stroke).The analyses of mortality were based on nationwide mortality data published by the National Statistical Office from 1984 to 1999. All the mortality rates were adjusted for age using the direct method. Changes in major CVD risk factors (blood pressure, cigarette smoking, serum total cholesterol and diet) were also reviewed during similar periods. FINDINGS: During the 15-year period investigated, the age-adjusted mortality from CVD decreased markedly. It decreased by 57% in males (from 172.2 to 73.0/100,000) and 48% in females (from 135.5 to 70.2/100,000). The age-adjusted mortality from stroke decreased while the proportion of ischaemic strokes among total stroke deaths increased. The proportion increased about 5.2 times in men and 4.9 times in women. The age-adjusted mortality from hypertensive heart disease decreased markedly. It decreased by 92% in men (from 51.6 to 4.1/100,000) and 84% in women (from 34.1 to 5.3/100,000). Also the age-adjusted mortality from ischaemic heart disease increased significantly. In 1999, the rates for men and women were 11.9 and 7.5/100,000, respectively. These rates were 3.8 and 3.6 times higher than the rates in 1984 for men and women, respectively. The changes of CVD risk factors in Korea observed during a similar period were a decrease in hypertension prevalence, although still present at a high level, an increase in serum total cholesterol level and intake of total fat along with a high, although decreasing, prevalence of cigarette smoking. INTERPRETATION: The mortality changes in Korea are consistent with the change that occurs during the transition from the age of receding pandemics to the age of degenerative and man-made diseases. This study has indicated that the change of CVD mortality was closely associated with the change in CVD risk factors. In order to avert the ongoing epidemic of CVD in developing countries, prevention and treatment of modifiable risk factors must become a high health priority.     

1990—2019年中国人群退行性二尖瓣病变疾病负担研究

目的探讨1990至2019年中国人群退行性二尖瓣病变(DMVD)疾病负担变化趋势。方法基于2019年全球疾病负担研究(GBD 2019)数据库, 采用患病人数、新发病例数、死亡人数、伤残调整寿命年(DALY)以及患病率、发病率、死亡率、DALY率及其年龄标化率等指标, 分析1990至2019年中国人群DMVD疾病负担变化趋势。结果 2019年中国DMVD患病人数、新发病例数及死亡人数分别为461.2、27.0、0.129万例, 与1990年相比分别增长了209.0%、199.1%和13.2%。2019年DMVD的年龄标化患病率、发病率和死亡率分别为228.1/10万、12.7/10万和0.075/10万, 与1990年相比, 变化率分别为32.6%、42.8%和-54.1%。另外, 2019年的数据还显示, 女性的年龄标化患病率和发病率均高于男性[年龄标化患病率:男性190.1(181.5～198.9)/10万、女性262.0(250.3～273.9)/10万;年龄标化发病率:男性10.5(10.0～11.0)/10万、女性14.9(14.3～15.6)/10万];DMVD患病人数最多...     

Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002

BACKGROUND: Varicella zoster virus (VZV) causes varicella and, later in the life of the host, may reactivate to cause herpes zoster (HZ). Because it is hypothesized that exposure to varicella may boost immunity to latent VZV, the vaccination-associated decrease in varicella disease has led some to suggest that the incidence of HZ might increase. We assessed the impact that varicella vaccination has on the incidence of varicella and of HZ. METHODS: Codes for cases of varicella and of HZ in an HMO were determined in automated databases of inpatients and outpatients, on the basis of the Ninth Revision of the International Classification of Diseases. We calculated the incidence, during 1992-2002, of varicella and of HZ. RESULTS: The incidence of HZ remained stable as the incidence of varicella decreased. Age-adjusted and -specific annual incidence rates of varicella decreased steadily, starting with 1999. The age-adjusted rates decreased from 2.63 cases/1000 person-years during 1995 to 0.92 cases/1000 person-years during 2002; among children 1-4 years old, there was a 75% decrease between 1992-1996 and 2002. Age-adjusted and -specific annual incidence rates of HZ fluctuated slightly over time; the age-adjusted rate was highest, at 4.05 cases/1000 person-years, in 1992, and was 3.71 cases/1000 person-years in 2002. CONCLUSIONS: Our findings revealed that the vaccination-associated decrease in varicella disease did not result in an increase in the incidence of HZ. These early findings will have to be confirmed as the incidence of varicella disease continues to decrease.     

Racial,Ethnic, and Age Disparities in Incidence and Survival of Intrahepatic Cholangiocarcinoma in the United States; 1995-2014

Introduction and aim. Despite reports of increased incidence of intrahepatic cholangiocarcinoma (iCCA) in the United States, the impact of age or influences of race and ethnicity are not clear. Disparities in iCCA outcomes across various population subgroups also are not readily recognized due to the rarity of this cancer. We examined ethnic, race, age, and gender variations in iCCA incidence and survival using data from the Surveillance, Epidemiology, and End Results Program (1995-2014).Material and methods. We assessed age-adjusted incidence rates, average annual percentage change in incidence, and hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and iCCA-specific mortality.Results. Overall, 11,127 cases of iCCA were identified, with an age-adjusted incidence rate of 0.92 per 100,000. The incidence rate increased twofold, from 0.49 per 100,000 in 1995 to 1.49 per 100,000 in 2014, with an average annual rate of increase of 5.49%. The iCCA incidence rate was higher among persons age 45 years or older than those younger than 45 years (1.71 vs. 0.07 per 100,000), among males than females (0.97 vs. 0.88 per 100,000) and among Hispanics than non-Hispanics (1.18 vs. 0.89 per 100,000). Compared to non-Hispanics, Hispanics had poorer 5-year all-cause mortality (HR = 1.11, 95%CI: 1.05-1.19) and poorer iCCA-specific mortality (HR = 1.15, 95%CI: 1.07-1.24). Survival rates were poor also for individuals age 45 years or older, men, and Blacks and American Indians/Alaska Natives. Conclusion.ConclusionThe results demonstrate ethnic, race, age and gender disparities in iCCA incidence and survival, and confirm continued increase in iCCA incidence in the United States.     

Racial,Ethnic, and Age Disparities in Incidence and Survival of Intrahepatic Cholangiocarcinoma in the United States; 1995-2014

Introduction. Despite reports of increased incidence of intrahepatic cholangiocarcinoma (iCCA) in the United States, the impact of age or influences of race and ethnicity are not clear. Disparities in iCCA outcomes across various population subgroups also are not readily recognized due to the rarity of this cancer. We examined ethnic, race, age, and gender variations in iCCA incidence and survival using data from the Surveillance, Epidemiology, and End Results Program (1995-2014).Materials and methods. We assessed age-adjusted incidence rates, average annual percentage change in incidence, and hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and iCCA-specific mortality.Results. Overall, 11,127 cases of iCCA were identified, with an age-adjusted incidence rate of 0.92 per 100,000. The incidence rate increased twofold, from 0.49 per 100,000 in 1995 to 1.49 per 100,000 in 2014, with an average annual rate of increase of 5.49%. The iCCA incidence rate was higher among persons age 45 years or older than those younger than 45 years (1.71 vs. 0.07 per 100,000), among males than females (0.97 vs. 0.88 per 100,000) and among Hispanics than non-Hispanics (1.18 vs. 0.89 per 100,000). Compared to non-Hispanics, Hispanics had poorer 5-year all-cause mortality (HR = 1.11, 95%CI: 1.05-1.19) and poorer iCCA-specific mortality (HR = 1.15, 95%CI: 1.07-1.24). Survival rates were poor also for individuals age 45 years or older, men, Blacks, and American Indians/Alaska Natives.Conclusion. The results demonstrate ethnic, race, age and gender disparities in iCCA incidence and survival, and confirm continued increase in iCCA incidence in the United States.     

Recent Trends in Asthma Hospitalization and Mortality in the United States

Objective. To study the recent trends in asthma hospitalization and mortality rates by age, gender, and race categories in the United States. Methods. The National Hospital Discharge Survey Database for the years 1995 to 2002 was used to examine trends in asthma hospitalization. An International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) code of 493.0 was used to identify primary hospitalization for asthma. Hospitalization rates were estimated using U.S. Census Bureau population estimates as denominators. Mortality data was obtained from the Center for Disease Control and Prevention Mortality Database. Death from asthma was identified using ICD-9-CM codes (493.0) for the years between 1995 and 1998 and ICD-10 codes (J45–J45.9) for 1999 and afterwards. Asthma hospitalization and mortality rates were estimated per 10,000 and per 100,000 populations, respectively. Crude relative risks (RR) were estimated to compare risks between various groups. Results. During the study period the age-adjusted asthma hospitalization rate decreased by 16.3% among white females (from 13.4/10,000 in 1995–1996 to 11.2/10,000 in 2001–2002), and by 7% (from 8.14/10,000 in 1995–1996 to 7.56/10,000 in 2001–2002) among white males. Among blacks the decrease in hospitalization rate was by 13.9% (from 38.18/10,000 in 1995–1996 to 32.86/10,000 in 2001–2002) in males and by 14.4% (from 40.21/10,000 in 1995–1996 to 34.42/10,000 in 2001–2002) in females. A narrowing of the black to white disparity in asthma hospitalization rate was noted for children younger than 10 years of age. On the other hand, the racial disparity among subjects 10 years and older narrowed until 2000 but has started to widen since then. The overall decrease in asthma mortality rate was evident for the age group ≥ 5, but remained unchanged for the age group less than five. The age adjusted asthma mortality rate has also decreased by 22.2% in blacks (from 3.33/100,000 in 1995 to 2.59/100,000 in 2001) and by 38.4% in whites (from 1.26/100,000 in 1995 to 0.78/100,000 in 2001). Conclusion. This study confirms that both asthma hospitalization and mortality rates decreased during the study period and the black to white racial disparity in asthma hospitalization has narrowed for children younger than 10 years of age. For those subjects 10 years and older the racial disparity in hospitalizations narrowed until 2000 but started to widen since then. The widening racial gap in adults is disconcerting and needs further observation to assess its persistence.     

Trends in incidence rates of ulcerative colitis and Crohn's disease

Between 1960 and 1979, three studies were conducted in the Baltimore Standard Metropolitan Statistical Area to ascertain the incidence rates of first hospitalizations for ulcerative colitis and Crohn's disease. The age-adjusted rates per 100,000 population for the 1977-1979 survey for ulcerative colitis in white and nonwhite males and females were 2.92, 1.79, 1.29, and 2.90, respectively; the Crohn's disease rates were 3.39, 3.54, 1.29, and 4.08, respectively. In Baltimore the age-adjusted rate for Crohn's disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females. The ulcerative colitis and Crohn's disease rates for nonwhite males are similar. The rate for white males exceeds that for nonwhite males for both ulcerative colitis and Crohn's disease, but the converse is true for females. Females have higher rates than males for Crohn's disease in both color groups and for ulcerative colitis among nonwhites. White ulcerative colitis rates are higher for males than for females. From the first to the second surveys, the white male and female rates for ulcerative colitis converge with increasing male and decreasing female rates, but then both decline from the second to the third surveys. For Crohn's disease, the age-adjusted rates increased for whites of both sexes and nonwhite females from the first to second surveys. The Crohn's disease rates appeared to stabilize for whites of both sexes between the second and present surveys, but they increased for nonwhites of both sexes. Trends in age-adjusted rates for other areas are also discussed.     

Seven-year trends in HIV-1 infection rates, and changes in sexual behaviour, among adults in rural Uganda

OBJECTIVE: To assess trends in HIV-1 infection rates and changes in sexual behaviour over 7 years in rural Uganda. METHODS: An adult cohort followed through eight medical-serological annual surveys since 1989-1990. All consenting participants gave a blood sample and were interviewed on sexual behaviour. RESULTS: On average, 65% of residents gave a blood sample at each round. Overall HIV-1 prevalence declined from 8.2% at round 1 to 6.9% at round 8 (P = 0.008). Decline was most evident among men aged 20-24 years (11.7 to 3.6%; P < 0.001) and women aged 13-19 (4.4% to 1.4%; P = 0.003) and 20-24 (20.9% to 13.8%; P = 0.003). However, prevalence increased significantly among women aged 25-34 (13.1% to 16.6%; P = 0.04). Although overall incidence declined from 7.7/1000 person-years (PY) in 1990 to 4.6/1000 PY in 1996, neither this nor the age-sex specific rates changed significantly (P > 0.2). Age-standardized death rates for HIV-negative individuals were 6.5/1000 PY in 1990 and 8.2/1000 PY in 1996; corresponding rates for HIV-positive individuals were 129.7 and 102.7/1000 PY, respectively. There were no significant trends in age-adjusted death rates during follow-up for either group. There was evidence of behaviour change towards increase in condom use in males and females, marriage at later age for girls, later sexual debut for boys and a fall in fertility especially among unmarried teenagers. CONCLUSIONS: This is the first general population cohort study showing overall long-term significant reduction in HIV prevalence and parallel evidence of sexual behaviour change. There are however no significant reductions in either HIV incidence or mortality.     

Incidence and differences in urban-rural seasonal variation of Type 1 (insulin-dependent) diabetes in Wisconsin

Summary In a hospital-based records study of Type 1 (insulin-dependent) diabetes mellitus among persons aged 0 to 29 years in two Wisconsin, USA counties (1970–79), the age-adjusted yearly incidence rate for white males (16.4/100,000) was significantly higher than for white females (11.6/100,000) (p = 0.006). Overall age-adjusted rates are similar to rates previously reported for the United States and the northern European countries of Denmark and Norway. Seasonal variation in diagnosis was found for total cases and males aged 10 to 19 years. A striking difference also was found in seasonal diagnosis between urban and rural cases. A diagnosis peak in the third and fourth quarter among rural cases contrasted with even quarterly distribution among urban cases. In addition, 52% of rural male cases aged 10 to 19 years were diagnosed during the fourth quarter while no seasonal pattern occurred among urban males the same ages. These findings identify subgroups for focus of future etiologic investigations.     

Chronic liver disease mortality in the United States, 1990-1998

In 1998, chronic liver disease (CLD) was the tenth leading cause of death in the U.S. Alcohol and hepatitis C are thought to be important etiologies. However, traditional methods for calculating CLD mortality rates from death certificates may underestimate hepatitis C-related CLD mortality. We studied patterns of CLD deaths reported from 1990 through 1998, using an expanded definition that included death certificates where CLD, viral hepatitis, or CLD-related sequelae were reported as the underlying cause. We calculated overall age-specific and age-adjusted mortality rates, and according to demographic characteristics and recorded causes, and evaluated trends using linear regression modeling. CLD mortality declined 5% overall from 1990 through 1994 (12.1 to 11.6/100,000; P = 0.002), but remained unchanged from 1995 through 1998 (P = 0.366). Decreases were similar for all causes except hepatitis C, for which rates increased 220% from 1993 to 1998 (0.57 to 1.67/100,000). Rates declined in all racial-ethnic groups except American Indians and Alaska Natives (AI/AN), among whom rates were unchanged. Of 30,933 CLD deaths in 1998, 39% were coded as alcohol related, 15% as hepatitis C, 4% as hepatitis B, and 44% had no recorded cause. Age-adjusted rates were higher among males (47.6/100,000) than females (32.2/100,000) and among Hispanics (19.1/100,000) compared with non-Hispanics (10.8/100,000). Rates among AI/AN (28.7/100,000) were more than twice those of African Americans and whites (12.9/100,000 and 11.5/100,000, respectively). In conclusion, 1998 CLD deaths and the proportion attributable to viral hepatitis increased by 23% and 19%, respectively, compared with traditional methods. Mortality declines of the early 1990s were not sustained after 1994. Large disparities in CLD mortality remain, particularly among American Indians and Alaska Natives.     

北京安贞防治区脑卒中变化趋势

本文对１９９０－１９９４年安贞防治区脑卒中变化趋势进行了分析研究。结果显示：５万余人口中，２５－７４岁脑卒中事件共计３９０例。其中男性２５４例，女性１３６例。缺血性事件为７４．１％，出血性事件为２３．６％，未分类事件为２．３％。标化发病率男、女两性均呈逐渐下降趋势，男性由３３８／１０万下降至２３４／１０万，女性由１９７／１０万下降至１５２／１０万。男女均有统计学显著差异（ｐ＜０．００１）。死亡率在男性有明显下降趋势，由６９／１０万下降至３９／１０万，女性由５０／１０万下降至３８／１０万，但无统计学差异。急性期病死率（４周以内）男性平均为１８．９％，女性平均为２７．９％。     

1981-2002年天津市食管癌流行趋势

目的 分析1981-2002年天津市食管癌流行趋势变化,帮助预测未来流行趋势,为进一步加强食管癌防治工作提供科学依据.方法 统计1981-2002年天津市内六个区食管癌的发病及死亡资料,计算男女各年龄段发病率、粗发病率、粗死亡率及世界人口标化发病率、标化死亡率等指标,分析天津市22年食管癌的流行趋势.采用年均变化百分比描述发病率和死亡率的升降幅度.结果 1981-2002年天津市累计报告食管癌病例8206例,其中男性5533例,女性2673例,男女比例为2.07∶1.45岁之前食管癌发病率较低(＜1/10万),45岁后逐渐上升,中位发病年龄69岁(四分位数间距为62～75岁).女性发病高峰年龄为75～80岁,较男性(80～85岁)提前,近几年女性发病高峰年龄出现后移,渐与男性接近.1981-2002年,食管癌粗发病率和标化发病率均呈下降趋势.男、女粗发病率和标化发病率年均分别下降2.22%、3.56%和5.18%、6.56%.各年龄组的发病率均呈下降趋势.22年间天津市食管癌死亡率呈下降趋势.结论 天津市食管癌发病率呈下降趋势,但食管癌患者的生存情况未获明显改善.