1996-2010年全国孕产妇死亡率变化趋势

目的 了解1996-2010年全国孕产妇死亡率和主要死亡原因的变化趋势及地区的差异变化。方法 采用以人群为基础的全国孕产妇死亡监测网的数据,1996-2005年覆盖了内地31个省、自治区、直辖市的176个监测区（县）,2006年后扩大至336个区（县）,统计1996-2010年全国不同时间、不同地区孕产妇死亡率、死因别死亡率、下降幅度和年平均下降速率。应用Cochran-Armitage趋势检验及Poisson检验,对1996-2010年的孕产妇死亡率、死因构成及地区间差异的变化趋势进行分析。结果 全国孕产妇死亡率从1996年的64.7/10万下降到2010年的30.0/10万,下降53.2％;2010年农村孕产妇死亡率（30.1/10万）高于城市（29.7/10万）,西部（46.1/10万）高于中部（29.1/10万）及东部地区（17.8/10万）。东、中、西部地区孕产妇死亡率下降幅度分别为37.76％、57.02％和66.27％。地区间差异在逐渐减少,2006-2010年间,农村孕产妇死亡率下降为城市的1.82倍,西部地区为东部地区的3.0倍。产科出血死亡的构成比从1996年的47.9％下降到2010年的27.8％,但仍是导致全国孕产妇死亡的首要因素。结论 全国孕产妇死亡率呈下降趋势,地区间孕产妇死亡率仍存在差异,但差异逐年减小,农村和西部地区仍是孕产妇死亡干预的重点;产科出血仍是各地区的主要死亡原因。     

Trends in the sex ratio of California births, 1960-1996

STUDY OBJECTIVE: The male sex ratio at birth (or the proportion of male births in a population) has been suggested as a sentinel environmental health indicator. Usually around 51%, the proportion may be dramatically decreased in offspring of persons with chemical exposures. Recent publications from the USA and elsewhere have noted a small but apparently declining male birth proportion, suggesting the effect of some environmental exposures. This paper sought to examine these trends more closely in California's large and diverse population. DESIGN: Using computerised birth certificate data, time trends were examined by multivariate linear and spline regression, controlling for demographic factors. SETTING: California. PARTICIPANTS: About 15 million births from 1960 to 1996. MAIN RESULTS: In the raw data, the male birth proportion is indeed declining. However, during this period, there were also shifts in demographics that influence the sex ratio. Controlling for birth order, parents' age, and race/ethnicity, different trends emerged. White births (which account for over 80%) continued to show a statistically significant decline, while other racial groups showed non-statistically significant declines (Japanese, Native American, other), little or no change (black), or an increase (Chinese). Finally, when the white births were divided into Hispanic and non-Hispanic (possible since 1982), it was found that both white subgroups suggest an increase in male births. CONCLUSION: This analysis shows that the decline in male births in California is largely attributable to changes in demographics.     

Trends in childhood renal cancer mortality in Brazil, 1980-2000

Mortality from childhood cancers has shown substantial declines in developed countries since 1960, with smaller favourable trends in South America. This study describes mortality trends in renal childhood cancer mortality in São Paulo state, Brazil, from 1980 to 2000. The age‐standardised mortality rates among the boys decreased from 0.36 per 100 000 inhabitants in 1984 to 0.09 in 1992, whereas the observed corresponding decline among girls was from 0.43 per 100 000 inhabitants in 1981 to 0.07 in 1990. Statistically significant declining trends in mortality rates were observed for boys (adjusted r² = 0.51, P < 0.001) and also for girls (adjusted r² = 0.40, P = 0.002), achieving in this group a significant reduction in age‐standardised mortality rates in the period (annual percentage change = ?4.21). Consistent decrease in mortality rates from childhood renal cancer was noted at São Paulo state. In the absence of changes in incidence rates, this decline could be attributed to the improvement in treatment protocols and supportive measures.     

Air pollution and daily mortality in Erfurt, east Germany, 1980-1989.

In Erfurt, Germany, unfavorable geography and emissions from coal burning lead to very high ambient pollution (up to about 4000 micrograms/m3 SO2 in 1980-89). To assess possible health effects of these exposures, total daily mortality was obtained for this same period. A multivariate model was fitted, including corrections for long-term fluctuations, influenza epidemics, and meterology, before analyzing the effect of pollution. The best fit for pollution was obtained for log (SO2 daily mean) with a lag of 2 days. Daily mortality increased by 10% for an increase in SO2 from 23 to 929 micrograms/m3 (5% quantile to 95% quantile). A harvesting effect (fewer people die on a given day if more deaths occurred in the last 15 days) may modify this by +/- 2%. The effect for particulates (SP, 1988-89 only) was stronger than the effect of SO2. Log SP (daily mean) increasing from 15 micrograms/m3 to 331 micrograms/m3 (5% quantile to 95% quantile) was associated with a 22% increase in mortality. Depending on harvesting, the observable effect may lie between 14% and 27%. There is no indication of a threshold or synergism. The effects of air pollution are smaller than the effects of influenza epidemics and are of the same size as meterologic effects. The results for the lower end of the dose range are in agreement with linear models fitted in studies of moderate air pollution and episode studies.     

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.     

北京市孕产妇与流动人口孕产妇1995-2004年死亡分析

目的 分析北京市孕产妇与流动人口孕产妇死亡资料，为制定干预措施提供依据。方法 采用回顾性调查方法。对北京市1995—2004年孕产妇死亡病例及评审资料进行分析。结果该期间北京市户籍孕产妇死亡率为17．9／10万，流动人口死亡率为51．3／10万。北京市孕产妇死因依次为栓塞（21．2％）、妊高征（18．3％）、产科出血（14．4％）和心脏病／异位妊娠（9．6％）。流动人口孕产妇死因依次为产科出血（25．2％）、栓塞（19．7％）、妊高征（17．3％）和肝病（9．5％）。孕产妇可避免死亡占18．9％，创造条件可避免死亡占37．7％，不可避免死亡占43．4％。结论 北京市户籍孕产妇死亡率已接近发达国家水平，流动人口孕产妇保健管理亟待加强。取缔非法接生、加强医务人员的培训及人才培养、提高医疗机构处理妊娠合并症及异位妊娠的急救抢救能力，是今后干预的重点。     

Breast cancer mortality in women of Southern Brazil, 1980-1999

OBJECTIVE: To analyze time and geographical trends of breast cancer mortality. METHODS: Annual mortality rates per 100,000 female inhabitants aged 20 to 59 years for the Baixada Santista metropolitan area, the city and state of S?o Paulo and Brazil, from 1980 to 1999, were standardized by age groups and analyzed. The analyses included regression models to estimate and compare time trends of each area.? RESULTS: Increasing mortality rate trends were observed for all areas. However, intrametropolitan variations have higher baselines and time trends than the other areas. Santos had standardized mortality rates between 25 and 35 per 100,000 women, which were the highest in the study. Differences between Santos rates and the rates of other cities included in the study were statistically significant (p<0.001). The cities of S?o Vicente, Cubat?o and Peruíbe of the Baixada Santista metropolitan area also showed increased mortality rates trends and higher rates than those for the state of S?o Paulo and Brazil. CONCLUSIONS: A similar increasing trend in mortality rates was observed in all cities of the study area and higher rates were seen in Santos. There is a need for further studies in order to identify the determinant conditions for this trend.     

Risk factors for maternal mortality in five Kampala hospitals, 1980-1986

A case-control study assessing risk factors for maternal mortality was carried out in five Kampala hospitals covering a period of seven years (1 January 1980 to 31 December 1986). The major predictors of maternal mortality were the general condition on admission, the mode of delivery and the Apgar score of the newborn. These predictors indicate that women at high risk were those admitted to hospital for delivery in a poor state of health. We believe that the risk of maternal mortality can be reduced through appropriate action by health workers and that there is a need for a more complete view of risk factors for both maternal and perinatal mortality to be obtained through population-based studies rather than only those women who deliver in hospital.     

Lung cancer mortality among women employed in high-risk industries and occupations in Harris County, Texas, 1977-1980

Lung cancer is rapidly becoming the leading cause of cancer mortality among women. Interviews conducted with 259 women with lung cancer and 278 women without lung cancer or with their next-of-kin in Harris County, Texas from July 1, 1977 to June 30, 1980 revealed that 12 (4.6%) of the women with lung cancer had never smoked cigarettes. The odds ratio (OR) for current smoking was 15.7. Odds ratios for smoking for living women (OR = 17.5) were higher than for those who were deceased (OR = 12.6). Lifetime occupational histories were classified a priori into high- and low-risk categories. Data were stratified according to employment in a high-risk industry or occupation, a high-risk industry, a high-risk occupation, or both a high-risk industry and occupation. Although not statistically significant, odds ratios for employment in high-risk categories support earlier estimates that attributed 5% of lung cancer mortality in women to employment in hazardous occupations. Employment of a husband or household member in selected industries and occupations yielded significantly increased odds ratios. More cases (15.9%) than controls (6.9%) reported a family history of lung cancer (OR = 2.4). No significant increase in smoking-adjusted odds ratios was found for the use of hair spray, hand-held dryers, or alcohol, or for having lived with a household member who smoked cigarettes.     

Trends in mortality rates from non-Hodgkin lymphoma in Southeast Brazil, 1980-2007

Mortality rates from non-Hodgkin lymphoma (NHL) have declined in many countries in recent decades. However, mortality estimates for Brazil indicate an increase in these rates. This study aimed to analyze NHL mortality trends for 1980-2007 in individuals 20 years and older in State capitals in Southeast Brazil. Population data were obtained from the Mortality Information System and the Health Statistics Division of the Unified National Health System (DATASUS). Age-related mortality trends were analyzed using polynomial regression models. In the 60 and older age group, a statistically significant upward linear trend was observed for Belo Horizonte and S?o Paulo in 1980-2007. When analyzed in two different periods, 1980-1995 and 1996-2007, statistically significant increases in NHL mortality rates were only observed in the former period. These results suggest that the increase in 1980-2007 may have resulted from the rising mortality rates from 1980 to 1995, since no statistically significant trends were observed in the latter period.     

Birth weight and hospital mortality among liveborn infants, 1975-1996

OBJECTIVE: To assess the trend of birth weight and hospital mortality rate of newborns, in a maternity hospital of Campinas, SP. METHODS: A total of 215,435 births of a maternity hospital in Campinas, S. Paulo State, Brazil, was studied between 1976 and 1996. Information was collected from registration files and annual reports of medical care. All the newborns from that period were included. The causes of death that occurred before the discharge, regardless the age, were analyzed. For data analysis, Epi info 6.01 method was used. RESULTS: Birth weight distribution remained the same for the 22 years period studied. Low birth weight was seen in about 9% of newborns, and accounted for 82% of hospital deaths in 1996. Below average weight was observed in about 24% of the newborns. We could notice an improvement in survival for those who had a birth weight between 1,000 g and 1,999 g. In 1975, 13.3% of those with weights between 1,000 g and 1,499 g survived and 73.8% of those who weighed between 1,500 g and 1,999 g. In 1996, survival rates increased to 69. 1% and 87.7% respectively. Hospital mortality rate among infants whose weight was below 1,000 g remained high, between 78.9% and 100%, even in the 90's. There was a reduction of hospital mortality rates from 17 to 11 per thousand live births. CONCLUSIONS: There was not any change in the distribution of birth weight despite improvements in life conditions of Campinas population. The decrease in mortality rates is due to improvement in health care which is very expensive. There is a need of other studies to allow why birth weight distribution remained the same.     

Lifestyle and reduced mortality among active California Mormons, 1980-2004

OBJECTIVE: The objective is to measure the relationship of several healthy characteristics of the Mormon lifestyle to mortality. METHOD: We examined 9815 religiously active California Mormon adults followed for mortality during 1980-2004 and 15,832 representative U.S. white adults enrolled in the 1987 National Health Interview Survey (NHIS) and followed for mortality during 1988-1997. The standardized mortality ratio (SMR) and 95% confidence interval (CI) was calculated relative to U.S. whites defined to have a SMR of 1.00. RESULTS: Active California Mormons practice a healthy lifestyle advocated by their religion, which emphasizes a strong family life, education and abstention from tobacco and alcohol. Unusually low SMRs occurred among married never smokers who attended church weekly and had at least 12 years of education. For those aged 25-99 years at entry, the SMR for all causes of death was 0.45 (0.42-0.48) for males and 0.55 (0.51-0.59) for females. For those aged 25-64 years at entry, the SMR for all causes of death was 0.36 (0.32-0.41) for males and 0.46 (0.40-0.53) for females. Life expectancy from age 25 was 84 years for males and 86 years for females. These SMRs were largely replicated among similarly defined persons of all religions within the NHIS cohort. CONCLUSIONS: Several healthy characteristics of the Mormon lifestyle are associated with substantially reduced death rates and increased life expectancy.     

Regression analysis of time trends in perinatal mortality in Germany 1980-1993

Numerous investigations have been carried out on the possible impact of the Chernobyl accident on the prevalence of anomalies at birth and on perinatal mortality. In many cases the studies were aimed at the detection of differences of pregnancy outcome measurements between regions or time periods. Most authors conclude that there is no evidence of a detrimental physical effect on congenital anomalies or other outcomes of pregnancy following the accident. In this paper, we report on statistical analyses of time trends of perinatal mortality in Germany. Our main intention is to investigate whether perinatal mortality, as reflected in official records, was increased in 1987 as a possible effect of the Chernobyl accident. We show that, in Germany as a whole, there was a significantly elevated perinatal mortality proportion in 1987 as compared to the trend function. The increase is 4.8% (p = 0.0046) of the expected perinatal death proportion for 1987. Even more pronounced levels of 8.2% (p = 0. 0458) and 8.5% (p = 0.0702) may be found in the higher contaminated areas of the former German Democratic Republic (GDR), including West Berlin, and of Bavaria, respectively. To investigate the impact of statistical models on results, we applied three standard regression techniques. The observed significant increase in 1987 is independent of the statistical model used. Stillbirth proportions show essentially the same behavior as perinatal death proportions, but the results for all of Germany are nonsignificant due to the smaller numbers involved. Analysis of the association of stillbirth proportions with the (137)Cs deposition on a district level in Bavaria discloses a significant relationship. Our results are in contrast to those of many analyses of the health consequences of the Chernobyl accident and contradict the present radiobiologic knowledge. As we are dealing with highly aggregated data, other causes or artifacts may explain the observed effects. Hence, the findings should be interpreted with caution, and further independent evidence should be sought.     

Rubella susceptibility among pregnant women in North London, 1996-1999

BACKGROUND: Rubella infection and congenital rubella are currently rare in the United Kingdom, although sporadic cases occur, often associated with travel abroad. Uptake of the combined measles, mumps and rubella (MMR) vaccine has declined in recent years, and there is a danger that rubella infection could start to circulate again, with serious implications for susceptible pregnant women. This could be a particular problem in communities where there are relatively high rubella susceptibility rates because of either poor vaccine uptake over several years or the presence of significant numbers of recent immigrants from countries without routine rubella vaccination programmes. METHODS: Routinely collected data on rubella susceptibility in pregnant women in the former North West Thames region were available for 1996-1999. Associations between year of delivery, maternal age, parity and ethnic group, and rubella susceptibility were explored. RESULTS: Overall rubella susceptibility declined significantly from 2.6 per cent to 2.4 per cent between 1996 and 1999. Whereas less than 2 per cent of British-born women were susceptible, overall susceptibility for other women was about 5 per cent. African and Asian women had particularly high susceptibility rates, and patterns of susceptibility by age and parity varied across ethnic groups. CONCLUSIONS: If rubella were to re-establish itself in the United Kingdom, women who had come to Britain in later childhood or adult life would be at higher risk of acquiring infection in pregnancy than indigenous women. Appropriate local and national strategies should be devised to ensure that all such women are offered rubella vaccination at the earliest opportunity.     

White infant mortality in Appalachian states, 1976-1980 and 1996-2000: changing patterns and persistent disparities

Purpose: Appalachian counties have historically had elevated infant mortality rates. Changes in infant mortality disparities over time in Appalachia are not well‐understood. This study explores spatial inequalities in white infant mortality rates over time in the 13 Appalachian states, comparing counties in Appalachia with non‐Appalachian counties. Methods: Data are analyzed for 1,100 counties in 13 Appalachian states that include 420 counties designated as Appalachian by the Appalachian Regional Commission. Area Resource File data for 1976‐1980 and 1996‐2000 provide county‐ and city‐level infant mortality rates, poverty rates, rural‐urban continuum codes, and numbers of physicians per 1,000 residents. Multiple regression analyses evaluate whether Appalachian counties are significantly associated with elevated white infant mortality in each time period, accounting for covariates. Findings: White infant mortality rates decreased substantially in all sub‐regions over the last 2 decades; however, disparities in infant mortality did not diminish in Appalachian counties compared to non‐Appalachian counties. After accounting for poverty, rural/urban status, and health care resources, Appalachian counties were significantly associated with comparatively higher infant mortality during the late 1970s but not in the late 1990s. At the more recent time point, higher poverty rates, residence in more rural areas, and lower physician density were associated with greater infant mortality risk. Conclusion: Appalachian counties continue to experience relatively elevated infant mortality rates. Poverty and rurality remain important dimensions of health service need in Appalachia.