Socioeconomic effects on child mortality in the United States.

Despite considerable reason for scholarly and policy interest in socioeconomic mortality differentials, socioeconomic effects on child and teenage mortality in the United States have been a neglected research topic because of several data limitations. Exploiting data obtained for other purposes, this paper reports socioeconomic effects on the mortality of children and teenagers. Socioeconomic mortality differentials among children are large--at least as large as those among adults. The major source of socioeconomic mortality differences among children is apparently differential risk to accidental death. Within the child population, the strength of socioeconomic effects varies directly with the relative importance of accidents as a component of overall mortality.     

Exploring spatial patterns of mortality: the new atlas of United States mortality

The National Center for Health Statistics, CDC, has produced an Atlas of United States Mortality which includes maps of rates for the leading causes of death in the United States for the period 1988-1992. As part of this project, many aspects of statistical mapping have been re-examined to maximize the atlas's effectiveness in conveying accurate mortality patterns to epidemiologists and public health practitioners. Because recent cognitive research demonstrated that no one map style is optimal for answering many different map questions, maps and graphs of several different mortality statistics are included for each cause of death. New mixed effects models were developed to provide predicted rates and improved variance estimates. Results from these models were smoothed using a weighted head-banging algorithm to produce maps of general spatial trends free of background noise. Maps of White female lung cancer rates from the new atlas are presented here to illustrate how this innovative combination of maps and graphs permits greater exploration of the underlying mortality data than is possible from previous single-map atlas designs. Published in 1999 by John Wiley & Sons, Ltd. This article is a U.S. Government work and is in the public domain in the United States.     

Income inequality and mortality in metropolitan areas of the United States.

OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.     

Testicular cancer in the United States: trends in incidence and mortality

The patterns of incidence and mortality of testicular cancer in the United States indicate substantial differences by age, race, time period, and geographical region. An epidemic increase over time in the risk of testicular cancer is noted for young men aged 15-44, with the most recent birth cohorts showing the greatest rate of increase. Indeed, some of the evidence suggests the possibility of two separate increases, one apparent from at least the late 1930's through the late 1950's and the second appearing in the late 1970's. The incidence data for blacks also show a young adult peak, even though the rates for whites are four to five times higher than for blacks at all ages except early childhood. Mortality rates for older men consistently declined over the 30-year period, while rates for younger men showed a dramatic drop only for the most recent time period. Aetiological factors yet to be determined may be responsible for the increasing incidence of testicular cancer in young adults. Survival factors appear to explain the age-specific differences between the incidence and mortality curves over time.     

Trends in the geographic inequality of cardiovascular disease mortality in the United States, 1962-1982

Substantial geographic variation of cardiovascular disease (CVD) mortality within the U.S. has been recognized for decades. Analyses reported here address the question of whether relative geographic inequality has increased or decreased during the period of rapidly declining CVD mortality 1962-1982. Trends in geographic inequality, as measured by the weighted coefficient of variation of State Economic Area rates, are analyzed for whites and blacks by sex for 10-year age groups 35-44 to 85 and over. The average annual percent change in the coefficient of variation for each demographic group is presented for all cause mortality, all CVD, stroke and ischemic heart disease. In general, geographic inequalities declined in total mortality for all except the youngest age group. This is consistent with reports of a strong convergence of age-adjusted cancer mortality in U.S. counties. By contrast, increasing geographic inequality dominates in the CVD categories, especially for whites in heart disease and stroke. At younger ages, increases in the coefficient of variation for all race-sex groups exceeded 1% per year in stroke and 2% per year in heart disease. These results suggest that factors influencing the percent decline of CVD mortality are not reaching communities of the U.S. equally. Since increases in relative inequality are strongest in the younger age groups, the pattern of inequality may be accentuated as these cohorts move into ages of higher mortality.     

Socioeconomic factors and mass shootings in the United States

This study explores whether population-level measures of income inequality and poverty rates are associated with mass shootings in the United States. We test these potential connections by examining the incidence rate of mass shootings using random effects negative binomial regressions for a panel data-set that included 3144 counties for the years 1990–2015. According to the adjusted models, income inequality is significantly associated with the three or more victim-related injuries (incidence rate ratio [IRR]?=?1.39; 95% confidence interval [CI]?=?1.11, 1.67; P < .001) and four or more victim-related deaths definition of mass shootings (IRR = 1.36; 95% CI = 1.08, 1.64; P < .01). However, poverty rates lack a reliable association with the three or more injuries (IRR = 1.07; 95% CI = .75, 1.39) and four or more deaths definition (IRR = .95; 95% CI = .71, 1.19). When considered in conjunction with the literature on inequality and crime, these results indicate that counties with high inequality may foster an environment of anger and resentment that ultimately leads to mass shootings.     

Automation of mortality data coding and processing in the United States of America

The development in the United States of America of an automated system for coding mortality data (Automated Classification of Medical Entities--ACME) was undertaken with two major objectives in mind: (i) to introduce consistent and rapid assignment of underlying cause-of-death coding with reduced needs for manpower training; and (ii) to allow better utilization of medical information on death certificates for multiple cause-of-death analyses. The ACME system meets both of these objectives; the National Center for Health Statistics (NCHS) produces all of its underlying cause-of-death statistics for the United States on the basis of this system, and multiple cause-of-death data are routinely available for additional epidemiological study beyond the traditional methods of vital statistics analyses. Enhancements of the automated system, primarily through the software known as MICAR, reduce even further the levels of training necessary for persons doing the basic data entry. MICAR additionally will ease transitions between ICD revisions by reducing the need for coder reorientation and by permitting rapid calculation of comparability ratios when new revisions are introduced.     

Abortion-related mortality in Brazil: decrease in spatial inequality]

Abortion is not only a major cause of obstetric hospitalization in poor countries, but it also represents the failure of the public health system to provide enough information about contraceptive methods and thus prevent pregnancies. In Brazil, the high utilization rates of health facilities due to abortions reflect the ongoing difficulties with family planning and contraception. In addition, mortality resulting from abortions serves as an indicator of the quality of abortion procedures, an important point in a country where the practice is illegal and therefore done clandestinely. In this study, we analyzed the rates of mortality resulting from abortions among women 10 to 54 years old, including women who died from spontaneous and induced abortion, from 1980 to 1995, for the various regions of the country. The information we used came from the mortality data bank of the public health system of the Ministry of Health. Population data were obtained from the Brazilian Institute for Geography and Statistics. We studied 2,602 deaths, 15% of which were due to missed abortion, spontaneous abortion, or legally permitted induced abortion. The other 85% of the deaths were due to illegal induced abortions or to nonspecified abortions. The mortality rates from abortion-related causes have steadily decreased in all the regions of Brazil, but this improvement has been unevenly distributed in the country. The region with the smallest decrease in this rate (38% over 15 years) was the Northeast. The age of women dying from abortions progressively declined over the period studied.     

Socioeconomic inequality in infant mortality in Iran and across its provinces

OBJECTIVE: To measure the socioeconomic inequality in infant mortality in Iran (the Islamic Republic of Iran). METHODS: We analysed data from the provincially representative Demographic and Health Survey, which was done in Iran in 2000. We used a dichotomous hierarchical ordered probit model to develop an indicator of socioeconomic status of households. We assessed the inequality in infant mortality by using the odds ratio of infant mortality between the lowest and highest socioeconomic quintiles at both the provincial and national levels, and the concentration index, an inequality measure based on the entire socioeconomic distribution. RESULTS: We found a decreasing trend in the infant mortality rate in relation to socioeconomic quintiles. The poorest to richest odds ratio was 2.34 (95% CI = 1.78-3.09). The concentration index of infant mortality in Iran was -0.1789 (95% CI = -0.2193--0.1386). Furthermore, the inequality of infant mortality between the lowest and highest quintiles was significant and favoured the better-off in most of the provinces. However, this inequality varied between provinces. CONCLUSION: Socioeconomic inequality in infant mortality favours the better-off in the country as a whole and in most of its provinces, but the degree of this inequality varies between the provinces. As well as its national average, it is important to consider the provincial distribution of this indicator of population health.     

The contribution of ionizing radiation to cancer mortality in the United States

Although ionizing radiation has been well known as a carcinogen for more than 70 years, only a small part of the total cancer mortality burden in the United States can be attributed to radiation effects—less than 3%. Little can be done about much of the exposure to radiation that exists—about half of the total results from natural background radiation. More than 40% derives from medical and dental practice—mostly as diagnostic X-rays. Something less than 5% comes from nuclear weapons fallout from atmospheric tests and well under 1% from the use of nuclear energy for generating electric power. Substantial reduction of the total radiation burden on the population can be achieved only by reduction of X-rays used in medicine and dentistry. This will, however, involve careful consideration of the balance between radiation benefits and risks, as well as requiring that such X-ray exposures be reduced to the minimum required to achieve the necessary medical purpose.     

Changing heat-related mortality in the United States

Heat is the primary weather-related cause of death in the United States. Increasing heat and humidity, at least partially related to anthropogenic climate change, suggest that a long-term increase in heat-related mortality could occur. We calculated the annual excess mortality on days when apparent temperatures--an index that combines air temperature and humidity--exceeded a threshold value for 28 major metropolitan areas in the United States from 1964 through 1998. Heat-related mortality rates declined significantly over time in 19 of the 28 cities. For the 28-city average, there were 41.0 +/- 4.8 (mean +/- SE) excess heat-related deaths per year (per standard million) in the 1960s and 1970s, 17.3 +/- 2.7 in the 1980s, and 10.5 +/- 2.0 in the 1990s. In the 1960s and 1970s, almost all study cities exhibited mortality significantly above normal on days with high apparent temperatures. During the 1980s, many cities, particularly those in the typically hot and humid southern United States, experienced no excess mortality. In the 1990s, this effect spread northward across interior cities. This systematic desensitization of the metropolitan populace to high heat and humidity over time can be attributed to a suite of technologic, infrastructural, and biophysical adaptations, including increased availability of air conditioning.     

Malignant mesothelioma surveillance: a comparison of ICD 10 mortality data with SEER incidence data in nine areas of the United States

With the implementation in 1999 of ICD-10 death certificate coding in the United States, mortality data specific to malignant mesothelioma became readily available on a national basis. To evaluate the accuracy and completeness of diagnosis and coding for mesothelioma on the death certificate, mortality information was compared with incidence data. A mortality/incidence ratio was calculated for each of the nine areas covered by the SEER Program, using National Vital Statistics mortality data from 1999 and 2000, and the SEER incidence data for 1998 and 1999. The mortality/incidence ratio for the two years combined for all areas was 0.82. Only two areas (Connecticut and Atlanta) had ratios <80%. The overall correlation coefficient between mortality and incidence rates was 0.96. Thus, mortality data coded using ICD-10 can be a valid source for mesothelioma surveillance and can be instituted without major cost if a national mortality statistics program based on ICD-10 is in place, making it feasible even for developing countries.     

Age dependence of cohort phenomena in breast cancer mortality in the United States

Breast cancer mortality has increased in most parts of the world, and many explanations have been postulated. In this paper, the authors examined the evolution of mortality rates for white and nonwhite females in the United States from 1950-1979. Using both graphic techniques and Poisson regression models, they found that there has been strong modification of apparent cohort effects by age. For both white and nonwhite females, they observed an increase in mortality rates limited to the postmenopausal ages.