Active surveillance of maternal mortality in New York City

OBJECTIVES: This study examined the usefulness of computer-assisted active surveillance in identifying maternal deaths in New York City. METHODS: Computerized searches of hospital discharge and autopsy record databases were conducted for maternal deaths occurring in 1997. RESULTS: Active surveillance revealed 14 new maternal deaths not previously reported, an 88% increase. Nine of these deaths were found through the hospital discharge database search, 1 was found through the autopsy record search, and 4 were found in both searches. Overall maternal mortality ratios associated with active surveillance and routine surveillance were 24.3 and 13.0 deaths per 100 000 live births, respectively. CONCLUSIONS: Active surveillance of maternal mortality is useful in identifying new maternal deaths. Existing databases can be used relatively easily to augment routine surveillance of maternal mortality.     

Maternal mortality in New York City: Excess mortality of black women

To assess maternal mortality in New York City, birth certificates and mortality records for New York City from 1988 through 1994 were linked and examined. During these 7 years, maternal mortality in New York City (defined by the International Classification of Diseases, 9th edition [ICD-9], as 630–676) per 100,000 live births signicantly exceeded that of the country as a whole (20.2 vs. 8.2, respectively). Within New York City, an even greater variation of maternal mortality by race/ethnicity was noted, with the mortality ratio of whites, blacks, and Hispanics being 7.1, 39.5, and 14.4 per 100,000 live births, respectively. Socioeconomic characteristics such as educational attainment, marital status, and income influenced maternal mortality more in non-blacks than blacks. Analyses of cause-specific mortality revealed that, overall, ectopic pregnancy, embolism, and hypertension were the leading causes of death. However, the major factors explaining the excess maternal mortality among blacks were hypertension (mortality ratio of blacks to whites 5.57,95% confidence interval 2.30–13.39), ectopic pregnancy (4.78,95% confidence interval 2.40–9.51), and abortion (4.58, 95% confidence interval 1.72–12.22). These findings confirm a persisting gap in maternal death between black and white women. Indeed, if all New Yorkers who became pregnant enjoyed the survival of the city's non-Hispanic white residents, the difference in maternal mortality between the city and the nation would be eliminated.     

Income inequality and infant mortality in New York City

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6–29.6/1,000 live births: range in income inequality: 12.7–27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P<.001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions. Data collection and initial analyses for this project were supported in part by an Investigator Award in Health Policy Research from The Robert Wood Johnson Foundation. The views expressed are those of the authors and do not imply endorsement by The Robert Wood Johnson Foundation.     

Cancer mortality among Puerto Rican-born residents in New York City

More than half the 800,000 Puerto Rican migrants living in the United States resided in New York City in 1970. Mortality statistics from 1969-1971 indicate that Puerto Rican natives in the metropolis have a standardized mortality ratio for cancer which is 77% of that of non-Puerto Rican white males and 81% of that of non-Puerto Rican white females. The age-adjusted death rates of the Puerto Rican-born residing in New York City for cancers of the lung, prostate, bladder, ovary, and rectum are low, ranging from 43-70% of those of non-Puerto Rican whites; rates for breast cancer and colon cancer are somewhat lower relative to those for non-Puerto Rican whites. As is true for Puerto Ricans on the island, migrants to New York City have excessive levels of cancer of the cervix and esophagus (each roughly three times that of non-Puerto Rican whites) and cancer of the stomach (almost twice that of non-Puerto Rican whites).     

Decrease in infant mortality in New York City after 1989.

OBJECTIVES: This study identified factors contributing to the rapid decline in infant mortality in New York City from 1989 to 1992. METHODS: Changes in birthweight distributions and in birthweight/age-, cause-, and birthweight/age/cause-specific mortality rates from 1988/89 (before the mortality reduction) to 1990/91 were identified from New York City vital statistics data. RESULTS: Infant, neonatal, and postneonatal mortality of very-low-birthweight (< 1500 g) and normal-birthweight infants decreased significantly. The declines were almost entirely due to decreases in birthweight-specific mortality rates, rather than increased birthweights. All races experienced most of these reductions. Mortality decreased significantly for 6 causes of death. These decreases were consistent with the birthweight/age groups experiencing mortality declines. CONCLUSIONS: Widespread, multiple perinatal and postnatal factors contributed to the decline in infant mortality.     

Stroke Risk among Chinese Immigrants in New York City

Background: Little is known of risk factors for stroke among Chinese immigrants to the United States. We have conducted a case–control study to identify risk factors for stroke among foreign-born Chinese in New York City. Methods: From September 2000 to June 2003, 187 sequential stroke cases (44 hemorrhagic) and 204 controls matched on age, gender, and years since immigration were recruited from New York Downtown Hospital, which was located next to New York City Chinatown. Risk factor status was assessed by questionnaire interview and medical chart review, which included clinical factors, sociodemographic characteristics, personal and family histories, and behavior and lifestyle factors, as well as behavioral changes after immigration to the United States. Results: For cases and controls, mean ages were 74.8 and 74.7 years, 47.3% of cases and 47.5% of controls were male, and mean years since immigration to the United States were 26.7 and 26.8, respectively. Sociodemographic characteristics and behavioral pattern including cigarette smoking, exercise, and usage of special diet or dietary supplements were similar between cases and controls. However, stroke patients were more likely to have hypertension (76% vs. 59%, p≤0.001), increased blood pressure (165/84 mmHg vs. 140/74 mmHg, p≤0.001) and left ventricular hypertrophy (LVH) (10.1% vs. 4.3%, p≤0.05), and less likely to consume poultry (odds ratio 0.80, 95% confidence interval (CI) 0.59–1.00); fish (0.70, 95% CI 0.42–0.96), fruit and vegetable juice (0.83, 95% CI 0.70–0.95), and grains (0.79, 95% CI 0.62–0.96) than were controls. Conclusion: Among Chinese immigrants in New York City, as in general population, poor controlled hypertension was related to the risk of stroke. Therefore, Chinese immigrants presenting with hypertension and/or a family history of hypertension should be detected and followed up regularly to monitor the blood pressure level. In addition, difference in food intake between stroke and control patients may present an opportunity for behavior intervention to prevent stroke.     

Trends in cancer mortality among Puerto Rican-born migrants to New York City

Age-standardized cancer death rates in Puerto Rican-born males and females residing in New York City have been calculated for 1979-81, and compared with those for white non-Puerto Rican-born people. For all population groups the rates in 1979-81 have been compared with rates in 1969-71. For some cancer sites, in particular cancers of the lung, breast and ovary, the Puerto Rican migrant population exhibited rates well below those of other residents of New York at both time periods. For other sites, most notably colon cancer (and to a lesser extent, prostate and bladder cancer), the rates for Puerto Ricans were somewhat lower than those of other New Yorkers in 1979-81, but had very markedly increased from levels shown in the earlier period. The Puerto Rican-born population at each time period had considerably higher rates of stomach cancer and cervical cancer than did 'other' white New Yorkers. Although substantial reductions in risk for these sites occurred among Puerto Ricans during the intercensal period examined, these corresponded to the reductions among 'other' white New York residents. The trends are discussed with reference to differences in lifestyle patterns, especially diet.     

The urban built environment and overdose mortality in New York City neighborhoods

Accidental drug overdose continues to be a substantial cause of mortality for drug users. Characteristics of the neighborhood built environment may be important determinants of the likelihood of drug overdose mortality independent of individual-level factors. Using data from the New York City Office of the Chief Medical Examiner, we conducted a multilevel case control study using data on accidental overdose deaths as cases and non-overdose accidental deaths as controls. We used archival data from the New York City Housing and Vacancy Survey and the Mayor's Office of Operations to assess characteristics of neighborhood external (e.g. dilapidation of buildings) and internal (e.g. quality of utilities in houses) built environment. Multilevel analyses were used to assess the relations between the neighborhood built environment and the likelihood of overdose death. Six out of the eight characteristics of the external environment studied and three out of the six characteristics of the internal environment studied were significantly associated with the likelihood of fatal drug overdose in multilevel models after adjusting for individual-level (age, race, sex) and neighborhood-level (income, drug use) variables. Deterioration of the built environment, particularly the external environment, is associated with an increased likelihood of fatal accidental drug overdose. Disinvestment in social resources, psychosocial stressors, neighborhood differences in response to a witnessed overdose, and differences in vulnerability to the adverse consequences of drug use in different neighborhoods may explain the observed associations.     

Diet,Physical Activity,and Cardiovascular Disease Risk Factors Among Older Chinese Americans Living in New York City

Cardiovascular disease (CVD) is the leading cause of death in the US and affects Chinese Americans disproportionately compared to other ethnic groups in the American population. However, few studies have examined CVD risk factors, including diet and physical activity, in Chinese Americans. This investigation used a cross-sectional design to evaluate the dietary intake, dietary supplement use, and physical activity of 125 older Chinese Americans aged 50–98 years, and to determine how these behaviors may be related to obesity and other CVD risk factors. Sociodemographic information, CVD risk factors, dietary intake, and physical activity were obtained from all participants recruited from health fairs conducted in New York City (NYC). The findings revealed that older Chinese American adults living in NYC had a high prevalence of overweight and obesity, borderline hypertension, pre-diabetes, and diabetes. Many participants did not meet their daily requirements calcium, potassium, folate, vitamin B6, and vitamin B12, several minerals and vitamins important for cardiovascular health. Although most participants consumed an adequate numbers of servings of foods from the main food groups, most did not meet the recommended number of servings of dairy foods and only one in four adults took a multivitamin supplement daily. After adjusting for potential confounders, daily consumption of oil/sweets and dairy foods was positively associated with waist circumference. Also, daily consumption of oils/sweets, meats, and grains was positively associated with systolic blood pressure. The majority of the participants reported at least 30 min of moderate intensity physical activity per day. Dietary intake or supplement use did not show protective effects but performing vigorous physical activity may reduce risk of CVD in this population.     

Health Behaviors of Older Chinese Adults Living in New York City

The dramatic increase in the number of older immigrants living in the U.S. presents new challenges to policy makers concerned with promoting healthy aging. To date, however, strikingly little is known regarding the health and health trajectories of older immigrants. This paper examines the prevalence and predictors of important health behaviors associated with chronic disease prevention, including current smoking status, physical activity, alcohol use, and body mass index (BMI). We analyzed data from the 2003 New York City Chinese Health Survey (NYC CHS), the largest probability-based sample of Chinese immigrants residing in two distinct communities. In-person interviews were conducted with 517 representative men and women aged 55-75. Logistic regression modeling was used to test the influence of demographic, socioeconomic status, acculturation, and health characteristics on selected health behaviors. Results revealed that having more education and better physical health status were associated with greater participation in physical activity. Gender-specific analyses indicated that the effect of selected predictors varied between the sexes. For example, among older Chinese women, acculturation was negatively associated with alcohol use. This study provides some of the first evidence on health behaviors of one of the fastest growing older immigrant groups in the U.S. Study results add to the emerging literature on the complex nature of immigrant health trajectories, and demonstrate that contrary to prior research, living a greater proportion of time in the U.S. can be associated with selected positive health behaviors. Further longitudinal studies are needed to help inform policy initiatives to encourage healthy aging among diverse older immigrant groups.     

The effect of surfactant on birthweight-specific neonatal mortality rate, New York City

PURPOSE: Surfactant has been shown to cause decreased neonatal mortality rate (NMR) in randomized studies of preterm infants. It is not clear whether the introduction of surfactant caused a decrease in neonatal mortality in a community. This study explores the hypothesis that the introduction of surfactant in 1990 to 1991 explains a decrease in neonatal mortality in New York City (NYC) among infants with birthweight of 500 to 1499 g. METHODS: For each of the 20 hospitals in New York City that began using surfactant in 1990 or 1991, we compared the NMR in the 2 years before the introduction of surfactant with the NMR in the 2 years after its introduction. Poisson regression models were fit to the death rates, adjusting for birthweight and other determinants of neonatal mortality. RESULTS: NMR in the 20 hospitals decreased by 13.7% (from 231.3 to 199.6 neonatal deaths per 1000 live births). This decrease remained significant after adjusting for birthweight and other risk factors. Infants with birthweight 1000 to 1249 grams benefited most from the introduction of surfactant; their NMR decreased by 19.6%. After adjusting for birthweight, those born before the introduction of surfactant were 1.18 times as likely to die in the first 27 days as those born after the introduction of surfactant (95% CI 1.04, 1.33). CONCLUSION: It appears that surfactant had a significant impact on NMR in NYC among very low birthweight babies.     

Fine particulate matter constituents associated with cardiovascular hospitalizations and mortality in New York City

Background

Recent time-series studies have indicated that both cardiovascular disease (CVD)mortality and hospitalizations are associated with particulate matter (PM). However, seasonal patterns of PM associations with these outcomes are not consistent, and PM components responsible for these associations have not been determined. We investigated this issue in New York City (NYC), where PM originates from regional and local combustion sources.

Objective

In this study, we examined the role of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM_2.5) and its key chemical components on both CVD hospitalizations and on mortality in NYC.

Methods

We analyzed daily deaths and emergency hospitalizations for CVDs among persons ≥ 40 years of age for associations with PM_2.5, its chemical components, nitrogen dioxide (NO₂), carbon monoxide, and sulfur dioxide for the years 2000–2006 using a Poisson time-series model adjusting for temporal and seasonal trends, temperature effects, and day of the week. We estimated excess risks per interquartile-range increases at lags 0 through 3 days for warm (April through September) and cold (October through March) seasons.

Results

The CVD mortality series exhibit strong seasonal trends, whereas the CVD hospitalization series show a strong day-of-week pattern. These outcome series were not correlated with each other but were individually associated with a number of PM_2.5 chemical components from regional and local sources, each with different seasonal patterns and lags. Coal-combustion–related components (e.g., selenium) were associated with CVD mortality in summer and CVD hospitalizations in winter, whereas elemental carbon and NO₂ showed associations with these outcomes in both seasons.

Conclusion

Local combustion sources, including traffic and residual oil burning, may play a year-round role in the associations between air pollution and CVD outcomes, but transported aerosols may explain the seasonal variation in associations shown by PM_2.5 mass.