Trends in "avoidable" mortality in Sweden, 1974-1985.

STUDY OBJECTIVE--The aim was to analyse trends in "avoidable" mortality in Sweden, and to contribute to the methodology of avoidable mortality as an index of the quality of care. SETTING AND PARTICIPANTS--All deaths of Swedish citizens and other residents in Sweden during the period 1974-1985 were analysed as to causes of death between ages 0 and 64 years. MEASUREMENTS AND MAIN RESULTS--Total mortality delined during the 12 year period studied. Avoidable causes of death were grouped into preventable and treatable causes according to Rutstein's classification. In men, treatable diseases declined more during the 12 year period studied than did total mortality. When lung cancer was excluded, preventable diseases declined for both sexes. Certain avoidable causes of death decreased compared to total mortality, while some others showed an increase. The death rate increased for some avoidable causes of death such as pneumonia other than viral. In women death rates increased for chronic bronchitis and emphysema as well as for malignant neoplasms of trachea, bronchus, and lung, while for boys aged 1-14 years bronchitis NOS and asthma showed an increasing death rate. CONCLUSIONS--The study indicates that the avoidable mortality method is sensitive enough to describe important changes in the mortality pattern. The explicit definition of treatable and preventable causes of death constitutes a methodological development in epidemiological analysis of this type. Further studies on the quality of care should combine this method with other methods examining the structure and process of health care.     

Improved survival after acute myocardial infarction in Finland, 1974-1985.

The survival of people suffering an acute myocardial infarction (AMI) aged 45-74 years in Finland was examined using information on hospital discharges and deaths during the period 1974-1985. There were 128,922 cases of initial AMI events, including 37,041 deaths that occurred outside hospital. The 3-day, 1-month and 1-year survival rates in 1981-1985 were 67%, 60% and 54% for males, and 73%, 65% and 58% for females. The overall risk of dying declined by 22% between 1974-1975 and 1984-1985, but this varied by age and follow-up time. The greatest decline (28%) was attained in 3-day mortality at ages 45-54 years while very little improvement occurred between the third day and the first month following the attack, possibly due to selection during the first few days. It is concluded that survival after AMI in Finland has improved substantially, and this should have affected mortality in the general population to a significant extent.     

Social differences in late fetal death and infant mortality in Sweden 1985–86

Summary. Social differences in late fetal death and infant mortality were examined in a population-based prospective study. All singletons born to Nordic citizens in Sweden 1985–86 were included, 185 156 births in all. The overall rates of late fetal death and infant mortality were 3.5 and 5.3 per 1000 respectively. Socio-economic status of the household (SES) and mothers' education were used as social indicators. Logistic regression analyses showed significant odds ratios between 1.3 and 1.8 for late fetal death for blue-collar workers and women with less than 12 years education. The analyses of neonatal mortality showed a U-shaped relationship: both unskilled blue-collar workers and high level white-collar workers had significant odds ratios (OR) as compared with intermediate level white-collar workers (OR=1.5). Similar results were obtained when using the mothers' education as indicator of social status: 9 years education or less or 15 years or more were associated with significant higher mortality rates than 12 years education (OR=1.6). An inverse relationship between social status and post-neonatal mortality was seen in the crude analysis. Mothers' education revealed more social differences than SES (crude OR=2.0 and 1.5 respectively in the least privileged group). However, when adjusting for the effects of maternal age, parity and smoking, no significant odds ratios for the social variables were obtained.     

北京市1965-1974年居民死因分析

目的 填补1965-1974年北京市居民死亡资料的历史空白,为其他地区死亡数据的补充提供参考。方法 通过专家咨询了解北京市居民死亡资料保存情况,采用分层抽样方法采集北京市城区该期间死亡居民户个案信息。应用死亡率、死亡构成、死因顺位等指标进行描述性分析。结果 收集1965-1974年北京市城区10个派出所保存的死亡居民户个案信息11 668条。该时期北京市城区居民前十位死亡原因依次为心脏病、肿瘤、脑血管病、意外伤害、呼吸系统疾病、消化系统疾病、传染病和寄生虫病、神经系统疾病、泌尿生殖系统疾病、内分泌、营养代谢类疾病,占全死因的84.19%。意外伤害占总死亡的13.22%,高于1964年与1975年水平,差异有统计学意义（P<0.01）,自杀占全部意外伤害死亡的54.47%,位居意外伤害死亡的首位。男性前三位死因分别为意外伤害、肿瘤和心脏病,女性为心脏病、肿瘤和脑血管病。结论 1965-1974年北京市城区居民死亡的主要疾病从传染病向慢性非传染性疾病过渡。受历史原因影响,意外伤害成为该时期影响人群健康的主要原因之一。     

Certification and coding of two underlying causes of death in The Netherlands and other countries of the European Community.

Differences in certification and coding of causes of death between countries of the European Community were studied by sending sets of case histories to samples of certifying physicians. Completed certificates were coded by national coding offices and by by a WHO reference centre. Detection fractions ranged from 60% to 92% in a first study (concerning cases of chronic obstructive pulmonary disease) and from 80% to 94% in a second study (concerning cases of cancer). A detailed analysis of the findings for the Netherlands, which performed very well in both studies, reveals a substantial frequency of errors in certification (as opposed to errors in diagnosis). Comparison of national and reference centre coding suggests that the Dutch coding process is to a certain extent adapted to the frequency of these certification errors, leading to deviations from WHO coding rules. It is concluded that certification and coding practices should be studied together and that further international standardisation of coding practices will not necessarily improve the validity of national cause of death statistics.     

Violent death in a metropolitan county: II. Changing patterns in suicides (1959-1974).

Suicide rates in Cuyahoga County (metropolitan Cleveland) rose from 10.2 in 1958 to 12.5 per 100,000 populations in 1974 (23 per cent increase) with the greatest rise among nonwhite males (from 5.9 to 13.1, or 122 per cent). Increased rates were observed in both the city (19 per cent increase) and suburbs (35 per cent increase). Rates increased among young non-white and white adults of both sexes aged 15--34 years, but decreased slightly among adults aged 65 years and older. These findings are consistent with national trends. Alcohol was present in the blood of one-fourth of the individuals who were "dead on arrival," and at intoxicating levels in 20 per cent. There were increasing percentages of victims with positive blood alcohol and with intoxicating levels during the study period. White male victims in the city had significantly higher frequencies of such findings than their counterparts in the suburbs. The rates of suicide committed by firearms rose among all race-sex groups, with the greatest increase among city nonwhite males (2.1 to 7.7, or 267 per cent). Suicide by chemical agents (roughly one-half being barbiturates) increased in all groups except city nonwhite males, with the greatest increase among white males and suburban white females. Firearms among males and poisoning among females displaced asphyxia as the leading modes of suicide.     

Social policy and economic change in Chile, 1974-1985: the case of children

Taking the case of Chile in the period 1974-85, this article examines the impact of economic conditions and social policies on poor households, and especially on children. The study starts with an analysis of the nature of the economic policies implemented in Chile during 1974-85 and their effects on income distribution and on the material living conditions of poor households. It then looks into the social policies, government expenditure, and the main programs directed toward poor households and children, as well as at the changes in child welfare that followed. From this macrosocial level the study diverts to the household level and describes, based on several in-depth studies of small samples of households in the Santiago metropolitan area during the years 1982-85, the daily experiences of poor households--their deteriorating economic conditions and the behaviors adopted to stretch scarce resources to satisfy basic needs. The final part draws some lessons from the Chilean case.     

Causes of death in the Sami population of Sweden, 1961-2000

BACKGROUND: Indigenous people often have a pattern of mortality that is disadvantageous in comparison with the general population. The knowledge on causes of death among the Sami, the natives of northern Scandinavia, is limited. The aim of the present study was to compare gender and cause specific mortality patterns for reindeer herding Sami, non-herding Sami, and non-Sami between 1961 and 2000. METHODS: A Sami cohort was constructed departing from a group of index-Sami identified as either reindeer herding Sami or Sami eligible to vote for the Sami parliament. Relatives of index-Sami were identified in the National Kinship Register and added to the cohort. The cohort contained a total of 41 721 people (7482 reindeer herding Sami and 34 239 non-herding Sami). A demographically matched non-Sami reference population four times as large, was compiled in the same way. Relative mortality risks were analysed by calculating standardized mortality ratios (SMRs). RESULTS: The differences in overall mortality and life expectancy of the Sami, both reindeer herding and non-herding, compared with the reference population were relatively small. However, Sami men showed significantly lower SMR for cancers but higher for external causes of injury. For Sami women, significantly higher SMR was found for diseases of the circulatory system and diseases of the respiratory system. An increased risk of dying from subarachnoid haemorrhage was observed among both Sami men and women. CONCLUSIONS: The similarities in mortality patterns are probably a result of centuries of close interaction between the Sami and the non-Sami, while the observed differences might be due to lifestyle, psychosocial and/or genetic factors.     

Sudden infant death syndrome during weekends and holidays in Norway in 1967-1985

A few previous studies have revealed an increased risk for sudden infant death syndrome (SIDS) during weekends and holidays suggesting environmental factors as potential trigger mechanisms for death. In the present study, the weekend/holiday effect has been assessed on the basis of 1480 SIDS cases in 19 Norwegian counties during a 19-year period (1967-85). The phenomenon has been confirmed for 17 of the 19 counties. Special attention has been attached to differences in the geographical and seasonal distribution of the phenomenon. Deaths of other causes in infancy did not display such a dependency on the day of the week.     

Variation in demand for accident and emergency departments in England from 1974 to 1985.

Over the period 1974-85 the range of mean annual new attendance rates at Accident and Emergency departments among English health districts was 36-673 per 1000 residents. The socio-economic diversity of these districts explained only one-third of the variation. The rates rose significantly (p less than 0.05) in 89 per cent of districts over the twelve years. Again, socio-economic variation only partly explained differences in district trends. Increases were greater among districts with higher mean rates. In order to plan first-contact care rationally we need a better understanding of the factors underlying these trends.     

Smoke load/cancer death rate associations in Korea females, 1985-2004

BACKGROUND: Korea female death rates from many cancers have risen rapidly since 1985. The sources of those cancer death epidemics are unclear but may be related to rising cumulative tobacco smoke damage (smoke load). We assessed Korea female smoke load/cancer death rate associations from 1985 to 2004. METHODS: Lung cancer rates were used as a smoke load bio-index. Subtracting lung, stomach, and uterine corpus cancer death World age standard rates (rates) from all-sites rates gave us non-lung-stomach-uterine corpus (NLSUc) rates. Lung/NLSUc linear regressions were run, adjusted for autocorrelation. Estimated, lower, and upper bound smoking-attributable fractions (SAFs) were calculated using the formula SAF=1-{(unexposeds' cancer death rate)/(observed rate)}, based on the linear regression and respective best, upper, and lower bound estimated lung, stomach, and uterine cancer death rates in the unexposed. RESULTS: Lung cancer death rates (smoke load) can explain 88% of the variance in NLSUc rates from 1985 to 2004 after adjusting for autocorrelation. The estimated Korea female all-sites cancer death rate SAF in 2004 was 43% (sensitivity range 29-56%). CONCLUSIONS: Smoke load, probably from tobacco given the epidemic time course, may cause a large cancer death burden in Korea females despite their very low self-reported prevalence of smoking.     

Enteric fever in Scotland, 1967-1974.

A review of 194 cases of enteric infection in Scotland during 1967-74, is reported. Diagnosis was confirmed by the laboratory isolation of Salmonella typhi (64 cases), S. paratyphi A (3) and S. paratyphi B (127), from blood or faeces; 174 persons were clinically ill and 20 were symptomless infections. Most patients (81-0%) were under 35 years of age, with the highest incidence occurring among young adults of 15-24 years, many of whom had been travelling overseas. One-third of all cases (65) were imported infections; the remaining 129 patients had not been outside the United Kingdom. A significantly greater proportion of typhoid infection (54-7%) was contracted overseas, in contrast to paratyphoid B with only one-fifth of cases (21-2%) being imported; all three cases of paratyphoid A were imported. The geographic distribution of origin of imported infections is discussed, along with the frequency of organisms belonging to different phage types. Two deaths occurred, one of which was the result of complications of paratyphoid fever. All other patients responded well to treatment, although two persons continued to excrete and became chronic carriers. A few examples are given of episodes of particular epidemiological interest. It is expected that in future years there will be a continued increase in the proportion of imported infections as more persons travel overseas, concurrent with the continuing decline in the number of chronic carriers resident in the British Isles.