PMR study of mortality among Alabama workers and farmers

Computerized records of all Alabama deaths occurring to persons 16 years of age and over for the 5-year period 1984-1988 were obtained from the Alabama Department of Public Health. Using proportionate mortality ratio (PMR) methodology and death certificate occupation, cause-specific mortality patterns were examined for all Alabama decedents (N = 182,178), for all Alabama workers (N = 125,369), and for the occupational group of “farm operators and managers” (N = 11,691). In comparison with the U.S. general population, little difference was found between cause-specific PMR results for the total Alabama population and those for all workers, suggesting the absence of a generalized “healthy worker effect.” In comparison with the U.S. population, PMR results for farmers suggested lowered mortality from all malignant neoplasms and all heart disease, and elevated mortality from all external causes of death. In comparison with the Alabama population, PMR results for farmers continued to suggest lowered mortality from all malignant neoplasms, specifically for cancers of the respiratory, digestive and lymphopoietic systems. However, significantly elevated PMRs for external causes of death appeared only among nonwhite female farmers. Further investigation of these deaths suggested that this finding was more likely attributable to an increased risk of housefire deaths associated with rural lifestyle than with occupational factors.     

Perinatal and infant mortality: a worldwide issue: A commentary

The editorial on perinatal and infant mortality: a worldwideissue, Eur J Public Hlth 1996; 6: 157–8, appropriatelylinks reductions in perinatal and infant mortality with improvementsin socioeconomic status in developing and developed countries.However, in summary discussions of the worldwide trends of infantdeaths, certain critical issues that also influence the ratesof perinatal and infant mortality deserve mentioning, even ifbriefly. These critical issues include race/ethnic status, thepre-conception health status of the mother, the past obstetricshistory, the very important effect of low birth weight and pretermdelivery, the effect of maternal education and the relationshipbetween maternal mortality/morbidity and infant survival. Ibriefly review the relationship between infant deaths and thesecritical issues. Discussing these critical issues in summaryarticles may help advance policy and programme debate on howto reduce the rate of infant deaths worldwide effectively.     

The size of educational differences in mortality from specific causes of death in men and women

This study examines the association between education and mortality from specific causes of death based on mortality records for 1996 and 1997, and 1996 population census data from the Region of Madrid (Spain). Poisson regression models were used to estimate the percentage increase in mortality associated with 1 year less education. The percentage increases in mortality from stomach cancer, lung, bladder and liver cancers, for aids, chronic obstructive pulmonary disease, pneumonia and influenza, and chronic liver disease and cirrhosis were higher in men than in women, whereas the percentage increases in mortality from colon cancer, diabetes mellitus, ischemic heart disease and nephritis, nephrosis and nephrotic syndrome were higher in women. The results found for some causes of death – lung cancer, ischemic heart disease, diabetes mellitus and chronic obstructive pulmonary disease – reflect the variations by educational level in the prevalence of lifestyle-related risk factors in men and women. Various hypotheses have been suggested for other causes of death, but it is not known why the magnitude of the association between education and mortality from some causes of death differs between men and women. Future studies of this subject may provide some clues as to the underlying mechanisms of this association.     

Ethnic differences in rates of infant mortality and sudden infant death in Sweden, 1978-1990

This study examined ethnic differences in infant mortality rates(IMRs) and rates of sudden infant death syndrome (SIDS) amongSwedish and immigrant women between 1978 and 1990 in Sweden.The study population comprised 1,265,942 single live birthsto women between the ages of 15 and 44 years in Sweden. Datafrom 3 registers In Sweden were linked to obtain medical andsociodemographic information for each mother and child in thestudy. Logistic regression analyses were employed to assessethnic differences in infant mortality and SIDS while controllingfor relevant confounders. This study revealed no ethnic differencesin IMRs. There were also no ethnic differences in the mortalityrates due to SIDS, except for immigrant women from SoutheastAsia and the Pacific Islands who experienced significantly higherrates of SIDS than Swedish women. This study shows that, ingeneral, the IMRs and mortality rates due to SIDS are not aserious public health problem among immigrant women in Swedenand suggests several reasons why this is the case.     

Geographic analysis of infant mortality in New Zealand, 1995–2008: an ethnicity perspective

Objective : To detect spatial clusters of high infant mortality rates in New Zealand for Māori and non‐Māori populations and verify if these clusters are stable over a certain time period (1995–2008) and similar between the two populations. Method : We applied the Kulldorff's spatial scan statistics on data collected by New Zealand Ministry of Health (1995 to 2008) at the territorial local authorities (TLA) level. Kappa coefficient was used to assess the concordance between clusters obtained for Māori and non‐Māori populations. T‐test analyses were conducted to identify associations between spatial clusters and two predictors (population density and deprivation score). Results : There are some significant spatial clusters of infant mortality in New Zealand for both Māori and Non‐Māori. The concordance of the cluster locations between the two populations is strong (kappa=0.77). Unsurprisingly, infant mortality clusters for both Māori and Non‐Māori are associated with the deprivation score. The population density predictor is only significantly and positively associated with clusters obtained for the non‐Māori population. After controlling for deprivation the presence of spatial clusters is all but eliminated. Conclusions : Infant mortality patterns are geographically similar for both Māori and Non‐Māori. However, there are differences geographically between the two populations after accounting for deprivation. Implications : Health services that can affect infant mortality should be aware of the geographical differences across NZ. Deprivation is an important factor in explaining infant mortality rates and policies that ameliorate its effects should be pursued, as it is the major determinant of the geographical pattern of infant mortality in NZ.     

Keratinocyte cancers in South Australia: incidence,geographical variability and service trends

Objectives: To determine the incidence, multiplicity, geographical variability and service trends of keratinocyte cancers (KC) in South Australia (SA). Methods: Medicare Australia data with a unique identifier were used to assess the number of people treated over years 2010–2014. A maximum of one KC service claim per year was used to determine incidence. Age‐standardised rates were estimated as were KC service activity trends. Results: There were 497,581 services to 204,183 SA residents for KC, solar keratoses, locally aggressive skin tumours or suspicious skin lesions. Of these, n=159,137 services were for KC (77,502 people). The five‐year (2010–2014) age‐standardised rate of KC in SA was 1,466.6 (95%CI 1,458.3‐1,474.8) per 100,000. Forty per cent of people had more than one KC removed. Men accounted for more incident cases (59.2%). Age‐specific rates showed least variability over time in the youngest age group (15–44 years). For 26 geographical areas, higher age‐standardised ratios of KC were seen in coastal and agricultural areas. There was a 59% increase in services for KC from 2000 to 2015. Conclusions: Age‐standardised rates for KC are relatively stable in SA, but regional variations are evident. Services for KC continue to rise. Implications for public health: This is the first systematic report of KC in SA. We demonstrate the utility of using validated Medicare data for assessing KC incidence and trends.     

2006-2013年苏州市立医院围产儿死亡情况分析

目的通过了解苏州市立医院围产儿死亡情况,分析影响围产儿死亡的原因,降低围产儿死亡率,提高围产保健质量。方法以2006-2013年在苏州市立医院分娩的产妇为对象,以产房《分娩登记本》和电子监测信息系统登记为依据,统计围产儿死亡及死因情况。结果 2006-2013年苏州市立医院本部、北区、东区共分娩围产儿147 201例,围产儿死亡1161例,围产儿死亡率7.89‰。围产儿死亡的主要原因为出生缺陷、脐带胎盘因素、母亲疾病、早产低体重、原因不明。多胎妊娠围产儿死亡率高于单胎妊娠围产儿死亡率。外地户籍人口围产儿死亡率高于本地户籍人口围产儿死亡率。结论规范外地户籍人口和高危妊娠管理,加强优生优育指导,规范围产保健管理,以降低围产儿死亡率。     

Ethnicity,household composition and COVID-19 mortality: a national linked data study

ObjectiveTo estimate the proportion of ethnic inequalities explained by living in a multi-generational household.DesignCausal mediation analysis.SettingRetrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020).ParticipantsAdults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568).Main outcome measuresHazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health.ResultsLiving in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06–1.30) and 1.21 (95% CI 1.06–1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01–1.13) for elderly men and 1.17 (95% CI 1.07–1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups.Conclusion Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.     

Primary care, infant mortality, and low birth weight in the states of the USA

STUDY OBJECTIVE: The study tests the extent to which primary care physician supply (office based primary care physicians per 10 000 population) moderates the association between social inequalities and infant mortality and low birth weight throughout the 50 states of the USA. DESIGN: Pooled cross sectional, time series analysis of secondary data. Analyses controlled for state level education, unemployment, racial/ethnic composition, income inequality, and urban/rural differences. Contemporaneous and time lagged covariates were modelled. SETTING: Eleven years (1985-95) of data from 50 US states (final n = 549 because of one missing data point). MAIN RESULTS: Primary care was negatively associated with infant mortality and low birth weight in all multivariate models (p<0.0001). The association was consistent in contemporaneous and time lagged models. Although income inequality was positively associated with low birth weight and infant mortality (p<0.0001), the association with infant mortality disappeared with the addition of sociodemographic covariates. CONCLUSIONS: In US states, an increased supply of primary care practitioners-especially in areas with high levels of social disparities-is negatively associated with infant mortality and low birth weight.     

Estimating mortality and causes of death in Turkey: methods, results and policy implications

BACKGROUND: Cause-specific mortality statistics are primary evidence for health policy formulation, programme evaluation, and epidemiological research. In Turkey, a partially functioning vital registration system in urban areas yields fragmentary evidence on levels and causes of mortality. This article discusses the application of innovative methods to develop national mortality estimates in Turkey, and their implications for national health development policies. METHODS: Child mortality levels from the Demography and Health Survey (DHS) were applied to model life tables to estimate age-specific death rates. Reported causes of death from urban areas were adjusted using re-distribution algorithms from the Global Burden of Disease (GBD) Study. Rural cause structure was estimated from epidemiological models. Local epidemiological data was used to adjust model-based estimates. RESULTS: Life expectancy at birth in 2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10 years lower than in Western Europe. Leading causes of death include major vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths, chronic obstructive lung disease and lung cancer in men, but also perinatal causes, lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of deaths, although this may be an underestimate. CONCLUSIONS: Mortality estimates are uncertain in Turkey, given the poor quality of death registration systems. Application of burden of disease methods suggests that there has been progress along the epidemiological transition. Key health development strategies for Turkey include improved access to communicable disease control technologies, and urgent attention to the development of a reliable, nationally representative health information system.     

全国县级公立医院综合改革第一批示范县改革进展研究

目的:全面分析全国县级公立医院综合改革第一批四个示范县的改革措施、取得的效果、形成的经验与面临的问题,并对进一步深化改革提出建议。方法:通过现场调研收集资料,主要包括统计描述和内容分析法。结果:四县(市)主要从医改领导体制和工作机制、政府投入责任、公立医院补偿机制、医联体建设、基本医保制度、现代医院管理制度、人事薪酬制度等方面进行改革,具体措施各有侧重;在控制医疗费用、优化医院收入结构、提高基本医保补偿、降低就医负担、提高医务人员收入、提升服务能力等方面取得积极效果。结论与建议:四县(市)的公立医院综合改革均取得重要突破和显著进展,但仍存在一些共性体制机制障碍和各自的特定问题;建议进一步推广已形成的经验,强化"三医"联动,针对具体问题不断完善细化改革措施。     

应用Fairlie分解法的老年人自评健康状况性别差异研究

目的  了解我国老年人健康状况之间存在的性别差异,为缩小老年人性别之间存在的健康差异,提高健康公平性提供依据。 方法  以2013年中国健康与养老追踪调查（China health and retirement longitudinal study,CHARLS）中3 744名65岁及以上老年人为研究对象,采用Stata 14.0软件分析老年人健康状况存在的性别差异。 结果  3 744名老年人当中,男性的自评健康率为47.1%,女性为41.6%。不同性别老年人健康状况差异有统计学意义（χ²=11.74,P<0.001）;经Fairlie分解后得出,老年人自评健康状况之间存在的性别差异,主要受生活方式、收入和受教育程度的影响（均有P<0.05）,贡献率分别为73.98%、17.48%和16.70%。 结论  我国男性老年人的自评健康状况好于女性。对女性老年人加大健康教育的宣传工作,提倡形成健康的生活习惯和生活方式,有益于提高女性老人的健康水平,从而缩小老年人健康状况的性别差异,促进老年人的健康公平。     

不同喂养方式对城乡6～12个月婴儿体重、身长增值的影响

<正> “不同喂养方式对0～6个月婴儿体重,身长增值的影响”的结果提示,在乳制品供应不足缺乏科学喂养指导的农村6个月内婴儿体重增值以母乳喂养最为理想,人工喂养最差。而有乳制品供应充足并能及时得到科学育儿知识的城市地区,混合喂养和人工喂养小儿的身长、体重增值可达到和母乳喂养相同的效果。母乳除能保证生长发育良好外,还可增强     

Use of multiple cause of death data in cancer mortality analyses

BACKGROUND: In a cancer mortality study, the decision of whether to define a study outcome via underlying cause of death (UCD) or via multiple cause of death (MCD) information may impact relative risk (RR) estimates and associated confidence intervals. METHODS: Simple equations are presented that relate RR estimates obtained in a cancer incidence study to the RR estimates obtained in mortality studies using UCD and MCD information. Data from the Surveillance, Epidemiology and End Results program were used to obtain information about the detection and confirmation rates of cancer diagnoses made via UCD. Data from US cause of death data tapes were used to obtain information on the ratio of UCD to MCD listings for cancer outcomes. Numerical examples illustrate the use of these equations. RESULTS: In our examples, the RRs obtained via analyses of MCD were close to those obtained via analyses of UCD (but of greater precision), even when assuming that the confirmation rate of cancer diagnoses made via MCD listing was substantially lower than that of diagnoses made via UCD. CONCLUSIONS: These finding are supportive of the use of MCD information in cancer mortality studies.     

Maternal and infant health of Mexican immigrants in the USA: the effects of acculturation,duration, and selective return migration

Background. A significant body of research on minority health shows that while Hispanic immigrants experience unexpectedly favorable outcomes in maternal and infant health, their advantage deteriorates with increased time of residence in the USA. This is referred to as the ‘acculturation paradox.’

Objective. We assess the ‘acculturation paradox’ hypothesis that attributes this deterioration in birth and child health outcomes to negative effects of acculturation and behavioral adjustments made by immigrants while living in the USA, and investigate the potential for the existence of a selective return migration.

Design. We use a sample of Mexican immigrant women living in two Midwestern communities in the USA to analyze the effects of immigrant duration and acculturation on birth outcomes once controlling for social, behavioral, and environmental determinants of health status. These results are verified by conducting a similar analysis with a nationally representative sample of Mexican immigrants.

Results. We find duration of residence to have a significant and nonlinear relationship with birth outcomes and acculturation to not be statistically significant. The effect of mediators is minimal.

Conclusion. The analyses of birth outcomes of Mexican immigrant women shows little evidence of an acculturation effect and indirectly suggest the existence of a selective return migration mechanism.     

Evaluation of the impact of the Family Health Program on infant mortality in Brazil, 1990-2002

OBJECTIVE: To use publicly available secondary data to assess the impact of Brazil's Family Health Program on state level infant mortality rates (IMR) during the 1990s. DESIGN: Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women's literacy and fertility, physicians and nurses per 10,000 population, and hospital beds per 1,000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections. SETTING: 13 years (1990-2002) of data from 27 Brazilian states. MAIN RESULTS: From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1,000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p<0.01). Access to clean water and hospital beds per 1,000 were negatively associated with IMR, while female illiteracy, fertility rates, and mean income were positively associated with IMR. Examination of interactions between Family Health Program coverage and diarrhoea deaths suggests the programme may reduce IMR at least partly through reductions in diarrhoea deaths. Interactions with deaths from acute respiratory infections were ambiguous. CONCLUSIONS: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.     

The color of death: race,observed skin tone,and all-cause mortality in the United States

ABSTRACT

Objective: This paper examines how mortality covaries with observed skin tone among blacks and in relation to whites. Additionally, the study analyzes the extent to which social factors such as socioeconomic status affect this relationship.

Design: This study uses data from the 1982 General Social Survey (N?=?1,689) data linked to the National Death Index until 2008. We use this data to examine the links between race, observed skin tone among blacks, and all-cause mortality. Piecewise exponential hazard modeling was used to estimate disparities in skin tone mortality among blacks, and relative to whites. The multivariate models control for age, education, gender, region, metropolitan statistical area, marital status, labor force status, and household income.

Results: Observed skin tone is a significant determinant of mortality among blacks and in relation to whites. Light skinned blacks had the lowest mortality hazards among blacks, while respondents with medium and dark brown skin experienced significantly higher mortality. The observed skin tone mortality disparities covaried with education; there are significant mortality disparities across observed skin tone groups among black respondents with high school or more education, and nonsignificant disparities among those with less education.

Conclusion: It is crucial to identify the social processes driving racial disparities in health and mortality. The findings reveal that the nuanced social experiences of blacks with different observed skin tones markedly change the experience of racial inequality. Research on the nuanced social processes and biological mechanisms that connect differences in observed skin tone to mortality outcomes promises to better illuminate the experience of racial inequality and policy mechanisms we can use to undermine it.