Mortality due to smoking in Tunisia in 1997]

In Tunisia, in spite of the high prevalence of the cigarette smoking among males, there consequences in term of mortality were not until evaluated. These last can be estimated from tobacco consumption data, mortality statistics and estimates of risks observed among populations of smokers in cohort studies. Numbers of deaths by causes have been estimated from WHO for 1998 year. Smoking prevalence have been estimated from a national survey conducted in 1996 by l'Institut National de Santé Publique and the National League against the Tuberculosis and the Respiratory Illness. Mortality attributable to tobacco in Tunisia has been estimated 6430 deaths. The effect of smoking are a lot more important at the man (5580 deaths), contributing to 22% of male deaths, that at the woman (850 deaths) contributing at 4% of the female deaths. The present mortality to tobacco is similar to certain developed countries as France or Canada. The consumption of cigarettes even though it recorded a light decrease during these last years, remain even elevated notably at the young. Then it is waited to see an increase of tobacco related deaths during the future decades. It is urgent to conduct an efficient politics against this tobacco epidemic by helping the smoker to stop smoking and preventing teenagers to begin to smoke.     

Morbidity due to smoking in The Netherlands: an estimated 90,000 clinical hospital admissions in 2005

OBJECTIVE: To estimate the number of hospital admissions due to smoking tobacco. DESIGN: Theoretical study based on data from the Dutch National Medical Registration. METHOD: Attributive fractions were determined based on the percentages of smokers and ex-smokers and the relative risks for certain diseases. Applying the attributive fractions to the number of hospital admissions provided an estimation of the number of tobacco-related hospital admissions. RESULTS: In 2005, there were 89,800 clinical hospital admissions in the Netherlands that could be attributed to smoking in the age group 35 years or more. This amounts to 7.5% of all hospital admissions in this age group. CONCLUSION: A large number of hospital admissions can be attributed to smoking.     

Population attributable numbers and fractions of deaths due to smoking: a pooled analysis of 180,000 Japanese

Objective

Age- and sex-specific population attributable fraction (PAF) and premature deaths attributable to smoking were estimated from a pooled analysis of cohort studies in Japan.

Methods

A pooled analysis of individual participant data from 13 well-qualified cohort studies throughout Japan (a total of 183,251 Japanese aged 40-89, 69,502 men and 113,749 women; the baseline years between 1987 and 1995 with average 10 years of follow-up) was performed. Poison regression model was used to estimate age- and sex-specific hazard ratios, and their PAFs of all-cause deaths and number of annual premature deaths attributable to smoking were estimated.

Results

Overall PAF attributable to smoking was 24.6% in men and 6.0% in women. The estimated number of annual premature deaths due to smoking was 121,854 (men: 109,998; women: 11,856) in Japan. The age-specific PAF was largest in men aged 60-69 (47.7%) and in women aged 50-59 (12.2%). In the older group aged 70-79 and 80-89, PAF was 15.4% and 8.0% in men and 3.5% and 1.5% in women, respectively.

Conclusions

Age-specific PAFs attributable to smoking in Japanese men are much larger than that reported from other Asian countries.     

Mortality among young immigrants to California: injury compared to disease deaths

According to a variety of indicators, immigrants are in better health than the U.S.-born population. Little research, however, has investigated foreign- and U.S.-born differentials in mortality. We investigated adolescent and young adult immigrants' risk of death due to disease and injury, the leading cause of death of young persons in the United States. The death certificates of 15- to 34-year-old California residents who died from 1989 through 1993 comprised the study population. Disease and injury deaths were identified using ICD-9 codes on the California Master Mortality data files. Frequencies and gender-standardized rates and risk ratios were calculated by nativity (U.S., non-U.S.) and by ethnicity and nativity. Immigrants are represented appropriately in unintentional injury deaths but underrepresented in suicides and overrepresented in homicides among 15- to 34-year-old California residents. Hispanics appear to account for the foreign- and U.S.-born differences in suicide and homicide. By contrast, immigrants constitute a lower proportion of disease deaths than expected. Empirical data about health risks to immigrants are needed to develop informed policy. These data indicate that young immigrants, at least in terms of mortality, do not constitute a burden in that they are at lower or similar risk of death than U.S.-born youth. Homicide is the sole exception to this pattern.     

Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in The Netherlands

In order to assess the impact of medical care innovations on post-1950 mortality in The Netherlands, we analysed trends in mortality from a selection of conditions suggested by Rutstein et al.'s lists of "unnecessary untimely mortality". This selection covers 11 types of innovation, and includes 35 conditions which have become amenable to medical care. Loglinear regression analysis shows that for most of these conditions mortality declined during each of two subperiods (1950-1968; 1969-1984). Mortality decline accelerated in the second subperiod for many conditions. Reductions in mortality from these conditions between 1950/54 and 1980/84 added 2.96 and 3.95 years to life expectancy at birth of Dutch males and Dutch females respectively. A priori evidence indicates that these mortality reductions are due to some extent to 'spontaneous' incidence declines. Although the exact contribution of medical care innovations to these changes in mortality thus cannot be determined, the impact of medical care on post-1950 mortality in The Netherlands could well have been substantial.     

Four million neonatal deaths: counting and attribution of cause of death

Each year there are an estimated four million neonatal deaths and at least 3.2 million stillbirths. Three-quarters of the world's neonatal deaths are counted only through five-yearly retrospective household surveys. Without these surveys we would have no data, but limitations remain particularly in detecting deaths on the first day of life. Comparable reliable neonatal cause of death data through vital registration are available for less than 5% of the world's neonatal deaths, necessitating modelled estimates for the majority of the world. Improving the quantity, quality and frequency of data for numbers and causes of neonatal deaths is essential to effectively guide the increasing investments to reduce these deaths. Advancing the data requires general investment in information systems and specific improvements of tools and methods for both household surveys and verbal autopsy, particularly the use of consistent case definitions and hierarchical attribution of cause of death. An important paradigm shift is from historical categories for cause of death ('perinatal causes') to programmatic categories which are consistent with the International Classification of Diseases. If neonatal deaths remain uncounted, they cannot count in policy and in programmes.     

Mortality in general practice: problems concerning deaths in institutions

Following the provision of all general practitioners in Grampian with data on their practice death rates, the experience of death rates at institutions in the region was examined. Nursing homes are more likely to be situated in less deprived areas and their age-specific death rates are generally higher than those experienced by residents from non-institutional settings. For residents in non-institutional settings in Grampian, higher death rates generally parallel increasing deprivation. This expected trend is reversed when describing the mortality experience of nursing home residents. One reason for this is the movement of elderly people to the locations of nursing homes in less deprived areas. Methodological issues are discussed and proposals are made to improve the analysis of mortality in this article.     

Mortality of liver cirrhosis and alcoholism in France from 1950 to 1981

This work presents the evolution of mortality in France in males and females by acute or chronic alcoholism and cirrhosis of the liver between the years 1950 and 1981. The cohort analysis and the transversal trend analysis are used. The alcoholic mortality risk decreases for both sexes. This is confirmed by cohort and transversal analyses which make this decrease visible since 1958 in the various age groups. On the other hand, cirrhosis mortality's trend is to stabilisation.     

Estimating the causes of 4 million neonatal deaths in the year 2000

BACKGROUND: Information on cause-of-death is lacking for 98% of the world's 4 million neonatal deaths that occur in countries with inadequate vital registration (VR). Our aim was to estimate, by country for the year 2000, the distribution of neonatal deaths across programme-relevant causes including: asphyxia, preterm birth, congenital abnormalities, sepsis/pneumonia, neonatal tetanus, diarrhoea, and 'other'. METHODS: Two sources of neonatal cause-of-death data were examined: VR datasets for countries with high coverage (>90%), and published and unpublished studies identified through systematic searches. Multinomial regression was used to model the distribution of neonatal deaths. A VR-based model was used to estimate the distribution of causes of death for 37 low-mortality countries without national data. A study-based model was applied to obtain estimates for 111 high-mortality countries. Uncertainty estimates were derived using the jackknife approach. RESULTS: Data from 44 countries with VR (96 797 neonatal deaths) and from 56 studies (29 countries, 13 685 neonatal deaths) met inclusion criteria. The distribution of reported causes of death varied substantially between countries and across studies. Based on 193 countries, the major causes of neonatal death globally were estimated to be infections (sepsis/pneumonia, tetanus, and diarrhoea, 35%), preterm birth (28%), and asphyxia (23%). Regional variation is important. Substantial uncertainty surrounds these estimates. CONCLUSIONS: This exercise highlights the lack of reliable cause-of-death data in the settings in which most neonatal deaths occur. Complex statistical models are not a panacea. Representative data with comparable case definitions and consistent hierarchical cause-of-death attribution are required.     

Proportions of cancer deaths attributable to cigarette smoking in women

Over two-thirds of a million American women mostly over age 45 were enrolled in a prospective mortality study in 1982 and followed up for four years. In this time period 1,527 women died of six smoking-related cancer sites: oral cavity, esophagus, pancreas, larynx, lung, and bladder. Age-adjusted death rates in nonsmokers were used to obtain smoking-attributable risks and numbers of deaths due to these six cancers. Among current smokers, 601 deaths (85.5% of current smokers' deaths) were attributable to cigarette smoking, and among former smokers 284 (69.3% of ex-smokers' deaths) were attributable to smoking. Cigarette smoking accounted for 885 excess deaths at these sites, giving a population-attributable risk of 57.9%. Over three-quarters of these excess deaths were due to lung cancer. Cigarette smoking, despite increases in smoking cessation, is still responsible for well over half of the deaths from these six types of cancer in women.     

Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation

In August 2002, the Subcommittee on Cessation of the Interagency Committee on Smoking and Health (ICSH) was charged with developing recommendations to substantially increase rates of tobacco cessation in the United States. The subcommittee's report, A National Action Plan for Tobacco Cessation, outlines 10 recommendations for reducing premature morbidity and mortality by helping millions of Americans stop using tobacco. The plan includes both evidence-based, population-wide strategies designed to promote cessation (e.g., a national quitline network) and a Smokers' Health Fund to finance the programs (through a 2 US dollar per pack excise tax increase). The subcommittee report was presented to the ICSH (February 11, 2003), which unanimously endorsed sending it to Secretary Thompson for his consideration. In this article, we summarize the national action plan.