Christmas and New Year as risk factors for death

This paper poses three questions: (1) Does mortality from natural causes spike around Christmas and New Year? (2) If so, does this spike exist for all major disease groups or only specialized groups? (3) If twin holiday spikes exist, need this imply that Christmas and New Year are risk factors for death? To answer these questions, we used all official U.S. death certificates, 1979–2004 (n = 57,451,944) in various hospital settings to examine daily mortality levels around Christmas and New Year. We measured the Christmas increase by comparing observed deaths with expected deaths in the week starting on Christmas. The New Year increase was measured similarly. The expected number of deaths was determined by locally weighted regression, given the null hypothesis that mortality is affected by seasons and trend but not by holidays. On Christmas and New Year, mortality from natural causes spikes in dead-on-arrival (DOA) and emergency department (ED) settings. There are more DOA/ED deaths on 12/25, 12/26, and 1/1 than on any other day. In contrast, deaths in non-DOA/ED settings display no holiday spikes. For DOA/ED settings, there are holiday spikes for each of the top five disease groups (circulatory diseases; neoplasms; respiratory diseases; endocrine/nutritional/metabolic diseases; digestive diseases). For all settings combined, there are holiday spikes for most major disease groups and for all demographic groups, except children. In the two weeks starting with Christmas, there is an excess of 42,325 deaths from natural causes above and beyond the normal winter increase. Christmas and New Year appear to be risk factors for deaths from many diseases. We tested nine possible explanations for these risk factors, but further research is needed.     

Variation in deliberate self-harm around Christmas and New Year

Seasonal and temporal variations in suicide by patient and demographic groups, though important, have been investigated infrequently. This study examined patterns of non-fatal deliberate self-harm (DSH) during Christmas and New Year (from December 16th to January 6th) by specific patient and demographic group. The sample comprised 19,346 people who presented with 31,369 episodes of DSH to a general hospital Emergency Department in Oxford, UK. Autoregression analysis of all episodes from 1976 to 2003 (controlling for day of the week, month and year) revealed significant reductions (-30% to -40%) in the occurrence of DSH compared with expected numbers on each day from December 19th to 26th (except the 23rd), though no significant increase was found on any of the subsequent 11 days. When analysed separately, young people aged under 25 years showed decreases (-60%) in the occurrence of DSH on several days throughout Christmas (p<0.001) and New Year (p<0.01). Patients with partner relationship problems showed a decrease 3 days before Christmas Day (-80%, p<0.001) and an increase on New Year's Day (+100%, p<0.01). Patients with family relationship problems showed decreases before Christmas and after New Year (-60%, p<0.01). Patients with social isolation problems, or a previous history of DSH showed decreases (-60%, p<0.01) before Christmas only. Patients who used alcohol at the time of DSH or in the 6h beforehand, but did not chronically misuse alcohol, showed an increase (+250%, p<0.01) on New Year's Day. There was no significant variation in the occurrence of DSH for patient groups with either low/medium or high suicide intent. The findings elucidate how social and individual factors may interact in contributing to DSH. They are of theoretical interest, and have important clinical implications regarding identification of patient groups especially susceptible to DSH at New Year.     

Mortality in hartford, connecticut: A comparison with the South Bronx, New York

Very high mortality rates have been reported in large inner-city areas such as the South Bronx and Harlem in New York City, but also may occur in smaller US urban areas. Using published death rates for the South Bronx as the standard, the standardized mortality ratio was slightly lower than 1.00 for Hartford, Connecticut (population 139,739 in 1990), but more than 1.00 for three impoverished Hartford census tracts that contained public housing projects. Compared with the South Bronx, death rates in Hartford were lower for human immunodeficiency virus (HIV), injury-homicide, and alcohol-drugs, but higher for hypertension-stroke (in all three tracts) and cancer (in two of the three tracts). Variations in patterns of causes of death among impoverished US urban areas have implications for planning epidemiologic studies and targeting interventions.     

中国城乡脑中风的流行病学:1986年死亡率分析

在全国范围内(台湾省未查)抽取199个调查点,共查5 790 864人,发现当年死于脑中风者4 446例,粗死亡率为76.78/10万,其95%置信区间为74.52~79.04/10万;用中国1986年农村和城市人口构成调整后,死亡率为77.15/10万;用中国1982年人口构成比标化后为57.25/10万;用世界标准人口标化后为80.94/10万。分别计算了各大区和省的脑中风死亡率,并且对脑中风标化死亡率和经、纬度的关系作了相关回归分析,发现均呈正相关,并有线性回归关系。也就是说,在中国,脑中风的死亡率从南向北逐渐升高,从东向西逐步降低。脑中风死亡率城市明显高于农村,大城市的市区明显高于其郊区。用趋势检验法和圆型分布法分析了死亡病例的按月分布,发现在一月份有一个不十分明显的,但在统计学上有意义的死亡高峰。脑中风的死亡率随年龄的增长而升高,两者之间的关系符合Logistic曲线的轨迹。     

2004-2005年山东省女性乳腺癌死亡率调查

[目的]通过对乳腺癌死亡资料分析,掌握山东省乳腺癌的死亡水平及变化趋势。[方法]利用山东省第三次死因调查资料．对山东省2004-2005年乳腺癌死亡病例进行分析,对其死亡特点和趋势进行描述和分析。[结果]2004～2005年山东省女性乳腺癌的粗死亡率为6．62／10万,中国人口标化死亡率为5．44／10万,世界人口标化死亡率为5．68／10万．处于中等水平。死亡率城市高于农村,经济发达的沿海地区高于内陆地区。死亡率随年龄增高而增高。20世纪90年代以来,死亡率迅速上升,主要是人口因素和非人口因素共同作用的结果。[结论]山东省女性乳腺癌死亡率处于中等水平但上升迅速,必须引起重视,加强其预防和干预。     

Projection of Cancer Incidence and Mortality From 2020 to 2035 in the Korean Population Aged 20 Years and Older

Objectives:This study aimed to identify the current patterns of cancer incidence and estimate the projected cancer incidence and mortality between 2020 and 2035 in Korea.Methods:Data on cancer incidence cases were extracted from the Korean Statistical Information Service from 2000 to 2017, and data on cancer-related deaths were extracted from the National Cancer Center from 2000 to 2018. Cancer cases and deaths were classified according to the International Classification of Diseases, 10th edition. For the current patterns of cancer incidence, age-standardized incidence rates (ASIRs) and age-standardized mortality rates were investigated using the 2000 mid-year estimated population aged over 20 years and older. A joinpoint regression model was used to determine the 2020 to 2035 trends in cancer.Results:Overall, cancer cases were predicted to increase from 265 299 in 2020 to 474 085 in 2035 (growth rate: 1.8%). The greatest increase in the ASIR was projected for prostate cancer among male (7.84 vs. 189.53 per 100 000 people) and breast cancer among female (34.17 vs. 238.45 per 100 000 people) from 2000 to 2035. Overall cancer deaths were projected to increase from 81 717 in 2020 to 95 845 in 2035 (average annual growth rate: 1.2%). Although most cancer mortality rates were projected to decrease, those of breast, pancreatic, and ovarian cancer among female were projected to increase until 2035.Conclusions:These up-to-date projections of cancer incidence and mortality in the Korean population may be a significant resource for implementing cancer-related regulations or developing cancer treatments.     

2003年～2004年杨浦区户籍居民和流动人口伤害流行病学特征分析

目的了解上海市杨浦区户籍居民和流动人口伤害死亡的特征差异,为伤害预防和研究提供信息。方法利用上海市杨浦区疾病预防控制中心2003年~2004年的死亡登记系统资料,采用ICD-10进行死因分类,分别比较各种伤害类别的死亡比重。结果2003年~2004年上海市杨浦区户籍居民和流动人口的伤害平均死亡率分别为32.75/10万和41.74/10万。男性流动人口伤害死亡率高于户籍居民和女性流动人口;流动人口中的15岁以下各年龄组、45~50岁和65岁以上各年龄组的伤害死亡率高于户籍居民相应年龄组人群。户籍居民伤害致死的外部原因以坠落、交通事故、自杀和中毒为主;流动人口以交通事故、坠落、自杀和他杀为主,两者有所不同。结论2003年~2004年上海市杨浦区的户籍居民及流动人口的伤害平均死亡率均处于较高的水平;流动人口的伤害问题相对较大。应实施有针对性的干预措施,预防和控制伤害的发生。     

成都市温江区肺癌发病率和死亡率调查分析

目的 调查分析成都市温江区肺癌的发病率和死亡率,为制定肺癌的科学防治策略提供指导. 方法 整理成都市温江区疾病预防控制中心2008-2010年肺癌的发病资料和死亡资料,统计和分析肺癌发病和死亡病例数、粗发病率和死亡率、中国标化发病率和死亡率、世界标化发病率和死亡率等指标. 结果 成都市温江区2008-2010年肺癌粗发病率为32.65/10万,其中男性39.62/10万,女性25.56/10万.粗死亡率为19.05/10万,其中男性22.31/10万,女性15.43/10万.男性肺癌的发病率居恶性肿瘤发病率的第一位,女性居第二位.男性肺癌的死亡率居恶性肿瘤的第一位,女性居第四位. 结论 肺癌是严重危害温江居民的恶性肿瘤,但总体上温江区肺癌发病率和死亡率较低,男性和中老年是肺癌防治的重点对象.     

厦门市2002～2009年大肠癌死亡状况及YLL分析

目的 了解2002～2009年厦门市大肠癌死亡率、分布特征及寿命损失情况.方法 对2002～2009年厦门市大肠癌死亡登记资料和人口数据进行统计分析,计算粗死亡率、标化率、累积率及寿命损失年(YLL)等指标,绘制死亡率分布地图.结果 2002～2009年厦门市大肠癌平均死亡率为7.66/10万,标化死亡率为4.57/10万,0～ 74岁累积率为0.75％,居恶性肿瘤死亡顺位第5位,显著低于2006年全国肿瘤登记地区大肠癌死亡水平(标化死亡率6.2W10万),但总体呈明显上升趋势,女性死亡率上升幅度明显高于男性.大肠癌主要危及中老年人群,平均死亡年龄为66.2岁,86.45％死亡病例发生在50岁以上人群,城市死亡率高于农村,男性死亡率高于女性.2002～2009年厦门市大肠癌PYLL　为10127.5人年,占全死因PYLL的1.62％,AYLL为10.5人年,减寿率为0.80‰.结论　厦门市大肠癌死亡率上升趋势明显,对中老年人群危害日益严重,对女性尤为突出,应积极采取有效干预措施.     

1975-2006年武汉市居民糖尿病死亡率分析及预测

目的分析1975—2006年武汉市居民糖尿病死亡率的变化并进行趋势预测。方法利用1975—2006年武汉市居民死亡资料,对武汉市1975—2006年糖尿病死亡资料进行流行病学分析,并利用灰色动态模型GM（1,1）预测武汉市2007—2012年糖尿病死亡率趋势。结果2006年武汉市居民糖尿病死亡率为19.97/10万,较1975年上升了11.61倍,年平均递增率为8.23%,高于心脑血管疾病、呼吸系统疾病、恶性肿瘤的死亡率增长速度。女性死亡率明显高于男性,男女死亡率之比为0.63∶1。武汉市糖尿病年均高死亡率的前3位均为经济发达的汉口地区,江汉区最高,为11.56/10万,汉南区最低,为3.23/10万。所建立的灰色模型预测方程为Y（t）=26.43e0.07735（t-1）-24.71,预测到2012年武汉市居民糖尿病死亡率将达到34.42/10万。结论武汉市居民糖尿病死亡率上升趋势明显,提示应加强防治力度。     

A Comparative Study of Mortality Among Puerto Rican Injection Drug Users in East Harlem, New York, and Bayamon, Puerto Rico

Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY—HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR—HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.     

Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients

We have conducted a historical cohort study to assess cardiovascular mortality among psoriasis patients. Using the Swedish Inpatient Registry, we selected 8991 patients hospitalized for psoriasis at dermatological wards. To represent an outpatient cohort, 19,757 members of the Swedish Psoriasis Association were selected. Mortality from cardiovascular diseases was compared with the general population. We found no increased cardiovascular mortality among outpatients with psoriasis (standardized mortality ratio, SMR 0.94; 95% confidence interval, CI: 0.89-0.99). The overall risk among inpatients admitted at least once was increased by 50% (SMR 1.52; 95% CI: 1.44-1.60). The excess risk increased with increasing number of hospital admissions (p for trend <0.001). Cardiovascular mortality was higher among those admitted at younger ages (p for trend <0.001; SMR 2.62, 95% CI: 1.91-3.49, for patients aged 20 to 39 years at first admission). Young age at first admission appeared to further increase the risk among those who were repeatedly admitted. We conclude that a diagnosis of psoriasis per se does not appear to increase the risk for cardiovascular mortality. Severe psoriasis, however, here measured as repeated admissions, and early age at first admission, is associated with increased risk for cardiovascular death.     

Students and smoking: Targeted tobacco promotion in the North East of England

Background: The aim of this study was to Investigate the extentto which students in the North East of England are exposed totwo alternative tobacco marketing tactics: direct mailing (‘junkmail’) and the sponsorship of musicoriented events particularlyattractive to young people (e.g. discos, ‘raves’or concerts). Method: Self-completion questionnaires were administeredto convenience samples of predominantly first-year studentsaged 16–24 years attending further education collegesin Gateshead and South Tyneside. The questionnaire assessedthe receipt of smoking-related ‘junk mail’ and attendanceat music-oriented events sponsored by tobacco companies. Results:Almost one in nine students, one in seven smokers and one in13 non-smokers had been exposed to one or both types of tobaccopromotion. One in 12 of the under-18s (including over one ineight smokers and almost one in 17 non-smokers) had been exposedto one or both types of tobacco promotion. Conclusions: Thefindings provide evidence that the tobacco industry is violatingthe UK Voluntary Agreement on Tobacco Products' Advertisingand Promotion, with companies sponsoring events particularlyappealing to young people and the continued inclusion of youngpeople on mailing lists. This study provides further evidenceof the ineffectiveness of voluntary agreements in regulatingthe promotional activities of the tobacco Industry. It is recommendedthat, in the wake of the European Union directive on tobaccoadvertising, a more active and formal mechanism for monitoringtobacco promotion and verifying the claims of the tobacco industrybe introduced.     

Changes in summer temperature and heat-related mortality since 1971 in North Carolina,South Finland,and Southeast England

Three climatically diverse regions were studied to determine the impact of temperature change on heat-related mortality from 1971 to 1997. Median regressions showed that May-August temperatures in North Carolina rose by 1.0 degrees C (95% CL 0.0-2.0 degrees C) from 23.5 degrees C (74.3 degrees F), were unchanged in South Finland at 13.5 degrees C (56.3 degrees F), and rose in Southeast England 2.1 degrees C (0.3-4.0 degrees C) from 14.9 degrees C (58.8 degrees F). After determining for each region the daily temperature (as a 3 degrees C band) at which the mortality was the lowest, annual heat-related mortality was obtained as excess mortality per million at temperatures above this. Annual heat-related mortality per million (among the population at risk, aged 55+) fell in North Carolina by 212 (59-365) from 228 (140-317) to only 16 (not significant, NS); fell in South Finland by 282 (66-500) from 382 (257-507) to 99 (NS); and fell in Southeast England by 2.4 (NS) from 111 (41-180) to 108 (41-176). The falls in North Carolina and South Finland remained significant after allowances were made for changes in age, sex, and baseline mortality. Increased air conditioning probably explains the virtual disappearance of heat-related mortality in the hottest region, North Carolina, despite warmer summers. Other lifestyle changes associated with increasing prosperity probably explain the favorable trends in the cooler regions.     

上海市部分疾病死亡水平变化对平均寿命变化的贡献

目的定量分析上海市部分疾病死亡水平变化对平均寿命变化的贡献。方法将影响人群健康的问题分为感染类疾病、肿瘤、脑血管疾病、伤害以及其他疾病5类。应用去死因寿命方法分析1953—1999年上海市居民死亡登记资料,定量估计疾病别实际死亡水平变化对平均寿命的影响,并用趋势卡方作标化死亡率趋势分析,用Pearson相关分析描述社会经济因素与寿命变化的关系。结果1953—1999年间,上海市居民感染类疾病的粗死亡率、地区别、性别标化死亡率呈下降趋势;市区居民伤害粗死亡率上升,其分性别标化率上升趋势显著,郊县居民则变化方向相反,其分性别标化率未见显著趋势变化;上海市居民肿瘤、脑血管疾病粗死亡率上升显著,其地区别、性别标化死亡率呈下降趋势或未见趋势变化。1979年后感染性疾病死亡率变化对上海市区人群平均寿命上升的贡献率在33%左右,高于其他3类非传染性疾病。而郊县男性伤害和感染类疾病的死亡率变化对平均寿命上升的贡献率分别达40.26%和25.18%。脑血管疾病死亡率变化对郊县男性平均寿命上升的影响是负向的。郊县女性的伤害和感染类疾病的死亡率变化对郊县女性平均寿命上升的贡献率最高,达21.60%和12.55%。1996年肿瘤死亡率对人群平均寿命的潜在影响最显著,其次为脑血管疾病,伤害居第3位,感染类疾病居末位。上海市医疗资源水平与居民平均寿命上升相关性较好。结论上海市控制感染类疾病成效显著,潜在疾病控制策略应以肿瘤、脑血管疾病及伤害为重点。基于死亡风险竞争分析的去死因寿命分析有助于建立疾病控制规划的平均寿命目标。     

The equity of access to orthodontic dental care for children in the North East of England

OBJECTIVES: To assess the equity of access to primary care orthodontic treatment in relation to deprivation in the County Durham and Tees Valley Strategic Health Authority area. STUDY DESIGN: An observational study based on Dental Practice Board data for the County Durham and Tees Valley Strategic Health Authority area with a population of 1.13 million. METHODS: The postcode of all orthodontic claims made by National Health Service dentists across the area in the financial years 2002/2003 and 2003/2004 were obtained and the claim rate per 1000 at risk population calculated for each ward. These ward rates were then compared to both the level of deprivation measured by the Index of Multiple Deprivation 2000 and the children's dental registration rate of the area. RESULTS: Inequity in access to orthodontic care was observed. There was a moderate negative correlation r = -0.40 suggesting wards with the lowest claim rates had the greatest deprivation. In addition, the wards with the lowest child dental registration rates also had the lowest claim rates for orthodontic treatment. CONCLUSIONS: Currently, there is inequity of access to orthodontic treatment for children in County Durham and Tees Valley. The move towards local commissioning for dental services within the NHS will provide an opportunity to reduce inequalities in access.     

Commissioning regional specialist services-HIV and AIDS. Experiences of a consortium arrangement in the North East of England

The introduction of effective double combination therapy for HIV disease in 1996 and triple therapy in 1997 had cost implications for both purchasers and providers of regional specialist services. There is evidence that more patients presented for treatment. A consortium purchasing approach was undertaken in the North East of England to manage the introduction of combination therapy, to ensure that therapy was available for those who could benefit and to minimise the financial risk for individual health districts. The strengths and weaknesses of such an approach are discussed as well as the potential application to commissioning other specialist services.