Bladder cancer mortality in New Jersey counties, and relationship with selected environmental variables

Age-adjusted mortality rates for bladder cancer were calculated for the 21 New Jersey (NJ) counties (USA) during the period 1968-1977, and compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US 1973-1977. The county rates were also correlated with: the rates of low birth weight, birth defects, infant mortality; chemical waste disposal sites; annual per capital income; per cent of the population working in the chemical industries; density of population and urbanization indices of 21 NJ counties. Age-adjusted bladder cancer mortality rates in 95% of NJ counties were higher than national and SEER area rates. The overall NJ State rates for four subgroup populations were highly significantly (p less than 0.001) greater than the national rates. There was a statistically significant correlation between bladder and lung cancer mortality among females in 21 NJ counties which may suggest a common risk factor--namely cigarette smoking. There was no such correlation between bladder and lung cancer mortality among males. There was a statistically significant association between bladder cancer mortality in individual counties and the percentage of the adult population working in the chemical industries.     

Respiratory organs cancer mortality in New Jersey counties and the relationship with selected demographic and environmental variables

The state of New Jersey (N.J.) has been thought to have an unusually high overall cancer mortality rate; this assumption has been based on national 1950–1969 mortality data for N.J. counties. This study presents an analysis of more recent rates of respiratory cancer mortality in 21 N.J. counties during 1968–1977, a comparison with the 1950–1969 rates, and associations between current respiratory cancer mortality rates and selected demographic and environmental variables. Age-adjusted mortality rates for cancer of respiratory organs were calculated for the N.J. counties during the period 1968–1977 and compared with the period 1950–1969, with the Surveillance, Epidemiology, and End Results (SEER) survey, and with cancer mortality in the United States, 1973–1977. The county rates were also correlated with chemical toxic-waste disposal sites (CTWDS), annual per capita income, percentage of the population employed in chemical industries, the density of population, and the urbanization index of each of 21 N.J. counties. The lung, bronchus, trachea, and pleura cancer mortality rates among white and nonwhite males and females in N.J. were substantially higher than the national rates during the period 1950–1969. In more recent years, the increases in U.S. mortality rates for lung, bronchus, trachea, and pleura cancers were significantly greater (P < 0.01) than those found in most of the 21 N.J. counties. As a consequence, the national rates are now more comparable to N.J. rates. Although the gaps between N.J. and the United States in these rates have narrowed, the observed number of laryngeal and lung cancer deaths remained significantly higher (P < 0.01 to P < 0.0001) than expected cancer deaths, based on U.S. rates, among one or more subgroup populations (white and nonwhite males and females) in several N.J. counties. Among white men in Middlesex, Camden, Burlington, and Ocean counties, the observed number of deaths for lung cancer was found to be significantly (P < 0.0001) greater than the expected number of deaths. In Hudson county observed deaths from both laryngeal and lung cancer among white men were significantly greater than the expected number of deaths from these cancers (P < 0.0001). Statistically significant and positive correlations were found between laryngeal cancer mortality and CTWDS, urbanization index, and population density. Lung cancer mortality also correlated significantly with CTWDS in N.J. Both larynx and lung cancer mortality showed significant and consistent negative correlations with annual per capita-income in N.J. Some of the implications of the study findings are discussed and recommendations made for future investigations.     

Female reproductive organs and breast cancer mortality in New Jersey counties and the relationship with certain environmental variables

Age-adjusted female reproductive organs and breast cancer mortality rates (all sites combined) were higher in 19 of 21 New Jersey counties than the U.S. national rates. Compared with national trends, New Jersey cervical cancer and corpus uteri rates have declined less than the national rate among all races. Ovarian and breast cancer rates have not changed over the years, a pattern similar to that of the nation. New Jersey cancer mortality rates during the period 1968-1977 that highly significantly (P less than 0.0005) exceeded national rates were cancers of the cervix in 2 counties among whites and in one county among nonwhites; of the corpus uteri and uterus not specified in 3 counties among whites; of the ovaries in 3 counties among whites; and of the breast in 10 counties among whites. The overall New Jersey cancer mortality significantly (P less than 0.0005) exceeded national rates for ovarian cancer among whites and nonwhites and for breast cancer among whites. Statistically significant and positive correlations were found between breast cancer mortality and chemical toxic waste disposal sites, annual per capita income, urbanization index, and population density among whites in 21 New Jersey counties. Ovarian cancer mortality was also significantly and positively correlated with annual per capita income, and negatively with birth defects. Cervical cancer mortality showed a significant negative correlation with annual per capita income and a significant positive correlation with birth defects and low birth weight among nonwhites in 21 New Jersey counties.     

Changing patterns of ischaemic heart disease mortality in New Jersey 1968-1982, and the relationship with urbanization

Geographical variations in the declining rates of ischaemic heart disease (IHD) mortality may provide clues about various environmental risk factors responsible as a mass influence on the population IHD rate. The rate of IHD decline in 18 of 21 NJ counties was 2 to 45% less than the USA national rate of decline. The overall decline of IHD mortality in New Jersey (NJ) counties lagged significantly (p less than 0.05 to p less than 0.0003) behind the national trend. Age-adjusted mortality rate (AAMR) for IHD in NJ's 21 counties were 4% to 56% higher than the US rates. The IHD mortality rate of 14 of 21 NJ, counties and the entire state were significantly (p less than 0.005 to p less than 0.000001) above the US rate. Highly urbanized, industrialized, and densely populated NJ counties had the highest IHD rates. In these highly urbanized, industrialized and overcrowded NJ counties the AAMR for IHD was significantly higher and the IHD decline was significantly lower than that in the US. There was a significant (p less than 0.02 to p less than 0.00001) inverse association between annual per capita income and IHD rates. These data suggest that a high degree of urbanization, extensive industrialization, high population density and low socioeconomic status were acting as mass influences on the NJ population IHD rate.     

Diet and cancer mortality in the counties of Sweden

The association between standardized cancer mortality rate ratios from 1969-1978 and dietary practices was examined in an ecologic study of the 24 counties of Sweden by means of several independent data sources. The study supports the hypothesis that a high intake of cereal fiber protects against colorectal cancer (r = -0.75 for males and r = -0.67 for females). This study found no association between fat intake and colorectal cancer. However, a negative correlation between milk consumption and this type of cancer was found. A suggested hypothesis is that calcium protects against colorectal cancer, since milk is the major source for calcium intake in Sweden. This could indicate that, for societies with a high fat intake, preventive measures which increase the intake of fiber and milk or calcium might have a greater impact on mortality from cancer of the colon and rectum than would a moderate decrease in the intake of fat. There are no indications in this study that fat intake promotes breast cancer.     

Trends in cancer mortality rates,Bergen County,New Jersey, 1962-75.

Publication of the "Atlas of Cancer Mortality for U.S. Counties, 1950-1969" caused a great deal of concern in counties shown in the Atlas to have had high cancer mortality rates in relation to the United States as a whole. An analysis was made of temporal trends of cancer mortality in Bergen County, a "high-rate county" in northeastern New Jersey, by calculating age-adjusted cancer mortality rates by sex and site for Bergen County residents for the period 1962-75. Mortality rates and time rates of change in mortality rates were compared to those in the United States as a whole. Male and female rates for respiratory cancer and male rates for all sites combined increased significantly more quickly in the United States than in Bergen County during the study period. The authors discuss these trends and recommended that recent time-specific mortality rates be furnished to county health commissions on a regular basis.     

Pregnancy-related mortality in New Jersey, 1975 to 1989.

OBJECTIVES. National data are thought to underestimate pregnancy-related mortality in the United States. A multisource surveillance system for pregnancy-associated deaths in New Jersey offers an opportunity to identify the magnitude of and the trends in pregnancy-related mortality at the state level. METHODS. Data from all reported pregnancy-related deaths in the state from 1975 to 1989 were studied, and pregnancy mortality ratios were calculated. RESULTS. The New Jersey pregnancy mortality ratio decreased from the late 1970s to the early 1980s but began to rise in the late 1980s. The pregnancy mortality ratio for non-Whites was 3.6 times that for Whites for the 15-year period. The causes of pregnancy-related deaths changed over the 15-year period, with direct obstetrical causes playing a decreasing role. AIDS has become the major cause of pregnancy-related mortality in New Jersey. Finally, approximately 44% of the pregnancy-related deaths were considered to be preventable by the physician or patient or both. CONCLUSIONS. New efforts must be made to combat the recent rise in pregnancy-related deaths, with special attention to preventing deaths among non-White women.     

Premature mortality and chronic alcoholism: medical examiner cases, New Jersey

To obtain estimates of premature mortality from nonviolent causes associated with chronic alcoholism, median ages at death were calculated for 994 Essex County, New Jersey Medical Examiner cases aged 25 or older classified as (1) 'nonabusers' or (2) alcoholics whose underlying cause of death was natural disease and (3) those who died of chronic alcoholism. Alcohol-associated mortality accounts for considerable years of potential life lost. Differences in its life-shortening effects according to sex, race, and natural disease versus chronic alcoholism as underlying and/or contributing cause(s) of death are analyzed. Criteria for classifying cases as alcoholics were: (1) autopsy findings attributable to alcoholism; (2) case information that the decedent was a 'known alcoholic', or ever had any health or other related problems because of drinking; or, (3) alcohol-specific disease or condition attributable to alcoholism as underlying or contributing cause of death. Nonabusers were cases not classified as alcoholics and/or other drug abusers. Nonabusers had the oldest median age at death, followed by alcoholics who died of (1) natural disease and (2) chronic alcoholism. Female nonabusers were older than their male counterparts, whereas female alcoholics whose underlying cause of death was natural diseases or chronic alcoholism were younger than male alcoholics with the same underlying cause. Median age at death was considerably lower for blacks than whites in all subgroups, with consistently greater race than sex differences. Evidence is presented which supports the accelerated development of alcoholism symptoms and associated illness among women. Aspects of increased mortality risk among alcoholics with natural disease and/or chronic alcoholism as underlying or contributing cause(s) of death are discussed.     

Spatio-temporal analysis of the relationship between WNV dissemination and environmental variables in Indianapolis,USA

Background  

This study developed a multi-temporal analysis on the relationship between West Nile Virus (WNV) dissemination and environmental variables by using an integrated approach of remote sensing, GIS, and statistical techniques. WNV mosquito cases in seven months (April-October) of the six years (2002–2007) were collected in Indianapolis, USA. Epidemic curves were plotted to identify the temporal outbreaks of WNV. Spatial-temporal analysis and k-mean cluster analysis were further applied to determine the high-risk areas. Finally, the relationship between environmental variables and WNV outbreaks were examined by using Discriminant Analysis.     

Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of GI cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107–110), 110 (106–113), and 109 (107–110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small. Am. J. Ind. Med. 31:713–718, 1997. © 1997 Wiley-Liss, Inc.     

Selenium in forage crops and cancer mortality in U.S. counties

The potential protective effect of selenium status on the risk of developing cancer has been examined in animal and epidemiologic studies. This ecological study investigated the association between U.S. county forage selenium status and site- and sex-specific county cancer mortality rates (1950-1969) using weighted least squares regression. Consistent, significant (p less than .01) inverse associations were observed for cancers of the lung, rectum, bladder, esophagus, and cervix in a model limited to rural counties and for cancers of the lung, breast, rectum, bladder, esophagus, and corpus uteri in a model of all counties. No consistent significant positive associations were observed in the rural county models. This remarkable degree of consistency for the inverse associations strengthens the likelihood of a causal relationship between low selenium status and an increased risk of cancer mortality.     

Gastric cancer in New Mexico counties with significant deposits of uranium

Several counties in northern New Mexico display high rates of mortality from gastric cancer. Significant differences in sex-specific, age-adjusted, average annual stomach cancer mortality rates among whites from 1970-1979 were found between counties with significant deposits of uranium compared to those without significant deposits. These results remained unchanged when either socioeconomic status or Hispanic ethnicity were considered. Additional research needs to consider individual characteristics and competing risk factors for individuals with gastric cancer in these counties. A working hypothesis is that residents of counties with significant deposits of uranium are exposed to higher-than-average environmental levels of radionuclides such as radon and radon daughters, or to trace elements such as arsenic, cadmium, selenium, and lead which are commonly found in areas with uranium deposits.     

Current trends in perinatal mortality statistics at the New Jersey Obstetric Center

The study presents an overview of the changes in perinatal mortality rates at the Statewide Perinatal Center of New Jersey during the past decades. According to the data, the increase in the rate of cesarean sections from 4.5 percent to 17 percent, and the comparable reduction of the rates of manipulative intrapartum and extraction procedures, contributed significantly to the decrease of the perinatal mortality rates from 51/1000 to 17/1000 between 1971 and 1983. Of the new technical tools, those utilized for the evaluation of fetal well-being antepartum appeared to be more useful then those used intrapartum. On account of the high prevalence of genital infections in the population, the recent acceptance in the service of the use of invasive intrapartum technology, appears to have impacted unfavorably upon the perinatal mortality trends. The increased rate of births of premature babies, the widespread abuse of habit forming drugs in the community, and the routine use of procedures requiring artificial rupture of the membranes, probably all contributed to the rapid increase of the perinatal mortality rate in the Center from 15/1000 in 1986 to 28/1000 in 1988. It is concluded that perinatal care is a complex medical and social task. The overall result of the relevant efforts depends to a great extent upon the social environment, and the moral standing, educational level and motivation of the recipients.     

Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties, 1990

OBJECTIVES: We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties. METHODS: We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics. RESULTS: Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality. CONCLUSIONS: Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level.     

Market reform in New Jersey and the effect on mortality from acute myocardial infarction

OBJECTIVE: To determine whether mortality rates for patients with acute myocardial infarction (AMI) changed in New Jersey after implementation of the Health Care Reform Act, which reduced subsidies for hospital care for the uninsured and changed hospital payment to price competition from a rate-setting system based on hospital cost. DATA SOURCES/STUDY SETTING: Patient discharge data from hospitals in New Jersey and New York from 1990 through 1996 and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). STUDY DESIGN: A comparison between states over time of unadjusted and risk-adjusted mortality and cardiac procedure rates. DATA COLLECTION: Discharge data were obtained for 286,640 patients with the primary diagnosis of AMI admitted to hospitals in New Jersey or New York from 1990 through 1996. Records of 364,273 NIS patients were used to corroborate time trends. PRINCIPAL FINDINGS: There were no significant differences in AMI mortality among insured patients in New Jersey relative to New York or the NIS. However, there was a relative increase in mortality of 41 to 57 percent among uninsured New Jersey patients post-reform, and their rates of expensive cardiac procedures decreased concomitantly. CONCLUSIONS: The introduction of hospital price competition and reductions in subsidies for hospital care of the uninsured were associated with an increased mortality rate among uninsured New Jersey AMI patients. A relative decrease in the use of cardiac procedures in New Jersey may partly explain this finding. Additional studies should be done to identify whether other market reforms have been associated with changes in the quality of care.     

Infant mortality in Newark,New Jersey. A study of sociodemographic and medical factors.

Newark, a metropolitan industrial town, experienced the highest infant mortality of any major city in the United States in the 1960s and early 1970s. Between 1970 and 1973, however, infant mortality among non-whites in this city declined strikingly. This decline could not be directly related to declines (a) in birth rates, (b) in the proportions of babies of low birth weight, (c) in the proportions of babies born to mothers in unfavorable age groups, (d) in the general fertility rates, or (e) in the illegitimacy rates. The decline may have been related (a) to the removal from childbearing cohorts of the group of females in the population--as yet undefined--whose babies would have been at high risk of infant mortality, (b) to the falling birth rate, (d) to better postnatal care--or to all of these factors. The study data suggest a multifactorial basis for the precipitous decline and also suggest that further major reductions in infant mortality among both nonwhites and whites will require better definition of the causes of low birth weight.     

项目地区获取孕产期保健知识对孕产妇死亡率影响的研究

目的:分析孕产妇及其家属获取孕产期保健知识对孕产妇死亡率的影响,探讨提高该地区的孕产期保健知识的有效措施。方法:采用1∶1配对病例对照研究方法,选择孕产妇死亡率较高、人均收入较低、多民族聚居的贵州省内22个项目县中所有在2004年死亡的农村孕产妇与非死亡的孕产妇,应用多因素Logistic回归分析了解获取孕产期保健知识的内容和途径对孕产妇死亡率的影响。结果:被调查地区孕产妇了解孕产期保健知识的比例低于45%。其中,对照组获取孕产期保健知识多于病例组,两组获取知识的内容和途径存在明显差异,病例组获取知识的主要途径是自己的经验和亲朋传说。结论:该地区孕产妇对孕产期保健知识的获取不足,存在信息来源、获取信息的能力、理解信息的程度、宣传方式方法的差异,这些差异影响了孕产妇死亡率。