An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania

CONTEXT: Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE: To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN: Cross-sectional review of records and survey, conducted in February and March 1998. SETTING: Mtendeli refugee camp, Tanzania. PARTICIPANTS: For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES: Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS: The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS: Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.     

Delayed childbearing in Sweden

Using data from the Swedish Medical Birth Registry, we examined whether reproductive history influenced pregnancy outcomes among women aged 30 to 39 years who gave birth to a first or second child in 1976 through 1980. They were classified group 1, primigravida; group 2, gravida 2, para O; and group 3, gravida 2, para 1. Compared with women aged 20 through 24 years with the same parity and gravidity, the relative risk (RR) of late fetal deaths was significantly greater among those aged 35 through 39 years (RR: group 1 = 1.76, group 2 = 2.22, and group 3 = 2.39). The risk of giving birth to newborns who were low birth weight and preterm, or low birth weight at term, or 2,500 g or greater but preterm was greater among women aged 30 through 39 years in groups 1 and 2--significantly so for group 1 aged 30 through 39 years v group 1 aged 20 through 24 years. Risk increased with maternal age, from 30 through 34 to 35 through 39 years. The increased risk with age and parity-gravidity has ramifications for the increasing rate of delayed childbearing in the United States and elsewhere.     

A prospective study of aspirin use and primary prevention of cardiovascular disease in women

OBJECTIVE. The aim of the study was to examine prospectively the association between regular aspirin use and the risk of a first myocardial infarction and other cardiovascular events in women. DESIGN. Prospective cohort study including 6 years of follow-up. SETTING. Registered nurses residing in 11 US states. PARTICIPANTS. US registered nurses (n = 87,678) aged 34 to 65 years and free of diagnosed coronary heart disease, stroke, and cancer at baseline. Followup was 96.7% of total potential person-years of follow-up. MAIN OUTCOME MEASURES. Incidence of myocardial infarction, stroke, cardiovascular death, and all important vascular events. RESULTS. During 475,265 person-years of follow-up, we documented 240 nonfatal myocardial infarctions, 146 nonfatal strokes, and 130 deaths due to cardiovascular disease (total, 516 important vascular events). Among women who reported taking one through six aspirin per week, the age-adjusted relative risk (RR) of a first myocardial infarction was 0.68 (95% confidence interval [CI], 0.52 to 0.89; P = .005), as compared with those women who took no aspirin. After simultaneous adjustment for risk factors for coronary disease, the RR was 0.75 (95% CI, 0.58 to 0.99; P = .04). For women aged 50 years and older, the age-adjusted RR was 0.61 (95% CI, 0.45 to 0.84; P = .002) and the multivariate RR was 0.68 (95% CI, 0.50 to 0.93; P = .02). We observed no alteration in the risk of stroke (multivariate RR = 0.99; P = .94). The multivariate RR of cardiovascular death was 0.89 (P = .56) and of important vascular events was 0.85 (P = .12). When examined separately, the results were nearly identical for the subgroups who took one through three and four through six aspirin per week. Among women who took seven or more aspirin per week, there were no apparent reductions in risk. CONCLUSIONS. The use of one through six aspirin per week appears to be associated with a reduced risk of a first myocardial infarction among women. A randomized trial in women is necessary, however, to provide conclusive data on the role of aspirin in the primary prevention of cardiovascular disease in women.     

Delayed childbearing and risk of adverse perinatal outcome. A population-based study.

OBJECTIVE--To investigate the effect of advancing maternal age on pregnancy outcome among healthy nulliparous women, after adjustment for demographic characteristics, smoking, history of infertility, and other medical conditions. DESIGN--A population-based cohort study was conducted with prospectively collected data from the Swedish Medical Birth Register. PATIENTS--Nulliparous Nordic women (N = 173,715), aged 20 years and above, who delivered single births at Swedish hospitals from 1983 through 1987. OUTCOME MEASURES--Late fetal and early neonatal death rates; rates of very low birth weight (VLBW, less than 1500 g), moderately low birth weight (MLBW, 1500 through 2499 g), very preterm delivery (less than or equal to 32 weeks), moderately preterm delivery (33 through 36 weeks), and small-for-gestational-age (SGA) infants (less than -2 SDs). RESULTS--Compared with women aged 20 to 24 years, women aged 30 to 34 years had significantly higher adjusted odds ratios (ORs) of late fetal deaths (OR = 1.4); VLBW (OR = 1.2); MLBW (OR = 1.4); very preterm birth (OR = 1.2); and SGA infants (OR = 1.4). Among women aged 35 to 39 years, the adjusted OR was significantly higher for VLBW (OR = 1.9); MLBW (OR = 1.7); very preterm birth (OR = 1.7); moderately preterm birth (OR = 1.2); and SGA infants (OR = 1.7). Among women 40 years old and older, the adjusted OR was significantly higher for VLBW (OR = 1.8); MLBW (OR = 2.0); very preterm birth (OR = 1.9); moderately preterm birth (OR = 1.5); and SGA infants (OR = 1.4). CONCLUSIONS--Delayed childbearing is associated with an increased risk of poor pregnancy outcomes after adjustment for maternal complications and other risk factors.     

Malnutrition, measles, mortality, and the humanitarian response during a famine in Ehiopia

CONTEXT: The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia. OBJECTIVES: To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district. DESIGN AND SETTING: Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection. PARTICIPANTS: A total of 595 households comprising 4032 people living in Gode district of Ethiopia. MAIN OUTCOME MEASURES: Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m(2) among adults and older persons. RESULTS: Of the 595 households, 346 (58.2%) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3%) deaths were among children younger than 5 years and 72 (24.6%) were among children aged 5 to 14 years. The crude mortality rate was 3.2/10 000 per day (95% confidence interval [CI], 2.4-3.8/10 000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10 000 per day (95% CI, 5.4-8.2/10 000 per day). Approximately 77% of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3% of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1% (95% CI, 24.7%-33.4%). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m(2)) among adults aged 18 to 59 years was 22.7% (95% CI, 17.9%-27.5%). CONCLUSIONS: To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.     

Maternal mortality in Maroua Provincial Hospital, Cameroon (2003-2005)

BACKGROUND: In September 2000, the Heads of States of the 191 countries of the United Nations approved the Millennium Declaration in which reduction of pregnancy-related deaths to a quarter by 2015 was one of its goals. However, before the middle of the first decade of this millennium, there were no reports on the status of maternal mortality in Maroua, Cameroon. OBJECTIVE: The aim of this study was to establish baseline data on maternal mortality for future evaluation of pregnancy-related mortality trends in this city. SUBJECTS AND METHODS: Maternal deaths that occurred from 2003 to 2005 in Maroua City, Cameroon, were analyzed. Mortality ratios were determined by comparing the number of the deaths related to pregnancy with that of women with safe deliveries. Mortality risks were determined by comparing the characteristics of women with pregnancy-related deaths to those of women with safe deliveries. RESULTS: The overall maternal mortality ratio was 1266 maternal deaths per 100,000 live births. The leading causes of death were hypertension (17.5%), obstetric infections (14.3%), uterine rupture (14.3%), anaemia (12.7%) and HIV complications (9.5%). Among the women who died, 28.6% were teenagers and 14.3% were at their sixth delivery (or above). Compared with women aged 20 to 24 years, those aged 25 to 29 years were more than twice as likely to die from pregnancy-related causes (HR: 2.34; CI: 1.07,5.08; p = 0.029). A similar trend was also found in those aged 30 to 34 years (HR: 2.26; CI: 1.02,5.00; p = 0.042). CONCLUSION: The findings suggest that Maternal Mortality Ratio in Maroua, City Cameroon, is very high. Since most of the causes of death were preventable, we propose that the current maternal and Family Planning strategies be reviewed with the view to reducing the current trend. Such a strategy would enable the Maroua city to meet the Millennium goals by 2015.     

Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women

CONTEXT: Postmenopausal estrogen use is associated with increased risk of endometrial and breast cancer, 2 hormone-related cancers. The effect of postmenopausal estrogen use on ovarian cancer is not established. OBJECTIVES: To examine the association between postmenopausal estrogen use and ovarian cancer mortality and to determine whether the association differs according to duration and recency of use. DESIGN AND SETTING: The American Cancer Society's Cancer Prevention Study II, a prospective US cohort study with mortality follow-up from 1982 to 1996. PARTICIPANTS: A total of 211 581 postmenopausal women who completed a baseline questionnaire in 1982 and had no history of cancer, hysterectomy, or ovarian surgery at enrollment. MAIN OUTCOME MEASURE: Ovarian cancer mortality, compared among never users, users at baseline, and former users as well as by total years of use of estrogen replacement therapy (ERT). RESULTS: A total of 944 ovarian cancer deaths were recorded in 14 years of follow-up. Women who were using ERT at baseline had higher death rates from ovarian cancer than never users (rate ratio [RR], 1.51; 95% confidence interval [CI], 1.16-1.96). Risk was slightly but not significantly increased among former estrogen users (RR, 1.16; 95% CI, 0.99-1.37). Duration of use was associated with increased risk in both baseline and former users. Baseline users with 10 or more years of use had an RR of 2.20 (95% CI, 1.53-3.17), while former users with 10 or more years of use had an RR of 1.59 (95% CI, 1.13-2.25). Annual age-adjusted ovarian cancer death rates per 100 000 women were 64.4 for baseline users with 10 or more years of use, 38.3 for former users with 10 or more years of use, and 26.4 for never users. Among former users with 10 or more years of use, risk decreased with time since last use reported at study entry (RR for last use <15 years ago, 2.05; 95% CI, 1.29-3.25; RR for last use >/=15 years ago, 1.31; 95% CI, 0.79-2.17). CONCLUSIONS: In this population, postmenopausal estrogen use for 10 or more years was associated with increased risk of ovarian cancer mortality that persisted up to 29 years after cessation of use.     

Neonatal outcome of children born to women with tuberculosis

BACKGROUND: As the incidence of tuberculosis (TB) has increased worldwide, it is expected that pregnant women will acquire this infection more frequently. Mycobacterium tuberculosis infection during pregnancy may represent a risk for maternal and neonatal complications. METHODS: We studied the perinatal events of 35 consecutive pregnancies complicated by TB from March 1990 to June 1998; 105 apparently healthy pregnant women were included as controls, matched in age, gestational age upon arrival at the Institute, and socioeconomic status. Frequency and type of neonatal complications were recorded. Relative risk (RR) with 95% confidence interval (CI) was calculated. To control potentially confounding variables, a stratified analysis was performed. RESULTS: Seventeen (48.5%) tuberculous mothers had a pulmonary infection and 18 (51.5%), an extrapulmonar localization of the TB. The neonatal morbidity rate in children born to women with TB was 23% against 3.8% of the children of the control cohort (p <0.05). Average weight of newborn infants of tuberculous mothers was 2,859 +/- 78.5 g, while average weight at birth of control neonates was 3,099 +/- 484 g (p = 0.03). Newborns of women with TB had a higher risk of prematurity (RR 2.1; 95% CI 1-4.3), perinatal death (RR 3.1; 95% CI 1.6-6), and weight at birth less than 2,500 g (RR 2.2; 95% CI 1.1-4.9). Pulmonary localization of the TB and late start of the treatment in the mothers increase the risk of perinatal death and neonatal morbidity. CONCLUSIONS: Children born to women with TB have an increased risk of morbidity and mortality in the neonatal period.     

Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men

OBJECTIVE. To investigate the long-term effects of multifactorial primary prevention of cardiovascular diseases (CVD). DESIGN. The 5-year randomized, controlled trial was performed between 1974 and 1980. The subjects and their risk factors were reevaluated in 1985. Posttrial mortality follow-up was continued up to December 31, 1989. SETTING. Institute of Occupational Health, Helsinki, Finland, and Second Department of Medicine, University of Helsinki. PARTICIPANTS. In all, 3490 business executives born during 1919 through 1934 participated in health checkups in the late 1960s. In 1974, 1222 of these men who were clinically healthy, but with CVD risk factors, were entered into the primary prevention trial; 612 were randomized to an intervention and 610 to a control group. INTERVENTIONS. During the 5-year trial, the subjects of the intervention group visited the investigators every fourth month. They were treated with intensive dietetic-hygienic measures and frequently with hypolipidemic (mainly clofibrate and/or probucol) and antihypertensive (mainly beta-blockers and/or diuretics) drugs. The control group was not treated by the investigators. MAIN OUTCOME MEASURES. Total mortality, cardiac mortality, mortality due to other causes. RESULTS. Total coronary heart disease risk was reduced by 46% in the intervention group as compared with the control group at end-trial. During 5 posttrial years, the risk factor and medication differences were largely leveled off between the groups. Between 1974 and 1989 the total number of deaths was 67 in the intervention group and 46 in the control group (relative risk [RR], 1.45; 95% confidence interval [CI], 1.01 to 2.08; P = .048); there were 34 and 14 cardiac deaths (RR, 2.42; 95% CI, 1.31 to 4.46; P = .001), two and four deaths due to other CVD (not significant), 13 and 21 deaths due to cancer (RR, 0.62; 95% CI, 0.31 to 1.22; P = .15), and 13 and one deaths due to violence (RR, 13.0; 95% CI, 1.70 to 98.7; P = .002), respectively. Multiple logistic regression analysis of treatments in the intervention group did not explain the 15-year excess cardiac mortality. CONCLUSION. These unexpected results may not question multifactorial prevention as such but do support the need for research on the selection and interaction(s) of methods used in the primary prevention of cardiovascular diseases.     

Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults

CONTEXT: Dietary sodium is positively associated with blood pressure, and ecological and animal studies both have suggested that high dietary sodium intake increases stroke mortality. OBJECTIVE: To examine the risk of cardiovascular disease associated with dietary sodium intake in overweight and nonoverweight persons. DESIGN: Prospective cohort study. SETTING: The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992. PARTICIPANTS: Of those aged 25 to 74 years when the survey was conducted in 1971 -1975 (14407 participants), a total of 2688 overweight and 6797 nonoverweight persons were included in the analysis. MAIN OUTCOME MEASURES: Dietary sodium and energy intake were estimated at baseline using a single 24-hour dietary recall method. Incidence and mortality data for cardiovascular disease were obtained from medical records and death certificates. RESULTS: For overweight and nonoverweight persons, over an average of 19 years of follow-up, the total number of documented cases were as follows: 680 stroke events (210 fatal), 1727 coronary heart disease events (614 fatal), 895 cardiovascular disease deaths, and 2486 deaths from all causes. Among overweight persons with an average energy intake of 7452 kJ, a 100 mmol higher sodium intake was associated with a 32% increase (relative risk [RR], 1.32; 95% confidence interval [CI], 1.07-1.64; P = .01) in stroke incidence, 89% increase (RR, 1.89; 95% CI, 1.31-2.74; P<.001) in stroke mortality, 44% increase (RR, 1.44; 95% CI, 1.14-1.81; P = .002) in coronary heart disease mortality, 61% increase (RR, 1.61; 95% CI, 1.32-1.96; P<.001) in cardiovascular disease mortality, and 39% increase (RR, 1.39; 95% CI, 1.23-1.58; P<.001) in mortality from all causes. Dietary sodium intake was not significantly associated with cardiovascular disease risk in nonoverweight persons. CONCLUSIONS: Our analysis indicates that high sodium intake is strongly and independently associated with an increased risk of cardiovascular disease and all-cause mortality in overweight persons.     

Hormone replacement therapy after a diagnosis of breast cancer: cancer recurrence and mortality

OBJECTIVE: To determine whether hormone replacement therapy (HRT) after treatment for breast cancer is associated with increased risk of recurrence and mortality. DESIGN: Retrospective observational study. PARTICIPANTS AND SETTING: Postmenopausal women diagnosed with breast cancer and treated by five Sydney doctors between 1964 and 1999. OUTCOME MEASURES: Times from diagnosis to cancer recurrence or new breast cancer, to death from all causes and to death from primary tumour were compared between women who used HRT for menopausal symptoms after diagnosis and those who did not. Relative risks (RRs) were determined from Cox regression analyses, adjusted for patient and tumour characteristics. RESULTS: 1122 women were followed up for 0-36 years (median, 6.08 years); 154 were lost to follow-up. 286 women used HRT for menopausal symptoms for up to 26 years (median, 1.75 years). Compared with non-users, HRT users had reduced risk of cancer recurrence (adjusted relative risk [RR], 0.62; 95% CI, 0.43-0.87), all-cause mortality (RR, 0.34; 95% CI, 0.19-0.59) and death from primary tumour (RR, 0.40; 95% CI, 0.22-0.72). Continuous combined HRT was associated with a reduced risk of death from primary tumour (RR, 0.32; 95% CI, 0.12-0.88) and all-cause mortality (RR, 0.27; 95% CI, 0.10-0.73). CONCLUSION: HRT use for menopausal symptoms by women treated for primary invasive breast cancer is not associated with an increased risk of breast cancer recurrence or shortened life expectancy.     

A meta-analysis of low-dose aspirin for the prevention of pregnancy-induced hypertensive disease

BACKGROUND.--Pregnancy-induced hypertension (PIH), defined as either isolated hypertension after the 20th week of gestation or hypertension with proteinuria (preeclampsia), occurs in 5% to 15% of pregnancies and is associated with maternal and neonatal morbidity. Previous clinical trials with small numbers of patients have suggested that aspirin in doses of 60 to 150 mg/d during the second and third trimesters reduces the risk of PIH and improves maternal and neonatal outcomes. OBJECTIVE.--We performed a meta-analysis of the six published controlled trials to estimate more precisely (1) the magnitude of protection of aspirin from PIH; (2) the effect of aspirin on severe low-birth-weight infants, cesarean section, and perinatal mortality; and (3) the risk of adverse effects. METHODS.--We critically and independently evaluated study methods, assigned a quality score to each trial, and abstracted quantitative outcomes data. For each outcome, both relative risk (RR) and the number needed to be treated were calculated. RESULTS.--Among 394 subjects from six trials, the RR of PIH among women who took aspirin was 0.35 (95% confidence interval [CI], 0.22 to 0.55) and the number needed to be treated was 4.4, meaning that between four and five high-risk women would need to be treated with aspirin to prevent one case of PIH. Aspirin reduced the risk of severe low birth weight among newborns by 44% (RR = 0.56; 95% CI, 0.36 to 0.88) and reduced the risk of cesarean section by 66% overall (RR = 0.34; 95% CI, 0.25 to 0.48), although the specific indications for cesarean section were generally not described. There was no effect on fetal and neonatal death (RR = 0.88; 95% CI, 0.32 to 2.46), and there were no maternal or neonatal adverse effects associated with taking aspirin. CONCLUSION.--This meta-analysis suggests that low-dose aspirin reduces the risks of PIH and severe low birth weight, with no observed risk of maternal or neonatal adverse effects.     

Racial disparities in infection-related mortality at Alice Springs Hospital, Central Australia, 2000--2005

OBJECTIVE: To compare infection-related mortality rates and pathogens isolated for Indigenous and non-Indigenous adult patients at Alice Springs Hospital (ASH). DESIGN, PARTICIPANTS AND SETTING: Retrospective study of inhospital deaths of adults (patients aged > or = 15 years) associated with an infection during a medical or renal admission to ASH between 1 January 2000 and 31 December 2005. MAIN OUTCOME MEASURES: Admission- and population-based infection-related mortality rates and mortality rate ratios (MRRs) for Indigenous versus non-Indigenous adults. RESULTS: There were 513 deaths, of 351 Indigenous and 162 non-Indigenous patients. For Indigenous patients, 60% of deaths were infection-related, compared with 25% for non-Indigenous patients (P < 0.001). The admission-based infection-related MRR for Indigenous versus non-Indigenous adults was 2.2 (95% CI, 1.6-3.1) (15.3 v 6.8 deaths per 1000 admissions; P < 0.001). After adjusting for age and year of death, the population-based infection-related MRR was 11.3 (95% CI, 8.0-15.8) overall (351 v 35 deaths per 100,000 population; P < 0.001) and 31.5 (95% CI, 16.1-61.8) for patients aged < 60 years. The median age of patients who died with an infection was 49 (interquartile range [IQR], 38-67) years for Indigenous and 73 (IQR, 58-80) years for non-Indigenous patients (P < 0.001). For Indigenous patients, 56% of infection-related deaths were associated with bacterial sepsis, with half of these due to enteric organisms. Other deaths followed chronic hepatitis B infection, invasive fungal infections and complications of strongyloidiasis. CONCLUSION: Indigenous patients at ASH are 11 times more likely than non-Indigenous patients to die with an infectious disease. This racial disparity reflects the ongoing socioeconomic disadvantage experienced by Indigenous Australians.     

Fatal occupational injuries in the United States, 1980 through 1985

The National Traumatic Occupational Fatality surveillance project was designed to gather demographic, employment, and injury information from death certificates for all deaths due to injuries at work in the United States. Approximately 7000 workers have died each year during the 6-year period from 1980 through 1985: 94% were men, and 6% were women. Unintentional injuries caused the deaths of 83% of the men and 50% of the women. Eleven percent of the men and 39% of the women died from homicide. While the greatest number of deaths occurred in the group aged 20 through 34 years, fatality rates were highest among those aged 70 years and older. Expressed as deaths per 100,000 workers, annual fatality rates for black workers (7.7) were slightly higher than for white workers (6.5). The four industrial groups with the highest fatality rates were mining (31.9); transportation, communication, and public utilities (25.4); construction (24.0); and agriculture, forestry, and fishing (20.7). From 1980 through 1985 the annual traumatic occupational fatality rate fell 23%.     

Impact of Heat Wave in 2005 on Mortality in Guangzhou,China

ObjectiveTo assess the impact of the heat wave in 2005 on mortality among the residents in Guangzhou and to identify susceptible subpopulations in Guangzhou, China.MethodsThe data of daily number of deaths and meteorological measures from 2003 to 2006 in Guangzhou were used in this study. Heat wave was defined as ≥7 consecutive days with daily maximum temperature above 35.0 °C and daily mean temperature above the 97th percentile during the study period. The excess deaths and rate ratio (RR) of mortality in the case period compared with the reference period in the same summer were calculated.ResultsDuring the study period, only one heat wave in 2005 was identified and the total number of excess deaths was 145 with an average of 12 deaths per day. The effect of the heat wave on non-accidental mortality (RR=1.23, 95% CI: 1.11-1.37) was found with statistically significant difference. Also, greater effects were observed for cardiovascular mortality (RR=1.34, 95% CI: 1.13-1.59) and respiratory mortality (RR=1.31, 95% CI: 1.02-1.69). Females, the elderly and people with lower socioeconomic status were at significantly higher risk of heat wave-associated mortality.ConclusionThe 2005 heat wave had a substantial impact on mortality among the residents in Guangzhou, particularly among some susceptible subpopulations. The findings from the present study may provide scientific evidences to develop relevant public health policies and prevention measures aimed at reduction of preventable mortality from heat waves.     

Drinking and recreational boating fatalities: a population-based case-control study.

CONTEXT: Alcohol is increasingly recognized as a factor in many boating fatalities, but the association between alcohol consumption and mortality among boaters has not been well quantified. OBJECTIVES: To determine the association of alcohol use with passengers' and operators' estimated relative risk (RR) of dying while boating. DESIGN, SETTING, AND PARTICIPANTS: Case-control study of recreational boating deaths among persons aged 18 years or older from 1990-1998 in Maryland and North Carolina (n = 221), compared with control interviews obtained from a multistage probability sample of boaters in each state from 1997-1999 (n = 3943). MAIN OUTCOME MEASURE: Estimated RR of fatality associated with different levels of blood alcohol concentration (BAC) among boaters. RESULTS: Compared with the referent of a BAC of 0, the estimated RR of death increased even with a BAC of 10 mg/dL (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4). The OR was 52.4 (95% CI, 25.9-106.1) at a BAC of 250 mg/dL. The estimated RR associated with alcohol use was similar for passengers and operators and did not vary by boat type or whether the boat was moving or stationary. CONCLUSIONS: Drinking increases the RR of dying while boating, which becomes apparent at low levels of BAC and increases as BAC increases. Prevention efforts targeted only at those operating a boat are ignoring many boaters at high risk. Countermeasures that reduce drinking by all boat occupants are therefore more likely to effectively reduce boating fatalities.     

Recent time-trends of age-specific death rates for breast cancer: Quebec and other provinces, 1965 through 1974.

For the 10-year period 1965 through 1974 the age-specific death rates for cancer of the breast decreased among middle-aged women, especially at ages 40 to 49 years, in Quebec, the Maritimes and the Prairies but not in Ontario or British Columbia. In women under 35 years of age the mortality generally increased, while in women aged 60 to 64 years there was little change except in the Prairies, where the rate increased. It seems probable that the trends reflect changes in incidence rather than in case-fatality. Some, but not all, of the pattern could be explained by changes in fertility over the past 50 years.     

Postneonatal deaths in North Carolina, 1959-1963

The data presented indicate that the disturbing upward trend in infant mortality in North Carolina has been arrested and possibly reversed during the 1959 through 1963 period. Information obtained from death certificates indicates that infections accounted for slightly more than half (52.4%) of the postneonatal deaths occurring in the study periods. The most common type of infection was influenza and pneumonia, followed by gastroenteritis and colitis, infective and parasitic disease, meningitis, and acute respiratory infections, in that order of frequency. Infections were responsible for a greater percentage of the postneonatal deaths among nonwhite (58.5%) than amon white infants (40.7%). the postneonatal death rate from infections was 13.4 for nonwhite infants and 2.2 for white infants. The next most common cause of postneonatal mortality -- congenital malformations -- was relatively more important in the white race, being responsible for approximately 25% of white deaths and only 6% of nonwhite deaths. I11 defined and unknown causes ranked 3rd in importance, with postneonatal death rates of 3.0 for nonwhite and .4 for white infants. Accidents, wich ranked 4th, were responsible for approximately 10% of the postneonatal deaths in each race. In both races, the risk of postneonatal death was greater in infants born to younger mothers, partiuclarly those under age 20. For the infants of mothers under age 15, the postneonatal death rate was 3 times as high as for those of 20-24 year old mothers. Beginning with age 20, the risk of postneonatal mortality decreases gradually as maternal age increases up to 35 years, when it begins to rise again in the white race. In nonwhite races, the decline continoues to age 40. Infants born to young mothers of nonwhite races suffer relatively higher postneonatal mortality than do their white counterparts. The postneonatal mortality rate is lowest for 1st born infants of both races. Among nonwhites, it is highest for the 2nd born; in the white race, it rises with each successive birth, with the exception of the 5th. Postneonatal mortality among very small white infants (those weighing less thatn 1500 gm at birth) was some 7 times that of infants weighing more than 2500 gm; it was even higher in nonwhite races being nearly 2 1/2 times that of the white group and appoproximately 4 times higher than the rate for nonwhite infants weighing more than 2500 gm at birth. The risk of postneonatal death for nonwhite infants born illegitimately was 1 1/2 times as great for those born in wedlock. Among white infants, the risk was almost twice as great for those born out of wedlock.