White infant mortality in Appalachian states, 1976-1980 and 1996-2000: changing patterns and persistent disparities

Purpose: Appalachian counties have historically had elevated infant mortality rates. Changes in infant mortality disparities over time in Appalachia are not well‐understood. This study explores spatial inequalities in white infant mortality rates over time in the 13 Appalachian states, comparing counties in Appalachia with non‐Appalachian counties. Methods: Data are analyzed for 1,100 counties in 13 Appalachian states that include 420 counties designated as Appalachian by the Appalachian Regional Commission. Area Resource File data for 1976‐1980 and 1996‐2000 provide county‐ and city‐level infant mortality rates, poverty rates, rural‐urban continuum codes, and numbers of physicians per 1,000 residents. Multiple regression analyses evaluate whether Appalachian counties are significantly associated with elevated white infant mortality in each time period, accounting for covariates. Findings: White infant mortality rates decreased substantially in all sub‐regions over the last 2 decades; however, disparities in infant mortality did not diminish in Appalachian counties compared to non‐Appalachian counties. After accounting for poverty, rural/urban status, and health care resources, Appalachian counties were significantly associated with comparatively higher infant mortality during the late 1970s but not in the late 1990s. At the more recent time point, higher poverty rates, residence in more rural areas, and lower physician density were associated with greater infant mortality risk. Conclusion: Appalachian counties continue to experience relatively elevated infant mortality rates. Poverty and rurality remain important dimensions of health service need in Appalachia.     

An examination of the effects of mountaintop removal coal mining on respiratory symptoms and COPD using propensity scores

Previous research on public health consequences of mountaintop removal (MTR) coal mining has been limited by the observational nature of the data. The current study used propensity scores, a method designed to overcome this limitation, to draw more confident causal inferences about mining effects on respiratory health using non-experimental data. These data come from a health survey of 682 adults residing in two rural areas of Virginia, USA characterized by the presence or absence of MTR mining. Persons with a history of occupational exposure as coal miners were excluded. Nine covariates including age, sex, current and former smoking, overweight, obesity, high school education, college education, and exposure to coal as a home-heating source were selected to estimate propensity scores. Propensity scores were tested for balance and then used as weights to create quasi-experimental exposed and unexposed groups. Results indicated that persons in the mountaintop mining group had significantly (p?相似文献   

The association between mountaintop mining and birth defects among live births in central Appalachia, 1996-2003

Birth defects are examined in mountaintop coal mining areas compared to other coal mining areas and non-mining areas of central Appalachia. The study hypothesis is that higher birth-defect rates are present in mountaintop mining areas. National Center for Health Statistics natality files were used to analyze 1996–2003 live births in four Central Appalachian states (N=1,889,071). Poisson regression models that control for covariates compare birth defect prevalence rates associated with maternal residence in county mining type: mountaintop mining areas, other mining areas, or non-mining areas. The prevalence rate ratio (PRR) for any birth defect was significantly higher in mountaintop mining areas compared to non-mining areas (PRR=1.26, 95% CI=1.21, 1.32), after controlling for covariates. Rates were significantly higher in mountaintop mining areas for six of seven types of defects: circulatory/respiratory, central nervous system, musculoskeletal, gastrointestinal, urogenital, and ‘other’. There was evidence that mountaintop mining effects became more pronounced in the latter years (2000–2003) versus earlier years (1996–1999.) Spatial correlation between mountaintop mining and birth defects was also present, suggesting effects of mountaintop mining in a focal county on birth defects in neighboring counties. Elevated birth defect rates are partly a function of socioeconomic disadvantage, but remain elevated after controlling for those risks. Both socioeconomic and environmental influences in mountaintop mining areas may be contributing factors.     

Mortality from heart,respiratory, and kidney disease in coal mining areas of Appalachia

Purpose  The purpose of this study was to test whether population mortality rates from heart, respiratory and kidney disease were higher as a function of levels of Appalachian coal mining after control for other disease risk factors. Methods  The study investigated county-level, age-adjusted mortality rates for the years 2000–2004 for heart, respiratory and kidney disease in relation to tons of coal mined. Four groups of counties were compared: Appalachian counties with more than 4 million tons of coal mined from 2000 to 2004; Appalachian counties with mining at less than 4 million tons, non-Appalachian counties with coal mining, and other non-coal mining counties across the nation. Forms of chronic illness were contrasted with acute illness. Poisson regression models were analyzed separately for male and female mortality rates. Covariates included percent male population, college and high school education rates, poverty rates, race/ethnicity rates, primary care physician supply, rural-urban status, smoking rates and a Southern regional variable. Results  For both males and females, mortality rates in Appalachian counties with the highest level of coal mining were significantly higher relative to non-mining areas for chronic heart, respiratory and kidney disease, but were not higher for acute forms of illness. Higher rates of acute heart and respiratory mortality were found for non-Appalachian coal mining counties. Conclusions  Higher chronic heart, respiratory and kidney disease mortality in coal mining areas may partially reflect environmental exposure to particulate matter or toxic agents present in coal and released in its mining and processing. Differences between Appalachian and non-Appalachian areas may reflect different mining practices, population demographics, or mortality coding variability.     

海门市居民糖尿病与心脑血管疾病死亡率相关性分析

目的：从居民疾病死亡率来探讨糖尿病与心脑血管疾病的相关性。方法：通过海门市人口死因资料，应用SPSS14．0软件包进行Pearson相关分析。结果：海门市居民糖尿病、脑血管疾病、心血管疾病的死亡率，男性从1989年的1．98／10万、83．44／10万、20．22／10万，上升到2008年的19．74／10万、180．69／10万、44．21／10万；女性从1989年的4．52／10万、107．84／10万、27．89／10万，上升到2008年的22．95／10万、175．29／10万、62．53／10万，糖尿病的上升幅度特别明显，男女分别上升9．97倍、5．08倍。脑血管疾病（男r=0.922，女r=0.933）、心血管疾病（男r=0.902，女r=0.910）的死亡率与糖尿病的死亡率呈显著相关（P〈0．001），且脑血管疾病与心血管疾病的死亡率间也有相关性（男r=0．926，女r=0．939，P〈0.001）。结论：脑血管疾病、心血管疾病的死亡率与糖尿病的死亡率呈显著相关，临床学与流行病学专家应携手针对三种疾病的共同危险因素开展防治工作。     

Particulate matter exposures, mortality, and cardiovascular disease in the health professionals follow-up study

Background: The association of all-cause mortality and cardiovascular outcomes with air pollution exposures has been well established in the literature. The number of studies examining chronic exposures in cohorts is growing, with more recent studies conducted among women finding risk estimates of greater magnitude. Questions remain regarding sex differences in the relationship of chronic particulate matter (PM) exposures with mortality and cardiovascular outcomes.Objectives: In this study we explored these associations in the all-male Health Professionals Follow-Up Study prospective cohort.Methods: The same spatiotemporal exposure estimation models, similar outcomes, and biennially updated covariates were used as those previously applied in the female Nurses’ Health Study cohort.Results: Among 17,545 men residing in the northeastern and midwestern United States, there were 2,813 deaths, including 746 cases of fatal coronary heart disease (CHD). An interquartile range change (4 µg/m³) in average exposure to PM ≤ 2.5 µm in diameter in the 12 previous months was not associated with all-cause mortality [hazard ratio (HR) = 0.94; 95% confidence interval (CI), 0.87–1.00] or fatal CHD (HR = 0.99; 95% CI, 0.87–1.13) in fully adjusted models. Findings were similar for separate models of exposure to PM ≤ 10 µm in diameter and PM between 2.5 and 10 µm in diameter and for copollutant models.Conclusions: Among this cohort of men with high socioeconomic status living in the midwestern and northeastern United States, the results did not support an association of chronic PM exposures with all-cause mortality and cardiovascular outcomes in models with time-varying covariates. Whether these findings suggest sex differences in susceptibility or the protective impact of healthier lifestyles and higher socioeconomic status requires additional investigation.     

Regional variation in cardiovascular mortality in Australia 2009–2012: the impact of remoteness and socioeconomic status

Objective: To assess the extent to which socioeconomic status (SES) contributes to geographic disparity in cardiovascular disease (CVD) mortality. Methods: An ecological study assessed the association between remoteness and CVD mortality rates, and the mediating effect of SES on this relationship, using Australia‐wide data from 2009 to 2012. Results: Socioeconomic status explained approximately one‐quarter of the increased CVD mortality rates for females in inner and outer regional areas, and more than half of the increased CVD mortality rates in inner regional and remote/very remote areas for males, compared to major cities. After allowing for the mediating effect of SES, females living in inner regional areas and males living in remote/very remote areas had the greatest CVD mortality rates (Mortality Rate Ratio: 1.12, 95%CI 1.07–1.17; MRR: 1.15, 95%CI 1.05–1.25, respectively) compared to those in major cities. Conclusion: Socioeconomic status explained a substantial proportion of the association between where a person resides and CVD mortality rates; however, remoteness has an effect above and beyond SES for a number of subpopulations. Implications for public health: This study highlights the need to focus on both socioeconomic disadvantage and accessibility to reduce CVD mortality in regional and remote Australia.     

Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants

ObjectivesEmerging evidence suggests contrasting health effects for leisure-time and occupational physical activity. In this systematic review, we synthesized and described the epidemiological evidence regarding the association between occupational physical activity and cardiovascular disease (CVD) mortality.MethodsA literature search was performed in PubMed, Embase, CINAHL, PsycINFO and Evidence-Based Medicine Reviews, from database inception to 17 April 2020. Articles were included if they described original observational prospective research, assessing the association between occupational physical activity and CVD mortality among adult workers. Reviews were included if they controlled for age and gender and at least one other relevant variable. We performed meta-analyses on the associations between occupational physical activity and CVD mortality.ResultsWe screened 3345 unique articles, and 31 articles (from 23 studies) were described in this review. In the meta-analysis, occupational physical activity showed no significant association with overall CVD mortality for both males [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.87–1.15] and females (HR 0.95, 95% CI 0.82–1.09). Additional analysis showed that higher levels of occupational physical activity were non-significantly associated with a 15% increase in studies reporting on the outcome ischemic heart disease mortality (HR 1.15, 95% CI 0.88–1.49).ConclusionsWhile the beneficial association between leisure-time physical activity and CVD mortality has been widely documented, occupational physical activity was not found to have a beneficial association with CVD mortality. This observation may have implications for our appreciation of the association between physical activity and health for workers in physically demanding jobs, as occupational physical activity may not be health enhancing.     

Psychosocial determinants of premature cardiovascular mortality differences within Hungary

OBJECTIVES: The life expectancy gap between Central-Eastern European (CEE) countries, including Hungary, and Western Europe (WE) is mainly attributable to excess cardiovascular (CV) mortality in midlife. This study explores the contribution of socioeconomic, work related, psychosocial, and behavioural variables to explaining variations of middle aged male and female CV mortality across 150 sub-regions in Hungary. DESIGN: Cross sectional, ecological analyses. SETTING: 150 sub-regions of Hungary. Participants and METHODS: 12 643 people were interviewed in Hungarostudy 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were income, education, control in work, job insecurity, weekend working hours, social support, depression, hostility, anomie, smoking, body mass index, and alcohol misuse. MAIN OUTCOME MEASURES: Gender specific standardised premature (45-64 years) total CV, ischaemic heart disease, and cerebrovascular mortality rates in 150 sub-regions of Hungary. RESULTS: Low education and income were the most important determinants of mid-aged CV mortality differences across sub-regions. High weekend workload, low social support at work, and low control at work account for a large part of variation in male premature CV mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most noticeably to variations in premature CV mortality rates among women. Low social support from friends, depression, anomie, hostility, alcohol misuse and cigarette smoking can also explain a considerable part of variations of premature CV mortality differences. CONCLUSION: Variations in middle aged CV mortality rates in a rapidly changing society in CEE are largely accounted for by distinct unfavourable working and other psychosocial stress conditions.     

Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years

BACKGROUND: Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical activity, can account for relative differences in cardiovascular and all-cause mortality by educational level. METHODS: Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied. RESULTS: Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small. CONCLUSIONS: Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.     

Association between daily mortality from respiratory and cardiovascular diseases and air pollution in Taiwan

Background

Many studies have investigated the effects of air pollutants on disease and mortality. However, the results remain inconsistent and inconclusive. We thought that the impact of different seasons or ages of people may explain these differences.

Methods

Measurement of the five pollutants (particulate matter <10 μm in aerodynamic diameter (PM₁₀), SO₂, NO₂, O₃, and CO) was monitored by automated measuring units at five different stations. Monitoring stations were provided by the Taiwan Environmental Protection Agency (EPA) from 1997 to 1999. The subjects in the study were classified in two groups: those 65 years of age and older, and those of all ages (including the subjects in the ?65 group). Data on daily mortality caused by respiratory disease, cardiovascular disease, and all other causes including the two aforementioned was collected by the Taiwan Department of Health (DOH). A time-series regression model was used to analyze the relative risk of respiratory and cardiovascular diseases due to air pollution in the summer and winter seasons.

Results

Risk of death from all causes and mortality from cardiovascular diseases during winter was significantly positively correlated with levels of SO₂, CO, and NO₂ for both groups of subjects and additionally with PM₁₀ for the elderly (?65 years old) group. There were significant positive correlations with respiratory diseases and levels of O₃ for both groups. However, the only significant positive correlation was with O₃ (RR=1.283) for the elderly group during summer. No other parameters showed significance for either group.

Conclusion

Our findings contribute to the evidence of an association between SO₂, CO, NO₂, and PM₁₀ and mortality from respiratory and cardiovascular diseases, especially among elderly people during the winter season.     

Time trends of cardiovascular mortality and post-menopausal hormone use in Finland

The purpose of this paper was to study the relationship of post-menopausalhormone therapy to cardiovascular mortality by time trend analysis.Mortality and incidence figures by age and sex in 1970–1993in Finland were obtained from published and unpublished statisticsand the extent of hormone therapy use by age from previous nationwidesurveys. Percent changes in mortality were calculated for differentage groups and time periods (1970–1976, 1977–1987and 1988–1993, chosen by the extent of hormone use). Atheoretical reduction in mortality among 50–54 and 55–59year old women was calculated by using the time trends amongmen and older women (60–64 years) as the bases and bymultiplying the proportion of users by four hypothetical estimates(100, 50, 30, and 0% of benefit among users). The actual reductionin ischaemic heart disease and total cardiovascular mortalityin the age groups with highest post-menopausal hormone use wasnot larger than in other female age groups or among men. Until1987, the actual mortality of 50–54 and 55–59 yearold women was lower than that predicted from both the data ofolder women and men and from the assumed benefits of hormonetherapy. In the last time period the actual mortality was relativelynearer the predicted mortality both among 50–54 and 55–59year old women. This time trend analysis does not support theclaim that post-menopausal hormone therapy notably preventscardiovascular mortality.