Gastrointestinal cancer mortality in New Jersey counties, and the relationship with environmental variables

The State of New Jersey (NJ) USA has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for its 21 counties. This paper presents an analysis of gastrointestinal (GI) cancer mortality rates in New Jersey counties during 1968-1977, a comparison with the 1950-1969 rates, and associations between current GI cancer mortality rates and selected environmental variables. Age-adjusted mortality rates for GI cancers were calculated for the 21 NJ counties during the period 1968-1977, and were 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 distribution of chemical toxic waste disposal sites; annual per capita income; the rates of low birth weight, birth defects, and infant mortality; chemical industry distribution; percentage of the population employed in chemical industries; the density of population; and the urbanization index for each of the counties. Some of the major findings are: Age-adjusted GI cancer mortality rates (all sites combined) were higher than national rates in 20 of 21 NJ counties. In comparison with national trends, NJ stomach cancer rates have declined less, oesophageal cancer rates have declined more, and pancreatic cancer mortality rates have followed similar patterns. Cancer mortality rates in NJ during the period 1968-1977 significantly (p less than 0.0001) exceeded national rates for cancer of the oesophagus (white male, non-white male), stomach (men and women), colon (white male, white female, non-white female), and rectum (whites only). In 18 of the 21 NJ counties, the observed number of cancer deaths for at least one GI cancer site was significantly greater than expected at the 0.0001 level for at least one population subgroup. Among white men, a significant (p less than 0.0001) excess of observed over expected cancer deaths was observed for three or more GI cancer sites in seven counties. The environmental variables that were most frequently associated with GI cancer mortality rates (except pancreatic cancer) were degree of urbanization, population density, and chemical toxic waste disposal sites. Some of the implications of the study findings are discussed and recommendations made for future investigations.     

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.     

Patterns of infant mortality and cancer death in Alabama, USA

Aim  To use recent information of infant and cancer mortality in Alabama counties of the USA to test their relationships with social, economic, and environmental conditions at a large scale to identify potential public health issues. Subjects and methods  The data of infant mortality rates and cancer deaths in the recent years, biodiversity, including species number of plants, fishes, reptiles, and amphibians, roadless areas, metropolitan areas, river basins, African-American and minority populations, and per person income for all 67 Alabama counties were obtained and organized by geographic information system. The relationships between infant mortality rates and cancer deaths and social, economic, and environmental conditions at a large scale were analyzed. Results  Infant mortality was significantly higher in African-American and other minority populations than in white populations, but cancer mortality was higher in white populations than in African-American and minority populations. There was no significant difference in infant mortality rate between populations in the urban areas and the rural areas, but the mortality rate of cancers was significantly higher in the rural population than in the urban population. Mortality rates for cancers in wealthy counties were lower than in poorer counties. The incidences of infant and cancer mortality were lower in counties with higher biodiversity. The emergent spatial pattern suggests that the incidences of infant and cancer mortality were higher in the Sipsey/Warrior River Basin, Coosa/Tallapoosa River Basin, and Conecuh River Basins. Conclusion  This study indicates that ethnic disparities in infant and cancer mortality still exist in Alabama. This study also suggests that pattern analyses at larger scales can provide new insight for understanding public health.     

Contribution of birth defects to infant mortality among racial/ethnic minority groups, United States, 1983

Linked birth/infant death data from the National Center for Health Statistics (NCHS) for the 1983 U.S. birth cohort, the latest year for which linked data were available, were evaluated in order to assess the contribution of birth defects to infant mortality among racial/ethnic groups. Of the 34,566 singleton infant deaths with specified birth weight born to U.S. residents, birth defects were listed as an underlying cause of death for 7,678 (22.2%) infants and as a contributing cause of death for an additional 1,006 (2.9%) infants. Infant mortality rates due to birth defects were highest among American Indians (2.9 deaths/1,000 live births), followed by Asians and Hispanics (2.6), and blacks (2.5). Proportional mortality due to birth defects varied among racial/ethnic groups; it was greatest among Asians (27%), followed by whites (25%), Hispanics (24%), American Indians (18%), and blacks (13%). Also, infant mortality rates due to birth defects were high among minority infants of low birth weight, particularly among those born weighing between 1,500 and 2,499 g. Within this group of infants, proportional mortality due to birth defects ranged from 52% among Asians to 29% among blacks. These data indicated that birth defects were an important contributor to infant mortality among all racial/ethnic groups. Birth-defects surveillance systems should be used to evaluate whether racial/ethnic differences in infant mortality from birth defects are due to differences in incidence and/or survival among minority infants with birth defects.     

Risk factors for infant mortality from diseases in Japan 1995-98

OBJECTIVE: Since 1995, additional information (i.e. birth weight, singleton/multiple births, gestational weeks, maternal age, maternal parity and stillbirth experience) has been required for certificates of infant (less than 1 year of age) death from diseases in Japan. The present study examined the effects of biological, demographic and social variables, as reported on birth and death certificates, on infant, neonatal and postneonatal mortality in Japan. METHODS: Using data from vital statistics between 1995 and 1998, more than 4,787,000 livebirths and 16,000 infant deaths from diseases were analyzed. Univariate and multivariate analyses with the Poisson regression model were employed to assess the effects of variables on infant, neonatal and postneonatal mortality by singleton and multiple livebirths separately. RESULTS: The infant mortality rates from diseases were 3.2/1000 for singleton livebirths and 17.7/1000 for multiple livebirths. In singleton livebirths, low birth weight, infant born in earlier years, being a male infant, employment status as "unemployed or unknown", short gestational weeks, late birth in multiparity and maternal stillbirth experience were all significantly related to increased risk of neonatal and postneonatal deaths. Teenage mother were also at high risk of postneonatal deaths. Regional differences were observed. Compared with singleton livebirths, birthweight-specific mortality rates in multiple livebirths were relatively low among infants weighing under 2500 g. In multiple livebirths, elevated risk of death was associated with low birth weight, infant born in earlier years, employment status as "unemployed or unknown" and short gestational weeks. However, late birth in multiparity was related to a reduced risk of death, and maternal stillbirth experience was not a significant variable. CONCLUSION: This study provided the first quantitative estimate of risk of infant mortality from diseases in Japan. Since a more detailed elucidation of actual conditions and risk factors of infant deaths by vital statistics has become possible, efficient measures for improvement of infant mortality are to be expected.     

Overview of the National Infant Mortality Surveillance (NIMS) project--design, methods, results

The recent slowdown in the decline of infant mortality in the United States and the continued high risk of death among black infants (twice that of white infants) prompted a consortium of Public Health Service agencies to collaborate with all States in the development of a national data base from linked birth and infant death certificates. This National Infant Mortality Surveillance (NIMS) project for the 1980 U.S. birth cohort provides neonatal, postneonatal, and infant mortality risks for blacks, whites, and all races in 12 categories of birth weights. (Note: Neonatal mortality risk = number of deaths to infants less than 28 days of life per 1,000 live births; postneonatal mortality risk = number of deaths to infants 28 days to less than 1 year of life per 1,000 neonatal survivors; and infant mortality risk = number of deaths to infants less than 1 year of life per 1,000 live births.) Separate tabulations were requested for infants born in single and multiple deliveries. For single-delivery births, tabulations included birth weight, age at death, race of infant, and each of these characteristics: infant's live-birth order, sex, gestation, type of delivery, and cause of death; and mother's age, education, prenatal care history, and number of prior fetal losses at 20 weeks' or more gestation. An estimated 95 percent of eligible deaths were included in the NIMS tabulations. The analyses focus on three components of infant mortality: birth weight distribution of live births, neonatal mortality, and postneonatal mortality. The most important predictor for infant survival was birth weight, with an exponential improvement in survival by increasing birth weight to its optimum level. The nearly twofold higher risk of infant mortality among blacks was related to a higher prevalence of low birth weights and to higher mortality risks in the neonatal period for infants weighing 3,000 grams or more, and in the postneonatal period for all infants, regardless of birth weight. Regardless of other infant or maternal risk factors, the black-white gap persisted for infants weighing 2,500 grams or more.     

Some mechanisms linking economic inequality and infant mortality

We use data from the 1985, 1987 and 1991 United States Vital Statistics Linked Infant Birth and Death Records to assess the relationship between state-level economic inequality and an infant's probability of death. We find that economic inequality is associated with higher neonatal mortality even after we control mother's age and race and state characteristics that are likely to be associated with both inequality and infant death. Inequality is not associated with post-neonatal mortality. We assess three mechanisms that could link income inequality and infant deaths: non-linearity in the relationship between parental income and infant death, economic segregation, and state health care spending. Our evidence suggests that non-linearity in the relationship between family income and infant health accounts for little of the relationship between inequality and infant death. However inequality is associated with greater economic segregation, which in turn is associated with a higher probability of infant death. This effect is partially offset by the fact that inequality is also associated with state spending on health care, which is in turn associated with lower death rates. The increase in economic segregation increased infant deaths more than the increase in health care spending reduces them, so the net effect of economic inequality is to increase infant deaths especially in the first month after birth.     

Infant mortality in three population-based cohorts in Southern Brazil: trends and differentials

We studied time trends in infant mortality and associated factors between three cohort studies carried out in Pelotas, Rio Grande do Sul State, Brazil, in 1982, 1993, and 2004. All hospital births and deaths were determined by means of regular visits to hospitals, registrar's offices, and cemeteries. This data was used to calculate neonatal, post-neonatal, and infant mortality rates per thousand live births. Rates were also calculated according to cause of death, sex, birth weight, gestational age, and family income. The infant mortality rate fell from 36.4 per 1,000 live births in 1982 to 21.1 in 1993 and 19.4 in 2004. Major causes of infant mortality in 2004 were perinatal causes and respiratory infections. Mortality among low birth weight children from poor families fell 16% between 1993 and 2004; however, this rate increased by more than 100% among high-income families due to the increase in the number of preterm deliveries in this group. The stabilization of infant mortality in the last decade is likely to be due to excess medical interventions relating to pregnancies and delivery care.     

Variations in infant mortality rates among municipalities in the state of Ceará, Northeast Brazil: an ecological analysis.

BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceará, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceará, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceará.     

The postponement of neonatal deaths into the postneonatal period: evidence from Massachusetts

Part of the slow decline in the postneonatal mortality rate and the rapid decline in the neonatal mortality rate during the 1970s may have been due to a postponement of some neonatal deaths into the postneonatal period. The authors hypothesized that any such postponement should be accompanied by a lack of decline, or even an increase, in late neonatal and postneonatal mortality rates among low birth weight babies and babies dying of conditions originating in the perinatal period. To examine this theory, the authors used vital records data to compare infant mortality rates in Massachusetts during 1970-1972 with rates during 1978-1980. Log-linear hazard models were used to calculate death rates, while controlling for changes in maternal age, race, education, and prior reproductive history. The authors found that babies of birth weight under 1,500 g had no decline in late neonatal mortality rates and babies of birth weight under 2,500 g had no decline in postneonatal mortality rates. Babies of birth weight 500-999 g had an increased postneonatal mortality rate (rate ratio = 2.4; 95% confidence limits = 1.0-5.4). These unimproved or increased death rates were due in part to conditions originating in the perinatal period. The authors conclude that, although infant mortality rates have declined, this postponement was real, and that efforts to monitor infant mortality will benefit from its routine quantification.     

Mortality Data System: a case study on municipalities with data underreporting

The study was part of a survey conducted in clusters of Brazilian municipalities (counties) characterized by serious underreporting of deaths, with the objective of estimating infant mortality in these areas in 2000. The article discusses the principal sources of information on infant deaths in these municipalities, as well as some problems related to the implementation of the Mortality Data System (SIM). The methodology included an active search for deaths in previously registered official and unofficial sources, which identified 344 deaths not processed in the SIM (66% of total deaths). There were a low percentage of deaths processed in the SIM and coming from official sources (notary public offices and healthcare facilities), thus highlighting problems with reporting of deaths, issuing of death certificates, and data flows. The important contribution by the Community Health Agents Program/ Family Health Program points to the need for active data search in this source as a routine activity in municipalities with underreporting of data. Insufficient training of professionals and high staff turnover were major issues in the system's deficient implementation.     

Cancer Mortality Rates in Appalachia: Descriptive Epidemiology and an Approach to Explaining Differences in Outcomes

Cancer is a leading cause of death in the Appalachian region of the United States. Existing studies compare regional mortality rates to those of the entire nation. We compare cancer mortality rates in Appalachia to those of the nation, with additional comparisons of Appalachian and non-Appalachian counties within the 13 states that contain the Appalachian region. Lung/bronchus, colorectal, female breast and cervical cancers, as well as all cancers combined, are included in analysis. Linear regression is used to identify independent associations between ecological socioeconomic and demographic variables and county-level cancer mortality outcomes. There is a pattern of high cancer mortality rates in the 13 states containing Appalachia compared to the rest of the United States. Mortality rate differences exist between Appalachian and non-Appalachian counties within the 13 states, but these are not consistent. Lung cancer is a major problem in Appalachia; most Appalachian counties within the 13 states have significantly higher mortality rates than in-state, non-Appalachian counterparts. Mortality rates from all cancers combined also appear to be worse overall within Appalachia, but part of this disparity is likely driven by lung cancer. Education and income are generally associated with cancer mortality, but differences in the strength and direction of these associations exist depending on location and cancer type. Improving high school graduation rates in Appalachia could result in a meaningful long term reduction in lung cancer mortality. The relative importance of household income level to cancer outcomes may be greater outside the Appalachian regions within these states.     

Infant mortality and low birth weight among black and white infants--United States, 1980-2000

Despite substantial reductions in U.S. infant mortality during the past several decades, black-white disparities in infant mortality rates persist. One of the Healthy People 2010 national objectives for maternal and infant health is to reduce deaths among infants aged < 1 year to < or = 4.5 per 1,000 live births among all racial/ethnic groups (objective 16-1c). Important determinants of racial/ethnic differences in infant mortality are low birth weight (LBW), defined as < 2500 grams, and very low birth weight (VLBW), defined as < 1500 grams. High birth weight-specific mortality rates (BWSMRs) occur at these low birth weights. Healthy People 2010 goals include reducing LBW to 5% and VLBW to 0.9% of live births (objectives 16-10a and 16-10b, respectively). To assess progress toward meeting these national objectives, CDC analyzed birth and death certificate data from the National Center for Health Statistics. This report describes trends in mortality and birth weight among black and white infants, which indicate persistent black-white disparities and underscore the need for prevention strategies that reduce preterm delivery and specific medical conditions that lead to infant death.     

Socio-spatial inequalities in the adequacy of Ministry of Health data on births and deaths at the municipal level in Brazil, 2000-2002

This study analyzed socio-spatial inequalities in the adequacy of Ministry of Health data systems on live births (SINASC) and deaths (SIM) for estimating infant mortality at the municipal level in Brazil. Data from 2000-2002 for all municipalities were analyzed according to population size and geographic region. Five indicators were considered: age-standardized mortality rate; ratio of reported-to-estimated live births; relative mean deviation of the mortality rate; relative mean deviation of the birth rate; and proportion of deaths with undetermined causes. Adequacy criteria were established statistically for eight Brazilian States in which vital statistics were adequate. The results showed important socio-spatial inequalities: in general, the proportion of adequate vital statistics was higher in the Central-South of the country and in larger municipalities. The live birth data system received the best evaluation for three items. The mortality data system requires both a reduction in underreporting and improved data on cause of death in order to orient health programs focused on decreasing inequalities in infant mortality in Brazil.     

江西省第3次死因回顾恶性肿瘤调查结果分析

目的 分析江西省第3次死因回顾调查地区恶性肿瘤死亡分布特点和流行趋势,为制定恶性肿瘤干预措施提供依据.方法 抽取2004-2005年全国第3次死因回顾调查江西省2个市6个县恶性肿瘤死亡资料,按性别和地区分别计算恶性肿瘤死亡专率、恶性肿瘤死因构成比、年龄别恶性肿瘤死因构成比、中国和世界人口标化死亡率(简称中标率、世标率)、恶性肿瘤死因顺位.结果 2004-2005年江西省恶性肿瘤死亡病例7842例,死亡率为115.37/10万,男性为144.59/10万,女性为83.77/10万;中标率为83.41/10万,男性为110.03/10万,女性为56.68/10万;世标率为110.34/10万.恶性肿瘤死亡率男性高于女性,城市高于农村,差异均有统计学意义(P＜0.01).江西省居民恶性肿瘤死亡的前5位分别为肺癌、肝癌、胃癌、结直肠癌和食管癌.前3位恶性肿瘤死因中城市依次为肺癌、肝癌和胃癌,农村依次为肝癌、胃癌和肺癌.结论 江西省第3次死因回顾调查地区恶性肿瘤死亡率低于全国平均水平,而高于西部地区水平,肺癌、肝癌和胃癌是严重危害江西省城乡居民最主要的肿瘤死因.     

The epidemiology of necrotizing enterocolitis infant mortality in the United States.

OBJECTIVES: This study examined trends and risk factors for infant mortality associated with necrotizing enterocolitis in the United States. METHODS: Necrotizing enterocolitis-associated deaths and infant mortality rates from 1979 through 1992 were determined by means of US multiple cause-of-death and linked birth/infant death data. RESULTS: Annual necrotizing enterocolitis infant mortality rates decreased from 1979 through 1986 but increased thereafter and were lower during the 3-year period before (1983 through 1985;11.5 per 100,000 live births) the introduction of surfactants than after (1990 through 1992; 12.3 per 100,000). Low-birthweight singleton infants who were Black male, or born to mothers younger than 17 had increased risk for necrotizing enterocolitis-associated death. CONCLUSIONS: As mortality among low-birth weight infants continues to decline and smaller newborns survive early causes of death, necrotizing enterocolitis-associated infant mortality may increase.     

The effect of terminations of pregnancy for fetal abnormalities on trends in mortality to one year of age in Western Australia

Summary highlighted the contribution of birth defects. Over this time there has also been an increasing number of terminations of pregnancy for fetal abnormality. However, the effect of these terminations on mortality rates in Australia has not yet been estimated. The Western Australian Birth Defects Registry (BDR) records all birth defects that are diagnosed in stillbirths, livebirths and in pregnancies terminated because of a fetal abnormality. All cases on the BDR over the period 1980-98 were categorised into one of eight main birth defect groups and analysed in four time periods to show trends. Linkage provided information on deaths to one year of age, defined as perinatal plus postneonatal deaths. The proportion of terminations for fetal abnormality that would have resulted in a death before one year of age was estimated in two ways. The first method used the proportion of births with a birth defect in each diagnostic category that resulted in a death. The second method involved determination of likelihood of survival to one year of all terminations for fetal abnormality through independent review by two experts. Whilst mortality to one year of age for all birth defects has declined from 4.36/1000 births in 1980-84 to 2.75/1000 births in 1995-98, terminations of pregnancies for fetal abnormalities increased from 1.19/1000 births to 4.70/1000 births. After including the estimated mortality associated with terminations for fetal abnormality, the decline in mortality to one year of age associated with birth defects from 1980 to 1998 changed from a 37% reduction to a 15% reduction based on observed mortality 1980-84, and an 11% increase in mortality based on individual case review, highlighting the importance of considering terminations in mortality analyses.     

Differences in cause-specific infant mortality among Chinese, Japanese, and white Americans.

Although black-white differences in infant mortality have received much attention, information is limited about mortality differentials among Asian Americans. This study investigated racial differences in infant mortality in a sample of 21,288 Chinese, 11,882 Japanese, and 65,818 white resident singleton livebirths obtained from the National Center for Health Statistics 1983 and 1984 linked birth/infant death files. The crude infant mortality rates were 8.03, 6.56, and 8.46 per 1,000 livebirths for Chinese, Japanese, and white births, respectively. Cause-specific mortality varied considerably among the three racial groups. While the Japanese had lower rates of infant deaths and deaths from perinatal conditions for firstborn infants, they had higher rates of sudden infant death syndrome, as did Chinese females. The results of a logistic regression analysis indicate that the racial differences in total and cause-specific mortality persist when adjustment is made for demographic factors, use of prenatal care, infant sex, and birth weight. The effect of these latter variables on infant mortality varied by causes of death. The relations between infant mortality and variables such as marital status, maternal education, and birth interval appear indirect, operating partially through birth weight. While birth weight was the single strongest determinant of infant mortality, its relative importance varied by cause of death. The study findings suggest that policy decisions surrounding racial differences in infant mortality should not only be considered in light of specific races, but also with regard to cause-specific mortality. Moreover, additional research is needed to understand the cultural, biological, and behavioral factors that give rise to the racial differences.