Leading causes of death among children under 5 years of age in the various population groups of the RSA in 1970

The mortality rates (MRs) of children under 5 years of age in the various population groups of the RSA were calculated as deaths/10(5) for various causes of death and groupings of causes of death as classified by the International Classification of Diseases. In 1970 the ten leading causes of death among Coloured and Black children under 5 years of age in the RSA were similar to those among children in developing countries. The rank order of causes of death (in MRs/10(5] among Coloured children was as follows: gastro-enteritis (1 733), pneumonia (725), immaturity (405), ill-defined causes of death (168), nutritional deficiencies (167), measles (126), anoxia (97), 'other bacterial diseases' (91), inflammatory diseases of the nervous system (55) and tuberculosis (48). The ten leading causes of death among White children in the RSA were characteristic of children in Western developed countries. The rank order (in MRs/10(5] was as follows: immaturity (144), anoxia (94), pneumonia (46), gastro-enteritis (41), congenital heart disease (32), other accidents (19), birth injury (19), ill-defined causes of death (12) and inflammatory diseases of the nervous system (11).     

Variations in mortality of the coloured, white and Asian population groups in the RSA, 1978-1982. Part IV. Respiratory diseases

Respiratory diseases are major causes of death in South Africa. The reported mortality rates (MRs) for: (i) pneumonia and influenza; (ii) chronic obstructive lung disease and allied conditions; (iii) pulmonary tuberculosis; and (iv) carcinoma of the lung and bronchus over a 5-year period are examined in relation to age, sex, ethnic group and year. Such data have not previously been reported in South Africa. MRs for all respiratory diseases (except lung carcinoma) were substantially higher in coloureds than in whites or Asians. In each ethnic group and for each disease category, MRs for males were higher than for females, especially in those over the age of 24 years. For all, except lung carcinoma, MRs were highest at the extremes of life. Changes in respiratory disease MRs over the 5-year period were examined by calculating the age standardised MRs for each condition in each of the 5 years. There was a clear decline in the MR for pneumonia over this period in all groups. The MR for chronic obstructive pulmonary disease rose in all groups, except Asian females. Similarly, the MR for carcinoma increased in all groups, except white females. The MR for tuberculosis was highest in coloured males (10 times greater than in Asian males and 100 times greater than in white females). The pattern of respiratory disease MRs in white South Africans is very similar to that in the USA, whereas in coloureds MRs for infectious diseases remain high and are added to by the burden of cigarette smoking-related deaths.     

Mortality rates of black infants in Soweto compared with other regions of South Africa

Mortality rates (MRs)/100,000 for 1980 were calculated for black infants under 1 year of age for all causes of death and for the leading causes of death--gastro-enteritis, ill-defined causes, perinatal conditions, and the pneumonias--in three regions, Soweto, the 34 'selected' magisterial districts (all urban) and the rural areas in the RSA. The results showed a low MR for all causes of death (2813,7/100,000) and a low ranking of gastro-enteritis (third) in Soweto. In contrast the infant health situation in the 34 'selected' magisterial districts showed an MR from all causes of death which was three times higher (8,594/100,000) than in Soweto and gastro-enteritis was the leading cause of death with an MR 10 times higher than in Soweto. If the infant deaths and infant population in Soweto are subtracted from these figures in the 34 'selected' magisterial districts the MR is 10,156,8/100,000. Valid comparisons between the MRs of the rural areas and either Soweto or the 34 'selected' magisterial districts cannot be made. The MRs of the causes of death in the rural areas of 3,456/100,000 are palpably incorrect and due to under-reporting. An estimation of the under-reporting is that at least 20,000 infant deaths in rural areas were not reported in 1980, compared with the 14,327 deaths which were reported.     

Trends in age-specific mortality rates for ischaemic heart disease, 1968 - 1977

Age-specific mortality rates (MRs) were calculated for each year of the period 1968 - 1977 for ischaemic heart disease (IHD) in males and females of the USA, Australia, Finland, Scotland, England and Wales, and of South Africa (Whites). The age range studied, in 10-year intervals, was 15 - 64 years. In the younger age groups (15-24, 25-34 and 35-44 years) the MRs of White South Africans were two to three times as high as those of other populations over the whole 10-year period. In the older age groups the differences narrowed. MRs for IHD in the USA decreased markedly in all age groups over the period studied, the decreases varying from 20% to 40%. Decreases in MRs for IHD also occurred among Australians and Finns but were neither as consistent nor as large as those occurring in the USA. No consistent changes were observed in the other three populations.     

A comparison of mortality rates from cancer in white, Indian and coloured adults in 1970 and 1980

In 1980 lung cancer was associated with the highest mortality rate (MR) in white, Indian and coloured men in the RSA. MRs for this type of cancer were higher in 1980 than in 1970 in all three populations, the increase of 47% in that for coloured men being especially marked. On the other hand, MRs for stomach cancer were lower in 1970 than in 1980 in men from all three populations; however, this type of cancer was still associated with the second highest MR in all groups in 1980. Breast and lung cancer had the highest MRs in white women. In this group there was little change in the MR for breast cancer, but a 27% increase in that for lung cancer over the 10-year period. The three types of cancer associated with the highest MRs in coloured women were cancer of the cervix, breast and stomach. In this group the MR for breast cancer dropped by 22% and that for lung cancer increased by 135% over the 10-year period. In Indian women MRs for cancer of the stomach, breast and cervix ranked highest, a marked increase occurring only in the MR for breast cancer. The MR for lung cancer in Indian women showed a decrease of 71% in 1980 compared with 1970.     

Deaths from and mortality rates for largely preventable causes of death in whites in the RSA. Comparison of the situations in 1970 and 1980

The numbers of deaths from and age-adjusted mortality rates (MRs) for largely preventable causes of death in white males and females aged 15 - 64 years in 1970 and 1980 were compared. The causes of death considered were lung cancer, ischaemic heart disease (IHD), cerebrovascular disease, chronic lung diseases, cirrhosis of the liver, motor vehicle accidents and suicide. In spite of an increase in the white population in this age group from 2,39 million in 1970 to 2,93 million in 1980, the number of deaths from the above causes decreased, with two exceptions. The exceptions were lung cancer, where the number of deaths increased from 482 in 1970 to 535 in 1980, and suicide--up from 433 to 516. The decreases over the 10-year period were substantial in some cases. For example, the number of deaths from IHD fell from 4000 to 3486. The MRs (those for 1980 were age-adjusted) decreased over the 10-year period in all cases, except in the case of lung cancer where the MR remained at 20/100 000. This seems to indicate that anti-smoking campaigns in RSA have not yet begun to influence the incidence of this disease in the white population.     

Decline in the ischaemic heart disease mortality rates of South Africans, 1968-1985

The age-adjusted ischaemic heart disease (IHD) mortality rates (MRs) of white, Asian and coloured South Africans aged 35-74 years were studied for the period 1968-1985. Asians have the highest IHD MR in the RSA, followed by whites, coloureds and then blacks. Asian female have much higher rates than females in the other groups, especially in the older age groups. Asian males have noticeably higher rates in the younger age groups. Coloured females aged 35-44 years have a surprisingly high rate. Declines of 36.5% (from 482 to 306/100,000) for whites between 1970 and 1985, 27.5% (from 583 to 422/100,000) for Asians between 1973 and 1985, and 19.5% (from 287 to 231/100,000) for coloureds between 1976 and 1985 were observed. Rates declined among both males and females as well as in all the age groups studied. Trends in IHD MRs for black South Africans were studied for 1978-1985. The MRs for IHD among blacks are very much lower than those for South African Asians, coloureds and whites. The age-adjusted IHD MR for all South Africans was 162/100,000 in 1978 and had dropped to 121/100,000 in 1985, a 25.3% decline.     

Trends in adolescent pregnancies at Tygerberg Hospital, 1976-1980

This study was undertaken to highlight trends relating to pregnancies among females aged less than 21 years seen at Tygerberg Hospital, Parowvallei, CP, during the 5-year period 1976-1980 inclusive. There was a fairly steady decline in the pregnancy rate for Coloured adolescents over this period. The rate for Black adolescents increased after a 3-year decline, and that for Whites also increased after a 2-year drop. The caesarean section rate increased after a marked drop in 1978, both in White adolescents and in the White group as a whole, possibly due to an increase in the instrumental delivery rate in 1978. The caesarean section rate has increased steadily among non-Whites, while the forceps delivery rate for non-Whites declined to below the normal level of 15% and that for Whites fell after a steep increase in 1978. Vacuum extractions appeared to be very popular during the first 3 years, but the rates declined rapidly towards 1979-1980, particularly in the White group. Pre-eclamptic toxaemia remains a problem among White adolescents. Among both Whites and non-Whites 1978 seems to have been a disastrous year as far as the outcome of pregnancies is concerned, with an increase in the incidence of miscarriage. A drop in the non-White stillbirth rate in 1978 was followed by a sharp rise in 1979-1980. The incidence of abruptio placentae and placenta praevia rose in 1978, but in 1979-1980 dropped to below 10% for Whites and to below 15% for non-Whites. Premature deliveries are still common among non-Whites, with average incidences of 23% for the 5-year period for non-Whites and 8,5% for Whites. Pregnancy rates for unmarried Coloured and Black adolescents remain high, and the rate for Whites increased slightly over the 5-year period.     

Acute respiratory infections as an important cause of childhood deaths in South Africa

Compared with other major preventable childhood diseases, such as diarrhoea, acute respiratory infections (ARI) have received comparatively little attention as an important cause of death in children. In this study of mortality from ARI in South Africa, national data was examined for the period 1968-1985, and data for Greater Cape Town for 1987. Almost 90% of ARI deaths were attributable to pneumonia and large inter-group differences were found that favoured whites and Asians over blacks and coloureds. For example, during 1980-1985 the mortality rate for pneumonia in coloured infants under 1 year of age was 11 times that observed in whites (88 v. 981/100,000). Pneumonia accounted for 14.5% of coloured and 12.7% of black deaths under 1 year of age during this period, compared with 6.7% of white and Asian deaths. The mortality rates from pneumonia declined substantially (50%) over the 18-year period in whites, coloureds and Asians. Sequential data for blacks is not available. There was a marked seasonality of deaths among coloured and Asian infants, with rates peaking in winter months. In Cape Town, pneumonia is now a more important cause of death among white and coloured children than diarrhoea, while it ranks with diarrhoea as a cause of death in black children. In all population groups, death rates from ARI are from 7 times to 270 times greater than those recorded in Western European countries. Studies are urgently required to discover why South African children suffer such a high mortality from ARI and how these deaths can be prevented.     

Comparison of mortality rates for cancer in black adults--1970 v. 1980

Mortality rates (MRs) for cancer in black men and women, aged 25-74 years, in the 34 'selected' (urban) magisterial districts were calculated for 1980 and compared with the MRs for cancer in 1970. All MRs were age-adjusted to the age distribution of the white population in 1970 to enable valid comparisons to be made. A notable feature was the increase in MRs for cancer of the oesophagus and cancer of the lungs over the period. Cancer of the liver was among the three leading causes of deaths from cancer in both black men and women, which contrasted markedly with the situation in the other populations of the RSA. Examination of MRs for all causes of death and of deaths from cancer in the 16.9 million black population in 1980 suggests that there was a very substantial under-reporting of deaths, particularly in the rural areas of RSA. It is estimated that around 60,000 deaths were not reported. The implications of this finding are discussed and an interim solution proposed.     

Changes in infant mortality rates among whites, coloureds and urban blacks in the RSA over the period 1970-1983

Using national mortality statistics, we found that infant mortality rates (IMRs) declined among whites and coloureds in the RSA over the period 1970-1983, the decrease in coloured IMR being from 134,8 to 50,7/1 000 and that in white IMR from 21,6 to 12,6/1 000. The decrease in the IMR among coloureds was mainly due to the decline in post-neonatal mortality rates (PNMRs). Since post-neonatal deaths are generally due to gastro-enteritis, pneumonia, malnutrition and measles, the decline in mortality is probably due to a decrease in these causes. The decrease in early neonatal mortality made only a small contribution to the decline in the IMR among coloureds. In the case of whites the decrease in the IMR was largely due to the decline in the early neonatal mortality rate (ENMR); these deaths usually result from low birth weight, the respiratory distress syndrome, asphyxia and infections. The decline in the PNMR played a minor role. National IMRs for blacks are not reported annually, but IMRs can be calculated for the two census years 1970 and 1980 for blacks in 34 'selected' (urban) magisterial districts, and were 124,4 and 85,9/1 000 respectively. A valid IMR for 'rural' Transkei from a well-conducted epidemiological study was 130/1 000 in 1980. The components of the IMRs for blacks can only be determined for certain urban areas with large black populations such as Soweto (adjacent to Johannesburg), where the IMR fell from 81,4/1 000 in 1970 to 25,5/1 000 in 1983. The decline in the IMR was due to decreases in both the ENMR and the PNMR.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mortality from cardiovascular diseases in the various population groups in the Republic of South Africa

Cardiovascular mortality rates (MRs) for 1970 were calculated from Department of Statistics reports for the various populations of the RSA and showed that the MRs for chronic rheumatic heart disease were highest in Coloureds and lowest in Whites, the rates for Asians and Blacks being intermediate, and that a relatively high proportion of all cardiovascular deaths in the 15- 24-year group were due to this disease. It was also found that the pattern of cardiovascular diseases differed in the various population groups as follows: in White males the MRs for ischaemic heart disease (IHD) were high (4 times the rate for cerebrovascular disease (CVD). In White females the MRs for IHD and CVD were similar and accounted for most deaths from cardiovascular disease. The MRs for hypertensive disease were low in Whites. Asians in the older age groups had the highest MRs for IHD, CVD and hypertensive disease of all the population groups. The MRs for IHD of Asians in general exceeded those of Whites. Coloureds had high MRs for CVD, relatively high MRs for hypertensive disease and other forms of heart disease (mainly ill-defined heart disease) and relatively low MRs for IHD (compared with Asians and Whites). Blacks had high MRs for CVD and other forms of heart disease (mainly ill-defined heart disease), relatively high MRs for hypertensive disease and very low MRs for IHD. The MRs for cardiovascular diseases in Blacks are not reliable.     

Characteristics of infant mortality in the RSA 1929-1983. Part II. Causes of death among white and coloured infants

The relative contribution of different causes of death in the first year of life is presented for the period 1929-1983. Infections and perinatal and respiratory causes most commonly result in infant death among coloureds, while perinatal and congenital causes are commonest among whites. Over the 54-year period studied the mortality rate due to infections has fallen dramatically among whites but much less so among coloureds. The two causes of death for which the ratios of coloured to white mortality are highest, viz. infections (28 times) and respiratory causes (9 times), are those which have the greatest post-neonatal mortality component.     

Causes of death in aged burn patients: analysis of 36 cases

Over a 10-year period 110 patients over the age of 65 years were admitted to the Burn Center, Rui Jin Hospital and 36 (32.7 per cent) died. Significant differences between the survivors and non-survivors were related to the total burn surface area and full skin thickness burn size. Among the causes of death, pre-existing cardiopulmonary diseases and associated inhalation injury were particularly important since pneumonia was considered as a primary cause of death in 13 patients, myocardial disease in two, cor-pulmonale and heart failure in two. Care of the early fluid resuscitation, early excision of deep burn wounds and grafting, prevention or treatment of a variety of life-threatening complications, and nutritional supplementation appeared to decrease the mortality of aged burn patients.     

Causes of death in a rural hospital in 1983

All 749 deaths recorded by a rural hospital during 1983 were listed in five age groups according to the 9th revision of the International Classification of Diseases. The largest number of deaths were in adults aged 50 years and over and in children aged under 2 years, and the most frequent causes of death were malnutrition, hypertension, prematurity, heart failure and gastro-enteritis.     

Cause- and age-specific mortality rates from accidents, poisoning and violence

Cause- and age-specific mortality rates (MRs) were calculated for 1980 for all four population groups in the RSA for certain accidents, poisonings and violence as they are grouped in the WHO International Classification of Diseases (ICD). Cause-specific MRs of coloureds, Asians and blacks were age-adjusted to the age-distribution of whites in 1980 in order to judge the relative importance of the various causes of death. This showed that in whites and Asians motor vehicle accidents (MVAs) head the rank order of MRs; furthermore the first three MRs in the rank order, namely for MVAs, suicide and violence, are common in these two populations. A similar situation exists among coloureds and blacks in that the MRs for homicide rank first and the first four causes of death in the rank order of MRs--homicide, MVAs, violence and other accidents--are common to those two population groups. The fact that deaths from MVAs and violence rank so high in the MRs for all four population groups lends support to the contention that the RSA is a 'violent society'.     

Increasing Survival and Changing Causes of Death in Myelopathy Patients

ABSTRACT

Survival, mortality rates, and causes of death were determined for 132 myelopathy patients during the 9-year period between April 1973 and March 1982. The average age was 54; 81% were paralyzed by trauma. Average survival was 15 years. Myelopathy mortality was eight times that of the general population for the third decade of life but comparable by the seventh decade. The major causes of death were pulmonary (41 patients- 71% with pneumonia or bronchitis), vascular (37 patients- 54% with ischemic heart disease), gastrointestinal (19 patients—42% with carcinoma, 32% with peritonitis). and urinary (16 patients- 50% with renal failure and 44% with carcinoma). As survival of myelopathy patients has improved, deaths due to pneumonia, ischemic heart disease, carcinoma, and renal failure have become the major causes of death.     

Smoking and chronic respiratory symptoms in 11--15 year-old children

A questionnaire was used to assess the prevalence of smoking and chronic respiratory symptoms in 315 White and 290 Coloured children in the 11--15-year old group. The quantity and duration of smoking, reasons for starting the habit, and social influences were examined. Simple tests of ventilatory function were also done. This study highlights the early age of onset of smoking in South African children, as in other countries, and provides a data base on which anti-smoking programmes can be structured.     

Rectal prolapse in childhood--the role of infections and infestations

Seventy-eight cases of rectal prolapse in childhood treated during a 3-year period are reviewed retrospectively. A cause of prolapse which could be corrected surgically was found in 9 children (12%). Among the remaining 69, 25 children (36%) were infested with a variety of parasites, 4 (6%) had a specific dysentery, and 6 (9%) had a convincing clinical picture of gastro-enteritis. In 34 patients no precise diagnosis could be made; however, among children without a mechanical or neurological lesion, 90% responded rapidly to anthelmintics and symptomatic treatment.     

Trends in Pediatric Melanoma Mortality in the United States, 1968 through 2004

BACKGROUND AND OBJECTIVE Mortality from melanoma in children is a poorly understood and controversial problem in dermatology. There is paucity of research into this important public health dilemma. The purpose of this study was to characterize pediatric melanoma mortality in the United States and to evaluate trends over time.
METHODS AND MATERIALS Deaths were derived from a database of more than 75 million records of the U.S. Center for National Health Statistics based on routine death certification. Information on age, race, gender, and geographic location was available for years 1968 through 2004.
RESULTS During the 37-year period, there were 643 deaths attributed to melanoma in children under 20 years of age in the United States, an average of 18 per year. The overall age-adjusted mortality rate for melanoma in children was 2.25 deaths per year (per 10 million at-risk individuals). Mortality rates were strongly associated with age. In the oldest age group (age 15–19 years) the mortality rate was approximately an order of magnitude 8–18 times higher compared to younger age groups. Mortality among males was 25% higher than females. Mortality rates for white children were more than twice as high as black children. Overall mortality from melanoma in children declined steadily from 1968 to 2004. The highest mortality rates were observed in Idaho, Nevada, Arizona, and New Mexico.
CONCLUSIONS Although mortality from melanoma among children in the United State is low, the magnitude of the public health burden from this preventable cause of death is substantial. In contrast to results of studies suggesting that the incidence of melanoma may be rising in children and adolescents, the data suggest that mortality in these groups may be falling. Additional study is warranted to further characterize and ultimately reduce mortality from childhood melanoma.