Cancer and other mortality patterns among United States furniture workers

Cause specific mortality was investigated among 36,622 members of a national furniture workers' union who were first employed in unionised shops between 1946 and 1962. Overall mortality for each race and sex group was less than expected when compared with United States death rates (white men SMR = 0.8, black men SMR = 0.7, white women SMR = 0.8, black women SMR = 0.5); however, raised risks were observed among white men employed in specific types of furniture industries and followed up for 20 or more years after first employment. Lymphatic and haematopoietic cancers were significantly raised (SMR = 1.8) among wood furniture workers followed up for at least 20 years due to excess deaths from leukaemia (SMR = 2.0) and non-Hodgkin's lymphoma (SMR = 2.0). Mortality from acute myeloid leukaemia was particularly high in this group (SMR = 4.7) based on six observed cases. Metal furniture workers followed up for at least 20 years experienced a significant excess of all cancers combined (SMR = 1.6), with non-significant increases in cancers of the lung, stomach, and colorectum. This group also had non-significant excesses of liver cirrhosis, arteriosclerotic heart disease, and cerebrovascular disease. Nasal cancer was not found to be significantly raised in this cohort, though the average follow up period may not have been sufficient to detect an excess risk for this uncommon tumour.     

Smoking cessation and mortality trends among two United States populations.

The long-term impact of smoking cessation on mortality is assessed among two U.S. populations: a large cohort of U.S. veterans aged 55-64 at entry and followed from 1954 through 1979 and the NHANES I Epidemiologic Followup Study (NHEFS) cohort of a national sample of U.S. adults aged 55-74 at entry and followed from 1971 through 1992. Direct and indirect survey data indicate that 50-70% of those who were current cigarette smokers at entry had quit smoking during the 19- to 26-year follow-up periods. The impact of smoking cessation on mortality among the cigarette smokers as a whole has been assessed by determining the time trend of the relative risk (RR) of death and 95% confidence interval (CI) for the cigarette smokers compared with never-smokers over the entire follow-up period in both cohorts. The total death rates for the 1954/57 U.S. veteran smokers as a whole (63,159 males) have converged only slightly toward those of never-smokers, from RR = 1.65 (1.58-1.72) during 1954-1959 to RR = 1.61 (1.58-1.63) during 1954-1979. The lung cancer death rates for 1954/57 smokers as a whole have not converged toward those of never-smokers, with RR = 10.89 (7.70-15.41) during 1954-1959 and RR = 11.10 (9.78-12.61) during 1954-1979. The total death rates for the 1971-1975 NHEFS smokers as a whole (694 males and 1116 females) have not converged toward those of never-smokers. For males, RR = 1.92 (1.46-2.52) during 1971-1982 and RR = 1.96 (1.63-2.36) during 1971-1992; for females, RR = 1.79 (1.31-2.46) during 1971-1982 and RR = 1.79 (1.47-2.17) during 1971-1992. The lung cancer death rates have diverged, based on small numbers of deaths. For males, RR = 15.76 (2.06-120.61) during 1971-1982 and RR = 22.20 (5.31-92.92) during 1971-1992; for females, RR = 2.92 (0.57-15.06) during 1971-1982 and RR = 4.74 (1.94-11.59) during 1971-1992. These trends are contrary to the substantial convergence predicted by the death rate trends among U.S. veterans who were former smokers at the beginning of follow-up. While these results confirm that those former smokers who survive for at least 5 years experience death rates that converge toward those of never-smokers, they also indicate that a cohort of cigarette smokers that undergoes substantial cessation experiences a death rate that does not converge toward the death rate of never-smokers. The fact that there has been no convergence for lung cancer is quite surprising, as this is the disease most strongly linked to smoking and smoking cessation and less likely to be influenced by other lifestyle factors. Further investigation is needed for a complete understanding of the impact of smoking cessation.     

Cancer and other mortality patterns among United States furniture workers.

Cause specific mortality was investigated among 36,622 members of a national furniture workers' union who were first employed in unionised shops between 1946 and 1962. Overall mortality for each race and sex group was less than expected when compared with United States death rates (white men SMR = 0.8, black men SMR = 0.7, white women SMR = 0.8, black women SMR = 0.5); however, raised risks were observed among white men employed in specific types of furniture industries and followed up for 20 or more years after first employment. Lymphatic and haematopoietic cancers were significantly raised (SMR = 1.8) among wood furniture workers followed up for at least 20 years due to excess deaths from leukaemia (SMR = 2.0) and non-Hodgkin's lymphoma (SMR = 2.0). Mortality from acute myeloid leukaemia was particularly high in this group (SMR = 4.7) based on six observed cases. Metal furniture workers followed up for at least 20 years experienced a significant excess of all cancers combined (SMR = 1.6), with non-significant increases in cancers of the lung, stomach, and colorectum. This group also had non-significant excesses of liver cirrhosis, arteriosclerotic heart disease, and cerebrovascular disease. Nasal cancer was not found to be significantly raised in this cohort, though the average follow up period may not have been sufficient to detect an excess risk for this uncommon tumour.     

Health, life expectancy, and mortality patterns among immigrant populations in the United States

BACKGROUND: The US immigrant population has grown considerably in the last three decades, from 9.6 million in 1970 to 32.5 million in 2002. However, this unprecedented population rise has not been accompanied by increased immigrant health monitoring. In this study, we examined the extent to which US- and foreign-born blacks, whites, Asians, and Hispanics differ in their health, life expectancy, and mortality patterns across the life course. METHODS: We used National Vital Statistics System (1986-2000) and National Health Interview Survey (1992-1995) data to examine nativity differentials in health outcomes. Logistic regression and age-adjusted death rates were used to examine differentials. RESULTS: Male and female immigrants had, respectively, 3.4 and 2.5 years longer life expectancy than the US-born. Compared to their US-born counterparts, black immigrant men and women had, respectively, 9.4 and 7.8 years longer life expectancy, but Chinese, Japanese, and Filipino immigrants had lower life expectancy. Most immigrant groups had lower risks of infant mortality and low birthweight than the US-born. Consistent with the acculturation hypothesis, immigrants' risks of disability and chronic disease morbidity increased with increasing length of residence. Cancer and other chronic disease mortality patterns for immigrants and natives varied considerably, with Asian Immigrants experiencing substantially higher stomach, liver and cervical cancer mortality than the US-born. Immigrants, however, had significantly lower mortality from lung, colorectal, breast, prostate and esophageal cancer, cardiovascular disease, cirrhosis, diabetes, respiratory diseases, HIV/AIDS, and suicide. INTERPRETATION: Migration selectivity, social support, socio-economic, and behavioural characteristics may account for health differentials between immigrants and the US-born.     

Temperature and mortality among the elderly in the United States: a comparison of epidemiologic methods

BACKGROUND: Time-series analyses have been used for decades to investigate time-varying environmental exposures. Recently, the case-crossover design has been applied to assess acute effects of air pollution. Our objective was to compare time-series and case-crossover analyses using varying referent periods (ie, unidirectional, ambidirectional, and time-stratified). METHODS: We examined the association between temperature and cardiorespiratory mortality among the elderly population in the 20 largest metropolitan areas of the United States. Risks were estimated by season and geographic region in 1992. We obtained weather data from the National Climatic Data Center and mortality data from the Division of Vital Statistics. Conditional logistic regression (case-crossover) and Poisson regression (time-series) were used to estimate the increased risk of cardiorespiratory mortality associated with a 10 degrees F increase in daily temperature, accounting for dew-point temperature and other potential confounding factors. RESULTS: In the time-stratified case-crossover analysis, the strongest associations were found in the summer; in the Southwest, Southeast, Northwest, Northeast, and Midwest, the odds ratios were 1.15 (95% confidence interval=1.07-1.24), 1.10 (0.96-1.27), 1.08 (0.92-1.26), 1.08 (1.02-1.15), and 1.01 (0.92-1.11), respectively. Mostly null or negative associations were found in the winter, spring, and fall. The ambidirectional case-crossover and the time-series analyses produced quantitatively similar results to those from the time-stratified analysis. The unidirectional analysis produced conflicting results. CONCLUSIONS: Inferences from studies of weather and mortality using the ambidirectional or time-stratified case-crossover approaches and the time-series analyses are comparable and provide consistent findings in this study.     

AIDS trends among Hispanics in the United States.

OBJECTIVES. In 1991 the incidence of acquired immunodeficiency syndrome (AIDS) in the United States was 31.6 per 100,000 population among Hispanics and 11.8 per 100,000 among non-Hispanic Whites. The purpose of this study was to further describe the AIDS epidemic among Hispanics by examining differences in risk factors among different Hispanic groups (as defined by birthplace). METHODS. AIDS cases reported to the Centers for Disease Control and Prevention from 1988 through 1991 were reviewed. RESULTS. For men, except for those born in Puerto Rico, the predominant exposure category was male-male sex. The proportion of cases due to injection drug use was 35% among Hispanic men born in the United States, 27% among men born in the Dominican Republic, and 61% among men born in Puerto Rico, but < 10% among other Hispanic men and non-Hispanic White men. For women the predominant exposure category was injection drug use among Hispanics born in the United States (56%) and Puerto Rico (46%) and among non-Hispanic Whites (42%). The proportion of cases associated with injection drug use was significantly lower (< 30%) among other Hispanic women. CONCLUSIONS. AIDS prevention strategies must be geared toward different exposure categories among different Hispanic groups.     

Testicular cancer in the United States: trends in incidence and mortality

The patterns of incidence and mortality of testicular cancer in the United States indicate substantial differences by age, race, time period, and geographical region. An epidemic increase over time in the risk of testicular cancer is noted for young men aged 15-44, with the most recent birth cohorts showing the greatest rate of increase. Indeed, some of the evidence suggests the possibility of two separate increases, one apparent from at least the late 1930's through the late 1950's and the second appearing in the late 1970's. The incidence data for blacks also show a young adult peak, even though the rates for whites are four to five times higher than for blacks at all ages except early childhood. Mortality rates for older men consistently declined over the 30-year period, while rates for younger men showed a dramatic drop only for the most recent time period. Aetiological factors yet to be determined may be responsible for the increasing incidence of testicular cancer in young adults. Survival factors appear to explain the age-specific differences between the incidence and mortality curves over time.     

Cohort patterns in mortality trends among the elderly in seven European countries, 1950-99

BACKGROUND: Secular trends in old-age mortality are of crucial importance to population ageing. For the understanding and prediction of these trends, it is important to determine whether birth cohort effects, i.e. long-lasting effects of exposures earlier in life, are important in determining mortality trends up to old age. This study aimed to identify and describe cohort patterns in trends in mortality among the elderly (>60 years of age) in seven European countries. METHODS: A standard age-period-cohort analysis was applied to all-cause and cause-specific mortality data by 5-year age groups and sex, for Denmark, England and Wales, Finland, France, The Netherlands, Norway, and Sweden, in the period 1950-99. RESULTS: Cohort patterns were identified in all countries, for both the sexes and virtually all causes of death. They strongly influenced the trends in all-cause mortality among Danish, Dutch, and Norwegian men, and the trends in mortality from infectious diseases, lung cancer (men only), prostate cancer, breast cancer, and chronic obstructive pulmonary disease (COPD). All-cause mortality decline stagnated among Danish, Dutch, and Norwegian male birth cohorts born between 1890 and 1915, among French men born after 1920, and among women from all countries born after 1920. Where all-cause mortality decline stagnated, cohort patterns in mortality from lung cancer, COPD, and to a lesser extent ischaemic heart diseases, were unfavourable as well. For infectious diseases, stomach cancer, and cerebrovascular diseases, mortality increased among cohorts born before 1890, and decreased strongly thereafter. CONCLUSIONS: Cohort effects related to factors such as living conditions in childhood and smoking in adulthood were important in determining the recent trends in mortality among the elderly in seven European countries.     

Spatial patterns of natural hazards mortality in the United States

Background  

Studies on natural hazard mortality are most often hazard-specific (e.g. floods, earthquakes, heat), event specific (e.g. Hurricane Katrina), or lack adequate temporal or geographic coverage. This makes it difficult to assess mortality from natural hazards in any systematic way. This paper examines the spatial patterns of natural hazard mortality at the county-level for the U.S. from 1970–2004 using a combination of geographical and epidemiological methods.     

Cancer mortality among Mexican immigrants in the United States

In 1980 there were more than 2 million Mexican-born immigrants living in the United States. Mortality statistics for 1979-81 indicate that the standardized mortality ratio for cancer among Mexican immigrants is 72 percent of that among all white males and 77 percent of that among all white females. The age-adjusted death rates of the Mexican-born population for cancers of the lung, colon, rectum, bladder, and breast are significantly lower: less than 60 percent of those for the entire U.S. white population. Excessive levels of cancers of the stomach, liver, and cervix occur among Mexican-born U.S. residents; age-adjusted rates for these sites exceed the rates among the total U.S. white population by more than 75 percent. These data, based on U.S. diagnostic practices, confirm that broad differences--twofold, for some cancer sites--exist between the cancer rates among immigrants from Mexico and other whites in the United States. The close correspondence between the mortality data presented in this study and comparable incidence data from another study indicates that differential survival does not explain the differences in cancer mortality among Mexican immigrants.     

Automation of mortality data coding and processing in the United States of America

The development in the United States of America of an automated system for coding mortality data (Automated Classification of Medical Entities--ACME) was undertaken with two major objectives in mind: (i) to introduce consistent and rapid assignment of underlying cause-of-death coding with reduced needs for manpower training; and (ii) to allow better utilization of medical information on death certificates for multiple cause-of-death analyses. The ACME system meets both of these objectives; the National Center for Health Statistics (NCHS) produces all of its underlying cause-of-death statistics for the United States on the basis of this system, and multiple cause-of-death data are routinely available for additional epidemiological study beyond the traditional methods of vital statistics analyses. Enhancements of the automated system, primarily through the software known as MICAR, reduce even further the levels of training necessary for persons doing the basic data entry. MICAR additionally will ease transitions between ICD revisions by reducing the need for coder reorientation and by permitting rapid calculation of comparability ratios when new revisions are introduced.     

Breast cancer trends among young women in the United States

BACKGROUND: It has been suggested that exposures associated with industrialization have increased breast cancer risk among young women in recent decades in the United States despite data demonstrating declining breast cancer mortality in birth cohorts born after 1945. METHODS: Trends for in situ and invasive breast cancer incidence rates from 1975 through 2002 among white and black U.S. women ages 20 to 49 are evaluated by decade of age using linear regression analyses. RESULTS: Despite increasing rates of in situ breast cancer after 1980 reflecting increased use of mammography, invasive breast cancer rates declined for both white and black women under age 50. These declines are consistent with a decrease in birth cohort risk of breast cancer for women born after 1945. CONCLUSIONS: Invasive breast cancer incidence rates are not increasing in young U.S. women despite increases in mammography and trends in known risk factors (eg, reproductive factors) that would predict increasing risk.     

Reproductive mortality in the United States: recent trends and methodologic considerations.

Between 1975 and 1982, the annual number of deaths attributable to pregnancy and childbirth, induced abortion, and contraception in the United States declined from 1,083 to 751. The mortality rates for each of these components decreased by 35,89, and 35 per cent, respectively, and the overall reproductive mortality rate dropped by 35 per cent. The death rate due to pregnancy and childbirth is 25 times greater than that due to induced abortion and eight times more than that to contraceptive-associated mortality. In 1982 nearly 30 million women used contraceptives, while slightly fewer than four million women were pregnant to term. The decrease in contraceptive-associated mortality between 1975 and 1982 probably reflects a combination of safer contraceptives, fewer women using contraceptive methods that may not be safest for them, and an increasing number of sterilizations, which remove women from the group at highest risk of contraceptive-related mortality. Maternal mortality appears to be slowing its rate of decline, while induced abortion mortality has been very low since the legalization of abortion.     

Prostate cancer incidence and mortality rates and trends in the United States and Canada

OBJECTIVE: The purpose of this study was to compare prostate cancer incidence and mortality trends between the United States and Canada over a period of approximately 30 years. METHODS: Prostate cancer incident cases were chosen from the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) Program to estimate rates for the United States white males and from the Canadian Cancer Registry for Canadian men. National vital statistics data were used for prostate cancer mortality rates for both countries, and age-adjusted and age-specific incidence and mortality rates were calculated. Joinpoint analysis was used to identify significant changes in trends over time. RESULTS: Canada and the U.S. experienced 3.0% and 2.5% growth in age-adjusted incidence from 1969-90 and 1973-85, respectively. U.S. rates accelerated in the mid- to late 1980s. Similar patterns occurred in Canada with a one-year lag. Annual age-adjusted mortality rates in Canada were increasing 1.4% per year from 1977-93 then fell 2.7% per year from 1993-99. In the U.S., annual age-adjusted mortality rates for white males increased 0.7% from 1969-1987 and 3.0% from 1987-91, then decreased 1.2% and 4.5% during the 1991-94 and 1994-99 periods, respectively. CONCLUSIONS: Recent incidence patterns observed between the U.S. and Canada suggest a strong relationship to prostate-specific antigen (PSA) test use. Clinical trials are required to determine any effects of PSA test use on prostate cancer and overall mortality.