铁矿工人队列死因研究

目的 探索危害铁矿作业工人健康的主要疾患及职业有害因素对工人寿命的影响.方法 用流行病学队列研究方法,对武钢大冶铁矿7 469名职工从1972年开始随访30余年,以全国城市居民年龄别死亡率为参照,用标化死亡比（SMR）作为统计指标,并计算95%可信区间.结果 自1972年至2003年底,共计199 108.0人年,死亡1 752人,累积死亡率为23.5%.影响铁矿工人寿命的主要疾病按累积死亡率从高到低排序分别是：肿瘤（7.8%）、脑血管疾病（3.9%）、心血管系疾病（3.4%）和呼吸系疾病（2.9%）,恶性肿瘤以肺癌和肝癌最多,分别占总死亡数的10%和7.4%.全死因SMR为1.06,高于全国平均水平.死亡率明显升高的疾病有鼻咽癌、肝癌、肺癌、尘肺和意外事故,SMR分别为1.84、1.51、1.83、14.94和1.25.队列中接尘工人与非接尘工人比较,接尘工人全死因、胃癌、肺癌、呼吸系统疾病、心血管疾病和意外事故的累积死亡率明显升高（相对危险度分别为1.35、1.83、1.61、2.27、1.34和1.69）.结论 以粉尘为主的职业有害因素明显影响铁矿工人健康和寿命.     

An update of mortality from all causes among white uranium miners from the Colorado plateau study group

To place previously recognized mortality risks into the context of the total mortality from all causes, an updated retrospective cohort mortality study was conducted on 3,238 white males from the US Public Health Service cohort of Colorado Plateau uranium miners. Vital status was followed from 1960 through 1990. Life-table analyses used combined New Mexico, Arizona, Utah, and Colorado mortality rates for external comparison and mortality risks within the lowest radon-exposure or duration-employed category for internal comparison. Significantly elevated SMRs were found for pneumoconioses (SMR = 24.1, 95% CI 16.0–33.7), lung cancer (SMR = 5.8, 95% CI 5.2–6.4), tuberculosis (SMR = 3.7, 95% CI 1.9–6.2), chronic obstructive respiratory diseases (SMR = 2.8, 95% CI 2.2–3.5), emphysema (SMR = 2.5, 95% CI 1.9–3.2), benign and unspecified tumors (SMR = 2.4, 95% CI 1.0–4.6), and diseases of the blood and blood-forming organs (SMR = 2.4, 95% CI 1.0–5.0). No significantly lowered SMRs were found for any disease. For lung cancer and pneumoconioses, standardized rate ratios increased with increasing exposure to radon progeny or duration of employment. Most findings from this update are consistent with previous studies. Not observed were previously elevated SMRs for chronic nephritis and for acute alcoholism. New findings observed were elevated SMRs for benign and unspecified tumors and for diseases of the blood and blood-forming organs. The most important long-term mortality risks for the white uranium-miners continue to be lung cancer and pneumoconioses, for which SMRs remain significantly elevated after a mean period of 22.4 years since last uranium mining. Am. J. Ind. Med. 31:211–222, 1997. © 1997 Wiley-Liss, Inc.     

四川省凉山彝族自治州静脉吸毒人群死亡率及死因的前瞻性队列研究

目的　了解四川省凉山彝族自治州静脉吸毒人群死亡率及死因。方法　于 2002 年 11月筛选和招募静脉吸毒人群队列376人,调查其社会人口学和吸毒行为特征。队列随访时间为 1 年,计算静脉吸毒人群的死亡率和死因构成,对死亡危险因素采用单因素和多因素 Cox回归分析。结果队列随访1年中,死亡28人,死亡率为77.32/1000 人年(95%CI:48.68~105.95),标准化死亡比为47.62(95%CI:31.63~68.71)。主要死因是吸毒过量,占全部死因的64.3%(18/28)。多因素Cox回归分析未发现与死亡(包括全部死因)有统计学关联的变量;但发现社会人口学因素中的单身和吸毒行为中的吸毒年限(≥9年)两个变量与吸毒过量死亡有统计学关联(P<0.05),其危险比分别是4.51(95%CI:1.03~19.67)和2.77(95%CI:1.10~7.00)。结论　吸毒过量致死是凉山州静脉吸毒者的主要死亡原因,需要进一步研究与吸毒过量死亡有关的因素以及干预对策。     

1990～1992年广西老年人口主要死因及死亡率分析

目的 为制订广西老年保健和老年病防治研究计划提供科学依据。方法 应用19901－1992年广西随机抽样10市，县人口死因调查资料，分析人口老龄化指标，老年人口主要死因和死亡率。结果 广西老年人口系数为8．5％，长寿水平10．67％，老少比27％，老年人口前5位死因为呼吸系统疾病（28．40％），脑血管病（22．90％），恶性肿瘤（10．49），心脏病（9．00％），消化系统疾病（7．74％），占老年人口总死亡人数的78．50％。结论 广西人口类型为向老龄化过渡型。造成广西老年人主要死因的这些疾病与不良生活方式，行为和环境因素有关。因此改善环境，从青少年期开始培养良好生活方式和行为是主要的预防措施。     

Risk factors and early detection of lung cancer in a cohort of Chinese tin miners

PURPOSE: To examine risk factors and establish a biologic specimen and data bank for the study of early markers of lung cancer.

METHODS: We designed a dynamic cohort using an ongoing lung cancer screening program among radon- and arsenic-exposed tin miners in Yunnan China. Through the first four years of the study, 8,346 miners aged 40 years and older with over 10 years of occupational exposure have been enrolled, risk factors have been assessed, annual sputum and chest radiographs have been obtained, and numerous biologic specimens have been collected.

RESULTS: A total of 243 new lung cancer cases have been identified through 1995. Radon and arsenic exposures are the predominant risk factors, but lung cancer risk is also associated with chronic bronchitis and silicosis, as well as a number of measures of exposure to tobacco smoke, including early age of first use, duration, and cumulative exposure. Tumor and sputum samples are being examined for early markers of lung cancer.

CONCLUSION: A cohort of occupationally-exposed tin miners with an extensive biologic specimen repository has been successfully established to simultaneously study the etiology and early detection of lung cancer.     

某综合医院2003—2011年道路交通事故住院患者的死因分析

目的揭示某综合医院道路交通事故住院患者的直接死因及其主要交通事故特征,为预防道路交通事故的发生和医院创伤救治提供基础资料和参考依据。方法对汕头市某综合医院2003—2011年道路交通事故住院患者的住院病案信息进行核实、统计分析。结果共收集7039名病例,男女之比为2．35：1,总死亡人数为145人,其中男性104人,女性41人,致死率为2．06％,秋季致死率高,随着年龄增加,死亡率增高,男性致死率高于女性致死率,其死亡率之比为1．08：1。病人死亡的前3位直接死因为：重型颅脑损伤,脑肿胀,脑挫伤和创伤性硬膜下血肿;前3位交通事故类型为：未特指的机动车交通事故,骑摩托车与小汽车（轻型货车）相撞,行人与摩托车相撞;死者主要为摩托车骑乘者（64例,44．14％）。结论道路交通事故住院患者直接死因为颅脑损伤,主要事故类型为摩托车交通事故。应加强对摩托车事故预防,佩戴好头盔,医院要加强对颅脑损伤的有效救治与管理。     

Use of multiple cause of death data in cancer mortality analyses

BACKGROUND: In a cancer mortality study, the decision of whether to define a study outcome via underlying cause of death (UCD) or via multiple cause of death (MCD) information may impact relative risk (RR) estimates and associated confidence intervals. METHODS: Simple equations are presented that relate RR estimates obtained in a cancer incidence study to the RR estimates obtained in mortality studies using UCD and MCD information. Data from the Surveillance, Epidemiology and End Results program were used to obtain information about the detection and confirmation rates of cancer diagnoses made via UCD. Data from US cause of death data tapes were used to obtain information on the ratio of UCD to MCD listings for cancer outcomes. Numerical examples illustrate the use of these equations. RESULTS: In our examples, the RRs obtained via analyses of MCD were close to those obtained via analyses of UCD (but of greater precision), even when assuming that the confirmation rate of cancer diagnoses made via MCD listing was substantially lower than that of diagnoses made via UCD. CONCLUSIONS: These finding are supportive of the use of MCD information in cancer mortality studies.     

2013年南通市开发区居民死因监测分析

目的了解南通市开发区居民2013年死亡率和主要死亡原因,为制定预防保健措施提供科学依据。方法采用国际疾病分类ICD-10进行死因编码,录入全国疾病监测系统软件Death Reg 2005,并使用该软件进行统计分析。结果 2013年开发区共死亡978人,总死亡率为6.64‰。平均期望寿命为82.42岁。死因构成以恶性肿瘤、脑血管病、呼吸系统疾病、心脏病、损伤中毒居前5位。肺癌、肝癌、胃癌分居恶性肿瘤死亡的前3位。结论慢性病已成为南通市开发区居民死亡的主要原因,应做好健康教育工作,降低慢性病的发生率。     

云锡矿工慢性支气管炎与肺癌关系的队列研究

目的探讨云锡矿工既往慢性支气管炎与肺癌的关系。方法利用前瞻性队列研究方法,分析云锡矿工肺癌高危人群慢性支气管炎与肺癌死亡危险的关系。结果1992—1999年,共9 295名云锡矿工进入队列,随访至2001年底,共443例肺癌死亡。慢性支气管炎可增加肺癌死亡危险性,调整危险比(HR)为1.5(95%CI:1.3～1.8),慢性支气管炎与肺鳞癌呈显著正相关,与腺癌和小细胞癌症的关联则无显著性。分层分析结果表明,两者关联仅在吸烟者中差异具有显著性。结论慢性支气管炎可能是云锡矿工肺癌死亡的危险因素之一,其致肺癌的危险应引起重视并加以控制。     

An intergenerational and lifecourse study of health and mortality risk in parents of the 1958 birth cohort: (II) mortality rates and study representativeness

OBJECTIVES: We recently traced and flagged parents for the participants in the National Child Development Survey (NCDS, 1958 cohort). This paper evaluates the representativeness of the study population and assesses our success in identifying the biological parents. STUDY DESIGN: Intergenerational cohort study. METHODS: Parents for participants in the NCDS (born 1 week in March 1958) were traced and flagged for mortality follow-up (14 334 fathers, 15 076 mothers). Standardized mortality rates (SMRs) were calculated using data from England, Scotland and Wales during corresponding time periods. RESULTS: By 31 December 2003, 6808 fathers and 4148 mothers (born 1890-1943) had died (569 918 and 645 354 years of follow-up, respectively). The overall mortality rate in this parent population was lower compared with the age-, gender-, period- and area-standardized reference rates (SMRs of 83 for fathers and 86 for mothers). Mortality rates for biological parents were higher if cohort members had had non-biological parent figures during the childhood surveys (SMRs of 135 for fathers and 374 for mothers). Parental smoking (in 1974) was strongly associated with lung cancer mortality among biological parents [HR 6.1, 95% confidence intervals (CI) 4.6-8.1 for fathers; HR 15.0, 95% CI 9.7-23 for mothers) but not among non-biological parents (HR 2.0, 95% CI 0.8-5.5; HR 1.8, 95% CI 0.4-7.9, respectively) which demonstrates that the tracing of the biological parents had been successful. CONCLUSIONS: Mortality is markedly reduced in a cohort of parents compared with the general population. The validity of identification of biological parents is demonstrated by the strong association between smoking and lung cancer.     

730例育龄妇女死亡原因及相关因素分析

目的:分析影响韶关市城区育龄妇女死亡的相关因素,探讨相应的干预措施。方法:对韶关市城区常住人口1998~2006年的育龄妇女死亡资料进行回顾性分析。结果:育龄妇女死亡730例,恶性肿瘤(39.32%)与意外死亡(29.32%)是育龄妇女死亡的主要原因。在恶性肿瘤死因中,居前3位的分别是消化系肿瘤、呼吸系肿瘤和乳腺癌,但居首位的单一疾病却是乳腺癌。交通事故和自杀是意外死亡的主要原因。不同年龄的育龄妇女恶性肿瘤和意外死亡的构成比在统计学上有显著性差异(P<0.001)。结论:降低恶性肿瘤和意外死亡的发生率,是降低育龄妇女死亡的关键。在开展健康教育时,对年龄偏大的育龄妇女,应普及自身防癌知识,尤其是乳腺的"自我检查",并加强对肿瘤的防治;对年龄偏小者以开展人生观和道德观教育为主,培养其良好的心理素质,降低意外事故的发生率。     

2004-2005年广东省第3次死因回顾性调查样本代表性与数据质量评价

目的阐述2004—2005年广东省第3次死因回顾调查样本代表性与数据质量,为资料利用提供依据。方法通过多阶段分层整群抽样方法,对广东省13个县（市、区）2004-2005年全部死亡人群进行回顾调查,依据人口学特征、拟舍优度检验、玛叶指数等对2004-2005年广东省第3次死因回顾调查样本（其中12个调查点数据）的代表性进行评价,从死因诊断依据、死亡率、死因编码质量等方面评价数据质量。结果本次调查覆盖全省12个市、县（区）共758．5472万人口,无论是年龄构成还是性别比、地域和社会经济等指标统计学检验,还是年龄构成的拟合优度检验,调查样本与2000年广东省人口普查户籍人口相比,差异均无统计学意义（均P〉0．05）;选取调查样本10—69岁和20～79岁2个年龄组样本,计算玛叶指数为3．59,说明调查样本人口数据无年龄偏好。本次调查地区共收集2004-2005年12个调查点死亡个案99919例,平均粗死亡率为658．6／10万,10个调查点粗死亡率符合质控要求,婴儿死亡率为6．7％。,全部死亡个案的死因最高诊断单位以县及以上医疗机构为主,达62．48％,死因最高诊断依据以临床＋理化和临床诊断为主,合占85．93％;其中死于恶性肿瘤个案的诊断单位以县及以上医疗机构诊断比例最高,达89．33％,诊断依据以尸检、病理、手术和临床＋理化等合计比例达83．76％。全部调查个案的编码总体准确率达96．07％,死因不明率为1．89％,死因不准确率为1．56％,死因错误率为0．48％。结论2004—2005年广东省第3次死因回顾调查样本代表性良好,调查结果可代表全省情况,调查过程质控严格,数据完整性、可靠性和准确性指标均符合质控要求,数据质量良好。     

腰围与男性肺癌发病关系的前瞻性队列研究

目的 探讨腰围与男性肺癌发病风险的关系。方法 以开滦集团全体在职及离退休男性职工为调查对象,自2006年5月建立开滦集团男性动态队列并随访。基线调查时收集研究对象身高、体重、腰围等信息,并在随访时收集结局事件信息。腰围按五分位数进行分组：<80、80~、85~、90~、≥95 cm,并以腰围80~cm组为参比组,采用多因素Cox比例风险回归模型分析腰围与男性肺癌发病的风险比（HR）和95%CI。结果 截止2014年12月31日,共有105 386名研究对象进入队列,共随访739 651.13人年,平均随访7.00年,共收集肺癌新发病例707例。以80~cm组为参比组,调整年龄、文化程度、吸烟状态、累计吸烟量、饮酒情况、体育锻炼、工作环境、糖尿病史后,腰围<80及85~、90~、≥95 cm组发生肺癌的HR值（95%CI）分别为1.17（0.90~1.52）及0.96（0.74~1.23）、0.94（0.72~1.21）、0.80（0.63~1.03）,趋势检验P=0.005。按吸烟、饮酒状态分层分析显示,腰围与肺癌发病风险在吸烟（腰围≥95 cm组与80~cm组相比：HR=0.69,95%CI：0.48~0.99）、饮酒（腰围≥95 cm组与80~cm组相比：HR=0.65,95%CI：0.45~0.94）者中呈负相关。结论 腰围可能与男性肺癌的发病风险之间有负相关关系。     

2011 - 2015年遵义市死因监测结果分析

目的 探讨2011 - 2015年遵义市死因监测点居民死亡水平、主要死因及趋势,为制定合理的疾病预防控制措施提供参考依据。方法 采用描述流行病学方法,分析2011 - 2015年遵义市死因监测点居民的死亡率、死因构成和死因顺位。结果 2011 - 2015年遵义市死因监测点居民从103.41万人上升至105.54万人,5年间共死亡26 147例,总体粗死亡率为507.62/10万,标化死亡率为455.55/10万,各年粗死亡率依次为:512.15/10万、538.61/10万、418.87/10万、583.25/10万、486.75/10万,标化死亡率依次为:590.20/10万、467.94/10万、368.50/10万、491.47/10万、415.44/10万,总体呈下降趋势,各年男性死亡率均高于女性。全人群的前五位死因依次为:脑血管疾病、肿瘤、呼吸系统疾病、心脏病和损伤及中毒,不同年龄阶段主要死因存在差异,0～14岁人群主要死因为损伤及中毒、围生期疾病、先天异常;15～44岁组的主要死因是损伤及中毒、肿瘤、脑血管疾病;45～64岁组的主要死因为肿瘤、脑血管疾病、损伤及中毒;≥65岁组的主要死因为脑血管疾病、呼吸系统疾病、肿瘤、心脏病。结论 脑血管疾病、肿瘤、呼吸系统疾病等慢性非传染性疾病是遵义市居民的主要死因,损伤及中毒的防控应以44岁以下人群为重点,45岁及以上人群应以脑血管疾病、肿瘤等慢性病为防控重点。     

1999-2007年干部病房住院患者疾病谱及其主要死因分析

目的利用较大样本住院资料分析我院干部病房住院患者病种和死亡疾病的构成,探讨干部病房近9年疾病的发病情况和导致死亡的主要病种。方法回顾性分析1999年1月～2007年12月我院干部病房住院患者6471例临床资料,疾病的诊断依据《国际疾病分类第9次修订本》,按年度对各疾病病种分布、死亡病因、患病年龄进行分析。结果在近9年中住院患者的年龄和死亡年龄逐渐增加,呼吸道感染、冠心病、高血压和脑血管病是患者住院的主要疾病,而导致死亡的主要疾病分别是肿瘤、肺部感染、冠心病和脑血管疾病。结论有效地控制和预防呼吸道感染、肿瘤和心脑血管疾病是今后预防保健的重点。     

2010-2016年广州市户籍居民主要死因分析及对寿命损失的影响

目的 分析2010—2016年广州市户籍人口疾病死亡趋势变化对期望寿命及潜在寿命损失（PYLL）的影响,为政府制定疾病预防控制规划和政策提供依据。方法 对死因登记报告信息系统报告的2010—2016年广州市户籍人口死因监测资料进行分析,死因分类采用ICD-10中的死因分类标准进行编码及分析统计。通过死亡率、年度变化百分比、期望寿命、去死因期望寿命、减寿年数等指标进行分析,并描述疾病死亡变化对期望寿命和潜在寿命损失的影响。结果 2010—2016年广州市户籍人口死亡327 769例,平均死亡率为563.67/10万（标化率为327.19/10万）,以平均每年0.66％的速度上升。死因顺位前3位的是心脑血管疾病、恶性肿瘤、呼吸系统疾病,平均死亡率分别为204.61/10万、148.43/10万、88.99/10万。损伤中毒（伤害）、肌肉骨骼疾病和结缔组织疾病、内分泌营养代谢疾病死亡率平均每年上升11.54%,10.62%、5.53%。年平均PYLL为443 653人年,PYLL率为53.20‰,呈上升趋势。主要死因造成的PYLL的前3位分别是恶性肿瘤、心脑血管疾病、损伤中毒（伤害）,平均PYLL分别为177 631、88 302和58 678人年。结论 2010—2016年广州市户籍人口疾病死亡趋势变化对期望寿命影响从大到小依次为心脑血管疾病、恶性肿瘤、呼吸系统疾病。恶性肿瘤、心脑血管疾病和损伤中毒（伤害）等造成的潜在寿命损失逐渐加大。加强对这些慢性病的防治是广州市卫生工作的重点,尤其是预防恶性肿瘤的发生、提高其早诊早治对减少寿命损失有重要意义。     

2015年天津市户籍居民恶性肿瘤死亡及去死因期望寿命分析

目的 探讨天津市户籍居民恶性肿瘤死亡及去死因期望寿命情况。方法 收集2015年天津市户籍居民全死因登记资料,按照全球疾病负担中恶性肿瘤分类标准进行分类,计算各类恶性肿瘤死亡率及去除之后对期望寿命的影响。结果 2015年天津市户籍居民因恶性肿瘤死亡17 641例,粗死亡率为171.79/10万,标化率为86.32/10万。其中男性死亡10 165例,粗死亡率为197.39/10万,标化率为95.41/10万,女性死亡7 476例,粗死亡率为146.04/10万,标化率为76.65/10万。男性恶性肿瘤死亡排前5位的是肺癌、肝癌、胃癌、结直肠肛门癌和胰腺癌;女性恶性肿瘤死亡排前5位的是肺癌、乳腺癌、肝癌、结直肠肛门癌和胃癌。去除恶性肿瘤后男性和女性期望寿命分别增长3.53岁和2.88岁,其中去除肺癌之后分别增长1.25岁和0.97岁,远超过其他恶性肿瘤。结论 肺癌是造成天津市户籍居民死亡及期望寿命减少的主要疾病,亟需采取有效的预防措施加以遏制。     

Temporal trends in the leading causes of death among a large national cohort of patients with colorectal cancer from 1975 to 2009 in the United States

PurposeTo assess the distribution of proportion of deaths from causes other than colorectal cancer (CRC) over time and temporal trends of cause-specific cumulative incidence of death due to six leading causes in patients with CRC.MethodsOverall, 375,462 patients with CRC in nine Surveillance, Epidemiology, and End Results registries from 1975 to 2009 were included. Competing risks proportional hazards regression was used to examine the effect of diagnostic periods on the risk of cause-specific death.ResultsFrom 1975 to 2009 by 5-year interval, the proportion of deaths from causes other than CRC increased significantly with diagnostic periods according to the lengths of follow-up (P < .0001). The 5-year risk of death significantly decreased with diagnostic periods for all-cause, CRC, and circulation diseases among all age groups (<65, 65–74, and ≥75 years) but increased for chronic obstructive pulmonary disease, diabetes, and Alzheimer disease among patients aged 65 years or older.ConclusionsDeaths due to causes other than CRC increased significantly over time regardless of tumor stage and site but more sharply in those with early-stage and distal colon cancer. The increasing leading causes of death are chronic obstructive pulmonary disease, diabetes, and Alzheimer disease, which may be prevented or delayed substantially by modification or intervention in lifestyle or other factors.     

Trajectories and individual determinants of repeated seasonal flu vaccination use over the long term using data from the French E3N cohort

Despite the implementation of incentive policies to promote seasonal flu vaccination for more than 20 years in France, the coverage of high-risk individuals remains largely insufficient. While there is extensive literature on the determinants of vaccination in a given year, it rarely considers the specificity of flu vaccination, which must be repeated every autumn to remain effective. We aim to fill this gap by focusing on the flu vaccination behavior of high-risk individuals (65 years and older, chronic diseases) over a 15-year period. Based on data from 87,820 women in the French E3N cohort, we used sequence analysis methods (localized Optimal Matching) to identify typical seasonal flu vaccination profiles based on individual trajectories from 2004 to 2018. Then, using a multinomial model, we studied the individual determinants associated with the different patterns of vaccination use identified. Sequence analysis resulted in a partition of 8 clusters, which can be summarized into 4 typical behaviors: almost half of the women get vaccinated against flu each year (43%); conversely, another important share never get vaccinated against flu (32%); some do not get vaccinated for several years and then get vaccinated every year (20%); and finally, a minor share discontinued vaccination (5%). Thus, once women start getting vaccinated they generally continue every year. Nonetheless, this is a double-edged sword, as an important share of women considered at risk refrain from being vaccinated for more than a decade. Determinants associated with regular vaccination are being more at risk (age, weight, and chronic diseases), being in contact with physicians, being more educated, being in couple, having children, not smoking, and undergoing breast cancer screening.