Long-term mortality consequences of childhood family context in Liaoning,China, 1749–1909

We examine the effects on adult and old age mortality of childhood living arrangements and other aspects of family context in early life. We focus on features of family context that have already been shown to be associated with infant or child mortality in historical and developing country populations. We apply discrete-time event-history analysis to longitudinal, individual-level household register data for a rural population in northeast China from the eighteenth and nineteenth centuries. Loss of a mother in childhood, a short preceding birth interval, and high maternal age were all associated with elevated mortality risks later in life. Such effects persist in a model with fixed effects that account for unobserved characteristics of the community and household. An important implication of these results is that in high-mortality populations, features of early-life family context that are associated with elevated infant and child mortality may also predict adverse mortality outcomes in adulthood.     

Analysis and Forecast of the Mortality of Diabetes Mellitus in China

[目的]分析1990～1999年我国城市和农村居民糖尿病死亡率的现况特点并预测未来5年的变化趋势.[方法]根据<全国卫生统计年报>资料,对我国1990至1999年糖尿病死亡率的现况进行流行病学分析,并利用灰色动态模型GM(1.1)预测我国2000至2005年城市和农村糖尿病死亡率趋势.[结果]城市1999年糖尿病死亡率为15.37/10万而农村为5.13/10万,分别是1990年死亡率的1.89倍和1.71倍;女性的死亡率高于男性,城市和农村男女死亡率之比分别为0.63∶1和0.76∶1;根据1990～1999死亡率所建立的城市的灰色模型预测方程为t=-106.481 7×(1-e0.074 58t)-Yt-1(t=1,2,...,N),而农村的方程为t=-33.605 3×(1-e0.075 37t)-Yt-1(t=1,2,...,N);预测到2005年我国城市和农村糖尿病死亡率将分别达到25.24/10万人和8.15/10万人;精度检验证明了城市和农村的预测模型拟合良好而外推测值可信.[结论]我国人群糖尿病死亡率上升趋势明显,提示有关部门应加强防治力度;灰色模型GM(1.1)能够较好地预测糖尿病死亡率的近期变化趋势.     

Estimating the contribution of mortality selection to the East–West German mortality convergence

Background

Before German reunification, old-age mortality was considerably higher in East Germany than West Germany but converged quickly afterward. Previous studies attributed this rapid catch-up to improved living conditions. We add to this discussion by quantifying for the first time the impact of mortality selection.

Methods

We use a gamma-Gompertz mortality model to estimate the contribution of selection to the East–West German mortality convergence before and after reunification.

Results

We find that, compared to the West, frailer East Germans died earlier due to deteriorating mortality conditions leading to converging mortality rates for women and men already over age 70 before 1990. After 1990, the selection of frailer individuals played only a minor role in closing the East–west German mortality gap. However, our study suggests that, after reunification, old-age mortality improved quickly because the more robust population in the East benefitted greatly from ameliorating external factors such as health care and better living standards.

Conclusion

Our results from a natural experiment show that selection of frail individuals plays an important role in population-level mortality dynamics. In the case of the German reunification, East German old-age mortality already converged before 1990 because of stronger selection pressure.

     

Trends in smoking prevalence and attributable mortality in China, 1991–2011

ObjectiveChina is the largest producer of tobacco worldwide. We assessed secular trends in prevalence of smoking, average cigarettes per day, mean age of initiation, and mortality attributable to smoking among the Chinese population between 1991 and 2011.DesignData came from the China Health and Nutrition Survey, conducted eight times between 1991 and 2011. A total of 83,447 participants aged 15 years or older were included in this study. Trends in smoking were stratified by sex, age, and region (urban vs. rural).ResultsIn 2011, 311 millions individuals were current smokers in China, with 295 million men and 16 million women, respectively. Between 1991 and 2011, the prevalence of current smoking decreased from 60.6% to 51.6% in men, and from 4.0% to 2.9% in women. However, during this period, the average number of cigarettes smoked per day per smoker increased from 15.0 to 16.5 in males, and from 8.5 to 12.4 in females. Further, age of smoking initiation decreased from 21.9 to 21.4 years in men and from 31.4 to 28.4 years in women. In 2011, 16.5% of all deaths in men and 1.7% in women were due to smoking. Between 1991 and 2011, the total number of deaths caused by smoking increased from 800,000 to 900,000.ConclusionsDuring the past 20 years, a slight decrease in smoking prevalence was observed in the Chinese population. However, cigarette smoking remains a major cause of death in China, especially in men.     

The Risks of Overweight,Obesity and Abdominal Obesity in Middle Age after Exposure to Famine in Early Life: Evidence from the China’s 1959–1961 Famine

Objective

Several studies have revealed that exposure to famine in early life was associated with higher body mass index(BMI) and waist circumference, and most of them used data from cross-sectional studies and defined those born before or after the famine period as non-exposed participants, which ignored the effects caused by age. Our objective was to study the effects of undernutrition in early life on overweight, obesity and abdominal obesity in those aged 54–56.

Methods

This was a retrospective cohort study with the status at age of 54–56 as outcomes. 1092 participants born between 1959 and 1961 from 2015 wave of China Health and Retirement Longitudinal Study (CHARLS) were defined as exposed and 1616 born between 1955 and 1957 from 2011 wave of CHARLS were defined as control. We used the prevalence odds ratios(ORs) to estimate the risks of overweight, obesity, abdominal obesity, and stratified by famine severity and sex separately for comparisons.

Results

Exposed group had higher risks of overweight (OR 1.357, 95%CI 1.067,1.727) and obesity (OR 1.356, 95%CI 1.001,1.836) in women, not in men. Participants in exposed group were more likely to have abdominal obesity (OR 1.362, 95%CI 1.139,1.629), regardless of famine severity and gender.

Conclusion

Undernutrition in early life increased the risks of overweight and obesity in women not in men. And the risk of abdominal obesity was increased with the experience of undernutrition at early age both in men and women.

     

Widening Rural–Urban Disparities in All-Cause Mortality and Mortality from Major Causes of Death in the USA, 1969–2009

This study examined trends in rural–urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural–urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural–urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005–2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005–2009 than in 1990–1992. Causes of death contributing most to the increasing rural–urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer’s disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.     

Influenza associated mortality in Southern China, 2010–2012

Objective

Influenza caused substantial morbidity and mortality worldwide. The mortality burden caused by influenza has been under evaluation; however, data assessing this burden have been relatively sparse in tropical or subtropical regions. We estimated influenza-associated mortality in Guangzhou, China and assessed the excess mortality due to different influenza virus subtypes.

Methods

We estimated influenza-associated excess mortality due to all-cause, pneumonia and influenza, cardiorespiratory disease and other influenza-associated diagnoses from weekly numbers of deaths and influenza surveillance data through negative binomial regression model during 2010–2012.

Results

Estimates derived from the model indicated that influenza resulted in 14.72 (95% confidence interval (CI), 12.12–17.31) deaths per 100,000 population per year from all-cause death among all ages group. Most deaths (84.2%) occurred among people aged ≥65 years. B virus caused 5.84 (95%CI, 4.10–7.58) deaths per 100,000 population for all-cause death, which was higher than A (H3N2) (4.89, 95%CI, 3.19–6.59) or A(H1N1)pdm09 (3.99, 95%CI, 2.32–5.66).

Conclusions

Influenza is responsible for a substantial mortality especially among people aged ≥65 years and influenza B virus caused the highest influenza-associated mortality. The results highlight the need for seasonal influenza vaccination programs in subtropical areas to decrease excess mortality.     

Spatial and temporal inequalities in mortality in the USA, 1968–2016

Previous UK and European research has highlighted important variations in mortality between populations after adjustment for key determinants such as poverty and deprivation. The aim here was to establish whether similar populations could be identified in the US, and to examine changes over time. We employed Poisson regression models to compare county-level mortality with national rates between 1968 and 2016, adjusting for poverty, education, race (a proxy for exposure to racism), population change and deindustrialisation. Results are presented by means of population-weighted cartograms, and highlight widening spatial inequalities in mortality over time, including an urban to rural, and south-westward, shift in areas with the highest levels of such unexplained ‘excess’ mortality. There is a need to understand the causes of the excess in affected communities, given that it persists after adjustment for such a broad range of important health determinants.     

Cancer mortality and oil production in the Amazon Region of Ecuador, 1990–2005

Objectives  To compare cancer mortality rates in Amazon cantons (counties) with and without long-term oil exploration and extraction activities. Methods  Mortality (1990 through 2005) and population census (1990 and 2001) data for cantons in the provinces of the northern Amazon Region (Napo, Orellana, Sucumbios, and Pastaza), as well as the province with the capital city of Quito (Pichincha province) were obtained from the National Statistical Office of Ecuador, Instituto Nacional del Estadistica y Censos (INEC). Age- and sex-adjusted mortality rate ratios (RR) and 95% confidence intervals (CI) were estimated to evaluate total and cause-specific mortality in the study regions. Results  Among Amazon cantons with long-term oil extraction, activities there was no evidence of increased rates of death from all causes (RR = 0.98; 95% CI = 0.95–1.01) or from overall cancer (RR = 0.82; 95% CI = 0.73–0.92), and relative risk estimates were also lower for most individual site-specific cancer deaths. Mortality rates in the Amazon provinces overall were significantly lower than those observed in Pichincha for all causes (RR = 0.82; 95% CI = 0.81–0.83), overall cancer (RR = 0.46; 95% CI = 0.43–0.49), and for all site-specific cancers. Conclusions  In regions with incomplete cancer registration, mortality data are one of the few sources of information for epidemiologic assessments. However, epidemiologic assessments in this region of Ecuador are limited by underreporting, exposure and disease misclassification, and study design limitations. Recognizing these limitations, our analyses of national mortality data of the Amazon Region in Ecuador does not provide evidence for an excess cancer risk in regions of the Amazon with long-term oil production. These findings were not consistent or supportive of earlier studies in this region that suggested increased cancer risks.     

Methuselah's medicine: Pharmaceutical innovation and mortality in the United States, 1960–2000

Although there is a good deal of speculation surrounding the role of pharmaceutical innovation in late 20th century mortality improvements in the United States, there is little empirical evidence on the topic and there remains a good deal of doubt regarding whether pharmaceuticals matter at all for mortality. Using a reliable indicator of pharmaceutical innovation—yearly approvals of new molecular entities (NMEs) by the Food and Drug Administration, along with information on priority status and disease-category indication—this study examines the relationship between pharmaceutical innovation and life expectancy between 1960 and 2000. The study demonstrates a significant relationship between pharmaceutical innovation and life expectancy at birth, which is robust to controls for gross domestic product, as well as controls for various forms of medical spending. The relationship with life expectancy is robust, in part, because pharmaceutical innovation has a stronger relationship with early-life mortality (between 20 and 50) than with later-life mortality (65 and over), even though older persons consume more pharmaceuticals and many recently approved drugs target conditions more common in later life. There is, to be sure, another side to the results. There is some evidence, for example, that the relationship between pharmaceutical innovation and mortality has declined over time, suggesting a change in the kind of innovations now entering the market. Nevertheless, there is more to contemporary pharmaceutical innovation than the development of mere “halfway” technologies. The overall relationship between innovation and mortality is sufficiently strong to warrant further consideration as a key determinant of trends in mortality.     

Firearm mortality in California, 2000–2015: the epidemiologic importance of within-state variation

Purpose

Firearm mortality is a significant problem in the United States. Previous studies have largely focused on firearm mortality at the national or state level, leaving open the question of within-state variation. This study examined firearm mortality within California.

Trends in cancer mortality of the digestive tract in Belgrade,Yugoslavia, 1975–1989

During the period of 1975–1989, in the Belgrade population increasing mortality trends were established for colon and rectal cancer, cancer of the pancreas and gallbladder and bile ducts cancer, for both sexes, and for esophageal cancer in males. Stomach and liver cancer mortality decreased in females. In males, stomach cancer mortality after a prolonged steady decrease suddenly rose in the years 1988 and 1989. Mortality rates series for esophageal cancer in females and for liver cancer in males did not fit any usual trend function.     

Physical activity and mortality: is the association explained by genetic selection?

Public health recommendations promote physical activity to improve health and longevity. Recent data suggest that the association between physical activity and mortality may be due to genetic selection. Using data on twins, the authors investigated whether genetic selection explains the association between physical activity and mortality. Data were based on a postal questionnaire answered by 13,109 Swedish twin pairs in 1972. The national Cause of Death Register was used for information about all-cause mortality (n=1,800) and cardiovascular disease mortality (n=638) during 1975-2004. The risk of death was reduced by 34% for men (relative risk=0.64, 95% confidence interval: 0.50, 0.83) and by 25% for women (relative risk=0.75, 95% confidence interval: 0.50, 1.14) reporting high physical activity levels. Within-pair comparisons of monozygotic twins showed that, compared with their less active co-twin, the more active twin had a 20% (odds ratio=0.80, 95% confidence interval: 0.65, 0.99) reduced risk of all-cause mortality and a 32% (odds ratio=0.68, 95% confidence interval: 0.49, 0.95) reduced risk of cardiovascular disease mortality. Results indicate that physical activity is associated with a reduced risk of mortality not due to genetic selection. This finding supports a causal link between physical activity and mortality.     

Committees for the prevention of infant mortality in the State of Paraná, Brazil: implementation and operation

This article reports on the implementation and operation of committees for the prevention of infant mortality in the State of Paraná, Brazil, with the operational strategies, formation, and relations at three levels: State, regional, and municipal. To implement the committees it was necessary to train professionals to investigate infant deaths. In two years the committees analyzed 50% of the infant deaths occurring in the State. The goal is to increase the number of cases analyzed and to continue to monitor the committees' work, seeking improved performance, agility, and data quality.     

Short-Term Effects of Air Pollution on Mortality in the Cities of Rouen and Le Havre,France, 1990–1995

In this study, the authors examined the short-term effects of ambient air pollution on mortality across 2 French cities: Rouen and Le Havre. In Poisson regression models, which controlled for day-of-week effects, the authors used nonparametric smoothing to control for temporal trend, weather, and influenza epidemics. In Rouen, an interquartile range increase of 60.5–94.1 μg/m³ of ozone was associated with an increase of 4.1 % (95% confidence interval = 0.6, 7.8) of total mortality. Daily variations in sulfur dioxide (interquartile range increase = 17.6–36.4 μg/m³) were also associated with an 8.2% increase (95% confidence interval = 0.4, 16.6) in respiratory mortality. An increase of 6.1% (95% confidence interval = 1.5, 10.9) of cardiovascular mortality was also observed with an interquartile range increase of nitrogen dioxide (i.e., 25.3–42.2 μg/m³). With respect to Le Havre, an interquartile range increase in daily levels of sulfur dioxide (11.3–35.6 μg/m³) was associated with an increase of approximately 3% (95% confidence interval = 0.8, 5) of cardiovascular mortality. For particulate matter less than or equal to 13 urn in diameter (interquartile increase = 21.5, 45.4 μg/m³), an increase of 6.2% (95% confidence interval = 0.1,12.8) was observed. The estimates of pollutant effects and their standard deviations were slightly affected by the degree of smoothing temporal variations in this study. When low collinearity was present, the 2-pollutant models provided acceptable estimates of pollutant effects. They suggested that the ozone effect was independent of the Black Smoke effect, and that the effects of sulfur dioxide and nitrogen dioxide were unlikely to be confounded by ozone concentrations. However, high collinearity leads to large estimates of the pollutant coefficient variances and, therefore, leads to inaccurate estimates of pollutant effects. The analysis of the contributory effects of different pollutant mixtures requires further investigation in those instances in which high collinearity between pollutants is present.     

Epidemiological trends of sepsis in the twenty-first century (2000–2013): an analysis of incidence,mortality, and associated costs in Spain

Background

Sepsis has represented a substantial health care and economic burden worldwide during the previous several decades. Our aim was to analyze the epidemiological trends of hospital admissions, deaths, hospital resource expenditures, and associated costs related to sepsis during the twenty-first century in Spain.

Methods

We performed a retrospective study of all sepsis-related hospitalizations in Spanish public hospitals from 2000 to 2013. Data were obtained from records in the Minimum Basic Data Set. The outcome variables were sepsis, death, length of hospital stay (LOHS), and sepsis-associated costs. The study period was divided into three calendar periods (2000–2004, 2005–2009, and 2010–2013).

Results

Overall, 2,646,445 patients with sepsis were included, 485,685 of whom had died (18.4%). The incidence of sepsis (events per 1000 population) increased from 3.30 (2000–2004) to 4.28 (2005–2009) to 4.45 (2010–2013) (p?<?0.001). The mortality rates from sepsis (deaths per 10,000 population) increased from 6.34 (2000–2004) to 7.88 (2005–2009) to 7.89 (2010–2013) (p?<?0.001). The case fatality rate (CFR) or proportion of patients with sepsis who died decreased from 19.1% (2000–2004) to 18.4% (2005–2009) to 17.9% (2010–2013) (p?<?0.001). The LOHS (days) decreased from 15.9 (2000–2004) to 15.7 (2005–2009) to 14.5 (2010–2013) (p?<?0.001). Total and per patient hospital costs increased from 2000 to 2011, and then decreased by the impact of the economic crisis.

Conclusions

Sepsis has caused an increasing burden in terms of hospital admission, deaths, and costs in the Spanish public health system during the twenty-first century, but the incidence and mortality seemed to stabilize in 2010–2013. Moreover, there was a significant decrease in LOHS in 2010–2013 and a decline in hospital costs after 2011.

     

Associates of Neonatal,Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012–2013 Demographic and Health Surveys

Objectives Pakistan is one of five nations contributing to half of the world’s child mortality and holds under-five mortality rates which are nearly double global targets. Reasons for this shortfall include civil conflicts, political uncertainty, low education, poverty, rural–urban disparities, and limited health care access. The aim of this study was to explore associations between individual characteristics, community factors, and child mortality in Pakistan. Methods Data were derived from the 2012 to 2013 Pakistan Demographic and Health Survey, and included 7399 live births and 380 child deaths. Multivariate, multilevel logistic regression was used to model risk of neonatal, infant and under-five child deaths. Results Seventy-one percent of child deaths occurred during the neonatal period. Significant factors (p < 0.05) associated with lower odds of child mortality included adhering to recommended minimum of 24 months interpregnancy interval and higher household wealth. These were significant for neonatal (OR 0.448; 0.871), infancy (OR 0.465; 0.881), and under-five deaths (OR 0.465; 0.879). Employed mothers had higher odds of neonatal (OR 1.479), infant (OR 1.506), and child mortality (OR 1.459). Likewise, women living in consanguineous marriages had higher odds of infant (OR 1.454) and under-five deaths (OR 1.381). Children in Balochistan, Punjab, and Sindh, regions disproportionately poor, rural with low levels of education, were at highest risk of dying. Conclusions for Practice Findings may assist in designing targeted interventions, developing appropriate public health messaging, and implementing policies designed to lower child mortality. Focusing on lowering rates of maternal poverty, increasing opportunities for education, and improving access to health care could assist in reducing child mortality in Pakistan.