Injury mortality in East Germany

OBJECTIVES: This study determined the effects of social changes in East Germany since 1989 on patterns of injury mortality. METHODS: Death certificate data regarding injuries from 1980 through 1995 and police data regarding traffic injuries in East Germany from 1980 through 1998 were compared with similar data from West Germany. RESULTS: The number of motor vehicle-related injuries and deaths in East Germany increased dramatically between 1989 and 1991, whereas those in West Germany declined slightly. The increased mortality in the more rural East has especially involved young men driving automobiles on rural roads and has persisted since reunification of East and West Germany. Falls, other accidents, and suicides have shown no such effect. Homicide among East German men has increased but remains uncommon. CONCLUSIONS: Recent social changes in East Germany, including increased access to motor vehicles and decreased restrictions on personal freedom, have been associated with increased motor vehicle crashes and mortality, especially among young men and on rural roads.     

Homicide surveillance--United States, 1979-1988.

From 1979 through 1988, 217,578 homicides occurred in the United States, an average of greater than 21,000 per year. Homicide rates during this 10-year period were about 1.5 times higher than the rates during the 1950s. The national homicide rate of 10.7/100,000 in 1980 was the highest ever recorded. Homicide occurs disproportionately among young adults. Among the 15- to 34-year age group, homicide is the fourth most common cause of death among white females, the third most common cause among white males, and the most common cause among both black females and black males. In 1988, nearly two-thirds (61%) of homicide victims were killed with a firearm, 75% of these with a handgun. More than half (52%) of homicide victims were killed by a family member or acquaintance, and about one-third (35%) of homicides stemmed from a conflict not associated with another felony. The homicide mortality rate among young black males 15-24 years of age has risen 54% since 1985. Ninety-nine percent of the increase was accounted for by homicides in which the victim was killed with a firearm. The surveillance data summarized in this report should assist public health practitioners, researchers, and policymakers in addressing this important public health problem.     

Visual disturbances in a population-based survey of 6962 subjects: the German National Health Examination Survey 1998

BACKGROUND: Available prevalence estimates of visual disturbances (excluding blindness) in Germany are based on data from highly selective populations. This report describes the prevalence of visual disturbances and potential determinants based on the German National Health Examination Survey from 1998. METHODS: A population-based cross-sectional study of the non-institutionalized population in unified Germany. People aged 18-79 years were eligible and were contacted by a multi-mode approach. The response proportion was 61%, resulting in a sample of 7124 subjects who participated in the study. Visual disturbances were assessed by a self-administered questionnaire. RESULTS: Prevalance rates are higher among women in unified as well as in East- and West Germany. The higher overall prevalence rates among women is mostly driven by higher prevalance rates at ages 18-49 years, especially for shortsightedness. The prevalence rates are higher in West Germany than East Germany. Visual disturbances are more prevalent among the middle and upper social class than the lower social class. Above the age group 40-44, the prevalence of visual disturbances considerably increases, to approximately 100% in the age group 55 years or older for both sexes and in both parts of Germany. CONCLUSIONS: Nearly 100% of German adults aged 50-79 years have some degree of visual disturbance that requires refractive correction. Prevalence rates of visual disturbances are higher among people from West Germany, people of higher social status and among women. Uncorrected visual disturbances are most prevalent in the age group 18-34 years and more often among males and subjects of lower social status.     

Entwicklung der Herz-Kreislauf-Morbidität und -Mortalität in Ostdeutschland nach der politisch-ökonomischen Wende

Cardiovascular mortality decreased in the GDR between 1980 and 1989 in men by 14 % and in women by 18 %. In 1990, however, among men as well as women the rates increased considerably, particularly for the age group 25-44 (18 % and 17 %, respectively), but also for the age group 45-64 (7 % for both sexes). Compared with the mortality rates of 1989 this increase resulted in an excess-mortality of approximately 1120 cardiovascular deaths in this age range in East Germany during the year of the reunification. The re-arrangement of the coding practice in this year is obviously not an explaination for this phenomenon. There were, on the other hand, very similar trends of the cardiovascular mortality and the myocardial infarction and stroke morbidity in the years before and after the reunification. The stroke morbidity developed quite parallel with the hypertension prevalence rates. But we observed no relationship between the trends in hypercholesterolemia and smoking, on the one hand, and the myocardial infarction attack rates, on the other hand. However, the prevalence of psychosocial risk factors (social network, job stress, life events) increased considerably. This fact seems to play an important role particularly in the increase of the incidence of myocardial infarctions after the political change. Cardiovascular mortality droped after the reunification to a faster rate than before the reunification especially in the age range below 65 years. Nevertheless, cardiovascular mortality is still currently much higher in East than in West Germany. Therefore, in order to bring the East German rates in line with the West German rates it will probably still take a long time.     

Trends in workplace homicides in the U.S., 1993-2002: a decade of decline

BACKGROUND: Trends in workplace homicide rates are compared to the trends in U.S. homicides from 1993 to 2002, inclusively. The homogeneity of workplace homicide rates by victim demographics, circumstances, and types of events are also addressed. METHODS: Using publicly available data from several sources, Poisson models are used to statistically compare the trends of workplace homicide rates versus U.S. homicide rates and to compare trends within categories of workplace homicides. RESULTS: Overall, there was a significant decline in the rates of occupational homicide of approximately 6% per year during the study time period; this decline was found to be statistically greater than the decline of all U.S. homicides (5% per year). Taxi cab drivers and chauffeurs demonstrated the greatest decline of all occupational subgroups. When looking at the circumstances of workplace homicides, only the rate of homicides committed during a robbery or other crime demonstrated a significant decline. CONCLUSIONS: While workplace homicides have declined in the U.S., the declines have not occurred uniformly across demographic and occupational categories.     

Lebenserwartung, vorzeitig verlorene Lebensjahre und vermeidbare Sterblichkeit im Ost-West-Vergleich

The dynamics of convergence between East and West Germany in the life-prolonging process continued undiminished from 1990 until 2001. The regional differences in premature and avoidable mortality were clearly reduced, both between East and West and between the individual federal states. In the East and in the West there was an increase in life expectancy in all age groups and for both sexes, whereby the increase in life expectancy was considerably greater in East Germany and in all of the East German federal states. Also, the standardized potential years of life lost before the age of 65 decreased more intensively in East Germany. The women in East Germany achieved a lower premature mortality due to illness in the year 2001 than those in West Germany. In the initial year of 1990, the years of life lost were 27.2% greater. Unnatural premature mortality (especially due to accidents) was also relatively high in East Germany in the year 2001, but it is clearly being reduced. The avoidable mortality has been more than cut in half in all East German federal states since 1990. An almost complete alignment between East and West in regard to avoidable mortality was achieved in the year 2001. The phase of economic stagnation that can be observed in East Germany since 1997 has up to now not led to a worsening in the constitutive health references presented above.     

Effects of the Repeal of Missouri’s Handgun Purchaser Licensing Law on Homicides

In the USA, homicide is a leading cause of death for young males and a major cause of racial disparities in life expectancy for men. There are intense debate and little rigorous research on the effects of firearm sales regulation on homicides. This study estimates the impact of Missouri’s 2007 repeal of its permit-to-purchase (PTP) handgun law on states’ homicide rates and controls for changes in poverty, unemployment, crime, incarceration, policing levels, and other policies that could potentially affect homicides. Using death certificate data available through 2010, the repeal of Missouri’s PTP law was associated with an increase in annual firearm homicides rates of 1.09 per 100,000 (+23 %) but was unrelated to changes in non-firearm homicide rates. Using Uniform Crime Reporting data from police through 2012, the law’s repeal was associated with increased annual murders rates of 0.93 per 100,000 (+16 %). These estimated effects translate to increases of between 55 and 63 homicides per year in Missouri.     

The relative contribution of income inequality and imprisonment to the variation in homicide rates among Developed (OECD), South and Central American countries

Homicide rates vary widely across and within different continents. In order to address the problem of violence in the world, it seems important to clarify the sources of this variability. Despite the fact that income inequality and imprisonment seem to be two of the most important determinants of the variation in homicide rates over space and time, the concomitant effect of income inequality and imprisonment on homicide has not been examined. The objective of this cross-sectional ecological study was to investigate the association of income inequality and imprisonment with homicide rates among Developed (OECD), South and Central American countries. A novel index was developed to indicate imprisonment: the Impunity Index (the total number of homicides in the preceding decade divided by the number of persons in prison at a single slice in time). Negative binomial models were used to estimate rate ratios of homicides for young males and for the total population in relation to Gini Index and Impunity Index, controlling for infant mortality (as a proxy for poverty levels), Gross Domestic Product per-capita, education, percentage of young males in the population and urbanization. Both low income inequality and low impunity (high imprisonment of criminals) were related to low homicide rates. In addition, we found that countries with lower income inequality, lower infant mortality (less poverty), higher average income (GDP per-capita) and higher levels of education had low impunity. Our results are compatible with the hypothesis that both low income inequality and imprisonment of criminals, independent of each other and of other social-structural circumstances, may greatly contribute to the reduction in homicide rates in South and Central American countries, and to the maintenance of low levels of homicides in OECD countries. The Impunity Index reveals that countries that show greater commitment to education and to distribution of income also show greater commitment to punish serious criminal behavior.     

Blue Thursday? Homicide and suicide among urban 15-24-year-old black male Americans.

A comparative analysis was made of day of the week variations in homicide and suicide deaths among 15-24-year-old white males, black males, white females, and black females in the 22 counties with the most black persons in the United States. Thirty-seven percent of black Americans and 14 percent of white Americans lived in these densely populated counties. The authors expected a weekend excess of homicide and a Monday excess of suicide. They found a pronounced excess of homicides on weekends, especially among white males. A slight excess of suicide was observed on Monday, but other slight excesses of suicide were also found. Young black males exhibited an unexpected excess of homicides and suicides on Thursday. On Thursdays the black male-white male ratio for homicide was 1.43 and for suicide, 1.26. Possible explanations for the young black males' blue Thursday phenomenon are offered.     

Homicide in the workplace in Ontario: occupations at risk and limitations of existing data sources

This study has identified workplace homicides in Ontario from 1975 to 1985, described those at risk, and examined what existing data sources are most suitable for locating the occurrence of these events. Homicides were identified from two sources: the Office of the Chief Coroner and the Ontario Mortality Database (OMDB). Of the 84 homicides identified, 87% occurred among males; the average annual work-related homicide rate was 0.17 per 100,000 workers, with a male-to-female ratio of 5.2:1. The rates in males were about one-eighth of those reported in California and Texas. The highest rates occurred among policemen, gas station attendants, security guards, and taxi drivers, and in restaurants and in certain retail operations such as jewelry stores. These homicides represented about 4% of all traumatic workplace fatalities. Firearms were responsible for 56% of these homicides and the motive was robbery in 50%. The OMDB proved to be an awkward source from which to identify such deaths because there is no "injury-at-work" field on death certificates. Other existing sources of data were not able to locate work-related homicides. Guidelines to protect those at high risk of assault and homicide should be developed.     

AIDS – Wie leben schwule Männer heute? Kurzfassung der Ergebnisse der Befragung November 1999

A four page questionnaire was included in the November 1999 edition of 10 monthly German magazines for gay men to investigate how this population responds to risks posed by HIV/AIDS. This was the sixth time the questionnaire was administered in the former West Germany since 1987 and the fourth time in the former East Germany since 1991. A total of 2995 men responded (16% from the former East Germany, and 84% from the former West Germany). In 1999, 72% of respondents from both the western and eastern parts of the country did not engage in risk contacts in the twelve months preceding the survey, where risk contact was defined as unprotected anal intercourse with partners whose serostatus was unknown or whose status differed from that of the subject. In 1996, this percentage was 72% for East Germans and 76% for West Germans. The occurrence of protective behaviour in East and West has become increasingly similar over time; whereas, the proportion of men in the West German samle taking risks has increased since 1996. Whether the increased risk-taking in the West can be attributed to the introduction of combination therapy is a question which cannot be answered on the basis of the data gathered.     

The Relationship Between Gun Ownership and Stranger and Nonstranger Firearm Homicide Rates in the United States, 1981–2010

Objectives. We examined the relationship between gun ownership and stranger versus nonstranger homicide rates.Methods. Using data from the Supplemental Homicide Reports of the Federal Bureau of Investigation’s Uniform Crime Reports for all 50 states for 1981 to 2010, we modeled stranger and nonstranger homicide rates as a function of state-level gun ownership, measured by a proxy, controlling for potential confounders. We used a negative binomial regression model with fixed effects for year, accounting for clustering of observations among states by using generalized estimating equations.Results. We found no robust, statistically significant correlation between gun ownership and stranger firearm homicide rates. However, we found a positive and significant association between gun ownership and nonstranger firearm homicide rates. The incidence rate ratio for nonstranger firearm homicide rate associated with gun ownership was 1.014 (95% confidence interval = 1.009, 1.019).Conclusions. Our findings challenge the argument that gun ownership deters violent crime, in particular, homicides.Firearms cause more than 31 000 deaths annually in the United States.1 Since the tragic shooting of 20 children and 7 adults in Newtown, Connecticut, in 2012, several states have enacted or debated legislation to restrict the availability of firearms.2 Some gun rights advocates have argued that restricting the availability of guns might cause harm by removing an effective deterrent to crime.3-5 Lott, for example, has suggested that reducing the number of guns held by law-abiding citizens might increase homicides because “it would be easier for criminals to prey on the weakest citizens, who would find it more difficult to defend themselves.”5^(p11) Understanding whether increased gun ownership increases or decreases homicides is essential to inform public policy regarding measures to address firearm violence.Of particular interest is the question of whether higher gun ownership is associated with lower rates of stranger homicide (i.e., homicide committed by a person unknown to the victim) because such a relationship is consistent with the hypothesis that increased household ownership of guns deters violent crime by strangers who might otherwise have killed the potential victim.Multiple cross-sectional studies have demonstrated a correlation between higher gun ownership at the state level and higher overall state-specific rates of firearm homicide.6-18 Most recently, we reported a strong and robust relationship between estimated gun ownership in the 50 states and firearm homicide rates over the period 1981 to 2010, while controlling for 20 potential state-level confounding variables.19 None of these studies distinguished between stranger and nonstranger homicides. We are not aware of any published studies that have examined the relationship between gun ownership and stranger versus nonstranger homicide rates.Although the US Department of Justice regularly provides national statistics on rates of stranger versus nonstranger homicide,20,21 we are aware of no published studies that report state-specific data on stranger versus nonstranger homicide. Understanding state-specific patterns of victimization in terms of the relationship between homicide victims and offenders, and identifying the trends in these patterns, would inform state efforts to reduce homicide rates.22Several studies have examined the relationship between homicide victims and offenders in specific settings, such as national youth homicides22; national homicides23,24; Allegheny County, Pennsylvania, homicides25; adolescent homicides in North Carolina26; homicides in Contra Costa County, California27; and national homicides among intimate partners.28 Nationally, between 1980 and 2008, of the homicides for which the relationship between victim and offender was known (63.1% of all homicides), approximately one fifth (21.9%) were stranger homicides.20 We are not aware of any published data on how this may vary among states.In this article, we report and analyze stranger and nonstranger homicides at the state level during the period 1981 to 2010 and examine the relationship between those rates and state-specific household gun ownership during the same years. To the best of our knowledge, ours is the first study to report state-specific data on stranger and nonstranger homicide rates and examine the relationship between state-level gun ownership and stranger and nonstranger homicide rates, while controlling for differences in a wide range of state-level factors associated with homicide.     

Alcohol and fatal injuries: temporal patterns

Although alcohol use has been established as a risk factor for injuries associated with motor vehicle crashes, the role of alcohol for other unintentional and intentional injuries is less defined. A review of 102,401 deaths investigated by North Carolina medical examiners in the period 1973-1983 characterized the temporal patterns of ethyl alcohol in unintentional injury fatalities, suicides, homicides, and persons who died of natural or unknown causes. Victims of homicides (85.9%) and suicides (77.7%) were tested for alcohol more frequently than were fatalities resulting from unintentional injury (67.5%) or natural causes (61.6%). Alcohol was present in 62.8% of homicide victims, 48.6% of unintentional injury fatalities, 35.3% of suicides, and 14.4% of deaths from natural causes. The percentage of alcohol-associated deaths for each manner of death showed little yearly or seasonal variation. Alcohol was most frequently detected in persons fatally injured on the weekend and from 6 PM to 6 AM. This study highlights the magnitude of alcohol's role in intentional and unintentional injuries, especially for persons injured at night and on weekends.     

Regional variations in homicide mortality in Jalisco,Mexico

The present study describes regional variations in homicide rates in Jalisco State, Mexico, in 1989-1991, 1994-1996, and 1999-2000, analyzing the trends by gender and socioeconomic stratum. Using mortality data generated by the National Institute for Statistics, Geography, and Information Technology, homicide rates adjusted by age and gender were calculated, along with rate/female rate ratios; rate ratios by socioeconomic stratum and 95% confidence intervals were also calculated. According to the results, the homicide rate showed: a downward trend in the 1990s; a regional homicide mortality pattern, with the highest rates in peripheral regions, considered among the poorest areas in the State; municipalities with the lowest socioeconomic conditions also presenting a statistically significant excess homicide mortality; and an evident over-mortality from homicide among males. The results point to tasks and challenges for public health and law enforcement institutions, including the need to implement different inter-institutional policies that take into consideration the characteristics of homicide and violent crime in Jalisco.     

Cross-sectional study on influenza vaccination,Germany, 1999-2000

To assess influenza vaccination coverage in Germany, we conducted a nationwide telephone survey in November 1999 in adults (>18 yrs) using random-digit dialing. Overall, 23% of 1,190 survey participants reported having been vaccinated (adjusted 18%) with 16% (adjusted 15%) in former West Germany versus 35% (adjusted 32%) in former East Germany. Immunization rates for vaccination target groups were lower in West Germany (21%) than in East Germany (40%). Seven percent of health-care workers were immunized. Previous influenza vaccination, positive attitudes towards immunization, and having a family physician increased the rate of vaccination; fear of adverse effects lowered the rate. Family physicians performed 93% of the vaccinations, which suggests their key role in improving low vaccination coverage in Germany. The fact that >71% (850/1,190) of participants belonged to at least one of the vaccination target groups recommended by the German Standing Commission on Immunization emphasizes the need to focus the definition of target groups.     

Weight gain in two adult cohorts in East and West Germany reunification

BACKGROUND: Several epidemiological studies have shown consistently higher prevalence rates of obesity and overweight in East German adults compared to West German adults before German reunification in 1990. If different lifestyle factors after German division contribute to these differences, one might speculate that trends of obesity and overweight in the East and West after German reunification in 1990 would be similar. OBJECTIVE: To examine weight gain in East and West German adult cohorts in the decade after German reunification. METHODS: The study population includes 554 individuals with complete data aged 20 - 47 years in 1990-92 participating in the ten year follow-up of the European Community Respiratory Health Survey (ECRHS) in the German centres Hamburg (West) and Erfurt (East). Age and occupation-adjusted prevalence and incidence rates, stratified for gender and centre, were calculated for the Erfurt and Hamburg cohorts. RESULTS: The prevalence of overweight increased in males and females in both cities, and was statistically significant for Hamburg males (32.7% to 44.9%), Hamburg females (12.3% to 25.4%) and Erfurt females (18.5% to 31.2%). The increase in the prevalence of obesity was statistically significant for males (Hamburg: 3.7% to 7.9%; Erfurt: 5.2% to 10.8%) and for females only in Hamburg (6.4% to 14.2%). The increase in the prevalence of overweight and obesity were larger in Hamburg than in Erfurt. Moreover, the incidence rates of obesity were higher in Hamburg for both sexes, but were not statistically significant CONCLUSION: Our findings indicate different patterns of weight gain in 2 study sites in East- and West-Germany. These results might reflect a convergence of initially higher prevalences of overweight and obesity in the East with initially lower prevalences in the West.     

Infectious diseases before and after German unification: trends in mortality and morbidity

After the fall of the Berlin Wall in 1989 the former communist countries of central and eastern Europe underwent substantial social and economic changes that had a major impact on health. The situation of the former German Democratic Republic was unique in that its existing institutions were replaced rapidly and it was quickly integrated economically with the West. This study describes recent trends in morbidity and mortality from infectious diseases in East and West Germany before and after unification using routine data from 1980 onwards. Substantial differences in morbidity and mortality resulting from infectious diseases were observed between East and West Germany. These seem to be the complex result of societal and health system differences in both parts of Germany before unification, differing population dynamics and health behaviours, and an increasing westernisation in the eastern part of Germany during recent years.     

Homicide, suicide, motor vehicle crash, and fall mortality: United States'' experience in comparative perspective.

US mortality data on motor vehicle crashes, falls, suicide, and homicide for 1980 are compared with corresponding data for France, Japan, West Germany, and the United Kingdom. Unadjusted and age-specific death rates are presented, together with age-adjusted rates of years of life lost (YLL). A large male excess in rates is typical outside the fall category. Motor vehicle crashes are the predominant cause of YLL, and the United States manifests the highest YLL rates for each sex. US fall death rates at the older ages are exceeded by those of France and West Germany. The elderly generally manifest the greatest risk of suicide; American females exhibit a unique rate decline after ages 45-54 years, however. Beyond early adulthood, US suicide rates are lower than those of France, Japan, and West Germany. US homicide rates dwarf those of the comparison countries with 16- to 29-fold differentials separating prime-risk American males aged 25-34 years from their foreign counterparts.     

Measuring homicide in Russia: a comparison of estimates from the crime and vital statistics reporting systems

The Russian homicide rate more than tripled between 1988 and 1994 and is now among the highest in the world. This dramatic increase, together with newly available data from a post-Soviet Russian government that is becoming more transparent, has led to a growing number of studies of homicide in Russia. As of yet, however, there has been no systematic evaluation of the homicide reporting systems in the country. This article examines the comparability of the two main sources of homicide estimates in Russia, crime data from the Ministry of the Interior and mortality data from the vital statistics registration system. These estimates are compared annually and by administrative region. Annual estimates from the vital statistics reporting system have reported an average of nearly 40% more homicides than the crime reporting system over the last decade and a half. Regionally, mortality estimates are higher than crime estimates in 66 of 78 regions, and eight of the 12 regions where crime estimates are higher are in areas where previous validation procedures suggest mortality data are suspect. As the regional homicide rate increases, so does the gap between the two estimates. Case definitions of these sources lead us to expect small discrepancies between them, but this does not account for the large differences revealed here. Both systems under-report, for different reasons, and some of the under-enumeration in both systems is purposeful and/or results from a lack of human and monetary resources. Mortality data are probably better for most purposes, especially when comparing Russia to other nations and when estimating causal models. Both systems should be used with caution, however, and the choice between them should depend on the nature of each study.     

Homicides in Medellín, Colombia, from 1990 to 2002: victims, motives and circumstances

In Medellín, Colombia, homicide has been the first cause of morbidity and mortality for 20 years. Medellín has the highest homicide rates of all major cities in Latin America. This study describes the victims, motives, and circumstances in homicides in Medellín from 1990 to 2002. The period included 55,365 homicides, of which 1,394 were randomly studied. Of this sample, 93.6% (95%CI: 92.2%-94.8%) were males, 77.0% (95%CI: 75.0%-79.5%) less than 35 years of age, one-fourth had consumed alcohol, and nine out of ten were killed with firearms. The main motives were revenge and armed robbery. 37.0% (95%CI: 34.0%-41.0%) of the victims lived in the lowest socioeconomic stratum of the city. Characteristics of homicides in Medellín have remained unchanged since the 1980s, when the most violent period in the city's history began. The most heavily affected groups are young males who live and die in poor neighborhoods, and the murders are individual acts that leave no wounded behind.