Influenza-related mortality in Spain, 1999-2005

Objective

To estimate the excess deaths attributed to influenza in Spain, using age-specific generalized linear models (GLM) and the Serfling model for the period 1999-2005.

Method

We reviewed mortality from influenza and pneumonia and all-cause deaths. We used an additive GLM procedure, including the numbers of weekly deaths as a response variable and the number of influenza virus and respiratory syncytial virus weekly isolates, the population and two variables to adjust for annual fluctuations as covariates. Using the Serfling model, we removed the trend and applied a temporal regression model, excluding data from December to April to account for the expected baseline mortality in the absence of influenza activity.

Results

Globally, the excess mortality attributable to influenza was 1.1 deaths per 100,000 for influenza and pneumonia and 11 all-cause deaths per 100,000 using the GLM model. The highest mortality rates were obtained with the Serfling model in adults older than 64 years, with an excess mortality attributable to influenza of 57 and 164 deaths per 100,000 for influenza and pneumonia and all-cause, respectively.

Conclusions

The GLM model, which takes viral activity into account, yields systematically lower estimates of excess mortality than the Serfling model. The GLM model provides independent estimates associated with the activity of different viruses and even with other factors, which is a significant advantage when trying to understand the impact of viral respiratory infections on mortality in the Spanish population.     

Increase in Clostridium difficile-related mortality rates, United States, 1999-2004

Reported mortality rates from Clostridium difficile disease in the United States increased from 5.7 per million population in 1999 to 23.7 per million in 2004. Increased rates may be due to emergence of a highly virulent strain of C. difficile. Rates were higher for whites than for other racial/ethnic groups.     

Morbidity and mortality rates in a NOVA SCOTIA First Nations Community, 1996-1999

BACKGROUND: Despite an abundance of data and analysis of First Nations morbidity and mortality rates, accurate data have not been available to serve the First Nations community in Eastern Canada. METHODS: Data for Eskasoni, the largest Mi'kmaq community, were obtained for 1996 through 1999 and Cape Breton and Nova Scotia were used as regional and provincial reference populations respectively. Age-adjusted relative risks (AARR) were calculated for overall mortality and disease-specific hospital admissions. RESULTS: Eskasoni's mortality AARR was greater than 1.0 in 3 of the 4 years studied, although the data may understate Eskasoni's mortality rates. Eskasoni's total admission AARRs were significantly greater than the two reference populations. Neoplasm admission rates were generally lower, while circulatory disease admission AARRs were significantly higher. A rise in diabetic admission rates was noted with the AARR reaching statistical significance in the final years of the study. Respiratory disease was the leading cause of hospitalization with significantly greater rates of admission than regional or provincial rates. Pneumonia and influenza accounted for more than one half of respiratory admissions. Infectious disease admissions were more prevalent in Eskasoni while rates of liver disease were generally low. CONCLUSION: Results suggest that members of the largest Mi'kmaq band are at greater risk for a number of disease categories and health promotion should be targeted toward respiratory ailments, circulatory disease and diabetic management. Further analysis, however, remains an important priority.     

Neighbourhood mortality inequalities in New York City, 1989-1991 and 1999-2001

OBJECTIVES: To examine whether inequalities in mortality across socioeconomically diverse neighbourhoods changed alongside the decline in mortality observed in New York City between 1990 and 2000. DESIGN: Cross-sectional analysis of neighbourhood-level vital statistics. SETTING: New York City, 1989-1991 and 1999-2001. MAIN RESULTS: In both poor and wealthy neighbourhoods, age-adjusted mortality for most causes declined between the time periods, although mortality from diabetes increased. Relative inequalities decreased slightly-largely in the under 65 years population-although all-cause rates in 1999-2001 were still 50% higher, and rates of years of potential life lost before age 65 years were 150% higher, in the poorest communities than in the wealthiest ones (relative index of inequality 1.7 and 3.3, respectively). The relative index of inequality for mortality from AIDS increased from 4.7 to 13.9. Over 50% of the excess mortality in the poorest neighbourhoods in 1999-2001 was due to cardiovascular disease, AIDS and cancer. CONCLUSIONS: In New York City, despite substantial declines in absolute mortality and rate differences between poor and wealthy neighbourhoods, great relative socioeconomic inequalities in mortality persist.     

Occupational injury mortality: New Mexico 1998-2002

BACKGROUND: The current study characterizes patterns of occupational injury fatalities in New Mexico for the 5-year period 1998-2002. METHODS: The study applied methods developed by the Council of State and Territorial Epidemiologists/National Institute for Occupational Safety and Health (CSTE/NIOSH) Occupational Health Indicator Work Group and compared the relative strength and weakness of two different datasets (CFOI and NMVRHS) for occupational injury fatality surveillance. RESULTS: Annual occupational injury mortality rates ranged from 4.4 to 7.6 per 100,000 employed persons aged 16 and over compared to annual US rates of 4.0-4.6 per 100,000. Risk factors for higher mortality rates included age over 65 years, self-employment, non-US citizenship, being African-American or Hispanic, and occurrence in rural counties. The top industry for fatality rate was mining followed by transportation, public utilities, agriculture, and construction. CONCLUSIONS: Applying CSTE/NIOSH Occupational Health Indicator protocol and using both CFOI and NMVRHS data improved the characterization of occupational injury mortality and the setting of priorities for prevention intervention.     

Neighborhood poverty, mortality rates, and excess deaths among African Americans: Philadelphia 1999-2001

We used vital statistics and census data to determine whether mortality rates in Philadelphia were associated with neighborhood poverty, and to what extent excess mortality among African Americans was associated with neighborhood poverty. Gender-specific, age-adjusted mortality rates for 1999-2001 were strongly associated with neighborhood poverty among both women and men overall, and among both African Americans and non-Hispanic whites. The actual number of deaths among African Americans was 5,305 higher than it would have been if African Americans had had the same gender- and age-specific mortality rates as the average for non-Hispanic whites in Philadelphia, and 1,944 higher than if African Americans had had the same gender- and age-specific rates as non-Hispanic whites in the same neighborhood poverty categories. The excess mortality associated with neighborhood poverty and the socioeconomic factors that force large numbers of African Americans into poverty and high-poverty neighborhoods appear to be major factors in excess mortality among African Americans.     

Adverse events associated with ingestion of gamma-butyrolactone--Minnesota, New Mexico, and Texas, 1998-1999

Products containing gamma-butyrolactone (GBL) are marketed for many claimed purposes, including to induce sleep, release growth hormone, enhance sexual activity and athletic performance, relieve depression, and prolong life. GBL is converted by the body into gamma-hydroxybutyrate (GHB), a drug banned outside of clinical trials approved by the Food and Drug Administration (FDA). Recognized manifestations of GHB toxicity include bradycardia, hypothermia, central nervous system depression, and uncontrolled movements. This report describes seven cases of GBL toxicity involving the product "Revivarant," which is labeled as containing 1.82 g of GBL per fluid ounce, reported from two hospital emergency departments (EDs) in Minnesota during October-December 1998 and summarizes an additional 34 cases of GBL toxicity reported to poison centers in New Mexico and Texas during October 1998-January 1999.     

Hypothermia-related deaths--United States, 1999-2002 and 2005

Hypothermia, defined as a core body temperature of <95 degrees F (<35 degrees C), is preventable. Excessive exposure to cold temperatures leads to potentially fatal central nervous system depression, arrhythmias, and renal failure. Advanced age, chronic medical conditions, substance abuse, and homelessness are among risk factors for hypothermia-related death. This report describes three hypothermia-related deaths that occurred during 2005 and reviews CDC data on hypothermia-related deaths during 1999-2002 in the United States. Public health strategies should target U.S. populations at increased risk for exposure to excessive cold and recommend behavior modification (e.g., dressing warmly, modifying activity levels, or avoiding alcohol) to help reduce mortality and morbidity from hypothermia.     

Effects of measles-control activities--African region, 1999-2005

In 1999, of approximately 871,000 deaths from measles worldwide, 61% occurred in sub-Saharan Africa. In 2001, countries in the World Health Organization (WHO) African Region began an accelerated measles-control program to reduce by half by 2005 the number of deaths that were caused by measles in 1999. The African Region accelerated measles-control program was based on four strategies: improving routine vaccinations; providing a second opportunity for measles vaccination through a routine, 2-dose vaccination schedule or through supplementary immunization activities (SIAs); improving measles case management; and establishing case-based surveillance with laboratory confirmation for all suspected measles cases. Seven countries in the region had already completed catch-up SIAs by 2000, before the regional program began; in 2001, additional countries in the region began implementing catch-up, and later, follow-up SIAs, and steps were taken to improve routine vaccination coverage with measles vaccine and other vaccines in the Expanded Programme on Immunization schedule. This report summarizes the nationwide SIAs and other measles-control activities conducted in the WHO African Region during 1999-2004, analyzes the trends in reported measles cases since 1990, and compares the annual number of measles cases reported in 2005 with those reported in 1999.     

Trends in cancer mortality rates,Bergen County,New Jersey, 1962-75.

Publication of the "Atlas of Cancer Mortality for U.S. Counties, 1950-1969" caused a great deal of concern in counties shown in the Atlas to have had high cancer mortality rates in relation to the United States as a whole. An analysis was made of temporal trends of cancer mortality in Bergen County, a "high-rate county" in northeastern New Jersey, by calculating age-adjusted cancer mortality rates by sex and site for Bergen County residents for the period 1962-75. Mortality rates and time rates of change in mortality rates were compared to those in the United States as a whole. Male and female rates for respiratory cancer and male rates for all sites combined increased significantly more quickly in the United States than in Bergen County during the study period. The authors discuss these trends and recommended that recent time-specific mortality rates be furnished to county health commissions on a regular basis.     

Waterborne diseases in the state of Mexico, Mexico (2000-2005)

This paper reports a spatial-temporal examination of waterborne disease data from the State of Mexico, 2000 to 2005, by county as the spatial unit. It was found that the incidence of waterborne disease did not decrease during the period under study. Inequality between metropolitan areas and rural zones was observed. People living in population centres had lower incidence of water-related diseases, possibly due to better access to services. In all cases, children under five years old suffered a much higher relative morbidity than the population in general. Improvement of the water distribution network between 2000 and 2005 could explain the decrease in morbidity from 30% to 15%, for the total population, and from 34% to 18.5%, for children under five years old. Coverage of sewer services over the period was not substantially improved; as a result the coefficient of determination remained nearly constant: 16.5% for the total population and 25% for children under five. Maintenance and operation deficiencies in the water distribution and wastewater sanitation systems play an important role in the incidence of this type of disease. It was found that the institutional division of the territory does not correspond to the actual distribution of the risk areas.     

Participation in high school physical education--Ontario, Canada, 1999-2005

School-based physical education (PE) programs provide regular and structured opportunities for youths to participate in moderate or vigorous physical activities that help meet the Canadian public health recommendation for 90 minutes of daily physical activity. To examine prevalence and trends in PE participation among high school students (i.e., grades 9-12) in Ontario, Canada, during 1999-2005, researchers at the University of Toronto and the University of Guelph analyzed data from the Ontario Student Drug Use Survey (OSDUS). This report describes the results of that analysis, which indicated a significant linear decrease from 1999 to 2005 in the percentage of students who were enrolled in PE. Female and older students were least likely to be enrolled in PE and to participate in vigorous physical activity during the average PE class. As in the United States, coordinated programs involving schools, communities, and policy makers are needed to provide effective PE for all youths in Ontario.     

Injury mortality in American Indian, Hispanic, and non-Hispanic white children in New Mexico, 1958-1982

Childhood fatalities from injuries are a serious public health problem in New Mexico, a state which ranks second in the nation in injury-related mortality rates. To determine the extent of injury mortality in children in this state, and to examine time trends and differences in mortality rates in New Mexico's American Indian, Hispanic, and non-Hispanic white children aged 0-14 years, we analyzed vital records collected from 1958 to 1982. American Indian children experienced the highest mortality rates from all external causes combined. Among all three major ethnic groups, children aged 0-4 years were at the highest risk for injury fatalities. Unintentional injuries accounted for 85% of all injury-related deaths. Motor vehicle crashes and drowning were the first and second leading causes of death in all three groups, while other important causes of death included fire, choking on food or other objects, poisoning, and homicide. Although the fatality rates on most types of injuries decreased over the 25-year period, childhood fatality rates for motor vehicle crashes and homicide increased in each ethnic group. Despite the overall decrease in injury mortality rates in New Mexican children, the rates are excessively high compared to other states, especially in American Indian children.     

Malignant mesothelioma mortality in the United States, 1999-2001

Malignant mesothelioma is strongly associated with asbestos exposure. This paper describes demographic, geographic, and occupational distributions of mesothelioma mortality in the United States, 1999-2001. The data (n = 7,524) were obtained from the National Center for Health Statistics multiple-cause-of-death records. Mortality rates (per million per year) were age-adjusted to the 2000 U.S. standard population, and proportionate mortality ratios (PMRs) were calculated by occupation and industry, and adjusted for age, sex, and race. The overall age-adjusted mortality rate was 11.52, with males (22.34) showing a sixfold higher rate than females (3.94). Geographic distribution of mesothelioma mortality is predominantly coastal. Occupations with significantly elevated PMRs included plumbers/pipefitters and mechanical engineers. Industries with significantly elevated PMRs included ship and boat building and repairing, and industrial and miscellaneous chemicals. These surveillance findings can be useful in generating hypotheses and developing strategies to prevent mesothelioma.     

中国2000--2005年孕产妇死亡趋势分析

目的 了解2000-2005年中国孕产妇死亡发生的主要特征、死亡率变化趋势、主要死亡原因及其变化.方法 在全国31个省、自治区、直辖市孕产妇死亡监测网内采用以人群为基础的流行病学调查方法.结果 2000-2005年中国农村孕产妇死亡率高于城市,边远地区高于内地、沿海;全国孕产妇死亡率由53.0/10万下降到47.6/10万,农村由67.2/10万下降到59.2/10万,城市由28.8/10万下降到27.6/10万,下降幅度分别为10.2%、11.9%和4.2%.2000年全国孕产妇死亡前3位死因为产科出血、妊娠期高血压和羊水栓塞,2005年前3位是产科出血、心脏病和妊娠期高血压,但产科出血始终是第一死因,导致产科出血的主要原因是胎盘滞留、宫缩乏力和子宫破裂.结论 2000-2005年全国孕产妇死亡率无趋势变化,主要死因是产科出血.降低农村及边远地区孕产妇死亡率和提高诊治产科出血基本技能是实现<中国妇女发展纲要(2000-2010年)>降低孕产妇死亡率目标的关键.     

哈尔滨市2005-2009年流感相关超额死亡分析

目的了解黑龙江省哈尔滨市2005-2009年流感可能导致的超额死亡,为流感防控提供参考。方法利用中国疾病预防控制中心基于人群的疾病监测系统中死因数据、国家流感中心流感病原学监测数据、气象数据(平均温度和湿度),分别采用率差模型和Poisson回归模型估算哈尔滨市2005-2009年流感相关超额死亡数。结果 2005-2009年哈尔滨市流感每年流行周数为9周左右,流行优势菌株为H1N1、H3N2和B型。2005-2009年哈尔滨市流感相关平均每周超额死亡率为2.69/10万。率差模型计算显示5年哈尔滨市超额死亡数为15 310人,其中0岁~组、1岁~组、15岁~组、50岁~组和65岁~组分别为414、64、2 210、3 600、7 727人。Poisson回归模型计算显示5年哈尔滨市超额死亡数为12 326人,其中0岁~组、1岁~组、15岁~组、50岁~组和65岁~组分别为290、33、1 569、2 988、7 184人。结论 哈尔滨市流感导致的超额死亡较高,主要发生在冬春季节,流行优势菌株为H1N1,其次为H3N2,B型较少。