Patterns of site-specific displacement in cancer mortality among migrants: the Chinese in the United States.

Taking advantage of the information gathered for the 1975 National Mortality Survey in China, this paper compares the levels of cancer mortality among foreign-born and United States-born Chinese around 1970 with those of the communities of origin of the majority of Chinese migrants to the US. Age-adjusted rates indicate two distinctive site-specific patterns among US Chinese: a downward trend for cancers of high risk among Guangdong and Hong Kong Chinese (nasopharynx, esophagus, liver, uterus, and perhaps stomach) and an upward trend for those sites of low risk among Chinese in Guangdong and Hong Kong (colon, lung, leukemia, and female breast). Further field studies are needed with emphasis on the birthplace of migrants and environmental changes in host countries.     

Diabetes and renal mortality in the United States.

The risk of renal death is examined in the United States population 15 years of age and older with and without diabetes. The renal mortality rate is 174.6 per 100,000 among people with diabetes and 42.5 per 100,000 among people without diabetes. The relative risk of renal mortality is 4.1 for diabetics, age-adjusted relative risk, 2.6. The risk of renal mortality is highest in young people with diabetes. Rates of renal mortality are higher than previously believed among Whites with diabetes and among women with diabetes.     

Solar activity and mortality in the United States.

Mortality from all causes, from coronary heart disease, and from stroke in the US was studied in relation to solar activity as measured by the geomagnetic index, Ap, on a daily basis for the years 1964-66 and on a monthly basis for the years 1964-71. The data did not support previous assertions by Soviet researchers of an association between solar activity and cardiovascular mortality.     

Socioeconomic effects on child mortality in the United States.

Despite considerable reason for scholarly and policy interest in socioeconomic mortality differentials, socioeconomic effects on child and teenage mortality in the United States have been a neglected research topic because of several data limitations. Exploiting data obtained for other purposes, this paper reports socioeconomic effects on the mortality of children and teenagers. Socioeconomic mortality differentials among children are large--at least as large as those among adults. The major source of socioeconomic mortality differences among children is apparently differential risk to accidental death. Within the child population, the strength of socioeconomic effects varies directly with the relative importance of accidents as a component of overall mortality.     

Annual productivity costs due to cervical cancer mortality in the United States.

BACKGROUND: Several studies have estimated annual US health care costs associated with cervical cancer; however, few data are available on the corresponding annual loss in women's productive earnings resulting from premature mortality owing to cervical cancer. The present study estimates annual productivity costs associated with cervical cancer mortality in the United States. METHODS: An analytic framework was developed for estimating the lost earnings that would have accrued during 2000 for women dying from cervical cancer during that and earlier years, who would have otherwise been alive and working in 2000. The following data from publicly available sources were gathered and analyzed for US women on an age-specific basis: 1) annual number of cervical cancer deaths during 2000 and preceding years; 2) estimated probability of otherwise being alive during 2000, for women dying from cervical cancer during the period 1935-2000; 3) labor force participation rates in 2000; and 4) mean annual earnings in 2000. RESULTS: Overall, it was estimated that there were 130,377 women who would have been alive during 2000 had they not died from cervical cancer during that or a previous year. Over 75% of these women died before age 60, with >25% dying prior to age 40, and it was estimated that 37,594 (29%) of these women would have had labor force earnings during 2000. The total productivity loss in 2000 owing to cervical cancer mortality was estimated at $1.3 billion. CONCLUSIONS: The annual productivity loss for cervical cancer estimated in the present analysis is several times higher than recent estimates of the annual US direct medical costs associated with cervical cancer ($300-$400 million).     

Fat and dietary fiber intake and colon cancer mortality: a chronological comparison between Japan and the United States

To estimate the role of dietary fiber (DF) and fat in the striking growth of colon cancer mortality in Japan after World War II, we analyzed relations between the above variables in comparison with those in the United States. In the United States, fat intake grew by only one-third over the past 70 years (from 124 g in 1909-1913 to 166 g in 1984), whereas colon cancer mortality increased fourfold (from 5 to 20 per 100,000). In Japan, although fat intake roughly doubled during the 40 years after World War II (from 20 to 38 g), colon cancer mortality grew 5.5-fold (from 2 to 11 per 100,000). It is difficult to give a consistent explanation for the growth patterns of colon cancer mortality in both countries on the basis of fat consumption as a cancer promoter. In the United States, DF intake continuously dwindled at a level always less than in Japan throughout this century. DF intake in Japan also declined rather steadily, except for war time, over the past 80 years. However, with regard to the growth pattern of colon cancer mortality, it began rising steeply around the period when the daily DF intake diminished below 20 g, suggesting the presence of a threshold level in this neighborhood in preventing the development of colon cancer.     

Impact of screening on incidence and mortality of prostate cancer in the United States

The potential confounding influence of changing treatment patterns and misattribution bias make a definitive conclusion about the link between PSA screening and mortality rates tentative at best. At least some of the mortality decline since 1991 appears likely to be due to screening, but the precise magnitude of the screening effect is difficult to estimate. The possible reduction in mortality due to screening, while uncertain, must be weighed against the substantial decrements in treatment-specific health outcomes (32-34) among men treated for clinically localized tumors typically detected by screening. Population data and ongoing screening trials in the United States and Europe (24, 35) will be complementary in the final determination of the relative contribution of the impact of screening versus other causes on recent mortality trends.     

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.     

The contribution of ionizing radiation to cancer mortality in the United States

Although ionizing radiation has been well known as a carcinogen for more than 70 years, only a small part of the total cancer mortality burden in the United States can be attributed to radiation effects—less than 3%. Little can be done about much of the exposure to radiation that exists—about half of the total results from natural background radiation. More than 40% derives from medical and dental practice—mostly as diagnostic X-rays. Something less than 5% comes from nuclear weapons fallout from atmospheric tests and well under 1% from the use of nuclear energy for generating electric power. Substantial reduction of the total radiation burden on the population can be achieved only by reduction of X-rays used in medicine and dentistry. This will, however, involve careful consideration of the balance between radiation benefits and risks, as well as requiring that such X-ray exposures be reduced to the minimum required to achieve the necessary medical purpose.     

Racial differences in ill defined cancer mortality in the United States and in the District of Columbia.

STUDY OBJECTIVE--The aim was to examine the epidemiology of unknown primary cancer mortality in the USA during 1979 to 1988 by age, sex, race, year, and geographical area. DESIGN--National (US) and state data were abstracted for deaths due to ill defined cancer (ICD-9 195.0 to 199.1) and all cancers combined (ICD-9 140.0-209.9). Age adjusted mortality rates were calculated using the 1980 USA population as the standard, and standardised rate ratios were derived. National total cancer incidence data were obtained from the surveillance, epidemiology and end results (SEER) program, and age and sex specific relative (black/white) cancer incidence rates were derived and compared to relative (black/white) mortality rates for ill defined cancer. State and regional median family income levels were obtained from the 1980 census and compared to corresponding mortality rates. SETTING--This study used data for the US population, the 50 states, and the District of Columbia. MEASUREMENTS AND MAIN RESULTS--During 1984-1988, ill defined cancers accounted for an average of 34,921 deaths each year in the USA (13.7 per 100,000 population). The mortality rate due to ill defined cancers is greater among blacks (19.3 per 100,000) than whites (13.2 per 100,000) (RR = 1.5) and has not declined since 1979. There is considerable geographical variation in the ill defined cancer mortality rate. Thus among blacks the highest rates were clustered in the central states (23 per 100,000) and the lowest rates were seen in the mountain and western states (17 per 100,000). The District of Columbia had the highest overall rate (21.7 per 100,000) when compared to all other states. The black/white relative mortality rate due to ill defined cancer was consistently greater than the black/white relative incidence of all cancers. CONCLUSIONS--Ill defined cancer mortality is the fourth leading site of cancer mortality in the USA, and accounts for 7.4% of cancer deaths annually. The large proportion of ill defined cancer deaths may have biased the accuracy of national and local cancer incidence and mortality statistics. The higher mortality of ill defined cancer among blacks is not explained by the higher overall cancer incidence among blacks and suggests the influence of socioeconomic or cultural barriers that may result in underutilisation of health services or substandard health care. Ill defined cancer mortality may be a sentinel indicator of deficiencies in the health care delivery system as well as a measure of progress against cancer.     

Changing heat-related mortality in the United States

Heat is the primary weather-related cause of death in the United States. Increasing heat and humidity, at least partially related to anthropogenic climate change, suggest that a long-term increase in heat-related mortality could occur. We calculated the annual excess mortality on days when apparent temperatures--an index that combines air temperature and humidity--exceeded a threshold value for 28 major metropolitan areas in the United States from 1964 through 1998. Heat-related mortality rates declined significantly over time in 19 of the 28 cities. For the 28-city average, there were 41.0 +/- 4.8 (mean +/- SE) excess heat-related deaths per year (per standard million) in the 1960s and 1970s, 17.3 +/- 2.7 in the 1980s, and 10.5 +/- 2.0 in the 1990s. In the 1960s and 1970s, almost all study cities exhibited mortality significantly above normal on days with high apparent temperatures. During the 1980s, many cities, particularly those in the typically hot and humid southern United States, experienced no excess mortality. In the 1990s, this effect spread northward across interior cities. This systematic desensitization of the metropolitan populace to high heat and humidity over time can be attributed to a suite of technologic, infrastructural, and biophysical adaptations, including increased availability of air conditioning.     

Measles mortality in the United States 1971-1975.

During 1971-75, an average of 35.4 measles-related deaths were recorded each year; one death for every 1,000 measles cases reported. Measles mortality rate was highest in children under 1 year of age, as was the death-to-case ratio. Mortality rates were higher in non-metropolitan than in metropolitan counties. Measles mortality rates were inversely related to median family income.     

Age dependence of cohort phenomena in breast cancer mortality in the United States

Breast cancer mortality has increased in most parts of the world, and many explanations have been postulated. In this paper, the authors examined the evolution of mortality rates for white and nonwhite females in the United States from 1950-1979. Using both graphic techniques and Poisson regression models, they found that there has been strong modification of apparent cohort effects by age. For both white and nonwhite females, they observed an increase in mortality rates limited to the postmenopausal ages.     

Regional variations of blood pressure in the United States are associated with regional variations in dietary intakes: the NHANES-III data

Compared with other regions in the United States, the southern region has had the highest stroke mortality rate and a more prevalent and resistant hypertension. We designed this analysis of the data obtained from the National Health and Nutritional Examination Survey III (NHANES-III), which is a community-based cross-sectional survey, to describe regional variations in blood pressure and the reported consumption of nutrients, focusing on those linked to blood pressure, in the United States. We selected the following variables from the NHANES-III data for this analysis: systolic and diastolic blood pressures, protein, carbohydrates, total fatty acids, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, fiber, sodium, potassium, calcium, magnesium, zinc, copper, iron, riboflavin, niacin, thiamin, alcohol and vitamins C, E, B-6 and B-12. Of the 17,752 participants in the survey who were 18 y of age or older, the south had the highest systolic and diastolic blood pressures (P < 0.005 for each) and reported the highest consumption of monounsaturated fatty acids, polyunsaturated fatty acids and cholesterol (P < 0.05 for all) and the least amount of fiber in the multivariate analysis (P < 0.005). The highest reported sodium consumption was in the south region (3.4 +/- 0.02 g), and the lowest was in the west (3.2 +/- 0.03 g; P < 0.05). The south also consumed the least potassium, calcium, phosphorous, magnesium, copper, riboflavin, niacin, iron and vitamins A, C and B-6 (P < 0.005). There was no difference among the four regions in frequency of "adding salt on the table." The region of the United States that includes the "stroke belt" has dietary patterns that may contribute to the high prevalence of hypertension and cardiovascular disease.     

Region of birth and mortality of blacks in the United States.

Analysis of black American death rates by region of birth and region of residence showed that southern-born blacks had the highest mortality rates and western-born blacks the lowest mortality rates. Blacks born in the northeast, midwest, and outside the US had rates intermediate between southern and western-born black rates. Blacks born in one region and who died in another had age-specific and age-adjusted mortality rates similar to their region of birth rather than their region of residence.