Past mortality from infectious diseases and current burden of allergic diseases in England and Wales

This study documents the changes in mortality in England and Wales over the last 100 years as a possible explanation for our increasingly allergy-prone Western society. A total of 53 million computerized recorded deaths, which occurred from 1901 to 2000 were analysed retrospectively. Childhood mortality decreased by 98%, from 40.6% of total annual deaths in 1901 to 0.9% in 2000. In 1901, 36.2% of all deaths and 51.5% of childhood deaths were from infectious diseases. By contrast in 2000, 11.6% of all deaths and only 7.4% of childhood deaths were from infectious diseases. Infectious diseases were a significant cause of childhood mortality in British cities until about 40 years ago. Several factors, including vaccination, antibiotics and improved sanitation have contributed to this trend. Survival of individuals with heightened immunity to infections may have led to natural selection of allergy-prone individuals in England and Wales. However, the relationship between changes in rates of infection and allergy is complex and not fully understood.     

Tetanus in England and Wales, 1984-2000

A review of national tetanus surveillance in England and Wales during 1984-2000 was undertaken to evaluate the surveillance system and national vaccination policy. Hospital Episode Statistics for tetanus in England for fiscal years 1989/90-1995/6 were also examined to estimate under-reporting. A total of 175 cases of tetanus were reported, giving an annual incidence of 0.20 per million, the lowest levels ever recorded. The highest incidence was in those aged over 64 years (0.66 per million) with no significant sex difference. Twenty (11%) cases were reported in people who were eligible for routine childhood vaccination. Outdoor injuries were the commonest reported exposure risk. Tetanus case under-reporting was estimated as 54-64%. We conclude that GPs should ensure that all their patients are fully vaccinated, targeting those born before 1961. High childhood tetanus vaccination coverage remains a priority. As the disease becomes rarer, enhanced tetanus case surveillance is essential for tetanus immunization policy evaluation.     

Geographical variation mortality from ischaemic heart disease in England and Wales.

Analysis ofthe proportional mortality attributed to ischaemic heart disease, adjusted for age, reminds us that many of the well known geographical, environmental, social, and economic variations within England and Wales are not disease specific.     

Deaths from ischaemic heart disease and infant mortality in England and Wales.

Death rates from ischaemic heart disease (IHD) in English and Welsh counties are correlated, in both men and women, with the infant mortality rates of those counties when the individuals whose deaths are considered were young, thus confirming previous findings in Norway. In England and Wales, however, there is an equally good correlation between deaths from IHD and infant mortality patterns up to and including that for the same time period as the IHD deaths. The British data provide no grounds for concluding from these relationships that living conditions during early life per se bear a causal relationship to deaths from IHD.     

Testicular cancer mortality in England and Wales 1971-80: variations by occupation.

The occupations of all males aged 15 and over dying of cancer of the testis in England and Wales from 1971 to 1980 (2434 cases) have been examined in a case control study. Significant excess mortality was found in farmers (although not farm workers), food manufacture and preparation workers, and draughtsmen, although the results show little evidence of a major role for occupation in the aetiology of this cancer. The results may, however, aid the search for those factors in modern life that may have contributed to the sharp rise in incidence of this cancer in recent years.