AIDS and changing patterns of mortality.

We compared changes in all-causes mortality rates, 1986 versus 1980, among members 25 to 44 years of age of demographically defined groups with high AIDS cumulative incidence to the changes among same-age, same-sex members of groups with low AIDS cumulative incidence. Among nonwhite men ages 25-44 residing in northeastern New Jersey (NJ) counties, AIDS cumulative incidence was 1,409 cases per 100,000; all-causes mortality was 413.8 deaths per 100,000 per year in 1980 and increased 74% to 726.6 deaths per 100,000 per year by 1986. In contrast, among white men ages 25-44 residing in other NJ counties, AIDS cumulative incidence was 75 cases per 100,000; all-causes mortality fell slightly from 192.6 deaths per 100,000 per year in 1980 to 189.2 deaths per 100,000 per year in 1986. Among nonwhite women ages 25-44 residing in northeastern NJ counties, AIDS cumulative incidence was 435 cases per 100,000; all-causes mortality was 162.07 deaths per 100,000 per year in 1980 and increased 70% to 276.3 deaths per 100,000 per year by 1986. Among white women ages 25-44 residing in other NJ counties, AIDS cumulative incidence was 9.1 cases per 100,000; all-causes mortality was 90.5 deaths per 100,000 per year in 1980 and fell slightly to 83.0 deaths per 100,000 per year in 1986. A substantial portion of the increased mortality of the groups with high AIDS cumulative incidence resulted from causes that have not been associated with HIV infection.     

Impact of the human immunodeficiency virus epidemic on mortality trends in young men, United States.

Following a long-term decline, death rates in men 25-44 years of age increased from 212 deaths/100,000 in 1983 to 236 deaths/100,000 in 1987. To assess the impact of human immunodeficiency virus (HIV) infections on this trend and to identify causes that are increasing in association with the HIV epidemic, we analyzed national mortality statistics and compared death rates in states with high and low incidence of acquired immunodeficiency syndrome (AIDS). In 1987, there were 10,248 deaths with HIV infection, AIDS, or conditions in the AIDS surveillance definition assigned as the underlying cause, representing 11 percent of deaths for men in this age group compared to less than 1 percent in 1980. In addition, deaths with other underlying causes, such as other infections, drug abuse, and unknown/unspecified causes, had diverging and higher rates in states with high versus low AIDS incidence. In the absence of deaths due to HIV/AIDS and excess deaths due to these associated conditions, we estimate that death rates for men 25-44 years of age would have been 201-209/100,000 in 1987. For 1987, approximately 70-90 percent of HIV-related deaths were reported through national AIDS surveillance. The HIV epidemic has led to a reversal in mortality trends and to increases in various causes of death for young men.     

Estimating the Haemophilus influenzae type b (Hib) disease burden and the impact of Hib vaccine in Fiji

AIMS: To estimate Haemophilus influenzae type b (Hib) disease burden in Fiji in children under the age of 5 years (under-5s) prior to vaccine introduction. To compare estimates from WHO's Hib rapid assessment tool (RAT), with that from decline in disease after vaccine introduction. METHODS: Laboratory data (meningitis), hospitalization and mortality data (pneumonia and meningitis) before and after Hib vaccine introduction were collected. The RAT protocol provides two independent estimates of pre-vaccine disease burden (one based on meningitis incidence laboratory data and the other based on mortality statistics). A third estimate uses the decline in disease following vaccine introduction. RESULTS: The decline in meningitis hospitalizations implies a pre-vaccine Hib meningitis incidence of 66 per 100,000 in under-5s. This compares with a pre-vaccine RAT estimate of Hib meningitis incidence of 84 per 100,000 (for 1992-1993). The RAT estimated the total annual pre-vaccine Hib burden (meningitis plus pneumonia) at 476 cases and 36 deaths per year ("meningitis incidence method") and 70 cases and 5 deaths ("child mortality method"). Hib vaccine led to declines of 32% (95% confidence interval (CI)=11-48%), and 78% (95% CI=22-94%) for all under-5s meningitis hospitalizations and deaths, respectively. There was no similar consistent decline in pneumonia hospitalizations or deaths after vaccine introduction, except for a statistically significant reduction in pneumonia mortality in children aged under 1 year. CONCLUSIONS: Hib disease constitutes an important burden on the health of Pacific children that can be rapidly reduced with Hib vaccine. In this setting, routine morbidity statistics (comparing pre-and post-vaccine) provided an estimate of Hib meningitis burden which is broadly similar to that of the Hib RAT, suggesting that both might be valid ways to estimate Hib meningitis incidence. However, Hib pneumonia burden could not be estimated from routine statistics.     

Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults.

OBJECTIVES: This study assessed the impact of diabetes on mortality associated with pneumonia and influenza among non-Hispanic Black and White US adults. METHODS: Data were derived from the National Mortality Followback Survey (1986) and the National Health Interview Survey (1987-1989). RESULTS: Regardless of race, sex, and socioeconomic status, people with diabetes who died at 25 to 64 years of age were more likely to have pneumonia and influenza recorded on the death certificate than people without diabetes who died at comparable ages (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 2.3, 7.7). For those 65 years and older, the risk remained elevated among Whites with diabetes (OR = 2.2, 95% CI = 1.7, 2.7) but not among Blacks with diabetes (OR = 1.0, 95% CI = 0.6, 1.7). It was estimated that about 17,000 (10.3%) of the 167,000 deaths associated with pneumonia and influenza that occurred in 1986 were attributable to diabetes. CONCLUSIONS: The impact of diabetes on deaths associated with pneumonia and influenza is substantial. Targeted immunizations among people with diabetes may reduce unnecessary deaths associated with pneumonia and influenza.     

Mortality of migrants from the Caribbean to England and Wales: effect of duration of residence

Aim To investigate mortality of Caribbean migrants in England and Wales by duration of residence and age at migration. METHOD: Study members in a national cohort, aged 25-54 years in 1971, were followed up from 1971 to 2000. There were 1540 migrant Caribbeans amongst whom there were 329 deaths during follow-up. Cox regression models were used to analyse mortality from cardiovascular disease and cancers. All results were adjusted for sex and socioeconomic position. RESULTS: All-cause mortality was not related to duration of residence or age at migration at ages 25-34 or 35-44 years in 1971. At ages 45-54 years a pattern of increasing mortality with each additional year of residence prior to 1971 (hazard ratio [HR] = 1.07, 95% CI: 0.95, 1.20, 144 deaths) and with each additional year of age at migration (HR = 1.09, 95% CI: 0.97, 1.22) was observed. Circulatory disease mortality, accounting for 40% of all deaths, contributed to this pattern. At ages 45-54 years, both duration of residence (HR = 1.21, 95% CI: 1.01, 1.44, 62) and age at migration (HR = 1.25, 95% CI: 1.06, 1.49) increased per year of each. Of these deaths, stroke mortality was positively associated with both predictors (HR = 1.38, 95% CI: 1.10, 1.74 for duration of residence and HR = 1.44, 95% CI: 1.15, 1.80 for age at migration), a pattern due to effects at ages 45-54 years. Deaths from coronary heart disease showed similar trends in the oldest age cohort. No significant trends were observed for deaths from cancers. CONCLUSION: Circulatory disease mortality in Caribbean migrants increased with increasing duration of residence and age at migration in the oldest age cohort, primarily due to the effects from stroke mortality.     

AIDS and HIV infection in Poland in 2002

The cumulative number of AIDS cases diagnosed in Poland from 1986 up to the end of 2002 reached 1273, and 618 AIDS deaths were registered during this time. The yearly number of newly diagnosed cases remained stable (113 in 2002, incidence 0.3 per 100,000), but with 48 reported deaths the downward trend in AIDS mortality, experienced since 1996, was not sustained. Additionally, taking into account the official life statistics data, AIDS deaths might be underreported. In 2002, 574 newly detected HIV infections were reported (incidence 1.5 per 100,000), which is within the range observed in the past years. Injecting drug users constituted the most numerous risk group both among the AIDS cases (56.5%) and the HIV infection cases (31.1%). The proportion of reports of HIV infections with missing information regarding the risk group further increased in 2002, coming up to 55%. In order to monitor the epidemiological situation better quality of data will need to be assured.     

AIDS and HIV infection in Poland in 2003

The cumulative number of AIDS cases diagnosed in Poland from 1986 through 2003 reached 1421, and 676 AIDS deaths were registered during this time. Compared to previous years there was a slight increase in number of diagnosed AIDS cases (139 in 2003, incidence 0.36 per 100,000, comparing to 116 in 2002). Moreover the upward trend in AIDS mortality, which began in 2002, continued in 2003, with 61 reported deaths (a 27% increase as compared to 2002 and 45% increase as compared to 2001). Additionally, taking into account the official life statistics data, AIDS deaths might be underreported. In 2003, 610 newly detected HIV infections were reported (incidence 1.5 per 100,000), which is within the range observed in the past years. Injecting drug users constituted the most numerous risk group both among the AIDS cases (59.7%) and the HIV infection cases (35.6%). The proportion of reports of HIV infections with missing information on the risk group, however, remained very high (55% of all reports). In order to monitor the epidemiological situation better quality of data will need to be assured.     

Burden of pneumonia in patients with viral and bacterial coinfection in Spain during six consecutive influenza seasons,from 2009–10 to 2014–15

PurposeLower respiratory infections remain the most lethal communicable disease worldwide. Viral and bacterial coinfections (VBC) are common complications in patients with seasonal influenza and are associated with around 25% of all influenza-related deaths. The burden of pneumonia in patients with VBC in Spain is poorly characterized. To address this question, we aimed to provide population data over a period of six consecutive influenza seasons, from 2009–10 to 2014–15.MethodsWe used the discharge report from the Minimum Basic Data Set (MBDS), published annually by the Spanish Ministry of Health, to retrospectively analyse hospital discharge data in individuals aged ≥60 years with a diagnosis of pneumonia and influenza, based on the International Classification of Diseases (ICD-9-CM codes 480–486 and 487–488, respectively), from 1 October 2009 to 30 September 2015.ResultsIn total, 1933 patients ≥60 years old were hospitalized for pneumonia and influenza, of whom 55.2% were male. The median age was 74 years (interquartile range [IRQ] 15); half of the patients were ≥75 years old. Influenza was the main diagnosis in 64.4% of the patients, and all–cause pneumonia in 15.8%, half of whom were assigned a diagnostic code for pneumococcal pneumonia. The mean annual hospitalization rate was 2.99 per 100,000 population (95% CI 2.9–3.1) throughout the study period, while the highest rate, 5.6 per 100,000 population (95% CI 5.2–6.0), was observed in the 2013–14 season. The mean annual mortality rate was 0.5 deaths per 100,000 population (95% CI 0.4–0.6) and in-hospital case fatality rate was 16.1% (95% CI 14.5–17.8).ConclusionsIn Spain, community-acquired pneumonia and influenza continue to be an important cause of hospitalization and mortality in patients over 60 years of age. There is an urgent need to further develop prevention strategies such as joint vaccination for both pathologies.     

AIDS as a leading cause of death among young adults in Italy

The objective of this study is to describe the impact of AIDS on the mortality of young adult (aged 25 to 44 years) in Italy, at both the national and regional level. We analyzed the official mortality data for Italy: the most recent data available being from 1990. General mortality trends show that while mortality among young women is still decreasing (i.e. from a standardized rate of 83.8 per 100,000 in 1980 to 68.4 in 1990), mortality among young men began to rise in the mid-1980s, after a steady decrease over many years. Among the 25–34 year olds, however, this reversal in trend is more marked, notwithstanding a decrease or stabilization in most major causes of death. In fact it coincides with the appearance and spread of AIDS in Italy, which has affected young men in particular. (The peak age group for AIDS deaths is the 25–34 year olds). Mortality data from 1990 reveal that AIDS is the fourth leading cause of death in Italy among men between the ages of 25 and 44 years. Among 25–34 year-old men, however, AIDS is the second leading cause of death, after road accidents. AIDS also contributes greatly to the general mortality in individual regions, both among 25–44 year-old men (Lombardy, Liguria, Lazio, Emilia-Romagna, Tuscany), and especially among 25–34 year-old men (Lombardy, Liguria, Lazio, Sardinia, where it is the number one cause of death, Emilia-Romagna, Tuscany, and Veneto, where it is the number two cause of death).     

2012—2018年洛阳市女性乳腺癌发病死亡特征分析

目的 利用2012—2018年洛阳市肿瘤登记数据评估全市女性乳腺癌的流行情况,为全市乳腺癌的防控提供依据。 方法 利用2012—2018年肿瘤登记数据分城乡地区和年龄组评估全市女性乳腺癌的流行情况,计算发病率、死亡率、累积率、截缩率、标化率和平均年度变化百分比(average annual percentage change, AAPC)等指标,人口标准化率按照2000年中国标准人口结构(简称中标率)和Segi's世界标准人口结构(简称世标率)进行计算。 结果 2012—2018年洛阳市女性乳腺癌发病人数6 600例,平均发病率为41.43/10万,中国人口和世界人口标化发病率分别为33.01/10万和30.87/10万,0～74岁累积发病率为3.35%,35～64岁截缩率为74.71/10万。乳腺癌位居女性全部恶性肿瘤发病的第一位(15.80%)。2012—2018年洛阳市女性乳腺癌死亡人数1 491例,死亡率为8.88/10万,中国人口和世界人口标化死亡率分别为6.58/10万和6.32/10万,0～74岁累积死亡率为0.73%,35～64岁截缩率为13.26/10万,乳腺癌死亡位居女性全部恶性肿瘤死亡的第五位(6.99%)。洛阳市女性乳腺癌发病和死亡年龄集中在40～69岁和40～79岁人群。城市地区发病和死亡(中标率:40.03/10万,8.59 /10万)均高于农村地区(中标率:29.87/10万,5.69/10万)。洛阳市女性乳癌世界标化发病率随时间呈上升趋势(AAPC为3.102%,95%CI为0.487%~5.813%,P<0.05),世界标化死亡率无明显变化(AAPC为-6.681%,95%CI为-13.501%~0.746%,P>0.05)。 结论 乳腺癌是威胁洛阳市女性健康的主要恶性肿瘤之一,疾病负担日益加重,应进一步加强乳腺癌的综合防治工作。     

Invasive group A streptococcal infections, clinical manifestations and their predictors, Montreal, 1995-2001

We identified 306 invasive group A streptococcal infections (IGASI) by passive population-based surveillance in Montreal, Canada, from 1995 to 2001. The average yearly reported incidence was 2.4 per 100,000 persons, with a 14% death rate. Among clinical manifestations, incidence of pneumonia increased from 0.06 per 100,000 in 1995 to 0.50 per 100,000 in 2000. Over a span of 7 years, the odds of developing pneumonia increased (odds ratio [OR] = 1.21, 95% confidence interval [CI] 1.0-1.5), while they decreased for soft-tissue infections (OR = 0.86, 95% CI 0.7-1.0). Serotypes M1 and M3 accounted for 30% of IGASI. However, neither serotype was significantly associated with specific clinical manifestations, which suggests that manifestation development among IGASI might be attributable to host or environmental factors rather than the pathogen. In our study, these factors included age, gender, underlying medical conditions, and living environment, yet none explained temporal changes in risk for pneumonia and soft-tissue infections.     

Epidemiology of community-acquired pneumonia in children seen in hospital

There is little UK data on hospital admission rates for childhood pneumonia, lobar pneumonia, severity or risk factors. From 13 hospitals serving the catchment population, demographic and clinical details were prospectively collected between 2001 and 2002 for children aged 0-15 years, seen by a paediatrician with community-acquired pneumonia (CAP) and consistent chest X-ray changes. From 750 children assessed in hospital, incidence of CAP was 14.4 (95% CI 13.4-15.4)/10,000 children per year and 33.8 (95% CI 31.1-36.7) for <5-year-olds; with an incidence for admission to hospital of 12.2 (95% CI 11.3-13.2) and 28.7 (95% CI 26.2-31.4) respectively. Where ascertainment was confirmed, incidence of CAP assessed in hospital was 16.1 (95% CI 14.9-17.3) and 41.0 (95% CI 37.7-44.5) in the 0-4 years age group, whilst incidence for hospital admission was 13.5 (95% CI 12.4-14.6) and 32 (95% CI 29.1-35.1) respectively. In the <5 years age group incidence of lobar pneumonia was 5.6 (95% CI 4.5-6.8)/10,000 per year and severe disease 19.4 (95% CI 17.4-21.7)/10,000 per year. Risk of severe CAP was significantly increased for those aged <5 years (OR 1.50, 95% CI 1.07-2.11) and with prematurity, OR 4.02 (95% CI 1.16-13.85). It also varied significantly by county of residence. This is a unique insight into the burden of hospital assessments and admissions caused by childhood pneumonia in the United Kingdom and will help inform future preventative strategies.     

Characteristics of tuberculosis patients with positive sputum smear in Catalonia, Spain

BACKGROUND: Patients with positive sputum smears are those with the capacity to spread infection. The objective of this study was to describe the incidence of tuberculosis in Catalonia (an autonomous community in the northeast of Spain which includes Barcelona) and to determine risk factors associated to patients with positive sputum smear test. METHODS: New cases of tuberculosis detected by active surveillance between May 1996 and April 1997 were studied. The study was analysed as a coincident cases and controls study. The rate of incidence was calculated per 100,000 persons-year. The association of the dependent variable--case of tuberculosis with positive sputum smear--with the remainder of independent variables was determined by odds ratio (OR) with a 95% confidence interval (CI). RESULTS: A total of 2508 cases of tuberculosis were detected. The rate of incidence was 41.4 per 100,000 persons-year. Of these 19.4% (487/2508) were coinfected with HIV and 35.6% (893/2508) presented a positive sputum smear, which implies a rate of 14.7 per 100,000 persons-year. In an adjusted multivariate analysis, cases with positive smears were positively associated with the 15-24 (OR=1.9; 95% CI: 1.4-2.4), 25-34 (OR=2.1; 95% CI: 1.7-2.7) and 35-44 years (OR=1.7; 95% CI: 1.3-2.2) age compared with persons 45 years old and above; with males (OR=1.8; 95% CI: 1.5-2.2) and consumers of alcohol (OR=2.1; 95% CI: 1.7-2.7) and negatively with those under 15 years of age (OR=0.1; 95% CI: 0.1-0.2) and coinfection with HIV (OR=0.5; 95% CI: 0.3-0.7). CONCLUSIONS: Measures to control tuberculosis transmission (prompt diagnosis, study of contacts and directly observed treatments) should be reinforced for male adults with excessive consumption of alcohol.     

What happens to people diagnosed with tuberculosis? A population-based cohort

We examined different patient outcomes following diagnosis of tuberculosis (TB). Incident cases were reported to the enhanced surveillance system in the East of England, between 2000 and 2003. For the 575 cases reported in 2001 and 2002, outcomes were assessed 1 year after initiating treatment. The crude clinical incidence rate of TB was 6.0 cases/100,000 person-years (pyr) [95% confidence interval (CI) 5.7-6.4], highest in the 25-29 years age group (14.9, 95% CI 12.9-17.1 cases/100,000 pyr) and among Black Africans (328.6, 95% CI 286.9-374.6 cases/100,000 pyr). Patients born abroad were 2.35 (95% CI 1.03-5.32) times more likely to be lost to follow-up than those born in the United Kingdom. Age at diagnosis (OR 1.05, 95% CI 1.04-1.07) and pulmonary disease (OR 2.73, 95% CI 1.21-6.15) were independently associated with mortality. Elderly patients and those with pulmonary TB appear to have worse outcomes despite treatment. Foreign-born patients may need closer follow-up to ensure favourable outcomes.     

Mumps: Burden of disease in France

This article provides a review of the epidemiological data on mumps in France since 1986. The results of 26 years of monitoring in general practice by the Sentinel network are analysed, such as hospitalisation data between 2004 and 2010, as well as mortality data between 2000 and 2009. The annual incidence rate has plummeted between 1986 and 2011, from 859 cases per 100,000 inhabitants [95% CI: 798–920] to 9 cases per 100,000 inhabitants [95% CI: 4–14]. A change in the age distribution is significant with an increase of Relative Illness Ratio (RIR) for patients over 20 years. Since 2000, vaccine status has also changed, and the majority of recent mumps cases occur among previously vaccinated patients. The average annual hospitalisation rate is 3.2 per 1 million inhabitants. Mumps was identified as the initial cause of death in 1 case every 5 years. This study estimates the burden of mumps disease in France.     

Influenza-related hospitalisation and death in Australians aged 50 years and older

Estimating the true burden of influenza is problematic because relatively few hospitalisations or deaths are specifically coded as influenza related. Statistical regression techniques using influenza and respiratory syncytial virus surveillance data were used to estimate the number of excess hospitalisations and deaths attributable to influenza. Several International Classification of Diseases 10th Revision (ICD-10) groupings were used for both hospitalisation and mortality estimates, including influenza and pneumonia, other respiratory disorders, and circulatory disorders. For Australians aged 50-64 years, the annual excess hospitalisations attributable to influenza were 33.3 (95%CI: 23.2-43.4) per 100,000 for influenza and pneumonia and 57.6 (95%CI: 32.5-82.8) per 100,000 for other respiratory disorders. For Australians aged > or =65 years, the annual excess hospitalisations attributable to influenza were 157.4 (95%CI: 108.4-206.5) per 100,000 for influenza and pneumonia and 282.0 (95%CI: 183.7-380.3) per 100,000 for other respiratory disorders. The annual excess all-cause mortality attributable to influenza was 6.4 (95%CI: 2.6-10.2) per 100,000 and 116.4 (95%CI: 71.3-161.5) per 100,000, for Australians aged 50-64 years and those aged > or =65 years, respectively. In the age-group > or =65 years, a significant association was found between influenza activity and circulatory mortality. We conclude that influenza is responsible for a substantial amount of mortality and morbidity, over and above that which is directly diagnosed as influenza in Australians aged > or =50 years.     

Survival, progression to AIDS and immunosuppression in HIV-positive individuals before and after the introduction of the highly active antiretroviral therapy (HAART)

We evaluated the changes in the progression to death and AIDS and in the mean level of CD4 lymphocytes by calendar period in HIV-positive individuals before and after the introduction of HAART. Through data collected in a prospective cohort study (Italian Seroconversion Study) of 1899 HIV-infected persons with well estimated date of seroconversion, considered as time-zero of analysis, we calculated Kaplan-Meier curves and Cox models, allowing for staggered entries, to estimate the cumulative probability of survival and hazard-ratios (HR) for death and for AIDS by calendar period (1980-1996: pre-HAART era, 1997-1998: first HAART era, and 1999-2001: second HAART era), age at seroconversion, gender, and exposure category. During 17251 person-years, 660 HIV-positive patients developed AIDS and 510 died. Before 1997, the cumulative probability of survival, at twelve years from seroconversion, was 51.0%. In the period 1997-1998 the probability was 77.3% and in the period 1999-2001 it further increased at 91.2%. In the period 1980-1996 only older age at seroconversion was associated with more rapid progression to death. In the period 1987-2001 individuals infected through injecting drug use had a reduced increase of survival compared to those infected through sexual contact. Similar results were obtained for progression to AIDS. Finally we estimated an improved level of immunesuppression in the period 1987-2001. In fact, while in the period 1980-1996 we estimated a decrease of the CD4 lymphocites of -54.8 cells/mm3 (95% CI: -52.0; -57.6) per year; after 1996, we estimated an increase of CD4 of +39.6 (95% CI +34.1; +45.1)per year. This study provides strong evidence that the efficacy of the HAART estimated in the controlled clinical trials has resulted in a real reduction at the population level of morbidity and mortality.     

Combined oral contraceptives, smoking, and cardiovascular risk

STUDY OBJECTIVE: To assess age specific incidence and mortality of stroke, acute myocardial infarction (AMI), and idiopathic venous thromboembolism (VTE) associated with use of modern low dose combined oral contraceptives (OCs) and the interaction with smoking. DESIGN: Hospital-based case-control study. SETTING: Hospitals in Oxford region in the United Kingdom, which covered a defined population, during the period 1989-1993. METHODS: Relative risk estimates from the WHO Collaborative Study and observed incidence rates from the Oxford region were used to estimate age specific incidence of each disease among women without cardiovascular risk factors and model total cardiovascular incidence and mortality. RESULTS: Among women who did not use OCs, smoke nor had any other cardiovascular risk factors, total incidence of stroke and AMI were less than 2 events per 100,000 woman years in those aged 20-24 years and rose exponentially with age to 8 events per 100,000 among women aged 40-44 years. Incidence of idiopathic VTE among women who did not use OCs rose linearly with age (from 3.3 per 100,000 at ages 20-24 years to 5.8 per 100,000 at ages 40-44 years). The increased risk of idiopathic VTE associated with OC use among non-smokers constituted over 90% of all cardiovascular events for women aged 20-24 years and more than 60% in those aged 40-44 years. Fatal cardiovascular events were dominated by haemorrhagic stroke and AMI, and among OC users who smoked these two diseases accounted for 80% of cardiovascular deaths among women aged 20-24 years, rising to 97% among those aged 40-44 years. Cardiovascular mortality associated with smoking was greater than that associated with OC use at all ages. Attributable risk associated with OC use was 1 death per 370,000 users annually among women aged 20-24 years, 1 per 170,000 at ages 30-34 years, and 1 per 37,000 at ages 40-44 years. Among smokers, the cardiovascular mortality attributable to OC use was estimated to be about 1 per 100,000 users annually among women aged less than 35 years, and about 1 per 10,000 users annually among those above the age of 35 years. CONCLUSION: The incidence of fatal cardiovascular events among women aged less than 35 years is low. The VTE risk associated with OC use is the largest contributor to OC induced adverse effects. The potentially avoidable excess VTE risk associated with the newer progestogens desogestrel and gestodene would account for a substantial proportion of total cardiovascular morbidity in this age group. For women over age 35 years the absolute risks associated with OC use and smoking are greater because of the steeply rising incidence of arterial diseases. The combination of smoking and OC use among such women is associated with particularly increased risks. Any potential reduction in AMI or stroke risk with use of third generation OCs would be a more important consideration among older compared with younger women, particularly if they smoke. However, the mortality associated with smoking is far greater than that associated with OC use (of any type) at all ages.     

Incidence of fatal myocarditis: a population-based study in Finland

To study the incidence of fatal myocarditis in the general population, the authors retrospectively collected all death certificates recording myocarditis as the underlying cause of death in Finland in 1970-1998. The incidence of myocarditis and its proportion of all deaths were calculated from 141.4 million person-years and 1.35 million deaths. Myocarditis was recorded as the underlying cause of death in 639 cases. Thus, its death certificate-based incidence was 0.46 (95% confidence interval (CI): 0.43, 0.49) per 100,000 person-years, and it caused 0.47 (95% CI: 0.44, 0.51) of 1,000 deaths. The incidence of 0.51 (95% CI: 0.46, 0.56) in males was higher than the incidence of 0.42 (95% CI: 0.37, 0.47) in females, the odds ratio being 1.34 (95% CI: 1.15, 1.58) (p < 0.001). The proportion of deaths caused by myocarditis was highest (up to six of 1,000 deaths) in children and adults aged less than 45 years. Because previous histopathologic reanalysis showed that only 32% of cases fulfilled the Dallas criteria, the authors estimated the incidence of histopathologically certain fatal myocarditis to be 0.15 (95% CI: 0.13, 0.17) per 100,000. The death certificate-based incidence of fatal myocarditis was found to be 0.46 per 100,000, and the histopathologically corrected incidence was 0.15 per 100,000.     

Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986

Blacks in the US experience increased mortality (1113 versus 745 per 100,000 males; 631 versus 411 per 100,000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17,366 deaths and 286,813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)