Category Of Mortality Research Articles

Neonatal piglet traits of importance for survival in crates and indoor pens

The primary aim of the present study was to investigate whether the same piglet traits contributed to the same causes of neonatal piglet mortality in crates (CT) and pens (PN). Gilts originating from 2 distinct genetic groups that differed in breeding value for piglet survival rate at d 5 (SR5) were used. These were distributed to farrow in either PN or CT as follows: high-SR5 and CT (n = 30); low-SR5 and CT (n = 27); high-SR5 and PN (n = 22); and low-SR5 and PN (n = 24). Data on individual piglets were collected at birth, including interbirth interval; birth order; birth weight; rectal temperature at birth, 2 h after birth, and 24 h after birth; cordal plasma lactate; and latency to first suckle. Based on autopsy, causes of mortality were divided into stillborn, bitten to death, starvation, crushed, disease, and other causes. Potential risk factors of dying were estimated using a GLM with a logit link function. No significant effect (NS) of housing was observed on the odds of a piglet being stillborn (F(1,73) = 0.1, NS), being crushed (F(1,53) = 1.4, NS), or dying of starvation (F(1,53) = 0.3, NS). No significant differences were observed between the 2 genetic groups for any category of mortality. Piglet traits for pre- and postnatal survival were the same for CT and PN. The odds of being stillborn were increased in piglets born late in the birth order (F(1,1061) = 33.5, P < 0.0001), after a long interbirth interval (F(1,1061) = 19.2, P < 0.0001), and with a lighter birth weight (F(1,1061) = 9.2, P = 0.003). The lighter the birth weight of the piglets, the greater were the odds of being crushed (F(1,1050) = 18, P < 0.0001) and dying of starvation (F(1,1050) = 19, P < 0.0001). The lower the rectal temperature 2 h after birth, the greater were the odds of being crushed (F(1,1050) = 4.6, P = 0.03), starving (F(1,1050) = 16.6, P < 0.0001), or dying of diseases (F(1,1050) = 4.9, P = 0.03). Increased cordal plasma lactate increased the odds of dying from starvation (F(1,1050) = 18, P < 0.0001). In both CT and PN, the birth weight, body temperature 2 h after birth, and birth process were important traits related to crushing, starvation, and disease. Neither housing nor breeding value influenced mortality or traits of importance for the inborn viability of piglets. The results emphasize that the microclimate in the PN for newborn piglets and its heat-preserving properties are more important for survival than whether the sow is crated or penned.

Child health in peri-urban communities of Kenya: Determinants and challenges

Infant and child death in developing countries constitute the largest age category of mortality. This is because children under the age of five years are the group most vulnerable to diseases caused by inadequate child care, health risks, and poor environmental conditions.The overall aim of this study was to explore the demographic, environmental, socio-economic and health seeking behavioural factors contributing to childhood mortality in peri-urban communities. A cross-sectional analytical study was undertaken between January and May 2007 adopting both quantitative and qualitative approaches. Quantitative data was collected using a semi-structured questionnaire administered to 384 mothers aged 15 - 49 years and having children aged below five years alive or dead. Qualitative data was collected through focus group discussions and key informant interviews with selected participants. The main outcome measure was identification of the main determinants of childhood mortality at household level in the peri-urban communities based on proportions of children dead, correlation coefficients and multiple regression analysis. The study revealed that the main determinants of child health in peri-urban communities are maternal occupation and immunizations uptake (t = -5.094, P = 0.000 and t = -3.888, P = 0.012 respectively). Treatment of drinking water, source of drinking water and maternal age also had strong influence on child health (t = -3.647, P = 0.028 and t = -3.111, P = 0.034 respectively).Maternal occupation emerged as the main determinant of child health in peri-urban communities. Overindulgence of mothers in small scale businesses and casual work in urban centers compromises child care hence the high infant and child morbidity and mortality reported in peri-urban settings. This calls for focused health education and services targeting the mothers. Key words: Infant, child, mortality, morbidity, determinants, peri-urban.

Factors Associated with Physician Agreement on Verbal Autopsy of over 27000 Childhood Deaths in India

IntroductionEach year, more than 10 million children younger than five years of age die. The large majority of these deaths occur in the developing world. The verbal autopsy (VA) is a tool designed to ascertain cause of death in such settings. While VA has been validated against hospital diagnosed cause of death, there has been no research conducted to better understand the factors that may influence individual physicians in determining cause of death from VA.Methodology/Principal FindingsThis study uses data from over 27,000 neonatal and childhood deaths from The Million Death Study in which 6.3 million people in India were monitored for vital status between 1998 and 2003. The main outcome variable was physician agreement or disagreement of category of death and the variables were assessed for association using the kappa statistic, univariate and multivariate logistic regression using a conceptual hierarchical model, and a sensitivity and specificity analysis using the final VA category of mortality as the gold standard. The main variables found to be significantly associated with increased physician agreement included older ages and male gender of the deceased. When taking into account confounding factors in the multivariate analysis, we did not find consistent significant differences in physician agreement based on the death being in a rural or urban area, at home or in a health care facility, registered or not, or the respondent's gender, religion, relationship to the deceased, or whether or not the respondent lived with the deceased.Conclusions/SignificanceFactors influencing physician agreement/disagreement to the greatest degree are the gender and age of the deceased; specifically, physicians tend to be less likely to agree on a common category of death in female children and in younger ages, particularly neonates. Additional training of physician reviewers and continued adaptation of the VA itself, with a focus on gender and age of the deceased, may be useful in increasing rates of physician agreement in these groups.

Morbidity and mortality among road users in Benin-city, Nigeria

Murray and Krug had reported that road traffic injuries are a major cause of death globally, with disproportionate number occurring in developing counties. Seventy out of 308 deaths that occurred in Benin City from August 2002-July 2003, representing 22.7% of all deaths was due to road traffic injuries. Despite this observation, there is a paucity of data on road traffic morbidity and mortality. The aim of this study was to evaluate patterns of morbidity and mortality among drivers and passengers of cars involved in road traffic accidents in Benin-City Nigeria from August 2002-July 2003 as a base line data. Eighty-seven car drivers and passengers who were studied were part of a larger study, involved in a road traffic accident and brought to the accident and emergency units of either the University of Benin Teaching Hospital or the State Specialist Hospital between August 2002-July 2003.The injured ones were examined and dead patients had autopsy done on them. Over all, out of 283 total accidents cases reviewed in the period of study 87 were car occupants representing 30.7% of all accident cases, and 67 patients (23.7%) sustained varying injuries, while 20 patients (7.1%) died. Commercial cars were involved in majority of cases 85%. Males were also more in number. Intracranial hemorrhage was the predominant cause of death. Occupants of cars accounted for the singular most common category of morbidity and mortality among all road users. The male to female ratio was 2.1:1. Windscreen injuries most commonly associated with facial and head injuries represented the commonest cause of morbidity and mortality. The commonest autopsy finding as cause of death was intra-cranial hemorrhage.

Infant mortality rate in India: Still a long way to go

Infant Mortality Rate (IMR) is regarded as an important and sensitive indicator of the health status of a community. It also reflects the general standard of living of the people and effectiveness of interventions for improving maternal and child health in a country. Compared to other indicators like crude birth rate maternal mortality rate and under-five mortality rate etc this indicator has always been accorded greater importance by the public health specialists because infant mortality is the single largest category of mortality. Moreover deaths during infancy are due to a particular mix of diseases and conditions to which the adult population is less exposed and less vulnerable. Changes in specific health interventions affect IMR more rapidly and directly and hence it may change more dramatically than the crude death rate in a population. This is clearly demonstrated in a developing country like India. In the 1960s IMR in India used to hover around the 100 mark in the country. (excerpt)

Sudden Unexpected Death in Epilepsy

Patients with epilepsy have a mortality rate higher than that of the general population; sudden unexpected death represents a significant category of mortality in these patients. The precise frequency of occurrence of sudden unexpected death in epilepsy (SUDEP) is not well defined, with a range of 1 in 370 to 1100 in the general epileptic population. A major difficulty with incidence studies is the continued reluctance in using the term SUDEP as a cause of death, making reliance solely on death certificates inconsistent and incomplete. Knowledge about SUDEP remains limited, as no single common risk factor has yet been identified, although predisposing conditions have been suggested. The purpose of this study is to review the association between several clinical variables and SUDEP to elucidate risk factors. The characteristics of the 67 cases in this series correlate with published findings in previous studies. Attributes that may be used to define an at-risk group of epileptics include age less than 40 years, male gender, long history of seizure disorder, undermedication or poorly controlled seizure activity, and mental or physical stress. Education of physicians as to the existence of SUDEP and risk factors is imperative in improving patient education and reduction in mortality.

Competing risks analysis of lamb mortality in a terminal sire composite population.

Mortality records from birth to weaning of 8,301 lambs from a composite population at the U.S. Meat Animal Research Center were analyzed using a competing risks model. The advantage of the competing risks model over traditional survival analyses is that different hazards of mortality can be assigned to different causes, such as disease, dystocia, and starvation. In this study, specific causes of mortality were grouped into dam-related (DAMR; e.g., dystocia and starvation), pneumonia (PNEU), disease (DIS; excluding pneumonia), and other (OTHER) categories. The hazard of mortality was analyzed using a competing risk approach, where each mortality category was assumed to be independent. Continuous- and discrete-time survival analyses were implemented using sire, animal, and maternal effects mixed models. The continuous-time survival analysis used the Weibull model to describe the hazard of mortality for each category of mortality. Under the discrete-time survival analysis, a complementary log-log link function was used to analyze animal-time data sets using weekly intervals for each category of mortality. Explanatory variables were sex, type of birth, contemporary group, and age of dam. The significant influences of type of birth and age of dam effects were consistent across category of mortality, and the sex effect was significant for all categories except the OTHER category. Estimates of variance components indicated strong maternal effects for all categories except for PNEU. Estimates of additive genetic heritabilities from the discrete maternal effects models were 0.08+/-0.04, 0.09+/-0.18, 0.16+/-0.12, 0.19+/-0.09, and 0.14+/-0.10 for OVERALL (all causes combined), DIS, DAMR, PNEU, and OTHER categories, respectively. Ignoring the cause of the defining event in mortality and longevity studies may hide important genetic differences. Therefore, the effectiveness of breeding programs relying on models that ignore multiple causes of an event in time-to-event data, such as mortality and longevity, could be affected.

REVIEW Sudden unexpected death in epilepsy (SUDEP): risk factors and case control studies

Sudden unexpected death is an important category of mortality in the population with epilepsy. Possible risk factors have been identified from an epidemiological study of this phenomenon, but the exact mechanisms remain unclear. Some of these factors include: male sex; age 20–40 years; generalized seizures; poor seizure control; poor compliance with medication. Case-control studies now being undertaken are the next step in the elucidation of these factors. The results of one study to date reinforce the view that, in the majority of cases, sudden unexpected death in epilepsy (SUDEP) is a seizure-related event. This suggests that improvement in seizure control and the avoidance of polytherapy may be important in risk reduction. An ongoing exploratory case-control study in the UK has identified 154 cases of SUDEP, each of which will have four controls, matched for age and geographical location, in order to examine the influence of various parameters on the risk of sudden death.

Mortality of sheep exported by sea: evidence of similarity by farm group and of regional differences.

To determine whether mortality of sheep exported by sea is similar for sheep from the same farm exported in different years or is associated with the region of origin. Mortalities were monitored in farm groups of sheep exported from the southwest of Western Australia under normal commercial conditions. Mortalities were monitored on commercial shipments from 1985 to 1996. For each consignment, the mortality rate was assigned its percentile ranking within the month and year of loading of the ship. A mortality rate was high if its percentile ranking was above a selected cut-off value. Five cut-off values were used in separate analyses. The spatial distribution of farms with high mortality was compared between and within zones of rainfall and length of pasture-growing season. A total of 479 groups of sheep from 405 farms was monitored. Mortality rates ranged from nil to 28.2%. Half of all deaths were from 14.2% of the consignments. There was a significant association (P < 0.05) between the category of mortality (high or low) in the first and second years of monitoring for four of the five cut-off values. The spatial analyses indicated that there were more high-mortality groups, and the average mortality was higher, in the zones of higher rainfall and longer pasture-growing season (P < 0.001). Mortality data can be used to identify regions and groups of sheep that are at risk of suffering high death rates when exported by sea.

Trends in infectious disease mortality in Australia, 1979-1994.

To examine trends in infectious disease mortality in Australia over the period 1979-1994. Descriptive study based on Australian Bureau of Statistics data. All persons who died in Australia during 1979-1994. Infectious diseases as the underlying cause of death by International Classification of Diseases, Ninth Revision codes. Overall mortality from infectious diseases declined from 29.2/100,000 population in 1979-1981 to 24.1/100,000 in 1992-1994 (P = 0.02). Respiratory infection was the major category of infectious disease mortality, declining from 15.8/100,000 in 1979-1981 to 10.6/100,000 in 1992-1994. HIV infection (increasing from 0 to 2.9/100,000) replaced kidney/urinary tract infection (3.3 to 1.5/100,000) as the second most common category of infectious disease mortality. There were also significant increases in mortality from septicaemia (1.0 to 2.6/100,000), and viral hepatitis (0.2 to 0.5/100,000). The only group in which infectious disease mortality increased was men aged 25-44 years (3.4 to 15.1/100,000). The Northern Territory had the highest mortality rate from infectious disease, but showed a substantial decline (162 to 76/100,000) over the study period. There were also significant declines in Victoria, Queensland, and Western Australia. Mortality from infectious disease in Australia declined overall between 1979 and 1994. The substantial decline in the Northern Territory suggests a decline among indigenous Australians. HIV infection has become a leading cause of infectious disease mortality, particularly among adult males.

Associations between disease and occupation: hypotheses generated from the National Mortality Followback Survey.

This study uses the National Mortality Followback Survey of 1986 to identify the top five Sentinel Health Events Occupational [SHE(O)s], the five leading causes of death, and to ascertain the primary occupations and industries associated with these. We found that, as expected, cardiovascular diseases were four of the five leading causes of death overall. In addition, the SHE(O) responsible for most deaths was cancer of the trachea, bronchus, and lung, followed by renal failure, bladder cancer, myeloid leukemia, and liver cancer. We employed proportionate mortality ratios to analyze the relationship between industry and occupation and category of mortality. In brief, we validated findings by other researchers; for example, farmers were at lower risk of cancer of the trachea, bronchus, and lung, and workers in eating/drinking places had excess risk of liver cancer. We also hypothesize other relationships, such as between motor vehicle dealers and bladder cancer.

Dynamics of dead wood in old-growth hemlock–hardwood forests of northern Wisconsin and northern Michigan

We studied the dynamics of coarse woody debris (logs and snags) in old-growth forests by estimating rates of tree mortality, snag change, and log decay in hemlock–hardwood stands located in northern Wisconsin and northern Michigan. To estimate mortality and snag changes, we recensused live trees and dead snags in permanent plots in 15 stands. We also recorded recent mortality along transects, and noted category of mortality (standing death, breakage, or uprooting) for gap-maker trees and logs in 25 stands. Decay rates were estimated from a simple exponential model of wood density from log sections against the age of the wood since tree death, and from ages of trees growing on decaying "nurse" logs. From data obtained in permanent plots, annual tree mortality averaged 0.9% original basal area, 0.9% original live tree density, and 4.8 trees/ha. Of the three categories of tree mortality, standing death accounted for 62% of all mortality, while breakage represented 25%, and uprooting, 13%. Based on origin of logs, species composition affected category of mortality. Eastern hemlock (Tsugacanadensis (L.) Carr.) was significantly more prone to uprooting while yellow birch (Betulaalleghaniensis Britton) and paper birch (Betulapapyrifera Marsh.) were less prone to uprooting than expected if independence of species and categories of mortality were assumed (χ2 = 216.5, df = 14, p &lt; 0.001). Changes in snags (fragmentation to shorter snags or collapse at the base) occurred for &lt;7% of the original snags annually. Fragmentation occurred for 2.1 snags/(ha × year), and collapse for 1.3 snags/(ha × year). We estimated that it takes nearly 200 years for hemlock logs to lose structural integrity and become partially incorporated into the soil. At &gt;350 years, the two oldest hemlock–hardwood stands had accumulated volumes of logs &gt;65 m3/ha distributed among all decay classes, and appeared to be at a dead wood equilibrium in which rates of log production from mortality balance rates of wood loss by decay.

Alcohol Drinking and Mortality among Men Enrolled in an American Cancer Society Prospective Study

We studied whether moderate alcohol drinkers have a lower total and coronary heart disease (CHD) mortality than nondrinkers. Among 276,802 U.S. men aged 40-59 enrolled in 1959 in an American Cancer Society prospective study, 42,756 deaths, 18,771 from CHD, occurred during the following 12 years (3% of the cohort was lost to follow-up). Using nondrinkers (55.3% of the cohort) as a reference category, age- and smoking-stratified relative risks (RR) of total mortality were 0.88 for occasional drinkers, 0.84 for those drinking 1 drink per day, 0.93, 1.02, 1.08, 1.22, and 1.38 for those drinking 2, 3, 4, 5, and 6 or more drinks per day, respectively. RRs of CHD mortality were 0.86, 0.79, 0.80, 0.83, 0.74, 0.85, and 0.92, respectively. Multivariate analysis failed to identify other confounders. No changes in RRs were introduced by excluding subjects with poor health or history of chronic disease at enrollment (32.8% of the cohort) or excluding subjects who died during the first 6 years of follow-up. These data indicate an apparent protective effect of moderate alcohol intake on CHD mortality that cannot be attributed to the inclusion of subjects with CHD or related diseases into the nondrinker category.

Addiction Mortality in the United States, 1980: Tobacco, Alcohol, and Other Substances

The literature on tobacco alcohol heroin cocaine and other drugs was surveyed and titles abstracts and copies of recent relevant articles were obtained in the effort to make an overall estimate of addiction mortality. A printout of US mortality by every cause in 1980 was obtained from the National Center for Health Statistics to facilitate identification of drug-related deaths by discrete categories. Colleagues in government agencies provided pertinent publications and participated in work group discussions of methods and findings. Data from 2 broad-based epidemiological studies of excess mortality from smoking among adult US males during the 1950s and 1960s are presented in tables. These studies indicate that at least 80% of male deaths from lung cancer were attributable to smoking and that total excess mortality among smokers was more than 5 times the number of lung cancer deaths in the combined population of smokers and nonsmokers. Using lung cancer deaths as an index of total deaths from smoking it was estimated that there were approximately 250000 deaths from smoking in the US during 1960 and there were about 300000 such deaths in the US during 1966. Because cardiovascular disease death rates have fallen substantially during the last 15 years while lung cancer death rates have continued to increase the lung cancer index of total excess mortality from smoking must be recalibrated by means of another broad-gauged prospective study of smoking and mortality from smoking during the 1980s. The 3rd major category of excess mortality from smoking is comprised of the noncancerous but life destroying diseases of the respiratory system. Total adult mortality from noncancerous diseases of the respiratory system in 1980 attributable to smoking is estimated to have been about 61000 deaths. Epidemiological studies consistently show higher peptic ulcer disease morbidity and mortality rates for smokers than for nonsmokers. A large proportion of fires in homes and hotels are caused by smoking an estimated 250000 deaths from accidental fires caused by smoking in 1980. It is estimated that the total number of excess deaths in the US in 1980 attributable to smoking cigarettes was approximately 485000. The 100000 deaths ascribed to alcohol in 1980 represent approximately 5% of total US mortality in 1980. It is estimated that US mortality in 1980 attributable to acute overdose probably exceeded 5000 deaths.

Infant Mortality and Breast-Feeding in North-Eastern Brazil

An analysis of the relationship between the failure to breast feed and infant mortality in Northeastern Brazil the poorest region of 1 of the worlds largest developing countries is presented. The data for the analysis come from the Northeast Brazil Family Planning/Maternal-Child Health Survey of 1980. The survey was conducted in 4 of the 9 states of the northeastern region of Brazil and it consisted of interviews with 7852 women of all marital statuses between the ages of 15 and 44. Each respondent was asked for information about the breast feeding of her most recently born child and if that child was no longer alive the age (in months) at which he/she died. Breast feeding information was obtained on 5190 children. Children born less than 1 year prior to their mothers interview were excluded along with children who survived less than 1 month. After exclusions 3457 children were left for the analysis. Children are categorized as either ever breast fed or never breast fed. Only 79% of women whose last child survived at least 1 month reportedly ever breast fed that child. In 3 of the states infants were breast fed for only around 5 months on average. The proportion of infants breast fed from birth varied little across the population from 73.8% for the best educated to 84.4% for women not using maternal-child health services in association with their last birth. Of children who survived at least 1 month 4.9% died before reaching age 1. Overall the probability of dying is about 1.6 times greater among never breast fed infants than among their counterparts. Within every category of every control variable mortality is lower among breast fed than nonbreast fed infants. The greatest absolute differences according to breast feeding status show up for children of rural residents the uneducated the currently employed and those using neither maternal child health service. For each of these groups infant mortality among never breast fed children exceeds 10%. Within urban areas the relationship between infant mortality and breast feeding generally appears quite weak showing up strongly in only a few categories. For the sample as a whole breast feeding remains highly associated with infant mortality; nonbreast feeders have an estimated relative risk of 1.7.