Changing Patterns Of Mortality Research Articles

Changing mortality patterns in Kimberley Aborigines

To examine the causes of officially reported deaths from several categories among Aboriginal and non-Aboriginal people in a statistical division of north-west Australia from 2002 to 2011. A cross-sectional analysis of official Death Registration data to calculate mortality rate ratios (Aboriginal against non-Aboriginal) for that decade in six major International Classification of Disease (ICD)-10 categories. The study setting was the West Kimberley Health District in the far north of Western Australia. Death rates of Aborigines relative to non-Aborigines were much higher, by more than 10 times in some categories. Most of the excess deaths in these categories were due to circulatory diseases, injury and poisonings, neoplasms, diabetes, respiratory, and genitourinary conditions. This study has documented the heavy burden of mortality in West Kimberley Aborigines compared with the pattern found in non-Aboriginal people living in the same region.

Globalisation, and the Changing Patterns of Mortality and Morbidity Associated with Social Inequality —

Globalisation, and the Changing Patterns of Mortality and Morbidity Associated with Social Inequality —

Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India

BackgroundRapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups.ObjectiveThe study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups.DesignA mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers.ResultsThe mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected.ConclusionsThe rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable.

Changes in Mortality Patterns Following Total Hip or Knee Arthroplasty Over the Past Two Decades: A Nationwide Cohort Study

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective procedures for patients with moderate-to-severe osteoarthritis. Mortality rates after THA and TKA may have changed because of new surgical techniques, improvement of peri- and postoperative care, and performance of surgery in older patients having multiple comorbidities. However, data on secular mortality trends are scarce. We undertook this study to evaluate mortality patterns between 1989 and 2007 in patients undergoing elective THA and TKA. In a Danish retrospective nationwide cohort study, 71,812 patients who underwent THA and 40,642 patients who underwent TKA were identified between January 1989 and December 2007. All-cause and disease-specific mortality was assessed, stratified by calendar periods. Using Cox proportional hazards models, relative risks (RRs) of mortality were calculated between different calendar periods, adjusted for age, sex, and comorbid diseases. Since the early 1990s, short-term survival following elective THA and TKA has greatly improved. Compared with the period between 1989 and 1991, 60-day mortality rates between 2004 and 2007 were substantially lower for patients undergoing THA (RR 0.40, 95% confidence interval [95% CI] 0.28-0.58) and for patients undergoing TKA (RR 0.37, 95% CI 0.21-0.67). This trend was far superior to what was seen in the general population. The decrease in mortality was greatest for deaths from myocardial infarction, venous thromboembolism, pneumonia, and stroke. Patients tended to have more presurgical comorbidity over time, and the duration of hospital stay was roughly halved. Mortality rates following elective THA and TKA have decreased substantially since the early 1990s, despite patients having more presurgical comorbidity. These findings are reassuring for patients undergoing elective THA or TKA.

Evidence for localised HIV related micro-epidemics associated with the decentralised provision of antiretroviral treatment in rural South Africa: a spatio-temporal analysis of changing mortality patterns (2007-2010).

BackgroundIn this study we analysed the spatial and temporal changes in patterns of mortality over a period when antiretroviral therapy (ART) was rolled out in a rural region of north–eastern South Africa. Previous studies have identified localised concentrated HIV related sub–epidemics and recommended that micro–level analyses be carried out in order to direct focused interventions.MethodsData from an ongoing health and socio–demographic surveillance study was used in the analysis. The follow–up was divided into two periods, 2007–2008 and 2009–2010, representing the times immediately before and after the effects on mortality of the decentralised ART provision from a newly established local health centre would be expected to be evident. The study population at the start of the analysis was approximately 73 000 individuals. Data were aggregated by village and also using a 2 × 2 km grid. We identified villages, grid squares and regions in the site where mortality rates within each time period or rate ratios between the periods differed significantly from the overall trends. We used clustering techniques to identify cause–specific mortality hotspots.FindingsComparing the two periods, there was a 30% decrease in age and gender standardised adult HIV–related and TB (HIV/TB) mortality with no change in mortality due to other causes. There was considerable spatial heterogeneity in the mortality patterns. Areas separated by 2 to 4 km with very different epidemic trajectories were identified. There was evidence that the impact of ART in reducing HIV/TB mortality was greatest in communities with higher mortality rates in the earlier period.ConclusionsThis study shows the value of conducting high resolution spatial analyses in order to understand how local micro–epidemics contribute to changes seen over a wider area. Such analyses can support targeted interventions.

Clinical oncology in resource-limited settings.

Infectious Agents and Cancer is introducing a new section of Clinical Oncology with the main objective of stimulating debate through articles published in the section. Infectious diseases have been the major causes of morbidity and mortality in human populations, and have dominated the medical approach to clinical and public health. Successful efforts to control mortality from acute infections have paved the way for chronic, mostly indolent, infections to become major causes of morbidity. Cancer, hitherto thought to be rare in resource-limited settings, is becoming a major contributor. The changes in mortality patterns are due, in part, to diseases linked to rapid changes in lifestyle, urbanization, and pollution. These diseases include many of the non-infection associated cancers. However, there is a dearth of information about the burden, pathogenesis, and therapeutic approaches about cancer in resource-limited countries. There are also substantial other challenges, including economic, infrastructure, technology, and personnel. The Journal advocates for interactive local–global (lo-bal) efforts to generate relevant knowledge about cancer burden, pathogenesis, and therapeutic approaches using a bottom-up approach to sharpen the focus on local and global relevance of research and clinical and public practice, particularly in resource-limited countries. The section on Clinical Oncology in Infectious Agents and Cancer will harness these “lo-bal” strategies to reduce substantially the time from concept, discovery, and development and implementation of locally and globally applicable diagnostic and therapeutic technologies.

The changing demographics of Australia over the last 30 years

The changing demographics of <scp>A</scp>ustralia over the last 30 years

The Soria Moria approach to pediatric forensic issues

Pediatric forensic pathology has been a controversial and evolving area in recent years [1, 2]. High profile court cases in many countries, including the United Kingdom and Canada, have focused both professional and public attention on deficiencies in diagnoses and approaches to cases, sometimes with resultant highly unfortunate miscarriages of justice [3, 4]. Examples of irresponsible testimony in court by physicians in cases of child maltreatment and neglect, as well as the medicolegal consequences caused by a medical examiner’s inadequate expertise and experience in pediatric pathology, have been described [5, 6]. Attempts to redress this situation have included the involvement of professional organizations and courts in reviewing cases and in establishing protocols and guidelines. A special issue of Forensic Science Medicine and Pathology was published in 2010 in which a number of issues were reviewed and analyzed including terminology and classifications for unexpected deaths in infancy and the place of parents at infant death scenes [7–9]. Additional problems in the field include declining numbers of trainee pathologists who are interested in pediatric forensic issues and adult practitioners who sometimes make the mistake of extrapolating from adult cases back to children. One way of addressing these problems is to hold meetings that specifically focus on pediatric forensic issues. This has not, however, been a common occurrence. An exception to this is the annual meeting convened in Norway by the Department of Forensic Pathology and Clinical Forensic Medicine of the Norwegian Institute of Public Health at the Soria Moria Convention Center, outside the main city of Oslo. The meeting has been held on an annual basis since 1993; it is an international meeting with English as the official language, although often with a Norwegian meeting held on the preceding day. The meeting lasts for two and a half days and covers a wide range of topics focusing particularly on sudden infant death syndrome (SIDS) and on sudden and unexpected infant and childhood death. The meeting is quite small limited to between 40 and 60 participants, who come from a variety of forensic, clinical, and research backgrounds. To give an insight into the types of presentations that occur, the program for this year (2013) will be reviewed. On the first morning, a session was held on the epidemiology of SIDS and sudden death in infants and children. This included overviews of changing patterns in mortality and trends in classifications, the relationship of SIDS rates to immunizations, death scene investigations in Norway, and discussion on parental responses to death scene examinations and bereavement issues. The morning concluded with a session where participants were able to have short presentations of submitted difficult cases that had raised particular diagnostic or legal problems. Topics included concealed births, second impact syndrome, accidents with bicycle helmets, positional asphyxia, and dehydration. The remainder of the day was devoted to R. W. Byard (&) Discipline of Anatomy and Pathology, The University of Adelaide, Level 3 Medical School North Building, Frome Road, Adelaide, SA 5005, Australia e-mail: roger.byard@sa.gov.au

Mortality trends among Alaska Native people: successes and challenges

BackgroundCurrent mortality rates are essential for monitoring, understanding and developing policy for a population's health. Disease-specific Alaska Native mortality rates have been undergoing change.ObjectiveThis article reports recent mortality data (2004–2008) for Alaska Native/American Indian (AN/AI) people, comparing mortality rates to US white rates and examines changes in mortality patterns since 1980.DesignWe used death record data from the state of Alaska, Department of Vital Statistics and SEER*Stat software from the National Cancer Institute to calculate age-adjusted mortality rates.ResultsAnnual age-adjusted mortality from all-causes for AN/AI persons during the period 2004–2008 was 33% higher than the rate for US whites (RR=1.33, 95% CI 1.29–1.38). Mortality rates were higher among AN/AI males than AN/AI females (1212/100,000 vs. 886/100,000). Cancer remained the leading cause of death among AN/AI people, as it has in recent previous periods, with an age-adjusted rate of 226/100,000, yielding a rate ratio (RR) of 1.24 compared to US whites (95% CI 1.14–1.33). Statistically significant higher mortality compared to US white mortality rates was observed for nine of the ten leading causes of AN/AI mortality (cancer, unintentional injury, suicide, alcohol abuse, chronic obstructive pulmonary disease [COPD], cerebrovascular disease, chronic liver disease, pneumonia/influenza, homicide). Mortality rates were significantly lower among AN/AI people compared to US whites for heart disease (RR=0.82), the second leading cause of death. Among leading causes of death for AN/AI people, the greatest disparities in mortality rates with US whites were observed in unintentional injuries (RR=2.45) and suicide (RR=3.53). All-cause AN/AI mortality has declined 16% since 1980–1983, compared to a 21% decline over a similar period among US whites.ConclusionMortality rates and trends are essential to understanding the health of a population and guiding policy decisions. The overall AN/AI mortality rate is higher than that of US whites, although encouraging declines in mortality have occurred for many cause specific deaths, as well as for the overall rate. The second leading cause of AN/AI mortality, heart disease, remains lower than that of US whites.

Temporal Evolution of Mortality Indicators

In Spain, as in other developed countries, significant changes in mortality patterns have occurred during the 20th and 21st centuries. One reflection of these changes is life expectancy, which has improved in this period, although the robustness of this indicator prevents these changes from being of the same order as those for the probability of death. If, moreover, we bear in mind that life expectancy offers no information as to whether this improvement is the same for different age groups, it is important and necessary to turn to other mortality indicators whose past and future evolution in Spain we are going to study. These indicators are applied to Spanish mortality data for the period 1981–2008, for the age range 0–99. To study its future evolution, the mortality ratios have to be projected using an adequate methodology, namely, the Lee-Carter model. Confidence intervals for these predictions can be calculated using the methodology that Lee and Carter apply in their original article for expected lifetime confidence intervals, but they take into account only the error in the prediction of the mortality index obtained from the ARIMA model adjusted to its temporal series, excluding other sources of error such as that introduced by estimations of the other parameters in the model. That is why bootstrap procedures are preferred, permitting the combination of all sources of uncertainty.

Comparative Selenium Toxicity to Laboratory-Reared and Field-Collected Hyalella azteca (Amphipoda, Hyalellidae)

Selenium (Se) contamination of aquatic habitats is a global environmental issue. Although organic forms of Se are thought to represent the most bioavailable forms of Se, elevated concentrations of inorganic Se can cause toxicity in aquatic organisms such as benthic invertebrates. To assess the potential role of Se in mortalities observed during previous in situ invertebrate exposures, laboratory experiments on toxicity of inorganic Se (selenate) to Hyalella azteca were performed. Both a laboratory-reared and a field-collected H. azteca population were exposed to Se concentrations ranging from near 0 (control) to 21.79 mg/L, and survival of exposed individuals was monitored over 10 days. In the laboratory-reared H. azteca, significant changes in mortality pattern and reductions in mean survival time (MST) were noted in the test groups exposed to ≥0.164 mg/L Se. In the field-collected animals however, significant changes in mortality pattern and reductions in MST were measured in H. azteca exposed to ≥1.43 mg/L Se. The 10-day LC50s were 0.086 and 0.574 mg Se/L for the laboratory and field-collected H. azteca populations, respectively. The laboratory-reared group thus was about one order of magnitude more sensitive to Se exposure than the field-collected amphipods. Our results suggest that Se toxicity was likely not a major contributor to amphipod mortalities observed in earlier field studies. Furthermore, population-specific tolerances of the test organisms may need to be considered when extrapolating laboratory-generated data to field situations.

P2-265 Mortality in older men of Southeast Brazil: a study of associated causes of death

IntroductionThe adoption of unhealthy western lifestyles has contributed to changes in mortality patterns in developing countries. The aim of this study was to evaluate associated causes of death in older...

Mortality Among U.S. Astronauts: 1980–2009

It has been nearly 20 yr since the first published astronaut mortality analysis. Using astronaut vital data and general population mortality rates, we calculate Standardized Mortality Ratios (SMR) for both total and specific causes of death among astronauts between January 1980 and June 2009 to look for changes in mortality patterns over time. Astronaut vital data were derived from the Johnson Space Center website and the Astronaut Fact Book. General population mortality rates were taken from the Human Mortality Database and the Centers for Disease Control. SMR were computed as the ratio of observed deaths to expected deaths using indirect standardization to several comparison populations. All SMR declined from the 1980s to the 2000s, though astronauts are still at increased risk of accidental death (SMR = 574, 95% C.I. 335-919). Astronauts are at greatly reduced risk of death by cardiovascular disease (SMR = 27, 95% C.I. 9-63) and cancer (SMR = 47, 95% C.I. 19-97), and astronauts are now at decreased risk of all-cause mortality compared with the general population. The SMR show that mortality from circulatory disease, cancer, and accidents have all declined from previous estimates, though astronauts are still at increased risk of accidental death. Improvements in circulatory disease mortality are likely due to intensive health screening and physical fitness within the Astronaut Corps. Similarly, physical fitness may be contributing to the reduction in cancer mortality. Fewer airplane crashes have contributed to the decreased risk of fatal accidents, which in turn is driving the reduction in all-cause mortality risk.

The Epidemiological Transition: Policy and Planning Implications for Developing Countries

Medical Scientists are beginning to understand better some of the trends in the changing disease and mortality patterns but policymakers need to know how to use this information to make decisions about the priorities for the health sector. This Paper is aimed at x-raying this shift in morbidity and mortality patterns and make recommendations for possible shift in planning and policies. Relevant literatures were reviewed from medical journals, library search and internet source using Google search engine as well as international, national and local journals. The key words employed were: Epidemiological Transition with particular emphasis on policy and planning implications in developing countries. Several studies have outlined definitions, stages and historical perspectives of epidemiological transition, as well as the scenarios in developed and developing countries. The impending challenges and policy and planning implications in the developing countries were suggested and outlined in this paper. It is very obvious that epidemiological transition is here with us as there are transformations in the age, cause, and sex structure of death in developing world. Yet not much progress has been made towards averting the dire consequences. A fundamental policy shift therefore needs to be put in place.

Prostate cancer screening: current status and future perspectives

With the publication of the long-term results of two randomized screening trials and updates to screening guidelines from many organizations, the past 2 years have been eventful in the field of prostate cancer screening. Both the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial--which failed to identify a benefit of screening in a community setting--and the European Randomized Study of Screening for Prostate Cancer--which showed a modest benefit to screening in a clinical trial setting--have sought to address the role of screening in reducing mortality from prostate cancer. Epidemiologic evidence supports the role of PSA screening in the stage and grade migration of prostate cancer, but to date the evidence for its role in changing mortality patterns is more equivocal. As a result, little support exists at present among urologic and cancer prevention organizations for population-based PSA screening. Particularly in the USA, where PSA screening has been relatively widespread, reductions in prostate-cancer-specific mortality are likely to be in part related to improvements in treatment, rather than solely to PSA screening. The substantial risk of overdiagnosis and overtreatment of latent prostate cancer means that methods to increase the specificity of prostate cancer screening, and particularly its ability to identify high-risk disease, are essential. Strategies such as the use of 5alpha-reductase inhibitors in high-risk patients, and the continued development of urinary and genetic markers hold promise in this regard.

Early and Late Perioperative Outcomes Following Radical Cystectomy: 90-Day Readmissions, Morbidity and Mortality in a Contemporary Series

Radical cystectomy remains associated with significant morbidity. Most series report outcomes with relatively short-term followup that may underestimate the true magnitude of the procedure and many report length of hospital stay but ignore readmission rates. We analyzed the predictors of early (30 days or less), late (31 to 90 days) and cumulative 90-day hospital readmissions, as well as morbidity and mortality rates. We reviewed our prospectively collected database of 753 patients who underwent radical cystectomy for urothelial cancer between January 2001 and December 2007. We examined the relationship between clinical variables and readmission rates during the early, late and 90-day postoperative period, and reviewed mortality and perioperative morbidity rates. There were 200 (26.6%) patients readmitted in the first 90 days following radical cystectomy. Of these patients 148 (19.7%) were readmitted early, 81 (10.8%) were readmitted late, and 29 (3.9%) had an early and late readmission. Logistical regression revealed gender (OR 1.50, 95% CI 1.00-2.27, p = 0.05), age adjusted Charlson comorbidity index (OR 1.19, 95% CI 1.06-1.34, p = 0.003) and any postoperative complications before discharge home (OR 1.84, 95% CI 1.19-2.83, p = 0.006) as independent predictors of 90-day readmission. The 30 and 90-day mortality rates were 2.1% (16) and 6.9% (52), respectively. Readmission rates after radical cystectomy are significant, approaching 27% within the first 90 days. Gender and age adjusted Charlson comorbidity index were independent predictors providing preoperative information identifying patients more likely to require readmission or possibly to benefit from a longer initial hospital stay.

Mortality measurement in transition: proof of principle for standardised multi-country comparisons

ObjectiveTo demonstrate the viability and value of comparing cause-specific mortality across four socioeconomically and culturally diverse settings using a completely standardised approach to VA interpretation.MethodsDeaths occurring between 1999 and 2004 in Butajira (Ethiopia), Agincourt (South Africa), FilaBavi (Vietnam) and Purworejo (Indonesia) health and socio-demographic surveillance sites were identified. VA interviews were successfully conducted with the caregivers of the deceased to elicit information on signs and symptoms preceding death. The information gathered was interpreted using the InterVA method to derive population cause-specific mortality fractions for each of the four settings.ResultsThe mortality profiles derived from 4784 deaths using InterVA illustrate the potential of the method to characterise sub-national profiles well. The derived mortality patterns illustrate four populations with plausible, markedly different disease profiles, apparently at different stages of health transition.ConclusionsGiven the standardised method of VA interpretation, the observed differences in mortality cannot be because of local differences in assigning cause of death. Standardised, fit-for-purpose methods are needed to measure population health and changes in mortality patterns so that appropriate health policy and programmes can be designed, implemented and evaluated over time and place. The InterVA approach overcomes several longstanding limitations of existing methods and represents a valuable tool for health planners and researchers in resource-poor settings.

Global Patterns of Cancer Incidence and Mortality Rates and Trends

While incidence and mortality rates for most cancers (including lung, colorectum, female breast, and prostate) are decreasing in the United States and many other western countries, they are increasing in several less developed and economically transitioning countries because of adoption of unhealthy western lifestyles such as smoking and physical inactivity and consumption of calorie-dense food. Indeed, the rates for lung and colon cancers in a few of these countries have already surpassed those in the United States and other western countries. Most developing countries also continue to be disproportionately affected by cancers related to infectious agents, such as cervix, liver, and stomach cancers. The proportion of new cancer cases diagnosed in less developed countries is projected to increase from about 56% of the world total in 2008 to more than 60% in 2030 because of the increasing trends in cancer rates and expected increases in life expectancy and growth of the population. In this review, we describe these changing global incidence and mortality patterns for select common cancers and the opportunities for cancer prevention in developing countries.

Memory, Forgetting, and Economic Crisis:

Closely linked to the increase in psychotropic pill consumption, forgetting and remembering emerged from devastated social scenarios as a new local idiom among poor youth in the late 1990s and the new millennium. Drawing on ethnographic fieldwork carried out during the years of the deepest economic crisis in Argentina (2001-03), I argue that psychotropic pill consumption is associated with not only deteriorating economic conditions but also changes in the quality and price of cocaine, and in the scarcity and subsequent change of status of medications during the economic breakdown. Taking into account developments in the field of memory studies, I examine the relationship among political economy, social memory work, and changing drug-use practices. Regarding memory as a social practice, I argue that the growth of psychotropic pill consumption in the late 1990s can be understood through the interplay of Paul Ricoeur's notions regarding different kinds and levels of forgetting. By analyzing changing survival strategies, social network dismantlement, changing mortality patterns, and abusive police repression, I discuss how social fragmentation engendered by structural reforms has modified social memory work.

Nature of socioeconomic inequalities in neonatal mortality: population based study

Objective To investigate time trends in socioeconomic inequalities in cause specific neonatal mortality in order to assess changing patterns in mortality due to different causes, particularly prematurity, and identify key...