Death Records Research Articles

Use of Death Records to Augment Notifiable Conditions Reporting in Washington State.

Health care providers are required to report newly diagnosed notifiable conditions including the case's vital status according to state regulations, but it is uncertain how many cases remain unreported. Death certificates could potentially serve as a data source for detecting unreported deaths due to notifiable conditions. We sought to evaluate the usefulness of electronic death records to augment notifiable conditions reporting in Washington State. Cross-sectional study. All residents of Washington State. Decedents from 2010-2012. Total number of fatal cases of acute infectious notifiable conditions in Washington residents estimated by capture-recapture analysis, proportion of estimated fatal cases reported to Washington's notifiable conditions database (Public Health Issue Management System [PHIMS]), and the proportion of estimated fatal cases identified solely from the death records. Information was obtained by searching multiple cause-of death fields on 2010-2012 death records for keywords for acute infectious notifiable conditions. Capture-recapture analysis estimated 317 fatal cases of these conditions could be expected over the 3 years studied (95% CI: 276,358). Public Health Issue Management System alone identified 38% of total estimated cases; using PHIMS and death record data increased identification to 71%. Electronic filing of death records was very timely, with a median of 4 days to visibility. Death record data were highly complete. Use of death records will augment the notifiable condition reporting system and potentially improve mortality estimates and disease control.

Infant and maternal risk factors related to necrotising enterocolitis-associated infant death in the United States.

To evaluate necrotising enterocolitis (NEC)-associated infant death and identify risk factors related to NEC infant death in the United States. The United States Period Linked Birth/Infant Death data for 2010-2013 were utilised to determine risk factors associated with NEC infant death. Infant mortality rates (IMRs) were calculated and a retrospective matched case-control analysis was performed. An infant case was defined as having the International Classification of Diseases, Tenth Revision code for NEC listed on the death record. Controls were matched on birthweight and randomly selected. Conditional multivariable logistic regression models stratified by birthweight were conducted to determine risk factors for NEC infant death. The average annual NEC IMR was 12.5 deaths per 100 000 live births and was higher among very low birthweight (VLBW) compared to normal birthweight infants and among black compared to white infants. For VLBW infants, the multivariable analysis identified male sex, five-minute Apgar score of less than 7, and white infants born to a mother who is less than or equal to 19 years of age to be related with NEC-associated infant death. Paediatricians should be aware of the factors related to NEC-associated infant death to reduce the number of infants at greatest risk for NEC and focus on racial disparities.

Contributions to Racial Disparity in Mortality among Children with Down Syndrome

To evaluate whether racial differences across a variety of medical factors collected in a longitudinal clinical database at a specialty clinical for children with Down syndrome provide insight into contributors to racial disparity in mortality. Comprehensive medical histories of 763 children receiving medical care at a Down syndrome specialty clinic were retrospectively reviewed regarding prenatal, postnatal, and medical issues, as well as subspecialty referrals. Frequency calculations and logistic regression were performed. The National Death Index was used to query death record databases to correlate medical histories with mortality data. Prenatal drug use and intubation were significantly more frequent, but hyperbilirubinemia was significantly less frequent, in black children compared with white children with Down syndrome. Among children with Down syndrome aged <5years, significant increases in referral to cardiology were seen for black children compared with white children. Trends were seen in an increased incidence of congenital heart disease for black children. Correlations with death records did not demonstrate differences in rates of cardiac-related deaths. Minimal racial disparity was seen for all other measures investigated. Racial disparity in mortality exists, but the underlying cause remains unidentified despite use of a comprehensive, longitudinal database of individuals with Down syndrome and review of death records. Referrals to cardiology might be a clue to the underlying cause, perhaps as an indicator of access to care, but cardiac disease does not account for the disparity in mortality.

How do states die: lessons for Israel

Israel is one of the only countries whose continued existence is called into question. The history of state death and particularly the record of state death since the end of the Cold War provide insights into the kinds of threats that are most likely to bring about the demise of countries in the twenty-first century, including Israel. This record suggests that armed conquest is no longer a principal danger to countries. Instead, state death is more likely to arise by a peaceful decision to end the state. The reasons for this decision vary case by case, but changes in the policy of a great power, ethnic strife, and a growing belief in the illegitimacy of the country’s right to exist have all played key roles in recent state deaths. Israel struggles with each of these issues, making the lessons of state death especially relevant for its future. By learning from the experience of state deaths, Israel can best assess its own vulnerabilities and determine what it needs to do to maximize its prospects for survival.

Fetal Deaths in Brazil: Historical Series Descriptive Analysis 1996-2012.

Objective We seek to comprehensively assess stillbirths in Brazil, to compare the Brazilian findings with global trends and to identify the limitations of the fetal death record system. Method We studied fetal deaths in Brazil between 1996 and 2012 within the following five regions of the country: the North, Northeast, Southeast, South, and Central-West, through an analysis of data obtained from the Unified Health System's (SUS) Informatics Department. The rates of stillbirth in Brazil and in these regions were calculated in relation to the maternal and gestational age and education, birth weight, type of pregnancy, delivery type, weight ranges and cause of death. Results There were 579,661 recorded fetal deaths and a decrease of 22.9% in the stillbirth rate. In 2012, the overall rate was 10.0/1000 births; the North and Northeast regions had the highest rates (10.3 and 12.1, respectively) and the South region had the lowest rate (7.7/1000 births). Two-thirds of the deaths occurred in pregnancies of 28 or more weeks. Low education was an important risk factor, with rates of 24.3/1000 birth in women with no formal education and 4.7/1000 birth in women with 12 or more years of study in 2012. More than 40% of the causes of deaths were nonspecific. Conclusions Despite the gradual decline in stillbirth rates, Brazil still has stillbirth rates that are nearly two times higher than those found in developed countries. There are inequalities between country regions portrayed by the significant variation in mortality rates specified by cause.

Defining Sickle Cell Disease Mortality Using a Population-Based Surveillance System, 2004 through 2008.

Population-based surveillance data from California and Georgia for years 2004 through 2008 were linked to state death record files to determine the all-cause death rate among 12,143 patients identified with sickle cell disease (SCD). All-cause death rates, by age, among these SCD patients were compared with all-cause death rates among both African Americans and the total population in the two states. All-cause death rates were also compared with death rates for SCD derived from publicly available death records: the compressed mortality files and multiple cause of death files. Of 12,143 patients identified with SCD, 615 patients died. The all-cause mortality rate for the SCD population was lower than the all-cause mortality rate among African Americans and similar to the total population all-cause mortality rates from birth through age 4 years, but the rate was higher among those with SCD than both the African American and total population rates from ages 5 through 74 years. The count of deceased patients identified by using population-based surveillance data (n=615) was more than twice as high as the count identified in compressed mortality files using SCD as the underlying cause of death alone (n=297). Accurate assessment of all-cause mortality and age at death requires long-term surveillance via population-based registries of patients with accurately diagnosed SCD.

Hip Fracture-Related Mortality among Older Adults in the United States: Analysis of the CDC WONDER Multiple Cause of Death Data, 1999–2013

Objectives. To examine trends in hip fracture-related mortality among older adults in the United States between 1999 and 2013. Material and Methods. The Wide-Ranging Online Data for Epidemiological Research system was used to identify adults aged 65 years and older with a diagnosis of hip fracture reported in their multiple cause of death record. Joinpoint regression analyses were performed to estimate the average annual percent change in hip fracture-related mortality rates by selected characteristics. Results. A total of 204,254 older decedents listed a diagnosis of hip fracture on their death record. After age adjustment, hip fracture mortality rates decreased by −2.3% (95% CI, −2.7%, and −1.8%) in men and −1.5% (95% CI, −1.9%, and −1.1%) in women. Similarly, the proportion of in-hospital hip fracture deaths decreased annually by −2.1% (95% CI, −2.6%, and −1.5%). Of relevance, the proportion of cardiovascular diseases reported as the underlying cause of death decreased on average by −4.8% (95% CI, −5.5%, and −4.1%). Conclusions. Hip fracture-related mortality decreased among older adults in the United States. Downward trends in hip fracture-related mortality were predominantly attributed to decreased deaths among men and during hospitalization. Moreover, improvements in survival of hip fracture patients with greater number of comorbidities may have accounted for the present findings.

Out of Africa: From Homo naledi to ‘Homo cyborg’

No tools were unearthed, only traces of tool-using capabilities. No death record was chronicled, only sweeping estimations of several thousands or millions of years. No enhanced cognitive functioning was alleged, only insinuations of a primitive brain the size of an orange. As scientists hunted for fragments of our earliest life forms in underground cave systems, they may also have uncovered traces of our not-so-human futures.

Quality registries: exciting opportunities.

Quality registries: exciting opportunities.

A Study on Maternal Mortality in Baba Raghav Das Medical College, Gorakhpur

ABSTRACT Introduction Prevention of maternal deaths is one of our foremost goals to provide safety to motherhood and to avoid loss to the family, society, and the nation. Maternal mortality ratio (MMR) of Uttar Pradesh is very high as compared to national average. Within the state, there is wide variation in MMR. The explanations and answers to these regional variations are complex. This study was planned with the objectives to explore each and every maternal death that had occurred in Baba Raghav Das Medical College in the last 4 years (2011—2014). Materials and methods In this study, data were collected from records of all maternal deaths that had occurred in the Department of Obstetrics and Gynecology, Baba Raghav Das Medical College, Gorakhpur from March 2011 to December 2014. Records of all maternal deaths during this period were scrutinized for socio-demographic profile, obstetric history, antenatal care history, causes of maternal mortality, time trend, geographical or regional distribution, admission and death interval, condition of patients on admission, outcome of pregnancy, and reasons for delay. Records of number of maternal deaths and live births were also collected for previous 11 years (2004—2014). Results Maternal mortality ratio has dropped almost six times in the last 11 years. Early age at marriage, illiteracy, poor socioeconomic status, and multiparity were found to be important determinants of maternal mortality and can act as risk factors. The pattern of causes of maternal deaths in this institute (preeclampsia) is different from that found in the community (postpartum hemorrhage). Delay in seeking care because of unawareness and illiteracy and ignorance was found to be the major contributing factor for most of the maternal deaths. How to cite this article Shrivastava R, Tiwari HC, Sangal R. A Study on Maternal Mortality in Baba Raghav Das Medical College, Gorakhpur. J South Asian Feder Obst Gynae 2016;8(4):294-298.

Subestimación de la mortalidad causada por el tránsito en México:análisis subnacional

To estimate the potential underestimation of mortality from traffic injuries at the subnational level in Mexico for a period of 15 years and to identify social and economic variables at the state level that could potentially be associated with the quality of statistical classification of deaths. Secondary analysis of validated mortality databases for the period 1999-2013 was conducted. Using multiple imputation models, registries that could potentially be attributed to road traffic deaths were estimated and the potential underestimation of mortality due to this external cause was quantified. A simple correlation analysis was carried out. The potential underestimation of deaths from traffic injuries during the period was 18.85% at the national level, with significant variations by state. From the data analyzed, there was no statistical evidence of any association of the percentage of road traffic deaths underestimation with the variables analyzed. Performance in terms of mortality classification is different at the state level in Mexico. This information is useful for targeting interventions to improve the recording of deaths in the country.

Carfilzomib Dosing Patterns and Survival in Patients with Relapsed and Refractory Multiple Myeloma: An Analysis from US Community Oncology Practices

IntroductionWhile novel agents have improved survival over the last decade, multiple myeloma (MM) remains incurable. Carfilzomib (CFZ), a second-generation proteasome inhibitor, was approved in July 2012 by the US Food and Drug Administration and had a label change in July 2015. During this study's data period, the label recommended Cycle 1 dose at 20 mg/m2/day and if tolerated increase Cycle 2 dose and subsequent cycles doses to 27 mg/m2/day. The purpose of this study is to assess baseline characteristics, CFZ dosing patterns and survival among MM patients in a US community oncology setting.MethodsA retrospective study of MM patients from US Oncology Network practices that fully implemented McKesson Specialty Health's iKnowMed (iKM) oncology-specific electronic health records database was conducted on patients whose first treatment of CFZ (index) occurred between Jul-2012 and Nov-2014. Patients were eligible if they had a documented initial MM diagnosis date and had their first CFZ cycle documented in the database. Additionally, patients were required, before Dec-2014, to have either another visit to the practice post-index or a record of death and not have participated in interventional clinical trials during the previous 6 years. Data on eligible patients were collected up to March 2015. The death event was defined by the Social Security Death Index, supplemented by iKM; patients without the event were censored at the date of last observed visit. To adjust for clinical practice variations, a 10% variability was allowed for the recommended daily dose levels of 20 mg/m2 and 27 mg/m2. A subgroup was defined for patients with a 2nd cycle: "escalators" if they received 20 mg/m2/day doses throughout Cycle 1 and increased to 27 mg/m2/day on the first dose of Cycle 2; "non-escalators" if they received only 20 mg/m2 doses throughout Cycle 1 and did not increase to 27 mg/m2 on the first dose of Cycle 2; receiving any dose not equal to 20 or 27 mg/m2 were classified into "other". Survival after index was estimated using the Kaplan-Meier method with 95% confidence intervals (CI). A multivariable Cox proportional hazards (PH) model was conducted to evaluate the impact of escalation on survival accounting for selected baseline demographic and clinical characteristics.ResultsThe cohort of 718 CFZ patients were identified with a median (interquartile range [IQR]) age of 68 (61-75) years at index, 57% (n=409) were male, and 12% (n=87) were Black and 77% (n=551) were Caucasian. At initial MM diagnosis, 19%, 27% and 42% were ISS Stage I, II, and III, respectively. Median (IQR) time from MM diagnosis to index was 3.6 (1.9-5.8) years. At index, 66% of patients had an ECOG performance status of 0-1, 21% of 2, and 2% of 3+; 54% (n=369) had moderate to severe renal impairment (eGFR<60 mL/min per 1.73 m2). Ninety percent (n=644) of patients started CFZ at 20 mg/m2, 4% (n=27) at 27 mg/m2 and 4% (n=25) at 15 mg/m2. Patients had a median (IQR) of 4 (2-7) cycles of CFZ and 45% (n=321) escalated to ≥27 mg/m2. Among these 321 patients, median (IQR) time to first escalation was 30 (28-56) days with 60% escalating in Cycle 2. The subgroup defined in "Methods" included 605 patients: 148 (24%) escalators, 342 (57%) non-escalators, and 115 (19%) other. Median (95% CI) duration from index to death was 21 (17.5-23.2) months. Unadjusted overall survival (OS) was significantly lower among non-escalators compared to escalators (log-rank p=0.024) [Figure 1]. Survival rates (95% CI) for non-escalators and escalators were 68% (62-74%) and 75% (66-82%) at year 1 and 42% (33-50%) and 61% (49-71%) at year 2, respectively. Within the multivariable Cox model, escalators showed a 33% significantly lower risk of death compared to non-escalators (HR=0.67, p=0.03) while also accounting for race, sex, age group, renal function per EGFR, and MM chain type. Other significant variables in this model were: EGFR < 15 and 15-29 vs 30-59 ml/min per 1.73m2 (HR=2.79, p<0.01; HR=1.64, p=0.04, respectively) and lambda vs kappa light chain (HR=1.55, p=0.03).ConclusionsThese results indicate escalation of CFZ at first dose of Cycle 2 is associated with better survival than dosing at 20 mg/m2 in Cycle 1 but not escalating at the start of Cycle 2. More research is needed to assess factors that impact physician decision-making on dose escalation to better inform physicians to improve the quality of multiple myeloma care. [Display omitted] DisclosuresRifkin:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Onyx Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees. Fonseca:McKesson Specialty Health, which received funding to conduct this research: Employment, Equity Ownership. Chen:Onyx Pharmaceuticals: Employment. Fox:McKesson Specialty Health, which received funding to conduct this research: Employment. Browning:Onyx Pharmaceuticals, An Amgen Subsidiary: Employment. Cong:Onyx Pharmaceuticals: Employment, Equity Ownership.

Epidemiologic and Clinical Characteristics of Thalassemia (Thal) Intermedia (TI) in the United States

IntroductionTI is increasingly prevalent in the US due to changing immigration patterns. It is underdiagnosed, leading to inadequate or delayed management. This study reviewed the prevalence, epidemiology, and clinical characteristics of TI in patients (pts) in the US.MethodsMedical records from 1/1997- 4/2014 at 4 US hematology centers were reviewed. Index date was the 1st TI visit at a center on or after 1/1/1997. Eligible pts had a TI diagnosis (≤8 mean packed red blood cell transfusions per year (yr) over a ≥3-y period after index date) and ≥12 months of follow-up. Data spanned from index date to death or last record. Descriptive analyses of demographic and clinical data were done by TI subtype.ResultsOf 138 pts enrolled, 84 had α-thal, 39 had β-thal, and 15 had E/β-thal. 74% of α-thal pts had deletional (del) Hb H, and 26% had non-deletional (ndel) Hb H. 59% of β-thal pts had homozygous or compound heterozygous β-globin mutations (8% with α deletion, 51% without), 20% had a single β mutation with α-gene triplication, 13% had autosomal dominant β thal, and 8% had other β-globin mutations. Of the E/β-thal pts, 80% had E/β0 and 20% had E/β+.Median age at index date was 2.3 yr (1.64 del; 6.1 ndel) in the α-thal group, 9.2 yr in the β-thal group, and 2.2 yr in the E/β-thal group. Most α-thal (77%) and E/β-thal (87%) pts were Asian; most β-thal pts were White (46%) or African-American (36%). Most α-thal (56%) and E/β-thal (53%) pts were of Southeast Asian origin; most β-thal pts were of Mediterranean (31%) or African (21%) origin. 21%, 10%, and 20% of α, β, and E/β-thal pts, respectively, were foreign-born, and 5%, 3% and 7%, respectively, were transfused outside of the US. Observation length was similar across subtypes (median: 5.3 yr).Clinical comorbidities are shown in Table 1. 22% of pts received ≥1 transfusion, while 7% of pts received ≥8 transfusions in any 1 yr to treat anemia, acute hemolysis, or cardiac abnormality; increased transfusions were initiated due to growth failure, acute hemolysis, or unspecified reasons.β-thal pts had a higher mean number of transfusions per pt per yr (PPPY) (α: 0.4 (0.0 del; 1.5 ndel), β: 0.9, E/β: 0.2) and higher mean serum ferritin (ng/mL) (204.3; 511.7; 362.4), and more often had iron chelation therapy (ICT) (11%; 28%; 7%). There was an association between higher serum ferritin, more frequent transfusions, and older age. In pts <10 yr, mean number of transfusions PPPY for regularly and ever transfused was 4.0 and 2.1, and serum ferritin for regularly, ever, and never transfused was 723.7, 438.0, and 146.4 ng/mL. In pts >18 yr, these values were 9.8 and 4.6 transfusions PPPY and 1166.8, 1042.2, and 521.4 ng/mL. An association also existed between ICT and higher mean serum ferritin (ICT: 769.9; no ICT: 463.7 ng/mL).22% of pts had ≥1 liver iron test, and 18% had ≥1 cardiac iron test. Tested pts were older than those not tested (median yr, liver iron: 26.1 vs 7.4; cardiac: 20.1 vs 4.6). Among tested pts, 78% (25/32) had abnormal liver iron results. Median (range) LIC based on R2 or SQUID was 10.8 (2.5-18.2) mg/g dw, with corresponding within-12-month serum ferritin of 494 (127-1770) ng/mL. 49% (17/35) of pts tested had abnormal cardiac results based on electrocardiogram or echocardiogram.Table 1Clinical comorbiditiesAllα-thalα-thal delα-thal ndelβ-thalE/β-thalN=138N=84N=62N=22N=39N=15Splenomegaly54%55%39%100%51%60%Extramedullary hematopoiesis28%24%13%55%36%33%Growth retardation21%23%18%36%13%33%Hepatomegaly21%24%13%55%15%20%Infections needing hospitalization/IV antibiotics21%25%19%41%15%13%Hypoparathyroidism/hypocalcemia15%17%8%41%10%20%Osteopenia/osteoporosis13%11%5%27%21%7%Bone deformities9%6%5%9%21%0%Splenectomy and/or cholecystectomy9%5%2%14%21%0%Cardiomegaly4%6%2%18%0%7%ConclusionTI in the US affects a diverse population. Our data showed a higher prevalence in African-Americans than previously documented. Rates of comorbidity and transfusion frequency increased with age. 18% and 4% of pts were born and transfused outside of the US, potentially leading to additional transfusion-related morbidity. Consistent with extant data, serum ferritin in TI often underestimated actual LIC, rendering more pts potentially eligible for ICT than observed. Morbidities observed in this study underscore the need for better and earlier diagnosis, substantiating the need for nationwide TI screening/surveillance to optimize management. DisclosuresVichinsky:Novartis: Research Funding. Kwiatkowski:Novartis: Research Funding; Sideris Pharmaceuticals: Consultancy; Shire Pharmaceuticals and Sideris Pharmaceuticals: Consultancy; ISIS: Membership on an entity's Board of Directors or advisory committees. Paley:Novartis: Employment. Vekeman:Novartis: Research Funding. Cheng:Novartis: Research Funding. Damron:Novartis: Research Funding. McCormick:Novartis: Research Funding. Sasane:Novartis: Employment. Qiu:Novartis: Employment. Duh:Novartis: Research Funding. Thompson:Bluebird bio: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Mast: Research Funding; Apopharma: Consultancy; Baxter: Consultancy, Research Funding.

Premature Mortality Among Adults With Schizophrenia in the United States.

Although adults with schizophrenia have a significantly increased risk of premature mortality, sample size limitations of previous research have hindered the identification of the underlying causes. To describe overall and cause-specific mortality rates and standardized mortality ratios (SMRs) for adults with schizophrenia compared with the US general population. We identified a national retrospective longitudinal cohort of patients with schizophrenia 20 to 64 years old in the Medicaid program (January 1, 2001, to December 31, 2007). The cohort included 1,138,853 individuals, 4,807,121 years of follow-up, and 74,003 deaths, of which 65,553 had a known cause. Mortality ratios for the schizophrenia cohort standardized to the general population with respect to age, sex, race/ethnicity, and geographic region were estimated for all-cause and cause-specific mortality. Mortality rates per 100,000 person-years and the mean years of potential life lost per death were also determined. Death record information was obtained from the National Death Index. Adults with schizophrenia were more than 3.5 times (all-cause SMR, 3.7; 95% CI, 3.7-3.7) as likely to die in the follow-up period as were adults in the general population. Cardiovascular disease had the highest mortality rate (403.2 per 100,000 person-years) and an SMR of 3.6 (95% CI, 3.5-3.6). Among 6 selected cancers, lung cancer had the highest mortality rate (74.8 per 100,000 person-years) and an SMR of 2.4 (95% CI, 2.4-2.5). Particularly elevated SMRs were observed for chronic obstructive pulmonary disease (9.9; 95% CI, 9.6-10.2) and influenza and pneumonia (7.0; 95% CI, 6.7-7.4). Accidental deaths (119.7 per 100,000 person-years) accounted for more than twice as many deaths as suicide (52.0 per 100,000 person-years). Nonsuicidal substance-induced death, mostly from alcohol or other drugs, was also a leading cause of death (95.2 per 100,000 person-years). In a US national cohort of adults with schizophrenia, excess deaths from cardiovascular and respiratory diseases implicate modifiable cardiovascular risk factors, including especially tobacco use. Excess deaths directly attributable to alcohol or other drugs highlight threats posed by substance abuse. More aggressive identification and management of cardiovascular risk factors, as well as reducing tobacco use and substance abuse, should be leading priorities in the medical care of adults with schizophrenia.

Primary care visits due to injuries among the Aboriginal off-reserve population of British Columbia, Canada, 1991-2010.

BackgroundAboriginal people in British Columbia (BC) have higher injury incidence than the general population. This report describes variability in visits to primary care due to injury, among injury categories, time periods, geographies, and demographic groups.MethodsWe used BC’s universal health care insurance plan as a population registry, linked to practitioner payment and vital statistics databases. We identified Aboriginal people by insurance premium group and birth and death record notations. Within that population we identified those residing off-reserve according to postal code. We calculated crude incidence and Standardized Relative Risk (SRR) of primary care visit due to injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC.ResultsDuring 1991 through 2010, the crude rate of primary care visit due to injury in BC was 3172 per 10,000 person-years. The Aboriginal off-reserve rate was 4291 per 10,000 and SRR was 1.41 (95 % confidence interval: 1.41 to 1.42). Northern and non-metropolitan HSDAs had higher SRRs, within both total BC and Aboriginal off-reserve populations. In every age and gender category, the HSDA-standardized SRR was higher among the Aboriginal off-reserve than among the total population. For all injuries combined, and for the categories of trauma, poisoning, and burn, between 1991 and 2010, crude rates and SRRs declined substantially, but proportionally more rapidly among the Aboriginal off-reserve population, so the gap between the Aboriginal off-reserve and total populations is narrowing, particularly among metropolitan residents.ConclusionsThese findings corroborate our previous reports regarding hospitalizations due to injury, suggesting that our observations reflect real disparities and changes in the underlying incidence of injury, and are not merely artefacts related to health care utilization.

English

Estimates of the risk of death from prostate cancer are valuable for making screening decisions. Knowing a man's risk of death from prostate cancer can help him select the best PSA threshold for biopsy. Estimates of All-Cause Death (ACD) risk are limited to the population studied. Estimates of Cancer-Specific Death (CSD) risk are more useful than ACD risk. There are two methods of estimating CSD risk: 1) Using records of the cause of death, and 2) Net survival methods that remove other causes from ACD risk. Net survival methods are superior to relying on cause of death because they do not depend on judgment; but they depend heavily on estimates of No-Cancer Death (NCD) risk. Here we present approaches to estimating CSD risk for datasets that may not have records of cause of death. We use data for prostate cancer from the U.S. Department of Veterans Affairs (VA) with data for over 14 million men and 33 million PSA tests. VA has superb death record data for veterans but does not have good records of cause of death. Therefore, net survival methods are the only way to estimate CSD risk for VA data, which puts a premium on accurate estimates of NCD risk.

Abstract A35: Association between calcium and beta-carotene intake and risk of prostate cancer in Seoul Male Cohort Study

Abstract Prostate cancer is a 5th common cancer among Korean male population, but the incidence is increasing rapidly (12.1% per year). The 5-year relative survival of prostate cancer in Korea is relatively poor (80.1% for 2001-2005 incident cases) compared to other developed countries (99.4%, 2001-2007 incident cases in SEER U.S.A), probably due to later stage at diagnosis. Dietary factors are strongly related to the risk of prostate cancer. Calcium and beta-carotene has been suggested to have a positive and an inverse association with the risk of prostate cancer, respectively. However, several recent studies showed no association with dietary calcium and either no or a positive association with bet-carotene, especially among smokers. We aimed to test the association between calcium and beta-carotene intake and the risk of prostate cancer in a Korean male population. Seoul Male Cohort was established in 1993. Members were recruited from the male beneficiaries of the Korean Health Insurance Company, who were aged 40-59 and living in Seoul. A lifestyle questionnaire survey was conducted through mailing. Dietary intake was measured using a quantitative food frequency questionnaire with 88 food items. Nutrient intake was calculated and the amount was categorized into quartiles (q1-the lowest quartile, q4-the highest quartile). Cancer occurrence was identified through data linkage to the Korean Central Cancer Registry and Korean Death Records. A total of 14,533 members were followed up until December 31, 2008, and 123 incident prostate cancer cases were identified. Multivariable hazard ratios (aHR) and 95% confidence intervals (95%CI) were calculated using Cox's regression model. There was no significant difference between prostate cancer patients and non-cancer cohort members in terms of initial age, family history, body mass index, alcohol intake, and smoking, whereas prostate cancer patients had higher education (p&amp;lt;0.036). Higher calcium intake was not associated with prostate cancer (q4 vs. q1, aHR=0.98, 95%CI = 0.51-1.88, ptrend=0.81). Moderate, but not significant, risk increase by beta-carotene intake was observed (q4 vs. q1, aHR=1.60, 95%CI = 0.93-2.77, ptrend=0.06). Baseline smoking rate among cohort members was high (76%). Therefore, we observed the same result in a subgroup analysis with smokers only. In conclusion, calcium intake did not increase the risk of prostate cancer, and beta-carotene intake may increase the risk of prostate cancer in a Korean male population. Citation Format: Myung-Hee Shin, Jong-Myon Bae, Moo-Song Lee, Dong-Hyun Kim, Zhong-Min Li, Yoon-Ok Ahn. Association between calcium and beta-carotene intake and risk of prostate cancer in Seoul Male Cohort Study. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A35.

Contemporary radical cystectomy outcomes in patients with invasive bladder cancer: a population-based study.

To determine the contemporary survival outcomes from a whole population and identify significant predictors of survival, as contemporary population-based survival outcomes after radical cystectomy (RC) for the treatment of bladder cancer (BC) are sparse. Reports suggest a large disparity between population outcomes and those of centres of excellence. All invasive BC cases diagnosed between 2001 and 2007 in New South Wales, Australia, were identified from the Central Cancer Registry. Records of treatment and death were electronically linked. All patients who underwent RC between 2001 and 2009 were selected for this study (804 patients). Follow-up was to the end of 2009. Outcomes assessed were disease-specific survival (DSS) and overall survival (OS). Multivariable Cox regression and log-rank analysis were used to model and compare survival within groups. Of 804 patients diagnosed during the study period 420 (52.2%) died during follow-up. The 5-year DSS and OS for all patients was 59.6% and 53.2%, respectively. The 5-year DSS for patients with localised, regional and distant disease, undergoing RC was 72%, 51% and 10%, respectively. Age (P < 0.001) and stage (P < 0.001) were associated with 5-year DSS and OS after adjusting for all other variables. High-volume centres had significantly better 5-year DSS compared with low-volume centres (P < 0.05). The 30-day mortality for high- vs low-volume centres was 1.8% and 3.6%, respectively. Perioperative mortality improved over time for high- and moderate-volume centres but not for low-volume centres. Contemporary survival outcomes after RC are much improved compared with older studies and appear close to results from academic centres of excellence. High-volume centres report better 5-year DSS outcomes than lower volume centres.

Methodological Challenges Using Publicly Available Government Records To Describe And Identify Racial/ Disparities In Infant Mortality Risk: Conceptual And Methodological Challenges

Introduction: The infant mortality rate (IMR) of a population is a reflection of the socioeconomic conditions on the health of mothers and newborns. IMR are higher among Blacks, Hispanics, and Native Americans, in comparison to White Americans. Environmental exposures and race-exposure interactions, as well as individual characteristics need to be addressed. Income inequality in an area can play a role in infant mortality. The purpose of this investigation is to describe methodological challenges when using government records to identify racial disparities in infant mortality risk. Methods: Data used in this study will be derived from the US Vital Statistics Linked Birth and Infant Death Records (LBID). Information on maternal and infant socio-demographic characteristics, place of birth, and exposures for infant health are available. We will use the Gini coefficient as our main exposure of interest. Results: One methodological challenge is the use of differing versions of the US Standard Certificate of Live Birth (the unrevised and the revised versions). By 2008, 27 states used the revised version, resulting in several covariates being collected differently and are not easily comparable. In the unrevised version, mothers were asked to report the average number of cigarettes per day. In the revised version, mothers were asked to estimate the average number of cigarettes smoked per day during each trimester. Differing measurements were utilized to collect education and access to prenatal care. Therefore, interaction terms between race and exposures might be difficult to examine. Discussion: Due to variability in how birth certificate data is collected, it is difficult to accurately test whether behaviors and socioeconomic characteristics help to explain differences in risk for mortality across racial groups, when investigating the relationship between income inequality and risk for mortality among infants. Methods in how to address this challenge will be discussed.

Validity of in-hospital mortality data among patients with acute myocardial infarction or stroke in National Health Insurance Research Database in Taiwan

ObjectiveThe aim of this study was to determine the validity of in-hospital mortality records in the National Health Insurance Research Database (NHIRD) by cross-comparing with death records from the electronic medical records (EMR) of a medical center in southern Taiwan. MethodsData on patients admitted to the medical center for acute myocardial infarction (AMI) or stroke during the years 2005 to 2010 were extracted from the two databases and cross-linkages with patients' characteristics (birth date, gender, admission date, and discharge date). While the death record was available in the catastrophic illness registry data files (CIRD), we also estimated the insurance status and death record in the CIRD subset using confirmed death cases. Additionally, agreement in comorbidities between records from the two databases was evaluated. ResultsA total of 6197 cases were successfully linked, with a linkage rate of 96.56% of cases in the NHIRD when linked to those from the EMR. Among the linked population, 538 of 682 patients retrieved as expired in the NHIRD were also so recorded in the EMR. This yielded a positive predictive value of 0.79 when the EMR was used as the gold standard. Patients having death records in both the CIRD subset and the EMR totaled 364, which yielded a percentage positive agreement rate of 76%. The consistency in comorbidity diagnoses between the two databases was more than 90% among matched cases. ConclusionsThe accuracy of death records in the NHIRD was high, and appears to be a valid resource for population research in cardiovascular diseases.