Decrease In Case Fatality Rate Research Articles

Mortality of tetanus at the Lagos University Teaching Hospital, Nigeria

Records of 349 tetanus patients, aged 10 years and above, admitted to the Lagos University Teaching Hospital, Nigeria, between 1990 and 1999 were reviewed. The male:female ratio was 1.98:1, and the ages were between 10 and 88 years, with a mean age of 29.8 years. The overall case fatality rate (CFR) of tetanus was 36.96% (33.19% for men and 44.44% for women). The CFR is similar to that previously reported in the hospital, but higher than that reported from Europe and North America. The lowest CFR was in the 10-19-year age group, and there was a trend towards increasing CFR with increasing age. Tetanus patients in the intensive care unit (ICU) had a significantly higher CFR than those in the medical wards. Unlike in developed countries, where management of tetanus in ICU has resulted in a decrease in CFR, the CFR of tetanus at the Lagos University Teaching Hospital has not significantly reduced over the years.

Estimated case fatality rate of pulmonary embolism, 1979 to 1998

Trends in the estimated case fatality rate of pulmonary embolism (PE) in the United States were obtained from the Bureau of the Census Compressed Mortality File and the National Hospital Discharge Survey. The estimated case fatality rate of PE increased from 1979 to 1989, then decreased through 1998. It increased exponentially with age and was higher in African-American than Caucasian patients (rate ratio 1.42; 95% confidence interval 1.40 to 1.44). The declining population mortality rate of PE from 1979 to 1989 appears to be due to a decreased incidence of PE, reflective of improved prophylaxis, whereas the continued declining population mortality rate of PE through 1998 reflects a decreased case fatality rate due to earlier and better management.

MALIGNANT MELANOMA FROM THE DERMATOLOGIC PERSPECTIVE

Early recognition and treatment of thin cutaneous melanomas (stages Ia and Ib) have contributed to a decreased case-fatality rate during the past several decades. The only known preventable risk factor for melanoma is sun protection in childhood, which directly affects the number of melanocytic nevi developing in an adult. Additional risk factors, clinical features, and the malignant potential of precursor lesions are discussed. The four major clinicopathologic subtypes of melanoma are described with recommendations for appropriate biopsy techniques for suspected melanoma. Nationwide skin cancer screenings by dermatologists and greater public awareness of the warning signs of melanoma have enhanced detection of early melanoma and have promoted chances for a cure.

Perinatal mortality and case fatality after placental abruption in Norway 1967-1991.

To study national secular trends in Norway of perinatal mortality and case fatality to placental abruption (PA) and associations with cesarean section (CS). A population based cohort study. The Medical Birth Registry of Norway. 9,592 cases of placental abruption (PA) of a total of 1,446,154 births notified in Norway 1967-1991. Comprehensive perinatal mortality (all stillbirths > or = 16 weeks of gestation and early neonatal deaths) and standard perinatal mortality (all stillbirths > or = 28 weeks of gestation and all early neonatal deaths). Case fatality rate. From 1967 through 1991, the standard perinatal mortality rate due to placental abruption (PA) in Norway decreased from 2.5 per 1000 births (13.5% of all deaths) in 1967 to 0.9 (13.2%) in 1991. The comprehensive perinatal mortality rate due to placental abruption (PA) in Norway decreased from 3.2 to 1.7 per 1000. The proportion of all perinatal deaths due to PA increased from 11.4% in 1967-1971 to 217.0 in 1987-91 and decreased in all gestational age categories. Case fatality in PA with cesarean section (CS) was generally lower than in PA without CS, regardless of gestational age. Placental abruption is an important cause of perinatal mortality in Norway. Our results are in favor of an active approach with frequent use of cesarean section, also at lower gestational ages. The decreasing case fatality rate by year of birth in all gestational age groups may be attributed to improved obstetric and perinatal care.

Has there been a decline in subarachnoid hemorrhage mortality?

We studied subarachnoid hemorrhage in the population of Rochester, Minnesota, for the 40-year period from 1945 through 1984. The average annual incidence rate of subarachnoid hemorrhage in Rochester has remained constant at approximately 11 per 100,000 population. Age-specific incidence rates increased with age. However, the average annual mortality rate for subarachnoid hemorrhage in Rochester has shown a decreasing trend, from 6.8 per 100,000 population in 1955-1964 to 4.3 in 1975-1984. It is likely that this is due to a decrease in case-fatality rates from 57% in 1945-1974 to 42% in 1975-1984 (p = 0.10). This decreasing trend was also evident in annual mortality rates from subarachnoid hemorrhage for US white men and women. The reason for the improved case-fatality rate is unclear, but it may be related to changes in management. The interval from onset of subarachnoid hemorrhage to surgery decreased from a median of 12 days in 1975-1979 to 2 days in 1980-1984, and of those who survived to receive medical attention, more patients received some form of medical treatment in 1980-1984. Whether either or both of these changes have led to the decrease in the case-fatality rate is uncertain.

Mortality from violent causes among the elderly population in Finland in 1951-1979.

The changes in violence-related mortality rates among the population aged 65 years or older in Finland from 1951-1979 were studied with the help of the official mortality statistics. Factors underlying these changes were also examined. The most distinctive findings were, first, the increase in accident-related mortality rates of both males and females in the 1950s and, second, the sharp decrease of those rates with respect to women from 1960-1975 compared to the decrease for males during that same period. The changes in mortality for males were mainly due to changes in frequency of motor-vehicle fatalities, whereas the changes for females were mainly due to changes in mortality caused by accidental falls and limb fractures. Improvements in classification methods resulting in the decrease of unspecified causes of death were apparently the main cause of the recorded increase in violent mortality in the early 1950s. The incidence of traffic accidents has decreased in the latter half of the 1970s. Thus, the minor decrease in motor-vehicle accident mortality for men most evidently was due to a decreased incidence. The incidence of hip and limb fractures in women increased. Thus, it was not a lowered incidence but instead a decreased case-fatality rate which caused the decreased mortality in females. Early mobilization after hip operations and decreased dependence level among the elderly apparently resulted in the decreased fatality rates.