Differences In Disease Rates Research Articles

The quantification of alcohol‐caused morbidity and mortality in Australia: a critique *

One of the more controversial conclusions of the Commonwealth Department of Community Services and Health's report on The quantification of drug caused morbidity and mortality in Australia 1988 is that alcohol "causes" about 5% of all deaths in Australia. Against the background of this conclusion, this paper reviews current concepts of what constitutes a causal relationship and how the existence of causation is diagnosed in a nonexperimental setting. The conclusion of the report appears to rest on the assumption that all differences in disease rates between users and non-users of alcohol (or other drugs) are causal in nature--an assumption which is tantamount to equating statistical association with causation. Moreover, the estimate of alcohol-caused deaths, derived from the summation of alcohol-caused deaths from a large number of medical conditions, is at considerable variance with an estimate of total alcohol-caused deaths computed directly from total death rates. The latter estimate actually indicates that alcohol prevents more deaths than it causes in the population as a whole, a conclusion that is compatible with the findings of several recent large cohort studies, from which it is in fact derived. The discrepancy between the two estimates casts doubt on the validity of the assumptions underlying the methodology that has been applied.

Reducing Cholesterol Levels in Elderly Persons-Reply

In Reply.— Dr Brotons and Dr Goldstein have made some excellent points that need to be considered carefully by both public health practitioners and clinicians involved in the prevention of coronary heart disease. It is definitely true that the attributable risk, ie, the absolute difference in rates of disease at a higher level of a risk factor compared with a lower value, provides more information in terms of the actual impact of that risk factor on disease incidence than does the relative risk. In fact, in our study, the attributable risk for the difference between the upper quartile and lower quartiles of serum cholesterol level was approximately 8 per 1000 person-years in the elderly compared with 4 per 1000 person-years in the middleaged men, while the relative risks were about the same. In reply to Dr Goldstein, we did not mean to suggest how elderly individuals with elevated serum cholesterol

Incidence of minor maladies and their relationship to intelligence in school children.

This paper is based on the records of medical consultations over a period of one school year at a War Office sponsored boarding school situated in northern Germany. The school, which catered for some 650 children aged 11 to 1 8 years whose intelligence varied between wide limits, provided boarding accommodation for both sexes. The pupils were drawn from British Forces families in Germany. No differentiation in living conditions was made at this school between dull or bright children. The boarding houses were basically similar and provided a high degree of comfort. Most dormitories contained two to four beds and were centrally heated. Toilet facilities were good with adequate showers and baths and constant hot water. The school meals were well planned, adequate in amount, and supervised by teachers who saw that all children had a normal varied diet. Clothing for all children conformed to minimum requirements stipulated by the school. Soiled clothes were laundered once weekly and house matrons ensured that they were kept clean and mended. The teaching staff actively encouraged the children to maintain a high standard of personal cleanliness. They were also quick to notice any ailing child who was promptly sent to see the doctor. In short, the environment for the pupils whilst at school was uniform and its effect on the differences in disease rates was therefore minimized. The medical staff consisted of one whole-time medical officer, one hospital matron, and four nurses. All routine treatments to ambulant patients were given in the medical centre. The school hospital had eighteen beds and was designed to deal with short-stay patients. Serious cases were sent to the nearest British Forces hospital. Every effort was made to prevent attendance at the medical centre being used as an excuse for absenteeism. Consulting and treatment times were held at the centre outside normal school hours and any child detained there was given a note for the teacher stating the time of dismissal. For the period under review (September, 1953, to July, 1954) a treatment record card was kept for every child attending the medical centre. Each consultation was noted on the card and new cases were entered in a disease group index. The entries on the cards were those dealing with everyday illnesses and did not include routine medical examination findings. Patients requiring treatment in bed were admitted to the school hospital and their particulars and case summaries were recorded in the admission register. The children were divided into two groups according as their Intelligence Quotients (I.Q.) were less or greater than 110. This figure was chosen in order to give groups comparable with secondary modern school and grammar school pupils in England. The numbers in each group were sufficiently close to permit a comparative study. Mental testing was carried out by means of the Moray House tests taken at the age of 11 years. The results were available for the majority of children and the remainder were classified by being given an advanced test or being interviewed by a teacher panel. It has been found that the group intelligence tests give results comparable with those obtained by the Termanized-Binet test (Moray House test series). Previous work (Terman, 1921) showed that the I.Q. for a given child remained remarkably constant, and re-tests during periods of from 2 to 7 years gave similar results. For the purpose of this study the composition of each group was taken to be constant except for minor variations due to school leavers and new entrants. At the beginning of each term a census was taken of all children in attendance in order to minimize the effect of changes in the school population on the calculation of rates per hundred.