Highest Proportional Mortality Research Articles

Is Cardiovascular Disease, Diabetes, HIV/AIDS And Tuberculosis Pre-Disposing Risk Factors For Increased Infection By SARS-Cov-2 And/or Death From COVID-19? Preliminary Results and Implications for South-East Asia

Aims: Early clinical data indicate that both the susceptibility to infection and the outcomes (e.g., death) of COVID-19 are strongly associated with pre-existing clinical conditions and diseases, especially cardiovascular disease (CVD). A preliminary epidemiological study, based on five months of diagnosed cases for COVID-19, for the beginning of the pandemic, January to 06 June 2020, was undertaken for the six major global regions: Europe, The Americas, Western Pacific, Eastern Mediterranean, South-East Asia and Africa, covering 173 infected countries. Methods: Pre-existing medical conditions that were considered to affect the number of infections by SARS-CoV-2 virus, and death by COVID-19 were the prevalence of CVD, diabetes mellitus (DM), Human Immunodeficiency Virus (HIV) and Tuberculosis (TB). A comparison was done to establish correlation, if any, between the prevalence of these four comorbid diseases and the observed number of COVID-19 cases (infections) and deaths, by Pearson correlation analysis Findings: The global prevalence of the four pre-existing diseases is: CVD (1 332,1 million, 17,2%) > DM (686,4 million, 8,9%) > HIV (37,9 million, 0,8%) > TB (6,2 million, 0,08%), and is ranked as follows per region (% of global): CVD: Western Pacific 29,05% > South-East Asia 26,26% > America 16,65% > Europe 14,32% > Eastern Mediterranean 8,32% > Africa 6,31%; DM: South East Asia : 27,32% > Western Pacific: 24,42% > Eastern Mediterranean: 15,51 > The Americas (14,94) > Europe: 9,08 > Africa: 8,73%; HIV : Africa (74,9) > The Americas (10,3) > Europe (6,6) > Western Pacific (5,4) > Eastern Mediterranean (1,5) > South-East Asia (1,30); TB : Africa (39,5%) > Western Pacific (31,0) > Eastern Mediterranean(13,1%) > South-East Asia (7,6%) > The Americas (4,7%) > Europe (4,1%). The most common comorbid conditions for COVID-19 patients are, in decreasing prevalence: CVD > DM > HPT > Chronic Obstructive Pulmonary Disease > HIV > cerebrovascular disease/obesity > cancer/smoking/chronic kidney disease > TB. Within regions: for The Americas, there was a significant correlation between deaths due to underlying DM. Four regions had a significant correlation for underlying CVD: Europe: Infection due to CVD; Eastern Mediterranean: Infection due to CVD; South-East Asia: Deaths due to CVD and TB; Western Pacific: Deaths due to CVD; Africa: Infection due to HIV. Across regions: South-East Asia: ranked first as having a significant correlation for deaths due to CVD and TB, followed by Western Pacific: deaths due to CVD, Americas: deaths due to DM, Europe: infection due to CVD, Africa: infection due to HIV, and the Eastern Mediterranean: infection due to CVD. The global COVID-19 CFR, based on total deaths and cases, at 16 August 2020, is 3,58%. The approximate CFR for COVID-19 patients with comorbidity is: 10,6% ± 1,1 for CVD, 9,4% ± 5,6 for DM and 6,0% ± 0 for HPT. The South-East Asia region appeared to have a significant correlation, for all 4 co-morbid conditions, and risk of infection by SARS-CoV-2, and deaths by COVID-19, in decreasing rank: deaths vs TB/CVD > deaths/cases vs DM > deaths vs HIV. Conclusions: The common global diseases (CVD, DM, HIV, TB) are also risk factors for SARS-CoV-2 infection and deaths by COVID-19, in decreasing rank: CVD > DM > HIV > TB. Continents, and countries, with currently high proportional mortality due to non-communicable diseases, (CVD and DM), like South-East Asia, appear to be at higher risk for infection and death by COVID-19, compared to those with higher proportionality due to communicable diseases (HIV, TB), like Africa. The high number of case infections and death due to COVID-19 in the Western Cape appears to be similar to that for The Americas, where DM appears to be a significant comorbid condition.

Inequalities in Mortality Rates from Malformations of Circulatory System Between Brazilian Macroregions in Individuals Younger Than 20 Years.

ResumoFundamentos Os óbitos por malformações do aparelho circulatório (MAC) em 2015 corresponderam a 43% daqueles por malformações congênitas (MC) em menores de 20 anos de idade no mundo. Os óbitos por MAC apresentam maior impacto sobre a redução da mortalidade, pelo fato de serem evitáveis na maioria das vezes, com o correto diagnóstico e tratamento.Objetivo Conhecer a distribuição da mortalidade por MAC por sexo, grupos etários e macrorregiões do Brasil no período de 2000 a 2015, nos menores de 20 anos de idade.Métodos Estudo descritivo das taxas de mortalidade por 100 mil e sua mortalidade proporcional, por MAC, outras malformações congênitas (OutMC), doenças do aparelho circulatório (DAC), causas mal definidas (CMD) e causas externas (CE) no Brasil, no período de 2000 a 2015 nos menores de 20 anos. As populações foram obtidas no Instituto Brasileiro de Geografia e Estatística e os óbitos no Departamento de Informática do Sistema Único de Saúde/Ministério da Saúde.Resultados Ocorreram 1.367.355 óbitos por todas as causas nos menores de 20 anos de idade, sendo 61,7% do sexo masculino e 55,0% dos óbitos nos menores de 1 ano. Os óbitos por MC em quaisquer órgãos ou sistemas foram 144.057 e os por MAC corresponderam a 39% desses óbitos. Em ambos os sexos, a mortalidade anual por MAC foi de 5,3/100 mil habitantes e a mortalidade proporcional (MP) foi de 4,2%, por DAC 2,2%, por CMD 6,2% e por CE 24,9%. As MAC não especificadas apresentaram as maiores taxas de MP em todas as idades e sexos, notadamente nas regiões Norte e Nordeste (60%). Os óbitos por quaisquer MC ocorreram 5,7 vezes mais no primeiro ano de vida do que nas outras faixas etárias (MAC: 5,0; OutMC: 6,4).Conclusão No Brasil, de 2000 a 2015, nos menores de 20 anos de idade, a MAC foi a principal causa de óbito dentre todas as malformações, sendo duas vezes mais importante do que as DAC, principalmente nos menores de 1 ano de idade.A frequência de diagnósticos imprecisos de óbitos por MAC ainda é elevada em todas as idades, sexos, e principalmente nas regiões Norte e Nordeste, o que requer fortalecimento das estratégias de saúde pública e maior atenção ao recém-nascido com objetivo de diagnosticar e instituir tratamento precoce das cardiopatias congênitas com consequente redução na mortalidade. (Arq Bras Cardiol. 2020; 115(6):1164-1173)

Mortality attributable to sugar sweetened beverages consumption in Mexico: an update.

In 2010, sugar sweetened beverages (SSBs) were estimated to cause 12% of all diabetes, cardiovascular disease (CVD) and obesity-related cancer deaths in Mexico. Using new risk estimates for SSBs consumption, we aimed to update the fraction of Mexican mortality attributable to SSBs, and provide subnational estimates by region, age, and sex. We used an established comparative risk assessment framework. All-cause mortality estimates were calculated from a recent pooled cohort analysis. Age- and sex-specific relative risks for SSBs-disease relationships were obtained from updated meta-analyses. Demographics and nationally representative estimates of SSBs intake were derived from the National Health and Nutrition Survey 2012; and mortality rates, from the National Institute of Statistics and Geography. Attributable mortality was calculated by estimating the population attributable fraction of each disease, with uncertainty in data inputs propagated through Monte Carlo probabilistic sensitivity analyses. In Mexican adults 20 years and older, 6.9% (95%UI: 5.4-8.5) of all cause-mortality was attributable to SSBs, representing 40,842 excess deaths/year (95%UI: 31,950-50,138). Furthermore, 19% of diabetes, CVD and obesity-related cancer mortality was attributable to SSBs (95%UI: 11.0-26.5), representing 37,000 excess deaths/year (95%UI 21,240-51,045). Of these, 35.6% were diabetes-related (95%UI 16.4-52.0). Proportional burden was highest in the South (22.8%), followed by the Center (18.0%) and North (17.4%). Men aged 45-64-years in the Center region had highest proportional mortality (37.2%), followed by 20-44-year-old men living in the South (35.7%) and both men and women aged 20-44 living in the Center (34.4%). Utilizing current evidence linking SSBs to cardiometabolic disease and obesity-related cancers, earlier estimates of Mexican mortality attributable to SSBs could have been underestimated. Mexico urgently needs stronger policies to reduce SSBs consumption and reduce these burdens.

The role of the G20 economies in global health.

The Meetings of Health Ministers of the Group of Twenty (G20) that started at the G20 Summit in Berlin, Germany in 2017 have provided a platform for the discussion of global health matters such as antimicrobial resistance (AMR), public health emergencies, and universal health coverage. Similar issues are also discussed at meetings of the G7 and the World Health Assembly (WHA). This article will examine recent data to explore the characteristics of the G20 and its potential for improving health outcomes. G20 countries have a leading role to play in helping other countries improve global health outcomes because member countries have already faced many issues associated with aging society and increased prevalence of non-communicable diseases (NCDs). Indeed, 71% of the world's elderly population lives in the G20 countries and most of these countries have a high proportional mortality from NCDs of more than 70%. G20 countries are also responsible for a disproportionate share of global impacts. For instance, 72% of CO2 emissions are produced by G20 countries. Migration dynamics and its consequences also need to be considered from the perspective of optimizing health outcomes. Moreover, 78% of the world's top 50 pharmaceutical companies are located in the G20 countries. There is ample room for G20 countries to pursue collaborative and cooperative approaches that can complement the roles of the G7 and WHA in similar health issues. The G20 could, for example, share experiences on dealing with aging and NCDs, reduce their CO2 emissions, prohibit the production of low-quality medicines, and use standardized health check-up formats for migrants and refugees to transfer their own health information. As a group, the G20 countries have the potential to solve global health problems and other issues. The convening of high-level health meetings at G20 summits has the potential to facilitate such endeavors.

Estimated Global, Regional, and National Cardiometabolic Disease Burdens Related to Red and Processed Meat Consumption: An Analysis from the Global Dietary Database (P10-073-19)

ObjectivesRed and processed meats are associated with cardiometabolic disease (CMD) risk; yet, corresponding global burdens are not well established. We aimed to quantify the impact of meat intake on coronary heart disease (CHD) and type 2 diabetes mortality by nation (n = 187), super-region (n = 9), age (20 + y), and sex using the largest standardized Global Dietary Database (GDD) available. MethodsA comparative risk assessment model estimated the absolute and % CHD and diabetes mortality attributable to suboptimal unprocessed red and processed meat consumption, incorporating data and corresponding uncertainty on: intakes from the GDD, estimated by a Bayesian hierarchical imputation model using national and sub-national surveys worldwide (266 surveys; 1630,069 individuals; 113/187 countries; 82% of the world’s population); etiologic effects of meat intake on CHD and diabetes mortality from meta-analyses of prospective cohorts; optimal population meat intakes based on observed intakes associated with lowest risk; and disease-specific deaths from the Global Burden of Diseases. ResultsIn 2010, suboptimal red meat intake was associated with 43,987 (95% uncertainty interval: 42,243–45,635) diabetes deaths, accounting for 3.5% (3.4–3.6%) of global diabetes mortality. Highest proportional mortality was estimated in Central African Republic, United Arab Emirates, and Gabon (Figure 1). Similar attributable mortality was seen in men (4%) vs women (3%), and higher in younger (25–54 y; 5–7%) vs older (55–85 y; 1–4%) adults. Processed meat intake was linked to 510,214 (482,092–541,175) CHD and 86,923 (83,832–90,488) diabetes deaths, accounting for 7.3% (6.9–7.8%) of global CHD and 6.9% (6.7–7.2%) of diabetes mortality. CHD mortality was highest in Panama, Costa Rica, and Colombia, and diabetes mortality in Panama, Belarus, and El Salvador (Figure 2). Attributable mortality was higher in men vs women (CHD: 9 vs 6%; diabetes: 8 vs 6%), and in younger vs older adults (14–15% vs 4–11%; 12–15% vs 3–9%). Meat-related CMD burdens in 1990 and 2015 will be presented at the meeting. ConclusionsSuboptimal processed meat intake contributed to substantial CMD mortality, greatly exceeding burdens attributed to unprocessed red meats. Such data highlight the need for strategies to reduce meat, particularly processed meat, consumption. Funding SourcesGates Foundation. Supporting Tables, Images and/or Graphs▪▪

Longevity and mortality in Kennel Club registered dog breeds in the UK in 2014

BackgroundThe domestic dog is one of the most diverse mammalian species, exhibiting wide variations in morphology, behaviour and morbidity across breeds. Therefore, it is not unexpected that breeds should also exhibit variation in mortality and longevity. While shorter longevity per se may not necessarily be a welfare issue, a generally foreshortened lifespan in a breed that is accompanied by a high prevalence of a particular cause of death may reveal potentially serious welfare concerns and highlight scope to improve breed welfare. Survey data gathered directly from owners offer useful insights into canine longevity and mortality that can support the overall evidence base for welfare reforms within breeds.ResultsMortality data on 5663 deceased dogs registered with the UK Kennel Club were collected from an owner-based survey. The most commonly reported causes of death were old age (13.8%), unspecified cancer (8.7%) and heart failure (4.9%); with 5.1% of deaths reported as unknown cause. Overall median age at death was 10.33 years (interquartile range: 7.17–12.83 years). Breeds varied widely in median longevity overall from the West Highland Terrier (12.71 years) to the Dobermann Pinscher (7.67 years). There was also wide variation in the prevalence of some common causes of death among breeds, and in median longevity across the causes of death.ConclusionSubstantial variation in the median lifespan and the prominent causes of death exists across breeds. This study has identified some breeds with both a low median lifespan and also a high proportional mortality for one or more specific causes of death that should be considered as both potential welfare concerns as well as opportunities for improvement.

Mortality from multiple sclerosis in British military personnel.

While analysing trends in occupational mortality in England and Wales, we noticed an unexpectedly elevated proportion of deaths from multiple sclerosis (MS) among men in the armed forces. To document and explore possible explanations for the observed excess. We analysed data on underlying cause of death and last full-time occupation for 3,688,916 deaths among men aged 20-74 years in England and Wales during 1979-2010, calculating proportional mortality ratios (PMRs) standardised for age. We compared PMRs for MS in the armed forces with those for each main social class, and in selected other occupations. We also compared PMRs for MS with those for motor neurone disease (MND). The overall PMR for MS in the armed forces during 1979-2010 was 243 (95%CI 203-288). The excess was apparent in each of three separate decades of study (PMRs, ranging from 220 to 259), and across the entire age range. PMRs for MS were not elevated to the same extent in comparator occupations, nor in any of the main social classes. There was no parallel increase in PMRs for MND. These findings suggest that the high proportional mortality from MS in British military personnel is unlikely to have occurred by chance, or as an artefact of the method of investigation. However, the only military cohort study with published results on MS does not support an increased risk. It would be useful to analyse data on MS from other established military cohorts, to check for evidence of a hazard.

Causes of death in 184 patients with type 1 Gaucher disease from the United States who were never treated with enzyme replacement therapy

Treatment for type 1 Gaucher disease (GD1) decreases morbidity from hematological cytopenias, hepatosplenomegaly and bone complications. Consequently, untreated symptomatic patients for study of late outcomes are hard to find. We identified 184 untreated GD1 patients (67.4% Ashkenazi; splenectomy 51.1%) who died between 1950 and 2010. Here, we report confirmed causes of death for these patients compared with the overall US population. Median age of death 66years (2–97years); causes of death (COD) with a high proportional mortality rate (PMR) included malignancies (PMR 1.57), suicide/drug overdose (PMR 3.86), liver disease (PMR 4.76) and septicemia (PMR 9.22). PMRs for CNS/gastrointestinal bleeding, pulmonary hypertension, post-splenectomy complications and Parkinsonism were also increased. PMR for heart disease (0.33) was significantly decreased. Average age at death was normal for heart disease, septicemia, suicide, and malignancies but younger for liver disease and Parkinsonism. COD more prevalent in splenectomy patients included liver disease, septicemia, pulmonary hypertension and GI bleeding. With timely diagnosis, improved risk assessment and obsolescence of splenectomy, GD1-associated malignancies, liver disease, septicemia, pulmonary hypertension, suicide and drug dependency may decrease with early institution of appropriate treatment. Our population of untreated patients is a valuable historical control for studies of the effect of GD1 treatment on premature mortality.

Proportional Mortality due to Heart Failure and Ischemic Heart Diseases in the Brazilian Regions from 2004 to 2011.

Background:Heart failure (HF) and ischemic heart diseases (IHD) are important causes of death in Brazil.Objective:To assess proportional mortality (PM) due to HF and IHD as underlying causes stratified by sex and age groups in the Brazilian geoeconomic regions from 2004 to 2011.Methods:Data from death certificates were obtained in the DATASUS site under the following International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision: 1) from chapter IX: I20 to I24 for acute IHD, I25 for chronic IHD, and I50 for HF; and 2) from chapter XVIII, for ill-defined causes (IDC).Results:Proportional mortality due to HF increased with age in both sexes and all regions, the highest percentages being found among elderly women. Among men, the highest percentages were observed in the West-Central region up to the ninth decade, but, among the eldest individuals, the highest percentages were identified in the Southern region. Among women, the regions did not differ up to the age group of 70-79 years, although the West-Central region took the lead from 50 to 79 years; however, from the age of 80 years on, the Southern region showed the highest PM due to HF. Proportional mortality due to acute IHD in all Brazilian regions and in both sexes increased up to the age group of 60-69 years, from which it decreased. Among men, the Southeastern region had the highest percentages in the age group of 50-59 years, while women had lower PM due to acute IHD than men in all regions. In both sexes, PM due to chronic IHD increased with age in the Southern and Southeastern regions, which did not happen in the others, while the Southern region had the highest rate of all regions for all age groups.Conclusions:Regional differences were more prominent at more advanced ages, especially when deaths due to IDC were excluded.

Emergency Department Deaths in a Nigerian University Hospital: Deaths Too Many.

We reviewed the demographic pattern and distribution of deaths in the emergency department (ED) of the University College Hospital (UCH) in order to identify gaps in the standard of care, thereby providing evidence for intervention and enhanced research in acute care. After obtaining institutional ethics approval, we retrospectively studied all deaths in the ED of UCH from January 1 to December 31, 2011. Data were retrieved from the ED's electronic register. During the 12-month period, a total of 10 728 patients attended the emergency centre and 647 deaths occurred, giving a mortality rate of 6.0%. Male deaths constituted 62% of all deaths. The mean age at death was 44.5 ± 19.1 (range 5 months-92) years. The age group with the highest proportional mortality was 60-69 years (11.4%). Out of all deaths, 295 (45.6%) had alterations of consciousness. Medicine was the specialty with the most deaths (56%), followed by surgery (40%) and lastly, obstetrics and gynaecology (4%). Of the 190 patients that died from trauma, 153 (80.5%) had injury severity score ≥ 15. Most deaths (75.4%) occurred within 24 hours of arrival and the 12-hour night shift had 322 (50%) of the mortalities. Autopsies were carried out in 36 (5.6%) of the 647 deaths. Of the 36 autopsies, 24 (66.7%) were deaths due to medical causes. Mortalities within 24 hours of presentation at the ED of UCH remain high. This calls for an efficient pre-hospital care, well-organized emergency transport system, new guidelines, establishment of protocols and regular audit.

Inequalities in health: do occupational risks matter?

In the 1908–1917 Italian Statistics on occupational mortality, the highest proportional mortality for accidents and violence included: falls among bricklayers, crushing among railwaymen, drowning for fishermen, explosions and asphyxiation in miners, burns in firemen, violence from animals among coachmen, frostbite among soldiers, lightning strikes in shepherds, electrocution in blacksmiths, sunstroke and snakebites for farmers, cuts for butchers.1 At that time, occupational mortality statistics were considered meaningful for occupational physicians and safety engineers, and for their responsibility in prevention: each occupation was linked to one accidental cause of death and one plausible explanation. Today, occupational exposures still provide convincing explanations for health inequalities, given that their social distribution is often skewed, with most exposed individuals belonging to the working … Correspondence: Giuseppe Costa, e-mail: giuseppe.costa{at}epi.piemonte.it

Asbestos related mortality in Northern Ireland: 1985-1994.

The association between Belfast and research into the hazardous effects of asbestos exposure goes back many years. This paper aims to update previous papers and review the burden of asbestos related disease in Northern Ireland today. A study was carried out of all deaths in Northern Ireland between 1985 and 1994 inclusive, in which an asbestos related disease was mentioned anywhere on the death certificate. During this 10 year period, 527 asbestos related deaths were recorded; 88 per cent of these were in men. A total of 410 (77.8 per cent) were registered as the primary cause of death but only 405 (76.9 per cent) of cases were the subject of an autopsy. Standardized rates of pleural cancer in males have been increasing at 3.2 per cent per year though the trend was not significant. Lower rates in the last two years may herald the commencement of a decline. Deaths were clustered around the Belfast estuary, the site of Northern Ireland's shipbuilding industry. High proportional mortality ratios were demonstrated for occupations associated with the shipbuilding and construction industries. Evidence is presented that casts doubt on the attribution of peritoneal cancers in females to asbestos exposure. If lung cancers are included, there may be an average of 81 asbestos related deaths in Northern Ireland every year. Asbestos related diseases continue to extract a heavy burden of ill health in Northern Ireland today. There are some indications that the upward trend may be on the wane but confirmation of this will have to await further data. Measures to reduce exposure in the workplace to both asbestos and to tobacco smoke are the only means of reducing this burden.

Life table of Tomicus piniperda (L.) (Col., Scolytidae) and its analysis

AbstractA life table was developed for the pine shoot beetle, Tomicus piniperda (L.), on the basis of two consecutive years of field research in Kunming, China. Based on the analysis of the life table, intraspecific larval competition, pine resin, parasitoids, predators and the other unknown factors composed the main factors affecting insect mortality. Among them the intraspecific larval competition contributed to highly proportional mortality of the population, approximately 39.85%, and was supposed to be a major factor determining productivity of the insect. The second highest proportional mortality, around 20.59%, was attributed to pine resin. The percentage of unknown mortality was 13.37%, in which temperature and humidity as well as forest hygiene were involved. For different stages the larval mortality of 52.38% was the highest compared with others, and therefore played the greatest role in the population mortality process. The mortality rate for the adult, egg and pupa was 15.5%, 5.8% and 2.7%, respectively. The generation mortality rate of 78.24% indicated a increasing population in Kunming over the study years

Factors affecting morbidity and mortality on-farm and on-station in the Ethiopian highland sheep

Factors affecting morbidity and mortality of the Ethiopian highland sheep were studied both on-farm and on-station at Debre Berhan between 1989 and 1990. Primary causes of infectious origin resulted in high proportional morbidity (88.4% on-farm) and mortality (72.9% on-farm and 71.8% on-station) rates. Nutritional and managemental factors were also responsible for mortalities in lambs. The most frequent secondary causes of morbidity and/or mortality were ectoparasites and nasal myiasis. Health management interventions on-station were not high enough to produce performance improvements above the on-farm levels. However, the occurrence of gastrointestinal parasites significantly ( P <0.05) differed between the two management systems. The frequency of some of the major causes of morbidity and mortality such as pneumonia, fasciolasis and enteritis were significantly ( P <0.01) affected by season and age of an animal. In order to alleviate the major health constraints identified in this study, a proper health management intervention involving vaccination, strategic anthelmintic treatment and feeding management are suggested.

Societies in transition: mortality patterns in Pacific Island populations.

The 22 Pacific Island countries and territories are in a state of demographic and epidemiological transition. Mortality data for the period around 1980 were collected from various sources and are presented in this comparative study. Because death registration in many Pacific countries is deficient some data have been adjusted for underenumeration; and some mortality estimates have been calculated by indirect means, using data from censuses or surveys. Cause of death information is affected by diagnostic inaccuracy and often tabulated in broad categories only; in some Pacific countries cause of death data are only available on hospital deaths. The less developed Melanesian malarious countries and the less developed dispersed atoll nations manifest higher mortality, and higher proportional mortality from infectious disease compared with other states. The more developed US-associated states, two New Zealand-associated states, and New Caledonian Europeans all have reasonably low mortality, and relatively high proportional mortality from cardiovascular disease (CVD). Females have longer life expectancy at birth than males in all countries except Vanuatu and the Solomon Islands. The phosphate-rich island of Nauru presents an atypical picture with considerable adult male mortality from diseases associated with modernization.

Occupational mortality among women in England and Wales.

Occupational mortality in women who died in England and Wales from 1970 to 1972 was analysed. Many of the associations found were consistent with those that have been described for men, with high mortality ratios for cirrhosis in barmaids and publicans, for suicide in the medical and allied professions, and for respiratory disease in textile workers. Parity is a determinant of patterns of disease in working women, and the relative excess of cancer of the breast, ovary, and uterine body in professional and clerical workers probably reflected the high proportion of nulliparous women in these groups. Other associations may have reflected true occupational hazards; one observation requiring further attention was the high proportional mortality ratio for anaemia in textile and clothing workers. The description of the occupational mortality among women in England and Wales is hampered by the incomplete recording of information about women's occupations at registration of death. As women now constitute 40% of the workforce, often have their own specific occupations, and possibly also have their own diseases related to specific occupations it is time for the registrar's guidelines on the recording of women's occupation--last reviewed at the beginning of this century--to be revised.