Mortality In Persons Research Articles

Mortality following lower extremity amputation in minorities with diabetes mellitus

The aim of this study was to identify the age adjusted and level specific mortality rate in African-Americans, Hispanics and non-Hispanic whites (NHW) during the perioperative period following a lower extremity amputation. We identified amputation data obtained from the Office of Statewide Planning and Development in California for 1991 from ICD-9-CM codes 84.11–84.18 and diabetes mellitus from any 250 related code. Amputations were categorized as foot (84.11–84.12), leg (84.13–84.16) or thigh (84.17–84.18). Death was coded under discharge status. Age adjusted and level specific mortality rates per 1000 amputees were calculated for each race/ethnic group. The age adjusted mortality was highest for African-Americans (41.39) compared to Hispanics (19.69) and NHW's (34.98). Mortality was consistently more frequent for proximal amputations. We conclude that mortality rates for persons with diabetes hospitalized for an amputation varied by race, gender and level of amputation. Higher prevalence or severity of risk factors may explain the excess mortality observed in African-Americans.

The Association between Weight Loss and Increased Longevity: A Review of the Evidence

Six published observational epidemiologic studies have reported evidence of reduced mortality rates in persons who have lost weight. In two studies, the reported protective effects of weight loss on mortality could not be justified by the data. In two other studies, weight loss was associated with both increased and decreased longevity in different subgroups. Only one study provided information on whether the weight loss was voluntary, but this study found similar effects of weight loss regardless of volition. These studies provided only limited information on the magnitude of weight loss associated with changes in longevity and no information on the types of methods used to achieve weight loss. Because of difficulties in studying long-term health outcomes related to obesity treatment, randomized, controlled trials are unlikely to provide a practical study design for this issue. Properly designed observational studies will probably provide the most useful information on the effects of voluntary weight loss on longevity.

Excess Mortality in Harlem

In recent decades mortality rates have declined for both white and nonwhite Americans, but national averages obscure the extremely high mortality rates in many inner-city communities. Using data from the 1980 census and from death certificates in 1979, 1980, and 1981, we examined mortality rates in New York City's Central Harlem health district, where 96 percent of the inhabitants are black and 41 percent live below the poverty line. For Harlem, the age-adjusted rate of mortality from all causes was the highest in New York City, more than double that of U.S. whites and 50 percent higher than that of U.S. blacks. Almost all the excess mortality was among those less than 65 years old. With rates for the white population as the basis for comparison, the standardized (adjusted for age) mortality ratios (SMRs) for deaths under the age of 65 in Harlem were 2.91 for male residents and 2.70 for female residents. The highest ratios were for women 25 to 34 years old (SMR, 6.13) and men 35 to 44 years old (SMR, 5.98). The chief causes of this excess mortality were cardiovascular disease (23.5 percent of the excess deaths; SMR, 2.23), cirrhosis (17.9 percent; SMR, 10.5), homicide (14.9 percent; SMR, 14.2), and neoplasms (12.6 percent; SMR, 1.77). Survival analysis showed that black men in Harlem were less likely to reach the age of 65 than men in Bangladesh. Of the 353 health areas in New York, 54 (with a total population of 650,000) had mortality rates for persons under 65 years old that were at lest twice the expected rate. All but one of these areas of high mortality were predominantly black or Hispanic. We conclude that Harlem and probably other inner-city areas with largely black populations have extremely high mortality rates that justify special consideration analogous to that given to natural-disaster areas.

CURRENT PROBLEMS IN DEATHS OF PERSONS UNDER 20 YEARS OF AGE

In the past 10 years mortality rates for persons under 20 have declined less rapidly than in that of the previous decades. Nevertheless, the application of new and well recognized procedures in the prevention of deaths due to pneumonia, influenza, appendicitis, diarrhea and contagious diseases, and tuberculosis have led to striking reductions in deaths due to these causes. Because of these reductions, other causes of death have assumed new importance. Thus, in children over one year of age accidents are today the leading cause of death. Heart disease, tuberculosis and cancer claim a high percentage among those from 10 to 20, while contagious and respiratory diseases are still important in children under 10. In infants, the deaths occurring before, at or near birth are of chief importance, with those associated with premature birth assuming an importance that demands active and immediate attention. Despite the gains made, deaths associated with childbirth (i.e., fetal and neonatal deaths) stand second today in claiming lives of all ages in New York City. Only heart disease has a larger mortality. The time has come for physicians to take cognizance of these facts and to see that all mothers and babies get the kind of care which good pediatricians and obstetricians know can be given. In addition, there is a pressing need for an intensified research program to the end that deaths in infancy and those due to accidents and heart disease can more effectively be prevented.

Changes in Infant and Child Mortality Rates

THE increase in average length of life since 1900 equals the increase during the previous hundred years. This remarkable achievement has followed from the application of the principles of sanitation, a rise in the general level of living, and, in certain instances, discoveries in prophylactic and therapeutic medicine, all of which have resulted in a sharp decline in the mortality rates of infancy, childhood, and early adult life. In 1900 the expectation of life at birth was 49 years; in 1935 it was 61 years-an increase of 12 years or nearly 25 per cent. One-third of this increase, namely 4 years, is the result of the decline in infant mortality. In other words, even if there had been no change in the mortality rates among persons one year of age and over between 1900 and 1935, the decrease in infant mortality during that period was sufficient to increase the expectation of life at birth by 4 years. If similar calculations are made using the mortality rates in 1935 of children less than 6 years of age and the 1900 mortality rates for persons 6 years and older, the expectation of life at birth would be 7 years greater than that in 1900, a difference equal to nearly 60 per cent of the actual increase from 1900 to 1935. Before proceeding to a discussion of the changes in infant and child mortality rates since 1930, it is essential to point out that the basic statistical data contain certain errors which affect the trend in mortality rates.' With the admission of Texas to the death registration area in 1933, birth and mortality data for the entire United States became available for the first