Vital Statistics Registry Research Articles

Trends of two HPV-associated cancers in Massachusetts: cervical and oropharyngeal cancer.

To understand trends in the incidence and mortality of two human papillomavirus (HPV)-associated cancers, cervical and oropharyngeal cancer, in Massachusetts. From 2004 to 2014, the Massachusetts Cancer Registry recorded 3,996 incident cases of oropharyngeal cancer and 2,193 incident cases of cervical cancer. Mortality data were obtained from the Massachusetts Registry of Vital Records and Statistics from 2008 to 2014. Rates were age-standardized to the 2000 U.S. population and trends were assessed using joinpoint regression. While the incidence rate of cervical cancer (5.46 per 100,000) decreased by 2.41% annually (p = 0.004), the incidence rate of oropharyngeal cancer among males (7.85 per 100,000) increased by 2.82% annually (p = 0.0002). Mortality rates for both cancers decreased from 2008 to 2014 but were not statistically significant (cervical - 3.73% annually, p = 0.29; oropharyngeal - 1.94% annually, p = 0.44). The rising incidence rate of oropharyngeal cancer in men and the decreasing, but relatively high, incidence rate of cervical cancer in women highlight the need for further screening and prevention by HPV vaccination in Massachusetts.

Assessing the health effects associated with occupational radiation exposure in Korean radiation workers: protocol for a prospective cohort study

IntroductionThe cancer risk of radiation exposure in the moderate-to-high dose range has been well established. However, the risk remains unclear at low-dose ranges with protracted low-dose rate exposure, which is...

Cancer Mortality among Persons with Human Immunodeficiency Virus Infection in New York City, 2001–2015

BackgroundWith the prolonged life-span of persons with HIV (PWH) due to anti-retroviral therapy, their cancer burden has increased. Cancer continues to be a leading cause of death among PWH. Studying cancer mortality can inform and guide the development of cancer screening and prevention strategies for PWH.MethodsWe analyzed data for all persons > = 13 years who were diagnosed with HIV from 2001 to 2015 and reported to the New York City (NYC) HIV surveillance registry (HSR). Using the HSR and the underlying cause of death obtained from the NYC vital statistics registry and the National Death Index, we examined age-specific and age-standardized mortality rates from cancer and compared time trends of deaths due to HIV-related8 cancer to deaths from non-HIV-related cancers.ResultsThere were 34,190 deaths reported among 154,688 PWH of whom nearly half (n = 16,804; 49.1%) died due to HIV (excluding HIV-related cancers). Among all deaths, HIV was the leading cause, followed by cancer (both HIV and non-HIV-related) (n = 5,271; 15.4%) and cardiovascular disease (n = 3,724, 10.9%). The top three causes of non-HIV-related cancer deaths were lung cancer (n = 1,040; 19.7%), liver cancer (n = 552; 10.5%), and colorectal cancer (n = 315; 5.6%). Although the mortality rate among PWH decreased over time (24.4 to 13.9 per 1,000 person-years from 2001 to 2015), the proportion of deaths attributable to all cancers increased (10.6% in 2001 to 19.9% in 2015, p < .0001). This increase was driven by non-HIV-related cancers (6.1% of all deaths in 2001 to 15.8% in 2015, p < .0001). The mean age increased from 2001 to 2015 among the dead (46 to 56 years) and among the censored (35 to 49 years). After controlling for demographic factors, transmission risk, and last CD4 count, the hazard ratio for cancer deaths was higher among people who inject drugs (HR = 1.5; 95% CI = 1.4–1.7) and those with last CD4 count < 200 (HR = 9.3; 95% CI = 8.3–10.5).ConclusionAlthough mortality rates are decreasing in PWH, deaths due to non-HIV-related cancers are increasing. The upward trend in the mean age suggests that aging may be contributing to this increase. Routine screening for liver and colon cancers along with smoking cessation may reduce lung, liver and colon cancer deaths.Disclosures All authors: No reported disclosures.

Temporal trends in prevalence, incidence, and mortality for rheumatoid arthritis in Quebec, Canada: a population-based study.

Health administrative data are a potentially efficient resource to conduct population-based research and surveillance, including trends in incidence and mortality over time. Our objective was to explore time trends in incidence and mortality for rheumatoid arthritis (RA), as well as estimating period prevalence. Our RA case definition was based on one or more hospitalizations with a RA diagnosis code, or three or more RA physician-billing codes, over 2years, with at least one RA billing code by a rheumatologist, orthopedic surgeon, or internist. To identify incident cases, a "run-in" period of 5years (1996-2000) was used to exclude prevalent cases. Crude age and sex-specific incidence rates were calculated (using data from 2001 to 2015), and sex-specific incidence rates were also standardized to the 2001 age structure of the Quebec population. We linked the RA cohort (both prevalent and incident patients) to the vital statistics registry, and standardized mortality rate ratios were generated. Negative binomial regression was used to test for linear change in standardized incidence rates and mortality ratios. The linear trends in standardized incidence rates did not show significant change over the study period. Mortality in RA was significantly higher than the general population and this remained true throughout the study period. Our prevalence estimate suggested 0.8% of the Quebec population may be affected by RA. RA incidence appeared relatively stable, and mortality was substantially higher in RA versus the general population and remained so over the study period. This suggests the need to optimize long-term RA outcomes.

Social Data Linkage Environment

ABSTRACTObjectivesThe Social Data Linkage Environment (SDLE) at Statistics Canada promotes the innovative use of existing administrative and survey data to address important research questions and inform socio-economic policy through record linkage. It expands the potential of data integration across multiple domains, such as health, justice, education and income, through the creation of linked analytical data files without the need to collect additional data from Canadians.ApproachAt the core of the SDLE is a Derived Record Depository (DRD), essentially a national dynamic relational data base containing only basic personal identifiers. The DRD is created by linking selected Statistics Canada source index files for the purpose of producing a list of unique individuals. These files are brought into the environment, processed and linked only once to the DRD. Each individual in the DRD is assigned an SDLE identifier. Some of the source index files used to build the DRD include tax records, vital statistics registration records (births and deaths), and immigrant data. Updates to these data files are linked to the DRD on an ongoing basis. Only basic personal identifiers are stored in the DRD. Examples of personal identifiers stored in the DRD include surnames, given names, date of birth, sex, insurance numbers, parents' names, marital status, addresses (including postal codes), telephone numbers, immigration date, emigration date and date of death. The paired SDLE identifiers and source index file record IDs resulting from the record linkage are stored in a Key Registry. To reduce the risk of privacy intrusiveness and to minimize the risk of disclosure, source files are separated into source index files and source data files. Employees performing the record linkages in SDLE have access to only the basic personal identifiers needed for linkage. Employees who build the analytical files for research have access only to the data stripped of personal identifiers.ResultsThe SDLE is a highly secure environment that facilitates the creation of linked population data files for social analysis. It is not a large integrated data base.ConclusionThe SDLE program facilitates pan-Canadian social and economic statistical research. It is a record linkage environment that: increases the relevance of existing surveys without collecting new data; substantially increases the use of administrative data; generates new information without additional data collection; maintains the highest privacy and data security standards; and promotes a standardized approach to record linkage processes and methods.

The HOMR-Now! Model Accurately Predicts 1-Year Death Risk for Hospitalized Patients on Admission

BackgroundThe Hospital-patient One-year Mortality Risk (HOMR) score is an externally validated index using health administrative data to accurately predict the risk of death within 1 year of admission to the hospital. This study derived and internally validated a HOMR modification using data that are available when the patient is admitted to the hospital. MethodsFrom all adult hospitalizations at our tertiary-care teaching hospital between 2004 and 2015, we randomly selected one per patient. We added to all HOMR variables that could be determined from our hospital's data systems on admission other factors that might prognosticate. Vital statistics registries determined vital status at 1 year from admission. ResultsOf 2,06,396 patients, 32,112 (15.6%) died within 1 year of admission to the hospital. The HOMR-now! model included patient (sex, comorbidities, living and cancer clinic status, and 1-year death risk from population-based life tables) and hospitalization factors (admission year, urgency, service and laboratory-based acuity score). The model explained that more than half of the total variability (Regenkirke's R2 value of 0.53) was very discriminative (C-statistic 0.92), and accurately predicted death risk (calibration slope 0.98). ConclusionOne-year risk of death can be accurately predicted using routinely collected data available when patients are admitted to the hospital.

Abstract MP053: Dietary Trimethylamine Intake and Cardiovascular Mortality Among Urban Chinese Adults

Background: Trimethylamine (TMA)-containing nutrients (choline, betaine and carnitine) are dietary precursors of a gut microbial-derived metabolite, trimethylamine-N-oxide (TMAO). Studies have suggested that elevated TMAO contributes to atherosclerosis and increased mortality in cardiovascular disease (CVD) patients. However, epidemiological evidence remains limited regarding whether high TMA intake may increase CVD mortality. No population-based study has evaluated animal vs. plant food-derived TMA in relation to CVD. Objective: We examined dietary TMA, from animal-source foods (e.g., eggs, red meat and fish) and/or from plant foods (e.g., soy foods, legumes and vegetables), in association with total CVD mortality and mortality from coronary heart disease (CHD) and ischemic and hemorrhagic stroke. We also evaluated whether the associations were modified by food sources of TMA and by major CVD risk factors. Methods: Included were 73216 women and 61190 men from two prospective cohort studies of Chinese adults. They were 40-74 years of age, free of cancer and with a plausible energy intake at baseline. Usual diets were assessed using food-frequency questionnaires. Dietary TMA intake was calculated using the USDA database. Vital status and cause of death were obtained via linkages with the vital statistics registry. Cox model was used to estimate HRs and 95% CIs. Results: During a mean follow-up of 12.5 years, we documented 3740 CVD deaths. After adjusting for potential confounders, including sociodemographics, lifestyle, disease history, and other dietary risk factors, high TMA intake was associated with increased mortality from total CVD and CHD–HR (95% CI) in the highest vs. lowest quintile of TMA intake was 1.33 (1.15, 1.53) for CVD mortality and 1.60 (1.25, 2.06) for CHD mortality; both p-trend=0.0001. A positive trend of association was also observed for ischemic stroke mortality (HR [95% CI] =1.31 [0.99, 1.74]), but not for hemorrhagic stroke mortality. With mutual adjustment, animal- and plant-sourced TMA showed similar magnitude of positive associations with CVD and CHD mortality–HR (95% CI) in the highest vs. lowest quintile was 1.13 (0.99, 1.29) for animal-TMA and 1.19 (1.07, 1.33) for plant-TMA related to CVD mortality, and 1.33 (1.05, 1.67) for animal-TMA and 1.29 (1.07, 1.57) for plant-TMA related to CHD mortality. The TMA-CVD mortality association seemed more evident in men than in women and among adults with higher socioeconomic status, higher waist-hip ratios, higher refined carbohydrate intakes, or diabetes, although no interactions were statistically significant. Conclusion: Our study suggests that high TMA intake, from either animal or plant food sources, is associated with increased mortality from atherosclerotic CVD among urban Chinese adults. Potential mechanism involving gut microbial production of TMAO needs to be investigated in future studies.

Prognostic impact of SPECT-MPI after renal transplantation

BackgroundWhile renal transplantation is increasingly performed for end-stage renal disease, there is a paucity of data on cardiac screening and prognostication post-transplant. We determined the prognostic value of SPECT-MPI in a cohort who underwent renal transplantation. MethodsAmong 4933 renal transplant recipients identified from the Canadian Organ Replacement Register, we examined outcomes of patients who underwent SPECT-MPI in Ontario, Canada. We determined morbidity and mortality using hospitalization and vital statistics registries, according to SPECT-MPI findings. ResultsWe studied 282 renal transplant recipients (median age 46 years [25th, 75th percentile 37, 58]) with detailed SPECT-MPI results available, followed for a median of 5.7 (3.3, 7.7) years. Among those undergoing SPECT-MPI (66% pharmacologic stress), 41% had an abnormal summed stress score (SSS > 0) and 31% demonstrated abnormal summed difference score (SDS > 0). Rates of cardiovascular death were 0.4 per 100 person-years among those with normal stress perfusion (SSS = 0) and 0.4 per 100 person-years with SDS = 0. After adjusting for age, sex, prior myocardial infarction (MI), and cardiac risk factors, an SSS ≥ 4 conferred increased risk of cardiovascular death or cardiovascular hospitalization with adjusted hazard ratios of 2.52 (95% CI 1.41, 4.52, P = .002) for SSS 4-6 and 2.61 (95% CI 1.52, 4.49, P < .001) for SSS ≥ 7. SDS was a significant predictor of cardiovascular death or hospitalization, with adjusted hazard ratios of 2.96 (95% CI 1.72, 5.09, P < .001) for SDS 4-6 and 3.26 (95% CI 1.64, 6.50, P < .001) for SDS ≥ 7. ConclusionAmong renal transplant recipients, SPECT-MPI predicted risk of cardiovascular death and cardiovascular hospitalization events.

Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial's Baseline Study Results.

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)–Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013–2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women’s and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013–2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013–14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.

A Malaria Ecology Index Predicted Spatial and Temporal Variation of Malaria Burden and Efficacy of Antimalarial Interventions Based on African Serological Data

Reducing the global health burden of malaria is complicated by weak reporting systems for infectious diseases and a paucity of vital statistics registration. This limits our ability to predict changes in malaria health burden intensity, target antimalarial resources where needed, and identify malaria impacts in retrospective data. We refined and deployed a temporally and spatially varying Malaria Ecology Index (MEI) incorporating climatological and ecological data to estimate malaria transmission strength and validate it against cross-sectional serology data from 39,875 children from seven sub-Saharan African countries. The MEI is strongly associated with malaria burden; a 1 standard deviation higher MEI is associated with a 50-117% increase in malaria risk and a 3-5 g/dL lower level of Hg. Results show that the relationship between malaria ecology and disease burden is attenuated with sufficient coverage of insecticide treated nets (ITNs) or indoor residual spraying (IRS). Having both ITNs and IRS reduce the added risk from adverse malaria ecology conditions by half. Readily available climate and ecology data can be used to estimate the spatial and temporal variation in malaria disease burden, providing a feasible alternative to direct surveillance. This will help target resources for malaria programs in the absence of national coverage of active case detection systems, and facilitate malaria research using retrospective health data.

A Global Cancer Surveillance Framework Within Noncommunicable Disease Surveillance: Making the Case for Population-Based Cancer Registries.

The growing burden of cancer among several major noncommunicable diseases (NCDs) requires national implementation of tailored public health surveillance. For many emerging economies where emphasis has traditionally been placed on the surveillance of communicable diseases, it is critical to understand the specificities of NCD surveillance and, within it, of cancer surveillance. We propose a general framework for cancer surveillance that permits monitoring the core components of cancer control. We examine communalities in approaches to the surveillance of other major NCDs as well as communicable diseases, illustrating key differences in the function, coverage, and reporting in each system. Although risk factor surveys and vital statistics registration are the foundation of surveillance of NCDs, population-based cancer registries play a unique fundamental role specific to cancer surveillance, providing indicators of population-based incidence and survival. With an onus now placed on governments to collect these data as part of the monitoring of NCD targets, the integration of cancer registries into existing and future NCD surveillance strategies is a vital requirement in all countries worldwide. The Global Initiative for Cancer Registry Development, endorsed by the World Health Organization, provides a means to enhance cancer surveillance capacity in low- and middle-income countries.

Cancer mortality in Yukon 1999–2013: elevated mortality rates and a unique cancer profile

ABSTRACTBackground: Although cancer is the leading cause of death in Canada, cancer in the North has been incompletely described.Objective: To determine cancer mortality rates in the Yukon Territory, compare them with Canadian rates, and identify major causes of cancer mortality.Design: The Yukon Vital Statistics Registry provided all cancer deaths for Yukon residents between 1999-2013. Age-standardised mortality rates (ASMRs) were calculated using direct standardisation and compared with Canadian rates. Standardised mortality ratios (SMRs) were calculated using indirect standardisation relative to age-specific rates from Canada, British Columbia (BC), and three sub-provincial BC administrative health regions : Interior Health (IH), Northern Health (NH) and Vancouver Coastal Health (VCH). Trends in smoothed ASMRs were examined with graphical methods.Results: Yukon’s all-cancer ASMRs were elevated compared with national and provincial rates for the entire period. Disparities were greatest compared with the urban VCH: prostate (SMRVCH=246.3, 95% CI 140.9–351.6), female lung (SMRVCH=221.2, 95% CI 154.3–288.1), female breast (SMRVCH=169.0 95% CI, 101.4–236.7), and total colorectal (SMRVCH=149.3, 95% CI 101.8–196.8) cancers were significantly elevated. Total stomach cancer mortality was significantly elevated compared with all comparators.Conclusions: Yukon cancer mortality rates were elevated compared with national, provincial, urban, and southern-rural jurisdictions. More research is required to elucidate these differences.

The population-level impact of public-sector antiretroviral therapy rollout on adult mortality in rural Malawi.

BACKGROUNDRecent evidence from health and demographic surveillance sites (HDSS) has shown that increasing access to antiretroviral therapy (ART) is reducing mortality rates in sub-Saharan Africa (SSA). However, due to limited vital statistics registration in many of the countries most affected by the HIV/AIDS epidemic, there is limited evidence of the magnitude of ART’s effect outside of specific HDSS sites. This paper leverages longitudinal household/family roster data from the Malawi Longitudinal Survey of Families and Health (MLSFH) to estimate the effect of ART availability in public clinics on population-level mortality based on a geographically dispersed sample of individuals in rural Malawi.OBJECTIVEWe seek to provide evidence on the population-level magnitude of the ART-associated mortality decline in rural Malawi and confirm that this population is experiencing similar declines in mortality as those seen in HDSS sites.METHODSWe analyze longitudinal household/family-roster data from four waves of the MLSFH to estimate mortality change after the introduction of ART to study areas. We analyze life expectancy using the Kaplan–Meier estimator and examine how the mortality hazard changed over time by individual characteristics with Cox regression.RESULTSIn the four years following rollout of ART, life expectancy at age 15 increased by 3.1 years (95% CI 1.1, 5.1), and median length of life rose by over ten years.CONTRIBUTIONOur observations show that the increased availability of ART resulted in a substantial and sustained reversal of mortality trends in SSA and assuage concerns that the post-ART reversals in mortality are not occurring at the same magnitude outside of specific HDSSs.

Fatal Alcohol Poisonings and Traffic Accidents in Russia

IntroductionRoad traffic injuries are the eight leading cause of death globally, and the leading cause of death for children and young adults [1,2]. According to prognosis, the worldwide road traffic injuries rank among the causes of death will climb to the fifth place by 2030, resulting in an estimated 2.4 million fatalities each year [2]. It is estimated that in the European Union 1.3 million road traffic accidents occur each year, resulting in 1.7 million injuries and over 40 000 deaths annually [3]. The direct and indirect costs of these accidents sums up to 160 billion euro, equal to 2% of the gross national product of the EU [2].Alcohol has been identified as one of the most significant risk factors for road traffic crashes in many developed and developing countries of the world [4]. At the individual level, there is dose-response relationship between alcohol consumption and fatal road traffic accidents, with risk of death increas-. ing non-linearly with increasing alcohol consumption [3]. Zador estimated that each 0.02 increase in a driver's BAC nearly doubled the risk of fatal crash [5]. It has been also estimated that the likelihood of being a fatally injured driver was at least 9 times greater at BACs of 0.05 to 0.09% than at zero BAC [4].Several studies report the positive association between alcohol consumption and traffic fatalities at the aggregate level. Skog evaluated the effects of changes in aggregate alcohol consumption on fatal motor vehicle traffic accidents in 14 western European countries after 1950 [6]. For male traffic accidents, significant relationships were uncovered in central and southern Europe, but not in northern Europe. Among females the effect was significant only in central Europe [6]. A more recent time series analysis based on Belarusian data for the period from 1970 to 1999 reported a close link between vodka sales per capita and road traffic fatality rates [7].Russia has one of the world's highest road traffic fatality rates due to drunk driving, poor road conditions, an outdated vehicle fleet [8,9]. Each year, approximately 30 000 Russians die in road accidents - about the same as in the European Union [2]. Road safety has attracted attention at the top levels of Russian politics, receiving mention in Putin's 2006 Annual Address to the Federal Assembly and serves as the centerpiece of a national speech by Medvedev in August 2009 [9].There is common believe that high level of alcohol consumption in conjunction with binge drinking pattern is a major determinant of high violent mortality rates in Russia [7,10-12]. Over the past 10 years, almost 40 000 Russians have died in road accidents caused by drunk drivers [9]. A large retrospective case-control study in three Russian industrial cities found dose-response association between alcohol consumption and mortality from road accidents: drinking of three or more bottles of vodka per week was strongly associated with deaths from road accidents both among men (RR= 4.20; CI: 3.31-5.34) and women (RR= 4.48; CI: 3.385.96) [13]. Although drunk driving officially accounts for 7,2% of all road traffic crashes at the national level, its proportion increases to one-fifth in some federal regions [9]. Furthermore, the most recent individual-level estimates suggest that 46.1% of all deaths from road accidents (47.7% and 41.0% of deaths among men and women respectively) were attributable to alcohol consumption [14].In line with this evidence we assume that a combination of higher level of alcohol consumption per capita and binge drinking of vodka results in a close association between alcohol and mortality from road accidents in Russia. To test this hypothesis trends in mortality from road accidents and fatal alcohol poisoning rates from 1970 to 2013 in Russia were analyzed employing time-series analysis.Material and methodsDataThe data on sex-specific road traffic fatality and fatal alcohol poisoning rates per 1 000 000 of the population were taken from the Russian vital statistics registration system. …

Prediagnosis body mass index and waist-hip circumference ratio in association with colorectal cancer survival.

The association of obesity on survival among patients with colorectal cancer (CRC) has not been well characterized. We investigated the association of prediagnostic body mass index (BMI)/waist-hip ratio (WHR) and total/cause-specific mortality in CRC patients. Our study included 1,452 patients who participated in two large cohort studies and were diagnosed with CRC during follow-up period. Participants were measured for anthropometrics and interviewed to collect relevant information at baseline, prior to any cancer diagnosis. Data on site-specific cancer incidence and cause-specific mortality were obtained via in-person surveys and annual record linkage with cancer and vital statistics registries. Cox proportional hazard models were used to evaluate the associations of BMI and WHR with survival. A total of 547 participants died during the follow-up period, including 499 who died of CRC. Relative to normal BMI (18.5 to <25.0 kg/m2 ), obesity (BMI ≥ 30 kg/m2 ) was associated with increased mortality resulting from all causes [hazard ratio (HR) = 1.5, 95% confidence interval (CI): 1.1-2.1] and CRC (HR = 1.5, 95% CI: 1.1-2.1). Elevated risk of death was also found among underweight patients (BMI < 18.5 kg/m2 ), although not all risk estimates were statistically significant. Overweight BMI (25.0 to <30.0 kg/m2 ) was not associated with risk of death among CRC patients, nor was WHR. In conclusion, prediagnostic BMI was associated with survival among CRC patients following a U-shape pattern; obesity was associated with high mortality after CRC diagnosis. These findings provide support for maintaining healthy weight to improve the survival of CRC patients.

The Nigerian Civil Registration and Vital Statistics System: Contexts, Institutions, Operation

Civil Registration and Vital Statistics (CRVS) Systems are playing increasing roles in national and global data infrastructure, facilitating the achievement of key developmental goals. The performance of CRVS systems in many developing countries including Nigeria is sub optimal and information on their structure and operations scanty. This paper characterizes the statutory, institutional, and operational elements and social contexts of the Nigerian CRVS System. It includes a context analysis of the system and a review of improvement strategies and interventions. The paper shows that the Nigerian CRVS System is built on viable statutory and institutional platforms—the constitutional enshrinement of: universal, compulsory and continuous civil registration and, a central registration institution—the National Population Commission (NPC). NPC has registration hierarchy and infrastructure deployed at every level of political administration and mechanisms for efficient coordination of registration and production of vital statistics on live-births, deaths and stillbirths amongst other vital events. The major weaknesses of the system include inadequate financing and deployment of registration facilities, conflicting statutes and institutional arrangements for the registration of key events like death and stillbirths. Other weaknesses include intra-organizational conflicts in resource allocation and weak ICT infrastructure within the NPC. These are compounded by overarching contextual issues namely registration unfriendly sociocultural norms, weak national data infrastructure, systemic corruption, poverty and undeveloped civic culture. Domestic initiatives and interventions to improve the system have focused on birth registration, while multilateral interventions have only made a modest impact on the system. Thus, holistic in-country improvement initiatives supported with robust interventions are imperative to overcome weaknesses in the Nigerian CRVS system. However fundamental improvements in CRVS systems in developing countries like Nigeria may likely only follow sustainable solutions to overarching contextual issues especially poor infrastructure, weak institutions, poverty and systemic corruption.

Abstract 3437: Cancer and all-cause mortality among white and blue collar workers in middle-aged and elderly chinese women in a prospective cohort study

Abstract Inequalities in health and mortality between white and blue collar workers have been well documented in western countries, particularly among men. Studies regarding occupation related mortality disparities in Asian populations including Chinese are limited. We included 74,941 40-70 years old Chinese women from the Shanghai Women's Health Study (SWHS) in an analysis of occupation and mortality. An in-person interview was conducted at enrolment to obtain lifetime job history as well as lifestyle and other potential risk factors for each participant. Each job title was coded in three digits according to the Chinese National Standard Occupation and Industry Codes Manual, and the categories of white and blue collar work were defined based on this coding. The information on mortality was provided by annual linkage to the Shanghai Vital Statistics Registry. Cox regression models were applied to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cause-specific mortality. In comparison with lifetime white collar workers, lifetime blue collar workers had 18% excess in all cause-mortality (HR = 1.18, 95% CI = 1.04-1.34) and 12% excess in cancer deaths (HR = 1.12, 95% CI = 0.93-1.35) after adjustment for lifestyle and other potential risk factors. A significantly increased risk was also associated with mortality from diabetes (HR = 1.89, 95% CI = 1.06-3.37). There were no statistically significant differences in mortality between white and blue collar workers for other causes of death including circulatory, respiratory, gastrointestinal or other diseases among this population. Our study provides suggestive evidence that blue collar workers may have a higher risk of total cancer mortality compared to white collar workers among women in Shanghai. Citation Format: Bu-Tian Ji. Cancer and all-cause mortality among white and blue collar workers in middle-aged and elderly chinese women in a prospective cohort study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3437.

Disparities in Paediatric Injury Mortality between Aboriginal and Non-Aboriginal Populations in British Columbia, 2001-2009.

Injury is the leading cause of death among children and youth in Canada. Significant disparities in injury mortality rates have been observed between Aboriginal and non-Aboriginal populations, but little is known about the age-, sex-, and mechanism-specific patterns of injury causing death. This study examines paediatric mortality in British Columbia from 2001 to 2009 using comprehensive vital statistics registry data. We highlight important disparities in Aboriginal and non-Aboriginal mortality rates, and use the Preventable Years of Life Lost (PrYLL) metric to identify differences between age groups and the mechanisms of injury causing death. A significantly greater age-adjusted mortality rate was observed among Aboriginal children (OR = 2.08, 95% CI: 1.41, 3.06), and significantly higher rates of death due to assault, suffocation, and fire were detected for specific age groups. Mapped results highlight regional disparities in PrYLL across the province, which may reflect higher Aboriginal populations in rural and remote areas. Crucially, these disparities underscore the need for community-specific injury prevention policies, particularly in regions with high PrYLL.

Religiosity as a protective factor against suicidal behaviour.

Data suggest that adherence to religious beliefs is associated with lower rates of suicide. A number of mediating factors have been hypothesized to explain this association, including enhanced social support, less substance abuse, and lower rates of psychopathology. We utilized data from a two-phase population-based, epidemiological study of mental disorders among young Jewish Israel born in a 10-year birth-cohort conducted in the 1980s. This study included data on religiosity and suicidal behaviour. Twenty-five years thereafter, mortality data were obtained from a national vital statistics registry. Rates of suicidal ideation were similar among secular, partially observant, and religious subjects (9.4%, 6.7%, and 6.2%, respectively; adjusted OR for linear trend: 0.80, 95% CI: 0.58-1.09). Rates of suicide attempts were significantly lower among religious subjects (2.4%, 2.5%, and 0.4% for secular, partially observant, and religious, respectively; adjusted OR for linear trend: 0.62, 95% CI: 0.43-0.88). Of the 4914 subjects, eight died by suicide: Seven of them were secular and one was partially observant (χ(2) = 2.52, P = 0.09). There were no differences in social functioning or rates of psychopathology among the study groups. Religiosity has a protective effect against suicide attempts, which is independent of social functioning, psychopathology, and substance use.

The Long-Term Effects of Cancer on Employment and Earnings

The study examines long-term effects of cancer on the work status and annual earnings of cancer survivors who had a strong attachment to the labor market prior to their cancer diagnosis. We use linkage data combining Canadian 1991 Census microdata with administrative records from the Canadian Cancer Registry, the Vital Statistics Registry and longitudinal personal income tax records. We estimate changes in the magnitude of cancer effects during the first 3years following the year of the diagnosis using a large sample of cancer survivors diagnosed at ages 25 to 61. The comparison group consists of similar workers never diagnosed with cancer. The empirical strategy combines coarsened exact matching and regression models to deal with observed and unobserved differences between the cancer and comparison groups. The results show moderate negative cancer effects on work status and annual earnings. Over the 3-year period following the year of the diagnosis, the probability of working is 5 percentage points lower for cancer survivors than for the comparison group, and their earnings are 10% lower. Our findings also suggest that the effects of cancer on labor market outcomes differ for high and low survival rate cancer categories. Copyright © 2016 John Wiley & Sons, Ltd.