Deaths Of Residents Research Articles

Potential years of life lost: what is the denominator?

To suggest an appropriate denominator for use with the statistic "potential years of life lost", in order to facilitate valid comparisons between health authorities. Analysis of OPCS population and mortality data for the period 1987-91. Data for Wales were analysed to provide comparisons between the nine district health authorities. There were 46,139 males and 30,258 females--that is, all deaths of Welsh residents, aged under 75 years, during the period 1987-91. The use of age sensitive denominators with the potential years of life lost statistic alters the rank position of Welsh district health authorities. It is suggested that potential years of life lost should be expressed as a rate per 100,000 potential years of life in public health common data sets, and elsewhere, to facilitate valid comparisons between health authorities.

Using mortality data to describe geographic variations inhealth status at sub-district level

Objective To describe sub-district variations in health status, using mortality data that021 are processed locally. Design A descriptive study of routinely collected death registration data, using 021 multicause coding. Setting The London Borough of Croydon, with a population of 319,200 divided into 021 27 electoral wards. Subjects Deaths of Croydon residents, registered with the Registrar of Births and021 Deaths, which occurred between January 1990 and December 1992 inclusive. Main outcome measures Variations in life expectancy, all-cause standardised mortality021 ratios (SMRs), and disease-specific mortality ratios between selected wards. Deaths in nursing homes were excluded to avoid bias. Results Data from 8,930 death registrations, of which 852 occurred in nursing homes, 021 were analysed by electoral ward. The range for all-cause SMRs, including nursing home deaths, was 153 (139–168) to 66 (58–75). When nursing home deaths were excluded, the SMRs for two wards that were significantly higher than the Croydon average fell into the average range. The range, excluding nursing home deaths, was 133 (113–153) to 71 (62–80). Life expectancy at birth varied from 79.8 years to 74.4 years, and life expectancy at age 65 by three years between wards at the two ends of the spectrum. The geographic distribution of ischaemic heart disease and diabetes showed significant differences. Conclusions We contend that death registration data are a useful tool for describing 021 sub-district variations in health status. Deaths of nursing home residents are a source of bias and should be excluded from the analysis. Multicause coding allows a more accurate description of geographic variations in specific diseases, such as ischaemic heart disease and diabetes.

History of Smoking from the Washington State Death Certificate

Beginning in 1988, a question added to the Washington State death certificate asked whether the decedent had smoked during the last 15 years of life. We analyzed death certificate data to evaluate the effectiveness of this question in identifying groups with high smoking rates and occupations with high rates of respiratory disease death among nonsmokers. We obtained statistical death certificate data from the Washington State Department of Health for resident deaths occurring between 1988 and 1991. Analyses included information on age, sex, race/ethnicity, marital status, underlying cause of death, high school graduation, smoking during the last 15 years of life, and occupation. Based on logistic regression analysis, we found that male sex, youth, divorced status, or death from lung cancer, chronic obstructive lung disease, or ischemic heart disease predicted a higher risk of smoking during the last 15 years of life. Hispanic ethnicity, single or widowed status, high school graduation, or death from breast cancer, diabetes, motor vehicle accidents, other accidents, or homicide predicted a lower risk of smoking. In farming occupations, there was an excess number of chronic obstructive lung disease deaths among nonsmokers. Findings from this study suggest that patterns of smoking during the last 15 years of life among decedents can provide useful public health surveillance information. The collection of risk factor information, such as smoking, should be recommended for the U.S. standard death certificate. Questions on smoking should be both simple and answerable by informants who may not have known the decedent for a lifetime. Additional studies on the accuracy of smoking history from the death certificate should be conducted.

Risk of male lung cancer attributed to coal combustion indoors in Shanghai : Tao X, Hong C-J, Yu S, Zhu H. School of Public Health, Shanghai Medical University, Shanghai 200032. Public Health Rev 1991;1992; 19:127–34

Lung cancer is now the leading cause of death among all male cancers in Shanghai. Besides the smoking habit, the indoor air pollution from coal combustion may also make some contribution. The purpose of our study is to explore the risk of lung cancer death in male residents who live in coal-using families. Stratified by two extreme levels of ambient sulphur dioxide (SO2) and inhalable particulate (IP) concentrations, 4 areas were chosen in the city proper: Area A (low SO2, low IP); Area B (high SO2, low IP); Area C (low SO2, high IP) and Area D (high SO2, high IP). Within each of these areas, two neighboring residential groups were chosen, one of which uses coal as fuel (group 1), with the other using coal gas or liquified petroleum gas as fuel (group 0). The percentages of smokers and the ambient environment of the two chosen groups within each area are comparable. Total person-years observed is 117,039 from 1 January 1978 to 31 December 1987 for all males in the 8 groups. The mortalities (per 100,000 person-years) of male lung cancer in the 8 groups are as follows: A0-22.33, A1-37.64; B0-27.14, B1-30.72; C0-41.77, C1-54.99; D0-49.97, D1-78.11. The result shows that male lung cancer mortality in the coal-using group is higher than that in the coal-gas-using group within each area. Mantel-Haenszel's Relative Risk (RRMH) of male lung cancer in coal-using groups is 1.44 stratified by ambient SO2 and IP and smoking levels.(ABSTRACT TRUNCATED AT 250 WORDS)

The Epidemiology of Suicide Among Farm Residents or Workers in Five North-Central States, 1980-1988

We studied suicide rates of those who resided in or worked within the five-state upper Midwest area (Wisconsin, Minnesota, North Dakota, South Dakota, and Montana) on farms and ranches from 1980 to 1988. All resident deaths constituted the universe of events (approximately 101,000 deaths per year). We retained only those deaths classified on the death certificate as “suicide” or “undetermined” and meeting specific residence and occupational criteria. Four rural populations were identified as at risk for suicide: farmers, farm women (homemakers), farm laborers, and children and adolescents. The rate of suicide among farmers ranged from 42 to 58 suicides per 100,000 farmers and ranchers. The rates of suicide for farm laborers and farm women were much lower, 3 to 6 and 2 to 9 events per 100,000, respectively. Children and adolescents residing on farms had the lowest suicide rates overall, at 1 to 4 events per 100,000; hobby farmers and farmers who held occupational positions off the farm had suicide rates of 3 to 30 events per 100,000. South Dakota and Montana reported proportionately more suicides of farmers and ranchers; Minnesota, North Dakota, and Wisconsin had fewer deaths. The typical farmer who committed suicide was 64 years of age; a farm woman, 48 years of age; farm laborer, 37 years of age; dual occupation farmer, 58 years of age; and an adolescent, 18 years of age. Among farmers, more suicides were detected during the Sunday through Tuesday interval; children, adolescents, and farm women were more likely to commit suicide on Friday or Saturday. April through June typically contained more events than other months, regardless of individual occupation. Where time of event was known, more farmers and farm women committed suicide between 9:00 AM and noon. Farm laborers and children and adolescents were most likely to commit suicide between midnight and 6:00 AM. Most victims chose firearms or poisoning by gas as the suicide method. Farm women, children, adolescents, and farm laborers were typically at low risk for suicide, but farmers and ranchers were one and one-half to two times more likely to commit suicide than other groups of men. We demonstrate a need for targeted research about underlying etiology and interventions focused on adult male residents of upper Midwest farms and ranches.

Age and Sex as Risk Factors for Burn Deaths Among Children

<i>Sir</i>.—Male sex is a well-described risk factor for death and disability due to injuries.^1,2Focusing on the preponderance of the overall risk for boys may, however, mask risks that are associated with age and/or developmental stage for injuries in general, or particular injuries. For example, Harel's analysis³of children's injuries reported in the 1981 National Health Interview Survey⁴revealed that 10-year-old girls reported more injuries than boys, leading him to suggest a maturational effect associated with the earlier onset of puberty in girls than in boys. Analysis of children's deaths due to burns in Michigan further highlights the importance of careful age stratification in elucidating the factors associated with burns. Death certificates were reviewed for the years 1980 through 1988 and all fire deaths (E-codes 890-924) in residents through the age of 20 years were analyzed. Conflagrations in private dwellings (E890) accounted for 592 (95%) of 626 of

Priority among air pollution factors for preventing chronic obstructive pulmonary disease in Shanghai

The problems that city environmental protection planners face are how important the air pollution exposures are in relation to chronic obstructive pulmonary disease (COPD) in local residents and which factor should be controlled most urgently. The purpose of our study is to determine the control priority among ambient sulphur dioxide (SO2), inhalable particulates (IP) and indoor use of coal to prevent COPD in residents of the city. Ambient air pollution is mainly from SO2 and IP(< 10nm). Indoor air pollution is mainly from the use of coal for heating and/or cooking. Distribution of ambient SO2, and IP concentrations were described using a quartic trend surface simulation. When stratified by two extreme levels of ambient SO2 and IP and types of fuel used indoors, eight local area populations in four communities with different combinations of exposure levels were selected. In each community a local area population mostly using coal and one mostly burning gas was chosen. Chronic obstructive pulmonary diseases (COPD, ICD 490–493) including chronic bronchitis, asthma and emphysema, are a major cause of death in residents of Shanghai. The relationship between the three air pollution factors and their health effects were analyzed at the level of mortality (1978–1987, 232 459 person-years), prevalence of symptoms (12 037 persons) of COPD, lung function and non-specific immunologic function (514 women). The results show that indoor use of coal has stronger associations with health than estimated exposure to ambient SO2 or IP.

Trends in "avoidable" mortality in Sweden, 1974-1985.

The aim was to analyse trends in "avoidable" mortality in Sweden, and to contribute to the methodology of avoidable mortality as an index of the quality of care. All deaths of Swedish citizens and other residents in Sweden during the period 1974-1985 were analysed as to causes of death between ages 0 and 64 years. Total mortality delined during the 12 year period studied. Avoidable causes of death were grouped into preventable and treatable causes according to Rutstein's classification. In men, treatable diseases declined more during the 12 year period studied than did total mortality. When lung cancer was excluded, preventable diseases declined for both sexes. Certain avoidable causes of death decreased compared to total mortality, while some others showed an increase. The death rate increased for some avoidable causes of death such as pneumonia other than viral. In women death rates increased for chronic bronchitis and emphysema as well as for malignant neoplasms of trachea, bronchus, and lung, while for boys aged 1-14 years bronchitis NOS and asthma showed an increasing death rate. The study indicates that the avoidable mortality method is sensitive enough to describe important changes in the mortality pattern. The explicit definition of treatable and preventable causes of death constitutes a methodological development in epidemiological analysis of this type. Further studies on the quality of care should combine this method with other methods examining the structure and process of health care.

Motorcycle helmet-use laws and head injury prevention

Objective. —To rebut criticism of a previous study of motorcycle helmet—use laws through reanalysis with improved measures of exposure, stratification for regional differences in crash risk, and addressing of total motorcycle-related mortality and the grounds for targeting motorcyclists for helmet-use laws. Design. —Death certificate—based correlational study of motorcycle-related deaths and motorcycle helmet—use laws. Population Studied. —United States resident deaths from 1979 through 1986. Results. —Regardless of the denominator used (resident population, motorcycle registrations, or motorcycle crashes), states with full helmet-use laws had consistently lower head injury—associated death rates than states without such laws, even when stratified by region. Total motorcycle-related mortality, however, was similar between law groups. On a registration or crash basis, motorcyclists who died in crashes had a fivefold to sixfold higher risk of head injury than those who died using any other type of motor vehicle. Conclusion. —Full helmet-use laws were consistently associated with lower rates of head injury—associated death. While disagreement remains on the acceptability of the legislative approach, the scientific basis for motorcycle helmet— use laws as a head injury prevention tool appears sound. (JAMA. 1992;267:1649-1651)

Impact of HIV infection on mortality in young men in a London health authority.

To determine the number of deaths attributable to HIV infection among men aged 15-64 in a geographically defined population in the United Kingdom. Retrospective review of death certificates and linkage with local and national HIV and AIDS surveillance data. Riverside District Health Authority, London. Numbers of deaths attributed to HIV infection in male residents of Riverside aged 15-64 and 15-44 over a six month period. Proportion of attributed deaths were (i) identified from death certificates by the Office of Population Censuses and Surveys as being due to HIV infection and (ii) reported as cases of AIDS or HIV related deaths to the Public Health Laboratory Service Communicable Disease Surveillance Centre. 34 of 213 (16%) deaths in men aged 15-64 and 27 of 69 (39%) deaths in men aged 15-44 were attributed to HIV infection. Six of 33 (18%) attributed deaths were identified by the Office of Population Censuses and Surveys and 32/34 (94%) were reported to the Communicable Disease Surveillance Centre. HIV infection was the leading cause of death in male residents of Riverside aged 15-44 and the third commonest cause of death in those aged 15-64. Most individuals dying of known HIV infection were reported to the Communicable Disease Surveillance Centre but identification of the true cause of death from the process of death certification was poor. Measures to improve the certification of HIV and AIDS or the use of AIDS surveillance information correctly to code the cause of death needs to be considered to ensure that the true impact of HIV infection is reflected in routine mortality statistics.

Motorcycle helmet-use laws and head injury prevention.

To rebut criticism of a previous study of motorcycle helmet-use laws through reanalysis with improved measures of exposure, stratification for regional differences in crash risk, and addressing of total motorcycle-related mortality and the grounds for targeting motorcyclists for helmet-use laws. Death certificate-based correlational study of motorcycle-related deaths and motorcycle helmet-use laws. United States resident deaths from 1979 through 1986. Regardless of the denominator used (resident population, motorcycle registrations, or motorcycle crashes), states with full helmet-use laws had consistently lower head injury-associated death rates than states without such laws, even when stratified by region. Total motorcycle-related mortality, however, was similar between law groups. On a registration or crash basis, motorcyclists who died in crashes had a fivefold to sixfold higher risk of head injury than those who died using any other type of motor vehicle. Full helmet-use laws were consistently associated with lower rates of head injury-associated death. While disagreement remains on the acceptability of the legislative approach, the scientific basis for motorcycle helmet-use laws as a head injury prevention tool appears sound.

Motorcycle Helmet—Use Laws and Head Injury Prevention

<h3>Objective.</h3> —To rebut criticism of a previous study of motorcycle helmet—use laws through reanalysis with improved measures of exposure, stratification for regional differences in crash risk, and addressing of total motorcycle-related mortality and the grounds for targeting motorcyclists for helmet-use laws. <h3>Design.</h3> —Death certificate—based correlational study of motorcycle-related deaths and motorcycle helmet—use laws. <h3>Population Studied.</h3> —United States resident deaths from 1979 through 1986. <h3>Results.</h3> —Regardless of the denominator used (resident population, motorcycle registrations, or motorcycle crashes), states with full helmet-use laws had consistently lower head injury—associated death rates than states without such laws, even when stratified by region. Total motorcycle-related mortality, however, was similar between law groups. On a registration or crash basis, motorcyclists who died in crashes had a fivefold to sixfold higher risk of head injury than those who died using any other type of motor vehicle. <h3>Conclusion.</h3> —Full helmet-use laws were consistently associated with lower rates of head injury—associated death. While disagreement remains on the acceptability of the legislative approach, the scientific basis for motorcycle helmet— use laws as a head injury prevention tool appears sound. (<i>JAMA</i>. 1992;267:1649-1651)

Particulate Air Pollution and Daily Mortality in Steubenville, Ohio

Particulate air pollution has been associated with daily mortality in London, England, both in the smog episodes of the 1950s and at the lower pollution levels of the late 1960s and early 1970s. Replicating these findings in the United States has been difficult, because particulates are usually sampled every sixth day. Replication, particularly with a gravimetric measure of particulates, is important in assessing the causality of the relation. Daily measurements of total suspended particulates by high volume gravimetric sampler are available for the Steubenville, Ohio, metropolitan area. These were matched to daily mortality counts from the detail mortality tapes of the National Center for Health Statistics. Deaths of residents which occurred outside the Steubenville Standard Metropolitan Statistical Area were excluded. Because of the much smaller population, the average total number of deaths per day in the Steubenville Standard Metropolitan Statistical Area over the 11-year period 1974-1984 was about 1% of the deaths in a typical London winter. Despite this reduced statistical power, total suspended particulate count was significantly associated with increased daily mortality in Poisson regression analyses controlling for season and temperature. An increase in particulates of 100 micrograms/m3 was associated with a 4% increase in mortality on the succeeding day. Associations with sulfur dioxide were not significant after adjustment for particulates. The relation appeared to continue at levels well below the current National Ambient Air Quality Standard.

Recent status of the medical examiner system in Japan: Demographic variation of medicolegal deaths in hyogo prefecture and uncertainty in medicolegal investigations conducted by medical practitioners

The medical examiner system has been steadily abolished in Japan. Instead, medicolegal investigations are entrusted by the police to medical practitioners, who are not permitted to perform autopsies. The necessity for the medical examiner system was assessed through inquest records in Hyogo, one of the three prefectures which still have medical examiner systems. Standardized mortality ratios (SMRs) for accidents and suicides were negatively associated with population density, being high in rural areas with a large proportion of elderly citizens, while the SMR for natural deaths was high in urbanized areas and associated with the proportion of inquests to total resident deaths. The high proportion of inquests, however, did not always mean that inquest records were of good quality. Significant differences in the quality of medicolegal investigations seemed to exist between medical examiners and medical practitioners. That is, in order to certify the cause-of-death, medical examiners performed autopsies in about half of their cases, while only 2% of medical practitioner cases were subjected to autopsies. Medical practitioners, who certified the cause-of-death as “heart failure” without advising an autopsy, were regularly entrusted with inquests. It is likely that the causes-of-death for medicolegal cases may be questionable since more than 85% of all medicolegal deaths were investigated by medical practitioners, which may cause inaccuracy in at least 3–7% of mortality statistics. It is necessary to educate medical practitioners concerning the importance of mortality statistics and ICD and on the validity of autopsies, in order to obtain accurate mortality statistics from medicolegal cases.

Guidelines on oral anticoagulation: second edition.

OBJECTIVE--To suggest an appropriate denominator for use with the statistic "potential years of life lost", in order to facilitate valid comparisons between health authorities. DESIGN--Analysis of OPCS population and mortality data for the period 1987-91. SETTING--Data for Wales were analysed to provide comparisons between the nine district health authorities. SUBJECTS--There were 46,139 males and 30,258 females--that is, all deaths of Welsh residents, aged under 75 years, during the period 1987-91. MAIN RESULTS--The use of age sensitive denominators with the potential years of life lost statistic alters the rank position of Welsh district health authorities. CONCLUSION--It is suggested that potential years of life lost should be expressed as a rate per 100,000 potential years of life in public health common data sets, and elsewhere, to facilitate valid comparisons between health authorities.

Classification and Analysis of Fetal Deaths in Massachusetts

Fetal deaths, in contrast to infant deaths, have been subject to epidemiologic analysis infrequently. We characterized 574 Massachusetts resident fetal deaths from 1982 and assessed the accuracy of cause-of-death information available from vital records compared with that from corresponding fetal autopsies. The fetal death rate exceeded the neonatal mortality rate. Fetal mortality was higher among black, unmarried, and older mothers. Fetuses of multiplegestation pregnancies had an unusually high risk of fetal death. Autopsy reports were obtained for 61% of fetal deaths. The underlying cause of death from the fetal death record differed from that on the autopsy report in 55% of cases. Systematic collection of population-based autopsy data is a useful approach for improving the quality and accuracy of mortality statistics on fetal deaths. Many stillbirths remain unexplained, however, and research is needed to identify pathological markers that might reduce the heterogeneity within the fetal deaths currently ascribed to unknown causes. (JAMA. 1989;261:1757-1762)

Classification and Analysis of Fetal Deaths in Massachusetts

Fetal deaths, in contrast to infant deaths, have been subject to epidemiologic analysis infrequently. We characterized 574 Massachusetts resident fetal deaths from 1982 and assessed the accuracy of cause-of-death information available from vital records compared with that from corresponding fetal autopsies. The fetal death rate exceeded the neonatal mortality rate. Fetal mortality was higher among black, unmarried, and older mothers. Fetuses of multiple-gestation pregnancies had an unusually high risk of fetal death. Autopsy reports were obtained for 61% of fetal deaths. The underlying cause of death from the fetal death record differed from that on the autopsy report in 55% of cases. Systematic collection of population-based autopsy data is a useful approach for improving the quality and accuracy of mortality statistics on fetal deaths. Many stillbirths remain unexplained, however, and research is needed to identify pathological markers that might reduce the heterogeneity within the fetal deaths currently ascribed to unknown causes.

The recent trend of mortality in Great Britain

This note continues a regular series on mortality rates in Great Britain; the previous note in the series appeared in J.I.A.114, 135 and dealt with mortality in 1984 and 1985.Following the 1981 Census, estimates of the resident population have been produced on a new definition. This includes residents temporarily outside the country but excludes foreign visitors. It includes members of both H.M. and foreign forces stationed in the United Kingdom but excludes members of H.M. forces who are stationed abroad. The figures for deaths are not precisely consistent with the new definition of the population, since they do not necessarily include all deaths of residents temporarily absent from the U.K.

Factors affecting place of death in Washington State, 1968-1981.

A study was carried out to determine factors affecting place of death (home, hospital, nursing home or "other places") among all 426,115 resident deaths in Washington State during 1968-1981, using death certificate information. Sixteen percent of deaths occurred at home, 74% in institutions (51% in hospitals, 23% in nursing homes) and 9% at "other places." Age, marital status and cause of death all strongly affect place of death. Further, the effect of each factor was strongly dependent on the others. Sex had no effect on place of death after controlling for other factors. Elderly people died relatively more frequently in nursing homes, infants and middle aged people in hospitals and young adults in "other places." The frequency of deaths at home was quite constant by age. Hospitals were the most common place of death following both vascular disease (including heart attack) and neoplasms, and nursing homes were the most common place of death following cerebrovascular disease (including "stroke"). Race, socioeconomic status and urban or rural residents affected the place of death only slightly or not at all. The place of death pattern changed little during the time period 1968-1981, except for a slight increase in frequency of home deaths and a corresponding decrease in the frequency of deaths in other places. Among cancer patients, the likelihood of death at home was positively associated with longer periods of survival after diagnosis. Cancer patients of hospitals serving targeted populations, such as veterans, were relatively more likely to die in a hospital and less likely to die in a nursing home compared to other cancer patients, suggesting that the "targeted" hospitals are sometimes serving a nursing home function. There was a marked difference in the terminal cancer caseload by hospital. The number of cancer deaths per cancer diagnosis varied widely across hospitals (0.1 to 1.6) and was unrelated to size of the hospital or level of services offered. Intervention aimed at affecting place of death, such as increasing the number of deaths at home, will need to take account of the joint effect of age, marital status and disease.

Journey into understanding mentally retarded people's experiences around death.

Chronicles a seven-year journey working with mentally retarded adults who traditionally had avoided mentioning resident deaths. Notes how procedural changes, a deepening sense of community, reduction in staff fears, and attitude changes toward death contributed to a new attempt at dealing with this inevitable process. Stresses the observations that the reactions and responses of the mentally retarded resembles those of normal people. Bases observations on clinical data gathered from a variety of settings both within and beyond the institutional context.