White Mortality Research Articles

PROSTATE CANCER IN AMERICAN INDIANS, NEW MEXICO, 1969 to 1994

Purpose Prostate cancer is the most frequently diagnosed cancer as well as the leading cause of cancer death among American Indian men. Materials and Methods To describe further the occurrence of prostate cancer among American Indian men, we examined population based incidence, treatment, survival and mortality data for American Indians in New Mexico during the 25-year period 1969 to 1994. Results Although American Indian men have a lower risk of prostate cancer than non-Hispanic white men, the incidence and mortality rates are rising for American Indians, and mortality rates are now equal to those for nonHispanic white men. During the 25-year period age adjusted incidence rates for American Indians increased from 42.2/100,000 (95% confidence interval 27.1 to 57.3) to 64.6/100,000 (95% confidence interval 46.2 to 83.0). The burden of prostate cancer among American Indian men compared with nonHispanic white men was reflected in disproportionately high mortality rates in relation to incidence rates. The mortality rates were high because American Indian cases were more advanced at diagnosis, 23.3% of prostate cancers were diagnosed after distant spread had occurred compared with 11.6% for nonHispanic white men and the 5-year relative survival rate was poorer (57.1% compared with 77.6% for nonHispanic white men). Conclusions Effective and culturally sensitive cancer control efforts for prostate cancer in American Indian communities are urgently needed.

Metropolitan governance, residential segregation, and mortality among African Americans.

This study tested the hypothesis that the degree to which local government is metropolitanized is associated with mortality rates for African Americans and with residential segregation, which has itself previously been shown to be positively associated with mortality among African Americans. One hundred fourteen US standard metropolitan statistical areas were examined. The primary dependent variable was the age-adjusted, race- and sex-specific all-cause mortality rate, averaged for 1990 and 1991. The 2 primary independent variables were residential segregation, as measured by the index of dissimilarity, and metropolitanization of government, as measured by the central city's elasticity score. Mortality rates for male and female African Americans were lower in metropolitan statistical areas with more metropolitanized local governments and lower levels of residential segregation. Mortality for male and female Whites was not associated in either direction with residential segregation. White male mortality showed no association with level of metropolitanization, but lower White female mortality rates were associated with less metropolitanization. This study suggests the need for further research into whether policy changes in areas not traditionally thought of as "health policy" areas can improve the health of urban minorities.

Trends in pulmonary embolism mortality in the US elderly population: 1984 through 1991.

This study determined race-, age- and sex-specific trends in 30-day pulmonary embolism mortality rates. Medicare beneficiaries with a primary or secondary discharge diagnosis of pulmonary embolism from 1984 to 1991 (n = 391,991) were examined. For a primary diagnosis of pulmonary embolism, mortality rates declined by 15.2% and 16.0%, respectively, for White male patients 65 to 74 years old and 75 years or older. There was a corresponding decline in mortality rates for White women. For a secondary diagnosis of pulmonary embolism, mortality rates declined by 14.7% and 9.8%, respectively, for White male patients 65 to 74 years old and 75 years or older. The White mortality rate declines revealed in this study did not translate, in all cases, to Black patient groups.

Latin American Registry of dialysis and renal transplantation: 1993 annual dialysis data report.

The Latin American Registry of Dialysis and Transplantation was created in October 1991 and comprises the National Societies of Nephrology from 21 countries with a total population of 468.56 million inhabitants. This report includes data from 21,181 patients from Argentina, Brazil, Chile, El Salvador, Panama, Paraguay, Peru, Puerto Rico, Uruguay, and Venezuela who were receiving chronic dialysis treatment during 1993. Data was collected by individual patient questionnaires except from Chile and Brazil where the data was obtained from a local centre questionnaire. The prevalence rate averaged 131.1 per million population. The mean age of the 8972 incident patients was 50.5 years, with 58.2% males. The more frequent causes of renal failure were glomerulopathies (22.6%), vascular nephropathy (20.9%) and diabetes (16.9%). Haemodialysis was the most used treatment (88.3%). Gross mortality was 21.1% and the more frequent causes of death were cardiac complications and infections. The analysis of mortality risk factors using a logistic regression model showed that diabetics patients older than 65 years had the highest probability of death (43.0%) and patients with glomerulonephritis, younger than 65 years had the lowest (8.0%). The adjusted mortality rate was 241 deaths/1000 patient-years at risk when the USRDS 1987-1989 white mortality rate by age groups and primary diseases was used as standard. In spite of the economic difficulties, very important efforts have been made to treat ESRD patients and gross mortality statistics in some countries are similar to those reported by other regional registries.

Temporal Trends in Diabetes Mortality among American Indians and Hispanics in New Mexico: Birth Cohort and Period Effects

Rates of diabetes mortality are disproportionately high among ethnic minorities in the United States. To describe ethnic trends and cohort effects in diabetes mortality in New Mexico, the authors examined the trends in mortality rates for non-Hispanic whites. Hispanics, and American Indians in the state during the period 1958-1994. Age-specific rates were examined graphically to qualitatively describe the contribution of calendar period and birth cohort effects to changes in the rates. The authors also fit age-period-cohort models to these data. Age-adjusted diabetes mortality rates for American Indians and Hispanics surpassed rates for non-Hispanic whites for all but the earliest two time periods. In the 1993-1994 period, the age-adjusted mortality rate for American Indians was 3.8 times higher for men and 5.6 times higher for women than for their non-Hispanic white counterparts. Rates for American Indian men and women increased sharply over the 37-year period, by 565% and 1,105%, respectively. Mortality rates increased among Hispanics over the period of study but less rapidly than did rates among American Indians. Graphical analyses of age-specific rates were consistent with birth cohort effects among both American Indians and Hispanics and also with a period effect among American Indians. Results from age-period-cohort models indicate a birth cohort effect starting with the 1912 cohort in American Indians and the 1902 cohort in Hispanics. A period effect was present during the 1960s in American Indians. American Indians have experienced an epidemic rise in diabetes mortality in New Mexico; if current trends continue, diabetes may become the leading cause of mortality among American Indians in the state.

Prostate cancer incidence and mortality rates among white and black men.

This paper presents prostate cancer incidence and mortality rates in the United States by factors associated with the disease at diagnosis and explores racial differences in these rates. The analysis is based on population-based cancer data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Incidence rates increased sharply from 1973 to 1992 (more so among whites), with the increase attributed to screening and preferential finding of low-risk, slow-growing tumors (that is, length bias). Mortality rates increased slightly (more so among blacks). The 1988-1992 white and black prostate cancer mortality rates comprise cases diagnosed as early as 1973. These rates remained fairly constant for each stage category at diagnosis, except for black men diagnosed with localized or unstaged disease, in whom the rates increased. Of the white prostate cancer cases, 33% are diagnosed with localized disease, 16% are diagnosed with regional disease, and 38% are diagnosed with distant disease. The corresponding percentage for black patients are 31, 12, and 45%. Prostate cancer mortality rates for blacks diagnosed with localized, regional, distant, and unstaged disease are 1.9, 1.5, 2.4, and 2.0 times those of whites. The time from diagnosis to death depends on the stage and age at diagnosis, with the time somewhat longer for whites than blacks. This longer time period is due, in part, to better staging and length bias. The effect of therapy on prostate cancer mortality rates is unclear.

Adjustment for the confounding effect of cigarette smoking in an historical cohort mortality study of workers in a fiberglass manufacturing facility.

In 1986 a statistically significant lung cancer SMR based on U.S. white male national mortality rates was reported for male fibrous glass workers for follow-up through 1982 of a cohort of U.S. man-made mineral fiber workers. The Newark, Ohio, plant of Owens-Corning, which comprised 38% of the fibrous glass workers in that cohort, also exhibited a statistically significant lung cancer standardized mortality ratio based on U.S. white male mortality rates. A case-control study of the Newark workers demonstrated that a history of cigarette smoking and not exposure to respirable glass is the most important factor in lung cancer risk for workers at the Newark plant. We provide an estimate of the extent of confounding by cigarette smoking for the Newark plant nationally based lung cancer standardized mortality ratio with data not previously available and which suggests that adjusting for the confounding effect of cigarette smoking could reduce the lung cancer standardized mortality ratio to a non-statistically significant level.

Cancer mortality near Oak Ridge, Tennessee.

Oak Ridge, Tennessee, is the site of one of the two oldest nuclear facilities in the United States. Although precise records have not been maintained, low levels of radioactive products have been released into the environment since the facility began operation in World War II. Changes in age-adjusted cancer mortality rates for whites between the periods 1950-1952 and 1987-1989 were analyzed to assess whether these radioactive releases have had any adverse effects on the population living near Oak Ridge. Results indicate that the increases in the local area (under 100 miles from Oak Ridge) exceeded regional increases and far exceeded national increases. Within the region, increases were greatest in rural areas, in Anderson County (where Oak Ridge is located), in mountainous counties, and in the region downwind of Oak Ridge. Each of these findings suggest that low levels of radiation, ingested gradually by local residents, were a factor in the increases in local cancer death rates. Results indicate that more studies of this type are called for and that cessation of all future radioactive emissions from nuclear facilities should be considered.

Contrasting trends of prostate cancer incidence and mortality in New Mexico's Hispanics, non-Hispanic whites, American Indians, and blacks.

Prostate cancer has increased in epidemic proportions during the 1980s. Although marked differences in ethnic and racial temporal trends for prostate cancer have been observed both in the United States and internationally, the trends in Hispanics and American Indians have not been described extensively. To characterize the occurrence of prostate cancer among non-Hispanic whites, Hispanics, American Indians, and blacks in New Mexico, the authors examined cancer incidence data collected by the New Mexico Tumor Registry for the period 1969-1991 and mortality data collected by the New Mexico Bureau of Vital Statistics for the period 1958-1991. From 1969 to 1991, age-adjusted incidence rates increased from 74.4 to 139.1 per 100,000 (87%) among non-Hispanic whites and from 54.0 to 94.7 (75%) among Hispanics. American Indians had the lowest incidence rates of all groups. Over the same period, incidence rates for local-stage cancers increased by 93% and 81% among non-Hispanic whites and Hispanics, respectively, but were stable for American Indians and blacks, whereas rates for regional-stage cancers increased sharply. Incidence rates of distant-stage disease decreased among non-Hispanic whites from 1969 through 1991. In contrast, incidence rates of distant-stage disease among Hispanics increased through 1982. From 1983 to date, age-adjusted mortality rates of prostate cancer decreased among all groups except Hispanics. The patterns of incidence and mortality are consistent with a stage migration. The recent decrease in age-adjusted prostate cancer mortality rates for non-Hispanic whites is consistent with that expected following the decrease in distant-stage disease incidence. Differential access to medical care and prostate cancer screening may account for these trends.

Decline in stroke mortality in North Carolina. Description, predictions, and a possible underlying cause.

Data from the National Center for Health Statistics were used to describe the decline in age-adjusted stroke mortality rates from 1962 to 1987 for North Carolina and for six regions of the state. For the state as a whole, stroke mortality decreased from 0.0050 to 0.0018 (64% decrease) for white males, 0.0039 to 0.0016 (59% decrease) for white females, 0.0072 to 0.0030 (58% decrease) for black males, and 0.0064 to 0.0025 (61% decrease) for black females. Under the hypothesis that the rate of decline in stroke mortality will slow and approach a "floor," a four-parameter logistic model was fit to the data. This model suggests that most of the decline in North Carolina stroke rates had occurred by 1987 and that the rates are now approaching the floor. For example, the estimated 1987 white male stroke mortality rate was 0.00190 and the floor 0.00176, suggesting only a 7% decline in the future. Similar percentage differences between 1987 levels and the floor were estimated for the three other race-gender groups. This analysis also suggested that while the absolute disparity by sex and race decreased between 1962 and 1987, the ratio of black to white mortality rates and the ratio of male to female mortality rates remained relatively constant. Estimates of 1-year case-fatality rates from two surveys of hospitalized stroke patients in a high-mortality five-county region of North Carolina decreased from 51% in 1970 to 38% in 1980. This decrease in stroke fatality rate is sufficient to account for 64% of the decrease in mortality estimated for this region over the same period.

Disparate black and white neonatal mortality rates among infants of normal birth weight in Chicago: A population study

To determine the extent to which disparities in risk status and access to tertiary care affect racial differences in neonatal mortality rates among normal birth weight infants, we conducted a vital records study concerning normal weight black (N = 44,399) and white (N = 48,146) singleton births in Chicago. Neonatal mortality rate among black infants was twice that among white infants (3.3 deaths per 1000 births vs 1.5 deaths per 1000 births); the unadjusted black relative risk equaled 2.2 (95% confidence interval, 1.7 to 2.9). Because prematurity, growth retardation, congenital anomalies, low Apgar scores at 5 minutes, teenage mothers, and poverty were more common among black infants, multivariate analyses were performed. The disparity in mortality rate was greatest between black and white infants with none of these risk factors; relative risk for black infants equaled 3.6 (95% confidence interval, 2.0 to 6.7). Approximately 30% of all deaths of black infants were attributable to birth in nontertiary hospitals. When the confounding variables, including hospital of birth, were put into a multivariate logistic-regression model, the adjusted relative risk estimate (odds ratio) for black infants equaled 1.5 (95% confidence interval, 1.1 to 2.0). Traditional risk factors fail to explain the racial disparity in neonatal mortality rate among normal birth weight infants. Level of perinatal care available, or some factor closely related to this level, is an important determinant of neonatal chance of survival for normal birth weight urban black infants.

Community empowerment as a strategy for health promotion for black and other minority populations

THE HEALTH status of blacks, other minorities, and the poor remains unconscionably low when contrasted with that of white Americans. This disparity is not new but is an historical trend that can be seen across all categories of the leading causes of death and disease. In August 1985, the<i>Report of the Secretary's Task Force on Black and Minority Health</i>²noted that minorities experienced approximately 60 000 "excess deaths" annually. Margaret Heckler, who was then the secretary of the US Department of Health and Human Services, emphasized that the disparity is "an affront both to our ideals and to the ongoing genius of American Medicine." The six major contributors to the disparity between black and white death rates are cancer, cardiovascular disease and stroke, diabetes, chemical dependency, homicide and accidents, and infant mortality. Since the 1985 report, blacks and Latinos, in particular, also have evidenced a disproportionately high rate

Community Empowerment as a Strategy for Health Promotion for Black and Other Minority Populations

THE HEALTH status of blacks, other minorities, and the poor remains unconscionably low when contrasted with that of white Americans. This disparity is not new but is historical trend that can be seen across all categories of the leading causes of death and disease. In August 1985, the Report of the Secretary's Task Force on Black and Minority Health2 noted that minorities experienced approximately 60 000 excess deaths annually. Margaret Heckler, who was then the secretary of the US Department of Health and Human Services, emphasized that the disparity is an affront both to our ideals and to the ongoing genius of American Medicine. The six major contributors to the disparity between black and white death rates are cancer, cardiovascular disease and stroke, diabetes, chemical dependency, homicide and accidents, and infant mortality. Since the 1985 report, blacks and Latinos, in particular, also have evidenced a disproportionately high rate

Patterns of mortality from hereditary ataxias in the United States, 1971 and 1973-1978.

Mortality rates for deaths 'due to' and 'with' hereditary ataxias are presented for the first time. Age-adjusted mortality rates were higher for whites than for nonwhites of either sex, and for men in both racial groups. Age-specific mortality rates for whites showed a peak for 'hereditary spinal ataxia' in the 20-29 age group. For the other types of ataxias they were low until age 40 and increased thereafter. Heart diseases were a frequent cause of death in people dying 'with' hereditary ataxias. The median survival (from birth) for hereditary spinal ataxia in whites was 35 years.

Cancer mortality, incidence, and patient survival among American women.

Descriptive patterns of cancer among American women are presented utilizing national mortality statistics and data from several National Cancer Institute incidence surveys, the Connecticut Tumor Registry, the End Results Group Program, and the current Surveillance, Epidemiology, and End Results Program. From 1950 to 1980, deaths from cancer among women have become more numerous, but the overall age-adjusted mortality rates have not increased. Among white females, incidence and mortality rates for cancers of the stomach and cervix uteri have declined substantially during this time period, whereas lung cancer rates have increased dramatically. Improvements in survival rates are noteworthy for several types of cancer, including the leukemias, Hodgkin's disease, and the non-Hodgkin's lymphomas. There are substantial differences between the races and sexes in incidence rates by cancer site, and some differences in survival rates are also apparent. In the future, the numbers of women diagnosed with cancer will continue to increase as the larger cohorts of younger women age and as other causes of death continue to decline, with consequent increases in longevity. However, with the exception of lung cancer, large increases in rates for the common forms of cancer among women are not apparent.

The Black/White Mortality Crossover: Investigation in a Community-Based Study

The black/white mortality crossover at about age 75, a result of lower white mortality rates at younger ages and lower black rates at the oldest ages, has been observed in U.S. vital statistics since 1900. Though a persistant observation in such data, its validity has been challenged by questions about census enumeration and age reporting on death certificates. Analyses of 20 years experience of all-cause mortality in the community-based Evans County Study using a Weibull model of age specific mortality rates showed a statistically significant black/white mortality crossover for both men (at age 73) and women (at age 85). The finding of a crossover in this longitudinally followed population is significant because the age reporting for both survivors and age at death for nonsurvivors were obtained in the study protocol and did not rely on age reporting either in census data or on the death certificate. Differences in the age and sex patterns of mortality between two populations living in the same geographic region are relevant to questions about the etiology of the major age-related chronic diseases as well as to topics of current interest in health care policy.

Selective survival, aging and society

The concept of selective survival to advanced ages is introduced and discussed in relation to the black/white mortality “crossover” in the United States. Crossover refers to the phenomenon wherein black mortality rates become lower than white mortality rates after approximately age 75. This reversal of mortality rates between advantaged and disadvantaged populations also occurs between Native Americans and whites. Such crossovers have significant implications for explaining differences in patterns of aging across populations. We argue that higher rates of selective survival in disadvantaged, high mortality populations result in a greater proportion of healthy, very old people who may require less nursing-home care, who have low suicide rates, and who enjoy higher status in the family and community. Differences between populations with regard to selective survival imply that chronological age alone is not always a useful measure of aging and old age. Finally, we identify further lines of inquiry about selective survival and its effects on aging.

Coronary heart disease mortality rates in United States blacks, 1968–1978: Interstate variation

It has been shown that, among white males and females, recent declines in mortality from coronary heart disease (CHD) have not been uniform by region or state. Some clustering has emerged. To describe trends for the black population by states, we compared CHD death rates for persons aged 35 to 74 years for the years 1968–1972 in combination with rates for 1978. Reported mortality from 34 states with reasonably large black populations was described. Not all of the recent geographic shifts for white CHD mortality rates were apparent for blacks. Yet there were similarities, chief of which were the slower decline, and therefore worsening, of relative CHD mortality in certain states in Appalachia.

Altitude and mortality from chronic obstructive lung disease in New Mexico.

This study tested the hypothesis that altitude increases mortality from chronic obstructive lung disease (COLD) in New Mexico. A death was attributed to COLD if it resulted from chronic bronchitis, emphysema, or chronic obstructive lung disease, according to the Eighth Revision International Classification of Diseases, Adapted for Use in the United States. New Mexico's average annual ethnic and sex-specific mortality rates from COLD were calculated using death certificate data for the period 1969 to 1977. Deaths were assigned to altitude groups according to the county of residence at the time of death. Mortality rates for whites exceeded nationwide rates at all altitudes. However, mortality rates showed no increase with altitude. In fact, mortality from COLD decreased significantly with altitude for non-Hispanic white (Anglo) males (P less than .02). Immigration of Anglos to the lower altitudes of New Mexico probably explains these results.

Neonatal deaths in Alabama, 1970–1980: An analysis of birth weight- and race-specific neonatal mortality rates

Alabama birth and death certificate tapes for the years 1970–1980 were linked and analyzed to determine race-specific birth weight and neonatal mortality rate distributions. Changes which occurred over time were evaluated. Our analyses demonstrated that there were no substantial changes in birth weight distributions which could account for the nearly 50% reduction in the neonatal mortality rate in Alabama during this period. Birth weight changes did result in a 12% decrease in the white neonatal mortality rate but resulted in no decrease in the nonwhite neonatal mortality rate. All other improvement in the neonatal mortality rate is attributed to better survival within birth weight groups. Eighty percent of the reduction in the neonatal mortality rate during this period of time occurred in low-birth weight infants with most of the reduction found in infants weighing between 1,000 and 2,000 gm. Improvements in the quality of medical care and better access to medical care through regionalization of perinatal services, especially for low-birth weight infants, are suggested as the major reasons for this improvement.