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As a preliminary step in the investigation of high pancreas-cancer mortality among White males in a cluster of Louisiana parishes, we examined 876 pairs of certificates of death which occurred in this area during 1960–75. The pancreas-cancer death records were matched to controls by age, race, sex, year of death, and parish of residence. The odds ratios were increased about two-fold for workers in the oil refining and paper manufacturing industries, and slight elevations were seen among residents near refineries and food processing plants. Despite the limited residential and occupational information available on death certificates, this study suggests leads to environmental factor that can be further investigated by a case-control interview study in Louisiana. [ABSTRACT FROM AUTHOR]

Objectives. To identify relationships between US states' COVID-19 in-person activity limitation and economic support policies and drug overdose deaths among working-age adults in 2020. Methods. We used county-level data on 140 435 drug overdoses among adults aged 25 to 64 years during January 2019 to December 2020 from the National Vital Statistics System and data on states' COVID-19 policies from the Oxford COVID-19 Government Response Tracker to assess US trends in overdose deaths by sex in 3138 counties. Results. Policies limiting in-person activities significantly increased, whereas economic support policies significantly decreased, overdose rates. A 1-unit increase in policies restricting activities predicted a 15% average monthly increase in overdose rates for men (incident rate ratio [IRR] = 1.15; 95% confidence interval [CI] = 1.09, 1.20) and a 14% increase for women (IRR = 1.14; 95% CI = 1.09, 1.20). A 1-unit increase in economic support policies predicted a 3% average monthly decrease for men (IRR = 0.97; 95% CI = 0.95, 1.00) and a 4% decrease for women (IRR = 0.96; 95% CI = 0.93, 0.99). All states' policy combinations are predicted to have increased drug-poisoning mortality. Conclusions. The economic supports that states enacted were insufficient to fully mitigate the adverse relationship between activity limitations and drug overdoses. (Am J Public Health. 2024;114(7):714–722. https://doi.org/10.2105/AJPH.2024.307621) [ABSTRACT FROM AUTHOR]

This article discusses the limitations of traditional national cause of death statistics. These limitations derive from an attempt to conceptualize a multidimensional phenomenon and reduce down to a unidimensional framework. The article outlines the characteristics of a new multidimensional approach which involves the codification and tabulation of all causes (multiple causes) listed on death certificates. Preliminary data are presented which illustrate that multiple cause of death data do indeed represent a major new dimension to cause of death statistics. These data indicate that most major causes of death are contributory factors in many deaths in which they are not the underlying cause of death. For example, in 1976. diabetes mellitus was the underlying cause of approximately 35.000 deaths but was a contributing factor in another 100,000 deaths. This paper also demonstrates the contribution of multiple cause of death data to identifying patterns of association among diseases and the kinds of injuries resulting from various external causes. Finally, data are presented which depict the use of multiple cause data in evaluating the efficacy of the coding rules used to classify the underlying cause of death. (Am J Public Health 1982: 72:1265--1270.) [ABSTRACT FROM AUTHOR]

Adults, defined here as people between 15 and 59 years of age, in developing countries have a high risk of premature death and suffer from frequent morbidity and high rates of chronic impairment. Their ill health imposes a major burden on health services and large negative consequences on families, communities, and societies. This paper describes the level and impact of adult mortality and morbidity, and highlights some of its characteristics and causes, which in some cases contradict commonly held beliefs. It concludes that "adult health" is a legitimate public health concern for developing countries that is not being addressed. An agenda for remedial research and action is proposed. [ABSTRACT FROM AUTHOR]

Abstract: This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per ¢), traffic accidents (27 per ¢), and poisonings (15 per ¢). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per ¢ of cases and assault or homicide in 3 per ¢. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per ¢ of hospital-treated patients were still hospitalized and 0.8 per ¢ had died in hospital. The outcome correlated well with the ISS. [ABSTRACT FROM AUTHOR]

Monthly mortality figures for motorcyclists for each state in the United States were obtained for the period January 1975 through December 1978. Twenty-four states revealed or weakened their helmet use laws at various dates within this period. Two of these states subsequently reintroduced a strengthened law. This paper measures the effects of these law changes on motorcyclist mortality. The states that repealed or weakened their helmet laws were matched with one or more states from the same geographic region that either did not have helmet use laws or did not change such existing laws in this four-year period. The effect of weakening the law in each state was then estimated in three steps: 1) the mortality data from each state for the period prior to repeal were regressed on smoothed data from the matched states: 2) these equations were used to predict the numbers of motorcyclist deaths that would have been expected in each state in the period following the repeal or weakening of the law if the laws had not been changed: 3) these numbers of expected deaths were then compared with the actual numbers of deaths that occurred. Of the 26 law changes, it was found that 23 resulted in a greater number of actual deaths in the period following the repeal or weakening of the law than were predicted to occur if the law had not been changed. It is estimated that the repeals or weakening of motorcyclist helmet use laws were typically followed by almost 40 per cent increases in the numbers of fatally injured motorcyclists. [ABSTRACT FROM AUTHOR]

Objectives. Hospital bed side-rails, while intended for patient protection, can contribute to injury and death. Reports to the Food and Drug Administration (FDA) of hospital bed side-rail entrapment have increased. In this paper entrapment cases are reviewed and the population potentially at risk identified. Methods. FDA's database was searched for events involving hospital beds from January 1985 to August 1995 and entrapment cases were identified. Results. Of 111 entrapments, 65% were associated with death and 23% with injury. Conclusions. Advanced age, female sex, low body weight, and cognitive impairment may be associated with increased risk. Preventive measures are detailed. [ABSTRACT FROM AUTHOR]

Objectives. To determine whether unemployment and bankruptcy rates are related to increased excess deaths during the COVID-19 recession and to examine whether the current recession-based mortality rate not only is dependent on COVID-19 but also continues the pattern of recessions, especially the Great Recession, in relation to chronic disease mortality rates and mental health disturbances (e.g., including suicide) from 2000 to 2018. Methods. This study used pooled cross-sectional time series analysis to determine the impact of unemployment and bankruptcy rates on excess deaths from February to November 2020 for US states. The study used a second pooled cross-sectional time series analysis to determine whether the COVID-19‒ era recessional mortality continues the impact of prepandemic recessions (2000–2018) on multiple causes of mortality. Results. Ten percent unemployment was associated with approximately 48[thin space]149 excess deaths, while, jointly with bankruptcies, their combined effect produced 35 700 and 144 483 excess deaths, for unemployment and bankruptcies, respectively. These health-damaging COVID-19‒recessional findings suggest a reiteration of the significantly increased major cause‒specific mortality during 2000 to 2018, mitigated by the size of the health care workforce. Conclusions. Minimization of deaths attributable to the COVID-19 recession requires ample funding for the unemployed and underemployed, especially Black and Hispanic communities, along with significant investments in the health workforce. (Am J Public Health. 2021;111(11):1950–1959. https://doi.org/10.2105/AJPH.2021.306490) [ABSTRACT FROM AUTHOR]

Since its founding, the US government has sorted people into racial/ethnic categories for the purpose of allowing or disallowing their access to social services and protections. The current Office of Management and Budget racial/ethnic categories originated in a dominant racial narrative that assumed a binary biological difference between Whites and non-Whites, with a hard-edged separation between them. There is debate about their continued use in researching group differences in mortality profiles and health outcomes: should we use them with modifications, cease using them entirely, or develop a new epistemology of human similarities and differences? This essay offers a research framework for including in these debates the daily lived experiences of the 110 million racialized non-White Americans whose lived experiences are the legacy of historically limited access to society's services and protections. The experience of Latinos in California is used to illustrate the major elements of this framework that may have an effect on mortality and health outcomes: a subaltern fuzzy-edged multivalent racial narrative, agency, voice, and community and cultural resilience. [ABSTRACT FROM AUTHOR]

The areal approach utilized in mortality analysis for cities in the past is argued to be fruitful for suburban mortality analysis as well. Through factor analysis of four Census Tract indicators, weighted scores were computed and socioeconomic groups were constructed for each central city and each suburban area for three selected metropolitan areas: Birmingham, AL, Buffalo, NY, and indianapolis, IN. Mortality rates from Heart Diseases, Malignant Neoplasms, and All Other Causes of death were found to be inversely associated with socioeconomic status in both the central cities and the suburban communities of these selected metropolitan areas. Evidence points to increasing socioeconomic differentials between 1960 and 1970 especially for males for the central cities and for suburban rings in spite of reductions, in mortality during this period. [ABSTRACT FROM AUTHOR]

An excerpt from the article “A Narrative of the Proceedings of the Black People During the Late Awful Calamity in Philadelphia and a Refutation of Some Censures Thrown Upon Them in Some Late Publications” by Absalom Jones and Richard Allen in the October, 2019 issue of ''American Journal of Public Health'' is presented which focuses on the yellow fever epidemic that struck Philadelphia, Pennsylvania, in 1793 and the false belief that white physicians and lay people erroneously thought that Black people were immune to yellow fever because of their race.

Objectives. To test the hypothesis that deaths of despair, a marker of social suffering, were associated with greater support for Brexit in the United Kingdom's 2016 European Union referendum. Methods. We used cross-local authority regression models of Brexit vote shares on changes in suicide and drug-related death rates before (2005–2007) and after the recession (2014–2016), adjusting for sociodemographic factors. The population comprised 345 local authorities in England and Wales. Results. Mortality rates were associated with voting patterns. An increase of 10 drug-related deaths per 100 000 was associated with a 15.25-percentage-point increase in Brexit votes (95% confidence interval [CI] = 10.27, 20.24), while an increase of 10 suicides per 100 000 was associated with a 9.97-percentage-point increase in vote shares for Brexit (95% CI = 6.25, 13.70). These results were substantially attenuated after we adjusted for education, and reduced to nonsignificance for drug mortality (b = 2.18; 95% CI = –0.21, 4.57) and suicide (b = 0.94; 95% CI = –0.32, 2.21) upon inclusion of other sociodemographic factors. Conclusions. Worsening mortality correlated with Brexit votes. These phenomena appear to share similar antecedents. A rise in such deaths may point to deeper social problems that could have political consequences. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of business cycles on the rate of heart disease mortality. Based on the research paper of an Australian economist, R.A. Dunn, results revealed that there was an epidemic increase of mortality from heart infections since 1930. This accounted from the economic development of a country which reflected that depression in the economy described a typical epidemic parabolic path while its recession caused smaller parabolic trend. In view of this, Dunn concluded that stress factor was the primary factor to increase death rates.

Abstract: Agricultural occupational fatalities in Pennsylvania for the years 1985-87 were followed up. Supplemental data concerning the occupation of the deceased and circumstances of the fatal accident were obtained from a family member. The number of fatalities designated as agriculturally and occupationally related by the National Traumatic Occupational Fatality (NTOF) system was compared with the number of fatalities identified by using alternative criteria for classification of agriculturally and occupationally related fatalities. There may be nearly a 30 percent error in the NTOF method resulting in a 20 percent undercount. [ABSTRACT FROM AUTHOR]

Abstract: The total number of outpatient visits to 10 hospital emergency rooms declined 64 per cent and emergency admissions 35 per cent immediately after the February 1978 blizzard in Rhode Island: both quickly returned to normal levels. Three days after the storm, admissions for myocardial infarction increased markedly. Total mortality and ischemic heart disease deaths showed a considerable increase for the five-day period following the blizzard. The physical and psychological stress of the blizzard probably precipitated cardiac deaths in susceptible individuals. (Am J Public Health 69: 1050-1052, 1979.) [ABSTRACT FROM AUTHOR]

Objectives. I examined the frequency and developmental timing of traumatic loss resulting from the health disparity of homicide among young Black men in Baltimore, Maryland. Methods. Using a modified grounded theory approach, I conducted in-depth semistructured interviews with 40 Black men (aged 18-24 years) from January 2012 to June 2013. I also constructed adapted life history calendar tools using chronologies of loss, and (1) provided a comprehensive history of loss, (2) determined a specific frequency of homicide deaths, (3) indicated participants' relationship to the decedents, and (4) identified the developmental timing of deaths. Results. On average, participants knew 3 homicide victims who were overwhelmingly peers. Participant experiences of homicide death started in early childhood, peaked in adolescence, and persisted into emerging adulthood. The traumatic loss of peer homicide was a significant developmental turning point and disrupted participants' social networks. Conclusions. The traumatic loss of peer homicide was a prevalent life course experience for young Black men and identified the need for trauma- and grief-informed interventions. Future research is needed to examine the physical and psychosocial consequences, coping resources and strategies, and developmental implications of traumatic loss foryoung Black men in urban contexts. [ABSTRACT FROM AUTHOR]

Suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many drug intoxication deaths as accidents or unintentional and heterogeneous ascertainment and coding practices across states. As the tide of prescription and illicit drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on premorbid behavior. We propose incorporating deaths from drug self-intoxication and investigations of all poisoning deaths into the National Violent Death Reporting System, which contains misclassified homicides and undetermined intent deaths, to facilitate efforts to comprehend and reverse the surging rate of drug intoxication fatalities. [ABSTRACT FROM AUTHOR]

Alcohol consumption on a per capita country basis is associated with diabetes mortality rates for men. The relation is also positive for women, but not statistically significant. Countries that consume primarily beer have higher diabetes mortality rates than countries that consume primarily spirits or wine. [ABSTRACT FROM AUTHOR]

Abstract: Age-specific death rates for pedestrian-car accidents among the populations living in four contiguous areas of a large city one being the downtown area and the others gradually more removed from it were compared. The rates are highest downtown and decrease progressively in the outlying areas, the absolute differences between areas being largest above age 65. These data suggest that pedestrian accident prevention efforts should lake into account the specific needs of the elderly living in the inner city. [ABSTRACT FROM AUTHOR]

Although assessing the costs of an intervention to prevent child maltreatment is straightforward, placing a monetary value on benefits is challenging. Respondents participating in a statewide random-digit-dialed survey were asked how much they would be willing to pay to prevent a death caused by child maltreatment. Our results suggested that society may value preventing a death from child maltreatment at $15 million. If a child maltreatment intervention is effective enough to save even 1 life, then in many cases, its benefits will outweigh its costs. [ABSTRACT FROM AUTHOR]

In August 2002, the Subcommittee on Cessation of the Interagency Committee on Smoking and Health (ICSH) was charged with developing recommendations to substantially increase rates of tobacco cessation in the United States. The subcommittee's report, A National Action Plan for Tobacco Cessation, outlines 10 recommendations for reducing premature morbidity and mortality by helping millions of Americans stop using tobacco. The plan includes both evidence-based, population-wide strategies designed to promote cessation (e.g., a national quitline network) and a Smokers' Health Fund to finance the programs (through a $2 per pack excise tax increase). The subcommittee report was presented to the ICSH (February 11, 2003), which unanimously endorsed sending it to Secretary Thompson for his consideration. In this article, we summarize the national action plan. (Am J Public Health. 2004;94:205-210) [ABSTRACT FROM AUTHOR]

Objectives. This study examined whether differences in heat alone, as opposed to public health interventions or other factors, accounted for the reduction in heat-related deaths and paramedic emergency medical service (EMS) runs between 1995 and 1999 during 2 heat waves occurring in Milwaukee, Wis. Methods. Two previously described prediction models were adapted to compare expected and observed heat-related morbidity and mortality in 1999 based on the city's 1995 experience. Results. Both models showed that heat-related deaths and EMS runs in 1999 were at least 49% lower than levels predicted by the 1995 relation between heat and heat-related deaths or EMS runs. Conclusions. Reductions in heat-related morbidity and mortality in 1999 were not attributable to differences in heat levels alone. Changes in public health preparedness and response may also have contributed to these reductions. [ABSTRACT FROM AUTHOR]

Objectives. In this study, data on violent deaths in the Bronx, New York City, from the 1970, 1980, awl 1990 censuses were analyzed. Methods. The incidence and areal density of intentional deaths were mapped by health area. Simple and stepwise regressions between violent death measures and other factors were performed. Results. The incidence of deaths at levels of those in the highest 1970 quintile spread so that by 1990 only 2 areas saw incidences at levels of the lowest 1970 quintile. Overcrowding, socio-economic status, population, population change, and drug deaths in simple regressions and overcrowding, socio-economic status, and low-weight births in stepwise regressions correlated significantly with violent death incidence or density. Conclusions. Understanding the spatiotemporal development of violence can contribute to public policy on violence. [ABSTRACT FROM AUTHOR]

The trend from 1983 to 1990 of drug-related mortality (defined as the sum of deaths from acute drug reactions and the acquired immunodeficiency syndrome [AIDS] in drug users) among the population 15 to 39 years of age in Madrid, Spain, was studied and compared with mortality from all causes. All of the mortality rates increased from 1983 to 1990: all causes, from 101/100 000 to 148/100 000; acute drug reactions, from 3/100 000 to 15/100 000; and AIDS, from 0 to 20/100 000. Drug-related mortality represented 60% of the increase in the rate from all causes in males and 170% of the increase in females. The increases in drug-related mortality are likely to continue in the future. [ABSTRACT FROM AUTHOR]

Objectives. This study compared the relative strength of he associations of a set of structural (social, economics, and political) variables and a set of health services variables with state-level infant, neonatal, and postneonatal mortality. It also examined whether health services mediate the relationships between structural variables and state-level infant, neonatal, and posteneonatal mortality. Methods. With the state as the unit of analysis, data for all 50 states were analyzed by means of multiple regression. Results. Structural variables accounted for substantially more variance in infant, neonatal, and postneonatal morality than health services variables, and health services variables were more strongly related to infant mortality than to neonatal or postneonatal mortality. When health services variables were controlled, the strengths of the associations between the structural variables and infant, neonatal, and postneonatal mortality were reduced but remained statistically significant. Conclusions. A substantial portion of the variance in state-level infant mortality is accounted for by States structural characteristics, which are partially mediated by health services. [ABSTRACT FROM AUTHOR]

Objectives. Hip fractures can have devastating effects on the lives of older individuals. We determined the frequency of occurrence of hip fracture and the baseline factors predicting death and institutionalization at 6 months after hip fracture. Methods. A representative cohort of 2812 individuals aged 65 years and older was followed prospectively for 6 years. Hip fractures were identified, and the occurrence of death and institutionalization within 6 months of the fracture was determined. Prefracture information on physical and mental function, social support, and demographic features and in-hospital data on comorbid diagnoses, fracture site, and complications were analyzed to determine predictors of death and institutionalization after hip fracture. Results. Of 120 individuals suffering a hip fracture. 22 (18%) died within 6 months and 35 (29%) were institutionalized at 6 months. The predictors of death in multiple logistic regression included fracture site, a high number of complications, and poor baseline mental status. The primary predictor of institutionalization was poor baseline mental status. Conclusions. The frequency of death, institutionalization, and loss of function after hip fracture should prompt a reevaluation of the current approach to this problem. [ABSTRACT FROM AUTHOR]

Objectives. Previous studies have examined mortality in alcoholics receiving extended inpatient alcoholism treatment, but few have investigated less intense treatment. This study examined mortality within 3 years after discharge from varying intensities of inpatient alcoholism treatment. Methods. Using the computerized database of the Department of Veterans Affairs, we identified men participating in varying intensities of inpatient alcoholism treatment and followed them for 3 years after discharge. Adjusted mortality rates were computed and survival analysis was performed to assess the risk of death, adjusting for factors that may be related to mortality. Results. The death rate was lower for men who completed extended formal inpatient treatment than for those who began, but did not complete, inpatient treatment or those who underwent short detoxification. Differences among the treatment groups remained after age, race, marital status, and disease severity were controlled. Conclusions. These results suggest that extended formal inpatient alcoholism treatment is associated with a lower risk of death than less intense forms of inpatient treatment. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to assess agreement on cause of death reporting in end-stage renal disease patients by comparing death certificates and reports to an end-stage renal disease registry. Methods. Death certificates and registry reporting forms were retrieved for a random sample of 335 treated end-stage renal disease patients who died between 1980 and 1986 in Maryland. On the registry form, patient death was ascribed to 1 of 22 precoded causes by the patient's nephrologist of record. Corresponding death certificates were coded, according to rules of the International Classification of Diseases, 9th edition, by a trained observer unaware of the registry report. Agreement was measured by the kappa statistic. Results. Overall cause of death agreement was poor (31%), and varied by the following categories: renal disease (40% on death certificates vs 0% on registry reports), cardiovascular disease (26% vs 47%), infectious disease (16% vs 22%), cancer (7% vs 5%), and withdrawal from therapy (0% vs 3%). Agreement was higher for transplant recipients than for dialyzed patients. Conclusions. Death certificates and registry reports yield different descriptions of mortality in end-stage renal disease patients. These sources of information should not be used interchangeably. Improvements to International Classification of Diseases coding of renal diseases and the determination of the reliability and validity of the US Renal Data System reporting process are necessary steps in the development of renal disease epidemiology. [ABSTRACT FROM AUTHOR]

Objectives. This study describes causes of death in persons with acquired immunodeficiency syndrome (AIDS) and assesses the completeness of reporting of human immunodeficiency virus (HIV) infection or AIDS on death certificates of persons with AIDS. Methods. AIDS case reports were linked with death certificates in 11 local/state health departments; underlying and associated causes of death were available for 32 513 persons with AIDS who died. Results. HIV/AIDS was designated as the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987 (the year specific coding procedures were implemented for HTV/AIDS). Most other underlying causes of death were conditions within the AIDS case definition (notably Pneumocystis carinii pneumonia), pneumonia, infections outside the AIDS case definition, and drug abuse. Unintentional injuries, suicide, and homicide were less common. HIV/AIDS was listed as underlying or associated on S8% of death certificates from 1987 to 1989; reporting varied primarily by HIV exposure category and time between diagnosis and death. Conclusions. Physicians and other health care professionals should realize their critical role in accurately documenting HIV-related mortality on death certificates. Such data can ultimately influence the allocation of health care resources for HIV-infected individuals. [ABSTRACT FROM AUTHOR]

Objective. This study monitors trends in place of death among persons with acquired immunodeficiency syndrome (AIDS) as a measure of health circ usage patterns and terminal health care among persons infected with human immunodeficiency virus (HIV). Methods. Sixteen health departments collected death certificates fur 55 186 persons with AIDS whose deaths occurred through 1991. Place of death was categorized as hospital, residence, hospice or nursing home, and other. Results. The percentage of AIDS deaths at hospital facilities decreased from 92% in 1983 to 57% in 1991. In 1988, 23% of deaths occurred at home or in hospices and nursing homes. This trend was more evident among men. Whites, and men who had sex with men; less so among persons with other modes of exposure; and not at all among injecting drug users and children with perinatally acquired AIDS. Place of death varied by geographic location, with the greatest percentage of hospital deaths in the Northeast (91%) and the greatest percentage of at-home deaths in the West (27%). Conclusions. The percentage of AIDS deaths at home or in hospices and nursing homes has increased since 1983. These trends may reflect changes in hospital use for end-stage HIV infection. Decreasing hospitalization and increasing outpatient services and home care will decrease costs and may allow HIV-infected persons improved social support. [ABSTRACT FROM AUTHOR]

Objectives. The objectives of this study were to determine (1) if there were significant differences between patients who died at a public hospital and those who died at a university hospital that functions as a private, community hospital, and (2) if those differences were associated with an increased risk of death. Methods. Chart review collected variables used by the Health Care Financing Administration in mortality analyses to examine how severity of illness data contribute to accurate predictions of death in a public hospital compared with a university hospital. Results. Compared with patients who died at the university hospital, public hospital patients who died had more comorbid disease, were more severely ill, more likely to be emergently admitted, and more likely to be admitted from an extended-care facility. Inclusion of severity of illness with variables previously used to predict mortality significantly improved the accuracy of mortality prediction models for the public hospital but not for the university hospital. Conclusions. The results suggest that urban public hospitals provide care to more severely ill patients. Administrative data sets may not be adequate to identify these differences between patient populations. [ABSTRACT FROM AUTHOR]

Objectives. Mortality studies of lead workers have shown excesses of nonmalignant renal disease and cerebrovascular disease. Animal studies and one human study have shown excess kidney cancer. We have updated a mortality study of male lead smelter workers (n = 1990). Methods. An analysis was conducted using standard life table techniques. The updated analysis added 11 years of follow-up and 363 new deaths. Results. The original study had found elevated but nonsignificant risks for kidney cancer, stroke, and nonmalignant renal disease, probably attributable to lead exposure. Deaths from accidents and nonmalignant respiratory disease were significantly elevated, but probably not as a result of lead exposure. In the updated study, no new deaths from nonmalignant renal disease occurred (9 observed, standardized mortality ratio = 1.21). Three more deaths from kidney cancer were observed, yielding a standardized mortality ratio of 1.93 (9 observed, 95% CI = 0.88, 3.67), which increased for those who had worked in areas with the highest lead exposure (8 observed, standardized mortality ratio = 2.39, 95% CI = 1.03, 4.71). Cerebrovascular disease remained elevated for those with more than 20 years of exposure (26 observed, standardized mortality ratio = 1.41, 95% CI = 0.92, 2.07). Conclusions. This cohort with high lead exposure showed a diminishing excess of death from nonmalignant renal disease, a continued excess from kidney cancer, and an excess of cerebrovascular disease only in those with longest exposure to lead. [ABSTRACT FROM AUTHOR]

Objectives. Proposed increases in corporate average fuel economy standards would probably lead to lighter cars. Well-established relationships between occupant risk and car mass predict consequent additional casualties. However, if size, not mass, is the causative factor in these relationships, then decreasing car mass need not increase risk. This study examines whether mass or size is the causative factor. Methods. Data from the Fatal Accident Reporting System are used to explore relationships between car mass, car size (as represented by wheelbase), and driver fatality risk in two-car crashes. Results. When cars of identical (or similar) wheelbase but different mass crash into each other, driver fatality risk depends strongly on mass; the relationship is quantitatively similar to that found in studies that ignore wheelbase. On the other hand, when cars of similar mass but different wheelbase crash into each other, the data reveal no dependence of driver fatality risk on wheelbase. Conclusions. Mass is the dominant causative factor in relationships between driver risk and car size in two-car crashes, with size, as such, playing at most a secondary role. Reducing car mass increases occupant risk. [ABSTRACT FROM AUTHOR]

Objectives. Earlier studies found striking differences in mortality from myocardial infarction between Roseto, a homogeneous Italian-American community in Pennsylvania, and other nearby towns between 1955 and 1965. These differences disappeared as Roseto became more "Americanized" in the 1960s. The present study extended the comparison over a longer period of time to test the hypothesis that the findings from this period were not due to random fluctuations in small communities. Methods. We examined death certificates for Roseto and Bangor from 1935 to 1985. Age-standardized death rates and mortality ratios were computed for each decade. Results. Rosetans had a lower mortality rate from myocardial infarction over the course of the first 30 years, but it rose to the level of Bangor's following a period of erosion of traditionally cohesive family and community relationships. This mortality-rate increase involved mainly younger Rosetan men and elderly women. Conclusions. The data confirmed the existence of consistent mortality differences between Roseto and Bangor during a time when there were many indicators of greater social solidarity and homogeneity in Roseto. [ABSTRACT FROM AUTHOR]

Background: Women, while noted for low occupational injury mortality rates, are more likely to die as victims of assault than from any other manner of injury at work. Methods: From the National Traumatic Occupational Fatality surveillance data, 950 women were identified who were fatally assaulted at work. Homicide rates were calculated for the demographic and employment characteristics of these women. Risk ratios among types of lethal injuries were examined. Results: During 1980-1985, the crude six-year workplace homicide rate was 4.0 deaths per million working women: one twentieth the homicide rate of the US female population. Decedents ranged from 16 years (the lowest age included in the data base) to 93 years of age. Working women older than 65 years had the highest age-specific homicide rate, 11.3 per million. Women younger than 20 had the lowest, 2.5 per million per year. Homicide rates for women of races other than White were nearly twice as high as those of Whites. The leading causes of death were gunshot wounds (64 percent), stabbings (19 percent), asphyxiations (7 percent), and blunt force trauma (6 percent). Nearly 43 percent of the deceased women had been employed in retail trade: 8.7 per million employed women annually. Conclusions: During 1980-1985, only 6 percent of the nation's victims of work-related injury deaths were female: 41 percent of those women were murdered. Homicide is currently the leading manner of traumatic workplace death among women in the United States. [ABSTRACT FROM AUTHOR]

Background: A large proportion of the disease and disability which affects older persons occurs in the years just prior to death. Little prospective evidence is available which quantifies the burden of morbidity and disability during these years. Methods: in three community-based cohorts of persons age 65 and older, chronic conditions and disability were evaluated for the three years prior to death in 531 persons who had three annual assessments and then died within one year of the third assessment. Number of chronic conditions, prevalence of disability in activities of daily living (ADLs), and prevalence of disability on a modified Rosow-Breslau scale were determined for these decedents and compared to 8821 members of the cohorts known to have survived. Results: Prevalence rates of disease and disability increased during the follow-up for both decedents and survivors, with decedents generally having higher rates than survivors. Disability rates prior to death, but not the number of diseases, increased with increasing age at death. The odds ratio for disability in ADLs at any of the three assessments for decedents versus survivors ranged from 3.0 to 4.2 in the three communities. In each community the odds ratio for ADL disability was higher in women decedents versus survivors than in men decedents versus survivors. Conclusions: These results have important implications for disability levels in future older populations in which death is projected to occur at increasingly higher ages. [ABSTRACT FROM AUTHOR]

Following a long-term decline, death rates in men 25-44 years of age increased from 212 deaths/100,000 in 1983 to 236 deaths/100,000 in 1987. To assess the impact of human immunodeficiency virus (HIV) infections on this trend and to identify causes that are increasing in association with the HIV epidemic, we analyzed national mortality statistics and compared death rates in states with high and low incidence of acquired immunodeficiency syndrome (AIDS). In 1987, there were 10,248 deaths with HIV infections AIDS, or conditions in the AIDS surveillance definition assigned as the underlying cause, representing 11 percent of deaths for men in this age group compared to less than 1 percent in 1980. In addition, deaths with other underlying causes, such as other underlying causes, such as other infections, drug abuser and unknown/unspecified causes, had diverging and higher rates in states with high versus low AIDS incidence. In the absence of deaths due to HIV/AIDS and excess deaths due to these associated conditions, we estimate that death rates for men 25-44 years of age would have been 201-209/100,000 in 1987. For 1987 approximately 70-90 percent of HIV-related deaths were reported through national AIDS surveillance. The HIV epidemic has led to a reversal in mortality trends and to increases in various causes of death for young men. [ABSTRACT FROM AUTHOR]

Abstract: Death certificates for residents of Nassau County, New York dying between 1980 and 1982 were examined for causes of death defined as Sentinel Health Events (Occupational) {SHE(O)}. Of 16,193 deaths from all causes, 2,286 (14.1 percent) were identified as SHE(O) deaths; 142 required no match because the cause of death was inherently related to the occupation or industry. Malignant neoplasms of the trachea, bronchus, or lung were the most frequently occurring SHE(O), accounting for 60 percent of all SHE(O) deaths and 81 percent of matched SHE(O) deaths. The construction industry was associated with the vast majority of such deaths. [ABSTRACT FROM AUTHOR]

Abstract: US mortality data on motor vehicle crashes, falls, suicide, and homicide for 1980 are compared with corresponding data for France, Japan, West Germany, and the United Kingdom. Unadjusted and age-specific death rates are presented, together with age-adjusted rates of years of life lost (YLL). A large male excess in rates is typical outside the fall category. Motor vehicle crashes are the predominant cause of YLL, and the United States manifests the highest YLL rates for each sex. US fall death rates at the older ages are exceeded by those of France and West Germany. The elderly generally manifest the greatest risk of suicide; American females exhibit a unique rate decline after ages 45-54 years, however. Beyond early adulthood, US suicide rates are lower than those of France, Japan, and West Germany. US homicide rates dwarf those of the comparison countries with 16- to 29-fold differentials separating prime-risk American males aged 25-34 years from their foreign counterparts. [ABSTRACT FROM AUTHOR]

Abstract: Since 1976 there has been a leveling off or slowdown in the rate of decline in coronary heart disease (CHD) mortality. The age-adjusted absolute annual rate of decline in CHD mortality rates during 1968-75 (A rate/100,000 population/year) was virtually identical for White males (-7.54), Black males (-7.85), and Black females (-7.20), and somewhat lower for White females (-4.25). During 1976-85, however, the secular trends diverged considerably. Age-adjusted rates continued to decline at the same annual rate for White males, while the decline was approximately half as steep for the other thre race-sex groups. During 1976-85 there was also a leveling off in the average annual per ¢ change in age-adjusted CHD mortality for Black males and females and White females when compared to 1968-75, while there was no change for White males. As a result, more than 40,000 White and Black females and Black males died of CHD in 1985 than would have died if CHD rates would have continued to decline at the 1968-75 trends. All comparisons were based on a reclassification of cause-of-death codes to maximize comparability between the 8th and 9th Revisions of the International Classification of Disease. These results suggest that the factors which have led to the continued decline in coronary heart disease may not have influenced all the demographic groups in this country equally over the last decade. INSET: Rural Hospital Closures May Harm the Elderly. [ABSTRACT FROM AUTHOR]

Abstract: Alcohol abuse in the State of Minnesota has an impact on health, health care resources, and the economy. Alcohol abuse was related to 3.3 per ¢ (1, 150) of deaths in Minnesota in 1983: of these, almost one-third were the result of fatal injuries. Alcohol abuse contributed to 12 per ¢ (33,909) of all years of potential life lost, two-thirds of which were secondary to injury. The estimated cost of alcohol abuse ranged from $1.4 billion to $2.1 billion, representing from 2.8 per ¢ to 4.3 per tent of rill personal income of Minnesotans, from 32 per ¢ to 50 per ¢ of State expenditures. and from 26 to 39 times the alcohol excise tax revenues generated in 1983. Alcohol-related direct medical CaFe costs were estimated to be at least $216 million. 3.8 per ¢ of Minnesota medical costs for 1983. Costs of reduced on-the-job productivity and short-term absentecism related to alcohol abuse were estimated to be between $630 million and $1.2 billion. The documentation of the costs of alcohol abuse is an important step in the campaign to reduce alcohol-related deaths, morbidity, and health care costs. [ABSTRACT FROM AUTHOR]

Abstract: A study was conducted of 4,054 Missouri home births occurring from 1978 through 1984. Of the 3,645 births whose planning status was identified, 3,067 (84 per ¢) were planned to be at home. Neonatal mortality was elevated for both planned (17 observed deaths vs 8.59 expected deaths) and unplanned home births (45 observed vs 33.19 expected) compared with physician-attended hospital births. Nearly all of the mortality excess for planned home births occurred in association with lesser trained attendants (12 observed vs 4.42 expected), while for unplanned home births the excess was entirely among infants weighing 1500 grams or more (19 observed vs 3.50 expected). For planned home births attended by physicians, certified nurse-midwives, or Missouri Midwife Association recognized midwives, there was little difference between observed and expected deaths (5 observed vs 3.92 expected). There also was little difference in deaths for unplanned home births weighing less than 1500 grams (26 observed vs 29.69 expected) compared with hospital births. The study provides evidence of the importance of having skilled attendants present at planned home births. [ABSTRACT FROM AUTHOR]

Abstract: To measure the quality of vital status data in a retrospective cohort study of mortality among former servicemen of the Vietnam Conflict era, test subjects of independently determined vital status were included among study subjects during vita] status ascertainment procedures, This allowed for differentiation between vital status "unknown" and incorrect assignment of vital status, and enabled measurement of the quality of both live and deceased vital status data. Four parameters based on sensitivity and specificity were used to express the quality of' vital status data, The deceased specificity rate was 100 per ¢. the deceased sensitivity rate was 95.7 per ¢, the live specificity rate was 98.5 per ¢, and the live sensitivity rate was 95.4 per ¢. U sing models of misclassification. the estimated death rate was found to be most sensitive to changes in the deceased specificity rate, indicating that emphasis should be given to minimizing incorrect ascertainment of truly alive subjects as deceased when developing vital status ascertainment procedures. [ABSTRACT FROM AUTHOR]

Abstract: Between October 1980 and July 1981, 1,878 women were attended by traditional birth attendants (TBAs) at four obstetric units in rural areas surrounding the city of Fortaleza in Northeast Brazil. Of these women, 232 (12.4 per ¢) were referred to a hospital in Fortaleza for delivery. The most important indicators for referral to hospital were: presence of an antenatal problem, complication of labor, or malpresentation. Based on record review, 65 referred women with none of these conditions were classified as low risk and 42 women not referred were classified as high risk fat least one such condition present). Of 1,878 deliveries, 32 (17 per 1,000) terminated as fetal deaths, and 12 infants died before discharge from hospital or obstetric unit (six per 1,000). The death rate was much higher for the high-risk cases (156 per 1,000 referrals, 95 for nonreferrals). Although some women may have been inappropriately referred while others who should have been were not referred, the system of referral has allowed TBAs to attend uncomplicated deliveries and to refer women with complications. (Am J Public Health 1985; 75:745-748.) [ABSTRACT FROM AUTHOR]

To evaluate the relative utility of the Social Security Administration and National Death Index as sources of mortality data. The vital status of 12,866 participants in the Multiple Risk Factor Intervention Trial was identified from these sources and compared lo the known mortality experience. The SSA correctly identified 87.8 per cent of the 409 deaths that occurred between 1974 and 1980. Underreporting of deaths by the SSA occurred for participants with certain demographic characteristics, especially marital status. For the years 1979 and 1980, the period for which the SSA and NDI have comparable data, the SSA correctly identified 93.2 per cent and the NDI correctly identified 98.4 per cent of the 191 known deaths. The NDI matching process resulted in a large number of false positive matches. [ABSTRACT FROM AUTHOR]

To test the feasibility of using large national probability samples provided by the US Census Bureau, a pilot project was initiated to link 230,000 Census-type records to the National Death Index (NDI). Using strict precautions to maintain the complete confidentiality of individual records, the Current Population Survey files of one month in 1973 and one month in 1978 were matched by computer to the 1979 NDI file. The basic question to be addressed was whether deaths so obtained are seriously undereestimated when there is no Social Security Number (SNN) in the Census record. The search of the NDI file resulted in 5,542 matches of which about 1,800 appear to be "true positives" representing deaths, the remainder are "false positives." Of the deaths, 80 per cent would still have been detected without SSN in the Census record. The main reasons for missing deaths (false negatives) were discrepancies in the year of birth and in the given name. Assuming certain changes in the NDI matching algorithm, the 80 per cent figure could increase to 85 per cent or higher; however, this could also cause significant increases in the number of false positives. The National Heart, Lung and Blood Institute (NHLBI) and Census Bureau staff are currently developing a probabilistic method to eliminate false positives from the NDI output tape. The results of the pilot study indicate that a larger research project is clearly feasible. [ABSTRACT FROM AUTHOR]

Deaths due tv diabetes with acidosis or coma (DAC) in the United States from 1970 through 1978 were analyzed to determine epidemiologic characteristics associated with mortality likely to be due to diabetic ketoacidosis (DKA), a complication of diabetes mellitus considered largely preventable. Annual age-adjusted rates for DAC deaths decreased during the study period, and the secular trend was significant in all regional, race, and sex groups examined. General population-based mortality rates increased linearly with age, were higher in nun-Whites than in Whiles among persons aged >14, were higher in females, and increased significantly with age in both races and both sexes. By region, rates were lowest in the West. DAC mortality rates specific to estimated diabetic populations decreased annually from 1970 to 1978 in all race and sex groups, and were highest at age ≥65, but did not show significant linear increases with age, except in non-Whites. These results indicate declining secular trends, as well as age. race, sex, and regional differences in the risk of such deaths. Further studies are warranted tv determine factors contributing to these differences, (Am J Public Health 1983: 73:1169-1173.) [ABSTRACT FROM AUTHOR]

The antismoking campaign has encouraged millions of people to quit smoking cigarettes and millions of others not to initiate the habit. Because quitting smoking, or deciding not to start, reduces one's mortality risks relative to the continuing smoker, we estimate that these consumption impacts resulted in the avoidance of more than 200,000 premature smoking-related deaths during 1964-1978. On average, each of these premature deaths averted translates into 23 additional years of life. Furthermore, campaign-related smoking cessation and non-initiation during the 1964-1978 period will result in the avoidance of many more premature deaths in the coming decades. Although these figures suggest that the antismoking campaign has been successful, tens of millions of Americans continue to smoke and the premature deaths avoided constitute only a small fraction of the 4 million deaths attributable to smoking that occurred during the same years. [ABSTRACT FROM AUTHOR]

Abstract: Data from the Manitoba Longitudinal Study on Aging (MLSA) were used to test the hypothesis that self-rated health (SRH) is a predictor of mortality independent of "objective health status" (OHS). Subjects wee a random sample of non-institutionalized residents of Manitoba aged 65+ in 1971 (n = 3.128). A single item measure of SRH was obtained during a survey conducted in 1971: a baseline measure of OHS was derived from physician and self-reported conditions and health service utilization data. Occurrence and date of death during the years 1971-1977 were known. Analyses of the data revealed that controlling for OHS, age, sex, life satisfaction, income and urban/ rural residence, the risk of early mortality (1971-1973) and late mortality (1974-1977) for persons whose SRH was poor was 2.92 and 2.77 times that of those whose SRH was excellent. This increased risk of death associated with poor self-rated health was > Hint associated with poor OHS. poor life satisfaction. low income and being made. These findings provide empirical support for the long held, but inadequately substantiated, belief that the way a person views his health is importantly related to subsequent health outcomes. [ABSTRACT FROM AUTHOR]

Currently about 15 per cent of hospital costs are attributed to intensive care. Research using statistical models has not adequately demonstrated that therapy in intensive care units (ICUs) is associated with reductions in the probability of death. In a study of 613 consecutive admissions to a multidisciplinary ICU, we reevaluate the relationship between ICU care and survival using a new acute physiology scoring system to control for the severity of illness of the patient population. When our severity of illness index was employed, we found a statistically significant and nonlinear relationship between the use of intensive medical care and the probability of survival. This statistical relationship produced a U-shaped curve with three distinct segments. The first segment exhibited an overall decrease in the probability of death with increasing therapy (275 admissions); the second segment, a fairly stable survival rate (281 admissions). Only in the third segment, where there were 57 admissions, did we find an overall increase in the probability of death as utilization of therapy increased. These findings suggest that quantitative measurement of severity of illness, when used in clinical studies, could produce improved insights into the relationship between therapy and health outcomes. [ABSTRACT FROM AUTHOR]