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Background: External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood. Methods: Individual level data from national health registries in Denmark (1978–2001), Finland (1987–2003), Norway (1967–2002), and Sweden (1974–2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016–2018. Gestational age was categorized as "very/moderately preterm" (23–33 weeks), "late preterm" (34–36 weeks), "early term" (37–38 weeks), "full term" (39–41 weeks), and "post term" (42–44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country's estimates in meta-analyses. Results: Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99–1.24) for males and 1.55 (95% CI 1.28–1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04–1.18) and 1.15 (95% CI 1.02–1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34–2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99–1.53] and 1.29 [95% CI 1.16–1.45], respectively) and females (HRs 1.53 [95% CI 0.97–2.41] and 1.35 [95% CI 1.07–1.71], respectively, with some heterogeneity across countries). Conclusions: Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males. [ABSTRACT FROM AUTHOR]

Abstract Background External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood. Methods Individual level data from national health registries in Denmark (1978–2001), Finland (1987–2003), Norway (1967–2002), and Sweden (1974–2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016–2018. Gestational age was categorized as “very/moderately preterm” (23–33 weeks), “late preterm” (34–36 weeks), “early term” (37–38 weeks), “full term” (39–41 weeks), and “post term” (42–44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country’s estimates in meta-analyses. Results Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99–1.24) for males and 1.55 (95% CI 1.28–1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04–1.18) and 1.15 (95% CI 1.02–1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34–2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99–1.53] and 1.29 [95% CI 1.16–1.45], respectively) and females (HRs 1.53 [95% CI 0.97–2.41] and 1.35 [95% CI 1.07–1.71], respectively, with some heterogeneity across countries). Conclusions Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males.

We aim to analyze the risk of death from specific external causes, including falls, complications of medical and surgical care, unintentional injuries, and suicide, in dementia patients. Swedish nationwide cohort study integrating 6 registers from May 1, 2007, through December 31, 2018, including the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Population-based study. Patients diagnosed with dementia from 2007 to 2018 and up to 4 controls matched on year of birth (±3 years), sex, and region of residence. The exposures of this study were diagnosis of dementia and dementia subtypes. Number of deaths and causes of mortality were obtained from death certificates compiled into the Cause of Death Register. Hazard ratios (HRs) and 95% CIs were estimated using Cox and flexible models, adjusted for sociodemographics, medical and psychiatric disorders. The study population included 235,085 patients with dementia [96,760 men (41.2%); mean age 81.5 (SD 8.5) years] and 771,019 control participants [341,994 men (44.4%); mean age 79.9 (SD 8.6) years], over 3,721,687 person-years. Compared with control participants, patients with dementia presented increased risk for unintentional injuries (HR 3.30, 95% CI 3.19-3.40) and falls (HR 2.67, 95% CI 2.54-2.80) during old age (≥75 y), and suicide (HR 1.56, 95% CI 1.02-2.39) in middle age (<65 y). Suicide risk was 5.04 times higher (HR 6.04, 95% CI 4.22-8.66) in patients with both dementia and 2 or more psychiatric disorders relative to controls (incidence rate per person-years, 1.6 vs 0.3). For dementia subtypes, frontotemporal dementia had the highest risks of unintentional injuries (HR 4.28, 95% CI 2.80-6.52) and falls (HR 3.83, 95% CI 1.98-7.41), whereas subjects with mixed dementia were less likely to die from suicide (HR 0.11, 95% CI 0.03-0.46) and complications of medical and surgical care (HR 0.53, 95% CI 0.40-0.70) compared to controls. Suicide risk screening and psychiatric disorders management in early-onset dementia and early interventions for unintentional injuries and falls prevention in older dementia patients should be provided. [ABSTRACT FROM AUTHOR]

This study aimed to analyse deaths due to external causes in males in northwest Slovakia. This was a cross-sectional autopsy study. The autopsy registry provided information on fatalities in males in northwest Slovakia due to external causes in 2015. Data were analysed by age, cause of death and blood alcohol concentration (BAC), and the contribution to overall mortality was calculated. From a total of 305 fatalities, the dominant cause of death was unintentional (other than traffic; 56.7%), followed by intentional (26.6%) and traffic (16.7%). A BAC of ≥0.5 g/kg was found in 43.9% of deaths. Lower levels of BACs (0.5–1.9 g/kg) were observed in relatively high proportions among the younger (aged ≤34 years) and older (aged ≥65 years) males (17.9% and 14.0%, respectively), as well as in the traffic and intentional injury cause of death categories (23.5% and 19.8%, respectively). Male deaths due to external causes had a 6.2% contribution to overall mortality in northwest Slovakia. Alcohol intoxication frequently co-occurs with fatalities from external causes, including at lower BACs, indicating the harmful role of alcohol at all concentrations. [ABSTRACT FROM AUTHOR]

This article analyses the mortality caused by road accidents in Moldova depending on the degree of involvement of pedestrians, cyclists, motorcyclists, drivers and passengers of transport units, depending on age and sex. Results suggest that traffic-related mortality in Moldova has shown an increased incidence among the young and working-age population, where a significant difference between males and females is observed. Among the youth, traffic-related deaths register between 10-27% of the overall mortality in both sexes. The risk exposure of dying in a traffic accident decreases with age and is less significant in the retired ages. During the years 1998-2015, avoidance of trafficrelated deaths would have assured an increase in life expectancy between 0.40-0.56 years in males, and 0.09-0.23 years in females. The continuous increase in the number of transport units on public roads, as well as in the number of hours spent in traffic, influences the degree of exposure to the risk of death or injury as a result of road traffic accidents. Trauma resulting from road accidents increases the incidence of premature mortality and disability among the population, which is reflected by the decrease of healthy life expectancy. It is ascertained that the road accident mortality requires a detailed and comprehensive analysis given the multitude of factors influencing deaths and injuries related to a traffic accident among the population. Thus, in order to improve road safety and reduce mortality incidence among traffic participants, a range of actions has to be implemented by the liable actors, including through the international experience.

To examine the relationship between Veterans' housing instability and mortality by homicide, suicide, and unintentional injury, this retrospective study examined administrative data from Veterans Health Administration (VHA) patients who responded to the Homelessness Screening Clinical Reminder (HSCR) between October 1, 2012 and September 30, 2016 and were searched through the National Death Index (NDI) for date and cause of death (N = 5,850,044). Analyses calculated survival time and compared mortality for three groups—(1) stably housed Veterans, (2) unstably housed Veterans, and (3) Veterans at imminent risk for housing instability—using adjusted Cox proportional hazards models. Stably housed Veterans had a significantly longer median survival time (3.3 years) than unstably housed Veterans and those at imminent risk for housing instability (2.5 and 2.6 years, respectively). Unstably housed Veterans and those at imminent risk for housing instability had greater risk of all-cause mortality (Adjusted Hazard Ratio [aHR] = 1.69 and 1.48, respectively) and of dying by homicide (aHR = 3.01 and 2.65, respectively), suicide (aHR = 1.75 and aHR = 1.80, respectively), and unintentional injury (aHR = 3.13 and aHR = 1.92, respectively) compared with stably housed Veterans. More proactive measures are needed to prevent external causes of mortality among Veterans who are unstably housed or at imminent risk for housing instability. [ABSTRACT FROM AUTHOR]

The ambivalence of mortality and life expectancy dynamics in Ukraine is a significant and complex demographic problem. Our aim is to examine the last tendencies of mortality and life expectancy, analyse the level and dynamics of mortality by major causes of death before the Russian military invasion of Ukraine. This analysis constitutes a base for the further comparative estimation of demographic losses due to the war. Trends of sex- and age-specific mortality are considered. Specific characteristics of mortality in urban and rural settlements are analysed. We use the following methods: demographic rates, standardized death rates (European standard population), life tables, decomposition method, descriptive statistics, graphic method. Our findings suggest that following a period of growth in life expectancy (2009-2013) a period of fluctuation and stagnation (2014-2019) has started in Ukraine under the influence of political-military and economic factors. Beginning with 2020, life expectancy was additionally influenced by COVID-19. Non-communicable diseases are among significant contributors to premature adult mortality in Ukraine. However, the excessive share of deaths (especially among men) is also related to external causes. The dynamics of mortality from cardiovascular diseases show a general trend of decline over the past fifteen years, however with fluctuations in the latest years. A deterioration has already taken place in 2020. There is a slight decrease in cancer mortality over the past fifteen years. The reduction in death rate from external causes in Ukraine over this period was significant. The standardized death rate from digestive diseases has increased with COVID-19 having played a leading role in the unfavourable changes of life expectancy over the past two years.

The article assesses the risk of exposure to athmospheric pollution on the life expectancy at birth and mortality in the Republic of Karelia. Special focus is on the long-term(1996–2016) variation of pollutant emissions from fixed sources and the statistically related to it change in the rate of mortality from external causes. Thus, the number of suicidesand murders in the period studied decreased simultaneously with a decrease in the emissions of solid particles (r = 0.92 and 0.89, respectively), CO (0.92 and 0.88), SO2 (0.77 and 0.72), etc. Such dependencies are consistent with available publications on the effect of chemical pollution on suicidal and aggressive human behavior, as well as the general trend of the effect of emitted solids on the number of crimes associated with violent actions against victims in the Northwest Federal District. The health hazard of exposure to dust-like particles is shown. Their concentration in urban air increases after the snowcover had thawed, especially in the case of a deficit of spring precipitation. Dust particles have partially acute-angled shapes and an elevated content of heavy metals (W, Cu,V, Co, Zn, Ni, Mn, Sb, Sn, Cr, Mo) compared to urban soils. The data presented in this article and their analysis are important for the continuation of research aimed at assessing environmental risks and reducing the negative impact of chemical pollution on human health and behavior.

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Objectives: To compare mortality by cancer sites and by other specific causes of death, and the prevalence of risk behaviors in farmers and non-farmers in Spain. Methods: Mortality by cause of death was calculated based on a longitudinal study with 10-years follow-up of 9.5 million men and 6 million women aged 20–64 years who were employed in 2001. The prevalence of risk behaviors was calculated from the 2001 National Health Survey in the 6464 employed men and 5573 employed women aged 20–64. The study subjects were grouped as farmers and non-farmers. For each cause of death, we estimated the ratio of age-standardized mortality rates, and for each risk behavior we estimated the age-standardized prevalence ratio in farmers versus non-farmers. Results: In men, the mortality rate for most cancer sites did not differ significantly between farmers and non-farmers, except for cancers of the lip, oral cavity, stomach, larynx and skin epidermoid carcinoma—which was higher in farmers—and cancers of the liver, pancreas and mesothelioma—which was lower in farmers. In contrast, farmers had a higher rate of mortality from most other diseases and from external causes of death. In women, farmers showed lower mortality from lung cancer, breast cancer and chronic lower respiratory disease, and higher mortality from external causes. The prevalence of smoking, excessive alcohol consumption, physical inactivity and obesity was higher in farmers than in non-farmers, except smoking and excessive alcohol consumption in women where prevalence was lower in farmers. Conclusions: Findings are different from those found in other studies. In men, greater exposure to the sun and the higher prevalence of risk behaviors in farmers could explain their excess mortality from some cancer sites and the other causes of death. However, other factors may be behind this excess risk of mortality from these causes, given that farmers did not show higher mortality from some cancers related to smoking. In women, no differences were observed in mortality rate for majority of causes of death between farmers and non-farmers. [ABSTRACT FROM AUTHOR]

This article presents for the first time an analysis of the continuous statistical data series on deaths from road accidents in Russia since 1956. The total number of deaths for 1956-2012 exceeded 1.4 million. The increase in mortality from traffic accidents started in the 1970s; since the beginning of the 1990s, the lag behind most developed countries has been growing. At 2012 mortality levels, about 85-95% of Russia’s deaths from road accidents were excessive compared with the number of deaths that would have occurred at age-specific mortality rates from this cause in selected European countries. Both the current characteristics of the general level of motorisation and the main indicators of traffic injuries, such as the number of deaths per 100 thousand persons, per 10 thousand vehicles or per number of kilometres traveled, show that in terms of transport development Russia lags 40-50 years behind Western countries. The article also examines the history of the inclusion of mortality from road accidents in the International Classification of Causes of Death (ICD) and the problems of reflecting this mortality in Russian mortality statistics. Age and sex-specific patterns and trends in Russian mortality from traffic accidents are analysed, as well as the differences in mortality for different categories of road users (e.g. drivers, passengers and pedestrians) for the longest period possible. International comparisons that allow for understanding the extent of Russian backwardness and seeing the long-term unsustainable trends in mortality from road accidents are presented. The author points out the necessity of further scientific research into road and transport safety problems and the development of effective safety improvement programmes in Russia aimed to overcome the lag.

The article discusses long-term mortality trends (since 1956) from external causes of death in Russia. Russia has long lagged behind developed countries in this domain. The level of mortality from external causes of death remains high and its structure is still archaic with large contribution of homicides, alcohol poisoning and injuries of undetermined intent. Excess number of deaths from life tables of Russia and Western European countries is compared. It is shown that in Russia the greatest excess losses are associated with mortality from poisonings among both sexes, suicide among men and homicide among women. Mortality from external causes, along with mortality from diseases of the circulatory system, has had a significant impact on life expectancy. In general, over the period 1956-2012 the increase in mortality from external causes in the 15-64 age group reduced life expectancy by 2.6 years for males and 0.7 years for females. The decline, starting in 2003, of mortality from external causes of death has slightly reduced the gap between Russia and developed countries, bringing the current Russian level closer to those levels reached in Russia in the mid-1960s and 1980s. However, given the fluctuations of mortality from external causes, it is premature to say whether the current decline in mortality is robust.

This study aimed to develop models based on Verbal Autopsy (VA) data and to estimate correct number of deaths from external causes in Thailand from 1996 to 2009. Logistic regression was used to create models of the three external causes of death classified by province, gender-age group and Vital registration (VR) cause-location group. Receiver operating characteristic (ROC) curves were used to validate the models by matching the number of reported deaths to the number of deaths predicted by the models. The models provided accurate prediction results, with false positive error rates 1.6%, 2.0% and 0.6% and sensitivities 73.8%, 46.3% and 62.0%, respectively. The results reveal that under-reporting of external causes of death increased over the 14-year period. Our statistical method confirms that the Thai 2005 VA data can be used to estimate external causes of death from VR report in Thailand to allow for the under-reporting rate.

Background: In low- and middle-income countries (LMICs), data on causes of death is often inaccurate or incomplete. In this paper, we test whether adding a few questions about injuries and accidents to mortality questionnaires used in representative household surveys would yield accurate estimates of the extent of mortality due to external causes (accidents, homicides, or suicides). Methods: We conduct a validation study in Niakhar (Senegal), during which we compare reported survey data to high-quality prospective records of deaths collected by a health and demographic surveillance system (HDSS). Results: Survey respondents more frequently list the deaths of their adult siblings who die of external causes than the deaths of those who die from other causes. The specificity of survey data is high, but sensitivity is low. Among reported deaths, less than 60Š of the deaths classified as due to external causes by the HDSS are also classified as such by survey respondents. Survey respondents better report deaths due to road-traffic accidents than deaths from suicides and homicides. Conclusions: Asking questions about deaths resulting from injuries and accidents during surveys might help measure mortality from external causes in LMICs, but the resulting data displays systematic bias in a rural population of Senegal. Future studies should 1) investigate whether similar biases also apply in other settings and 2) test new methods to further improve the accuracy of survey data on mortality from external causes. Contribution: This study helps strengthen the monitoring of sustainable development targets in LMICs by validating a simple approach for the measurement of mortality from external causes.

O artigo compara dados de homicídios de residentes no município de São Paulo entre 1996 e 2000, divulgados pelo Pro-aim, Fundação Seade e Ministério da Saúde; e de homicídios por distrito de residência da vítima no município de São Paulo em 2000, divulgados pelo Pro-aim e pela Fundação Seade. Foram considerados homicídios os óbitos por agressão; intervenção legal e eventos de intenção não determinada causados por disparo de arma de fogo e por contato com objeto cortante/penetrante ou contundente. A diferença entre os números da Fundação Seade e do Ministério da Saúde é desprezível, mas a diferença entre os números do Pro-aim e da Fundação Seade para homicídios de residentes ocorridos na capital em 2000 é expressiva para muitos distritos do município de São Paulo. Além disso, o Pro-aim não registra óbitos de residentes na capital ocorridos em outro município. As análises da taxa de homicídio por distrito do município de São Paulo que utilizam dados do Pro-aim podem levar a resultados muito diferentes das que utilizam dados da Fundação Seade.The article compares city (Pro-aim), state (Fundação Seade) and federal (Ministério da Saúde) data for homicides of residents in Sao Paulo city between 1996 and 2000; and Pro-aim and Fundação Seade data for homicides per district in Sao Paulo municipality, in 2000. As homicides were considered deaths caused by assault, legal intervention and events of undetermined intent caused by firearm discharge and contact with sharp or blunt objects. The difference between Fundação Seade and Ministério da Saúde data is worthless. But the difference between Pro-aim and Fundação Seade numbers for homicides of residents in Sao Paulo city in 2000 has statistical significance for a large number of districts. Furthermore, Pro-aim does not record deaths of residents in Sao Paulo city occurred in other cities. Analysis of homicide rates per district in Sao Paulo city that uses Pro-aim data can lead to different results than analysis that uses Fundação Seade data.

OBJETIVO: A taxa de mortalidade específica por acidentes de trânsito de veículos a motor é usualmente utilizada para efeito das políticas de saúde pública. Para mensurar o grau de violência no trânsito, foi realizado estudo com o objetivo de analisar o número de óbitos por acidentes de trânsito por veículo a motor. MÉTODOS: Com base nos dados sobre frota de veículos, população e óbitos por acidente de trânsito, publicados no Statiscal Yearbook (1999), Demografic Yearbook (1997), Denatran (1999), Ministério da Saúde (2000) e Fundação IBGE (2000), foram estudados 61 países e 51 localidades brasileiras.A taxa de mortalidade específica foi decomposta em número de veículos por habitante e número de óbitos por veículo. Numa primeira aproximação, cada uma das amostras (internacional e brasileira) foi subdividida em três grupos, de acordo com o número de veículos por habitante, para estudo da relação entre os três índices. Para testar a significância dessa relação, foi estimada uma função de regressão log-linear. RESULTADOS: Os resultados para as estimativas internacionais, assim como as do Brasil, demonstraram que, quanto maior o número de veículos por habitante, menor o número de óbitos por acidentes de trânsito por veículo, tendo-se elasticidade da ordem de -1,067, para as estimativas internacionais, e de -0,515, para as do Brasil. CONCLUSÕES: Para uma política de prevenção dos acidentes de trânsito, os resultados encontrados indicam a necessidade de estudar os fatores que possam explicar o maior número de óbitos por veículo nas regiões com menor número de veículos por habitante.OBJECTIVE: The mortality rate due to traffic accidents is an information often used while making public health policies. In order to measure traffic violence, a study was carried to analyze the number of death by traffic accidents per registered motor vehicle. METHODS: Based on the number of registered vehicles, population and traffic accident deaths, obtained from the Statistical Yearbook (1999), Demographic Yearbook (1997), Denatran (1999), Ministério da Saúde (2000) and Fundação IBGE (2000) 61 countries and 51 areas in Brazil were studied. Traffic accident mortality rate was broken down into registered motor vehicles per capita and the number of deaths per motor vehicle. To assess this relationship, the samples (international and Brazilian) were subdivided into three groups according to the number of vehicles per capita. To test the statistical significance of this relationship, log-linear regression was used. RESULTS: The number of deaths per motor vehicles is associated to the number of registered motor vehicles per capita. The statistical relationship is -1.067 for international data and -0.515 for the Brazilian data. CONCLUSIONS: To prevent traffic accidents, there is a need of further studies to explain the high numbers of deaths due to motor vehicles associated with the low rate of registered motor vehicles per capita.

Background: We present a method for reclassifying external causes of death categorized as "event of undetermined intent" (EUIs) into non-transport accidents, suicides, or homicides. In nations like Russia and the UK the absolute number of EUIs is large, the EUI death rate is high, or EUIs comprise a non-trivial proportion of all deaths due to external causes. Overuse of this category may result in (1) substantially underestimating the mortality rate of deaths due to specific external causes and (2) threats to the validity of studies of the patterns and causes of external deaths and of evaluations of the impact of interventions meant to reduce them. Methods: We employ available characteristics about the deceased and the event to estimate the most likely cause of death using multinomial logistic regression. We use the set of known non-transport accidents, suicides, and homicides to calculate an mlogit-based linear score and an estimated classification probability (ECP). This ECP is applied to EUIs, with varying levels of minimal classification probability. We also present an optional second step that employs a population-level adjustment to reclassify deaths that remain undetermined (the proportion of which varies based on the minimal classification probability). We illustrate our method by applying it to Russia. Between 2000 and 2011, 521,000 Russian deaths (15 % percent of all deaths from external causes) were categorized as EUIs. We used data from anonymized micro-data on the ~3 million deaths from external causes. Our reclassification model used 10 decedent and event characteristics from the computerized death records. Results: Results show that during this period about 14 % of non-transport accidents, 13 % of suicides, and 33 % of homicides were officially categorized as EUIs. Our findings also suggest that 2011 levels of non-transport accidents and suicides would have been about 24 % higher and of homicide about 82 % higher than that reported by official vital statistics data. Conclusions: Overuse of the external cause of death classification "event of undetermined intent" may indicate questionable quality of mortality data on external causes of death. This can have wide-ranging implications for families, medical professionals, the justice system, researchers, and policymakers. With our classification probability set as equal to or higher than 0.75, we were able to reclassify about two-thirds of EUI deaths in our sample. Our optional additional step allowed us to redistribute the remaining unclassified EUIs. Our method can be applied to data from any nation or sub-national population in which the EUI category is employed. [ABSTRACT FROM AUTHOR]

Aims: Immigrants are at increased risk of dying from external causes, particularly suicide. This study presents mortality data from a complete follow-up of a cohort of immigrants from the Former Soviet Union to Germany. Number of residential changes after migration and time period between residential change and death are analysed as predictors for suicide and other causes of mortality. Methods: A representative cohort of immigrants (n=34,393) was followed up until 31 December 2002. Residential changes were monitored through city registries. Standardized mortality ratios were calculated for all causes of death and external causes of death (suicides, accidents, other external causes) and deaths attributable to psychoactive substance use. Data on residential change were analysed using Poisson regression to examine differences in external-cause mortality among immigrants who changed residence after immigration. Mortality rates by time since changing residence were calculated, and linear regression analysis was performed to model the effect of cause of death on the time interval between residential change and death. Results: Male immigrants had a significantly higher risk of dying fromexternal causes and suicide than Germans, and this increases with frequency of residential changes. Suicide mortality was significantly higher shortly after residential change. Linear regression showed that time to death after residential change was 2.5 times shorter for suicide than for any other cause. Conclusions: High risk of death fromexternal causes and fromdeaths attributable to substance abuse in immigrants suggests integration problems. Preventive efforts at targeted integration programmes for immigrants, in particular shortly after residential change, are recommended. [ABSTRACT FROM AUTHOR]

The author offers comments on the article "Alcohol control policy and changes in alcohol-related traffic harm" by J. Rehm, which appears in the current issue.

The study aimed to explore the prospective associations between psychosocial factors at work from the job strain model and preventable mortality, including smoking- and alcohol-related mortality as well as external causes of death. The study was based on prospective data and relied on a sample of 1,511,456 individuals for which data on job history, mortality and causes of death were linked over the 1976-2002 period. Exposures were the factors from the job strain model imputed through a job-exposure matrix. Various time-varying measures of exposure were used including current exposure and two measures of cumulative exposure. Preventable mortality was defined using the OECD/Eurostat list of preventable causes of death. The associations between exposures and outcomes were studied using Cox proportional hazards models. Effect modification by gender was also assessed. Over the study period, 57,264 preventable deaths occurred before the age of 75 years. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with preventable mortality, and associations of stronger magnitude were found for job strain and isostrain among men. Stronger associations were observed for alcohol-related mortality than for smoking-related mortality and external causes of death. The fractions of preventable mortality attributable to current exposure to job strain and isostrain were significant among men only (5.1% and 3.3%). Psychosocial factors at work from the job strain model may play a role on preventable mortality. Intensifying research and prevention towards the psychosocial work environment may be helpful to reduce risky health-related behaviours and related mortality. [ABSTRACT FROM AUTHOR]

OBJETIVO: A taxa de mortalidade específica por acidentes de trânsito de veículos a motor é usualmente utilizada para efeito das políticas de saúde pública. Para mensurar o grau de violência no trânsito, foi realizado estudo com o objetivo de analisar o número de óbitos por acidentes de trânsito por veículo a motor. MÉTODOS: Com base nos dados sobre frota de veículos, população e óbitos por acidente de trânsito, publicados no Statiscal Yearbook (1999), Demografic Yearbook (1997), Denatran (1999), Ministério da Saúde (2000) e Fundação IBGE (2000), foram estudados 61 países e 51 localidades brasileiras.A taxa de mortalidade específica foi decomposta em número de veículos por habitante e número de óbitos por veículo. Numa primeira aproximação, cada uma das amostras (internacional e brasileira) foi subdividida em três grupos, de acordo com o número de veículos por habitante, para estudo da relação entre os três índices. Para testar a significância dessa relação, foi estimada uma função de regressão log-linear. RESULTADOS: Os resultados para as estimativas internacionais, assim como as do Brasil, demonstraram que, quanto maior o número de veículos por habitante, menor o número de óbitos por acidentes de trânsito por veículo, tendo-se elasticidade da ordem de -1,067, para as estimativas internacionais, e de -0,515, para as do Brasil. CONCLUSÕES: Para uma política de prevenção dos acidentes de trânsito, os resultados encontrados indicam a necessidade de estudar os fatores que possam explicar o maior número de óbitos por veículo nas regiões com menor número de veículos por habitante.