OBJECTIVES: This report presents final 1997 data on U.S. deaths and death rates according to demographic and medical characteristics such as age, sex, race, Hispanic origin, marital status, educational attainment, injury at work, State of residence, and cause of death. Trends and patterns in general mortality, life expectancy, and infant and maternal mortality are also described. A previous report presented preliminary mortality data for 1997. METHODS: In 1997 a total of 2,314,245 deaths were reported in the United States. This report presents descriptive tabulations of information reported on the death certificates. Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. Original records are filed in the State registration offices. Statistical information is compiled into a national data base through the Vital Statistics Cooperative Program of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. RESULTS: The 1997 age-adjusted death rate for the United States decreased to an all-time low of 479.1 deaths per 100,000 standard population, and life expectancy at birth increased to a record high of 76.5 years. The 15 leading causes of death remained the same as in 1996, although Human immunodeficiency virus (HIV) infection plummeted from the 8th leading cause of death to the 14th leading cause. Some of the 8th-14th leading causes of death shifted positions. HIV infection remained the leading cause of death for black persons aged 25-44 years. The largest decline in age-adjusted death rates among the leading causes of death was for HIV infection, which dropped 47.7 percent between 1996 and 1997. Mortality declined for all age groups, except for persons aged 85 and over. The infant mortality rate reached a record low of 7.2 infant deaths per 1,000 live births in 1997 although the decline in the rate from 1996 was not statistically significant. CONCLUSIONS: The overall improvements in general mortality and life expectancy in 1997 continue the long-term downward trend in U.S. mortality. The trend in U.S. infant mortality is of steady declines over the past four decades. (+info)
Income inequality and mortality in England.
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BACKGROUND: Despite the increasing evidence that income inequality causes reductions in life expectancy in developed countries, this relationship has not been explored in the United Kingdom, where local income data are not routinely available. We have surmounted this problem by employing an ecological design which applies national income data to local mortality and occupational data. METHODS: This ecological, cross-sectional study used 1991 mortality and Census data on the 366 English local government districts, and 1991 New Earnings Survey data for England, to determine the independent effect of income inequalities within English local authorities on the variation in all cause mortality between them. The subjects were all men and women recorded as economically active in the 1991 Census. We carried out linear regression analyses between all cause, all ages standardized mortality ratios, income inequality indexes and mean income levels of the local government districts. Results Both income inequality and mean income were independently associated with mortality. CONCLUSIONS: It is likely that income inequality makes an independent contribution to life expectancy in English local authorities. This finding adds further to the international evidence supporting the potentially positive health impact of increasing the scale of redistributive fiscal policies. (+info)
Laparotomy versus no laparotomy in the management of early-stage, favorable-prognosis Hodgkin's disease: a decision analysis.
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PURPOSE: To perform a decision analysis that compared the life expectancy and quality-adjusted life expectancy of early-stage, favorable-prognosis Hodgkin's disease (HD) managed with and without staging laparotomy, incorporating data on treatment outcomes of HD in the modern era. METHODS: We constructed a decision-analytic model to compare laparotomy versus no laparotomy staging for a hypothetical cohort of 25-year-old patients with clinical stages I and II, favorable-prognosis HD. Markov models were used to simulate the lifetime clinical course of patients, whose prognosis depended on the true pathologic stage and initial treatment. The baseline probability estimates used in the model were derived from results of published studies. Quality-of-life adjustments for procedures and treatments, as well as the various long-term health states, were incorporated. RESULTS: The life expectancy was 36.67 years for the laparotomy strategy and 35.92 years for no laparotomy, yielding a net expected benefit of 0.75 years for laparotomy staging. The corresponding quality-adjusted life expectancies for the two strategies were 35.97 and 35.38 quality-adjusted life years (QALYs), respectively, resulting in a net expected benefit of laparotomy staging of 0.59 QALYs. Sensitivity analysis showed that the decision of laparotomy versus no laparotomy was most heavily influenced by the quality-of-life weight assigned to the postlaparotomy state. CONCLUSION: Our model predicted that on average, for a 25-year-old patient, proceeding with staging laparotomy resulted in a gain in life expectancy of 9 months, or 7 quality-adjusted months. These results suggest that a role remains for surgical staging in the management of early-stage HD. (+info)
In 1997, a total of 2,314,245 deaths were registered in the United States-445 fewer than the record high of 2,314,690 in 1996. The overall age-adjusted death rate was 479.1 per 100,000 standard (1940) population, the lowest ever recorded. In 1997, nearly two thirds of deaths resulted from heart disease, cancer, and stroke. This report summarizes mortality patterns in 1997 and compares them with patterns in 1996. National death statistics are based on information from death certificates filed in state vital statistics offices and are compiled by CDC into a national database. Cause-of-death statistics are based on the underlying cause of death. Causes of death are recorded on the death certificate by the attending physician, medical examiner, or coroner using a format specified by the World Health Organization and endorsed by CDC. (+info)
Decision analysis in nuclear medicine.
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This review focuses primarily on the methodology involved in properly reviewing the literature for performing a meta-analysis and on methods for performing a formal decision analysis using decision trees. Issues related to performing a detailed metaanalysis with consideration of particular issues, including publication bias, verification bias and patient spectrum, are addressed. The importance of collecting conventional measures of test performance (e.g., sensitivity and specificity) and of changes in patient management to model the cost-effectiveness of a management algorithm is detailed. With greater utilization of the techniques discussed in this review, nuclear medicine researchers should be well prepared to compete for the limited resources available in the current health care environment. Furthermore, nuclear medicine physicians will be better prepared to best serve their patients by using only those studies with a proven role in improving patient management. (+info)
Lifetime health and economic benefits of weight loss among obese persons.
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OBJECTIVES: This study estimated the lifetime health and economic benefits of sustained modest weight loss among obese persons. METHODS: We developed a dynamic model of the relationship between body mass index (BMI) and the risks and costs of 5 obesity-related diseases: hypertension, hypercholesterolemia, type 2 diabetes, coronary heart disease (CHD), and stroke. We then calculated the lifetime health and economic benefits of a sustained 10% reduction in body weight for men and women aged 35 to 64 years with mild, moderate, and severe obesity. RESULTS: Depending on age, gender, and initial BMI, a sustained 10% weight loss would (1) reduce the expected number of years of life with hypertension, hypercholesterolemia, and type 2 diabetes by 1.2 to 2.9, 0.3 to 0.8, and 0.5 to 1.7, respectively; (2) reduce the expected lifetime incidence of CHD and stroke by 12 to 38 cases per 1000 and 1 to 13 cases per 1000, respectively; (3) increase life expectancy by 2 to 7 months; and (4) reduce expected lifetime medical care costs of these 5 diseases by $2200 to $5300. CONCLUSIONS: Sustained modest weight loss among obese persons would yield substantial health and economic benefits. (+info)
Risks and benefits of screening for intracranial aneurysms in first-degree relatives of patients with sporadic subarachnoid hemorrhage.
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BACKGROUND: The first-degree relatives of patients who have subarachnoid hemorrhage from ruptured intracranial aneurysms are themselves at risk for subarachnoid hemorrhage. We studied the benefits and risks of screening for aneurysms in the first-degree relatives of patients with sporadic subarachnoid hemorrhage. METHODS: We screened 626 first-degree relatives (parents, siblings, or children) of 160 patients with sporadic subarachnoid hemorrhage, from a prospective series of 193 consecutive index patients. Magnetic resonance angiography was the screening tool, and conventional angiography was used as the reference test in subjects thought to have aneurysms. Six months after elective operation, outcome was assessed by means of the modified Rankin scale of neurologic function. This observational study design was combined with a decision-analysis model to estimate the effectiveness of screening. The efficiency of screening was defined by the number of relatives who needed to be screened in order to prevent one subarachnoid hemorrhage. RESULTS: Aneurysms were found in 25 of 626 first-degree relatives (4.0 percent; 95 percent confidence interval, 2.6 to 5.8 percent). Eighteen underwent surgery, which resulted in a decrease in function in 11 (disabling in 1). Five had aneurysms that were 5 to 11 mm in diameter, 11 had aneurysms that were less than 5 mm, and 2 had both small and medium-sized aneurysms. On average, surgery increased estimated life expectancy by 2.5 years for these 18 subjects (or by 0.9 month per person screened), at the expense of 19 years of decreased function per person. The number of relatives who would need to be screened in order to prevent 1 subarachnoid hemorrhage on a lifetime basis was 149, and 298 would have to be screened in order to prevent 1 fatal subarachnoid hemorrhage. CONCLUSIONS: Implementation of a screening program for the first-degree relatives of patients with sporadic subarachnoid hemorrhage does not seem warranted at this time, since the resulting slight increase in life expectancy does not offset the risk of postoperative sequelae. (+info)
Should this patient be screened for cancer?
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CONTEXT: Advances in imaging technology have provided numerous opportunities for cancer screening but have also raised numerous questions. GENERAL QUESTION: Who should be screened and how exactly should screening be performed? SPECIFIC RESEARCH CHALLENGE: If spiral computed tomography (spiral CT) were being considered for lung cancer screening, for example, important questions would need to be answered: Should nonsmokers be screened? How often should screening take place? What should the diagnostic work-up be after abnormal findings were seen on spiral CT? STANDARD APPROACH: Randomized, controlled trials (RCTs) are the most valid method for determining which medical interventions are most effective. These trials are particularly useful in the evaluation of screening because they eliminate the early detection biases that may result in groosly misleading survival statistics. POTENTIAL DIFFICULTIES: Randomized, controlled trials of screening are subject to other biases, and their results may be difficult to generalize. In addition, because they require an enormous number of participants and many years of follow-up, RCTs can be applied only to a small proportion of the questions about cancer screening. ALTERNATE APPROACH: Quantitative decision analysis can be applied to the remaining questions and help inform decision making about cancer screening. (+info)