Cross-national comparison of injury mortality: Los Angeles County, California and Mexico City, Mexico.
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BACKGROUND: Cross-national comparisons of injury mortality can suggest possible causal explanations for injuries across different countries and cultures. This study identifies differences in injury mortality between Los Angeles (LA) County, California and Mexico City DF, Mexico. METHODS: Using LA County and Mexico City death certificate data for 1994 and 1995, injury deaths were classified according to the International Classification of Diseases Ninth Revision-Clinical Modification external cause of injury codes. Crude, gender-, and age-adjusted annual fatality rates were calculated and comparisons were made between the two regions. RESULTS: Overall and age-adjusted injury death rates were higher for Mexico City than for LA County. Injury death rates were found to be higher for young adults in LA County and for elderly residents of Mexico City. Death rates for motor vehicle crashes, falls, and undetermined causes were higher in Mexico City, and relatively high rates of poisoning, homicide, and suicide were found for LA County. Motor vehicle crash and fall death rates in Mexico City increased beginning at about age 55, while homicide death rates were dramatically higher among young adults in LA County. The largest proportion of motor vehicle crash deaths was to motor vehicle occupants in LA County and to pedestrians in Mexico City. CONCLUSIONS: These findings illustrate the importance of primary injury prevention in countries having underdeveloped trauma care systems and should aid in setting priorities for future work. The high frequency of pedestrian fatalities in Mexico City may be related to migration of rural populations, differing vehicle characteristics and traffic patterns, and lack of safety knowledge. Mexico City's higher rate of fall-related deaths may be due to concurrent morbidity from chronic conditions, high-risk environments, and delay in seeking medical treatment. (+info)
Effects of a community-wide health education program on cardiovascular disease morbidity and mortality: the Stanford Five-City Project.
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The authors examined changes in morbidity and mortality from 1979 through 1992 during the Stanford Five-City Project, a comprehensive community health education study conducted in northern California. The intervention (1980-1986), a multiple risk factor strategy delivered through multiple educational methods, targeted all residents in two treatment communities. Potentially fatal and nonfatal myocardial infarction and stroke events were identified from death certificates and hospital records. Clinical information was abstracted from hospital charts and coroner records; for fatal events, it was collected from attending physicians and next of kin. Standard diagnostic criteria were used to classify all events, without knowledge of the city of origin. All first definite events were analyzed; denominators were estimated from 1980 and 1990 US Census figures. Mixed model regression analyses were used in statistical comparisons. Over the full 14 years of the study, the combined-event rate declined about 3% per year in all five cities. However, during the first 7-year period (1979-1985), no significant trends were found in any of the cities; during the late period (1986-1992), significant downward trends were found in all except one city. The change in trends between periods was slightly but not significantly greater in the treatment cities. It is most likely that some influence affecting all cities, not the intervention, accounted for the observed change. (+info)
Linking death reports from the Malaysian Family Life Survey-2 with birth and death certificates.
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The Malaysian Family Life Survey--2 (MFLS-2) was a population-based survey conducted in Peninsular Malaysia in 1988-89. Through detailed birth histories, it attempted to collect information on all pregnancies and their outcomes from ever-married women, as well as socioeconomic and health services-utilization data that might have affected mortality. The survey did not, however, collect information on the causes of infant death. The two objectives of this study were to assess the feasibility of linking all reported deaths among live births of women interviewed in the MFLS-2 to the birth and death certificates kept by the National Registration Department, and to determine the causes of death from the successfully matched death certificates. This information could be used in the development of specific health programs to decrease infant and child mortality. In this study, the success rates for linking survey data to birth and death certificates were 34.5% and 31.8% respectively. Methodological problems faced during the study are discussed, as are the strengths and limitations of record linking as a means of increasing the utility of birth histories for studying the causes of death. Ways to improve linkage rates of survey data with the national birth and death registration are also suggested. (+info)
Time series analysis of air pollution and mortality: effects by cause, age and socioeconomic status.
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OBJECTIVE: To investigate the association between outdoor air pollution and mortality in Sao Paulo, Brazil. DESIGN: Time series study METHODS: All causes, respiratory and cardiovascular mortality were analysed and the role of age and socioeconomic status in modifying associations between mortality and air pollution were investigated. Models used Poisson regression and included terms for temporal patterns, meteorology, and autocorrelation. MAIN RESULTS: All causes all ages mortality showed much smaller associations with air pollution than mortality for specific causes and age groups. In the elderly, a 3-4% increase in daily deaths for all causes and for cardiovascular diseases was associated with an increase in fine particulate matter and in sulphur dioxide from the 10th to the 90th percentile. For respiratory deaths the increase in mortality was higher (6%). Cardiovascular deaths were additionally associated with levels of carbon monoxide (4% increase in daily deaths). The associations between air pollutants and mortality in children under 5 years of age were not statistically significant. There was a significant trend of increasing risk of death according to age with effects most evident for subjects over 65 years old. The effect of air pollution was also larger in areas of higher socioeconomic level. CONCLUSIONS: These results show further evidence of an association between air pollution and mortality but of smaller magnitude than found in other similar studies. In addition, it seems that older age groups are at a higher risk of mortality associated with air pollution. Such complexity should be taken into account in health risk assessment based on time series studies. (+info)
Maternal socioeconomic characteristics and infant mortality from injuries in the Czech Republic 1989-92.
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OBJECTIVES: Infant and childhood mortality from injuries in Central and Eastern Europe is high but little is known about its determinants. This study examined whether maternal socioeconomic characteristics predict infant mortality from injuries in the Czech Republic. METHODS: Data on all live births registered in the Czech Republic 1989-91 (n=387 496) were linked with the national death register, 1989-92, using the unique national identification number. Effects of maternal socioeconomic characteristics, birth weight and gestational age, recorded in the birth register, on the risk of death from external causes (ICD-9 800-999) were estimated using logistic regression. RESULTS: Of the 195 linked infant deaths from external causes (rate 50/100000 live births), 73% were from suffocation. After controlling for other factors, the risk of death was higher in boys, declined with increasing maternal education (odds ratio for primary v university education 3.5, 95% confidence interval 1.5 to 8.6), maternal age, birth weight and gestational age, and was increased in infants of unmarried mothers and of mothers with higher parity. The effect of education appeared stronger in married mothers and in mothers of low parity. CONCLUSION: The risk of infant death from external causes in this population was strongly associated with maternal and family characteristics. (+info)
Effect of an older sibling and birth interval on the risk of childhood injury.
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OBJECTIVE: Certain family structures have been identified as putting children at high risk for injury. To further define children at highest risk, we set out to explore the effect of an older sibling and birth interval on the risk of injury related hospital admission or death. METHODS: Data were analyzed using a case-control design. Cases and controls were identified by linking longitudinal birth data from Washington state (1989-96) to death certificate records and hospital discharge data obtained from the Washington State Comprehensive Hospital Abstract Reporting System and frequency matched in a 1:2 ratio on year of birth. Cases consisted of singleton children 6 years of age or younger who were hospitalized or died as a result of injury during the years 1989-96. Multivariate logistic regression was used to identify and adjust for confounding variables. RESULTS: There were 3145 cases and 8371 controls. The adjusted odds ratio for injury in children with an older sibling was 1.50 (95% confidence interval 1.37 to 1.65). The effect was greatest in children under 2 years of age, and in those with a birth interval of less than two years. As the number of older siblings increased, so did the risk of injury, with the highest risk in children with three or more older siblings. CONCLUSION: These data suggest that the presence of an older sibling is associated with an increased risk of injury. The risk is highest in those with very short birth intervals. Potential mechanisms for this increased risk may relate to inadequate parental supervision. Pediatricians and other care providers need to be alert to these identifiable risk factors and then direct preventive strategies, such as home visits and educational programs, toward these families. (+info)
Long-term survival, place of death, and death certification in clinically diagnosed pre-senile dementia in northern England. Follow-up after 8-12 years.
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BACKGROUND: Information on survival and cause of death in pre-senile dementia is scarce and the organisation of services controversial. AIMS: To study survival, place of death and death certification in pre-senile dementia. METHOD: Patients aged 45-64 were identified from hospital and community sources in the Northern health region (1985-89) and classified as having pre-senile dementia of Alzheimer type (PDAT) or pre-senile vascular dementia (PVD) by applying an algorithm to case notes. Deaths were ascertained from the National Health Service Central Registry (NHSCR) to 31 December 1998. Survival analysis was performed using the SPSS/PC program, and expected survival calculated from life tables. RESULTS: Median survival time from diagnosis was 6.08 years and did not differ significantly in PDAT and PVD, or by age or gender; 19.3% of deaths occurred at home, 24.5% in nursing or residential homes and 56.3% in hospital; 72.4% of the death certificates mentioned dementia or Alzheimer's disease; 15.4% were still alive. CONCLUSIONS: Pre-senile dementia has a variable but usually chronic course, requiring appropriate planning and services. (+info)
Errors in registered birth weight and its implications for mortality statistics.
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BACKGROUND: Birth weight mortality statistics are important for examining trends and monitoring the outcomes of neonatal care. AIM: To determine the effects of errors in the registered birth weight on birth weight specific mortality. METHODS: All twins born in England and Wales during 1993-95 comprise the denominator population. For those twins that died, the Office for National Statistics (ONS) provided copies of the death certificates. From the information on the death certificates, the registered birth weight was validated and amended using predetermined rules. The neonatal, postneonatal, and infant mortality rates were recalculated. RESULTS: In 2.5% of cases the registered birth weight was "not stated" and in others there were miscoding errors. Important differences between published and amended birth weight specific mortality rates especially in <500 g and >/=3500 g groups were evident. CONCLUSIONS: The bias arising from these errors should be taken into account in interpreting mortality rates and their trends. (+info)