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Official reports of death rates and other vital statistics provide useful, but sometimes incomplete, demographic information for specific research investigations concerned with mortality. Furthermore, methods for determining these statistics may be unclear and cumbersome to apply. The current paper describes formulas and logical procedures for computing proportions of deaths, death rates, and other vital statistics on combined groups. A simplified approach to finding age-adjusted death rates based on standard frequency distributions is also described. A computer program for facilitating these computations is available from the author.

Objective: To determine whether the recording of diabetes on death certificates improved from 1986 to 1993. Method: Comparison of two National Mortality Follow-back Surveys that selected independent samples of death certificates with the purpose of obtaining information from informants about the decedents. Results: The recording of diabetes on death certificates did not improve from 1986 to 1993. Conclusion: Periodic monitoring of the accuracy of death certificates is essential for proper interpretation of mortality statistics which are routinely used to describe the burden of diabetes in our society.

Il existe de nombreuses difficultes dans l'enregistrement des certificats de deces et de nombreuses propositions ont ete faites pour ameliorer la delivrance de ces certificats ainsi que la precision de leur utilisation en statistiques de routine

This study derives suicide statistics for Leicestershire for the 6—year period 1988–1993, and explores risk factors for those with current and previous psychiatric contacts. The Leicestershire Mortality Statistics were scrutinised for possible suicides. Verdicts were reviewed, with consideration of further information when available, and coded as 'definite suicide', 'probable suicide', 'suicide unlikely' and 'definitely not suicide'. For those coded as definite or probable suicide, psychiatric records were examined further. Deaths were coded as definite suicide in 420 cases and probable suicide in a further 46 cases, of these: 347 were males, and 119 were females; 160 had a history of current and previous psychiatric care; and 46 had contact with psychiatric services within 1 week of death, a further 24 within 4 weeks and 23 within the previous 3 months. For the purposes of research and audit, identification of suicides should not rely solely on coroners' verdicts; a wider definition based upon the probab...

Sudden cardiac death is assumed to be the most frequent cause of death in adults in industrialized countries. Definition of sudden cardiac death is not uniform. The differences in definition mainly rely on timing, i. e., duration of preceding symptoms, which only may be present for a few minutes up to several hours before arrest or may be simply known or unknown even to a bystander. Sometimes the term sudden cardiac death is also set equivalent to sudden arrhythmic death. In fact, a large number of problems related to the definition and also to causes and mechanisms which may lead to the clinical diagnosis of sudden cardiac death exist. In a considerable number of patients these uncertainties lead to misdiagnoses and misclassifications which in turm probably have an important impact on death certificates, mortality statistics or interpretation of the results of clinical studies. This review article discusses some of the specific questions and problems which have to be faced when diagnosing sudden cardiac death.

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

Background: The question of whether to use advanced life support (ALS) or basic life support (BLS) for trauma patients in the prehospital setting has been much debated and still lacks a clear answer. The purpose of this study was to conduct a comprehensive critical review of the literature regarding this controversy Methods: A total of 174 articles on prehospital ALS or BLS for trauma were reviewed. Fifteen of these studies were found to involve mortality statistics for both ALS- and BLS-treated patients. Odds ratios were calculated for survival in ALS versus BLS and summarized across studies on the basis of multivariate scoring systems that incorporated both design and methodological assessment. Overall odds ratios for all studies were calculated on the basis of both raw data from the papers, and weighted odds ratios were calculated from the scoring systems. Results: Six studies were scored as being methodologically average (5 favoring BLS and 1 favoring ALS), two were scored as good (1 favoring BLS and 1 favoring ALS), seven as excellent (6 favoring BLS and 1 favoring ALS). Ten studies had an average study design score (6 favoring BLS and 4 favoring ALS) and seven had a good study design score (6 favoring BLS and 1 favoring ALS). Weighted odds ratio for dying was 2.59 for patients receiving ALS compared with those receiving BLS. The crude odds ratio was 2.92. Conclusion: The aggregated data in the literature have failed to demonstrate a benefit for on-site ALS provided to trauma patients and support the scoop and run approach.

Study objective: To determine whether the distributions of age and poisoning categories for poisoning deaths are similar in death certificates as compiled by the National Center for Health Statistics (NCHS) and US poison control centers as reported by the Toxic Exposure Surveillance System (TESS). Methods: Data from both databases for 1994 were examined. Mortality data from NCHS were identified by applicable E-codes of the International Classification of Diseases–ninth revision (ICD-9). All fatalities described in the TESS report were coded to conform to the ICD-9 system. Results: A total of 16,527 poisoning deaths were recorded by NCHS; 766 deaths were reported by TESS. For NCHS and TESS, respectively, the age distribution of unintentional drug poisonings (N=7,823; 155) and unintentional non-drug poisonings (N=1,234; 102) differed ( P P P ICD-9 codes and toxins associated with poisoning deaths. Conclusion: Deaths reported in TESS represent 5% of the poisoning deaths tabulated by NCHS. Differences observed in the 2 data sets may lead to differing health policies to address poisoning hazards. [Hoppe-Roberts JM, Lloyd LM, Chyka PA. Poisoning mortality in the United States: comparison of national mortality statistics and poison control center reports. Ann Emerg Med. May 2000;35:440-448.]

William Tomison, in charge of the Hudson's Bay Company's Cumberland House on the Saskatchewan River, described the devastating smallpox epidemic of 1781 and 1782. He understood contagion, practised isolation and disinfection, and provided mortality statistics during a 'virgin soil' epidemic. Above all, he showed remarkable compassion. He and his men took dying Indians into their already crowded quarters, and provided them with food, shelter and 24 h care. This article describes the epidemic and its aftermath.

Information on fatalities from flooding in Australia has been compiled from newspapers, historical accounts, and government and scientific reports. Records covering 1788 to 1996 indicate that at least 2213 persons have been killed in floods in Australia. The overall decadal death rate has decreased from 23.98 per 100 000 population in the 1800s to 0.04 per 100 000 in the 1990s. The greatest number of fatalities has occurred in New South Wales but, taking population into account, Queensland has been the most vulnerable state historically as, more recently, has been the Northern Territory. Most fatalities have occurred during February, and amongst males (80.6 per cent). The overall male:female death and death-rate ratios are both 4:1. Whereas the male:female death-rate ratio has fluctuated over time from 10:1 to 1:1, it does not approach equality. Most fatalities (38.5 per cent) have occurred through attempts to cross creeks, bridges or roads in times of flood. Another 31.5 per cent of victims were in house...

O trabalho descreve a evolução das estatísticas de freqüência de doenças e dos instrumentos utilizados para a apresentação das mesmas. Iniciando no século XVII com as primeiras apresentações sobre causas de morte e continuando até, praticamente, a metade do século XX como estatísticas de mortalidade por causa, o instrumento para a sistematização dessas apresentações era uma classificação de causas de morte. A partir da segunda metade do século XX, além das estatísticas de mortalidade por causas, começaram a ser produzidas rotineiramente as estatísticas de morbidade hospitalar, e o instrumento para apresentação passou a ser uma classificação de doenças e não apenas de causas de morte. Mais recentemente começou a haver adaptações dessa classificação para uso de especialidades médicas, passando a existir o que se convencionou chamar "família de classificações" e entre ela se inclui uma classificação de conseqüência de doenças. O uso da classificação de doenças, seja para mortalidade como para morbidade, possibilitou a realização de numerosos estudos epidemiológicos que ampliaram o conhecimento sobre saúde.

We compared the diagnoses obtained from the routine mortality statistics with the standardized World Health Organization (WHO) MONICA (multinational MONItoring of trends and determinants in CArdiovascular disease) classification in suspect coronary heart disease (CHD) deaths registered in the FINMONICA myocardial infarction (MI) register during 1983–1992. All CHD deaths from routine mortality statistics (International Classification of Diseases codes 410–414) were registered in the MI register. Of the CHD deaths in routine mortality statistics 1.7% in men and 4.8% in women did not fulfill the MONICA criteria for CHD death (P

STUDY OBJECTIVE: To validate the Belgian vital statistics for coronary heart disease (CHD) on the basis of an independent acute myocardial infarction (AMI) register, carried out as part of the WHO-MONICA project. DESIGN: Records of fatal cases of AMI in the WHO-MONICA register were individually linked to the corresponding death certificates. SETTING: Since 1983, the WHO-MONICA Collaborating Centre Ghent/Charleroi registers all fatal and non-fatal AMI in the age group 25-69 years in two geographical areas, Ghent in the northern Dutch speaking part and Charleroi in the southern French speaking part of Belgium. Registration is done according to the MONICA protocol. The official vital statistics in Belgium are published on a yearly basis. They are essentially a reflection of the "underlying" causes of death, coded according to the 9th revision of the International Classification of Diseases (ICD). The study was undertaken in the period 1983-1991. MAIN RESULTS: Out of a total of 741 (Ghent) and 934 (Charleroi) well documented MONICA fatal cases of AMI, 492 (66.4%) and 641 (68.6%), respectively, were officially labelled as CHD (ICD code 410-414); 438 (59.1%) and 385 (41.2%), respectively, were officially labelled as AMI (ICD code 410). A substantial fraction of the MONICA AMI cases--27.1% in Ghent and 38.2% in Charleroi--was coded as "other forms of CHD" (ICD 411-414) or as "other forms of heart disease" (ICD 420-429). The remaining MONICA AMI cases--13.8% in Ghent and 20.6% in Charleroi--were classified in either very aspecific (for example, atherosclerosis, ICD 440) or totally unrelated ICD codes (for example, neoplasm, ICD 140- 239). CONCLUSIONS: It is concluded from the results in this paper that a substantial part of all deaths caused by CHD in Belgium are labelled with incorrect ICD codes and are therefore misclassified in the official mortality statistics for Belgium. This is partly caused by a "drainage" of cases towards less specific CHD related ICD categories. A considerable fraction, however, seems to be absolutely misclassified.

0bjective. This paper describes the trends in tobacco sales and smoking prevalence in the French population, estimates the consequences of smoking on the mortality of this population, and discusses governmental actions: anti-tobacco campaigns, a ban on advertising, restriction of smoking in public places, and price increases. Data sources. Sales data were collected from the French tobacco monopoly, smoking prevalence data from surveys conducted by several institutes, and mortality statistics by cause from the Institut National de la Sante et de la Recherche Medicale. Results. Tobacco sales increased from 3 g per adult per day at the beginning of the century to a maximum of 6.8 g in 1975, then decreased by 10% between 1991 and 1996. Since the early 1950s, the proportion of smokers has been on the decline in the male population and on the increase in the female population. In France, 60,000 deaths are attributable to tobacco smoking. These deaths represent 12% of the total mortality. The advertising ban has been enforced and the recent price increase has led to a drop in sales. Conclusions. The consequences of tobacco smoking on the health of the female French population will increase for another 30 years, because of the increase in female smoking observed in the recent past, whereas the epidemic is leveling off in the male population.

Since 1901, the Swiss Federal Office of Statistics has published at least each decade detailed mortality statistics from tuberculosis. These cross-sectional data on deaths from respiratory tuberculosis from 1901 to 1991 were utilized to analyse retrospectively tuberculosis death experience within each birth cohort. The cross-sectional data indicate that tuberculosis mortality increases with age in each successive decade. Nevertheless, the cohort-contour approach indicates that this phenomenon is the result of a much higher mortality that each cohort experienced in their early adulthood, and that mortality form respiratory tuberculosis in Switzerland always preferentially affected the young. The data also indicate that tuberculosis mortality in Switzerland has been decreasing for at least 160 years, and perhaps peaked as early as in the eigh-teenth century.

This paper examines total and cause-specific mortality of the Kuwaiti population through a variety of life table models. Seasonality of diseases underlying mortality was also measured using the Fourier (cosinor) analysis. Results showed significant decline in total and infant mortality. Life table analysis showed that cardiovascular disease, accidental injury and malignant disease were the main causes of death in Kuwait and that ischemic heart disease was the major component of cardiovascular disease. The Fourier analysis showed a winter peak seasonality in January for total mortality, cardiovascular and respiratory diseases, and no seasonality for malignant disease, congenital anomalies or perinatal disease. Overall, Kuwait has the seasonal timing of developed countries for total mortality, cardiovascular and respiratory diseases due to the rapid changes in the life-style of people towards westernization. In conclusion, the study demonstrated the usefulness of national mortality statistics in measuring the force of mortality, and the ability of life table methods to assess the various roles that diseases may exhibit in the death process.

A specific neonatal death certificate has been put into use in France since April 1997. It must be completed for any infants born alive and deceased between 0 and 27 days. Its content is presented together with the results of an evaluation of its use performed during a 3 month period in 1996. This certificate is aimed to improve the mortality statistics of the neonatal period, thus helping to better define the priorities in the medical care and prevention fields.

As recently as the 1992 Report of the American Thoracic Society Workshop on Lung Transplantation, no QOL facts were given and no knowledge gaps related to QOL outcomes were cited. Even at the present time, the information in that area is based on a relatively small set of preliminary reports. Current information indicates that successful lung transplantation largely reverses the energy and physical mobility deficits reported by transplant candidates and that those improvements are sustained for at least several years after transplant. Recipients report improved health perceptions, fewer problems, and greater life satisfaction than candidates. The type and amount of QOL benefit appear to differ by underlying lung disorder, and recipients who develop obliterative bronchiolitis syndrome experience declines in QOL. Lung transplantation surgery is an expensive procedure initially, and costs remain high during follow-up. Little information is available on long-term QOL outcomes or cost-effectiveness. There is a compelling rationale for QOL research in lung transplantation. At the present time, some of the most challenging problems in transplantation, such as the selection of optimal timing for transplant and choice of immunosuppression medications, do not appear to have clear-cut survival or clinical benefits. Determination of the best approach to such problems is likely to hinge on patients' perceptions of the risk-to-benefit ratio, measured by their perceived QOL. Findings from QOL research need to be developed into interventions to enhance patient outcomes. As noted by Whitehead, QOL and potentially lethal noncompliance may be linked. Can we develop immune suppressive protocols that maintain clinical benefits while minimizing QOL burdens? Pilot studies suggest that QOL can be enhanced prior to transplant, and that health-related QOL prior to transplant may predict survival and clinical outcomes. As noted by Ramsey et al, multicenter studies are needed to achieve sufficient numbers for multivariate and subset analyses and to address issues such as the impact of diagnosis (indication for transplant) on QOL outcomes and cost-effectiveness. QOL and cost measures must be incorporated into large, longitudinal, multicenter clinical trials and observational studies to address those issues.

Aim To investigate fatalities from myocardial infarction at 28 days and one-year among patients aged 35–64 years in the Nordic and Lithuanian centres participating in the World Health Organization MONICA (Monitoring of Trends and Determinants of Cardiovascular Disease) Project. Methods and results Altogether 9100 myocardial infarction events registered according to the protocol of the MONICA Project were included in the study. For these events, one-year follow-up was carried out using routine mortality statistics. Fatalities were expressed as age standardized means per year for a 3-year period from the mid-1980s. The myocardial infarction fatalities at 28 days (including out-of-hospital deaths) in the eight participating populations varied among men, between 365% (95% confidence interval 32·6–40·4%) in Iceland and 54·6% (51·2–57·9%) in Kaunas, Lithuania. Among women, it varied from 32·4% (26·4–38·4) in Iceland to 57·5% (51·8–63·2%) in Glostrup, Denmark. More than half of this mortality occurred suddenly and the patient did not reach hospital alive. Fatalities for the period from day 28 to one year varied among men, from 5·3% (2·9–7·6%) in Iceland to 10·9% (8·0–13·8%) in North Karelia, Finland, and among women from 3·5% (0·4–6·5%) in Kuopio, Finland, to 13·5% (7·2–19·7%) in Glostrup, Denmark. Conclusions Approximately half of the myocardial infarction patients died within one year after the onset of the attack and half of those who died, died out-of-hospital. While the myocardial infarction fatalities differed considerably between the participating populations, differences of this magnitude are unlikely to be totally explained by differences in the registration procedures. Further comparisons of acute coronary care and secondary prevention measures are warranted.

31 Abstract. Congenital malformations are important public health issues since malformations are expensive conditions to treat. Congenital heart disease and neural tube defects are some of the commonest congenital anomalies. Advances in the diagnosis and treatment of these conditions should be reflected in declining specific mortality rates. The Maltese mortality statistics listing congenital heart disease and neural tube defects as the primary cause of death on death certificates were analysed for evidence of such trends. This study has shown that since 1950, there has been a significant fall in mortality from congenital heart disease in Malta (r = -0.84, p < 0.0001) which has not yet levelled off. There was no such trend for neural tube defects (r = -0.27, p < 0.83). In spite of these advances, about a third of infants born with congenital malformations still die from the disorder, mainly during the perinatal period.

Aims: To assess the effect of antidepressant consumption on the rate of hospitalization for depression and suicide. Methods: The epidemiological method of descriptive and analytical observation was used in 10-year study. Hospitalization data were collected for every patient hospitalized for depression. Suicide data were obtained from mortality statistics. Data on drug utilization from Zagreb Municipal Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the WHO Anatomical-Therapeutic- Chemical methodology. On DDD/TID calculation, data from the 2001 census were used , according to which the population of Zagreb was 770 058. Results: From 2001 to 2010, the rate of hospitalization for depression was reduced from 17.3/10, 000 to 15.4/10, 000. The mean length of hospital stay was reduced from 34.9 to 31.2 days. The rate of suicide decreased from 19.9/100, 000 to 14/100, 00. From 2001 to 2010, consumption of antidepressants increased by 89, 8% (from 10.8 to 20.5 DDD/TID) in outpatient health care. The highest rise was recorded in the outpatient consumption of SSRI by 106% (from 6.9 to 14.2 DDD/TID). Outpatient consumption of nonselective inhibitors of monoamine reuptake decreased by 46% (from 3.9 to 2.1 DDD/TID). The anxiolytic/antidepressant ratio decreased from 6, 45 to 2.55. Conclusions: The rate of hospitalization for depression decreased, the mean length of hospital stay was reduced, the rate of suicide decreased, while consumption of antidepressants, especially SSRI increased. The anxiolytic/antidepressant ratio as quality indicator decreased significantly. These trends reflect an improved psychiatric management through intensive programs, outpatient follow- up, and treatment with specific antidepressants. Respective education of family physicians in clinical psychopharmacology is of utmost importance for early recognition and treatment of mild and moderate depressive disorders.

Ministry of Health of Brazil. Universidade Federal de Minas Gerais. Grupo de Epidemiologia e Avaliação em Saúde. Belo Horizonte, MG, Brasil. Pan American Health Organization. Washington, DC, USA. Universidade Federal de Minas Gerais. Grupo de Epidemiologia e Avaliação em Saúde. Belo Horizonte, MG, Brasil. Universidade Federal de Minas Gerais. Grupo de Epidemiologia e Avaliação em Saúde. Belo Horizonte, MG, Brasil. Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil. Background The number of ill-defi ned causes of death (IDCD) has been a signifi cant problem among registered causes of death in Brazil. The IDCD proportion was 14·3% in 2000, with huge regional diff erences. In 2005, the Brazilian government implemented a project in order to decrease the IDCD in states and municipalities in the poorest regions. This study aims to compare the distribution of causes of death between IDCD investigated and observed data. Methods For each death certifi cate with IDCD all attempts were made by health-service professionals to trace existing information about the fi nal disease and cause of death. The sources of information were hospital records, municipality health departments, autopsies, family health teams, and civil registry records. For deaths that occurred at home, verbal autopsy questionnaires were applied. The underlying cause of death was assigned using the documented evidence available. Findings During 2006–10, 27·6% (132 056 of 478 674) of IDCD were investigated, and 64·2% (84 751 of 132 056) of these deaths were reclassifi ed into a defi ned group of causes. Deaths from diabetes, neuropsychiatric, and maternal conditions occurred with a higher frequency among ill-defi ned causes investigated and were under-diagnosed in observed data. Injuries were also under-reported, responsible for 7·7% (6551 of 84 751) of the diagnoses among IDCD in that period. Cancer and respiratory diseases occurred with a higher frequency among registered deaths than among IDCD (16·3% vs 11·1% for cancer and 11·0 vs 7·8% for respiratory diseases) when compared with circulatory or endocrine diseases (30·6% vs 43·1% for circulatory and 6·2% vs 10·2% for endocrine diseases). Interpretation These results show that the distribution of the cause of deaths after investigation of IDCD was diff erent from those in observed data. Therefore, these diff erences must be taken into consideration when making redistribution of ill-defi ned causes based on observed data to avoid bias. The investigation of IDCD is critical to the creation of a reference for applying corrections to the observed data as well as to strategically improve the quality of mortality data.

Background and Purpose In Lithuania, only routine mortality statistics have thus far provided data on the epidemiology of stroke. This study aims to assess the mortality, incidence, and case-fatality rate of stroke in the city of Kaunas, Lithuania, during 1986 to 1988. Methods A community-based stroke register was set up in 1986 to collect data on all suspected events of acute stroke that occurred in the population aged 35 to 64 years permanently residing in Kaunas. Crude and age-standardized attack rates, incidence, mortality, and case-fatality rates were calculated for the period studied. Results Among men, the average age-standardized incidence of stroke (referring to first-ever events) was 230/100 000, the attack rate (all events) was 300/100 000, and the mortality from all strokes was 68/100 000. Among women, the corresponding rates were 131/100 000, 154/100 000, and 35/100 000, respectively. Of 973 acute stroke events registered, 80% were first-ever strokes. The age-adjusted 28-day overall case-fatality rate and the case-fatality rate of first-ever stroke were 23.3% and 19.8% in men and 21.8% and 21.3% in women, respectively. Conclusions The findings from this first assessment of the incidence and mortality of stroke show that in the mid-1980s both were high in Kaunas compared with other countries. The case-fatality rate was similar to that reported for most other European countries. Further investigations are being carried out to assess the trends in mortality, incidence, and risk factors of stroke in the Kaunas population.

Penetrating chest traumas are highly lethal injuries and those surviving to hospital have an overall mortality approaching to 80%. Reported mortality statistics vary broadly and are awfully dependent on mechanism of wounding and internal organs involved. Despite considerable advances in pre-hospital care, operative techniques and intensive care management, the mortality has not changed over several decades. Here we present a case report where a contract worker working on railway track, sustained a penetrating chest injury by a metal piece.

Las muertes por violencias son un problema de salud pública por la magnitud de su impacto social y en los servicios de salud. Se realizó un estudio descriptivo de tendencia temporal a partir de los sistemas de información oficiales nacionales de mortalidad por violencias en Argentina y Brasil en el periodo 1990-2010. Se elaboraron indicadores de la calidad de la información según sexo, edad y causa de defunción. Los resultados muestran una tendencia temporal a la mejoría de calidad en los sistemas de información. Esta tendencia se repite cuando analizamos las muertes por violencias en particular, con una disminución de los registros por muertes por violencias de intencionalidad ignorada; y un porcentaje alto de muertes por armas de fuego de intencionalidad ignorada en Argentina. El análisis de la calidad de los sistemas de información de mortalidad por violencias permite detectar problemas y orientar acciones para obtener información de mayor calidad a fin de orientar políticas públicas preventivas. Violence-related deaths are a public health issue by virtue of the magnitude of their impact on society and on the health services. A study of the descriptive temporal trend was conducted using the official national information systems of violence-related mortality in Argentina and Brazil for the period from 1990 to 2010. Indicators were created to evaluate information quality by sex, age, and cause of death. The results demonstrate a temporal trend of improvement in the quality of the information systems. This trend is repeated especially when violence-related deaths are analyzed, with a decrease in the number of records for violence-related death of undetermined intent; as well as a high percentage of firearm-related deaths of undetermined intent in Argentina. The analysis of the quality of information systems regarding violence-related deaths makes it possible to detect problems and orient actions in order to obtain better quality information and therefore permit improvement in the creation of preventive public policies.

INTRODUCTION Poor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC's health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting. METHODS From June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals. RESULTS At intervention hospitals, the proportion of death certificates that reported heart disease as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period. CONCLUSION This NYC health department's hospital-level intervention led to durable changes in COD reporting.

Background We aimed to characterize changes in patterns of new HIV diagnoses, HIV-related mortality, and HAART use in Canada from 1995 to 2008. Methods Data on new HIV diagnoses were obtained from Health Canada, HIV-related mortality statistics were obtained from Statistics Canada, and information on the number of people on HAART was obtained from the single antiretroviral distribution site in British Columbia (BC), and the Intercontinental Marketing Services Health for Ontario and Quebec. Trends of new HIV-positive tests were assessed using Spearman rank correlations and the association between the number of individuals on HAART and new HIV diagnoses were estimated using generalized estimating equations (GEE). Results A total of 34,502 new HIV diagnoses were observed. Rates of death in BC are higher than those in Ontario and Quebec with the rate being 2.03 versus 1.06 and 1.21 per 100,000 population, respectively. The number of HIV infected individuals on HAART increased from 5,091 in 1996 to 20,481 in 2008 in the three provinces (4 fold increase). BC was the only province with a statistically significant decrease (trend test p

Each year, when new annual cancer incidence and mortality statistics are published, the media are quick and happy to report that cancer mortality is reducing, despite some increases in incidence. There is a lot for the oncology community to celebrate and be proud of in these declining mortality rates and the decades of work that have produced them. However, late-phase clinical trials for anticancer drugs have the highest failure rates of all the clinical areas.1 Furthermore, those drugs that are successful often do not provide sufficient improvement on already available therapies, meaning that health-care providers often cannot afford to make them available to the patients they were designed for.2 Against this backdrop, it is time to discuss oncology clinical trials—the elephant in the room.

Summary: The FRAX tool has been calibrated to the entire Dutch population, using nationwide ( hip ) fracture incidence rates and mortality statistics from the Netherlands. Data used for the Dutch model are described in this paper. Introduction: Risk communication and decision making about whether or not to treat with anti-osteoporotic drugs with the use of T-scores are often unclear for patients. The recently developed FRAX models use easily obtainable clinical risk factors to estimate an individual's 10-year probability of a major osteoporotic fracture and hip fracture that is useful for risk communication and subsequent decision making in clinical practice. As of July 1, 2010, the tool has been calibrated to the total Dutch population. This paper describes the data used to develop the current Dutch FRAX model and illustrates its features compared to other countries. Methods: Age- and sex-stratified hip fracture incidence rates ( LMR database ) and mortality rates ( Dutch national mortality statistics ) for 2004 and 2005 were extracted from Dutch nationwide databases ( patients aged 50+ years ). For other major fractures, Dutch incidence rates were imputed, using Swedish ratios for hip to osteoporotic fracture ( upper arm, wrist, hip, and clinically symptomatic vertebral ) probabilities ( age- and gender-stratified ). The FRAX tool takes into account age, sex, body mass index ( BMI ), presence of clinical risk factors, and bone mineral density ( BMD ). Results: Fracture incidence rates increased with increasing age: for hip fracture, incidence rates were lowest among Dutch patients aged 50–54 years ( per 10,000 inhabitants: 2.3 for men, 2.1 for women ) and highest among the oldest subjects ( 95–99 years; 169 of 10,000 for men, 267 of 10,000 for women ). Ten-year probability of hip or major osteoporotic fracture was increased in patients with a clinical risk factor, lower BMI, female gender, a higher age, and a decreased BMD T-score. Parental hip fracture accounted for the greatest increase in 10-year fracture probability. Conclusion: The Dutch FRAX tool is the first fracture prediction model that has been calibrated to the total Dutch population, using nationwide incidence rates for hip fracture and mortality rates. It is based on the original FRAX methodology, which has been externally validated in several independent cohorts. Despite some limitations, the strengths make the Dutch FRAX tool a good candidate for implementation into clinical practice.

Unfortunately, mortality statistics are not available for Saudi Arabia. In the absence of such data, this paper introduces data collected on the number of deaths from coronary heart disease (CHD), considered as a proportion of the total number of deaths, for patients in six hospitals in the Eastern Province of Saudi Arabia, for each month of the years 1409H and 1410H of the Hijri lunar calendar. These proportions, the so-called proportionate mortality ratio (PMR), are categorized in terms of gender and age, and in terms of a three-level lifestyle variable; namely, rural, urban, or bedouin. The data were analyzed using logistic regression. As might be expected, female deaths from CHD are a lower proportion of total deaths than are male deaths from CHD. However, an interesting conclusion is that CHD seems to be a less prevalent recorded cause of death among bedouins than among rural or urban Saudis. Some possible reasons are discussed. The proportion of recorded CHD deaths is higher in winter months and generally increases with increasing age (except for the very old). This study suggests some hypotheses about the size of the future CHD incidence in Saudi Arabia; it a) indicates the urgent need for comprehensive data collection and b) suggests the need for an effective health care program.

Background. This research was undertaken to review the status of behavioral and psychosocial cancer research in the underserved. Methods. The author extensively reviewed the literature related to behavioral and psychosocial cancer research in the underserved for this article. The author's experience as the Principal Investigator for the only National Institutes of Health smoking cessation study targeting Asian-Americans also was used in analyzing the literature and developing an agenda for the future. Results. Two questions and accompanying agenda items were addressed. The underserved were defined, and the effect of being underserved was illustrated through their disproportionate and earlier (younger) presence in morbidity and mortality statistics

Researchers agree on the importance of discounting costs and of including mortality rates in the cost computations. The authors present a simplified mathematical model that allows both DEALE-ing and discounting and permits easy computations of accrued and incremental costs. The general formula of the accrued discounted cost of treating over time of life expectancy is: A systematic discussion of the errors involved in the DEALE approximation shows that it will in most cases truly describe the ordering of the costs of various treatments. The DEALE are compared with the costs obtained by using actual mortality statistics. It was found that when two strategies have actual costs CA and CB such as CA greater than CB and C A/CB superior to 1.25, the ordering of CA and CB will always be kept in this simplified model. Key words: DEALE; costs; economics; discounting. (Med Decis Making 1994;14:98-103)

ResumenLa diferencia en el número de defunciones debidas al SIDA entre el Registro de mortalidad y el Registro de casos en Cataluña es relativamente pequeña, como consecuencia de la colaboración entre ambos registros. Las estadísticas oficiales de mortalidad son capaces de detectar directamente el 78% de las defunciones en los casos de SIDA en Cataluña. Esta proporción puede aumentar si se tienen en cuentan las defunciones por enfermedades indicativas de SIDA. Comparando los dos registros, la proporción global de falsos positivos de las estadísticas oficiales de mortalidad es del 8,2%. El análisis de la información de los boletines estadísticos de defunción permite sugerir recomendaciones simples para mejorar el conocimiento de la mortalidad por SIDA.SummaryDifferences betwen the number of AIDS deaths reported to the mortality register and to the AIDS register in Catalonia, Spain are relatively small, due to both registers cooperation. Official mortality statistics are able to identify 78% of AIDS deaths. This proportion can be increased if the deaths caused by AIDS indicative diseases are included. The overall proportion of false positives when comparing both registers is 8.2%. Analysis of the available information from death certificates is useful to suggest simple recommendations to improve the quality of AIDS mortality data.

Background/Aims Surgical quality is typically measured using 30-day morbidity and mortality statistics – measures that are not very meaningful for procedures such as lumpectomies and mastectomies that have extremely high survival rates. The University of Vermont previously developed a single-site Breast Cancer Surgical Outcomes (BRCASO) database to capture meaningful quality measures such as breast conservation rates, positive margins rates, and number of procedures to complete breast cancer surgery. We extended the BRCASO database to three Cancer Research Network (CRN) institutions to study variation in breast cancer surgical quality across providers, facilities, and health plans.

Background: Multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) are chronic neurologic diseases for which distinct explanations of the pathogenesis are lacking. Two large Swedish register studies have rather unexpectedly detected a correlation between MS and ALS. The aim of this study was to investigate if an association between ALS and MS could be demonstrated as has been shown earlier. Material and Methods: Data on mortality from ALS and MS, 1990–2010, were collected from the Swedish National Statistics Office. In all there were 5,696 deaths due to ALS and 3,941 deaths due to MS. Age- and sex-adjusted mortality rates were calculated. Results: There was no correlation between the mortality rates of ALS and MS in the 21 counties of Sweden for the period 1990–2010 (Spearman’s rho = –0.052; p = 0.822; n = 21). The national mean mortality rate for ALS throughout the period of 1990–2010 was 2.98 per 100,000 person-years (95% CI 2.87–3.08). For MS the national mean mortality rate was 2.04 per 100,000 person-years (95% CI 1.95–2.12). Conclusion: This study did not confirm the previously shown association between MS and ALS in Sweden.

Background: Surveillance of Creutzfeldt-Jakob disease (CJD) is still an important issue because of the variant CJD epidemic, which is in decline and also because of the emergence of novel forms of animal transmissible spongiform encephalopathy with zoonotic potential and the risk of nosocomial and blood transfusion-related transmission. Active surveillance has been implemented in most European countries and requires important human resources and funding. Here, we studied whether national mortality and morbidity statistics can be used as reliable indicators. Methods: CJD data collected by the French national CJD surveillance centre were compared with data registered in the national mortality statistics. Results: From 2000 to 2008, the two sources reported fairly similar numbers of CJD deaths. However, analysis of individual data showed important between-sources disagreement. Nearly 24% of CJD reported by the mortality register were false-positive diagnoses and 21.6% of the CJD cases diagnosed by the surveillance centre were not registered as CJD in the national mortality statistics. One out of 22 variant CJD cases was not reported as having any type of CJD in the mortality statistics. Conclusions:These findings raise doubt about the possibility of a reliable CJD surveillance only based on mortality data.

Introduction The U.S. oil and gas extraction industry has an elevated occupational fatality rate when compared to other industries, and this rate is correlated to the level of activity in the industry. This paper presents an analysis of worker fatalities in the U.S. oil and gas extraction industry for the years 2003-2008 and suggests strategies to prevent fatalities among the groups of workers most at risk of being killed on the job. Description of Processes Fatality rates were calculated by year, company type, and company size. The frequency of fatal events onshore and offshore, by occupation, age group and contributing factors are also reported. Results There were 648 fatalities in the oil and gas extraction industry during 2003-2008; the majority (91%) occurred to onshore workers. Transportation-related events were the leading cause of death for all workers. Drilling contractors and companies that employed fewer than 20 workers had the highest fatality rates. Conclusions This study found that the fatality rate in the oil and gas extraction industry remained elevated through 2008. Many of the fatalities were associated with three risk factors: seat belt non-use, workers being employed by small companies, and workers having been employed less than one year by their current company. Concentrating attention on these three risk factors could significantly decrease the number and rate of occupational fatalities in the oil and gas extraction industry. The recommendations made in this paper can be implemented by companies at low or no cost and can be incorporated into existing safety and health policies and procedures.

Mortality statistics represent important endpoints in epidemiological studies. The diagnostic validity of cerebral stroke and ischemic heart disease recorded as the underlying cause of death in Norwegian mortality statistics was assessed by using mortality data of participants in the Bergen Clinical Blood Pressure Study in Norway and autopsy records from the Gade Institute in Bergen. In the 41 years of the study (1965–2005) 4,387 subjects had died and 1,140 (26%) had undergone a post mortem examination; 548 (12%) died from cerebral stroke and 1,120 (24%) from ischemic heart disease according to the mortality statistics, compared to 113 (10%) strokes and 323 (28%) coronary events registered in the autopsy records. The sensitivity and positive predictive value of fatal cerebral strokes in the mortality statistics were 0.75, 95% confidence interval (CI) [0.66, 0.83] and 0.86 [0.77, 0.92], respectively, whereas those of coronary deaths were 0.87 [0.84, 0.91] and 0.85 [0.81, 0.89] respectively. Cohen’s Kappa coefficients were 0.78 [0.72, 0.84] for stroke and 0.80 [0.76, 0.84] for coronary deaths. In addition to female gender and increasing age at death, cerebral stroke was a negative predictor of an autopsy being carried out (odds ratio (OR) 0.69, 95% CI [0.54, 0.87]), whereas death from coronary heart disease was not (OR 1.14, 95% CI [0.97, 1,33]), both adjusted for gender and age at death. There was substantial agreement between mortality statistics and autopsy findings for both fatal strokes and coronary deaths. Selection for post mortem examinations was associated with age, gender and cause of death. publishedVersion

Bu çalısmanın amacı, “Ölüm Nedeni Istatistikleri” konusundaki ilgi proje kapsamındaAdnan Menderes Üniversitesi Uygulama ve Arastırma Hastanesinde ölüm nedenlerinin iyilestirilmesi için yapılan egitim ve denetim müdahalesinin 2008 ve 2009 yılları ölüm nedeni istatistiklerinde meydana getirdigi degisimi degerlendirmektir. Çalısma, ölüm belgesinin doldurulmasına yönelik egitim ve denetim olarak tanımlanan müdahalenin, müdahale öncesi dönem olan 2008 yılı ile müdahale sonrası dönem olan 2009 yılları ölüm nedeni istatistiklerinde meydana getirdigi degisimin karsılastırılmasına dayanmaktadır. Adnan Menderes Üniversitesi Uygulama ve Arastırma Hastanesinde 2008 yılında ölüm nedeni olarak toplam 54 farklı ölüm nedeni saptanmıstır. Eriskinlerde 72 (%36,4) ve çocuklarda 19 (%65,5) olmak üzere tüm ölümlerin 91'i (%40,1) “Kardiyak Arrest /Kardiyopulmoner arrest” olarak bildirilmistir. 2009 yılında “KardiyakArrest/ Kardiyopulmoner arrest” olarak bildirim yapılmamıstır (p

Violent conflict has a grave impact on human health and well-being. Collective violence affects not only the combatants, but with increasing frequency, the civilian population as well (World Health Organization, 2002; Waldman, 2005). We have sufficient statistical data documenting the morbidity and mortality of violent conflicts to conclude that war entails terrible human loss. But beyond the quantifiable mortality statistics lies the immeasurable suffering of war’s casualties. The injured. The dead. And the bereaved. The pain of innocent victims calls for a transformation in human relations that will move us beyond this historical trajectory of anguish.

The fatal toxicity indices of benzodiazepines during the 1980s were calculated from national prescribing data and mortality statistics. The overall rate was 5.9 deaths per million prescriptions for benzodiazepines taken alone or with alcohol only, anxiolytics being less toxic than hypnotics. Diazepam appeared more toxic than average among anxiolytics (PP

Mortality statistics from five populations of small New World monkeys (includinsg Callithrix jaccus, Leontopithecus rosalia, Saguinus fuscicollis, and Saguinus oedipus) were combined to generate a standard model life table reflecting the mortality patterns of these primates. The model is applied to three individual populations to illustrate a strategy for smoothing and interpolating mortality statistics of varying completeness and quality. © 1993 Wiley-Liss, Inc.

We report a comparative study of the Standardized Mortality Ratio (SMR) for circulatory system diseases and diet in a rural town and a fishing town in Kyoto Prefecture. SMR was assessed during the 5-year period from 1983 through 1987, and compared with the standard age- and sex-adjusted demographic and mortality statistics compiled by the National Census Bureau of Japan in 1985. A food frequency questionnaire in which the respondents evaluated their food consumption during the previous 1-year period was used to assess diet. The questionnaire was administered during February 1989 in the rural town and during February 1990 in the fishing town. In comparison with the standard statistics, SMR was higher in the rural town and lower in the fishing town. The inhabitants of the fishing town more frequently consumed low-fat and low-sodium foods, such as fish, potatoes, tofu, and green, yellow and other vegetables, and less frequently consumed high-fat and high-sodium foods, such as meat, fried food, pickles, than did the inhabitants of the rural town. The residents of the fishing town also consumed a greater variety of foods in one week. The two towns differ in geography and economic structure, and their inhabitants have different life-styles and eating habits. The lower SMR for circulatory system diseases in the fishing town may be related to the greater consumption of fish and vegetables with lower meat and salt intake, as well as the balanced of diet.

1. 1. An analysis of 212 consecutive cases of ectopic pregnancy without a death is given. 2. 2. The mortality statistics of ectopic pregnancy are reviewed. 3. 3. Evaluation of therapy is made.

Changes in the legal restrictions for alcohol consumption in 1969 liberated purchasing and marketing of low-alcohol beer. Subsequently, within the space of 5 years, the per capita consumption of absolute alcohol increased from 4.2 to 6.5 liters. To evaluate the possible effects of this change upon liver cirrhosis mortality as well as prevalence of liver cirrhosis in autopsy series, we surveyed mortality statistics and data from 8,533 medicolegal autopsies in 1968 through 1988. Liver cirrhosis mortality statistics revealed a highly significant (p less than 0.001) increase from 6.4 to 13.7 per 100,000 during the period, and similarly, the prevalence of liver cirrhosis in the autopsy series showed a highly significant (p less than 0.001) increase from 3.0% to 6.1%. More specifically, this increase was attributable to a highly significantly (Chi-square 15.4, p less than 0.001) increased proportion of alcoholic liver cirrhosis occurring at a younger age and almost exclusively in males. The stepwise mode of increase as well as the changes in sex and age distribution of cirrhosis since 1969 could be interpreted as an effect of distribution of consumption to a new generation of consumers. The forensic autopsy series seemed to reflect changes in per capita consumption with a shorter time lag than with mortality statistics. Additionally, only 7% of the 448 cirrhotics singled out from this material exhibited liver cirrhosis as a cause of death and were thus also included in the official mortality statistics, suggesting the greater accuracy of our forensic autopsy series.

Mortality statistics in amyotrophic lateral sclerosis (ALS), which is more commonly and generally termed motoneurone disease (MND) in the United Kingdom, have been shown to reflect the incidence of previously diagnosed cases of the disease in a more complete way than in other conditions [1,2]. An analysis of changing patterns of mortality may therefore be a particularly appropriate way of tracing the underlying trends in the disease and is in principle a useful way of investigating the relationship between environmental and genetically controlled factors in the genesis of the condition. The majority of analyses so far have concentrated on the crude rise in reported mortality rates evident in recent decades in a number of countries [2–5], on the uneven geographical distribution [6,7] and on the complex range of plausible causes for these reported rises. Debates have centred on whether the increases represent ‘real’ or ‘artifactual’ changes, with no apparent resolution of the issue [8,3]. Recently Riggs [9] proposed a novel way of analysing this issue by using a Gompertzian model and provided evidence of the existence of an inherently susceptible subset of the US population. Riggs indicated that while the rise in ALS mortality is real, it is for the most part the result of an increase in the size of this inherently susceptible sub-population due to greater longevity. In order to examine the wider applicability of a Gompertzian model to ALS the technique has been replicated with the mortality rates for England and Wales for the 27-year period from 1963 to 1989. The technique has been developed and extended to produce an estimate of the size of the inherently susceptible sub-population (both male and female) over the entire period.