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Death Certificates (death + certificate)
Selected AbstractsUsing Medical Examiner/Coroner-Generated Death Certificates in Research: Advantages and LimitationsJOURNAL OF FORENSIC NURSING, Issue 3 2005Steven A. Koehler certificates (DC) are often used by researchers as a valuable! data source. While the information provides a broad overview of cause and manner of death, there are limitations to DC use in research studies. [source] SMR Analysis of Historical Follow-Up Studies with Missing Death CertificatesBIOMETRICS, Issue 4 2000Werner Rittgen Summary. The evaluation of epidemiological follow-up studies is frequently based on a comparison of the number O of deaths observed in the cohort from a specified cause with the expected number E calculated from person years in the cohort and mortality rates from a reference population. The ratio SMR = 100 ×O/E is called the standardized mortality ratio (SMR). While person years can easily be calculated from the cohort and reference rates are generally available from the national statistical offices or the World Health Organization (WHO), problems can arise with the accessibility of the causes of death of the deceased study participants. However, the information that a person has died may be available, e.g., from population registers. In this paper, a statistical model for this situation is developed to derive a maximum likelihood (ML) estimator for the true (but unknown) number O* of deaths from a specified cause, which uses the known number O of deaths from this cause and the proportion p of all known causes of death among all deceased participants. It is shown that the standardized mortality ratio SMR * based on this estimated number is just SMR *= SMR/p. Easily computable confidence limits can be obtained by dividing the usual confidence limits of the SMR by the opposite limit of the proportion p. However, the confidence level , has to be adjusted appropriately. [source] Original Article: A prospective study of uric acid by glucose tolerance status and survival: the Rancho Bernardo StudyJOURNAL OF INTERNAL MEDICINE, Issue 6 2010C. K. Kramer Abstract., Kramer CK, von Mühlen D, Jassal SK, Barrett-Connor E (University of California, La Jolla, CA; and Hospital de Clinicas de Porto Alegre, RS, Brazil). A prospective study of uric acid by glucose tolerance status and survival: the Rancho Bernardo Study. J Intern Med 2010. Objectives., Little is known about uric acid (UA) levels and mortality in the context of glycaemia. We examined whether serum UA levels predict all-cause and cardiovascular disease (CVD) mortality differentially in older adults by glucose tolerance status. Design and methods., Between 1984 and 1987, 2342 community-dwelling men and women had an oral glucose tolerance test, UA measurement, and assessment of traditional CVD risk factors. We defined glucose tolerance status as normoglycaemia (NG), pre-diabetes (pre-DM), and type 2 diabetes mellitus (T2DM). Ninety per cent were followed for vital status up to 23 years. Death certificates were coded using the Ninth International Classification of Diseases. Results., Baseline age was 69.5 years; 44.4% were men. At baseline 939 had NG, 957 pre-DM, and 446 T2DM. The mean UA by glucose tolerance status was 327.1, 362.8, and 374.7 ,mol L,1. During follow-up, there were 1318 deaths 46.8% attributed to CVD. In Cox-regression analysis, each 119 ,mol L,1 (2 mg dL,1) increment in UA levels predicted an increased hazard ratio (HR) for all-cause deaths independent of age, smoking, body mass index, alcohol, physical activity, diuretic use and estimated glomerular filtration rate in all groups (NG: HR 1.25 95% CI 1.06,1.47, P =0.005; pre-DM: HR 1.20 95% CI 1.06,1.37, P = 0.04; T2DM: HR 1.20 95% CI 1.01,1.47, P = 0.04). After adjusting for CVD risk factors, the UA association with CVD mortality was significant only in the pre-DM and T2DM groups. Conclusion., All-cause mortality was independently associated with UA in all groups, but UA predicted CVD mortality only in those with abnormal glucose tolerance. [source] Identification and characterization of Kentucky self-employed occupational injury fatalities using multiple sources, 1995,2004AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2006Terry Bunn PhD Abstract Background Identification and characterization of occupational injury fatalities in self-employed workers typically relies on a single data source and thus may miss some cases. Methods Kentucky self-employed worker injury fatalities were identified using Fatality Assessment and Control Evaluation (FACE) program data (1995,2004) and compared to non self-employed worker data. Occupations and industries listed on death certificates were compared to those in which the decedent was actually engaged. Results Of 1,281 Kentucky worker injury deaths, 28% were self-employed. Death certificates failed to identify 31% of these deaths as work-related; industry and occupation were incorrectly identified in 27% and 16%, respectively. Fifty-seven percent of the deaths were in agriculture, primarily tractor-related. For Kentucky, the self-employed crude death rate was higher (27.6/100,000) than the non self-employed worker (5.4/100,000) rate or the US (11.5/100,000) self-employed rate. Conclusions Multiple information sources improve identification of self-employed status in work-related injury fatalities. Effective prevention requires accurate surveillance and examination of contributing factors. Self-employed worker injuries in high-risk industries should be more fully examined for development of effective injury prevention programs. Am. J. Ind. Med. 2006. © 2006 Wiley-Liss, Inc. [source] Analysis of Prior Health System Contacts as a Harbinger of Subsequent Fatal Injury in American IndiansTHE JOURNAL OF RURAL HEALTH, Issue 1 2005Teri L. Sanddal BS ABSTRACT: Context: Many American Indian nations, tribes, and bands are at an elevated risk for premature death from unintentional injury. Previous research has documented a relationship between alcohol-related injury and subsequent injury death among predominately urban samples. The presence or nature of such a relationship has not been documented among American Indians living in the northern plains. Purpose: The purpose of this study was to identify and characterize any association between prior injury and/or alcohol use contacts with the Indian Health Service (IHS) and subsequent alcohol-related injury death that may suggest opportunities for mitigation. Methods: Death certificates of American Indians who died from injury (ICD-9-E 800-999) in a rural IHS area over 6 consecutive years were linked to IHS acute-care facility records and toxicology reports. Deaths and prior IHS contacts were stratified by alcohol use as a contributing factor. Of the 526 injury deaths involving American Indians in the IHS area studied, 411 (78%) were successfully linked to IHS records. One hundred fifty-two of these cases met the inclusion criteria, with an additional 98 cases identified as a comparison group. Findings: No differences in alcohol use at time of death between groups with and without prior health care contact (for injury or alcohol) could be determined (81% vs 73%). A significant relationship was found between previous visits for acute or chronic alcohol use and subsequent alcohol-related fatalities (P =.01). Conclusions: Based on these findings, injury-prevention activities in the population studied should be initiated at the time of any health-system contact in which alcohol use is identified. Intervention strategies should be developed that convey the immediate risk of death from injury in these patients. [source] Mortality related to anaesthesia in France: analysis of deaths related to airway complications,ANAESTHESIA, Issue 4 2009Y. Auroy Summary Death certificates from the French national mortality database for the calendar year 1999 were reviewed to analyse cases in which airway complications had contributed to peri-operative death. Respiratory deaths (and comas) found in a previous national 1978,82 French survey (1 : 7960; 95% CI 1 : 12 700 to 1 : 5400) were compared with the death rate found in the present one: 1 : 48 200 (95% CI 1 : 140 000 to 1 : 27 500). In 1999, deaths associated with failure of the breathing circuit and equipment were no longer encountered and no death was found to be related to undetected hypoxia in the recovery unit. Deaths related to difficult intubation also occurred at a lower rate than in the previous report (1 : 46 000; 95% CI 1 : 386 000 to 1 : 13 000) in 1978,82 vs 1 : 176 000 (95% CI 1 : 714 000 to 1 : 46 000) in 1999, a fourfold reduction. In most cases, there were both inadequate practice and systems failure (inappropriate communication between staff, inadequate supervision, poor organisation). This large French survey shows that deaths associated with respiratory complications during anaesthesia have been strikingly reduced during this 15-year period. [source] Poisoning deaths among Finnish children from 1969 to 2003ACTA PAEDIATRICA, Issue 10 2009Juho E Kivistö Abstract Aim:, Trends in paediatric deaths due to poisoning are little studied. The aim of this study was to investigate the cause and secular trend of poisoning deaths among Finnish children. Methods:, Death certificates of all Finnish children aged 0,15 who died due to poisoning between 1969 and 2003 were obtained from the Statistics of Finland and analysed. Results:, During the study period, altogether 121 children aged 0,15 years died from poisoning in Finland. Among 0- to 4-year olds, the incidence of poisoning deaths declined to practically zero by the beginning of 1980s. Most of these deaths were unintentional poisonings. Among 5- to 15-year olds, the incidence of poisoning deaths varied during the study period. In this age group, up to 53% of the deaths were suicides among girls compared with 20% among boys (p = 0.017). The corresponding figures for substance abuse were 54% among boys and 9% among girls (p < 0.001). Conclusion:, Despite the declining secular trend seen in paediatric poisoning deaths in Finland from 1969 to 2003, the risk of death from both intentional and unintentional poisoning persists in children. Health programmes should be continued especially to promote well-being in families and to prevent teenage suicides and substance abuse. [source] Reporting of diabetes on death certificates using data from the UK Prospective Diabetes StudyDIABETIC MEDICINE, Issue 8 2005M. J. Thomason Abstract Aims To study the effect of age at death, sex, ethnic group, date of death, underlying cause of death and social class on the frequency of reporting diabetes on death certificates in known cases of diabetes. Methods Data were extracted from certificates recording 981 deaths which occurred between 1985 and 1999 in people aged 45 years or more who participated in the UK Prospective Diabetes Study, to which 23 English, Scottish and Northern Ireland centres contributed. Diabetes (9th revision of the International Classification of Diseases; ICD-9 250) entered on parts 1A,1C or 2A,2C of the death certificate was considered as reporting diabetes. Logistic regression analyses were used to determine independent factors associated with the reporting of diabetes. Results Diabetes was reported on 42% (419/981) of all death certificates and on 46% (249/546) of those with underlying cardiovascular disease causes. Reporting of diabetes was independently associated on all death certificates with per year of age increase (OR 1.02; 95% CI 1.001,1.04, P = 0.037), underlying cause of death (non-cardiovascular causes OR 0.76; 95% CI 0.59,0.98, P = 0.035) and social class (classes I,II OR 1.00; class III OR 1.35; 95% CI 0.96,1.89, P = 0.084, classes IV,V OR 1.48; 95% CI 1.05,2.10, P = 0.027). Stratification by age, sex, and underlying cause of death also revealed significant differences in the frequency of reporting diabetes over time. Conclusions The rate of reporting of diabetes on cardiovascular disease death certificates remains poor. This may indicate a lack of awareness of the importance of diabetes as a risk factor for cardiovascular disease. [source] Towards an understanding of the high death rate among young people with diabetes in UkraineDIABETIC MEDICINE, Issue 1 2001M. Telishevka SUMMARY Aims Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics since the late 1980s. The reasons for this increase, and the situation facing patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on their death certificate. Methods Interviews with surviving relatives or neighbours, combining elements of verbal autopsy and confidential enquiry. For those who had lived in the city of Lviv a random sample was taken. For those in rural areas a purposive sample was used to ensure coverage of more and less remote areas. Results Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified from their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypoglycaemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is officially available free of charge, most had retained supplies for use in an emergency. More than half had, at some time, purchased supplies. The large number of deaths from renal failure reflects the effective absence of renal replacement therapy for patients with diabetes. Conclusions Individuals with diabetes in Ukraine face profound challenges involving access to necessary care. Their needs require significantly more attention from policy makers. [source] Death of the first white resident of North QueenslandINTERNAL MEDICINE JOURNAL, Issue 10 2008D. Bossingham Abstract The first white resident of North Queensland's death certificate gives the final illness as ,arthritis'. This examination of contemporary records and more recent reports, together with the results of discussion with colleagues interested in medicine and history, attempts to suggest the reasons for his various symptoms and his final demise. This life story is reminiscent of a ,Boy's own' adventure with shipwrecks, survival at sea, coexistence with Aboriginal tribesmen before returning to ,white society', marriage and the start of a family. Are there lessons here for the twenty-first century physician and rheumatologist? Would the commonplace illnesses of mid nineteenth-century Queensland be very different to the problems seen in our outpatient clinics today? [source] Characteristics of anorexia nervosa-related deaths in Norway (1992,2000): Data from the National Patient Register and the Causes of Death RegisterINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 3 2005Deborah L. Reas PhD Abstract Objective This study investigated demographic and diagnostic characteristics of individuals whose medical record or death certificate indicated the presence of anorexia nervosa at the time of death. Method Two national registers, the National Patient Register (NPR) and the Causes of Death Register (CODR), were examined in Norway for anorexia nervosa-related deaths occurring across a 9-year period (1992,2000). Results The medical record or death certificate listed anorexia nervosa as a diagnosis or cause of death for 66 individuals. Rates of death were 6.46 and 9.93 per 100,000 deaths for the NPR and the CODR, respectively. A substantial percentage of deaths (43.9%) in both registers occurred at or above the age of 65 years. For the NPR, the mean age at the time of death was 61 years and 31% of deaths occurred among men. For the CODR, the mean age at the time of death was 49 years and 18% of deaths occurred among men. Discussion Potential merits and shortcomings of assessing mortality rates using register-based data without linkage to a previously identified clinical sample are discussed. © 2005 by Wiley Periodicals, Inc. [source] Agreement Between Nosologist and Cardiovascular Health Study Review of Deaths: Implications of Coding DifferencesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2009Diane G. Ives MPH OBJECTIVES: To compare nosologist coding of underlying cause of death according to the death certificate with adjudicated cause of death for subjects aged 65 and older in the Cardiovascular Health Study (CHS). DESIGN: Observational. SETTING: Four communities: Forsyth County, North Carolina (Wake Forest University); Sacramento County, California (University of California at Davis); Washington County, Maryland (Johns Hopkins University); and Pittsburgh, Pennsylvania (University of Pittsburgh). PARTICIPANTS: Men and women aged 65 and older participating in CHS, a longitudinal study of coronary heart disease and stroke, who died through June 2004. MEASUREMENTS: The CHS centrally adjudicated underlying cause of death for 3,194 fatal events from June 1989 to June 2004 using medical records, death certificates, proxy interviews, and autopsies, and results were compared with underlying cause of death assigned by a trained nosologist based on death certificate only. RESULTS: Comparison of 3,194 CHS versus nosologist underlying cause of death revealed moderate agreement except for cancer (kappa=0.91, 95% confidence interval (CI)=0.89,0.93). kappas varied according to category (coronary heart disease, kappa=0.61, 95% CI=0.58,0.64; stroke, kappa=0.59, 95% CI=0.54,0.64; chronic obstructive pulmonary disease, kappa=0.58, 95% CI=0.51,0.65; dementia, kappa=0.40, 95% CI=0.34,0.45; and pneumonia, kappa=0.35, 95% CI=0.29,0.42). Differences between CHS and nosologist coding of dementia were found especially in older ages in the sex and race categories. CHS attributed 340 (10.6%) deaths due to dementia, whereas nosologist coding attributed only 113 (3.5%) to dementia as the underlying cause. CONCLUSION: Studies that use only death certificates to determine cause of death may result in misclassification and potential bias. Changing trends in cause-specific mortality in older individuals may be a function of classification process rather than incidence and case fatality. [source] Patterns of Presentation, Diagnosis, and Treatment in Older Patients with Colon Cancer and Comorbid DementiaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Supriya K. Gupta MD Objectives: To estimate patterns of colon cancer presentation, diagnosis, and treatment according to history of dementia using National Cancer Institute (NCI) Surveillance, Epidemiology, and End-Result (SEER) Medicare data. Design: Population-level cohort study. Setting: NCI's SEER-Medicare database. Participants: A total of 17,507 individuals aged 67 and older with invasive colon cancer (Stage I-IV) were identified from the 1993,1996 SEER file. Medicare files were evaluated to determine which patients had an antecedent diagnosis of dementia. Measurements: Parameters relating to the cohort's patterns of presentation and care were estimated using logistic regressions. Results: The prevalence of dementia in the cohort of newly diagnosed colon cancer patients was 6.8% (1,184/17,507). Adjusting for possible confounders, dementia patients were twice as likely to have colon cancer reported after death (i.e., autopsy or death certificate) (adjusted odds ratio (AOR)=2.31, 95% confidence interval (CI)=1.79,3.00). Of those diagnosed before death (n=17,049), dementia patients were twice as likely to be diagnosed noninvasively than with tissue evaluation (i.e., positive histology) (AOR=2.02 95% CI=1.63,2.51). Of patients with Stage I -III disease (n=12,728), patients with dementia were half as likely to receive surgical resection (AOR=0.48, 95% CI=0.33,0.70). Furthermore, of those with resected Stage III colon cancer (n=3,386), dementia patients were 78% less likely to receive adjuvant 5-fluorouracil (AOR=0.22, 95% CI=0.13,0.36). Conclusion: Although the incidences of dementia and cancer rise with age, little is known about the effect of dementia on cancer presentation and treatment. Elderly colon cancer patients are less likely to receive invasive diagnostic methods or curative-intent therapies. The utility of anticancer therapies in patients with dementia merits further study. [source] Cause-specific mortality and death certificate reporting in adults with moderate to profound intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2009F. Tyrer Abstract Background The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Methods Cause-specific standardised mortality ratios (SMRs) and exact 95% confidence intervals were calculated by age and sex for adults with moderate to profound ID living in the unitary authorities of Leicester, Leicestershire and Rutland, UK, between 1993 and 2006. Causes of death were also studied to determine how often ID and associated conditions, such as Down syndrome, were mentioned. Results A total of 503 (17% of population) adults with ID died during the 14-year study period (30 144 person-years). Relatively high cause-specific mortality was seen for deaths caused by congenital abnormalities (SMR = 8560), diseases of the nervous system and sense organs (SMR = 1630), mental disorders (other than dementia) (SMR = 1141) and bronchopneumonia (SMR = 647). Excess deaths were also seen for diseases of the genitourinary system or digestive system, cerebrovascular disease, other respiratory infections, dementia (in men only), other circulatory system diseases (in women only) and accidental deaths (in women only). Two-fifths (n = 204; 41%) of deaths recorded in adults with ID mentioned ID or an associated condition as a contributing cause of death. Conclusions Strategies to reduce inequalities in people with ID need to focus on decreasing mortality from potentially preventable causes, such as respiratory infections, circulatory system diseases and accidental deaths. The lack of mention of ID on death certificates highlights the importance of effective record linkage and ID reporting in health and social care settings to facilitate the government's confidential inquiry into causes of death in this population. [source] Parkinson's disease mortality among male anesthesiologists and internistsMOVEMENT DISORDERS, Issue 12 2005Chava Peretz PhD Abstract Clusters of Parkinson's disease (PD) among healthcare professionals have been interpreted as evidence of an infectious etiology. Anesthetic gases have also been associated with parkinsonism symptoms and PD among patients undergoing general anesthesia. We investigated PD mortality among large cohorts of male U.S. anesthesiologists (n = 33,040) and internal medicine physicians (n = 33,044). PD mortality for any mention on a death certificate was lower than rates in U.S. men during 1979,1995 for both groups, although anesthesiologists had a significantly elevated risk for PD as underlying cause of death for 10-year follow-up. Direct comparisons of mortality between the two cohorts indicated excess PD mortality in anesthesiologists for >10-year follow-up for any mention and for underlying cause of death. These findings lend some support to the hypothesis that infectious agents or anesthetic gases may be associated etiologically with PD. © 2005 Movement Disorder Society [source] Demographic Data on the Victims of the September 11, 2001 Terror Attack on the World Trade Center, New York CityPOPULATION AND DEVELOPMENT REVIEW, Issue 3 2002Article first published online: 27 JAN 200 The magnitude of the death toll resulting from the attack on the World Trade Center is without precedent in the history of terrorist acts. Because of the scale and destructiveness of the buildings' collapse, a final list of the victims required a lengthy process, more so than was the case at the other sites of terrorist violence on the same day,at the Pentagon, Virginia (193 killed, 68 of these on American Airlines Flight 77), and near Shanksville, Pennsylvania (45 killed in the crash of United Airlines Flight 93). After the passing of a year, the list of the victims in New York, while essentially complete, is still not officially closed. On August 19, 2002, the city's medical examiner's office issued a list containing 2,819 names. Reproduced below are some data, released by the city's office of vital statistics, on the demographic characteristics of 2,723 victims (59 of these on United Airlines Flight 175 and 89 on American Airlines Flight 11) for whom a death certificate had been issued,an exacting procedure,as of August 16,2002. The cause of death, in each instance, was entered as homicide. The age distribution reflects the character of the World Trade Center,a workplace,and the time of day,early for tourist visits. The youngest victims perished as passengers in the two airplanes flown into the twin towers. [source] Mortality outcomes in pediatric rheumatology in the USARTHRITIS & RHEUMATISM, Issue 2 2010Philip J. Hashkes Objective To describe mortality rates, causes of death, and potential mortality risk factors in pediatric rheumatic diseases in the US. Methods We used the Indianapolis Pediatric Rheumatology Disease Registry, which includes 49,023 patients from 62 centers who were newly diagnosed between 1992 and 2001. Identifiers were matched with the Social Security Death Index censored for March 2005. Deaths were confirmed by death certificates, referring physicians, and medical records. Causes of death were derived by chart review or from the death certificate. Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were determined. Results After excluding patients with malignancy, 110 deaths among 48,885 patients (0.23%) were confirmed. Patients had been followed up for a mean ± SD of 7.9 ± 2.7 years. The SMR of the entire cohort was significantly decreased (0.65 [95% CI 0.53,0.78]), with differences in patients followed up for ,9 years. The SMR was significantly greater for systemic lupus erythematosus (3.06 [95% CI 1.78,4.90]) and dermatomyositis (2.64 [95% CI 0.86,6.17]) but not for systemic juvenile rheumatoid arthritis (1.8 [95% CI 0.66,3.92]). The SMR was significantly decreased in pain syndromes (0.41 [95% CI 0.21,0.72]). Causes of death were related to the rheumatic diagnosis (including complications) in 39 patients (35%), treatment complications in 11 (10%), non-natural causes in 25 (23%), background disease in 23 (21%), and were unknown in 12 patients (11%). Rheumatic diagnoses, age at diagnosis, sex, and early use of systemic steroids and methotrexate were significantly associated with the risk of death. Conclusion Our findings indicate that the overall mortality rate for pediatric rheumatic diseases was not increased. Even for the diseases and conditions associated with increased mortality, mortality rates were significantly lower than those reported in previous studies. [source] Reclassification of unexplained stillbirths using clinical practice guidelinesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009Elizabeth HEADLEY Background: Twenty-eight per cent of stillbirths in Australia remain unexplained. A clinical practice guideline (CPG) produced by the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Special Interest Group is in use to assist clinicians in the investigation and audit of perinatal deaths. Aims: To describe in a tertiary hospital using the PSANZ stillbirth investigation guidelines: (i) the distribution and classification of stillbirths, and (ii) the compliance with suggested stillbirth core investigations. Methods: Retrospective cohort of all stillbirths delivered between November 2005 and March 2008. Stillbirths were defined as no sign of life on delivery at , 20 weeks gestation or 400 g birthweight if gestation is unknown. Data were collected via the hospital Perinatal Mortality Audit Committee (PMAC). Cause of death was classified by the PSANZ Perinatal Death Classification. Results: There were 86 stillbirths (rate 7.2 per 1000 births). The percentage of unexplained stillbirths was 34% and 13% before and after CPG investigations, respectively. Unexplained stillbirths had the highest compliance with the recommended investigations. The initial cause of death documented on the death certificate was changed by the PMAC in 19 cases. The investigations most likely to prompt a change in the cause of death classification were autopsy and placental pathology. Conclusions: The percentage of unexplained stillbirths is lower than the national average in a hospital using the Perinatal Mortality Audit Guidelines. However, overall compliance is low, suggesting a targeted approach to investigation is used by clinicians despite a policy that aims to be non-selective. Autopsy and placental examination are the most useful investigations in assisting formal classification of cause of death. [source] Estimating breast cancer-specific and other-cause mortality in clinical trial and population-based cancer registry cohortsCANCER, Issue 22 2009James J. Dignam PhD Abstract BACKGROUND: To compute net cancer-specific survival rates using population data sources (eg, the National Cancer Institute's Surveillance, Epidemiology, and End Results [SEER] Program), 2 approaches primarily are used: relative survival (observed survival adjusted for life expectancy) and cause-specific survival based on death certificates. The authors of this report evaluated the performance of these estimates relative to a third approach based on detailed clinical follow-up history. METHODS: By using data from Cancer Cooperative Group clinical trials in breast cancer, the authors estimated 1) relative survival, 2) breast cancer-specific survival (BCSS) determined from death certificates, and 3) BCSS obtained by attributing cause according to clinical events after diagnosis, which, for this analysis was considered the benchmark "true" estimate. Noncancer life expectancy also was compared between trial participants, SEER registry patients, and the general population. RESULTS: Among trial patients, relative survival overestimated true BCSS in patients with lymph node-negative breast cancer; whereas, in patients with lymph node-positive breast cancer, the 2 estimates were similar. For higher risk patients (younger age, larger tumors), relative survival accurately estimated true BCSS. In lower risk patients, death certificate BCSS was more accurate than relative survival. Noncancer life expectancy was more favorable among trial participants than in the general population and among SEER patients. Tumor size at diagnosis, which is a potential surrogate for screening use, partially accounted for this difference. CONCLUSIONS: In the clinical trials, relative survival accurately estimated BCSS in patients who had higher risk disease despite more favorable other-cause mortality than the population at large. In patients with lower risk disease, the estimate using death certificate information was more accurate. For SEER data and other data sources where detailed postdiagnosis clinical history was unavailable, death certificate-based estimates of cause-specific survival may be a superior choice. Cancer 2009. © 2009 American Cancer Society. [source] Residual risk for acute stroke in patients with type 2 diabetes and hypertension in primary care: Skaraborg Hypertension and Diabetes ProjectDIABETES OBESITY & METABOLISM, Issue 5 2006K. Junga Aim:, The aim of this study was to investigate the risk of acute stroke in subgroups of patients treated for hypertension and type 2 diabetes in primary care. Methods:, Patients with hypertension only (n = 695), type 2 diabetes only (n = 181) or both (n = 240), who consecutively attended an annual control in primary care in Skara, Sweden during 1992,1993, were evaluated for cardiovascular disease risk factors and enrolled in this study. Subjects with neither hypertension nor type 2 diabetes (n = 824) who participated in a population survey in the same community served as controls. Possible events of acute stroke through 2002 were validated using hospital records and death certificates. Results:, During a mean follow-up time of 8.4 years, 190 first events of acute stroke, fatal or non-fatal, were ascertained. Risk factor levels were generally higher in all patient categories than in controls. Stroke risk was significantly increased in all male patients: hazard ratio 4.2 (95% CI 2.1,8.4) in patients with both conditions, 3.3 (1.5,7.0) in those with type 2 diabetes alone and 2.8 (1.5,5.3) in those with hypertension alone (adjusted for age, total cholesterol, current smoking, BMI and physical activity). Corresponding findings in women were 2.9 (1.5,5.8) in patients with type 2 diabetes only and 2.4 (1.2,4.7) in those with both conditions. However, in women with hypertension only, a significant risk was seen first when subjects were truncated at 85 years of age. There were too few fatal stroke events for conclusive results on stroke mortality. Conclusions:, A considerable risk of acute stroke remains in patients with type 2 diabetes and hypertension. Strategies for stricter multiple risk factor interventions should be implemented in primary care. [source] How many cases of Type 2 diabetes mellitus are due to being overweight in middle age?DIABETIC MEDICINE, Issue 1 2007Evidence from the Midspan prospective cohort studies using mention of diabetes mellitus on hospital discharge or death records Abstract Aims To relate body mass index (BMI) in middle age to development of diabetes mellitus. Methods Participants were 6927 men and 8227 women from the Renfrew/Paisley general population study and 3993 men from the Collaborative occupational study. They were aged 45,64 years and did not have reported diabetes mellitus. Cases who developed diabetes mellitus, identified from acute hospital discharge data and from death certificates in the period from screening in 1970,1976 to 31 March 2004, were related to BMI at screening. Results Of Renfrew/Paisley study men 5.4%, 4.8% of women and 5% of Collaborative study men developed diabetes mellitus. Odds ratios for diabetes mellitus were higher in the overweight group (BMI 25 to < 30 kg/m2) than in the normal weight group (BMI 18.5 to < 25 kg/m2) and highest in the obese group (BMI , 30 kg/m2). Compared with the normal weight group, age-adjusted odds ratios for overweight and obese Renfrew/Paisley men were 2.73 [95% confidence interval (CI) 2.05, 3.64] and 7.26 (95% CI 5.26, 10.04), respectively. Further subdividing the normal, overweight and obese groups showed increasing odds ratios with increasing BMI, even at the higher normal level. Assuming a causal relation, around 60% of cases of diabetes could have been prevented if everyone had been of normal weight. Conclusions Overweight and obesity account for a major proportion of diabetes mellitus, as identified from hospital discharge and death records. With recent increases in the prevalence of overweight, the burden of disease related to diabetes mellitus is likely to increase markedly. Primordial prevention of obesity would be a major strategy for reducing the incidence of diabetes mellitus in populations. [source] Reporting of diabetes on death certificates using data from the UK Prospective Diabetes StudyDIABETIC MEDICINE, Issue 8 2005M. J. Thomason Abstract Aims To study the effect of age at death, sex, ethnic group, date of death, underlying cause of death and social class on the frequency of reporting diabetes on death certificates in known cases of diabetes. Methods Data were extracted from certificates recording 981 deaths which occurred between 1985 and 1999 in people aged 45 years or more who participated in the UK Prospective Diabetes Study, to which 23 English, Scottish and Northern Ireland centres contributed. Diabetes (9th revision of the International Classification of Diseases; ICD-9 250) entered on parts 1A,1C or 2A,2C of the death certificate was considered as reporting diabetes. Logistic regression analyses were used to determine independent factors associated with the reporting of diabetes. Results Diabetes was reported on 42% (419/981) of all death certificates and on 46% (249/546) of those with underlying cardiovascular disease causes. Reporting of diabetes was independently associated on all death certificates with per year of age increase (OR 1.02; 95% CI 1.001,1.04, P = 0.037), underlying cause of death (non-cardiovascular causes OR 0.76; 95% CI 0.59,0.98, P = 0.035) and social class (classes I,II OR 1.00; class III OR 1.35; 95% CI 0.96,1.89, P = 0.084, classes IV,V OR 1.48; 95% CI 1.05,2.10, P = 0.027). Stratification by age, sex, and underlying cause of death also revealed significant differences in the frequency of reporting diabetes over time. Conclusions The rate of reporting of diabetes on cardiovascular disease death certificates remains poor. This may indicate a lack of awareness of the importance of diabetes as a risk factor for cardiovascular disease. [source] Towards an understanding of the high death rate among young people with diabetes in UkraineDIABETIC MEDICINE, Issue 1 2001M. Telishevka SUMMARY Aims Published rates of deaths attributed to diabetes mellitus among those aged under 50 have risen substantially in several former Soviet republics since the late 1980s. The reasons for this increase, and the situation facing patients with diabetes in these countries are poorly understood. The aim of this study was to describe the circumstances leading up to the death of individuals dying under the age of 50 years with mention of diabetes on their death certificate. Methods Interviews with surviving relatives or neighbours, combining elements of verbal autopsy and confidential enquiry. For those who had lived in the city of Lviv a random sample was taken. For those in rural areas a purposive sample was used to ensure coverage of more and less remote areas. Results Key informants were identified and agreed to be interviewed for 64 individuals out of a possible 79 with insulin-treated diabetes identified from their death certificates. The main immediate causes of death were renal failure (69%), ischaemic heart disease (9%), ketoacidosis (6%) and hypoglycaemia (3%). Over a third of men, but no women, were reported to have been heavy drinkers. Informants described many difficulties in obtaining regular supplies of insulin and related supplies since 1990. Although insulin is officially available free of charge, most had retained supplies for use in an emergency. More than half had, at some time, purchased supplies. The large number of deaths from renal failure reflects the effective absence of renal replacement therapy for patients with diabetes. Conclusions Individuals with diabetes in Ukraine face profound challenges involving access to necessary care. Their needs require significantly more attention from policy makers. [source] Trends in Parkinson's disease related mortality in England and Wales, 1993,2006EUROPEAN JOURNAL OF NEUROLOGY, Issue 9 2009A. Q. N. Mylne Background:, This paper describes changes in Parkinson's disease (PD) mortality in England and Wales between 1993 and 2006 using all information on death certificates. Methods:, Information on deaths was obtained from the Office for National Statistics. Mortality rates for any mention of PD on death certificates were directly age-standardized using the European standard population. Average yearly changes in mortality rates were estimated using linear regression. The underlying cause of death on death certificates where PD was mentioned was examined by sex and calendar period. Results:, Male PD age-standardized mortality rates for any mention of PD decreased from 15.0 to 11.7 per 100 000 between 1993 and 2006. Female PD mortality rates fell from 6.3 to 4.9 per 100 000. Decreases were greater for older age-groups. The proportion of deaths with PD recorded as the underlying cause increased by 50% in 2001 following implementation of the 10th revision of the International Classification of Diseases (ICD). Conclusion:, Parkinson's disease mortality rates in England and Wales are decreasing, especially for men and for older age-groups. Because of data limitations we are unable to ascertain whether the decrease of PD recorded on death certificates is because of a reduction in PD incidence, or to improved survival for PD patients resulting from advancements in PD treatments or to improvements in general medical care. The dramatic increase in PD as the underlying cause of death following ICD revision in 2001 demonstrates the dangers of using underlying cause of death to investigate mortality trends without being aware of the potential for artifacts. [source] Trends of mortality and causes of death among HIV-infected patients in Taiwan, 1984,2005HIV MEDICINE, Issue 7 2008C-H Yang Background The aim of this study was to analyse the trends of mortality and causes of death among HIV-infected patients in Taiwan from 1984 to 2005. Methods Registered data and death certificates for HIV-infected patients from Taiwan Centers for Disease Control were reviewed. Mortality rate and causes of deaths were compared among patients whose HIV diagnosis was made in three different study periods: before the introduction of highly active antiretroviral therapy (HAART) (pre-HAART: from 1 January 1984 to 31 March 1997), in the early HAART period (from 1 April 1997 to 31 December 2001), and in the late HAART period (from 1 January 2002 to 31 December 2005). A subgroup of 1161 HIV-infected patients (11.4%) followed at a university hospital were analysed to investigate the trends of and risk factors for mortality. Results For 10 162 HIV-infected patients with a mean follow-up of 1.97 years, the mortality rate of HIV-infected patients declined from 10.2 deaths per 100 person-years (PY) in the pre-HAART period to 6.5 deaths and 3.7 deaths per 100 PY in the early and late HAART periods, respectively (P<0.0001). For the 1161 patients followed at a university hospital (66.8% with CD4 count <200 cells/,L), HAART reduced mortality by 89% in multivariate analysis, and the adjusted hazard ratio for death was 0.28 (95% confidence interval 0.24, 0.33) in patients enrolled in the late HAART period compared with those in the pre-HAART period. Seventy-six per cent of the deaths in the pre-HAART period were attributable to AIDS-defining conditions, compared with 36% in the late HAART period (P<0.0001). The leading causes of non-AIDS-related deaths were sepsis (14.7%) and accidental death (8.3%), both of which increased significantly throughout the three study periods. Compared with patients acquiring HIV infection through sexual contact, injecting drug users were more likely to die from non-AIDS-related causes. Conclusions The mortality of HIV-infected patients declined significantly after the introduction of HAART in Taiwan. In the HAART era, AIDS-related deaths decreased significantly while deaths from non-AIDS-related conditions increased. [source] Shift in the burden of cancer towards older people , a retrospective population-based studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2007S. Ahmad Summary Cancer is age-related. However, oncology and palliative medicine services focus on the needs of younger and middle-aged adults. This study examined trends in cancer deaths across age in Wales over the last 20 years. All Wales death certificates from 1981 to 2001 were examined for total and cancer deaths. Place of death and age were noted. Total deaths decreased from 35 015 in 1981 to 32 966 in 2001 while cancer deaths increased from 7369 (21.1% of all deaths) to 8292 (25.2%). Deaths due to cancer increased in the over 85 years from 9.1% to 13.1%, 75,84 years (17.1,25.2%), 65,74 years (25,35.7%), 45,64 years (33.5,40.4%) and fell from 18.3% to 16.1% in those under 44 years. Cancer deaths over 75 years increased from 33.6% of cancer deaths in 1981 to 50.1% in 2001. Cancer deaths in the community decreased from 2713 in 1981 to 2153 in 2001 and increased in hospital from 4398 to 5185 and care homes from 258 to 954. The increase in hospital cancer deaths is mainly because of 75,84 year olds (1207,1840), and the over 85 years (294,740). Half of all cancer deaths are now in those over 75 years. Cancer deaths have shifted from the community to hospital and care homes mainly because of cancer in older people. Services need to be developed to target this population. [source] Circadian Activity Rhythms and Mortality: The Study of Osteoporotic FracturesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2010Gregory J. Tranah PhD OBJECTIVES: To determine whether circadian activity rhythms are associated with mortality in community-dwelling older women. DESIGN: Prospective study of mortality. SETTING: A cohort study of health and aging. PARTICIPANTS: Three thousand twenty-seven community-dwelling women from the Study of Osteoporotic Fractures cohort (mean age 84). MEASUREMENTS: Activity data were collected using wrist actigraphy for a minimum of three 24-hour periods, and circadian activity rhythms were computed. Parameters of interest included height of activity peak (amplitude), midline estimating statistic of rhythm (mesor), strength of activity rhythm (robustness), and time of peak activity (acrophase). Vital status, with cause of death adjudicated through death certificates, was prospectively ascertained. RESULTS: Over an average of 4.1 years of follow-up, there were 444 (14.7%) deaths. There was an inverse association between peak activity height and all-cause mortality rates, with higher mortality rates observed in the lowest activity quartile (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.63,2.92) than in the highest quartile after adjusting for age, clinic site, race, body mass index, cognitive function, exercise, instrumental activity of daily living impairments, depression, medications, alcohol, smoking, self-reported health status, married status, and comorbidities. A greater risk of mortality from all causes was observed for those in the lowest quartiles of mesor (HR=1.71, 95% CI=1.29,2.27) and rhythm robustness (HR=1.97, 95% CI=1.50,2.60) than for those in the highest quartiles. Greater mortality from cancer (HR=2.09, 95% CI=1.04,4.22) and stroke (HR=2.64, 95% CI=1.11,6.30) was observed for later peak activity (after 4:33 p.m.; >1.5 SD from mean) than for the mean peak range (2:50,4:33 p.m.). CONCLUSION: Older women with weak circadian activity rhythms have higher mortality risk. If confirmed in other cohorts, studies will be needed to test whether interventions (e.g., physical activity, bright light exposure) that regulate circadian activity rhythms will improve health outcomes in older adults. [source] Plasma Carboxymethyl-Lysine, an Advanced Glycation End Product, and All-Cause and Cardiovascular Disease Mortality in Older Community-Dwelling AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Richard D. Semba MD OBJECTIVES: To determine whether older adults with high plasma carboxymethyl-lysine (CML), an advanced glycation end product, are at higher risk of all-cause and cardiovascular disease (CVD) mortality. DESIGN: Prospective cohort study. SETTING: Population-based sample of adults aged 65 and older residing in Tuscany, Italy. PARTICIPANTS: One thousand thirteen adults participating in the Invecchiare in Chianti study. MEASUREMENTS: Anthropometric measures, plasma CML, fasting plasma total, high-density and low-density lipoprotein cholesterol, triglycerides, glucose, creatinine. Clinical measures: medical assessment, diabetes mellitus, hypertension, coronary heart disease, heart failure, stroke, cancer. Vital status measures: death certificates and causes of death according to the International Classification of Diseases. Survival methods were used to examine the relationship between plasma CML and all-cause and CVD mortality, adjusting for potential confounders. RESULTS: During 6 years of follow-up, 227 (22.4%) adults died, of whom 105 died with CVD. Adults with plasma CML in the highest tertile had greater all-cause (hazard ratio (HR)=1.84, 95% confidence interval) CI)=1.30,2.60, P<.001) and CVD (HR=2.11, 95% CI=1.27,3.49, P=.003) mortality than those in the lower two tertiles after adjusting for potential confounders. In adults without diabetes mellitus, those with plasma CML in the highest tertile had greater all-cause (HR=1.68, 95% CI=1.15,2.44, P=.006) and CVD (HR=1.74, 95% CI=1.00,3.01, P=.05) mortality than those in the lower two tertiles after adjusting for potential confounders. CONCLUSION: Older adults with high plasma CML are at higher risk of all-cause and CVD mortality. [source] Agreement Between Nosologist and Cardiovascular Health Study Review of Deaths: Implications of Coding DifferencesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2009Diane G. Ives MPH OBJECTIVES: To compare nosologist coding of underlying cause of death according to the death certificate with adjudicated cause of death for subjects aged 65 and older in the Cardiovascular Health Study (CHS). DESIGN: Observational. SETTING: Four communities: Forsyth County, North Carolina (Wake Forest University); Sacramento County, California (University of California at Davis); Washington County, Maryland (Johns Hopkins University); and Pittsburgh, Pennsylvania (University of Pittsburgh). PARTICIPANTS: Men and women aged 65 and older participating in CHS, a longitudinal study of coronary heart disease and stroke, who died through June 2004. MEASUREMENTS: The CHS centrally adjudicated underlying cause of death for 3,194 fatal events from June 1989 to June 2004 using medical records, death certificates, proxy interviews, and autopsies, and results were compared with underlying cause of death assigned by a trained nosologist based on death certificate only. RESULTS: Comparison of 3,194 CHS versus nosologist underlying cause of death revealed moderate agreement except for cancer (kappa=0.91, 95% confidence interval (CI)=0.89,0.93). kappas varied according to category (coronary heart disease, kappa=0.61, 95% CI=0.58,0.64; stroke, kappa=0.59, 95% CI=0.54,0.64; chronic obstructive pulmonary disease, kappa=0.58, 95% CI=0.51,0.65; dementia, kappa=0.40, 95% CI=0.34,0.45; and pneumonia, kappa=0.35, 95% CI=0.29,0.42). Differences between CHS and nosologist coding of dementia were found especially in older ages in the sex and race categories. CHS attributed 340 (10.6%) deaths due to dementia, whereas nosologist coding attributed only 113 (3.5%) to dementia as the underlying cause. CONCLUSION: Studies that use only death certificates to determine cause of death may result in misclassification and potential bias. Changing trends in cause-specific mortality in older individuals may be a function of classification process rather than incidence and case fatality. [source] Hospice Usage by Minorities in the Last Year of Life: Results from the National Mortality Followback SurveyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2003K. Allen Greiner MD OBJECTIVES: To examine racial/ethnic variations in rates of hospice use in a national cohort and to identify individual characteristics associated with hospice use. DESIGN: Secondary analysis of the 1993 National Mortality Followback Survey (NMFS), a nationally obtained sample using death certificates and interviews with relatives (proxy respondents) to provide mortality, social, and economic data and information about healthcare utilization in the last year of life for 23,000 deceased individuals. SETTING: Hospice care. PARTICIPANTS: Individuals aged 15 and older who died in 1993. Subjects were included in this analysis if they died of nontraumatic causes (N = 11,291). MEASUREMENTS: Hospice use was dichotomized by proxy responses indicating use or nonuse of home or inpatient hospice services. The percentage of individuals using hospice services in the last year of life was calculated. RESULTS: Unadjusted bivariate results found that African Americans were less likely to use hospice than whites (odds ratio (OR) = 0.59; P < .001) and that those without a living will (LW) (OR = 0.23; P < .001) and without a cancer diagnosis (OR = 0.28; P < .001) were less likely to use hospice. The negative relationship between African Americans and hospice use was unaffected when controlled for sex, education, marital status, existence of a LW, income, and access to health care. Logistic models revealed that presence of a LW diminished the negative relationship between African Americans and hospice use, but the latter remained significant (OR = 0.83; P = .033). A subanalysis of subjects aged 55 and older showed a significant interaction between access to care and race/ethnicity with respect to hospice use (P = .044). Inclusion of income in this multivariable logistic model attenuated the relationship between African-American race/ethnicity and hospice use (OR = 0.77), and the difference between whites and African Americans became only marginally statistically significant (P = .060). CONCLUSION: In the 1993 NMFS, hospice use was negatively associated with African-American race/ethnicity independent of income and access to healthcare. The relationship is not independent of age, insurance type, or history of stroke. For subjects aged 55 and older, access to healthcare may be an important confounder of the negative relationship between African-American race/ethnicity and hospice use. Consistent with previous studies, this analysis found that African Americans were less likely to use LWs than whites. The reduced importance of African-American race/ethnicity on hospice use with the inclusion of presence of a LW in logistic models suggests that similar cultural processes may shape differences between African Americans and whites in advance care planning and hospice use. [source] | |||||||||||||||||||||||||||||||||||||