Premature mortality in Slovenia in relation to selected biological, socioeconomic, and geographical determinants.
Department of Public Health, University School of Medicine, Ljubljana, Slovenia. firstname.lastname@example.org
AIM To determine biological (sex and age), socioeconomic (marital status, education, and mother tongue) and geographical (region) factors connected with causes of death and lifespan (age at death, years-of-potential-life-lost, and mortality rate) in Slovenia in the 1990s. METHODS In this population-based cross-sectional study, we analyzed all deaths in the 25-64 age group (N=14 816) in Slovenia in 1992, 1995, and 1998. Causes of death, classified into groups according to the 10th revision of International Classification of Diseases, were linked to the data on the deceased from the 1991 Census. Stratified contingency-table analyses were performed. Years-of-potential-life-lost (YPLL) were calculated on the basis of population life-tables stratified by region and linearly modeled by the characteristics of the deceased. Poisson regression was applied to test the differences in mortality rate. RESULTS Across all socioeconomic strata, men died at younger age than women (index of excess mortality in men exceeded 200 for all studied years) and from different prevailing causes (injuries in men aged <45 years; neoplasms in women aged >35 years). For men, higher education was associated with fewer deaths from digestive and respiratory system diseases. The least educated women died relatively often from circulatory diseases, but rarely from neoplasms. Single people died from neoplasms less often. Marriage in comparison with divorce reduced the mortality rate by 1.9-fold in both men and women (P<0.001). Mortality rate in both men and women decreased with increasing education level (P<0.001). Mortality rate of ethnic Slovenians was half the mortality rate of ethnic minority members and immigrants (P<0.001). Analysis of YPLL revealed limited and nonlinear impact of education level on premature mortality. The share of neoplasms was the highest in the cluster of socioeconomically prosperous regions, whereas the share of circulatory diseases was increased in poorer regions. Significant differences were found between individual regions in age at death and mortality rate, and the differences decreased over the studied period. CONCLUSION These data may aid in understanding the nature, prevalence and consequences of mortality as related to socioeconomic inequalities, and thus serve as a basis for setting health and social policy goals and planning health measures.
A case-control analysis of socio-economic and marital status differentials in alcohol- and non-alcohol-related mortality among working-age Russian males.
Department of Criminal Justice, Indiana University, Bloomington, IN 47401, USA. email@example.com
BACKGROUND We examined the role of socio-economic status (SES) and marital status in premature mortality among working-age Russian males. Life expectancy among this group dropped sharply following the collapse of the Soviet Union and has yet to recover despite the relative economic and political stability of the last decade. METHODS We employed individual-level data from a large-scale, population-based, case-control study (n = 3500). Adjusting for age group, hazardous drinking and smoking status, we estimated mortality odds ratios to determine the impact of SES and marital status on premature mortality due to all, alcohol- and non-alcohol-related causes of death. RESULTS Results revealed clear protective effects of SES and marital status against premature mortality. Although the effects for marital status were significant across alcohol- and non-alcohol-related causes of death, the effects of SES were largely limited to non-alcohol-related causes of death. When heavy drinkers were excluded from the analysis, however, SES was found to protect against premature mortality for alcohol-related causes. CONCLUSION While hazardous drinking is known to be a leading cause of premature mortality among working-age Russian males, it is unwise to ignore other factors. Given the substantial social and economic impacts in Russia of the dissolution of the Soviet Union, it is important to examine the health effects of SES and marital status and other social forces in the nation. Our results reveal that while Russia has a very different past in terms of medicine, public health and economic institutions, it currently faces public health threats that follow similar patterns to those found in Western nations.
Department of Social Medicine, Faculty of Public Health, Kaunas University of Medicine, A. Mickevicius St 9, LT-44307 Kaunas, Lithuania. firstname.lastname@example.org
OBJECTIVES To analyse the changes in mortality inequalities by marital status over the period of socio-economic transition in Lithuania and to estimate the contribution of major causes of death to marital-status differences in overall mortality. METHODS A survey based on routine mortality statistics and census data for 1989 and 2001 for the entire country. RESULTS The proportion of married population has declined over the past decade. Widowed men and never married women were found to be at highest risk of mortality throughout the period under investigation. Although inequalities have not grown considerably, mortality rates have increased significantly for divorced populations and for never married men, widening the mortality gap. Cardiovascular diseases contributed most to excess mortality of never married and divorced men, as well as all unmarried groups of women. The excess mortality of widowed men from external causes was greatest in 2001. CONCLUSIONS Marriage can be considered as a health protecting factor, particularly in relation to mortality from cardiovascular diseases and external causes. Local and national policies aimed at health promotion must focus primarily on improving the position of unmarried groups and providing psychological support.
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Int J Public Health. 2012 Nov 7;: 23132128
Education and training of public health professionals in the European Region: variation and convergence.
Faculty of Medicine, Centre School of Public Health and Management, University of Belgrade, Belgrade, Serbia, email@example.com.
OBJECTIVES: To assess the exit competences of public health graduates across a diverse European landscape. METHODS: The target population comprised 80 full institutional members of the Association of Schools of Public Health in the European Region with a participation rate 82.5 %. The web-based questionnaire covered institutional profiles and the ranking of exit competences for master of public health programmes, grouped according to WHO Essential Public Health Operations. RESULTS: European schools and departments usually are small units, funded from tax money. A total of 130 programmes have been indicated, together releasing 3,035 graduates in the last year before the survey. All competence groups showed high reliability and high internal consistency (α > 0.75, p < 0.01). The best teaching output has been assessed for health promotion, followed by disease prevention and identification of health hazards in the community, the least in emergency preparedness. CONCLUSIONS: Given the fragmentation of the institutional infrastructure, the harmonisation of programme content and thinking is impressive. However, the educational capacity in the European Region is far from being sufficient if compared to aspired US levels.
Time trends in prescribing habits of anxiolytics and antidepressants in Slovenian family practices (with emphasis on elderly patients).
National Institute of Public Health of Slovenia, Ljubljana, Slovenia.
The aim of the study was to investigate prescription of anxiolytics and antidepressants among Slovenian family physicians regarding drug class with an emphasis on the elderly population and possible time-trends. Exploratory survey and register-based analysis of anxiolytic and antidepressant prescriptions of one hundred family physicians in Slovenia was performed in 2005 and 2008. Drugs included in the study were classified according to the Anatomical-Therapeutic-Chemical (ATC) drug classification system, and ATC data were used to calculate defined daily doses (DDD) per 1,000 practice population per day. The most often prescribed anxiolytics and antidepressants were identified and anxiolytic/antidepressant ratio was estimation by patient age-group for the two studied years. Benzodiazepines showed highest share in the overall utilization of psychotropic drugs. The ratio between short- and long-acting benzodiazepines decreased by about one tenth during the observed period. Long-acting benzodiazepines were prescribed more often to the older patients. The decrease in anxiolytic/antidepressant ratio from 2005 to 2008 was the smallest in the elderly population. Further research is needed to ascertain the prescribers' attitudes in order to devise strategies to further improve prescribing performance in elderly patients.
Therapeutic electric stimulation does not affect immune status in healthy individuals - a preliminary report.
ABSTRACT: BACKGROUND: Neuromuscular electric stimulation is widely used for muscle strengthening in clinical practice and for preventative purposes. However, there are few reports on the effects of electric stimulation on the immune response of the organism, and even those mainly describe the changes observed immediately after the electrotherapeutic procedures. The objective of our study was to examine the possible immunological consequences of moderate low-frequency transcutaneous neuromuscular electric stimulation for quadriceps muscle strengthening in healthy individuals. METHODS: The study included 10 healthy volunteers (5 males, 5 females, mean age 37.5 years). At the beginning and after a two-week electric stimulation program, muscle strength was measured and peripheral blood was collected to analyse white blood cells by flow cytometry for the expression of cell surface antigens (CD3, CD19, CD4, CD8, CD4/8, DR/3, NK, Th reg, CD25+CD3+, CD25+CD4+, CD25+CD8+, CD69+CD3+, CD69+CD4+, CD69+CD8+) and phagocytosis/oxidative killing function. RESULTS: Muscle strength slightly increased after the program on the dominant and the nondominant side. No statistically or clinically significant difference was found in any of the measured blood and immune cells parameters as well as phagocytosis and oxidative burst function of neutrophil granulocytes and monocytes one day after the program. CONCLUSIONS: The program of transcutaneous low-frequency electric stimulation slightly strengthened the quadriceps femoris muscle while producing no changes in measured immunological parameters. Hence, therapeutic low-frequency electric stimulation appears not to be affecting the immune response of healthy persons.
Eur J Epidemiol. 2012 Jul 25;: 22828955
Socioeconomic inequalities in homicide mortality: a population-based comparative study of 12 European countries.
Andrew Stickley, Mall Leinsalu, Anton E Kunst, Matthias Bopp, Bjørn Heine Strand, Pekka Martikainen, Olle Lundberg, Katalin Kovács, Barbara Artnik, Ramune Kalediene, Jitka Rychtaříková, Bogdan Wojtyniak, Johan P Mackenbach
Stockholm Centre on Health of Societies in Transition, Södertörn University, 14189, Huddinge, Sweden.
Recent research has suggested that violent mortality may be socially patterned and a potentially important source of health inequalities within and between countries. Against this background the current study assessed socioeconomic inequalities in homicide mortality across Europe. To do this, longitudinal and cross-sectional data were obtained from mortality registers and population censuses in 12 European countries. Educational level was used to indicate socioeconomic position. Age-standardized mortality rates were calculated for post, upper and lower secondary or less educational groups. The magnitude of inequalities was assessed using the relative and slope index of inequality. The analysis focused on the 35-64 age group. Educational inequalities in homicide mortality were present in all countries. Absolute inequalities in homicide mortality were larger in the eastern part of Europe and in Finland, consistent with their higher overall homicide rates. They contributed 2.5 % at most (in Estonia) to the inequalities in total mortality. Relative inequalities were high in the northern and eastern part of Europe, but were low in Belgium, Switzerland and Slovenia. Patterns were less consistent among women. Socioeconomic inequalities in homicide are thus a universal phenomenon in Europe. Wide-ranging social and inter-sectoral health policies are now needed to address the risk of violent victimization that target both potential offenders and victims.
Sensitivity and specificity of von Frey's hairs for the diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus.
University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia. firstname.lastname@example.org
OBJECTIVE The aim was to evaluate von Frey's hairs as a diagnostic tool for peripheral neuropathy in type-2 diabetes patients with symptoms typical for diabetic neuropathy with respect to nerve conduction studies (NCSs) and a combination of clinical examination and NCS. PATIENTS AND METHODS 65 patients with type-2 diabetes (33 men) with mean age 62.1 (SD 6.5) years, mean diabetes duration 17.5 (SD 9) years and mean symptom duration 5.2 (SD 4.3) years were examined with the set of von Frey's hairs. Diabetic neuropathy was diagnosed trough Neuropathy Disability Score (NDS). NCSs were performed on ulnar, peroneal, tibial and sural nerves. RESULTS Sensitivity of von Frey's hairs vs. NCS as the gold standard ranged from 37% to 79% and specificity from 65% to 87%. Sensitivity vs. combination of NDS and NCS ranged from 38% to 85% and specificity from 62% to 85%. CONCLUSIONS Von Frey's hairs have moderate sensitivity and specificity for diagnosis of neurophysiological and also clinical neuropathy. Being a fast and easy-to-perform procedure, they could be appropriate as a screening test in clinical practice.
Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?
Iris Plug, Rasmus Hoffmann, Barbara Artnik, Matthias Bopp, Carme Borrell, Giuseppe Costa, Patrick Deboosere, Santi Esnaola, Ramune Kalediene, Mall Leinsalu, Olle Lundberg, Pekka Martikainen, Enrique Regidor, Jitka Rychtarikova, Bjorn Heine Strand, Bogdan Wojtyniak, Johan P Mackenbach
ABSTRACT: BACKGROUND: Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Data and methods Cause-specific mortality data for people aged 30-74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30-74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients. RESULTS: In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. CONCLUSIONS: We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies.
Content validity and inter-rater reliability of the Halliwick-concept-based instrument 'Swimming with Independent Measure'.
University Rehabilitation Institute of Republic of Slovenia, Slovenia.
The Halliwick concept is widely used in different settings to promote joyful movement in water and swimming. To assess the swimming skills and progression of an individual swimmer, a valid and reliable measure should be used. The Halliwick-concept-based Swimming with Independent Measure (SWIM) was introduced for this purpose. We aimed to determine its content validity and inter-rater reliability. Fifty-four healthy children, 3.5-11 years old, from a mainstream swimming program participated in a content validity study. They were evaluated with SWIM and the national evaluation system of swimming abilities (classifying children into seven categories). To study the inter-rater reliability of SWIM, we included 37 children and youth from a Halliwick swimming program, aged 7-22 years, who were evaluated by two Halliwick instructors independently. The average SWIM score differed between national evaluation system categories and followed the expected order (P<0.001), whereby a ceiling effect was observed in the higher categories. High inter-rater reliability was found for all 11 SWIM items. The lowest reliability was observed for item G (sagittal rotation), although the estimates were still above 0.9. As expected, the highest reliability was observed for the total score (intraclass correlation 0.996). The validity of SWIM with respect to the national evaluation system of swimming abilities is high until the point where a swimmer is well adapted to water and already able to learn some swimming techniques. The inter-rater reliability of SWIM is very high; thus, we believe that SWIM can be used in further research and practice to follow the progress of swimmers.
Popul Health Metr. 2012 ;10 (1):3 22340018
Alyson A van Raalte, Anton E Kunst, Olle Lundberg, Mall Leinsalu, Pekka Martikainen, Barbara Artnik, Patrick Deboosere, Irina Stirbu, Bogdan Wojtyniak, Johan P Mackenbach
Max Planck Institute for Demographic Research, Rostock, Germany. email@example.com.
UNLABELLED ABSTRACT: BACKGROUND Studies of socioeconomic inequalities in mortality consistently point to higher death rates in lower socioeconomic groups. Yet how these between-group differences relate to the total variation in mortality risk between individuals is unknown. METHODS We used data assembled and harmonized as part of the Eurothine project, which includes census-based mortality data from 11 European countries. We matched this to national data from the Human Mortality Database and constructed life tables by gender and educational level. We measured variation in age at death using Theil's entropy index, and decomposed this measure into its between- and within-group components. RESULTS The least-educated groups lived between three and 15 years fewer than the highest-educated groups, the latter having a more similar age at death in all countries. Differences between educational groups contributed between 0.6% and 2.7% to total variation in age at death between individuals in Western European countries and between 1.2% and 10.9% in Central and Eastern European countries. Variation in age at death is larger and differs more between countries among the least-educated groups. CONCLUSIONS At the individual level, many known and unknown factors are causing enormous variation in age at death, socioeconomic position being only one of them. Reducing variations in age at death among less-educated people by providing protection to the vulnerable may help to reduce inequalities in mortality between socioeconomic groups.
Alyson A van Raalte, Anton E Kunst, Patrick Deboosere, Mall Leinsalu, Olle Lundberg, Pekka Martikainen, Bjørn Heine Strand, Barbara Artnik, Bogdan Wojtyniak, Johan P Mackenbach
Research group of Life Course Dynamics and Demographic Change, Max Planck Institute for Demographic Research, Rostock, Germany. firstname.lastname@example.org
BACKGROUND Whereas it is well established that people with a lower socio-economic position have a shorter average lifespan, it is less clear what the variability surrounding these averages is. We set out to examine whether lower educated groups face greater variation in lifespans in addition to having a shorter life expectancy, in order to identify entry points for policies to reduce the impact of socio-economic position on mortality. METHODS We used harmonized, census-based mortality data from 10 European countries to construct life tables by sex and educational level (low, medium, high). Variation in lifespan was measured by the standard deviation conditional upon survival to age 35 years. We also decomposed differences between educational groups in lifespan variation by age and cause of death. RESULTS Lifespan variation was higher among the lower educated in every country, but more so among men and in Eastern Europe. Although there was an inverse relationship between average life expectancy and its standard deviation, the first did not completely predict the latter. Greater lifespan variation in lower educated groups was largely driven by conditions causing death at younger ages, such as injuries and neoplasms. CONCLUSIONS Lower educated individuals not only have shorter life expectancies, but also face greater uncertainty about the age at which they will die. More priority should be given to efforts to reduce the risk of an early death among the lower educated, e.g. by strengthening protective policies within and outside the health-care system.
Use of the International Classification of Functioning, Disability, and Health in traumatic brain injury rehabilitation: linking issues and general perspectives.
European Project MURINET, University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia.
OBJECTIVE The aims of this study were to summarize the possible benefits of using the International Classification of Functioning, Disability, and Health (ICF) in rehabilitation after traumatic brain injury and to explore the technical aspects of linking existing medical records to the ICF in such cases. DESIGN A literature review was conducted using PubMed, Cochrane Collaboration, and Trip. Medical records of 100 patients admitted to University Rehabilitation Institute of Slovenia in 2007-2009 were linked to the ICF. RESULTS Fourteen relevant articles were identified from 2002 to 2010, suggesting that in patients with traumatic brain injury, the ICF can contribute to evaluation of disabilities, identification of treatment goals and intervention targets, and categorizing important environmental factors. Linking existing medical records to the ICF proved successful although time-consuming. Identified challenges included need for frequent use of ``unspecified'' qualifier, different scope of reports from different specialists, and mapping of either one Functional Independence Measure to more ICF codes or vice versa. CONCLUSIONS Despite some criticism, the literature suggests that the ICF is useful as a model of health and disability and the basis for the development of practical instruments for description and assessment of functioning of persons with traumatic brain injury. Although challenging, time-consuming, and subject to limitations, linking existing medical records to the ICF can provide a clear functional profile of a patient or group with the additional advantage of being able to describe contextual factors.
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Crisis. 2011 ;32 (4):178-85 21940252
Maurizio Pompili, Marco Innamorati, Monica Vichi, Maria Masocco, Nicola Vanacore, David Lester, Gianluca Serafini, Roberto Tatarelli, Diego De Leo, Paolo Girardi
Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy. email@example.com
BACKGROUND Suicide is a major cause of premature death in Italy and occurs at different rates in the various regions. AIMS The aim of the present study was to provide a comprehensive overview of suicide in the Italian population aged 15 years and older for the years 1980-2006. METHODS Mortality data were extracted from the Italian Mortality Database. RESULTS Mortality rates for suicide in Italy reached a peak in 1985 and declined thereafter. The different patterns observed by age and sex indicated that the decrease in the suicide rate in Italy was initially the result of declining rates in those aged 45+ while, from 1997 on, the decrease was attributable principally to a reduction in suicide rates among the younger age groups. It was found that socioeconomic factors underlined major differences in the suicide rate across regions. CONCLUSIONS The present study confirmed that suicide is a multifaceted phenomenon that may be determined by an array of factors. Suicide prevention should, therefore, be targeted to identifiable high-risk sociocultural groups in each country.
Semmelweis Egyetem Magatartástudományi Intézet, MTA-SE Mentális Egészségtudományok Kutatócsoport, Budapest. firstname.lastname@example.org
The mortality rate for 40- 69-year-old men was 12.2/thousand males of corresponding age in 1960 and 16.2 in 2005: it increased by 33%, while among 40- 69-year-old women it decreased from 9.6 0/thousand females of corresponding age to 7.8. The aim of the present follow up study was to analyze which psychosocial risk factors might explain the high premature mortality rates among Hungarian men. Participants in the Hungarostudy 2002 study, a nationally representative sample, 1130 men and 1529 women were contacted again in the follow up study in 2006, who in 2002 were between the age of 40-69 years. By 2006, 99 men (8.8%) and 53 women (3.5%) died in this age group. Socio-economic, psychosocial and work-related measures, self-rated health, chronic disorders, depressive symptoms (BDI), WHO well-being, negative affect, self-efficacy, meaning in life and health behavioral factors were included in the analysis. After adjustment according to smoking, alcohol abuse, BMI, education and age, a number of variables were significant predictors of mortality only in men: low education, low subjective social status, low personal and family income, insecurity of work, no control in work, severe depression, no meaning in life, low social support from spouse, low social support from child. Socio-economic and work related risk factors predicted only male premature death. Among women dissatisfaction with personal relations was the most important risk factor. Among men depression seems to mediate between these chronic stress factors and premature death.
Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study.
Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada. email@example.com
OBJECTIVE To examine mortality in a representative nationwide sample of homeless and marginally housed people living in shelters, rooming houses, and hotels. DESIGN Follow-up study. SETTING Canada 1991-2001. PARTICIPANTS 15 100 homeless and marginally housed people enumerated in 1991 census. MAIN OUTCOME MEASURES Age specific and age standardised mortality rates, remaining life expectancies at age 25, and probabilities of survival from age 25 to 75. Data were compared with data from the poorest and richest income fifths as well as with data for the entire cohort RESULTS Of the homeless and marginally housed people, 3280 died. Mortality rates among these people were substantially higher than rates in the poorest income fifth, with the highest rate ratios seen at younger ages. Among those who were homeless or marginally housed, the probability of survival to age 75 was 32%(95% confidence interval 30% to 34%) in men and 60%(56% to 63%) in women. Remaining life expectancy at age 25 was 42 years (42 to 43) and 52 years (50 to 53), respectively. Compared with the entire cohort, mortality rate ratios for men and women, respectively, were 11.5 (8.8 to 15.0) and 9.2 (5.5 to 15.2) for drug related deaths, 6.4 (5.3 to 7.7) and 8.2 (5.0 to 13.4) for alcohol related deaths, 4.8 (3.9 to 5.9) and 3.8 (2.7 to 5.4) for mental disorders, and 2.3 (1.8 to 3.1) and 5.6 (3.2 to 9.6) for suicide. For both sexes, the largest differences in mortality rates were for smoking related diseases, ischaemic heart disease, and respiratory diseases. CONCLUSIONS Living in shelters, rooming houses, and hotels is associated with much higher mortality than expected on the basis of low income alone. Reducing the excessively high rates of premature mortality in this population would require interventions to address deaths related to smoking, alcohol, and drugs, and mental disorders and suicide, among other causes.
Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia, United States of America. firstname.lastname@example.org
BACKGROUND Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups. However, no studies have examined trends in inequalities using recent US national data. METHODOLOGY/PRINCIPAL FINDINGS We calculated annual age-standardized death rates from 1993-2001 for 25-64 year old non-Hispanic whites and blacks by level of education for all causes and for the seven most common causes of death using death certificate information from 43 states and Washington, D.C. Regression analysis was used to estimate annual percent change. The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated. For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates. The rate ratio (RR) comparing the least versus most educated increased from 2.9 (95% CI, 2.8-3.1) in 1993 to 4.4 (4.1-4.6) in 2001 among white men, from 2.1 (1.8-2.5) to 3.4 (2.9-3-9) in black men, and from 2.6 (2.4-2.7) to 3.8 (3.6-4.0) in white women. CONCLUSION Socioeconomic inequalities in mortality are increasing rapidly due to continued progress by educated white and black men and white women, and stable or worsening trends among the least educated.
Cause-specific inequalities in mortality in Scotland: two decades of change. A population-based study.
MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, UK. email@example.com
BACKGROUND Socioeconomic inequalities in mortality have increased in recent years in many countries. We examined age-, sex-, and cause-specific mortality rates for social groups in and regions of Scotland to understand the patterning of inequalities and the causes contributing to these inequalities. METHODS We used death records for 1980-82, 1991-92 and 2000-02 together with mid-year population estimates for 1981, 1991 and 2001 covering the whole of Scotland to calculate directly standardised mortality rates. Deaths and populations were coded to small areas (postcode sectors and data zones), and deprivation was assessed using area based measures (Carstairs scores and the Scottish Index of Multiple Deprivation). We measured inequalities using rate ratios and the Slope Index of Inequality (SII). RESULTS Substantial overall decreases in mortality rates disguised increases for men aged 15-44 and little change for women at the same ages. The pattern at these ages was mostly attributable to increases in suicides and deaths related to the use of alcohol and drugs. Under 65 a 49% fall in the mortality of men in the least deprived areas contrasted with a fall of just 2% in the most deprived. There were substantial increases in the social gradients for most causes of death. Excess male mortality in the Clydeside region was largely confined to more deprived areas, whilst for women in the region mortality was in line with the Scottish experience. Relative inequalities for men and women were greatest between the ages of 30 and 49. CONCLUSION General reductions in mortality in the major causes of death (ischaemic heart disease, malignant neoplasms) are encouraging; however, such reductions were socially patterned. Relative inequalities in mortality have increased and are greatest among younger adults where deaths related to unfavourable lifestyles call for direct social policies to address poverty.
Socio-economic status inequality and major causes of death in adults: a 5-year follow-up study in rural Vietnam.
Health Strategy and Policy Institute, Ministry of Health, 138 Giang Vo Street, Hanoi, Vietnam. firstname.lastname@example.org
OBJECTIVES This study aimed to analyse the associations between cause-specific mortality in adults (aged 20 years and above) and socio-economic status (SES) in a rural setting of Vietnam during a time of economic transition. STUDY DESIGN The study was carried out as part of the FilaBavi demographic surveillance system, with a dynamic cohort of 50,000 inhabitants from January 1999 to December 2003. METHODS Causes of death in the adult population were derived using verbal autopsy. A Cox regression model was employed to check the association of SES with three major causes of death: communicable diseases; non-communicable diseases; and injuries. RESULTS The crude mortality rates were 9.2 and 6.6 per 1000 person-years in adult males and females, respectively. Men had higher mortality rates than women for all mortality categories and for all levels of education and household economic situation (HES). Mortality rates increased substantially with age, and showed similar age effects for all mortality categories with the strongest association for non-communicable diseases. Education was an important factor for survival in general, and high HES seemed to benefit men more than women. CONCLUSIONS Interventions and policies to reduce exposure to risk factors for non-communicable diseases are needed in low-education groups. However, further study is needed to analyse the mortality inequity across all age groups.
Education level inequalities and transportation injury mortality in the middle aged and elderly in European settings.
C Borrell, A Plasència, M Huisman, G Costa, A Kunst, O Andersen, M Bopp, J-K Borgan, P Deboosere, M Glickman, S Gadeyne, C Minder, E Regidor, T Spadea, T Valkonen, J P Mackenbach
Institute of Health Policy and Management, School of Public Health, National Taiwan University, Taipei, Taiwan. email@example.com
OBJECTIVE: To study the differential distribution of transportation injury mortality by educational level in nine European settings, among people older than 30 years, during the 1990s. METHODS: Deaths of men and women older than 30 years from transportation injuries were studied. Rate differences and rate ratios (RR) between high and low educational level rates were obtained. RESULTS: Among men, those of low educational level had higher death rates in all settings, a pattern that was maintained in the different settings; no inequalities were found among women. Among men, in all the settings, the RR was higher in the 30-49 age group (RR 1.46, 95% CI 1.32 to 1.61) than in the age groups 50-69 and > or = 70 years, a pattern that was maintained in the different settings. For women for all the settings together, no differences were found among educational levels in the three age groups. In the different settings, only three had a high RR in the youngest age group, Finland (RR 1.33, 95% CI 1.01 to 1.74), Belgium (RR 1.38; 95% CI 1.13 to 1.67), and Austria (RR 1.49, 95% CI 0.75 to 2.96). CONCLUSION: This study provides new evidence on the importance of socioeconomic inequalities in transportation injury mortality across Europe. This applies to men, but not to women. Greater attention should be placed on opportunities to select intervention strategies tailored to tackle socioeconomic inequalities in transportation injuries.
[Trends in mortality from ischemic heart disease and acute myocardial infarction in Costa Rica, 1970-2001]
Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), San José, Costa Rica. firstname.lastname@example.org
OBJECTIVE: To describe epidemiologic trends in mortality from cardiovascular diseases (CVD), ischemic heart disease (IHD), and acute myocardial infarction (AMI) in Costa Rica, by sex and geographic region, between 1970 and 2001. METHODS: We performed a descriptive study of mortality from CVD, IHD, and AMI in Costa Rica between 1970 and 2001. Information was obtained from the Central American Population Center's database. Mortality data for IHD and AMI between 1970 and 2001 were analyzed in accordance with the latest revision of the International Classification of Diseases (ICD). Costa Rica's territory was divided into the following regions: the metropolitan area (8 cantons), the semi-urban area of Valle Central (18 cantons), the rural area of Valle Central (17 cantons), the semi-urban lowlands (12 cantons), and the rural lowlands (26 cantons). Mortality trends by quinquennia (between 1970 and 1999) and for the 2000-2001 biennium were examined in the form of crude mortality rates per 100 000 inhabitants for each cause or group of causes, by age, sex, and year of death. All rates were adjusted for sex, age, year of death, and geographic region through the direct method of standardization, using the population of Latin America in 1960 as the standard population. RESULTS: Mortality from CVD dropped by an average of 33%(46.6% among women and 20.2% among men), while mortality from IHD rose by an average of 18.4%(6.1% among women and 28.4% among men). The adjusted mortality rate for AMI among men rose by 12.8% over the study period and dropped slightly by 4.4% among women. Mortality from CVD, IHD, and AMI was greater in men than in women during the entire study period. Mortality rates for IHD and AMI rose in semi-urban and urban areas, especially in the rural lowlands, where they increased with respect to the 1995-1999 rates by 123.9% and 76.9%, respectively. CONCLUSIONS: A reduction in mortality from CVD was noted. The largest rates were seen among men and in persons 75 years of age or older. The largest increases in mortality rates from IHD and AMI were seen in semi-urban and rural areas, among men, and in persons 75 years of age or older. Special attention should be paid to risk factors for CVD, such as smoking, arterial hypertension, overweight and obesity, sedentary habits, and an unhealthy diet.
Educational differentials in mortality from cardiovascular disease among men and women: the Israel Longitudinal Mortality Study.
School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Ein Karem, Jerusalem, Israel. email@example.com
PURPOSE While socioeconomic inequalities in cardiovascular disease have been observed in most industrialized countries, available information in Israel centers on ethnic variations and the role of education has yet to be investigated. This study examines educational differentials in cardiovascular mortality in Israel for both men and women aged 45 to 69 and 70 to 89 years. METHODS Data are based on a linkage of records from a 20% sample of the 1983 census with the records of deaths occurring until the end of 1992. The study population includes 152,150 individuals and the number of cardiovascular deaths was 14,651. Educational differentials were assessed for mortality of diseases of the circulatory system, ischemic heart diseases, cerebrovascular diseases, hypertensive diseases, and sudden death. RESULTS Substantial mortality differentials were found among individuals aged 45 to 69 years, with larger inequalities among women. The age-adjusted relative risk for mortality of cardiovascular diseases among those with elementary education (< or =8 years) compared with those with high education (> or=13 years) was 1.46 (95% CI: 1.32-1.61) for men and 2.06 (95% CI: 1.76-2.41) for women. Differentials among the elderly were markedly narrower than those for younger adults. Similar trends were observed for mortality of subgroups of causes including cerebrovascular diseases and ischemic heart diseases. Educational differentials were not affected by adjustment for ethnic origin and car ownership. CONCLUSIONS Those with 8 years of education or less suffer higher risk of cardiovascular mortality compared with adults with 13 or more years of education. Young, less educated women are more vulnerable, and health and social policies oriented towards this group are needed.
Cah Que Demogr. 1993 ;22 (1):179-92 12346106
"The aim of this article is to draw a portrait of the principal causes of death and hospitalization on the Island of Montreal. Age and sex specific rates are compared to those for all of Quebec. Furthermore, the evolution of mortality rates by cause of death is traced from 1976 to 1990. AIDS, which was unheard of before 1983, now represents the number one ranking cause of death among men aged 25 to 44 years. For most of the causes considered here, a decline in mortality has been observed between 1976 and 1990. However, mortality rates for pulmonary diseases have increased significantly for both sexes, as have rates for lung cancer among women."(SUMMARY IN ENG AND SPA)