Socioeconomic and spatial differentials in mortality and means of committing suicide in New South Wales, Australia, 1985-91

Analysis of suicide mortality in New South Wales, Australia is undertaken with reference to marital status and occupational status between 1986-89/90 and with reference to the principal means of committing suicide. Not currently married male manual workers were particularly at risk although marital status variations were significant with both genders and at different ages. Between 1985-91 male suicide mortality rates were significantly higher in inland non-metropolitan regions, especially among younger men, and were higher in inner areas of metropolitan Sydney. While there were no significant variations by marital status in the means of committing suicide there were variations between genders, and there were regional and social class variations in the use of guns with males. The use of guns was a factor in the elevated suicide mortality levels among inland rural youth and men, and among farmers and transport workers while the use of poisons was also significant with these occupational groups. The use of poisons was greater among persons committing suicide in the areas of elevated mortality in inner Sydney and the use of guns much lower.     

Poisoning mortality, 1985-1995

Poisoning was reported as the underlying cause of death for 18,549 people in the United States in 1995 and was ranked as the third leading cause of injury mortality, following deaths from motor vehicle traffic injuries and firearm injuries. Poisoning was the leading cause of injury death for people ages 35 to 44 years. Poisoning death rates were higher in 1995 than in any previous year since at least 1979. From 1990 to 1995, the age-adjusted rate of death from poisoning increased 25%; all of the increase was associated with drugs. About three-fourths of poisoning deaths (77%) in 1995 were caused by drugs. The age-adjusted rate of drug-related poisoning deaths for males (7.2 per 100,000) in 1995 was more than twice that for females (3.0 per 100,000). From 1985 to 1995, poisoning death rates for males ages 35-54 years nearly doubled to 20.4 per 100,000, and the drug-related poisoning death rate for males ages 35-54 years nearly tripled, reaching 16.1 per 100,000. From 1990 to 1995, death rates associated with opiates and cocaine more than doubled among males ages 35-54 years. The numbers of opiate and cocaine poisoning deaths for 1995 more than doubled when all multiple cause of death codes were examined instead of only the underlying cause of death codes.     

Suicide in urban New South Wales, Australia 1985-1994: socio-economic and migrant interactions

Variation of suicide with socio-economic status (SES) in urban NSW (Australia) during 1985-1994, by sex and country or region of birth, was examined using Poisson regression analysis of vital statistics and population data (age >? approximately 15 yr). Quintiles of SES were defined by municipality of residence and comparisons of suicide by SES were adjusted for age and country (or region) of birth (COB), and examined by COB. Risk of suicide in females was 28% that of males for all adults and 21% for youth (age 15-24 yr). Suicide risk was lower in males from southern Europe, Middle East and Asia, and higher in northern and eastern European males, compared to the Australian-born. Risks for suicide increased significantly with decreasing SES in males, but not in females. The relationship of male suicide and SES was stronger when controlled for COB. For males, the relative risk of suicide, adjusted for age and COB, was 66% higher in the lowest SES quintile compared to the highest quintile. and 39% higher for youth (age 15-24 yr). For male suicide, the population attributable fraction for SES (less than the highest quintile) was 27%. Analysis of SES differentials in male suicide according to COB indicated a significant inverse suicide gradient in relation to SES for the Australian-born and those born in New Zealand and the United Kingdom or Eire, but not in non-English speaking COB groups, except for Asia. For Australian-born males, suicide risk was 71% higher in the lowest SES group (compared to the highest), adjusted for age. These findings indicate that SES plays an important role in male suicide rates among the Australian-born and migrants from English-speaking countries and Asia, and among youth; but not in female suicide, nor suicide in most non-English speaking migrant groups. Reduction in SES differentials through economic and social policies may reduce male suicide in lower SES groups and should be seen to be at least as important as individual level interventions.     

Worldwide trends in suicide mortality, 1955-1989

Expression of keratin K5 (and K14) in multilayered epithelia occurs predominantly in the basal layer of proliferating keratinocytes. When a keratinocyte becomes committed to terminal differentiation, it moves out of the basal layer towards the epithelial surface. As part of this program of terminal differentiation, the expression of K5 (and K14) is downregulated in suprabasal cells, and new pairs of differentiation-specific keratins are expressed. To define the cis-acting DNA sequences required for K5 cell-type- and differentiation-specific expression, chimeric gene fusions between portions of the bovine keratin K5 locus and the Escherichia coli lacZ gene were used to generate transgenic mice. In the genomic fragment consisting of 5.3 kb of 5' flanking sequences, 6.1 kb corresponding to the body of the gene and 4.5 kb of 3' flanking sequences, the subfragment extending from -5300 bp to +138 bp was the smaller region that directed lacZ expression to stratified epithelia in a manner analogous to the endogenous keratin K5. Proximal sequences from -1300 bp to +138 bp were inactive. We also determined the expression pattern of keratin K5 during mouse development using an antiserum specific for mouse keratin K5. Expression was first detected in ectodermal cells of 11.5 days postcoitum embryos, and from day 13.5 postcoitum onwards K5 was detected in the precursors of most epithelia and organs which express K5 at adult stages. This pattern was reproduced, with few differences, by the construct with sequences from -5300 bp to +138 bp fused to the lacZ gene. These findings identify sequences between -5.3 kb and -1.3 kb of the bovine K5 gene as being important for cell-type- and differentiation-specific gene expression both during mouse development and in the adult.     

Incidence, survival and mortality in cervical cancer in Norway, 1956-1990

Long-term trends in incidence, survival and mortality were examined in women with squamous cell carcinoma and adenocarcinoma of the uterine cervix, diagnosed in Norway in the 35-year period 1956-1990. During the 1970s the number of cervical smears increased substantially in Norway, although no organised screening programme was introduced. Special attention was paid to the time period 1971-1990 to evaluate the effect of the extensive spontaneous screening. In addition, the prognostic importance of clinical stage and age was explored. In the squamous cell carcinoma patients the incidence rate peaked in the time period 1971-1975, since when there has been a decrease. In the adenocarcinoma patients the incidence rate rose through the years 1976-1990. Also, the proportion of adenocarcinomas increased in this time period. The mortality rates in both histological types declined modestly through the years 1966-1990. A more favourable stage distribution was noted among the squamous cell carcinomas (P = 0.00), but not among the adenocarcinomas, when comparing the two diagnostic periods 1971-1975 and 1981-1985. The multivariate analysis (GLIM) revealed that stage was the most important prognostic factor in both histological types (P = 0.00). In the squamous cell carcinoma patients the relative rate increased (P = 0.04) in the last period. There was a tendency towards a poorer prognosis in younger women in this group, but age did not prove to be an important prognostic factor (P = 0.08).     

The South African HIV epidemic, reflected by nine provincial epidemics, 1990-1996

OBJECTIVES: To determine by serological examination the annual point prevalence rates of infection with the human immunodeficiency virus (HIV) in representative samples of subjects in the nine provinces of South Africa, 1990-1996. DESIGN: Annual cross-sectional point prevalence surveys conducted in October/November of each year. SETTING: South Africa, including areas that used to be known as self-governing and independent National States. SUBJECTS: Pregnant women in the age group 15-49 years who attend antenatal clinic services provided by the public health services, and who act as an indicator group of the HIV epidemic among the heterosexually active population. OUTCOME MEASURES: HIV positivity as determined serologically; done consistently over several years, this serves to monitor the distribution and trend of the HIV epidemic in each of the nine provinces of South Africa. RESULTS: Empirical data gained from seven annual, consecutive countrywide surveys demonstrate a wide geographical variation in the point prevalence rates of HIV infection. In October/November 1996 the point prevalence rates (%) were as follows: Western Cape 3.09, Northern Cape 6.57, Northern Province 7.96, Eastern Cape 8.10, Gauteng 15.49, Mpumalanga 15.77, Free State 17.49, KwaZulu-Natal 19.90 and North West 25.13. The weighted national average was 14.17%. There are indications that some of the provinces (KwaZulu-Natal and possibly Mpumalanga) might have passed a point of inflection suggesting deceleration in their specific rates of increase. These results are, however, counterbalanced by the exponential growth still being experienced in provinces with large populations such as Gauteng and the Eastern Cape. It is concluded that the net effect of these divergent trends currently affects the national figure only marginally. A major deflection from the exponential growth patterns seen hitherto can be anticipated only once all or most of the highly populated provinces have traversed their respective points of inflection. The exponential model significantly explains the HIV epidemics in the provinces. The combination of these provincial epidemics describes the initial exponential phase of the epidemic.     

Socioeconomic differences in 'avoidable' mortality in Sweden 1986-1990

BACKGROUND: 'Avoidable' mortality is commonly studied as an indicator of the outcome of health care. In this study socioeconomic differences in avoidable mortality in Sweden from 1986 to 1990 are analysed and related methodological issues discussed. METHODS: The 1985 Swedish Population and Housing Census was linked to the National Cause of Death Register 1986-1990. Mortality from potentially 'avoidable' causes of death was analysed for the age group 21-64 years. Analyses were performed for different socioeconomic groups, blue-collar workers, white-collar workers and the self-employed as well as for individuals outside the labour market. Standardized Mortality Ratios were calculated using standardization by age and sex. RESULTS: For all indicators studied, the death rates for those not in work were higher than for people at work. The largest differences were found for chronic bronchitis, diabetes, bacterial meningitis, ulcer of the stomach and duodenum, chronic rheumatic heart disease, asthma and hypertensive and cerebrovascular disease. For these causes of death the risk of dying was between 3.1 and 7.5 times greater in the non-working population than in the work-force. The differences in avoidable mortality between blue-collar workers and white-collar workers and the self-employed were, however, much smaller. For most of the indicators no significant differences were found. For ulcers of the stomach and duodenum, however the death rate for blue-collar workers was 2.8 times higher than those for other categories in work. CONCLUSIONS: The small difference in mortality outcome for different socioeconomic groups within the work-force indicates an equal quality of care for these groups. The greatly increased risk among the non-working population, however, is a warning sign. These results may be due to a 'healthy worker' effect. The measurement of socioeconomic differences in mortality may be dependent on the time-period chosen between occupational exposure and mortality outcome.     

The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment

OBJECTIVE: To examine whether secular trends in risk factor levels and improvements in treatment can account for the observed decline in coronary heart disease mortality in the United States from 1980 to 1990 and to analyze the proportional contribution of these changes. DATA SOURCES: Literature review, US statistics, health surveys, and ongoing clinical trials. STUDY SELECTION: Data representative of the US situation nationwide reported in adequate detail. DATA EXTRACTION: A computer-simulation state-transition model of the US population between the ages of 35 and 84 years was developed to forecast coronary mortality. The input variables were estimated such that the combination of values led to an adequate agreement with reported coronary mortality figures. Subsequently, secular trends were modeled. DATA SYNTHESIS: Actual coronary mortality in 1990 was 34% (127,000 deaths) lower than would be predicted if risk factor levels, case-fatality rates, and event rates in those with and without coronary disease remained the same as in 1980. When secular changes in these factors were included in the model, predicted coronary mortality in 1990 was within 3% (10,000 deaths) of the observed mortality and explained 92% of the decline; only 25% of the decline was explained by primary prevention, while 29% was explained by secondary reduction in risk factors in patients with coronary disease and 43% by other improvements in treatment in patients with coronary disease. CONCLUSIONS: These results suggest that primary and secondary risk factor reductions explain about 50% of the striking decline in coronary mortality in the United States between 1980 and 1990 but that more than 70% of the overall decline in mortality has occurred among patients with coronary disease.     

Penicillin resistance in laboratory isolates of Streptococcus pneumoniae, in Western Australia, 1990-1994

Increasing frequency of penicillin resistance in Streptococcus pneumoniae has been reported worldwide. We report on clinical isolates of penicillin-resistant pneumococci (PRP) in Western Australia (WA) from 1990-1994. A retrospective survey of laboratories performing susceptibility testing, or receiving isolates referred from rural areas found resistant on oxacillin disc screening, was undertaken. Four of 11 laboratories could provide data for the five year time period inclusive. Information was provided on susceptibility to penicillin, type of specimen, date of isolation and; age, sex and race of individuals with PRP. Penicillin resistance increased from 1.3% to 9.0% over the five year period. PRP were rarely invasive. Highest age specific rates per 100,000 were found in children < 5 years (19.4) and adults > or = 60 years (5.1). Aboriginal ethnicity was associated with resistance. The increasing frequency of PRP in WA indicates the need for surveillance systems for their detection.     

Prediction of lung cancer mortality in four Central European countries, 1990-2009

In the present pilot study, our aim was to investigate whether associations could be demonstrated in psychiatric patients between the changes in plasma lipid and lipoprotein levels expected during treatment with psychoactive drugs and the changes in the patients' depressive and hostile behavior. One hundred and fourteen patients with various psychiatric disorders (depressive episode in bipolar affective disorder, depressive episode or recurrent depressive disorder, paranoid schizophrenia, and schizoaffective disorders) were included in the study. The following examinations were carried out in each patient on admission and at discharge: (1) the plasma lipid parameters total cholesterol (TC), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), high-density lipoprotein (HDL), and triglycerides (TRI) were determined, and (2) the psychopathological features were recorded employing the AMDP system and the AMDP Syndrome Scales. Within the context of a naturalistic clinical setting with a choice of psychoactive drugs available, patients were subdivided at the end of treatment into eight treatment groups, as follows: group 1, treatment with butyrophenones; group 2, treatment with tricyclics; group 3, treatment with butyrophenones and tricyclics; group 4, treatment with butyrophenones, tricyclics and selective serotonin reuptake inhibitors; group 5, treatment with butyrophenones and lithium; group 6, treatment with tricyclics and lithium; group 7, treatment with butyrophenones, tricyclics and lithium; and group 8, treatment with butyrophenones, tricyclics, selective serotonin reuptake inhibitors and lithium. To compare the changes in the eight treatment groups, mixed general linear models including diagnosis, gender, age, body mass index changes, and baseline values were applied using proc GLM of SAS. Butyrophenones induce an increase in TC, LDL, and TC/TRI ratio, whereas tricyclics lead to an increase in TC, LDL, VLDL, and TRI. In combined medication of butyrophenones and tricyclics the effects of tricyclics predominate. Comedication of lithium inhibits the increase in TC and LDL induced by butyrophenones and/or tricyclics. Treatment groups with lipid changes of the same type (decrease, no change, or increase) were combined in "lipid change groups". Analyses of variance or covariance (with psychopathological admission value as covariate where there were significant differences in psychopathological admission mean values between the groups) of these lipid change groups with regard to the changes in the Depressive Syndrome Scale and the Hostility Syndrome Scale gave results which are interpreted as follows: an increase in TC or LDL inhibits the remission of hostility, whereas an increase in TRI with concomitant decrease in TC, or else a relatively greater increase in TRI than in TC promotes the remission of hostility. A decrease in TRI or VLDL promotes the remission of depression. Our data and findings published in the literature may suggest that systemic changes in plasma lipid parameters, at the cellular level, induce changes in the fluidity of brain cell membranes. We hypothesize that an increase in plasma TC or LDL and/or a decrease in plasma TRI or VLDL may induce a relative decrease in brain cell membrane fluidity with decreased presynaptic serotonin reuptake and increased postsynaptic serotonin function. This proposed increase in brain serotonin function would finally result in an anti-depressive, aggression-promoting effect. Conversely, a decrease in plasma TC or LDL and/or an increase in plasma TRI or VLDL may induce a relative increase in brain cell membrane fluidity with increased presynaptic serotonin reuptake and decreased postsynaptic serotonin function. This proposed decrease in brain serotonin function would result in an anti-aggressive, depression-promoting effect.     

Asthma prevalence, morbidity and management practices in South Australia, 1992-1995

BACKGROUND: The Spring South Australian Health Omnibus Survey (SSAHOS) has been used to monitor trends in asthma prevalence, asthma morbidity and asthma management practices between 1992 and 1995. AIMS: To determine if self-reported asthma prevalence and availability of asthma action plans were increasing. To identify deficiencies in asthma management and opportunities for intervention. METHODS: Representative population survey by trained interviewers using a multistage, systematic, clustered area sample of 4200 households in South Australia where people aged 15 years or more are living. RESULTS: Over 3000 interviews were conducted each year. Between 1992 and 1995 the self-reported prevalence of asthma in those aged 15 years or more increased significantly from 15.7% to 20.3% (p < 0.0005), and the prevalence of current asthma increased from 9.3% to 11.4% (p < 0.05). The self-reported availability of individual asthma action plans increased from 21.9% in 1992 to 42.2% in 1995 (p < 0.0005). In 1992, 21% had a nebuliser at home, and 10.5% had a peak flow meter. In 1993, 61.4% were using preventive medications, and 35% thought bronchodilators were 'preventer' medications. In 1994 and 1995, between 12.5% and 15.6% had nocturnal awakening weekly or more often, and 31.4% had morning asthma symptoms weekly or more often. Between 20.1% and 20.8% had lost days from usual activities during the last year. Those on incomes below $20,000 had more symptoms, had more admissions to hospital, and required more medication than those on higher incomes. CONCLUSIONS: Self-reported asthma prevalence has increased. There remains a gap between current asthma management and that recommended by the National Asthma Campaign.     

Doctors detected self-administering opioids in New South Wales, 1985-1994: characteristics and outcomes

OBJECTIVE: To describe the characteristics and outcomes of doctors whose drug authorities were withdrawn as a result of self-administering opioids for non-medical purposes. DESIGN: Retrospective review of New South Wales Health Department information relating to all doctors whose authorities to possess, supply, prescribe or administer drugs of addiction had been withdrawn in the period 1985 to 1994 as a result of confirmed self-administration of opioids. OUTCOME MEASURES: Age, sex, geographical location and practice category at the time of intervention; drugs used; period of opioid use before authority withdrawal; means of detection; and registration status as at August 1995. RESULTS: From 1985 to 1994, 79 doctors had their drug authorities withdrawn (0.4% of the NSW medical profession in 1994). The groups significantly over-represented were general practitioners and those aged 30-39 years. Pethidine was the main drug used (66 doctors; 84%). Drug use for more than two years before detection was reported by 34 (43%) doctors. Community pharmacists were the source of reports leading to detection of 28 (35%) doctors. As at August 1995, 27 (34%) of the study group were not practising; 10 (13%) had died. CONCLUSION: Outcomes for these doctors were poor. There was substantial attrition from practice and a high mortality rate.     

Neonatal mortality amongst Scottish preterm singleton births (1985-1994)

BACKGROUND: Few studies have compared the incidence of deep venous thrombosis among ethnic groups. OBJECTIVE: To determine the incidence of deep venous thrombosis among ethnic groups. Design: Analysis of the linked California Patient Discharge Data Set from 1991 to 1994. Setting: California. PATIENTS: 17991 patients with idiopathic deep venous thrombosis (thrombosis without cancer or hospitalization within preceding 6 months) and 5573 patients with secondary thromboembolism (thromboembolism occurring within 3 months of seven different events). MEASUREMENTS: Ethnicity was determined by using race as documented in the data set. For idiopathic deep venous thrombosis, standardized age- and sex-adjusted incidences were calculated. For secondary thromboembolism, proportional hazards modeling was done. RESULTS: The annual incidence of idiopathic deep venous thrombosis per 1000000 persons older than 18 years of age was 230 for white persons, 293 for African Americans (rate ratio, 1.27 [95% CI, 1.07 to 1.51]), 139 for Hispanic persons (rate ratio, 0.60 [CI, 0.54 to 0.67]), and 60 for Asians and Pacific Islanders (rate ratio, 0.26 [CI, 0.22 to 0.30]). Compared with white persons, Asians and Pacific Islanders who developed secondary thromboembolism had a significantly lower relative risk (range, 0.22 to 0.61) for all seven conditions analyzed. CONCLUSIONS: Compared with white persons, Asians and Pacific Islanders have a very low incidence of idiopathic deep venous thrombosis and a very low relative risk for secondary venous thromboembolism.     

HIV media campaigns and HIV-1 testing trends at London genitourinary medicine clinic, 1985-1993

OBJECTIVE: To describe HIV-related media events in the context of first-time HIV-1-antibody testing trends at a London genitourinary medicine clinic. DESIGN: Demographic and behavioural data were collected prospectively for individuals tested for HIV-1 antibodies between September 1985 and September 1993, at the genitourinary medicine clinic of St Mary's Hospital, London. RESULTS: A total of 19,242 individuals were tested of whom 37% were women. Of the men tested 60% were heterosexual. The women at first time of testing were significantly younger [29.3 years; 95% confidence interval (CI), 28.8-29.7] than the men (32.5 years; 95% CI, 29.2-35.8); mean ages for both sexes did not change significantly over time. Overall, 199 women and 1539 men tested HIV-antibody-positive. The proportions of women testing positive increased significantly over time (chi 2 = 21.7, degrees of freedom = 1; P < 0.001), whereas the proportion of HIV-positive men remained constant for all sexual orientation groups. The proportion of heterosexual women testing positive (2.8%) was similar to the proportion of HIV-positive heterosexual men (2.9%). HIV-positive individuals were significantly older for both sexes. Throughout the study period numerous education campaigns were run using a variety of media complemented by a number of other HIV-related media events. CONCLUSIONS: Peak periods of attendance for HIV testing generally corresponded with increased HIV-related media activity and the greatest testing rates were observed when various HIV media events occurred concurrently. The increase in the number of heterosexuals tested suggests that the risk of heterosexual transmission of HIV has been recognized, at least among older individuals. The exact role of HIV-related media events, including celebrities disclosing their HIV-positive status, remains to be elucidated. Whether the relative under-representation of younger people is due to a lack of awareness, increased use of safer sex practices or reluctance to use the service also remains to be addressed. Given the increasing number of HIV-positive women and the relatively constant rate of HIV-positive tests in the male attendees an urgent need exists to assess the impact and effectiveness of specific HIV media campaigns.     

Supracervical and total abdominal hysterectomy trends in New York State: 1990-1996

To describe practice trends for total abdominal hysterectomy (TAH) and supracervical abdominal hysterectomy (SCH) in New York State and to identify fiscal features associated with these two operations, all inpatient discharges for TAH and SCH performed for benign indications from 1990 to 1996 were reviewed using the Statewide Planning and Resource Cooperative System, a centralized data reporting system. For each year examined, the number of TAHs and SCHs performed, the procedure rates adjusted for the total New York State female population, and the per diem charge (calculated from mean institutional charge as a function of average length of stay) were evaluated. While the TAH rate declined in New York State, from 34.0 in 1990 to 28.4 in 1996 (P = .01), the SCH rate increased nearly five-fold during the same period, from 0.62 to 3.07 (P = .0003). Patients tended to be discharged later following SCH than for TAH, although by 1996, the LOS for both operations was equivalent. The per diem institutional charge for SCH was consistently higher than for TAH in each year studied. The changes in charge and relative frequency of TAH and SCH in New York State invite further study to describe these trends more fully.