Numbers of infant deaths in Scotland, with special reference to sudden infant death syndrome.

There has been an increased interest during 1992 in the numbers of deaths from Sudden Infant Death Syndrome, because of reports of reductions in the numbers in several countries where changes in advice on infant care had been made. Numbers of infant deaths in general and of those due to the syndrome in particular are described and analysed by some of the variables which are provided at the time of registration. The decline in the number of deaths from the syndrome reported recently by the Scottish Cot Death Trust is supported by the full figures for 1991. This decline probably started about the latter part of 1990, well before the official letters giving advice on infant care that had been associated with a decline elsewhere. It was more marked in some areas of Scotland than others. There appears to be a cyclical pattern in the time-series of the numbers of deaths from the syndrome. Further investigation, both of the cyclical movement and of the recent decline in relation to other variables, would be worthwhile. Deaths in the neonatal period from the syndrome and those from other causes have both declined markedly during 1990 and 1991, after several years when the movements in their numbers seemed to be in opposite directions.

Trends in cancer incidence and mortality in Scotland: description and possible explanations.

Secular and cohort trends in mortality from cancer in Scotland during 1953-93, and incidence during 1960-90, were analysed using individual records from the national mortality and registration files. For certain cancer sites, the secular analyses of mortality were extended back to 1911 by use of published data. Mortality from cancer at older ages in Scotland has increased over the last 40 years. In each sex, this trend has been dominated by the effects of smoking: all-cancer rates and rates of lung cancer, now the most common fatal cancer in men and in women in Scotland, reached a peak in the cohort of men born at the turn of the century and the cohort of women born in the 1920s. For much of the period, the Scottish all-age rates of lung cancer were the highest reported in the world; they are now decreasing on a secular basis in men, but are still increasing in women. There have also been large increases at older ages in the incidence and mortality rates for cancer of the prostate in recent years. bladder cancer, nervous system cancer, non-Hodgkin's lymphoma, myeloma and leukaemia; for each there is likely to be a considerable artefactual element to the increase, with differing degrees of possibility that there may in addition be an element of real increase. Substantial decreases in mortality at all ages have occurred for stomach and colorectal cancers and substantial increases at all ages for pleural cancer and melanoma. Rates of mortality from breast cancer, the most common cancer in women in Scotland, have generally increased over the past 80 years; a temporary cessation in this upward trend occurred in the years during and after the Second World War, and recently rates have turned downward, probably at least in part because of better treatment. Mortality from ovarian cancer, the second most common reproductive-related female tumour in Scotland, has also increased at older ages. At younger ages, mortality from cancer in Scotland has decreased, especially in men, whereas incidence has not. This divergence, which has been a consequence of better treatment, has occurred especially for cancers of the testis and ovary, Hodgkin's disease and leukaemia. There have been increases at young adult ages, however, in both mortality from and incidence of oral and pharyngeal, oesophageal and laryngeal cancers in men, and melanoma and non-Hodgkin's lymphoma in each sex. Cervical cancer rates at young ages also increased, but this trend has reversed for incidence in the most recent birth cohorts. Incidence rates have also increased for testicular cancer in young adults and leukaemia in children. With the possible exceptions of non-Hodgkin's lymphoma and childhood leukaemia, the increasing rates are likely largely to reflect real rises in incidence, and they highlight the need for investigation of the causes of these cancers, and, when causes are known, for preventive action.