Population-based analysis of meningococcal disease mortality in the United States: 1990-2002.

BACKGROUND: Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in the United States. Approximately 10-15% of meningococcal patients died despite antimicrobial therapies. METHODS: We used vital records to assess meningococcal disease mortality in the United States during 1990-2002. Meningococcal cases were defined as reported deaths with recorded International Classification of Diseases, 9th revision (ICD-9) codes 036.0-036.9 or ICD-10 codes A39.0-A39.9. Denominator data were obtained from population estimates published by the U.S. Census Bureau. We analyzed the effects of age, sex, race/ethnicity and season of the year on meningococcal disease mortality. RESULTS: We identified 3335 meningococcal deaths. Both the crude and age-adjusted mortality rates were 0.10 death per 100,000 population per year (95% confidence interval, 0.09-0.10). Fifty-eight percent of deaths occurred among persons younger than 25 years old. Mortality was elevated in infants, young adults (15-24 years old), and older adults (older than 74 years old). Mortality rates in African-Americans were 1.45 and 3.32 times higher than mortality rates in whites and Asians/Pacific Islanders, respectively. Mortality caused by meningococcal disease rose in winter months and declined during the summer. Observed mortality rates increased from 1990 to 1997 and decreased from 1997 to 2002. CONCLUSIONS: Meningococcal disease continues to be an important, vaccine-preventable cause of death in the United States. Vaccination and other disease prevention efforts should be augmented for higher risk groups. Meningococcal mortality data can be used to assess the effectiveness of these efforts.

A population-based analysis of pneumococcal disease mortality in California, 1989-1998.

OBJECTIVES: Pneumococcal disease is an important cause of vaccine-preventable mortality. It is important to understand the burden and distribution of mortality so that prevention efforts can be targeted appropriately. This study evaluated pneumococcal disease mortality and its demographic correlates in California from 1989 to 1998. METHODS: Deaths due to pneumococcal disease were identified from statewide vital records data using multiple cause-coded information. Denominator data were obtained from estimates from the California Department of Finance. Crude and age-adjusted mortality rates and 95% confidence intervals were calculated for each age, gender, and racial/ethnic group. RESULTS: The age-adjusted pneumococcal disease mortality rate was 2.05 deaths per 100,000 population. Mortality was highest in elderly individuals (reaching 38.29 deaths per 100,000 population in individuals older than age 85). Age-adjusted mortality rates were elevated in the African American race/ethnicity group (2.96 deaths per 100,000 population) and males (2.67 deaths per 100,000 population). The majority of individuals who died of pneumococcal disease (78.9%) fell into at-risk groups indicated for vaccination. The majority of all pneumococcal deaths were caused by pneumococcal pneumonia. Mortality was seasonal, reaching a peak in the winter months. A decreasing trend in mortality was observed over the 10-year period examined. CONCLUSIONS: Pneumococcal disease remains a significant cause of vaccine-preventable mortality in the California population. Greater efforts must be made to vaccinate at-risk individuals, especially those in demographic groups at highest risk of death.

Knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a low-income, public health clinic population.

OBJECTIVE: The Public Health Center Vaccine Survey (PHCVS) examines the knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a largely low-income, urban, public health clinic population in Los Angeles County, USA. DESIGN: A cross-sectional survey of vulnerable individuals at risk for severe influenza infection was conducted in one of the nation's largest local public health jurisdictions. SUBJECTS: A total of 1541 clinic patients were recruited in the waiting rooms of five large public health centers in Los Angeles County from June to August, 2010. RESULTS: Among prospective respondents who met eligibility criteria, 92% completed the survey. The majority was black or Latino and most were between the ages of 18 and 44 years. More than half were unemployed; two-thirds had no health insurance; and nearly one-half reported having a high school education or less. About one-fifth reported they had received the H1N1 vaccine during the previous flu season. In comparative analyses, negative beliefs about vaccine safety and efficacy were highly predictive of H1N1 vaccination. Blacks were less likely than non-black respondents to report receiving the H1N1 vaccine (OR=0.7, 95% CI=0.6-1.0). Blacks were also less likely than other respondents to agree that vaccines can prevent disease (OR=0.4, 95% CI=0.3-0.5), that vaccines are safe (OR=0.5, 95% CI=0.4-0.6), and that they trust doctors/clinicians who recommend vaccines (OR=0.5, 95% CI=0.4-0.7). CONCLUSIONS: Study findings provide a useful risk profile of vulnerable groups in Los Angeles County, which may be generalizable to other urban jurisdictions in the United States. They also describe real world situations that can be used to forecast potential challenges that vaccine beliefs may pose to national as well as local influenza pandemic planning and response, especially for communities with limited access to these preventive services.

Increase in Clostridium difficile-related mortality rates, United States, 1999-2004.

Reported mortality rates from Clostridium difficile disease in the United States increased from 5.7 per million population in 1999 to 23.7 per million in 2004. Increased rates may be due to emergence of a highly virulent strain of C. difficile. Rates were higher for whites than for other racial/ethnic groups.

Using multiple cause-of-death data to investigate associations and causality between conditions listed on the death certificate.

Death rarely results from only one cause, and it can be caused by a variety of factors. Multiple cause-of-death data files can list as many as 20 contributing causes of death in addition to the reported underlying cause of death. Analysis of multiple cause-of-death data can provide information on associations between causes of death, revealing common combinations of events or conditions which lead to death. Additionally, physicians report the causal train of events through which they believe that different conditions or events may have led to each other and ultimately caused death. In this paper, the authors discuss methods used in studying associations between reported causes of death and in investigating commonly reported causal pathways between events or conditions listed on the death certificate.

Multiple sclerosis mortality and patterns of comorbidity in the United States from 1990 to 2001.

Multiple sclerosis (MS) is a neurodegenerative condition that can result in cognitive and physical disability and shortened life expectancy. However, population-based information is lacking regarding the mortality burden from MS in the United States. We investigated trends in MS mortality rates and examined important comorbidities in the United States from 1990 to 2001. MS deaths were matched by age, sex, and race/ethnicity with randomly selected deaths from other conditions for matched odds ratio comparisons. The overall age-adjusted mortality rate from MS was 1.44/100,000 population. MS mortality rates increased throughout the study period. MS mortality rates were higher in whites than in any other racial/ethnic group, followed by Blacks, Hispanics, American Indians/Alaska Natives, and Asians and Pacific Islanders. Observed mortality rates were more than 10 times lower in Asians and Pacific Islanders than in whites. The odds of pressure ulcers, urinary tract infections, and pneumonia/influenza being reported on the death certificate were higher in MS deaths than in matched controls.

A comparison of underlying cause and multiple causes of death: US vital statistics, 2000-2001.

BACKGROUND: Mortality statistics can be compiled using underlying cause-of-death data or multiple cause-of-death data, which include other contributing causes of death. METHODS: For the leading causes of death in the United States during 2000-2001, we compared underlying and multiple cause-of-death statistics. RESULTS: For some conditions, little difference was observed between the 2 estimates. For other conditions, up to 10 times more deaths were identified from multiple-cause data than from underlying-cause data. The 10 leading causes of death differed when using the 2 types of data. CONCLUSIONS: Whenever possible, underlying and multiple cause-of-death statistics should both be presented. Analyses that use only the underlying cause of death ignore additional information that is readily available from multiple-cause data, and the more limited data may underestimate the importance of several leading causes of death.

High incidence of HIV-associated mortality among black and Hispanic infants and women of childbearing age in the United States 1990-2001.

This study examined HIV-associated mortality in infants and in women of childbearing age (15-44 years) in the United States from 1990-2001. HIV-associated deaths were identified from national vital records using multiple cause-of-death data. HIV-associated mortality was higher in black and Hispanic women than in white women (rate ratio(black) = 13.5, 95% CI = 13.2-13.8; rate ratio(Hispanic) = 2.4, 95% CI = 1.9-3.2). Racial/ethnic trends in infant mortality rates from HIV reflected trends observed in women (rate ratio(black) = 16.3, 95% CI = 13.5-19.7; rate ratio(Hispanic) = 3.4, 95% CI = 3.3-3.5). HIV-associated mortality decreased in infants and in women of childbearing age following the availability of highly active antiretroviral therapy, but the decrease was considerably less marked in black women than in women of other racial/ethnic groups. Our findings indicate the need for increased emphasis on prevention of HIV mortality in black and Hispanic women and infants. Reduction of HIV prevalence in young women may also prevent infant mortality from HIV by reducing mother-to-child transmission.

Pressure ulcers: more lethal than we thought?

OBJECTIVE: To investigate the burden of pressure ulcer-associated mortality in the United States and to examine racial/ethnic differences and associated comorbidities. DESIGN: A descriptive study with matched odds ratio comparisons. SETTING: The United States, 1990-2001. PARTICIPANTS: Pressure ulcer-associated deaths were identified from national multiple cause-coded death records from 1990 to 2001. MAIN OUTCOME MEASURES: Age-adjusted mortality rates and matched odds ratio comparisons of pressure ulcer-associated deaths with deaths from other conditions. MAIN RESULTS: Between 1990 and 2001, pressure ulcers were reported as a cause of death among 114,380 persons (age-adjusted mortality rate, 3.79 per 100,000 population; 95% confidence interval [CI], 3.77-3.81). For 21,365 (18.7%) of these deaths, pressure ulcers were reported as the underlying cause. Nearly 80% of pressure ulcer-associated deaths occurred in persons at least 75 years old. Septicemia was reported in 39.7% of pressure ulcer-associated deaths (matched odds ratio, 11.3; 95% CI, 11.0-11.7). Multiple sclerosis, paralysis, Alzheimer disease, osteoporosis, and Parkinson disease were reported more often in pressure ulcer-associated deaths than in matched controls. Pressure ulcer-associated mortality was higher among blacks than among whites (age-adjusted rate ratio, 4.22; 95% CI, 4.16-4.27). CONCLUSION: Pressure ulcers are associated with fatal septic infections and are reported as a cause of thousands of deaths each year in the United States. Incapacitating chronic and neurodegenerative conditions are common comorbidities, and mortality rates in blacks are higher than in other racial/ethnic groups.