Cause-specific mortality and cancer morbidity in 390 male workers exposed to high purity talc, a six-decade follow-up.

BACKGROUND: This study updates information on mortality and cancer morbidity in a cohort of Norwegian talc workers. METHODS: Follow-up was extended with 24 years, covering 1953-2011. Comparisons were made with the general population and between subgroups within the cohort. RESULTS: Standardized mortality ratio for non-malignant respiratory disease (NMRD) was 0.38 (95%CI: 0.18, 0.69) and for diseases of the circulatory system (CVD) 0.98 (95%CI: 0.82, 1.16). A non-significantly increased NMRD risk was observed at high dust exposures. There were no deaths from pneumoconiosis. CONCLUSIONS: With the clear limitations of a small cohort, our results do hint at an effect of talc dust on mortality from NMRD other than pneumoconiosis, covered by a strong and persisting healthy worker effect. Also, an effect on CVD mortality, masked by a healthy worker selection into the cohort cannot be ruled out. Excess mortality from pneumoconiosis seen in other studies, may reflect exposure to quartz and, possibly, bias due to comparability problems.

Accuracy of fatal occupational injury registration in a high-income country: A comparison of two-source capture-recapture estimates with the number of cases identified in four register systems in Norway, 2000-2003.

Background: Globally, work-related deaths (injuries and diseases) are a major social and public health problem. Register data on fatal occupational injuries in high-income countries may be considered to have high quality, especially when reporting is mandatory and regulated by law. We aimed to assess the accuracy of work-related injury death statistics in Norway, with reference to the Labour Inspection Authority and three other on-going registration systems (the cause-specific mortality register, the register for governmental compensations, and the register for insurance companies). Methods: In this register-based study, we used the capture-recapture technique to adjust for undercounting. We investigated whether the capture-recapture method using two or three sources gave a valid estimate of fatal occupational injuries as compared with the number of cases identified in four registers administrated by the Norwegian Labour Inspection Authority, Statistics Norway, the Labour and Welfare Administration, and Finance Norway. The inclusion criteria were fatal unintentional injuries among residents of Norway between 2000 and 2003 that occurred while working for income in private and public land-based industries. We obtained ethical and legal approvals. Results: In a period of four years (2000-2003), the Labour Inspection Authority registered 171 occupational injury deaths among residents employed in land-based industries. Two combinations of data sources gave capture-recapture estimates of 246 [95% CI 216; 279] and 265 [95% CI 234; 299] deaths. In total, 246 cases were identified in the four registration systems, which was 44% higher than the number of deaths registered by the Labour Inspection Authority. The Labour Inspection Authority had the most complete register out of the four registration systems. Conclusions: The capture-recapture method used on two overlapping data sources gave highly valid estimates of the total deaths. We demonstrated the existence of significant weaknesses in the registration systems in a country considered to have high-quality register data.

Sudden death in sports among young adults in Norway.

AIM: The aim of the study was to explore sudden cardiac death during physical activity in young adults in Norway. MATERIALS AND METHODS: This retrospective study examined adults aged 15-34 years during the period 1990-1997. The Cause of Death Registry was used to identify cases of sudden cardiac death in sports. These cases were validated with information from medical records and autopsy reports. RESULTS: Twenty-three sports-related sudden deaths (22 men), mean age 27 years (17-34 years), were identified. Causes of death were myocardial infarction (11), myocarditis (5), conduction abnormalities (2), aortic stenosis (1), cardiac rupture (1), hypertrophic obstructive cardiomyopathy (1), congenital coronary anomaly (1), and coronary sclerosis without defined infarction (1). The deaths were distributed across different types of sports activities. The incidence of deaths among physically active young men was 0.9 per 100,000. CONCLUSION: The number of myocardial infarctions is higher than expected. The incidence is similar to that found in other studies. A vast majority of the cases of death were men.

[Mortality due to occupational injury is underreported]. / Arbeidsskadedødsfall blir underrapportert.

BACKGROUND: The Norwegian Labour Inspection Authority records fatal occupational injuries in mainland bases activities, i.e. all sectors except offshore, aviation, shipping, hunting and fishing; the Registry's information on these injuries has been considered complete. The present study aimed at testing this assumption. MATERIAL AND METHODS: In 2000 - 03, the Labour Inspection Authority recorded 183 fatal occupational injuries; 171 of the deceased were residents in Norway. Each of these deaths were compared with fatal occupational injuries in the Norwegian Cause of Death Registry. A capture-recapture model was used to estimate the real number of fatal occupational injuries. RESULTS: In 2000 - 03, 214 fatal occupational injuries were recorded among residents in Norway employed in all sectors (except offshore, aviation, shipping, hunting and fishing) in at least one of the two registries (98 cases were reported in both registries). The Norwegian Labour Inspection Authority mainly lacked information about (in comparison with the Death Registry) deaths in the military (1 of 9), in the health and social services (3 of 7), road traffic accidents (36 of 52) and deaths in Northern Norway/Spitsbergen (17 of 28). One third of all recorded cases (77 of 214) were caused by transport accidents. Risk by industry (deaths per 100 million work hours) was highest for primary industries (7.0) and for <> (4.1). The real number of fatal injuries was estimated to 246, or 44 % more than the 171 deaths registered by the Labour Inspection Authority. INTERPRETATION: Fatal occupational injuries are much more frequent than reported in the official registries. Underreporting, particularly of road traffic accidents/transport accidents, may lead to misinterpretation of risks and time trends and of need for preventive action.

Burden of suicide presented as one of the leading causes of death: uncover facts or misrepresent statistics?

BACKGROUND: Suicide is a relatively rare incident. Nevertheless, parts of the literature on intentional self-harm behaviour state that suicide is one of the leading causes of death. We aimed to assess the evidence behind the statement that suicide is a leading cause of death across all ages, with reference to the methods of ranking causes of death. METHODS: Two sets of data were used: For the European Union (EU) we used cause specific mortality statistics from the European Statistical Office (Eurostat) for the data-year 2014, and globally and for the WHO European Region we used data from Global Health Estimates (GHE) 2015. We used different sets of rules to select mutually exclusive leading underlying causes of mortality for Europe (EU28). We also present lists with estimates of leading causes of death globally, and for the WHO European Region based on the GHE 2015. RESULTS: In 2014, 1.2% of all reported deaths in the Europe Union (EU28) were due to suicide, and 1.4% globally (2015) according to the WHO estimates. In Europe, suicide was ranked as number 11 and 15 in the two different ranking lists we used, and according to GHE-2015, suicide was ranked as the 17th leading cause globally, and number 14 in the WHO European Region. Looking at the differences by sex, suicide for males was ranked as the ninth and the tenth leading cause of death in two ranking lists for the European Union. For females, suicide was number 13 in the first and 23 in the second list, respectively. CONCLUSIONS: Different cause lists and rules for ranking produce different leading causes of mortality. The quality of data can also affect the ranking. Our rankings suggested that suicide was not among the ten leading causes of death in Europe or globally. To ensure that ranking causes of death is not driven by political motives and funding considerations, standard methods and official tabulation lists should be used. The rankings do not necessarily present the causes of mortality of greatest public health importance.

[Acute poisonings in Norway 1999-2004--morbidity and mortality]. / Akutte forgiftninger 1999-2004--sykelighet og dødelighet.

BACKGROUND: Monitoring of acute poisoning is important for health authorities. There have been local studies and national studies in limited areas such as drug poisoning, but morbidity and mortality associated with acute poisoning has not been presented collectively at a national level. The aim of the study is to establish morbidity and mortality associated with acute poisoning in Norway. MATERIAL AND METHODS: The study material comprised data from the Norwegian Patient Register and the Norwegian Causes of Death Register on patients with acute poisoning from 1999 through 2004. Data from somatic hospitals include patients who were discharged after 5 hours. RESULTS: Almost 11,000 discharges with acute poisoning, coded as main or other condition (ICD-10 F and T codes), were recorded from somatic hospitals annually. The hospital mortality was 0.8 %. About 500 acute poisoning deaths occurred annually, 20 % within and 80 % of them outside hospitals. INTERPRETATION: The results show increased morbidity and stable mortality by acute poisoning in Norway, 1999-2004. Information in the Cause-of-Death and especially the Patient Register should be improved. More detailed information by type of drugs and substances and external causes are needed for monitoring and prevention.

Deaths by poisoning in Norway 2003-2012.

CONTEXT: Poisoning is an important category of avoidable deaths in Norway and an important public health issue. Close monitoring of any development in this field is essential for effective preventive measures. OBJECTIVE: To assess the pattern and trends of poisoning mortality in Norway from 2003 to 2012 based on official mortality data. MATERIALS AND METHODS: This is a population-based registry study. We analyzed the underlying external cause of death data, in order to assess poisoning deaths (ICD-10) by accidents (X40-X49); intentional self-harm (suicide) (X60-X69); assault (homicide) (X85-X90); and poisoning of undetermined intent (Y10-Y19). We compared poisoning deaths to other injury mechanisms and used multiple injury cause data to identify substances involved in poisoning deaths. Poisson regression was applied to estimate the trend. RESULTS: Poisoning was the second leading mechanism of injury deaths in Norway from 2003 to 2012, causing between 424 and 496 deaths each year. The rates of poisoning deaths varied between 8 and 11 per 100,000 inhabitants, with a peak in 2004. About 3366 of the 4620 poisoning deaths in the decade were accidental. Opioids were the most common causative agents. Heroin caused 150 deaths in 2004. The numbers fell to 63 in 2012 but showed great yearly variations. Deaths by methadone increased from 24 in 2003 to 61 in 2012. DISCUSSION: Poisoning mortality rates declined from 2003 to 2012. Interpretation of the data, however, should be done with caution, and comparison with other countries may be biased due to differences in data production procedures. Evaluation of the effect of preventive measures to reduce mortality should be emphasized. CONCLUSION: Poisonings remain a significant cause of mortality by injury in Norway. Emphasis should be placed on following the trends closely, especially regarding methadone deaths.

Mixed impact of firearms restrictions on fatal firearm injuries in males: a national observational study.

INTRODUCTION: Public health organizations have recommended restricted access and safe storage practices as means to reduce firearm injuries and deaths. We aimed to assess the effect of four firearm restrictions on firearm deaths in Norway 1969-2009. METHODS: All deaths due to firearm discharge were included (5,660 deaths, both sexes). The statistical analysis to assess impact of firearm legislations was restricted to males because of the sex disproportionality (94% were males). RESULTS: A total of 89% of firearm deaths (both sexes) were classified as suicide, 8% as homicide, and 3% as unintentional (accident). During the past four decades, male accidental firearm death rates were reduced significantly by 90%. Male firearms suicide rates increased from 1969 to 1991 by 166%, and decreased by 62% from 1991 to 2009. Despite the great reduction in male accidental firearm deaths, we were unable to demonstrate effects of the laws. In contrast, we found that a 1990 regulation, requiring a police permit before acquiring a shotgun, had a beneficial impact on suicide in the total sample and in those aged 15-34 years. Male firearm homicides decreased post-2003 regulation regarding storing home guard weapons in private homes. CONCLUSIONS: Our findings suggest that two laws could have contributed to reduce male firearm mortality. It is, however, a challenge to measure the role of four firearm restrictions. The null findings are inconclusive, as they may reflect no true impact or study limitations.

Comparing ICD-9 and ICD-10: the impact on intentional and unintentional injury mortality statistics in Italy and Norway.

BACKGROUND: The international classification of diseases (ICD) provides guidelines for the collection, classification and dissemination of official cause-of-death statistics. New revisions of the ICD can potentially disrupt time trends of cause-of-death statistics and affect between-country comparisons. The aim of this study was to measure how switching from ICD-9 to ICD-10 affected mortality statistics for external causes of death, i.e. intentional and unintentional injuries, in Italy and Norway. METHODS: A sample of death certificates (N=454,897) were selected in Italy from the first year the ICD-10 was implemented (2003) and reclassified from ICD-10 to ICD-9 by the Italian National Institute of Statistics. A sample of death certificates was also selected in Norway (N=10,706) from the last year the ICD-9 was used (1995) and reclassified according to ICD-10 by Statistics Norway. The reclassification (double-coding) was performed by special trained personal in governmental offices responsible for official mortality statistics. Although the reclassification covered all causes of death (diseases and injuries) in the sample, our analysis focused on just one ICD chapter XX. This was external causes of mortality (injury deaths), and covered 15 selected categories of injuries. RESULTS: The switch from ICD-9 to ICD-10 had a significant net impact on 8 of the 15 selected categories. In Italy, accidental falls decreased by 76%; traffic accidents decreased by 9%; suicide by hanging decreased by 3%; events of undetermined intent decreased by 69%; and overall injury deaths decreased by 4%. These net decreases reflect the moving of death records from injury categories in ICD-9 to other injury or disease categories in ICD-10. In Norway, the number of records in three categories decreased significantly: transport accidents, 9%; traffic accidents, 13%; and suicide by self-poisoning, 18%. No statistically significant differences (net changes) were observed in the total number of accidents, suicides and homicides in either country. CONCLUSIONS: Switching to ICD-10 did not change the overall trends for accidents, homicides and suicides in either country. However, the number of records in some injury subcategories e.g. accidental falls and traffic accidents, decreased. Changing classification can thus affect the ranking of causes of injury mortality, with consequences for public health policy.

Changes in statistical methods affected the validity of official suicide rates.

OBJECTIVE: This study investigates whether changes in registration and coding practices influenced official suicide rates in Norway from 1988 to 2002. STUDY DESIGN AND SETTING: A Poisson regression model was used to evaluate rates of suicide and potentially competing underlying causes of death. Setting in Norway 1988-2002. RESULTS: From 1988 to 1994, suicide mortality decreased significantly, by 23.7%. Simultaneously, rates of causes of death potentially masking suicide decreased or remained fairly stable. From 1994 to 2002, however, there were no significant changes in suicide rates but accidental poisoning, which may mask suicide, increased significantly by 32.4%. Also, "ill-defined causes" of death increased by 16.7%, indicating poorer data quality. CONCLUSION: This study suggests that the decreasing suicide rate in 1988-94 reflects a real change. However, the general quality of mortality statistics has deteriorated since the late 1990s, making it difficult to assess developments since 1994. Such variations in the reliability of official suicide statistics complicate international comparisons. However, shifts in the death rate because of "ill-defined" causes could serve as a warning that data quality is not consistent over time.

Chain of care for patients with intentional self-harm: an effective strategy to reduce suicide rates?

Chain of care for patients with intentional self-harm was important in the Norwegian national action plan to prevent suicide. In this study there were two aims: (1) to calculate the potential effects of chain of care on reducing suicide rates, and (2) to assess whether suicide rates decreased more in areas where chain of care had been implemented than in other areas. We observed no differences in changes in suicide rates between areas with and without the intervention. The calculated potential effects of chain of care on national suicide rates were very small, even under unrealistically favorable conditions.

Characteristics of anorexia nervosa-related deaths in Norway (1992-2000): data from the National Patient Register and the Causes of Death Register.

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.

[Cause of death registry--an important data source for medical research]. / Dødsårsaksregisteret--en viktig datakilde for medisinsk forskning.

Statistics on mortality and cause of death are of crucial importance to epidemiological research. The Cause of Death Register kept by Statistics Norway is the only national register including information on cause of death for all deceased persons registered as residents in Norway at their time of death, whether death occurred in Norway or abroad. This article presents historical information and guidelines for research access to individual data on cause of death.