Urban-rural differences in China's crude death rate changes.

BACKGROUND: From 1982 to 2010, the country's crude death rate (CDR) dropped sharply, fluctuated, and finally slightly declined. There is a big difference in CDR between urban and rural areas. From 1982 to 1990, the CDR in the country and the countryside declined, and the CDR in cities and towns rose. After 1990, the CDR in cities gradually decreased, the CDR in towns first fell and then rose, and the CDR in the countryside steadily increased. The CDR is affected by changes in the age-specific death rate (ASDR) and age structure. METHODS: This paper decomposes CDR changes into the influence of declines in ASDR and the impact of age structure changes based on 1982, 1990, 2000, and 2010 census data. RESULTS: The decline in ASDR reduces the CDR, and the aging population increases the CDR (including cities, towns, and the countryside). At the same time, decomposing the difference between the countryside and cities (or the countryside and towns) CDRs found that after 1990, the influence of ASDR differences and age structure differences increased with time. Our results revealed a more significant effect of ASDR differences. The combined effect of two factors (ASDR and age structure) makes the 0, 1-14, 15-64 age groups reduce the CDR, and the 65+ age group increases the CDR. In addition, the 0-year-old group has a not negligible impact on the changes in CDR, although it accounts for a small proportion of the total population. CONCLUSIONS: The influence of ASDR and age structure differs over time (1982 to 1990, 1990 to 2000, and 2000 to 2010) and across regions (cities, towns, the countryside). Considering the slow decline in ASDR and the accelerated aging population, we can infer that the CDR in 2020 will stabilize or even rise slightly instead of dropping significantly (compared with the CDR in 2010). This study provides a basis for the formulation of relevant public health policies.

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: the double burden of non-communicable diseases and injuries.

OBJECTIVES: Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. METHODS: Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. RESULTS: Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality. CONCLUSION: Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities.

Do not neglect SARS-CoV-2 hospitalization and fatality risks in the middle-aged adult population.

OBJECTIVES: This study aimed at estimating the SARS-CoV-2 infection hospitalization (IHR) and infection fatality ratios (IFR) in France. PATIENTS AND METHODS: A serosurvey was conducted in 9782 subjects from the two French regions with the highest incidence of COVID-19 during the first wave of the pandemic and coupled with surveillance data. RESULTS: IHR and IFR were 2.7% and 0.49% overall. Both were higher in men and increased exponentially with age. The relative risks of hospitalization and death were 2.1 (95% CI: 1.9-2.3) and 3.8 (2.4-4.2) per 10-year increase, meaning that IHR and IFR approximately doubled every 10 and 5 years, respectively. They were dramatically high in the very elderly (80-90 years: IHR: 26%, IFR: 9.2%), and also substantial in younger adults (40-50 years: IHR: 0.98%, IFR: 0.042%). CONCLUSIONS: These findings support the need for comprehensive preventive measures to help reduce the spread of the virus, even in young or middle-aged adults.

Delay-Adjusted Age-Specific COVID-19 Case Fatality Rates in a High Testing Setting: South Korea, February 2020 to February 2021.

In South Korea, a country with a high coronavirus disease 19 (COVID-19) testing rate, a total of 87,324 COVID-19 cases, including 1562 deaths, have been recorded as of 23 February 2021. This study assessed the delay-adjusted COVID-19 case fatality risk (CFR), including data from the second and third waves. A statistical method was applied to the data from 20 February 2021 through 23 February 2021 to minimize bias in the crude CFR, accounting for the survival interval as the lag time between disease onset and death. The resulting overall delay-adjusted CFR was 1.97% (95% credible interval: 1.94-2.00%). The delay-adjusted CFR was highest among adults aged ≥80 years and 70-79 years (22.88% and 7.09%, respectively). The cumulative incidence rate was highest among individuals aged ≥80 years and 60-69 years. The cumulative mortality rate was highest among individuals aged ≥80 years and 70-79 years (47 and 12 per million, respectively). In South Korea, older adults are being disproportionately affected by COVID-19 with a high death rate, although the incidence rate among younger individuals is relatively high. Interventions to prevent COVID-19 should target older adults to minimize the number of deaths.

Impacto directo e indirecto del COVID-19 en la esperanza de vida al nacer de Chile en el año 2020 / Direct and indirect impact of COVID-19 on life expectancy at birth in Chile in 2020 / Impacto direto e indireto da COVID-19 na expectativa de vida ao nascer no Chile em 2020

Resumen: El artículo muestra el impacto directo e indirecto del COVID-19 en la esperanza de vida de Chile durante el año 2020, utilizando las estadísticas de defunciones definitivas publicadas en marzo del año 2023. Para ello, se estimó una mortalidad contrafactual para año 2020 sin el COVID-19, siguiendo el patrón de mortalidad según causas de muerte desde 1997 a 2019, se elaboraron tablas de mortalidad para calcular la esperanza de vida para los años 2015 a 2020 y para el año 2020 estimado, y luego se descompuso la diferencia entre la esperanza de vida esperada y observada del año 2020 según grupos de edad y causas de muerte. La esperanza de vida del año 2020 quiebra la tendencia a su aumento entre 2015 y 2019, mostrando un retroceso, en hombres y en mujeres, con respecto al año 2019, de 1,32 y 0,75 años respectivamente. Con respecto al año 2020 estimado, la esperanza de vida del 2020 observado es 1,51 años menor en hombres y 0,92 en mujeres, pero el impacto directo del COVID-19 en pérdida de esperanza de vida fue mayor, 1,89 para los hombres y 1,5 para las mujeres, concentrándose en las edades entre los 60 y 84 años en hombres y entre 60 y 89 años en mujeres. El impacto directo negativo del COVID-19 a la esperanza de vida en parte fue contrarrestado por impactos indirectos positivos significativos en dos grupos de causas de muerte, las enfermedades del sistema respiratorio y las enfermedades infecciosas y parasitarias. El estudio muestra la necesidad de distinguir los impactos directos e indirectos del COVID-19, por la incidencia que pueden tener en la salud pública cuando el COVID-19 baje su intensidad y se eliminen las restricciones de movilidad.

Abstract: This article shows the direct and indirect impacts of COVID-19 on life expectancy in Chile in 2020, based on mortality statistics published in March 2023. To this end, a counterfactual mortality was estimated for 2020 without COVID-19; based on the pattern of mortality by cause of death from 1997 to 2019, mortality charts were created to calculate life expectancy from 2015 to 2020 and an estimation for 2020, and the difference between expected and observed life expectancy in 2020 was then separated by age group and cause of death. Life expectancy in 2020 interrupted the upward trend from 2015 to 2019, showing a decline of 1.32 years in men and 0.75 years in women compared to 2019. Compared to the estimated 2020, life expectancy was 1.51 years lower in men and 0.92 years lower in women, but the direct impact of COVID-19 on the decrease in life expectancy was greater (1.89 for men and 1.5 for women) in the 60-84 age group in men and the 60-89 age group in women. The direct negative impact of COVID-19 on life expectancy was partially mitigated by significant positive indirect impacts on two groups of causes of death: diseases of the respiratory system and infectious and parasitic diseases. This study shows the need to differentiate direct and indirect impacts of COVID-19, due to the implications for public health when the intensity of COVID-19 decreases and mobility restrictions are suspended.

Resumo: Este artigo apresenta os impactos direto e indireto da COVID-19 na expectativa de vida no Chile em 2020 a partir de estatísticas de mortalidade publicadas em março de 2023. Para tanto, foi estimada uma mortalidade contrafactual para 2020 sem a COVID-19; a partir do padrão de mortalidade por causa de morte de 1997 a 2019, foram criadas tabelas de mortalidade para calcular a expectativa de vida para o período de 2015 a 2020 e para o ano estimado de 2020 e, em seguida, a diferença entre a expectativa de vida esperada e observada em 2020 foi separada por faixa etária e causa de morte. A expectativa de vida em 2020 interrompe a tendência de aumento entre 2015 e 2019, mostrando um declínio com relação a 2019 de 1,32 ano nos homens e 0,75 ano nas mulheres. Com relação ao ano estimado de 2020, a expectativa de vida observada é 1,51 ano menor nos homens e 0,92 nas mulheres, mas o impacto direto da COVID-19 na diminuição da expectativa de vida foi maior (1,89 para homens e 1,5 para mulheres), concentrando-se nas idades entre 60 e 84 anos nos homens e entre 60 e 89 anos nas mulheres. O impacto direto negativo da COVID-19 na expectativa de vida foi parcialmente atenuado por impactos indiretos positivos significativos em dois grupos de causas de morte: doenças do sistema respiratório e doenças infecciosas e parasitárias. Este estudo mostra a necessidade de diferenciar impactos diretos e indiretos da COVID-19, devido às implicações para a saúde pública quando a intensidade da COVID-19 diminuir e as restrições de mobilidade forem suspensas.

Ischemic heart disease and alcohol-related causes of death: a view of the French paradox.

PURPOSE: In France the low rates of death due to ischemic heart disease have been attributed to the high consumption of alcohol. However, the question remains: are the higher death rates for causes associated with alcohol consumption an explanation? METHODS: Diseases were defined according to the International Classification of Diseases, revision 9. World Health Organization data on country- and age-specific death rates were used. RESULTS: Official causes-of-death statistics for men 40-74 years of age show that in 1990 French men under 50 years old had low death rates from ischemic heart disease but a relatively high all-cause mortality rate, in contrast to low rates for men 60 to 74 years of age. Among French men aged 40-44 years in 1960, 34% had died before reaching the age of 70-74 years. In comparison, 37% in the United States and 36% in England and Wales, had died by this age, with 4.5%, 14.1%, and 15.2% of deaths, respectively, due to ischemic heart disease. If all of the men who died early of causes associated with alcohol had died of ischemic heart disease, there would still be a lower rate in France (21%) than in the United States (26%) or in England and Wales (25%). CONCLUSION: Thus, although some of the chronic heavy drinkers in France die early of causes associated with excessive alcohol consumption, this is not the only reason for the low ischemic heart disease death rates.

Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990.

Coronary heart disease and stroke death rates were compared for six ethnic groups (non-Hispanic white, Hispanic, African-American, Chinese, Japanese, and Asian Indian) by sex and age (25 to 44, 45 to 64, 65 to 84, and 25 to 84 years old) using California census and 1985 to 1990 death data. African-American men and women in all age groups had the highest rates of death from coronary heart disease, stroke, and all causes (except for coronary heart disease in the oldest men). Hispanics, Chinese, and Japanese in all age-sex groups had comparatively low death rates for coronary heart disease and stroke, although stroke was proportionally an important cause of death for Chinese and Japanese groups. Coronary heart disease was an important cause of death for Asian Indians although death rates were generally not higher than those for other ethnic groups. Ethnic differences were most marked for women and younger age groups.

Specificity of association in analysis of mortality and inference on causality.

Specificity of association between putative risk factor and disease under study is important to inference on causality. Nevertheless many studies investigate mortality of a single disease without comparison with a control. Age-standardized proportional mortality ratios make single disease studies into case-control studies and thus demonstrate whether or not associations are disease specific. Comparison of disease-specific with all-cause mortality experiences of whole populations classified by exposure, clearly distinguishes between exposures associated with more death and with earlier/younger death, thereby overcoming an important limitation of the familiar standardized mortality ratio (SMR). Smoking is associated with more death from lung cancer (lifetime cause-specific proportions, never 1%, light 6%, moderate 8% and heavy 12%) and with earlier/younger death from ischaemic heart disease (never 35%, light 34%, moderate 32% and heavy 29%).

Trends in cerebrovascular disease mortality in Singapore: 1970-1994.

BACKGROUND: Cerebrovascular disease has been the third leading cause of death in Singapore for the last 25 years. This study was carried out to examine recent trends in cerebrovascular disease mortality in Singapore, and to study corresponding changes in stroke risk factors in our population. METHODS: The Registry of Births and Deaths, Singapore, publishes annual reports on births and deaths. The cause of death is coded using the International Classification of Diseases Revisions 8 (1969-1978) and 9 (1979 onwards). Data for this study were obtained using rubrics 430-438. Death rates were age- and sex-standardized to the World Standard Population, and separately for males and females. Cerebrovascular disease risk factor patterns were derived from national epidemiological health surveys conducted from 1970 and 1994. RESULTS: The absolute number of deaths annually from cerebrovascular disease rose from 1041 in 1970 to 1692 in 1994. Crude death rates remained stable at 50-60 per 100000, accounting for 10-12% of all deaths. Standardized death rates showed a distinct fall from 99 per 100000 in 1976 to 59 per 100000 in 1994, 101 to 60 per 100000 in males and 95 to 57 per 100000 in females. National health surveys have shown a fall in the prevalence of undetected hypertension, smoking and hyperlipidaemia; the prevalence of obesity was unchanged, while that of diabetes mellitus rose over the same period. The mortality trends found in this study are unlikely to be due to changing fashions in coding or inadequate data collection. CONCLUSION: As in many countries in the world, cerebrovascular disease mortality in Singapore has fallen over the last 25 years; this may in part be related to the decline in stroke risk factors in our population.

Trends in mortality from cutaneous malignant melanoma in Belgium.

BACKGROUND AND METHODS: Changes over time of mortality rates from cutaneous malignant melanoma (CMM) in Belgium were analysed, based on people (n = 3695) aged 25-84 years, who died of CMM from 1954 to 1992. All data were collected from the Belgian National Institute of Statistics. For the log-linear analysis and calculation of the average annual change, only the data from 1973 to 1992 were considered. RESULTS: The age-adjusted mortality rates (per 10(5)) for the age group 25-84 years old increased from 0.5 in 1954 to 3.0 in 1992 in men, and from 0.8 in 1954 to 2.2 in 1992 in women. The average annual percentage change in men (-0.003%) was stable over the period 1973-1982, and increased to 4.4% over the period 1983-1992. In women, the average annual increase was 4.6% over the period 1973-1982, and continued to increase to 6.8% over the period 1983-1992. Log-linear analysis showed that the change in rates for both men and women was mainly due to an age-'drift' effect, contrary to the results of the average annual percentage change in men. CONCLUSION: The risk of dying from CMM increased in men and women continuously over the whole period, irrespective of birth cohort. In both men and women, there was approximately a 20% increase in CMM mortality per 5-year period.

The influence of gender on determinants of urban childhood mortality in Bangladesh.

To assess sociodemographic characteristics predicting childhood mortality in urban Bangladesh, we conducted a case-control study of subjects selected from 51 low and middle class areas of urban Dhaka between 14 October 1984 and 13 October 1985. Cases were the 38 children who died aged under six years during the study interval; six surviving controls aged under six years were selected for each case. Factors associated with childhood deaths included being under one year of age (OR (odds ratio) = 11.80; p less than 0.0001), and several direct and indirect indicators of poor economic status: ie head of household earning a daily wage rather than a salary (OR = 2.63; p less than 0.01); residence in a single-room dwelling (OR = 2.63; p less than 0.05); or residence in a structure of inferior construction (OR = 2.58; p less than 0.05). There were important gender-specific differences in the risk factors. Having one or more male siblings was associated with an increased risk of death for male children (OR = 2.78; p less than 0.05), while having at least one female sibling was suggestively associated with the risk of death for female children (OR = 2.47; p less than 0.10). Family dependence on daily wages rather than on a salary was associated with male deaths (OR = 6.24; p less than 0.001) but not with female deaths (OR = 1.38). Other indices of poverty (poor construction of house and single-room dwellings) were also associated with an increased risk of male but not female deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Geographical variation of cancer mortality in Italy.

The distribution of death certification rates from various cancers or groups of cancers in broad Italian geographical areas (north/centre/south) was analysed. In both sexes, total cancer mortality was considerably elevated in the north of the country compared to southern regions (around 70% for males and 30% for females in the truncated 35-64 rate), and generally intermediate in central areas. Northern mortality rates were higher for respiratory cancers and other tobacco related neoplasms (excluding bladder), with a north/south ratio ranging from 1.5 for lung and most respiratory sites to about 4.0 for oesophageal cancer in males. There was little tendency towards a leveling of these differences in younger (40-49 year old) males. Northern areas showed higher death certification rates for cancers of the stomach, large bowel, liver and most other digestive sites. The lower gastric cancer mortality registered in southern Italy is curious, since this is the poorest part of the country. Death certification rates from all other common neoplasms (uterus apart) were also elevated in the north. The geographical variation, however, appeared more limited for non-epithelial neoplasms. The substantial differences in cancer mortality between various Italian geographical areas can hardly be dismissed as due to lower death certification accuracy in the south. Some of the differences can be explained in terms of available knowledge of the causes of cancer (eg reproductive factors for breast and ovarian neoplasms, alcohol plus tobacco for oesophageal cancer). However, the lower mortality from respiratory cancers in southern areas can only with some difficulty be totally explained in terms of tobacco consumption. Likewise, the north/south variation cannot be related to non-specific consequences of industrialization, since cancer mortality was similarly elevated in highly industrialized and chiefly rural northern areas. It is conceivable that dietary factors may also explain some of the differences. However, at present, there is no obvious general explanation for this quite peculiar geographical distribution of cancer mortality within a single country.

PIP: The authors examine variations in mortality due to cancer among the northern, central, and southern regions of Italy. Using data from official death records for the years 1969-1978, the authors calculate age-standardized mortality rates for all ages and for ages 35-64, and age-specific mortality rates for men and women aged 40-49. The results are presented by sex and region for 29 categories of cancer. The analysis shows a clear north-south gradient with consistently higher mortality rates in the north, lower rates in the south, and intermediate values in the central region. More detailed findings according to sex, age, and type of cancer are discussed, and possible reasons for the geographical variations, including regional patterns concerning diet, alcohol consumption, and smoking, are considered.

Cancer mortality in the Republic of San Marino.

San Marino is a small independent Republic encircled by Italy, with a population of approximately 20,000. It still maintains an ethnic profile favoured by a tendency to genetic segregation due to endogamy. Since 1908 detailed data have been kept on all deaths among residents also for those dying outside the country. In this study the mortality trends based on crude rates are reported for all neoplasms and for selected sites in the years 1908 to 1980, showing increased rates for all neoplasms and the highest rate for stomach cancer. Age-adjusted death rates were calculated for all neoplasms and for selected sites, by sex, in the years 1966 to 1980. Stomach cancer was the commonest cause of cancer death in San Marino and its age-adjusted death rate was the highest in the world. A sharp increase was also observed for respiratory tract and colorectal cancers in recent years.

Changing mortality patterns for major cancers in Spain, 1951-1985.

Mortality trends for main cancer sites in Spain from 1951-1985 are presented. Age-standardized mortality rates per 100,000 were computed using the direct method. The Spanish population of 1970 was used as the standard. Age-standardized mortality rates for total cancer showed a marked increase among men throughout the period of study. This can be attributed mainly to the increase in lung cancer mortality (from 8.63 person-years to 44.74 between 1951 and 1985), which was only partially balanced by a reduction in the stomach cancer mortality (from 36.18 to 18.31). Among women the increase in total cancer is lower overall. It occurred mainly during the 1950s and thereafter the trend has remained stable and even declined in recent years. Lung cancer mortality rates among women have remained fairly stable and stomach cancer followed the same pattern as for men. Breast cancer mortality increased constantly during the period (from 7.21 to 19.38) but it was not until 1978 that it became the leading cause of cancer mortality among women.

Epidemiological transition in Trinidad and Tobago, West Indies 1953-1992.

BACKGROUND: This study aimed to describe trends in age-specific mortality from diabetes mellitus, hypertension, cerebrovascular disease and ischaemic heart disease in Trinidad and Tobago between 1953 and 1992 and to relate them to earlier changes in infant mortality rates. METHODS: Average annual age-specific mortality rates per 100 000 were calculated for 5-year time periods from 1953-1957 to 1988-1992 and plotted by mid-year of birth for cohorts born 1874-1882 to 1944-1952. Regression analyses were performed to test associations between adult mortality rates, and infant mortality rates for the same birth cohorts and period of death. RESULTS: Infant mortality declined from 180 per 1000 in 1901 to 10 per 1000 in 1992. Age-standardized mortality from diabetes mellitus increased, in men, from 60 in 1958-1962 to 278 in 1988-1992, in women the increase was from 89 to 303. Mortality from hypertension declined, in men, from 232 in 1953-1957 to 73 in 1988-1992, and in women, from 206 to 67. Cerebrovascular mortality increased, in men, from 341 in 1953-1957 to 451 in 1963-1967 before declining to 224 in 1988-1992. In women cerebrovascular mortality increased from 292 in 1953-1957 to 361 in 1963-1967 before declining to 196 in 1988-1992. There was evidence of a deceleration in cerebrovascular mortality for cohorts born after 1908-1918. Ischaemic heart disease mortality remained constant. Mid-cohort infant mortality rates were not associated with adult mortality after adjusting for age and period of death. CONCLUSION: Declining infant mortality was subsequently associated with declining mortality from cerebrovascular disease and hypertensive disease and increasing mortality from diabetes mellitus but there was no association with ischaemic heart disease mortality. These relationships were confounded by secular changes associated with year of death.

Age-period-cohort analysis of suicide mortality rates in Spain, 1959-1991.

BACKGROUND: Although there is evidence that suicide rates may be increasing in Spain, formal epidemiological studies have been limited to specific cities or counties. The objective of this study was to investigate nationwide trends in suicide mortality from 1959 to 1991 in Spain, with emphasis on age, period, and cohort effects. METHODS: Age- and sex-specific suicide mortality rates from 1959 until 1991 were obtained from official vital statistics tables from the Instituto Nacional de Estadística, the official registry of vital statistics in Spain. Poisson regression and graphical methods were used to model and estimate age, period and cohort effects. RESULTS: Suicide mortality rates increased with age, with a proportional increment for each decade of life of 45% (95% confidence interval: 45-46%). In both males and females, age-adjusted suicide mortality rates decreased from 1959 until the late 1970s and early 1980s. In 1982, trends started to increase, returning to the levels of 1959 in less than 6 years. Cohort effects were small for cohorts born prior to 1940. For cohorts born after 1950, suicide rates increased markedly. CONCLUSIONS: The increase in suicide mortality in younger cohorts and the high rates of suicide in the elderly demand further investigation to establish causal mechanisms and preventive strategies.

Coronary heart disease mortality in Australia: is mortality starting to increase among young men?

BACKGROUND: There has been a major decline in mortality from coronary heart disease (CHD) in Australia from about 1967 through to 1989, occurring across all age groups simultaneously. We have analysed data up until 1992 to examine for trends within age cohorts. METHODS: Death registrations for acute myocardial infarction and CHD were used to construct male and female 5-year age- and cohort-specific mortality rates starting at 1900-1904 for cohorts and 25-29 years for age. Trends within age group and within cohort were compared across time. RESULTS: Across all female and most male birth cohorts there was a decrease in CHD mortality across the time period. In the youngest male cohorts there was a significant flattening in the rate of decline in the most recent periods. Comparison of age-specific mortality across cohorts showed the mortality at any period to be lower in the most recent cohort. CONCLUSIONS: This analysis demonstrates a continuing decline in mortality from CHD among females of all ages in Australia although the rate of decline appears to have slowed or even ceased in younger males.

Causes of death contributing to urban socioeconomic mortality differences in Amsterdam.

BACKGROUND: Socioeconomic mortality differences exist between parts of many cities. This study aims to identify causes of death associated with such mortality differences and which preventive or curative interventions can modify. METHODS: Associations were compared between socioeconomic status and age-standardized mortality by borough of Amsterdam, The Netherlands (n = 22) for causes of death grouped by feasible interventions. RESULTS: In men, mortality due to external and ill-defined causes occurs more frequently in low-income boroughs. In women, this holds for smoking-related and ill-defined causes. AIDS-related mortality is higher in boroughs with a high educational level. Mortality in low-income boroughs is generally higher for those causes of death which explain the relatively high urban mortality. CONCLUSIONS: Interventions to decrease urban socioeconomic mortality differences should be targeted on violence and accidents in men and smoking in women. Incomplete notification of deaths in low-income boroughs obscures some differences but also indicates problems in urban general practice and specific risks for immigrant residents. AIDS reduces the size of mortality differences among men, probably temporarily. Both feasibility and type of interventions are relevant for many urban areas.

Trends in occupational mortality among middle-aged men in Sweden 1961-1990.

BACKGROUND: Many European countries have in recent decades reported growing socioeconomic differentials in mortality. While these trends have usually paralleled high unemployment and increasing income disparities, Sweden had low unemployment and narrowing income differences. This study describes trends, 1961-1990, in total and cardiovascular mortality among men, 45-69 years of age, in major occupational classes in Sweden. METHODS: From census data four cohorts were created from those enumerated in 1960, 1970, 1980 and 1985. Through record linkage with the Swedish cause of death registry the mortality in each cohort was followed for 5-10 years. Age-standardized mortality trends 1961-1990 were calculated for occupational groups, categorized according to sector of the economy. RESULTS: The increase in mortality among middle-aged men in Sweden 1965-1980 was mainly a result of increasing cardiovascular mortality among industrial workers and farmers. In the 1980s the trend for these groups changed into a last decrease in mortality similar to that for non-manual occupations for the whole period. Consequently the rate ratio for industrial workers in comparison with men having a professional/managerial type of occupation increased from 0.98 to 1.43. The slowest decrease is now found among unqualified occupations in services and transportation. CONCLUSIONS: While Sweden, during the period studied, had narrowing income differentials and low unemployment this result points to the importance of working conditions in understanding trends and distribution of male adult mortality.

Premature mortality in Italy during the first decade of the AIDS epidemic: 1984-1993.

BACKGROUND: AIDS has become a leading cause of premature mortality in many countries, owing to the decline in other major causes of premature death and the increase in AIDS itself. This study was carried out to determine the trends in premature mortality due to selected causes in Italy. METHODS: Data from the Italian Mortality Data Base, for the ten years from 1984 to 1993 (the first decade of the AIDS epidemic) were analysed. Premature mortality was measured in terms of years of potential life lost before the age of 70 years (YPLL), excluding infant mortality. Trends in premature mortality due to AIDS were compared with those of the principal causes of premature death: lung cancer, colon-rectum cancer, stomach cancer, leukaemia, female breast cancer, uterine cancer, myocardial infarction, stroke, liver diseases, suicide, road accidents and overdose. RESULTS: In this period there has been a marked increase in premature mortality from AIDS both among males aged 1-69 years (from a rate of YPLL of 0.01 per 1000 in 1984 to 3.71 in 1993) and females of the same age group (from 0 deaths in 1984 to a rate of YPLL of 1.02). Throughout the same period all the other causes of premature death have been declining, with the exception of suicide and overdose among males, and overdose and lung cancer among females. For people aged 25-44 years, AIDS has become the greatest cause of premature death. The increasing trend in premature mortality due to AIDS is most pronounced in the northern and central areas of Italy. CONCLUSIONS: AIDS is the leading cause of death among males aged 25-44 years in Italy and is having an important impact on premature mortality among females in the same age group.