Predictive factors of long-term mortality of persons with tetraplegic spinal cord injury: an 11-year French prospective study.

STUDY DESIGN: Longitudinal study with mortality follow-up. OBJECTIVE: Identify predictive factors for long-term mortality following tetraplegic spinal cord injury (TSCI). SETTING: The Tetrafigap survey is a multi-centre epidemiological survey on the long-term outcome of persons with TSCI, initiated in France in 1995 with the participation of 35 rehabilitation centres. METHODS: The mortality follow-up involves 1241 persons with TSCI who were admitted to one of the study rehabilitation units at the initial phase and who completed the initial self-administered questionnaire. There were 226 observed deaths (18.2%) during an 11-year period. Logistic regression methods, with estimates of odds ratios (ORs), incorporating clinical, functional and social participation data were used to determine the factors related to mortality. This was followed by multivariate analysis to determine the best predictive factors for long-term mortality. RESULTS: Risk of death increases significantly with age but not with the time elapsed since the accident. The risk of death is higher in men. Interestingly, clinical variables are not the best predictors of long-term mortality. Instead, the significant effect of poor social participation (being single, infrequent contact with friends) and functional limitations (full assistance required with dressing or eating) persists after adjustment for other variables. CONCLUSION: Once the medical situation becomes more stable, factors related to the long-term mortality of persons with TSCI are not exactly identical to those observed in the short acute-phase and during the first year after the accident. Social participation has a significant effect on mortality.

[From epidemiological transition to health transition]. / De la transition épidémiologique à la transition sanitaire.

The "Epidemiological Transition" concept proposed by Abdel Omran in 1971 was the first theory attempting to explain the extraordinary progess that industrialized countries have achieved in health since the 18th century. Within the broader framework of the demographic transition, an important implication of this concept was that life expectancy in modern societies would converge toward limits determined by the new epidemiological conditions. In the ensuing decades, however the convergence process appears to have stopped as a result of a number of setbacks including the health crisis in Eastern Europe and AIDS in Africa. These setbacks do not fundamentally contradict the theory. A much greater contradiction was the unexpected dramatic decrease in cardiovascular disease that began as early as the 70s and had a major positive impact on life expectancy. Based on the concept of "Health Transition" described by Julio Frenk et al., we propose a complete revision of the health implications of the demographic transition based the idea of successive cycles of divergences/convergences induced by the appearance and generalization of major breakthroughs in health technologies and strategies. Three such cycles can be clearly identified on an international level corresponding to control of infectious then cardiovascular diseases, and perhaps most recently to the initial successes achieved in the field of ageing.

[Gender gap in life expectancy: the reasons for a reduction of female advantage]. / Ecart d'espérance de vie entre les sexes: les raisons du recul de l'avantage féminin.

BACKGROUND: After a large increase during the 19th and the 20th century, for two decades the gap in life expectancy between sexes has been reducing in most industrialised countries. In France, where it was specially large, it stopped increasing in the early 1980s and decreased in the most recent years. The paper investigates reasons for these recent trends in France and in the industrialised countries. METHODS: Two types of data are used for analysis. Death probabilities from life tables are used for calculating male excess mortality by age and estimating the role of various age groups in life expectancy differences by sex. Sex- and cause-specific mortality rates from INED database for France and from WHO database for other countries are used to assess the part played by various causes of death in the gender gap and its evolution. RESULTS: In France, the stabilisation of the gap is mainly related to the decrease in cardiovascular mortality for men who benefit from the same progress but later than women. In the most recent years, the reduction of the gap is due to the trend reversal of male cancer mortality which is now decreasing, specially because of the reduction of lung cancer mortality. In European countries, taken as examples (England & Wales, Sweden, Switzerland, Italy) cardiovascular mortality is also the main responsible for the decreasing differences. Conversely, in Japan, the gap is still increasing specially for mortality from cancer and respiratory diseases. CONCLUSIONS: The recent gap narrowing between male and female life expectancy in France is not a specific case. It does not mean that female health situation is worsening but it is related to an acceleration of progress for males. This reduction will most probably go on in the next years, except if females would enjoy dramatic progression in old age mortality.

Where there are no data: what has happened to life expectancy in Georgia since 1990?

In recent years there has been a considerable increase in understanding of changes in mortality in Russia and some other former Soviet republics. However, the situation in the republics of the Caucasus remains poorly understood. Information on Georgia is especially fragmentary as a fifth of the country remains outside government control, there has been large scale migration since 1991, and the introduction of fees for vital registration has compromised the quality of official statistics. The aim of the study is to produce plausible estimates for life expectancy in Georgia for the period 1990-1998 and thus to assess whether Georgia has undergone changes similar to other former Soviet republics in the post-independence period. Four models were used to construct life tables. Model 1 used officially published statistics on deaths and population. Model 2 applied new estimates of population derived from household surveys to the observed deaths. Model 3 adjusted model 2 for under-registration at extremes of life, with parameter estimates derived from a survey of infant mortality and comparison of observed rates with Coale-Demeny standard life tables. Model 4 arose following inspection of death rates by cause that revealed implausible discontinuities in cancer mortality rates and involved applying the estimates of under-registration that this finding implied to model 3. The four models produce quite different estimates of life expectancy, differing by 7.8 y for men and 6.8 y for women by 1998. In any of the models, however, Georgia does not appear to have experienced the marked deterioration in life expectancy seen in Russia following the transition to independence. Importantly, Georgia had also not experienced a marked improvement in life expectancy during the 1985 Soviet anti-alcohol campaign, again unlike other Soviet republics.Official statistics substantially over-estimate life expectancy at birth in Georgia. Despite undergoing a civil war, life expectancy in Georgia has been less affected by the transition than has Russia and the overall trends in mortality since the mid 1980s suggest that this may be because alcohol has played a smaller role in these changes than it did in Russia.

Cancer mortality in Russia and Ukraine: validity, competing risks and cohort effects.

BACKGROUND: The dramatic increase in mortality in Russia and Ukraine in the late 1980s and 1990s has been due to increases in certain causes of death, particularly cardiovascular disease and accidents and violence. In contrast, there has been a slight fall in mortality from cancer. METHODS: This paper presents an analysis of trends and patterns in cancer mortality and examines four possible explanations for its recent fall: changes in data collection; cohort effects; competing mortality from other causes of death; and improvements in health care. RESULTS: All contribute to some extent to the observed changes, with each affecting predominantly different age groups. There is evidence of a significant underrecording of cancer deaths among the elderly especially in rural areas and of significant changes in coding practices in the early 1990s. Competing mortality from cardiovascular diseases and accidents can explain some reduction in male deaths from cancer in middle age. Birth cohort effects can explain some reduction among males after early middle age and among females at all ages. The impact of changes in health care are more difficult to identify with certainty but there is evidence of reduced deaths from childhood leukaemia. IMPLICATIONS: Recent changes in mortality in Russia are complex and their understanding will require a multidisciplinary approach embracing demography, epidemiology and health services research.

Health crisis in Russia. II. Changes in causes of death: a comparison with France and England and Wales (1970 to 1993).

"Trends in Russian mortality appear all the more negative in comparison with the very favourable trends in most Western countries, especially during the last two decades. To highlight the most damaging causes, we compare Russian cause-specific mortality trends with those observed in France and England and Wales, two countries for which we have reconstructed continuous time series of deaths by cause.... It was within the framework of...30 categories [of causes] that we calculated death rates by age group and standardized mortality rates by cause...."

Health crisis in Russia. I. Recent trends in life expectancy and causes of death from 1970 to 1993.

The authors analyze trends in life expectancy and causes of death in Russia from 1970 to 1993, with a focus on reasons for the recent declines in life expectancy. "Before discussing the trends themselves, we shall...look at the possible distortions that changes in data quality may have produced. However, even if it has been exaggerated to some degree, nobody contests the reality of the Soviet health crisis, and we shall attempt to derive some explanation by analysing the age and cause-of-death structures of mortality in Russia."

Mortality by cause in the USSR in 1970-1987: the reconstruction of time series.

"This paper is the first step in an exploration of Soviet cause-of-death statistics which became accessible after 1986. Its main aim is the reconstruction of consistent annual series for the period 1970-1987 in spite of changes in cause-of-death classification caused by the 1980 revision of the Soviet nosological system. In a second part, the series thus reconstructed are analysed to describe the main features of the evolution of mortality during these two decades, using first standardized mortality rates for several very important specific causes and, second, using a method of decomposition of life expectancy changes. For the first time, trends in causes of death are thus shown for the crucial period where life expectancy has grown again after two decades of regression." (SUMMARY IN FRE)

Reconstitution of annual life tables for nineteenth-century France.

"The nineteenth century was not one of runaway health progress, but it marked a deep transformation of mortality conditions [in France]. The reconstitution of mortality tables by single years of age and calendar years makes it possible to study this transformation in detail, and to distinguish between period fluctuations and structural changes. In the present article, we have given preference to graphic representation, and purposely limited the statistics.... We have also given preference to the period approach." Consideration is given to annual mortality trends, life expectancy, age-specific probability of dying, the war-related crisis years of 1813, 1871, and 1915, and differentials in mortality by sex. Data generally concern the period 1806-1898.

Comparative study of mortality trends in France and the Czech Republic since 1950.

PIP: This is a comparative study of mortality trends in France and the Czech part of Czechoslovakia by age, sex, and cause of death from 1950 to 1985. The authors note that during this period, life expectancy in both countries grew but the disparity between the two nations also increased, with France having the higher life expectancy. This difference is examined, and implications for the broader disparity in mortality between Western and Eastern Europe are considered.^ieng

[A comparative analysis of mortality by cause in the Czech Socialist Republic and in France with regard to developments since 1950]. / Srovnavaci analyza umrtnosti podle pricin v Ceske Socialisticke Republice a ve Francii ve vyvojovem pohledu od roku 1950.

PIP: Mortality since 1950 in France and the Czech part of Czechoslovakia is analyzed. The authors note that mortality in both countries declined until 1960, at which date both total and infant mortality were lower in the Czech Socialist Republic. Following 1960, mortality continued to decline in France, particularly in the decade 1970-1980, and among those over age 40. In contrast, mortality in the Czech Socialist Republic has increased since 1960. Changes in mortality by eight major causes are analyzed over time using direct standardization methods for each sex from 1950 to 1984 in both countries. The results indicate that diseases of the circulatory system and neoplasms are the major causes of death in the Czech Socialist Republic, with the greatest contrast with France concerning mortality from cerebrovascular and cardiovascular diseases.^ieng