Worldwide trends in suicide mortality, 1955-1989.

Patterns and trends in suicide mortality for the period 1955-89 for 57 countries (28 from Europe, the former Soviet Union, Canada, the United States, 14 Latin American countries, 8 from Asia and 2 from Africa, Australia and Oceania) were analyzed on the basis of official death certification data included in the World Health Organization mortality database. Over the most recent calendar quinquennium (1985-1989), Hungary had the highest rate for men (52.1 per 100,000, all ages, world standard), followed by Sri Lanka (49.6), Finland (37.2) and a number of central European countries. North American, Japan, Australia and New Zealand and several European countries had intermediate suicide rates (between 15 and 25 per 100,000), whereas overall mortality from suicide was low in the United Kingdom, southern Europe, Latin America and reporting countries and areas from Africa and Asia, except Japan, Singapore and Hong Kong. The pattern for women was similar, although the absolute values were considerably lower. The highest values were in Sri Lanka (19.0 per 100,000), followed by Hungary (17.6) and several other central European countries, with rates between 9 and 15 per 100,000. Female suicide rates were comparatively elevated in Japan, Hong Kong, Singapore and Cuba. With respect to trends over time, the figures were relatively favourable in less developed areas of the world, including Latin America and several countries from Asia, with the major exception of Sri Lanka. Of concern are, in contrast, the upward trends, particularly for elderly men in Canada, the United States, Australia and New Zealand and, mostly, the substantial rises over most recent decades of suicide rates in young cohorts of males in Japan and several European countries, Australia and New Zealand. These trends were often in contrast with more favourable patterns in women, and can be discussed in terms of ethnic, cultural and socioeconomic factors, aspects of psychiatric care or availability of instruments and methods of suicide.

Worldwide pattern of mortality from motor vehicle accidents, 1950-1990.

Trends in age-specific and age-standardized death certification rates from motor vehicle accidents over the period 1950-1990 were analyzed for 48 countries from four continents (2 from North America, 10 from Latin America, 8 from Asia, 26 from Europe, Australia and New Zealand) on the basis of data produced by the World Health Organization mortality database. In most developed western and Asiatic countries, mortality rates increased until the late 1960's or early 1970's, and declined thereafter to reach values often lower than those of the early 1950's, although the number of circulating vehicles has substantially increased over the same calendar period. The extent of the decline was, however, different in various countries, as well as in the two sexes and in various age groups, thus leading to complex cohort and period patterns. In general, countries (like the U.S.A. or U.K.), where the number of motor vehicles had increased earlier, have now comparatively higher rates at younger than at middle and older age, while the opposite is observed in countries with later spread of motor vehicles. Further, there were a few countries, including Kuwait, Venezuela and several other Latin American countries, Australia and New Zealand, and several southern and eastern European countries, with exceedingly high rates from motor vehicle accidents, and where comprehensive interventions on this important cause of death are therefore a public health priority.

Trends in uterine cancer mortality in the Americas, 1955-1988.

Trends in uterine cancer mortality over the period 1955-1988 were analyzed for 14 selected Latin American countries and for the United States and Canada on the basis of the official death certification data from the World Health Organization database. In the late 1960s uterine cancer mortality in Latin America ranged from 7.8/100,000 in the Dominican Republic to 26.4/100,000 in Venezuela and was around 10/100,000 in the United States and Canada. Over the last two decades most Latin American countries (with the exception of the Dominican Republic and Ecuador) showed declines in mortality rates ranging from about 10% in Argentina and Mexico to 25-35% in Cuba, Chile, Uruguay, and Venezuela. These declines were however appreciably smaller than those in the United States and Canada, where falls in uterine cancer mortality approached 50%. In comparison with recent rates in the United States and Canada (around 5/100,000), mortality from uterine cancer was still high in all Central and South American countries (between 11 and 20/100,000), with the sole exception of Puerto Rico (6.3/100,000). The highest rates were in Paraguay and Ecuador (over 20/100,000). The overall variation in all age-standardized uterine cancer mortality in Latin America remained around threefold during the period 1965-1988 (i.e., between 22/100,000 in Paraguay and 6.3/100,000 in Puerto Rico). However, if the United States and Canada were also considered, the ratio between the highest and lowest mortality rate at all ages increased from about threefold during the period 1965-1969 to over fourfold in the late 1980s. This diverging pattern between North and Latin America was even clearer in young women (20-44 years), when most uterine cancer originates from the cervix, and less evident in the elderly. In the young, recent upward trends were observed in Argentina, Costa Rica, and the Dominican Republic. These mortality patterns are discussed with reference to risk factor exposure, cytologic screening programs, changes in hysterectomy rates, treatment, and case ascertainment and certification.

Mortality patterns and trends for lung cancer and other tobacco-related cancers in the Americas, 1955-1989.

Mortality from cancers of the oral cavity and pharynx, oesphagus, larynx and lung between 1955 and 1989 has been analysed for USA, Canada and 14 countries in Latin America. Among males, Uruguay, Cuba, Argentina and Puerto Rico have the highest rates for all sites, and Peru, Ecuador, Dominican Republic, Mexico and Colombia have the lowest rates. Among females, Cuba, Colombia and Puerto Rico rank high for all sites, and Mexico, Paraguay, Ecuador and Peru rank low. For both sexes, lung cancer mortality rates from the US and Canada are high, whereas rates from other sites are intermediate. An increasing trend in lung cancer mortality over time is shown in all countries except Cuba (no changes), Argentina, Paraguay and Peru (decreasing trend). In Latin America, the tobacco-related lung cancer epidemic is in its early phase among males, and very early phase among females.