Mortality by Hispanic status in the United States.

OBJECTIVE: To compare all-cause and cause-specific mortality rates between Hispanic and non-Hispanic groups and estimate the effect of family income, place of birth, and place of residence on these rates. DESIGN: Cohort study using national survey data matched to the National Death Index, with a mortality follow-up period of 9 years. SETTING: The noninstitutionalized population of the United States. PARTICIPANTS: Approximately 700,000 respondents (aged 25 years or older), including 40,000 Hispanics, to national surveys conducted by the US Bureau of the Census (Current Population Surveys). OUTCOME MEASURES: All causes and underlying cause of death, coded from the death certificate, occurring between 1979 and 1987. RESULTS: Adjusting for age, Hispanics were shown to have lower mortality from all causes compared with non-Hispanics (standardized rate ratio [SRR], 0.74 for men, 0.82 for women), lower mortality from cancer (SRR, 0.69 for men, 0.61 for women), lower mortality from cardiovascular disease (SRR, 0.65 for men, 0.80 for women), higher mortality from diabetes (SRR, 1.86 for men, 2.38 for women), and higher mortality from homicide (SRR, 3.60 for men). After adjusting for differences in annual family income, the relative mortality ratios were even lower for Hispanics than non-Hispanics. CONCLUSIONS: These data describe, in a large national cohort study, a lower mortality in Hispanics than in non-Hispanics. This mortality is particularly low after adjustment for differences in family income.

Black-white mortality differences by family income.

Death rates among US black men and women under 75 years of age are higher than for their white counterparts. The explanation for this excess risk, though attributed to socioeconomic factors, remains unclear. We calculated mortality rates by family income for blacks and whites in a representative sample of the US population (National Longitudinal Mortality Study). For persons aged less than 65 years of age, mortality rates are lower in those with higher family income for both blacks and whites, and both men and women. However, at each level of income, blacks have higher mortality than whites. Higher levels of family income are also associated with lower death rates from cardiovascular disease, cancer, and deaths from causes other than cardiovascular disease or cancer. After adjustment for income, blacks have higher death rates from each of these three general causes. For subjects below 65 years, the mortality gradient by income is larger than the gradient by race. The differences in mortality rates by race not accounted for by income may be due to other differences such as access to health care, type or quality of medical care, or behavioral risk factors that disadvantage black populations.

Life expectancy by employment status, income, and education in the National Longitudinal Mortality Study.

Based on data from the National Longitudinal Mortality Study for 1979-85, life expectancies are estimated for white men and white women by education, by family income, and by employment status. Life expectancy varies directly with amount of schooling and with family income. Differences in life expectancy at age 25 between the highest and the lowest levels of education completed were about 6 years for white men and about 5 years for white women. For family income, differences between the highest and the lowest income groups were about 10 years for white men and 4.3 years for white women. The largest differences in life expectancy were between employment categories. At age 25, white men in the labor force lived on average about 12 more years than those not in the labor force, and white women lived on average about 9 more years. For those who were unable to work compared with those in the labor force, the difference for white men was about 20 years; for white women, 29 years. Results in this study showed much the same differentials in life expectancy for education as the earlier Kitagawa-Hauser study.

Air-conditioning and mortality in hot weather.

A cohort of 72,740 persons for whom information on household air-conditioning was available was monitored for mortality via the National Death Index from April 1980 through December 1985. A total of 2,275 deaths occurred among the members of this cohort. The basic question addressed was whether persons in households with air-conditioning experienced lower death rates during hot weather than persons in households without air-conditioning. This question was examined for both central and room air-conditioning. The analysis was based on a state-by-state approach, that cross-tabulated deaths by air-conditioning status (yes or no) and average temperature during the month of death (less than 21.2 degrees C (less than 70 degrees F) or greater than or equal to 21.2 degrees C (greater than or equal to 70 degrees F)). The Mantel-Haenszel and sign tests were used to summarize the data. For central air-conditioning versus no air-conditioning, statistically significant benefits (p less than 0.05, Mantel-Haenszel test) were observed for the overall total, for females, for persons not in the labor force, and for persons living in fewer than six rooms. These groups had more exposure to air-conditioning. The relative risk for the total group was 0.58, implying that in hot weather, the death rate for persons who had central air-conditioning was 42 percent lower than the rate for persons who did not have air-conditioning, after confounding variables had been controlled for. For room air-conditioning versus no air-conditioning, the odds ratio for the total group was 0.96, which was not significantly different from 1.0, suggesting that no real benefit was derived from room air-conditioning. Some reasons for the lack of a demonstrable benefit for room air-conditioning are given.

Validity of demographic characteristics on the death certificate.

In a sample of the United States population from the Census Bureau's current Population Surveys, we compared demographic characteristics with those recorded on the death certificate for the 43,000 decedents in the samples followed from 1979 to 1985. Overall percentage agreements were: Sex 99.5, Race 99.4, Place of birth 99.4, Hispanic origin 98.7, and Veteran status 95.2. Relatively fewer American Indians and Asian/Pacific Islanders had death certificates that agreed with the baseline race (73.6% and 82.4%, respectively). The direction of disagreement suggests that current estimates of mortality rates for American Indians and Asian/Pacific Islanders are underestimated.

Mortality by employment status in the National Longitudinal Mortality Study.

A mortality follow-up of 452, 192 persons aged 25 years or more who were characterized with respect to employment status was conducted using the National Death Index for the years 1979 through 1983. The cohort, part of the National Longitudinal Mortality Study, was drawn from Current Population Survey samples representative of the US population using selected months during the years 1979-1983. Employed persons aged 25-64 years were found to have standardized mortality ratios from 61% to 74% of the average, depending upon their sex and race. Unemployed men had standardized mortality ratios slightly above 100, but these values were 1.6 and 2.2 times higher than those for employed white men and black men, respectively. Those classified as unable to work had very high mortality ratios, from two to seven times the average. In the older age groups, 65 years or more, very low mortality ratios were found for those who were still employed. These relations were maintained after adjustment for family income and educational level. These results 1) describe the magnitude of mortality risk for clearly defined employment categories, 2) identify segments of the population with especially high mortality requiring greater public health recognition, and 3) suggest further research into the health consequences of the various employment/nonemployment conditions.

Trends in mortality from chronic obstructive pulmonary disease among U.S. veterans: 1954 to 1979.

Recent trends in chronic obstructive pulmonary disease (COPD) mortality are described for a cohort of nearly 300,000 insured veterans who were followed for survival from 1954 through 1979. Death rates from COPD for the veterans by smoking status were compared with U.S. death rates for white males 55 to 84 yr of age over the same period. The main findings were that the veterans experienced sharp increases in COPD mortality over the 26-yr study period, much like the U.S. findings. However, the observed increases were not as great as those for the United States. The COPD rates for veterans who were cigarette smokers showed the same pattern as for all veterans. Some important differences by age were noted. Thus, for ages 60 to 64 and 65 to 69, the direction of the trend among veterans appeared to change from initial increases in the COPD death rate to later decreases while at the same time the three oldest age groups (70-74, 75-79, and 80-84) continued to experience increases in mortality over the whole period. These findings were similar to those for the United States. Several possible explanatory factors for these changes are discussed.

Trends in mortality from coronary heart disease and stroke among U.S. veterans; 1954-1979.

A cohort of nearly 300,000 insured veterans (Dorn Cohort), experienced a much greater percent decline in CHD death rate over the period, 1954-1979, than the population of the U.S., while for stroke, the percent decline in death rate was virtually the same as the U.S. For CHD, greater percent declines were noted over the study period for non-smokers compared to cigarette smokers, for professionals compared to non-professionals and for persons with high socioeconomic scores (SES) compared to those with low scores. In each group, younger persons experienced greater percent declines than older persons. For stroke, non-smokers experienced a somewhat greater percent decline in rate than smokers but this did not hold true for all age groups. Unlike CHD, professionals experienced a smaller percent decline in their stroke death rate than non-professionals, as did persons with high SES compared to those with low SES. The contradictory patterns observed for the two diseases with respect to occupation and SES suggest that the risk factors for stroke and coronary heart disease are not exactly the same. Throughout, the findings were much more convincing for CHD than for stroke.

Leukaemia and smoking habits among United States veterans.

The relation between leukaemia and smoking habits was examined in data from the veterans' smoking study, a prospective study of mortality among 248,000 United States veterans, of whom 723 died of leukaemia during 1954-69. A significant increase in mortality from leukaemia among cigarette smokers (relative risk 1.53) was found, together with a dose-response relation with amount smoked (trend p less than 0.001). The relation was strongest (relative risk 1.72) for monocytic and chronic and unspecified myeloid leukaemias (ICD (7th revision) codes 204.1 and 204.2). For these leukaemias the increase was almost twofold (relative risk 1.93) among current smokers of over 20 cigarettes daily. Ex-cigarette smokers also showed an increase of leukaemia (relative risk 1.39; p less than 0.001). These findings are consistent with other studies and relevant to the interpretation of minor increases of leukaemia both in population and in individual based studies. If causal they also imply that smoking is responsible for many more deaths from leukaemia in adults than all other known causes combined.

Probabilistic methods in matching census samples to the National Death Index.

The National Death Index (NDI) of the National Center for Health Statistics is a powerful tool for identifying deaths in epidemiologic studies. The NDI will generate a list of possible matches for every input record according to the NDI matching criteria. The task of determining a true or correct match out of the list of possible matches becomes formidable when a large number of records are being investigated. In the National Longitudinal Mortality Study nearly one million Census records are being matched to the NDI, thus requiring an efficient and accurate method to screen out the false positive matches. In a pilot study to the larger mortality follow-up, Census Bureau files containing 226,000 person records were matched to the 1979 NDI. The results of this match were used to generate a probabilistic method to separate the possible matches into categories of true positives, false positives and those of questionable status requiring manual review of the Census record and the death certificate. Of the 5542 possible matches about one-third were ultimately determined to be true positives and two-thirds false positives. The probabilistic method was validated by replications on subsets of the data and promises to save considerable time in review of records in the large national study of mortality.

Mortality patterns among U.S. veterans by occupation. I. Cancer.

The mortality experience of a nation-wide cohort of 293,958 veterans was analyzed by occupation and industry to generate hypotheses in occupational cancer. Results are presented on 107,563 deaths occurring between 1954 and 1970. Information on usual employment (occupation and industry) and smoking habits was available from questionnaires completed in 1954 and 1957. Complete enumeration of these results by occupation and industry is available as special National Cancer Institute monographs from the author (A. B.). This report presents the mortality experience for selected occupations. Excesses of lung cancer among shipyard workers, truck drivers, and plumbers are consistent with previous reports. Elevated risks for stomach cancer among carpenters and machinists may reflect exposure to dusts, abrasives, and cutting oils.

The British-Norwegian migrant study: 5-year mortality differentials due to cigarette smoking.

Cigarette smoking and 5-year survivorship of 20,017 British and 10,016 Norwegian migrants to the United States were compared with 17,696 British and 26,155 Norwegian nonmigrants. The highest mortality ratios for 5-year age-adjusted death rates observed were of cigarette smokers to nonsmokers, ranging from 1.40 to 1.60 for men and from 1.18 to 1.36 for women. Mortality ratios of nonmigrants to migrants ranged from 1.07 to 1.19 for men and from 1.22 to 1.36 for women. Mortality ratios for British to Norwegian groups ranged from 1.13 to 1.27. Some differences in mortality ratios for cardiovascular diseases contrasted with mortality ratios for noncardiovascular diseases were noted. The most important of these differences was the apparent lack of any consistent difference between nonmigrants and migrants in their 5-year cardiovascular mortality rates, although there were consistent differences for noncardiovascular diseases.

On the feasibility of linking census samples to the National Death Index for epidemiologic studies: a progress report.

To test the feasibility of using large national probability samples provided by the US Census Bureau, a pilot project was initiated to link 230,000 Census-type records to the National Death Index (NDI). Using strict precautions to maintain the complete confidentiality of individual records, the Current Population Survey files of one month in 1973 and one month in 1978 were matched by computer to the 1979 NDI file. The basic question to be addressed was whether deaths so obtained are seriously underestimated when there is no Social Security Number (SSN) in the Census record. The search of the NDI file resulted in 5,542 matches of which about 1,800 appear to be "true positives" representing deaths, the remainder are "false positives." Of the deaths, 80 per cent would still have been detected without SSN in the Census record. The main reasons for missing deaths (false negatives) were discrepancies in the year of birth and in the given name. Assuming certain changes in the NDI matching algorithm, the 80 per cent figure could increase to 85 per cent or higher; however, this could also cause significant increases in the number of false positives. The National Heart, Lung and Blood Institute (NHLBI) and Census Bureau staff are currently developing a probabilistic method to eliminate false positives from the NDI output tape. The results of the pilot study indicate that a larger research project is clearly feasible.

The British-Norwegian migrant study--analysis of parameters of mortality differentials associated with angina.

The prevalence of selected cardiorespiratory symptoms was ascertained by a common mail questionnaire for 73,884 men and women in the United States, Great Britain and Norway. The study groups were identified in the early 1960's and included 30,033 British and Norwegian migrants to the United States and 43,851 non-migrants who resided in Great Britain and Norway. The main study objectives were to contrast the morbidity and mortality experience of the migrant and non-migrant groups in the light of known national differences in mortality from cardiorespiratory diseases in the early 1960's. At that time, the U.S. had the highest death rates from coronary heart disease while Great Britain had the highest rates for lung cancer and for chronic non-specific lung disease. Norway had the lowest rates for all three rubrics. The prevalence of "angina" and other symptoms was ascertained for each of the study groups. Contrary to expectation, angina was reported much more frequently by persons remaining in Britain and Norway than by migrants to the United States. Mortality rates during the five years and responding to the symptoms questionnaire were determined and mortality patterns were evaluated according to the presence or absence of angina. Angina was found to be a strong predictor of cardiovascular mortality. In the absence of angina, it was observed that migrants had similar mortality rates to non-migrants regardless of country of origin. However, the British had higher mortality rates from cardiovascular and from non-cardiovascular causes than the Norwegians. The primary determinant of angina prevalence was found to be migration status. It is believed that this differential was determined primarily by selection of those who migrate, with the migrants to the U.S. being a healthier group than their counterparts remaining in the native country.

Cancer mortality among nonsmokers in an insured group of U.S. veterans.

In a 16-year follow-up of insured U.S. veterans, standardized mortality ratios (SMR) for cancer were calculated for nonsmokers (55,049); as the standard, cancer rates of all respondents (248,046) were used. For all cancers, nonsmokers had an SMR of 71%; for lung cancer, they had an SMR of 21%. The data for nonsmokers were further analyzed with risk of cancer assessed according to residence and usual occupation and industry. Among the nonsmokers, SMR were especially low for dentists, carpenters, and lawyers, and for the electric light and power and printing industries. By division of the country, SMR for nonsmokers were especially low for the Mountain States.

Smoking and causes of death among U.S. veterans: 16 years of observation.

In a 16-year mortality followup of some 293,000 insured U.S. veterans, specific causes of death were studied in relation to smoking status. The main results confirmed earlier findings.Mortality ratios for cigarette smokers as compared with nonsmokers were 1.73 for all causes of death, 1.58 for all cardiovascular diseases, 2.12 for all cancers, and 4.31 for all respiratory diseases. The highest ratios (those greater than 5.0) were observed for cor pulmonale, aortic aneurysm, emphysema and bronchitis, cancer of the pharynx, cancer of the esophagus, cancer of the larynx, and cancer of the lung and bronchus. The greatest excess in deaths in terms of observed numbers minus expected was found for the cardiovascular diseases, in particular for coronary heart disease.Mortality ratios for ex-cigarette smokers who had stopped smoking for reasons other than physicians' orders were much lower compared with nonsmokers than the mortality ratios for current cigarette smokers: 1.21 for all causes, 1.15 for all cardiovascular diseases, 1.39 for all cancers, and 2.08 for all respiratory diseases. For most causes of death, the mortality ratios for ex-cigarette smokers who had stopped smoking for reasons other than physicians' orders varied inversely with the number of years of cessation. For some diseases, the mortality risk for the ex-cigarette smoker returned to normal almost immediately after the cessation of smoking, whereas for others, the return to normal was more gradual. The first group included stroke and the combined category of influenza and pneumonia; the second group included cardiovascular diseases as a whole and coronary heart disease. For still other diseases, although the mortality ratio declined with the length of time smoking was discontinued, substantial excess risks remained even after 20 years of cessation. In this third group were aortic aneurysm, bronchitis and emphysema, and lung cancer-diseases with very high mortality ratios for current cigarette smokers. Parkinson's disease remained the one disease that clearly exhibited a negative association with cigarette smoking.

Smoking and life expectancy among U.S. veterans.

Life expectancies were estimated for selected groups of smokers, ex-smokers, and nonsmokers based on the results of a 16-year mortality follow-up of 198,820 U.S. veterans. Life expectancy varied inversely with number of cigarettes smoked per day. The most pronounced differences were between nonsmokers and heavy cigarette smokers (40+ per day). These differences in life expectancy were greatest at the younger ages--nearly 9 years at ages 35 and 40. Life expectancies for cigarette smokers varied directly with age began smoking. For all ages, differences in life expectancy between nonsmokers and ex-cigarette smokers who stopped for other than doctor's orders were less than those between nonsmokers and current cigarette smokers. Results in the present study clearly confirmed Hammond's earlier findings.

Cardiorespiratory disease mortality among British and Norwegian migrants to the United States.

Mortality rates for coronary heart disease (CHD), chronic non-specific lung disease (CNSLD), and lung cancer for ages 45-74 years were studied for British and Norwegian migrants to the U.S. and for sample of U.S. native-born. The observed order for CHD and lung cancer was as anticipated, with native-born experiencing the highest CHD rate, British migrants the highest lung cancer rate, and, in each instance, Norwegian migrants experiencing the lowest rates. For CNSLD, contrary to national comparisons, the British migrant rates were about equal to the U.S. native-born although Norwegian migrant rates were lowest, as expected. Migrants who were younger than 15 years of age at migration experienced the highest CHD mortality levels, but a decreasing gradient in mortality level with increasing age at migration did not materialize. Due to inherent limitations in the data, results for CNSLD and lung cancer mortality levels with respect to age at migration remain uncertain. Data on cigarette smoking status indicated substantial excess mortality for cigarette smokers compared to non-smokers and occasional smokers for all groups studied.

Trends in urban mortality in relation to fluoridation status.

Mortality trends from 1950 to 1970 were studied for 473 cities in the United States with populations of 25,000 or more in 1950, according to fluoridation status of their water supplies. Findings showed no relationship between fluoridation and observed changes in general mortality over the 20-year period. Also, no relationship was found between fluoridation and heart or cancer death rate trends.

Associations of coronary and stroke mortality with temperature and snowfall in selected areas of the United States, 1962-1966.

Daily temperatures and snowfall were related to coronary and stroke deaths in selected standard metropolitan statistical areas for the 5-year period 1962-1966. Typically an inverse approximately linear pattern of coronary heart disease (CHD) and of stroke mortality with temperature was seen over the greater part of the temperature range, with mortality reaching a low for days with average Fahrenheit temperatures in the 60's and 70's (15.6-26.6 C), and then rising sharply at higher temperatures. Snowfall was found to be associated with higher CHD and stroke mortality for a 5-, or 6-day period. Temperatures 1 and 2 days prior to death were also found to be associated with deaths from CHD and stroke. Very hot days appeared to exert a cumulative effect upon mortality in many of the areas.