Widening of socioeconomic inequalities in U.S. death rates, 1993-2001

Background

Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups. However, no studies have examined trends in inequalities using recent US national data.

Methodology/Principal Findings

We calculated annual age-standardized death rates from 1993–2001 for 25–64 year old non-Hispanic whites and blacks by level of education for all causes and for the seven most common causes of death using death certificate information from 43 states and Washington, D.C. Regression analysis was used to estimate annual percent change. The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated. For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates. The rate ratio (RR) comparing the least versus most educated increased from 2.9 (95% CI, 2.8–3.1) in 1993 to 4.4 (4.1–4.6) in 2001 among white men, from 2.1 (1.8–2.5) to 3.4 (2.9–3–9) in black men, and from 2.6 (2.4–2.7) to 3.8 (3.6–4.0) in white women.

Conclusion

Socioeconomic inequalities in mortality are increasing rapidly due to continued progress by educated white and black men and white women, and stable or worsening trends among the least educated.     

Trends in pulmonary embolism death rates for Canada and the United States, 1962-87.

To investigate the effect of advances in the prevention and treatment of pulmonary embolism, we examined the rates of death from pulmonary embolism in Canada for 1965-87 and compared them with those for the United States for 1962-84. The direct method of age standardization was used on sex-specific and age-specific death rates, with the 1960 US population as the standard. In both countries the death rates increased then decreased, although the changes in the Canadian rates occurred later and were less pronounced than those in the US rates. Men and elderly people were at higher risk of death from pulmonary embolism than women and younger people. Prevention strategies, possibly including encouraging a more active lifestyle and targetting high-risk groups, may further reduce pulmonary embolism death rates in both countries.     

Human echinococcosis mortality in the United States, 1990-2007

Background

Despite the endemic nature of Echinococcus granulosus and Echinococcus multilocularis infection in regions of the United States (US), there is a lack of data on echinococcosis-related mortality. To measure echinococcosis-associated mortality in the US and assess possible racial/ethnic disparities, we reviewed national-death certificate data for an 18-year period.

Methodology/Principal Findings

Echinococcosis-associated deaths from 1990 through 2007 were identified from multiple-cause-coded death records and were combined with US census data to calculate mortality rates. A total of 41 echinococcosis-associated deaths occurred over the 18-year study period. Mortality rates were highest in males, Native Americans, Asians/Pacific Islanders, Hispanics and persons 75 years of age and older. Almost a quarter of fatal echinococcosis-related cases occurred in residents of California. Foreign-born persons accounted for the majority of echinococcosis-related deaths; however, both of the fatalities in Native Americans and almost half of the deaths in whites were among US-born individuals.

Conclusions/Significance

Although uncommon, echinococcosis-related deaths occur in the US. Clinicians should be aware of the diagnosis, particularly in foreign-born patients from Echinococcus endemic areas, and should consider tropical infectious disease consultation early.     

Time trends and age-period-cohort analyses on incidence rates of nasopharyngeal carcinoma during 1993-2007 in Wuhan, China

Background: Declines in incidence rates of nasopharyngeal carcinoma (NPC) were observed in Hong Kong and Taiwan but not other high-risk regions in China, while evidences from low-risk regions in China are still lacking. This study aimed to examine the time trends (1993–2007) of NPC in Wuhan (a low-risk region) and assess the birth cohort and calendar period effects on the observed temporal trends. Method: Using data from Wuhan Cancer Registry, age-standardized annual incidence rates of NPC were calculated by the direct method using the WHO World Standard Population (2000) as the reference. Trend in incidence rates of NPC during 1993–2007 was evaluated. Age–period–cohort models were also applied to assess the effects of age, calendar time and birth cohort on the observed temporal trends. Results: A total of 1685 new NPC cases (1210 males and 475 females) were diagnosed during 1993–2007 in Wuhan. The annual percentage change in incidence rates of NPC were 0.15% (95% confidence interval: ?3.88% to 4.34%) for males and ?1.17% (95% confidence interval: ?4.85% to 2.66%) for females. No obvious cohort or period effect on the incidence rates of NPC was observed. Conclusion: The incidence rates of NPC remained stable during 1993–2007 in Wuhan, a low-risk region in China.     

Risk-adjusted female breast cancer incidence rates in the United States

A method has been previously proposed for estimating risk-adjusted incidence rates (RAIRs) from cancer data from the Surveillance, Epidemiology, and End Results (SEER) program. Unlike conventionally reported SEER-based cancer incidence rates in the United States, but similar to the approach taken by the International Association of Cancer Registries and the International Agency for Research on Cancer, the method uses only the first primary cancer of the given site. In addition, it also adjusts for population-based cancer prevalence in order to obtain a better population-based measure of cancer risk. For most cancers multiple cancer primaries are rare and the prevalence of the disease is low. However, female breast cancer has a comparatively high risk of subsequent breast cancers and is the most prevalent cancer in women. Hence, in white women RAIRs are 3.0% lower in ages 30-39, 4.2% lower in ages 40-49, 4.0% lower in ages 50-59, 4.1% lower in ages 60-69, 3.8% lower in ages 70-79, and 4.3% lower in ages 80 years and older compared with conventional rates. Corresponding lower percentages for black women are 3.9%, 6.9%, 5.1%, 7.8%, 6.0%, and 2.2%, respectively. Age-group specific trends in breast cancer incidence rates differed between RAIRs and conventional incidence rates, increasingly so with older age. The number of cancer cases in the United States is estimated from conventional incidence rates and population estimates. In 2007, the estimated number of malignant breast cancer cases was 181,665 for white women and 20,203 for black women. The estimated number of breast cancer cases decreased by 4.8% for whites and 6.5% for blacks when based on RAIRs. RAIRs are a better measure of breast cancer risk and trends in RAIRs are better for monitoring the effect of risk factors.     

Estimated HIV incidence in the United States, 2006-2009

Background

The estimated number of new HIV infections in the United States reflects the leading edge of the epidemic. Previously, CDC estimated HIV incidence in the United States in 2006 as 56,300 (95% CI: 48,200–64,500). We updated the 2006 estimate and calculated incidence for 2007–2009 using improved methodology.

Methodology

We estimated incidence using incidence surveillance data from 16 states and 2 cities and a modification of our previously described stratified extrapolation method based on a sample survey approach with multiple imputation, stratification, and extrapolation to account for missing data and heterogeneity of HIV testing behavior among population groups.

Principal Findings

Estimated HIV incidence among persons aged 13 years and older was 48,600 (95% CI: 42,400–54,700) in 2006, 56,000 (95% CI: 49,100–62,900) in 2007, 47,800 (95% CI: 41,800–53,800) in 2008 and 48,100 (95% CI: 42,200–54,000) in 2009. From 2006 to 2009 incidence did not change significantly overall or among specific race/ethnicity or risk groups. However, there was a 21% (95% CI:1.9%–39.8%; p = 0.017) increase in incidence for people aged 13–29 years, driven by a 34% (95% CI: 8.4%–60.4%) increase in young men who have sex with men (MSM). There was a 48% increase among young black/African American MSM (12.3%–83.0%; p<0.001). Among people aged 13–29, only MSM experienced significant increases in incidence, and among 13–29 year-old MSM, incidence increased significantly among young, black/African American MSM. In 2009, MSM accounted for 61% of new infections, heterosexual contact 27%, injection drug use (IDU) 9%, and MSM/IDU 3%.

Conclusions/Significance

Overall, HIV incidence in the United States was relatively stable 2006–2009; however, among young MSM, particularly black/African American MSM, incidence increased. HIV continues to be a major public health burden, disproportionately affecting several populations in the United States, especially MSM and racial and ethnic minorities. Expanded, improved, and targeted prevention is necessary to reduce HIV incidence.     

Black church arson in the United States, 1989-1996

A prevalent theme in the public forum on the recent wave of black church arson in the United States is that the events are part of an overarching conspiracy on the part of hate groups to start a race war. In attempting to discount this theme, critics have concluded that events of black church arson are not racially motivated, and instead are random acts of insurance fraud and delinquency. We argue that competition theory sheds light on these recent events by moving us away from both sides of this debate. We argue that, in the absence of good data on connections between various hate groups, it is useful to consider this wave of ethnic violence as a result of ethnic competition for economic and political resources. Using yearly event counts and time-series cross sectional data, we test hypotheses derived from competition theory. We conclude that competition for both economic and political resources increases the yearly counts of black church arson.     

Congenital cytomegalovirus mortality in the United States, 1990-2006

Background

Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection in the United States disproportionately affecting minority races and those of lower socio-economic class. Despite its importance there is little information on the burden of congenital CMV-related mortality in the US. To measure congenital CMV-associated mortality in the US and assess possible racial/ethnic disparities, we reviewed national death certificate data for a 17-year period.

Methods

Congenital CMV-associated deaths from 1990 through 2006 were identified from multiple-cause-coded death records and were combined with US census data to calculate mortality rates.

Results

A total of 777 congenital CMV-associated deaths occurred over the 17-year study period resulting in 56,355 years of age-adjusted years of potential life lost. 71.7% (557) of congenital CMV-associated deaths occurred in infants (age less than 1 year). Age-adjusted mortality rates stratified by race/ethnicity revealed mortality disparities. Age-adjusted rate ratios were calculated for each racial/ethnic group using whites as the reference. Native Americans and African Americans were 2.34 (95% CI, 2.11–2.59) and 1.89 (95% CI, 1.70–2.11) times respectively, more likely to die from congenital CMV than whites. Asians and Hispanics were 0.54 (95% CI, 0.44–0.66) and 0.96 (95% CI, 0.83–1.10) times respectively, less likely to die from congenital CMV than whites.

Conclusions/Significance

Congenital CMV infection causes appreciable mortality in the US exacting a particular burden among African Americans and Native Americans. Enhanced surveillance and increased screening are necessary to better understand the epidemiology of congenital CMV infection in addition to acceleration of vaccine development efforts.     

Duck plague epizootics in the United States, 1967-1995

In 1967, the first confirmed diagnosis of duck plague (DP) in the USA was made from pekin ducks (Anas platyrhynchos domesticus) on commercial duck farms on Long Island, New York. Within 10 mo, DP was confirmed as the cause of death in migratory waterfowl on a Long Island bay. This paper reviews 120 DP epizootics reported from 1967 to 1995 that involved waterfowl species native to North America or were reported in areas with free-flying waterfowl at risk. Duck plague epizootics occurred in 21 states with the greatest number reported in Maryland (29), New York (18), California (16), and Pennsylvania (13). The greatest frequency of epizootics (86%) was detected during the months of March to June. At least 40 waterfowl species were affected with the highest frequency of epizootics reported in captive or captive-reared ducks including muscovy ducks (Cairina moschata) (68%), mallard ducks (A. platyrhynchos) (18%) and black ducks (A. rubripes) (14%). The greatest number of waterfowl died in three epizootics that involved primarily migratory birds in 1967 and 1994 in New York (USA) and 1973 in South Dakota (USA). The greatest number of DP epizootics reported since 1967 appear to have involved flocks of non-migratory rather than migratory waterfowl; therefore, in our opinion it remains unknown if DP is enzootic in either non-migratory or migratory waterfowl.     

Homicide and fertility rates in the United States: a comment

The negative correlation between annual homicide and fertility rates reported by Lyster (1974) is confirmed by statistical analysis extended to show that the correlation is largely confined to the post-World War 2 and holds for whites and nonwhites in nearly equal degree. Data support the hypothesis that homicide and fertility rates are responding to variations in psychological stress among young adults associated with swings in relative cohort size, the proportion of those ages 15-29 to those ages 30-64. It is suggested that periods of increase in the relative number of young men weakens their labor market position, and the result is to increase psychological stress, to discourage traditional role fulfillment such as family building, and to encourage antisocial behavior, indexed here by homicide rate.