Lung Cancer Mortality Trends in Canada, 1931-1960

Trends in mortality due to lung cancer in Canada since 1931 were reviewed and data for 1960 presented. In 1960, 2223 male deaths were due to lung cancer. In each five-year age group over 45, there has been a distinct increase in male lung cancer death rates since 1931. The greatest increase occurred between the ages of 65 and 79. The age group 70-74, where the lung cancer mortality rates increased from 10.7 in the period 1931-33 to 173.5 in 1958-60, indicates the trend. Between 1931 and 1960, the proportion of male lung cancer deaths to all male cancer deaths increased from 3% to 18.8%. Female deaths due to lung cancer numbered 321 in 1960. Between 1931 and 1960 the proportion of female lung cancer deaths to all female cancer deaths increased only from 1.4% to 3.2%.     

Epidemiologic transition in an isolated indigenous community in the Valley of Oaxaca, Mexico

The objective of the present study is to analyze age-specific mortality in a rural indigenous community in the throes of a secular increase in size in the Valley of Oaxaca, southern Mexico, over 30 years, 1970-1999. Variation in mortality by age group was analyzed over time for evidence of an epidemiological transition. The seasonal rain pattern in the Valley of Oaxaca (83% from May through September) was evaluated for its relationship with mortality in wet and dry months. Mortality and causes of death changed markedly over the 30-year interval. Infant and preschool mortality, overall mortality, and causes of death changed from the 1970s through the 1990s. Prereproductive deaths (<15 years) predominated in the 1970s and were largely due to gastrointestinal and respiratory diseases, with periodic outbreaks of measles. Deaths of adults 65+ years predominated in the 1990s and were largely due to degenerative diseases usually associated with aging. The marked changes in age and causes of death over the three decades (epidemiologic transition from Stage I to Stage II) occurred concurrently with significant secular increases in body size in children, adolescents, and young adults, highlighting improved health and nutritional conditions in the community which is in early Stage II of the demographic transition. The demographic transition to Stage II is a leading indicator (15-25 years lag) for the onset of the secular trend, while the epidemiologic transition to Stage II is a predictor that the secular increase is in process in the study community.     

Physicians' strike and general mortality: Croatia's experience of 2003

The aim of the study was to establish whether the physicians' strike, which took place in Croatia in 2003, had an impact on the mortality of the population. Mortality data from the National Bureau of Statistics relating to the strike period (15 January - 14 February 2003) were selected and compared with the previous and subsequent periods of the same duration in 2001, 2002 and 2004. Of the 52,575 deaths in 2003, Croatia recorded 4,682 (8.9%, 95% Confidence interval 8.4-9.4) in the strike period from the 15th of January to the 14th of February 2003 or 1.1 deaths per 1000. No deviations of the 15th of January to the 14th of February period's share of the death total in relation to other observation periods were noted. It is impossible to associate the strike based on the figures shown in this paper with either an increase or decrease in population mortality.     

Epidemiological patterns of tuberculosis in Croatia in the period 1996-2005

The last comprehensive publication on tuberculosis in Croatia and the earliest impact of war, besides the yearly routine reports, was done in 1996 in Croatian. We were, therefore, interested to explore incidence trends and to highlight the early post-war tuberculosis epidemiological patterns in the next ten years period (1996-2005). A retrospective analysis of epidemiological data on all registered tuberculosis cases in Croatia searching the databases of 21 Croatian Public Health Institutes and the National Tuberculosis Registry was made. During the study period, the total tuberculosis incidence rates in Croatia dropped from 45 to 25.8/100 000 inhabitants. The average highest age-specific rates were recorded in the age group > or = 65 years being in decrease in all age groups. Paediatric cases (0-14 years) represented 4.5% of all cases. Tuberculosis cases among males were recorded in 64% cases, and 83.6% were indigenous population. Tuberculosis was bacteriologically confirmed in 67.7% cases. A low proportion of drug resistance (3.3%) was recorded. During 1985-2005, 56 tuberculosis cases among 242 AIDS cases were reported. Tuberculosis mortality showed a decreasing trend (p < 0.001). However, tuberculosis has still had the highest mortality rates among infectious diseases in Croatia. Despite the War chain of events and tuberculosis programmatic changes, tuberculosis incidence rates in Croatia have been decreasing but they are still far away from national target, incidence rate of 10/100 000 declared in 1998 and much higher than in European Union and Western Europe. Tuberculosis among children, resistance to tuberculosis drugs and HIV prevalence, significant problems in many European countries, have not caused problems in tuberculosis control in Croatia. This favourable epidemiological situation must be kept and improved through strengthened tuberculosis control measures.     

Excess mortality associated with influenza epidemics in Portugal, 1980 to 2004

Background

Influenza epidemics have a substantial impact on human health, by increasing the mortality from pneumonia and influenza, respiratory and circulatory diseases, and all causes. This paper provides estimates of excess mortality rates associated with influenza virus circulation for 7 causes of death and 8 age groups in Portugal during the period of 1980–2004.

Methodology/Principal Findings

We compiled monthly mortality time series data by age for all-cause mortality, cerebrovascular diseases, ischemic heart diseases, diseases of the respiratory system, chronic respiratory diseases, pneumonia and influenza. We also used a control outcome, deaths from injuries. Age- and cause-specific baseline mortality was modelled by the ARIMA approach; excess deaths attributable to influenza were calculated by subtracting expected deaths from observed deaths during influenza epidemic periods. Influenza was associated with a seasonal average of 24.7 all-cause excess deaths per 100,000 inhabitants, approximately 90% of which were among seniors over 65 yrs. Excess mortality was 3–6 fold higher during seasons dominated by the A(H3N2) subtype than seasons dominated by A(H1N1)/B. High excess mortality impact was also seen in children under the age of four years. Seasonal excess mortality rates from all the studied causes of death were highly correlated with each other (Pearson correlation range, 0.65 to 0.95, P<0.001) and with seasonal rates of influenza-like-illness (ILI) among seniors over 65 years (Pearson correlation rho>0.64, P<0.05). By contrast, there was no correlation with excess mortality from injuries.

Conclusions/Significance

Our excess mortality approach is specific to influenza virus activity and produces influenza-related mortality rates for Portugal that are similar to those published for other countries. Our results indicate that all-cause excess mortality is a robust indicator of influenza burden in Portugal, and could be used to monitor the impact of influenza epidemics in this country. Additional studies are warranted to confirm these findings in other settings.     

The Trends in Excess Mortality in Winter vs. Summer in a Sub-Tropical City and Its Association with Extreme Climate Conditions

While there is literature on excess winter mortality, there are few studies examining the evolution of its trend which may be changing in parallel with global warming. This study aimed to examine the trend in the excess mortality in winter as compared to summer among the older population in a sub-tropical city and to explore its association with extreme weather. We used a retrospective study based on the registered deaths among the older population in Hong Kong during 1976-2010. An Excess Mortality for Winter versus Summer (EMWS) Index was used to quantify the excess number of deaths in winter compared to summer. Multiple linear regressions were used to analyze the trends and its association with extreme weather. Overall, the EMWS Index for ischemic heart disease, cerebrovascular diseases, chronic lower respiratory diseases, pneumonia, and other causes were 43.0%, 34.2%, 42.7%, 23.4% and 17.6%, respectively. Significant decline was observed in the EMWS Index for chronic lower respiratory diseases and other causes. The trend in the index for cerebrovascular diseases depended on the age group, with older groups showing a decline but younger groups not showing any trend. Meteorological variables, in terms of extreme weather, were associated with the trends in the EMWS Index. We concluded that shrinking excess winter mortality from cerebrovascular diseases and chronic lower respiratory diseases was found in a sub-tropical city. These trends were associated with extreme weather, which coincided with global warming.     

Temperature-induced excess mortality in Moscow,Russia

After considering the observed long-term trends in average monthly temperatures distribution in Moscow, the authors evaluated how acute mortality responded to changes in daily average, minimum and maximum temperatures throughout the year, and identified vulnerable population groups, by age and causes of death. A plot of the basic mortality–temperature relationship indicated that this relationship was V-shaped with the minimum around 18°C. Each 1°C increment of average daily temperature above 18°C resulted in an increase in deaths from all non-accidental causes by 2.8%, from coronary heart disease by 2.7%, from cerebrovascular diseases by 4.7%, and from respiratory diseases by 8.7%, with a lag of 0 or 1 day. Each 1°C drop of average daily temperature from +18°C to −10°C resulted in an increase in deaths from all non-accidental causes by 0.49%, from coronary heart disease by 0.57%, from cerebrovascular diseases by 0.78%, and from respiratory diseases by 1.5%, with lags of maximum association varying from 3 days for non-accidental mortality to 6 days for cerebrovascular mortality. In the age group 75+ years, corresponding risks were consistently higher by 13–30%. The authors also estimated the increase in non-accidental deaths against the variation of daily temperatures. For each 1°C increase of variation of temperature throughout the day, mortality increased by 0.3–1.9%, depending on other assumptions of the model.     

Time trends in testicular cancer in Croatia 1983-2007: rapid increases in incidence, no declines in mortality

Testicular cancer, although a rare malignancy, represents the most common cancer in young male populations of Western origin. While increasing incidence trends of testicular cancer have been reported, mortality is declining in many high-resource settings. Using national data from the Croatian National Cancer Registry for the period 1983-2007, time trends were analysed by joinpoint regression and Age-Period-Cohort models. The present study is the first to analyse the testicular cancer trends in the Croatian population. Over the 25-year period, a mean number of 89 incident cases and 13 deaths were reported annually. The observed mean annual increases in age-standardised rates were 7.0% for incidence and 1.6% for mortality, with no abrupt linear changes (joinpoints) identified. The incidence rates of testicular cancer incidence have been steeply increasing in successive cohorts born since the mid-1930s. The rapid rise in testicular cancer incidence in the Croatian population appears to be one of the highest rates of increase recorded in Europe and worldwide. The lack of decline in the mortality rates over time, while based on relatively few deaths, highlights a need for improvements in diagnostics and management of therapy in Croatia in order to improve the survival and quality-of-life of testicular cancer patients.     

Opportunities with W.H.O

Available statistics were studied to define the extent of the lung cancer problem in Canada. Because of the low overall survival in treated and untreated cases at one year, mortality figures provide a rough index of morbidity from this disease.Male lung cancer death rates rose steadily from 3.0 to 24.6, and female rates from 1.6 to 4.0 per 100,000 population between 1931 and 1961. In males, the greatest increase occurred in the 70-74 year age group (eighteen-fold) and in females in the 80-84 year age group (seven-fold).Lung cancer caused 2774 deaths in Canada in 1961, and was the leading cause of cancer deaths for males in all age groups from 40 to 79 years. It accounted for approximately 1 in 5 of all cancer deaths in males and 1 in 26 in females.Lung cancer mortality in Canada has not increased to the same extent as in certain other countries, but to counter the rising trend, changes in the smoking habits of the population are required as well as community and industrial control of atmospheric carcinogens.     

The rising incidence and mortality of prostate cancer in Belgrade population

The purpose of this study was to analyze the epidemiological situation of prostate cancer in Belgrade population. Morbidity data were obtained from the Institute of Public Health of Serbia for the period 1999-2005. Mortality data for the period 1990-2006, were derived from the Statistical Office of Republic of Serbia. Average standardized incidence and mortality rates for the prostate cancer were 33.57 and 11.86 respectively. Standardized incidence rates of prostate cancer steadily increased from 29.34 per 100,000 in 1999 to 36.86 per 100,000 in 2005. In the observed period, the mortality rates significantly increased in the age groups 50-59 (y = 2.77+0.42x, p = 0.015), 70-79 (y = 61.92+10.70x, p = 0.000) and 80+ (y = 183.08+19.99x, p = 0.000). The average annual percentage of changes (AAPC) was the highest (7.2%) for the 70-79 age group, the lowest (0.1%) for the youngest group (< or = 50), and 5% for the total. The increase of prostate cancer incidence and mortality during the observed period in Belgrade population indicate urgent need for Serbian health professionals to adopt existing evidence-based cancer control and preventive measures. A national policy including prostate specific antigen (PSA) screening should be considered.     

Age specific trends in asthma mortality in England and Wales, 1983-95: results of an observational study.

OBJECTIVE: To determine trends in asthma mortality by age group in England and Wales during 1983-95. DESIGN: Observational study. SETTING: England and Wales. SUBJECTS: All deaths classified as having an underlying cause of asthma registered from 1 January 1983 to 31 December 1995. MAIN OUTCOME MEASURE: Time trends for age specific asthma deaths. RESULTS: Deaths in the age group 5-14 years showed an irregular downward trend during 1983-95; deaths in the age groups 15-44, 45-64, and 65-74 years peaked before 1989 and then showed a downward trend; and deaths in the age group 75-84 years peaked between 1988 and 1993 and subsequently dropped. Trends were: age group 5-14 years, 6% (95% confidence interval 3% to 9%); 15-44 years, 6% (5% to 7%); 45-64 years, 5% (4% to 6%); 65-74 years, 2% (1% to 3%). Deaths in the 75-84 and 85 and over categories plateaued. CONCLUSIONS: There are downward trends in asthma mortality in Britain, which may be due to increased use of prophylactic treatment.     

Studies of mortality of atomic bomb survivors. Report 13: Solid cancer and noncancer disease mortality: 1950-1997

This continues the series of general reports on mortality in the cohort of atomic bomb survivors followed up by the Radiation Effects Research Foundation. This cohort includes 86,572 people with individual dose estimates, 60% of whom have doses of at least 5 mSv. We consider mortality for solid cancer and for noncancer diseases with 7 additional years of follow-up. There have been 9,335 deaths from solid cancer and 31,881 deaths from noncancer diseases during the 47-year follow-up. Of these, 19% of the solid cancer and 15% of the noncancer deaths occurred during the latest 7 years. We estimate that about 440 (5%) of the solid cancer deaths and 250 (0.8%) of the noncancer deaths were associated with the radiation exposure. The excess solid cancer risks appear to be linear in dose even for doses in the 0 to 150-mSv range. While excess rates for radiation-related cancers increase throughout the study period, a new finding is that relative risks decline with increasing attained age, as well as being highest for those exposed as children as noted previously. A useful representative value is that for those exposed at age 30 the solid cancer risk is elevated by 47% per sievert at age 70. There is no significant city difference in either the relative or absolute excess solid cancer risk. Site-specific analyses highlight the difficulties, and need for caution, in distinguishing between site-specific relative risks. These analyses also provide insight into the difficulties in interpretation and generalization of LSS estimates of age-at-exposure effects. The evidence for radiation effects on noncancer mortality remains strong, with risks elevated by about 14% per sievert during the last 30 years of follow-up. Statistically significant increases are seen for heart disease, stroke, digestive diseases, and respiratory diseases. The noncancer data are consistent with some non-linearity in the dose response owing to the substantial uncertainties in the data. There is no direct evidence of radiation effects for doses less than about 0.5 Sv. While there are no statistically significant variations in noncancer relative risks with age, age at exposure, or sex, the estimated effects are comparable to those seen for cancer. Lifetime risk summaries are used to examine uncertainties of the LSS noncancer disease findings.     

Studies of mortality of atomic bomb survivors. Report 13: solid cancer and noncancer disease mortality: 1950-1997

This continues the series of general reports on mortality in the cohort of atomic bomb survivors followed up by the Radiation Effects Research Foundation. This cohort includes 86,572 people with individual dose estimates, 60% of whom have doses of at least 5 mSv. We consider mortality for solid cancer and for noncancer diseases with 7 additional years of follow-up. There have been 9,335 deaths from solid cancer and 31,881 deaths from noncancer diseases during the 47-year follow-up. Of these, 19% of the solid cancer and 15% of the noncancer deaths occurred during the latest 7 years. We estimate that about 440 (5%) of the solid cancer deaths and 250 (0.8%) of the noncancer deaths were associated with the radiation exposure. The excess solid cancer risks appear to be linear in dose even for doses in the 0 to 150-mSv range. While excess rates for radiation-related cancers increase throughout the study period, a new finding is that relative risks decline with increasing attained age, as well as being highest for those exposed as children as noted previously. A useful representative value is that for those exposed at age 30 the solid cancer risk is elevated by 47% per sievert at age 70. There is no significant city difference in either the relative or absolute excess solid cancer risk. Site-specific analyses highlight the difficulties, and need for caution, in distinguishing between site-specific relative risks. These analyses also provide insight into the difficulties in interpretation and generalization of LSS estimates of age-at-exposure effects. The evidence for radiation effects on noncancer mortality remains strong, with risks elevated by about 14% per sievert during the last 30 years of follow-up. Statistically significant increases are seen for heart disease, stroke, digestive diseases, and respiratory diseases. The noncancer data are consistent with some non-linearity in the dose response owing to the substantial uncertainties in the data. There is no direct evidence of radiation effects for doses less than about 0.5 Sv. While there are no statistically significant variations in noncancer relative risks with age, age at exposure, or sex, the estimated effects are comparable to those seen for cancer. Lifetime risk summaries are used to examine uncertainties of the LSS noncancer disease findings.     

Secular trends in incidence and mortality of bladder cancer in China, 1990–2017: A joinpoint and age-period-cohort analysis

BackgroundBladder cancer is closely related to occupational carcinogens, and China is undergoing a rapid industrialization. However, trend of bladder cancer incidence and mortality remains unknown in China.MethodsIncidence and mortality rates of bladder cancer (1990–2017) were collected for each 5-year age group stratified by gender (males/females) from the Global Burden of Disease (GBD) 2017 study. The average annual percentage change (AAPC) of rates were analyzed by joinpoint regression analysis; age, period and cohort effects on incidence and mortality were simultaneously estimated by age-period-cohort model.ResultsThrough 1990–2017, age-standardized incidence rates significantly rose in men (AAPC = 0.72%, 95% CI: 0.5%, 0.9%) while decreased in women (-1.25%: -1.6%, -0.9%); age-standardized mortality rates decreased in both men (-1.09%: -1.2%, -0.9%) and women (-2.48%: -2.8%, -2.2%). The joinpoint regression analysis showed the mortality almost decreased in all age groups; while the incidence increased in men for older age groups (from 45 to 49 to 80–84). Moreover, age effect showed the incidence and mortality increased with age; the incidence and mortality increased with time period, while in women period effect stop decreasing and began to increase since 2007; cohort effect showed them decreased with birth cohorts.ConclusionsThe incidence of bladder cancer is increasing in men but mortality decreases in both sexes. Both the incidence and mortality in men substantially increase with age and period, while the rates in women increased with period since 2007. The period effect may indicate the increased risks to bladder cancer in Chinese men. Etiological studies are needed to identify the factors driving these trends of bladder cancer.     

Trends in breast cancer mortality in Trinidad and Tobago—A 35-year study

Background: Breast cancer is the most frequently diagnosed cancer among women worldwide. This study examines the breast cancer mortality patterns and trends in the Caribbean island state, Trinidad and Tobago for the 35-year period, 1970–2004. Methods: A retrospective analysis of the trends in breast cancer mortality from 1970 to 2004 was conducted. Crude mortality per 100,000 women, age-standardized mortality using World Standard population and age-stratified mortality were calculated and comparison was made between age groups above and below 50 years. Results: A general pattern of increase was observed in both crude and age-standardized mortality. The overall average crude mortality was 15.6 per 100,000 women (95% confidence interval (CI) 13.9–17.1) and the average age-standardized mortality was 18.0 per 100,000 women (95% CI 16.7–19.2). There was a pattern of increase in mortality with increasing age. The mortality rate was considerably higher for the age groups above 50 years than those less than 50 years of age both showing an upward trend over the 35-year period. Conclusions: Breast cancer mortality continued to increase over the 35-year period in Trinidad and Tobago. This study did not identify the exact reasons for this increasing trend. However, it is known that Trinidad and Tobago is becoming much more industrialized. It may be speculated that decrease in fertility rates, increase in the incidence of obesity and hormone utilization could have influenced this trend.     

The State of Health in Older Adults in Japan: Trends in Disability,Chronic Medical Conditions and Mortality

Both life expectancy and healthy life expectancy in Japan have been increasing and are among the highest in the world, but the gap between them has also been widening. To examine the recent trends in old age disability, chronic medical conditions and mortality in Japan, we retrospectively analyzed three nationally representative datasets: Comprehensive Survey of Living Conditions (2001–2013), Patient Survey (1996–2011) and Vital Statistics (1995–2010). We obtained the sex- and age-stratified trends in disability rate, treatment rates of nine selected chronic medical conditions (cerebrovascular diseases, joint disorders, fractures, osteoporosis, ischemic heart disease, diabetes mellitus, hypertension, pneumonia and malignant neoplasms), total mortality rate and mortality rates from specific causes (cerebrovascular diseases, heart diseases, pneumonia and malignant neoplasms) in both sexes in four age strata (65–69, 70–74, 75–79, 80–84 years). Disability rates declined significantly in both sexes. Treatment rates of all selected medical conditions also decreased significantly, except for fractures in women and pneumonia. Both total mortality rate and cause-specific mortality rates decreased in both sexes. We concluded that the recent decline in disability rates, treatment rates of chronic medical conditions and mortality rates points toward overall improvement in health conditions in adults over the age of 65 years in Japan. Nonetheless, considering the increase in the number of older adults, the absolute number of older adults with disability or chronic medical conditions will continue to increase and challenge medical and long-term care systems.     

Cardiovascular disease mortality in Canada.

During the past two decades approximately one half of all deaths in Canada were due to cardiovascular diseases. Ischemic heart disease and cerebrovascular disease caused more than 60% and 20% of those deaths respectively. The mortality rates for ischemic heart disease in males increased slightly until 1965 and then dropped substantially, whereas the rates for females, which were declining at least since the early 1960s, accelerated in their decline. As a consequence, the rates for males remain almost twice as high as those for females. The reductions were initially observed in males 25 to 34 years old and in all age groups of females, but became apparent in a wider range of ages in the second period reviewed (1969 through 1977). The mortality of cerebrovascular disease has gradually diminished for both sexes since the 1950s, but the decline has been more pronounced among females, who originally had the higher rate. Marked geographic differences in mortality rates still exist in Canada despite the decline in death rates for both ischemic heart disease and cerebrovascular disease in all regions of the country. Surprising regional differences in times of onset of these declines have been demonstrated. For ischemic heart disease Ontario maintains the highest and the Prairies the lowest mortality rates. Quebec, despite a sustained decline, still ranks third, while the Pacific region shows the second-lowest rates in the country. The Atlantic region showed the lowest rates of decline in the period reviewed. The reduction in the mortality of ischemic heart disease in Canada (16.4% between 1969 and 1977) must be considered real for a variety of reasons. Direct evidence is not available to elucidate whether the reduction is the consequence of reduced incidence, increased survival or a combination of the two factors. The potential role of various factors that may have contributed to this decline is briefly discussed in this article.     

The association between temperature and mortality in tropical middle income Thailand from 1999 to 2008

We have investigated the association between tropical weather condition and age-sex adjusted death rates (ADR) in Thailand over a 10-year period from 1999 to 2008. Population, mortality, weather and air pollution data were obtained from four national databases. Alternating multivariable fractional polynomial (MFP) regression and stepwise multivariable linear regression analysis were used to sequentially build models of the associations between temperature variable and deaths, adjusted for the effects and interactions of age, sex, weather (6 variables), and air pollution (10 variables). The associations are explored and compared among three seasons (cold, hot and wet months) and four weather zones of Thailand (the North, Northeast, Central, and South regions). We found statistically significant associations between temperature and mortality in Thailand. The maximum temperature is the most important variable in predicting mortality. Overall, the association is nonlinear U-shape and 31 °C is the minimum-mortality temperature in Thailand. The death rates increase when maximum temperature increase with the highest rates in the North and Central during hot months. The final equation used in this study allowed estimation of the impact of a 4 °C increase in temperature as projected for Thailand by 2100; this analysis revealed that the heat-related deaths will increase more than the cold-related deaths avoided in the hot and wet months, and overall the net increase in expected mortality by region ranges from 5 to 13 % unless preventive measures were adopted. Overall, these results are useful for health impact assessment for the present situation and future public health implication of global climate change for tropical Thailand.     

Weather and deaths in Pittsburgh,Pennsylvania: A comparison with Birmingham,Alabama

The relationship between weather and daily mortality was examined over a 4-year period in the temperate climate of Pittsburgh, Pennsylvania. Eight weather parameters were correlated with daily mortality using multiple, simple, and partial correlation techniques. Results from this study were then compared with results obtained from a previous investigation involving an identical analysis of the effects of weather on death in the subtropical climate of Birmingham, Alabama. Although the relationship between weather and total mortality is statistically significant in both areas, weather in the temperate region accounts for a greater portion of the daily variation in number of deaths. In both cities the effect of weather increases with age and is more intense among the white than the nonwhite population but does not appear to vary with sex. In both places weather significantly influences death due to respiratory diseases and circulatory diseases in general, but affects little, mortality from cancer or behaviorally related causes. The cities differ, however, in that Pittsburgh weather is significantly associated with deaths from ischemic heart disease but not with cerebrovascular mortality, while the reverse is observed in Birmingham. The cities also differ in specific meteorological factors and in the seasonal distribution of the intensity of the weather-mortality relationship.