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Clinical Obstetrics and Gynecology Jun 2018This article provides a review of maternal mortality data and their limitations in the United States. National maternal mortality data, which rely heavily on vital... (Review)
Review
This article provides a review of maternal mortality data and their limitations in the United States. National maternal mortality data, which rely heavily on vital statistics, document that the risk of death from pregnancy-related causes has not declined for >25 years and that striking racial disparities persist. State-based maternal mortality reviews, functional in many states, obtain detailed information on medical and nonmedical factors contributing to maternal deaths. Without this detailed knowledge from state-level data and without addressing recognized quality problems with vital statistics data at the national-level, we will have difficulty understanding maternal death trends and preventing future such deaths.
Topics: Cause of Death; Centers for Disease Control and Prevention, U.S.; Databases, Factual; Female; Humans; Maternal Age; Maternal Mortality; Pregnancy; Pregnancy Complications; Prenatal Care; Public Health Surveillance; Racial Groups; United States
PubMed: 29561285
DOI: 10.1097/GRF.0000000000000362 -
The Journal of Obstetrics and... Mar 2018Secular trends of preterm birth in Japan between 1979 and 2014 were examined to determine whether changes could be explained by a shift in the distribution of maternal...
AIM
Secular trends of preterm birth in Japan between 1979 and 2014 were examined to determine whether changes could be explained by a shift in the distribution of maternal age at delivery and parity and/or by changes in age-specific preterm birth rates.
METHODS
Live birth data for 1979 to 2014 were obtained from the Japanese Ministry of Health, Labour and Welfare. Analyses were limited to singleton children born in Japan (n = 43 632 786). Preterm birth was defined using two cut-offs at < 37 or < 34 weeks of gestation. Crude and standardized rates of preterm birth were calculated for firstborn and later-born singletons by maternal age at delivery for specific time periods.
RESULTS
Throughout the study period, the rates of preterm birth (both at < 37 and < 34 weeks of gestation) were higher among mothers aged 20 and younger, and mid-30s and older, compared to mothers in their 20s or early 30s. The rates of preterm birth at < 37 (but not at < 34) weeks decreased for mothers aged in their late 30s and 40s, and increased for mothers in their 20s and early 30s. Standardized rates of preterm birth showed a secular increase for preterm births at < 37 but not < 34 weeks of gestation.
CONCLUSION
The rates of preterm birth among mothers aged in their 20s and early 30s increased between 1979 and 2014, which contributed to the secular increase in rates of preterm birth at < 37 weeks.
Topics: Adult; Birth Rate; Female; Humans; Japan; Maternal Age; Premature Birth; Young Adult
PubMed: 28901036
DOI: 10.1111/jog.13460 -
Canadian Journal of Public Health =... Oct 2022Attributing individual deaths to extreme heat events (EHE) in Canada and elsewhere is important for understanding the risk factors, protective interventions, and burden...
Attributing individual deaths to extreme heat events (EHE) in Canada and elsewhere is important for understanding the risk factors, protective interventions, and burden of mortality associated with climate change. However, there is currently no single mechanism for identifying individual deaths due to EHE and different agencies have taken different approaches, including (1) vital statistics coding based on medical certificates of death, (2) probabilistic methods, and (3) enhanced surveillance. The 2018 EHE in Montréal provides an excellent case study to compare EHE deaths identified by these different approaches. There were 353 deaths recorded in the vital statistics data over an 8-day period, of which 102 were potentially attributed to the EHE by at least one approach and 251 were not attributed by any approach. Only nine of the 102 deaths were attributed to the EHE by all three approaches, 23 were attributed by two approaches, and 70 were attributed by only one approach. Given that there were approximately 50 excess deaths during the EHE, it remains unclear exactly which of the total 353 deaths should be attributed to the extreme temperatures. These results highlight the need for a more systematic and cooperative approach to EHE mortality in Canada, which will continue to increase as the climate changes.
Topics: Canada; Climate Change; Extreme Heat; Humans; Vital Statistics
PubMed: 35951167
DOI: 10.17269/s41997-022-00672-2 -
PloS One 2021EUROCAT is a European network of population-based congenital anomaly (CA) registries. Twenty-one registries agreed to participate in the EUROlinkCAT study to determine...
EUROCAT is a European network of population-based congenital anomaly (CA) registries. Twenty-one registries agreed to participate in the EUROlinkCAT study to determine if reliable information on the survival of children born with a major CA between 1995 and 2014 can be obtained through linkage to national vital statistics or mortality records. Live birth children with a CA could be linked using personal identifiers to either their national vital statistics (including birth records, death records, hospital records) or to mortality records only, depending on the data available within each region. In total, 18 of 21 registries with data on 192,862 children born with congenital anomalies participated in the study. One registry was unable to get ethical approval to participate and linkage was not possible for two registries due to local reasons. Eleven registries linked to vital statistics and seven registries linked to mortality records only; one of the latter only had identification numbers for 78% of cases, hence it was excluded from further analysis. For registries linking to vital statistics: six linked over 95% of their cases for all years and five were unable to link at least 85% of all live born CA children in the earlier years of the study. No estimate of linkage success could be calculated for registries linking to mortality records. Irrespective of linkage method, deaths that occurred during the first week of life were over three times less likely to be linked compared to deaths occurring after the first week of life. Linkage to vital statistics can provide accurate estimates of survival of children with CAs in some European countries. Bias arises when linkage is not successful, as early neonatal deaths were less likely to be linked. Linkage to mortality records only cannot be recommended, as linkage quality, and hence bias, cannot be assessed.
Topics: Birth Certificates; Congenital Abnormalities; Europe; Female; Humans; Infant, Newborn; Male; Pregnancy; Registries; Vital Statistics
PubMed: 34449798
DOI: 10.1371/journal.pone.0256535 -
BMC Pregnancy and Childbirth Mar 2024In Japan, difference in birth rates depending on educational attainment has not been investigated. This study aimed to reveal birth rates in Japan depending on the... (Comparative Study)
Comparative Study
BACKGROUND
In Japan, difference in birth rates depending on educational attainment has not been investigated. This study aimed to reveal birth rates in Japan depending on the highest level of educational attainment and their trends over the years using nationwide government statistics data.
METHODS
Individual-level data from Vital Statistics and the Census from 2000, 2010, and 2020 were used for birth and population data, respectively. Data linkage was conducted for males and females in the Census and fathers and mothers in the Vital Statistics using information about gender, household, nationality, marital status, birth year, birth month, prefecture, and municipality for individuals. The birth rate was calculated by gender, a five-year age group, the highest level of educational attainment achieved, and year. In addition, the slope index of inequality (SII) and relative index of inequality (RII) were calculated to evaluate the degree of inequality in birth rates, depending on the educational attainment.
RESULTS
Birth rates were higher in persons with lower educational attainment compared to those with a higher educational attainment among males and females in their twenties, while they tended to be higher in persons with higher educational attainment among those in their thirties and forties. Additionally, an increase in the birth rate from 2000 to 2020 was the largest in university graduates among males aged 25-49 years and women aged 30-49 years, and a decrease in the birth rate was the smallest in university graduates among males and females aged 20-24 years. As a result, SII and RII increased from 2000 to 2020 among males and females in their thirties and forties.
CONCLUSIONS
In conclusion, persons with higher educational attainment tended to have a relatively favorable trend in the birth rate compared with persons with lower educational attainment in recent decades. It suggested that enhanced administrative support for individuals with lower educational attainment or lower socioeconomic status may be required to ameliorate the declining birth rate in Japan.
Topics: Female; Humans; Male; Birth Rate; Censuses; Educational Status; Japan; Socioeconomic Factors; Young Adult; Adult; Middle Aged
PubMed: 38486147
DOI: 10.1186/s12884-024-06382-6 -
Injury Dec 2023Falls are a significant public health issue in aging societies. This study aimed to examine the temporal, seasonal, and spatial patterns in fall-related mortality in...
BACKGROUND
Falls are a significant public health issue in aging societies. This study aimed to examine the temporal, seasonal, and spatial patterns in fall-related mortality in Japan, and to investigate the potential factors associated with fall-related mortality.
METHODS
The number of unintentional fall-related deaths from 1979 to 2019 were obtained from Japanese vital statistics and crude and direct age-standardized mortality rates (DSR) were calculated. We also calculated the standardized mortality ratio (SMR) to determine seasonal and prefectural differences. In addition, spatial regression was conducted to examine the potential factors associated with fall-related mortality.
RESULTS
The DSR among those over 65 years old showed a decreasing trend from 1979, but remained unchanged from 1990 to 2019. Based on the spatial regression model, the factors significantly associated with SMRs were the proportion of the aged population (Coefficient: 0.049), the number of hospitals (0.118), the number of clinics (1.169), the number of hospital beds (-0.060), and the number of physiotherapists (-0.069) for men; and the proportion of aged single households (-0.060), the number of hospitals (0.132), the number of clinics (1.498), the number of hospital beds (-0.051), and the number of physicians (-0.308) for women.
CONCLUSIONS
Fall-related mortality among Japanese elderly people has remained unchanged in recent years. In addition, seasonal and spatial patterns were also observed, and it was found that demographic data and healthcare resources in the prefectures affected fall-related mortality rates. Appropriate prevention measures of fall-related deaths should be considered according to the region-specific characteristics and issues.
Topics: Male; Aged; Humans; Female; Accidental Falls; Japan; Seasons; Vital Statistics; Public Health
PubMed: 37867027
DOI: 10.1016/j.injury.2023.111138 -
JAMA Network Open Feb 2023Reducing maternal mortality is a global objective. The maternal mortality ratio (MMR) is low in Hong Kong, China, but there has been no local confidential enquiry into...
IMPORTANCE
Reducing maternal mortality is a global objective. The maternal mortality ratio (MMR) is low in Hong Kong, China, but there has been no local confidential enquiry into maternal death, and underreporting is likely.
OBJECTIVE
To determine the causes and timing of maternal death in Hong Kong and identify deaths and their causes that were missed by the Hong Kong vital statistics database.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study was conducted among all 8 public maternity hospitals in Hong Kong. Maternal deaths were identified using prespecified search criteria, including a registered delivery episode between 2000 to 2019 and a registered death episode within 365 days after delivery. Cases as reported by the vital statistics were then compared with the deaths found in the hospital-based cohort. Data were analyzed from June to July 2022.
MAIN OUTCOMES AND MEASURES
The outcomes of interest were maternal mortality, defined as death during pregnancy or within 42 days after ending the pregnancy, and late maternal death, defined as death more than 42 days but less than 1 year after end of the pregnancy.
RESULTS
A total of 173 maternal deaths (median [IQR] age at childbirth, 33 [29-36] years) were found, including 74 maternal mortality events (45 direct deaths and 29 indirect deaths) and 99 late maternal deaths. Of 173 maternal deaths, 66 women (38.2%) of individuals had preexisting medical conditions. For maternal mortality, the MMR ranged from 1.63 to 16.78 deaths per 100 000 live births. Suicide was the leading cause of direct death (15 of 45 deaths [33.3%]). Stroke and cancer deaths were the most common causes of indirect death (8 of 29 deaths [27.6%] each). A total of 63 individuals (85.1%) died during the postpartum period. In the theme-based approach analysis, the leading causes of death were suicide (15 of 74 deaths [20.3%]) and hypertensive disorders (10 of 74 deaths [13.5%]). The vital statistics in Hong Kong missed 67 maternal mortality events (90.5%). All suicides and amniotic fluid embolisms, 90.0% of hypertensive disorders, 50.0% of obstetric hemorrhages, and 96.6% of indirect deaths were missed by the vital statistics. The late maternal death ratio ranged from 0 to 16.36 deaths per 100 000 live births. The leading causes of late maternal death were cancer (40 of 99 deaths [40.4%]) and suicide (22 of 99 deaths [22.2%]).
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of maternal mortality in Hong Kong, suicide and hypertensive disorder were the dominant causes of death. The current vital statistics methods were unable to capture most of the maternal mortality events found in this hospital-based cohort. Adding a pregnancy checkbox to death certificates and setting up a confidential enquiry into maternal death could be possible solutions to reveal the hidden deaths.
Topics: Pregnancy; Humans; Female; Hong Kong; Maternal Death; Maternal Mortality; Cross-Sectional Studies; Hypertension, Pregnancy-Induced; Suicide
PubMed: 36811857
DOI: 10.1001/jamanetworkopen.2023.0429 -
Preventing Chronic Disease Apr 2019Little is known about trends in the overall combined burden of fatal and nonfatal cerebrovascular disease events in the United States. Our objective was to describe the... (Comparative Study)
Comparative Study
INTRODUCTION
Little is known about trends in the overall combined burden of fatal and nonfatal cerebrovascular disease events in the United States. Our objective was to describe the combined burden by age, sex, and region from 2006 through 2014.
METHODS
We used data on adults aged 35 and older from 2006 through 2014 Nationwide Emergency Department Sample, National Inpatient Sample of the Healthcare Cost and Utilization Project, and the National Vital Statistics System. We calculated age-standardized cerebrovascular disease event rates by using the 2010 US Census population. Trends in rates were assessed by calculating the relative percentage change (RPC) between 2006 and 2014, and by using Joinpoint to obtain P values for overall trends.
RESULTS
The age-standardized rate increased significantly for total cerebrovascular disease events (primary plus comorbid events) from 1,050 per 100,000 in 2006 to 1,147 per 100,000 in 2014 (P < .05 for trend). Treat-and-release emergency department visits with comorbid cerebrovascular disease events increased significantly, from 114 per 100,000 in 2006 to 213 per 100,000 in 2014 (RPC of 87%, P < .05 for trend). Significant rate increases were identified among adults aged 35 to 64 with an RPC of 19% in primary cerebrovascular disease events, 48% in comorbid cerebrovascular disease events, and 36% in total events.
CONCLUSION
Our findings have important implications for the increasing cerebrovascular disease burden among adults aged 35 to 64. Focused prevention strategies should be implemented, especially among young adults who may be unaware of existing modifiable risk factors.
Topics: Adult; Age Factors; Cerebrovascular Disorders; Cost of Illness; Female; Geography; Humans; Incidence; Male; Middle Aged; Prevalence; Sex Factors; United States
PubMed: 31022369
DOI: 10.5888/pcd16.180411 -
Journal of Health and Social Behavior Dec 2022Postmortem diagnostic overshadowing-defined as inaccurately reporting a disability as the underlying cause of death-occurs for over half of adults with cerebral palsy....
Postmortem diagnostic overshadowing-defined as inaccurately reporting a disability as the underlying cause of death-occurs for over half of adults with cerebral palsy. This practice obscures cause of death trends, reducing the effectiveness of efforts to reduce premature mortality among this marginalized health population. Using data from the National Vital Statistics System 2005 to 2017 U.S. Multiple Cause of Death files (N = 29,996), we identify factors (sociodemographic characteristics, aspects of the context and processing of death, and comorbidities) associated with the inaccurate reporting of cerebral palsy as the underlying cause of death. Results suggest that inaccurate reporting is associated with heightened contexts of clinical uncertainty, the false equivalence of disability and health, and potential racial-ethnic bias. Ending postmortem diagnostic overshadowing will require training on disability and health for those certifying death certificates and efforts to redress ableist death certification policies.
Topics: Adult; Humans; Death Certificates; Cause of Death; Cerebral Palsy; Clinical Decision-Making; Uncertainty
PubMed: 35266426
DOI: 10.1177/00221465221078313 -
Disaster Medicine and Public Health... Mar 2022The aim of this study was to examine birth outcomes in areas affected by Hurricane Michael.
OBJECTIVE
The aim of this study was to examine birth outcomes in areas affected by Hurricane Michael.
METHODS
Vital statistics data of 2017-2019 were obtained from the state of Florida. Births occurring in the year before and after the date of Hurricane Michael (October 7, 2018) were used. Florida counties were divided into 3 categories reflecting extent of impact from Hurricane Michael. Birth outcomes including incidence of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) were also compared before and after Hurricane Michael. Spontaneous and indicated PTBs were distinguished based on previously published algorithms. Multiple regression was used to control for potential confounders.
RESULTS
Both LBW (aRR 1.19, 95% CI: 1.07, 1.32) and SGA (aRR 1.11, 95% CI: 1.01, 1.21) were higher in the year after Michael than the year before in the most-affected area; a similar effect was not seen in other areas. A stronger effect was seen for exposure in the first trimester or in the 2 months after Michael than in the second or third trimester.
CONCLUSION
Consistent with many previous studies, this study of Hurricane Michael found an effect on fetal growth.
Topics: Female; Infant, Newborn; Humans; Premature Birth; Florida; Cyclonic Storms; Vital Statistics; Pregnancy Complications
PubMed: 35236537
DOI: 10.1017/dmp.2021.367