Regional and chronological differences of urogenital cancer deaths in Japan

PURPOSE: We investigated the changing patterns of urogenital cancer deaths during the past 22 years in Japan. METHODS: We analyzed patients that died from cancer of the prostate, bladder and kidney between 1973-1994. Age-adjusted death rates (adjusted to the world population), standardized mortality ratios (SMR) according to each prefectures and age-specific death rates for each types of cancer were calculated and changes in these patterns were analyzed. RESULTS: Age-adjusted death rates for cancer of the prostate increased from 2.29 in 1973 to 4.36 in 1994, a 1.9-fold increase. Death rates for cancer of the bladder were stable in males and declined in females. Death rates for cancer of the kidney (15 years or older) increased from 1.45 in 1973 to 2.72 in 1994, a 1.9-fold increase in males, and tended to increase in females as well. In the SMR analysis by prefecture, distribution in 1973-84 (former period) and that in 1985-94 (later period) were similar, and characteristic features were observed for each type of cancer. Age-specific death rates for cancer of the prostate and bladder rose by an index power of age, but that for cancer of the kidney reached a plateau or decreased after an index power increase to a certain age. The rate of increase in age-specific death rates (later period/former period) rose according to age, especially 70 years or older, in cancer of the prostate and kidney in both males and females. However, age-specific death rates in the later period from cancer of the bladder was higher only in patients 85 years or older, but was lower in other age groups. CONCLUSIONS: Death rates for cancer of the prostate and kidney (15 years or older) tended to increase, while that of the bladder remained stable or decreased. It is expected that detection and treatment of these disease can be improved by utilizing these epidemiologic information.     

Characterization of mutant Bordetella pertussis adenylate cyclase toxins with reduced affinity for calmodulin. Implications for the mechanism of toxin entry into target cells

BACKGROUND: Data and statistics are presented on cancer death certification for 1993 in Italy, updating previous publications covering the period 1955-1992. METHODS: Data for 1993 subdivided into 30 cancer sites are presented in 8 tables, including age- and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 year age group. RESULTS: Age-adjusted death certification rates (on the world standard population) for all neoplasms declined from 189.8 in 1992 (and a peak of 199.2 in 1986) to 187.8/100,000 males in 1993, and remained stable around 100,000 females. The favorable trends were even larger in middle and younger age males, but not in children below age 15, whose overall age-standardized cancer mortality rates increased for the fourth subsequent year. Lung cancer was the leading site of cancer mortality, with over 30,900 deaths. For the fifth subsequent year, its rates in males declined, to reach 56.0/100,000. The decline in lung cancer rates is now established in Italian males and is substantial in middle age, whereas the rise in female lung cancer rates seems to have leveled off over the last few years. Rates for other major cancer sites (intestines, stomach, female breast, prostate, pancreas, leukemias and lymphomas) were stable, but some decrease was apparent also in 1993 for Hodgkin's disease. CONCLUSIONS: Italian cancer mortality rates in 1993 were moderately favorable in males, due to the leveling of the tobacco-related epidemic, whereas no appreciable change was registered in females. The persisting unfavorable trends in childhood cancer mortality should be investigated.     

The main causes of death in Spain, 1992; comment

BACKGROUND: To study the mortality from the leading causes of death in Spain in 1992 and trends since 1980. POPULATION AND METHOD: The number of deaths was obtained from mortality statistics. We included the 12 causes with the highest mortality rates in 1992 and calculated for each cause of death the age adjusted mortality rates for each year in the study period, the percent change from 1990 to 1992 and from 1980 to 1992, and the adjusted ratio of rates between men and women in 1992. RESULTS: The leading causes of death in 1992 were malignant neoplasms, with 24.3% of deaths and a mortality rate of 205.6 per 100,000 population; diseases of the heart, with 22.6% and a rate of 191.8 per 100,000; and cerebrovascular disease, with 12.7% and a rate of 107.6 per 100,000 population. Between 1980 and 1992 the adjusted mortality rate increased for four causes of death: malignant neoplasms; chronic obstructive pulmonary disease and similar diseases; nephritis, nephrotic syndrome and nephrosis; and suicide. From 1990 to 1992, the adjusted mortality rate declined for all other causes of death. From 1990 to 1992, the adjusted mortality rate declined for all causes of death except for malignant neoplasms and human immunodeficiency virus (HIV) infection, which rose 0.4% and 69%, respectively. The adjusted mortality rate was higher in men than in women for all causes of death except for diabetes mellitus and atherosclerosis. CONCLUSIONS: Except for malignant neoplasms and HIV infection, mortality from all other leading causes of death declined in 1992 with respect to 1990, independently of the trend experienced by each cause of death in the eighties.     

Cancer mortality in Italy, 1994, and an overview of trends from 1955 to 1994

BACKGROUND: Data and statistics are presented on cancer death certification in Italy, updating previous publications covering the period 1955-1993. METHODS: Data for 1994 and the quinquennium 1990-94 subdivided into 30 cancer sites are presented in 8 tables, including age- and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35-64 year age group. Trends in age-standardized rates for major cancer sites are plotted from 1955 to 1994. RESULTS: The age-standardized (world standard) death certification rates from all neoplasms steadily declined from the peak of 199.2/100,000 males in 1988 to 186.3 in 1994, and in females from 102.5 in 1989 to 98.6 in 1994. Ever larger was the decline in truncated rates, for males from the peak of 275.1/100,000 in 1983 to 223.2 (-19%) in 1994, and for females from 151.6/100,000 in 1987 to 136.4 (-10%). A major component of the favourable cancer mortality trends in males was lung cancer (accounting for 31,000 deaths in both sexes combined in 1994), whose overall age-standardized rates declined from 60.3 in 1987-89 to 54.6/100,000 males in 1994 (-9%), and from the peak of 96.7 in 1983 at ages 35 to 64 to 72.7 in 1994 (-25%). In contrast, female lung cancer rates have remained stable from 1992 onwards, but have increased from 7.2 to 7.7 at all ages and from 10.6 to 11.0 at age 35-64 between 1985-89 and 1990-94. These different trends in the two sexes reflect the patterns and trends in smoking among Italian males and females. CONCLUSIONS: Cancer mortality trends in Italy over the period 1990-94 were relatively favourable, mainly reflecting the decline in lung cancer rates in males, together with the persistent declines in gastric cancer in both sexes and in cervix uteri for women. Continuous advancements were registered for neoplasms amenable to treatment, essentially testicular cancer, Hodgkin's disease and childhood leukaemias. The major unfavourable trends were observed for non Hodgkin's lymphomas, and require therefore further monitoring, besides a clearer understanding of their determinants. Italy maintains an intermediate level of cancer mortality on a European scale, suggesting that further progress is possible, mostly for tobacco-related neoplasms in males.     

Acute myocardial infarction case fatality, incidence and mortality rates in a population registry in Gerona, Spain, 1990-1992. REGICOR Investigators

BACKGROUND: Community-based registries provide the best approach to assessing the impact of myocardial infarction (MI) in a population. The objective of the present study was to determine MI mortality, incidence, attack rate and 28-day case fatality in the province of Gerona, Spain from 1990 to 1992. METHODS: Standardized methods were used to find, register and classify MI cases in that population (509628 inhabitants) as definite, possible and insufficient-data MI. RESULTS: Of the 1456 cases fulfilling eligibility criteria, 850 (58.4%) were classified as definite MI, 162 (11.1%) as fatal possible MI, 232 (15.9%) as no MI and 160 (11.0%) as fatal insufficient data. The 1990-1992 age-standardized incidence rates (first MI cases only) for definite and fatal possible MI were 140.8 per 100000 men and 20.4 per 100000 women, all aged 35-64 years; attack rates (first and recurrent MI cases) were 182.9 and 24.5, and mortality rates 46.4 and 5.8, respectively. Case fatality at 28 days was 27.4% and 19.9% in men and women, respectively, but women died later over that period. With respect to men, the age-adjusted risk among women of dying within 28 days post-MI was 1.26 (95% confidence interval [CI]: 0.94-1.69). CONCLUSIONS: Myocardial infarction, incidence, mortality rates and case fatality in Gerona are among the lowest in the world. Age-adjusted case fatality within 28 days is only marginally higher in women than in men, but fatal cases occur later within this period in women.     

Partial agonists and full antagonists at the human and murine bradykinin B1 receptors

OBJECTIVE: To examine the incidence of first diagnosis of invasive squamous cell carcinoma (SCC) of the skin over time. DESIGN: Retrospective, population-based incidence study. SETTING: Enumerated, geographically isolated, semiurban population served by the Mayo Clinic and its affiliated hospitals and the Olmsted Medical Center, including its affiliated hospital in Rochester, Minn. METHODS: Using the Rochester Epidemiology Project databases that capture virtually all medical care provided to the residents of Rochester, we identified and reviewed records of all documented residents in whom histologically proven, invasive SCC of the skin was first diagnosed between 1984 and 1992. Age and sex stratum-specific rates were calculated, and age-adjusted rates observed over time for individuals aged 35 years or older were analyzed using Poisson regression. Adjusted rates were compared with the results of other studies. RESULTS: Review of 1630 records identified 511 incidence cases of SCC. Tumors located on the head and neck accounted for 66.4% of tumors in females and 72.9% in males. The annual age- and sex-specific incidence rates per 100,000 increased from 0 cases among males aged 0 to 14 years to 1286.0 cases among males aged 85 years or older. Over time, the annual age-adjusted incidence rates per 100,000 females rose from 46.5 (95% confidence interval [CI], 32.4-60.6) for the 1984 to 1986 period to 99.6 (95% CI, 80.4-118.7) for the 1990 to 1992 period and were 71.2 (95% CI, 61.7-80.8) overall. The corresponding rates for males were 125.9 (95% CI, 95.3-156.4), 191.0 (95% CI, 156.9-225.0), and 155.5 (95% CI, 137.0-174.0). The age- and sex-adjusted SCC incidence rates for the period from 1987 to 1989 and 1990 to 1992 exceeded those for the period from 1984 to 1986 (P = .03 and P < .001, respectively). Our age-adjusted rates for SCC were within the ranges seen in other white populations from temperate climates. CONCLUSION: The frequencies of first diagnosis of SCC are increasing at rates beyond those explainable by demographic shifts alone.     

Laryngeal neoplasm mortality in Oklahoma: 1950-1970

A survey of death certificates of victims with laryngeal cancer in Oklahoma for the period 1950 to 1970 attempts to corroborate findings of the current literature. Sex-race specific death rates per 100,000 for white, nonwhite, and American Indian populaces displayed a distinct sex and racial pattern: respectively, 38.52, 28.11, and 12.52 for males; 5.25, 1.23, and 0 for females. Age-adjusted death rates per 100,000 for white males for the four consecutive five-year periods were 19.00, 21.64, 20.91, and 26.81; these rates show constant mortality for laryngeal cancer for the period between 1950 and 1965, followed by an increase of approximately 30% in the 1966 to 1970 interval. Similar analysis of the white females, nonwhite males, and nonwhite females did not reveal such a clear secular pattern, although the adjustment for age did preserve the sex and racial pattern indicated above. Age-adjusted laryngeal cancer death rates of 42.34, 46.14, and 48.51 for the rural, nonmetropolitan, and metropolitan counties, respectively, indicated a direct association between mortality and degree of urbanization. All findings appeared to be in concordance with those given in the recent literature.     

Glycopyrrolate vs. atropine during anaesthesia for laryngoscopy and bronchoscopy

The mortality from motor neuron disease (MND) and multiple sclerosis (MS) was studied among immigrants to England and Wales from the Indian subcontinent, the Caribbean, and East and West Africa during the 10 years 1979-88. The MND mortality among ethnic Asian males was only half and for females one fifth of that expected at English rates. MND mortality in Caribbean immigrants was somewhat lower than expected. White immigrants from the Indian subcontinent had the expected MND mortality. MS mortality was low among Asian, West Indian, and African immigrants. This study is evidence that MND mortality is not the same in all ethnic groups.     

Analysis of immunoglobulin genes in splenic marginal zone lymphoma suggests ongoing mutation

BACKGROUND: The incidence of venous thromboembolism has not been well described, and there are no studies of long-term trends in the incidence of venous thromboembolism. OBJECTIVES: To estimate the incidence of deep vein thrombosis and pulmonary embolism and to describe trends in incidence. METHODS: We performed a retrospective review of the complete medical records from a population-based inception cohort of 2218 patients who resided within Olmsted County, Minnesota, and had an incident deep vein thrombosis or pulmonary embolism during the 25-year period from 1966 through 1990. RESULTS: The overall average age- and sex-adjusted annual incidence of venous thromboembolism was 117 per 100000 (deep vein thrombosis, 48 per 100000; pulmonary embolism, 69 per 100000), with higher age-adjusted rates among males than females (130 vs 110 per 100000, respectively). The incidence of venous thromboembolism rose markedly with increasing age for both sexes, with pulmonary embolism accounting for most of the increase. The incidence of pulmonary embolism was approximately 45% lower during the last 15 years of the study for both sexes and all age strata, while the incidence of deep vein thrombosis remained constant for males across all age strata, decreased for females younger than 55 years, and increased for women older than 60 years. CONCLUSIONS: Venous thromboembolism is a major national health problem, especially among the elderly. While the incidence of pulmonary embolism has decreased over time, the incidence of deep vein thrombosis remains unchanged for men and is increasing for older women. These findings emphasize the need for more accurate identification of patients at risk for venous thromboembolism, as well as a safe and effective prophylaxis.     

Treatment of aggression and irritability after head injury

Epidemiological characteristics of colorectal cancer may differ by particular anatomical subsite, suggesting that the subsite-specific colorectal cancers may represent different disease entities. This study explored the time trends over a 23-year period in colorectal cancer incidence at various subsites by sex and age group. Data on the incidence of colorectal cancer were obtained from a population-based cancer registry in Shanghai, People's Republic of China. Between 1972 and 1994, 30,693 patients with colorectal cancer were registered at the Shanghai Cancer Registry. The overall age-adjusted colorectal cancer incidence rates increased > 50%, or 2% per year from 1972-1977 to 1990-1994, from 14 to 22 per 100,000 among men and from 12 to 19 per 100,000 among women. The increases in rates were considerably more rapid for colon cancer, with rates approximately doubling, than they were for rectal cancer. Proximal colon cancer was more common than distal colon cancer over the whole study period, whereas rates for both cancers rose with similar annual percentage changes (> 5% per year) and across virtually all age groups. The estimated annual increases rose from 2% at ages 35-44 years to 7% at ages 75-84 years for proximal colon cancer, but they were more uniform for distal colon cancer (5-6% per year). Age-adjusted and age-specific rectal cancer rates changed little. The male:female age-adjusted rate ratio for colorectal cancer was 1.19 in 1990-1994. The ratios increased over time and varied by subsites, with ratios increasing from the proximal colon to the distal colon and to the rectum. Furthermore, men had higher rates than women for distal colon and rectal cancers at ages 55 and older, whereas women had higher rates than men at younger ages for these two cancers. Male:female rate ratios for proximal colon cancer did not vary substantially with age. The findings from this study indicate that subsite-specific incidence rates of colorectal cancer differ by sex and age and in their time trends. Cancers arising in the proximal colon, distal colon, and rectum may have somewhat different disease etiologies.     

Laboratory animal allergy

Since the second World War, excess mortality of males has been steadily growing in Poland. The aim of this paper was to analyze the basic relationships between excess male mortality and some social and economic factors, with special reference to both age and place of residence. Data published in Demographic Yearbooks and included in reports produced by the Government Population Council were used in the analysis. The excess male mortality is expressed in terms of male/female mortality ratio, and also in terms of the difference between the average female and male life expectancy. In the early 1990s the general male mortality rate in Poland was by 23% higher than the general female mortality rate, whereas in males at younger working age (20-44 years) mortality was three times higher, and in the older age (45-64 years) groups 2.7 times higher than the female mortality. Compared with the majority of European countries, Poland is characterised by high rates of excess male mortality, which points to a deteriorated health status of the population. At present, excess mortality of the working age males is much higher than in the 1960s and 1970s. Our analysis of the 1960-1994 trends revealed that the highest excess male mortality occurs in the 20-24 age group. Although recently a falling trend has been observed in the infant, juvenile and post working age groups, a continuous increase is noted in the working age population of Poland. Causes of death were also included in our analysis. Among circulatory diseases, the highest excess mortality was due to acute myocardial infarction (the risk of death from this disease was 8 times higher for males than for females). Accidents, injuries and poisoning constitute another leading group of causes responsible for excess mortality (6/1 male/female death risk ratio). The excess male mortality rates are higher in the rural than in the urban areas. The excess male mortality was also reflected in the indices of average life expectancy. In 1995, the average life expectancy was 67.6 years for males and 76.4 years for females. Thus, in Poland males live 8.6 years shorter than females on average. Increased excess mortality among the working age males, a considerable difference between male and female average life expectancy, disturbed demographic male/female balance, these are at least some of the reasons why further in depth studies of excess male mortality in Poland should continue.     

Cervical cancer mortality in Belgium, 1955-1989. A descriptive study

This study describes trends in cervical cancer mortality among women in Belgium from 1954 to 1989. Data are analysed by means of the standardised mortality rate, age- and cohort-specific mortality rates and standardised cohort mortality ratios. The age-standardised mortality rate decreased progressively from 6.3/100,000 women-years in the first period (1955-1959) to 3.8/100,000 in 1985-1989, indicating a decline of 39.7% over the seven quinquennial periods. A decrease was observed in almost all age groups between 30 and 69 years. In the last 15 years, no further decline, but even a discrete increase, occurred for the age categories younger than 50 years. The successive cohorts born between 1915 and 1939 expressed a continuing lower risk of cervical cancer mortality. This trend was not observed for the most recent generations, for whom even a slight increase of the standardised cohort mortality ratio could be distinguished.     

Long-term survival after resection for bronchogenic carcinoma

Of 915 resections for bronchogenic carcinoma over a 25-year period (1945-1969), 249 patients survived over 5 years; 127 of the patients eligible survived over 10 years, 61 over 15 years, and 22 over 20 years. The case material was divided into three time periods: 1945-49, 1950-59 and 1960-69, as well as by extent of resection. Lobectomy became the operation of choice, pneumonectomy being reserved for the more extensive lesions. Observed survival rates at 5, 10 and 15 years for 561 patients in the lobetomy series were 35, 22 and 15%, respectively, but strikingly increased to 41, 28 and 19% in the 1960-69 period. Observed rates for 354 patients having pneumonectomies were similar for three time periods, being 16, 8 and 6% at 5, 10 and 15 years, respectively. Relative survival rates for the lobectomy series at 5, 10 and 15 years rose from 33, 28 and 26%, repectively, in the 1950-59 period to 50, 39 and 35% in the last time period, becoming a near horizontal curve segment after 5 years. Dominant factors in survival were extent of the lesion and stage of nodal involvement, histologic type and location being less significant.     

Clinical features, molecular genetics, and pathophysiology of dominant optic atrophy

CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.     

Decreasing rates of cervical cancer among American Indians and Hispanics in New Mexico (United States)

Minority women in New Mexico (United States)--including American Indian and Hispanic women--have shown disproportionately high incidence rates of invasive cervical cancer during the 1960s and 1970s. Several public health programs in New Mexico were directed toward early detection of cervical cellular abnormalities, particularly targeting the state's minority women. To evaluate the effectiveness of these programs, we examined the New Mexico Surveillance, Epidemiology, and End Results (SEER) data collected from 1969-92, and calculated average annual, age-specific, and age-adjusted incidence rates by ethnic group (American Indian, Hispanic, and non-Hispanic White) for five-year time intervals. We also calculated age-adjusted mortality rates for cervical cancer in the same ethnic groups using state vital records. Age-adjusted incidence rates for invasive cervical cancer show substantial temporal decreases, especially for minority women in the state. The age-adjusted incidence rate decreased by 66 percent, from 30.3 to 10.3 per 100,000 for American Indian women, and by 61 percent, from 26.1 to 10.2 per 100,000 for Hispanic women. A stage shift to earlier stages of cervical neoplasia occurred over the study period, with a substantially higher proportion of in situ compared with invasive cancers diagnosed in the most recent cf the most remote time period. The ratio of incidence rates of in situ to invasive cancers changed dramatically for both American Indian and Hispanic women. Cervical cancer mortality rates decreased steadily among Hispanic women from 1958 to 1992; the decrease among American Indian women was less stable and fluctuated due to small numbers. Ongoing targeted screening programs should help to reduce cervical cancer incidence and mortality further in New Mexico.     

Transgenic insertional mutagenesis. Applications to inner-ear genetics

STUDY OBJECTIVE: Despite significant declines since the late 1960s, coronary mortality remains the leading cause of death for African Americans. African Americans in the US South suffer higher rates of cardiovascular disease than African Americans in other regions; yet the mortality experiences of rural-dwelling African Americans, most of whom live in the South, have not been described in detail. This study examined urban-rural differentials in coronary mortality trends among African Americans for the period 1968-86. SETTING: The United States South, comprising 16 states and the District of Columbia. STUDY POPULATION: African American men and women aged 35-74 years. DESIGN: Analysis of urban-rural differentials in temporal trends in coronary mortality for a 19 year study period. All counties in the US South were grouped into five categories: greater metropolitan, lesser metropolitan, adjacent to metropolitan, semirural, and isolated rural. Annual age adjusted mortality rates were calculated for each urban status group. In 1968, observed excesses in coronary mortality were 29% for men and 45% for women, compared with isolated rural areas. Metropolitan areas experienced greater declines in mortality than rural areas, so by 1986 the urban-rural differentials in coronary mortality were 3% for men and 11% for women. CONCLUSIONS: Harsh living conditions in rural areas of the South precluded important coronary risk factors and contributed to lower mortality rates compared with urban areas during the 1960s. The dramatic transformation from an agriculturally based economy to manufacturing and services employment over the course of the study period contributed to improved living conditions which promoted coronary mortality declines in all areas of the South; however, the most favourable economic and mortality trends occurred in metropolitan areas.     

Time trends of lung and larynx cancers in Italy

During the period 1970-1989, age-adjusted mortality rates for lung cancer in Italy increased by more than 50%, while rates for larynx cancer in males decreased by approximately 13%. This study aims to interpret this difference, which seems to contradict the finding that cigarette smoking is a common major risk factor for both lung and larynx cancer. To this end, we jointly analyzed the time trends of incidence, survival and mortality. We first examined survival data taken from the population-based Lombardy Cancer Registry (northern Italy). Based on data referring to 880 incident cases of larynx cancer, diagnosed during the period 1976-1987, we estimated a 3% annual increase in relative survival. By contrast, no significant period effect was observed for survival rates of 2,259 incident cases of lung cancer. National incidence rates were estimated using official mortality data and the above-described survival data. Age-adjusted estimated incidence rates increased, from 1970 to 1989, for both cancer sites: +55% for male lung, +56% for female lung, and +22% for male larynx. Moreover, the patterns of birth-cohort effect, which are diverging for mortality, are nearly parallel with regard to incidence. This analysis suggests that a substantial improvement in survival of larynx cancer patients may largely explain the differences in mortality trends for cancer of lung and larynx.     

Decrease in calcitonin-containing cells in truncus arteriosus

Parkinson's disease mortality was analyzed in Italy for the period from 1951 through 1987. The adjusted mortality was 4.27 and 2.77/100,000 population, respectively, for men and women. Adjusted rates increased in both sexes (63% increase in men and 80% in women in 1983 through 1987 vs 1951 through 1952). Age-specific mortality increased in subjects aged over 75 years and decreased in those under 64 years. The analysis by birth cohorts demonstrated higher rates in the cohorts born between 1890 and 1910 than in those born before and after that period. Even if these changes in Parkinson's disease mortality might reflect better case ascertainment and the increase of life expectancy of patients with Parkinson's disease, there is some evidence that the temporal variation is associated with the changing experiences of different birth cohorts.     

Epidemiology of Creutzfeldt-Jakob disease in the United States, 1979-1990: analysis of national mortality data

The trends and current incidence of Creutzfeldt-Jakob disease (CJD) was examined by using a unique and potentially high sensitive source for case ascertainment. We analyzed death certificate information for 1979-1990 from US multiple-cause-of-death mortality data, compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention. We evaluated death certificate data for US residents for whom CJD was listed as one of the multiple causes of death on the death certificate (046.1) from the International Statistical Classification of Diseases, Injuries, and Causes of Death (9th revision). Age-adjusted and age-specific CJD death rates by gender, race, and region were calculated to measure the disease incidence because of the rapidly fatal course of the disease for most patients with CJD. We identified 2,614 deaths with CJD listed on the death certificates. The average annual age-adjusted mortality rate was 0.9 deaths per million persons (range 0.8-1.1). The mean age at death was 67 years. CJD-related deaths were uncommon among persons younger than 50 years of age (4.3% of all deaths). The highest average annual mortality rate was for those persons aged 70-74 years (5.9 deaths per million persons). A slight majority (53.0%) of the deaths was in females, but the age-adjusted mortality rate was 1.2 times higher for males. Most deaths (94.8%) were in whites; the mortality rate for blacks was only 40% of that for whites. The age-adjusted CJD mortality rate in the United States is similar to published estimates of the crude incidence of CJD worldwide.(ABSTRACT TRUNCATED AT 250 WORDS)