The black/white mortality crossover: investigation from the perspective of the components of aging.
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Biomedical subjects
Publications and source records attributed to S S Poss.
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A study is made of the effects of associated causes of death, and of dependency among causes of death, by observing the relative importance of one cause of death when another is eliminated under various competing risk models. Two disease pairs, cancer and infectious disease and stroke and ischemic heart disease, are selected for analysis because they represent different types of disease dependence. Crude probabilities of death for each disease are calculated for the U.S. white male population in 1969. Next, the effects of the complementary disease in a pair are hypothetically eliminated in one of three ways: (a) a standard competing risk adjustment for cause elimination when deaths are singly caused (Chiang, 1968), (b) lethal defect-pattern of failure computations for multiply caused death when no causal order is inferred (Manton et al., 1976), and (c) relative susceptibility, computations for multiply caused deaths when causes are ordered (Wong, 1977). The paper closes with a discussion of the relative merits of the three types of adjustments.
An analysis is performed to ascertain the joint incidence of two causes of death, acute myocardial infarct and stroke, for the deaths of residents of Massachusetts and North Carolina in 1969. To assay their association an explicit biological model of the nature of the relation is posited. It is shown that, under this model, Chiang's (1968) theory of competing risks may be extended to the case in which an individual's death may have multiple causes. Furthermore, techniques are developed which allow us to model the survival parameters derived under the model by categorical data procedures of the type introduced by Grizzle, Starmer and Koch (1969). The study shows that there is a greater incidence of the joint occurrence of stroke and myocardial infarct on death certificates in North Carolina than in Massachusetts, a pattern consistent with the generally higher stroke mortality in North Carolina. Furthermore, the incidence of the joint occurrence of the two diseases shows a clear age "gradient" increasing through the age range of the analysis. Males and females show somewhat different patterns of age variation in that state-by-age interaction terms are more prominent in the model fitted for females than for males.
A lethal defect-wear model of mortality is presented which rationalizes the assumption of independent risks when death may be due to more than a single condition. Under this model, it is shown how competing risk theory and standard categorical data methods may be merged in a unified approach to the analysis of multiple-cause mortality data. The methodology is used to analyze linkages among diseases in the mortality data and evaluate the implication of the elimination of patterns of morbid states for multiple-cause mortality data from deaths occurring in 1969 in North Carolina.