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PubMed1993

Age and fatal work-related falls.

In the work environment, an increased risk of fatal injury from falls is seen at ages not normally considered to be old. This study examined fatality data from a National Institute for Occupational Safety and Health death certificate database and from Occupational Safety and Health Administration (OSHA) investigations to analyze the relationship of age to fatal work-related falls. For 1980 to 1986, death certificates reported 43,505 fatal work injuries in men, 4179 of which were from falls. Fatality rates from falls showed an increase for older workers beginning with the age group of 45-54, whereas fatal injury rates for other work-related causes did not increase until the age group of 55-64. OSHA investigations of 996 fatal work-related falls in 1984-1986 reported that falls from ladders accounted for 20% of fatal falls in workers aged 55 and over, significantly more than the average of 9% of all falls for workers of all ages. OSHA data also showed that fatal falls among older workers were associated with lower energy of impact, which means that the height of fatal falls tends to decrease with increasing age.

Accidental Falls↗

PubMed2000

Fatal toxicity associated with antidepressant use in primary care.

BACKGROUND: New selective serotonin reuptake inhibitors (SSRIs) are perceived to be much safer in use than older tricyclic antidepressants (TCAs). However, previous assessments of association with fatal toxicity were made too soon after the introduction of the new drugs to permit accurate estimation. AIM: To determine the level of association of antidepressant drugs with fatal poisoning in the treatment of depression. METHOD: National data for England and Wales for three years (1993 to 1995) for fatal poisonings associated with antidepressants were obtained and, together with national primary care data on prescribing, were used to calculate fatality association by antidepressant drug. RESULTS: There were substantial variations between drugs in the level of association with fatal poisoning. Assuming an average treatment episode lasted three months, one fatality is associated with 11,800 treatment episodes of antidepressant use (95% CI = 11,120 to 12,580) when only single substance fatalities are considered. For SSRIs as a group the association was one in 411,800 (95% CI = 243,300 to 1.34 million) and for TCAs one in 8130 (95% CI = 7650 to 8670). However, for one of the newer TCAs, lofepramine, the single substance fatality rate associated with its use was one in 233,700 (95% CI = 124,500 to 1.89 million), which is not statistically significantly different from the SSRIs (P = 0.35). CONCLUSIONS: Estimated death rates associated with specific antidepressants should be compared with caution because drugs may be used selectively in patients with differing severity of depression. The proportion of these fatalities that could be prevented by switching to safer antidepressants is unclear when so few deaths are recorded as accidental; when there is intent to do self-harm the potential for switching to other means is unknown. However, this approach to relative toxicity may remain the best available since it is unlikely that a randomised trial will ever be conducted with a large enough sample size to obtain experimental data. Fatalities from antidepressant poisoning are very rare but if safety is paramount then lofepramine or an SSRI are justifiable treatment choices.

Antidepressive Agents, Second-Generation↗

PubMed1995

Cancer fatalism among elderly Caucasians and African Americans.

PURPOSE: To determine the relationship between selected demographic factors (e.g., education, income, ethnicity, gender, age) and cancer fatalism. DESIGN: Descriptive study. SETTING: Randomly selected senior citizen centers in a southern state. SAMPLE: The majority of the participants (N = 192) were female African Americans. Mean age of participants was 76 years, mean years of education was < or = 8 years, and mean income was below $6,500 per year. METHODS: Demographic data was collected and Powe Fatalism Inventory was completed in face-to-face interviews. MAIN RESEARCH VARIABLES: Education, income, ethnicity, gender, age, and cancer fatalism. FINDINGS: Significant negative correlations between cancer fatalism and education and income were found. Significant correlations also existed between cancer fatalism and ethnicity and gender. Age was not a significant predictor of cancer fatalism. CONCLUSIONS: As participants' level of education and income decreased, cancer fatalism scores increased. African Americans and females had higher mean cancer fatalism scores. Education, income, ethnicity, and gender could be used to predict cancer fatalism scores. IMPLICATIONS FOR NURSING PRACTICE: Future research should evaluate the relationship between cancer fatalism and early detection practices.

Black or African American↗

PubMed1997

Five years of work-related injuries and fatalities in Minnesota. Agriculture: a high-risk industry.

This report describes the Minnesota Fatality Assessment and Control Evaluation Study (MN FACE), a federally funded initiative to study fatal injuries in the workplace. The purpose of the program is to investigate various types of occupational fatalities and to identify risk factors that contribute to work-related fatalities. Initially, the MN FACE program only investigated fatalities related to falls, confined spaces, and electrocutions. In 1994, MN FACE also began investigating fatalities associated with agricultural work. Agriculture continues to be one of the nation's most hazardous industries, ranking fourth among industries in the United States at high risk for work-related fatalities. MN FACE investigated 46 agriculture-related fatalities during 1994-95. Forty-one percent of the fatalities involved tractors, and 66% of these accidents were tractor rollovers. Other leading causes of agricultural fatalities included grain bin and manure pit asphyxiations.

Accidents, Occupational↗

PubMed1998

Risk of fatal pulmonary embolism in patients with treated venous thromboembolism.

CONTEXT: The most serious complication of deep vein thrombosis (DVT) or nonfatal pulmonary embolism (PE) is fatal PE. However, reliable estimates as to the risk of fatal PE in patients with treated DVT or PE are lacking. OBJECTIVE: To provide reliable estimates of the risk of fatal PE and the case-fatality rate of recurrent DVT or PE among patients presenting with symptomatic DVT or PE, during and following 3 months of anticoagulant therapy. DATA SOURCES: A MEDLINE literature search was performed to identify prospective studies in which patients with symptomatic DVT or PE were treated with 5 to 10 days of heparin and 3 months of oral anticoagulants. We searched the years 1966 to September 1997 using the search terms thrombophlebitis, diagnosis, drug therapy, and prognosis. Current Contents and bibliographies were also scanned. DATA EXTRACTION: Of 137 retrieved studies, 25 studies satisfied predetermined methodologic criteria and were included in the analysis. DATA SYNTHESIS: Among patients presenting with DVT, the rate of fatal PE during anticoagulant therapy was 0.4% (95% confidence interval [CI], 0.2%-0.6%); following anticoagulant therapy it was 0.3 per 100 patient-years (95% CI, 0.1-0.8). The case-fatality rate of recurrent DVT or PE during anticoagulant therapy was 8.8% (95% CI, 5.0%-14.1%); following anticoagulant therapy it was 5.1% (95% CI, 1.4%-12.5%). Among patients presenting with PE, the rate of fatal PE during anticoagulant therapy was 1.5% (95% CI, 0.9%-2.2%); following anticoagulant therapy it was 0 per 265 patient-years (95% CI, 0-3.6). The case-fatality rate of recurrent DVT or PE among patients presenting with PE was 26.4% (95% CI, 16.7%-38.1%). CONCLUSION: Among patients with symptomatic PE or DVT who are treated with anticoagulants for 3 months, fatal PE is rare during and following anticoagulant therapy. Patients presenting with PE are more likely to die of recurrent PE or DVT than are patients presenting with DVT.

Anticoagulants↗

PubMed1996

Fatalities in the construction industry in the United States, 1992 and 1993.

To improve the estimates of occupational fatality rates for persons employed in the construction industry, several sources of data on the number of fatalities (the numerator) and the number of persons engaged in construction work (the denominator) were examined. Based on this examination, the Census of Fatal Occupational Injuries (CFOI), complied by the Bureau of Labor Statistics (BLS), was used to obtain numerators and the Current Population Survey, conducted by the Bureau of the census for the BLS, was used to obtain denominators. Adjustments were made in the numerator to include only occupations that were included in the denominator. Occupations were divided into two groups-those in the construction trades and those in other occupations within construction (e.g., clerical, sales). The analysis found fatality rates of 14.2 and 13.3 per 100,000 person-years, respectively, for 1992 and 1993, with wide variation in rates among the different trades. There were also major differences among the trades in the types of fatal injuries. Self-employed workers had much lower death rates overall than wage workers, but this is largely due to much lower proportions of high hazard trades among the self-employed. There have been wide variations in the occupational fatality rates reported for construction workers each year due to the differing methods of estimating the number of fatalities by the different data sources. This study provides a baseline of fatality rates using the best available current data. It compares the results from these data sources with those from other sources that have been used and discusses some of the problems inherent in the data from other sources. This study provides a significantly improved protocol for the calculation of fatality rates against which later rates can be compared consistently. Nevertheless, many deficiencies in the data sources used are identified. There remains ample room for continued improvement.

Accidents, Occupational↗

PubMed2004

The effect of rate denominator source on US fatal occupational injury rate estimates.

BACKGROUND: The Current Population Survey (CPS) is often used as a source of denominator information for analyses of US fatal occupational injury rates. However, given the relatively small sample size of the CPS, analyses that examine the cross-classification of occupation or industry with demographic or geographic characteristics will often produce highly imprecise rate estimates. The Decennial Census of Population provides an alternative source for rate denominator information. We investigate the comparability of fatal injury rates derived using these two sources of rate denominator information. METHODS: Information on fatal occupational injuries that occurred between January 1, 1983 and December 31, 1994 was obtained from the National Traumatic Occupational Fatality surveillance system. Annual estimates of employment by occupation, industry, age, and sex were derived from the CPS, and by linear interpolation and extrapolation from the 1980 and 1990 Census of Population. Fatal injury rates derived using these denominator data were compared. RESULTS: Fatal injury rates calculated using Census-based denominator data were within 10% of rates calculated using CPS data for all major occupation groups except farming/forestry/fishing, for which the fatal injury rate calculated using Census-based denominator data was 24.69/100,000 worker-years and the rate calculated using CPS data was 19.97/100,000 worker-years. The choice of denominator data source had minimal influence on estimates of trends over calendar time in the fatal injury rates for most major occupation and industry groups. CONCLUSIONS: The Census offers a reasonable source for deriving fatal injury rate denominator data in situations where the CPS does not provide sufficiently precise data, although the Census may underestimate the population-at-risk in some industries as a consequence of seasonal variation in employment.

Accidents, Occupational↗

PubMed2002

The population consumption model, alcohol control practices, and alcohol-related traffic fatalities.

BACKGROUND: More than 40% of urban traffic fatalities are alcohol related and the rate of such fatalities varies more than 10-fold across U.S. cities. These variations might be explained by differences in local alcohol control policies and practices. METHODS: We conducted a cross-sectional survey of state Alcohol Beverage Control agencies and local city police departments in 107 cities that participate in the National Highway and Traffic Safety Administration's Fatality Analysis Reporting System. We examined the association of alcohol control practices in 1997 and alcohol-related traffic fatalities per daily vehicle miles traveled, 1995-1997. RESULTS: Ninety-seven (91%) cities participated. Regulations related to alcohol accessibility, licensure of alcohol outlets, disciplinary procedures of alcohol outlets, and enforcement of blood alcohol concentration laws were associated with lower rates of fatalities. Cities with 9 or fewer of the 20 regulations had 1.46-fold greater alcohol-related traffic fatality rates than cities with 15 or more of these regulations, representing 392 excess deaths annually. Beer consumption was found to be a potential mediator of the effect of regulations on traffic fatalities. CONCLUSIONS: Alcohol beverage regulations are associated with alcohol-related traffic fatalities. Localities should consider greater restrictions on alcohol accessibility, stricter disciplinary measures for violations, and stricter licensure requirements as a potential means to reduce alcohol-related traffic fatalities.

Accidents, Traffic↗

PubMed1988

The relationship between alcohol-related traffic fatalities and per capita consumption of alcohol, Ontario, 1957-1983.

In this research, the impact of per capita consumption of alcohol on alcohol-related traffic fatalities in Ontario between 1957 and 1983 was examined. Three measures of alcohol involvement were selected. The first, drinking drivers (police reported) involved in fatal accidents, was a direct measure. The second and third, single-vehicle fatal accidents and nighttime fatal accidents, were surrogate measures. Also, three corresponding measures of fatal accidents not involving alcohol (normal drivers [police reported] involved in fatal accidents, multiple vehicle fatal accidents, and daytime fatal accidents) were chosen to control for general road safety trends. The results of regression analyses indicated that both per capita consumption and general road safety trends were significant contributors to all three measures of alcohol-involved fatalities. These and other recent data suggest that any effort to prevent alcohol-related problems such as liver cirrhosis through control of per capita consumption will also have a beneficial impact on alcohol-related accidents.

Accidents, Traffic↗

PubMed1993

Work-related road fatalities in Australia, 1982-1984.

A study of work-related fatalities, based on coroners' records, has provided national data on work-related road fatalities. A total of 1,544 work-related fatalities were identified over 1982-1984. Of these, 600 (39%) resulted from injuries sustained in road vehicle accidents on public roads; 366 (24%) in the course of work, and 234 (15%) while commuting between home and work. These figures are likely to underestimate work-related road fatalities because the coroners' records often did not contain the required information. The incidence of road fatalities declined slightly over the three years, although the proportion amongst all work-related fatalities remained constant. The at-work victims tended to be older than victims of road death generally. Fifty-six percent of the at-work cases were in the occupational group "drivers, road transport". Articulated trucks accounted for 41% of the at-work cases. Drivers made up 79% of the at-work group. In contrast, drivers accounted for only 38% of all road deaths. Two-thirds of the at-work road fatalities occurred outside capital city districts, the proportion of nonmetropolitan cases being highest for deaths involving articulated trucks. This is striking, in view of Australia's highly urbanised population. Blood alcohol data were available for 76% of the at-work cases and 79% of the commuting fatalities. Of these, 15% and 13%, respectively, had a blood alcohol of 0.05 g/100mL or more. In contrast, 6% of other workplace fatalities for which blood alcohol data were available had such levels. This difference may reflect more assiduous blood-alcohol testing of road-accident victims.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗

PubMed2004

Effects of lowering the legal BAC to 0.08 on single-vehicle-nighttime fatal traffic crashes in 19 jurisdictions.

BACKGROUND: In the past few decades, numerous policies, including those that lower legal blood alcohol concentration limits, have been enacted to reduce alcohol-impaired driving. In the US, 41 states and the District of Columbia have enacted 0.08 per se laws, which specify that if a driver's BAC is at or above 0.08, a violation has occurred even if the driver does not show signs of intoxication. OBJECTIVE: We examined effects of lowering the blood alcohol concentration limit to 0.08 per se on fatal traffic crashes in 18 states and the District of Columbia, and whether effects of the law varied by state or by baseline rates of fatal traffic crashes. METHOD: Data on fatal traffic crashes were obtained from the Fatality Analysis Reporting System, including all states that enacted 0.08 per se prior to 2001 in the contiguous United States. Effects of the 0.08 law were examined in each state separately, and the overall effect across states was examined using a mixed-model Poisson regression on single-vehicle-nighttime fatal traffic crashes. RESULTS: State-specific analyses showed that fatal traffic crashes significantly decreased in three of the 19 states following the introduction of the 0.08 law, prior to adjusting for potential confounders. The mixed-model regression showed a statistically significant 5.2% reduction in single-vehicle-nighttime fatal traffic crashes associated with the 0.08 law across all states, after adjusting for administrative license revocation, the number of Friday and Saturday nights in a month, and trends in all other types of fatal traffic crashes. Findings indicate that the effect of the 0.08 law does not vary significantly by state or baseline rate of fatal traffic crashes in a state, and no significant statistical interaction exists between 0.08 and administrative license revocation policy effects.

Accidents, Traffic↗

PubMed2004

The epidemiology of case fatality rates for suicide in the northeast.

STUDY OBJECTIVE: We examine how method-specific case fatality rates for suicide differ by age and sex. METHODS: Seven northeastern states provided mortality and hospital discharge data (1996 to 2000). Suicide acts were divided into 8 categories according to the method used. For each method, the fraction of acts resulting in death (the method-specific case fatality rate) was calculated. Only suicide acts that resulted in hospitalization or death were included. RESULTS: Overall, 13% of all suicide acts proved lethal (23% for males compared with 5% for females; 7% for people aged 15 to 24 years compared with 34% for individuals aged > or =65 years). Poisoning with drugs accounted for 74% of acts but only 14% of fatalities; firearms and hanging accounted for only 10% of acts but 67% of fatalities. Firearms were the most lethal means (91% resulted in death), followed by drowning (84%) and hanging (82%). For every means, method-specific case fatality rates were higher for male victims and older individuals. Age and sex were associated with overall case fatality rates primarily because of their association with the distribution of methods chosen. CONCLUSION: Our findings are based on suicide acts that result in hospitalization or death and therefore underestimate the actual incidence of suicide acts and overestimate case fatality rates. Nevertheless, we find that age and sex influence overall case fatality rates primarily through their association with methods used, rather than because of variation in method-specific case fatality rates.

Adolescent↗

PubMed2005

Student drivers: a study of fatal motor vehicle crashes involving 16-year-old drivers.

STUDY OBJECTIVE: Motor vehicle crashes are the leading cause of death for US teenagers, accounting for 40% of fatalities. The purpose of this study was to compare novice (aged 16 years) and experienced (aged 25 to 49 years) drivers involved in fatal motor vehicle crashes with respect to crash characteristics and driver behaviors. METHODS: This cross-sectional study of fatal motor vehicle crashes in Colorado used data from the Fatality Analysis Reporting System (1995 to 2001). Driver and crash variables were compared in the 2 age groups using separate logistic regression models, adjusted for sex, geographic locale, and year. RESULTS: Two thousand four hundred twenty fatal motor vehicle crashes were included; 158 fatalities (6.5%) were novice drivers. Novice drivers were more likely to have been speeding (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.34 to 3.08); driving recklessly (OR 4.78, 95% CI 3.31 to 6.92); charged with a traffic violation (OR 3.08, 95% CI 2.20 to 4.31); in a single-vehicle (OR 1.84, 95% CI 1.32 to 2.57), rollover (OR 1.36, 95% CI 0.97 to 1.91) or run-off-the-road (OR 1.54, 95% CI 1.03 to 2.30) crash; and carrying 2 (OR 4.52, 95% CI 2.75 to 7.41) or more (OR 4.07, 95% CI 2.49 to 6.55) passengers. Safety belt nonuse was high for novice (48%) and experienced (42%) drivers (OR 1.19, 95% CI 0.86 to 1.67). Novice drivers had older cars (mean difference 1.5 years, 95% CI 0.37 to 2.57 years). Novice drivers were less likely to be involved in crashes caused by alcohol (OR 0.24, 95% CI 0.14 to 0.41) or adverse weather (OR 0.37, 95% CI 0.19 to 0.75) and to be driving a sport utility vehicle (OR 0.62, 95% CI 0.39 to 0.97). CONCLUSION: Fatal motor vehicle crashes involving novice drivers are characterized by speeding, recklessness, single-vehicle and rollover crashes, and traffic law violations, suggesting that novice drivers bear considerable responsibility for their fatal crashes. Moreover, almost half of 16-year-old drivers involved in fatal motor vehicle crashes were not wearing their safety belts. These data may prove useful in strengthening graduated licensing laws and in improving drivers' education courses and public safety campaigns.

Accidents, Traffic↗

PubMed2006

Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users.

BACKGROUND: Non-fatal overdose is a major determinant of morbidity among injection drug users (IDU). We sought to evaluate factors associated with non-fatal overdose among IDU in Vancouver. METHODS: We examined non-fatal overdose among participants in the Vancouver Injection Drug Users Study. Correlates of non-fatal overdose occurring between 1996 and 2004 were identified using generalized estimating equations (GEE). RESULTS: There were 1587 participants included in this analysis, including 576 (36%) women. At baseline, 750 (47%) reported a history of non-fatal overdose. In total, 985 reports of non-fatal overdose were made during follow-up by 519 (32.7%) participants. In multivariate GEE analyses, factors independently associated with non-fatal overdose included: heroin injection (AOR=2.67), cocaine injection (AOR=2.01), benzodiazepine use (AOR=2.00), requiring help injecting (AOR=1.58), binge drug use (AOR=1.52), homelessness (AOR=1.38), alcohol use (AOR=1.32), street injecting (AOR=1.22), non-injectable opiate use (AOR=1.16), speedball use (AOR=1.15), and recent incarceration (AOR=1.14). Younger age (AOR=0.99) and methadone use (AOR=0.51) were protective. CONCLUSIONS: We found that non-fatal overdose was common among local IDU. Non-fatal overdose was associated with several factors that may be amenable to intervention, including opiate and stimulant use, and the characteristic of requiring help with injecting. These findings indicate the need for the ongoing development of structural interventions to address this common cause of morbidity among IDU.

Adolescent↗

PubMed2004

Farm fatalities to youth 1995-2000: A comparison by age groups.

PROBLEM: Although a myriad of research illustrates the safety issues related to farm fatalities in youth populations, very little empirical evidence exists that includes work and non-work related farm fatalities to all youths under 20 years of age at the national level. METHODS: This research will use death certificate data for the six years from 1995 to 2000 that were collected by NIOSH from all 50 state vital statistics registries. Demographic data from the 1998 CAIS were used in rate calculations. In addition to providing annual fatality rates and descriptions of the general causes of death, this research will examine the variation between age groups. RESULTS: Analysis of 695 total farm-related youth fatalities shows an average annual fatality rate of 9.3 fatalities per 100,000 youths. Males account for 80% of these fatalities. The most prevalent causes of death are: machinery (25%), motor vehicle (17%), drowning (16%), suicide (8%) and homicide (6%). Of all youth fatalities occurring while at work, 45% are to youths less than 16 years of age. This same age group accounts for 71% of all non-work related fatalities. SUMMARY: This research will provide farm families and researchers more detailed information on farm hazards that contribute to the deaths of youths. As these youths may encounter hazards while working or playing in their daily environment, identification and elimination of these hazards will increase overall safety on the farm. This research also indicates the need to include youths under 16 years of age in future comprehensive farm safety research.

Accidents↗

PubMed2002

The independent contribution of driver, crash, and vehicle characteristics to driver fatalities.

Several driver, crash, and vehicle characteristics may affect the fatality risk of drivers involved in crashes. To determine the independent contribution of these variables to drivers' fatality risk, we used data from single-vehicle crashes with fixed objects contained in the US Fatal Accident Reporting System. A multivariate logistic regression revealed that the odds ratio (OR) of a fatal injury increased with age, reaching 4.98 (99% confidence interval (CI) = 2.01-12.37) for drivers aged 80 + compared with drivers aged 40-49 years. Female gender (OR = 1.54, 99% CI = 1.35-1.76) and blood alcohol concentration greater than 0.30 (OR = 3.16. 99% CI = 1.96-5.09) were also associated with higher fatality odds. In comparison with front impacts, driver-side impacts doubled the odds of a fatality (OR = 2.26, 99% CI = 1.92-2.65), and speeds in excess of 111 kilometers per hour (kph: 69 mph) prior to or at impact were related to higher fatality odds (OR = 2.64, 99% CI = 1.82-3.83) compared with speeds of less than 56 kph (35 mph). Three-point seatbelts were protective against fatal injuries (OR = 0.46, 99% CI = 0.39-0.53 compared with no belt). These data suggest that increasing seatbelt use, reducing speed, and reducing the number and severity of driver-side impacts may prevent fatalities. The importance of age and gender suggests that the specific safety needs of older drivers and female drivers may need to be addressed separately from those of men and younger drivers.

Accidents, Traffic↗

PubMed1998

Cellular phones and fatal traffic collisions.

A case-control study was conducted to determine statistical associations between traffic fatalities and the use or presence of a cellular phone, given involvement in a collision. The hypothesis of this study does not imply that cellular phones directly affect fatalities, but that phones increase the risk of certain accident characteristics in fatal collisions more than those same characteristics in non-fatal collisions. Analysis employed data from 223,137 traffic accidents occurring between 1992 and 1995. Information on collision characteristics and cellular phone involvement for each fatality was compared with the same information for each non-fatality (controls). Statistically adjusting for other collision variables (age, gender, alcohol use, speed, inattention and driving left of center), an approximate nine-fold increased risk was found for a fatality given the use of a cellular phone. An approximate two-fold increased risk for a fatality was found given the presence of a cellular phone in the vehicle. Combined effects of reported phone use, driving to the left of center and inattention increased the risk of a fatal collision more than phone use did by itself. This analysis implies a statistical, but not necessarily a causal, relationship. A multitude of factors are involved in any traffic collision, and the exact cause of an accident and its severity level is difficult to disentangle.

Accidents, Traffic↗

PubMed2002

Trends in case-fatality in 22968 patients admitted for the first time with atrial fibrillation in Scotland, 1986-1995.

BACKGROUND: Although atrial fibrillation (AF) is an important cause of cardiovascular morbidity and mortality there is a paucity of data describing hospitalisation rates and case-fatality associated with this common arrhythmia. This study examines recent trends in first-ever hospitalisations for AF in Scotland. METHODS: Using the linked Scottish Morbidity Record Scheme, we identified all 22968 patients admitted to Scottish hospitals for the first time with a principal diagnosis of AF between 1986 and 1995. For each calendar year we calculated short (30-day) and medium (31 day to 2 years) case-fatality rates. Adjusting for each patient's age, sex, deprivation status, concurrent diagnoses and prior hospitalisation status, we examined whether case-fatality rates had significantly improved during this 10-year period. RESULTS: Between 1986 and 1995 the number of men hospitalised for the first time with AF increased by 926 (125%) to 1730 per annum and the number of women and by 875 (105%) to 1712 (both P<0.001). Hospitalisation rates increased from 0.31 to 0.70/1000 men and from 0.32 to 0.65/1000 women (both P<0.001). By the end of this period the proportion of men had increased from 48 to 50%. In both sexes, the median age of patients rose--in men from 66 to 68 years and in women from 74 to 75 years (both P<0.01). Despite the increasing age of patients and greater comorbidity, short-term (30-day) case-fatality declined from 4.0 to 3.1% in men (P<0.001) and 4.1 to 3.8% (P<0.01) in women. Similarly, medium-term (31-day to 2-year) case-fatality fell from 25 to 22% in men and 27 to 25% (both P<0.001) in women. Adjusting for the age, sex, extent of deprivation, secondary diagnoses and prior hospitalisation of hospitalised patients, we found that the risk of short-term case-fatality in the 1995 male and female cohort significantly declined by 21% (P<0.05) and 24% (P<0.05), respectively, in comparison to the 1986 cohort. The adjusted risk of case-fatality in the medium term also declined significantly in men by 30% (P<0.05) over this period and by 20% (P<0.05) in women relative to 1986. CONCLUSION: The number of first-ever hospitalisations for AF has increased twofold during the 10-year period 1986-1995. Although the age of patients has progressively increased during this period, short and medium case-fatality rates have declined, especially in men. This may partly reflect better treatment of AF. However, changing admission thresholds and other factors could also have led to an apparent improvement in prognosis. Nevertheless, medium-term case fatality remains substantial after a first ever admission to hospital with AF.

Aged↗