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PubMed2001

Trends in incidence, case-fatality and recurrence of myocardial infarction in the Danish MONICA population 1982-1991.

BACKGROUND: Growing awareness of risk factors for myocardial infarction (MI), continuous mass campaigns on lifestyle factors, increasing use of heart rehabilitation and improved treatment should imply decreases in the incidence, case-fatality and recurrence rates of MI. The purpose of the study was to assess trends in the incidence, case-fatality and recurrence rate of MI and to analyse whether any changes seen were due to a period or a cohort effect. METHODS: The Danish MONICA population comprises all men and women aged 25-74 years in the period 1982-1991 living in a suburban area of Copenhagen, Denmark. Fatal and non-fatal attacks classified as definite MI and non-fatal attacks classified as possible MI were included. The incidence rate was analysed by Poisson regression, the case-fatality rate by logistic regression, and the rate of recurrence by Cox regression. Age-period-cohort analyses were carried out according to a method described by Clayton and Schifflers. RESULTS: During the 10-year period a significant decrease in the incidence rate of MI was seen for men and women and for the rate of recurrent MI. The decrease in incidence and recurrence could not unambiguously be ascribed to a period or cohort effect. The rate of case-fatality after a first MI was not changed significantly during the period, whereas men and women had different trends in case-fatality after recurrent MI. CONCLUSIONS: In accordance with results from other Western countries we found a decline in the incidence and recurrence rate of MI. Contrary, the lack of a decrease in the case-fatality rate after a first MI was unexpected and difficult to explain.

Adult↗

PubMed2006

Fatality of acute coronary events in relation to hypertension and low-grade inflammation: a population-based cohort study.

Hypertension has been associated with increased case-fatality rates among individuals who subsequently suffer from acute coronary events. It is unknown whether inflammation modifies this relationship. This population-based study explored the effects of inflammation and hypertension on incidence of coronary event, and on the fatality of the future events. Blood pressure (BP) and five inflammation-sensitive plasma proteins (ISPs, fibrinogen, orosomucoid, alpha 1-antitrypsin, haptoglobin and ceruloplasmin) were determined in 6071 healthy men. During the mean follow-up of 19 years, 679 men had a first coronary event (non-fatal myocardial infarction or death from coronary heart disease). Of them, 197 (29%) were fatal cases (death during the first day). As expected, hypertension was associated with increased incidence of coronary events and increased proportion of fatal cases. At all levels of BP, high ISPs (> or =2 ISPs in top quartile) significantly added to the incidence of events. Men with high ISPs had the highest case-fatality rates. The difference in case-fatality rate between men with and without high ISPs was, however, significant only in men with normal BP (<130/85 mm Hg) (33 vs 19%, P < 0.05), and not in men with moderate or severe hypertension (> or =160/100 mm Hg) (40 vs 35%, P = 0.32). High ISPs add to the incidence of coronary events at all levels of BP. Hypertension and inflammation are both independently associated with increased case-fatality in subjects who later have an acute coronary event. The influence of ISPs on the case-fatality rate seems to be most important in men with normal BP.

Adult↗

PubMed1996

Exploring the declining case fatality in acute stroke. Population-based observations in the northern Sweden MONICA Project.

OBJECTIVES: Declining case fatality in acute stroke has been reported from many western countries. The aim of this study was to explore in what subset of patients the decline in case fatality has occurred. SETTING: In a population-based study, acute stroke events were recorded in the age group 25-74 years in northern Sweden during the years 1985-1993 within the framework of the WHO MONICA Project. SUBJECTS: In total 3486 men and 2212 women with a first-ever stroke (except subarachnoid haemorrhage) were included. MAIN OUTCOME: Change in stroke incidence, case fatality and neurological deficits at onset over a 9-year period. RESULTS: The incidence (first-ever stroke) did not change over the years, while the overall case fatality decreased from 18.2% in 1985-1987 to 13.5% in 1991-1993. In both men and women with non-haemorrhagic stroke, a trend was seen towards an increasing incidence of mild stroke events over the years. In both sexes, a significant decline in case fatality was seen in patients with minor deficits at onset, while no change in case fatality was seen in patients with extensive deficits. There was no change in incidence of intracerebral haemorrhage, but the case fatality in patients with intracerebral haemorrhage declined significantly from 36% to 29% during the study period. CONCLUSIONS: A declining case fatality was observed in both men and women. Among patients with non-haemorrhagic stroke, the decline was confined to patients with minor deficits. The declining case fatality can be attributed both to a shift in the severity towards more patients presenting with mild symptoms, and an improved prognosis in patients with minor deficits at onset, probably because of improved medical management.

Adult↗

PubMed1995

Fatal injuries after cocaine use as a leading cause of death among young adults in New York City.

BACKGROUND: Cocaine intoxication can lead to fatal cardiovascular and cerebrovascular events. In addition, the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries. Since New York City is a center for the importation and distribution of cocaine, we sought to determine the extent of cocaine use among city residents with fatal injuries. METHODS: Among a total of 14,843 residents of New York City who received fatal injuries from 1990 through 1992, we determined the proportion who used cocaine shortly before their deaths. We also determined the population-based rates of fatal injuries that were known to follow cocaine use and the proportion of all deaths of New York City residents that was represented by these cases for each demographic stratum. For adults 15 to 44 years of age, fatal injury after cocaine use was ranked with other causes of death as though it was a separate cause. RESULTS: Cocaine use, as measured by the detection of the metabolite benzoylecgonine in urine or blood, was found in 26.7 percent of all New York City residents receiving fatal injuries; free cocaine was detected in 18.3 percent. Approximately one third of deaths after cocaine use were the result of drug intoxication, but two thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If fatal injury after cocaine use was considered as a separate cause of death, it would rank among the five leading causes of death among those 15 to 44 years of age in New York City. CONCLUSIONS: Fatal injuries among cocaine users account for a substantial proportion of all deaths among young adults in New York City.

Adolescent↗

PubMedDate not supplied

Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis.

BACKGROUND: Ambulance crashes have become an increasing source of public concern. Emergency medical services directors have little data to develop ambulance operation and risk management policies. OBJECTIVE: To describe fatal ambulance crash characteristics, identifying those that differentiate emergency and nonemergency use crashes. METHODS: This was a retrospective analysis of all fatal ambulance crashes on U.S. public roadways reported to the Fatality Analysis Reporting System (FARS) database from 1987 to 1997. Main outcome measures were 42 variables describing crash demographics, crash configuration, vehicle description, crash severity, and ambulance operator and vehicle occupant attributes. RESULTS: Three hundred thirty-nine ambulance crashes caused 405 fatalities and 838 injuries. These crashes occurred more often between noon and 6 PM (39%), on improved (99%), straight (86%), dry roads (69%) during clear weather (77%), while going straight (80%), through an intersection (53%), and striking (81%) another vehicle (80%) at an angle (56%). Most crashes (202/339) and fatalities (233/405) occurred during emergency use. These crashes occurred significantly more often at intersections (p < 0.001), at an angle (p < 0.001), with another vehicle (p < 0.001). Most crashes resulted in one fatality, not in the ambulance. Thirty pedestrians and one bicyclist comprised 9% of all fatalities. In the ambulance, most serious and fatal injuries occurred in the rear (OR 2.7 vs front) and to improperly restrained occupants (OR 2.5 vs restrained). Sixteen percent of ambulance operators were cited; 41% had poor driving records. CONCLUSIONS: Most crashes and fatalities occurred during emergency use and at intersections. The greater burden of injury fell upon persons not in the ambulance. Rear compartment occupants were more likely to be injured than those in the front. Crash and injury reduction programs should address improved intersection control, screening to identify high-risk drivers, appropriate restraint use, and design modifications to the rear compartment of the ambulance.

Accidents, Occupational↗

PubMed2003

Pedestrian casualties and fatalities in road traffic crashes in a South African municipality.

A study of the pedestrian casualties and fatalities in road traffic crashes in Durban, a South African municipality, for 1999 was undertaken using official road traffic accident data. The pedestrians age 25 to 44, although only 23.9% of the population, were 39.3% of the casualties and 48.2% of the fatalities. The most vulnerable pedestrians were those 30 to 34 years old who were 6.1% of the population, 11.7% of the casualties, and 14.6% of the fatalities; 35- to 39-year-olds who were 6% of the population, 8.8% of the casualties, and 13.5% of the fatalities; and the 40- to 44-year-olds who were 4.9% of the population, 7.5% of the casualties, and 10.2% of the fatalities. Cars were involved in 52% of the vehicle-pedestrian crashes but had fewer crashes than minibuses and buses, and fewer casualties and fatalities than minibuses, buses, and motorcycles. Minibuses recorded the most crashes at 1,037 per 100 million km, the highest casualty rate of 268 per 100 million km, and highest fatality rate of 17 per 100 million km. Buses, which were involved in 3% of the vehicle-pedestrian crashes, had 951 crashes per 100 million km, 182 casualties per 100 million km, and 11 fatalities per 100 million km. Motorcycles were involved in 1% of the vehicle-pedestrian crashes and had per 100 million km 508 crashes, 192 casualties, and 7 fatalities. There was no statistically significant difference in the monthly distribution of the road traffic crashes.

Accidents, Traffic↗

PubMed2004

Airway remodeling: a comparison between fatal and nonfatal asthma.

BACKGROUND: Airway remodeling has been recently one of the main goals in asthma research because it has been implicated to influence airway behavior and evolution of asthma; hence, important in long-term followup of asthmatic patients. METHODS: Airways of fatal asthma (n=3), non-fatal asthma (n=3) and control cases (n=4) were studied using morphometry and immunohistochemical and H&E staining. RESULTS: The basement membrane was thicker in the cartilaginous and membranous airways of fatal and non-fatal asthma groups compared to the control group (p<0.05). Smooth muscle shortening was greater in airways of fatal asthma cases while submucosal gland area and mucus plug occupying ratio were greater in fatal asthma large airways compared to the two other groups (p<0.01). Increased intact and degranulated mast cells were observed in smooth muscle and in submucosal gland of fatal asthma airways (p<0.01) and were associated with greater degree of smooth muscle shortening and larger submucosal gland area, respectively. Eosinophil and EG2+ cell infiltrations were greatest in lamina propria of airways of fatal asthma than in nonfatal and control cases (p<0.01), but were not associated with any airway structural change. CONCLUSION: Increased infiltration of eosinophils in the lamina propria and mast cells in smooth muscle and submucosal glands may have a role in airway remodeling of fatal asthma airways but needs further investigation. Moreover, mast cells in cartilaginous airways may participate in the regulation of smooth muscle tone and mucous gland secretion and hyperplasia.

Adult↗

PubMed2003

Cancer fatalism: the state of the science.

Cancer fatalism--the belief that death is inevitable when cancer is present--has been identified as a barrier to participation in cancer screening, detection, and treatment. Yet this literature has not been reviewed in a comprehensive and systematic manner. Therefore, this literature review addressed (1) philosophical and theoretical underpinnings of cancer fatalism; (2) relationships among demographic factors, cancer fatalism, and cancer screening; (3) the role of cancer fatalism for patients diagnosed with cancer; and (4) intervention strategies. Most of the reviewed studies were descriptive or correlational, did not have an explicit theoretical framework, had varied definitions of fatalism, and reported screening as "intent to screen" or as "past screening behaviors." Review of the studies suggests that cancer fatalism develops over time and is most frequently reported among medically underserved persons and those with limited knowledge of cancer. Cancer fatalism may be modified through culturally relevant interventions that incorporate spirituality. Emphasis must be placed on recognizing the role of cancer fatalism when planning health promotion activities. Future studies should focus on the consistent measurement of cancer fatalism and testing intervention strategies.

Breast Neoplasms↗

PubMed2006

Reduced lung function predicts increased fatality in future cardiac events. A population-based study.

OBJECTIVE: Moderately reduced lung function in apparently healthy subjects has been associated with incidence of coronary events. However, whether lung function is related to the fatality of the future events is unknown. This study explored whether reduced forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV(1)) in initially healthy men is related to the fatality of the future coronary events. DESIGN: Prospective cohort study. SETTING: Population-based study from Malmö, Sweden. SUBJECTS: A total of 5452 healthy men, 28-61 years of age. MAIN OUTCOME MEASURES: Incidence of first coronary events was monitored over a mean follow-up of 19 years. The fatality of the future events was studied in relation to FEV and FVC. RESULTS: A total of 589 men suffered a coronary event during follow-up, 165 of them were fatal during the first day. After risk factors adjustment, low FEV or FVC were associated with incidence of coronary events (fatal or nonfatal) and this relationship was most pronounced for the fatal events. Amongst men who subsequently had a coronary event, the case-fatality rates were higher in men with low FEV or FVC. Adjusted for risk factors, the odds ratio for death during the first day was 1.00 (reference), 1.63 (95% CI: 0.9-3.1), 1.86 (1.0-3.5) and 2.06 (1.1-3.9), respectively, for men with FVC in the 4th, 3rd, 2nd, and lowest quartiles (trend: P < 0.05). FEV showed similar relationships with the fatality rates. CONCLUSION: Apparently healthy men with moderately reduced lung function have higher fatality in future coronary events, with a higher proportion of coronary heart disease deaths and less nonfatal myocardial infarction.

Adult↗

PubMed1996

A comparative analysis of alcohol in fatal and nonfatal bicycling injuries.

Bicycling is the leading cause of recreational injury, resulting in more than half a million emergency department visits and about 900 deaths each year in the United States. Previous research on bicycling injury was conducted predominantly in children and focused on the effectiveness of safety helmets. Few studies have examined the role of alcohol in bicycling injuries. This study examined the magnitude of and factors related to alcohol involvement in fatal and nonfatal bicycling injuries, and tested the hypothesis that alcohol intoxication is associated with significantly increased likelihood of fatality given a serious bicycling injury. Medical examiner data on all fatally injured bicyclists aged 10 years or older from 1987 to 1994 in Maryland (fatal cases, n = 63) were compared with trauma registry data on all injured bicyclists who were treated at a regional trauma center during the same time period (nonfatal cases, n = 253) on variables related to blood alcohol concentrations (BACs), demographic characteristics, and injury circumstances. The fatal cases were more likely than the nonfatal cases to have positive BACs (30% vs. 16%, p < 0.01) and to be legally intoxicated (i.e., BACs > or = 0.10%) (22% vs. 13%, p < 0.01). For both fatal and nonfatal cases, intoxication was more prevalent among victims who were male, aged 20 to 39 years, or who were injured at nighttime (7:00 PM to 6:59 AM). Bicyclists who died at the scene were four times as likely as those who died at hospitals to be legally intoxicated (35% vs. 9%, p < 0.02). Given a serious bicycling injury, intoxication was associated with significantly increased likelihood of fatality, with an adjusted odds ratio of 2.8 (95% confidence interval, 1.3 to 6.3). This increased likelihood of fatality was probably due in part to the fact that the rate of helmet use at the time of injury among the intoxicated was much lower than among the sober (6% vs. 31%, p < 0.05). Results indicate that alcohol plays an important role in fatal and serious bicycling injuries. Preventing intoxicated biking should be incorporated into helmet campaigns and other bicycle safety programs.

Accidents, Traffic↗

PubMed1996

Sex differences in case fatality before and after admission to hospital after acute cardiac events: analysis of community based coronary heart disease register.

OBJECTIVE: To determine whether the reported higher case fatality in hospital after an acute cardiac event in women can be explained by sex differences in mortality before admission and in baseline risk factors. DESIGN: Analyses of data from a community based coronary heart disease register. SETTING: Auckland region, New Zealand. SUBJECTS: 5106 patients aged 25-64 years with an acute cardiac event leading to coronary death or definite myocardial infarction within 28 days of onset, occurring between 1986 and 1992. MAIN OUTCOME MEASURES: Case fatality before admission, 28 day case fatality for patients in hospital, and total case fatality after an acute cardiac event. RESULTS: Despite a more unfavourable risk profile women tended to have lower case fatality before admission than men (crude odds ratio 0.88; 95% confidence interval 0.77 to 1.02). Adjustment for age, living arrangements, smoking, medical history, and treatment increased the effect of sex (0.72; 0.60 to 0.86). After admission to hospital, women had a higher case fatality than men (1.76; 1.43 to 2.17), but after adjustment for confounders this was reduced to 1.18 (0.89 to 1.58). Total case fatality 28 days after an acute cardiac event showed no significant difference between men and women (0.85; 0.70 to 1.02) CONCLUSIONS: The higher case fatality after an acute cardiac event in women admitted to hospital is largely explained by differences in living status, history, and medical treatment and is balanced by a lower case fatality before admission.

Adult↗

PubMed2002

Older driver involvements in police reported crashes and fatal crashes: trends and projections.

OBJECTIVES: Older drivers have become a larger part of the driving population and will continue to do so as the baby boomers reach retirement age. The purpose of this study was to identify the potential effects of this population increase on highway safety. METHODS: Driver involvement rates for all police reported crashes were calculated per capita, per licensed driver, and per vehicle-mile of travel for 1990 and 1995. Also, driver involvement rates for fatal crashes were calculated for 1983, 1990, and 1995. Based on current crash rates per licensed driver and estimates of the future number of licensed drivers, projections of crashes involving drivers aged 65 and older were made for years 2010, 2020, and 2030. RESULTS: Driver crash involvement rates per capita decreased with age, but fatal involvement rates per capita increased starting at age 70. The same pattern existed for involvement rates per licensed driver. For both all crashes and fatal crashes, involvement rates per mile driven increased appreciably at age 70. Using projections of population growth, it was estimated that for all ages there will be a 34% increase in the number of drivers involved in police reported crashes and a 39% increase in the number involved in fatal crashes between 1999 and 2030. In contrast, among older drivers, police reported crash involvements are expected to increase by 178% and fatal involvements may increase by 155% by 2030. Drivers aged 65 and older will account for more than half of the total increase in fatal crashes and about 40% of the expected increase in all crash involvements; they are expected to account for as much as 25% of total driver fatalities in 2030, compared with 14% presently. CONCLUSIONS: By most measures, older drivers are at less risk of being involved in police reported crashes but at higher risk of being in fatal crashes. Although any projections of future crash counts have inherent uncertainty, there is strong evidence that older drivers will make up a substantially larger proportion of drivers involved in fatal crashes by 2030 because of future increases in the proportion of the population aged 65 and older, and trends toward increased licensure rates and higher annual mileage among older persons. Countermeasures to reduce the anticipated death toll among older drivers should address the increased susceptibility to injury of older vehicle occupants in crashes.

Accidents, Traffic↗

PubMed1990

Low incidence of fatal coronary heart disease in Pima Indians despite high prevalence of non-insulin-dependent diabetes.

The incidence of fatal coronary heart disease (CHD) was determined in a population of Pima Indians from the Gila River Indian Community in Arizona. Between 1975 and 1984, 394 deaths occurred among 4,828 subjects aged 5 years or older, and 199 of these occurred in the 1,093 persons with non-insulin-dependent diabetes. Only 28 deaths were attributed to CHD; all occurred among the 689 diabetic persons 45 years of age or older. No CHD deaths occurred among the 419 nondiabetic subjects 45 years of age or older. The rate of fatal CHD among the diabetic subjects was higher in men than in women and increased with advancing age and duration of diabetes. A higher incidence of fatal CHD was associated with proteinuria, renal insufficiency, medial arterial calcification, diabetic retinopathy, insulin therapy, and an abnormal electrocardiogram. In Pima Indians aged 50-79 years, the incidence of fatal CHD was less than half that found in the Framingham population after controlling for age, sex, and diabetes (incidence rate ratio, 0.4; 95% confidence interval, 0.2-0.7). Factors protecting Pima Indians from fatal CHD may include racial heritage, low serum concentrations of total and low density lipoprotein cholesterol, and rarity of heavy smoking. Among the diabetic subjects, mortality from diabetic renal disease, which shows many of the same risk factors, may selectively compete and remove those at risk for fatal CHD. This would not, however, explain the lack of fatal CHD among the nondiabetic subjects. Fatal CHD shares many of the risk factors associated with the specific microvascular complications of diabetes, and diabetes and its associated attributes are the major predictors of fatal CHD in this population.

Aged↗

PubMed2000

The effect of age and duration of disease on airway structure in fatal asthma.

We hypothesized that if airway remodeling is related to duration of asthma, that when matched for severity, the airways of older adults should show greater alterations than the airways of younger adults. Using standard morphometric techniques, we compared airways with basement membrane perimeters (Pbm) between 2 and 10 mm from young individuals who died of asthma (n = 14, range 17-23 yr), and older individuals with fatal asthma (n = 13, range 40-49 yr). Comparisons were also made with normal airways from age-matched adults. Wall area was increased in old individuals with fatal asthma compared with young individuals with fatal asthma, primarily due to greater adventitial area, whereas wall area in young individuals with fatal asthma was not different from control subjects. Within muscle bundles the connective tissue matrix was increased around individual cells in individuals with asthma, unrelated to age. After adjustment for this change, smooth muscle area in both asthma groups was still greater than in age-matched control subjects, in old individuals with fatal asthma 4-fold greater (p = 0.04), and in young individuals with fatal asthma 2-fold greater (p = 0.03). Airway narrowing was increased in old versus young individuals with fatal asthma, with both groups more narrowed than control subjects. Intralumenal obstruction and subepithelial collagen in the two asthma groups were significantly greater than in control subjects, but there was no age effect. These data provide support for the hypothesis that there is an increase in airway wall area, including smooth muscle, and airway narrowing with increasing duration of severe asthma or with older age. The observation that total wall thickness was not greater in young individuals with young fatal asthma than in control subjects suggests that factors other than airway wall geometry contribute to the pathogenesis of fatal attacks in this age group.

Adolescent↗

PubMed1996

Airway structure and inflammatory cells in fatal attacks of asthma.

Fatal attacks of asthma usually occur against a background of chronic persistent symptoms, presumably due to chronic airway inflammation and changes in airway wall structure. Death from asthma is usually attributed to excessive airway narrowing due to a combination of muscle spasm and mucous plugging. To test the hypothesis that airway wall structure and/or the inflammatory cell profile are related to the duration of a fatal attack of asthma, inflammatory cell profiles and airway structure were examined in cases of fatal asthma and related to the duration of the fatal attack. In transverse sections of large and small airways from subjects dying from asthma, the numbers of eosinophils, neutrophils and lymphomononuclear cells were counted. The amount of smooth muscle shortening, the areas of airway wall, smooth muscle, mucous gland and cartilage were measured. Cell counts, airway dimensions and muscle shortening were compared in cases dying within 2 h of the fatal attack (short duration) and those dying more than 5 h after the onset of the fatal attack (long duration). In cases with fatal attacks of short duration, the numbers of neutrophils and the mucous gland area were increased and the numbers of eosinophils were reduced compared to cases with fatal attacks of long duration. Lymphocyte numbers, airway wall thickness, the areas of smooth muscle and cartilage and the amount of smooth muscle shortening were similar in the two groups. These findings suggest fatal attacks of asthma may be triggered by an inflammatory stimulus and suggest that increased production of mucous may contribute to sudden death in such cases.

Adolescent↗

PubMed1994

Geographic distribution of hospitalization rates, case fatality, and mortality from stroke in the United States.

We analyzed state-specific stroke-hospitalization, case-fatality, and mortality rates for the US Medicare population for 1989, using national data resources of the Health Care Financing Administration (HCFA), the National Center for Health Statistics, and the Bureau of the Census. State-specific hospital admission rates for stroke ranged from 0.66 to 1.26%, compared with the national value of 0.94%. Both hospital-usage rates and deviations of observed rates from predicted values (based on statistical models of the HCFA) showed significant spatial autocorrelation, with high rates clustered in the southeastern United States and low rates clustered in the Mountain census division of the West and also somewhat in the Northeast. Case-fatality rates increased nationally from 14.9% at 15 days after hospital admission to 31.2% at 180 days after hospital admission. State-level case-fatality rates showed relatively little interstate variation and no clear or consistent spatial pattern, although there was statistically significant spatial autocorrelation at several intervals after hospital admission. Admission rates and case-fatality rates were not significantly associated at any interval after admission to 180 days, suggesting that variation in case-fatality rates was not simply a result of differences in severity-of-illness thresholds for hospital admission. State-specific stroke-mortality rates ranged from 294.5 to 523.5 per 100,000 population, compared with the national value of 415.3 per 100,000 population. State-specific mortality rates for stroke showed significant spatial autocorrelation, with high rates clustered in the South and low rates clustered in the Northeast and the Mountain census division of the West. The spatial distribution of stroke-mortality rates strongly resembled the spatial distribution of hospitalization rates but did not resemble the spatial distribution of case-fatality rates at any interval from 15 to 180 days after hospital admission. Indeed, in univariate spatial-regression models fitted to the data using a maximum likelihood procedure and weighted for non-constant variances, the best predictor of state-level stroke-mortality rates was the hospital-utilization rate for stroke; attempts to improve the model by including case fatality at various intervals and interaction terms did not yield a significant improvement. These data suggest that factors determining stroke occurrence and hospital utilization are more important than factors determining case fatality in terms of explaining the long-standing distribution of stroke mortality in the United States. Factors affecting only case fatality but not hospitalization, such as the quality of medical care provided in the hospital, cannot explain the geographic distribution of stroke mortality in the United States.

Aged↗

PubMed1993

Alcohol's effect on fatality risk from a physical insult.

Although alcohol's effect on the risk of being involved in a traffic crash is well known, its influence on the risk of death, given that a crash has occurred, is more uncertain. One study published a few years ago finds that alcohol increases such risk. The present study examines alcohol's effect on fatality risk in a crash using data and methods independent of the previous study, and provides estimates as a function of blood alcohol concentration (BAC). Data for drivers with measured BAC who were fatally injured in a two-car crash were selected from the Fatal Accident Reporting System (FARS). The study uses two sets of fatal crashes. For one, the probability that a BAC = 0 driver was killed is low, so that if alcohol increased fatality risk, this would generate additional fatalities at higher BAC levels. For the other set of crashes, fatality risk was sufficiently close to 100% that other factors had little opportunity to influence it. Dividing the fatalities that can be affected by alcohol by those that cannot measures alcohol's influence on fatality risk, and gives that a driver with BAC = 0.1% is 1.9 +/- 0.2 times as likely as is a BAC = 0 driver to be killed in the same crash. The corresponding ratio for a BAC = 0.25% driver is 3.3 +/- 0.5. While derived using the "laboratory" of traffic, there does not appear to be any obvious reason why the results should not apply to physical trauma in general, so a BAC of 0.1% doubles the risk of death from a given impact, and a BAC of 0.25% triples the risk.

Accidents, Traffic↗

PubMed1993

Automobile driver fatalities in frontal impacts: air bags compared with manual belts.

OBJECTIVES: The effectiveness of air bags was estimated in this study by comparing driver fatalities in frontal crashes with driver fatalities in nonfrontal crashes, for cars with air bags and manual belts and cars with manual belts only. METHODS: Fatal Accident Reporting System data for drivers fatally injured during 1985 to 1991 in 1985 to 1991 model year cars that were equipped with air bags in or before model year 1991 were analyzed. RESULTS: Driver fatalities in frontal crashes in air bag cars were 28% lower than those in comparable cars with manual belts only. This percentage was used for estimating the overall fatality reduction in air bag cars. The reduction was greater in large cars (50%) than in midsize cars (19%) or in small cars (14%). Air bags reduced driver fatalities in frontal crashes involving ejection by about 9%. Fatalities in frontal crashes among drivers who were reportedly using manual belts at the time of the crash were reduced by about 15%. The comparable reduction among drivers who were reportedly not using manual belts was 31%. CONCLUSION: It was estimated that air bags reduced the total number of all driver fatalities by about 19%.

Accidents, Traffic↗