Transport accident mortality in Chile: trends from 2000 to 2012

Abstract The aim of this study is to describe the trends of transport accident mortality in Chile from 2000 to 2012 by year, geographic distribution, gender, age group, and type of accident. Population-based study. Data for transport accident mortality in Chile between 2000 and 2012 were used. The crude and adjusted per region transport accident mortality rates were calculated per 100,000 inhabitants. The annual percentage change (APC) of the rates and relative risks (RR) were calculated. The average transport accident mortality rate (TAMR) in Chile (2000-2012) was 12.2. The rates were greater in men (19.7) than in women (4.8), with a RR of 4.1. The rates were higher in the country's southern zone (15.9), increasing in recent years in the southern zone, with a significant positive APC in the northern and central zones. The Maule region had the highest rate (21.1), although Coquimbo was the region with the most significant APC (2.2%). The highest rate (20.3) was verified in the 25-40 age group. The highest rate (14.3) was recorded in 2008. The most frequent type of accident was pedestrian. In general the APC trends of the rates are increasing significantly. This, added to rapid annual automotive growth, will only exacerbate mortality due to transport accidents.

Late Maternal Deaths and Deaths from Sequelae of Obstetric Causes in the Americas from 1999 to 2013: A Trend Analysis

BACKGROUND

Data on maternal deaths occurring after the 42 days postpartum reference time is scarce; the objective of this analysis is to explore the trend and magnitude of late maternal deaths and deaths from sequelae of obstetric causes in the Americas between 1999 and 2013, and to recommend including these deaths in the monitoring of the Sustainable Development Goals (SDGs).

METHODS

Exploratory data analysis enabled analyzing the magnitude and trend of late maternal deaths and deaths from sequelae of obstetric causes for seven countries of the Americas: Argentina, Brazil, Canada, Colombia, Cuba, Mexico and the United States. A Poisson regression model was developed to compare trends of late maternal deaths and deaths from sequelae of obstetric causes between two periods of time: 1999 to 2005 and 2006 to 2013; and to estimate the relative increase of these deaths in the two periods of time.

FINDINGS

The proportion of late maternal deaths and deaths from sequelae of obstetric causes ranged between 2.40% (CI 0.85% - 5.48%) and 18.68% (CI 17.06% - 20.47%) in the seven countries. The ratio of late maternal deaths and deaths from sequelae of obstetric causes per 100,000 live births has increased by two times in the region of the Americas in the period 2006-2013 compared to the period 1999-2005. The regional relative increase of late maternal death was 2.46 (p<0.0001) times higher in the second period compared to the first.

INTERPRETATION

Ascertainment of late maternal deaths and deaths from sequelae of obstetric causes has improved in the Americas since the early 2000's due to improvements in the quality of information and the obstetric transition. Late and obstetric sequelae maternal deaths should be included in the monitoring of the SDGs as well as in the revision of the International Classification of Diseases' 11th version (ICD-11).

Homicide in Chile: Trends 2000-2012

BACKGROUND

Homicide, an external cause of morbidity and mortality, caused 473,000 deaths worldwide in 2012, a rate of 6.2 per 100,000 inhabitants. The aim of this study was to describe homicide mortality trends in Chile between 2000 and 2012 by year, gender, age group, geographic distribution (by zone and by region) and type of homicide.

METHODS

This was a population-based study. Data for homicide mortality in Chile between 2000 and 2012 were used and they were provided by the Chilean Ministry of Health's Department of Statistics and Health Information (DEIS) and PAHO/WHO. The homicide mortality rates were calculated per 100,000 inhabitants. The study variables were year, geographic distribution, gender, age group and type of homicide. The annual percentage change (APC) of the rates was analyzed, and a logarithm of the rates by year and region was fitted by applying linear regression models. In addition, relative risks (RR) were calculated. 95% confidence intervals were considered in all the analyses.

RESULTS

The average yearly rate of homicide (HMR) in Chile (2000-2012) was 4.9. The rates were higher in men (8.7) than in women (1.1), with a RR of 8.2. The rates were higher in the country's central zone (5.0), increasing in recent years in the southern zone, with a significant positive APC of 1.1%. The Aisén Region had the highest rate (7.6), although Antofagasta was the region with the most significant APC (3.1%). The highest rate (9.2) was verified in the 25 to 39 age group. The highest rate (5.5) was recorded in 2005. The most frequent type of homicide was assault with an object (44.8%).

CONCLUSIONS

Although the homicide rates are higher in the southern zone of the country, the northern zone is showing a tendency to increase, becoming an even more serious problem, which not only affects those directly involved, but society as a whole.

Suicide among young people in the Americas

PURPOSE

To examine suicide mortality trends among young people (10-24 years of age(1)) in selected countries and territories of the Americas.

METHODS

An ecological study was conducted using a time series of suicide mortality data from 19 countries and one territory in the Region of the Americas from 2001 to 2008, comprising 90.3% of the regional population. The analyses included age-adjusted suicide mortality rates, average annual variation in suicide mortality rates, and relative risks for suicide, by age and sex.

RESULTS

The mean suicide rate for the selected study period and countries/territory was 5.7/100,000 young people (10-24 years), with suicide rates higher among males (7.7/100,000) than females (2.4/100,000). Countries with the highest total suicide mortality rates among young people (10-24 years) were Guyana, Suriname, Nicaragua, El Salvador, Chile, and Ecuador; countries with the lowest total suicide mortality rates included Mexico, Venezuela, Cuba, and Brazil, and the U.S. territory of Puerto Rico. During this period, there was a significant increase in suicide mortality rates among young people in the following countries: Argentina, Chile, Ecuador, Mexico, and Suriname; countries with significant decreases in suicide mortality rates included Canada, Colombia, Cuba, El Salvador, and Venezuela. The three leading suicide methods in the Americas were hanging, firearms, and poisoning.

CONCLUSIONS

Some countries of the Americas have experienced a rise in adolescent and youth suicide during the study period, with males at a higher risk of committing suicide than females. Adolescent and youth suicide policies and programs are recommended, to curb this problem. Methodological limitations are discussed.

Air contaminant statistical distributions with application to PM10 in Santiago, Chile

The use of statistical distributions to predict air quality is valuable for determining the impact of air chemical contaminants on human health. Concentrations of air pollutants are treated as random variables that can be modeled by a statistical distribution that is positively skewed and starts from zero. The type of distribution selected for analyzing air pollution data and its associated parameters depend on factors such as emission source and local meteorology and topography. International environmental guideline use appropriate distributions to compute exceedance probabilities and percentiles for setting administrative targets and issuing environmental alerts. The distribution bears a relationship to the normal distribution, and there are theoretical - and physical-based mechanistic arguments that support its use when analyzing air-pollutant data. Others distribution have also been used to model air population data, such as the beta, exponential, gamma, Johnson, log-logistic, Pearson, and Weibull distribution. One model also developed from physical-mechanistic considerations that has received considerable interest in recent year is the Birnbaum-Saunders distribution. This distribution has theoretical arguments and properties similar to those of the log-normal distribution, which renders it useful for modeling air contamination data. In this review, we have addressed the range of common atmospheric contaminants and the health effects they cause. We have also reviewed the statistical distributions that have been use to model air quality, after which we have detailed the problem of air contamination in Santiago, Chile. We have illustrated a methodology that is based on the Birnbaum-Saunders distributions to analyze air contamination data from Santiago, Chile. Finally, in the conclusions, we have provided a list of synoptic statements designed to help readers understand the significance of air pollution in Chile, and in Santiago, in particular, but that can be useful to other cites and countries.

Homicídios na região das Américas: magnitude, distribuição e tendências, 1999-2009

O objetivo do estudo foi descrever a magnitude e a distribuição da mortalidade por homicídios nas Américas e analisar suas tendências. Foram analisados óbitos por homicídios (X85 a Y09 e Y35) de 32 países das Américas, período 1999-2009, registrados no Sistema de Informações de Mortalidade/Organização Pan Americana da Saúde. Utilizou-se modelo binomial negativo para estudar as tendências. Cerca de 121.297 mortes por homicídios (89% homens e 11% mulheres) ocorreram anualmente nas Américas, predominando as idades de 15 a 24 e de 25 a 39 anos. Em 2009, a taxa padronizada de homicídios da região foi 15,5/100.000. Os países com taxas/100.000 baixas foram Canadá (1,8), Argentina (4,4), Cuba (4,8), Chile (5,2) e Estados Unidos (5,8); e com taxas/100.000 altas foram El Salvador (62,9), Guatemala (51,2), Colômbia (42,5), Venezuela (33,2) e Porto Rico (25,8). Entre 1999-2009 as taxas da região permaneceram estáveis; aumentaram em nove países, como Venezuela (p < 0,001), Panamá (p < 0,001), El Salvador (p < 0,001) e Porto Rico (p < 0,001); diminuíram em quatro países, especialmente na Colômbia (p < 0,001); e permaneceram estáveis no Brasil, Estados Unidos, Equador e Chile. O aumento no México ocorreu no período mais recente. Apesar dos esforços empreendidos, diversos países têm taxas altas de homicídios e crescimento nas mesmas.

Cardiovascular disease mortality in the Americas: current trends and disparities

OBJECTIVE

To describe the current situation and trends in mortality due to cardiovascular disease (CVD) in the Americas and explore their association with economic indicators.

DESIGN AND SETTING

This time series study analysed mortality data from 21 countries in the region of the Americas from 2000 to the latest available year.

MAIN OUTCOMES MEASURES

Age-adjusted death rates, annual variation in death rates. Regression analysis was used to estimate the annual variation and the association between age-adjusted rates and country income.

RESULTS

Currently, CVD comprised 33.7% of all deaths in the Americas. Rates were higher in Guyana (292/100 000), Trinidad and Tobago (289/100 000) and Venezuela (246/100 000), and lower in Canada (108/100 000), Puerto Rico (121/100 000) and Chile (125/100 000). Male rates were higher than female rates in all countries. The trend analysis showed that CVD death rates in the Americas declined -19% overall (-20% among women and -18% among men). Most countries had a significant annual decline, except Guatemala, Guyana, Suriname, Paraguay and Panama. The largest annual declines were observed in Canada (-4.8%), the USA (-3.9%) and Puerto Rico (-3.6%). Minor declines were in Mexico (-0.8%) and Cuba (-1.1%). Compared with high-income countries the difference between the median of death rates in lower middle-income countries was 56.7% higher and between upper middle-income countries was 20.6% higher.

CONCLUSIONS

CVD death rates have been decreasing in most countries in the Americas. Considerable disparities still remain in the current rates and trends.

Intrabiliary rupture of hepatic echinococcosis, a risk factor for developing postoperative morbidity: a cohort study

BACKGROUND

The aim of this study was to determine if intrabiliary rupture (IBR), an evolutive complication of hepatic echinococcosis (HE), is a risk factor for developing postoperative morbidity (POM).

METHODS

This was a concurrent cohort study that included patients operated on for HE between 1996 and 2006 and who had clinical check-ups at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Principal outcome variable was "development POM," considered dichotomously. The exposure variable was the presence of IBR, analyzed dichotomously (present or absent) and according to the number of IBR (without, with one, and with two or more). The sample size was considered on the basis of a 95% confidence interval (95% CI), a power of 80%, a 1:2 ratio of patients without and with IBR, and a 10% proportion of POM in patients without IBR and 26% in patients with IBR. Descriptive statistics and bivariate and multivariate analyses were used. Relative risks (RR) and 95% CI were calculated.

RESULTS

The cohorts (median age of 42 years, 56.4% female, a median cyst diameter of 15 cm, and a follow-up of 118 months) were composed of 96 patients without IBR (38.1%) and 156 patients with IBR (61.9%). A morbidity rate of 17.1% was verified (9.4% in the group without IBR and 21.8% in the group with IBR [p = 0.011]). An adjusted RR of 3.4 (95% CI = 2.64, 4.18) was verified for the comparison of subgroups without IBR vs. with two or more IBR (p < 0.001).

CONCLUSION

The presence of two or more IBR constitutes a risk factor for developing POM in patients with HE.