Analysis of the Incidence of Macrosomia in Japan by Parental Nationalities at 5-year Intervals From 1995 to 2020

OBJECTIVES

We investigated trends in the incidence rate of macrosomia and its association with parental nationalities using Vital Statistics data in Japan.

METHODS

We used singleton birth data every 5 years from 1995 to 2020. The incidence rate of macrosomia was calculated according to specific attributes (maternal age, infant's sex, parental nationalities, parity, and household occupation) over time (years). In addition, a log-binomial model was used to investigate the relationship between the incidence of macrosomia and the attributes. This study compared Korea, China, the Philippines, Brazil, and other countries with Japan in terms of parental nationalities. "Other countries" indicates countries except for Japan, Korea, China, the Philippines, and Brazil.

RESULTS

The study included 6 180 787 births. The rate of macrosomia in Japan decreased from 1.43% in 1995 to 0.88% in 2020, and the decrease was observed across all parental nationalities. The rates for Japanese parents were the lowest values among parental nationalities during the timespan investigated. Multivariate regression analysis showed that mothers from Korea, China, the Philippines, Brazil, and other countries had a significantly higher risk of macrosomia than those from Japan (risk ratio, 1.91, 2.82, 1.59, 1.74, and 1.64, respectively). Furthermore, fathers from China, the Philippines, Brazil, and other countries had a significantly higher risk of macrosomia than those from Japan (risk ratio, 1.66, 1.38, 1.88, and 3.02, respectively).

CONCLUSIONS

The rate of macrosomia decreased from 1995 to 2020 in Japan for parents of all nationalities, and the risk of macrosomia incidence was associated with parental nationality.

Discrepancies Between Preliminary and Final COVID-19 Mortality Data - the Case of Serbia

Since the start of the COVID-19 pandemic, countries have scrambled to set up data collection and dissemination pipelines. These data end up in various online datasets. While it has been evident from the beginning that these preliminary data produced by some countries are not very reliable, the mortality data from Serbia seemed particularly problematic. These data are included in all major COVID-19 databases and utilized for research purposes worldwide. Discrepancies were identified between the preliminary mortality data reported through the emergency necessitated system and the final mortality data generated by the regular vital statistics pipeline. The number of deaths due to COVID-19 in Serbia, as reported preliminarily, does not align with the final death toll, which is more than three times higher. To evaluate the impact of the problematic data on research, we identified databases that include these data and reviewed the articles that utilized them. Our literature review identified at least 86 studies that were impacted by these problematic data. We strongly advise researchers to disregard the preliminary COVID-19 mortality data from Serbia. If all-cause mortality data is available, any preliminary data should be validated using excess mortality.

Estimation of national and subnational all-cause mortality indicators in Nepal, 2017

BACKGROUND

Despite the civil registration and vital statistics (CRVS) system in Nepal operating for several decades, it has not been used to produce routine mortality statistics. Instead, mortality statistics rely on irregular surveys and censuses that primarily focus on child mortality. To fill this knowledge gap, this study estimates levels and subnational differentials in mortality across all ages in Nepal, primarily using CRVS data adjusted for incompleteness.

METHODS

We analyzed death registration data (offline or paper-based) and CRVS survey reported death data, estimating the true crude death rate (CDR) and number of deaths by sex and year for each province and ecological belt. The estimated true number of deaths for 2017 was used with an extension of the empirical completeness method to estimate the adult mortality (45q15) and life expectancy at birth by sex and subnational level. Plausibility of subnational mortality estimates was assessed against poverty head count rates.

RESULTS

Adult mortality in Nepal for 2017 is estimated to be 159 per 1000 for males and 116 for females, while life expectancy was estimated as 69.7 years for males and 73.9 years for females. Subnationally, male adult mortality ranges from 129 per 1000 in Madhesh to 224 in Karnali and female adult mortality from 89 per 1000 in Province 1 to 159 in Sudurpashchim. Similarly, male life expectancy is between 64.9 years in Karnali and 71.8 years in Madhesh and female male life expectancy between 69.6 years in Sudurpashchim and 77.0 years in Province 1. Mountain ecological belt and Sudurpashchim and Karnali provinces have high mortality and high poverty levels, whereas Terai and Hill ecological belts and Province 1, Madhesh, and Bagmati and Gandaki provinces have low mortality and poverty levels.

CONCLUSIONS

This is the first use of CRVS system data in Nepal to estimate national and subnational mortality levels and differentials. The national results are plausible when compared with Global Burden of Disease and United Nations World Population Prospects estimates. Understanding of the reasons for inequalities in mortality in Nepal should focus on improving cause of death data and further strengthening CRVS data.

Linkage of the nationally representative Canadian Community Health Survey - Nutrition 2004 to routinely collected mortality records

The Canadian Community Health Survey (CCHS) - Nutrition 2004 (n=35,107; interview dates from January 2004 to January 2005) linked to the Canadian Vital Statistics - Death Database (CVSD) (2011) represents a novel linkage of a population-based, nationally representative nutrition survey with routinely collected mortality records (including date and cause of death). The linkage was done through individual tax data in Canada, and contains longitudinal records for 29,897 Canadians aged 0 years and older-1,753 of whom died-in the 10 provinces of Canada. The median follow-up time was 7.49 years, with 102,953 person-years among males and 114,876 person-years among females (unweighted), and included a special sampling survey weight (for linked data) to account for those who did not agree to share and link their information. The CCHS - Nutrition 2004 linked to CVSD has been used to evaluate associations between lifestyle and sociodemographic characteristics and mortality. Using these data, statistical methods have been developed and tested to control random and systematic measurement errors when evaluating the relationship between different dietary exposures (evaluated using repeated 24-hour dietary recalls) and health outcomes. The linked data are available through Statistics Canada's Research Data Centres.

Analysis of the regional distribution of road traffic mortality and associated factors in Japan

BACKGROUND

Regional differences in road traffic (RT) mortality among municipalities have not been revealed in Japan. Further, the association between RT mortality and regional socioeconomic characteristics has not been investigated. We analyzed geographic differences in RT mortality and its associated factors using the Vital Statistics in Japan.

METHODS

We used data on RT mortality by sex and municipality in Japan from 2013 to 2017. We calculated the standardized mortality ratio (SMR) of RT for each municipality by sex using an Empirical Bayes method. The SMRs were mapped onto a map of Japan to show the geographic differences. In addition, an ecological study investigated the municipal characteristics associated with the SMR using demographic socioeconomic, medical, weather, and vehicular characteristics as explanatory variables. The ecological study used a spatial statistical model.

RESULTS

The mapping revealed that the number of municipalities with a high SMR of RT (SMR > 2) was larger in men than in women. In addition, SMRs of capital areas (Kanagawa and Tokyo prefectures) tended to be low in men and women. The regression analysis revealed that population density was negatively associated with the SMR in men and women, and the degree of the association was the largest among explanatory variables. In contrast, there was a positive association between the proportion of non-Japanese persons and SMR. The proportions of lower educational level (elementary school or junior high school graduates), agriculture, forestry, and fisheries workers, service workers, and blue-collar workers were positively associated with the SMR in men. The proportion of unemployed persons was negatively associated with the SMR in men.

CONCLUSIONS

Socioeconomic characteristics are associated with geographic differences in RT mortality particularly in men. The results suggested preventive measures targeted at men of low socioeconomic status and non-Japanese persons are needed to decrease RT mortality further.

Release of Civil Registry Causes of Death Data in Iran (2015 to 2019) - Expectations and Doubts!

BACKGROUND

The National Organization for Civil Registration (NOCR) of Iran has reported causes of death data by ICD-10 chapters for the first time in 2020.

METHODS

We used this report to review the share of ICD chapters among all deaths in each province and compare them with the Global Burden of Disease (GBD) study.

RESULTS

There are major changes in the distribution of causes of death between 2017 and 2018, especially in D50-D89 (Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism) from 0.76% to 38.94%, and I00-I99 (Diseases of the circulatory system) from 39.27% to 7.09%. Such dramatic changes are probably the results of changes in coding practices or definitions or issues in analysis.

CONCLUSION

Causes of death reports should be timely, clear, and robust on methods. They should contain a minimum level of details, at least 3-digit ICD codes to be useful for public health and medical professionals.

Excessive risk of second-cancer incidence and cancer mortality in patients with esophageal cancer

BACKGROUND

Second primary cancers have impact on survival in patients who achieved cure for the first esophageal cancer. We, therefore, assessed the risk of incidence and mortality for second primary cancer by calculating standardized incidence ratio (SIR) and standardized mortality ratio (SMR) in patients with superficial or localized esophageal cancer without lymph node metastases as the first cancer (index cancer).

METHODS

Data on cancer development and subsequent causes of deaths were collected from integrated database of the Osaka Cancer Registry and the Vital Statistics of Japan. Records with information on patients with index esophageal cancer diagnosed between 2004 and 2013 were extracted from the database. Then, SIR and SMR for second primary cancers that developed in other organ were calculated with the reference to the general population during the same period. All probability values are two-tailed.

RESULTS

Of 473,784 case records, 3022 cases of patients with index esophageal cancer were identified. Significantly higher SMRs/SIRs for cancers in mouth/pharynx, larynx, pancreas, and leukemia were confirmed with the values of 10.78/16.16, 8.56/6.44, 2.33/2.31, and 3.96/4.42, respectively. Significantly, higher SIRs for stomach, lung, and skin cancers were confirmed with the values of 2.84, 2.36, and 3.38, respectively, while SMRs were not significantly higher in these cancers.

CONCLUSIONS

Significantly higher risks for mouth/pharynx, larynx, pancreas, and leukemia as second cancers were clarified. Careful surveillance for these cancers is required for esophageal cancer patients.

[Updating of the official statistics of deaths causes: "Let's get stronger after the COVID-19 pandemic".]

The National Spanish Institute of Statistics (INE) website is the main means of communication for official statistics in Spain. The INE publishes the annual statistics of deaths according to the cause of death. This vital statistic has improved a lot in recent years; also, thanks to the collaboration from the Autonomous Communities. There are certain areas that could optimize its usefulness. Indicator improvements could include provisional case-counts by causes of death, besides the age-standardization of specified causes of death and the Potential Years of Life Lost by cause of death, for territorial comparison. Meanwhile, the usefulness of social indicators applied to the statistics of death causes could be enhanced, as is the case of education. By updating the databases, it would be possible to maintain the registries of deceased and their causes of death without an annual closure before the statistical publication. Moreover, we could link the databases of demographic records of the population to their health files, to obtain individually the people at risk of sickness or death, and to enable their respective vital, social, health trajectories for statistics. In this way, the INE would increase its leadership and reference on mortality statistics in Spain and EuroStat, as well. Furthermore, the State, Autonomous and municipal administrations could redefine their publication offer into a more specified or innovative statistics of death causes.

The importance of the rate of pure "attended deaths at home" for objective outcome indicator for assessing the prevalence of home care in Japan

BACKGROUND

No study has yet been performed on the importance of the rate of pure "attended deaths at home," excluding examined deaths subjected to a postmortem examination. Therefore, in the present study, we investigated actual state of pure "attended deaths at home," in order to provide reference data for the future development of end-of-life care at home.

METHODS

We performed a detailed survey in Yokohama City according to the type of death, age, and underlying cause of death in cases of home deaths, based on the detailed version of the Vital Statistics Survey Death Forms. Then, we divided deaths occurring in each municipality in Kanagawa Prefecture into two categories: "examined deaths" or "attended deaths," which were also stratified by the place of death, based on the Vital Statistics, and data on number of death cases subjected to postmortem examination from the Kanagawa Prefectural Police Headquarters.

RESULTS

In 2013, the survey in Yokohama City showed large differences in age distribution and cause of death between examined and attended deaths. In 2014, home deaths accounted for 15.7% of all deaths in the prefecture, whereas the overall proportion of attended deaths at home was 6.9%.

CONCLUSIONS

We should utilize the rate of pure "attended deaths at home" for objective outcome indicator.

Smoking and Variation in the Hispanic Paradox: A Comparison of Low Birthweight Across 33 US States

The Hispanic Paradox in birth outcomes is well documented for the US as a whole, but little work has considered geographic variation underlying the national pattern. This inquiry is important given the rapid growth of the Hispanic population and its geographic dispersion. Using birth records data from 2014 through 2016, we document state variation in birthweight differentials between US-born white women and the three Hispanic populations with the largest numbers of births: US-born Mexican women, foreign-born Mexican women, and foreign-born Central and South American women. Our analyses reveal substantial geographic variation in Hispanic immigrant-white low birthweight disparities. For example, Hispanic immigrants in Southeastern states and in some states from other regions have reduced risk of low birthweight relative to whites, consistent with a "Hispanic Paradox." A significant portion of Hispanic immigrants' birthweight advantage in these states is explained by lower rates of smoking relative to whites. However, Hispanic immigrants have higher rates of low birthweight in California and several other Western states. The different state patterns are largely driven by geographic variation in smoking among whites, rather than geographic differences in Hispanic immigrants' birthweights. In contrast, US-born Mexicans generally have similar or slightly higher odds of low birthweight than whites across the US. Overall, we show that the Hispanic Paradox in birthweight varies quite dramatically by state, driven by geographic variation in low birthweight among whites associated with white smoking disparities across states.

Are Sexual Minorities Less Likely to Participate in Surveys? An Examination of Proxy Nonresponse Measures and Associated Biases with Sexual Orientation in a Population-Based Health Survey

One of the implicit assumptions in survey research is lower response rates by sexual minorities than non-minorities. With rapidly changing public attitudes towards same-sex marriage, we reconsider this assumption. We used data from the 2013 and 2014 National Health Interview Survey (NHIS) that include contact history data for all sample families (n=117,589) as well as sexual orientation information about adults sampled from responding families (n=71,110). We created proxy nonresponse indicators based on contact efforts and reluctance from contact history data and linked them to sexual orientation of the sample adult and simulated nonresponse. The data did not support the assumption: straight adults were more difficult to get cooperation from than non-straights. With female sexual minorities showing higher nonresponse than the male counterpart, special considerations are required. Replication analyses may provide insights into what factors influence study participation decisions, which will inform how nonresponse may impact the accuracy of research findings.

Associations Between State-Level Policies Regarding Alcohol Use Among Pregnant Women, Adverse Birth Outcomes, and Prenatal Care Utilization: Results from 1972 to 2013 Vital Statistics

BACKGROUND

Policies regarding alcohol use during pregnancy continue to be enacted and debated in the United States. However, no study to date has examined whether these policies are related to birth outcomes-the outcomes they ultimately aim to improve. Here, we assessed whether state-level policies targeting alcohol use during pregnancy are related to birth outcomes, which has not been done comprehensively before.

METHODS

The study involved secondary analyses of birth certificate data from 148,048,208 U.S. singleton births between 1972 and 2013. Exposures were indicators of whether the following 8 policies were in effect during gestation: Mandatory Warning Signs (MWS), Priority Treatment for Pregnant Women, Priority Treatment for Pregnant Women/Women with Children, Reporting Requirements for Data and Treatment Purposes, Prohibitions Against Criminal Prosecution, Civil Commitment, Reporting Requirements for Child Protective Services Purposes, and Child Abuse/Child Neglect. Outcomes were low birthweight (<2,500 g), premature birth (<37 weeks), any prenatal care utilization (PCU), late PCU, inadequate PCU, and normal (≥7) APGAR score. Multivariable fixed-effect logistic regressions controlling for both maternal- and state-level covariates were used for statistical analyses.

RESULTS

Of the 8 policies, 6 were significantly related to worse outcomes and 2 were not significantly related to any outcomes. The policy requiring MWS was related to the most outcomes: specifically, living in a state with MWS was related to 7% higher odds of low birthweight (p < 0.001); 4% higher odds of premature birth (p < 0.004); 18% lower odds of any PCU (p < 0.001); 12% higher odds of late PCU (p < 0.002); and 10% lower odds of a normal APGAR score (p < 0.001) compared to living in a state without MWS.

CONCLUSIONS

Most policies targeting alcohol use during pregnancy do not have their intended effects and are related to worse birth outcomes and less PCU.

Quality Assurance Audit of Technique Failure and 90-Day Mortality after Program Discharge in a Canadian Home Hemodialysis Program

BACKGROUND AND OBJECTIVES

Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition).

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We conducted an audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing quality assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit.

RESULTS

Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P=0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; P<0.01). In the 6 months before exit, the negative disposition group had significantly more in-center respite dialysis sessions, had more and longer hospitalizations, and required more on-call care team support in terms of phone calls and drop-in visits (each P<0.05). The most common reason for modality conversion was medical instability in 15 of 23 (65%) followed by caregiver or care partner burnout in three of 23 (13%) each. The 90-day mortality among patients undergoing modality conversion was 26%.

CONCLUSIONS

Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization (e.g., hospitalization, respite treatments, nursing time, etc.).

Counting Marriages in the United States: The Value of County-Level Administrative Data

Rapid family change has occurred in the United States, but it has not been accurately charted at the local level. Our capacity to understand spatial variation in marriage is hindered by the deterioration and defunding of the U.S. marriage and divorce vital statistics system. While there is easily accessible state-level data, there is no central depository of county-level administrative marriage data preventing researchers from addressing questions about the geographic concentration as well as variation in marriage rates. We compiled 2010 county-level administrative marriage data from over 3000 counties in 49 states. We find there is wide variation in marriage rates within states with marriage rates varying more across states than within states. While the American Community Survey (ACS) is often used to study marriage rates in the U.S., we find that ACS data can only be used to assess local marriage rates for less than one in ten counties. Our findings demonstrate the high level of spatial variation in marriage and the significance of relying on county- rather than state-level marriage rates.

Semantic Interoperability, E-Health and Australian Health Statistics

E-health implementation in Australia will depend upon interoperable computer systems to share information and data across the health sector. Semantic interoperability, which preserves the meaning of information and data when it is shared or re-purposed, is critical for safe clinical care, and also for any re-use of the information or data for other purposes. One such re-use is for national health statistics. Usable statistics rely on comparable and consistent data, and current practice is to use agreed national data standards to achieve this. The standardisation and interoperability needed to support e-health should also provide strong support for national health statistics. This report discusses some of the semantic interoperability issues involved in moving from the current data supply process for national health statistics to an e-health-enabled future.

Law No. 5 of 1985 (Civil Code), 1985

Among other things this Law contains the following provisions: Article 71. (1) The personality (status of person) of a human being shall commence at the moment of being born alive. It shall terminate upon his death. (2) The law shall lay down the rights of a foetus in utero. Article 72. (1) The facts of birth and death shall be recorded (or: proved) by entries in registers kept for that purpose. (2) If there is no such evidence or if it should appear that the entries in the register are incorrect, it shall be permissible to prove the same by any legal means of proof. Article 76. (1) The family of a person shall consist of his spouse and relatives. (2) All persons coming from a common stock shall be deemed to be relatives. Article 77. (1) A direct relationship is the relationship of root and branch (direct lineage). An indirect relationship is the link between persons of common stock without direct lineage, whether or not within the degree of consanguinity precluding marriage. Article 78. In calculating the degree of direct relationship each upwards stage of generation to the source shall be regarded as one degree away from that source. In calculating the degree of indirect relationship degrees of ascent from the descendants to the common origin shall be taken into account, and then downwards from him to the last generation, and each stage shall be counted as a degree with the exception of the common source. Article 79. One of the relations of the spouses shall be regarded as having the same degree of relationship to the other spouse.

[Diagnostic expressions and causes of death. Some reflections on their utilization in the demographic analysis of mortality]

The author discusses "the main difficulties that arise from the use of the diagnostical expressions used to report [causes of death].... From an interdisciplinary point of view, the work stresses the need to study in depth the causal explanation of mortality. It favours the creation of interpretative schemes showing the causal associations, direct or otherwise, between the determinants of good or bad health and the mortality problems as revealed in the death causes." (SUMMARY IN ENG AND FRE)

Adult mortality and proportions orphaned in Austria in 1991

"At the Austrian micro-census taken in June 1991, a question was inserted on survival of parents and grandparents (on both sides), with the object of investigating family networks.... By comparing the census information on survival of parents and the corresponding direct measures of mortality, we have an opportunity to assess the validity of techniques which are commonly used in countries with defective vital registration. We shall consider here female adult mortality and proportions of persons whose mothers have died (maternal orphanhood).... This method, which hinges on the reporting of a single event that is no doubt remembered well, proves a good substitute for direct mortality measures, despite a slight underestimation. It describes the performance of cohorts, some of which are relatively old, but the results can be translated into the recent period."

Reducing costs of censuses in Norway through use of administrative registers

"For some years it has been the policy of Statistics Norway to collaborate with various governmental agencies in order to use administrative registers in statistics production. This policy has been supported politically, and a new Statistics Act has been useful in these efforts. The purpose of this paper is to present the strategy and methodology used to produce statistics in general, census statistics in particular, when based on a combined use of administrative registers and directly collected data. Experiences from Norwegian censuses since 1960 will be presented."