With the help of my colleagues, I have been conducting epidemiological studies on biliary tract cancer (BTC), including gallbladder cancer (GBC) and extrahepatic bile duct cancer (BDC), in Japan and Chile for about 19 years. Clustered areas with high mortality rates, especially for female GBC were found to correspond with places or prefectures in Japan that were famous for rice production. The roles of known risk factors, such as gallstones and cholecystitis, were examined, but no single factor was implicated in the high mortality rates for GBC in these areas. A working hypothesis, called the “rice production hypothesis” was formulated; this initial hypothesis was replaced by a new multifactorial causation hypothesis: GBC is more likely to occur in individuals with a genetic susceptibility and a past history of gallstones or cholecystitis who are exposed to geographically specific environmental factors, such as agricultural chemicals. On the basis of various analytical studies, it is concluded that a certain agricultural chemical was responsible for the occurrence of GBC. At the time of writing, no evidence has been obtained to disprove our hypothesis. We have also conducted international collaborative studies in Chile, which has the highest mortality rate for GBC in the world. Bile from Chileans was found to have a higher mutagenic activity than that from Japanese subjects; Chileans with a history of constipation or a habit of consuming red chilli pepper had a high risk of developing GBC, if they also had gallstone(s). The presence of a regional difference in p53 mutagenesis was also observed.
seconds ; Gallstones ; Mortality Vital Statistics ; Cancer of Biliary Tract ; Spatial Distribution

The aims of this study were to demonstrate the trend of overall mortality rate and premature mortality rate for select types of cancer in Japan and to assess the utility as a target indicator. The age-adjusted mortality rate for the total population (overall mortality rate) and that for persons under 65 years of age (under 65 mortality rate) for stomach cancer, liver cancer and lung cancer from 1950 to 1997 in Japan were calculated. Moreover, the turning point year of the mortality trend was estimated using a regression model of the rate of annual increase in each mortality rate. As the results show, a decline in the under 65 mortality rate preceding a decline in the overall mortality rate was observed in stomach cancer and male liver cancer. Also, the under 65 mortality rate due to lung cancer seemed to begin to decline in recent years for males, while the overall mortality rate has been increasing. This study suggests that the premature mortality rate is a more sensitive indicator of the effectiveness of cancer prevention. Hence, because of not only the larger burden of premature deaths but also the sensitivity, premature mortality is considered to be suitable as a target indicator for cancer prevention strategies.
Mortality Vital Statistics ; Malignant Neoplasms ; trends ; Japan ; Prevention

The purpose of this study was to clarify the survival rates and prognostic factors in elderly Japanese patients with hip fractures. This study investigated the outcome of 256 patients aged 60 years and older with surgically treated hip fractures. Information including age, gender, duration of hospitalization, place of residence before fracture and at discharge, and level of mobility before fracture and at discharge was obtained from patient records. The survival of the patients after discharge was determined by mail surveys supplemented with telephone inquiries.The observed survival rates were significantly lower than the expected survival rates (p<0.001, by Mantel Haenszel test). The short-term mortality rates were 6% for six months and 12.7% for one year, which were lower than previously reported rates in Western countries. Significantly higher hazard ratios (HR) for mortality adjusted for age and gender were observed in patients who had lived in places other than their own home before fracture (HR=2.67(1.63-4.3)), were discharged to places other than their own home (Nursing home HR=2.25 (1.24-4.1) or to a non-orthopedic unit (HR=5.95 (3.12-11.34)), those requiring full-time assistance for mobility at discharge (HR=5.71 (3.59-9.01)), and those who had stayed in a hospital for fewer than 40 days (HR=2.20 (1.38-3.51)). After adjusting for the effects of all the potential prognostic factors, discharge to places other than their own home and the lowest level of mobility at discharge remained significant factors causing adverse effects on survival.Therefore, to improve the prognosis, patients should be allowed to recover to a level at which they can ambulate with some assistance, enabling them return to their own homes.
survival aspects ; seconds ; Japanese language ; prognostic ; Mortality Vital Statistics

PURPOSE: In Korea before 1996, the perinatal mortality rates (PMRs) were reported by individual studies, but the Korea Ministry of Health and Welfare started official reports of PMRs from 1996, and Statistics Korea provides the annual official data since 2007. The present study observed the decreasing trends of PMR and compared the PMRs between OECD nations. Thereby, we surveyed the terminology of PMR and the international trends in the usage of the calculation methods and intended to provide uniformity in calculating PMR in Korea. Also, the authors speculated some perinatal problems to be improved in the future in order to decrease PMR further. METHODS: Data before 1996 were gathered from individual reports, and after 1996 were utilized from Ministry of Health and Welfare, and Statistics Korea. Data of OECD nations were analyzed from OECD Health Data 2010. The changes in annual PMR of Korea was reviewed, which is helpful to recognize the current state of Korea, and was compared to that of OECD nations. RESULTS: During the past 50 years, the PMRs of Korea were remarkably improved (PMRs: 60 in 1960s, 35 in 1970s, 30 in 1980s, approximately, respectively). The official PMR values of Korea are as following: 6.0 in 1996, 5.2 in 1999, 4.6 in 2002, 4.2 in 2005, 3.6 in 2006, 3.7 in 2007, 3.6 in 2008, and 3.4 in 2009. The decreasing pattern of the annual PMR value was observed and the most recent value reflected the excellent situation in PMR compared to other OECD nations. CONCLUSION: Accordingly, we could observe the encouraging levels of PMR in Korea. We speculate that following efforts should be accompanied to achieve further improvement in PMR, such as improvements in neonatal and maternity transfer system, establishment in perinatal care centers, and establishment in perinatal research network system in Korea.
Epidemiologic Methods ; Korea ; Perinatal Care ; Perinatal Mortality ; Public Health ; Vital Statistics

PURPOSE: The death rate of liver cancer in Korea has been reported as one of the highest in the world. This study was conducted to investigate geographical variations of liver cancer mortality in Korea in order to obtain insight into possible environmental factors related to liver cancer. MATERIALS AND METHODS: The sex-specific standardized mortality ratios (SMRs) of liver cancer were calculated for 168 basic administrative units in Korea based upon the vital statistics for the seven years 1992 to 1998, as well as the sex- and age-specific population of each area for 1995. The SMRs were classified into six categories and depicted on a map for each sex. RESULTS: The southern provinces showed clearly higher mortality rates as compared to the rest of the country in both males and females. Looking at the maps in detail, there was a geographical variation even within the southern provinces. The areas around large rivers, some costal areas, and costal islands showed a high mortality rate. Even in the middle and northern provinces, the eastern costal areas showed relatively higher mortality rates as compared to inland areas. Conversely, some southern areas known for low levels of pollution showed relatively lower mortality rates. CONCLUSION: This finding suggests a possible relationship between liver cancer and water-related foods from polluted rivers or seas. Further studies should be performed in order to clarify which factors cause this geographical variation.
Female ; Humans ; Islands ; Korea* ; Liver Neoplasms* ; Liver* ; Male ; Mortality* ; Oceans and Seas ; Rivers ; Vital Statistics

OBJECTIVES: To evaluate the accuracy of the registered cause of death in a county and its related factors. METHODS: The data used in this study was based on 504 cases, in a county of Chonnam province, registered between January and December 1998. Study subjects consisted of 388 of the 504 cases, and their causes of death were established by an interview survey of the next of kin or neighbor and medical record surveys. We compared the registered cause of death with the confirmed cause of death, determined by surveys and medical records, and evaluated the factors associated with the accuracy of the registered cause of death. RESULTS: 62.6% of the deaths were concordant with 19 Chapters classification of cause of death. external causes of mortality, endocrine, nutritional and metabolic diseases, neoplasms and diseases of the circulatory system showed the good agreement between the registered cause of death and the confirmed cause of death. The factors relating to the accuracy of the registered cause of death were the doctors' diagnosis for the cause of death (adjusted Odds Ratio: 2.67, 95% Confidence Interval: 1.21-5.89) and the grade of the public officials in charge of the death registry (adjusted Odds Ratio: 0.30, 95% CI= 0.12-0.78). CONCLUSIONS: The accuracy of the registered cause of death was not high. It could be improved by using the doctors' diagnosis for death and improving the job specification for public officials who deal with death registration.
Cause of Death* ; Classification ; Diagnosis ; Jeollanam-do ; Medical Records ; Mortality ; Nutritional and Metabolic Diseases ; Odds Ratio ; Vital Statistics

OBJECTIVETo evaluate the results of the active follow-up among registered cancer patients in 2002 - 2005 in urban areas of Beijing.

METHODSA number of 63 997 cancer patients diagnosed during 2002 - 2005 were selected from the surveillance database of Beijing Office for Cancer Prevention and Control. By matching the identity information of the patients with the death surveillance database built by the vital statistic department in Beijing, 29 223 patients were confirmed to be alive.1149 cases were removed from the study due to lack of exact key variables, such as address and telephone numbers. 28 074 patients were, at last, included in the active follow-up study. The investigators and the inspectors, who accepted standard training program, investigated each patient's status of census register and survival condition by phone calling, household interview and visits at local police station or residential committee. The loss ratio of follow-up and the constituent ratio of the withdrawal reasons were calculated.

RESULTSAmong the 28 074 patients selected in active follow-up, 21 696 patients were followed successfully; 1453 of whom didn't have the census register of Beijing, which accounted for 6.70%. Out of the other 20 243 Beijing residents, 4715 patients (23.29%) were already dead and 84.22% (3971/4715) of them replenished the failure to report by passive follow-up. Among all the 4715 dead cases, 4405 (93.43%) patients were died from cancer. The follow-up study helped to replenish the vital statistics in different districts, the ratio ranged from 4.87% and 8.85%. 6378 patients were withdrawn from the study. The loss ratio was 22.72% (6378/28 074), and the total loss ratio was 12.03% ((6378 + 1149)/(63 997 - 1453)). Of these withdrawal cases, 3041 (47.68%) were lost to follow-up in that the investigators can't find the patients or the relatives of the patients according to the registered phone number or address information. The other reasons included: the patients removed to other areas (1199 cases, 18.80%), the patients and their family members were temporarily not at home (127 cases, 1.99%), the patients and their family members rejected to answer the interview (292 cases, 4.58%), and other reasons (1719 cases, 26.95%).

CONCLUSIONThe method of active follow-up towards registered cancer patients can replenish the missing information which could not be collected from passive follow-up procedure; and therefore effectively improve the quality of data in cancer registration.

China ; epidemiology ; Follow-Up Studies ; Humans ; Neoplasms ; epidemiology ; mortality ; prevention & control ; Vital Statistics

OBJECTIVETo describe geographical distribution and its transition of mortality of cancers in China.

METHODSThe information of 2 513 949 310 person years were collected in 1973-1975 and 142 660 482 person years in 2004-2005 respectively. Being standardizing the death rates of these two survey with 2000 national census population, the changes of mortality of main cancers was observed and the geographic distribution of cancers in 2004-2005 was analyzed.

RESULTSA total of 1 865 445 cancer deaths were collected in 1973-1975, the standardized death rate was 99.61/100 000, and 193 839 cancer deaths were collected in 2004-2005, the standardized death rate was 123.72/100 000, with growth of 24.20%. District mortality analysis showed that the provincial standardized cancer death rates varied greatly, with the highest in Heilongjiang (7443 cases, 183.34/100 000), and the lowest in Yunnan (2454 cases, 61.03/100 000). The highest standardized death rate of esophageal cancer, gastric cancer, liver cancer, colon cancer, lung cancer, nasopharyngeal cancer, leukemia, female breast cancer, cervical cancer was in Henan (3535 cases, 32.95/100 000), Gansu (1333 cases, 59.35/100 000), Heilongjiang (1640 cases, 38.63/100 000), Shanghai (390 cases, 11.58/100 000), Heilongjiang (2382 cases, 60.15/100 000), Hainan (36 cases, 7.04/100 000), Tianjin (161 cases, 5.45/100 000), Heilongjiang (179 cases, 8.09/100 000), Xinjiang (131 cases, 10.69/100 000) respectively; the lowest standardized cancer death rate of above-mentioned cancers was in Yunnan (63 cases, 1.59/100 000), Beijing (235 cases, 5.95/100 000), Tianjin (454 cases, 10.86/100 000), Tibet (3 cases, 0.82/100 000), Tibet (12 cases, 3.29/100 000), Qinghai (0 case, 0.00/100 000), Tibet (1 cases, 0.28/100 000), Tibet (6 cases, 2.88/100 000), Chongqing (27 cases, 1.02/100 000) respectively.

CONCLUSIONComparing the two surveys, the standardized mortality of cancers was increased. Most of cancers occurred obviously in cluster by geographical distribution.

Cause of Death ; China ; epidemiology ; Demography ; Female ; Geography ; Humans ; Male ; Neoplasms ; epidemiology ; mortality ; Vital Statistics

OBJECTIVETo overview the contribution of diabetes in the burden of diseases.

METHODSBased on the data published by MOH, prevalence rate, mortality rate, cause eliminated life year were used to calculate the health burden of disease. Meanwhile, direct economic burden of diseases was presented.

RESULTSAccording the calculation, about 23 million of people suffered from diabetes and 90,000 died from diabetes. The cause eliminated life year attributed to diabetes is different between urban and rural, 0.21 years for urban and 0.08 years for rural. Moreover, the direct economic burden reached 1.071 billion RMB, about 1.88% of national health expenditure at the same period.

CONCLUSIONThe burden of diabetes, based on calculation of both health and economic burden, and will give a heavy pressure to the government and society.

China ; epidemiology ; Cost of Illness ; Diabetes Mellitus ; economics ; mortality ; Humans ; Prevalence ; Rural Population ; statistics & numerical data ; Survival Rate ; Urban Population ; statistics & numerical data ; Vital Statistics

OBJECTIVES: Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea. METHODS: Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012. RESULTS: The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012). CONCLUSIONS: In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.
Cause of Death ; Child Mortality/*trends ; Child, Preschool ; Communicable Diseases/mortality ; Databases, Factual ; Female ; Humans ; Infant ; Male ; Neoplasms/mortality ; Nervous System Diseases/mortality ; Republic of Korea ; Sex Ratio ; Vital Statistics