Determinants of regional differences in lung cancer mortality in the Netherlands

Although regional differences in lung cancer mortality are likely to be attributable to regional differences in tobacco smoking, studies in various countries found only weak relationships. This paper aimed at explaining regional differences in lung cancer mortality in the Netherlands. In a first step, clues for the role of smoking were obtained from a detailed description of regional mortality differences. These differences were found to be strongly determined by cohort effects: they vary between birth cohorts, and have been stable for over 30 years. Regional mortality differences reflect a diffusion of the lung cancer epidemic from high-income regions to low-income regions. These findings are suggestive of a relationship with regional differences in trends in cigarette smoking. In a second step, by means of multiple regression analysis, mortality differences in 1980–84 were related to available data on cigarette smoking and two other possible risk factors: work in transport and manufacturing industry, and air contamination. The independent variables referred to the 1970s. Positive associations with various smoking measures were found for women, but for men the associations were weak or non-existent. Mortality differences among men 45–64 years were associated with work in transport and manufacturing industry. Strong associations w

Mortality due to unintentional injuries in The Netherlands, 1950-1995

OBJECTIVE: To detect and explain changing trends in incidence, case fatality rates, and mortality for unintentional injuries in the Netherlands for the years 1950 through 1995. METHODS: Using national registry data, the authors analyzed trends in traffic injuries, occupational injuries, and home and leisure injuries. RESULTS: Between 1950 and 1970, mortality from unintentional injuries rose, reflecting an increasing incidence of injuries. This was followed by a sharp decline in mortality due to a decreasing incidence combined with a rapidly falling case fatality rate. Starting in the second half of the 1980s, the decline in mortality leveled off as the incidence of several injury subclasses once again rose. The observed trends reflect several background factors, including economic fluctuations (influencing exposure), preventive measures (reducing injury risk and injury severity), and improvements in trauma care (lowering the severity-adjusted case fatality rate). CONCLUSIONS: Injury mortality can be reduced through measures that lowe

The Present Stage of China's Capitalism

The finding that mortality differences between occupational classes in England and Wales have widened during the postwar period raises the question whether a similar development has occurred in other industrialised countries. In this paper, a comparison is made with results from a geographical study on the Netherlands. This study compares four periods between 1950 and 1984 by means of a standard regional division, a single socio-economic index, uniform cause-of-death groups and a standard regression procedure. During the postwar period, the relationship between socio-economic level and all-cause mortality has become (more) negative. This development can to a large extent be attributed to 'negative' trends for lung cancer, diabetes mellitus, ischaemic heart disease, cerebrovascular disease and traffic accidents. High-level regions have fared better partly because favourable changes in national mortality trends seem to have begun first in these regions. The findings from this regional study agree to a large extent with evidence from Dutch studies at the individual level. It is concluded that socio-economic mortality differences in England and Wales and the Netherlands have probably developed similarly in various respect

Differences in the misreporting of chronic conditions, by level of education: the effect on inequalities in prevalence rates

OBJECTIVES: Many studies of socio-economic inequalities in the prevalence of chronic conditions rely on self-reports. For chronic nonspecific lung disease, heart disease, and diabetes mellitus, we studied the effects of misreporting on variations in prevalence rates by respondents' level of education. METHODS: In 1991, a health interview survey was conducted in the southeastern Netherlands with 2867 respondents. Respondents' answers were compared with validated diagnostic questionnaires in the same survey and the diagnoses given by the respondents' general practitioners. RESULTS: Misreporting of chronic lung disease, heart disease, and diabetes may be extensive. Depending on the condition and the reference data used, the confirmation fractions ranged between .61 and .96 and the detection fractions between .13 and .93. Misreporting varied by level of education, and although various patterns were observed, the dominant pattern was that of more underreporting among less educated persons. The effects on prevalence rates were to underestimate differences by level of education to a sometimes considerable degree. CONCLUSIONS: Misreporting of chronic conditions differs by respondents' level of education. Health interview survey data underestimate socioeconomic inequalities in the prevalence of chronic conditions

Development of the Shodo-shima Soy Sauce Industry in the Modern Period and the Market of Its Soy Sauce : The Case of Marukin Shoyu Co., Ltd. (<Special Issue> The Study of Economic History : A New Area)

Objectives. The objectives of this study were: (i) to identify trajectories in the level and time course of disability, (ii) to determine the relative frequency of each trajectory, and (iii) to assess the relationship of these trajectories with age, sex and the presence of four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, severe low back complaints and diabetes mellitus). Methods. We used six measurements of disability and information on mortality from a longitudinal study in Dutch persons aged 15-74. We used cluster analyses to group persons with similar levels and time courses of disability into disability trajectories. Deaths were classified into a separate trajectory. Multinomial regression was used to assess the relationship of the trajectories with age, sex and the four chronic diseases. Information on disability in the last year(s) prior to death was used to examine disability prior to death. Results. Nine trajectories of disability were identified, while all deaths were classified into a separate trajectory; 74% was entirely non-disabled. The size of the other trajectories varied from 10% (permanently mildly disabled) to 0.5% (severely disabled with large increase in disability). Significant associations were found with age and, correcting for age and sex, with asthma/COPD, heart disease and low back complaints, but not with diabetes. The ORs were generally highest for trajectories characterized by severe disability, although disease-specific associations were also found. Among the deaths, 41% of the trajectories were associated with disability pr

Factors that determine the effectiveness of screening for congenital heart malformations at child health centres

BACKGROUND: The actual yield from current screening for clinically significant congenital heart malformations in Dutch child health care is far from optimal. In this study factors that determine the effectiveness of this screening are identified and recommendations for the optimization of the screening programme are formulated. METHODS: Eighty-two patients with a clinically significant congenital heart malformation were consecutively included in this study. Parents and child health centre physicians were interviewed in order to establish the screening, detection and referral history. Paediatric cardiologists established whether these patients were diagnosed 'in time' or 'too late'. RESULTS: Incomplete performance of the screening examination has more influence on the occurrence of delayed diagnoses than failure by parents to adhere to the complete visit schedule. Adequate screening advances detection of congenital heart malformations. Severity, however, is the most predominant determinant of the age at referral and diagnosis, as well as of the risk of complications. In only 7 out of 39 patients diagnosed 'too late', could no avoidable cause for an adverse outcome be found. In 10 cases (25%) there was a prolonged interval between first referral and diagnosis. CONCLUSION: To optimize the yield of the screening programme, improvement in the performance of the child health centre physicians and the co-operation of other physicians involved in reducing the interval between referral and diagnosis are required. Thus a considerable improvement in the prevention of complications of congenital heart malformations can be obtained

Predicting Firm Level Stock Returns: Implications for Asset Pricing and Economic Links

We examine the predictive ability of stock price ratios, stock return dispersion and distribution measures for firm level returns. Analysis typically focusses on market level returns, however, for the underlying asset pricing model to hold, firm-level predictability should be present. Additionally, we examine the economic content of predictability by considering whether the predictive coefficient has the theoretically correct sign and whether it is related to future output growth. While stock returns reflect investor expectations regarding future economic conditions, they are often too noisy to act as predictor. We use the time-varying predictive coefficient as it reflects investor confidence in the predictive relation. Results suggest that a subset of stock price ratios have predictive power for individual firm stock returns, exhibit the correct coefficient sign and has predictive power for output growth. Each of these ratios has a measure of fundamentals divided by the stock price and has a positive relation with stock returns and output growth. This implies that as investors expect future economic conditions to improve and earnings and dividends to rise, so expected stock returns will increase. This supports the cash flow channel as the avenue through which stock return predictability arises