Using vital statistics to estimate the population-level impact of osteoporotic fractures on mortality based on death certificates, with an application to France (2000-2004)

Abstract Background We developed a methodology using vital statistics to estimate the impact of osteoporotic fractures on the mortality of an entire population, and applied it to France for the period 2000-2004. Methods Current definitions of osteoporotic fractures were reviewed and their components identified. We used the International Classification of Diseases with national vital statistics data for the French adult population and performed cross-classifications between various components: age, sex, I-code (site) and E-code (mechanism of fracture). This methodology allowed identification of appropriate thresholds and categorization for each pertinent component. Results 2,625,743 death certificates were analyzed, 2.2% of which carried a mention of fracture. Hip fractures represented 55% of all deaths from fracture. Both sexes showed a similar pattern of mortality rates for all fracture sites, the rate increased with age from the age of 70 years. The E-high-energy code (present in 12% of death certificates with fractures) was found to be useful to rule-out non-osteoporotic fractures, and to correct the overestimation of mortality rates. Using this methodology, the crude number of deaths associated with fractures was estimated to be 57,753 and the number associated with osteoporotic fractures 46,849 (1.85% and 1.78% of all deaths, respectively). Conclusion Osteoporotic fractures have a significant impact on overall population mortality.</p

Regional prediction of landslide hazard using probability analysis of intense rainfall in the Hoa Binh province, Vietnam.

The main objective of this study is to assess regional landslide hazards in the Hoa Binh province of Vietnam. A landslide inventory map was constructed from various sources with data mainly for a period of 21 years from 1990 to 2010. The historic inventory of these failures shows that rainfall is the main triggering factor in this region. The probability of the occurrence of episodes of rainfall and the rainfall threshold were deduced from records of rainfall for the aforementioned period. The rainfall threshold model was generated based on daily and cumulative values of antecedent rainfall of the landslide events. The result shows that 15-day antecedent rainfall gives the best fit for the existing landslides in the inventory. The rainfall threshold model was validated using the rainfall and landslide events that occurred in 2010 that were not considered in building the threshold model. The result was used for estimating temporal probability of a landslide to occur using a Poisson probability model. Prior to this work, five landslide susceptibility maps were constructed for the study area using support vector machines, logistic regression, evidential belief functions, Bayesian-regularized neural networks, and neuro-fuzzy models. These susceptibility maps provide information on the spatial prediction probability of landslide occurrence in the area. Finally, landslide hazard maps were generated by integrating the spatial and the temporal probability of landslide. A total of 15 specific landslide hazard maps were generated considering three time periods of 1, 3, and 5 years

Geographical mapping of type 1 diabetes in children and adolescents in south east Sweden

Study objective: As earlier studies have shown space-time clusters at onset of type 1 diabetes in the south east region of Sweden we investigated if there also has been any geographical clusters of diabetes in this region. Design: The place of residence (coordinates) at the time of diagnosis were geocoded in a geographical information system (GIS). All children diagnosed with type 1 diabetes up to 16 years of age at diagnosis between 1977–1995 were included. The population at risk was obtained directly from the population registry for the respective years and geographical area levels. Setting: South east region of Sweden containing 5 counties, 49 municipalities, and 525 parishes. Main results: A significant geographical variation in incidence rate were found between the municipalities (p<0.001) but not between the counties. The variation became somewhat weaker when excluding the six largest municipalities (p<0.02). In municipalities with increased risk (>35.1/100 000) the major contribution comes from children in age group 6–10 years of age at diagnosis. There were no obvious differences between the age groups in municipalities with decreased risk (<20.1/100 000). Boys and girls had about the same degree of geographical variation. Conclusions: Apart from chance, the most probable explanation for the geographical variation in the risk for children and adolescents to develop type 1 diabetes between the municipalities in the region is that local environmental factors play a part in the process leading to the disease

Risk factor analysis of diarrhoeal disease incidence in faecal sludge-applying farmers' households in Tamale, Ghana

This study assesses the effect of risk factors and their inter-related mediation on diarrhoeal disease incidence in households applying faecal sludge in agricultural fields in Tamale, Ghana. Risk factors were assigned to three inter-related blocks: distal socio-economic, proximal public and domestic domains. The study involved 1,431 individuals living in 165 faecal sludge-applying households followed bi-weekly for 12 months. The incidence rate of diarrhoeal disease in the sludge-applying households was 1.09 (95% CI: 0.78-1.23) diarrhoeal episodes per person year at risk. Risk factors for diarrhoeal disease transmission in the public domain included sludge drying time (population attributable fraction (PAF) of 6%) and distance covered to collect water (PAF? 18%). The main distal socio-economic risk factor was wealth status (PAF? 15%). In the domestic domain, the risk factor significantly associated with diarrhoeal disease transmission was, not washing hands with soap after defecation (PAF ? 18%). About 17% of the effect of sludge drying time (including distance to water facilities) was mediated by the domestic domain risk factors. The study recommends risk management strategies in sludge-applying households that address public and domestic domain risk factors in addition to specific farm level interventions

Chlorination byproducts and nitrate in drinking water and risk for congenital cardiac defects

Drinking water disinfection byproducts have been associated with an increased risk for congenital defects including cardiac defects. Using Swedish health registers linked to information on municipal drinking water composition, individual data on drinking water characteristics were obtained for 58,669 women. Among the infants born, 753 had a cardiac defect. The risk for a cardiac defect was determined for ground water versus surface water, for different chlorination procedures, and for trihalomethane and nitrate concentrations. Ground water was associated with an increased risk for cardiac defect when crude rates were analyzed but after suitable adjustments this excess rate was found to be determined by chlorination procedures including chlorine dioxide. Chlorine dioxide appears itself as an independent risk factor for cardiac defects (adjusted odds ratio 1.61 (95% CI 1.00-2.59)). The risk for cardiac defects increased with increasing trihalomethane concentrations (P = 0.0005). There was an indicated but statistically nonsignificant excess risk associated with nitrate concentration. The individual risk for congenital cardiac defect caused by chlorine dioxide and trihalomethanes is small but as a large population is exposed to public drinking water, the attributable risk for cardiac defects may not be negligible. (C) 2002 Elsevier Science (USA)