Premature Mortality - Continued more between income levels than did CMF. The YPLLI exceeded the CMF by the greatest amount in the lowest income quintile; thus, the greatest excess in premature mortality occurred in this group. Among the leading causes of death listed in Table 1, the disparity in mortality among income groups is greatest for alcoholism. The YPLLI and CMF decreased in each successive income quintile from Group I to Group V. The YPLLI for alcoholism was 11.7 times higher for Group I than for Group V. Previous studies have shown increased levels of alcohol abuse among persons with low income (4). Others have suggested that alcohol-related diseases are less likely to be reported on the death certificates of persons with higher incomes. The Oregon Center for Health Statistics queries certifying physicians regarding the deaths of any persons for whom the cause of death was suggestive of alcohol abuse (e.g., liver cirrhosis) (5). In 1984, Oregon's mortality rate for all liver disease and cirrhosis (ICD-9 571.0–571.9) was slightly higher (12.0/100,000 population) than that for the United States as a whole (11.6/100,000), but the mortality rate for alcoholic liver disease and cirrhosis (ICD-9 571.0-571.3) was twice as high (9.8 compared with 4.8). In 1984, 82% of all liver disease and deaths from cirrhosis in Oregon were reported to be alcohol-related; this was the highest percentage for any state. Chronic obstructive pulmonary disease (COPD), the fifth leading cause of death and the ninth leading cause of YPLL, caused the second greatest disparity in mortality among income groups. The YPLLI for COPD was highest for Group I and lowest for Group V; the difference between the two groups was fourfold. For unintentional injuries, Group I had the highest YPLLI, 1.2 times that of Group V. However, this finding masked a substantial difference in YPLLI for nonmotor vehicle-related unintentional injury (ICD-9 E826-E949); the YPLLI for the poorest quintile was 1.7 times that for the wealthiest. Both groups had similar YPLLI for motor vehicle-related unintentional injuries. FIGURE 1. Comparative mortality figures (CMF) and years of potential life lost indices (YPLLI) for all causes of death, by income groups* – Multnomah County, Oregon, 1976-1984 Premature Mortality - Continued Reported by: DD Hopkins, MS, JA Grant-Worley, MS, KL Stebbins, LN Wright, MD, JE Gordon, PhD, LR Foster, MD, State Epidemiologist, Oregon Health Div. Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, CDC. Editorial Note: Years of potential life lost is a measure of mortality that emphasizes causes of death that are important at ages under an arbitrary cut-off, 70 years in this study. A recent study in West Virginia (6) found that crude YPLL rates were higher in counties with low per capita income. The Multnomah County data demonstrate a large variation in premature mortality by economic status in a major metropolitan area. Census tracts are often more homogeneous than counties, and studies based on them may yield a more definitive picture of the relationship between mortality and income. The high rates of premature mortality found in low income areas, in particular, provide direction for public health prevention efforts. TABLE 1. Years of potential life lost (YPLL), years of potential life lost index (YPLLI), number of deaths, and comparative mortality figures (CMF) for selected causes of death, by lowest and highest income quintiles* Multnomah County, Oregon, 1976-1984 *Group I is the lowest income quintile; Group V is the highest. *95% confidence interval excludes 1.00 (p<0.05). Alcoholism includes alcoholic psychosis, alcohol dependence syndrome, alcoholic gastritis, alcoholic cardiomyopathy, alcoholic polyneuropathy, and alcoholic liver disease. References 1. Kleinman JC. Mortality. In: National Center for Health Statistics. Statistical notes for health planners. No. 3. Rockville, Maryland: US Department of Health, Education, and Welfare, Public Health Service, 1977; PHS publication no. (HRA)77-1237. 2. National Center for Health Statistics. International classification of diseases, adapted for use in the United States. Eighth revision. Washington, DC: US Department of Health, Education, and Welfare, Public Health Service, 1968; PHS publication no. 1693. 3. World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Ninth revision. Geneva: World Health Organization, 1977. 4. Millar WJ. Sex differentials in mortality by income level in urban Canada. Can J Public Health 1983;74:329-34. 5. Hopkins DD. Questioning the physician: a survey of the cause of death query criteria used by centers for health statistics in the United States and the efficacy of the criteria used by the Oregon Center for Health Statistics. Portland, Oregon: Oregon Department of Human Resources, 1987. 6. Centers for Disease Control. Premature mortality in West Virginia, 1978-1982. MMWR 1987; 36:29-33. Self-Reported Hearing Loss Among Workers Potentially Exposed to Industrial Noise United States Noise-induced loss of hearing has been recognized as an occupational health problem since the 18th century (1). Occupational deafness is an irreversible, sensorineural condition that results from damage to the nerve cells of the inner ear. Recent estimates from surveys indicate that between 7.4 and 10.2 million people work at sites where the level of noise presents an increased risk of hearing loss (85 decibels [dBA] or higher) (2). During the period 1978-1987, an estimated $835 million was paid in workers' compensation claims for occupationally induced hearing impairment (3). To assess the prevalence of hearing-loss symptoms among adult workers in the United States, investigators from the National Institute for Occupational Safety and Health (NIOSH) recently analyzed data collected during the 1971 and 1977 National Health Interview Surveys (NHIS) conducted by the National Center for Health Statistics (NCHS) (4,5). NHIS is a continuing household survey of a stratified TABLE II. Notifiable diseases of low frequency, United States *Two of the 26 reported cases for this week were imported from a foreign country or can be directly traceable to a known internationally imported case within two generations. |