National Morbidity

Health Effects Institute (2003) Revised analyses of the national morbidity, mortality, and air pollution study, part II revised analyses of selected time-series studies of air pollution and health. Health Effects Institute, Cambridge... 

The APHEA (Air Pollution and Health—An European Approach) project studied air-pollution effects in 15 and later with the APHEA 2 project in 34 European cities (Katsouyanni et al. 1995, 1997, 2001). The NMMAPS (National Morbidity, Mortality, and Air Pollution Study) project in the United States focused on time-series analyses of PMio effects on mortality during 1987-1994 in the 90 largest US cities (Samet et al. 2000a, b, c), and in the 20 largest US cities in more detail (Dominici et al. 2000a, b). These data have been summarized in the US-EPA s particulate matter criteria document (US-EPA 2004) and in a met analysis carried out by a WHO-Europe task group (Anderson et al. 2004). 

Fig. 3 Risk estimates of short-term mortality for a 10 )rg/m increase of PMio from WHO-Task Group (Anderson et al. 2004) and US-National morbidity, Mortality, and Air Pollution Study—NMMAPS (Samet et al. 2000b)...

Many studies of PM, especially early ones, examine health associations only with measures of PM mass. Some of the other investigations which draw associations between PM concentrations (i.e. mass) and mortahty include Pope et al. (2009) the National Morbidity, Mortahty, and Air Pollution (NMMAPS) Study (Health Effects Institute 2000) and a follow-up of the Six Cities study with more years of data (Laden et al. 2006). A recent paper of interest estimates the monetized health damage per ton of emission of different PM2.5 species, based upon how many people are exposed to the emissions, while continuing to assume constant toxicity across all components of PM2.5 (Fann et al. 2009). While these studies demonstrate clear associations between PM2.5 mass exposures and patterns of mortality and morbidity, the most important question facing pollution researchers has yet to be adequately addressed what pollutants are the ones we need to preferentially regulate to benefit the public health, and which ones, perhaps, cause httle harm to the public health This question becomes more important if PM2 5 species with relatively little mass, especially widespread species, turn out to be particularly harmful, because if PM2.5 is regulated on the basis of mass, species with relatively little mass are not likely to be targets for reduction. 

Samet, J.M., Dominici, F., Zeger, S.L., Schwartz, J., Dockery, D.W. (2000). National Morbidity, Mortality, and Air Pollution Study, Cambridge, MA, Health Effects Institute. 

Further detailed analyses of the ECA data have been extrapolated to USA national costs (Rice and Miller, 1998). It was calculated that the economic costs of mental disorders in 1990 in the USA totalled US 147.8 billion. Anxiety disorders were the most cosdy, amounting to 46.6 billion, just under a third of the total. Direct costs spent on mental health care totalled 67 billion, of which anxiety disorders accounted for only 11 billion (16.5%). Drug costs were 2191 million, of which anxiety disorders accounted for 1167 million—over half Morbidity costs—the value of goods and services not produced because of mental disorders — amounted to 63.1 billion, with anxiety disorders accounting for 34.2 billion, 54.2% of the total. This reflects the high prevalence of anxiety disorders in the community and the high associated rate of lost productivity. In contrast, patients with affective disorders appeared better able to function (Rice and Miller, 1995). In summary, anxiety disorders are common, disruptive and costly to society drug treatment is a substantial element of treatment costs (11%) compared with, say, schizophrenia (2.2%). 

Burg JE, Gist GL, Allred SL, et al. 1995. The national exposure registry - morbidity analysis of noncancer outcomes from the trichloroethylene subregistry baseline data. International Journal of Occupational Medicine and Toxicology 4 237-257. 

DAWN is a morbidity and mortality information system, funded by the National Institute on Drug Abuse, in which data are collected from a sample of more than 800 hospitals located in 27 major metropolitan areas in the continental United States, from a National panel of hospitals outside of these areas, and from medical examiners/coroners located in 26 major metropolitan areas. 

ONS (2001b). Psychiatric morbidity among adults, 2000 (Office of National Statistics). Available at www.statistics.gov.uk... 

NIOSH. 1988b. NIOSH recommendations for occupational safety and health standards. Morbidity and mortality weekly report [supplement] Vol. 37 S-7. Atlanta, GA U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health. 

Among elderly women as much as 80% suffer from involuntary voiding of the bladder, urinary incontinence (UI). In the United States approximately 12.5 million people are affected by incontinence and a European study showed a prevalence of between 12% and 22% in all ages and an increase to 30-40% in ages over 75 years (Hampel et al. 1997). Women experience UI twice as often as men. Incontinence becomes more common in old age, with existing co-morbidity of all kinds and life styles (Box 5.5). There are different forms of urinary incontinence and they differ in cause and treatment. This problem causes not only personal distress but also a considerable cost for society as a whole (Jackson 1997). Lower quality of life is often reported in people with UI and the risk increases by the withdrawal from social interaction and participation in sports and other activities. An estimated cost for the care of patients with UI in the United States was approximately 26 billion dollars in year 1995 (Wagner and Hu 1998). Other studies have come up with a calculated cost that represents two percent of the total national health budget. 

NIOSH. 1986. National Institute for Occupational Safety and Health. Morbidity and Mortality Weekly Supplement 35 19S. 

Fiji. I have presented the morbidity statistics for the South Pacific Commission area but the situation in several of the island nations is worthy of particular attention. In Fiji, ciguatera had not been considered a major public health problem, but as noted by health workers and supported by morbidity statistics, there has been an apparent rise in ciguatoxicity since the mid-1970 s. Species confirmed by Raj (10) as being ciguatoxic are listed in Table II. 

Rates of Homicide, Suicide, and Firearm-Related Death among Children—26 Industrialized Countries. Morbidity and Mortality Weekly Report, vol. 46, February 7, 1997, pp. lOlffi Concludes that the United States has by far the highest rates of child homicide, suicide, and firearms-related deaths among the industrialized nations. 

Kessler, R. C., P. Stang, H. U. Wittchen, M. Stein, and E. E. Walters. Lifetime Co-morbidities Between Social Phobia and Mood Disorders in the US National Comorbidity Survey. Psychological Medicine 29(3) (1999) 555-567. 

It is now widely agreed that approximately 25% of the world s food crops are affected each year by variable levels of mycotoxins which can have considerable economic consequences for the crop, livestock producers, grain handlers, processors, consumers and indeed national economies (Miller, 1998). It has been conservatively estimated that annual losses in the US and Canada, as a result of mycotoxin occurrence, to the feed and livestock industries alone can be in the region of US 5 billion (Charmley et al., 1995). In developing countries, regular mycotoxin presence in the diet will also affect the human populations, causing morbidity and premature deaths. 

Hypertension is the most common cardiovascular disease. Thus, the third National Health and Nutrition Examination Survey (NHANES III), conducted from 1992 to 1994, found that 27% of the USA adult population had hypertension. The prevalence varies with age, race, education, and many other variables. Sustained arterial hypertension damages blood vessels in kidney, heart, and brain and leads to an increased incidence of renal failure, coronary disease, cardiac failure, and stroke. Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels and to substantially reduce morbidity and mortality rates. Many effective drugs are available. Knowledge of their antihypertensive mechanisms and sites of action allows accurate prediction of efficacy and toxicity. As a result, rational use of these agents, alone or in combination, can lower blood pressure with minimal risk of serious toxicity in most patients. 

B33. Buyon, J. P., Hiebert, R., Copel, J., Craft, J., Friedman, D., et al., Autoimmune-associated congenital heart block Demographics, mortality, morbidity and recurrence rates obtained from a national neonatal lupus registry. J. Am. Coll. Cardiol. 31, 1658-1666 (1998). 

Fonarow GC, Wright RS, Spencer FA, et al. Effect of statin use within the first 24 hours of admission for acute myocardial infarction on early morbidity and mortality. Early withdrawal of statin therapy in patients with non-ST-segment elevation myocardial infarction national registry of myocardial infarction. Use of lipid-lowering medications at discharge in patients with acute myocardial infarction data from the National Registry of Myocardial Infarction 3, AmJ Cardiol 2005 96 61 1-616. 

HIV infection in humans is now pandemic. As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimate that AIDS has killed more than 25 million people since it was first recognized on December 1, 1981, making it one of the most destructive pandemics in recorded history. Antiretroviral treatment reduces both the mortality and the morbidity of HIV infection, but routine access to antiretroviral medication is not available in all countries. An alternative therapy to circumvent this problem is the use of polyanionic substances, which demonstrated a number of promising features as potential anti-HIV drug candidates. In this respect, various SPs (e.g., heparin, DS, dextrin sulfate, cyclo dextrin sulfate, curdlan sulfate, pentosan polysulfate, mannan sulfate, sulfoevernan, and fucoidan) and derivatives thereof (e.g., O-acylated heparin, polyacetal polysulfate, polyvinyl alcohol sulfate, and modified cyclo dextrin sulfates) have been found to inhibit HIV replication in vitro at concentrations that are up to 10 000-fold lower than the cytotoxic concentration [2,71]. 

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