Identifying States with a Higher Age-Standardized Incidence Rate for Lung Cancer in Non-Hispanic Blacks vs Non-Hispanic Whites in Both Women and Men: United States, 2015-2017.

BACKGROUND: Higher overall age-standardized incidence rates (ASIRs) for lung-bronchus cancer in non-Hispanic (NH) African Americans/Blacks (NH Blacks) vs NH Whites have been reported in the United States for men and not women, but surveillance is needed by sex and age group in each state/District of Columbia. METHODS: The aim of this study was to identify any state with a statistically significantly elevated NH Black/NH White ratio (>1.00, with 95% CI not including 1.00) for the average annual (2015-2017) overall ASIR (or in selected age groups) for lung-bronchus cancer in both women and men. A US Cancer Statistics research database covered 100% of the United States population. RESULTS: The NH Black/NH White ratio of overall ASIRs was elevated in men in the United States (1.11, vs 0.84 in women), but also in 2 states in women vs 6 in men in the Midwest region, including both sexes in Wisconsin, and in both sexes in the District of Columbia (with low ASIRs in NH Whites). The ratio of ASIRs for the group aged 20-49 years was statistically significantly elevated in women in California (1.44), but the ratio in men in California (1.30) did not reach statistical significance. The ratio of ASIRs was elevated in both sexes in 5 states for the group aged 50-59 years vs 3 for the group aged 60-69 years, but with higher ratios (and in additional states) in men vs women, in the Midwest; and for both age groups in California. CONCLUSIONS: Findings support the need for intensified tobacco control efforts for NH Blacks in several states/District of Columbia, and for surveillance of NH Black/NH White ratios of ASIRs by sex in geopolitical areas within these states.

Anatomical variation in the right non-recurrent laryngeal nerve reported from studies using pre-operative arterial imaging.

The right non-recurrent (inferior) laryngeal nerve (NRLN) is a rare anatomical variant associated with an arterial anomaly, the aberrant right subclavian artery (ARSA), that is detectable by pre-operative imaging (POI) using computed tomography and/or ultrasound. Most surgical studies have utilized two major types, NRLNs arising near the upper pole of the thyroid gland (type 1), vs. at a lower level (type 2) but with two subtypes defined by relationships to the inferior thyroid artery (ITA). This review found 8 English language surgical studies using POI that reported at least 1 NRLN and had anatomical information; of the 88 right NRLNs, 69.3% were classified as type 2 and 30.7% as type 1. Meta-analysis yielded a weighted proportion of 74.0% for type 2, but with substantial heterogeneity. For a subgroup of 5 POI studies with information on subtypes, 22 (59.5%) of 37 type 2 nerves were type 2a (i.e., running at or above the ITA). Similarly, a separate review of large surgical series without POI found that 60.4% of all 91 type 2 NRLNs were type 2a. The study findings should be relevant to the increasing numbers of anterior neck surgeries including bilateral thyroidectomies. A need was identified for studies on inter-observer reliability (agreement) among surgeons on NRLN types, and on injury rates (and related symptoms) by the type of NRLN.

Oropharyngeal Carcinomas Strongly Associated with Human Papillomavirus: Incidence Trends in the Elderly US Population Using SEER vs US Cancer Statistics Databases.

BACKGROUND: For squamous cell carcinoma (SCC) of the base of tongue and palatine tonsil, the oropharyngeal sites most strongly associated with human papillomavirus (HPV), increasing age-standardized incidence rates (ASIRs) (2002-2012) have been reported for elderly US men but not women. These findings were based on data from Surveillance, Epidemiology, and End Results (SEER) registries, covering 28% of the US population. METHODS: Trends in ASIRs (2001- 2014) at ages ≥65 years for base of tongue-palatine tonsil SCC were analyzed using a SEER research database, along with a US Cancer Statistics (USCS) research database with registries covering 48 states (98% of the US population). Annual percent change in ASIR was estimated using joinpoint regression. RESULTS: Using either SEER or USCS, ASIRs for ages ≥65 years increased after the late 2000s for women, whereas men showed a larger and more continuous increase during 2001-2014. Increases were evident for the age subgroups 65-74 and 75-84 years, but the trend for women aged 75-84 years was clearer using USCS vs SEER. For 2003-2014, the 38 states in USCS that were certified by the North American Association of Central Cancer Registries showed increases for women and men that were similar to those using all 48 USCS states or SEER. CONCLUSIONS: Continued surveillance is needed, along with studies on HPV markers in tumor tissues for large samples of elderly oropharyngeal SCC patients. Findings support the need for expanding resources for diagnosis, treatment and clinical trials for the growing numbers of elderly oropharyngeal SCC patients.

Declining Proportion of Incident Squamous Cell Carcinomas of the Oral Cavity Coded as Unknown for American Joint Committee TNM Stage:SEER Registries, 2004-2014.

BACKGROUND: For squamous cell carcinomas of the oral cavity (OCSCC), American Joint Committee on Cancer (AJCC) TNM stage at diagnosis is widely used by clinicians. In US cancer registries, AJCC 6th edition stage was derived by computer algorithm from codes based on the Collaborative Stage System (CSS) for diagnoses from 2004-2015, but unknown stage is an issue. METHODS: A research database of population-based Surveillance, Epidemiology, and End Results (SEER) Program registries (covering about 28% of the US population) included AJCC stage for diagnoses in 2004-2014. Trends (2004-2014) were examined in the proportion of invasive OCSCC cases coded as unknown vs known (ie, I-IV) for AJCC stage group. RESULTS: The proportion with AJCC stage unknown declined from 22.5% for 2004 to 12.3% for 2014, reaching as low as 9.8% for age 45-64 years (although higher for older age groups) and 8.1% for all cases with cancerdirected surgery. The largest decline was for the T (tumor size/local extension) component of TNM. The proportion coded as stage IV increased from 22.1% for 2004 to 31.5% for 2014. CONCLUSIONS: The proportion with unknown AJCC stage declined substantially. Surveillance (including non-SEER registries) is needed using registry coding of extent of disease that has replaced CSS, and after the advent of registry coding using the AJCC 8th edition, which includes changes in staging of OCSCC that are relevant to clinicians.

Prevalence of the aberrant right subclavian artery reported in a published systematic review of cadaveric studies: The impact of an outlier.

The aberrant or anomalous right subclavian artery (ARSA), which arises directly from the aortic arch and crosses to the right side usually behind the esophagus, is a rare but clinically important anatomical variant. A published systematic review (SR) of 15 cadaveric studies on ARSA reported that prevalence ranged from 0.2% to 13.3% of the general population; the total unweighted prevalence of ARSA was 325 cases in 13,208 bodies or 2.46%. The present review, however, found that the 13.3% figure was for 133 cases from a larger case series without a denominator. Three other studies either had an imprecise denominator or were limited to congenital conditions associated with ARSA. After exclusions and modifications, ARSA prevalence for the remaining 11 studies in the SR ranged from 0.19%, with a 95% confidence interval (CI) of 0.00-1.08%, to 2.52% (CI= 0.69-6.32%). The unweighted prevalence for all 11 studies combined was 1.23%, and the pooled prevalence estimate from a meta-analysis was 1.30% (CI = 0.86-1.82%). In conclusion, overall findings from SRs on the prevalence of rare anatomical variants such as ARSA may be affected by outliers. Clin. Anat. 30:1024-1028, 2017. © 2017 Wiley Periodicals, Inc.

Relationship of the recurrent laryngeal nerve to the inferior thyroid artery: A comparison of findings from two systematic reviews.

Systematic reviews (SRs) of anatomical studies may include a meta-analysis (MA) that provides weighted averages as pooled estimates of prevalence. The relationship of the recurrent laryngeal nerve (RLN) to the inferior thyroid artery (ITA) or its branches has been assessed in two published SRs, one without MA of 32 studies (SR1) and the other with MA of 79 studies (SR2). Both SRs reported differences in RLN-ITA patterns (in three categories) by side of the body, but the anterior pattern was less frequent in SR1 vs. SR2. The aim of this review was to explain the differences. The unweighted data from SR1 were found to be more affected (vs. SR2) by a single study with the largest number of RLNs and a low proportion anterior. In a MA using data from SR1, the pooled prevalence estimate for the anterior pattern was substantial (35%) on the right side (vs. 15% on the left) and close to the findings published in SR2. These consistent findings should be relevant to surgeons in attempting to avoid iatrogenic injury to RLNs. Comparison of methods and results from two or more SRs on the same anatomical relationships may be useful in evidence-based anatomy. Clin. Anat. 30:318-321, 2017. © 2017 Wiley Periodicals, Inc.

Growth of the Epidemic of Human Papillomavirus-Related Oropharyngeal Carcinomas in Whites in Selected US Metropolitan and Nonmetropolitan Counties, 1992-2013.

BACKGROUND: Age-standardized incidence rates (ASIRs) for US non-Hispanic whites (NHWs) have been increasing since 1999 for squamous cell carcinomas (SCC) at oropharyngeal (OP) anatomic sites strongly associated with human papillomavirus (HPV), as also reported from certain European countries. ASIRs declined slightly, however, from 2000­2006 to 2007­2012 in Stockholm County, Sweden (an urban area) for SCC of the tonsil (TSCC) but not base of tongue (BTSCC). For the United States, this study examined the growth of the epidemic of these cancers in 1992­2013. METHODS: Using join-point regression, trends were examined in ASIRs for BTSCC and TSCC for NHWs in US metropolitan vs nonmetropolitan counties included in a unique Surveillance, Epidemiology, and End Results (SEER) program database covering 1992­2013 (11 registries). Representativeness of recent trends was assessed using a larger SEER database (17 registries) covering only 2000­2013. RESULTS: ASIRs for NHWs were lower for nonmetropolitan vs metropolitan counties in 1992­1996 but rapidly increased and converged over time (especially using SEER-17). There was no decline in rates for TSCC in metropolitan counties, but for BTSCC, the increase was smaller in recent vs earlier years. Reporting delay of cases diagnosed in recent years was low in both groups of counties. CONCLUSIONS: Findings indicate the need for ongoing surveillance including additional US registries, and determining if rates in nonmetropolitan counties will surpass those in metropolitan counties. The rapid rise in rates in SEER nonmetropolitan counties also suggests the need for similar surveillance in countries with larger rural populations.

Surveillance of Tonsillar Cancer Incidence Rates in Minority Groups vs Non-Hispanic Whites in Large US Metropolitan Areas.

BACKGROUND: For oropharyngeal (OP) cancers at anatomical sites regarded as related to human papillomavirus (HPV), surveillance using population-based cancer registries has shown that age-standardized incidence rates are higher in US non-Hispanic whites (NHWs) vs minority groups. Surveillance in large racially-ethnically diverse urban areas also should be considered. METHODS: Using the US Cancer Statistics database, age-standardized incidence rates per year were obtained for 2003­2013 for carcinomas of the tonsil, the OP site most strongly associated with HPV. Data were available for NHWs, non-Hispanic blacks (NHBs), and Hispanic whites (HWs) in 20 large metropolitan statistical areas (MSAs), and for Asian-Pacific Islanders in 8 of these MSAs. Trends in annual rates were examined using join-point regression. RESULTS: The overall rate (2003­2013) was higher for NHWs vs each minority group in almost all MSAs. Little or no NHW­NHB difference was found in 3 MSAs, using abbreviated titles: San Francisco, with a relatively high rate for NHBs; San Diego, with high rates for both groups; and Detroit, with a low rate for NHWs and a high rate for NHBs. For individual MSAs with sufficient data for trends in at least 1 minority group, rising rates for NHWs diverged from NBHs and HWs in New York, and from NHBs in Chicago but not from NHBs in Detroit. For HWs, rates increased statistically significantly in the Miami MSA, vs a smaller increase in the Los Angeles MSA and no increase in the New York MSA. CONCLUSIONS: Surveillance of OP carcinoma incidence by MSA appears justified, but should use databases that attempt to collect information on racial­ ethnic subgroups (eg, birthplace and/or ancestry for HWs).

Using Data on Tumor Grade in Cancer Registries to Enhance Surveillance of Oropharyngeal Cancers in Relation to the Human Papillomavirus Epidemic.

BACKGROUND: Incidence rates have been increasing in US whites for squamous cell carcinoma (SCC) at anatomic sites involving the oropharynx (OP) and classified as potentially associated with human papillomavirus (HPV). Registries have not routinely collected data on HPV status of tumors. High tumor grade (poorly differentiated or undifferentiated), however, has been associated with HPV positivity in clinical studies. This study explored the potential value of adding data on tumor grade to registry-based surveillance efforts. METHODS: Data were obtained on tumor grade for 39,907 OP SCCs diagnosed in 2000-2012 at HPV-associated OP sites in a research database for Surveillance, Epidemiology, and End Results (SEER) Program registries. Grade was compared by anatomic site. Annual percent change in the age-standardized incidence rate was estimated by joinpoint regression. RESULTS: HPV-associated OP SCC sites were predominantly (87%) base of tongue and tonsils (BTT). High-grade comprised 40% for BTT vs 20%-30% for other HPV-associated sites. Temporal increases in total rates for BTT were evident for whites, who had statistically significant increases for high grade but persistently low rates for low grade. Rates increased for unknown grade, reflecting a decline in cancer-directed surgery. CONCLUSIONS: Findings support the use of tumor grade for surveillance of OP SCC in relation to the HPV epidemic. Future studies should include non-SEER registries, and also examine HPV status for unknown grade and consistency in grading among pathologists.

Surveillance of US Death Rates from Chronic Diseases Related to Excessive Alcohol Use.

AIMS: To assess the utility of multiple-cause (MC) death records for surveillance of US mortality rates from chronic causes related to excessive alcohol use. METHODS: The Alcohol-Related Disease Impact (ARDI) resource produced estimates of the population 'alcohol attributable fraction' (AAF) due to excessive drinking for each alcohol-related (AAF > 0%) cause of death, and used AAFs to estimate numbers of alcohol-related deaths from alcohol-related underlying causes (UC) in adults age 20-64 and 65+ years in 2006-2010. For surveillance, this study used MC death file to identify individual deaths (2006-2010) with an 'alcohol-induced' cause (AAF = 100%) anywhere on the certificate, and to obtain US rates of premature death (ages 15-64 and 65-74 years) for 1999-2012. RESULTS: Using the selected MC records, numbers of deaths from alcohol-related chronic UC (2006-2010) were 81% of ARDI estimates for age 20-64, but only 40% for 65+ years. The MC records identified substantial numbers of deaths from causes (e.g. certain infectious diseases) not included as alcohol-related in ARDI, but included in surveillance of premature death rates for chronic UC. Also, premature death rates for chronic alcohol-induced causes using only the UC (as in routine mortality statistics) were only about half the rates based on MC; all rates increased in recent years but some reached statistical significance only by using MC. CONCLUSIONS: Using MC records underestimated total US deaths from alcohol-related chronic causes as the UC, but enhanced surveillance of rates for premature deaths involving chronic causes that may be related to excessive alcohol use.

Increase in Distant Stage Breast Cancer Incidence Rates in US Women Aged 25-49 Years, 2000-2011: The Stage Migration Hypothesis.

Background. Unexplained increases have been reported in incidence rates for breast cancer diagnosed at distant stage in younger U.S. women, using data from the Surveillance, Epidemiology and End Results (SEER) Program. Methods. This report focused on recent SEER trends (2000-2011) in age-standardized incidence rates of invasive breast cancer at ages 25-39 and 40-49 years and the hypothesis that stage migration may have resulted from advances in detecting distant metastases at diagnosis. Results. Increases in the rates for distant stage were roughly equal to decreases in the rates for the most advanced stage subgroups within regional stage; this was evident for estrogen receptor (ER) negative cancers, associated with poorer prognosis, but not for ER positive cancers. The 3-year relative survival rate increased over time for distant stage (especially in the ER positive subgroup) and regional stage but not for localized stage; these trends do not contradict the stage-migration hypothesis. Conclusions. Findings provide some support for stage migration as one explanation for the recent increase in incidence of distant stage breast cancer, but additional studies are needed using other databases.

Surveillance of the frequency and results of testing of incident oropharyngeal cancers for human papillomavirus: the potential role of population-based cancer registries.

Temporal increases in incidence rates for certain cancers of the oropharynx (OP), especially the base of tongue and tonsil (BTT), have been interpreted in relation to the epidemic of human papillomavirus (HPV) infection, but data on the actual presence of HPV in these tumors are limited. Data on the frequency and results of testing for HPV in OP cancers in defined populations also can be useful to clinicians. This study used the American Joint Committee on Cancer Collaborative Staging System's Site-Specific Factor 10 (SSF 10) for HPV status of OP tumors, collected by some registries for diagnoses since 2010. The study included 483 incident invasive BTT cancers diagnosed in 2010-2012 and reported to the Connecticut Tumor Registry of the Surveillance, Epidemiology and End Results (SEER) Program. Of the 483 cancers, 45.8 percent were reportedly tested for HPV in tumor tissue; the proportion coded as unknown declined from 54.6 percent for 2010 to 34.3 percent for 2012. The 153 cases reported as HPV-positive comprised 69.2 percent of the 221 cases with a known HPV test result, which is consistent with the proportions reported in the literature. Trends (2000-2010) in BTT cancer incidence rates in Connecticut were representative of trends in all 18 SEER registries combined. Similar studies are needed from other US central cancer registries that are collecting or want to start collecting HPV status of OP tumors, along with data on the specific types of HPV testing, for surveillance of the frequency and results of HPV testing of OP cancers.

Recent improvement in completeness of incidence data on acute myeloid leukemia in US cancer registries.

A limitation of data prior to 2010 on incidence of leukemia in US population-based cancer registries is that acute myeloid leukemia (AML) diagnosed as progression (transformation) from a previously diagnosed myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN, other than polycythemia vera), or chronic myeloid leukemia (CML) was not reportable. Data were used from a research database for the 18 cancer registries of the Surveillance, Epidemiology and End Results (SEER) Program, and from all registries in the US Cancer Statistics (USCS) database. Analyses compared the age-standardized incidence rate (ASIR) per 100,000 for AML before (ie, 2000-2009) vs after (ie, 2010) the new reportability rules for AML. The ASIR for all ages combined fluctuated until increasing from 3.60 (95 percent CI, 3.47-3.73; N = 3,068) in 2009 to 3.89 (95 percent CI, 3.76-4.03; N = 3,355) in 2010 in SEER, and from 3.64 (95 percent CI, 3.58-3.71; N = 11,488) in 2009 to 3.89 (95 percent CI, 3.82-3.96; N = 12,351) in 2010 in USCS. The increase from 2009 to 2010 was limited to ages 60+ years (from 13.87 to 15.59 in SEER and from 14.13 to 15.34 in USCS). The SEER research database allowed analysis by the number of cancers per person, which showed that the increase in AML cases and rates for age 60+ years from 2009 to 2010 was due to an increase in cases with a previous cancer(s) largely representing newly-reportable post-MDS, post-MPN and post-CML AML cases. Continued surveillance is needed to address the eventual impact of delayed reporting of diagnoses in 2010 on estimates and projections of AML incidence in the US population.

Inaccuracies in oral cavity-pharynx cancer coded as the underlying cause of death on U.S. death certificates, and trends in mortality rates (1999-2010).

OBJECTIVE: To enhance surveillance of mortality from oral cavity-pharynx cancer (OCPC) by considering inaccuracies in the cancer site coded as the underlying cause of death on death certificates vs. cancer site in a population-based cancer registry (as the gold standard). METHODS: A database was used for 9 population-based cancer registries of the Surveillance, Epidemiology and End Results (SEER) Program, including deaths in 1999-2010 for patients diagnosed in 1973-2010. Numbers of deaths and death rates for OCPC in the SEER population were modified for apparent inaccuracies in the cancer site coded as the underlying cause of death. RESULTS: For age groups <65 years, deaths from OCPC were underestimated by 22-35% by using unmodified (vs. modified) numbers, but temporal declines in death rates were still evident in the SEER population and were similar to declines using routine mortality data for the entire U.S. population. Deaths were underestimated by about 70-80% using underlying cause for tonsillar cancers, strongly associated with human papillomavirus (HPV) infection, but a lack of decline in death rates was still evident. CONCLUSION: Routine mortality statistics based on underlying cause of death underestimate OCPC deaths but demonstrate trends in OCPC death rates that require continued surveillance in view of increasing incidence rates for HPV-related OCPC.

Trend in rates for deaths with mention of schizophrenia on death certificates of US residents, 1999-2010.

BACKGROUND: Trends in mortality rates for schizophrenia using multiple causes of death (including contributory causes) coded on death certificates in the US resident population apparently have not been reported. METHODS: Age-standardized rates for deaths per 100,000 in 1999-2010 at age 15+ years (and for 15-64 and 65+ years) with mention of schizophrenia were examined for the US resident population, including variation by age, gender, race (blacks/African Americans and whites) and region. RESULTS: Deaths at age 15+ years coded with schizophrenia as underlying cause were only 12 % of all deaths with mention of schizophrenia, for which the rate declined from 1.58 in 1999 (3,407 deaths) to 1.32 in 2010 (3,422 deaths) (percentage change or PC = -16 %). Declines were larger in females than males, in whites than blacks, and occurred in the Northeast, Midwest and South but not the West. The rate increased for age 15-64 years (PC = +28 %) (mainly in males), however, while declining for age 65+ years (PC = -35 %). For deaths at age 15-64 years with schizophrenia coded as other than the underlying cause, the largest continuous increase was for endocrine-metabolic diseases (predominantly diabetes mellitus) as underlying cause, with smaller increases in males for cardiovascular diseases, external causes and neoplasms. CONCLUSION: Trends in the US rate for deaths with mention of schizophrenia varied among the sociodemographic groups examined. The lack of decline for age 15-64 years requires further study especially with regard to mediators (e.g., obesity) of excess mortality in schizophrenia identified from cohort studies.

Persistent disparity in prevalence of current cigarette smoking between US adolescents with vs. without a past-year major depressive episode.

Using data from annual (2004-2010) cross-sectional surveys of nationally representative samples, the prevalence rate of current (i.e., past 30 days) cigarette smoking among US adolescents age 12-17 years was twice as high for those with vs. without a past-year major depressive episode (PYMDE) (22 vs. 11% in the 2004 survey and 16 vs. 8% in the 2010 survey). The proportion of all US adolescent current smokers who had a PYMDE was about 24% for females; 70-80% of all smokers with PYMDE were females. The persistently higher smoking rates in US adolescents with vs. without PYMDE emphasizes the need for interventions.

Cancers coded as tongue not otherwise specified: relevance to surveillance of human papillomavirus-related cancers.

Data from US population-based cancer registries have shown increasing incidence rates for cancer of the base of the tongue, interpreted as related to the epidemic of human papillomavirus (HPV) infection, but rates could be underestimated due to miscoding of some base of tongue cancers to tongue "not otherwise specified" (NOS). Tongue NOS was the most commonly coded subsite among incident (2000-2011) invasive cancers of the oral tongue (tongue excluding base of tongue and lingual tonsil which together comprise the posterior one-third of the tongue) in the 18 Surveillance, Epidemiology and End Results (SEER) Program registries combined and in the Connecticut SEER registry. All 173 cases of tongue NOS cancer in the Connecticut SEER registry diagnosed in selected years were reviewed. Only 5% were recoded to base of tongue, decreasing from over time from 8% to 2%, resulting in minimal impact on the incidence rate for base of tongue cancer in Connecticut. Most (76%) of the 173 tongue NOS cases were recoded to anterior two-thirds of tongue NOS, ruling out base of tongue as the actual site but resulting in underestimation of incidence rates for anterior two-thirds NOS in Connecticut. Similar studies are needed on tongue NOS cancers in other US cancer registries, along with studies on the HPV status of tumors at specific subsites of the oral tongue, to enhance surveillance and interpretation of trends in cancer incidence in relation to the HPV epidemic.

Trend (1999-2009) in U.S. death rates from myelodysplastic syndromes: utility of multiple causes of death in surveillance.

BACKGROUND: For myelodysplastic syndromes (MDS) (formerly known as preleukemia), a diverse group of myeloid neoplasms usually involving anemia in elderly persons, trends in U.S. death rates apparently have not been reported. METHODS: Trends in annual age-standardized rates per 100,000 from 1999 to 2009 were examined for MDS using multiple causes vs. underlying cause alone, coded on death certificates for U.S. residents. RESULTS: The death rate (all ages combined) for MDS increased from 1999 to 2009, from 1.62 to 1.84 using underlying cause alone and from 2.89 to 3.27 using multiple causes. Rates using multiple causes were about 80% higher than those based on underlying cause alone. From 2001 to 2004 the rate for MDS using underlying cause alone (but not using multiple causes) declined, accompanied by an increase in the rate for deaths from leukemia as underlying cause with mention of MDS; this trend coincided with the advent of the 2001 World Health Organization's reclassification of certain MDS as leukemia. The MDS rate for age 65+ years increased after 2005, whereas the rate for age 25-64 years was low but declined from 2001 to 2003 and then stabilized. For deaths with MDS coded as other than underlying cause, rates did not decline for deaths from each of the two most common causes (i.e., cardiovascular diseases and leukemia). CONCLUSIONS: Evidence for decreases in MDS-related mortality rates was limited; the increase at age 65+ years is consistent with increases in incidence rates reported from cancer registries. Using multiple causes of death vs. only the underlying cause results in substantially higher MDS-related death rates, shows the impact of changes in the classification of myeloid neoplasms and emphasizes the importance of reducing cardiovascular disease mortality in MDS patients.

Trends in bipolar disorder or depression as a cause of death on death certificates of US residents, 1999-2009.

BACKGROUND: Temporal trends in mortality from bipolar disorder (BD) or depression in the US population, based on multiple causes (MC) rather than underlying cause (UC) alone on death certificates, apparently have not been examined. METHOD: The annual US age-standardized rate (ASR) for deaths per 100,000 US residents age 15+ years, and age-specific rates, for BD or depression using MC versus UC alone was examined for 1999-2009; percentage change (PC) from 1999 to 2009 was calculated. RESULTS: The ASRs at age 15+ years were much higher using MC than UC alone. For BD using MC, the ASR increased from 1999 to 2009 (PC +69.2 %) with larger increases in age groups within 15-64 years (PCs about 200 %). For depression using MC, the ASR rose from 1999 to 2003 and then declined, but the decline was restricted to age 65+ years; the ASR at age 15-64 years increased from 1999 to 2009 (PC +55.5 %). For deaths at age 15-64 years with BD or depression as other than UC, the ASRs increased for external causes, cardiovascular diseases, external causes, and neoplasms as UC. CONCLUSION: The large increases in mortality from BD using MC are consistent with reported increases in BD prevalence rates in the US population. The temporal increases in death rates related to mood disorders at age 15-64 years may provide further support for the need for interventions to address the mediators of excess mortality identified from cohort studies.