Neurological deaths of American adults (55-74) and the over 75′s by sex compared with 20 Western countries 1989-2010: Cause for concern

Abstract

Background:Have USA total neurological deaths (TNDs) of adults (55–74) and the over 75's risen more than in twenty Western Countries?Methods:World Health Organization TND data are compared with control mortalities cancer mortality rates (CMRs) and circulatory disease deaths (CDDs) between 1989–1991 and 2008–2010 and odds ratios (ORs) and confidence intervals calculated.Results:Neurological Deaths – Twenty country (TC) average 55–74 male rates per million (pm) rose 2% to 503 pm, USA increased by 82% to 627 pm. TC average females rose 1% to 390 pm, USA rising 48% to 560 pm. TC average over 75's male and female increased 117% and 143%; USA rising 368% and 663%, significantly more than 16 countries. Cancer mortality – Average 55–74 male and female fell 20% and 12%, USA down 36% and 18%. TC average over 75's male and female fell 13% and 15%, the USA 29% and 2%. Circulatory deaths – TC average 55–74 rates fell 60% and 46% the USA down 54% and 53%. Over 75's average down 46% and 39%, USA falling 40% and 33%. ORs for rose substantially in every country. TC average 75's ORs for CMR: TND male and females were 1:2.83 and 1:3.04 but the USA 1:5.18 and 1:6.50. The ORs for CDD: TND male and females TC average was 1:3.42 and 1:3.62 but the USA 1:6.13 and 1:9.89.Conclusions:Every country's neurological deaths rose relative to the controls, especially in the USA, which is a cause for concern and suggests possible environmental influences.

Controlled population-based comparative study of USA and international adult [55-74] neurological deaths 1989-2014

“…The latter analysis used the later baseline years of 1989‐91, which confirmed the earlier onset of neurological morbidity and that neurological deaths continued to increase in the majority of the countries reviewed 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Rises in USA the over‐75s neurological deaths were considerable as the USA had significantly greater increases than fourteen of the other twenty nations, with threefold rises in American men and a fivefold increase in women in just 21 years 8. Furthermore, there is a new interest in neurological diseases in Latin America and Asia, with a rising incidence than previously, although the rates remain lower than those found in developed countries,2, 12, 13 suggesting this is increasingly a worldwide phenomenon.…”

“…Only country‐specific research could resolve this latter problem. The issue of reliability of diagnosis can be significant,14 but is largely resolved at the point of death in a global category such as “nervous disease deaths” 1, 5, 6, 7, 8. It is acknowledged that 100% accuracy can never be established, but as the WHO data are collected in a consistent and uniform system in these broad categories this is probably the most reliable and valid international data as yet available.…”

“…An example best explains this. Rises in neurological deaths5, 7, 8 had been attributed to rises in population15, 16, 17. Odds ratio tests this using the ratio of change in the USA elderly population, 1989 and 2014, giving a ratio of 1.49 and divides it into the ratio of change of neurological deaths, 5.13 and the ensuing ratio of ratios is the odds ratio of 3.44.…”

“…The accumulation of evidence has continued to build in this century 5, 6, 7, 8. The first international comparison of the changing neurological mortality was between 1979‐1981 and 1995‐1997 in twenty‐one developed countries found that the dementias were starting a decade earlier in a number of nations 5, 7.…”

“…However, the diagnostic issue has limited impact as it is mortality rates that are measured not separate diagnostic categories, and at this point, there is little evidence of diagnostic uncertainty as the primary cause of death is categorized as being due to a neurological condition 1, 5, 6, 7, 8. Moreover, the Gompertzian position appears to have ignored the marked changes between the sexes and in different countries 1, 5, 6, 7, 8, 9, 10, 11. Crucially, the Gompertzian hypothesis does not account for the substantial rise in early onset dementia reported in many Western countries 12, 13, 18, 19, 20, 21, 22…”