Anita Brock

Suicide rates in young men in England and Wales in the 21st century: time trend study

Objectives To explore trends in suicide in young people to investigate the recent observation that after year on year rises in the 1970s, 1980s, and early 1990s, rates in young men are now declining. Design Time trend analysis. Setting England and Wales, 1968-2005. Population Men and women aged 15-34 years. Results Since the 1990s, rates of suicide in young men have declined steadily and by 2005 they were at their lowest level for almost 30 years. This decline is partly because of a reduction in poisoning with car exhaust gas as an increased number of cars have catalytic converters; but there have been declines in suicides from all common methods, including hanging, suggesting a more pervasive effect. Other risk factors for suicide, such as unemployment and divorce, have also decreased. Possible recent reductions in alcohol use among young men and increases in prescribing of antidepressants do not seem to be temporally related to the decline in suicide. Conclusions Suicide rates in young men have declined markedly in the past 10 years in England and Wales. Reductions in key risk factors for suicide, such as unemployment, might be contributing to lower rates.

Patterns of suicide by occupation in England and Wales: 2001–2005

BACKGROUND Suicide rates vary by occupation but this relationship has not been frequently studied. AIMS To identify the occupations with significantly high suicide rates in England and Wales in 2001-2005 and to compare these with rates from previous decades. METHOD Mortality data from death registrations in England and Wales over the calendar years 2001-2005 were used to calculate proportional mortality ratios (PMRs) and standardised mortality ratios (SMRs) for both men and women aged 20-64 years by their occupation. RESULTS Among men, in 2001-2005, construction workers, and plant and machine operatives had the greatest number of suicides. The highest PMRs were for health professionals (PMR=164) and agricultural workers (PMR=133). Among women, administrative and secretarial workers had the greatest number of suicides yet the highest PMRs were found for health (PMR=232), and sport and fitness (PMR=244) occupations. CONCLUSIONS Excess mortality from suicide remains in some occupational groups. The apparent changes in suicide patterns merits further exploration, for example examining the prevalence of depression and suicidal ideation in medical practitioners, dentists, veterinarians, agricultural workers, librarians and construction workers.

Mortality from all cancers and lung, colorectal, breast and prostate cancer by country of birth in England and Wales, 2001–2003

Mortality from all cancers combined and major cancers among men and women aged 20 years and over was compared by country of birth with that of the whole of England and Wales as the reference group. Population data from the 2001 Census and mortality data for 2001–2003 were used to estimate standardised mortality ratios. Data on approximately 399 000 cancer deaths were available, with at least 400 cancer deaths in each of the smaller populations. Statistically significant differences from the reference group included: higher mortality from all cancers combined, lung and colorectal cancer among people born in Scotland and Ireland, lower mortality for all cancers combined, lung, breast and prostate cancer among people born in Bangladesh (except for lung cancer in men), India, Pakistan or China/Hong Kong, lower lung cancer mortality among people born in West Africa or the West Indies, higher breast cancer mortality among women born in West Africa and higher prostate cancer mortality among men born in West Africa or the West Indies. These data may be relevant to causal hypotheses and in relation to health care and cancer prevention.

Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis

Objective To assess the effect of the UK Committee on Safety of Medicines’ announcement in January 2005 of withdrawal of co-proxamol on analgesic prescribing and poisoning mortality. Design Interrupted time series analysis for 1998-2007. Setting England and Wales. Data sources Prescribing data from the prescription statistics department of the Information Centre for Health and Social Care (England) and the Prescribing Services Unit, Health Solutions Wales (Wales). Mortality data from the Office for National Statistics. Main outcome measures Prescriptions. Deaths from drug poisoning (suicides, open verdicts, accidental poisonings) involving single analgesics. Results A steep reduction in prescribing of co-proxamol occurred in the post-intervention period 2005-7, such that number of prescriptions fell by an average of 859 (95% confidence interval 653 to 1065) thousand per quarter, equating to an overall decrease of about 59%. Prescribing of some other analgesics (co-codamol, paracetamol, co-dydramol, and codeine) increased significantly during this time. These changes were associated with a major reduction in deaths involving co-proxamol compared with the expected number of deaths (an estimated 295 fewer suicides and 349 fewer deaths including accidental poisonings), but no statistical evidence for an increase in deaths involving either other analgesics or other drugs. Conclusions Major changes in prescribing after the announcement of the withdrawal of co-proxamol have had a marked beneficial effect on poisoning mortality involving this drug, with little evidence of substitution of suicide method related to increased prescribing of other analgesics.

Alcohol-related and hepatocellular cancer deaths by country of birth in England and Wales: analysis of mortality and census data

BACKGROUND The incidence of and mortality from alcohol-related conditions, liver disease and hepatocellular cancer (HCC) are increasing in the UK. We compared mortality rates by country of birth to explore potential inequalities and inform clinical and preventive care. DESIGN Analysis of mortality for people aged 20 years and over using the 2001 Census data and death data from 1999 and 2001-2003. SETTING England and Wales. MAIN OUTCOME MEASURES Standardized mortality ratios (SMRs) for alcohol-related deaths and HCC. RESULTS Mortality from alcohol-related deaths (23 502 deaths) was particularly high for people born in Ireland (SMR for men [M]: 236, 95% confidence interval [CI]: 219-254; SMR for women [F]: 212, 95% CI: 191-235) and Scotland (SMR-M: 187, CI: 173-213; SMR-F 182, CI: 163-205) and men born in India (SMR-M: 161, CI: 144-181). Low alcohol-related mortality was found in women born in other countries and men born in Bangladesh, Middle East, West Africa, Pakistan, China and Hong Kong, and the West Indies. Similar mortality patterns were observed by country of birth for alcoholic liver disease and other liver diseases. Mortality from HCC (8266 deaths) was particularly high for people born in Bangladesh (SMR-M: 523, CI: 380-701; SMR-F: 319, CI: 146-605), China and Hong Kong (SMR-M: 492, CI: 168-667; SMR-F: 323, CI: 184-524), West Africa (SMR-M: 440, CI, 308-609; SMR-F: 319, CI: 165-557) and Pakistan (SMR-M: 216, CI: 113-287; SMR-F: 215, CI: 133-319). CONCLUSIONS These findings show persistent differences in mortality by country of birth for both alcohol-related and HCC deaths and have important clinical and public health implications. New policy, research and practical action are required to address these differences.

Early onset of breast cancer in British Black women.

British Journal of Cancer (2008) 98, 2011. doi:10.1038/sj.bjc.6604415 www.bjcancer.comPublished online 10 June 2008& 2008 Cancer Research UKSir,We read with interest the article by Bowen et al (2008) reportingdifferences between age of onset, type of breast cancer and survivalin British black and white women in East London. They reportedthat, compared to white women, black women presented onaverage 21 years younger, that tumours in younger black womenwere more likely to be aggressive and that survival was pooreramong black women despite similar treatment and socioeconomicstatus.However, we were surprised by the authors’ statement that therehave been no previous published data on the patterns of breastcancer in British black women. We recently reported data in thisjournal on mortality from various cancers including breast cancerby country of birth in the United Kingdom (Wild et al, 2006). Weused country of birth in our analysis because death certificates inthe United Kingdom do not specify ethnicity. Although werecognise that country of birth does not necessarily reflectethnicity, it is a reasonable proxy. For example 85% of womenborn in the Caribbean and West Indies identified themselves as‘Black Caribbean’ in the 2001 Census (Office for National Statistics,2001).We reported higher breast cancer mortality, with standardisedmortality ratios (SMR) and 95% confidence intervals (CI) amongwomen born in West Africa of 132 (105–163) and in North Africaof 132 (96–176). This was an unexpected finding not reported inprevious similar analyses of mortality by country of birth and wewere interested to see the potential explanations offered by thefindings of Bowen et al.Secondly, we would like to offer an additional explanation forthe observed age difference at presentation in the British blackwomen. The national Census indicates that the British blackpopulation in the United Kingdom is younger in comparison to thewhite population (Office for National Statistics, 2001). This mayinfluence the mean age at presentation of disease. The authorshave sought to compare the age structure in the two populations;however, because broad age groups (16–59 years and 60 years ormore) were used, important variations in age structure mayremain unnoticed. It is a common mistake to deduce from themean age of presentation that the disease occurs earlier. Estimatesof age-specific rates are essential to assess whether true differencesexist in age at presentation.Finally, in our study (Wild et al, 2006) we did not find asignificant excess of breast cancer mortality for women born in theWest Indies (SMR 92 [80–106]), the majority of whom are likely tobe black. There was a much larger number of breast cancer deaths(208) for women born in the West Indies over the 3-year period ofthe study than the 85 and 43 breast cancer deaths among womenborn in West and North Africa respectively. This suggests thatthere may be heterogeneity of breast cancer risk among Britishblack women. ‘British black’ is likely to be too broad a term for thestudy of ethnic differences and ethnicity should be further definedwhere possible (Agyemang et al, 2005).