BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

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Patternsof Mortality in Childhood
of the State Health Department in epidemiologic studies on tuberculosis. The
tuberculosis death rate in Tennessee was one of the highest in the United States
were low. Through the
and the financial resources for combating the problem
Williamson County Tuberculosis Study conducted with financial assistance from
aspects of the problem analyzed in
the Rockefeller Foun(ation, many
were
depth. The excessive calcification found in the lungs of residents of the area
led to Dr. Amos Christie's discovery of sensitivity to histoplasinin. That comresearch
prograin, which combined a longitudinal study of
munity-centered
tuberculosis with a preventive program, made unusual contributions. This same
policy of coinmunity-centered research oriented toward prevention in specific
areas and countries is one that should he developed in Latin America.
The Inter-American Investigation of Mortality in Childhood is the second
large, coordinated research jrogram undertaken by tile Pan American Health
Organization to gain a greater understanding of the epidemiology of diseases
as the basis for health programs in the Americas. The marked geographic
variations observed in death rates from the cardiovascular diseases, and in
particular arteriosclerotic heart disease, )roml)ted the Organization to carry out
the first of these programs in 1962-1964 in twelve cities, eleven in the Americas
and one in Bristol, England. The primiary objective was to produce an accurate
and comprehensive account of mortality in adults 15-74 yearrs of age. The
findings of that Investigation made it clear that there were wide and true
differences in mortality from cardiovascular diseases and malignant neoplasms
that could not be attributed to differences in nosology or classification. MIany
areas were l)inpointed in which further research was needed in order to gain
more knowledge of the epidemiology of cardiovascul'ar diseases, malignant
neoplasms, as well as others such as cirrhosis of the liver and diabetes mellitus.
The results of that Investigation showed that the additional information
clinical
available in hospital and autopsy records, when combined with the
data, would make it possible to arrive at more precise deterinination of the
causes of death. The selection of one single cause often )roved difficult if not
impossible. Suitable nimethods of handling multiple causes and combinations of
causes therefore had to be devised. Moreover, it was recommended that
modern computer techniques be tried for study of the epidemiology of diseases,
not as isolated entities but as combinations of pathological states.
The Division of General Medical Sciences of the U.S. National Institutes of
Health awarded a grant (No. GM-08682) to PAHO for the conduct of that first
research programi. The findings were reported in the volume Patterns of Urban
Mortality (Scientific Publicationi PAHO No. 151, 1967), which appeared also
in Spanish with the title ('aractcristicasde la inortalidadurbana (1968).
Fortunately, the opportunity was providcd to utilize the experience gained
in that first large geographic study of diseases inia much amore ambitious
program of research on mortality in childhood. Early in 1966 a protocol and
procedures for a comprehensive investigation of mortality in infancy and early
childhood in the Americas were developed by the Pan American Health