Pneumonia, Flu Death Rate Is Up

The nation’s death rate from pneumonia and influenza, which reached an all-time low in 1982, has begun to rise again for reasons as yet unexplained. The trend, identified by statisticians at the Metropolitan Life Insurance Co., is so recent, it apparently has not been noticed by government health officials.

But the development, disclosed in a quarterly Metropolitan Life report, is clear enough, experts at the firm believe. An editor’s note concludes: “In this age of sophisticated medical and prevention practice, who would ever guess that pneumonia and influenza were becoming problematic conditions again? It is a fact.”

Bottomed Out in 1982

New data developed by Metropolitan Life appears to indicate that the flu and pneumonia death rate for the population at large bottomed out at 10.9 per 100,000 persons in 1982 but then started to climb, reaching 12.2 in 1984, an estimated 13.2 in 1985 and an apparently higher figure in 1986--though final rates have not yet been calculated. The company said there were 48,886 total flu and pneumonia deaths in 1982, but 66,630 last year.

Some of the difference, Metropolitan Life concluded, is due to the varying nature of seasonal influenza outbreaks, which assure at least some differences in rates and mortality each year. Influenza is a comparatively minor illness, but in high-risk populations it can develop into potentially fatal pneumonia. Flu and pneumonia deaths generally affect the very young and very old most severely. Recent trends suggest that the age groups from 65 to 74 and 75 and over have been hardest hit in the last four years. People especially vulnerable include those with diabetes, emphysema, stroke histories and heart disease.

But the consistency of the increase implies that a trend has developed beyond normal annual fluctuations, Metropolitan Life said. The company found there were more total flu and pneumonia deaths in 1986 than in any single year since 1969. At the federal government’s Centers for Disease Control in Atlanta, Dr. Thomas Torok said government researchers have not yet analyzed 1985 or 1986 data and are, for the moment, unable to confirm development of the trend identified by Metropolitan Life. “I’m not disputing what they’re saying,” he said. “I just haven’t seen it.”

Smoking and Death

Researchers at the National Cancer Institute have concluded that more than a third of male 35-year-old heavy smokers will die of causes directly related to tobacco use by the time they are 85. In fact, the researchers say, a 35-year-old heavy smoker has a 16% chance of dying from such a cause by age 65 and a 36% prospect of death by 85.

In other words, concludes a team led by Dr. Margaret Mattson of the institute’s division of cancer prevention and control, the risk of death from smoking vastly outstrips other potential causes of death that smokers may cite to justify their continued behavior. For instance, said Mattson and two other institute researchers in an article in the American Journal of Public Health, many smokers justify continued smoking in the belief that the prospect of actually dying from it is not significantly different from being killed in a car accident or airplane crash.

The prospect of a 35-year-old man dying in a motor vehicle crash by age 65 is just .7% and by 85, only 1%. For all accidents combined, the death chances are 1.5% by 65 and 2.4% by 85. The risk of airliner crash death for the same 35-year-old was so low it was not computed. Overall, there is just a 1 in 814,000 chance per trip that anyone will die in a plane crash.

“Perhaps . . . the risks from smoking are so familiar by now that the message is becoming less newsworthy and persuasive and is losing its power,” the team concluded. “But in fact, we have no other preventive message so powerful.”

Baby Cooing Test

Researchers at Johns Hopkins University in Baltimore have devised what amounts to a skills test to evaluate linguistic development of babies and infants even before they can speak coherent words. Reasoning that “language development is the best predictor of future intellectual endowment,” the team had to overcome an obvious problem: If a child can’t yet speak, how does one measure verbal skills?

The solution, Dr. Bruce Shapiro said, turned out to be development of a questionnaire for parents in which doctors inquire about the time at which certain significant baby talk and other verbal behaviors begin.

“Children don’t do particularly well in the office setting,” Shapiro said in explaining the quandary of doctors trying to test infants. “They’ll fuss. They’ll cry. They won’t perform as expected.”

Cooing, defined as uttering “long vowel sounds used in a melodic fashion,” would begin by age 2 or 3 months in a normal child, he said. Babbling would be expected by 6 or 7 months. At about a year, a baby should have uttered his or her first word, “other than dada or mama ,” Shapiro said in a telephone interview.

“We’ve found,” he said, “that these early milestones, if you will, are related to developmental outcomes.” The Johns Hopkins team is in the final stages of developing questionnaires and interpretive materials to permit pediatricians to test the linguistic skills of children from birth through about age 3. Shapiro said any doctor who read articles describing the techniques already published in medical journals could begin the practice now.

Circumcision Update

In what will probably only intensify the ongoing controversy over whether circumcision is a justifiable medical practice, an expert in the field has reported preliminary results of a study that indicates uncircumcised boys from 1 to 14 get urinary tract infections at a rate 2.5 times greater than those who are circumcised.

The disclosure was made in an exchange of letters to the editor published in the journal Pediatrics. The new study is being conducted by Dr. Thomas Wiswell, an Army Medical Corps officer at Brook Army Hospital in Texas and a leading expert in the circumcision controversy. Wiswell, who has said he would not routinely circumcise newborns--including his own sons--nevertheless writes that the new study finds that circumcision provides an apparent protection from urinary tract infection at least to adolescence. Such protection was previously thought to be confined to newborn boys.

“We do not yet advocate that all males should be circumcised to prevent urinary tract infections,” Wiswell noted, but he said his research team believes parents of newborn boys should be told in detail about the apparent link between circumcision and such complications.