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BLOOD
The Journal
VOL.
II,
NO.
of Hematology
JANUARY,
i
A STATISTICAL
By
STUDY
S.
MILTON
OF MORTALITY
M.D.,
SACKS,
I.
S
URVEY
kemia
of the
morbidity
estimated
1931
the
population.
tan Life Insurance
States
annually
search
for further
supplement
to
statistical
B.S.
SEEMAN,
INTRODUCTION
literature
a virtual
annual
ISADORE
LEUKEMIA
death
reveals
absence
rate
a paucity
of statistical
of mortality
studies.
from
leukemia
in
data on
Neilsent
Denmark
at
leuin
per
i
Wintrobe’
noted
that according
to statistics
of the MetropoliCompany
there were 3,500
deaths
due to leukemia
in the United
between
1934
and 1936.
The application
of biostatistical
technic
50,000
to the
threefold
medical
and
AND
FROM
1947
analysis
knowledge
clinical
and
of mortality
from
of etiological
laboratory
leukemia
factors
research.
may
serve
in
The
to:
leukemia
results
offers
a
of careful
elucidate
(i)
specifi-
cally the trends
in mortality,
(i)
indicate
needed
areas for further
study,
and ()
demonstrate
the numerical
significance
of the problem.
Two
factors
support
the preferability
of an analysis
of mortality
data:
(i)
compulsory
registration
of all deaths
and the collection
of statistics
in a central
authority
that
the
provide
almost
complete
case fatality
rate from
reporting
leukemia
on a death
certificate
of almost
every
of analyzing
the incidence
of leukemia
cautions
must be observed
in interpreting
i.Changes
in
the
age
distribution
of deaths,
is ioo per
diagnosed
through
death
of
certificates.
The
is reflected
in mortality
3. Improvement
in
the
reporting
4. For the
of the
United
care
exercised
a population
statistics.
diagnostic
incidence
States,
in the
technics
of that
mortality
disease
data
will
of years,
any
disease
but expanding
geographical
area.
in the procedures
of mortality
tabulation
of discontinuity
visions
of the
in published
International
From
the
Department
of Medicine,
of Medicine,
and
the
Statistical
indicates
reporting
of
will
a spurious
cause
tend
of
to increase
death
records.
represent
figures
introduce
death
certification
an
from
element
mortality
statistics.
Such
changes
result
from
List of Causes
of Death,
revisions
of the Manual
Subdepartmeat
Section,
of Clinical
Baltimore
City
Pathology,
Health
University
Department.
of
for diseases
of a medical
on case and
prior
to 1933
an incomplete
5. Changes
School
introduce
particularly
statements
execution
for
experience
insuring
the
(i)
case. In spite of the advantages
mortality
figures,
a number
statistics
in general.
element
into crude death
rate trends
over a period
influenced
largely
by the factor
of age.
i.
Death
statistics
are derived
from physicians’
on death
and
cent,
of
Maryland
reof
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2.
STATISTICAL
Joint
Causes
tabulation
Each
of Death
when
of these
is to review
STUDY
used
several
factors
the
trends
Influence
in the
OF
MORTALITY
United
States
the
make
of mortality
of Procedural
revision
of
possible
leukemia.
leukemia
the
Relatively
have
been
the
United
this
paper.
It must
from
Changes
leukemia
States
classification
of
minor
changes
made
since 192.0.
since
be noted,
only
192.0,
1900
Mortality
however,
that
in that year classified
under
made
by the U. S. Bureau
deaths
would
have
been
1,139
1910
disease
for
for
statistical
revisions.
of which
1944.
Statistics
List
Until
of Causes
of
the revision
omission
deaths
charged
tive side.
In the revision
discontinued,
and
blood;
residual
group
established.
of 1938
diseases
a separate
rubric
currently
in use,4
so certified
were
classification
for
1938
tO
used
of diagnosis
and
from leukemia.
consideration
assigned
reporting
of the
the
leukemia
result
from the
analysis
due
to Hodgkin’s
disease
and
in reality
a form of leukeof the deaths
attributed
to
of pseudoleukemia
obviously
err on
has been exthe conserva-
for pseudoleukemia
under
nonspecific
disease
was
was
diseases
provided
forthcoming
title
in the
and
in the
revision
major
an
understatement
of the
group
International
assigned
of the
List
to tumors.
was
have
allied
disorders
concerning
these
accumulate,
revisions
in their
that problems
of classification
in
in
to pseudo-
of communicable
diseases;
and a new subrubric
for aleukemias
To maintain
continuity,
only the leukemia
figures
since
1938
diseases.
As further
data on their etiology
tion may be expected.*
It is apparent,
then,
tentatively
true
true
in
of 192.9 and the revision
of
This study
revealed
that in
pseudoleukemia
title
of the
the rubric
classified
Hodgkin’s
been
of the mortality
when
a comparative
been used in this study.
All of these changes
in the categories
assigned
to leukemias
in the International
List
reflect
changing
medical
concepts
*Preliminary
from
of all
both the revision
of the Census.’
charged
to the
title.
Since the entire
the figures from 1910
established
rubric
for
mortality
have
to 1938 results
in an understatement
This fact was demonstrated
in 1940
study,
under
the
of leukemia
leukemia
list. Of these
deaths,
1,777
or 83 per cent were
2.47 or ii
per cent were due to aleukemia.
Aleukemia,
mia, appears
to constitute
a significant
proportion
the pseudoleukemia
cluded
from this
was
separately
true
192.9
has
to
for pseudoleukemia
Hodgkin’s
figures
the
of deaths
1938
was
those
deaths
cause
of the International
has been provided.
in specific
terms
In the discussion
the
from
process.
of the
one
from
on Leukemia:
a subclassification
192.0
leukemia
leukemic
1940,
to select
only a single
title under which
Hodgkin’s
disease
was also classified
was
for leukemia.
It is impossible,
therefore,
to discuss
mortality
from leufrom
ioo
to 192.0 without
recognizing
the exaggeration
inherent
in the
as a result
of the inclusion
of more
or less closely
allied
conditions.
With
to
LEUKEMIA
causes are certified
jointly,
and other
procedural
is considered
in the present
study,
the purpose
Since ioo
there
have been five revisions
Death.
In each revision
a rubric
for leukemia
of 192.0
assigned
kemia
figures
FROM
of Causes
classificaadded
to
number
of
of
Deaths
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MILTON
Changes
on
the
in
the
trend
The
crude
has
in
STATES
of
rate
from
i .0
per
330
AND
joint-cause
mortality
UNITED
mortality
risen
an increase
rate in 192.1
for
of recorded
II.
States
rules
S. SACKS
IN
leukemia
had
LEUKEMIA
in the
no
significant
effect
MORTALITY
United
population
cent8
(fig.
i and
in figure
i results
observed
have
leukemia.
EXPERIENCE
100,000
3
SEEMAN
selection
from
from
per
ISADORE
in
table
i).
primarily
States
tO
1900
Death
Registration
4.3 per ioo,00o
The apparent
drop
from the revision
in
1944,
in the death
of this title
1910.
4.5
4.0
z
o
3.5
-
I.
-i
a.
0
3.0
0
0
0#{149}
0
0
LM
a.
I,’
I-
2.0
-
I-
0
1.5
-
.0
I
900
I
I
l9I(
905
I
1920
915
1925
1930
1
1
935
940
________I
YEAR
FIG.
I.
CRUDE
DEATH
RATE
FROM
LEUKEMIA,
UNITED
Influences
The
United
data (table
i) indicate
States
at a rate nearly
Thus,
States
the average
from
1915
persons
(fig.
2.).
death
through
The
of Race,
Sex,
that leukemia
two and one-half
rates
causes
STATES
per
1940
for
ioo,ooo
were
1.7
this
DEATH
REGISTRATION
1900-1944
and Age
affects
times
the white
population
in the
as great as that for nonwhites.
population
for white
consistent
STATES,
difference
for the Death
persons
and
are
not
i.i
Registration
for colored
entirely
obvious
945
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4
STATISTICAL
STUDY
OF
MORTALITY
at this time.
Undoubtedly
some of this
in the availability
of thorough
medical
Males
TABLE
are affected
i.-Mortality
by leukemia
from
Leukemia,
by
difference
diagnosis
at a rate
Race
and
FROM
is accounted
for these two
one-third
Sex,
United
greater
States
Number
Death
Rate
1000
er
Year
ropulation
LEUKEMIA
Death
than
that
Registration
for females.
States,
1921-1942
of deaths
White
Total
for by differences
groups.
Nonwhite
-
Total
Female
Male
Leukemias
Total
Male
Female
(74a)*
1942.
3.9
5,189
4,947
1,838
2.109
2.42.
145
1941
3,7
4,954
4,705
1715
1,990
2.49
143
io6
1940
3.7
4,896
4,646
1,719
1.917
2.50
,6o
90
1939
3.3
4,2.80
4,077
1,336
1.741
2.03
113
90
True
Leukemias
97
(71a)t
1938
3.2.
4,116
3,92.2.
1,187
1,635
2.04
ii6
88
1937
3.0
3,899
3,702.
1,115
1.587
197
109
88
1936
i.8
3,62.8
3,476
1,004
1,471
151
1935
2.8
3,552.
3,391
1,953
1,438
i6i
2934
1.7
3,403
3,117
i,8o
1,411
176
95
8,
2933
1.5
3,088
1,959
1,715
1,134
119
84
45
82.
70
6,
100
1931
1.3
1,770
1,669
1,509
,,,6o
‘01
63
38
1931
1.3
1,691
2.583
,,,i
1,071
109
64
45
1930
1.1
1,508
2.400
1,411
,o8
73
35
36
988
(6a)
Leukemia
192.9
1.0
1,159
1,174
1,138
936
8
49
192.8
1.9
1,185
1,097
i,i8o
917
88
50
38
1917
1.9
1,997
1,931
1,098
833
66
35
31
192.6
i.8
1,854
1.786
1,013
773
68
37
1915
1.7
1,759
i,68
999
6o
70
41
192.4
i.6
1,543
1,481
869
6,i
62.
40
2.2.
1913
1.5
1,414
1,366
774
592.
8
36
11
1911
1.4
1,343
1,190
748
542.
53
30
2.3
1911
1.4
1,117
1,179
676
503
38
i8
2.0
International
List
of Causes
t International
List
of Causes
of Death,
Fourth
List
of Causes
of Death,
Third
*
International
The
average
corresponding
The
death
a rate of
remaining
15.7
death
rates
rate
rate
for
of
per
ioo,ooo
females
was
for all groups
deaths
high
at
Death,
per ioo,ooo
even older
Fifth
Revision,
is highest
1938.
Revision,
1919.
Revision,
males
1.2.
per
31
2.9
I
1910.
from
1915
through
was
1940
1.9;
the
ioo,ooo.
in the
ages
after
years,
with
the
peak,
population,
occurring
between
75 and 84 years, and
ages.
A secondary
peak
at ages under
years
is
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MILTON
noted.
The
definite
rates
rise
An
over
85 years,
where
males
reaches
age group
75-84
years.
at all
ages
colored
rate
the
Death
of
years
first
Rate
year;
per
deaths
Nonwhite
per
44,
that
Population,
100,000
States,
Male
by
higher
after
which
a
for the years
observations
rate.
than
the rate
for white
Race
and
Sex,
rate
in the
for
females
United
age
The
population
100,000
is greater
it exceeds
colored
between
States
Death
1925-1940
Total
White
a slightly
males
White
________________________________ ___________
Year
Nonwhite
___________ __________
_______________________
Female
Male
Female
Male
Female
1940
3.9
1.9
4.3
3.1
4.6
3.3
1.4
1939
3.5
1.5
3.7
t.8
3.9
3.0
1.7
1938
3.4
1.5
3.7
1.7
3.9
2.8
i.8
1937
3.2.
1.5
3.4
i.6
3.6
a.8
1.7
1936
3.0
1.2.
3.2.
1.4
3.5
1.6
i.
1.1
1935
3.0
1.1
3.2.
1.4
3.4
1.5
1.5
0.9
1934
i.8
1.4
3.0
1.4
3.1
1.5
1.5
1.1
1933
i.6
1.0
1.9
1.1
3.0
2.2.
1.3
0.7
1.3
1.3
1931
1.5
0.9
1.6
1.0
1.8
1.2.
1.1
o.6
1931
1.4
0.9
i.6
1.9
1.8
1.0
1.1
o.8
1930
1.3
0.9
1.5
i.8
a.6
1.9
1.3
o.6
1919
1.1
0.7
1.1
1.7
1.3
,.8
0.9
o.6
1918
i.,
o.8
1.1
1.7
1.3
,.8
0.9
0.7
1917
1.0
0.7
1.1
i.6
1.1
1.7
0.7
o.6
1916
1.9
0.7
1.0
i.6
1.1
1.7
o.8
0.7
1915
i.8
o.8
1.0
1.4
1.1
1.5
0.9
o.6
and
ages.
When
and
the
through
the same general
relationships.
by no other
group
at any
have
11.1
for colored
Registration
i
5
SEEMAN
years show
is exceeded
males
a maximum
The
after
1.-Leukemia
TABLE
in the
The rates for the two
rate for white
males
for white
females
lower
ISADORE
of the death
rates from leukemia
in the United
States
specific
for age, race, and sex, affords
some interesting
(table
3, fig. 3).
In 1940
the death
except
distinctly
AND
occurs.
analysis
and 1940,
1931
are
S. SACKS
34 years.
the
The
total
rate
death
sex to a standard
crude
death
rate
adjusted
percentage
rate from
increase
percentage
increase
for white
rate
from
population,
trend
very
1911
tO
in the
in the
1915
crude
females
leukemia
exceeds
from
192.1
1940
for
tO
colored
1940
and
rate.
adjusted
from
From
rate
1915
1930
tO
to
is slightly
of the change
in the death
indicates
that the greatest
rate from
increases
1940
1935
below
at all
for
age
is seen to follow
increase
in the
exactly
and from
the
5
that
females
is adjusted
the trend in the adjusted
rate
closely
(table
4). The percentage
It is thus apparent
that the rise in the total
death
to 1940
is due in only very small part to a changing
tion.
Review
1931
to
that
1935
for
the
same as the
to 1940
the
crude
rate.
rate from leukemia
from 1911
age distribution
of the popula-
leukemia
in each age
are occurring
at those
group
from
ages where
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6
STATISTICAL
the rate is highest.
from
1931
to 1940,
per cent (table
STUDY
OF
Thus,
while
the average
MORTALITY
the death
percentage
FROM
LEUKEMIA
rate at all ages increased
by 6i per cent
increase
for all ages over 64 was 104
).
KEY
--
-
WHITE
MALE
WHITE
FEMALE
NON-WHITE
MALE
NON-WHITE
FEMALE
8.0
7.0
6.0
t
0
MA&.
I.
1.0
‘
0.9
hI
.-.-.,
/ ,‘
-WHiTE
NON
,.
0.7
_“%
-,,
0.6
‘.
,‘
,-
.
-Et-5ALE
#{149}1
%_
0.5
1-
0.4
U
0
0.3
0.2
0.1
I
i
i
t
I
I
I
I
I
I
I
0
02
0i
CO
0
i
I
1
02
0
,
0I
0
YEAR
FIG.
2..
DEATH
RATE
DEATH
FROM
LEUKEMIA
BY
REGJSTRATION
(logarithmic
It becomes
in the total
obvious,
death
rate
therefore,
that
from leukemia
percentage
to increase,
of the population
and at the same
increasing
rate.
RACE
STATES,
AND
SEX,
UNITED
STATES
192.5-1940
scale)
under
present
conditions
is to be anticipated,
since
in the older ages most
time these age groups
a continued
the number
rise
and
affected
by leukemia
continues
are affected
by leukemia
at an
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MILTON
3.-Leukemia
TABLE
Death
S.
Rates
per
s ex
All
Ages
Under
1 Year
1-4
Years
AND
ISADORE
Population,
100,000
Death
R a e an d
SACKS
15-24
Years
States,
ii
25-34
Years
35-44
Years
7
Race,
and
45-54
Years
55-64
Years
65-74
Years
8.7
11.9
ii.6
for
Specific
Registration
5-14
Years
SEEMAN
Age,
and
Sex,
United
States
io
75-84
Years
85 Years
and
Over
1940
Total
White
Male
Female
4.5
1.9
1.5
i.6
2.6
4.9
5.2.
4.9
2..O
,.
i.6
2.7
5.0
8.
.6
.6
2.4
1.9
1.7
3.1
5.5
10.5
4.8
4.1
i.6
ii
1.5
2.3
4.5
3.7
4.9
3.9
4.6
I
I
7.3
15.7
6.9
16.3
7.1
‘4.9
2.1.1
6.3
10.4
11.9
7.6
Nonwhite
1.9
2.5
2.0
0.7
1.1
1.2.
2.2.
3.6
5.1
3.1
4.7
5.5
Male
2.4
2.5
1.4
1.0
1.4
1.7
2.3
4.2
6.
5.3
8.i
6.4
Female
1.3
1.5
1.5
0.4
0.7
o.8
1.1
3.0
3.5
0.9
i.
4.8
5.3
7.5
5.9
3.7
I
‘93’
Total
2.3
2.8
White
2.9
1.3
1.0
1.1
1.9
3.2.
2.4
2.9
3.2.
1.4
1.1
1.3
2.0
3.4
.6
7.9
6.,
4.1
Male
2.8
2.8
3.6
1.7
1.4
1.4
1.1
3.6
6.
9.2
7.9
6.7
Female
2.0
3.1
2.8
,.,
o.8
a.,
,.8
3.1
4.6
6.
4.4
1.1
Nonwhite
0.9
i.8
0.4
0.7
o.8
0.9
1.1
1.3
1.4
1.1
3.2
-
Male
1.1
1.8o.6,.l
1.1
0.7
1.4
1.5
o.6
1.4
1.1
-
Female
o.8
1.7
0.7
,.,
2.5
o.8
4.2
-
0.2
0.2
0.5
1.1
MALE
FEMALE
LEGEND
250
WHITE
-
-
-
NON-WHITE
z
0
20.0
0
0
o
5.0
0
0
a.
io
I-
5.0
65
75
85
(00
05
(5
25
35
45
55
(00
AGE
FIG.
3.
DEATH
RATES
FROM
LEUKEMIA
SPECIFIC
FOR
AGE,
RACE,
AND
SEX,
UNITED
STATES,
1940
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
8
STATISTICAL
STUDY
Factors
Data
on
cell
type
and
Special
analysis
was
leukemia
in Baltimore
the five year period
with
cell
of the
TABLE
type
of Cell
specified,
of
records
indicated
chronicity;
not
LEUKEMIA
Chronicity
available
cent
and
myeloid
of these
Adjusted
States,
*
and
87 per
lymphoid
in Crude and Age-Sex
per
are
constituting
incidence
Year
Type
FROM
for
the
United
States
Death
Rates
Years,
Age-Sex
from
6i per
deaths,
Leukemia,
indicated
Only
cent
were
United
States
acute
Death
and
Percentage
Rate per
Populations
Increase
Crude
Over
Rate
Previous
Date
Adjusted
Rate
1.4
1.4
1.7
1.7
11.4
11.4
1930
2.1
1.1
2.3.5
2.3.5
1935
t.8
2.7
33.3
28.6
1940
3.7
3.5
31.1
29.6
TABLE
Standard
.-Percentage
Million
increase
in
Population
from
Age-Specific
All
S. Census
Death
of
Rates,
1930.
Percentage
Increase
ages
1931
years
50.0
2.5-34
years
33.3
35-44
years
36.8
45-54
years
53.1
5 5-64
years
64.
65-74
years
58.7
per cent chronic.
of the myeloid
and
over
cent
population.
In the
cell type and chronicity
of the lymphoid
cases
in other
studies,9
ages while
chronic
Baltimore
in children
persons
age
45
I
i
86.
Of the deaths
with
cases and
per cent
been noted
of younger
After
i66.
years
years
As has
acteristic
most commonly
character
affected
6o per
1940
46.1
15-14
8
to
55.2
years
75-84
Death
75.0
year
4 years
5-14
States
6o.9
I
I-
United
1931-1940,
States
Group
Under
leukemia.
U.
Leukemia
Registration
Age
39
Registration
192.5
to
an
63 per cent
1921-1940
Adjusted
Death
100,000
total
leukemias.
deaths
for Selected
Crude
Death
Rate
100,000
Population
of the
192.1
Adjusted
as a
therefore
made of the original
records
of 154 deaths
filed with
the Baltimore
City
Health
Department
1939
through
1943.
It was observed
that
the deaths
equal
4.-Trend
MORTALITY
chronicity
whole.
from
during
almost
OF
experience
under
from
the
death
the occurrence
of acute
leukemia
leukemia
affects
the older segments
studied
years
through
rate
specified,
were acute.
(table
6), acute
leukemia
of age. In general
leukemia
years more frequently
from
chronic
leukemia
is charof the
occurred
of an acute
than
chronic
rises
markedly.
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
There
appears
lymphoid
Race
S. SACKS
to be no very
significant
or myeloid
sex appear
and
different
MILTON
cell
type
cell type.
to affect
only
The
Manual
of Joint
gives
preference
6.-Average
TABLE
ISADORE
age
the
9
SEEMAN
selection
incidence
of acute
Associated
with
in the
case
and
chronic
of leukemias
of
leukemias
of
insignificantly.
Causes
Census
AND
Annual
of Death
Causes
to
Death
of Death4
a large
Rate
used
number
from
Leukemia
Age,
Baltimore,
and
Leukemia
by the
of
per
United
conditions
States
Population,
100,000
Bureau
when
of the
certified
by
jointly
Chronicity,
Cell
Origin,
1939-1943
Age
Chronicity and Cell
Origin
_________________________
All
Ages
-1
1-4
___________________________________________
5-14
15-24
25-34
35-44
45-54
55-64
65’-74
75+
3.69
7.55
12.06
10.2.5
1.51
3.84
Total
3.59
1.96
5.66
2.05
2.31
1.70
2.66
Acute
‘.37
1.96
3.92.
,.ii
i.i6
‘.05
1.33
Lymphoid
.8
-
Myeloid
.6i
-
Monocytic
.07
-
Unspecified
.12.
1.96
Chronic
Lymphoid
Myeloid
i.i8
.87
-
.7.9
.x8
.87
.a6
.64
.39
.89
.37
.87
.15
.i8
-
.i6
-
-
.13
.31
.13
.47
.31
-
.02.
.26
.i6
-
i.i8
7.03
3.84
1.51
2.56
3.01
-
.39
-
Unspecified
.33
the
to
United
reveal
conditions.
containing
In
1940,
States
the
In all
leukemia
1,381
have
relationship
.63
1.03
-
0.77
1.2.8
underlying
.59
1.48
.29
.74
.13
.15
years
-
-
.i8
.8
2.51
1.18
i.66
3.19
5.02
0.38
0.92.
1.62.
x.66
3.48
4.52.
0.2.5
cause
of death.
1917,
the
.2.9
0.74
made
underlying
-
0.52
the
accidents.
for
.8
i.i6
-
diseases,
tuberculosis,
from violence
or
between
1.61
.15
-
.26
0.31
-
.26
-
-
3.48
been
-
-
.02
as the
.50
-
Monocyric
in assignment
1.45
-
.i
acute
communicable
deaths,
and deaths
.74
-
.i6
leukemia
3.0’
-
-
are the
maternal
3.52.
1.74
-
.49
with
2.56
3.19
.74
-
Myeloid
0.87
-
-
.2.6
-
-
-
.47
1.49
1.2.8
-
-
1.31
Myeloid
.59
-
-
.49
1.54
1.48
.15
-
-
‘.33
Lymphoid
.74
2.56
1.00
-
Lymphoid
.43
-
-
.50
-
Unspecified
i.4
-
-
.13
-
-
Unspecified
.52.
.88
.40
Monocytic
1.74
.51
-
.87
.74
.79
causes
Chief
among
these
venereal
diseases,
cancer,
Joint-cause
studies
for
1915,
of
and
death
1940
and
in an effort
associated
three
of these
years
more
than
95 per cent of all certificates
were
classified
to this cause
by Census
Bureau
procedures.
death
certificates
listed
other
causes
in addition
to leukemia.
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
10
STATISTICAL
Analysis
of these
or tabulation
from
than
to cancer,
was
records
although
to leukemia,
year
per
i
leukemia.
There
cent
States
both
condition
leukemia
charged
there
to
was
splenic
7.-Death
TABLE
Rate
from
for
splenic
Leukemia
the
in Census
was
Tracts
assigned
associated
on
973
every
was
death
same
According
certificates
4 deaths
as
certificates
listed
o8
to
as an
deaths
an
were
splenic
disease
associated
to Median
the
recognized
year
assigned
with
During
for
recognized
Grouped
neoplasm
Thus
this
6 deaths
the
were
of death
Ninety-one
every
assigned
anemia.
anemia
During
disease
spleen
and
other
was
of
which
of the
mortality
cause
death
or site
anemia.
in which
spleen.
Thus
nature
cause
process.
of the
the
the
some
the
leukemia
pernicious
death
to
certificates
both
that
than
I
the
reporting,
of the true
cases
or a disease
leukemic
disease.
in which
i
the
a disease
of these
72.
listing
reveal
other
was
in diagnosis,
assigned
joint-cause
anemia
figures
in
and
of error
of instances
records
was assigned
to anemias
charged
to anemia,
there
associated
In
1,186
LEUKEMIA
in understatement
certificates
certificate.
listed
141
FROM
sources
result
death
195
remaining
were
United
1940,
might
in a majority
Of the
MORTALITY
possible
which
There
were
stated
on the
unknown.
OF
reveals
procedure
leukemia.
leukemia
STUDY
factor
Monthly
Rent,
in
Baltimore
19391943
Median
Contract
or
Estimated
Monthly
Rent
Total
$a.oo
3.6
154
Per cent of
Leukemia
Deaths
in Hospitals
74.7
115
3.3
17
4.0
13
141,119
34
2.8
2.9
76.5
85.3
15-19.99
167,581
2.4
2.9
i8
75.0
30-34.99
111.410
11
3.5
17
8
80.9
8o.o
34-39.99
56,611
10
3.5
40-44.99
53.766
17
6.3
10
8.8
66,394
25
7.5
Il
48.0
over
the leukemic
as potential
By
the
graphic
city
process.
sources
use
of
available
in
Baltimore
into
seven
of less
than
more.
Analysis
reveals
a rising
segments
the
in part
larger
medical
of the Economic
data
monthly
on
designated
ranging
to
of the
death
rate
from
death
rate
for
the
the
personal
aid
a rise
economic
access
financial
at
public
(table
7).
from
in each
resources
and
this
is available.
with
with
trend
in
may
facilities
the
poorest
divide
a median
of
economic
the
geo-
to
rent
status
where
diagnostic
those
small
those
of these
economic
Perhaps
exhaustive
the
is possible
monthly
groups,
to more
expense
status
in
of
it
a median
leukemia
lowest
each
tracts,”t
with
paralleling
two
groups
greater
those
must therefore
be recognized
statistical
study.
in
census
in economic
month
8o.o
Factor
rental
as
per
intermediate
by
Influence
segments
8
categories
of disease
case material
for
$i
except
in
These
two
of additional
areas
rental
whom
Leukemia
Deaths
in
Hospitals
100,000
10
and
with
Rate
per
Population
85,374
10-14.99
than
Death
6i,ii,
$I5-’9.99
for
Leukemia
Deaths
1939-1943
853.578
Under
the
Total
Population
Census
April 1, 1940
or
segments
each
of
rate
is
be
these
higher
accounted
for
families
resources
to
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
MOUiVT
SINAI
iio’r
MILTON
Analysis
that
74.7
This
the
with
same
a mean
period.
after which
the
comforts
which
for
economic
percentage
of
was undoubtedly
INTERNATIONAL
of the
England
8.-Death
TABLE
of hospital
the
deaths
Rates
rate
Wales,’1
per
hospital
made
deaths
during
and
United
IN
from
leukemia
Canada,
the
Popul.t:cn
100,000
from
Wales,
States’
)
and
city
England
and
indicates
(table
7).
causes
the
before
of
highest
death
41.1
death
to secure
the
MORTALITY
pseudoleukemia*
in the
and
the
Pseudoleukemia,
Paris,
II
from
leukemia,
in many
a period
of hospitalization
of Paris12
and
enJ
all
with
LEUKEMIA
Leukemia
Canada,
from
segments
EXPERIENCE
death
and
L1tRa
SEEMAN
patients
in this group
returned
home
their
financial
status
made
possible.
III.
Comparison
ISADORE
in the five year period
1939-1943
leukemia
occurred
in hospitals
percentage
Although
rates
have
the lowest
instances
the diagnosis
1931
AND
of the deaths
in Baltimore
per cent of the deaths
from
compares
for
S. SACKS
fTAL
year
United
United
States
States,
England
1931
\Vales
Paris
Canadat
Age
Male
Total
Female
A:
All
ages
3.48
Age-Sex
2.85
4.09
B:
Under5
5-14
Total
Male
Adjusted
Specific
Total
Death
Rate$
1.19
l.53
3.75
3.03
Age-Sex
Female
Death
Male
e
3.2l
a.83
Total
Male
naeie
l.l9
L.75
1.81
Rates
3.71
2.97
3.03
2.35
1.34
-
i.i6
1.33
2.69
1.48
3.81
2.2.6
1.84
1.88
1.34
0.73
1.35
15-24
1.18
1.32.
2.36
1.31
1.71
o.8i
1.41
24-44
3.33
2.35
3.35
2.03
2.89
1.49
2.02.
a.56
45-64
7.42
5.43
5.83
3.98
4.12
3.2.7
5.19
3.16
8.i8
8.92.
4.76
4.30
9.86
4.62
6
ai.43
andover
White
*
t
population
Exclusive
Death
of the
Death
of
rates
only
Yukon
for
and
at all ages
U. S. Census
of
Registration
the
the
have
U. S. Death
Registration
Northwest
been
States.
Territories.
adjusted
for
age
and
sex
to the
Standard
Million
Population
1930.
States
indicates
that
the
general
experience
corresponds
closely
with
that
observed
for the United
States.
For greater
comparability,
white
population
of the United
States
has been included
(table
8).
To arrive
at a total death
rate for each community
which
is comparable
of differences
in population
with
respect
to age
and
sex
composition,
adjusted
for age and sex have
been computed.
The age-sex
adjusted
per ioo,ooo
population
for 1931
were:
United
States,
3.5; England
3.o; Paris,
i.;
Canada,
1.3.
When
it is remembered
that procedural
cause-of-death
*DI1ly
munities
the
classification
combined
studied.
figures
exercise
for
leukemia
an
and
influence
pseudoleukemia
in international
were
available
only
the
in spite
death
rates
death
rates
and Wales,
variations
in
comparability
for
some
of
the
com-
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
IL
STATISTICAL
of mortality
statistics,
STUDY
the
small
OF
MORTALITY
differences
in these
similar
experience
in each of the communities
The incidence
of leukemia
in each sex
rates for each area shows
some variations.
males
was
Canada
43 per
was
cent, with
Analysis
deviations
group
the
occurring
than
the
9.-Death
TABLE
trend
and
Rates
over
a very
death
rate for
The
Wales,
per zo
are
are
observed:
relatively
rates
and
for
area
Population
0,000
rate
for
by Five
Year
goiter
cough
death
than
by sex for
Paris,
76 per
substantiates
the
Selected
Causes,
rates
in the
in Paris,
Periods,
__________
of Death
the
higher
lowest
Leukemia
Whooping
in
cent,
in each
(i)
with
United
other
the
States
in Canada
areas,
and
secondary
Death
peak
Registration
Rate
per 100,000
__________
1935
Population
______________________
1930
1925
3.7
i.8
2.1
1.7
2.8
i.8
3.4
3.4
1920
1.9
2.2.
3.7
4.8
6.7
Dysentery
1.9
1.9
2.8
3.1
4.0
Alcoholism
1.9
i.6
3.5
3.6
1.0
Diphtheria
a.a
3.1
4.9
7.8
1.1
Malaria
in
1920-1940
Death
__________
1940
Exophthalmic
rates
difference
64 per
in each case.
of the deaths
the
years.
States
Cause
observed
.
general
6 years
indicate
studied.
as revealed
by the age adjusted
In the United
States
the death
females.
and
LEUKEMIA
States,
with
the highest
age specific
rates
occurring
older
and a secondary
high
in the ages under
Some
ages under
experience
in the group
5-14
(i)
for
for England
for the United
45 years and
from
age
greater
cent,
the rate for males
higher
of the age distribution
observations
in the groups
the
cent
per
i
FROM
11.5
3.5
2.9
2.0
3.4
.
i.8
4.8
7.8
7.6
Poliomyelitis
o.8
o.8
a.2.
a.
0.9
Scarlet fever
0.5
1.1
1.9
2.7
4.6
0.5
1.1
3.6
1.0
i.6
0.0
0.0
0.1
0.7
o.6
Typhoid
&
paratyphoid
Meningococcus
fever
a
meningitis
Smallpox
IV.
In
1942.
more
THE
persons
smallpox,
meningococcus
fever,
and diphtheria
that for the anemias,
since
The
per
more
leukemia
ioo,ooo
in the
and
population
in
192.0
from typhoid
population
leukemia
more
United
MORTALITY
States
meningitis,
scarlet
combined.7
The death
whooping
cough,
the
per cent for diphtheria,
89.1
ing cough
were experienced
in the
OF
died
FROM
LEUKEMIA
from
the
leukemias
complete
rate
to 3.7 in
fever
to i.o,
an increase
per cent
period
Decreases
artificial
must
still
from
United
States.
rose from
1.9
of 94.7
1940,
per cent for scarlet
during
this period.
it
in the
States
during
the same twenty-year
a decline
of 86.8 per cent.
is undoubtedly
reporting,
than
fever, poliomyelitis,
malaria,
typhoid
rate from leukemia
was higher
than
dysenteries,
or alcoholism.
Each year
than 5,ooo persons
have died of the leukemias
death
rate in the U. S. Death
Registration
1940
The death
rate
7.6 per ioo,ooo
SIGNIFICANCE
(table
9).
fell from
of 98.4
fever, and 81.4 per cent for whoopWhile
much
of the apparent
rise
and
attributable
be observed
that
to better
leukemia
diagnosis
has
been
a
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
MILTON
more
important
diseases
generally
traditionally
in
the
cause of death
recognized
received
main
S. SACKS
the
attention
nature.
average
For
of $5o2..oo
was
per death;
per death.
$0.17
the
research
able
in
per death.
contributed
studies
for
listed
years
latter
departments
The
than many
of those
group
which
have
of health
neglect
of
those
are,
research
each
in all other
death.
report
are
infectious
Corresponding
kidneys,
$0.38
to note that
in this
in leukemia
of course,
more
widespread
knowledge
this failure
contributed
Data from a study
by Medical
Memorial
was spent in research
on poliomyelitis
an
1940.
there
diseases
of the
It is significant
for research
13
and control
are largely
beyond
present
health
administration
and finance.
That
as well is shown
in an analysis
of funds
1940
$2..19
of official
of a communicable
for this purpose
by foundations
Funds,
Inc.,13 show
that in
$4.00
SEEMAN
ISADORE
during
the last twenty
as health
hazards.
The
causes
of death
whose
etiology
is a common
failure
of public
applies
to the field of research
of
AND
for
almost
per death;
leukemia
and
was
Such
1940.
diseases
figures
diseases
entirely
funds
an average
for
as may
cancer
were
of the
absent
heart,
from
now
be avail-
risen
continu-
negligible.
SUMMARY
The
recorded
desth
rate
ously
since 1900,
with
rate of 1.9 per ioo,ooo
94.7
per
cent
in
from
leukemia
an accelerated
population
in
this
twenty-year
in the
rate
192.0
period.
United
of increase
tO
3.7 in
This
States
has
since 1930.
1940
represents
increase
cannot
The rise from a
an increase
of
be accounted
for
by changes
in the age distribution
of the population,
for the age specific
death
rates have increased
in each age group.
The factor
of increasing
recognition
of the
disease
resulting
from improved
diagnostic
technics
and greater
use of hospitals
with
their
laboratory
facilities
must be given
adequate
consideration
to determine
the causes
for the rising
death
rate.
White
persons
are affected
at a rate more
than
twice
as great
Some
of the difference
must
be attributed
diagnostic
services.
Males
experience
a rate
females.
Leukemia
greatest
affects
frequency,
rate
higher
rate
falls
was
3.7 per
age
1.5
than
to the
100,000
persons
in the
and
population
any
the
other
lowest
age
point.
population.
older
ages,
under
under
In
to variations
approximately
1940
The
particularly
over
years
experiences
45 years.
the
of age
In the
death
highest
in the
one-third
as nonwhites.
availability
greater
years,
from
15.7
per
equal
incidence
of lymphoid
and
myeloid
with
ages
leukemia
the
ages
in the
lowest
Nearly
death
all
occurred
100,000
leukemia.
the
for
group
75-84 years.
Under
i year
the rate was 4.9 per 100,000.
The
per ioo,ooo,
occurred
in the ages from 15 tO 2.4 years.
Figures
for the city of Baltimore
for the five-year
period
1939-1943
almost
of
than
a mortality
intermediate
rate
rate,
in an effort
rate,
indicate
of the deaths
studied
in Baltimore
were reported
as acute leukemia.
leukemia
appears
to be more common
than acute lymphoid.
After
Acute myeloid
age 45 chronic
leukemia
acute
most
is more
frequently
observed;
younger
persons
experience
an
two-thirds
leukemia
commonly.
Undoubtedly
neither
diagnosed
many
nor
deaths
recorded
result
from
on a death
leukemia
certificate.
in which
Clinical
this
disease
was
evidence
indicates
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
14
STATISTICAL
that
the
causes
STUDY
in which
this
OF
failure
anemia,
and diseases
of the spleen.
are certified
jointly
with
leukemia
Comparison
of the experience
trends
of mortality
from leukemia
communities.
The
ences
in
England
Each
age
and
rates
since
more
1940
FROM
would
LEUKEMIA
occur
most
commonly
are
cancer,
Statistical
evidence
reveals
that these conditions
in a significant
number
and proportion
of cases.
of several
countries
indicates
that
the general
in the United
States
are common
to the other
per
and sex composition
Wales,
3.o; Paris
year
from
death
MORTALITY
population
100,000
in
of the population
and Canada
2.3.
2..5;
than
persons
,ooo
adjusted
1931
were:
in the
for
United
United
States
on a case
of leukemia
differ-
States,
3.5;
have
died
leukemia.
REFERENCES
J.:
NEILSEN,
worker.
2
Chronic
Acta radiol.
I3
M. M.: Clinical
WINTROBE,
Comparison
Deaths
of Cause
in the
Bureau
Manual
occupational
of
385, 1931.
Hematology.
of Death
United
the
Census,
19.’
14,
U. S. Department
Census,
and
of the
Death
FORKNER,
i6th
11
The
of
E.:
CLAUDE
Census
ment
of the
United
of Death
1938
Revisions
Reports,
(Fifth
Bureau
States,
Registrar
No.
for
Each
Commerce,
Revision)
of the
U.
of the
International
S. Department
and Joint
Census,
of
List.
Commerce,
Causes
of Death
(Fourth
1940.
of Commerce,
U. S. Department
1900-1940.
Cause,
and
12
Prefecture
13
Ville
de Paris,
Anne
Siseass, HENRY
S.: The
de la Seine,
of the
Statistical
Tables,
Part
Service
192.9,
future
of Commerce,
United
of
Bureau
of the
Census,
Review
of the
Vital
67,
25.’
1911-1936.
Bureau
1941-1944.
Allied
Disorders.
New
and Housing
by Census
Census,
Census,
of Commerce,
States,
the
of the
Bureau
U. S. Department
Bureau
Leukemia
Bureau
General’s
II),
States.
U. S. Population
of Commerce,
Series,
and
Statistics-Special
of Commerce,
United
Rates
U. S. Department
1
of Causes
U. S. Department
Statistics.
Statistics
Deaths
pp. 539-4#{176}.
1941,
392.9
in a radium
1943.
Mortality
Vital
based
1944.
List
Vital Statistics Rates in the
by the
Vital
1940.
a discussion
Philadelphia,
Assignments
States,
of the International
Edition).
ray poisoning:
Census,
1937-1941.
Statistics-Special
Reporrs,
1946.
York,
Tracts,
1938,
p.
Baltimore,
Il.
Maryland,
U. S. Depart-
1947..
of England
and
Wales
for
the
Year
1931
(New
Annual
I.
du Travail
et de Ia Statistique
et 1931.
of medical
research.
Municipale:
Annuaire
Sratistique
1930
In Philosophy
of Science
12.’
19-11,
1945.
de la
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
1947 2: 1-14
A STATISTICAL STUDY OF MORTALITY FROM LEUKEMIA
MILTON S. SACKS and ISADORE SEEMAN
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