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.Both stud-ies excluded children with clinical tuberculosis.Similar rates were found inautopsy studies of persons who died from diseases other than tuberculosis.The ability of infected humans to resist clinical tuberculosis was most strik-ingly demonstrated by a tragic accident in Lubeck, Germany, in 1926 where249 babies were inadvertently given massive doses of virulent tubercle ba-cilli.Although 31% died of acute tuberculosis, the remaining 69% devel-oped only minor lesions and were free of tuberculosis twelve years later.31Tuberculosis rates were highest in the lowest socio-economic groups.Louis Dublin compared tuberculosis mortality rates for three types of Met-ropolitan Life Insurance Company policyholders: low-income persons whopaid small premiums weekly for industrial insurance; middle- and upper-income persons who paid much larger premiums quarterly or less often forordinary insurance; and an in-between group that paid moderate premiumsmonthly for intermediate insurance.For white males ages 15 74 in 1925,industrial policyholders had a tuberculosis mortality rate of 1.4 per 1,000 poli-cyholders, intermediate policyholders had a rate of 1.1 per 1,000 policyhold-ers, and ordinary policyholders had a rate of 0.6 per 1,000 policyholders.32Nationality groups with similar tuberculosis infection rates had strik-ingly different tuberculosis mortality rates.Chadwick and Zack s study inthe early 1920s found that the reactions to the tuberculin test were aboutthe same (from 25% to 30%) among Massachusetts schoolchildren whosemothers were born in the United States, Great Britain, Ireland, Germany 106 Health Education for Healthy LifestylesTable 7.1: Pulmonary Tuberculosis Mortality Rates By Place Of Birth: New York City,1912 1193(rates per 1,000 persons)Nationalityof parentsPlace of Birth Nationality of deceased of deceased1912 1913 1912deaths rate deaths rate deaths rateAustro-Hungary 347 1.3 330 1.2 380 1.0England 165 2.1 147 1.9 160 1.4Germany 503 1.8 479 1.7 1,152 1.9Ireland 1,057 4.2 1,111 4.4 2,515 4.5Italy 409 1.2 446 1.3 540 1.0Russia 395 0.8 448 0.9 456 0.6Scotland 58 2.5 69 3.0 71 2.0Sweden 87 2.5 97 2.8 111 2.1U.S.A.5,021 1.8 4,939 1.7 1,595 1.6Total 8,591 1.8 8,601 1.8 8,591 1.8Sources: New York City Department of Health, Annual Report of the Board of Health for the Year EndingDecember 31, 1912 (New York: 1913), 166; New York City Department of Health, Annual Report forthe Calendar Year 1913 (New York: 1914), 178.and Austria, the Scandinavian countries, Italy, and Russia and Poland.Yettuberculosis mortality rates varied greatly by nationality in a manner simi-lar to total mortality.In New York City in 1912 and 1913 tuberculosismortality rates were lower for those born in Italy, Russia, and Austro-Hun-gary (the last two groups were mostly Jews) than for those born in theUnited States and Western Europe (see Table 7.1).Socio-economic factorswere important within nationality groups, so that, for example, Jews inlow-income neighborhoods in New York City had much higher tuberculo-sis rates than those in high-income neighborhoods.33The downward secular trend in tuberculosis mortality that began inthe second half of the nineteenth century continued unabated during theearly twentieth century.Massachusetts, an urban state with the first reliabledeath registration statistics, showed a decline from 3.1 tuberculosis deathsper 1,000 population in 1880 to 1.9 in 1900 and 0.6 in 1930.This wasmuch greater than the overall decline in the state s death rates, so that theproportion of all deaths that were caused by tuberculosis decreased from16% to 5% over the period.Statistics from the U.S.death registration areashowed a very similar trend, with tuberculosis mortality rates decliningfrom 1.9 per 1,000 persons in 1900 to 0.7 in 1930 while total death ratesdeclined from 17.2 to 11.3 per 1,000 persons.34 The Germ Theory and Health Education 107The decline in tuberculosis mortality rates benefited both low and highsocio-economic groups, according to studies of Metropolitan Life InsuranceCompany policyholders.Between 1911 and 1943 white and nonwhite maleand female industrial life insurance policyholders ages 16 24 and 26 45 expe-rienced substantial declines in their tuberculosis mortality rates (see Table 7.2).The decline was greatest for white males age 26 45 and for nonwhite (pri-marily black) males and females in both age groups.Comparisons of thelower socio-economic status industrial policyholders with the higher socio-economic status ordinary policyholders showed that tuberculosis mortalityrates declined by about two-thirds for both groups between 1911 and 1930.By 1936 39, female industrial policyholders had only slightly higher tu-berculosis mortality rates than female ordinary policyholders, but male in-dustrial policyholders continued to have much higher rates than male ordi-nary policyholders, mostly due to differences in occupations.35Table 7.2: Tuberculosis Mortality Rates, by Age, Sex, and Race: Metropolitan LifeInsurance Company Industrial and Ordinary Policyholders, 1911 43(deaths per 1,000 policies)Industrial Policyholderswhite white colored coloredmale female male femaleAges 16 251911 2.2 2.2 5.5 7.11926 0.7 1.2 3.0 4.61943 0.2 0.2 1.3 1.8Ages 26 451911 5.1 2.8 5.2 4.41926 1.6 1.1 2.9 2.51943 0.6 0.3 1.5 1.11936 39(deaths per 1,000 policies)Male FemaleType of Life Insurance Type of Life InsuranceAge Industrial Ordinary Industrial Ordinary26 35 0.6 0.3 0.5 0.436 45 0.9 0.4 0.4 0.346 55 1.3 0.5 0.3 0.256 65 1.4 0.6 0.4 0.3Source: Malvin E.Davis, Industrial Life Insurance in the United States (New York: McGraw-Hill, 1944),302, 318 19. 108 Health Education for Healthy LifestylesAlthough most of the secular decline occurred during a period ofrising standards of living, the decline did not result from that factor alone.Tuberculosis mortality rates continued to drop during the depression ofthe 1930s at a greater rate than the overall death rate despite steadily dete-riorating economic conditions.The tuberculosis mortality rates per 1,000population in the United States death registration area declined from 1.9in 1901 to 1.1 in 1920, 0.7 in 1930, and 0.5 in 1940.The overall crudedeath rate declined from 16.4 in 1901 to 13.0 in 1920, 11.3 in 1930, and10.8 in 1940.From 1930 to 1940, the proportion of all deaths from tuber-culosis dropped from 6.2% to 4.6%.The pulmonary tuberculosis mortal-ity crude death rates per 1,000 population in New York City dropped from2.3 in 1901 to 1.1 in 1920, 0.6 in 1930, and 0.5 in 1937.The overallcrude death rate in the city declined from 19.9 per 1,000 population in1901 to 12.9 in 1920, 10.8 in 1930, and 10.4 in 1937.Between 1930 and1937, the proportion of all deaths from tuberculosis dropped from 5.6%to 4.8% [ Pobierz całość w formacie PDF ]
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.Both stud-ies excluded children with clinical tuberculosis.Similar rates were found inautopsy studies of persons who died from diseases other than tuberculosis.The ability of infected humans to resist clinical tuberculosis was most strik-ingly demonstrated by a tragic accident in Lubeck, Germany, in 1926 where249 babies were inadvertently given massive doses of virulent tubercle ba-cilli.Although 31% died of acute tuberculosis, the remaining 69% devel-oped only minor lesions and were free of tuberculosis twelve years later.31Tuberculosis rates were highest in the lowest socio-economic groups.Louis Dublin compared tuberculosis mortality rates for three types of Met-ropolitan Life Insurance Company policyholders: low-income persons whopaid small premiums weekly for industrial insurance; middle- and upper-income persons who paid much larger premiums quarterly or less often forordinary insurance; and an in-between group that paid moderate premiumsmonthly for intermediate insurance.For white males ages 15 74 in 1925,industrial policyholders had a tuberculosis mortality rate of 1.4 per 1,000 poli-cyholders, intermediate policyholders had a rate of 1.1 per 1,000 policyhold-ers, and ordinary policyholders had a rate of 0.6 per 1,000 policyholders.32Nationality groups with similar tuberculosis infection rates had strik-ingly different tuberculosis mortality rates.Chadwick and Zack s study inthe early 1920s found that the reactions to the tuberculin test were aboutthe same (from 25% to 30%) among Massachusetts schoolchildren whosemothers were born in the United States, Great Britain, Ireland, Germany 106 Health Education for Healthy LifestylesTable 7.1: Pulmonary Tuberculosis Mortality Rates By Place Of Birth: New York City,1912 1193(rates per 1,000 persons)Nationalityof parentsPlace of Birth Nationality of deceased of deceased1912 1913 1912deaths rate deaths rate deaths rateAustro-Hungary 347 1.3 330 1.2 380 1.0England 165 2.1 147 1.9 160 1.4Germany 503 1.8 479 1.7 1,152 1.9Ireland 1,057 4.2 1,111 4.4 2,515 4.5Italy 409 1.2 446 1.3 540 1.0Russia 395 0.8 448 0.9 456 0.6Scotland 58 2.5 69 3.0 71 2.0Sweden 87 2.5 97 2.8 111 2.1U.S.A.5,021 1.8 4,939 1.7 1,595 1.6Total 8,591 1.8 8,601 1.8 8,591 1.8Sources: New York City Department of Health, Annual Report of the Board of Health for the Year EndingDecember 31, 1912 (New York: 1913), 166; New York City Department of Health, Annual Report forthe Calendar Year 1913 (New York: 1914), 178.and Austria, the Scandinavian countries, Italy, and Russia and Poland.Yettuberculosis mortality rates varied greatly by nationality in a manner simi-lar to total mortality.In New York City in 1912 and 1913 tuberculosismortality rates were lower for those born in Italy, Russia, and Austro-Hun-gary (the last two groups were mostly Jews) than for those born in theUnited States and Western Europe (see Table 7.1).Socio-economic factorswere important within nationality groups, so that, for example, Jews inlow-income neighborhoods in New York City had much higher tuberculo-sis rates than those in high-income neighborhoods.33The downward secular trend in tuberculosis mortality that began inthe second half of the nineteenth century continued unabated during theearly twentieth century.Massachusetts, an urban state with the first reliabledeath registration statistics, showed a decline from 3.1 tuberculosis deathsper 1,000 population in 1880 to 1.9 in 1900 and 0.6 in 1930.This wasmuch greater than the overall decline in the state s death rates, so that theproportion of all deaths that were caused by tuberculosis decreased from16% to 5% over the period.Statistics from the U.S.death registration areashowed a very similar trend, with tuberculosis mortality rates decliningfrom 1.9 per 1,000 persons in 1900 to 0.7 in 1930 while total death ratesdeclined from 17.2 to 11.3 per 1,000 persons.34 The Germ Theory and Health Education 107The decline in tuberculosis mortality rates benefited both low and highsocio-economic groups, according to studies of Metropolitan Life InsuranceCompany policyholders.Between 1911 and 1943 white and nonwhite maleand female industrial life insurance policyholders ages 16 24 and 26 45 expe-rienced substantial declines in their tuberculosis mortality rates (see Table 7.2).The decline was greatest for white males age 26 45 and for nonwhite (pri-marily black) males and females in both age groups.Comparisons of thelower socio-economic status industrial policyholders with the higher socio-economic status ordinary policyholders showed that tuberculosis mortalityrates declined by about two-thirds for both groups between 1911 and 1930.By 1936 39, female industrial policyholders had only slightly higher tu-berculosis mortality rates than female ordinary policyholders, but male in-dustrial policyholders continued to have much higher rates than male ordi-nary policyholders, mostly due to differences in occupations.35Table 7.2: Tuberculosis Mortality Rates, by Age, Sex, and Race: Metropolitan LifeInsurance Company Industrial and Ordinary Policyholders, 1911 43(deaths per 1,000 policies)Industrial Policyholderswhite white colored coloredmale female male femaleAges 16 251911 2.2 2.2 5.5 7.11926 0.7 1.2 3.0 4.61943 0.2 0.2 1.3 1.8Ages 26 451911 5.1 2.8 5.2 4.41926 1.6 1.1 2.9 2.51943 0.6 0.3 1.5 1.11936 39(deaths per 1,000 policies)Male FemaleType of Life Insurance Type of Life InsuranceAge Industrial Ordinary Industrial Ordinary26 35 0.6 0.3 0.5 0.436 45 0.9 0.4 0.4 0.346 55 1.3 0.5 0.3 0.256 65 1.4 0.6 0.4 0.3Source: Malvin E.Davis, Industrial Life Insurance in the United States (New York: McGraw-Hill, 1944),302, 318 19. 108 Health Education for Healthy LifestylesAlthough most of the secular decline occurred during a period ofrising standards of living, the decline did not result from that factor alone.Tuberculosis mortality rates continued to drop during the depression ofthe 1930s at a greater rate than the overall death rate despite steadily dete-riorating economic conditions.The tuberculosis mortality rates per 1,000population in the United States death registration area declined from 1.9in 1901 to 1.1 in 1920, 0.7 in 1930, and 0.5 in 1940.The overall crudedeath rate declined from 16.4 in 1901 to 13.0 in 1920, 11.3 in 1930, and10.8 in 1940.From 1930 to 1940, the proportion of all deaths from tuber-culosis dropped from 6.2% to 4.6%.The pulmonary tuberculosis mortal-ity crude death rates per 1,000 population in New York City dropped from2.3 in 1901 to 1.1 in 1920, 0.6 in 1930, and 0.5 in 1937.The overallcrude death rate in the city declined from 19.9 per 1,000 population in1901 to 12.9 in 1920, 10.8 in 1930, and 10.4 in 1937.Between 1930 and1937, the proportion of all deaths from tuberculosis dropped from 5.6%to 4.8% [ Pobierz całość w formacie PDF ]