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PubMedDate not supplied

Excess mortality of bipolar and unipolar manic-depressive patients.

To compare mortality in bipolar and unipolar manic-depressive patients, 2168 manic-depressive first admissions reported to the Danish Psychiatric Central Register were divided into a bipolar group (19%), i.e., patients with at least one admission for mania during an average observation period of six years, and a unipolar group. When compared with the general population, the total group had an increased mortality by suicide and accidents in both sexes and by non-violent causes in men. The bipolar group had a higher non-violent mortality than the unipolar group, but the violent mortality was not different. Statistical problems introduced by patients switching from the unipolar to the bipolar group during the period of observation are discussed.

Accidents↗
PubMed1996

Excess mortality associated with the use of a rapid infusion system at a level 1 trauma center.

The Rapid Infusion System (RIS) is a device which can deliver warm fluid and blood products rapidly and at precise rates. It has been in use since 1990 for the management of victims of major trauma at the R Adams Cowley Shock Trauma Center (STC) in Baltimore. Although the RIS is unquestionably a convenience to the anesthesiologist, no study to date has addressed its effect on patient outcome. We have therefore undertaken a retrospective review of all uses of the RIS on trauma patients during the years in which it has been available at the Shock Trauma Center, comparing actual patient mortality both to expected mortality derived from the STC Trauma Registry, and to matched historical controls who did not receive fluids via the RIS. A total of 527 patients were included in the study. The mean volume infused via the RIS was 9724 ml, and the total volumes ranged from 24-117 585 ml. Overall survival was significantly less than expected (52.9% vs. 61.8%, P < 0.001). Survival in penetrating trauma was similar to expected, but in blunt trauma it was considerably less (48.8% vs. 63.0%, P < 0.001). Patients whose probability was between 0.1% and 0.9% also survived significantly less frequently than expected (44.3% vs. 57%, n = 105, P < 0.008). In those patients who received less than 6000 ml via the RIS, the actual and expected survival rates were almost identical. In those receiving more than 6000 ml (180 patients), the difference between actual and expected survival was striking (37.2% vs. 57.2%, P < 0.0001). As compared to matched control patients injured to the same extent during the same time period, patients who received fluids via the RIS had a 4.8 times greater chance of dying (95% confidence interval 2.4-7.1). These data call into question current protocols for rapid volume infusion in trauma management and point to the need for further prospective trials.

Fluid Therapy↗
PubMed1996

Excess mortality of unemployed men and women during a period of rapidly increasing unemployment.

BACKGROUND: Previous studies have found evidence of higher mortality rates among unemployed people than among those in employment, but the effect of changes in national unemployment rates on this association is unclear. We studied mortality in both men and women during a period of rapidly increasing unemployment in Finland. METHODS: In this prospective study of mortality in the Finnish population aged 25-59 years (2.5 million people), baseline sociodemographic data were obtained from the 1990 census and information on employment status in 1987-92 from Statistics Finland's labour force data files. Mortality follow-up was established by record linkage to death certificates from 1991 to 1993. FINDINGS: Individuals who experienced unemployment between 1987 and 1992 had greater mortality than those in employment after control for age, education, occupational class, and marital status. The mortality ratios for men and women unemployed for the first time in 1990, at a time of low national unemployment were 2.11 (95% CI 1.76-2.53) and 1.61 (1.09-2.36), respectively. These values were lower for those who were unemployed for the first time in 1992 when the national unemployment rate was very high (men 1.35 [1.16-1.56], women 1.30 [0.97-1.75]). The jobless who were re-employed had higher mortality than those who were continuously employed, but not as high as those who remained unemployed. INTERPRETATION: We have found that the association between unemployment and mortality weakens as the general unemployment rate increases. Studies that took place when the unemployment rate was low may thus overestimate the effect of unemployment on mortality because of unaccounted confounding.

Adult↗
PubMed1999

Risk factors for excess mortality in Harlem. Findings from the Harlem Household Survey.

INTRODUCTION: In 1980, age-adjusted mortality rates in Central Harlem were the highest among New York City's 30 health districts. This population-based study was designed to describe the self-reported frequency of selected health conditions, behavioral risk factors, preventive health practices, and drug use in the Harlem community. METHODS: From 1992 to 1994, in-person interviews were conducted among 695 adults aged 18 to 65 years who were randomly selected from dwelling-unit enumeration lists for the Central Harlem health district. Descriptive statistics were computed for men and women separately, and compared to other population-based surveys. RESULTS: Self-reported medical insurance coverage in Harlem was unexpectedly high (74% of men, 86% of women) as was lifetime use of preventive health practices, e.g., blood cholesterol screening (58% of men, 70% of women). However, lifetime rates of substance use, e.g. crack cocaine (14%) and self-reported history of traumatic events, e.g., witnessing someone seriously injured or violently killed (49% of men, 21% of women) were also high in Harlem, especially in comparison to other populations. CONCLUSIONS: This study has identified important patterns of similarities and differences in risk behaviors between Harlem and other populations. Potential solutions to the health problems of Harlem may lie in the creation of strategies that operate at the community, municipal, and regional level, as well as at the level of individual behavior and risk-taking.

Adolescent↗
PubMed1999

Causes of excess mortality in cerebral palsy.

It is well known that individuals with cerebral palsy (CP) are subject to higher mortality than the general population but the causes of this have not been systematically analysed. This study investigates mortality in a Californian population of 45,292 individuals with CP, 4028 of whom died during the 1986 to 1995 study period. The aims of this study were to identify diseases that may be causally linked with CP, and diseases whose diagnosis and/or treatment need improvement. Overall, the standardized mortality ratio (SMR) was 8.4. Mortality from breast cancer was three times that of the general population, suggesting poorer detection and/or treatment. The dramatic elevation of mortality due to brain cancer, especially in children (SMR=24), raises the possibility of a link between this and CP. Cause of death was non-specific in some individuals. Therefore, these SMRs are conservative. As expected, SMRs due to respiratory diseases were very high but, contrary to anecdotal reports, such diseases did not account for most deaths. High SMRs were also found for diseases of the circulatory and digestive systems. Finally, a marked elevation of deaths was due to external causes, including drowning and being hit by motor vehicles.

Adolescent↗
PubMed2000

Simultaneous pancreas-kidney transplantation reduces excess mortality in type 1 diabetic patients with end-stage renal disease.

BACKGROUND: Diabetic renal disease continues to be the most significant cause of end-stage renal disease (ESRD) in the United States. Renal transplantation improves diabetic ESRD patient survival; however, the diabetic state remains associated with poor patient survival. Simultaneous pancreas-kidney (SPK) transplantation can restore normoglycemia and thus may improve outcomes. METHODS: We assessed the impact of SPK on age-range-matched type 1 diabetic patients who underwent renal transplantation at a single center. The observed/expected life span and annual mortality rates (AMRs) were used as measures of survival. A Cox proportional hazards analysis was used to analyze the impact of potential variables on mortality in SPK recipients. RESULTS: SPK transplantation (N = 335) increased the observed/expected life span compared with diabetic cadaveric (DM-Cad, N = 147) and live-donor (DM-Live, N = 160) transplant recipients (P = 0.004) and significantly reduced the AMRs (SPK, 1. 5%; DM-Cad, 6.27%; DM-Live, 3.65%, P = 0.008, SPK vs. other DM). Moreover, the SPK observed/expected life span and AMR were not significantly different from that of age-range-matched nondiabetic transplant recipients (N = 492). The only variable that was significantly associated with patient survival was discharge serum creatinine (relative risk 1.16, P < or = 0.0154). CONCLUSION: These data demonstrate that SPK improves the ability for type 1 diabetic patients to live more of their expected life span. This suggests that glycemic control, even as a late intervention in a diabetic patient's lifetime, may beneficially affect survival.

Adult↗
PubMed2001

Excess mortality from breast cancer 20 years after diagnosis when life expectancy is normal.

In a population-based study, causes of death were traced of 418 deceased breast cancer patients diagnosed in 1960-1979 who survived at least 10 years after diagnosis. The pattern of causes of death in these patients was compared with the general female population using standardized mortality ratios (SMRs). Of 418 patients surviving at least 10 years, 196 (47%) died from breast cancer and 50 (12%) died from another cancer. The SMR for breast cancer was 15.8 (95% CI: 13.1-18.8) 10-14 years after diagnosis; it was still 4.7 (95% CI: 2.6-7.8) after 20 years. Overall mortality was higher than expected 10-14 years after diagnosis (SMR: 1.3; 95% CI: 1.1-1.5), but lower after more than 20 years (SMR: 0.6; 95% CI: 0.4-0.7). Despite a normal (or even improved) life expectancy for breast cancer patients 20 years after diagnosis the risk of dying from this disease remained elevated.

Adult↗