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PubMed1984

Using national mortality data to study the changing sex differential in mortality.

Sex differences in mortality vary widely among the developed countries. Male overmortality is highest in Finland and the USSR, followed closely by France, Poland, the USA and Canada. The differential is lowest in Japan, Ireland and in south-eastern Europe. The sex mortality ratio is highest at ages 15-24 years with a second peak generally occurring around age 60. The excess mortality of males at the younger ages is due largely to motor vehicle accidents while higher death rates from heart disease and lung cancer in particular account for a substantial proportion of male excess mortality during the later years of working life. During the course of the 20th century, the impact of sex differences in mortality from the infectious and parasitic diseases has declined, as has the contribution from maternal mortality. Males have also benefited from a decline in industrial accidents but this has been more than countered by rising death rates from heart diseases, lung cancer and motor vehicle accidents.

Adolescent↗
PubMed2005

All-cause mortality and mortality of myocardial infarction for 989 legally castrated men.

BACKGROUND: Male gender is an independent coronary risk factor. METHOD: Long-term follow-up of 989 Danish men who underwent legal castration between 1929 and 1968. RESULTS: The legally castrated men were unmarried and belonged to social class IV and V more often than were Danish men in general. During the follow-up until 2000, 835 of the 989 (85%) castrated men died, including 148 who died of myocardial infarction. In multiple Poisson regression analyses, the men had a standardized mortality rate (SMR) for all-cause mortality of 1.30 (95% CI: 1.26-1.36) and a SMR for mortality of myocardial infarction of 1.08 (95% CI: 1.04-1.16). Thus, the castrated men had a lower proportion of deaths of myocardial infarction (148/792, 18.7% (95% CI: 16.0-21.6%)) than was expected based on the mortality rates for the Danish male population (136/608, 22.4%). The castrated men had discordant changes for the SMR for all-cause mortality and mortality of myocardial infarction whereas subgroups of the Danish population previously has been found to have concordant changes for the two SMRs. CONCLUSION: The castrated men had fewer deaths of myocardial infarction than expected, so men may not have increased risk of coronary heart disease from unphysiologically low levels of endogenous androgens.

Adult↗
PubMed2005

An intergenerational and lifecourse study of health and mortality risk in parents of the 1958 birth cohort: (II) mortality rates and study representativeness.

OBJECTIVES: We recently traced and flagged parents for the participants in the National Child Development Survey (NCDS, 1958 cohort). This paper evaluates the representativeness of the study population and assesses our success in identifying the biological parents. STUDY DESIGN: Intergenerational cohort study. METHODS: Parents for participants in the NCDS (born 1 week in March 1958) were traced and flagged for mortality follow-up (14 334 fathers, 15 076 mothers). Standardized mortality rates (SMRs) were calculated using data from England, Scotland and Wales during corresponding time periods. RESULTS: By 31 December 2003, 6808 fathers and 4148 mothers (born 1890-1943) had died (569 918 and 645 354 years of follow-up, respectively). The overall mortality rate in this parent population was lower compared with the age-, gender-, period- and area-standardized reference rates (SMRs of 83 for fathers and 86 for mothers). Mortality rates for biological parents were higher if cohort members had had non-biological parent figures during the childhood surveys (SMRs of 135 for fathers and 374 for mothers). Parental smoking (in 1974) was strongly associated with lung cancer mortality among biological parents [HR 6.1, 95% confidence intervals (CI) 4.6-8.1 for fathers; HR 15.0, 95% CI 9.7-23 for mothers) but not among non-biological parents (HR 2.0, 95% CI 0.8-5.5; HR 1.8, 95% CI 0.4-7.9, respectively) which demonstrates that the tracing of the biological parents had been successful. CONCLUSIONS: Mortality is markedly reduced in a cohort of parents compared with the general population. The validity of identification of biological parents is demonstrated by the strong association between smoking and lung cancer.

Adult↗
PubMed2006

Education, gender, and mortality: does schooling have the same effect on mortality for men and women in the US?

In this paper I examine whether the effect of education on mortality for US adults differs by gender. Discrete time logit models were used to analyze a nationally representative dataset (NHANES I) with 12,036 adults who were 25-74-years-old at the baseline survey in 1971-1975, and then re-interviewed three times through 1992. Demographic characteristics, health behaviors and economic status were controlled as potential confounding or mediating factors in the education-mortality relationship. The results showed that education had a comparable effect on mortality for men and women. No statistically significant gender difference was found in all-cause mortality, or mortality by cause of death, among younger persons, and among the elderly. Analysis by marital status, however, suggested that these findings apply only to married men and women. Among the divorced, there was a statistically significant gender difference whereby education had no effect on mortality for men while divorced women evidenced a strong education gradient (seven percent lower odds of dying for each year of schooling). Possible explanations for these patterns are discussed.

Adult↗
PubMed1999

A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study.

A sample of over 400,000 men and women, ages 25-64, from the National Longitudinal Mortality Study (NLMS), a cohort study representative of the noninstitutionalized US population, was followed for mortality between the years of 1979 and 1989 in order to compare and contrast the functional forms of the relationships of education and income with mortality. Results from the study suggest that functional forms for both variables are nonlinear. Education is described significantly better by a trichotomy (represented by less than a high school diploma, a high school diploma or greater but no college diploma, or a college diploma or greater) than by a simple linear function for both men (p < 0.0001 for lack of fit) and women (p = 0.006 for lack of fit). For describing the association between income and mortality, a two-sloped function, where the decrease in mortality associated with a US$1000 increase in income is much greater at incomes below US$22,500 than at incomes above US$22,500, fits significantly better than a linear function for both men (p < 0.0001 for lack of fit) and women (p = 0.0005 for lack of fit). The different shapes for the two functional forms imply that differences in mortality may primarily be a function of income at the low end of the socioeconomic continuum, but primarily a function of education at the high end.

Adult↗
PubMed1996

Breast cancer mortality rates are levelling off or beginning to decline in many western countries: analysis of time trends, age-cohort and age-period models of breast cancer mortality in 20 countries.

Age-standardised mortality rates for breast cancer were examined for 20 countries in Europe, North America, Australia and New Zealand from 1950 to 1992 and age-birth cohort and age-period of death models were fitted to the data. Breast cancer mortality rates generally increased in the earlier decades, but more recently rates have levelled off or begun to decline in most countries. Only in 4 of the 20 countries studied, Belgium, Hungary, Poland and Spain, was there no evidence of a decline or leveling off or mortality in recent birth cohorts or in recent years. In the other countries the decline in mortality appeared to be in part due to birth cohort effects and in part due to period effects. The birth cohort effects were suggestive of a decline in breast cancer rates among women born after about 1920 and were evident in many countries especially Canada, The Netherlands, The United Kingdom and the United States. The decline in mortality in women born after 1920 appeared to be in part related to a reduction in childlessness and a reduction in age at first birth in those generations. As well as the birth cohort effects, there was some evidence of a recent overall decline in mortality rates in several countries, e.g. Austria, FRG, Greece and the UK, and this may be due to an increase in survival resulting from improved management and treatment of women with breast cancer.

Adult↗
PubMed2002

Adjusted mortality rates: a tool for creating more meaningful league tables for stillbirth and infant mortality rates.

A number of problems associated with league tables of performance indicators have been discussed in the literature. This paper attempts to address these problems for stillbirth and infant mortality rates in order to produce meaningful and useful information for the government, general public and health professionals. Composite stillbirth and infant mortality rates, low birth-weight and very low birth-weight rates were determined for the 100 English Health Authorities for 1996-1997. Townsend deprivation scores for these districts were also obtained. The mortality rates were adjusted by multiple regression for very low birth-weight and Townsend score separately and together. Confidence intervals were calculated for the dual-adjusted rates. Almost 60% of the variability in mortality rates were explained by Townsend score and very low birth-weight rates together. Adjusted league tables showed how the individual and combined predictors affect the individual mortality rates for each Health Authority. There was considerable overlap in the confidence intervals for the adjusted rates although there were a few Health Authorities whose mortality rates were clearly below most others. We conclude that fairer and more useful information is provided by geographically based league tables which give both crude rates and rates adjusted for single and multiple predictor variables. The inclusion of confidence intervals aids interpretation of annual random variations and knowledge of differences in the effects of the individual predictors enables better resource targeting.

England↗
PubMed1998

The effect of lead time bias on severity of illness scoring, mortality prediction and standardised mortality ratio in intensive care--a pilot study.

The effect of lead time bias on severity of illness scoring, mortality prediction and standardised mortality ratios was examined in a pilot study of 76 intensive care (ICU) patients using APACHE II, APACHE III and SAPS II scoring systems. The inclusion of data collected in the period prior to ICU admission increased severity of illness scores and estimated risk of hospital mortality significantly for all three scoring systems (p < 0.01) by up to 14 points and 42.7% (APACHE II), 50 points and 26.3% (APACHE III) and 23 points and 33.4% (SAPS II), respectively. Standardised mortality ratios fell from 0.99 to 0.79 (APACHE II), 0.96 to 0.84 (APACHE III) and 0.75 to 0.64 (SAPS II), but these changes failed to reach statistical significance. Lead time bias had most effect in medical patients and on emergency admissions, and least effect in patients admitted from the operating theatre. These trends suggest that mortality ratios may not necessarily reflect intensive care unit performance and indicate that a larger study of the effect of lead time bias, case mix, pre-ICU care or post-ICU management on standardised mortality ratios is indicated.

Adolescent↗
PubMedDate not supplied

The role of air pollution and other factors in local variations in general mortality and cancer mortality.

Age-adjusted indices of female cancer mortality and total male mortality in 31 California countries were correlated with air pollution data and with geographic and socioeconomic data from the 1970 United States Census and elsewhere. Air quality was the worst in those countries where socioeconomic status was highest. Cancer mortality showed positive correlations with air pollution levels. Overall male mortality was lower in the affluent but polluted coastal counties. However, when partial correlation coefficients were calculated, controlling for the confounding variables, both overall male mortality and female cancer mortality showed positive correlations with air pollution indices. Stepwise regression analysis produced similar results.

Actuarial Analysis↗
PubMed1982

Does income affect mortality? An analysis of the effects of different types of income on age/sex/race-specific mortality rates in the United States.

This article explores the question of whether or not higher incomes are associated with lower mortality rates. Some recent research on this issue has suggested that income either has no effect on or may even be positively correlated with mortality rates. By contrast, earlier studies consistently found a negative relationship--higher income (or economic status) was generally associated with lower mortality rates. This paper extends the prior research in two significant ways. First, the issue is analyzed separately for eight adult and four infant age/sex/race-specific population cohorts. Second, total family income is broken down into several components to investigate whether different types of income have differential effects on mortality rates. In addition, the problem of untangling the joint effects of education and income on mortality also is explored. The results tend to support the hypothesis that higher income is associated with lower mortality rates. However, the magnitude of the impact of income is small, although it is consistently larger for infants than for adults.

Adolescent↗
PubMed2007

A comparison of trends in incidence and mortality rates of breast cancer, incidence to mortality ratio and stage at diagnosis between Arab and Jewish women in Israel, 1979-2002.

In Israel, breast cancer is the most common malignancy in women, but there are large intra-population differences. The aim of this study was to compare the incidence and mortality, incidence to mortality rate ratio and stage at diagnosis of breast cancer between Arab and Jewish women in Israel. Data on all cases of breast cancer, stage at diagnosis and mortality were obtained from the National Cancer Registry and the Central Bureau of Statistics. Trends in age-specific and age-adjusted incidence and mortality rates, rate ratios and stage at diagnosis were examined for Arab and Jewish women during 1979-2002. Five-year survival rates for 1995-1999 were compared by stage. Among Arab women, age-adjusted incidence rates increased by 202.1%, from 14.1 per 100,000 in 1979-1981 to 42.6 in 2000-2002. Among Jewish women, the rates increased by 45.7%, from 71.1 per 100,000 women in 1979-1981 to 103.6 in 2000-2002. Incidence to mortality rate ratio increased for both population groups, but it is still lower among Arab women. In every age group, Arab women were more likely to be diagnosed at a more advanced stage of the disease. The rise in breast cancer incidence and mortality rates and the later stage of diagnosis among Arab women emphasize the urgent need for increasing early detection of breast cancer in the Arab population by improving rates of compliance with screening mammography.

Arabs↗
PubMed1996

Outlook for survivors of childhood in sub-Saharan Africa: adult mortality in Tanzania. Adult Morbidity and Mortality Project.

OBJECTIVE: To measure age and sex specific mortality in adults (15-59 years) in one urban and two rural areas of Tanzania. DESIGN: Reporting of all deaths occurring between 1 June 1992 and 31 May 1995. SETTING: Eight branches in Dar es Salaam (Tanzania's largest city), 59 villages in Morogoro rural district (a poor rural area), and 47 villages in Hai district (a more prosperous rural area). SUBJECTS: 40,304 adults in Dar es Salaam, 69,964 in Hai, 50,465 in Morogoro rural. MAIN OUTCOME MEASURES: Mortality and probability of death between 15 and 59 years of age (45Q15). RESULTS: During the three year observation period a total of 4929 deaths were recorded in adults aged 15-59 years in all areas. Crude mortalities ranged from 6.1/1000/year for women in Hai to 15.9/1000/year for men in Morogoro rural. Age specific mortalities were up to 43 times higher than rates in England and Wales. Rates were higher in men at all ages in the two rural areas except in the age group 25 to 29 years in Hai and 20 to 34 years in Morogoro rural. In Dar es Salaam rates in men were higher only in the 40 to 59 year age group. The probability of death before age 60 of a 15 year old man (45Q15) was 47% in Dar es Salaam, 37% in Hai, and 58% in Morogoro; for women these figures were 45%, 26%, and 48%, respectively. (The average 45Q15s for men and women in established market economies are 15% and 7%, respectively.) CONCLUSION: Survivors of childhood in Tanzania continue to show high rates of mortality throughout adult life. As the health of adults is essential for the wellbeing of young and old there is an urgent need to develop policies that deal with the causes of adult mortality.

Adolescent↗
PubMedDate not supplied

Mortality experience in a rapidly developing economy in Taiwan: infant mortality, gender gap, and occupational risks.

Mortality data of Taiwan for 1981 through 1986 were analyzed using three different statistics in order to assess the role of environmental and lifestyle factors in causing mortality variations. Infant mortality rates from different geographic regions generally correlated well with overall mortality from all ages, suggesting that there are many common risk factors affecting the entire age range of the population. The mortality rates of tobacco- and alcohol-related causes of death and cancers were much higher in males than females. A number of cancer sites, including the lung, the liver, the stomach, and the nasopharynx, showed more than twofold excesses in males. In contrast, females had a tenfold excess of genital cancer and a 33% higher rate of diabetes. With rapid industrialization, occupational hazards played an increasing role in the development of cancer and other causes of death. During the study period, fishermen showed increased risk for cancers of the stomach, the esophagus, and the liver, while construction workers had an increased risk for cancer of the esophagus. Peasants and soldiers had an elevated suicide mortality. Among apprentices, fatal injuries were high. Findings from this study are useful in setting priorities for health and safety programs and directing efforts such as health education programs and other preventive strategies against disease.

Adolescent↗
PubMed2006

Religious attendance and mortality: implications for the black-white mortality crossover.

This study investigates the relationships among religious attendance, mortality, and the black-white mortality crossover. We build on prior research by examining the link between attendance and mortality while testing whether religious involvement captures an important source of population heterogeneity that contributes to a crossover Using data from the Established Populations for Epidemiologic Studies of the Elderly, we find a strong negative association between attendance and mortality. Our results also show evidence of a racial crossover in mortality rates for both men and women. When religious attendance is modeled in terms of differential frailty, clear gender differences emerge. For women, the effect of attendance is race- and age-dependent, modifying the age at crossover by 10 years. For men, however; the effect of attendance is not related to race and does not alter the crossover pattern. When other health risks are modeled in terms of differential frailty, wefind neither race nor age-related effects. Overall, the results highlight the importance of considering religious attendance when examining racial and gender differences in age-specific mortality rates.

Black or African American↗
PubMed1998

Time trends in twin perinatal mortality in northern England, 1982-94. Northern Region Perinatal Mortality Survey Steering Group.

The dynamics of perinatal mortality rates (PNMR) and causes of death in twin pregnancies over 13 years in the Northern Region of the National Health Service in England is described. All twin perinatal deaths occurring between 1982-1994 were identified from the Northern Region Perinatal Mortality Survey. The twinning rate increased from 9.9 per 1000 maternities in 1982 to 12.0 in 1994. There was a total of 10,734 twin pregnancies and of these 421 resulted in 530 perinatal deaths. The perinatal mortality rate in twins significantly decreased over time (1982-87, 55.4 per 1000; 1988-94, 44.4 per 1000; P = 0.01). The PNMR was significantly higher for twins from like-sexed than from unlike-sexed pairs (53.5 and 34.4 per 1000 respectively, P < 0.001). Despite no improvement in birthweight distribution in the twin population, birthweight-specific perinatal mortality rates for both like and unlike-sexed twins decreased for each birthweight category in 1988-94 compared with 1982-87. Twins with very low birthweight (< 1500 g) comprised 69%, and preterm twins (< 37 completed weeks of gestation) 74.9% of all twin perinatal deaths. The major immediate cause of early neonatal death was pulmonary immaturity (63%); antepartum anoxia caused 76.9% of antenatal deaths. Unexplained preterm labour and intrauterine death were the leading obstetric factors underlying death in twins. Despite a decrease over the 13 years, the perinatal mortality rate in twins in the Northern Region remains high. Continued monitoring of trends in twinning and mortality rates is needed to inform health care planning.

Birth Weight↗
PubMed2002

Cause-specific mortality in a population with diabetes: South Tees Diabetes Mortality Study.

OBJECTIVE: To describe the mortality of a population with diabetes compared with the local nondiabetic population, using age-, sex-, and cause-specific death rates and relative and absolute differences in death rates. RESEARCH DESIGN AND METHODS: A population-based cohort of 4,842 people with diabetes living within South Tees, U.K., was identified and followed from 1 January 1994 to 31 December 1999. Causes of death were obtained from death certificates, and mortality rates were compared with the nondiabetic population of the same area for the same time period. RESULTS: There were 1,205 deaths (24.9%) in the study population during the 6 years of study. For type 2 diabetes, mortality from cardiovascular causes was significantly increased in both sexes and at all ages. Relative death rates for the age band 40-59 years were 5.47 (95% CI 4.18-7.15) for men and 5.60 (3.44-9.14) for women. The relative death rates declined with age for both sexes, but absolute excess mortality increased with age. There were no consistent differences in noncardiovascular death rates, other than for renal disease. Similar outcomes were found for type 1 diabetes, although these results were limited by a much smaller population size. People with diabetes and renal impairment had significantly higher mortality than people with diabetes alone, with a rate ratio of 7.27 for people with type 2 diabetes aged 40-59 years. CONCLUSIONS: In an area of the U.K. with high cardiovascular death rates, people with diabetes had significantly higher cardiovascular death rates than people without diabetes. Interventions targeted at cardiovascular risk factors should be used to try and reduce this excess premature mortality, which is especially high in those with renal impairment.

Adult↗
PubMed1999

Mortality among US adult Asians and Pacific Islanders: findings from the National Health Interview Surveys and the National Longitudinal Mortality Study.

OBJECTIVES: To assess the mortality of the adult Asian and Pacific Islander population in the United States. METHODS: Cohort study using data from the National Health Interview Survey (1986 to 1994) and the National Longitudinal Mortality Study. Deaths were ascertained by matching the National Death Index with average follow-ups of 5.3 and 9 years, respectively, for the two studies. RESULTS: Respondents from the pooled National Health Interview Surveys included 532,794 non-Hispanic whites, 94,242 blacks, 52,725 Hispanics, and 16,936 Asians and Pacific Islanders, all of whom were at least 18 years of age at baseline. The National Longitudinal Mortality Study included 373,397 non-Hispanic whites, 41,262 blacks, 23,356 Hispanics, and 8,390 Asians and Pacific Islanders. Overall age-standardized mortality was the lowest in Asians/Pacific Islanders, whose risk of death was about 40% lower than whites'. Adjustment for differences in education levels had a minimal influence on the mortality advantage in Asians/Pacific Islanders. CONCLUSIONS: Longitudinal cohorts provide an important source of health status information on Asians and Pacific Islanders. These two studies from representative national samples suggest that overall mortality is substantially lower among Asians and Pacific Islanders than in all other major ethnic groups.

Adolescent↗
PubMed1975

Mortality factors in diabetes. A 20 year mortality study.

The life expectancy of well controlled diabetics has been considered to be approximately that of the normal individual. A 20 year prospective study of the mortality of diabetics who applied for life insurance to the Equitable Life Assurance Society did not confirm this. The study population comprised 10,538 individuals with an average exposure of 7.9 years. During the period of the study 1,478 deaths were recorded, giving a mortality ratio of 335%. Mortality decreased with increasing age at diagnosis of diabetes. Mortality increased with increasing duration of the disease. Mortality was lowest in cases treated by diet only. Mortality in cases with poor control was two and one-half times that of cases with good control. Albuminuria on examination was an extremely unfavorable prognostic factor. Hypertension had a particularly adverse effect on the diabetic as compared to the non-diabetic, especially at ages under 40.

Adolescent↗