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PubMed2000

Excess mortality associated with increased pulse pressure among middle-aged men and women is explained by high systolic blood pressure.

OBJECTIVE: To assess the risk of death from coronary heart disease, stroke, all cardiovascular diseases and all-cause mortality associated with pulse pressure among the middle-aged population. METHODS AND DESIGN: A prospective 15-year follow-up cohort study was conducted of two independent cross-sectional random samples of the population who participated in baseline surveys in 1972 or 1977. Each survey included a self-administered questionnaire with questions on smoking and antihypertensive drug treatment, measurements of height, weight and blood pressure and the determination of the serum cholesterol concentration. Multivariate analyses were performed by using Cox proportional hazard models. SETTING: The provinces of North Karelia and Kuopio in eastern Finland PARTICIPANTS: Men and women aged 45-64 years with no history of myocardial infarction or stroke at the time of the baseline survey were selected. In total 4333 men and 5270 women took part in this follow-up study. RESULTS: The relative risk of coronary heart disease, stroke, cardiovascular disease and all-cause mortality increased with the increasing pulse pressure in individuals aged 45-64 years independent of the diastolic blood pressure level. Only in women with diastolic blood pressure > or = 95 mmHg was the relative risk of fatal stroke not statistically significant. After adjustment for systolic blood pressure, the positive association between mortality and increasing pulse pressure disappeared. CONCLUSION: Increasing pulse pressure is a predictor of death from coronary heart disease, stroke, cardiovascular disease and all causes in men and women aged 45-64 years, but the increase in risk is entirely associated with the increase in systolic blood pressure.

Blood Pressure↗
PubMed1994

Predictors of the excessive mortality rates of dialysis patients in the United States.

It is now well recognized that the United States has the highest mortality rate for end-stage renal disease patients receiving dialysis among the industrialized nations. The possible causes of this almost 25% gross mortality rate (23.6% in 1992) are becoming clearer. After numerous investigations of the various possibilities, it is now evident that the causes are multifactorial. Basically, the US reimbursement for dialysis payment rate has been kept low (essentially no increase since 1973) by allowing inflation to advance and maintaining the actual costs. The industry has responded in a number of ways, some of which have proven harmful. For example, the reuse of dialyzers was probably reasonable and has not proven to be a problem: reductions in staff for older and sicker populations has probably been harmful to the patient's well being; and the shortening of dialysis treatments may have produced more problems than any other change. Essentially, as patients receive less dialysis they feel worse and lose their appetite, thus resulting in weight loss. Frequently dialysis is reduced further because of reduction in certain chemical markers, eg, blood urea nitrogen, that nephrologists use as clinical measurements. This results in a malnourished patient with a low serum albumin level. It is believed but not yet proven that an increase in the dialysis prescription, ie, more dialysis, can reverse this decline. Currently the United States faces the challenges of reducing its mortality rate for end-stage renal disease patients to compare with that of other industrial countries while remaining at the current reimbursement rate, which is less than half that of Germany and one quarter that of Japan.

Humans↗
PubMed2006

Excess mortality in winter in Finnish intensive care.

BACKGROUND: In the general population, mortality from acute myocardial infarctions, strokes and respiratory causes is increased in winter. The winter climate in Finland is harsh. The aim of this study was to find out whether there are seasonal variations in mortality rates in Finnish intensive care units (ICUs). METHODS: We analysed data on 31,040 patients treated in 18 Finnish ICUs. We measured severity of illness with acute physiology and chronic health evaluation II (APACHE II) scores and intensity of care with therapeutic intervention scoring system (TISS) scores. We assessed mortality rates in different months and seasons and used logistic regression analysis to test the independent effect of various seasons on hospital mortality. We defined 'winter' as the period from December to February, inclusive. RESULTS: The crude hospital mortality rate was 17.9% in winter and 16.4% in non-winter, P = 0.003. Even after adjustment for case mix, winter season was an independent risk factor for increased hospital mortality (adjusted odds ratio 1.13, 95% confidence interval 1.04-1.22, P = 0.005). In particular, the risk of respiratory failure was increased in winter. Crude hospital mortality was increased during the main holiday season in July. However, the severity of illness-adjusted risk of death was not higher in July than in other months. An increase in the mean daily TISS score was an independent predictor of increased hospital mortality. CONCLUSION: Severity of illness-adjusted hospital mortality for Finnish ICU patients is higher in winter than in other seasons.

APACHE↗
PubMed1996

Excess mortality among former adolescent male out-patients.

Mortality among 156 males and 122 females referred to an out-patient adolescent psychiatric clinic in a Finnish town between 1984 and 1989 was examined. During the follow-up (mean duration 6 years; range 0-6.3 years for the deceased, 0.6-10.3 years for the survivors), 16 male subjects but no females had died. Among those who had died, the mode of death was suicide in 11 cases. The mortality for any cause for males was 10.3% and that for suicide was 7.1%. All male victims had similar high levels of individual and familial disturbances. Current suicidal ideation and suicide attempts, poor psychosocial functioning and a recommendation for psychiatric hospital treatment during the index treatment were associated with male mortality/suicidality. A high risk for mortality for several years after psychiatric treatment was found. It is concluded that, in clinical settings, perceived current suicidal tendencies should be assessed carefully.

Adolescent↗
PubMed1999

Does social disadvantage contribute to the excess mortality in rheumatoid arthritis patients?

BACKGROUND: Socioeconomic deprivation is associated with increased mortality from cardiovascular causes and malignancy. The influence of disadvantage in patients with rheumatoid arthritis (RA), who are known to have premature mortality, has not been ascertained. AIM: To assess the relation between the level of patient deprivation and mortality in RA patients. METHODS: 200 RA patients, enrolled in a study comparing sulfasalazine and penicillamine in 1984-85, have been followed up prospectively for 12 years. Subjects were categorised into Carstairs groups with deprivation scores ranging from 1 (most affluent) to 7 (most deprived). Information about deaths was obtained from the Registrar General in Scotland, death certificates and GP/hospital records. RESULTS: There were more RA patients in the deprived areas then expected compared with the West of Scotland and England and Wales. Some 47.5% of the RA patients had died by 12 years-the majority of cardiorespiratory causes or malignancy. There were no differences in the median age or disease duration in the various Carstairs groups at study entry, but the percentage of deaths was higher in the more deprived groups after 12 years (36% dead in most affluent area compared with 61% in the most deprived, that is, in groups 6 and 7). CONCLUSION: In patients with RA increasing deprivation was associated with premature mortality. If confirmed elsewhere these findings have implications for rheumatological management strategies, for researchers involved in collaborative studies of patients from different socioeconomic backgrounds and for resource allocation.

Adult↗
PubMed1983

Excess mortality among children discharged from hospital after treatment for diarrhoea in rural Bangladesh.

Five hundred and fifty one children aged between 3 months and 3 years were followed up at home for 12 months after treatment of diarrhoea in a rural treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. During follow up the children were found to have a significantly higher mortality than generally observed in the community. The first three months after discharge appeared to be crucial, some 70% of the deaths occurring in that period. Severely malnourished children (nutritional state below 56% of the American National Center for Health Statistics (NCHS) standard of weight for age ratio) had a risk of death 14 times that of their well nourished counterparts (nutritional state 66% or more of the NCHS standard). The highest mortality occurred in 2 year olds, one in three of the severely malnourished children dying compared with one in 10 of the moderately malnourished. This pattern was not seen in children aged under 2 years. Immediate priority should be given to providing nutritional rehabilitation for malnourished children who contract diarrhoea.

Age Factors↗
PubMed1985

Are low cholesterol values associated with excess mortality?

The relation between cholesterol concentration and mortality was studied prospectively over 17 years in 630 New Zealand Maoris aged 25-74. The dead or alive state of each person was determined in 1981. The causes of death were divided into three categories: cancer, cardiovascular disease, and "other." Using univariate and both linear and non-linear multivariate methods of analysis for survivorship data, significant inverse relations with serum cholesterol were found for total mortality in women, for mortality from cancer in men and women, and for other causes of mortality in both men and women. The inverse and non-linear association with total mortality in women remained significant when deaths in the first five years of follow up were excluded. This suggests that the association was not explained by undetected illness causing low cholesterol concentrations at the time of initial examination.

Adult↗