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PubMed2000

Excess mortality from avoidable and non-avoidable causes in men of low socioeconomic status: a prospective study in Korea.

STUDY OBJECTIVE: The objective of this study was to evaluate the magnitude and contributory factors of socioeconomic differentials in mortality in a cohort of Korean male civil servants. DESIGN: A prospective observational study of male civil servants followed up for five years after baseline measurement. SETTING: All civil service offices in Korea. PARTICIPANTS AND MEASUREMENTS: The study was conducted on 759,665 Korean male public servants aged 30-64 at baseline examination in 1992. The grade of monthly salary of these participants divided into four groups, a proxy indicator of socioeconomic status (SES), was the main predictive variable. Mortality of the participants was followed up from 1992 to 1996. The causes of deaths were categorised into four groups according to the medical amenability: avoidable, partly avoidable, non-avoidable, and external causes of death. The risk of mortality associated with SES was estimated using the Cox proportional hazard model. MAIN RESULTS: Lowest SES group had significantly higher risk of mortality from most causes compared with the highest SES group in the order of external cause (relative risk (RR): 2.26), avoidable (RR: 1.65), all cause (RR: 1.59), and non-avoidable mortality (RR: 1.54). With the adjustment of known risk factors, significantly higher risks of mortality in lowest SES group were attenuated but persisted. Looking at the deaths from partly avoidable causes, significantly higher risks of mortality in the lowest SES group was observed from cerebrovascular disease but not from coronary heart disease. CONCLUSIONS: Socioeconomic differentials in non-avoidable as well as avoidable mortality, persisting even under the control of risk factors, suggest that mortality is influenced not only by the quality of health care and different distribution of risk factors but also by other aspects of SES that are yet unknown.

Administrative Personnel↗
PubMed1987

Excess mortality among Swedish chimney sweeps.

In a cohort study of 5464 union organised Swedish chimney sweeps employed at any time between 1918 and 1980 mortality was studied from 1951 to 1982 with national statistics used as a reference. Follow up was possible for 98.6% of the individuals: 717 deaths were observed against 540 expected. There was an increased mortality from coronary heart disease, respiratory diseases, and several types of malignant tumours. Lung cancer mortality was significantly increased and positively correlated to the number of years employed. A fivefold risk increase for oesophageal cancer and liver cancer was found. The increased mortality could be attributed to exposure to combustion products in the work environment but not to smoking habits.

Adult↗
PubMed1994

A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists.

The association between the use of inhaled beta-agonists and the risk of death and near-death from asthma has previously been reported. It was based on a nested case-control study of 129 cases and 655 control subjects selected from a cohort of 12,301 users of asthma drugs followed during the period 1980 through 1987. In this paper we examine the question of asthma and non-asthma mortality using data from the entire cohort of 12,301 asthmatics. There were 46 asthma and 134 non-asthma deaths in this cohort, for which there were 47,842 person-years of follow-up. The overall rate of asthma death was 9.6 per 10,000 asthmatics per year. This rate varied significantly according to the use of fenoterol, albuterol, or oral corticosteroids in the prior 12 months and the number of asthma hospitalizations in the prior 2 years. The rate decreased significantly, by 0.6 asthma deaths per 10,000 asthmatics per year over the study period, after controlling for the effect of the four other risk factors. It also increased significantly with the use of all beta-agonists, and more so for fenoterol than for albuterol, although this difference was partly explained by the dose inequivalence of the two drugs. Change-point dose-response curves showed that the risk of asthma death began to escalate drastically at about 1.4 canisters (of 20,000 micrograms each) per month of inhaled beta-agonist, the recommended limit. For non-asthma death, the overall rate of 28 deaths per 10,000 asthmatics per year was not related to the use of inhaled beta-agonists.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed2000

An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit.

The APACHE III derived standardized mortality ratio has been suggested as a statistic to measure intensive care unit (ICU) effectiveness. From 1991 data collected on 519 consecutive admissions to the Royal Adelaide Hospital ICU a standardized mortality ratio of 1.25 was calculated. Of the 174 deaths only 95 had a prediction of death greater than 0.5. As part of a quality assurance study we undertook a retrospective case note audit to try to identify factors that were associated with the low mortality prediction (< 0.5) in hospital deaths. Firstly we analysed the patient population that died to determine the factors that were different between patients who had a mortality prediction of greater than 0.5 versus those who had a mortality prediction of less than 0.5. Next we analysed the patient population with a mortality prediction of less than 0.5 and compared actual survivors with patients who died in hospital. Amongst low mortality prediction patients admitted to the Royal Adelaide Hospital ICU we identified age, a history of acute myocardial infarction, presentation to ICU after a cardiac arrest or with an elevated creatinine and the development of acute renal failure and septicaemia during the ICU admission as being associated with in-hospital mortality. We also documented that late hospital deaths on the ward after ICU discharge occurred more frequently with low predicted hospital mortality ICU patients. Factors other than the APACHE III score may be associated with hospital deaths of ICU patients.

APACHE↗
PubMed1998

Excess mortality of mental disorder.

BACKGROUND: We describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders. METHOD: With a Medline search (1966-1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes. RESULTS: Highest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy. CONCLUSION: All mental disorders have an increased risk of premature death.

Cause of Death↗
PubMed2004

Growth hormone and pituitary radiotherapy, but not serum insulin-like growth factor-I concentrations, predict excess mortality in patients with acromegaly.

Increased mortality in patients with acromegaly has been confirmed in a number of retrospective studies, but causative factors and relationship to serum IGF-I remain uncertain. The West Midlands Pituitary database contains details of 419 patients (241 female) with acromegaly. Serum IGF-I data from the Regional Endocrine Laboratory were available for 360 patients (86%). At diagnosis, mean age was 47 yr (range, 12-84) and mean duration of follow-up was 13 yr (0.5-48). Sixty-one percent were treated by surgery and 39% by nonsurgical means. Radiotherapy was used alone or as adjuvant therapy in 50%. All patients were registered with the Office of National Statistics to obtain information on deaths. At the date of analysis (31 December 2001), 95 of the 419 patients had died (43 males), giving a standardized mortality ratio of 1.26 [confidence interval (CI), 1.03-1.54; P = 0.046]. After controlling for age and sex, data indicated that mortality was increased in subjects with posttreatment GH levels more than 2 micro g/liter, compared with those with levels less than 2 micro g/liter [ratio of mortality rates (RR), 1.55 (range, 0.97-2.50); P = 0.068]. By contrast, a much smaller increase was observed for subjects with elevated posttreatment IGF-I levels compared with those with normal levels [RR, 1.20 (range, 0.71-2.03); P = 0.50]. Treatment with radiotherapy was associated with increased mortality [RR, 1.67 (range, 1.09-2.56); P = 0.018], with cerebrovascular disease the predominant cause of death [standardized mortality ratio, 4.42 (range, 2.71-7.22); P = 0.005]. These results confirm the increased mortality in acromegaly and suggest that reduction of GH levels to less than 2 micro g/liter is beneficial in terms of improving long-term outcome. The sole use of IGF-I as a marker for effective treatment of acromegaly is not justified by this data. This study also highlights the potential deleterious effect of radiotherapy.

Acromegaly↗
PubMed2002

Malnutrition and excess mortality in Shangri-La.

Populations living at high altitude in the Tibetan highlands suffer extraordinarily high rates of maternal mortality, infant and juvenile mortality, and infectious morbidity. Poverty and living condition, more than altitude, contribute to the adverse statistics. The traditional nomadic herders are the most affected among the residents. The question remains whether contemporary standards of adequate health and nutrition are compatible with the integral folkways of traditional tribal groups.

Humans↗
PubMed2006

Urban-rural differences in excess mortality among high-poverty populations: evidence from the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health.

Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.

Adult↗
PubMed1992

Coronary artery disease is the major determinant of excess mortality in patients with insulin-dependent diabetes mellitus and persistent proteinuria.

The goal of this review was to assess the magnitude of coronary artery disease (CAD) mortality and its determinants in insulin-dependent diabetes mellitus (IDDM) patients with persistent proteinuria. By reanalyzing data from two previously published studies of patients with nephropathy, it was found that these patients had extremely high CAD mortality rates in comparison with IDDM patients without proteinuria, but only after the age of 35 yr. In addition, the risk of CAD death was associated with high serum cholesterol levels but was unrelated to systemic blood pressure, smoking habits, and obesity. Further studies of the determinants of CAD in patients with IDDM and proteinuria are urgently needed. Except for efforts to lower serum cholesterol, it is not known whether any other measure can be undertaken to reduce the extremely high mortality due to CAD that afflicts IDDM patients with persistent proteinuria, in particular those patients whose renal failure might have been "successfully" postponed by antihypertensive therapy.

Adult↗
PubMed2005

Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts.

OBJECTIVES: We analyzed neighborhood heterogeneity in associations among mortality, race/ethnicity, and area poverty. METHODS: We performed a multilevel statistical analysis of Massachusetts all-cause mortality data for the period 1989 through 1991 (n=142836 deaths), modeled as 79813 cells (deaths and denominators cross-tabulated by age, gender, and race/ethnicity) at level 1 nested within 5532 block groups at level 2 within 1307 census tracts (CTs) at level 3. We also characterized CTs by percentage of the population living below poverty level. RESULTS: Neighborhood variation in mortality across CTs and block groups was not accounted for by these areas' age, gender, and racial/ethnic composition. Neighborhood variation in mortality was much greater for the Black population than for the White population, largely because of CT-level variation in poverty rates. CONCLUSIONS: Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty.

Adolescent↗
PubMed1981

Underestimation of the role of pneumonia and influenza in causing excess mortality.

Underestimation of pneumonia and influenza (P&I) mortality during influenza epidemics was explored in 38 P&U associated deaths among a population of adults during two influenza A (H3N2) epidemics. Pneumonia or influenza was mentioned on 32 (84 per cent) of the death certificates. However, based on rules for assigning cause of death, only nine (24 per cent, SE = 7) and 23 (61 per cent, SE = 8) of the cases would have been included in P&I mortality statistics compiled by the National Center for Health Statistics and the Center for Disease Control, respectively.

Aged↗
PubMed1982

Excess mortality from traffic accidents among elderly pedestrians living in the inner city.

Age-specific death rates for pedestrian-car accidents among the populations living in four contiguous areas of a large city, one being the downtown area and the others gradually more removed from it, were compared. The rates are highest downtown and decrease progressively in the outlying areas, the absolute differences between areas being largest above age 65. These data suggest that pedestrian accident prevention efforts should take into account the specific needs of the elderly living in the inner city.

Accidents, Traffic↗