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PubMed2006

Impact of adjuvant therapy and mammography on U.S. mortality from 1975 to 2000: comparison of mortality results from the cisnet breast cancer base case analysis.

The CISNET breast cancer program is a consortium of seven research groups modeling the impact of various cancer interventions on the national trends of breast cancer incidence and mortality. Each of the modeling groups participated in a CISNET breast cancer base case analysis with the objective of assessing the impact of mammography and adjuvant therapy on breast cancer mortality between 1975 and 2000. The comparative modeling approach used to address this question allowed for a unique view into the process of modeling. Results shown here expand on those recently reported in the New England Journal of Medicine (Berry et al., N Engl J Med 2005;353:1784-92) by presenting mortality impact in several different ways to facilitate comparisons between models. Comparisons of each group's results in the context of modeling assumptions made during the process gave insight into how specific model assumptions may have affected the results. The median estimate for the percent decline in breast cancer mortality due to mammography was 15% (range of 8%-23%), and the median estimate for the percent decline in mortality due to adjuvant treatment was 19% (range of 12%-21%). A detailed discussion of the differences in modeling approaches and how those differences may have influenced the mortality results concludes the chapter.

Adult↗
PubMed2003

Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study.

Calcification complications are frequent among long-term dialysis patients. However, the prognostic implication of cardiac valve calcification in this population is not known. This study aimed to determine if cardiac valve calcification predicts mortality in long-term dialysis patients. Baseline echocardiography was performed in 192 patients (mean +/- SD age, 55 +/- 12 yr) on continuous ambulatory peritoneal dialysis (mean +/- SD duration of dialysis, 39 +/- 31 mo) to screen for calcification of the aortic valve, mitral valve, or both. Valvular calcification was present in 62 patients. During the mean follow-up of 17.9 mo (range, 0.6 to 33.9 mo), 46 deaths (50% of cardiovascular causes) were observed. Overall 1-yr survival was 70% and 93% for patients with and without valvular calcification (P < 0.0001, log-rank test). Cardiovascular mortality was 22% and 3% for patients with and without valvular calcification (P < 0.0001). Multivariable Cox regression analysis showed that cardiac valve calcification was predictive of an increased all-cause mortality (hazard ratio [HR], 2.50; 95% CI, 1.32 to 4.76; P = 0.005) and cardiovascular death (HR 5.39; 95% CI, 2.16 to 13.48; P = 0.0003) independent of age, male gender, dialysis duration, C-reactive protein, diabetes, and atherosclerotic vascular disease. Eighty-nine percent of patients with both valvular calcification and atherosclerotic vascular disease, 23% of patients with valvular calcification only, 21% of patients with atherosclerotic vascular disease only, and 13% of patients with neither complication died at 1-yr (P < 0.0005). The cardiovascular death rate was 85% for patients with both complications, 13% for patients with valvular calcification only, 14% for patients with atherosclerotic vascular disease only, and 5% for those with neither complication (P < 0.0005). The number of calcified valves was associated with all-cause mortality (P < 0.0005) and cardiovascular death (P < 0.0005). One-year all-cause mortality was 57% for patients with both aortic and mitral valves calcified, 40% for those with either valve calcified, and 15% for those with neither valve calcified. In conclusion, cardiac valve calcification is a powerful predictor for mortality and cardiovascular deaths in long-term dialysis patients. Valvular calcification by itself has similar prognostic importance as the presence of atherosclerotic vascular disease. Its coexistence with other atherosclerotic complications indicates more severe disease and has the worst outcome.

Aged↗
PubMed1990

A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital.

The aims of this study were to: 1) determine the incidences and causes of mortality associated with anaesthesia and surgery, 2) identify important factors associated with mortality in hospital, and 3) estimate the mortality risk associated with anaesthesia and surgery when a combination of risk factors are present. A total of 7306 anaesthetized patients undergoing abdominal, urological, gynaecological, or orthopaedic surgery were included in the study. Of these, 0.05% (1:1800) died during anaesthesia, 0.1% (1:730) during the recovery period, and the overall mortality rate in hospital was 1.2% (1:81). Most deaths occurred in the elderly (greater than or equal to 70 years of age) and were unavoidable due to progression of the presenting condition, such as advanced cancer, or co-existing diseases such as cardiopulmonary or renal failure. Of the patients who developed myocardial infarction (MI) following anaesthesia, 67% (8/12) died in the postoperative period. Half of the MI patients who died received regional anaesthesia, and in addition suffered from periods of cardiovascular dysfunction intraoperatively. By utilizing logistic regression analysis, a model for prediction of mortality risk was developed. The model included five significant preoperative predictive variables: age; patients with history of chronic heart disease, and renal disease; emergency surgery; and the type of operation. With this model it is possible to distinguish between patients with very different mortality risks.

Adult↗
PubMed2001

Mortality over two centuries in large pedigree with familial hypercholesterolaemia: family tree mortality study.

OBJECTIVE: To estimate all cause mortality from untreated familial hypercholesterolaemia free from selection for coronary artery disease. DESIGN: Family tree mortality study. SETTING: Large pedigree in Netherlands traced back to a single pair of ancestors in the 19th century. SUBJECTS: All members of pedigree aged over 20 years with 0.5 probability of carrying a mutation for familial hypercholesterolaemia. MAIN OUTCOME MEASURE: All cause mortality. RESULTS: A total of 70 deaths took place among 250 people analysed for 6950 person years. Mortality was not increased in carriers of the mutation during the 19th and early 20th century; it rose after 1915, reached its maximum between 1935 and 1964 (standardised mortality ratio 1.78, 95% confidence interval 1.13 to 2.76; P=0.003), and fell thereafter. Mortality differed significantly between two branches of the pedigree (relative risk 3.26, 95% confidence interval 1.74 to 6.11; P=0.001). CONCLUSIONS: Risk of death varies significantly among patients with familial hypercholesterolaemia. This large variability over time and between branches of the pedigree points to a strong interaction with environmental factors. Future research is required to identify patients with familial hypercholesterolaemia who are at extreme risk and need early and vigorous preventive measures.

Adult↗
PubMed1993

Mortality of iron miners in Lorraine (France): relations between lung function and respiratory symptoms and subsequent mortality.

An increased mortality from lung and stomach cancer was found in previous studies on Lorraine iron miners. A detailed analysis, however, was not possible due to the lack of data for survivors. In this study the cohort included 1178 workers selected at random from all the 5300 working miners aged between 35 and 55 at the start of the follow up period, which ranged from 1975 to 1985. Occupational exposures and tobacco consumption, lung function tests, and respiratory symptoms were assessed for each subject in 1975, 1980, and 1985. This study confirmed the excess of lung cancer (standardised mortality ratio (SMR) = 389, p < 0.001) and of stomach cancer (SMR = 273, p < 0.05). There was no excess of lung cancer in non-smokers and moderate smokers (< 20 pack-years) or the miners who worked only at the surface or underground for less than 20 years. A significant excess (SMR = 349, p < 0.001) was found in moderate smokers when they worked underground for between 20 and 29 years. Heavy smokers (over 30 pack-years) or subjects who worked underground for more than 30 years experienced a high risk: SMR = 478 (p < 0.001) for moderate smokers who worked underground for over 30 years; 588 (p < 0.001) for heavy smokers who worked underground for between 20 and 29 years; and 877 (p < 0.001) for heavy smokers who worked underground for over 30 years. This showed an interaction between smoking and occupational exposure. The excess mortality from lung cancer was because there were some subjects who died young (from 45 years old). Comparison with the results of a previous study showed that additional hazards produced by diesel engines and explosives increased the mortality from lung cancer. The SMR was higher than 400 (p < 0.001) from 45 years old instead of from 56 years. A relation was found between a decrease in vital capacity (VC), forced expiratory volume in one second (FEV1) and of FEV1/VC and mortality from all causes and from lung cancer in heavy smokers or men who had worked underground for more than 20 years. Respiratory symptoms were related to mortality from lung cancer among smokers (moderate and heavy) who worked underground for more than 20 years. It is considered that the risk of lung cancer in the Lorraine iron miners was mainly due to dust, diesel engines, and explosives although the role of low exposure to radon daughters could not be totally excluded.

Adult↗
PubMed1993

Factors predictive of long-term coronary heart disease mortality among 10,059 male Israeli civil servants and municipal employees. A 23-year mortality follow-up in the Israeli Ischemic Heart Disease Study.

Over 10,000 male civil servants and municipal employees in Israel, aged 40 years and above, underwent an extensive clinical, biochemical, anthropometric, sociodemographic and psychosocial evaluation in 1963, 1965 and 1968. Follow-up for mortality was continued through 1986. Over 23 years, a number of previously established risk factors for coronary heart disease (CHD) incidence were found to predict mortality. The long-term follow-up assisted in illustrating temporal patterns. A single causal assessment of blood pressure retained high prediction for long-term mortality. Blood lipids, while significantly associated with both coronary and all-cause mortality, exhibited a small contribution to the latter, when compared to hypertension, cigarette smoking habits and diabetes. Weak associations of long-term coronary mortality with the dietary intake patterns of fatty acids, as reported at baseline, were probably fully mediated by the effect of the diet on serum cholesterol. Religious orthodoxy appeared to provide a degree of immunity, part of which was independent of life-style correlates. A number of now well-established associations in cardiovascular epidemiology were first demonstrated, or amplified, in the study. Patterns of ethnic diversity in the risk factor and prevalence rates of CHD persisted, as viewed from the angle of mortality rates, over nearly a quarter of a decade, highlighting the enigma of a migrant country as a cardiovascular melting pot.

Adult↗
PubMed1995

[Risk factors for mortality and mortality rate of sumo wrestlers].

We compared the mortality rate of sumo wrestlers with that of the contemporaneous Japanese male population, and inferred the usefulness of an index for predicting longevity in sumo wrestlers. The standardized mortality ratios (SMR) for sumo wrestlers were very high in each period, and also high for ages from 35 to 74. Cox's proportional hazards model analysis revealed that the variables in "nyuumaku" entry year and BMI were statistically significant (p < 0.05) factors in mortality. In the survival curves, the lower BMI group had good life expectancy compared with the higher BMI group. In conclusion, the higher rate of mortality in sumo wrestlers seems to be due to the markedly higher rate of mortality from 35 to 74 years old. In sumo wrestlers, also, this study provides evidence that the higher overweight groups have substantially higher risks for mortality.

Adult↗
PubMed1998

Estimation of the cumulated exposure to polychlorinated dibenzo-p-dioxins/furans and standardized mortality ratio analysis of cancer mortality by dose in an occupationally exposed cohort.

For a cohort of 1189 male German former herbicide and insecticide workers with exposure to polychlorinated dibenzo-p-dioxins and -furans (PCDD/F), we report an extended standardized mortality ratio (SMR) analysis based on a new quantitative exposure index. This index characterizes the cumulative lifetime exposure by integrating the estimated concentration of PCDD/F at every point in time (area under the curve). Production department-specific dose rates were derived from blood levels and working histories of 275 workers by applying a first-order kinetic model. These dose rates were used to estimate exposure levels for all cohort members. Total mortality was elevated in the cohort; 413 deaths yielded an SMR of 1.15 (95% confidence interval [Cl] 1.05, 1.27) compared to the mortality of the population of Germany. Overall cancer mortality (n = 124) was significantly increased (SMR = 1.41, 95% Cl 1.17, 1.68). Various cancer sites showed significantly increased SMRs. The exposure index was used for an SMR analysis of total cancer mortality by dose. For 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) a significant trend (p = 0.01) for the SMRs with increasing cumulative PCDD/F exposure was observed. The SMR in the first exposure quartile (0-125.2 ng/kg x years) was 1.24 (95% Cl 0.82, 1.79), increasing to 1.73 (95% Cl 1.21, 2.40) in the last quartile (> or = 2503.0 ng/kg x years). For all congeners combined as toxic equivalencies (TEQ) using international toxic equivalency factors, a significant increase in cancer mortality was observed in the second quartile (360.9-1614.4 ng/kg x years, SMR 1.64; 95% Cl 1.13, 2.29) and the fourth quartile (> or = 5217.7 ng/kg x years TEQ, SMR 1.64, 95% Cl 1.13, 2.29). The trend test was not significant. The results justify the use of this cohort for a quantitative risk assessment for TCDD and to a lesser extent for TEQ.

Adult↗
PubMed1975

Infant mortality in Macaca mulatta: neonatal and post-neonatal mortality at the California Primate Research Center, 1968-1972. A retrospective study.

Seven hundred forty-two Macaca mulatta births were recorded at the California Primate Research Center, 1968-1972. The neonatal mortality rate (deaths smaller than or equal to 30 days of age) was 10.8%, and the post-neonatal mortality rate (deaths at 31-183 days) was 6.9%. The neonatal mortality rate was higher in outdoor group cages than in indoor individual cages (24.8 vs. 8.0%). The post-neonatal mortality rate was also higher outdoors than indoors (15.9 vs. 5.9%). Outdoor mortality showed apparent seasonal variation, while indoor mortality did not.

Age Factors↗
PubMed2001

[Correlation between cancer mortality and alcohol-related mortality in a South-Hungarian village].

The author, who had former practical experience in the research-field of the medical statistics and alcohol-epidemiology, has collected the data of the total, and the cause-specific mortality continuously in the village where he has worked as the single GP from December 1986 to 1999. The village is located in the Great Hungarian Plain. It is an agricultural community, currently with population of 2042 inhabitants. The longevity in the village was above the national average. Total mortality and cause specific mortality in the village were calculated between January 1, 1987 and December 31, 1999. During the period, 503 people died. From these 278 (55.3%) were male, and 225 (44.7%) were female. 118 deaths, 23.5% of all deaths in the village were cancer-related. 67.7% (80 cases) of these were among males, and 32.3% (38 cases) among females. 40.7% (48 cases) of cancer-related deaths were attributable to gastrointestinal-tract cancers (ICD 10 C15-C26). The proportion of deaths which were directly or indirectly alcohol-related was 35.8% (180 cases) of the total mortality. In 50% (90 causes) of these deaths, the cause of death was one of the "especially characteristic death's cause of alcoholics". Proportion of alcohol-related-mortality attributable to cancer-related causes was high as 23.9% (43 cases); and vice versa: proportion of cancer-mortality attributable to alcohol-related causes was 36.4% (50% among males, and only 7.9% among females). Cancers of the cavity of mouth and pharynx as cause of death (6 cases) occurred only among alcohol-addicted males. The most important epidemiological conclusion is that the prevention of alcoholism/alcohol abuse is one of the most promising way for the prevention of (certain) cancers, too.

Adolescent↗
PubMed1995

International analysis of insulin-dependent diabetes mellitus mortality: a preventable mortality perspective. The Diabetes Epidemiology Research International (DERI) Study.

Differential survival associated with insulin-dependent diabetes mellitus (IDDM) was evaluated in a cross-country study using four population-based IDDM cohorts from Japan (n = 1,374), Israel (n = 610), Allegheny County, Pennsylvania (n = 995), and Finland (n = 5,144). For the purpose of this cross-country comparison, the Allegheny County cohort was taken to be representative of the United States. The mortality status as of January 1, 1990, was determined for all individuals who were diagnosed with diabetes at the age of less than 18 years between 1965 and 1979 and who were taking insulin at the time of hospital discharge. The results showed that the mortality experience for IDDM individuals in Japan and the United States was much worse than that in Finland and Israel. The age-adjusted mortality rates (per 100,000 person-years) for the four cohorts were 760 (Japan), 158 (Israel), 408 (Allegheny County), and 250 (Finland). By using the mortality data from Allegheny County, Pennsylvania, to extrapolate to the US IDDM mortality experience, the authors estimated 2,396 deaths among individuals with IDDM in the United States. It was calculated that 1,261 (53%) of these deaths would not have occurred in the United States given Finland's mortality rates. It is critical to determine why individuals with IDDM in the United States have a poorer outcome.

Adolescent↗
PubMed1993

[Predictive factors for in-hospital mortality and delayed mortality following aneurysmal subarachnoid hemorrhage].

It is important to detect predictive factors for in-hospital and delayed mortality of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm. Forty-eight patients with initial bleeding of aneurysmal SAH were referred to our hospital from January 1982 to December 1985. In-hospital mortality was 16.7% (8 to 48), and 15% (6) of forty patients died later during the follow-up period. Using the Kaplan-Meier method we were able to conclude that, cumulatively, there was 70.8% probability that much patients would survive for 10 years. We analysed predictive factors of in-hospital and delayed mortality retrospectively. The most significant predictive factor for in-hospital mortality was SAH grading on admission, and for delayed mortality (29.2%) age on admission was the best predictive factor. In fact, two patients died with cardiac event during the follow-up period. This result suggests that, although the SAH grading on admission was the second most significant factor for delayed mortality, patients who survived in the acute phase had a survival probability similar to those in a normal control group.

Adult↗
PubMed1982

Monitoring perinatal mortality by birth weight specific mortality rates.

The perinatal mortality at University Central Hospital of Turku, Finland decreased significantly from 15.7/1000 in years 1970-75 to 8.9/1000 in years 1976-78. The main decrease has occurred in weight groups of 1000 g and more. In years 1976-78 the perinatal mortality of non-malformed babies in the weight group 1500-1999 g was 93/1000, in the group 2000-2499 g 21/1000 and in the group of 2500 g and over 1.7/1000. The early neonatal mortality of non-malformed infants has decreased significantly only in the weight group of 1500-1999 g. The 1-week survival rate has been 48% in the weight group 500-999 g, but 77% in the weight group 1000-1499 g. The birth weight specific mortality rates are greatly required when the quality of obstetrical care is assessed. Birth weight specific neonatal mortality rates are essential when guidelines for elective termination of third trimester pregnancy are designed.

Birth Weight↗
PubMed1994

Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: results of a cross-national comparison.

Using data from United Nations sources we conducted an international comparison study of infant and maternal mortality rates and life expectancy at birth. We examined these three dependent variables in relation to a range of independent variables including dietary factors, medical resource availability, gross national product (GNP/capita), literacy rates, growth in the labor force, and provision of sanitation facilities and safe water. Based on exploratory stepwise regression models, we fitted a series of general linear models for each of the three dependent variables. For the models with the highest explanatory ability, the percent of households without sanitation facilities showed the strongest association with all three dependent variables: life expectancy at birth (R2 = 0.83, B = -0.088, P = 0.0007); infant mortality rate (R2 = 0.87, B = +0.611, P < 0.0001); and maternal mortality rate (R2 = 0.54, B = +8.297, P = 0.002). Additional significant predictors of life expectancy at birth and infant mortality rate included the quantity of animal products consumed, the percent of households without safe water, excess calories consumed as fat, and the total literacy level. Maternal mortality rate was significantly associated with total energy consumption and excess energy consumed as fat. Using residuals from the general linear models we chose three outlying countries: Costa Rica, Sri Lanka and Egypt, on which to do case studies. These country case studies are discussed briefly in regard to characteristics that could account for their differing statistical relationships.

Adult↗
PubMed2004

The suitability of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand.

OBJECTIVE: To compare the performance of the Pediatric Index of Mortality (PIM), PIM2, the Pediatric Risk of Mortality (PRISM), and PRISM III in Australia and New Zealand. DESIGN: A two-phase prospective observational study. Phase 1 assessed the performance of PIM, PRISM, and PRISM III between 1997 and 1999. Phase 2 assessed PIM2 in 2000 and 2001. SETTING: Ten intensive care units in Australia and New Zealand. PATIENTS: Included in the study were 26,966 patients aged <16 yrs; 1,147 patients died in the intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Discrimination between death and survival was assessed by calculating the area under the receiver operating characteristic plot for each model. The areas (95% confidence interval) for PIM, PIM2, PRISM, and PRISM III were 0.89 (0.88-0.90), 0.90 (0.88-0.91), 0.90 (0.89-0.91), and 0.93 (0.92-0.94). The calibration of the models was assessed by comparing the number of observed to predicted deaths in different diagnostic and risk groups. Prediction was best using PIM2 with no difference between observed and expected mortality (standardized mortality ratio [95% confidence interval] 0.97 [0.86-1.05]). PIM, PRISM III, and PRISM all overpredicted death, predicting 116%, 130%, and 189% of observed deaths, respectively. The performance of individual units was compared during phase 1, using PIM, PRISM, and PRISM III. There was agreement between the models in the identification of outlying units; two units performed better than expected and one unit worse than expected for each model. CONCLUSIONS: Of the models tested, PIM2 was the most accurate and had the best fit in different diagnostic and risk groups; therefore, it is the most suitable mortality prediction model to use for monitoring the quality of pediatric intensive care in Australia and New Zealand. More information about the performance of the models in other regions is required before these results can be generalized.

Australia↗
PubMed2006

Mortality inequalities in times of economic growth: time trends in socioeconomic and regional inequalities in under 5 mortality in Indonesia, 1982-1997.

STUDY OBJECTIVE: To examine time trends in socioeconomic and regional inequalities in under 5 mortality in Indonesia during almost two decades of economic growth. DESIGN: Under 5 mortality was calculated for the total population and for subgroups by maternal education, household wealth, rural/urban residence, and island group, using the 1987, 1991, 1994, and 1997 Indonesian Demographic and Health Surveys. Inequalities were calculated using Cox proportional hazards analysis. SETTING: Indonesia, 1982-1997. Main PARTICIPANTS: 18,205, 33,907, 39,433, and 37,533 children respectively, aged under 5 years, born to women included in the above mentioned surveys. MAIN RESULTS: Under 5 mortality declined substantially during the 1980s and 1990s. Educational inequalities in under 5 mortality decreased, although not statistically significantly, from a hazard ratio of 2.00 (95%CI 1.60, 2.50) to 1.52 (95%CI 1.27, 1.82). Inequalities between urban and not electrified rural areas increased, from 1.84 (95%CI 1.48, 2.28) to 2.18 (95%CI 1.70, 2.80). Inequalities between the Outer Islands and the central islands of Java/Bali increased from 1.16 (95%CI 0.92, 1.46) to 1.43 (95%CI 1.17, 1.74). Irregular time trends were seen for inequalities by household wealth. Trends in health care use were fairly similar for the low and high educated. CONCLUSIONS: These results for education show that socioeconomic inequalities in under 5 mortality do not inevitably rise in times of rapid economic growth. Widening or narrowing of health inequalities in times of economic growth might depend on how equally this growth is distributed.

Adolescent↗
PubMed1989

[Study of general mortality and of mortality related to malaria in the mountains of Kivu, Zaire].

A longitudinal study in the "health region" of Katana (Kivu, Zaïre) has permitted to determine age and disease specific mortality rates. The infant mortality rate is 172 per 1000/year, the child mortality rate 45 p.1000/year and the crude rate 24 p.1000/year. Two thirds of this mortality are related to infectious and parasitic diseases: measles, diarrhoea, respiratory diseases and malaria. In the mountainous Katana region (4500 feet), malaria is responsible for 12%, of the decrease and the specific mortality rates are 3 p.1000/year in the general population and 18 and 6 p.1000/year in, respectively, the 0 to 11 month and 1 to 4 year age groups. We discuss the potential of PHC to improve, in the framework of an integrated development approach, this unfavorable health situation.

Adolescent↗
PubMed1980

[Higher rural mortality or lower urban mortality in France? (author's transl)].

Examination of crude and standardized rates, life expectancies and death probabilities by age shows an excess of mortality for males and females in little towns (less than 10 000 inhabitants) and on the other hand a lower mortality in parisian area. One aspect of the problem--relation between mortality and urbanisation (localities size)--is not the same with the sexes. For males, there is a lower mortality in rural area, on the contrary, for females, mortality is decreasing while the size of the locality is increasing. It would be possible to explain this results by parameters closely connected with urbanisation, such as socio-economic groups, marital status, health system. A next research will take this parameters and medical causes into account.

Adolescent↗