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PubMed2004

Associations between white blood cell count and risk for cerebrovascular disease mortality: NHANES II Mortality Study, 1976-1992.

PURPOSE: To examine associations between elevated white blood cell count (WBC) and cerebrovascular disease (CeVD) mortality independent of cigarette smoking and by gender. METHODS: We used Cox regression analyses of data from 8459 adults (3982 men; 4477 women) aged 30 to 75 years in the NHANES II Mortality Study (1976-1992) to estimate the relative risk of death from CeVD across quartiles of WBC. RESULTS: During 17 years of follow-up, there were 192 deaths from CeVD (93 men; 99 women). Compared with those with WBC (cells/mm(3))<5700, adults with WBC>8200 were at increased risk of CeVD mortality (relative risk [RR], 2.1; 95% confidence interval [CI], 1.2-3.7) after adjustment for smoking and other cardiovascular disease risk factors. Similar results were observed among never smokers (RR, 2.0; 95% CI, 1.0-3.8). The adjusted relative risk of CeVD mortality comparing those with WBC>8200 to those with WBC<5700 was 1.5 (95% CI, 0.7-3.5) among men and 2.7 (95% CI, 1.4-5.0) among women. CONCLUSIONS: Elevated WBC may predict CeVD mortality even after considering the effects of smoking and other cardiovascular disease risk factors.

Adult↗
PubMed2004

Self-reported health and adult mortality risk: an analysis of cause-specific mortality.

The relationship between self-reported health and mortality is well documented, but less well understood. This study uses the National Health Interview Survey linked to mortality data from the National Death Index to examine the association between self-reported health and a comprehensive set of underlying cause of death and multiple cause of death categories. We also examined whether gender moderates the relationship between self-reported health and cause-specific mortality risk. Results show that the relationship between self-rated health and mortality differs by cause of death and by number of causes. Deaths due to diabetes, infectious and respiratory diseases, and a higher number of causes are most strongly associated with subjective health. Self-reported health also exhibits a moderately strong association with deaths due to heart disease, stroke, and cancer. In contrast, self-rated health is only weakly or not associated with deaths due to accident, homicide, and suicide. The relationship between self-reported health and mortality risk is also found to be stronger among men for several causes, although not for all. These findings should help researchers and policy-makers to better understand the specific predictive power of this important global measure of health.

Adult↗
PubMed1996

Sarcoidosis mortality in the United States 1979-1991: an analysis of multiple-cause mortality data.

PURPOSE: We sought to describe sarcoidosis mortality in the United States from 1979 through 1991. METHODS: We analyzed death certificate reports compiled by the National Center for Health Statistics for the period 1979 through 1991. RESULTS: Of the 26,866,600 people who died during the study period, 9,014 had a diagnosis of sarcoidosis listed on their death certificates. We restricted our study group to 5,791 people who died because of sarcoidosis or one of its complications. Among men, age-adjusted mortality rates increased from 1.3 per 1,000,000 in 1979 to 1.6 per 1,000,000 in 1991, and among women, these rates increased from 1.9 per 1,000,000 in 1979 to 2.5 per 1,000,000 in 1991. Age-adjusted mortality rates were consistently higher among blacks than whites. Age-adjusted mortality rates stratified by race, varied by state. Among whites, the highest rates were in northern states, while among blacks, the highest rates were in the Middle Atlantic and northern Midwestern states. CONCLUSIONS: Reported mortality due to sarcoidosis varies by region, sex, and race. We cannot determine whether these differences are related to characteristics of the disease, or problems in death certification and coding.

Adolescent↗
PubMed2000

Stroke mortality in urban and rural Tanzania. Adult Morbidity and Mortality Project.

BACKGROUND: Most data for stroke mortality in sub-Saharan Africa are hospital based. We aimed to establish the contribution of cerebrovascular disease to all-cause mortality and cerebrovascular disease mortality rates in adults aged 15 years or more in one urban and two rural areas of Tanzania. METHODS: Regular censuses of the three surveillance populations consisting of 307,820 people (125,932 aged below 15 years and 181,888 aged 15 or more) were undertaken with prospective monitoring of all deaths arising in these populations between June 1, 1992 and May 31, 1995. Verbal autopsies were completed with relatives or carers of the deceased to assess, when possible, the cause of death. FINDINGS: During the 3-year observation period 11,975 deaths were recorded in the three surveillance areas, of which 7629 (64%) were in adults aged 15 years or more (4088 [54%] of these in men and 3541 [46%] in women). In the adults, 421 (5.5%) of the deaths were attributed to cerebrovascular disease, 225 (53%) of these in men and 196 (47%) in women. The yearly age-adjusted rates per 100,000 in the 15-64 year age group for the three project areas (urban, fairly prosperous rural, and poor rural, respectively) were 65 (95% CI 39-90), 44 (31-56), and 35 (22-48) for men, and 88 (48-128), 33 (22-43), and 27 (16-38) for women, as compared with the England and Wales (1993) rates of 10.8 (10.0-11.6) for men and 8.6 (7.9-9.3) for women. INTERPRETATION: We postulate that the high rates in Tanzania were due to untreated hypertension. Our study assessed mortality over a single time period and therefore it is not possible to comment on trends with time. However, ageing of the population is likely to lead to a very large increase in mortality from stroke in the future.

Adolescent↗
PubMed2002

Sleep duration and mortality: The effect of short or long sleep duration on cardiovascular and all-cause mortality in working men and women.

BACKGROUND: There is evidence to suggest that insufficient sleep may have an adverse effect on physical and psychological health. Previous studies have reported that when adjusting for major risk factors for cardiovascular disease and a number of demographic and social variables, sleeping 7-8 h each night is associated with lower mortality. These studies, however, have excluded any consideration of stress, which is known to be related to a number of behavioural risk factors for disease and, like sleep, may influence neurochemical, hormonal and immunological functioning. METHODS: This study revisits the associations between sleep duration, cardiovascular disease risk factors and mortality, taking into account the perceived stress of individuals. The data come from a cohort of working Scottish men and women recruited between 1970 and 1973; approximately half of the cohort was screened for a second time, 4-7 years after the baseline examination. RESULTS: For both men and women, higher self-perceived stress was associated with a reduction in the hours of sleep reported. The pattern of mortality from all causes and the pattern of mortality from cardiovascular disease were consistent for both men and women. When sleep was measured on one occasion only, the risk of dying was reduced for men sleeping more than 8 h in every 24 h compared with those sleeping 7-8 h over the same period. This was after adjustment had been made for age, marital status, social class, cardiovascular risk factors and stress. The risk of dying was increased for women sleeping less than 7 h in every 24 h compared with those sleeping 7-8 h over the same period, after similar adjustments. When the data from the 1st and 2nd screening were considered longitudinally, both men and women who reported that they slept less than 7 h on both occasions that they were questioned, had a greater risk of dying from any cause than those who had reported sleeping 7-8 h at both screenings, after adjusting for age, marital status, social class and stress. CONCLUSIONS: Short sleep over a prolonged period may be associated with an increased risk of mortality: men and women who reported sleeping fewer than 7 h in 24 on two occasions between 4 and 7 years apart, had greater risk of dying from any cause over a 25 year period than those who reported sleeping 7-8 h on both occasions that they were questioned.

Journal Article↗
PubMed1980

Mortality patterns following internal fixation for acute femoral neck fractures in the elderly with special emphasis on potential excess mortality following reoperations.

Mortality patterns and excess mortality have been studied and quantified in 103 patients treated with internal fixation for acute, displaced femoral neck fractures with special emphasis on the potential excess mortality which may follow later operations for capital necrosis, failure of the osteosynthesis, etc. Of 103 patients studied 31 needed one or more reoperations. We have confirmed previously published reports that excess mortality is limited to the first six months after the primary operation. Quantification of the excess mortality which may follow reoperations shows that later operations are not followed by an increased death rate compared with the standard population.

Aged↗
PubMed1989

Culicidae (Diptera) mortality resulting from insecticide aerosols compared with mortality from droplets on sentinel cages.

The mortality of female Aedes aegypti exposed to an ultralow-volume (ULV) aerosol for 15 min and then transferred to clean cages was compared to the mortality of females exposed to the contaminated sentinel exposure cages. ULV aerosol sprays of fenitrothion (50% AI) were dispersed at 180 and 205 ml/min, and ULV aerosol sprays of bendiocarb (18.87% AI) were dispersed at 90 and 120 ml/min in an open field. At 24 h after exposure, the mean percentage of mortality of Ae. aegypti in cages previously exposed to insecticides was 87% at 46 m and 71.8% at 91 m downwind of aerosol generation for the four flow rates. The mean percentage of mortality of Ae. aegypti exposed to the aerosol and then transferred to clean cages was 74.5% at 46 m and 68% at 91 m. Insecticide droplets deposited on exposed cages caused significant mortality to Ae. aegypti. Data show that sentinel mosquitoes used in insecticide bioassays should be transferred into clean holding containers as soon as possible after exposure to prevent biasing of results from insect contact with insecticide deposited on cage walls and screens.

Aerosols↗
PubMed1983

Long-term mortality study of oil refinery workers. I. Mortality of hourly and salaried workers.

This longitudinal study examined the mortality and cancer experience of workers at the Gulf Oil refinery located in Port Arthur, Texas. The cohort was studied over a period of 41 years, from 1937 to 1978, and consisted of 16,880 employees, with an accumulation of 406,198 person-years; 4361 deaths were observed. Emphasis of this study was placed on the experience of the hourly and salaried male workers employed one day or more and those with a minimum of one year employment. The standardized mortality ratio analysis revealed generally favorable mortality experience of the refinery workers, including that of overall cancer. Statistically significant deficits in mortality were found for several cancer sites including bladder, liver, and esophageal cancer. Many of the increased cancer risks suggested in the literature were not confirmed in this study. Although bone cancer was found to be increased significantly, review of those death certificates raises questions as to the accuracy of the recording and coding of this cancer. Sample size of this study is capable of providing sufficient statistical power for the detection of a twofold increase in mortality risk for many cancers, if such risk exists.

Adult↗
PubMed1990

Geographic variations in US asthma mortality: small-area analyses of excess mortality, 1981-1985.

US asthma mortality rates have been increasing during the past 10 years. Little is known about the geographic variation of this infrequent health event. Using US vital records for the 1981-1985 period, small-area variation of excess asthma mortality of young adults was studied. Several geopolitical definitions were used to define populations. A total of 22 single counties, 12 metropolitan statistical areas, 11 health service areas, and 29 state economic areas were identified as having mortality significantly in excess of that expected, based on US race/sex-specific rates. Significant variation in asthma mortality was found at several levels of geopolitical classification of the data. Elevated areas included the central plains states and three large urban metropolitan areas--Chicago, Illinois, New York, New York, and Phoenix, Arizona--as well as a few mostly suburban populations. Areas with excess mortality may provide a useful population base for further epidemiologic investigation into the risk factors associated with the more frequent morbid events of this disease, such as emergency room and hospital utilization.

Adolescent↗
PubMed1984

The mortality of Ontario undertakers and a review of formaldehyde-related mortality studies.

In a study of the mortality of Ontario undertakers, a cohort of 1,477 men first licensed during 1928 through 1957 was followed up until the end of 1977. Numbers of observed and expected deaths were determined for the period 1950 through 1977, using mortality rates of Ontario men as the standard. In all, 319 persons had died, compared with 322 expected. Ontario undertakers were not at increased risk of death from cancers at sites of contact with formaldehyde. Cirrhosis of the liver (standardized mortality ratio, 238) and chronic rheumatic heart disease (standardized mortality ratio, 199) were the only causes of death found to be significantly in excess. The data are discussed in the context of current epidemiologic information on the mortality experience of persons exposed to formaldehyde.

Adult↗
PubMed1992

Delayed increases in liver cirrhosis mortality and frequency of alcoholic liver cirrhosis following an increment and redistribution of alcohol consumption in Finland: evidence from mortality statistics and autopsy survey covering 8533 cases in 1968-1988.

Changes in the legal restrictions for alcohol consumption in 1969 liberated purchasing and marketing of low-alcohol beer. Subsequently, within the space of 5 years, the per capita consumption of absolute alcohol increased from 4.2 to 6.5 liters. To evaluate the possible effects of this change upon liver cirrhosis mortality as well as prevalence of liver cirrhosis in autopsy series, we surveyed mortality statistics and data from 8,533 medicolegal autopsies in 1968 through 1988. Liver cirrhosis mortality statistics revealed a highly significant (p less than 0.001) increase from 6.4 to 13.7 per 100,000 during the period, and similarly, the prevalence of liver cirrhosis in the autopsy series showed a highly significant (p less than 0.001) increase from 3.0% to 6.1%. More specifically, this increase was attributable to a highly significantly (Chi-square 15.4, p less than 0.001) increased proportion of alcoholic liver cirrhosis occurring at a younger age and almost exclusively in males. The stepwise mode of increase as well as the changes in sex and age distribution of cirrhosis since 1969 could be interpreted as an effect of distribution of consumption to a new generation of consumers. The forensic autopsy series seemed to reflect changes in per capita consumption with a shorter time lag than with mortality statistics. Additionally, only 7% of the 448 cirrhotics singled out from this material exhibited liver cirrhosis as a cause of death and were thus also included in the official mortality statistics, suggesting the greater accuracy of our forensic autopsy series.

Adult↗
PubMed1993

After correcting for worse baseline characteristics, women treated with thrombolytic therapy for acute myocardial infarction have the same mortality and morbidity as men except for a higher incidence of hemorrhagic stroke. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Study.

BACKGROUND: In the prethrombolytic era, women with myocardial infarction were reported to have a worse outcome than men. This analysis evaluates the association of sex with morbidity and mortality after thrombolytic therapy. METHODS AND RESULTS: Data were analyzed from 8261 of the 8387 randomized patients with acute myocardial infarction who received thrombolytic therapy in the International Tissue Plasminogen Activator/Streptokinase Mortality Study (baseline data were missing for 126 patients) and were followed for 6 months. Women made up 23% (n = 1944) of the study population. Baseline characteristics were worse in women: they were 6 years older, were more likely to have a history of previous infarction (P < .01), antecedent angina (P < .01), hypertension (P < .0001), or diabetes (P < .0001); were in a higher Killip class on admission (P < .0002); and received thrombolytic therapy 18 minutes later than men (P < .0001). Fewer women were smokers (P < .0001). Women had a higher hospital (12.1% versus 7.2%, P < .0001) and 6-month mortality (16.6% versus 10.4%, P < .0001) and were more likely to develop cardiogenic shock (9.1% versus 6.3%, P < .0001), bleeding (7.2% versus 5.3%, P < .01), and hemorrhagic (1% versus 0.3%, P < .001) or total stroke (2.2% versus 1.1%, P < .0001) during hospitalization. Reinfarction rates and requirement for angioplasty or surgery did not differ. After correction for worse baseline characteristics, women had similar morbidity and mortality apart from a significantly higher incidence of hemorrhagic stroke, which remained significant even after accounting for weight and treatment allocation (odds ratio, 2.90; P < .01). CONCLUSIONS: After thrombolytic therapy for acute myocardial infarction, women have similar morbidity and mortality to men but suffer from a higher incidence of hemorrhagic stroke.

Aged↗
PubMed2002

Global and regional estimates of cancer mortality and incidence by site: I. Application of regional cancer survival model to estimate cancer mortality distribution by site.

BACKGROUND: The Global Burden of Disease 2000 (GBD 2000) study starts from an analysis of the overall mortality envelope in order to ensure that the cause-specific estimates add to the total all cause mortality by age and sex. For regions where information on the distribution of cancer deaths is not available, a site-specific survival model was developed to estimate the distribution of cancer deaths by site. METHODS: An age-period-cohort model of cancer survival was developed based on data from the Surveillance, Epidemiology, and End Results (SEER). The model was further adjusted for the level of economic development in each region. Combined with the available incidence data, cancer death distributions were estimated and the model estimates were validated against vital registration data from regions other than the United States. RESULTS: Comparison with cancer mortality distribution from vital registration confirmed the validity of this approach. The model also yielded the cancer mortality distribution which is consistent with the estimates based on regional cancer registries. There was a significant variation in relative interval survival across regions, in particular for cancers of bladder, breast, melanoma of the skin, prostate and haematological malignancies. Moderate variations were observed among cancers of colon, rectum, and uterus. Cancers with very poor prognosis such as liver, lung, and pancreas cancers showed very small variations across the regions. CONCLUSIONS: The survival model presented here offers a new approach to the calculation of the distribution of deaths for areas where mortality data are either scarce or unavailable.

Age Distribution↗
PubMedDate not supplied

The Pittsburgh Insulin-Dependent Diabetes Mellitus (IDDM) Morbidity and Mortality Study: case-control analyses of risk factors for mortality.

Although children with IDDM are at a sevenfold increased risk of dying when compared with nondiabetic individuals of the same age, the factors associated with the excess in mortality remain unclear. To investigate potential determinants of mortality among IDDM patients, a case-control study was conducted. These retrospectively obtained data indicated that shorter relative height at onset, frequent diabetes-related readmissions, the presence of diabetes complications, a family history of diabetes, premature familial mortality, no participation in school team sports, and a lower level of education were related to subsequent mortality among males. Among females, however, a shorter duration of diabetes clinic attendance and the presence of diabetes complications were the only significant associations to mortality.

Adolescent↗
PubMed1998

Hemochromatosis-associated mortality in the United States from 1979 to 1992: an analysis of Multiple-Cause Mortality Data.

BACKGROUND: Hemochromatosis, which can lead to serious chronic diseases resulting from iron overload, has an estimated prevalence of 50 to 80 cases per 10000 persons. However, little population-based information is available on the impact of hemochromatosis on morbidity and mortality. OBJECTIVE: To evaluate trends over 14 years in deaths and medical conditions associated with hemochromatosis in the United States. DESIGN: We searched Multiple-Cause Mortality Files compiled by the National Center for Health Statistics for the years 1979 to 1992 for all records listing hemochromatosis. We used these data to calculate age-adjusted and age-specific mortality rates, identify medical conditions associated with a known diagnosis of hemochromatosis at death, and calculate proportionate mortality ratios for these medical conditions. RESULTS: The listing of hemochromatosis on death certificates increased 60% from 1979 to 1992. Decedents with hemochromatosis were 23, 13, and 5 times more likely to have liver neoplasms, liver disease, and cardiomyopathy, respectively, than were decedents without hemochromatosis. Conversely, decedents with liver neoplasms, liver disease, and cardiomyopathy were 26, 14, and 5 times more likely, respectively, to have hemochromatosis than were decedents without these conditions. Hemochromatosis was 82 times more likely in persons with the combination of liver neoplasms and diabetes and 43 times more likely in those with the combination of liver disease and diabetes than in those without these conditions. CONCLUSIONS: Comparison of the reported prevalence of hemochromatosis among decedents with estimates of prevalence in the general U.S. population suggests that either the penetrance or the recognition of hemochromatosis, or both, is low. Nevertheless, substantial mortality resulting from liver disease, liver neoplasms, cardiomyopathy, and a combination of liver disease and diabetes in patients with hemochromatosis argues for the improved diagnosis and treatment of hemochromatosis in persons with these conditions.

Age Distribution↗
PubMed2004

WBC count and the risk of cancer mortality in a national sample of U.S. adults: results from the Second National Health and Nutrition Examination Survey mortality study.

Inflammation has been shown to be a risk factor for several chronic diseases. Few epidemiologic studies have examined the relationship between markers of inflammation and cancer. The current study included 7,674 Second National Health and Nutrition Examination Survey (NHANES II) participants, 30 to 74 years of age, between 1976 and 1980. Mortality follow-up through December 31, 1992 was assessed using the National Death Index and Social Security Administration Death Master File. A graded association between higher WBC and higher risk of total cancer mortality was observed [highest versus lowest quartile (relative risk [RR] 2.23; 95% confidence interval [CI], 1.53-3.23)] after adjusting for age, sex, and race. After further adjustment for smoking, physical activity, body mass index, alcohol intake, education, hematocrit, and diabetes, WBC remained significantly associated (P trend = 0.03) with total cancer mortality [highest versus lowest quartile (RR 1.66; 95% CI, 1.08-2.56)]. In stratified analyses, increased WBC was associated with higher risk of non-lung cancer (P trend = 0.04), but not lung cancer (P trend = 0.18). Among never smokers, a 1 SD increase in WBC (2.2 x 10(9) cells/L) was associated with greater risk of total (RR 1.32; 95% CI, 1.05-1.67) and non-lung (RR 1.30; 95% CI, 1.03-1.63) cancer mortality. These findings support the hypothesis that inflammation is an independent risk factor for cancer mortality. Additional studies are needed to determine whether circulating levels of inflammatory markers are associated with increased risk of incident cancer.

Adult↗
PubMed1978

[The importance of primary operation from the point of view of mortality in patients with femoral neck fractures. I. Comparative study of mortality after primary and delayed operations. The part played by the patients age (author's transl)].

Authors with regard to primary or delayed surgical treatment analyse the mortality of 2,612 patients with proximal femur fractures treated in the National Institute of Traumatology during the years 1971--75. Within this material 2,055 case history of surgically treated femoral neck and pertrochanteric fractures are evaluated. An important difference in favour of primary intervention was found between the mortality of primary and delayed operations both in femoral neck and pertrochanteric fractures. In pertrochanteric fractures the mortality increased gradually starting from the day of injury. Regarding age related mortality, there was a significant difference in each age group in favour of primary operations. Thus the increased mortality encountered after delayed operations can't be explained by a selection with regard to age.

Age Factors↗
PubMed1985

Mortality among workers in the Florida phosphate industry. I. Industry-wide cause-specific mortality patterns.

A retrospective cohort mortality study was conducted on 17,601 white and 4,722 nonwhite male workers in the Florida phosphate mining and chemical processing industry. Concerns about potential risks from naturally-occurring sources of ionizing radiation and anecdotal reports of lung cancer among workers prompted this investigation. Historical follow-up was conducted for the years 1949 to 1978. In comparison with U.S. rates, small excess of mortality rates of lung cancer were observed for white (standardized mortality ratio [SMR] equals 1.22) and nonwhite workers (SMR = 1.24); however, these excesses disappeared when contrasts were made with prevailing rates in Florida. Emphysema mortality was also slightly elevated in comparison with U.S. rates; the SMRs were 1.48 and 1.73 for white and nonwhite workers, respectively. Neither disease was related to overall length of employment. Detailed analyses of mortality in relation to work assignments are presented in the companion article.

Adult↗