Excess mortality in rheumatoid arthritis--is it the disease or the drugs?
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Aged↗
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Results for “Excess Mortality”
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Excessive mortality in market-age turkeys associated with cellulitis.
Between July, 1993, and October, 1994, seven cases were examined that consisted of increased mortality in commercial turkeys due to cellulitis. The condition started at 13-16 wk of age in toms and persisted until the birds were marketed. The mortality rate was 1-2% per week. Lesions began on the ventrum of the tail and consisted of swelling and the formation of vesiclelike structures. Most of the affected birds also had an accumulation of gelatinous fluid in the subcutis of the tail and breast areas. The underlying musculature was often darkened or petechiated. Clostridium perfringens type A was isolated from two of the cases. Lesions similar to those found in the field were reproduced experimentally in turkeys injected with the subcutaneous fluid obtained from birds in field cases.
Animals↗
[Airborne small particles as a cause of pulmonary diseases and excessive mortality?].
The paper reviews the available literature with regard to human health effects of fine particulate matter (PM10, PM2.5) from a Danish perspective. Fine particulate matter is not routinely measured in any Danish air pollution monitoring programme. Preliminary surveys show elevated PM2.5 levels in Copenhagen corresponding to levels found in other cities in Europe and the USA, and a close relationship between outdoor and indoor concentrations. It has been roughly estimated that about 400 people in the Greater Copenhagen area may suffer a premature death due to airborne fine particulate matter. A limited number of Danish studies support the view that health effects (respiratory symptoms and increased medication) can be observed in sensitive city populations at air pollution levels well below international air quality standards.
Air Pollutants↗
Excess mortality, influenza epidemiological surveillance indicator.
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Epidemiologic Methods↗
Reply to Jack E. Riggs' "Deprenyl, excess mortality, and epidemiological traps". Parkinson's Disease Research Group of the United Kingdom.
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Adult↗
Effect of ethnicity on mortality of very low birthweight infants in Israel.
BACKGROUND: Multiple demographic, genetic, and environmental factors differ between Muslim and Jewish infants in Israel. OBJECTIVE: To evaluate whether, after adjustment for perinatal factors associated with mortality, excess mortality occurs in very low birthweight (VLBW) Muslim compared with Jewish infants. DESIGN: The Israel National VLBW infant database includes data on 99% of all VLBW births in Israel. The study population comprised 5015 Jewish and 1549 Muslim VLBW infants of more than 23 weeks gestation, born between 1995 and 1999. The Mantel-Haenszel test was used for stratified analysis and logistic regression analysis to assess the effect of ethnic origin on mortality. RESULTS: The death rate was significantly higher among Muslim infants (22.7% v 17.2%; crude odds ratio 1.42; 95% confidence interval 1.24 to 1.63). Excess mortality in Muslims occurred mainly in the 32-33 week (8.0% v 2.8%) and >33 week (14.7% v 4.7%) gestational age groups, and in birthweight groups of 1000-1249 g (17.6% v 9.3%) and 1250-1500 g (9.1% v 3.6%). In VLBW infants without congenital malformations, there was a significantly higher risk of mortality among Muslim infants (odds ratio 1.28; 95% confidence interval 1.04 to 1.57) compared with Jewish infants, after adjustment for gestational age, birth weight, small for gestational age, prenatal care, prenatal steroid treatment, plurality, mode of delivery, and Apgar score. CONCLUSIONS: Excess mortality was present among Muslim VLBW infants without congenital malformations. Perinatal factors associated with increased risk of mortality were more prevalent in the Muslim VLBW population. The pattern of disparities suggests inadequate access to, or utilisation of, effective perinatal technology in the Muslim population in Israel.
Databases, Factual↗
Geographic variation in mortality from breast cancer among white women in the United States.
BACKGROUND: For several decades, mortality from breast cancer has been higher in the northeastern part of the United States than in other regions, particularly the South. Rates have also been somewhat higher in the Midwest and West than in the South, especially among older women. The reasons for these geographic variations are not well understood. PURPOSE: The objective of this study was to evaluate geographic differences in U.S. breast cancer mortality rates in 1987, after taking into account regional differences in the distribution of recognized breast cancer risk factors (e.g., late age at first live birth) and certain prognostic factors (e.g., mammography use). METHODS: The 1987 breast cancer mortality rates for four regions of the country were obtained from the National Center for Health Statistics. Regional data on the distribution of breast cancer risk factors were obtained from 1987 National Health Interview Cancer Epidemiology Supplement interviews with 9778 white women aged 20-79 years. Regional data on the distribution of mammography use were obtained from 1987 National Health Interview Cancer Control Supplement interviews with 3795 white women aged 50-79 years. RESULTS: Age-adjusted mortality ratios (MRs) among women 50 years and older were 1.15, 1.18, and 1.30 in the West, Midwest, and Northeast, respectively, compared with the South. Corresponding MRs among women 20-49 years old were 1.01, 1.08, and 1.07 in the West, Midwest, and Northeast, respectively, compared with the South. After adjustment for recognized risk factors and certain prognostic factors, MRs among older women were 1.13 (95% confidence interval [CI] = 1.04-1.23), 1.08 (95% CI = 1.01-1.16), and 1.13 (95% CI = 1.04-1.23) in the West, Midwest, and Northeast, respectively, compared with the South. Corresponding MRs among younger women were 0.94 (95% CI = 0.76-1.16), 1.05 (95% CI = 0.92-1.18), and 0.99 (95% CI = 0.86-1.14), respectively. CONCLUSION: Before adjustment for regional differences in recognized risk factors and prognostic factors, mortality excesses among younger women in the Northeast, Midwest, and West were less than 10% compared with the South. After adjustment, MRs were near unity for all regions. Among older women, the excess mortality was more substantial before adjustment for relevant factors, ranging from 15% in the West to 30% in the Northeast. Approximately 50% of the excesses in the Northeast and Midwest and 10% of the excess in the West could be explained on the basis of regional differences in the prevalence of recognized breast cancer risk factors and prognostic factors. After adjustment for these factors, the magnitude of excess in breast cancer mortality in the Northeast (13%) was comparable to that in the West (13%) but still slightly higher than that in the Midwest (8%).
Adult↗
Mortality among rubber workers: IX. Curing workers.
This research examined mortality among 1,152 white male production workers employed in the tire-curing department of a large rubber manufacturing plant. To determine whether these men had any cause-specific mortality excesses, their experience was compared with that of both the U.S. white male general population and a group of production workers at the same plant who had not worked in the curing division. Both types of comparisons indicated that the curing workers experienced excess mortality from lung cancer. There were 45 deaths from lung cancer among curing workers compared to 24.6 expected based on the age- and calendar period-specific rates of other rubber workers. In addition, the mortality rate ratio for pneumonia was 2.2 for curing relative to noncuring workers. These findings are consistent with the results of other studies and suggest that occupational exposures may have contributed to the development of pulmonary disease among curing workers.
Age Factors↗
A population-based study of prognosis of ruptured cerebral aneurysm: mortality and recurrence of subarachnoid hemorrhage.
OBJECTIVE: To determine the risk of recurrent subarachnoid hemorrhage (SAH), mortality, and relative survivorship following SAH caused by ruptured cerebral aneurysm (RCA). DESIGN/METHODS: The 86 individuals with a first diagnosis of SAH caused by RCA in Iceland from 1958 through 1968 were followed a minimum of 24 years (range, 24 to 32.5 years) or until death to determine mortality and to identify those with recurrent SAH. RESULTS: Thirty-eight patients (44%) died within 30 days of the index event. Two additional (both comatose from onset of ictus) died in the following month. There were no deaths between 3 and 6 months after onset. Based upon the age/gender-specific person years of observation for the population of Iceland, the Standardized Mortality Ratio for the 44 surgically treated patients surviving 6 months was 1.3. Those neurologically normal or with only mild impairment at 6 months had no identified increase in mortality. Excess mortality that was limited to individuals with severe neurologic deficit at 6 months could be identified through the first 10 years after onset. Two 6-month survivors experienced recurrent SAH. CONCLUSIONS: Early mortality is high (47%) in patients with RCA. In patients operated on for RCA and surviving 6 months, recurrent SAH occurred in 5%. Survivorship among patients surgically treated and neurologically normal or with mild residual neurologic impairment at 6 months following presentation was similar to that expected in the general population. Survivorship among patients surgically treated who had severe residual neurologic impairment at 6 months was significantly reduced.
Adult↗
[Socioeconomic inequalities in health in the Tuscany Longitudinal Study (SLTO): persistence and changes over time in overall mortality and selected causes (lung cancer, liver cirrhosis, AIDS and overdose)].
We evaluate the persistence of social inequalities in overall mortality or mortality by causes (lung cancer, liver cirrhosis; AIDS and overdose) in the Tuscany Longitudinal Study (SLTo), a record linkage-study on the census population identified at the 1981 and 1991 censuses in Leghorn (1981: 175,741 subjects; 1991: 167,512 subjects), and 1991 in Florence (403,294 subjects), Central Italy. The census data allow an evaluation of socio-economic status of each subject, using variables such as education or occupation, or constructing indexes inclusive of deprivation indexes. Follow-up is from the census up to 1995 and for specific causes of death from 1987 (Leghorn) or 1991 (Florence). Estimates of risk are computed comparing rates of mortality among socio-economic groups, by means of poisson regression models, or by means of Standardized Mortality Ratios using the indirect method. The causes of deaths have been selected mainly because explained by known and strong determinants. As far as overall mortality, the results suggest the persistence of gradients by social class, more often negative among males. Mortality from lung cancer has a strong negative social class gradient among males, and a divergent gradient among women in the two towns, which is interpreted as the effect of a different prevalence of smoking by period, social class and sex. High RRs among lower socio-economic groups have been detected for liver cirrhosis mortality. Excess mortality of AIDS and overdose, an expression of the recent drug crisis, concentrates on the lower social strata and in young adults. Whereas mortality from AIDS has been detected among both sexes, deaths from overdose are occurring among males only. Being AIDS and overdose recent diseases, they stress the persistence of social inequalities over time.
Acquired Immunodeficiency Syndrome↗
Smoking and health in old age. A ten-year follow-up study.
The implications for health of smoking habits at entry were evaluated in a 10-year longitudinal study of a population of men and women aged exactly 70 at entry and otherwise selected only according to geography. Seventy-six per cent of the men and 39% of the women were smokers at 70, 32% of the male and 20% of the female smokers were inhalers. In men, heavy smoking (greater than or equal to 15 g tobacco per day and inhalation) was statistically associated with low systolic blood pressure, intermittent claudication, chronic bronchitis, low body mass index and low serum insulin, but not with forced expiratory volume in first second (FEV1). In the 10-year follow-up period heavy smoking in men was associated with excess total mortality, excess mortality from malignant neoplasms, excess mortality from non-malignant pulmonary diseases and increased decrease in FEV1. In women, but not in men, inhalation was statistically associated with excess total mortality.
Aged↗
Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes.
AIMS/HYPOTHESIS: We aimed to examine the mortality rates, excess mortality and causes of death in diabetic patients from ten centres throughout the world. METHODS: A mortality follow-up of 4713 WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD) participants from ten centres was carried out, causes of death were ascertained and age-adjusted mortality rates were calculated by centre, sex and type of diabetes. Excess mortality, compared with the background population, was assessed in terms of standardised mortality ratios (SMRs) for each of the 10 cohorts. RESULTS: Cardiovascular disease was the most common underlying cause of death, accounting for 44 % of deaths in Type I (insulin-dependent) diabetes mellitus and 52 % of deaths in Type II (non-insulin-dependent) diabetes mellitus. Renal disease accounted for 21% of deaths in Type I diabetes and 11% in Type II diabetes. For Type I diabetes, all-cause mortality rates were highest in Berlin men and Warsaw women, and lowest in London men and Zagreb women. For Type II diabetes, rates were highest in Warsaw men and Oklahoma women and lowest in Tokyo men and women. Age adjusted mortality rates and SMRs were generally higher in patients with Type I diabetes compared with those with Type II diabetes. Men and women in the Tokyo cohort had a very low excess mortality when compared with the background population. CONCLUSION/INTERPRETATION: This study confirms the importance of cardiovascular disease as the major cause of death in people with both types of diabetes. The low excess mortality in the Japanese cohort could have implications for the possible reduction of the burden of mortality associated with diabetes in other parts of the world.
Cardiovascular Diseases↗
[Mortality among drug addicts in Norway].
Current drug abusers in Norway seem to differ from those of 25-30 years ago in several respects, namely with regard to selection to drug abuse, living conditions, and the social responses to drug abuse. These factors may all be relevant for morbidity and mortality. Mortality and excess mortality under the age of 50 was assessed on the basis of data on 1,491 drug abusers admitted to the National Clinic for Drug Abusers (Statens klinikk for narkomane) during the years 1961-91. A significant excess mortality among the drug abusers was found for both genders, in all age groups and for all three decades. Males displayed a higher mortality than females, and the mortality among drug abusers increased with increasing age. Excess mortality was higher for women than for men and decreased with increasing age. The most prevalent causes of death were overdoses, suicides and accidents. Mortality from overdoses and diseases was higher among persons admitted during the 1970s and 1980s compared with persons admitted during the 1960s. The results are discussed in light of the qualitative differences between the former and present populations of drug abusers in Norway.
Adult↗
Sex differences and sustained excess in mortality among discordant twins in Matlab, Bangladesh: 1977-1985.
This paper reports findings from a study that compared survival of 204 pairs of liveborn twins discordant for sex and a random sample of 2371 singleton live births from the same population in Matlab, Bangladesh during the period 1977-1985. The discordant twins showed no evidence of sex differential in neonatal survival. They had neonatal mortality of 287 and infant mortality of 468, both per 1000 live births. These rates were respectively five and four times the rate for singletons in the study. Survival from 12 months through age nine years was similar overall for both discordant twins and singletons for each sex. However, higher female than male mortality was present among discordant twins after the first few months of life. This differential was most prominent during the second year of life and appeared wider than that observed for the singletons.
Bangladesh↗
Impact of influenza vaccination on seasonal mortality in the US elderly population.
BACKGROUND: Observational studies report that influenza vaccination reduces winter mortality risk from any cause by 50% among the elderly. Influenza vaccination coverage among elderly persons (> or =65 years) in the United States increased from between 15% and 20% before 1980 to 65% in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. We tried to reconcile these conflicting findings by adjusting excess mortality estimates for aging and increased circulation of influenza A(H3N2) viruses. METHODS: We used a cyclical regression model to generate seasonal estimates of national influenza-related mortality (excess mortality) among the elderly in both pneumonia and influenza and all-cause deaths for the 33 seasons from 1968 to 2001. We stratified the data by 5-year age group and separated seasons dominated by A(H3N2) viruses from other seasons. RESULTS: For people aged 65 to 74 years, excess mortality rates in A(H3N2)-dominated seasons fell between 1968 and the early 1980s but remained approximately constant thereafter. For persons 85 years or older, the mortality rate remained flat throughout. Excess mortality in A(H1N1) and B seasons did not change. All-cause excess mortality for persons 65 years or older never exceeded 10% of all winter deaths. CONCLUSIONS: We attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.
Age Distribution↗
Mortality in a follow-up of 500 psychiatric outpatients. I. Total mortality.
Total or all-cause mortality data were determined from a prospective study of 500 randomly selected psychiatric outpatients during a mean follow-up period of seven years. With the use of age-, sex-, and race-adjusted methods, a mortality nearly twice that expected from reference population rates was observed. Mortality was excessive among younger, but not older, patients; and among white men and women and black men, but not among black women. Certain psychiatric diagnoses (based on structured personal interviews performed at index and using explicit criteria) were associated with excess mortality: alcoholism, antisocial personality, drug addiction, homosexuality, organic brain syndrome, and schizophrenia. Excess mortality was not observed among patients with primary affective disorders, ie, disorders not antedated by nonaffective psychiatric illness.
Adolescent↗
Investigation of the association between excess winter mortality and socio-economic deprivation.
BACKGROUND: Excess winter mortality is higher in England and Wales than in other European countries with similar or lower average winter temperatures. It might be expected that excess winter mortality would be higher in areas with greater socio-economic deprivation, and if this were so preventive interventions could be directed at populations in these areas. The association between deprivation and excess winter mortality has not been adequately investigated in the past. The aim of this study was to look at the association between excess winter mortality and socio-economic deprivation, so that policy decisions to reduce this excess mortality could be appropriately directed. METHODS: Super Profile groups derived from the 1991 Census were used as a measure of socio-economic status. The age-standardized excess winter death index (EWDI) was calculated for each Super Profile group, for the population of Bradford. The EWDI was also calculated for the manufacturing districts (Office for National Statistics area classification), a relatively deprived group, and compared with that for England and Wales. RESULTS: No significant trend was found in age-standardized excess winter mortality across the Super Profile groups. The manufacturing districts had a similar EWDI to the national value. CONCLUSION: Excess winter mortality is not associated with deprivation. Further research to identify the important aetiological factors and appropriate interventions to reduce excess winter mortality is needed.
Adult↗
Additive and multiplicative covariate regression models for relative survival incorporating fractional polynomials for time-dependent effects.
Relative survival is used to estimate patient survival excluding causes of death not related to the disease of interest. Rather than using cause of death information from death certificates, which is often poorly recorded, relative survival compares the observed survival to that expected in a matched group from the general population. Models for relative survival can be expressed on the hazard (mortality) rate scale as the sum of two components where the total mortality rate is the sum of the underlying baseline mortality rate and the excess mortality rate due to the disease of interest. Previous models for relative survival have assumed that covariate effects act multiplicatively and have thus provided relative effects of differences between groups using excess mortality rate ratios. In this paper we consider (i) the use of an additive covariate model, which provides estimates of the absolute difference in the excess mortality rate; and (ii) the use of fractional polynomials in relative survival models for the baseline excess mortality rate and time-dependent effects. The approaches are illustrated using data on 115 331 female breast cancer patients diagnosed between 1 January 1986 and 31 December 1990. The use of additive covariate relative survival models can be useful in situations when the excess mortality rate is zero or slightly less than zero and can provide useful information from a public health perspective. The use of fractional polynomials has advantages over the usual piecewise estimation by providing smooth estimates of the baseline excess mortality rate and time-dependent effects for both the multiplicative and additive covariate models. All models presented in this paper can be estimated within a generalized linear models framework and thus can be implemented using standard software.
Breast Neoplasms↗