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PubMed1984

The mortality odds ratio (MOR) in occupational mortality studies--selection of reference occupation(s) and reference cause(s) of death.

In occupational mortality studies, the information on the population at risk is frequently not available. In these circumstances, the rate ratio of interest can be assessed through the mortality odds ratio (MOR), given appropriate selections of reference occupation(s) and reference disease(s). The reference occupation should be chosen with a view to three aspects of validity: (1) comparability of effects, i.e., identity of mortality effects between the index and the reference occupation apart from the effect of the exposure under study; (2) comparability of contrasted populations, i.e., same job entry and exit factors and similar health promotion programmes when related to the mortality under study; and (3) comparability of mortality information, i.e., same diagnostic and certification practices for the cause of death of interest between the contrasted populations. The reference causes of death must also satisfy these requirements with the additions that the exposure under study have no effect on the risk of reference causes of death, and that the accuracy of information about the compared occupations be the same as in the context of the index cause of death. Throughout the discussion, an example of exploring cancer risks among lens manufacturing workers is used.

Epidemiologic Methods↗
PubMed1994

Determinants of operative mortality in elderly patients undergoing coronary artery bypass grafting. Emphasis on the influence of internal mammary artery grafting on mortality and morbidity.

Coronary artery bypass grafting has been performed for elderly patients (> or = 70 years) with increasing frequency. From January 1986 through June 1993, 1399 elderly patients underwent isolated coronary bypass grafting. Of these patients, 823 had saphenous vein grafts alone and 576 had internal mammary artery grafting, including unilateral (n = 546) and bilateral (n = 28). Overall operative mortality was 8.86%. Operative mortality for unilateral internal mammary artery grafting (6.41%) was lower than for saphenous vein grafting only (9.96%, p = 0.021) and bilateral internal mammary artery grafting (21.43%, 6/28, p = 0.018). Fewer patients undergoing internal mammary artery grafting had postoperative complications (low cardiac output, intraaortic balloon pumping, and neurologic complications) than patients having saphenous vein grafting only. To determine risk factors for mortality and the influence of internal mammary artery grafting on the outcome, we analyzed 55 variables (27 preoperative, 15 intraoperative, and 13 postoperative) by univariate analysis. Significant variables (age, gender, height, weight, surface area, diabetes, obesity, body mass index, history of congestive heart failure, myocardial infarction, or arrhythmia, functional class, left ventricular ejection fraction, stenosis of the left anterior descending or right coronary artery, emergency operation, reoperation, number of grafts, perfusion time, and bilateral or right internal mammary artery grafting) were included in a stepwise multiple logistic regression analysis. The logistic regression demonstrates that those preoperative (history of congestive heart failure or myocardial infarction, low ejection fraction, female gender, and old age), intraoperative (long cardiopulmonary bypass time, emergency operation, reoperation, and use of right internal mammary artery grafting), and postoperative (postoperative complications) variables are independently associated with higher mortality. This study reveals the high-risk groups in elderly patients undergoing coronary bypass and suggests that a left internal mammary artery graft in combination with saphenous vein grafting may achieve a lower operative mortality and morbidity than other procedures in selected elderly patients undergoing coronary artery bypass grafting.

Age Factors↗
PubMed1994

Is diet an independent risk factor for mortality? 20 year mortality in the Italian rural cohorts of the Seven Countries Study.

The relation of diet to mortality is examined using the data of the Italian rural cohorts of the Seven Countries Study, a prospective investigation of factors related to cardiovascular disease. The present analysis includes 1536 men aged 45-64 years, whose dietary habits and food consumption, including alcoholic beverages, were measured in 1965. Of the 1536, 668 (43.5%) died during a follow-up period of 20 years. Large differences in survival probabilities were observed for different dietary patterns (i.e. for different intakes of energy and nutrients). The dietary pattern that corresponded to the lowest mortality rate (27% after 20 years) was: more than 2800 kcal/d (11.7 MJ/d), with more than 41% of the calories coming from carbohydrates, more than 9% from proteins, between 16% and 23% from unsaturated lipids, and between 13% and 19% from alcohol. As the number of disagreements from the previous conditions increases, the mortality rate increases to reach 69% in 20 years in the worst case. Differences in mortality persisted after adjustment for confounders and some major established mortality risk factors.

Cardiovascular Diseases↗
PubMed1990

Age patterns of mortality for older women: an analysis using the age-specific rate of mortality change with age.

"In this paper we propose a mortality measure that seems useful in analyzing age patterns of death rates. The measure, which will be denoted by k(x), indicates the proportional increase or decrease with age in the risk of death at a given age x, and is called the age-specific rate of mortality change with age." Estimations are presented for women in 10 countries. "Eight of the selected sets of data are for developed nations in the 1960s and 1970s, and the other two sets of data, for Taiwan, 1931-35, and for Germany, 1910-11, represent relatively high mortality. For France and West Germany, three different periods are included for an investigation of cohort effects on the observed age patterns." Other mathematical models of age-specific mortality rates are discussed and compared. (SUMMARY IN FRE)

Adult↗
PubMed1985

[Some problems concerning the selection of the most appropriate mortality model for the indirect estimation of infant mortality].

"This paper analyzes the problems that arise when infant mortality estimates are derived through the probabilities of dying obtained from the application of the Coale-Trussell technique to the proportion of children deceased according to age of mother derived from census or survey data. These problems arise because this operation requires the acceptance of a mortality model by age." The author outlines "some criteria for the selection of the model through the use of information from Vital Statistics and surveys. Finally, it is stated that an alternative for the study of infant mortality trends is the selection of an indicator less affected by the mortality structure by age...." The problems are illustrated using data from selected countries in Latin America. (summary in ENG)

Age Factors↗
PubMed1988

Decline in mortality among young Americans during the 20th century: prospects for reaching national mortality reduction goals for 1990.

A review of mortality data for persons younger than 25 years of age in the United States reveals striking declines in death rates since the turn of the century. Mortality among infants during their first year of life decreased from 1 in 6 in 1900 to 1 in 100 in 1986. Between 1900 and 1984 the annual death rate for children 1 through 4 years of age decreased from 1 in 50 to 1 in 2,000, for children 5 through 14 years of age, from 1 in 250 to 1 in 4,000, and for persons 15 through 24 years of age, from 1 in 165 to 1 in 1,000. Public health measures, advances in medical science, legislative initiatives, and the organization and delivery of health care have all contributed to these improvements in varying degrees during different decades. For the decade 1975 through 1984, the overall death rate decreased by 20%, with declines for all causes except suicide, cardiovascular diseases, and renal diseases. All of the surgeon general's mortality reduction goals for 1990 for America's youth should be reached except those for infant mortality and suicide. Improvement in these death rates will require better access to health care by those in need and reductions in environmental stress.

Accidents↗
PubMed1999

Exploring spatial patterns of mortality: the new atlas of United States mortality.

The National Center for Health Statistics, CDC, has produced an Atlas of United States Mortality which includes maps of rates for the leading causes of death in the United States for the period 1988-1992. As part of this project, many aspects of statistical mapping have been re-examined to maximize the atlas's effectiveness in conveying accurate mortality patterns to epidemiologists and public health practitioners. Because recent cognitive research demonstrated that no one map style is optimal for answering many different map questions, maps and graphs of several different mortality statistics are included for each cause of death. New mixed effects models were developed to provide predicted rates and improved variance estimates. Results from these models were smoothed using a weighted head-banging algorithm to produce maps of general spatial trends free of background noise. Maps of White female lung cancer rates from the new atlas are presented here to illustrate how this innovative combination of maps and graphs permits greater exploration of the underlying mortality data than is possible from previous single-map atlas designs. Published in 1999 by John Wiley & Sons, Ltd. This article is a U.S. Government work and is in the public domain in the United States.

Adult↗
PubMed1975

The effect of availability and utilization of prenatal care and hospital services on infant mortality rates. Summary of the findings of the Louisiana Infant Mortality Study. Part II.

A total of 69,556 birth and 1,541 death certificates from Louisiana, 1972, were reviewed. Infant, neonatal, and postneonatal mortality rates were computed for number of prenatal visits, type of hospital of delivery, hospital vs. nonhospital delivery, and geographical access to health care. The mortality rates were twice as great for infants born outside of hospitals. With no prenatal care, the infant mortality rates were between four- and tenfold greater than the rates of women receiving more than nine visits even when race, poverty, geography, and birth weight were considered. Infant mortality rates were twice as high in the neonatal period and three times greater in the postneonatal period among the poor who utilized charity hospitals. This study illustrates a method which could be incorporated into state vital statistics reports which would detect populations at risk of excess infant deaths and would provide a more refined analysis of birth and infant death data to monitor improvements in care of high-risk groups.

Black or African American↗
PubMed1992

Mortality among the elderly in the U.S., 1956-1987: demonstration of the upper boundary to Gompertzian mortality.

Mortality in the United States among individuals aged 85 years and older between the years 1956 and 1987 was analyzed using a cumulative summation technique. This analysis demonstrates that general mortality conforms to Gompertzian dynamics through age 96 years for both men and women. Of the 33 320 985 deaths in men in the U.S. between 1956 and 1987, only 123,643 (0.37%) occurred in men aged 97 years and older. Of the corresponding 26,946,599 deaths in women, only 327,291 (1.21%) occurred in women aged 97 years and older. These results suggest that the competitive and deterministic features of the Gompertzian model of human aging and mortality remain valid through age 96 years and cover the vast majority of human mortality.

Aged↗
PubMed1990

Socio-economic mortality differences in The Netherlands in 1950-1984: a regional study of cause-specific mortality.

The finding that mortality differences between occupational classes in England and Wales have widened during the postwar period raises the question whether a similar development has occurred in other industrialised countries. In this paper, a comparison is made with results from a geographical study on the Netherlands. This study compares four periods between 1950 and 1984 by means of a standard regional division, a single socio-economic index, uniform cause-of-death groups and a standard regression procedure. During the postwar period, the relationship between socio-economic level and all-cause mortality has become (more) negative. This development can to a large extent be attributed to 'negative' trends for lung cancer, diabetes mellitus, ischaemic heart disease, cerebrovascular disease and traffic accidents. High-level regions have fared better partly because favourable changes in national mortality trends seem to have begun first in these regions. The findings from this regional study agree to a large extent with evidence from Dutch studies at the individual level. It is concluded that socio-economic mortality differences in England and Wales and the Netherlands have probably developed similarly in various respects.

Cause of Death↗
PubMed1992

Indigenous mortality: placing Australian aboriginal mortality within a broader context.

The purpose of this study was to evaluate whether contemporary Australian Aboriginal mortality patterns are different from those exhibited by Canadian Registered Indians, New Zealand Maoris, and American Indians and Alaskan natives. Data on Australian Aborigines were procured from published studies conducted in New South Wales, the Northern Territory, Queensland, and Western Australia; while data on Canadian Registered Indians, New Zealand Maoris, and American Indians and Alaskan natives were obtained respectively from unpublished tables produced by Health and Welfare Canada, the National Health Statistics Centre, and the Indian Health Service. Mortality patterns were compared by evaluating differences in life expectancy and in age- and cause-specific patterns of death. This analysis demonstrates that although Australian Aborigines, Canadian Registered Indians, New Zealand Maoris, and American Indians and Alaskan natives have similar patterns of high adult mortality, Australian Aborigines are generally characterized by lower life expectancies at birth and higher age- and cause-specific death rates. Overall, these findings suggest that the mortality patterns of Australian Aborigines are strikingly different from those exhibited by the other three indigenous populations and that existing information on risk, psychosocial, and genetic factors does not really explain why Australian Aborigines as compared to these other indigenous groups have such high rates of death and low life expectancy.

Adolescent↗
PubMed1996

The shape of the relationship between income and mortality in the United States. Evidence from the National Longitudinal Mortality Study.

A follow-up study based on a large national sample was used to examine differences in the well-established inverse gradient between income and mortality at different income levels. The study showed the income-mortality gradient to be much smaller at high income levels than at low to moderate income levels in the working age (25 to 64 years) and elderly (over 65 years) populations for men and women both before and after adjustment for other socioeconomic variables. In addition, a much larger gradient existed for working age women at extreme poverty levels than for those women at low to moderate income levels. The income-mortality gradient was much smaller in the elderly than in the working age population. The study also examined the ability of several different mathematic functions of income to delineate the relationship between income and mortality. The study suggested that the health benefits associated with increased income diminish as income increases.

Adult↗
PubMed2004

Determining the threshold effect of ozone on daily mortality: an analysis of ozone and mortality in Seoul, Korea, 1995-1999.

Many studies have shown a positive association between ambient ozone levels and mortality. Typically, these findings are based on models that assume a linear relationship between log mortality and ozone level. In this study, we adapted generalized additive models in which ozone effects are presumed to occur in three different ways: as a simple linear term, as a cubic natural spline term, and as a combination of two linear terms (a threshold model). We applied these models to daily time-series data for Seoul, Korea for the years 1995-1999 and found that the threshold model always fits best among the three. A 2.6% (95% CI: 1.7-3.5) increase of estimated relative risk (RR) in the total mortality associated with a 21.5 ppb increase of daily 1-h maximum ozone lagged by 1 day was observed by linear Poisson's regression. However, a 3.4% (95% CI: 2.3-4.4) increase in the estimated RR was observed using the threshold model. Adjustments for other ambient pollutants caused little changes to these results; 2.4-2.5% in the linear models and 3.2-3.4% in the threshold models. In addition, the largest difference in the estimated RRs of the linear and threshold models was observed in the summer: 1.9% (95% CI: 0.5-3.3) by the linear model and 3.8% (95% CI: 2.0-5.7) by the threshold model. These findings indicate that the conventional time-series Poisson regression model, which dose not take threshold into consideration, could underestimate the true risk of the ozone effect on daily mortality.

Adolescent↗
PubMed2006

Utility of the MAYO End-Stage Liver Disease score, King's College Criteria, and a new in-hospital mortality score in the prognosis of in-hospital mortality in acute liver failure.

INTRODUCTION: Several prognostic scores attempt to aid in the selection of patients with acute liver failure (ALF) to be treated either medically or by liver transplantation; however, their lack of fulfillment does not predict spontaneous survival in ALF and refined prognostic criteria are needed to improve such selection. Our aim was to evaluate and compare a new ALF in-hospital mortality prediction score versus King's College Criteria (KCC) and model for End-Stage Disease (MELD) score. METHODS: First-time ALF-diagnosed individuals admitted to our institution (n = 58) were grouped according their final outcome as "alive" or "death," and those significantly different variables between groups entered into a logistic regression and lineal regression models. An ALF in-hospital mortality score (ALFIHMS) was produced and its sensitivity, specificity, and area under receiver operator characteristics were compared with those of KCC and MELD scores. RESULTS: Since no significant differences (P = .81) in mortality rates between fulminant and subfulminant hepatic failure were found, no further analysis according to ALF's classification was performed. After obtaining and comparing ALFIHMS with KCC and MELD, we found that ALFIHMS prediction accuracy is higher than that of KCC and MELD score and that an ALFIHMS cutoff point >15 points is associated with an in-hospital mortality probability >50%. CONCLUSIONS: ALFIHMS has higher prognostic accuracy than KCC and MELD scores in ALF.

Hospital Mortality↗
PubMed2003

[Intrahospital mortality after discharge from the ICU (hidden mortality) in patients who required mechanical ventilation].

BACKGROUND AND OBJECTIVE: Our goal was to determine the hidden mortality (HM) in patients who underwent an episode of mechanical ventilation (MV). We also analyzed the factors associated with an increase in the risk of hidden mortality. PATIENTS AND METHOD: Prospective cohort study. Patients admitted to an ICU who required MV and who were monitored until their discharge from hospital. We performed a multivariate study with a logistic regression model including all the variables that were present in a univariate analysis p < 0.20. RESULTS: Forty-one of the 215 patients who were discharged from the ICU died when they were admitted to hospital, which represents a hidden mortality rate of 19% (CI 95% 11%-27%). A mean period of 9 days elapsed between discharge from the ICU and patient's death, with 25% of patients dying within the first two days. Commonest cause of death was respiratory failure (37%). Factors independently associated with an increase in the risk of hidden mortality were (values expressed as adjusted odds ratio (CI 95%): age > 74 years 1.15 (1.01 to 1.26) (p = 0.02); APACHE II > 29 1.14 (1.01 to 1.27) (p = 0.04); reason for MV being coma 1.21 (1.07 to 1.37) (p = 0.002); reason for MV being cardiopulmonary arrest 1.28 (1.18 to 1.68) (p < 0.001); tracheotomy in ICU 1.31 (1.19 to 1.68) (p < 0.001) and stay in the ICU longer than 16 days 1.35 (1.01 to1.70) (p = 0.04). CONCLUSIONS: An important number of patients discharged from the ICU after an episode of MV die in hospital. Risk factors associated with an increased risk of death in hospital identify a group of patients who, after excluding those with non-cardiopulmonary resuscitation orders, would possibly benefit from high surveillance or intermediate care units.

APACHE↗
PubMed1999

Age at natural menopause and total mortality and mortality from ischemic heart disease: the Adventist Health Study.

We studied the relationship between age at natural menopause and total mortality as well as mortality from ischemic heart disease in a cohort of 6182 California Seventh-Day Adventist women who reported a natural menopause. During follow-up from 1976 through 1988, there were 1831 deaths. A total of 308 deaths due to ischemic heart disease occurred in women who denied ischemic heart disease at start of follow-up. An early menopause was associated with increased total mortality (P value for linear trend <0.001) and ischemic heart disease mortality (P value for linear trend = 0.03). This relationship could not be explained by possible confounding variables. Our results support the hypothesis that an early natural menopause (35-40 years old) increases the risk of ischemic heart disease. There is, however, also some evidence of increased risk of ischemic heart disease in women with a very late menopause (>55 years), particularly in women who never have used postmenopausal estrogens.

Adult↗
PubMed1998

Importance of heart failure as a cause of death. Changing contribution to overall mortality and coronary heart disease mortality in Scotland 1979-1992.

AIMS: As heart failure is a syndrome arising from another condition, such as coronary heart disease, it is rarely officially coded as the underlying cause of death regardless of the cause recorded by the physician at the time of certification. We sought to assess the true contribution of heart failure to overall mortality and coronary heart disease mortality and to examine how this contribution has changed over time. METHODS AND RESULTS: We carried out a retrospective analysis of all death certificates in Scotland between 1979 and 1992 for which heart failure was coded as the underlying or a contributory cause of death. From a total of 833622 deaths in Scotland between 1979 and 1992, heart failure was coded as the underlying cause in only 1.5% (13695), but as a contributory cause in a further 14.3% (126073). In 1979, 28.5% of male and 40.4% of female deaths attributed to coronary heart disease (coded as the underlying cause of death) also had a coding for heart failure. In 1992 these percentages had risen significantly to 34.1% and 44.8%, respectively (both P<0.001). Mortality rates for heart failure as the underlying or contributory cause of death, standardized by age and sex, fell significantly over the period studied in all ages and in both sexes: by 31% in men and 41% in women <65 years and 15.8% in men and 5.1% in women > or =65 years, respectively (P<0.01 for all changes). CONCLUSIONS: Death from heart failure is substantially underestimated by official statistics. Furthermore, one third or more of deaths currently attributed to coronary heart disease may be related to heart failure and this proportion appears to be increasing. While the absolute numbers of deaths caused by heart failure remains constant, this study is the first to show that standardized mortality rates are declining.

Age Distribution↗
PubMed2006

A new model for investigating the mortality effects of multiple air pollutants in air pollution mortality time-series studies.

Because the U.S. Environmental Protection Agency regulates air pollutants independently, the majority of time-series studies on air pollution and mortality have focused on estimating the adverse health effects of a single pollutant. However, due to the sometimes high correlation between air pollutants, the results from studies that focus on a single air pollutant can be difficult to interpret. In addition, the high correlation between air pollutants can produce problems of interpretation for the standard method of investigating the adverse health effects due to multiple air pollutants. The standard method involves simultaneously including the multiple air pollutants in a single statistical model. Because of this, the development of new models to concurrently estimate the adverse health effects of multiple air pollutants has recently been identified as an important area of future research. In this article, a new model for disentangling the joint effects of multiple air pollutants in air pollution mortality time-series studies is introduced. This new model uses the time-series data to assign each air pollutant a weight that indicates the pollutant's contribution to the air pollution mixture that affects mortality and to estimate the effect of this air pollution mixture on mortality. This model offers an improvement in statistical estimation precision over the standard method. It also avoids problems of interpretation that can occur if the standard method is used. This new model is then illustrated by applying it to time-series data from two U.S. counties.

Air Pollutants↗