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PubMed2002

Cancer death rates--Appalachia, 1994-1998.

Cancer is the second leading cause of death in the United States. Although descriptive analyses of mortality data are used often to identify variations by time and person, analyses that focus on regional variations are less common. Appalachia is a U.S. region with a high prevalence of risk factors for cancer (e.g., tobacco use, physical inactivity, and inadequate access to medical care). Analyses that focus on Appalachia provide valuable information for cancer control, research, and intervention. To assess the impact of cancer in Appalachia, researchers from the University of Kentucky and Pennsylvania State University, in collaboration with CDC, analyzed mortality data from CDC's National Center for Health Statistics for 1994-1998. This report summarizes the results of that analysis, which indicate elevated cancer mortality, underscoring the need for ongoing cancer prevention and control programs as a major public health priority in this region.

Appalachian Region↗
PubMed1992

Post-term pregnancy: fetal death rate with antepartum surveillance.

Management of the post-term pregnancy depends on the certainty of dating, likelihood of successful induction, and risks of expectant management. To estimate the risk of fetal death in an expectantly managed post-term population, we reviewed 8038 consecutive post-term gestations followed expectantly with a twice-weekly nonstress test and amniotic fluid index. There were nine antepartum fetal deaths and no intrapartum fetal deaths, a fetal mortality rate of 1.12 per 1000. Timing of delivery of the post-term gestation balances this risk of loss of a viable fetus with the risks of uncertain dating and failure of induction of labor.

Female↗
PubMed2004

Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase.

BACKGROUND: A heightened risk of stroke and death among octogenarians undergoing carotid artery stenting (CAS) has been reported. The multicenter Carotid Revascularization Endarterectomy vs. Stent Trial (CREST) supported by the National Institute of Neurological Disorders, National Institutes of Health, compares the efficacy of carotid endarterectomy (CEA) and CAS in an ongoing clinical trial. This effort also includes a "lead-in" phase of symptomatic (>50% stenosis) and asymptomatic (>70% stenosis) patients. The protocol calls for patients to receive aspirin and clopidogrel before and 30-days after CAS and to be examined by a study neurologist preprocedure, at 24-hours, and at 30-day. The occurrence of stroke and death was reviewed by an independent clinical events committee. METHODS: The association of age and periprocedural stroke and death was examined in 749 lead-in patients undergoing CAS (30.7% symptomatic, 69.3% asymptomatic). Patients were separated into four age categories: less than 60, 60 to 69, 70 to 79, and 80 years or older, and the proportion of patients with stroke and death during the 30-day periprocedural period was calculated for each category. RESULTS: An increasing proportion of patients suffered stroke and death with increasing age (P = .0006); 2 (1.7%) of 120 patients under age 60, 3 (1.3%) of 229 aged 60 to 69, 16 (5.3%) of 301 aged 70 to 79, and 12 (12.1%) of 99 patients aged 80 years and older. These increasingly high complication rates at older ages were not mediated by adjustment for symptomatic status, use of antiembolic devices, gender, percentage of carotid stenosis, or the presence of distal arterial tortuosity. CONCLUSIONS: Interim results from the lead-in phase of CREST show that the periprocedural risk of stroke and death after CAS increases with age in the course of a credentialing registry. This effect is not mediated by potential confounding factors. Randomized trial data are needed to compare the CAS versus CEA periprocedural risk of stroke and death by age. Pending results from randomized studies, care should be taken when CAS is performed in older patient populations.

Adult↗
PubMed2004

Do anesthesiologists die at a younger age than other physicians? Age-adjusted death rates.

UNLABELLED: I designed this study to determine whether anesthesiologists are susceptible to premature death. Three specialty groups were studied: anesthesiologists, internists, and all other physicians. Records were examined of all American physicians who died in the years 1989, 1990, 1995, 2000, and 2001, and those who were alive at the end of 1989, 1995, 2000, and 2001. Anesthesiologists had a statistically significant younger mean age at death (crude mortality) (68.98 +/- 15.55 yr) (n = 723) than did internists (74.41 +/- 14.24 yr) (n = 2285) and all other physicians (75.21 +/- 13.3 yr) (n = 18,328) (P < 0.001). However, by factoring in the ages of the living members of the study populations, there was no statistical difference in age-specific mortality. IMPLICATIONS: It has been suggested that one of the potential occupational hazards of the practice of anesthesiology is premature death. This study disproves the notion that anesthesiologists die at a younger age than other physicians.

Adult↗
PubMed1997

Drug use and pulmonary death rates in increasingly symptomatic asthma patients in the UK.

BACKGROUND: There is concern about an increase in deaths from respiratory causes in asthma patients using long acting beta agonists. According to the guidelines of the British Thoracic Society, long acting beta agonists, ipratropium bromide, and theophylline should be used to treat patients with increasing asthma severity who are already receiving treatment with short acting beta agonists and inhaled steroids. A study was therefore undertaken to compare the characteristics and short term respiratory mortality rates in first time users of one of these three drugs. METHODS: An open cohort study with a nested case-control analysis was performed on the UK based General Practice Research Database (GPRD). First time users of either salmeterol (n = 8386), ipratropium bromide (n = 4305), or theophylline (n = 4228) between 1 January 1992 and 30 April 1995 were identified and followed for 16 weeks. Drug usage patterns, predictors for respiratory mortality, and the number of deaths at 16 weeks in the three drug groups were compared. RESULTS: The three asthma drugs were most often prescribed to patients with severe asthma. Age, a concomitant diagnosis of chronic obstructive pulmonary disease or emphysema, number of asthma drug prescriptions, number of visits to the general practitioner, and whether or not the patient had been admitted to hospital due to the respiratory disease in the 12 months prior to the start of the new drug therapy were strong predictors for asthma mortality. After adjusting for several risk factors, the relative risk estimates of a respiratory death for ipratropium bromide and theophylline users compared with salmeterol users were 1.8 (95% CI 0.4 to 9.6) and 3.0 (95% CI 0.4 to 22.4), respectively. CONCLUSIONS: In the UK population studied, salmeterol, ipratropium bromide and theophylline are regularly used to treat patients with asthma of increasing severity. Salmeterol use was not associated with an increase in short term mortality compared with ipratropium bromide and theophylline.

Adolescent↗
PubMed1992

Does exercise reduce all-cancer death rates?

A reanalysis is made of earlier data relating to initial physical fitness and the likelihood of death from all forms of cancer. It is argued that the original analysis may have been biased by an association between initial fitness and other health habits, particularly cigarette smoking. The association with fitness status remains after reanalysis of the data on the assumption that current smoking leads to a uniform doubling of the risk of cancer death, but the effect is weaker than previously reported. There remains some potential bias, in that the quantity of current smoking may have been linked to fitness status. Some 55% of deaths were untraced, but it is argued that any socioeconomic or other bias from this cause is likely to account for the association between cancer risk and low fitness status. Any reduction of cancer risk is associated with the change from an extremely sedentary to a moderately sedentary lifestyle. It thus cannot be explained in terms of the mechanisms previously invoked to explain low risks of colonic and reproductive cancers in endurance athletes.

Exercise↗