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PubMed1998

Excess cancer mortality in six Dutch pedigrees with the familial atypical multiple mole-melanoma syndrome from 1830 to 1994.

An increased incidence of systemic cancers has been described in some reports of familial atypical multiple mole-melanoma kindreds. If the gene defect underlying the familial atypical multiple mole-melanoma syndrome is not only important for the development of melanoma of the skin, the impact of the defect on life expectancy may be much higher than previously thought. We investigated all-cause mortality from 1830 to the present and causes of death from 1941 to 1994 in proven, obligate, and potential CDKN2 mutation carriers to obtain an estimate of the impact of a hereditary defect of the CDKN2 gene on mortality. From 1830 to 1994 there were 65 deaths, although only 42 deaths were expected [standardized mortality ratio (SMR) 1.6, 95% confidence interval (CI) 1.2-2.0] and the SMR doubled with calendar time. Excess mortality was shown in most of the families, but was confined to ages 35-70 y (SMR 2.1, 95%CI 1.5-2.9). Excess mortality could be fully attributed to cancer mortality, especially to pancreatic carcinoma and melanoma of the skin. There appeared to be some heterogeneity among the families, especially due to the specific cancer pattern within a family. The impact of the defect of the CDKN2 gene is rising over calendar time, mainly because the mortality in the general population has been falling. Excess mortality was not only due to melanoma, but also to pancreatic carcinoma. Therefore, follow-up programs of affected family members should not be confined to a regular check of the atypical nevi.

Adult↗
PubMed2001

[Clinical study on mortality of rheumatoid arthritis compared with malignant rheumatoid arthritis].

OBJECTIVE: To determine how the mortality of patients with rheumatoid arthritis (RA) behave in comparison with that of patients with malignant rheumatoid arthritis (MRA). METHODS: The mortality of RA patients selected at randam identified in 1991-2000 (n = 104) was compared with that of 18 MRA patients. Hazard ratios of death were calculated with a multivariate survival analysis. A clinical study of patients with both RA and MRA was performed in mortality. RESULTS: Excess mortality was seen in MRA patients in Kaplan-Meier survival curves (p = 0.02 by log-rank test). MRA patients were treated more often with cytostatic and immunosuppressive drugs. Infection was the main cause of death in both RA and MRA patients. Vasculitis was not reported as the cause of death in MRA patients. Secondary amyloidosis played an important role in RA death rather than MRA. CONCLUSION: There remained an excess mortality in MRA patients compared with RA, and infection was attributable to the key cause of death in both RA and MRA suggesting therapeutic side effects.

Aged↗
PubMed1989

[The impact of excess male mortality on sex structure. The Italian case, 1951-1981].

The purpose of this note is to analyze male excess mortality in relation to general mortality trends in a country with low levels of mortality, using Italian data for the period 1951-1981, and to examine the effect of this excess male mortality on the sex distribution of the population. Consideration is given to the apparent paradox whereby "at least during the first half of life, the sex ratio increases when excess male mortality increases. This paradox shows that the index traditionally used for measuring the disadvantage of men with regard to survival, is not the most appropriate one." (SUMMARY IN ENG AND SPA)

Demography↗
PubMedDate not supplied

The confounding of race and geography: how much of the excess stroke mortality among African Americans is explained by geography?

INTRODUCTION: The excess stroke mortality among African Americans and Southerners is well known. Because a higher proportion of the population living in the 'Stroke Belt' is African American, then a portion of the estimated excess risk of stroke death traditionally associated with African-American race may be attributable to geography (i.e., race and geography are 'confounded'). In this paper we estimate the proportion of the excess stroke mortality among African Americans that is attributable to geography. METHODS: The numbers of stroke deaths at the county level are available from the vital statistics system of the US. A total of 1,143 counties with a population of at least 500 whites and 500 African Americans were selected for these analyses. The black-to-white stroke mortality ratio was estimated with and without adjustment for county of residence for those aged 45-64 and for those aged 65 and over. The difference in the stroke mortality ratio before versus after adjustment for county provides an estimate of the proportion of the excess stroke mortality inappropriately attributed to race (that is in fact attributable to geographic region). RESULTS: For ages 45-64, the black-to-white stroke mortality ratio was reduced from 3.41 to 3.04 for men, and from 2.82 to 2.60 for women, suggesting that between 10 and 15% of the excess mortality traditionally attributed to race is rather due to geography. Over the age of 65, the black-to-white stroke mortality ratio was reduced from 1.31 to 1.27 for men, and from 1.097 to 1.095 for women, suggesting that between 2 and 13% of the excess mortality attributed to black race is actually attributable to geography. The reductions of all the four age strata gender groups were highly significant. DISCUSSION: These results suggest that a significant, although relatively small, proportion of the excess mortality traditionally attributed to race is rather a factor of geography.

Age Factors↗
PubMed2006

Mortality among discharged psychiatric patients in Florence, Italy.

OBJECTIVE: Psychiatric disorders involve an increased risk of mortality. In Italy psychiatric services are community based, and hospitalization is mostly reserved for patients with acute illness. This study examined mortality risk in a cohort of psychiatric inpatients for 16 years after hospital discharge to assess the association of excess mortality from natural or unnatural causes with clinical and sociodemographic variables and time from first admission. METHODS: At the end of 2002 mortality and cause of death were determined for all patients (N=845) who were admitted during 1987 to the eight psychiatric units active in Florence. The mortality risk of psychiatric patients was compared with that of the general population of the region of Tuscany by calculating standardized mortality ratios (SMRs). Poisson multivariate analyses of the observed-to-expected ratio for natural and unnatural deaths were conducted. RESULTS: The SMR for the sample of psychiatric patients was threefold higher than that for the general population (SMR=3.0; 95 percent confidence interval [CI]=2.7-3.4). Individuals younger than 45 years were at higher risk (SMR=11.0; 95 percent CI 8.0-14.9). The SMR for deaths from natural causes was 2.6 (95 percent CI=2.3-2.9), and for deaths from unnatural causes it was 13.0 (95 percent CI=10.1-13.6). For deaths from unnatural causes, the mortality excess was primarily limited to the first years after the first admission. For deaths from natural causes, excess mortality was more stable during the follow-up period. CONCLUSIONS: Prevention of deaths from unnatural causes among psychiatric patients may require promotion of earlier follow-up after discharge. Improving prevention and treatment of somatic diseases of psychiatric patients is important to reduce excess mortality from natural causes.

Adolescent↗
PubMed1992

Standardized mortality ratio analysis on a sample of severely injured patients from a large Canadian city without regionalized trauma care.

Flora's Z statistic and standardized mortality ratios (SMRs) as indicators of excess mortality were calculated for a sample of 355 patients with major trauma. A statistically significant overall excess mortality was observed in this sample (Z = 6.77, SMR = 1.81, p less than 0.05). Advanced life support provided by physicians at the scene (MD-ALS) was not associated with reduced excess mortality. A significant trend toward lower excess mortality was associated with a higher level of trauma care at the receiving hospital (p less than 0.05). Total prehospital time over 60 minutes was associated with a significant increase in excess mortality (p less than 0.001). These results support regionalization of trauma care and failed to show any benefit associated with MD-ALS.

Adolescent↗
PubMed1994

Death from malignant disease after surgery for duodenal ulcer.

A total of 2241 patients who had an operation for duodenal ulcer between 1947 and 1968 were followed up to determine the cause of death and to compare the observed number of deaths with the expected. Death certificates were traced for 1251 of 1387 known to have died. Observed deaths from all causes were significantly greater than expected (O/E 1.13) (95% CI 1.08 to 1.20). This was because of significant increases in deaths from neoplasms (O/E 1.25) (95% CI 1.13 to 1.39) and digestive diseases (O/E 1.71) (95% CI 1.11 to 2.59). Analysis of deaths from malignant disease showed an excess of deaths from carcinoma of lung (O/E 1.37) (95% CI 1.14 to 1.62) and from smoking related cancers (O/E 1.32) (95% CI 1.13 to 1.52) but there was no significant excess mortality from any other neoplasm. An excess of deaths within one year of the operation was seen from circulatory disease (O/E 1.85) (95% CI 1.17 to 2.78), respiratory disease (O/E 3.56) (95% CI 1.78 to 6.37), and digestive disease (O/E 21.46) (95% CI 13.75 to 31.93). These deaths are concentrated in the first postoperative month and as there is no excess mortality from circulatory, respiratory or digestive disease between 1 and 20 years postoperatively, show the direct effects of the operation as a cause of death. This together with the excess mortality from all respiratory disease confirms that excess mortality after duodenal ulcer surgery is, in the short term, the result of the operation itself and in the long term largely attributable to cigarette smoking. Operations for gastric ulcer largely account for the subsequent excess mortality from gastric cancer reported after peptic ulcer surgery. The findings do not support the theory that the operation has carcinogenic effects and do not support the case for routine endoscopic screening after operations for duodenal ulcer.

Adult↗
PubMed1985

Mortality of lead smelter workers.

To examine patterns of death in lead smelter workers, a retrospective analysis of mortality was conducted in a cohort of 1,987 males employed between 1940 and 1965 at a primary lead smelter in Idaho. Overall mortality was similar to that of the United States white male population (standardized mortality ratio (SMR) = 98). Excess mortality, however, was found from chronic renal disease (SMR = 192; confidence interval (CI) = 88-364), and the risk of death from renal disease increased with increasing duration of employment, such that after 20 years employment, the standardized mortality ratio reached 392 (CI = 107-1,004). Excess mortality was also noted for nonmalignant respiratory disease (SMR = 187, CI = 128-264). Eight of 32 deaths in this category were caused by silicosis; at least five workers who died of silicosis had been miners for a part of their lives. An additional 11 deaths resulted from tuberculosis (SMR = 139; CI = 69-249); in six of these cases, silicosis was a contributory cause of death. Cancer mortality was not increased overall (SMR = 95; CI = 78-114). An increase, however, was noted for deaths from kidney cancer (six cases; SMR = 204; CI = 75-444). Finally, excess mortality was noted for injuries (SMR = 138; CI = 104-179); 13 (23%) of the 56 deaths in this category were caused by mining injuries. The data from this study are consistent with previous reports of increased mortality from chronic renal disease in persons exposed occupationally to lead.

Actuarial Analysis↗
PubMed1989

Influenza mortality and excess deaths in the elderly, 1967-82.

This study assessed the influence of influenza on mortality from heart and lung diseases in people over 70 years of age. The data used were obtained from the Dutch Bureau of Statistics. With a regression model, the observed monthly mortality from heart and lung diseases (influenza not included) in people over 70 years is explained with a yearly variable, a monthly variable and the overall monthly number of influenza mortality cases, assuming that monthly mortality has a Poisson distribution. The monthly excess mortality from heart and lung diseases (influenza not included) due to influenza among elderly people (greater than 70 years) is estimated. This study suggests that 1400 deaths per million per year were due to influenza in people over 70 years of age in the study period of 16 years. It can be concluded that one influenza death in the population over 70 years 'generates' almost two deaths diagnosed as heart and lung diseases in the elderly.

Aged↗
PubMed1979

Causes of the excessive rates of perinatal mortality and prematurity in pregnancies complicated by maternal urinary-tract infections.

The study was undertaken to determine the causes of the more frequent pre-term deliveries, fetal and neonatal deaths associated with maternal urinary-tract infections during pregnancy. The combined perinatal mortality rate for eight common placental and fetal disorders was 42 per thousand births in the infected vs. 21 per thousand in the noninfected, owing to a greater mortality from noninfectious placental and fetal disorders in the gestations with the urinary-tract infections (P less than 0.001). All the mortality excess took place when the urinary-tract infections occurred within 15 days of delivery. Death rates were highest when the urinary-tract infections coexisted with maternal hypertension and acetonuria.Hydramnios, amniotic-fluid bacterial infections and abruptio placentae were responsible for two thirds of the more frequent preterm deliveries in the pregnancies complicated by urinary-tract infections.

Abruptio Placentae↗
PubMed1991

"Bread and a pennyworth of treacle": excess female mortality in England in the 1840s.

The author analyzes excess female mortality in nineteenth-century England. She concludes that such mortality was affected by the economic environment and that "much literary evidence points to unequal access to food and a resulting susceptibility to epidemic and respiratory diseases as the transmission mechanism converting dependence and discrimination into relatively high death rates." Women were also adversely affected by harsh labor conditions, in addition to the heavy duties involved in motherhood and housework.

Demography↗
PubMed2001

Temperature, housing, deprivation and their relationship to excess winter mortality in Great Britain, 1986-1996.

OBJECTIVES: To examine the associations between temperature, housing, deprivation and excess winter mortality using census variables as proxies for housing conditions. DESIGN: Small area ecological study at electoral ward level. Setting Great Britain between 1986 and 1996. PARTICIPANTS: Men and women aged 65 and over. MAIN OUTCOME MEASURES: Deaths from all causes (International Classification of Diseases, Ninth Revision [ICD-9] codes 0-999), coronary heart disease (ICD-9 410-414), stroke (ICD-9 430-438) and respiratory diseases (ICD-9 460-519). Odds of death occurring in winter period of the four months December to March compared to the rest of the year. RESULTS: During the study period (excluding the influenza epidemic year of 1989/90), a total of 1,682,687 deaths occurred in winter and 2,825,223 deaths occurred during the rest of the year among people aged > or =65 (around 30,000 excess winter deaths per year). A trend of higher excess winter mortality with age was apparent across all disease categories (P < 0.01). There was a significant association between winter mortality and temperature with a 1.5% higher odds of dying in winter for every 1 degrees C reduction in 24-h mean winter temperature. The amount of rain, wind and hours of sunshine were inversely associated with excess winter mortality. Selected housing variables derived from the English House Condition Survey showed little agreement with census-derived variables at electoral ward level. For all-cause mortality there was little association between deprivation and excess winter mortality, although lack of central heating was associated with a higher risk of dying in winter (odds ratio [OR] = 1.016, 95% CI : 1.009-1.022). CONCLUSIONS: Excess winter mortality continues to be an important public health problem in Great Britain. There was a strong inverse association with temperature. Lack of central heating was associated with higher excess winter mortality. Further work is needed to disentangle the complex relationships between different indicators of housing quality and other measures of socioeconomic deprivation and their relationship to the high number of excess winter deaths in Great Britain.

Aged↗
PubMed2001

The impact of heat waves and cold spells on mortality rates in the Dutch population.

We conducted the study described in this paper to investigate the impact of ambient temperature on mortality in the Netherlands during 1979-1997, the impact of heat waves and cold spells on mortality in particular, and the possibility of any heat wave- or cold spell-induced forward displacement of mortality. We found a V-like relationship between mortality and temperature, with an optimum temperature value (e.g., average temperature with lowest mortality rate) of 16.5 degrees C for total mortality, cardiovascular mortality, respiratory mortality, and mortality among those [Greater and equal to] 65 year of age. For mortality due to malignant neoplasms and mortality in the youngest age group, the optimum temperatures were 15.5 degrees C and 14.5 degrees C, respectively. For temperatures above the optimum, mortality increased by 0.47, 1.86, 12.82, and 2.72% for malignant neoplasms, cardiovascular disease, respiratory diseases, and total mortality, respectively, for each degree Celsius increase above the optimum in the preceding month. For temperatures below the optimum, mortality increased 0.22, 1.69, 5.15, and 1.37%, respectively, for each degree Celsius decrease below the optimum in the preceding month. Mortality increased significantly during all of the heat waves studied, and the elderly were most effected by extreme heat. The heat waves led to increases in mortality due to all of the selected causes, especially respiratory mortality. Average total excess mortality during the heat waves studied was 12.1%, or 39.8 deaths/day. The average excess mortality during the cold spells was 12.8% or 46.6 deaths/day, which was mostly attributable to the increase in cardiovascular mortality and mortality among the elderly. The results concerning the forward displacement of deaths due to heat waves were not conclusive. We found no cold-induced forward displacement of deaths.

Adolescent↗
PubMed2005

Relative risk of mortality associated with diabetes as a function of birth weight.

OBJECTIVE: Birth weight is a risk factor for both diabetes and mortality. Diabetes is a risk factor for mortality. Whether the excess mortality observed for diabetes varies with birth weight is unclear. RESEARCH DESIGN AND METHODS: Among all 2,508 Rochester, Minnesota, residents who first met research criteria for adult-onset diabetes in 1960-1995, 171 were born locally in-hospital after 1922 (i.e., birth weights available) as singleton, term infants. Each case subject and two age- and sex-matched nondiabetic control subjects (born locally, residing locally when the case subject met the criteria for diabetes) were followed through 31 December 2000 for vital status. RESULTS: Of the diabetic case subjects, 16% (27 of 171) died vs. 7% (25 of 342) of control subjects (P = 0.004). The difference was less for normal-birth-weight (NBW) (2,948-<3,856 g) individuals (12% [12 of 102] vs. 8% [20 of 246], P = 0.31) than for abnormal-birth-weight individuals (low birth weight [LBW] 20% [8 of 39] vs. 2% [1 of 46], P = 0.01; high birth weight [HBW] 23% [7 of 30] vs. 8% [4 of 50], P = 0.16), as confirmed with age- and sex-adjusted Cox proportional hazards (diabetes-associated hazard ratio 1.4 [95% CI 0.69-2.90] for NBW vs. 4.8 [1.7-13.3] for abnormal birth weight, test for interaction P = 0.056). The observed diabetes deaths were greater than expected, based on mortality for the general population (27 vs. 13.3, P < 0.001), with 70% of excess deaths occurring among LBW (8 vs. 2.2, P < 0.001) and HBW (7 vs. 3.1, P = 0.03) individuals. CONCLUSIONS: The excess mortality observed for diabetes appears disproportionately concentrated among abnormal-birth-weight individuals, thus identifying a subset of at-risk diabetic individuals and reinforcing the importance of NBW deliveries.

Aged↗
PubMed2004

Trends in survival and cause of death in Danish patients with multiple sclerosis.

The Danish Multiple Sclerosis Registry contains information about all Danish patients in whom multiple sclerosis has been diagnosed since 1948. The purpose of this study was to analyse trends in survival and causes of death of these patients and to compare them with those of the general population. The study comprised all patients with onset in the period 1949-1996. All case records were validated and classified according to standardized diagnostic criteria. Data on emigration and death were obtained by record linkage to official registers. The end of follow-up was 1 January 2000 for emigration and death, and 1 January 1999 for cause-specific deaths. Standardized mortality ratios and excess death rates were calculated for various causes of death and periods after multiple sclerosis onset, and time trends in survival probability were analysed by Cox regression. The study comprised 9881 patients, of whom 4254 had died before end of follow-up. The median survival time from onset was approximately 10 years shorter for multiple sclerosis patients than for the age-matched general population, and multiple sclerosis was associated with an almost threefold increase in the risk for death. According to death certificates, more than half (56.4%) of the patients had died from multiple sclerosis. They also had excess mortality rates from other diseases, except cancer, and from accidents and suicide. The probability for survival improved significantly during the observation period. Thus, the 10-year excess mortality was almost halved in comparison with that in the middle of the 1900s.

Adult↗
PubMed1995

Four-year survival after hip fractures--an analysis in two Finnish health care regions.

We studied the survival of 390 patients with fresh hip fractures sustained in 1989 by a population of about 441 thousand in two health care regions in Finland during four years. The most significant explanatory factors of mortality were place of injury, place after primary treatment and age. The excess mortality of men compared with the reference population at one year was 21% and in women 16%. After this, the excess mortality rates increased slowly in both sexes and were 37% for men and 24% for women at four years. In those who had sustained the fracture in a traffic accident the mortality at four years was slightly lower than that in the reference population, and in those who had sustained the fracture in other accident outdoors there was a 10% excess mortality. Patients who had sustained the injury at home had at four years a 25% and those who had sustained the injury in institutions a 46% excess mortality. The excess mortality at four years was lowest in those who were discharged home (14%) and highest in those who were discharged to other institutions (27%).

Adult↗
PubMed2004

Socio-economic deprivation and excess winter mortality and emergency hospital admissions in the South Yorkshire Coalfields Health Action Zone, UK.

The aims of this study were to describe the pattern of excess winter mortality and emergency hospital admissions in the South Yorkshire Coalfields Health Action Zone, and to examine the relationship between excess winter mortality and emergency hospital admissions and socio-economic deprivation at the enumeration district level. We analysed monthly deaths from 1981 to 1999 and monthly emergency hospital admissions from 1990 to 1999 for cardiovascular disease, respiratory disease and all other causes of death for people aged 45 years and above. We used the enumeration district level Townsend socio-economic deprivation score to categorize enumeration districts by quintile. Excess winter mortality ratios (observed/expected) for females and males, respectively, were 1.70 and 1.58 for respiratory disease, 1.25 and 1.20 for cardiovascular disease, and 1.09 and 1.07 for all other causes of death. The excess winter hospital admission ratio for respiratory disease was 1.80 for females and 1.58 for males. No excess was evident for the other two groups of conditions. We found no significant increase in excess winter mortality ratios with increasing socio-economic deprivation. There was also no significant increase in the excess winter respiratory admission ratio with increasing deprivation. With regard to age, we found P<0.0001 and for all other diseases P>0.001 and also in the excess winter hospital admission ratio for respiratory disease P<0.0001 With regard to sex, the excess ratios were lower in men than in women for both respiratory mortality P<0.05 and respiratory hospital admissions P<0.0001 We also observed that excess winter mortality ratios decreased significantly over the 18-year period for cardiovascular disease P<0.05 and for all other diseases P<0.05. Our results suggest that measures to reduce excess winter mortality should be implemented on a population-wide basis and not limited to socio-economically deprived areas. There may also be a case for tailoring interventions to specifically meet the needs of older people.

Aged↗
PubMed1998

Comparative safety evaluation of non-narcotic analgesics.

Both spontaneous reports and single outcome studies may distort the overall safety evaluation of drugs. We identified epidemiologic studies, published from January 1970 to December 1995, that investigated the association of serious adverse effects with aspirin, diclofenac, acetaminophen, and dipyrone to determine and compare the excess mortality associated with short-term drug use. The estimated excess mortality due to community-acquired agranulocytosis, aplastic anemia, anaphylaxis, and serious upper gastrointestinal complications was 185 per 100 million for aspirin, 592 per 100 million for diclofenac, 20 per 100 million for acetaminophen, and 25 per 100 million for dipyrone. The estimates were largely influenced by the excess mortality associated with upper gastrointestinal complications. A relative risk estimate of 300 or more for the association of dipyrone with agranulocytosis would have been necessary for the excess mortality of dipyrone to be comparable to that of aspirin or diclofenac. Based on published epidemiologic evidence used to determine the excess mortality associated with short-term use of these four non-narcotic analgesics, the current regulatory ranking of the drugs appears inappropriate.

Acetaminophen↗