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PubMed1985

Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality.

In a six- to 12-year follow-up study of 500 psychiatric outpatients, death from natural causes occurred 11/2 times the expected rate, although the excess was not significant. Death from unnatural causes occurred 31/2 times the expected rate, a significant elevation. Suicide and homicide rates were particularly excessive. Unnatural mortality was excessive among younger, but not older, patients, and among all sex-race groups except black women, none of whom died unnaturally. Initial psychiatric diagnoses highly predictive of unnatural death included alcoholism, antisocial personality, drug addiction, and homosexuality. Secondary affective disorder was predictive of excess unnatural mortality, but in all cases of such death one of the four disorders associated with excess mortality antedated the affective disturbance. No patient with an index diagnosis of primary affective disorder died of an unnatural cause. Despite a frequent history of suicide attempts, hysteria was not associated with excess unnatural mortality.

Adolescent↗

PubMed2000

Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term.

BACKGROUND: On the basis of evidence from non-randomised studies, it has been recommended that all babies born through thick meconium should have their tracheas intubated so that suctioning of their airways can be performed. The aim is to reduce the incidence and severity of meconium aspiration syndrome. However, for term babies who are vigorous at birth endotracheal intubation may be both difficult and unnecessary. OBJECTIVES: To determine if endotracheal intubation and suction of the airways at birth in vigorous term meconium-stained babies is more beneficial than routine resuscitation including aspiration of the oro-pharynx. SEARCH STRATEGY: The search was made from Oxford Database of Perinatal Trials, the Neonatal Trials Registry of the Cochrane Neonatal Collaborative Review Group and information obtained from knowledgeable practising neonatologists. SELECTION CRITERIA: Randomised trials which compared a policy of routine vs no (or selective) use of endotracheal intubation and aspiration in the immediate management of vigorous term meconium-stained babies at birth. DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes including mortality, meconium aspiration syndrome, other respiratory conditions, pneumothorax, need for oxygen supplementation, stridor, convulsions and hypoxic-ischaemic encephalopathy were abstracted and analysed using Revman 3.1.1. MAIN RESULTS: Four randomised controlled trials of endotracheal intubation at birth in vigorous term meconium-stained babies were identified. Meta-analysis of these trials does not support routine use of endotracheal intubation at birth in vigorous meconium-stained babies to reduce mortality, meconium aspiration syndrome, other respiratory symptoms or disorders, pneumothorax, oxygen need, stridor, HIE and convulsions. REVIEWER'S CONCLUSIONS: Routine endotracheal intubation at birth in vigorous term meconium-stained babies has not been shown to be superior to routine resuscitation including oro-pharyngeal suction. This procedure cannot be recommended for vigorous infants until more research is available.

Humans↗

PubMed1983

Exposures and mortality among chrysotile asbestos workers. Part II: mortality.

A retrospective cohort mortality study was conducted among a cohort of 1,261 white males employed one or more months in chrysotile asbestos textile operations and followed between 1940 and 1975. Statistically significant excess mortality was observed for all causes combined (standardized mortality ratio [SMR] = 150), lung cancer (SMR = 135), diseases of the circulatory system (SMR = 125), nonmalignant respiratory diseases (SMR = 294), and accidents (SMR = 134). Using estimated fiber exposure levels in conjunction with detailed worker job histories, exposure-response relationships were investigated. Strong exposure-response relationships for lung cancer and asbestos related non-malignant respiratory diseases were observed. Compared with data for chrysotile miners and millers, chrysotile textile workers were found to experience significantly greater lung cancer mortality at lower lifetime cumulative exposure levels. Factors such as differences in airborne fiber characteristics may partially account for the large differences in exposure response between textile workers and miners and millers.

Asbestos↗

PubMed1987

The morbidity and mortality of vermiculite miners and millers exposed to tremolite-actinolite: Part II. Mortality.

The vermiculite ore and concentrate of a mine and mill located near Libby, Montana was found to be contaminated with a fiber of the tremolite/acetinolite series. A study was conducted to estimate the exposure-response relationship for mortality for 575 men who had been hired prior to 1970 and employed at least 1 year at the Montana site. Individual cumulative fiber exposure (fiber-years) was calculated. Results indicated that mortality from nonmalignant respiratory disease (NMRD) and lung cancer was significantly increased compared to the U.S. white male population. For those workers more than 20 years since hire, the standard mortality rate (SMR) for lung cancer (ICDA 162-163) was 84.7, 225.1, 109.3, and 671.3 for less than 50, 50-99, 100-399, and more than 399 fiber-years respectively. Corresponding results for NMRD (ICDA 460-519) were 327.8, 283.5, 0, and 278.4. Based on a linear model for greater than 20 years since hire, the estimated percentage increase in lung cancer mortality risk was 0.6% for each fiber-year of exposure. At 5 fiber-years, the estimated percentage was 2.9% from an unrestricted (nonthreshold) linear model and 0.6% from a survival model.

Aluminum Silicates↗

PubMed2000

Mortality-rate crossovers and maximum lifespan in advantaged and disadvantaged populations: accelerated-mortality and sudden-death models.

One population is advantaged relative to another by our definition if its survival function is greater at all ages. A population has a lifespan maximum if there is an age at which its survival function becomes exactly zero. Earlier work concerned conditions under which the mortality-rate functions of advantaged and disadvantaged populations displaying lifespan maxima always crossed. Here two survival models of populations having lifespan maxima are presented in which mortality-rate crossings between advantaged and disadvantaged subpopulations may fail to appear. One, the accelerated-mortality model, has a continuous survival function; in the other, the sudden-death model, the survival function is discontinuous. Both differ from examples examined previously in that their mortality-rate functions become infinite at their lifespan maxima.

Animals↗

PubMed1989

Increased survival after APSAC: 30-day and 12-month mortality data from the APSAC Intervention Mortality Study.

Preliminary analysis of mortality data from the anisoylated plasminogen streptokinase activator complex (APSAC) Intervention Mortality Study (AIMS) showed a 47% reduction in 30-day mortality (with a 95% confidence interval of 21 to 65%) for patients treated with APSAC within 6 hours of onset of acute myocardial infarction. After follow-up of 1,004 patients for 30 days after randomization in the double-blind, placebo-controlled, clinical trial, researchers found that 61 patients (12.2%) in the placebo group had died compared with 32 patients (6.4%) in the APSAC group (p = 0.0016). Incomplete follow-up of these patients for 1 year provided an estimated mortality of 19.4% in the placebo group and 10.8% in the APSAC group (log-rank test for survival to year p = 0.0006). Benefit was seen irrespective of age, site of infarction and time from onset of symptoms up to 6 hours.

Aged↗

PubMed2006

Usefulness of aortic root dimension in persons > or = 65 years of age in predicting heart failure, stroke, cardiovascular mortality, all-cause mortality and acute myocardial infarction (from the Cardiovascular Health Study).

Echocardiographic measures of left ventricular (LV) function and structure as well as left atrial size have been reported to predict adverse cardiovascular disease (CVD) outcomes. Although anatomic changes of the aortic root are likely to reflect effects of hypertension and atherosclerosis, few data are available on the predictive value of aortic root dimension (ARD) for outcome in free-living populations. The purpose of this investigation was to determine whether in a cohort of patients aged > or = 65 years ARD was associated with traditional coronary heart disease (CHD) risk factors and with 10-year incident CVD outcomes. In the National Heart, Lung, and Blood Institute-sponsored Cardiovascular Health Study, 3,933 free-living black and white men and women > or = 65 years of age without prevalent CVD had 2-dimensional directed M-mode echocardiographic measurements of ARD as part of a comprehensive evaluation. ARD was associated with age and gender (greater in men) but not race. ARD was also positively associated with diastolic blood pressure, LV hypertrophy, major electrocardiographic abnormalities, and other echocardiographic measures, including LV mass, ventricular septal and posterior wall thickness, and LV dimension. After adjustment for other known risk factors, high ARD was associated with an increased risk for incident congestive heart failure (CHF) in men (hazard ratio for upper compared with all other quintiles 1.47, p = 0.014), stroke in men and women (hazard ratio 1.39 per cm, p = 0.015), CVD mortality in men and women (hazard ratio 1.48 per cm, p = 0.007), and total mortality in men and women taking antihypertensive medications (hazard ratio 1.46 per cm, p = 0.007), but not with incident myocardial infarction (MI) (hazard ratio 0.89, p = 0.39). In conclusion, in a cohort of patients aged > or = 65 years without clinical CVD at baseline, ARD was associated with several CHD risk factors and measures of subclinical disease and was predictive of incident CHF, stroke, CVD mortality, and all-cause mortality, but not of incident MI.

Age Factors↗

PubMed2004

The mortality risks of smokers in Taiwan: Part I: cause-specific mortality.

BACKGROUND: Few studies of adverse health effects from smoking have been conducted in southeastern Asian populations which may exhibit racial, cultural, and smoking behavioral differences that could affect mortality patterns. This study aims to quantify cause-specific mortality risks among cigarette smokers in Taiwan. METHODS: The study population for this investigation was derived from two existing prospective study cohorts: a community-based cohort and a cohort composed of civil servants and teachers. Smoking data were obtained by face-to-face interview in the community cohort and by self-administered questionnaire in the civil servant/teacher cohort. The mortality risks of current smokers, adjusted for age, were compared to those of nonsmokers using Cox's proportional hazards model and dose-response relationships were examined by variables of smoking intensity and duration. RESULTS: Male smokers had significantly higher all-cause mortality than nonsmokers. Cigarette smoking was also significantly associated with increased risks of dying from cancer, cardiovascular disease, respiratory disease, chronic bronchitis, diabetes, peptic ulcer, liver cirrhosis, and kidney disease. In addition, smokers had an increase in risk of fatal injuries from motor vehicle accidents and nonmotor vehicle accidents, as well as cancers of the oral cavity nasopharynx, esophagus, stomach, rectum, liver, and lungs. Risks for women smokers were generally higher than those for men, although this is based on small numbers of smokers. In women, deaths from all causes, all cancers, and cancers of the cervix, liver, and lung, cardiovascular disease, and respiratory disease were also significantly increased. The mean age at death for smokers who died before age 65 from smoking-related diseases was 57.4 years, which represented a loss of 22 years of life expectancy. CONCLUSIONS: The pervasive and serious impact of cigarette smoking on the health of Taiwanese cannot be underestimated.

Adult↗

PubMed2002

Mortality of pulmonary artery banding in the current era: recent mortality of PA banding.

BACKGROUND: The mortality of pulmonary artery banding improved significantly in the 1980s. However, we lack information on this procedure in the current era. METHODS: The results of pulmonary artery banding in 365 patients who had operations between 1966 and 2001 were reviewed. The patients were divided into three groups: (1) group 1 patients who had operations between 1966 and 1979, (2) group 2 patients who had operations between 1980 and 1989, and (3) group 3 patients who had operations between 1990 and 2001. RESULTS: Significantly younger and smaller patients have been operated on recently (mean age: group 1, 169.0 +/- 40 days; group 2, 101.8 +/- 11 days; and group 3, 69.7 +/- 8.9 days; and mean weight: 4.6 +/- 0.1, 4.1 +/- 0.1, and 3.2 +/- 0.1 kg, respectively). A decrease was found in the number of simple cardiac anomalies, such as isolated ventricular septal defects. The early mortality in the three groups was 38.3% for group 1 (65 of 187), 13.5% for group 2 (15 of 111), and 13.8% for group 3 (12 of 87). Although the mortality did not vary significantly between groups 2 and 3, it improved over time in patients weighing less than 3 kg. Multivariate analysis of group 3 demonstrated that no isolated variable, including sex, weight, and diagnosis was a significant risk factor. CONCLUSIONS: Despite the advances in perioperative management, we found no improvement in the early mortality of pulmonary artery banding during the last decade. These results will support the preference for primary repair of intracardiac anomalies in small infants. However, this operation can now be performed with the same risk even in smaller patients. We believe that pulmonary artery banding has a role in the treatment of congenital cardiac anomalies.

Body Weight↗

PubMed2000

Competing risks in absence of independence: impact of AIDS on liver function failure mortality, and lung cancer on ischemic heart disease mortality.

The increase in lung cancer (LC) mortality can produce a decrease in mortality from other causes, including ischemic heart disease (IHD). This problem (called the competing risks problem) has been addressed usually assuming independence between the competing causes of death. Our purpose is to show that assuming dependence of causes of death allows obtaining a better estimation of cumulative mortality. We use a clinical epidemiological example on the impact of AIDS in liver function failure in a cohort of drug users. The competing effect under dependence is 47% higher than under independence. This result is compared with a population-based example on LC and IHD mortalities in Spanish people in 1992. LC and IHD share tobacco smoking as a common risk factor, so independence cannot be assumed. Under the independence assumption, both life expectancy and number of deaths from IHD are underestimated. The difference is small compared to the model computed under dependence and it occurs mainly in the elderly (0.3% more deaths in people aged 70 and over).

Acquired Immunodeficiency Syndrome↗

PubMed1992

Using USRDS generated mortality tables to compare local ESRD mortality rates to national rates.

Mortality tables of the U.S. Renal Data System allow description of national mortality rates among prevalent dialysis patients in five-year age groups and four major categories of causes of ESRD for Black and White patients. Based on these tables derived from over 50,000 deaths in dialysis patients during 1987 to 1989 a methodology is described that allows comparison of local or regional mortality rates to national rates with determination of a standardized mortality ratio and statistical significance. Since this methodology adjusts for patient age, race and cause of ESRD, it can serve as a useful tool for dialysis research and local quality assurance.

Adolescent↗

PubMed2005

Acne in adolescence and cause-specific mortality: lower coronary heart disease but higher prostate cancer mortality: the Glasgow Alumni Cohort Study.

Androgen level or androgen activity is implicated in several health outcomes, but its independent role remains controversial. This study investigated the association between history of acne in young adulthood, a marker of hormone activity, and cause-specific mortality in the Glasgow Alumni Cohort Study. Male students who attended Glasgow University between 1948 and 1968 and participated in voluntary health checks reported history of acne (n = 11,232). Vital status has been traced, and risk factors in adulthood are known for about 50% of the participants. Those with a history of acne were more often nonsmokers while university students and tended to be from a lower socioeconomic position. The two groups did not differ in other adolescent (height, body mass index, blood pressure, and number of siblings) or in most adult risk factors. Students who reported a history of acne had a lower risk of all-cause (hazard ratio = 0.89, 95% confidence interval (CI): 0.76, 1.04) and coronary heart disease (hazard ratio = 0.67, 95% CI: 0.48, 0.94) mortality but had some evidence of a higher risk of prostate cancer mortality (hazard ratio = 1.67, 95% CI: 0.79, 3.55). This study shows that androgen activity during adolescence may protect against coronary heart disease but confer a higher risk of prostate cancer mortality.

Acne Vulgaris↗

PubMed1995

Mortality in psychiatric patients, with a specific focus on cancer mortality associated with schizophrenia.

BACKGROUND: Higher mortality rates among psychiatric patients compared with the general population have been widely reported. On the other hand, lower cancer mortality for schizophrenics has been occasionally pointed out. Few studies from Japan have investigated mortality among psychiatric patients, and this study is the first large-scale follow-up in this country. METHODS: A total of 4980 patients admitted to a national mental hospital from 1948 through 1982 were followed up until 31 August 1985. The standardized mortality ratios (SMR) were calculated in comparison to the general population, using the person-years method. RESULTS: The SMR for total deaths and those for malignancy were as follows for males/females respectively: 2.55/3.02 and 0.84/1.37 for schizophrenia, 1.76/2.37 and 1.44/2.10 for depression, 2.45/3.04 and 1.18/1.82 for mania, 1.81/1.90 and 0.27/1.07 for neurosis, 5.55/4.33 and 1.85/3.34 for alcohol/drug abuse, and 3.65/3.57 and 1.01/0.72 for organic brain syndrome. CONCLUSIONS: The SMR for total deaths were significantly elevated in schizophrenia, depression, mania, neurosis, alcohol/drug abuse, and organic brain syndrome, respectively. The SMR for malignancy were not elevated nor lowered significantly in any of these disease categories. The SMR for stomach cancer in male schizophrenics was significantly lower (0.27; P < 0.05).

Cause of Death↗

PubMed1990

Cancer mortality and lipid and lipoprotein levels. Lipid Research Clinics Program Mortality Follow-up Study.

The associations of serum lipid and lipoprotein levels with the risk of cancer mortality were assessed in 2,753 men and 2,476 women aged 40-79 years at baseline (1972-1976) who participated in the Lipid Research Clinics Program Mortality Follow-up Study through 1984. Seventy-nine cancer deaths occurred in men and 65 occurred in women during an average follow-up time of 8.4 years. Total cholesterol and low-density lipoprotein (LDL) cholesterol were significantly inversely associated with overall cancer mortality in men, but no relation was observed in women. Neither high-density lipoprotein (HDL) cholesterol nor triglycerides were significantly related to total cancer mortality in either sex, although in women. HDL cholesterol was positively associated with risk of death from gynecologic cancers. Compared with men with higher cholesterol levels, the relative risk of death from colon cancer, adjusted for age, body mass, cigarette smoking, and alcohol consumption, was 5.20 (95 percent confidence interval (Cl) 1.61-16.8) in men with total cholesterol levels less than or equal to 187 mg/dl and 4.79 (95 percent CI 1.37-16.8) in those with LDL cholesterol levels less than or equal to 119 mg/dl. Death from smoking-related cancers was inversely related to baseline total cholesterol but not to LDL cholesterol. The absence of an association with HDL cholesterol, which has been shown to be lower in persons with clinically manifest malignancy, and evidence from survival curves suggest that the inverse relation in men is not due to preexisting disease.

Adult↗

PubMed1981

Mortality among rubber workers. III. Cause-specific mortality, 1940-1978.

This report describes mortality occurring between 1940 and mid-1978 among 29,087 men and women employed in a rubber plant for at least two years. Mortality patterns for the period July 1, 1974, to July 1, 1978, were compared to previously published findings for January 1, 1940, through June 30, 1974. Expected numbers of deaths were based on U.S. general population mortality data. There were excess deaths from bladder cancer and leukemia among white male union members during both follow-up periods. During recent follow-up of white male union members employed for at least five years, there were excesses in deaths from three additional cancers: esophageal cancer (11 observed/4.8 expected), biliary and liver cancer (6 observed/3.3 expected) and lymphoma and multiple myeloma (14 observed/5.8 expected). Evidence from other studies of rubber workers suggests that observed excesses in deaths from bladder cancer and leukemia are related to work-place exposures. The present findings suggest that occupational exposures etiologically relevant to these diseases may not have been reduced in recent years or that sufficient time has not elapsed for such reductions to result in decreased mortality. Further investigation is required to clarify the contribution of occupational factors to observed excesses in deaths form cancers of the esophagus and the biliary passages and liver and from lymphoma and multiple myeloma.

Aged↗

PubMed1988

Reanalysis of lung cancer mortality in a National Cancer Institute study on mortality among industrial workers exposed to formaldehyde.

The results of an historical cohort study of mortality among individuals occupationally exposed to formaldehyde were announced in 1986 by Blair et al (JNCI 1986; 76:1071-1084). The study was a joint undertaking of the National Cancer Institute and the Formaldehyde Institute, and concluded, ". . .this large multiplant cohort study provided little evidence to suggest that formaldehyde exposure affected the mortality experience of these industrial workers." However, there were concerns by a number of workers that the design and analysis of the study had possibly masked an existing occupational hazard. Analyzing time-integrated exposure to formaldehyde without simultaneously considering length of exposure and comparing mortality of formaldehyde workers to mortality of the general population could have masked an increase in cancer risks because of the healthy worker effect. A copy of the data of the study was obtained from the principal investigator and reanalyzed. We find a significantly increased risk for all cancers and for lung cancer as a function of cumulative exposure when workers with higher levels of exposure are compared with those with little or no exposure while simultaneously considering length of exposure. When the risk ratio (RR) for lung cancer at less than or equal to 0.1 ppm cumulative exposure (CX) is taken as 1.0, the lung cancer RR for CX of 0.1 to 0.5 ppm is 1.41 (1.20 to 1.66), the RR for CX of 0.5 to 2.0 ppm is 1.73 (1.42 to 2.11), and the RR for CX greater than or equal to 2.0 is 1.70 (1.32 to 2.18). Hourly workers have a significantly higher RR than salaried workers (RR = 1.58).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1997

Tuberculosis Mortality and Silica Exposure: A Case-Control Study Based on a National Mortality Database for the Years 1983-1992.

A case-control study (8,740 cases; 83,338 controls) was done to evaluate the association between potential occupational exposure to silica and risk of tuberculosis (TB) mortality, using the National Occupational Mortality Surveillance database for 1983-1992. Potential silica exposure was based on the decedent's usual industry and occupation. Assignment of potential exposure to silica was based on the entire range of industries and occupations. Odds ratios (ORs) for mortality from respiratory TB associated with potential high and intermediate exposures to silica were 1.30 (95% CI 1.14-1.48) and 1.07 (95% CI 0.77-1.47), respectively, adjusting for silicosis, other pneumoconioses, age, gender, race, socioeconomic status, and potential exposure to active TB. The elevated OR was seen in all subgroups: male, female, white, and black. The average age at death among respiratory TB cases with potential silica exposure was significantly younger by four years than that among cases without potential silica exposure. The findings suggest that potential occupational exposure to silica alone, in the absence of silicosis, is associated with respiratory TB mortality, with a dose-response relationship.

Journal Article↗

PubMed1996

The mortality experience of individuals on the Salford Psychiatric Case Register. I. All-cause mortality.

BACKGROUND: Several studies, mainly non-UK based, have reported higher than expected mortality for individuals with mental illness. This investigation in Salford (England) was undertaken to determine local experiences. METHOD: An historical cohort design was employed with record linkage to determine status at study end: maximum follow-up was 18 years. All 6952 individuals with schizophrenia, neuroses, affective or personality disorders, enrolled on the psychiatric case register between 1 January 1968 and 31 December 1975 were recruited: there were 199 exclusions. Death was the study end-point. RESULTS: Observed mortality was 65% higher than expected and elevated throughout the whole of follow-up. Mortality was higher in younger ages, females and subjects born locally. Circulatory disorders, injury and poisoning each caused approximately one-third of the excess deaths. CONCLUSIONS: Documenting mortality risk has important applications for prioritisation, resource allocation, developing control programmes, evaluating service effectiveness, disease forecasting and future research.

Adolescent↗