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PubMedDate not supplied

Comparison of the mortality of a cohort with the mortality of a reference population in a prognostic study.

It is standard practice in epidemiological studies to compare the observed mortality of a cohort to the mortality expected in a reference population of the same age and sex distributions computed from national statistics. The same methods can be used in a prognostic study where the effects on survival of potential prognostic factors are studied in a cohort of patients with a given disease. Writing the hazard function in the cohort as the product of the hazard function in the reference population and a function of some characteristics of the patients, one can derive simple estimates and statistical tests of the standardised mortality ratios (Breslow et al.). The study of a cohort of patients with thyroid cancer will provide an example.

Adult↗
PubMed1988

Mortality and living conditions: relative mortality levels and their relation to the physical quality of life in urban populations.

The general inverse association between mortality and the availability of material resources has been well established in large populations. Using data for Israeli urban locations, we show that indirectly standardized mortality ratios (SMR) are well able to capture this relationship in small populations for which reliable age specific mortality data are not available; and that they are inversely related to the standard of living, as measured by a variety of census based indicators. It is thus suggested that SMRs offer a ready indicator of living standards in populations for which more specific indicators may not be readily accessible.

Female↗
PubMed2005

Life-course influences on mortality at older ages: evidence from the Oslo Mortality Study.

Several studies have investigated the cumulative influence of disadvantage acting from early to adult life. And they suggest that risk of death increases in a cumulative fashion. Few studies have investigated the life-course influences on social inequality in mortality in early old age. In this study we wanted to follow a cohort through their adult working age into retirement and investigate pathways that may give increased risk of mortality. A cohort of all inhabitants in the age range 68-72 who lived in the municipality of Oslo on 1st January 1990 was selected. Data were obtained by linking censuses from 1960, 1970 and 1980 with tax registry in 1990 and death registry 1990-1998. Independent variables were occupational class in 1960, 1970 and 1980 and household income in 1990. Occupational class was coded as manual and non-manual and household income as above or below median household income. A cumulative model was developed by adding times of disadvantage. Then a pathway model was developed which investigated the specific trajectories individuals followed. Most of the increased risk of death was explained by individuals' social conditions in 1990. In the cumulative model, there was no clear gradient in the groups between the bottom and top categories. This suggests that the cumulative model is not important in the high mortality age and that the relative importance of a cumulative effect varies by stages of the life course.

Aged↗
PubMedDate not supplied

[Avoidable years of life lost ratio: an indicator to identify excess mortality in health areas. Mortality workshop of the Valencia region].

Avoidable mortality has been proposed as an outcome indicator of health services. Until now the Standardized Mortality Ratio (SMR) has been the effect measure most used to detect excesses in avoidable mortality. We propose the use, as a complementary measure, of the Avoidable Years of Life Lost Ratio (AYLLR). We show that for tuberculosis, hypertension and for all avoidable deaths both measures provide complementary information, since in some areas where observed deaths are below the expected number (SMR less than 100) we detect an observed number of years of life lost higher than expected (AYLLR greater than 100), due to the occurrence of these deaths at younger ages. The AYLLR is a standardized effect measure that puts a higher weight to premature deaths.

Catchment Area, Health↗
PubMed2000

Marital status and mortality: the national longitudinal mortality study.

PURPOSE: To examine the effect of marital status (married, widowed, divorced/separated, and never-married) on mortality in a cohort of 281,460 men and women, ages 45 years and older, of black and white races, who were part of the National Longitudinal Mortality Study (NLMS). METHODS: Major findings are based on assessments of estimated relative risk (RR) from Cox proportional hazards models. Duration of bereavement for the widowed is also estimated using the Cox model. RESULTS: For persons aged 45-64, each of the non-married groups generally showed statistically significant increased risk compared to their married counterparts (RR for white males, 1.24-1.39; white females, 1.46-1.49; black males, 1.27-1.57; and black females, 1. 10-1.36). Older age groups tended to have smaller RRs than their younger counterparts. Elevated risk for non-married females was comparable to that of non-married males. For cardiovascular disease mortality, widowed and never-married white males ages 45-64 showed statistically significant increased RRs of 1.25 and 1.32, respectively, whereas each non-married group of white females showed statistically significant increased RRs from 1.50 to 1.60. RRs for causes other than cardiovascular diseases or cancers were high (for white males ages 45-64: widowed, 1.85; divorced/separated, 2.15; and never-married, 1.48). The importance of labor force status in determining the elevated risk of non-married males compared to non-married females by race is shown. CONCLUSIONS: Each of the non-married categories show elevated RR of death compared to married persons, and these effects continue to be strong after adjustment for other socioeconomic factors.

Age Distribution↗
PubMed1990

Overall mortality and cancer mortality around French nuclear sites.

Higher than expected mortality from leukaemia has been observed in the population under age 25 living around Sellafield and Dounreay, nuclear reprocessing plants in the United Kingdom. We report the results of a similar study for the population residing around nuclear sites in France. The number of leukaemia deaths was 58, comparable to the 62 in control areas, and slightly less than the 67 expected from national mortality statistics. Twelve deaths due to Hodgkin's disease were observed around nuclear sites; this is about twice the number of Hodgkin's deaths observed in control areas and twice the number expected from national mortality statistics. This observation must, however, be interpreted in light of the fact that several causes of deaths were studied, increasing the play of chance.

Adolescent↗
PubMedDate not supplied

Revised analyses of the National Morbidity, Mortality, and Air Pollution Study: mortality among residents of 90 cities.

This article presents findings from updated analyses of data from 90 U.S. cities assembled for the National Morbidity, Mortality, and Air Pollution Study (NMMAPS). The data were analyzed with a generalized additive model (GAM) using the gamfunction in S-Plus (with default convergence criteria previously used and with more stringent criteria) and with a generalized linear model (GLM) with natural cubic splines. With the original method, the estimated effect of PM(10) (particulate matter 10 microm in mass median aerodynamic diameter) on total mortality from nonexternal causes was a 0.41% increase per 10-microg/m(3) increase in PM(10); with the more stringent criteria, the estimate was 0.27%; and with GLM, the effect was 0.21%. The effect of PM(10) on respiratory and cardiovascular mortality combined was greater, but the pattern across models was similar. The findings of the updated analysis with regard to spatial heterogeneity across the 90 cities were unchanged from the original analyses.

Air Pollution↗
PubMed1975

Studies of mortality and morbidity data. II. Mortality from all causes in Ontario Counties during 1964-1968.

Age-adjusted mortality rates, for all causes of death, are tabulated for all ages by sex for the 55 Ontario counties and districts. The rates are based on all deaths of Ontario residents during 1964-1968 and 1966 census populations. The consistent trends in rates, both for the two sexes and for various 10- and 20-year age groups, indicate that there is a region of about eight adjoining counties, across the center of the province, which has abnormally high mortality, and two regions to the east and west of York, each consisting of three adjoining counties which have abnormally low mortality. The relevance of these findings to aging studies is indicated, and possible further investigations of them are discussed.

Adult↗
PubMed2002

The temporal pattern of mortality responses to air pollution: a multicity assessment of mortality displacement.

Although the association between particulate matter and mortality or morbidity is generally accepted, controversy remains about the importance of the association. If it is due solely to the deaths of frail individuals, which are brought forward by only a brief period of time, the public health implications of the association are fewer than if there is an increase in the number of deaths. Recently, other research has addressed the mortality displacement issue in single-city analysis. We analyzed this issue with a distributed lag model in a multicity hierarchic modeling approach, within the Air Pollution and Health: A European Approach (APHEA-2) study. We fit a Poisson regression model and a polynomial distributed lag model with up to 40 days of delay in each city. In the second stage we combined the city-specific results. We found that the overall effect of particulate matter less than 10 microM in aerodynamic diameter (PM10) per 10 microg/m3 for the fourth-degree distributed lag model is a 1.61% increase in daily deaths (95% CI = 1.02-2.20), whereas the mean of PM10 on the same day and the previous day is associated with only a 0.70% increase in deaths (95% CI = 0.43-0.97). This result is unchanged using an unconstrained distributed lag model. Our study confirms that the effects observed in daily time-series studies are not due primarily to short-term mortality displacement. The effect size estimate for airborne particles more than doubles when we consider longer-term effects, which has important implications for risk assessment.

Air Pollutants↗
PubMed2003

Can a mortality excess in remote areas of Australia be explained by indigenous status? A case study using neonatal mortality in Queensland.

OBJECTIVE: To assess the extent to which indigenous status confounds the association between remoteness and neonatal mortality in Queensland. METHODS: We used routine data from the Queensland Perinatal Data Collection. Poisson regression modelling was used to assess confounding. RESULTS: Babies born to Indigenous mothers have mortality rates 2.42 times those of the rest of the population, regardless of whether they live in urban, rural or remote areas (95% CI 2.09-2.80). The babies of non-Indigenous women who live in remote areas have a low risk of neonatal death, similar to their rural and urban counterparts. CONCLUSION: In Queensland, the key demographic variable that determines neonatal mortality is indigenous status, not remoteness. IMPLICATIONS: Policymakers should not assume that an excess of a particular health problem in remote areas necessarily reflects equal disadvantage for all the Australians who live there.

Fetal Death↗
PubMed1999

Mortality one-year postdischarge from a Veterans Affairs geriatric evaluation and management unit: assessing mortality risks.

OBJECTIVE: To assess at Geriatric Evaluation and Management Unit (GEM) admission factors that affect mortality 12-months postdischarge and to develop a preliminary risk scoring protocol to guide targeting of GEM care. SETTING: A 24 bed-GEM at a Veterans Affairs (VA) Medical Center. DESIGN: Relative risks (RR) were assessed using prospective data; a risk protocol from 1988-1989 data was tested on 1990-1991 patients. SUBJECTS: A total of 283 male patients, aged 60 to 102, discharged over 4 years. RESULTS: Age at GEM admission did not correlate with death (r = .14; P = .145), but did correlate with risk scores (r = .33, P < .001). The risk protocol had a sensitivity of .67 and specificity of 1.00. High and low risk patients had mortalities of 51% versus 20%, a Wilcoxon (Gehan) statistic of 15.22, df = 1, and P < .001. Differences in mortality ceased about 100 days postdischarge. Three univariate RR exceeded 1.00 at a 99% Confidence Interval (CI): IADL score (RR: 1.12; CI, 1.03-1.21); nursing acuity score (RR: 1.78; CI: 1.02-3.11); and a primary diagnosis of pneumonia/sepsis (RR: 3.95; CI, 1.60-9.78). Four RRs exceeded 1.00 at a 90% CI: dementia (RR: 1.78; CI, 1.02-3.09); transfer into the GEM from a medical service (RR: 1.47; CI, 1.02-2.12); deconditioning/functional decline (RR: 1.67; CI, 1.12-2.48); and use of a Foley catheter (RR: 2.22; CI, 1.11-4.45). Thirteen other potential risk factors were found in a multivariate analysis. CONCLUSIONS: The point estimates of risk factors may help clinicians target GEM care, but the development of a useable risk protocol requires additional work. Causal models may be needed to assess patient conditions related to successful treatment in GEMs.

Aged↗
PubMed2006

Cancer mortality patterns in Ghana: a 10-year review of autopsies and hospital mortality.

BACKGROUND: Cancer mortality pattern in Ghana has not been reviewed since 1953, and there are no population-based data available for cancer morbidity and mortality patterns in Ghana due to the absence of a population-based cancer registry anywhere in the country. METHODS: A retrospective review of autopsy records of Department of Pathology, and medical certificate of cause of death books from all the wards of the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana during the 10-year period 1991-2000 was done. RESULTS: The present study reviews 3659 cancer deaths at the KBTH over the 10-year period. The male-to-female ratio was 1.2:1. The mean age for females was 46.5 [Standard Deviation (SD), 20.8] years, whilst that of males was 47.8 (SD, 22.2) years. The median age was 48 years for females and 50 years for males. Both sexes showed a first peak in childhood, a drop in adolescence and young adulthood, and a second peak in the middle ages followed by a fall in the elderly, with the second peak occurring a decade earlier in females than in males. The commonest cause of cancer death in females was malignancies of the breast [Age-Standardized Cancer Ratio (ASCAR), 17.24%], followed closely by haematopoietic organs (14.69%), liver (10.97%) and cervix (8.47%). Whilst in males, the highest mortality was from the liver (21.15%), followed by prostate (17.35%), haematopoietic organs (15.57%), and stomach (7.26%). CONCLUSION: Considering the little information available on cancer patterns in Ghana, this combined autopsy and death certification data from the largest tertiary hospital is of considerable value in providing reliable information on the cancer patterns in Ghana.

Adolescent↗
PubMed1983

[Analysis of the mortality patterns in an area supplying migratory tunnel workers 1. Regional differences in the mortality patterns].

Tunnel work, digging a tunnel at the face, is a highly specialized job today. Many tunnel workers migrate from one place to another away from home throughout the year. They are exposed to hazardous factors such as dust, vibration, noise and so on, working under the two 12-hour shift system. Recently it has been reported that many workers who had suffered from pneumoconiosis and/or vibration disease returned to their home areas. The southern part of Oita Prefecture is well known as being one of the areas which supply many tunnel workers. In order to study the long-term effects of tunnel work on the health of the tunnel workers, the authors compared the mortality rate in the district supplying many tunnel workers with that of the district supplying few workers. Nine causes of death were chosen among many as indices indicating the characteristics of the structure of mortality in the district supplying many tunnel workers. The authors estimated these causes of death in relation to sex and age, analyzing simple correlations between the 9 causes of death and 33 socioeconomic factors. A principal component analysis of these indices was also carried out. The results were as follows. A close relationship was found between tunnel work and three causes of death such as silicotuberculosis (010), tuberculosis (010-019, A 6), and infective and parasitic diseases (000-136). The other 5 causes of death such as diseases of the digestive system (520-577), neoplasms (014-259), all causes (000-999), stomach cancer (151, A 47) and pneumoconiosis (515) were related not only to tunnel work but also to other regional characteristics such as fishery workers rate. No relationship was found between tunnel work and death by cerebrovascular disease (430-438, A 85). These results show that the tunnel work has an influence on the structure of mortality in the area supplying these workers.

Adult↗
PubMed2000

[Female mortality in reproductive age in the State of Sao Paulo, Brazil, 1991-1995: underlying causes of death and maternal mortality].

OBJECTIVE: To describe female mortality in the reproductive age (15 to 49 years old) in the State of S. Paulo, Brazil, from 1991 to 1995, according to the age and underlying causes of death. METHODS: Underlying causes of death, according to the International Classification of Diseases, 9th Revision, were determined in the program Automated Classification of Medical Entities (ACME), developed by "Fundação Seade", which provided us data files and estimated women population by age groups and numbers of live births during the 1991 - 1995 period. Specific rates were calculated per 100,000 women and maternal mortality rates were given per 100,000 live births. Percentages of death were calculated for sub-groups. The median of the rates for a five-year-period was calculated to allow the comparison among the leading underlying causes of death. RESULTS: "Cellular immunity deficiency" increased from 1991 to 1995 in women aged 25 or more which seems to be concomitant to the spreading of the AIDS epidemic among women. Lesions and poisonings were the leading causes of death in younger women, but after the age of 35 cardiovascular diseases and neoplasms became the chief causes. Infectious and parasitic diseases were rated in the 7th or 8th positions in all ages. Accidents and homicides were high. Maternal mortality rates ranged from 43.7 to 49.6 per 100,000 live births, their leading causes were presented and discussed. CONCLUSIONS: Women in the reproductive age were exposed to external factors, chronic diseases and AIDS. The majority of maternal causes of death are preventable diseases. There is a lack of adequate and extensive antenatal care as well as in delivery and postpartum care.

Adolescent↗
PubMed1997

Developing mortality patterns: robust modified generalized likelihood ratio algorithm for infant mortality rate change detection.

A new robust modified generalized likelihood ratio algorithm, which enables the changes of mortality rates to be detected automatically, is applied. The procedure is based on the calculation of discrimination function using robust least squares estimates of AR mortality rates residuals. The feasibility of the approach is demonstrated with experimental data concerning infant mortality rate in Serbia.

Algorithms↗
PubMed1999

The impact of specific occupation on mortality in the U.S. National Longitudinal Mortality Study.

We compare mortality differences for specific and general categories of occupations using a national cohort of approximately 380,000 persons aged 25-64 from the U.S. National Longitudinal Mortality Study. Based on comparisons of relative risk obtained from Cox proportional-hazards model analyses, higher risk is observed in moving across the occupational spectrum from the technical, highly skilled occupations to less-skilled and generally more labor-intensive occupations. Mortality differences obtained for social status groups of specific occupations are almost completely accounted for by adjustments for income and education. Important differences are shown to exist for selected specific occupations beyond those accounted for by social status, income, and education. High-risk specific occupations include taxi drivers, cooks, longshoremen, and transportation operatives. Low-risk specific occupations include lawyers, natural scientists, teachers, farmers, and a variety of engineers.

Adult↗
PubMed1999

[Reduction in malformation-related early mortality--a possibility for modifying perinatal mortality].

From 1980 to 1996 1.8% of all births died as a result of malformations during the first week of life. This rate has been declining significantly after 1992. Congenital malformations of the heart have increased significantly because of improved diagnostic methods. From 1980 to 1996 0.67/1000 of all children died of vitium cordis during the first week of life. From 1992 to 1996 this group of malformations increased the perinatal mortality rate by 0.4/1000. There is a decreased mortality rate of neural tube defects by 0.25/1000 1980 to 1986 and by 0.08/1000 1992 to 1996. Trisomy 21: the early mortality rate decreased from 0.07/1000 to 0.03/1000. The number of non-deceased children with Down's syndrome remains constant, even though 40 per cent of all cases with trisomy 21 were prenatal. 3 per cent of all malformed newborn died during the first week of life as a result of their congenital malformations. The possibility of primary prevention of malformations with folic acid has not been sufficiently utilised.

Cause of Death↗
PubMed1999

Drinking water, mortality, and life expectancy: an assessment of the east-west mortality gap in Europe.

The role of the drinking water in public health has been recognised for many years. Recent ecological studies of mortality rates in Slovakia when compared to indicators of environmental pollution have shown surprising results--areas with greater air pollution seem to have lower total mortality rates. This paradox may be explained by a number of other factors, including urban/rural occupational conditions, socio-economic status, access to health care, and perhaps drinking water. Overall population access to safe drinking water is about the same between East and West Europe, but more careful evaluation suggest at least one important difference. About 35.7% of the people in Central and Eastern European countries do not have 100% access to safe drinking water in their rural areas, compared to only 18.7% of the rural populations in Western Europe who do not have full access to safe drinking water. This study examines access to safe drinking water, assesses overall drinking water quality, and utilises an index of drinking water quality to perform correlation with total mortality, selected chronic diseases which have been associated with drinking water contamination, and life expectancy at birth. These methods are applied to data for East-West Europe, Slovakia, and detailed urban-rural comparisons for three areas of Slovakia (Trnava, Banská Bystrica, and Kosice).

Adolescent↗