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PubMed1981

Methods for the analysis of mortality risks across heterogeneous small populations: examination of space-time gradients in cancer mortality in North Carolina counties 1970-75.

A method of analyzing mortality rates in heterogeneous populations is presented. This method, appropriate for the investigation of mortality rates in small geographic areas (e.g., counties) where the forces of mobility operate to selectively "package" person, is applied to the determination of whether a spatial west-east gradient in cancer mortality rates existed in North Carolina over the period 1970 to 1975. A significant gradient (as well as a significant temporal trend) is determined to exist in the data, though only for particular race, age and sex-specific demographic groups. Several alternate hypotheses are presented to explain the existence of the spatial gradient in these particular demographic groups.

Adult↗
PubMed1995

Mortality studies in systemic lupus erythematosus. Results from a single center. II. Predictor variables for mortality.

OBJECTIVE: To analyze the factors associated with mortality in patients with systemic lupus erythematosus (SLE), followed prospectively in a single center. METHODS: The study included 665 patients with SLE followed over a 20-year period according to a standard protocol. Clinical laboratory information has been entered into a database. Univariate analysis was carried out to identify prognostic factors of death. The Cox proportional hazard regression model was used to estimate risk ratio of death. RESULTS: Renal damage, thrombocytopenia, lung involvement, systemic lupus erythematosus disease activity index (SLEDAI) > or = 20 at presentation, and age > or = 50 at diagnosis were predictive factors for mortality in the univariate as well as in the multivariate analyses. Hypertension and ischemic heart disease were significantly associated with death only in the univariate analysis. CONCLUSION: Renal damage, thrombocytopenia, SLEDAI > or = 20 at presentation, lung involvement, and age > or = 50 at diagnosis are prognostic factors associated with mortality.

Adolescent↗
PubMed1996

Breast cancer mortality between 1950 and 1987 after exposure to fractionated moderate-dose-rate ionizing radiation in the Canadian fluoroscopy cohort study and a comparison with breast cancer mortality in the atomic bomb survivors study.

The relationship between exposure to low-linear energy transfer ionizing radiation and subsequent breast cancer mortality risk is reported based on a further 7 years of follow-up in the Canadian fluoroscopy study. Amongst 31,917 women first treated for tuberculosis in a Canadian institution between 1930 and 1952, a total of 688 breast cancer deaths were observed between 1950 and 1987. There is a strong linear trend of increasing risk with increasing dose (P < 0.0001), with the excess relative risk per sievert decreasing with age at exposure (P = 0.0003). The excess relative risk is approximately constant between 5 and 39 years after exposure, with a suggestion of a decrease between 40 and 57 years after exposure, though this could be a chance effect (P = 0.22). Combined analyses of the Canadian fluoroscopy data and the data for the atomic bomb survivors with respect to breast cancer mortality are also reported. In general the two studies are reasonably consistent, the only distinct difference being the much greater excess relative risk per sievert amongst women exposed to very high doses in the province of Nova Scotia (P, heterogeneity <0.0001). Based on the combined data sets a simple relative risk (RR) model for the effect of a dose of D sieverts at age A years is developed: RR(D) = 1.0 + 0.52D exp[-0.10(A-15)]. This model fits the combined data well, and is used to predict excess lifetime risks of breast cancer mortality after radiation exposure from routine annual mammography.

Adolescent↗
PubMed1998

[Physical activity for decreasing cardiovascular mortality and total mortality. A public health perspective].

Forty years of epidemiological research have shown that physical activity as well as physical fitness are inversely related to cardiovascular and all-cause mortality in men and women. This association is likely to be causal. The moderate and most active or fit individuals experience mortality rates that are approximately one-third to one half lower than the rates among those least active or fit. Furthermore, moderate or high levels of physical activity or cardiorespiratory fitness seem to protect against the influence of other potential predictors on mortality. There appears to be a dose-response curve. The greatest benefit is registered when the least active become moderately active or fit. In western societies the prevalence of physical inactivity has been found to be as high as 40%. Exercise guidelines, as traditionally prescribed for disease prevention and improvement of aerobic capacity, unfortunately have failed to enhance the level of physical activity. Currently, exercise training is being extended to include broader physical activity. This new paradigm emphasizes the potential effectiveness of moderately intense activities of daily life (lifestyle activity) for achieving health benefit, and aims at improving levels of general energy expenditure throughout the day. This paper analyses the actual epidemiological evidence for these new recommendations and discusses approaches at different levels of physical activity intervention including individual, community, organisational, environmental and policy-level strategies to increase the activity levels of inactive population groups as well as across the population as a whole.

Adult↗
PubMed2000

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

BACKGROUND: Kangaroo mother care (KMC), defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. OBJECTIVES: To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional care after the initial period of stabilization with conventional care. SEARCH STRATEGY: We used the standard search strategy of the Neonatal Review Group of the Cochrane Collaboration. MEDLINE, EMBASE, LILACS, POPLINE and CINAHL databases, and the Cochrane Controlled Trials Register (Cochrane Library) up to Issue 2, 2000, were searched using the key words terms "kangaroo mother care" or "kangaroo mother method" or "skin-to-skin contact" and "infants" or "low birthweight infants". SELECTION CRITERIA: Randomised trials comparing KMC and conventional neonatal care in LBW infants. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. Statistical analysis was conducted using the standard Cochrane Collaboration methods. MAIN RESULTS: Three studies, involving 1362 infants, were included. All the trials were conducted in developing countries. The studies were of moderate to poor methodological quality. The most common shortcomings were in the areas of blinding procedures for those who collected the outcomes measures, handling of drop outs, and completeness of follow-up. The great majority of results consist of results of a single trial. KMC was associated with the following reduced risks: nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49, 95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95% confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months follow-up (relative risk 0.37, 95% confidence interval 0.15 to 0.89), not exclusively breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to 0.68), and maternal dissatisfaction with method of care (relative risk 0.41, 95% confidence interval 0.22 to 0.75). KMC infants had gained more weight per day by discharge (weighted mean difference 3.6 g/day, 95% confidence interval 0.8 to 6.4). Scores on mother's sense of competence according to infant stay in hospital and admission to NICU were better in KMC than in control group (weighted mean differences 0.31 [95% confidence interval 0.13 to 0.50] and 0.28 [95% confidence interval 0.11 to 0.46], respectively). Scores on mother's perception of social support according to infant stay in NICU were worse in KMC group than in control group (weighted mean difference -0.18 (95% confidence interval -0.35 to -0.01). There was no evidence of a difference in infant mortality. However, serious concerns about the methodological quality of the included trials weaken credibility in these findings. REVIEWER'S CONCLUSIONS: Although KMC appears to reduce severe infant morbidity without any serious deleterious effect reported, there is still insufficient evidence to recommend its routine use in LBW infants. Well designed randomized controlled trials of this intervention are needed.

Breast Feeding↗
PubMed1992

Life table analysis of infant mortality and feto-infant mortality distributed on causes of death in Denmark 1983-1987.

The survival function of 263,322 singletons of the 1983-1987 Danish birth cohorts (262,159 liveborn and 1163 stillborn babies) with mortality distributed on functional groups of underlying causes of death is presented in two graphic forms on the basis of Kaplan-Meier estimates. About half of all first-day deaths in liveborn babies occurred during the first 4 hours. More than half of all first-week deaths happened during the first day. More than half of all deaths from 31 weeks to 76 weeks after the first day of the last menstrual period (LMP) were either fetal deaths prior to the onset of labour unexplained by fetal factors or unexplained sudden infant death syndrome (SIDS) deaths. Graphic presentation of feto-infant mortality distributed on functional cause-of-death groups improved the expression of the relative contribution and timing of the different causes of deaths. Despite a high autopsy rate and a uniform coding practice the distribution on causes of deaths from register data should be interpreted with caution. Full use of the feto-infant approach is only achieved with data which include late abortions. Thus the feto-infant approach is of special interest in countries which have registers of live births and fetal deaths from week 22 of gestation or earlier. The integration of the life table approach and analysis of underlying causes of deaths should be further explored as a way of utilizing vital statistic databases for the evaluation of perinatal care.

Cause of Death↗
PubMed1997

The Israel Longitudinal Mortality Study--differential mortality in Israel 1983-1992: objectives, materials, methods and preliminary results.

The main objective of this study was to investigate mortality differentials in the Israeli population, aged 40 years and above, with regard to major demographic and socio-economic characteristics, in the nine-and-a-half years following the census of 1983. The method of data collection consisted of a linkage of records from the 20% sample of the census with the records of deaths occurring until the end of 1992. The linked file contains the socio-economic and demographic data from the census, and dates and causes of death taken from the death records. This paper focuses on a systematic evaluation of the quality of the linked file, and includes a description of the characteristics of the file. Methods of verification are presented and sources of possible errors are discussed. Results of bivariate analyses of mortality differentials in relation to marital status, ethnic origin, level of education, employment, occupation and income are presented.

Adult↗
PubMed2000

Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants.

BACKGROUND: This section is under preparation and will be included in the next issue. OBJECTIVES: In preterm or low birth weight infants, does targeting ambient oxygen concentration to achieve a lower versus higher blood oxygen range, or administering restricted versus liberal supplemental oxygen, influence mortality, retinopathy of prematurity, lung function, growth or development? SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. An additional literature search was conducted of the MEDLINE, EMBASE, and CINAHL databases in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR). SELECTION CRITERIA: All trials in preterm or low birth weight infants utilising random or quasi-random patient allocation, in which ambient oxygen concentrations were targeted to achieve a lower versus higher blood oxygen range, or restricted versus liberal oxygen was administered, were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The methodological quality of the eligible trials was assessed independently by each author for the degree selection, performance, attrition and detection bias. Data were extracted and reviewed independently by the each author. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group. MAIN RESULTS: The restriction of oxygen significantly reduced the incidence and severity of retinopathy of prematurity without unduly increasing death rates in the meta-analysis of the five trials included in this review. The one trial that specifically addressed the question of lower versus higher PaO2 found no effect on death, but did not report (in sufficient detail to warrant inclusion) the effect of this intervention on eye or other outcomes. The effects of either of these oxygen administration policies on other clinically meaningful outcomes including chronic lung disease and long term growth, neurodevelopment, lung or visual function were not reported in any of the available trials. REVIEWER'S CONCLUSIONS: The results of this meta-analysis confirm the commonly held view of today's clinicians that a policy of unrestricted, unmonitored oxygen therapy has potential harms, without clear benefits. However, the question of what is the optimal target range for maintaining blood oxygen levels in preterm/LBW infants was not answered by the data available for inclusion in this review.

Humans↗
PubMed1990

The use of logit models to investigate social and biological factors in infant mortality. V: A multilogit analysis of stillbirths, neonatal and post-neonatal mortality.

Infant mortality data for England and Wales, cross classified by mother's age, parity and social class were published for 1949/50 and 1975. Previous analyses of these data have been based on graphical, tabular and logit models of stillbirths, neonatal and post-neonatal deaths separately. This paper summarizes the overall changes in infant mortality using a multilogit model. The model selected is illustrated by appropriate graphical presentations.

Adolescent↗
PubMed1997

Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care.

OBJECTIVE: To develop a logistic regression model that predicts the risk of death for children less than 16 years of age in intensive care, using information collected at the time of admission to the unit. DESIGN: Three prospective cohort studies, from 1988 to 1995, were used to determine the variables for the final model. A fourth cohort study, from 1994 to 1996, collected information from consecutive admissions to all seven dedicated paediatric intensive care units in Australia and one in Britain. RESULTS: 2904 patients were included in the first three parts of the study, which identified ten variables for further evaluation. 5695 children were in the fourth part of the study (including 1412 from the third part); a model that used eight variables was developed on data from four of the units and tested on data from the other four units. The model fitted the test data well (deciles of risk goodness-of-fit test p = 0.40) and discriminated well between death and survival (area under the receiver operating characteristic plot 0.90). The final PIM model used the data from all 5695 children and also fitted well (p = 0.37) and discriminated well (area 0.90). CONCLUSIONS: Scores that use the worst value of their predictor variables in the first 12-24 h should not be used to compare different units: patients mismanaged in a bad unit will have higher scores than similar patients managed in a good unit, and the bad unit's high mortality rate will be incorrectly attributed to its having sicker patients. PIM is a simple model that is based on only eight explanatory variables collected at the time of admission to intensive care. It is accurate enough to be used to describe the risk of mortality in groups of children.

Adolescent↗
PubMed1989

A comparison of low birth weight, perinatal mortality, and infant mortality between first and second births to women 17 years old and younger.

Several studies and vital statistics reports have indicated that second pregnancies in the young adolescent have worse outcomes than first pregnancies. This study compared the birth weights and mortality rates of first and second births to 407 teenagers who were less than or equal to 17 years old at the time of the second delivery. Contrary to previous studies, the mean birth weight was significantly lower for first births than for second births (p = 0.0001), even though patients registered for care earlier with their first pregnancy. The perinatal and infant mortality rates for first births were nearly double the rates for second births.

Adolescent↗
PubMed1995

Sex mortality differentials and selective survival in large medfly cohorts: implications for human sex mortality differentials.

Experimental studies on male-female mortality differences in nonhuman species are important because they provide insights into both the nature of age-specific gender differences and the concept of selective survival--whether one subgroup in a population (e.g., males) is consistently more frail than another subgroup (e.g., females). We found that it was not possible to classify either sex as more robust or longer lived since relative longevity was conditional on age (young or old), cage conditions (solitary confinement or grouped cages), and treatment (starvation, irradiation, or density). Implications of these findings are discussed including selective survival, demographic selection, a framework for male-female mortality differentials, and an evolutionary perspective on gender differences in longevity.

Animals↗
PubMed2006

Performance of Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country.

OBJECTIVE: To determine the discriminative ability and calibration of existing scoring systems in predicting the outcome (mortality) in children admitted to an Indian pediatric intensive care unit (PICU). DESIGN: Prospective cohort study. SETTING: Pediatric Intensive Care Unit, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, from July 1, 2002, to July 31, 2003. PATIENTS: A total of 246 patients were admitted. After exclusion of 29 neonates and two patients who stayed in the PICU for 0.8. However, all the models underpredicted mortality. The likely reasons for this could be differences in the patient profile and greater load of severity of illness being managed with lesser resources--both physical and human--and differences in the quality of care.

Adolescent↗
PubMed2006

Low birthweight and mortality: the tendency to repeat low birthweight and its association with early neonatal and infant morbidity and mortality.

Previous studies have demonstrated the tendency to repeat gestational age and birthweight in successive pregnancies and that this tendency is associated with infant survival. Thus, newborn outcome and survival is less favourable if the gestational age and size departs from this maternal tendency. This paper aims to study diseases or conditions that might be associated with this effect. Data were provided through a linkage between three Danish health registries: the Danish Fertility Database, the National Hospital Registry, and the Registry for Preventive Medicine. Such linkage was possible due to the use of unique ID-person numbers. The study included all 8219 second-order low-birthweight (LBW) singleton Danish births, 1980-94, of whom 7811 were liveborn. It was also required that the mother's first delivery took place during that period. The analysis considered 7803 of these births; eight were excluded due to insufficient information. Of the second-order LBW children, 26% had an elder sibling who was also LBW. Early neonatal mortality of a 'non-repeat' LBW birth was 1.3 times higher than 'repeat' LBW births [53.8 vs. 41.2 per 1000; RR 1.31; 95% CI 1.03, 1.65], as was infant mortality [78.4 vs. 60.8 per 1000; RR 1.30; 95% CI 1.06, 1.56]. Also, proportionately more LBW repeat births had Apgar scores of >or=7 after 1 and 5 min. Overall, repeat second-order LBW babies weighed 68 g more than non-repeat LBW babies (P < 0.001). At term, the weight difference was 160 g higher among repeat LBW births (P < 0.001). The mean number of hospitalisations during the first year of life was lower among repeat than non-repeat LBW babies (2.30 vs. 2.46, P < 0.001), while the mean duration of stay was 23.71 vs. 23.97 days (P > 0.05). Newborn immaturity was the most common diagnosis for hospitalisation, and infections the second most common. There were no differences between repeat and non-repeat LBW births in the proportion with each diagnosis. Apart from the differences in birthweight, we were unable to explain the improved survival for repeat compared with non-repeat LBW babies. Except for differences in Apgar scores, we observed no differences in morbidity based on registered hospitalisations during infancy.

Apgar Score↗
PubMed2004

The mortality index for neonatal transportation score: a new mortality prediction model for retrieved neonates.

OBJECTIVE: To develop a mortality prediction score for retrieved neonates based on the information given at the first telephone contact with a retrieval service. METHODS: Data from the New South Wales Newborn and Pediatric Emergency Transport Service database were examined. Analysis was performed with the results for 2504 infants (median gestational age: 36 weeks; range: 24-43 weeks) who were <72 hours of age at the time of referral and whose outcome (neonatal death or survival) was known. The study population was divided randomly into 2 halves, the derivation and validation cohorts. Univariate analysis was performed to identify variables in the derivation cohort related to neonatal death. The variables were entered into a multivariate logistic regression analysis with neonatal death as the outcome. Receiver operator characteristic (ROC) curves were constructed with the regression model and data from the derivation cohort and then the validation cohort. The results were used to generate an integer-based score, the Mortality Index for Neonatal Transportation (MINT) score. ROC curves were constructed to assess the ability of the MINT score to predict perinatal and neonatal death. RESULTS: A 7-variable (Apgar score at 1 minute, birth weight, presence of a congenital anomaly, and infant's age, pH, arterial partial pressure of oxygen, and heart rate at the time of the call) model was constructed that generated areas under ROC curves of 0.82 and 0.83 for the derivation and validation cohorts, respectively. The 7 variables were then used to generate the MINT score, which gave areas under ROC curves of 0.80 for both neonatal and perinatal death. CONCLUSION: Data collected at the first telephone contact by the referring hospital with a regionalized transport service can identify neonates at the greatest risk of dying.

Analysis of Variance↗
PubMed1990

Perinatal mortality in a Swedish county 1980-1984. Mortality pattern and its amenability.

A retrospective, community based study on perinatal mortality was performed in a sparsely populated county with decentralized antenatal and maternity care. Neither level of care nor domicile showed any relation to perinatal mortality. A substantial underreporting of perinatal deaths was revealed. Death causes were classified according to the modified Aberdeen classification. One child per 2,000 births is stillborn due to asphyxia during delivery. Maternal age outside the optimal age range for reproduction was a significant risk factor. A suboptimal standard of care was identified in 33% of the perinatal deaths.

Adult↗
PubMed1993

Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial.

OBJECTIVE: To evaluate the relation between weight variability and death in high-risk, middle-aged men participating in the Multiple Risk Factor Intervention Trial (MRFIT). DESIGN: Cohort study with 3.8 years of follow-up. SETTING: Multicenter, collaborative, primary prevention trial conducted at 22 clinical centers in the United States. PARTICIPANTS: Men (n = 10,529) who were 35 to 57 years old at baseline and who were in the upper 10% to 15% of risk for coronary heart disease because of smoking, high blood pressure, and elevated cholesterol level. Participants were seen at least annually for 6 to 7 years for medical evaluations in study clinical centers. MEASUREMENTS: Death from cardiovascular disease (228 deaths) and from all causes (380 deaths). RESULTS: The primary measure of weight variability was the intrapersonal standard deviation of weight (ISD), which was calculated from measured weights obtained at clinic visits during a 6- to 7-year period. All-cause death rates per 1000 person-years of follow-up across ISD quartiles were 8.28, 8.25, 10.57, and 11.07 from the first to fourth quartiles, respectively. After adjusting for baseline risk factors associated with weight change, the relative risk for all-cause mortality in the fourth compared with the first quartile was 1.64 (95% CI, 1.21 to 2.23). Cardiovascular death and ISD showed a similar pattern. The association between weight change and death was not observed in the heaviest men. CONCLUSION: Greater weight variability was associated with a greater risk for cardiovascular disease and all-cause mortality in some types of high-risk men.

Adult↗
PubMed2000

Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality.

BACKGROUND: The debate on breastfeeding in areas of high HIV prevalence has led to the development of simulation models that attempt to assess the risks and benefits associated with breastfeeding. An essential element of these simulations is the extent to which breastfeeding protects against infant and child mortality; however, few studies are available on this topic. We did a pooled analysis of studies that assessed the effect of not breastfeeding on the risk of death due to infectious diseases. METHODS: Studies were identified through consultations with experts in international health, and from a MEDLINE search for 1980-98. Using meta-analytical techniques, we assessed the protective effect of breastfeeding according to the age and sex of the infant, the cause of death, and the educational status of the mother. FINDINGS: We identified eight studies, data from six of which were available (from Brazil, The Gambia, Ghana, Pakistan, the Philippines, and Senegal). These studies provided information on 1223 deaths of children under two years of age. In the African studies, virtually all babies were breastfed well into the second year of life, making it impossible to include them in the analyses of infant mortality. On the basis of the other three studies, protection provided by breastmilk declined steadily with age during infancy (pooled odds ratios: 5.8 [95% CI 3.4-9.8] for infants <2 months of age, 4.1 [2.7-6.4] for 2-3-month-olds, 2.6 [1.6-3.9] for 4-5-month-olds, 1.8 [1.2-2.8] for 6-8-month-olds, and 1.4 [0.8-2.6] for 9-11-month-olds). In the first 6 months of life, protection against diarrhoea was substantially greater (odds ratio 6.1 [4.1-9.0]) than against deaths due to acute respiratory infections (2.4 [1.6-3.5]). However, for infants aged 6-11 months, similar levels of protection were observed (1.9 [1.2-3.1] and 2.5 [1.4-4.6], respectively). For second-year deaths, the pooled odds ratios from five studies ranged between 1.6 and 2.1. Protection was highest when maternal education was low. INTERPRETATION: These results may help shape policy decisions about feeding choices in the face of the HIV epidemic. Of particular relevance is the need to account for declining levels of protection with age in infancy, the continued protection afforded during the second year of life, and the question of the safety of breastmilk substitutes in families of low socioeconomic status.

Breast Feeding↗