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PubMed2004

A 50-year historical cohort mortality study of workers in a pharmaceutical plant.

An historical cohort study was conducted of workers at a pharmaceutical manufacturing plant. The cohort mortality experience of workers ever employed at the plant over the period from 1950 to 1999 was examined. The 1958 workers accumulated 44,294 person-years of experience at the plant, and a total of 384 deaths were identified. Our findings from external comparisons based on standardized mortality ratios (SMRs) in the cohort provide no evidence of excess mortality risk from all causes combined (SMR=0.75), all cancers combined (SMR=0.96), or from certain other individual causes of death. No patterns of excess mortality risk were apparent after stratifying on age and sex or job classification. The mortality experience of this cohort was generally more favorable than that of the general population.

Cause of Death↗
PubMed2004

Neighborhood poverty, mortality rates, and excess deaths among African Americans: Philadelphia 1999-2001.

We used vital statistics and census data to determine whether mortality rates in Philadelphia were associated with neighborhood poverty, and to what extent excess mortality among African Americans was associated with neighborhood poverty. Gender-specific, age-adjusted mortality rates for 1999-2001 were strongly associated with neighborhood poverty among both women and men overall, and among both African Americans and non-Hispanic whites. The actual number of deaths among African Americans was 5,305 higher than it would have been if African Americans had had the same gender- and age-specific mortality rates as the average for non-Hispanic whites in Philadelphia, and 1,944 higher than if African Americans had had the same gender- and age-specific rates as non-Hispanic whites in the same neighborhood poverty categories. The excess mortality associated with neighborhood poverty and the socioeconomic factors that force large numbers of African Americans into poverty and high-poverty neighborhoods appear to be major factors in excess mortality among African Americans.

Black or African American↗
PubMed2000

Elevated mortality rates from circulatory disease in African American men and women of Los Angeles County, California--a possible genetic susceptibility?

OBJECTIVE: Reports of higher mortality in African Americans have often focused on socioeconomic differences. Such differences do not explain the excess mortality in African Americans compared with Hispanics in Los Angeles County. We suggest the existence of genetic factors to explain at least some of the differences in mortality risk. METHODS: We compared the mortality rates from circulatory diseases in African American and Hispanic adults of Los Angeles County for 1988 to 1992 with the frequency of the angiotensin-converting enzyme (ACE) genotype. RESULTS: African American adults 45 to 74 years old had a 2-fold higher overall mortality rate than Hispanics. The largest differences were seen for hypertensive disease and cardiomyopathy in men; the most striking differences were seen in the youngest age group. Rates were lower in women than in men, but African American women also showed substantial excess compared with Hispanics. ACE genotype also showed a significant difference between the Hispanic and African American population; the latter had a significantly higher prevalence of the DD genotype, which is associated with a higher level of circulating enzyme, and lower prevalence of the II genotype, which is associated with a lower enzyme level. CONCLUSION: African American adults aged 45 to 74 years in Los Angeles County have a substantial excess mortality from hypertensive diseases compared with a similar Hispanic population. The frequency of the ACE DD genotype was higher in African Americans than in Hispanics. These studies may indirectly support the possibility of a genetic contribution to the excess hypertensive disease mortality in African Americans.

Aged↗
PubMed2001

Excess male mortality at the productive age in Poland at the end of the 20th century.

In the last decades of the 20th century there was observed a continuous increase in mortality rates of men at the productive age, which still causes enormous economic and social problems. Thus the aim of the paper is the analysis of the causes of excess death rates in men at the productive age in Poland. There were gathered demographic data collected by the Main Statistical Office (GUS) concerning Polish society as well as available epidemiological data related to the state of health of male population in Poland. The mortality rates referring to Polish males were analysed in several age groups. It was observed that the main causes of excess male mortality in Poland were cardiovascular diseases, neoplasms as well as trauma and accidents, which is consistent with the trends in the whole population. The mortality rates from ischaemic heart disease and pulmonary cancer have doubled in the years 1970-1990. However, in the last years of the 20th century there is perceived a decreasing trend in mortality of men at the productive age. The maintenance of this trend will be very profitable for the Polish society in the new millennium.

Adult↗
PubMed2000

Mortality in a population with long-term exposure to inorganic selenium via drinking water.

We analyzed the 1986-1997 mortality in a cohort of 2065 residents of an Italian municipality which had been exposed to drinking water with a high content of inorganic selenium over a long period of time, and compared it with mortality in the remainder of the municipal population. Mortality from malignant neoplasms increased [standardized mortality ratio (SMR) 1.17, 95% confidence interval (CI) 0.96-1.42], mainly due to an excess mortality from melanoma and colorectal cancer in both sexes, kidney cancer in men, and lymphoid malignancies in women. Overall cardiovascular mortality changed little (SMR 1.05, 95% CI 0.89-1.23), despite the higher cerebrovascular mortality (SMR 1.43, 95% CI 1.03-1.93). Coronary disease mortality slightly decreased (SMR 0.87, 95% CI 0.63-1.16), due to a low mortality among women. We also noted an excess mortality from Parkinson's disease in men and from motor neuron disease in women. Evaluation of these findings is, however, hampered by the lack of information about potential lifestyle confounders, the fact that the exposure could only be characterized by a simple dichotomization, and the inconsistencies of most estimates between the two sexes.

Adult↗
PubMed2001

Historical cohort study of US man-made vitreous fiber production workers: I. 1992 fiberglass cohort follow-up: initial findings.

This 1986 to 1992 update and expansion of an earlier historical cohort study examined the 1946 to 1992 mortality experience of 32,110 workers employed for 1 year or more during 1945 to 1978 at any of 10 US fiberglass (FG) manufacturing plants. Included are (1) a new historical exposure reconstruction for respirable glass fibers and several co-exposures (arsenic, asbestos, asphalt, epoxy, formaldehyde, polycyclic aromatic hydrocarbons, phenolics, silica, styrene, and urea); and (2) a nested, matched case-control study of 631 respiratory system cancer (RSC) deaths in male workers during 1970 to 1992 with interview data on tobacco smoking history. Our findings to date from external comparisons based on standardized mortality ratios (SMRs) in the cohort study provide no evidence of excess mortality risk from all causes combined, all cancers combined, and non-malignant respiratory disease. Also, excluding RSC, we observed no evidence of excess mortality risk from any of the other cause-of-death categories considered. For RSC among the total cohort, we observed a 6% excess (P = 0.05) based on 874 deaths. Among long-term workers (5 or more years of employment) we observed a not statistically significant 3% excess based on 496 deaths. Among the total cohort, we observed increases in RSC SMRs with calendar time and time since first employment, but these were less pronounced among long-term workers. RSC SMRs were not related to duration of employment among the total cohort or long-term workers. In an externally controlled analysis of male workers at risk between 1970 and 1992, we observed no association between RSC SMRs and increasing exposure to respirable FG. Our findings to date from internal comparisons based on rate ratios in the case-control study of RSC were limited to analyses of categorized study variables with and without adjustment for smoking. On the basis of these analyses, the duration of exposure and cumulative exposure to respirable FG at the levels encountered at the study plants did not appear to be associated with an increased risk of RSC. RSC risk also did not seem to increase with time since first employment. There is some evidence of elevated RSC risk associated with non-baseline levels of average intensity of exposure to respirable glass, but when adjusted for smoking this was not statistically significant, and there was no apparent trend with increasing exposure. This same pattern of findings was observed for duration of exposure, cumulative exposure, and average intensity of exposure to formaldehyde. None of the other individual co-exposures encountered in the study plants appeared to be associated with an increased risk of RSC. The primary focus of ongoing analyses is to determine the extent to which our present findings are robust to alternative characterizations of exposure.

Adult↗
PubMed1996

Nutritional status and delayed mortality following early exposure to measles.

Community studies in Guinea-Bissau have found that exposure to measles prior to 6 months of age is associated with delayed mortality later in childhood. In an attempt to understand the underlying mechanism, we examined the role of pre-exposure nutritional status and the impact of exposure to measles on growth and subsequent mortality in these outbreaks. Though exposed children were lighter than controls, there was no association between pre-exposure weight-for-age and subsequent mortality adjusting for age. Although exposure was strongly associated with excess mortality, it did not have a negative impact on growth. Adjustment for state of nutrition did not alter the mortality ratio (MR) between 6 and 59 months of age for exposed children and controls; exposed children examined anthropometrically between 6-17 months had a MR of 3.70 compared with controls. This trend was the same for anthropometric measurements obtained at 18-59 months of age. Among the controls, there was a significant association between weight-for-age and subsequent mortality to the age of 5 years. However, for exposed children there was no association; the relation between weight-for-age and subsequent mortality was significantly different for exposed children compared with controls (tests for interaction between exposure and anthropometric measurements at 6-17 months: P = 0.05). Growth faltering as a consequence of early exposure to measles does not explain the marked excess mortality among these children. Further studies of the process underlying delayed mortality after early exposure to measles are warranted.

Anthropometry↗
PubMed2006

High bone turnover is an independent predictor of mortality in the frail elderly.

UNLABELLED: Osteoporotic fractures are associated with accelerated bone turnover and excess mortality. In a prospective study of 1112 frail subjects (79% female; mean age, 86 years), high bone turnover was an independent predictor of all-cause mortality. This association seemed to be mainly manifested in deaths from cardiovascular causes. INTRODUCTION: Osteoporotic fractures are associated with accelerated bone turnover and excess mortality. In a prospective cohort study of elderly men and women, we assessed whether the rate of bone turnover measured by markers of bone remodeling is a direct predictor of mortality. MATERIALS AND METHODS: We measured serum concentrations of the aminoterminal propeptide of type I collagen (PINP), a marker of bone formation, and of the carboxyterminal telopeptide of type I collagen (CTX-I), a marker of bone resorption, along with serum PTH and 25-hydroxyvitamin D [25(OH)D] levels in 1112 subjects (79% female; mean age, 86 years) living in residential care. Co-morbidity was measured using the Implicit Illness Severity Scale. Fracture data were validated by a radiology report. Mortality and causes of death were ascertained from death certificates. RESULTS: Over a median follow-up of 817 days, 559 (50.3%) subjects died. In univariate analyses, time to death from all causes was significantly (p < 0.01) associated with age (HR = 1.62 per 10 years), male sex (HR = 1.33), immobility (HR = 1.94), co-morbidity (HR = 0.31, mild versus severe), lower weight (HR = 0.83 per 10-kg increase), impaired cognitive function (HR = 2.14, severe versus normal), number of medications (HR = 1.05 each), hip fracture (HR = 2.26), log serum creatinine (HR = 1.67), log PTH (HR = 1.29), CTX-I (HR = 1.70, highest 25% versus lowest 75%), and PINP (HR = 1.46, highest 25% versus lowest 75%). In multivariate analysis adjusting for age, sex, immobility, co-morbidity, weight, cognitive function, number of medications, PTH, and hip fracture status, the highest quartile was significantly more likely to die than the rest for both serum CTX-I (HR = 1.39; 95% CI: 1.14-1.70; p = 0.002) and PINP (HR = 1.25; 95% CI: 1.02-1.52; p = 0.03). For individual causes of death, CTX-I was significantly associated with deaths from cardiac causes (HR = 1.78: 95% CI: 1.27-2.50; p < 0.001). CONCLUSIONS: We conclude that in the frail elderly, high bone turnover is associated with all cause mortality independently of age, sex, health status, serum PTH levels, and hip fracture status. The mechanism of the effect of bone turnover on mortality seems to be mainly manifested in deaths from cardiovascular causes.

Aged↗
PubMed1996

Patterns of mortality in second generation Irish living in England and Wales: longitudinal study.

OBJECTIVE: To examine the mortality of second generation Irish living in England and Wales. DESIGN: Longitudinal study of 1% of the population of England and Wales (longitudinal study by the Office of Population Censuses and Surveys (now the Office for National Statistics)) followed up from 1971 to 1989. SUBJECTS: 3075 men and 3233 women aged 15 and over in 1971. MAIN OUTCOME MEASURES: Age and sex specific standardised mortality ratios for all causes, cancers, coronary heart disease, cerebrovascular diseases, respiratory diseases, and injuries and poisonings. Deaths were also analysed by socioeconomic indicators. RESULTS: 786 deaths were traced to men and 762 to women. At working ages (men, aged 15-64; women, 15-59) the mortality of men (standardised mortality ratio 126) and women (129) was significantly higher than that of all men and all women. At ages 15-44, relative disadvantages were even greater both for men (145) and for women (164). Mortality was raised for most major causes of death. Significant excess mortality from cancers was seen for men of working age (132) and for women aged 60 and over (122). At working ages mortality of the second generation Irish in every social class and in the categories of car access and housing tenure was higher than that of all men and all women in the corresponding categories. Adjusting for these socioeconomic indicators did not explain the excess mortality. CONCLUSION: Mortality of second generation Irish men and women was higher than that of all men and all women and for most major causes of death. While socioeconomic factors remain important, cultural and lifestyle factors are likely to contribute to this adverse mortality.

Adolescent↗
PubMed1992

Long-term survival of 1986 patients with intracranial meningioma diagnosed from 1953 to 1984 in Finland. Comparison of the observed and expected survival rates in a population-based series.

Intracranial meningioma was diagnosed and histologically verified in 1986 patients, 597 men and 1389 women, between 1953 and 1984 in Finland. The closing date of this survival study was December 31, 1987, and the follow-up was complete. Meningiomas, usually slowly growing and surgically curable benign tumors, caused considerable short-term mortality, with a relative survival rate (RSR) of 83% at 1 year, and slight but continual long-term mortality, with RSR of 71% at 15 years. From 1979 to 1984, when computed tomography (CT) was available, the mortality at 3 months for the patients who had surgical procedures was 2% in those younger than 45 years and 10% in those older than 64 years; patients who did not have operations had 1-year mortality of 61%. The short-term and long-term excess mortalities are associated significantly with old age, no surgical procedure, and the period of diagnosis; the long-term excess mortality also is associated with male gender.

Adolescent↗
PubMed2003

Cardiovascular disease mortality.

Although mortality from cardiovascular diseases (CVDs) has been declining, it remains the leading cause of death among urban U.S. blacks. McCord and Freeman reported CVD as the major contributor to excess mortality in Central Harlem. However the disease-specific CVD mortality was not assessed. Thus, it was unclear what the distribution of specific CVDs was in Central Harlem and their contribution to excess mortality. We reviewed the vital statistics records of New York City (NYC) Department of Health for 1990 and identified all cases in which the cause of death was coded as cardiovascular (International Classification of Diseases-ICD, 9th Revision, codes 391, 393-398, 401-404, 410, 411, 414-417, 420-438 and 440-444). The total and disease-specific CVD mortality for NYC and Central Harlem were calculated using the appropriate 1990 census data as the denominator. Central Harlem residents aged between 25-64 years were at least twice as likely to die from cardiovascular causes, compared to NYC residents. Hypertension-related deaths, ICD codes 401 (essential hypertension), 402 (hypertensive heart disease), 403 (hypertensive renal disease), and 404 (hypertensive heart and renal disease), were the major cause of excess death for men and women in Central Harlem. These findings show the importance of hypertension as the main determinant of the excess cardiovascular mortality in urban blacks and suggest an increased risk of cardiovascular death in blacks residing in Central Harlem.

Adult↗
PubMed2005

All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age.

The objective of this study was to assess whether an increasing severity of sleep apnoea is associated with increased all-cause mortality hazards and to assess whether the syndrome is associated with excess mortality, in comparison with the general population. Participants included 14,589 adult males, aged 20-93 yrs, referred to the sleep clinics with suspected sleep apnoea or diagnosed with sleep apnoea. Altogether, 372 deaths were recorded after a median follow-up of 4.6 yrs. The crude all-cause mortality rate was 5.55/1,000 patient yrs, increasing with apnoea severity. Cox proportional analysis revealed that both respiratory disturbance index (RDI) and body mass index significantly influenced all-cause mortality hazard but there was no interaction between them. Males with respiratory disturbance index >30 had a significantly higher mortality hazard rate than the reference group of males with RDI < or =10. Comparing mortality rates of males with moderate/severe sleep apnoea to the general population revealed that only males aged <50 yrs showed an excess mortality rate. The hazard of mortality in sleep apnoea increases with apnoea severity as indexed by respiratory disturbance index. Moderate and severe levels of sleep apnoea are moderately associated with an increased risk of all-cause mortality, in comparison with the general population, particularly in males aged <50 yrs. The lack of information about possible confounders and treatment effects should be taken into consideration in the interpretation of these results.

Adult↗
PubMed1988

Differential mortality among semiskilled applicants of disability pension.

The mortality experience among 4,440 applicants for disability pension has been examined during a period of observation of ten years. All applicants were males and had been member of the Danish Semiskilled Workers' Union. The reference group consists of age matched male members of the same union. The applicants for disability pension experienced a considerable excess mortality when compared with the reference group. The higher mortality risk is still present more than ten years after the application has been settled. The persons who were refused disability pension experienced an elevated mortality, too. In opposition to previous studies it is not found informative to put forward a common estimate of the elevated mortality rate because the group of disability applicants is very heterogeneous concerning their mortality experience; the excess mortality is most elevated among persons granted the high level pension, among the youngest, and during the period closest to the award.

Adult↗
PubMed2002

Mortality analysis in patients with atrial fibrillation and implantable permanent pacemaker after ablation of the atrioventricular node.

OBJECT: Atrial fibrillation is associated with excess mortality. This analysis was performed to determine the magnitude of the excess mortality risk. METHODS: Life table analysis of a published study of 350 patients undergoing radiofrequency ablation of the atrioventricular node and permanent pacemaker implantation for symptomatic paroxysmal or chronic atrial fibrillation. A substantial proportion of subjects had evidence of left ventricular dysfunction. RESULTS: In this cohort, compared to expected population mortality, the relative mortality ratio was 234% and the annual excess death rate was 46 deaths/1000.

Aged↗
PubMed1998

Mortality among tuberculosis patients in The Netherlands in the period 1993-1995.

This study aimed to estimate excess mortality among tuberculosis patients in The Netherlands and identify risk factors for tuberculosis-associated mortality. The national tuberculosis register provided data on patients diagnosed in the period 1993-1995. Excess mortality in tuberculosis cases, according to age and sex, was determined by comparison with national mortality rates. Risk factors were identified and adjustment for confounders was carried out using Cox's proportional hazard analysis. Of 4,340 patients alive at diagnosis, 258 died within 1 yr while on treatment. The Kaplan-Meier survival probability after 1 yr was 93%. Tuberculosis patients had a standardized mortality ratio of 8.3. Independent risk factors for mortality were: gender; age; presence of a malignancy or human immunodeficiency virus (HIV) infection; addiction to alcohol or drugs; localization of tuberculosis; and the type of medical officer having made the diagnosis. Of all deaths, 83% occurred in two risk groups comprising 21% of tuberculosis patients: those aged > or =65 yrs and those having HIV infection or a malignancy. Tuberculosis patients in The Netherlands are at a considerably increased risk of death. However, the prognosis is very good for those aged less than 65 yrs and without human immunodeficiency virus infection or a malignancy.

Adult↗
PubMed1984

Mortality experience in relation to tobacco chewing and smoking habits from a 10-year follow-up study in Ernakulam District, Kerala.

Mortality experience of a cohort of 10 287 individuals age 15 years and over selected by random sampling in Ernakulam district of Kerala was recorded in house-to-house surveys over a 10-year period. Mortality rates were analysed according to tobacco habits of chewing and smoking, taking-age and sex distribution into consideration. Tobacco chewing was practised most commonly by females and these females had significantly higher age-adjusted mortality rates than those who did not use tobacco (relative risk 1.3). Excess mortality among male bidi smokers (relative risk 1.5) was also significant and comparable to the excess mortality among cigarette smokers reported from Western countries.

Adolescent↗
PubMed2006

Differences in management of older women influence breast cancer survival: results from a population-based database in Sweden.

BACKGROUND: Several reports have shown that less aggressive patterns of diagnostic activity and care are provided to elderly breast carcinoma patients. We sought to investigate whether differences in the management of older women with breast cancer are associated with survival. METHODS AND FINDINGS: In an observational study using a population-based clinical breast cancer register of one health-care region in Sweden, we identified 9,059 women aged 50-84 y diagnosed with primary breast cancer between 1992 and 2002. The 5-y relative survival ratio was estimated for patients classified by age group, diagnostic activity, tumor characteristics, and treatment. The 5-y relative survival for breast cancer patients was lower (up to 13%) in women 70-84 y of age compared to women aged 50-69 y, and the difference was most pronounced in stage IIB-III and in the unstaged. Significant differences in disease management were found, as older women had larger tumors, had fewer nodes examined, and did not receive treatment by radiotherapy or by chemotherapy as often as the younger women. Adjustment for diagnostic activity, tumor characteristics, and treatment diminished the relative excess mortality in stages III and in the unstaged, whereas the excess mortality was only marginally affected in stage IIB. CONCLUSIONS: Less diagnostic activity, less aggressive treatment, and later diagnosis in older women are associated with poorer survival. The large differences in treatment of older women are difficult to explain by co-morbidity alone.

Age Distribution↗
PubMed1990

[Analysis of mortality among the population of productive age in Poland. I. Mortality among men and women and the higher mortality rate among men of productive age in Poland 1951-1985].

The paper presents the results of this study on mortality rate during the period of 1951-1985 for men and women aged 20-64. Moreover, the differences between male and female mortalities were analysed with a view of investigating the problem of excessive mortality ratio of men. In the period under study the descending and then ascending tendency of the mortality rate could be observed both in the male and female populations. Up to 1965 male mortality decreased gradually (by 35%) whereas the following years witnessed considerable rise of the level of male mortality (by 30% to 1985), which referred especially to males at the age range between 40 and 49, years. As regards the female population the mortality rate was decreasing till 1975. For the last 10 years increased female mortality has been observed, however, their dynamics is much more lower than that for the female group (by 6.2% less than for 1975). During the whole period examined i.e. 1951-1985 the excessive mortality ratio in men was found to be higher by 60.4%. High dynamics of the ratio concerned male population at lower age ranges.

Adult↗