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PubMed1978

The quality of life of the dentist.

That elusive concept 'quality of life', which has become a topic of increasing concern in this day among members of the dental profession, has been examined in the light of findings in the behavioral sciences and those of the medical sciences, particularly morbidity and mortality studies. A review of the literature reveals too few studies in the behavioral sciences; and those that do address the problem do so obliquely. Findings from morbidity studies are controvertible. One recent large-scale study of mortality identified no excess mortality from particular causes among United States white male dentists as a group--this included the much often talked about 'excess of suicide'. The position maintained is that the quality of life of the dentist is good relative to other professions or labors in the absence of 'hard' data to the contrary. A plea is made for additional studies in the future and a continued and cooperative association of medical and behavioral scientists to monitor the 'total health' of the profession.

Aged↗

PubMed1987

History of black mortality and health before 1940.

This article documents the history of black mortality between 1850 and 1940 and begins the process of placing that history into the context of the more general history of mortality decline in the United States. One aspect of this process has been to discuss the trends in mortality among blacks and whites living in the same general geographic areas--for example, comparing southern rural blacks with southern rural whites. A second part has been to relate black mortality to many of the factors that have been discussed as determinants of general mortality trends--such as water and sanitation, the urban disadvantage in mortality, and child care and feeding practices. During the second half of the nineteenth century, black mortality declined only slightly or not at all. Between 1850 and 1880 there may have been some decline in child mortality, but the trends in adult mortality are indeterminate. Between 1880 and 1900 both child and adult mortality rates were constant. Sometime between 1900 and 1910 mortality rates among blacks began to decline at all ages, especially in urban areas. During the first four decades of this century mortality rates among American blacks declined substantially. Expectation of life at birth increased from about 35 years to about 54 years, which represents a significant improvement in health and living standards. The life expectancy among blacks in 1940, however, was still two years below the value for whites in the death registration area in 1920. (This may exaggerate the difference slightly since the mortality rates for 1919 and 1920 were artificially low following the pandemic of influenza in 1918. In addition, the mortality rates in the DRA may not have been representative of the whole white population.) Throughout the period studied, blacks had substantially higher mortality rates than whites living in the same area. Although the amount of excessive mortality among blacks differed from place to place and period to period, we did not find a single area or time when black mortality rates were close to those of whites. The examination of causes of death among whites and blacks in 1920 showed that racial differences in the amount of tuberculosis explained a substantial part of the mortality differences in New York and North Carolina, but blacks probably had excessive mortality due to all causes.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗

PubMed1989

Determinants of head injury mortality: importance of the low risk patient.

Data were obtained prospectively for 7,912 head-injured patients admitted from 1980 to 1981 to 41 hospitals in 3 U.S. metropolitan areas. Highly significant independent predictors of mortality were motor score, number of reactive eyes, systolic blood pressure, abdominal injury, chest injury, age, and hospital unit (hospital or group of hospitals). The difference between the number of deaths observed and the number expected, by hospital unit, ranged from 43% below expectation to 52% above expectation. The 2 hospital units with the lowest mortality had only 1 death, where 9.4 would be expected, in patients whose risk of death was estimated to be less than 10%. In the single hospital with clearly excess mortality, however, the standardized mortality ratios were 208, 135, and 144% for the risk groups whose probabilities of death were 0 to 50, 50 to 80, and 80 to 100%, respectively. The lack of deaths in those hospitals with the best mortality experience and the excess mortality in the hospital with the worst mortality experience appear to be explained largely by differences in patients who, by clinical criteria, seem to be at low risk for death, and not by severely injured patients.

Adolescent↗

PubMed1999

Mortality among workers in the geothermal power plants at Larderello, Italy.

BACKGROUND: Since the early 1990s various European electricity companies have set up a research program, named EURELEX, devoted to the development of a comprehensive and validated title-occupation--job-exposure matrix (i.e., an instrument to assess exposures from occupations and jobs), in order to estimate and quantify past exposure to a number of potentially carcinogenic agents plus a few selected other toxic substances. The EURELEX program was first applied in Italy to a cohort of geothermal workers in Larderello, Tuscany. METHODS: The cohort mortality study comprised 4,237 men who had worked at the geothermal power plant between 1950 and 1990. Vital status and death certificates were obtained from registration offices in the municipality of birth or death. Particular attention was paid to neoplastic effects of exposure to asbestos, largely used in the past for pipeline insulating purposes. The matrix allowed the workers to be subdivided into several categories according to estimated absestos exposure. Smoking information was not available. RESULTS: No excess mortality was found for all causes and total cancer mortality. A small excess of pleural cancer (2 obs. vs. 1.4 exp.) was not statistically significant. The effect of other agents included in the matrix was also examined: the small excess of leukemia among those exposed to solvents prior to 1963 (year of benzene ban in Italy) did not reach the level of statistical significance. No cases of leukemia were found among the workers presumed to have been exposed to important ELF electromagnetic fields. CONCLUSION: The study provides reassuring information on a large cohort of a unique geothermal power plant since no significant excess mortality for asbestos related cancers was observed. Furthermore, it represents a useful application and validation of a comprehensive job-exposure matrix for the electric industry in Europe.

Asbestos↗

PubMed2004

Increased mortality in depressive disorders: a review.

Several factors have been proposed to explain the relationship between excess mortality and depressive disorders. These include mechanisms such as increased suicide rates, hazardous health behavior (smoking, alcohol use, unhealthy eating), psychologic reactions to developing a medical illness, biological dysregulations (hyperactivity of the hypothalamic pituitary adrenal, neuro-immune dysregulation, sympathoadrenergic dysregulation), and noncompliance with medical treatment. The evidence supporting the role of each of these mechanisms in excess mortality varies considerably. The causal direction in most of the mechanisms is not clear. It is possible that the explanatory factors, such as smoking, compliance, or biological mechanisms, cause depression, or that depression causes these factors, or that both are explained by a third, underlying factor. We will summarize the evidence supporting these mechanisms, and propose options for possible interventions aimed at reducing the increased risk of dying.

Chronic Disease↗

PubMed1990

Elevated mortality following transurethral resection of the prostate for benign hypertrophy! But why?

This paper reevaluates the recently reported excess mortality following transurethral resection of the prostate (TURP) for benign hypertrophy as compared with traditional open resection (OPEN). We studied survival through linkage of hospital discharge data with mortality data for the entire male population of Denmark (1977-85). For a maximum of 10.5 years 38,067 prostatectomy patients were followed. Adjusting for age and health status before surgery, TURP patients were subject to significantly higher levels of mortality than OPEN patients (RR = 1.19, 95% confidence interval (1.15-1.24). The extent to which this difference is attributable to the surgical intervention itself remains an open question. The two groups of patients are quite different with regard to age and preoperative health status, and available data may not be sufficient to control such differences through statistical analysis. On the other hand, the difference in mortality persisted over calendar time, even during periods when the pattern of utilization for the two procedures changed significantly (constant RR = 1.19, adjusting for age and comorbidity). The most important causes of death among Danish TURP patients differ from the causes suggested on the basis of previously reported Canadian data. The current evidence is thus ambiguous with regard to hypothetical biologic mechanisms behind the excess mortality over TURP patients. Further investigations are needed to evaluate the safety and effectiveness of prostate surgery.

Aged↗

PubMed1977

Mortality among patients with ankylosing spondylitis not given X-ray therapy.

We investigated age-specific mortality rates of 836 patients with ankylosing spondylitis diagnosed during 1935-57. These patients were not given deep x-ray therapy, and thus their mortality was not confounded by possible late effects of radiation. Follow-up observation was to January 1, 1968--on the average, over 13 years from enrollment. Men had higher mortality than women; excess mortality was observed in men for diseases known to be associated with spondylitis, such as ulcerative colitis, nephritis and tuberculosis or other respiratory disease. In addition, their mortality risk relative to the general male population was fourfold for all gastrointestinal disease, nearly twofold for accidents, suicide and cerebrovascular disease and 40 per cent in excess for other circulatory diseases. These results indicate that, at least in men, ankylosing spondylitis has life-threatening consequences related to many organ systems, consistent with systemic vascular degeneration as one long-term consequence of the disease.

Female↗

PubMed2006

In a population-based prospective study, no association between high blood pressure and mortality after age 85 years.

OBJECTIVE: To study the impact of a history of hypertension and current blood pressure on mortality in the oldest old. DESIGN: An observational population-based cohort study. SETTING: Community city of Leiden, The Netherlands. PARTICIPANTS: Five hundred and ninety-nine inhabitants of the birth-cohort 1912-1914 were enrolled on their 85th birthday. There were no selection criteria related to health or demographic characteristics. INTERVENTIONS: The mean follow-up was 4.2 years. Medical histories were obtained from general practitioners. Medication histories were obtained from the participant's pharmacist. Blood pressure was measured twice at baseline. MAIN OUTCOME MEASURES: All cause and cardiovascular mortality. RESULTS: Five hundred and seventy-one participants were included, 39.2% had a history of hypertension. During follow-up 290 participants died, 119 due to cardiovascular causes. Compared to participants without a history of hypertension, those with a history of hypertension had increased mortality from cardiovascular causes [relative risk (RR) 1.60, confidence interval (CI) 1.06-2.40] but equal mortality from all causes (RR 1.19, CI 0.91-1.55). High blood pressure at baseline (age 85) was not a risk factor for mortality. Baseline blood pressure values below 140/70 mmHg (n = 48) were associated with excess mortality, predominantly in participants with a history of hypertension. CONCLUSION: In the oldest old, high blood pressure is not a risk factor for mortality, irrespective of a history of hypertension. Blood pressure values below 140/70 mmHg are associated with excess mortality.

Aged↗

PubMed1991

Mortality from cancer of the colon or rectum among workers exposed to ethyl acrylate and methyl methacrylate.

Mortality from colon and rectum cancer has been reviewed in three cohorts working in 1933-1982 in two plants manufacturing and polymerizing acrylate monomers. The two cohorts with later dates of hire showed no excess mortality. In the earliest cohort, excess colon cancer seemed restricted to men employed extensively in the early 1940s in jobs entailing the highest exposures to vapor-phase ethyl acrylate (EA) and methyl methacrylate (MMA) monomer and volatile by-products of the EA/MMA polymerization process. The excess mortality appeared only some two decades after the equivalent of three years' employment in jobs with the most intense exposures. A smaller elevation in colon cancer mortality also appeared in a low-exposure group in the early cohort. Rectal cancer mortality was elevated in the same categories that showed excess rates of colon cancer death. Because of the lower rates, the rectal cancer results are more imprecise.

Acrylates↗

PubMed1999

Mortality in treated heterozygous familial hypercholesterolaemia: implications for clinical management. Scientific Steering Committee on behalf of the Simon Broome Register Group.

Clinical management of heterozygous familial hypercholesterolaemia is largely based on evidence from a small number of observational studies and extrapolation from the results of clinical trials of lipid-lowering in patients with polygenic hypercholesterolaemia The objectives of this study were (i) to determine the absolute and relative mortality of patients with treated heterozygous familial hypercholesterolaemia, (ii) to estimate the effect of changes in treatment efficacy on mortality trends over time, and (iii) to examine the implications of these findings for patient management. A cohort of 605 men and 580 women aged 20-79 years with heterozyous familial hypercholesterolaemia were recruited from 21 out-patient lipid clinics in the UK. Patients were followed prospectively from 1980 to 1995 for 8770 person-years. Absolute mortality was calculated, and relative risk was expressed as the ratio of the number of observed deaths to the number expected in the general population of England and Wales. Forty six of the 73 deaths were due to coronary heart disease. In women aged 20-39, despite treatment, the relative risk of a fatal coronary event was increased 125-fold (95% confidence intervals 15-451) and the annual coronary mortality was 0.17%. In men aged 20-39 the relative risk was increased 48-fold (17-105) and the annual coronary mortality was 0.46%. The relative risk decreased with age but the absolute risk increased. For men and women aged 60-79, the annual coronary mortality was 1.1% representing a significant excess mortality for women (relative risk 2.6, 1.3-4.5) but not for men (RR 1.1, 0.5-2.3). Non-coronary mortality was not increased at any age (RR for all ages 0.68, 0.45-0.99). There was a decline in the relative risk for coronary mortality in patients aged 20-59 from an eight-fold (4.8-7.2) increased risk before 1992 to 3.7 (1.6-7.2.) thereafter (P=0.08). The results suggest that the prognosis for patients with heterozygous familial hypercholesterolaemia has improved with the introduction of more effective treatment, and that lipid-lowering therapy is not associated with increased non-coronary mortality. These findings and the excess coronary mortality observed suggest that all affected adult men and post-menopausal women should be treated with HMG-CoA reductase inhibitors.

Adult↗

PubMedDate not supplied

Social inequities in health: Rochester, New York.

This paper reports an investigation of social inequities in the distribution of low birth weight risks and mortality rates for Rochester, N.Y., a community reported to have relatively good access to medical care. The prevalence of low birth weight and no prenatal care were lower for each race/education group than those observed in comparable national data. Mortality rates were higher in the poorer areas for each sex, race, age group, and disease category. The excess mortality in the poorer areas declined significantly over the period studied for conditions amenable to medical care but not for conditions not amenable. In minorities, however, the excess mortality increased significantly for amenable conditions with no change for nonamenable conditions. The results are consistent with the hypothesis that the socially disadvantaged suffer an excess burden of morbidity and mortality. Access to medical care may make a significant contribution to reducing these inequities, but major barriers to equitable health and health care remain, particularly for minorities. This is an important but neglected area of concern for family medicine, and the implications are discussed.

Cross-Sectional Studies↗

PubMed1996

Causes of death associated with psychiatric illness.

BACKGROUND: A prospective cohort analysis of mortality, among entrants to a population-based psychiatric case register, was undertaken to identify specific causes of death responsible for the increased risk of mortality previously reported in this large group of unselected patients. METHODS: The analysis was based on a study population of 16,871 cases, aged 15-89 years, from Worcester and Kidderminster Health Districts, entering the case register between 1974 and 1984 and generating a total of 85,073 patient-years (PYR) of observation. The underlying cause of death was coded to the relevant revision of the International Classification of Diseases (ICD). Numbers of deaths observed in the study population were compared with the number of deaths expected on the basis of mortality rates for England and Wales. Comparisons were made for eight main causes of death, aggregated at Chapter level of the ICD, and 11 categories of psychiatric diagnoses. Two indices of mortality were used for evaluation: relative risk (RR) = observed deaths/expected deaths; and excess mortality rate (EMR) = (observed-expected deaths)/PYR. RESULTS: RRs were significantly raised for accidents, including suicides, as anticipated, and for various main causes of death. The increased risk of accidental death was found across the majority of the 11 psychiatric diagnostic groups although the EMRs were low at less than 5/1000 PYR. Deaths from respiratory disorders gave rise to the highest RRs after accidental deaths, and were responsible for substantial excess mortality among in-patients and patients with psychotic illnesses (especially dementia). The largest numbers of deaths of both sexes were due to diseases of the circulatory system, with a 40 per cent excess of observed over expected values in the whole series. The excess was due mainly to deaths of in-patients and of patients with psychotic diagnoses. No excess of deaths owing to neoplasms was found for either in-patients or out-patient groups. CONCLUSIONS: The findings that psychiatric illness is associated with an increased risk of death from "natural' causes and that the level of risk was related to the severity and to the diagnostic category of the illness have implications for patterns of care and use of resources.

Adolescent↗

PubMed2000

Mortality in two recent reports of clinical trials on patients with congestive heart failure compared with mortality in three previous clinical trials.

BACKGROUND: Several clinical trials of drug treatment of patients with congestive heart failure (CHF) have previously been reported as Mortality Abstracts in the Journal of Insurance Medicine. Results are presented here for two similar clinical trials reported in September 1999 and compared with the previous results. RESULTS: In a recent international multicenter clinical trial, excess mortality in terms of excess death rates (EDRs) was reduced from 195 per 1000 per year in the placebo group to 139 in the group treated with Spironolactone. There was no significant reduction in the Danish multicenter study of Dofetilide to convert the atrial fibrillation (AF) to a normal rhythm in the 25% of the CHF patients who had AF (EDR was 224 in the placebo group and 216 in the Dofetilide group). In both of these studies, there were more patients with severe CHF than in the previous studies and the EDR values were higher. Results from the Danish study by severity according to the New York Heart Association (NYHA) classification show a progressive increase in EDR from 173 in class 2 to 237 in class 3 to 392 in class 4. CONCLUSION: Excess mortality in symptomatic CHF is far outside the issue limits for individual life insurance, but these results are of potential utility for the underwriting of such cases for structured settlement annuities.

Aged↗

PubMed2006

Survival and mortality rates among Danes with MS.

Long-term survival and trends in overall and cause-specific excess mortality among people with MS have been studied using the Danish Multiple Sclerosis Registry, which contains information about all Danish MS patients since the mid-20th Century. A total of 4254 deaths among approximately 10,000 people with MS, representing more than 200,000 person-years of observation, have been analysed. Overall, mortality was almost three times higher and life expectancy 10 years less among people with MS than for the general population. However, excess mortality has declined significantly since 1950.

Denmark↗

PubMed1997

Breast cancer five-year survival, by New South Wales regions, 1980 to 1991.

Breast cancer five-year relative survival was calculated for 16 urban and rural regions in New South Wales (NSW) for cases incidents in 1980-1991. Survival analysis employed cancer registry data linked with the death register, and age- and period-matched regional mortality of NSW women. Proportional hazard regression analysis was used to compare excess mortality in breast cancer cases in each region. The effect of region was significant (P < 0.05) in analysis, after age and the follow-up variable (and their interaction) were adjusted for, although no region was significantly different from the referent group (chosen because of average relative five-year survival). When degree of spread and its interactions were entered into the model, the effect of region became nonsignificant. A significant linear trend (P < 0.05) in the adjusted relative risk for excess mortality in breast cancer cases was noted when regions were divided into quartiles based on socioeconomic status, with higher relative risk in low-socioeconomic-status groups; this effect also disappeared with adjustment for degree of spread at diagnosis. There was no general effect of rurality versus capital city or other metropolitan centres. This study demonstrates a small effect of region of residence and implied socioeconomic status on breast cancer survival in NSW women, but this becomes nonsignificant when the data are adjusted for degree of spread at diagnosis. This suggests that earlier diagnosis would be of benefit in reducing minor inequalities in breast cancer survival in NSW women.

Adult↗

PubMed1976

A cohort study on mortality from cancer and other causes among workers at a metal refinery.

A non-concurrent prospective study was made on deaths from cancer and other causes occurring among 2,675 male workers at a metal refinery from 1949 to 1971. The expected number of deaths computed by applying age- and cause-specific death rates of Japanese males to these workers was compared with the observed number of deaths. Among 839 copper smelters, significantly increased mortalities were noted for lung cancer (SMR = 1,189) and colon cancer, but nor for cancer of the stomach, liver (primary) and biliary passages, pancreas and skin or for leukemia, tuberculosis, cerebrovascular diseases, heart diseases and liver cirrhosis. A dose-response relationship was demonstrated between the mortality from lung cancer and the degree of exposure. A very high excess mortality from lung cancer (SMR = 2,500) was seen among copper smelters who were considered to have been most heavily exposed to arsenic or workers who had engaged in sintering and blast furnace operations for 15 years of more before 1949. The latent period of lung cancer was 37.6 years on average, and not related to level of exposure. Twenty-six of 29 deaths from lung cancer among copper smelters occurred after they had left the refinery. Other production workers and clerical workers showed no significant excess mortality from any kind of cancer.

Colonic Neoplasms↗

PubMed1981

Prognosis in cardiac pacing. A comparison between patients with atrioventricular block and sick sinus syndrome.

The prognosis of 64 patients with atrioventricular (AV) block among 128 consecutive patients, 65 males and 63 females, treated with permanent pacemakers, was compared with that of 56 patients with sick sinus syndrome (SSS) during a mean observation period of 32.5 months. A poor survival rate was found in patients with known coronary heart disease (CHD) compared to those with isolated conduction defect (ICD). Among patients with CHD, a higher mortality was found in patients with AV block than in those with SSS (58 vs. 24%). Likewise, among patients with ICD the mortality in AV block was higher than in SSS (31 vs. 15%). Regression analysis showed a mortality excess in AV block vs. SSS (p=0.02), males vs. females (p=0.04). The mortality excess in patients with CHD vs. ICD was significant (p=0.01). It is concluded that the increased mortality rate in patients with AV block is related to widespread myocardial damage, this being especially pronounced in patients with CHD.

Adult↗

PubMed1983

Mortality from cancer and other causes among workers at a metal refinery.

Hidden cases of occupational lung cancer among males were revealed by a case-control study in a town. The findings were confirmed by a prospective study on mortality among the employees of a metal refinery. It demonstrated not only a significantly increased mortality from lung cancer among copper smelters but also definite dose-response relationships between mortality from lung cancer and the degree of exposure. A very high excess mortality from lung cancer (0/E = 25.00) was observed among copper smelters who were considered to have been most heavily exposed to arsenic and/or other carcinogenic substances or workers who had been engaged in sintering and blast furnace operations for 15 years or more before 1949. The average latency period of lung cancer was 37.6 years, and unrelated to the level of exposure. Twenty-six of 29 deaths from lung cancer among copper smelters occurred after they had left the company. Other production workers and clerical workers showed no significant excess mortality from any kind of cancer.

Female↗