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PubMed1994

Excess mortality in general hospital patients with delirium: a 5-year follow-up of 519 patients seen in psychiatric consultation.

Mortality was determined in 519 patients with delirium who were seen in psychiatric consultation in two general hospitals. Among 419 patients with simple delirium (DSM-III: 293.00) in-hospital mortality was 26%. As compared to average hospital patients the age adjusted in-hospital excess mortality ratio varied from 6.2 for patients with malignancies to 2.1 for patients with motor system disease. After hospital discharge the 5-yr cumulative mortality was 51%. As compared to the general population excess mortality was noted in most, but not in all diagnostic subgroups. The age and sex adjusted excess mortality ratio varied from 14.1 for malignancies to 1.3 for motor system disease. The figures underline a general notion that delirium may be an indicator of disorders of grave prognosis, but mortality appears to depend more on the medical condition than on the presence of delirium.

Adolescent↗
PubMed1982

Excess mortality in panic disorder. A comparison with primary unipolar depression.

We located 113 former inpatients with panic disorder 35 years after index admission. According to age- and sex-specific Iowa population figures, patients with panic disorder had significant excess mortality due to death by unnatural causes. Other studies suggest that secondary depression and alcoholism may have had a role in these deaths. Men with panic disorder also exhibited excess mortality due to circulatory system disease. In an age- and sex-matched patient group with primary unipolar depression, both men and women showed excess mortality. Suicide accounted for 20.0% and 16.2% of deaths in the panic disorder and primary depression groups, respectively. We conclude that panic disorder accounted for much of the excess mortality formerly noted in the "neuroses."

Agoraphobia↗
PubMed1978

Excess mortality in schizophrenia and affective disorders. Do suicides and accidental deaths solely account for this excess?

Excess mortality was found in the first decade of follow-up for schizophrenia and affective disorders. This trend continued for schizophrenia throughout the entire four decades of the follow-up period. Suicides were higher than expected for all psychiatric groups except female schizophrenics and male manics. Accidental deaths were higher in these two groups, which did not show significantly excessive suicide rates. Suicides and accidental deaths were then excluded from the mortality analysis to determine their contribution to excess nortality. We conclude that death due to suicides and accidental deaths is not the sole cause for excess mortality, especially in schizophrenia.

Accidents↗
PubMedDate not supplied

Evidence for interaction between air pollution and high temperature in the causation of excess mortality.

Studies have demonstrated repeatedly that air pollution in Athens is associated with a small but statistically significant increase in mortality. Extremely high air temperatures can also cause excess mortality. This study investigated whether air pollution and air temperature have synergistic effects on excess mortality in Athens. Data concerning the increased number of deaths in July 1987 (when a major "heat wave" hit Greece) were compared to the deaths in July of the 6 previous years. This comparison revealed a greater increase in the number of deaths in Athens (97%), compared to all other urban areas (33%) and to all non-urban areas (27%). Data on the daily levels of smoke, sulfur dioxide, and ozone; the number of deaths that occurred daily; and meteorological variables were collected for a 5-y period. The daily value of Thom's discomfort index was calculated. Multiple linear regression models were used to investigate main and interactive effects of air temperature and Thom's discomfort index and air pollution indices. The daily number of deaths increased by more than 40 when the mean 24-h air temperature exceeded 30 degrees C. The main effects of an air pollution index are not statistically significant, but the interaction between high levels of air pollution and high temperature (> or = 30 degrees C) are statistically significant (p < .05) for sulfur dioxide and are suggestive (p < .20) for ozone and smoke. Similar results were obtained when the discomfort index was used, instead of temperature in the models.

Air Pollutants↗
PubMed1989

Excess mortality ratio with reference to the lowest age-sex-specific death rates among countries.

Indicators based on mortality data have long been used to measure the level of health status and to monitor and evaluate the progress and achievements of health programmes. Their usefulness is particularly obvious when dealing with preventable deaths. This article proposes the use of the lowest death rate recorded among industrialized countries for each age/sex group as an achievable target and as a reference for assessing the amount of excess mortality. The resulting indicator, excess mortality ratio (EMR), reveals some features of the mortality pattern which may not be easily noticed by means of other mortality indicators. Two sets of the lowest age-sex-specific death rates are considered, namely one comprising the lowest rates recorded in each calendar year (the current minimum) and the other comprising the lowest rates ever recorded since 1950 (the historical minimum). The former may be used for monitoring whether a country is moving ahead in mortality reduction in pace with low mortality countries, while the latter may be considered as a realistic goal for a country's mortality reduction. In computing the EMR, the lowest death rates are first applied to the age-sex composition of the population of a given country for a given calendar year to obtain the number of deaths which would have been expected under the lowest mortality pattern; the expected number is then subtracted from the actual number of deaths recorded in the country during the calendar year to yield the "excess". The indicator is finally calculated by taking the ratio of the excess to the expected minimum. The historical minimum death rates found from the records maintained in WHO's mortality data base are shown in Table 2 (for country codes used, see Table 1). The minimum rates have themselves declined with time as seen in Table 4, especially in young age groups, and the declining trend has been more marked in females. These trends are seen also in individual countries' data (Table 3). A comparison of the cause-of-death pattern of a country with that of the world's lowest death rate will reveal the causes to which the country's excess mortality is attributable, as seen in Table 5. At the same time, the table also shows that even the lowest rates are made up of causes which are largely preventable. The world's lowest rate therefore may be regarded as conservative targets for mortality reduction.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Coronary risk factors and excess mortality from all causes and specific causes.

Data from two Italian rural cohorts of the Seven Countries Study are used to examine the relationship between level at entry to the study of some coronary risk factors and subsequent mortality. The target follow-up period of 15 years after entry to the study is complete. Causes of death are classified according to standard criteria and age-adjusted rates are calculated. The analysis shows that blood pressure and smoking are risk factors that explain a substantial amount of total mortality, whereas serum cholesterol seems to be a specific risk factor for coronary mortality. The excess risks of death attributable to blood pressure, smoking, serum cholesterol and also the estimated risk of death are reported.

Adult↗
PubMed2001

Quality of medical care and excess mortality in older patients with mental disorders.

BACKGROUND: This study investigated whether differences in quality of medical care might explain a portion of the excess mortality associated with mental disorders in the year after myocardial infarction. METHODS: This study examined a national cohort of 88 241 Medicare patients 65 years and older who were hospitalized for clinically confirmed acute myocardial infarction. Proportional hazard models compared the association between mental disorders and mortality before and after adjusting 5 established quality indicators: reperfusion, aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and smoking cessation counseling. All models adjusted for eligibility for each procedure, demographic characteristics, cardiac risk factors and history, admission characteristics, left ventricular function, hospital characteristics, and regional factors. RESULTS: After adjusting for the potential confounding factors, presence of any mental disorder was associated with a 19% increase in 1-year risk of mortality (hazard ratios [HR], 1.19; 95% confidence interval [CI], 1.04-1.36). After adding the 5 quality measures to the model, the association was no longer significant (HR, 1.10; 95% CI, 0.96-1.26). Similarly, while schizophrenia (HR, 1.34; 95% CI, 1.01-1.67) and major affective disorders (HR, 1.11; 95% CI, 1.02-1.20) were each initially associated with increased mortality, after adding the quality variables, neither schizophrenia (HR, 1.23; 95% CI, 0.86-1.60) nor major affective disorder (HR, 1.05; 95% CI, 0.87-1.23) remained a significant predictor. CONCLUSIONS: Deficits in quality of medical care seemed to explain a substantial portion of the excess mortality experienced by patients with mental disorders after myocardial infarction. The study suggests the potential importance of improving these patients' medical care as a step toward reducing their excess mortality.

Adrenergic beta-Antagonists↗
PubMed2004

[Excess mortality in people over 65 years old during summer heat waves in Marseille. Comparison before and after a preventive campaign].

INTRODUCTION: High temperatures induce excess mortality in the population, even in our country. The 1983 heat wave in Marseille led to the development of warning messages in a preventive campaign since 1984. OBJECTIVE: To compare mortality of people over 65 years old during summer heat waves before and after a campaign in Marseille. METHOD: The INSEE mortality data were analysed according to the mean temperatures supplied by the National Meteorological Office from 1968 to 1997. A mortality index was developed to limit the effect of the progression in mortality over the last 30 years. The heat wave was defined as a temperature >or=26 degrees C lasting for 2 days during the months of June to August. RESULTS: The mean summer temperature in Marseille has increased from 22 to 23 degrees C in 30 years. The number of days of heat wave has also increased during this period. The mean index of daily excess mortality has dropped from 3.27 (1968-82) to 1.32 (1984-97) (p=0.008). CONCLUSION: The effects of global warming have been noted in Marseilles over the last 30 years. There has been no disappearance in excess mortality, but the warning messages appear to have been partially effective, even if other factors may have intervened (air-conditioning...). This prevention, like that for the risks related to air pollution, should be generalized because it is inexpensive, although assessment of its efficacy is difficult.

Aged↗
PubMed2003

The components of excess mortality after hip fracture.

A high excess mortality is well described after hip fracture. Deaths are in part related to comorbidity and in part due directly or indirectly to the hip fracture event itself (causally related deaths). The aim of this study was to examine the quantum and pattern of mortality following hip fracture. We studied 160,000 hip fractures in men and women aged 50 years or more, in 28.8 million person-years from the patient register of Sweden, using Poisson models applied to hip fracture patients and the general population. At all ages the risk of death was markedly increased compared with population values immediately after the event. Mortality subsequently decreased over a period of 6 months, but thereafter remained higher than that of the general population. The latter function was assumed to account for deaths related to comorbidity and the residuum assumed to be due to the hip fracture. Causally related deaths comprised 17-32% of all deaths associated with hip fracture (depending on age) and accounted for more than 1.5% of all deaths in the population aged 50 years or more. Hip fracture was a more common cause for mortality than pancreatic or stomach cancer. Thus, interventions that decreased hip fracture rate by, say, 50% would avoid 0.75% or more of all deaths.

Aged↗
PubMed2001

Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study.

OBJECTIVES: To establish the age and sex specific mortality for people with diabetes in comparison with local and national background populations; to investigate the relationship between mortality and material deprivation in an unselected population with diabetes. DESIGN: Longitudinal study, using a population based district diabetes register. SETTING: South Tees, United Kingdom. PARTICIPANTS: All people known to have diabetes living in Middlesbrough and Redcar and Cleveland local authorities on 1 January 1994. MAIN OUTCOME MEASURE: Death, from any cause, between 1 January 1994 and 31 December 1999. RESULTS: Over the six years of the study 1205 (24.9%) of 4842 participants died. All cause standardised mortality ratios for type 1 diabetes were 641 (95% confidence interval 406 to 962) in women and 294 (200 to 418) in men, and those for type 2 diabetes were 160 (147 to 174) in women and 141 (130 to 152) in men. Cause specific standardised mortality ratios were increased for ischaemic heart disease, cerebrovascular disease, and renal disease; no reductions in mortality from other causes were seen. The risk of premature death increased significantly with increasing material deprivation (P<0.001). CONCLUSIONS: Diabetes is associated with excess mortality, even in an area with high background death rates from cardiovascular disease. This excess mortality is evident in all age groups, most pronounced in young people with type 1 diabetes, and exacerbated by material deprivation. Aggressive approaches to the management of cardiovascular risk factors could reduce the excess mortality in people with diabetes.

Adolescent↗
PubMed1991

Excess mortality in critically ill patients with nosocomial bloodstream infections.

To determine the excess mortality attributable to hospital-acquired bloodstream infections, we applied the acute physiology and chronic health evaluation (APACHE) II classification to 34 critically ill patients with this complication. The study included primary bloodstream infections, defined by a positive blood culture at least three days after hospitalization, in the absence of any other apparent source of infection. The most frequent blood isolates included Staphylococcus aureus (39 percent), Gram-negative rods (24 percent), and Candida albicans (15 percent); the spectrum of blood isolates suggested that most infections were related to intravascular catheters. In a control group of intensive care unit patients (n = 384), the death rate predicted by APACHE II was similar to the observed death rate (35.3 vs 37.8 percent). In a subgroup of control patients (n = 34), chosen for APACHE II scores that matched the patients with bloodstream infections, predicted and observed death rates were also similar (53.1 vs 52.9 percent). For patients with bloodstream infections, however, observed mortality (82.4 percent) significantly exceeded the predicted value (54.1 percent, p = 0.025). We conclude that critically ill patients who develop nosocomial bloodstream infections are at greater risk of death than patients with comparable severity of illness without this complication. The difference between the observed and predicted death rates, 28 percent, represents the excess mortality associated with bloodstream infection in critically ill patients.

Adult↗
PubMed2006

Excess mortality related to the August 2003 heat wave in France.

OBJECTIVES: From August 1st to 20th, 2003, the mean maximum temperature in France exceeded the seasonal norm by 11-12 degrees C on nine consecutive days. A major increase in mortality was then observed, which main epidemiological features are described herein. METHODS: The number of deaths observed from August to November 2003 in France was compared to those expected on the basis of the mortality rates observed from 2000 to 2002 and the 2003 population estimates. RESULTS: From August 1st to 20th, 2003, 15,000 excess deaths were observed. From 35 years age, the excess mortality was marked and increased with age. It was 15% higher in women than in men of comparable age as of age 45 years. Excess mortality at home and in retirement institutions was greater than that in hospitals. The mortality of widowed, single and divorced subjects was greater than that of married people. Deaths directly related to heat, heatstroke, hyperthermia and dehydration increased massively. Cardiovascular diseases, ill-defined morbid disorders, respiratory diseases and nervous system diseases also markedly contributed to the excess mortality. The geographic variations in mortality showed a clear age-dependent relationship with the number of very hot days. No harvesting effect was observed. CONCLUSIONS: Heat waves must be considered as a threat to European populations living in climates that are currently temperate. While the elderly and people living alone are particularly vulnerable to heat waves, no segment of the population may be considered protected from the risks associated with heat waves.

Adolescent↗
PubMed1988

A preliminary study of excess mortality using a psychiatric case register.

Systematic screening of death certificates referable to residents of two health districts covered by a psychiatric case register allows the study of excess mortality in unselected psychiatric patients from a defined area of known population. Deaths among the case register patients exceeded those expected by 80%; the relative risk was maximal during the first year after registration and was significantly raised in both sexes and in patients of all age-groups. Patients may be selected by service use and by diagnostic group: the excess mortality of "inpatients" both in relative and absolute terms exceeded that of "outpatients". For dementia patients both the relative risk and more notably the absolute risk was high, and the excess mortality was significantly raised in both sexes and all age-groups. It was again greatest during the first year after registration. Deaths of patients with schizophrenia and paranoid psychosis exceeded those expected by 40 per cent and the excess was limited to the first year after registration and occurred predominantly among men.

Adolescent↗
PubMed1998

Investigation by Parkinson's Disease Research Group of United Kingdom into excess mortality seen with combined levodopa and selegiline treatment in patients with early, mild Parkinson's disease: further results of randomised trial and confidential inquiry.

OBJECTIVE: To determine whether the excess mortality observed in patients who received both levodopa and selegiline in a randomised trial could be explained by revised diagnosis of Parkinson's disease, autonomic or cardiovascular effects, more rapid disease progression, or drug interactions. DESIGN: Open randomised trial and blind comparison and reclassification of the cause of death of patients who were recruited from 93 hospitals between 1985 and 1990 and who had died before December 1993 in arms 1 and 2. SETTING: United Kingdom. SUBJECTS: 624 patients with early Parkinson's disease who were not receiving dopaminergic treatment and a subgroup fo 120 patients who died during the trial. INTERVENTIONS: Levodopa and a dopa carboxylase inhibitor (arm 1), levodopa and a dopa decarboxylase inhibitor in combination with selegiline (arm 2), or bromocriptine alone (arm 3). MAIN OUTCOME MEASURES: All cause mortality for 520 subjects in arms 1 and 2 and for 104 subjects who were randomised into these arms from arm 3. Cause specific mortality for people who died in the original arms 1 and 2 on the basis of the opinion of a panel, revised diagnosis and disability ratings, evidence from clinical records of either autonomic or cardiovascular episodes, other clinical features before death, and drug interactions. RESULTS: After extended follow up (mean 6.8 years) until the end of September 1995, when arm 2 was terminated, the hazard ratio for arm 2 compared with arm 1 was 1.32 (95% confidence interval 0.98 to 1.79). For subjects who were randomised from arm 3 the hazard ratio for arm 2 was 1.54 (0.83 to 2.87). When all subjects were included the hazard ratio was 1.33 (1.02 to 1.74) and after adjustment for other baseline factors it was 1.30 (0.99 to 1.72). The excess mortality seemed to be greatest in the third and fourth year of follow up. Cause specific death rates showed an excess of deaths from Parkinson's disease only (hazard ratio 2.5 (1.3 to 4.7)). No significant differences were found for revised diagnosis, disability rating scores, autonomic or cardiovascular events, other clinical features, or drug interactions. Patients who died in arm 2 were more likely to have had possible dementia and a history of falls before death compared with those who died in arm 1. CONCLUSION: The results consistently show excess mortality in patients treated with combined levodopa and selegiline. Revised diagnosis, autonomic or cardiovascular events, or drug interactions could not explain this finding, but falls and possible dementia were more common in arm 2. The results do not support combined treatment in patients with newly diagnosed Parkinson's disease. In more advanced disease, combined treatment should perhaps be avoided in patients with postural hypotension, frequent falls, confusion, or dementia.

Antiparkinson Agents↗
PubMed2003

Absence of excess mortality in critically ill patients with nosocomial Escherichia coli bacteremia.

OBJECTIVE: To evaluate excess mortality in critically ill patients with Escherichia coli bacteremia after adjustment for severity of illness. DESIGN: Retrospective (1992-2000), pairwise-matched (1:2), risk-adjusted cohort study. SETTING: Fifty-four-bed ICU in a university hospital including a medical and surgical ICU, a unit for care after cardiac surgery, and a burns unit. PATIENTS: ICU patients with nosocomial E. coli bacteremia (defined as cases; n = 64) and control-patients without nosocomial bloodstream infection (n = 128). METHODS: Case-patients were matched with control-patients on the basis of the Acute Physiology and Chronic Health Evaluation (APACHE) II system: an equal APACHE II score (+/- 2 points) and diagnostic category. In addition, control-patients were required to have an ICU stay at least as long as that of the respective case-patients prior to onset of the bacteremia. RESULTS: The overall rate of appropriate antibiotic therapy in patients with E. coli bacteremia was high (93%) and such therapy was initiated soon after onset of the bacteremia (0.6 +/- 1.0 day). ICU patients with E. coli bacteremia had more acute renal failure. No differences were noted between case-patients and control-patients in incidence of acute respiratory failure, hemodynamic instability, or age. No differences were observed in length of mechanical ventilation or length of ICU stay. In-hospital mortality rates for cases and controls were not different (43.8% and 45.3%, respectively; P = .959). CONCLUSION: After adjustment for disease severity and acute illness and in the presence of adequate antibiotic therapy, no excess mortality was found in ICU patients with E. coli bacteremia.

APACHE↗
PubMed2003

Excess mortality due to diabetes in Mississippi and the estimated extent of underreporting on death certificates.

OBJECTIVE: To develop alternative estimates of the excess mortality attributable to diabetes in Mississippi. METHODS: For each age/sex group, the total (all cause) mortality rate in the population was partitioned into the mortality rates for diabetics (M1) and non-diabetics (M0), using age- and sex-specific mortality rate ratios for diabetics from the Verona Diabetes Study. M1 and M0 were used, respectively, to calculate the predicted number of deaths and the 'usual' number of deaths (the number expected if diabetics had the same mortality rates as non-diabetics) in diabetics. The difference between predicted and 'usual' deaths is the number of excess deaths in diabetics--that is, deaths attributable specifically to diabetes. This was compared to the number of deaths in which diabetes was registered on death certificates as an underlying and/or contributory cause. RESULTS: In Mississippi in 1998-2000, 2,322 male and 3,436 female deaths in diabetics were calculated to be excess. These numbers are approximately three times the numbers of deaths in which diabetes was registered on the death certificate as the underlying cause of death. The excess numbers of deaths are much closer to the total numbers of deaths due to diabetes (that is, where diabetes is listed as either an underlying or a contributory cause of death). CONCLUSIONS: When reporting diabetes mortality numbers, public health agencies should consider reporting total registered diabetes deaths, not just registered underlying deaths. Better education of providers and others to increase the awareness of the importance of listing diabetes on the death certificate would help to increase concern and make diabetes a priority for public health action. Persons with diabetes have higher mortality rates and excess premature mortality, and diabetes ranks consistently among the leading causes of death in Mississippi and the U.S. Yet it has long been known that mortality attributable to diabetes is underestimated. Cause-of-death statistics are unreliable due to underreporting of diabetes on death certificates, and estimates based on attributable risk calculations do not take into account competing risks for mortality. In view of the public health importance of diabetes, it would be useful to develop alternative estimates of the burden of excess mortality attributable to it. In this paper I estimate the excess mortality attributable to diabetes for the diabetic population of Mississippi using epidemiologic data on the prevalence of diabetes and the relative risk of mortality among persons with diabetes.

Cause of Death↗
PubMed1996

Excess mortality of psychiatric inpatients in Taiwan.

The 6-year mortality rate of a nation-wide cohort of Taiwanese psychiatric inpatients admitted during the 1-year period from 1987 to 1988 was examined via record linkage. The psychiatric care system in Taiwan is mainly hospital-based. Of the 13,385 patients studied (9309 men and 4076 women), 2039 (1720 men and 319 women) had died by the end of 1993. The standardized mortality ratio (SMR) in this sample (3.10 for men and 4.83 for women) was as high as those reported in western industrialized countries during the pre-deinstitutionalization era. We also examined the relationship between the excess mortality of patients and age, sex, causes of death, diagnostic categories, and length of hospital stay. In general, the SMR was greatest for the youngest age group, women, unnatural deaths, substance use disorders, and in the first year after admission. Although the main cause for the excess mortality was unnatural deaths, there was also an excess mortality due to natural causes across all diagnostic categories. Several recommendations for the improvement of psychiatric care in Taiwan are made on the basis of these findings.

Adolescent↗
PubMed1999

Geographical patterns of excess mortality in Spain explained by two indices of deprivation.

STUDY OBJECTIVE: To analyse the geographical patterns and the magnitude of the association between deprivation and mortality in Spain. To estimate the excess of mortality in more deprived areas of the country by region. DESIGN: Cross sectional ecological study using 1991 census variables and mortality data for 1987-1992. SETTING: 2220 small areas in Spain. MAIN RESULTS: A geographical gradient from north east to south west was shown by both mortality and deprivation levels in Spain. Two dimensions of deprivation (that is, Index 1 and Index 2) obtained by exploratory factor analysis using four census indicators were found to predict mortality: mortality over 65 years of age was more associated with Index 1, while mortality under 65 years of age was more associated with Index 2. Excess mortality in the most deprived areas accounted for about 35,000 deaths. CONCLUSIONS: Two indices of deprivation strongly predict mortality in two age groups. Excess number of deaths in the most deprived geographical areas account for 10% of total number of deaths annually. In Spain there is great potential for reducing mortality if the excess risk in more deprived areas fell to the level of the most affluent areas.

Cities↗