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PubMed2000

Excess coronary mortality among Australian men and women living outside the capital city statistical divisions.

OBJECTIVES: To compare rates of mortality from coronary heart disease (CHD) between populations living within and outside Australian capital city statistical divisions. DESIGN AND SETTING: Descriptive epidemiological study based on data for all residents of Australia aged 30-69 years who died between 1986 and 1996 in all States and Territories of Australia. MAIN OUTCOME MEASURES: Standardised mortality rates from all causes and coronary heart disease as coded by the Australian Bureau of Statistics, and estimated excess deaths in populations living outside capital city statistical divisions. RESULTS: Between 1986 and 1996, mortality from CHD declined by 46% in men and 51% in women, and accounted for 61% of the decline in mortality from all causes in men and 48% in women. More deaths than expected from acute myocardial infarction resulted in mortality rates from CHD up to 30% higher in men and 21% higher in women living outside the capital city statistical divisions, and accounted for an overall estimated excess of 3835 deaths from CHD in men (32% of excess deaths from all causes), and 1385 deaths from CHD in women (27% of excess deaths from all causes) over the 11-year study period. CONCLUSIONS: Although there were impressive declines in coronary mortality in all Australian States and Territories from 1986 to 1996, populations living outside capital cities continue to have higher death rates from CHD. These differences in mortality rates indicate a need for further research into factors which may influence mortality rates for CHD in rural and remote areas, and immediate measures to ensure optimal treatment of coronary risk factors and acute coronary events in such populations.

Adult↗
PubMed2006

Adjusted mortality after hip fracture: From the cardiovascular health study.

OBJECTIVES: To estimate the risk of death associated with hip fracture (HFx), stratifying by sex and time since fracture. DESIGN: Prospective cohort study compared participants with and without hip fracture, matched on sex, age, race, recruitment period, and time since enrollment. SETTING: The Cardiovascular Health Study, a more-than-15-year longitudinal study of 5,888 older individuals from four U.S. sites. PARTICIPANTS: Three hundred seventy-nine individuals with HFx were compared with 1,134 without HFx. MEASUREMENTS: Extended Cox models were used to estimate mortality hazard ratios (HRs) for different periods after fracture, adjusting for prefracture health. RESULTS: Age- and race-adjusted excess mortality was 9% in women and 24% in men 1 year after fracture, and 24% in women and 26% men 5 years postfracture. Multivariable-adjusted HRs of mortality associated with HFx in women were 7.1 (95% confidence interval (CI) = 2.3-21.5), 2.1 (95% CI = 1.0-4.1), 1.4 (95% CI = 1.1-2.0), and 1.0 (95% CI = 0.6-1.5) for 0 to 1 months, 2 to 6 months, 7 months to 4 years, and 5 to 8 years, respectively, after index date. In men, respective HRs for the same time periods were 39.9 (95% CI = 5.2-308.7), 3.8 (95% CI = 1.4-10.3), 1.1 (95% CI = 0.7-1.8), and 1.0 (95% CI = 0.3-2.7). HRs adjusted for age and race were 20% to 40% higher. CONCLUSION: The risk of mortality was highest in the first 6 months after HFx. In men, the risk of death approximated that of men without HFx after 6 months; in women, a moderately greater risk persisted through the fourth year. Although the mortality pattern was different in women and men, excess mortality 5 years postfracture was similar for both sexes.

Aged↗
PubMed1989

Long term survival and cure after childhood cancer.

Investigations of long term survival and evidence concerning cure among children surviving at least three years after most of the more common childhood cancers treated in Britain between 1960 and 1981 are reported. The results indicate striking improvements in survival beyond three years for many childhood tumours over this period. For most childhood tumours considered over 80% of those who had survived at least three years were alive 10 years later. Comparison of mortality observed among survivors with that expected for the general population showed evidence of cure among those who had survived at least three years after non-Hodgkin lymphomas and non-genetic retinoblastoma. Survivors of other tumours, with sufficient cases surviving beyond 10 years to examine excess mortality, rarely experienced an excess that exceeded one extra death per 100 survivors per year. Children who had survived at least 10 years after other embryonal tumours, soft tissue sarcomas, or osteosarcoma never experienced an excess mortality exceeding one extra death per 200 survivors per year.

Adolescent↗
PubMed1991

Changes in mortality among psychiatric inpatients, 1968-1982.

Data based on a national classification of mental disorders were collected continuously between 1968 and 1976, and then every two years from 1976 to 1982, following the same standards, in French public sector psychiatric hospitals. It was possible to study the evolution of deaths over this period taking all causes combined and by psychiatric diagnosis. The hospitalized population was estimated using data on length of stay and analysing them by the person-years method. The number of observed deaths was compared with the number of deaths expected applying the mortality rate of the general population to the numbers of inpatients of the same sex and age group and this gave us a standardised mortality ratio:SMR. Excess mortality in psychiatric inpatients, still apparent in this population, is decreasing except among women aged under 45, for whom it remains very high. Taking all causes of death combined, the mortality level in 1982 was almost 10 times higher than in the same female age group in the general population. Even when mortality is studied after exclusion of traffic accident deaths, the gap between men and women remained almost the same. The SMR for psychoses and mental retardation should no tendency to decrease in women aged under 55 and the SMR for neuroses showed a regular increase from 1972. A reduction was observed for all diagnostic groups studied in the 55 plus age group, for both men and women.

Adult↗
PubMed2002

Survival and potential years of life lost after hip fracture in men and age-matched women.

Hip fracture is associated with a higher mortality rate in men than in women. However, mean age of men and women with hip fracture differs markedly. Thus, some of the differences in the clinical pattern and outcome between genders could be related to different ages. To avoid the influence of age on gender-specific outcome, we analyzed prefracture conditions and hip fracture outcome in a cohort of men and of age-matched women. Risk factors for low bone mass were recorded in 106 men (mean age +/- SD, 80.3 +/- 9.3 years) and 264 age-matched women (mean age 81.4 +/- 8.0) with hip fracture. We compared mortality rate, survival, years of potential life lost and modification of housing conditions. These outcomes were prospectively assessed during an average 3.6 years follow-up (up to 7 years). Men with hip fracture differed from age-matched hip-fractured women by a higher alcohol and tobacco consumption, a greater frequency of living in couple, and by less prevalent fractures. Mortality rate after hip fracture was significantly higher in men (RR = 1.74, 95% CI 1.34-2.24). Since mortality is higher in the general male population, we compared reduction in life expectancy taking into account the gender-specific mortality rate. The excess mortality in each age-group of hip-fractured patients, which was measured during the whole follow-up period, and is an estimate of death attributable to fracture, did not differ between genders. Reduction in life expectancy due to hip fracture was similar in both genders (5.9 +/- 4.5 and 5.8 +/- 4.8 years, in men and women, respectively; NS), but the proportion of the years of life lost was higher in men (70 +/- 33%) than in women (59 +/- 42%, p < 0.01). It was concluded that for the same age, mortality rate after hip fracture was higher in men than in women. Although the reduction in life expectancy was similar in both genders, the proportion of the years of life lost was higher in men, suggesting a worse impact of hip fracture on survival in men, even after consideration of the higher mortality rate in the general male population.

Aged↗
PubMed1994

Surgical treatment of left ventricular aneurysm--assessment of risk factors for early and late mortality.

Consecutive patients operated on for left ventricular aneurysm from 1970 through August 1989 (n = 303) were evaluated with respect to survival. Early mortality, i.e. within 30 days, was 8.9%; 23% in patients who underwent aneurysm resection alone, 8.1% in cases of aneurysm resection with coronary artery bypass grafting (CABG), and 6.3% in those undergoing CABG only. Multivariate logistic regression revealed that advanced New York Heart Association (NYHA) functional class, non-use of the internal mammary artery as a graft and thromboendarterectomy increased the early risk. The total observed survival was 86% at 1 year, 72% at 5 years and 45% at 10 years. Multivariate analysis based on observed survival, using the Cox proportional hazards model, identified advanced NYHA functional class and non-use of the internal mammary artery as independent indicators of poor survival. Relative mortality, defined as the ratio of observed mortality in the study group to mortality among comparable persons from the general Swedish population, was used as a measure of disease-specific mortality. An apparent excess mortality in patients operated on for left ventricular aneurysm was found. A notable finding was that the use of the internal mammary artery to graft the left anterior descending artery improved the outcome substantially in patients with a left ventricular aneurysm.

Adult↗
PubMed2005

Urinary cadmium and mortality among inhabitants of a cadmium-polluted area in Japan.

The influence of cadmium (Cd) body burden on mortality remains controversial. Excess mortality and the dose-response relationship between mortality and urinary cadmium excretion were investigated in this study among environmentally exposed subjects. A 15-year follow-up study was carried out on 3119 inhabitants (1403 men and 1716 women) of the Cd-polluted Kakehashi River basin, whose urinary Cd concentration was examined in a 1981-1982 health impact survey. The mortality risk of high urinary Cd (> or = 10 microg/g Cr) subjects after adjustment for age using Cox's proportional hazard model was higher than that of moderate urinary Cd (< 10 microg/g Cr) subjects in both sexes. When the subjects were divided into five groups according to the amount of urinary Cd (<3, 3-5, 5-10, 10-20, > or = 20 microg/g Cr), the mortality risk was significantly increased among the subjects with urinary Cd > or = 3 microg/g Cr in proportion to the increases in the amount of urinary Cd concentration after adjustment for age, especially in women. Furthermore, special causes of death among high and moderate urinary Cd were investigated, and mortality risk ratio for heart failure, which is a cause of death often diagnosed in cases with a gradual deterioration culminating in death, was significantly increased in both sexes, compared with the moderate urinary Cd subjects. Also, in women the mortality risk for renal diseases in the high urinary Cd subjects was significantly higher than that in the moderate urinary Cd subjects. These results suggest that a causal association between Cd body burden and mortality exists among inhabitants environmentally exposed to Cd but that no special disease may be induced except renal diseases.

Aged↗
PubMed2005

Impact of deep infection after hip fracture surgery on function and mortality.

Our aim was to evaluate the impact of deep wound infection after hip fracture surgery on functional outcome and mortality. Two thousand, two hundred and seventy-six consecutive surgically treated patients with non-pathological fractures, aged over 50 years (mean age 78.3 years), were followed up prospectively. The 29 patients who had deep infection (rate 1.3%) and who received revision surgery were compared with controls without infection, matched for age, sex, residential status at fracture, fracture type, treatment method and walking ability. When the functionality of hip fracture patients was evaluated four months after the primary operation, the patients with deep wound infection had impaired walking ability (P=0.039) and required walking aids, including wheelchairs, more often than the control patients (48% vs 20.8%, P=0.022). At four months, the mean duration of hospitalization at the primary hospital was significantly longer for the cases than the controls (P<0.001). Diabetes was more common in the patients with deep infection (P=0.038). Staphylococcus aureus was the most commonly isolated micro-organism, and it was associated with higher one-year mortality (57%) than the other bacteria (14.3%, P=0.014); the overall mortality of the infected patients and controls was 34.5% and 24.1% at one year, respectively (P=0.508). In conclusion, deep infection after a hip fracture operation impairs short-term functional outcome and slightly increases mortality, with an excess mortality rate of 10.4%.

Aged↗
PubMed1995

Survival in families with hereditary protein C deficiency, 1820 to 1993.

OBJECTIVES: To establish the survival of individuals heterozygous for hereditary protein C deficiency, who have an increased risk of venous thrombotic events, and to compare it with the survival of the general population. DESIGN: Retrospective study in pedigrees of 23 families with hereditary protein C deficiency for period 1820 and 1993. SETTING: 23 completed family trees of 24 probands from various parts of the Netherlands with symptoms of protein C deficiency. SUBJECTS: All 736 members of the 23 families with a 50% or 100% probability of being (or having been) heterozygous for the genetic defect on the basis of DNA analysis or their place in the pedigrees, following mendelian rules. MAIN OUTCOME MEASURES: Observed mortality compared with the mortality of the general Dutch population; the standardised mortality ratio was calculated by dividing the observed mortality by the expected mortality. RESULTS: No excess mortality was found in the 206 proved heterozygous individuals and "obligatory transmitters" (those who have definitely passed on the deficiency) (standardised mortality ratio 0.95 (95% confidence interval 0.5 to 1.2)) or in the 530 family members with a 50% genetic probability of heterozygosity (1.10 (0.9 to 1.3)). CONCLUSION: Heterozygous individuals with hereditary protein C deficiency type I have normal survival compared with the general population. Prophylactic anticoagulant treatment may prevent thrombotic events in heterozygous individuals but may not be expected to improve their survival.

Adolescent↗
PubMed1994

Acutely injured patients with trauma in Massachusetts: differences in care and mortality, by insurance status.

OBJECTIVES: This study was designed to determine whether resource use and mortality differed by insurance status for patients with acute trauma. METHODS: All adults emergently hospitalized in Massachusetts during 1990 with acute trauma (n = 15,008) were examined. RESULTS: After adjustment for confounders, uninsured patients were as likely to receive care in an intensive care unit as were patients with private insurance (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.85, 1.11) but were less likely to undergo an operative procedure (OR = 0.68, 95% CI = 0.63, 0.74) or physical therapy (OR = 0.61, 95% CI = 0.57,0.67) and were more likely to die in a hospital (OR = 2.15, 95% CI = 1.44, 3.19). Compared with patients with private insurance, those with Medicaid were less likely to receive an operative procedure (0.85, 0.75-0.97), were equally likely to receive care in an intensive care unit (OR = 1.05, 95% CI = 0.86, 1.30) or physical therapy (OR = 0.90, 95% CI = 0.79, 1.02), and were no more likely to die (OR = 1.28, 95% CI = 0.69,2.39). CONCLUSIONS: These results suggest that the uninsured receive less trauma-related care and have a higher mortality rate. The excess mortality in uninsured patients may be avoided if their resource use is increased to that of insured patients.

Acute Disease↗
PubMed2001

[Disease burden of diabetes mellitus type II in the Netherlands: incidence, prevalence and mortality ].

A consistent estimate of the prevalence, mortality and incidence of diabetes mellitus type II in the Netherlands was obtained by combining data from several sources using statistical and modelling techniques. In the Netherlands, the prevalence of diabetes in the age-group 30-74 years is 2.7-3.2%. The prevalence increases with age: for men by 7% per year of age and for women by almost 8% per year of age. This age-related increase will give rise to a 36% increase in the prevalence of diabetes in the period 1993-2010. Diabetic patients account for 12% of the total mortality in men and 18% in women; in 2.5% and 5% of the cases respectively, diabetes is the cause of mortality. If this excess mortality could be eliminated then the life expectancy for men with diabetes would increase by 4.7 years at the age of 45 and for women the corresponding increase would be 6.3 years. The estimated incidence per year increases from 8 per 10,000 men (7 for women) in the age group 40-44 years to 80 per 10,000 men (86 for women) in the age group 75-79 years.

Age Distribution↗
PubMed1989

Men's and women's mortality in the past.

This is a historical survey of adult mortality in western Europe from 1625 to 1900, with a focus on the state of women's health during this period. The author attempts to determine whether "women's health in the past was more precarious than it is to-day...[and assesses] the influence of maternal mortality on the excess mortality of women during part of their adult lives." Mortality comparisons are made among female age groups, countries, and historical periods.

Demography↗
PubMed1993

[The epidemiology of asthma in the elderly. Apropos of a review of the literature].

Increased longevity and the maintenance of autonomy in the elderly has lead to an enlargement of the study of asthma beyond 65 years. If the majority of published work in the literature concludes there is an excess mortality in the elderly asthmatic one cannot exclude the possibility that this excess mortality is due to the association, at this age, of asthma with other respiratory problems. This association would also explain the great variations in prevalence reported by different authors, from 3 to 6% with notable differences according to the sex. Bronchial reactivity appears to be less linked to allergy after 65 than in the young subject. In the elderly asthmatic the frequency of a past history of allergy and of positive cutaneous tests are weaker than in the young, and there is little difference when compared to the non-asthmatic subject. On the other hand the majority of studies show that smoking, respiratory infections, and social class are particularly linked to asthma beyond the age of 65. Although the data on predictive factors may be rare and contradictory certain published works suggest that deterioration in respiratory function most often precedes the appearance of symptoms suggesting the diagnosis. Many uncertainties remain in relation to asthma in the elderly. This is because in large part there are insufficiently specific identifying criteria. There is a need to develop standardised methods of evaluating respiratory handicap, notably specific data on the quality of life as this would be indispensable in evaluating the consequence of asthma in the elderly subject.

Aged↗
PubMed1998

Mortality in rheumatoid arthritis: experience in four clinical series compared with the experience in the 1983 medical impairment study.

BACKGROUND: Survival curves and decimal Standardized Mortality Ratios (SMRs) were reported in 1994 for four clinical series of patients with Rheumatoid Arthritis (RA), with use of a common data processing system. It was felt to be desirable to compare the excess mortality observed in clinical patients with the excess mortality found in substandard policyholders with RA in the 1983 Medical Impairment Study. RESULTS: The weighted mean SMR was 2.25 for the male RA patients and 2.42 for the females. Although similar in magnitude to the percentage male and female Mortality Ratios (MRs) in the 1983 Medical Impairment Study, the derived Excess Death Rate (EDR) was higher for the clinical RA patients, despite the lower select mortality versus the population mortality, even after adjustment for difference in mean age between the clinical and insurance series. CONCLUSION: The higher EDR in four clinical series of RA patients probably reflects a higher proportion of more severe cases, who are declined for insurance or do not accept a highly rated offer.

Adult↗
PubMed2004

Mortality in relation to smoking: 50 years' observations on male British doctors.

OBJECTIVE: To compare the hazards of cigarette smoking in men who formed their habits at different periods, and the extent of the reduction in risk when cigarette smoking is stopped at different ages. DESIGN: Prospective study that has continued from 1951 to 2001. SETTING: United Kingdom. PARTICIPANTS: 34 439 male British doctors. Information about their smoking habits was obtained in 1951, and periodically thereafter; cause specific mortality was monitored for 50 years. MAIN OUTCOME MEASURES: Overall mortality by smoking habit, considering separately men born in different periods. RESULTS: The excess mortality associated with smoking chiefly involved vascular, neoplastic, and respiratory diseases that can be caused by smoking. Men born in 1900-1930 who smoked only cigarettes and continued smoking died on average about 10 years younger than lifelong non-smokers. Cessation at age 60, 50, 40, or 30 years gained, respectively, about 3, 6, 9, or 10 years of life expectancy. The excess mortality associated with cigarette smoking was less for men born in the 19th century and was greatest for men born in the 1920s. The cigarette smoker versus non-smoker probabilities of dying in middle age (35-69) were 42% nu 24% (a twofold death rate ratio) for those born in 1900-1909, but were 43% nu 15% (a threefold death rate ratio) for those born in the 1920s. At older ages, the cigarette smoker versus non-smoker probabilities of surviving from age 70 to 90 were 10% nu 12% at the death rates of the 1950s (that is, among men born around the 1870s) but were 7% nu 33% (again a threefold death rate ratio) at the death rates of the 1990s (that is, among men born around the 1910s). CONCLUSION: A substantial progressive decrease in the mortality rates among non-smokers over the past half century (due to prevention and improved treatment of disease) has been wholly outweighed, among cigarette smokers, by a progressive increase in the smoker nu non-smoker death rate ratio due to earlier and more intensive use of cigarettes. Among the men born around 1920, prolonged cigarette smoking from early adult life tripled age specific mortality rates, but cessation at age 50 halved the hazard, and cessation at age 30 avoided almost all of it.

Adult↗
PubMed1997

Blood pressure and cardiovascular morbidity and mortality rates in the elderly.

The influence of blood pressure on the development of cardiovascular disease and mortality rate beyond 75 years of age has been uncertain. A reported inverse relation to mortality rate noted in the very old could reflect poor cardiovascular health. This report examines the impact of blood pressure on cardiovascular morbidity and mortality rates and all-cause mortality rate in those aged 75 to 94 years. For this analysis the data were the Framingham study subjects found free of cardiovascular disease and a second sample of those with cardiovascular disease present on the biennial examinations. Investigation of the relation of systolic and diastolic blood pressures to all causes and cardiovascular morbidity and mortality rates within each 2-year interval for those aged 75 to 94 years was carried out. Over the period of 38 years of follow-up there were increasing cardiovascular morbidity and mortality rates with increasing blood pressure levels for both men and women in the sample free of cardiovascular disease. In those with cardiovascular disease at the biennial examination there was a distinct U-shaped curve of cardiovascular mortality rate in relation to systolic blood pressure in men with a substantial increase in mortality rate below systolic pressures of 120 mm Hg for both men and women. Excess mortality rate reported in elderly persons with low blood pressure appears to be a result of poor cardiovascular health and not from the low pressure itself. The excess mortality rate reported for low blood pressure levels in persons older than 75 years derives from the inclusion of the substantial proportion of this age group who have cardiovascular disease.

Aged↗
PubMed1994

Hereditary antithrombin deficiency: heterogeneity of the molecular basis and mortality in Dutch families.

We studied the molecular basis and genetic heterogeneity of hereditary antithrombin (III) deficiency in nine Dutch families. Polymerase chain reaction (PCR) amplification and direct sequencing of all antithrombin gene exons and flanking intronic regions identified mutations in eight families. Given the opportunity to correlate the molecular basis with survival, we addressed the relevance of molecular defects to mortality in inherited antithrombin deficiency. The defects included single nucleotide deletions (7671 del G, 7768-69 del G) and insertions (5501 ins A, 2463 G-->TC) that lead to frameshifts, a single base substitution [5381 C-->T (129Arg-->stop)] leading to a premature termination codon, and single base substitutions resulting in amino acid substitutions [2652 A-->C (63Tyr-->Ser), 13380 T-->C (421Ile-->Thr), and 13407 G-->T (430Cys-->Phe)]. All affected individuals were heterozygous for the defects. Previously we found in Dutch families that antithrombin deficiency did not lead to higher mortality compared with the general population. In accordance with these findings, we observed no excess mortality in the nine families [Observed:Expected, 52:52.6; standardised mortality ratio (SMR) 1.0, 95% confidence interval (CI), 0.7-1.3]. Our findings confirmed a considerable genetic heterogeneity underlying antithrombin deficiency. We therefore concluded that the lack of excess mortality in these families is not caused by a Dutch mild defect. We suggest that the longevity is not affected by molecular defects in the antithrombin gene and hypothesize that differences in mortality or natural history between families most likely result from other (genetic) risk factors.

Antithrombin III↗
PubMed1996

Mortality of white South African gold miners.

OBJECTIVES: This two part study aimed to determine whether there was an excess mortality generally or for some diseases among middle aged white South African gold miners on the Witwatersrand and whether the underground dust exposure of these miners contributed to the development of lung cancer, chronic obstructive pulmonary disease (COPD), or ischaemic heart disease (IHD). METHODS: A cohort of 4925 white miners in South Africa, born between 1 January 1916 and 31 December 1930 who were alive and working in the vicinity of Johannesburg on 1 January 1970, then aged between 39 and 54, was followed up for 20 years by which time 2032 had died. Most were gold miners (about 87% had worked 85% or more of their shifts in gold mines). Standardised mortality ratios (SMRs) were calculated as percentages of the number of deaths observed in the cohort for a condition as stated on the death certificate divided by the number expected on the basis of concurrent mortality in the reference population (the total age specific white male population of South Africa). A case-control analysis was performed for three diseases (lung cancer, COPD, and IHD), the results of which are presented for those miners in the cohort who had spent at least 85% of their service on gold mines and had worked at least 15% of their shifts underground. RESULTS: The SMR for all causes of death was 129.6%, raised because of excess mortality due to the following causes: lung cancer (SMR = 139.8%), IHD (124.1%), COPD (189%) and cirrhosis of the liver (155.3%). Smoking was confirmed to be the main risk factor for lung cancer and COPD although cumulative dust exposure was found to increase the risk of COPD in conjunction with smoking. No significant risk of lung cancer resulted from exposure to dust. High blood pressure and smoking were found to increase the risk of IHD, but no association between IHD and the quetelet index (weight/height2) was found. CONCLUSIONS: The most significant and unexpected finding was the 30% increase in the SMR for all causes. Very little of this increase could be attributed to mining and the main factor for this was probably the adoption of an unhealthy lifestyle by these men (compared with other South African white men) particularly smoking (86% were smokers) and alcohol consumption.

Adult↗