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PubMed2026

Sex-stratified mortality trends in preterm birth complications in Sierra Leone: progress, persistence, and equity implications.

BACKGROUND: Preterm birth complications remain a leading cause of neonatal mortality in Sierra Leone, despite recent health system gains. Evidence on long-term sex-specific disparities in mortality due to preterm birth complications is limited, constraining equitable neonatal care planning. OBJECTIVE: To examine two‑decade trends in sex‑stratified mortality from preterm birth complications using standardized equity indicators. METHODS: We conducted a retrospective longitudinal analysis of sex-disaggregated mortality estimates from the World Health Organization (WHO) Global Health Estimates (GHE), accessed through the WHO Health Equity Assessment Toolkit (HEAT), Built-in Database Edition (Version 6.0). Mortality rates per 100,000 population were extracted for 2001, 2006, 2011, 2016, and 2021. Inequality was assessed using absolute difference (D), relative ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). RESULTS: Mortality declined substantially between 2001 and 2021 for both males (85.1-49.3 per 100,000) and females (71.2-39.9 per 100,000). Male mortality remained consistently higher across all years, with relative ratios indicating approximately 20-25% excess mortality among male neonates. Absolute inequalities narrowed modestly over time, whereas relative inequalities remained largely unchanged. PAR and PAF remained close to zero throughout the study period. Wider uncertainty intervals in earlier years reflected limited empirical data availability. CONCLUSION: Although preterm mortality declined over two decades, a persistent male disadvantage remained in Sierra Leone. These findings highlight the importance of integrating sex-disaggregated equity monitoring into neonatal policies and programmes. Future research should evaluate strategies to reduce the persistent excess mortality among male neonates while sustaining overall improvements in neonatal survival and progress toward Sustainable Development Goal 3.2.

Humans↗
PubMed2005

A meta-analysis of excess cardiac mortality on Monday.

BACKGROUND: Available evidence suggests a peak in the incidence of cardiovascular events on Mondays compared to other days of the week. The exact magnitude of the excess risk and the role of age and gender, however, remain unclear. OBJECTIVE: To quantify the excess risk associated with the Monday peak in cardiovascular mortality and to explore the role of age and gender. METHODS: A meta-analysis of available published studies reporting on weekly patterns in incidence of myocardial infarction and sudden cardiac death was performed. RESULTS: Reports based on routinely collected data from population statistics (n = 5) generally reported a lower odds ratio (OR) of an event on Monday than studies with a confirmed diagnosis (n = 16). The pooled OR estimate based on population statistics was 1.04 (95%CI: 1.03; 1.05), whereas the pooled OR estimate based on confirmed diagnoses was 1.19 (95%CI: 1.17; 1.21). Subgroup analysis yielded an OR of 1.19 (95%CI: 1.07; 1.31) for men and 1.15 (95%CI: 0.99; 1.32) for women. Odds ratios for patients younger than 65 years of age and 65 or older were 1.22 (95%CI: 1.09; 1.36) and 1.16 (95%CI: 1.07; 1.27), respectively. The differences between subgroup odds ratios were not statistically significant. CONCLUSION: The incidence of sudden cardiac death is markedly increased on Monday, similar for men and women, and for subjects below and above 65 years of age.

Age Factors↗
PubMed1996

Reproductive factors and prognosis of uterine cervical cancer in Norway.

Based on Norwegian registry and census data, the influence of reproductive factors on excess mortality from cervical cancer was examined. Parity level had no impact on the excess mortality. In parous women, a beneficial effect of an early first birth was found, most pronounced in 20- to 39-year-old women with squamous cell carcinoma.

Adult↗
PubMedDate not supplied

[A comparative analysis of mortality in the Americas].

"The analysis concentrates on the mortality of [the] adult population at ages 15 to 74 in 8 countries of the American continent.... Results are presented by age, sex and principal groups of causes of death. It is concluded that: a) mortality can significantly decline further in the Americas; b) there are noticeable mortality differentials by cause among countries; [and] c) all the countries still have excess mortality in certain age groups and causes of death, and hence, the mortality transition has not ended." (SUMMARY IN ENG)

Adult↗
PubMed1969

A critical evaluation of influenza surveillance.

The present system of global surveillance of influenza worked effectively in identifying the importance and character of the Hong Kong variant and informing the world of new developments as they occurred. Many deficiencies still exist in the surveillance system that require attention if it is to serve effectively in guiding future control of influenza. More quantitative data are needed regarding incidence of clinical disease, age- and sex-specific attack rates, character and severity of complications, socio-economic factors influencing mortality and distribution and utilization of influenza vaccines.The most valuable index for global surveillance of influenza is excess mortality due to respiratory causes. A comparison of the mortality experience in England and Wales with that in the USA reveals that sharply defined epidemics of influenza A recurred in both countries at intervals of 2-3 years. Mortality rates in England and Wales were considerably greater than in the USA and excess mortality during influenza epidemics was markedly higher in the former country with a notable exception in 1968-69, when the pandemic due to the Hong Kong variant was much more severe in the USA and the mortality in England and Wales was only slightly increased. Mortality data from many other parts of the world could be made available and would materially enhance the effectiveness of the global influenza surveillance programme.

England↗
PubMed2003

Mortality in rheumatoid arthritis patients treated with or without methotrexate.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease associated with excess mortality. In 1974 a registry of RA patients was established at the Wichita Arthritis Center. It has been directed by its founder, Dr. Frederick Wolfe, ever since. The database for RA patients provided results for the present study and 1 of the 4 series reported previously. RESULTS: These are based on a consecutive series (after specific exclusions) of RA patients, 18 years of age and older, treated at the Wichita Arthritis Center, 1981 through 1999. During this period, 588 of the total 1240 RA patients were treated with methotrexate, and 652 patients did not receive any methotrexate. Total exposure amounted to 7584 patient-years, and total deaths numbered 191. An elaborate statistical method was developed by Wolfe and a team of Harvard epidemiologists to adjust for prognostic risk factors, which were higher in the methotrexate than in the non-methotrexate group. Detailed descriptive data were included in the database. Overall excess mortality in comparison with population rates was higher in the methotrexate than in the non-methotrexate group, but the unadjusted difference was not significant. Results for the 1981-1999 total Wichita cohort were compared with those of the 1974-1990 cohort and the 1983 Impairment Study (both before and after adjustment to the older age distribution of the Wichita patients). CONCLUSION: Mortality improved somewhat in the RA patients at the Wichita Center from 1974-1990 to 1980-1999. In the later period, mortality was lower in patients treated with methotrexate than in those not so treated. After the authors of the source article made adjustments for the increased RA severity in the patients treated with methotrexate, mortality was significantly lower in the methotrexate-treated group, with a mortality hazard ratio of 0.4 (95% confidence interval 0.2-0.8).

Actuarial Analysis↗
PubMed1999

Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications.

BACKGROUND: Surgical correction of mitral regurgitation in patients with no or mild symptoms remains controversial, particularly because the impact of preoperative symptoms on postoperative outcome is unknown. METHODS AND RESULTS: The long-term outcome of 478 patients with organic mitral regurgitation (199 in NYHA functional class I/II and 279 in class III/IV before surgery) operated on between 1984 and 1991 was analyzed. In patients in NYHA class I/II before surgery compared with those in class III/IV, postoperative long-term survival was higher (at 10 years, 76+/-5% versus 48+/-4%, P<0.0001), with lower operative mortality (0.5% versus 5.4%, P=0.003) and better late survival (P<0.0001). Comparison of observed and expected survival showed identical curves in patients in class I/II before surgery (P=0.18), whereas excess mortality was observed in patients in class III/IV before surgery (P<0.0001). Excess mortality associated with severe symptoms was also confirmed in all subgroups (all P<0.003) and in multivariate analysis (P=0.0036; adjusted hazard ratio [95% CI], 1.81 [1.21 to 2.70]). CONCLUSIONS: In patients with organic mitral regurgitation, preoperative functional class III/IV symptoms are associated with excess short- and long-term postoperative mortality independently of all baseline characteristics. These data should lead to consideration of surgical correction of severe organic mitral regurgitation when no or minimal symptoms are present in patients at low operative risk, especially if repair is feasible.

Aged↗
PubMed1997

Influence of left ventricular function on survival after coronary artery bypass grafting.

BACKGROUND: Preoperative left ventricular function is a most important predictor for survival in patients with ischemic heart disease. To elucidate the optimal timing of recommended coronary artery bypass grafting, we investigated the influence of different aspects of preoperative left ventricular function on relative survival. METHODS: To calculate the relative survival and estimate the disease-specific survival, we compared 6,514 patients who survived the first month after primary coronary artery bypass grafting with the general Swedish population stratified by age, sex, and 5-year calendar period. In particular we studied the relation between relative survival and different aspects of left ventricular performance, namely left ventricular function at rest, New York Heart Association functional class, and number of previous myocardial infarctions. RESULTS: The three variables (left ventricular function at rest, New York Heart Association functional class, and number of previous myocardial infarctions) as well as age and follow-up year gave independent information concerning relative survival. The results from this multivariate analysis were used to define a risk score for each patient. Patients were categorized into different risk groups. Patients in the low-risk group (30% of the total) showed a survival better than that of the population at large for 9 years after operation. The medium-risk group had no or low excess mortality for about 7 years, and the high-risk group (25%) showed increased excess mortality immediately after operation. CONCLUSIONS: If primary coronary artery bypass grafting is performed before the left ventricular function and physical performance deteriorate, survival is excellent.

Actuarial Analysis↗
PubMed2004

Increasing inequalities in premature mortality in Great Britain.

STUDY OBJECTIVE: To describe inequalities in all cause premature mortality between and within regions of Great Britain and how these inequalities have changed between 1979 and 1998. DESIGN: Retrospective study using routine population and death data aggregated into five year age and sex groups for each of 20 years. SETTING: All 459 local authority districts (England and Wales) and local government districts (Scotland). PARTICIPANTS: Estimated population and registered deaths aged 0-64. MAIN OUTCOME MEASURES: Indirectly standardised mortality ratios for all cause mortality; percentages of deaths that would be avoided if there were no inequalities between and within regions. RESULTS: The decrease in premature mortality of 36% seen in Great Britain ranged from 42% in Wales to 33% in Scotland and 31% in London. Differences between regions led to excess mortality of about 25% in Scotland, the North East, and the North West. In London excess mortality increased from 14% to 19%. Inequalities within regions increased in most parts of Great Britain, the exceptions being Wales, London, and the South West. The largest increase was seen in Scotland where the percentage of excess deaths increased from 23% to 33%. CONCLUSIONS: A decrease in premature mortality in Great Britain was seen in all regions, although less pronounced in London, but the gap between regions remained. Inequalities between districts within regions vary from one region to another and have increased in nearly every part of Great Britain.

Adolescent↗
PubMed2001

Widespread body pain and mortality: prospective population based study.

OBJECTIVE: To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess. DESIGN: Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location. SETTING: North west England. PARTICIPANTS: 6569 people who took part in two pain surveys during 1991-2. MAIN OUTCOME MEASURES: Pain status at baseline and subsequent mortality. RESULTS: 1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78). CONCLUSION: There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with "unexplained" widespread pain symptoms, such as those with fibromyalgia.

Adult↗
PubMed1985

The mortality of boot and shoe makers, with special reference to cancer.

The study describes the mortality of 5 017 men known to have been employed in the boot and shoe manufacturing industry in three towns in Great Britain in 1939. At the end of 1982, 97.5% of the men were traced, and 3 434 (68.4%) were known to be dead. Expected numbers were calculated according to the person-years method and were adjusted according to the standardized mortality ratios of the counties in which the towns were situated. The mortality experience of the men for all causes, all cancers combined, and all other causes was favorable. The anticipated excess of deaths from nasal cancer (10 observed, 1.87 expected) was found, and the excess was significant for workers in the finishing room. Deficits were found for other types of respiratory cancer. An excess mortality from leukemia was found for workers in one town (7 observed, 3.0 expected), and the excess was significant for workers in the lasting and making room, where glues and solvents, including benzene, were known to have been used. An excess mortality from rectal cancer was found for workers in two towns (61 observed, 47.6 expected), and it was significant for workers in the lasting and making rooms (25 observed, 12.4 expected). Some supporting evidence for a risk of rectal cancer in this industry was found in the literature.

Adhesives↗
PubMed1998

Mortality in a large population-based cohort of patients with drug-treated diabetes mellitus.

OBJECTIVES: This paper presents detailed cause-specific data about excess mortality among diabetic persons in Finland, by age and sex. METHODS: Five-year follow-up data on the Finnish population aged 30 through 74 years were analyzed. During these 5 years, 11,215 persons with diabetes and 102,843 persons without diabetes died. The diabetic population was defined as people who were entitled to free medication for diabetes at the beginning of the follow-up period, that is, at the end of 1980. RESULTS: The relative mortality of persons with drug-treated diabetes compared with nondiabetic persons was higher among women (3.4) than among men (2.4). Almost three quarters of the mortality excess was due to circulatory diseases. For most other causes of death, too, diabetic persons had higher than average mortality. The exceptions were lung cancer, chronic obstructive pulmonary disease, and alcohol poisoning. CONCLUSIONS: Diabetes is a general risk factor for untimely death and makes a significant contribution to overall national death rates, particularly for circulatory diseases. Lower than average mortality from smoking-related diseases and alcohol poisoning, however, warrant optimism about the effects of health education among diabetic persons.

Adult↗
PubMed1980

Survival and mortality pattern among Swedish smelter workers.

The study analyses work history and mortality data for 3919 male workers first employed during 1928-66 at Rönnskärsverken, a copper smelter in north-east Sweden. 99% of the workers were traced from employment records and central population registers. By means of standarized mortality ratios and life-table analysis comparisons were made with both the general and local populations. For all causes excess mortality is 18% relative to the general population. This can be ascribed to tumours and circulatory diseases, for which excess figures are 39 and 32% respectively. For tumours, the excess mortality is mainly due to lung cancer for which the risk is trebled relative to the general population and 5-fold relative to local populations. For circulatory diseases, the excess figure is mainly accounted for by cerebrovascular disease with an elevated risk of 60-70%. The probable remaining life-time from 50 years is 2 years shorter than for Swedish men in the 60's. Internal comparisons were made to analyse the importance of latency, exposure, calendar time and place of work. A dose-response analysis clearly indicates that the roasters and arsenic departments are risk places for the development of cancer, especially lung cancer. A 50-year old worker who has been exposed to the roasters for more than 5 years, has a probable remaining life-time which is almost 3 years shorter than the average Rönnskär employee and almost 5 years shorter than the average Swedish male. Case-control studies aimed at exploring exposure associated with stomach cancer and cerebrovascular mortality are under way.

Adolescent↗
PubMed2003

[The consequences of the heat wave in August 2003 on the mortality of the elderly. The first overview].

THE DELETERIOUS EFFECTS OF HEAT WAVES: In fragile persons, particularly in the elderly, heat waves provoke excessive mortality. They may also have indirect effects through the decompensation of a chronic, notably cardiovascular or respiratory, disease, or direct heat stroke effects. Heat stroke is defined as a severe disease with body temperature exceeding 40 degrees C and central neurological manifestations, heat stroke in the very elderly leads to a high rate of mortality, particularly when complications related to bed rest and loss of autonomy are since added. Regarding therapeuty, treatment of heat stroke relies on cooling the body and reanimation measures to compensate organ failure, with relief of the dehydration hypovolemia. The heat wave in August 2003 provoked excess mortality particularly in the elderly with 69% of the deaths concerning persons aged over 75. In the future, preventive measures must be taken to limit the health consequences of any heat waves to come.

Aged↗
PubMed2006

Mortality in southern England during the 2003 heat wave by place of death.

More than 2000 deaths were attributed to the August 2003 heat wave in England and Wales. We analysed excess mortality in southern England during the heat wave by place of death. Excess mortality was 33 per cent in those aged 75 and over and 13.5 per cent in the under 75 age group during the 10 day heat wave. Among those aged 75 and over, deaths at home increased by 33 per cent and deaths in nursing homes increased by 42 per cent. Around one quarter of the heat wave attributable deaths occurred in care homes, but this is likely to be an underestimate as some residents may have been admitted to hospital before death. There is a need for further research to assess the risk of heat-related mortality in hospital in-patients and the residents of care homes in order to improve prevention strategies.

Aged↗
PubMed2000

Thrombolysis.

The most widely studied thrombolytic drugs in stroke have been streptokinase (SK) and alteplase. The three large trials with streptokinase were terminated prematurely. The combined results reveal an early increased risk of cerebral haemorrhage and death, with no net benefit at final follow-up, even in subgroups. Some controversy persists, however. The dose may have been inappropriately high, very early treatment has not been fully tested, and concomitant use of aspirin or heparin may have contributed to the deleterious effect. Even so, there is no evidence to guide the choice of a lower dose, streptokinase predisposes to a prolonged anticoagulant effect, and is associated with hypotension which may offset any benefit. The four large alteplase trials in acute stroke were more encouraging. The NINDS study was clearly positive and supporting evidence comes from the two ECASS trials when subjected to meta-analysis. The trials have shown additional functional recovery in 0.6% of patients receiving SK within 6 h and in 7.6% with alteplase, at the expense of excess mortality of 1.1% for alteplase and 11.7% for SK. There was an absolute cerebral haemorrhage excess of 10.7% with SK and 8% for alteplase. If alteplase use is restricted to < 3 h from stroke onset, the NNT is 10.7 with no excess mortality; later treatment (3-6 h) gives an NNT of 26 and absolute mortality of 3.4%. Finally, early fibrinogen depletion with ancrod also appears to have beneficial effects when treatment is started within 3 h of stroke onset. Further trials are still required to establish, inter alia, the outer limit of the therapeutic window, to identify sub-groups of patients in whom clear benefit (or harm) exists and to establish appropriate management protocols for concomitant treatment. Thrombolysis with alteplase within 3 h of stroke onset may be considered for patients in whom haemorrhage and established infarction have been excluded. Trained assessment is essential, since there is an increased risk of haemorrhagic conversion that may be fatal. Patients considering thrombolytic treatment should appreciate that 1 in 10 patients have improved outcome, 1 in 20 suffer haemorrhagic conversion and 1 in 100 may die as a result of treatment. Treatment much later than 3 h from stroke onset in unselected patients is as likely to kill as to cure.

Clinical Trials as Topic↗
PubMed1994

[Prevention of coronary heart disease in familial hypercholesterolemia].

Familial forms of isolated hypercholesterolemia are inherited autosomal-dominantly and are caused by defects of the low-density lipoprotein (LDL) receptor protein or its ligand, the apolipoprotein B-100, the exclusive apolipoprotein moiety of the LDL particles. Mutations at the LDL receptor gene locus (more than 150 different mutations have been described up to now) lead to familial hypercholesterolemia (FH); the only mutation at the apolipoprotein B-100 gene locus described in detail so far leads to the so-called familial defective apolipoprotein B-100 (FDB). Both lipid disorders are characterized by an increased risk for premature atherosclerosis involving primarily the coronary arteries. An increased risk for coronary heart disease can be expressed statistically by the excess mortality. In particular, individuals between the age of 20 and 59 are affected by an excess mortality; coronary deaths are approximately 100 times more frequent in patients between 20 and 39 with familial forms of hypercholesterolemia than within the normal population. On the other hand, in patients with myocardial infarctions before the age of 60, the diagnosis of FH is approximately 20 to 30 times more frequent than within the normal population. A regression of cardiovascular lesions subsequent to an intensive lipid-lowering therapy has clearly been demonstrated in patients with familial forms of hypercholesterolemia. Because of the serious prognosis of untreated familial forms of isolated hypercholesterolemia with respect to longevity, it is important to identify patients and their relatives with FH and FDB as early as possible and to treat them, besides a lipid-lowering diet, intensively with lipid-lowering drugs.

Adult↗
PubMed2000

Mortality in Western Australian psychiatric patients.

BACKGROUND: The aim was to examine mortality in psychiatric patients in Western Australia (WA), over a time period of considerable change in the delivery of mental health services. METHODS: A population-based record linkage analysis was undertaken to quantify mortality among people with mental illness in WA. Mortality rates were calculated in users of mental health services and compared with rates in the whole population of WA. Trends in mortality were also examined using relative survival analysis, and proportional hazards regression. RESULTS: The overall mortality rate ratio was 2.57 in males (95% CI: 2.51-2.64), and 2.18 in females (2.12-2.24). The highest cause-specific mortality rate ratio was for deaths due to suicide [RR: 7.37 in males (95% CI: 6.74-8.05) and 8.38 in females (95% CI: 7.11-9.89)], with mortality rate ratios being significantly greater than 1 for all other major causes of death. A relative survival analysis found that the excess mortality risk was concentrated in the first few years after first contact with mental health services. Proportional hazards regression analysis found a slight elevation of mortality rates over time. CONCLUSIONS: Mortality among psychiatric patients remains high and appears to be increasing. Highest excess mortality rate is associated with suicide, but mortality rates are significantly elevated for all major causes of death.

Female↗