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PubMed1977

Mortality from cardiovascular diseases among diabetics.

A retrospective analysis of a cohort of 5210 diabetic patients revealed a mortality rate 1.3 times higher than in the general population of Warsaw. The higher death rate in the cohort under study was mainly due to an excess mortality from coronary heart disease and cerebrovascular disease. The excess mortality was greater in men than in women. Th risk of death from cardiovascular diseases was higher among the patients with early onset diabetes. Mortality from cerebrovascular disease was highest in patients treated with insulin, intermediate in the group treated with oral drugs, and lowest in the group treated only with diet. The mortality ratio from coronary heart disease in men was not related to the method of hypoglycaemic therapy given at the onset or during the course of the diabetes. In women, the highest mortality was in the group treated with insulin, intermediate in the group treated with oral agents, and lowest in the group treated with diet only.

Adolescent↗
PubMed1989

Further results from a census based mortality study of fertiliser manufacturers.

The results of a further follow up of two cohorts of men identified as manufacturers of fertilisers in the 1961 and 1971 censuses of England and Wales are reported. Both cohorts have now been followed up until 1985 through the National Health Service Central Register. In the 1961 cohort the previous findings are replicated--low mortality from all causes, all cancers, and all circulatory diseases, and no evidence of dose response relation nor excess mortality from cancer at any site. In the 1971 cohort there remain more deaths from cancer than expected but none of the observed deaths from individual cancers differs significantly from expectation by comparison with national mortality rates or rates for other employed men. Evidence of an association between cancer mortality and frequency of exposure to nitrate containing dust is strengthened in the reanalysis of the 1971 cohort after longer follow up, but a negative trend, significant for digestive organ cancers, is observed in the analysis by product type in which manufacturers of straight nitrogen and compound fertilisers might have been expected to be most at risk. Failure to find specifically any excess mortality from gastric cancer and the contradictory dose response relations, weigh against the notion that the nonsignificant excesses of cancers in the 1971 cohort are related to nitrate exposure.

Air Pollutants, Occupational↗
PubMed1985

Mortality among a sample of chemical company employees.

A general mortality survey was done on a 5% random-start systematic sample (N = 1,666) of present and former white male employees of a Texas chemical plant. The purpose was to determine whether there were any unusual patterns of cause-specific mortality that would require further research with case-control studies. Mortality risks were examined by duration of employment and year of hire as surrogates for more specific exposure data. Among all employees in the sample, there was significant excess mortality due to All Cancer, Ill-Defined Conditions, and All External Causes of Death, and a significant deficit from All Circulatory Diseases. The excess mortality from All Cancer was primarily attributable to excess cancers of the kidney, lung, and pancreas. The excesses for lung and kidney cancer were statistically significant. Those employed for 1 year or more experienced significantly lower mortality from All Causes than those employed for less than 1 year.

Adult↗
PubMed1976

Do you die from rheumatism? The five-year mortality in a middle-aged population sample with respect to reported joint symptoms.

With special reference to reported joint symptoms, the five-year mortality was studied of a population sample of 3394 persons, 56-60 years old in 1965. An age- and sex-matched comparison was made between the mortality of the total population of the same age-group, and the sample investigated. A significant excess mortality was found for males reporting previous hospital admission for "rheumatoid arthritis". In this group, however, only 28% really had rheumatoid arthritis according to generally used criteria. The other diseases were mainly previous rheumatic fever and degenerative joint disease. It is concluded that males are harder hit by degenerative joint disease than females. The sample investigated had a lower mortality than the population from which it was sampled. The comparability of a fixed sample and a mean population found in official statistics is discussed. The non-response group was estimated to have a considerable excess mortality.

Arthritis, Rheumatoid↗
PubMed1990

Occurrence of non-gastric cancer in the digestive tract after remote partial gastrectomy: analysis of an Amsterdam cohort.

If peptic ulcer surgery favors the formation of carcinogenic N-nitroso compounds in the gastric remnant, an increased risk of cancer at sites in the gastrointestinal tract distant from the stomach might be predicted. To estimate the risk of carcinomas in the digestive tract, other than the stomach, occurring after partial gastrectomy, we analyzed an Amsterdam cohort of 2,633 post-gastrectomy patients operated on for benign disease between 1931 and 1960. Mortality in the study population was compared with the general Dutch population through person-year analysis. An excess mortality of biliary tract cancer (O/E:2.64; CL:1.32-4.72; p less than 0.01) and pancreatic cancer (O/E:1.65; CL:1.06-2.44; p less than 0.05) was found in males more than 5 years after surgery; females showed only an increased risk of pancreatic cancer in the first 5 years postoperatively (O/E:15.33; CL:1.85-55.43; p less than 0.01), probably due to misdiagnosis. All other non-gastric sites of the digestive tract carried no increased risk for cancer. In males, mortality due to colorectal cancer more than 5 years post-operatively was significantly decreased (O/E:0.58; CL 0.34-0.92; p less than 0.01). The excess mortality of biliary-tract and pancreatic cancer in males, which increases with the duration of post-operative interval, is consistent with a dose-response phenomenon. This study therefore supports the hypothesis that carcinogens are not only locally activated in the gastric remnant, but are hepatically excreted and initiate cancer in the biliary tree and pancreatic duct. Further exploration of this mechanism of carcinogenesis is warranted, since it may also explain the pathogenesis of pancreatic and biliary cancers in patients without gastrectomy.

Biliary Tract Neoplasms↗
PubMed1994

Follow-up study of chrysotile asbestos textile workers: cohort mortality and case-control analyses.

Previous studies of mortality among white males employed in a Charleston, South Carolina asbestos textile plant using chrysotile demonstrated significant excess mortality due to asbestos-related disease and a steep exposure-response relationship for lung cancer. This cohort was further studied by adding 15 years of follow-up and including mortality among white female and black male workers. Nested case-control analyses were undertaken to further explore possible differences in lung cancer risk by textile operation as well as possible confounding by mineral oil exposures. Preliminary data for white males have been previously published. White males experienced statistically significant excess mortality due to lung cancer (standardized mortality ratio [SMR] = 2.30; confidence interval [CI] = 1.88-2.79), all causes (SMR = 1.48; CI = 1.38-158), all cancers (SMR = 1.50; CI = 1.29-1.72), diabetes mellitus (SMR = 2.05; CI = 1.18-3.33), heart disease (SMR = 1.41; CI = 1.26-1.58), cerebrovascular disease (SMR = 1.50; CI = 1.08-2.02), pneumoconiosis and other respiratory diseases (SMR = 4.10; CI = 3.10-5.31), and accidents (SMR = 1.49; CI = 1.15-1.91). Among white females, statistically significant excesses occurred for lung cancer (SMR = 2.75; CI = 2.06-3.61), all causes (SMR = 1.21; CI = 1.11-1.32), pneumoconiosis and other respiratory diseases (SMR = 2.40; CI = 1.53-3.60), and other respiratory cancers (SMR = 14.98; CI = 4.08-38.7). Among the total cohort of black males, the only statistically significant excess observed was for pneumoconiosis (SMR = 2.19; CI = 1.23-3.62). Based on historical exposure measurements at the plant, there was a positive exposure-response relationship for both lung cancer and pneumoconiosis. Data for the entire cohort demonstrate an increase in the lung cancer relative risk of 2-3% for each fiber/cc-year of cumulative chrysotile exposure. This relationship was more consistent for the white male workers. The excess risk for lung cancer among white males and females appeared to occur at cumulative exposures lower than those for black males. Possible reasons for the lesser lung cancer risk among black males include less smoking and differences in airborne fiber characteristics experienced by black males as a result of plant job placement patterns. The case-control analysis found employment in preparation and carding operations (where most of the black males worked) to be associated with a slightly reduced lung cancer risk, although not statistically significant, whereas spinning and twisting employment was associated with a statistically significant increased lung cancer risk compared to other plant operations.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗
PubMed1996

Mortality and medical comorbidity among psychiatric patients: a review.

OBJECTIVES: To fuel advocacy for improved health care for mentally ill persons, the authors reviewed the literature that describes excess mortality and underrecognition and undertreatment of comorbid medical conditions in this population. Barriers to optimal primary medical care for psychiatric patients are discussed. METHODS: A MEDLINE search focusing on mortality and medical problems in psychiatric patients yielded 66 papers in English published between 1934 and 1996. These studies and a German paper from 1912 are included in the review. RESULTS AND CONCLUSIONS: Standardized mortality ratios for psychiatric patients, derived from comparisons with the general population and matched control groups, have repeatedly demonstrated excess mortality from both natural and unnatural causes among psychiatric patients. Several large studies that have attempted to clarify the issues underlying increased death rates are discussed. Although no single diagnostic group emerges as being at particularly high risk, substance abuse disorders alone or in combination with other psychiatric disorders have been repeatedly found to lead to increased mortality rates. Other studies have also repeatedly demonstrated that psychiatric patients suffer a high rate of comorbid medical illnesses, which are largely undiagnosed and untreated and which may cause or exacerbate psychiatric symptoms. Atypical presentations are common, and changes in vision are the symptoms most predictive of medical illness. Elderly patients and those with diagnoses of organic brain syndromes are at highest risk for comorbid medical illness. Parity in the medical and mental health treatment of psychiatric patients requires both political advocacy and development of primary care programs capable of efficiently meeting their needs.

Adult↗
PubMed2003

Mortality in parents after death of a child in Denmark: a nationwide follow-up study.

BACKGROUND: Little is known about the effect of parental bereavement on physical health. We investigated whether the death of a child increased mortality in parents. METHODS: We undertook a follow-up study based on national registers. From 1980 to 1996, we enrolled 21062 parents in Denmark who had a child who had died (exposed cohort), and 293745 controls--ie, parents whose children were alive, and whose family structure matched that of the exposed cohort. Natural deaths were defined with ICD8 codes 0000-7969 and ICD10 codes A00-R99, and unnatural deaths with codes 8000-9999 and V01-Y98. We used Cox's proportional-hazards regression models to assess the mortality rate of parents up to 18 years after bereavement. FINDINGS: We observed an increased overall mortality rate in mothers whose child had died (hazards ratio 1.43, 95% CI 1.24-1.64; p<0.0001). An excess mortality from natural causes (1.44, 1.15-1.78; p<0.0001) was noted in mothers only during the 10th-18th year of follow-up. Mothers had increased mortality rates from unnatural causes throughout follow-up, with the highest rate recorded during the first 3 years (3.84, 2.48-5.88; p<0.0001). Bereaved fathers had only an early excess mortality from unnatural causes (1.57, 1.06-2.32; p=0.04). Mothers who lost a child due to an unnatural death or an unexpected death had a hazard ratio of 1.72 (1.38-2.15; p=0.0040) and 1.67 (1.37-2.03; p=0.0037), respectively. INTERPRETATION: The death of a child is associated with an overall increased mortality from both natural and unnatural causes in mothers, and an early increased mortality from unnatural causes in fathers.

Adolescent↗
PubMed2001

Cause-specific mortality in a cohort of patients with diabetes mellitus: a population-based study in Sweden.

A cohort of patients with diabetes mellitus hospitalised in Sweden from 1965 to 1983 was followed up until 1989, by linkages of population-based registers. Standardised mortality ratios (SMR), adjusted for confounding variables, and 95% confidence intervals (CIs) were calculated. After exclusion of the first year of follow-up (to reduce the effect of selection bias), the cohort consisted of 144,427 patients, of whom 92,248 patients died during follow-up. The SMR for all causes of death combined was 2.62 (95% CI 2.58-2.67) among men and 3.23 (95% CI 3.18-3.28) among women. The excess mortality was still evident 20 years after first hospitalisation, but became less marked with longer follow-up time. Patients with presumably insulin-dependent diabetes mellitus (IDDM) had the highest SMRs (10.2; CI 9.5-11.0); however, there was a significant (34%) improvement over time in their mortality risk. We conclude that excess mortality persisted throughout all calendar periods and at all ages, indicating the need for health care prevention measures.

Adult↗
PubMed2000

Winter mortality in relation to climate.

We report further details of the Eurowinter survey of cold related mortalities and protective measures against cold in seven regions of Europe, and review these with other evidence on the relationship of winter mortality to climate. Data for the oldest subject group studied, aged 65-74, showed that in this vulnerable group, high levels of protection against indoor and outdoor cold at given outdoor temperatures were found mainly in countries with cold winters, and were associated with low levels of excess mortality at a given level of outdoor cold. Regions such as London that had poor protection against cold and/or high baseline mortalities had higher levels of winter excess mortality than expected for the coldness of their winters.

Aged↗
PubMed1994

Survival of patients with multiple sclerosis in Denmark: a nationwide, long-term epidemiologic survey.

We estimated survival probability and excess death rates for patients with MS on the basis of data from the Danish Multiple Sclerosis Registry, which includes virtually all patients diagnosed with MS in Denmark (population, five million) since 1948. We reviewed and reclassified all case records according to standardized diagnostic criteria. By linkage to the Danish Central Population Registry, we lost to follow-up only 25 patients who had emigrated. The median survival time from onset of the disease was 28 years in men (compared with 40 years in the matched general male population) and 33 years in women (versus 46 years). The median survival time from diagnosis was 22 years in men (versus 37 years) and 28 years in women (versus 42 years). The excess death rate between onset and follow-up (observed deaths per 1,000 person-years minus the expected number of deaths in a matched general population) was 14.3 in men, which was significantly higher than in women (12.0). Excess mortality increased with age at onset of MS in people of each sex. The 10-year excess death rate has decreased significantly in recent decades. Excess mortality was highest in cases with cerebellar symptoms at onset.

Adult↗
PubMed1995

[Survival in disseminated sclerosis in Denmark. A nation-wide study of the period 1948-1986].

We estimated survival probability and excess death rates for patients with multiple sclerosis (MS) on the basis of data from the Danish Multiple Sclerosis Registry, which includes virtually all patients diagnosed with MS in Denmark since 1948. We reviewed and reclassified all case records according to standardized diagnostic criteria. By linkage to the Danish Central Population Registry and the National Registry of Causes of Death complete follow-up of all MS patients was achieved, with the exception of 25 patients who had emigrated. A total of 2300 of the 6727 MS patients included in the study had died before the onset of the disease was 28 years in men (compared with 40 years in the matched general male population) and 33 years in women (versus 46 years). The excess death rate between onset and follow-up (observed deaths per 1000 person-year minus the expected number of deaths in a matched general population) was 14.3 in men, which was significantly higher than in women (12.0). Excess mortality increased with age at onset of MS in people of each sex. The 10-year excess death rate has decreased significantly in recent decades. Excess mortality was highest in cases with cerebellar symptoms at onset.

Adult↗
PubMed1991

Trends in cancer incidence, survival and mortality in northern Sweden 1960-1986.

The impact of cancer on a population may be measured in several ways. Incidence, relative survival and mortality are frequently utilized for this purpose. Incidence and relative survival are, however, often influenced by changes in the diagnostics of incident cancer, particularly by an altered rate of detection of non-fatal cancer. Mortality, as traditionally studied, is often influenced by changes of death causes diagnostics or of coding routines. In an attempt to overcome some of these difficulties, the concept of excess mortality was suggested, which is independent of death cause diagnoses or coding routines, as well as of the rate of detection of non-fatal cancer. In order to elucidate time trends in the overall effects of cancer we analysed incidence, survival and mortality from all cancer in the northern region of Sweden 1960-1986. An increasing age-adjusted cancer incidence was paralleled by an improvement in relative survival, whereas age-adjusted cancer mortality was mainly unchanged, at least when studied as excess mortality. We interpreted these findings as due mainly to an increased detection of non-fatal cancer, and to an unchanged occurrence rate of fatal cancer.

Adolescent↗
PubMed1996

Weight fluctuation, mortality and vascular disease in Pima Indians.

OBJECTIVE: To examine the relationship of weight fluctuation to mortality rates and incidence of vascular disease. SUBJECTS: A cohort of Pima Indians, 572 of whom had non-insulin-dependent diabetes mellitus and 766 without diabetes. DESIGN: Individuals were invited biennially to research examinations. The root mean square error (RMSE) of the linear trend of weight with time for the first four examinations after age 20 years was used as an index of weight fluctuation. Subjects were followed from the fourth examination until death or until 31 December 1991. The mortality rate ratio (MRR) and its 95% confidence interval (CI) for those with a high weight fluctuation index relative to those with a lower value were determined. The median duration of follow up was 9.3 (range 0.1-22.6) years. MEASUREMENTS: All cause mortality (n = 356); incidence of diabetic retinopathy (n = 145), diabetic nephropathy (n = 132) and electrocardiographic abnormalities (n = 82). RESULTS: There was no significant relationship between weight fluctuation and mortality for diabetic subjects (MRR = 1.0, 95% CI 0.8-1.3, p = 0.91). Nondiabetic subjects with a high weight fluctuation index had a higher mortality rate than those with a lower index (MRR = 1.5, 95% CI 1.0-2.1, p = 0.03); the association was stronger among men than among women. The excess mortality in the high weight fluctuation group was not due to cardiovascular diseases, but to noncardiovascular causes and the risk for alcohol-related death was particularly increased. Weight fluctuation was not associated with the incidence of diabetic retinopathy, nephropathy or electrocardiographic abnormalities. CONCLUSIONS: A high weight fluctuation index was associated with higher mortality rates in nondiabetic, but not in diabetic, Pima Indians. The excess mortality is largely due to noncardiovascular causes of death and may reflect lifestyle factors associated with weight fluctuation, rather than its metabolic effects.

Adult↗
PubMed2006

Renal impairment and outcomes in heart failure: systematic review and meta-analysis.

OBJECTIVES: We estimated the prevalence of renal impairment in heart failure (HF) patients and the magnitude of associated mortality risk using a systematic review of published studies. BACKGROUND: Renal impairment in HF patients is associated with excess mortality, although precise risk estimates are unclear. METHODS: A systematic search of MEDLINE (through May 2005) identified 16 studies characterizing the association between renal impairment and mortality in 80,098 hospitalized and non-hospitalized HF patients. All-cause mortality risks associated with any renal impairment (creatinine >1.0 mg/dl, creatinine clearance [CrCl] or estimated glomerular filtration rate [eGFR] <90 ml/min, or cystatin-C >1.03 mg/dl) and moderate to severe impairment (creatinine > or =1.5, CrCl or eGFR <53, or cystatin-C > or =1.56) were estimated using fixed-effects meta-analysis. RESULTS: A total of 63% of patients had any renal impairment, and 29% had moderate to severe impairment. After follow-up > or =1 year, 38% of patients with any renal impairment and 51% with moderate to severe impairment died versus 24% without impairment. Adjusted all-cause mortality was increased for patients with any impairment (hazard ratio [HR] = 1.56; 95% confidence interval [CI] 1.53 to 1.60, p < 0.001) and moderate to severe impairment (HR = 2.31; 95% CI 2.18 to 2.44, p < 0.001). Mortality worsened incrementally across the range of renal function, with 15% (95% CI 14% to 17%) increased risk for every 0.5 mg/dl increase in creatinine and 7% (95% CI 4% to 10%) increased risk for every 10 ml/min decrease in eGFR. CONCLUSIONS: Renal impairment is common among HF patients and confers excess mortality. Renal function should be considered in risk stratification and evaluation of therapeutic strategies for HF patients.

Creatinine↗
PubMed1984

Using national mortality data to study the changing sex differential in mortality.

Sex differences in mortality vary widely among the developed countries. Male overmortality is highest in Finland and the USSR, followed closely by France, Poland, the USA and Canada. The differential is lowest in Japan, Ireland and in south-eastern Europe. The sex mortality ratio is highest at ages 15-24 years with a second peak generally occurring around age 60. The excess mortality of males at the younger ages is due largely to motor vehicle accidents while higher death rates from heart disease and lung cancer in particular account for a substantial proportion of male excess mortality during the later years of working life. During the course of the 20th century, the impact of sex differences in mortality from the infectious and parasitic diseases has declined, as has the contribution from maternal mortality. Males have also benefited from a decline in industrial accidents but this has been more than countered by rising death rates from heart diseases, lung cancer and motor vehicle accidents.

Adolescent↗
PubMed1977

Alcoholic females. II. Causes of death with reference to sex difference.

The aim of this study has been to explore and compare the mortality of 100 female and 100 male alcoholics, admitted to a department of alcoholic diseases in 1963-69. The patients were early cases and mortality was studied during an observation period of 6-12 years. A total of 18 women and 16 men died. As compared with the general population, mortality was 5.6 and 3.0 times higher than expected for the women and men, respectively. Among the women a significant excess mortality was found for accidents, suicides, diseases of the respiratory system, and especially cirrhosis of the liver. Mortality among the men was significantly higher than expected due to suicides, diseases of the circulatory system, neoplasms, chronic alcoholism, and acute alcohol poisoning. The excess mortality from suicides found for both sexes was highest in the female group. Despite the hitherto rather small number of deaths in the two groups, the high frequency of cirrhosis of the liver among the women is striking.

Accidents↗
PubMed1977

Mortality of male members of the Danish Semi-skilled Unskilled Workers' Union in 1973.

The purpose of this cross-sectional study is to evaluate contemporary age and cause specific mortalities of a large group of employed men. The population is the 228,612 male members, aged 20-64, of Denmark's largest trade union, the Semi-skilled and Unskilled Workers' Union (SID). A Standard Mortality Ratio (SMR) of 93.9 compared to all men in Denmark is found. However, the distribution of mortality by age does not resemble that found in many other studies, and is usually said to result from the 'healthy worker effect'. Excess mortality is found in the younger age groups, while the opposite is the case in the older groups, mainly because of a deficit of deaths from chronic illness. Notably higher age and cause specific SMRs are found for violent and unnatural deaths, and higher SMRs for cancer of the lungs and of lymphatic and haemopoietic tissues. Regional variations are found, but no correlation found between mortality and size of union 'local'. However, cancer mortality is higher among members of specialized locals, which are situated in larger urban area. The excess mortality of members of the largest locals in the Copenhagen area is due to deaths by cancer and by violent and unnatural causes. Findings and problems will be examined further in an ongoing cohort study and in other specialized studies under preparation.

Adult↗