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PubMed1996

Mortality of patients who dropped out from regular lithium prophylaxis: a collaborative study by the International Group for the Study of Lithium-treated patients (IGSLI).

Excess mortality has repeatedly been found in patients with recurrent affective disorders. In previous studies our group has shown that during long-term lithium treatment the mortality of such patients is not significantly higher than that of the general population. In the present study, we extended our investigation to 273 patients from the earlier IGSLI cohort who subsequently dropped out from regular lithium prophylaxis. The standardized mortality ratio (SMR) for the whole group was 2.5, significantly higher (P < 0.01) than 1.0, which is the SMR of the general population. Furthermore, the SMR of the patients from each of the participating countries, namely Denmark, Germany and Austria, was significantly higher than 1.0. These findings strengthen the evidence accumulated in previous investigations that regular long-term lithium treatment does in fact markedly reduce the excess mortality of patients with recurrent affective disorders.

Antimanic Agents↗
PubMed1987

Mortality of tar distillation workers.

Two hundred and fifty-five British tar distillery workers were followed from 1 January 1967 to 31 December 1983. Seventy-five men had died by the end of the follow-up, compared with 73.3 deaths expected on the basis of age-specific regional population death rates. Excess mortality occurred from lung cancer (12 deaths, 7.5 expected), bladder cancer (3 deaths, 0.7 expected) and diseases of the arteries and veins (5 deaths, 2.1 expected). Although the number of deaths from ischemic heart disease was not significantly increased overall (29 deaths, 25.3 expected), eight deaths from this cause occurred among men under 55 years of age compared with 3.9 expected. Four small matched case-referent studies, comparing men who died from these four causes with survivors, failed to reveal any associations between excess mortality and job type. In the light of other studies, it is concluded that the excess lung and bladder cancer mortality was work-related, while the deaths from ischemic heart disease and diseases of the arteries and veins merit further investigation.

Aged↗
PubMed1996

Mortality among patients with schizophrenia.

Results from a 40-year followup study of psychotic patients are presented to illustrate some of the major findings and unanswered questions about excess mortality in schizophrenia and to suggest analytical approaches that take full account of the potential effects of sample heterogeneity. In this study, hospital-diagnosed schizophrenia patients were at increased mortality risk whether or not they met research criteria for schizophrenia. In addition, mortality outcomes of several major diagnostic groups were similar despite substantial clinical and demographic differences between the groups at baseline. These results suggest that both diagnosis-specific and nondiagnostic factors are needed to account for excess mortality in patients with major psychiatric disorders. The issue of heterogeneity is also crucial for the clinical purposes of predicting and ultimately reducing the mortality risk of psychiatric patients, for example, in delineating profiles of high-risk patients who are not necessarily typical of other patients with the same diagnosis.

Adult↗
PubMed1981

Long-term prognosis after transient ischemic attacks.

A retrospective follow-up study of 243 patients with transient ischemic attacks (TIA) is reported. The long-term mortality of the patients was higher than that of the corresponding general population. It is demonstrated that the excess mortality over the whole period of observation, irrespective of the age and sex of the patients, can be characterized by a single figure expressing the slope of the curve obtained by semilogarithmic plotting of the ratios of observed to expected survival against time. The use of this numerical expression--in the present series -0.04--will thus facilitate comparisons of the survival of TIA patients drawn from different populations. Unfavourable prognostic factors were: carotid TIA, associated extracerebral disease, and a history of hypertension. Fatal strokes, being four times as frequent as expected according to published incidence figures, accounted for 20% of the deaths, heart disease 38%. Stroke deaths tended to occur earlier than cardiac deaths. The results support the concept that most TIAs, like strokes, are incidents in the progressive course of a generalized vascular disease. The finding of a constant excess mortality over the years following a TIA makes it difficult to recommend a discontinuation of prophylactic therapy at any particular time.

Age Factors↗
PubMed2001

Mortality of opiate users in Vienna, Austria.

The purpose of this study was to investigate whether there are differences in overall and cause-specific mortality rates of opiate users in maintenance treatment and of opiate users not in any drug treatment program in Vienna, Austria. A cohort of opiate-users enrolled in maintenance treatment in Vienna and a cohort of individuals involved in opiate-related emergencies from 1995 to 1997 were retrospectively analyzed. The standardized mortality rate of opiate-users enrolled in maintenance treatment was 12.1 and that of individuals involved in opiate-related emergencies was 48.8. Excess mortality was found for all categories for both groups. In the face of the extremely high excess mortality of opiate users involved in opiate-related emergencies, measures have to be taken to get these individuals in drug treatment programs as soon as possible.

Adolescent↗
PubMed1998

Income inequality and mortality in metropolitan areas of the United States.

OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.

Adolescent↗
PubMed2002

Mortality among Japanese construction workers in Mie Prefecture.

AIMS: A historical cohort mortality study was conducted among 17 668 members of the Construction Workers' Health Insurance Society of Mie Prefecture in Japan, in order to verify the relation between occupations and mortality status. METHODS: The cohort was followed from 2 April 1973 to 1 April 1998. Standardised mortality ratios (SMR) were calculated for all members and each job classification. RESULTS: 98.7% of the members were traced successfully until the date when the follow up terminated. When all members were considered together, significant excess mortality was observed for "accidents and adverse effects". Significant excess mortalities were also observed for lung cancers among scaffold men and ironworkers, for cancer of the oesophagus among plumbers, and for "chronic liver disease and cirrhosis" among scaffold men and painters. CONCLUSION: Results suggest that more detailed investigations, which would include some minor job classifications should be undertaken. This is an updated cohort study which was partially completed in 1997.

Accidents, Occupational↗
PubMed2004

Mortality in rheumatoid disease.

This paper provides an overview of rheumatoid disease from the perspective of its impact on mortality. The term, rheumatoid arthritis, may promote the misconception that this disease is relatively trivial and easily managed; therefore, "rheumatoid disease" is preferred. Numerous long-term studies in many settings have established that significant excess mortality is associated with rheumatoid disease, and that this excess mortality is related to cardiovascular disease deaths. Inflammation in rheumatoid and cardiovascular diseases shares the same biologic mechanisms. Severity of extraarticular disease, decline in functional level, and level of inflammatory activity are associated with increased risk of mortality. Detection and measurement of novel inflammatory biomarkers may provide tools to assess prognosis and to monitor therapy. Close attention to the management of traditional cardiovascular risk factors is essential in these patients. Whether disease modifying antirheumatic drug (DMARD) therapy will reduce all-cause and cardiovascular disease mortality in rheumatoid disease is the subject of ongoing studies.

Arthritis, Rheumatoid↗
PubMed1981

Prognosis of diabetes mellitus in a geographically defined population.

The centralised registration and care of all diabetics in a geographically defined population has provided an epidemiological basis for a longitudinal investigation of the prognosis of this disease. Records of all newly diagnosed diabetics who had been registered in the Erfurt district (population 1.25 million) in 1966 were studied in relation to the time period 1966-1976. Of the known 2,560 diabetics (910 men, 1,650 women; 93.7% greater than 40 years of age), 1,054 had died during the 10-year follow-up period. Cardiovascular causes accounted for the majority of deaths (63%). In almost all age classes proportionally more men than women had died at follow-up; there was a significant difference in the 60-69 year group (men 61.6%, women 46.2%). In comparison with the general population, excess mortality ranged from 2.1 to 1.0, decreasing with age at onset without significant differences between men and women. Excess mortality was present in most age classes and was evident within the first year after diagnosis. Current life-table analysis confirmed the shortened life expectancy of the diabetics. The lower life expectancy of noninsulin-dependent diabetics may not be due to hyperglycaemia alone but probably also involves a variety of atherongenic risk factors.

Adolescent↗
PubMed2005

Selecting criteria for monitoring patients with rheumatoid arthritis.

Four treatment objectives govern the management of rheumatoid arthritis (RA): to control the clinical manifestations, to prevent structural damage, to prevent functional impairments, and to reduce excess mortality. Disease activity determines the extent of structural damage, the severity of functional impairments, and in part the excess mortality related to cardiovascular disease. In established RA, the functional impairments depend also on the extent of the structural damage. Methods for assessing disease activity, treatment responses, structural damage, and functional impairments are reviewed herein. A standardized follow-up protocol is suggested as a means of achieving greater uniformity in clinical practice.

Arthritis, Rheumatoid↗
PubMed1991

Cultural and economic determinants of geographical mortality patterns in The Netherlands.

STUDY OBJECTIVE: The geographical pattern of mortality in The Netherlands is dominated by an area of relatively high mortality in the southern part of the country. The aim was to analyse the background of this geographical mortality pattern in the early 1980s, and its evolution over time since the early 1950s. DESIGN: Mortality data by district (n = 39), cause of death (13 large causes, "symptoms and ill defined conditions", all other causes), and time period (1950-54, 1960-64, 1970-74, 1980-84) were available from the Netherlands Central Bureau of Statistics. Standardised mortality ratios were calculated, and the logarithms of these were related to three sociodemographic characteristics using multiple, ordinary least squares regression analysis. SETTING: This study used data for the whole Dutch population. MAIN RESULTS: Although the geographical mortality pattern has been rather stable over the last decades, a clear tendency towards convergence is also apparent. Approximately 90% of the current excess mortality in the southern part of the country is due to cardiovascular diseases. The results of regression analysis show that the excess mortality is primarily related to the high percentage of Roman Catholics in this part of the country, and additionally to a slightly lower average income. In The Netherlands, a higher percentage of Roman Catholics in the population is linked with higher all cause mortality rates, as well as with higher mortality rates for lung cancer, ischaemic heart disease, cerebrovascular disease, arterial disease, and chronic non-specific lung disease. Survey data show that these associations are partly due to a higher prevalence of smoking among Roman Catholics. As in many other countries, a lower average income is linked with high all cause mortality rates in The Netherlands. Cause specific data show negative associations for stomach cancer, ischaemic heart disease, cerebrovascular disease, chronic non-specific lung disease, and traffic accidents. Since the early 1950s the association between geographical mortality patterns and the percentage of Roman Catholics in the population has gradually become less strongly positive. This suggests that the convergence of the mortality rates in the South towards the national average may be related to a gradual lessening of differences in lifestyle between population groups. CONCLUSIONS: Both cultural and economic factors are important in the explanation of geographical mortality patterns in The Netherlands.

Adolescent↗
PubMed1983

The relation of coronary disease, stroke, and mortality to weight in youth and in middle age.

During ten years of follow-up 701 deaths occurred among 8006 45-68-year-old Honolulu Japanese men who were originally examined in 1965-68. Mortality was highest in both the leanest and fattest men and lowest in the fourth quintile of body mass index (BMI). The excess deaths in the top quintile were due primarily to coronary heart disease which was directly and positively related to BMI. In the bottom two quintiles excess mortality was due to cancer and "other" causes and was confined to men who had lost weight between age 25 and examination. This finding suggests that excess mortality in thin middle-aged men is due to occult antecedent disease rather than leanness per se. When BMI at age 25 was considered, men in the bottom quintile had the lowest mortality in middle age. It is concluded that upward revision of tables of desirable weight for young men would be unwarranted. A modest increase in the upper limit in middle-aged men may be justifiable, but the evidence is incomplete.

Adult↗
PubMedDate not supplied

Trends in invasive cutaneous melanoma in Saskatchewan 1970-1999.

BACKGROUND: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possible anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. OBJECTIVE: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. METHODS: Information about cases of primary cutaneous melanoma for the 30-year period 1970-1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. RESULTS: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors tht predicted excess mortality at five years were tumor thickness, Clark level, and gender. CONCLUSION: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristic (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.

Chi-Square Distribution↗
PubMed2001

Updated mortality study of workers at a petroleum refinery in Torrance, California, 1959 to 1997.

The updated cohort consisted of 3328 workers who were employed at the Mobil (now ExxonMobil) Torrance, California, refinery for at least 1 year between 1959 and 1997. The vital status of the cohort was determined through a variety of sources, including company employment or retirement records, the Social Security Administration's Death Master File, and the National Death Index. The updated study covered an observation period of 38 years from 1960 to 1997, with a total of 60,612 person-years of observation. A total of 705 (21.2%) cohort members were identified as having died. Mortality data were analyzed in terms of cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs), with expected deaths based on US national cause-, gender-, race-, year-, and age-specific mortality rates. The overall mortality of the cohort was significantly lower than expected when compared with the US general population (SMR, 81.9; 95% CI, 76.0 to 88.2). Overall cancer mortality was also lower than expected (SMR, 79.8; 95% CI, 67.9 to 93.1). For specific cancer sites, significant mortality deficits were observed for cancer of the digestive system (SMR, 70.9; 95% CI, 49.4 to 98.6) and cancer of the respiratory system (SMR, 74.1; 95% CI, 55.5 to 97.0). No significant increase was reported for any site-specific cancer. For nonmalignant diseases, no significant increase was observed for any cause. In particular, significant mortality deficits were reported for ischemic heart disease (SMR, 87.7; 95% CI, 77.2 to 99.3), chronic endocardial disease and other myocardial insufficiencies (SMR, 8.3; 95% CI, 0.2 to 46.0), all other heart disease (SMR, 64.2; 95% CI, 43.0 to 92.2), and influenza and pneumonia (SMR, 59.2; 95% CI, 33.1 to 97.6). Detailed analysis by length of employment did not reveal any significant mortality excess or upward trend. Analyses of male employees by job classification (process and maintenance) were conducted. Among maintenance workers, mortality from cirrhosis of the liver (SMR, 190.1; 95% CI, 101.2 to 325.1) and suicide (SMR, 208.6; 95% CI, 111.1 to 356.7) were significantly elevated. However, these mortality excesses did not seem to be related to employment at the refinery. No other causes of death showed significant increase among maintenance workers. A similar separate analysis was conducted for process workers, and no significant excess was detected for any cause. The findings from the present study are discussed in conjunction with results from previous investigations of employees at the Torrance refinery and with results from other refinery studies. Potential limitations of the study are also discussed.

Adult↗
PubMed2004

Ten-year mortality and glucose tolerance status in an elderly Finnish population.

The aim of this study was to determine the 10-year mortality rate of an elderly population aged 70 years or over (n=379) with reference to glucose tolerance status, taking into account other determinants of excess mortality. The baseline examination during 1991-1992 included a postal questionnaire, a physical examination and a 2h OGTT, which was classified according to both the 1985 WHO criteria and the 1999 WHO criteria. Follow-up was continued until death or until 31 December 2001. 66% of men and 51% of women died within 10 years. In men, the cumulative mortalities were 84% for previously diagnosed diabetes, 67% for undiagnosed diabetes, 67% for impaired glucose tolerance (IGT) and 60% for normal glucose tolerance (NGT). The corresponding percentages for women were 76, 52, 49, and 40%. Male gender, poor self-rated health and previously diagnosed diabetes were the most powerful predictors of mortality. When adjustments were made for age, gender, BMI, cardiovascular disease, hypertension, physical exercise and self-rated health, the estimated relative mortality rate was 2.0 (95% CI 1.5-2.7) among previously diagnosed diabetic subjects, 1.3 (CI 0.8-2.2) among undiagnosed diabetic subjects and 1.1 (0.8-1.5) among IGT subjects compared to NGT subjects. These relative mortalities were higher in women than in men. When abnormal glucose tolerance was pooled into one category, the OR for excess mortality was 1.4 (95% CI 1.1-1.9).

Aged↗
PubMed1990

Cohort mortality study of Seattle fire fighters: 1945-1983.

Fire fighters are known to be occupationally exposed to many toxic substances. However, the limited number of previous studies has not demonstrated any consistent excess mortality from diseases of a priori concern, such as lung cancer, non-malignant respiratory disease, and cardiovascular disease. We studied 2,289 Seattle fire fighters from 1945 through 1983, and observed 383 deaths. Excess mortality from leukemia (SMR = 503, n = 3) and multiple myeloma (SMR = 989, n = 2) was observed among fire fighters with 30 years or more fire combat duty. Lung cancer mortality was elevated (SMR = 177, n = 18) among fire fighters 65 years old or older. We also analyzed the data by considering fire fighters at risk only after 30 years from first exposure. In this analysis, a trend of increasing risk with increasing exposure was observed for diseases of the circulatory system. For this cause of death, fire fighters with 30 years or more fire combat duty had a relative risk of 1.84 compared to those with less than 15 years of fire combat duty.

Cause of Death↗
PubMed1991

Premature death among outpatients at a community mental health center.

In a ten-year prospective study, mortality among psychiatric outpatients under age 40 was investigated in a sample of 322 Belgian patients who first visited a community mental health center in a district of Brussels between 1970 and 1973. Fifteen of the patients died before age 40. Compared with 15 matched controls from the group of living patients, the deceased patients had a higher incidence of concurrent physical illness and changed residence less frequently. The standardized mortality ratio for male patients in the study was 5.05 times greater than expected for a sample of the general population of Belgium, and for women it was 5.63 times greater. Not all of the excess mortality could be attributed to suicide. Results confirmed previous findings of excess mortality due to natural causes in this population and of the greater incidence of mortality during the first years of treatment.

Adolescent↗
PubMed2005

Season of death and birth predict patterns of mortality in Burkina Faso.

BACKGROUND: Mortality in developing countries has multiple causes. Some of these causes are linked to climatic conditions that differ over the year. Data on season-specific mortality are sparse. METHODS: We analysed longitudinal data from a population of approximately 35,000 individuals in Burkina Faso. During the observation period 1993-2001, a total number of 4,098 deaths were recorded. The effect of season on mortality was investigated separately by age group as (i) date of death and (ii) date of birth. For (i), age-specific death rates by month of death were calculated. The relative effect of each month was assessed using the floating relative risk method and modelled continuously. For (ii), age-specific death rates by month of birth were calculated and the mean date of birth among deaths and survivors was compared. RESULTS: Overall mortality was found to be consistently higher during the dry season (November to May). The pattern was seen in all age groups except in infants where a peak was seen around the end of the rainy season. In infants we found a strong association between high mortality and being born during the time period September to February. No effect was seen for the other age groups. CONCLUSIONS: The observed excess mortality in young children at or around the end of the rainy season can be explained by the effects of infectious diseases and, in particular, malaria during this time period. In contrast, the excess mortality seen in older children and adults during the early dry season remains largely unexplained although specific infectious diseases such as meningitis and pneumonia are possible main causes. The association between high infant mortality and being born at around the end of the rainy season is probably explained by most of the malaria deaths in areas of high transmission intensity occurring in the second half of infancy.

Adolescent↗