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PubMed1987

Validation of diagnoses on death certificates for male alcoholics in Stockholm.

The mortality and the causes of death have been studied in a cohort consisting of 1548 male alcoholics in Stockholm. During the period 1969-1981 there were 542 cases of death in this population. The mortality rates were triple those for males in Stockholm generally. Using the official causes of death there was a highly significant excess mortality in the following diagnostic groups: Cancer in the upper digestive region, primary hepatic cancer, cirrhosis in the liver, pancreatitis, pneumonia, alcoholism and alcoholic poisoning, suicides and other causes of violent death as well as ischemic heart disease. The underlying and contributing causes of death on the death certificates were reclassified according to ICD-rules using clinical records and autopsy protocols. It was found that the underlying cause of death was incorrect in 21.8% of the cases. Important information was withheld in further 19.8%. After validation there was no longer any excess mortality in ischemic heart disease. The number of alcohol-related diagnoses, i.e. alcoholic cardiomyopathy, cirrhosis and fatty liver with alcoholism and alcoholic intoxication, was much greater. It is concluded that there is a underreporting of alcohol-related diseases and injuries which has a great influence on the reliability of death statistics.

Adult↗
PubMed2005

The impact of the summer 2003 heat waves on mortality in four Italian cities.

This study evaluates the impact of the 2003 heat wave on cause-specific mortality and the role of demographic characteristics and socioeconomic conditions that may have increased the risk of mortality in four Italian cities: Bologna, Milan, Rome and Turin. Daily mortality counts, for the resident population by age, sex and cause of death were considered. Daily excess mortality was calculated as the difference between the number of deaths observed and the smoothed average. The impact of heat on health is measured in terms of maximum apparent temperature. The greatest excess in mortality was observed in the north west of Italy (Turin, +23% and Milan, +23%). The old (75-84 years) and the very old (85+ years) were the age groups most affected, and when stratifying by sex, the increase in mortality seemed to be greater among females. The greatest excess in mortality was registered in those with low socioeconomic status in Rome (+17.8%) and in those with lower education levels in Turin (+43%). The analysis of cause-specific mortality not only confirms results from previous studies of an increase in heat-related mortality by respiratory and cardiovascular diseases, but also shows a significant excess in mortality for diseases of the central nervous system and for metabolic/endocrine disorders. Results from 2003 highlight the necessity of targeting future prevention programmes at the susceptible sub-groups identified. The introduction of warning systems alongside efficient preventive plans and the monitoring of mortality during heat waves may represent a valid tool for the reduction of heat-related deaths.

Adult↗
PubMed1993

Age and sex differentials in mortality during two nineteenth century population crises.

"The exceptionally detailed Finnish materials are used to examine age- and sex-specific mortality in different regions during the country's last famine, the Great Famine of the 1860s. This is compared with another mortality crisis, the 1808-09 War. The results show that in cases when multiple infectious diseases were responsible for elevated mortality, the increases for different age categories were, by and large, proportional to the levels prevailing during normal times. However, excess mortality showed more variability for children. Furthermore, age- and sex-specific social behaviour (specifically large-scale temporary migration) during the crisis period shaped the age patterns and sex differentials in mortality." (SUMMARY IN FRE)

Behavior↗
PubMed1979

Epidemiology of influenza in Lower Saxony during the period 1968-1978 with particular emphasis on subtypes A(H3N2) and A(H1N1) in winter 1977-78.

The influenza surveillance in Lower Saxony is based mainly on laboratory investigations, and especially those which involve the isolation of influenza viruses throughout the year. These investigations have provided information on the circulation of influenza viruses and of the antigenic drift during the Hong Kong period which resulted in many different variants. Since the advent of the Hong Kong virus subtype, a high excess mortality was observed only in the winter of 1969-70. In most of the other years there was a low excess mortality which coincided with the circulation of the influenza A viruses in the population. During the last winter 1978, influenza A viruses were not isolated before February. In February and March, the two distinct subtypes H3N2 and H1N1 circulated simultaneously. The influenza A(H1N1) virus attacked only children and young adults whereas the patients infected with influenza A(H3N2) virus ranged over all age groups.

Adolescent↗
PubMed1983

Mortality among male workers at a thorium-processing plant.

The long-term health effects of exposure to thorium are of interest because of the possible increased use of thorium as an energy source in reactors using 232Th to produce 233U. Mortality is described in a cohort of 3039 men who were employed between 1940 and 1973 at a company involved in the production of thorium and rare earth chemicals from monazite sand. Based on deaths ascertained by the Social Security Administration and mortality rates for U.S. white males, the standardized mortality ratio (SMR) for all causes was 1.05 with 95% confidence limits (95% CL) of 0.96 and 1.15. Much of the excess mortality was attributable to non-occupational motor vehicle accidents (SMR = 1.64; 95% CL = 1.16 and 2.23), but SMRs were also high for lung cancer (1.44; 95% CL = 0.98 and 2.02), pancreatic cancer (2.01; 95% CL = 0.92 and 3.82), and diseases of the respiratory system (1.31; 95% CL = 0.92 and 1.83). In a subgroup of 592 men who worked for at least one year in selected jobs (indicative of highest exposure to thorium and thoron) that was followed up more intensively, the SMR for pancreatic cancer was significantly elevated (i.e. 4.13; 95% confidence limits = 1.34 and 9.63). The SMR for lung cancer was 1.68 (95% CL = 0.81 and 3.09), while that for respiratory diseases was 1.20 (95% CL = 0.52 and 2.37). Information on smoking habits in a sample of survivors suggested that smoking could have explained at least part of the excess mortality from lung and pancreatic cancer and from diseases of the respiratory system. Continued follow-up of the cohort through morbidity and mortality studies is needed to evaluate further the possible long-term effects of exposure to radioactivity and chemicals in the thorium extraction process.

Adult↗
PubMed1997

Comparative mortality in mentally retarded patients in California, with and without Down's syndrome, 1986-1991.

BACKGROUND: The large database of the California Department of Developmental Services provides a data source for mortality rates in persons with mental retardation by age, sex, severity, cause and associated conditions. RESULTS: Data for 1986-1991 were used to determine age-related mortality rates in cases with and without Down's Syndrome, in three severity levels of mental retardation. Distribution data for the data-base population are also given. CONCLUSION: In both Down's and non-Down's patient groups excess mortality increased with severity of mental retardation at all ages. In both groups excess mortality tended to decrease with advancing age to age 35-39 years, and to increase at the older ages. The age increase in excess death rate at age 40 years and up was steeper in the patients with Down's Syndrome.

Adolescent↗
PubMed1996

Premature mortality in aboriginal adults in the Northern Territory, 1979-1991.

OBJECTIVE: To identify important causes of premature mortality among Aboriginal adults in the Northern Territory (NT), 1979-1991. METHODS: All deaths of NT Aboriginal residents aged 15-64 years which occurred in the NT between 1979 and 1991 and which were recorded by the Registry of Births, Deaths and Marriages were included. Standardised mortality ratios (SMRs) were used to compare the number of deaths observed among Aboriginals in the NT to those expected, based on overall Australian rates. Years of potential life lost before age 65 (YPLL65) were estimated for specific causes of death. RESULTS: Aboriginal women (overall SMR, 5.5) and Aboriginal men (SMR, 4.7) experienced a high burden of excess mortality from almost every cause of death. This excess increased over time, especially for Aboriginal women. Among Aboriginal men, the most important causes of premature death were motor vehicle accidents (11% of excess deaths and 17% of YPLL65), ischaemic heart disease (10% of excess deaths and 10% of YPLL65), pneumonia and influenza (8% of excess deaths and 6% of YPLL65), and homicide (7% of excess deaths and 8% of YPLL65). For Aboriginal women, the most important causes included homicide (7% of excess deaths and 11% of YPLL65), chronic obstructive pulmonary disease (10% of excess deaths and 5% of YPLL65), rheumatic heart disease (7% of excess deaths and 8% of YPLL65), and ischaemic heart disease (6% of excess deaths and 5% of YPLL65). CONCLUSIONS: The wide variety of causes of excess mortality will require an equally wide variety of solutions, both medical and non-medical, and a long term commitment will be necessary to achieve reductions in premature mortality among NT Aboriginal adults.

Adolescent↗
PubMed2005

What's killing Americans in the prime of life?

This article compares health outcomes in the United States with those prevailing in other nations, in terms of survival during the prime of life, ages 15 to 59 years. To seek to explain U.S. mortality excesses, age-gender-cause-specific mortality rates are compared for the United States and nine economically comparable nations, using World Health Organization national survival statistics (life tables) and age-gender-specific mortality rates by major causes. Additional data were drawn from the U.S. National Center for Health Statistics. Compared with other nations in the WHO's mortality database, in the United States 15-year-old girls rank 38th and 15-year-old boys rank 34th in their likelihood of reaching age 60. U.S. adults ages 15 to 64 years have higher total mortality than those in the nine other developed nations selected for the study (and in more nations as well), for both genders and for all the five decades of life considered. The authors identify the specific causes of excess U.S. mortality. Despite huge expenditures for medical care, U.S. citizens have embarrassingly high death rates during the prime of life. Nine issues are highlighted that may illuminate ways to improve health in the United States.

Adolescent↗
PubMed1986

Effect of metoprolol in postinfarction patients with increased heart size.

Mortality was analysed in relation to clinical and radiological signs of left ventricular failure in a double-blind randomized comparison of 154 post-myocardial infarction patients assigned to metoprolol (100 mg b.i.d.) and 147 patients assigned to placebo treatment. The maximal respiratory rate in the coronary care unit and the relative heart size measured by chest X-ray examination prior to discharge from hospital were used for evaluation of myocardial function. In the placebo group mortality was higher in those with elevated maximal respiratory rate (11% vs. 27%, P less than 0.05) and in those with larger hearts (8% vs. 33%, P less than 0.001). No increase in mortality in patients with findings of left ventricular dysfunction was found in the metoprolol treated group. This was not due to an excess mortality in patients with preserved left ventricular function, but rather due to a reduction in mortality among patients with impaired left ventricular function. In patients with relative heart sizes greater than 460 ml m-2 (= median), mortality was higher in the placebo treated patients as compared to metoprolol treated patients (33% vs 16%, P less than 0.05). During the three year follow-up, repeat chest X-ray examination showed similar heart sizes in the two treatment groups. Furthermore, treatment with digitalis and diuretics were similar in the two treatment groups although more patients in the metoprolol group were withdrawn due to uncontrolled left ventricular heart failure (7 vs 1, P less than 0.05). We conclude that elevated maximal respiratory rate in the coronary care unit and heart enlargement on a pre-discharge chest X-ray, indicate a worsened prognosis. This excess mortality is reduced by metoprolol treatment during a three year follow-up.

Cardiomegaly↗
PubMed1976

Inorganic arsenic--ambient level approach to the control of occupational cancerigenic exposures.

In 1820 the first malignancies ascribed as due to occupational arsenic exposure were reported as scrotal cancers among smelters. A century later the causal relationship between chronic occupational, environmental or medical arsenical exposure and skin carcinogenesis was firmly established. From 1948 to 1975, nine out of eleven epidemiological studies have shown, initially or upon review, significant excess mortality from respiratory cancer among diverse occupations exposed to various inorganic arsenicals. Two of the nine studies have shown concommitant, significant excess mortality from lymphatic cancer, and another, from skin cancer. Additionally, two such studies have revealed a dose-response relationship between arsenical exposure and lung carcinogenesis. In the first, reported in 1969, the relationship was semi-quantitative, with a possible interactive role by sulfur dioxide or other contaminants. The other demonstrated a dose-response which was quantitative for arsenic per se. Upon our reinterpretation, this dose-response also demonstrated an increased lung cancer mortality risk apparently at arsenic concentrations above 1 mug/M3, calculated as the 8-hour TWA daily exposure over a 40-year working life. However, these and related data do not reveal a definite no-effect exposure level. Thus, in the absence of data documenting a cancerigenically safe level of occupational exposure and because of the environmental ubiquity of arsenic, the conclusion is drawn that the arsenic body burden of workers should not be occupationally increased above that produced by the ambient level.

Arsenic↗
PubMed1990

[Heart effect of arterial hypertension. Heart hypertrophy as a risk factor. Study technics (electrocardiogram, echocardiography, exercise test and Holter].

Left ventricular hypertrophy, a known consequence of hypertension, is associated with an excess mortality independent of other known cardiovascular risk factors. There are multiple mechanisms in which left ventricular hypertrophy may account for this excess mortality including increased incidence of arrhythmias, systolic an diastolic dysfunction, relative ischemia, and associated coronary artery disease. Diastolic dysfunction, manifested by reduced ventricular distensibility of the hypertrophic left ventricle, appears to be an early characteristic of the hypertensive heart since echocardiographic techniques have demonstrated diastolic filling abnormalities in untreated essential hypertensives even before significant left ventricular hypertrophy appears. The presence of left ventricular hypertrophy is difficult to detect by electrocardiography. Echocardiography seems to be the best non-invasive method for the detection of hypertensive heart disease: it shows early abnormalities of left ventricular compliance, frequently left ventricular hypertrophy and late abnormalities of myocardial contractility.

Arrhythmias, Cardiac↗
PubMed1987

Long-term survival in malignant melanoma with special reference to age and sex as prognostic factors.

A total of 12,353 (97.5%) of all patients with a first malignant melanoma newly diagnosed in Sweden during the period 1960-82 were subjected to a complete computerized follow-up with respect to survival through December 31, 1982. Calculation of relative survival rates (RSs) revealed a consistently more favorable course in women than in men, the 5-year RSs being 80.8 and 68.0% and the 10-year RSs being 75.0 and 61.8%, respectively. Prolonged follow-up and analyses of annual excess mortality showed, in addition, that men surviving about 10 years constituted an apparently cured fraction, whereas among women there was an excess mortality throughout the observation period. The prognosis was increasingly more favorable at younger ages in males, whereas no regular age trend emerged in the female group of patients. A multivariate analysis indicated that the findings were not confounded by temporal trends in RSs or by differences in tumor location between the groups compared and also that the relative hazard was significantly higher for men than for women only during the first 8 years after diagnosis.

Adult↗
PubMed1983

[Mortality from respiratory diseases among agricultural and non-agricultural workers in France from 1970 to 1974].

The mortality due to respiratory disease was studied in France between 1970 and 1974 as well as in seven other countries in the European Economic Community. The French results were presented as an index of mortality by cause of death, enabling a comparison of the mortality in different groups of the population. Data was supplied for 7 diagnostic groups defined according to List A of the International Classification of Diseases. The population studied consisted of men and women between 15 to 64 years, classified according to residence (urban or rural) and profession (agricultural worker or not). In addition the indices of mortality for farmers or agricultural employees were compared to men of the same social class, for the same period. The comparisons between the urban and the rural background revealed an excess mortality for respiratory tuberculosis, lung cancer, bronchitis, emphysema and asthma for those in urban areas. In the rural environment an excess mortality was noted for acute respiratory diseases in both men and women; this was also found comparing agricultural to non-agricultural workers. Lastly, if one compared agricultural and non-agricultural workers of the same social class, deaths due to acute and chronic respiratory infections were higher in the agricultural workers. These results show the relative importance already stressed in other studies, of acute respiratory diseases in agricultural workers.

Adult↗
PubMed1981

Alcohol and mortality. A ten-year Kaiser-Permanente experience.

We studied 10-year mortality in relation to baseline alcohol use habits among four groups of 2015 persons, well matched for age, sex, race, and cigarette smoking. Persons reporting daily use of two drinks or fewer fared best; the heaviest drinkers (six or more drinks) had a doubled mortality rate, and users of three to five drinks had a mortality rate, and users of three to five drinks had a mortality rate approximately 50% higher. The nondrinkers had a mortality rate similar to that of users of three to five drinks per day. Cancer, cirrhosis, accidents, and nonmalignant respiratory conditions contributed significantly to the excess mortality of the heavier drinkers; coronary disease mortality was significantly higher among nondrinkers. Smoking intensity was a possible factor in the increased mortality of heavier drinkers, but the data were also compatible with the hypothesis that smoking and drinking are synergistic in the production of certain cancers and nonmalignant chronic respiratory illness. Other traits associated with alcohol use or abstinence are possible contributors to the excess mortality of both heavy drinkers and nondrinkers.

Adult↗
PubMed1990

Maternal cigarette smoking during pregnancy, adiposity, social class, and perinatal outcome in Cardiff, Wales, 1965-1977.

There have been several reports in which maternal nutritional status has been implicated as either a mediating or moderating factor in the relationship between maternal cigarette smoking and birthweight and perinatal survival. Also, there is evidence that the effects of maternal cigarette smoking on both intrauterine growth and fetal viability are more intense among women of lower social status. The well-maintained data set of the Cardiff Births Survey from 1965-1977 afforded an opportunity to review these issues among over 50,000 births in south Wales (the survey took place in Cardiff City through 1973 and subsequently included suburban areas of South Glamorgan). The major findings were: (1) Smoking was much more common with descending maternal social status; (2) among upper status women, smokers had similar or slightly greater mean Quetelet's indices (kg/m2) than nonsmokers. Among lower status women, smokers were considerably thinner than nonsmokers; (3) the greater the adiposity of the mother, the less the association between cigarette smoking and depressed birthweight; (4) perinatal mortality was significantly higher among heavy smokers (10 or more cigarettes a day) than among nonsmokers; and (5) neither the decrease in birthweight nor the excess mortality associated with smoking was greater among those of lower rather than upper social status, except among class I women, among whom smoking was only minimally associated with depressed birthweight. With the inclusion of the South Glamorgan suburban population in the survey after 1974, the excess mortality associated with heavy smoking dropped from 53 to 16%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Incidence of asthma and mortality in a cohort of young adults: a 7-year prospective study.

BACKGROUND: Few longitudinal data exist on the incidence of asthma in young adults and on the overall mortality risk due to asthma. A 7-year follow-up prospective study was performed to assess the incidence of asthma and mortality from all causes in a cohort of young adults. METHODS: The life status of a cohort of 6031 subjects, aged 20-44 years, who replied to a respiratory screening questionnaire between 1991 and 1992, was ascertained in 1999. A new questionnaire investigating the history of asthma was subsequently sent to the 5236 subjects who were still alive and residents in the areas of the study. 3880 subjects (74%) replied to the second questionnaire. RESULTS: The incidence of adult-onset asthma was 15.3/10,000/year (95%CI: 11.2-20.8). The presence of asthma-like symptoms (IRR: 4.17; 95%CI: 2.20-7.87) and allergic rhinitis (IRR: 3.30; 95%CI: 1.71-6.36) at baseline were independent predictors of the onset of asthma, which was more frequent in women (IRR: 2.32; 95%CI: 1.16-4.67) and increased in the younger generations. The subjects who reported asthma attacks or nocturnal asthma symptoms at baseline had an excess mortality risk from all causes (SMR = 2.05; 95%CI: 1.06-3.58) in the subsequent seven years. The excess mortality was mainly due to causes not related to respiratory diseases. CONCLUSION: Asthma occurrence is a relevant public health problem even in young adults. The likelihood of developing adult onset asthma is significantly higher in people suffering from allergic rhinitis, in women and in more recent generations. The presence of asthma attacks and nocturnal symptoms seems to be associated with a potential excess risk of all causes mortality.

Adult↗
PubMed2006

Reduced heart rate variability and baroreflex sensitivity in primary biliary cirrhosis.

BACKGROUND: Standardized mortality ratio for primary biliary cirrhosis (PBC) is 2.87. Even after accounting for liver and cancer-related deaths there is an unexplained excess mortality associated with PBC. We have assessed heart rate variability (HRV) and baroreflex sensitivity (BRS) risk factors associated with cardiovascular mortality, in 57 PBC patients and age- and sex-matched normal controls. METHODS: HRV and BRS were measured non-invasively in subjects and controls. Beat to beat RR interval and 'Portapres' blood pressure data were processed using power spectral analysis. Power was calculated in very low frequency (VLF), low-frequency (LF) and high-frequency (HF) bands according to international guidelines. BRS (alpha) was computed using cross-spectrum analysis. Patients also underwent fatigue severity assessment using a measure validated for use in PBC. RESULTS: PBC patients had significantly lower total HRV compared with controls (P=0.02), with the reduction occurring predominantly in the LF domain (P=0.03). BRS was also significantly reduced compared with controls (P=0.02). There were no significant differences in HRV or BRS between cirrhotic and non-cirrhotic patients. Within the PBC patient group HRV was significantly lower in fatigued than in non-fatigued patients (P<0.05). CONCLUSION: Abnormalities of HRV and BRS in PBC are not specific to advanced disease but are associated with fatigue severity. Abnormalities could be associated with increased risk of sudden cardiac death, potentially contributing to the excess mortality seen in PBC.

Aged↗
PubMed1991

Hypertension and prognosis in established diabetic nephropathy.

In the patient with diabetes mellitus the onset of intermittent and then persistent proteinuria signals the development of established nephropathy. This heralds an extremely poor prognosis and mortality in this group has been estimated to be 80 to 100 times greater than that of an age-matched normal population. The excess mortality and its associated morbidity exists for both insulin-dependent and non-insulin-dependent patients who develop proteinuria. The final cause of death is often cardiovascular, such as myocardial infarction or a cerebrovascular accident, rather than end stage renal failure with death from uraemia. Strict and aggressive control of blood pressure during this stage is the only therapy that has been shown to slow the decline in glomerular filtration. To date, there have been no studies large enough to establish if this can produce the desired effect of reducing the excess mortality in this group. The newer antihypertensive agents may have a specific role but this also remains to be shown conclusively; their major advantage may be related to their fewer side-effects especially on cardiovascular risk factors in this highly susceptible group.

Angiotensin-Converting Enzyme Inhibitors↗