Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Excess Mortality”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 649 records · Page 36Linked to original sources
PubMed2004

Invasive aspergillosis in critically ill patients: attributable mortality and excesses in length of ICU stay and ventilator dependence.

Invasive aspergillosis is a rare disease in intensive care unit (ICU) patients and carries a poor prognosis. The aim of the present study was to determine the attributable mortality due to invasive aspergillosis in critically ill patients. In a retrospective, matched cohort study (July 1997-December 1999), 37 ICU patients with invasive aspergillosis were identified together with 74 control patients. Matching of control (1:2) patients was based on the acute physiology and chronic health evaluation (APACHE) II classification: an equal APACHE II score (+/-1 point) and diagnostic category. This matching procedure results in an equal expected in-hospital mortality for cases and controls. Additionally, control patients were required to have an ICU stay equivalent to or longer than the case before the first culture positive for Aspergillus spp. Patients with invasive aspergillosis were more likely to experience acute renal failure (43.2% versus 20.5%; P = 0.020). They also had a longer ICU stay (median: 13 days versus seven days; P < 0.001) as well as a more extended period of mechanical ventilator dependency (median: 13 days versus four days; P < 0.001). Hospital mortalities for cases and controls were 75.7% versus 56.8%, respectively (P=0.051). The attributable mortality was 18.9% (95% CI: 1.1-36.7). A multivariate survival analysis showed invasive aspergillosis [hazard ratio (HR): 1.9, 95% CI: 1.2-3.0; P = 0.004] and acute respiratory failure (HR: 6.5, 95%: 1.4-29.3; P < 0.016) to be independently associated with in-hospital mortality. In conclusion, it was found that invasive aspergillosis in ICU patients carries a significant attributable mortality of 18.9%. In a multivariate analysis, adjusting for other co-morbidity factors, invasive aspergillosis was recognized as an independent predictor of mortality.

Aspergillosis↗
PubMed1989

Asbestos and kidney cancer: the evidence supports a causal association.

The role of asbestos in the etiology of lung cancer and of mesothelioma of the pleura and peritoneum has been well documented. The evidence for a causal association between asbestos and other human cancers is not as extensive but suggests that asbestos may be carcinogenic at several different sites. This paper is concerned specifically with a possible causal association between asbestos and human kidney cancer. A review of the evidence to date indicates that only three human studies have sufficient statistical power to detect an excess mortality from kidney cancer among workers exposed to asbestos. All three were occupational cohort studies, and two of these gave strong direct evidence for such an excess; a study of U.S. insulators (kidney cancer SMR = 2.22, 90% CI 1.44-3.30), and a study of U.S. asbestos products company workers (kidney cancer SMR = 2.76, 90% CI 1.29-5.18). The third study, of Italian shipyard workers, reported excess mortality from "cancers of the kidney, urinary bladder, and other urinary organs" (SMR = 1.98, 90% CI 1.42-2.70). Further support for a causal association includes studies finding asbestos fibers in human kidneys and urine, as well as reports of kidney tumors in two animal bioassays. It is concluded that asbestos should be regarded as a probable cause of human kidney cancer.

Animals↗
PubMed1988

Mortality among migrant tunnel workers.

To clarify the mortality pattern of migrant tunnel workers, a retrospective cohort study was conducted in the southern part of Oita Prefecture, which is well known as a source area for tunnel workers. This study was made on 1,078 tunnel workers and 943 non-tunnel workers who were observed for 8 years and 6 months from January 1975 to June 1983. The overall SMR of tunnel workers was 162 which was statistically significant. The SMRs for pulmonary tuberculosis (SMR = 3,267), industrial accidents (SMR = 1,000), and pneumoconiosis (SMR = 26,000) which were all closely related to tunnelling work were extraordinarily high and statistically significant. Mortality from lung cancer was considerably higher among tunnel workers than among non-tunnel workers. The results of ratios of observed to expected deaths by age-group showed significant excess mortality in three age-groups: 40 to 49, 50 to 59, and 60 to 69. These findings show that migrant tunnel workers have serious health problems. On the other hand, in non-tunnel workers, the overall SMR was 89. No significant excess mortality was observed for any cause of death or any age-group.

Adult↗
PubMedDate not supplied

The outcome of diabetic pregnancies: a prospective study.

In a large prospective study of pregnancy the perinatal mortality rate was 141/1000 births for diabetic gestations in which the onset of labour was spontaneous, 33/1000 for diabetic gestations in which labour was induced or the infant delivered by Caesarean section and 34/1000 for the non-diabetics. Forty per cent of the perinatal mortality excess in the diabetics was due to the consequences of maternal vascular lesions, i.e. large placental infarcts and marked retardation of placental growth. Seventeen per cent of the perinatal mortality excess was related to maternal acidosis or to insulin shock, 12% to severe congenital anomalies, 12% to the complications of Caesarean sections and the remainder to other disorders. Mothers with diabetes mellitus had more than twice the frequency of atheromata, fibrinoid change and thrombi in decidual arteries as non-diabetic mothers. Histological grading revealed that overweight newborns of diabetic mothers had immature lungs by comparison with the lungs of normally grown infants of diabetic mothers and infants of non-diabetic mothers. Low IQ values and an excess of neurological abnormalities in children of diabetic mothers who were ketotic during pregnancy were found to be due to amniotic fluid bacterial infections and their complications rather than to the maternal ketosis.

Birth Weight↗
PubMed1987

Impact of influenza epidemics on mortality in the United States from October 1972 to May 1985.

Baseline levels of mortality in the United States in the absence of influenza epidemics were estimated using cyclical regression models applied to national vital statistics from October 1972 to May 1985. Models were developed by age and by region. Results from 1983 to 1985 are preliminary. More mortality than predicted by the theoretical baseline occurred during nine influenza seasons. Epidemics with high morbidity in children and young adults occurred in 1976/77 and 1978/79. Regional differences in the impact of influenza occurred occasionally. Total influenza-associated excess mortality in six epidemics from the winters of 1972/73 to 1980/81 was about 200,000. About 80-90 per cent of excess mortality occurred in persons over 64 years old.

Aged↗
PubMed2003

A propensity analysis of late versus early nephrologist referral and mortality on dialysis.

Previous studies have analyzed the association between late versus early nephrologist referral (LR, ER) and poor clinical outcomes in patients with end-stage renal disease. We sought to determine whether these poor outcomes were causally related to LR, or whether LR was a proxy for poorer access to health care in general. An inception cohort of incident dialysis patients enrolled in the New Jersey Medicare or Medicaid programs was identified. Using a large number of demographic, clinical, and health care utilization covariates, propensity scores (PS) were then calculated to predict whether a given patient had been seen by a nephrologist at 90 d before first dialysis. Cox proportional hazards models were then built to test the association between timing of nephrologist referral and mortality during the first year of dialysis, using PS adjustment and matching to determine whether this association was confounded by other measures of reduced healthcare utilization. Neither adjustment for PS (HR = 1.31; 95% CI, 1.17 to 1.47) nor matching (HR = 1.40; 95% CI, 1.23 to 1.59) materially changed the initial 36% excess mortality in LR compared with ER patients (HR = 1.36; 95% CI, 1.22 to 1.51). Excess mortality among LR was limited to the first 3 mo of dialysis (HR = 1.75; 95% CI, 1.48 to 2.08) but not present thereafter (HR = 1.03; 95% CI, 0.84 to 1.25). Late nephrologist referral is an independent risk factor for early death on dialysis, even after controlling for other indicators of healthcare utilization. Further research is needed to identify patients at particular risk so that interventions to prevent early deaths on dialysis in LR patients can be developed and tested.

Aged↗
PubMed1994

Death and survival in a cohort of heroin addicts from London clinics: a 22-year follow-up study.

Data are presented on the 43 people who died over a 22-year follow-up period of a cohort of 128 heroin addicts drawn in 1969 from the newly opened London clinics. The main causes of death were drug-related, with 18 deaths specifically determined as due to overdose, of which the great majority were among people being prescribed opiates at the time. The mortality rate was a mean of 1.84% annually, and the excess mortality ratio was 11.9. This excess was highest at the beginning and varied over the period of study, appearing higher at the opening of the clinics and again in the mid-1980s. No sex differences in mortality rates were demonstrated but the excess mortality was concentrated at younger ages. No prediction of the 85 survivors could be made on the basis of length of heroin use prior to study intake, nor on age at intake.

Adolescent↗
PubMed1982

Late mortality after surgery for peptic ulcer.

To examine the claim that life expectancy is reduced after curative peptic-ulcer surgery, we studied mortality and its causes in 779 men with peptic ulcer treated surgically between 1947 and 1965. The minimum follow-up period of survivors was 15 years. There was an excess mortality in the three major age groups (30 to 39, 40 to 49, and 50 to 59 years at operation), as compared with the general population (P less than 0.001), with a mean shift of 9.1 years in the survival curve. Surgery was not the direct cause of death. In particular, the eight deaths from carcinoma of the stomach were no more than expected. Excess mortality was due to smoking-associated disease, which accounted for 200 deaths. Eighty-three per cent of the patients were cigarette smokers. We conclude that substituting highly selective vagotomy for gastrectomy will not lead to improved survival, because 80 per cent of patients now having operations for ulcer are heavy cigarette smokers.

Adult↗
PubMed2003

Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980-1998.

BACKGROUND: People with mental illness suffer excess mortality due to physical illnesses. AIMS: To investigate the association between mental illness and ischaemic heart disease (IHD) hospital admissions, revascularisation procedures and deaths. METHOD: A population-based record-linkage study of 210 129 users of mental health services in Western Australia during 1980-1998. IHD mortality rates, hospital admission rates and rates of revascularisation procedures were compared with those of the general population. RESULTS: IHD (not suicide) was the major cause of excess mortality in psychiatric patients. In contrast to the rate in the general population, the IHS mortality rate in psychiatric patients did not diminish over time. There was little difference in hospital admission rates for IHD between psychiatric patients and the general community, but much lower rates of revascularisation procedures with psychiatric patients, particularly in people with psychoses. CONCLUSIONS: People with mental illness do not receive an equitable level of intervention for IHD. More attention to their general medical care is needed.

Australia↗
PubMed2005

Coronary heart disease in the elderly--underwriting and pricing issues.

OBJECTIVE: The purpose of this analysis was to estimate the degree of excess mortality in elderly people with coronary heart disease. METHODS: Pertinent studies were found via an Internet search of English language articles in the National Library of Medicine. Excess mortality was estimated by the traditional calculations used in mortality methodology. RESULTS: Mortality ratios for coronary heart disease were very high at young ages and tapered with advancing age, reaching levels at ages 80 and older of 130% to 180%. Comparison with other mortality studies indicated that this pattern was typical for most impairments. Present value calculations showed that relative risk (mortality ratio) was lower at older ages, but absolute risk (mortality cost) was much higher. CONCLUSIONS: Mortality ratios for coronary heart disease and most common impairments are generally lower in elderly people. This has important underwriting and pricing implications. Disregarding what might be considered "low" mortality ratios in the elderly means that large additional risks are accepted with no additional premium.

Adult↗
PubMed1991

Data-based interventions for cancer control in Texas.

The percentage of excess mortality based on the ratio of the race-ethnic-sex-specific regional rate to the state rate was used to identify regions with differing risks of lung, breast, and cervical cancer. Mortality maps show wide variation in mortality risks for these cancers not only by race and ethnicity but also by geographic region. Cancer-staging information from the State Cancer Registry indicated that excess mortality for breast and cervical cancers in black and Mexican-American women results largely from the later detection of these cancers. Together with geographic mapping of data on cancer mortality, data on the prevalence of tobacco use and on the use of Papanicolaou's tests and mammograms can be used to select and direct interventions to specific regions and to the highest risk populations. Evaluation of routinely collected cancer data, particularly in state health departments, is a primary step in implementing programs to control and prevent cancer in Texas.

Black or African American↗
PubMed1999

Mortality in rheumatoid arthritis.

Rheumatoid arthritis reduces not only quality but also length of life. In the 14 main studies conducted since 1980, in a total of 13,424 patients, the mean standardized mortality ratio was 1.82 (range, 0.87-3) as compared to the population at large. Life expectancy was shortened by 5 to 10 years in most studies. The diversity of the methods used explains the discrepancies among results. Excess mortality may occur in only some subsets of patients. Both rheumatoid complications and an increase in nonspecific causes of death (e.g., infections) contribute to the excess mortality. Factors predictive of premature death are the same as those predictive of functional impairment. Many unknowns remain about the condition of rheumatoid arthritis patients at the end of their life.

Arthritis, Rheumatoid↗
PubMed1984

WHO cooperative trial on primary prevention of ischaemic heart disease with clofibrate to lower serum cholesterol: final mortality follow-up. Report of the Committee of Principal Investigators.

This is the final report on mortality amongst men in the WHO cooperative trial of the prevention of ischaemic heart disease (IHD) by clofibrate and it takes the follow-up a further 4 years to the end of 1982. Mean observation was 13.2 years, 5.3 in the trial and 7.9 afterwards. 1788 deaths were recorded in 208 000 man-years. In the 877 new deaths reported here, there was an excess of 9 deaths in the high cholesterol control group compared with the clofibrate-treated group. In the whole period there were 70 (11%) more deaths in the clofibrate-treated group. Excess mortality in the clofibrate-treated group was much greater during the "treatment period" (there was an excess of 47% during treatment compared with 5% after treatment had ended) and was due to a wide variety of causes other than IHD. Thus, the excess mortality in the clofibrate-treated group has not continued after the end of treatment. The substantial excess previously reported remains unexplained.

Cholesterol↗
PubMed1997

Mortality among patients with ulcerative colitis: Rome 1970-1989.

The aim of this study was to analyze the pattern of mortality among patients with ulcerative colitis (UC) and compare it with mortality in the general population of the same age and sex. All patients with UC admitted to one of the Inflammatory Bowel Disease Clinics in Rome, from January 1970 to December 31, 1989 were enrolled. Vital status was ascertained through the Registry Office of the last municipality of residence as of July 1, 1990. Cause of death was ascertained through record linkage with the national or regional mortality file and coded using the ninth revision of the International Classification of Diseases. Standardized Mortality Ratios (SMRs) were computed to compare mortality among UC patients with mortality in the general population of the same age and sex. Out of a total of 508 UC patients admitted during the study period, 27 deaths were observed, compared with 27.6 expected (SMR = 98). After excluding prevalent cases, an excess risk of death was observed among newly diagnosed cases in the first year after diagnosis (SMR = 644; p < 0.001); ulcerative colitis was the main reason for this excess mortality. Mortality for other diseases was close to that expected. In conclusion, ulcerative colitis impairs life expectancy in the first year after diagnosis, while no excess mortality seems to be present afterwards.

Adult↗
PubMed1997

Mortality in psychiatric hospital patients: a cohort analysis of prognostic factors.

BACKGROUND: This work followed a group of patients living in a psychiatric hospital in Central Italy in 1978 at the time of enforcement of the Italian reform law (No. 180) for closing down mental hospitals. The study had the following aims: a) to compare in terms of mortality patients discharged into the community with patients who did not experience deinstitutionalization; b) to determine the survival of the cohort of patients and to analyse prognostic risk factors for death; c) to analyse differences in mortality rates between psychiatric patients and the general population. METHODS: The study was designed as an historical follow-up investigation. Univariate (product limit) and multivariate (proportional hazards model) methods were used to estimate prognostic variables and related death risks. Mortality was assessed using standardized mortality ratios (SMR) on the entire cohort as well as after stratification according to age, sex, cause of death and discharge status, assuming the Abruzzo Region's population as standard. RESULTS: Length of hospitalization and discharge from hospital are prognostic variables for death risk, with relative risks respectively of 4.22 (95% confidence interval [CI]: 2.41-7.40) for a length of hospitalization of 10-25 years, and 8.13 (95% CI: 4.73-13.88) for non-discharge. The global SMR of the cohort was 2.68 (95% CI: 2.42-3.07). Non-discharged patients showed higher SMR than discharged. Excess mortality was found both in males and females for circulatory, respiratory and undefined diseases. A significantly lower mortality for cancer was observed in male patients. A strong excess mortality was observed in younger patients (20-29 years: SMRmales = 43.57; SMRfemales = 97.52). CONCLUSIONS: Longer periods of hospitalization and non-discharge from hospital are the main risk factors for death in psychiatric patients, who globally experience higher death rates than the general population for a wide spectrum of causes of death, whatever their diagnosis or gender. These findings strongly suggest positive actions in order to overcome the effects of institutionalization.

Adult↗
PubMed1989

Respiratory symptoms as predictors of 27 year mortality in a representative sample of British adults.

OBJECTIVE: To examine associations between reported respiratory symptoms (as elicited by questionnaire) and subsequent mortality. DESIGN: Prospective cohort study. SETTING: 92 General practices in Great Britain. PARTICIPANTS: A nationally representative sample of 1532 British men and women aged between 40 and 64. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular disease, lung cancer, and chronic bronchitis. RESULTS: Subjects were interviewed in 1958 regarding various respiratory symptoms (including cough, phlegm, breathlessness, and wheeze) by using a questionnaire which formed the basis of the Medical Research Council's questionnaire on respiratory symptoms. By the end of 1985, 889 deaths had been reported, including 51 in men due to chronic bronchitis. After adjustment for differences in age and smoking habits death rates from chronic bronchitis in men who reported symptoms were greater than those in men who did not for each of the symptoms examined. The adjusted mortality ratios were 3.4 (95% confidence interval 1.8 to 6.5) for morning cough, 3.7 (2.0 to 6.9) for morning phlegm, 6.4 (3.0 to 13.8) for breathlessness when walking on the level, and 10.5 (4.4 to 24.6) for wheeze most days or nights. Mortality ratios were also significantly raised for four episodic symptoms not usually included in more recent respiratory symptom questionnaires--namely, occasional wheeze (mortality ratio 6.0; 95% confidence interval, 2.4 to 15.1), weather affects chest (5.7; 3.1 to 10.3), breathing different in summer (4.9; 2.8 to 8.6), and cold usually goes to chest (3.7; 2.0 to 6.8). The excess mortality associated with these symptoms remained significant after further adjustment for breathlessness or phlegm. Ratios for all cause mortality in men and women were also significantly raised for most respiratory symptoms, death rates being some 20-50% higher in people reporting symptoms after adjustment for age, sex, and smoking. Breathlessness was the only symptom significantly associated with excess mortality from cardiovascular disease (mortality ratio 1.4 (95% confidence interval 1.0 to 1.9) for breathlessness when walking on the level). Ratios were generally around unity and not significant for mortality due to lung cancer. CONCLUSIONS: The results suggest that episodic symptoms, which often do not appear in standard respiratory questionnaires, predict subsequent mortality from chronic obstructive airways disease. This supports the hypothesis that reversible airflow obstruction may be a precursor of progressive and irreversible decline in ventilatory function.

Adult↗
PubMed1999

Elevated mortality from nonalcohol-related chronic liver disease among female rubber workers: is it associated with exposure to nitrosamines?

BACKGROUND: Despite several case reports describing liver toxicity of nitrosamines and the fact that some N-nitroso compounds are used to induce cirrhosis of the liver in animal models, this association has not been investigated in epidemiological studies. METHODS: A cohort of 2,875 female rubber workers who were active on January 1, 1976, or hired thereafter, and who had been employed for at least 1 year in one of five plants producing tires or technical rubber goods was followed for mortality from January, 1976, through December, 1991. Work histories were reconstructed using routinely documented "cost center codes" and classified into six work areas. Age and calendar year standardized mortality ratios (SMR) and 95% confidence intervals (95% CI) were calculated and stratified by plant, work area, year of hire, and years of employment in the respective work area. RESULTS: The excess mortality from cirrhosis of the liver was most pronounced for nonalcohol-related cirrhosis of the liver (ICD-9 571.4-571.9: 10 deaths, SMR 202; 95% CI 97-372). Mortality from alcohol-related cirrhosis of the liver (ICD-9 571.0-571.3: 3 deaths, SMR 153; 95% CI 31-446) and from other alcohol-related diseases (organic psychoses, injury, and poisoning) was not statistically significantly elevated. All 10 cases of nonalcohol-related cirrhosis had worked in production of technical rubber goods (SMR 279; 95% CI 134-514) and risks increased with earlier years of hire and with longer duration of employment in this work area. DISCUSSION: Although our results must be interpreted with caution, they suggest that the observed excess deaths from cirrhosis of the liver are associated with occupational risk factors. In light of additional evidence from case reports and animal data, exposure to nitrosamines may be a plausible risk factor for the observed excess mortality.

Adult↗
PubMedDate not supplied

Relative heart volume and subsequent mortality in old people.

In 1971 radiologic heart volume was measured in 721 men and women over the age of 65 as part of a cardio-respiratory screening examination in a rural community in Central Finland. The survival time for the whole series examined was followed for up to ten years. Relative heart volume did not differ between the sexes, but it increased with age in both men and women. The relative heart volume of almost every second woman exceeded 450 ml/m2, whereas in men it exceeded 500 ml/m2 in only every fifth. These limits have often been considered appropriate for the respective sexes. There was an inverse correlation between relative heart volume and survival time. A large relative volume predicted excess mortality due to cardiovascular diseases. A small relative heart volume predicted excess mortality attributable to tumours and respiratory diseases.

Aged↗