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PubMed2003

Mortality after spousal loss: are there socio-demographic differences?

This study evaluates the effect of spousal death on mortality among Israeli adults and examines differences in this effect by duration of bereavement, age, sex, education, ethnic origin, household size, and number of children. Data are taken from the Israel Longitudinal Mortality Study which is based on a linkage of records from a 20% sample of the 1983 census to records of deaths occurring during the period 1983-1992. The study population comprised 49,566 men and 41,264 women, of whom 4,402 (9%) and 11,114 (27%), respectively, were bereaved during the follow-up period. Excess mortality among the bereaved was evident among both men and women, especially after bereavement of short duration. During the first 6 months, the excess mortality was about 50% among women and about 40% among men. For men, the effect of bereavement on mortality decreased linearly with age, with a relative risk of 3 among younger men during early widowhood. Bereavement had a greater impact on the more educated men. The effect of bereavement did not vary by ethnic origin or household size.

Age Factors↗
PubMed1986

Mortality study of workers in the man-made mineral fiber production industry in the United Kingdom.

The workforces of two factories in the United Kingdom have been followed up to the end of 1984 as part of the collaborative European study of the health of workers in the man-made mineral fiber industry. In the cohort from an English glass-wool plant there was no suggestion of any excess mortality compared to national or local rates, except for lung cancer among men in comparison to the national level. However, the data indicate that the workers were largely local persons by place of birth, occupation, and death, and they therefore suggest that the national comparison was inappropriate. Lung cancer mortality showed little relationship to length of employment, duration of time since first exposure, occupational classification, or level of exposure. In the cohort from a continuous-filament plant in Northern Ireland no excess mortality from cancer was found. There were, however, raised death rates from violent causes and cardiovascular disease, but these rates were not exceptional for the area of the country in which the factory was located. No deaths from mesothelioma were reported in either cohort.

Construction Materials↗
PubMed1996

A 50-year mortality follow-up of a large cohort of oil refinery workers in Texas.

To investigate further the possible role of occupational exposures on mortality, an update of a large Texas petroleum refinery cohort was undertaken. Between 1937 and 1987, 6799 deaths were identified among 17,844 employees. Relative to the general population of Texas, the overall standardized mortality ratio (SMR) showed a statistically significant deficit, as did nine other cause-of-death categories. Statistically significant mortality excesses were found for bone cancer (SMR = 207.8: 95% confidence interval [CI], 110.6 to 355.3), acute lymphocytic leukemia (ALL) (SMR = 259.6; 95% CI, 112.1 to 511.5), and benign/unspecified neoplasms (SMR = 194.9; 95% CI, 129.5 to 281.7). However, none of these diseases demonstrated an exposure-response relationship with length of employment. Subcohort mortality analyses by sex and race groups, length of employment, interval since hire, period of hire, and pay status were also performed. Overall, the update findings do not indicate that any excess mortality occurred as a result of employment at the refinery.

Cause of Death↗
PubMed2002

Oral anticoagulation and risk of death: a medical record linkage study.

OBJECTIVE: To study how mortality varies with different degrees of anticoagulation reflected by the international normalised ratio (INR). DESIGN: Record linkage analysis with death hazard estimated as a continuous function of INR. DATA SOURCES: 46 anticoagulation clinics in Sweden with computerised medical records. SUBJECTS: Records for 42 451 patients, 3533 deaths, and 1.25 million INR measurements. MAIN OUTCOME MEASURES: Mortality from all causes and from intracranial haemorrhage. RESULTS: Mortality from all causes of death was strongly related to level of INR. Minimum risk of death was attained at 2.2 INR for all patients and 2.3 INR for patients with mechanical heart valve prostheses. A high INR was associated with an excess mortality: with an increase of 1 unit of INR above 2.5, the risks of death from cerebral bleeding (149 deaths) and from any cause were about doubled. Among patients with an INR of > or =3.0, 1069 deaths occurred within 7 weeks; if the risk coincided with that with an INR of 2.9, the expected number of deaths would have been 569. Thus at least 500 deaths were associated with a high INR value, but not necessarily caused by the treatment. CONCLUSIONS: The excess mortality associated with high INR values supports the use of less intensive treatment and a small therapeutic window, with INR close to 2.2-2.3 irrespective of the indication for anticoagulant treatment. More preventive actions should be taken to avoid episodes of high INR.

Administration, Oral↗
PubMed2005

A nationwide survey of mortality in acromegaly.

CONTEXT: Increased mortality in acromegaly has been confined to those with posttreatment basal GH of 2.5 microg/liter or greater, but the impact of IGF-I and pituitary radiotherapy on mortality has remained controversial. OBJECTIVE: The purpose of this nationwide survey was to examine the all-cause mortality of patients with acromegaly and evaluate the impact of treatment outcome and mode of treatment on survival. DESIGN, SETTING, AND PATIENTS: All-cause mortality of all patients with acromegaly diagnosed during January 1980 and December 1999 in the five university hospitals of Finland was followed up by the end of 2002 (12.5 +/- 5.6 yr) and compared with that of the general population by using age- and gender-adjusted standardized mortality ratios (SMRs). Logistic regression analysis was used to investigate factors related to mortality within the survey population. MAIN OUTCOME MEASURE: Mortality was the main outcome measure. RESULTS: Of the 334 patients, 56 (16.8%) had died during follow-up. SMR of the patients was 1.16 [confidence interval (CI) 0.85-1.54, not significant (NS)]. However, patients with basal serum GH concentration 2.5 microg/liter or greater (SMR 1.63, CI 1.10-2.35, P < 0.001) measured 5.2 +/- 4.4 yr after the initial treatment, and those irradiated (SMR 1.69, CI 1.05-2.58, P < 0.001) showed excess mortality. In a multivariate model, the effect of radiotherapy was of borderline significance only (P = 0.083). Posttreatment IGF-I levels, available for 72.2% of the patients, did not have impact on mortality. CONCLUSIONS: The posttreatment basal GH concentration less than 2.5 microg/liter in acromegalic patients is associated with a normal lifespan. Excess mortality is confined to poorly controlled patients and possibly those who have received conventional radiotherapy.

Acromegaly↗
PubMed2003

Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial.

OBJECTIVE: To compare the mortality of critically ill patients given either enteral feeding with an immune-enhancing formula or parenteral nutrition (PN). We report the results of a planned interim analysis on patients with severe sepsis which was undertaken earlier than planned once a meta-analysis suggested excess mortality in patients with severe sepsis given enteral immunonutrition. DESIGN: Randomised multicentre unblinded controlled clinical trial. SETTING: Thirty-three General Intensive Care Units in Italy. PATIENTS AND PARTICIPANTS: Among the 237 recruited patients, 39 had severe sepsis or septic shock; 21 of them received PN. INTERVENTIONS: Eligible patients received either total PN or enteral nutrition, the latter containing extra L-arginine, omega-3 fatty acids, vitamin E, beta carotene, zinc, and selenium. MEASUREMENTS AND RESULTS: The primary endpoint for the subgroup analysis on patients with severe sepsis was mortality on Intensive Care Unit (ICU). The ICU mortality of patients with severe sepsis given enteral nutrition (EN) was higher than for those given PN (44.4% vs 14.3%; p=0.039). More patients given EN than patients given PN still had severe sepsis when they died (38.9% vs 9.5%, p=0.055). Recruitment of patients with severe sepsis was subsequently stopped. CONCLUSIONS: Our results show that enteral immunonutrition, compared to PN, may be associated with excess mortality in patients with severe sepsis.

APACHE↗
PubMed1996

Serum calcium and survival in a large health screening program.

There is evidence that hyperparathyroidism is associated with increased morbidity and mortality. It is not known, however, whether elevated serum calcium (S-Ca) by itself is associated with those risks. We, therefore, examined mortality rate in relation to a single S-Ca value obtained at screening of a large population (n = 33,346) during a mean follow-up period of 10.8 yr. A survival analysis was performed, comparing groups with S-Ca values above different defined limits with those below these limits, adjusting for age and date of screening. We found that men less than 50 yr of age at screening (n = 21,131) with S-Ca greater than 2.45 mmol/L exhibited a 20% increased mortality rate compared with those with lower S-Ca values (odds ratio = 1.2; P < 0.005), whereas those with S-Ca greater than 2.60 mmol/L had a doubled rate (odds ratio = 2.0; P < 0.0002). Men less than 50 yr of age with S-Ca levels between 2.51-2.55 mmol/L exhibited a 50% increased risk of death from all causes compared with those with S-Ca between 2.31-2.45 (P < 0.0001). The excess mortality in those with S-Ca above 2.5 mmol/L was largely attributable to cardiovascular diseases (58%), although a significant excess mortality was also evident for malignant disorders (28%). In contrast, the risk of obtaining a diagnosis of malignant disease was not found to increase with rising S-Ca levels. These results indicate that the risk of premature death in men less than 50 yr of age increases with rising S-Ca, even within the normal range, and this increase may be largely due to cardiovascular diseases.

Adult↗
PubMed1996

Multivariate analyses of mortality from coronary heart disease due to biological and behavioural factors.

Due to affluence and a sedentary life style a great deal of people in the western countries are affected by coronary heart disease (CHD). The relation between CHD and certain risk factors pertaining to life style is evaluated in this study. A primary purpose is to study certain crucial risk factors for women. The main variables are age, smoking, overweight (measured by BMI), blood pressure and exercise. This prospective study is based on self-reported data from the nation-wide Swedish Level of Living Survey and on data from the national Cause of Death Register. The data were analysed separately by sex using a proportional hazards model. The sample was divided into two strata: those with heart disease and/or diabetes initially, and all the rest. A sample of 2546 men and 2760 women between 45 and 74 years of age was followed from 1980 to the end of 1990. During this period 189 men and 75 women died of coronary heart disease (CHD). It was found that high blood pressure raised the relative risk (RR) of death from CHD by almost 60% in both men and women. Male smokers (> 14 cigarettes a day) had about 60% (significant) and female smokers (> 10 cigarettes a day) 150% (significant) excessive mortality from CHD. Different levels of overweight among women were strongly related to excess mortality from CHD, ranging between 100 and 300%. Among men there was no such relation. Lack of physical activity showed only a weak (non-significant) increased risk of death due to CHD. Diabetes was also found to be an important risk factor for mortality from CHD, especially among women, being seven times as high as among non diabetics. A test of sex differences revealed that there were two significant interactions, namely between sex and overweight, and between sex and age. Background variables in relation to mortality from all cardiovascular diseases (CVD) were also studied. There were of course many similarities between the effects of the background variables in both the disease groups, but there were interesting differences too, e.g. overweight turned out to be a significant risk factor also for men and physical inactivity for women.

Aged↗
PubMed2003

Changing heat-related mortality in the United States.

Heat is the primary weather-related cause of death in the United States. Increasing heat and humidity, at least partially related to anthropogenic climate change, suggest that a long-term increase in heat-related mortality could occur. We calculated the annual excess mortality on days when apparent temperatures--an index that combines air temperature and humidity--exceeded a threshold value for 28 major metropolitan areas in the United States from 1964 through 1998. Heat-related mortality rates declined significantly over time in 19 of the 28 cities. For the 28-city average, there were 41.0 +/- 4.8 (mean +/- SE) excess heat-related deaths per year (per standard million) in the 1960s and 1970s, 17.3 +/- 2.7 in the 1980s, and 10.5 +/- 2.0 in the 1990s. In the 1960s and 1970s, almost all study cities exhibited mortality significantly above normal on days with high apparent temperatures. During the 1980s, many cities, particularly those in the typically hot and humid southern United States, experienced no excess mortality. In the 1990s, this effect spread northward across interior cities. This systematic desensitization of the metropolitan populace to high heat and humidity over time can be attributed to a suite of technologic, infrastructural, and biophysical adaptations, including increased availability of air conditioning.

Adolescent↗
PubMedDate not supplied

[Obesity in the elderly and very elderly--prognostic significance and practical conclusions].

Epidemiological work on the age-dependency of the relation between overweight and mortality confirms an opinion which is traditional among physicians and has it roots in a mixture of biological understanding and common sense. The data base can be summarized in three points: 1) Up to the age of 60-65 years, overweight is combined with decreased life expectancy. The excess mortality is found mainly in the cardiovascular area and can be explained by the well-known risk factors of atherosclerosis. In the Framingham-study, overweight per se is a risk factor for this group of diagnoses. 2) In the age group 65-74 years, the relation between overweight and excess mortality vanishes gradually; the right arm of the U- or J-curve levels off. The optimal BMI moves to the right, and the right arm of the curve is shortened. 3) In high age, from 75-80 years on, overweight coincides with improved prognosis. The geriatric literature is in agreement in the sense that overweight is no problem in high age.

Aged↗
PubMed1994

[Incidence, differential diagnosis, work capacity, mortality and cause of death in Parkinson disease].

Parkinson's disease is one of the most frequent neurological diseases, which affects about 1% of the population older than 65 years. After manifestation the clinical signs of Parkinson's disease chronically progress. According to the Hoehn and Yahr scale the severity of parkinsonian symptoms is graded into 5 stages. Interindividually there is a considerable range in the rate of progression, which is on average 0.4 per year on the Hoehn and Yahr scale. Intraindividually the progression of clinical symptoms is approximately linear. If the interval between two consecutive Hoehn and Yahr stages is known, the further rate of progression can be estimated by extrapolation. Correlated with the progression of disease is a diminution of earning capacity. As there is no cure, Parkinson's disease only terminates with the death of the patient accompanied by excess mortality and reduced life expectancy. Since the introduction of L-DOPA a significant reduction of excess mortality has already been achieved. For treated patients the mean time of survival is 13-14 years after the onset of clinical signs.

Aged↗
PubMed1995

Mortality in rheumatoid arthritis.

Patients with rheumatoid arthritis (RA) have a substantially reduced life expectancy. The standardized mortality ratio in different studies has ranged from 1.13 to 2.98. This mainly applies to rheumatoid factor (RF)-positive cases, although there is a subgroup of RF-negative cases with an adverse long-term prognosis. Clinically based studies probably overestimate the true shortening of life span and population-based studies may underestimate it. Excess mortality from infection and from renal disease likely reflects the presence of severe disease, whereas most of the added mortality from gastrointestinal causes is treatment related. The reasons for the surplus of mortality from cardiovascular causes are not fully known. RF may have a direct role, and preillness factors such as smoking may predipose patients to RA and also render them susceptible to cardiovascular diseases. The excess mortality associated with RA is appreciably higher than is apparent from the cases in which RA is regarded as an underlying cause of death. The effect of treatment on mortality remains largely unknown.

Arthritis, Rheumatoid↗
PubMed1998

Age and liver transplantation: a report of the Liver Transplantation Database.

BACKGROUND: The average age of liver transplant recipients has increased steadily during the last decade. The effects of recipient age on outcome of liver transplantation were evaluated in a large prospective database. METHODS: A total of 735 adult recipients of single-organ liver transplants for nonfulminant liver disease enrolled in a large prospective database between 1990 and 1994 were analyzed for associations of patient age with outcomes. Patients were categorized into two groups: younger being <60 and older being > or = 60 years of age. RESULTS: Older liver transplant recipients were more likely to be female, white, and have the diagnoses of primary biliary cirrhosis or cryptogenic cirrhosis than younger recipients, who were more likely to have the diagnosis of alcoholic liver disease. Disease severity was similar between the two groups. After transplantation, the durations of stay in the intensive care unit and hospital were longer for older than for younger transplant recipients, but episodes of acute rejection were less frequent. The quality of life at 1 year was similar among older and younger recipients. Patient survival was lower for older than for younger recipients (81% vs. 90% at 1 year; P=0.004), whereas graft survival was not different (80% vs. 85% at 1 year; P=0.163). The excess mortality among older recipients was largely due to nonhepatic causes, including infectious, cardiac, and neurological diseases occurring within 6 months after transplantation. CONCLUSIONS: Although patient survival was significantly lower among liver transplant recipients above the age of 60 years, the excess mortality was due to nonhepatic, largely age-related problems. The overall success of liver transplantation and improvement in quality of life for older recipients is excellent.

Adult↗
PubMed1984

Is breast cancer a curable disease? A study of 14,731 women with breast cancer from the Cancer Registry of Norway.

The question whether breast cancer is curable remains controversial. Late recurrences and death from the disease are not infrequent. Long term follow-up of a large patient population is necessary to study this issue. The authors report a study of 14,731 cases of breast cancer reported to the Cancer Registry of Norway with follow-up times ranging from 5 to 18 years. A model in which the logarithms of the survival times were assumed to be normally distributed, the lognormal model, fitted the data well for individual stages, age groups, and periods of treatment. The cured fraction, i.e., consisting of those only subject to normal mortality risks, was estimated from the model to 35 +/- 1% standard error. In Stages 1, 2, 3, and 4 it was 54 +/- 3%, 27 +/- 1%, 19 +/- 2%, and 2 +/- 1%, respectively. It is concluded, however, that the estimated cure rate in Stages 3 and 4 should be regarded with caution in view of the methodological problems involved in the analysis and the small number of patients with long follow-up. The estimated cured fraction in both the individual stages and in the entire material was significantly higher in patients younger than 55 years of age than in older patients. The median survival of non-cured patients was estimated to be 3.6 years for the entire material. In Stage 1, 2, 3, and 4 it was 7.6 years, 3.4 years, 2.1 years, and 0.7 years, respectively. The lognormal model seems to be a good approximation of breast cancer survival. The model is consistent both with late excess mortality and with the presence of a cured fraction. It is noteworthy that an excess mortality was observed during the whole follow-up period. Extrapolations from the model should therefore be cautiously judged until supported by observed data.

Aged↗
PubMed1986

Census based mortality study of pharmaceutical industry workers.

This study was designed to investigate whether the mortality of British pharmaceutical industry workers showed any evidence of occupationally related patterns associated with particular sections of the industry with special emphasis on cancers and respiratory diseases. The data were extracted from census schedules by the Office of Population Censuses and Surveys using occupational categories recorded by pharmaceutical workers at the 1961 and 1971 censuses of England and Wales. Subsequent mortality was ascertained through the National Health Service Central Registry. Both cohorts, followed up to the end of 1981, showed a "healthy worker effect," with overall SMRs ranging from 0.77 to 1.04, though comparison with the employed populations of the longitudinal study reduced this effect by 25%. Evidence of inconsistent excess mortality was noted in small numbers for suicide (SMR 0.91 to 2.79) and cancer of the large intestine (SMR 1.09 to 2.38). There was no clear association between the type of industry and the causes of death investigated. Although the census based study has several methodological shortcomings, there was no evidence, on the basis of this study, to suggest any excess mortality risk from employment in the pharmaceutical industry.

Adult↗
PubMed2000

Long-term survival after repair of tetralogy of Fallot.

BACKGROUND: Tetralogy of Fallot (TOF) is the most common cause of cyanotic congenital heart disease. Long-term survival has improved because of lower operative mortality and surgical repair in infancy or early childhood prior to the development of cardiac compromise from chronic hypoxia. Thus, more people with repaired TOF will survive to adulthood and will be interested in insurance coverage. RESULTS: This paper reported 36-year follow-up of 490 patients observed for a mean duration of 25 years after surgical repair of TOF; 42 deaths occurred, 62% of which were due to cardiac causes, principally sudden cardiac death and congestive cardiac failure. Mortality ratios were generally highest for the first 10 years of follow-up, ranging from 309% (ages < 10 years) to 714% (ages 20-39 years). By age, mortality ratios were stable and relatively similar for ages to 19 years and variable at older ages due to the small exposure. Most patients were actively at work (70.8%), homemakers (20.1%), or retired (6.1%); 3% were unable to work. CONCLUSION: For patients < 10 years of age and 10-19 years of age at the time of surgery who were alive after 1 year after the repair of the TOF, excess mortality persisted at least 30 years after surgery and did not vary a great deal with duration of the follow-up. Based on limited data, excess mortality for age group 20-39 years was higher compared with those in a younger age group during the first 10 years after surgery and decreased thereafter. Survival rates similar to those of the general population were attained in subjects who did not require treatment with a right ventricular outflow patch and who had normal hematocrit levels prior to surgery. Elevated morbidity risk was manifest by cardiac symptoms, arrhythmias, subsequent heart surgery, and disability in 3% of patients.

Adolescent↗
PubMed1994

Variation in mortality rates in Tel Aviv region municipalities.

Age, sex and cause-specific mortality rates in 1982-86 for eight municipalities in the Tel Aviv region were compared to comparable rates of a reference population--the 1984 Jewish population of Israel. Residents of Or Yehuda, Tel Aviv, Holon and Bat Yam had an elevated risk of dying. Of particular interest is the elevated risk among adult residents of the Tel Aviv municipality. Males and females aged 30-44 had excess mortality from heart disease and external causes of death, and males aged 45-64 from ischemic heart disease and external causes. Tel Aviv females aged 30-44 also had excess mortality from cerebrovascular disease and females aged 45-64 from malignancy. High mortality rates in these age groups contribute considerably to years of life lost, and it is suggested that local health service or governmental action should be taken to investigate and reduce the disparities. Small area analysis, as shown here, may provide considerable information for monitoring community health.

Adolescent↗
PubMed1993

Mortality among people affected by toxic oil syndrome.

The authors conducted a mailed questionnaire survey of a 5% sample of the cohort of 20,643 people officially recognized by the Spanish government as having had toxic oil syndrome, a previously undescribed illness that was epidemic in Spain in 1981. After three mailings of a letter and questionnaire, responses for only 66% of the sample had been received. Nevertheless, responses were obtained from virtually all remaining patients (or surrogates for them in the cases of patients that had died) when they were sought by telephone. In 1981, there was clear-cut excess mortality in the cohort (standardized mortality ratio [SMR] 6.51; 95% confidence interval [CI]: 3.92-10.17). During the period January 1982 through 7 March 1988, there was no statistically significant overall mortality excess except during the period 1982-1983 among people aged < 65 years (SMR 2.26; 95% CI: 1.03-4.29). Toxic oil syndrome substantially altered the patterns of mortality among affected people. Analysis of deaths by cause among the TOS cohort will be useful for further evaluation of the long-term impact of the TOS epidemic.

Adolescent↗