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PubMed2004

Life-course experiences and mortality by adult social class among young men.

Circumstances over the life-course may contribute to adult social class differences in mortality. However, it is only rarely that the life-course approach has been applied to mortality studies among young adults. The aim of this study is to determine to what extent social class differences in mortality among young Finnish men are explained by living conditions in the parental home and life paths related to transitions in youth. The data for males born in 1956-60 based on the 1990 census records are linked with death records (3184 deaths) by cause of death for 1991-98, and with information on life-course circumstances from the 1970, 1975, 1980, and 1985 censuses. Controlling for living conditions in the parental home-social class, family type, number of siblings, language and region of residence-reduced the high excess mortality of the lower non-manual (RR 1.51, 95% CI: 1.28-1.79), skilled manual (RR 2.94, 2.54-3.40), and unskilled manual class (RR 4.08, 3.51-4.73) by 10% in all-cause mortality. The equivalent reduction for cardiovascular disease was 28% and for alcohol-related causes 16%. The effect of parental home on mortality differences was mainly mediated through its effect on youth paths (pathway model). Educational, marital, and employment paths had a substantial effect-independent of parental home-on social class differences from various causes of death. When all these variables were controlled for adult social class differences in cause specific mortality were reduced by 75-86%. Most of this reduction in mortality differences can be attributed to educational path. However, marital and employment paths had their independent effects, particularly on the excess mortality of unskilled manual workers with disproportionately common exposure to long-term unemployment and living without a partner. In summary, social class differences in total mortality among men in their middle adulthood were only partly determined by parental home but they were mainly attributable to educational, marital, and employment paths in youth.

Adult↗
PubMed1979

A cohort study of mortality and cancer incidence in ethylene oxide production workers.

Ethylene oxide, important as an intermediate product in the chemical industry and for sterilising hospital equipment, is mutagenic in several organisms; carcinogenicity has been suspected although this had not been supported by clinical data. Ethylene oxide has been produced by a Swedish company since the beginning of the 1940s. This paper describes a cohort study of the mortality and the cancer incidence among full-time exposed workers in ethylene oxide production, a group of maintenance workers with intermittent exposure and a group of unexposed controls. Investigation of the production processes in the building at different times has shown that workers were exposed to ethylene dichloride, ethylene chlorohydrin, ethylene, and small amounts of bis-(2-chloroethyl) ether as well as to ethylene oxide and traces of other chemicals. The full-time exposed cohort shows a considerable excess mortality deriving mainly from increased mortality from tumours and also from diseases of the circulatory system. The cancer incidence study, including living persons with malignancies, showed a significant excess in the full-time cohort. Of the 16 patients with tumours in the two more exposed cohorts there were three cases of leukaemia, six of tumours in the alimentary tract and four of urogenital malignancy. The excess mortality and cancer incidence cannot be attributed to any particular chemical in the production process, but ethylene oxide and ethylene dichloride are the prime suspects.

Chemical Industry↗
PubMed2005

Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction.

AIMS: Atrial fibrillation (AF) is a common complication in patients with acute myocardial infarction and is associated with an increase in the risk of death. The excess mortality associated with AF complicating acute myocardial infarction has not been studied in detail. Observations indicate that AF facilitates induction of ventricular arrhythmias, which may increase the risk of sudden cardiovascular death (SCD). A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments. METHODS AND RESULTS: We analysed the relation between AF/atrial flutter (AFL) and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infarction screened in the TRAndolapril Cardiac Evaluation registry. This cohort of patients with an enzyme-verified acute myocardial infarction was admitted to 27 centres in 1990-92. Survival status was obtained 2 years after screening of the last patient. An independent endpoint committee assessed the modes of death. Left ventricular ejection fraction was determined in all the screened patients and information about presence or absence of AF/AFL was prospectively collected. Sustained or paroxysmal AF/AFL was observed in 1149 patients (19%) during hospitalization. During follow-up, 1659 patients (34%) died: 482 (50%) patients with AF/AFL and 1177 (30%) patients without AF/AFL, P<0.001. SCD occurred in 536, non-SCD occurred in 725, and 398 died of non-cardiovascular causes (includes 142 unclassifiable cases). The adjusted risk ratio of AF/AFL for total mortality was 1.33 (95% CI: 1.19-1.49; P<0.0001) and the risk ratio for SCD was 1.31 (95% CI: 1.07-1.60; P<0.009). The adjusted risk ratio of AF/AFL for non-SCD was 1.43 (95% CI: 1.21-1.70; P<0.0001). CONCLUSION: The excess mortality observed in patients with AF/AFL following acute myocardial infarction is due to a significant increase in both SCD and non-SCD.

Adult↗
PubMed1997

Electrocardiographic Minnesota code findings predicting short-term mortality in asymptomatic subjects. The Italian RIFLE Pooling Project (Risk Factors and Life Expectancy).

Aim of the study was to analyze the predictive power on short term mortality of electrocardiographic findings in asymptomatic subjects belonging to samples of the general population. In the Italian RIFLE Pooling Project (Risk Factors and Life Expectancy) 12 180 men and 10 373 women aged 30 to 69 years had a resting electrocardiogram (ECG) recorded at baseline examination. All of them were free from clinically symptomatic heart disease and represented 23 cohorts spread all over Italy. ECGs were read by the Minnesota Code using 5 large categories of abnormalities, i.e. Q-QS abnormalities, ST-T abnormalities, high R. waves, major arrhythmias, and blocks. Some clinically relevant ECG combination of abnormalities were also analyzed. Six-year mortality from coronary heart disease (CHD), cardiovascular diseases (CVD) and all-cause mortality (ALL) were the end-point. Those ECG findings were relatively common and covered the majority (80 to 90%) of all abnormalities found in the general population before excluding subjects with symptomatic heart disease. Most ECG findings on most occasions were associated with an excess mortality from the three end-points in both men and women and among relatively young (age 30-49) and mature (age 50-69) adults. The strongest predictor of fatal events were Q-QS items and blocks. The most consistent predictors were ST-T findings, although this was true for men and not for women. Relative risk against the absence of abnormalities (one by one and all together) were adjusted by multivariate analysis feeding in the models some possible confounders, i.e. age, systolic blood pressure, serum cholesterol, cigarette consumption and body mass index. Relative risks in cells with more than 20 events (cells being separately made by men, women, the 5 ECG findings categories and the 3 end-points) were ranging 1.00 to 9.88 for Q-QS abnormalities, 1.03 to 3.76 for ST-T abnormalities, 1.28 to 5.14 for high R waves, 0.81 to 2.28 for arrhythmias and 0.79 to 3.59 for blocks. Most of these relative risks were statistically significant. Combinations of clinically relevant ECG findings in the same individual (LVH, possible and definite myocardial infarction) were rare but carried a severe prognosis with high and statistically significant relative risks among men (ranging between 3.19 and 7.24) while they could not be properly tested in most cells for women due to the small numbers involved. It is concluded that in the general population high rates of prevalent ignored ECG abnormalities in asymptomatic subjects are associated with significant excess mortality from CHD, CVD and all-cause mortality, suggesting a high prevalence of silent heart disease.

Adult↗
PubMed1991

Increase in mortality associated with blindness in rural Africa.

Forty-seven persons were identified with visual impairment (visual acuity of 6/60 or less in their better eye) during a population-based survey in 1986 of eye disease in three villages in central Tanzania. Four years later, 41 (87%) of them and 70 (82%) of 84 age-, sex-, and village-matched controls with normal functional vision (visual acuity 6/18 or better in the better eye) were traced, and those who were still alive were re-examined. The remainder were reported to be alive but had moved to other villages. Deaths among those aged 40-79 years amounted to 10 among the 37 visually impaired and 7 among the 70 sighted controls. This gave an excess mortality rate (odds ratio) of 3.33 times (1.03-11.04, 95% Cl) among the visually impaired compared to their age-matched controls. The excess mortality rate for visually impaired women was 4.11 (0.72-25.5) and 2.71 (0.50-15.2) for visually impaired men. Nine out of 25 with vision of less than 3/60 in their better eye had died. The higher mortality rate among the visually impaired suggests that, in this environment, blindness is not only associated with considerable disability but is also associated with a shortened life expectancy, especially for women.

Adolescent↗
PubMed2006

Heart transplantation for end-stage valvular disease: indications and results.

PURPOSE OF REVIEW: The aim of this study is to appraise the indications of a small group of heart transplanted patients with valvular disease, to analyse both their particular issues and results compared with the etiologies of other transplanted patients. RECENT FINDINGS: Analysis of recent data shows that valvular patients represent between 3 and 5% of transplantation indications. This proportion of valvular patients had a tendency to decrease in many countries. These patients on the whole have undergone multiple reoperations. Pulmonary resistance analysis has to be especially rigorous for this group. A primary excess mortality is directly related to multiple reoperations. Mean and long-term results are then strictly comparable with other etiologies. There are a few very specific indications for recurrent endocarditis in this group. SUMMARY: Valvular patients represent a subgroup of transplanted patients with a slight primary excess mortality but with identical long-term results.

Cause of Death↗
PubMed1998

Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.

BACKGROUND: Atrial fibrillation (AF) causes substantial morbidity. It is uncertain whether AF is associated with excess mortality independent of associated cardiac conditions and risk factors. METHODS AND RESULTS: We examined the mortality of subjects 55 to 94 years of age who developed AF during 40 years of follow-up of the original Framingham Heart Study cohort. Of the original 5209 subjects, 296 men and 325 women (mean ages, 74 and 76 years, respectively) developed AF and met eligibility criteria. By pooled logistic regression, after adjustment for age, hypertension, smoking, diabetes, left ventricular hypertrophy, myocardial infarction, congestive heart failure, valvular heart disease, and stroke or transient ischemic attack, AF was associated with an OR for death of 1.5 (95% CI, 1.2 to 1.8) in men and 1.9 (95% CI, 1.5 to 2.2) in women. The risk of mortality conferred by AF did not significantly vary by age. However, there was a significant AF-sex interaction: AF diminished the female advantage in survival. In secondary multivariate analyses, in subjects free of valvular heart disease and preexisting cardiovascular disease, AF remained significantly associated with excess mortality, with about a doubling of mortality in both sexes. CONCLUSIONS: In subjects from the original cohort of the Framingham Heart Study, AF was associated with a 1.5- to 1.9-fold mortality risk after adjustment for the preexisting cardiovascular conditions with which AF was related. The decreased survival seen with AF was present in men and women and across a wide range of ages.

Adult↗
PubMed2005

Mortality from lung and kidney disease in a cohort of North American industrial sand workers: an update.

BACKGROUND: A previously published cohort study of some 2670 employees of the North American sand industry, followed through 1994, provided strong evidence of a causal relationship between quartz exposure and death from both silicosis and lung cancer, after allowance for cigarette smoking and in the absence of known occupational carcinogens. Unexpectedly, a significant excess mortality from chronic non-malignant renal disease [observed 16; expected 7.6; standardized mortality ratio (SMR) 212] was also found, whereas deaths from renal cancer at this stage were close to expectation (observed 6; expected 5.2). OBJECTIVES: Our primary aim was to discover whether death from chronic renal disease was related to the estimated intensity of crystalline silica exposure. A further aim was to determine whether or not our previous estimates of lung cancer and silicosis risk were confirmed by mortality in the cohort 6 years later. METHODS: With help from the US National Death Index, surviving members of the cohort, with the exception of employees of a small plant in Canada, were traced through 2000. The cause of death was determined for all who had died, for comparison against National and State mortality rates. Nested case-referent analyses were then undertaken, as previously, of deaths from lung cancer and silicosis, plus end-stage renal disease and kidney cancer, in relation to quantitative re-estimates of quartz exposure. RESULTS: The total number of deaths through 1994 was 990; there were 231 additional deaths during the period 1995-2000. The SMRs were significantly higher in the later than the earlier period, mainly due to a relative increase in heart disease and external causes. The updated odds ratios for lung cancer and silicosis were almost identical to those published previously, with lung cancer risk again related to average silica concentration and cumulative exposure, but not to length of employment. In contrast, risks of neither end-stage renal disease nor renal cancer were related to cumulative exposure, although now based on 19 cases (SMR 239), and 10 cases (SMR 202), respectively, in fact, opposite trends were apparent for both diseases. However, because of the small numbers there was only limited power to assess the statistical significance of these trends or of any separate relationship with the duration or intensity of exposure. CONCLUSIONS: Our findings support a causal relationship between lung cancer and quartz exposure after allowance for cigarette smoking, in the absence of other known carcinogens, but failed to find similar evidence to explain the excess mortality from either chronic renal disease or kidney cancer.

Case-Control Studies↗
PubMed1995

[Mortality among the dye industry workers. II. An analysis of malignant neoplasm mortality].

A mortality study was carried out among workers employed in a plant producing different kinds of dyes, including benzidine. The cohort comprised 8,523 males and 2,006 females whose vital status was recorded between Jan 1, 1945 and Dec. 31, 1991. They had worked in this plant for, at least, 3 months between Jan. 1, 1945 and Dec 31, 1974. The cohort was divided into 4 subcohorts: I. those exposed only to benzidine: II. those exposed to benzidine and other occupational hazards; III. those involved directly in the dye production but not exposed to benzidine, and IV. those not involved directly in the dye production-mainly administrative staff. Death risk was estimated on the basis of standardized mortality ratio (SMR) determined by means of the person-years method. The general population of Poland was taken as a reference group. The observed number of deaths in the cohort and each subcohort was compared with expected deaths. The comparison was based on national rates by adjustment for age, gender and calendar time. Significant excessive mortality due to cancer of urinary bladder was observed in the male subcohort I (SMR = 14.69), II (SMR = 16.34) and III (SMR = 3.17); due to malignant neoplasm of pancreas in the male subcohort II (SMR = 3.26); due to malignant neoplasm of testis in the male subcohort III (SMR = 3.17); due to malignant neoplasm of pancreas in the male subcohort II (SMR = 3.26); due to malignant neoplasm of testis in the male subcohort III (SMR = 3.23). Significant excessive mortality due to malignant neoplasm of liver and intrahepatic bile ducts was found in the female subcohort IV (SMR = = 2.36).

Chemical Industry↗
PubMed1996

From first class to third class: recent upheaval in antiarrhythmic therapy--lessons from clinical trials.

In recent years, the results of large randomized and controlled trials of antiarrhythmic agents for primary and secondary prevention of ventricular tachycardia and ventricular fibrillation have changed perceptions of the actions of antiarrhythmic agents regarding both efficacy and risk. The premature termination of the CAST trials of primary prevention in postinfarct patients highlighted the proarrhythmic risk and inefficacy of the sodium channel blockers (class I action), encainide, flecainide, and moricizine, in patients at relatively low risk for death in the long term. The excess mortality with therapy was attributed to proarrhythmia due to facilitation of reentry, especially during acute ischemia. About the same time, European trials with amiodarone, a complex agent with antiadrenergic action and powerful action to prolong refractoriness (class III action), indicated enhanced survival after infarction with amiodarone but not with agents with class I action. Recent verbal reports of larger and placebo-controlled trials (EMIAT and CAM-IAT) confirm a significant reduction in arrhythmia mortality, possibly with a favorable trend in total mortality. While an older trial with dl-sotalol (class III and beta-blocking actions) showed a trend toward improved survival after infarction, a recent trial with d-sotalol in patients with recent infarction or remote infarction and heart failure was prematurely terminated because of excess mortality attributed to proarrhythmia (torsades de pointes), indicating the importance of beta-blocking properties of a class III agent. A secondary prevention trial (ESVEM) in patients surviving an episode of VT or VF showed significant superiority of dl-sotalol compared to an array of agents that block sodium channels with respect to both efficacy and tolerance. Occurrence rates of arrhythmias treated with drugs tested for efficacy either by suppression of inducible arrhythmias or by suppression of spontaneous ectopy were higher and equivalent for both testing methods. A secondary prevention trial of amiodarone and multiple agents that block sodium channels in survivors of cardiac arrest (CASCADE) showed a significant increased efficacy of amiodarone but poorer long-term tolerance compared with the other agents. Comparative analysis of the results of the various trials suggests that class III action coupled with antiadrenergic action is more efficacious in both primary and secondary prevention of life-threatening ventricular arrhythmias and that lethal proarrhythmias may be the predominant effect in attempts at primary prevention in low-risk populations due to class I or so-called pure class III action.

Adrenergic beta-Antagonists↗
PubMed2005

Mortality associated with Barrett's esophagus and gastroesophageal reflux disease diagnoses-a population-based cohort study.

INTRODUCTION: Patients with Barrett's esophagus have a much increased risk of esophageal adenocarcinoma but recent evidence suggests no increase in overall mortality. We have reexamined this surprising finding in a large, prospectively population-based cohort study. METHODS: Cohorts of patients having Barrett's esophagus (n=1,677), esophagitis (n=6,392), simple reflux (n=6,328), and a standard reference cohort representing the general population in the United Kingdom (n=13,416) were selected from General Practice Research Database. The last three cohorts were matched to the Barrett's cohort by general practice, age, and sex. Mortality rates and hazard ratios with their 95% confidence intervals were calculated for deaths due to all causes and deaths due to all causes except esophageal cancer occurring beyond the first year of the follow-up. RESULTS: A total of 1,725 deaths were analyzed including 49 deaths in subjects having esophageal cancer. Of 111 deaths in the Barrett's cohort, 13 (12%) were in subjects with esophageal cancer. Compared with the reference cohort, hazard ratios for all causes of death were 1.37 (1.12-1.66) for the Barrett's, 1.16 (1.02-1.32) for the esophagitis, and 1.16 (1.01-1.33) for the reflux cohorts. The corresponding figures for deaths due to all causes except esophageal cancer were 1.23 (1.00-1.51), 1.13 (0.99-1.30), and 1.15 (1.00-1.31). Of the excess mortality rates in the Barrett's, esophagitis, and reflux cohorts, at the most 45%, 20%, and 13%, respectively, could be attributed to esophageal cancer. CONCLUSION: People with Barrett's esophagus and gastroesophageal reflux disease have higher mortality rates than the general population, and an increase in esophageal cancer risk accounts for less than half the excess mortality in Barrett's.

Adult↗
PubMed2005

Survival after hip fracture.

Although it is known that overall mortality is increased after hip fracture, the influence of hip fracture risk factors on the subsequent mortality and cause of death has not been well studied. The objective of this study was to establish the survival after hip fracture in women and to assess the impact of comorbidity on mortality. We identified a complete population-based set of 2,245 incident hip fracture cases and 4,035 randomly selected population-based controls among women 50-81 years old in Sweden and followed these subjects for an average of 5 years through the Swedish National Inpatient and Cause-of-Death Registers. Information on factors related to hip fracture was obtained through linkage to hospital discharge data and through a mailed questionnaire. We studied excess mortality of hip fracture patients compared to controls using survival curves and proportional hazard regression models. During follow-up, 896 hip fracture patients (40%) and 516 (13%) controls died. The relative risk (RR) of death, adjusted for age and previous hospitalization for serious disease, was 2.3 (95% CI 2.0-2.5). Although the highest mortality risks were in the 1st 6 months post-fracture, RRs for fractures versus controls were increased for at least 6 years. Increased mortality was apparent both in those with evidence of comorbidity and those without. Hip fracture patients have a substantially increased risk of death that persists for at least 6 years post-fracture. The relative excess mortality is independent of comorbidity and known hip fracture risk factors.

Age Distribution↗
PubMed2000

[Perspectives and limits in treatment of obesity].

The widely propagated morbidity and mortality risks of obesity appear somewhat exaggerated, except for morbid obesity (BMI > 40 kg/m2) and for high risk obese subgroups concerning diabetes mellitus, hypertension, metabolic syndrome and obstructive sleep apnea syndrome. Non-medical reasons represent a major component of the social pressure that is presently experienced by obese persons in our society. Weight reduction represents the primary therapeutic approach in overweight patients with type 2 diabetes, hypertension, metabolic syndrome and obstructive sleep apnea, and it may be recommended in high-risk individuals for primary prevention of these diseases. Massive obesity is associated with excess mortality, especially in younger, physically inactive men with upper-body-segment obesity. It is widely assumed that weight reduction will lead to a reduction of excess mortality in these individuals; so far, however, there is no proof for this assumption. Non-medicamentous conservative therapeutic approaches to weight reduction have the advantage of safety, even though their long-term efficacy is generally disappointing. There are no randomized, controlled trials to prove a reduction of morbidity or mortality risks and of therapeutic safety for pharmacological, invasive or surgical methods to treat obesity.

Body Mass Index↗
PubMed1991

Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial.

BACKGROUND AND METHODS: In the Cardiac Arrhythmia Suppression Trial, designed to test the hypothesis that suppression of ventricular ectopy after a myocardial infarction reduces the incidence of sudden death, patients in whom ventricular ectopy could be suppressed with encainide, flecainide, or moricizine were randomly assigned to receive either active drug or placebo. The use of encainide and flecainide was discontinued because of excess mortality. We examined the mortality and morbidity after randomization to encainide or flecainide or their respective placebo. RESULTS: Of 1498 patients, 857 were assigned to receive encainide or its placebo (432 to active drug and 425 to placebo) and 641 were assigned to receive flecainide or its placebo (323 to active drug and 318 to placebo). After a mean follow-up of 10 months, 89 patients had died: 59 of arrhythmia (43 receiving drug vs. 16 receiving placebo; P = 0.0004), 22 of nonarrhythmic cardiac causes (17 receiving drug vs. 5 receiving placebo; P = 0.01), and 8 of noncardiac causes (3 receiving drug vs. 5 receiving placebo). Almost all cardiac deaths not due to arrhythmia were attributed to acute myocardial infarction with shock (11 patients receiving drug and 3 receiving placebo) or to chronic congestive heart failure (4 receiving drug and 2 receiving placebo). There were no differences between the patients receiving active drug and those receiving placebo in the incidence of nonlethal disqualifying ventricular tachycardia, proarrhythmia, syncope, need for a permanent pacemaker, congestive heart failure, recurrent myocardial infarction, angina, or need for coronary-artery bypass grafting or angioplasty. CONCLUSIONS: There was an excess of deaths due to arrhythmia and deaths due to shock after acute recurrent myocardial infarction in patients treated with encainide or flecainide. Nonlethal events, however, were equally distributed between the active-drug and placebo groups. The mechanisms underlying the excess mortality during treatment with encainide or flecainide remain unknown.

Actuarial Analysis↗
PubMed2006

A vulnerability study of the low-income elderly in the context of high temperature and mortality in Seoul, Korea.

INTRODUCTION: We investigated the impact of environmental high temperature on mortality in Seoul, Korea, and the consequences of high temperature-induced mortality with a focus on the low-income elderly. METHODS: Changes in the risk of death by age and income were estimated by a 1 degrees C increase in temperature using a generalized additive model adjusting for non-temperature related factors: time trends, seasonality, and air pollution. The study covered the years of 2000, 2001, and 2002. RESULTS: We found that income and age were potential factors in high-temperature-induced excess mortality. Evidences to support these results are as follows: first, regarding the effect of an economic factor in the association between mortality and high temperature, the study shows that the mortality rate of the low-income group is higher, by as much as 1.3- to 1.7-fold, than that of the general population. Second, taking age into consideration, the mortality of low-income elderly people is 1.5-fold higher than that of the whole low-income group. The combined effect of income and age on mortality is estimated as 2.3-fold higher than that of the general population. But the results of the low-income and elderly group were not statistically significant due to wide standard deviation. CONCLUSIONS: The relationship between high-temperature-induced excess mortality, income, and age suggests the need for a public health message, yet many results were not statistically significant: preventive and health care interventions need to be administered to the elderly and low-income group during periods of high temperature.

Adaptation, Physiological↗
PubMed2003

Survival from breast cancer among South Asian and non-South Asian women resident in South East England.

Ethnic differences in breast cancer survival have been observed in the USA but have not been examined in Britain. We aimed to investigate such differences between South Asian (i.e. those with family roots in the Indian subcontinent) and non-South Asian (essentially British-native) women in England. Primary breast cancer cases incident in 1986 -1993 and resident in South East England were ascertained through the Thames Cancer and Registry and followed up to the end of 1997. Cases of South Asian ethnicity were identified on the basis of their names by using a previously validated computer algorithm. A total of 1037 South Asian and 50 201 non-South Asian breast cancer cases were included in the analysis; 30% of the South Asian (n=312) and 44% (n=22 201) of the non-South Asian cases died during follow-up. South Asian cases had a higher relative survival than non-South Asians throughout the follow-up period. The 10-year relative survival rates were 72.6% (95% confidence interval: 69.0, 75.9%) and 65.2% (64.5, 65.8%) for South Asians and non-South Asians, respectively. The excess mortality rates experienced by South Asians were 82% (72, 94%) of those experienced by non-South Asians (P=0.004). The magnitude of this effect was slightly reduced with adjustment for differences in age at diagnosis, but was strengthened with further adjustment for differences in stage at presentation and socioeconomic deprivation (excess mortality rates in South Asians relative to non-South Asians=72% (63, 82%), P&<0.001). These findings indicate that the higher survival from breast cancer in the first 10 years after diagnosis among South Asian was not due to differences in age at diagnosis, socioeconomic deprivation or disease stage at presentation.

Adult↗
PubMed1994

Mortality in relation to smoking: 40 years' observations on male British doctors.

OBJECTIVE: To assess the hazards associated with long term use of tobacco. DESIGN: Prospective study of mortality in relation to smoking habits assessed in 1951 and again from time to time thereafter, with causes sought of deaths over 40 years (to 1991). Continuation of a study that was last reported after 20 years' follow up (1951-71). SUBJECTS: 34,439 British male doctors who replied to a postal questionnaire in 1951, of whom 10,000 had died during the first 20 years and another 10,000 have died during the second 20 years. RESULTS: Excess mortality associated with smoking was about twice as extreme during the second half of the study as it had been during the first half. The death rate ratios during 1971-91 (comparing continuing cigarette smokers with life-long non-smokers) were approximately threefold at ages 45-64 and twofold at ages 65-84. The excess mortality was chiefly from diseases that can be caused by smoking. Positive associations with smoking were confirmed for death from cancers of the mouth, oesophagus, pharynx, larynx, lung, pancreas, and bladder; from chronic obstructive pulmonary disease and other respiratory diseases; from vascular diseases; from peptic ulcer; and (perhaps because of confounding by personality and alcohol use) from cirrhosis, suicide, and poisoning. A negative association was confirmed with death from Parkinson's disease. Those who stopped smoking before middle age subsequently avoided almost all of the excess risk that they would otherwise have suffered, but even those who stopped smoking in middle age were subsequently at substantially less risk than those who continued to smoke. CONCLUSION: Results from the first 20 years of this study, and of other studies at that time, substantially underestimated the hazards of long term use of tobacco. It now seems that about half of all regular cigarette smokers will eventually be killed by their habit.

Adult↗
PubMed2000

Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality.

The objective of the present study was to determine the incidence of pituitary adenomas (PAs) and the associated rates and causes of mortality in a large population. The study population comprised 2279 patients (1010 women and 1269 men) of all individuals (n = 3321) with pituitary tumors included in the Swedish Cancer Registry between 1958 and 1991. The mean age (+/-SD) at diagnosis was 52.3 +/-15.7 yr. The age-standardized incidence of PA increased significantly from approximately 6 cases/million inhabitants in 1958 to 11 cases/ million in 1991. The age-specific incidence peaked between 60-70 yr of age in both sexes. Excess mortality was found in the study population. The total number of deaths was 842. The standardized mortality ratio (SMR) for the study population was 2.0. The SMR for women (2.3) was significantly (P < 0.01) higher than that for men (1.9). Cardiovascular diseases were the most common cause of mortality among patients, accounting for 346 deaths (SMR, 1.6). The difference between the sexes was significant (men, 1.4; women, 1.8; P < 0.05). Cerebrovascular death occurred in 97 patients (SMR, 2.4), with no significant difference between men (SMR, 2.5) and women (SMR, 2.2). Excess mortality was also observed for tumors, endocrine diseases, and gastrointestinal diseases. These findings suggest that the annual incidence of PA is increasing. Possible explanations are improved diagnostic skill and/or increased awareness of pituitary diseases among physicians. However, a real increase in the incidence of PA cannot be ruled out.

Adenoma↗