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PubMed1999

Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis.

BACKGROUND: Psoriasis is seen as a disease that does not kill. However, it is associated with alcohol intake and smoking. Thus, there could be excess mortality due to causes related to alcohol intake and smoking among patients with psoriasis. DESIGN: A cohort was identified from the nationwide Hospital Discharge Register from January 1, 1973, through December 31, 1984, and mortality was followed up for 22 years by linkage with the Cause-of-Death Register, from January 1, 1973, through December 31, 1995. PATIENTS: A cohort of 3132 men and 2555 women admitted to inpatient treatment with psoriasis as the principal diagnosis. MAIN OUTCOME MEASURES: Date and underlying cause of death. RESULTS: We observed 1918 deaths in contrast to the 1211 deaths expected on the basis of the national mortality rates. The all-cause standardized mortality ratio (SMR) for men was 1.62 (95% confidence interval [CI], 1.52-1.71); for women, 1.54 (95% CI, 1.43-1.64). Among men, the highest SMRs were found for alcohol psychosis (8.91 [95% CI, 2.89-20.70]) and liver disease, ie, cirrhosis, fatty liver, and hepatitis (6.98 [95% CI, 5.34-8.96]). Among women, the highest SMR was found for liver disease (5.06 [95% CI, 2.70-8.65]). Excess mortality was high for all causes of death directly related to alcohol; the SMR for men was 4.46 (95% CI, 3.60-5.45); for women, 5.60 (95% CI, 2.98-8.65). CONCLUSIONS: Patients with moderate to severe psoriasis are at increased risk for death. Alcohol is a major cause for this excess mortality.

Alcohol Drinking↗
PubMed2004

[Excess mortality by diarrhea simultaneous to a cholera epidemic in Northeastern Brazil].

OBJECTIVE: To evaluate excess mortality due to infectious diarrhea without etiological diagnosis, occurring simultaneously to Vibrio cholerae circulation. METHODS: Statistical modeling was applied to a time series of deaths ascribed to "poorly defined intestinal infections" (International Classification of Diseases -- ICD-9) and "presumably infectious diarrhea and gastroenteritis" (ICD-10), between 1980 and 1998 in the Northeast region of Brazil. The prediction of expected values was obtained after a discontinuity point. Excess mortality was calculated as the difference between observed figures and those estimated by the model. RESULTS: Between 1992 and 1994, only 19.3% of deaths by cholera were actually notified. In 1993, the year in which the epidemic reached its peak in the area, our modeling estimated underregistration at 82.2%. CONCLUSIONS: Results indicate substantial underregistration of cholera mortality during the epidemic in Northeastern Brazil.

Animals↗
PubMed1996

The Swedish randomised mammography screening trials: analysis of their effect on the breast cancer related excess mortality.

OBJECTIVE: To apply an indirect method for estimation of the breast cancer related excess mortality in the Swedish randomised mammography screening trials. SETTING: Randomised trials on mammography screening have, in Sweden, been performed in the counties of Kopparberg (W) and Ostergötland (E), the so called WE study, and in the three largest cities in Sweden, Stockholm (southern part), Gothenburg, and Malmö. An overview of the trials was presented in the Lancet in 1993 and included 156,911 women in the invited group and 125,866 in the control group. METHODS: The excess mortality in the breast cancer subgroups was estimated by indirect standardisation using official national cause of death statistics according to Statistics Sweden as a reference. RESULTS: The estimated reduction of the breast cancer related mortality was 24% for the whole group (40-74 years at randomisation). The corresponding figures for the age groups 40-49, 50-59, and 60-69 years were 6%, 28%, and 34% respectively. CONCLUSION: The results are very similar to those presented earlier based on the traditional comparison of the breast cancer mortality in the invited and in the control group. This analysis further strengthens previous reports on a beneficial effect of mammography screening, which is especially pronounced in the age group 50-69.

Adult↗
PubMed1991

The decline in winter excess mortality in The Netherlands.

In most countries, numbers of deaths rise considerably during the winter season. This winter excess in mortality has, however, been declining during recent decades. The causes of this decline are hardly known. This paper attempts to derive a number of hypotheses on the basis of a detailed description of trends in winter excess mortality in the Netherlands. Numbers of death by age, cause of death, and month of death for the period 1953-1988 were analysed by log-linear regression. There was a 50% reduction in winter excess mortality between the 1950s and 1970 followed by a much smaller reduction in later years. The decline in winter excess for total mortality can largely be attributed to parallel declines for a number of cardiovascular and respiratory diseases. Excess mortality decreased for winter months without influenza epidemics as well as for those with epidemics. The results suggest that the decline in winter excess mortality in the Netherlands can only partly be explained by decreases in influenza-associated mortality. It is argued that the role of the introduction of central heating is minimal and that a fundamental role is played by factors closely related to socioeconomic progress.

Adolescent↗
PubMed1997

Excess mortality of schizophrenia. A meta-analysis.

BACKGROUND: This paper presents a structured review of the published information on the mortality of schizophrenia. METHOD: A meta-analysis of the literature. RESULTS: Schizophrenia has a significantly increased mortality from natural and unnatural causes. Twenty-eight percent of the excess mortality is attributable to suicide and 12% to accidents. The rest of the excess mortality is from the same broad range of conditions which cause deaths in the general population. Further interpretation is hampered by confounding variables, wide confidence intervals and reservations about generalising from individual cohorts. CONCLUSIONS: The available evidence suggests that schizophrenia is associated with a large increased mortality from suicide and a moderate increased mortality from natural causes. A number of possible interventions have been identified, but we do not yet have reliable means of detecting any changes in mortality which might result.

Accidents↗
PubMed2007

Excess mortality of hepatocellular carcinoma and morbidity of liver cirrhosis and hepatitis in HCV-endemic areas in an HBV-endemic country: geographic variations among 502 villages in southern Taiwan.

AIMS: The aim of this study was to investigate excess mortality for hepatocellular carcinoma (HCC) and prevalence of hepatitis and liver cirrhosis (LC) in hepatitis C virus (HCV)-endemic areas in Taiwan, which is a hepatitis B virus (HBV)-endemic country. METHODS: Tainan County, located in southern Taiwan, consists of 533 villages in 31 townships. A total of 56 702 subjects >or= 40 years old (mean age, 60.9 +/- 11.8 years) were enrolled from 502 of the 533 villages between April and November 2004 (n >or= 20/village). Serum blood HBV surface antigen (HBsAg), antibody to HCV (anti-HCV) and alanine transaminase (ALT) levels and platelet counts were measured. Township-specific mortality for liver cancer (ICD = 155) for both sexes between 1992 and 2001 were obtained from official publications. RESULTS: The prevalence of anti-HCV in Tainan County was 10.2% (township range, 2.6-30.9%; village range, 0-90.5%). The prevalence of HBsAg was 10.9% (township range, 5.5-17.2%; village range, 0-30.8%). The prevalence of hypertransaminemia (serum ALT > 40 IU/L) was 12.8%. At township levels, prevalence of anti-HCV (r2 = 0.92, P < 0.001), HBsAg and anti-HCV (multiple r2 = 0.94) were correlated with hypertransaminemia prevalence by single and multiple linear analysis, respectively. At village levels, prevalence of anti-HCV (r2 = 0.52, P < 0.001), HBsAg and anti-HCV (multiple r2 = 0.53) were each correlated with prevalence of hypertransaminemia, respectively. The prevalence of thrombocytopenia (<150,000 platelets/microL) was 5.5%, and adopted as a surrogate prevalence for LC. At township levels, prevalence of anti-HCV (r2 = 0.58) was the only factor correlated by multivariate analysis with prevalence of thrombocytopenia. At village levels, prevalence of anti-HCV and female-to-male ratio (multiple r2 = 0.43) were each independently associated with prevalence of thrombocytopenia. At township levels, HBsAg prevalence (r2 = 0.42) was more correlated with HCC mortality than anti-HCV prevalence (r2 = 0.28) for male subjects, while anti-HCV prevalence (r2 = 0.45) was more correlated with HCC mortality than HBsAg prevalence (r2 = 0.14) for female subjects. Prevalence of HBV and HCV infection were associated by multivariate analysis with both male (multiple r2 = 0.62) and female (multiple r2 = 0.53) HCC mortality. CONCLUSIONS: Prevalence of anti-HCV showed significant correlations with prevalence of hypertransaminemia, thrombocytopenia and liver cancer mortality. The findings indicate excessive mortality due to HCC, and LC and hepatitis prevalence in HCV-endemic areas in Taiwan, an HBV-endemic country.

Carcinoma, Hepatocellular↗
PubMed2004

Winter excess mortality in intensive care in the UK: an analysis of outcome adjusted for patient case mix and unit workload.

OBJECTIVE: To investigate whether mortality in UK intensive care units is higher in winter than in non-winter and to explore the importance of variations in case mix and increased pressure on ICUs. DESIGN AND SETTING: Cohort study in 115 adult, general ICUs in England, Wales and Northern Ireland. PATIENTS AND PARTICIPANTS: 113,389 admissions from 1995 to 2000. MEASUREMENTS AND RESULTS: Hospital mortality following admission to ICU was compared between winter (December-February) and non-winter (March-November). The causes of any observed differences were explored by adjusting for the case mix of admissions and the workload of the ICUs. Crude hospital mortality was higher in winter. After adjusting for case mix using the APACHE II mortality probability this effect was reduced but still significant. When additional factors reflecting case mix and workload were introduced into the model, the overall effect of winter admission was no longer significant. Factors reflecting both the case mix of the individual patient and of the patients in surrounding beds were found to be significantly associated with outcome. After adjustment for other factors, the occupancy of the unit (proportion of beds occupied) was not significantly associated with mortality. CONCLUSIONS: The excess winter mortality observed in UK ICUs can be explained by variation in the case mix of admissions. Unit occupancy was not associated with mortality.

APACHE↗
PubMed2005

Excess mortality in Black compared with White patients with Type 1 diabetes: an examination of underlying causes.

AIMS: Excess mortality in Type 1 diabetes has previously been found among Black individuals. The aim of the present study was therefore to determine underlying causes. METHODS: A longitudinal study of 1261 [1184 White (93.9%) and 76 Black (6.0%)] individuals diagnosed with Type 1 diabetes between 1965 and 1979, at age<17 years from the Allegheny County, Pennsylvania and Children's Hospital of Pittsburgh registries. Subjects were contacted in 1999 to determine living status and, where appropriate, cause of death. Living status was determined in 1183 participants (93.8%). RESULTS: Of the 200 deaths overall, cause of death was determined in 157 subjects (79%); 31 dying from acute and 101 from chronic complications, and 25 from non-diabetes related causes. Seven deaths were investigated but no cause determined. Black participants had a significantly higher mortality rate compared with White participants for acute complications (hazard ratio=4.9, 95% confidence interval: 2.0, 11.6), but not for any other cause. There was a temporal decline in the 20-year mortality rates in both racial groups across the three cohorts diagnosed in 1965-69, 1970-74 and 1975-79. CONCLUSIONS: These results show that the excess mortality in Black people was attributed to acute complications which therefore should be a focus for prevention.

Adolescent↗
PubMed2003

Excess mortality after hospitalisation for vertebral fracture.

An excess mortality is well described after vertebral fracture. Deaths are in part related to co-morbidity, but could also be due to the fracture event itself, either directly or indirectly. The aim of this study was to examine the quantum and pattern of mortality following vertebral fracture. We identified 16,051 men and women aged 50 years or more with a vertebral fracture that required hospitalization in 28.8 million person years from the patient register of Sweden. Mortality after vertebral fracture was examined using Poisson models applied to fracture patients and compared to that of the general population. At all ages, the risk of death was markedly increased immediately after the event. After a short period of declining risk, the risk increased with age at a rate that was higher than that of the general population and comparable to that 1 year after hip fracture. The latter function was assumed to be due to deaths related to co-morbidity and the residuum assumed to be due to the vertebral fracture. Causally related deaths comprised 28% of all deaths associated with vertebral fracture (depending on age). We conclude that a minority of deaths following hospitalization for vertebral fracture are attributable to the fracture itself under the assumptions we used.

Age Distribution↗
PubMed2000

Structured settlement annuities, part 2: mortality experience 1967--95 and the estimation of life expectancy in the presence of excess mortality.

BACKGROUND: the mortality experience for structured settlement (SS) annuitants issued both standard (Std) and substandard (SStd) has been reported twice previously by the Society of Actuaries (SOA), but the 1995 mortality described here has not previously been published. We describe in detail the 1995 SS mortality, and we also discuss the methodology of calculating life expectancy (e), contrasting three different life-table models. RESULTS: With SOA permission, we present in four tables the unpublished results of its 1995 SS mortality experience by Std and SStd issue, sex, and a combination of 8 age and 6 duration groups. Overall results on mortality expected from the 1983a Individual Annuity Table showed a mortality ratio (MR) of about 140% for Std cases and about 650% for all SStd cases. Life expectancy in a group with excess mortality may be computed by either adding the decimal excess death rate (EDR) to q' for each year of attained age to age 109 or multiplying q' by the decimal MR for each year to age 109. An example is given for men age 60 with localized prostate cancer; annual EDRs from a large published cancer study are used at duration 0-24 years, and the last EDR is assumed constant to age 109. This value of e is compared with e from constant initial values of EDR or MR after the first year. Interrelations of age, sex, e, and EDR and MR are discussed and illustrated with tabular data. CONCLUSIONS: It is shown that a constant MR for life-table calculation of e consistently overestimates projected annual mortality at older attained ages and underestimates e. The EDR method, approved for reserve calculations, is also recommended for use in underwriting conversion tables.

Compensation and Redress↗
PubMed1997

Excess mortality from breast cancer in relation to mammography screening in northern Sweden.

OBJECTIVES: Previous randomised studies of mammography screening have shown a significant effect on breast cancer mortality, particularly in women aged 50-69 at randomisation. Breast cancer mortality has traditionally been studied by judgments on causes of death, either from cause of death registers or from medical records. In this study an alternative method was used, estimating the excess mortality associated with breast cancer. SETTING: In 1990 two counties of northern Sweden started population based mammography screening of women aged 40-74. The unscreened population in the two other counties of the same region were selected as controls. RESULTS: Excess mortality associated with breast cancer was lower in the screened population, and was discernible three to four years after the start of screening. The relative risk estimate, based on the cumulative excess number of deaths from breast cancer during 1990-95 in the screened versus the control population aged 40-74 (at diagnosis of breast cancer), was 0.72 (95% confidence interval (CI) 0.53 to 0.99). For women aged 50-69 it was 0.67 (95% CI 0.46 to 0.99). In the 50-69 age group the estimated excess number of deaths from breast cancer during 1995 was 17.0 per 100,000 women (95% CI 5.0 to 29.0) in the screened counties and 51.1 per 100,000 (95% CI 30.2 to 71.9) in the unscreened counties. CONCLUSIONS: Population based routine screening has substantial effects on breast cancer mortality in women aged 50-69. Estimation of excess mortality can be used in future studies to evaluate the effects of mammography screening on breast cancer mortality.

Adult↗
PubMed2004

Obesity-related excess mortality rate in an adult intensive care unit: A risk-adjusted matched cohort study.

OBJECTIVE: To evaluate the obesity-related mortality rate in an intensive care unit. DESIGN: An exposed/unexposed matched cohort study. SETTING: An 18-bed adult medical-surgical intensive care unit in a 1,100-bed regional and teaching hospital in France. PATIENTS: From January 1, 1999, to December 31, 2001, 170 mechanically ventilated exposed patients (obese patients with body mass index of >30 kg/m) were matched with 170 mechanically ventilated unexposed patients (with ideal body mass index of 18.5-24.9 kg/m). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The matching process was conducted according to eight criteria: cause of admission, indication for ventilatory support, immunologic status, cardiac status, probability of death (+/-5%), age (+/-7 yrs), gender, and acquisition of severe events appearing within 24 hrs before admission (defined as resuscitated cardiac arrest, acute respiratory distress syndrome, or septic shock). The mortality rate between exposed and unexposed patients was compared by univariate analysis and then was adjusted for other possible confounding factors by multivariate analysis, using conditional logistic regression. The matching process was successful for 1,360 of 1,360 criteria. Obesity was significantly associated with intensive care unit mortality (odds ratio, 2.1; 95% confidence interval, 1.2-3.6). Obesity-related excess mortality was verified mainly for the youngest patients (odds ratio, 2.5; 95% confidence interval, 1.6-6.1) and for the patients with a probability of intensive care unit death of 11-50% (odds ratio, 2.6; 95% confidence interval, 1.2-5.5). This excess mortality rate could be explained by the higher risk of intensive care unit acquired complications among obese patients than among the unexposed ones (odds ratio, 4; 95% confidence interval, 1.4-11.8). CONCLUSIONS: Obesity is an independent risk factor for intensive care unit death and should be regarded as a severe comorbidity in such units.

Aged↗
PubMed2002

Excess mortality in depression: a meta-analysis of community studies.

BACKGROUND: Although most studies examining the relationship between depression and mortality indicate that there is excess mortality in depressed subjects, this is not confirmed in all studies. Furthermore, it has been hypothesized that mortality rates in depressed men are higher than in depressed women. Finally, it is not clear if the increased mortality rates exist only in major depression or also in subclinical depression. METHODS: A meta-analysis was conducted to examine these questions. A total of 25 studies with 106,628 subjects, of whom 6416 were depressed, were examined. Both univariate and multivariate analyses were conducted. RESULTS: The overall relative risk (RR) of dying in depressed subjects was 1.81 (95% CI: 1.58-2.07) compared to non-depressed subjects. No major differences were found between men and women, although the RR was somewhat larger in men. The RR in subclinical depression was no smaller than the RR in clinical depression. LIMITATIONS: Only RRs of mortality were examined, which were not corrected for important confounding variables, such as chronic illnesses, or life-style. In the selected studies important differences existed between study characteristics and populations. The number of comparisons was relatively small. CONCLUSIONS: There is an increased risk of mortality in depression. An important finding of this study is that the increased risk not only exists in major depression, but also in subclinical forms of depression. In many cases, depression should be considered as a life-threatening disorder.

Adolescent↗
PubMed2002

Effect of perioperative complications on excess mortality among women after coronary artery bypass: the Israeli Coronary Artery Bypass Graft Study (ISCAB).

BACKGROUND: Widely observed excess mortality among women after coronary artery bypass grafting is still largely unexplained, although case-mix factors have been identified. We evaluated the contribution of perioperative complications to the risk of 180-day mortality among women while adjusting for case-mix factors. METHODS: This is part of a prospective, 1-year nationwide Israeli coronary artery bypass graft study of 1029 female and 3806 male patients. Deaths within 180 days were independently ascertained. Case-mix risk strata were obtained from a pooled Cox survival model (including all subjects and study variables) by using the adjusted coefficients corresponding to the case-mix factors within the model. Sex-specific mortality associated with perioperative complications was evaluated within the strata. In addition, sex-specific Cox models were constructed. RESULTS: Higher mortality among women compared with that among men was significant within the pooled model (hazard ratio, 1.4; P =.038) and was evident early in the postoperative period. Women tended to cluster in the highest risk quartile compared with men (39.8% vs 20.9%, P <.001). However, although the incidence of perioperative complications was similar for the 2 sexes, the associated mortality for a given perioperative complication was higher among women. Sex-specific Cox models confirmed the above findings. For example, the hazard ratio for women with low postoperative hemoglobin was 6.9, whereas for men, the hazard ratio was 3.9. CONCLUSIONS: The role of perioperative factors in the excess mortality among women after coronary artery bypass grafting shifts the focus of attention from the selection of women for the operation to the in-hospital experience. Improving the outcome for women will entail efforts to prevent complications in the perioperative period.

Aged↗
PubMed2003

[Excess mortality associated with antibiotic resistant Salmonella typhimurium].

INTRODUCTION: The use of antimicrobials in food production has been associated with drug-resistance in foodborne pathogens such as Salmonella and Campylobacter. However, little is known about the health impact of antimicrobial drug-resistance in these pathogens. In a matched cohort study, we determined the mortality associated with drug-resistance in Salmonella Typhimurium. MATERIAL AND METHODS: Data from the Danish Surveillance Registry for Enteric Pathogens were linked with the Civil Registration System and the Danish National Patient Registry. By survival analysis, the two-year mortality among patients was compared with a matched sample of the general Danish population adjusted for differences in comorbidity. RESULTS: Among 2047 cases of S. Typhimurium, 59 deaths were identified. Patients with pan-susceptible strains of S. Typhimurium were 2.3 times (95 per cent confidence interval [CI] 1.5-3.5) more likely to die in the two-year follow-up period after infection than persons in the general Danish population. Patients infected with strains resistant to ampicillin, chloramphenicol, streptomycin, sulfonamide, and tetracycline were 4.8 times (95 per cent CI 2.2-10.5) more likely to die, whereas quinolone-resistance was associated with a 10.3 times (95 percent CI 2.8-37.8) higher mortality than the general population. DISCUSSION: Overall, infections with S. Typhimurium were associated with excess mortality. Patients infected with multi-drug resistant strains had a tendency towards higher mortality than patients infected with non-multiresistant strains. Particular risk was associated with quinolone-resistance in foodborne S. Typhimurium, and the excess mortality among patients infected with multi-drug resistant S. Typhimurium could be attributed to additional quinolone resistance in many of the multi-drug resistant isolates.

4-Quinolones↗
PubMed1996

Excess mortality among blacks and whites in the United States.

BACKGROUND: Although the general relations between race, socioeconomic status, and mortality in the United States are well known, specific patterns of excess mortality are not well understood. METHODS: Using standard demographic techniques, we analyzed death certificates and census data and made sex-specific population-level estimates of the 1990 death rates for people 15 to 64 years of age. We studied mortality among blacks in selected areas of New York City, Detroit, Los Angeles, and Alabama (in one area of persistent poverty and one higher-income area each) and among whites in areas of New York City, metropolitan Detroit, Kentucky, and Alabama (one area of poverty and one higher-income area each). Sixteen areas were studied in all. RESULTS: When they were compared with the nationwide age-standardized annual death rate for whites, the death rates for both sexes in each of the poverty areas were excessive, especially among blacks (standardized mortality ratios for men and women in Harlem, 4.11 and 3.38; in Watts, 2.92 and 2.60; in central Detroit, 2.79 and 2.58; and in the Black Belt area of Alabama, 1.81 and 1.89). Boys in Harlem who reached the age of 15 had a 37 percent chance of surviving to the age of 65; for girls, the likelihood was 65 percent. Of the higher-income black areas studied, Queens--Bronx had the income level most similar to that of whites and the lowest standardized mortality ratio (men, 1.18; women, 1.08). Of the areas where poor whites were studied, Detroit had the highest standardized mortality ratios (men, 2.01; women, 1.90). On the Lower East Side of Manhattan, in Appalachia, and in Northeast Alabama, the ratios for whites were below the national average for blacks (men, 1.90; women, 1.95). CONCLUSIONS: Although differences in mortality rates before the age of 65 between advantaged and disadvantaged groups in the United States are sometimes vast, there are important differences among impoverished communities in patterns of excess mortality.

Adolescent↗
PubMed2001

Excess mortality in women with hospital-acquired bloodstream infection.

PURPOSE: We examined the outcomes of bloodstream infection in men and in women and whether any sex-related differences were explained by underlying disorders, severity of disease, or clinical management. SUBJECTS AND METHODS: Using a prospectively collected database, we compared in-hospital mortality in men and women. We used multivariable logistic regression analysis to test whether sex-related differences could be due to potential confounders. RESULTS: Of 4250 patients with bloodstream infections, 1750 (41%) had hospital-acquired infections. The overall case fatality was 31% (625 of 2032) in women and 29% (631 of 2218, P = 0.1) in men. However, 43% (325/758) of the women with hospital-acquired infections died, compared with 33% (327/992) of the men (P = 0.0001). In a multivariate analysis, female sex was associated with greater mortality in patients with hospital-acquired infections (odds ratio = 1.7; 95% confidence interval: 1.1 to 2.6). The excess mortality in women was mainly seen in patients with major underlying disorders (fatality rate of 45% [234 of 525] in women vs. 32% in men [234 of 743, P = 0.0001). CONCLUSIONS: Mortality in women with hospital-acquired bloodstream infections is substantially greater than in men. The excess mortality was concentrated in women with severe underlying disorders, suggesting that sepsis might have accentuated differences in the outcome of underlying disorders in women.

Adult↗
PubMed1993

Excess mortality for the unmarried in rural Bangladesh.

Prospective data from the Matlab surveillance area in rural Bangladesh, 1974-1982, were used in this study to show that divorced and never-married adults (aged 15-44 years) had significantly higher mortality than their currently married peers with differences in disability status accounting for some of this excess risk. Widowed individuals on the other hand had no excess mortality relative to the currently married. A certain proportion of the sharp reduction in mortality associated with remarriage after divorce for men could be attributed to differences in disability between the remarried group and those who remained divorced. Household economic status indicators could account for little of the excess mortality of divorced and never-married individuals relative to their married counterparts. These findings provide support for the hypothesis that a certain proportion of mortality differentials by marital status in this population can be attributed to selection into marriage and remarriage on the basis of underlying disability status. The evidence for the protective effect of increased economic status associated with the currently married state is less convincing.

Adolescent↗