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PubMed2002

Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease.

To assess whether generic and specific health-related quality of life (HRQL) are independently associated with total and specific mortality in patients with chronic obstructive pulmonary disease (COPD), we followed until 1999 a cohort of 321 male patients with COPD, recruited in 1993-1994 at outpatient respiratory clinics. Baseline characteristics recorded under stable clinical conditions included forced spirometry, arterial blood gas tensions, dyspnea scales, 11 comorbid conditions, St. George's Respiratory Questionnaire (SGRQ), and SF-36 Health Survey. Vital status was assessed through reinterviews, the Mortality Register, and clinical records. Subjects who died (106) were older (69.8 versus 62.5 years) (p < 0.001), had lower body mass index (BMI) (25.4 versus 27.1) (p < 0.01), were more impaired in the clinical characteristics studied (%FEV(1), 34.0 versus 51.0) (p < 0.001), and had long-term oxygen therapy more frequently (31% versus 7%) (p < 0.001). Survival was shorter when worse HRQL was reported. SGRQ total and SF-36 physical summary scores were independently associated with total and respiratory mortality in Cox models, including age, FEV(1), and BMI. The total mortality-standardized hazard ratios for both HRQL measures were 1.3, whereas those for FEV(1) were 1.6. HRQL measures provide independent and relevant information on the health status of male patients with COPD. Their use should be considered for a more thorough evaluation and staging of patients with COPD.

Adult↗
PubMed2005

Volume-based referral for cardiovascular procedures in the United States: a cross-sectional regression analysis.

BACKGROUND: We sought to estimate the numbers of patients affected and deaths avoided by adopting the Leapfrog Group's recommended hospital procedure volume minimums for coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). In addition to hospital risk-adjusted mortality standards, the Leapfrog Group recommends annual hospital procedure minimums of 450 for CABG and 400 for PCI to reduce procedure-associated mortality. METHODS: We conducted a retrospective analysis of a national hospital discharge database to evaluate in-hospital mortality among patients who underwent PCI (n = 2,500,796) or CABG (n = 1,496,937) between 1998 and 2001. We calculated the number of patients treated at low volume hospitals and simulated the number of deaths potentially averted by moving all patients to high volume hospitals under best-case conditions (i.e., assuming the full volume-associated reduction in mortality and the capacity to move all patients to high volume hospitals with no related harms). RESULTS: Multivariate adjusted odds of in-hospital mortality were higher for patients treated in low volume hospitals compared with high volume hospitals for CABG (OR 1.16, 95% CI 1.10-1.24) and PCI (OR 1.12, 95% CI 1.05-1.20). A policy of hospital volume minimums would have required moving 143,687 patients for CABG and 87,661 patients for PCI from low volume to high volume hospitals annually and prevented an estimated 619 CABG deaths and 109 PCI deaths. Thus, preventing a single death would have required moving 232 CABG patients or 805 PCI patients from low volume to high volume hospitals. CONCLUSION: Recommended hospital CABG and PCI volume minimums would prevent 728 deaths annually in the United States, fewer than previously estimated. It is unclear whether a policy requiring the movement of large numbers of patients to avoid relatively few deaths is feasible or effective.

Aged↗
PubMed2007

Incidence of low central venous oxygen saturation during unplanned admissions in a multidisciplinary intensive care unit: an observational study.

INTRODUCTION: It has been shown that early central venous oxygen saturation (ScvO2)-guided optimization of hemodynamics can improve outcome in septic patients. The early ScvO2 profile of other patient groups is unknown. The aim of this study was to characterize unplanned admissions in a multidisciplinary intensive care unit (ICU) with respect to ScvO2 and outcome. METHODS: Ninety-eight consecutive unplanned admissions to a multidisciplinary ICU (median age 63 [range 19 to 83] years, median Simplified Acute Physiology Score [SAPS II] 43 [range 11 to 92]) with a clinical indication for a central venous catheter were included in the study. ScvO2 was assessed at ICU arrival and six hours later but was not used to guide treatment. Length of stay in ICU (LOSICU) and in hospital (LOShospital) and 28-day mortality were recorded. RESULTS: ScvO2 was 70% +/- 12% (mean +/- standard deviation) at admission and 71% +/- 10% six hours later (p = 0.484). Overall 28-day mortality was 18%, LOSICU was 3 (1 to 28) days, and LOShospital was 19 (1 to 28) days. Patients with an ScvO2 of less than 60% at admission had higher mortality than patients with an ScvO2 of more than 60% (29% versus 17%, p < 0.05). Changes in ScvO2 during the first six hours were not predictive of LOSICU, LOShospital, or mortality. CONCLUSION: Low ScvO2 in unplanned admissions and high SAPS II are associated with increased mortality. Standard ICU treatment increased ScvO2 in patients with a low admission ScvO2, but the increase was not associated with LOSICU or LOShospital.

Adult↗
PubMed2005

Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making.

PURPOSE: The aim of this study was to evaluate the prognostic value of the WHO proposal, to assess the role of the main prognostic factors in myelodysplastic syndromes (MDSs) classified into WHO subgroups, and to estimate mortality (standardized mortality ratio [SMR]) and life expectancy in these groups as a basis for clinical decision making. PATIENTS AND METHODS: Four hundred sixty-seven patients who were diagnosed as having de novo MDS at the Division of Hematology, University of Pavia (Pavia, Italy), between 1992 and 2002, were evaluated retrospectively for clinical and hematologic features at diagnosis, overall survival (OS), and progression to leukemia (leukemia-free survival). RESULTS: Significant differences in survival were noted between patients with refractory anemia (RA), refractory cytopenia with multilineage dysplasia, RA with excess blasts, type 1 (RAEB-1), and RAEB-2. The effect of demographic factors on OS was observed in MDS patients without excess blasts (age, P = .001; sex, P = .006), as in the general population. The mortality of RA patients 70 years or older did not differ significantly from that of the general population (SMR, 1.62; P = .06). Cytogenetics was the only International Prognostic Scoring System variable showing a prognostic value in MDS classified into WHO subgroups. Transfusion-dependent patients had a significantly shorter survival than patients who did not require transfusions (P < .001). Developing a secondary iron overload significantly affected the survival of transfusion-dependent patients (P = .003). CONCLUSION: These data show that the WHO classification of MDSs has a relevant prognostic value. This classification, along with cytogenetics, might be useful in decisions regarding transplantation. MDS with isolated erythroid lineage dysplasia identifies a subset of truly low-risk patients, for whom a conservative approach is advisable.

Adult↗
PubMed2005

Mortality in individuals with severe deficiency of alpha1-antitrypsin: findings from the National Heart, Lung, and Blood Institute Registry.

STUDY OBJECTIVE: To clarify the mortality rate and causes of death of individuals with alpha(1)-antitrypsin (AAT) deficiency, the Death Review Committee (DRC) of the National Heart, Lung, and Blood Institute Registry of Individuals with Severe AAT Deficiency reviewed all available medical records regarding the deaths of study subjects during Registry follow-up (up to 7.2 years). METHODS: Individual determinations by each member of the three-person DRC led to consensus judgments regarding the underlying cause and the immediate and contributing causes of death. RESULTS: Of the 1,129 Registry subjects, 204 died (18.1%) [approximately 3%/yr]. Record availability permitted detailed review in 120 decedents, and death certificates were available in 56 of the remaining 84 subjects (67%). Emphysema and cirrhosis were the most common underlying causes of death (72% and 10%, respectively), with malignancy and diverticulitis accounting for 3% of deaths each. To assess attributable mortality, standardized mortality ratio analysis was performed and indicated that excess mortality was ascribable entirely to lung and liver disease. CONCLUSIONS: We conclude that severe AAT deficiency poses a significant threat to health, that severe airflow obstruction is a major determinant of mortality, and that liver and lung disease account for the excess mortality in affected individuals. These findings support current efforts to enhance diagnostic recognition and treatment of AAT-deficient individuals.

Adult↗
PubMed1996

Filgrastim. A reappraisal of pharmacoeconomic considerations in the prophylaxis and treatment of chemotherapy-induced neutropenia.

Neutropenia is a frequent and often dose-limiting complication of chemotherapy and is associated with considerable patient morbidity and mortality. Standard treatment in patients who become febrile includes hospitalisation and empirical antibiotic therapy. Filgrastim is a recombinant human granulocyte colony-stimulating factor (rHuG-CSF). It significantly decreases the incidence of febrile neutropenia in patients receiving standard-dose chemotherapy, and shortens the duration of febrile neutropenia in patients undergoing autologous bone marrow transplantation (BMT) or peripheral blood progenitor cell (PBPC) infusion after myeloablative chemotherapy regimens. These effects are usually associated with a decrease in hospitalisation and antibiotic requirements. The contribution of filgrastim therapy to beneficial effects on other clinically important end-points (e.g. quality of life, tumour relapse rate, and short and long term survival) remains to be accurately determined. Pharmacoeconomic data concerning the use of filgrastim as an adjunct to standard-dose chemotherapy are derived largely from the results of phase III trials. Cost analyses based on hospital charges suggest that the cost of providing filgrastim therapy can be fully recouped if the drug is used as primary prophylaxis in previously untreated patients, for whom the risk of developing febrile neutropenia is at least 40%. Reserving filgrastim for use in patients who have developed febrile neutropenia in a previous chemotherapy cycle may result in further cost savings. However, careful patient selection is required, since potential cost savings will vary depending upon the risk of hospitalisation in the absence of filgrastim treatment. Infusion of filgrastim-mobilised PBPCs is emerging as a preferred strategy in patients receiving myeloablative chemotherapy, and promising results have been obtained from cost analyses. From a pharmacoeconomic viewpoint, future research should be directed towards defining optimum dosage regimens and hence improving the cost-effective use of filgrastim. Data evaluating patient quality of life and treatment preferences would help define the cost utility of filgrastim therapy. In the meantime, available pharmacoeconomic data support the use of filgrastim as an adjunct to chemotherapy in selected clinical situations.

Antineoplastic Agents↗
PubMed2006

Diabetes as a tracer condition in international benchmarking of health systems.

OBJECTIVE: To assess the performance of health systems using diabetes as a tracer condition. RESEARCH DESIGN AND METHODS: We generated a measure of "case-fatality" among young people with diabetes using the mortality-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0-14 years were extracted from the World Health Organization DiaMond study for the period 1990-1994; data on death from diabetes for ages 0-39 years were obtained from the World Health Organization mortality database and converted into age-standardized death rates for the period 1994-1998, using the European standard population. RESULTS: The M/I ratio varied >10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type 1 diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada. CONCLUSIONS: The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for stimulating more detailed assessments of whether such problems exist, and what can be done to address them.

Benchmarking↗
PubMed1996

Relative mortality in lower limb amputees with diabetes mellitus.

A nationwide epidemiological study included 3516 primary major lower limb amputations in diabetic patients, during the period 1982 to 1992. On this well defined diabetic amputee population the relative mortality (Standard Mortality Ratio, SMR) has been analysed. The mortality rate was found to be 8 times the expected during the first year following amputation. The relative mortality is higher for females than males. An inverse relation between age and SMR was found, and the SMR was significantly related to the level of amputation. No significant difference could be detected when analysing SMR in relation to subdiagnosis (NIDDM vs IDDM) or SMR in relation to the period of treatment 1982-87 versus 1988-92.

Adult↗
PubMed2006

Non-transplant therapy for older adults with acute myeloid leukemia.

Acute myeloid leukemia is a disease of older adults, with a median age at diagnosis of 68 years. This group represents a high-risk population, because inherent disease characteristics predict for resistance to chemotherapy and advanced age is accompanied by high treatment-related mortality. Standard remission-induction and postremission therapy can result in a median disease-free survival of 10 months and rare long-term survival. Efforts to improve outcomes have not made a major impact on complete remission rates of 40% to 60%, or on overall survival. Newer therapies, divided into aggressive and nonaggressive approaches, focus on targeting the disease biology specific to older adults and on maximizing quality of life. Clinical trials should be considered at every stage of treatment in this group of patients.

Acute Disease↗
PubMed1993

Variations in mortality and length of stay in intensive care units.

OBJECTIVE: To evaluate the amount of variation in in-hospital mortality and length of intensive care unit (ICU) stay that can be accounted for by clinical data available at ICU admission. DESIGN: Inception cohort study. SETTING: Forty-two ICUs in 40 hospitals, including 26 hospitals that were randomly selected and 14 large tertiary care hospitals that volunteered for the study. PARTICIPANTS: A consecutive sample of 16,622 patients and 17,440 ICU admissions. MEASUREMENTS AND MAIN OUTCOMES: Data on selected demographic characteristics, comorbidity, and specific physiologic variables were recorded during the first ICU day for an average of 415 admissions at each ICU; hospital discharge status (dead or alive) and length of ICU stay were recorded for individual patients; and the ratio of actual to predicted in-hospital mortality, standardized mortality ratios, and the ratio of actual to predicted length of ICU stay were recorded for individual ICUs. RESULTS: Unadjusted in-hospital mortality rates for the 42 units varied from 6.4% to 40%, and 90% (R2 = 0.90) of this variation was attributable to patient characteristics at admission. The standard mortality ratio varied from 0.67 to 1.25. The mean unadjusted length of ICU stay varied from 3.3 to 7.3 days, and 78% of the variation (R2 = 0.78) was attributed to patient and selected institutional characteristics. The best performing unit had a length of stay ratio of 0.88, whereas the poorest performing unit had a ratio of 1.21. CONCLUSIONS: Clinicians can use readily available admission data to adjust for considerable variations in patient severity and type in different ICUs. Such data should permit precise evaluation and comparison of ICU effectiveness and efficiency, which varied substantially in this study, and result in improved methods of risk prediction and evaluation of new medical practices.

Aged↗
PubMedDate not supplied

Is there a link between the variation in gastric cancer mortality and differences in Helicobacter pylori prevalence in different regions of France?

An ecological study was performed to correlate the cumulative gastric cancer mortality rate to the prevalence of Helicobacter pylori infection in France. National data on mortality, standardized for age and gender, and the results of a nationwide prevalence study on Helicobacter pylori infection among 1,586 patients consulting for symptoms other than upper digestive tract symptoms, in seven defined French regions were used. The correlation was described by linear regression with the standardized data and then evaluated in a linear regression model including age and gender as co-variables. The Southwest region was the least affected by the infection (15.2%) while prevalence varied from 20.5 to 25.3% for the other regions. The cumulative gastric cancer mortality rate varied from 34.4 to 51.8/100,000. The prevalence of Helicobacter pylori infection in the model explained 5% of the variability in the gastric cancer mortality. A number of biases which were difficult to control could explain the lack of association between these variables.

Adolescent↗
PubMed2000

Relationships between in-hospital and 30-day standardized hospital mortality: implications for profiling hospitals.

OBJECTIVE: To examine the relationship of in-hospital and 30-day mortality rates and the association between in-hospital mortality and hospital discharge practices. DATA SOURCES/STUDY SETTING: A secondary analysis of data for 13,834 patients with congestive heart failure who were admitted to 30 hospitals in northeast Ohio in 1992-1994. DESIGN: A retrospective cohort study was conducted. DATA COLLECTION: Demographic and clinical data were collected from patients' medical records and were used to develop multivariable models that estimated the risk of in-hospital and 30-day (post-admission) mortality. Standardized mortality ratios (SMRs) for in-hospital and 30-day mortality were determined by dividing observed death rates by predicted death rates. PRINCIPAL FINDINGS: In-hospital SMRs ranged from 0.54 to 1.42, and six hospitals were classified as statistical outliers (p <.05); 30-day SMRs ranged from 0.63 to 1.73, and seven hospitals were outliers. Although the correlation between in-hospital SMRs and 30-day SMRs was substantial (R = 0.78, p < .001), outlier status changed for seven of the 30 hospitals. Nonetheless, changes in outlier status reflected relatively small differences between in-hospital and 30-day SMRs. Rates of discharge to nursing homes or other inpatient facilities varied from 5.4 percent to 34.2 percent across hospitals. However, relationships between discharge rates to such facilities and in-hospital SMRs (R = 0.08; p = .65) and early post-discharge mortality rates (R = 0.23; p = .21) were not significant. CONCLUSIONS: SMRs based on in-hospital and 30-day mortality were relatively similar, although classification of hospitals as statistical outliers often differed. However, there was no evidence that in-hospital SMRs were biased by differences in post-discharge mortality or discharge practices.

Aged↗
PubMed2002

Pulmonary disease caused by Mycobacterium avium-intracellulare in HIV-negative patients: five-year follow-up of patients receiving standardised treatment.

SETTING AND OBJECTIVE: Previous reports on small numbers highlighted the need for a prospective study of the clinical features and response to treatment of pulmonary disease caused by Mycobacterium avium-intracellulare (MAC). DESIGN AND METHODS: Patients with two positive cultures were randomised to 2 years of rifampicin and ethambutol or of rifampicin, ethambutol and isoniazid. Clinical, bacteriological and radiological progress was monitored for 5 years. RESULTS: Seventy-five patients entered the study. They had a mean age of 64 years (range 29-87) and the sexes were balanced. Approximately two-thirds had previous/ co-existing lung disease(s). Sputum was positive on direct smear in 56%, and cavitation was observed in 61%, most having at least one large cavity. Just under half had bilateral disease and one-third extensive disease. Disease was confined to upper zone(s) in 25%. Twenty-seven (36%) died within 5 years, three because of MAC disease. There were 11 treatment failures and 10 relapses, with no correlation between those and in vitro resistance. Forty-five (60%) were alive at 5 years, of whom 23 were confirmed cured. CONCLUSION: Pulmonary disease caused by MAC is associated with high morbidity and mortality. Standard susceptibility tests do not correlate with the response of the disease to chemotherapy. Rifampicin and ethambutol, with or without isoniazid, cured 31%, a result comparable with or better than that found previously with more toxic regimens, but mortality (36%) remains high. More effective regimens are needed, and management of coexisting illnesses and general health needs to be to maximised.

Adult↗
PubMed1992

[The evolution of mortality from ischemic heart disease in Basque Country 1975-1990].

BACKGROUND: Given the importance of ischemic cardiopathy (IC) as a cause of death in industrialized countries, the trend of mortality by IC in people from 30 to 69 years of age residing in the Basque Country between 1975-1990 were studied. Furthermore, the evolution of the mortality by cardiac diseases and by other causes which may compete with IC in the certification or coding of the cause of death was studied. METHODS: The rate of mortality standardized by age by the direct methods were estimated from data from the Natural Movement of Population. The trend was graphically studied and quantified by means of the percentage difference between the rates. RESULTS: Mortality by IC decreased between 1975-1990 by 37% in men and 46% in women with a mean annual percentage decrease of 2.8% and 2.9%, respectively. Mortality by cardiac disease decreased 34% in men and 52% in women. CONCLUSIONS: Mortality by ischemic cardiopathy in the Basque Country has significantly decreased in both sexes. This decrease is not explicable by possible changes over the years in the practises of certification or coding of the cause of death.

Adult↗
PubMedDate not supplied

Efficacy, safety and tolerability of streptokinase in multiloculated empyema.

BACKGROUND: Empyema thoracis is a common illness with significant morbidity and mortality. Standard treatment of Empyema includes tube drainage and antibiotics. But the tube drainage often fails if the fluid is loculated. Intrapleural Streptokinase has been used in multiloculated empyemas with good success rate. We evaluated the efficacy and safety of intra-pleural Streptokinase in loculated empyemas. METHODS: A total of 15 patients admitted in Pulmonology unit with multiloculated empyemas whose drainage via drainage tube was less than 100 ml during the last 24 hours were included in the study. Aliquots of 250,000 units of Streptokinase in 100 ml of normal saline were instilled into the pleural cavity and the tube clamped for 3 hours. Response was assessed by clinical outcome, measurement of drain output after unclamping and subsequent chest radiography and serial chest ultrasounds. RESULTS: Streptokinase enhanced drainage in all patients with complete resolution of Empyema in 13 patients. Two patients with thickened visceral pleura following empyema drainage were referred to thoracic surgeon for decortication. The number of instillations of Streptokinase per patient ranged from 1 to 3 and the volume of drained empyema fluid ranged from 60 ml to 600 ml per patient. Streptokinase was well tolerated in all patients. CONCLUSION: Intrapleural Streptokinase is a safe and effective means of increasing the tube drainage in multiloculated Empyema without causing systemic fibrinolysis.

Adolescent↗
PubMed2004

Performance evaluation of APACHE II score for an Indian patient with respiratory problems.

BACKGROUND & OBJECTIVES: Realising the utility of scoring systems in mortality prediction of critically ill patients admitted to intensive care units (ICUs), studies worldwide have expressed a need to validate the Acute Physiology and Chronic Health Evaluation (APACHE) II score for databases of respective countries. Literature available in this area in the Indian context is scanty. The present study was undertaken to evaluate the performance of APACHE II score in prediction of mortality risk, as well as in determination of model validity in critically ill Indian patients with respiratory problems. METHODS: The study was prospectively carried out over 18 months at respiratory ICU of a tertiary Institute in New Delhi, which admitted consecutive medical (with lung ailments) and surgical (who had undergone any elective thoracic surgical procedure under general anaesthesia) patients. Based on chief indication of ICU admission, the medical patients were further divided into sub-groups I (respiratory) and II (non-respiratory). APACHE II points were assigned to all patients for calculating their individual predicted risks of mortality. Standard mortality ratio (SMR) was computed with 95 per cent confidence intervals (CI). Calibration of model was analysed by calculating Lemeshow and Hosmer goodness of fit X(2) statistic and by plotting calibration curve, whereas discrimination was evaluated by calculating area under a receiver operating characteristic (ROC) curve. RESULTS: Of the 393 consecutive patients admitted to respiratory ICU during the study period, 63 were left out on account of exclusion criteria. Mean APACHE II score of the remaining 330 patients was 12.87+/-8.25 and range from 1 to 47. There were 287 (87%) survivors and 43 (13%) non-survivors, whose mean APACHE II scores, being respectively 11.34+/-6.75 (range 1-37) and 23.09+/-10.01 (range 5-47), were significantly different (P<0.01). The study had a predicted mortality of 7.9 per cent and an SMR value of 1.65 (95% CI from 0.4 to 3.0). Mean APACHE II score of those having medical ailments was significantly higher (P<0.01) than surgical patients. The non-respiratory sub-group had a significantly higher (P<0.01) mean APACHE II score than respiratory sub-group. 59 per cent of patients did not get APACHE II points owing to being <45 yr of age. In addition, against 10 immunocompromised patients, 77 others did not get APACHE II points despite having apparently compromised immunity due to co-existence of tuberculosis (TB), diabetes mellitus, dual pathologies or past history of anti-TB treatment. Observed and predicted mortality rose with 5-point APACHE II score, but did not correlate for patients of any comparable group. Average ICU stay of 16 days for those with medical disease was significantly longer (P<0.01) than 9.5 days for surgical patients. APACHE II scoring system showed a poor calibration and discrimination ability for Indian respiratory patients. INTERPRETATION & CONCLUSION: Despite the rise in observed and predicted mortality with 5-point APACHE II score, predicted mortality did not correlate with observed mortality for critically ill patients admitted to an Indian respiratory ICU. The scoring system also showed a poor calibration as well as discrimination. The model may be more useful for Indian patients by lowering down the cut-off value in allotment of age points and by awarding the weightage to factor like co-existing immunocompromised state.

APACHE↗
PubMed1990

[Selected elements of health status of the Polish population in relation to other European countries in the light of the program "Health for all up to 2000"].

Total mortality from main causes of death (diseases of circulatory system, malignant neoplasms, injuries and poisoning) life expectancy at birth, infant and maternal mortality in Poland in the years 1970-1988 were analyzed on the basis of targets of the regional strategy for "Health for all by the year 2000" (HFA 2000). It seems that it isn't possible to achieve targets concerning mortality by the year 2000. However it is possible to decrease infant and maternal mortality. Standardization of health indicators to european population allows to compare health status of the polish population to other european countries. This comparison shows that situation in Poland is not optimistic.

Adolescent↗
PubMedDate not supplied

Trends in malignant skin melanoma and other skin cancers in Spain, 1975-1983, and their relation to solar radiation intensity.

Epidemiological studies have shown solar exposure to play an important role in the appearance of skin cancer. We investigated the association between mortality standardized by the indirect method for malignant skin melanoma and other skin cancers and the mean intensity of solar radiation during July and August for the different provinces in Spain. A statistically significant relation was observed (p less than .05) for these two months but not upon considering mean annual solar radiation. We thus suggest that intermittent, intense exposure to sunlight constitutes an important risk factor for skin cancer. We observed an 8.5% and 15.72% increase in mortality due to malignant skin melanoma and other skin cancers, respectively, during the period 1975-1983. Mortality was slightly higher among males than females.

Dose-Response Relationship, Radiation↗