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PubMed1998

Do education and income buffer the effects of death of spouse on mortality?

In this paper, we estimate the effects of the death of a spouse on the mortality of the survivor in different education and income groups. These socioeconomic resources may buffer the harmful effects of the stressful life event of the loss of one's spouse. The data come from a prospective study of mortality among all 35- to 74-year-old married Finnish persons. Follow-up was established by record linkage to death certificate registers for 1986-1991 (about 86,000 deaths, of which almost 5,500 occurred among the bereaved). The relative mortality after the death of one's spouse was broadly similar in different education and income groups. Absolute differences in mortality rates between bereaved and nonbereaved persons were larger in the lower end of the social spectrum, however. This pattern held for four broad categories of death: both sexes and two age groups (35-64 years and 65-74 years). The degree to which socioeconomic resources buffer the effects of death of spouse depends on whether it is assessed in terms of rate differences or rate ratios. Nevertheless, regardless of measurement choice, the effects of bereavement exist in all socioeconomic groups analyzed in this study. Furthermore, because of the high absolute level of mortality, the burden of excess mortality experienced after the death of one's spouse is heavier in the lower social strata.

Adult↗
PubMed2001

Excess autoimmune disease mortality among school teachers.

OBJECTIVE: To investigate evidence of an association between school teaching and mortality from autoimmune diseases. METHODS: A proportional mortality study using US death certificates from the 1985-95 period was conducted. Death certificates that listed elementary or secondary school teaching as the usual occupation were identified, as were those that cited any of 13 autoimmune diseases as a cause of death. Proportional mortality ratios (PMR) were calculated to compare autoimmune disease mortality among teachers to that among persons in other professional occupations. RESULTS: The PMR for total autoimmune disease mortality among teachers was 113 (p < 0.0001). Rheumatic diseases accounted for 53.1% of the total excess in mortality and multiple sclerosis accounted for 39.9%. Significantly elevated autoimmune disease mortality occurred for female teachers (PMR = 111, p < 0.0001), male teachers (PMR = 124, p < 0.0001), white teachers (PMR = 112, p < 0.0001), non-white teachers (PMR = 118, p = 0.005), elementary teachers (PMR = 111, p < 0.0001), and secondary teachers (PMR = 130, p < 0.0001). There was an inverse trend (p < 0.0001) in the level of excess mortality relative to age. PMR were 149, 144, 127, 118, 108, and 102 for teachers in the 35-44, 45-54, 55-64, 65-74, 75-84, and > or = 85 year age groups, respectively. Excess mortality was significantly greater in secondary teachers than elementary teachers both in total (PMR = 112, p = 0.04) and in the 35-44 age group (PMR = 155, p = 0.03). CONCLUSION: Our results substantiate excess mortality from autoimmune diseases among teachers and suggest that, relatively early in their careers, teachers experience an occupational exposure that increases risk of autoimmune diseases.

Adult↗
PubMed1984

A mortality study of cement workers.

Occupational exposure to dust has been linked with excess mortality from stomach cancer. To examine this hypothesis in respect of cement workers the mortality of a group of men, identified as cement workers in 1939, was followed up from 1948 to 1981. An excess of mortality from stomach cancer was found which is not thought to be explained by the social class distribution of the study population. Mortality from respiratory disease was not increased.

Adult↗
PubMed1998

Mortality from birth to adult life: a longitudinal study of twins.

We have examined mortality from birth through adult life in a cohort of 2562 twins born in Birmingham, UK, between 1950 and 1954. Their birthweights and obstetric details had been recorded as part of a longitudinal study of births in Birmingham. There were a total of 151 perinatal deaths (perinatal mortality rate = 116 per 1000 births) and 227 infant deaths (infant mortality rate = 94 per 1000 live births). 70 deaths occurred after the age of one year. In comparison with national mortality rates in the UK, overall mortality in the twins was high (standard mortality rate, SMR = 259, 95% CI 221-300). Mortality was highest in the first year of life and, although it then declined progressively, it remained significantly higher that that of the general population until age 5 years. The excess mortality was largely due to conditions originating in the perinatal period but there were excess rates of congenital abnormalities, diseases of the respiratory system, digestive system and nervous and sensory organs. A Cox proportional Hazards analysis showed that the risk of death was related to low birthweight, prematurity and male sex. Death of the co-twin was highly predictive of mortality throughout the period of follow up. These studies not only underline the excess mortality associated with twin birth but show for the first time that this excess mortality extends into childhood.

Adolescent↗
PubMedDate not supplied

An epidemiological review of the mortality of bereavement.

Epidemiological literature revealing excess mortality in the newly widowed is reviewed. The risk varies by age and sex. Younger persons and men are at higher risk. There are manifold specific causes of death characterized by conditions manifest in middle and late life. Cause specificity also varies by sex. Methodological problems in this literature are mitigated by application of varied methodology and replication of basic findings. Socioeconomic status and "social" stress are not well controlled as independent variables. Nevertheless, they probably do not explain the large relative risk of mortality among the bereaved. Pathogenetic mechanisms resulting from a loss are probably twofold: physiologic changes associated with the loss response and behavioral changes that comprise health maintenance or chronic disease management. Because of its important as a health problems, as a fundamental human reaction, and as a research strategy for the basic psychosomatic hypothesis, bereavement is a prime target of investigation.

Adult↗
PubMed2005

[New findings on the influence of body weight on mortality].

The link between obesity/adipositas and excess mortality has been a prominent topic in medical literature for some time. The epidemic increase in obesity in the western world is going to confront the medical profession with a new problem, particularly with regard to life expectancy trends and appropriate prophylactic measures. Swiss Reinsurance Company (Swiss Re), which has a large portfolio of life reinsurance business, has conducted a follow-up study over an observation period of 25 years (1976 - 2001) to investigate the correlation between body weight and mortality. The findings indicate that the lifestyle-related risks of obesity and adipositas, especially in combination with other risk factors such as high blood pressure and smoking, contribute to a significantly elevated mortality risk.

Adiposity↗
PubMed2006

[Estimation of the range of excess death associated with influenza epidemics: application of a model using annual mortality rates and the seasonal index for determining minimum excess mortality estimates].

OBJECTIVE: To determine the range of excess death associated with influenza in Japan. METHODS: The monthly rates for mortality from all causes other than accidents (ICD9: E800-E949, ICD-10: V01-X59) were determined from the Japanese national vital statistics for 1987-2003. By employing a model using the annual mortality rates and the seasonal index, the number of expected deaths and the 95% range of mortality in the absence of influenza-associated deaths (normal range) were obtained. Point estimation of excess mortality during an influenza season was performed by calculation of differences between the number of deaths observed and the number of deaths expected. The range of excess death was defined: the lower limit of the excess death was performed by calculation of difference between the number of deaths observed and the upper limit of the normal range. The upper limit of the excess death, on the contrary, was performed by calculation of difference between the number of deaths observed and the lower limit of the normal range. Based on the results of a survey of tendencies in the occurrence of infectious diseases, months showing a high prevalence of influenza and associated deaths were regarded as "months when the rate of death from influenza was 0.9 deaths/100,000 person-years or higher". RESULTS: The excess death determined by point estimation was largest in 1999, followed by 1995, 1993, 1997, 2000, and 2003. The point estimation (range of excess death) in 1999 was approximately 49,000 (approximate range, 37,000-60,000). Correspondingly, the excess death in 1995 was approximately 38,000 (approximate range, 27,000-48,000). While values in 1993, 1997, 2000, and 2003 were in the approximate range of 21,000 to 25,000, the range of excess death of each year showed the differences: approximate range from 15,000 to 36,000 in 1993, from 18,000 to 31,000 in 1997, from 18,000 to 28,000 in 2000, and from 11,000 to 34,000 in 2003, respectively. From comparison of the range of excess deaths by year, that in 1995 appeared to be the largest among the examined years. CONCLUSION: By considering the range of variation in the number of deaths in the years when no influenza epidemics occurred, the increase (the largest number and smallest number of deaths) associated with elevation the prevalence of influenza could be determined. Estimation of the range of excess deaths can be considered a useful method for understanding the influence of influenza on public health.

Disease Outbreaks↗
PubMed1998

Fatness and muscularity as risk indicators of child mortality in rural Congo.

OBJECTIVES: To examine the relationship of anthropometrical indicators of fatness and muscularity with mortality in children in a rural African community. BACKGROUND: A prospective cohort study was carried out in the rural health zone of Bwamanda, Northern Congo using a random cluster sample of 5167 children, aged 0-5 years. MAIN OUTCOME MEASURES: Short- and long-term mortality rates, being deaths within 3 months and deaths in 3-month periods observed 3-30 months after enrolment. Rates of all cause mortality and of mortality from kwashiorkor or marasmus, by level of baseline fatness and muscularity. Indicators of fatness and muscularity were obtained by correcting anthropometric arm fat and arm muscle areas for age, sex, weight and height. RESULTS: The relationship of both the fatness and muscularity scores with short-term mortality was marked by a clear threshold (-0.5 SDS) below which there was a significant rise in mortality from all causes as well as from kwashiorkor and marasmus. These excess mortalities were also found in normal weight children. Fatness and muscularity scores remained significant determining factors of short-term mortality in a multiple logistic regression analysis with sex, age, season and weight-for-age. A ROC curve analysis showed that fat and muscularity scores had better predictive abilities than weight-for-age. Low fat status had a bad prognosis on the long-term in underweight children. CONCLUSIONS: Measures of current nutritional status should not be based on weight indices alone. Objective and/or clinical evaluation of fat and muscle status (also in normal weight children) should be added in order to detect a higher proportion of malnourished children and to more accurately evaluate mortality risk.

Adipose Tissue↗
PubMed1998

Inverse association of serum cholesterol with plasma insulin in the elderly. Cross-sectional and prospective analyses.

Cross-sectional studies have suggested that high plasma insulin is associated with relatively low levels of low density lipoprotein (LDL)-cholesterol. The present study was aimed at re-testing this association in a 70-year-old age cohort (N = 1023), and testing whether it could be caused by excessive mortality of hyperinsulinemic subjects with high LDL-cholesterol. A reverse U-shaped association between LDL-cholesterol and fasting plasma insulin was confirmed. LDL-cholesterol, HDL-cholesterol and total cholesterol were lowest in the highest insulin quarter. These associations remained after adjustment for diabetes, obesity and general health status. The combination of high LDL-cholesterol (> 4.25 mmol/L, 75th percentile) and high insulin (> 10 IU/L, 50th percentile) was not associated with excess 5-year mortality in this age cohort. Nor was it associated with excess mortality in four other elderly age cohorts (N = 1188), in which similar associations of cholesterol and insulin have been demonstrated. Thus, the inverse association of LDL-cholesterol with fasting insulin in the elderly is not caused by selective over mortality.

Aged↗
PubMed2002

The uneven tides of the health transition.

As spectacular mortality reductions have occurred in all developing nations at all national income levels, the epidemiologic transition theory suggests that cause-of-mortality patterns should shift from communicable diseases especially prevalent among infants and children to problems resulting from non-communicable conditions at older ages. Global estimates confirm this expectation, and mortality from these latter conditions has become predominant worldwide, leading some observers to argue for a corresponding shift in the public health agenda. In this paper, we nuance this finding by studying the important poverty-gradient concealed in the global estimates. Our results demonstrate the remaining cause-of-death disparities between the world's poorest and richest populations. We find that the poorest population (1st quintile) experiences higher mortality than the richest population (5th quintile) in each of the three main groups of mortality causes but that the excess mortality of the poorest population is mostly due to the higher incidence of communicable diseases (77% of excess deaths). Overall, those diseases only account for 34.2% of deaths in the world but still dominate mortality causes among the poorest 20% of the world population (58.6% of all deaths). Moreover, these results appear robust to alternative estimates of the international distribution of the world's poorest people. While recognizing the emerging agenda of the non-communicable conditions, we thus underscore the "unfinished agenda" of communicable diseases in many countries. As populations affected by these diseases are predominantly among the poorer, equity considerations should caution against a premature shift away from these diseases.

Cause of Death↗
PubMed2006

Mortality in schizophrenia.

PURPOSE: The purpose of this article is to describe the current status of knowledge on excess mortality in schizophrenia and its causative factors, and to expand upon previous work evaluating approaches that may reduce mortality rates. METHODS: Literature available since 1995 was identified in a computerized search of the bibliographical databases Medline and Embase, using the topics 'mortality' and 'schizophrenia', and in a cross-reference search for articles that were particularly relevant. RESULTS: Schizophrenia is associated with mortality rates that are two to three times higher than those expected or observed in the general population. This excess of mortality is accounted for by a combination of an increased risk of suicide, in particular in young male patients soon after diagnosis, and more importantly, a higher number of natural deaths. In order to diminish the level of suicide among people with schizophrenia, the majority of research has focused on the identification of risk factors that predispose patients to attempt or commit suicide, while unhealthy styles, polypharmacy and inadequate healthcare have been shown to contribute to the high natural mortality. The link between the use of antipychotics and mortality has not been yet clarified. CONCLUSION: Dramatically increased mortality of schizophrenia patients is well established. It is time to move beyond this topic, and work towards interventions that aim at reducing the mortality risk in such patients.

Antipsychotic Agents↗
PubMed1986

Mortality among outpatients with anxiety disorders.

An earlier follow-up of inpatients with panic disorder attributed excess mortality among men to death from unnatural causes and from cardiovascular disease. The present study sought to determine the stability of this finding with a 12-year follow-up of 155 outpatients with anxiety neurosis. As in the first study, men were twice as likely to die as expected, and this excess in deaths was attributable to cardiovascular disease and suicide. Given the small numbers in both studies, however, the link between panic disorder and excess cardiovascular mortality remains tentative.

Ambulatory Care↗