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PubMed1995

Cancer incidence and mortality near the Baglan Bay petrochemical works, South Wales.

OBJECTIVES: To study incidence and mortality of leukaemias, cancer of the larynx, and other cancers near the petrochemical plant at Baglan Bay, in response to local concerns of an alleged cluster of cancers in the vicinity. METHODS: This is a small area study of cancer incidence, 1974-84 and of mortality, 1981-91 based on the national postcoded data held by the Small Area Health Statistics Unit and with population and socioeconomic data from the 1981 census. The study is centred on BP Chemicals Ltd, Baglan Bay, Port Talbot, West Glamorgan, South Wales and includes a general population sample of 115,721 people (1981 census) living within 7.5 km of the plant. Cancer incidence and mortality for all cancers, leukaemias, and cancer of the larynx were examined within 7.5 km and 3 km of the plant, and tests for decline in risk of these cancers with distance from the plant were carried out. Mortality from several other cancers possibly associated with the petrochemical industry was also studied. RESULTS: There were 5417 incident cancer cases and 2458 cancer deaths within 7.5 km of the plant during the periods of study. There was an 8% excess incidence of all cancers within 7.5 km, and a 24% excess of cancer of the larynx, consistent with a general excess of these cancers in West Glamorgan, but no apparent decline in incidence with distance from the plant, nor excess mortality. There was also no evidence of decline in leukaemia incidence or mortality with distance, at all ages or in children. Among the other causes included in the mortality study, there was an excess of multiple myeloma within 7.5 km, especially among women, and a significant decline in mortality from non-Hodgkin's lymphomas although there was no excess overall within 7.5 km. CONCLUSIONS: The apparent excess incidence of all cancers and cancer of the larynx within 7.5 km of the BP Chemical Ltd works was consistent with an excess more generally in West Glamorgan, possibly related, at least to some extent, to cancer registration in Wales. There was no excess mortality from these cancers. The results for multiple myeloma and especially non-Hodgkin's lymphomas may have been chance findings in view of the multiple tests of significance carried out in the study. A study of lymphatic and haematopoietic cancers near oil refineries in Great Britain is to be undertaken that will help put the findings of the present study in wider context.

Adolescent↗
PubMed1975

Relationships in Canada between mortality from tumours of the gastrointestinal tract and marital status.

The mortality from tumours of the gastrointestinal tract in the Canadian population in 1970-72 was 16% higher in single than in married men (on the basis of age-adjusted rates), 25% higher in widowed men and 28% higher in divorced men. All these differences were unlikely to be due to chance. The rates were 4% higher for single women, 14% higher for widows and 22% higher for divorced women, compared with the married. The differences for single and divorced women were not significant. Substantial excess mortality was found in the unmarried for tumours of the mouth, pharynx and esophagus, and rectum; for tumours of the stomach and colon the excess was small or nonexistent. This variation between sites suggests that systematic errors in the census data used as denominators are not responsible for the high mortality for the unmarried from certain tumours. The effect is found in conditions for which treatment can have made little difference (e.g., a 75% excess mortality for tumours of the esophagus in single men compared with married) and in conditions for which differences in the use of medical facilities may have been important (e.g., a 44% excess mortality for tumours of the rectum in widowers).

Aged↗
PubMed1991

Mortality among psychiatric inpatients in Singapore.

This study examines the Standardized Mortality Ratio (SMR) by age, sex and cause of death among psychiatric inpatients in Singapore. Mortality in mentally ill inpatients was found to be 2.79 times that of the general population. The SMR decreased with age and the SMR for those 70 years and above was lower than that reported in the literature. The mortality ratio was most accentuated in the younger patients, especially in the female. Excess mortality was observed in both the natural as well as the unnatural causes of death. Among the natural causes of death, infection and pneumonia showed high excess in mortality. In the unnatural causes of death, suicide was predominant.

Adolescent↗
PubMed1986

The method of transmission of epidemic influenza: further evidence from archival mortality data.

Evidence for influenza-associated excess mortality in the three centuries before the 20th has been sought from parish burial registers in Cumbria, Devon, Dyfed, East Anglia, Gloucestershire and Northumbria, compared with inter-epidemic years. Most of the registers showed excess of burials concordant with eight historic influenza epidemics. Comparison of the dates of these epidemics, deduced from the burials data in different areas, showed a rate of spread difficult to reconcile with direct person-to-person spread of influenza from the sick. An alternative explanation based on development of latency of the virus in the sick person and subsequent seasonal reactivation is discussed.

Disease Outbreaks↗
PubMed1990

Mortality among three Puerto Rican populations: residents of Puerto Rico and migrants in New York City and in the balance of the United States, 1979-81.

"This study attempts to explain similarities and differences in the mortality experience of three population groups: Puerto Ricans on the island commonwealth, Puerto Rican born persons in New York City and Puerto Rican born persons in the rest of mainland United States. Mortality is much higher among Puerto Ricans in New York City than among those residing elsewhere. Much of the difference is due to excess mortality caused by cirrhosis of the liver and homicide. Puerto Rican born persons living on the mainland but outside New York City generally have low mortality, even when compared with U.S. whites."

Americas↗
PubMed1990

Insulin-dependent diabetes mellitus mortality. The risk of cigarette smoking.

The relation between cigarette smoking and mortality was examined prospectively in a population of adult insulin-dependent diabetes mellitus (IDDM) patients. In 1981, information on smoking history and other health and lifestyle factors was obtained by questionnaire from 93% of the 723 patients included in the Children's Hospital of Pittsburgh IDDM registry who were diagnosed between 1950 and 1964. Vital status as of January 1, 1988 was ascertained for 98% of the 548 patients who participated in the baseline survey and were alive as of January 1, 1982. Fifty-four cases died during the 6-year follow-up (32 male, 22 female). Proportional hazards analysis revealed that heavy smoking was a significant independent predictor of all-cause mortality among females but not males. The excess mortality in female diabetics was explained primarily by a marked excess risk of coronary heart disease mortality in smokers. These data strongly suggest that cigarette smoking, especially among diabetic females, should be avoided in order to improve longevity.

Cause of Death↗
PubMed1993

Sex differences in the impact of coexistent diabetes on survival in patients with coronary heart disease.

OBJECTIVE: To evaluate the sex difference in the impact of diabetes on survival in patients with coronary heart disease. RESEARCH DESIGN AND METHODS: Cohort study based on a sample from a hospital registry in Chicago, IL. A total of 974 consecutive patients (585 men and 389 women) with angiographically confirmed coronary artery disease were followed for 4.6 yr. RESULTS: At baseline, 160 men and 155 women had diabetes. The age-adjusted relative risk of death from all causes for patients with diabetes versus patients without diabetes was 0.93 (95% confidence interval 0.65-1.34) in men and 1.99 (95% CI 1.30-3.05) in women. For cardiac death, the corresponding relative risk was 1.00 (95% CI 0.64-1.56) and 1.96 (95% CI 1.19-3.24) in men and women, respectively. Baseline differences in age, hypertension, body mass index, number of diseased vessels, and ejection fraction did not fully explain the excess mortality risk in diabetic women. Excess risk was apparent in both cardiac and noncardiovascular categories. Among nondiabetic patients, the risk of death was significantly lower in women compared with men (multivariate-adjusted relative risk = 0.61, 95% CI 0.41-0.89). However, the mortality risk of diabetic women became similar to men as a whole (relative risk = 1.13, 95% CI 0.80-1.60). CONCLUSIONS: Diabetes confers a substantially higher risk of mortality in women than in men when it occurs in the presence of coronary heart disease.

Age Factors↗
PubMed2001

Beating the heat: development and evaluation of a Canadian hot weather health-response plan.

An increasing number of cities subject to hazardous summer weather in the United States and Canada have begun to develop and implement hot weather response plans to prevent heat-related illnesses and deaths. In this study we focus on heat-mortality relationships in Toronto, Ontario, between 1980 and 1996 and evaluate the potential effectiveness of the city's interim hot weather-health response plan. Using two heat stress indexes--humidex and apparent temperature--we identified excess mortality associated with hot and humid weather and then estimated excess deaths for hot and cool summers. Mortality rates for all ages and for > 64 years age groups rose with increasing humidex and apparent temperature, with no significant increase for the population < 65 years. Excess mortality occurred as low as the 30-35 degrees C humidex range, which is below the 40 degrees C humidex used to issue a heat warning under Toronto's interim hot weather response plan. During a hot summer (such as 1988 or 1995), 32 excess deaths would be expected, whereas 34 fewer deaths than baseline levels would be expected during a cool summer like 1982 or 1992. Days with high humidex levels occur infrequently in Toronto, and thus exposure is limited under current climatic conditions. In the event of a warming climate, more days with dangerously high humidex levels are likely to occur, and summer deaths are expected to increase. Toronto's hot weather health-response plan is an important early step for adaptation to climate change.

Adult↗
PubMed2004

Long sleep and mortality: rationale for sleep restriction.

Epidemiologic studies have consistently shown that sleeping >8 h per night is associated with increased mortality. Indeed, the most recent American Cancer Society data of 1.1 million respondents showed that sleeping longer than 7.5 h was associated with approximately 5% of the total mortality of the sample. The excess mortality was found even after controlling for 32 potentially confounding risk factors. Although epidemiologic data cannot prove that long sleep duration causes mortality, there is sufficient evidence to warrant future testing of the hypothesis that mild sleep restriction would decrease mortality in long sleepers. Sleep restriction might resemble dietary restriction as a potential aid to survival. Sleep restriction has several potential benefits besides possible enhanced survival. Acute sleep restriction can have dramatic antidepressant effects. Also, chronic sleep restriction is perhaps the most effective treatment for primary insomnia. Conversely, spending excessive time in bed can elicit daytime lethargy and exacerbate sleep fragmentation, resulting in a vicious cycle of further time in bed and further sleep fragmentation. Sleep restriction may be most beneficial for older adults, who tend to spend excessive time in bed and have more sleep fragmentation compared with young adults.

Aging↗
PubMed2005

Life expectancy--a commentary on this life table variable.

In 1992, I wrote an article on a method of modifying the Decennial US Life Table to accommodate any pattern of excess mortality expressed in terms of excess death rate (EDR), for the specific purpose of calculating the reduced life expectancy, e. I believe this was the first article published in the Journal of Insurance Medicine (JIM) that dealt specifically with life expectancy as an index of survival and risk appraisal, never used in the classification of extra mortality risk in applicants for life insurance. In this commentary, I discuss the 1989-91 US Decennial Life Table in detail. I link the subject matter of the 1992 article with several more recent articles that also focus on the utility of life expectancy in underwriting structured settlement annuities and preparing reports on life expectancy for an attorney in a tort case. A few references are given for further reading on life table methodology and its use in the most accurate estimate of life expectancy, given the inherent limitations of the life table and the limited duration of follow-up studies.

Adolescent↗
PubMed1999

New insights into the Far Eastern pattern of mortality.

Some of the highest levels of excess mortality of males found anywhere in the world were present in several Far Eastern populations during the 1960s and 1970s but have progressively disappeared since that time. This study uses cause-of-death data to determine the diseases responsible for the existence and attenuation of these sex differences in Hong Kong, Singapore, and Taiwan. The results indicate that respiratory tuberculosis is the single most important underlying cause of the existence and attenuation of the pattern, that the role of liver diseases is not clear cut, and that other causes (such as cardiovascular diseases) are also important. A review of numerous risk factors yields no compelling reason why these populations experienced such large sex differences in mortality. However, it seems likely that public health and biomedical improvements (particularly those related to the reduction in mortality from tuberculosis) played a critical role in the attenuation of the Far Eastern mortality pattern.

Cause of Death↗
PubMed1979

Trout mortalities as a result of Streptococcus infection.

Excessive mortalities were experienced in the bigger rainbow trout (Salmo gairdneri) at an efficiently managed trout farm. All tests for known toxins in the feed and water proved to be negative. A faecal Streptococcus which belongs to the Lancefield group D but which could not be identified as belonging to any of the recognized species within this group, was isolated from the spleens, livers and kidneys of affected fish. Pathogenicity studies with this organism proved it to be highly fatal to trout but not to Mozambique bream (Sarotherodon mossambicus), banded bream (Tilapia sparrmenii), carp (Cyprinus carpio) or largemouth bass (Micropterus salmoides). The isolation and biochemical characteristics of the organism are described. The symptoms, gross- and histopathology of this disease are described and discussed. The disease resembles a haemorrhagic septicaemia and appears to be associated with intensification and conditions of stress.

Animals↗
PubMedDate not supplied

Mortality and industrial hygiene study of workers exposed to polychlorinated biphenyls.

Because of the demonstrated toxic effects on animals resulting from exposure to polychlorinated biphenyls (PCBs), the National Institute for Occupational Safety and Health conducted a retrospective cohort mortality study of 2,567 workers in two plants where PCBs were used in the manufacture of electrical capacitors. All workers included in the study were employed for at least 3 months in areas of the plants where PCBs were used. The vital status of 98% of the two cohorts was determined, and 39,018 person-years were accumulated. All-cause mortality was lower than expected (163 obs. vs 182.4 exp.) as well as all cancer mortality (39 obs. vs 43.8 exp.). Excess mortality was noted for rectal cancer (4 obs. vs 1.19 exp.) and liver cancer (3 obs. vs 1.07 exp.), although neither excess was statistically significant. In one of the plants the observed mortality due to cirrhosis of the liver was also elevated. The results of detailed industrial hygiene surveys conducted in each plant are also presented.

Female↗
PubMed2001

Socioeconomic inequalities in cancer survival in England and Wales.

BACKGROUND: Cancer survival often has been reported as lower for the poor than the rich, but, to the authors' knowledge, systematic national estimates of deprivation gradients in survival over long periods of time have not been available. METHODS: The authors estimated national population-based survival rates for almost 3 million people who were diagnosed with 1 of 58 types of cancers (47 in adults, 11 in children) in England and Wales during the 20-year period 1971-1990 and followed through December 31, 1995. Cancer patients were assigned by their address at diagnosis to 1 of 5 categories (quintiles of the national distribution) of material deprivation by using a standard index derived from census data on unemployment, car ownership, household overcrowding, and social class that was available for all 109,000 census tracts in Great Britain. The authors used relative survival rates: the ratio of observed survival among the cancer patients to the survival that would have been expected if they had had the same background mortality as the general population. Background mortality differed widely among socioeconomic categories, and the authors constructed life tables from raw national mortality data by gender, single year of age, calendar period of death, and socioeconomic category to adjust for it. The authors used variance-weighted least squares regression to estimate both time trends in age standardized survival and socioeconomic gradients in survival. The number of avoidable deaths was estimated from the observed mortality excess compared with the expected mortality in each group of patients. RESULTS: Survival rose steadily for most cancers over 25 years to 1995 in England and Wales, but inequalities in survival between patients living in rich and poor areas were geographically widespread and persistent over this period of time. These patterns existed for 44 of 47 adult cancers examined but not for 11 childhood cancers. These inequalities in survival represented more than 2500 deaths that would have been avoided each year if all cancer patients had had the same chance of surviving up to 5 years after diagnosis as patients in the most affluent group. CONCLUSIONS: The largest national cancer survival study has provided strong evidence of systematic disadvantage in outcome among patients who lived in poorer districts compared with those who lived in wealthier districts.

Adolescent↗
PubMed2004

Does depression in old age increase only cardiovascular mortality? The Leiden 85-plus Study.

BACKGROUND: Depression in old age is associated with an increased mortality risk of cardiovascular disease but the mortality risk from non-cardiovascular causes is disputed. OBJECTIVE: To investigate the effect of depression on cardiovascular and non-cardiovascular mortality in old age. METHODS: We prospectively followed 500 subjects from age 85 years onwards within the population-based Leiden 85-plus Study. Depressive symptoms were assessed annually with the 15-item Geriatric Depression Scale (GDS-15). Mortality risks were estimated in a Cox proportional-hazards model with the annual assessment of depression (GDS-15> or =4 points) as a time-dependent covariate. RESULTS: During 1654 person-years of follow-up (mean per person, 3.2 years), depression was associated with a two-fold increase of all cause mortality [Relative Risk (RR), 1.83; 95% Confidence Interval (CI), 1.24-2.69] that was not explained by comorbid conditions. Both cardiovascular mortality and non-cardiovascular mortality contributed equally to the excess mortality (RR 1.95 and 1.75 respectively). CONCLUSION: Depression in old age contributes to an increase of both cardiovascular and non-cardiovascular mortality. Motivational depletion may play an important role in the increased mortality in elderly with depression.

Aged↗
PubMed1983

Drinking habits and death. The Yugoslavia cardiovascular disease study.

In a prospective study of more than 10000 Yugoslav men it was found that consumption of alcoholic beverages was inversely related to non-sudden death from coronary heart disease (CHD) and positively related to death from trauma. The consequence was an apparently U-shaped relation between alcohol consumption and death, the lowest mortality being among moderate drinkers. Excess mortality from trauma was evident only among men under 55 and only for those who reported at entry to the study that they had been drunk during the preceding week. Alcohol consumption as reported at entry was unrelated to subsequent mortality from liver cirrhosis or any form of cancer. An enlarged liver, however, was associated with higher death rates for liver cirrhosis. This raises the possibility that some of the men were heavy drinkers preceding their entry to the study but were no longer drinking heavily at the time of entry. Enlarged liver, however, was also related to hypertension and to chronic obstructive pulmonary disease and thus was not a specific indicator of alcohol abuse in this population. Recent drunkenness but not frequency of drinking was related to death from trauma and liver cirrhosis and to sudden CHD death. In short, both the pattern of drinking and the usual level of alcohol consumption appear to be related to mortality in this population.

Adult↗
PubMed1991

Blood pressure and mortality risk in the elderly.

Blood pressure was assessed between 1981 and 1983 in all persons over age 65 years in three communities (East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington countries, Iowa), and cause-specific mortality was monitored annually over the subsequent 5 years as part of the National Institute on Aging-sponsored Established Populations for Epidemiologic Studies of the Elderly. Each community had 80% or more participation: in East Boston, 3,809 persons with 903 deaths, in New Haven, 2,812 persons with 804 deaths, and in Iowa, 3,673 persons with 763 deaths. At 2 years, odds of death from all causes were higher in the low (less than 130 mmHg) than the middle (130-159 mmHg) systolic blood pressure group for persons aged 65-79 years in all three populations. By 5 years, cardiovascular death increased with increasing systolic pressure in all three communities and reached significance in Iowa. Cancer death was highest in the low systolic pressure stratum in all three centers. All-cause, cardiovascular death, and cancer mortality was highest in the low (less than 75 mmHg) diastolic blood pressure group in East Boston, even at 5 years. Blood pressures obtained 9 years earlier in 2,079 (68%) of the East Boston participants showed a significantly higher risk of cardiovascular death with increasing systolic pressure and no relation between diastolic pressure and mortality risk. In the elderly, excess mortality at lower levels of blood pressure during early follow-up may in part be due to the effects of illness and disability present at baseline. This may obscure the usual rise in mortality with increasing systolic pressure. There is no consistent relation between diastolic pressure and mortality.

Aged↗
PubMed1984

Epidemiology of myasthenia gravis in Norway.

The number of patients with myasthenia gravis diagnosed and registered in Norway from 1912-1981 has been collected, representing essentially all diagnosed cases during these 70 years. Until 1948, Oslo University Hospital, the National Hospital, had the only neurological department. in Norway. Since then, neurological departments have been established throughout our country. All these departments and all practising neurologists in Norway responded to the appeal for the necessary information on their diagnosed patients up to the end of 1981. The majority of the results are based on the period 1951-1981. The National Bureau of Statistics has registered the deaths of myasthenia gravis cases since 1951, and since 1956 where it has constituted an underlying or contributory cause. The incidence rate by diagnosis per million population 1951-1981 is 2.6 for males, 5.3 for females and 4 for both sexes. The prevalence per million population is 52 for males, 127 for females and 90 for both sexes. The mortality in males is 144% and in females 155% of the mortality in the population. The excess mortality is much greater in patients below 60 years of age, especially in females where a value of 483% if found.

Adolescent↗