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PubMed2004

Adult mortality in sub-Saharan Africa: evidence from Demographic and Health Surveys.

This article reports levels, trends, and age patterns of adult mortality in 23 sub-Saharan Africa countries, based on the sibling histories and orphanhood data collected by the countries' Demographic and Health Surveys. Adult mortality has risen sharply since HIV became prevalent, but the size and speed of the mortality increase varies greatly among countries. Excess mortality is concentrated among women aged 25-39 and among men aged 30-44. These data suggest that the increase in the number of men who die each year has exceeded somewhat the increase for women. It is time for a systematic attempt to reconcile the demographic and epidemiological evidence concerning AIDS in Africa.

Adult↗
PubMed2000

Dangers of growth hormone therapy in critically ill patients.

Prolonged stay of patients is the major challenge for modern intensive care because of its effects on morbidity and resource utilization. Severe trauma or infection are associated with the catabolic response, characterized by increased protein turnover and negative nitrogen balance. Severe catabolism leads to end-organ dysfunction and muscular weakness prolonging the need for mechanical ventilation. Catabolism cannot be prevented with standard parenteral or enteral nutritional formulas. In order to prevent the complications of catabolism in intensive care patients, recombinant growth hormone (rhGH) has been applied during two decades as an experimental therapy for patients requiring parenteral nutrition and for those with respiratory failure. Administration of rhGH has resulted in positive nitrogen balance, and studies in mechanically ventilated patients suggest that it may shorten the need for ventilatory support. In contrast to the results of these relatively small studies, a recent multinational randomized controlled trial revealed that the administration of rhGH (with doses 10-20 times higher than those used for replacement therapy) increases the mortality of critically ill patients. This excessive mortality in patients treated with rhGH was related to infections and development of multiple organ failure. Administration of high doses of rhGH to critically ill patients cannot thus be recommended.

APACHE↗
PubMed2003

Growth hormone and mannan-binding lectin: emerging evidence for hormonal regulation of humoral innate immunity.

An increasing number of studies in animals and humans indicate that growth hormone (GH) and insulin-like growth factor-I (IGF-I) modulate immune function. It was recently reported that, surprisingly, GH therapy increased the mortality in critically ill patients. The excessive mortality was almost entirely due to septic shock or multi-organ failure, which could suggest that a GH-induced modulation of immune function was involved. Mannan-binding lectin (MBL) is a plasma protein that plays an important role in innate immunity through activation of the complement cascade and inflammation following binding to carbohydrate structures. The serum concentration of MBL is subject to large between-subjects differences, which primarily are caused by genetic factors. However, mounting evidence supports a significant influence from growth hormone on MBL levels. In the present review, we focus on the function of MBL, on the influence of growth hormone on MBL levels, and on the possible clinical consequences of this new link between the endocrine and the immune system.

Acute-Phase Reaction↗
PubMed1993

Mortality from lung cancer in Ontario uranium miners.

Mortality from lung cancer was greater in Ontario uranium miners than in the general male population of Ontario (observed = 152, expected = 67.6, standardised mortality ratio 225, 95% confidence interval 191-264). Part of the excess of lung cancer may be because the proportion of men who are smokers or have smoked is greater in uranium miners than in Ontario men. Smoking does not explain the whole excess. Mortality from lung cancer in Ontario uranium miners is clearly related to exposure to short lived radon progeny. The excess relative risk of lung cancer from the same degree of exposure to short lived radon progeny is greatest five to 14 years after exposure and less subsequently. It is greater in men under the age of 55 years and less in older men. Part of the excess of lung cancer mortality in Ontario uranium miners is probably also due to exposure to arsenic that occurred earlier in gold mines. In Ontario uranium miners, the lung cancer mortality from exposure to arsenic increases as the intensity of exposure to short lived radon progeny increases. This finding is consistent with the hypothesis that the risk of lung cancer from exposure to arsenic is enhanced by exposure to other carcinogens. In Ontario uranium miners, the proportion of lung cancers that are small cell carcinomas is greater than in the general population. The proportion of small cell carcinomas is especially great five to 14 years after exposure to short lived radon progeny and in men who die from lung cancer at younger ages.

Adult↗
PubMed2003

[High summer temperatures and mortality in the Czech Republic 1982-2000].

The heat-stress-related mortality, which is among main impacts of periods of high summer temperature on society, was reported in many European countries, but analyses focusing on central European population have been rare. Results of the analysis for the period of 1982-2000 in the Czech Republic indicate that heat stress leads to a considerably increased all-causes mortality and mortality due to cardiovascular diseases. Periods with the highest deviations of the daily number of deaths from a baseline (in all-year data) are influenza epidemics and heat waves; the distribution of days with the highest excess mortality in a year is clearly bimodal, showing a main peak in winter and a secondary one in summer. Summer days with a considerably increased mortality are almost entirely days with a positive temperature deviation from the seasonal course. Deviations of mortality from the baseline exceed 100 deaths daily (more than 30% relative increase) in heat wave peaks, and the excess total mortality during the severe 1994 heat waves was +456 deaths (+10.3%) for June 17 to 30, and 8 deaths (+12.3%) for July 24 to August 8. The relative increase in mortality due to cardiovascular diseases was even more pronounced. The mortality displacement effect played an important role, since it was estimated to account for as much as 52% of the total number of victims for the June 1994 heat wave and 48% for the July-August heat wave. People who would die soon without oppressive weather conditions make about half of the total number of deaths, which is a larger value compared to what other studies reported. The increased mortality is observed at maximum (average, minimum) daily temperatures higher than 25 degrees C (18 degrees C, 14 degrees C) and their anomalies from mean seasonal courses larger than 3 degrees C. The same values hold for both the total and cardiovascular mortality. The mortality response at high temperatures is more pronounced in females than males. Correlations between mortality and temperature variables (including heat index) are positive and statistically significant (P = 0.01), stronger for deviations of meteorological variables from seasonal courses than for raw values, in females than males, and for heat index than for any temperature variable and summer simmer index. The unlagged correlations are stronger than correlations with lags 1-3 days; positive values of correlation coefficients hold for lags 0 to 3 days only while at lags of 4 to 25 days, the link is negative (mostly statistically significant) which demonstrates the mortality displacement effect and its time extent.

Adolescent↗
PubMed1990

Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986.

Blacks in the US experience increased mortality (1113 versus 745 per 100,000 males; 631 versus 411 per 100,000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17,366 deaths and 286,813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

A prospective study of depression and mortality in patients with type 2 diabetes: the Fremantle Diabetes Study.

AIMS/HYPOTHESIS: Depression is associated with excess mortality in patients with type 2 diabetes. We investigated the impact, and possible causal mechanisms, of depression on all-cause and cardiac mortality in patients with type 2 diabetes. METHODS: We recruited 1,273 patients with type 2 diabetes from a postcode-defined community (average age 64.1+/-11.2 years, 48.7% males, median duration of diabetes 4 years [range 1.0-9.0]) and followed them for 7.8+/-2.4 years. Depression was assessed using data obtained using a quality-of-life questionnaire, and cause and date of death were obtained from the state registry. RESULTS: Depression was present in 31.5% of subjects at recruitment. Depressed subjects had a longer duration of diabetes, more cardiovascular risk factors, CHD, cerebrovascular disease and diabetic microvascular complications at baseline, and higher all-cause and cardiac mortality rates during follow-up. In Cox proportional hazards models and after adjustment for demographic and diabetes-related variables and cardiovascular risk factors, depression was significantly associated with excess all-cause and cardiac mortality. When diabetic microvascular and macrovascular complications were added to the Cox models, depression was not significantly associated with excess all-cause or cardiac mortality. CONCLUSIONS/INTERPRETATION: Depression in patients with type 2 diabetes is associated with a greater prevalence of complications but is not an independent predictor of all-cause or cardiac mortality. Depression may contribute to the progression of important prognostic variables in diabetes, particularly macrovascular and microvascular disease.

Aged↗
PubMed2007

Mortality experiences among 15+ year survivors of childhood and adolescent cancers.

BACKGROUND: Studies of childhood and adolescent cancer survivorship have tended to focus on limited survival intervals (e.g., 5 and 10 years). Our report evaluates gender-specific overall mortality, as well as mortality by age group, and by cause, among 15+ year survivors of cancer diagnosed during childhood or adolescence. PROCEDURE: This was a retrospective cohort study of 565 15+ year childhood cancer survivors from Roswell Park Cancer Institute's Long-Term Follow-Up Project. Sex- and age-specific person-years at risk were accumulated and applied to age-specific mortality rates for New York State, excluding New York City. Standardized mortality ratios (SMRs), and 95% confidence intervals, were calculated and compared to mortality risks of the general population. RESULTS: Second malignancy was the leading cause of death among male and female survivors (15/38 deaths, 39%). Excess overall mortality was noted among both males (SMR = 284) and females (SMR = 371). Significant mortality excesses were seen in both genders for deaths due to primary malignant neoplasms and secondary malignancies, as well as cardiac deaths among males. Excess mortality was noted across most age strata. In the scenario of no cancer relapse, overall mortality in both genders did not differ significantly from the general population. CONCLUSIONS: Long-term survivors of childhood and adolescent cancers continue to demonstrate significant excess mortality. However, overall mortality among 15+ year survivors without a relapse appears to be comparable to the general population. The leading cause of death among 15+ year survivors is second malignancy in this study, which represents a novel and important finding in terms of long-term follow-up.

Adolescent↗
PubMed1996

The evolution of mortality in an industrial town: Le Creusot in the nineteenth century.

"The article examines the population of the town of Le Creusot [France]...with respect to the characteristics and evolution of mortality in the second third of the nineteenth century.... The authors analyze mortality statistics of Le Creusot in relation to other towns in the same department (Saone-et-Loire), to the neighboring city of Lyon, to another industrial town, Seraing, and with France as a whole. The effects of industrialization and the influx of labor on the mortality rate of Le Creusot appear to be undeniable. Life expectancy at birth among inhabitants of Le Creusot in 1836 was thus attained again only in 1876, after forty years of worsening living and environmental conditions. Among the causes noted for excess mortality in industrial towns, it is important to distinguish those due to working conditions (accidents, fatigue) and the direct consequences of industrial activity (factory smoke, toxic waste) from those due to living and housing conditions and the state of public and private hygiene in the town."

Cause of Death↗
PubMedDate not supplied

[A study on mortality around six municipal solid waste landfills in Tuscany Region].

OBJECTIVE: Describing mortality of populations residing in the neighbourhoods of selected waste landfill sites and contributing to the definition of their health status. DESIGN: Descriptive study of mortality at municipality and aggregated municipalities level. SETTING AND METHODS: Mortality from 1995 to 2000 in six areas of five provinces of Tuscany Region where municipal and/or hazardous waste landfills are located. Areas considered at higher exposure were those including municipalities where inhabitants mainly reside within 5 km from selected landfills. Comparison was made with rates observed in the five provinces in the same period. Statistical comparisons were perfomed using standardised mortality ratios (SMR) and bayesian mortality ratios (BMR) adjusted for age. MAIN OUTCOMES: Mortality for all causes, groups and specific causes of cancer and non-cancer diseases. RESULTS: Statistically significant mortality excesses were found for circulatory system and cerebrovascular diseases, for lymphohematopoietic system, liver and bladder cancer and non-Hodgkins lymphoma. CONCLUSION: Methods utilized have produced preliminary indications on associations between residence in areas with landfills and mortality. These excesses, also due to the limitations of macrogeographic studies, indicate that further insights at microgeographic level are needed.

Cause of Death↗
PubMed1986

Digoxin therapy and mortality after myocardial infarction. Experience in the MILIS Study.

Recent studies have led to controversy about whether long-term digoxin therapy after confirmed or suspected myocardial infarction increases mortality. We analyzed the mortality experience in 903 patients enrolled in the Multicenter Investigation of Limitation of Infarct Size (MILIS). As in previous studies, the decision to treat or not to treat with digoxin was made by the patient's personal physician on the basis of the usual clinical indications. Cumulative mortality was 28 percent for the 281 digoxin-treated patients as compared with 11 percent for the 622 patients who did not receive digoxin (P less than 0.001; follow-up interval, six days to 36 months; mean, 25.1 months). However, patients treated with digoxin had more base-line characteristics predictive of mortality than did their counterparts. Adjustment for these differences with two separate applications of the Cox method yielded P values of 0.14 and 0.34 for tests of difference in mortality, providing no evidence for a significant excess mortality associated with digoxin. Thus, the findings in the MILIS population do not support the assertion that digoxin therapy is excessively hazardous after infarction, but the existence of an undetected harmful effect can only be excluded with a randomized study. Until the results of such a study are available, we recommend careful consideration of whether any treatment of ventricular dysfunction is actually needed, consideration of alternatives to digoxin therapy, and restriction of digoxin use to the subgroup of patients (with severe chronic congestive failure and a dilated left ventricle) previously shown to have a beneficial clinical response.

Clinical Trials as Topic↗
PubMed1996

Proportionate mortality study of golf course superintendents.

A proportionate mortality study of a cohort of golf course superintendents was conducted using death certificates for 686 deceased members of the Golf Course Superintendents Association of America who died from 1970 to 1992. White males were included in the study population from all 50 states. The study objective was to compare mortality from this cohort to the general U.S. white male population. The proportionate mortality ratio (PMR) for all types of cancer was 136 (CI: 121, 152). Significant excess mortality from smoking-related diseases was observed. The PMR for arteriosclerotic heart disease was 140, which was significantly elevated (CI: 127, 155). In addition, the PMR for all respiratory diseases was 176 (CI: 135,230), while the PMR for emphysema was 186 (CI: 101,342). The PMR for lung cancer was 117 (CI: 93, 148). Mortality for four cancer types--brain, lymphoma (non-Hodgkin's lymphoma, NHL), prostate, and large intestine--occurred at elevated levels within this cohort: brain cancer PMR = 234 (CI: 121,454), non-Hodgkin's lymphoma (NHL) PMR = 237 (CI: 137,410), prostate cancer PMR = 293 (CI: 187,460), and large intestine cancer PMR = 175 (CI: 125,245). The PMR for diseases of the nervous system was 202 (CI: 123,333). A similar pattern of elevated NHL, brain, and prostate cancer mortality along with excess deaths from diseases of the nervous system has been noted among other occupational cohorts exposed to pesticides.

Agriculture↗
PubMed1967

Summary of a Canadian study of smoking and health.

The object of this study was to investigate the relationship between residence, occupation and smoking habits, and mortality from chronic diseases, particularly lung cancer. It was a prospective study, initiated by a questionnaire sent to Canadian veteran pension recipients. The study was based on the replies of 78,000 males and 14,000 females, together with data on the deaths occurring among these respondents over a six-year follow-up period-July 1, 1956 to January 30, 1962.The outstanding finding of this study was that cigarette smokers compared to non-smokers had excessive mortality, particularly from heart and circulatory diseases, lung cancer, and bronchitis and emphysema. The mortality ratios for heart and circulatory diseases were elevated even for those who smoked cigarettes less than five years, and remained relatively constant as the duration of smoking increased. The mortality ratios for lung cancer increased markedly as the duration of smoking increased. A small excess in mortality was noted among urban residents. An association between cause of death and occupation was not evident in this study.Findings based on the data on smoking collected in this study were incorporated into the Report of the U.S. Surgeon-General's Advisory Committee on Smoking and Health.

Adult↗
PubMed1987

Influenza: quantifying morbidity and mortality.

Because of their dramatic impact, morbidity and mortality associated with influenza have been recognized since at least the time of Elizabeth I of England. Excess mortality has been documented since 1889, and the infamous 1918 outbreak confirmed that influenza was truly one of the last major plagues. Despite the clear recognition of large clusters of influenza activity, it is still difficult to quantify precisely the total impact of influenza morbidity and mortality, since laboratory confirmation is required for exact diagnosis. Many methods have been developed to provide estimates of the mortality associated with influenza. These methods are usually predicated on establishing expected baseline rates of mortality. Deaths in excess of these rates are then calculated--and attributed to the circulating influenza virus. In this way, groups at high risk of mortality have been defined as the elderly and those with chronic conditions. Special-risk groups, such as those in institutions, have also been identified. The quantification of morbidity has required different approaches, and here community and family studies have made major contributions. In contrast to mortality, morbidity is most pronounced in children and young adults, and the diseases, although self-limited, are often quite severe. Although the size of the outbreaks varies, influenza infection can be documented annually. Thus, each year must be considered an influenza year.

Adolescent↗
PubMed2002

Long-term mortality of women with a diagnosis of breast cancer.

Survival from breast cancer has improved over the last few years, but scanty information is available on the long-term follow-up. We therefore considered data on 1,095 women with breast cancer diagnosed between 1974 and 1984 in the Swiss Cancer Registry of Vaud (population 616,000 inhabitants) who had survived for at least 10 years. Overall, 129 deaths from breast cancer were observed 10-19 years after the original diagnosis, corresponding to a standardized mortality ratio (SMR) of 20.3 (95% confidence interval (CI) 17.0-24.2). An excess mortality from breast cancer was observed 10-14 (SMR = 22.6) and 15-19 (SMR = 13.4) years after the original diagnosis. The SMR was 25.2 for women diagnosed with breast cancer at age <60 years. Consequently, total mortality was also elevated (SMR = 2.0, based on 294 deaths). None of the other causes of death was significantly elevated, but mortality from cardiovascular disease was 1.4 (95% CI 0.9-2.0) 15-19 years after breast cancer diagnosis. A second primary breast cancer was observed in 89 women. Of these, 19 (21%) died of breast cancer. Therefore in women diagnosed with breast cancer, there remains a substantial excess of breast cancer mortality up to 20 years after the original diagnosis.

Aged↗
PubMed1997

[Mortality in adults with asthma. Results from the Osterbro study].

A prospective analysis of overall and cause-specific mortality in subjects with self-reported asthma was undertaken using the data from The Copenhagen City Heart Study. A sample of 13,540 individuals selected from the general population was followed for 17 years. Survival of subjects with self-reported asthma was significantly poorer than that of non-asthmatics, the excess mortality being limited to pulmonary mortality. After statistical adjustment for age, length of school education, and smoking, women with asthma had a 1.7 higher risk of dying than women without asthma. The similar risk for men was 1.5. Inclusion of one-second forced expiratory volume, in % predicted, in the mortality analyses showed that the increased risk of death associated with asthma was mediated mainly through reduced lung function. We conclude that in the general population self-reported asthma is associated with a slight excess of mortality, mainly due to respiratory disease.

Adult↗
PubMed1993

Long-term mortality of Nazi concentration camp survivors.

Nazi concentration camp survivors have been shown to have excess mortality in the first 20 years following their release. To determine if this excess persists, Israeli civil servants were studied. Mortality of camp survivors and of other post-war European immigrants was compared 20-41 years following World War II. Using survival analysis and proportional hazards models, no difference in mortality rates was found.

Adult↗
PubMed1998

No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmö Preventive Trial with diet and exercise.

Impaired glucose tolerance (IGT) is associated with increased mortality due to ischaemic heart disease (IHD), but as it is not known whether this excess mortality can be reduced by preventing or delaying the development of non-insulin-dependent diabetes mellitus (NIDDM), a long-term NIDDM prevention trial of dietary counselling and physical exercise was launched at Malmö, Sweden, the 12-year follow-up of which is reported here. At 12-year follow-up of 6956 men who underwent health screening at 48 years of age, an IGT intervention group (n = 288) who participated in a long-term NIDDM prevention programme were compared with an IGT non-randomised routine treatment group (n = 135), a diabetic group (n = 144), and the remainder, the normal glucose tolerance (NGT) group (n = 6389). The variables studied included the levels of blood glucose, plasma insulin, blood pressure, blood lipids, lung function and maximum oxygen uptake. Subjects with IGT were characterised by overweight, poor vital capacity, hypertension, hypertriglyceridaemia and hyperinsulinaemia. The mortality rate in the IGT intervention group was similar to that in the NGT group (6.5 vs 6.2 per 1000 person years at risk) and lower than that in the IGT routine treatment group (6.5 vs 14.0, p = 0.009). In the two IGT groups taken together, intervention but not body mass index, systolic blood pressure, smoking, cholesterol or the 2-h glucose level predicted mortality. Systolic blood pressure was a predictor of IHD mortality among IGT subjects; and in the cohort as a whole, body mass index, systolic blood pressure, hypercholesterolaemica, diabetes and smoking were predictors of IHD mortality. The findings suggest that a long-term intervention programme, with an emphasis on lifestyle changes, including dietary counselling and physical exercise, will reduce mortality in subjects with IGT who are at an increased risk of both developing NIDDM and of premature death due to IHD and other causes.

Cohort Studies↗