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PubMed1996

Mortality in adults with self-reported asthma. Copenhagen City Heart Study Group.

BACKGROUND: On the question of whether asthma shortens survival the published work gives no clear answer. We have prospectively analysed overall and cause-specific mortality in persons with self-reported asthma. METHODS A sample of 13 540 individuals (6104 men) 20 years of age or older, randomly selected from the general population of the city of Copenhagen, was followed for 17 years. FINDINGS: Survival in participants with self-reported asthma was significantly poorer than in 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 (95% confidence interval 1.3--2.2). Although the relative risk (RR) of dying with asthma was slightly lower in men (RR = 1.5, 95% Cl 1.2-1.9) the difference between sexes was not significant. The results were similar within smoking groups and the highest risk of death associated with asthma was seen among never-smokers (RR = 2.1, 95% Cl 1.6-2.3). 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. INTERPRETATION: We conclude that, in the general population, self-reported asthma is associated with a slight excess of mortality, mainly from respiratory diseases.

Adult↗
PubMed2002

Cause-specific mortality in a population with diabetes: South Tees Diabetes Mortality Study.

OBJECTIVE: To describe the mortality of a population with diabetes compared with the local nondiabetic population, using age-, sex-, and cause-specific death rates and relative and absolute differences in death rates. RESEARCH DESIGN AND METHODS: A population-based cohort of 4,842 people with diabetes living within South Tees, U.K., was identified and followed from 1 January 1994 to 31 December 1999. Causes of death were obtained from death certificates, and mortality rates were compared with the nondiabetic population of the same area for the same time period. RESULTS: There were 1,205 deaths (24.9%) in the study population during the 6 years of study. For type 2 diabetes, mortality from cardiovascular causes was significantly increased in both sexes and at all ages. Relative death rates for the age band 40-59 years were 5.47 (95% CI 4.18-7.15) for men and 5.60 (3.44-9.14) for women. The relative death rates declined with age for both sexes, but absolute excess mortality increased with age. There were no consistent differences in noncardiovascular death rates, other than for renal disease. Similar outcomes were found for type 1 diabetes, although these results were limited by a much smaller population size. People with diabetes and renal impairment had significantly higher mortality than people with diabetes alone, with a rate ratio of 7.27 for people with type 2 diabetes aged 40-59 years. CONCLUSIONS: In an area of the U.K. with high cardiovascular death rates, people with diabetes had significantly higher cardiovascular death rates than people without diabetes. Interventions targeted at cardiovascular risk factors should be used to try and reduce this excess premature mortality, which is especially high in those with renal impairment.

Adult↗
PubMed1976

Cancer mortality among rubber workers: an epidemiologic study.

Several previous epidemiologic studies of the rubber industry--an industry that uses many chemicals--have identified excess mortality from certain specific cancers. In this study, four cohorts of active and retired workers, at four major rubber-tire plants, were identified historically and followed for the ten-year period from 1964 to 1973. The cancer mortality of these four population was compared, separately and combined, with that of the general community. For all cancers combined, there was a slight excess above the expected number of deaths, whereas for some specific cancers (stomach, colon, prostate, and neoplasms of the lymphatic and hematopoietic system) there was a marked excess of deaths. Proportional mortality analysis at other small plants revealed similar excesses for these cancers, and some excess for lung, bladder, and CNS cancers. Analysis of detailed individual work histories reveals an association of certain cancers with specific job exposures; in particular, lymphatic leukemia and solvent exposure, and lung cancer and curing-room exposure. For both bladder cancer and stomach cancer, preliminary analyses indicate an association with groups of jobs in adjacent production stages (handling and mixing raw ingredients, and processing the "green" precured rubber, respectively). Further analytic studies are currently under way to identify groups of rubber workers at increased risk of other specific cancers.

Adult↗
PubMed1991

Difference in mortality between patients treated with captopril or enalapril in the Xamoterol in Severe Heart Failure Study.

The double-blind, placebo-controlled, multinational trial Xamoterol in Severe Heart Failure randomized 290 patients treated with captopril and 217 treated with enalapril to xamoterol or placebo. At the end of the 100-day follow-up period, the cumulative probability of survival in patients with coronary artery disease or with dilated cardiomyopathy decreased in the captopril group (90.3%) when compared with the enalapril group (97.2%). The excess mortality in the captopril group could not be related to the indexes of the severity of heart failure, such as baseline exercise duration, functional class, cardiothoracic ratio, ejection fraction or dose of diuretic drugs. Furthermore, the excess in mortality was seen in all subsets of patients examined as well as across countries. Examination of the dosing regimen used, however, suggests that insufficient daily dosage of captopril or the inadequate schedule of administration, or both, might be responsible for different degrees of angiotensin-converting enzyme inhibition between the enalapril and captopril groups and hence for the difference in mortality. It is important in future clinical trials to determine to what extent complete circadian angiotensin-converting enzyme inhibition is necessary to provide the full benefit of this therapy in heart failure.

Adrenergic beta-Agonists↗
PubMed2005

Early and late mortality after myocardial infarction in men and women: prospective observational study.

OBJECTIVE: To compare characteristics, management, and outcome of myocardial infarction (MI) in men and women. DESIGN: Prospective observational study. SETTING: District general hospital in southwest Scotland. PARTICIPANTS: 966 men and 597 women admitted with first MI between 1994 and 2000 with follow up to the end of 2001. RESULTS: 393 (40.7%) men and 305 (51.1%) women died during a median follow up of 3.4 years for the survivors. Univariate analysis indicated an excess mortality among women (hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.25 to 1.68), which disappeared after adjustment for age, smoking, co-morbidity, previous vascular disease, diabetes, hypertension, and social deprivation (HR 1.02, 95% CI 0.87 to 1.20). There was also an excess early mortality within 30 days among women (HR 1.54, 95% CI 1.20 to 1.98), though this did not retain significance after adjustment for the same covariates (HR 1.04, 95% CI 0.79 to 1.37). Small and insignificant differences were found in the proportion of men and women receiving thrombolysis on admission and secondary prophylactic drugs at discharge, except for statins and beta blockers, which were respectively more (adjusted odds ratio 1.48, 95% CI 1.10 to 1.98) and less (adjusted odds ratio 0.78, 95% CI 0.60 to 1.00) commonly prescribed to women. CONCLUSION: Results suggest that the poorer outcome for women after MI reported in other studies may reflect sex bias in management as well as differences in age and co-morbidity and support the view that if women have access to the same quality of care as men then survival will be the same.

Age Factors↗
PubMed1986

Mortality of radiologists and pathologists in the Radiation Registry of Physicians.

The overall and cause-specific mortality experience of male radiologists and a comparable group of medical specialists, pathologists, who were included in the Radiation Registry of Physicians, is presented. The study population consists of an early-entry cohort of physicians who were members of either the American College of Radiology or the College of American Pathologists as of Jan. 1, 1962, and a late-entry cohort of similar members who joined these societies between January 1962, and June 1972. The purpose of the study was to determine if occupational exposure to low levels of ionizing radiation resulted in excess mortality from all causes and specific causes, or decreased survival patterns for radiologists compared with pathologists over the 16-year period, 1962 to 1977. The data revealed that radiologists and pathologists were comparable regarding overall mortality experience for all entrants, the early-entry cohort, and the late-entry cohort. Further analyses revealed a gradient in mortality between the two specialties, with the largest differences in the earliest birth subcohorts for all three groups, and a significant excess in mortality among radiologists in those subcohorts of the late-entry cohort born before 1920. Such a gradient may indicate an exposure effect associated with time of first exposure or duration of exposure, but not associated with time of entry into a professional society. Nevertheless, overall age-specific and age-adjusted mortality rates among radiologists and pathologists were lower in the late-entry cohort compared with the early-entry cohort, thus indicating some effect of time of entry within each specialty.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Cardiovascular mortality in winter.

Ischaemic heart disease is the biggest single cause of excess mortality in winter, accounting for approximately half of all the excess deaths. Most of these deaths take place hours or a day or two after exposure to cold suggesting that some result from thrombosis starting during or shortly after cold exposure, although some can result from immediate reflex effects of cold, and some can occur in association with respiratory deaths which are delayed many days after cold weather. Changes in blood composition observed in the cold that may explain the rapid thrombotic deaths include increased red cell count, plasma cholesterol, and plasma fibrinogen, which are all thrombogenic. The protective protein C does not increase significantly. British data suggests that cold housing particularly affects respiratory mortality in winter, and outdoor cold exposures mortality from arterial thrombosis. A Europe-wide survey is now being run as part of the EC- funded project "Eurowinter" to assess such factors.

Cardiovascular Diseases↗
PubMed2004

The X-linkage hypotheses for SIDS and the male excess in infant mortality.

Sudden Infant Death Syndrome is characterized globally by a 50% excess in males per 1000 live births of each gender. We previously hypothesized that this male excess may arise from a single X-linked gene locus with a dominant allele (p = 1/3) that is protective against potentially terminal cerebral anoxia by catalyzing anaerobic oxidation and a recessive allele (q = 2/3) that is unprotective. We now hypothesize this same terminal mechanism for all other causes of infant respiratory death (50% male excess) and that infant cardiac death is equally probable for males and females (0% male excess). With these hypotheses, we model the male excess of all infant mortality (under 5 years) as 25% per 1000 live births of each gender. We show for the USA (1979-2000) that this model of a 25% male excess accurately predicts the male excess mortality under 1 year (24.15%), from 1 to 4 years (25.42%), and under 5 years (24.51%).

Cause of Death↗
PubMed1997

Region of birth and mortality from circulatory diseases among black Americans.

OBJECTIVES: This study examines the relationship between birth-place and mortality from circulatory diseases among American Blacks. METHODS: All Black deaths from circulatory diseases (International Classification of Diseases, 9th Revision. codes 390 through 459) were extracted from the National Center for Health Statistics mortality detail files for 1979 through 1991. Age-specific and age-adjusted mortality rates with 95% confidence intervals were calculated for males and females for combinations of five regions of residence at birth and four regions of residence at death. RESULTS: Males had higher mortality rates from circulatory diseases than females in every regional combination of birthplace and residence at death. For both genders, the highest rates were for those who were born in the South but died in the Midwest; the lowest rates were for those who were born in the West but died in the South. Excess mortality for both Southern-born males and females begins at ages 25 through 44. CONCLUSIONS: There is a region-of-birth component that affects mortality risk from circulatory diseases regardless of gender or residence at time of death. We must examine how early life experiences affect the development of circulatory disorders.

Adult↗
PubMed1983

Mortality among workers from a plastics producing plant: a matched case-control study nested in a retrospective cohort study.

Earlier proportional mortality studies of workers in a plastics producing plant in Massachusetts indicated excess mortality from certain digestive and genitourinary cancers. To more definitively examine mortality among these workers a retrospective cohort study was conducted for 2,490 male wage earners who worked at least one year during 1949-1966. Vital status was determined as of Dec. 31, 1976, for 99.7% of the cohort and death certificates were obtained for 98.0% of 603 observed deaths. Comparison with the local county white males revealed a slight excess in digestive system cancer (standard mortality ratio [SMR] = 101.8) and a statistically significant excess (p less than .05) in genitourinary cancer (SMR = 153.6). A relationship was suggested between cancer of the rectum, liver, and pancreas and both the duration and interval from onset of exposure. A secondary matched case-control study was conducted to determine if particular jobs or work areas were related to the excesses found in the primary study. This analysis did not support the hypothesis that digestive or genitourinary cancer was related to a general plant exposure or date of hire. Possible associations warranting continued surveillance were found between rectal cancer and cellulose nitrate production and between prostatic cancer and polystyrene processing. Digestive and genitourinary cancers other than rectal and prostate were not related to employment in any of 21 occupational exposure categories examined.

Adult↗
PubMed2000

Body mass index and mortality among hospitalized patients.

BACKGROUND: Body mass index (weight in kilograms divided by the square of the height in meters [BMI]) is known to be associated with overall mortality. However, the effect of age on excess mortality from all causes associated with obesity is controversial. The aim of the present study is to determine the effect of age on the relationship between BMI and mortality. METHODS: We analyzed data from a large collaborative observational study group, the Italian Group of Pharmacoepidemiology in the Elderly (GIFA), that collected data on hospitalized patients. A total of 18,316 patients consecutively admitted to 79 clinical centers during 5 different surveys in 1998, 1991, 1993, 1995, and 1997 were enrolled in the present study. The main outcome measure was the relative hazard ratio of death for different levels of BMI. RESULTS: Mortality rate was lowest among men and women with BMIs from 25.0 through 27.4 kg/m(2) (relative risk, 0.24; 95% confidence interval, 0.15-0.38). The graphed relationship between BMI and mortality in younger patients was hyperbolic, with increased death rates at the lowest and highest BMI rankings. On the contrary, the older patients showed an increased death rate at the lowest BMIs with only a slight elevation at the highest BMIs (>35 kg/m(2)). CONCLUSIONS: Our results suggest that BMI, a simple anthropometric measure of nutritional status, is an important predictor of mortality among young and old hospitalized patients. Even when controlling for clinical and functional variables, a low BMI remained a significant and independent predictor of shortened survival. Furthermore, the finding of the high BMI associated with minimum hazard in elderly subjects supports some past findings and opposes others and, if confirmed, has important implications for geriatric clinical guidelines.

Adult↗
PubMed2004

Mortality in childhood-onset epilepsy.

OBJECTIVES: To evaluate mortality in children with newly diagnosed epilepsy, to determine the risk of death, and to identify predictors of death from the point of diagnosis. DESIGN: Prospective community-based cohort of 613 children with newly diagnosed epilepsy. The outcome measure was death. Chi2 Tests were used for bivariate analyses and the Cox proportional hazards model for multivariable analyses. Standardized mortality ratios were used to quantify the excess mortality in the cohort relative to the population. RESULTS: Thirteen deaths occurred during 4733 person-years of follow-up, for a crude death rate of 2.7 per 1000 person-years (0.52 per 1000 person-years in those with nonsymptomatic epilepsy and 12.6 per 1000 person-years in those with symptomatic epilepsy). Ten deaths were associated with the underlying cause of the seizures, 2 were associated with the occurrence or probable occurrence of seizures, and 1 was unrelated to seizures or the underlying disorder. On multivariable analysis, symptomatic etiology (rate ratio, 10.2; 95% confidence interval [CI], 2.1-49.6) and epileptic encephalopathy (rate ratio, 13.3; 95% CI, 3.4-51.7) were independently associated with mortality. The overall standardized mortality ratio for the cohort was 7.54 (95% CI, 4.38-12.99). In children with symptomatic epilepsy, the standardized mortality ratio was 33.46 (95% CI, 18.53-60.43), and in those with nonsymptomatic epilepsy, it was 1.43 (95% CI, 0.36-5.73). CONCLUSIONS: Children with epilepsy have an increased risk of death. Most deaths occur in children with severe underlying conditions and are not directly related to the occurrence of seizures.

Adolescent↗
PubMed2006

Surgical repair of coarctation of the aorta: up to 40 years of follow-up.

OBJECTIVE: Coarctation of the aorta (CoA) was previously considered cured after surgical repair. Evidence for excess mortality and late morbidity has later accumulated, although studies with long-term follow-up remain sparse. The aim was to identify patients operated for CoA at Aarhus University Hospital, Denmark between 1965 and 1985 and to assess surgical and late mortality and cardiovascular morbidity in this cohort and possible predictors for an adverse outcome. METHODS: Two hundred and twenty nine patients were identified. Baseline characteristics and morbidity and mortality data were obtained from medical records, registries and databases and analysed by Kaplan-Meier graphs and multivariate Cox regression analyses. RESULTS: There were 14 (6%) surgical deaths. The survival in patients who were alive 30 days postoperatively was 95% 10 years after surgery, and 91%, 83% and 69% after 20, 30 and 40 years, respectively. The mortality rate ratio for all long-term survivors compared with an age- and sex-matched reference group was 4.3 (2.9-6.4). In those with no cardiovascular comorbidity at the time of repair, it was 3.4 (1.8-6.4). The causes of late deaths were cardiovascular in 63%. CoA repair in the early decade, age below 1 year at repair and high level of comorbidity were predictors for late mortality. Twenty five percent of current survivors were on antihypertensive medication and further cardiovascular morbidity had occurred in 46 (26%), including cardiovascular surgery and catheter interventions in 35 (19%). Freedom from death, reintervention and cardiovascular complications other than hypertension was 60% 30 years after surgery in the entire study population. CONCLUSIONS: Repaired CoA is associated with excess cardiovascular mortality and morbidity and often in need of reintervention. These patients, therefore, need careful follow-up.

Adolescent↗
PubMed2007

Higher mortality in areas of lower socioeconomic position measured by a single index of deprivation in Japan.

OBJECTIVES: To formulate an index representing area deprivation and elucidate the relation between the index and mortality in Japan. STUDY DESIGN: Ecological study for prefectures (N=47) and municipalities (N=3366) across Japan. METHODS: Based on socioeconomic indicators of seven domains of deprivation (i.e. unemployment, overcrowding, low social class and poverty, low education, no home ownership, low income and vulnerable group), an index was formulated using the z-scoring method. The relation between the index and mortality was examined by correlation analysis, hierarchical Poisson regression and comparison of standardized mortality ratio according to the index. RESULTS: The deprivation index ranged from -7.48 to 10.98 for prefectures and from -16.97 to 13.82 for municipalities. The index was significantly positively correlated with prefectural mortality, especially in the population aged under 74 years: r=0.65 for men and r=0.41 for women. At the municipal level, hierarchical Poisson regression showed a significant positive coefficient of the index to mortality for both men and women, and excess mortality in the most deprived fifth compared to the least deprived fifth was 26.4% in men and 11.8% in women. CONCLUSIONS: We formulated a deprivation index, which was substantially related to mortality at the prefectural and municipal levels. This study highlights the higher risk of dying among populations in socially disadvantaged areas and encourages the use of indices representing area socioeconomic conditions for further studies of area effects on health.

Adult↗
PubMed2003

The impact of gender on the treatment and outcomes of patients with early reinfarction after fibrinolysis: insights from ASSENT-2.

AIMS: To assess gender differences in patients with early reinfarction after fibrinolysis for acute myocardial infarction (AMI) and the impact of these differences on treatment and outcomes. METHODS AND RESULTS: We studied 3.7% of men (n=481) and 4.8% of women (n=189) with early reinfarction after fibrinolysis for AMI in the ASSENT-2 trial of 16,949 patients. Women with reinfarction were older and more often had hypertension, diabetes, and major bleeding prior to reinfarction. Despite adjustment for these differences, women with reinfarction were less likely to receive repeat fibrinolytic therapy (OR: 0.55; 95% CI: 0.37-0.84). Aggressive treatment by either repeat fibrinolysis or urgent revascularization was associated with reduced 1-year mortality irrespective of gender. Death within 24 h of reinfarction was more frequent in women and accounted for a greater proportion of their 1-year mortality (56.0 vs 34.8%; p=0.02). The excess mortality in women at 1 year (27.3 vs 19.9%; p=0.045) was eliminated after adjustment for gender differences in baseline risk profile. CONCLUSION: Women with early reinfarction following fibrinolysis for AMI had more frequent early death and were managed less aggressively. These findings suggest the need for increased awareness and timely intervention in these patients.

Aged↗
PubMed2004

Fibre-supplemented tube feeding in the hospitalised elderly.

OBJECTIVES: To evaluate the effect of fibre supplementation in enteral feeding on bowel function in hospitalised geriatric patients, and to assess its metabolic and nutritional efficiency. DESIGN: Prospective randomised controlled trial with stratification for diabetes. SETTING: Department of Geriatrics at the University of Antwerp. SUBJECTS: During 30 months (January 2000-June 2002) every hospitalised patient requiring tube feeding was assessed for eligibility (n = 183). Finally 172 patients (19% diabetics) were randomised. METHODS: An enteral nutritional regimen consisting of 30 kcal/kg in 2000 ml with a calorie/nitrogen ratio of 156 with or without fibre was instituted. At weekly intervals, stool output was qualitatively evaluated by recording frequency, volume (small <1/2 cup, large >1/2 cup) and consistency (solid-formed, soft-pasty or liquid-watery). Nutritional and metabolic effects were evaluated through laboratory analysis. RESULTS: Overall mortality was 24% with a trend for excess mortality in diabetic patients (33.3% versus 21.6% in non-diabetics; P = 0.176). There was no difference in duration of feeding between the fibre group (27.5 days; 95% CI = 19.1-35.9) and the no fibre group (27.9 days; 95% CI = 20.2-35.5). In the fibre-supplemented group, stool frequency was lower (4.1 per week; 95% CI = 3.7-4.6) than in controls (6.3 per week; 95% CI = 5.6-6.9). Qualitatively, stool consistency was higher (P < 0.001) but no difference in volume was noted. There were no differences in final laboratory parameters between groups. CONCLUSIONS: Fibre supplementation improved bowel function with reduced stool frequency and more solid stool consistency. It did not affect the nutritional efficiency of enteral feeding in hospitalised geriatric patients. Diabetes may be a risk factor for mortality in malnourished patients requiring tube feeding.

Aged↗
PubMed2004

Childhood cognitive ability and deaths up until middle age: a post-war birth cohort study.

BACKGROUND: Childhood IQ has been related to mortality in later life in four studies. Cognitive ability may be a mediator between early disadvantage and mortality, a marker of the efficiency of information processing in the central nervous system, or predict entry to safe adult environments or healthy behaviours. We examined mortality in relation to cognitive ability at age 8 years in a birth cohort and investigated these possible reasons. METHODS: Cox's proportional hazards models were used to investigate the effect of early cognitive ability on all-cause mortality in 2057 women and 2192 men born in England, Scotland, and Wales in March 1946 and followed until age 54 years. We tested whether the relationship was accounted for by childhood socioeconomic conditions or serious illness, education, adult socioeconomic conditions, or smoking. RESULTS: Cognitive ability was related to mortality in men but not women. The excess mortality rate in men was concentrated in the bottom quarter of the cognitive score (hazard ratio [HR] for bottom versus top quarter 1.8, 95% CI: 1.0, 3.0) and there was no gradient across the range of ability. Adjustment for childhood socioeconomic conditions and serious illness had a small effect on the HR for deaths between 9 and 54 years while adjustment for education or early adult socioeconomic conditions halved the HR for deaths from age 26 years. Smoking was not a mediator of the effect of early ability on adult mortality. CONCLUSIONS: Greater cumulative exposure to poor lifetime socioeconomic conditions is the most likely explanation for the observed relationship between low cognitive ability in childhood and mortality. This relationship may therefore be elucidated further by studying the causes of lifelong socioeconomic inequalities in health.

Adult↗
PubMed1994

Clinical manifestations of blunt cardiac injury: a challenge to the critical care practitioner.

Life-threatening cardiac emergencies following blunt chest trauma demand accurate assessments and rapid interventions to prevent unnecessary complications and death. Critical care practitioners must recognize the subtle clues that indicate cardiac trauma and the decompensation that occurs if the injuries are not recognized early. Blunt cardiac trauma can manifest as myocardial concussion with an associated low mortality or as cardiac rupture with an excessive mortality. Traditional diagnostic laboratory studies such as cardiac enzymes have proven ineffective in the trauma patient population. Therefore, the role of the critical care practitioner is centered on assessing patients for the clinical manifestations of decreased myocardial performance, particularly those patients with limited cardiac reserve.

Contusions↗