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PubMed2004

Mortality and predictors of mortality in a cohort of Brazilian type 2 diabetic patients.

OBJECTIVE: To investigate mortality rates and predictors of mortality in Brazilian type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A prospective follow-up study was carried out with 471 type 2 diabetic outpatients. Primary end points were all-cause, diabetes-related, and cardiovascular deaths. Excess mortality in this cohort was evaluated by calculating standardized mortality ratios (SMRs) in relation to those of the Rio de Janeiro population. Predictors of mortality were assessed by Kaplan-Meier survival curves and by uni- and multivariate Cox survival analyses. RESULTS: During a median follow-up of 57 months (range 2-84 months), 121 (25.7%) patients died, 91 (75.2%) from diabetes-related causes and 44 (36.4%) from cardiovascular diseases. After adjusting for age and sex, the all-cause SMR was 3.36 (95% confidence interval [CI] 2.81-4.02) and the cardiovascular SMR was 3.28 (CI 2.44-4.41). In the Cox multivariate analysis, the predictors of mortality were older age, increased 24-h proteinuria, preexisting vascular disease, presence of frequent ventricular premature contractions and prolonged maximum heart rate-corrected QT interval on baseline electrocardiogram, and decreased serum HDL cholesterol. The use of beta-blockers was a protective factor. In Kaplan-Meier curves, these variables were capable of distinguishing subgroups of patients with significantly different prognoses. CONCLUSIONS: Brazilian type 2 diabetic patients had a more than threefold excess mortality than the general population, largely because of increased cardiovascular mortality risk. Several clinical, laboratory, and electrocardiographic predictors of mortality were identified that could possibly be modified to decrease the mortality burden of type 2 diabetes in Brazil.

Adolescent↗
PubMed2003

Regional variations in mortality rates of pancreatic cancer in China: results from 1990-1992 national mortality survey.

AIM: To examine the regional variations in mortality rates of pancreatic cancer in China. METHODS: Aggregated mortality data of pancreatic cancer were extracted from the 1990-1992 national death of all causes and its mortality survey in China. Age specific and standardized mortality rates were calculated at both national and provincial levels with selected characteristics including sex and residence status. RESULTS: Mortality of pancreatic cancer ranked the ninth and accounted for 1.38 percent of the total malignancy deaths. The crude and age standardized mortality rates of pancreatic cancer in China in the period of 1990-1992 were 1.48/100,000 and 1.30/100,000, respectively. Substantial regional variations in mortality rates across China were observed with adjusted mortality rates ranging from 0.43/100,000 to 3.70/100,000 with an extremal value of 8.7. Urban residents had significant higher pancreatic mortality than rural residents. CONCLUSION: The findings of this study show different mortality rates of this disease and highlight the importance of further investigation on factors, which might contribute to the observed epidemiological patterns.

Adolescent↗
PubMed2003

Trends in prostate cancer incidence and mortality: an analysis of mortality change by screening intensity.

BACKGROUND: The rate of death from prostate cancer has recently declined in many areas of the world. Over the past 15 years prostate-specific antigen (PSA) screening has increased in popularity, which has resulted in increases in the incidence of prostate cancer. Over the same period there have been changes in the management of the disease and, in particular, the use of androgen ablation. We set out to examine the relation between changes in prostate cancer incidence (a surrogate for PSA screening) and subsequent changes in mortality in regions using common treatment recommendations. METHODS: We used data from prostate cancer cases and deaths reported to the British Columbia Cancer Registry during 1985-1999 to examine trends in incidence and mortality in 88 small health areas (SHAs) among men aged 50-74 years. We conducted 2 analyses. In the first we classified the SHAs by intensity of PSA screening (low, medium or high) according to their ranked age-standardized incidence rate of prostate cancer in 1990-1994 and examined subsequent trends in prostate cancer mortality. In the second analysis we examined the SHA-specific relative change in prostate cancer incidence between 1985-1989 and 1990-1994 and correlated it with the relative change in mortality for cases diagnosed after 1990. RESULTS: Between 1985-1989 and 1990-1994 the incidence of prostate cancer increased by 53.2% and 14.6% among men aged 50-74 and those 75 and over respectively. Between 1985-1989 and 1995-1999 prostate cancer mortality declined by 17.6% and 7.9% in the 2 age groups respectively. Among men aged 50-74 years SHAs with low, middle and high levels of screening had respective increases in prostate cancer incidence of 5.4%, 53.6% and 70.5% between 1985-1989 and 1990-1994. Corresponding decreases in mortality between 1985-1989 and 1995-1999 were 28.9%, 18.0% and 13.5%. Mortality declines were greatest in SHAs with low screening levels (p = 0.032). Before 1990 prostate cancer mortality was similar in the 3 screening groups (p = 0.72). Regions with the smallest increases in incidence had the largest declines in mortality. INTERPRETATION: We found no association between the intensity of PSA screening and subsequent decreases in prostate cancer mortality.

Age Distribution↗
PubMed1994

[Dynamics of asthma mortality in France: seasonal fluctuations and peak mortality in 1985-87].

In the face of an observed increase in asthma mortality since the end of the 70's an analysis of the time series of the deaths for the period 1979-89 was conducted; which shows a peaking of mortality between 1985 and 1987. A different seasonal component of asthma mortality has been identified for the age group 5-34 and over 34 group. For the later, mortality was found to peak during winter and dropping to the lowest point in summer, well synchronised with the mortality due to respiratory infection. For the former, mortality usually peaks during summer and troughs during the winter, independently of the mortality due to respiratory infection. A bimodal repartition of deaths was observed in the age group 5-34 with a main peak in summer (July) and a secondary peak in autumn (October). Modeling of the deaths series by season shows a dramatic rise in mortality during the years 1985, 1986 and 1987 affecting both age groups. During these 3 years, the global over-mortality is 21%. The increase has affected all the seasons allowing for seasonal variations of each age group. Factors responsible for the death seasonality in each age group are discussed. The temporary action of a non-specific factor was proposed to explain the cross-sectional character of the mortality crisis in the population; namely the influenza epidemics during the 1985 and 1986 winters.

Adolescent↗
PubMed1996

Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?

Much remains to be understood about how low socioeconomic status (SES) increases cardiovascular disease and mortality risk. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (1984-1993) were used to estimate the associations between acute myocardial infarction and income, all-cause mortality, and cardiovascular mortality in a population-based sample of 2,272 Finnish men, with adjustment for 23 biologic, behavioral, psychologic, and social risk factors. Compared with the highest income quintile, those in the bottom quintile had age-adjusted relative hazards of 3.14 (95% confidence interval (CI) 1.77-5.56), 2.66 (95% CI 1.25-5.66), and 4.34 (95% CI 1.95-9.66) for all-cause mortality, cardiovascular mortality, and AMI, respectively. After adjustment for risk factors, the relative hazards for the same comparisons were 1.32 (95% CI 0.70-2.49), 0.70 (95% CI 0.29-1.69), and 2.83 (95% CI 1.14-7.00). In the lowest income quintile, adjustment for risk factors reduced the excess relative risk of all-cause mortality by 85%, that of cardiovascular mortality by 118%, and that of acute myocardial infarction by 45%. These data show how the association between SES and cardiovascular mortality and all-cause mortality is mediated by known risk factor pathways, but full "explanations" for these associations will need to encompass why these biologic, behavioral, psychologic, and social risk factors are differentially distributed by SES.

Adult↗
PubMed1975

Perinatal mortality and maternal mortality at the Provincial Hospital, Quang Ngai, South Vietnam, 1967-1970.

The perinatal mortality, maternal mortality, infant mortality rates, and the complications of delivery at the Provincial Hospital of Quang Ngai, South Vietnam are described. The perinatal mortality is the only valid statistic available as the infant usually leaves the hospital within three days of delivery. Knowledge pertaining to the 4th to 28th day after birth is scanty and there is insufficient knowledge about the first year of life. Infant mortality is estimated at 277 per 1,000 live births. The perinatal mortality 64.6 per 1,000 live births, and maternal mortality, 106 per 10,000 live births are extremely high in contrast to Western countries. The high perinatal mortality is attributable to deaths during birth, the neonatal and immediate postnatal period. The high maternal mortality is primarily due to caesarean section, anemia, uterine rupture, toxemia, post-partum hemorrhage and puerperal infection.

Anemia↗
PubMed1990

[A single year birth cohort analysis of mortality in Japan, 1950 to 1984, statistical method and all cause mortality].

Mortality of single birth year cohort were calculated using the data tape of Information Service on World Health Statistics, WHO, 1950-1984. The data tape gave population and number of deaths for each year of age under 5 years of age and by 5 years of age for ages from 5 to 84 years. Population and number of deaths by age for each year of age in each calendar year were estimated by interpolation. Populations for each year of age were interpolated by B-spline interpolation. Number of deaths for each year of age were calculated by application of "two dimensional semi-Hermite method" after estimation of number of deaths for age 80, 81,......84, using Sprague interpolation factors. Age-specific cohort mortality curves were lower for each successive cohort, demonstrating the so-called "cohort phenomenon", clearly. Ratios of mortalities at the same age, for each successive 5 year interval cohort, which indicate cohort-by-cohort changes of mortalities, were thus less than 1.0 in almost all age groups. In recent years the ratios have gradually been leveling off at 0.8-0.9. Cohorts born in the early Showa Era (around 1930) showed higher ratios than all other cohorts, indicating relatively poor improvement in mortalities compared to the other cohorts. Ratios of cohort mortalities for successive ages within the same cohort, which indicates mortalities increase with advance of age, were greater than 1.0 after adulthood. These particular results showed that the increase in mortality with age accelerated after 30 years of age and that a difference in trend was observed between male and female after age 50. This new method of cohort analysis, single birth year cohort, gives clearer results than those obtained by methods heretofore utilized in cohort studies and is useful for more detailed analysis of cohort mortality.

Adolescent↗
PubMedDate not supplied

Estimation of perinatal mortalities in the world's countries from maternal mortalities.

Perinatal mortality was estimated by the regression equation log10 Y = 0.7826log10X + 0.08, obtained by perinatal mortality (Y) and maternal mortality (X) in Japan in 1960-1990. The error rate was approximately 9% in the estimation. Unpublished Japanese perinatal mortality in 1899-1947 was estimated from maternal mortality by using the equation, and appropriate results were obtained. Perinatal mortalities of the world's countries were estimated from their maternal mortalities listed in UNICEF reports with use of the above equation. Two peaks were noted in the country number distribution at 0-19 and 120-140 of estimated perinatal mortality. The mortality was 20-99 in 43% of 111 countries analyzed and 100 or more in 25%. The results suggest that further efforts should be made for the improvement of worldwide maternal and child health.

Australia↗
PubMed2005

Effect of healthcare on mortality: trends in avoidable mortality in Australia and comparisons with Western Europe.

OBJECTIVES: Using the concept of avoidable mortality, international studies suggest that healthcare has been effective in reducing mortality. This paper provides an analysis of avoidable mortality in Australia and compares trends with those of Western Europe. METHODS: Using unit-record mortality data, we calculated avoidable mortality rates in Australia for 1968-2001. We partitioned avoidable causes into three categories: those amenable to medical care; those mainly responsive to health policy; and ischaemic heart disease. We used Poisson regression to model the trends. We compared trends with those of nine European countries using published data. RESULTS: Total avoidable death rates fell by 68% in females and 72% in males. The corresponding non-avoidable death rates fell by 35 and 33%. The annual declines in avoidable mortality rates were: 3.47% [95% confidence intervals (CI) 3.44-3.50%] in males and 3.89% (95% CI 3.86-3.91%) in females. For non-avoidable mortality rates, the annual declines were 1.09% (95% CI 1.05-1.13%) and 0.95% (95% CI 0.92-0.98%), respectively. In females, declines in death rates from causes amenable to medical care contributed 54% to the decline in avoidable mortality rates, ischaemic heart disease contributed 45%, and causes responsive to health policy intervention contributed 1%. In males, the corresponding contributions were 32, 57 and 11%. These rates, and the declines between 1980 and 1998, were comparable with selected European countries, with Australia's ranking improving over the period. CONCLUSION: Trends in avoidable mortality in Australia suggest that the Australian healthcare system has been effective in improving population health. Australia's experience compares favourably with that of Europe.

Adolescent↗
PubMed2003

Examining geographic patterns of mortality: the atlas of mortality in small areas in Spain (1987-1995).

BACKGROUND: Small-area mortality atlases have been demonstrated to be a useful tool for both showing general geographical patterns in mortality data and identifying specific high-risk locations. In Spain no study has so far systematically examined geographic patterns of small-area mortality for the main causes of death. This paper presents the main features, contents and potential uses of the Spanish Atlas of Mortality in small areas (1987-1995). METHODS: Population data for 2,218 small areas were drawn from the 1991 Census. Aggregated mortality data for 14 specific causes of death for the period 1987-1995 were obtained for each small area. Empirical Bayes-model-based estimates of age-adjusted relative risk were displayed in small-area maps for each cause/gender/age group (0-64 or 65 and over) combination using the same range of values (i.e. septiles) and colour schemes. RESULTS: The 'Spanish Atlas of Mortality' includes multiple choropleth (area-shaded) small-area maps and graphs to answer different questions about the data. The atlas is divided into three main sections. Section 1 includes the methods and comments on the main maps. Section 2 presents a two-page layout for each leading cause of death by gender including 1) a large map with relative risk estimates, 2) a map that indicates high- and low-risk small areas, 3) a graph with median and interquartile range of relative risk estimates for 17 large regions of Spain, and 4) relative-risk maps for two age groups. Section 3 provides specific information on the geographical units of analysis, statistical methods and other supplemental maps. CONCLUSION: The 'Spanish Atlas of Mortality' is a useful tool for examining geographical patterns of mortality risk and identifying specific high-risk areas. Mortality patterns displayed in the atlas may have important implications for research and social/health policy planning purposes.

Adolescent↗
PubMed2005

Drug-related mortality and its impact on adult mortality in eight European countries.

OBJECTIVE: To estimate the mortality rates from drug-related deaths and other causes among problem drug users and population attributable risk of death due to opiate use in eight study sites in Europe. METHODS: Opiate users were recruited from drug treatment centres during the period 1990-1998 and deaths followed up through national or local mortality registries. Gender-specific overall mortality rate, proportion of deaths by cause (drug-related, HIV, other), standardized mortality ratios (SMRs), and the attributable risk fraction (ARF) were estimated. RESULTS: Crude mortality rates varied from 1 per 100 person-years in the Dublin and London cohorts to 3.8 per 100 person-years in Barcelona. The highest drug-related mortality rate was 10 per 1,000 person-years in Barcelona; the rates were approximately 7 per 1,000 person-years in Denmark, London, Rome, and Vienna, and <3.5 per 1,000 person-years for the others cohorts. The mortality rate for AIDS was <2 per 1,000 person-years in all the cohorts except Lisbon, Rome, and Barcelona, for which it was approximately 6 per 1,000 person-years. The highest SMR among males was 21.1 in Barcelona, and among females the highest SMRs were 53.7 and 37.7 in Barcelona and Rome, respectively. In Denmark the ARF was 5%, whereas it was >10% in all other study sites and 24% in Barcelona. CONCLUSION: Cohort mortality studies, especially in combination with estimates of prevalence, provide useful insights into the impact of opiate use on mortality across European countries and emphasize how preventing overall and drug-related deaths among opiate users can significantly improve the health of the population.

Adolescent↗
PubMed1998

All-cause mortality and cardiovascular disease mortality in three American Indian populations, aged 45-74 years, 1984-1988. The Strong Heart Study.

Community mortality surveillance for 1984-1988 was conducted by researchers of the Strong Heart Study, which examined the incidence, prevalence, and risk factors of cardiovascular disease in three American Indian populations, aged 45-74 years, in Arizona, Oklahoma, and South/North Dakota. All-cause and cardiovascular disease mortality rates were determined through the use of death certificate data. Cardiovascular disease deaths were confirmed by independent systematic review of medical records. In all three populations, men had higher all-cause and cardiovascular disease mortality rates than did women. Oklahoma exhibited slightly lower 5-year, age-adjusted, all-cause mortality (96/1,000) than did Arizona (107/1,000) and South/North Dakota (114/1,000). The leading cause of death among both sexes in Oklahoma and in South/North Dakota was cardiovascular disease. Diabetes mellitus led among Arizona women. The other major causes of death were cancer, liver disease including cirrhosis, and injury. When compared with the rates in each state, average annual all-cause mortality rates were higher for the American Indian populations in almost every age group. The all-cause annual mortality rates in the three Indian populations were close to rates in the US black population and higher than the rates of the entire US population and of US whites. This trend was amplified in the 45- to 64-year age group. Only in the 65- to 74-year age group did mortality rates in the Indian population approach those of the US population. Cardiovascular disease mortality rates were close to the US averages in Arizona and Oklahoma, but they were more than two times higher in South/North Dakota among those between 45 and 64 years of age. Thus, American Indians in Arizona, Oklahoma, and South/North Dakota exhibit high all-cause mortality rates. In particular, the South/North Dakota population cardiovascular disease death rate appears to present a potential target for community-based programs to intervene on known risk factors to promote healthy lifestyles.

Aged↗
PubMed1998

Age-standardised mortality and proportional mortality analyses of aboriginal and non-aboriginal deaths in metropolitan, rural and remote areas.

The study's aim was to assess how much of the variation in disease-specific mortality between metropolitan, rural and remote areas is specific to those diseases or reflects the all-cause mortality pattern. The ranges and variances of disease-specific standardised proportional mortality ratios between geographical areas were compared to those of the corresponding standardised mortality ratios. For most chapters in the International Classification of Diseases, the ranges and variances of the standardised proportional mortality ratios were less than 40% of those of the corresponding standardised mortality ratios. Only a small proportion of the variation in mortality can therefore be attributed to a specific disease component; the remainder must be attributed to an underlying 'force of mortality'. Research, programs and policies addressing the socio-economic disadvantages of living in remote areas may lead to a greater improvement in mortality than those targeting specific diseases.

Australia↗
PubMed2003

Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data.

OBJECTIVE: To design and validate a statistical method for evaluating the performance of surgical units that adjusts for case volume and case mix. DESIGN: Validation study using routinely collected data on in-hospital mortality. DATA SOURCES: Two UK databases, the ASCOT prospective database and the risk scoring collaborative (RISC) database, covering 1042 patients undergoing surgery in 29 hospitals for gastro-oesophageal cancer between 1995 and 2000. STATISTICAL ANALYSIS: A two level hierarchical logistic regression model was used to adjust each unit's operative mortality for case mix. Crude or adjusted operative mortality was plotted on mortality control charts (a graphical representation of surgical performance) as a function of number of operations. Control limits defined as 90%, 95%, and 99% confidence intervals identified units whose performance diverged significantly from the mean. RESULTS: The mean in-hospital mortality was 12% (range 0% to 50%). The case volume of the units ranged from one to 55 cases a year. When crude figures were plotted on the mortality control chart, four units lay outside the 90% control limit, including two outside the 95% limit. When operative mortality was adjusted for risk, three units lay outside the 90% limit and one outside the 95% limit. The model fitted the data well and had adequate discrimination (area under the receiver operating characteristics curve 0.78). CONCLUSIONS: The mortality control chart is an accurate, risk adjusted means of identifying units whose surgical performance, in terms of operative mortality, diverges significantly from the population mean. It gives an early warning of divergent performance. It could be adapted to monitor performance across various specialties.

Hospital Mortality↗
PubMed2006

Applying a moving total mortality count to the cities in the NMMAPS database to estimate the mortality effects of particulate matter air pollution.

OBJECTIVES: To apply a new method for estimating the association between daily ambient particulate matter air pollution (PM) and daily mortality to data from over 100 United States cities contained in the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) database and to see whether the results from the 90 cities NMMAPS analysis are robust to this different modelling approach. This new method has recently been shown to provide improved estimates for the association between PM and daily mortality when every-day PM data are unavailable. It avoids the need for selecting a lag of PM at which the mortality effects of PM are to be investigated. METHODS: With the aid of analytical methods and databases developed for NMMAPS, Poisson log linear models controlling for long term trends and weather effects were used to estimate the association between PM and mortality for cities in the NMMAPS database using the new method. A two stage Bayesian hierarchical model was then used to combine city specific estimates to form a national average PM mortality effect estimate. RESULTS: A 10 microg/m3 increase in PM was associated with a 0.12% increment in total mortality and a 0.17% increment in cardiovascular and respiratory mortality. These results are consistent with those found in the NMMAPS analysis. CONCLUSIONS: There is a statistically significant association between short term changes in PM and mortality on average for the cities contained in the NMMAPS database. These findings are further evidence that this widespread pollutant adversely affects public health.

Adult↗
PubMed2003

Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD.

BACKGROUND: Acute exacerbations form a major component of the socioeconomic burden of COPD. As yet, little information is available about the long-term outcome of patients who have been hospitalized with acute exacerbations, although high mortality rates have been reported. STUDY OBJECTIVE: The aim of this study was to investigate prospectively the outcome for all patients admitted to the hospital with acute exacerbations of COPD during hospital admission and after 1-year of follow-up. Furthermore, patient characteristics related to increased mortality rate were analyzed. DESIGN: We investigated prospectively the 1-year mortality rate and potential determinants of mortality for all patients admitted to the hospital with an acute exacerbation between January 1 and December 31, 1999. RESULTS: A total of 171 patients were included in the study. The mortality rate during hospital stay was 8%, increasing to 23% after 1 year of follow-up. Despite a comparable in-hospital mortality rate (6%), the 1-year mortality rate was significantly higher for patients admitted to the ICU for respiratory failure (35%). The multivariate Cox proportional hazards model was used to determine independent predictors of survival. Variables included in the regression model were age, sex, FEV(1), PaO(2), PaCO(2), body mass index, long-term use of oral corticosteroids, comorbidity index, and hospital readmissions. The maintenance use of oral glucocorticosteroids (relative risk [RR], 5.07; 95% confidence interval [CI], 2.03 to 12.64), PaCO(2) (RR, 1.17; 95% CI, 1.01 to 1.38), and age (RR, 1.07; 95% CI, 1.01 to 1.12) were independently related to mortality. CONCLUSION: We conclude that the prognosis for patients who have been admitted to the hospital for acute exacerbation of COPD is poor. Long-term use of oral corticosteroids, higher PaCO(2), and older age could be identified as risk factors associated with higher mortality.

Adrenal Cortex Hormones↗
PubMed1994

Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women?

OBJECTIVE: To determine whether asymptomatic bacteriuria in elderly ambulatory women is a marker of increased mortality and, if so, whether it is because of an association with other determinants of mortality or because asymptomatic bacteriuria is itself an independent cause, the removal of which might improve longevity. DESIGN: A cohort study and a controlled clinical trial of the effect of antimicrobial treatment. SETTING: A geriatric center and 21 continuing care retirement communities. PARTICIPANTS: Women without urinary tract catheters. MEASUREMENTS: Urine cultures every 6 months (the same organism at 10(5) colony-forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria), comorbidity, and mortality. RESULTS: In the observational study, infected residents (n = 318) were older, and sicker, and had higher mortality (18.7 per 100,000 resident-days) than uninfected residents (n = 1173; 10.1 per 100,000 resident-days). However, in a multivariate Cox analysis, infection was not related to mortality (relative risk, 1.1; P > 0.2), whereas age at entry and self-rated health (score 1 [excellent] to 4 [bad or poor]) were strong predictors. In the clinical trial, mortality in 166 treated residents (13.8 per 100,000 resident-days) was comparable to that of 192 untreated residents (15.1 per 100,000 resident-days); the relative rate was 0.92 (95% CI, 0.57 to 1.47). The cure rates among treated and untreated residents were 82.9% and 15.6%, respectively. CONCLUSION: Urinary tract infection was not an independent risk factor for mortality, and its treatment did not lower the mortality rate. Screening and treatment of asymptomatic bacteriuria in ambulatory elderly women to decrease mortality do not appear warranted.

Aged↗
PubMed2000

[Variations on in-hospital mortality rates based on an administrative database aortocoronary bypass mortality rate].

BACKGROUND: The aim of this work is to assess outcomes of coronary artery bypass graft in Spain, studying in-hospital mortality rates, comparing results across hospitals where this procedure is performed, investigating the variables associated with mortality, and trying to determine whether the differences in each hospital could be explained by differences in quality or by differences in the selection of patients. PATIENTS AND METHODS: Observational study. Patients were registered in the UHDMDS from year 1994 with the codes of ICD 9 CM: 36.10 a 36.19. Crude mortality rates by hospital will be obtained, as well as mortality odds ratios for different variables, and standardized mortality ratio, obtaining the expected mortality for each hospital based on the age, sex, Charlson comorbidity index, and priority of the admission of the patients. RESULTS: The overall mortality rate was 4.8%. Mortality was higher in some age groups (65-69, 70-74 and > 79 years), when Charlson comorbidity index was equal or higher than 2, and in cases of urgent admission. Differences between observed and standardized mortality rate in the five hospitals with more than 150 interventions were not statistically significant.

Adult↗