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PubMed1993

Recent trends in sex mortality ratios for adults in developed countries.

This paper analyzes changes in sex mortality ratios between 1979 and 1987 for adults in 23 developed countries. (A sex mortality ratio is the ratio of male to female death rates.) Previous analyses have shown that during the mid-twentieth century sex mortality ratios increased for all adult age groups. During the 1980s sex mortality ratios continued to increase for 25-34 year olds, but showed mixed trends for other adult age groups. For example, for older adults aged 55-64, sex mortality ratios increased in Southern and Eastern European countries and Japan, but sex mortality ratios decreased in Northern European and Anglophone countries. Trends in several causes of death contributed to these trends in sex mortality ratios. For example, for 25-34 year olds, increases in men's suicide rates and HIV or AIDS mortality contributed to the increases in sex mortality ratios. For older adults, it was hypothesized that decreasing sex differences in cigarette smoking in recent decades would result in decreasing sex differences in lung cancer and ischemic heart disease mortality during the 1980s. The predicted decrease in sex differences in lung cancer mortality was observed in many countries; women had more unfavorable lung cancer mortality trends than men in the Anglophone countries and Northern and Central Western European countries. In contrast, very little evidence was found for the predicted decrease in sex differences in ischemic heart disease. The paper presents additional data concerning the contributions of trends in specific causes of death to changes in sex mortality ratios and briefly reviews evidence concerning probable causes of the observed mortality trends. It appears that recent trends in sex mortality ratios have been influenced by changing sex differences in smoking and a variety of additional factors, such as the effects of improvements in health care interacting with inherent sex differences in vulnerability to ischemic heart disease.

Adult↗
PubMed1994

Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: an eleven-year statewide experience.

PURPOSE: The purposes of this study were (1) to determine the current population-based mortality rate for the surgical treatment of abdominal aortic aneurysms (AAA) in Michigan, (2) to document changes in mortality rates over 11 years, and (3) to identify risk factors for operative mortality. METHODS: A statewide database provided clinical information on all Michigan hospital admissions with a diagnosis of AAA from 1980 to 1990. The mortality rate analysis included all admissions with a primary diagnosis of AAA that underwent repair. Determination of diagnoses and comorbidities were based on International Classification of Diseases-ninth revision-Clinical Modification codes. RESULTS: Conventional surgical repairs were performed on 8185 intact and 1829 ruptured AAA. Hospital mortality rates accompanying operation for intact AAA decreased from 13.6% in 1980 to 5.6% in 1990 (p < 0.001). Mortality rates over the 11 years averaged 10.7% in women and 6.8% in men (p < 0.001). Mortality rates averaged 10.7% in 4170 admissions of patients 70 years old or older and 4.2% in 4015 admissions of patients 69 years old or younger. Preexistent kidney failure was associated with an average mortality rate of 41.2% compared with 6.2% without this comorbidity. Preexistent dysrhythmia increased mortality rates from 6.6% to 13.6%. Uncomplicated hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, diabetes, arterial occlusive disease, and ischemic heart disease in recent years were not associated with increased mortality rates. Hospitals with an annual volume of 21 or more intact AAA repairs had a surgical mortality rate of 6.2%, compared with 8.9% in hospitals with lower surgical volume (p < 0.001). Mortality rates for surgical repair of ruptured AAA averaged 49.8% and did not improve significantly over the 11 years studied. CONCLUSION: Despite a dramatic drop in surgical mortality rates, repair of intact AAA remains a formidable undertaking. This population-based series documents a substantially higher mortality rate than most selected series. The unchanged mortality rate for ruptured AAA suggests that development of better algorithms to identify those AAA most apt to rupture and earlier intervention in those instances is likely to improve patient survival rates.

Age Distribution↗
PubMedDate not supplied

Prognostic indices for intra-hospital mortality in Nigerian diabetic NIDDM patients. Role of gender and hypertension.

Hypertension and diabetes mellitus are independently associated with a high rate of target organ complications, which is particularly accentuated in the Negroid race. The aims of this study were to evaluate the mortality associated with diabetes mellitus and concurrent hypertension and diabetes mellitus in indigenous Africans, and to identify and assess the factors that are predictive of intra-hospital mortality in Non-Insulin Dependent Diabetes Mellitus (NIDDM) diabetic Nigerians. The subsequent impact of the modification of these risk factors was also evaluated. A prospective study of 51 hypertensive-diabetic (Non-Insulin Dependent Diabetics, NIDDM) Nigerians (32 males, 19 females) over a 15-month period, from 1996 to 1997 was undertaken. The mean admission blood pressures were 170/102+/-35/22 mm Hg, with a body mass index (BMI) of 25.4+/-10.2 kg/m(2). A total of 54 normotensive (BP<130/85 mm Hg)-NIDDM diabetic Nigerians (30 men, 24 women), who were concurrently admitted in the hospital, were compared to the hypertensive-NIDDM. The total mortality of all the NIDDM diabetics, as well as the mortality rates in normotensives and hypertensive-diabetics, were computed. The causes of death and associated complications were noted. Predictive indices of intrahospital mortality were statistically evaluated by comparison of proportions, chi(2) test, Fischer's exact test, logistic regression, and analysis of variance (ANOVA).Over-all mortality rate among all the diabetics (both normotensive and hypertensive) was 26.6% (28/105), which was significantly higher than the crude death rate on the Internal Medicine service of 17.8% (P=0.006) or the non-obstetric crude death rate in the hospital of 10.96% (P=0.001) Among the hypertensive-NIDDM patients (n=51) the mortality rate was 31.4% (16 deaths/51 patients). This was slightly higher than the value of 22.2% (12 deaths/54 patients) seen in normotensive -NIDDM patients. The mortality rate among the male diabetics (23/63 patients) 46.6% was significantly higher than female mortality rate of 11.6% (5/43). The 95% Confidence interval for the difference in mortality rates being 16.9% to 53.3% (P<0.0001, z=3.57). The impact of gender remained significant by the chi(2) test, chi(2)=7.17, P=0.007. 50% of the deaths in hypertensive-diabetics had associated stroke (8/16), while none of the 12 deaths among the normotensive-diabetics was stroke-related (P=0.008, Fisher's exact test). The case fatality rate for stroke in hypertensive-NIDDM men (7/7.9) was significantly greater than in hypertensive-NIDDM women (1.0/7) (P=0.04,by Fisher's exact test). Male gender, presence of Hyperosmolar Non-Ketotic Coma (HONK) (P<0. 05), associated stroke (P<0.01) and a Glasgow coma < or =10 (P<0.01) were found to be poor prognostic indices for mortality in hypertensive-NIDDM. Aggressive anti-platelet, (aspirin) anti-hypertensive, and strict glycemic control, instituted early and intensively, especially in male hypertensive-NIDDM Nigerians have resulted in reduction in the mortality rates from 26.6% in 1997 to 12.6% in 1999 [P=0.05, 95% CI -26.9% to -1.3%]. The prognosis in 1999 of hospitalized African diabetics is still dismal. Hypertensive-NIDDM represents a higher risk group for intra-hospital mortality in black Africans. Male patients appear to have significantly (P<0.001) enhanced risk, especially with thrombotic/stroke-related deaths (P<0.01). However, intervention measures can reduce the mortality rate considerably, even in developing countries. The mechanisms of the apparent male mortality excess require elucidation.

Adult↗
PubMed2005

Commentary: economic growth is the basis of mortality rate decline in the 20th century--experience of the United States 1901-2000.

BACKGROUND: The hypothesis that economic growth has been the principal source of mortality decline during the 20th century in the United States is investigated. This hypothesis is consistent with the large epidemiological literature showing socioeconomic status to be inversely related to health status and unemployment associated with elevated morbidity and mortality rates. Despite evidence over many years showing economic growth, over at least a decade, to be fundamental to mortality rate declines and unemployment rates showing lagged, cumulative effects on mortality rate increases, a recent paper argues that the impact of economic growth is to increase the mortality rate. METHODS: This study utilizes age-adjusted mortality rates over 1901-2000 in the United States as the outcome measure, while independent variables include real GDP per capita in purchasing power parity, the unemployment rate, and the employment to population ratio. A basic interaction model is constructed whereby (i) real GDP per capita, (ii) the unemployment rate, and (iii) the multiplicative interaction between real GDP per capita and the unemployment rate are analysed in relation to age-adjusted mortality rates. The Shiller procedure is used to estimate the distributed lag relations over at least a decade for variables (i), (ii), and (iii). The error correction method is used to examine these relations for both levels and annual changes in independent and dependent variables. RESULTS: While GDP per capita, over the medium- to long-term, is strongly inversely related to mortality rates during 1901-2000, in the very short term-i.e. within the first few months-rapid economic growth is occasionally associated with increased mortality rates estimated in annual changes. With respect to the unemployment rate, the first year (without lag) will frequently be associated with a decrease in mortality, but thereafter, and at least for the following decade, the effect is to increase the mortality rate. Thus, the net effect of increased unemployment is a substantial increase in mortality. This is also reflected in the entirely negative relation between the cumulative effects of the employment to population ratio and mortality rates over a decade. CONCLUSIONS: Economic growth, cumulatively over at least a decade, has been the central factor in mortality rate decline in the US over the 20th century. The volatility of rapid economic growth as it departs from its major trend, has a very short-term effect (within a year) to increase mortality-partly owing to adaptation to new technology and the adjustment of the formerly unemployed to new jobs, social status, and organizational structures.

Economics↗
PubMed1990

Competing causes of death. A review of recent trends in mortality in industrialized countries with special reference to cancer.

In most industralized countries, the last two decades or so have been characterized by a further significant reduction in mortality. Summary measures of mortality, such as the age-standardized death rate, have declined in parallel with reductions in CVD mortality. Yet, cancer mortality over all ages has risen in the majority of industralized countries. However, this rise in cancer mortality has been accompanied by a rise in the average age at death from the disease, suggesting further progress in deferring death. How much of the observed increase in cancer mortality for such sites as the brain, as well as for multiple myeloma, is real is difficult to determine. Certainly, for countries such as the United States, where mortality from ill-defined causes and ill-defined cancer sites has not fallen, it is quite probable that the increase in death rates largely reflects a real increase in cancer risk. There can be little doubt that the rise in lung cancer mortality is a real trend and this has repeatedly been shown to mirror, with an appropriate lag period, previous changes in cigarette consumption. On the other hand, for some countries, such as France, Japan, and Italy, there have been very substantial postwar declines in mortality rates from ill-defined causes, and hence any increase in mortality from diseases for which diagnostic precision is known to have improved must be viewed with some caution. The reductions in CVD mortality have also been accompanied by a rise in the average age at death and a decline in the proportion of all deaths attributable to CVD. There have thus been fewer CVD deaths and these deaths are increasingly postponed to higher ages. This is reflected by the widespread decline in summary indices of premature mortality, such as the age-standardized death rate at ages 35 to 74 years. On the other hand, cancer death rates at these ages have risen in several countries, suggesting that at least some of the "younger" persons "saved" from dying from CVD are now succumbing to cancer. The suggestion that previous cigarette smoking has "claimed" the majority of "saved" lives from CVD is supported by the evidence on mortality trends for major sites of cancer. (The principal site of the disease for which mortality in males at ages 35 to 74 years rose in most countries substantially is lung cancer, which accounts for the vast majority of the rise in overall cancer mortality where it has occurred.) These conclusions would be strengthened if one could demonstrate parallel trends based on incidence data.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Traffic↗
PubMed2004

Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures.

UNLABELLED: Our objectives were to better define the rates and determinants of in-hospital and 1-year mortality after hip fracture. We studied a population-based cohort of 3981 hip fracture patients. Using multivariable regression methods, we identified risk factors for mortality (older age, male sex, long-term care residence, 10 prefracture co-morbidities) and calculated a hip fracture-specific score that could accurately predict or risk-adjust in-hospital and 1-year mortality. Our methods, after further validation, may be useful for comparing outcomes across hospitals or regions. INTRODUCTION: Hip fractures in the elderly are common and associated with significant mortality and variations in outcome. The rates and determinants of mortality after hip fracture are not well defined. Our objectives were (1) to define the rate of in-hospital and 1-year mortality in hip fracture patients, (2) to describe co-morbidities at the time of fracture, and (3) to develop and validate a multivariable risk-adjustment model for mortality. MATERIALS AND METHODS: We studied a population-based cohort of 3981 hip fracture patients > or =60 years of age admitted to hospitals in a large Canadian health region from 1994 to 2000. We collected sociodemographic and prefracture co-morbidity data. Main outcomes were in-hospital and 1-year mortality. We used multivariable regression methods to first derive a risk-adjustment model for mortality in 2187 patients treated at one hospital and then validated it in 1794 patients treated at another hospital. These models were used to calculate a score that could predict or risk-adjust in-hospital and 1-year mortality after hip fracture. RESULTS AND CONCLUSIONS: The median age of the cohort was 82 years, 71% were female, and 26% had more than four prefracture co-morbidities. In-hospital mortality was 6.3%; 10.2% for men and 4.7% for women (adjusted odds ratio, 1.8; 95% CI, 1.3-2.4). Mortality at 1 year was 30.8%; 37.5% for men and 28.2% for women (adjusted p < 0.001). Older age, male sex, long-term care residence, and 10 different co-morbidities were independently associated with mortality. Risk-adjustment models based on these variables had excellent accuracy for predicting mortality in-hospital (c-statistic = 0.82) and at 1 year (c-statistic = 0.74). We conclude that 1 in 15 elderly patients with hip fracture will die during hospitalization, and almost one-third of those who survive to discharge will die within the year. The determinants of mortality were primarily older age, male sex, and prefracture co-morbidities. Our hip fracture-specific risk-adjustment tool is pragmatic and reliable, and after further validation, may be useful for comparing outcomes across different hospitals or regions.

Aged↗
PubMed2003

US birth weight/gestational age-specific neonatal mortality: 1995-1997 rates for whites, hispanics, and blacks.

OBJECTIVE: In recent years, gains in neonatal survival have been most evident among very low birth weight, preterm, and low birth weight (LBW) infants. Most of the improvement in neonatal survival since the early 1980s seems to be the consequence of decreasing birth weight-specific mortality rates, which occurred during a period of increasing preterm and LBW rates. Although the decline in neonatal mortality has been widely publicized in the United States, research suggests that clinicians may still underestimate the chances of survival of an infant who is born too early or too small and may overestimate the eventuality of serious disability. So that clinicians may have current and needed ethnic- and race-specific estimates of the "chances" of early survival for newborn infants, we examined birth weight/gestational age-specific neonatal mortality rates for the 3 largest ethnic/racial groups in the United States: non-Hispanic whites, Hispanics, and non-Hispanic blacks. Marked racial variation in birth weight and gestational age-specific mortality has long been recognized, and growing concerns have been raised about ongoing and increasing racial disparities in pregnancy outcomes. Our purpose for this investigation was to provide an up-to-date national reference for birth weight/gestational age-specific neonatal mortality rates for use by clinicians in care decision making and discussions with parents. METHODS: The National Center for Health Statistics linked live birth-infant death cohort files for 1995-1997 were used for this study. Singleton live births to US resident mothers with a reported maternal ethnicity/race of non-Hispanic white, non-Hispanic black, or Hispanic (n = 10 610 715) were selected for analysis. Birth weight/gestational age-specific neonatal mortality rates were calculated using 250 g/2-week intervals for each ethnic/racial group. RESULTS: The overall neonatal mortality rates for whites, Hispanics, and blacks were 3.24, 3.45, and 8.16 neonatal deaths per 1000 live births, and the proportion of births <28 weeks was 0.35%, 0.45%, and 1.39%, respectively. Newborns who weighed <1500 g comprised <2.5% of all births in each racial/ethnic group but accounted for >50% of neonatal deaths. For whites, Hispanics, and blacks, >50% of newborns 24 to 25 weeks of gestational age survived. For most combinations of birth weights <3500 g and gestational ages of <37 weeks, the neonatal mortality rate was lowest among blacks, compared with whites or Hispanics. At these same gestational age/birth weight combinations, Hispanics have slightly lower mortality rates than whites. For combinations of birth weights >3500 g and gestational ages of 37 to 41 weeks, Hispanics had the lowest neonatal mortality rate. In these birth weight/gestational age combinations, where approximately two thirds of births occur, blacks had the highest neonatal mortality rate. CONCLUSIONS: Compared with earlier reports, these data suggest that a substantial improvement in birth weight/gestational age-specific neonatal mortality has occurred in the United States. Regardless of ethnicity/race, the risk of a neonatal death does not exceed 50% (the suggested definition for the limit of viability), except for birth weights below 500 g and gestational ages <24 weeks. Notwithstanding, ethnic/racial variations in neonatal mortality rates continue to persist, both in overall rates and within birth weight/gestational age categories. Blacks continue to have higher proportions for preterm and LBW births, compared with either whites or Hispanics. At the same time, blacks experience lower risks of neonatal mortality for preterm and LBW infants, while having higher risks of mortality among term, postterm, normal birth weight, and macrosomic births.

Black or African American↗
PubMed1997

Pediatric mortality probability estimated from pre-ICU severity of illness.

OBJECTIVE: The Pediatric Risk of Mortality (PRISM) score is a measure of illness severity based on abnormalities observed in the bedside examination and laboratory assessment. PRISM scores obtained after pediatric intensive care unit (PICU) admission predict mortality probability, but no previous efforts to evaluate mortality risk before PICU admission have been reported. Our study was performed on patients admitted to PICUs at four pediatric tertiary care centers to derive a quantitative estimate of hospital mortality probability as a function of PRISM scores obtained at referring hospitals before PICU transfer. Performance of the model was tested by evaluating accuracy of mortality predictions obtained from pre-ICU PRISM scores in a separate validation set of patients. METHODS: Patients were randomized to the derivation or validation sets. Data were recorded prospectively from observations made at hospitals referring to the study PICUs. Patients included 780 infants and children with medical and surgical emergencies and trauma. Electively admitted patients were excluded from analysis. RESULTS: The relationship between mortality probability (P) and the pre-ICU PRISM score is expressed by the equation: P = er/(1 + er). In this equation, r is an empirical function of the pre-ICU PRISM score: r = .197 x PRISM - 4.705. The mortality probability rises from near 0 at low scores, approaching 1 (certainty) above a PRISM score of 40. Mortality probability exceeds 10% at a score of 13 and exceeds 50% at a score of 24. Performance of predictions in the validation set of patients was evaluated for five categories of mortality probability. The observed number of deaths corresponded to predicted mortality across the range of illness severity. When compared for each tertiary institution, observed mortality rates were similar to predictions for three of four institutions. For data obtained at institution D, the observed mortality of 17% significantly exceeded the 7% predicted rate. In infants younger than 1 year, as well as children 1 year and older, observed mortality rates were similar to predicted. CONCLUSIONS: The pre-ICU PRISM score as a measure of illness severity provides an estimate of hospital mortality probability. Further investigation is required to determine the use of pre-ICU mortality estimates in making clinical decisions.

Humans↗
PubMed2003

Pregnancy-related mortality surveillance--United States, 1991--1999.

PROBLEM/CONDITION: The risk of death from complications of pregnancy has decreased approximately 99% during the twentieth century, from approximately 850 maternal deaths per 100,000 live births in 1900 to 7.5 in 1982. However, since 1982, no further decrease has occurred in maternal mortality in the United States. In addition, racial disparity in pregnancy-related mortality ratios persists; since 1940, mortality ratios among blacks have been at least three to four times higher than those for whites. The Healthy People 2000 objective for maternal mortality of no more than 3.3 maternal deaths per 100,000 live births was not achieved during the twentieth century; substantial improvements are needed to meet the same objective for Healthy People 2010. REPORTING PERIOD COVERED: This report summarizes surveillance data for pregnancy-related deaths in the United States for 1991-1999. DESCRIPTION OF SYSTEM: The Pregnancy Mortality Surveillance System was initiated in 1987 by CDC in collaboration with state health departments and the American College of Obstetricians and Gynecologists Maternal Mortality Study Group. Health departments in the 50 states, the District of Columbia, and New York City provide CDC with copies of death certificates and available linked outcome records (i.e., birth certificates or fetal death certificates) of all deaths occurring during or within 1 year of pregnancy. State maternal mortality review committees, the media, and individual providers report a limited number of deaths not otherwise identified. Death certificates and relevant birth or fetal death certificates are reviewed by clinically experienced epidemiologists at CDC to determine whether they are pregnancy-related. RESULTS: During 1991-1999, a total of 4,200 deaths were determined to be pregnancy-related. The overall pregnancy-related mortality ratio was 11.8 deaths per 100,000 live births and ranged from 10.3 in 1991 to 13.2 in 1999. The pregnancy-related mortality ratio for black women was consistently higher than that for white women for every characteristic examined. Older women, particularly women aged >/= 35 years and women who received no prenatal care, were at increased risk for pregnancy-related death. The distribution of the causes of death differed by pregnancy outcome. Among women who died after a live birth (i.e., 60% of the deaths), the leading causes of death were embolism and pregnancy-induced hypertension. INTERPRETATION: The reported pregnancy-related mortality ratio has substantially increased during 1991-1999, probably because of improved ascertainment of pregnancy-related deaths. Black women continued to have a 3-4 times higher pregnancy-related mortality ratio than white women. In addition, pregnancy-related mortality has the largest racial disparity among the maternal and child health indicators. Reasons for this difference could not be determined from the available data. PUBLIC HEALTH ACTIONS: Continued surveillance and additional studies should be conducted to monitor the magnitude of pregnancy-related mortality, to identify factors that contribute to the continuing racial disparity in pregnancy-related mortality, and to develop effective strategies to prevent pregnancy-related mortality for all women. In addition, CDC is working with state health departments, researchers, health-care providers, and other stakeholders to improve the ascertainment and classification of pregnancy-related deaths.

Adolescent↗
PubMed2003

[Regional differences of mortality from malignancies in Hungary].

INTRODUCTION: The mortality of the Hungarian population is very unfavourable in relation to other European countries. Mortality from malignant diseases is the second most frequent cause of death in both sexes. The most frequent localisation of cancer is that of the bronchi and the lungs, followed by colorectal, breast and oral cavity cancers. AIM: Of the publication was to demonstrate the spatial distribution of mortality from malignant diseases of all sites, bronchi and the lungs, as well as mortality from cancer of the thyroid gland and leukaemias, and to evaluate the possible impact of the Chernobyl nuclear accident on the frequency of cancer mortality. METHOD: The spatial distribution of mortality in the country is evaluated by computing standardized mortality ratio on settlement level, using geographical information system. In case of frequent mortality events a region analysis was carried out, in the opposite case--a cluster analysis. RESULTS: Regarding the spatial distribution of mortality from all malignant diseases of 0-64 year-old males there are regions with excess mortality in almost each county. In case of women of this age group, there is a significantly higher mortality in Budapest, in three counties in the Eastern part of the country, and in some settlements in Transdanubia. Mortality from the cancer of the bronchi and the lungs significantly accumulates in both sexes in four counties in Eastern Hungary. Mortality from cancer of the thyroid gland and leukaemias does not show typical spatial accumulation as well. CONCLUSIONS: The premature mortality from all malignant diseases and of cancer of the bronchi and lungs of the Hungarian male and female population shows an increasing tendency. Mortality from the latter cause shows a typical spatial accumulation, which causes should be investigated in analytical epidemiological studies. The potential causative role of the Chernobyl accident could not be proven in any case.

Adolescent↗
PubMedDate not supplied

Variation in state-specific infant mortality risks.

Data from the National Infant Mortality Surveillance project were used to examine the State-specific variations in infant, neonatal, and postneonatal mortality and to examine some of the factors affecting the risks of death. The infant mortality risk, defined as the risk of death before 1 year of age to an infant born in the 1980 birth cohort, in the highest risk State was nearly three times that in the lowest risk State. Mortality risk ratios of two or greater were found when comparing high and low States for overall black infant mortality risks, overall neonatal mortality, neonatal mortality risks for black and white infants examined separately, neonatal mortality risks for low birth weight infants regardless of race, and overall postneonatal mortality and postneonatal mortality for white infants. The lowest State-specific black mortality risks were higher than the highest white risks for overall infant mortality and neonatal mortality. The differences between State extremes in mortality risks are greater than the differences between the United States and the Scandinavian countries with the lowest infant mortality.

Female↗
PubMed1983

Sex differences in human mortality: the role of genetic factors.

This paper reviews evidence concerning genetic factors that influence sex differences in human mortality, with attention to the interactions between genetic and environmental factors. Some widely quoted earlier conclusions, for example, that males have consistently higher fetal mortality than females, are not supported by current evidence. For example, for late fetal mortality, males had higher rates than females in earlier historical data, but not in recent data for several advanced industrial countries. This reflects a changing balance between an inherently greater female vulnerability for one major type of late fetal mortality and inherently greater male vulnerability for several other types of late fetal mortality that have declined in importance as health care has improved. Males appear to be inherently more vulnerable than females to infant mortality, although the causes of this vulnerability are poorly understood. X-linked immunoregulatory genes appear to contribute to greater female resistance to infectious diseases. Despite these apparent inherent advantages for females, in some situations females have had higher infant mortality and higher infectious disease mortality than males, apparently due to environmental disadvantages for females, such as less adequate diet and health care. Inherent sex differences in reproductive physiology and anatomy contribute to higher female mortality for breast cancer and maternal mortality. For these causes of death, as for the other categories discussed, the death rates and thus the contributions to sex differences in total mortality vary considerably depending on environmental conditions. Several hypothesized contributions of sex hormones to sex differences in mortality are at present controversial due to contradictions and limitations in the available data. There may be effects of male sex hormones on sex differences in behavior which contribute to males' higher death rates for accidents and other violent causes. Women's endogenous sex hormones may reduce women's risk of ischemic heart disease. For both violent deaths and ischemic heart disease it appears that any genetic contributions to sex differences in mortality are strongly reinforced by the cultural influences that foster more risky behavior in males, including more use of weapons, employment in hazardous occupations, heavy alcohol consumption and cigarette smoking. It appears that these cultural influences on sex differences in behavior are widespread cross-culturally in part because of the effects of inherent sex differences in reproductive functions on the cultural evolution of sex roles. These examples illustrate the complexity and importance of interactions between genetic and environmental factors in determining sex differences in human mortality.

Accidents↗
PubMed2005

Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options.

PURPOSE: This study examined the accuracy of Portsmouth Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity system (P-POSSUM) in predicting the mortality of patients who underwent operations for obstructing colorectal cancer. It also is attempted to analyze the actual mortality and the predicted P-POSSUM mortality of different surgical options for obstructing left-sided cancer. METHODS: Data on patients who underwent surgery for obstructing colorectal cancer during 1998 to 2002 were collected. Mortality predicted by P-POSSUM was compared to the actual mortality with the method of linear analysis. The accuracy of using P-POSSUM to predict mortality in this group of patients was assessed by Hosmer and Lemeshow goodness of fit test and Receiver Operator Characteristic curve analysis. The predicted and actual mortality of patients who underwent different surgical options also were analyzed. RESULTS: A total of 160 patients were included in the study and 18 patients died postoperatively. The operative mortality was 11.3 percent. P-POSSUM predicted overall mortality of 15 percent. The observed and predicted mortality was found to have no significant lack of fit (chi-squared = 5.98; degree of freedom = 3; P = 0.11). The area under Receiver Operator Characteristic curve analysis was 0.75. For patients with left-sided tumors, P-POSSUM predicted mortality and actual mortality of patients who had resection without anastomosis were both significantly higher than patients with single-stage resection and primary anastomosis (P = 0.044 and 0.011, respectively). CONCLUSIONS: P-POSSUM system is valid for prediction of overall mortality in patients with operations for obstructing colorectal cancer. Estimation of P-POSSUM predicted mortality during operation and its ability to correlate with choice of procedure is an area that is worth further study in emergency colorectal surgery.

Adult↗
PubMed1984

Cardiovascular mortality trends in Minnesota, 1960-1978. The Minnesota Heart Survey.

Age-adjusted mortality rates from coronary heart disease (CHD) and other causes were examined in Minnesota for the years 1960-1978. Regions differed in CHD mortality levels and time trends. The greatest decline in CHD mortality occurred in the Twin Cities. The Northeast region had the highest CHD mortality. Influenza and pneumonia death rates were unrelated to CHD trends. Stroke mortality, which also declined sharply, showed no regional differences. Cancer mortality was highest in the Twin Cities and Northeast regions and increased significantly over the period; most of this increase was due to a striking increase in lung cancer mortality. The authors conclude that: (1) the CHD mortality decline in Minnesota was similar to that in the United States; (2) regional differences within the state in CHD mortality levels and trends were statistically significant; (3) CHD trends were not explained by influenza epidemics; (4) regions differed in mortality rates for hypertension in the same way as they did in CHD mortality, but differed little in stroke mortality. This leaves unclear the role of hypertension in regional CHD differences. (5) Trends in cancer mortality indicate that a general decline in mortality, due to factors affecting a wide variety of diseases does not explain the downward trends in CHD mortality.

Adult↗
PubMed2001

Asthma mortality in Uruguay, 1984-1998.

BACKGROUND: Asthma mortality rates have increased worldwide during the past several years despite the increased availability of new and effective medications. Few studies show reliable data from Latin American countries. OBJECTIVE: To determine asthma mortality rates from 1984 to 1998 and to relate mortality to sales of asthma medications. METHODS: We conducted a retrospective epidemiologic study in the total population of Uruguay. Data were obtained from the Department of Statistics of the Ministry of Public Health. Trends in mortality rates were analyzed using linear regression procedures. Spearman rank correlations were used to relate mortality rates to sales of asthma medications. RESULTS: The mean overall mortality rate was 5.10 per 100,000 during the period 1984 to 1998, (range 6.08 to 3.39) and showed a decreasing trend (P = 0.001). During the period 1995 to 1998, a more pronounced decrease was observed (mean mortality rate, 4.10 per 100,000). In the 5- to 34-year-old age group the mean mortality rate was 0.43 (range 0.65 to 0.13). Similarly, the mortality rate in this age group decreased particularly in the 1994 to 1998 period (mean 0.19; P = 0.005). Finally, the mortality rate was inversely correlated with sales of inhaled corticosteroids; for the overall mortality rate, p = -0.71, P = 0.003; for 5- to 34-year-old age group, p = -0.63, P = 0.01. CONCLUSIONS: Although mortality attributable to asthma seems to be decreasing, the overall mortality rate is still high compared with more economically developed countries. A more pronounced decrease in asthma mortality has been seen in the 5- to 34-year-old group. At present, Uruguay is a Latin American country with a low rate of asthma mortality. This is probably related to the use of new therapies to treat asthma.

Adolescent↗
PubMed2001

Mortality among problem drug users in Rome: an 18-year follow-up study, 1980-97.

AIM: To analyse overall and cause-specific mortality among problem drug users (PDUs) attending treatment centres in Rome and to evaluate differences in mortality between genders. METHODS: A cohort of 11 432 PDUs entering treatment in Rome between 1980 and 1995 was enrolled and followed-up as of May 31, 1997. Directly standardized mortality rates and standardized mortality ratios (SMRs) and their 95% confidence intervals (95% CI) were calculated. RESULTS: The study population included mainly males (82%), heroin users (92%) and had a mean age of 26.6 (SD 5.9) at enrollment. At the end of the study period 1734 deaths were observed. Overall mortality rates began to increase in 1985-86 and decreased slightly afterwards. AIDS mortality peaked in 1991-92 (13.2/1000) and fell in the following years. A slight decrease in overdose mortality also occurred after 1989-90. Mortality for causes other than AIDS and overdose remained high and relatively steady for the whole study period. Women showed higher mortality rates for AIDS but lower mortality rates for overdose than males. Overall mortality risk among drug addicts was about 15 times higher compared to the general population of the same age among men, and 38 times higher among women. CONCLUSIONS: AIDS mortality among drug addicts began to decrease earlier than expected; the decrease was particularly significant in the period 1993-94 for both sexes. Afterwards a continuous but slight decrease was observed among males only. Even though overdose mortality has also decreased slightly in recent years, we still observe high mortality levels for both overdose and all other causes. These findings suggest that interventions directed specifically towards the reduction of baseline mortality are still needed.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Cancer mortality among New Mexico's Hispanics, American Indians, and non-Hispanic Whites, 1958-1987.

BACKGROUND: Racial and ethnic differences in cancer incidence and mortality are well documented. New Mexico's ethnically and racially diverse population provides an opportunity to further examine ethnic and racial differences in cancer occurrence. PURPOSE: To address differences in cancer mortality among the state's Hispanics, American Indians, and non-Hispanic Whites, we examined mortality data collected from 1958 through 1987. METHODS: Sex and age-specific and age-adjusted cancer mortality rates were calculated for all sites and specific sites for American Indians, Hispanics, and non-Hispanic Whites. From 1958 through 1987, deaths due to malignant neoplasms were coded according to the International Classification of Diseases. The categories of malignant neoplasms investigated were chosen, in part, to minimize bias due to changes in disease classification. Ethnicity was assigned by the Bureau of Vital Statistics on the basis of information on death certificates. Denominators were derived from the censuses of 1960, 1970, 1980, and 1990. Age-standardized mortality rates were calculated for 5-year periods (1958-1962, 1963-1967, 1968-1972, 1973-1977, 1978-1982, and 1983-1987), with the 1970 U.S. population as the standard. We also examined age-specific rates by time period. RESULTS: Within each of New Mexico's ethnic groups, overall cancer mortality increased over the 30-year time span, and the cancer mortality rates were greater for males than for females. For most major cancer sites, mortality rates for New Mexico's non-Hispanic Whites were comparable with data for U.S. Whites. American Indians had the lowest rates for most sites, whereas cancer mortality rates for most sites among Hispanics were intermediate between the two other groups. However, Hispanics and American Indians had higher mortality rates for cancers of the gallbladder, cervix, and stomach compared with non-Hispanic Whites throughout most of the study period. Several other cancer sites showed major mortality rate differences among these racial and ethnic groups, including cancers of the colon, rectum, breast, bladder, lung, ovary, and uterus. We also observed strong temporal trends of increasing or decreasing mortality rates for several cancer sites. CONCLUSIONS: Race and ethnicity have been strong determinants of cancer mortality in New Mexico. Within the span of one generation, cancer mortality has changed substantially for some cancer sites in each of the population groups studied. IMPLICATIONS: These mortality data underscore the need for appropriately designed etiologic studies of cancer in diverse racial and ethnic groups. Such etiologic studies could provide new insights concerning risk factors for cancer and useful data for developing race- and ethnic-specific cancer control strategies.

Adult↗
PubMed2002

All-cause mortality in randomized trials of cancer screening.

BACKGROUND: The most widely accepted end point in randomized cancer screening trials is disease-specific mortality. The validity of this end point, however, rests on the assumption that cause of death can be determined accurately. An alternative end point is all-cause mortality, which depends only on the accurate ascertainment of deaths and when they occur. We compared disease-specific and all-cause mortality in published randomized cancer-screening trials to indirectly assess the validity of the disease-specific mortality end point. METHODS: We examined all 12 published randomized trials of cancer screening for which both end points were available (seven of mammography, three of fecal occult blood detection, and two of chest x-ray screening for lung cancer). For each randomized trial, we subtracted disease-specific mortality observed in the screened group from that observed in the control group and all-cause mortality in the screened group from that in the control group. We then compared the differences in these two mortality measures. RESULTS: In five of the 12 trials, differences in the two mortality rates went in opposite directions, suggesting opposite effects of screening. In four of these five trials, disease-specific mortality was lower in the screened group than in the control group, whereas all-cause mortality was the same or higher. In two of the remaining seven trials, the mortality rate differences were in the same direction but their magnitudes were inconsistent; i.e., the difference in all-cause mortality exceeded the disease-specific mortality in the control group. Thus, results of seven of the 12 trials were inconsistent in their direction or magnitude. CONCLUSION: Major inconsistencies were identified in disease-specific and all-cause mortality end points in randomized cancer screening trials. Because all-cause mortality is not affected by bias in classifying the cause of death, it should be examined when interpreting the results of randomized cancer-screening trials.

Bias↗