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PubMed1998

Hypertensive vascular disease as a cause of death in blacks versus whites: autopsy findings in 587 adults.

Cardiovascular disease is the major cause of excess mortality among urban US blacks, but autopsy data comparing black-white differences in underlying pathological causes of cardiovascular death are lacking. We reviewed all 720 adult cases autopsied in 1991 in the New York City Medical Examiner's Office in which the coded cause of death was cardiovascular disease (International Classification of Diseases, 9th Revision, codes 391, 393 to 398, 401 to 404, 410, 411, 414 to 417, 420 to 438, and 440 to 444). After exclusion of 133 cases because race was missing or coded as other than black or white, gender was not coded, or there was an unusual circumstances of death or extreme obesity, 587 cases were available for analysis. There were 314 black and 273 white subjects. Black women were younger than white women at time of death (mean age, 54.7 versus 61.5 years; P<.001), whereas black and white men did not differ in mean age at death. Hypertensive vascular disease was the autopsy cause of death in 42% of blacks compared with 23% of whites (P<.001). Conversely, atherosclerotic heart disease was the autopsy cause of death in 64% of white subjects but only 38% of blacks. These patterns were consistent in both sexes and after adjustment for age. Hypertensive vascular disease was far more common than atherosclerotic heart disease as the cause of death at autopsy among blacks compared with whites in New York City, whereas atherosclerotic heart disease was more common in whites. These findings suggest that ineffective control of hypertension is a major factor contributing to excess cardiovascular mortality among urban blacks.

Adult↗
PubMed1995

A comparison of cause of death between patients treated with hemodialysis and peritoneal dialysis.

Mortality rates associated with peritoneal dialysis (PD) have been found to be higher than those associated with hemodialysis (HD) among prevalent U.S. patients over the age of 55 in the preceding study. Given the substantial technical differences between PD and HD, causes of death might also be expected to differ between these dialytic modalities. In order to help elucidate the relative contributions of these technical differences and to further the understanding of the excess mortality observed among PD-treated dialysis patients, this epidemiologic study compared cause of death in prevalent HD- and PD-treated patients in a large national sample, adjusting for demographic characteristics. Data for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up, were obtained from the U.S. Renal Data System. Patients were censored at transplantation. Death rates per 100 patient years for seven cause-of-death categories were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes), and < 1 yr or > 1 yr of prior ESRD, by use of the Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. There was a significantly increased mortality risk for PD compared with HD for all cause-of-death categories, except malignancy, for which there was a higher mortality risk for HD. The excess all-cause mortality observed in PD-treated patients can be accounted for, in decreasing order, by infection (35%), acute myocardial infarction (24%), other cardiac causes (16%), cerebrovascular disease (8%), withdrawal (8%), and malignancy (-6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗
PubMed1993

Do family physicians make good sentinels for influenza?

OBJECTIVE: To determine whether volunteer family physician reports of the frequency of influenza-like illness (ILI) usefully supplement information from other influenza surveillance systems conducted by the Centers for Disease Control and Prevention. DESIGN: Evaluation of physician reports from five influenza surveillance seasons (1987-88 through 1991-92). SETTING: Family physician office practices in all regions of the United States. PARTICIPANTS: An average of 140 physicians during each of five influenza seasons. INTERVENTIONS: None. OUTCOME MEASURES: An office visit or hospitalization of a patient for ILI, defined as presence of fever (temperature > or = 37.8 degrees C) and cough, sore throat, or myalgia, along with the physician's clinical judgment of influenza. A subset of physicians collected specimens for confirmation of influenza virus by culture. RESULTS: Physicians attributed 81,408 (5%) of 1,672,542 office visits to ILI; 2754 (3%) patients with ILI were hospitalized. Persons 65 years of age and older accounted for 11% of visits for ILI and 43% of hospitalizations for ILI. In three of five seasons, physicians obtained influenza virus isolates from a greater proportion of specimens compared with those processed by World Health Organization laboratories (36% vs 12%). Influenza virus isolates from sentinel physicians peaked from 1 to 4 weeks earlier than those reported by World Health Organization laboratories. Physicians reported peak morbidity 1 to 4 weeks earlier than state and territorial health departments in four of five seasons and 2 to 5 weeks earlier than peak mortality reported by 121 cities during seasons with excess mortality associated with pneumonia and influenza. CONCLUSIONS: Family physicians provide sensitive, timely, and accurate community influenza morbidity data that complement data from other surveillance systems. This information enables monitoring of the type, timing, and intensity of influenza activity and can help health care workers implement prevention or control measures.

Adolescent↗
PubMed2006

Survival of Parkinson's disease patients in a large prospective cohort of male health professionals.

Parkinson's disease (PD) patients have higher mortality than individuals without PD. However, most of the previous studies were based on prevalent cases and few examined the potential effects of duration and smoking on the survival of PD patients. We compared the survival experience of 288 men with incident PD diagnosed between 1986 and 2000 with that of 51,012 men free of PD in the Health Professionals Follow-up Study. As of January 2002, 92 deaths occurred among PD cases and 8,485 among men without PD. After controlling for age, men with PD had 60% higher mortality than those without PD (95% CI: 1.3-2.0). PD mortality was strongly related to disease duration: compared with men without PD, the age-adjusted relative risk for PD patients was 1.1 during the first 5 years from diagnosis, 2.3 from 5 to 10 years, and 3.5 after 10 years (P < 0.0001 for trend). As expected, cigarette smoking was strongly and positively associated with total mortality among men free of PD (comparing >30 pack-years vs. never smokers, relative risk, 2.0; P < 0.0001 for trend), but this association was not observed among PD patients (RR: 1.0; P = 0.95 for trend). This study confirms that PD patients have a higher mortality than individuals without PD and that the excess mortality increases with disease duration. However, smoking seems to impose little additional risk among PD patients in this large cohort of health professionals.

Age Factors↗
PubMed2004

[Impact of smoking on the results of coronary artery bypass surgery].

BACKGROUND AND PURPOSE: The proportion of patients undergoing coronary artery bypass surgery (CABG) with a history of smoking is increasing. The aim of this study was to examine the effect of smoking on outcomes following CABG. PATIENTS AND METHODS: 6,367 consecutive patients who underwent CABG between April 1997 and March 2003 were analyzed retrospectively. Logistic regression was used to risk-adjust inhospital outcomes, while Cox proportional hazards analysis was used to risk-adjust Kaplan-Meier survival curves. Outcomes were adjusted for variables suggested by the American Heart Association and the American College of Cardiology. RESULTS: 947 patients (14.9%) were current smokers (smoking within 1 month of surgery), while 3,857 (60.6%) were ex-smokers and 1,563 (24.5%) nonsmokers. After adjusting for differences in case-mix, current smokers were more likely to develop chest infections (p < 0.001), atelectasis (p < 0.001), and require ventilation > 48 h (p = 0.003). Current smokers were also more likely to stay in intensive care for > 3 days (p < 0.001). There was no association between smoking status and in-hospital mortality. Ex-smokers were not associated with excess mortality (p = 0.11), while current smokers had significantly increased mortality during follow-up (p = 0.029). CONCLUSION: Current smokers are associated with increased respiratory complications, and prolonged stay on intensive care. Although not associated with in-hospital mortality, there appears to be a significant increase in mortality in smokers during a 4-year follow-up period. Patients should be encouraged to stop smoking to maximize the long-term benefits of CABG.

Aged↗
PubMed1995

The U-shaped association between body mass index and mortality: relationship with weight gain in a Native American population.

In order to determine whether weight loss explains high mortality rates in those with a low body mass index (BMI), the relationships between BMI, rate of weight gain and mortality were examined in Pima Indians. Subjects were 814 diabetic and 1814 nondiabetic participants in a longitudinal survey who had at least two examinations after age 20. Median duration of follow-up was 8.1 (range 0.03-25.1) years. BMI showed a U-shaped relationship with mortality rates in men with the lowest rates in the 30-35 kg/m2 category; an inverse relationship was seen in women. Subjects who were losing weight had higher mortality rates than those who were gaining. However, excess mortality among the lightest subjects was present among those who were gaining weight. Among nondiabetic subjects, the mortality ratio (MR) for BMI < 25 kg/m2 compared with 30-35 kg/m2 was 1.5 [95% confidence interval (CI) 1.0-2.2] unadjusted for weight gain, while the adjusted MR was 1.3 [95% CI 0.9-1.9]. Weight loss, which may reflect underlying illness, is associated with high mortality rates in Pima Indians but does not fully account for the high mortality in the lightest individuals.

Adult↗
PubMed2000

Gender differences in the management and outcome of acute myocardial infarction in unselected patients in the thrombolytic era.

This study compares the clinical features, management, and outcome in men and women from a consecutive, unselected series of patients with acute myocardial infarction (AMI) who were admitted to a university cardiac center over a 3-year period. It is a retrospective observational study of 1,059 admissions with AMI identified through the Hospital In-Patient Enquiry (HIPE) registry, validated according to Minnesota Manual criteria, and followed for a period of up to 5 years (median 36 months). Women comprised 40% of all admissions, had a higher hospital mortality (24% vs. 16%, p<0.001), and were less likely to receive thrombolysis (23% vs. 33%, p<0.01), admission to coronary care (65% vs. 77%, p<0.001), or subsequent invasive or noninvasive investigations (55% vs. 63%, p<0.01). However, women with AMI were older than men with AMI (71 vs. 65 years, p<0.001). After adjusting for age, differences that remained significant were prevalence of hypertension (odds ratio [OR] 2.12, 95% confidence intervals [CI] 1.56 to 2.88) and cigarette smoking (OR 0.47, 95% CI 0.35 to 0.65), management in coronary care (OR 0.66, 95% CI 0.49 to 0.88), and hospital mortality (OR 1.48, 95% CI 1.07 to 2.04). Excess mortality occurred predominantly in women <65 years old (18% vs. 8%, OR [multivariate] 2.35, 95% CI 1.19 to 4.56), among whom multivariate analysis demonstrated a significantly lower thrombolysis rate (OR 0.48, 95% CI 0.27 to 0.86). In this group, lack of thrombolysis independently predicted hospital mortality (OR 5.37, 95% CI 1.45 to 19.82). Female gender was not an independent predictor of mortality following AMI (OR 1.42, 95% CI 0.90 to 2.26). Thus, among unselected patients, female gender is associated with, but not an independent predictor of, reduced survival after AMI. Gender differences in mortality are greatest in younger patients, who are less likely to receive thrombolysis and in whom lack of thrombolysis is independently associated with mortality after AMI.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Behavior of mortality indicators in small geographic areas: relative standardized mortality ratio and standardized proportional mortality ratio].

One of the most commonly used indicators in mortality studies is the Standardized Mortality Ratio (SMR) being the Relative Standardized Mortality Ratio (RSMR) an indicator of the relative magnitude of the SMR for a specific cause of death. Along with these indicators, which must be calculated by using the population at risk, there is the Standardized Proportional Mortality Ratio (SPMR), an indicator which measures the excess mortality referring to the proportional mortality established for a standard population. This paper reviews the theoretic conditions described in literature as being necessary to establish a probability interval for the RSMR centered on the SPMR as well as the correlations between both indicators and the use of the SPMR as a predictor of the RSMR. The results obtained clearly show how difficult it is for these theoretic conditions to exist. However, they do suggest that the SPMR be used as a predictor of RSMR.

Cause of Death↗
PubMed1999

Patient survival after renal transplantation: II. The impact of smoking.

Renal transplant recipients have significantly higher mortality than individuals without kidney disease and the excess mortality is mainly due to cardiovascular causes. In this study, we sought to determine the impact of smoking, a major cardiovascular risk factor, on patient and renal graft survival. The study population included all adult recipients of first cadaveric kidney transplants done in our institution from 1984 to 1991. By selection, all patients were alive and had a functioning graft for at least 1 yr after transplantation. Smoking history was gathered prior to transplantation. The follow-up period was 84.3 + 41 months and during this time 28%, of the patients died and 21%, lost their graft. By univariate and multivariate analysis, patient survival, censored at the time of graft loss, correlated with these pre-transplant variables: age (p < 0.0001); diabetes (p = 0.0002); history of cigarette smoking (p = 0.004); time on dialysis prior to the transplant (p = 0.0005); and cardiomegaly by chest X-ray (p = 0.0005). Post-transplant variables did not correlate with patient mortality. By Cox regression, patient survival time was significantly shorter in diabetics (p < 0.0001), smokers (p = 0.0005), and recipients older than 40 yr. However, there were no significant differences between the survival of smokers, non-diabetics, diabetics, and older recipients. Patient death was the most common cause of renal transplant failure in smokers, in patients older than 40 yr, and in diabetics, but these patient characteristics did not correlate with graft survival. The prevalence of different causes of death was not significantly different between smokers and non-smokers. In conclusion, a history of cigarette smoking correlates with decreased patient survival after transplantation, and the magnitude of the negative impact of smoking in renal transplant recipients is quantitatively similar to that of diabetes.

Adult↗
PubMed1990

Trends in mortality rates in the diabetic population of the GDR.

Based upon the National Diabetes Registry the mortality rates were assessed annually between 1961 and 1987 in the total diabetic population of the GDR. The rise of diabetes prevalence from 724/10(5) up to 3988/10(5) during the 27-year observation period was associated with an increase of relative mortality rates from 466% to 600% in insulin-treated diabetics, from 352% up to 528% in non-insulin-treated diabetics. By calculation of standardized mortality ratios (SMR) it could be shown that excess mortality is dependent on age but not at all on sex. Insulin-treated diabetics exhibited their maximum SMR of 650% to 750% at ages 25 to 45 years, while in non-insulin-treated diabetics the maximum SMR amounted to 450% at ages 25 to 35 years. In contrast to trends of the total relative mortality rates that of the overall age structure adjusted SMR of diabetics was characterized by a declining tendency, which may be a reflection of the improvement in diabetes care in our country, and which underscores the dependence of mortal, ty rates on the methods used for evaluation.

Adolescent↗
PubMed2000

Short-term results after aortic valve replacement with stentless xenografts in elderly patients.

OBJECTIVE: Our aim was to chart the short-term results of the first 75 of our patients who had undergone first-time aortic valve replacement (AVR) with stentless xenografts. DESIGN: Our study included a complete follow-up (mean/max. 1.5/3.7 years) of the first 75 patients (42 males, 33 females; mean age 74, range 61-84 years) who underwent a first AVR with stentless xenografts. RESULTS: Forty-three percent of patients were in functional class II and 57% in classes III-IV preoperatively. Coronary artery bypass grafting (CABG) was performed in 33 patients. Early mortality (< or = 30 days) was 6.7%, with no significant relation to CABG or age. Crude survival was 81% (95% confidence interval, CI: 71-91 %) at 3 years. Using a multivariate analysis, we identified a low left ventricular ejection fraction as a predictor of early and late mortality. Late survival (early mortality excluded) was comparable with the survival of a matched Danish background population. There were six embolic events (all cerebral: 3 minor, 1 major, 2 fatal), while two patients underwent redo-AVR because of either endocarditis (fatal) or aortic regurgitation caused by malaligned commissures. There were no other valve-related complications. Cumulative freedom was 89% (95% CI: 79-99%) for embolism and 86% (95% CI: 76-96 %) for all complications at 3 years. At the end of the study, 64% of the survivors were in functional class I, 34% were in class II and 2% in class III. CONCLUSIONS: Considering the age composition of our patients, and compared with international results, our early mortality rates were acceptable. The absence of late excess mortality compared with the background population and the functional status at end-of-study may indicate the potential haemodynamic advantages of stentless aortic valves, at least in the short term.

Aged↗
PubMed1995

Cancer mortality among Chinese migrants: a review.

BACKGROUND: Epidemiological studies of cancer among migrant groups are beneficial in that they can provide insight into genetic and environmental factors in disease aetiology. Seven studies in the epidemiological literature have examined cancer mortality in migrants from China; methodological features and findings, which display remarkable consistencies between studies, are reviewed here. METHODS: Papers were included that compare site-specific cancer mortality patterns in first and second generation migrants to the experience in the host regions using vital statistics and census data. Rates had to be standardized either indirectly (using age-specific rates from the host regions) or directly (using a standard age structure) and standardized mortality ratios (SMR) or rate ratios (RR) were calculated. RESULTS: Migrant males had overall mortality from cancer that was often in significant excess compared to the host experience; results for females (for overall cancer) were equivocal. Both sexes had large and significant excess mortality from nasopharyngeal and liver cancer; SMR and RR were also consistently elevated for cancers of the stomach and oesophagus. There was notable attenuation in the high risk at these four sites in the second generation. All studies reported pronounced and significant reduced risk for prostatic cancer and female breast cancer, with little or no increase in mortality in the second generation. The SMR and RR also tended to be below unity for brain, bladder and kidney cancer. CONCLUSIONS: The results of this review indicate that cancer risk at several sites among Chinese migrants appears to be in transition, and that these findings are consistent across studies.

Canada↗
PubMed2000

Marital status and mortality in British women: a longitudinal study.

BACKGROUND: Most previous studies on marital status and mortality did not adjust for the effect of 'marital selection'. Little research has been done about the relation between marital status and mortality in British women, with the exception of research on bereavement. METHODS: Subjects consisted of women aged > or = 35 in a longitudinal study of a nationally representative sample. Marital status and covariates were enumerated at a baseline interview in 1984/85 and a follow-up interview in 1991/92. Death data up to May 1997 were obtained from the National Health Service Central Register. Cox regression was used to estimate hazard ratios (HR) for the single, divorced and widowed states in relation to the married state. RESULTS: Having adjusted for age and martial selection factors, being single (HR = 1.45) was significantly associated with higher all-cause mortality. Being divorced and being widowed showed no excess mortality risk (each HR = 1.09). CONCLUSIONS: Being single was associated with higher mortality. A causal interpretation is plausible. Being divorced and being widowed were not associated with higher mortality.

Adult↗
PubMed2004

Retrospective cohort study of false alarm rates associated with a series of heart operations: the case for hospital mortality monitoring groups.

OBJECTIVE: To examine the efficacy of different methods of detecting a high death rate and determining whether an increase in deaths after heart transplantation could be explained by chance. DESIGN: Retrospective analysis of deaths after heart transplantation. Seven methods were used: mortality above national average, mortality excessively above national average, test of moving average mortality, test of number of consecutive deaths, sequential probability ratio test (SPRT), cusum graph with v-mask, and CRAM chart. The national average mortality was not available and a rate of 15% was used instead as the benchmark. SETTING: Regional cardiothoracic unit. PARTICIPANTS: All 371 patients who received a heart transplant in the programme, 1986-2000. MAIN OUTCOME MEASURES: 30 day survival after transplantation. RESULTS: All methods provided evidence that the 30 day mortality had been high at some stage. The probability that the finding was a false positive depended on which test was used. At the end of the series the average mortality, sequential probability ratio, and cusum tests indicated a level of deaths higher than the benchmark while the remaining four tests yielded negative results. CONCLUSIONS: If the decision to test for outlying mortality is made retrospectively, in the light of the data, it is not possible to determine the false positive rate. Prospective on-site mortality monitoring with the CRAM chart is recommended as this method can quantify the death rate and identify periods when an audit of cases is indicated, even when data from other institutions are not available. A hospital mortality monitoring group can routinely monitor all deaths in the hospital, by specialty, using hospital episode statistics (HES) data and appropriate statistical methods.

Cohort Studies↗
PubMed2003

Long-term mortality after poliomyelitis.

BACKGROUND: Few studies have described mortality and cause of death among persons with a history of polio. METHODS: We identified a group of patients diagnosed with poliomyelitis in Copenhagen between 1919 and 1954. We obtained information on vital status through May 1997 and on cause of death by linkage with the Danish Civil Registration System and the Danish Cause-of-Death Register. Overall and cause-specific standardized mortality ratios served as the measure of mortality risk relative to that of the general population. RESULTS: We observed 1295 deaths among 5977 polio patients compared with an expected 1141 deaths (standardized mortality ratio = 1.14; 95% confidence interval = 1.07-1.20). Excess mortality was restricted to polio patients with a history of severe paralysis of the extremities (1.69; 1.32-2.15) or patients who had been treated for respiratory failure during the epidemics (2.71; 2.18-3.37). Apart from polio patients with respiratory failure, long-term mortality did not appear to increase until 20 years after discharge. Contracting severe paralytic poliomyelitis at a young age seemed to increase long-term mortality. The most common causes of death were polio sequelae (standardized mortality ratio = 141; 95% confidence interval = 98-203), respiratory tract diseases (1.38; 1.13-1.69), breast cancer (1.40; 1.06-1.85), gastrointestinal diseases (1.44; 1.14-1.82) and suicide (1.53; 1.25-1.86). Except for polio sequelae, causes of death did not differ between paralytic and nonparalytic polio patients. CONCLUSIONS: Survivors of poliomyelitis, especially severely paralyzed polio patients, have an increased long-term mortality.

Adolescent↗
PubMed1988

[Premature mortality in France: relative importance of the main causes of death according to the number of years of life lost].

The importance of major causes of deaths in France have been studied for 1972 and 1982, using years of potential life lost before age 65 and in relation to life expectancy. These indicators of premature mortality have been compared to death rates. Unintentional injuries and malignant neoplasms are the two main causes of mortality before age 65. There is an important excess mortality for males, particularly for unintentional injuries. Total premature mortality declined between 1972 and 1982, but cancer mortality for males and suicide and chronic bronchitis mortality for both sexes have increased. Cardiac mortality decreased only for females.

Adolescent↗
PubMed1985

Examples of early mortality follow-up studies.

Numerous mortality studies may be found in publications of the life insurance industry dating back about a century. Examples presented include mortality in asthma history (1903), overweight (1844-1905), and hypertension (1907-11). The favorable effect of underwriting selection on mortality was recognized early, and standard insurance mortality tables in North America have always distinguished between select and ultimate mortality rates. The mortality ratio has been the traditional measure of excess mortality in insurance follow-up studies. Similar mortality studies in the medical literature before 1920 are extremely difficult for investigators to locate. One important exception with regard to methodology and completeness of comparative mortality and survival results was a 20-year follow-up of pulmonary tuberculosis patients after discharge that was reported in 1908.

Actuarial Analysis↗
PubMed1979

[Tobacco, mortality and morbidity of atherosclerotic cardiovascular diseases--a prospective study in Paris].

In the Paris Prospective Study, after a 6,5 year follow-up, mortality and atherosclerotic disease incidence are studied according to the tobacco consumption measured at entry among 7746 middle-aged men in the same administrative group. Mortality is 3 times higher among smokers; the excess mortality of smokers concerns particularly cancers, especially cancers of the upper part of the digestive tube or lung cancers and coronary heart disease. The incidences of leg atherosclerosis and of hard coronary diseases increase very much with the quantity smoked and inhaled. The cigarette consumption is linked with the development of coronary diseases independently of other risk factors; it is taken into account in a five risk factor combination which gives the best estimation of individual risk of future disease. The theoretical effects of the reduction of cigarette consumption on the individual risk or on the incidence of coronary diseases are given. A multifactorial prevention with a small reduction of the level of several risk factors might reduce that incidence in the population.

Administrative Personnel↗