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PubMed1983

A long-term follow-up study of diabetic patients in Osaka, Japan: mortality and causes of death.

A long-term follow-up study of diabetic patients was carried out in Osaka, Japan. The subjects were 1,850 diabetics, who were first seen at our hospital between 1960-1979, and they were followed up until the end of 1980. Both the mean annual mortality rate and the O/E ratio indicated an excess mortality in diabetic patients compared to the general population, and a higher mortality in males than in females. Factors related to the prognosis of the subjects were elevated systolic blood pressure, albuminuria and elevated fasting glucose levels at the baseline, and poor metabolic control and insulin treatment during the follow-up period. Cerebrocardiovascular and renal diseases accounted for nearly half of all deaths. When compared to the expected death rate, the increase in the number of deaths due to renal disease was remarkable. Malignant neoplasms also exhibited an increase in the O/E ratio, and were responsible for one quarter of all deaths. In particular, an increase in cancer of the liver and of the pancreas was noted. In addition, an increased O/E ratio was observed for cirrhosis of the liver.

Aged↗
PubMed1995

Excess female child mortality in the developing world during the 1970s and 1980s.

"How did...excess female child mortality evolve from the 1970s to the 1980s, during a period when mortality declined significantly? Is there a relationship between the intensity of the phenomenon and levels of mortality or certain social development indicators? These are some of the questions which the article discusses on the basis of reliable and comparable data taken from approximately 60 [developing] countries."

Cross-Cultural Comparison↗
PubMed1987

Mortality and disability among granite workers.

The objective of the present study was to investigate the mortality, disability, and long-term morbidity of granite workers. The study included 1,026 workers hired between 1940 and 1971 and followed until the end of 1981. The total number of deaths was 235, and the expected number was 229.7. Excess mortality rates were observed for respiratory diseases (observed/expected = 28/13.9). The number of tumor deaths was 46 (expected 44.9). Excess lung cancer mortality was evident at 15 to 35 years of latency; the observed number of lung cancer deaths for the follow-up period of 25 to 29 years was 8, while 2.1 were expected. Mortality from cardiovascular diseases and violent deaths was slightly less than expected. The results for disability and long-term morbidity showed elevated incidence and prevalence rates for respiratory diseases and rheumatoid arthritis. The observed number of disability pensions due to rheumatoid arthritis in 1981 was 10 observed versus 1.8 expected, and the observed number of patients granted free medication was 19 versus 8.1 expected. The results indicate that granite dust exposure per se may be an etiologic and pathogenetic factor for lung cancer, cancer of the gastrointestinal tract, and some extrapulmonary nonmalignant chronic diseases.

Adolescent↗
PubMed1995

Mortality among workers at a plastics manufacturing and research and development facility: 1946-1988.

Mortality through 1988 was studied for 5,932 male employees who worked between January 1, 1946 and December 31, 1967 at a New Jersey plastics manufacturing and research and development facility. The cohort was followed for an average of 32 years and included 1,859 deaths. Potential exposures included asbestos, formaldehyde, and polyvinyl chloride (PVC). Mortality rates for the cohort were compared to both U.S. and state mortality rates, and analyses were also performed by lagging duration of employment. Based on U.S. rates, mortality among hourly males (n = 3,853) from all cancers was similar to expected [standardized mortality ratio (SMR), 102; 95% confidence interval (CI), 92-114]. Excess mortality among hourly workers was seen for pancreatic cancer (SMR, 146; 95% CI, 95-216) and "malignancies of other parts of the respiratory system" (SMR, 373; 95% CI, 121-870). The latter excess was due entirely to five deaths from pleural mesothelioma. There were no deaths identified due to nasal cavity or nasopharyngeal cancers, or angiosarcoma of the liver. Mortality from leukemia among research and development workers (n = 1,421) was significantly elevated (SMR, 265; 95% CI, 115-524) and related to assignment to process development. This study verifies the excess of pancreatic cancer among workers at the facility seen in earlier studies and observes excesses of mesothelioma due to asbestos exposure and leukemia in process development workers.

Adolescent↗
PubMed2000

Does arsenic exposure increase the risk for circulatory disease?

Studies of residents in communities with high endemic concentrations of arsenic in drinking water suggest a deleterious effect on the circulatory system; however, studies among workers with high occupational exposures generally have shown either no or weak associations. This discrepancy could be a result of the healthy worker effect, including the healthy hire component and the healthy worker survivor effect (HWSE). Therefore, the authors conducted analyses of arsenic exposure in relation to circulatory disease mortality among 2,802 Tacoma, Washington, smelter workers by using 1) internal comparisons to control for the healthy hire effect and 2) the lagging method, adjustment for employment status, and the G-null test to control for the HWSE. Both lagging and adjustment for work status increased circulatory mortality rate ratios at all exposure levels, as compared with a baseline Poisson model. This excess mortality was limited to cardiovascular disease; no excess was observed for cerebrovascular disease. G-null analyses suggested no adverse effect, but power was very limited for this analysis. Overall, these results may indicate that the HWSE obscures an effect of arsenic on circulatory disease. Since cardiovascular deaths constitute about one-third of total mortality, small rate ratios translate into large numbers of excess deaths and, if causal, could be of wide public health significance. Further studies of arsenic exposure and cardiovascular disease are needed, and those conducted in occupational cohorts must control for the HWSE.

Adult↗
PubMed1994

Role of dialysis dose on morbidity and mortality in maintenance hemodialysis patients.

The United States dialysis population has an excessive mortality rate that cannot be fully explained by comorbid conditions or demographic factors. The quantity of dialysis has been suggested to be insufficient. This report reviews the several dialysis-related factors that impact on mortality. Since the National Cooperative Dialysis Study in 1983, there have been no controlled trials. However, numerous retrospective and two recent larger prospective studies indicate that increasing the quantity of dialysis by 40% to 50% of that traditionally provided in the United States will significantly improve survival. This is equivalent to a Kt/V of less than 1.2 and possibly less than 1.4 using single pool urea kinetics. It is estimated that this would save an additional 8,000 to 16,000 lives per year.

Equipment Reuse↗
PubMed2001

Gender differences in predictors of mortality in nursing home residents with AD.

OBJECTIVE: To evaluate whether the excess mortality in men with AD can be explained by a gender difference in the predictors of mortality. METHODS: The authors studied 2,838 men and 6,385 women over 65 years of age with AD admitted, between 1992 and 1995, to 1 of nearly 1,500 nursing homes in five U.S. states (Kansas, Maine, Mississippi, New York, and South Dakota). Resident level data including sociodemographic characteristics, dementia severity, measures of physical disability, comorbidity, and other clinical variables were collected with the Minimum Data Set. Information on death was derived through linkage to Medicare enrollment files; the median follow-up was 23 months. Baseline characteristics were used to predict age at time of death in Cox proportional hazard models. RESULTS: Men with AD had an increased risk of mortality relative to women, adjusted for differences in the distribution of age and race. The most important predictors of death in men were those related to the disease itself. These were the severity of dementia and the occurrence of episodes of delirium. Instead, death among women was associated with measures of disability, namely, impairment in performing the activities of daily living, presence of pressure sores, malnutrition, and comorbidity. CONCLUSION: These data suggest that the underlying mechanisms for AD may be different in men and women. Future studies of survival and progression of AD need to examine men and women separately.

Aged↗
PubMed1987

A cohort study on mortality of "yusho" patients: a preliminary report.

In 1968, a mass food poisoning (yusho) occurred in western Japan involving more than 1,850 people, the majority of whom were residents of Fukuoka and Nagasaki prefectures. The poisoning is now understood to have been caused by ingestion of a commercial brand of rice oil contaminated with polychlorinated derivatives of biphenyls, dibenzofurans, quaterphenyls, and some other related compounds. The number of deaths seen among 1,761 victims (887 males and 874 females) from the date of official registration as yusho up to the end of 1983 was compared with the expected number of deaths which was calculated on the basis of the national age, sex, and cause-specific death rates. Neither significantly increased nor significantly decreased mortality was seen among overall causes of death in males and females. A significant excess mortality was seen for malignant neoplasms at all sites in males but not in females. Neither significantly increased nor decreased mortality was seen for cancer of the esophagus, stomach, rectum and colon, pancreas, breast, and uterus. For cancer of the liver, however, a considerably increased mortality was seen in both males and females but the excess was statistically significant only in males. It was also notable that such increased mortality due to liver cancer was seen mainly among the patients living in Fukuoka prefecture but not at all among those in Nagasaki prefecture which approximate the yusho patients in Fukuoka prefecture in number. Deaths from chronic liver diseases and liver cirrhosis were also found to be increased in both sexes but the increase was not statistically significant.

Cohort Studies↗
PubMed2005

Safety and efficacy of ximelagatran: meta-analysis of the controlled randomized trials for the prophylaxis or treatment of venous thromboembolism.

BACKGROUND: Ximelagatran has been approved in Europe for VTE prophylaxis in orthopedic surgery at fixed doses and without laboratory monitoring. Aim of the study was to evaluate safety and efficacy of ximelagatran in a meta-analysis of prophylaxis and/or treatment randomized controlled trials. METHODS: Absolute risk of events for ximelagatran and OR for its comparison with LMWH and coumarins were calculated. Subgroup analysis was performed for ximelagatran regimen, comparator agent, type of surgery, starting time of prophylaxis. RESULTS: Twelve studies and 16,992 patients were meta-analysed. Ximelagatran showed an absolute risk of major VTE of 4.04% and 1.69% and of major bleedings of 1.68% and 1.03% in prophylaxis and treatment trials, respectively. In prophylaxis trials, a significant excess mortality (OR: 2.5; 95% CI: 1.02 - 6.13) and an excess in major bleedings (OR: 1.41; 95% CI: 0.93 - 2.14) was found in the whole ximelagatran group. No evidence of treatment effect for major VTE was seen in the comparison with LMWH (OR: 1.01; 95% CI: 0.52 - 1.97). The cohort of patients treated with 24 mg b.i.d. showed similar results. An increase in the absolute risk of bleeding (from 1.04% to 3.03%) was found between post and preoperative administration of ximelagatran. Major VTE risk was increased when ximelagatran was compared to b.i.d. LMWH. CONCLUSIONS: Ximelagatran can be considered for its potential advantages for prevention and treatment of VTE. Future efforts are needed by researchers to prospectively investigate the best postoperatively starting time and by clinicians to monitor overall mortality in prophylactic use.

Anticoagulants↗
PubMed2002

Coronary atherosclerosis in diabetes mellitus: a population-based autopsy study.

OBJECTIVES: The study was conducted to test the hypothesis that the prevalence of coronary atherosclerosis is greater among diabetic than among nondiabetic individuals and is similar for diabetic individuals without clinical coronary artery disease (CAD) and nondiabetics with clinical CAD. BACKGROUND: Persons with diabetes but without clinical CAD encounter cardiovascular mortality similar to nondiabetic individuals with clinical CAD. This excess mortality is not fully explained. We examined the association between diabetes and coronary atherosclerosis in a geographically defined autopsied population, while capitalizing on the autopsy rate and medical record linkage system available via the Rochester Epidemiology Project, which allows rigorous ascertainment of coronary atherosclerosis, clinical CAD, and diabetes. METHODS: Using two measures, namely a global coronary score and high-grade stenoses, the prevalence of atherosclerosis was analyzed in a cohort of autopsied residents of Rochester, Minnesota, age 30 years or older at death, while stratifying on diabetes, clinical CAD diagnosis, age, and gender. RESULTS: In this cohort, diabetes was associated with a higher prevalence of atherosclerosis. Among diabetic decedents without clinical CAD, almost three-fourths had high-grade coronary atherosclerosis and more than half had multivessel disease. Without diabetes, women had less atherosclerosis than men, but this female advantage was lost with diabetes. Among those without clinical CAD, diabetes was associated with a global coronary disease burden and a prevalence of high-grade atherosclerosis similar to that observed among nondiabetic subjects with clinical CAD. CONCLUSIONS: These findings provide mechanistic insights into the excess risk of clinical CAD among diabetic individuals, thereby supporting the need for aggressive prevention of atherosclerosis in all diabetic individuals, irrespective of clinical CAD symptoms.

Adult↗
PubMedDate not supplied

Black-white inequalities in mortality and life expectancy, 1933-1999: implications for healthy people 2010.

OBJECTIVES: Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities. METHODS: Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated. RESULTS: Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender-specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940-1999. CONCLUSIONS: The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in black-white inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.

Adolescent↗
PubMed1997

Indicators of socio-economic position and their relation to mortality in Sweden.

This paper estimates the effects on mortality of some indicators of socio-economic position such as employment status (SEI), education and housing tenure. The data from 32,853 persons aged 25-64 were collected from seven independent samples of the Swedish population in 1979-1985. The study was designed as a longitudinal follow-up study ranging from day of interview to December 1993. Information on the dependent variable was obtained from the Cause of Death Register by the personal registration number. The data were analysed by a proportional hazard model. Being a low educated female or renting a flat was associated with increased mortality when tested simultaneously for all independent variables. The excess mortality among unskilled persons and skilled labourers/lower level employees (males) disappeared in successive models when one variable at a time was included in the main models. Sickness pension for males and females, long-term unemployment for males, and ethnicity were also related to increased mortality.

Adult↗
PubMed1992

Skin anergy and tuberculosis.

In our experience tuberculin skin anergy (negative response to 10 TU Mantoux) occurs in 8% of patients with tuberculosis. In this study we compare 81 patients with skin anergy and proven tuberculosis with a background reactive population of patients with tuberculosis. Patients with skin anergy and tuberculosis were older and had fewer symptoms--less cough, less sputum production, less haemoptysis, less malaise, less chest pain--than patients with skin reactivity. There was no difference with respect to male/female ratio, marital status, smoking habits, coexistent major illness, prescribed medications at diagnosis, nor the proportion of patients with extrapulmonary tuberculosis, previous history of BCG vaccination or past history of tuberculosis. Comparison of chest radiographs showed more advanced, more bilateral and more miliary disease in the anergic patients. Pyrexia and elevated ESR at diagnosis were also more common in this group. Fewer of the anergic group of patients were consistently culture negative after 1 month's treatment compared to the background population. Mortality was higher in the anergic group, but this excess mortality occurred from causes other than tuberculosis. Repeat Mantoux testing was performed in 20 of the 81 anergic patients, after a minimum of 3 months of antituberculous chemotherapy, and 14 had become tuberculin positive, suggesting that tuberculin skin anergy may be a temporary phenomenon.

Adult↗
PubMed2001

Long-term trends in marital status mortality differences in The Netherlands 1850-1970.

This article describes the long-term trends in marital status mortality differences in the Netherlands using a unique dataset relating to the period 1850-1970. Poisson regression analysis was applied to calculate relative mortality risks by marital status. For two periods, cause-of-death by marital status could be used. Clear differences in mortality by marital status were observed, with strongly increasing advantages for married men and women and a relative increase in the mortality of widowed compared with non-married people. Excess mortality among single and formerly married men and women was visible in many cause-of-death categories, and this became more widespread during the last decades of the nineteenth century. Hypotheses are formulated that might explain why married men and women underwent a stronger decrease in mortality up until the end of World War II.

Cause of Death↗
PubMed1997

Dose-response associations of silica with nonmalignant respiratory disease and lung cancer mortality in the diatomaceous earth industry.

The potential carcinogenicity of crystalline silica to humans remains a controversial issue. The authors conducted an historical cohort mortality study of 2,342 male workers exposed to crystalline silica, predominantly cristobalite, in a diatomaceous earth mining and processing facility in California. During the years 1942-1994, mortality excesses were detected for nonmalignant respiratory diseases (NMRD) (standardized mortality ratio = 2.01, 95% confidence interval (CI) 1.56-2.55) and lung cancer (standardized mortality ratio = 1.29, 95% CI 1.01-1.61). NMRD mortality rose sharply with cumulative exposure to respirable crystalline silica; allowing for a 15-year latency, the rate ratio for the highest exposure stratum (> or = 5.0 mg/m3-years) was 5.35 (95% CI 2.23-12.8). The rate ratio for lung cancer reached 2.15 (95% CI 1.08-4.28) in the highest exposure category. These associations were unlikely to have been confounded by smoking or asbestos exposure. The findings indicate a strong dose-response relation for crystalline silica and NMRD mortality. The lung cancer results, although less convincing, add further support to an etiologic role for crystalline silica.

Adult↗
PubMed2004

Effects of high- and low-dose amiodarone on mortality, left ventricular remodeling, and hemodynamics in rats with experimental myocardial infarction.

We examined the effect of high- (AHD) and low-dose (ALD) amiodarone on survival, hemodynamics, and left ventricular remodeling in rats with experimental myocardial infarction (MI). Thirty minutes after coronary artery ligation or sham operation, amiodarone (100 or 20 mg/kg/d) or placebo was given by gavages daily for 8 weeks. Eight weeks later, hemodynamic measurements were performed and left ventricular (LV) volume was determined after KCl-induced cardiac arrest. Early after MI, mortality was lower after both doses of amiodarone. However, excess mortality beginning 15 days after MI outweighed reduced early mortality in rats treated with AHD. Body weight and heart rate were reduced significantly and maximal stroke volume index improved by AHD. In rats with MI, AHD significantly shifted LV pressure-volume curves to the right and increased LV operating volume (2.84 +/- 0.10 versus 2.20 +/- 0.07 mL/kg, P < 0.05). In conclusion, high-dose amiodarone aggravated LV remodeling in rats with large experimental chronic MI probably by lowering heart rate. An early beneficial effect on mortality was probably also lost later by this mechanism. Low-dose amiodarone improved survival without effect on LV remodeling.

Amiodarone↗
PubMed1991

Sudden infant deaths and cold weather: was the rise in infant mortality in 1986 in England and Wales due to the weather?

Using the daily number of deaths due to sudden infant death syndrome in England and Wales from 1979 to 1985, and the daily temperature recorded at the London Weather Centre, two models were constructed, one including a temperature term and one without it, and the models used to predict the mortality in 1986. It was found that the model using temperature had a slightly better predictive power and successfully accounted for the increased mortality in February 1986. Thus, we conclude that the excess mortality of February 1986 was associated with the unusually cold weather during that month.

Cold Climate↗
PubMed2005

Mortality of epilepsy in developed countries: a review.

Mortality in people with epilepsy has been studied in many different populations. In population-based incidence cohorts of epilepsy with 7-29 years follow-up, there was up to a threefold increase in mortality, compared to the general population (standardized mortality ratios [SMR] ranged from 1.6 to 3.0). When studies include selected epilepsy populations where patients with frequent and severe seizures are more common, the mortality is even greater. Relative survivorship (RS) following the diagnosis of epilepsy was 91%, 85%, and 83% after 5, 10, and 15 years, respectively. In a population with childhood-onset epilepsy, RS was 94% and 88% after 10 and 20 years. The level of increased mortality is affected by several factors. In idiopathic epilepsy where the causes of seizures are unknown, the results are conflicting. There was no significant increase in mortality in studies from Iceland, France, and Sweden, a barely increased risk in a study from the United Kingdom, and a significantly increased risk in a study from the United States. In contrast, all studies report a significant increased mortality in remote symptomatic epilepsy (standardized mortality ratios [SMRs] ranging from 2.2 to 6.5). The highest mortality is found in patients with epilepsy and neurodeficits present since birth, including mental retardation or cerebral palsy (SMRs ranging from 7 to 50). Mortality is also affected by age, with the highest SMRs in children, the combined effect of low mortality in the reference population, and high mortality in children with neurodeficits and epilepsy. The highest excess mortality is found in the elderly, > or =75 years. A pronounced increase in mortality is found during the first year following the onset of seizures due to underlying severe diseases. The increased mortality remains in different studies 2-14 years following diagnosis. Most of the factors responsible for the increased mortality are related to the underlying disorder causing epilepsy with pneumonia, cerebrovascular disease, and neoplastic disorders (risk remains elevated when primary brain tumors are excluded), as the most frequently recorded causes. The most common direct seizure-related cause of death in adolescents and young adults is sudden unexpected death, which is 24 times more common than in the general population.

Adolescent↗