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PubMedDate not supplied

[Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001].

BACKGROUND: Many studies have proposed Avoidable Mortality (ME) to monitor the performance of health services although its usefulness is limited by the multiplicity of the avoidable mortality lists being used. Time trends from 1986-2001 and the geographical distribution of avoidable mortality by provinces, are presented for Spain. METHODS: An Avoidable Mortality consensus list is being used. It includes avoidable mortality through the intervention of health services (ISAS in Spanish) and through health policy interventions (IPSI in Spanish). Time trends are analyzed adjusting Poisson or Joinpoint regression models and the annual percentages of change (APC) are estimated. Changes in geographical distribution between the first half of the analysed period and the second are tested by means of standard mortality ratios (SMR) and comparative mortality rates (CMR) for each province. RESULTS: Between 1986 and 2001 avoidable mortality decreased (APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidable mortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction was observed for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) and an irregular trend for IPSI (between 1986-1990 increase APC: 4.86; CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72 and -2.40). CONCLUSIONS: Avoidable mortality decreased more than non avoidable mortality and important geographical variability can be observed among provinces which should be monitored in order to identify the health services weaknesses. The higher ISAS mortality was observed in southern provinces and the higher IPSI mortality in some areas on the coast. The pattern is somewhat similar for both analyzed periods.

Adolescent↗
PubMed2001

Infant mortality due to perinatal causes in Brazil: trends, regional patterns and possible interventions.

CONTEXT: Brazilian infant and child mortality levels are not compatible with the country's economic potential. In this paper, we provide a description of levels and trends in infant mortality due to perinatal causes and malformations and assess the likely impact of changing intermediate-level determinants, many of which are amenable to direct interventions through the health or related sectors. TYPE OF STUDY: Review paper. METHODS: Two main sources of mortality data were used: indirect mortality estimates based on censuses and surveys, and rates based on registered deaths. The latter were corrected for under-registration. Combination of the two sources of data allowed the estimation of cause-specific mortality rates. Data on current coverage of preventive and curative interventions were mostly obtained from the 1996 Demographic and Health Survey. Other national household surveys and Ministry of Health Statistics were also used. A thorough review of the Brazilian literature on levels, trends and determinants of infant mortality led to the identification of a large number of papers and books. These provided the background for the analyses of risk factors and potential interventions. RESULTS: The indirect infant mortality rate estimate for 1995-97 is of 37.5 deaths per thousand live births, about six times higher than in the lowest mortality countries in the world. Perinatal causes account for 57 % of all infant deaths, and congenital malformations are responsible for 11.2 % of these deaths. Mortality levels are highest in the Northeast and North, and lowest in the South and Southeast; the Center-West falls in between. Since surveys of the North region do not cover rural areas, mortality for this region may be underestimated. CONCLUSIONS: A first priority for the further reduction in infant mortality in Brazil is to improve equality among regions, since the North and Northeast, and particularly rural areas, still show very high death rates. Further reductions in infant mortality will largely depend on decreasing deaths due to perinatal causes. Improvements in the coverage and particularly in the quality of antenatal and delivery care are urgently needed. Another intervention with a potential important impact on infant mortality is the promotion of family planning. Improving birth weight might lead to an 8 % reduction in infant mortality but the efficacy of available interventions is low.

Birth Weight↗
PubMed2001

The treatment of coronary heart disease: an update. Part 2: Mortality trends and main causes of death in the Greek population.

The Seven Countries Study, carried out in the 1960s, showed a low cardiovascular disease (CVD) mortality in the Greek population. Since then, although the age-adjusted all-cause mortality has gradually and steadily decreased, CVD mortality has increased, mainly due to a rise in ischaemic heart disease (IHD) mortality, and, more specifically, myocardial infarction (MI). The number of MIs per 100,000 men aged 30-69 years increased from 195 in 1981 to 297 in 1988 and from 35 to 52 in women, respectively. Age-adjusted IHD mortality in men aged 45-74 years almost doubled from 1956 to 1978. The rate of increase slowed down for a decade and since 1990 it has declined slightly. In women, the age-adjusted IHD mortality increased, but to a lesser degree until 1990, and then it started to decline. Cerebrovascular mortality was higher than IHD mortality in women and equal to IHD mortality in men in the late 1950s and early 1960s, but it started to decrease in 1972 in men, and in 1973 in women. Cancer mortality is the second commonest cause of death in both genders. Age-adjusted cancer mortality (in those aged 45-74 years) increased slightly in men until 1979 and then remained stable. In women, it remained stable until 1991 and then started to decline. The eradication of malaria and rheumatic fever, the decrease in infectious diseases, the improvement of the medical care system and the rise of the population's socio-economic level achieved during the last five decades in Greece have reduced all-cause mortality. On the other hand, the changes in lifestyle (lack of physical exercise, new dietary habits) have resulted in a higher IHD mortality. However, this increase is less than would be expected, taking into account the rise in blood cholesterol levels and the high prevalence of smoking. The recent small decline in IHD mortality is probably attributable to better treatment of IHD rather than to preventive measures.

Adult↗
PubMed2002

Decline in mortality of coronary heart disease among whites and blacks in Wisconsin 1979-1998.

OBJECTIVES: 1) To examine overall trends in Coronary Heart Disease (CHD) mortality in Wisconsin from 1979 to 1998 to assess progress toward Wisconsin's "Public Health Agenda for the Year 2000" goal; and 2) to compare the trends in mortality rates due to CHD by race, gender, and age groups between the periods of 1979-1983 and 1994-1998. METHODS: Mortality data for CHD (ICD codes 410-414, 429.2) were retrieved from the Center for Disease Control and Prevention's WONDER database. Age-specific CHD mortality rates were calculated as averages over the 5-year periods, 1979-1983 and 1994-1998. Both the percentage change in mortality rates between the two periods and the number of lives saved during the 1994-1998 period as a result of change were obtained. To look at racial disparities in mortality, relative rates, that is, ratios between mortality rates of blacks and whites in the 1994-1998 period, were calculated. RESULTS: Between the two time periods (1979-1983 and 1994-1998) there was a 40% reduction of CHD mortality in most age groups for white men and women. The slowest decline in mortality occurred among black men: 11% in the 35-44 age group and less than 30% among those 55 years and older. Although the mortality rate declines for black women over the study period were similar to those for whites overall, in the 1994-1998 period mortality rates among younger black women aged 35 to 54 were 2 to 4 times higher than those for white women in the corresponding age groups. CONCLUSION: Wisconsin achieved its year 2000 objective for CHD mortality reductions in 1998, experiencing a 49% decline in CHD mortality from 1979 to 1998. Despite this overall decline, however, there was a noticeable difference in the trends among demographic groups, suggesting a further focus on racial disparities in CHD mortality.

Adult↗
PubMed2002

Mortality patterns in the Russian Federation: indirect technique using widowhood data.

OBJECTIVE: The Russian mortality crisis of the early 1990s attracted considerable attention, but information on possible covariates of mortality is lacking, and concerns have been raised about the validity of official mortality data. To help elucidate the determinants of mortality, we examined whether indirect demographic techniques could be used to study mortality in countries such as the Russian Federation, where mortality data are inadequate, using input data independent from official vital statistics. METHODS: A national sample of the population was interviewed (n = 1600, response rate = 67%). Participants who had ever been married (82% of the sample) were asked about the date of birth and vital status of their first spouse. Spousal mortality was then estimated indirectly for the 531 men and 710 women for whom valid data were available. FINDINGS: The estimated risk of death between the ages of 35-69 years was 57% for male spouses and 17% for female spouses. Corresponding figures derived from national data for 1990 were 52% and 25% for the Russian Federation, and 31% and 20% for the United Kingdom. According to spouses' reports, 38% of their husbands died from cardiovascular disease, 22% from cancer, and 14% from injuries and accidents. Mortality of male spouses was inversely related to the education level of their wives, and the age-adjusted hazard ratios for death from all causes, compared to primary education, were 0.77 for secondary education and 0.57 for university education (trend P = 0.03). Mortality was also inversely related to ownership of household items, but not to size of settlement, pride in Russia, membership in the Soviet Communist Party, nationality or self-assessed social status. CONCLUSIONS: Although the indirect estimates were imprecise (partly owing to the small population size of the study), and mortality in women was probably underestimated (owing to many factors, including poorer reporting by males and high male mortality), our results are nevertheless consistent with the mortality pattern observed in official mortality data. The indirect technique thus appears to be a useful tool to study the determinants of mortality in the Russian Federation and other populations, where reliable or sufficiently extensive data are not available.

Adult↗
PubMed2003

[High summer temperatures and mortality in the Czech Republic 1982-2000].

The heat-stress-related mortality, which is among main impacts of periods of high summer temperature on society, was reported in many European countries, but analyses focusing on central European population have been rare. Results of the analysis for the period of 1982-2000 in the Czech Republic indicate that heat stress leads to a considerably increased all-causes mortality and mortality due to cardiovascular diseases. Periods with the highest deviations of the daily number of deaths from a baseline (in all-year data) are influenza epidemics and heat waves; the distribution of days with the highest excess mortality in a year is clearly bimodal, showing a main peak in winter and a secondary one in summer. Summer days with a considerably increased mortality are almost entirely days with a positive temperature deviation from the seasonal course. Deviations of mortality from the baseline exceed 100 deaths daily (more than 30% relative increase) in heat wave peaks, and the excess total mortality during the severe 1994 heat waves was +456 deaths (+10.3%) for June 17 to 30, and 8 deaths (+12.3%) for July 24 to August 8. The relative increase in mortality due to cardiovascular diseases was even more pronounced. The mortality displacement effect played an important role, since it was estimated to account for as much as 52% of the total number of victims for the June 1994 heat wave and 48% for the July-August heat wave. People who would die soon without oppressive weather conditions make about half of the total number of deaths, which is a larger value compared to what other studies reported. The increased mortality is observed at maximum (average, minimum) daily temperatures higher than 25 degrees C (18 degrees C, 14 degrees C) and their anomalies from mean seasonal courses larger than 3 degrees C. The same values hold for both the total and cardiovascular mortality. The mortality response at high temperatures is more pronounced in females than males. Correlations between mortality and temperature variables (including heat index) are positive and statistically significant (P = 0.01), stronger for deviations of meteorological variables from seasonal courses than for raw values, in females than males, and for heat index than for any temperature variable and summer simmer index. The unlagged correlations are stronger than correlations with lags 1-3 days; positive values of correlation coefficients hold for lags 0 to 3 days only while at lags of 4 to 25 days, the link is negative (mostly statistically significant) which demonstrates the mortality displacement effect and its time extent.

Adolescent↗
PubMed2003

Peripheral differential leukocyte counts and subsequent mortality from all diseases, cancers, and cardiovascular diseases in Taiwanese.

BACKGROUND AND PURPOSE: A higher total leukocyte count has been reported to predict all-cause mortality in men, but data are limited for this relation in women and for the relation between differential leukocyte counts and all-cause mortality in both men and women. This study was designed to analyze these relationships in Taiwanese. METHODS: A total of 8447 subjects were enrolled from participants in a physical check-up program at National Taiwan University Hospital from 1995 to 1997. Information on mortality was obtained from a national mortality databank that was updated to the end of 2001. Data were analyzed by Student's t test and Cox regression analysis. RESULTS: Among the 245 deaths, 88 were due to cancer and 62 were due to cardiovascular diseases. Cox regression analysis revealed an inverse association between lymphocyte count and all-cause mortality in the study group as a whole (all subjects, p < 0.01, hazard ratio = 0.73). This inverse association was mainly due to an inverse association between lymphocyte count and cancer mortality (p < 0.05, hazard ratio = 0.64), especially the mortality from hepatoma (p = 0.010, hazard ratio = 0.29). The latter hazard ratio of 0.29 indicates that, in all subjects, every decrease of 1.0 x 10(9)/L in lymphocyte count increased the risk of mortality from hepatoma by 3.45-fold during an average follow-up period of 65.5 months. There was a positive association between total leukocyte count and all-cause mortality in men (p < 0.05, hazard ratio = 1.10), mainly due to both the neutrophil and monocyte counts having positive associations with the cardiovascular mortality (both p < 0.05, hazard ratio = 1.23 and 1.22, respectively). The latter hazard ratio of 1.22 indicates that, in men, every increase of 0.1 x 10(9)/L in monocyte count increased the risk of cardiovascular mortality by 1.22-fold. CONCLUSIONS: In Taiwanese adults of both genders, a lower lymphocyte count is associated with cancer mortality, especially mortality from hepatoma. In Taiwanese men, higher neutrophil and monocyte counts are associated with cardiovascular mortality.

Adolescent↗
PubMed2005

[Census population vs. registration population: which population denominator should be used to calculate geographical mortality].

OBJECTIVES: Studies on the geographical differences in mortality tend to use a census population, rather than a registration population, as the denominator of mortality rates in South Korea. However, an administratively determined registration population would be the logical denominator, as the geographical areas for death certificates (numerator) have been determined by the administratively registered residence of the deceased, rather than the actual residence at the time of death. The purpose of this study was to examine the differences in the total number of a district population, and the associated district-specific mortality indicators, when two different measures as a population denominator (census and registration) were used. METHODS: Population denominators were obtained from census and registration population data, and the numbers of deaths (numerators) were calculated from raw death certificate data. Sex- and 5-year age-specific numbers for the populations and deaths were used to compute sex- and age-standardized mortality rates (by direct standardization methods) and standardized mortality ratios (by indirect standardization methods). Bland-Altman tests were used to compare district populations and district-specific mortality indicators according to the two different population denominators. RESULTS: In 1995, 9 of 232 (3.9%) districts were not included in the 95% confidence interval (CI) of the population differences. A total of 8 (3.4%) among 234 districts had large differences between their census and registration populations in 2000, which exceeded the 95% CI of the population differences. Most districts (13 of 17) exceeding the 95% CI were rural. The results of the sex- and age-standardized mortality rates showed 15 (6.5%) and 16 (6.8%) districts in 1995 and 2000, respectively, were not included in the 95% CI of the differences in their rates. In addition, the differences in the standardized mortality ratios using the two different population denominators were significantly greater among 14 districts in 1995 and 11 districts in 2002 than the 95% CI. Geographical variations in the mortality indicators, using a registration population, were greater than when using a census population. CONCLUSION: The use of census population denominators may provide biased geographical mortality indicators. The geographical mortality rates when using registration population denominators are logical, but do not necessarily represent the exact mortality rate of a certain district. The removal of districts with large differences between their census and registration populations or associated mortality indicators should be considered to monitor geographical mortality rates in South Korea.

Censuses↗
PubMed1993

Mortality from violent causes in the Americas.

This article provides an assessment of 1986 mortality from violent causes in the Americas. Directed at assisting with development of preventive public health measures, it employs data available in the PAHO data base to focus on the under-25 year age group, compare mortality from violent causes with mortality from infectious and parasitic diseases, and evaluate the relative role of motor vehicle traffic accidents, other accidents, suicide, homicide, and deaths from unknown causes in mortality from violent causes. The study uses the classification of causes presented in the International Classification of Diseases, Ninth Revision. The results show that 517,465 deaths from violent causes were registered in 28 countries and political units of the Americas in 1986, mortality from these causes ranging from 19.3 deaths per 100,000 inhabitants in Jamaica to 125 in El Salvador. Examination of available 1980-1986 data from five countries points to steady increases in mortality from violent causes in Brazil and Cuba that began respectively in 1983 and 1984. Assessment of male and female 1986 mortality from these causes in nine countries showed male mortality to be substantially higher, the lowest male:female ratio (in Cuba) being 1.9:1. Among infants, infectious and parasitic disease mortality was greater than mortality from violent causes in most countries. However, from age 1 to the study's 25-year cutoff, mortality from violent causes was found to exceed infectious and parasitic disease mortality in most countries and to play an especially large role in deaths among those 19-24 years old. Data from eight countries suggested that accidents other than motor vehicle traffic accidents were accounting for much of the mortality from violent causes among infants and the 1-4 year age group in 1986, while motor vehicle traffic accidents rivaled other accidents in importance among the older (5-9, 10-14, 15-19, and 19-24) age groups. It appears that the information presented could prove of considerable use in developing policies designed to reduce morbidity and mortality from violent causes (1).

Adolescent↗
PubMedDate not supplied

[Seasonal variation in mortality in the city of Valencia, Spain].

OBJECTIVE: To study the seasonal variation in mortality for all causes, grouped according to age and sex, within the city of Valencia during the period 1976-1990 and its relationship with air temperature. MATERIAL AND METHODS: This is an ecological study using monthly global mortality and mean atmospheric temperature statistics for the city of Valencia, Spain between 1976 and 1990. The principal variable has turned out to be mortality for all causes. Mortality rates have been determined for specific age groups (0-4, 35-49, 50-64, 65-74 and > or = 75), as well as for both genders, within the city of Valencia for each of the 180-month period of investigation. Average monthly mortality data has been obtained and the percentage variation has been calculated. Graphical analysis has been used to examine the seasonal variation in mortality and in order to discern the nature of any relationship between atmospheric temperature and mortality. The regression line has been adjusted using the Loess method (smoothed regression motive, locally pondered). The association between mean temperature and mortality has calculated by means of multiple regression analysis controlling for trend, seasonality and period effect. RESULTS: A clear seasonal pattern emerges with mortality peaking during the Winter months and dipping during the Summer and early Autumn. The increase in mortality seen during the month of January came to 27.7% of the total mortality for females and 19.5% of the total mortality for males. By age groups, this increase was greater in the 75-plus age group. Graphically, the relationship between temperature and mortality has a V-shape appearance, with a lower mortality level when the mean daily temperature for the month in question is approximately 23 degrees Celsius. Based on this relationship, two complementary.

Adult↗
PubMed2004

Impact of diabetes and previous myocardial infarction on long-term survival: 25-year mortality follow-up of primary screenees of the Multiple Risk Factor Intervention Trial.

BACKGROUND: The magnitude of coronary mortality risk associated with diabetes or prior myocardial infarction (MI) is debatable. Modulating effects of age, risk factors, and duration of follow-up may explain discrepancies in previous research. Associations with noncardiovascular mortality are little explored. OBJECTIVES: To compare mortality patterns in men with a history of diabetes or MI and to assess modulating effects on mortality of age, cardiovascular risk factors, and follow-up duration. METHODS: We compared the 25-year mortality of 4809 men with diabetes only and 4625 men with MI only (all men aged 35-57 years). RESULTS: The adjusted hazard ratio (HR) for all-cause mortality for those with MI only vs those with diabetes only was 0.97 (95% confidence interval, 0.92-1.03; P =.32). The pattern of deaths was different: higher coronary mortality (HR = 1.37; P<.001) and lower mortality from noncardiovascular causes (HR = 0.66; P<.001) in those with MI only compared with those with diabetes only. This finding prevailed across all ages and levels of cardiovascular risk factors. Hazard ratios for coronary mortality significantly declined over follow-up (2.7, 1.7, 1.2, 1.1, and 1.0 for < or =5, 6-10, 11-15, 16-20, and >20 years of follow-up, respectively), whereas HRs for noncardiovascular mortality remained relatively constant. CONCLUSIONS: Overall, diabetes and MI were similarly strong predictors of total mortality. Higher mortality from noncardiovascular causes was observed in those with diabetes only, whereas prior MI was more strongly predictive of coronary mortality than diabetes at any age and level of cardiovascular risk factors. The difference in coronary mortality between the 2 groups was most evident in the first 10 years of follow-up.

Adult↗
PubMed2003

Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model.

CONTEXT: A predictive model of mortality in heart failure may be useful for clinicians to improve communication with and care of hospitalized patients. OBJECTIVES: To identify predictors of mortality and to develop and to validate a model using information available at hospital presentation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of 4031 community-based patients presenting with heart failure at multiple hospitals in Ontario, Canada (2624 patients in the derivation cohort from 1999-2001 and 1407 patients in the validation cohort from 1997-1999), who had been identified as part of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. MAIN OUTCOME MEASURES: All-cause 30-day and 1-year mortality. RESULTS: The mortality rates for the derivation cohort and validation cohort, respectively, were 8.9% and 8.2% in hospital, 10.7% and 10.4% at 30 days, and 32.9% and 30.5% at 1 year. Multivariable predictors of mortality at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher urea nitrogen level (all P<.001), and hyponatremia (P<.01). Comorbid conditions associated with mortality included cerebrovascular disease (30-day mortality odds ratio [OR], 1.43; 95% confidence interval [CI], 1.03-1.98; P =.03), chronic obstructive pulmonary disease (OR, 1.66; 95% CI, 1.22-2.27; P =.002), hepatic cirrhosis (OR, 3.22; 95% CI, 1.08-9.65; P =.04), dementia (OR, 2.54; 95% CI, 1.77-3.65; P<.001), and cancer (OR, 1.86; 95% CI, 1.28-2.70; P =.001). A risk index stratified the risk of death and identified low- and high-risk individuals. Patients with very low-risk scores (< or =60) had a mortality rate of 0.4% at 30 days and 7.8% at 1 year. Patients with very high-risk scores (>150) had a mortality rate of 59.0% at 30 days and 78.8% at 1 year. Patients with higher 1-year risk scores had reduced survival at all times up to 1 year (log-rank, P<.001). For the derivation cohort, the area under the receiver operating characteristic curve for the model was 0.80 for 30-day mortality and 0.77 for 1-year mortality. Predicted mortality rates in the validation cohort closely matched observed rates across the entire spectrum of risk. CONCLUSIONS: Among community-based heart failure patients, factors identifiable within hours of hospital presentation predicted mortality risk at 30 days and 1 year. The externally validated predictive index may assist clinicians in estimating heart failure mortality risk and in providing quantitative guidance for decision making in heart failure care.

Aged↗
PubMed2005

Thyroid function and mortality in patients treated for hyperthyroidism.

CONTEXT: Hyperthyroidism has been reported to cause excess all-cause and circulatory mortality. Whether this can be reversed is unknown, as is the influence of mild persisting thyroid dysfunction and treatment-induced hypothyroidism. OBJECTIVES: To determine whether radioiodine treatment is associated with increased mortality and to determine the influences of mild thyroid dysfunction and the development of overt hypothyroidism treated with thyroxine (T(4)). DESIGN, SETTING, AND PARTICIPANTS: A population-based study of 2668 individuals aged 40 years or older treated for overt hyperthyroidism with radioiodine in the West Midlands region of England from 1984-2002. MAIN OUTCOME MEASURES: Cause of death compared with age- and period-specific mortality in England and Wales and assessment of the influence of T(4) therapy for radioiodine-induced hypothyroidism and subclinical thyroid dysfunction on mortality. RESULTS: In 15,968 person-years of follow-up, 554 died vs 487 expected deaths (standardized mortality ratio [SMR], 1.14; 95% confidence interval [CI], 1.04-1.24, P=.002). Increased risks of all-cause and circulatory deaths vs age- and period-specific mortality were observed in follow-up in those not requiring, or prior to, T(4) therapy. These increased risks were not observed during follow-up on T(4) therapy (circulatory disease SMR prior to T(4), 1.33; 95% CI, 1.14-1.53 vs SMR, 0.91; 95% CI, 0.70-1.17 during T(4)). Patients receiving T(4) had decreased risk of mortality vs risk in the period not requiring, or prior to, T(4) therapy (all-cause mortality hazard ratio [HR], 0.65; 95% CI, 0.54-0.79; circulatory mortality HR, 0.65; 95% CI, 0.48-0.87). Increased all-cause mortality vs the background population was observed in the period prior to T(4) therapy in follow-up associated with low, normal, and high serum thyrotropin. The SMR for ischemic heart disease increased slightly when analyzed by serum thyrotropin, high serum thyrotropin being the highest SMR (low thyrotropin SMR, 1.06; 95% CI, 0.75-1.45; normal thyrotropin SMR, 1.17; 95% CI, 0.76-1.71; high thyrotropin SMR, 1.48; 95% CI, 0.86-2.37). Comparison within the cohort showed that mild hypothyroidism prior to T(4) therapy was associated with increased risk of mortality from ischemic heart disease vs biochemical euthyroidism (HR, 2.08; 95% CI, 1.04-4.19). CONCLUSIONS: Patients treated with radioiodine for hyperthyroidism had increased mortality vs age- and period-specific mortality in England and Wales, a finding no longer evident during T(4) therapy. This supports treating hyperthyroidism with doses of radioiodine sufficient to induce overt hypothyroidism. The association within the cohort of mortality from ischemic heart disease with subclinical hypothyroidism suggests T(4) replacement should be considered should this biochemical abnormality develop after radioiodine therapy.

Adult↗
PubMedDate not supplied

[Geographical distribution of the male/female ratio of cardiovascular mortality in Spain].

OBJECTIVES: To describe the geographic distribution of the male/female ratio (MFR) of mortality from ischaemic heart disease (IHD) and cerebrovascular disease (CVD) in 1991-1995 in Spain, and to examine wether the differences between men and women in exposure to cardiovascular risk factors could explain such distribution. METHODS: Mortality data come from National Vital Statistics. Age-adjusted mortality rates for the period 1991-1995 were calculated for IHD and CVD using the direct method, in population aged 40 to 79 years. Data on tobacco and alcohol consumption, hypertension, hypercholesterolemia, diabetes, obesity, sedentariness, and health services use come from the 1993 Spanish National Health Survey, and socioeconomic data from the 1991 Population Census. Data were analyzed by correlation and Poisson regression methods. RESULTS: MFR of mortality from IHD and CVD are higher in the provinces of the north of Spain, and are correlated negatively with mortality from IHD and CVD. This negative association is stronger for mortality in women than in men. Among the risk factors examined, only MFR of alcohol consumption showed a significant (p < 0.05) association with MFR of mortality from IHD and CVD. MFR of alcohol consumption explains 23 and 14% of the provincial variation in MFR of mortality from IHD and CVD, respectively, and showed a U shaped relationship with MFR of mortality for both diseases. CONCLUSIONS: Provinces in the north of Spain, which register the lowest cardiovascular mortality, show the highest MFR of IHD and CVD mortality, because of the lower mortality in women than in men. As derived from the dose-response relationship between MFR of IHD and CVD mortality and the MFR of alcohol consumption, a higher alcohol consumption in men could contribute to a higher MFR of cardiovascular mortality in some Spanish provinces.

Adult↗
PubMed1996

Asthma mortality in Israel 1971-1990.

BACKGROUND: One of the enigmas in asthma is that our improved understanding of the pathophysiology and the introduction of new modalities to treat asthma has not led to a parallel decrease in asthma mortality. On the contrary, morbidity and mortality from asthma have increased since the mid-seventies in most of the western countries. This trend of increased asthma mortality rate was not observed in Israel in a survey that examined the changes in asthma mortality rate in Israel during 1960-1986. A small but statistically insignificant increase in asthma mortality rate during the last years of that survey solicited for reexamination and extension of the survey. OBJECTIVES: The purpose of the present study was to evaluate the changes in the asthma mortality rate in Israel during the years 1971-1990. METHODS: We extracted the statistical data on asthma mortality rate in Israel during the 1971-1990 period. Because of the small numbers each year and the variations in asthma mortality rate between years, the data were analyzed after grouping the asthma mortality rate into 5-year periods. RESULTS: The rates, expressed as deaths per 100,000 population per year, were 0.43, 0.18, 0.39, and 0.40 in the 5- to 34-year-old group for the periods 1971-1975. 1976-1980, 1981-1985, and 1986-1990, respectively. We found a statistically significant increase in asthma mortality rate during the 1981-1985 and 1986-1990 periods as compared with 1975-1980 in the young (<34 years old) population. The increase in asthma mortality rate was greater among males. The mortality rate in the older population (35-64 year olds) decreased during 1976-80 as compared with 1971-1975 but did not change thereafter. The rates were 10.4, 4.8, 4.5, and 4.4 cases per 100,000 for 1971-1975, 1976-80, 1981-85, and 1986-90, respectively. CONCLUSIONS: Asthma mortality rate increased in Israel in the young age group (5-34 years) during 1980-1990. This is similar to reports from many other countries with advanced medical care systems. The decrease of asthma mortality rate in 1976-80 probably reflect the general improvement in medical care in Israel during these years.

Adolescent↗
PubMed2004

A cohort study of cancer mortality among Biology Research Laboratory workers in The Netherlands.

OBJECTIVE: To examine cancer mortality among persons employed in biology research institutes. METHOD: A historical cohort study was undertaken in the Netherlands. The cohort, comprising 7307 laboratory workers employed by the four participating institutes between 1960 and 1992, was followed for mortality from 1960 to 1995 (median follow-up time 16.5 years). Causes of death were obtained for 98% of all deaths. Cancer mortality in the cohort was compared with that in the general population by computation of the standardized mortality ratio (SMR). The Cox proportional hazards model was used to compare cancer mortality among laboratory workers with that in an internal reference population consisting of unexposed research personnel (n = 2,404). RESULTS: All-cause mortality among laboratory workers was significantly lower than that in the general population. Total cancer mortality and lung cancer mortality were also significantly decreased (SMR = 0.8; 95% confidence interval CI = 0.7-0.9 and SMR = 0.7; 95% CI = 0.6-0.9), respectively. However, when compared to the internal reference population, laboratory workers had a slightly increased cancer mortality (relative risk (RR) = 1.3 95% CI = 0.9-1.9). Among men, a 2.5-fold (95% CI = 1.0-6.3) increase of lung cancer mortality was observed which could not be explained by differences in smoking habits. Lung cancer mortality increased with longer follow-up. Results with regard to a priori defined fields of research showed significantly increased cancer mortality (in particular from lung cancer) for men working in genetics (RR = 3.8), virology (RR = 4.1) and plant physiology (RR = 2.1). CONCLUSION: Laboratory workers have a favorable cancer mortality pattern as compared to the general population. However, this favorable pattern disappears when a comparison is made with a control group of unexposed research personnel. The excess lung cancer mortality among male laboratory workers was concentrated in certain fields of research, which warrants further research to identify specific exposures related to the increased risk.

Adult↗
PubMed2003

The association between mental health, physical function, and hemodialysis mortality.

BACKGROUND: Mortality rates for individuals on chronic hemodialysis remain very high; therefore, strategies are needed to identify individuals at greatest risk for mortality so preventive strategies can be implemented. One such approach is to stratify individuals by self-reported mental health and physical function. Examining these parameters at baseline, and over time, may help identify individuals at greater risk for mortality. METHODS: We enrolled 14,815 individuals with end-stage renal disease (ESRD) and followed these individuals for up to 2 years. The mean age was 61.0 +/- 15.4 years (range, 20 to 96 years) and 31% were African Americans. The SF-36 Health Survey was administered 1 to 3 months after hemodialysis initiation and 6 months later. We examined the associations between the initial SF-36 Health Survey mental component summary (MCS) and physical component summary (PCS) scores and mortality during the follow-up period, and examined the associations between 6-month decline in PCS and MCS scores and subsequent mortality. We also examined the interactions between age and MCS and PCS scores. The general population-based mean of each of these scores was 50 with a standard deviation of 10. The main outcome measurement was death. RESULTS: Self-reported baseline mental health (MCS score) and physical function (PCS score) were both independently associated with increased mortality, and 6-month decline in these parameters was also associated with increased mortality. The multivariate hazard ratios for 1-year mortality for MCS scores of less than 30, 30 to 39, and 40 to 49 were 1.48 (95% CI, 1.32 to 1.64), 1.23 (95% CI, 1.14 to 1.32) and 1.18 (95% CI, 1.10 to 1.26) compared with a MCS score of 50 or more. The hazard ratios for PCS scores of less than 20, 20 to 29, and 30 to 39 were 1.97 (95% CI, 1.64 to 2.36), 1.62 (95% CI, 1.36 to 1.92), and 1.32 (95% CI, 1.11 to 1.57) compared with a PCS score of 50 or more. Six-month decline in self-reported mental health (hazard ratio, 1.07; 95% CI, 1.02 to 1.12, per 10-point decline in MCS score) and physical function (hazard ratio, 1.25; 95% CI, 1.18 to 1.33, per 10-point decline in PCS score) were also both significantly associated with an additional increase in mortality beyond baseline risk. We also found a significant interaction between age and physical function (P = 0.02). Specifically, there was a graded response between the PCS score category and mortality in most age strata, but this relationship was not observed in the oldest age (85 years old or older). CONCLUSION: In individuals newly initiated on chronic hemodialysis, self-reported baseline mental health and physical function are important, independent predictors of mortality, and there is a graded relationship between these parameters and mortality risk. Following these parameters over time provides additional information on mortality risk. One must also consider age when interpreting the relationship between physical function and mortality.

Adult↗
PubMed1998

Toward a broader definition of heat-related death: comparison of mortality estimates from medical examiners' classification with those from total death differentials during the July 1995 heat wave in Chicago, Illinois.

The classification of heat-related deaths solely according to body temperatures underestimates the magnitude of heat-related mortality during heat waves. Broader classifications are often used, but their utility in defining the mortality and identifying at-risk populations has not been evaluated. Using death data from the July 1995 heat wave in Chicago, the authors compared heat-related mortality rates based on the classification of heat-related deaths by the Cook County Medical Examiner's Office (CCMEO), with excess mortality rates based on total mortality differentials during and before the heat wave. In July 1995, the overall mortality in Chicago was 19 deaths per 100,000 population for heat-related mortality and 24 to 26 deaths per 100,000 population for excess mortality. Across Chicago community areas, the two mortality rates were closely related (r = 0.73-0.79; p < .01), but heat-related mortality rates were lower than excess mortality rates in community areas where excess mortality rates were higher (slope < 1; p < .01), a finding indicating an underestimation of heat-related deaths in such areas. The underestimation could not be explained by uncertainties in estimating excess mortality rates or by differences in socioeconomic and demographic characteristics among communities. These results support using the broader CCMEO classification of heat-related deaths as a relative indicator to target communities for prevention and relief efforts, but not as an adequate measure of actual heat-related mortality in a high-risk neighborhood.

Aged↗