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PubMed2005

Effect of diabetes and hypertension on obesity-related mortality.

BACKGROUND: Obesity is increasing and, along with it, greater mortality resulting from the overweight condition. Weight-reduction surgery is recommended for many obese patients based on a perceived risk of greater obesity-related mortality. However, many of the studies cited to justify this have aggregated patient groups together, making it difficult to apply their findings to individual patients. METHODS: The combined National Health Interview Survey database from the years 1986-1994 that has been linked to the National Death Index was analyzed. Patients were stratified for their body mass index (BMI) category, the presence or absence of diabetes and hypertension, gender, and race. The contribution of hypertension and diabetes to mortality was determined by Cox proportional hazards modeling. The absolute magnitude that the effect gender, race, BMI, hypertension, and diabetes had on mortality was determined by examination of stratified age-adjusted death rates. RESULTS: We analyzed 662,443 records from individuals interviewed between 1986 and 1994. Of these, 49,391 had died in the follow-up period (mean follow-up, 7.2 years; range, 1-14 years). Cox proportional hazards modeling-adjusting for age, race, and gender-revealed that hypertension (hazard ratio = 1.35 [95% CI 1.34-1.35], P < .0001) and diabetes (hazard ratio = 2.29 [95% CI 2.28-2.29], P < .0001) increased mortality independent of body weight. Serious obesity was associated with an increased mortality by Cox modeling (hazard ratio = 1.72 [95% CI 1.71-1.73], P < .0001); however, when assessed by stratified age-adjusted mortality rates, this increase was numerically small because of the relatively low mortality rate for those without hypertension or diabetes. The presence of hypertension or diabetes substantially increased age-adjusted mortality rates. Much of the increased mortality observed in diabetic patients was attributable to complications of diabetes and not necessarily from atherosclerosis. CONCLUSION: Because weight-loss surgery successfully cures hypertension or diabetes in most obese patients, it should be considered for obese patients having these diseases. Based on the greatly elevated mortality associated with diabetes, surgery may be justified for obese diabetic patients with BMIs lower than the currently accepted criteria. In contrast, for the morbidly obese without diabetes or hypertension, mortality is only slightly increased from obesity alone. In terms of mortality, the benefits of weight reduction resulting from weight-loss surgery are less clear if there is no coexistent diabetes or hypertension.

Adolescent↗
PubMed1999

A longitudinal field study of mortality and Marek's disease in Norwegian and imported white Leghorns.

High mortality during the first part of the laying period was observed in Norwegian White Leghorns during the period 1988-1992. A longitudinal field study with repeated measurement of cumulative mortality was undertaken in the period from January 1994 to January 1996 to investigate (1) the mortality and susceptibility to Marek's disease (MD) in the Norwegian strain (NB41) compared to two imported layers, (2) the effect of MD on the total cumulative mortality in the period from 16 to 32 weeks of age in White Leghorn flocks, and (3) the effect of MD as judged by repeated measurement of cumulative mortality in the same period. All five layer hatcheries and 67% of the pullet-rearing farms in Norway participated in the field study. The egg-production farms were sampled by convenience. Recordings for the whole period were completed for 169 flocks in 101 farms. The statistical analyses were performed using both a general fixed-effects linear model and a mixed model with repeated measurements, with total flock-level cumulative mortality and flock-level cumulative mortality in four-week intervals as outcome variables, respectively. The overall cumulative flock-level incidence of MD was 12% (24% and 8% in NB41 and Lohmann White, respectively). MD was not recorded in any of the Shaver White flocks. A significant difference (p < 0.001) was found in (1) total cumulative mortality: 8.2% in the NB41 and 5.0% in the imported layers, and (2) 'interval-specific' cumulative mortality: 0.36% in the NB41 and 0.15% in the imported birds. A strong relationship was also demonstrated between MD and repeated measurements of 'interval-specific' cumulative mortality (p < 0.001) but not when cumulative mortality was used as an overall measure for the whole laying period (p = 0.11). The results from the repeated-measures analysis also indicated a stronger effect of MD on flock-level 'interval-specific' cumulative mortality in the NB41 than in the imported hens. The different cumulative mortality and susceptibility to MD observed in the NB41, compared to the imported hens, shows that the farmers will be able to reduce their losses by replacing the NB41 strain with one of the imported strains.

Animals↗
PubMedDate not supplied

Geography of diabetes mellitus mortality in Mexico: an epidemiologic transition analysis.

BACKGROUND: The worldwide prevalence of diabetes mellitus (DM) will increase from 135 to 300 million cases by the year 2025. In Mexico, DM is the third cause of general mortality and the primary cause of mortality in the 55- to 64-year-old age group. The purpose of this study was to analyze the characteristics of DM mortality trends in Mexico from 1980 to 2000 in the context of this epidemiologic transition. METHODS: Age-adjusted mortality rates were estimated for DM as underlying cause of death using World Health Organization (WHO) reference population. To evaluate magnitude of risks, standardized mortality ratio (SMR) was calculated; prematurity of mortality was evaluated by means of potential lost life years index (PLLYI). Diabetes mortality trends in the U.S. were calculated with information from the Centers for Disease Control (CDC) public registry and were age-adjusted for comparison. RESULTS: Total number of deaths due to DM during the period was 582,826. Standardized mortality ratio by state showed higher mortality in the northern Mexican states; PLLYI was higher in the northern states. Mortality trends in Mexico showed a rapid increase during the 1980s followed by a less acute increment in the 1990s. Age-adjusted mortality rate trends in the U.S. were lower than those in Mexico. CONCLUSIONS: This study shows an increase in DM age-adjusted mortality trends during the years 1980-2000 in Mexico. The observed pattern of mortality varies widely throughout the country, probably due to differences in socioeconomic conditions and in access to healthcare.

Cause of Death↗
PubMed1997

Mortality from hereditary cerebral haemorrhage with amyloidosis--Dutch type. The impact of sex, parental transmission and year of birth.

Hereditary cerebral haemorrhage with amyloidosis--Dutch type (HCHWA-D) is an autosomal dominant disorder, caused by a single base mutation in the amyloid beta precursor protein (beta PP) gene located on chromosome 21, resulting in recurrent haemorrhagic strokes and dementia. Though HCHWA-D is caused by a dominant mutation, the phenotypic expression varies widely, suggesting modulation of the phenotypic expression by additional factors. In this study we investigated the influence of sex, parental transmission and year of birth on mortality from HCHWA-D. Since the early sixties, clinical and genealogical data of patients with HCHWA-D have been collected. The standardized mortality rate (relative to the general population) was calculated to compare the mortality within the pedigrees with the mortality in the Dutch population. The influence of sex, parental transmission and year of birth on survival were studied using Cox's proportional hazard model. By December 1, 1995, a total of 187 cases were identified belonging to four large families. Mortality rate in affected individuals was fourfold increased compared with the Dutch population (relative mortality 4.0; 95% confidence interval 3.4-4.7) and higher in females than in males (relative mortality risk 8.0 and 2.6, respectively). Mortality rate was lower when HCHWA-D was maternally transmitted (mortality relative to paternal transmission 0.7; 95% confidence interval 0.5-1.0). Year of birth had no effect on the mortality of the affected individuals. Survival of HCHWA-D has not yet increased, in spite of higher standards of general medicine, i.e. the mortality rate did not decline over the years. Female sex was a major factor increasing mortality rate in HCHWA-D. Paternal transmission had a just significant effect on mortality rate in HCHWA-D. The possible mechanisms behind these phenomena remain unexplained by this clinical study.

Amyloid beta-Protein Precursor↗
PubMed2003

Drug-related mortality and fatal overdose risk: pilot cohort study of heroin users recruited from specialist drug treatment sites in London.

Fatal overdose and drug-related mortality are key harms associated with heroin use, especially injecting drug use (IDU), and are a significant contribution to premature mortality among young adults. Routine mortality statistics tend to underreport the number of overdose deaths and do not reflect the wider causes of death associated with heroin use. Cohort studies could provide evidence for interpreting trends in routine mortality statistics and monitoring the effectiveness of strategies that aim to reduce drug-related deaths. We aimed to conduct a retrospective mortality cohort study of heroin users recruited from an anonymous reporting system from specialist drug clinics. Our focus was to test whether (1). specialist agencies would agree to participate with a mortality cohort study, (2). a sample could be recruited to achieve credible estimates of the mortality rate, and (3). ethical considerations could be met. In total, 881 heroin users were recruited from 15 specialist drug agencies. The overall mortality rate of the cohort of heroin users was 1.6 (95% confidence interval [CI], 1.1 to 2.2) per 100 person-years. Mortality was higher among males, heroin users older than 30 years, and injectors, but not significantly higher after adjustment in a Cox proportional hazard model. Among the 33 deaths, 17 (52%) were certified from a heroin/methadone or opiate overdose, 4 (12%) from drug misuse, 4 (12%) unascertained, and 8 (24%) unrelated to acute toxic effects of drug use. Overall, the overdose mortality rate was estimated to be at least 1.0 per 100 person-years. The standardized mortality ratio (SMR) was 17 times higher for female and male heroin users in the cohort compared to mortality in the non-heroin-using London population aged 15-59 years. The pilot study showed that these studies are feasible and ethical, and that specialist drug agencies could have a vital role to play in the monitoring of drug-related mortality.

Adult↗
PubMed2002

Evaluation of factors that have reduced mortality from acute pancreatitis over the past 20 years.

BACKGROUND: The mortality associated with acute pancreatitis varies markedly in different studies, with most frequently reported mortality rates of 10% to 15% for all cases and 15% to 90% for attacks regarded as "severe." More recently, various centers have recorded lower mortality rates of 4% to 7% for all attacks of acute pancreatitis and 20% to 50% for those regarded as severe. GOALS: To investigate whether there has been a reduction in mortality associated with acute pancreatitis over the past 20 years and the reasons for this reduction. STUDY: Intended as a review, this study included the authors' 20-year prospective assessment of mortality as it relates to the severity of the disease, complications, and current therapy. For the mortality results, the study was divided into four 4-year periods from 1977 to 1998 and the past 3 years (i.e., 1998-2001). For comparison, the mortality figures from some other large studies are presented. RESULTS: This study showed that the initial reduction in mortality related to acute pancreatitis coincided with the recognition and application of the signs of severity, either Ranson's prognostic signs or Bank's clinical criteria. These signs dictated admission to intensive care unit (ICU) therapy, the intensity of ICU monitoring, and the importance of organ-specific emergent therapy. Further mortality reduction in the 1990s could be attributed to either a more select study sample or earlier and more selective endoscopic or surgical debridement of infected tissue, endoscopic cyst drainage, and angiographic control of gastrointestinal bleeding. Improved nutritional support by jejunal feeding, earlier use of antibiotic therapy, gut sterilization, early endoscopic retrograde cholangiopancreatography for common bile duct stones and necrosectomy for noninfected necrosis have reduced the overall mortality associated with acute pancreatitis to a mean of 5% (range, 3.8-7%) for all cases and 20% (range, 15-25%) for severe cases. However, it is clear that the greater the number of signs denoting severity of organ failure, the higher the mortality. CONCLUSIONS: There has been considerable reduction in the mortality associated with acute pancreatitis over the past 20 years. The reasons are multifactorial, but recognition of severity signs, early implementation of organ-specific therapy, and newer endoscopic, surgical, and angiographic therapy for infection cyst and bleeding appear to have been the major factors in reducing mortality.

Acute Disease↗
PubMed1995

Alcohol intake and cardiovascular mortality in hypertensive patients: report from the Department of Health Hypertension Care Computing Project.

OBJECTIVE: To determine the benefits and risks of drinking alcohol in treated hypertensives. DESIGN: A prospective study of 6,369 hypertensives (3,161 men) attending primarily hospital clinics in the UK. METHODS: Relative risks both for drinkers compared with non-drinkers and for level of alcohol consumption were calculated for mortality from ischaemic heart disease, stroke, non-circulatory and all causes. RESULTS: At presentation 76% of the men and 48% of the women reported recent alcohol consumption. Compared with drinkers, non-drinkers were older, less likely to smoke and had a higher untreated blood pressure. After adjustment for confounding factors, male drinkers had a reduced risk of stroke mortality and possibly of ischaemic heart disease mortality. Similar results were observed in women for stroke mortality but not for ischaemic heart disease mortality. The trend remained after adjustment for previous cardiovascular disease. In men the lowest risk of ischaemic heart disease mortality occurred at intakes of > 21 units per week and stroke mortality was lowest at 1-10 units per week. Men consuming > 21 units per week had a twofold higher non-circulatory mortality. Total mortality was lowest in men who drank 1-10 units per week. Similar effects of alcohol on cardiovascular mortality were observed in women. CONCLUSIONS: Alcohol intake may reduce stroke mortality in treated hypertensives. Ischaemic heart disease mortality in men may also be reduced, especially at higher intakes ( > 21 units per week). The beneficial effects were offset by increasing incidence of non-circulatory causes of death. Alcohol consumption of 1-10 units per week was associated with the lowest mortality in men.

Adolescent↗
PubMed1997

The significance of ulcer disease on late mortality after partial gastric resection.

OBJECTIVE: To study the causes of long-term mortality after peptic ulcer surgery with special attention to the impact of underlying ulcer disease. DESIGN: Retrospective cohort investigation. PATIENTS: A cohort of 1305 patients who had surgery for gastric and duodenal ulcer disease 29 to 59 years ago. At the end of follow-up 80% of gastric ulcer patients, and 64% of duodenal ulcer patients were dead. RESULTS: Overall mortality was significantly higher among gastric ulcer patients: standardized mortality ratio (SMR) 1.17 (95% confidence interval (CI) 1.05-1.29); duodenal ulcer patients had an overall mortality comparable to the reference population: SMR 1.06 (CI 0.97-1.15). Excess mortality among gastric ulcer patients was found to be due to neoplasms in gastrointestinal organs (SMR 1.54 (CI 1.11-2.11) which developed more than 20 years postoperatively, and to respiratory diseases and suicide unrelated to time since surgery. An increased mortality due to malignant tumours, respiratory diseases and suicide was also found among duodenal ulcer patients but this increased mortality was offset due to a significantly decreased mortality in diseases of the heart and vascular system (SMR 0.86 (CI 0.75-0.97)), evident mainly after 20 years postoperatively. Excess mortality due to gastrointestinal cancers outnumbered excess mortality from carcinomas in the respiratory organs, and was due to cancers in the stomach, colon and pancreas. CONCLUSION: An increased mortality due to gastrointestinal carcinoma, especially gastric and pancreatic carcinoma, is apparent regardless of underlying ulcer disease. As preventive measures against these tumours have yielded little benefit in prospective trials, and as smoking-related diseases and tumours together with suicide constitute 75% of the excess mortality, measures to combat smoking and suicide might be more worthwhile to reduce mortality in this cohort.

Adolescent↗
PubMed2004

Trends in sepsis-related neonatal mortality in the United States, 1985-1998.

BACKGROUND: In the United States, bacterial sepsis affects up to 32,000 live births annually. In the 1990s, intrapartum antibiotic prophylaxis (IAP) was recommended to prevent maternal-infant transmission of group B Streptococcus (GBS), a leading cause of sepsis occurring in the first week of life (early onset sepsis). Since IAP has been used, early onset GBS disease declined 70%; however, increased antibiotic use associated with IAP might lead to more severe or antimicrobial resistant etiologies of sepsis. To understand the influence of IAP on neonatal sepsis, in general, we evaluated neonatal mortality from sepsis before and after IAP recommendations were issued. METHODS: Using the National Center for Health Statistics Linked Birth/Infant Death Datasets, we compared trends in sepsis-related early neonatal mortality (<7 days) and late neonatal mortality (7-27 days) among singleton United States births from 1985 through 1991 to 1995 through 1998 [data beyond 1998 not included because of International Classification of Diseases (ICD)-10/ICD-9 coding differences]. We compared trends in mortality between the 2 time periods by estimating the average annual percent change in mortality using log linear regression and stratified by gestational age. RESULTS: Combined early and late neonatal mortality from sepsis averaged 39.6/100,000 live births from 1985 through 1991 and 31.8/100,000 live births from 1995 through 1998. Early neonatal mortality from sepsis averaged 24.9/100,000 live births from 1985 through 1991 and 15.6 from 1995 through 1998; late neonatal mortality averaged 14.8/100,000 live births from 1985 through 1991 and 16.2 from 1995 through 1998. Early neonatal mortality declined more steeply after IAP recommendations were issued, 5.0% annually from 1995 through 1998 versus 3.0% annually from 1985 through 1991. Late neonatal mortality increased more from 1995 through 1998, 5.0% annually compared with 0.5% from 1985 through 1991. CONCLUSIONS: Lower mortality rates and greater declines in early neonatal mortality from sepsis during 1995-1998 indicate greater survival of infants beyond 7 days of life and suggest an association with GBS disease prevention efforts. Thus these findings provide some evidence for continuing IAP for GBS-colonized women. Our findings of apparent increasing trends in late neonatal mortality from sepsis necessitate follow-up with clinical studies.

Female↗
PubMed1991

Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales.

OBJECTIVE: To examine mortality from ischaemic heart disease and cerebrovascular disease in England and Wales by country of birth of the deceased. DESIGN: Standardised mortality ratios were computed by country of birth groups for ischaemic heart disease and cerebrovascular disease for 1979-83 and 1970-2 by using the five year age-sex specific rates for England and Wales for 1979-83 as standard. SETTING: England and Wales 1970-2 and 1979-83. RESULTS: In 1979-83 mortality from ischaemic heart disease was highest in men and women born in the Indian subcontinent (standardised mortality ratio 136 and 146 respectively). Young Indian men suffered the greatest excess (313 at ages 20-29). Other groups with raised mortality included Irish, Scottish, and Polish born immigrants. Those born in the Caribbean, the old Commonwealth, west Europe, and the United States had low death rates. In England and Wales mortality from ischaemic heart disease declined by 5% in men and 1% in women between 1970-2 and 1979-83, with greatest percentage declines in immigrants born in the United States, South Africa, the old Commonwealth, the Caribbean, and France. immigrant groups with raised mortality in the earlier period showed little improvement, and mortality from ischaemic heart disease increased among Indians (6% in men and 13% in women). In 1979-83 mortality from cerebrovascular disease was highest in Caribbeans (standardised mortality ratios 176 in men and 210 in women), followed by Africans, Indians, and Irish. Rates were low in west Europeans. Mortality from stroke declined by 28% overall in this period, a rate of decline shared by most groups. Men from the Indian subcontinent showed a decline of only 3%. CONCLUSION: In the 1980s mortality from ischaemic heart disease and cerebrovascular disease differed significantly between ethnic groups in England and Wales. In general, ethnic groups that experienced lower mortality from ischaemic heart disease in the 1970s showed the greatest improvement over the following decade.

Adult↗
PubMed1997

Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up study.

OBJECTIVE: To estimate the contribution of excessive alcohol use to socioeconomic variation in mortality among men and women in Finland. DESIGN: Register based follow up study. SUBJECTS: The population covered by the 1985 and 1990 censuses, aged > or = 20 in the follow up period 1987-93. MAIN OUTCOME MEASURES: Total mortality and alcohol related mortality from all causes, from diseases, and from accidents and violence according to socioeconomic position. The excess mortality among other classes compared with upper non-manual employees and differences in life expectancy between the classes were used to measure mortality differentials. RESULTS: Alcohol related mortality constituted 11% of all mortality among men aged > or = 20 and 2% among women and was higher among manual workers than among other classes. It accounted for 14% of the excess all cause mortality among manual workers over upper non-manual employees among men and 4% among women and for 24% and 9% of the differences in life expectancy, respectively. Half of the excess mortality from accidents and violence among male manual workers and 38% among female manual workers was accounted for by alcohol related deaths, whereas in diseases the role of alcohol was modest. The contribution of alcohol related deaths to relative mortality differentials weakened with age. CONCLUSIONS: Class differentials in alcohol related mortality are an important factor in the socioeconomic mortality differentials in Finland, especially among men, among younger age groups, and in mortality from accidents and violence.

Adult↗
PubMed2006

Ulcerative colitis: no rise in mortality in a European-wide population based cohort 10 years after diagnosis.

BACKGROUND: Population based studies have revealed varying mortality for patients with ulcerative colitis but most have described patients from limited geographical areas who were diagnosed before 1990. AIMS: To assess overall mortality in a European cohort of patients with ulcerative colitis, 10 years after diagnosis, and to investigate national ulcerative colitis related mortality across Europe. METHODS: Mortality 10 years after diagnosis was recorded in a prospective European-wide population based cohort of patients with ulcerative colitis diagnosed in 1991-1993 from nine centres in seven European countries. Expected mortality was calculated from the sex, age and country specific mortality in the WHO Mortality Database for 1995-1998. Standardised mortality ratios (SMR) and 95% confidence intervals (CI) were calculated. RESULTS: At follow-up, 661 of 775 patients were alive with a median follow-up duration of 123 months (107-144). A total of 73 deaths (median follow-up time 61 months (1-133)) occurred compared with an expected 67. The overall mortality risk was no higher: SMR 1.09 (95% CI 0.86 to 1.37). Mortality by sex was SMR 0.92 (95% CI 0.65 to 1.26) for males and SMR 1.39 (95% CI 0.97 to 1.93) for females. There was a slightly higher risk in older age groups. For disease specific mortality, a higher SMR was found only for pulmonary disease. Mortality by European region was SMR 1.19 (95% CI 0.91 to 1.53) for the north and SMR 0.82 (95% CI 0.45-1.37) for the south. CONCLUSIONS: Higher mortality was not found in patients with ulcerative colitis 10 years after disease onset. However, a significant rise in SMR for pulmonary disease, and a trend towards an age related rise in SMR, was observed.

Adolescent↗
PubMed1995

Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases.

Of 279 patients admitted to a specialist unit with acute pancreatitis, 210 were admitted directly and 69 were transferred for treatment of local or systemic complications. Outcome was assessed in terms of mortality and morbidity and in relation to aetiology, predicted severity of disease (modified Glasgow score), organ failure (modified Goris multiple organ failure score), and need for surgical intervention. The death rate was 1.9% in patients admitted directly but was 18.8% in those transferred from other units. Mortality in gall stone related pancreatitis was 3% compared with 15% (p = 0.03) in pancreatitis of unknown aetiology and 27% (p = 0.01) in post-endoscopic retrograde cholangiopancreatography pancreatitis. Mortality was related to age (mortality > 55 years old 11% v 2%; p = 0.003) and Goris score (score 0, mortality 0% v score 5-9, mortality 67%; p = 0.001). In patients transferred from other units, mortality was 11% in those transferred within a week of diagnosis and 35% when transfer was delayed (p = 0.04). Thirty six patients had pancreatic necrosis on dynamic computed tomography of whom 29 underwent pancreatic necrosectomy with a 34% mortality. Mortality was related to the modified Goris score (median score 2 in survivors v 6 in non-survivors; p = 0.005) and was higher when necrosectomy was performed within the first two weeks of admission (100% vs 21%; p = 0.004). In conclusion, mortality in acute pancreatitis is influenced by age, aetiology of the disease, and presence of organ failure. Patients transferred for specialist care have a 10-fold greater mortality than those admitted directly and mortality is greatest when transfer is delayed. Early necrosectomy carries a prohibitively high mortality.

Acute Disease↗
PubMed1996

Air pollution and mortality in Barcelona.

STUDY OBJECTIVES: Studies conducted in Barcelona reported a short term relation between daily air pollutant values and emergency department admissions for exacerbation of chronic obstructive pulmonary diseases and asthma. Air pollution in Barcelona is mainly generated by vehicle exhaust and is below the World Health Organization air quality guidelines. The acute relation between air pollution and mortality was assessed. DESIGN: Daily variations in total mortality, mortality in subjects older than 70 years, and cardiovascular and respiratory mortality were related with daily variations in air pollutants for the period 1985-91, using autoregressive Poisson regression models that allow to control for temperature, relative humidity and variables handling temporal and autoregressive patterns. MAIN RESULTS: Black smoke and sulphur dioxide (SO2) were related to total mortality (relative risks (RR) for 100 micrograms/m3 = 1.07 and 1.13 respectively), elderly mortality (RR = 1.06 and 1.13), cardiovascular mortality (RR = 1.09 and 1.14), and respiratory mortality (RR = 1.10 and 1.13); all the associations being statistically significant, except for respiratory mortality (p = 0.07). The association between SO2 and respiratory mortality was stronger in summer (1.24, p < 0.01) than in winter (1.08, p > 0.1). Oxidant pollutants (nitrogen dioxide and ozone) were positively related with elderly mortality (RR = 1.05 and 1.09, respectively) and cardiovascular mortality (RR = 1.07 and 1.09) during the summer (p < 0.05), but not during the winter. CONCLUSIONS: Current air pollutant levels were related to mortality in Barcelona. These results were consistent with similar studies in other cities and coherent with previous studies with emergency room admissions in Barcelona.

Age Factors↗
PubMed1999

Update of the Texaco mortality study 1947-93: Part II. Analyses of specific causes of death for white men employed in refining, research, and petrochemicals.

OBJECTIVE: To examine patterns of mortality for specific causes of death with increases in the Texaco mortality study to determine if the patterns are related to employment in the petroleum industry. METHODS: Mortality patterns by duration of employment in various job groups were examined for mesothelioma, non-Hodgkin's lymphoma, multiple myeloma, cell type specific leukaemia, and brain tumours. RESULTS: Mortality from mesothelioma was examined for the total cohort and for two maintenance groups with the greatest potential for exposure to asbestos. The insulator group had a standardised mortality ratio (SMR) of 3029, and a larger group consisting of insulators, carpenters, labourers, electricians, pipefitters, boiler-makers, and welders had an SMR of 411. The mortalities from mesothelioma increased with increasing duration of employment. Mortality was lower for those first employed after 1950. An analysis of all brain tumours for the total cohort and some job and unit subgroups resulted in an SMR of 178 for those employed on the units related to motor oil and 166 for those employed as laboratory workers. Mortality from brain tumours in both of these job groups was higher for those employed > or = 5 years in the group. An analysis of non-Hodgkin's lymphoma showed no consistent patterns among the various employment groups. Mortality from multiple myeloma was non-significantly increased among people employed on the crude (SMR = 155) and fluid catalytic cracking units (SMR = 198). Leukaemia mortality was not increased for the total cohort, and a cell type analysis of leukaemia mortality for the total cohort showed no significant increases for the major cell types. However, there were significant increases for acute unspecified leukaemia (SMR = 276) and leukaemia of unknown cell type (SMR = 231). CONCLUSIONS: Analyses of specific causes of death by duration of employment in various job and process units did not show any patterns which suggest that, other than for mesothelioma, any of these increases in mortalities were likely to have resulted from workplace exposures or from employment at one of the places included in the Texaco mortality study.

Brain Neoplasms↗
PubMed2005

Long-term all-sites cancer mortality time trends in Ohio, USA, 1970-2001: differences by race, gender and age.

BACKGROUND: There were significant changes in cancer mortality in the USA over the last several decades, in the whole country and in particular states. However, no in depth analysis has been published so far, dealing with changes in mortality time trends in the state of Ohio. Since the state of Ohio belongs to the states of relatively high level of all-sites mortality in both males and females, it is of interest to analyze recent changes in mortality rates, as well as to compare them with the situation in the rest of the USA. The main aim of this study was to analyze, describe and interpret all-sites cancer mortality time trends in the population of the State of Ohio. METHODS: Cancer mortality data by age, sex, race and year for the period 1970-2001 were obtained from the Surveillance Research Program of the National Cancer Institute SEER*Stat software. A joinpoint regression methodology was used to provide estimated annual percentage changes (EAPCs) and to detect points in time where significant changes in the trends occurred. RESULTS: In both, males and females mortality rates were higher in blacks compared with whites. The difference was bigger in males (39.9%) than in women (23.3%). Mortality rates in Ohio are generally higher than average USA rates--an overall difference was 7.5% in men in 1997-2001, and 6.1% in women. All-sites mortality trends in Ohio and in the whole USA are similar. However, in general, mortality rates in Ohio remained elevated compared with the USA rates throughout the entire analyzed period. The exceptions are the rates in young and middle-aged African Americans. CONCLUSION: Although direction of time trends in Ohio are similar in Ohio and the whole US, Ohio still have cancer mortality rates higher than the US average. In addition, there is a significant discrepancy between white and black population of Ohio in all-sites mortality level, with disadvantage for Blacks. To diminish disparities in cancer mortality between African Americans and white inhabitants of Ohio efforts should be focused on increasing knowledge of black people regarding healthy lifestyle and behavioral risk factors, but also on diminishing socioeconomic differences, and last but not least, on better access to medical care.

Adult↗
PubMed2003

National maps of the effects of particulate matter on mortality: exploring geographical variation.

In this paper, we present national maps of relative rates of mortality associated with short-term exposure to particulate matter < 10 micro m in aerodynamic diameter (PM(10)). We report results for 88 of the largest metropolitan areas in the United States from 1987 to 1994 for all-cause mortality, combined cardiovascular and respiratory deaths, and other causes of mortality. Maximum likelihood estimates of the relative rate of mortality associated with PM(10)and the degree of statistical uncertainty were obtained for each of the 88 cities by fitting a separate log-linear regression of the daily mortality rate on air pollution level and potential confounders. We obtained Bayesian estimates of the relative rates by fitting a hierarchical model that takes into account spatial correlation among the true city-specific relative rates. We found that daily variations of PM(10) are positively associated with daily variations of mortality. In particular, the relative rate estimates of cardiovascular and respiratory mortality associated with PM(10) are larger on average than the relative rate estimates of all-cause and other-cause mortality. The estimated increase in the relative rate of death from cardiovascular and respiratory mortality, all-cause mortality, and other-cause mortality were 0.31% (95% posterior interval, 0.15-0.5), 0.22% (95% posterior interval, 0.1-0.38), and 0.13% (95% posterior interval, -0.05 to 0.29), respectively. Bayesian estimates of the city-specific relative rates ranged from 0.23% to 0.35% for cardiovascular and respiratory mortality, from 0.18% to 0.27% for all causes, and from 0.10% to 0.20% for other causes of mortality. The spatial characterization of effects across cities offers the potential to identify factors that could influence the effect of PM(10) on health, including particle characteristics, offering insights into mechanisms by which PM(10) causes adverse health effects.

Air Pollutants↗
PubMed2006

Mortality in pharmacologically treated older adults with diabetes: the Cardiovascular Health Study, 1989-2001.

BACKGROUND: Diabetes mellitus (DM) confers an increased risk of mortality in young and middle-aged individuals and in women. It is uncertain, however, whether excess DM mortality continues beyond age 75 years, is related to type of hypoglycemic therapy, and whether women continue to be disproportionately affected by DM into older age. METHODS AND FINDINGS: From the Cardiovascular Health Study, a prospective study of 5,888 adults, we examined 5,372 participants aged 65 y or above without DM (91.2%), 322 with DM treated with oral hypoglycemic agents (OHGAs) (5.5%), and 194 with DM treated with insulin (3.3%). Participants were followed (1989-2001) for total, cardiovascular disease (CVD), coronary heart disease (CHD), and non-CVD/noncancer mortality. Compared with non-DM participants, those treated with OHGAs or insulin had adjusted hazard ratios (HRs) for total mortality of 1.33 (95% confidence interval [CI], 1.10 to 1.62) and 2.04 (95% CI, 1.62 to 2.57); CVD mortality, 1.99 (95% CI, 1.54 to 2.57) and 2.16 (95% CI, 1.54 to 3.03); CHD mortality, 2.47 (95% CI, 1.89 to 3.24) and 2.75 (95% CI, 1.95 to 3.87); and infectious and renal mortality, 1.35 (95% CI, 0.70 to 2.59) and 6.55 (95% CI, 4.18 to 10.26), respectively. The interaction of age (65-74 y versus > or =75 y) with DM was not significant. Women treated with OHGAs had a similar HR for total mortality to men, but a higher HR when treated with insulin. CONCLUSIONS: DM mortality risk remains high among older adults in the current era of medical care. Mortality risk and type of mortality differ between OHGA and insulin treatment. Women treated with insulin therapy have an especially high mortality risk. Given the high absolute CVD mortality in older people, those with DM warrant aggressive CVD risk factor reduction.

Administration, Oral↗