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PubMed1992

Mortality of all incident cases of diabetes mellitus in Sweden diagnosed 1983-1987 at age 15-34 years. Diabetes Incidence Study in Sweden (DISS) Group.

From 1983 all incident cases of diabetes in the age group 15-34 years in Sweden have been recorded prospectively. The aim of the present study was to assess the mortality pattern of cases reported for 1983-87 and followed until the end of 1987. Eighteen deaths were identified by linkage to the national death register. When comparing the mortality in the cohort with Swedish males and females in general, an excess mortality was found in all the groups studied. It is, however, less pronounced if the analysis is restricted to those with Type 1 diabetes (standardized mortality ratio (SMR) and 95% confidence interval = 2.1; 0.8, 4.6), Type 2 diabetes (SMR = 4.8; 1.3, 12.3) or Type 1 + Type 2 (SMR = 2.7; 1.3, 5.0). Eight (44%) of the deaths were in patients with secondary diabetes, a diagnosis that applied to less than 3% of the cohort. Alcohol abuse was prevalent in six cases and suspected in another two. Hypoglycaemia was established as a cause of death in only one case but could not be excluded in a further six. Only one death was associated with ketoacidosis. No valid support for an increased risk of the 'dead in bed' syndrome was found. We suggest that diabetes was decisively important for the death in two cases and less important in 10. In the remaining six cases the existing documentation precludes a proper judgement.

Adolescent↗
PubMed2006

Neighbourhood mortality inequalities in New York City, 1989-1991 and 1999-2001.

OBJECTIVES: To examine whether inequalities in mortality across socioeconomically diverse neighbourhoods changed alongside the decline in mortality observed in New York City between 1990 and 2000. DESIGN: Cross-sectional analysis of neighbourhood-level vital statistics. SETTING: New York City, 1989-1991 and 1999-2001. MAIN RESULTS: In both poor and wealthy neighbourhoods, age-adjusted mortality for most causes declined between the time periods, although mortality from diabetes increased. Relative inequalities decreased slightly-largely in the under 65 years population-although all-cause rates in 1999-2001 were still 50% higher, and rates of years of potential life lost before age 65 years were 150% higher, in the poorest communities than in the wealthiest ones (relative index of inequality 1.7 and 3.3, respectively). The relative index of inequality for mortality from AIDS increased from 4.7 to 13.9. Over 50% of the excess mortality in the poorest neighbourhoods in 1999-2001 was due to cardiovascular disease, AIDS and cancer. CONCLUSIONS: In New York City, despite substantial declines in absolute mortality and rate differences between poor and wealthy neighbourhoods, great relative socioeconomic inequalities in mortality persist.

Adolescent↗
PubMed1987

Cancer mortality in an Italian rubber factory.

The purpose of the study was to describe the mortality experience of an Italian cohort of rubber workers and an attempt was made to identify any occupational cancer hazards that might currently be affecting men employed in this type of work. A total of 4917 male workers who first started working in a large rubber factory between 1962 and 1972 have been followed up until 31 January 1983. The number of deaths from all causes and from malignant neoplasms was determined and compared with the expected number of deaths calculated from mortality rates for the province in which the population of the plant lived. Mortality from all causes was 85% of that expected. A slight overall excess of deaths from cancer (SMR = 119) was found; this was entirely due to the excess mortality in the 35-44 age group. In order further to evaluate the possible existence of a cancer risk SMRs were analysed by duration of exposure, time since first exposure, and for specific sites of cancer. A trend in SMR with duration of exposure was found for employees with 10 years of follow up or more. A high risk for some tumour sites emerged.

Adolescent↗
PubMed2006

Are implantable cardioverter defibrillator shocks a surrogate for sudden cardiac death in patients with nonischemic cardiomyopathy?

BACKGROUND: Ventricular tachyarrhythmias long enough to cause implantable cardioverter defibrillator (ICD) shocks are generally thought to progress to cardiac arrest. In previous ICD trials, shocks have been considered an appropriate surrogate for sudden cardiac death (SCD) because the number of shocks has been thought to be equivalent to the mortality excess in patients without ICDs. The practice of equating ICD shocks with mortality is controversial and has not been validated critically. METHODS AND RESULTS: The Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial was a prospective, randomized, multicenter trial of ICD therapy in 458 patients with nonischemic cardiomyopathy. Patients were randomized to receive standard medical therapy (STD) or STD plus an ICD. Shock electrograms were reviewed, and the cause of death was evaluated by a separate blinded events committee. There were 15 SCD or cardiac arrests in the STD group and only 3 in the ICD arm. In contrast, of the 229 patients randomized to an ICD, 33 received 70 appropriate ICD shocks. Patients in the ICD arm were more likely to have an arrhythmic event (ICD shock plus SCD) than patients in the STD arm (hazard ratio 2.12, 95% CI 1.153 to 3.893, P=0.013). The number of arrhythmic events when one includes syncope as a potential arrhythmic event was similar in both groups (hazard ratio 1.20, 95% CI 0.774 to 1.865, P=0.414). Approximately the same number of total events was noted in each arm when we compared syncope plus SCD/cardiac arrest in the STD arm with SCD plus ICD shocks plus syncope in the ICD arm. CONCLUSIONS: Appropriate ICD shocks occur more frequently than SCD in patients with nonischemic cardiomyopathy. This suggests that episodes of nonsustained ventricular tachycardia frequently terminate spontaneously in such patients.

Aged↗
PubMed2006

Mortality and medical comorbidity among patients with serious mental illness.

OBJECTIVES: This study examined mortality and medical comorbidity among patients with serious mental illness in Ohio. METHODS: Data for 20,018 patients admitted to an Ohio public mental health hospital between 1998 and 2002 were matched against state death records, and 608 deaths were identified. Leading causes of death and medical comorbidities, years of potential life lost (YPLL), and standardized mortality ratios were calculated for this population. RESULTS: Heart disease (126 persons, or 21 percent) and suicides (108 persons, or 18 percent) were the leading causes of death. The mean+/-SD number of YPLL was 32.0+/-12.6 years. The highest cause-specific mean YPLL was for suicides (41.7+/-10.3 years). Deaths from unnatural causes had higher mean YPLL than deaths from any other causes. Cause-specific mean YPLL were higher for women than for men, except for homicides, pneumonia and influenza, and heart disease. The aggregated standardized mortality ratio from all causes of death was 3.2, corresponding to 417 excess deaths (p<.001). Obesity (144 persons, or 24 percent) and hypertension (136 persons, or 22 percent) were the most prevalent medical comorbidities. CONCLUSIONS: This study demonstrated excess mortality among patients in Ohio with serious mental illness. Results highlight the need to integrate delivery of currently fragmented mental and physical health services and to target interventions that improve quality-of-life outcomes for this population.

Adolescent↗
PubMed2000

Adolescent psychiatric in-patients. A high-risk group for premature death.

BACKGROUND: Research has demonstrated increased mortality rates in adolescent psychiatric in-patients. AIMS: To investigate this excess mortality by calculating standardised mortality ratios (SMRs) relative to cause of death, diagnosis, cohort and age. METHOD: A nationwide Norwegian sample of 1095 former adolescent psychiatric in-patients were followed up 15-33 years after first hospitalisation by record linkage to the National Death Cause Registry. RESULTS: The SMR was significantly increased for almost all causes of death investigated. In males, all psychiatric diagnoses had significantly increased SMRs, whereas in females, organic mental disorder, anxiety disorder and affective disorder had non-significantly increased SMRs. The SMR was significantly elevated for all age-spans and cohorts investigated. CONCLUSIONS: A broad prevention strategy is needed to combat the increased mortality rates found in adolescent psychiatric in-patients.

Adolescent↗
PubMed1996

[Environment and health: an analysis of intra-urban differentials in the city of São Paulo, Brazil].

A field study undertaken in the city of S. Paulo is presented as part of the project Environment and Health in Developing Countries: An Analysis of Intra-Urban Differentials Using Existing Data financed by the Ministry of Foreign Affairs of the United Kingdom with academic support from the London School of Hygiene and Tropical Medicine (LSHTM). The research aim was to fill in the gaps in the information needed to establish associations between mortality, urbanization and the environment. Statistics were produced by means of existing data collected by city departments, research carried out by universities and census data. Data quality was assessed taking into consideration data coverage, accuracy, and sensibility to pinpoint deprived areas in the city of S. Paulo. Socioeconomic data were used to create a composite index for districts and subdistrict in order to form four socioeconomic zones. Mortality differentials between the zones by five broad age groups (0-4, 5-14, 15-44, 45-64 e 65+) and four ICD chapters (circulatory, respiratory, infectious and parasitic and external causes) are presented. The zoning used showed that 43.8% of S. Paulo residents live in areas under the worst socioeconomic conditions. Health data demonstrated that people living in this areas had higher rates of mortality then those living in the areas with the best conditions. Finally, excess mortality data are analyzed and suggested as a good method for allocating health resources.

Adolescent↗
PubMed1983

Differential mortality among alcoholics by sample site.

In a sample of 1,289 alcoholics from four clinical sites, the overall mortality rate after five to eight years of observation was 22.0 per cent, 3.1 times the expected rate. Patients from the medical and surgical services of a general hospital suffered 4.0 times the rate of expected mortality and died most often of medical causes associated with alcoholism. Patients of the public alcoholism ward had a mortality rate 3.3 times the expected rate and died of causes often associated with low social class. Private psychiatric patients had a mortality rate 2.3 times the expected rate, and psychiatric outpatients had an excess mortality ratio of 2.1. Sample site must be considered as a variable in the study of mortality among alcoholics.

Adult↗
PubMed2004

A population-based registry study of infant mortality in the Arctic: Greenland and Denmark, 1973-1997.

OBJECTIVES: We sought to determine precise estimates of infant mortality rates and to describe overall trends in infant mortality in Greenland and Denmark from 1973 to 1997. METHODS: We analyzed data from population-based registries of all live-born infants in Greenland and Denmark to calculate infant mortality rates from 1973 to 1997. RESULTS: Between the periods of 1973-1977 and 1993-1997, neonatal mortality rates in Greenland declined from 20.9 per 1000 live-born infants to 15.7, and postneonatal mortality rates declined from 20.9 per 1000 to 5.9. Infant mortality rates were significantly higher in Greenland than in Denmark, and the excess mortality was uniformly distributed over all birthweight percentiles. In Greenland, the risk of infant death was significantly lower if the mother was born outside Greenland. CONCLUSIONS: Postneonatal mortality rates in Greenland have decreased significantly during the past 25 years, but little progress has been made in decreasing neonatal mortality rates. Disparities exist among children with different maternal origins.

Arctic Regions↗
PubMed1999

Depressive symptoms and 3-year mortality in older hospitalized medical patients.

BACKGROUND: Depressive symptoms are common in hospitalized older persons. However, their relation to long-term mortality is unclear because few studies have rigorously considered potential confounders of the relation between depression and mortality, such as comorbid illness, functional impairment, and cognitive impairment. OBJECTIVE: To measure the association between depressive symptoms and long-term mortality in hospitalized older persons. DESIGN: Prospective cohort study. SETTING: General medical service of a teaching hospital. PATIENTS: 573 patients 70 years of age or older. MEASUREMENTS: Depressive symptoms (Geriatric Depression Scale score), severity of acute illness (Acute Physiology and Chronic Health Evaluation II score), burden of comorbid illness (Charlson comorbidity index score), physical function (a nurse assessed dependence in six activities of daily living), and cognitive function (modified Mini-Mental State Examination) were measured at hospital admission. Mortality over the 3 years after admission was determined from the National Death Index. Mortality rates among patients with six or more depressive symptoms were compared with those among patients with five or fewer symptoms. RESULTS: The mean age of the patients was 80 years; 68% of patients were women. Patients with six or more depressive symptoms had greater comorbid illness, functional impairment, and cognitive impairment at admission than patients with fewer depressive symptoms. Three-year mortality was higher in patients with six or more depressive symptoms (56% compared with 40%; hazard ratio, 1.56 [95% CI, 1.22 to 2.00]; P < 0.001). After adjustment for age, acute illness severity, comorbid illness, functional impairment, and cognitive impairment at the time of admission, patients with six or more depressive symptoms continued to have a higher mortality rate during the 3 years after admission (hazard ratio, 1.34 [CI, 1.03 to 1.73]). Although depressive symptoms contributed less to the mortality rate than did the total burden of comorbid medical illnesses, the excess mortality rate associated with depressive symptoms was greater than that conferred by one additional comorbid medical condition. CONCLUSIONS: Depressive symptoms are associated with long-term mortality in older patients hospitalized with medical illnesses. This association is not fully explained by greater levels of comorbid illness, functional impairment, and cognitive impairment in patients with more depressive symptoms.

Activities of Daily Living↗
PubMed1998

Cancer risk in workers of the pulp and paper industry in Poland. A continued follow-up.

A mortality cohort study was undertaken among Polish pulp and paper workers. This paper concentrates on neoplasms mortality among men and women employed continuously for at least one year in the factory producing sulphate pulp, paper board and paper products. A retrospective observation carried out till 31 December 1995 covered 10,460 workers employed during the years 1968-1990. The cohort accessibility was 99%. Cancer risk was evaluated on the basis of standardized mortality ratio (SMR) calculated according to the person-years method. The general population of Poland was the reference population. The results of a 23-year cohort observation, published earlier, showed a lowered overall mortality from all causes and from all malignant neoplasms, and a significant excess of death from peritoneum and prostate cancer among pulp mill male subcohort. The conclusion was drawn that a 'young' cohort and relatively short follow-up period might have affected the results. The results presented in this paper, obtained after further five years of observation showed in the male cohort an excess of deaths from cancer of respiratory tract and peritoneum (lung SMR = 122, nasal cavities SMR = 587, peritoneum SMR = 562). An approximate correction for smoking habits resulted in only 4 decreased risk estimates for lung cancer, indicating a small positive confounding effect of smoking in this material. In female cohort an excess of brain cancer was found (SMR = 355). Only the excess mortality from cancers of nose, lung and peritoneum was coherent with the exposure to higher concentrations of wood dust, pulp, paper and board dust. It may support a hypothesis that these factors as well as dust pollutants, not yet identified in this study, may be considered as one of the risk factors contributing to the incidence of neoplasms of these sites.

Cause of Death↗
PubMed1985

Assessing efficiency of passive immune transfer in dairy herds.

Blood serum immunoglobulin concentrations of calves during their 2nd wk of life had a .97 correlation with 1st wk concentrations. Correlations between 1st wk concentrations and those in the 3rd, 4th, 5th, and 6th wk of life were .91, .90, .81, and .69. Ten herds were divided into those with mortality rates above and below the median. The major difference in distributions of immunoglobulin concentration between the two groups was percent of calves with concentrations less than 2.5 mg/ml during the 1st wk of life. Calves were sampled monthly for a full year in 19 herds, and all but one herd had one or more calves with immunoglobulin concentrations under 5.0 mg/ml. Overall, calves having immunoglobulin concentrations under 5.0 mg/ml were exposed to excess mortality risk; however, most of the excess risk was concentrated in three herds with high mortality rates (16 to 20%). Evaluating the efficiency of passive immune transfer through the use of management data was unreliable in comparison with assaying serum samples for immunoglobulin concentration.

Agammaglobulinemia↗
PubMed2005

Mass vaccination of schoolchildren against influenza and its impact on the influenza-associated mortality rate among children in Japan.

BACKGROUND: Influenza control based on mass vaccination of schoolchildren was implemented in Japan in the 1960s and was associated with a decrease in the overall mortality rate. The program was discontinued in 1994. The discontinuation was followed by a seasonal increase in the mortality rate. Lately, young children and elderly persons have been receiving influenza vaccines. The purpose of this study was to investigate changes in influenza-related mortality among young children before and after discontinuation of mass vaccination of schoolchildren. METHODS: We calculated the monthly all-cause mortality rates during 1972-2003 and the pneumonia and influenza (P&I) mortality rates during 1972-1999 for young children (age, 1-4 years). We estimated the excess mortality rates attributable to influenza by computing the baseline annual mortality rate as a centered, 3-year moving average of the number of deaths reported during the 2 preceding and the following Decembers. RESULTS: Prominent winter peaks in monthly all-cause mortality rates among young children occurred in the 1990s. They coincided with the winter peaks in monthly P&I mortality rates among young children and were very similar to the winter peaks observed among elderly persons. The number of excess deaths of young children was estimated to be 783 in the 11 winter seasons from 1990 to 2000, whereas no winter peaks in the number of deaths were seen after 2000. CONCLUSIONS: It is likely that discontinuation of mass vaccination of schoolchildren was responsible for the increase in influenza-associated deaths among young children in the 1990s. The recent increase in influenza vaccinations among young children, together with the routine therapeutic use of neuraminidase inhibitors, has led to a decrease in the influenza-associated mortality rate.

Aged↗
PubMed1982

A historical prospective mortality study of workers in copper and zinc refineries.

Earlier health studies of workers in electrolytic refinery operations have raised concern that workers may experience excess morbidity and premature death as a result of hazardous occupational exposures. This study was designed to determine if the refinery operation is associated with any excess mortality patterns. A cohort of 4,802 male workers exposed for at least one year during 1946-1975 was assembled from nine U.S. zinc and copper refineries. Vital status was ascertained for 4,241 (88%) of the cohort. Death certificates were obtained for 84% (355/423) of the deceased. Overall standard mortality ratios (SMRs) were calculated to be 92 for the cohort, 97 for the subgroup of copper refinery workers, and 83 for the subgroup of zinc refinery workers. Significantly high cause-specific SMRs were as follows: (1) cerebrovascular disease (CBVD) for the cohort; (2) all cancers, cancer of the digestive tract, and CBVD for the copper subgroup; (3) all cancers, cancer of the respiratory tract, and CBVD for one plant that demonstrated a significantly high overall SMR (133). The significant excess of cancer deaths among the study cohort is largely due to the plant that exhibited the significantly high overall mortality rate, but lack of smoking data qualifies this finding. The significant excess of CBVD seems to be consistent across plants and further research seems warranted to verify the finding.

Adolescent↗
PubMed2004

Stroke in a biracial population: the excess burden of stroke among blacks.

BACKGROUND AND PURPOSE: Excess mortality resulting from stroke is an important reason why blacks have higher age-adjusted mortality rates than whites. This observation has 2 possible explanations: Strokes occur more commonly among blacks or blacks have higher mortality rates after stroke. Our population-based epidemiological study is set in the Greater Cincinnati/Northern Kentucky region of 1.31 million people, which is representative of the US white and black populations with regard to many demographic and socioeconomic characteristics. METHODS: Hospitalized cases were ascertained by International Classification of Diseases (ninth revision) discharge codes, prospective screening of emergency department admission logs, and review of coroner's cases. A sampling scheme was used to ascertain cases in the out-of-hospital setting. All potential cases underwent detailed chart abstraction by study nurses, followed by physician review. Race-specific incidence and case fatality rates were calculated. RESULTS: We identified 3136 strokes during the study period (January 1, 1993, to June 30, 1994). Stroke incidence rates were higher for blacks at every age, with the greatest risk (2- to 5-fold) seen in young and middle-aged blacks (<65 years of age). Case fatality rates did not differ significantly in blacks compared with whites. Applying the resulting age- and race-specific rates to the US population in 2002, we estimate that 705,000 to 740,000 strokes have occurred in the United States, with a minimum of 616,000 cerebral infarctions, 67,000 intracerebral hemorrhages, and 22,000 subarachnoid hemorrhages. CONCLUSIONS: Excess stroke-related mortality in blacks is due to higher stroke incidence rates, particularly in the young and middle-aged. This excess burden of stroke incidence among blacks represents one of the most serious public health problems facing the United States.

Adult↗
PubMed2000

[Morbidity and mortality in pandemic influenza in Norway].

This article is partly based on a newly published influenza pandemic preparedness plan and risk analysis for future pandemics in Norway, and presents estimates on morbidity and mortality in influenza pandemics in Norway in the 20th century. In addition, estimates on morbidity and mortality for a future pandemic are given. One of the main conclusions is that excess mortality in connection with Spanish influenza and Asian influenza is highly underestimated. The proportion of the infected that died in the pandemics was low, and was highest for Spanish influenza. The morbidity will be highest if a pandemic similar to Asian influenza reappears, while mortality will be highest if a Spanish flu is repeated. In the worst case scenario for a pandemic today, based on the figures from the Spanish flu, the number of excess deaths could reach 29,000, an increase of 60% compared to the average annual number of deaths seen in the 1990s.

Disease Outbreaks↗
PubMed1982

An increased risk for lung cancer mortality associated with sugarcane farming.

In a study to determine putative occupation-related factors responsible for the excessive mortality due to lung cancer in southern Louisiana, the next-of-kin were interviewed of 284 of 400 persons (71%) randomly sampled from a total of 815 persons who died of lung cancer during 1971 through 1977 and had lived in any of 10 parishes (counties) of southern Louisiana. Of the decedents, 108 (38%) had been employed for at least 6 months as sugarcane farm workers at some time during their lives. Logistic regression analysis indicated this industrial involvement differed significantly (P less than 0.0001) from that of a control group, consisting of persons who had died of any cause other than lung cancer and who were matched for year of death, age, sex race, and parish of residence; only 58 (20%) matched controls had had sugarcane farm employment (odds ratio = 2.4; 95% confidence interval, 2.0-2.9). Employment in other industries or tobacco consumption could not account for the elevated risk of lung cancer mortality associated with sugarcane farming. After adjustment for smoking, the relative risk estimate of lung cancer mortality for sugarcane farm workers was 2.4 (95% confidence limits, 1.7-3.6). The sugarcane farmers who died with lung cancer had worked for longer periods in the sugarcane farm industry than did those sugarcane farmers in whom lung cancer did not develop (P = 0.006). No specific histopathologic cell type was noted to be increased in persons who had been employed in sugarcane farming; however, 2 sugarcane farmers had had mesotheliomas.

Age Factors↗
PubMed1993

Childhood cancer mortality in the European Community, 1950-1989.

A descriptive study on childhood cancer mortality was carried out in the European Community (EC) covering the period 1950-1989. An annual total of 3392 cancer deaths were seen among children in the EC during the period 1979-1988, yielding an age-standardised cancer mortality rate of 50 per 10(6). Leukaemia was the most prevalent cause of death among children with cancer (39%). Excess mortality was observed among boys for cancers at all sites combined and for cancers at specific sites, exclusive of malignant tumours of the kidney. This excess is presumed to be due mainly to sex differences in incidence. Markedly higher mortality rates of childhood cancer were seen in southern countries of the EC than in central and northern countries. This difference appeared to be due mainly to differences in cancer incidence among the countries and to a lesser degree to differences in treatment and survival. An overall decline in mortality from childhood cancer in the EC occurred from the early 1960s. In spite of the improvements in survival, however, childhood cancer remains a major cause of death in the EC, affecting about 15% of children between the ages of 1 and 14.

Adolescent↗