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PubMed2000

Influence of congenital heart disease on mortality after noncardiac surgery in hospitalized children.

OBJECTIVE: To evaluate the incremental risk of congenital heart disease on mortality after noncardiac surgery in children. DESIGN: We reviewed the clinical information network database of the University Hospital Consortium for the period January 1, 1993, through December 31, 1996, and identified 191 261 patients <18 years old having 1 or more noncardiovascular surgical procedures. Of these patients, 6.5% had a diagnosis of congenital heart disease. Patients having ambulatory surgery are excluded from this database. Short-term (1-, 2-, and 3-day) and 30-day mortality were compared, as well as mortality for neonates, infants (31 days to 1 year), and older children (1-17 years); mortality for the 100 most common surgical procedures, mortality for 10 relatively minor surgical procedures, and mortality in subgroups of patients with minor versus severe cardiac diagnoses. RESULTS: Short-term and 30-day mortality was increased in the patients with congenital heart disease patients (30-day mortality odds ratio 3.5; 95% confidence limit, 3.2-3.9). Mortality was also increased in patients with congenital heart disease in the 2 youngest age groups, for the 100 most common operations, and for 10 relatively minor operations. Children with more severe heart disease diagnoses had higher mortality than did children carrying less serious cardiac diagnoses. CONCLUSION: A diagnosis of congenital heart disease adds significant incremental risk of mortality in children requiring inpatient noncardiovascular surgery. This outcome difference is present for both minor and major surgical procedures, and regardless of whether mortality is measured at 1, 3, or 30 days. The incremental risk is greatest in neonates and infants where the presence of congenital heart disease is associated with a 2-fold increase in mortality from noncardiac surgery.

Adolescent↗
PubMed2006

Changing relationship of blood pressure with mortality over time among hemodialysis patients.

High BP is a major risk factor for atherosclerotic cardiovascular disease mortality in the general population. Surprising, studies that have been conducted among hemodialysis (HD) patients have yielded conflicting data on the relationship between BP and mortality. This study explores two hypotheses among HD patients: (1) The relationship between BP and mortality changes over time, and (2) mild to moderate hypertension is well tolerated. Incident HD patients who were treated at Dialysis Clinic Inc. facilities between 1993 and 2003 were studied. Primary end points were atherosclerotic cardiovascular disease and all-cause mortality. The relationship between BP and mortality was analyzed in two sets of Cox proportional hazards models. Model-B explored the relationship between baseline BP and mortality in sequential time periods. Model-TV assessed the relationship between BP, treated as time-varying, and mortality. The study sample (n = 16,959) was similar in characteristics to the United States Renal Data Systems population, although black patients were slightly overrepresented. Model-B demonstrated that the relationship between baseline BP and mortality changes over time. Low systolic BP (<120 mmHg) was associated with increased mortality in years 1 and 2. High systolic BP (> or =150 mmHg) was associated with increased mortality among patients who survived > or =3 yr. Low pulse pressure was associated with increased mortality. Model-TV demonstrated that mild to moderate systolic hypertension may be relatively well tolerated. In conclusion, the relationship between baseline BP and mortality changes over time. Mild to moderate systolic hypertension was associated with only modest increases in mortality.

Adult↗
PubMed2002

[Perioperative mortality and morbidity in the year 2000 in 502 Japanese certified anesthesia-training hospitals: with a special reference to ASA-physical status--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety].

Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 certified training hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to ASA physical status (ASA-PS). The total number of anesthesia available for this analysis was 897,733. The percentages of patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E are 38.0, 40.3, 8.5, 0.4, 4.3, 5.3, 2.5, and 0.7%, respectively. Mortality and morbidity from all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and surgical problems were as follows. The incidences of cardiac arrest (per 10,000 cases of anesthesia) were 1.11, 3.26, 12.25, 54.60, 0.77, 4.46, 21.08 and 217.75 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 6.89, 20.22, 62.18, 148.21, 6.71, 20.38, 106.72 and 592.21 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7 postoperative days) after cardiac arrest were 0.26, 0.77, 3.69, 41.60, 0.00, 1.06, 9.42 and 163.31 per 10,000 cases of anesthesia in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.32, 1.38, 9.75, 70.20, 0.26, 2.12, 29.15 and 353.02 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthesia than in elective anesthesia. ASA-PS correlated well with overall mortality and morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.23, 0.50, 1.32, 0.00, 0.00, 0.85, 2.69 and 4.95 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 3.13, 5.56, 11.46, 5.20, 3.87, 5.94, 13.90 and 14.85 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.03, 0.03, 0.00, 0.00, 0.00, 0.21, 0.45 and 3.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.03, 0.06, 0.00, 0.00, 0.00, 0.21, 0.45 and 6.60 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rate totally attributable to anesthesia among patients with good physical status (ASA-PS of I, II, I E, II E) was 0.05. Anesthetic management was mainly responsible for critical events in patients with good physical status, while coexisting diseases were in those with poor physical status. Surgical problems including procedures and massive hemorrhage were the leading causes of mortality in patients with good physical status. We reconfirmed that ASA-PS is useful to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation in those with poor physical status. Reducing mortality and morbidity from surgical problems is also required for improving perioperative mortality.

Anesthesia↗
PubMed2003

Excess mortality due to diabetes in Mississippi and the estimated extent of underreporting on death certificates.

OBJECTIVE: To develop alternative estimates of the excess mortality attributable to diabetes in Mississippi. METHODS: For each age/sex group, the total (all cause) mortality rate in the population was partitioned into the mortality rates for diabetics (M1) and non-diabetics (M0), using age- and sex-specific mortality rate ratios for diabetics from the Verona Diabetes Study. M1 and M0 were used, respectively, to calculate the predicted number of deaths and the 'usual' number of deaths (the number expected if diabetics had the same mortality rates as non-diabetics) in diabetics. The difference between predicted and 'usual' deaths is the number of excess deaths in diabetics--that is, deaths attributable specifically to diabetes. This was compared to the number of deaths in which diabetes was registered on death certificates as an underlying and/or contributory cause. RESULTS: In Mississippi in 1998-2000, 2,322 male and 3,436 female deaths in diabetics were calculated to be excess. These numbers are approximately three times the numbers of deaths in which diabetes was registered on the death certificate as the underlying cause of death. The excess numbers of deaths are much closer to the total numbers of deaths due to diabetes (that is, where diabetes is listed as either an underlying or a contributory cause of death). CONCLUSIONS: When reporting diabetes mortality numbers, public health agencies should consider reporting total registered diabetes deaths, not just registered underlying deaths. Better education of providers and others to increase the awareness of the importance of listing diabetes on the death certificate would help to increase concern and make diabetes a priority for public health action. Persons with diabetes have higher mortality rates and excess premature mortality, and diabetes ranks consistently among the leading causes of death in Mississippi and the U.S. Yet it has long been known that mortality attributable to diabetes is underestimated. Cause-of-death statistics are unreliable due to underreporting of diabetes on death certificates, and estimates based on attributable risk calculations do not take into account competing risks for mortality. In view of the public health importance of diabetes, it would be useful to develop alternative estimates of the burden of excess mortality attributable to it. In this paper I estimate the excess mortality attributable to diabetes for the diabetic population of Mississippi using epidemiologic data on the prevalence of diabetes and the relative risk of mortality among persons with diabetes.

Cause of Death↗
PubMed1994

Cancer incidence in atomic bomb survivors. Part IV: Comparison of cancer incidence and mortality.

This report compares cancer incidence and mortality among atomic bomb survivors in the Radiation Effects Research Foundation Life Span Study (LSS) cohort. Because the incidence data are derived from the Hiroshima and Nagasaki tumor registries, case ascertainment is limited to the time (1958-1987) and geographic restrictions (Hiroshima and Nagasaki) of the registries, whereas mortality data are available from 1950-1987 anywhere in Japan. With these conditions, there were 9,014 first primary incident cancer cases identified among LSS cohort members compared with 7,308 deaths for which cancer was listed as the underlying cause of death on death certificates. When deaths were limited to those occurring between 1958-1987 in Hiroshima or Nagasaki, there were 3,155 more incident cancer cases overall, and 1,262 more cancers of the digestive system. For cancers of the oral cavity and pharynx, skin, breast, female and male genital organs, urinary system and thyroid, the incidence series was at least twice as large as the comparable mortality series. Although the incidence and mortality data are dissimilar in many ways, the overall conclusions regarding which solid cancers provide evidence of a significant dose response generally confirm the mortality findings. When either incidence or mortality data are evaluated, significant excess risks are observed for all solid cancers, stomach, colon, liver (when it is defined as primary liver cancer or liver cancer not otherwise specified on the death certificate), lung, breast, ovary and urinary bladder. No significant radiation effect is seen for cancers of the pharynx, rectum, gallbladder, pancreas, nose, larynx, uterus, prostate or kidney in either series. There is evidence of a significant excess of nonmelanoma skin cancer in the incidence data, but not in the mortality series. Cancers of the salivary gland and thyroid are also in excess in the incidence series, but they were not evaluated in the earlier mortality analyses. For all solid tumors the estimated excess relative risk at 1 Sv (ERR1Sv) for incidence (ERR1Sv = 0.63) is 40% larger than the excess relative risk (ERR) based on mortality data from 1950-1987 in all Japan (ERR1Sv = 0.45). The corresponding excess absolute risk (EAR) point estimate is 2.7 times greater for incidence than mortality. For some cancer sites, the difference in the magnitude of risk between incidence and mortality is greater. These differences reflect the greater diagnostic accuracy of the incidence data and the lack of full representation of radiosensitive but relatively nonfatal cancers, such as breast and thyroid, in the mortality data. Analyses of both incidence and mortality data are needed since the two end points provide complementary information for risk assessment.

Adolescent↗
PubMed1993

Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index.

OBJECTIVE: To evaluate the relationship between the ankle/arm blood pressure index (AAI, the ratio of ankle to arm systolic blood pressure, a measure of peripheral arterial disease) and short-term cardiovascular morbidity and mortality in older adults with systolic hypertension. DESIGN: Prospective cohort study, 1- to 2-year follow-up (mean, 16 months). SETTING: Eleven of 16 field centers from the Systolic Hypertension in the Elderly Program. PARTICIPANTS: 1537 older men and women with systolic hypertension. MAIN OUTCOME MEASURES: All-cause mortality, coronary heart disease (CHD) mortality, cardiovascular disease (CVD) mortality, and CHD and CVD morbidity and mortality. RESULTS: The AAI was measured at the 1989-1990 clinic examination and was 0.9 or less in 25.5% of 1537 participants. A low AAI was associated with most major CHD and CVD risk factors. In those with a low AAI (< or = 0.9) compared with those with an AAI of more than 0.9, age- and sex-adjusted relative risks for mortality end points at follow-up were as follows: total mortality, 3.8 (95% confidence interval [CI], 2.1 to 6.9); CHD mortality, 3.24 (95% CI, 1.4 to 7.5); and CVD mortality, 3.7 (95% CI, 1.8 to 7.7). For CVD morbidity and mortality, the age- and sex-adjusted relative risk was 2.5 (95% CI, 1.5 to 4.3). After adjustment for baseline CVD and other cardiovascular risk factors, the relative risk for total mortality was 4.1 (95% CI, 2.0 to 8.3) and for CVD morbidity and mortality, 2.4 (95% CI, 1.3 to 4.4). Results were similar when participants with clinical CVD at baseline were excluded. CONCLUSION: A low AAI appears to be an important predictor of morbidity and mortality among older adults with systolic hypertension.

Aged↗
PubMed1995

Infant mortality and famine: a study in historical epidemiology in northern England.

OBJECTIVE: To examine whether periodic variations in annual infant mortality were associated with malnutrition and the poor quality of the food supply available to the community. DESIGN: Retrospective study of historical epidemiology of infant mortality by time series analysis and family reconstitution of parish registers of burials and baptisms. SETTING: Penrith, Cumbria, England, 1557-1812. SUBJECTS: A total of 17,500 births during 1557-1812. RESULTS: This community in the Eden Valley, Cumbria, close to the Scottish borders, was living under marginal conditions with high mortality and low fertility. Clear oscillations in infant mortality synchronise with the oscillations in the wheat price index which is regarded as a measure of the availability of food to the community, and to pregnant and nursing mothers in particular. Input-output analysis showed that the relationship between the wheat price index (input) and infant mortality (output) was highly significant (p < 0.001). Events during the famine of 1623 have been analysed in detail: high wheat prices during pregnancy caused subsequent severe infant mortality but did not have indirect effects on the subsequent mortality of the surviving children over the age of 1 year. Non-stationary oscillations in neonatal and post neonatal mortality were strongly coherent (p < 0.001) with the wheat price index throughout the period. CONCLUSIONS: Infant mortality is particularly sensitive to famine and also to the quality of the food supply available to pregnant and nursing mothers. The lags between neonatal and post-neonatal mortalities and wheat prices, together with the analysis of the famine of 1623, support the hypothesis that neonatal mortality was related to malnutrition in pregnancy whereas post-neonatal mortality was primarily directly dependent on exogenous causes in the first year of life.

England↗
PubMed2004

Mortality patterns among residents in Louisiana's industrial corridor, USA, 1970-99.

BACKGROUND: Because of the high concentration of oil refining and petrochemical facilities, the industrial area of the lower Mississippi River of South Louisiana has been termed the Industrial Corridor and has frequently been referred to as the "Cancer Corridor". AIMS: To quantitatively assess the "Cancer Corridor" controversy based on mortality data available in the public domain, and to identify potential contributing factors to the observed differences in mortality. METHODS: Age adjusted mortality rates were calculated for white and non-white males and females in the Industrial Corridor, Louisiana, and the United States for the time periods 1970-79, 1980-89, and 1990-99. RESULTS: All-cause mortality and all cancer combined for white males in the Industrial Corridor were significantly lower than the corresponding Louisiana population while Louisiana had significantly higher rates than the US population for all three time periods. Cancer of the lung was consistently higher in the Industrial Corridor region relative to national rates but lower than or similar to Louisiana. Non-respiratory disease and cerebrovascular disease mortality for white males in the Industrial Corridor were consistently lower than either Louisiana or the USA. However, mortality due to diabetes and heart disease, particularly during the 1990s, was significantly higher in the Industrial Corridor and Louisiana when compared to the USA. Similar mortality patterns were observed for white females. The mortality for non-white males and females in the Industrial Corridor was generally similar to the corresponding populations in Louisiana. There were no consistent patterns for all cancer mortality combined. Stomach cancer was increased among non-whites in both the Industrial Corridor and Louisiana when compared to the corresponding US data. Mortality from diabetes and heart disease among non-whites was significantly higher in the Industrial Corridor and Louisiana than in the USA. CONCLUSIONS: Mortality rates in the Industrial Corridor area were generally similar to or lower than the State of Louisiana, which were increased compared to the United States. Contrary to prior public perceptions, mortality due to cancer in the Industrial Corridor does not exceed that for the State of Louisiana.

Adolescent↗
PubMed2001

Widening Black/White mortality differentials among US children during the 1980s.

OBJECTIVES: With the exception of infants, mortality rate differentials among Black and White children have received very little attention. We address four empirical questions: 1) Did the Black/White childhood mortality disparity grow between 1980 and 1990? 2) What causes of death account for Black/White disparities in childhood mortality and temporal changes in the size of this disparity? 3) Do economic disparities between Black and White families account for Black/White childhood mortality differentials in 1980 or 1990? 4) Do growing economic disparities between Black and White families explain any growth in childhood mortality differentials? METHODS: Childhood mortality patterns and causes of excess deaths in Black children are examined in the nation overall and in three major metropolitan areas-Chicago, Detroit, and New York-using a dataset combining death certificate and Census data. Logistic regression analyses utilize Census socioeconomic information to identify the relationship between mortality risk and local area income in the metro areas. RESULTS: Black children's relative mortality disadvantage grew more severe during the 1980s, with startling growth in Black/White disparities seen in many age- and sex-specific metro populations. While White children generally experienced marked mortality declines, Black children's rates fell more slowly or actually increased, most dramatically among adolescent boys in Detroit and Chicago. Excess deaths among younger Black children were most often fire-related, while homicide was the predominant cause at older ages. Regression analyses confirmed that areal income was significantly and strongly related to child mortality at both time points in all study areas. However, the deterioration in areal income for Black children relative to Whites from 1980 to 1990 did not explain their worsening mortality rates over the time period. CONCLUSIONS: Black children are increasingly suffering excess deaths relative to White children. We find that Black children's mortality disadvantage is largely accounted for by areal economic disadvantage; however, expanding death rate disparities over time represented more than simply growth in income differentials. Our results suggest that other adverse exposures also have increasingly served to compromise Black children's life chances during the 1980s.

Adolescent↗
PubMed1989

Excess mortality ratio with reference to the lowest age-sex-specific death rates among countries.

Indicators based on mortality data have long been used to measure the level of health status and to monitor and evaluate the progress and achievements of health programmes. Their usefulness is particularly obvious when dealing with preventable deaths. This article proposes the use of the lowest death rate recorded among industrialized countries for each age/sex group as an achievable target and as a reference for assessing the amount of excess mortality. The resulting indicator, excess mortality ratio (EMR), reveals some features of the mortality pattern which may not be easily noticed by means of other mortality indicators. Two sets of the lowest age-sex-specific death rates are considered, namely one comprising the lowest rates recorded in each calendar year (the current minimum) and the other comprising the lowest rates ever recorded since 1950 (the historical minimum). The former may be used for monitoring whether a country is moving ahead in mortality reduction in pace with low mortality countries, while the latter may be considered as a realistic goal for a country's mortality reduction. In computing the EMR, the lowest death rates are first applied to the age-sex composition of the population of a given country for a given calendar year to obtain the number of deaths which would have been expected under the lowest mortality pattern; the expected number is then subtracted from the actual number of deaths recorded in the country during the calendar year to yield the "excess". The indicator is finally calculated by taking the ratio of the excess to the expected minimum. The historical minimum death rates found from the records maintained in WHO's mortality data base are shown in Table 2 (for country codes used, see Table 1). The minimum rates have themselves declined with time as seen in Table 4, especially in young age groups, and the declining trend has been more marked in females. These trends are seen also in individual countries' data (Table 3). A comparison of the cause-of-death pattern of a country with that of the world's lowest death rate will reveal the causes to which the country's excess mortality is attributable, as seen in Table 5. At the same time, the table also shows that even the lowest rates are made up of causes which are largely preventable. The world's lowest rate therefore may be regarded as conservative targets for mortality reduction.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Time-trends and causes of infant, neonatal and postneonatal mortality in Mexico, 1980-1990.

OBJECTIVE: This article analyzes the time-trends and causes of infant, neonatal, and postneonatal mortality in Mexico during the 1980's. MATERIAL AND METHODS: Data on infant deaths came from yearly tabulations (1980 to 1990) published by the Mexican government. Time-trends of mortality rates were determined by simple linear regression models. The parallelism test was performed for evaluating similarities in trends in neonatal and postneonatal mortality rates by causes. RESULTS: During the 1980's, infant mortality rates in Mexico declined from 40.4 to 31.1/1000 (beta = -0.791). Postneonatal mortality rates showed a strong decrease (beta = -0.892), while neonatal mortality rates were almost stationary (beta = 0.089). Significant rate decreases were observed for intestinal infections, Pneumonia and influenza and All other causes while Certain perinatal problems, Congenital defects and Nutritional deficiencies increased. No changes were observed in Acute respiratory infections. The neonatal proportional mortality showed an incremental trend accounting for 37.6% in 1980 and ascending to 48.8% in 1990 of the mortality in the first year of life. CONCLUSIONS: This analysis indicates that the reduction in infant mortality in Mexico during the 1980's was due to declining postneonatal mortality while neonatal mortality rates remain almost unchanged.

Age Factors↗
PubMed1998

State-level infant, neonatal, and postneonatal mortality: the contribution of selected structural socioeconomic variables.

Reducing infant mortality in the United States is a national priority. States' infant mortality rates vary substantially. Public health researchers, practitioners, and leaders have long argued that social and other structural factors must be addressed if health outcomes are to be improved. A knowledge of which structural variables are most strongly related to state-level infant mortality is needed to guide the development of policies and programs to reduce this mortality. The authors examine the importance of several structural (social, economic, and political) variables for state-level infant, neonatal, and postneonatal mortality. With the state as the unit of analysis, data for all 50 states were analyzed using multiple regression. Together, the structural variables accounted for two-thirds of the variance in infant and neonatal mortality rates and over half of the variance in postneonatal mortality rates. States with proportionately larger black populations had higher infant, neonatal, and postneonatal mortality rates. States with greater percentages of high school graduates had lower neonatal mortality rates but higher postneonatal mortality rates. The findings suggest that a better understanding of the relationship between states' social structure and infant health outcomes is needed if state-level infant mortality is to be reduced.

Analysis of Variance↗
PubMed2003

Trends in prostate cancer mortality among black men and white men in the United States.

BACKGROUND: Prostate cancer mortality rates in the United States declined sharply after 1991 in white men and declined after 1992 in black men. The current study was conducted to investigate possible mechanisms for the declining prostate cancer mortality rates in the United States. METHODS: The authors examined and compared patterns of prostate cancer incidence, survival rates, and mortality rates among black men and white men in the United States using the 1969-1999 U.S. prostate cancer mortality rates and the 1975-1999 prostate cancer incidence, survival, and incidence-based mortality rates from the Surveillance, Epidemiology, and End Results (SEER) Program for the U.S. population. The SEER data represent approximately 10% of the U.S. population. RESULTS: Prostate cancer incidence and mortality rates showed transient increases after 1986, when the U.S. Food and Drug Administration approved the use of prostate specific antigen (PSA) testing. The age-adjusted prostate cancer mortality rates for men age 50-84 years, however, have dropped below the rate in 1986 since 1995 for white men and since 1997 for black men. In fact, for white men ages 50-79 years, the 1998 and 1999 rates were the lowest observed since 1950. Incidence-based mortality rates by disease stage revealed that the recent declines were due to declines in distant disease mortality. Moreover, the decrease in distant disease mortality was due to a decline in distant disease incidence, and not to improved survival of patients with distant disease. CONCLUSIONS: Similar incidence, survival, and mortality rate patterns are seen in black men and white men in the United States, although with differences in the timing and magnitude of recent rate decreases. Increased detection of prostate cancer before it becomes metastatic, possibly reflecting increased use of PSA testing after 1986, may explain much of the recent mortality decrease in both white men and black men.

Aged↗
PubMed2003

Mortality from cancer and other causes among male airline cockpit crew in Europe.

Airline pilots and flight engineers are exposed to ionizing radiation of cosmic origin and other occupational and life-style factors that may influence their health status and mortality. In a cohort study in 9 European countries we studied the mortality of this occupational group. Cockpit crew cohorts were identified and followed-up in Denmark, Finland, Germany, Great Britain, Greece, Iceland, Italy, Norway and Sweden, including a total of 28,000 persons. Observed and expected deaths for the period 1960-97 were compared based on national mortality rates. The influence of period and duration of employment was analyzed in stratified and Poisson regression analyses. The study comprised 547,564 person-years at risk, and 2,244 deaths were recorded in male cockpit crew (standardized mortality ratio [SMR] = 0.64, 95% confidence interval [CI] = 0.61-0.67). Overall cancer mortality was decreased (SMR = 0.68; 95% CI = 0.63-0.74). We found an increased mortality from malignant melanoma (SMR = 1.78, 95% CI = 1.15-2.67) and a reduced mortality from lung cancer (SMR = 0.53, 95% CI = 0.44-0.62). No consistent association between employment period or duration and cancer mortality was observed. A low cardiovascular mortality and an increased mortality caused by aviation accidents were noted. Our study shows that cockpit crew have a low overall mortality. The results are consistent with previous reports of an increased risk of malignant melanoma in airline pilots. Occupational risk factors apart from aircraft accidents seem to be of limited influence with regard to the mortality of cockpit crew in Europe.

Accidents, Aviation↗
PubMedDate not supplied

Audit of a rural hospital's coronary care unit: comparison of two predictive instruments of acute myocardial infarction mortality.

The purpose of the study was to compare observed mortality of a rural hospital coronary care unit with mortality rates estimated by two predictive instruments of mortality. The mortality rates of 86 consecutive patients with confirmed acute myocardial infarction were compared with those predicted by the presence or absence of eight risk factors for mortality identified by the Thrombolysis in Myocardial Infarction (TIMI) trial, and mortality predicted by a logistic regression equation LRE). Seventeen patients (20 per cent) died within 6 weeks of admission; the number of TIMI risk factors present predicted a mortality of 9.8 per cent, and the instrument of Selker's predicted a mortality of 25.9 per cent. Patients with 3 TIMI risk factors had a significantly higher mortality than predicted (46.2 versus 13.0 per cent, p < 0.01). There were no significant differences between the receiver operating characteristic (ROC) curve of either instrument. The predictions of Selker's instrument, however, showed no significant difference from observed mortality, even when the patients were grouped into quintiles, and the predicted mortality rates were corrected for any presumed benefit from thrombolysis. The predictive instrument of Selker more consistently estimates observed mortality than the presence of risk factors identified by the TIMI trial.

Aged↗
PubMed2000

Mortality in Western Australian psychiatric patients.

BACKGROUND: The aim was to examine mortality in psychiatric patients in Western Australia (WA), over a time period of considerable change in the delivery of mental health services. METHODS: A population-based record linkage analysis was undertaken to quantify mortality among people with mental illness in WA. Mortality rates were calculated in users of mental health services and compared with rates in the whole population of WA. Trends in mortality were also examined using relative survival analysis, and proportional hazards regression. RESULTS: The overall mortality rate ratio was 2.57 in males (95% CI: 2.51-2.64), and 2.18 in females (2.12-2.24). The highest cause-specific mortality rate ratio was for deaths due to suicide [RR: 7.37 in males (95% CI: 6.74-8.05) and 8.38 in females (95% CI: 7.11-9.89)], with mortality rate ratios being significantly greater than 1 for all other major causes of death. A relative survival analysis found that the excess mortality risk was concentrated in the first few years after first contact with mental health services. Proportional hazards regression analysis found a slight elevation of mortality rates over time. CONCLUSIONS: Mortality among psychiatric patients remains high and appears to be increasing. Highest excess mortality rate is associated with suicide, but mortality rates are significantly elevated for all major causes of death.

Female↗
PubMed2006

Short-term and long-term mortality in very elderly patients admitted to an intensive care unit.

OBJECTIVE: To report short-term and long-term mortality of very elderly ICU patients and to determine independent risk factors for short-term and long-term mortality DESIGN AND SETTING: Retrospective cohort study in the medical/surgical ICU of a tertiary university teaching hospital. PATIENTS: 578 consecutive ICU patients aged 80 years or older. RESULTS: Demographic, physiological, and laboratory values derived from the first 24h after ICU admission. ICU mortality of unplanned surgical (34.0%) and medical patients (37.7%) was higher than that of planned surgical patients (10.6%), as was post-ICU hospital mortality (26.5% and 29.7% vs. 4.4%). Mortality 12 months after hospital discharge, including ICU and hospital mortality, was 62.1% in unplanned surgical and 69.2% in medical patients vs. 21.6% in planned patients. Only median survival of planned surgical patients did not differ from survival in the age- and gender-matched general population. Independent risk factors for ICU mortality were lower Glasgow Coma Scale score, higher SAPS II score, the lowest urine output over 8 h, abnormal body temperature, low plasma bicarbonate levels, and higher oxygen fraction of inspired air. High urea concentrations and admission type were risk factors for hospital mortality, and high creatinine concentration was an independent risk factor for 12-month mortality. CONCLUSION: Mortality in very elderly patients after unplanned surgical or medical ICU admission is higher than after planned admission. The most important factors independently associated with ICU mortality were related to the severity of illness at admission. Long-term mortality was associated with renal function.

Aged↗
PubMed2006

Mortality partitions and their relevance to research on senescence.

The reasons for classifying causes of death into aggregate groups are discussed and the impact of mortality partitions on analyses of mortality is described. Special emphasis is given to a mortality partition that distinguishes between intrinsic causes of death that arise primarily from the failure of biological processes that originate within an organism, and extrinsic causes of death that are primarily imposed on the organism by outside forces. Examples involving mortality data for mice, dogs, and humans are used to illustrate how this mortality partition infuses biological reasoning into mathematical models used to analyze and predict senescent-determined mortality, enhances the information content of the mortality schedules generated from these models, improves mortality comparisons between populations within species separated by time or geographic location, and provides a logical pathology endpoint for making interspecies comparisons of mortality. By bridging biology and the statistics of mortality, a mortality partition based on intrinsic and extrinsic causes of death provides both structure and direction for research on senescent-determined mortality.

Aging↗