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PubMed1987

Mortality of workers in styrene-butadiene polymer production.

A total of 13,920 males who had worked in eight styrene-butadiene rubber polymer manufacturing plants in the US and Canada for at least 1 year were followed for deaths from 1943 when the industry began to 1979. Mortality ratios standardized for age, race, and calendar time using US male rates as a comparison revealed no excess mortality in this population for any cause of death. The overall standardized mortality ratio (SMR) for all causes was 0.81. Only the SMR for arteriosclerotic heart disease among black males showed a significant excess (SMR = 1.28). Examination of risks by major work areas such as production, utilities, maintenance, and other jobs, as well as by salaried and hourly pay grade, revealed no significant differences in cancer mortality by specific sites. Because the ratios for selected digestive cancers were above the all-cause SMR, this group of neoplasms is under further investigation as is the exposure profile of specific jobs within the industry.

Adult↗
PubMed1998

[Mortality of men with occupational lead poisoning in Poland].

The cohort method was used in the study. A retrospective observation covered 4.556 males with occupational disease, manifested by lead poisoning, diagnosed during the years 1970-1992. Mortality risk analysis by causes was based on standardized mortality ratios (SMRs) calculated by person-years method. Their statistical significance was assessed by means of the test based on Poisson distribution. The general adult male population was adopted as the reference population. The state of the cohort as of 31 December 1992 was considered. The cohort accessibility was 95.6%. The study revealed increased total mortality among lead poisoned males (670 deaths; SMR = 108; 95% CI: 100-116). Significant excess mortality was observed in diseases of the digestive system (37 deaths; SMR = 148; 95% CI: 104-204), including chronic hepatitis and cirrhosis (19 deaths; SMR = 173; 95% CI: 104-270); malignant neoplasms of respiratory and intrathoracic organs (82 deaths; SMR = 135; 95% CI: 107-168), including malignant neoplasm of larynx (13 deaths; SMR = 213; 95% CI: 113-364). In the subcohort with high exposure, death risk was significantly enhanced in comparison to the general population (153 deaths; SMR = 129; 95% CI: 109-151). In addition, significant excess of malignant neoplasms was observed (43 deaths; SMR = 151; 95% CI: 109-203) including liver (4 deaths; SMR = 419; 95% CI: 114-1073) and respiratory and intrathoracic organs tumors (21 deaths; SMR = 175; 95% CI: 108-268).

Adult↗
PubMed1997

Low blood pressure and five-year mortality in a Stockholm cohort of the very old: possible confounding by cognitive impairment and other factors.

OBJECTIVES: Low blood pressure has often been reported to be related to excess mortality in people over the age of 75 years. This study examined whether other predictors may account for the association. METHODS: A community-based cohort of 1810 people who were aged 75 years and older was followed for 5 years. RESULTS: The relative risk of death was 1.39 (95% confidence interval [CI] = 1.11, 1.73) for people with systolic pressure lower than 130 mm Hg and 1.21 (95% CI = 1.02, 1.43) for those with diastolic pressure lower than 75 mm Hg, compared with corresponding reference groups, when all other variables were simultaneously considered in Cox proportional hazards models. The observed association was present mainly in subjects with at least two of the three conditions (cardiovascular disease, limitation in activities of daily living, or cognitive impairment). The effect of low diastolic pressure on mortality was also significant in those with only cognitive impairment. CONCLUSIONS: Preexisting cardiovascular disease, limitation in activities of daily living, and, more important, cognitive impairment may be responsible for the association of low blood pressure with increased mortality in the very old in that they cause both reductions in blood pressure and excess deaths.

Activities of Daily Living↗
PubMed1997

A cohort mortality study of foundry workers.

Since the 1970s, hygienic improvements have led to a reduction in the level of airborne pollutants in Danish foundries. This mortality study reflects the exposure situation prior to 1970, and the findings may be used as a baseline for future evaluations of the preventive impact of reduced exposure. Mortality data were derived from a historical cohort study in which 3,056 foundry workers were compared with 43,024 workers employed in other industries. The foundry workers' life-long risk of dying from pneumoconioses averaged 2% and the corresponding standardized mortality ratio (SMR) equaled 7,368 (95% confidence interval (95% CI): 4,029-12,363). Excess mortality was also seen for chronic bronchitis and emphysema (SMR = 132, 95% CI: 98-185). Nonsignificant increases were seen for buccal cancer, stomach cancer, colon cancer, and urothelial cancer. In conclusion, Danish foundry workers exposed prior to 1970 seem to suffer an excess risk of devastating lung disease of occupational origin.

Adolescent↗
PubMed1977

Mortality from pneumonia and risk conditions during influenza epidemics. High influenza morbidity during nonepidemic years.

Increases in mortality from pneumonia and high-risk chronic diseases have not occurred during recent influenza epidemics. Excess mortality during the past four influenza epidemics in the United States is attributable to influenza reported as a primary cause of death, and the average excess was only about 4,000 deaths per epidemic. Most clinical influenza severe enough to cause hundreds of millions of days of bed disability during nonepidemic as well as epidemic years is not caused by the influenza viruses. During the nonepidemic year of 1973 to 1974, there were 61,841,000 episodes of clinical influenza severe enough to put people to bed for an average of 3.6 days. In my judgment there is now no basis for recommending annual administration of influenza vaccines to so-called high-risk groups and persons over 64 years of age.

Age Factors↗
PubMed2001

Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature.

BACKGROUND: No recent attempt has been made to synthesise information on mortality and dementia despite the theoretical and practical interest in the topic. Our objective was to estimate the influence on mortality of cognitive impairment and dementia. METHODS: Data sources were Medline, Embase, personal files and colleagues' records. Studies were considered if they included a majority of persons aged 65 and over at baseline either drawn from a total community sample or drawn from a random sample from the community. Samples from health care facilities were excluded. The search located 68 community studies. Effect sizes were extracted from the studies and if they were not included in the published studies, effect sizes were calculated where possible: this was possible for 23 studies of cognitive impairment and 32 of dementia. No attempt was made to contact authors for missing data. RESULTS: For the studies of cognitive impairment Fisher's method (a vote counting method), gave a p-value (from eight studies) of 0.00001. For studies of dementia, age-adjusted confidence intervals (CI) were pooled (odds ratio (OR) 2.63 with 95% CI 2.17 to 3.21 from six studies). CONCLUSIONS: Levels of cognitive impairment commonly found in community studies give rise to an increased risk of mortality, and this appears to be true even for quite mild levels of impairment. The analysis confirms the increased risk of mortality for dementia, but reveals a dearth of information on the causes of the excess mortality and on possible effect modification by age, dementia subtype or other variables.

Age Distribution↗
PubMed1999

Impact of glycaemic control, hypertension and insulin treatment on general and cause-specific mortality: an Italian population-based cohort of type II (non-insulin-dependent) diabetes mellitus.

The aims of this study were to assess the impact of diabetes and associated variables (fasting plasma glucose, blood pressure, antidiabetic treatment, body mass index) on general and cause-specific mortality in an Italian population-based cohort with Type II (non-insulin-dependent) diabetes mellitus, comprising mainly elderly patients. The patients (n = 1967) who had Type II diabetes were identified in 1988 with an 80% estimated completeness of ascertainment. In 1995, a mortality follow-up (98% completeness) of the cohort was done amounting to a total of 11153 person-years. Observed and expected number of deaths were 577 and 428.7, respectively, giving a standardized mortality ratio (SMR) of 1.35 (95% CI 1.24-1.46). The most common underlying causes of death were malignant neoplasm, ischaemic heart disease and cerebrovascular diseases, which accounted for 18%, 17.8% and 17.5% of deaths, respectively. Cardiovascular disease as a whole (international classification of disease ICD-9 390-459) accounted for 260 of 577 deaths (SMR 1.21, 95% CI 1.07-1.36). In internal analysis, the most important predictors of general mortality were insulin-treatment (relative risk [RR] 1.72, 95% CI 1.19-2.49) and a fasting plasma glucose greater than 8.89 mmol/l ([RR] 1.29, 95 % CI 1.04-1.60), whereas the most important predictors of cardiovascular diseases were insulin-treatment and hypertension. In conclusion, this population-based study showed: 1) slight mortality excess of 35% in Type II diabetes being associated with 2) a 30% increased mortality in subjects with baseline fasting glucose greater than 8.89 mmol/l and 3) a 40% increased risk of death from cardiovascular diseases in hypertensive patients.

Aged↗
PubMed1984

Issues in the natural history and treatment of coronary heart disease in black populations: medical management.

Data from multiple sources indicate that the death rate for blacks is higher than for the general population-in part because of higher mortality from cardiovascular causes. The Cardiovascular Mortality Survey, carried out in Los Angeles, indicates that the combined effects of increased mortality from high blood pressure and related causes (e.g. stroke, cerebrovascular disease), together with an ischemic heart disease mortality rate that is only a little below the mean, accounts for the overall excess mortality rates in blacks. In addition, black patients have been shown to have higher risk profiles compared with the study mean in a large study of beta-blocker therapy, and a definite treatment effect was demonstrated. Further prospective studies of natural history and response to therapy are indicated for appropriately selected patient groups.

Adult↗
PubMed1991

Long-term unemployment and mortality in Sweden, 1980-1986.

The mortality of a cohort of long-term unemployed men and women in Sweden (N = 28,846) was followed up during the period 1980-1986. Compared to a population of employed, the total mortality rate ratios (with 95% confidence limit) were 1.37 (1.22-1.53); for men 1.61 (1.42-1.84) and for women 1.14 (0.91-1.42). The young/middle-aged men had about four times higher relative mortality than all men. Suicide and alcohol-related deaths could not explain the excess mortality among these men. It is discussed whether the high risks for young/middle-aged men could be an effect of mental disturbances due to unemployment followed by high psycho-social stress. The effect of employment status on social and psychological identity may be greater for men than for women, for whom there may be more compensatory factors.

Adult↗
PubMed2006

High mortality in diabetic patients with acute myocardial infarction: cardiovascular co-morbidities contribute most to the high risk.

BACKGROUND: High mortality rates have been reported in diabetic patients after acute myocardial infarction (AMI). The excess mortality has been attributed to the diabetic state itself. We aimed to investigate how other risk factors along with diabetes per se may predict mortality in an unselected AMI population. METHODS: A representative sample of an unselected AMI population was collected over a three-month period. Data on patients' histories, co-morbidity, presenting features and treatment were collected from medical records. The data sets included outcome variables at discharge, after 6 months and after 2.5 years. Patients with confirmed diabetes on admission to hospital were registered as diabetic patients. RESULTS: Of the 901 patients admitted to hospital with AMI, 121 (14%) were diabetic patients. Compared with the nondiabetic patients significantly fewer of the diabetic patients were alive at discharge (78% vs 86%), after 6 months (64% vs 78%) and after 2.5 years (42% vs 65%). In multiple logistic regression analyses adjusted for age, sex and smoking status, the most important predictor of death at 2.5 years was heart failure, followed by previous MI, diabetes, and angina pectoris. The population attributable risk (PAR) of death after 2.5 years was 7% for diabetes, 17% for previous MI, 13% for heart failure and 12% for angina pectoris. CONCLUSION: Among patients with diabetes suffering an AMI the already established cardiovascular co-morbidities, which previously partly or fully might have been caused by diabetes, contributed more than diabetes per se to high mortality in-hospital and in the follow-up period.

Aged↗
PubMed2001

Causes of death in autism.

The objective of this study was to determine which causes of death are more frequent in persons with autism, and by how much, compared with the general population. Subjects were 13,111 ambulatory Californians with autism, followed between 1983 and 1997. The units of study were person-years, each linked to the subject's age, sex, and cause of death (if any) for the specific year. Observed numbers of cause-specific deaths were compared with numbers expected according to general population mortality rates. Standardized mortality rates (SMRs) were computed for each mental retardation level. Elevated death rates were observed for several causes, including seizures and accidents such as suffocation and drowning; elevated mortality due to respiratory disease was observed among persons with severe mental retardation. Overall, excess mortality was especially marked for persons with severe mental retardation, but life expectancy is reduced even for persons who are fully ambulatory and who have only mild mental retardation.

Adolescent↗
PubMed2002

A prospective study of adiposity and all-cause mortality: the Malmö Diet and Cancer Study.

OBJECTIVE: This study aims to examine the association between various measures of adiposity and all-cause mortality in Swedish middle-aged and older men and women and, additionally, to describe the influences of age and sex on these associations. RESEARCH METHODS AND PROCEDURES: A prospective analysis was performed in a cohort of 10,902 men and 16,814 women ages 45 to 73 years who participated in the Malmö Diet and Cancer Study in Sweden. Baseline examinations took place between 1991 and 1996, and 982 deaths were documented during an average follow-up of 5.7 years. All-cause mortality was related to the following variables measured at baseline: body mass index (BMI), percentage of body fat, lean body mass (LBM), and waist-to-hip ratio (WHR), with adjustment for age and selected covariates. Body composition data were derived from bioelectrical impedance analysis. RESULTS: The association between percentage of body fat and mortality was modified by age, particularly in women. For instance, fatness was associated with excess mortality in the younger women but with reduced mortality in the older women. Weaker associations were seen for BMI than for percentage of body fat in both sexes. Placement in the top quintiles of waist-to-hip ratio, independent of overall body fat, was a stronger predictor of mortality in women than in men. The observed associations could not be explained by bias from early death or antecedent disease. DISCUSSION: The findings reveal sex and age differences for the effects of adiposity and WHR on mortality and indicate the importance of considering direct measures of adiposity, as opposed to BMI, when describing obesity-related mortality risks.

Adipose Tissue↗
PubMed2000

Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade.

BACKGROUND: Thrombocytopenia is infrequently associated with abciximab therapy but may contribute to hemorrhagic risk. Factors associated with development of thrombocytopenia, the role of weight-adjustment in concomitant heparin administration, and clinical outcomes in patients with thrombocytopenia are not well defined. METHODS AND RESULTS: Pooled data from 3 placebo-controlled, randomized trials (EPIC, EPILOG, and EPISTENT) of abciximab therapy during percutaneous coronary intervention identified 178 patients (2. 4% of 7290 patients) in whom thrombocytopenia (platelet count <100 x 10(9)/L) developed after enrollment. Multivariate regression analysis identified age (>65 years; P <.001), weight (<90 kg; P =. 023), baseline platelet count (<200 x 10(9)/L; P <.001), abciximab therapy (P =.002), and enrollment into the EPIC trial (P <.001) to be associated with development of thrombocytopenia. Major and minor nonsurgical hemorrhage and transfusion were more frequent (all P <. 001) in thrombocytopenic patients. Although the primary composite clinical end point of these trials (death, myocardial infarction, or urgent revascularization to 30 days) was observed with similar frequency in patients with (11.2%) and those without (7.9%; P =.114) thrombocytopenia, 30-day mortality rate was higher in thrombocytopenic patients (8.4% vs 0.6%, respectively; P <.001). This excess mortality rate persisted after excluding patients in whom thrombocytopenia was first noted after the performance of coronary bypass surgery (4.8% vs 0.6%; P <.001). Among patients in whom thrombocytopenia developed during these trials, those who received prophylactic abciximab had fewer primary end point events (7.1% vs 23.1%; P =.056) and had a lower 30-day mortality rate (3.5% vs 15.4%; P =.048) than patients with thrombocytopenia who had received prophylactic placebo. CONCLUSIONS: Thrombocytopenia associated with abciximab therapy for percutaneous coronary intervention was more frequent in older, lighter-weight patients, those with lower baseline platelet counts, and in those patients who were enrolled into the EPIC trial. Both bleeding and transfusion events occur more frequently in patients with thrombocytopenia. Patients in whom thrombocytopenia developed during these trials had increased mortality rates to 30 days not attributable to the performance of coronary bypass surgery. Among patients with thrombocytopenia, those who received prophylactic abciximab had better clinical outcomes including survival than those who did not.

Abciximab↗
PubMed2000

Reproductive history and mortality later in life: a comparative study of England and Wales and Austria.

Does a woman's reproductive history influence her life span? This study explores the question with data from the contemporary female populations of England and Wales and Austria. It is the first comparative study to investigate the relationship between fertility and mortality late in life. We find similar patterns and age-specific trends of excess mortality in both populations: parity significantly influences longevity, as do both an early and a late birth. These differences in longevity are not explained by differences in educational or family status. The impact of a woman's reproductive history on her life span is small, however, compared to the influence of her level of education or family status.

Austria↗
PubMed2005

Mortality and mental illness.

BACKGROUND: The finding by Lawrence, Holman and Jablensky (Duty to Care) that mortality among the mentally ill in Western Australia was 2.5 times that of the general population, seemingly, has great significance for public policy concerning the mentally ill. 'Mortality' could be a useful outcome measure for mental health services. OBJECTIVES: To replicate that study in the Australian Capital territory (ACT), comparing mortality rates in the mentally ill with those of the total population. METHOD: A list of all people who contacted the ACT mental health services between 1985 and 2000 was compiled. Using the national register of deaths (Australian Institute of Health and Welfare), persons known to the mental health services who died between 1990 and 2000 were identified and sex, date of birth, date of death, cause of death and place of death were noted. Using Australian Bureau of Statistics data for all deaths in the ACT, deaths in the total population and in the mentally ill population were tabulated for the period 1996-2000. With 1996 data as the base, using total population data from the ABS and mental health population data derived by amending 'the list' to remove duplications, pre1996 deaths and post1996 additions, mortality rates for the period 1996-2000 were compared. RESULTS: The gender and age distribution of the mentally ill population and the total population, and of deaths in those populations, were very different. One third of all deaths in the mentally ill occurred outside of the ACT. Compared with the general population, mortality in the mentally ill (including deaths outside of the ACT) was only slightly excessive for 'all causes' and ischaemic heart disease but grossly excessive for 'suicide'. CONCLUSIONS: This study did not confirm the excessive mortality rate in the mentally ill reported by Lawrence et al. except for suicide. Many methodological issues in using population studies to attempt to measure the size of the increase were identified. Differences in method between the ACT and WA studies probably explain the differences in results. Caution is urged in using the results of mortality studies as determinants of public policy or to evaluate services.

Adolescent↗
PubMed1996

Body mass index and disability pension in middle-aged men--non-linear relations.

BACKGROUND: Obesity has, in a number of studies, been found to correlate to disability and mortality, primarily due to diseases of the circulatory and musculoskeletal systems. In addition, an excess mortality among underweight subjects has been observed in previous studies. METHODS: Five complete birth-year cohorts (1926-1930) of male residents in Malmö (n = 7697) were invited to the survey at the Department of Preventive Medicine, Malmö General Hospital, and 5926 (77%) attended with complete data. Each subject was followed from inclusion, defined by the date of examination, until the end of the calendar year when he turned 58, a total study period of approximately 11 years. Data on about 300 questionnaire items and laboratory tests were determined at the health survey visit. Nationwide Swedish data registers were used for surveillance. RESULTS: Of the participants, 4.7% were underweight, 37.7% overweight, 7.3% obese and 50.3% normal weight; 849 (14.3%) had been granted disability pension at the end of follow-up, 717 after screening. After adjustment for smoking there was a J-shaped relation between body mass index (BMI) and incidence of disability pension, the relative risk ( with the normal group as reference) among underweight men being 1.9. For the overweight subjects it was 1.3 and for the obese 2.8, all differences were significant. Disease of the musculoskeletal and circulatory systems and mental disorders accounted for 67.2% of all main diagnoses resulting in disability pensions during follow-up. A total of 377 (6.4%) men died during follow-up. Diseases of the circulatory system, neoplasms, injury/poisoning and diseases of the respiratory system accounted for 91.8% of the deaths. CONCLUSIONS: Both underweight, overweight and obesity were related to risk of disability pension, with a J-shaped risk relationship.

Body Mass Index↗
PubMed1981

Cancer of the larynx and other occupational hazards of mustard gas workers.

An attempt was made to tract 511 men and women who manufactured mustard gas during the 1939--1945 war. Despite limitations in the identifying data available, 428 (84%) were traced to the end of 1974. The numbers of deaths from all neoplasms combined (45) and from all other causes (136) were slightly greater than those expected from national death rates, but not significantly so. Two deaths were attributed to carcinoma of the larynx and one to carcinoma of the trachea, compared with an expected number of 0.40 (P less than 0.02). Carcinoma of the larynx was also mentioned on the death certificate of another man. Seven subjects are known to have developed cancer of the larynx, compared with 0.75 expected (P less than 0.001). Excess mortality was also observed from cancer of the lung, pneumonia and accidents, but the excesses were small and difficult to interpret.

Adult↗
PubMed1998

The Austin Doyle Lecture, High Blood Pressure Research Council of Australia. Renal disease as a metaphor: towards a more integrated view of aboriginal health.

1. The health of Aboriginal people in the Northern Territory of Australia is among the worst in the world, with mortality rates increased in every 'disease-specific' category and averaging overall approximately five-fold those of non-Aboriginal Australians. Health services, which in most regions are rudimentary, fragmented and under-resourced, have been slow to recognize and meet this challenge. However, the cost implications of an epidemic of renal failure have stimulated concern that broader mortality statistics could not. 2. In one high-risk Aboriginal community, we found that renal disease can be detected and its course chartered by a simple and reliable screening test. Renal disease arises out of a broad menu of risk factors that reflect poverty, disadvantage and accelerated lifestyle changes and its expression is progressively amplified with the simultaneous operation of more than one risk factor. It is intimately related to other 'diseases' through shared risk factors and pathophysiology. We also found that people with established renal disease participated enthusiastically in a pharmacological treatment programme, with excellent clinical responses that predict a marked reduction in renal failure and cardiovascular morbidity and mortality over the intermediate term. 3. It is likely that most other causes of excess mortality in Aboriginal people are, like renal disease, multideterminant, with a substantial base of shared risk factors. They are probably equally susceptible to modification. We must move away from 'single-cause' disease models, eliminate counterproductive specialty barriers and rectify the unbalanced focus and resource commitment to hospital-based, high technology treatments of people with advanced and irreversible disease. We must advocate for coherent, sustained, integrated public health and primary care programmes to improve the whole health profile and for screening and treatment programmes to modify the course of disease in people already afflicted.

Albuminuria↗