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PubMed1997

Hodgkin's disease: complications of therapy and excess mortality.

BACKGROUND: The long-term survival of patients treated for Hodgkin's disease permits careful evaluation of long-term complications and excess mortality. PATIENTS AND METHODS: Between 1960 and 1995, 2498 patients who were treated for Hodgkin's disease at Stanford University were evaluated. Survival, freedom from relapse, and important complications of therapy (cardiac disease and secondary cancers) were analyzed, and risk of mortality from all causes was calculated utilizing absolute excess risk calculations. RESULTS: The risk of death from Hodgkin's disease is 17% at 15 years of follow-up and increases only slightly thereafter. The risk of death from other causes is also 17% at 15 years, but increases sharply thereafter. The major causes of mortality (other than Hodgkin's disease) are secondary cancers and cardiac disease. Second cancers with significant increase in risk include leukemia (acute nonlymphocytic), non-Hodgkin's lymphoma, lung/pleural cancer, breast cancer, melanoma, soft tissue and bone sarcomas, stomach cancer, salivary gland tumors, thyroid cancer, and pancreatic cancer. The absolute excess risk of death from causes other than Hodgkin's disease increases during each five-year follow-up interval for at least 25 years. However, the absolute excess risk of death during similar follow-up periods is less for patients treated in more recent years (1980-1995) than in the prior treatment era (1962-1980). CONCLUSIONS: Mortality for causes other than Hodgkin's disease is important in the long-term follow-up of patients. Causes of death are often treatment related. Changes in treatment programs can reduce the long-term excess risk of death from complications of therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

Excess mortality among male unskilled and semi-skilled workers. A negative slope with age.

Mortality for male unskilled and semi-skilled workers in Denmark, Norway, and England and Wales is 40-50%--about the average for all men with equivalent economic status in the younger age groups, but declines towards the average at pensionable age. The negative slope of the graph for relative mortality with age would seem to be due to an excess mortality deriving from accidents and violent deaths predominantly in the younger age groups, to an unfavourable recruitment into the labour force, health-wise, to an exclusion of older, unhealthy persons from the labour force and to a mortality from circulatory diseases almost equal to the average for other social groups. Finally, movements between social groups should be taken into account in the analysis of mortality differences.

Adolescent↗
PubMed2003

Persistent excess mortality from lung cancer in patients with stage I non-small-cell lung cancer, disease-free after 5 years.

Among patients with non-small-cell lung cancer (NSCLC), those with pathological stage I have the best expectation of survival; however, survival is reduced to less than 50% in the long term. At present, it is unclear when patients can be reasonably defined as cured, and if they experience a higher incidence of malignant/nonmalignant diseases and a lower expectation of survival than the general population. A total of 134 stage I NSCLC patients, who had undergone resection at the Thoracic Surgery Unit of the General Hospital of Verona (north-eastern Italy) from October 1987 to December 1993, were still disease-free at 5 years. These subjects were further followed up, and morbidity and mortality rates were compared with those recorded in the general population of the same geographical area. The standardised incidence ratios (SIRs) for all malignancies and for lung cancer were higher than expected (2.39, 95% CI=1.6-3.5, P<0.001; 10.1, 95% CI=6.2-15.6, P<0.0001, respectively). The standardised mortality ratio (SMR) was also significantly increased (1.73, 95% CI=1.1-2.6, P=0.013). The excess mortality could be entirely explained by an increase in mortality from lung cancer (5.7, 95% CI=2.8-10.1, P<0.0001). This study shows that patients, resected for pathological stage I NSCLC and tumour-free after 5 years, have a higher incidence of new lung cancer compared with the general population, which in turn determines an excess in all-cause mortality in the following years.

Adult↗
PubMed1993

Excess mortality after early exposure to measles.

The impact of exposure to measles before 6 months of age has been investigated by comparing survival to 5 years of age for exposed children and controls in an urban (Bandim) and a rural (Quinhamel) area of Guinea-Bissau. In Bandim, cumulative mortality from time of exposure to age 5 years was 34.4% among exposed children and 9.3% among controls. In a matched pair analysis, exposed children had a mortality ratio (MR) of 3.80 (95% confidence interval [CI]: 1.42-10.18) compared with controls. In an unpaired analysis using Cox' regression model to standardize for background variables (sex, measles infection, age at exposure, exposure from own household, measles vaccination), there was little change in the MR (3.84, CI: 1.55-9.48). Even after 2 years of age, the exposed children tended to have higher mortality (MR = 7.96, CI: 0.98-64.74). In the rural area, the MR between exposed children and controls was 11.39 (CI: 1.42-91.51). Limited serological data suggest that at least some of the exposed had subclinical measles. In the urban area, where two studies of early exposure have been carried out, excess mortality among exposed children corresponds to 40% and 52%, respectively, of the acute measles mortality. Since these deaths would not be associated with measles in a study of protection against death after vaccination, measles immunization may have a much greater effect on childhood mortality than has previously been assumed.

Age Factors↗
PubMed1973

Use of excess mortality from respiratory diseases in the study of influenza.

Since 1970, WHO has conducted a collaborative study on the use of "excess mortality" from respiratory diseases (that is, the number of deaths actually recorded in excess of the number expected on the basis of past seasonal experience) in order to assess in 13 different countries the severity of influenza epidemics. The use of computer-produced seasonal expected and actual curves permits quick visual assessment of influenza activity in any one country, as well as comparisons between different countries. The study demonstrates that an excess in the observed over the expected number of total deaths does not necessarily indicate an excess in deaths from influenza, and it is therefore limited, at least for the present time, to deaths from respiratory disease. It provides a week-to-week record of deaths from acute respiratory disease in countries where weekly returns are available and a retrospective analysis of the disease pattern in the collaborating countries. This study will be continued for a number of years and, apart from its value to the individual countries, should provide useful comparisons between countries with different climates.

Asia↗
PubMedDate not supplied

[Excess mortality in an inner-city area: the case of Ciutat Vella in Barcelona].

The purpose of this study is to compare mortality indicators in the district of Ciutat Vella (the more socio-economically deprived in Barcelona) with the entire city, for the 1983-87 period. Crude death rates, as well as age, sex and cause-specific deaths rates were calculated from vital statistics data; life expectancy, years of potential life lost (YPLL), the Comparative Mortality Figure (CMF) and avoidable mortality rates were also computed. All indicators point out at an excess of mortality in Ciutat Vella, when compared to the whole city. Life expectancy was 73 years (4 years less than for Barcelona as a whole); infant mortality was 15.6 per 1,000 births (as opposed to 9 for Barcelona). The CMF was 129 (95% confidence interval: 126.2-131.8), while the YPLL ratio was 182.1 (95% confidence interval: 173.1-191.8), mainly attributed to excess mortality due to tuberculosis, cirrhosis and to homicides and drug-related deaths. The percentage of avoidable deaths was 9.5% in Ciutat Vella compared with 8.23% for Barcelona as a whole. These data confirm the need to actively pursue intervention programs to improve health in Ciutat Vella, although further small-area analysis at the level of neighbourhood and of health care areas would be advisable.

Age Factors↗
PubMed1997

Asthma in Hawaii: a tradition of excess mortality.

Hawaii has the highest asthma mortality in the nation and clinically has always had high rates. In contrast, international consensus has it that deaths have been rare over the past two centuries to 1950. The objective of this study was to document Hawaii's asthma mortality over the centuries to 1950. Asthma mortality was examined from pre- and early European times through kahunas, aphorisms, historical libraries, and materia medica. In 1879, vital statistics became available locally and from 1901 from the federal government. Asthma deaths were not rare in ancient Hawaii. Vital statistics in 1879 revealed an asthma mortality of 83/100,000 which declined to 4.0 by 1950. U.S. and international mortality, at least to 1930, was almost unknown. Compared to U.S. and international rates, Hawaii's asthma mortality has been excessive since ancient days.

Adolescent↗
PubMedDate not supplied

Shortening of life span and causes of excess mortality in a population-based series of subjects with rheumatoid arthritis.

OBJECTIVES: To obtain information on the shortening of the life span and the causes of excess death in a population-based series of subjects with rheumatoid arthritis (RA). METHODS: The study included all 1666 subjects who had died in Finland in 1989 and were entitled under the nationwide sickness insurance scheme to receive specially reimbursed medication for RA. Demographic data on the Finnish population and sickness insurance statistics were used as the basis for computations. RESULTS: The life span in subjects with RA was shortened by 15-20% from the date of onset of illness. The determinants of excess mortality could be studied in females. About 40% of the excess deaths were due to cardiovascular causes, 30% to infections, 15% to amyloidosis, and the remaining 15% to diverse causes. CONCLUSION: This data provides an enlightened basis for understanding mortality associated with RA.

Aged↗
PubMed1986

Excess mortality from stomach cancer, lung cancer, and asbestosis and/or mesothelioma in crocidolite mining districts in South Africa.

To determine whether exposure to crocidolite is associated with excess mortality, the authors calculated standardized mortality ratios based on deaths in South African crocidolite mining districts from 1968 to 1980 for selected causes of death. Contiguous districts were used as controls. To take account of background geographic variability, they divided the control districts into groups of population size similar to those of the crocidolite mining districts. Standardized mortality ratios in crocidolite mining districts were elevated for asbestosis and/or mesothelioma, and cancer of the lung and stomach. These findings could not be explained by background geographic variability in mortality and are likely to be due to exposure to South African crocidolite during mining and milling or to environmental contamination. The increased standardized mortality ratios for stomach cancer are of particular interest, since excess deaths have not previously been shown in individuals exposed to crocidolite alone.

Adolescent↗
PubMed2002

Excess mortality or institutionalization after hip fracture: men are at greater risk than women.

OBJECTIVES: To assess 2-year excess mortality or institutionalization risk associated with hip fracture in community-dwelling people aged 60 and over. DESIGN: Cohort study. SETTING: Auckland, New Zealand, from July 1991 to February 1996. PARTICIPANTS: Five hundred sixty-five community-dwelling older people recently hospitalized with a hip fracture and 782 randomly selected controls, frequency matched for age and gender, living in the same catchment area as the cases. MEASUREMENTS: Two-year mortality or institutionalization status. RESULTS: Over half (52.1%) of male hip fracture cases and 12.4% of male controls were dead or institutionalized, compared with 39.2% of female hip fracture cases and 19.7% of female controls. The odds ratio, adjusted for baseline demographic characteristics, medical status, and physical function, for death or institutionalization was 6.89 (95% confidence interval (CI) = 2.75-17.27) for men and 1.48 (95% CI = 1.02-2.19) for women. CONCLUSIONS: For both men and women who incur a hip fracture, the risks of dying or being institutionalized within 2 years are higher than for their peers. The independent effect of hip fracture on this outcome was significantly greater for men than women. The marked influences of prefracture health status, physical limitations, and gender on outcome have important implications for preventative strategies.

Activities of Daily Living↗
PubMed1987

The HCFA excess mortality lists: a methodological critique.

The Health Care Financing Administration recently released a list of hospitals with allegedly excessive mortality rates. This paper examines and explains several flaws in the mortality study that are important to consider for proper interpretation and understanding of the HCFA results.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1980

Excessive mortality and causes of death in morbidly obese men.

A group of 200 morbidly obese men (average weight, 143.5 kg; age, 23 to 70 years) were admitted to a weight control program between 1960 and 1977 and were followed up for a mean period of 7 1/2 years. There was complete follow-up until the termination of the study or until death for 185 men. Fifteen men were followed up for fractional periods. Fifty of the 200 died during the course of the study. Life-table techniques, comparing the mortality among the obese with that among men in the general population, demonstrated a 12-fold excess mortality in the obese in the age group 25 to 34 years and a sixfold excess in the age group 35 to 44 years. This ratio diminished with advancing age. Cardiovascular disease was reported as the cause of death more frequently and malignancies less frequently than they were for men in the US general population.

Adult↗
PubMed1995

Interpreting excess mortality in a prevention trial for older adults.

BACKGROUND: In a randomized trial evaluating preventive services for older adults excess mortality was observed in the treatment group. We examined four explanations: unbalance of baseline characteristics, unintended effects of the intervention, consequence of an autonomy intervention (including increased number of living wills in the treatment group), and chance. We focus here on the effects of the autonomy intervention. METHODS: Preparation of living wills in the treatment and control groups was compared both at baseline and follow-up. A linear predictor of mortality was used to identify participants at high risk of dying. Charts of these 200 participants were reviewed for evidence of serious medical events and resuscitation decisions. Rates of life-sustaining treatment were compared between treatment and controls using logistic regression. RESULTS: More living wills (65%) were noted for the treatment group than control group (47%) at follow-up. Thirty-six per cent of participants were identified as having a serious medical event; of these, participants in the treatment group were over twice as likely not to receive life-sustaining treatment. CONCLUSIONS: Advance directives contributed to excess deaths, indicating the success of the autonomy intervention.

Advance Directives↗
PubMed1990

Excess mortality by natural causes of Italian schizophrenic patients.

The risk of mortality over a 5- to 8-year period for a total 1-year prevalence cohort of schizophrenic patients extracted by means of the South-Verona Psychiatric Case Register (Italy) was assessed using three methods: (1) case control with both non-psychotic patients and the general population matched for sex and age; (2) indirect standardization using mortality tables; (3) a recently described method using survival tables. All methods yielded an excess mortality associated with schizophrenia, close to the two-fold increase described in other studies, while the survival tables method produced a higher standardized mortality ratio (SMR). The increased SMR did not appear solely attributable to suicide. Most deaths were attributable to natural causes. This is a departure from other recently reported mortality studies. The possible reasons are discussed.

Adult↗
PubMed1998

Contribution of smoking to excess mortality in Harlem.

The New York City neighborhood of Harlem has mortality rates that are among the highest in the United States. In absolute numbers, cardiovascular disease and cancer account for the overwhelming majority of deaths, especially among men, and these deaths occur at relatively young ages. The aim of this research was to examine self-reported smoking habits according to measures of socioeconomic status among Harlem men and women, in order to estimate the contribution of tobacco consumption to Harlem's remarkably high excess mortality. During 1992-1994, in-person interviews were conducted among 695 Harlem adults aged 18-65 years who were randomly selected from dwelling unit enumeration lists. The self-reported prevalence of current smoking was strikingly high among both men (48%) and women (41%), even among highly educated men (38%). The 21% of respondents without working telephones reported an even higher prevalence of current smoking (61%), indicating that national and state-based estimates which rely on telephone surveys may seriously underestimate the prevalence of smoking in poor urban communities. Among persons aged 35-64 years, the smoking attributable fractions for selected causes of death were larger in Harlem than in either New York City as a whole or the entire United States for both men and women. Tobacco consumption is likely to be one of several important mediators of the high numbers of premature deaths in Harlem.

Adolescent↗
PubMed2006

Socioeconomic position and excess mortality during the heat wave of 2003 in Barcelona.

The objective of this study is to determine whether the excess of mortality which occurred in Barcelona during the summer of 2003 was dependent on age, gender and educational level. We included all deaths among Barcelona residents 20 years of age and older that occurred in the city during the months of June, July and August of 2003 and also during the same months of the five preceding years. Poisson regression models were fitted to obtain the risk of death in 2003 with respect to the period 1998-2002. The relative risk (RR) of mortality during the summer of 2003, compared to the summers of the previous 5 years, was higher for women than for men and among older ages. Although an increase among women was observed in all educational groups, in some age groups the increase was larger for people with less than primary education. The excess number of deaths was higher for those with less education. These results suggest that age, gender and educational level were important determinants of excess mortality in the 2003 Barcelona heat wave.

Adult↗
PubMed2002

Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis.

OBJECTIVE: To investigate the occurrence of extraarticular manifestations (ExRA) in a well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine their effect on mortality. METHODS: Using the resources of the Rochester Epidemiology Project, a retrospective medical record review was conducted of a cohort of 424 cases of RA in Olmsted County, MN, USA, diagnosed during the period 1955-1985. These cases had been classified using the American College of Rheumatology 1987 criteria for RA. Patients were followed 1955-1998 (median followup 14.8 yrs; range 0.2-42.8 yrs), and incident ExRA manifestations were recorded according to predefined criteria. Data on comorbidities were extracted using the definitions of the Charlson comorbidity index. Survival was compared to the general population using Kaplan-Meier estimates. RESULTS: ExRA occurred in 169 patients, corresponding to an incidence rate of 3.67/100 person-yrs. Compared to the general population, survival among patients with RA was decreased. Survival among patients with ExRA was markedly decreased compared to the general population and to patients without ExRA (p < 0.001). A particularly poor prognosis was noted in a subgroup of 63 patients (incidence rate 1.04/100 person-yrs) who fulfilled predefined criteria for severe ExRA (i.e., vasculitis, pericarditis, pleuritis, and/or Felty's syndrome). For RA patients who did not fulfill these criteria, there was no significant increase of mortality (p = 0.09). In a multivariate model of mortality, including age, sex, and the presence of known comorbidities, the presence of one or more of these ExRA was the strongest predictor of mortality. CONCLUSION: In this first community based study of extraarticular manifestations in RA, virtually all the excess mortality occurred in a subgroup of patients with severe extraarticular disease, suggesting that extraarticular disease is the major predictor of mortality in patients with RA.

Age Factors↗
PubMed1995

[Maternal mortality and birth distribution: a possible explanation of excess mortality in France].

Maternal mortality is higher in France than in most European countries with the same health standards. The analysis of the French rates shows that the changes, between 1975 and 1991, in the birth distribution according to the age of the mothers, explain 14% of all maternal deaths in 1991. The proportion of livebirths from mothers aged 30 years and over has increased from 21% in 1976 to 37% in 1991 in France and only 32% in England and Wales. For the period 1988-1990, crude maternal mortality was 9.4 per 100,000 livebirths in France and 7.4 in England and Wales. Direct standardization removes differences between birth distributions of each country and allows to calculate a standardized mortality rate of 8.6 for the French data. The variation between the crude and the standardized French rates is explained by the fact that 18 of the 210 deaths for the considered period were associated to the older mother's age distribution than in England and Wales.

Adult↗