Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MORTALITY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,135 records · Page 63Linked to original sources
PubMedDate not supplied

Mortality of a cohort of road construction and maintenance workers with work disability compensation.

BACKGROUND: Surveillance systems of occupational mortality are useful tools to identify cases of diseases suspected as occupational and to monitor their occurrence over time, in space and in population subgroups. Many surveillance systems make use of administrative data in which information about occupations and/or economic sectors of the subjects enrolled is reported, such as death certificates, hospital discharge data, census data, tax and pension records, and workers' compensation archives. OBJECTIVES: In the present study we analyzed the mortality of a cohort of road construction and maintenance workers enrolled through the Italian national archive of work disability compensations, also in order to evaluate the possible use of this administrative source to monitor occupational mortality. METHODS: 8,000 subjects (7,879 males) receiving a disability compensation while working in the "road construction and maintenance" sector were identified from INAIL (National Institute for Insurance of Accidents at Work) archives. Vital status of these subjects was ascertained using the information available in INAIL archives and in the national tax register. For those found to be deceased from INAIL or tax archives, or without any information on vital status, a mail follow-up was started. We considered as observation period the years from 1980 to 1993. A record linkage with the ISTAT (Italian Institute of Statistics) national mortality registry was performed and the cause of death was retrieved for 964 out of 1,259 subjects. The analysis was restricted to males, leaving altogether 863 observed deaths with ascertained cause (84.7% of 1,019 total male deaths). SMR for overall mortality and PMR for specific cause mortality were computed, using the general Italian male population as reference. RESULTS: Overall mortality was significantly reduced (SMR = 79.0; 95% CI = 74.2-84.0). Proportional mortality analysis revealed significant excess risks for all malignant tumours (332 deaths, PMR = 1.08) and for digestive diseases (87 deaths, PMR = 1.34), while mortality for cardiovascular diseases was significantly decreased (288 deaths, PMR = 0.90). Among specific causes of death, significant excess mortality was found for cancer of testicles (2 deaths, PMR = 5.98), liver and biliary ducts (32 deaths, PMR = 1.40), and for silicosis (10 deaths, PMR = 3.07) and cirrhosis (64 deaths, PMR = 1.40). CONCLUSIONS: The excess mortality observed for all cancers, digestive diseases and silicosis, and the decreased risk for cardiovascular diseases are in agreement with the results of other studies conducted on workers in road construction and maintenance. As expected, the low overall mortality and the reduced risk from cardiovascular diseases indicate that these workers present a strong "healthy worker effect".

Cause of Death↗
PubMed2005

Mortality study of policies on insured lives with diabetes mellitus known at time of issue.

BACKGROUND: This is an Impairment Study Capture System (ISCS) study of contemporary diabetes mellitus mortality among insured lives. Because the diagnosis and treatment of diabetes has changed during the last 15 years, many applicants may be expected to exhibit more favorable outcomes than in the past. The study covers policy-years durational experience extending to only 10 years. METHODS: We analyzed the total mortality experience of 41,972 insurance policies. The policies were issued at standard or substandard premium rates between 1989 and 2002 policy anniversaries. The number of policies terminated by death (actual deaths) is compared with expected deaths using the 2001 Valuation Basic Table (2001 VBT). Main outcome measures are expressed as mortality ratios (MR %) and excess death rates/1000 (EDR/M). Poisson confidence intervals are used to test the statistical significance of mortality ratios at the 95% confidence limit. RESULTS: The total experience is based on 103,104 policy-years exposure: males 57,888 policy-years (56%) and females 45,216 policy-years (44%). There were 495 policy-deaths 284 male and 211 female. Substandard risks represented the majority of the total exposure, 76,658 policy-years in both sexes combined (male 56%, female 44%). The mean duration of substandard exposure was 2.3 years. Total mortality for all insured age-groups and risk categories combined was 187%. The mortality ratios for policies rated standard had confidence intervals that were consistent with 100% of the 2001 VBT. The mortality ratios for policies rated substandard had confidence intervals that were above 100% of the 2001 VBT. Mortality ratios varied with the type of treatment. They were lowest in those treated with diet alone and highest in individuals treated with diet plus insulin. CONCLUSION: A clinical diagnosis of diabetes continues to demonstrate evidence of increased, but improving, mortality in insured individuals. The underwriting risk appraisal process effectively categorizes the risk, especially for the substandard classes where the ratings assigned to policies were consistent with the mortality results. The lack of significant differences in the mortality ratios between males and females as well as between nonsmokers and smokers indicate that the early duration variations by gender and smoking status in the 2001 VBT account for these differences in early duration diabetes mortality. Subsequent follow-up studies containing longer durations may show these differences emerging. Results must be interpreted with caution because of the small data set, limited number of ISCS participating companies, and durational experience extending to only 10 policy years.

Adolescent↗
PubMed1991

[Epidemiology of stroke in urbans and rural areas of China: an analysis of stroke mortality rates in 1986].

This paper reported the stroke mortality rates in China in 1986.5 790,864 people from 199 locations sampling from all parts of China (the Taiwan province un-investigated) were investigated and 4,446 cases of death were found. The mortality rate was 76.78 per 10(5) people and its 95% CI was 74.42-79.04/10(5). The mortality rate adjusted using population composition of the cities and rural areas of China in 1986 was 77.15/10(5). The mortality rate standardized by direct method use in the China population in 1982 was 57.25/10(5) and the mortality rate standardized use in the world standard population was 80.94/10(5). The mortality rates of the great regions and provinces were counted respectively, and the relationship between the mortality rates and the geographical locations were analyzed in the correlation and the regression. It was found that there were a relationships of positive correlation and liner regression between the mortality rates and the latitude degree and the longitude, that was to say, the mortality rates increased gradually from south to north and decreased progressively from east to west in China. The stroke mortality rates in the cities were higher than in the rural areas, and in the city districts higher than in its outskirts in the big cities. Then the distribution of case number in months was analyzed using the methods of the test for trend and circular distribution, a peak of that was significantly in the statistics was found in January although it was not very high. The stroke mortality rates were gradually arose as age increasing, and the relationship between the mortality rates and age may be fitted with the logistic curve.

Adult↗
PubMed1991

Impact of unstable angina on operative mortality with coronary revascularization at varying time intervals after myocardial infarction.

We have performed a retrospective study of patients undergoing coronary artery bypass grafting for postinfarction angina in an effort to determine the influence of recency of myocardial infarction and unstable angina on operative mortality. Time from myocardial infarction to bypass was arbitrarily divided into five intervals. Nine hundred ninety-three patients having isolated coronary bypass for postinfarction angina were analyzed, and a significant trend of increased operative mortality with recency of myocardial infarction was found (p less than 0.001). When patients were operated on during the time interval zero to 24 hours after infarction, the operative mortality rate was 18.6%. In the interval from 1 day to 1 week after infarction, the operative mortality rate was 7.4%; 1 week to 3 weeks, 5.9%; and 3 weeks to 3 months, 2.7%. In patients operated on more than 3 months after infarction, the operative mortality rate was 3.9%. The operative mortality rate in 360 patients with postinfarction stable angina was 0.83% compared with 7.3% in 633 patients with postinfarction unstable angina (p less than 0.001). Of 18 risk factors tested, 12 were found by univariate analysis to be independent predictors of operative mortality, including recency of myocardial infarction and unstable angina. Stepwise logistic regression analysis of independent predictive variables revealed that unstable angina, previous surgical revascularization, preoperative hypotension, nonelective surgery, preoperative cardiac arrest, and female sex were the strongest predictors of mortality; recency of myocardial infarction was not a factor. When acute surgical reperfusion is not the primary treatment strategy for patients with myocardial infarction, operative mortality with coronary bypass is increased with the recency of myocardial infarction. The reason for this increase in operative mortality is a patient selection process in which those with persistent or intermittent myocardial ischemia, as reflected in the clinical syndrome of unstable angina, are selected for operation. Unstable angina is a major determinant of operative mortality after myocardial infarction. In patients with stable angina, operative mortality is not increased by the recency of myocardial infarction.

Adult↗
PubMed1990

[Myocardial infarction mortality among men 30-69 years of age in Norwegian counties 1966-87].

The article describes mortality from ischaemic heart disease, including sudden, unexpected death, among males aged 30-69 years in all 19 Norwegian counties for the period 1966-87. During this period, the age-adjusted mortality rate in Norway for the 30-69 year age group was highest in 1966-70, and declined by 15% until 1983-87. The decline in mortality was greatest in the 40-49 year age group, but was also clearly evident in the 50-59 and 60-69 year groups. In twelve of the counties there was a statistically significant (p less than 0.05) decrease in mortality from 1966-70 to 1983-87. In one county, Oppland, located in central south-eastern Norway, mortality increased by 19% (p less than 0.01). The increased mortality in this county was most prominent in the 50-59 year group (34%, p less than 0.01). The most favourable change in mortality took place in Rogaland, in south-western Norway, where mortality decreased by 29% (p less than 0.001) from 1966-70 to 1983-87. Positive changes in mortality were also seen in Finnmark, a county with traditionally very high mortality rates. This study was not designed to explain the regional differences in mortality, but the authors point to principal explanatory factors. The regional differences in mortality time trends might be an argument for geographical differentiation of preventive measures.

Adult↗
PubMed1988

Factors affecting mortality in transduodenal sphincteroplasty.

An analysis of 1,200 consecutive transduodenal sphincterotomies performed between 1967 and 1985 is presented herein. The over-all mortality rate was 3.75 per cent. Since 1980, however, the mortality rate has decreased to 2.1 per cent. The mortality rate was influenced by the age of the patient at the time of the operation (p less than 0.005). Furthermore, the mortality rate increased from decade to decade (less than 30 years, zero per cent; greater than 70 years, 6 per cent). The operative mortality rate was also influenced by general risk factors--hypertony (mortality rate of 5.8 per cent, not significant), diabetes (mortality rate of 6.5 per cent, p congruent to 0.05), renal failure (15.5 per cent, p less than 0.005), jaundice (bilirubin level in survivors, 78.3 micromoles per liter and in those who died, 120.4 micromoles per liter, p less than 0.005) and vital indication (mortality rate of 15 per cent, p less than 0.01). Although the indication for sphincterotomy had a small influence on the mortality (papilla stenosis without bile duct stones, 1.7 per cent; papilla stenosis with common duct stones, 3.6 per cent, and impacted stones in the papilla, 5.0 per cent), these small differences are not significant. A significant influence, however, was due to complicating intraoperative findings, such as bilioenteral fistulas (a mortality rate of 10.8 per cent, p less than 0.0005). The fact that the mortality rate increased in patients with T-tube insertion shows that operative problems and complications influence the mortality rate for sphincterotomy. From these results, we concluded that, in the aforementioned risk groups, a preoperative endoscopic sphincterotomy should be strongly considered, as the risk from the surgical procedure is diminished by the endoscopic relief of the obstruction of the biliary tract.

Adult↗
PubMedDate not supplied

Excess mortality in small dialysis centers. The result of dialyzing high-risk patients.

End Stage Renal Disease Network 12 regularly collects information describing the Medicare dialysis population within its boundaries (Iowa, Nebraska, Missouri, and Kansas). Hoping to foster a regional quality improvement program, Network 12 began calculating provider specific mortality rates in 1988. These rates were extremely variable, but small dialysis units (< or = 30 patients) generally had higher mortality rates than their larger counterparts. To determine why mortality rates were inversely proportional to the number of patients treated within the center, we undertook a more intensive statistical review of patient mortality rate within the network. Actual and expected mortality rates were derived for each Network 12 dialysis center. Forty-eight percent of dialysis centers served 30 or fewer patients (small centers), and 40% had an expected mortality rate < or = 5 deaths per year. In 1989 and 1990, the crude mortality rate for dialysis centers enrolling 30 or fewer patients exceeded that of larger dialysis centers (p = 0.02). When Standardized Mortality Ratios were analyzed, this relationship disappeared (p = 0.83). Statistical review of dialysis providers is a complex process. Adjusting mortality rates for patient characteristics known to influence survival obviated the relation of dialysis unit size to patient mortality rate within Network 12. This suggests that patients were not randomly assigned to dialysis units and that small providers enrolled a disproportionate number of high risk patients. Adjusting mortality rates for endemic patient characteristics did not reduce the extreme variability noted in small mortality rates. This uncertainty, embedded in probability theory, cannot be eliminated from the statistical analysis of small samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodialysis Units, Hospital↗
PubMed1996

Factors associated with perioperative mortality in dogs with surgically managed gastric dilatation-volvulus: 137 cases (1988-1993).

OBJECTIVE: To evaluate factors associated with perioperative mortality in dogs with gastric dilatation-volvulus and to determine the influence of treatment differences between university and private specialty practices on outcome. DESIGN: Retrospective analysis of medical records. ANIMALS: 137 dogs with gastric dilatation-volvulus. PROCEDURE: Signalment; frequency of preoperative and postoperative treatments and complications; intraoperative findings; surgical technique; and hematologic, serum biochemical, and electrocardiographic results were recorded, evaluated for association with mortality, and compared between institutions. RESULTS: Mortality did not differ between institutions, and overall mortality was 18% (24/137). Surgical techniques differed between institutions, but were not associated with mortality. Gastric necrosis was associated with significantly higher mortality (46%; 13/28). When partial gastrectomy or splenectomy was performed, mortality (35 and 32% or 8/23 and 10/31, respectively) was significantly increased. Splenectomy was performed in 11 of 23 dogs requiring partial gastrectomy, and when both procedures were performed, mortality (55%; 6/11) was significantly increased. Preoperative cardiac arrhythmias were associated with significantly higher mortality (38%; 6/16). Mortality in dogs > 10 years old was not significantly greater than that in younger dogs. CLINICAL IMPLICATIONS: Patient management differences between practices did not seem to influence survival in dogs with surgically managed gastric dilatation-volvulus. Signalment, including age, did not influence mortality. Gastric necrosis, gastric resection, splenectomy, and preoperative cardiac arrhythmias were associated with mortality > 30%.

Animals↗
PubMed1996

[Mortality in non-specific respiratory tract inflammation and bronchial obstructive diseases in relation to the environment in the Czech Republic].

BACKGROUND: Despite antibiotic treatment the mortality from inflammations of the airways is still high in our country and worldwide. The objective of the present work is a review of the mortality from respiratory diseases with regard to their prevalence, in relation to gender in the whole Czech Republic and in different regions, in Prague and in southern and northern Bohemia. METHODS AND RESULTS: During the last years the order of mortality from respiratory diseases is as follows: lung cancer, chronic bronchitis and pneumonia, whereby in men the first place is held by lung cancer, in women by pneumonia. In 1992-1994 in the Czech Republic the relative mortality rate from acute bronchitis (bronchiolitis). pneumonia and influenza combined was 24.8, 20.7 and 20.6/100,000 population. In Prague the increment of this mortality was as follows: in 1993-13.5/100,000, in 1994-14.8/100,000. A marked increase was recorded in southern Bohemia (from 16.9 to 26.0) but a drop in northern Bohemia (from 14.5 to 12.2/100,000 population). In 1992 and 1993 in the Czech Republic the number of deaths from diseases associated with respiratory infections -influenza, pneumonia, acute bronchitis (bronchiolitis) and diseases associated with bronchial obstruction (chronic bronchitis, bronchial asthma and pulmonary emphysema) was balanced. In 1994 there was a marked drop in the mortality from diseases with bronchial obstruction as compared with 1993-N 2104/679. In 1994, as compared with 1992 and 1993, the mortality relation in these two groups was reversed and in 1994 mortality from respiratory infections predominates markedly over mortality from obstructions. In Prague infections predominate 1.6 times, in northern Bohemia 1.5 times and in southern Bohemia as much as 3.8 times. CONCLUSIONS: In the Czech Republic the mortality from acute bronchitis (bronchiolitis), pneumonia and influenza combined was in 1993 and 1994 20.7 and 20.6 per 100 000 population. In 1994 the mortality from diseases associated with bronchial obstruction declined markedly, while the mortality from respiratory infections increased in southern Bohemia.

Bronchitis↗
PubMed1998

Ischemic heart disease and stroke mortality in African-American, Hispanic, and non-Hispanic white men and women, 1985 to 1991.

We compare recent trends in ischemic heart disease (IHD) and stroke mortality in California among the 6 major sex-racial or -ethnic groups. Rates of age-specific and -adjusted mortality were calculated for persons aged 35 and older during the years 1985 to 1991. Log-linear regression modeling was performed to estimate the average annual percentage change in mortality. During 1985 through 1991, the mortality for IHD and stroke was generally highest for African Americans, intermediate for non-Hispanic whites, and lowest for Hispanics. Age-adjusted mortality for IHD declined significantly in all sex-racial or -ethnic groups except African-American women, and stroke rates declined significantly in all groups except African-American and Hispanic men. African Americans had excess IHD mortality relative to non-Hispanic whites until late in life, after which mortality of non-Hispanic whites was higher. Similarly, African Americans and Hispanics had excess stroke mortality relative to non-Hispanic whites early in life, whereas stroke mortality in non-Hispanic whites was higher at older ages. The lower IHD and stroke mortality among Hispanics was paradoxical, given the generally adverse risk profile and socioeconomic status observed among Hispanics. An alarmingly high prevalence of self-reported cardiovascular disease risk factors in 1994 to 1996, particularly hypertension, leisure-time sedentary lifestyle, and obesity, is a serious public health concern, with implications for future trends in cardiovascular disease mortality. Of particular concern was the growing disparities in stroke and IHD mortality among younger-aged African Americans relative to Hispanics and non-Hispanic whites.

Adolescent↗
PubMed1996

Pregnancy-related mortality in the United States, 1987-1990.

OBJECTIVE: To use data from the Centers for Disease Control and Prevention's (CDC) Pregnancy-Related Mortality Surveillance System to examine trends in pregnancy-related mortality and risk factors for pregnancy-related death. METHODS: In collaboration with ACOG and state health departments, the Pregnancy-Related Mortality Surveillance System has collected information on all deaths caused by pregnancy since 1979. Multiple data sources were used, including national death files, state health departments, maternal mortality review committees, individuals, and the media. As part of the initiation of the Pregnancy-Related Mortality Surveillance System in 1987, CDC staff contacted state health department personnel and encouraged them to identify and report pregnancy-related deaths. Data were reviewed and coded by experienced clinicians. Pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births) were calculated. RESULTS: After decreasing annually after 1979, the reported pregnancy-related mortality ratio increased from 7.2 in 1987 to 10.0 in 1990. This increase occurred among women of all races. A higher risk of pregnancy-related death was found with increasing maternal age, increasing live-birth order, no prenatal care, and among unmarried women. The leading causes of pregnancy-related death were hemorrhage, embolism, and hypertensive disorders of pregnancy. During the periods 1979-1986 and 1987-1990, the cause-specific pregnancy-related mortality ratios decreased for deaths due to hemorrhage and anesthesia, whereas pregnancy-related mortality ratios due to cardiomyopathy and infection increased. The leading causes of death varied according to the outcome of the pregnancy. CONCLUSION: Increased efforts to identify pregnancy-related deaths have contributed to an increase in the reported pregnancy-related mortality ratio. More than half of such deaths, however, are probably still unreported. Adequate surveillance of pregnancy-related mortality and morbidity is necessary for interpreting trends, identifying high-risk groups, and developing effective interventions.

Adolescent↗
PubMed2003

Mortality trends for 23,505 Medicare patients hospitalized with heart failure in Northeast Ohio, 1991 to 1997.

BACKGROUND: Clinical trials have identified major therapeutic advances for heart failure (HF), but the degree to which survival has improved among the general population of patients with HF is not known. This study analyzed mortality trends from 1991 to 1997 for 23,505 Medicare patients hospitalized with a first admission for HF at 29 Northeast Ohio hospitals. METHODS: We linked databases from the Cleveland Health Quality Choice (CHQC) program and Medicare to allow identification of first admissions for HF and death date. We adjusted for changes in admission illness severity using chart data from CHQC (eg, vital signs, do-not-resuscitate status, comorbid conditions, and laboratory results). Logistic regression was used to analyze trends in risk-adjusted mortality. RESULTS: At baseline (1991), crude inhospital, 30-day and 1-year mortality rates were 6.4%, 8.6% and 36.5%, respectively. Between 1991 and 1997, mean length of stay declined steeply from 9.2 days to 6.6 days (P <.001 for trend). Risk-adjusted inhospital mortality also declined markedly (absolute-decline -3.7%, 95% CI -4.3 to -3.0), a 52.8% relative decrease. However, the decline in 30-day mortality was only -1.4% (95% CI -2.5 to -0.1, P <.05), a 15.3% relative decrease. The 1-year mortality declined -5.3% (95% CI -3.2 to -7.4, P <.001), a 14.6% relative decrease. CONCLUSIONS: Long-term mortality for patients hospitalized with HF improved from 1991 to 1997, although mortality remains very high. The 30-day mortality declined far less than inhospital mortality, indicating that mortality shortly after discharge increased. This raises concerns that the marked reduction in length of stay is causing adverse consequences.

Aged↗
PubMed1997

Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study.

BACKGROUND: Plausible projections of future mortality and disability are a useful aid in decisions on priorities for health research, capital investment, and training. Rates and patterns of ill health are determined by factors such as socioeconomic development, educational attainment, technological developments, and their dispersion among populations, as well as exposure to hazards such as tobacco. As part of the Global Burden of Disease Study (GBD), we developed three scenarios of future mortality and disability for different age-sex groups, causes, and regions. METHODS: We used the most important disease and injury trends since 1950 in nine cause-of-death clusters. Regression equations for mortality rates for each cluster by region were developed from gross domestic product per person (in international dollars), average number of years of education, time (in years, as a surrogate for technological change), and smoking intensity, which shows the cumulative effects based on data for 47 countries in 1950-90. Optimistic, pessimistic, and baseline projections of the independent variables were made. We related mortality from detailed causes to mortality from a cause cluster to project more detailed causes. Based on projected numbers of deaths by cause, years of life lived with disability (YLDs) were projected from different relation models of YLDs to years of life lost (YLLs). Population projections were prepared from World Bank projections of fertility and the projected mortality rates. FINDINGS: Life expectancy at birth for women was projected to increase in all three scenarios; in established market economies to about 90 years by 2020. Far smaller gains in male life expectancy were projected than in females; in formerly socialist economies of Europe, male life expectancy may not increase at all. Worldwide mortality from communicable maternal, perinatal, and nutritional disorders was expected to decline in the baseline scenario from 17.2 million deaths in 1990 to 10.3 million in 2020. We projected that non-communicable disease mortality will increase from 28.1 million deaths in 1990 to 49.7 million in 2020. Deaths from injury may increase from 5.1 million to 8.4 million. Leading causes of disability-adjusted life years (DALYs) predicted by the baseline model were (in descending order): ischaemic heart disease, unipolar major depression, road-traffic accidents, cerebrovascular disease, chronic obstructive pulmonary disease, lower respiratory infections, tuberculosis, war injuries, diarrhoeal diseases, and HIV. Tobacco-attributable mortality is projected to increase from 3.0 million deaths in 1990 to 8.4 million deaths in 2020. INTERPRETATION: Health trends in the next 25 years will be determined mainly by the ageing of the world's population, the decline in age-specific mortality rates from communicable, maternal, perinatal, and nutritional disorders, the spread of HIV, and the increase in tobacco-related mortality and disability. Projections, by their nature, are highly uncertain, but we found some robust results with implications for health policy.

Adolescent↗
PubMed1998

Mortality from birth to adult life: a longitudinal study of twins.

We have examined mortality from birth through adult life in a cohort of 2562 twins born in Birmingham, UK, between 1950 and 1954. Their birthweights and obstetric details had been recorded as part of a longitudinal study of births in Birmingham. There were a total of 151 perinatal deaths (perinatal mortality rate = 116 per 1000 births) and 227 infant deaths (infant mortality rate = 94 per 1000 live births). 70 deaths occurred after the age of one year. In comparison with national mortality rates in the UK, overall mortality in the twins was high (standard mortality rate, SMR = 259, 95% CI 221-300). Mortality was highest in the first year of life and, although it then declined progressively, it remained significantly higher that that of the general population until age 5 years. The excess mortality was largely due to conditions originating in the perinatal period but there were excess rates of congenital abnormalities, diseases of the respiratory system, digestive system and nervous and sensory organs. A Cox proportional Hazards analysis showed that the risk of death was related to low birthweight, prematurity and male sex. Death of the co-twin was highly predictive of mortality throughout the period of follow up. These studies not only underline the excess mortality associated with twin birth but show for the first time that this excess mortality extends into childhood.

Adolescent↗
PubMed2006

Levels and differentials in childhood mortality in South Africa, 1977-1998.

This study uses the 1996 Census and the 1998 Demographic and Health Survey (DHS) to investigate the level of and trend in infant and child mortality and their covariates in South Africa. Census estimates of childhood mortality are higher than those from the DHS. Analysis suggests that the former overestimate mortality while the latter are probably slightly too low. Both inquiries document a reversal of the trend toward lower mortality in the 1990s. Under-five mortality increased by about a third during the five years up to early 1998. By then the infant mortality rate was about 55 per 1000 and under-five mortality 72 per 1000. Other factors may explain the tapering off of the decline in mortality after the late 1980s but AIDS deaths account for its increase. Inequalities in childhood mortality between population groups, rooted in past discriminatory apartheid policies, shrank between the late-1970s and mid-1990s. However, they remain substantial and are largely unaccounted for by province, metropolitan residence and inter-group differences in mothers' education. The HIV/AIDS epidemic is likely to offset the beneficial impact of post-apartheid pro-poor policies and may exacerbate racial differences in childhood mortality in South Africa. There is an urgent need to improve the routine collection of statistics to monitor child mortality so as to assess progress towards the Millennium Development Goals and track inequalities.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Sex differences in measles mortality: a world review.

BACKGROUND: In general females have a lower mortality than males at all ages. Excess female mortality has been documented in certain high mortality situations, in particular in South Asia. However, females may have a higher mortality for certain causes of death. One of the causes of death for which excess female mortality is suspected is measles. METHOD: Sex differences in measles mortality are investigated using all national data on causes of death published by WHO since 1950. An index of excess mortality is used: the geometric mean of the female sex ratios of age-specific deaths rates from measles, from age 0 to 44 years. RESULTS AND CONCLUSIONS: When pooled together, the results show an excess of female mortality from birth until age 50 years. The excess female mortality appears small at age 0-4 (+4.2%), larger at age 5-14 (+10.9%) and peaks during the female reproductive period, at age 15-44 (+42.6%). This pattern of excess female mortality occurs in all the major regions of the world: Europe, North and South America, Far-East Asia, the Middle East and South Asia. The only noticeable exceptions are the Philippines and Thailand. The validity of the finding is extensively reviewed. Emphasis lies on the statistical power to prove that sex differences in measles mortality do exist, on the critical analysis of a case study in England and Wales, on the comparison with the overall pattern of sex differences and on available data on sex differences in incidence. Possible explanations are reviewed.

Adolescent↗
PubMed2004

Contemporary patterns of Pacific Island mortality.

BACKGROUND: The Pacific Island countries are at different stages of the demographic and epidemiological transitions. The availability of accurate and current mortality data is of vital importance for priority setting in health. Available mortality data generally underestimate death rates among both children and adults. In many Pacific Island populations, little is reliably known about levels and causes of death, particularly among adults. METHODS: The results of two comprehensive approaches to obtaining mortality estimates are reported. First, a systematic review of available life expectancy and infant mortality information reported by countries from 1990 onwards was undertaken and evaluated with respect to quality, and a final "best estimate" was established. Methods were based on registered deaths and indirect demographic methods. The second approach consisted of a demographic evaluation of vital registration data for completeness, with death rates adjusted accordingly, or where vital registration was not available, the application of new model life table methods to generate life tables from estimates of child mortality, as used by the World Health Organisation (WHO). RESULTS: This analysis reveals substantial uncertainty about mortality conditions in Pacific Island populations. In some countries, life expectancy variations of 10 years or more were recorded in the 1990s, depending on the source. Best approaches suggest that life expectancy (at birth) varied considerably, from levels of around 55-60 years in some Melanesian and Micronesian states to levels above 70 years in low-mortality countries. The principal issues with regard to uncertainty around mortality levels include underenumerated vital registration data; annual stochastic fluctuations in mortality in small populations; errors in the imputation of adult mortality from infant and childhood rates; implausible results from indirect demographic methods; use of possibly inappropriate model life tables to adjust death data or for indirect methods; and inadequately described and implausible projections. The WHO model life table method based on adjusted vital registration generally yielded results similar to those suggested by an evaluation of published data, with some exceptions, which are further discussed. CONCLUSIONS: This study indicates the urgent need to improve infrastructure, training, and resources for routine mortality estimation in many Pacific Island countries in order to better inform and evaluate health and public policy.

Adult↗
PubMed1996

Mortality in Micronesian Nauruans and Melanesian and Indian Fijians is not associated with obesity.

The association of obesity with mortality was investigated in population-based samples of Micronesian Nauruans (n = 1,400), Melanesian Fijians (n = 1,279), and Indian Fijians (n = 1,182), over 10 years from 1982 in Nauru, and 11 years from 1980 in Fiji. At the end of follow-up, vital status was known for all Nauruans and all but 3.5% of Fijians. Mortality rates were higher in Nauru than Fiji, and in Melanesians than Indians. The mean body mass index of decedents was similar to or less than (Nauruan men, p < 0.001) that of survivors in each sex-ethnic group. Crude mortality rates showed an inverse relation with body mass index in Nauruan men, with inconsistent relations in other sex-ethnic groups. After stratification by diabetes status, there was no relation between mortality and obesity in nondiabetic subjects, but an inverse relation was observed among diabetic subjects in each population. These findings persisted even after the exclusion of subjects who died within the first 2 years of follow-up. After controlling for age, smoking, and diabetes status in Cox proportional hazard models, body mass index (as a continuous variable) was not related to mortality in any sex/ethnic group and tended to be negatively associated with mortality risk. Interactions of body mass index with age, smoking, and diabetes status were not significant. Mortality risk was significantly increased in older subjects and in diabetic subjects, and cigarette smoking also increased risk in some groups. Stratification of analyses according to cigarette smoking did not alter the nature of the results. The association of mortality and body mass index categorized by quartiles was also investigated. After adjusting for age alone, or age, smoking, and diabetes status, the lower quartiles of body mass index were consistently associated with the highest relative risk for mortality. Quadratic terms for body mass index did not improve Cox models in subjects with normal glucose tolerance. Relations with cardiovascular disease mortality were also assessed and results were inconsistent, although positive trends were observed in Nauruan women (p = 0.02) and Melanesian men (p = 0.06). Overall, there was little evidence to suggest that obesity was a risk factor for total or cardiovascular mortality in these populations. However, obesity is clearly associated with a high risk of diabetes and other morbid conditions and at least on this basis it would seem desirable to prevent obesity in these and other Pacific populations.

Adult↗