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PubMed2006

A critical analysis on Italian perinatal mortality in a 50-year span.

BACKGROUND: Perinatal mortality rate is used as an indicator of reproductive health worldwide. In western countries, national mortality registers are usually accurate and reliable. METHODS AND AIMS: We reviewed the data recorded in the past 50 years in Italy on perinatal and infant mortality. Each single class of mortality rate (according to WHO definitions) was assessed on temporal trends allowing a critical speculative analysis, mainly focusing on the last 20 years, in an attempt to evaluate the impact of prenatal diagnosis. RESULTS: Infant mortality rate (IMR) constantly decreased in the study period whereas early neonatal mortality rate progressively diminished in a 5-year comparison till the early 1990s. Perinatal mortality showed a linear negative trend until the 1980s, after which the decrease steadied at about 23% in the following 5-year period. Infant mortality attributable to congenital anomalies throughout a 20-year span (1980-2000) was steady at about 23% although a progressive reduction in general infant mortality was reported. CONCLUSIONS: A higher reduction in neonatal and perinatal mortality rate was found before the wide availability of the ultrasonographic prenatal diagnosis and the introduction of the law on voluntary abortion in Italy. Given these data, it seems that advances in neonatal care have improved the infant survival rates more than prenatal diagnosis, whereas obstetric care is linked to a reduction of the early perinatal mortality rate.

Congenital Abnormalities↗

PubMed2006

Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: a statewide experience.

OBJECTIVE: The purpose of this study was to determine the 30-day and 365-day mortality for the repair of thoracoabdominal aortic aneurysms (TAA), when stratified by age, in the general population. These data provide clinicians with information more applicable to an individual patient than mortality figures from a single institutional series. METHODS: Data were obtained from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1991 to 2002. These data were linked to the state death certificate file, allowing for continued information on the status of the patients after hospital discharge. All patients undergoing elective and ruptured TAA repair as coded by International Classification of Diseases, 9th Clinical Modification (ICD-9, CM) in California were identified. Patients aged <50 or >90 years old were excluded. We determined 30- and 365-day mortality and stratified our findings by decade of patient age (eg, 50 to 59). Demographics of elective and ruptured cases were also compared. RESULTS: We identified 1010 patients (797 elective, 213 ruptured) who underwent TAA repair. Mean patient ages were 70.0 (elective) and 72.1 years (ruptured). Men comprised 62% of elective and 68% of ruptured aneurysm patients, and 80% (elective) and 74% (ruptured) were white. Overall elective patient mortality was 19% at 30 days and 31% at 365 days. There was a steep increase in mortality with increasing age, such that elective 365-day mortality increased from about 18% for patients 50 to 59 years old to 40% for patients 80 to 89 years old. The elective case 31-day to 365-day mortality ranged from 7.8% for the youngest patients to 13.5%. Mortality for ruptured cases was 48.4% at 30 days and 61.5% at 365 days, and these rates also increased with age. CONCLUSIONS: Our observed 30-day mortality for TAA repairs is consistent with previous reports; however, mortality at 1 year demonstrates a significant risk beyond the initial perioperative period, and this risk increases with age. These data reflect surgical mortality for TAA repair in the general population and may provide more useful data for surgeons and patients contemplating TAA surgery.

Age Distribution↗

PubMed2006

Trends, complications, and mortality in peripheral vascular surgery.

BACKGROUND: The recent evolution in treatments for peripheral vascular disease has dated available mortality statistics for vascular intervention. Moreover, many of our current mortality statistics are derived from single-institution studies that are often not reflective of outcomes in general practice. To provide current and generalizable data regarding mortality and trends for peripheral vascular interventions, we examined two national data sets (Nationwide Inpatient Sample, 1998-2003, and National Hospital Discharge Survey, 1979-2003) and four states (New York, California, Florida, and New Jersey, 1998-2003). METHODS: Four procedures--abdominal aortic aneurysm repair (nonruptured), lower extremity revascularization, amputation, and carotid revascularization--were selected by cross-referencing International Classification of Diseases, 9th Revision, diagnostic and procedural codes. For significance, the t test was used for continuous variables, the chi2 test was used for dichotomous variables, and the chi2 test was used for mortality trends. RESULTS: From 1998 to 2003, there was a progressive decrease in the national per capita rate of amputations: 13.2% overall and 21.2% for major amputations (P < .0001). Nationally and regionally, mortality has only slightly declined. For lower extremity revascularization, after a sharp increase during the 1980s to 100,000 open procedures, the volume remained constant for 10 years and began to decline in 1998, reaching 70,000 cases in 2003. In contrast, since 1996, endovascular interventions have increased 40%. Mortality during the 1998 to 2003 period remained virtually stable at 1.5% to 2% for endovascular procedures and 3% to 4% for open procedures. The overall volume of abdominal aortic aneurysm repair has not changed substantially for the past 6 years; however, endovascular repair is now used for nearly half the cases (46.5% regional and 43.0% national). Mortality for open repair has not changed, remaining at approximately 5%, whereas for endovascular repair, mortality has declined from 2.6% in 2000 to less than 1.5% in 2003. After the rapid increase in open carotid revascularization in the early 1990s, the total volume has declined 5% nationally from 1998 to 2003. Regional data demonstrated an overall 12% reduction in carotid revascularization volume since 1998; this reduction was due to a 16% decline in open carotid revascularization. During this same period, the use of angioplasty-stent carotid revascularization doubled. Mortality for the open procedures is 0.5% and is significantly higher (2%-3%) for endovascular carotid revascularization. Stroke rates for endovascular carotid revascularization are also higher: 2.13% vs 1.28% for open procedures (P < .0001). CONCLUSIONS: Dramatic shifts in the management of peripheral vascular disease have occurred together with an overall decline in mortality. There seems to be a significant mortality advantage for endovascular as compared with traditional surgery except for carotid endarterectomy. The increasing safety of vascular interventions should be considered when deciding which patients to treat but with the caveat that endovascular interventions are not always safer than open repair.

Amputation, Surgical↗

PubMed2005

Effects of husbands' and wives' education on each other's mortality.

Education is an important predictor of one's own cardiovascular disease (CVD) and overall mortality. Little is known, however, regarding the effect of other individuals, specifically a spouse, on these risks. In the present study, we examine the contribution of a spouse's educational attainment and the effect of educational discrepancy between spouses on CVD and overall mortality. Data were taken from the Israel Longitudinal Mortality Study, which linked a 20% sample of the 1983 census to mortality records through 1992. The study cohort comprised 37,618 married couples aged 45-69 years. During the 9.5-year follow-up 6,058 men and 2,568 women died. Overall and CVD mortality hazard ratios were calculated using Cox proportional hazard regression models. We found that the educational attainment of both spouses were significant predictors of one's own overall mortality. For CVD mortality, however, a wife's educational attainment was a stronger predictor of her husband's risk of dying than his own educational level, while for women a husband's education had little affect. Educational discrepancy between partners did not affect overall mortality and had a varied effect on CVD mortality by sex. Specifically, highly educated women had an almost two-fold increased risk of CVD mortality when married to less educated husbands, while lesser-educated women were not affected by their spouses' educational attainment. Spouses' education adds valuable information when assessing mortality differentials among married persons, and socioeconomic characteristics of one's immediate family are important influences on one's health.

Aged↗

PubMed2001

Aortic valve replacement in geriatric patients: determinants of in-hospital mortality.

BACKGROUND: Aortic valve replacement is a common procedure in elderly patients. There has been a great deal of controversy about the risks associated with early mortality. Uncertainty of the risk associated with a small valve continues to remain controversial. This study was designed to identify the risk factors influencing early mortality and establish an accurate model for the prediction of in-hospital mortality. METHODS: One hundred eighty septuagenarians and octogenarians (58% women; mean age, 76 +/- 4.7 years) underwent primary isolated aortic valve replacement between 1986 and 1997. There was an overall mortality of 16.7% (n = 180). Patients with a body surface area less than 1.8 m2 had an in-hospital mortality of 23.2% (n = 95) compared with 8.1% (n = 74; p = 0.009) for patients with a body surface area of 1.8 m2 or more. Patients with a cardiopulmonary bypass time of less than 100 minutes experienced an early mortality of 8.9% (n = 56) compared with a 10.2% (n = 59) early mortality for patients on bypass time between 100 and 124 minutes and a 29.6% (n = 64) early mortality in patients with a pump time longer than 124 minutes (p = 0.040). RESULTS: Multivariate logistic regression analysis identified small body surface area and long cardiopulmonary bypass time as independent risk factors. A higher mortality was seen in female patients and patients receiving smaller valves. However, there was a strong correlation between small body surface area, small valve size, and female gender. CONCLUSIONS: Small body surface area and long cardiopulmonary bypass time are two independent risk factors in early mortality for elderly patients undergoing primary isolated aortic valve replacement. The use of small valves does not influence early mortality.

Aged↗

PubMed2006

Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies.

BACKGROUND: Studies of the association between obesity, and total mortality and cardiovascular events in patients with coronary artery disease (CAD) have shown contradictory results. We undertook a systematic review to determine the extent and nature of this association. METHODS: We selected cohort studies that provided risk estimates for total mortality, with or without cardiovascular events, on the basis of bodyweight or obesity measures in patients with CAD, and with at least 6 months' follow-up. CAD was defined as history of percutaneous coronary intervention, coronary artery bypass graft, or myocardial infarction. We obtained risk estimates for five predetermined bodyweight groups: low, normal weight (reference), overweight, obese, and severely obese. FINDINGS: We found 40 studies with 250,152 patients that had a mean follow-up of 3.8 years. Patients with a low body-mass index (BMI) (ie, <20) had an increased relative risk (RR) for total mortality (RR=1.37 [95% CI 1.32-1.43), and cardiovascular mortality (1.45 [1.16-1.81]), overweight (BMI 25-29.9) had the lowest risk for total mortality (0.87 [0.81-0.94]) and cardiovascular mortality (0.88 [0.75-1.02]) compared with those for people with a normal BMI. Obese patients (BMI 30-35) had no increased risk for total mortality (0.93 [0.85-1.03]) or cardiovascular mortality (0.97 [0.82-1.15]). Patients with severe obesity (> or =35) did not have increased total mortality (1.10 [0.87-1.41]) but they had the highest risk for cardiovascular mortality (1.88 [1.05-3.34]). INTERPRETATION: The better outcomes for cardiovascular and total mortality seen in the overweight and mildly obese groups could not be explained by adjustment for confounding factors. These findings could be explained by the lack of discriminatory power of BMI to differentiate between body fat and lean mass.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

[Trends in infant mortality in Barcelona [Spain], 1983-1998].

OBJECTIVE: To analyze trends in infant mortality, taking into account its main components and the principal causes of death between 1983 and 1998 in the city of Barcelona (Spain). METHODS: We calculated overall mortality rates and mortality rates by sex for infant, postneonatal, neonatal, early neonatal, and late neonatal mortality in residents of the city of Barcelona from 1983 to 1998. Data were obtained from the births and deaths register. Data were grouped in 4-year periods. Poisson regression models were adjusted to obtain relative risks of mortality for comparison among the 4-year periods. The percentage of variation between rates in the different periods was also calculated. RESULTS: There were 1.564 deaths in the 16 years. 896 (57.3%) were males and 668 (42.7%) were females. Infant mortality rates varied from 10.5 per 1,000 live births in 1986 to 3.4 ten years later (1996). Between 1983 and 1988 mortality rates remained stable, decreasing after 1989. The neonatal mortality rate, and especially the early neonatal mortality rate, showed a greater decrease than the postneonatal mortality rate. The main causes of death were congenital defects (47.4%) and perinatal causes (32.1%). CONCLUSIONS: Mortality rates decreased over the study period but not with the same intensity as in previous deca des.

Age Factors↗

PubMedDate not supplied

[Mortality in Catalonia: description and comparison by age and sex].

OBJECTIVE: To assess the fit of the parametric mortality laws proposed by Heligman and Pollard to the mortality experience of Catalonia (Spain) with the goal of describing and comparing mortality by age and gender, in the time periods 1985-86 and 1990-91. DATA AND METHODS: The data were obtained from the official mortality Registry and population Census for the respective years. Observed conditional probabilities of dying by age and gender were adjusted using the parametric mortality laws formulated by Heligman and Pollard. These laws provide information about mortality characteristics in childhood, in youth and in adults. Goodness of fit of the models was assessed using chi-square, sign, and Steven's tests. Significant outliners were also determined and considered in the analysis. RESULTS: In Catalonia from 1985-86 to 1990-91 the probability of dying increased among people aged 16 to 40 years, this being higher in males as compared to females. For people older than 40 years of age the probability of dying in males did not change, but decreased for females. In this time period, the probability of dying slightly decreased during childhood. The life expectancy at birth for males decreased from 74.12 years in 1985-86 to 73.85 years in 1990-91. In contrast, the life expectancy at birth for females increased from 80.08 years in 1985-86 to 80.88 in 1990-91, thus widening mortality differences by gender. CONCLUSIONS: Heligman and Pollard laws of mortality are useful in describing mortality by age and gender, as well as in analyzing the evolution of mortality over time. The unfavorable evolution of mortality among young men living in Catalonia has contributed to reversing the trend of life expectancy at birth in the twentieth century.

Adolescent↗

PubMedDate not supplied

[Trends in infectious diseases mortality in Spain].

OBJECTIVE: The aim of this study was to describe the trend and geographical distribution of mortality by infectious diseases in Spain between 1980 and 1993. METHODS: Deaths caused by infectious diseases ocurred in Spain between 1980-1993 were studied. Data were obtained from the national mortality registry from the Instituto Nacional de Estadística. Deaths included in the International Diseases Classification (ICD-9) in group I were included, and also deaths by infectious diseases included in other groups. The trend in mortality risk was evaluated by means of a log-lineal Poisson model. Standardized mortality rates (SMR) by age for each Spanish province in 1980-83 and 1990-93, were calculated to identify geographical differences in mortality. These SMR were compared using Spearman correlation coefficient. RESULTS: Between 1980 and 1993, the adjusted mortality rate by infectious diseases decreased around 1.4% each year. In 1980 and also in 1993 respiratory tract infections were the first cause of death, 29.6 and 20.3 deaths for 105 inhabitants, respectively. The second cause of death was tuberculosis in 1980, 3.9 x 10⁵ and HIV infection in 1993, 10.7 x 10⁵. This decrease in infectious diseases mortality during the studied period was shown in all age groups, except for the 25 to 44 age group, were mortality rate increased by seven times. The geographical distribution showed that the provinces with the highest mortality rate were the same in 1980-83 and in 1990-93 (Spearman coefficient: 0.49; p < 0.001). CONCLUSIONS: Because deaths by infectious diseases are distributed in different groups in the ICD-9, their impact on mortality is underestimated, although they are the fourth cause of death in Spain. However, between 1980 and 1993 it has been shown a decrease in mortality by these diseases, except for the 25-44 age group where an impressive increase ocurred due to HIV infection. No differences between provinces have been shown.

Communicable Diseases↗

PubMed2001

Social inequalities in ischaemic heart and cerebrovascular disease mortality in men: Spain and France, 1980-1982 and 1988-1990.

In this study we analyse the trend in socio-economic differences in mortality from ischaemic heart and cerebrovascular diseases in the economically active male population aged 25-64 years in Spain and France. The data used were taken from deaths from these two causes in 1980-1982 and 1988-1990; in the case of Spain the data came from the Eight Provinces Study. Individuals were grouped into four categories - professional/managerial, clerical/sales/service workers, farmers, and manual workers - and the mortality rate ratio was estimated with reference to the professional/managerial group. For ischaemic heart disease in 1980-1982, professionals and managers aged 25-44 years had the lowest risk of mortality in Spain, and the highest risk of mortality in France; in 1988-1990 the socioeconomic differences in mortality in Spain increased, whereas the relation was inverted in France. In 1980-1982, professionals and managers aged 45-64 years had higher mortality from ischaemic heart disease than the other occupational groups in both countries; in 1988-1990 this relation was inverted, except in the case of clerical/sales/service workers in Spain. For cerebrovascular disease, manual workers experienced the highest mortality in the 25-44 year age group in 1980-1982, and the differences increased in 1988-1990 in all groups with respect to professionals and managers in both places. Professionals and managers in France and manual workers in Spain had the highest mortality between 45 and 64 years in 1980-1982; in contrast, in 1988-1990 professionals and managers had the lowest risk of mortality from this disease in both Spain and France, although in Spain the magnitude was similar to that of clerical/sales/service workers. In general terms, mortality from each disease was different in professionals and managers than in clerical/sales/service workers. Thus, the pattern of mortality and its evolution in different socio-economic groups cannot be analysed accurately when the two occupational groups are combined in a single large group of non-manual workers.

Adult↗

PubMed2003

Sociodemographics, self-rated health, and mortality in the US.

Using data from the 1987 National Medical Expenditure Survey, a representative sample of US civilians, and their 5-year mortality, we examined the adjusted relationships among baseline self-reported health, derived from SF-20 subscales (health perceptions, physical function, role function and mental health) and sociodemographics (age, sex, race/ethnicity, income and education) and subsequent mortality. Included were 21,363 persons aged 21 and over, with complete follow-up on 19,812. Physical function showed the greatest decline with age, whereas mental health increased slightly. Women reported lower health for all scales except role function. Greater income was associated with better health, least marked for mental health. Greater education was associated with better health, most marked for health perceptions. Compared with whites, blacks reported lower health, whereas Latinos reported higher health. Lower self-reported health predicted increased adjusted mortality. After adjustment for baseline self-rated health, the relationships between income and education and mortality were greatly attenuated, whereas the relationships between age, gender, race/ethnicity and mortality were not. Self-rated health exhibited more profound relationships with mortality in younger persons, those with more education, and whites. In conclusion, lower socioeconomic status (SES), and being black are associated with lower reported health status and higher mortality; women report lower health status but exhibit lower mortality; and Latinos report higher health status and exhibit lower mortality. The effects of SES on mortality are largely explained by their associations with self-rated health, whereas, the effects of gender and race/ethnicity on mortality appear to act through independent pathways. Because of these differential sociodemographic relationships caution is urged when using self-rated health measures in research, clinical, and policy settings.

Activities of Daily Living↗

PubMed1998

Social mobility and 21 year mortality in a cohort of Scottish men.

The objective of this prospective cohort study was to determine the contribution of changes in social class within and between generations to mortality risk and to socioeconomic differentials in mortality. In 27 workplaces in the west of Scotland. 5567 men aged 35-64 years when screened, provided information on their father's occupation, their own first occupation and their occupation at screening. Mortality risk, from broad causes of death by intergenerational and intragenerational social mobility groups, was measured after 21 years. For all or some of the 3 routes of mobility (childhood to screening, labour market entry to screening and childhood to labour market entry), increasing values were seen across the 4 groups (stable non manual, upwardly mobile, downwardly mobile and stable manual) for diastolic blood pressure, body mass index, current smoking, early school leaving, angina, bronchitis, severe chest pain, and proportion living in deprived areas. Decreasing values were seen for serum cholesterol, height, FEV1, exercise, never and ex-smokers, wine drinkers and car users. For mobility between childhood and screening and between childhood and labour market entry, mortality risk was highest for the stable manual group and lowest for the stable non manual group for all cause, cardiovascular disease and other causes of death. The upwardly and downwardly mobile groups had intermediate risks. For cancer mortality, the stable manual group had the highest risk with the other groups having lower and similar risks. For mobility between labour market entry and screening, the highest risk was for the downwardly mobile group for all cause and cardiovascular mortality. For cancer mortality, the risk was higher for men in manual social classes at all occasions. Adjustment for risk factors attenuated but could not completely explain the differentials in mortality risk. Overall, major differences in mortality risk were seen between the stable non manual and the stable manual groups, to which social mobility does not contribute. With the exception of the small intragenerationally downwardly mobile group there was little evidence that social mobility itself was associated with mortality outcomes different from those expected on the basis of lifetime socioeconomic experience. This is consistent with the suggestion that the main influence of socioeconomic position on mortality risk is an accumulative one, acting across the lifecourse.

Adult↗

PubMed1999

The meaning of early mortality after CABG.

OBJECTIVE: Investigations of early mortality after coronary artery bypass grafting (CABG) are predominantly based on 30-day mortality or hospital mortality. The advantages, disadvantages, and usefulness of hospital mortality and 30-day mortality analyses to investigate the early risk after CABG are evaluated. METHODS: A total of 4985 patients underwent isolated CABG from June 1988 to June 1997. A follow-up was performed 180 days after CABG (response rate: 98.6%). RESULTS: The mean hospital stay was 13.5+/-9.6 days, the range was 0 to 142 days (25% quartile, 9 days; median, 12 days; 75% quartile, 15 days). The hospital mortality was 5.3%. The 30-day mortality was 5.6%. The non-parametric Kaplan-Meier curve of the time interval 0-180 days postoperatively proves the persistence of the still decreasing behaviour of the survival curve beyond the 30th day until about the 60th postoperative day. Stratified by era of operation, the 'early phase' after CABG seems to be prolonged beyond 30 days at least for the more recent operation era since 1991. Risk stratification proves that the higher the risk group, the more the early phase tends towards a prolongation. CONCLUSIONS: The hospital mortality reflects institutional habits concerning postoperative patient care. Therefore, a systematic underestimation of early mortality is likely. In contrast to hospital stay, the evaluation of 30-day mortality requires a follow-up procedure but allows interinstitutional comparisons. Nevertheless, 30-day mortality systematically underestimates the early risk, at least in the more recent CABG period. So, a standardized evaluation of a longer time period (p.e. 180 days) is recommended.

Coronary Artery Bypass↗

PubMed1998

Ruptured abdominal aortic aneurysms: factors influencing postoperative mortality and long-term survival.

OBJECTIVE: To update mortality rates and long-term survival of patients admitted to the hospital with ruptured abdominal aortic aneurysm (AAA) and to study prognostic factors associated with mortality. DESIGN: Retrospective follow-up. MATERIALS: 309 patients (274 men, 35 women, average age 71) admitted to the hospital between January 1980 and January 1994 who were surgically treated for ruptured AAA were studied. METHODS: To identify the preoperative (9), intraoperative (23) and postoperative (49) variables associated with mortality logistic regression analysis (mortality within 48 h) and Cox regression analysis (mortality between 48 h and 30 days) were performed. RESULTS: Hospital mortality improved from 1980 to 1994. Compared with the normal population adjusted for age and sex the long-term mortality rate was increased (standardised mortality ratio 2.1; 95% confidence interval 1.7-2.5). Increased age, peroperative hypotension and need for a bifurcated graft were associated with significantly increased mortality. Co-morbidity was not a predictive variable. Overall hospital mortality was 25%. CONCLUSION: Surgical repair of ruptured AAA should be considered even in patients with co-morbidity. Elderly patients with severe preoperative hypotension have a very high mortality rate and surgery may not be justified in these cases. Long-term survival is also worse in older patients.

Aged↗

PubMed2025

Mediating effects of waist circumference and BMI on the association between meal frequency and mortality.

OBJECTIVE: To examine the potential indirect effect of meal frequency on mortality via obesity indices. DESIGN: Prospective cohort study. SETTING: Korean Genome and Epidemiology Study. PARTICIPANTS: This cohort study involved 148 438 South Korean adults aged 40 years and older. RESULTS: Meal frequency at the baseline survey was assessed using a validated FFQ. Outcomes included all-cause mortality, cancer mortality and CVD mortality. Cox proportional hazards regression models were employed to examine the relationship between meal frequency and the risk of mortality. Mediation analyses were performed with changes in obesity indices (BMI and weight circumference (WC)) as mediators. In comparison to the three-time group, the once-per-day and four-times-per-day groups had a higher risk for all-cause mortality. The irregular frequency group had a higher risk for CVD mortality. Both once-per-day and four-times-per-day groups exhibited higher risks for cancer mortality. The effect of meal frequency on all-cause mortality was partially mediated by WC. For specific-cause mortality, similar mediation effects were found. CONCLUSIONS: The data suggests that three meals per day have a lower mortality and longer life expectancy compared with other meal frequencies. Increased waist circumference partially mediates this effect. These findings support the implementation of a strategy that addresses meal frequency and weight reduction together.

Humans↗

PubMed2005

Waist circumference and body composition in relation to all-cause mortality in middle-aged men and women.

OBJECTIVE: Waist circumference is directly related to all-cause mortality when adjusted for body mass index (BMI). Body fat and fat-free body mass, when mutually adjusted, show with increasing values an increasing and decreasing relation to all-cause mortality. We investigated the association of waist circumference and body composition (body fat and fat-free mass), mutually adjusted, to all-cause mortality. DESIGN: A Danish prospective cohort study with a median follow-up period of 5.8 y. SUBJECTS: In all, 27 178 men and 29 875 women, born in Denmark, aged 50-64 y, and without diagnosis of cancer at the time of invitation. MEASUREMENTS: Waist circumference and body composition estimated from impedance measurements. Cox's regression models were used to estimate the mortality rate ratios (RR). RESULTS: Waist circumference was strongly associated with all-cause mortality after adjustment for body composition; the mortality RR was 1.36 (95% confidence intervals (CI): 1.22-1.52) times higher per 10% larger waist circumference among men and 1.30 (95% CI: 1.17-1.44) times higher among women. Adjustment for waist circumference eliminated the association between high values of the body fat mass index (BFMI) and all-cause mortality. The association between fat-free mass index (FFMI) and mortality remained unaltered. CONCLUSION: Waist circumference accounted for the mortality risk associated with excess body fat and not fat-free mass. Waist circumference remained strongly and directly associated with all-cause mortality when adjusted for total body fat in middle-aged men and women, suggesting that the increased mortality risk related to excess body fat is mainly due to abdominal adiposity.

Abdomen↗

PubMed2001

The relationship between educational level and mortality. The Reykjavík Study.

OBJECTIVE: Epidemiological studies have indicated an association between socioeconomic factors and health. It has not been clearly established whether this association is wholly or partly independent of classical risk factors. Our objective was to estimate the relationship between educational level and coronary artery disease (CAD), mortality and all-cause mortality. The Reykjavík Study involving 18 912 participants followed-up 4-30 years provides an ideal opportunity to address this question. DESIGN AND SUBJECTS: The participants were aged 33-81 years and living in the Reykjavík area. They were divided into four groups according to education. The standard risk factors were assessed on entry and mortality, and cause of death registered during follow-up. Multiple Cox regression analysis was applied to assess the relationship between age at examination, year of examination, educational level and mortality. RESULTS: The all-cause mortality and CAD mortality was significantly related to education, even after adjustment for classical risk factors. For men, 14% (95% CI: 2-24) reduction was found in CAD mortality for those having high school education relative to elementary school. The figures for junior college and university education were 17% (95% CI: 1-31) and 38% (95% CI: 21-32), respectively. These figures were only slightly lower when major CAD risk factors were controlled for and still significant. Similar figures were found for all-cause mortality. For women 34% (95% CI: 18-48) reduction was found in CAD mortality for high school education and 55% (95% CI: 22-74) for junior college, but too few had university education for reliable results. The figures were lower for all-cause mortality, but significant. The figures were reduced when major CAD risk factors were controlled for, but still significant. CONCLUSION: Education is a strong protective factor both for all-cause and CAD mortality. Only a small part of this effect can be explained through conventional risk factors.

Adult↗

PubMed2000

Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.

We studied infant mortality rates in Canada within specific gestational age and birthweight categories after using probabilistic techniques to link information in Statistics Canada's live births data base (1985-94) with that in the death data base (1985-95). Gestational age- and birthweight-specific mortality rates in 1992-94 were contrasted with those in 1985-87 with changes expressed in terms of relative risks with 95% confidence intervals [CI]. Statistically significant reductions in infant mortality were observed beginning at 24-25 weeks of gestation and extended across the gestational age range to post-term births. Crude infant mortality rates, infant mortality rates among those > or = 500 g and among those > or = 1000 g decreased by 22%, 25% and 26%, respectively, from 1985-87 to 1992-94. The magnitude of the reductions in infant mortality rates ranged from 14% [95% CI 7, 21%] at 24-25 weeks of gestation to 40% [95% CI 31, 47%] at 28-31 weeks. Almost all reductions in gestational age- and birthweight-specific infant mortality between 1985-87 and 1992-94 were due to approximately equal reductions in neonatal and post-neonatal mortality. Live births > or = 42 weeks of gestation did not follow this rule; post-neonatal mortality rates among such live births decreased significantly by 51% [95% CI 26, 68%], although neonatal mortality rates showed no significant change. The mortality reductions observed across the gestational age and birthweight range are probably a consequence of specific clinical interventions complementing improvements in fetal growth. Temporal changes in the outcome of post-term pregnancies need to be carefully examined, especially in relation to recent changes in the obstetric management of such pregnancies.

Adult↗