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PubMedDate not supplied

The return on investment in health care: from 1980 to 2000.

OBJECTIVE: To estimate the return on US investment (ROI) in overall health as well as four specific conditions. METHODS: The study utilized three distinct approaches to "triangulate" the evidence as related to ROI in health care: 1) an estimation of the average ROI in additional health-care service expenditures in the United States for the year 2000 compared with the year 1980, based on US summaries of health expenditures and health outcomes; 2) an estimate of the ROI in Medicare services for the period from 1985 to 2000 for treatment of heart attack, stroke, type 2 diabetes, and breast cancer, based on National Long-term Care Survey data and Medicare claims; and 3) an estimate of the ROI for selected major treatment innovations for the same four conditions during the period from 1975 to 2000. RESULTS: We calculated that each additional dollar spent on overall health-care services produced health gains valued at Dollars 1.55 to Dollars 1.94 under our base case assumptions. The return on health gains associated with treatment for heart attack, stroke, type 2 diabetes, and breast cancer were Dollars 1.10, Dollars 1.49, Dollars 1.55, and Dollars 4.80, respectively, for every additional dollar spent by Medicare. The ROI for specific treatment innovations ranged from both savings in treatment costs and gains in health to gains in health valued at Dollars 1.12 to Dollars 38.00 for every additional dollar spent. CONCLUSION: The value of improved health in the US population in 2000 compared with 1980 significantly outweighs the additional health-care expenditures in 2000 compared with 1980.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1996

Factors related to total cholesterol and blood pressure in British 9 year olds.

STUDY OBJECTIVE: To assess which factors are associated with total cholesterol concentration and blood pressure in 9 year olds, and to examine the extent to which a report of a heart attack in a close relative identifies children with a high total cholesterol value or high systolic blood pressure. DESIGN: This was a cross sectional study. SETTING: The analysis was based on 22 study areas from a representative English sample, 14 areas from a representative Scottish sample, and 20 areas from an inner city sample. PARTICIPANTS: There were 1987 children aged 8 or 9 whose blood pressure was measured and 1662 children whose total cholesterol was assessed. MEASUREMENTS AND MAIN RESULTS: Blood pressure was measured using the Dinamap 1846 automated sphygmomanometer and cholesterol using the Lipotrend C. Multiple regression analysis was used to examine the independent associations with each of the outcome variables. Either weight for height or sum of skinfolds measured in four sites was highly associated with the outcome measures in the study (p < 0.001). Fatter or overweight children had higher blood pressure and higher cholesterol concentrations. Child's height was also associated with the outcome measures in most of the analyses, but was positively related to blood pressure and negatively associated with cholesterol value. There was an association between diastolic blood pressure and area of residence as represented by the regional health authority (RHA), but the association was not the same as the association reported between coronary heart disease, standardised mortality ratio, and RHA. Children with low birth weight and those with shorter gestation had higher systolic blood pressure (p < 0.05 and p < 0.01 respectively), but not diastolic blood pressure. A report of a premature heart attack in a parent or a grandparent was not associated with higher cholesterol or blood pressure. CONCLUSIONS: Reducing obesity in children, together with the avoidance of smoking, may be an appropriate action to prevent coronary heart disease in adulthood. A report of heart disease in a close relative is an ineffective means of identifying children at greater risk of high cholesterol or blood pressure without other measurements from relatives.

Blood Pressure↗
PubMed2004

The health effects of restricting prescription medication use because of cost.

BACKGROUND: High out-of-pocket expenditures for prescription medications could lead people with chronic illnesses to restrict their use of these medications. Whether adults experience adverse health outcomes after having restricted medication use because of cost is not known. METHODS: We analyzed data from 2 prospective cohort studies of adults who reported regularly taking prescription medications using 2 waves of the Health and Retirement Study (HRS), a national survey of adults aged 51 to 61 in 1992, and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a national survey of adults aged 70 or older in 1993 (n = 7991). We used multivariable logistic and Poisson regression models to assess the independent effect on health outcomes over 2 to 3 years of follow up of reporting in 1995-1996 having taken less medicine than prescribed because of cost during the prior 2 years. After adjusting for differences in sociodemographic characteristics, health status, smoking, alcohol consumption, body mass index (BMI), and comorbid chronic conditions, we determined the risk of a significant decline in overall health among respondents in good to excellent health at baseline and of developing new disease-related adverse outcomes among respondents with cardiovascular disease, diabetes, arthritis, and depression. RESULTS: In adjusted analyses, 32.1% of those who had restricted medications because of cost reported a significant decline in their health status compared with 21.2% of those who had not (adjusted odds ratio [AOR], 1.76; confidence interval [CI], 1.27-2.44). Respondents with cardiovascular disease who restricted medications reported higher rates of angina (11.9% vs. 8.2%; AOR, 1.50; CI, 1.09-2.07) and experienced higher rates of nonfatal heart attacks or strokes (7.8% vs. 5.3%; AOR, 1.51; CI, 1.02-2.25). After adjusting for potential confounders, we found no differences in disease-specific complications among respondents with arthritis and diabetes, and increased rates of depression only among the older cohort. CONCLUSIONS: Cost-related medication restriction among middle-aged and elderly Americans is associated with an increased risk of a subsequent decline in their self-reported health status, and among those with preexisting cardiovascular disease with higher rates of angina and nonfatal heart attacks or strokes. Such cost-related medication restriction could be a mechanism for worse health outcomes among low-income and other vulnerable populations who lack adequate insurance coverage.

Aged↗
PubMedDate not supplied

Reliability and accuracy of a cardiovascular risk questionnaire and body shape figures for body size in Mexican obese subjects.

UNLABELLED: There is little information about the validity of questionnaires used by research related to obesity. The aim of this study was to demonstrate the reliability and accuracy of a cardiovascular risk questionnaire and perception of body size pictorials (BSP) measured in Mexican obese subjects. This was a cross-sectional study designed as two independent phases. The aims were: a) To calculate a concordance index between questionnaires and clinical records. b) To measure the reliability of the questionnaire and BSP by test-retest. Phase one: Eighty-four subjects were invited to answer the questionnaire (the average age was 46.1 +/- 14.9 years, BMI 36.4 +/- 7.2). The concordance obtained for heart attack, type 2 diabetes mellitus and high blood pressure was greater than kappa 0.6. High uric acid, hypercholesterolemia and hypertriglyceridemia showed low concordance. Phase two: One hundred and two subjects were invited (the average age was 50.8 +/- 14.4 years, IMC 35.6 +/- 6.8). A high concordance in test-retest (ri = 0.71, p < 0.001) and for correlation coefficients between BSP and BMI (r = 0.72, p < 0.01) was found. CONCLUSION: These data suggest that this questionnaire is reliable and data regarding diagnosis of type 2 diabetes mellitus, heart attack and high blood pressure are accurate in people who have been treated in hospital. Obese subjects are able to classify with accuracy their own BSP and that of other individuals. This kind of perception was not altered.

Adult↗
PubMedDate not supplied

Potential savings from reducing inequalities in health.

BACKGROUND: Numerous studies have established that socio-economic position is positively related to health status, but we know little about the real costs of these differences across an entire population. This paper estimates the potential savings in morbidity and dollars from reducing the inequalities in health among Winnipeg residents. METHODS: We measure excess morbidity by examining rates of premature death, hip fracture, and heart attack according to the relative affluence of the Winnipeg neighbourhood. We also assess the total expenditures on physician and hospital care by neighbourhood of residence. We then estimate the savings that could have been achieved if 1 ) the health of the two poorest quintiles had been raised to the level of the middle quintile, and 2) the health of the poorest four quintiles had been raised to the level of the top quintile. RESULTS: Thirty-seven percent of Winnipeg's premature deaths, 22% of the heart attacks, 20% of the hip fractures and 15% of total expenditures on hospitals and physicians ($62 million in 1999 dollars) could have been avoided if residents of the less wealthy 80% of neighbourhoods enjoyed health similar to those in the wealthiest neighbourhoods. CONCLUSION: The potential savings from reducing the socio-economic-related differences in health are high, whether they are measured in terms of morbidity or dollars. Research is needed to determine the extent to which these potential savings are achievable.

Adolescent↗
PubMed2002

Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases.

BACKGROUND: Panoramic radiographs (PMX)s may provide information about systemic health conditions. AIMS: i). To study clinical periodontal conditions and collect self-reported health status in a cohort of 1084 older subjects; ii). to study signs of alveolar bone loss and carotid calcification from panoramic radiographs obtained from these subjects; and iii). to study associations between study parameters. MATERIAL AND METHODS: PMXs from 1064 adults aged 60-75 (mean age 67.6, SD +/- 4.7) were studied. Signs of alveolar bone loss, vertical defects, and molar furcation radiolucencies defined periodontal status. Medical health histories were obtained via self-reports. Signs of carotid calcification were identified from panoramic radiographs. RESULTS: The PMX allowed assessment of 53% of the films (Seattle 64.5% and Vancouver 48.4%). A self-reported history of a stroke was reported by 8.1% of men in Seattle and 2.9% of men in Vancouver (P < 0.01). Heart attacks were reported by 12% of men in Seattle and 7.2% in Vancouver (N.S.). PMX evidence of periodontitis was found in 48.5% of the subjects, with carotid calcification in 18.6%. The intraclass correlation score for PMX findings of carotid calcification and stroke was 0.24 (95% CI: 0.10-0.35, P < 0.001). The odds ratio for PMX carotid calcification and periodontitis was 2.1 (95% CI: 1.3-3.2, P < 0.001), and for PMX carotid calcification and stroke 4.2 (95% CI: 1.9-9.1, P < 0.001). The associations disappeared when smoking was accounted for. A history of a heart attack was associated with stroke, gender, age, and PMX scores of alveolar bone loss. CONCLUSIONS: PMXs may provide valuable information about both oral conditions and signs of carotid calcification, data that are consistent with self-reported health conditions. Alveolar bone loss as assessed from PMXs is associated with cardiovascular diseases.

Aged↗
PubMed1977

Comparison of results from a cardiac ambulance manned by medical or non-medical personnel.

During a 20-month period a "cardiac" ambulance was manned on alternate days by specially-trained ambulance personnel only, or by such personnel plus a doctor. The presence of a doctor did not lead to any reduction in the mortality of patients with heart-attacks. Although transport to hospital by the special service was associated with a low pre-hospital mortality, this was balanced by a high pre-hospital mortality in the group of patients brought to hospital by routine ambulances at times when the special vehicle was manned, but for some reason was not used. There was evidence of unintentional selection of low-risk cases for transport by the cardiac ambulance. The number of lives saved by the special service was too small to cause any significant reduction in the overall mortality from heart-attacks in Nottingham.

Adult↗
PubMed2006

Genetic susceptibility to myocardial infarction and coronary artery disease.

Atherosclerotic involvement in the coronary arteries, which can result in heart attack and sudden death, is a common disease and prototypic of a complex human trait. To understand its genomic basis, eight linkage studies of sibling pairs have been performed. Although there was limited inter-study concordance of important loci, two gene variants in the leukotriene pathway (ALOX5AP and LTA4) have emerged as susceptibility factors for myocardial infarction (MI). Genome-wide association studies have also been undertaken, and the pro-inflammatory cytokine lymphotoxin-alpha (LTA), and its key ligand galectin-2 (LGALS2) have been identified as genes implicated in predisposition for heart attack. By cueing into the genomic basis for low serum LDL cholesterol levels, much work has been done to advance the importance of the serine protease PCSK9, which modulates LDL receptor function. Lifelong lowered LDL cholesterol associated with PCSK9 point mutations in 2-3% of individuals have been shown to provide marked protection from coronary artery disease (CAD). Most of the success in this field has been with the phenotype of MI, which is considerably more restrictive than CAD. Four principal and interdependent processes--lipoprotein handling, endothelial integrity, arterial inflammation, and thrombosis--have been supported as important via the clustering of genes, thus far implicated in CAD susceptibility. Of note, connecting genes in a single pathway (leukotriene), of a protein and its ligand (LTAalpha) or from one disease to another [age-related macular degeneration (AMD); complement factor H (CFH)], or even three disease characterized by inflammation (MHC2) have now been reported. Although the population attributable risk for any of the genes identified to date is limited, such discovery is likely to be accelerated in the future.

5-Lipoxygenase-Activating Proteins↗
PubMed1975

Follow-up of emergency ambulance calls in Nottingham: implications for coronary ambulance servie.

Information about patients in ambulance service records has been linked to that in the patients' hospital records in an attempt to make the most efficient use of a special ambulance service for patients suspected of having heart attacks. During one week 248 emergency (999) calls for an ambulance were made by the public in the city of Nottingham. The quality of information given to the ambulance centre was poor, and all four patients eventually found to have had a myocardial infarction were described as having collapsed. A further study of patients who were also described as having collapsed has led to a system which allows an ambulance controller to send a "coronary ambulance" only in answer to those emergency calls where there is a reasonable possibility that the patient has had a heart attack.

Ambulances↗
PubMed1995

Risk of neoplastic and other diseases among people with heterozygosity for hereditary hemochromatosis.

BACKGROUND: Increased body iron stores have been associated with risk of heart attack in men and risk of cancer and colonic adenoma in both sexes. Because heterozygous carriers of hereditary hemochromatosis (HH) have on the average increased iron stores compared with noncarriers of the HH gene and comprise as much as 15% of the American population, disease risk in HH heterozygotes was investigated. METHODS: A community-based cohort was defined, in which the exposure variable was heterozygosity for HH. Heterozygotes were identified by mailing individuals homozygous for HH questionnaires concerning the health histories of their parents (predominantly heterozygotes or exposed). Spouses of the HH homozygotes were asked to complete accompanying questionnaires concerning their parents (unexposed). The frequencies for exposed and unexposed, age-adjusted relative risks (RR), and 95% confidence intervals (CI), of cancer, heart disease, and stroke as causes of death as well as the cumulative incidence of heart attack, diabetes, stroke, hypertension, colonic adenoma, and cancers of the lung, colorectum, breast, cervix, pancreas, stomach, and blood were estimated. RESULTS: Data were available for 1950 HH heterozygotes and 1656 unexposed subjects. Elevated RR were observed in HH heterozygotes in males for diabetes (RR, 1.16; 95% CI, 1.01-1.33), colorectal cancer (RR, 1.28; CI, 1.07-1.53), and hematologic malignancy (RR, 1.30; CI, 1.30-1.63), for colonic adenoma in females (RR, 1.29; CI, 1.08-1.53) and males (RR, 1.24; CI, 1.05-1.46), and for stomach cancer in females (RR, 1.37; CI, 1.04-1.79). CONCLUSIONS: Heterozygosity for HH is associated with increased risk for colorectal neoplasia, diabetes, hematologic malignancy, and gastric cancer. No increased risk of heart disease, cancer death, or cancers of the lung, breast, or cervix were demonstrated.

Adult↗
PubMed2006

Public perceptions and experiences of myocardial infarction, cardiac arrest and CPR in London.

INTRODUCTION: The lay public have limited knowledge of the symptoms of myocardial infarction ("heart attack"), and inaccurate perceptions of cardiac arrest survival rates. Levels of CPR training and willingness to intervene in cardiac emergencies are also low. AIMS: To explore public perceptions of myocardial infarction and cardiac arrest; investigate perceptions of cardiac arrest survival rates; assess levels of training and attitudes towards CPR, and explore the types of interventions considered useful for increasing rates of bystander CPR among Greater London residents. METHODS: A quantitative interview survey was conducted with 1011 Greater London residents. Eight focus groups were also conducted to explore a range of issues in greater depth and validate trends that emerged in the initial survey. RESULTS: Chest pain was the most commonly recognised symptom of "heart attack". Around half of the respondents were aware that a myocardial infarction differs from a cardiac arrest, although their ability to explain this difference was limited. The majority overestimated that at least a quarter of cardiac arrest patients in London survive to hospital discharge. Few participants had received CPR training, and most were hesitant about performing the procedure on a stranger. CONCLUSIONS: Awareness and knowledge of CPR, and reactions to cardiac emergencies, reflect relatively low levels of CPR training in London. Publicising cardiac arrest survival figures may be instrumental in prompting members of the public to train in CPR and motivating those who have been trained to intervene in a cardiac emergency.

Adolescent↗
PubMed1992

Perceived morbidity as a determinant of health behavior.

It is hypothesized that perceived morbidity, a concept closely related to perceived vulnerability, is an important determinant of health behaviors. In this cross-sectional study (N = 2740), perceived morbidity was conceptualized as a categorical variable defining six distinct morbidity groups: the hypertension, high cholesterol, angina pectoris, heart attack, stroke and 'morbidity-free' groups. We used analyses of covariance to identify differences in health behaviors between the six groups; the analyses were done separately for middle-aged (40-60 years old) and older ( greater than 60 years old) respondents. Results show that perceived morbidity had a significant effect on fat consumption (P less than 0.001) and on physical activity (P < 0.01). In both age ranges, the morbidity-free group had the highest fat consumption; among the middle-aged respondents, the level of physical activity was significantly lower in the morbidity-free group than in the heart attack group. Furthermore, respondents in the high cholesterol group showed consistently a 'better' health behavior than people in the hypertension group. Overall, these results suggest that the concept of perceived morbidity may be useful in explaining inter-individual differences in health behaviors.

Adolescent↗
PubMed1995

Changing inaccurate perceptions of health risk: results from a randomized trial.

We sought to identify and correct inaccurate perceptions of risk among 1,317 adult patients in a primary care setting. Patients' perceived risks of heart attack, stroke, cancer, and motor vehicle crash were assessed and compared with a measure of risk derived from a health risk appraisal. Patients were then randomly assigned to receive computer-generated individualized risk feedback, risk feedback plus behavioral change feedback, or no feedback. Changes in perceived risk from baseline to a 6-month follow-up were compared across study groups. Results showed that individualized risk feedback was effective in increasing perceived stroke risk among patients who had underestimated their stroke risk at baseline and in reducing perceived risk of cancer among patients who had overestimated their cancer risk at baseline. Individualized risk feedback did not alter patients' perception of their heart attack and motor vehicle crash risks.

Accidents, Traffic↗
PubMed1992

Why me? Causal thinking, affect, and expectations in myocardial infarction patients.

This study investigated whether patients who seek an explanation for their heart attack, as compared to those who do not, differ in their affect, in expectations about their future recovery, and in expectations about coping with their future. Forty-two myocardial infarction patients were interviewed, in both the acute and convalescent stages, as to whether they had thought about "Why me?" Approximately half of the patients at each stage reported searching for an answer to that question. The patients remained generally consistent in their self-reported anxiety, depression, and hostility over time; however, patients who had not thought about "Why me?" reported less anxiety than those who had. No significant differences were found in affect in patients who gave a specific cause for their heart attack and in those who could not. Patients were significantly less optimistic about their future recovery at follow-up than when they were in the hospital, but there were no differences in expectations for future recovery or for future coping of those who had and those who had not thought about "Why me?"

Adaptation, Psychological↗
PubMed2004

Accuracy of offspring reports of parental cardiovascular disease history: the Framingham Offspring Study.

BACKGROUND: Family history is used to infer the risk for heart disease; however, little is known about the accuracy of family history reports. OBJECTIVE: To examine the accuracy of offspring reports of parental cardiovascular disease. DESIGN: Validation study. SETTING: Framingham Heart Study. PARTICIPANTS: Offspring participants of the multigenerational Framingham Heart Study with both parents in the original cohort. MEASUREMENTS: 791 men and 837 women (mean age, 57 years) completed a family history questionnaire from 1995 to 1998. Offspring reports were compared with confirmed medical evidence of parental status, and positive and negative predictive values and likelihood ratios were calculated. RESULTS: Positive reports of high blood pressure, diabetes, and high cholesterol levels in fathers were accurate: Positive predictive values were 83% (95% CI, 80% to 86%), 76% (CI, 70% to 82%), and 78% (CI, 73% to 83%), respectively. Corresponding positive predictive values for reports in mothers were 91% (CI, 89% to 93%), 79% (CI, 73% to 85%), and 88% (CI, 84% to 92%), respectively. Positive predictive values for reports of paternal heart attack occurring before 55 years of age and for stroke occurring before 65 years of age were 28% (CI, 22% to 34%) and 43% (CI, 33% to 53%), respectively, whereas the positive likelihood ratios were 8.6 (CI, 6.8 to 10.9) and 11.2 (CI, 9.2 to 13.6), respectively. Negative predictive values for parental history reports were greater than 90%, except for high blood pressure and high cholesterol level (negative predictive values, 33% to 55%, and negative likelihood ratios, 0.47 to 0.88). LIMITATIONS: This study does not determine whether more accurate measures of family history would meaningfully improve estimation of cardiovascular risk. CONCLUSIONS: Negative parental history reports were reliable, except for hypertension and high cholesterol levels. Although reports of parental premature heart attack and stroke had high likelihood ratios, their predictive values were low because the prevalence of these conditions was low in parents. If patients were more aware of their parents' medical illnesses, they might be able to estimate their risk for disease more accurately and perhaps motivate themselves to follow a healthy lifestyle.

Adult↗
PubMed1995

Can nurses safely assess suitability for thrombolytic therapy? A pilot study.

Thrombolytic therapy reduces mortality in patients with acute myocardial infarction. Early treatment is crucial and any system which reduces 'door-to-needle' time without placing the patient at risk is to be encouraged. A group of 20 patients with suspected heart attack was assessed by coronary care nurses and preregistration house officers with regard to: time of symptom onset; admission 12 lead electrocardiogram, presence of contraindications to thrombolytic therapy. Nurses and house officers were asked to state whether or not they considered thrombolysis indicated, and if so, which agent they would recommend on an 'intention to treat' basis. Participating staff were given the option of referral for senior medical opinion. There was no difference in nurses' and house officers' stated intentions regarding thrombolytic therapy. A group of 46 patients was assessed by nurses alone on an 'intention to treat' basis; in this latter group nurses' management intentions were identical to those of the responsible doctor prescribing treatment. Appropriately trained nurses can assess patients with suspected heart attack accurately and safely for thrombolytic therapy. In practice, this could reduce delays to thrombolysis and merits further scrutiny.

Coronary Care Units↗
PubMed2003

Update on calcium antagonists and the kidney.

PURPOSE OF REVIEW: The treatment of hypertension has been proven to reduce cardiovascular and renal risk. The role of long-acting calcium channel antagonists in the management of hypertension has been confused in the past because of a lack of controlled clinical trials on people with hypertension and in subpopulations including those with diabetes and renal disease. The year 2002 saw the publication of the results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, the largest ever prospective drug-treatment trial, which involved 33 357 people with hypertension and included a calcium-antagonist group of 9048 individuals. Major publications on blood pressure control in people with kidney disease include the African American Study of Kidney Disease and Hypertension, and publications on people with diabetes include the results of the normotensive arm of the Appropriate Blood Pressure Control in Diabetes trial. RECENT FINDINGS: The main finding, from the studies reported in the last year, is that blood pressure control can be achieved using one or more of the first-line agents, including diuretics, calcium antagonists and angiotensin-converting enzyme inhibitors. On the basis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, diuretics make clinical and economic sense as initial therapy for those with hypertension. Calcium antagonists are well tolerated and effective and should be considered as the initial drug therapy when diuretics are not tolerated or when multiple drug therapy is indicated. Angiotensin-converting enzyme inhibitors should be used in people with nephropathy, and, in these patients, will nearly always need to be part of multiple drug therapy to achieve blood pressure control. When blood pressure control can be achieved in largely non-nephropathic populations, there is further evidence that the drug class used as initial therapy may not be important. One of the main themes coming from the literature in the last year is that renal function is increasingly being recognized as an important outcome measure and marker of cardiovascular risk. SUMMARY: The focus in blood pressure management must now be on identifying those with hypertension and bringing their blood pressure to target. For the majority of those with hypertension and renal disease, multiple drug therapy will be required, and, to achieve blood pressure targets, calcium antagonists are an appropriate part of this regimen. Particular attention is needed for nephropathic patients because of their higher risk of progression and the need for combination therapy; this group is likely to be the focus of future research and publications.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

[Menopause and postmenopause. Prognostic criteria in insurance medicine].

The increasing proportion of elderly people in the population is presenting politics, society and also medicine with significant new challenges. Gerontology and geriatrics play a role in every area of preventive and curative medicine. Since the life expectancy of women is about 8 years longer than that of men and the greater portion of an aging society will be female, gynaecology takes on special significance. The necessity of developing old-age gynaecology becomes more and more urgent, particularly in view of the fact that postmenopausal women still have more than one third of their lives before them, a period which they would like to and should spend in good mental, psychological and physical condition. Postmenopausal hormone replacement therapy has been remarkably successful in treating climateric complaints and in positively affecting the entire organism. The ability of women to virtually avert later consequences of the hormone deficiency, including osteoporosis-induced fractures, heart attacks and strokes, by means of long-term hormone replacement is one of the great achievements of our time. Furthermore, the importance of hormone replacement therapy in the possible reduction of certain types of genital cancer, as endometrial and ovarial carcinoma, cannot be overstated. Gynaecology has taken a great step toward enabling older women to spend this third stage of their lives free of unnecessary disease or suffering. There is a consensus in literature and among medical experts today that the advantages of estrogen replacement during and following menopause have been proven and are to be highly regarded. The advantages and risks of hormone therapy will be explored from the special standpoint of morbidity and mortality ratings, particularly for the disease patterns of osteoporosis, Alzheimer's disease, heart attack, stroke, as well as breast, endometrial, ovarial and colon cancer. For insurance medicine, these aspects are of paramount significance. Quantification with regard to morbidity and mortality statistics is a challenge that will have to be faced in the years to come.

Adult↗