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PubMed2004

Association between microfilarial load and excess mortality in onchocerciasis: an epidemiological study.

BACKGROUND: Infection with the parasitic filarial nematode Onchocerca volvulus can lead to severe visual impairment and ultimately blindness. Excess mortality has been noted among people with onchocerciasis, but it is not clear whether this effect is entirely due to blindness, or mediated by some more direct effects of the infection. METHODS: We assessed the relations between infection with O volvulus, visual acuity, and host mortality with data obtained by the Onchocerciasis Control Programme in West Africa from 2315 villages in 11 countries. FINDINGS: 297,756 people were eligible for follow-up, and accumulated 2,579449 person-years of follow-up from 1971 through 2001. 24,517 people died during this period; 1283 (5.2%) of these deaths were due to onchocerciasis. Mortality of the human host was significantly and positively associated with increasing microfilarial burden (p<0.00001), but not with blindness after adjustment for microfilarial load and other variables. Overall, after adjustment for microfilarial load and other variables, female individuals had a risk of death about 7.5% lower than males (p<0.00001). Rates of mortality peaked in the mid 1980s but generally decreased thereafter. INTERPRETATION: We have shown a direct relation between O volvulus microfilarial load and host mortality in a comprehensive dataset and in both sexes.

Adolescent↗
PubMed1982

Association of excess mortality from chronic nonspecific lung disease with epidemics of influenza. Comparison of experience in the United States and in England and Wales, 1968 to 1976.

Mortality from chronic nonspecific lung disease reported in the United States and in England and Wales during the period 1968 to 1976 was studied to determine if excessive deaths from this condition were associated with epidemics of influenza. In both countries, peaks of excess mortality of this type did indeed occur during such epidemics; however, these excesses were considerably more marked in the British data where the estimated number of such deaths over the 8-yr period was 15,800 compared with 6,000 for the United States. There was a decreasing secular trend in age-specific death rates for chronic nonspecific lung disease among British males of all ages, whereas only middle-aged males showed such a trend in the United States; older American males were subject to a substantially increasing trend. The respective trends in such mortality observed among males in the 2 countries were also seen among females but were smaller in magnitude.

Adult↗
PubMedDate not supplied

Excess mortality, length of stay, and costs associated with serious fungal infections among elderly cancer patients: findings from linked SEER-Medicare data.

OBJECTIVE: To calculate the excess mortality, length of stay, and costs attributable to serious fungal infections in hospitalized elderly patients with selected cancers. METHODS: This study involved a retrospective cohort analysis using linked data from the Surveillance, Epidemiology and End Results Program of the National Cancer Institute (SEER) and Medicare claims data. Study cohorts included patients aged 65 years and older who newly received a diagnosis of a selected cancer (acute myeloid leukemia [AML] or squamous cell carcinoma of the head and neck [SCCHN]) in a SEER registry between 1991 and 1996 and who had a subsequent diagnosis of a serious fungal infection during an inpatient hospitalization, and hospitalized controls without a fungal infection matched 1:1 by age, geographic region, receipt of recent chemotherapy, concomitant bacterial infection, timing of the index hospitalization, and cancer stage at diagnosis (for SCCHN patients only). RESULTS: Eighty AML patients and 52 SCCHN patients experienced a serious fungal infection involving hospitalization. Relative to matched controls, SCCHN patients with fungal infections had significantly higher all-cause mortality (40% vs. 14%, P = 0.002), while mortality rates did not differ between AML cohorts. Patients with fungal infections had significantly longer index hospitalizations regardless of cancer type (mean: 30 days vs. 19 days for AML patients; 20 days vs. 9 days for SCCHN patients), and correspondingly higher Medicare payments (mean +/- SD: 34,268 dollars +/- 31,811 dollars vs. 21,416 dollars +/- 22,449 dollars among AML patients, P < 0.0001; 25,942 dollars +/- 29,122 dollars vs. 10,131 dollars +/- 10,686 dollars among SCCHN patients, P < 0.0001). CONCLUSIONS: Efforts to prevent these infections and/or initiate early treatment may yield both clinical and economic benefits.

Aged↗
PubMed1995

["The main cause of the differences is the crime": An attempt at explaining the excess mortality of illegitimate children in The Hague in the mid-nineteenth century].

During the last quarter of the 19th century, illegitimate children had much higher infant mortality than legitimate children. To investigate which factors played a role in this, we collected information on the household situation and the life course of all illegitimate children, born in the Dutch city of The Hague in the years 1850-1852. Use was made of birth and death certificates and of the population registers of the city. We compared our information with data on a random sample of legitimate children,, born in the same city. After children had reached the age of one month, mortality among illegitimate children became very high, compared to that of our reference group. Proportional hazards analysis showed that this excess mortality was caused by a set of factors, the most important being the age of the mother at birth, regional background, and the socio-economic group to which the notifier of the birth belonged. Aside from those factors, legal status of the child as such had an effect on infant mortality. The unwed mothers most likely to lose their child in its first year of life lived alone with their child and were obliged to resume work to support themselves and their child. The opportunity to breastfeed may have played a key role in this.

Cause of Death↗
PubMed2005

A study of excess mortality during influenza epidemics in the Czech Republic, 1982-2000.

Influenza related mortality rates have been established in many countries; nevertheless, studies focusing on the Central European population have been rare to date. We assess mortality attributable to influenza by comparing all cause mortality and mortality due to diseases of the circulatory system during influenza epidemic and non-epidemic periods, as defined by acute respiratory infection surveillance data. Data on total mortality, mortality due to diseases of the circulatory system and surveillance data for influenza and other respiratory infections were used in a general linear model with a logarithmic link for dependence of left censored mortality data over time, and week as a categorical factor. Results of the analysis show statistically significant (p <0.001) differences in excess mortality rates between influenza epidemic and non-epidemic periods in the Czech Republic between 1982 and 2000. We estimate that 2.17% of all cause mortality, and 2.57% of mortality due to diseases of the circulatory system throughout the study period was attributable to influenza, with an estimated annual average of 2661 and 1752 deaths respectively. The highest numbers of deaths were reported during seasons when influenza A/H3N2 was the predominant circulating strain. Improving vaccination coverage against influenza is considered to be the primary strategy for prevention of influenza associated mortality.

Adolescent↗
PubMed1978

Excess mortality from influenza in a large urban population, Rome, Italy, 1956--76.

Influenza activity was studied in the Rome population from 1956 to 1976 by analysis of mortality from respiratory causes and from all causes. During cold weather months, type A influenza virus was associated, as a rule, with epidemic excess deaths at two year intervals while type B virus was prevalent twice during isolation data were also compared with epidemic excess mortality during four consecutive years. The evidence obtained indicated that influenza virus isolation alone does not represent a reliable index of epidemic influenza activity in this population. The proportion of deaths attributed to respiratory causes consistently increased in every epidemic, the most pronounced increases occurring during large epidemics. The break-down by age of deaths from respiratory causes in the course of two epidemic periods showed that the percentage distribution of deaths was essentially the same as in non-epidemic periods. This evidence indicates that the same factors influencing the age-related distribution of mortality from respiratory causes during non-epidemic periods, probably affect the fatal outcome of influenza during epidemics.

Absenteeism↗
PubMed1998

[Excess mortality in critically ill patients after treatment with human albumin].

According to the results of a systematic review of randomized clinical studies administration of human albumin to critically ill patients is associated with excess mortality, compared with withholding albumin or administration of crystalloid fluids. The study appears to be well done. Also, there are various explanatory pathophysiological mechanisms supporting the association. However, a favourable effect of albumin in certain patient groups cannot be excluded. Alternatives to albumin are available in most clinical situations, but unfortunately, they are not completely without drawbacks. The use of albumin has to be limited; it might only be abolished when a better effect of other fluids, such as synthetic solutions, is demonstrated.

Albumins↗
PubMed1996

A twofold excess mortality among black compared with white IDDM patients in Allegheny county, Pennsylvania. Pittsburgh DERI Mortality Study Group.

OBJECTIVE: To examine the long-term mortality experience of blacks who develop IDDM in childhood. RESEARCH DESIGN AND METHODS: The 11-25-year mortality status of individuals with IDDM who participated in the Diabetes Epidemiology Research International (DERI) Mortality Study was verified as of 1 January 1990 for 1,008 (94%) of the 1,076 individuals in the study. Life-table analysis was performed, and race-specific rates were determined for the final sample. RESULTS: Among black patients, 14.9% died compared with 6.6% of the white patients after a maximum of 25 years of follow-up. African-Americans experienced an age-adjusted mortality rate that was over twice that of whites for the entire period (9.4 vs. 3.8 per 1,000 person-years, respectively; P < 0.05) and at each 5-year interval of follow-up. Among blacks, the mortality rate for females (15.9/1,000 person-years) was 8.4 times (P < 0.05) that of males (1.9/1,000 person-years). In contrast, this sex difference was not seen among whites. Acute complications of diabetes accounted for 40% of the mortality in the black patients, while only 23% of the white patients died from acute causes. CONCLUSIONS: The data suggest that some of the excess mortality in black IDDM patients may be preventable.

Adolescent↗
PubMedDate not supplied

Comparing high- and low-performing hospitals using risk-adjusted excess mortality and cost inefficiency.

This study examines characteristics associated with high- and low-performing hospitals, where performance is defined in terms of both mortality outcomes and efficiency. In particular, we use data for Florida hospitals in 1999-2001 to classify hospitals into performance groups based on both risk-adjusted excess mortality and cost efficiency. The results indicate that hospitals in the high-performing group were more likely to be for-profit, had higher occupancy rates, had proportionately more Medicare and proportionately fewer Medicaid and self-pay patients, used fewer patient-care personnel per admission, and had higher operating margins than all other hospitals. Hospitals in the low-performing group, on the other hand, were less likely to be for-profit, had more beds, used more patient-care personnel per admission, had lower pay per patient-care personnel, had higher average costs, and had lower operating margins than all other hospitals. Interestingly, managed care presence, measured by proportion of HMO-PPO admissions, was not a significant factor in differentiating hospital performance groups.

Cost-Benefit Analysis↗
PubMed2002

Excess mortality associated with blindness in the onchocerciasis focus of the Mbam Valley, Cameroon.

The association between blindness, mortality and nutritional status was investigated in a retrospective cohort study in villages of central Cameroon where onchocerciasis is hyper-endemic. Overall, 101 blind subjects and 101 non-blind controls matched with the blind for age, sex and (generally) village of residence were followed for 10 years. Blindness gave rise to a significant increase in mortality (relative risk = 2.3; P = 0.012), the life expectancy of the blind adults being reduced by 4 years compared with that of their controls. For a given age, excess mortality was found to be associated with a late onset of blindness. The causes of death were similar for the blind and the controls but blind subjects had relatively low body mass indices, which may lead to relatively early fatal disease outcomes. These results are similar to those obtained in other parts of Africa and emphasise, once more, the demographic impact of blindness in developing countries.

Adult↗
PubMed1992

An analysis of excess mortality rates for persons with non-insulin-dependent diabetes mellitus in Western Australia using the Cox proportional hazards regression model.

A cohort of 888 rural, nonaboriginal persons with non-insulin-dependent diabetes mellitus identified in Western Australia through surveys in 1978-1982 were followed for death until the end of 1986. A total of 257 deaths were observed. Excess mortality in this cohort as compared with the general Australian population was investigated by calculating standardized mortality ratios and using the Cox proportional hazards regression model with hazard rates for the general population as the baseline. The overall standardized mortality ratio was 1.83 (95% confidence interval 1.51-2.16) for women and 1.43 (95% confidence interval 1.18-1.67) for men. Cause-specific comparisons with the general population showed that the majority of excess deaths could be attributed to diseases of the circulatory system. Factors assessed at the baseline survey that were independently prognostic of shorter survival were early onset of diabetes (for females only), high plasma glucose level, retinopathy, macrovascular disease, albuminuria (for females only), and elevated plasma creatinine level. Reductions in life expectancy at 60 years of age as compared with the general population averaged about 5 years but could be as much as 16 years for female diabetics with early onset of diabetes, high plasma glucose levels, and several complications.

Aged↗
PubMed2001

Excess mortality due to pneumonia or influenza during influenza seasons among persons with acquired immunodeficiency syndrome.

BACKGROUND: Anecdotal reports suggest that influenza-related morbidity may be high among persons with acquired immunodeficiency syndrome (AIDS), but little information is available concerning the population-level impact of influenza on mortality in persons with AIDS. METHODS: Using the Multiple Cause-of-Death data files, which contain information on all deaths occurring in the United States each year, we calculated the numbers of excess deaths and rates of excess death due to pneumonia or influenza among persons with AIDS aged 13 years and older during the influenza seasons 1991-1992 through 1993-1994. For comparison, numbers of excess deaths and excess death rates were also calculated for several other groups including the general US population aged 13 years and older and the general US population aged 65 years and older. RESULTS: During the 1991-1992, 1992-1993, and 1993-1994 influenza seasons, there were 261, 254, and 191 excess deaths due to pneumonia or influenza in persons with AIDS and excess death rates of 19.74, 15.38, and 10.17 deaths per 10 000 persons, respectively, compared with a summer baseline period. For the same seasons, we observed excess death rates of 1.40, 1.62, and 1.48 for the general US population aged 13 years and older and 8.10, 9.28, and 8.54 for the general US population aged 65 years and older. Thus, persons with AIDS had excess death rates substantially higher than the general US population and similar to, if not somewhat higher than, the general US population aged 65 years and older, a group that is already targeted for annual vaccination. The findings were similar when we compared the preinfluenza season with the influenza season. CONCLUSIONS: Persons with AIDS have significant excess mortality due to pneumonia or influenza during influenza seasons and should be considered a high-risk group that is targeted for the prevention of influenza.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Excess mortality among elderly psychiatric in-patients with organic mental disorder.

BACKGROUND: Many studies have shown hospitalised mentally ill patients to have a higher mortality risk than the general population. METHOD: Data of patients with organic mental disorders of ICD-9 categories 290, 293, 294 and 310 from seven psychiatric hospitals with defined catchment areas were analysed. During an observation period of 2.5 years 1821 treatment periods in these diagnostic categories were recorded. RESULTS: During hospitalisation 137 patients died from natural causes. The age- and sex-adjusted mortality rates show an increased mortality risk of 7.5 times, compared to the general population. The odds ratio of a logistic regression demonstrate the overwhelming influence of the medical diagnosis. CONCLUSION: Medical factors, including pneumonias, contribute most to the excess mortality.

Aged↗
PubMed1984

Epidemiologic data on excess mortality and life expectancy in insulin-dependent diabetes mellitus--critical review.

Generalizations of prognosis with regard to insulin-dependent diabetes (IDDM) in epidemiological statistics are impaired not only by great intraindividual variations, but also due to methodical difficulties. Due to recent prognostic studies IDDM, particular in young age, must be considered as a rather serious disease with a 5 to 10 fold higher excess mortality in comparison with the general population. There are only few exact data about the extent of life shortening. Age of onset represents the most significant factor in life shortening. The younger the patient is at the age of onset the shorter he lives. From about 70 years onward diabetes has little or no effect on longevity. Whether the prognosis of IDDM has improved within the last decades remains uncertain. Long-term studies clearly indicate that IDDM is compatible also with a long life in a good health. Why many diabetics develop life shortening complications and why some patients do not cannot be answered with conclusive evidence.

Adolescent↗
PubMed2004

A combination of serum low albumin and above-average cholesterol level was associated with excess mortality.

BACKGROUND: There is no population-based prospective study concerning the relation between serum albumin and mortality in a non-Western population, and few previous studies included the subgroup analysis stratified by serum cholesterol level. METHODS: A 13.7-year cohort study was conducted on 6,957 males and females aged 30-59 years from 300 randomly selected areas throughout Japan, who participated in the National Survey on Circulatory Disorders in 1980. RESULTS: In the group with median and above of total cholesterol, one standard deviation (SD) increment of serum albumin (2.6 g/L for males and 2.4 g/L for females) was inversely associated with all-cause mortality for both males and females (relative risk RR = 0.68 and 0.81: 95% confidence interval CI = 0.53-0.87 and 0.68-0.98), and with cancer mortality for females (RR = 0.74; 95% Cl = 0.57-0.96);and the lowest category of serum albumin (< or = 43 g/L) showed the highest cardiovascular mortality for males (RR = 5.04; 95% CI = 1.04-24.5) among the three albumin categories. These relationships were not evident in the group with total cholesterol level below median. CONCLUSION: A combination of a low albumin level and above average cholesterol level, even both within the clinical normal range,is associated with excess mortality in the Japanese general population.

Adult↗
PubMedDate not supplied

Bacteriuria and excess mortality: what should the next steps be?

Population studies have been reviewed that demonstrate that bacteriuria confers an increased risk of earlier death and that this risk is greater in older-age groups. Whether this relationship is due to the capacity of bacteria to infect selectively those who are already seriously ill or is a direct consequence of the presence of bacteria remains to be decided. However, studies have already demonstrated that the excess mortality associated with bacteriuria in hospitalized patients with indwelling catheters can be greatly reduced by simple devices that prevent bacteriuria and that this reduction in rates of bacteriuria is accompanied by a corresponding significant decline in associated mortality. The time is therefore right for a large-scale, controlled clinical trial of the effect on mortality of treatment of bacteriuria in older-age populations. However, such a trial cannot be conducted in the manner in which such studies have been conducted in the past--i.e., with a single course of treatment given over a brief time as the only method of therapy. Instead, more individualized treatment will be necessary if the effect of bacteriuria on mortality in the general population is to be investigated in a scientifically sound manner.

Aged↗
PubMed1990

The effect of known risk factors on the excess mortality of black adults in the United States.

We compared the mortality rate ratios, before and after adjustment for different risk factors, of black vs white adults in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. For persons 35 to 54 years old, the rate ratio of mortality for blacks vs whites decreased from 2.3 (unadjusted) to 1.9 when adjusted simultaneously for six well-established risk factors (smoking, systolic blood pressure, cholesterol level, body-mass index, alcohol intake, and diabetes) and decreased from 1.9 to 1.4 when adjusted for the six risk factors plus family income. Thus, approximately 31% of the excess mortality can be accounted for by six well-established risk factors and a further 38% by family income. This leaves 31% unexplained. Broader social and health system changes and research targeted at the causes of the mortality gap, coupled with increased efforts aimed at modifiable risk factors, may all be needed for egalitarian goals in health to be realized.

Adult↗