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PubMed2026

Current Diagnostic Pathways for Rheumatoid Arthritis-Associated Interstitial Lung Disease Result in Substantial Underdiagnosis and Excess Mortality: A Multicenter Norwegian Quality Assurance Audit.

OBJECTIVE: Recent guidelines suggest risk-stratified screening for rheumatoid arthritis-associated interstitial lung disease (RA-ILD). However, the diagnostic gap between current routine care and this screening approach remains unquantified. We assessed currently detected RA-ILD in Norway, benchmarking findings against recent screening-based estimates of the true disease burden. METHODS: This 10-year quality assurance audit across six centers covered 43% of the Norwegian population. RA-ILD cases identified via ICD-10 codes were confirmed by manual chart review. Prevalence was calculated relative to a registry-derived total RA background population and benchmarked against a 10% expected target derived from recent prospective studies. Mortality was compared to a 3:1 frequency-matched RA control group using Cox proportional hazards regression. RESULTS: Among 17,305 RA patients, 188 (1.1%) had verified ILD; when benchmarked against an expected 10% prevalence, this indicates an 89% diagnostic gap in routine clinical care. Mean age at ILD detection was 67.5 years. Most cases (93.6%) possessed &#x2265;2 established risk factors for RA-ILD: 93.6% were seropositive, 76.1% had smoking histories, while RA onset age &#x2265;60 and persistently increased inflammatory laboratory markers were present in over half of patients. RA-ILD was associated with significantly increased mortality; 66 (4.1/100 person-years) deaths occurred in the RA-ILD group vs. 120 (2.3/100 person-years) among RA controls (HR 1.77; 95% CI: 1.31-2.39, p<0.001). CONCLUSION: When comparing to prevalence expectations, current routine care may leave a substantial proportion of cases undetected, primarily capturing a high-risk phenotype with excess mortality. Systematic, risk-stratified screening is needed to bridge this diagnostic gap, aiming to enable earlier intervention.

Interstitial lung disease↗
PubMed1985

The Iowa record-linkage study. III. Excess mortality among patients with 'functional' disorders.

Our investigation of the pattern of mortality among former inpatients in nine diagnostic groups was based on deaths found among 4,869 former inpatients of the University of Iowa Psychiatric Hospital, Iowa City, during a ten-year period. Comparisons were made with expected values based on a relevant Iowa control population. The first two years of follow-up was a period of great risk but not after. Excessive mortality from "unnatural" causes was found among patients of either sex with an affective disorder, schizophrenia, alcohol or other drug abuse, and personality disorders, among men with acute schizophrenia or neuroses, and among women with depressive neuroses. Women with acute schizophrenia or a psychophysiologic disorder or special symptom were at risk for a "natural" death. These findings confirm the risk of reduced life span that patients in all nine categories share.

Adult↗
PubMed1990

The excess mortality rate. A useful concept in cancer epidemiology.

Death cause registers and cancer incidence registers are often used to elucidate progress (or lack of progress) in the battle against cancer. Trends in the age-adjusted mortality rate of cancer or of specific cancer types may thus mirror the overall effect of anticancer interventions (prevention, early diagnostics, treatment), but are often influenced by changes in the death cause diagnostics or in the coding routines at the registers. Relative survival rate (or its inversion, relative mortality rate) is sometimes used in order to elucidate improvement due to treatment. It is independent of the death cause diagnoses but often seriously influenced by changes in diagnostics of incident cancer; earlier diagnosis and increased detection of non-fatal cases may thus give an improved relative survival rate, quite unrelated to any improvement in the treatment. In the present paper the excess mortality rate is introduced as a measure which can give additional information concerning effects of anticancer interventions. In contrast to age-adjusted mortality rate it is not dependent on death cause diagnoses or coding routines, and in contrast to relative survival it is independent of the rate of non-fatal incident cancer cases.

Neoplasms↗
PubMed1997

Excess mortality associated with blindness in leprosy patients in Korea.

Vision loss and blindness are potential complications of leprosy. There is little data available to indicate the impact of eye complications on life expectancy and quality of life. We sought to determine the relative risk of death in blind leprosy patients compared to nonblind leprosy patients. A population-based ocular survey of 510 mycobacteriologically negative leprosy patients in rural South Korea, conducted in 1988, formed the study population. After a 7-year period patients were traced to determine their status (alive, dead, lost to follow up). Blind patients showed a 4.8-fold risk of death, even after adjusting for other factors, compared to nonblind patients. Young blind leprosy patients had the highest relative risk of death. Excess mortality was not associated with any specific cause of blindness, ocular pathology, or type of disease. Findings from our study suggest that all leprosy patients with ocular disabilities (including those released from antileprosy treatment) should be targeted to receive eye care to prevent vision loss. Particular emphasis should be placed on young patients.

Aged↗
PubMed2003

The public health burden of material deprivation: excess mortality in leading causes of death in Spain.

OBJECTIVE: The aim of the study is to investigate the burden of deprivation-associated excess of deaths by 10 leading causes of death in each gender and two age groups. DESIGN: A small-area ecological study using two indices of material deprivation drawn from 1991 census and mortality data aggregated for 1987-1995 was undertaken. SETTING: 2218 small areas in Spain. Data are presented by region. MAIN OUTCOME MEASURES: The 10 leading causes of death in each gender and two age groups were determined. RESULTS: The deprivation-associated excess mortality in the top 10 leading causes of death was 14.4 and 11% for males and females, respectively. Excess mortality in the 9-year period studied accounted for more than 222,000 deaths. A large proportion of excess deaths was found in causes related to smoking and alcohol consumption among males and diet-related causes of death among females. The most deprived regions within the country showed the highest mortality risk. CONCLUSIONS: Material deprivation appears to be manifested in high mortality rates differently by gender and region. It imposes a significant public health burden that demands urgently attention and action by health policy-makers.

Adolescent↗
PubMedDate not supplied

[An unusual excess of mortality in a small Tuscan municipality and the "nursing home effect"].

OBJECTIVE: In the last decades unusual mortality excesses were observed in the small area of Montaione, where the main activities are agriculture and tourism. The aim of this study was to evaluate if the observed excess mortality had to be attributed to the deaths occurred among the local large Nursing Home's guests which were half of the total deaths registered among residents. DESIGN: Empirical Bayesian Mortality Ratios (EBMR), applying the method of Clayton and Kaldor, were calculated either including or excluding the guests of the Nursing Home from the deaths and from the population. Only the population with age > or = 65 was included in the analysis. The expected deaths were calculated using the Tuscan population mortality rates by sex, age and specific cause of death (all causes, cardiovascular diseases, cerebrovascular diseases, digestive diseases and respiratory diseases). RESULTS: Excluding the guests of the Nursing Home from the analysis it was observed a strong decrease of the EBMRs for almost all causes considered, but those for cerebrovascular and respiratory diseases. CONCLUSION: The results obtained underline the necessity to take in consideration also a possible "Nursing Home effect" in evaluating mortality excesses in small areas.

Aged↗
PubMed1998

Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave.

STUDY OBJECTIVE: To assess the impact on mortality of the heatwave in England and Wales during July and August 1995 and to describe any difference in mortality impact between the Greater London urban population and the national population. DESIGN: Analysis of variation in daily mortality in England and Wales and in Greater London during a five day heatwave in July and August 1995, by age, sex, and cause. SETTING: England and Wales, and Greater London. MAIN RESULTS: An estimated 619 extra deaths (8.9% increase, approximate 95% confidence interval 6.4, 11.3%) were observed during this heatwave in England and Wales, relative to the expected number of deaths based on the 31-day moving average for that period. Excess deaths were apparent in all age groups, most noticeably in women and for deaths from respiratory and cerebrovascular disease. Using published daily mortality risk coefficients for air pollutants in London, it was estimated that up to 62% of the excess mortality in England and Wales during the heatwave may be attributable to concurrent increases in air pollution. In Greater London itself, where daytime temperatures were higher (and with lesser falls at night), mortality increased by 16.1% during the heatwave. Using the same risk coefficients to estimate the excess mortality apparently attributable to air pollution, more than 60% of the total excess in London was apparently attributable to the effects of heat. CONCLUSION: Analysis of this episode shows that exceptionally high temperatures in England and Wales, though rare, do cause increases in daily mortality.

Adolescent↗
PubMed1981

[Excess mortality in out-patients psychiatry: first results of a Geneva study].

The project intends to prove an excess of mortality among the out-patients of the official psychiatric center of Geneva. The study is of the follow-up retrospective type. The primary results confirm the hypothesis. They show an increased relative risk of death by suicide and other non natural causes, for both sexes, as well as by natural causes (especially respiratory diseases) but only among women.

Adult↗
PubMed1991

Excess mortality associated with diuretic therapy in diabetes mellitus.

OBJECTIVE: To determine whether the high mortality among diabetic patients receiving treatment for hypertension can be explained by associated risk factors or must be attributed to a deleterious effect of antihypertensive treatment. DESIGN: Cohort analytic study with a median follow-up of 4.5 years. SETTING: Outpatients with diabetes and severe retinopathy who were enrolled in a multicenter, randomized clinical trial of laser treatment to prevent blindness had ophthalmologic examinations every 4 months and annual medical examinations that included measurement of blood pressure and recording of anti-hypertensive treatment. Only 5.5% of the patients were unavailable for follow-up. When a patient died, the circumstances surrounding the death were reviewed and classified by a mortality review committee. PARTICIPANTS: --There were 759 participants in the study; they were white, were aged 35 to 69 years, and had normal serum creatinine levels at the baseline examination. MEASUREMENTS AND MAIN RESULTS: --Patients were classified into five groups according to information recorded at the baseline and first annual follow-up examinations: normotensive (diastolic blood pressure less than 90 mm Hg), untreated hypertensive, hypertensive treated by diuretics alone, hypertensive treated by other agents alone, and hypertensive treated by both agents. Cardiovascular mortality was higher in patients treated for hypertension than in patients with untreated hypertension. The excess was primarily found in patients treated with diuretics alone, although that group had the lowest blood pressure with treatment. After adjusting for differences in risk factors, cardiovascular mortality was 3.8 times higher in patients treated with diuretics alone than in patients with untreated hypertension (P less than .001). CONCLUSIONS: --In individuals with diabetes, intervention with diuretics to reduce hypertension is associated with excess mortality. Until there is a clinical trial showing a beneficial effect of diuretic treatment in diabetic patients, there is urgent need to reconsider its continued usage in this population.

Adult↗
PubMed2003

Can a mortality excess in remote areas of Australia be explained by indigenous status? A case study using neonatal mortality in Queensland.

OBJECTIVE: To assess the extent to which indigenous status confounds the association between remoteness and neonatal mortality in Queensland. METHODS: We used routine data from the Queensland Perinatal Data Collection. Poisson regression modelling was used to assess confounding. RESULTS: Babies born to Indigenous mothers have mortality rates 2.42 times those of the rest of the population, regardless of whether they live in urban, rural or remote areas (95% CI 2.09-2.80). The babies of non-Indigenous women who live in remote areas have a low risk of neonatal death, similar to their rural and urban counterparts. CONCLUSION: In Queensland, the key demographic variable that determines neonatal mortality is indigenous status, not remoteness. IMPLICATIONS: Policymakers should not assume that an excess of a particular health problem in remote areas necessarily reflects equal disadvantage for all the Australians who live there.

Fetal Death↗
PubMed2001

Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair.

OBJECTIVE: Rupture of abdominal aortic aneurysms (AAAs) remains lethal. In a report of patients treated in the 1980s, we recommended aggressive management. Our continued experience prompted us to reevaluate this policy. METHODS: We reviewed clinical variables affecting outcome, morbidity, mortality, and trends in mortality of all patients managed at our institution with ruptured AAAs between January 2, 1980, and November 30, 1998. RESULTS: The study group included 413 consecutive patients, 339 men and 74 women. The mean age was 74.3 years (range, 49-96); 116 (28%) patients were older than 80 years. AAA was diagnosed before rupture in 119 (29%) patients. Eighty (19%) patients had preoperative cardiac arrest. Twenty-nine (7%) patients died before operation; 65 (17%) died during the operation. The surgical mortality rate (30-day) was 37%; the overall mortality rate was 45% and was higher in women (68%) than in men (40%) (P <.001). Advanced age, APACHE (Acute Physiology and Chronic Health Evaluation) II score, initial hematocrit, and preoperative cardiac arrest were associated multivariately with 30-day mortality rates by means of stepwise logistic regression (P <.05). Twelve (23%) of 53 patients with cardiac arrest survived the operation. Logistic regression, adjusted for age, sex, and APACHE II score, demonstrated a decrease in overall and 30-day mortality rates (P <.001) over 18 years. The mean overall mortality rate was 51% from 1980 to 1984 and 42% from 1994 to 1998. CONCLUSIONS: The mortality rate of ruptured AAAs remains excessive, despite improvement over 18 years. Patients older than 80 years with shock or cardiac arrest have the highest mortality rate and should be evaluated for possible endovascular treatment. Because the diagnosis of AAA was unknown in more than 70% of patients, screening of the high-risk population and elective repair are recommended.

APACHE↗
PubMed2001

Excess mortality in bipolar and unipolar disorder in Sweden.

BACKGROUND: Selected groups of patients with bipolar and unipolar disorder have an increased mortality rate from suicide and natural causes of death. However, there has been no population-based study of mortality of patients followed up from the onset of the illness. METHODS: All patients with a hospital diagnosis of bipolar (n = 15 386) or unipolar (n = 39 182) disorder in Sweden from 1973 to 1995 were identified from the inpatient register and linked with the national cause-of-death register to determine the date and cause of death. Overall and cause-specific standardized mortality ratios (SMRs) and numbers of excess deaths were calculated by 5-year age classes and 5-year calendar periods. RESULTS: The SMRs for suicide were 15.0 for males and 22.4 for females with bipolar disorder, and 20.9 and 27.0, respectively, for unipolar disorder. For all natural causes of death, SMRs were 1.9 for males and 2.1 for females with bipolar disorder, and 1.5 and 1.6, respectively, for unipolar disorder. For bipolar disorder, most excess deaths were from natural causes, whereas for unipolar disorder, most excess deaths were from unnatural causes. The SMR for suicide was especially high for younger patients during the first years after the first diagnosis. Increasing SMR for suicide during the period of study was found for female patients with unipolar disorder. CONCLUSIONS: This population-based study of patients treated in the hospital documented increased SMRs for suicide in patients with bipolar and unipolar disorder. The SMR for all natural causes of death was also increased, causing about half the excess deaths.

Adolescent↗
PubMedDate not supplied

[Avoidable years of life lost ratio: an indicator to identify excess mortality in health areas. Mortality workshop of the Valencia region].

Avoidable mortality has been proposed as an outcome indicator of health services. Until now the Standardized Mortality Ratio (SMR) has been the effect measure most used to detect excesses in avoidable mortality. We propose the use, as a complementary measure, of the Avoidable Years of Life Lost Ratio (AYLLR). We show that for tuberculosis, hypertension and for all avoidable deaths both measures provide complementary information, since in some areas where observed deaths are below the expected number (SMR less than 100) we detect an observed number of years of life lost higher than expected (AYLLR greater than 100), due to the occurrence of these deaths at younger ages. The AYLLR is a standardized effect measure that puts a higher weight to premature deaths.

Catchment Area, Health↗
PubMedDate not supplied

[Death of elderly patients in the Santa Genoveva Clinic in Rio de Janeiro: excess mortality that the public health system could have prevented].

From January to May 1996, 156 inpatients died in a clinic for elderly people in Rio de Janeiro, Brazil. The highest mortality rate was observed in May: 143/1,000 inpatients. As a result, the clinic was closed by the Ministry of Health. This study investigated whether the excessive number of deaths observed in the clinic in early 1996 was unexpected or reflected prevailing conditions. The investigation used the Public Health System database (SIH-SUS). The study period was 01/1993 to 05/1996. The investigation was based on: 1) a time-series analysis of the number of deaths and crude mortality rates and 2) comparison of the mortality rates observed in that clinic with those calculated for 15 area hospitals, defined as the reference rates. Risk of death in the clinic was higher than expected in 28 of the 41 months considered in the study. Highest risks were observed in January 1993 (RRcrude = 2.23; 95% CI 1.56-3. 14) and May 1996 (RRadjusted = 2.73; 95% CI 1.88-3.95). The high mortality rates observed in the clinic in 1996 were already present in 1993. Thus, adequate use of the SIH-SUS could have anticipated and avoided the excess mortality identified in early 1996.

Aged↗
PubMed2006

Mortality excess in individuals with elevated IgA anti-transglutaminase antibodies: the KORA/MONICA Augsburg cohort study 1989-1998.

OBJECTIVES: Immunoglobulin A (IgA) autoantibodies to tissue transglutaminase (tTG) are commonly used for screening and diagnosing of celiac disease. We examined the hypothesis that elevated IgA anti-tTG antibodies were associated with higher all-cause mortality risk. METHODS: The cohort, 2333 men and 2300 women, was based on the follow-up of participants of a representative population-based survey in Southern Germany (KORA/MONICA Augsburg project) conducted in 1989-1990. The endpoint for the vital status with cause of death was the year 1998. The sera drawn at baseline and stored at -80 degrees C, were recently screened with an IgA enzyme-linked immunosorbent assay (ELISA) using human recombinant tTG. Age-standardized mortality rates and age-adjusted hazard ratios were calculated. RESULTS: From the 4633 sera analyzed, 63 had an IgA anti-tTG concentration>or=7 AU/ml. Of these 63 individuals, 15 died between 1989 and 1998. The age-adjusted hazard ratio (HRa) of all-cause mortality was 1.86 (95% CI: 1.01-3.41) and 3.92 (95% CI: 1.44-10.71) for men and women, respectively. The excess of cancer mortality was even higher with an HR(a) of 2.47 (95% CI: 0.89-6.83) in men and of 6.65 (95% CI: 2.04-21.63) in women. CONCLUSIONS: Individuals with elevated IgA anti-tTG antibodies had a highly increased mortality risk, particularly due to cancer. New studies are necessary to clarify if this increased risk is due to undiagnosed celiac disease or/and if this elevated IgA anti-tTG antibodies level is a marker of serious diseases like cancer, chronic liver disease or end-stage heart failure.

Adult↗
PubMedDate not supplied

Excess mortality from hepatocellular carcinoma in an HCV-endemic township of an HBV-endemic country (Taiwan).

Taiwan is an endemic area of hepatitis B virus (HBV). All previous studies have concluded that HBV is the major cause of hepatocellular carcinoma (HCC) in Taiwan. An HBV- and hepatitis C virus (HCV)-endemic township, Tzukuan, in southern Taiwan has been identified with the prevalence of 24% for HB surface antigen (HBsAg) and 37% for anti-HCV antibodies. To elucidate the aetiology of HCC and impact of HCV in this township, we conducted a case-control study and compared HBV-related liver cancer mortality in Tzukuan and Taiwan as a whole. Based on cancer registration datasets of 2 medical centres from 1991 to 1995, we recruited 18 male and 9 female HCC cases from the study township. Their mean age (+/- standard deviation) was 60.3 (+/- 7.3) years. Randomly sampled from a community-based survey, 4 age- (+/- 2 years) and sex-matched residents were selected as community controls for each HCC case. The HBsAg carrier rate was 40.7% in cases and 25.0% in controls (P = 0.1). Anti-HCV positive rate was 88.9% in cases and 53.7% in controls (P = 0.008). Age-adjusted liver cancer mortality in Tzukuan (36.5 per 10(5)) was significantly higher than that of Taiwan as a whole (20 per 10(5)). Based on the HBsAg-positive rate among HCC patients (40.7% in Tzukuan and 77.4-86.6% in Taiwan), the estimated HBV-related liver cancer mortality was similar in Tzukuan (14.9 per 10(5)) and Taiwan (15.8-17.3 per 10(5)). We concluded that HCV was the major risk factor for excess liver cancer mortality in this HCV-endemic township of the HBV-endemic country.

Carcinoma, Hepatocellular↗