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PubMed2005

Physical activity as a determinant of mortality in women.

BACKGROUND: There is substantial evidence that higher levels of activity reduce the risk of mortality, but several research questions remain about the protective effect of physical activity. We aimed to quantify the effect of physical activity on overall mortality in younger women and to assess the effect of past versus current activity. METHODS: During 1991-1992, we enrolled 99,099 women, age 30-49 years, from the entire country of Norway and one Swedish region, in a population-based cohort study. The women provided information on physical activity level at age 14 and 30 years and at enrollment, as well as information on other personal characteristics at enrollment. We achieved complete follow-up into 2003 using record linkages to nationwide registers. We used Cox proportional hazard models to calculate multivariate relative risks (RRs) of dying from any cause. RESULTS: During an average 11.4 years of follow-up, 1,313 women died. Risk of death decreased with increasing physical activity at enrollment (5 categories; P for trend<0.0001) and was reduced by half in the highest compared with the lowest category (RR=0.46; 95% confidence intervals=0.33-0.65). This protective effect was consistent across strata of age at entry, smoking, country, and education. After adjustment for physical activity at enrollment, activity at age 14 and 30 was not associated with mortality. CONCLUSIONS: Current physical activity substantially reduces mortality among women. This association is observed even with low levels of physical activity and is accentuated with increased physical activity.

Adult↗
PubMed2003

On the importance of age-adjustment methods in ecological studies of social determinants of mortality.

OBJECTIVE: To illustrate the potential sensitivity of ecological associations between mortality and certain socioeconomic factors to different methods of age-adjustment. DATA SOURCES: Secondary analysis employing state-level data from several publicly available sources. Crude and age-adjusted mortality rates for 1990 are obtained from the U.S. Centers for Disease Control. The Gini coefficient for family income and percent of persons below the federal poverty line are from the U.S. Bureau of Labor Statistics. Putnam's (2000) Social Capital Index was downloaded from http://www.bowlingalone.com; the Social Mistrust Index was calculated from responses to the General Social Survey, following the method described in Kawachi et al. (1997). All other covariates are obtained from the U.S. Census Bureau. STUDY DESIGN: We use least squares regression to estimate the effect of several state-level socioeconomic factors on mortality rates. We examine whether these statistical associations are sensitive to the use of alternative methods of accounting for the different age composition of state populations. Following several previous studies, we present results for the case when only mortality rates are age-adjusted. We contrast these results with those obtained from regressions of crude mortality on age variables. PRINCIPAL FINDINGS: Different age-adjustment methods can cause a change in the sign or statistical significance of the association between mortality and various socioeconomic factors. When age variables are included as regressors, we find no significant association between mortality and either income inequality, minority racial concentration, or social capital. CONCLUSIONS: Ecological associations between certain socioeconomic factors and mortality may be extremely sensitive to different age-adjustment methods.

Adolescent↗
PubMedDate not supplied

Community-based study of mortality in children with epilepsy.

We used the records of a statewide pediatric mortality surveillance system to determine mortality rates and causes of death in children with epilepsy. Of the 1,095 children aged 1-14 years who died in the state of Victoria during the study period 1985-1989, 93 had a history of epilepsy. Six children (6%) had primary epilepsy, and 87 (94%) had secondary epilepsy. Death was (a) directly attributable to epilepsy in 20 (22%), including 11 with sudden unexplained death, (b) not directly attributable to epilepsy in 59 (63%), and (c) of undetermined cause in 14 (15%). No classifiable death occurred as a direct result of status epilepticus. The average annual mortality rates for children with epilepsy were (a) death from all causes, 30.6 in 10,000 [95% confidence interval (CI) 19.7, 47.5], and (b) death attributable to epilepsy, 6.6 in 10,000 (95% CI 3.7, 11.8). Relative to the all-cause mortality rate in children without epilepsy, the all-cause mortality rate ratios were (a) all children with epilepsy, 13.2 (95% CI 8.5, 20.7); (b) primary epilepsy, 1.1 (95% CI 0.5, 2.6); and (c) secondary epilepsy, 49.7 (95% CI 31.7, 77.9). The mortality rate ratios for secondary epilepsy relative to primary epilepsy were (a) death from all causes, 43.5 (95% CI 19.0, 99.5); and (b) death attributable to epilepsy, 9.0 (95% CI 3.3, 24.8). Epilepsy appeared on the death certificate of only 11 of 20 (55%) children whose deaths were attributable to epilepsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Determinants of mortality in status epilepticus.

Using univariate and multivariate regression analysis, we studied seizure duration, seizure type, age, etiologies, other clinical features, and mortality among 253 adults with status epilepticus (SE) admitted to the Medical College of Virginia. Cerebral vascular disease and discontinuation of antiepileptic drugs (AEDs) were the most prominent causes of SE, each accounting for approximately 22% of all patients in the series. The other principle etiologies were alcohol withdrawal, idiopathic, anoxia, metabolic disorders, hemorrhage, infection, tumor, drug overdose, and trauma. When the patients were divided into two groups, the group with SE lasting < 1 h had a lower mortality as compared with seizure duration > or = 1 h. Low mortality rates were noted in alcohol and AED discontinuation etiologies. Anoxia and increasing age were significantly correlated with higher mortality. The mortality rates of partial and generalized SE were not significantly different. Race and sex did not affect mortality significantly. Our findings represent the first multivariate analysis of predictive indicators of mortality in SE and demonstrate that specific factors influence mortality rate in SE.

Adolescent↗
PubMed2005

Lifestyle determinants and mortality in German vegetarians and health-conscious persons: results of a 21-year follow-up.

BACKGROUND: The long-term observation of vegetarians in affluent countries can provide insight into the relative effects of a vegetarian diet and lifestyle factors on mortality. METHODS: A cohort study of vegetarians and health-conscious persons in Germany was followed-up prospectively for 21 years, including 1,225 vegetarians and 679 health-conscious nonvegetarians. Standardized mortality ratios compared with the German general population were calculated for all causes and specific causes. Within the cohort, Poisson regression modeling was used to investigate the joint effects of several risk factors on overall and cause-specific mortality. RESULTS: Standardized mortality ratios for all-cause mortality was significantly below 100: 59 [95% confidence interval (95% CI), 54-64], predominantly due to a deficit of deaths from circulatory diseases. Within the cohort, vegetarian compared with nonvegetarian diet had no effect on overall mortality [rate ratio (RR), 1.10; 95% CI, 0.89-1.36], whereas moderate and high physical activity significantly reduced risk of death (RR, 0.62, 0.64), adjusted for age, sex, smoking, alcohol intake, body mass index, and educational level. Vegetarian diet was however associated with a reduced RR of 0.70 (95% CI, 0.41-1.18) for ischemic heart disease, which could partly be related to avoidance of meat. CONCLUSIONS: Both vegetarians and nonvegetarian health-conscious persons in this study have reduced mortality compared with the general population. Within the study, low prevalence of smoking and moderate or high level of physical activity but not strictly vegetarian diet was associated with reduced overall mortality. The nonsignificant reduction in mortality from ischemic heart diseases in vegetarians compared with health-conscious persons could be explained in part by avoidance of meat intake.

Adult↗
PubMedDate not supplied

Determinants of mortality in patients with severe sepsis.

OBJECTIVE: To evaluate the relative importance of predictors of in-hospital mortality in severe sepsis and compare the performance of generic and disease-specific mortality prediction models. METHODS: The author used data from all 826 patients receiving placebo in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial. After a variety of clinical factors were examined for their univariate association with in-hospital mortality, logistic regression models incorporating successively more inclusive sets of predictors were created and compared. For each model, discrimination was assessed and the relative contribution of each model component to overall model explanatory power evaluated. The accuracy of using the Acute Physiology and Chronic Health Evaluation (APACHE) II score in isolation as an indicator of "high risk" was assessed by comparing model predictions from APACHE-only models to those of disease-specific models. RESULTS: Age, a number of laboratory values, and APACHE II score were significant univariate predictors of mortality. In multivariable models, age and laboratory values contributed the most information to model predictions; the contribution of the APACHE II score, in particular, the acute physiology component, was modest at best. A risk model including only the total APACHE II score had a c-statistic of 0.686, whereas the best performing disease-specific model had a c-statistic of 0.787. Use of the APACHE II score alone to establish high risk versus low risk resulted in misclassification of 26% of patients. CONCLUSIONS: Individual severe sepsis patient outcomes depend on an array of clinical predictors. Models incorporating sepsis disease-specific risk factors may predict mortality more accurately than generic ICU severity measures.

APACHE↗
PubMedDate not supplied

Determinants of mortality in oncology patients colonized or infected with Staphylococcus aureus.

Oxacillin-resistant Staphylococcus aureus (ORSA) infection is an important cause of hospital morbidity and mortality. The objective of this study was to identify the main factors associated with death in patients colonized or infected with Staphylococcus aureus in a cancer center. A matched-pair case-control study enrolled all patients infected or colonized with ORSA (cases) admitted to the Hospital do Câncer in Rio de Janeiro from 01/01/1992 to 12/31/1994. A control was defined as a patient hospitalized during the same period as the case-patients and colonized or infected with oxacillin-susceptible Staphylococcus aureus (OSSA). The study enrolled 95 cases and 95 controls. Patient distribution was similar for the two groups (p > or = 0.05) with respect to gender, underlying diseases, hospital transfer, prior infection, age, temperature, heart and respiratory rates, neutrophil count, and duration of hospitalization. Univariate analysis of putative risk factors associated with mortality showed the following significant variables: admission to the intensive care unit (ICU), presence of bacteremia, use of central venous catheter (CVC), ORSA colonization or infection, pneumonia, use of urinary catheter, primary lung infection, prior use of antibiotics, mucositis, and absence of cutaneous abscesses. Multivariate analysis showed a strong association between mortality and the following independent variables: admission to ICU (OR [odds ratio] = 7.2), presence of Staphylococcus bacteremia (OR = 6.8), presence of CVC (OR = 5.3), and isolation of ORSA (OR = 2.7). The study suggests a higher virulence of ORSA in comparison to OSSA in cancer patients.

Catheterization, Central Venous↗
PubMed1980

Socio-economic determinants of mortality in industrialized countries.

In the early 1950s, it was generally considered that social mortality differentials appeared during the 1st stages of industrialization and would be resolved with the socialization of health services. Admittedly, at that time, the spectacular progress achieved through antibiotics encouraged the belief that health was merely a matter of medicine and that the institution of a social security scheme would suffice for minimizing the risks of death that were not directly involved in the natural differences between individuals. 30 years have passed and the expectation of life has lengthened (although less than anticipated), but the social differences remain. They are, in fact, by no means attributable to lack of medical science. The elimination of the most discriminating causes of death (alcoholism, accidents, suicide, tuberculosis, etc.) is less dependent on further scientific progress than on a complete change in living conditions and behavior. The reduction in the excess mortality of the poorer classes from other causes (cancer, cardiovascular diseases, etc.) again calls more for a thorough cultural transformation of the least privileged social categories than for the discovery of new therapies or increased expenditure on hospitals. Faced with a mortality that is already very unequal (selection, differential risks), the various social categories behave in basically different ways, which, while aggravating the real inequities, lead to an apparent morbidity that is inversely proportional to true morbidity and to a more prompt and frequent use of medical care among the social categories in which true morbidity is lowest. Inequality with respect to death is only 1 dimension of social inequality. It was an illusion to imagine that 1 could be eliminated without the other. Today that illusion has been destroyed. That does not mean that the present situation must be accepted. Inequality with respect of death is still 1 of the most disgraceful consequences of social inequality and its abolition must still be our aim. Obviously, however, this aim cannot be achieved through the health services alone.

Americas↗
PubMedDate not supplied

[What determines decreased mortality among patients treated for alcoholic delirium?].

The course and results of treatment of delirium tremens in 218 patients and pre-delirium syndrome in 569 patients treated in the Psychiatric Department of the Hospital for Miners in Bytom between 1966 and 1984 was analysed. During this period there was found mitigation in the severity of the psychosis and a fall in the number of patients displaying the fully developed syndrome in relation to patients suffering from abortive forms (pre-delirium syndromes). Among the patients treated no deaths were noted. In the opinion of the authors the use of appropriate psychotropic drugs in patients with DT is only one of the many factors influencing the course of this psychosis. As important and often more important is intensive somatic treatment of patients in a severe general condition.

Adult↗
PubMedDate not supplied

Role of the cancer registries in determining cancer mortality in Asia?

Data on incidence, prevalence, and disease specific mortality are frequently incomplete, not very reliable or are lacking in many countries particularly in Asia and Africa. In the absence of dependable data from the Civil Registration System (CRS), many countries have developed their own Sample Registration System (SRS). Due to several socio-economic constraints cause is not adequately noted in the death certificates. Sample registration system practice in India helps in this but for correlating with cancer registry data this is not the optimal. When cancer morbidity figures from SRS system and cancer registry are compared the SRS figures are low. Reasons for fewer cancer deaths in Municipal Corporation reports may be due to that they only look at primary cause of death and overlook the secondary or underlying causes. There are also a number of reasons for under-registration of cancer deaths in cancer registries but they nevertheless give a more accurate picture. Many registries collect follow-up information for survival studies, which is also helpful to improve cancer mortality data. Tumour registries also represent important resources for rapid identification of cancer survivors for research studies.

Asia↗