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PubMed2005

Survival expectations of the obese: Is excess mortality reflected in perceptions?

OBJECTIVE: This study compared self-reported subjective life expectancy (i.e., probability of living to age 75) for normal-weight, overweight, and obese weight groups to examine whether individuals are internalizing information about the health risks due to excessive weight. RESEARCH METHODS AND PROCEDURES: Using data from the Health and Retirement Study, a total of 9035 individuals 51 to 61 years old were analyzed by BMI category. The primary outcome measure was individuals' reports about their own expectations of survival to age 75. Absolute and relative risks of survival were compared with published estimates of survival to age 75. RESULTS: Consistently, higher levels of BMI were associated with lower self-estimated survival probabilities. Differences relative to normal weight ranged from 4.9% (p < 0.01) for male nonsmokers to 8.8% (p < 0.001) for female nonsmokers. However, these differences were substantially less than those obtained from published survival curve estimates, suggesting that obese individuals tended to underestimate mortality risks. DISCUSSION: Individuals appeared to underestimate the mortality risks of excessive weight; thus, knowledge campaigns about the risks of obesity should remain a top priority.

Aged↗
PubMed2001

Hyperglycaemia: link to excess mortality.

Asymptomatic diabetes is defined by chronic hyperglycaemia. The 2-h post-challenge glucose level is not generally used in practice and consequently not recommended for diagnosis, so diabetes is defined from fasting hyperglycaemia. Several large studies have been used to evaluate the impact of different diagnostic definitions on the risk of premature death. Meta-analysis of component studies in the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) study showed that for all-cause mortality fasting glucose did not carry an independent risk but the 2-h post-challenge glucose carried a significant risk after adjusting for factors including fasting glucose. Increasing fasting glucose also did not carry a significant excess risk for cardiovascular mortality but there was an overall significant relative risk with increasing 2-h post-challenge glucose. Analysis of 20-year follow-up data from the combined Whitehall, Paris and Helsinki studies demonstrated that after adjusting for other risk factors men in the upper 20 per cent of the 2-h glucose distribution and those in the upper 2.5 per cent for fasting glucose had a significantly higher risk of all-cause mortality compared with men in the lower 80 per cent of each distribution. Analysis of the Paris Prospective study alone showed that all-cause mortality was highest in those with isolated 2-h post-challenge hyperglycaemia. In men without known diabetes there were J-shaped relationships between both fasting and 2-h glucose and all-cause, cardiovascular and cancer mortalities. Fasting and 2-h glucose levels are highly correlated and hyperglycaemia by either definition is undoubtedly a risk factor for premature death, whatever the cause.

Adult↗
PubMed2001

Neonatal late-onset bloodstream infection: attributable mortality, excess of length of stay and risk factors.

BACKGROUND: Bloodstream infection represents a major threat among neonates under intensive care with considerable impact on morbidity and mortality. This study evaluated extra stay, attributable mortality and the risk factors associated with late-onset bloodstream infection (LO-BSI) among neonates admitted to a neonatal intensive care unit during a 4-year period. METHODS: A retrospective matched cohort study was conducted. For each case, there was one control patient without LO-BSI matched for sex, birth weight, gestational age, duration of hospitalization prior to the date of LO-BSI in the respective cases, underlying illness and birth date. A novel test, sequential plan, was employed for attributable mortality analysis in addition to standard tests. Multiple logistic regression was employed for risk factor analysis. RESULTS: Fifty pairs of cases and controls were compared. LO-BSI prolonged hospital stay of 25.1 days in pairs where both subjects survived. Overall attributable mortality was 24% (95% CI: 9-39% p < 0.01) and specific attributable mortality due to Staphylococcus epidermidis was 26.7% (95% CI: 23-30.4%; p = 0.01). Blood and/or blood components transfusion was independently associated with neonatal LO-BSI (OR: 21.2; 95% CI: 1.1-423). CONCLUSIONS: LO-BSI infection prolongs hospital stay and is associated with increased mortality among neonates. In the present series, blood transfusion was a significant risk factor for LO-BSI.

Brazil↗
PubMed1991

Excess mortality among 3302 patients with 'pure' anxiety neurosis.

The survival probability and causes of death before the age of 70 years were analyzed among 3302 inpatients with "pure" anxiety neurosis in Stockholm County, Sweden, who were tracked in case registries by means of automated record linkage during a 14-year period. When all patients with other psychiatric diagnoses and substance abuse were excluded, and marital status controlled for, there was a significant excess of deaths due to verified and undetermined suicides, ie, nearly one third of all deaths. These unnatural deaths preempted any excess in natural causes before the age of 70 years, such as cardiovascular disease. Treatment policy with regard to the use of anxiolytic drugs was not found to influence mortality. We concluded that the risk of suicide in inpatients before the age of 70 years with anxiety disorders may be as high as that in persons with depression or other diagnoses who require inpatient care.

Adult↗
PubMed2005

Co-proxamol overdose is associated with a 10-fold excess mortality compared with other paracetamol combination analgesics.

AIMS: To assess the relative toxicity of co-proxamol in overdose in comparison to the 2 other paracetamol-opioid combination products, co-codamol and co-dydramol. METHODS: Data collected over a 2-year period (July 2000-June 2002) was used to estimate the frequency of overdose and death for the three most popular paracetamol-opioid compound analgesics. Prescription data for Scotland and Edinburgh, the number of overdoses (derived from overdose admissions in Edinburgh) or Poisons Information Service contacts in Scotland, and national death records were used to calculate a series of indicators relating morbidity (admissions), surrogates of morbidity (poisons enquiries by telephone or internet) and mortality to prescriptions. RESULTS: When related to prescription volume overdoses involving co-proxamol in Scotland were 10 times more likely to be fatal (24.6 (19.7, 30.4)) when compared with co-codamol (2.0 (0.88, 4.0)) or co-dydramol (2.4 (0.5, 7.2)). In contrast there was no difference in the presentation rate or enquiry rates for these analgesics when corrected for prescriptions. CONCLUSIONS: The excess hazard from co-proxamol is due to inherent toxicity rather than increased use in overdose. We estimate from this study that withdrawal of co-proxamol would prevent 39 excess deaths per annum in Scotland alone.

Acetaminophen↗
PubMed1988

Excess mortality among formerly hospitalized child psychiatric patients.

Mortality was investigated in 881 male and 450 female formerly hospitalized child psychiatric patients in a four- to 15-year follow-up. Death from natural causes was not increased, but death from unnatural causes occurred at a rate more than twice as high as expected based on age- and sex-matched comparisons with the general population of the state of Iowa. Increased risk of unnatural death was found in five of eight psychiatric diagnostic categories but was significant only for Mental Reasoning, a category that combined patients with organic mental disorders, schizophrenia, or mental retardation. Clinical variables associated with an excess rate of unnatural death included age 15 years or older at the time of admission, the absence of a second psychiatric diagnosis, the presence of previous psychiatric hospitalizations, and the presence of a seizure disorder. Among the 23 unnatural deaths, the 11 (47.8%) suicides were excessive, but accidents and homicides were not.

Accidents↗
PubMed1985

Excess mortality among psychiatric patients. The Iowa Record-Linkage Study.

Of 5,412 patients admitted to the University of Iowa Psychiatric Hospital between Jan 1, 1972, and Dec 31, 1981, three hundred thirty-one died during the follow-up period, significantly more than expected. The risk for premature death was greatest among women and the young, especially those between the ages of 30 and 39 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either sex with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psycho-physiologic disorders and special symptoms; and men with neuroses. Suicide and accidental death were more frequent than expected and were responsible for two thirds of the excess deaths. During the total time of follow-up, women were at risk for natural deaths but men were not. Our most important finding was that 99% of the excess deaths occurred within two years of discharge. During this period there were undue numbers of both "natural" and "unnatural" deaths. The first two years after discharge are a time of great risk for psychiatric patients, particularly women.

Accidents↗
PubMed1996

Excessive mortality in young free-ranging male nonhuman primates with low cerebrospinal fluid 5-hydroxyindoleacetic acid concentrations.

BACKGROUND: The purpose of this study was to assess the impact of central serotonin turnover rate on survival to adulthood among nonhuman primates living in a large, free-ranging colony. METHODS: The rate of mortality was ascertained over a 4-year period after obtaining blood and cisternal cerebrospinal fluid (CSF) samples from 49 free-ranging, 2-year-old prepubertal male rhesus monkeys. Cerebrospinal fluid was assayed for 5-hydroxyindoleacetic acid (5-HIAA), norepinephrine, 3-methoxy-4-hydroxyphenylgycol, and homovanillic acid. Blood plasma was assayed for adrenocorticotropic hormone, cortisol, and testosterone. Following the sampling of body fluids, records of scars and wounds and aggressive encounters were used to rank the subjects from low to high in aggressiveness. Direct observations of aggressive behavior were collected from 27 of the subjects over a 3-month period. RESULTS: Four years later, 6 of the 49 subjects were known to be dead and an additional 5 had been missing for more than 2 years and were presumed dead. The CSF 5-HIAA concentrations were predictive of which subjects died, with 46% of the subjects with low CSF 5-HIAA concentrations dead or presumed dead. None of the subjects from the highest CSF 5-HIAA concentration quartile were dead or missing. Indeed, 91% of the dead subjects came from the 2 lowest quartiles of CSF 5-HIAA concentrations. Direct observations of aggressive behavior showed that dead or missing subjects had initiated escalated aggression, a measure of unrestrained aggression that has a high probability of trauma or injury, at a higher rate than subjects that were known to be alive. The cause of death could be ascertained for 6 of the 11 missing subjects. The 4 subjects that were known to die as a consequence of aggressive encounters came from the lowest quartile of CSF 5-HIAA concentrations and had been rated as more aggressive during their initial capture. Subjects captured more than once possessed lower CSF 5-HIAA concentrations, were rated as more aggressive, and were more likely to suffer early death than those captured only once. CONCLUSION: These findings suggest that low CSF 5-HIAA concentrations quantified early in life is a powerful biological predictor of future excessive aggression, risk taking, and premature death among nonhuman primate males.

Aggression↗
PubMed1985

The Iowa record-linkage study. II. Excess mortality among patients with organic mental disorders.

Of 543 patients with organic mental disorders hospitalized at the University of Iowa Psychiatric Hospital, Iowa City, during a ten-year period, 87 died. This mortality was significant based on a control population. Patients of all ages were at risk for early death, especially those younger than 40 years. Risk was greatest during the first two years of follow-up; thereafter the observed death rate approached the expected rate. Patients were at special risk for death from "natural" causes, particularly cancer and heart disease among women, and influenza or pneumonia or "other" natural causes among men. During the first two years of follow-up, men were also at risk for death from accidents or suicide. Women with alcohol- and drug-related psychoses were at risk for death early in follow-up, but the diagnosis was not associated with risk from "unnatural death" in either sex.

Accidents↗
PubMed2003

Excess mortality among long-stay psychiatric patients in Northern Finland.

BACKGROUND: According to several studies, mortality in psychiatric patients is higher than in the general population, but cause-specific mortality analyses in long-stay psychiatric patients have not been studied very much. Individual follow-ups have been called for in order to identify possible treatment deficiencies and to make recommendations for clinical practices. In this study, mortality of long-stay psychiatric patients has been monitored for the years 1992-2000 and contrasted with that prevalent in the general population. METHOD: Data on psychiatric patients (N = 253) who were treated without a break for at least 6 months during 1992 in the Department of Psychiatry at Oulu University Hospital were linked with the National Death Register. Standardised mortality rates (SMRs) were determined according to gender, age groups, and different causes of death. RESULTS: Of the total study population, 80.2 % had schizophrenia, 5.1 % other functional psychoses, 9.5 % organic mental disorders, 2.4 % personality disorders and 2.8 % mood disorders. Sixty-nine (27.3 %) of the patients (aged 31-88 years) had died before the end of the year 2000. The all-cause death risk for both males and females was four times that of the general population. The mortality risk was over ten-fold for males and almost 30-fold for females in the youngest age group (25-34 years), with suicides explaining about 75 % of these deaths. SMRs were found to decrease at older age, mortality thus approaching that of the general population. Diseases of the circulatory system were the most common single cause of death in both genders and mortality due to that cause exceeding mortality in the general population nearly 3.6-fold. However, the probability of death was highest (SMR 17.5) in connection with diseases of the digestive system. Increased risks of death due to respiratory complications (SMR 9.3), accidents (SMR 5.1) and neoplasms (SMR 2.1) were also noted. The overall death rates did not differ in relation to social class or professional education. CONCLUSIONS: Long-stay psychiatric patients were found to die from the same natural causes as the rest of the general population. However, the mortality risk of the long-stay psychiatric patients compared with that of the general population was notably higher, despite ongoing improvements in medical care and facilities. Inadequately organised somatic care and the prevailing culture of "non-somatic" treatment in psychiatry were suggested to, at least in part, explain this phenomenon. Attention ought to increasingly focus on somatic examinations and various health educational programmes specially designed for psychiatric patients and involving matters like healthy diet, smoking cessation and physical exercise. These practices should be a regular part of any patient's treatment programme. Also, the need to recognise factors associated with a patient's psychiatric disorder that could limit that patient's ability to communicate somatic symptoms and/or even lead to a refusal by that patient to have somatic diseases treated was seen as essential for providers of psychiatric services.

Adult↗