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PubMed1991

Relationship of hospitalized stroke rate and in-hospital mortality to the decline in US stroke mortality.

Data from the National Hospital Discharge Survey was used to estimate the admission rate and in-hospital mortality for US stroke patients from 1970 to 1987. Over this period the hospital admission rate increased from 5.0 per 1,000 population to 5.5 per 1,000, while the in-hospital mortality fell from 18.6 to 10.0% of discharges. When patients experiencing general or late effects or transient ischemic attacks were excluded, the hospital admission rate increased from 2.8 to 4.8 per 1,000 and in-hospital mortality fell from 26 to 12% of discharges. Admission rates increased from 1970 to 1987 for both hemorrhagic strokes and cerebral infarctions, but fell for ill-defined cerebrovascular events, presumably reflecting increased use of computed tomography and magnetic resonance imaging during this period. Mortality for hemorrhagic strokes decreased from 45 to 30% of discharges, mortality for infarctions decreased from 24 to 13% and mortality for ill-defined events fell from 24 to 17%. There are several limitations with the use of the National Hospital Discharge Survey data to estimate changes in hospital admission rates and in-hospital mortality. However, these data suggest a greater role for decreasing case fatality in explaining nationwide declines in stroke mortality rates than has generally been acknowledged.

Acute Disease↗
PubMed2000

A moderate intake of wine is associated with reduced total mortality and reduced mortality from cardiovascular disease.

OBJECTIVE: The aim of this study was to investigate the effects of the consumption of wine, beer and distilled spirits on total mortality and on mortality from cardiovascular disease. METHOD: The consumption of wine, beer and distilled spirits was assessed in 1,828 individuals by a psychiatrist. Subjects were selected according to expected level of need for health services, from a random sample of 24,043 individuals aged 18-65 years. Mortality was recorded after 22 years and the results related to those for the individuals not exposed to the factor examined. The results were adjusted for age, expected level of need for health services, total alcohol consumption, gender, body-mass index, tobacco use and social class. RESULTS: Intake of wine once a week or more (compared with intake of wine less than once a week or not at all) was associated with a relative risk ratio of 0.58 for total mortality (95% CI: 0.40-0.84) and a relative risk ratio of 0.49 for mortality from cardiovascular disease (95% CI: 0.27-0.90). The risk reduction seemed to be confined to those consumers of wine who had an intake of less than 140 grams of alcohol per week and consumed the beverage once a week. Ex-drinkers had an increased relative risk ratio in total mortality compared with lifelong abstainers and individuals who consumed less than 50 grams of alcohol per week (relative risk ratio = 2.64; 95% CI: 1.56-4.49). CONCLUSIONS: A low to moderate intake of wine seems, unlike the consumption of distilled spirits and beer, to be associated with reduced total mortality and reduced mortality from cardiovascular disease.

Adolescent↗
PubMed1991

International evaluation of cause-specific mortality and IDDM. Diabetes Epidemiology Research International Mortality Study Group.

OBJECTIVE: A cross-cultural study was completed to evaluate differences in mortality patterns in four population cohorts in Japan; Israel; Allegheny County, Pennsylvania; and Finland. RESEARCH DESIGN AND METHODS: Cases were diagnosed between 1 January 1965 and 31 December 1979. Mortality was determined as of 1 January 1985. There were 147 deaths occurring in the 8212 insulin-dependent diabetes mellitus (IDDM) patients in the four countries. A standardized protocol for assessing causes of death (cause-specific mortality) was developed; in this article, we report the causes. RESULTS: Major overall mortality differences by country appeared, with IDDM subjects in Japan much more likely to die than in the other countries. In Japan, the elevated mortality was the result of acute diabetes-related complications and kidney disease. For all countries, mortality from acute diabetes-related complications accounted for a surprisingly high percentage of deaths (greater than 25% in each country). A larger percentage of cases in Finland died as a result of suicide than for the other three countries. CONCLUSIONS: The results suggest that there are major cross-country differences in cause-specific mortality and that much of the premature mortality associated with diabetes is potentially preventable.

Cause of Death↗
PubMed1992

[A marked decline in the mortality from ischemic heart disease among middle aged Danish men in the 1980's and simultaneous changes of mortality because of other causes].

The mortality from ischaemic heart disease (IHD) in 35-64 year old Danish men has declined by 27% from 1981 to 1989. In the same period, a lesser increase in mortality from all other causes was observed. However, this is a heterogenous phenomenon, since the mortality from (in particular) infectious diseases (AIDS), diabetes mellitus, and a number of diseases related to heavy drinking has increased, whereas the suicide rate and mortality from lung cancer (in 1985-89) have decreased. It is not possible to evaluate the contribution of improved treatment of IHD cases and a decreasing incidence of disease, respectively, to the decline in mortality from IHD. A decreasing incidence is very probable, however, since both the percentage of smokers and the plasma cholesterol levels in middle-aged men have declined significantly since mid-1970s and leisure time physical activity has increased. The trend in IHD mortality in the 1980s points to a sustained decline in the 1990s and a levelling off in the increase in mortality from other causes. Thus total mortality is expected to decrease more rapidly in the 1990s, resulting in an increase in life expectancy of Danish men.

Adult↗
PubMed2000

Structured settlement annuities, part 2: mortality experience 1967--95 and the estimation of life expectancy in the presence of excess mortality.

BACKGROUND: the mortality experience for structured settlement (SS) annuitants issued both standard (Std) and substandard (SStd) has been reported twice previously by the Society of Actuaries (SOA), but the 1995 mortality described here has not previously been published. We describe in detail the 1995 SS mortality, and we also discuss the methodology of calculating life expectancy (e), contrasting three different life-table models. RESULTS: With SOA permission, we present in four tables the unpublished results of its 1995 SS mortality experience by Std and SStd issue, sex, and a combination of 8 age and 6 duration groups. Overall results on mortality expected from the 1983a Individual Annuity Table showed a mortality ratio (MR) of about 140% for Std cases and about 650% for all SStd cases. Life expectancy in a group with excess mortality may be computed by either adding the decimal excess death rate (EDR) to q' for each year of attained age to age 109 or multiplying q' by the decimal MR for each year to age 109. An example is given for men age 60 with localized prostate cancer; annual EDRs from a large published cancer study are used at duration 0-24 years, and the last EDR is assumed constant to age 109. This value of e is compared with e from constant initial values of EDR or MR after the first year. Interrelations of age, sex, e, and EDR and MR are discussed and illustrated with tabular data. CONCLUSIONS: It is shown that a constant MR for life-table calculation of e consistently overestimates projected annual mortality at older attained ages and underestimates e. The EDR method, approved for reserve calculations, is also recommended for use in underwriting conversion tables.

Compensation and Redress↗
PubMedDate not supplied

[Retrospective study on the mortality of children under 5 in a rural district of the region of Brazzaville (People's Republic of Congo). I. Rate and causes of mortality].

A retrospective study of 1,003 children permits us to identify precisely rates and causes of mortality in children under 5 years old in a rural holoendemic malaria area of the People's Republic of the Congo. The mortality rates are distinctly lower than those generally observed in tropical Africa. Infant mortality (0-1 year) was found to be 71%, mortality 13%, early neonatal mortality (0-7 days) 41% and mortality between 1-5 years, 49%. Main causes of mortality are those related to pregnancy (prematurity, obstetrical pathology) and with infectious diseases particularly measles. On the other hand, no death seems to be attributable directly to malaria in this study.

Age Factors↗
PubMed1997

Trends and patterns of mortality associated with birth defects and genetic diseases in the United States, 1979-1992: an analysis of multiple-cause mortality data.

Contemporary information on the trends and patterns of mortality associated with birth defects and genetic diseases is lacking in the United States. To study these trends and patterns, we used the Multiple-Cause Mortality Files of the National Center for Health Statistics. From 1979 through 1992, 320,208 deaths in the United States were associated with birth defects and genetic diseases. The age-adjusted mortality rates for people with birth defects declined from about 8.2/100,000 in 1979 to about 6.7/100,000 in 1992, and the mortality rates for people with genetic diseases increased from 2.2/100,000 in 1979 to 2.5/100,000 in 1992. The mortality rate was higher among men than among women and higher among blacks than among whites or other races for both birth defect- and genetic disease-associated deaths. The rate among infants with birth defects was more than 25 times higher than that among other age groups. About half of the children whose deaths were associated with birth defects had cardiovascular system defects, 15% had central nervous system defects, and 12% had chromosomal defects. For deaths associated with genetic diseases, hereditary neurologic or storage disorders were the most common genetic diseases (38%), followed by metabolic disorders (21%), sickle cell and thalassemia (12%). The decline in the rate of mortality from birth defects in the United States probably reflects improvements in medical and surgical care and other factors. Most of the mortality associated with birth defects remains in the pediatric age group (less than 15 years old). The upward trend we detected for the deaths with genetic diseases was most likely related to improved recognition and reporting of some genetic diseases rather than to the increased prevalence.

Adolescent↗
PubMed2001

The association between daily mortality and ambient air particle pollution in Montreal, Quebec. 1. Nonaccidental mortality.

This study was undertaken to determine whether variations in concentrations of particles in the ambient air of Montreal, Quebec, during the period 1984 to 1993, were associated with daily variations in nonaccidental mortality. Fixed-site air pollution monitors in Montreal provided daily mean levels of various measures of particulates and gaseous pollutants. Total sulfates were also measured daily (1986-1993) at a monitoring station 150 km southeast of the city (Sutton, Quebec). We estimated associations for PM(2.5), PM(10), total suspended particles, coefficient of haze (COH), extinction coefficient, and sulfates. We used coefficient of haze, extinction coefficient, and Sutton sulfates to predict fine particles and sulfates for days that were missing. To estimate the associations between nonaccidental mortality and ambient air particles, we regressed the logarithm of daily counts of nonaccidental mortality on the daily mean levels for the above measures of particulates, after accounting for seasonal and subseasonal fluctuations in the mortality time series, non-Poisson dispersion, weather variables, and gaseous pollutants. There were 140,939 residents of Montreal who died during the study period. We found evidence of associations between daily nonaccidental deaths and most measures of particulate air pollution. For example, the mean percentage increase (MPC) for an increase of total suspended particles of 28.57 microg/m(3) (interquartile range, IQ), evaluated at lag 0 days, was 1.86% (95% confidence interval (CI): 0.00-3.76%), and for an increase of coefficient of haze (IQ=18.5 COH units per 327.8 linear m) the MPC was 1.44% (95% CI: 0.75-2.14%). These results are similar to findings from other studies (the mean percentage increase in nonaccidental deaths for a 100 microg/m(3) increase in daily total suspended particles was 6.7%). We also found increases for fine particles and for inhalable particles, but the confidence intervals included unity. All measures of sulfates showed increased daily mortality; e.g., the MPC for sulfates from fine particles (IQ=3.51 microg/m(3)) was 1.86% (95% CI: 0.40-3.35%). We generally found higher excesses in daily mortality for persons 65 years of age and for exposures averaged across lags 0, 1, and 2 days. The slope of the association between daily mortality and ambient air particles in Montreal, which has lower levels of pollution than most major urban centers, is similar to that reported in most other industrialized cities. This study therefore provides further evidence that the association is linear and that any threshold effect, should it exist, would be found at lower levels of air pollution than those found in Montreal.

Aged↗
PubMed1998

Beyond infant mortality: gender and stillbirth in reproductive mortality before the twentieth century.

Though it has been the largest component of reproductive mortality since its statutory registration in 1928, stillbirth has received little attention from historical demographers, who have relied on the more orthodox indicator of early human survival changes - "infant mortality". The exclusion of stillbirth hampers demographic analysis, underestimates progress in newborn vitality, and over-privileges post-natal causes in theoretical explanation. A case is made for estimating stillbirth before 1928 as a ratio of early neonatal death, and for employing perinatal mortality as an historical indicator of female health status. The long-run trend of reproductive mortality (encompassing mature foetal and live born infant death during the first eleven months) reveals a substantial decline in perinatal causes in the first industrial century (1750-1850), implying a major concurrent improvement in the nutritional status of child bearers. Reproductive mortality is a more complete indicator of death in infancy. It offers demographers a means of fracturing the fertility versus mortality dualism and a potential purchase on gender as a demographic variable, while re-opening the case on mortality in the demographic dynamic of the world we have lost.

Fetal Death↗
PubMed1995

Sex differences in human mortality and aging at late ages: the effect of mortality selection and state dynamics.

Models of gender differences in human mortality and aging depend on assumptions about temporal rates of physiological change. Simple models like the Gompertz fail to describe the mortality of either males or females at late ages. This suggests a need for biologically more detailed models to represent the age dependency of human mortality as well as gender differences in that age dependence. By modeling the sex-specific interaction of time-varying covariates with multiple dimensions of mortality selection, one can more accurately describe the age dependence of mortality and more complex physiological aging patterns. The multivariate model of aging changes is used to describe gender differences using data from (a) a longitudinal study of physiological changes and mortality and (b) a nationally representative longitudinal survey of changes in function and mortality.

Adult↗
PubMed1985

Declining fertility in England and Wales as a major cause of the twentieth century decline in mortality. The role of changing family size and age structure in infectious disease mortality in infancy.

The decline in infectious disease mortality in England and Wales beginning about 1880 has been attributed to improved nutrition, hygiene, and sanitation. Such an explanation does not adequately explain the lack of improvement in infant and diarrheal disease mortality before 1900 nor the abrupt subsequent decline. A hypothesis was proposed that the decline in fertility rate was a major cause of the decline in infant mortality by raising the median age at infection. The hypothesis could only be tested indirectly. A review of morbidity data demonstrates the importance of family characteristics on the median age at infection for measles, pertussis, and common respiratory illness. The association of parity with infectious disease mortality supports the hypothesis. A method was developed for estimating the change in birth order distribution resulting from declining fertility. Using 1949-1950 data, it was shown that declining fertility could account for at least a 24% decline in postneonatal mortality due to bronchitis and pneumonia. Age-specific measles mortality rates are consistent, with an increase in age at infection. Declining fertility appears to have played a major role in the decline in infectious disease mortality in England and Wales by increasing the median age at infection.

Adolescent↗
PubMed1995

Estimating standardized mortality odds ratios with national mortality followback data.

Proportionate mortality analyses are often used to study cause-specific mortality when population denominators are not available. The purpose of this paper is to present an extension of published proportionate mortality ratio logistic regression methods used to analyze such data. This paper describes methods used to estimate standardized mortality odds ratios (SMORs) with numerator data and the problems encountered when external standard rates are not available for all strata of interest. This paper focuses on the case where one has representative mortality followback data. These data are based on a large, representative sample of deaths from a defined population for whom numerous covariates about the decedents are collected from surviving family members. With these data, one may use logistic regression methods to generate fully standardized estimates of risk, SMORs, with numerator data. It is also possible to generate SMORs that allow for effect modification. Mortality followback data are also a more flexible data source from which one may generate substitutes for external standard mortality rate ratios to be used with previously developed SMOR methods. An application of the methods is provided using logistic regression.

Heart Diseases↗
PubMed2005

A meta-analysis of time-series studies of ozone and mortality with comparison to the national morbidity, mortality, and air pollution study.

BACKGROUND: Although many time-series studies of ozone and mortality have identified positive associations, others have yielded null or inconclusive results, making the results of these studies difficult to interpret. METHODS: We performed a meta-analysis of 144 effect estimates from 39 time-series studies, and estimated pooled effects by lags, age groups, cause-specific mortality, and concentration metrics. We compared results with pooled estimates from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS), a time-series study of 95 large U.S. urban centers from 1987 to 2000. RESULTS: Both meta-analysis and NMMAPS results provided strong evidence of a short-term association between ozone and mortality, with larger effects for cardiovascular and respiratory mortality, the elderly, and current-day ozone exposure. In both analyses, results were insensitive to adjustment for particulate matter and model specifications. In the meta-analysis, a 10-ppb increase in daily ozone at single-day or 2-day average of lags 0, 1, or 2 days was associated with an 0.87% increase in total mortality (95% posterior interval = 0.55% to 1.18%), whereas the lag 0 NMMAPS estimate is 0.25% (0.12% to 0.39%). Several findings indicate possible publication bias: meta-analysis results were consistently larger than those from NMMAPS; meta-analysis pooled estimates at lags 0 or 1 were larger when only a single lag was reported than when estimates for multiple lags were reported; and heterogeneity of city-specific estimates in the meta-analysis were larger than with NMMAPS. CONCLUSIONS: This study provides evidence of short-term associations between ozone and mortality as well as evidence of publication bias.

Age Factors↗
PubMed2005

Mortality from lung cancer and tobacco smoking in Ohio (U.S.): will increasing smoking prevalence reverse current decreases in mortality?

BACKGROUND: Despite significant changes in smoking patterns within the past few decades, lung cancer remains a major cause of cancer deaths in many developed countries in people of each sex, and one of the most important public health issues. The study aims to analyze the possible impact of changes in tobacco smoking practices in the state of Ohio (U.S.) on current and future trends and patterns of lung cancer mortality. MATERIALS AND METHODS: Mortality rates from lung cancer were calculated for the period 1970 to 2001 on the basis of data from the National Center for Health Statistics. The Joinpoint regression approach was used to evaluate changes in time trends by sex, age, and race. Data on smoking prevalence in Ohio were retrieved from the Centers for Disease Control and Prevention website. RESULTS: Lung cancer mortality rates in Ohio have declined among men of all ages as well as in specific age groups in the 1990s, and the rate of increase among middle-aged and elderly women has dropped over time. The mortality rate among young women (ages 20-44) began to increase during the early 1990s. The prevalence of smoking in Ohio has increased since the early 1990s, especially among young persons. CONCLUSIONS: Recent trends in tobacco smoking in Ohio indicate that the declining trends in lung cancer mortality might be reversed in the future. An early indicator of possible change is the recent increase in mortality among young women. Implementation of the Ohio Comprehensive Tobacco Use Prevention Strategic Plan might help to disseminate proven prevention strategies among the inhabitants of Ohio and might thus prevent future increases in lung cancer mortality rates in the state.

Adult↗
PubMed2002

Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women.

BACKGROUND: Data are conflicting over whether women have higher mortality than men after coronary artery bypass graft (CABG) surgery. Younger but not older women hospitalized for acute myocardial infarction have higher in-hospital mortality rates than men. We hypothesized that younger women also have higher in-hospital mortality rates after CABG. METHODS AND RESULTS: We studied 51 187 patients (30% women) included in the National Cardiovascular Network database who received CABG at 23 clinical centers between October 1993 and December 1999. Compared with men, fewer women were white and more women had risk factors and comorbidities. These differences were more apparent in younger patients. In all age groups, however, women had higher left ventricular ejection fraction and fewer diseased vessels. Women had higher in-hospital mortality rates than men, but sex differences in mortality were more marked among younger patients. Women <50 years of age were 3 times more likely to die than men (3.4% versus 1.1%), and women 50 to 59 years of age were 2.4 times more likely to die than men (2.6% versus 1.1%). In the older age categories, the sex difference in in-hospital mortality was less marked (P<0.001 for the interaction between sex and age). Adjustment for preoperative risk factors only slightly decreased the strength of this interaction. CONCLUSIONS: Younger women undergoing CABG surgery are at a higher risk of in-hospital death than men, but this difference in risk decreases with advancing age. Additional investigation is needed to determine why in-hospital mortality is higher in women after CABG, with particular focus on younger women.

Age Distribution↗
PubMed2001

Reconsidering mortality compression and deceleration: an alterative model of mortality rates.

In this research we develop a model of mortality rates that parameterizes mortality deceleration and compression, permits hypothesis tests for change in these parameters over time, and allows for formal gender comparisons. Our model fits mortality data well across all adult ages 20-105 for 1968-1992 U.S. white data, and the results offer some confirmation of findings of mortality research using conventional methods. We find that the age at which mortality deceleration begins is increasing over time, that decompression of mortality is occurring, and that these trends vary substantially across genders, although male and female mortality patterns appear to be converging to some extent.

Adult↗
PubMed2002

Why do foreign-born blacks have lower infant mortality than native-born blacks? New directions in African-American infant mortality research.

OBJECTIVE: This study focuses attention on maternal nutrition and stress as possible reasons for excess black infant mortality after exploring lower infant mortality for the infants of foreign-born black mothers compared to native-born black mothers. METHODS: All births to non-Hispanic black women in New York City from 1988-1992 were examined and infant mortality for the infants of native-born women was compared to infant mortality for the infants of foreign-born women. RESULTS: Before controlling for potential confounders on the birth certificate, the infants of native-born black women had a greater risk of infant mortality than the infants of foreign-born black women: OR = 1.48 (95% confidence interval [CI] = 1.38, 1.58). After controlling for potential confounders, the infants of native-born black women still had a greater risk of infant mortality than the infants of foreign-born black women: OR(a) = 1.32 (95% Cl = 1.21, 1.43). CONCLUSIONS: Maternal nutrition and stress are possible causes of excess black infant mortality. They should be topics for research and program development.

Black or African American↗
PubMed1984

Mortality and social class in New Zealand. III: male mortality by ethnic group.

Social class differences in male mortality in New Zealand were investigated separately for Maori, Pacific Island and other New Zealand males aged 15-64. All three groups displayed strong social class mortality gradients but, for each class, the Maori mortality rates were approximately 50% higher than the rates for the "other" category, while the Pacific Islander rates generally occupied an intermediate position. The Maori mortality rates were particularly high for the disease groupings of respiratory diseases, infectious diseases, genito-urinary diseases, endocrine, nutritional and metabolic disorders and diseases of the circulatory system other than coronary heart disease and cerebrovascular disease--even when the data were adjusted for age and social class factors. The Pacific Islander rates were high for the same disease groupings except for endocrine, nutritional and metabolic disorders. Overall, there were substantial social class differences and ethnic differences in mortality and these were largely independent so that only about one-fifth of the Maori mortality excess was attributable to social class factors. Four-fifths of the Maori excess was not attributable to such factors indicating that interventions aimed specifically at lower socio-economic groups will not eliminate the current mortality differences between Maoris and non-Maoris.

Adolescent↗