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Sample records for all-cause child mortality

  1. Vaccination and all-cause child mortality from 1985 to 2011: global evidence from the Demographic and Health Surveys.

    PubMed

    McGovern, Mark E; Canning, David

    2015-11-01

    Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality. PMID:26453618

  2. Structural pluralism and all-cause mortality.

    PubMed Central

    Young, F W; Lyson, T A

    2001-01-01

    OBJECTIVES: This study tested the hypothesis that "structural pluralism" reduces age-standardized mortality rates. Structural pluralism is defined as the potential for political competition in communities. METHODS: US counties were the units of analysis. Multiple regression techniques were used to test the hypothesis. RESULTS: Structural pluralism is a stronger determinant of lower mortality than any of the other variables examined--specifically, income, education, and medical facilities. CONCLUSIONS: These findings support the case for a new structural variable, pluralism, as a possible cause of lower mortality, and they indirectly support the significance of comparable ecologic dimensions, such as social trust. PMID:11189808

  3. Suicidal Ideation is Associated With All-Cause Mortality.

    PubMed

    Shiner, Brian; Riblet, Natalie; Westgate, Christine Leonard; Young-Xu, Yinong; Watts, Bradley V

    2016-09-01

    Suicidal ideation may be associated with all-cause mortality. Available research shows that treatment of depression reduces the risk of all-cause mortality in patients with suicidal ideation. However, this finding has not been replicated in a clinical population, where patients have various mental health conditions. We examined the association between suicidal ideation and all-cause mortality in a clinical cohort. We stratified patients presenting to a mental health clinic from January 2005 through December 2007 based upon their degree of suicidal ideation and obtained vital status information through June 2015. We compared groups using survival analysis, adjusting for patient characteristics and treatment receipt. Among 1,869 patients who completed the initial assessment, there were 363 deaths. Patients with the highest levels of suicidal ideation died at increased rates. Cause-of-death data in the year following the initial assessment indicates that the difference in mortality is not likely attributable to suicide. Accounting for patient characteristics and treatment, which included medical care and mental health care, did not meaningfully diminish the relationship between suicidal ideation and all-cause mortality. Additional research is needed to determine specific treatment elements that may moderate the relationship between suicidal ideation and all-cause mortality. PMID:27612350

  4. Statin Use Reduces Prostate Cancer All-Cause Mortality

    PubMed Central

    Sun, Li-Min; Lin, Ming-Chia; Lin, Cheng-Li; Chang, Shih-Ni; Liang, Ji-An; Lin, I-Ching; Kao, Chia-Hung

    2015-01-01

    Abstract Studies have suggested that statin use is related to cancer risk and prostate cancer mortality. We conducted a population-based cohort study to determine whether using statins in prostate cancer patients is associated with reduced all-cause mortality rates. Data were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 5179 patients diagnosed with prostate cancer who used statins for at least 6 months between January 1, 1998 and December 31, 2010. To form a comparison group, each patient was randomly frequency-matched (according to age and index date) with a prostate cancer patient who did not use any type of statin-based drugs during the study period. The study endpoint was mortality. The hazard ratio (HR) and 95% confidence interval (CI) were estimated using Cox regression models. Among prostate cancer patients, statin use was associated with significantly decreased all-cause mortality (adjusted HR = 0.65; 95% CI = 0.60–0.71). This phenomenon was observed among various types of statin, age groups, and treatment methods. Analyzing the defined daily dose of statins indicated that both low- and high-dose groups exhibited significantly decreased death rates compared with nonusers, suggesting a dose–response relationship. The results of this population-based cohort study suggest that using statins reduces all-cause mortality among prostate cancer patients, and a dose–response relationship may exist. PMID:26426656

  5. Association Between Interstitial Lung Abnormalities and All-Cause Mortality

    PubMed Central

    Putman, Rachel K.; Hatabu, Hiroto; Araki, Tetsuro; Gudmundsson, Gunnar; Gao, Wei; Nishino, Mizuki; Okajima, Yuka; Dupuis, Josée; Latourelle, Jeanne C.; Cho, Michael H.; El-Chemaly, Souheil; Coxson, Harvey O.; Celli, Bartolome R.; Fernandez, Isis E.; Zazueta, Oscar E.; Ross, James C.; Harmouche, Rola; Estépar, Raúl San José; Diaz, Alejandro A.; Sigurdsson, Sigurdur; Gudmundsson, Elías F.; Eiríksdottír, Gudny; Aspelund, Thor; Budoff, Matthew J.; Kinney, Gregory L.; Hokanson, John E.; Williams, Michelle C; Murchison, John T.; MacNee, William; Hoffmann, Udo; O’Donnell, Christopher J.; Launer, Lenore J.; Harrris, Tamara B.; Gudnason, Vilmundur; Silverman, Edwin K.; O’Connor, George T.; Washko, George R.; Rosas, Ivan O.; Hunninghake, Gary M.

    2016-01-01

    IMPORTANCE Interstitial lung abnormalities have been associated with decreased six-minute walk distance, diffusion capacity for carbon monoxide and total lung capacity; however to our knowledge, an association with mortality has not been previously investigated. OBJECTIVE To investigate whether interstitial lung abnormalities are associated with increased mortality. DESIGN, SETTING, POPULATION Prospective cohort studies of 2633 participants from the Framingham Heart Study (FHS) (CT scans obtained 9/08–3/11), 5320 from the Age Gene/Environment Susceptibility (AGES)-Reykjavik (recruited 1/02–2/06), 2068 from COPDGene (recruited 11/07–4/10), and 1670 from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) (between 12/05–12/06). EXPOSURES Interstitial lung abnormality status as determined by chest CT evaluation. MAIN OUTCOMES AND MEASURES All cause mortality over approximately 3 to 9 year median follow up time. Cause-of-death information was also examined in the AGES-Reykjavik cohort. RESULTS Interstitial lung abnormalities were present in 177 (7%) of the participants from FHS, 378 (7%) from AGES-Reykjavik, 156 (8%) from COPDGene, and in 157 (9%) from ECLIPSE. Over median follow-up times of ~3–9 years there were more deaths (and a greater absolute rate of mortality) among those with interstitial lung abnormalities compared to those without interstitial lung abnormalities in each cohort; 7% compared to 1% in FHS (6% difference, 95% confidence interval [CI] 2%, 10%), 56% compared to 33% in AGES-Reykjavik (23% difference, 95% CI 18%, 28%), 16% compared to 11% in COPDGene (5% difference, 95% CI −1%, 11%) and 11% compared to 5% in ECLIPSE (6% difference, 95% CI 1%, 11%). After adjustment for covariates, interstitial lung abnormalities were associated with an increase in the risk of death in the FHS (HR=2.7, 95% CI, 1.1–65, P=0.030), AGES-Reykjavik (HR 1.3, 95% CI 1.2–1.4, P<0.001), COPDGene (HR=1.8, 95% CI, 1.1, 2

  6. Adverse childhood experiences and premature all-cause mortality.

    PubMed

    Kelly-Irving, Michelle; Lepage, Benoit; Dedieu, Dominique; Bartley, Mel; Blane, David; Grosclaude, Pascale; Lang, Thierry; Delpierre, Cyrille

    2013-09-01

    Events causing stress responses during sensitive periods of rapid neurological development in childhood may be early determinants of all-cause premature mortality. Using a British birth cohort study of individuals born in 1958, the relationship between adverse childhood experiences (ACE) and mortality≤50 year was examined for men (n=7,816) and women (n=7,405) separately. ACE were measured using prospectively collected reports from parents and the school: no adversities (70%); one adversity (22%), two or more adversities (8%). A Cox regression model was carried out controlling for early life variables and for characteristics at 23 years. In men the risk of death was 57% higher among those who had experienced 2+ ACE compared to those with none (HR 1.57, 95% CI 1.13, 2.18, p=0.007). In women, a graded relationship was observed between ACE and mortality, the risk increasing as ACE accumulated. Women with one ACE had a 66% increased risk of death (HR 1.66, 95% CI 1.19, 2.33, p=0.003) and those with ≥2 ACE had an 80% increased risk (HR 1.80, 95% CI 1.10, 2.95, p=0.020) versus those with no ACE. Given the small impact of adult life style factors on the association between ACE and premature mortality, biological embedding during sensitive periods in early development is a plausible explanatory mechanism. PMID:23887883

  7. Body Mass Index (BMI) and All-Cause Mortality Pooling Project

    Cancer.gov

    The BMI and All-Cause Mortality Pooling Project quantified the risk associated with being overweight and the extent to which the relationship between BMI and all-cause mortality varies by certain factors.

  8. Hemoglobin Screening Independently Predicts All-Cause Mortality.

    PubMed

    Fulks, Michael; Dolan, Vera F; Stout, Robert L

    2015-01-01

    Objective .- Determine if the addition of hemoglobin testing improves risk prediction for life insurance applicants. Method .- Hemoglobin results for insurance applicants tested from 1993 to 2007, with vital status determined by Social Security Death Master File follow-up in 2011, were analyzed by age and sex with and without accounting for the contribution of other test results. Results .- Hemoglobin values ≤12.0 g/dL (and possibly ≤13.0 g/dL) in females age 50+ (but not age <50) and hemoglobin values ≤13.0 g/dL in all males are associated with progressively increasing mortality risk independent of the contribution of other test values. Increased risk is also noted for hemoglobin values >15.0 g/dL (and possibly >14.0 g/dL) for all females and for hemoglobin values >16.0 g/dL for males. Conclusion .- Hemoglobin testing can add additional independent risk assessment to that obtained from other laboratory testing, BP and build in this relatively healthy insurance applicant population. Multiple studies support this finding at older ages, but data (and the prevalence of diseases impacting hemoglobin levels) are limited at younger ages. PMID:27584842

  9. The impact of prescription opioids on all-cause mortality in Canada.

    PubMed

    Imtiaz, Sameer; Rehm, Jürgen

    2016-01-01

    An influential study from the United States generated considerable discussion and debate. This study documented rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, with clear linkages of all-cause mortality to increasing rates of poisonings, suicides and chronic liver disease deaths. All of these causes of deaths are strongly related to the use of legal and illegal substances, but the study stressed the importance of prescription opioids. Given the similarities between the United States and Canada in prescription opioid use, the assessment of similar all-cause mortality trends is relevant for Canada. As this commentary highlights, the all-cause mortality shifts seen in the United States cannot be seen in Canada for either sex or age groups. The exact reasons for the differences between the two countries are not clear, but it is important for public health to further explore this question. PMID:27476513

  10. Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk

    PubMed Central

    Lee, Duck-chul; Pate, Russell R.; Lavie, Carl J.; Sui, Xuemei; Church, Timothy S.; Blair, Steven N.

    2014-01-01

    Background Although running is a popular leisure-time physical activity, little is known about the long-term effects of running on mortality. The dose-response relations between running, as well as the change in running behaviors over time and mortality remain uncertain. Objectives We examined the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, aged 18 to 100 years (mean age, 44). Methods Running was assessed on the medical history questionnaire by leisure-time activity. Results During a mean follow-up of 15 years, 3,413 all-cause and 1,217 cardiovascular deaths occurred. Approximately, 24% of adults participated in running in this population. Compared with non-runners, runners had 30% and 45% lower adjusted risks of all-cause and cardiovascular mortality, respectively, with a 3-year life expectancy benefit. In dose-response analyses, the mortality benefits in runners were similar across quintiles of running time, distance, frequency, amount, and speed, compared with non-runners. Weekly running even <51 minutes, <6 miles, 1-2 times, <506 metabolic equivalent-minutes, or <6 mph was sufficient to reduce risk of mortality, compared with not running. In the analyses of change in running behaviors and mortality, persistent runners had the most significant benefits with 29% and 50% lower risks of all-cause and cardiovascular mortality, respectively, compared with never-runners. Conclusions Running, even 5-10 minutes per day and slow speeds <6 mph, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate healthy but sedentary individuals to begin and continue running for substantial and attainable mortality benefits. PMID:25082581

  11. Effects of Running on Chronic Diseases and Cardiovascular and All-Cause Mortality.

    PubMed

    Lavie, Carl J; Lee, Duck-chul; Sui, Xuemei; Arena, Ross; O'Keefe, James H; Church, Timothy S; Milani, Richard V; Blair, Steven N

    2015-11-01

    Considerable evidence has established the link between high levels of physical activity (PA) and all-cause and cardiovascular disease (CVD)-specific mortality. Running is a popular form of vigorous PA that has been associated with better overall survival, but there is debate about the dose-response relationship between running and CVD and all-cause survival. In this review, we specifically reviewed studies published in PubMed since 2000 that included at least 500 runners and 5-year follow-up so as to analyze the relationship between vigorous aerobic PA, specifically running, and major health consequences, especially CVD and all-cause mortality. We also made recommendations on the optimal dose of running associated with protection against CVD and premature mortality, as well as briefly discuss the potential cardiotoxicity of a high dose of aerobic exercise, including running (eg, marathons). PMID:26362561

  12. Associations between antioxidants and all-cause mortality among US adults with obstructive lung function.

    PubMed

    Ford, Earl S; Li, Chaoyang; Cunningham, Timothy J; Croft, Janet B

    2014-11-28

    Chronic obstructive pulmonary disease is characterised by oxidative stress, but little is known about the associations between antioxidant status and all-cause mortality in adults with this disease. The objective of the present study was to examine the prospective associations between concentrations of α- and β-carotene, β-cryptoxanthin, lutein/zeaxanthin, lycopene, Se, vitamin C and α-tocopherol and all-cause mortality among US adults with obstructive lung function. Data collected from 1492 adults aged 20-79 years with obstructive lung function in the National Health and Nutrition Examination Survey III (1988-94) were used. Through 2006, 629 deaths were identified during a median follow-up period of 14 years. After adjustment for demographic variables, the concentrations of the following antioxidants modelled as continuous variables were found to be inversely associated with all-cause mortality among adults with obstructive lung function: α-carotene (P= 0·037); β-carotene (P= 0·022); cryptoxanthin (P= 0·022); lutein/zeaxanthin (P= 0·004); total carotenoids (P= 0·001); vitamin C (P< 0·001). In maximally adjusted models, only the concentrations of lycopene (P= 0·013) and vitamin C (P= 0·046) were found to be significantly and inversely associated with all-cause mortality. No effect modification by sex was detected, but the association between lutein/zeaxanthin concentrations and all-cause mortality varied by smoking status (P interaction= 0·048). The concentrations of lycopene and vitamin C were inversely associated with all-cause mortality in this cohort of adults with obstructive lung function. PMID:25315508

  13. All-cause and cause-specific mortality of different migrant populations in Europe.

    PubMed

    Ikram, Umar Z; Mackenbach, Johan P; Harding, Seeromanie; Rey, Grégoire; Bhopal, Raj S; Regidor, Enrique; Rosato, Michael; Juel, Knud; Stronks, Karien; Kunst, Anton E

    2016-07-01

    This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level. PMID:26362812

  14. Risks of all-cause and suicide mortality in mental disorders: a meta-review.

    PubMed

    Chesney, Edward; Goodwin, Guy M; Fazel, Seena

    2014-06-01

    A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients. PMID:24890068

  15. Risks of all-cause and suicide mortality in mental disorders: a meta-review

    PubMed Central

    Chesney, Edward; Goodwin, Guy M; Fazel, Seena

    2014-01-01

    A meta-review, or review of systematic reviews, was conducted to explore the risks of all-cause and suicide mortality in major mental disorders. A systematic search generated 407 relevant reviews, of which 20 reported mortality risks in 20 different mental disorders and included over 1.7 million patients and over a quarter of a million deaths. All disorders had an increased risk of all-cause mortality compared with the general population, and many had mortality risks larger than or comparable to heavy smoking. Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa. These higher mortality risks translate into substantial (10-20 years) reductions in life expectancy. Borderline personality disorder, anorexia nervosa, depression and bipolar disorder had the highest suicide risks. Notable gaps were identified in the review literature, and the quality of the included reviews was typically low. The excess risks of mortality and suicide in all mental disorders justify a higher priority for the research, prevention, and treatment of the determinants of premature death in psychiatric patients. PMID:24890068

  16. Reduction of drinking in problem drinkers and all-cause mortality.

    PubMed

    Rehm, J; Roerecke, M

    2013-01-01

    Alcohol consumption has been linked with considerable mortality, and reduction of drinking, especially of heavy drinking, has been suggested as one of the main measures to reduce alcohol-attributable mortality. Aggregate-level studies including but not limited to natural experiments support this suggestion; however, causality cannot be established in ecological analysis. The results of individual-level cohort studies are ambiguous. On the other hand, randomized clinical trials with problem drinkers show that brief interventions leading to a reduction of average drinking also led to a reduction of all-cause mortality within 1 year. The results of these studies were pooled and a model for reduction of drinking in heavy drinkers and its consequences for all-cause mortality risk was estimated. Ceteris paribus, the higher the level of drinking, the stronger the effects of a given reduction. Implications for interventions and public health are discussed. PMID:23531718

  17. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population.

    PubMed

    Peng, Tao-Chun; Chen, Wei-Liang; Wu, Li-Wei; Chen, Ying-Jen; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching; Yang, Ya-Hui

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988-94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males. PMID:27595105

  18. The Effect of Neurobehavioral Test Performance on the All-Cause Mortality among US Population

    PubMed Central

    Wu, Li-Wei; Liaw, Fang-Yih; Wang, Gia-Chi; Wang, Chung-Ching

    2016-01-01

    Evidence of the association between global cognitive function and mortality is much, but whether specific cognitive function is related to mortality is unclear. To address the paucity of knowledge on younger populations in the US, we analyzed the association between specific cognitive function and mortality in young and middle-aged adults. We analyzed data from 5,144 men and women between 20 and 59 years of age in the Third National Health and Nutrition Examination Survey (1988–94) with mortality follow-up evaluation through 2006. Cognitive function tests, including assessments of executive function/processing speed (symbol digit substitution) and learning recall/short-term memory (serial digit learning), were performed. All-cause mortality was the outcome of interest. After adjusting for multiple variables, total mortality was significantly higher in males with poorer executive function/processing speed (hazard ratio (HR) 2.02; 95% confidence interval 1.36 to 2.99) and poorer recall/short-term memory (HR 1.47; 95% confidence interval 1.02 to 2.12). After adjusting for multiple variables, the mortality risk did not significantly increase among the females in these two cognitive tests groups. In this sample of the US population, poorer executive function/processing speed and poorer learning recall/short-term memory were significantly associated with increased mortality rates, especially in males. This study highlights the notion that poorer specific cognitive function predicts all-cause mortality in young and middle-aged males. PMID:27595105

  19. Weight change and all-cause mortality in older adults: A meta-analysis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This meta-analysis of observational cohort studies examined the association between weight change (weight loss, weight gain, and weight fluctuation) and all-cause mortality among older adults. We used PubMed (MEDLINE), Web of Science, and Cochrane Library to identify prospective studies published in...

  20. Meta-analysis of All-Cause Mortality According to Serum 25-Hydroxyvitamin D

    PubMed Central

    Kim, June Jiwon; Mohr, Sharif Burgette; Gorham, Edward Doerr; Grant, William B.; Giovannucci, Edward L.; Baggerly, Leo; Hofflich, Heather; Ramsdell, Joe Wesley; Zeng, Kenneth; Heaney, Robert P.

    2014-01-01

    We examined the relationship between serum 25-hydroxyvitamin D (25[OH]D) and all-cause mortality. We searched biomedical databases for articles that assessed 2 or more categories of 25(OH)D from January 1, 1966, to January 15, 2013. We identified 32 studies and pooled the data. The hazard ratio for all-cause mortality comparing the lowest (0–9 nanograms per milliliter [ng/mL]) to the highest (> 30 ng/mL) category of 25(OH)D was 1.9 (95% confidence interval = 1.6, 2.2; P < .001). Serum 25(OH)D concentrations less than or equal to 30 ng/mL were associated with higher all-cause mortality than concentrations greater than 30 ng/mL (P < .01). Our findings agree with a National Academy of Sciences report, except the cutoff point for all-cause mortality reduction in this analysis was greater than 30 ng/mL rather than greater than 20 ng/mL. PMID:24922127

  1. Income distribution, public services expenditures, and all cause mortality in US states

    PubMed Central

    Dunn, J.; Burgess, B.; Ross, N.

    2005-01-01

    Introduction: The objective of this paper is to investigate the relation between state and local government expenditures on public services and all cause mortality in 48 US states in 1987, and determine if the relation between income inequality and mortality is conditioned on levels of public services available in these jurisdictions. Methods: Per capita public expenditures and a needs adjusted index of public services were examined for their association with age and sex specific mortality rates. OLS regression models estimated the contribution of public services to mortality, controlling for median income and income inequality. Results: Total per capita expenditures on public services were significantly associated with all mortality measures, as were expenditures for primary and secondary education, higher education, and environment and housing. A hypothetical increase of $100 per capita spent on higher education, for example, was associated with 65.6 fewer deaths per 100 000 for working age men (p<0.01). The positive relation between income inequality and mortality was partly attenuated by controls for public services. Discussion: Public service expenditures by state and local governments (especially for education) are strongly related to all cause mortality. Only part of the relation between income inequality and mortality may be attributable to public service levels. PMID:16100315

  2. Housework Reduces All-Cause and Cancer Mortality in Chinese Men

    PubMed Central

    Yu, Ruby; Leung, Jason; Woo, Jean

    2013-01-01

    Background Leisure time physical activity has been extensively studied. However, the health benefits of non-leisure time physical activity, particular those undertaken at home on all-cause and cancer mortality are limited, particularly among the elderly. Methods We studied physical activity in relation to all-cause and cancer mortality in a cohort of 4,000 community-dwelling elderly aged 65 and older. Leisure time physical activity (sport/recreational activity and lawn work/yard care/gardening) and non-leisure time physical activity (housework, home repairs and caring for another person) were self-reported on the Physical Activity Scale for the Elderly. Subjects with heart diseases, stroke, cancer or diabetes at baseline were excluded (n = 1,133). Results Among the 2,867 subjects with a mean age of 72 years at baseline, 452 died from all-cause and 185 died from cancer during the follow-up period (2001–2012). With the adjustment for age, education level and lifestyle factors, we found an inverse association between risk of all-cause mortality and heavy housework among men, with the adjusted hazard ratio (HR) of 0.72 (95%CI = 0.57–0.92). Further adjustment for BMI, frailty index, living arrangement, and leisure time activity did not change the result (HR = 0.71, 95%CI = 0.56–0.91). Among women, however, heavy housework was not associated with all-cause mortality. The risk of cancer mortality was significantly lower among men who participated in heavy housework (HR = 0.52, 95%CI = 0.35–0.78), whereas among women the risk was not significant. Men participated in light housework also were at lower risk of cancer mortality than were their counterparts, however, the association was not significant. Leisure time physical activity was not related to all-cause or cancer mortality in either men or women. Conclusion Heavy housework is associated with reduced mortality and cancer deaths over a 9-year period. The underlying mechanism needs further

  3. Are psychosocial stressors associated with the relationship of alcohol consumption and all-cause mortality?

    PubMed Central

    2014-01-01

    Background Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality. Methods Three cross-sectional MONICA surveys (conducted 1984–1995) including 11,282 subjects aged 25–74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables. Results Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p = 0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes. Conclusions The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors. PMID:24708657

  4. Renal Function and All-Cause Mortality Risk Among Cancer Patients

    PubMed Central

    Yang, Yan; Li, Hui-yan; Zhou, Qian; Peng, Zhen-wei; An, Xin; Li, Wei; Xiong, Li-ping; Yu, Xue-qing; Jiang, Wen-qi; Mao, Hai-ping

    2016-01-01

    Abstract Renal dysfunction predicts all-cause mortality in general population. However, the prevalence of renal insufficiency and its relationship with mortality in cancer patients are unclear. We retrospectively studied 9465 patients with newly diagnosed cancer from January 2010 to December 2010. Renal insufficiency was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration equation. The hazard ratio (HR) of all-cause mortality associated with baseline eGFR was assessed by Cox regression. Three thousand sixty-nine patients (32.4%) exhibited eGFR <90 mL/min/1.73 m2 and 3% had abnormal serum creatinine levels at the time of diagnosis. Over a median follow-up of 40.5 months, 2705 patients (28.6%) died. Compared with the reference group (eGFR ≥ 60 mL/min/1.73 m2), an elevated all-cause mortality was observed among patients with eGFR < 60 mL/min/1.73 m2 stratified by cancer stage in the entire cohort, the corresponding hazard ratios were 1.87 (95% CI, 1.41–2.47) and 1.28 (95% CI, 1.01–1.62) for stage I to III and stage IV, respectively. However, this relationship was not observed after multivariate adjustment. Subgroup analysis found that eGFR < 60 mL/min/1.73 m2 independently predicted death among patients with hematologic (adjusted HR 2.93, 95% CI [1.36–6.31]) and gynecological cancer (adjusted HR 2.82, 95% CI [1.19–6.70]), but not in those with other cancer. Five hundred fifty-seven patients (6%) had proteinuria. When controlled for potential confounding factors, proteinuria was a risk factor for all-cause mortality among patients in the entire cohort, regardless of cancer stage and eGFR values. When patients were categorized by specific cancer type, the risk of all-cause death was only significant in patients with digestive system cancer (adjusted HR, 1.85 [1.48–2.32]). The prevalence of renal dysfunction was common in patients with newly diagnosed cancer. Patients

  5. Traffic air pollution and mortality from cardiovascular disease and all causes: a Danish cohort study

    PubMed Central

    2012-01-01

    Background Traffic air pollution has been linked to cardiovascular mortality, which might be due to co-exposure to road traffic noise. Further, personal and lifestyle characteristics might modify any association. Methods We followed up 52 061 participants in a Danish cohort for mortality in the nationwide Register of Causes of Death, from enrollment in 1993–1997 through 2009, and traced their residential addresses from 1971 onwards in the Central Population Registry. We used dispersion-modelled concentration of nitrogen dioxide (NO2) since 1971 as indicator of traffic air pollution and used Cox regression models to estimate mortality rate ratios (MRRs) with adjustment for potential confounders. Results Mean levels of NO2 at the residence since 1971 were significantly associated with mortality from cardiovascular disease (MRR, 1.26; 95% confidence interval [CI], 1.06–1.51, per doubling of NO2 concentration) and all causes (MRR, 1.13; 95% CI, 1.04–1.23, per doubling of NO2 concentration) after adjustment for potential confounders. For participants who ate < 200 g of fruit and vegetables per day, the MRR was 1.45 (95% CI, 1.13–1.87) for mortality from cardiovascular disease and 1.25 (95% CI, 1.11–1.42) for mortality from all causes. Conclusions Traffic air pollution is associated with mortality from cardiovascular diseases and all causes, after adjustment for traffic noise. The association was strongest for people with a low fruit and vegetable intake. PMID:22950554

  6. Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality

    PubMed Central

    Onat, Altan; Can, Günay; Kaya, Ayşem; Akbaş, Tuğba; Özpamuk-Karadeniz, Fatma; Şimşek, Barış; Çakır, Hakan; Yüksel, Hüsniye

    2015-01-01

    AIM: To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality. METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality. RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women. CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies. PMID:26730168

  7. High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III123

    PubMed Central

    Chang, Alex R; Lazo, Mariana; Appel, Lawrence J; Gutiérrez, Orlando M; Grams, Morgan E

    2014-01-01

    Background: Elevated serum phosphorus is associated with all-cause mortality, but little is known about risk associated with dietary phosphorus intake. Objective: We investigated the association between phosphorus intake and mortality in a prospective cohort of healthy US adults (NHANES III; 1998–1994). Design: Study participants were 9686 nonpregnant adults aged 20–80 y without diabetes, cancer, or kidney or cardiovascular disease. Exposure to dietary phosphorus, which was assessed by using a 24-h dietary recall, was expressed as the absolute intake and phosphorus density (phosphorus intake divided by energy intake). All-cause and cardiovascular mortality was assessed through 31 December 2006. Results: Median phosphorus intake was 1166 mg/d (IQR: 823–1610 mg/d); median phosphorus density was 0.58 mg/kcal (0.48–0.70 mg/kcal). Individuals who consumed more phosphorus-dense diets were older, were less often African American, and led healthier lifestyles (smoking, physical activity, and Healthy Eating Index). In analyses adjusted for demographics, cardiovascular risk factors, kidney function, and energy intake, higher phosphorus intake was associated with higher all-cause mortality in individuals who consumed >1400 mg/d [adjusted HR (95% CI): 2.23 (1.09, 4.5) per 1-unit increase in ln(phosphorus intake); P = 0.03]. At <1400 mg/d, there was no association. A similar association was seen between higher phosphorus density and all-cause mortality at a phosphorus density amount >0.35 mg/kcal [adjusted HR (95% CI): 2.27 (1.19, 4.33) per 0.1-mg/kcal increase in phosphorus density; P = 0.01]. At <0.35 mg/kcal (approximately the fifth percentile), lower phosphorus density was associated with increased mortality risk. Phosphorus density was associated with cardiovascular mortality [adjusted HR (95% CI): 3.39 (1.43, 8.02) per 0.1 mg/kcal at >0.35 mg/kcal; P = 0.01], whereas no association was shown in analyses with phosphorus intake. Results were similar by subgroups of

  8. Heat-Related Mortality in India: Excess All-Cause Mortality Associated with the 2010 Ahmedabad Heat Wave

    PubMed Central

    Azhar, Gulrez Shah; Mavalankar, Dileep; Nori-Sarma, Amruta; Rajiva, Ajit; Dutta, Priya; Jaiswal, Anjali; Sheffield, Perry; Knowlton, Kim; Hess, Jeremy J.; Azhar, Gulrez Shah; Deol, Bhaskar; Bhaskar, Priya Shekhar; Hess, Jeremy; Jaiswal, Anjali; Khosla, Radhika; Knowlton, Kim; Mavalankar, Mavalankar; Rajiva, Ajit; Sarma, Amruta; Sheffield, Perry

    2014-01-01

    Introduction In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8°C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. Methods We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1–31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. Results The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest “summer” months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19–25, 2010), mortality rate ratios were 1.76 [95% CI 1.67–1.83, p<0.001] and 2.12 [95% CI 2.03–2.21] applying reference periods (May 12–18, 2010) from various years. Conclusion The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot

  9. Does cytomegalovirus infection contribute to socioeconomic disparities in all-cause mortality?

    PubMed

    Feinstein, Lydia; Douglas, Christian E; Stebbins, Rebecca C; Pawelec, Graham; Simanek, Amanda M; Aiello, Allison E

    2016-09-01

    The social patterning of cytomegalovirus (CMV) and its implication in aging suggest that the virus may partially contribute to socioeconomic disparities in mortality. We used Cox regression and inverse odds ratio weighting to quantify the proportion of the association between socioeconomic status (SES) and all-cause mortality that was attributable to mediation by CMV seropositivity. Data were from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994), with mortality follow-up through December 2011. SES was assessed as household income (income-to-poverty ratio ≤1.30;>1.30 to≤1.85;>1.85 to≤3.50;>3.50) and education (high school). We found strong associations between low SES and increased mortality: hazard ratio (HR) 1.80; 95% confidence interval (CI): 1.57, 2.06 comparing the lowest versus highest income groups and HR 1.29; 95% CI: 1.13, 1.48 comparing high school education. 65% of individuals were CMV seropositive, accounting for 6-15% of the SES-mortality associations. Age modified the associations between SES, CMV, and mortality, with CMV more strongly associated with mortality in older individuals. Our findings suggest that cytomegalovirus may partially contribute to persistent socioeconomic disparities in mortality, particularly among older individuals. PMID:27268074

  10. Associations of Posthemodialysis Weights above and below Target Weight with All-Cause and Cardiovascular Mortality

    PubMed Central

    Kshirsagar, Abhijit V.; Falk, Ronald J.; Brunelli, Steven M.

    2015-01-01

    Background and objectives Fluid removal via ultrafiltration is a primary function of hemodialysis, and inadequate volume control is associated with significant morbidity and mortality among chronic dialysis patients. Treatment-to-treatment fluid removal goals are typically calculated on the basis of interdialytic weight gain and prescribed target weight. The clinical effect of frequent missed target weights is unclear. This study was designed to evaluate the associations of postdialysis weights above and below the prescribed target weight (separately) and outcomes. Design, setting, participants, & measurements Data were taken from a national cohort of 10,785 prevalent, thrice-weekly, in-center hemodialysis patients dialyzing from 2005 to 2008 (median time at risk, 2.1 [25th percentile, 75th percentile] years) at a single dialysis organization. Patients were characterized as having an above target weight miss if their postdialysis weight was >2 kg above target weight in at least 30% of baseline treatments (14.6% of cohort), or they were characterized as control otherwise. Below target weight miss characterization was analogous for patients with postdialysis weight >2 kg below target weight (6.6% of cohort). Coprimary endpoints were all-cause and cardiovascular mortality. Results Above target weight miss in at least 30% of treatments (versus not) was associated with greater all-cause mortality (adjusted hazard ratio, 1.28; 95% confidence interval, 1.15 to 1.43); and below target weight miss in at least 30% of treatments (versus not) was associated with greater all-cause mortality (adjusted hazard ratio, 1.22; 95% confidence interval, 1.05 to 1.40). Both above and below target weight misses were also significantly associated with greater cardiovascular mortality. Secondary analyses demonstrated dose-response relationships between target weight misses and mortality. Results from sensitivity analyses considering the difference in postdialysis and target weights as a

  11. Neighborhood racial composition, social capital and black all-cause mortality in Philadelphia.

    PubMed

    Hutchinson, Rebbeca N; Putt, Mary A; Dean, Lorraine T; Long, Judith A; Montagnet, Chantal A; Armstrong, Katrina

    2009-05-01

    Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia. PMID:19324485

  12. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe.

    PubMed

    Bobak, Martin; Malyutina, Sofia; Horvat, Pia; Pajak, Andrzej; Tamosiunas, Abdonas; Kubinova, Ruzena; Simonova, Galina; Topor-Madry, Roman; Peasey, Anne; Pikhart, Hynek; Marmot, Michael G

    2016-01-01

    Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50% increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3% of men) were 1.23 (95% CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2% of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men. PMID:26467937

  13. Prediabetes, elevated iron and all-cause mortality: a cohort study

    PubMed Central

    Mainous, Arch G; Tanner, Rebecca J; Coates, Thomas D; Baker, Richard

    2014-01-01

    Objectives Data have indicated low to non-existent increased mortality risk for individuals with prediabetes, but it is unclear if the risk is increased when the patient has elevated iron markers. Our purpose was to examine the mortality risk among adults with prediabetes in the context of coexisting elevated transferrin saturation (TS) or serum ferritin. Setting Data collected by the third National Health and Nutrition Examination Survey 1988–1994 (NHANES III) in the USA and by the National Center for Health Statistics for the National Death Index from 1988 to 2006. Participants Individuals age 40 and older who participated in the NHANES and provided a blood sample. Primary outcome variable Mortality was measured as all-cause mortality. Results Adjusted analyses show that prediabetes has a small increased mortality risk (HR=1.04; 95% CI 1.00 to 1.08). Persons who had prediabetes and elevated serum ferritin had an increased HR for death (HR=1.14; 95% CI 1.04 to 1.24) compared with those who had normal ferritin and normal glucose. Among persons with prediabetes who had elevated TS, they had an increased mortality risk (HR=1.88; 95% CI 1.06 to 3.30) compared with those with normal TS levels and normal glucose. Conclusions The mortality risk of prediabetes is low. However, among individuals who have coexisting elevated iron markers, particularly TS, the risk rises substantially. PMID:25500370

  14. Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis

    PubMed Central

    Probst, Charlotte; Roerecke, Michael; Behrendt, Silke; Rehm, Jürgen

    2014-01-01

    Background: Factors underlying socioeconomic inequalities in mortality are not well understood. This study contributes to our understanding of potential pathways to result in socioeconomic inequalities, by examining alcohol consumption as one potential explanation via comparing socioeconomic inequalities in alcohol-attributable mortality and all-cause mortality. Methods: Web of Science, MEDLINE, PsycINFO and ETOH were searched systematically from their inception to second week of February 2013 for articles reporting alcohol-attributable mortality by socioeconomic status, operationalized by using information on education, occupation, employment status or income. The sex-specific ratios of relative risks (RRRs) of alcohol-attributable mortality to all-cause mortality were pooled for different operationalizations of socioeconomic status using inverse-variance weighted random effects models. These RRRs were then combined to a single estimate. Results: We identified 15 unique papers suitable for a meta-analysis; capturing about 133 million people, 3 741 334 deaths from all causes and 167 652 alcohol-attributable deaths. The overall RRRs amounted to RRR = 1.78 (95% confidence interval (CI) 1.43 to 2.22) and RRR = 1.66 (95% CI 1.20 to 2.31), for women and men, respectively. In other words: lower socioeconomic status leads to 1.5–2-fold higher mortality for alcohol-attributable causes compared with all causes. Conclusions: Alcohol was identified as a factor underlying higher mortality risks in more disadvantaged populations. All alcohol-attributable mortality is in principle avoidable, and future alcohol policies must take into consideration any differential effect on socioeconomic groups. PMID:24618188

  15. Development and Validation of a Clinical Risk-Assessment Tool Predictive of All-Cause Mortality

    PubMed Central

    Bello, Ghalib A; Dumancas, Gerard G; Gennings, Chris

    2015-01-01

    In clinical settings, the diagnosis of medical conditions is often aided by measurement of various serum biomarkers through the use of laboratory tests. These biomarkers provide information about different aspects of a patient’s health and overall function of multiple organ systems. We have developed a statistical procedure that condenses the information from a variety of health biomarkers into a composite index, which could be used as a risk score for predicting all-cause mortality. It could also be viewed as a holistic measure of overall physiological health status. This health status metric is computed as a function of standardized values of each biomarker measurement, weighted according to their empirically determined relative strength of association with mortality. The underlying risk model was developed using the biomonitoring and mortality data of a large sample of US residents obtained from the National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI). Biomarker concentration levels were standardized using spline-based Cox regression models, and optimization algorithms were used to estimate the weights. The predictive accuracy of the tool was optimized by bootstrap aggregation. We also demonstrate how stacked generalization, a machine learning technique, can be used for further enhancement of the prediction power. The index was shown to be highly predictive of all-cause mortality and long-term outcomes for specific health conditions. It also exhibited a robust association with concurrent chronic conditions, recent hospital utilization, and current health status as assessed by self-rated health. PMID:26380550

  16. Impact of acquired comorbidities on all-cause mortality rates among older breast cancer survivors

    PubMed Central

    Ahern, Thomas P.; Lash, Timothy L.; Thwin, Soe Soe; Silliman, Rebecca A.

    2010-01-01

    Background Breast cancer survivors with higher numbers of comorbidities at the time of primary treatment suffer higher rates of all-cause mortality than comparatively healthier survivors. The effect of time-varying comorbidity status on mortality in breast cancer survivors, however, has not been well investigated. Objective We examined longitudinal comorbidity in a cohort of women treated for primary breast cancer to determine whether accounting for comorbidities acquired after baseline assessment influenced the hazard ratio of all-cause mortality compared with an analysis using only baseline comorbidity. Methods Cox proportional hazards adjusted for age, race/ethnicity, and exercise habits were modeled using (1) only a baseline Charlson index; (2) four Charlson index values collected longitudinally and entered as time-varying covariates, with missing values addressed by carrying forward the prior observation; and (3) the four longitudinal Charlson scores entered as time-varying covariates, with missing values multiply imputed. Results The three modeling strategies yielded similar results; Model 1 HR: 1.4 per unit increase in Charlson index, 95% CI: 1.2, 1.7; Model 2 HR: 1.3, 95% CI: 1.1, 1.5 and Model 3 HR: 1.4, 95% CI: 1.2, 1.6. Conclusions Our findings indicate that a unit increase in the Charlson comorbidity index raises the hazard rate for all-cause mortality by approximately 1.4-fold in older women treated for primary breast cancer. The conclusion is essentially the same whether accounting only for baseline comorbidity or accounting for acquired comorbidity over a median follow-up period of 85 months. PMID:19106734

  17. Health behaviors and all-cause mortality in African American men.

    PubMed

    Thorpe, Roland J; Wilson-Frederick, Shondelle M; Bowie, Janice V; Coa, Kisha; Clay, Olivio J; LaVeist, Thomas A; Whitfield, Keith E

    2013-07-01

    Because of the excess burden of preventable chronic diseases and premature death among African American men, identifying health behaviors to enhance longevity is needed. We used data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III) and the NHANES III Linked Mortality Public-use File to determine the association between health behaviors and all-cause mortality and if these behaviors varied by age in 2029 African American men. Health behaviors included smoking, drinking, physical inactivity, obesity, and a healthy eating index score. Age was categorized as 25-44 years (n = 1,045), 45-64 years (n = 544), and 65 years and older (n = 440). Cox regression analyses were used to estimate the relationship between health behaviors and mortality within each age-group. All models were adjusted for marital status, education, poverty-to-income ratio, insurance status, and number of health conditions. Being a current smoker was associated with an increased risk of mortality in the 25- to 44-year age-group, whereas being physically inactive was associated with an increased risk of mortality in the 45- to 64-year age-group. For the 65 years and older age-group, being overweight or obese was associated with decreased mortality risk. Efforts to improve longevity should focus on developing age-tailored health promoting strategies and interventions aimed at smoking cessation and increasing physical activity in young and middle-aged African American men. PMID:23649171

  18. To Flourish or Not: Positive Mental Health and All-Cause Mortality

    PubMed Central

    Simoes, Eduardo J.

    2012-01-01

    Objectives. We investigated whether positive mental health predicts all-cause mortality. Methods. Data were from the Midlife in the United States (MIDUS) study (n = 3032), which at baseline in 1995 measured positive mental health (flourishing and not) and past-year mental illness (major depressive episode, panic attacks, and generalized anxiety disorders), and linked respondents with National Death Index records in a 10-year follow-up ending in 2005. Covariates were age, gender, race, education, any past-year mental illness, smoking, physical inactivity, physical diseases, and physical disease risk factors. Results. A total of 6.3% of participants died during the study period. The final and fully adjusted odds ratio of mortality was 1.62 (95% confidence interval [CI] = 1.00, 2.62; P = .05) for adults who were not flourishing, relative to participants with flourishing mental health. Age, gender, race, education, smoking, physical inactivity, cardiovascular disease, and HIV/AIDS were significant predictors of death during the study period. Conclusions. The absence of positive mental health increased the probability of all-cause mortality for men and women at all ages after adjustment for known causes of death. PMID:22994191

  19. Gender differences and disparities in all-cause and coronary heart disease mortality: epidemiological aspects.

    PubMed

    Barrett-Connor, Elizabeth

    2013-08-01

    This overview is primarily concerned with large recent prospective cohort studies of adult populations, not patients, because the latter studies are confounded by differences in medical and surgical management for men vs. women. When early papers are uniquely informative they are also included. Because the focus is on epidemiology, details of age, sex, sample size, and source as well as study methods are provided. Usually the primary outcomes were all-cause or coronary heart disease (CHD) mortality using baseline data from midlife or older adults. Fifty years ago few prospective cohort studies of all-cause or CHD mortality included women. Most epidemiologic studies that included community-dwelling adults did not include both sexes and still do not report men and women separately. Few studies consider both sex (biology) and gender (behavior and environment) differences. Lifespan studies describing survival after live birth are not considered here. The important effects of prenatal and early childhood biologic and behavioral factors on adult mortality are beyond the scope of this review. Clinical trials are not discussed. Overall, presumptive evidence for causality was equivalent for psychosocial and biological exposures, and these attributes were often associated with each other. Inconsistencies or gaps were particularly obvious for studies of sex or gender differences in age and optimal measures of body size for CHD outcomes, and in the striking interface of diabetes and people with the metabolic syndrome, most of whom have unrecognized diabetes. PMID:24054926

  20. Predicting all-cause mortality from basic physiology in the Framingham Heart Study.

    PubMed

    Zhang, William B; Pincus, Zachary

    2016-02-01

    Using longitudinal data from a cohort of 1349 participants in the Framingham Heart Study, we show that as early as 28-38 years of age, almost 10% of variation in future lifespan can be predicted from simple clinical parameters. Specifically, we found diastolic and systolic blood pressure, blood glucose, weight, and body mass index (BMI) to be relevant to lifespan. These and similar parameters have been well-characterized as risk factors in the relatively narrow context of cardiovascular disease and mortality in middle to old age. In contrast, we demonstrate here that such measures can be used to predict all-cause mortality from mid-adulthood onward. Further, we find that different clinical measurements are predictive of lifespan in different age regimes. Specifically, blood pressure and BMI are predictive of all-cause mortality from ages 35 to 60, while blood glucose is predictive from ages 57 to 73. Moreover, we find that several of these parameters are best considered as measures of a rate of 'damage accrual', such that total historical exposure, rather than current measurement values, is the most relevant risk factor (as with pack-years of cigarette smoking). In short, we show that simple physiological measurements have broader lifespan-predictive value than indicated by previous work and that incorporating information from multiple time points can significantly increase that predictive capacity. In general, our results apply equally to both men and women, although some differences exist. PMID:26446764

  1. Weight Change and All-Cause Mortality in Older Adults: A Meta-Analysis.

    PubMed

    Cheng, Feon W; Gao, Xiang; Jensen, Gordon L

    2015-01-01

    This meta-analysis of observational cohort studies examined the association between weight change (weight loss, weight gain, and weight fluctuation) and all-cause mortality among older adults. We used Pub Med (MEDLINE), Web of Science, and Cochrane Library to identify prospective studies published in English from inception to November 2014. Seventeen prospective studies met the inclusion criteria and were included in this meta-analysis. Higher all-cause mortality risks were noted with weight change: weight loss (pooled RR, 1.67; 95% CI, 1.51-1.85; p < 0.001 for heterogeneity), weight gain (pooled RR, 1.21; 95% CI, 1.09-1.33; p = 0.03 for heterogeneity), and weight fluctuation (pooled RR, 1.53; 95% CI, 1.36-1.72; p = 0.43 for heterogeneity). Similar results were observed with stricter criteria for sensitivity analyses. None of the study characteristics had statistically significant effects on the pooled RR, except for study quality on weight loss. Weight change is associated with higher mortality risk among community-dwelling adults 60 years and older. PMID:26571354

  2. Association between physical performance and all-cause mortality in CKD.

    PubMed

    Roshanravan, Baback; Robinson-Cohen, Cassianne; Patel, Kushang V; Ayers, Ernest; Littman, Alyson J; de Boer, Ian H; Ikizler, T Alp; Himmelfarb, Jonathan; Katzel, Leslie I; Kestenbaum, Bryan; Seliger, Stephen

    2013-04-01

    In older adults, measurements of physical performance assess physical function and associate with mortality and disability. Muscle wasting and diminished physical performance often accompany CKD, resembling physiologic aging, but whether physical performance associates with clinical outcome in CKD is unknown. We evaluated 385 ambulatory, stroke-free participants with stage 2-4 CKD enrolled in clinic-based cohorts at the University of Washington and University of Maryland and Veterans Affairs Maryland Healthcare systems. We compared handgrip strength, usual gait speed, timed up and go (TUAG), and 6-minute walking distance with normative values and constructed Cox proportional hazards models and receiver operating characteristic curves to test associations with all-cause mortality. Mean age was 61 years and the mean estimated GFR was 41 ml/min per 1.73 m(2). Measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. Fifty deaths occurred during the median 3-year follow-up period. After adjustment, each 0.1-m/s decrement in gait speed associated with a 26% higher risk for death, and each 1-second longer TUAG associated with an 8% higher risk for death. On the basis of the receiver operating characteristic analysis, gait speed and TUAG more strongly predicted 3-year mortality than kidney function or commonly measured serum biomarkers. Adding gait speed to a model that included estimated GFR significantly improved the prediction of 3-year mortality. In summary, impaired physical performance of the lower extremities is common in CKD and strongly associates with all-cause mortality. PMID:23599380

  3. Resveratrol levels and all-cause mortality in older community-dwelling adults

    PubMed Central

    Semba, Richard D.; Ferrucci, Luigi; Bartali, Benedetta; Urpí-Sarda, Mireia; Zamora-Ros, Raul; Sun, Kai; Cherubini, Antonio; Bandinelli, Stefania; Andres-Lacueva, Cristina

    2015-01-01

    Importance Resveratrol, a polyphenol found in grapes, red wine, chocolate, and certain berries and roots, is considered to have antioxidant, anti-inflammatory, and anti-cancer effects in humans and is related to longevity in some lower organisms. Objective To determine whether resveratrol levels achieved with diet are associated with inflammation, cancer, cardiovascular disease, and mortality in humans. Design Prospective cohort study, the Invecchiare in Chianti (InCHIANTI) Study (“Aging in the Chianti Region”), 1998-2009. Setting Two villages in the Chianti area, Tuscany region of Italy. Participants Population-based sample of 783 community-dwelling men and women, ≥65 y Exposure 24-h urinary resveratrol metabolites Main outcomes and measures Primary outcome measure was all-cause mortality. Secondary outcomes were markers of inflammation (serum C-reactive protein [CRP], interleukin [IL]-6, IL-1β, and tumor necrosis factor [TNF]-α), and prevalent and incident cancer and cardiovascular disease Results Mean (95% Confidence Interval) log total urinary resveratrol metabolite concentrations were 7.08 (6.69, 7.48) nmol/g creatinine. During nine years of follow-up, 268 (34.3%) of the participants died. From the lowest to the highest quartile of baseline total urinary resveratrol metabolites, the proportion of participants who died from all causes was 34.4, 31.6, 33.5, and 37.4%, respectively (P = 0.67). Participants in the lowest quartile had a hazards ratio for mortality of 0.80 (95% confidence interval 0.54, 1.17) when compared with those in the highest quartile of total urinary resveratrol in a multivariable Cox proportional hazards model that adjusted for potential confounders. Resveratrol levels were not significantly associated with serum CRP, IL-6, IL-1β, TNF-α, prevalent or incident cardiovascular disease or cancer. Conclusions: In older community-dwelling adults, total urinary resveratrol metabolite concentration was not associated with inflammatory

  4. Psycho-socioeconomic bio-behavioral associations on all-cause mortality: cohort study

    PubMed Central

    Loprinzi, Paul D.; Davis, Robert E.

    2016-01-01

    Background: The purpose of this study was to examine the cumulative effects of psychological,socioeconomic, biological and behavioral parameters on mortality. Methods: A prospective design was employed. Data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were used (analyzed in 2015); follow-up mortality status evaluated in 2011. Psychological function was assessed from the Patient Health Questionnaire-9 (PHQ-9) as a measure of depression. Socioeconomic risk was assessed from poverty level, education, minority status, and social living status. Biological parameters included cholesterol, weight status, diabetes, hypertension and systemic inflammation. Behavioral parameters assessed included physical activity (accelerometry), dietary behavior, smoking status (cotinine) and sleep. These 14 psycho-socioeconomic bio-behavioral (PSBB) parameters allowed for the calculation of an overall PSBB Index, ranging from 0-14. Results: Among the evaluated 2530 participants, 161 died over the unweighted median follow-up period of 70.0 months. After adjustment, for every 1 increase in the overall PSBB index score,participants had a 15% reduced risk of all-cause mortality (HR = 0.85; 95% CI: 0.76-0.96). After adjustment, the Behavioral Index (HR = 0.73; 95% CI: 0.60-0.88) and the Socioeconomic Index(HR = 0.82; 95% CI: 0.68-0.99) were significant, but the Psychological Index (HR = 0.67; 95%CI: 0.29-1.51) and the Biological Index (HR = 1.03; 95% CI: 0.89-1.18) were not. Conclusion: Those with a worse PSBB score had an increased risk of all-cause mortality.Promotion of concurrent health behaviors may help to promote overall well-being and prolong survival. PMID:27386420

  5. Geographic Inequalities in All-Cause Mortality in Japan: Compositional or Contextual?

    PubMed Central

    Suzuki, Etsuji; Kashima, Saori; Kawachi, Ichiro; Subramanian, S. V.

    2012-01-01

    Background A recent study from Japan suggested that geographic inequalities in all-cause premature adult mortality have increased since 1995 in both sexes even after adjusting for individual age and occupation in 47 prefectures. Such variations can arise from compositional effects as well as contextual effects. In this study, we sought to further examine the emerging geographic inequalities in all-cause mortality, by exploring the relative contribution of composition and context in each prefecture. Methods We used the 2005 vital statistics and census data among those aged 25 or older. The total number of decedents was 524,785 men and 455,863 women. We estimated gender-specific two-level logistic regression to model mortality risk as a function of age, occupation, and residence in 47 prefectures. Prefecture-level variance was used as an estimate of geographic inequalities in mortality, and prefectures were ranked by odds ratios (ORs), with the reference being the grand mean of all prefectures (value  = 1). Results Overall, the degree of geographic inequalities was more pronounced when we did not account for the composition (i.e., age and occupation) in each prefecture. Even after adjusting for the composition, however, substantial differences remained in mortality risk across prefectures with ORs ranging from 0.870 (Okinawa) to 1.190 (Aomori) for men and from 0.864 (Shimane) to 1.132 (Aichi) for women. In some prefectures (e.g., Aomori), adjustment for composition showed little change in ORs, while we observed substantial attenuation in ORs in other prefectures (e.g., Akita). We also observed qualitative changes in some prefectures (e.g., Tokyo). No clear associations were observed between prefecture-level socioeconomic status variables and the risk of mortality in either sex. Conclusions Geographic disparities in mortality across prefectures are quite substantial and cannot be fully explained by differences in population composition. The relative contribution

  6. Healthy lifestyle behaviors and all-cause mortality among adults in the United States✩

    PubMed Central

    Ford, Earl S.; Bergmann, Manuela M.; Boeing, Heiner; Li, Chaoyang; Capewell, Simon

    2015-01-01

    Objective To examine the links between three fundamental healthy lifestyle behaviors (not smoking, healthy diet, and adequate physical activity) and all-cause mortality in a national sample of adults in the United States. Method We used data from 8375 U.S. participants aged ≥ 20 years of the National Health and Nutrition Examination Survey 1999–2002 who were followed through 2006. Results During a mean follow-up of 5.7 years, 745 deaths occurred. Compared with their counterparts, the risk for all-cause mortality was reduced by 56% (95% confidence interval [CI]: 35%–70%) among adults who were nonsmokers, 47% (95% CI: 36%, 57%) among adults who were physically active, and 26% (95% CI: 4%, 42%) among adults who consumed a healthy diet. Compared with participants who had no healthy behaviors, the risk decreased progressively as the number of healthy behaviors increased. Adjusted hazard ratios and 95% confidence interval were 0.60 (0.38, 0.95), 0.45 (0.30, 0.67), and 0.18 (0.11, 0.29) for 1, 2, and 3 healthy behaviors, respectively. Conclusion Adults who do not smoke, consume a healthy diet, and engage in sufficient physical activity can substantially reduce their risk for early death. PMID:22564893

  7. Relationship between alkaline phosphatase and all-cause mortality in peritoneal dialysis patients.

    PubMed

    Fein, Paul A; Asadi, Sara; Singh, Priyanka; Hartman, William; Stuto, Steven; Chattopadhyay, Jyotiprakas; Avram, Morrell M

    2013-01-01

    Elevated levels of serum alkaline phosphatase (AlkPhos) have been reported to be associated with increased mortality risk in hemodialysis (HD) patients. We examined the association of serum AlkPhos with all-cause mortality in our PD patients. The study enrolled 90 PD patients beginning in 1995. On enrollment, demographics and clinical and biochemical data were recorded. Patients were followed to September 2011. Mean age of the enrollees was 52 years, with 61% being women, and most (81%) being of African descent. Mean and median AlkPhos were 135 U/L and 113 U/L respectively. Mean and maximum follow-up were 2.61 and 16 years respectively. As expected, AlkPhos correlated directly with serum intact parathyroid hormone (r = 0.36, p = 0.003). In a Cox multivariate regression analysis with adjustment for confounding variables, AlkPhos as a continuous (relative risk: 1.016; p = 0.004) anda categorical variable [> 120 U/L and < or = 120 U/L (relative risk: 6.0; p = 0.03)] remained a significant independent predictor of mortality. For each unit increase in enrollment AlkPhos, there was a 1.6% increase in the relative risk of death. Elevated serum AlkPhos is significantly and independently associated with increased mortality risk in our PD patients followed for up to 16 years. AlkPhos should be evaluated prospectively as a potential therapeutic target in clinical practice. PMID:24344494

  8. Road traffic noise is associated with increased cardiovascular morbidity and mortality and all-cause mortality in London

    PubMed Central

    Halonen, Jaana I.; Hansell, Anna L.; Gulliver, John; Morley, David; Blangiardo, Marta; Fecht, Daniela; Toledano, Mireille B.; Beevers, Sean D.; Anderson, Hugh Ross; Kelly, Frank J.; Tonne, Cathryn

    2015-01-01

    Aims Road traffic noise has been associated with hypertension but evidence for the long-term effects on hospital admissions and mortality is limited. We examined the effects of long-term exposure to road traffic noise on hospital admissions and mortality in the general population. Methods and results The study population consisted of 8.6 million inhabitants of London, one of Europe's largest cities. We assessed small-area-level associations of day- (7:00–22:59) and nighttime (23:00–06:59) road traffic noise with cardiovascular hospital admissions and all-cause and cardiovascular mortality in all adults (≥25 years) and elderly (≥75 years) through Poisson regression models. We adjusted models for age, sex, area-level socioeconomic deprivation, ethnicity, smoking, air pollution, and neighbourhood spatial structure. Median daytime exposure to road traffic noise was 55.6 dB. Daytime road traffic noise increased the risk of hospital admission for stroke with relative risk (RR) 1.05 [95% confidence interval (CI): 1.02–1.09] in adults, and 1.09 (95% CI: 1.04–1.14) in the elderly in areas >60 vs. <55 dB. Nighttime noise was associated with stroke admissions only among the elderly. Daytime noise was significantly associated with all-cause mortality in adults [RR 1.04 (95% CI: 1.00–1.07) in areas >60 vs. <55 dB]. Positive but non-significant associations were seen with mortality for cardiovascular and ischaemic heart disease, and stroke. Results were similar for the elderly. Conclusions Long-term exposure to road traffic noise was associated with small increased risks of all-cause mortality and cardiovascular mortality and morbidity in the general population, particularly for stroke in the elderly. PMID:26104392

  9. Surface-Based Body Shape Index and Its Relationship with All-Cause Mortality

    PubMed Central

    Rahman, Syed Ashiqur; Adjeroh, Donald

    2015-01-01

    Background Obesity is a global public health challenge. In the US, for instance, obesity prevalence remains high at more than one-third of the adult population, while over two-thirds are obese or overweight. Obesity is associated with various health problems, such as diabetes, cardiovascular diseases (CVDs), depression, some forms of cancer, sleep apnea, osteoarthritis, among others. The body mass index (BMI) is one of the best known measures of obesity. The BMI, however, has serious limitations, for instance, its inability to capture the distribution of lean mass and adipose tissue, which is a better predictor of diabetes and CVDs, and its curved (“U-shaped”) relationship with mortality hazard. Other anthropometric measures and their relation to obesity have been studied, each with its advantages and limitations. In this work, we introduce a new anthropometric measure (called Surface-based Body Shape Index, SBSI) that accounts for both body shape and body size, and evaluate its performance as a predictor of all-cause mortality. Methods and Findings We analyzed data on 11,808 subjects (ages 18–85), from the National Health and Human Nutrition Examination Survey (NHANES) 1999–2004, with 8-year mortality follow up. Based on the analysis, we introduce a new body shape index constructed from four important anthropometric determinants of body shape and body size: body surface area (BSA), vertical trunk circumference (VTC), height (H) and waist circumference (WC). The surface-based body shape index (SBSI) is defined as follows: SBSI=(H7/4)(WC5/6)BSAVTC(1) SBSI has negative correlation with BMI and weight respectively, no correlation with WC, and shows a generally linear relationship with age. Results on mortality hazard prediction using both the Cox proportionality model, and Kaplan-Meier curves each show that SBSI outperforms currently popular body shape indices (e.g., BMI, WC, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), A Body Shape Index (ABSI)) in

  10. Parity and All-cause Mortality in Women and Men: A Dose-Response Meta-Analysis of Cohort Studies

    PubMed Central

    Zeng, Yun; Ni, Ze-min; Liu, Shu-yun; Gu, Xue; Huang, Qin; Liu, Jun-an; Wang, Qi

    2016-01-01

    To quantitatively assess the association between parity and all-cause mortality, we conducted a meta-analysis of cohort studies. Relevant reports were identified from PubMed and Embase databases. Cohort studies with relative risks (RRs) and 95% confidence intervals (CIs) of all-cause mortality in three or more categories of parity were eligible. Eighteen articles with 2,813,418 participants were included. Results showed that participants with no live birth had higher risk of all-cause mortality (RR= 1.19, 95% CI = 1.03–1.38; I2 = 96.7%, P < 0.001) compared with participants with one or more live births. Nonlinear dose-response association was found between parity and all-cause mortality (P for non-linearity < 0.0001). Our findings suggest that moderate-level parity is inversely associated with all-cause mortality. PMID:26758416

  11. Obesity is associated with insulin resistance but not skeletal muscle dysfunction or all-cause mortality.

    PubMed

    Loenneke, Jeremy P; Loprinzi, Paul D

    2016-02-01

    Recent work has found that older adults with obesity and systemic inflammation have associated metabolic dysfunction but do not have associated lower lean mass or strength. However, this lean mass estimate may be inflated with obesity, given that 15 % of adipose tissue is composed of fat-free tissue. The primary purpose of this study was to investigate, in a nationally representative sample of adults, whether obese adults with chronic systemic inflammation (unhealthy) have differences in lean mass, muscle strength, and insulin resistance when compared to normal weight individuals without elevated levels of systemic inflammation (healthy). A secondary objective was to determine whether these potential differences were moderated by physical activity and to determine if these groups had a differential risk for all-cause mortality. Our findings suggests that the unhealthy group was associated with higher upper body lean mass (β = 823; 95 % confidence interval (CI) 637-1010; P < 0.001), lower body lean mass (β = 2724; 95 % CI 2291-3158; P < 0.001), and strength (β = 34.6; 95 % CI 13.5-55.7; P = 0.003) compared to the healthy group despite having systemic inflammation and correcting for fat-free adipose tissue. However, the unhealthy group was associated with insulin resistance (odds ratio (OR) = 16.1; 95 % CI 2.7-96.1; P = 0.005) although this finding was attenuated in those physically active (OR = 8.5; 95 % CI 2.43-30.15; P = 0.003). Despite this metabolic dysfunction, there was no difference in all-cause mortality risk between groups (hazard ratio (HR) = 1.16 (95 % CI 0.69-1.96; P = 0.54)) suggesting that higher amounts of lean mass and strength may be protective of premature mortality. PMID:26698153

  12. Relation of Adiponectin to All-Cause Mortality, Cardiovascular Mortality, and Major Adverse Cardiovascular Events (from the Dallas Heart Study).

    PubMed

    Witberg, Guy; Ayers, Colby R; Turer, Aslan T; Lev, Eli; Kornowski, Ran; de Lemos, James; Neeland, Ian J

    2016-02-15

    Adiponectin is a key component in multiple metabolic pathways. Studies evaluating associations of adiponectin with clinical outcomes in older adults have reported conflicting results. We investigated the association of adiponectin with mortality and cardiovascular disease (CVD) morbidity in a young, multiethnic adult population. We analyzed data from participants in the Dallas Heart Study without baseline CVD who underwent assessment of total adiponectin from 2000 to 2002. The primary outcome of all-cause mortality was assessed over median 10.4 years of follow-up using multivariable-adjusted Cox proportional hazards models. Secondary outcomes included CVD mortality, major adverse cardiovascular and cerebrovascular events (MACCE), and heart failure (HF). The study cohort included 3,263 participants, mean age 43.4 years, 44% women, and 50% black. There were 184 deaths (63 CVD), 207 MACCE, and 46 HF events. In multivariable models adjusted for age, gender, race, hypertension, diabetes, smoking, high-density lipoprotein cholesterol-C, hyperlipidemia, high-sensitivity C-reactive protein level, estimated glomerular filtration rate, and body mass index, increasing adiponectin quartiles were positively associated with all-cause mortality Q4 versus Q1 (hazard ratio [HR] = 2.27; 95% confidence interval [CI] 1.47, 3.50); CVD mortality Q4 versus Q1 (HR = 2.43; 95% CI 1.15, 5.15); MACCE Q4 versus Q1 (HR = 1.71; 95% CI 1.13, 2.60); and HF Q4 versus Q1 (HR = 2.95; 95% CI 1.14, 7.67). Findings were similar with adiponectin as a continuous variable and consistent across subgroups defined by age, gender, race, obesity, diabetes, metabolic syndrome, or elevated high-sensitivity C-reactive protein. In conclusion, higher adiponectin was associated with increased mortality and CVD morbidity in a young, multiethnic population. These findings may have implications for strategies aimed at lowering adiponectin to prevent adverse outcomes. PMID:26800774

  13. Structural stigma and all-cause mortality in sexual minority populations.

    PubMed

    Hatzenbuehler, Mark L; Bellatorre, Anna; Lee, Yeonjin; Finch, Brian K; Muennig, Peter; Fiscella, Kevin

    2014-02-01

    Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR] = 3.03, 95% Confidence Interval [CI] = 1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations. PMID:23830012

  14. Structural Stigma and All-Cause Mortality in Sexual Minority Populations

    PubMed Central

    Hatzenbuehler, Mark L.; Bellatorre, Anna; Lee, Yeonjin; Finch, Brian; Muennig, Peter; Fiscella, Kevin

    2013-01-01

    Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma—operationalized as living in communities with high levels of anti-gay prejudice—increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR] =3.03, 95% Confidence Interval [CI]=1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations. PMID:23830012

  15. Oxidative Stress Predicts All-Cause Mortality in HIV-Infected Patients

    PubMed Central

    Masiá, Mar; Padilla, Sergio; Fernández, Marta; Rodríguez, Carmen; Moreno, Ana; Oteo, Jose A.; Antela, Antonio; Moreno, Santiago; del Amo, Julia; Gutiérrez, Félix

    2016-01-01

    Objective We aimed to assess whether oxidative stress is a predictor of mortality in HIV-infected patients. Methods We conducted a nested case-control study in CoRIS, a contemporary, multicentre cohort of HIV-infected patients, antiretroviral-naïve at entry, launched in 2004. Cases were patients who died with available stored plasma samples collected. Two age and sex-matched controls for each case were selected. We measured F2-isoprostanes (F2-IsoPs) and malondialdehyde (MDA) plasma levels in the first blood sample obtained after cohort engagement. Results 54 cases and 93 controls were included. Median F2-IsoPs and MDA levels were significantly higher in cases than in controls. When adjustment was performed for age, HIV-transmission category, CD4 cell count and HIV viral load at cohort entry, and subclinical inflammation measured with highly-sensitive C-reactive protein (hsCRP), the association of F2-IsoPs with mortality remained significant (adjusted OR per 1 log10 increase, 2.34 [1.23–4.47], P = 0.009). The association of MDA with mortality was attenuated after adjustment: adjusted OR (95% CI) per 1 log10 increase, 2.05 [0.91–4.59], P = 0.080. Median hsCRP was also higher in cases, and it also proved to be an independent predictor of mortality in the adjusted analysis: OR (95% CI) per 1 log10 increase, 1.39 (1.01–1.91), P = 0.043; and OR (95% CI) per 1 log10 increase, 1.46 (1.07–1.99), P = 0.014, respectively, when adjustment included F2-IsoPs and MDA. Conclusion Oxidative stress is a predictor of all-cause mortality in HIV-infected patients. For plasma F2-IsoPs, this association is independent of HIV-related factors and subclinical inflammation. PMID:27111769

  16. Modeling the sssociation between 25[OH]D and all-cause mortality in a representative US population sample

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vitamin D has been identified as a potential key risk factor for several chronic diseases and mortality. The association between all-cause mortality and circulating levels of 25-ydroxyvitamin D (25[OH]D) has been described as non-monotonic with excess mortality at both low and high levels (1). Howev...

  17. Cognitive Function and All-Cause Mortality in Maintenance Hemodialysis Patients

    PubMed Central

    Drew, David A.; Weiner, Daniel E.; Tighiouart, Hocine; Scott, Tammy; Lou, Kristina; Kantor, Amy; Fan, Li; Strom, James A.; Singh, Ajay K.; Sarnak, Mark J.

    2014-01-01

    Background Cognitive impairment is common in hemodialysis patients and associated with significant morbidity. Limited information exists on whether cognitive impairment is associated with survival, and whether type of cognitive impairment is important. Study Design Longitudinal cohort. Setting & Participants Cognitive function was assessed at baseline and yearly using a comprehensive battery of cognitive tests in 292 prevalent hemodialysis patients. Predictor Using principal component analysis, individual test results were reduced into 2 domain scores, representing memory and executive function. By definition, each score carried a mean of 0 and SD of 1. Outcomes Association of each score with all-cause mortality was assessed using Cox proportional hazards models adjusted for demographics as well as dialysis and cardiovascular (CV) risk factors. Results Mean age of participants was 63 years, 53% were male, 23% were African American and 90% had at least a high school education. During median follow up of 2.1 (IQR, 1.1–3.7) years, 145 deaths occurred. Each 1-SD better executive function score was associated with 35% lower hazard of mortality (HR, 0.65; 95% CI, 0.55–0.76). In models adjusting for demographics and dialysis-related factors, this relationship was partially attenuated but remained significant (HR, 0.81; 95% CI, 0.67–0.98), while adjustment for CV disease and heart failure further attenuated it (HR, 0.87; 95% CI, 0.72–1.06). Use of time-dependent models showed a similar unadjusted association (HR, 0.62; 95% CI, 0.54–0.72), with the relationship remaining significant after adjustment for demographics, dialysis, and CV risk factors (HR, 0.79; 95% CI, 0.66–0.94). Better memory was associated with lower mortality in univariate analysis (HR per 1 SD, 0.82 [95% CI, 0.69–0.96]), but not when adjusting for demographics (HR, 1.00; 95% CI, 0.83–1.19). Limitations Patients with dementia were excluded from the full battery, perhaps underestimating

  18. Osteoarthritis and all-cause mortality in worldwide populations: grading the evidence from a meta-analysis

    PubMed Central

    Xing, Dan; Xu, Yuankun; Liu, Qiang; Ke, Yan; Wang, Bin; Li, Zhichang; Lin, Jianhao

    2016-01-01

    The objective of this study is to investigate the association between osteoarthritis (OA) and all-cause mortality in worldwide populations and to develop recommendations according to GRADE evidence levels. Literature search through Nov 2015 was performed using the electronic databases (including MEDLINE, EMBASE, EBSCO and Cochrane library). The prospective cohort trials that investigated the association between the symptomatic OA (SxOA) or radiological OA (ROA) and all-cause mortality were identified. Hazard ratios (HR) of all-cause mortality in patients with RxOA or ROA were pooled respectively. The evidence quality was evaluated using the GRADE system, while the recommendations were taken according to the quality. Nine of the published literature met the eligible criteria. Meta-analysis revealed that there was no significant difference in the association between SxOA and all-cause mortality (HR = 0.91, 95% CI: 0.68–1.23) and between ROA and all-cause mortality (HR = 1.13, 95% CI: 0.95–1.35). The overall GARDE evidence quality was very low, which will lower our confidence in taking recommendations. To summarize, there was no reliable and confident evidence existed currently in respect of the association between OA and all-cause mortality. Due to the very low level of evidence quality currently, high-quality studies are still required. PMID:27087682

  19. Effects of habitual coffee consumption on cardiometabolic disease, cardiovascular health, and all-cause mortality.

    PubMed

    O'Keefe, James H; Bhatti, Salman K; Patil, Harshal R; DiNicolantonio, James J; Lucan, Sean C; Lavie, Carl J

    2013-09-17

    Coffee, after water, is the most widely consumed beverage in the United States, and is the principal source of caffeine intake among adults. The biological effects of coffee may be substantial and are not limited to the actions of caffeine. Coffee is a complex beverage containing hundreds of biologically active compounds, and the health effects of chronic coffee intake are wide ranging. From a cardiovascular (CV) standpoint, coffee consumption may reduce the risk of type 2 diabetes mellitus and hypertension, as well as other conditions associated with CV risk such as obesity and depression; but it may adversely affect lipid profiles depending on how the beverage is prepared. Regardless, a growing body of data suggests that habitual coffee consumption is neutral to beneficial regarding the risks of a variety of adverse CV outcomes including coronary heart disease, congestive heart failure, arrhythmias, and stroke. Moreover, large epidemiological studies suggest that regular coffee drinkers have reduced risks of mortality, both CV and all-cause. The potential benefits also include protection against neurodegenerative diseases, improved asthma control, and lower risk of select gastrointestinal diseases. A daily intake of ∼2 to 3 cups of coffee appears to be safe and is associated with neutral to beneficial effects for most of the studied health outcomes. However, most of the data on coffee's health effects are based on observational data, with very few randomized, controlled studies, and association does not prove causation. Additionally, the possible advantages of regular coffee consumption have to be weighed against potential risks (which are mostly related to its high caffeine content) including anxiety, insomnia, tremulousness, and palpitations, as well as bone loss and possibly increased risk of fractures. PMID:23871889

  20. Plasma Biomarkers of Inflammation, the Kynurenine Pathway, and Risks of All-Cause, Cancer, and Cardiovascular Disease Mortality

    PubMed Central

    Zuo, Hui; Ueland, Per M.; Ulvik, Arve; Eussen, Simone J. P. M.; Vollset, Stein E.; Nygård, Ottar; Midttun, Øivind; Theofylaktopoulou, Despoina; Meyer, Klaus; Tell, Grethe S.

    2016-01-01

    We aimed to evaluate 10 biomarkers related to inflammation and the kynurenine pathway, including neopterin, kynurenine:tryptophan ratio, C-reactive protein, tryptophan, and 6 kynurenines, as potential predictors of all-cause and cause-specific mortality in a general population sample. The study cohort was participants involved in a community-based Norwegian study, the Hordaland Health Study (HUSK). We used Cox proportional hazards models to assess associations of the biomarkers with all-cause mortality and competing-risk models for cause-specific mortality. Of the 7,015 participants, 1,496 deaths were recorded after a median follow-up time of 14 years (1998–2012). Plasma levels of inflammatory markers (neopterin, kynurenine:tryptophan ratio, and C-reactive protein), anthranilic acid, and 3-hydroxykynurenine were positively associated with all-cause mortality, and tryptophan and xanthurenic acid were inversely associated. Multivariate-adjusted hazard ratios for the highest (versus lowest) quartiles of the biomarkers were 1.19–1.60 for positive associations and 0.73–0.87 for negative associations. All of the inflammatory markers and most kynurenines, except kynurenic acid and 3-hydroxyanthranilic acid, were associated with cardiovascular disease (CVD) mortality. In this general population, plasma biomarkers of inflammation and kynurenines were associated with risk of all-cause, cancer, and CVD mortality. Associations were stronger for CVD mortality than for mortality due to cancer or other causes. PMID:26823439

  1. Investigation of Gender Heterogeneity in the Associations of Serum Phosphorus with Incident Coronary Artery Disease and All-Cause Mortality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Serum phosphorus levels are associated with increased morbidity and mortality in patients with chronic kidney disease. We examined whether serum phosphorus is associated with all-cause mortality and incident myocardial infarction in the general population using 13,998 middle age subjects from the At...

  2. Usual walking speed and all-cause mortality risk in older people: A systematic review and meta-analysis.

    PubMed

    Liu, Bing; Hu, Xinhua; Zhang, Qiang; Fan, Yichuan; Li, Jun; Zou, Rui; Zhang, Ming; Wang, Xiuqi; Wang, Junpeng

    2016-02-01

    The purpose of this study was to investigate the relationship between slow usual walking speed and all-cause mortality risk in older people by conducting a meta-analysis. We searched through the Pubmed, Embase and Cochrane Library database up to March 2015. Only prospective observational studies that investigating the usual walking speed and all-cause mortality risk in older adulthood approaching age 65 years or more were included. Walking speed should be specifically assessed as a single-item tool over a short distance. Pooled adjusted risk ratio (RR) and 95% confidence interval (CI) were computed for the lowest versus the highest usual walking speed category. A total of 9 studies involving 12,901 participants were included. Meta-analysis with random effect model showed that the pooled adjusted RR of all-cause mortality was 1.89 (95% CI 1.46-2.46) comparing the lowest to the highest usual walk speed. Subgroup analyses indicated that risk of all-cause mortality for slow usual walking speed appeared to be not significant among women (RR 1.45; 95% CI 0.95-2.20). Slow usual walking speed is an independent predictor of all-cause mortality in men but not in women among older adulthood approaching age 65 years or more. PMID:27004653

  3. Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis☆

    PubMed Central

    Laramée, Philippe; Leonard, Saoirse; Buchanan-Hughes, Amy; Warnakula, Samantha; Daeppen, Jean-Bernard; Rehm, Jürgen

    2015-01-01

    Background Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. Methods MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. Findings We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). Interpretation AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption. PMID:26629534

  4. Sexual Orientation and All-Cause Mortality Among US Adults Aged 18 to 59 Years, 2001-2011.

    PubMed

    Cochran, Susan D; Björkenstam, Charlotte; Mays, Vickie M

    2016-05-01

    To determine whether sexual minorities have an earlier mortality than do heterosexuals, we investigated associations between sexual orientation assessed in the 2001 to 2010 National Health and Nutrition Examination Surveys (NHANES) and mortality in the 2011 NHANES-linked mortality file. Mortality follow-up time averaged 69.6 months after NHANES. By 2011, 338 individuals had died. Sexual minorities evidenced greater all-cause mortality than did heterosexuals after adjusting for demographic confounding. These effects generally disappeared with further adjustment for NHANES-detected health and behavioral differences. PMID:26985610

  5. Sexual Orientation and All-Cause Mortality Among US Adults Aged 18 to 59 Years, 2001–2011

    PubMed Central

    Björkenstam, Charlotte; Mays, Vickie M.

    2016-01-01

    To determine whether sexual minorities have an earlier mortality than do heterosexuals, we investigated associations between sexual orientation assessed in the 2001 to 2010 National Health and Nutrition Examination Surveys (NHANES) and mortality in the 2011 NHANES-linked mortality file. Mortality follow-up time averaged 69.6 months after NHANES. By 2011, 338 individuals had died. Sexual minorities evidenced greater all-cause mortality than did heterosexuals after adjusting for demographic confounding. These effects generally disappeared with further adjustment for NHANES-detected health and behavioral differences. PMID:26985610

  6. Skipping Breakfast and Risk of Mortality from Cancer, Circulatory Diseases and All Causes: Findings from the Japan Collaborative Cohort Study

    PubMed Central

    Yokoyama, Yae; Onishi, Kazunari; Hosoda, Takenobu; Amano, Hiroki; Otani, Shinji; Kurozawa, Youichi; Tamakoshi, Akiko

    2016-01-01

    Background Breakfast eating habits are a dietary pattern marker and appear to be a useful predictor of a healthy lifestyle. Many studies have reported the unhealthy effects of skipping breakfast. However, there are few studies on the association between skipping breakfast and mortality. In the present study, we examined the association between skipping breakfast and mortality from cancer, circulatory diseases and all causes using data from a large-scale cohort study, the Japan Collaborative Cohort Study (JACC) Study. Methods A cohort study of 34,128 men and 49,282 women aged 40–79 years was conducted, to explore the association between lifestyle and cancer in Japan. Participants completed a baseline survey during 1988 to 1990 and were followed until the end of 2009. We classified participants into two groups according to dietary habits with respect to eating or skipping breakfast and carried out intergroup comparisons of lifestyle. Multivariate analysis was performed using the Cox proportional hazard regression model. Results There were 5,768 deaths from cancer and 5,133 cases of death owing to circulatory diseases and 17,112 cases for all causes of mortality during the median 19.4 years follow-up. Skipping breakfast was related to unhealthy lifestyle habits. After adjusting for confounding factors, skipping breakfast significantly increased the risk of mortality from circulatory diseases [hazard ratio (HR) = 1.42] and all causes (HR = 1.43) in men and all causes mortality (HR = 1.34) in women. Conclusion Our findings showed that skipping breakfast is associated with increasing risk of mortality from circulatory diseases and all causes among men and all causes mortality among women in Japan. PMID:27046951

  7. Milk Consumption and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis.

    PubMed

    Larsson, Susanna C; Crippa, Alessio; Orsini, Nicola; Wolk, Alicja; Michaëlsson, Karl

    2015-09-01

    Results from epidemiological studies of milk consumption and mortality are inconsistent. We conducted a systematic review and meta-analysis of prospective studies assessing the association of non-fermented and fermented milk consumption with mortality from all causes, cardiovascular disease, and cancer. PubMed was searched until August 2015. A two-stage, random-effects, dose-response meta-analysis was used to combine study-specific results. Heterogeneity among studies was assessed with the I² statistic. During follow-up periods ranging from 4.1 to 25 years, 70,743 deaths occurred among 367,505 participants. The range of non-fermented and fermented milk consumption and the shape of the associations between milk consumption and mortality differed considerably between studies. There was substantial heterogeneity among studies of non-fermented milk consumption in relation to mortality from all causes (12 studies; I² = 94%), cardiovascular disease (five studies; I² = 93%), and cancer (four studies; I² = 75%) as well as among studies of fermented milk consumption and all-cause mortality (seven studies; I² = 88%). Thus, estimating pooled hazard ratios was not appropriate. Heterogeneity among studies was observed in most subgroups defined by sex, country, and study quality. In conclusion, we observed no consistent association between milk consumption and all-cause or cause-specific mortality. PMID:26378576

  8. Milk Consumption and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis

    PubMed Central

    Larsson, Susanna C.; Crippa, Alessio; Orsini, Nicola; Wolk, Alicja; Michaëlsson, Karl

    2015-01-01

    Results from epidemiological studies of milk consumption and mortality are inconsistent. We conducted a systematic review and meta-analysis of prospective studies assessing the association of non-fermented and fermented milk consumption with mortality from all causes, cardiovascular disease, and cancer. PubMed was searched until August 2015. A two-stage, random-effects, dose-response meta-analysis was used to combine study-specific results. Heterogeneity among studies was assessed with the I2 statistic. During follow-up periods ranging from 4.1 to 25 years, 70,743 deaths occurred among 367,505 participants. The range of non-fermented and fermented milk consumption and the shape of the associations between milk consumption and mortality differed considerably between studies. There was substantial heterogeneity among studies of non-fermented milk consumption in relation to mortality from all causes (12 studies; I2 = 94%), cardiovascular disease (five studies; I2 = 93%), and cancer (four studies; I2 = 75%) as well as among studies of fermented milk consumption and all-cause mortality (seven studies; I2 = 88%). Thus, estimating pooled hazard ratios was not appropriate. Heterogeneity among studies was observed in most subgroups defined by sex, country, and study quality. In conclusion, we observed no consistent association between milk consumption and all-cause or cause-specific mortality. PMID:26378576

  9. Dietary, circulating beta-carotene and risk of all-cause mortality: a meta-analysis from prospective studies.

    PubMed

    Zhao, Long-Gang; Zhang, Qing-Li; Zheng, Jia-Li; Li, Hong-Lan; Zhang, Wei; Tang, Wei-Guo; Xiang, Yong-Bing

    2016-01-01

    Observational studies evaluating the relation between dietary or circulating level of beta-carotene and risk of total mortality yielded inconsistent results. We conducted a comprehensive search on publications of PubMed and EMBASE up to 31 March 2016. Random effect models were used to combine the results. Potential publication bias was assessed using Egger's and Begg's test. Seven studies that evaluated dietary beta-carotene intake in relation to overall mortality, indicated that a higher intake of beta-carotene was related to a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.83, 95%CI: 0.78-0.88) with no evidence of heterogeneity between studies (I(2) = 1.0%, P = 0.416). A random-effect analysis comprising seven studies showed high beta-carotene level in serum or plasma was associated with a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.69, 95%CI: 0.59-0.80) with low heterogeneity (I(2) = 37.1%, P = 0.145). No evidence of publication bias was detected by Begg's and Egger's regression tests. In conclusion, dietary or circulating beta-carotene was inversely associated with risk of all-cause mortality. More studies should be conducted to clarify the dose-response relationship between beta-carotene and all-cause mortality. PMID:27243945

  10. Pooling European all-cause mortality: methodology and findings for the seasons 2008/2009 to 2010/2011.

    PubMed

    Nielsen, J; Mazick, A; Andrews, N; Detsis, M; Fenech, T M; Flores, V M; Foulliet, A; Gergonne, B; Green, H K; Junker, C; Nunes, B; O'Donnell, J; Oza, A; Paldy, A; Pebody, R; Reynolds, A; Sideroglou, T; Snijders, B E; Simon-Soria, F; Uphoff, H; VAN Asten, L; Virtanen, M J; Wuillaume, F; Mølbak, K

    2013-09-01

    Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the ‘summarized’ approach, data across countries were summarized and analysed as one overall country. In the ‘stratified’ approach, heterogeneities between countries were taken into account. Pooling using the ‘stratified’ approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe. PMID:23182146

  11. Association between various sedentary behaviours and all-cause, cardiovascular disease and cancer mortality: the Multiethnic Cohort Study

    PubMed Central

    Kim, Yeonju; Wilkens, Lynne R; Park, Song-Yi; Goodman, Marc T; Monroe, Kristine R; Kolonel, Laurence N

    2013-01-01

    Background It has been proposed that time spent sitting increases all-cause mortality, but evidence to support this hypothesis, especially the relative effects of various sitting activities alone or in combination, is very limited. Methods The association between various sedentary behaviours (time spent: sitting watching television (TV); in other leisure activities; in a car/bus; at work; and at meals) and mortality (all-cause and cause-specific) was examined in the Multiethnic Cohort Study, which included 61 395 men and 73 201 women aged 45–75 years among five racial/ethnic groups (African American, Latino, Japanese American, Native Hawaiian and White) from Hawaii and Los Angeles, USA. Results Median follow-up was 13.7 years and 19 143 deaths were recorded. Total daily sitting was not associated with mortality in men, whereas in women the longest sitting duration (≥10 h/day vs <5 h/day) was associated with increased all-cause (11%) and cardiovascular (19%) mortality. Multivariate hazard ratios (HR) for ≥5 h/day vs <1 h/day of sitting watching TV were 1.19 in men (95% confidence interval (CI) 1.10–1.29) and 1.32 in women (95% CI 1.21–1.44) for all-cause mortality. This association was consistent across four racial/ethnic groups, but was not seen in Japanese Americans. Sitting watching TV was associated with an increased risk for cardiovascular mortality, but not for cancer mortality. Time spent sitting in a car/bus and at work was not related to mortality. Conclusions Leisure time spent sitting, particularly watching television, may increase overall and cardiovascular mortality. Sitting at work or during transportation was not related to mortality. PMID:24062293

  12. Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island.

    PubMed

    Lin, Yu-Kai; Wang, Yu-Chun; Lin, Pay-Liam; Li, Ming-Hsu; Ho, Tsung-Jung

    2013-09-01

    This study aimed to identify optimal cold-temperature indices that are associated with the elevated risks of mortality from, and outpatient visits for all causes and cardiopulmonary diseases during the cold seasons (November to April) from 2000 to 2008 in Northern, Central and Southern Taiwan. Eight cold-temperature indices, average, maximum, and minimum temperatures, and the temperature humidity index, wind chill index, apparent temperature, effective temperature (ET), and net effective temperature and their standardized Z scores were applied to distributed lag non-linear models. Index-specific cumulative 26-day (lag 0-25) mortality risk, cumulative 8-day (lag 0-7) outpatient visit risk, and their 95% confidence intervals were estimated at 1 and 2 standardized deviations below the median temperature, comparing with the Z score of the lowest risks for mortality and outpatient visits. The average temperature was adequate to evaluate the mortality risk from all causes and circulatory diseases. Excess all-cause mortality increased for 17-24% when average temperature was at Z=-1, and for 27-41% at Z=-2 among study areas. The cold-temperature indices were inconsistent in estimating risk of outpatient visits. Average temperature and THI were appropriate indices for measuring risk for all-cause outpatient visits. Relative risk of all-cause outpatient visits increased slightly by 2-7% when average temperature was at Z=-1, but no significant risk at Z=-2. Minimum temperature estimated the strongest risk associated with outpatient visits of respiratory diseases. In conclusion, the relationships between cold temperatures and health varied among study areas, types of health event, and the cold-temperature indices applied. Mortality from all causes and circulatory diseases and outpatient visits of respiratory diseases has a strong association with cold temperatures in the subtropical island, Taiwan. PMID:23764675

  13. Predictive Value of Carotid Distensibility Coefficient for Cardiovascular Diseases and All-Cause Mortality: A Meta-Analysis

    PubMed Central

    Yuan, Chuang; Wang, Jing; Ying, Michael

    2016-01-01

    Aims The aim of the present study is to determine the pooled predictive value of carotid distensibility coefficient (DC) for cardiovascular (CV) diseases and all-cause mortality. Background Arterial stiffness is associated with future CV events. Aortic pulse wave velocity is a commonly used predictor for CV diseases and all-cause mortality; however, its assessment requires specific devices and is not always applicable in all patients. In addition to the aortic artery, the carotid artery is also susceptible to atherosclerosis, and is highly accessible because of the surficial property. Thus, carotid DC, which indicates the intrinsic local stiffness of the carotid artery and may be determined using ultrasound and magnetic resonance imaging, is of interest for the prediction. However, the role of carotid DC in the prediction of CV diseases and all-cause mortality has not been thoroughly characterized, and the pooled predictive value of carotid DC remains unclear. Methods A meta-analysis, which included 11 longitudinal studies with 20361 subjects, was performed. Results Carotid DC significantly predicted future total CV events, CV mortality and all-cause mortality. The pooled risk ratios (RRs) of CV events, CV mortality and all-cause mortality were 1.19 (1.06–1.35, 95%CI, 9 studies with 18993 subjects), 1.09 (1.01–1.18, 95%CI, 2 studies with 2550 subjects) and 1.65 (1.15–2.37, 95%CI, 6 studies with 3619 subjects), respectively, for the subjects who had the lowest quartile of DC compared with their counterparts who had higher quartiles. For CV events, CV mortality and all-cause mortality, a decrease in DC of 1 SD increased the risk by 13%, 6% and 41% respectively, whereas a decrease in DC of 1 unit increased the risk by 3%, 1% and 6% respectively. Conclusions Carotid DC is a significant predictor of future CV diseases and all-cause mortality, which may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CV diseases

  14. Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women.

    PubMed

    Hodgson, Jonathan M; Prince, Richard L; Woodman, Richard J; Bondonno, Catherine P; Ivey, Kerry L; Bondonno, Nicola; Rimm, Eric B; Ward, Natalie C; Croft, Kevin D; Lewis, Joshua R

    2016-03-14

    Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7%) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95% CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95% CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95% CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality. PMID:26787402

  15. Diabetes treatments and risk of heart failure, cardiovascular disease, and all cause mortality: cohort study in primary care

    PubMed Central

    Coupland, Carol

    2016-01-01

    Objective To assess associations between risks of cardiovascular disease, heart failure, and all cause mortality and different diabetes drugs in people with type 2 diabetes, particularly newer agents, including gliptins and thiazolidinediones (glitazones). Design Open cohort study. Setting 1243 general practices contributing data to the QResearch database in England. Participants 469 688 people with type 2 diabetes aged 25-84 years between 1 April 2007 and 31 January 2015. Exposures Diabetes drugs (glitazones, gliptins, metformin, sulphonylureas, insulin, other) alone and in combination. Main outcome measure First recorded diagnoses of cardiovascular disease, heart failure, and all cause mortality recorded on the patients’ primary care, mortality, or hospital record. Cox proportional hazards models were used to estimate hazard ratios for diabetes treatments, adjusting for potential confounders. Results During follow-up, 21 308 patients (4.5%) received prescriptions for glitazones and 32 533 (6.9%) received prescriptions for gliptins. Compared with non-use, gliptins were significantly associated with an 18% decreased risk of all cause mortality, a 14% decreased risk of heart failure, and no significant change in risk of cardiovascular disease; corresponding values for glitazones were significantly decreased risks of 23% for all cause mortality, 26% for heart failure, and 25% for cardiovascular disease. Compared with no current treatment, there were no significant associations between monotherapy with gliptins and risk of any complications. Dual treatment with gliptins and metformin was associated with a decreased risk of all three outcomes (reductions of 38% for heart failure, 33% for cardiovascular disease, and 48% for all cause mortality). Triple treatment with metformin, sulphonylureas, and gliptins was associated with a decreased risk of all three outcomes (reductions of 40% for heart failure, 30% for cardiovascular disease, and 51% for all cause

  16. Predictors, Including Blood, Urine, Anthropometry, and Nutritional Indices, of All-Cause Mortality among Institutionalized Individuals with Intellectual Disability

    ERIC Educational Resources Information Center

    Ohwada, Hiroko; Nakayama, Takeo; Tomono, Yuji; Yamanaka, Keiko

    2013-01-01

    As the life expectancy of people with intellectual disability (ID) increases, it is becoming necessary to understand factors affecting survival. However, predictors that are typically assessed among healthy people have not been examined. Predictors of all-cause mortality, including blood, urine, anthropometry, and nutritional indices, were…

  17. All-Cause Mortality for Diabetics or Individuals with Hyperglycemia Applying for Life Insurance.

    PubMed

    Freitas, Stephen A; MacKenzie, Ross; Wylde, David N; Roudebush, Bradley T; Bergstrom, Richard L; Holowaty, J Carl; Hart, Anna; Rigatti, Steven J; Gill, Stacy J

    2016-01-01

    Diabetics and individuals with lab results consistent with a diagnosis of diabetes or hyperglycemia were extracted from data covering US residents who applied for life insurance between January 2007 and January 2014. Information about these applicants was matched to the Social Security Death Master File (SSDMF) and another commercially available death source file to determine vital status. Due to the inconsistencies of reporting within the death files, there were two cohorts of death cases, one including the imputed year of birth (full cohort of deaths), and the second where the date of birth was known (reduced cohort of deaths). The study had approximately 8.5 million person-years of exposure. Actual to expected (A/E) mortality ratios were calculated using the Society of Actuaries 2008 Valuation Basic Table (2008VBT) select table, age last birthday and the 2010 US population as expected mortality rates. With the 2008VBT as an expected basis, the overall A/E mortality ratio was 3.15 for the full cohort of deaths and 2.56 for the reduced cohort of deaths. Using the US population as the expected basis, the overall A/E mortality ratio was 0.98 for the full cohort of deaths and 0.79 for the reduced cohort. Since there was no smoking status information in this study, all expected bases were not smoker distinct. A/E mortality ratios varied by disease treatment category and were considerably higher in individuals using insulin. A/E mortality ratios decreased with increasing age and took on a J-shaped distribution with increasing BMI (Body Mass Index). The lowest mortality ratios were observed for overweight and obese individuals. The A/E mortality ratio based on the 2008VBT decreased with the increase in applicant duration, which was defined as the time since initial life insurance application. PMID:27562107

  18. Symptoms of depression and all-cause mortality in farmers, a cohort study: the HUNT study, Norway

    PubMed Central

    Letnes, Jon Magne; Hilt, Bjørn; Bjørngaard, Johan Håkon; Krokstad, Steinar

    2016-01-01

    Objectives To explore all-cause mortality and the association between symptoms of depression and all-cause mortality in farmers compared with other occupational groups, using a prospective cohort design. Methods We included adult participants with a known occupation from the second wave of the Nord-Trøndelag Health Study (Helseundersøkelsen i Nord-Trøndelag 2 (HUNT2) 1995–1997), Norway. Complete information on emigration and death from all causes was obtained from the National Registries. We used the depression subscale of the Hospital Anxiety and Depression Scale (HADS) to measure symptoms of depression. We compared farmers to 4 other occupational groups. Our baseline study population comprised 32 618 participants. Statistical analyses were performed using the Cox proportional hazards models. Results The estimated mortality risk in farmers was lower than in all other occupations combined, with a sex and age-adjusted HR (0.91, 95% CI 0.82 to 1.00). However, farmers had an 11% increased age-adjusted and sex-adjusted mortality risk compared with the highest ranked socioeconomic group (HR 1.11, 95% CI 0.98 to 1.25). In farmers, symptoms of depression were associated with a 13% increase in sex-adjusted and age-adjusted mortality risk (HR 1.13, 95% CI 0.88 to 1.45). Compared with other occupations this was the lowest HR, also after adjusting for education, marital status, long-lasting limiting somatic illness and lifestyle factors (HR 1.08, 95% CI 0.84 to 1.39). Conclusions Farmers had lower all-cause mortality compared with the other occupational groups combined. Symptoms of depression were associated with an increased mortality risk in farmers, but the risk increase was smaller compared with the other occupational groups. PMID:27188811

  19. Increased All-Cause, Liver, and Cardiac Mortality among Hepatitis C Virus-seropositive Blood Donors

    PubMed Central

    Guiltinan, Anne M.; Kaidarova, Zhanna; Custer, Brian; Orland, Jennie; Strollo, Angela; Cyrus, Sherri; Busch, Michael P.; Murphy, Edward L.

    2010-01-01

    Hospital-based studies suggest that hepatitis C virus (HCV) infection causes frequent cirrhosis, hepatocellular carcinoma, and mortality, but epidemiologic studies have shown less morbidity and mortality. The authors performed a retrospective cohort study of 10,259 recombinant immunoblot assay-confirmed, HCV antibody-positive (HCV+), allogeneic blood donors from 1991 to 2002 and 10,259 HCV antibody-negative (HCV−) donors matched for year of donation, age, gender, and Zone Improvement Plan Code (ZIP Code). Vital status through 2003 was obtained from the US National Death Index, and hazard ratios with 95% confidence intervals were calculated by survival analysis. After a mean follow-up of 7.7 years, there were 601 (2.92%) deaths: 453 HCV+ and 148 HCV− (hazard ratio (HR) = 3.13, 95% confidence interval (CI): 2.60, 3.76). Excess mortality in the HCV+ group was greatest in liver-related (HR = 45.99, 95% CI: 11.32, 186.74), drug- or alcohol-related (HR = 10.81, 95% CI: 4.68, 24.96), and trauma/suicide (HR = 2.99, 95% CI: 2.05, 4.36) causes. There was also an unexpected increase in cardiovascular mortality among the HCV+ donors (HR = 2.21, 95% CI: 1.41, 3.46). HCV infection is associated with a significant, threefold increase in overall mortality among former blood donors, including significantly increased mortality from liver and cardiovascular causes. High rates of mortality from drug/alcohol and trauma/suicide causes are likely due to lifestyle factors and may be at least partially preventable. PMID:18203734

  20. Sagittal Abdominal Diameter Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Incident Peritoneal Dialysis Patients

    PubMed Central

    Lee, Mi Jung; Shin, Dong Ho; Kim, Seung Jun; Yoo, Dong Eun; Ko, Kwang Il; Koo, Hyang Mo; Kim, Chan Ho; Doh, Fa Mee; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Choi, Kyu Hun; Kang, Shin-Wook

    2013-01-01

    Backgrounds and Aims Visceral fat has a crucial role in the development and progression of cardiovascular disease, the major cause of death in end-stage renal disease (ESRD). Although sagittal abdominal diameter (SAD), as an index of visceral fat, significantly correlated with mortality in the general population, the impact of SAD on clinical outcomes has never been explored in ESRD patients. Therefore, we sought to elucidate the prognostic value of SAD in incident peritoneal dialysis (PD) patients. Methods We prospectively determined SAD by lateral abdominal X-ray at PD initiation, and evaluated the association of SAD with all-cause and cardiovascular mortality in 418 incident PD patients. Results The mean SAD was 24.5±4.3 cm, and during a mean follow-up of 39.4 months, 97 patients (23.2%) died, and 49.4% of them died due to cardiovascular disease. SAD was a significant independent predictor of all-cause [3rd versus 1st tertile, HR (hazard ratio): 3.333, 95% CI (confidence interval): 1.514–7.388, P = 0.01; per 1 cm increase, HR: 1.071, 95% CI: 1.005–1.141, P = 0.03] and cardiovascular mortality (3rd versus 1st tertile, HR: 8.021, 95% CI: 1.994–32.273, P = 0.01; per 1 cm increase, HR: 1.106, 95% CI: 1.007–1.214, P = 0.03). Multivariate fractional polynomial analysis also showed that all-cause and cardiovascular mortality risk increased steadily with higher SAD values. In addition, SAD provided higher predictive value for all-cause (AUC: 0.691 vs. 0.547, P<0.001) and cardiovascular mortality (AUC: 0.644 vs. 0.483, P<0.001) than body mass index (BMI). Subgroup analysis revealed higher SAD (≥24.2 cm) was significantly associated with all-cause mortality in men, women, younger patients (<65 years), and patients with lower BMI (<22.3 kg/m2). Conclusions SAD determined by lateral abdominal X-ray at PD initiation was a significant independent predictor of all-cause and cardiovascular mortality in incident PD patients. Estimating visceral fat by

  1. Kidney Function, Albuminuria, and All-Cause Mortality in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

    PubMed Central

    Warnock, David G.; Muntner, Paul; McCullough, Peter A.; Zhang, Xiao; McClure, Leslie A.; Zakai, Neil; Cushman, Mary; Newsome, Britt B.; Kewalramani, Reshma; Steffes, Michael W.; Howard, George; McClellan, William M.

    2010-01-01

    Background Chronic kidney disease (CKD) and albuminuria are associated with increased risk of all-cause mortality. Study Design Prospective observational cohort study Setting and Participants 17,393 participants (mean age, 64.3 ± 9.6 years) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Predictor Estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (ACR). Outcome All-cause mortality (710 deaths); median duration of follow-up: 3.6 years. Measurements and Analysis Categories of eGFR (90– <120, 60–<90, 45–<60, 30–<45, and 15–<30 mL/min/1.73 m2) and urinary ACR (<10 mg/g or normal, 10–<30 mg/g or high normal, 30–300 mg/g or high, and >300 mg/g or very high). Cox’s proportional hazards models were adjusted for demographic factors, cardiovascular covariates, and hemoglobin. Results The background all-cause mortality rate for participants with normal ACR, eGFR of 90–<120 mL/min/1.73 m2 and no CHD was 4.3 deaths/1,000 person-years. Higher ACR was associated with an increased multivariable adjusted hazard ratio for all-cause mortality within each eGFR category. Reduced eGFR was associated with higher adjusted hazard ratio for all-cause mortality for participants with high normal (P value = 0.01) and high (P value <0.001) ACR values, but not for those with normal or very high ACR values. Limitations Only one laboratory assessment for serum creatinine and ACR was available Conclusions Increased albuminuria was an independent risk factor for all-cause mortality. Reduced eGFR was associated with increased mortality risk among those with high normal and high ACR. The mortality rate was low in the normal ACR group and increased in the very high ACR group but did not vary with eGFR in these groups. PMID:20692752

  2. All-Cause Mortality of Low Birthweight Infants in Infancy, Childhood, and Adolescence: Population Study of England and Wales

    PubMed Central

    Watkins, W. John; Kotecha, Sarah J.; Kotecha, Sailesh

    2016-01-01

    Background Low birthweight (LBW) is associated with increased mortality in infancy, but its association with mortality in later childhood and adolescence is less clear. We investigated the association between birthweight and all-cause mortality and identified major causes of mortality for different birthweight groups. Methods and Findings We conducted a population study of all live births occurring in England and Wales between 1 January 1993 and 31 December 2011. Following exclusions, the 12,355,251 live births were classified by birthweight: 500–1,499 g (very LBW [VLBW], n = 139,608), 1,500–2,499 g (LBW, n = 759,283), 2,500–3,499 g (n = 6,511,411), and ≥3,500 g (n = 4,944,949). The association of birthweight group with mortality in infancy (<1 y of age) and childhood/adolescence (1–18 y of age) was quantified, with and without covariates, through hazard ratios using Cox regression. International Classification of Diseases codes identified causes of death. In all, 74,890 (0.61%) individuals died between birth and 18 y of age, with 23% of deaths occurring after infancy. Adjusted hazard ratios for infant deaths were 145 (95% CI 141, 149) and 9.8 (95% CI 9.5, 10.1) for the VLBW and LBW groups, respectively, compared to the ≥3,500 g group. The respective hazard ratios for death occurring at age 1–18 y were 6.6 (95% CI 6.1, 7.1) and 2.9 (95% CI 2.8, 3.1). Male gender, the youngest and oldest maternal age bands, multiple births, and deprivation (Index of Multiple Deprivation score) also contributed to increased deaths in the VLBW and LBW groups in both age ranges. In infancy, perinatal factors, particularly respiratory issues and infections, explained 84% and 31% of deaths in the VLBW and LBW groups, respectively; congenital malformations explained 36% and 23% in the LBW group and ≥2,500 g groups (2,500–3,499 g and ≥3,500 g groups combined), respectively. Central nervous system conditions explained 20% of deaths in childhood/adolescence in the VLBW

  3. Duration of Thyroid Dysfunction Correlates with All-Cause Mortality. The OPENTHYRO Register Cohort

    PubMed Central

    Laulund, Anne Sofie; Nybo, Mads; Brix, Thomas Heiberg; Abrahamsen, Bo; Jørgensen, Henrik Løvendahl; Hegedüs, Laszlo

    2014-01-01

    Introduction and Aim The association between thyroid dysfunction and mortality is controversial. Moreover, the impact of duration of thyroid dysfunction is unclarified. Our aim was to investigate the correlation between biochemically assessed thyroid function as well as dysfunction duration and mortality. Methods Register-based follow-up study of 239,768 individuals with a serum TSH measurement from hospitals and/or general practice in Funen, Denmark. Measurements were performed at a single laboratory from January 1st 1995 to January 1st 2011. Cox regression was used for mortality analyses and Charlson Comorbidity Index (CCI) was used as comorbidity score. Results Hazard ratios (HR) with 95% confidence intervals (CI) for mortality with decreased (<0.3 mIU/L) or elevated (>4.0 mIU/L) levels of TSH were 2.22; 2.14–2.30; P<0.0001 and 1.28; 1.22–1.35; P<0.0001, respectively. Adjusting for age, gender, CCI and diagnostic setting attenuated the risk estimates (HR 1.23; 95% CI: 1.19–1.28; P<0.0001, mean follow-up time 7.7 years, and HR 1.07; 95% CI: 1.02–1.13; P = 0.004, mean follow-up time 7.2 years) for decreased and elevated values of TSH, respectively. Mortality risk increased by a factor 1.09; 95% CI: 1.08–1.10; P<0.0001 or by a factor 1.03; 95% CI: 1.02–1.04; P<0.0001 for each six months a patient suffered from decreased or elevated TSH, respectively. Subdividing according to degree of thyroid dysfunction, overt hyperthyroidism (HRovert 1.12; 95% CI: 1.06–1.19; P<0.0001), subclinical hyperthyroidism (HRsubclinical 1.09; 95% CI: 1.02–1.17; P = 0.02) and overt hypothyroidism (HRovert 1.57; 95% CI: 1.34–1.83; P<0.0001), but not subclinical hypothyroidism (HRsubclinical 1.03; 95% CI: 0.97–1.09; P = 0.4) were associated with increased mortality. Conclusions and Relevance In a large-scale, population-based cohort with long-term follow-up (median 7.4 years), overt and subclinical hyperthyroidism and overt but not subclinical hypothyroidism

  4. Dietary, circulating beta-carotene and risk of all-cause mortality: a meta-analysis from prospective studies

    PubMed Central

    Zhao, Long-Gang; Zhang, Qing-Li; Zheng, Jia-Li; Li, Hong-Lan; Zhang, Wei; Tang, Wei-Guo; Xiang, Yong-Bing

    2016-01-01

    Observational studies evaluating the relation between dietary or circulating level of beta-carotene and risk of total mortality yielded inconsistent results. We conducted a comprehensive search on publications of PubMed and EMBASE up to 31 March 2016. Random effect models were used to combine the results. Potential publication bias was assessed using Egger’s and Begg’s test. Seven studies that evaluated dietary beta-carotene intake in relation to overall mortality, indicated that a higher intake of beta-carotene was related to a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.83, 95%CI: 0.78–0.88) with no evidence of heterogeneity between studies (I2 = 1.0%, P = 0.416). A random-effect analysis comprising seven studies showed high beta-carotene level in serum or plasma was associated with a significant lower risk of all-cause mortality (RR for highest vs. lowest group = 0.69, 95%CI: 0.59–0.80) with low heterogeneity (I2 = 37.1%, P = 0.145). No evidence of publication bias was detected by Begg’s and Egger’s regression tests. In conclusion, dietary or circulating beta-carotene was inversely associated with risk of all-cause mortality. More studies should be conducted to clarify the dose-response relationship between beta-carotene and all-cause mortality. PMID:27243945

  5. Association of sarcopenic obesity with the risk of all-cause mortality: A meta-analysis of prospective cohort studies.

    PubMed

    Tian, Simiao; Xu, Yang

    2016-02-01

    Many prospective studies have investigated the relationship between sarcopenic obesity (SO) and risk of mortality. However, the results have been controversial. The aim of the present study was to evaluate the association between SO and all-cause mortality in adults by a meta-analysis of prospective cohort studies. A systematic literature search was carried out through electronic databases up to September 2014. A total of nine articles with 12 prospective cohort studies, including 35 287 participants and 14 306 deaths, were included in the meta-analysis. Overall, compared with healthy subjects, subjects with SO had a significant increased risk of all-cause mortality (pooled HR 1.24, 95% CI 1.12-1.37, P < 0.001), with significant heterogeneity among studies (I(2)  = 53.18%, P = 0.0188), but no indication for publication bias (P = 0.7373). Heterogeneity became low and no longer significant in the subgroup analyses by three SO definitions. More importantly, SO, defined by mid-arm muscle circumference and muscle strength criteria, significantly increased the risk of mortality (HR 1.46, 95% CI 1.23-1.73 and 1.23, 1.09-1.38, respectively). The risk of all-cause mortality did not appreciably change considering the geography (USA cohorts and non-USA cohorts) or the duration of follow up (≥10 years and <10 years). However, the risk estimate was only significant in men (HR 1.23, 95% CI 1.08-1.41, P = 0.0017), not in women (HR 1.16, P = 0.1332). The results of the present study show that subjects with SO are associated with a 24% increase risk of all-cause mortality, compared with those without SO, in particular in men; the significant association was found independent of geographical location and duration of follow up. PMID:26271226

  6. Pericardial Fat is Associated with All-Cause Mortality but not Incident CVD: The Rancho Bernardo Study

    PubMed Central

    Larsen, Britta A.; Laughlin, Gail A.; Saad, Sarah D.; Barrett-Connor, Elizabeth; Allison, Matthew A.; Wassel, Christina L.

    2015-01-01

    Objective Pericardial and intra-thoracic fat are associated with prevalent cardiovascular disease (CVD) and CVD risk factors. However, it is unclear if these fat depots predict incident CVD events and/or all-cause mortality. We examined prospective associations between areas of pericardial and intra-thoracic fat and incident CVD and mortality over a 12-year follow-up in a subset of participants without baseline clinical CVD from the Rancho Bernardo Study (RBS). Methods Participants were 343 community-dwelling older adults (mean baseline age=67) who completed a clinic visit in 2001–02, including a computed tomography scan of the chest. Incident CVD and mortality were recorded through January 2013. Results Over a 12.6-year median follow-up, there were 60 incident CVD events and 49 deaths. Pericardial fat was associated with all-cause mortality, such that each standard deviation increment predicted a 34% higher chance of death after adjusting for demographics, lifestyle factors, comorbidities, and visceral fat (95% CI=1.01–1.78). When categorized by tertile, those in the middle tertile of pericardial fat showed no increased risk of mortality, while those in the highest tertile had 2.6 times the risk (95% CI=1.10–5.97) compared to the lowest tertile. There was a marginal association between intra-thoracic fat and mortality (p=0.06). Neither pericardial nor intra-thoracic fat was significantly associated with incident CVD. There were no significant interactions by sex. Conclusions Higher pericardial, but not intra-thoracic, fat was associated with earlier all-cause mortality in older adults over a 12-year follow-up. This association was primarily driven by a higher mortality rate in those in the highest tertile of pericardial fat. PMID:25702617

  7. Intelligence in youth and all-cause-mortality: systematic review with meta-analysis

    PubMed Central

    Calvin, Catherine M; Deary, Ian J; Fenton, Candida; Roberts, Beverly A; Der, Geoff; Leckenby, Nicola; Batty, G David

    2011-01-01

    Background A number of prospective cohort studies have examined the association between intelligence in childhood or youth and life expectancy in adulthood; however, the effect size of this association is yet to be quantified and previous reviews require updating. Methods The systematic review included an electronic search of EMBASE, MEDLINE and PSYCHINFO databases. This yielded 16 unrelated studies that met inclusion criteria, comprising 22 453 deaths among 1 107 022 participants. Heterogeneity was assessed, and fixed effects models were applied to the aggregate data. Publication bias was evaluated, and sensitivity analyses were conducted. Results A 1-standard deviation (SD) advantage in cognitive test scores was associated with a 24% (95% confidence interval 23–25) lower risk of death, during a 17- to 69-year follow-up. There was little evidence of publication bias (Egger’s intercept = 0.10, P = 0.81), and the intelligence–mortality association was similar for men and women. Adjustment for childhood socio-economic status (SES) in the nine studies containing these data had almost no impact on this relationship, suggesting that this is not a confounder of the intelligence–mortality association. Controlling for adult SES in five studies and for education in six studies attenuated the intelligence–mortality hazard ratios by 34 and 54%, respectively. Conclusions Future investigations should address the extent to which attenuation of the intelligence–mortality link by adult SES indicators is due to mediation, over-adjustment and/or confounding. The explanation(s) for association between higher early-life intelligence and lower risk of adult mortality require further elucidation. PMID:21037248

  8. Depression or anxiety and all-cause mortality in adults with atrial fibrillation - A cohort study in Swedish primary care.

    PubMed

    Wändell, Per; Carlsson, Axel C; Gasevic, Danijela; Wahlström, Lars; Sundquist, Jan; Sundquist, Kristina

    2016-02-01

    Objective Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting. Methods The study population included adults (n = 12 283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored. Results The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR = 1.28, 95% CI 1.08-1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients. Conclusions Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice. PMID:26758363

  9. Excessive Access Cannulation Site Bleeding Predicts Long-Term All-Cause Mortality in Chronic Hemodialysis Patients.

    PubMed

    Tsai, Wan-Chuan; Chen, Hung-Yuan; Lin, Chi-Lin; Huang, Shu-Chen; Hsu, Shih-Ping; Pai, Mei-Fen; Peng, Yu-Sen; Chiu, Yen-Ling

    2015-10-01

    Our group has previously reported that excessive vascular access bleeding during dialysis treatment in stable hemodialysis (HD) patients was associated with anemia and may indicate poorer health. The association between excessive blood loss from access cannulation site and clinical outcomes was unknown. We hypothesized that excessive access bleeding may have an impact on all-cause and cardiovascular (CV) mortality in this population. We prospectively conducted an observational, longitudinal study of 360 HD patients. Excessive access bleeding was defined as at least an occurrence of blood loss greater than 4 mL per HD session during a study period of one month. During a median follow-up of 83 months, all-cause mortality and CV mortality were registered. Outcomes were analyzed by Kaplan-Meier and Cox proportional hazards regression analyses. A total of 118 (32.8%) participants died and 54 of these were from CV death. Using a multivariate Cox proportional hazards regression, access bleeding was found to be an independent predictor of all-cause mortality (HR 1.67, 95% CI 0.96-2.91, P = 0.070) but not for CV death (HR 1.53, 95% CI 0.88-2.68, P = 0.135). Our study identified that excessive access cannulation site bleeding could be a novel marker for increased risk of death in HD patients. PMID:25944488

  10. Effect of Drinking on All-Cause Mortality in Women Compared with Men: A Meta-Analysis

    PubMed Central

    Wang, Chao; Xue, Haifeng; Wang, Qianqian; Hao, Yongchen; Li, Dianjiang; Gu, Dongfeng

    2014-01-01

    Abstract Background: Alcoholic beverages are consumed by humans for a variety of dietary, recreational, and other reasons. It is uncertain whether the drinking effect on risk of all-cause mortality is different between women and men. We conducted a meta-analysis to evaluate the effect of drinking on the risk of all-cause mortality in women compared with men. Methods: We selected cohort studies with measures of relative risk (RR) and 95% confidence interval (CI) for all-cause mortality for drinkers versus nondrinkers by sex. Sex-specific RR and 95% CI were used to estimate the female-to-male ratio of RR (RRR) and 95% CI. Pooled estimates of RRR across studies were obtained by the fixed-effects model or the random-effects model (if heterogeneity was detected). Second-order fractional polynomials and random effects meta-regression models were used for modeling the dose-risk relationship. Results: Twenty-four studies were considered eligible. A total of 2,424,964 participants (male: 1,473,899; female: 951,065) were enrolled and 123,878 deaths (male: 76,362; female: 47,516) were observed. Compared with nondrinkers, the pooled female-to-male RRR for drinkers was 1.07 (95% CI: 1.02, 1.12). Subgroup analyses showed that the increased risk among female drinkers appeared to be consistent. J-shaped dose–response relationship was confirmed between alcohol and all-cause mortality in men and women, respectively. Moreover, the female-to-male RRR of all-cause mortality were 1.52 (95% CI: 1.01, 2.29), 1.95 (95% CI: 1.08, 3.49), and 2.36 (95% CI: 1.15, 4.88), respectively, for those who consumed 75, 90, and 100 g/day of alcohol. Conclusions: Females had an increased risk for all-cause mortality conferred by drinking compared with males, especially in heavy drinkers. The present study suggested that female drinkers, particularly heavy drinkers, should moderate or completely reduce their level of consumption to have a health benefit. PMID:24611563

  11. Associations of sitting behaviours with all-cause mortality over a 16-year follow-up: the Whitehall II study

    PubMed Central

    Pulsford, Richard M; Stamatakis, Emmanuel; Britton, Annie R; Brunner, Eric J; Hillsdon, Melvyn

    2015-01-01

    Background: Sitting behaviours have been linked with increased risk of all-cause mortality independent of moderate to vigorous physical activity (MVPA). Previous studies have tended to examine single indicators of sitting or all sitting behaviours combined. This study aims to enhance the evidence base by examining the type-specific prospective associations of four different sitting behaviours as well as total sitting with the risk of all-cause mortality. Methods: Participants (3720 men and 1412 women) from the Whitehall II cohort study who were free from cardiovascular disease provided information on weekly sitting time (at work, during leisure time, while watching TV, during leisure time excluding TV, and at work and during leisure time combined) and covariates in 1997–99. Cox proportional hazards models were used to investigate prospective associations between sitting time (h/week) and mortality risk. Follow-up was from date of measurement until (the earliest of) death, date of censor or July 31 2014. Results: Over 81 373 person-years of follow-up (mean follow-up time 15.7 ± 2.2 years) a total of 450 deaths were recorded. No associations were observed between any of the five sitting indicators and mortality risk, either in unadjusted models or models adjusted for covariates including MVPA. Conclusions: Sitting time was not associated with all-cause mortality risk. The results of this study suggest that policy makers and clinicians should be cautious about placing emphasis on sitting behaviour as a risk factor for mortality that is distinct from the effect of physical activity. PMID:26454871

  12. Antiplatelet Treatment Reduces All-Cause Mortality in COPD Patients: A Systematic Review and Meta-Analysis.

    PubMed

    Pavasini, Rita; Biscaglia, Simone; d'Ascenzo, Fabrizio; Del Franco, Annamaria; Contoli, Marco; Zaraket, Fatima; Guerra, Federico; Ferrari, Roberto; Campo, Gianluca

    2016-08-01

    Previous studies clearly showed that patients with chronic obstructive pulmonary disease (COPD) are at high risk for cardiovascular events. Platelet activation is significantly heightened in these patients, probably because of a chronic inflammatory status. Nevertheless, it is unclear whether antiplatelet treatment may contribute to reduce all-cause mortality in COPD patients. To clarify this issue, we performed a systematic review and meta-analysis including patients with COPD (outpatients or admitted to hospital for acute exacerbation). The primary endpoint was all-cause mortality. We considered studies stratifying the study population according the administration or not of antiplatelet therapy and reporting its relationship with the primary endpoint. Overall, 5 studies including 11117 COPD patients were considered (of those 3069 patients were with acute exacerbation of COPD). IHD was present in 33% of COPD patients [95%CI 31%-35%). Antiplatelet therapy administration was common (47%, 95%CI 46%-48%), ranging from 26% to 61%. Of note, IHD was considered as confounding factor at multivariable analysis in all studies. All-cause mortality was significantly lower in COPD patients receiving antiplatelet treatment (OR 0.81; 95%CI 0.75-0.88). The data was consistent both in outpatients and in those with acute exacerbation of COPD. The pooled studies analysis showed a very low heterogeneity (I(2) : 8%). Additional analyses (meta-regression) showed that antiplatelet therapy administration was effective independently (to potential confounding factors as IHD, cardiovascular drugs and cardiovascular risk factors. In conclusion, our meta-analysis suggested that antiplatelet therapy might significantly contribute to reduce all-cause mortality in COPD patients. PMID:26678708

  13. Association Between Tooth Loss, Body Mass Index, and All-Cause Mortality Among Elderly Patients in Taiwan

    PubMed Central

    Hu, Hsiao-Yun; Lee, Ya-Ling; Lin, Shu-Yi; Chou, Yi-Chang; Chung, Debbie; Huang, Nicole; Chou, Yiing-Jenq; Wu, Chen-Yi

    2015-01-01

    Abstract To date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15–1.61], 1.24 (95% CI: 1.08–1.42), and 1.19 (95% CI: 1.09–1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21–1.83; 1–9 teeth: HR = 1.23, 95% CI: 1.03–1.47; 10–19 teeth: HR = 1.20, 95% CI: 1.06–1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05–1.79; 1–9 teeth: HR = 1.27, 95% CI: 1.07–1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight. PMID:26426618

  14. Relation of Periodontitis to Risk of Cardiovascular and All-Cause Mortality (from a Danish Nationwide Cohort Study).

    PubMed

    Hansen, Gorm Mørk; Egeberg, Alexander; Holmstrup, Palle; Hansen, Peter Riis

    2016-08-15

    Periodontitis and atherosclerosis are highly prevalent chronic inflammatory diseases, and it has been suggested that periodontitis is an independent risk factor of cardiovascular disease (CVD) and that a causal link may exist between the 2 diseases. Using Danish national registers, we identified a nationwide cohort of 17,691 patients who received a hospital diagnosis of periodontitis within a 15-year period and matched them with 83,003 controls from the general population. We performed Poisson regression analysis to determine crude and adjusted incidence rate ratios of myocardial infarction, ischemic stroke, cardiovascular death, major adverse cardiovascular events, and all-cause mortality. The results showed that patients with periodontitis were at higher risk of all examined end points. The findings remained significant after adjustment for increased baseline co-morbidity in periodontitis patients compared with controls, for example, with adjusted incidence rate ratio 2.02 (95% CI 1.87 to 2.18) for cardiovascular death and 2.70 (95% CI 2.60 to 2.81) for all-cause mortality. Patients with a hospital diagnosis of periodontitis have a high burden of co-morbidity and an increased risk of CVD and all-cause mortality. In conclusion, our results support that periodontitis may be an independent risk factor for CVD. PMID:27372888

  15. Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis

    PubMed Central

    Xie, Jun; Huang, Wei; Xu, Biao

    2015-01-01

    Background A number of studies have assessed the predictive effect of QRS-T angles in various populations since the last decade. The objective of this meta-analysis was to evaluate the prognostic value of spatial/frontal QRS-T angle on all-cause death and cardiac death. Methods PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from their inception until June 5, 2014. Studies reporting the predictive effect of spatial/frontal QRS-T angle on all-cause/cardiac death in all populations were included. Relative risk (RR) was used as a measure of effect. Results Twenty-two studies enrolling 164,171 individuals were included. In the combined analysis in all populations, a wide spatial QRS-T angle was associated with an increase in all-cause death (maximum-adjusted RR: 1.40; 95% confidence interval [CI]: 1.32 to 1.48) and cardiac death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90), a wide frontal QRS-T angle also predicted a higher rate of all-cause death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90). Largely similar results were found using different methods of categorizing for QRS-T angles, and similar in subgroup populations such as general population, populations with suspected coronary heart disease or heart failure. Other stratified analyses and meta-analyses using unadjusted data also generated consistent findings. Conclusions Spatial QRS-T angle held promising prognostic value on all-cause death and cardiac death. Frontal QRS-T angle was also a promising predictor of all-cause death. Given the good predictive value of QRS-T angle, a combined stratification strategy in which QRS-T angle is of vital importance might be expected. PMID:26284799

  16. Association of Versican Turnover with All-Cause Mortality in Patients on Haemodialysis

    PubMed Central

    Genovese, Federica; Karsdal, Morten A.; Leeming, Diana J.; Scholze, Alexandra; Tepel, Martin

    2014-01-01

    Objective Cardiovascular diseases are among the most common causes of mortality in renal failure patients undergoing haemodialysis. A high turnover rate of the proteoglycan versican, represented by the increased presence of its fragmentation products in plasma, has previously been associated with cardiovascular diseases. The objective of the study was to investigate the association of versican turnover assessed in plasma with survival in haemodialysis patients. Methods A specific matrix metalloproteinase-generated neo-epitope fragment of versican (VCANM) was measured in plasma of 364 haemodialysis patients with a 5-years follow-up, using a robust competitive enzyme-linked immunosorbent assays. Association between VCANM plasma concentration and survival was assessed by Kaplan-Meier analysis and adjusted Cox model. Results Haemodialysis patients with plasma VCANM concentrations in the lowest quartile had increased risk of death (odds ratio, as compared to the highest quartile: 7.1, p<0.001), with a reduced survival of 152 days compared to 1295 days for patients with plasma VCANM in the highest quartile. Multivariate analysis showed that low VCANM (p<0.001) and older age (p<0.001) predicted death in haemodialysis patients. Conclusions Low concentrations of the versican fragment VCANM in plasma were associated with higher risk of death among haemodialysis patients. A possible protective role for the examined versican fragment is suggested. PMID:25354390

  17. Maximum bite force at age 70 years predicts all-cause mortality during the following 13 years in Japanese men.

    PubMed

    Iwasaki, M; Yoshihara, A; Sato, N; Sato, M; Taylor, G W; Ansai, T; Ono, T; Miyazaki, H

    2016-08-01

    There is limited information on the impact of oral function on mortality among older adults. The aim of this prospective cohort study was to examine whether an objective measure of oral function, maximum bite force (MBF), is associated with mortality in older adults during a 13-year follow-up period. Five hundred and fifty-nine community-dwelling Japanese (282 men and 277 women) aged 70 years at baseline were included in the study. Medical and dental examinations and a questionnaire survey were conducted at baseline. Maximum bite force was measured using an electronic recording device (Occlusal Force-Meter GM10). Follow-up investigation to ascertain vital status was conducted 13 years after baseline examinations. Survival rates among MBF tertiles were compared using Cox proportional hazards regression models stratified by sex. There were a total of 111 deaths (82 events for men and 29 for women). Univariable analysis revealed that male participants in the lower MBF tertile had increased risk of all-cause mortality [hazard ratio (HR) = 1·94, 95% confidence interval (CI) = 1·13-3·34] compared with those in the upper MBF tertile. This association remained significant after adjustment for confounders (adjusted HR = 1·84, 95% CI = 1·07-3·19). Conversely, no association between MBF and all-cause mortality was observed in female participants. Maximum bite force was independently associated with all-cause mortality in older Japanese male adults. These data provide additional evidence for the association between oral function and geriatric health. PMID:27084614

  18. All-Cause and Cause-Specific Mortality among Users of Basal Insulins NPH, Detemir, and Glargine

    PubMed Central

    Strandberg, Timo E.; Christopher, Solomon; Haukka, Jari; Korhonen, Pasi

    2016-01-01

    Background Insulin therapy in type 2 diabetes may increase mortality and cancer incidence, but the impact of different types of basal insulins on these endpoints is unclear. Compared to the traditional NPH insulin, the newer, longer-acting insulin analogues detemir and glargine have shown benefits in randomized controlled trials. Whether these advantages translate into lower mortality among users in real life is unknown. Objective To estimate the differences in all-cause and cause-specific mortality rates between new users of basal insulins in a population-based study in Finland. Methods 23 751 individuals aged ≥40 with type 2 diabetes, who initiated basal insulin therapy in 2006–2009 were identified from national registers, with comprehensive data for mortality, causes of death, and background variables. Propensity score matching was performed on characteristics. Follow-up time was up to 4 years (median 1.7 years). Results 2078 deaths incurred. With NPH as reference, the adjusted HRs for all-cause mortality were 0.39 (95% CI, 0.30–0.50) for detemir, and 0.55 (95% CI, 0.44–0.69) for glargine. As compared to glargine, the HR was 0.71 (95% CI, 0.54–0.93) among detemir users. Compared to NPH, the mortality risk for both cardiovascular causes as well as cancer were also significantly lower for glargine, and especially for detemir in adjusted analysis. Furthermore, the results were robust in various sensitivity analyses. Conclusion In real clinical practice, mortality was substantially higher among users of NPH insulin as compared to insulins detemir or glargine. Considering the large number of patients who require insulin therapy, this difference in risk may have major clinical and public health implications. Due to limitations of the observational study design, further investigation using an interventional study design is warranted. PMID:27031113

  19. Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data

    PubMed Central

    Oyebode, Oyinlola; Gordon-Dseagu, Vanessa; Walker, Alice; Mindell, Jennifer S

    2014-01-01

    Background Governments worldwide recommend daily consumption of fruit and vegetables. We examine whether this benefits health in the general population of England. Methods Cox regression was used to estimate HRs and 95% CI for an association between fruit and vegetable consumption and all-cause, cancer and cardiovascular mortality, adjusting for age, sex, social class, education, BMI, alcohol consumption and physical activity, in 65 226 participants aged 35+ years in the 2001–2008 Health Surveys for England, annual surveys of nationally representative random samples of the non-institutionalised population of England linked to mortality data (median follow-up: 7.7 years). Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion). Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted. PMID:24687909

  20. Meta-analysis on the risk of all-cause mortality and cardiovascular death in the early stage of hypertension.

    PubMed

    Yue, Menglin; Zhang, Huimin; Li, Rong

    2016-07-01

    To evaluate the relationship among the early stage of hypertension, cardiovascular death, the mortality of coronary heart disease and stroke. Two researchers searched online data of PubMed, Embase and Cochrane library databases and other related papers and manual retrieval conference papers. A prospective cohort study of relative risks and 95% CIs about the comparison with ideal blood pressure, the pre-hypertension and the all-cause mortality or the death of cardiovascular that corrected a variety of risk factors. Compared with ideal blood pressure, the corrected risk factors, the pre-hypertension couldn't increase the RR of the all caused mortality; but it could increase remarkably the mortality of cardiovascular, coronary heart disease and stroke, and there was a significant difference between the two later (P<0.001). Compared with the ideal blood pressure, the pre-hypertension still increased the risk of death of cardiovascular disease and the death rate of the stroke was higher than coronary heart disease. PMID:27592484

  1. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study

    PubMed Central

    Lassale, Camille; Gunter, Marc J.; Romaguera, Dora; Peelen, Linda M.; Van der Schouw, Yvonne T.; Beulens, Joline W. J.; Freisling, Heinz; Muller, David C.; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C.; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K.; Katzke, Verena A.; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J.; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Boer, Jolanda M. A.; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G. M.; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72–0.79) to 0.88 (0.84–0.92) for all-cause, 0.76 (0.69–0.83) to 0.84 (0.76–0.92) for CVD and 0.78 (0.73–0.83) to 0.91 (0.85–0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

  2. Effect of Dipeptidyl Peptidase-4 Inhibitor on All-Cause Mortality and Coronary Revascularization in Diabetic Patients

    PubMed Central

    Park, Hyo Eun; Jeon, Jooyeong; Hwang, In-Chang; Sung, Jidong; Lee, Seung-Pyo; Kim, Hyung-Kwan; Cho, Goo-Yeong; Sohn, Dae-Won

    2015-01-01

    Background Anti-atherosclerotic effect of dipeptidyl peptidase-4 (DPP-4) inhibitors has been suggested from previous studies, and yet, its association with cardiovascular outcome has not been demonstrated. We aimed to evaluate the effect of DPP-4 inhibitors in reducing mortality and coronary revascularization, in association with baseline coronary computed tomography (CT). Methods The current study was performed as a multi-center, retrospective observational cohort study. All subjects with diabetes mellitus who had diagnostic CT during 2007-2011 were included, and 1866 DPP-4 inhibitor users and 5179 non-users were compared for outcome. The primary outcome was all-cause mortality and secondary outcome included any coronary revascularization therapy after 90 days of CT in addition to all-cause mortality. Results DPP-4 inhibitors users had significantly less adverse events [0.8% vs. 4.4% in users vs. non-users, adjusted hazard ratios (HR) 0.220, 95% confidence interval (CI) 0.102-0.474, p = 0.0001 for primary outcome, 4.1% vs. 7.6% in users vs. non-users, HR 0.517, 95% CI 0.363-0.735, p = 0.0002 for secondary outcome, adjusted variables were age, sex, presence of hypertension, high sensitivity C-reactive protein, glycated hemoglobin, statin use, coronary artery calcium score and degree of stenosis]. Interestingly, DPP-4 inhibitor seemed to be beneficial only in subjects without significant stenosis (adjusted HR 0.148, p = 0.0013 and adjusted HR 0.525, p = 0.0081 for primary and secondary outcome). Conclusion DPP-4 inhibitor is associated with reduced all-cause mortality and coronary revascularization in diabetic patients. Such beneficial effect was significant only in those without significant coronary stenosis, which implies that DPP-4 inhibitor may have beneficial effect in earlier stage of atherosclerosis. PMID:26755932

  3. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.

    PubMed

    Lassale, Camille; Gunter, Marc J; Romaguera, Dora; Peelen, Linda M; Van der Schouw, Yvonne T; Beulens, Joline W J; Freisling, Heinz; Muller, David C; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K; Katzke, Verena A; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H Bas; Boer, Jolanda M A; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G M; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

  4. Associations of high HDL cholesterol level with all-cause mortality in patients with heart failure complicating coronary heart disease

    PubMed Central

    Cai, Anping; Li, Xida; Zhong, Qi; Li, Minming; Wang, Rui; Liang, Yingcong; Chen, Wenzhong; Huang, Tehui; Li, Xiaohong; Zhou, Yingling; Li, Liwen

    2016-01-01

    Abstract The aim of the present study was to evaluate the association between HDL cholesterol level and all-cause mortality in patients with ejection fraction reduced heart failure (EFrHF) complicating coronary heart disease (CHD). A total of 323 patients were retrospectively recruited. Patients were divided into low and high HDL cholesterol groups. Between-group differences and associations between HDL cholesterol level and all-cause mortality were assessed. Patients in the high HDL cholesterol group had higher HDL cholesterol level and other lipid components (P <0.05 for all comparison). Lower levels of alanine aminotransferase (ALT), high-sensitivity C-reactive protein (Hs-CRP), and higher albumin (ALB) level were observed in the high HDL cholesterol group (P <0.05 for all comparison). Although left ventricular ejection fraction (LVEF) were comparable (28.8 ± 4.5% vs 28.4 ± 4.6%, P = 0.358), mean mortality rate in the high HDL cholesterol group was significantly lower (43.5% vs 59.1%, P = 0.007). HDL cholesterol level was positively correlated with ALB level, while inversely correlated with ALT, Hs-CRP, and NYHA classification. Logistic regression analysis revealed that after extensively adjusted for confounding variates, HDL cholesterol level remained significantly associated with all-cause mortality although the magnitude of association was gradually attenuated with odds ratio of 0.007 (95% confidence interval 0.001–0.327, P = 0.012). Higher HDL cholesterol level is associated with better survival in patients with EFrHF complicating CHD, and future studies are necessary to demonstrate whether increasing HDL cholesterol level will confer survival benefit in these populations of patients. PMID:27428188

  5. Abdominal obesity modifies the risk of hypertriglyceridemia for all-cause and cardiovascular mortality in hemodialysis patients.

    PubMed

    Postorino, Maurizio; Marino, Carmen; Tripepi, Giovanni; Zoccali, Carmine

    2011-04-01

    Hypertriglyceridemia is the most prevalent lipid alteration in end-stage renal disease, and we studied the relationship between serum triglycerides and all-cause and cardiovascular death in these patients. Since abdominal fat modifies the effect of lipids on atherosclerosis, we analyzed the interaction between serum lipids and waist circumference (WC) as a metric of abdominal obesity. In a cohort of 537 hemodialysis patients, 182 died, 113 from cardiovascular causes, over an average follow-up of 29 months. In Cox models that included traditional and nontraditional risk factors, there were significant strong interactions between triglycerides and WC to both all-cause and cardiovascular death. A fixed (50 mg/dl) excess in triglycerides was associated with a progressive lower risk of all-cause and cardiovascular mortality in patients with threshold WC <95 cm but with a progressive increased risk in those above this threshold. A significant interaction between cholesterol and WC with all-cause and cardiovascular death emerged only in models excluding the triglycerides-WC interaction. Neither high-density lipoprotein (HDL) nor non-HDL cholesterol or their interaction terms with WC were associated with study outcomes. Thus, the predictive value of triglycerides and cholesterol for survival and atherosclerotic complications in hemodialysis patients is critically dependent on WC. Hence, intervention studies in end-stage renal disease should specifically target patients with abdominal obesity and hyperlipidemia. PMID:21178980

  6. Body mass index before and after breast cancer diagnosis: Associations with all-cause, breast cancer, and cardiovascular disease mortality

    PubMed Central

    Nichols, Hazel B.; Trentham-Dietz, Amy; Egan, Kathleen M.; Titus-Ernstoff, Linda; Holmes, Michelle D.; Bersch, Andrew J.; Holick, Crystal N.; Hampton, John M.; Stampfer, Meir J.; Willett, Walter C.; Newcomb, Polly A.

    2009-01-01

    Background Factors related to improving outcomes in breast cancer survivors are of increasing public health significance. We examined post-diagnosis weight change in relation to mortality risk in a cohort of breast cancer survivors. Methods We analyzed data from a cohort of 3,993 women aged 20−79 living in New Hampshire, Massachusetts or Wisconsin with invasive, nonmetastatic breast cancers diagnosed in 1988−1999 identified through state registries. Participants completed a structured telephone interview 1−2 years after diagnosis and returned a mailed follow-up questionnaire in 1998−2001 that addressed post-diagnosis weight and other factors. Vital status information was obtained from the National Death Index through December 2005. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated from Cox proportional hazards models and adjusted for pre-diagnosis weight, age, stage, smoking, physical activity and other important covariates. Results During an average 6.3 years of follow-up from the post-diagnosis questionnaire, we identified 421 total deaths, including 121 deaths from breast cancer and 95 deaths from cardiovascular disease. Increasing post-diagnosis weight gain and weight loss were each associated with greater all-cause mortality. Among women who gained weight after breast cancer diagnosis, each 5 kg gain was associated with a 12% increase in all-cause mortality (p=0.004), a 13% increase in breast cancer-specific mortality (p=0.01), and a 19% increase in cardiovascular disease mortality (p=0.04). Associations with breast cancer mortality were not modified by pre-diagnosis menopausal status, cigarette smoking, or body mass index. Conclusion These findings suggest that efforts to minimize weight gain after a breast cancer diagnosis may improve survival. PMID:19366908

  7. What is the effect of unemployment on all-cause mortality? A cohort study using propensity score matching

    PubMed Central

    Clemens, Tom; Popham, Frank; Boyle, Paul

    2015-01-01

    Background There is a strong association between unemployment and mortality but whether this relationship is causal remains debated. This study utilises population level administrative data from Scotland within a propensity score framework to explore whether the association between unemployment and mortality may be causal. Methods The study examined a sample of working men and women aged 25 to 54 in 1991. Subsequent employment status in 2001 was observed (in work or unemployed) and the relative all-cause mortality risk of unemployment between 2001 and 2010 was estimated. To account for potential selection into unemployment of those in poor health, a propensity score matching approach was used. Matching variables were observed prior to unemployment and included health status up to the year of unemployment (hospital admissions and self-reported limiting long term illness) as well as measures of socio-economic position. Results Unemployment was associated with a significant all-cause mortality risk relative to employment for men (hazard ratio 1.85 95% CI 1.33-2.55). This effect was robust to controlling for prior health and socio-demographic characteristics. Effects for women were smaller and statistically insignificant (HR 1.51 95% CI 0.68-3.37). Conclusion For men, the findings support the notion that the often observed association between unemployment and mortality may contain a significant causal component though for women there is less support for this conclusion. However, female employment status, as recorded in the census, is more complex than for men and may have served to under-estimate any mortality effect of unemployment. Future work should examine this issue further. PMID:25161201

  8. Independent and joint effects of sedentary time and cardiorespiratory fitness on all-cause mortality: the Cooper Center Longitudinal Study

    PubMed Central

    Shuval, Kerem; Finley, Carrie E; Barlow, Carolyn E; Nguyen, Binh T; Njike, Valentine Y; Pettee Gabriel, Kelley

    2015-01-01

    Objectives To examine the independent and joint effects of sedentary time and cardiorespiratory fitness (fitness) on all-cause mortality. Design, setting, participants A prospective study of 3141 Cooper Center Longitudinal Study participants. Participants provided information on television (TV) viewing and car time in 1982 and completed a maximal exercise test during a 1-year time frame; they were then followed until mortality or through 2010. TV viewing, car time, total sedentary time and fitness were the primary exposures and all-cause mortality was the outcome. The relationship between the exposures and outcome was examined utilising Cox proportional hazard models. Results A total of 581 deaths occurred over a median follow-up period of 28.7 years (SD=4.4). At baseline, participants’ mean age was 45.0 years (SD=9.6), 86.5% were men and their mean body mass index was 24.6 (SD=3.0). Multivariable analyses revealed a significant linear relationship between increased fitness and lower mortality risk, even while adjusting for total sedentary time and covariates (p=0.02). The effects of total sedentary time on increased mortality risk did not quite reach statistical significance once fitness and covariates were adjusted for (p=0.05). When examining this relationship categorically, in comparison to the reference category (≤10 h/week), being sedentary for ≥23 h weekly increased mortality risk by 29% without controlling for fitness (HR=1.29, 95% CI 1.03 to 1.63); however, once fitness and covariates were taken into account this relationship did not reach statistical significance (HR=1.20, 95% CI 0.95 to 1.51). Moreover, spending >10 h in the car weekly significantly increased mortality risk by 27% in the fully adjusted model. The association between TV viewing and mortality was not significant. Conclusions The relationship between total sedentary time and higher mortality risk is less pronounced when fitness is taken into account. Increased car time, but

  9. High diet quality is associated with a lower risk of cardiovascular disease and all-cause mortality in older men.

    PubMed

    Atkins, Janice L; Whincup, Peter H; Morris, Richard W; Lennon, Lucy T; Papacosta, Olia; Wannamethee, S Goya

    2014-05-01

    Although diet quality is implicated in cardiovascular disease (CVD) risk, few studies have investigated the relation between diet quality and the risks of CVD and mortality in older adults. This study examined the prospective associations between dietary scores and risk of CVD and all-cause mortality in older British men. A total of 3328 men (aged 60-79 y) from the British Regional Heart Study, free from CVD at baseline, were followed up for 11.3 y for CVD and mortality. Baseline food-frequency questionnaire data were used to generate 2 dietary scores: the Healthy Diet Indicator (HDI), based on WHO dietary guidelines, and the Elderly Dietary Index (EDI), based on a Mediterranean-style dietary intake, with higher scores indicating greater compliance with dietary recommendations. Cox proportional hazards regression analyses assessed associations between quartiles of HDI and EDI and risk of all-cause mortality, CVD mortality, CVD events, and coronary heart disease (CHD) events. During follow-up, 933 deaths, 327 CVD deaths, 582 CVD events, and 307 CHD events occurred. Men in the highest compared with the lowest EDI quartile had significantly lower risks of all-cause mortality (HR: 0.75; 95% CI: 0.60, 0.94; P-trend = 0.03), CVD mortality (HR: 0.63; 95% CI: 0.42, 0.94; P-trend = 0.03), and CHD events (HR: 0.66; 95% CI: 0.45, 0.97; P-trend = 0.05) but not CVD events (HR: 0.79; 95% CI: 0.60, 1.05; P-trend = 0.16) after adjustment for sociodemographic, behavioral, and cardiovascular risk factors. The HDI was not significantly associated with any of the outcomes. The EDI appears to be more useful than the HDI for assessing diet quality in relation to CVD and morality risk in older men. Encouraging older adults to adhere to the guidelines inherent in the EDI criteria may have public health benefits. PMID:24572037

  10. DOT associated with reduced all-cause mortality among tuberculosis patients in Taipei, Taiwan, 2006–2008

    PubMed Central

    Yen, Y-F.; Rodwell, T. C.; Yen, M-Y.; Shih, H-C.; Hu, B-S.; Li, L-H.; Shie, Y-H.; Chuang, P.; Garfein, R. S.

    2012-01-01

    OBJECTIVE To determine whether patients receiving directly observed treatment (DOT) had lower all-cause mortality than those treated with self-administered treatment (SAT) and to identify factors associated with mortality among tuberculosis (TB) patients. DESIGN All TB patients in Taipei, Taiwan, diagnosed between 2006 and 2008 were included in a retrospective cohort study. RESULTS Among 3624 TB patients, 45.5% received DOT, which was disproptionately offered to older patients and those with more underlying illness and severe TB disease. After controlling for patient sociodemographic factors, clinical findings and underlying comorbidities, the odds of death was 40% lower (aOR 0.60, 95%CI 0.5–0.8) among patients treated with DOT than those on SAT. After adjusting for DOT, independent predictors of death included non-Taiwan birth, increasing age, male, unemployment, end-stage renal disease requiring dialysis, malignancy, acid-fast bacilli smear positivity and pleural effusion. CONCLUSION DOT was associated with lower all-cause mortality after controlling for confounding factors. DOT should be expanded in Taiwan to improve critical treatment outcomes among TB patients. PMID:22236917

  11. Birth characteristics and all-cause mortality: a sibling analysis using the Uppsala birth cohort multigenerational study.

    PubMed

    Juárez, S; Goodman, A; De Stavola, B; Koupil, I

    2016-08-01

    This paper investigates the association between perinatal health and all-cause mortality for specific age intervals, assessing the contribution of maternal socioeconomic characteristics and the presence of maternal-level confounding. Our study is based on a cohort of 12,564 singletons born between 1915 and 1929 at the Uppsala University Hospital. We fitted Cox regression models to estimate age-varying hazard ratios of all-cause mortality for absolute and relative birth weight and for gestational age. We found that associations with mortality vary by age and according to the measure under scrutiny, with effects being concentrated in infancy, childhood or early adult life. For example, the effect of low birth weight was greatest in the first year of life and then continued up to 44 years of age (HR between 2.82 and 1.51). These associations were confirmed in within-family analyses, which provided no evidence of residual confounding by maternal characteristics. Our findings support the interpretation that policies oriented towards improving population health should invest in birth outcomes and hence in maternal health. PMID:27138055

  12. Socioeconomic Status across the Life Course and All-Cause and Cause-Specific Mortality in Finland

    PubMed Central

    Elo, Irma T.; Martikainen, Pekka; Myrskylä, Mikko

    2014-01-01

    We used high quality register based data to study the relationship between childhood and adult socio-demographic characteristics and all-cause and cause-specific mortality at ages 35–72 in Finland among cohorts born in 1936–1950. The analyses were based on a 10% sample of households drawn from the 1950 Finnish Census of Population with the follow-up of household members in subsequent censuses and death records beginning from the end of 1970 through the end of 2007. The strengths of these data come from the fact that neither childhood nor adult characteristics are self reported and thus are not subject to recall bias, misreporting and no loss to follow-up after age 35. In addition, the study population includes several families with at least two children enabling us to control for unobserved family characteristics. We documented significant associations between early life social and family conditions on all-cause mortality and cause-specific mortality, with protective effects of higher childhood socio-demographic characteristics varying between 10% and 30%. These associations were mostly mediated through adult educational attainment and occupation, suggesting that the indirect effects of childhood conditions were more important than their direct effects. We further found that adult socioeconomic status was a significant predictor of mortality. The associations between adult characteristics and mortality were robust to controls for observed and unobserved childhood characteristics. The results imply that long-term adverse health consequences of disadvantaged early life social circumstances may be mitigated by investments in educational and employment opportunities in early adulthood. PMID:24369809

  13. Longitudinal Patterns of Blood Pressure, Incident Cardiovascular Events, and All-Cause Mortality in Normotensive Diabetic People.

    PubMed

    Wu, Zhijun; Jin, Cheng; Vaidya, Anand; Jin, Wei; Huang, Zhe; Wu, Shouling; Gao, Xiang

    2016-07-01

    Lower blood pressure (BP) within the normotensive range has been suggested to be deleterious in diabetic people using antihypertensive drugs. We hypothesized that BP <120/80 mm Hg and BP trajectories may predict further risk of all-cause mortality or cardiovascular events in normotensive diabetic individuals. We included 3159 diabetic adults, free of hypertension, atherosclerotic cardiovascular diseases, or cancer in 2006 (baseline), from a community-based cohort including 101 510 participants. A total of 831 participants with BP <120/80 mm Hg and 2328 participants with BP of 120 to 139/80 to 89 mm Hg were included. BP and other clinical covariates were repeatedly measured every 2 years. During 7 years of follow-up, we documented 247 deaths and 177 cardiovascular events. Diabetic people with BP <120/80 mm Hg had a 46% increased risk of all-cause mortality (95% confidence interval, 10%-93%) compared with those with BP of 120 to 139/80 to 89 mm Hg at baseline. We then estimated the association between BP trajectories from 2006 to 2008 and adverse events among 2311 diabetic people who had both BP measures at 2006 and 2008. Relative to stable BP of 120 to 139/80 to 89 mm Hg, having persistently BP <120/80 mm Hg (hazard ratio: 2.35; 95% confidence interval, 1.10-5.01) or a spontaneous decrease in BP from 120 to 139/80 to 89 to <120/80 mm Hg (hazard ratio: 3.04; 95% confidence interval, 1.56-5.92) was significantly associated with an increased risk of all-cause mortality during 2008 to 2014. A rise in BP from 120 to 139/80 to 89 to ≥140/90 mm Hg conferred a high risk of cardiovascular events (hazard ratio: 1.98; 95% confidence interval, 1.24-3.17). In normotensive diabetic people having a low BP or a decline in BP was both associated with an increased risk of all-cause mortality, whereas development of incident hypertension increased the risk of cardiovascular events. PMID:27217407

  14. Estimating the Time-Varying Joint Effects of Obesity and Smoking on All-Cause Mortality Using Marginal Structural Models.

    PubMed

    Banack, Hailey R; Kaufman, Jay S

    2016-01-15

    Obesity and smoking are independently associated with a higher mortality risk, but previous studies have reported conflicting results about the relationship between these 2 time-varying exposures. Using prospective longitudinal data (1987-2007) from the Atherosclerosis Risk in Communities Study, our objective in the present study was to estimate the joint effects of obesity and smoking on all-cause mortality and investigate whether there were additive or multiplicative interactions. We fit a joint marginal structural Poisson model to account for time-varying confounding affected by prior exposure to obesity and smoking. The incidence rate ratios from the joint model were 2.00 (95% confidence interval (CI): 1.79, 2.24) for the effect of smoking on mortality among nonobese persons, 1.31 (95% CI: 1.13, 1.51) for the effect of obesity on mortality among nonsmokers, and 1.97 (95% CI: 1.73, 2.22) for the joint effect of smoking and obesity on mortality. The negative product term from the exponential model revealed a submultiplicative interaction between obesity and smoking (β = -0.28, 95% CI: -0.45, -0.11; P < 0.001). The relative excess risk of interaction was -0.34 (95% CI: -0.60, -0.07), indicating the presence of subadditive interaction. These results provide important information for epidemiologists, clinicians, and public health practitioners about the harmful impact of smoking and obesity. PMID:26656480

  15. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients.

    PubMed

    Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-02-01

    Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27-6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17-0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22-6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA during the first

  16. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients

    PubMed Central

    Kwon, Young Eun; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Park, Kyoung Sook; Lee, Mi Jung; Park, Jung Tak; Han, Seung H.; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-01-01

    Abstract Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27–6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17–0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22–6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA

  17. Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All-Cause Mortality in Kidney Transplant Recipients.

    PubMed

    Dahle, D O; Åsberg, A; Hartmann, A; Holdaas, H; Bachtler, M; Jenssen, T G; Dionisi, M; Pasch, A

    2016-01-01

    Calcification of the vasculature is associated with cardiovascular disease and death in kidney transplant recipients. A novel functional blood test measures calcification propensity by quantifying the transformation time (T50 ) from primary to secondary calciprotein particles. Accelerated T50 indicates a diminished ability of serum to resist calcification. We measured T50 in 1435 patients 10 weeks after kidney transplantation during 2000-2003 (first era) and 2009-2012 (second era). Aortic pulse wave velocity (APWV) was measured at week 10 and after 1 year in 589 patients from the second era. Accelerated T50 was associated with diabetes, deceased donor, first transplant, rejection, stronger immunosuppression, first era, higher serum phosphate and lower albumin. T50 was not associated with progression of APWV. During a median follow-up of 5.1 years, 283 patients died, 70 from myocardial infarction, cardiac failure or sudden death. In Cox regression models, accelerated T50 was strongly and independently associated with both all-cause and cardiac mortality, low versus high T50 quartile: hazard ratio 1.60 (95% confidence interval [CI] 1.00-2.57), ptrend   = 0.03, and 3.60 (95% CI 1.10-11.83), ptrend   = 0.02, respectively. In conclusion, calcification propensity (T50 ) was strongly associated with all-cause and cardiac mortality of kidney transplant recipients, potentially via a cardiac nonAPWV-related pathway. Whether therapeutic improvement of T50 improves outcome awaits clarification in a randomized trial. PMID:26375609

  18. All-Cause, Cardiovascular, and Cancer Mortality in Western Alaska Native People: Western Alaska Tribal Collaborative for Health (WATCH)

    PubMed Central

    Metzger, Jesse S.; Koller, Kathryn R.; Jolly, Stacey E.; Asay, Elvin D.; Wang, Hong; Wolfe, Abbie W.; Hopkins, Scarlett E.; Kaufmann, Cristiane; Raymer, Terry W.; Trimble, Brian; Provost, Ellen M.; Ebbesson, Sven O. E.; Austin, Melissa A.; Howard, William James; Umans, Jason G.; Boyer, Bert B.

    2014-01-01

    Objectives. We determined all-cause, cardiovascular disease (CVD), and cancer mortality in western Alaska Native people and examined agreement between death certificate information and adjudicated cause of deaths. Methods. Data from 4 cohort studies were consolidated. Death certificates and medical records were reviewed and adjudicated according to standard criteria. We compared adjudicated CVD and cancer deaths with death certificates by calculating sensitivity, specificity, predictive values, and κ statistics. Results. Men (n = 2116) and women (n = 2453), aged 18 to 95 years, were followed an average of 6.7 years. The major cause of death in men was trauma (25%), followed by CVD (19%) and cancer (13%). The major cause of death in women was CVD (24%), followed by cancer (19%) and trauma (8%). Stroke rates in both genders were higher than those of US Whites. Only 56% of deaths classified as CVD by death certificate were classified as CVD by standard criteria; discordance was higher among men (55%) than women (32%; κs = 0.4 and 0.7). Conclusions. We found lower rates for coronary heart disease death but high rates of stroke mortality. Death certificates overestimated CVD mortality; concordance between the 2 methods is better for cancer mortality. The results point to the importance of cohort studies in this population in providing data to assist in health care planning. PMID:24754623

  19. European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture.

    PubMed

    Medin, Emma; Goude, Fanny; Melberg, Hans Olav; Tediosi, Fabrizio; Belicza, Eva; Peltola, Mikko

    2015-12-01

    The objective of this study was to compare healthcare performance for the surgical treatment of hip fractures across and within Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. Differences in age-adjusted and sex-adjusted 30-day and one-year all-cause mortality rates following hip fracture, as well as the length of stay of the first hospital episode in acute care and during a follow up of 365 days, were investigated, and associations between selected country-level and regional-level factors with mortality and length of stay were assessed. Hungary showed the highest one-year mortality rate (mean 39.7%) and the lowest length of stay in one year (12.7 days), whereas Italy had the lowest one-year mortality rate (mean 19.1 %) and the highest length of stay (23.3 days). The observed variations were largely explained by country-specific effects rather than by regional-level factors. The results show that there should still be room for efficiency gains in the acute treatment of hip fracture, and clinicians, healthcare managers, and politicians should learn from best practices. This study demonstrates that an international comparison of acute hospital care is possible using pooled individual-level administrative data. PMID:26633868

  20. Losing Life and Livelihood: A Systematic Review and Meta-Analysis of Unemployment and All-Cause Mortality

    PubMed Central

    Roelfs, David J.; Shor, Eran; Davidson, Karina W.; Schwartz, Joseph E.

    2011-01-01

    Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random-effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late-career. The risk of death was highest during the first 10 years of follow up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors. PMID:21330027

  1. Relationship between body mass index reference and all-cause mortality: evidence from a large cohort of Thai adults.

    PubMed

    Yiengprugsawan, Vasoontara; Banwell, Cathy; Zhao, Jiaying; Seubsman, Sam-ang; Sleigh, Adrian C

    2014-01-01

    We investigate variation in body mass index (BMI) reference and 5-year all-cause mortality using data from 87151 adult Open University students nationwide. Analyses focused on BMI reference bands: "normal" (≥18.5 to <23), "lower normal" (≥18.5 to <20.75), "upper normal" (≥20.75 to <23), and "narrow Western normal" (≥23 to <25). We report hazard ratios (HR) and 95% Confidence Intervals adjusting for covariates. Compared to lower normal, adults aged 35-65 years who were obese (BMI ≥ 30) were twice as likely to die during the follow-up (HR 2.37; 1.01-5.70). For the same group, when using narrow Western normal as the reference, the results were similar (HR 3.02; 1.26-7.22). However, different combinations of BMI exposure and reference band produce quite different results. Older age persons belonging to Asian overweight BMI category (≥23 to <25) were relatively protected from mortality (HR 0.57; 0.34-0.96 and HR 0.49; 0.28-0.84) when assessed using normal (≥18.5 to <23) and upper normal (≥20.75 to <23) as reference bands. Use of different "normal" reference produced varying mortality relationships in a large cohort of Thai adults. Caution is needed when interpreting BMI-mortality data. PMID:25485146

  2. Association between Six Minute Walk Test and All-Cause Mortality, Coronary Heart Disease-Specific Mortality, and Incident Coronary Heart Disease

    PubMed Central

    Yazdanyar, Ali; Aziz, Michael M; Enright, Paul L; Edmundowicz, Daniel; Boudreau, Robert; Sutton-Tyrell, Kim; Kuller, Lewis; Newman, Anne B

    2015-01-01

    Objectives To examine the association between six-minute walk test (6 MWT) performance and all-cause mortality, coronary heart disease mortality, and incident coronary heart disease in older adults. Methods We conducted a time-to-event analysis of 1,665 Cardiovascular Health Study participants with a 6 MWT and without prevalent cardiovascular disease. Results During a mean follow-up of 8 years, there were 305 incident coronary heart disease events, 504 deaths of which 100 were coronary heart disease-related deaths. The 6 MWT performance in the shortest two distance quintiles was associated with increased risk of all-cause mortality (290-338 meters: HR 1.7; 95% CI, 1.2-2.5; <290 meters: HR 2.1; 95% CI, 1.4-3.0). The adjusted risk of coronary heart disease mortality incident events among those with a 6 MWT <290 meters was not significant. Discussion Performance on the 6 MWT is independently associated with all-cause mortality and is of prognostic utility in community-dwelling older adults. PMID:24695552

  3. The association of clinical indication for exercise stress testing with all-cause mortality: the FIT Project

    PubMed Central

    Kim, Joonseok; Al-Mallah, Mouaz; Juraschek, Stephen P.; Brawner, Clinton; Keteyian, Steve J.; Nasir, Khurram; Dardari, Zeina A.; Blumenthal, Roger S.

    2016-01-01

    Introduction We hypothesized that the indication for stress testing provided by the referring physician would be an independent predictor of all-cause mortality. Material and methods We studied 48,914 patients from The Henry Ford Exercise Testing Project (The FIT Project) without known congestive heart failure who were referred for a clinical treadmill stress test and followed for 11 ±4.7 years. The reason for stress test referral was abstracted from the clinical test order, and should be considered the primary concerning symptom or indication as stated by the ordering clinician. Hierarchical multivariable Cox proportional hazards regression was performed, after controlling for potential confounders including demographics, risk factors, and medication use as well as additional adjustment for exercise capacity in the final model. Results A total of 67% of the patients were referred for chest pain, 12% for shortness of breath (SOB), 4% for palpitations, 3% for pre-operative evaluation, 6% for abnormal prior testing, and 7% for risk factors only. There were 6,211 total deaths during follow-up. Compared to chest pain, those referred for palpitations (HR = 0.72, 95% CI: 0.60–0.86) and risk factors only (HR = 0.72, 95% CI: 0.63–0.82) had a lower risk of all-cause mortality, whereas those referred for SOB (HR = 1.15, 95% CI: 1.07–1.23) and pre-operative evaluation (HR = 2.11, 95% CI: 1.94–2.30) had an increased risk. In subgroup analysis, referral for palpitations was protective only in those without coronary artery disease (CAD) (HR = 0.75, 95% CI: 0.62–0.90), while SOB increased mortality risk only in those with established CAD (HR = 1.25, 95% CI: 1.10–1.44). Conclusions The indication for stress testing is an independent predictor of mortality, showing an interaction with CAD status. Importantly, SOB may be associated with higher mortality risk than chest pain, particularly in patients with CAD. PMID:27186173

  4. All-cause and Cardiovascular mortality among ethnic German immigrants from the Former Soviet Union: a cohort study

    PubMed Central

    Ronellenfitsch, Ulrich; Kyobutungi, Catherine; Becher, Heiko; Razum, Oliver

    2006-01-01

    Background Migration is a phenomenon of particular Public Health importance. Since 1990, almost 2 million ethnic Germans (Aussiedler) have migrated from the former Soviet Union (FSU) to Germany. This study compares their overall and cardiovascular disease (CVD) mortality to that of Germany's general population. Because of high overall and CVD mortality in the FSU and low socio-economic status of Aussiedler in Germany, we hypothesize that their mortality is higher. Methods We conducted a retrospective cohort study for 1990–2002 with data of 34,393 Aussiedler. We assessed vital status at population registries and causes of death at the state statistical office. We calculated standardized mortality ratios (SMRs) for the whole cohort and substrata of covariables such as age, sex and family size. To assess multivariate effects, we used Poisson regression. Results 1657 cohort members died before December 31, 2002, and 680 deaths (41.03%) were due to CVD. The SMR for the whole cohort was 0.85 (95%-CI 0.81–0.89) for all causes of death and 0.79 (95%-CI 0.73–0.85) for CVD. SMRs were higher than one for younger Aussiedler and lower for older ones. There was no clear effect of duration of stay on SMRs. For 1990–93, SMRs were significantly lower than in subsequent years. In families comprising at least five members upon arrival in Germany, SMRs were significantly lower than in smaller families. Conclusion In contrast to our hypothesis on migrants' health, overall and CVD mortality among Aussiedler is lower than in Germany's general population. Possible explanations are a substantially better health status of Aussiedler in the FSU as compared to the local average, a higher perceived socio-economic status of Aussiedler in Germany, or selection effects. SMR differences between substrata need further exploration, and risk factor data are needed. PMID:16438727

  5. Soy and Soy Products Intake, All-Cause Mortality, and Cause-Specific Mortality in Japan: The Jichi Medical School Cohort Study.

    PubMed

    Yamasaki, Kyoko; Kayaba, Kazunori; Ishikawa, Shizukiyo

    2015-07-01

    Soy and soy products are popular ingredients in the Japanese diet. This study aimed to determine whether soy or soy products intake was associated with all-cause mortality in a community-based cohort in Japan. A total of 11 066 participants were obtained from an annual community-based health examination program. A self-administered questionnaire was used to collect information concerning soy and soy products intake and potential confounding factors. Associations between soy and soy products intake and all-cause mortality were assessed using hazard ratios (HRs). After adjusting for all factors, morality was significantly higher in men with infrequent soy intake (HR = 1.53; 95% confidence interval [CI] = 1.13-2.07) and with almost daily intake (HR = 1.55; 95% CI = 1.19-2.03) compared with intake 1 to 2 times per week. Cancer mortality was higher among men who reported rarely eating soy (HR = 1.74; 95% CI = 1.08-2.79). Soy products intake was not statistically significantly associated with all-cause mortality in both sexes. PMID:24958613

  6. Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort

    PubMed Central

    Marshall, Nathaniel S.; Wong, Keith K.H.; Cullen, Stewart R.J.; Knuiman, Matthew W.; Grunstein, Ronald R.

    2014-01-01

    Objective: To ascertain whether objectively measured obstructive sleep apnea (OSA) independently increases the risk of all cause death, cardiovascular disease (CVD), coronary heart disease (CHD), stroke or cancer Design: Community-based cohort Setting and Participants: 400 residents of the Western Australian town of Busselton Measures: OSA severity was quantified via the respiratory disturbance index (RDI) as measured by a single night recording in November-December 1990 using the MESAM IV device, along with a range of other risk factors. Follow-up for deaths and hospitalizations was ascertained via record linkage to the end of 2010. Results: We had follow-up data in 397 people and then removed those with a previous stroke (n = 4) from the mortality/ CVD/CHD/stroke analyses and those with cancer history from the cancer analyses (n = 7). There were 77 deaths, 103 cardiovascular events (31 strokes, 59 CHD) and 125 incident cases of cancer (39 cancer fatalities) during 20 years follow-up. In fully adjusted models, moderate-severe OSA was significantly associated with all-cause mortality (HR = 4.2; 95% CI 1.9, 9.2), cancer mortality (3.4; 1.1, 10.2), incident cancer (2.5; 1.2, 5.0), and stroke (3.7; 1.2, 11.8), but not significantly with CVD (1.9; 0.75, 4.6) or CHD incidence (1.1; 0.24, 4.6). Mild sleep apnea was associated with a halving in mortality (0.5; 0.27, 0.99), but no other outcome, after control for leading risk factors. Conclusions: Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality, incident stroke, and cancer incidence and mortality in this community-based sample. Commentary: A commentary on this article appears in this issue on page 363. Citation: Marshall NS; Wong KK; Cullen SR; Knuiman MW; Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, and cancer incidence and mortality in the Busselton health study cohort. J Clin Sleep Med 2014;10(4):355-362. PMID:24733978

  7. Low all-cause mortality despite high cardiovascular risk in elderly Greek-born Australians: attenuating potential of diet?

    PubMed

    Kouris-Blazos, Antigone; Itsiopoulos, Catherine

    2014-01-01

    Elderly Greek-born Australians (GA) consistently show lower rates of all-cause and CVD mortality compared with Australian-born. Paradoxically, however, this is in spite of a higher prevalence of CVD risk factors. This paper reviews the findings from the Food Habits in Later Life (FHILL) study, other studies on Greek migrants to Australia and clinical studies investigating dietary mechanisms which may explain the "morbidity mortality paradox". The FHILL study collected data between 1988 and 1991 on diet, health and psycho-social variables on 818 people aged 70 and over from Sweden, Greece, Australia (Greeks and Anglo-Celts), Japan and were followed up for 5-7 years to determine survival status. The FHILL study was the first to develop a score which captured the key features of a traditional plant-based Mediterranean diet pattern (MDPS). A higher score improved overall survival in both Greek and non-Greek elderly reducing the risk of death by 50% after 5-7 years. Of the 5 cohorts studied, elderly GA had the lowest risk of death, even though they had the highest rates of obesity and other CVD risk factors (developed in the early years of migration with the introduction of energy dense foods). GA appeared to be "getting away" with these CVD risk factors because of their continued adherence in old age to a Mediterranean diet, especially legumes. We propose that the Mediterranean diet may, in part, be operating to reduce the risk of death and attenuate established CVD risk factors in GA by beneficially altering the gut microbiome and its metabolites. PMID:25516310

  8. Risk of All-Cause and Prostate Cancer-Specific Mortality After Brachytherapy in Men With Small Prostate Size

    SciTech Connect

    Nguyen, Paul L.; Chen, Ming H.; Choueiri, Toni K.; Hoffman, Karen E.; Hu, Jim C.; Martin, Neil E.; Beard, Clair J.; Dosoretz, Daniel E.; Moran, Brian J.; Katin, Michael J.; Braccioforte, Michelle H.; Ross, Rudi; Salenius, Sharon A.; Kantoff, Philip W.; D'Amico, Anthony V.

    2011-04-01

    Background: Brachytherapy for prostate cancer can be technically challenging in men with small prostates ({<=}20 cc), but it is unknown whether their outcomes are different than those of men with larger prostates. Methods and Materials: We studied 6,416 men treated with brachytherapy in one of 21 community-based practices. Cox regression and Fine and Gray's regression were used to determine whether volume {<=}20 cc was associated with a higher risk of all-cause mortality (ACM) or prostate cancer-specific mortality (PCSM), respectively, after adjustment for other known prognostic factors. Results: 443 patients (6.9%) had a prostate volume {<=}20 cc. After a median follow-up of 2.91 years (interquartile range, 1.06-4.79), volume {<=}20 cc was associated with a significantly higher risk of ACM (adjusted hazard ratio = 1.33 [95% CI 1.08-1.65], p = 0.0085) with 3-year estimates of ACM for {<=}20 cc vs. >20 cc of 13.0% vs. 6.9% (p = 0.028). Only 23 men (0.36%) have died of prostate cancer, and no difference was seen in PCSM by volume (p = 0.4). Conclusion: Men with small prostates at the time of implant had a 33% higher risk of ACM, and the underlying cause of this remains uncertain. No increase in PCSM was observed in men with volume {<=}20cc, suggesting that a small prostate should not in itself be a contraindication for brachytherapy, but inasmuch as absolute rates of PCSM were small, further follow-up will be needed to confirm this finding.

  9. Time Trends in Incidence and Mortality of Acute Myocardial Infarction, and All-Cause Mortality following a Cardiovascular Prevention Program in Sweden

    PubMed Central

    Journath, Gunilla; Hammar, Niklas; Elofsson, Stig; Linnersjö, Anette; Vikström, Max; Walldius, Göran; Krakau, Ingvar; Lindgren, Peter; de Faire, Ulf; Hellénius, Mai-Lis

    2015-01-01

    Background In 1988, a cardiovascular prevention program which combined an individual and a population-based strategy was launched within primary health-care in Sollentuna, a municipality in Stockholm County. The aim of this study was to investigate time trends in the incidence of and mortality from acute myocardial infarction and all-cause mortality in Sollentuna compared with the rest of Stockholm County during a period of two decades following the implementation of a cardiovascular prevention program. Materials and Methods The average population in Sollentuna was 56,589 (49% men) and in Stockholm County (Sollentuna included) 1,795,504 (49% men) during the study period of 1987–2010. Cases of hospitalized acute myocardial infarction and death were obtained for the population of Sollentuna and the rest of Stockholm County using national registries of hospital discharges and deaths. Acute myocardial infarction incidence and mortality were estimated using the average population of Sollentuna and Stockholm in 1987–2010. Results During the observation period, the incidence of acute myocardial infarction decreased more in Sollentuna compared with the rest of Stockholm County in women (-22% vs. -7%; for difference in slope <0.05). There was a trend towards a greater decline in Sollentuna compared to the rest of Stockholm County in the incidence of acute myocardial infarction (in men), acute myocardial mortality, and all-cause mortality but the differences were not significant. Conclusion During a period of steep decline in acute myocardial infarction incidence and mortality in Stockholm County the municipality of Sollentuna showed a stronger trend in women possibly compatible with favorable influence of a cardiovascular prevention program. Trial Registration ClinicalTrials.gov NCT02212145 PMID:26580968

  10. Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies

    PubMed Central

    Olofin, Ibironke; McDonald, Christine M.; Ezzati, Majid; Flaxman, Seth; Black, Robert E.; Fawzi, Wafaie W.; Caulfield, Laura E.; Danaei, Goodarz

    2013-01-01

    Background Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies. Methods Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (−2≤Z<−1), moderate (−3≤Z<−2), or severe (Z<−3) anthropometric deficits with the reference category (Z≥−1). Results 53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality. Conclusions All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases

  11. Trends in child mortality in India.

    PubMed

    Behl, A S

    2013-01-01

    To assess Indias recent trends in child mortality rates and disparities and identify ways to reduce child mortality and wealth-related health disparities, we analyzed three years of data from Indias National Family Health Survey related to child mortality. Nationally, declines in average child mortality were statistically significant, but declines in inequality were not. Urban areas had lower child mortality rates than rural areas but higher inequalities. Interstate differences in child mortality rates were significant, with rates in the highest-mortality states four to six times higher than in the lowest-mortality states. However, child mortality in most states declined. PMID:23396786

  12. Association Between Physical Activity and Risk of All-Cause Mortality and Cardiovascular Disease in Patients With Diabetes

    PubMed Central

    Kodama, Satoru; Tanaka, Shiro; Heianza, Yoriko; Fujihara, Kazuya; Horikawa, Chika; Shimano, Hitoshi; Saito, Kazumi; Yamada, Nobuhiro; Ohashi, Yasuo; Sone, Hirohito

    2013-01-01

    OBJECTIVE The association between habitual physical activity (PA) and lowered risk of all-cause mortality (ACM) and cardiovascular disease (CVD) has been suggested in patients with diabetes. This meta-analysis summarizes the risk reduction in relation to PA, focusing on clarifying dose-response associations. RESEARCH DESIGN AND METHODS Electronic literature searches were conducted for cohort studies that examined relative risk (RR) of ACM or CVD in relation to PA in patients with diabetes. For the qualitative assessment, RR for the highest versus the lowest PA category in each study was pooled with a random-effects model. We added linear and spline regression analyses to assess the quantitative relationship between increases in PA and ACM and CVD risk. RESULTS There were 17 eligible studies. Qualitatively, the highest PA category had a lower RR [95% CI] for ACM (0.61 [0.52–0.70]) and CVD (0.71 [0.60–0.84]) than the lowest PA category. The linear regression model indicated a high goodness of fit for the risk of ACM (adjusted R2 = 0.44, P = 0.001) and CVD (adjusted R2 = 0.51, P = 0.001), with the result that a 1 MET-h/day incrementally higher PA was associated with 9.5% (5.0–13.8%) and 7.9% (4.3–11.4%) reductions in ACM and CVD risk, respectively. The spline regression model was not significantly different from the linear model in goodness of fit (P = 0.14 for ACM risk; P = 0.60 for CVD risk). CONCLUSIONS More PA was associated with a larger reduction in future ACM and CVD risk in patients with diabetes. Nevertheless, any amount of habitual PA was better than inactivity. PMID:23349151

  13. Apolipoprotein E Epsilon 4 Allele Interacts with Sex and Cognitive Status to Influence All-Cause and Cause-Specific Mortality Among US Older Adults

    PubMed Central

    Beydoun, May A.; Beydoun, Hind A.; Kaufman, Jay S.; An, Yang; Resnick, Susan M.; O'Brien, Richard; Ferrucci, Luigi; Zonderman, Alan B.

    2012-01-01

    Background Apolipoprotein E ε4 (ApoE4 carrier) status, sex and cognitive impairment may interact to affect all-cause and cause-specific mortality risk. Objectives To confirm associations of ApoE4 carrier status, sex and time-dependent cognitive status with mortality risk, and investigate these associations' joint effects in a cohort of community-dwelling US adults. Design & Setting Data from the Baltimore Longitudinal Study of Aging were used. Participants Of n=3,047 (First-visit Age:17–98y, 60.1% men), we selected a sample with complete genetic data and with ≥1 visit at age≥50y (n=1,461). Measurements Time-to-death from all, cardiovascular or non-cardiovascular causes. Results Survival probability was lower for ApoE4 carriers, particularly at oldest ages. Cox proportional hazards model for all-cause mortality yielded a hazard ratio (HR) for ApoE4 carrier vs. non-carriers of 1.31,95%CI:1.02–1.68. This association was also found for cardiovascular mortality. Time-dependent all-cause dementia (HR=1.73, 95%CI:1.33–2.26) and mild cognitive impairment (HR=1.95,95%CI:1.42–2.67) increased all-cause mortality risk, associations also detected for non-cardiovascular mortality. When individuals were free of cognitive impairment, a dose-response relationship with ε4 alleles was found for all-cause mortality (HR=1.40,95%CI:0.94–2.07 for 1 ε4, and HR=2.61; 95%CI:1.12–6.07 for 2 ε4). After Alzheimer's Disease-type (AD) dementia onset, carrying only 1 ε4 allele increased all-cause mortality risk by ~77% compared to non-carriers. ApoE4 carrier status increased all-cause mortality risk in men and interacted with time-dependent AD to increase the risk of this outcome (RERI=2.15; 95% CI:1.22–3.07). Conclusion We found that ApoE4 carrier status increased all-cause and cardiovascular mortality risks, while interacting with sex and time-dependent AD status to affect all-cause mortality. PMID:23581910

  14. Occupational Class Inequalities in All-Cause and Cause-Specific Mortality among Middle-Aged Men in 14 European Populations during the Early 2000s

    PubMed Central

    Toch-Marquardt, Marlen; Menvielle, Gwenn; Eikemo, Terje A.; Kulhánová, Ivana; Kulik, Margarete C.; Bopp, Matthias; Esnaola, Santiago; Jasilionis, Domantas; Mäki, Netta; Martikainen, Pekka; Regidor, Enrique; Lundberg, Olle; Mackenbach, Johan P.

    2014-01-01

    This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000–2005, were used. Analyses concerned men aged 30–59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD), all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF). Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France) also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark). Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations. PMID:25268702

  15. Associations Between the Serum Metabolome and All-Cause Mortality Among African Americans in the Atherosclerosis Risk in Communities (ARIC) Study.

    PubMed

    Yu, Bing; Heiss, Gerardo; Alexander, Danny; Grams, Morgan E; Boerwinkle, Eric

    2016-04-01

    Early and accurate identification of people at high risk of premature death may assist in the targeting of preventive therapies in order to improve overall health. To identify novel biomarkers for all-cause mortality, we performed untargeted metabolomics in the Atherosclerosis Risk in Communities (ARIC) Study. We included 1,887 eligible ARIC African Americans, and 671 deaths occurred during a median follow-up period of 22.5 years (1987-2011). Chromatography and mass spectroscopy identified and quantitated 204 serum metabolites, and Cox proportional hazards models were used to analyze the longitudinal associations with all-cause and cardiovascular mortality. Nine metabolites, including cotinine, mannose, glycocholate, pregnendiol disulfate, α-hydroxyisovalerate, N-acetylalanine, andro-steroid monosulfate 2, uridine, and γ-glutamyl-leucine, showed independent associations with all-cause mortality, with an average risk change of 18% per standard-deviation increase in metabolite level (P < 1.23 × 10(-4)). A metabolite risk score, created on the basis of the weighted levels of the identified metabolites, improved the predictive ability of all-cause mortality over traditional risk factors (bias-corrected Harrell's C statistic 0.752 vs. 0.730). Mannose and glycocholate were associated with cardiovascular mortality (P < 1.23 × 10(-4)), but predictive ability was not improved beyond the traditional risk factors. This metabolomic analysis revealed potential novel biomarkers for all-cause mortality beyond the traditional risk factors. PMID:26956554

  16. Elevated Circulating Osteoprotegerin and Renal Dysfunction Predict 15-Year Cardiovascular and All-Cause Mortality: A Prospective Study of Elderly Women

    PubMed Central

    Zhu, Kun; Lim, Ee M.; Bollerslev, Jens; Prince, Richard L.

    2015-01-01

    Background Data on the predictive role of estimated glomerular filtration rate (eGFR) and osteoprotegerin (OPG) for cardiovascular (CVD) and all-cause mortality risk have been presented by our group and others. We now present data on the interactions between OPG with stage I to III chronic kidney disease (CKD) for all-cause and CVD mortality. Methods and Results The setting was a 15-year study of 1,292 women over 70 years of age initially randomized to a 5-year controlled trial of 1.2 g of calcium daily. Serum OPG and creatinine levels with complete mortality records obtained from the Western Australian Data Linkage System were available. Interactions were detected between OPG levels and eGFR for both CVD and all-cause mortality (P < 0.05). Compared to participants with eGFR ≥60ml/min/1.73m2 and low OPG, participants with eGFR of <60ml/min/1.73m2 and elevated OPG had a 61% and 75% increased risk of all-cause and CVD mortality respectively (multivariate-adjusted HR, 1.61; 95% CI, 1.27-2.05; P < 0.001 and HR, 1.75; 95% CI, 1.22-2.55; P = 0.003). This relationship with mortality was independent of decline in renal function (P<0.05). Specific causes of death in individuals with elevated OPG and stage III CKD highlighted an excess of coronary heart disease, renal failure and chronic obstructive pulmonary disease deaths (P < 0.05). Conclusion The association between elevated OPG levels with CVD and all-cause mortality was more evident in elderly women with poorer renal function. Assessment of OPG in the context of renal function may be important in studies investigating its relationship with all-cause and CVD mortality. PMID:26222774

  17. Serum Anion Gap Predicts All-Cause Mortality in Patients with Advanced Chronic Kidney Disease: A Retrospective Analysis of a Randomized Controlled Study

    PubMed Central

    Lee, Sung Woo; Kim, Sejoong; Na, Ki Young; Cha, Ran-hui; Kang, Shin Wook; Park, Cheol Whee; Cha, Dae Ryong; Kim, Sung Gyun; Yoon, Sun Ae; Han, Sang Youb; Park, Jung Hwan; Chang, Jae Hyun; Lim, Chun Soo; Kim, Yon Su

    2016-01-01

    Background and Objectives Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified. Methods A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15–60 mL/min/1.73m2. Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality. Results Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0–5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520–0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143–7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG. Conclusions A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed. Trial Registration Clinicaltrials.gov NCT 00860431 PMID:27249416

  18. The Pretreatment Neutrophil/Lymphocyte Ratio Is Associated with All-Cause Mortality in Black and White Patients with Non-metastatic Breast Cancer

    PubMed Central

    Rimando, Joseph; Campbell, Jeff; Kim, Jae Hee; Tang, Shou-Ching; Kim, Sangmi

    2016-01-01

    The pretreatment neutrophil/lymphocyte ratio (NLR), derived from differential white blood cell counts, has been previously associated with poor prognosis in breast cancer. Little data exist, however, concerning this association in Black patients, who are known to have lower neutrophil counts than other racial groups. We conducted a retrospective cohort study of 236 Black and 225 non-Hispanic White breast cancer patients treated at a single institution. Neutrophil and lymphocyte counts were obtained from electronic medical records. Univariate and multivariate Cox regression models were used to determine hazard ratios (HRs) and 95% confidence intervals (95% CIs) of all-cause mortality and breast cancer-specific mortality in relation to pretreatment NLR. Overall, there were no associations between an elevated pretreatment NLR (NLR ≥3.7) and all-cause or breast cancer-specific mortality. Among patients without metastasis at the time of diagnosis, an elevated pretreatment NLR was independently associated with all-cause mortality, with a multivariable HR of 2.31 (95% CI: 1.10–4.86). Black patients had significantly lower NLR values than White patients, but there was no evidence suggesting racial heterogeneity of the prognostic utility of NLR. Pretreatment NLR was an independent predictor of all-cause mortality but not breast cancer-specific mortality in non-metastatic breast cancer patients. PMID:27064712

  19. Short-term effect of dust storms on the risk of mortality due to respiratory, cardiovascular and all-causes in Kuwait

    NASA Astrophysics Data System (ADS)

    Al-Taiar, Abdullah; Thalib, Lukman

    2014-01-01

    This study aimed to investigate the impact of dust storms on short-term mortality in Kuwait. We analyzed respiratory and cardiovascular mortality as well as all-cause mortality in relation to dust storm events over a 5-year study period, using data obtained through a population-based retrospective ecological time series study. Dust storm days were identified when the national daily average of PM10 exceeded 200 μg/m3. Generalized additive models with Poisson link were used to estimate the relative risk (RR) of age-stratified daily mortality associated with dust events, after adjusting for potential confounders including weather variables and long-term trends. There was no significant association between dust storm events and same-day respiratory mortality (RR = 0.96; 95 %CI 0.88-1.04), cardiovascular mortality (RR = 0.98; 95 %CI 0.96-1.012) or all-cause mortality (RR = 0.99; 95 %CI 0.97-1.00). Overall our findings suggest that local dust, that most likely originates from crustal materials, has little impact on short-term respiratory, cardiovascular or all-cause mortality.

  20. Short-term effect of dust storms on the risk of mortality due to respiratory, cardiovascular and all-causes in Kuwait.

    PubMed

    Al-Taiar, Abdullah; Thalib, Lukman

    2014-01-01

    This study aimed to investigate the impact of dust storms on short-term mortality in Kuwait. We analyzed respiratory and cardiovascular mortality as well as all-cause mortality in relation to dust storm events over a 5-year study period, using data obtained through a population-based retrospective ecological time series study. Dust storm days were identified when the national daily average of PM10 exceeded 200 μg/m(3). Generalized additive models with Poisson link were used to estimate the relative risk (RR) of age-stratified daily mortality associated with dust events, after adjusting for potential confounders including weather variables and long-term trends. There was no significant association between dust storm events and same-day respiratory mortality (RR = 0.96; 95%CI 0.88-1.04), cardiovascular mortality (RR = 0.98; 95%CI 0.96-1.012) or all-cause mortality (RR = 0.99; 95%CI 0.97-1.00). Overall our findings suggest that local dust, that most likely originates from crustal materials, has little impact on short-term respiratory, cardiovascular or all-cause mortality. PMID:23329278

  1. All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997–2010

    PubMed Central

    2013-01-01

    Background Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIV-infected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 person-years (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997–2003). Conclusion Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection. PMID:23961924

  2. Are Sitting Occupations Associated with Increased All-Cause, Cancer, and Cardiovascular Disease Mortality Risk? A Pooled Analysis of Seven British Population Cohorts

    PubMed Central

    Stamatakis, Emmanuel; Chau, Josephine Y.; Pedisic, Zeljko; Bauman, Adrian; Macniven, Rona; Coombs, Ngaire; Hamer, Mark

    2013-01-01

    Background There is mounting evidence for associations between sedentary behaviours and adverse health outcomes, although the data on occupational sitting and mortality risk remain equivocal. The aim of this study was to determine the association between occupational sitting and cardiovascular, cancer and all-cause mortality in a pooled sample of seven British general population cohorts. Methods The sample comprised 5380 women and 5788 men in employment who were drawn from five Health Survey for England and two Scottish Health Survey cohorts. Participants were classified as reporting standing, walking or sitting in their work time and followed up over 12.9 years for mortality. Data were modelled using Cox proportional hazard regression adjusted for age, waist circumference, self-reported general health, frequency of alcohol intake, cigarette smoking, non-occupational physical activity, prevalent cardiovascular disease and cancer at baseline, psychological health, social class, and education. Results In total there were 754 all-cause deaths. In women, a standing/walking occupation was associated with lower risk of all-cause (fully adjusted hazard ratio [HR] = 0.68, 95% CI 0.52–0.89) and cancer (HR = 0.60, 95% CI 0.43–0.85) mortality, compared to sitting occupations. There were no associations in men. In analyses with combined occupational type and leisure-time physical activity, the risk of all-cause mortality was lowest in participants with non-sitting occupations and high leisure-time activity. Conclusions Sitting occupations are linked to increased risk for all-cause and cancer mortality in women only, but no such associations exist for cardiovascular mortality in men or women. PMID:24086292

  3. Whole-grain consumption and the risk of all-cause, CVD and cancer mortality: a meta-analysis of prospective cohort studies.

    PubMed

    Wei, Honglei; Gao, Zong; Liang, Rui; Li, Zengqiang; Hao, Hong; Liu, Xu

    2016-08-01

    Results of the relationships between dietary whole-grain consumption and the risk of all-cause, CVD and cancer-specific mortality are mixed. We summarised the evidence based on a meta-analysis of prospective cohort studies. Pertinent studies were identified by searching articles in the MEDLINE and EMBASE databases up to 20 January 2016 and by reviewing the reference lists of the retrieved articles. Random-effects models were used to calculate summary relative risks (SRR) and 95 % CI. In all, eleven prospective studies (ten publications) were included in the meta-analysis. There were a total of 816 599 subjects and 89 251 cases of all-cause mortality. On the basis of the highest v. the lowest categories of intake, whole grains may be associated with a lower risk of mortality from all causes (SRR 0·87; 95 % CI 0·84, 0·90), CVD (SRR 0·81; 95 % CI 0·75, 0·89) and all cancers (SRR 0·89; 95 % CI 0·82, 0·96). For each 3 servings/d increase in whole-grain intake, there was a 19 % reduction in the risk of all-cause mortality (SRR 0·81; 95 % CI 0·76, 0·85), a 26 % reduction in CVD mortality (SRR 0·74; 95 % CI 0·66, 0·83) and a 9 % reduction in cancer mortality (SRR 0·91; 95 % CI 0·84, 0·98). The current meta-analysis provides some evidence that high intake of whole grains was inversely associated with the risk of all-cause, CVD and cancer-specific mortality. Further well-designed studies, including clinical trials and in different populations, are required to confirm our findings. PMID:27215285

  4. The usefulness of age and sex to predict all-cause mortality in patients with dilated cardiomyopathy: a single-center cohort study

    PubMed Central

    Li, Xiaoping; Cai, Chi; Luo, Rong; Jiang, Rongjian; Zeng, Jie; Tang, Yijia; Chen, Yang; Fu, Michael; He, Tao; Hua, Wei

    2015-01-01

    Objective Recent studies have shown that sex and age are associated with outcomes in patients with cardiomyopathy. The purpose of this study was to determine the all-cause mortality of dilated cardiomyopathy (DCM) by age and sex. Methods and results The patients were divided into non-elderly (age <60 years, n=811) and elderly (age ≥60 years, n=331) groups. No difference in the all-cause mortality rate was observed between elderly and non-elderly patients (27.2% vs 22.2%, log-rank χ2=2.604, P=0.107). Furthermore, no significant difference in mortality was observed between the male and female patients (23.3% vs 24.5%, log-rank χ2=0.707, P=0.400). However, subgroup analysis revealed that elderly male patients exhibited a higher mortality rate than non-elderly male patients (29.4% vs 21.3%, log-rank χ2=5.898, P=0.015), while no difference was observed between the elderly female patients and non-elderly female patients. In the Cox analysis, neither age nor sex was a significant independent predictor of all-cause mortality in patients with DCM. Conclusion In conclusion, no significant difference in mortality between male and female patients or between the elderly and non-elderly patients was observed. Only among males was a difference in mortality observed; elderly male patients experienced greater mortality than that of non-elderly male patients. No effect of age or sex on all-cause mortality was observed in patients with DCM. PMID:26396507

  5. Cereal fibre intake and risk of mortality from all causes, CVD, cancer and inflammatory diseases: a systematic review and meta-analysis of prospective cohort studies.

    PubMed

    Hajishafiee, Maryam; Saneei, Parvane; Benisi-Kohansal, Sanaz; Esmaillzadeh, Ahmad

    2016-07-01

    Dietary fibre intake has been associated with a lower risk of mortality; however, findings on the association of different sources of dietary fibre with mortality are conflicting. We performed a systematic review and meta-analysis of the prospective cohort studies to assess the relation between cereal fibre intake and cause-specific mortality. Medline/PubMed, SCOPUS, EMBASE, ISI web of Science and Google scholar were searched up to April 2015. Eligible prospective cohort studies were included if they provided hazard ratios (HR) or relative risks (RR) and corresponding 95 % CI for the association of cereal fibre intake and mortality from all causes, CVD, cancer and inflammatory diseases. The study-specific HR were pooled by using the random-effects model. In total, fourteen prospective studies that examined the association of cereal fibre intake with mortality from all causes (n 48 052 death), CVD (n 16 882 death), cancer (n 19 489 death) and inflammatory diseases (n 1092 death) were included. The pooled adjusted HR of all-cause mortality for the highest v. the lowest category of cereal fibre intake was 0·81 (95 % CI 0·79, 0·83). Consumption of cereal fibre intake was associated with an 18 % lower risk of CVD mortality (RR 0·82; 95 % CI 0·78, 0·86). Moreover, an inverse significant association was observed between cereal fibre intake and risk of death from cancer (RR 0·85; 95 % CI 0·81, 0·89). However, no significant association was seen between cereal fibre intake and inflammation-related mortality. This meta-analysis provides further evidence that cereal fibre intake was protectively associated with mortality from all causes, CVD and cancer. PMID:27193606

  6. Association of resting heart rate and hypertension stages on all-cause and cardiovascular mortality among elderly Koreans: the Kangwha Cohort Study

    PubMed Central

    Ryu, Mikyung; Bayasgalan, Gombojav; Kimm, Heejin; Nam, Chung Mo; Ohrr, Heechoul

    2016-01-01

    Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined effect on mortality in stages of hypertension according to updated clinical guidelines among elderly population is unclear. Methods We followed a cohort of 6100 residents (2600 males and 3500 females) of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits (to 1991), and were confirmed by death record matching with the National Statistical Office (1992−2005). Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee criteria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate > 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61–79 beats/min, with hazard ratios values of 1.43 (95% CI: 1.00−1.92) on all-cause mortality for prehypertension, 3.01 (95% CI: 1.07–8.28) on cardiovascular mortality for prehypertension, and 8.34 (95% CI: 2.52−28.19) for stage 2 hypertension. Increased risk (HR: 3.54, 95% CI: 1.16–9.21) was observed among those with both a resting heart rate ≥ 80 beats/min and prehypertension on cardiovascular mortality in women. Conclusions Individuals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovascular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients. PMID:27605937

  7. Daytime Napping and the Risk of Cardiovascular Disease and All-Cause Mortality: A Prospective Study and Dose-Response Meta-Analysis

    PubMed Central

    Yamada, Tomohide; Hara, Kazuo; Shojima, Nobuhiro; Yamauchi, Toshimasa; Kadowaki, Takashi

    2015-01-01

    Study Objectives: To summarize evidence about the association between daytime napping and the risk of cardiovascular disease and all-cause mortality, and to quantify the potential dose-response relation. Design: Meta-analysis of prospective cohort studies. Methods and Results: Electronic databases were searched for articles published up to December 2014 using the terms nap, cardiovascular disease, and all-cause mortality. We selected well-adjusted prospective cohort studies reporting risk estimates for cardiovascular disease and all-cause mortality related to napping. Eleven prospective cohort studies were identified with 151,588 participants (1,625,012 person-years) and a mean follow-up period of 11 years (60% women, 5,276 cardiovascular events, and 18,966 all-cause deaths). Pooled analysis showed that a long daytime nap (≥ 60 min/day) was associated with a higher risk of cardiovascular disease (rate ratio [RR]: 1.82 [1.22–2.71], P = 0.003, I2 = 37%) compared with not napping. All-cause mortality was associated with napping for ≥ 60 min/day (RR: 1.27 [1.11–1.45], P < 0.001, I2 = 0%) compared with not napping. In contrast, napping for < 60 min/day was not associated with cardiovascular disease (P = 0.98) or all-cause mortality (P = 0.08). Meta-analysis demonstrated a significant J-curve dose-response relation between nap time and cardiovascular disease (P for nonlinearity = 0.01). The RR initially decreased from 0 to 30 min/day. Then it increased slightly until about 45 min/day, followed by a sharp increase at longer nap times. There was also a positive linear relation between nap time and all-cause mortality (P for non-linearity = 0.97). Conclusions: Nap time and cardiovascular disease may be associated via a J-curve relation. Further studies are needed to confirm the efficacy of a short nap. Citation: Yamada T, Hara K, Shojima N, Yamauchi T, Kadowaki T. Daytime napping and the risk of cardiovascular disease and all-cause mortality: a prospective study and

  8. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease

    PubMed Central

    Raj Krishnamurthy, Vidya M.; Wei, Guo; Baird, Bradley C.; Murtaugh, Maureen; Chonchol, Michel B.; Raphael, Kalani L.; Greene, Tom; Beddhu, Srinivasan

    2016-01-01

    Chronic kidney disease is considered an inflammatory state and a high fiber intake is associated with decreased inflammation in the general population. Here, we determined whether fiber intake is associated with decreased inflammation and mortality in chronic kidney disease, and whether kidney disease modifies the associations of fiber intake with inflammation and mortality. To do this, we analyzed data from 14,543 participants in the National Health and Nutrition Examination Survey III. The prevalence of chronic kidney disease (estimated glomerular filtration rate less than 60 ml/min per 1.73 m2) was 5.8%. For each 10-g/day increase in total fiber intake, the odds of elevated serum C-reactive protein levels were decreased by 11% and 38% in those without and with kidney disease, respectively. Dietary total fiber intake was not significantly associated with mortality in those without but was inversely related to mortality in those with kidney disease. The relationship of total fiber with inflammation and mortality differed significantly in those with and without kidney disease. Thus, high dietary total fiber intake is associated with lower risk of inflammation and mortality in kidney disease and these associations are stronger in magnitude in those with kidney disease. Interventional trials are needed to establish the effects of fiber intake on inflammation and mortality in kidney disease. PMID:22012132

  9. Incidence of All-Cause and Cardiovascular Mortality Predicted by Symmetric Dimethylarginine in the Population-Based Study of Health in Pomerania

    PubMed Central

    Schwedhelm, Edzard; Wallaschofski, Henri; Atzler, Dorothee; Dörr, Marcus; Nauck, Matthias; Völker, Uwe; Kroemer, Heyo K.; Völzke, Henry; Böger, Rainer H.; Friedrich, Nele

    2014-01-01

    Background L-Arginine and its dimethylated derivatives asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) have been associated with cardiovascular (CV) and all-cause mortality in populations at risk. The present study aimed to investigate the prognostic value of L-arginine and its derivatives in the general population. Methods and Results We evaluated 3,952 individuals (1,936 men and 2,016 women) aged 20–81 (median (IQR) 51 (37; 64) years) from the population-based Study of Health in Pomerania (SHIP). Associations of continuous [per standard deviation (SD) increase] and categorized (age- and sex-specific tertiles) serum L-arginine, ADMA, and SDMA concentrations with all-cause and cause-specific mortality were analysed. During a median (IQR) follow-up period of 10.1 (9.3; 10.8) years (38,476 person-years), 426 deaths (10.8%) were observed, including 139 CV deaths (3.5%), and 150 cancer deaths (3.8%). After multivariable adjustment, we revealed a positive association of SDMA with all-cause [hazard ratio (HR) per SD increase: 1.16, 95% confidence interval (CI): 1.07–1.25] and CV mortality [HR: 1.19, 95% CI: 1.05–1.35]. In contrast, we did not observe any association of SDMA with cancer mortality. Neither L-arginine nor ADMA were associated with all-cause or CV mortality. Conclusion SDMA, but not ADMA, is an independent predictor of all-cause and CV mortality in a large population-based cohort of European ancestry. PMID:24819070

  10. Associations of All-Cause Mortality with Census-Based Neighbourhood Deprivation and Population Density in Japan: A Multilevel Survival Analysis

    PubMed Central

    Nakaya, Tomoki; Honjo, Kaori; Hanibuchi, Tomoya; Ikeda, Ai; Iso, Hiroyasu; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro

    2014-01-01

    Background Despite evidence that neighbourhood conditions affect residents' health, no prospective studies of the association between neighbourhood socio-demographic factors and all-cause mortality have been conducted in non-Western societies. Thus, we examined the effects of areal deprivation and population density on all-cause mortality in Japan. Methods We employed census and survival data from the Japan Public Health Center-based Prospective Study, Cohort I (n = 37,455), consisting of middle-aged residents (40 to 59 years at the baseline in 1990) living in four public health centre districts. Data spanned between 1990 and 2010. A multilevel parametric proportional-hazard regression model was applied to estimate the hazard ratios (HRs) of all-cause mortality by two census-based areal variables —areal deprivation index and population density—as well as individualistic variables such as socioeconomic status and various risk factors. Results We found that areal deprivation and population density had moderate associations with all-cause mortality at the neighbourhood level based on the survival data with 21 years of follow-ups. Even when controlling for individualistic socio-economic status and behavioural factors, the HRs of the two areal factors (using quartile categorical variables) significantly predicted mortality. Further, this analysis indicated an interaction effect of the two factors: areal deprivation prominently affects the health of residents in neighbourhoods with high population density. Conclusions We confirmed that neighbourhood socio-demographic factors are significant predictors of all-cause death in Japanese non-metropolitan settings. Although further study is needed to clarify the cause-effect relationship of this association, the present findings suggest that health promotion policies should consider health disparities between neighbourhoods and possibly direct interventions towards reducing mortality in densely populated and highly

  11. Child Mortality Rate in Ethiopia

    PubMed Central

    Susuman, A Sathiya

    2012-01-01

    Ethiopia’s childhood mortality has continued to decline although at a swift pace. The drop in urban childhood mortality decline, duration of breastfeeding is the principle reason for the overall decline in mortality trends in Ethiopia. Data from the Ethiopian Demographic and Health Surveys 2000 and 2005 were used. Indirect estimation of Brass and Trussell’s methods were adopted. Selected demographic and socio-economic variables were included in the analysis with statistically significant effects. Findings clearly show neonatal and post neonatal mortality decline gradually. Even though, Ethiopia’s childhood mortality rates are still high. The result shows less than 2 years birth interval have higher infant mortality rates than higher birth interval (113 deaths per 1000). The proper spacing of births allows more time for childcare to make more maternal resources available for the care of the child and mother. Therefore, further research is urgent for regional level and national level investigation. PMID:23113145

  12. Unpacking the 'black box' of total pathogen burden: is number or type of pathogens most predictive of all-cause mortality in the United States?

    PubMed

    Simanek, A M; Dowd, J B; Zajacova, A; Aiello, A E

    2015-09-01

    A 'black box' paradigm has prevailed in which researchers have focused on the association between the total number of pathogens for which individuals are seropositive (i.e. total pathogen burden) and various chronic diseases, while largely ignoring the role that seropositivity for specific combinations of pathogens may play in the aetiology of such outcomes and consequently mortality. We examined the association between total pathogen burden as well as specific pathogen combinations and all-cause mortality in the United States. Data were from individuals aged ⩾25 years tested for cytomegalovirus (CMV), herpes simplex virus (HSV)-1, HSV-2 and Helicobacter pylori, with mortality follow-up to 31 December 2006 in the National Health and Nutrition Examination Survey (NHANES) III (N = 6522). We did not observe a statistically significant graded relationship between total pathogen burden level and all-cause mortality. Furthermore, compared to those seronegative for all four pathogens, the greatest statistically significant rate of all-cause mortality was for those CMV+/HSV-2+ (hazard ratio 1·95, 95% confidence interval 1·13-3·35) adjusting for age, gender, race/ethnicity, education level, body mass index (kg/m2) and smoking status. Interventions targeting prevention or treatment of particular pathogens may be more effective for reducing mortality than those focused solely on reducing overall pathogen burden. PMID:25518978

  13. The reverse J shaped association between serum total 25- hydroxyvitamin D and all-cause mortality: The impact of assay standardization

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The impact of standardizing the originally measured serum total 25-hydroxyvitamin D [25(OH)D] values from Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) on the association between 25(OH)D and rate of all-cause mortality was evaluated. Values were standardized to gold ...

  14. Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: the Japan Dialysis Outcomes and Practice Pattern Study.

    PubMed

    Inaba, Masaaki; Karaboyas, Angelo; Akiba, Takashi; Akizawa, Tadao; Saito, Akira; Fukuhara, Shunichi; Combe, Christian; Robinson, Bruce M

    2014-07-01

    The association of low blood pressure (BP) with high mortality is a characteristic for hemodialysis patients. This analysis clarifies the association of BP with mortality and stroke in Japanese hemodialysis (HD) patients and examines the association separately for patients with and without antihypertensive medication (BP meds). We analyzed 9134 patients from Japan in phases 1-4 (1999-2011) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective cohort study of in-center HD patients. The association of patient systolic (SBP) and diastolic (DBP) blood pressure with all-cause and cause-specific mortality was assessed using adjusted Cox regression. A U-shaped association between BP and all-cause mortality was observed, with lowest mortality for baseline SBP 140-159 mmHg and DBP 65-74 mmHg. Both SBP and DBP were positively and monotonically associated with stroke-related death: hazard ratio (95% confidence interval) was 1.24 (1.01-1.53) per 20 mmHg higher SBP and 1.23 (1.05-1.44) per 10 mmHg higher DBP. No evidence of interaction was found between SBP and use of BP meds regarding all-cause mortality (P for interaction = 0.97); the association between SBP and stroke-related death was slightly stronger among patients not on BP meds than patients on BP meds (P for interaction = 0.09). In Japanese HD patients, both low and high BP are associated with all-cause mortality. This analysis also documents a positive and monotonic association of BP with stroke-related deaths. Although our analysis indicates that the prescription of BP meds to hypertensive patients might protect against stroke-related death, additional study is warranted. PMID:24629041

  15. The Influence of Source of Social Support and Size of Social Network on All-Cause Mortality

    PubMed Central

    Becofsky, Katie M.; Shook, Robin P.; Sui, Xuemei; Wilcox, Sara; Lavie, Carl J.; Blair, Steven N.

    2015-01-01

    Objective To examine associations between relative, friend, and partner support, as well as size and source of weekly social network, on mortality risk in the Aerobics Center Longitudinal Study (ACLS). Patients and Methods In a mail-back survey completed between January 1, 1990 and December 31, 1990, adult ACLS participants (n=12,709) answered questions regarding whether they received social support from relatives, friends, and spouse/partner (yes or no for each), and the number of friends and relatives they had contact with at least once per week. Participants were followed until December 31, 2003 or death. Cox proportional hazard regression evaluated the strength of the associations, controlling for covariates. Results Participants (25% women) averaged 53.0 years at baseline. During a median 13.5 years of follow-up, 1,139 deaths occurred. Receiving social support from relatives reduced mortality risk 19% (HR 0.81, 95% CI 0.68–0.95). Receiving spousal/partner support also reduced mortality risk 19% (HR 0.81, 95% CI 0.66-.99). Receiving social support from friends was not associated with mortality risk (HR 0.90, 95% CI 0.75–1.09), however, participants reporting social contact with 6 or 7 friends on a weekly basis had a 24% lower mortality risk than those in contact with ≤ 1 friend (HR 0.76, 95% CI 0.58–0.98). Contact with 2–5 or ≥8 friends was not associated with mortality risk, nor was number of weekly relative contacts. Conclusions Receiving social support from one’s spouse/partner and relatives and maintaining weekly social interaction with 6–7 friends reduced mortality risk. Such data may inform interventions to improve long-term survival. PMID:26055526

  16. N-3 long-chain polyunsaturated fatty acids and risk of all-cause mortality among general populations: a meta-analysis

    PubMed Central

    Chen, Guo-Chong; Yang, Jing; Eggersdorfer, Manfred; Zhang, Weiguo; Qin, Li-Qiang

    2016-01-01

    Prospective observational studies have shown inconsistent associations of dietary or circulating n-3 long-chain polyunsaturated fatty acids (LCPUFA) with risk of all-cause mortality. A meta-analysis was performed to evaluate the associations. Potentially eligible studies were identified by searching PubMed and EMBASE databases. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using the random-effects model. Eleven prospective studies involving 371 965 participants from general populations and 31 185 death events were included. The summary RR of all-cause mortality for high-versus-low n-3 LCPUFA intake was 0.91 (95% CI: 0.84–0.98). The summary RR for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake was 0.83 (95% CI: 0.75–0.92) and 0.81 (95% CI: 0.74–0.95), respectively. In the dose-response analysis, each 0.3 g/d increment in n-3 LCPUFA intake was associated with 6% lower risk of all-cause mortality (RR = 0.94, 95% CI: 0.89–0.99); and each 1% increment in the proportions of circulating EPA and DHA in total fatty acids in blood was associated with 20% (RR = 0.80, 95% CI: 0.65–0.98) and 21% (RR = 0.79, 95% CI: 0.63–0.99) decreased risk of all-cause mortality, respectively. Moderate to high heterogeneity was observed across our anlayses. Our findings suggest that both dietary and circulating LCPUFA are inversely associated with all-cause mortality. PMID:27306836

  17. N-3 long-chain polyunsaturated fatty acids and risk of all-cause mortality among general populations: a meta-analysis.

    PubMed

    Chen, Guo-Chong; Yang, Jing; Eggersdorfer, Manfred; Zhang, Weiguo; Qin, Li-Qiang

    2016-01-01

    Prospective observational studies have shown inconsistent associations of dietary or circulating n-3 long-chain polyunsaturated fatty acids (LCPUFA) with risk of all-cause mortality. A meta-analysis was performed to evaluate the associations. Potentially eligible studies were identified by searching PubMed and EMBASE databases. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using the random-effects model. Eleven prospective studies involving 371 965 participants from general populations and 31 185 death events were included. The summary RR of all-cause mortality for high-versus-low n-3 LCPUFA intake was 0.91 (95% CI: 0.84-0.98). The summary RR for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake was 0.83 (95% CI: 0.75-0.92) and 0.81 (95% CI: 0.74-0.95), respectively. In the dose-response analysis, each 0.3 g/d increment in n-3 LCPUFA intake was associated with 6% lower risk of all-cause mortality (RR = 0.94, 95% CI: 0.89-0.99); and each 1% increment in the proportions of circulating EPA and DHA in total fatty acids in blood was associated with 20% (RR = 0.80, 95% CI: 0.65-0.98) and 21% (RR = 0.79, 95% CI: 0.63-0.99) decreased risk of all-cause mortality, respectively. Moderate to high heterogeneity was observed across our anlayses. Our findings suggest that both dietary and circulating LCPUFA are inversely associated with all-cause mortality. PMID:27306836

  18. Effect of Urate-Lowering Therapy on All-Cause and Cardiovascular Mortality in Hyperuricemic Patients without Gout: A Case-Matched Cohort Study

    PubMed Central

    Chen, Jiunn-Horng; Lan, Joung-Liang; Cheng, Chi-Fung; Liang, Wen-Miin; Lin, Hsiao-Yi; Tsay, Gregory J; Yeh, Wen-Ting; Pan, Wen-Harn

    2015-01-01

    Objectives An increased risk of mortality in patients with hyperuricemia has been reported. We examined (1) the risk of all-cause and cardiovascular disease (CVD) mortality in untreated hyperuricemic patients who did not receive urate-lowering therapy (ULT), and (2) the impact of ULT on mortality risk in patients with hyperuricemia. Methods In this retrospective case-matched cohort study during a mean follow-up of 6.4 years, 40,118 Taiwanese individuals aged ≥17 years who had never used ULT and who had never had gout were examined. The mortality rate was compared between 3,088 hyperuricemic patients who did not receive ULT and reference subjects (no hyperuricemia, no gout, no ULT) matched for age and sex (1:3 hyperuricemic patients/reference subjects), and between 1,024 hyperuricemic patients who received ULT and 1,024 hyperuricemic patients who did not receive ULT (matched 1:1 based on their propensity score and the index date of ULT prescription). Cox proportional hazard modeling was used to estimate the respective risk of all-cause and CVD (ICD-9 code 390–459) mortality. Results After adjustment, hyperuricemic patients who did not receive ULT had increased risks of all-cause (hazard ratio, 1.24; 95% confidence interval, 0.97–1.59) and CVD (2.13; 1.34–3.39) mortality relative to the matched reference subjects. Hyperuricemic patients treated with ULT had a lower risk of all-cause death (0.60; 0.41–0.88) relative to hyperuricemic patients who did not receive ULT. Conclusion Under-treatment of hyperuricemia has serious negative consequences. Hyperuricemic patients who received ULT had potentially better survival than patients who did not. PMID:26683302

  19. Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs

    PubMed Central

    Lin, Shu-Yu; Lee, Wei-Ju; Chou, Ming-Yueh; Peng, Li-Ning; Chiou, Shu-Ti; Chen, Liang-Kung

    2016-01-01

    Background Frailty Index, defined as an individual’s accumulated proportion of listed health-related deficits, is a well-established metric used to assess the health status of old adults; however, it has not yet been developed in Taiwan, and its local related structure factors remain unclear. The objectives were to construct a Taiwan Frailty Index to predict mortality risk, and to explore the structure of its factors. Methods Analytic data on 1,284 participants aged 53 and older were excerpted from the Social Environment and Biomarkers of Aging Study (2006), in Taiwan. A consensus workgroup of geriatricians selected 159 items according to the standard procedure for creating a Frailty Index. Cox proportional hazard modeling was used to explore the association between the Taiwan Frailty Index and mortality. Exploratory factor analysis was used to identify structure factors and produce a shorter version–the Taiwan Frailty Index Short-Form. Results During an average follow-up of 4.3 ± 0.8 years, 140 (11%) subjects died. Compared to those in the lowest Taiwan Frailty Index tertile (< 0.18), those in the uppermost tertile (> 0.23) had significantly higher risk of death (Hazard ratio: 3.2; 95% CI 1.9–5.4). Thirty-five items of five structure factors identified by exploratory factor analysis, included: physical activities, life satisfaction and financial status, health status, cognitive function, and stresses. Area under the receiver operating characteristic curves (C-statistics) of the Taiwan Frailty Index and its Short-Form were 0.80 and 0.78, respectively, with no statistically significant difference between them. Conclusion Although both the Taiwan Frailty Index and Short-Form were associated with mortality, the Short-Form, which had similar accuracy in predicting mortality as the full Taiwan Frailty Index, would be more expedient in clinical practice and community settings to target frailty screening and intervention. PMID:27537684

  20. Depression or anxiety and all-cause mortality in adults with atrial fibrillation – A cohort study in Swedish primary care

    PubMed Central

    Wändell, Per; Carlsson, Axel C.; Gasevic, Danijela; Wahlsträm, Lars; Sundquist, Jan; Sundquist, Kristina

    2016-01-01

    Objective Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting. Methods The study population included adults (n = 12 283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored. Results The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR = 1.28, 95% CI 1.08–1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients. Conclusions Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice. PMID:26758363

  1. Dose-Response Relationship of Physical Activity to Premature and Total All-Cause and Cardiovascular Disease Mortality in Walkers

    PubMed Central

    Williams, Paul T.

    2013-01-01

    Purpose To assess the dose-response relationships between cause-specific mortality and exercise energy expenditure in a prospective epidemiological cohort of walkers. Methods The sample consisted of the 8,436 male and 33,586 female participants of the National Walkers' Health Study. Walking energy expenditure was calculated in metabolic equivalents (METs, 1 MET = 3.5 ml O2/kg/min), which were used to divide the cohort into four exercise categories: category 1 (≤1.07 MET-hours/d), category 2 (1.07 to 1.8 MET-hours/d), category 3 (1.8 to 3.6 MET-hours/d), and category 4 (≥3.6 MET-hours/d). Competing risk regression analyses were use to calculate the risk of mortality for categories 2, 3 and 4 relative to category 1. Results 22.9% of the subjects were in category 1, 16.1% in category 2, 33.3% in category 3, and 27.7% in category 4. There were 2,448 deaths during the 9.6 average years of follow-up. Total mortality was 11.2% lower in category 2 (P = 0.04), 32.4% lower in category 3 (P<10−12) and 32.9% lower in category 4 (P = 10−11) than in category 1. For underlying causes of death, the respective risk reductions for categories 2, 3 and 4 were 23.6% (P = 0.008), 35.2% (P<10−5), and 34.9% (P = 0.0001) for cardiovascular disease mortality; 27.8% (P = 0.18), 20.6% (P = 0.07), and 31.4% (P = 0.009) for ischemic heart disease mortality; and 39.4% (P = 0.18), 63.8% (P = 0.005), and 90.6% (P = 0.002) for diabetes mortality when compared to category 1. For all related mortality (i.e., underlying and contributing causes of death combined), the respective risk reductions for categories 2, 3 and 4 were 18.7% (P = 0.22), 42.5% (P = 0.001), and 57.5% (P = 0.0001) for heart failure; 9.4% (P = 0.56), 44.3% (P = 0.0004), and 33.5% (P = 0.02) for hypertensive diseases; 11.5% (P = 0.38), 41.0% (P<10−4), and 35.5% (P = 0.001) for dysrhythmias: and 23.2% (P = 0.13), 45.8% (P = 0.0002), and 41

  2. Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the Breast Cancer Family Registry

    PubMed Central

    Keegan, Theresa H. M.; Milne, Roger L.; Andrulis, Irene L.; Chang, Ellen T.; Sangaramoorthy, Meera; Phillips, Kelly-Anne; Giles, Graham G.; Goodwin, Pamela J.; Apicella, Carmel; Hopper, John L.; Whittemore, Alice S.; John, Esther M.

    2010-01-01

    Few studies have considered the joint association of body mass index (BMI) and physical activity, two modifiable factors, with all-cause mortality after breast cancer diagnosis. Women diagnosed with invasive breast cancer (n=4,153) between 1991 and 2000 were enrolled in the Breast Cancer Family Registry through population-based sampling in Northern California, USA; Ontario, Canada; and Melbourne and Sydney, Australia. During a median follow-up of 7.8 years, 725 deaths occurred. Baseline questionnaires assessed moderate and vigorous recreational physical activity and BMI prior to diagnosis. Associations with all-cause mortality were assessed using Cox proportional hazards regression, adjusting for established prognostic factors. Compared with no physical activity, any recreational activity during the three years prior to diagnosis was associated with a 34% lower risk of death (hazard ratio (HR) = 0.66, 95% confidence interval (CI): 0.51-0.85) for women with estrogen receptor (ER)-positive tumors, but not those with ER-negative tumors; this association did not appear to differ by race/ethnicity or BMI. Lifetime physical activity was not associated with all-cause mortality. BMI was positively associated with all-cause mortality for women diagnosed at age ≥50 years with ER-positive tumors (compared with normal-weight women, HR for overweight = 1.39, 95% CI: 0.90-2.15; HR for obese = 1.77, 95% CI: 1.11-2.82). BMI associations did not appear to differ by race/ethnicity. Our findings suggest that physical activity and BMI exert independent effects on overall mortality after breast cancer. PMID:20140702

  3. Examining the association between serum lactic dehydrogenase and all-cause mortality in patients with metabolic syndrome: a retrospective observational study

    PubMed Central

    Wu, Li-Wei; Kao, Tung-Wei; Lin, Chien-Ming; Yang, Hui-Fang; Sun, Yu-Shan; Liaw, Fang-Yih; Wang, Chung-Ching; Peng, Tao-Chun; Chen, Wei-Liang

    2016-01-01

    Objectives Emerging evidence indicates that elevated serum lactic dehydrogenase (LDH) levels are associated with increased cardiovascular mortality, but the mechanisms for this relationship remain uncertain. Since metabolic syndrome (MetS) is correlated with a higher risk of cardiovascular complications, we investigated the joint association between serum LDH levels and all-cause mortality in the US general population with MetS. Design Retrospective study. Setting The USA. Participants A retrospective observational study of 3872 adults with MetS and 7516 adults without MetS in the National Health and Nutrition Examination Survey III was performed. Main outcome measures Participants with and without MetS were both divided into 3 groups according to their serum LDH level. Multivariable Cox regression analyses and Kaplan-Meier survival probabilities were used to jointly relate all-cause, cardiovascular and cancer mortality risk to different serum LDH levels. Results For all-cause mortality in participants with MetS, multivariable adjusted HRs were 1.006 (95% CI 0.837 to 1.210; p=0.947) for serum LDH of 149–176 U/L compared with 65–149 U/L, and 1.273 (95% CI 1.049 to 1.547; p=0.015) for serum LDH of 176–668 U/L compared with 65–149 U/L. Conclusions Results support a positive association between higher level of serum LDH and mortality from all causes in individuals with MetS. PMID:27217285

  4. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

    PubMed Central

    Okayama, Akira; Okuda, Nagako; Miura, Katsuyuki; Okamura, Tomonori; Hayakawa, Takehito; Akasaka, Hiroshi; Ohnishi, Hirofumi; Saitoh, Shigeyuki; Arai, Yusuke; Kiyohara, Yutaka; Takashima, Naoyuki; Yoshita, Katsushi; Fujiyoshi, Akira; Zaid, Maryam; Ohkubo, Takayoshi; Ueshima, Hirotsugu

    2016-01-01

    Objectives To evaluate the impact of dietary sodium and potassium (Na–K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population. Setting Prospective cohort study. Participants In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30–79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na–K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model. Primary outcome measures Mortality from total and subtypes of stroke, CVD and all causes. Results A total of 1938 deaths from all causes were observed over 176 926 person-years. Na–K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na–K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na–K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality. Conclusions Dietary Na–K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population

  5. Effects of blood triglycerides on cardiovascular and all-cause mortality: a systematic review and meta-analysis of 61 prospective studies

    PubMed Central

    2013-01-01

    The relationship of triglycerides (TG) to the risk of death remains uncertain. The aim of this study was to determine the associations between blood triglyceride levels and cardiovascular diseases (CVDs) mortality and all-cause mortality. Four databases were searched without language restriction for relevant studies: PubMed, ScienceDirect, EMBASE, and Google Scholar. All prospective cohort studies reporting an association between TG and CVDs or all-cause mortality published before July 2013 were included. Risk ratios (RRs) with 95% confidence intervals (CIs) were extracted and pooled according to TG categories, unit TG, and logarithm of TG using a random-effects model with inverse-variance weighting. We identified 61 eligible studies, containing 17,018 CVDs deaths in 726,030 participants and 58,419 all-cause deaths in 330,566 participants. Twelve and fourteen studies, respectively, reported the effects estimates of CVDs and total mortality by TG categories. Compared to the referent (90–149 mg/dL), the pooled RRs (95% CI) of CVDs mortality for the lowest (< 90 mg/dL), borderline-high (150–199 mg/dL), and high TG (≥ 200 mg/dL) groups were 0.83 (0.75 to 0.93), 1.15 (1.03 to 1.29), and 1.25 (1.05 to 1.50); for total mortality they were 0.94 (0.85 to 1.03), 1.09 (1.02 to 1.17), and 1.20 (1.04 to 1.38), respectively. The risks of CVDs and all-cause deaths were increased by 13% and 12% (p < 0.001) per 1-mmol/L TG increment in twenty-two and twenty-two studies reported RRs per unit TG, respectively. In conclusion, elevated blood TG levels were dose-dependently associated with higher risks of CVDs and all-cause mortality. PMID:24164719

  6. Cooking Coal Use and All-Cause and Cause-Specific Mortality in a Prospective Cohort Study of Women in Shanghai, China

    PubMed Central

    Kim, Christopher; Seow, Wei Jie; Shu, Xiao-Ou; Bassig, Bryan A.; Rothman, Nathaniel; Chen, Bingshu E.; Xiang, Yong-Bing; Hosgood, H. Dean; Ji, Bu-Tian; Hu, Wei; Wen, Cuiju; Chow, Wong-Ho; Cai, Qiuyin; Yang, Gong; Gao, Yu-Tang; Zheng, Wei; Lan, Qing

    2016-01-01

    Background: Nearly 4.3 million deaths worldwide were attributable to exposure to household air pollution in 2012. However, household coal use remains widespread. Objectives: We investigated the association of cooking coal and all-cause and cause-specific mortality in a prospective cohort of primarily never-smoking women in Shanghai, China. Methods: A cohort of 74,941 women were followed from 1996 through 2009 with annual linkage to the Shanghai vital statistics database. Cause-specific mortality was identified through 2009. Use of household coal for cooking was assessed through a residential history questionnaire. Cox proportional hazards models estimated the risk of mortality associated with household coal use. Results: In this cohort, 63% of the women ever used coal (n = 46,287). Compared with never coal use, ever use of coal was associated with mortality from all causes [hazard ratio (HR) = 1.12; 95% confidence interval (CI): 1.05, 1.21], cancer (HR = 1.14; 95% CI: 1.03, 1.27), and ischemic heart disease (overall HR = 1.61; 95% CI: 1.14, 2.27; HR for myocardial infarction specifically = 1.80; 95% CI: 1.16, 2.79). The risk of cardiovascular mortality increased with increasing duration of coal use, compared with the risk in never users. The association between coal use and ischemic heart disease mortality diminished with increasing years since cessation of coal use. Conclusions: Evidence from this study suggests that past use of coal among women in Shanghai is associated with excess all-cause mortality, and from cardiovascular diseases in particular. The decreasing association with cardiovascular mortality as the time since last use of coal increased emphasizes the importance of reducing use of household coal where use is still widespread. Citation: Kim C, Seow WJ, Shu XO, Bassig BA, Rothman N, Chen BE, Xiang YB, Hosgood HD III, Ji BT, Hu W, Wen C, Chow WH, Cai Q, Yang G, Gao YT, Zheng W, Lan Q. 2016. Cooking coal use and all-cause and cause-specific mortality in

  7. Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT).

    PubMed

    Yang, Wei; Li, Jian-Ping; Zhang, Yan; Fan, Fang-Fang; Xu, Xi-Ping; Wang, Bin-Yan; Xu, Xin; Qin, Xian-Hui; Xing, Hou-Xun; Tang, Gen-Fu; Zhou, Zi-Yi; Gu, Dong-Feng; Zhao, Dong; Huo, Yong

    2016-01-01

    The association between elevated body mass index (BMI) and risk of death has been reported in many studies. However, the association between BMI and all-cause mortality for hypertensive Chinese adults remains unclear. We conducted a post-hoc analysis using data from the China Stroke Primary Prevention Trial (CSPPT). Cox regression analysis was performed to determine the significance of the association of BMI with all-cause mortality. During a mean follow-up duration of 4.5 years, 622 deaths (3.0%) occurred among the 20,694 participants aged 45-75 years. A reversed J-shaped relationship was observed between BMI and all-cause mortality. The hazard ratios (HRs) for underweight (<18.5 kg/m²), overweight (24.0-27.9 kg/m²), and obesity (≥28.0 kg/m²) were calculated relative to normal weight (18.5-23.9 kg/m²). The summary HRs were 1.56 (95% CI, 1.11-2.18) for underweight, 0.78 (95% CI 0.64-0.95) for overweight and 0.64 (95% CI, 0.48-0.85) for obesity. In sex-age-specific analyses, participants over 60 years of age had optimal BMI in the obesity classification and the results were consistent in both males and females. Relative to normal weight, underweight was associated with significantly higher mortality. Excessive weight was not associated with increased risk of mortality. Chinese hypertensive adults had the lowest mortality in grade 1 obesity. PMID:27338470

  8. Association between Body Mass Index and All-Cause Mortality in Hypertensive Adults: Results from the China Stroke Primary Prevention Trial (CSPPT)

    PubMed Central

    Yang, Wei; Li, Jian-Ping; Zhang, Yan; Fan, Fang-Fang; Xu, Xi-Ping; Wang, Bin-Yan; Xu, Xin; Qin, Xian-Hui; Xing, Hou-Xun; Tang, Gen-Fu; Zhou, Zi-Yi; Gu, Dong-Feng; Zhao, Dong; Huo, Yong

    2016-01-01

    The association between elevated body mass index (BMI) and risk of death has been reported in many studies. However, the association between BMI and all-cause mortality for hypertensive Chinese adults remains unclear. We conducted a post-hoc analysis using data from the China Stroke Primary Prevention Trial (CSPPT). Cox regression analysis was performed to determine the significance of the association of BMI with all-cause mortality. During a mean follow-up duration of 4.5 years, 622 deaths (3.0%) occurred among the 20,694 participants aged 45–75 years. A reversed J-shaped relationship was observed between BMI and all-cause mortality. The hazard ratios (HRs) for underweight (<18.5 kg/m2), overweight (24.0–27.9 kg/m2), and obesity (≥28.0 kg/m2) were calculated relative to normal weight (18.5–23.9 kg/m2). The summary HRs were 1.56 (95% CI, 1.11–2.18) for underweight, 0.78 (95% CI 0.64–0.95) for overweight and 0.64 (95% CI, 0.48–0.85) for obesity. In sex-age-specific analyses, participants over 60 years of age had optimal BMI in the obesity classification and the results were consistent in both males and females. Relative to normal weight, underweight was associated with significantly higher mortality. Excessive weight was not associated with increased risk of mortality. Chinese hypertensive adults had the lowest mortality in grade 1 obesity. PMID:27338470

  9. All-cause, drug-related, and HIV-related mortality risk by trajectories of jail incarceration and homelessness among adults in New York City.

    PubMed

    Lim, Sungwoo; Harris, Tiffany G; Nash, Denis; Lennon, Mary Clare; Thorpe, Lorna E

    2015-02-15

    We studied a cohort of 15,620 adults who had experienced at least 1 jail incarceration and 1 homeless shelter stay in 2001-2003 in New York City to identify trajectories of these events and tested whether a particular trajectory was associated with all-cause, drug-related, or human immunodeficiency virus (HIV)-related mortality risk in 2004-2005. Using matched data on jail time, homeless shelter stays, and vital statistics, we performed sequence analysis and assessed mortality risk using standardized mortality ratios (SMRs) and marginal structural modeling. We identified 6 trajectories. Sixty percent of the cohort members had a temporary pattern, which was characterized by sporadic experiences of brief incarceration and homelessness, whereas the rest had the other 5 patterns, which reflected experiences of increasing, decreasing, or persistent jail or shelter stays. Mortality risk among individuals with a temporary pattern was significantly higher than those of adults who had not been incarcerated or stayed in a homeless shelter during the study period (all-cause SMR: 1.35, 95% confidence interval (CI): 1.14, 1.59; drug-related SMR: 4.60, 95% CI: 3.17, 6.46; HIV-related SMR: 1.54, 95% CI: 1.03, 2.21); all-cause and HIV-related SMRs in other patterns were not statistically significantly different. When we compared all 6 trajectories, the temporary pattern was more strongly associated with higher mortality risk than was the continuously homelessness pattern. Institutional interventions to reduce recurrent cycles of incarceration and homelessness are needed to augment behavioral interventions to reduce mortality risk. PMID:25660082

  10. Historical Trends and Regional Differences in All-Cause and Amenable Mortality Among American Indians and Alaska Natives Since 1950

    PubMed Central

    Kunitz, Stephen J.; Veazie, Mark; Henderson, Jeffrey A.

    2014-01-01

    American Indian and Alaska Native (AI/AN) death rates declined over most of the 20th century, even before the Public Health Service became responsible for health care in 1956. Since then, rates have declined further, although they have stagnated since the 1980s. These overall patterns obscure substantial regional differences. Most significant, rates in the Northern and Southern Plains have declined far less since 1949 to 1953 than those in the East, Southwest, or Pacific Coast. Data for Alaska are not available for the earlier period, so its trajectory of mortality cannot be ascertained. Socioeconomic measures do not adequately explain the differences and rates of change, but migration, changes in self-identification as an AI/AN person, interracial marriage, and variations in health care effectiveness all appear to be implicated. PMID:24754651

  11. Cardiovascular recovery from psychological and physiological challenge and risk for adverse cardiovascular outcomes and all-cause mortality

    PubMed Central

    Panaite, Vanessa; Salomon, Kristen; Jin, Alvin; Rottenberg, Jonathan

    2015-01-01

    Objective Exaggerated cardiovascular (CV) reactivity to laboratory challenge has been shown to predict future CV morbidity and mortality. CV recovery, has been less studied, and has yielded inconsistent findings, possibly due to presence of moderators. Reviews on the relationship between CV recovery and CV outcomes have been limited to cross-sectional studies and have not considered methodological factors. We performed a comprehensive meta-analytic review of the prospective literature investigating CV recovery to physical and psychological challenge and adverse cardiovascular outcomes. Methods We searched PsycINFO and PubMed for prospective studies investigating the relationship between CV recovery and adverse CV outcomes. Studies were coded for variables of interest and for effect sizes (ES). We conducted a random effects weighted meta-analysis. Moderators were examined with ANOVA-analog and meta-regression analyses. Results Thirty seven studies met inclusion criteria (N=125386). Impaired recovery from challenge predicted adverse cardiovascular outcomes (summary effect, r = .17, p < .001). Physical challenge was associated with larger predictive effects than psychological challenge. Moderator analyses revealed that recovery measured at 1 minute post-exercise, passive recovery, use of mortality as an outcome measure, and older sample age were associated with larger effects. Conclusions Poor recovery from laboratory challenges predicts adverse CV outcomes, with recovery from exercise serving as a particularly strong predictor of CV outcomes. The overall ES for recovery and CV outcomes is similar to that observed for CV reactivity and suggests that the study of recovery may have incremental value for understanding adverse CV outcomes. PMID:25829236

  12. Upper gastrointestinal bleeding as a risk factor for dialysis and all-cause mortality: a cohort study of chronic kidney disease patients in Taiwan

    PubMed Central

    Liang, Chih-Chia; Chang, Chiz-Tzung; Wang, I-Kuan; Huang, Chiu-Ching

    2016-01-01

    Objective Impaired renal function is associated with higher risk of upper gastrointestinal bleeding (UGIB) in patients with chronic kidney disease and not on dialysis (CKD-ND). It is unclear if UGIB increases risk of chronic dialysis. The aim of the study was to investigate risk of chronic dialysis in CKD-ND patients with UGIB. Setting All CKD-ND stage 3–5 patients of a CKD programme in one hospital between 2003 and 2009 were enrolled and prospectively followed until September 2012. Primary and secondary outcome measures Chronic dialysis (dialysis for more than 3 months) started and all-cause mortality. The risk of chronic dialysis was analysed using Cox proportional hazard regression with adjustments for age, gender and renal function, followed by competing-risks analysis. Results We analysed 3126 CKD-ND patients with a mean age of 65±14 years for 2.8 years. Of 3126 patients, 387 (12.4%) patients developed UGIB, 989 (31.6%) patients started chronic dialysis and 197 (6.3%) patients died. UGIB increased all-cause mortality (adjusted HR (aHR): 1.51, 95% CI 1.07 to 2.13) and the risk of chronic dialysis (aHR; 1.29, 95% CI 1.11 to 1.50). The subdistribution HR (SHR) of UGIB for chronic dialysis (competing event: all-cause mortality) was 1.37 (95% CI 1.15 to 1.64) in competing-risks analysis with adjustments for age, renal function, gender, diabetes, haemoglobin, albumin and urine protein/creatinine ratio. Conclusions UGIB is associated with increased risk of chronic dialysis and all-cause mortality in patients with CKD-ND stages 3–5. This association is independent of age, gender, basal renal function, haemoglobin, albumin and urine protein levels. PMID:27150184

  13. Health Factors and Risk of All-Cause, Cardiovascular, and Coronary Heart Disease Mortality: Findings from the MONICA and HAPIEE Studies in Lithuania

    PubMed Central

    Tamosiunas, Abdonas; Luksiene, Dalia; Baceviciene, Migle; Bernotiene, Gailute; Radisauskas, Ricardas; Malinauskiene, Vilija; Kranciukaite-Butylkiniene, Daina; Virviciute, Dalia; Peasey, Anne; Bobak, Martin

    2014-01-01

    Aims This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population. Methods Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45–64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD. Results Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006–2008 than in 1983–1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5–6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15–0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12–0.97) but not in women (HR 0.38, 95% CI 0.09–1.67). Conclusions An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly

  14. All-Cause, Cardiovascular, and Cancer Mortality Rates in Postmenopausal White, Black, Hispanic, and Asian Women With and Without Diabetes in the United States

    PubMed Central

    Ma, Yunsheng; Hébert, James R.; Balasubramanian, Raji; Wedick, Nicole M.; Howard, Barbara V.; Rosal, Milagros C.; Liu, Simin; Bird, Chloe E.; Olendzki, Barbara C.; Ockene, Judith K.; Wactawski-Wende, Jean; Phillips, Lawrence S.; LaMonte, Michael J.; Schneider, Kristin L.; Garcia, Lorena; Ockene, Ira S.; Merriam, Philip A.; Sepavich, Deidre M.; Mackey, Rachel H.; Johnson, Karen C.; Manson, JoAnn E.

    2013-01-01

    Using data from the Women's Health Initiative (1993–2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models were used for the comparison from which hazard ratios and 95% confidence intervals were computed. Within each racial/ethnic subgroup, women with diabetes had an approximately 2–3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups. Population attributable risk percentages (PARPs) take into account both the prevalence of diabetes and hazard ratios. For all-cause mortality, whites had the lowest PARP (11.1, 95% confidence interval (CI): 10.1, 12.1), followed by Asians (12.9, 95% CI: 4.7, 20.9), blacks (19.4, 95% CI: 15.0, 23.7), and Hispanics (23.2, 95% CI: 14.8, 31.2). To our knowledge, the present study is the first to show that hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups when stratified by diabetes status. Because of the “amplifying” effect of diabetes prevalence, efforts to reduce racial/ethnic disparities in the rate of death from diabetes should focus on prevention of diabetes. PMID:24045960

  15. The Association between Sulfonylurea Use and All-Cause and Cardiovascular Mortality: A Meta-Analysis with Trial Sequential Analysis of Randomized Clinical Trials

    PubMed Central

    Varvaki Rados, Dimitris; Catani Pinto, Lana; Reck Remonti, Luciana; Bauermann Leitão, Cristiane; Gross, Jorge Luiz

    2016-01-01

    Background Sulfonylureas are an effective and inexpensive treatment for type 2 diabetes. There is conflicting data about the safety of these drugs regarding mortality and cardiovascular outcomes. The objective of the present study was to evaluate the safety of the sulfonylureas most frequently used and to use trial sequential analysis (TSA) to analyze whether the available sample was powered enough to support the results. Methods and Findings Electronic databases were reviewed from 1946 (Embase) or 1966 (MEDLINE) up to 31 December 2014. Randomized clinical trials (RCTs) of at least 52 wk in duration evaluating second- or third-generation sulfonylureas in the treatment of adults with type 2 diabetes and reporting outcomes of interest were included. Primary outcomes were all-cause and cardiovascular mortality. Additionally, myocardial infarction and stroke events were evaluated. Data were summarized with Peto odds ratios (ORs), and the reliability of the results was evaluated with TSA. Forty-seven RCTs with 37,650 patients and 890 deaths in total were included. Sulfonylureas were not associated with all-cause (OR 1.12 [95% CI 0.96 to 1.30]) or cardiovascular mortality (OR 1.12 [95% CI 0.87 to 1.42]). Sulfonylureas were also not associated with increased risk of myocardial infarction (OR 0.92 [95% CI 0.76 to 1.12]) or stroke (OR 1.16 [95% CI 0.81 to 1.66]). TSA could discard an absolute difference of 0.5% between the treatments, which was considered the minimal clinically significant difference. The major limitation of this review was the inclusion of studies not designed to evaluate safety outcomes. Conclusions Sulfonylureas are not associated with increased risk for all-cause mortality, cardiovascular mortality, myocardial infarction, or stroke. Current evidence supports the safety of sulfonylureas; an absolute risk of 0.5% could be firmly discarded. Review registration PROSPERO CRD42014004330 PMID:27071029

  16. High urinary homoarginine excretion is associated with low rates of all-cause mortality and graft failure in renal transplant recipients.

    PubMed

    Frenay, Anne-Roos S; Kayacelebi, Arslan Arinc; Beckmann, Bibiana; Soedamah-Muhtu, Sabita S; de Borst, Martin H; van den Berg, Else; van Goor, Harry; Bakker, Stephan J L; Tsikas, Dimitrios

    2015-09-01

    Renal transplant recipients (RTR) have an increased cardiovascular risk profile. Low levels of circulating homoarginine (hArg) are a novel risk factor for mortality and the progression of atherosclerosis. The kidney is known as a major source of hArg, suggesting that urinary excretion of hArg (UhArg) might be associated with mortality and graft failure in RTR. hArg was quantified by mass spectrometry in 24-h urine samples of 704 RTR (functioning graft ≥1 year) and 103 healthy subjects. UhArg determinants were identified with multivariable linear regression models. Associations of UhArg with all-cause mortality and graft failure were assessed using multivariable Cox regression analyses. UhArg excretion was significantly lower in RTR compared to healthy controls [1.62 (1.09-2.61) vs. 2.46 (1.65-4.06) µmol/24 h, P < 0.001]. In multivariable linear regression models, body surface area, diastolic blood pressure, eGFR, pre-emptive transplantation, serum albumin, albuminuria, urinary excretion of urea and uric acid and use of sirolimus were positively associated with UhArg, while donor age and serum phosphate were inversely associated (model R (2) = 0.43). During follow-up for 3.1 (2.7-3.9) years, 83 (12 %) patients died and 45 (7 %) developed graft failure. UhArg was inversely associated with all-cause mortality [hazard risk (HR) 0.52 (95 % CI 0.40-0.66), P < 0.001] and graft failure [HR 0.58 (0.42-0.81), P = 0.001]. These associations remained independent of potential confounders. High UhArg levels are associated with reduced all-cause mortality and graft failure in RTR. Kidney-derived hArg is likely to be of particular importance for proper maintenance of cardiovascular and renal systems. PMID:26142633

  17. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality: a collaborative meta-analysis of general population cohorts

    PubMed Central

    Matsushita, Kunihiro; van der Velde, Marije; Astor, Brad C; Woodward, Mark; Levey, Andrew S; de Jong, Paul E; Coresh, Josef; Gansevoort, Ron T

    2014-01-01

    Background A comprehensive evaluation of the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality is required for assessment of the impact of kidney function on risk in the general population, with implications for improving the definition and staging of chronic kidney disease (CKD). Methods A collaborative meta-analysis of general population cohorts was undertaken to pool standardized data for all-cause and cardiovascular mortality. The two kidney measures and potential confounders from 14 studies (105,872 participants; 730,577 person-years) with urine albumin-to-creatinine ratio (ACR) measurements and seven studies (1,128,310 participants; 4,732,110 person-years) with urine protein dipstick measurements were modeled. Findings In ACR studies, mortality risk was unrelated to eGFR between 75-105 ml/min/1·73 m2 and increased at lower eGFR. Adjusted hazard ratios (HRs) for all-cause mortality at eGFR 60, 45, and 15 (versus 95) ml/min/1·73 m2 were 1·18 (95% CI: 1·05-1·32), 1·57 (1·39-1·78), and 3·14 (2·39-4·13), respectively. ACR was associated with mortality risk linearly on the log-log scale without threshold effects. Adjusted HRs for all-cause mortality at ACR 10, 30, and 300 (versus 5) mg/g were 1·20 (1·15-1·26), 1·63 (1·50-1·77), and 2·22 (1·97-2·51). eGFR and ACR were multiplicatively associated with mortality without evidence of interaction. Similar findings were observed for cardiovascular mortality and in dipstick studies. Interpretation Lower eGFR (<60 ml/min/1·73 m2) and higher albuminuria (ACR ≥10 mg/g) were independent predictors of mortality risk in the general population. This study provides quantitative data for using both kidney measures for risk evaluation and CKD definition and staging. PMID:20483451

  18. Marital status, intergenerational co-residence and cardiovascular and all-cause mortality among middle-aged and older men and women during wartime in Beirut: gains and liabilities.

    PubMed

    Sibai, Abla M; Yount, Kathryn M; Fletcher, Astrid

    2007-01-01

    Studies from the West have shown an increased risk of mortality with various indicators of social isolation. In this study, we examine associations of marital status and intergenerational co-residence with mortality in Lebanon, a country that suffered wars and atrocities for almost 16 years. Using data from a retrospective 10-year follow-up study (1984-1994) among 1567 adults aged 50 years and older in Beirut, cardiovascular disease and all-cause mortality rates (per 1000 person-years) were computed for men and women separately. Age-adjusted Mantel-Haenszel rate ratios (RR) and their 95% confidence intervals (CI) were estimated, and associations were examined using multivariate Poisson regression analysis. Most men (91.3%) were married at baseline, in contrast to only 55.4% of women. Compared to men, women were more likely to be living in one- and three-generation households and with a married child at baseline. While widowhood was associated with an increased risk of all-cause mortality among men only, being never married was associated with a higher CVD mortality risk among men and women. The presence of an adult married child was associated with a significantly higher mortality risk for men and women, even after adjusting for household socioeconomic indicators, marital status, lifestyle variables or pre-existing health-related conditions (hypertension, cholesterol, and diabetes) at baseline. The popular belief that co-residence with adult children reflects greater support networks and an avenue for old age security may not be a valid presumption in the Lebanese context during times of war. PMID:17030373

  19. Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort.

    PubMed

    Johnsen, Nina F; Frederiksen, Kirsten; Christensen, Jane; Skeie, Guri; Lund, Eiliv; Landberg, Rikard; Johansson, Ingegerd; Nilsson, Lena M; Halkjær, Jytte; Olsen, Anja; Overvad, Kim; Tjønneland, Anne

    2015-08-28

    No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992-8, included 120 010 cohort members aged 30-64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v

  20. Association of Posttraumatic Stress Disorder and Depression With All-Cause and Cardiovascular Disease Mortality and Hospitalization Among Hurricane Katrina Survivors With End-Stage Renal Disease

    PubMed Central

    Edmondson, Donald; Gamboa, Christopher; Cohen, Andrew; Anderson, Amanda H.; Kutner, Nancy; Kronish, Ian; Mills, Mary A.

    2013-01-01

    Objectives. We determined the association of psychiatric symptoms in the year after Hurricane Katrina with subsequent hospitalization and mortality in end-stage renal disease (ESRD) patients. Methods. A prospective cohort of ESRD patients (n = 391) treated at 9 hemodialysis centers in the New Orleans, Louisiana, area in the weeks before Hurricane Katrina were assessed for posttraumatic stress disorder (PTSD) and depression symptoms via telephone interview 9 to 15 months later. Two combined outcomes through August 2009 (maximum 3.5-year follow-up) were analyzed: (1) all-cause and (2) cardiovascular-related hospitalization and mortality. Results. Twenty-four percent of participants screened positive for PTSD and 46% for depression; 158 participants died (79 cardiovascular deaths), and 280 participants were hospitalized (167 for cardiovascular-related causes). Positive depression screening was associated with 33% higher risk of all-cause (hazard ratio [HR] = 1.33; 95% confidence interval [CI] = 1.06, 1.66) and cardiovascular-related hospitalization and mortality (HR = 1.33; 95% CI = 1.01, 1.76). PTSD was not significantly associated with either outcome. Conclusions. Depression in the year after Hurricane Katrina was associated with increased risk of hospitalization and mortality in ESRD patients, underscoring the long-term consequences of natural disasters for vulnerable populations. PMID:23409901

  1. Urinary Albumin-Creatinine Ratio, Estimated Glomerular Filtration Rate, and All-Cause Mortality Among US Adults With Obstructive Lung Function

    PubMed Central

    Ford, Earl S.

    2015-01-01

    BACKGROUND Elevated urinary albumin-creatinine ratio (UACR) and decreased estimated glomerular filtration rate (eGFR) predict all-cause mortality, but whether these markers of kidney damage and function do so in adults with obstructive lung function (OLF) is unclear. The objective of this study was to examine the associations between UACR and eGFR and all-cause mortality in adults with OLF. METHODS Data of 5,711 US adults aged 40 to 79 years, including 1,390 adults with any OLF who participated in the National Health and Nutrition Examination Survey III (1988–1994), were analyzed. Mortality follow-up was conducted through 2006. RESULTS During the median follow-up of 13.7 years, 650 adults with OLF died. After maximal adjustment, mean levels of UACR were higher in adults with moderate-severe OLF (7.5 mg/g; 95% CI, 6.7–8.5) than in adults with normal pulmonary function (6.2 mg/g; 95% CI, 5.8–6.6) (P = .003) and mild OLF (6.2 mg/g; 95% CI, 5.5–6.9) (P = .014). Adjusted mean levels of eGFR were lower in adults with moderate-severe OLF (87.6 mL/min/1.73 m2; < 95% CI, 86.0–89.1) than in adults with normal lung function (89.6 mL/min/1.73 m2; < 95% CI, 88.9–90.3) (P = .015). Among adults with OLF, hazard ratios for all-cause mortality increased as levels of UACR, modeled as categorical or continuous variables, increased (maximally adjusted hazard ratio for quintile 5 vs 1: 2.23; 95% CI, 1.56–3.18). eGFR, modeled as a continuous variable but not as quintiles, was significantly associated with mortality. CONCLUSIONS UACR and eGFR, in continuous form, were associated with all-cause mortality among US adults with OLF. PMID:25079336

  2. Associations between number of sick-leave days and future all-cause and cause-specific mortality: a population-based cohort study

    PubMed Central

    2014-01-01

    Background As the number of studies on the future situation of sickness absentees still is very limited, we aimed to investigate the association between number of sick-leave days and future all-cause and cause-specific mortality among women and men. Methods A cohort of 2 275 987 women and 2 393 248 men, aged 20–64 years in 1995 was followed 1996–2006 with regard to mortality. Data were obtained from linked authority-administered registers. The relative risks (RR) and 95% confidence intervals (CI) of mortality with and without a 2-year wash-out period were estimated by multivariate Poisson regression analyses. All analyses were stratified by sex, adjusting for socio demographics and inpatient care. Results A gradually higher all-cause mortality risk occurred with increasing number of sick-leave days in 1995, among both women (RR 1.11; CI 1.07-1.15 for those with 1–15 sick-leave days to RR 2.45; CI 2.36-2.53 among those with 166–365 days) and men (RR 1.20; CI 1.17-1.24 to RR 1.91; CI 1.85-1.97). Multivariate risk estimates were comparable for the different causes of death (circulatory disease, cancer, and suicide). The two-year washout period had only a minor effect on the risk estimates. Conclusion Even a low number of sick-leave days was associated with a higher risk for premature death in the following 11 years, also when adjusting for morbidity. This was the case for both women and men and also for cause-specific mortality. More knowledge is warranted on the mechanisms leading to higher mortality risks among sickness absentees, as sickness certification is a common measure in health care, and most sick leave is due to diagnoses you do not die from. PMID:25037232

  3. Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort

    PubMed Central

    Ding, Ding; Rogers, Kris; van der Ploeg, Hidde; Stamatakis, Emmanuel; Bauman, Adrian E.

    2015-01-01

    Background Lifestyle risk behaviors are responsible for a large proportion of disease burden worldwide. Behavioral risk factors, such as smoking, poor diet, and physical inactivity, tend to cluster within populations and may have synergistic effects on health. As evidence continues to accumulate on emerging lifestyle risk factors, such as prolonged sitting and unhealthy sleep patterns, incorporating these new risk factors will provide clinically relevant information on combinations of lifestyle risk factors. Methods and Findings Using data from a large Australian cohort of middle-aged and older adults, this is the first study to our knowledge to examine a lifestyle risk index incorporating sedentary behavior and sleep in relation to all-cause mortality. Baseline data (February 2006– April 2009) were linked to mortality registration data until June 15, 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting, and unhealthy (short/long) sleep duration were measured by questionnaires and summed into an index score. Cox proportional hazards analysis was used with the index score and each unique risk combination as exposure variables, adjusted for socio-demographic characteristics. During 6 y of follow-up of 231,048 participants for 1,409,591 person-years, 15,635 deaths were registered. Of all participants, 31.2%, 36.9%, 21.4%, and 10.6% reported 0, 1, 2, and 3+ risk factors, respectively. There was a strong relationship between the lifestyle risk index score and all-cause mortality. The index score had good predictive validity (c index = 0.763), and the partial population attributable risk was 31.3%. Out of all 96 possible risk combinations, the 30 most commonly occurring combinations accounted for more than 90% of the participants. Among those, combinations involving physical inactivity, prolonged sitting, and/or long sleep duration and combinations involving smoking and high alcohol intake had the strongest associations with all-cause

  4. Increased all-cause mortality with use of psychotropic medication in dementia patients and controls: A population-based register study.

    PubMed

    Jennum, Poul; Baandrup, Lone; Ibsen, Rikke; Kjellberg, Jakob

    2015-11-01

    We aimed to evaluate all-cause mortality of middle-aged and elderly subjects diagnosed with dementia and treated with psychotropic drugs as compared with controls subjects. Using data from the Danish National Patient Registry, n=26,821 adults with a diagnosis of dementia were included. They were compared with 44,286 control subjects with a minimum follow-up of four years and matched on age, gender, marital status, and community location. Information about psychotropic medication use (benzodiazepines, antidepressants, antipsychotics) was obtained from the Danish Medicinal Product Statistics. All-cause mortality was higher in patients with dementia as compared to control subjects. Mortality hazard ratios were increased for subjects prescribed serotonergic antidepressant drugs (respectively, HR=1.355 (SD=0.023), P=0.001 in patients; HR=1.808 (0.033), P<0.001 in controls), tricyclic antidepressants (HR=1.004 (0.046), P=0.925; HR=1.406 (0.061), P<0.001), benzodiazepines (HR=1.131 (0.039), P=0.060); HR=1.362 (0.028), P<0.001), benzodiazepine-like drugs (HR=1.108 (0.031), P=0.078; HR=1.564 (0.037, P<0.001), first-generation antipsychotics (HR=1.183 (0.074), P=0.022; HR=2.026 (0.114), P<0.001), and second-generation antipsychotics (HR=1.380 (0.042), P<0.001; HR=1.785 (0.088), P<0.001), as compared with no drug use. Interaction analysis suggested statistically significantly higher mortality hazard ratios for most classes of psychotropic drugs in controls than in dementia patients. We found that use of psychotropic drugs is associated with increased all-cause mortality in both patients with dementia and control subjects. Thus, the frequently reported increased mortality with antipsychotic drugs in dementia is not restricted to subjects with impaired cognition and is not restricted to only one class of psychotropic drugs. PMID:26342397

  5. Examining Non-Linear Associations between Accelerometer-Measured Physical Activity, Sedentary Behavior, and All-Cause Mortality Using Segmented Cox Regression

    PubMed Central

    Lee, Paul H.

    2016-01-01

    Healthy adults are advised to perform at least 150 min of moderate-intensity physical activity weekly, but this advice is based on studies using self-reports of questionable validity. This study examined the dose-response relationship of accelerometer-measured physical activity and sedentary behaviors on all-cause mortality using segmented Cox regression to empirically determine the break-points of the dose-response relationship. Data from 7006 adult participants aged 18 or above in the National Health and Nutrition Examination Survey waves 2003–2004 and 2005–2006 were included in the analysis and linked with death certificate data using a probabilistic matching approach in the National Death Index through December 31, 2011. Physical activity and sedentary behavior were measured using ActiGraph model 7164 accelerometer over the right hip for 7 consecutive days. Each minute with accelerometer count <100; 1952–5724; and ≥5725 were classified as sedentary, moderate-intensity physical activity, and vigorous-intensity physical activity, respectively. Segmented Cox regression was used to estimate the hazard ratio (HR) of time spent in sedentary behaviors, moderate-intensity physical activity, and vigorous-intensity physical activity and all-cause mortality, adjusted for demographic characteristics, health behaviors, and health conditions. Data were analyzed in 2016. During 47,119 person-year of follow-up, 608 deaths occurred. Each additional hour per day of sedentary behaviors was associated with a HR of 1.15 (95% CI 1.01, 1.31) among participants who spend at least 10.9 h per day on sedentary behaviors, and each additional minute per day spent on moderate-intensity physical activity was associated with a HR of 0.94 (95% CI 0.91, 0.96) among participants with daily moderate-intensity physical activity ≤14.1 min. Associations of moderate physical activity and sedentary behaviors on all-cause mortality were independent of each other. To conclude, evidence from

  6. Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis

    PubMed Central

    Chang, Hsiao-Wen; Li, Yi-Hwei; Hsieh, Chang-Hsun; Liu, Pang-Yen

    2016-01-01

    Background The obesity paradox phenomenon has been found in different populations, such as heart failure and coronary heart disease, which suggest that patients with established cardiovascular disease (CVD) and with normal weight had higher risk of mortality than those with overweight or obesity. However, the obesity paradox is controversial among patients with diabetes which has been considered as the coronary heart disease equivalent. The aim of our study was to summarize current findings on the relationship between body mass index (BMI) and all-cause mortality in patients with diabetes and make a meta-analysis. Methods We searched previous studies from MEDLINE, EMBASE, and the Cochrane databases using the keywords: BMI, mortality, diabetes, and obesity paradox or reverse epidemiology. Finally, sixteen studies were identified and 385,925 patients were included. Patients were divided into five groups based on BMI (kg/m2) levels: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), mild obesity (30–34.9), and morbid obesity (>35). A random effect meta-analysis was performed by the inverse variance method. Results As compared with the normal weight, the underweight had higher risk of mortality [hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.32–1.91]. In contrast, the overweight and the mild obesity had lower risk of mortality than the normal weight (HR: 0.86, 95% CI: 0.78–0.96, and 0.88, 95% CI: 0.78–1.00, respectively), but the morbid obesity did not (HR: 0.99, 95% CI: 0.84–1.16). In addition, the subgroup analysis by sex showed that the overweight had the lowest mortality as compared with the normal weight (HR: 0.82, 95% CI: 0.74–0.90) and the obesity in males, but the risk of mortality did not differ among groups in females. Notably, the heterogeneity was significant in most of group comparisons. Conclusions Our meta-analysis showed a U-shaped relationship between BMI and all-cause mortality in patients with diabetes

  7. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies

    PubMed Central

    Keum, NaNa; Giovannucci, Edward; Fadnes, Lars T; Boffetta, Paolo; Greenwood, Darren C; Tonstad, Serena; Vatten, Lars J; Riboli, Elio; Norat, Teresa

    2016-01-01

    Objective To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. Data sources PubMed and Embase searched up to 3 April 2016. Study selection Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. Data synthesis Summary relative risks and 95% confidence intervals calculated with a random effects model. Results 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings—for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I2=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I2=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I2=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I2=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I2=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I2=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I2=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I2=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I2=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I2=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated

  8. Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

    PubMed Central

    Vandenheede, Hadewijch; Vikhireva, Olga; Pikhart, Hynek; Kubinova, Ruzena; Malyutina, Sofia; Pajak, Andrzej; Tamosiunas, Abdonas; Peasey, Anne; Simonova, Galina; Topor-Madry, Roman; Marmot, Michael; Bobak, Martin

    2014-01-01

    Background Relatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually all studies include only education. The aim of this study is to quantify and compare socioeconomic inequalities in all-cause mortality during the 2000s in urban population samples from four CEE/FSU countries, by three different measures of socioeconomic position (SEP) (education, difficulty buying food and household amenities), reflecting different aspects of SEP. Methods Data from the prospective population-based HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study were used. The baseline survey (2002–2005) included 16 812 men and 19 180 women aged 45–69 years in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and seven Czech towns. Deaths in the cohorts were identified through mortality registers. Data were analysed by direct standardisation and Cox regression, quantifying absolute and relative SEP differences. Results Mortality inequalities by the three SEP indicators were observed in all samples. The magnitude of inequalities varied according to gender, country and SEP measure. As expected, given the high mortality rates in Russian men, largest absolute inequalities were found among Russian men (educational slope index of inequality was 19.4 per 1000 person-years). Largest relative inequalities were observed in Czech men and Lithuanian subjects. Disadvantage by all three SEP measures remained strongly associated with increased mortality after adjusting for the other SEP indicators. Conclusions The results emphasise the importance of all SEP measures for understanding mortality inequalities in CEE/FSU. PMID:24227051

  9. Is the adiposity-associated FTO gene variant related to all-cause mortality independent of adiposity? Meta-analysis of data from 169,551 Caucasian adults

    PubMed Central

    Mirza, S. S.; Zhao, J. H.; Chasman, D. I.; Fischer, K.; Qi, Q.; Smith, A. V.; Thinggaard, M.; Jarczok, M. N.; Nalls, M. A.; Trompet, S.; Timpson, N. J.; Schmidt, B.; Jackson, A. U.; Lyytikäinen, L. P.; Verweij, N.; Mueller-Nurasyid, M.; Vikström, M.; Marques-Vidal, P.; Wong, A.; Meidtner, K.; Middelberg, R. P.; Strawbridge, R. J.; Christiansen, L.; Kyvik, K. O.; Hamsten, A.; Jääskeläinen, T.; Tjønneland, A.; Eriksson, J. G.; Whitfield, J. B.; Boeing, H.; Hardy, R.; Vollenweider, P.; Leander, K.; Peters, A.; van der Harst, P.; Kumari, M.; Lehtimäki, T.; Meirhaeghe, A.; Tuomilehto, J.; Jöckel, K.-H.; Ben-Shlomo, Y.; Sattar, N.; Baumeister, S. E.; Smith, G. Davey; Casas, J. P.; Houston, D. K.; März, W.; Christensen, K.; Gudnason, V.; Hu, F. B.; Metspalu, A.; Ridker, P. M.; Wareham, N. J.; Loos, R. J. F.; Tiemeier, H.; Sonestedt, E.; Sørensen, T. I. A.

    2015-01-01

    Summary Previously, a single nucleotide polymorphism (SNP), rs9939609, in the FTO gene showed a much stronger association with all-cause mortality than expected from its association with body mass index (BMI), body fat mass index (FMI) and waist circumference (WC). This finding implies that the SNP has strong pleiotropic effects on adiposity and adiposity-independent pathological pathways that leads to increased mortality. To investigate this further, we conducted a meta-analysis of similar data from 34 longitudinal studies including 169,551 adult Caucasians among whom 27,100 died during follow-up. Linear regression showed that the minor allele of the FTO SNP was associated with greater BMI (n = 169,551; 0.32 kg m−2; 95% CI 0.28–0.32, P < 1 × 10−32), WC (n = 152,631; 0.76 cm; 0.68–0.84, P < 1 × 10−32) and FMI (n = 48,192; 0.17 kg m−2; 0.13–0.22, P = 1.0 × 10−13). Cox proportional hazard regression analyses for mortality showed that the hazards ratio (HR) for the minor allele of the FTO SNPs was 1.02 (1.00–1.04, P = 0.097), but the apparent excess risk was eliminated after adjustment for BMI and WC (HR: 1.00; 0.98–1.03, P = 0.662) and for FMI (HR: 1.00; 0.96–1.04, P = 0.932). In conclusion, this study does not support that the FTO SNP is associated with all-cause mortality independently of the adiposity phenotypes. PMID:25752329

  10. Nondisease-Specific Problems and All-Cause Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

    PubMed Central

    Bowling, C. Barrett; Booth, John N.; Safford, Monika; Whitson, Heather E.; Ritchie, Christine; Wadley, Virginia G.; Cushman, Mary; Howard, Virginia; Allman, Richard M.; Muntner, Paul

    2013-01-01

    Background/Objectives Problems that cross multiple domains of health are frequently assessed in older adults. We evaluated the association between six of these nondisease-specific problems and mortality among middle-aged and older adults. Design Prospective, observational cohort Setting U.S. population sample Participants Participants included 23,669 black and white US adults ≥ 45 years of age enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements Nondisease-specific problems included cognitive impairment, depressive symptoms, falls, polypharmacy, impaired mobility and exhaustion. Age-stratified (<65, 65-74, and ≥ 75 years) hazard ratios for all-cause mortality were calculated for each problem individually and by number of problems. Results Among participants < 65, 65-74, ≥ 75 years old, one or more nondisease-specific problems occurred in 40%, 45% and 55% of participants, respectively. Compared to those with none of these problems the multivariable adjusted hazard ratios and 95% confidence intervals for all-cause mortality associated with each additional nondisease-specific problem was 1.34 (1.23–1.46), 1.24 (1.15–1.35) and 1.30 (1.21–1.39), among participants < 65, 65 – 74 years, ≥ 75 years of age, respectively. Conclusion Nondisease-specific problems were associated with mortality across a wide age spectrum. Future studies should determine if treating these problems will improve survival and identify innovative healthcare models to address multiple nondisease-specific problems simultaneously. PMID:23617688

  11. Is the adiposity-associated FTO gene variant related to all-cause mortality independent of adiposity? Meta-analysis of data from 169,551 Caucasian adults.

    PubMed

    Zimmermann, E; Ängquist, L H; Mirza, S S; Zhao, J H; Chasman, D I; Fischer, K; Qi, Q; Smith, A V; Thinggaard, M; Jarczok, M N; Nalls, M A; Trompet, S; Timpson, N J; Schmidt, B; Jackson, A U; Lyytikäinen, L P; Verweij, N; Mueller-Nurasyid, M; Vikström, M; Marques-Vidal, P; Wong, A; Meidtner, K; Middelberg, R P; Strawbridge, R J; Christiansen, L; Kyvik, K O; Hamsten, A; Jääskeläinen, T; Tjønneland, A; Eriksson, J G; Whitfield, J B; Boeing, H; Hardy, R; Vollenweider, P; Leander, K; Peters, A; van der Harst, P; Kumari, M; Lehtimäki, T; Meirhaeghe, A; Tuomilehto, J; Jöckel, K-H; Ben-Shlomo, Y; Sattar, N; Baumeister, S E; Davey Smith, G; Casas, J P; Houston, D K; März, W; Christensen, K; Gudnason, V; Hu, F B; Metspalu, A; Ridker, P M; Wareham, N J; Loos, R J F; Tiemeier, H; Sonestedt, E; Sørensen, T I A

    2015-04-01

    Previously, a single nucleotide polymorphism (SNP), rs9939609, in the FTO gene showed a much stronger association with all-cause mortality than expected from its association with body mass index (BMI), body fat mass index (FMI) and waist circumference (WC). This finding implies that the SNP has strong pleiotropic effects on adiposity and adiposity-independent pathological pathways that leads to increased mortality. To investigate this further, we conducted a meta-analysis of similar data from 34 longitudinal studies including 169,551 adult Caucasians among whom 27,100 died during follow-up. Linear regression showed that the minor allele of the FTO SNP was associated with greater BMI (n = 169,551; 0.32 kg m(-2) ; 95% CI 0.28-0.32, P < 1 × 10(-32) ), WC (n = 152,631; 0.76 cm; 0.68-0.84, P < 1 × 10(-32) ) and FMI (n = 48,192; 0.17 kg m(-2) ; 0.13-0.22, P = 1.0 × 10(-13) ). Cox proportional hazard regression analyses for mortality showed that the hazards ratio (HR) for the minor allele of the FTO SNPs was 1.02 (1.00-1.04, P = 0.097), but the apparent excess risk was eliminated after adjustment for BMI and WC (HR: 1.00; 0.98-1.03, P = 0.662) and for FMI (HR: 1.00; 0.96-1.04, P = 0.932). In conclusion, this study does not support that the FTO SNP is associated with all-cause mortality independently of the adiposity phenotypes. PMID:25752329

  12. Single nucleotide polymorphisms in obesity-related genes and all-cause and cause-specific mortality: a prospective cohort study

    PubMed Central

    Gallicchio, Lisa; Chang, Howard H; Christo, Dana K; Thuita, Lucy; Huang, Han Yao; Strickland, Paul; Ruczinski, Ingo; Clipp, Sandra; Helzlsouer, Kathy J

    2009-01-01

    Background The aim of this study was to examine the associations between 16 specific single nucleotide polymorphisms (SNPs) in 8 obesity-related genes and overall and cause-specific mortality. We also examined the associations between the SNPs and body mass index (BMI) and change in BMI over time. Methods Data were analyzed from 9,919 individuals who participated in two large community-based cohort studies conducted in Washington County, Maryland in 1974 (CLUE I) and 1989 (CLUE II). DNA from blood collected in 1989 was genotyped for 16 SNPs in 8 obesity-related genes: monoamine oxidase A (MAOA), lipoprotein lipase (LPL), paraoxonase 1 and 2 (PON1 and PON2), leptin receptor (LEPR), tumor necrosis factor-α (TNFα), and peroxisome proliferative activated receptor-γ and -δ (PPARG and PPARD). Data on height and weight in 1989 (CLUE II baseline) and at age 21 were collected from participants at the time of blood collection. All participants were followed from 1989 to the date of death or the end of follow-up in 2005. Cox proportional hazards regression was used to obtain the relative risk (RR) estimates and 95% confidence intervals (CI) for each SNP and mortality outcomes. Results The results showed no patterns of association for the selected SNPs and the all-cause and cause-specific mortality outcomes, although statistically significant associations (p < 0.05) were observed between PPARG rs4684847 and all-cause mortality (CC: reference; CT: RR 0.99, 95% CI 0.89, 1.11; TT: RR 0.60, 95% CI 0.39, 0.93) and cancer-related mortality (CC: reference; CT: RR 1.01, 95% CI 0.82, 1.25; TT: RR 0.22, 95% CI 0.06, 0.90) and TNFα rs1799964 and cancer-related mortality (TT: reference; CT: RR 1.23, 95% CI 1.03, 1.47; CC: RR 0.83, 95% CI 0.54, 1.28). Additional analyses showed significant associations between SNPs in LEPR with BMI (rs1137101) and change in BMI over time (rs1045895 and rs1137101). Conclusion Findings from this cohort study suggest that the selected SNPs are not

  13. Elevated AST-to-platelet ratio index is associated with increased all-cause mortality among HIV-infected adults in Zambia

    PubMed Central

    Vinikoor, Michael J.; Sinkala, Edford; Mweemba, Aggrey; Zanolini, Arianna; Mulenga, Lloyd; Sikazwe, Izukanji; Fried, Michael W.; Eron, Joseph J.; Wandeler, Gilles; Chi, Benjamin H.

    2015-01-01

    Background and Aims We investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in Zambia Methods Among HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunologic status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART. Results Among 20,308 adults in the analysis cohort, 1,027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4+ count <200 cells/mm3, and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71–10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21–1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31–1.89) were associated with increased all-cause mortality. Conclusion Liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings. PMID:25581487

  14. Neighbourhood Characteristics and Long-Term Air Pollution Levels Modify the Association between the Short-Term Nitrogen Dioxide Concentrations and All-Cause Mortality in Paris

    PubMed Central

    Deguen, Séverine; Petit, Claire; Delbarre, Angélique; Kihal, Wahida; Padilla, Cindy; Benmarhnia, Tarik; Lapostolle, Annabelle; Chauvin, Pierre; Zmirou-Navier, Denis

    2015-01-01

    Background While a great number of papers have been published on the short-term effects of air pollution on mortality, few have tried to assess whether this association varies according to the neighbourhood socioeconomic level and long-term ambient air concentrations measured at the place of residence. We explored the effect modification of 1) socioeconomic status, 2) long-term NO2 ambient air concentrations, and 3) both combined, on the association between short-term exposure to NO2 and all-cause mortality in Paris (France). Methods A time-stratified case-crossover analysis was performed to evaluate the effect of short-term NO2 variations on mortality, based on 79,107 deaths having occurred among subjects aged over 35 years, from 2004 to 2009, in the city of Paris. Simple and double interactions were statistically tested in order to analyse effect modification by neighbourhood characteristics on the association between mortality and short-term NO2 exposure. The data was estimated at the census block scale (n=866). Results The mean of the NO2 concentrations during the five days prior to deaths were associated with an increased risk of all-cause mortality: overall Excess Risk (ER) was 0.94% (95%CI=[0.08;1.80]. A higher risk was revealed for subjects living in the most deprived census blocks in comparison with higher socioeconomic level areas (ER=3.14% (95%CI=[1.41-4.90], p<0.001). Among these deprived census blocks, excess risk was even higher where long-term average NO2 concentrations were above 55.8 μg/m3 (the top tercile of distribution): ER=4.84% (95%CI=[1.56;8.24], p for interaction=0.02). Conclusion Our results show that people living in census blocks characterized by low socioeconomic status are more vulnerable to air pollution episodes. There is also an indication that people living in these disadvantaged census blocks might experience even higher risk following short-term air pollution episodes, when they are also chronically exposed to higher NO2 levels

  15. Factors Associated With Cancer Incidence and With All-Cause Mortality After Cancer Diagnosis Among Human Immunodeficiency Virus-Infected Persons During the Combination Antiretroviral Therapy Era

    PubMed Central

    Patel, Pragna; Armon, Carl; Chmiel, Joan S.; Brooks, John T.; Buchacz, Kate; Wood, Kathy; Novak, Richard M.

    2014-01-01

    Background.  Little is known about survival and factors associated with mortality after cancer diagnosis among persons infected with human immunodeficiency virus (HIV). Methods.  Using Poisson regression, we analyzed incidence rates of acquired immune deficiency syndrome (AIDS)-defining cancers (ADC), non-AIDS-defining infection-related cancers (NADCI), and non-AIDS-defining noninfection-related cancers (NADCNI) among HIV Outpatient Study participants seen at least twice from 1996–2010. All-cause mortality within each cancer category and by calendar period (1996–2000, 2001–2005, 2006–2010) were examined using Kaplan-Meier survival methods and log-rank tests. We identified risk factors for all-cause mortality using multivariable Cox proportional hazard models. Results.  Among 8350 patients, 627 were diagnosed with 664 cancers. Over the 3 time periods, the age- and sex-adjusted incidence rates for ADC and NADCNI declined (both P < .001) and for NADCI did not change (P = .13). Five-year survival differed by cancer category (ADC, 54.5%; NADCI, 65.8%; NADCNI, 65.9%; P = .018), as did median CD4 cell count (107, 241, and 420 cells/mm3; P < .001) and median log10 viral load (4.1, 2.3, and 2.0 copies/mL; P < .001) at cancer diagnosis, respectively. Factors independently associated with increased mortality for ADC were lower nadir CD4 cell count (hazard ratio [HR] = 3.02; 95% confidence interval [CI], 1.39–6.59) and detectable viral load (≥400 copies/mL; HR = 1.72 [95% CI, 1.01–2.94]) and for NADCNI, age (HR = 1.50 [95% CI, 1.16–1.94]), non-Hispanic black race (HR = 1.92 [95% CI, 1.15–3.24]), lower nadir CD4 cell count (HR = 1.77 [95% CI, 1.07–2.94]), detectable viral load (HR = 1.96 [95% CI, 1.18–3.24]), and current or prior tobacco use (HR = 3.18 [95% CI, 1.77–5.74]). Conclusions.  Since 1996, ADC and NADCNI incidence rates have declined. Survival after cancer diagnosis has increased with concomitant increases in CD4 cell count in recent

  16. Association between Insulin Monotherapy versus Insulin plus Metformin and the Risk of All-Cause Mortality and Other Serious Outcomes: A Retrospective Cohort Study

    PubMed Central

    Holden, Sarah E.; Jenkins-Jones, Sara; Currie, Craig J.

    2016-01-01

    Aims To determine if concomitant metformin reduced the risk of death, major adverse cardiac events (MACE), and cancer in people with type 2 diabetes treated with insulin. Methods For this retrospective cohort study, people with type 2 diabetes who progressed to insulin with or without metformin from 2000 onwards were identified from the UK Clinical Practice Research Datalink (≈7% sample of the UK population). The risks of all-cause mortality, MACE and incident cancer were evaluated using multivariable Cox models comparing insulin monotherapy with insulin plus metformin. We accounted for insulin dose. Results 12,020 subjects treated with insulin were identified, including 6,484 treated with monotherapy. There were 1,486 deaths, 579 MACE (excluding those with a history of large vessel disease), and 680 cancer events (excluding those in patients with a history of cancer). Corresponding event rates were 41.5 (95% CI 39.4–43.6) deaths, 20.8 (19.2–22.5) MACE, and 21.6 (20.0–23.3) cancer events per 1,000 person-years. The adjusted hazard ratios (aHRs) for people prescribed insulin plus metformin versus insulin monotherapy were 0.60 (95% CI 0.52–0.68) for all-cause mortality, 0.75 (0.62–0.91) for MACE, and 0.96 (0.80–1.15) for cancer. For patients who were propensity-score matched, the corresponding aHRs for all-cause mortality and cancer were 0.62 (0.52–0.75) and 0.99 (0.78–1.26), respectively. For MACE, the aHR was 1.06 (0.75–1.49) prior to 1,275 days and 1.87 (1.22–2.86) after 1,275 days post-index. Conclusions People with type 2 diabetes treated with insulin plus concomitant metformin had a reduced risk of death and MACE compared with people treated with insulin monotherapy. There was no statistically significant difference in the risk of cancer between people treated with insulin as monotherapy or in combination with metformin. PMID:27152598

  17. High sodium:potassium intake ratio increases the risk for all-cause mortality: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

    PubMed

    Judd, Suzanne E; Aaron, Kristal J; Letter, Abraham J; Muntner, Paul; Jenny, Nancy S; Campbell, Ruth C; Kabagambe, Edmond K; Levitan, Emily B; Levine, Deborah A; Shikany, James M; Safford, Monika; Lackland, Daniel T

    2013-01-01

    Increased dietary Na intake and decreased dietary K intake are associated with higher blood pressure. It is not known whether the dietary Na:K ratio is associated with all-cause mortality or stroke incidence and whether this relationship varies according to race. Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans aged 45 years or older. Diet was assessed using the Block 98 FFQ and was available on 21 374 participants. The Na:K ratio was modelled in race- and sex-specific quintiles for all analyses, with the lowest quintile (Q1) as the reference group. Data on other covariates were collected using both an in-home assessment and telephone interviews. We identified 1779 deaths and 363 strokes over a mean of 4·9 years. We used Cox proportional hazards models to obtain multivariable-adjusted hazard ratios (HR). In the highest quintile (Q5), a high Na:K ratio was associated with all-cause mortality (Q5 v. Q1 for whites: HR 1·22; 95 % CI 1·00, 1·47, P for trend = 0·084; for blacks: HR 1·36; 95 % CI 1·04, 1·77, P for trend = 0·028). A high Na:K ratio was not significantly associated with stroke in whites (HR 1·29; 95 % CI 0·88, 1·90) or blacks (HR 1·39; 95 % CI 0·78, 2·48), partly because of the low number of stroke events. In the REGARDS study, a high Na:K ratio was associated with all-cause mortality and there was a suggestive association between the Na:K ratio and stroke. These data support the policies targeted at reduction of Na from the food supply and recommendations to increase K intake. PMID:25191561

  18. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts

    PubMed Central

    Coombs, Ngaire; Stamatakis, Emmanuel; Biddulph, Jane P

    2015-01-01

    Objectives To examine the suitability of age specific limits for alcohol consumption and to explore the association between alcohol consumption and mortality in different age groups. Design Population based data from Health Survey for England 1998-2008, linked to national mortality registration data and pooled for analysis using proportional hazards regression. Analyses were stratified by sex and age group (50-64 and ≥65 years). Setting Up to 10 waves of the Health Survey for England, which samples the non-institutionalised general population resident in England. Participants The derivation of two analytical samples was based on the availability of comparable alcohol consumption data, covariate data, and linked mortality data among adults aged 50 years or more. Two samples were used, each utilising a different variable for alcohol usage: self reported average weekly consumption over the past year and self reported consumption on the heaviest day in the past week. In fully adjusted analyses, the former sample comprised Health Survey for England years 1998-2002, 18 368 participants, and 4102 deaths over a median follow-up of 9.7 years, whereas the latter comprised Health Survey for England years 1999-2008, 34 523 participants, and 4220 deaths over a median follow-up of 6.5 years. Main outcome measure All cause mortality, defined as any death recorded between the date of interview and the end of data linkage on 31 March 2011. Results In unadjusted models, protective effects were identified across a broad range of alcohol usage in all age-sex groups. These effects were attenuated across most use categories on adjustment for a range of personal, socioeconomic, and lifestyle factors. After the exclusion of former drinkers, these effects were further attenuated. Compared with self reported never drinkers, significant protective associations were limited to younger men (50-64 years) and older women (≥65 years). Among younger men, the range of protective effects was

  19. Low Systolic Blood Pressure and Mortality From All Causes and Vascular Diseases Among Older Middle-aged Men: Korean Veterans Health Study

    PubMed Central

    Yi, Sang-Wook; Ohrr, Heechoul

    2015-01-01

    Objectives: Recently, low systolic blood pressure (SBP) was found to be associated with an increased risk of death from vascular diseases in a rural elderly population in Korea. However, evidence on the association between low SBP and vascular diseases is scarce. The aim of this study was to prospectively examine the association between low SBP and mortality from all causes and vascular diseases in older middle-aged Korean men. Methods: From 2004 to 2010, 94 085 Korean Vietnam War veterans were followed-up for deaths. The adjusted hazard ratios (aHR) were calculated using the Cox proportional hazard model. A stratified analysis was conducted by age at enrollment. SBP was self-reported by a postal survey in 2004. Results: Among the participants aged 60 and older, the lowest SBP (<90 mmHg) category had an elevated aHR for mortality from all causes (aHR, 1.9; 95% confidence interval [CI], 1.2 to 3.1) and vascular diseases (International Classification of Disease, 10th revision, I00-I99; aHR, 3.2; 95% CI, 1.2 to 8.4) compared to those with an SBP of 100 to 119 mmHg. Those with an SBP below 80 mmHg (aHR, 4.5; 95% CI, 1.1 to 18.8) and those with an SBP of 80 to 89 mmHg (aHR, 3.1; 95% CI, 0.9 to 10.2) also had an increased risk of vascular mortality, compared to those with an SBP of 90 to 119 mmHg. This association was sustained when excluding the first two years of follow-up or preexisting vascular diseases. In men younger than 60 years, the association of low SBP was weaker than that in those aged 60 years or older. Conclusions: Our findings suggest that low SBP (<90 mmHg) may increase vascular mortality in Korean men aged 60 years or older. PMID:25857648

  20. Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies

    PubMed Central

    Hu, Frank B; Wu, Kana; Must, Aviva; Chan, Andrew T; Willett, Walter C; Giovannucci, Edward L

    2016-01-01

    Objective To assess body shape trajectories in early and middle life in relation to risk of mortality. Design Prospective cohort study. Setting Nurses’ Health Study and Health Professionals Follow-up Study. Population 80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and provided body mass index at age 50, followed from age 60 over a median of 15-16 years for death. Main outcome measures All cause and cause specific mortality. Results Using a group based modeling approach, five distinct trajectories of body shape from age 5 to 50 were identified: lean-stable, lean-moderate increase, lean-marked increase, medium-stable/increase, and heavy-stable/increase. The lean-stable group was used as the reference. Among never smokers, the multivariable adjusted hazard ratio for death from any cause was 1.08 (95% confidence interval 1.02 to 1.14) for women and 0.95 (0.88 to 1.03) for men in the lean-moderate increase group, 1.43 (1.33 to 1.54) for women and 1.11 (1.02 to 1.20) for men in the lean-marked increase group, 1.04 (0.97 to 1.12) for women and 1.01 (0.94 to 1.09) for men in the medium-stable/increase group, and 1.64 (1.49 to 1.81) for women and 1.19 (1.08 to 1.32) for men in the heavy-stable/increase group. For cause specific mortality, participants in the heavy-stable/increase group had the highest risk, with a hazard ratio among never smokers of 2.30 (1.88 to 2.81) in women and 1.45 (1.23 to 1.72) in men for cardiovascular disease, 1.37 (1.14 to 1.65) in women and 1.07 (0.89 to 1.30) in men for cancer, and 1.59 (1.38 to 1.82) in women and 1.10 (0.95 to 1.29) in men for other causes. The trajectory-mortality association was generally weaker among ever smokers than among never smokers (for all cause mortality: P for interaction <0.001 in women and 0.06 in men). When participants were classified jointly according to trajectories and history of type 2 diabetes, the increased risk of death associated with heavier

  1. All-Cause Mortality in Patients with Type 2 Diabetes in Association with Achieved Hemoglobin A1c, Systolic Blood Pressure, and Low-Density Lipoprotein Cholesterol Levels

    PubMed Central

    Chiang, Hou-Hsien; Tseng, Fen-Yu; Wang, Chih-Yuan; Chen, Chi-Ling; Chen, Yi-Chun; See, Ting-Ting; Chen, Hua-Fen

    2014-01-01

    Background To identify the ranges of hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels which are associated with the lowest all-cause mortality. Methods A retrospective cohort of 12,643 type 2 diabetic patients (aged ≥18 years) were generated from 2002 to 2010, in Far-Eastern Memorial Hospital, New Taipei city, Taiwan. Patients were identified to include any outpatient diabetes diagnosis (ICD-9: 250), and drug prescriptions that included any oral hypoglycemic agents or insulin prescribed during the 6 months following their first outpatient visit for diabetes. HbA1c, SBP, and LDL-C levels were assessed by the mean value of all available data, from index date to death or censor date. Deaths were ascertained by matching patient records with the Taiwan National Register of Deaths. Results Our results showed general U-shaped associations, where the lowest hazard ratios occurred at HbA1c 7.0–8.0%, SBP 130–140 mmHg, and LDL-C 100–130 mg/dL. The risk of mortality gradually increases if the patient's mean HbA1c, SBP, or LDL-C during the follow-up period was higher or lower than these ranges. In comparison to the whole population, the adjusted hazard ratio (95% CI) for patients with HbA1c 7.0–8.0%, SBP 130–140 mmHg, and LDL-C 100–130 mg/dL were 0.69 (0.62–0.77), 0.80 (0.72–0.90), and 0.68 (0.61–0.75), respectively. Conclusions In our type 2 diabetic cohort, the patients with HbA1c 7.0–8.0%, SBP 130–140 mmHg, or LDL-C 100–130 mg/dL had the lowest all-cause mortality. Additional research is needed to confirm these associations and to further investigate their detailed mechanisms. PMID:25347712

  2. Early Fungicidal Activity as a Candidate Surrogate Endpoint for All-Cause Mortality in Cryptococcal Meningitis: A Systematic Review of the Evidence

    PubMed Central

    Montezuma-Rusca, Jairo M.; Powers, John H.; Follmann, Dean; Wang, Jing; Sullivan, Brigit; Williamson, Peter R.

    2016-01-01

    Background Cryptococcal meningitis (CM) is a leading cause of HIV-associated mortality. In clinical trials evaluating treatments for CM, biomarkers of early fungicidal activity (EFA) in cerebrospinal fluid (CSF) have been proposed as candidate surrogate endpoints for all- cause mortality (ACM). However, there has been no systematic evaluation of the group-level or trial-level evidence for EFA as a candidate surrogate endpoint for ACM. Methods We conducted a systematic review of randomized trials in treatment of CM to evaluate available evidence for EFA measured as culture negativity at 2 weeks/10 weeks and slope of EFA as candidate surrogate endpoints for ACM. We performed sensitivity analysis on superiority trials and high quality trials as determined by Cochrane measures of trial bias. Results Twenty-seven trials including 2854 patients met inclusion criteria. Mean ACM was 15.8% at 2 weeks and 27.0% at 10 weeks with no overall significant difference between test and control groups. There was a statistically significant group-level correlation between average EFA and ACM at 10 weeks but not at 2 weeks. There was also no statistically significant group-level correlation between CFU culture negativity at 2weeks/10weeks or average EFA slope at 10 weeks. A statistically significant trial-level correlation was identified between EFA slope and ACM at 2 weeks, but is likely misleading, as there was no treatment effect on ACM. Conclusions Mortality remains high in short time periods in CM clinical trials. Using published data and Institute of Medicine criteria, evidence for use of EFA as a surrogate endpoint for ACM is insufficient and could provide misleading results from clinical trials. ACM should be used as a primary endpoint evaluating treatments for cryptococcal meningitis. PMID:27490100

  3. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    SciTech Connect

    Nguyen, Paul L.; Chen, Ming-Hui; Beckman, Joshua A.; Beard, Clair J.; Martin, Neil E.; Choueiri, Toni K.; Hu, Jim C.; Dosoretz, Daniel E.; Moran, Brian J.; Salenius, Sharon A.; Braccioforte, Michelle H.; Kantoff, Philip W.; D'Amico, Anthony V.; Ennis, Ronald D.

    2012-03-15

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  4. Parental Incarceration and Child Mortality in Denmark

    PubMed Central

    Andersen, Signe Hald; Lee, Hedwig; Karlson, Kristian Bernt

    2014-01-01

    Objectives. We used Danish registry data to examine the association between parental incarceration and child mortality risk. Methods. We used a sample of all Danish children born in 1991 linked with parental information. We conducted discrete-time survival analysis separately for boys (n = 30 146) and girls (n = 28 702) to estimate the association of paternal and maternal incarceration with child mortality, controlling for parental sociodemographic characteristics. We followed the children until age 20 years or death, whichever came first. Results. Results indicated a positive association between paternal and maternal imprisonment and male child mortality. Paternal imprisonment was associated with lower child mortality risks for girls. The relationship between maternal imprisonment and female child mortality changed directions depending on the model, suggesting no clear association. Conclusions. These results indicate that the incarceration of a parent may influence child mortality but that it is important to consider the gender of both the child and the incarcerated parent. PMID:24432916

  5. On hunger and child mortality in India.

    PubMed

    Gaiha, Raghav; Kulkarni, Vani S; Pandey, Manoj K; Imai, Katsushi S

    2012-01-01

    Despite accelerated growth there is pervasive hunger, child undernutrition and mortality in India. Our analysis focuses on their determinants. Raising living standards alone will not reduce hunger and undernutrition. Reduction of rural/urban disparities, income inequality, consumer price stabilization, and mothers’ literacy all have roles of varying importance in different nutrition indicators. Somewhat surprisingly, public distribution system (PDS) do not have a significant effect on any of them. Generally, child undernutrition and mortality rise with poverty. Our analysis confirms that media exposure triggers public action, and helps avert child undernutrition and mortality. Drastic reduction of economic inequality is in fact key to averting child mortality, conditional upon a drastic reordering of social and economic arrangements. PMID:22451985

  6. Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality.

    PubMed

    Edmondson, Donald; Rieckmann, Nina; Shaffer, Jonathan A; Schwartz, Joseph E; Burg, Matthew M; Davidson, Karina W; Clemow, Lynn; Shimbo, Daichi; Kronish, Ian M

    2011-12-01

    Approximately 15% of patients with acute coronary syndromes (ACS) develop posttraumatic stress disorder (PTSD) due to their ACS event. We assessed whether ACS-induced PTSD symptoms increase risk for major adverse cardiac events (MACE) and all-cause mortality (ACM) in an observational cohort study of 247 patients (aged 25-93 years; 45% women) hospitalized for an ACS at one of 3 academic medical centers in New York and Connecticut between November 2003 and June 2005. Within 1 week of admission, patient demographics, Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, and depression status were obtained. At 1-month follow-up, ACS-induced PTSD symptoms were assessed with the Impact of Events Scale-Revised. The primary endpoint was combined MACE (hospitalization for myocardial infarction, unstable angina or urgent/emergency coronary revascularization procedures) and ACM, which were actively surveyed for 42 months after index event. Thirty-six (15%) patients had elevated intrusion symptoms, 32 (13%) elevated avoidance symptoms, and 21 (9%) elevated hyperarousal symptoms. Study physicians adjudicated 21 MACEs and 15 deaths during the follow-up period. In unadjusted Cox proportional hazards regression analyses, and analyses adjusted for sex, age, clinical characteristics and depression, high intrusion symptoms were associated with the primary endpoint (adjusted hazard ratio, 3.38; 95% confidence interval, 1.27-9.02; p = .015). Avoidance and hyperarousal symptoms were not associated with the primary endpoint. The presence of intrusion symptoms is a strong and independent predictor of elevated risk for MACE and ACM, and should be considered in the risk stratification of ACS patients. PMID:21807378

  7. Statistical Analysis of Factors Affecting Child Mortality in Pakistan.

    PubMed

    Ahmed, Zoya; Kamal, Asifa; Kamal, Asma

    2016-06-01

    Child mortality is a composite indicator reflecting economic, social, environmental, healthcare services, and their delivery situation in a country. Globally, Pakistan has the third highest burden of fetal, maternal, and child mortality. Factors affecting child mortality in Pakistan are investigated by using Binary Logistic Regression Analysis. Region, education of mother, birth order, preceding birth interval (the period between the previous child birth and the index child birth), size of child at birth, and breastfeeding and family size were found to be significantly important with child mortality in Pakistan. Child mortality decreased as level of mother's education, preceding birth interval, size of child at birth, and family size increased. Child mortality was found to be significantly higher in Balochistan as compared to other regions. Child mortality was low for low birth orders. Child survival was significantly higher for children who were breastfed as compared to those who were not. PMID:27354000

  8. Maternal education and child mortality in Zimbabwe.

    PubMed

    Grépin, Karen A; Bharadwaj, Prashant

    2015-12-01

    In 1980, Zimbabwe rapidly expanded access to secondary schools, providing a natural experiment to estimate the impact of increased maternal secondary education on child mortality. Exploiting age specific exposure to these reforms, we find that children born to mothers most likely to have benefited from the policies were about 21% less likely to die than children born to slightly older mothers. We also find that increased education leads to delayed age at marriage, sexual debut, and first birth and that increased education leads to better economic opportunities for women. We find little evidence supporting other channels through which increased education might affect child mortality. Expanding access to secondary schools may greatly accelerate declines in child mortality in the developing world today. PMID:26569469

  9. Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study

    PubMed Central

    Joshy, Grace; Arora, Manish; Korda, Rosemary J; Chalmers, John; Banks, Emily

    2016-01-01

    Objective To investigate the relationship between oral health and incident hospitalisation for ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke and peripheral vascular disease (PVD) and all-cause mortality. Design Prospective population-based study of Australian men and women aged 45 years or older, who were recruited to the 45 and Up Study between January 2006 and April 2009; baseline questionnaire data were linked to hospitalisations and deaths up to December 2011. Study exposures include tooth loss and self-rated health of teeth and gums at baseline. Setting New South Wales, Australia. Participants Individuals aged 45–75 years, excluding those with a history of cancer/cardiovascular disease (CVD) at baseline; n=172 630. Primary outcomes Incident hospitalisation for IHD, HF, ischaemic stroke and PVD and all-cause mortality. Results During a median follow-up of 3.9 years, 3239 incident hospitalisations for IHD, 212 for HF, 283 for ischaemic stroke and 359 for PVD, and 1908 deaths, were observed. Cox proportional hazards models examined the relationship between oral health indicators and incident hospitalisation for CVD and all-cause mortality, adjusting for potential confounding factors. All-cause mortality and incident CVD hospitalisation risk increased significantly with increasing tooth loss for all outcomes except ischaemic stroke (ptrend<0.05). In those reporting no teeth versus ≥20 teeth left, risks were increased for HF (HR, 95% CI 1.97, 1.27 to 3.07), PVD (2.53, 1.81 to 3.52) and all-cause mortality (1.60, 1.37 to 1.87). The risk of IHD, PVD and all-cause mortality (but not HF or ischaemic stroke) increased significantly with worsening self-rated health of teeth and gums (ptrend<0.05). In those reporting poor versus very good health of teeth and gums, risks were increased for IHD (1.19, 1.03 to 1.38), PVD (1.66, 1.13 to 2.43) and all-cause mortality (1.76, 1.50 to 2.08). Conclusions Tooth loss and, to a lesser extent, self

  10. Small area-level socioeconomic status and all-cause mortality within 10 years in a population-based cohort of women: Data from the Geelong Osteoporosis Study

    PubMed Central

    Brennan-Olsen, Sharon L.; Williams, Lana J.; Holloway, Kara L.; Hosking, Sarah M.; Stuart, Amanda L.; Dobbins, Amelia G.; Pasco, Julie A.

    2015-01-01

    Background The social gradient of health and mortality is well-documented. However, data are scarce regarding whether differences in mortality are observed across socio-economic status (SES) measured at the small area-level. We investigated associations between area-level SES and all-cause mortality in Australian women aged ≥ 20 years. Methods We examined SES, obesity, hypertension, lifestyle behaviors and all-cause mortality within 10 years post-baseline (1994), for 1494 randomly-selected women. Participants' residential addresses were matched to Australian Bureau of Statistics Census data to identify area-level SES, and deaths were ascertained from the Australian National Deaths Index. Logistic regression models were adjusted for age, and subsequent adjustments made for measures of weight status and lifestyle behaviors. Results We observed 243 (16.3%) deaths within 10 years post-baseline. Females in SES quintiles 2–4 (less disadvantaged) had lower odds of mortality (0.49–0.59) compared to SES quintile 1 (most disadvantaged) under the best model, after adjusting for age, smoking status and low mobility. Conclusions Compared to the lowest SES quintile (most disadvantaged), females in quintiles 2 to 5 (less disadvantaged) had significantly lower odds ratio of all-cause mortality within 10 years. Associations between extreme social disadvantage and mortality warrant further attention from research, public health and policy arenas. PMID:26844110

  11. Fish, omega-3 long-chain fatty acids, and all-cause mortality in a low-income US population: results from the Southern Community Cohort Study

    PubMed Central

    Villegas, R; Takata, Y; Murff, H; Blot, WJ

    2015-01-01

    Background We examined associations between fish and n-3 LCFA and mortality in a prospective study with a large proportion of blacks with low socio-economic status. Methods and Results We observed 6,914 deaths among 77,604 participants with dietary data (follow-up time 5.5 years). Of these, 77,100 participants had available time-to-event data. We investigated associations between mortality with fish and n-3 LCFA intake, adjusting for age, race, sex, kcals/day, body mass index (BMI), smoking, alcohol consumption, physical activity, income, education, chronic disease, insurance coverage, and meat intake. Intakes of fried fish, baked/grilled fish and total fish, but not tuna, were associated with lower mortality among all participants. Analysis of trends in overall mortality by quintiles of intake showed that intakes of fried fish, baked/grilled fish and total fish, but not tuna, were associated with lower risk of total mortality among all participants. When participants with chronic disease were excluded, the observed association remained only between intakes of baked/grilled fish, while fried fish was associated with lower risk of mortality in participants with prevalent chronic disease. The association between n-3 LCFA intake and lower risk of mortality was significant among those with diabetes at baseline. There was an inverse association of mortality with fried fish intake in men, but not women. Total fish and baked/grilled fish intakes were associated with lower mortality among blacks while fried fish intake was associated with lower mortality among whites. Effect modifications were not statistically significant. Conclusion Our findings suggest a modest benefit of fish consumption on mortality. PMID:26026210

  12. Labor migration and child mortality in Mozambique

    PubMed Central

    Yabiku, Scott T.; Agadjanian, Victor; Cau, Boaventura

    2013-01-01

    Male labor migration is widespread in many parts of the world, yet its consequences for child outcomes and especially childhood mortality remain unclear. Male labor migration could bring benefits, in the form of remittances, to the families that remain behind and thus help child survival. Alternatively, the absence of a male adult could imperil the household's well-being and its ability to care for its members, increasing child mortality risks. In this analysis, we use longitudinal survey data from Mozambique collected in 2006 and 2009 to examine the association between male labor migration and under-five mortality in families that remain behind. Using a simple migrant/non-migrant dichotomy, we find no difference in mortality rates across migrant and non-migrant men's children. When we separated successful from unsuccessful migration based on the wife's perception, however, stark contrasts emerge: children of successful migrants have the lowest mortality, followed by children of non-migrant men, followed by the children of unsuccessful migrants. Our results illustrate the need to account for the diversity of men's labor migration experience in examining the effects of migration on left-behind households. PMID:23121856

  13. Association of Heart-Type Fatty Acid-Binding Protein with Cardiovascular Risk Factors and All-Cause Mortality in the General Population: The Takahata Study

    PubMed Central

    Otaki, Yoichiro; Watanabe, Tetsu; Takahashi, Hiroki; Hirayama, Atushi; Narumi, Taro; Kadowaki, Shinpei; Honda, Yuki; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Konta, Tsuneo; Shibata, Yoko; Fukao, Akira; Daimon, Makoto; Ueno, Yoshiyuki; Kato, Takeo; Kayama, Takamasa; Kubota, Isao

    2014-01-01

    Background Despite many recent advances in medicine, preventing the development of cardiovascular diseases remains a challenge. Heart-type fatty acid-binding protein (H-FABP) is a marker of ongoing myocardial damage and has been reported to be a useful indicator for future cardiovascular events. However, it remains to be determined whether H-FABP can predict all-cause and cardiovascular deaths in the general population. Methods and Results This longitudinal cohort study included 3,503 subjects who participated in a community-based health checkup with a 7-year follow-up. Serum H-FABP was measured in registered subjects. The results demonstrated that higher H-FABP levels were associated with increasing numbers of cardiovascular risk factors, including hypertension, diabetes mellitus, obesity, and metabolic syndrome. There were 158 deaths during the follow-up period, including 50 cardiovascular deaths. Deceased subjects had higher H-FABP levels compared to surviving subjects. Multivariate Cox proportional hazard regression analysis revealed that H-FABP is an independent predictor of all-cause and cardiovascular deaths after adjustments for confounding factors. Subjects were divided into four quartiles according to H-FABP level, and Kaplan-Meier analysis demonstrated that the highest H-FABP quartile was associated with the greatest risks for all-cause and cardiovascular deaths. Net reclassification index and integrated discrimination index were significantly increased by addition of H-FABP to cardiovascular risk factors. Conclusions H-FABP level was increased in association with greater numbers of cardiovascular risk factors and was an independent risk factor for all-cause and cardiovascular deaths. H-FABP could be a useful indicator for the early identification of high-risk subjects in the general population. PMID:24847804

  14. Predictive Validity of the American College of Cardiology/American Heart Association Pooled Cohort Equations in Predicting All-Cause and Cardiovascular Disease-Specific Mortality in a National Prospective Cohort Study of Adults in the United States.

    PubMed

    Loprinzi, Paul D; Addoh, Ovuokerie

    2016-06-01

    The predictive validity of the Pooled Cohort risk (PCR) equations for cardiovascular disease (CVD)-specific and all-cause mortality among a national sample of US adults has yet to be evaluated, which was this study's purpose. Data from the 1999-2010 National Health and Nutrition Examination Survey were used, with participants followed up through December 31, 2011, to ascertain mortality status via the National Death Index probabilistic algorithm. The analyzed sample included 11,171 CVD-free adults (40-79 years of age). The 10-year risk of a first atherosclerotic cardiovascular disease (ASCVD) event was determined from the PCR equations. For the entire sample encompassing 849,202 person-months, we found an incidence rate of 1.00 (95% CI, 0.93-1.07) all-cause deaths per 1000 person-months and an incidence rate of 0.15 (95% CI, 0.12-0.17) CVD-specific deaths per 1000 person-months. The unweighted median follow-up duration was 72 months. For nearly all analyses (unadjusted and adjusted models with ASCVD expressed as a continuous variable as well as dichotomized at 7.5% and 20%), the ASCVD risk score was significantly associated with all-cause and CVD-specific mortality (P<.05). In the adjusted model, the increased all-cause mortality risk ranged from 47% to 77% based on an ASCVD risk of 20% or higher and 7.5% or higher, respectively. Those with an ASCVD score of 7.5% or higher had a 3-fold increased risk of CVD-specific mortality. The 10-year predicted risk of a first ASCVD event via the PCR equations was associated with all-cause and CVD-specific mortality among those free of CVD at baseline. In this American adult sample, the PCR equations provide evidence of predictive validity. PMID:27180122

  15. The decline in child mortality: a reappraisal.

    PubMed Central

    Ahmad, O. B.; Lopez, A. D.; Inoue, M.

    2000-01-01

    The present paper examines, describes and documents country-specific trends in under-five mortality rates (i.e., mortality among children under five years of age) in the 1990s. Our analysis updates previous studies by UNICEF, the World Bank and the United Nations. It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident. A consistent series of estimates of under-five mortality rate is provided and an indication is given of historical trends during the period 1950-2000 for both developed and developing countries. It is estimated that 10.5 million children aged 0-4 years died in 1999, about 2.2 million or 17.5% fewer than a decade earlier. On average about 15% of newborn children in Africa are expected to die before reaching their fifth birthday. The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%. During the 1990s the decline in child mortality decelerated in all the WHO regions except the Western Pacific but there is no widespread evidence of rising child mortality rates. At the country level there are exceptions in southern Africa where the prevalence of HIV is extremely high and in Asia where a few countries are beset by economic difficulties. The slowdown in the rate of decline is of particular concern in Africa and South-East Asia because it is occurring at relatively high levels of mortality, and in countries experiencing severe economic dislocation. As the HIV/AIDS epidemic continues in Africa, particularly southern Africa, and in parts of Asia, further reductions in child mortality become increasingly unlikely until substantial progress in controlling the spread of HIV is achieved. PMID:11100613

  16. Association between resting heart rate across the life course and all-cause mortality: longitudinal findings from the Medical Research Council (MRC) National Survey of Health and Development (NSHD)

    PubMed Central

    Hartaigh, Bríain Ó; Gill, Thomas M; Shah, Imran; Hughes, Alun D; Deanfield, John E; Kuh, Diana; Hardy, Rebecca

    2014-01-01

    Background Resting heart rate (RHR) is an independent risk factor for mortality. Nevertheless, it is unclear whether elevations in childhood and mid-adulthood RHR, including changes over time, are associated with mortality later in life. We sought to evaluate the association between RHR across the life course, along with its changes and all-cause mortality. Methods We studied 4638 men and women from the Medical Research Council (MRC) National Survey of Health and Development (NSHD) cohort born during 1 week in 1946. RHR was obtained during childhood at ages 6, 7 and 11, and in mid-adulthood at ages 36 and 43. Using multivariable Cox regression, we calculated the HR for incident mortality according to RHR measured at each time point, along with changes in mid-adulthood RHR. Results At age 11, those in the top fifth of the RHR distribution (≥97 bpm) had an increased adjusted hazard of 1.42 (95% CI 1.04 to 1.93) for all-cause mortality. A higher adjusted risk (HR, 95% CI 2.17, 1.40 to 3.36) of death was also observed for those in the highest fifth (≥81 bpm) at age 43. For a > 25 bpm increased change in the RHR over the course of 7 years (age 36–43), the adjusted hazard was elevated more than threefold (HR, 95% CI 3.26, 1.54 to 6.90). After adjustment, RHR at ages 6, 7 and 36 were not associated with all-cause mortality. Conclusions Elevated RHR during childhood and midlife, along with greater changes in mid-adulthood RHR, are associated with an increased risk of all-cause mortality. PMID:24850484

  17. IQ in late adolescence/early adulthood, risk factors in middle age and later all-cause mortality in men: the Vietnam Experience Study

    PubMed Central

    Batty, G D; Shipley, M J; Mortensen, L H; Boyle, S H; Barefoot, J; Grønbæk, M; Gale, C R; Deary, I J

    2013-01-01

    Objective To examine the role of potential mediating factors in explaining the IQ–mortality relation. Design, setting and participants A total of 4316 male former Vietnam-era US army personnel with IQ test results at entry into the service in late adolescence/early adulthood in the 1960/1970s (mean age at entry 20.4 years) participated in a telephone survey and medical examination in middle age (mean age 38.3 years) in 1985–6. They were then followed up for mortality experience for 15 years. Main results In age-adjusted analyses, higher IQ scores were associated with reduced rates of total mortality (hazard ratio (HR)per SD increase in IQ 0.71; 95% CI 0.63 to 0.81). This relation did not appear to be heavily confounded by early socioeconomic position or ethnicity. The impact of adjusting for some potentially mediating risk indices measured in middle age on the IQ–mortality relation (marital status, alcohol consumption, systolic and diastolic blood pressure, pulse rate, blood glucose, body mass index, psychiatric and somatic illness at medical examination) was negligible (<10% attenuation in risk). Controlling for others (cigarette smoking, lung function) had a modest impact (10–17%). Education (0.79; 0.69 to 0.92), occupational prestige (0.77; 0.68 to 0.88) and income (0.86; 0.75 to 0.98) yielded the greatest attenuation in the IQ–mortality gradient (21–52%); after their collective adjustment, the IQ–mortality link was effectively eliminated (0.92; 0.79 to 1.07). Conclusions In this cohort, socioeconomic position in middle age might lie on the pathway linking earlier IQ with later mortality risk but might also partly act as a surrogate for cognitive ability. PMID:18477751

  18. Mid-regional pro-atrial natriuretic peptide as a prognostic marker for all-cause mortality in patients with symptomatic coronary artery disease.

    PubMed

    von Haehling, Stephan; Papassotiriou, Jana; Hartmann, Oliver; Doehner, Wolfram; Stellos, Konstantinos; Geisler, Tobias; Wurster, Thomas; Schuster, Andreas; Botnar, Rene M; Gawaz, Meinrad; Bigalke, Boris

    2012-11-01

    In the present study, we investigated the prognostic value of MR-proANP (mid-regional pro-atrial natriuretic peptide). We consecutively evaluated a catheterization laboratory cohort of 2700 patients with symptomatic CAD (coronary artery disease) [74.1% male; ACS (acute coronary syndrome), n=1316; SAP (stable angina pectoris), n=1384] presenting to the Cardiology Department of a large primary care hospital, all of whom underwent coronary angiography. Serum MR-proANP and other laboratory markers were sampled at the time of presentation or in the catheterization laboratory. Clinical outcome was assessed by hospital chart analysis and telephone interviews. The primary end point was all-cause death at 3 months after enrolment. Follow-up data were complete in 2621 patients (97.1%). Using ROC (receiver operating characteristic) curves, the AUC (area under the curve) of 0.73 [95% CI (confidence interval), 0.67-0.79] for MR-proANP was significantly higher compared with 0.58 (95% CI, 0.55-0.62) for Tn-I (troponin-I; DeLong test, P=0.0024). According to ROC analysis, the optimal cut-off value of MR-proANP was at 236 pmol/l for all-cause death, which helped to find a significantly increased rate of all-cause death (n=76) at 3 months in patients with elevated baseline concentrations (≥236 pmol/l) compared with patients with a lower concentration level in Kaplan-Meier survival analysis (log rank, P<0.001). The predictive performance of MR-proANP was independent of other clinical variables or cardiovascular risk factors, and superior to that of Tn-I or other cardiac biomarkers (all: P<0.0001). MR-proANP may help in the prediction of all-cause death in patients with symptomatic CAD. Further studies should verify its prognostic value and confirm the appropriate cut-off value. PMID:22690794

  19. Childhood Club Participation and All-cause Mortality in Adulthood: A 65-year Follow-up Study of a Population-representative Sample in Scotland

    PubMed Central

    Calvin, Catherine M.; Batty, G. David; Brett, Caroline E.; Deary, Ian J.

    2015-01-01

    Objective Social participation in middle- and older-age is associated with lower mortality risk across many prospective cohort studies. However there is a paucity of evidence on social participation in youth in relation to mortality, which could help inform an understanding of the origin of the association, and give credence to causality. The present study investigates the relation of early life club membership—a proxy measure of social participation—with mortality risk in older age in a nationally representative sample. Methods We linked historical data collected on the 6-Day Sample of the Scottish Mental Survey 1947 during the period 1947-1963 with vital status records up to April 2014. Analyses were based on 1059 traced participants (446 deceased). Results Club membership at age 18 years was associated with lower mortality risk by age 78 years (hazard ratio=0.54, 95% CI 0.44 to 0.68, p<.001). Club membership remained a significant predictor in models that included early life health, socioeconomic status (SES), measured intelligence, and teachers’ ratings of dependability in personality. Conclusion In a study which circumvented the problem of reverse causality, a proxy indicator of social participation in youth was related to lower mortality risk. The association may be mediated by several behavioural and neurobiological factors, which prospective ageing cohort studies could address. PMID:26176775

  20. Fluid Intelligence Is Independently Associated with All-Cause Mortality over 17 Years in an Elderly Community Sample: An Investigation of Potential Mechanisms

    ERIC Educational Resources Information Center

    Batterham, Philip J.; Christensen, Helen; Mackinnon, Andrew J.

    2009-01-01

    The long-term relationship between lower intelligence and mortality risk in later life is well established, even when controlling for a range of health and sociodemographic measures. However, there is some evidence for differential effects in various domains of cognitive performance. Specifically, tests of fluid intelligence may have a stronger…

  1. Physical activity and all-cause mortality among older Brazilian adults: 11-year follow-up of the Bambuí Health and Aging Study

    PubMed Central

    Ramalho, Juciany RO; Mambrini, Juliana VM; César, Cibele C; de Oliveira, César M; Firmo, Josélia OA; Lima-Costa, Maria Fernanda; Peixoto, Sérgio V

    2015-01-01

    Objective To investigate the association between physical activity (eg, energy expenditure) and survival over 11 years of follow-up in a large representative community sample of older Brazilian adults with a low level of education. Furthermore, we assessed sex as a potential effect modifier of this association. Materials and methods A population-based prospective cohort study was conducted on all the ≥60-year-old residents in Bambuí city (Brazil). A total of 1,606 subjects (92.2% of the population) enrolled, and 1,378 (85.8%) were included in this study. Type, frequency, and duration of physical activity were assessed in the baseline survey questionnaire, and the metabolic equivalent task tertiles were estimated. The follow-up time was 11 years (1997–2007), and the end point was mortality. Deaths were reported by next of kin during the annual follow-up interview and ascertained through the Brazilian System of Information on Mortality, Brazilian Ministry of Health. Hazard ratios (95% confidence intervals [CIs]) were estimated by Cox proportional-hazard models, and potential confounders were considered. Results A statistically significant interaction (P<0.03) was found between sex and energy expenditure. Among older men, increases in levels of physical activity were associated with reduced mortality risk. The hazard ratios were 0.59 (95% CI 0.43–0.81) and 0.47 (95% CI 0.34–0.66) for the second and third tertiles, respectively. Among older women, there was no significant association between physical activity and mortality. Conclusion It was possible to observe the effect of physical activity in reducing mortality risk, and there was a significant interaction between sex and energy expenditure, which should be considered in the analysis of this association in different populations. PMID:25931817

  2. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies

    PubMed Central

    de Souza, Russell J; Mente, Andrew; Maroleanu, Adriana; Cozma, Adrian I; Kishibe, Teruko; Uleryk, Elizabeth; Budylowski, Patrick; Schünemann, Holger; Beyene, Joseph

    2015-01-01

    Objective To systematically review associations between intake of saturated fat and trans unsaturated fat and all cause mortality, cardiovascular disease (CVD) and associated mortality, coronary heart disease (CHD) and associated mortality, ischemic stroke, and type 2 diabetes. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Registry of Controlled Trials, Evidence-Based Medicine Reviews, and CINAHL from inception to 1 May 2015, supplemented by bibliographies of retrieved articles and previous reviews. Eligibility criteria for selecting studies Observational studies reporting associations of saturated fat and/or trans unsaturated fat (total, industrially manufactured, or from ruminant animals) with all cause mortality, CHD/CVD mortality, total CHD, ischemic stroke, or type 2 diabetes. Data extraction and synthesis Two reviewers independently extracted data and assessed study risks of bias. Multivariable relative risks were pooled. Heterogeneity was assessed and quantified. Potential publication bias was assessed and subgroup analyses were undertaken. The GRADE approach was used to evaluate quality of evidence and certainty of conclusions. Results For saturated fat, three to 12 prospective cohort studies for each association were pooled (five to 17 comparisons with 90 501-339 090 participants). Saturated fat intake was not associated with all cause mortality (relative risk 0.99, 95% confidence interval 0.91 to 1.09), CVD mortality (0.97, 0.84 to 1.12), total CHD (1.06, 0.95 to 1.17), ischemic stroke (1.02, 0.90 to 1.15), or type 2 diabetes (0.95, 0.88 to 1.03). There was no convincing lack of association between saturated fat and CHD mortality (1.15, 0.97 to 1.36; P=0.10). For trans fats, one to six prospective cohort studies for each association were pooled (two to seven comparisons with 12 942-230 135 participants). Total trans fat intake was associated with all cause mortality (1.34, 1.16 to 1.56), CHD mortality

  3. Personality Facets and All-Cause Mortality Among Medicare Patients Aged 66 to 102: A Follow-on Study of Weiss and Costa (2005)

    PubMed Central

    Costa, Paul T.; Weiss, Alexander; Duberstein, Paul R.; Friedman, Bruce; Siegler, Ilene C.

    2014-01-01

    Objectives To investigate associations between the personality factors and survival during 8 years follow-up. Methods Domains of personality and selected facet scores were assessed in 597 Medicare recipients (aged 66 to 102 years) who were followed up for approximately 8 years. Personality domains and factors were assessed using the Revised NEO Personality Inventory (NEO-PI-R). Using proportional hazards regression, the present study builds on a previous analysis of the NEO-PI-R domains and selected facet scores, which revealed that the Neuroticism facet Impulsiveness, Agreeableness facet Straightforwardness, and Conscientiousness facet Self-Discipline were related to longer life during 4 years of follow-up. In the present study, we extended the follow-up period by an additional 4 years, examining all 30 facets, and using accelerated failure time (AFT) modeling as an additional analytic approach. Unlike proportional hazards regression, AFT permits inferences about the median survival length conferred by predictors. Each facet was tested in a model that included health-related covariates and NEO-PI-R factor scores for dimensions that did not include that facet. Results Over the 8-year mortality surveillance period, Impulsiveness was not significant, but Straightforwardness and Self-Discipline remained significant predictors of longevity. When dichotomized, being high versus average or low on Self-Discipline was associated with an approximately 34% increase in median lifespan. Longer mortality surveillance also revealed that each standard deviation of Altruism, Compliance, Tender-Mindedness, and Openness to Fantasy was associated with an estimated 9–11% increase in median survival time. Conclusions After extending the follow-up period from 4 to 8 years, Self-Discipline remained a powerful predictor of survival. Facets associated with imagination, generosity, and higher quality interpersonal interactions become increasingly important when the follow-up period was

  4. The effect of statins on microalbuminuria, proteinuria, progression of kidney function, and all-cause mortality in patients with non-end stage chronic kidney disease: A meta-analysis.

    PubMed

    Zhang, Zhenhong; Wu, Pingsheng; Zhang, Jiping; Wang, Shunyin; Zhang, Gengxin

    2016-03-01

    Conclusive evidence regarding the effect of statins on non-end stage chronic kidney disease (CKD) has not been reported previously. This meta-analysis evaluated the association between statins and microalbuminuria, proteinuria, progression, and all-cause mortality in patients with non-end stage CKD. Databases (e.g., PubMed, Embase and the Cochrane Library) were searched for randomized controlled trials (RCTs) with data on statins, microalbuminuria, proteinuria, renal health endpoints, and all-cause mortality patients with non-end stage CKD to perform this meta-analysis. The mean difference (MD) of the urine albumin excretion ratios (UAER), 24-h urine protein excretion, and risk ratios (RR) of all-cause mortality and renal health endpoints were calculated, and the results are presented with 95% confidence intervals (CI). A total of 23 RCTs with 39,419 participants were selected. The analysis demonstrated that statins statistically reduced UAER to 26.73μg/min [95%CI (-51.04, -2.43), Z=2.16, P<0.05], 24-h urine protein excretion to 682.68mg [95%CI (-886.72, -478.63), Z=6.56, P<0.01] and decreased all-cause mortality [RR=0.78, 95%CI (0.72, 0.84), Z=6.08, P<0.01]. However, the analysis results did not indicate that statins reduced the events of renal health endpoints [RR=0.96, 95%CI (0.91,1.01), Z=1.40, P>0.05]. In summary, our study indicates that statins statistically reduced microalbuminuria, proteinuria, and clinical deaths, but statins did not effectively slow the clinical progression of non-end stage CKD. PMID:26776964

  5. Child mortality in Goa: a cross-sectional analysis.

    PubMed

    Rao, S R; Pandey, A; Shajy, K I

    1997-01-01

    This paper is a study of the determinants of child mortality in the relatively developed Indian state of Goa. Data from the National Family Health Survey (NFHS, 1992-93) conducted in the state of Goa have been used to examine the child mortality experiences of 1,331 women who were within a marriage lasting 15 years. An aggregated index of child mortality, which summarizes the mortality experiences of a woman with exposure adjustment, is the study variable. Maternal education and longer birth spacing were found to lower child mortality risks significantly. PMID:9325655

  6. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

    PubMed Central

    2015-01-01

    -sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections

  7. Predictors of all-cause and cardiovascular-specific mortality in type 2 diabetes: A competing risk modeling of an Iranian population

    PubMed Central

    Sadeghpour, Sahar; Faghihimani, Elham; Hassanzadeh, Akbar; Amini, Masoud; Mansourian, Marjan

    2016-01-01

    Background: In Asian population, diabetes mellitus is increasing and has become an important health problem in recent decades. In Iran, cardiovascular disease (CVD) accounts for nearly 46% of the total costs spent for diabetes-associated diseases. Because individuals with diabetes have highly increased CVD risk compared with normal individuals, it is important to diagnosis factors that may increase CVD risk in diabetic patients. The study objective was to identify predictors associated with CVD mortality in patients with type 2 diabetes (T2D) and to develop a prediction model for cardiovascular (CV)-death using a competing risk approach. Materials and Methods: The study population consisted of 2638 T2D (male = 1110, female = 1528) patients aged ≥35 years attending from Endocrine and Metabolism Research Center in Isfahan for a mean follow-up period of 12 years; predictors for different cause of death were evaluated using cause specific Cox proportional and subdistribution hazards models. Results: Based on competing modeling, the increase in blood pressure (BP) (spontaneously hypertensive rats [SHR]: 1.64), cholesterol (SHR: 1.55), and duration of diabetes (SHR: 2.03) were associated with CVD-death. Also, the increase in BP (SHR: 1.85), fasting blood sugar (SHR: 2.94), and duration of diabetes (SHR: 1.68) were associated with other death (consist of cerebrovascular accidents, cancer, infection, and diabetic nephropathy). Conclusions: This finding suggests that more attention should be paid to the management of CV risk in type 2 diabetic patients with high cholesterol, high BP, and long diabetes duration. PMID:27274497

  8. Computed Tomography-Derived Cardiovascular Risk Markers, Incident Cardiovascular Events, and All-Cause Mortality in Non- Diabetics. The Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Yeboah, Joseph; Carr, J. Jeffery; Terry, James G.; Ding, Jingzhong; Zeb, Irfan; Liu, Songtao; Nasir, Khurram; Post, Wendy; Blumenthal, Roger S.; Budoff, Matthew J.

    2014-01-01

    AIM We assess the improvement in discrimination afforded by the addition thoracic aorta calcium (TAC), aortic valve calcification (AVC), mitral annular calcification (MAC), pericardial adipose tissue volume (PAT) and liver attenuation (LA) to Framingham risk score(FRS) + coronary artery calcium (CAC) for incident CHD/CVD in a multi ethnic cohort. Methods and Results A total 5745(2710 were intermediate Framingham risk, 210 CVD and 155 CHD events) 251 had adjudicated CHD, 346 had CVD events, 321 died after 9 years of follow-up. Cox proportional hazard, receiver operator curve (ROC) and net reclassification improvement (NRI) analyses. In the whole cohort and also when the analysis was restricted to only the intermediate risk participants: CAC, TAC, AVC and MAC were all significantly associated with incident CVD/CHD/ mortality; CAC had the strongest association. When added to the FRS, CAC had the highest area under the curve (AUC) for the prediction of incident CHD/CVD; LA had the least. The addition of TAC, AVC, MAC, PAT and LA to FRS + CAC all resulted in a significant reduction in AUC for incident CHD [0.712 vs. 0.646, 0.655, 0.652, 0.648 and 0.569; all p<0.01 respectively] in participants with intermediate FRS. The addition of CAC to FRS resulted in an NRI of 0.547 for incident CHD in the intermediate risk group. The NRI when TAC, AVC, MAC, PAT and LA were added to FRS + CAC were 0.024, 0.026, 0.019, 0.012 and 0.012 respectively, for incident CHD in the intermediate risk group. Similar results were obtained for incident CVD in the intermediate risk group and also when the whole cohort was used instead of the intermediate FRS group. Conclusion The addition of CAC to the FRS provides superior discrimination especially in intermediate risk individuals compared with the addition of TAC, AVC, MAC, PAT or LA for incident CHD/CVD. Compared with FRS + CAC, the addition of TAC, AVC, MAC, PAT or LA individually to FRS + CAC worsens the discrimination for incident CHD

  9. Association of serum uric acid with all-cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA Augsburg cohort. World Health Organization Monitoring Trends and Determinants in Cardiovascular Diseases.

    PubMed

    Liese, A D; Hense, H W; Löwel, H; Döring, A; Tietze, M; Keil, U

    1999-07-01

    Because previous findings have been inconsistent, we explored the association of serum concentrations of uric acid with all-cause and cardiovascular disease mortality and myocardial infarction prospectively. We used data from 1,044 men who are members of the World Health Organization Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) Augsburg cohort. The men, 45-64 years of age in 1984-1985, were followed through 1992. There were 90 deaths, 44 of which were related to cardiovascular disease; 60 men developed incident nonfatal or fatal myocardial infarction. We estimated hazard rate ratios from Cox proportional hazard models. Uric acid levels > or =373 micromol/liter (fourth quartile) vs < or =319 micromol/liter (first and second quartile) independently predicted all-cause mortality [hazard rate ratio = 2.8; 95% confidence interval (CI) = 1.6-5.0] after adjustment for alcohol, total cholesterol/high-density lipoprotein cholesterol ratio, hypertension, use of diuretic drugs, smoking, body mass index, and education. The adjusted risk of cardiovascular disease mortality was 2.2 (95% CI = 1.0-4.8), and that of myocardial infarction was 1.7 (95% CI = 0.8-3.3). Although residual confounding cannot be excluded, our results are among the few, in men, demonstrating a strong positive association of elevated serum uric acid with all-cause mortality. Future investigations may be able to evaluate whether uric acid contributes independently to the development of cardiovascular disease or is simply a component of the atherogenic metabolic condition known as the insulin resistance syndrome. PMID:10401873

  10. Matrix-assisted laser desorption/ionisation (MALDI) TOF analysis identifies serum angiotensin II concentrations as a strong predictor of all-cause and breast cancer (BCa)-specific mortality following breast surgery.

    PubMed

    Boccardo, Francesco; Rubagotti, Alessandra; Nuzzo, Pier Vitale; Argellati, Francesca; Savarino, Grazia; Romano, Paolo; Damonte, Gianluca; Rocco, Mattia; Profumo, Aldo

    2015-11-15

    MALDI-TOF MS was used to recognise serum peptidome profiles predictive of mortality in women affected by early BCa. Mortality was analysed based on signal profiling, and appropriate statistics were used. The results indicate that four signals were increased in deceased patients compared with living patients. Three of the four signals were individually associated with all-cause mortality, but only one having mass/charge ratio (m/z) 1,046.49 was associated with BCa-specific mortality and was the only peak to maintain an independent prognostic role after multivariate analysis. Two groups exhibiting different mortality probabilities were identified after clustering patients based on the expression of the four peptides, but m/z 1,046.49 was exclusively expressed in the cluster exhibiting the worst mortality outcome, thus confirming the crucial value of this peptide. The specific role of this peak was confirmed by competing risk analysis. MS findings were validated by ELISA analysis after demonstrating that m/z 1,046.49 structurally corresponded to Angiotensin II (ATII). In fact, mortality results obtained after arbitrarily dividing patients according to an ATII serum value of 255 pg/ml (which corresponds to the 66(th) percentile value) were approximately comparable to those previously demonstrated when the same patients were analysed according to the expression of signal m/z 1,046.49. Similarly, ATII levels were specifically correlated with BCa-related deaths after competing risk analysis. In conclusion, ATII levels were increased in women who exhibited worse mortality outcomes, reinforcing the evidence that this peptide potentially significantly affects the natural history of early BCa. Our findings also confirm that MALDI-TOF MS is an efficient screening tool to identify novel tumour markers and that MS findings can be rapidly validated through less complex techniques, such as ELISA. PMID:25994113

  11. Is Impact of Statin Therapy on All-Cause Mortality Different in HIV-Infected Individuals Compared to General Population? Results from the FHDH-ANRS CO4 Cohort

    PubMed Central

    Lang, Sylvie; Lacombe, Jean-Marc; Mary-Krause, Murielle; Partisani, Marialuisa; Bidegain, Frédéric; Cotte, Laurent; Aslangul, Elisabeth; Chéret, Antoine; Boccara, Franck; Meynard, Jean-Luc; Pradier, Christian; Roger, Pierre-Marie; Tattevin, Pierre; Costagliola, Dominique; Molina, Jean-Michel

    2015-01-01

    Background The effect of statins on all-cause mortality in the general population has been estimated as 0.86 (95%CI 0.79-0.94) for primary prevention. Reported values in HIV-infected individuals have been discordant. We assessed the impact of statin-based primary prevention on all-cause mortality among HIV-infected individuals. Methods Patients were selected among controls from a multicentre nested case-control study on the risk of myocardial infarction. Patients with prior cardiovascular or cerebrovascular disorders were not eligible. Potential confounders, including variables that were associated either with statin use and/or death occurrence and statin use were evaluated within the last 3 months prior to inclusion in the case-control study. Using an intention to continue approach, multiple imputation of missing data, Cox’s proportional hazard models or propensity based weighting, the impact of statins on the 7-year all-cause mortality was evaluated. Results Among 1,776 HIV-infected individuals, 138 (8%) were statins users. During a median follow-up of 53 months, 76 deaths occurred, including 6 in statin users. Statin users had more cardiovascular risk factors and a lower CD4 T cell nadir than statin non-users. In univariable analysis, the death rate was higher in statins users (11% vs 7%, HR 1.22, 95%CI 0.53-2.82). The confounders accounted for were age, HIV transmission group, current CD4 T cell count, haemoglobin level, body mass index, smoking status, anti-HCV antibodies positivity, HBs antigen positivity, diabetes and hypertension. In the Cox multivariable model the estimated hazard ratio of statin on all-cause mortality was estimated as 0.86 (95%CI 0.34-2.19) and it was 0.83 (95%CI 0.51-1.35) using inverse probability treatment weights. Conclusion The impact of statin for primary prevention appears similar in HIV-infected individuals and in the general population. PMID:26200661

  12. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series

    PubMed Central

    Báez-Saldaña, Renata; Villafuerte-García, Adriana; Cruz-Hervert, Pablo; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Ferreira-Guerrero, Elizabeth; Mongua-Rodríguez, Norma; Montero-Campos, Rogelio; Melchor-Romero, Ada; García-García, Lourdes

    2015-01-01

    Background Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases. Objective To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS. Material and Methods We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions. Results We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR): 30–150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08–0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06–0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses. Conclusions HAART for 180 days or more was associated

  13. Variation in prescribing of lipid-lowering medication in primary care is associated with incidence of cardiovascular disease and all-cause mortality in people with screen-detected diabetes: findings from the ADDITION-Denmark trial

    PubMed Central

    Simmons, R K; Carlsen, A H; Griffin, S J; Charles, M; Christiansen, J S; Borch-Johnsen, K; Sandbæk, A; Lauritzen, T

    2014-01-01

    Aims To examine variation between general practices in the prescription of lipid-lowering treatment to people with screen-detected Type 2 diabetes, and associations with practice and participant characteristics and risk of cardiovascular events and all-cause mortality. Methods Observational cohort analysis of data from 1533 people with screen-detected Type 2 diabetes aged 40–69 years from the ADDITION-Denmark study. One hundred and seventy-four general practices were cluster randomized to receive: (1) routine diabetes care according to national guidelines (623 individuals), or (2) intensive multifactorial target-driven management (910 individuals). Multivariable logistic regression was used to quantify the association between the proportion of individuals in each practice who redeemed prescriptions for lipid-lowering medication in the two years following diabetes diagnosis and a composite cardiovascular disease (CVD) outcome, adjusting for age, sex, prevalent chronic disease, baseline CVD risk factors, smoking and lipid-lowering medication, and follow-up time. Results The proportion of individuals treated with lipid-lowering medication varied widely between practices (0–100%). There were 118 CVD events over 9431 person-years of follow-up. For the whole trial cohort, the risk of CVD was significantly higher in practices in the lowest compared with the highest quartile for prescribing lipid-lowering medication [adjusted odds ratio (OR) 3.4, 95% confidence interval (CI) 1.6–7.3]. Similar trends were found for all-cause mortality. Conclusions More frequent prescription of lipid-lowering treatment was associated with a lower incidence of CVD and all-cause mortality. Improved understanding of factors underlying practice variation in prescribing may enable more frequent use of lipid-lowering treatment. The results highlight the benefits of intensive treatment of people with screen-detected diabetes (Clinical Trials Registry No; NCT 00237549). What's new Despite

  14. Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)123456

    PubMed Central

    Ward, Heather A; Norat, Teresa; Luan, Jian’an; May, Anne M; Weiderpass, Elisabete; Sharp, Stephen J; Overvad, Kim; Østergaard, Jane Nautrup; Tjønneland, Anne; Johnsen, Nina Føns; Mesrine, Sylvie; Fournier, Agnès; Fagherazzi, Guy; Trichopoulou, Antonia; Lagiou, Pagona; Trichopoulos, Dimitrios; Li, Kuanrong; Kaaks, Rudolf; Ferrari, Pietro; Licaj, Idlir; Jenab, Mazda; Bergmann, Manuela; Boeing, Heiner; Palli, Domenico; Sieri, Sabina; Panico, Salvatore; Tumino, Rosario; Vineis, Paolo; Peeters, Petra H; Monnikhof, Evelyn; Bueno-de-Mesquita, H Bas; Quirós, J Ramón; Agudo, Antonio; Sánchez, María-José; Huerta, José María; Ardanaz, Eva; Arriola, Larraitz; Hedblad, Bo; Wirfält, Elisabet; Sund, Malin; Johansson, Mattias; Key, Timothy J; Travis, Ruth C; Khaw, Kay-Tee; Brage, Søren; Wareham, Nicholas J; Riboli, Elio

    2015-01-01

    Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear. Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures. Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m2) (>30), and WC (≥102 cm for men, ≥88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures. Results: Significant interactions (PA × BMI and PA × WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16–30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity. Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which

  15. Child Mortality in a Developing Country: A Statistical Analysis

    ERIC Educational Resources Information Center

    Uddin, Md. Jamal; Hossain, Md. Zakir; Ullah, Mohammad Ohid

    2009-01-01

    This study uses data from the "Bangladesh Demographic and Health Survey (BDHS] 1999-2000" to investigate the predictors of child (age 1-4 years) mortality in a developing country like Bangladesh. The cross-tabulation and multiple logistic regression techniques have been used to estimate the predictors of child mortality. The cross-tabulation…

  16. Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study

    PubMed Central

    Skriver, Mette V; Sandbæk, Annelli; Kristensen, Jette K; Støvring, Henrik

    2015-01-01

    Objective We assessed the relationship of mortality with glycated hemoglobin (HbA1c) variability and with absolute change in HbA1c. Design A population-based prospective observational study with a median follow-up time of 6 years. Methods Based on a validated algorithm, 11 205 Danish individuals with type 2 diabetes during 2001–2006 were identified from public data files, with at least three HbA1c measurements: one index measure, one closing measure 22–26 months later, and one measurement in-between. Medium index HbA1c was 7.3%, median age was 63.9 years, and 48% were women. HbA1c variability was defined as the mean absolute residual around the line connecting index value with closing value. Cox proportional hazard models with restricted cubic splines were used, with all-cause mortality as the outcome. Results Variability between 0 and 0.5 HbA1c percentage point was not associated with mortality, but for index HbA1c ≤8% (64 mmol/mol), a variability above 0.5 was associated with increased mortality (HR of 1 HbA1c percentage point variability was 1.3 (95% CI 1.1 to 1.5) for index HbA1c 6.6–7.4%). For index HbA1c≤8%, mortality increased when HbA1c declined, but was stable when HbA1c rose. For index HbA1c>8%, change in HbA1c was associated with mortality, with the lowest mortality for greatest decline (HR=0.9 (95% CI 0.80 to 0.98) for a 2-percentage point decrease). Conclusions For individuals with an index HbA1c below 8%, both high HbA1c variability and a decline in HbA1c were associated with increased mortality. For individuals with index HbA1c above 8%, change in HbA1c was associated with mortality, whereas variability was not. PMID:25664182

  17. [Political crises in Africa and infant and child mortality].

    PubMed

    Garenne, M

    1997-01-01

    Many African countries experienced severe political crises after independence, and in a number of cases the crises had significant demographic consequences, especially for child mortality. Data based on maternity histories allowed the reconstruction of child mortality trends over the past 20-30 years in Uganda, Ghana, Rwanda, Madagascar, and Mozambique. The indicator used was the child mortality quotient (number of deaths of under-5 children per 1000 births). Uganda's child mortality declined from 227/1000 in 1960 to 154/1000 in 1970, but the trend was reversed in 1971, when Idi Amin Dada came to power, and the rate reached 204/1000 in 1982 before beginning to decline again. The level of mortality remained high, however, and was still 160/1000 in 1988. Ghana suffered a political and economic crisis during 1979-84. Child mortality rose from 130/1000 in 1978 to 175/1000 in 1983. Mortality rates began a rapid decline after structural adjustment programs were begun, possibly due to improved management of health services. The child mortality rate in Rwanda increased from around 220/1000 in 1960 to 240/1000 in 1975, before beginning a decline in the late 1970s that reached 140/1000 by 1990. The period of political stability and relative prosperity during the 15-year reign of Juvenal Habyarimana was associated with the decline. Political crises marked by student and peasant uprisings were associated with Madagascar's child mortality rate increase from about 145/1000 in 1960 to 185/1000 in 1985. Mozambique was beset by civil war after independence, in which destruction of the health infrastructure was a strategy. The child mortality rate increased from 270/1000 to 470/1000 between 1975 and 1986, a peak war year. The factors by which political crises affect mortality so profoundly remain to be explained, but particular attention should be given to studying the health sector. PMID:12178214

  18. Anxiety and Depressive Symptoms as Predictors of All-Cause Mortality among People with Insulin-Naïve Type 2 Diabetes: 17-Year Follow-Up of the Second Nord-Trøndelag Health Survey (HUNT2), Norway

    PubMed Central

    Nefs, Giesje; Tell, Grethe S.; Espehaug, Birgitte; Midthjell, Kristian; Graue, Marit; Pouwer, Frans

    2016-01-01

    Aim To examine whether elevated anxiety and/or depressive symptoms are related to all-cause mortality in people with Type 2 diabetes, not using insulin. Methods 948 participants in the community-wide Nord-Trøndelag Health Survey conducted during 1995–97 completed the Hospital Anxiety and Depression Scale with subscales of anxiety (HADS-A) and depression (HADS-D). Elevated symptoms were defined as HADS-A or HADS-D ≥8. Participants with type 2 diabetes, not using insulin, were followed until November 21, 2012 or death. Cox regression analyses were used to estimate associations between baseline elevated anxiety symptoms, elevated depressive symptoms and mortality, adjusting for sociodemographic factors, HbA1c, cardiovascular disease and microvascular complications. Results At baseline, 8% (n = 77/948) reported elevated anxiety symptoms, 9% (n = 87/948) elevated depressive symptoms and 10% (n = 93/948) reported both. After a mean follow-up of 12 years (SD 5.1, range 0–17), 541 participants (57%) had died. Participants with elevated anxiety symptoms only had a decreased mortality risk (unadjusted HR 0.66, 95% CI 0.46–0.96). Adjustment for HbA1c attenuated this relation (HR 0.73, 95% CI 0.50–1.07). Those with elevated depression symptoms alone had an increased mortality risk (fully adjusted model HR 1.39, 95% CI 1.05–1.84). Having both elevated anxiety and depressive symptoms was not associated with increased mortality risk (adjusted HR 1.30, 95% CI 0.96–1.74). Conclusions Elevated depressive symptoms were associated with excess mortality risk in people with Type 2 diabetes not using insulin. No significant association with mortality was found among people with elevated anxiety symptoms. Having both elevated anxiety and depressive symptoms was not associated with mortality. The hypothesis that elevated levels of anxiety symptoms leads to behavior that counteracts the adverse health effects of Type 2 diabetes needs further investigation. PMID:27537359

  19. Reducing child mortality in India in the new millennium.

    PubMed Central

    Claeson, M.; Bos, E. R.; Mawji, T.; Pathmanathan, I.

    2000-01-01

    Globally, child mortality rates have been halved over the last few decades, a developmental success story. Nevertheless, progress has been uneven and in recent years mortality rates have increased in some countries. The present study documents the slowing decline in infant mortality rates in india; a departure from the longer-term trends. The major causes of childhood mortality are also reviewed and strategic options for the different states of India are proposed that take into account current mortality rates and the level of progress in individual states. The slowing decline in childhood mortality rates in India calls for new approaches that go beyond disease-, programme- and sector-specific approaches. PMID:11100614

  20. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants

    PubMed Central

    Sen, Abhijit; Prasad, Manya; Norat, Teresa; Janszky, Imre; Tonstad, Serena; Romundstad, Pål; Vatten, Lars J

    2016-01-01

    Objective To conduct a systematic review and meta-analysis of cohort studies of body mass index (BMI) and the risk of all cause mortality, and to clarify the shape and the nadir of the dose-response curve, and the influence on the results of confounding from smoking, weight loss associated with disease, and preclinical disease. Data sources PubMed and Embase databases searched up to 23 September 2015. Study selection Cohort studies that reported adjusted risk estimates for at least three categories of BMI in relation to all cause mortality. Data synthesis Summary relative risks were calculated with random effects models. Non-linear associations were explored with fractional polynomial models. Results 230 cohort studies (207 publications) were included. The analysis of never smokers included 53 cohort studies (44 risk estimates) with >738 144 deaths and >9 976 077 participants. The analysis of all participants included 228 cohort studies (198 risk estimates) with >3 744 722 deaths among 30 233 329 participants. The summary relative risk for a 5 unit increment in BMI was 1.18 (95% confidence interval 1.15 to 1.21; I2=95%, n=44) among never smokers, 1.21 (1.18 to 1.25; I2=93%, n=25) among healthy never smokers, 1.27 (1.21 to 1.33; I2=89%, n=11) among healthy never smokers with exclusion of early follow-up, and 1.05 (1.04 to 1.07; I2=97%, n=198) among all participants. There was a J shaped dose-response relation in never smokers (Pnon-linearity <0.001), and the lowest risk was observed at BMI 23-24 in never smokers, 22-23 in healthy never smokers, and 20-22 in studies of never smokers with ≥20 years’ follow-up. In contrast there was a U shaped association between BMI and mortality in analyses with a greater potential for bias including all participants, current, former, or ever smokers, and in studies with a short duration of follow-up (<5 years or <10 years), or with moderate study quality scores. Conclusion Overweight and obesity is associated

  1. Evolution of infant and child mortality in Chile: a model.

    PubMed

    Hojman, D E

    1992-10-01

    The author contends that birth rate and infant and child mortality rates are jointly determined by demographic, economic, health care, and other influences. Working under this structural assumption, a multiequation model is developed, estimated, and simulated, in which real earnings, unemployment, midwife visits, access to cheap energy, public health expenditures, and degree of urbanization are determinant factors of declining infant and child mortality in Chile. Most notably, mortality declined during a period of increasing unemployment and falling living standards for at least part of the population. The study found all 3 rates to be jointly determined, but by different variables. Specifically, unemployment affected birth rate and child mortality rate, while declining infant mortality was based upon midwife visits, health expenditure, and access to cheap energy. At the policy level, trade-offs often result between infant and child mortality, especially where high birth rates prevail. Where movement along the Phillips curve is possible, higher earnings should be preferred over lower unemployment for the benefit of infant and child mortality. Preferred policy would week to provide a carefully balanced combination of better earnings and more midwife visits. PMID:12286009

  2. Family Planning and Child Survival: The Role of Reproductive Factors in Infant and Child Mortality.

    ERIC Educational Resources Information Center

    Conly, Shanti R.

    This report summarizes the evidence that family planning can reduce deaths of children under 5 years of age at a reasonable cost. The report also: (1) identifies the major reproductive factors associated with child mortality; (2) estimates the approximate reduction in child mortality that could be achieved through improved childbearing patterns;…

  3. Female circumcision and child mortality in urban Somalia.

    PubMed

    Mohamud, O A

    1991-01-01

    In Somalia, a demographer analyzed urban data obtained from the Family Health Survey to examine the effect female circumcision has on child mortality and the mechanism of that effect. Girls undergo female circumcision between 5-12 years old in Somalia. Since sunni circumcision (removal of the clitoral prepuce and tip of the clitoris) and clitoridectomy (removal of the entire clitoris) did not affect child mortality, he used them as the reference group. Infibulation (entire removal of the clitoris and of the labia minora and majora with the remains of the labia majora being sewn together allowing only a small opening for passage of urine) did affect child mortality. Female children who underwent infibulation and whose mothers most likely also underwent infibulation experienced higher mortality (13-72%) than those from other circumcised mothers. Female mortality exceeded male mortality indicating possible son preference. Mothers with clitoridectomy or infibulation had significantly higher infant mortality than those with sunni circumcision with the strongest effects during the neonatal period (95% and 42% higher mortality, respectively; p=.01). The effect of female circumcision on child mortality decreased with increased child's age. This higher than expected mortality among women with clitoridectomy may have been because women with infibulation had more stillbirths which were not counted as births. The exposed vagina of clitoridectomized women is more likely to be infected resulting in high risk of stillbirths and premature births than the closed vagina of infibulated women. The researcher suggested that the policies promoting education and consciousness raising may eventually eradicate female circumcision. This longterm campaign should use mass media, senior women of high status, and respected religious leaders. Legislation prohibiting this practice would only drive it underground under unsanitary conditions. Demographers should no longer ignore female circumcision

  4. Determinants of child mortality in south-west Uganda.

    PubMed

    Vella, V; Tomkins, A; Nidku, J; Marshall, T

    1992-01-01

    Anthropometric and sociodemographic variables were taken from 4320 children in a baseline survey carried out in March-April 1988 in the district of Mbarara, south-west Uganda. After 12 months a follow-up survey assessed the mortality of the children during the preceding year. Lack of ownership of cattle, recent arrival in the village, using candles for lighting, being of birth order higher than 5 and having a father with less than 8 years of schooling were significantly associated with child mortality. The addition of mid-upper arm circumference significantly improved the logistic model of socioeconomic variables and mortality and did not diminish the predictive power of socioeconomic variables in relation to increased mortality. This suggests that nutritional status and specific socioeconomic factors are both, independently, important predictors of child mortality. PMID:1737806

  5. Change of Serum BNP Between Admission and Discharge After Acute Decompensated Heart Failure Is a Better Predictor of 6-Month All-Cause Mortality Than the Single BNP Value Determined at Admission

    PubMed Central

    De Vecchis, Renato; Ariano, Carmelina; Giandomenico, Giuseppe; Di Maio, Marco; Baldi, Cesare

    2016-01-01

    Background B-type natriuretic peptide (BNP) is regarded as a reliable predictor of outcome in patients with acute decompensated heart failure (ADHF). However, according to some scholars, a single isolated measurement of serum BNP at the time of hospital admission would not be sufficient to provide reliable prognostic information. Methods A retrospective study was carried out on patients hospitalized for ADHF, who had then undergone follow-up of at least 6 months, in order to see if there was any difference in midterm mortality among patients with rising BNP at discharge as compared to those with decreasing BNP at discharge. Medical records had to be carefully examined to divide the case records into two groups, the former characterized by an increase in BNP during hospitalization, and the latter showing a decrease in BNP from the time of admission to the time of discharge. Results Ultimately, 177 patients were enrolled in a retrospective study. Among them, 53 patients (29.94%) had increased BNPs at the time of discharge relative to admission, whereas 124 (70.06%) exhibited decreases in serum BNP during their hospital stay. The group with patients who exhibited BNP increases at the time of discharge had higher degree of congestion evident in the higher frequency of persistent jugular venous distention (odds ratio: 3.72; P = 0.0001) and persistent orthopnea at discharge (odds ratio: 2.93; P = 0.0016). Moreover, patients with increased BNP at the time of discharge had a lower reduction in inferior vena cava maximum diameter (1.58 ± 2.2 mm vs. 6.32 ± 1.82 mm; P = 0.001 (one-way ANOVA)). In contrast, there was no significant difference in weight loss when patients with increased BNP at discharge were compared to those with no such increase. A total of 14 patients (7.9%) died during the 6-month follow-up period. Cox proportional hazard analysis revealed that BNP increase at the time of discharge was an independent predictor of 6-month all-cause mortality after

  6. Child mortality in a West African population protected with insecticide-treated curtains for a period of up to 6 years.

    PubMed Central

    Diallo, D. A.; Cousens, S. N.; Cuzin-Ouattara, N.; Nebié, I.; Ilboudo-Sanogo, E.; Esposito, F.

    2004-01-01

    OBJECTIVES: To determine the impact of insecticide-treated curtains (ITC) on all-cause child mortality (6-59 months) over a period of six years. To determine whether initial reductions in child mortality following the implementation of ITC are sustained over the longer term or whether "delayed" mortality occurs. METHODS: A rural population of ca 100 000 living in an area with high, seasonal Plasmodium falciparum transmission was studied in Burkina Faso. Annual censuses were conducted from 1993 to 2000 to measure child mortality. ITC to cover doors, windows, and eaves were provided to half the population in 1994 with the remainder receiving ITC in 1996. Curtains were re-treated or, if necessary, replaced annually. FINDINGS: Over six years of implementation of ITC, no evidence of the shift in child mortality from younger to older children was observed. Estimates of the reduction in child mortality associated with ITC ranged from 19% to 24%. CONCLUSIONS: In our population there was no evidence to suggest that initial reduction in child mortality associated with the introduction of insecticide-treated materials was subsequently compromised by a shift in child mortality to older-aged children. Estimates of the impact of ITC on child mortality in this population range from 19% to 24%. PMID:15042229

  7. Sociocultural determinants of infant and child mortality in Turkey.

    PubMed

    Aksit, B; Aksit, B

    1989-01-01

    This paper is an attempt to review and integrate international and Turkish research on infant and child mortality. Recent research and multivariate analyses in African, Latin American and Asian countries have revealed that in many countries mother's education is a powerful predictor of child survival. The present review of research in Turkey has indicated that urban/rural and regional differentials in infant mortality have been clearly established as by-products of fertility, contraception, and health surveys covering nationally representative samples. However, there are only a few multivariate explanatory models of infant/child mortality in Turkey to isolate and measure the effects of mother's education in relation to other variables. Nevertheless, existing studies in Turkey seem to suggest that mother's and father's education might link socio-economic, psychocultural, and biomedical variables with each other at community, household, and individual levels, providing clue for the formulation of future research designs and policy decisions. PMID:2648604

  8. Interferon-Based Treatment of Hepatitis C Virus Infection Reduces All-Cause Mortality in Patients With End-Stage Renal Disease: An 8-Year Nationwide Cohort Study in Taiwan.

    PubMed

    Hsu, Yueh-Han; Hung, Peir-Haur; Muo, Chih-Hsin; Tsai, Wen-Chen; Hsu, Chih-Cheng; Kao, Chia-Hung

    2015-11-01

    The long-term survival of end-stage renal disease (ESRD) patients with hepatitis C virus (HCV) infection who received interferon treatment has not been extensively evaluated.The HCV cohort was the ESRD patients with de novo HCV infection from 2004 to 2011; they were classified into treated and untreated groups according to interferon therapy records. Patients aged <20 years and those with a history of hepatitis B, kidney transplantation, or cancer were excluded. The control cohort included ESRD patients without HCV infection matched 4:1 to the HCV cohort by age, sex, and year of ESRD registration. We followed up all study participants until kidney transplantation, death, or the end of 2011, whichever came first. We assessed risk of all-cause mortality by using the multivariate Cox proportional hazard model with time-dependent covariate.In the HCV cohort, 134 patients (6.01%) received interferon treatment. Compared with the uninfected control cohort, the treated group had a lower risk of death (hazard ratio 0.47, 95% confidence interval [CI] 0.22-0.99). The untreated group had a 2.62-fold higher risk (95% CI 1.24-5.55) of death compared with the treated group. For the HCV cohort without cirrhosis or hepatoma, the risk of death in the treated group was further markedly reduced (hazard ratio 0.17, 95% CI 0.04-0.68) compared with that in the control cohort.For ESRD patients with HCV infection, receiving interferon treatment is associated with a survival advantage. Such an advantage is more prominent in HCV patients without cirrhosis or hepatoma. PMID:26632730

  9. Risk assessment of mortality for all-cause, ischemic heart disease, cardiopulmonary disease, and lung cancer due to the operation of the world's largest coal-fired power plant

    NASA Astrophysics Data System (ADS)

    Kuo, Pei-Hsuan; Tsuang, Ben-Jei; Chen, Chien-Jen; Hu, Suh-Woan; Chiang, Chun-Ju; Tsai, Jeng-Lin; Tang, Mei-Ling; Chen, Guan-Jie; Ku, Kai-Chen

    2014-10-01

    Based on recent understanding of PM2.5 health-related problems from fossil-fueled power plants emission inventories collected in Taiwan, we have determined the loss of life expectancy (LLE) and the lifetime (75-year) risks for PM2.5 health-related mortalities as attributed to the operation of the world's largest coal-fired power plant; the Taichung Power Plant (TCP), with an installed nominal electrical capacity of 5780 MW in 2013. Five plausible scenarios (combinations of emission controls, fuel switch, and relocation) and two risk factors were considered. It is estimated that the lifetime (75-y) risk for all-cause mortality was 0.3%-0.6% for males and 0.2%-0.4% for females, and LLE at 84 days in 1997 for the 23 million residents of Taiwan. The risk has been reduced to one-fourth at 0.05%-0.10% for males and 0.03%-0.06% for females, and LLE at 15 days in 2007, which was mainly attributed to the installation of desulfurization and de-NOx equipment. Moreover, additional improvements can be expected if we can relocate the power plant to a downwind site on Taiwan, and convert the fuel source from coal to natural gas. The risk can be significantly reduced further to one-fiftieth at 0.001%-0.002% for males and 0.001% for females, and LLE at 0.3 days. Nonetheless, it is still an order higher than the commonly accepted elevated-cancer risk at 0.0001% (10-6), indicating that the PM2.5 health-related risk for operating such a world-class power plant is not negligible. In addition, this study finds that a better-chosen site (involving moving the plant to the leeward side of Taiwan) can reduce the risk significantly as opposed to solely transitioning the fuel source to natural gas. Note that the fuel cost of using natural gas (0.11 USD/kWh in 2013) in Taiwan is about twice the price of using coal fuel (0.05 USD/kWh in 2013).

  10. Levels and patterns of infant and child mortality in Ghana.

    PubMed

    Gaisie, S K

    1976-02-01

    This paper attempts to measure infant and child mortality levels and also to determine their structures by utilzing the results of the 1968/69 National Demographic sample survey which was conducted under the directorship of the author. The measurement of infant and child mortality in Ghana is severely hampered by lack of reliable and adequate information on infant and child deaths. The existing data from the compulsory registration areas are deficient and can at best give an indication of only the level of urban infant and child mortalities. The tendency of censuses and surveys to miss a considerable proportion of infant and child deaths also imposes a further limitation on the extent to which the infant and child mortality rates can be accurately measured from the available data. This paper is therefore concerned with 2 major problems: 1) the adjustment of the current raw mortality data on the basis of detected errors as revealed by analytical methods and/or by the fitting of models, and 2) the estimation of infant and child mortality from independent source material (e.g., retrospective information on the number of children ever born and the number surviving). The most plausible estimate of infant mortality appears to be 133/thousand live births. Regional estimates range from 56 in the Accra Capital District to 192 in the Upper Region. Further, the urban rate is lower than the rural rate: 98 as against 161/thousand live births. An examination of child death rates by single years has shown that a large proportion of the deaths among children aged 0 to 4 occur in the 2nd year of life and that deaths in this age group account for the bulk of the deaths within the age group 1 to 4 years. The observed proportions of deaths at age 1 among all deaths within the 1 to 4 years age group range between 34 and 43%. These figures may be compared with 53% in Senegal between 1962 and 1968, and with 48 and 74% in Ibadan, Nigeria (1964/1966) and Mauritius (1961) respectively

  11. Child Mortality in the School Setting. Position Statement

    ERIC Educational Resources Information Center

    Bergren, Martha Dewey

    2012-01-01

    It is the position of the National Association of School Nurses (NASN) that data on children's deaths in school should be recorded, analyzed and reported at the local, state and national level. The systematic review of data on child deaths is necessary to drive interventions and policies that will decrease mortality from injuries, violence, acute…

  12. Income Inequality and Child Mortality in Wealthy Nations.

    PubMed

    Collison, David

    2016-01-01

    This chapter presents evidence of a relationship between child mortality data and socio-economic factors in relatively wealthy nations. The original study on child mortality that is reported here, which first appeared in a UK medical journal, was undertaken in a school of business by academics with accounting and finance backgrounds. The rationale explaining why academics from such disciplines were drawn to investigate these issues is given in the first part of the chapter. The findings related to child mortality data were identified as a special case of a wide range of social and health indicators that are systematically related to the different organisational approaches of capitalist societies. In particular, the so-called Anglo-American countries show consistently poor outcomes over a number of indicators, including child mortality. Considerable evidence has been adduced in the literature to show the importance of income inequality as an explanation for such findings. An important part of the chapter is the overview of a relatively recent publication in the epidemiological literature entitled The Spirit Level: Why Equality Is Better for Everyone, which was written by Wilkinson and Pickett. PMID:27197976

  13. Determinants of infant and child mortality in rural Haryana.

    PubMed

    Singhi, S; Kumar, R; Raina, N; Kumar, V

    1989-01-01

    To identify the individual and household level variables associated with increased risk of mortality, 159 infant and 50 child deaths (cases) and equal number of age matched live infants and children (controls) and their families were studied in a rural area of Haryana. The social, economic, educational and environmental characteristics of the case and control families were similar. Increased risk of infant and child mortality was associated with maternal age less than 20 and more than 30 years, birth order 4th or higher, unclean cord care at the time of child birth, failure of breast feeding during the first 3 months of age, lack of immunizations, and previous infant or child death(s) in the family (Odds ratio greater than 2; P less than 0.05-0.01 by X2 test). An emphasis on the interventions directed at control of the above mentioned variables may prove most helpful in reducing infant and child mortality in a rural area. PMID:2638678

  14. Child mortality and fertility in Colombia: individual and community effects.

    PubMed

    Rosenzweig, M R; Schultz, T P

    1982-03-01

    The education of a mother is strongly and positively correlated with the survival rate of her children. This paper combines household data from the Colombian Census of 1973 and characteristics of the 900 residential areas in Colombia, to test various hypotheses concerning the mechanism by which mother's education and public policies affect child survival and the distribution of health benefits resulting from policy interventions. The hypothesis is advanced that education provides people with skills in acquiring and decoding new information and thus effectively lowers the costs of using more beneficial child health and contraceptive technologies. Since a primary function of health and family planning programs is to disseminate information on these same technologies, the hypothesis is tested that mother's education and these program interventions may substitute for each other in improving child health and reducing family size. The empirical analysis confirms that in urban areas the availability of medical services, family planning activities, transportational infrastructure and climate, in addition to mother's education, are associated with child mortality ratios and fertility within a birth cohort of mothers. The least educated mothers are the most strongly affected, in terms of their reduced fertility and increased child survival rates, by the local urban health programs. The evidence is, thus, consistent with the substitution hypothesis. No effects of program interventions and medical facilities are found on rural populations, though both child mortality ratios and fertility are lower for more educated rural women. PMID:10256651

  15. Birth spacing, sibling rivalry and child mortality in India.

    PubMed

    Whitworth, Alison; Stephenson, Rob

    2002-12-01

    The detrimental impact of short preceding birth intervals on infant and early childhood mortality is well documented in demographic literature, although the pathways of influence within the relationship remain an area of debate. This paper examines the impact of the length of the preceding birth interval on under-two mortality in India, and examines the pathways through which short preceding birth intervals may lead to an increased risk of mortality. Three mortality periods are examined: neonatal, early post neonatal and late post-neonatal and toddler, using the 1992 Indian National Family Health Survey. A multilevel modelling approach is used to account for the hierarchical nature of the data. The determinants of infants following a short or long birth interval are also examined. The results show that short preceding birth intervals (< 18 months) are associated with an increased risk of mortality in all three age groups, and the effect is particularly marked in the early post-neonatal period. Significant interactions were found between the length of the preceding birth interval and maternal education, gender and the survival status of the previous child. The significance of these interactions varied with the age of the child. The results highlight the diluting effect that a higher level of maternal education has on the relationship between short preceding birth intervals and mortality risk. There is evidence to suggest that sibling rivalry is a pathway through which short birth intervals influence mortality, with the death of the previous sibling removing the competition for scarce resources, and resulting in lower risks of mortality than if the previous sibling was still alive. The greatest risks of an infant following a short birth interval are among those whose previous sibling died, high parities, those with young mothers, and those whose previous sibling was breastfed for a short duration. PMID:12409124

  16. Governance matters: an ecological association between governance and child mortality

    PubMed Central

    Lin, Ro-Ting; Chien, Lung-Chang; Chen, Ya-Mei; Chan, Chang-Chuan

    2014-01-01

    Background Governance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control. Methods We obtained indicators of six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of development factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time. Results Governance, development, and disease control showed clear inverse relations with the under-5 mortality rate (p<0.001). Per unit increases in governance, development, and disease control factors, the child mortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors. Conclusions In the effort to reduce the global under-5 mortality rate, addressing a country's need for better governance is as important as improvements in development and disease control. PMID:24711600

  17. Economic cycles and child mortality: A cross-national study of the least developed countries.

    PubMed

    Pérez-Moreno, Salvador; Blanco-Arana, María C; Bárcena-Martín, Elena

    2016-09-01

    This paper examines the effects of growth and recession periods on child mortality in the Least Developed Countries (LDCs) during the period 1990-2010. We provide empirical evidence of uneven effects of variations in Gross Domestic Product (GDP) per capita on the evolution of child mortality rate in periods of economic recession and expansion. A decrease in GDP per capita entails a significant rise in child mortality rates, whereas an increase does not affect child mortality significantly. In this context, official development assistance seems to play a crucial role in counteracting the increment in child mortality rates in recession periods, at least in those LDCs receiving greater aid. PMID:26998938

  18. The Impact of Anemia on Child Mortality: An Updated Review

    PubMed Central

    Scott, Samuel P.; Chen-Edinboro, Lenis P.; Caulfield, Laura E.; Murray-Kolb, Laura E.

    2014-01-01

    Iron deficiency anemia and child mortality are public health problems requiring urgent attention. However, the degree to which iron deficiency anemia contributes to child mortality is unknown. Here, we utilized an exhaustive article search and screening process to identify articles containing both anemia and mortality data for children aged 28 days to 12 years. We then estimated the reduction in risk of mortality associated with a 1-g/dL increase in hemoglobin (Hb). Our meta-analysis of nearly 12,000 children from six African countries revealed a combined odds ratio of 0.76 (0.62–0.93), indicating that for each 1-g/dL increase in Hb, the risk of death falls by 24%. The feasibility of a 1-g/dL increase in Hb has been demonstrated via simple iron supplementation strategies. Our finding suggests that ~1.8 million deaths in children aged 28 days to five years could be avoided each year by increasing Hb in these children by 1 g/dL. PMID:25533005

  19. Demographic variables in fetal and child mortality: Hmong in Thailand.

    PubMed

    Kunstadter, P; Kunstadter, S L; Podhisita, C; Leepreecha, P

    1993-05-01

    Conventional theories would not predict the 60% decline of infant mortality which has occurred among the Hmong population of Thailand, from 123/1000 in the mid-1960s to 48 in the mid-1980s. The Hmong population in northern Thailand has sustained high fertility and low use of modern health services. Most Hmong live in relatively remote rural villages and earn their living by self-employed farming. They have low levels of education, especially for women. They live in multi-generational patrilineal-patrilocal extended family households. Women's status is low. These characteristics contrast strongly with the majority ethnic Thai population, among whom a comparable mortality decline has been accompanied by widespread use of family planning, rapidly declining fertility, widespread use of modern health facilities, rapidly increasing levels of education for both sexes, rapid economic development, and a predominance of nuclear-based family households. Distributions of Hmong pregnancies by birth order and maternal age have remained relatively constant while fetal and young child death rates have declined for each level of parity and all maternal ages in recent cohorts. As predicted by conventional theories, infant mortality rates are highest among higher order births and for births to mothers of the highest ages, however there is relatively little effect on risk of infant mortality of first order pregnancies, or births to very young (10-14 year old) women. Fetal and infant mortality have declined steadily in recent cohorts at each parity level and all maternal ages. Modern medical care and decline in a surplus of female deaths associated with low status of women might explain the declines in fetal and child deaths regardless of parity or maternal age. Use of modern medical care for delivery is recent and accounts for less than 10% of all recent Hmong births, but survival rates are not consistently or significantly higher for children born with a modern birth attendant. Sex

  20. Success factors for reducing maternal and child mortality

    PubMed Central

    Schweitzer, Julian; Bishai, David; Chowdhury, Sadia; Caramani, Daniele; Frost, Laura; Cortez, Rafael; Daelmans, Bernadette; de Francisco, Andres; Adam, Taghreed; Cohen, Robert; Alfonso, Y Natalia; Franz-Vasdeki, Jennifer; Saadat, Seemeen; Pratt, Beth Anne; Eugster, Beatrice; Bandali, Sarah; Venkatachalam, Pritha; Hinton, Rachael; Murray, John; Arscott-Mills, Sharon; Axelson, Henrik; Maliqi, Blerta; Sarker, Intissar; Lakshminarayanan, Rama; Jacobs, Troy; Jacks, Susan; Mason, Elizabeth; Ghaffar, Abdul; Mays, Nicholas; Presern, Carole; Bustreo, Flavia

    2014-01-01

    Abstract Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond. PMID:25110379

  1. Child Mortality Estimation: Estimating Sex Differences in Childhood Mortality since the 1970s

    PubMed Central

    Sawyer, Cheryl Chriss

    2012-01-01

    Introduction Producing estimates of infant (under age 1 y), child (age 1–4 y), and under-five (under age 5 y) mortality rates disaggregated by sex is complicated by problems with data quality and availability. Interpretation of sex differences requires nuanced analysis: girls have a biological advantage against many causes of death that may be eroded if they are disadvantaged in access to resources. Earlier studies found that girls in some regions were not experiencing the survival advantage expected at given levels of mortality. In this paper I generate new estimates of sex differences for the 1970s to the 2000s. Methods and Findings Simple fitting methods were applied to male-to-female ratios of infant and under-five mortality rates from vital registration, surveys, and censuses. The sex ratio estimates were used to disaggregate published series of both-sexes mortality rates that were based on a larger number of sources. In many developing countries, I found that sex ratios of mortality have changed in the same direction as historically occurred in developed countries, but typically had a lower degree of female advantage for a given level of mortality. Regional average sex ratios weighted by numbers of births were found to be highly influenced by China and India, the only countries where both infant mortality and overall under-five mortality were estimated to be higher for girls than for boys in the 2000s. For the less developed regions (comprising Africa, Asia excluding Japan, Latin America/Caribbean, and Oceania excluding Australia and New Zealand), on average, boys' under-five mortality in the 2000s was about 2% higher than girls'. A number of countries were found to still experience higher mortality for girls than boys in the 1–4-y age group, with concentrations in southern Asia, northern Africa/western Asia, and western Africa. In the more developed regions (comprising Europe, northern America, Japan, Australia, and New Zealand), I found that the sex

  2. Comparison of three contemporary surgical scores for predicting all-cause mortality of patients undergoing percutaneous mitral valve repair with the MitraClip system (from the multicenter GRASP-IT registry).

    PubMed

    Adamo, Marianna; Capodanno, Davide; Cannata, Stefano; Giannini, Cristina; Laudisa, Maria Luisa; Barbanti, Marco; Curello, Salvatore; Immè, Sebastiano; Maffeo, Diego; Grasso, Carmelo; Bedogni, Francesco; Petronio, Anna Sonia; Ettori, Federica; Tamburino, Corrado

    2015-01-01

    The aim of this study was to explore the adaptability of 3 contemporary surgical scores (Logistic EuroSCORE [LES], EuroSCORE II [ESII], and Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) for prediction of mortality after percutaneous mitral valve repair with the MitraClip system. A total of 304 patients from the multicenter Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation in ITaly registry (GRASP-IT) were stratified based on LES, ESII, and STS-PROM tertiles and analyzed by different measurements of discrimination, calibration, and global accuracy with focus on 30-day and 1-, 2-, and 3-year mortality. A statistically significant gradient in the distribution of mortality was observed at all time points with ESII, at 2 years with LES, and at 2 and 3 years with STS-PROM. ESII had the best discrimination at 30 days (C-statistic 0.80), which remained acceptable at later follow-up, being significantly superior to that of LES at each time point (p = 0.003 at 30 days, p = 0.005 at 1 year, p = 0.011 at 2 years, and p = 0.029 at 3 years). Compared with STS-PROM, ESII showed better discrimination at 30 days (C-statistic 0.80 vs 0.62, p = 0.023). All scores overpredicted the risk of mortality at 30 days and were miscalibrated at 2 and 3 years. At 1 year, there was a good agreement between the observed and predicted probabilities for ESII and STS-PROM, whereas LES remained overpredictive. ESII showed the best global accuracy at 30 days and 1 year, whereas no notable differences were noted versus LES and STS-PROM at 2 and 3 years. In conclusion, lacking specific tools for risk stratification of patients undergoing MitraClip implantation, ESII holds favorable prognostic characteristics, which makes it a valid surrogate. PMID:25456878

  3. Monitoring Child Mortality through Community Health Worker Reporting of Births and Deaths in Malawi: Validation against a Household Mortality Survey

    PubMed Central

    Amouzou, Agbessi; Banda, Benjamin; Kachaka, Willie; Joos, Olga; Kanyuka, Mercy; Hill, Kenneth; Bryce, Jennifer

    2014-01-01

    Background The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. Methods and Findings Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95%CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. Conclusion This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs. PMID

  4. Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality: a cohort analysis based on 1 million person-years of follow-up in Västerbotten County, Sweden, during 1990–2006

    PubMed Central

    Blomstedt, Yulia; Norberg, Margareta; Stenlund, Hans; Nyström, Lennarth; Lönnberg, Göran; Boman, Kurt; Wall, Stig; Weinehall, Lars

    2015-01-01

    Objective To evaluate the impact of the Västerbotten Intervention Programme (VIP) by comparing all eligible individuals (target group impact) according to the intention-to-treat principle and VIP participants with the general Swedish population. Design Dynamic cohort study. Setting/participants All individuals aged 40, 50 or 60 years, residing in Västerbotten County, Sweden, between 1990 and 2006 (N=101 918) were followed from their first opportunity to participate in the VIP until age 75, study end point or prior death. Intervention The VIP is a systematic, long-term, county-wide cardiovascular disease (CVD) intervention that is performed within the primary healthcare setting and combines individual and population approaches. The core component is a health dialogue based on a physical examination and a comprehensive questionnaire at the ages of 40, 50 and 60 years. Primary outcomes All-cause and CVD mortality. Results For the target group, there were 5646 deaths observed over 1 054 607 person-years. Compared to Sweden at large, the standardised all-cause mortality ratio was 90.6% (95% CI 88.2% to 93.0%): for women 87.9% (95% CI 84.1% to 91.7%) and for men 92.2% (95% CI 89.2% to 95.3%). For CVD, the ratio was 95.0% (95% CI 90.7% to 99.4%): for women 90.4% (95% CI 82.6% to 98.7%) and for men 96.8% (95% CI 91.7 to 102.0). For participants, subject to further impact as well as selection, when compared to Sweden at large, the standardised all-cause mortality ratio was 66.3% (95% CI 63.7% to 69.0%), whereas the CVD ratio was 68.9% (95% CI 64.2% to 73.9%). For the target group as well as for the participants, standardised mortality ratios for all-cause mortality were reduced within all educational strata. Conclusions The study suggests that the VIP model of CVD prevention is able to impact on all-cause and cardiovascular mortality when evaluated according to the intention-to-treat principle. PMID:26685034

  5. Maternal bereavement: the heightened mortality of mothers after the death of a child.

    PubMed

    Espinosa, Javier; Evans, William N

    2013-07-01

    Using a 9-year follow-up of 69,224 mothers aged 20-50 from the National Longitudinal Mortality Survey, we investigate whether there is heightened mortality of mothers after the death of a child. Results from Cox proportional hazard models indicate that the death of a child produces a statistically significant hazard ratio of 2.3. There is suggestive evidence that the heightened mortality is concentrated in the first two years after the death of a child. We find no difference in results based on mother's education or marital status, family size, the child's cause of death or the gender of the child. PMID:22809832

  6. Using growth velocity to predict child mortality12

    PubMed Central

    Schwinger, Catherine; Van den Broeck, Jan

    2016-01-01

    Background: Growth assessment based on the WHO child growth velocity standards can potentially be used to predict adverse health outcomes. Nevertheless, there are very few studies on growth velocity to predict mortality. Objectives: We aimed to determine the ability of various growth velocity measures to predict child death within 3 mo and to compare it with those of attained growth measures. Design: Data from 5657 children <5 y old who were enrolled in a cohort study in the Democratic Republic of Congo were used. Children were measured up to 6 times in 3-mo intervals, and 246 (4.3%) children died during the study period. Generalized estimating equation (GEE) models informed the mortality risk within 3 mo for weight and length velocity z scores and 3-mo changes in midupper arm circumference (MUAC). We used receiver operating characteristic (ROC) curves to present balance in sensitivity and specificity to predict child death. Results: GEE models showed that children had an exponential increase in the risk of dying with decreasing growth velocity in all 4 indexes (1.2- to 2.4-fold for every unit decrease). A length and weight velocity z score of <−3 was associated with an 11.8- and a 7.9-fold increase, respectively, in the RR of death in the subsequent 3-mo period (95% CIs: 3.9, 35.5, and 3.9, 16.2, respectively). Weight and length velocity z scores had better predictive abilities [area under the ROC curves (AUCs) of 0.67 and 0.69] than did weight-for-age (AUC: 0.57) and length-for-age (AUC: 0.52) z scores. Among wasted children (weight-for-height z score <−2), the AUC of weight velocity z scores was 0.87. Absolute MUAC performed best among the attained indexes (AUC: 0.63), but longitudinal assessment of MUAC-based indexes did not increase the predictive value. Conclusion: Although repeated growth measures are slightly more complex to implement, their superiority in mortality-predictive abilities suggests that these could be used more for identifying children at

  7. Regional Infant and Child Mortality Review Committee--2011 final report.

    PubMed

    Wilson, Ann L; Sideras, James

    2012-12-01

    The 2011 annual report of the Regional Infant and Child Mortality Review Committee (RICMRC) is presented. Since 1997, the committee has reviewed 224 deaths to achieve its mission to "review infant and child deaths so that information can be transformed into action to protect young lives." In 2011, the committee reviewed 21 deaths (22 met the committee's criteria) of infants and children who were residents of Minnehaha, Turner, Lincoln, Hanson and Brookings counties in South Dakota. The manner of 12 of the reviewed deaths was natural with eight of these the result of progressive neurological diseases or conditions. In 2011 there were no deaths attributed to Sudden Infant Death Syndrome (SIDS), though there were two deaths of infants during sleep. One of these infants was ruled accidental as the baby died of aspiration and the other death occurred in an unsafe environment with its manner determined to be undecided. Six deaths were accidental, one of which occurred as a result of a fire in a home without functional smoke alarms. One motor vehicle death occurred, through no fault of the teen age driver. Another death resulted from tubing over a low head dam on the Big Sioux River. One youth suicide occurred to a resident of the region. PMID:23477038

  8. Maternal and child mortality indicators across 187 countries of the world: converging or diverging.

    PubMed

    Goli, Srinivas; Arokiasamy, Perianayagam

    2014-01-01

    This study reassessed the progress achieved since 1990 in maternal and child mortality indicators to test whether the progress is converging or diverging across countries worldwide. The convergence process is examined using standard parametric and non-parametric econometric models of convergence. The results of absolute convergence estimates reveal that progress in maternal and child mortality indicators is diverging for the entire period of 1990-2010 [maternal mortality ratio (MMR) - β = .00033, p < .574; neonatal mortality rate (NNMR) - β = .04367, p < .000; post-neonatal mortality rate (PNMR) - β = .02677, p < .000; under-five mortality rate (U5MR) - β = .00828, p < .000)]. In the recent period, such divergence is replaced with convergence for MMR but diverged for all the child mortality indicators. The results of Kernel density estimate reveal considerable reduction in divergence of MMR for the recent period; however, the Kernel density distribution plots show more than one 'peak' which indicates the emergence of convergence clubs based on their mortality levels. For child mortality indicators, the Kernel estimates suggest that divergence is in progress across the countries worldwide but tended to converge for countries with low mortality levels. A mere progress in global averages of maternal and child mortality indicators among a global cross-section of countries does not warranty convergence unless there is a considerable reduction in variance, skewness and range of change. PMID:24593038

  9. Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso.

    PubMed

    Becher, Heiko; Müller, Olaf; Dambach, Peter; Gabrysch, Sabine; Niamba, Louis; Sankoh, Osman; Simboro, Seraphin; Schoeps, Anja; Stieglbauer, Gabriele; Yé, Yazoume; Sié, Ali

    2016-04-01

    Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village-specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990-2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two-thirds reduction. PMID:26821122

  10. Religious Affiliation, Ethnicity, and Child Mortality in Chiapas, México

    PubMed Central

    Valle, Eunice D. Vargas; Potter, Joseph E.; Fernández, Leticia

    2015-01-01

    We investigate whether there is a relationship between religious affiliation and child mortality among indigenous and nonindigenous groups in Chiapas, México. Our analysis relies on Brass-type estimates of child mortality by ethnicity and religious affiliation and multivariate analyses that adjust for various socioeconomic and demographic factors. The data are from the 2000 Mexican Census 10 percent sample. Among indigenous people, Presbyterians have lower rates of child mortality than Catholics. However, no significant differentials are found in child mortality by religious affiliation among nonindigenous people. The indigenous health ministry of the Presbyterian Church and the social and cultural transformations that tend to accompany religious conversion may have an impact on child survival among disadvantaged populations such as the indigenous people in Chiapas. PMID:26146411

  11. Child mortality in a Nigerian city: its levels and socioeconomic differentials.

    PubMed

    Oni, G A

    1988-01-01

    Using the 'indirect' demographic estimation technique, levels of child mortality for some selected socioeconomic characteristics of mothers in Ilorin, an urban community in Nigeria, were derived. The adjusted effects of these variables on child mortality were assessed. The variables found to exert significant independent effects on child mortality included the husbands education, area of residence in the town, the parity of the mother, her use of modern contraception, availability of indoor pipe-borne water and the use of a refrigerator by the household. Reliable or useful information on child mortality in this part of Nigeria is hard to come by, hence, the estimates provided here can serve as useful baseline data for evaluating the impacts of child survival activities that are currently going on in that part of the country. PMID:3227367

  12. Intra-ethnic diversity in Hispanic child mortality, 1890-1910.

    PubMed

    Gutmann, M P; Haines, M R; Frisbie, W P; Blanchard, K S

    2000-11-01

    Using a representative sample of the Hispanic population of the United States based on the manuscripts of the 1910 census, we estimate childhood mortality for the period from approximately 1890 to 1910. We find high child mortality in the Hispanic population, higher than for non-Hispanic whites but not significantly different than among nonwhite non-Hispanics (mostly African Americans). Hispanic rural farm populations in California, Texas, and Arizona experienced high mortality, but not as high as other Hispanic populations. Child mortality was very high among Hispanic residents of New Mexico and those in Florida outside Tampa; it was especially low in the Hispanic population in Tampa. PMID:11086572

  13. Regional Infant and Child Mortality Review Committee: 2009 final report.

    PubMed

    Randall, Brad; Wilson, Ann

    2010-10-01

    The 2009 annual report of the Regional Infant and Child Mortality Review Committee (RICMRC) is presented. Since 1997, RICMRC has sought to achieve its mission to "review infant and child deaths so that information can be transformed into action to protect young lives." For the year 2009, the Committee reviewed 23 deaths from Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hanson, Miner and Brookings counties that met the following criteria: Children under age 18 dying subsequent to hospital discharge following delivery. Children who either died in these counties from causes sustained in them, or residents who died elsewhere from causes sustained in the 10-county region. The acronym SUID, (Sudden Unexpected Infant Death), is being increasingly used by investigators of infant deaths. SUID is an intentionally broad category used for any infant death where the cause of death is unapparent or multifactorial. Sudden Infant Death Syndrome (SIDS) is a subset of SUID. No deaths categorized as SIDS occurred in 2009. The committee has observed a stable decline in the number of deaths due to SIDS for the last several years with the exception of two SIDS deaths that occurred in 2008. The national SIDS rate of 0.55 per 1000 live births would suggest that our region should have one SIDS death per year. It would appear, on the average, that our region's SIDS incidence is close to that number. Many investigators believe that a "diagnostic drift" is occurring in the SIDS diagnosis. These investigators believe that some deaths certified as SIDS in earlier years may now be classified as "undetermined," or in the new terminology, SUID. Although the committee strives to be consistent year to year in its death investigation protocols, we have noticed that the number of deaths classified as "undetermined" has been increasing over the last few years (Figure 1). The majority of our "undetermined" manners of infant deaths appear to be related to concerns about possible asphyxial

  14. Reduction in child mortality in Ethiopia: analysis of data from demographic and health surveys

    PubMed Central

    Doherty, Tanya; Rohde, Sarah; Besada, Donela; Kerber, Kate; Manda, Samuel; Loveday, Marian; Nsibande, Duduzile; Daviaud, Emmanuelle; Kinney, Mary; Zembe, Wanga; Leon, Natalie; Rudan, Igor; Degefie, Tedbabe; Sanders, David

    2016-01-01

    Background To examine changes in under–5 mortality, coverage of child survival interventions and nutritional status of children in Ethiopia between 2000 and 2011. Using the Lives Saved Tool, the impact of changes in coverage of child survival interventions on under–5 lives saved was estimated. Methods Estimates of child mortality were generated using three Ethiopia Demographic and Health Surveys undertaken between 2000 and 2011. Coverage indicators for high impact child health interventions were calculated and the Lives Saved Tool (LiST) was used to estimate child lives saved in 2011. Results The mortality rate in children younger than 5 years decreased rapidly from 218 child deaths per 1000 live births (95% confidence interval 183 to 252) in the period 1987–1991 to 88 child deaths per 1000 live births in the period 2007–2011 (78 to 98). The prevalence of moderate or severe stunting in children aged 6–35 months also declined significantly. Improvements in the coverage of interventions relevant to child survival in rural areas of Ethiopia between 2000 and 2011 were found for tetanus toxoid, DPT3 and measles vaccination, oral rehydration solution (ORS) and care–seeking for suspected pneumonia. The LiST analysis estimates that there were 60 700 child deaths averted in 2011, primarily attributable to decreases in wasting rates (18%), stunting rates (13%) and water, sanitation and hygiene (WASH) interventions (13%). Conclusions Improvements in the nutritional status of children and increases in coverage of high impact interventions most notably WASH and ORS have contributed to the decline in under–5 mortality in Ethiopia. These proximal determinants however do not fully explain the mortality reduction which is plausibly also due to the synergistic effect of major child health and nutrition policies and delivery strategies. PMID:27175280

  15. How do masculinity, paternity leave, and mortality associate? -A study of fathers in the Swedish parental & child cohort of 1988/89.

    PubMed

    Månsdotter, Anna; Lundin, Andreas

    2010-08-01

    One of the proposed causes for the gender gap in longevity is the attitudes and practices culturally prescribed for men, often conceptualised as 'masculinity'. It has also been suggested that paternity leave, indicating a change from breadwinning to caring, could benefit men's lifetime health. In this study, the objective was to examine associations between 'masculinity' (assessed at the age of 18-19 years), paternity leave (1988-1990), and mortality patterns (1991-2008) based on a population of Swedish men who had a child in 1988/89 (N=72,569). 'Masculinity' was measured during the compulsory military conscription process by a psychologist based on leisure and occupational interests, and paternity leave was measured in fulltime days by registry data. The main finding was that low 'masculinity' ranking increased the risk of all-cause mortality, and mortality from alcohol and violent causes, while taking paternity leave between 30 and 135 days decreased the risk of all-cause mortality. However, the weak association found between 'masculinity' and paternity leave indicates that entering a caring role as a father is not predicted by 'masculinity' assessed in late adolescence, and that the studied phenomena influence male mortality independently of each other. PMID:20538394

  16. A hazards-model analysis of the covariates of infant and child mortality in Sri Lanka.

    PubMed

    Trussell, J; Hammerslough, C

    1983-02-01

    The purpose of this paper is twofold: (a) to provide a complete self-contained exposition of estimating life tables with covariates through the use of hazards models, and (b) to illustrate this technique with a substantive analysis of child mortality in Sri Lanka, thereby demonstrating that World Fertility Survey data are a valuable source for the study of child mortality. We show that life tables with covariates can be easily estimated with standard computer packages designed for analysis of contingency tables. The substantive analysis confirms and supplements an earlier study of infant and child mortality in Sri Lanka by Meegama. Those factors found to be strongly associated with mortality are mother's and father's education, time period of birth, urban/rural/estate residence, ethnicity, sex, birth order, age of the mother at the birth, and type of toilet facility. PMID:6832431

  17. Abolishing inequity, a necessity for poverty reduction and the realisation of child mortality targets.

    PubMed

    Målqvist, Mats

    2015-02-01

    The first Millennium Development Goal (MDG 1) due in 2015 concerns poverty reduction. It has been claimed to be fulfilled on a global level, but still more than 1 billion people are living in abject poverty. There is a strong link between the economy and child survival, and only a minority of countries will have reached the MDG target for child mortality reduction by 2015. This paper discusses the relationship between poverty and child survival. It argues that a focus on equity is necessary to further reduce child mortality, through poverty reduction in absolute terms and also through targeting interventions for increased child survival to disadvantaged populations. The political will to actually achieve real change for those in greatest need is crucial but not to be taken for granted, and the distribution rather than the generation of wealth needs to be made a priority in the post-MDG era. PMID:25613969

  18. REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS.

    PubMed

    Adedini, Sunday A; Odimegwu, Clifford; Imasiku, Eunice N S; Ononokpono, Dorothy N; Ibisomi, Latifat

    2015-03-01

    There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria. PMID:24411023

  19. Disparities in Under-Five Child Injury Mortality between Developing and Developed Countries: 1990–2013

    PubMed Central

    Huang, Yun; Wu, Yue; Schwebel, David C.; Zhou, Liang; Hu, Guoqing

    2016-01-01

    Objective: Using estimates from the 2013 Global Burden of Disease (GBD) study, we update evidence on disparities in under-five child injury mortality between developing and developed countries from 1990 to 2013. Methods: Mortality rates were accessed through the online visualization tool by the GBD study 2013 group. We calculated percent change in child injury mortality rates between 1990 and 2013. Data analysis was conducted separately for <1 year and 1–4 years to specify age differences in rate changes. Results: Between 1990 and 2013, over 3-fold mortality gaps were observed between developing countries and developed countries for both age groups in the study time period. Similar decreases in injury rates were observed for developed and developing countries (<1 year: −50% vs. −50% respectively; 1–4 years: −56% vs. −58%). Differences in injury mortality changes during 1990–2013 between developing and developed nations varied with injury cause. There were greater reductions in mortality from transport injury, falls, poisoning, adverse effects of medical treatment, exposure to forces of nature, and collective violence and legal intervention in developed countries, whereas there were larger decreases in mortality from drowning, exposure to mechanical forces, and animal contact in developing countries. Country-specific analysis showed large variations across countries for both injury mortality and changes in injury mortality between 1990 and 2013. Conclusions: Sustained higher child injury mortality during 1990–2013 for developing countries merits the attention of the global injury prevention community. Countries that have high injury mortality can benefit from the success of other countries. PMID:27399740

  20. Levels, trends & predictors of infant & child mortality among Scheduled Tribes in rural India

    PubMed Central

    Sahu, Damodar; Nair, Saritha; Singh, Lucky; Gulati, B.K.; Pandey, Arvind

    2015-01-01

    Background & objectives: The level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among Scheduled Tribes in rural areas. Methods: Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992–2006. Results: Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1.1-1.7) as compared with births to the mother's aged 20-29 yr. Hazard of under-five mortality was 42 per cent (95% CI=1.3-1.6) higher among four or more birth order compared with the first birth order. The risk of infant dying was higher among male children (HR = 1.2, 95% CI=1.1-1.4) than among female children while male children were at 30 per cent (HR=0.7, 95% CI=0.6-0.7) less hazard of child mortality than female children. Literate women were at 40 per cent (HR=0.6, 95% CI=0.50-0.76) less hazard of child death than illiterate women. Interpretation & conclusions: Mortality differentials by socio-demographic and economic factors were observed over the time period (1992-2006) among Scheduled Tribes (STs) in rural India. Findings support the need to focus on age at first birth and spacing between two births. PMID:26139791

  1. Inequality in child mortality across different states of India: a comparative study.

    PubMed

    De, Partha; Dhar, Arpita

    2013-12-01

    The burden of social inequality falls disproportionately on child health and survival. This inequality raises the question of how wide this gap is, or what its relation is with the level of child mortality. Whether these disparities are increasing or declining with the development and how they differ from region to region or from state to state within the country needs to be looked into. As a measure of inequality and to compare the disparities between different states of India, concentration curves and indices are constructed from infant and under five mortality data classified under different quintiles of wealth index from the National Family Health Survey (NFHS-3) data of India. Inequality measures indicate that inequality in child mortality is more concentrated in the comparatively developed states than the poorer states in India. PMID:23435164

  2. Association of selected risk factors with variation in child and adolescent firearm mortality by state.

    PubMed

    Murnan, Judy; Dake, Joseph A; Price, James H

    2004-10-01

    This study examined relationships between variation in child and adolescent firearm mortality by state and the following variables: childhood poverty rate, percent single parent families, percent population that is African American, percent population that is Hispanic, percent students carrying a gun, percent students carrying a weapon, percent students feeling unsafe, percent students feeling sad/hopeless, percent students academically at-risk, percent students involved infighting, percent students engaging in binge drinking behavior, violent crime rate for youths, individual gun laws in each state, prevalence of firearm ownership, and percent residing in urban area. Stepwise regression was calculated and one independent variable, prevalence of firearm ownership in the state, emerged as a significant predictor of child and adolescent firearm mortality. This variable predicted 47% of the variance from state to state in the child and adolescent firearm mortality. Schools need to address firearm safety and advocate for elimination of firearms accessible to youth. PMID:15554120

  3. Socioeconomic inequalities in child mortality: comparisons across nine developing countries.

    PubMed Central

    Wagstaff, A.

    2000-01-01

    This paper generates and analyses survey data on inequalities in mortality among infants and children aged under five years by consumption in Brazil, Côte d'Ivoire, Ghana, Nepal, Nicaragua, Pakistan, the Philippines, South Africa, and Viet Nam. The data were obtained from the Living Standards Measurement Study and the Cebu Longitudinal Health and Nutrition Survey. Mortality rates were estimated directly where complete fertility histories were available and indirectly otherwise. Mortality distributions were compared between countries by means of concentration curves and concentration indices: dominance checks were carried out for all pairwise intercountry comparisons; standard errors were calculated for the concentration indices; and tests of intercountry differences in inequality were performed. PMID:10686730

  4. Consequences of intimate partner violence against women on under-five child mortality in Bangladesh.

    PubMed

    Hossain, Md Akhtar; Sumi, Nahid Sultana; Haque, M Ershadul; Bari, Wasimul

    2014-05-01

    It is well established that intimate partner violence (IPV) against women adversely affects maternal morbidity and mortality. But a limited number of studies were found in the literature regarding the association between IPV and under-five child mortality. In this article, using Bangladesh Demographic and Health Survey (BDHS) 2007 data, we examined the effect of IPV on under-five child mortality. A product-limit approach was used for bivariate survival analysis, and Cox proportional hazard multiple regression models were used to investigate the effect of IPV controlling potential confounders. In bivariate analysis, the variables exposure to IPV, mother's age at birth, mother's education, residence type, division, number of children, wealth index, occupation, access to media, and decision autonomy were found to be potential risk factors for child mortality. Results indicated that women exposed to IPV were more likely to experience under-five child mortality compared with women not exposed. The unadjusted hazard ratio for IPV was 1.21 (95% confidence interval [CI] = [1.09, 1.35]) with p value < .01, whereas it was 1.16 (95% CI = [1.04, 1.29]) with p value < .01 and 1.13 (95% CI = [1.01, 1.26]) with p value < .05 in two adjusted models. These results implied that IPV against women is a problem not only for women but also for their children's survival. PMID:24288192

  5. Infant and Child Mortality in India in the Last Two Decades: A Geospatial Analysis

    PubMed Central

    Singh, Abhishek; Pathak, Praveen Kumar; Chauhan, Rajesh Kumar; Pan, William

    2011-01-01

    Background Studies examining the intricate interplay between poverty, female literacy, child malnutrition, and child mortality are rare in demographic literature. Given the recent focus on Millennium Development Goals 4 (child survival) and 5 (maternal health), we explored whether the geographic regions that were underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were also grappling with the elevated risk of child mortality; whether there were any spatial outliers; whether these relationships have undergone any significant change over historical time periods. Methodology The present paper attempted to investigate these critical questions using data from household surveys like NFHS 1992–1993, NFHS 1998–1999 and DLHS 2002–2004. For the first time, we employed geo-spatial techniques like Moran's-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression to address the research problem. For carrying out the geospatial analysis, we classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) following the Census of India Study and all estimates were generated for each of the geographic regions. Result/Conclusions This study brings out the stark intra-state and inter-regional disparities in infant and under-five mortality in India over the past two decades. It further reveals, for the first time, that geographic regions that were underprivileged in child nutrition or wealth or female literacy were also likely to be disadvantaged in terms of infant and child survival irrespective of the state to which they belong. While the role of economic status in explaining child malnutrition and child survival has weakened, the effect of mother's education has actually become stronger over time. PMID:22073208

  6. Survived infancy but still vulnerable: spatial-temporal trends and risk factors for child mortality in the Agincourt rural sub-district, South Africa, 1992-2007.

    PubMed

    Sartorius, Benn; Kahn, Kathleen; Collinson, Mark A; Vounatsou, Penelope; Tollman, Stephen M

    2011-05-01

    Targeting of health interventions to poor children at highest risk of mortality are promising approaches for enhancing equity. Methods have emerged to accurately quantify excess risk and identify space-time disparities. This provides useful and detailed information for guiding policy. A spatio-temporal analysis was performed to identify risk factors associated with child (1-4 years) mortality in the Agincourt sub-district, South Africa, to assess temporal changes in child mortality patterns within the study site between 1992 and 2007, and to produce all-cause and cause-specific mortality maps to identify high risk areas. Demographic, maternal, paternal and fertility-related factors, household mortality experience, distance to health care facility and socio-economic status were among the examined risk factors. The analysis was carried out by fitting a Bayesian discrete time Bernoulli survival geostatistical model using Markov chain Monte Carlo simulation. Bayesian kriging was used to produce mortality risk maps. Significant temporal increase in child mortality was observed due to the HIV epidemic. A distinct spatial risk pattern was observed with higher risk areas being concentrated in poorer settlements on the eastern part of the study area, largely inhabited by former Mozambican refugees. The major risk factors for childhood mortality, following multivariate adjustment, were mother's death (especially when due to HIV and tuberculosis), greater number of children under 5 years living in the same household and winter season. This study demonstrates the use of Bayesian geostatistical models for accurately quantifying risk factors and producing maps of child mortality risk in a health and demographic surveillance system. According to the space-time analysis, the southeast and upper central regions of the site appear to have the highest mortality risk. The results inform policies to address health inequalities in the Agincourt sub-district and to improve access to

  7. The global problems of child malnutrition and mortality in different world regions.

    PubMed

    El-Ghannam, Ashraf Ragab

    2003-01-01

    The study of child mortality occupies a special place in the field of demographic research, since it represents the negative component of population growth. Also, the world food problem has become a familiar topic since the end of the World War II. The idea that population growth will sometime in the future outrun food supplies and universal starvation occurs. This study deals with what happened in global and regional variations regarding the child malnutrition and mortality rates. The main objective of the study is to explain and to explore the effect of the social, demographic, economic and health factors on child malnutrition and mortality rates among different regions in the globe. The study includes ten regions of the whole world compared to other studies that covered only one or two regions. Data were collected from various sources. The sample involved 191 countries. These countries divided by regions of world as following. East Southern Africa, West Africa, East Asia and Pacific, South Asia, Eastern Europe and Central Asia, Europe, Middle East, North Africa, North America, and South America. The results of descriptive analysis show that the highest mean rate of child malnutrition was found in South Asia region (57 children per 100), while the smallest mean rate was found in Europe region (just 1 child per 100). In West Africa region, the average of child mortality rate per 1000, 172 children, was the highest among all regions in the world, while in Europe was found to be 14 children per 1000. The results of correlation coefficients reveal that there were positive associations between illiteracy rate, unemployment, poverty, fertility rate, family size, food consumption, maternal mortality rate, population per physician, and child malnutrition and mortality in the whole world regions. Some regions have strong significant associations, such as Sub-Saharan Africa, Asia, and Americas, and other were non-significant association, such as Europe, Middle East, and

  8. Association of Selected Risk Factors with Variation in Child and Adolescent Firearm Mortality by State

    ERIC Educational Resources Information Center

    Murnan, Judy; Dake, Joseph A.; Price, James H.

    2004-01-01

    This study examined relationships between variation in child and adolescent firearm mortality by state and the following variables: childhood poverty rate, percent single parent families, percent population that is African American, percent population that is Hispanic. percent students carrying a gun, percent students carrying a weapon, percent…

  9. Family Structure and Child Mortality in Sub-Saharan Africa: Cross-National Effects of Polygyny

    ERIC Educational Resources Information Center

    Omariba, D. Walter Rasugu; Boyle, Michael H.

    2007-01-01

    This study applies multilevel logistic regression to Demographic and Health Survey data from 22 sub-Saharan African countries to examine whether the relationship between child mortality and family structure, with a specific emphasis on polygyny, varies cross-nationally and over time. Hypotheses were developed on the basis of competing theories on…

  10. Multinational Corporations, Democracy and Child Mortality: A Quantitative, Cross-National Analysis of Developing Countries

    ERIC Educational Resources Information Center

    Shandra, John M.; Nobles, Jenna E.; London, Bruce; Williamson, John B.

    2005-01-01

    This study presents quantitative, sociological models designed to account for cross-national variation in child mortality. We consider variables linked to five different theoretical perspectives that include the economic modernization, social modernization, political modernization, ecological-evolutionary, and dependency perspectives. The study is…

  11. Water for Life: The Impact of the Privatization of Water Services on Child Mortality.

    ERIC Educational Resources Information Center

    Galiani, Sebastian; Gertler, Paul; Schargrodsky, Ernesto

    2005-01-01

    While most countries are committed to increasing access to safe water and thereby reducing child mortality, there is little consensus on how to actually improve water services. One important proposal under discussion is whether to privatize water provision. In the 1990s Argentina embarked on one of the largest privatization campaigns in the world,…

  12. Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study.

    PubMed Central

    Kabir, Zubair; Long, Jean; Reddaiah, Vankadara P.; Kevany, John; Kapoor, Suresh K.

    2003-01-01

    OBJECTIVE: To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. METHODS: In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. FINDINGS: The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. CONCLUSION: Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials. PMID:12764490

  13. Tackling Health Inequities in Chile: Maternal, Newborn, Infant, and Child Mortality Between 1990 and 2004

    PubMed Central

    Requejo, Jennifer Harris; Nien, Jyh Kae; Merialdi, Mario; Bustreo, Flavia; Betran, Ana Pilar

    2009-01-01

    Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100 000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. PMID:19443831

  14. Inequalities in child mortality in Mozambique: differentials by parental socio-economic position.

    PubMed

    Macassa, Gloria; Ghilagaber, Gebrenegus; Bernhardt, Eva; Diderichsen, Finn; Burström, Bo

    2003-12-01

    This study investigates the relation between socio-economic parental position (education and occupation) and child death in Mozambique using data from the Mozambican Demographic and Health Survey carried out between March and July 1997. The analysis included 9142 children born within 10 years before the survey. In spite of the Western system of classification used in the study, the results partly showed a parental socio-economic gradient of infant and child mortality in Mozambique. Father's education seemed to reflect the family's social standing in the Mozambique context, showing a strong statistical association with postneonatal and child mortality. However, maternal education as a measure of socio-economic position was not statistically significantly associated with child mortality. This finding may partly be explained by the extreme hardships experienced by the country (civil war and natural disasters) and the implementation of the Economic Structural Adjustment Programme that have also affected the health of women and their children during the years covered by this study. Other measures of socio-economic position applicable to the rural African setting should be investigated. PMID:14572835

  15. Tracking progress towards the Millennium Development Goals: reaching consensus on child mortality levels and trends.

    PubMed Central

    2006-01-01

    The increased attention to tracking progress towards the Millennium Development Goals (MDG), including Goal 4 of reducing child mortality, has drawn attention to a number of interrelated technical, operational and political challenges and to the underlying weaknesses of country health information systems upon which reliable monitoring depends. Assessments of child mortality published in 2005, for almost all low-income countries, are based on an extrapolation of the trends observed during the 1990s, rather than on the empirical data for more recent years. The validity of the extrapolation depends on the quality and quantity of the data used, and many countries lack suitable data. In the long run, it is hoped that vital registration or sample registration systems will be established to monitor vital events in a sustainable way. However, in the short run, tracking child mortality in high-mortality countries will continue to rely on household surveys and extrapolations of historical trends. This will require more collaborative efforts both to collect data through initiatives to strengthen health information systems at the country level, and to harmonize the estimation process. The latter objective requires the continued activity of a coordinating group of international agencies and academics that aims to produce transparent estimates -- through the consistent application of an agreed-upon methodology --for monitoring at the international level. PMID:16583082

  16. Inequality of child mortality among ethnic groups in sub-Saharan Africa.

    PubMed Central

    Brockerhoff, M.; Hewett, P.

    2000-01-01

    Accounts by journalists of wars in several countries of sub-Saharan Africa in the 1990s have raised concern that ethnic cleavages and overlapping religious and racial affiliations may widen the inequalities in health and survival among ethnic groups throughout the region, particularly among children. Paradoxically, there has been no systematic examination of ethnic inequality in child survival chances across countries in the region. This paper uses survey data collected in the 1990s in 11 countries (Central African Republic, Côte d'Ivoire, Ghana, Kenya, Mali, Namibia, Niger, Rwanda, Senegal, Uganda, and Zambia) to examine whether ethnic inequality in child mortality has been present and spreading in sub-Saharan Africa since the 1980s. The focus was on one or two groups in each country which may have experienced distinct child health and survival chances, compared to the rest of the national population, as a result of their geographical location. The factors examined to explain potential child survival inequalities among ethnic groups included residence in the largest city, household economic conditions, educational attainment and nutritional status of the mothers, use of modern maternal and child health services including immunization, and patterns of fertility and migration. The results show remarkable consistency. In all 11 countries there were significant differentials between ethnic groups in the odds of dying during infancy or before the age of 5 years. Multivariate analysis shows that ethnic child mortality differences are closely linked with economic inequality in many countries, and perhaps with differential use of child health services in countries of the Sahel region. Strong and consistent results in this study support placing the notion of ethnicity at the forefront of theories and analyses of child mortality in Africa which incorporate social, and not purely epidemiological, considerations. Moreover, the typical advantage of relatively small, clearly

  17. Space-Time Smoothing of Complex Survey Data: Small Area Estimation for Child Mortality

    PubMed Central

    Mercer, Laina D; Wakefield, Jon; Pantazis, Athena; Lutambi, Angelina M; Masanja, Honorati; Clark, Samuel

    2016-01-01

    Many people living in low and middle-income countries are not covered by civil registration and vital statistics systems. Consequently, a wide variety of other types of data including many household sample surveys are used to estimate health and population indicators. In this paper we combine data from sample surveys and demographic surveillance systems to produce small area estimates of child mortality through time. Small area estimates are necessary to understand geographical heterogeneity in health indicators when full-coverage vital statistics are not available. For this endeavor spatio-temporal smoothing is beneficial to alleviate problems of data sparsity. The use of conventional hierarchical models requires careful thought since the survey weights may need to be considered to alleviate bias due to non-random sampling and non-response. The application that motivated this work is estimation of child mortality rates in five-year time intervals in regions of Tanzania. Data come from Demographic and Health Surveys conducted over the period 1991–2010 and two demographic surveillance system sites. We derive a variance estimator of under five years child mortality that accounts for the complex survey weighting. For our application, the hierarchical models we consider include random effects for area, time and survey and we compare models using a variety of measures including the conditional predictive ordinate (CPO). The method we propose is implemented via the fast and accurate integrated nested Laplace approximation (INLA). PMID:27468328

  18. Exploring Child Mortality Risks Associated with Diverse Patterns of Maternal Migration in Haiti

    PubMed Central

    Smith-Greenaway, Emily; Thomas, Kevin

    2014-01-01

    Internal migration is a salient dimension of adulthood in Haiti, particularly among women. Despite the prevalence of migration in Haiti, it remains unknown whether Haitian women’s diverse patterns of migration influence their children’s health and survival. In this paper, we introduce the concept of lateral (i.e., rural-to-rural, urban-to-urban) versus nonlateral (i.e., rural-to-urban, urban-to-rural) migration to describe how some patterns of mothers’ internal migration may be associated with particularly high mortality among children. We use the 2006 Haitian Demographic and Health Survey to estimate a series of discrete-time hazard models among 7,409 rural children and 3,864 urban children. We find that, compared with their peers with nonmigrant mothers, children born to lateral migrants generally experience lower mortality whereas those born to nonlateral migrants generally experience higher mortality. Although there are important distinctions across Haiti’s rural and urban contexts, these associations remain net of socioeconomic factors, suggesting they are not entirely attributable to migrant selection. Considering the timing of maternal migration uncovers even more variation in the child health implications of maternal migration; however, the results counter the standard disruption and adaptation perspective. Although future work is needed to identify the processes underlying the differential risk of child mortality across lateral versus nonlateral migrants, the study demonstrates that looking beyond rural-to-urban migration and considering the timing of maternal migration can provide a fuller, more complex understanding of migration’s association with child health. PMID:25506111

  19. Extremes of maternal age and child mortality: analysis between 2000 and 2009☆

    PubMed Central

    Ribeiro, Fanciele Dinis; Ferrari, Rosângela Aparecida Pimenta; Sant'Anna, Flávia Lopes; Dalmas, José Carlos; Girotto, Edmarlon

    2014-01-01

    OBJECTIVE: To analyze the characteristics of infant mortality at the extremes of maternal age. METHOD: Retrospective, cross-sectional quantitative study using data from Live Birth Certificates, Death Certificates and from Child Death Investigation records in Londrina, Paraná, in the years of 2000-2009. RESULTS: During the 10-year study period , there were 176 infant deaths among mothers up to 19 years of age, and 113 deaths among mothers aged 35 years or more. The infant mortality rate among young mothers was 14.4 deaths per thousand births, compared to 12.9 deaths in the other age group. For adolescent mothers, the following conditions prevailed: lack of a stable partner (p<0.001), lack of a paid job (p<0.001), late start of prenatal care in the second trimester of pregnancy (p<0.001), fewer prenatal visits (p<0.001) and urinary tract infections (p<0.001). On the other hand, women aged 35 or more had a higher occurrence of hypertension during pregnancy (p<0.001), and of surgical delivery (p<0.001). Regarding the underlying cause of infant death, congenital anomalies prevailed in the group of older mothers (p=0.002), and external causes were predominant in the group of young mothers (p=0.019). CONCLUSION: Both age groups deserve the attention of social services for maternal and child health, especially adolescent mothers, who presented a higher combination of factors deemed hazardous to the child's health. PMID:25511003

  20. Overcoming Stagnation in the Levels and Distribution of Child Mortality: The Case of the Philippines

    PubMed Central

    Bermejo, Raoul; Firth, Sonja; Hodge, Andrew; Jimenez-Soto, Eliana; Zeck, Willibald

    2015-01-01

    Background Health-related within-country inequalities continue to be a matter of great interest and concern to both policy makers and researchers. This study aims to assess the level and the distribution of child mortality outcomes in the Philippines across geographical and socioeconomic indicators. Methodology Data on 159,130 children ever borne were analysed from five waves of the Philippine Demographic and Health Survey. Direct estimation was used to construct under-five and neonatal mortality rates for the period 1980–2013. Rate differences and ratios, and where possible, slope and relative indices of inequality were calculated to measure disparities on absolute and relative scales. Stratification was undertaken by levels of rural/urban location, island groups and household wealth. Findings National under-five and neonatal mortality rates have shown considerable albeit differential reductions since 1980. Recently released data suggests that neonatal mortality has declined following a period of stagnation. Declines in under-five mortality have been accompanied by decreases in wealth and geography-related absolute inequalities. However, relative inequalities for the same markers have remained stable over time. For neonates, mixed evidence suggests that absolute and relative inequalities have remained stable or may have risen. Conclusion In addition to continued reductions in under-five mortality, new data suggests that the Philippines have achieved success in addressing the commonly observed stagnated trend in neonatal mortality. This success has been driven by economic improvement since 2006 as well as efforts to implement a nationwide universal health care campaign. Yet, such patterns, nonetheless, accorded with persistent inequalities, particularly on a relative scale. A continued focus on addressing universal coverage, the influence of decentralisation and armed conflict, and issues along the continuum of care is advocated. PMID:26431409

  1. Estimating the net effect of HIV on child mortality in African populations affected by generalized HIV epidemics.

    PubMed

    Marston, Milly; Zaba, Basia; Salomon, Joshua A; Brahmbhatt, Heena; Bagenda, Danstan

    2005-02-01

    For a given prevalence, HIV has a relatively higher impact on child mortality when mortality from other causes is low. To project the effect of the epidemic on child mortality, it is necessary to estimate a realistic schedule of "net" age-specific mortality rates that would operate if HIV were the only cause of child death observable. We assume that this net pattern would be independent of mortality from other causes. We used African studies that measured the survival of HIV-infected children (direct data) or survival of children of HIV-infected mothers (indirect data). We developed a mathematic procedure to estimate the mortality of infected children from indirect data sources and obtained net HIV mortality patterns for each study population. The net age-specific HIV mortality pattern for infected children can be described by a double Weibull curve fitted to empiric data; this gives a functional representation of age-specific mortality rates that decline after infancy and rise in the preteens. The fitted curve that we would expect if HIV were the only effective cause of death shows 67% net survival at 1 year and 39% at 5 years. The curve also predicts 13% net survival at 10 years using constraints based on survival of infected adults. PMID:15671809

  2. Putting the "M" back in the Maternal and Child Health Bureau: reducing maternal mortality and morbidity.

    PubMed

    Lu, Michael C; Highsmith, Keisher; de la Cruz, David; Atrash, Hani K

    2015-07-01

    Maternal mortality and severe morbidity are on the rise in the United States. A significant proportion of these events are preventable. The Maternal Health Initiative (MHI), coordinated by the Maternal and Child Health Bureau at the Health Resources and Services Administration, is intensifying efforts to reduce maternal mortality and severe morbidity in the U.S. Through a public-private partnership, MHI is taking a comprehensive approach to improving maternal health focusing on five priority areas: improving women's health before, during and beyond pregnancy; improving the quality and safety of maternity care; improving systems of maternity care including both clinical and public health systems; improving public awareness and education; and improving surveillance and research. PMID:25626713

  3. [Infant and child mortality, marital fertility, and family economy among peasants in Navarre (1860-1930)].

    PubMed

    Erdozain, P; Mikelarena, F

    1996-01-01

    "This article analyzes the following four questions. Firstly, the evolutions of infant and child mortality and the evolution of marital fertility in rural Navarre [Spain] from 1860 to 1930. Secondly, the [registered] changes around the size and the composition of the rural households in the central area of Navarre where the stem-family prevailed....Thirdly, the evolution of the quotient between the numbers of potentially active household members and the number of consumption units. Finally, the technical change effects concerning the family labor requirements: the agrarian mechanization process and the intensification of crops." (EXCERPT) PMID:12321157

  4. The effect of maternal and child health and family planning services on mortality: is prevention enough?

    PubMed Central

    Fauveau, V; Wojtyniak, B; Chakraborty, J; Sarder, A M; Briend, A

    1990-01-01

    OBJECTIVE--To examine the impact on mortality of a child survival strategy, mostly based on preventive interventions. DESIGN--Cross sectional comparison of cause specific mortality in two communities differing in the type, coverage, and quality of maternal and child health and family planning services. In the intervention area the services were mainly preventive, community based, and home delivered. SUBJECTS--Neonates, infants, children, and mothers in two contiguous areas of rural Bangladesh. INTERVENTIONS--In the intervention area community health workers provided advice on contraception and on feeding and weaning babies; distributed oral rehydration solution, vitamin A tablets for children under 5, and ferrous fumarate and folic acid during pregnancy; immunised children; trained birth attendants in safe delivery and when to refer; treated minor ailments; and referred seriously ill people and malnourished children to a central clinic. MAIN OUTCOME MEASURES--Overall and age and cause specific death rates, obtained by a multiple step "verbal autopsy" process. RESULTS--During the two years covered by the study overall mortality was 17% lower among neonates, 9% lower among infants aged 1-5 months, 30% lower among children aged 6-35 months, and 19% lower among women living in the study area than in those living in the control area. These differences were mainly due to fewer deaths from neonatal tetanus, measles, persistent diarrhoea with severe malnutrition among children, and fewer abortions among women. CONCLUSIONS--The programme was effective in preventing some deaths. In addition to preventive components such as tetanus and measles immunisation, health and nutrition education, and family planning, curative services are needed to reduce mortality further. PMID:2390566

  5. Why do child mortality rates fall? An analysis of the Nicaraguan experience.

    PubMed Central

    Sandiford, P; Morales, P; Gorter, A; Coyle, E; Smith, G D

    1991-01-01

    A comprehensive review of available sources of mortality data was undertaken to document the changes that have occurred in infant mortality in Nicaragua over the last three decades. It was found that a rapid fall in infant mortality commenced in the early 1970s and has continued steadily since. Trends in several different factors which might have led to this breakthrough were examined including: income, nutrition, breastfeeding practices, maternal education, immunizations, access to health services, provision of water supplies and sanitation, and anti-malarial programs. Of these, improved access to health services appears to have been the most important factor. At a time when the number of hospital beds per capita was dropping, increasing numbers of health care professionals, particularly nurses, were becoming available to staff primary health care facilities built in the 1960s. These were provided at least partly in response to the growing political turmoil enveloping the nation at that time. Certain Nicaraguan cultural attributes may have added to the impact of the reforms. Efforts in the field of public health made since the 1979 insurrection appear to have maintained the decline in child mortality. PMID:1983913

  6. Impact of hospital delivery on child mortality: An analysis of adolescent mothers in Bangladesh.

    PubMed

    Pal, Sarmistha

    2015-10-01

    New medical inventions for saving young lives are not enough if these do not reach the children and the mother. The present paper provides new evidence that institutional delivery can significantly lower child mortality risks, because it ensures effective and timely access to modern diagnostics and medical treatments to save lives. We exploit the exogenous variation in community's access to local health facilities (both traditional and modern) before and after the completion of the 'Women's Health Project' in 2005 (that enhanced emergency obstetric care in women friendly environment) to identify the causal effect of hospital delivery on various mortality rates among children. Our best estimates come from the parents fixed effects models that help limiting any parents-level omitted variable estimation bias. Using 2007 Bangladesh Demographic Health Survey data from about 6000 children born during 2002-2007, we show that, ceteris paribus, access to family welfare clinic particularly boosted hospital delivery likelihood, which in turn lowered neo-natal, early and infant mortality rates. The beneficial effect was particularly pronouncedamong adolescent mothers after the completion of Women's Health Project in 2005; infant mortality for this cohort was more than halved when delivery took place in a health facility. PMID:26363451

  7. Cyclicality, Mortality, and the Value of Time: The Case of Coffee Price Fluctuations and Child Survival in Colombia

    PubMed Central

    Miller, Grant; Urdinola, B. Piedad

    2011-01-01

    Recent studies demonstrate procyclical mortality in wealthy countries, but there are reasons to expect a countercyclical relationship in developing nations. We investigate how child survival in Colombia responds to fluctuations in world Arabica coffee prices – and document starkly procyclical child deaths. In studying this result’s behavioral underpinnings, we highlight that: (1) The leading determinants of child health are inexpensive but require considerable time, and (2) As the value of time declines with falling coffee prices, so does the relative price of health. We find a variety of direct evidence consistent with the primacy of time in child health production. PMID:22090662

  8. Indicators of Child Health, Service Utilization and Mortality in Zhejiang Province of China, 1998–2011

    PubMed Central

    Zhang, Wei Fang; Xu, Yan Hua; Yang, Ru Lai; Zhao, Zheng Yan

    2013-01-01

    Objective To investigate the levels of primary health care services for children and their changes in Zhejiang Province, China from 1998 to 2011. Methods The data were drawn from Zhejiang maternal and child health statistics collected under the supervision of the Health Bureau of Zhejiang Province. Primary health care coverage, hospital deliveries, low birth weight, postnatal visits, breastfeeding, underweight, early neonatal (<7 days) mortality, neonatal mortality, infant mortality and under-5 mortality were investigated. Results The coverage rates for children under 3 years old and children under 7 years old increased in the last 14 years. The hospital delivery rate was high during the study period, and the overall difference narrowed. There was a significant difference (P<0.001) between the prevalence of low birth weight in 1998 (2.03%) and the prevalence in 2011 (2.71%). The increase in low birth weight was more significant in urban areas than in rural areas. The postnatal visit rate increased from 95.00% to 98.45% with a significant difference (P<0.001). The breastfeeding rate was the highest in 2004 at 74.79% and lowest in 2008 at 53.86%. The prevalence of underweight in children under 5 years old decreased from 1.63% to 0.65%, and the prevalence was higher in rural areas. The early neonatal, neonatal, infant and under-5 mortality rates decreased from 6.66‰, 8.67‰, 11.99‰ and 15.28‰ to 1.69‰, 2.36‰, 3.89‰ and 5.42‰, respectively (P<0.001). The mortality rates in rural areas were slightly higher than those in urban areas each year, and the mortality rates were lower in Ningbo, Wenzhou, and Jiaxing regions and higher in Quzhou and Lishui regions. Conclusion Primary health care services for children in Zhejiang Province improved from 1998 to 2011. Continued high rates of low birth weight in urban areas and mortality in rural areas may be addressed with improvements in health awareness and medical technology. PMID:23638155

  9. Relationship of the Presence of a Household Improved Latrine with Diarrhea and Under-Five Child Mortality in Indonesia

    PubMed Central

    Semba, Richard D.; Kraemer, Klaus; Sun, Kai; de Pee, Saskia; Akhter, Nasima; Moench-Pfanner, Regina; Rah, Jee Hyun; Campbell, Ashley A.; Badham, Jane; Bloem, Martin W.

    2011-01-01

    We characterized the relationship of the presence of an improved latrine with diarrhea and under-five child mortality in Indonesia. The proportion of rural and urban families, respectively, without an improved latrine was 52.1% and 16.2%, with a child with a history of diarrhea in the last 7 days was 8.2% and 9.7%, and with a history of under-five child mortality was 11.1% and 8.5%. Among rural and urban families, respectively, lack of an improved latrine was associated with a child history of diarrhea in the last 7 days (odds ratio [OR] = 1.23, 95% confidence interval [CI] = 1.18–1.29, P < 0.0001; OR = 1.20, 95% CI = 1.13–1.27, P < 0.0001) and under-five child mortality (OR = 1.29, 95% CI = 1.25–1.31, P < 0.0001; OR = 1.22, 95% CI = 1.12–1.32, P < 0.0001) in separate multivariable logistic regression models adjusting for covariates. The lack of a household improved latrine is associated with diarrhea and under-five child mortality in Indonesia. PMID:21363984

  10. Maternal Beliefs and Socioeconomic Correlated Factors on Child Mortality from Drowning in Caspian Sea Coastline

    PubMed Central

    Davoudi-Kiakalayeh, Ali; Mohammadi, Reza; Yousefzade-Chabok, Shahrokh

    2014-01-01

    Objective: To investigate maternal beliefs, practices about causes and determinant factors on drowning and maternal socioeconomic correlated factors on child mortality from drowning. Methods: From March 2005 to March 2009, in a register-based cohort study and household survey, individual records utilizing drowning registry data of northern Iran were enrolled.   Mothers (n=276) who responded to multiple questions in a household survey were included. The patterns, interrelationships and effects of socioeconomic correlated factors on child mortality were analyzed. Results: A significant difference in relation to mother's educational level and age and family income distribution was noticed. Participants in household survey also reported that establishment of a multi-sectorial collaboration, integration of public health messages into local television, additional rescue stations and lifeguard, hazard environment fencing, increasing adult supervision, more support on increasing swimming ability among the children were all effective on reducing of drowning death. Conclusion: Due to the high rate of drowning in children and lack of attention among olders, a greater emphasis should be placed on educating mothers to assist a better supervision on their children. PMID:27162872

  11. Socioeconomic differences in child mortality in central Poland at the end of the nineteenth century.

    PubMed

    Drozd-Lipińska, Alicja; Klugier, Ewa; Kamińska-Czakłosz, Małgorzata

    2015-07-01

    Analyses of historical or modern populations indicate a strong relationship between mortality level and standard of living, measured, among other factors, by degree of urbanization. The aim of this study was to assess mortality rates in children of up to 5 years of age in two populations living under different conditions in central modern Poland at the end of the 19th century: the rural parish of Kowal, under Russian partition, and Toruń, an industrial and urbanized centre under Prussian partition. Data on births and deaths were taken from birth certificate registries and from the Prussian statistics yearbooks for 1876-1894. Death rates of children aged 0-5 years were calculated, and also for annual age ranges. The urban population had lower birth rates (37.19‰), natural increase rates (8.0‰), population dynamics rates (1.26‰), which provide information about the relation between two components of a natural increase, i.e. births and deaths, and an over-mortality of boys in relation to girls. In the rural population these values were all higher: 53.67‰, 18.11‰ and 1.59‰ respectively. No impact was found of social stratification on child mortality in the wide age group of 0-5 years. However, for subsequent one-year age groups significant relationships between mortality level and size and industrialization level of the population centres were noted. The living conditions of infants in Toruń, although being in a better position as an area annexed by Prussia, were markedly worse than those of rural Kowal Parish. In the urban centre infant mortality was slightly over 269 for 1000 live born, and in Kowal Parish it was 163 for 1000 live born. The high infant mortality was balanced in Toruń by the higher mortality levels of children aged 2-5 years compared with Kowal Parish. Natural selection in the city had the greatest impact on infants, who did not have the protective influence of breast-feeding because women had to return to work shortly after giving

  12. Etiology of child mortality in Goroka, Papua New Guinea: a prospective two-year study.

    PubMed Central

    Duke, Trevor; Michael, Audrey; Mgone, Joyce; Frank, Dale; Wal, Tilda; Sehuko, Rebecca

    2002-01-01

    OBJECTIVE: To collect accurate data on disease- and microbial-specific causes and avoidable factors in child deaths in a developing country. METHODS: A systematic prospective audit of deaths of children seen at Goroka Hospital in the highlands of Papua New Guinea was carried out. Over a 24-month period, we studied 353 consecutive deaths of children: 126 neonates, 186 children aged 1-59 months, and 41 children aged 5-12 years. FINDINGS: The most frequent age-specific clinical diagnoses were as follows: for neonates--very low birth weight, septicaemia, birth asphyxia and congenital syphilis; for children aged 1-59 months--pneumonia, septicaemia, marasmus and meningitis; and for children aged 5-12 years--malignancies and septicaemia. At least one microbial cause of death was identified for 179 (50.7%) children and two or more were identified for 37 (10.5%). Nine microbial pathogens accounted for 41% of all childhood deaths and 76% of all deaths that had any infective component. Potentially avoidable factors were identified for 177 (50%) of deaths. The most frequently occurring factors were as follows: no antenatal care in high-risk pregnancies (8.8% of all deaths), very delayed presentation (7.9%), vaccine-preventable diseases (7.9%), informal adoption or child abandonment leading to severe malnutrition (5.7%), and lack of screening for maternal syphilis (5.4%). Sepsis due to enteric Gram-negative bacilli occurred in 87 (24.6%). The strongest associations with death from Gram- negative sepsis were adoption/abandonment leading to severe malnutrition, village births, and prolonged hospital stay. CONCLUSIONS: Reductions in child mortality will depend on addressing the commonest causes of death, which include disease states, microbial pathogens, adverse social circumstances and health service failures. Systematic mortality audits in selected regions where child mortality is high may be useful for setting priorities, estimating the potential benefit of specific and non

  13. Adjusted effects of domestic violence, tobacco use, and indoor air pollution from use of solid fuel on child mortality.

    PubMed

    Pandey, Shanta; Lin, Yuan

    2013-10-01

    Studies that have separately examined the consequences of gender based violence upon women, use of solid fuel for cooking, and mother and father's use of tobacco on child health have concluded that they serve as risk factors for maternal and child health. Some authors have implied that these studies may have run the risk of overestimating the burden of disease of one factor over another. In this paper, we included all four factors in the same model to estimate their adjusted effects on child mortality, controlling for the demographic factors. The data come from 2005 to 2006 National Family Health Survey of India that interviewed a nationally representative sample of 39,257 couples. Of the four factors, mothers' use of tobacco presented the highest risk for child mortality (OR = 1.42; CI = 1.27-1.60) followed by fathers' use of tobacco (OR = 1.23; CI = 1.12-1.36), households' use of solid fuel for cooking (OR = 1.23; CI = 1.06-1.43), and physical abuse upon mothers (OR = 1.20; CI = 1.10-1.32). Among the households that used solid fuel for cooking, improved cookstoves users experienced 28 % lower odds of child mortality (OR = 0.72; CI = 0.61-0.86) compared to nonusers of improved cookstoves. Additionally, increase in age of mothers at birth of first child, parents' education, and household wealth served as protective factors for child mortality. To prevent child death, programs should focus on reducing couple's use of tobacco, protecting women from physical abuse, and helping households switch from solid to liquid fuel. Moreover, a significant reduction in child death could be attained by improving girls' education, and delaying their age at marriage and first birth. PMID:23065299

  14. Applying an equity lens to child health and mortality: more of the same is not enough.

    PubMed

    Victora, Cesar G; Wagstaff, Adam; Schellenberg, Joanna Armstrong; Gwatkin, Davidson; Claeson, Mariam; Habicht, Jean-Pierre

    2003-07-19

    Gaps in child mortality between rich and poor countries are unacceptably wide and in some areas are becoming wider, as are the gaps between wealthy and poor children within most countries. Poor children are more likely than their better-off peers to be exposed to health risks, and they have less resistance to disease because of undernutrition and other hazards typical in poor communities. These inequities are compounded by reduced access to preventive and curative interventions. Even public subsidies for health frequently benefit rich people more than poor people. Experience and evidence about how to reach poor populations are growing, albeit largely through small-scale case studies. Successful approaches include those that improve geographic access to health interventions in poor communities, subsidized health care and health inputs, and social marketing. Targeting of health interventions to poor people and ensuring universal coverage are promising approaches for improvement of equity, but both have limitations that necessitate planning for child survival and effective delivery at national level and below. Regular monitoring of inequities and use of the resulting information for education, advocacy, and increased accountability among the general public and decision makers is urgently needed, but will not be sufficient. Equity must be a priority in the design of child survival interventions and delivery strategies, and mechanisms to ensure accountability at national and international levels must be developed. PMID:12885488

  15. Change in alcohol consumption and risk of death from all causes and from ischaemic heart disease.

    PubMed Central

    Lazarus, N B; Kaplan, G A; Cohen, R D; Leu, D J

    1991-01-01

    OBJECTIVE--To examine the association between alcohol consumption and mortality from all causes and from ischaemic heart disease with a focus on differentiating between long term abstainers and more recent non-drinkers. DESIGN--Cohort study of changes in alcohol consumption from 1965 to 1974 and mortality from all causes and ischaemic heart disease during 1974-84. SETTING--Population based study of adult residents of Alameda County, California. SUBJECTS--2225 women and 1845 men aged 35 and over in 1965. MAIN OUTCOME MEASURES--Alcohol consumption in 1964 and 1974 and mortality from all causes and from ischaemic heart disease during 1974-84. RESULTS--There was a significantly higher risk of death from all causes and from ischaemic heart disease in women who gave up drinking between 1965 and 1974 than in women who continued to drink (relative risk 1.72, 95% confidence interval 1.11 to 2.66, and 2.75, 1.44 to 5.23, for all causes and ischaemic heart disease respectively). A significant increase in risk was not seen in men who gave up drinking (1.32, 0.87 to 2.01, and 0.95, 0.41 to 2.20, respectively). Among men, long term abstainers compared with drinkers were at increased risk of death from all causes and from ischaemic heart disease, though the associations were not significant (1.40, 0.98 to 2.00, and 1.40, 0.76 to 2.58, for all causes and ischaemic heart disease respectively). CONCLUSION--Some of the increased risk of death from all causes and from ischaemic heart disease associated with not drinking in women seems to be accounted for by higher risks among those who gave up drinking. Men who are long term abstainers may also be at an increased risk of death. The heterogeneity of the non-drinking group should be considered when comparisons are made with drinkers. PMID:1912885

  16. Impact of child mortality and sociodemographic attributes on family size desires: some data from urban India.

    PubMed

    Saksena, D N; Srivastava, J N

    1984-01-01

    Using follow-up data on a sample of mothers who gave birth at a Lucknow city hospital in India, the family size ideals of the women were examined in relation to experienced and perceived levels of child mortality and socioeconomic and demographic characteristics. The fear of child mortality and their own experience tended to increase the size of family which the mothers considered to be ideal. Under the conditions of assured survival of all children born to a couple, the study mothers considered on the average 2.83 children as ideal, as compared to 3.68 under conditions of uncertain survival. The couples with a rural background thought higher numbers of children were ideal, as compared to those with an urban background. More of the females who belonged to joint families preferred fewer children compared to those in nuclear families. Within the overall mean ideal family size of 2.83, the Hindu females thought fewer children made up an ideal family than their Muslim counterparts. Further, among the Hindus, the mean number of children considered ideal varied inversely with caste status. About 44% of the illiterate females considered 4 or more children as ideal, compared to about 5% of those with education to graduate or higher levels. The educational level of the males also influenced the family size preferences of their wives which varied inversely with them. The family size ideals of the females varied significantly with their husbands' occupational status. The females who lived in relatively poor housing conditions considered higher numbers of children as ideal. The preference is for smaller families with younger mothers. The female's age at marriage is important. The females currently using birth control methods considered an average 2.72 children as ideal, in contrast to 2.98 for those who were not using any method; the difference in means is significant. PMID:6699037

  17. Child mortality in new industrial localities and opportunities for change: a survey in an Indian steel town.

    PubMed

    Crook, N; Malaker, C R

    1992-10-01

    As Asia becomes increasingly urbanized the effect of new industrial development on child mortality becomes of increasing interest. In India, considerable investment has been made in the social infrastructure of industrial new towns. This survey of Durgapur steel town in West Bengal shows that although the average level of child mortality in the working class population is favourable in comparison with other Indian cities, considerable differentials, that can be related to social, economic and environmental differences within the population, have arisen since the creation of the city in the late 1950s. The paper argues that the undertaking of selective sanitary interventions to improve access to drinking water (in particular) would be administratively feasible in these industrial new towns, of immediate impact, and indeed necessary if the differentials in mortality are to be eliminated. PMID:10148656

  18. Social Sector Expenditure and Child Mortality in India: A State-Level Analysis from 1997 to 2009

    PubMed Central

    Makela, Susanna M.; Dandona, Rakhi; Dilip, T. R.; Dandona, Lalit

    2013-01-01

    Background India is unlikely to meet the Millennium Development Goal for child mortality. As public policy impacts child mortality, we assessed the association of social sector expenditure with child mortality in India. Methods and Findings Mixed-effects regression models were used to assess the relationship of state-level overall social sector expenditure and its major components (health, health-related, education, and other) with mortality by sex among infants and children aged 1–4 years from 1997 to 2009, adjusting for potential confounders. Counterfactual models were constructed to estimate deaths averted due to overall social sector increases since 1997. Increases in per capita overall social sector expenditure were slightly higher in less developed than in more developed states from 1997 to 2009 (2.4-fold versus 2-fold), but the level of expenditure remained 36% lower in the former in 2009. Increase in public expenditure on health was not significantly associated with mortality reduction in infants or at ages 1–4 years, but a 10% increase in health-related public expenditure was associated with a 3.6% mortality reduction (95% confidence interval 0.2–6.9%) in 1–4 years old boys. A 10% increase in overall social sector expenditure was associated with a mortality reduction in both boys (6.8%, 3.5–10.0%) and girls (4.1%, 0.8–7.5%) aged 1–4 years. We estimated 119,807 (95% uncertainty interval 53,409 – 214,662) averted deaths in boys aged 1–4 years and 94,037 (14,725 – 206,684) in girls in India in 2009 that could be attributed to increases in overall social sector expenditure since 1997. Conclusions Further reduction in child mortality in India would be facilitated if policymakers give high priority to the social sector as a whole for resource allocation in the country’s 5-year plan for 2012–2017, as public expenditure on health alone has not had major impact on reducing child mortality. PMID:23409166

  19. Trends and patterns of modern contraceptive use and relationships with high-risk births and child mortality in Burkina Faso

    PubMed Central

    Maïga, Abdoulaye; Hounton, Sennen; Amouzou, Agbessi; Akinyemi, Akanni; Shiferaw, Solomon; Baya, Banza; Bahan, Dalomi; Barros, Aluisio J. D.; Walker, Neff; Friedman, Howard

    2015-01-01

    Background In sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births. Objective This paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso. Design The last three Demographic and Health Surveys – conducted in Burkina Faso in 1998, 2003, and 2010 – enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR). Results Overall, Burkina Faso's modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women's fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children. Conclusions Programmes that target sub-national differentials and leverage women's health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied

  20. Trends and social differentials in child mortality in Rwanda 1990–2010: results from three demographic and health surveys

    PubMed Central

    Musafili, Aimable; Essén, Birgitta; Baribwira, Cyprien; Binagwaho, Agnes; Persson, Lars-Åke; Selling, Katarina Ekholm

    2015-01-01

    Background Rwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010. Methods We performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15–49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method. Results Mortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005–2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR. Conclusions Recent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths. PMID:25870163

  1. Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

    PubMed Central

    Alfonso, Y. Natalia; Adam, Taghreed; Kuruvilla, Shyama; Schweitzer, Julian

    2016-01-01

    Introduction From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. Methods This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. Findings The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Conclusions Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across

  2. Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis

    PubMed Central

    Ezeh, Osita Kingsley; Agho, Kingsley Emwinyore; Dibley, Michael John; Hall, John Joseph; Page, Andrew Nicolas

    2015-01-01

    Objectives To identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria. Design, setting and participants A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. A multistage, stratified, cluster random sampling method was used to gather information on 63 844 singleton live-born infants of the most recent birth of a mother within a 5-year period before each survey was examined using cox regression models. Main outcome measures Postneonatal mortality (death between 1 and 11 months), infant mortality (death between birth and 11 months), child mortality (death between 12 and 59 months) and under-5 mortality (death between birth and 59 months). Results Multivariable analyses indicated that children born to mothers with no formal education was significantly associated with mortality across all four age ranges (adjusted HR=1.30, 95% CI 1.01 to 1.66 for postneonatal; HR=1.38, 95% CI 1.11 to 1.84 for infant; HR=2.13, 95% CI 1.56 to 2.89 for child; HR=1.19, 95% CI 1.02 to 1.41 for under-5). Other significant factors included living in rural areas (HR=1.48, 95% CI 1.16 to 1.89 for postneonatal; HR=1.23, 95% CI 1.03 to 1.47 for infant; HR=1.52, 95% CI 1.16 to 1.99 for child; HR=1.29, 95% CI 1.11 to 1.50 for under-5), and poor households (HR=2.47, 95% CI 1.76 to 3.47 for postneonatal; HR=1.40, 95% CI 1.10 to 1.78 for infant; HR=1.72, 95% CI 1.19 to 2.49 for child; HR=1.43, 95% CI 1.17 to 1.76 for under-5). Conclusions This study found that no formal education, poor households and living in rural areas increased the risk of postneonatal, infant, child and under-5 mortality among Nigerian children. Community-based interventions for reducing under-5 deaths are needed and should target children born to mothers of low socioeconomic status. PMID:25818271

  3. Child Mortality Estimation: Consistency of Under-Five Mortality Rate Estimates Using Full Birth Histories and Summary Birth Histories

    PubMed Central

    Silva, Romesh

    2012-01-01

    Background Given the lack of complete vital registration data in most developing countries, for many countries it is not possible to accurately estimate under-five mortality rates from vital registration systems. Heavy reliance is often placed on direct and indirect methods for analyzing data collected from birth histories to estimate under-five mortality rates. Yet few systematic comparisons of these methods have been undertaken. This paper investigates whether analysts should use both direct and indirect estimates from full birth histories, and under what circumstances indirect estimates derived from summary birth histories should be used. Methods and Findings Usings Demographic and Health Surveys data from West Africa, East Africa, Latin America, and South/Southeast Asia, I quantify the differences between direct and indirect estimates of under-five mortality rates, analyze data quality issues, note the relative effects of these issues, and test whether these issues explain the observed differences. I find that indirect estimates are generally consistent with direct estimates, after adjustment for fertility change and birth transference, but don't add substantial additional insight beyond direct estimates. However, choice of direct or indirect method was found to be important in terms of both the adjustment for data errors and the assumptions made about fertility. Conclusions Although adjusted indirect estimates are generally consistent with adjusted direct estimates, some notable inconsistencies were observed for countries that had experienced either a political or economic crisis or stalled health transition in their recent past. This result suggests that when a population has experienced a smooth mortality decline or only short periods of excess mortality, both adjusted methods perform equally well. However, the observed inconsistencies identified suggest that the indirect method is particularly prone to bias resulting from violations of its strong

  4. Mothers continuing bonds and ambivalence to personal mortality after the death of their child--an interpretative phenomenological analysis.

    PubMed

    Harper, Mairi; O'Connor, Rory; Dickson, Adele; O'Carroll, Ronan

    2011-03-01

    The main objective of this study was to identify how bereaved mothers describe their coping strategies in their own words. The literature on parental bereavement is sparse, and the present study aims to add to existing knowledge by eliciting the mothers' experiences covering a wide range of child ages including infants, younger children and adults. Semi-structured interviews were held with 13 bereaved mothers in the UK. Causes of death include accident, illness and suicide. The methodological approach was interpretative phenomenological analysis (IPA). This article reports two inter-related recurrent themes: (1) Continuing the bond with the deceased child and (2) Ambivalence to personal mortality. Participants reported that the relationship with their child was continued in a variety of ways, from tending to the grave and the child's remains, through linking objects or by establishing a symbolic representation of the child within their daily lives. All mothers talked openly about their own mortality, either demonstrating ambivalence about their own death, or expressing clear suicidal ideation. Death was seen as a release from living with the pain of loss. The presence of surviving siblings appeared to moderate suicidal ideation, but mothers expressed concerns about their ability to care adequately for other family members during times of intense grief. PMID:21328148

  5. The influence of infant and child mortality on fertility in selected countries of the Asian and Pacific region.

    PubMed

    1985-01-01

    Data from the World Fertility Survey (WFS) on 10 countries are used to measure the strength of 1 of 3 types of behavior (insurance behavior, breastfeeding and replacement behavior) influencing the relationship between infant mortality and fertility. 2 variables, the use of contraception at the time of the survey and the stated desire to stop bearing children, are cross-classified by the parity of women, whether they had experienced the death of a child, and if so, whether it was the last or an earlier child. Other tabulations measure the effect of the death of sons, as opposed to daughters, on the decision to have another child. Demographic and socioeconomic controls are introduced using multiple classification analysis. The 10 countries surveyed in the region are Bangladesh, Fiji, Indonesia, Malaysia, Nepal, Pakistan, the Philippines, the Republic of Korea, Sri Lanka and Thailand. Results indicate that the replacement effect operated most strongly in countries such as Fiji and Korea which have relatively low fertility rates and high contraceptive practice. In countries with high mortality, e.g., Bangladesh, Nepal and Pakistan, the effect of replacement behavior on the practice of contraception was minimal. However, where the desire to have no more children was studied, women who had lost a child were far less likely to say they wanted no more children. The direct experience of losing a child tended to make women, especially low parity women, more pronatalist. While the measurable effects of child mortality on fertility were small, the findings about attitudes were highly suggestive. They support the belief that population which are pronatalist are so in part because high mortality causes concern about the ultimate chances of the survival of their children. It is thus not difficult to believe that people insure against the deaths of their children by trying to have more children than they need. Of the 10 countries surveyed, the evidence for such insurance behavior

  6. The color of child mortality in Brazil, 1950-2000: social progress and persistent racial inequality.

    PubMed

    Wood, Charles H; Magno de Carvalho, José Alberto; Guimarães Horta, Cláudia Júlia

    2010-01-01

    Now that racism has been officially recognized in Brazil, and some universities have adopted affirmative-action admission policies, measures of the magnitude of racial inequality and analyses that identify the factors associated with changes in racial disparities over time assume particular relevance to the conduct of public debate. This study uses census data from 1950 to 2000 to estimate the probability of death in the early years of life, a robust indicator of the standard of living among the white and Afro-Brazilian populations. Associated estimates of the average number of years of life expectancy at birth show that the 6.6-year advantage that the white population enjoyed in the 1950s remained virtually unchanged throughout the second half of the twentieth century, despite the significant improvements that accrued to both racial groups. The application of multivariate techniques to samples selected from the 1960, 1980, and 2000 census enumerations further shows that, controlling for key determinants of child survival, the white mortality advantage persisted and even increased somewhat in 2000. The article discusses evidence of continued racial inequality during an era of deep transformation in social structure, with reference to the challenges of skin color classification in a multiracial society and the evolution of debates about color, class, and discrimination in Brazil. PMID:21188889

  7. The African Development Bank, structural adjustment, and child mortality: a cross-national analysis of Sub-Saharan Africa.

    PubMed

    Pandolfelli, Lauren E; Shandra, John M

    2013-01-01

    We conduct a cross-national analysis to test the hypothesis that African Development Bank (AfDB) structural adjustment adversely impacts child mortality in Sub-Saharan Africa. We use generalized least square random effects regression models and two-step Heckman models that correct for selection bias using data on 35 nations with up to four time points (1990, 1995, 2000, and 2005). We find substantial support for our hypothesis, which indicates that Sub-Saharan African nations that receive an AfDB structural adjustment loan tend to have higher levels of child mortality than Sub-Saharan African nations that do not receive such a loan. This finding remains stable even when controlling for selection bias on whether or not a Sub-Saharan African nation receives an AfDB structural adjustment loan. We conclude by discussing the methodological implications of the article, policy suggestions, and possible directions for future research. PMID:23821909

  8. The 2007 annual report of the Regional Infant and Child Mortality Review Committee.

    PubMed

    Randall, Brad; Wilson, Ann L

    2008-08-01

    The mission of the Regional Infant and Child Mortality Review Committee (RICMRC) is to review infant and child deaths so that information can be transformed into action to protect young lives. The 2007 review area includes South Dakota's Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties. Although there were no deaths in 2007 that met the criteria of the Sudden Infant Death Syndrome (SIDS) in our region, there were three infant deaths associated with unsafe sleeping environments (including adult co-sleeping) that either caused or potentially may have caused these infants' deaths. We need to continue to promote the "Back to Sleep" campaign message of not only placing infants to sleep on their backs, but also making sure infants are put down to sleep on safe, firm sleeping surfaces and that they are appropriately dressed for the ambient temperature. Parents need to be aware of the potential hazards of co-sleeping with their infants. Compared to nine such deaths in 2006, only four deaths in 2007 involved motor-vehicle crashes, none of which were alcohol related. Two drowning deaths illustrated the rapidity in which even momentary caregiver distractions can lead to deaths in children in and around water. Since 1997 the Regional Infant and Child Mortality Review Committee (RICMRC) has sought to achieve its mission to "review infant and child deaths so that information can be transformed into action to protect young lives." For 2007, the committee reviewed 25 deaths from Minnehaha, Turner, Lincoln, Moody, Lake, McCook, Union, Hansen, Miner and Brookings counties that met the following criteria: Children under the age of 18 dying subsequent to hospital discharge following delivery. Children who either died in these counties from causes sustained in them, or residents who died elsewhere from causes sustained in the 10-county region. The report that follows reviews the committee's activities for 2007. No deaths meeting the criteria

  9. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    PubMed

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region. PMID:26934625

  10. Regional inequalities of child mortality in peninsular Malaysia with special reference to the differentials between Perlis and Kuala Terengganu.

    PubMed

    Brehm, U

    1993-05-01

    In Peninsular Malaysia child mortality rates (5q0) vary from 13 to 63 per thousand at district level. The spatial pattern is closely associated with the regional distribution of socio-economic factors. But due to multicollinearity it is difficult to isolate the influence of socio-economic variables from other variables by employing aggregated data. However, individual data collected in a case-control-study that was conducted in Perlis and Kuala Terengganu confirm the important role of socio-economic factors. So it should be possible to achieve a further reduction of child mortality by raising the income and educational level of the under-privileged groups. Apart from that, as the case of Perlis shows, the provision of family planning and preventive medical services may also contribute to lower child mortality independent from socio-economic changes. But, as the comparison with Kuala Terengganu shows, the utilization of family planning and preventive medical services is not only influenced by the accessibility to, but also by the socio-culturally determined acceptability of such services. PMID:8511619

  11. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care

    PubMed Central

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries. To create a major change in Haiti’s health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic “community care grids” to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis. We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti’s health care system will be among the leaders in that region. PMID:26934625

  12. Effect of Investment in Malaria Control on Child Mortality in Sub-Saharan Africa in 2002–2008

    PubMed Central

    Akachi, Yoko; Atun, Rifat

    2011-01-01

    Background Around 8.8 million children under-five die each year, mostly due to infectious diseases, including malaria that accounts for 16% of deaths in Africa, but the impact of international financing of malaria control on under-five mortality in sub-Saharan Africa has not been examined. Methods and Findings We combined multiple data sources and used panel data regression analysis to study the relationship among investment, service delivery/intervention coverage, and impact on child health by observing changes in 34 sub-Saharan African countries over 2002–2008. We used Lives Saved Tool to estimate the number of lives saved from coverage increase of insecticide-treated nets (ITNs)/indoor residual spraying (IRS). As an indicator of outcome, we also used under-five mortality rate. Global Fund investments comprised more than 70% of the Official Development Assistance (ODA) for malaria control in 34 countries. Each $1 million ODA for malaria enabled distribution of 50,478 ITNs [95%CI: 37,774–63,182] in the disbursement year. 1,000 additional ITNs distributed saved 0.625 lives [95%CI: 0.369–0.881]. Cumulatively Global Fund investments that increased ITN/IRS coverage in 2002–2008 prevented an estimated 240,000 deaths. Countries with higher malaria burden received less ODA disbursement per person-at-risk compared to lower-burden countries ($3.90 vs. $7.05). Increased ITN/IRS coverage in high-burden countries led to 3,575 lives saved per 1 million children, as compared with 914 lives in lower-burden countries. Impact of ITN/IRS coverage on under-five mortality was significant among major child health interventions such as immunisation showing that 10% increase in households with ITN/IRS would reduce 1.5 [95%CI: 0.3–2.8] child deaths per 1000 live births. Conclusions Along with other key child survival interventions, increased ITNs/IRS coverage has significantly contributed to child mortality reduction since 2002. ITN/IRS scale-up can be more efficiently

  13. Aggressive Regimens for Multidrug-Resistant Tuberculosis Decrease All-Cause Mortality

    PubMed Central

    Mitnick, Carole D.; Franke, Molly F.; Rich, Michael L.; Alcantara Viru, Felix A.; Appleton, Sasha C.; Atwood, Sidney S.; Bayona, Jaime N.; Bonilla, Cesar A.; Chalco, Katiuska; Fraser, Hamish S. F.; Furin, Jennifer J.; Guerra, Dalia; Hurtado, Rocio M.; Joseph, Keith; Llaro, Karim; Mestanza, Lorena; Mukherjee, Joia S.; Muñoz, Maribel; Palacios, Eda; Sanchez, Epifanio; Seung, Kwonjune J.; Shin, Sonya S.; Sloutsky, Alexander; Tolman, Arielle W.; Becerra, Mercedes C.

    2013-01-01

    Rationale A better understanding of the composition of optimal treatment regimens for multidrug-resistant tuberculosis (MDR-TB) is essential for expanding universal access to effective treatment and for developing new therapies for MDR-TB. Analysis of observational data may inform the definition of an optimized regimen. Objectives This study assessed the impact of an aggressive regimen–one containing at least five likely effective drugs, including a fluoroquinolone and injectable–on treatment outcomes in a large MDR-TB patient cohort. Methods This was a retrospective cohort study of patients treated in a national outpatient program in Peru between 1999 and 2002. We examined the association between receiving an aggressive regimen and the rate of death. Measurements and Main Results In total, 669 patients were treated with individualized regimens for laboratory-confirmed MDR-TB. Isolates were resistant to a mean of 5.4 (SD 1.7) drugs. Cure or completion was achieved in 66.1% (442) of patients; death occurred in 20.8% (139). Patients who received an aggressive regimen were less likely to die (crude hazard ratio [HR]: 0.62; 95% CI: 0.44,0.89), compared to those who did not receive such a regimen. This association held in analyses adjusted for comorbidities and indicators of severity (adjusted HR: 0.63; 95% CI: 0.43,0.93). Conclusions The aggressive regimen is a robust predictor of MDR-TB treatment outcome. TB policy makers and program directors should consider this standard as they design and implement regimens for patients with drug-resistant disease. Furthermore, the aggressive regimen should be considered the standard background regimen when designing randomized trials of treatment for drug-resistant TB. PMID:23516529

  14. A gender based analysis of predictors of all cause death after transcatheter aortic valve implantation.

    PubMed

    Conrotto, Federico; D'Ascenzo, Fabrizio; Salizzoni, Stefano; Presbitero, Patrizia; Agostoni, Pierfrancesco; Tamburino, Corrado; Tarantini, Giuseppe; Bedogni, Francesco; Nijhoff, Freek; Gasparetto, Valeria; Napodano, Massimo; Ferrante, Giuseppe; Rossi, Marco Luciano; Stella, Pieter; Brambilla, Nedy; Barbanti, Marco; Giordana, Francesca; Grasso, Costanza; Biondi Zoccai, Giuseppe; Moretti, Claudio; D'Amico, Maurizio; Rinaldi, Mauro; Gaita, Fiorenzo; Marra, Sebastiano

    2014-10-15

    The impact of gender-related pathophysiologic features of severe aortic stenosis on transcatheter aortic valve implantation (TAVI) outcomes remains to be determined, as does the consistency of predictors of mortality between the genders. All consecutive patients who underwent TAVI at 6 institutions were enrolled in this study and stratified according to gender. Midterm all-cause mortality was the primary end point, with events at 30 days and at midterm as secondary end points. All events were adjudicated according to Valve Academic Research Consortium definitions. Eight hundred thirty-six patients were enrolled, 464 (55.5%) of whom were female. At midterm follow-up (median 365 days, interquartile range 100 to 516) women had similar rates of all-cause mortality compared with men (18.1% vs 22.6%, p = 0.11) and similar incidence of myocardial infarction and cerebrovascular accident. Gender did not affect mortality also on multivariate analysis. Among clinical and procedural features, glomerular filtration rate <30 ml/min/1.73 m(2) (hazard ratio [HR] 2.55, 95% confidence interval [CI] 1.36 to 4.79) and systolic pulmonary arterial pressure >50 mm Hg (HR 2.26, 95% CI 1.26 to 4.02) independently predicted mortality in women, while insulin-treated diabetes (HR 3.45, 95% CI 1.47 to 8.09), previous stroke (HR 3.42, 95% CI 1.43 to 8.18), and an ejection fraction <30% (HR 3.82, 95% CI 1.41 to 10.37) were related to mortality in men. Postprocedural aortic regurgitation was independently related to midterm mortality in the 2 groups (HR 11.19, 95% CI 3.3 to 37.9). In conclusion, women and men had the same life expectancy after TAVI, but different predictors of adverse events stratified by gender were demonstrated. These findings underline the importance of a gender-tailored clinical risk assessment in TAVI patients. PMID:25159239

  15. Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status

    PubMed Central

    Houle, Brian; Stein, Alan; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Tollman, Stephen M; Clark, Samuel J

    2013-01-01

    Background Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children’s risk of dying in rural South Africa. Methods We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994–2008. Using discrete time event history analysis we estimate children’s probability of dying by child characteristics and household composition (other children and adults other than parents) (N = 924 818 child-months), and household socio-economic status (N = 501 732 child-months). Results Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1–5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2–3.6), 3–5 months (OR 3.0; 95% CI 1.5–5.9), and 2 months (OR 11.8; 95% CI 7.6–18.3) before another household child dies. The odds of dying remain high at the time of another child’s death (OR 11.7; 95% CI 6.3–21.7) and for the 2 months following (OR 4.0; 95% CI 1.9–8.6). Having a related but non-parent adult aged 20–59 years in the household reduces the odds (OR 0.6; 95% CI 0.5–0.8). There is an inverse relationship between a child’s odds of dying and household socio-economic status. Conclusions This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health

  16. The Potential Impact of Changes in Fertility on Infant, Child, and Maternal Mortality. World Bank Staff Working Papers No. 698 and Population and Development Series No. 23.

    ERIC Educational Resources Information Center

    Trussell, James; Pebley, Anne R.

    The relationship between changes in the timing and quantity of fertility, such as those that might result from an effective family planning program in developing countries, and changes in child and maternal mortality is examined. Results from five multivariate studies estimate the changes in mortality that might occur from altering maternal age,…

  17. Decline in Child Hospitalization and Mortality After the Introduction of the 7-Valent Pneumococcal Conjugative Vaccine in Rwanda.

    PubMed

    Rurangwa, Janvier; Rujeni, Nadine

    2016-09-01

    Pneumonia is a public health problem in the tropics, and the 7-valent pneumococcal conjugative vaccine (PCV-7) has been introduced in an effort to prevent the disease and therefore reduce childhood mortality. In Rwanda, PCV-7 was introduced in 2009, and we aimed to determine its impact on the rate of child hospitalization/mortality due to pneumonia. A retrospective survey was conducted on hospitalization rates and pediatric deaths between two periods, that is, before the introduction of PCV-7 (2007-2009) and after the introduction of PCV-7 (2010-2013) in Kabutare District Hospital. There was a 53% reduction in hospitalization, with a significant decline in in-hospital deaths between the two periods. There was also a significant correlation between vaccination coverage and decline in hospitalization rates between 2009 and 2013. We conclude that PCV-7 vaccine is associated with significant reduction in the rate of child hospitalization and mortality but more mechanistic studies are warranted to determine the immunological impact, especially in the context of coinfections and malnutrition. PMID:27430538

  18. [The drama of maternal, infant and child mortality in Latin America and the Caribbean].

    PubMed

    1990-12-01

    99% of the half-million maternal deaths in the world each year occur in developing countries, and many are the result of inopportune or undesired pregnancies. Each month over a million infants an small children also die. In Latin America and the caribbean, women have a risk 50-100 times greater of dying as a result of pregnancy or delivery than women in the US, and their children have a 5 times greater risk of dying before heir 1st birthday. The majority of infant and maternal deaths are preventable. Education and family planning services, which are neither costly nor complicated, could significantly reduce these high mortality rates. A woman's lifetime risk of maternal death is related in great part to her economic and social environment, how many pregnancies she has had, and the availability of maternal health services, It is often difficult for women in developing countries to maintain good health especially if they are poor. They are frequently poorly nourished, and may be required to perform hard physical labor. Pregnancy places greater physical demands on them and may worsen existing health problems. Maternal health risks are substantially increased as well by age under 18 or over 40 years, parity over 4, previous delivery during the last 2 years, and preexisting health problems that could affect pregnancy. Some 75% of maternal deaths are believed to result from obstetrical complications. Hemorrhage, 1 of the most frequent,is more common among older women who have already had 4 or more deliveries. Hemorrhages can be fatal in areas lacking the capability to provide immediate transfusions. Toxemia can lead to convulsions and death if not treated early. Sepsis usually results from complications of an obstructed delivery in very young mothers. Illegal abortion is another major cause of maternal death. In some Latin American ad Caribbean countries, 1/2 of maternal deaths are due to illegal abortions under unhygienic conditions. The same obstetrical risks exist

  19. Child-Pugh versus MELD score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis

    PubMed Central

    Peng, Ying; Qi, Xingshun; Dai, Junna; Li, Hongyu; Guo, Xiaozhong

    2015-01-01

    A retrospective study was conducted to compare the performance of Child-Pugh and Model for End-Stage Liver Diseases (MELD) scores for predicting the in-hospital mortality of acute upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis. A total of 145 patients with a diagnosis of liver cirrhosis and acute UGIB between July 2013 and June 2014 were retrospectively analyzed (male/female: 94/51; mean age: 56.77±11.33 years; Child-Pugh class A/B/C: 46/64/35; mean Child-Pugh score: 7.88±2.17; mean MELD score: 7.86±7.22). The in-hospital mortality was 8% (11/145). Areas under receiving-operator characteristics curve (AUROC) for predicting the in-hospital mortality were compared between MELD and Child-Pugh scores. AUROCs for predicting the in-hospital mortality for Child-Pugh and MELD scores were 0.796 (95% confidence interval [CI]: 0.721-0.858) and 0.810 (95% CI: 0.736-0.870), respectively. The discriminative ability was not significant different between the two scoring systems (P=0.7241). In conclusion, Child-Pugh and MELD scores were similar for predicting the in-hospital mortality of acute UGIB in cirrhotic patients. PMID:25785053

  20. World Health Organization perspectives on the contribution of the Global Alliance for Vaccines and Immunization on reducing child mortality.

    PubMed

    Bustreo, F; Okwo-Bele, J-M; Kamara, L

    2015-02-01

    Child mortality has decreased substantially globally-from 12.6 million in 1990 to 6.3 million in 2013-due, in large part to of governments' and organisations' work, to prevent pneumonia, diarrhoea and malaria, the main causes of death in the postneonatal period. In 2012, the World Health Assembly adopted the Decade of Vaccines Global Vaccine Action Plan 2011-2020 as the current framework aimed at preventing millions of deaths through more equitable access to existing vaccines for people in all communities. The Global Alliance for Vaccines and Immunization (GAVI) plays a critical role in this effort by financing and facilitating delivery platforms for vaccines, with focused support for the achievements of improved vaccination coverage and acceleration of the uptake of WHO-recommended lifesaving new vaccines in 73 low-income countries. The GAVI Alliance has contributed substantially towards the progress of Millennium Development Goal 4 and to improving women's lives. By 2013, the GAVI Alliance had immunised 440 million additional children and averted six million future deaths from vaccine-preventable diseases in the world's poorest countries. The GAVI Alliance is on track to reducing child mortality to 68 per 1000 live births by 2015 in supported countries. This paper discusses the GAVI Alliance achievements related to Millennium Development Goal 4 and its broader contribution to improving women's lives and health systems, as well as challenges and obstacles it has faced. Additionally, it looks at challenges for the future and how it will continue its work related to reducing child mortality and improving women's health. PMID:25613965

  1. Using Health Extension Workers for Monitoring Child Mortality in Real-Time: Validation against Household Survey Data in Rural Ethiopia

    PubMed Central

    Amouzou, Agbessi; Kidanu, Aklilu; Taddesse, Nolawi; Silva, Romesh; Hazel, Elizabeth; Bryce, Jennifer; Black, Robert E.

    2015-01-01

    Background Ethiopia has scaled up its community-based programs over the past decade by training and deploying health extension workers (HEWs) in rural communities throughout the country. Consequently, child mortality has declined substantially, placing Ethiopia among the few countries that have achieved the United Nations’ fourth Millennium Development Goal. As Ethiopia continues its efforts, results must be assessed regularly to provide timely feedback for improvement and to generate further support for programs. More specifically the expansion of HEWs at the community level provides a unique opportunity to build a system for real-time monitoring of births and deaths, linked to a civil registration and vital statistics system that Ethiopia is also developing. We tested the accuracy and completeness of births and deaths reported by trained HEWs for monitoring child mortality over 15 -month periods. Methods and Findings HEWs were trained in 93 randomly selected rural kebeles in Jimma and West Hararghe zones of the Oromia region to report births and deaths over a 15-month period from January, 2012 to March, 2013. Completeness of number of births and deaths, age distribution of deaths, and accuracy of resulting under-five, infant, and neonatal mortality rates were assessed against data from a large household survey with full birth history from women aged 15–49. Although, in general HEWs, were able to accurately report events that they identified, the completeness of number of births and deaths reported over twelve-month periods was very low and variable across the two zones. Compared to household survey estimates, HEWs reported only about 30% of births and 21% of under-five deaths occurring in their communities over a twelve-month period. The under-five mortality rate was under-estimated by around 30%, infant mortality rate by 23% and neonatal mortality by 17%. HEWs reported disproportionately higher number of deaths among the very young infants than among the

  2. Changes in Child Mortality Over Time Across the Wealth Gradient in Less-Developed Countries

    PubMed Central

    2014-01-01

    BACKGROUND: It is unknown whether inequalities in under-5 mortality by wealth in low- and middle-income countries (LMICs) are growing or declining. METHODS: All Demographic and Health Surveys conducted between 2002 and 2012 were used to measure under-5 mortality trends in 3 wealth tertiles. Two approaches were used to estimate changes in under-5 mortality: within-survey changes from all 54 countries, and between-survey changes for 29 countries with repeated survey waves. The principal outcome measures include annual decline in mortality, and the ratio of mortality between the poorest and least-poor wealth tertiles. RESULTS: Mortality information in 85 surveys from 929 224 households and 1 267 167 women living in 54 countries was used. In the subset of 29 countries with repeat surveys, mortality declined annually by 4.36, 3.36, and 2.06 deaths per 1000 live births among the poorest, middle, and least-poor tertiles, respectively (P = .031 for difference). The mortality ratio declined from 1.68 to 1.48 during the study period (P = .006 for trend). In the complete set of 85 surveys, the mortality ratio declined in 64 surveys (from 2.11 to 1.55), and increased in 21 surveys (from 1.58 to 1.88). Multivariate analyses suggest that convergence was associated with good governance (P ≤ .03 for 4 governance indicators: government effectiveness, rule of law, regulatory quality, and control of corruption). CONCLUSIONS: Overall, under-5 mortality in low- and middle-income countries has decreased faster among the poorest compared with the least poor between 1995 and 2012, but progress in some countries has lagged, especially with poor governance. PMID:25384496

  3. Factors associated with trends in infant and child mortality in developing countries during the 1990s.

    PubMed Central

    Rutstein, S. O.

    2000-01-01

    The 1990s have seen a remarkable decrease in mortality among infants and children in most developing countries. In some countries, particularly in sub-Saharan Africa, these declines in mortality among children have slowed and are now increasing again. Internationally comparable data derived from survey programmes, such as the Demographic and Health Survey (DHS) programme, are available both to document the changes that have occurred in mortality and to provide insight into some of the factors that may explain these trends in mortality. The factors found in repeated DHS programmes that explain these trends fall into five categories: fertility behaviour; nutritional status, breastfeeding, and infant feeding; the use of health services by mothers and for children; environmental health conditions; and socioeconomic status. Both simple analyses and multivariate analyses of changes in these factors between surveys indicate that all factors affected the mortality trends. However, to explain trends in mortality, the variables themselves had to have changed over time. During the 1990s fertility behaviour, breastfeeding, and infant feeding have changed less than other factors and so would seem to have played a smaller role in mortality trends. This study confirms that trends in mortality during the 1990s were related to more than just a handful of variables. It would, therefore, be a mistake to concentrate policy actions on one or a few of these while forsaking others. Countries with the largest decreases in mortality have had substantial improvements in most of the factors that might be used to explain these changes. In some countries mortality has risen. In part these increases can be explained by the factors included in this study, such as deterioration in seeking medical care for children with fever. Other factors that were not measured, such as the increasing resistance of malaria to drug treatment and the increased prevalence of parental HIV/AIDS, may be contributing

  4. Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial

    PubMed Central

    Amouzou, Agbessi; Hazel, Elizabeth; Shaw, Bryan; Miller, Nathan P.; Tafesse, Mengistu; Mekonnen, Yared; Moulton, Lawrence H.; Bryce, Jennifer; Black, Robert E.

    2016-01-01

    We conducted a cluster randomized trial of the effects of the integrated community case management of childhood illness (iCCM) strategy on careseeking for and coverage of correct treatment of suspected pneumonia, diarrhea, and malaria, and mortality among children aged 2–59 months in 31 districts of the Oromia region of Ethiopia. We conducted baseline and endline coverage and mortality surveys approximately 2 years apart, and assessed program strength after about 1 year of implementation. Results showed strong iCCM implementation, with iCCM-trained workers providing generally good quality of care. However, few sick children were taken to iCCM providers (average 16 per month). Difference in differences analyses revealed that careseeking for childhood illness was low and similar in both study arms at baseline and endline, and increased only marginally in intervention (22.9–25.7%) and comparison (23.3–29.3%) areas over the study period (P = 0.77). Mortality declined at similar rates in both study arms. Ethiopia's iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality. This evaluation has allowed Ethiopia to strengthen its strategic approaches to increasing population demand and use of iCCM services. PMID:26787148

  5. Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial.

    PubMed

    Amouzou, Agbessi; Hazel, Elizabeth; Shaw, Bryan; Miller, Nathan P; Tafesse, Mengistu; Mekonnen, Yared; Moulton, Lawrence H; Bryce, Jennifer; Black, Robert E

    2016-03-01

    We conducted a cluster randomized trial of the effects of the integrated community case management of childhood illness (iCCM) strategy on careseeking for and coverage of correct treatment of suspected pneumonia, diarrhea, and malaria, and mortality among children aged 2-59 months in 31 districts of the Oromia region of Ethiopia. We conducted baseline and endline coverage and mortality surveys approximately 2 years apart, and assessed program strength after about 1 year of implementation. Results showed strong iCCM implementation, with iCCM-trained workers providing generally good quality of care. However, few sick children were taken to iCCM providers (average 16 per month). Difference in differences analyses revealed that careseeking for childhood illness was low and similar in both study arms at baseline and endline, and increased only marginally in intervention (22.9-25.7%) and comparison (23.3-29.3%) areas over the study period (P = 0.77). Mortality declined at similar rates in both study arms. Ethiopia's iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality. This evaluation has allowed Ethiopia to strengthen its strategic approaches to increasing population demand and use of iCCM services. PMID:26787148

  6. Spatial-temporal dynamics and structural determinants of child and maternal mortality in a rural, high HIV burdened South African population, 2000–2014: a study protocol

    PubMed Central

    Tlou, B; Sartorius, B; Tanser, F

    2016-01-01

    Introduction Child (infant and under-5) and maternal mortality rates are key indicators for assessing the health status of populations. South Africa's maternal and child mortality rates are high, and the country mirrors the continental trend of slow progress towards its Millennium Development Goals. Rural areas are often more affected regarding child and maternal mortalities, specifically in areas with a high HIV burden. This study aims to understand the factors affecting child and maternal mortality in the Africa Centre Demographic Surveillance Area (DSA) from 2003 to 2014 towards developing tailored interventions to reduce the deaths in resource poor settings. This will be done by identifying child and maternal mortality ‘hotspots’ and their associated risk factors. Methods and analysis This retrospective study will use data for 2003–2014 from the Africa Centre Demographic Information System (ACDIS) in rural KwaZulu-Natal Province, South Africa. All homesteads in the study area have been mapped to an accuracy of <2 m, all deaths recorded and the assigned cause of death established using a verbal autopsy interview. Advanced spatial-temporal clustering techniques (both regular (Kulldorff) and irregular (FleXScan)) will be used to identify mortality ‘hotspots’. Various advanced statistical modelling approaches will be tested and used to identify significant risk factors for child and maternal mortality. Differences in attributability and risk factors profiles in identified ‘hotspots’ will be assessed to enable tailored intervention guidance/development. This multicomponent study will enable a refined intervention model to be developed for typical rural populations with a high HIV burden. Ethics Ethical approval was received from the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (BE 169/15). PMID:27421296

  7. Violence against women increases the risk of infant and child mortality: a case-referent study in Nicaragua.

    PubMed Central

    Asling-Monemi, Kajsa; Peña, Rodolfo; Ellsberg, Mary Carroll; Persson, Lars Ake

    2003-01-01

    OBJECTIVE: To investigate the impact of violence against mothers on mortality risks for their offspring before 5 years of age in Nicaragua. METHODS: From a demographic database covering a random sample of urban and rural households in Le n, Nicaragua, we identified all live births among women aged 15-49 years. Cases were defined as those who had died before the age of 5 years, between January 1993 and June 1996. For each case, two referents, matched for sex and age at death, were selected from the database. A total of 110 mothers of the cases and 203 mothers of the referents were interviewed using a standard questionnaire covering mothers' experience of physical and sexual violence. The data were analysed for the risk associated with maternal experience of violence of infant and under-5 mortality. FINDINGS: A total of 61% of mothers of cases had a lifetime experience of physical and/or sexual violence compared with 37% of mothers of referents, with a significant association being found between such experiences and mortality among their offspring. Other factors associated with higher infant and under-5 mortality were mother's education (no formal education), age (older), and parity (multiparity). CONCLUSIONS: The results suggest an association between physical and sexual violence against mothers, either before or during pregnancy, and an increased risk of under-5 mortality of their offspring. The type and severity of violence was probably more relevant to the risk than the timing, and violence may impact child health through maternal stress or care-giving behaviours rather than through direct trauma itself. PMID:12640470

  8. Social determinants of child mortality in Niger: Results from the 2012 National Verbal and Social Autopsy Study

    PubMed Central

    Koffi, Alain K; Maina, Abdou; Yaroh, Asma Gali; Habi, Oumarou; Bensaïd, Khaled; Kalter, Henry D

    2016-01-01

    Background Understanding the determinants of preventable deaths of children under the age of five is important for accelerated annual declines – even as countries achieve the UN’s Millennium Development Goals and the target date of 2015 has been reached. While research has documented the extent and nature of the overall rapid decline in child mortality in Niger, there is less clear evidence to provide insight into the contributors to such deaths. This issue is the central focus of this paper. Methods We analyzed a nationally representative cross–sectional sample of 620 child deaths from the 2012 Niger Verbal Autopsy/Social Autopsy (VASA) Survey. We conducted a descriptive analysis of the data on preventive and curative care, guided by the coverage of proven indicators along the continuum of well child care and illness recognition and care–seeking for child illnesses encompassed by the BASICS/CDC Pathway to Survival model. Results Six hundred twenty deaths of children (1–59 months of age) were confirmed from the VASA survey. The majority of these children lived in households with precarious socio–economic conditions. Among the 414 children whose fatal illnesses began at age 0–23 months, just 24.4% were appropriately fed. About 24% of children aged 12–59 months were fully immunized. Of 601 children tracked through the Pathway to Survival, 62.4% could reach the first health care provider after about 67 minutes travel time. Of the 306 children who left the first health care provider alive, 161 (52.6%) were not referred for further care nor received any home care recommendations, and just 19% were referred to a second provider. About 113 of the caregivers reported cost (35%), distance (35%) and lack of transport (30%) as constraints to care–seeking at a health facility. Conclusion Despite Niger’s recent major achievements in reducing child mortality, the following determinants are crucial to continue building on the gains the country has made

  9. Birth spacing and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system.

    PubMed

    Fotso, Jean Christophe; Cleland, John; Mberu, Blessing; Mutua, Michael; Elungata, Patricia

    2013-11-01

    The majority of studies of the birth spacing-child survival relationship rely on retrospective data, which are vulnerable to errors that might bias results. The relationship is re-assessed using prospective data on 13,502 children born in two Nairobi slums between 2003 and 2009. Nearly 48% were first births. Among the remainder, short preceding intervals are common: 20% of second and higher order births were delivered within 24 months of an elder sibling, including 9% with a very short preceding interval of less than 18 months. After adjustment for potential confounders, the length of the preceding birth interval is a major determinant of infant and early childhood mortality. In infancy, a preceding birth interval of less than 18 months is associated with a two-fold increase in mortality risks (compared with lengthened intervals of 36 months or longer), while an interval of 18-23 months is associated with an increase of 18%. During the early childhood period, children born within 18 months of an elder sibling are more than twice as likely to die as those born after an interval of 36 months or more. Only 592 children experienced the birth of a younger sibling within 20 months; their second-year mortality was about twice as high as that of other children. These results support the findings based on retrospective data. PMID:22958417

  10. The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample

    PubMed Central

    Saggurti, Niranjan; Winter, Michael; Labonte, Alan; Decker, Michele R; Balaiah, Donta; Silverman, Jay G

    2010-01-01

    Objective To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting India. Population Women aged 15-49 years (n=124 385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19 302 births to 13 396 mothers). Main outcome measures In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age <1 year) and child (1-5 years) mortality; low birth weight (<2500 kg). Results The majority of births (73%; 13 042/19 302) were to mothers married as minors. Although bivariate analyses showed significant associations between maternal child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls. Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India. PMID:20093277

  11. Assessment of Malawi’s success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation

    PubMed Central

    Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

    2015-01-01

    Background Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. Methods We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007–2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. Results The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991–1995 to 119 deaths (95% CI 105 to 132) in the period 2006–2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide–treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Conclusions Malawi provides a strong example for countries in sub–Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community–based delivery platform, can lead to significant reductions in child mortality. PMID:26649176

  12. Mortality following snake bite envenomation by Bitis arietans in an HIV positive child: A case report.

    PubMed

    Firth, Gregory B; Street, Matthew; Ramguthy, Yammesh; Doedens, Linda

    2016-07-01

    Snake bites occur commonly in the rural areas of South Africa. Hospitals where snake bites are uncommon should always have protocols on standby in the event of such cases presenting. This is the first reported case documenting the effect of human immunodeficiency virus (HIV) on snake bite in South African children.A case report and review of relevant information about the case was undertaken.We present a case of a 1-year-old child referred from a peripheral hospital following a snake bite to the left upper limb with a compartment syndrome and features of cytotoxic envenomation. The patient presented late with a wide area of necrotic skin on the arm requiring extensive debridement. The underlying muscle was not necrotic. Polyvalent antivenom (South African Institute of Medical Research Polyvalent Snakebite Antiserum) administration was delayed by 4 days after the snake bite. The patient was also diagnosed with HIV and a persistent thrombocytopenia possibly due to both HIV infection and the snake bite venom. Lower respiratory tract infections with subsequent overwhelming sepsis ultimately resulted in the child's death.The case highlights the challenge of treating a snake bite in a young child with HIV and the detrimental outcome of delayed treatment. A protocol is essential in the management of snake bites in all hospitals.Level IV, Case report.This case highlights the interaction of snake bite envenomation and HIV infection on thrombocytopenia. PMID:27399076

  13. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature

    PubMed Central

    Onozuka, Daisuke; Hagihara, Akihito

    2015-01-01

    Abstract Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide. We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles. A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93–7.70) for all causes, 17.93% (95% eCI: 16.10–19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90–13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90–1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04–0.14; respiratory disease = 0.29%, 95% eCI: 0.07–0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47–7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% e

  14. Child acute malnutrition and mortality in populations affected by displacement in the Horn of Africa, 1997-2009.

    PubMed

    Mason, John B; White, Jessica M; Heron, Linda; Carter, Jennifer; Wilkinson, Caroline; Spiegel, Paul

    2012-03-01

    Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < -2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997-2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are

  15. Child Mortality Estimation: A Comparison of UN IGME and IHME Estimates of Levels and Trends in Under-Five Mortality Rates and Deaths

    PubMed Central

    Alkema, Leontine; You, Danzhen

    2012-01-01

    Background Millennium Development Goal 4 calls for a reduction in the under-five mortality rate (U5MR) by two-thirds between 1990 and 2015. In 2011, estimates were published by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) and the Institute for Health Metrics and Evaluation (IHME). The difference in the U5MR estimates produced by the two research groups was more than 10% and corresponded to more than ten deaths per 1,000 live births for 10% of all countries in 1990 and 20% of all countries in 2010, which can lead to conflicting conclusions with respect to countries' progress. To understand what caused the differences in estimates, we summarised differences in underlying data and modelling approaches used by the two groups, and analysed their effects. Methods and Findings UN IGME and IHME estimation approaches differ with respect to the construction of databases and the pre-processing of data, trend fitting procedures, inclusion and exclusion of data series, and additional adjustment procedures. Large differences in U5MR estimates between the UN IGME and the IHME exist in countries with conflicts or civil unrest, countries with high HIV prevalence, and countries where the underlying data used to derive the estimates were different, especially if the exclusion of data series differed between the two research groups. A decomposition of the differences showed that differences in estimates due to using different data (inclusion of data series and pre-processing of data) are on average larger than the differences due to using different trend fitting methods. Conclusions Substantial country-specific differences between UN IGME and IHME estimates for U5MR and the number of under-five deaths exist because of various differences in data and modelling assumptions used. Often differences are illustrative of the lack of reliable data and likely to decrease as more data become available. Improved transparency on methods and data used will help to

  16. Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

    PubMed Central

    Chola, Lumbwe; McGee, Shelley; Tugendhaft, Aviva; Buchmann, Eckhart; Hofman, Karen

    2015-01-01

    Introduction Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa. Methods The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030. Results If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers. Conclusion Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception. PMID:26076482

  17. The Impact of Education On Fertility and Child Mortality: Do Fathers Really Matter Less than Mothers? OECD Development Centre Working Paper, No. 217 (Formerly Webdoc No. 5)

    ERIC Educational Resources Information Center

    Breierova, Lucia; Duflo, Esther

    2003-01-01

    This paper takes advantage of a massive school construction program that took place in Indonesia between 1973 and 1978 to estimate the effect of education on fertility and child mortality. Time and region varying exposure to the school construction program generates instrumental variables for the average education in the household, and the…

  18. Assessing the impact of integrated community case management (iCCM) programs on child mortality: Review of early results and lessons learned in sub–Saharan Africa

    PubMed Central

    Amouzou, Agbessi; Morris, Saul; Moulton, Lawrence H; Mukanga, David

    2014-01-01

    Aim To accelerate progress in reducing child mortality, many countries in sub–Saharan Africa have adopted and scaled–up integrated community case management (iCCM) programs targeting the three major infectious killers of children under–five. The programs train lay community health workers to assess, classify and treat uncomplicated cases of pneumonia with antibiotics, malaria with antimalarial drugs and diarrhea with Oral Rehydration Salts (ORS) and zinc. Although management of these conditions with the respective appropriate drugs has proven efficacious in randomized trials, the effectiveness of large iCCM scale–up programs in reducing child mortality is yet to be demonstrated. This paper reviews recent experience in documenting and attributing changes in under–five mortality to the specific interventions of a variety of iCCM programs. Methods Eight recent studies have been identified and assessed in terms of design, mortality measurement and results. Impact of the iCCM program on mortality among children age 2–59 months was assessed through a difference in differences approach using random effect Poisson regression. Results Designs used by these studies include cluster randomized trials, randomized stepped–wedge and quasi–experimental trials. Child mortality is measured through demographic surveillance or household survey with full birth history conducted at the end of program implementation. Six of the eight studies showed a higher decline in mortality among children 2–59 months in program areas compared to comparison areas, although this acceleration was statistically significant in only one study with a decline of 76% larger in intervention than in comparison areas. Conclusion Studies that evaluate large scale iCCM programs and include assessment of mortality impact must ensure an appropriate design. This includes required sample sizes and sufficient number of program and comparison districts that allow adequate inference and attribution of

  19. [A perspective on living conditions: child and adolescent mortality in Manguinhos, Rio de Janeiro, Brazil].

    PubMed

    Moreira, Marcelo Rasga; Cruz Neto, Otavio; Sucena, Luiz Fernando Mazzei

    2003-01-01

    Using data from the Mortality Information System, this paper investigates the deaths of children and adolescents in the Manguinhos neighborhood from 1996 to 2000, to determine the main characteristics and associate key mortality aspects with local living conditions. An outlying working-class or "suburban" neighborhood of the city of Rio de Janeiro where the main campus of the Oswaldo Cruz Foundation is located, Manguinhos consists of 12 "communities" characterized by poverty, social exclusion, drug traffic, and structural violence. In light of these factors and the cultural, social, and economic potential of the Manguinhos population, the authors begin with the theoretical/ practical premise that living conditions played a major role in the deaths of these young citizens. The study of these fatal events may therefore lead to the elucidation of issues and problems that must be included on the agendas and in forums involving both health promotion projects and the Municipal, State, and Federal governments so that they can be appropriately addressed in the scope of public policies. PMID:12700795

  20. Marital fertility decline in the Netherlands: child mortality, real wages, and unemployment, 1860-1939.

    PubMed

    Schellekens, Jona; van Poppel, Frans

    2012-08-01

    Previous studies of the fertility decline in Europe are often limited to an earlier stage of the marital fertility decline, when the decline tended to be slower and before the large increase in earnings in the 1920s. Starting in 1860 (before the onset of the decline), this study follows marital fertility trends until 1939, when fertility reached lower levels than ever before. Using data from the Historical Sample of the Netherlands (HSN), this study shows that mortality decline, a rise in real income, and unemployment account for the decline in the Netherlands. This finding suggests that marital fertility decline was an adjustment to social and economic change, leaving little room for attitudinal change that is independent of social and economic change. PMID:22714058

  1. Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987-2011)

    PubMed Central

    2015-01-01

    Background Maternal mortality remains the leading cause of death and disability for reproductive-age women in resource-poor countries. The impact of a mother’s death on child outcomes is likely severe but has not been well quantified. This analysis examines survival outcomes for children whose mothers die during or shortly after childbirth in Butajira, Ethiopia. Methods This study uses data from the Butajira Health and Demographic Surveillance System (HDSS) site. Child outcomes were assessed using statistical tests to compare survival trajectories and age-specific mortality rates for children who did and did not experience a maternal death. The analyses leveraged the advantages of a large, long-term longitudinal dataset with a high frequency of data collection; but used a strict date-based method to code maternal deaths (as occurring within 42 or 365 days of childbirth), which may be subject to misclassification or recall bias. Results Between 1987 and 2011, there were 18189 live births to 5119 mothers; and 73 mothers of 78 children died within the first year of their child’s life, with 45% of these (n=30) classified as maternal deaths due to women dying within 42 days of childbirth. Among the maternal deaths, 81% of these infants also died. Children who experienced a maternal death within 42 days of their birth faced 46 times greater risk of dying within one month when compared to babies whose mothers survived (95% confidence interval 25.84-81.92; or adjusted ratio, 57.24 with confidence interval 25.31-129.49). Conclusions When a woman in this study population experienced a maternal death, her infant was much more likely to die than to survive—and the survival trajectory of these children is far worse than those of mothers who do not die postpartum. This highlights the importance of investigating how clinical care and socio-economic support programs can better address the needs of orphans, both throughout the intra- and post-partum periods as well as over

  2. Reducing child mortality: the contribution of Ceará state, northeast of Brazil, on achieving the Millennium Development Goal 4 in Brazil.

    PubMed

    Cavalcante e Silva, Anamaria; Correia, Luciano Lima; Campos, Jocileide Sales; Andrade, Francisca Maria de Oliveira; Silveira, Dirlene Mafalda Ildefonso da; Leite, Álvaro Jorge Madeiro; Rocha, Hermano A L; Machado, Márcia Maria Tavares; Cunha, Antonio Jose Ledo Alves da

    2015-04-01

    To describe the experience of Ceará, Northeast of Brazil, state on improving child survival, over a 20 year period, and discuss its contribution to Brazil's progress toward the achievement of MDG 4. Five population-based, statewide household surveys, with children <3 years of age, known as PESMIC (Mother and Child Health Survey of Ceará), were conducted in 1987, 1990, 1994, 2001 and 2007. They aimed to investigate levels and causes of mortality and access to child health services. The cluster sampling of 8,000 households identified 2,000 children on average. They used the same methodological approach and indicators. Important changes occurred in demographic and health indicators in the 20 year period, including 81 % reduction in the infant mortality rate, 43 % increase in breastfeeding rate and the achievement of a 95 % immunization rate. The prevalence of chronic malnutrition declined from 28 to 13 % and acute malnutrition from 13 to 5 %. Diarrheal diseases contributed with 36.6 % to the infant mortality in 1986 and 3.9 % in 2007. The major improvements in child health contributed substantially to the progress on MDG 4 in Brazil. Results of the 5 surveys produced reliable information for planning and evaluation that contributed to the remarkable progress made by the state. PMID:25095765

  3. Time to focus child survival programmes on the newborn: assessment of levels and causes of infant mortality in rural Pakistan.

    PubMed Central

    Fikree, Fariyal F.; Azam, Syed Iqbal; Berendes, Heinz W.

    2002-01-01

    OBJECTIVE: Population-based surveys were conducted in selected clusters of Pakistan's least developed provinces, Balochistan and North-West Frontier Province (NWFP), including the Federally Administered Tribal Areas (FATA), to assess levels and causes of neonatal and postneonatal mortality. METHODS: Interviews were conducted in a total of 54 834 households: Balochistan, 20 486; NWFP, 26 175; and FATA, 8173. Trained interviewers administered questionnaires after obtaining verbal informed consent from the respondents. Verbal autopsy interviews were conducted for infant deaths reported for the previous year. FINDINGS: The infant mortality rate based on combined data from the different sites was 99.7 per 1000 live births (range 129.0-70.1). The contribution of neonatal deaths to all infant deaths was much higher for NWFP (67.2%), where the overall rate was lowest, than for Balochistan (50.8%) and FATA (56.8%). Around 70% of all neonatal deaths occurred in the early neonatal period. The three main clinical causes of infant deaths were diarrhoea syndrome (21.6%), tetanus (11.7%) and acute respiratory infections (11.6%). In the neonatal period, however, tetanus (18.3%), small size for gestational age or low birth weight (15.3%), and birth injury (12.0%) accounted for nearly half (45.6%) of all deaths, while the contributions of diarrhoea syndrome (5.1%) and acute respiratory infections (6.0%) were less significant (11.1%). Tetanus was the cause of death for 21.7% and 17.1% of all infant deaths in FATA and NWFP respectively. CONCLUSION: The results suggest that there should be a shift in child survival programmes to give greater emphasis to maternal and neonatal health, in particular to maternal tetanus immunization, safe delivery and cord care. PMID:12075362

  4. Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam

    PubMed Central

    Minh, Hoang Van; Giang, Kim Bao; Hoat, Luu Ngoc; Chung, Le Hong; Huong, Tran Thi Giang; Phuong, Nguyen Thi Kim; Valentine, Nicole B.

    2016-01-01

    Introduction Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed ‘barriers’. Methods Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15–49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results. Results In Vietnam, about 54% of women aged 15–49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14–0.55; OR=0

  5. Integrating Space with Place in Health Research: A Multilevel Spatial Investigation Using Child Mortality in 1880 Newark, New Jersey

    PubMed Central

    Xu, Hongwei; Logan, John R.; Short, Susan E.

    2014-01-01

    Research on neighborhoods and health increasingly acknowledges the need to conceptualize, measure, and model spatial features of social and physical environments. In ignoring underlying spatial dynamics, we run the risk of biased statistical inference and misleading results. In this paper, we propose an integrated multilevel-spatial approach for Poisson models of discrete responses. In an empirical example of child mortality in 1880 Newark, New Jersey, we compare this multilevel-spatial approach with the more typical aspatial multilevel approach. Results indicate that spatially-defined egocentric neighborhoods, or distance-based measures, outperform administrative areal units, such as census units. In addition, although results did not vary by specific definitions of egocentric neighborhoods, they were sensitive to geographic scale and modeling strategy. Overall, our findings confirm that adopting a spatial-multilevel approach enhances our ability to disentangle the effect of space from that of place, and point to the need for more careful spatial thinking in population research on neighborhoods and health. PMID:24763980

  6. Achievements in preventing morbidity and mortality by researchers of the National Institute of Child Health and Human Development.

    PubMed

    Lipsett, M B

    1983-01-01

    In the 20 years since its creation, the National Institute of Child Health and Human Development (NICHD) has become a world leader in promoting research on fertility, high-risk pregnancy, care of newborns, nutrition, learning disorders, mental retardation, development of better contraceptives, and factors that influence family planning. NICHD also supports basic research that sheds light on normal processes in human development.This research has yielded impressive dividends. Improvement in the treatment of premature infants has contributed to a 22 percent decline in infant mortality in the United States between 1976 and 1980. Between 1962 and 1980, the maternal death rate from pregnancy and childbirth dropped 80 percent, owing largely to NICHD-supported research that has led to improved management of a number of conditions that are life-threatening to pregnant women.NICHD-supported research has led to the development of screening tests and treatments for certain metabolic disorders that cause mental retardation. Grantees of the Institute have also discovered a chromosomal disorder known to be a cause of mental retardation in men and have made research advances leading to better home care and a fuller role in community life for persons with Down's syndrome.Other NICHD studies seek to improve family planning methods and to find safer, more effective contraceptives. A promising development in this area is a class of synthetic brain hormones that could provide a new type of birth control pill for women and the first successful chemical contraceptive for men. PMID:6828637

  7. Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure

    PubMed Central

    Kheirbek, Raya E.; Fletcher, Ross D.; Bakitas, Marie A.; Fonarow, Gregg C.; Parvataneni, Sridivya; Bearden, Donna; Bailey, F. Amos; Morgan, Charity J.; Singh, Steven; Blackman, Marc R.; Zile, Michael R.; Patel, Kanan; Ahmed, Momanna B.; Tucker, Rodney O.; Brown, Cynthia J.; Love, Thomas E.; Aronow, Wilbert S.; Roseman, Jeffrey M.; Rich, Michael W.; Allman, Richard M.; Ahmed, Ali

    2015-01-01

    Background Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. Methods and Results Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998–2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post-discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years, 58% women, 18% African American). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio {HR} associated with hospice referral, 0.12; 95% confidence interval {CI}, 0.06–0.24). HRs (95% CIs) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post-discharge were 0.03 (0.04–0.21) and 0.17 (0.08–0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% vs. 27%), it was similar at 90 days (64% vs. 67% among hospice-eligible patients). Conclusions A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized HF patients. However, most HF patients who died within 6 months of hospital discharge did not receive a discharge hospice referral. PMID:26019151

  8. Deriving causes of child mortality by re–analyzing national verbal autopsy data applying a standardized computer algorithm in Uganda, Rwanda and Ghana

    PubMed Central

    Liu, Li; Li, Mengying; Cummings, Stirling; Black, Robert E.

    2015-01-01

    Background To accelerate progress toward the Millennium Development Goal 4, reliable information on causes of child mortality is critical. With more national verbal autopsy (VA) studies becoming available, how to improve consistency of national VA derived child causes of death should be considered for the purpose of global comparison. We aimed to adapt a standardized computer algorithm to re–analyze national child VA studies conducted in Uganda, Rwanda and Ghana recently, and compare our results with those derived from physician review to explore issues surrounding the application of the standardized algorithm in place of physician review. Methods and Findings We adapted the standardized computer algorithm considering the disease profile in Uganda, Rwanda and Ghana. We then derived cause–specific mortality fractions applying the adapted algorithm and compared the results with those ascertained by physician review by examining the individual– and population–level agreement. Our results showed that the leading causes of child mortality in Uganda, Rwanda and Ghana were pneumonia (16.5–21.1%) and malaria (16.8–25.6%) among children below five years and intrapartum–related complications (6.4–10.7%) and preterm birth complications (4.5–6.3%) among neonates. The individual level agreement was poor to substantial across causes (kappa statistics: –0.03 to 0.83), with moderate to substantial agreement observed for injury, congenital malformation, preterm birth complications, malaria and measles. At the population level, despite fairly different cause–specific mortality fractions, the ranking of the leading causes was largely similar. Conclusions The standardized computer algorithm produced internally consistent distribution of causes of child mortality. The results were also qualitatively comparable to those based on physician review from the perspective of public health policy. The standardized computer algorithm has the advantage of requiring minimal

  9. Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey

    PubMed Central

    Fledderjohann, Jasmine; Vellakkal, Sukumar; Khan, Zaky; Ebrahim, Shah; Stuckler, David

    2016-01-01

    Background: Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India’s slow progress in improving childhood survival. Methods: Using rounds 2 and 3 (2002—08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states (‘Empowered Action Groups’). Results: Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories. Conclusions: Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states. PMID:27063607

  10. Child mortality in the Democratic Republic of Congo: cross-sectional evidence of the effect of geographic location and prolonged conflict from a national household survey

    PubMed Central

    2014-01-01

    Background The child mortality rate is a good indicator of development. High levels of infectious diseases and high child mortality make the Democratic Republic of Congo (DRC) one of the most challenging environments for health development in Sub-Saharan Africa (SSA). Recent conflicts in the eastern part of the country and bad governance have compounded the problem. This study aimed to examine province-level geographic variation in under-five mortality (U5M), accounting for individual- and household-level risk factors including environmental factors such as conflict. Methods Our analysis used the nationally representative cross-sectional household sample of 8,992 children under five in the 2007 DRC Demographic and Health Survey. In the survey year, 1,005 deaths among this group were observed. Information on U5M was aggregated to the 11 provinces, and a Bayesian geo-additive discrete-time survival mixed model was used to map the geographic distribution of under-five mortality rates (U5MRs) at the province level, accounting for observable and unobservable risk factors. Results The overall U5MR was 159 per 1,000 live births. Significant associations with risk of U5M were found for < 24 month birth interval [posterior odds ratio and 95% credible region: 1.14 (1.04, 1.26)], home birth [1.13 (1.01, 1.27)] and living with a single mother [1.16 (1.03, 1.33)]. Striking variation was also noted in the risk of U5M by province of residence, with the highest risk in Kasaï-Oriental, a non-conflict area of the DRC, and the lowest in the conflict area of North Kivu. Conclusion This study reveals clear geographic patterns in rates of U5M in the DRC and shows the potential role of individual child, household and environmental factors, which are unexplained by the ongoing conflict. The displacement of mothers to safer areas may explain the lower U5MR observed at the epicentre of the conflict in North Kivu, compared with rates in conflict-free areas. Overall, the U5M maps point

  11. Determining Optimal Strategies to Reduce Maternal and Child Mortality in Rural Areas in Western China: an Assessment Using the Lives Saved Tool.

    PubMed

    Jiang, Zhen; Guo, Su Fang; Scherpbier, Robert W; Wen, Chun Mei; Xu, Xiao Chao; Guo, Yan

    2015-08-01

    China, as a whole, is about to meet the Millennium Development Goals for reducing the maternal mortality ratio (MMR) and infant mortality rate (IMR), but the disparities between rural area and urban area still exists. This study estimated the potential effectiveness of expanding coverage with high impact interventions using the Lives Saved Tool (LiST). It was found that gestational hypertension, antepartum and postpartum hemorrhage, preterm birth, neonatal asphyxia, and neonatal childhood pneumonia and diarrhea are still the major killers of mothers and children in rural area in China. It was estimated that 30% of deaths among 0-59 month old children and 25% of maternal deaths in 2008 could be prevented in 2015 if primary health care intervention coverage expanded to a feasible level. The LiST death cause framework, compared to data from the Maternal and Child Mortality Surveillance System, represents 60%-80% of neonatal deaths, 40%-50% of deaths in 1-59 month old children and 40%-60% of maternal deaths in rural areas of western China. PMID:26383598

  12. Household Size and Water Availability as Demographic Predictors of Maternal and Child Mortality in Delta State: Implications for Health Education

    ERIC Educational Resources Information Center

    Ogbe, Joseph O.

    2010-01-01

    The purpose of this study was to stimulate action to address and identify maternal, child and community needs towards the improvement in health of pregnant women, children and communities. Four null hypotheses were generated from the research questions while multiple regression analysis was used to analyse the data. The study found that household…

  13. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature: A Nationwide Study.

    PubMed

    Onozuka, Daisuke; Hagihara, Akihito

    2015-12-01

    Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide.We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles.A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93-7.70) for all causes, 17.93% (95% eCI: 16.10-19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90-13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90-1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04-0.14; respiratory disease = 0.29%, 95% eCI: 0.07-0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47-7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% eCI: 0.50-0.62) for extreme

  14. Community interventions to reduce child mortality in Dhanusha, Nepal: study protocol for a cluster randomized controlled trial

    PubMed Central

    2011-01-01

    Background Neonatal mortality remains high in rural Nepal. Previous work suggests that local women's groups can effect significant improvement through community mobilisation. The possibility of identification and management of newborn infections by community-based workers has also arisen. Methods/Design The objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers. MIRA Dhanusha community groups: a participatory intervention with women's groups. MIRA Dhanusha sepsis management: training of community volunteers in the recognition and management of neonatal sepsis. The study design is a cluster randomized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design. MIRA Dhanusha community groups: Female Community Health Volunteers (FCHVs) are supported in convening monthly women's groups. Nine groups per cluster (270 in total) work through two action research cycles in which they (i) identify local issues around maternity, newborn health and nutrition, (ii) prioritise key problems, (iii) develop strategies to address them, (iv) implement the strategies, and (v) evaluate their success. Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practices. MIRA Dhanusha sepsis management: FCHVs are trained to care for vulnerable newborn infants. They (i) identify local births, (ii) identify low birth weight infants, (iii) identify possible newborn infection, (iv) manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin, and (v) follow up infants and support families. Primary outcome: neonatal mortality rates. Secondary outcomes: MIRA Dhanusha community group: stillbirth, infant and under-two mortality rates, care practices and health care seeking behaviour, maternal diet

  15. All-Cause Cost Differences Between Robotic, Vaginal, and Abdominal Hysterectomy

    PubMed Central

    Woelk, Joshua L.; Borah, Bijan J.; Trabuco, Emanuel C.; Gebhart, John B.

    2015-01-01

    Objective To compare the all-cause costs of vaginal and abdominal hysterectomy with robotically assisted hysterectomy. Methods We identified all cases of robotically assisted hysterectomy, with or without bilateral salpingo-oophorectomy, treated at Mayo Clinic (Rochester, Minnesota) from January 1, 2007, through December 31, 2009. Cases were propensity score–matched (1:1) to cases of vaginal and abdominal hysterectomy, selected randomly from the 3 preceding years (before acquisition of the robotic surgical system). All-cause costs were abstracted through the sixth postoperative week from the Olmsted County Healthcare Expenditure and Utilization Database and compared between cohorts with a generalized linear modeling framework. Predicted costs were estimated with the recycled predictions method. Costs of operative complications also were compared. Results Predicted mean cost of robotically assisted hysterectomy was $2,253 more than that of vaginal hysterectomy ($13,619 vs $11,366; P<.001), although costs of complications were not significantly different. The predicted mean costs of robotically assisted vs abdominal hysterectomy were similar ($14,679 vs $15,588; P=.35), and the costs of complications were not significantly different. Conclusions Overall, vaginal hysterectomy was less costly than robotically assisted hysterectomy. Abdominal hysterectomy and robotically assisted hysterectomy had similar costs. PMID:24402586

  16. Cardiovascular risk factors predicting all causes of death in an occupational population sample.

    PubMed

    Menotti, A; Seccareccia, F

    1988-12-01

    A group of 768 men aged 40-59 at entry examination and belonging to an occupational sample of railroad employees in Rome have been examined for the measurement of some risk factors and followed-up for 20 years. In all 676 men, free from life-threatening diseases and with all measurements available, produced 166 fatal events in 20 years. Out of the 27 different personal characteristics considered only six contributed significantly to the multivariate prediction of all causes of death in the Cox proportional hazards computed by the forward stepwise technique. The factors predicting all causes of death were age, cigarette smoking, diabetes, blood pressure, mother's vital status and being on a diet prescribed by a doctor. The relative risk of those located in the upper decile of the estimated risk as compared to the bottom decile was 8.2. The results do not differ much from those obtained in a demographic sample studied in the same way. PMID:3225084

  17. Vascular Disease and Risk Stratification for Ischemic Stroke and All-Cause Death in Heart Failure Patients without Diagnosed Atrial Fibrillation: A Nationwide Cohort Study

    PubMed Central

    Melgaard, Line; Gorst-Rasmussen, Anders; Rasmussen, Lars Hvilsted; Lip, Gregory Y. H.; Larsen, Torben Bjerregaard

    2016-01-01

    Background Stroke and mortality risk among heart failure patients previously diagnosed with different manifestations of vascular disease is poorly described. We conducted an observational study to evaluate the stroke and mortality risk among heart failure patients without diagnosed atrial fibrillation and with peripheral artery disease (PAD) or prior myocardial infarction (MI). Methods Population-based cohort study of patients diagnosed with incident heart failure during 2000–2012 and without atrial fibrillation, identified by record linkage between nationwide registries in Denmark. Hazard rate ratios of ischemic stroke and all-cause death after 1 year of follow-up were used to compare patients with either: a PAD diagnosis; a prior MI diagnosis; or no vascular disease. Results 39,357 heart failure patients were included. When compared to heart failure patients with no vascular disease, PAD was associated with a higher 1-year rate of ischemic stroke (adjusted hazard rate ratio [HR]: 1.34, 95% confidence interval [CI]: 1.08–1.65) and all-cause death (adjusted HR: 1.47, 95% CI: 1.35–1.59), whereas prior MI was not (adjusted HR: 1.00, 95% CI: 0.86–1.15 and 0.94, 95% CI: 0.89–1.00, for ischemic stroke and all-cause death, respectively). When comparing patients with PAD to patients with prior MI, PAD was associated with a higher rate of both outcomes. Conclusions Among incident heart failure patients without diagnosed atrial fibrillation, a previous diagnosis of PAD was associated with a significantly higher rate of the ischemic stroke and all-cause death compared to patients with no vascular disease or prior MI. Prevention strategies may be particularly relevant among HF patients with PAD. PMID:27015524

  18. U.S. MORTALITY DATA

    EPA Science Inventory

    U.S. Mortality data, collected and maintained by the National Center for Health Statistics (NCHS), can be analyzed with the SEER*Stat software. The data covers all causes of death, not just cancer deaths. NCHS granted the SEER program limited permission to provide the mortality d...

  19. The novel marker LTBP2 predicts all-cause and pulmonary death in patients with acute dyspnoea.

    PubMed

    Breidthardt, Tobias; Vanpoucke, Griet; Potocki, Mihael; Mosimann, Tamina; Ziller, Ronny; Thomas, Gregoire; Laroy, Wouter; Moerman, Piet; Socrates, Thenral; Drexler, Beatrice; Mebazaa, Alexandre; Kas, Koen; Mueller, Christian

    2012-11-01

    The risk stratification in patients presenting with acute dyspnoea remains a challenge. We therefore conducted a prospective, observational cohort study enrolling 292 patients presenting to the emergency department with acute dyspnoea. A proteomic approach for antibody-free targeted protein quantification based on high-end MS was used to measure LTBP2 [latent TGF (transforming growth factor)-binding protein 2] levels. Final diagnosis and death during follow-up were adjudicated blinded to LTBP2 levels. AHF (acute heart failure) was the final diagnosis in 54% of patients. In both AHF (P<0.001) and non-AHF (P=0.015) patients, LTBP2 levels at presentation were significantly higher in non-survivors compared with survivors with differences on median levels being 2.2- and 1.5-fold respectively. When assessing the cause of death, LTBP2 levels were significantly higher in patients dying from pulmonary causes (P=0.0005). Overall, LTBP2 powerfully predicted early pulmonary death {AUC (area under the curve), 0.95 [95% CI (confidence interval), 0.91-0.98]}. In ROC (receiver operating characteristic) curve analyses for the prediction of 1-year mortality LTBP2 achieved an AUC of 0.77 (95% CI, 0.71-0.84); comparable with the predictive potential of NT-proBNP [N-terminal pro-B-type natriuruetic peptide; 0.77 (95% CI, 0.72-0.82)]. Importantly, the predictive potential of LTBP2 persisted in patients with AHF as the cause of dypnea (AUC 0.78) and was independent of renal dysfunction (AUC 0.77). In a multivariate Cox regression analysis, LTBP2 was the strongest independent predictor of death [HR (hazard ratio), 3.76 (95% CI, 2.13-6.64); P<0.0001]. In conclusion, plasma levels of LTBP2 present a novel and powerful predictor of all-cause mortality, and particularly pulmonary death. Cause-specific prediction of death would enable targeted prevention, e.g. with pre-emptive antibiotic therapy. PMID:22587491

  20. Late-Life Risk Factors for All-Cause Dementia and Differential Dementia Diagnoses in Women

    PubMed Central

    Neergaard, Jesper Skov; Dragsbæk, Katrine; Hansen, Henrik Bo; Henriksen, Kim; Christiansen, Claus; Karsdal, Morten Asser

    2016-01-01

    Abstract Since the first evidence of a decline in dementia incidence was reported in 2011, the focus on modifiable risk factors has increased. The possibility of risk factor intervention as a prevention strategy has been widely discussed; however, further evidence in relation to risk factors is still needed. The Prospective Epidemiologic Risk Factor (PERF I) study was an observational prospective study of postmenopausal Danish women who were initially examined between 1999 and 2001 (n = 5855). Follow-up data on diagnosis and survival as of December 31, 2014 was retrieved from the National Danish Patient Registry and the National Danish Causes of Death Registry. Cox proportional hazards regression model was applied to calculate adjusted hazard ratios (HR) for selected risk factors for dementia. Of 5512 eligible subjects, 592 developed dementia within the follow-up period of maximum 15 years. The independent factors associated with increased risk of all-cause dementia were depression (HR = 1.75 [95% CI 1.32–2.34]) and impaired fasting glucose levels. A dose–response relationship was observed between fasting glucose level and risk of dementia with HRs of 1.25 [1.05–1.49] and 1.45 [1.03–2.06] for impaired (5.6–6.9 mmol/L) and hyperglycemic (≥7.0 mmol/L) glucose levels, respectively. The factors associated with a decreased risk of dementia were overweight in late-life (HR = 0.75 [0. 62–0.89]) and physical activity at least once weekly (HR = 0.77 [0.61–0.96]). The identified risk factors for dementia in women in late-life are all considered modifiable. This supports the notion that prevention strategies may improve the poor future prospects for dementias in the ageing population. PMID:26986157

  1. The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda

    PubMed Central

    English, Lauren Lacey; Dunsmuir, Dustin; Kumbakumba, Elias; Ansermino, John Mark; Larson, Charles P; Lester, Richard; Barigye, Celestine; Ndamira, Andrew; Kabakyenga, Jerome

    2016-01-01

    Background Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation. Objective Our aim was to summarize the usability evaluation of the PARA app among target users, which consists of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool. Methods Health care workers (N=30) were recruited to participate at Mbarara Regional Referral Hospital and Holy Innocents Children’s Hospital in Mbarara, Southwestern Uganda. This usability study was conducted in two phases to allow for iterative improvement and testing of the interfaces. The PARA app was evaluated using quantitative and qualitative measures, which were compared between Phases 1 and 2 of the study. Participants were given two patient scenarios that listed hypothetical information (ie, demographic, social, and clinical data) to be entered into the app and to determine the patient’s risk of in-hospital and postdischarge mortality. Time-to-completion and user errors were recorded for each participant while using the app. A modified computer system usability questionnaire was utilized at the end of each session to elicit user satisfaction with the PARA app and obtain suggestions for future improvements. Results The average time to complete the PARA app decreased by 30% from Phase 1 to Phase 2, following user feedback and modifications. Participants spent the longest amount of time on the oxygen

  2. Research report--Volunteer infant feeding and care counselors: a health education intervention to improve mother and child health and reduce mortality in rural Malawi.

    PubMed

    Rosato, Mikey; Lewycka, Sonia; Mwansambo, Charles; Kazembe, Peter; Phiri, Tambosi; Chapota, Hilda; Vergnano, Stefania; Newell, Marie-Louise; Osrin, David; Costello, Anthony

    2012-06-01

    The aim of this report is to describe a health education intervention involving volunteer infant feeding and care counselors being implemented in Mchinji district, Malawi. The intervention was established in January 2004 and involves 72 volunteer infant feeding and care counselors, supervised by 24 government Health Surveillance Assistants, covering 355 villages in Mchinji district. It aims to change the knowledge, attitudes and behaviour of women to promote exclusive breastfeeding and other infant care practices. The main target population are women of child bearing age who are visited at five key points during pregnancy and after birth. Where possible, their partners are also involved. The visits cover exclusive breastfeeding and other important neonatal and infant care practices. Volunteers are provided with an intervention manual and picture book. Resource inputs are low and include training allowances and equipment for counselors and supervisors, and a salary, equipment and materials for a coordinator. It is hypothesized that the counselors will encourage informational and attitudinal change to enhance motivation and risk reduction skills and self-efficacy to promote exclusive breastfeeding and other infant care practices and reduce infant mortality. The impact is being evaluated through a cluster randomised controlled trial and results will be reported in 2012. PMID:23638270

  3. HbA1c and Risks of All-Cause and Cause-Specific Death in Subjects without Known Diabetes: A Dose-Response Meta-Analysis of Prospective Cohort Studies

    PubMed Central

    Zhong, Guo-Chao; Ye, Ming-Xin; Cheng, Jia-Hao; Zhao, Yong; Gong, Jian-Ping

    2016-01-01

    Whether HbA1c levels are associated with mortality in subjects without known diabetes remains controversial. Moreover, the shape of the dose–response relationship on this topic is unclear. Therefore, a dose–response meta-analysis was conducted. PubMed and EMBASE were searched. Summary hazard ratios (HRs) were calculated using a random-effects model. Twelve studies were included. The summary HR per 1% increase in HbA1c level was 1.03 [95% confidence interval (CI) = 1.01–1.04] for all-cause mortality, 1.05 [95% CI = 1.02–1.07) for cardiovascular disease (CVD) mortality, and 1.02 (95% CI = 0.99–1.07) for cancer mortality. After excluding subjects with undiagnosed diabetes, the aforementioned associations remained significant for CVD mortality only. After further excluding subjects with prediabetes, all aforementioned associations presented non-significance. Evidence of a non-linear association between HbA1c and mortality from all causes, CVD and cancer was found (all Pnon-linearity < 0.05). The dose–response curves were relatively flat for HbA1c less than around 5.7%, and rose steeply thereafter. In conclusion, higher HbA1c level is associated with increased mortality from all causes and CVD among subjects without known diabetes. However, this association is driven by those with undiagnosed diabetes or prediabetes. The results regarding cancer mortality should be treated with caution due to limited studies. PMID:27045572

  4. [Neonatal and child tetanus morbidity and mortality in the University hospitals of Abidjan, Côte d'Ivoire (2001-2010)].

    PubMed

    Aba, Y T; Cissé, L; Abalé, A K; Diakité, I; Koné, D; Kadiané, J; Diallo, Z; Kra, O; Oulaï, S; Bissagnéné, E

    2016-08-01

    The lack of data on neonatal tetanus and children in university hospitals (UH) in Abidjan for over a decade has motivated the realization of this study. The objective of this study is to evaluate the morbidity and mortality related to neonatal tetanus (NT) and child tetanus (CT) in Abidjan University Hospital from 2001 to 2010. It is a retrospective study, multicenter analysis with records of newborns and children suffering from tetanus in the three UH of Abidjan. The collection and analysis of data were made by the SPHINX 4.5 and EPI.INFO 6.0 software. In ten years, 242 cases of tetanus (53 NT cases and 189 CT cases) were collected with a predominance of cases after the fifth year of life (59.5%). The incidence rate of NT was less than 1 case per 1,000 live births. All mothers of the newborns were inhabiting the city of Abidjan. Their median age was 19 years [16-32] and 64% were teenagers. Gateways were dominated by umbilical wounds (77.3%) in the NTand skin wounds (59%) in CT. The cure rate was 30.2% in the NT and 60% in the CT. Lethality was 60% for NT and 22% for CT with a positive correlation with young age (neonates: p = 4.10-7, age <5 years: p = 0.01), lack of intraspinal injection of tetanus serum (p = 8.10-6), the absence of conventional antibiotic therapy (p = 0.023), the existence of metabolic complications (p = 2.10-5), the score of ≥ 4 Dakar (p = 0.005). Tetanus remains a real morbidly cause among children in Abidjan University Hospital with high lethality. However, the incidence of NT seems consistent with the incidence threshold desired by WHO. PMID:27177642

  5. A Retrospective Study of the Clinical Burden of Hospitalized All-Cause and Pneumococcal Pneumonia in Canada

    PubMed Central

    McNeil, Shelly A.; Qizilbash, Nawab; Ye, Jian; Gray, Sharon; Zanotti, Giovanni; Munson, Samantha; Dartois, Nathalie; Laferriere, Craig

    2016-01-01

    Background. Routine vaccination against Streptococcus pneumoniae is recommended in Canada for infants, the elderly, and individuals with chronic comorbidity. National incidence and burden of all-cause and pneumococcal pneumonia in Canada (excluding Quebec) were assessed. Methods. Incidence, length of stay, and case-fatality rates of hospitalized all-cause and pneumococcal pneumonia were determined for 2004–2010 using ICD-10 discharge data from the Canadian Institutes for Health Information Discharge Abstract Database. Population-at-risk data were obtained from the Statistics Canada census. Temporal changes in pneumococcal and all-cause pneumonia rates in adults ≥65 years were analyzed by logistic regression. Results. Hospitalization for all-cause pneumonia was highest in children <5 years and in adults >70 years and declined significantly from 1766/100,000 to 1537/100,000 per year in individuals aged ≥65 years (P < 0.001). Overall hospitalization for pneumococcal pneumonia also declined from 6.40/100,000 to 5.08/100,000 per year. Case-fatality rates were stable (11.6% to 12.3%). Elderly individuals had longer length of stay and higher case-fatality rates than younger groups. Conclusions. All-cause and pneumococcal pneumonia hospitalization rates declined between 2004 and 2010 in Canada (excluding Quebec). Direct and indirect effects from pediatric pneumococcal immunization may partly explain some of this decline. Nevertheless, the burden of disease from pneumonia remains high. PMID:27445530

  6. Leisure Time Physical Activity and Mortality in Chronic Kidney Disease: Preliminary findings from the MDRD study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease and all-cause mortality. In the general population, physical activity is associated with reduced mortality. We examined physical activity status in CKD patients and its relation to all-cause mortality. The Modified...

  7. Accident mortality among children

    PubMed Central

    Swaroop, S.; Albrecht, R. M.; Grab, B.

    1956-01-01

    The authors present statistics on mortality from accidents, with special reference to those relating to the age-group 1-19 years. For a number of countries figures are given for the proportional mortality from accidents (the number of accident deaths expressed as a percentage of the number of deaths from all causes) and for the specific death-rates, per 100 000 population, from all causes of death, from selected causes, from all causes of accidents, and from various types of accident. From these figures it appears that, in most countries, accidents are becoming relatively increasingly prominent as a cause of death in childhood, primarily because of the conquest of other causes of death—such as infectious and parasitic diseases, which formerly took a heavy toll of children and adolescents—but also to some extent because the death-rate from motor-vehicle accidents is rising and cancelling out the reduction in the rate for other causes of accidental death. In the authors' opinion, further epidemiological investigations into accident causation are required for the purpose of devising quicker and more effective methods of accident prevention. PMID:13383361

  8. Is there a reverse J-shaped association between 25-Hydroxyvitamin D and all-cause mortality? Results from the US Nationally Representative NHANES

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The concentration or threshold of 25-Hydroxyvitamin D [25(OH)D] needed to maximally suppress intact serum parathyroid hormone (iPTH) has been suggested as a measure of optimal vitamin D status. Depending upon the definition of maximal suppression of iPTH and the two-phase regression approach used, ...

  9. 122 CITIES MORTALITY REPORTING SYSTEM (122 MRS)

    EPA Science Inventory

    This system compiles summary mortality data by age group for all-causes and pneumonia and influenza as reported by Vital Statistic Registrars and Reporters within 122 U.S. cities. Additional information and access to a query system linked to 122 Cities Mortality data is available...

  10. Clinically diagnosed insomnia and risk of all-cause and diagnosis-specific disability pension: a nationwide cohort study.

    PubMed

    Jansson, Catarina; Alexanderson, Kristina; Kecklund, Göran; Akerstedt, Torbjörn

    2013-01-01

    Background. Insomnia and disability pension are major health problems, but few population-based studies have examined the association between insomnia and risk of disability pension. Methods. We conducted a prospective nationwide cohort study based on Swedish population-based registers including all 5,028,922 individuals living in Sweden on December 31, 2004/2005, aged 17-64 years, and not on disability or old age pension. Those having at least one admission/specialist visit with a diagnosis of disorders of initiating and maintaining sleep (insomnias) (ICD-10: G47.0) during 2000/2001-2005 were compared to those with no such inpatient/outpatient care. All-cause and diagnosis-specific incident disability pension were followed from 2006 to 2010. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated by Cox regression. Results. In models adjusted for prior sickness absence, sociodemographic factors, and inpatient/specialized outpatient care, associations between insomnia and increased risks of all-cause disability pension (IRR 1.35, 95% CI 1.09-1.67) and disability pension due to mental diagnoses (IRR 1.86, 95% CI 1.38-2.50) were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of disability pension due to cancer, circulatory, or musculoskeletal diagnoses were observed. Conclusion. Insomnia seems to be positively associated with all-cause disability pension and disability pension due to mental diagnoses. PMID:24490078

  11. Clinically Diagnosed Insomnia and Risk of All-Cause and Diagnosis-Specific Disability Pension: A Nationwide Cohort Study

    PubMed Central

    Alexanderson, Kristina; Kecklund, Göran; Åkerstedt, Torbjörn

    2013-01-01

    Background. Insomnia and disability pension are major health problems, but few population-based studies have examined the association between insomnia and risk of disability pension. Methods. We conducted a prospective nationwide cohort study based on Swedish population-based registers including all 5,028,922 individuals living in Sweden on December 31, 2004/2005, aged 17–64 years, and not on disability or old age pension. Those having at least one admission/specialist visit with a diagnosis of disorders of initiating and maintaining sleep (insomnias) (ICD-10: G47.0) during 2000/2001–2005 were compared to those with no such inpatient/outpatient care. All-cause and diagnosis-specific incident disability pension were followed from 2006 to 2010. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated by Cox regression. Results. In models adjusted for prior sickness absence, sociodemographic factors, and inpatient/specialized outpatient care, associations between insomnia and increased risks of all-cause disability pension (IRR 1.35, 95% CI 1.09–1.67) and disability pension due to mental diagnoses (IRR 1.86, 95% CI 1.38–2.50) were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of disability pension due to cancer, circulatory, or musculoskeletal diagnoses were observed. Conclusion. Insomnia seems to be positively associated with all-cause disability pension and disability pension due to mental diagnoses. PMID:24490078

  12. Increased Mortality in Narcolepsy

    PubMed Central

    Ohayon, Maurice M.; Black, Jed; Lai, Chinglin; Eller, Mark; Guinta, Diane; Bhattacharyya, Arun

    2014-01-01

    Objective: To evaluate the mortality rate in patients with narcolepsy. Design: Data were derived from a large database representative of the US population, which contains anonymized patient-linked longitudinal claims for 173 million individuals. Setting: Symphony Health Solutions (SHS) Source Lx, an anonymized longitudinal patient dataset. Patients/Participants: All records of patients registered in the SHS database between 2008 and 2010. Interventions: None Measurements and Results: Identification of patients with narcolepsy was based on ≥ 1 medical claim with the diagnosis of narcolepsy (ICD-9 347.xx) from 2002 to 2012. Dates of death were acquired from the Social Security Administration via a third party; the third party information was encrypted in the same manner as the claims data such that anonymity is ensured prior to receipt by SHS. Annual all-cause mortality rates for 2008, 2009, and 2010 were calculated retrospectively for patients with narcolepsy and patients without narcolepsy in the database, and standardized mortality ratios (SMR) were calculated. Mortality rates were also compared with the general US population (Centers for Disease Control data). SMRs of the narcolepsy population were consistent over the 3-year period and showed an approximate 1.5-fold excess mortality relative to those without narcolepsy. The narcolepsy population had consistently higher mortality rates relative to those without narcolepsy across all age groups, stratified by age decile, from 25-34 years to 75+ years of age. The SMR for females with narcolepsy was lower than for males with narcolepsy. Conclusions: Narcolepsy was associated with approximately 1.5-fold excess mortality relative to those without narcolepsy. While the cause of this increased mortality is unknown, these findings warrant further investigation. Citation: Ohayon MM; Black J; Lai C; Eller M; Guinta D; Bhattacharyya A. Increased mortality in narcolepsy. SLEEP 2014;37(3):439-444. PMID:24587565

  13. SOCIOECONOMIC DISPARITIES IN MORTALITY AMONG CHINESE ELDERLY*

    PubMed Central

    Luo, Weixiang; Xie, Yu

    2014-01-01

    This study examines the association of three different SES indicators (education, economic independence, and household per-capita income) with mortality, using a large, nationally representative longitudinal sample of 12,437 Chinese ages 65 and older. While the results vary by measures used, we find overall strong evidence for a negative association between SES and all-cause mortality. Exploring the association between SES and cause-specific mortality, we find that SES is more strongly related to a reduction of mortality from more preventable causes (i.e., circulatory disease and respiratory disease) than from less preventable causes (i.e., cancer). Moreover, we consider mediating causal factors such as support networks, health-related risk behaviors, and access to health care in contributing to the observed association between SES and mortality. Among these mediating factors, medical care is of greatest importance. This pattern holds true for both all-cause and cause-specific mortality. PMID:25098961

  14. Bayesian analysis of zero inflated spatiotemporal HIV/TB child mortality data through the INLA and SPDE approaches: Applied to data observed between 1992 and 2010 in rural North East South Africa

    NASA Astrophysics Data System (ADS)

    Musenge, Eustasius; Chirwa, Tobias Freeman; Kahn, Kathleen; Vounatsou, Penelope

    2013-06-01

    Longitudinal mortality data with few deaths usually have problems of zero-inflation. This paper presents and applies two Bayesian models which cater for zero-inflation, spatial and temporal random effects. To reduce the computational burden experienced when a large number of geo-locations are treated as a Gaussian field (GF) we transformed the field to a Gaussian Markov Random Fields (GMRF) by triangulation. We then modelled the spatial random effects using the Stochastic Partial Differential Equations (SPDEs). Inference was done using a computationally efficient alternative to Markov chain Monte Carlo (MCMC) called Integrated Nested Laplace Approximation (INLA) suited for GMRF. The models were applied to data from 71,057 children aged 0 to under 10 years from rural north-east South Africa living in 15,703 households over the years 1992-2010. We found protective effects on HIV/TB mortality due to greater birth weight, older age and more antenatal clinic visits during pregnancy (adjusted RR (95% CI)): 0.73(0.53;0.99), 0.18(0.14;0.22) and 0.96(0.94;0.97) respectively. Therefore childhood HIV/TB mortality could be reduced if mothers are better catered for during pregnancy as this can reduce mother-to-child transmissions and contribute to improved birth weights. The INLA and SPDE approaches are computationally good alternatives in modelling large multilevel spatiotemporal GMRF data structures.

  15. Mortality in Asia.

    PubMed

    1981-01-01

    Although the general trend in mortality between 1950 and 1975 in South and East Asia has been downward, there is considerable country-to-country variation in the rate of decline. In countries where combined economic, social, and political circumstances resulted in controlling the disease spectrum (e.g., China, Malaysia, Sri Lanka), mortality levels declined to those seen in low-mortality countries. In most of the large countries of the region however, mortality declined at a slower rate, even slowing down considerably in the 1970's while the death rates remained high (e.g., India, Bangladesh, Thailand, Philippines); this slowing down of mortality level is attributed essentially to the poverty-stricken masses of society which were not able to take advantage of social, technological, and health-promoting behavioral changes conducive to mortality decline. Infant mortality levels, although declining since 1950, followed the same dismal pattern of the general mortality level. The rate varies from less than 10/1000 live births (Japan) to more than 140/1000 (Bangladesh, Laos, Nepal). Generally, rural areas exhibited higher infant mortality than urban areas. The level of child mortality declines with increases in the mother's educational level in Bangladesh, India, Indonesia, Sri Lanka, and Thailand. The largest decline in child mortality occurs when at least 1 parent has secondary education. The premature retardation of mortality decline is caused by several factors: economic development, nutrition and food supply, provision and adequacy of health services, and demographic trends. The outlook for the year 2000 for most of Asia's countries will depend heavily on significant population increases. In most countries, particularly in South Asia, population is expected to increase by 75%, much of it in rural areas and among poorer socioeconomic groups. In view of this, Asia's health planners and policymakers will have to develop health policies which will strike a balance

  16. Underascertainment of Child Abuse Fatalities in France: Retrospective Analysis of Judicial Data to Assess Underreporting of Infant Homicides in Mortality Statistics

    ERIC Educational Resources Information Center

    Tursz, Anne; Crost, Monique; Gerbouin-Rerolle, Pascale; Cook, Jon M.

    2010-01-01

    Objectives: Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. Methods: A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant…

  17. Early Life Origins of All-Cause and Cause-Specific Disability Pension: Findings from the Helsinki Birth Cohort Study

    PubMed Central

    von Bondorff, Mikaela B.; Törmäkangas, Timo; Salonen, Minna; von Bonsdorff, Monika E.; Osmond, Clive; Kajantie, Eero; Eriksson, Johan G.

    2015-01-01

    Background There is some evidence linking sub-optimal prenatal development to an increased risk of disability pension (DP). Our aim was to investigate whether body size at birth was associated with transitioning into all-cause and cause-specific DP during the adult work career. Methods 10 682 people born in 1934–44 belonging to the Helsinki Birth Cohort Study had data on birth weight extracted from birth records, and on time, type and reason of retirement between 1971 and 2011 extracted from the Finnish Centre for Pensions. Results Altogether 21.3% transitioned into DP during the 40-year follow-up, mainly due to mental disorders, musculoskeletal disorders and cardiovascular disease. Average age of transitioning into DP was 51.3 (SD 8.4) for men and 52.2 (SD 7.6) for women. Cohort members who did not transition into DP retired 10 years later on average. Among men, higher birth weight was associated with a lower hazard of transitioning into DP, adjusted hazard ratio (HR) being 0.94 (95% confidence interval [CI] 0.88–0.99 for 1 SD increase in birth weight). For DP due to mental disorders the adjusted HR was 0.90, 95% CI 0.81, 0.99. A similar but non-significant trend was found for DP due to cardiovascular disease. Among women there were no associations between body size at birth and all-cause DP (p for interaction gender*birth weight on DP p = 0.007). Conclusions Among men disability pension, particularly due to mental disorders, may have its origins in prenatal development. Given that those who retire due to mental health problems are relatively young, the loss to the workforce is substantial. PMID:25849578

  18. Infant Mortality

    MedlinePlus

    ... Infant Mortality Infant Mortality: What is CDC Doing? Sudden Infant Death Syndrome Teen Pregnancy Contraception CDC Contraceptive Guidance for ... and low birth weight Maternal complications of pregnancy Sudden Infant Death Syndrome (SIDS) Injuries (e.g., suffocation). The top ...

  19. Exposures and mortality among chrysotile asbestos workers. Part II: mortality

    SciTech Connect

    Dement, J.M.; Harris, R.L. Jr.; Symons, M.J.; Shy, C.M.

    1983-01-01

    A retrospective cohort mortality study was conducted among a cohort of 1,261 white males employed one or more months in chrysotile asbestos textile operations and followed between 1940 and 1975. Statistically significant excess mortality was observed for all causes combined (standardized mortality ratio (SMR) . 150), lung cancer (SMR . 135), diseases of the circulatory system (SMR . 125), nonmalignant respiratory diseases (SMR . 294), and accidents (SMR . 134). Using estimated fiber exposure levels in conjunction with detailed worker job histories, exposure-response relationships were investigated. Strong exposure-response relationships for lung cancer and asbestos related non-malignant respiratory diseases were observed. Compared with data for chrysotile miners and millers, chrysotile textile workers were found to experience significantly greater lung cancer mortality at lower lifetime cumulative exposure levels. Factors such as differences in airborne fiber characteristics may partially account for the large differences in exposure response between textile workers and miners and millers.

  20. Verbal/Social Autopsy in Niger 2012–2013: A new tool for a better understanding of the neonatal and child mortality situation

    PubMed Central

    Bensaïd, Khaled; Yaroh, Asma Gali; Kalter, Henry D; Koffi, Alain K; Amouzou, Agbessi; Maina, Abdou; Kazmi, Narjis

    2016-01-01

    Niger, one of the poorest countries in the world, recently used for the first time the integrated verbal and social autopsy (VASA) tool to assess the biological causes and social and health system determinants of neonatal and child deaths. These notes summarize the Nigerien experience in the use of this new tool, the steps taken for high level engagement of the Niger government and stakeholders for the wide dissemination of the study results and their use to support policy development and maternal, neonatal and child health programming in the country. The experience in Niger reflects lessons learned by other developing countries in strengthening the use of data for evidence–based decision making, and highlights the need for the global health community to provide continued support to country data initiatives, including the collection, analysis, interpretation and utilization of high quality data for the development of targeted, highly effective interventions. In Niger, this is supporting the country’s progress toward achieving Millennium Development Goal 4. A follow–up VASA study is being planned and the tool is being integrated into the National Health Management Information System. VASA studies have now been completed or are under way in additional sub–Saharan African countries, in each through the same collaborative process used in Niger to bring together health policy makers, program planners and development partners. PMID:26955472

  1. Verbal/Social Autopsy in Niger 2012-2013: A new tool for a better understanding of the neonatal and child mortality situation.

    PubMed

    Bensaïd, Khaled; Yaroh, Asma Gali; Kalter, Henry D; Koffi, Alain K; Amouzou, Agbessi; Maina, Abdou; Kazmi, Narjis

    2016-06-01

    Niger, one of the poorest countries in the world, recently used for the first time the integrated verbal and social autopsy (VASA) tool to assess the biological causes and social and health system determinants of neonatal and child deaths. These notes summarize the Nigerien experience in the use of this new tool, the steps taken for high level engagement of the Niger government and stakeholders for the wide dissemination of the study results and their use to support policy development and maternal, neonatal and child health programming in the country. The experience in Niger reflects lessons learned by other developing countries in strengthening the use of data for evidence-based decision making, and highlights the need for the global health community to provide continued support to country data initiatives, including the collection, analysis, interpretation and utilization of high quality data for the development of targeted, highly effective interventions. In Niger, this is supporting the country's progress toward achieving Millennium Development Goal 4. A follow-up VASA study is being planned and the tool is being integrated into the National Health Management Information System. VASA studies have now been completed or are under way in additional sub-Saharan African countries, in each through the same collaborative process used in Niger to bring together health policy makers, program planners and development partners. PMID:26955472

  2. Mortality rates decline in Malaysia.

    PubMed

    1991-11-01

    Experiencing remarkable decreases in mortality rates over the past 3 decades, Malaysia currently has one of the lowest mortality rates among developing countries, a rate that compares favorably with those of developed countries. Between 1957 and 1989, the crude death rate dropped from 12.4/1000 population to 4.6. Over the same period, Malaysia recorded even greater decreases in the infant mortality rate, from 75.5/1000 births to 15.2. The Maternal mortality rate also declined from 1.48 in 1970 to 0.24 in 1988. The data indicates that mortality rates vary from state to state, and that rural areas have a higher mortality than urban areas. According to a study by the National Population and Family Development Board, the use of maternal and child health services has played an important role in reducing neonatal, perinatal, infant, child, and maternal mortality rates. Nearly all women in Malaysia receive antenatal services. While the country has achieved great gains on mortality rates, programs focusing on specific age and socioeconomic groups could lead to even greater reductions. The Minister for National Unity and Social Development, Dato Napsiah Omar, has called for the development of programs designed to improve the population's quality of life. PMID:12284509

  3. The Association of Serum Leptin with Mortality in Older Adults

    PubMed Central

    Harris, Tamara B.; Hsueh, Wen-Chi; Hue, Trisha; Leak, Tennille S.; Li, Rongling; Mehta, Mira; Vaisse, Christian

    2015-01-01

    Objective Elevated levels of serum leptin are associated with increased adiposity and production of pro-inflammatory cytokines. Both cytokines and body adiposity have been shown to predict cardiovascular events and mortality. The primary objective of the present study is to explore the associations between serum leptin and all-cause mortality and mortality from cardiovascular disease (CVD) over a span of 10 years, controlling for body adiposity and proinflammatory cytokines. Methods The Health, Aging and Body Composition (Health ABC) study is a prospective cohort of 3,075 older adults aged 70 to 79 years. This analysis includes 2,919 men and women with complete serum leptin and vital status data. Data on all-cause mortality and incident cardiovascular events (including Coronary Heart Disease and Congestive Heart Failure) were collected over 10 years of follow-up (mean 8.4 years). Results Women with leptin in quartile 2 and 3 were at lower risk of all-cause mortality, and those with leptin in quartile 2 were at lower risk of mortality from CVD as compared to women with lowest leptin values when adjusted for age, race, site, years of education, alcohol use, smoking, and physical activity. When these associations were additionally adjusted for body fat, C-reactive protein and pro-inflammatory cytokines, women with leptin values in quartile 3 were at lower risk of all-cause mortality and women with leptin in quartile 2 and 3 were at lower risk of mortality from CVD than women with lowest leptin values. These associations were not significant among men after adjusting for body fat and cytokines. Conclusions The present study suggests that moderately elevated concentrations of serum leptin are independently associated with lower risk of all-cause mortality and CVD-related mortality among older women. Among men, serum leptin is not associated with reduced risk of all-cause and CVD mortality after controlling for body fat and cytokines. PMID:26473487

  4. A Prospective Longitudinal Cohort to Investigate the Effects of Early Life Giardiasis on Growth and All Cause Diarrhea

    PubMed Central

    Donowitz, Jeffrey R.; Alam, Masud; Kabir, Mamun; Ma, Jennie Z.; Nazib, Forida; Platts-Mills, James A.; Bartelt, Luther A.; Haque, Rashidul; Petri, William A.

    2016-01-01

    Background. Growth stunting in children under 2 years of age in low-income countries is common. Giardia is a ubiquitous pathogen in this age group but studies investigating Giardia's effect on both growth and diarrhea have produced conflicting results. Methods. We conducted a prospective longitudinal birth cohort study in Dhaka, Bangladesh, with monthly Giardia and continuous diarrheal surveillance. Results. 629 children were enrolled within the first 72 hours of life, and 445 completed 2 years of the study. 12% of children were stunted at birth with 57% stunted by 2 years. 7% of children had a Giardia positive surveillance stool in the first 6 months of life, whereas 74% had a positive stool by 2 years. The median time to first Giardia positive surveillance stool was 17 months. Presence of Giardia in a monthly surveillance stool within the first 6 months of life decreased length-for-age Z score at 2 years by 0.4 (95% confidence interval, −.80 to −.001; P value .05) whereas total number of Giardia positive months over the 2-year period of observation did not. Neither variable was associated with weight-for-age Z score at 2 years. In our model to examine predictors of diarrhea only exclusive breastfeeding was significantly associated with decreased diarrhea (P value <.001). Concomitant giardiasis was neither a risk factor nor protective. Conclusions. Early life Giardia was a risk factor for stunting at age 2 but not poor weight gain. Presence of Giardia neither increased nor decreased odds of acute all cause diarrhea. PMID:27313261

  5. Late-Life Risk Factors for All-Cause Dementia and Differential Dementia Diagnoses in Women: A Prospective Cohort Study.

    PubMed

    Neergaard, Jesper Skov; Dragsbæk, Katrine; Hansen, Henrik Bo; Henriksen, Kim; Christiansen, Claus; Karsdal, Morten Asser

    2016-03-01

    Since the first evidence of a decline in dementia incidence was reported in 2011, the focus on modifiable risk factors has increased. The possibility of risk factor intervention as a prevention strategy has been widely discussed; however, further evidence in relation to risk factors is still needed. The Prospective Epidemiologic Risk Factor (PERF I) study was an observational prospective study of postmenopausal Danish women who were initially examined between 1999 and 2001 (n = 5855). Follow-up data on diagnosis and survival as of December 31, 2014 was retrieved from the National Danish Patient Registry and the National Danish Causes of Death Registry. Cox proportional hazards regression model was applied to calculate adjusted hazard ratios (HR) for selected risk factors for dementia. Of 5512 eligible subjects, 592 developed dementia within the follow-up period of maximum 15 years. The independent factors associated with increased risk of all-cause dementia were depression (HR = 1.75 [95% CI 1.32-2.34]) and impaired fasting glucose levels. A dose-response relationship was observed between fasting glucose level and risk of dementia with HRs of 1.25 [1.05-1.49] and 1.45 [1.03-2.06] for impaired (5.6-6.9 mmol/L) and hyperglycemic (≥7.0 mmol/L) glucose levels, respectively. The factors associated with a decreased risk of dementia were overweight in late-life (HR = 0.75 [0. 62-0.89]) and physical activity at least once weekly (HR = 0.77 [0.61-0.96]). The identified risk factors for dementia in women in late-life are all considered modifiable. This supports the notion that prevention strategies may improve the poor future prospects for dementias in the ageing population. PMID:26986157

  6. Relation between admission plasma fibrinogen levels and mortality in Chinese patients with coronary artery disease

    PubMed Central

    Peng, Yong; Wang, Hua; Li, Yi-ming; Huang, Bao-tao; Huang, Fang-yang; Xia, Tian-li; Chai, Hua; Wang, Peng-ju; Liu, Wei; Zhang, Chen; Chen, Mao; Huang, De-jia

    2016-01-01

    Fibrinogen (Fib) was considered to be a potential risk factor for the prognosis of patients with coronary artery disease (CAD), but there was lack of the evidence from Chinese contemporary population. 3020 consecutive patients with CAD confirmed by coronary angiography were enrolled and were grouped into 2 categories by the optimal Fib cut-off value (3.17 g/L) for all-cause mortality prediction. The end points were all-cause mortality and cardiac mortality. Cumulative survival curves showed that the risk of all-cause mortality was significantly higher in patients with Fib ≥3.17 g/L compared to those with Fib <3.17 g/L (mortality rate, 11.5% vs. 5.7%, p < 0.001); and cardiovascular mortality obtained results similar to those mentioned above (cardiac mortality rate, 5.9% vs. 3.6%, p = 0.002). Subgroup analysis showed that elevated Fib levels were predictive for the risk of all-cause mortality in the subgroups according to age, medical history, and diagnosis. COX multivariate regression analysis showed that plasma Fib levels remained independently associated with all-cause mortality after adjustment for multiple cardiovascular risk factors (all-cause mortality, HR 2.01, CI 1.51–2.68, p < 0.001). This study has found that Fib levels were independently associated with the mortality risk in Chinese CAD patients. PMID:27456064

  7. Young and vulnerable: Spatial-temporal trends and risk factors for infant mortality in rural South Africa (Agincourt), 1992-2007

    PubMed Central

    2010-01-01

    Background Infant mortality is an important indicator of population health in a country. It is associated with several health determinants, such as maternal health, access to high-quality health care, socioeconomic conditions, and public health policy and practices. Methods A spatial-temporal analysis was performed to assess changes in infant mortality patterns between 1992-2007 and to identify factors associated with infant mortality risk in the Agincourt sub-district, rural northeast South Africa. Period, sex, refugee status, maternal and fertility-related factors, household mortality experience, distance to nearest primary health care facility, and socio-economic status were examined as possible risk factors. All-cause and cause-specific mortality maps were developed to identify high risk areas within the study site. The analysis was carried out by fitting Bayesian hierarchical geostatistical negative binomial autoregressive models using Markov chain Monte Carlo simulation. Simulation-based Bayesian kriging was used to produce maps of all-cause and cause-specific mortality risk. Results Infant mortality increased significantly over the study period, largely due to the impact of the HIV epidemic. There was a high burden of neonatal mortality (especially perinatal) with several hot spots observed in close proximity to health facilities. Significant risk factors for all-cause infant mortality were mother's death in first year (most commonly due to HIV), death of previous sibling and increasing number of household deaths. Being born to a Mozambican mother posed a significant risk for infectious and parasitic deaths, particularly acute diarrhoea and malnutrition. Conclusions This study demonstrates the use of Bayesian geostatistical models in assessing risk factors and producing smooth maps of infant mortality risk in a health and socio-demographic surveillance system. Results showed marked geographical differences in mortality risk across a relatively small area

  8. Control of household air pollution for child survival: estimates for intervention impacts

    PubMed Central

    2013-01-01

    Background Exposure to household air pollution (HAP) from cooking with solid fuels affects 2.8 billion people in developing countries, including children and pregnant women. The aim of this review is to propose intervention estimates for child survival outcomes linked to HAP. Methods Systematic reviews with meta-analysis were conducted for ages 0-59 months, for child pneumonia, adverse pregnancy outcomes, stunting and all-cause mortality. Evidence for each outcome was assessed against Bradford-Hill viewpoints, and GRADE used for certainty about intervention effect size for which all odds ratios (OR) are presented as protective effects. Results Reviews found evidence linking HAP exposure with child ALRI, low birth weight (LBW), stillbirth, preterm birth, stunting and all-cause mortality. Most studies were observational and rated low/very low in GRADE despite strong causal evidence for some outcomes; only one randomised trial was eligible.Intervention effect (OR) estimates of 0.64 (95% CI: 0.55, 0.75) for ALRI, 0.71 (0.65, 0.79) for LBW and 0.66 (0.54, 0.81) for stillbirth are proposed, specific outcomes for which causal evidence was sufficient. Exposure-response evidence suggests this is a conservative estimate for ALRI risk reduction expected with sustained, low exposure. Statistically significant protective ORs were also found for stunting [OR=0.79 (0.70, 0.89)], and in one study of pre-term birth [OR=0.70 (0.54, 0.90)], indicating these outcomes would also likely be reduced. Five studies of all-cause mortality had an OR of 0.79 (0.70, 0.89), but heterogenity precludes a reliable estimate for mortality impact. Although interventions including clean fuels and improved solid fuel stoves are available and can deliver low exposure levels, significant challenges remain in achieving sustained use at scale among low-income households. Conclusions Reducing exposure to HAP could substantially reduce the risk of several child survival outcomes, including fatal pneumonia

  9. Musculoskeletal Fitness and Risk of Mortality.

    ERIC Educational Resources Information Center

    Katzmarzyk, Peter T.; Craig, Cora L.

    2002-01-01

    Quantified the relationship between musculoskeletal fitness and all-cause mortality in Canada, using measures of musculoskeletal fitness (situps, pushups, grip strength, and sit- and-reach trunk flexibility) from adult male and female participants in the Canadian Fitness Survey. Results indicated that some components of musculoskeletal fitness,…

  10. Infant Mortality: 1989 Research Accomplishments.

    ERIC Educational Resources Information Center

    National Inst. of Child Health and Human Development (NIH), Bethesda, MD.

    Collected in this document are reports of the National Institutes of Health's 1989 accomplishments in research on the problem of infant mortality. Reports are provided by the: (1) National Institute of Child Health and Human Development; (2) National Cancer Institute; (3) National Heart, Lung, and Blood Institute; (4) National Institute of…

  11. Beverage Habits and Mortality in Chinese Adults12

    PubMed Central

    Odegaard, Andrew O; Koh, Woon-Puay; Yuan, Jian-Min; Pereira, Mark A

    2015-01-01

    Background: There is limited research examining beverage habits, one of the most habitual dietary behaviors, with mortality risk. Objective: This study examined the association between coffee, black and green tea, sugar-sweetened beverages (soft drinks and juice), and alcohol and all-cause and cause-specific mortality. Methods: A prospective data analysis was conducted with the use of the Singapore Chinese Health Study, including 52,584 Chinese men and women (aged 45–74 y) free of diabetes, cardiovascular disease (CVD), and cancer at baseline (1993–1998) and followed through 2011 with 10,029 deaths. Beverages were examined with all-cause and cause-specific (cancer, CVD, and respiratory disease) mortality risk with the use of Cox proportional hazards regression. Results: The associations between coffee, black tea, and alcohol intake and all-cause mortality were modified by smoking status. Among never-smokers there was an inverse dose-response association between higher amounts of coffee and black tea intake and all-cause, respiratory-related, and CVD mortality (black tea only). The fully adjusted HRs for all-cause mortality for coffee for <1/d, 1/d, and ≥2/d relative to no coffee intake were 0.89, 0.86, and 0.83, respectively (P-trend = 0.0003). For the same black tea categories the HRs were 0.95, 0.90, and 0.72, respectively (P-trend = 0.0005). Among ever-smokers there was no association between coffee or black tea and the outcomes. Relative to no alcohol, light to moderate intake was inversely associated with all-cause mortality (HR: 0.87; 95% CI: 0.79, 0.96) in never-smokers with a similar magnitude of association in ever-smokers. There was no association between heavy alcohol intake and all-cause mortality in never-smokers and a strong positive association in ever-smokers (HR: 1.56; 95% CI: 1.40, 1.74). Green tea and sugar-sweetened beverages were not associated with all-cause or cause-specific mortality. Conclusions: Higher coffee and black tea intake was

  12. Ethnicity, Russification, and Excess Mortality in Kazakhstan*

    PubMed Central

    Sharygin, Ethan J.; Guillot, Michel

    2014-01-01

    Russians experience higher adult mortality than Central Asians despite higher socioeconomic status. This study exploits Kazakhstan’s relatively heterogeneous population and geographic diversity to study ethnic differences in cause-specific mortality. In multivariate regression, all-cause mortality rates for Russian men is 27% higher than for Kazakh men, and alcohol-related death rates among Russian men are 2.5 times higher (15% and 4.1 times higher for females, respectively). Significant mortality differentials exist by ethnicity for external causes and alcohol-related causes of death. Adult mortality among Kazakhs is higher than previously found among Kyrgyz and lower than among Russians. The results suggest that ethnic mortality differentials in Central Asia may be related to the degree of russification, which could be replicating documented patterns of alcohol consumption in non-Russian populations. PMID:26207118

  13. The effect of neighbourhood mortality shocks on fertility preferences: a spatial econometric approach.

    PubMed

    Owoo, Nkechi S; Agyei-Mensah, Samuel; Onuoha, Emily

    2015-07-01

    According to the demographic transition theory, fertility rates fall in response to declines in child mortality rates. Although national statistics indicate that child mortality rates have been declining over time, Ghana's fertility rates appear to have stalled. This paper hypothesises that women's fertility behaviours may be more responsive to child mortality experiences at more localised levels. Using all rounds of the Ghana Demographic and Health Surveys (1988-2008) and employing a variety of spatial and empirical estimation techniques, results indicate that in addition to own-child mortality, neighbourhood child mortality shocks are also a determinant of women's fertility in Ghana. Women in neighbourhoods with large child mortality shocks may desire more children as an "insurance" against future losses, as a result of their increased perceptions of own-child mortality risks. PMID:24947402

  14. Suicide Compared to Other Causes of Mortality in Physicians

    ERIC Educational Resources Information Center

    Torre, Dario M.; Wang, Nae-Yuh; Meoni, Lucy A.; Young, J. Hunter; Klag, Michael J.; Ford, Daniel E.

    2005-01-01

    Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results…

  15. Network Type and Mortality Risk in Later Life

    ERIC Educational Resources Information Center

    Litwin, Howard; Shiovitz-Ezra, Sharon

    2006-01-01

    Purpose: The purpose of this study was to examine the association of baseline network type and 7-year mortality risk in later life. Design and Methods: We executed secondary analysis of all-cause mortality in Israel using data from a 1997 national survey of adults aged 60 and older (N = 5,055) that was linked to records from the National Death…

  16. The healthy immigrant effect and mortality rates.

    PubMed

    Ng, Edward

    2011-12-01

    According to the 2006 Census, almost the Canadian population were foreign-born, a percentage that is projected to reach at least 25% by 2031. Studies based on age-standardized mortality rates (ASMR) have found a healthy immigrant effect, with lower overall rates among immigrants. A duration effect has also been observed-immigrants'