Elevated levels of circulating thyroid hormone do not cause the medical sequelae of hyperthyroidism.

PubMed

Kelly, Tammas; Denmark, Lawrence; Lieberman, Daniel Z

2016-11-03

Clinicians have been reluctant to use high dose thyroid (HDT) to treat affective disorders because high circulating levels of thyroid hormone have traditionally been equated with hyperthyroidism, and understood as the cause of the medical sequelae of hyperthyroidism, such as osteoporosis and cardiac abnormalities. This conclusion is not supported by (HDT) research. A literature review of research related to the morbidity and mortality of HDT treatment was performed. There exists a large body of research involving the use of HDT treatment to prevent the recurrence of differentiated thyroid cancer and to treat affective disorders. A review of this literature finds a lack of support for HDT as a cause of osteoporosis, nor is there support for an increase in morbidity or mortality associated with HDT. This finding contrasts with the well-established morbidity and mortality associated with Graves' disease, thyroiditis, and other endogenous forms of hyperthyroidism. The lack of evidence that exogenous HDT causes osteoporosis, cardiac abnormalities or increases mortality compared with the significant morbidity and mortality of hyperthyroidism requires an alternative cause for the medical sequelae of hyperthyroidism. One possibility is an autoimmune mechanism. High circulating levels of thyroid hormone is not the cause of the sequela of hyperthyroidism. The reluctance to using high dose thyroid is unwarranted. Copyright © 2016 Elsevier Inc. All rights reserved.

The effect of high temperature on cause-specific mortality: A multi-county analysis in China.

PubMed

Ban, Jie; Xu, Dandan; He, Mike Z; Sun, Qinghua; Chen, Chen; Wang, Wentao; Zhu, Pengfei; Li, Tiantian

2017-09-01

Although existing studies have linked high temperature to mortality in a small number of regions, less evidence is available on the variation in the associations between high temperature exposure and cause-specific mortality of multiple regions in China. Our study focused on the use of time series analysis to quantify the association between high temperature and different cause-specific mortalities for susceptible populations for 43 counties in China. Two-stage analyses adopting a distributed lag non-linear model (DLNM) and a meta-analysis allowed us to obtain county-specific estimates and national-scale pooled estimates of the nonlinear temperature-mortality relationship. We also considered different populations stratified by age and sex, causes of death, absolute and relative temperature patterns, and potential confounding from air pollutants. All of the observed cause-specific mortalities are significantly associated with higher temperature. The estimated effects of high temperature on mortality varied by spatial distribution and temperature patterns. Compared with the 90th percentile temperature, the overall relative risk (RR) at the 99th percentile temperature for non-accidental mortality is 1.105 (95%CI: 1.089, 1.122), for circulatory disease is 1.107 (95%CI: 1.081, 1.133), for respiratory disease is 1.095 (95%CI: 1.050, 1.142), for coronary heart disease is 1.073 (95%CI: 1.047, 1.099), for acute myocardial infarction is 1.072 (95%CI: 1.042, 1.104), and for stroke is 1.095 (95%CI: 1.052, 1.138). Based on our findings, we believe that heat-related health effect in China is a significant issue that requires more attention and allocation of existing resources. Copyright © 2017 Elsevier Ltd. All rights reserved.

Educational Differences in U.S. Adult Mortality: A Cohort Perspective*

PubMed Central

Masters, Ryan K.; Hummer, Robert A.; Powers, Daniel A.

2014-01-01

We use hierarchical cross-classified random-effects models to simultaneously measure age, period, and cohort patterns of mortality risk between 1986 and 2006 for non-Hispanic white and non-Hispanic black men and women with less than a high school education, a high school education, and more than a high school education. We examine all-cause mortality risk and mortality risk from heart disease, lung cancer, and unpreventable cancers. Findings reveal that temporal reductions in black and white men’s and women’s mortality rates were driven entirely by cohort changes in mortality. Findings also demonstrate that disparate cohort effects between education groups widened the education gap in all-cause mortality risk and mortality risk from heart disease and lung cancer across this time period. Educational disparities in mortality risk from unpreventable cancers, however, did not change. This research uncovers widening educational differences in adult mortality and demonstrates that a cohort perspective provides valuable insights for understanding recent temporal changes in U.S. mortality risk. PMID:25346542

Hemodiafiltration Reduces All-Cause and Cardiovascular Mortality in Incident Hemodialysis Patients: A Propensity-Matched Cohort Study.

PubMed

Maduell, Francisco; Varas, Javier; Ramos, Rosa; Martin-Malo, Alejandro; Pérez-Garcia, Rafael; Berdud, Isabel; Moreso, Francesc; Canaud, Bernard; Stuard, Stefano; Gauly, Adelheid; Aljama, Pedro; Merello, Jose Ignacio

2017-01-01

The majority of studies suggesting that online hemodiafiltration reduces the risk of mortality compared to hemodialysis (HD) have been performed in dialysis-prevalent populations. In this report, we conducted an epidemiologic study of mortality in incident dialysis patients, comparing post-dilution online hemodiafiltration and high-flux HD, with propensity score matching (PSM) used to correct indication bias. Our study cohort comprised 3,075 incident dialysis patients treated in 64 Spanish Fresenius Medical Care clinics between January 2009 and December 2012. The primary outcome of this study was to investigate the impact of the type of renal replacement on all-cause mortality. An analysis of cardiovascular mortality was defined as the secondary outcome. To achieve these objectives, patients were followed until December 2016. Patients were categorized as high-flux HD patients if they underwent this treatment exclusively. If >90% of their treatment was with online hemodiafiltration, then the patient was grouped to that modality. After PSM, a total of 1,012 patients were matched. Compared with patients on high-flux HD, those on online hemodiafiltration received a median replacement volume of 23.45 (interquartile range 21.27-25.51) L/session and manifested 24 and 33% reductions in all-cause and cardiovascular mortality (all-cause mortality hazards ratio [HR] 0.76, 95% CI 0.62-0.94 [p = 0.01]; and cardiovascular mortality HR 0.67, 95% CI 0.50-0.90 [p = 0.008]). This study shows that post-dilution online hemodiafiltration reduces all-cause and cardiovascular mortality compared to high-flux HD in an incident HD population. © 2017 S. Karger AG, Basel.

Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors.

PubMed

Li, Shanshan; Flint, Alan; Pai, Jennifer K; Forman, John P; Hu, Frank B; Willett, Walter C; Rexrode, Kathryn M; Mukamal, Kenneth J; Rimm, Eric B

2014-09-22

The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long-term benefits of a low-carbohydrate diet (LCD) are unknown, whether from animal or vegetable sources. There is a need to examine the associations between post-MI adherence to an LCD and all-cause and cardiovascular mortality. We included 2258 women from the Nurses' Health Study and 1840 men from the Health Professional Follow-Up Study who had survived a first MI during follow-up and provided a pre-MI and at least 1 post-MI food frequency questionnaire. Adherence to an LCD high in animal sources of protein and fat was associated with higher all-cause and cardiovascular mortality (hazard ratios of 1.33 [95% CI: 1.06 to 1.65] for all-cause mortality and 1.51 [95% CI: 1.09 to 2.07] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal-based LCD prospectively assessed from the pre- to post-MI period was associated with higher all-cause mortality and cardiovascular mortality (hazard ratios of 1.30 [95% CI: 1.03 to 1.65] for all-cause mortality and 1.53 [95% CI: 1.10 to 2.13] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant-based LCD was not associated with lower all-cause or cardiovascular mortality. Greater adherence to an LCD high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality post-MI. We did not find a health benefit from greater adherence to an LCD overall after MI. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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

USDA-ARS?s Scientific Manuscript database

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...

Triglyceride-to-high-density-lipoprotein-cholesterol ratio is an index of heart disease mortality and of incidence of type 2 diabetes mellitus in men.

PubMed

Vega, Gloria Lena; Barlow, Carolyn E; Grundy, Scott M; Leonard, David; DeFina, Laura F

2014-02-01

High triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) impart risk for heart disease. This study examines the relationships of TG/HDL-C ratio to mortality from all causes, coronary heart disease (CHD), or cardiovascular disease (CVD). Survival analysis was done in 39,447 men grouped by TG/HDL-C ratio cut point of 3.5 and for metabolic syndrome. National Death Index International Classification of Diseases (ICD-9 and ICD-10) codes were used for CVD and CHD deaths occurring from 1970 to 2008. Incidence of type 2 diabetes mellitus (DM) according to ratio was estimated in 22,215 men. Triglyceride/HDL-C ratio and cross-product of TG and fasting blood glucose (TyG index) were used in analysis. Men were followed up for 581,194 person-years. Triglyceride/HDL-C ratio predicted CHD, CVD, and all-cause mortality after adjustment for established risk factors and non-HDL-C. Mortality rates were higher in individuals with a high ratio than in those with a low ratio. Fifty-five percent of men had metabolic syndrome that was also predictive of CHD, CVD, and all-cause mortality. Annual incidence of DM was 2 times higher in men with high TG/HDL-C ratio than in those with a low ratio. Individuals with high TG/HDL-C ratio had a higher incidence of DM than those with a low ratio. The TyG index was not equally predictive of causes of mortality to TG/HDL-C, but both were equally predictive of diabetes incidence. Triglyceride/HDL-C ratio predicts CHD and CVD mortality as well as or better than do metabolic syndrome in men. Also, a high ratio predisposes to DM. The TyG index does not predict CHD, CVD, or all-cause mortality equally well, but like TG/HDL-C ratio, it predicts DM incidence.

Effects of diurnal temperature range on mortality in Hefei city, China

NASA Astrophysics Data System (ADS)

Tang, Jing; Xiao, Chang-chun; Li, Yu-rong; Zhang, Jun-qing; Zhai, Hao-yuan; Geng, Xi-ya; Ding, Rui; Zhai, Jin-xia

2017-12-01

Although several studies indicated an association between diurnal temperature range (DTR) and mortality, the results about modifiers are inconsistent, and few studies were conducted in developing inland country. This study aims to evaluate the effects of DTR on cause-specific mortality and whether season, gender, or age might modify any association in Hefei city, China, during 2007-2016. Quasi-Poisson generalized linear regression models combined with a distributed lag non-linear model (DLNM) were applied to evaluate the relationships between DTR and non-accidental, cardiovascular, and respiratory mortality. We observed a J-shaped relationship between DTR and cause-specific mortality. With a DTR of 8.3 °C as the reference, the cumulative effects of extremely high DTR were significantly higher for all types of mortality than effects of lower or moderate DTR in full year. When stratified by season, extremely high DTR in spring had a greater impact on all cause-specific mortality than other three seasons. Male and the elderly (≥ 65 years) were consistently more susceptible to extremely high DTR effect than female and the youth (< 65 years) for non-accidental and cardiovascular mortality. To the contrary, female and the youth were more susceptible to extremely high DTR effect than male and the elderly for respiratory morality. The study suggests that extremely high DTR is a potential trigger for non-accidental mortality in Hefei city, China. Our findings also highlight the importance of protecting susceptible groups from extremely high DTR especially in the spring.

Effects of diurnal temperature range on mortality in Hefei city, China

NASA Astrophysics Data System (ADS)

Tang, Jing; Xiao, Chang-chun; Li, Yu-rong; Zhang, Jun-qing; Zhai, Hao-yuan; Geng, Xi-ya; Ding, Rui; Zhai, Jin-xia

2018-05-01

Although several studies indicated an association between diurnal temperature range (DTR) and mortality, the results about modifiers are inconsistent, and few studies were conducted in developing inland country. This study aims to evaluate the effects of DTR on cause-specific mortality and whether season, gender, or age might modify any association in Hefei city, China, during 2007-2016. Quasi-Poisson generalized linear regression models combined with a distributed lag non-linear model (DLNM) were applied to evaluate the relationships between DTR and non-accidental, cardiovascular, and respiratory mortality. We observed a J-shaped relationship between DTR and cause-specific mortality. With a DTR of 8.3 °C as the reference, the cumulative effects of extremely high DTR were significantly higher for all types of mortality than effects of lower or moderate DTR in full year. When stratified by season, extremely high DTR in spring had a greater impact on all cause-specific mortality than other three seasons. Male and the elderly (≥ 65 years) were consistently more susceptible to extremely high DTR effect than female and the youth (< 65 years) for non-accidental and cardiovascular mortality. To the contrary, female and the youth were more susceptible to extremely high DTR effect than male and the elderly for respiratory morality. The study suggests that extremely high DTR is a potential trigger for non-accidental mortality in Hefei city, China. Our findings also highlight the importance of protecting susceptible groups from extremely high DTR especially in the spring.

Malaria's indirect contribution to all-cause mortality in the Andaman Islands during the colonial era.

PubMed

Shanks, G Dennis; Hay, Simon I; Bradley, David J

2008-09-01

Malaria has a substantial secondary effect on other causes of mortality. From the 19th century, malaria epidemics in the Andaman Islands' penal colony were initiated by the brackish swamp-breeding malaria vector Anopheles sundaicus and fuelled by the importation of new prisoners. Malaria was a major determinant of the highly variable all-cause mortality rate (correlation coefficient r(2)=0.60, n=68, p<0.0001) from 1872 to 1939. Directly attributed malaria mortality based on post-mortem examinations rarely exceeded one-fifth of total mortality. Infectious diseases such as pneumonia, tuberculosis, dysentery, and diarrhoea, which combined with malaria made up the majority of all-cause mortality, were positively correlated with malaria incidence over several decades. Deaths secondary to malaria (indirect malaria mortality) were at least as great as mortality directly attributed to malaria infections.

Causes of Death in Men With Prevalent Diabetes and Newly Diagnosed High- Versus Favorable-Risk Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

D'Amico, Anthony V., E-mail: adamico@partners.or; Braccioforte, Michelle H.; Moran, Brian J.

2010-08-01

Purpose: To determine whether prevalent diabetes mellitus (pDM) affects the presentation, extent of radiotherapy, or prostate cancer (PCa)-specific mortality (PCSM) and whether PCa aggressiveness affects the risk of non-PCSM, DM-related mortality, and all-cause mortality in men with pDM. Methods: Between October 1997 and July 2907, 5,279 men treated at the Chicago Prostate Cancer Center with radiotherapy for PCa were included in the study. Logistic and competing risk regression analyses were performed to assess whether pDM was associated with high-grade PCa, less aggressive radiotherapy, and an increased risk of PCSM. Competing risks and Cox regression analyses were performed to assess whethermore » PCa aggressiveness described by risk group in men with pDM was associated with the risk of non-PCSM, DM-related mortality, and all-cause mortality. Analyses were adjusted for predictors of high-grade PCa and factors that could affect treatment extent and mortality. Results: Men with pDM were more likely (adjusted hazard ratio [AHR], 1.9; 95% confidence interval [CI], 1.3-2.7; p = .002) to present with high-grade PCa but were not treated less aggressively (p = .33) and did not have an increased risk of PCSM (p = .58) compared to men without pDM. Among the men with pDM, high-risk PCa was associated with a greater risk of non-PCSM (AHR, 2.2; 95% CI, 1.1-4.5; p = .035), DM-related mortality (AHR, 5.2; 95% CI, 2.0-14.0; p = .001), and all-cause mortality (AHR, 2.4; 95% CI, 1.2-4.7; p = .01) compared to favorable-risk PCa. Conclusion: Aggressive management of pDM is warranted in men with high-risk PCa.« less

Adherence to the Healthy Eating Index and Alternative Healthy Eating Index dietary patterns and mortality from all causes, cardiovascular disease and cancer: a meta-analysis of observational studies.

PubMed

Onvani, S; Haghighatdoost, F; Surkan, P J; Larijani, B; Azadbakht, L

2017-04-01

This meta-analysis investigated the association of diet quality indices, as assessed by HEI and AHEI, and the risk of all-cause, cardiovascular and cancer mortality. We used PubMed, ISI Web of Science and Google Scholar to search for eligible articles published before July 2015. A total of 12 cohort studies (38 reports) and one cross-sectional study (three reports) met the inclusion criteria and were included in our meta-analysis. The highest level of adherence to the Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) was significantly associated with a reduced risk of all-cause mortality [relative risk (RR) = 0.77, 95% confidence intterval (CI) = 0.76-0.78], cardiovascular mortality (RR = 0.77, 95% CI = 0.74-0.80) and cancer mortality (RR = 0.83, 95% CI = 0.81-0.86). Egger regression tests provided no evidence of publication bias. The present study indicates that high adherence to HEI and AHEI dietary patterns, indicating high diet quality, are associated with reduced risk of all-cause mortality (as well as cardiovascular mortality and cancer mortality). © 2016 The British Dietetic Association Ltd.

Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer

PubMed Central

Yang, Juan; John, Esther M.; Kurian, Allison W.; Cheng, Iona; Leung, Rita; Koo, Jocelyn; Monroe, Kristine R.; Henderson, Brian E.; Bernstein, Leslie; Lu, Yani; Kwan, Marilyn L.; Sposto, Richard; Vigen, Cheryl L. P.; Wu, Anna H.; Keegan, Theresa H. M.; Gomez, Scarlett Lin

2015-01-01

We investigated social disparities in breast cancer (BC) mortality, leveraging data from the California Breast Cancer Survivorship Consortium. The associations of race/ethnicity, education, and neighborhood SES (nSES) with all-cause and BC-specific mortality were assessed among 9372 women with BC (diagnosed 1993–2007 in California with follow-up through 2010) from four racial/ ethnic groups [African American, Asian American, Latina, and non-Latina (NL) White] using Cox proportional hazards models. Compared to NL White women with high-education/high-nSES, higher all-cause mortality was observed among NL White women with high-education/ low-nSES [hazard ratio (HR) (95 % confidence interval) 1.24 (1.08–1.43)], and African American women with low-nSES, regardless of education [high education HR 1.24 (1.03–1.49); low-education HR 1.19 (0.99–1.44)]. Latina women with low-education/high-nSES had lower all-cause mortality [HR 0.70 (0.54–0.90)] and non-significant lower mortality was observed for Asian American women, regardless of their education and nSES. Similar patterns were seen for BC-specific mortality. Individual- and neighborhood-level measures of SES interact with race/ ethnicity to impact mortality after BC diagnosis. Considering the joint impacts of these social factors may offer insights to understanding inequalities by multiple social determinants of health. PMID:26072260

Disease-related mortality among 21,609 Norwegian male military peacekeepers deployed to Lebanon between 1978 and 1998.

PubMed

Strand, Leif Aage; Martinsen, Jan Ivar; Borud, Einar Kristian

2016-10-01

Our study assessed disease-related mortality among Norwegian male military peacekeepers deployed to Lebanon during 1978-1998. A total of 21,609 peacekeepers were followed from start of deployment through 2013. Standardized mortality ratios (SMRs) were calculated based on national rates for the overall cohort, by length of time since first deployment to Lebanon, and for service during high- and low-conflict periods. Poisson regression was used to determine the effect of conflict exposure. In the overall cohort, a decreased risk was seen for all-cause mortality (1213 deaths, SMR = 0.85), mortality from neoplasms (SMR = 0.89), and from non-neoplastic diseases (SMR = 0.68). Disease-related mortality was lower during the first 5 years of follow-up, while mortality from external causes was elevated. After 5 years, mortality from neoplasms and external causes were similar to national rates, but mortality from non-neoplastic diseases remained lower. The high-conflict exposure group had a two-fold increased risk of mortality from non-neoplastic diseases (rate ratio = 2.33), including ischemic heart disease (rate ratio = 2.25) compared to the low-conflict exposure group. We found a "healthy soldier effect" for all-cause mortality and disease-related mortality, but for neoplasms, this effect disappeared after 5 years. Conflict exposure was positively correlated with increased risk of mortality from non-neoplastic diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

Malaria’s Indirect Contribution to All-Cause Mortality in the Andaman Islands during the Colonial Era

PubMed Central

Shanks, G. Dennis; Hay, Simon I.; Bradley, David J.

2009-01-01

Malaria appears to have a substantial secondary effect on other causes of mortality. From the 19th century, malaria epidemics in the Andaman Islands Penal Colony were initiated by the brackish swamp breeding malaria vector Anopheles sundaicus and fueled by the importation of new prisoners. Malaria was a major determinant of the highly variable all-cause mortality rate (correlation coefficient r2=0.60, n=68, p< 0.0001) from 1872 to 1939. Directly attributed malaria mortality based on postmortem examinations rarely exceeded one fifth of total mortality. Infectious diseases such as pneumonia, tuberculosis, dysentery and diarrhea, which combined with malaria made up a majority of all-cause mortality, were positively correlated to malaria incidence over several decades. Deaths secondary to malaria (indirect malaria mortality) were at least as great as mortality directly attributed to malaria infections. PMID:18599354

Do women live longer or do men die earlier? Reflections on the causes of sex differences in life expectancy.

PubMed

Luy, Marc; Gast, Katrin

2014-01-01

Although many different factors have been identified to contribute to excess male mortality, it is still unclear which path of the complex cause-effect chain is the decisive driver of the life expectancy gap between women and men. The question behind this study is whether these sex differences are caused primarily by factors leading to low female mortality or rather by factors causing high male mortality. We hypothesise that they are to a large extent caused by specific subpopulations of men with particularly high mortality levels that decrease the average life expectancy of men. To test this hypothesis, we investigate in a meta-analysis the variability in mortality (VM) in women and men - defined as the range of death rates prevailing among subpopulations - in empirical studies analysing specific phenomena of mortality differentials. We used the data of 72 empirical studies, including 146 total effects (TE) and 1,718 single effects (SE) for 21 different risk factors. In 85% of TE and three quarters of SE the VM was higher in men than in women, taking into account men's higher overall mortality. The corresponding figures for the direct differences in the VM between women and men are 92 and 82%, respectively. Cases with higher female VM are rare exceptions and appear in particular in the highest age groups. We find support for our hypothesis that the disproportionate high mortality levels of specific male subpopulations are the central cause of the current extent of sex differences in life expectancy. Thus, public health programmes should be targeted toward these disadvantaged subpopulations among men which seem to be related primarily to socioeconomic characteristics.

Associations of objectively assessed physical activity and sedentary time with all-cause mortality in US adults: the NHANES study.

PubMed

Schmid, Daniela; Ricci, Cristian; Leitzmann, Michael F

2015-01-01

Sedentary behavior is related to increased mortality risk. Whether such elevated risk can be offset by enhanced physical activity has not been examined using accelerometry data. We examined the relations of sedentary time and physical activity to mortality from any cause using accelerometry data among 1,677 women and men aged 50 years or older from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 cycle with follow-up through December 31, 2006. During an average follow-up of 34.67 months and 4,845.42 person-years, 112 deaths occurred. In multivariate Cox proportional hazard models, greater sedentary time (≥ median of 8.60 hours/day) was associated with increased risk of mortality from any cause (relative risk (RR) = 2.03; 95% confidence interval (CI) = 1.09-3.81). Low level of moderate to vigorous physical activity (< median of 6.60 minutes/day) was also related to enhanced all-cause mortality risk (RR = 3.30; 95% CI = 1.33-8.17). In combined analyses, greater time spent sedentary and low levels of moderate to vigorous physical activity predicted a substantially elevated all-cause mortality risk. As compared with the combination of a low sedentary level and a high level of moderate to vigorous physical activity, the risks of mortality from all causes were 4.38 (95% CI = 1.26-15.16) for low levels of both sedentary time and physical activity, 2.79 (95% CI = 0.77-10.12) for greater time spent sedentary and high physical activity level, and 7.79 (95% CI = 2.26-26.82) for greater time spent sedentary and low physical activity level. The interaction term between sedentary time and moderate to vigorous physical activity was not statistically significant (p = 0.508). Both high levels of sedentary time and low levels of moderate to vigorous physical activity are strong and independent predictors of early death from any cause. Whether a high physical activity level removes the increased risk of all-cause mortality related to sedentariness requires further investigation.

Associations of Objectively Assessed Physical Activity and Sedentary Time with All-Cause Mortality in US Adults: The NHANES Study

PubMed Central

Schmid, Daniela; Ricci, Cristian; Leitzmann, Michael F.

2015-01-01

Background Sedentary behavior is related to increased mortality risk. Whether such elevated risk can be offset by enhanced physical activity has not been examined using accelerometry data. Materials and Methods We examined the relations of sedentary time and physical activity to mortality from any cause using accelerometry data among 1,677 women and men aged 50 years or older from the National Health and Nutrition Examination Survey (NHANES) 2003–2004 cycle with follow-up through December 31, 2006. Results During an average follow-up of 34.67 months and 4,845.42 person-years, 112 deaths occurred. In multivariate Cox proportional hazard models, greater sedentary time (≥ median of 8.60 hours/day) was associated with increased risk of mortality from any cause (relative risk (RR) = 2.03; 95% confidence interval (CI) = 1.09-3.81). Low level of moderate to vigorous physical activity (< median of 6.60 minutes/day) was also related to enhanced all-cause mortality risk (RR = 3.30; 95% CI = 1.33-8.17). In combined analyses, greater time spent sedentary and low levels of moderate to vigorous physical activity predicted a substantially elevated all-cause mortality risk. As compared with the combination of a low sedentary level and a high level of moderate to vigorous physical activity, the risks of mortality from all causes were 4.38 (95% CI = 1.26-15.16) for low levels of both sedentary time and physical activity, 2.79 (95% CI = 0.77-10.12) for greater time spent sedentary and high physical activity level, and 7.79 (95% CI = 2.26-26.82) for greater time spent sedentary and low physical activity level. The interaction term between sedentary time and moderate to vigorous physical activity was not statistically significant (p = 0.508). Conclusions Both high levels of sedentary time and low levels of moderate to vigorous physical activity are strong and independent predictors of early death from any cause. Whether a high physical activity level removes the increased risk of all-cause mortality related to sedentariness requires further investigation. PMID:25768112

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 temperatures prevail through much of April-June. PMID:24633076

Soy product consumption and the risk of all-cause, cardiovascular and cancer mortality: a systematic review and meta-analysis of cohort studies.

PubMed

Namazi, Nazli; Saneei, Parvane; Larijani, Bagher; Esmaillzadeh, Ahmad

2018-04-18

Currently, the association of soy intake with total- and cause-specific mortality is inconsistent. The aim of this study was to systematically review cohort studies on the association between the consumption of soy products and mortality from all-causes, cardiovascular disease (CVD), and cancer. We conducted a systematic search of the PubMed/Medline, ISI Web of Knowledge and Embase electronic databases up to October 2016. Prospective cohort studies that examined the association of soy products with the risk of all-cause, CVD and cancer mortality using the relative risk (RR) or Hazard Ratio (HR) with 95% CIs were considered. Random-effect models were used to pool the study results and heterogeneity was examined using the I2 index and Q test. Finally, 7 studies were included for the meta-analysis; three studies reported the risk of all-cause mortality. Four studies assessed the risk of mortality from CVD and cancer. In total, 39 250 deaths were reported among 627 209 participants in a 7 to 18-year follow-up. A high consumption of soy products was not significantly associated with a lower risk of mortality from all-causes (HR: 0.96, 95% CI: 0.90, 1.02, I2: 38.5%, and Pheterogeneity = 0.14), CVD (HR: 0.95, 95% CI: 0.82, 1.10, I2: 49.9%, and Pheterogeneity = 0.07), and cancer (HR: 0.98, 95% CI: 0.92, 1.05, I2: 0%, and Pheterogeneity = 0.75). These findings indicated no significant association between a high intake of soy products and all-cause, CVD, and cancer mortality. Further studies are needed to clarify the association between the types of soy products and the risk of mortality.

Effects of cryptic mortality and the hidden costs of using length limits in fishery management

USGS Publications Warehouse

Coggins, L.G.; Catalano, M.J.; Allen, M.S.; Pine, William E.; Walters, C.J.

2007-01-01

Fishery collapses cause substantial economic and ecological harm, but common management actions often fail to prevent overfishing. Minimum length limits are perhaps the most common fishing regulation used in both commercial and recreational fisheries, but their conservation benefits can be influenced by discard mortality of fish caught and released below the legal length. We constructed a computer model to evaluate how discard mortality could influence the conservation utility of minimum length regulations. We evaluated policy performance across two disparate fish life-history types: short-lived high-productivity (SLHP) and long-lived low-productivity (LLLP) species. For the life-history types, fishing mortality rates and minimum length limits that we examined, length limits alone generally failed to achieve sustainability when discard mortality rate exceeded about 0.2 for SLHP species and 0.05 for LLLP species. At these levels of discard mortality, reductions in overall fishing mortality (e.g. lower fishing effort) were required to prevent recruitment overfishing if fishing mortality was high. Similarly, relatively low discard mortality rates (>0.05) rendered maximum yield unobtainable and caused a substantial shift in the shape of the yield response surfaces. An analysis of fishery efficiency showed that length limits caused the simulated fisheries to be much less efficient, potentially exposing the target species and ecosystem to increased negative effects of the fishing process. Our findings suggest that for overexploited fisheries with moderate-to-high discard mortality rates, reductions in fishing mortality will be required to meet management goals. Resource managers should carefully consider impacts of cryptic mortality sources (e.g. discard mortality) on fishery sustainability, especially in recreational fisheries where release rates are high and effort is increasing in many areas of the world. ?? 2007 Blackwell Publishing Ltd.

Physical activity is independently associated with reduced mortality: 15-years follow-up of the Hordaland Health Study (HUSK)

PubMed Central

Kopperstad, Øyvind; Skogen, Jens Christoffer; Sivertsen, Børge; Tell, Grethe S.

2017-01-01

Background Physical activity (PA) is associated with lower risk for non-communicable diseases and mortality. We aimed to investigate the prospective association between PA and all-cause and cause-specific mortality, and the impact of other potentially contributing factors. Method Data from the community-based Hordaland Health Study (HUSK, 1997–99) were linked to the Norwegian Cause of Death Registry. The study included 20,506 individuals born 1950–1957 and 2,225 born in 1925–1927 (baseline age 40–49 and 70–74). Based on self-report, individuals were grouped as habitually performing low intensity, short duration, low intensity, longer duration or high intensity PA. The hazard ratios (HR) for all-cause and cause-specific mortality during follow-up were calculated. Measures of socioeconomic status, physical health, mental health, smoking and alcohol consumption were added separately and cumulatively to the model. Results PA was associated with lower all-cause mortality in both older (HR 0.75 (95% CI 0.67–0.84)) and younger individuals (HR 0.82 (95% CI 0.72–0.92)) (crude models, HR: risk associated with moving from low intensity, short duration to low intensity, longer duration PA, and from low intensity, longer duration to high intensity). Smoking, education, somatic diagnoses and mental health accounted for some of the association between physical activity and mortality, but a separate protective effect of PA remained in fully adjusted models for cardiovascular (HR 0.78 (95% CI 0.66–0.92)) and respiratory (HR 0.45 (95% CI 0.32–0.63) mortality (both age-groups together), as well as all-cause mortality in the older age group (HR 0.74, 95%CI 0.66–0.83). Conclusion Low intensity, longer duration and high intensity physical activity was associated with reduced all-cause, respiratory and cardiovascular mortality, indicating that physical activity is beneficial also among older individuals, and that a moderate increase in PA can be beneficial. PMID:28328994

Life-Space Mobility and Mortality in Older Women: Prospective Results from the Study of Osteoporotic Fractures.

PubMed

Mackey, Dawn C; Lui, Li-Yung; Cawthon, Peggy M; Ensrud, Kristine; Yaffe, Kristine; Cummings, Steven R

2016-11-01

To evaluate the relationship between life-space mobility (extent, frequency, independence of movement) and mortality in older women. Prospective cohort study. Four U.S. clinical sites. Women (N = 1,498) aged 75 to 102 (mean 87.6) followed from 2006 to 2015. Life-space during the past 4 weeks was assessed in an interview, scored from 0 (daily restriction to bedroom) to 120 (daily trips outside town without assistance), and categorized (0-20, 21-40, 41-60, 61-80, 81-120). All-cause mortality was the primary outcome; noncancer, cardiovascular, cancer, and noncardiovascular noncancer mortality were secondary outcomes. Over a mean 5.2 years, 842 (56.2%) women died. Unadjusted risk of all-cause mortality was 82.6% in women with the lowest level of life-space (0-20 points) and 36.2% in those with the highest level (81-120 points). In multivariable proportional hazards models, there was a strong relationship between less life-space and greater risk of all-cause mortality (P trend < .001). Women with the lowest level of life-space (0-20 points) had a risk of all-cause mortality that was 2.4 times as high (95% confidence interval (CI) = 1.5-4.0) as that of women with the highest level (81-120 points); women with life-space scores between 21 and 60 had a risk of all-cause mortality that was 1.5 times as high as that of women with the highest level. Each standard deviation decrease in life-space was associated with a 1.2 times greater (95% CI = 1.1-1.4) risk of all-cause mortality. Women unable to travel beyond their neighborhood without assistance had a risk of all-cause mortality that was 1.4 times (95% CI = 1.1-1.7) as high as that of women who could travel beyond their neighborhood without assistance. Results were similar for noncancer, cardiovascular, and other mortality and did not change after controlling for underlying disease or living arrangement. Life-space scores of 60 or less were associated with mortality in older women independent of other strong risk factors. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Spatiotemporal influence of temperature, air quality, and urban environment on cause-specific mortality during hazy days.

PubMed

Ho, Hung Chak; Wong, Man Sing; Yang, Lin; Shi, Wenzhong; Yang, Jinxin; Bilal, Muhammad; Chan, Ta-Chien

2018-03-01

Haze is an extreme weather event that can severely increase air pollution exposure, resulting in higher burdens on human health. Few studies have explored the health effects of haze, and none have investigated the spatiotemporal interaction between temperature, air quality and urban environment that may exacerbate the adverse health effects of haze. We investigated the spatiotemporal pattern of haze effects and explored the additional effects of temperature, air pollution and urban environment on the short-term mortality risk during hazy days. We applied a Poisson regression model to daily mortality data from 2007 through 2014, to analyze the short-term mortality risk during haze events in Hong Kong. We evaluated the adverse effect on five types of cause-specific mortality after four types of haze event. We also analyzed the additional effect contributed by the spatial variability of urban environment on each type of cause-specific mortality during a specific haze event. A regular hazy day (lag 0) has higher all-cause mortality risk than a day without haze (odds ratio: 1.029 [1.009, 1.049]). We have also observed high mortality risks associated with mental disorders and diseases of the nervous system during hazy days. In addition, extreme weather and air quality contributed to haze-related mortality, while cold weather and higher ground-level ozone had stronger influences on mortality risk. Areas with a high-density environment, lower vegetation, higher anthropogenic heat, and higher PM 2.5 featured stronger effects of haze on mortality than the others. A combined influence of haze, extreme weather/air quality, and urban environment can result in extremely high mortality due to mental/behavioral disorders or diseases of the nervous system. In conclusion, we developed a data-driven technique to analyze the effects of haze on mortality. Our results target the specific dates and areas with higher mortality during haze events, which can be used for development of health warning protocols/systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Chilean infant mortality decline: improvement for whom? Socioeconomic and geographic inequalities in infant mortality, 1990-2005.

PubMed

Hertel-Fernandez, Alexander Warren; Giusti, Alejandro Esteban; Sotelo, Juan Manuel

2007-10-01

To measure socioeconomic inequalities and differential risk in infant mortality on national and regional levels in Chile from 1990 to 2005, and propose new policy targets. The study analysed Chilean vital events registries from 1990 to 2005 for infant mortality by maternal education, head of household occupational status, cause, age and location of death. Annual infant mortality rates and relative risk were calculated by maternal education and head of household occupational status for each cause and age of death. Socioeconomic inequalities were then mapped to 29 regional health services. Reductions in the national infant mortality rate were driven by reductions among highly educated mothers, while recent stagnation in the national rate is caused by high levels of infant mortality among uneducated mothers. These vulnerable households are particularly prone to infant mortality risk due to infectious disease and trauma. We also identify clustering of high socioeconomic inequalities in infant mortality throughout the poorer north, indigenous south and densely populated metropolitan centre of Santiago. Finally, we report large inequities in vital statistics coverage, with infant deaths among vulnerable households much more likely to be inadequately defined than in the remaining population. These results indicate that the socioeconomically disadvantaged in Chile are at a significantly higher risk for infant mortality by infectious diseases and trauma during the first month of life. Efforts to reduce national infant mortality in Chile and other countries must involve policies that target child survival for at-risk populations for specific diseases, ages and locations.

Differences in education and premature mortality: a record linkage study of over 35 million Italians.

PubMed

Alicandro, Gianfranco; Frova, Luisa; Sebastiani, Gabriella; Boffetta, Paolo; La Vecchia, Carlo

2018-04-01

Large, representative studies are needed to evaluate cause-specific aspects of socio-economic inequalities in mortality. We conducted a census-based retrospective cohort study to quantify differences in cause-specific premature mortality by educational level in Italy. We linked the 2011 Italian census with 2012 and 2013 death registries. We used the mortality rate ratio (MRR) as a measure of relative inequality. Overall, 305 043 deaths (190 061 men-114 982 women) were registered from a population of 35 708 445 subjects aged 30-74. The age-standardized mortality rate for all educational levels was 57.68 deaths per 10 000 person-years among men and 31.41 among women. MRR from all causes was 0.51 (95% CI: 0.49; 0.52) in men and 0.63 (95% CI: 0.61; 0.65) in women for the highest (university) compared to the lowest level of education (none or primary school). The association was stronger in single than in married individuals: MRRs were 0.36 (95% CI: 0.34; 0.39) in single men, 0.57 (95% CI: 0.55; 0.59) in married men, 0.44 (95% CI: 0.40; 0.47) in single women and 0.69 (95% CI: 0.66; 0.72) in married women. High education was associated with lower mortality from liver, circulatory, chronic respiratory and genitourinary diseases in both sexes. Highly educated men had a lower mortality from lung cancer than less educated men, whereas highly educated women did not have a reduced mortality from lung and breast cancers. Level of education is a strong indicator of premature mortality. The magnitude of the association between educational level and mortality differs across sexes, marital status and causes of death.

Platelet count and total and cause-specific mortality in the Women's Health Initiative.

PubMed

Kabat, Geoffrey C; Kim, Mimi Y; Verma, Amit K; Manson, JoAnn E; Lin, Juan; Lessin, Lawrence; Wassertheil-Smoller, Sylvia; Rohan, Thomas E

2017-04-01

We used data from the Women's Health Initiative to examine the association of platelet count with total mortality, coronary heart disease (CHD) mortality, cancer mortality, and non-CHD/noncancer mortality. Platelet count was measured at baseline in 159,746 postmenopausal women and again in year 3 in 75,339 participants. Participants were followed for a median of 15.9 years. Cox proportional hazards models were used to estimate the relative mortality hazards associated with deciles of baseline platelet count and of the mean of baseline + year 3 platelet count. Low and high deciles of both baseline and mean platelet count were positively associated with total mortality, CHD mortality, cancer mortality, and non-CHD/noncancer mortality. The association was robust and was not affected by adjustment for a number of potential confounding factors, exclusion of women with comorbidity, or allowance for reverse causality. Low- and high-platelet counts were associated with all four outcomes in never smokers, former smokers, and current smokers. In this large study of postmenopausal women, both low- and high-platelet counts were associated with total and cause-specific mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

The HbA1c and All-Cause Mortality Relationship in Patients with Type 2 Diabetes is J-Shaped: A Meta-Analysis of Observational Studies

PubMed Central

Arnold, Luke W.; Wang, Zhiqiang

2014-01-01

BACKGROUND: Low blood glucose and HbA1c levels are recommended in the literature on management of diabetes. However, data have shown that low blood glucose is associated with serious adverse effects for the patients and the recommendation has been criticized. Therefore, this article revisits the relationship between HbA1c and all-cause mortality by a meta-analysis of observational studies. AIM: The aim of this study is to determine whether there is a J- or U-shaped non-linear relationship between HbA1c and all-cause mortality in type 2 diabetes patients, implying an increased risk to premature all-cause mortality at high and low levels of HbA1c. METHODS: A comprehensive literature search was conducted using PubMed, Medline, and Cochrane Library databases with strict inclusion/exclusion criteria. The published adjusted hazard ratios (HR) with 95% confidence intervals of all-cause mortality for each HbA1c category and per study were analyzed. Fractional polynomial regression was used with random effect modeling to assess the non-linear relationship of the HR trends between studies. Seven eligible observational studies with a total of 147,424 participants were included in the study. RESULTS: A significant J-shaped relationship was observed between HbA1c and all-cause mortality. Crude relative risk for all-cause mortality identified a decreased risk per 1% increase in HbA1c below 7.5% (58 mmol/mol) (0.90, CI 0.86-0.94) and an increased risk per 1% increase in HbA1c above 7.5% (58 mmol/mol) (1.04, CI 1.01-1.06). Observational studies revealed a J-shaped relationship between HbA1c and all-cause mortality, equivalent to an increased risk of mortality at high and low HbA1c levels. CONCLUSIONS: This increased mortality at high and low HbA1c levels has significant implications on investigating optimum clinical HbA1c targets as it suggests that there are upper and lower limits for creating a 'security zone' for diabetes management. PMID:25396402

Effect of increased leptin and C-reactive protein levels on mortality: results from the National Health and Nutrition Examination Survey.

PubMed

Amrock, Stephen M; Weitzman, Michael

2014-09-01

Leptin and C-reactive protein (CRP) have each been linked to adverse cardiovascular events, and prior cross-sectional research suggests that increased levels of both biomarkers pose an even greater risk. The effect of increased levels of both leptin and CRP on mortality has not, however, been previously assessed. We used data from the third National Health and Nutrition Examination Survey (NHANES III) to estimate the mortality effect of high leptin and high CRP levels. Outcomes were compared with the use of inverse-probability-weighting adjustment. Among 6259 participants included in the analysis, 766 were in their sex-specific, population-weighted highest quartiles of both leptin and CRP. Median follow-up time was 14.3 years. There was no significant difference in adjusted all-cause mortality between the groups (risk ratio 1.22, 95% confidence interval [CI], 0.97-1.54). Similar results were noted with the use of several different analytic methods and in many subgroups, though high leptin and CRP levels may increase all-cause mortality in males (hazard ratio, 1.80, 95% CI, 1.32-2.46; P for interaction, 0.011). A significant difference in cardiovascular mortality was also noted (risk ratio, 1.54, 95% CI, 1.08-2.18), though that finding was not confirmed in all sensitivity analyses.. In this observational study, no significant difference in overall all-cause mortality rates in those with high leptin and high CRP levels was found, though high leptin and CRP levels appear associated with increased mortality in males. High leptin and CRP levels also likely increase risk for cardiovascular death.. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Long-Term Effects of Stress Reduction on Mortality in Persons ≥55 Years of Age With Systemic Hypertension

PubMed Central

Schneider, Robert H.; Alexander, Charles N.; Staggers, Frank; Rainforth, Maxwell; Salerno, John W.; Hartz, Arthur; Arndt, Stephen; Barnes, Vernon A.; Nidich, Sanford I.

2005-01-01

Psychosocial stress contributes to high blood pressure and subsequent cardiovascular morbidity and mortality. Previous controlled studies have associated decreasing stress with the Transcendental Meditation (TM) program with lower blood pressure. The objective of the present study was to evaluate, over the long term, all-cause and cause-specific mortality in older subjects who had high blood pressure and who participated in randomized controlled trials that included the TM program and other behavioral stress-decreasing interventions. Patient data were pooled from 2 published randomized controlled trials that compared TM, other behavioral interventions, and usual therapy for high blood pressure. There were 202 subjects, including 77 whites (mean age 81 years) and 125 African-American (mean age 66 years) men and women. In these studies, average baseline blood pressure was in the prehypertensive or stage I hypertension range. Follow-up of vital status and cause of death over a maximum of 18.8 years was determined from the National Death Index. Survival analysis was used to compare intervention groups on mortality rates after adjusting for study location. Mean follow-up was 7.6 ± 3.5 years. Compared with combined controls, the TM group showed a 23% decrease in the primary outcome of all-cause mortality after maximum follow-up (relative risk 0.77, p = 0.039). Secondary analyses showed a 30% decrease in the rate of cardiovascular mortality (relative risk 0.70, p = 0.045) and a 49% decrease in the rate of mortality due to cancer (relative risk 0.49, p = 0.16) in the TM group compared with combined controls. These results suggest that a specific stress-decreasing approach used in the prevention and control of high blood pressure, such as the TM program, may contribute to decreased mortality from all causes and cardiovascular disease in older subjects who have systemic hypertension. PMID:15842971

Socio-Ecological Factors Affecting Pregnant Women's Anemia Status in Freetown, Sierra Leone

ERIC Educational Resources Information Center

M'Cormack, Fredanna; Drolet, Judy

2012-01-01

Background: Sierra Leone has high maternal mortality. Socio-ecological factors are considered contributing factors to this high mortality. Anemia is considered to be a direct cause of 4% of maternal deaths and an indirect cause of 20-40% of maternal deaths. Purpose: The current study explores socio-ecological contributing factors to the anemia…

Serum Bicarbonate and Mortality in Stage 3 and Stage 4 Chronic Kidney Disease

PubMed Central

Schold, Jesse D.; Arrigain, Susana; Jolly, Stacey E.; Wehbe, Edgard; Raina, Rupesh; Simon, James F.; Srinivas, Titte R.; Jain, Anil; Schreiber, Martin J.; Nally, Joseph V.

2011-01-01

Summary Background and objectives The incidence and prevalence of metabolic acidosis increase with declining kidney function. We studied the associations of both low and high serum bicarbonate levels with all-cause mortality among stage 3 and 4 chronic kidney disease (CKD) patients. Design, setting, participants, & measurements We examined factors associated with low (<23 mmol/L) and high (>32 mmol/L) serum bicarbonate levels using logistic regression models and associations between bicarbonate and all-cause mortality using Cox-proportional hazard models, Kaplan–Meier survival curves, and time-dependent analysis. Results Out of 41,749 patients, 13.9% (n = 5796) had low and 1.6% (n = 652) had high serum bicarbonate levels. After adjusting for relevant covariates, there was a significant association between low serum bicarbonate and all-cause mortality (hazard ratio [HR] 1.23, 95% CI 1.16, 1.31). This association was not statistically significant among patients with stage 4 CKD and diabetes. The time-dependent analysis demonstrated a significant mortality risk associated with a decline from normal to low bicarbonate level (HR 1.59, 95% CI 1.49, 1.69). High serum bicarbonate levels were associated with death irrespective of the level of kidney function (HR 1.74, 95% CI 1.52, 2.00). When serum bicarbonate was examined as a continuous variable, a J-shaped relationship was noted between serum bicarbonate and mortality. Conclusions Low serum bicarbonate levels are associated with increased mortality among stage 3 CKD patients and patients without diabetes. High serum bicarbonate levels are associated with mortality in both stage 3 and stage 4 CKD patients. PMID:21885787

Heat-related deaths in hot cities: estimates of human tolerance to high temperature thresholds.

PubMed

Harlan, Sharon L; Chowell, Gerardo; Yang, Shuo; Petitti, Diana B; Morales Butler, Emmanuel J; Ruddell, Benjamin L; Ruddell, Darren M

2014-03-20

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥ 65 during the months May-October for years 2000-2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90-97 °F; 32.2-36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide.

Flavonoid intake and mortality from cardiovascular disease and all causes: A meta-analysis of prospective cohort studies.

PubMed

Kim, Youngyo; Je, Youjin

2017-08-01

Accumulating studies have suggested that flavonoid intake is associated with a decreased risk of coronary heart disease and cardiovascular disease (CVD). There are many epidemiological studies on flavonoid intake and mortality, but no comprehensive investigation has yet been conducted. To quantitatively assess the association between flavonoid intake and mortality from CVD and all-causes, we performed a meta-analysis of prospective cohort studies. Eligible studies were identified by searching PubMed and Web of Science databases for all articles published up to May 2016 and via hand searching. Study-specific estimates adjusting for potential confounders were combined to calculate a pooled relative risk (RR) with 95% confidence interval (CI) using a random-effects model. A total of 15 prospective cohort studies that examined the association between flavonoid intake and mortality from CVD and all-causes were identified. The pooled RR of CVD mortality for the highest versus lowest category of flavonoid intake was 0.86 (95% CI: 0.75, 0.98). By subclass of flavonoids, all classes, except flavonols and isoflavones, showed significant inverse associations. A nonlinear association was found between flavonoid intake and CVD mortality in the dose-response analysis. For total mortality, a high intake of flavonoids was associated with lower total mortality (pooled RR = 0.86, 95% CI: 0.73, 1.00). Our findings indicate that a high intake of flavonoids is associated with reduced risk of mortality from CVD and all causes in men and women. These results support current recommendations of high fruit and vegetables intake as a part of a healthy diet. Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors.

PubMed

Mahmood, Mohammad Afzal; Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien; Wahabi, Hayfaa A

2018-01-01

Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

PubMed Central

Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien

2018-01-01

Background Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped. PMID:29682538

Population density, socioeconomic environment and all-cause mortality: a multilevel survival analysis of 2.7 million individuals in Denmark.

PubMed

Meijer, Mathias; Kejs, Anne Mette; Stock, Christiane; Bloomfield, Kim; Ejstrud, Bo; Schlattmann, Peter

2012-03-01

This study examines the relative effects of population density and area-level SES on all-cause mortality in Denmark. A shared frailty model was fitted with 2.7 million persons aged 30-81 years in 2,121 parishes. Residence in areas with high population density increased all-cause mortality for all age groups. For older age groups, residence in areas with higher proportions of unemployed persons had an additional effect. Area-level factors explained considerably more variation in mortality among the elderly than among younger generations. Overall this study suggests that structural prevention efforts in neighborhoods could help reduce mortality when mediating processes between area-level socioeconomic status, population density and mortality are found. Copyright © 2011 Elsevier Ltd. All rights reserved.

Association of extremely high levels of high-density lipoprotein cholesterol with cardiovascular mortality in a pooled analysis of 9 cohort studies including 43,407 individuals: The EPOCH-JAPAN study.

PubMed

Hirata, Aya; Sugiyama, Daisuke; Watanabe, Makoto; Tamakoshi, Akiko; Iso, Hiroyasu; Kotani, Kazuhiko; Kiyama, Masahiko; Yamada, Michiko; Ishikawa, Shizukiyo; Murakami, Yoshitaka; Miura, Katsuyuki; Ueshima, Hirotsugu; Okamura, Tomonori

2018-02-08

The effect of very high or extremely high levels of high-density lipoprotein cholesterol (HDL-C) on cardiovascular disease (CVD) is not well described. Although a few recent studies have reported the adverse effects of extremely high levels of HDL-C on CVD events, these did not show a statistically significant association between extremely high levels of HDL-C and cause-specific CVD mortality. In addition, Asian populations have not been studied. We examine the impact of extremely high levels of HDL-C on cause-specific CVD mortality using pooled data of Japanese cohort studies. We performed a large-scale pooled analysis of 9 Japanese cohorts including 43,407 participants aged 40-89 years, dividing the participants into 5 groups by HDL-C levels, including extremely high levels of HDL-C ≥2.33 mmol/L (≥90 mg/dL). We estimated the adjusted hazard ratio of each HDL-C category for all-cause death and cause-specific deaths compared with HDL-C 1.04-1.55 mmol/L (40-59 mg/dL) using a cohort-stratified Cox proportional hazards model. During a 12.1-year follow-up, 4995 all-cause deaths and 1280 deaths due to overall CVD were identified. Extremely high levels of HDL-C were significantly associated with increased risk of atherosclerotic CVD mortality (hazard ratio = 2.37, 95% confidence interval: 1.37-4.09 for total) and increased risk for coronary heart disease and ischemic stroke. In addition, the risk for extremely high HDL-C was more evident among current drinkers. We showed extremely high levels of HDL-C had an adverse effect on atherosclerotic CVD mortality in a pooled analysis of Japanese cohorts. Copyright © 2018 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections

PubMed Central

Song, Kyoung-Ho; Kim, Moonsuk; Kim, Chung Jong; Cho, Jeong Eun; Choi, Yun Jung; Park, Jeong Su; Ahn, Soyeon; Jang, Hee-Chang; Park, Kyung-Hwa; Jung, Sook-In; Yoon, Nara; Kim, Dong-Min; Hwang, Jeong-Hwan; Lee, Chang Seop; Lee, Jae Hoon; Kwak, Yee Gyung; Kim, Eu Suk; Park, Seong Yeon; Park, Yoonseon; Lee, Kkot Sil; Lee, Yeong-Seon

2016-01-01

ABSTRACT There are conflicting data on the association of vancomycin MIC (VAN-MIC) with treatment outcomes in Staphylococcus aureus infections. We investigated the relationship between high VAN-MIC and 30-day mortality and identified the risk factors for mortality in a large cohort of patients with invasive S. aureus (ISA) infections, defined as the isolation of S. aureus from a normally sterile site. Over a 2-year period, 1,027 adult patients with ISA infections were enrolled in 10 hospitals, including 673 (66%) patients with methicillin-resistant S. aureus (MRSA) infections. There were 200 (19.5%) isolates with high VAN-MIC (≥1.5 mg/liter) by Etest and 87 (8.5%) by broth microdilution (BMD). The all-cause 30-day mortality rate was 27.4%. High VAN-MIC by either method was not associated with all-cause 30-day mortality, and this finding was consistent across MIC methodologies and methicillin susceptibilities. We conclude that high VAN-MIC is not associated with increased risk of all-cause 30-day mortality in ISA infections. Our data support the view that VAN-MIC alone is not sufficient evidence to change current clinical practice. PMID:27956430

Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study.

PubMed

Asamoah, Benedict O; Moussa, Kontie M; Stafström, Martin; Musinguzi, Geofrey

2011-03-10

Ghana's maternal mortality ratio remains high despite efforts made to meet Millennium Development Goal 5. A number of studies have been conducted on maternal mortality in Ghana; however, little is known about how the causes of maternal mortality are distributed in different socio-demographic subgroups. Therefore the aim of this study was to assess and analyse the causes of maternal mortality according to socio-demographic factors in Ghana. The causes of maternal deaths were assessed with respect to age, educational level, rural/urban residence status and marital status. Data from a five year retrospective survey was used. The data was obtained from Ghana Maternal Health Survey 2007 acquired from the database of Ghana Statistical Service. A total of 605 maternal deaths within the age group 12-49 years were analysed using frequency tables, cross-tabulations and logistic regression. Haemorrhage was the highest cause of maternal mortality (22.8%). Married women had a significantly higher risk of dying from haemorrhage, compared with single women (adjusted OR = 2.7, 95%CI = 1.2-5.7). On the contrary, married women showed a significantly reduced risk of dying from abortion compared to single women (adjusted OR = 0.2, 95%CI = 0.1-0.4). Women aged 35-39 years had a significantly higher risk of dying from haemorrhage (aOR 2.6, 95%CI = 1.4-4.9), whereas they were at a lower risk of dying from abortion (aOR 0.3, 95% CI = 0.1-0.7) compared to their younger counterparts. The risk of maternal death from infectious diseases decreased with increasing maternal age, whereas the risk of dying from miscellaneous causes increased with increasing age. The study shows evidence of variations in the causes of maternal mortality among different socio-demographic subgroups in Ghana that should not be overlooked. It is therefore recommended that interventions aimed at combating the high maternal mortality in Ghana should be both cause-specific as well as target-specific.

Examining geographic patterns of mortality: the atlas of mortality in small areas in Spain (1987-1995).

PubMed

Benach, Joan; Yasui, Yutaka; Borrell, Carme; Rosa, Elisabeth; Pasarín, M Isabel; Benach, Núria; Español, Esther; Martínez, José Miguel; Daponte, Antonio

2003-06-01

Small-area mortality atlases have been demonstrated to be a useful tool for both showing general geographical patterns in mortality data and identifying specific high-risk locations. In Spain no study has so far systematically examined geographic patterns of small-area mortality for the main causes of death. This paper presents the main features, contents and potential uses of the Spanish Atlas of Mortality in small areas (1987-1995). Population data for 2,218 small areas were drawn from the 1991 Census. Aggregated mortality data for 14 specific causes of death for the period 1987-1995 were obtained for each small area. Empirical Bayes-model-based estimates of age-adjusted relative risk were displayed in small-area maps for each cause/gender/age group (0-64 or 65 and over) combination using the same range of values (i.e. septiles) and colour schemes. The 'Spanish Atlas of Mortality' includes multiple choropleth (area-shaded) small-area maps and graphs to answer different questions about the data. The atlas is divided into three main sections. Section 1 includes the methods and comments on the main maps. Section 2 presents a two-page layout for each leading cause of death by gender including 1) a large map with relative risk estimates, 2) a map that indicates high- and low-risk small areas, 3) a graph with median and interquartile range of relative risk estimates for 17 large regions of Spain, and 4) relative-risk maps for two age groups. Section 3 provides specific information on the geographical units of analysis, statistical methods and other supplemental maps. The 'Spanish Atlas of Mortality' is a useful tool for examining geographical patterns of mortality risk and identifying specific high-risk areas. Mortality patterns displayed in the atlas may have important implications for research and social/health policy planning purposes.

Caecal volvulus: a consequence of acute cholecystitis

PubMed Central

Anjum, Ghulam Ali; Jaberansari, Sarah; Habeeb, Kayode

2013-01-01

Caecal volvulus is an uncommon cause of closed loop intestinal obstruction which can lead to caecal gangrene and high mortality. Delay in diagnosis is one of the causes of this high mortality. Caecal volvulus is reported to be associated with previous abdominal surgery in most cases. We present the first reported case of caecal volvulus following/associated with acute cholecystitis. PMID:23749828

Distinctive role of income in the all-cause mortality among working age migrants and the settled population in Finland: A follow-up study from 2001 to 2014.

PubMed

Patel, Kishan; Kouvonen, Anne; Koskinen, Aki; Kokkinen, Lauri; Donnelly, Michael; O'Reilly, Dermot; Vaananen, Ari

2018-03-01

Although income level may play a significant part in mortality among migrants, previous research has not focused on the relationship between income, migration and mortality risk. The aim of this register study was to compare all-cause mortality by income level between different migrant groups and the majority settled population of Finland. A random sample was drawn of 1,058,391 working age people (age range 18-64 years; 50.4% men) living in Finland in 2000 and linked to mortality data from 2001 to 2014. The data were obtained from Statistics Finland. Cox proportional hazards models were used to investigate the association between region of origin and all-cause mortality in low- and high-income groups. The risk for all-cause mortality was significantly lower among migrants than among the settled majority population (hazards ratio (HR) 0.57; 95% confidence interval (CI) 0.53-0.62). After adjustment for age, sex, marital status, employment status and personal income, the risk of mortality was significantly reduced for low-income migrants compared with the settled majority population with a low income level (HR 0.46; 95% CI 0.42-0.50) and for high-income migrants compared with the high-income settled majority (HR 0.81; 95% CI 0.69-0.95). Results comparing individual high-income migrant groups and the settled population were not significant. Low-income migrants from Africa, the Middle East and Asia had the lowest mortality risk of any migrant group studied (HR 0.32; 95% CI 0.27-0.39). Particularly low-income migrants seem to display a survival advantage compared with the corresponding income group in the settled majority population. Downward social mobility, differences in health-related lifestyles and the healthy migrant effect may explain this phenomenon.

Identification of highly effective target genes for RNAi-mediated control of emerald ash borer, Agrilus planipennis.

PubMed

Rodrigues, Thais B; Duan, Jian J; Palli, Subba R; Rieske, Lynne K

2018-03-22

Recent study has shown that RNA interference (RNAi) is efficient in emerald ash borer (EAB), Agrilus planipennis, and that ingestion of double-stranded RNA (dsRNA) targeting specific genes causes gene silencing and mortality in neonates. Here, we report on the identification of highly effective target genes for RNAi-mediated control of EAB. We screened 13 candidate genes in neonate larvae and selected the most effective target genes for further investigation, including their effect on EAB adults and on a non-target organism, Tribolium castaneum. The two most efficient target genes selected, hsp (heat shock 70-kDa protein cognate 3) and shi (shibire), caused up to 90% mortality of larvae and adults. In EAB eggs, larvae, and adults, the hsp is expressed at higher levels when compared to that of shi. Ingestion of dsHSP and dsSHI caused mortality in both neonate larvae and adults. Administration of a mixture of both dsRNAs worked better than either dsRNA by itself. In contrast, injection of EAB.dsHSP and EAB.dsSHI did not cause mortality in T. castaneum. Thus, the two genes identified cause high mortality in the EAB with no apparent phenotype effects in a non-target organism, the red flour beetle, and could be used in RNAi-mediated control of this invasive pest.

High adult mortality among Hiwi hunter-gatherers: implications for human evolution.

PubMed

Hill, Kim; Hurtado, A M; Walker, R S

2007-04-01

Extant apes experience early sexual maturity and short life spans relative to modern humans. Both of these traits and others are linked by life-history theory to mortality rates experienced at different ages by our hominin ancestors. However, currently there is a great deal of debate concerning hominin mortality profiles at different periods of evolutionary history. Observed rates and causes of mortality in modern hunter-gatherers may provide information about Upper Paleolithic mortality that can be compared to indirect evidence from the fossil record, yet little is published about causes and rates of mortality in foraging societies around the world. To our knowledge, interview-based life tables for recent hunter-gatherers are published for only four societies (Ache, Agta, Hadza, and Ju/'hoansi). Here, we present mortality data for a fifth group, the Hiwi hunter-gatherers of Venezuela. The results show comparatively high death rates among the Hiwi and highlight differences in mortality rates among hunter-gatherer societies. The high levels of conspecific violence and adult mortality in the Hiwi may better represent Paleolithic human demographics than do the lower, disease-based death rates reported in the most frequently cited forager studies.

Associations of all-cause mortality with census-based neighbourhood deprivation and population density in Japan: a multilevel survival analysis.

PubMed

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

2014-01-01

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. 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. 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. 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 deprived neighbourhoods.

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 deprived neighbourhoods. PMID:24905731

Causes of death in rheumatoid arthritis: How do they compare to the general population?

PubMed

Widdifield, Jessica; Paterson, J Michael; Huang, Anjie; Bernatsky, Sasha

2018-03-07

To compare mortality rates, underlying causes of death, excess mortality and years of potential life lost (YPLL) among rheumatoid arthritis (RA) patients relative to the general population. We studied an inception cohort of 87,114 Ontario RA patients and 348,456 age/sex/area-matched general population comparators over 2000 to 2013. All-cause, cause-specific, and excess mortality rates, mortality rate ratios (MRRs), and YPLL were estimated. A total of 11,778 (14% of) RA patients and 32,472 (9% of) comparators died during 508,385 and 1,769,365 person-years (PY) of follow-up, respectively, for corresponding mortality rates of 232 (95% CI 228, 236) and 184 (95% CI 182, 186) per 10,000 PYs. Leading causes of death in both groups were diseases of the circulatory system, cancer, and respiratory conditions. Increased mortality for all-cause and specific causes was observed in RA relative to the general population. MRRs were elevated for most causes of death. Age-specific mortality ratios illustrated a high excess mortality among RA patients under 45 years of age for respiratory disease and circulatory disease. RA patients lost 7,436 potential years of life per 10,000 persons, compared with 4,083 YPLL among those without RA. Mortality rates were increased in RA patients relative to the general population across most causes of death. The potential life years lost (before the age of 75) among RA patients was roughly double that among those without RA, reflecting higher rate ratios for most causes of death and RA patients dying at earlier ages. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Determinants of Viraemia Copy-Years in People with HIV/AIDS Following Initiation of Antiretroviral Therapy

PubMed Central

Wright, Stephen T; Hoy, Jennifer; Mulhall, Brian; O’Connor, Catherine C; Petoumenos, Kathy; Read, Timothy; Smith, Don; Woolley, Ian; Boyd, Mark A

2014-01-01

Background Recent studies suggest higher cumulative HIV viraemia exposure measured as viraemia copy-years (VCY) is associated with increased all-cause mortality. The objectives of this study are (a) report the association between VCY and all-cause mortality, and (b) assess associations between common patient characteristics and VCY. Methods Analyses were based on patients recruited to the Australian HIV Observational Database (AHOD) who had received ≥ 24 weeks of antiretroviral therapy (ART). We established VCY after 1, 3, 5 and 10 years of ART by calculating the area under the plasma viral load time-series. We used survival methods to determine the association between high VCY and all-cause mortality. We used multivariable mixed-effect models to determine predictors of VCY. We compared a baseline information model with a time-updated model to evaluate discrimination of patients with high VCY. Results Of the 3021 AHOD participants that initiated ART, 2073(69%), 1667(55%), 1267(42%) and 638(21%) were eligible for analysis at 1, 3, 5, 10 years of ART respectively. Multivariable adjusted hazard ratio (HR) association between all-cause mortality and high VCY was statistically significant, HR 1.52(1.09, 2.13), p-value=0.01. Predicting high VCY after one-year of ART for a time-updated model compared to a baseline information only model, the area under the sensitivity/specificity curve (AUC) was 0.92 vs. 0.84; and at 10 years of ART, AUC: 0.87 vs. 0.61 respectively. Conclusion A high cumulative measure of viral load after initiating ART is associated with increased risk of all-cause mortality. Identifying patients with high VCY is improved by incorporating time-updated information. PMID:24463783

Flavonoid intake and all-cause mortality.

PubMed

Ivey, Kerry L; Hodgson, Jonathan M; Croft, Kevin D; Lewis, Joshua R; Prince, Richard L

2015-05-01

Flavonoids are bioactive compounds found in foods such as tea, chocolate, red wine, fruit, and vegetables. Higher intakes of specific flavonoids and flavonoid-rich foods have been linked to reduced mortality from specific vascular diseases and cancers. However, the importance of flavonoids in preventing all-cause mortality remains uncertain. The objective was to explore the association between flavonoid intake and risk of 5-y mortality from all causes by using 2 comprehensive food composition databases to assess flavonoid intake. The study population included 1063 randomly selected women aged >75 y. All-cause, cancer, and cardiovascular mortalities were assessed over 5 y of follow-up through the Western Australia Data Linkage System. Two estimates of flavonoid intake (total flavonoidUSDA and total flavonoidPE) were determined by using food composition data from the USDA and the Phenol-Explorer (PE) databases, respectively. During the 5-y follow-up period, 129 (12%) deaths were documented. Participants with high total flavonoid intake were at lower risk [multivariate-adjusted HR (95% CI)] of 5-y all-cause mortality than those with low total flavonoid consumption [total flavonoidUSDA: 0.37 (0.22, 0.58); total flavonoidPE: 0.36 (0.22, 0.60)]. Similar beneficial relations were observed for both cardiovascular disease mortality [total flavonoidUSDA: 0.34 (0.17, 0.69); flavonoidPE: 0.32 (0.16, 0.61)] and cancer mortality [total flavonoidUSDA: 0.25 (0.10, 0.62); flavonoidPE: 0.26 (0.11, 0.62)]. Using the most comprehensive flavonoid databases, we provide evidence that high consumption of flavonoids is associated with reduced risk of mortality in older women. The benefits of flavonoids may extend to the etiology of cancer and cardiovascular disease. © 2015 American Society for Nutrition.

Plasma eicosapentaenoic acid is negatively associated with all-cause mortality among men and women in a population-based prospective study.

PubMed

Miura, Kyoko; Hughes, Maria Celia B; Ungerer, Jacobus Pj; Green, Adèle C

2016-11-01

Omega-3 polyunsaturated fatty acids (PUFAs) have anti-inflammatory properties, whereas omega-6 PUFAs appear to have proinflammatory properties. We aimed to assess plasma omega-3 and omega-6 PUFA status in relation to all-cause mortality in an Australian community-based study. We hypothesized that omega-3 PUFA would be inversely associated, and omega-6 PUFA positively associated with all-cause mortality. Plasma phospholipid omega-3 (eicosapentaenoic acid [EPA], docosapentaenoic acid [DPA], docosahexaenoic acid, α-linolenic acid, and total) and omega-6 PUFAs (linoleic acid, arachidonic acid, and total) were measured among 1008 adults (44% men) in 1996. Plasma PUFA composition was quantified using gas chromatography. During 17-year follow-up, 98 men and 81 women died. After adjustment for potential confounding factors, plasma EPA was inversely associated with all-cause mortality overall (adjusted hazard ratio [HR] per 1-SD increase, 0.81; 95% confidence interval [CI], 0.68-0.95), in men (HR, 0.78; 95% CI, 0.62-0.98), and in women (HR, 0.78; 95% CI, 0.65-0.94), separately. Inverse associations with mortality among men were also seen for DPA (HR, 0.76; 95% CI, 0.60-0.97) and α-linolenic acid (HR, 0.73; 95% CI, 0.57-0.94). No omega-6 PUFAs were significantly associated with mortality. Our findings of reduced all-cause mortality in men and women who have high EPA in plasma, and in men with high plasma DPA and α-linolenic acid, partially support our hypothesis that omega-3 PUFAs help reduce mortality but provide no evidence that omega-6 PUFAs may increase mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Heart rate recovery, exercise capacity, and mortality risk in male veterans.

PubMed

Kokkinos, Peter; Myers, Jonathan; Doumas, Michael; Faselis, Charles; Pittaras, Andreas; Manolis, Athanasios; Kokkinos, John Peter; Narayan, Puneet; Papademetriou, Vasilios; Fletcher, Ross

2012-04-01

Both impaired heart rate recovery (HRR) and low fitness are associated with higher mortality risk. In addition, HRR is influenced by fitness status. The interaction between HRR, mortality, and fitness has not been clearly defined. Thus, we sought to evaluate the association between HRR and all-cause mortality and to assess the effects of fitness on this association. Treadmill exercise testing was performed in 5974 male veterans for clinical reasons at two Veterans Affairs Medical Centers (Washington, DC and Palo Alto, CA). HRR was calculated at 1 and 2 min of recovery. All-cause mortality was determined over a mean 6.2-year follow-up period. Mortality risk was significantly and inversely associated with HRR, only at 2 min. A cut-off value of 14 beats/min at 2 min recovery was the strongest predictor of mortality for the cohort (hazard ratio = 2.4; CI 1.6-3.5). The mortality risk was overestimated when exercise capacity was not considered. When both low fitness and low HRR were present (≤6 metabolic equivalents and ≤14 beats/min), mortality risk was approximately seven-fold higher compared to the High-fit + High-HRR group (>6 metabolic equivalents and >14 beats/min). HRR at 2 min post exercise is strongly and inversely associated with all-cause mortality. Exercise capacity affects HRR-associated mortality substantially and should be considered when applying HRR to estimate mortality.

Factors affecting morbidity and mortality on-farm and on-station in the Ethiopian highland sheep.

PubMed

Bekele, T; Woldeab, T; Lahlou-Kassi, A; Sherington, J

1992-12-01

Factors affecting morbidity and mortality of the Ethiopian highland sheep were studied both on-farm and on-station at Debre Berhan between 1989 and 1990. Primary causes of infectious origin resulted in high proportional morbidity (88.4% on-farm) and mortality (72.9% on-farm and 71.8% on-station) rates. Nutritional and managemental factors were also responsible for mortalities in lambs. The most frequent secondary causes of morbidity and/or mortality were ectoparasites and nasal myiasis. Health management interventions on-station were not high enough to produce performance improvements above the on-farm levels. However, the occurrence of gastrointestinal parasites significantly (P < 0.05) differed between the two management systems. The frequency of some of the major causes of morbidity and mortality such as pneumonia, fasciolasis and enteritis were significantly (P < 0.01) affected by season and age of an animal. In order to alleviate the major health constraints identified in this study, a proper health management intervention involving vaccination, strategic anthelmintic treatment and feeding management are suggested.

Extreme all-cause mortality in JUPITER requires reexamination of vital records.

PubMed

Serebruany, Victor L

2011-01-01

To compare all-cause mortality in JUPITER with other statin trials at 21 months of follow-up. Outcome advantages including all-cause mortality reduction yielded from the JUPITER trial support aggressive use of rosuvastatin and, perhaps by extension, other statins for primary prevention. Despite enrolling apparently healthy subjects and early trial termination at 21 months of mean follow-up, JUPITER revealed very high all-cause mortality in both the placebo (2.8%) and rosuvastatin (2.2%) arms. Comparison of all-cause mortality prorated for 21 months in 10 primary prevention studies and 1 acute coronary syndromes statin trial. The all-cause mortality in JUPITER was more than twice that of the average of primary prevention studies, matching well only with specific trials designed in diabetics (ASPEN or CARDS), early hypertension studies (ALLHAT-LLT) or a trial in patients with acute coronary syndromes (PROVE IT). Since the 'play of chance' is unlikely to explain these discrepancies due to excellent baseline match, excess death rates and all-cause mortality rates in both JUPITER arms must be questioned. It may be important that the study sponsor self-monitored sites. Excess all-cause mortality rates in the apparently relatively healthy JUPITER population are alarming and require independent verification. If, indeed, the surprising outcomes in JUPITER are successfully challenged, and considering established harm of statins with regard to rhabdomyolysis as well as, potentially, diabetes, millions of patients may find better and safer options for primary prevention of vascular events. Copyright © 2011 S. Karger AG, Basel.

Physiological selectivity and activity reduction of insecticides by rainfall to predatory wasps of Tuta absoluta.

PubMed

Barros, Emerson C; Bacci, Leandro; Picanco, Marcelo C; Martins, Júlio C; Rosado, Jander F; Silva, Gerson A

2015-01-01

In this study, we carried out three bioassays with nine used insecticides in tomato crops to identify their efficiency against tomato leaf miner Tuta absoluta, the physiological selectivity and the activity reduction of insecticides by three rain regimes to predatory wasps Protonectarina sylveirae and Polybia scutellaris. We assessed the mortality caused by the recommended doses of abamectin, beta-cyfluthrin, cartap, chlorfenapyr, etofenprox, methamidophos, permethrin, phenthoate and spinosad to T. absoluta and wasps at the moment of application. In addition, we evaluated the wasp mortality due to the insecticides for 30 days on plants that did not receive rain and on plants that received 4 or 125 mm of rain. Spinosad, cartap, chlorfenapyr, phenthoate, abamectin and methamidophos caused mortality higher than 90% to T. absoluta, whereas the pyrethroids beta-cyfluthrin, etofenprox and permethrin caused mortality between 8.5% and 46.25%. At the moment of application, all the insecticides were highly toxic to the wasps, causing mortality higher than 80%. In the absence of rain, all the insecticides continued to cause high mortality to the wasps for 30 days after the application. The toxicity of spinosad and methamidophos on both wasp species; beta-cyfluthrin on P. sylveirae and chlorfenapyr and abamectin on P. scutellaris, decreased when the plants received 4 mm of rain. In contrast, the other insecticides only showed reduced toxicity on the wasps when the plants received 125 mm of rain.

Trends and socioeconomic inequalities in amenable mortality in Switzerland with international comparisons.

PubMed

Feller, Anita; Schmidlin, Kurt; Clough-Gorr, Kerri M

2017-08-14

Amenable mortality is a composite measure of deaths from conditions that might be avoided by timely and effective healthcare. It was developed as an indicator to study health care quality. We calculated mortality rates for the population aged 0-74 years for the time-period 1996-2010 and the following groups of causes of death: amenable conditions, ischaemic heart diseases (IHD, defined as partly amenable) and remaining conditions. We compared the Swiss results with those published for 16 other high-income countries. To examine the association between amenable mortality and socioeconomic position, we calculated hazard ratios (HRs) by using Cox regression. Amenable mortality fell from 49.5 (95% confidence interval [CI] 48.2-51.0) to 35.7 (34.6-36.9) in males and from 55.0 (53.6-56.4) to 43.4 (42.2-44.6) per 100 000 person-years in females, when 1996-1998 was compared with 2008-2010. IHD mortality declined from 64.7 (95% CI 63.1-66.3) to 33.8 (32.8-34.8) in males and from 18.0 (17.2-18.7) to 8.5 (8.0-9.0) in females. However, between 1996-1998 and 2008-2010 the proportion of all-cause mortality attributed to amenable causes remained stable in both sexes (around 12% in males and 26% in females). Compared with 16 other high-income countries, Switzerland had the lowest rates of amenable mortality and ranked among the top five with the lowest ischaemic heart disease mortality. HRs of amenable causes in the lowest socioeconomic position quintile were 1.77 (95% CI 1.66-1.90) for males and 1.78 (1.47-2.16) for females compared with 1.62 (1.58-1.66) and 1.38 (1.33-1.43) for unamenable mortality. For ischaemic heart disease, HRs in the lowest socioeconomic position quintile were 1.76 (95% CI 1.66-1.87) for males and 2.33 (2.07-2.62) for females. Amenable mortality declined substantially in Switzerland with comparably low death rates for amenable causes. Similar to previous international studies, these Swiss results showed substantial socioeconomic inequalities in amenable mortality. Proportions of amenable mortality remained constant over time and patterns of inequalities observed for amenable causes in men did not substantially differ from those observed for non-amenable causes of death. Additional amenable mortality research is needed to better understand the factors contributing to mortality changes and social inequalities including information on disease characteristics and health care supply measures.

Are there differences in all-cause and coronary heart disease mortality between immigrants in Sweden and in their country of birth? A follow-up study of total populations.

PubMed

Gadd, Malin; Johansson, Sven-Erik; Sundquist, Jan; Wändell, Per

2006-04-21

Mortality from cardiovascular diseases is higher among immigrants than native Swedes. It is not clear whether the high mortality persists from the country of birth or is a result of migration. The purpose of the present study was to analyse whether all-cause and coronary heart disease mortality differ between immigrants in Sweden and in the country of birth. Two cohorts including the total population from Swedish national registers and WHO were defined. All-cause and CHD mortality are presented as age-adjusted incidence rates and incidence density ratios (IDR) in eight immigrant groups in Sweden and in their country of birth. The data were analysed using Poisson regression. The all-cause mortality risk was lower among seven of eight male immigrant groups (IDR 0.39-0.97) and among six of eight female immigrant groups (IDR 0.42-0.81) than in their country of birth. The CHD mortality risk was significantly lower in male immigrants from Norway (IDR = 0.84), Finland (IDR = 0.91), Germany (IDR = 0.84) and Hungary (IDR = 0.59) and among female immigrants from Germany (IDR = 0.66) and Hungary (IDR = 0.54) than in their country of birth. In contrast, there was a significantly higher CHD mortality risk in male immigrants from Southern Europe (IDR = 1.23) than in their country of birth. The all-cause mortality risk was lower in the majority of immigrant groups in Sweden than in their country of birth. The differences in CHD mortality risks were more complex. For countries with high CHD mortality, such as Finland and Hungary, the risk was lower among immigrants in Sweden than in their country of birth. For low-risk countries in South Europe, the risk was higher in immigrants in Sweden than in South Europe.

Elemental concentrations of ambient particles and cause specific mortality in Santiago, Chile: a time series study

PubMed Central

2012-01-01

Background The health effects of particulate air pollution are widely recognized and there is some evidence that the magnitude of these effects vary by particle component. We studied the effects of ambient fine particles (aerodynamic diameter < 2.5μm, PM2.5) and their components on cause-specific mortality in Santiago, Chile, where particulate pollution is a major public health concern. Methods Air pollution was collected in a residential area in the center of Santiago. Daily mortality counts were obtained from the National Institute of Statistic. The associations between PM2.5 and cause-specific mortality were studied by time series analysis controlling for time trends, day of the week, temperature and relative humidity. We then included an interaction term between PM2.5 and the monthly averages of the mean ratios of individual elements to PM2.5 mass. Results We found significant effects of PM2.5 on all the causes analyzed, with a 1.33% increase (95% CI: 0.87-1.78) in cardiovascular mortality per 10μg/m3 increase in the two days average of PM2.5. We found that zinc was associated with higher cardiovascular mortality. Particles with high content of chromium, copper and sulfur showed stronger associations with respiratory and COPD mortality, while high zinc and sodium content of PM2.5 amplified the association with cerebrovascular disease. Conclusions Our findings suggest that PM2.5 with high zinc, chromium, copper, sodium, and sulfur content have stronger associations with mortality than PM2.5 mass alone in Santiago, Chile. The sources of particles containing these elements need to be determined to better control their emissions. PMID:23116481

Heat-Related Deaths in Hot Cities: Estimates of Human Tolerance to High Temperature Thresholds

PubMed Central

Harlan, Sharon L.; Chowell, Gerardo; Yang, Shuo; Petitti, Diana B.; Morales Butler, Emmanuel J.; Ruddell, Benjamin L.; Ruddell, Darren M.

2014-01-01

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥65 during the months May–October for years 2000–2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90–97 °F; 32.2‒36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide. PMID:24658410

Weight fluctuation, mortality and vascular disease in Pima Indians.

PubMed

Hanson, R L; Jacobsson, L T; McCance, D R; Narayan, K M; Pettitt, D J; Bennett, P H; Knowler, W C

1996-05-01

To examine the relationship of weight fluctuation to mortality rates and incidence of vascular disease. A cohort of Pima Indians, 572 of whom had non-insulin-dependent diabetes mellitus and 766 without diabetes. Individuals were invited biennially to research examinations. The root mean square error (RMSE) of the linear trend of weight with time for the first four examinations after age 20 years was used as an index of weight fluctuation. Subjects were followed from the fourth examination until death or until 31 December 1991. The mortality rate ratio (MRR) and its 95% confidence interval (CI) for those with a high weight fluctuation index relative to those with a lower value were determined. The median duration of follow up was 9.3 (range 0.1-22.6) years. All cause mortality (n = 356); incidence of diabetic retinopathy (n = 145), diabetic nephropathy (n = 132) and electrocardiographic abnormalities (n = 82). There was no significant relationship between weight fluctuation and mortality for diabetic subjects (MRR = 1.0, 95% CI 0.8-1.3, p = 0.91). Nondiabetic subjects with a high weight fluctuation index had a higher mortality rate than those with a lower index (MRR = 1.5, 95% CI 1.0-2.1, p = 0.03); the association was stronger among men than among women. The excess mortality in the high weight fluctuation group was not due to cardiovascular diseases, but to noncardiovascular causes and the risk for alcohol-related death was particularly increased. Weight fluctuation was not associated with the incidence of diabetic retinopathy, nephropathy or electrocardiographic abnormalities. A high weight fluctuation index was associated with higher mortality rates in nondiabetic, but not in diabetic, Pima Indians. The excess mortality is largely due to noncardiovascular causes of death and may reflect lifestyle factors associated with weight fluctuation, rather than its metabolic effects.

Life expectancy and cardiovascular mortality in persons with schizophrenia.

PubMed

Laursen, Thomas M; Munk-Olsen, Trine; Vestergaard, Mogens

2012-03-01

To assess the impact of cardiovascular disease on the excess mortality and shortened life expectancy in schizophrenic patients. Patients with schizophrenia have two-fold to three-fold higher mortality rates compared with the general population, corresponding to a 10-25-year reduction in life expectancy. Although the mortality rate from suicide is high, natural causes of death account for a greater part of the reduction in life expectancy. The reviewed studies suggest four main reasons for the excess mortality and reduced life expectancy. First, persons with schizophrenia tend to have suboptimal lifestyles including unhealthy diets, excessive smoking and alcohol use, and lack of exercise. Second, antipsychotic drugs may have adverse effects. Third, physical illnesses in persons with schizophrenia are common, but diagnosed late and treated insufficiently. Lastly, the risk of suicide and accidents among schizophrenic patients is high. Schizophrenia is associated with a substantially higher mortality and curtailed life expectancy partly caused by modifiable risk factors.

U-Shaped Association Between Serum Uric Acid Level and Risk of Mortality: A Cohort Study.

PubMed

Cho, Sung Kweon; Chang, Yoosoo; Kim, Inah; Ryu, Seungho

2018-04-25

In addition to the controversy regarding the association of hyperuricemia with cardiovascular disease (CVD) mortality, few studies have examined the impact of a low uric acid level on mortality. We undertook the present study to evaluate the relationship between both low and high uric acid levels and the risk of all-cause and cause-specific mortality in a large sample of Korean adults over a full range of uric acid levels. A cohort study was performed in 375,163 South Korean men and women who underwent health check-ups from 2002 to 2012. Vital status and cause of death were ascertained from the national death records. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for mortality outcomes were estimated using Cox proportional hazards regression analysis. During a total of 2,060,721.9 person-years of follow-up, 2,020 participants died, with 287 CVD deaths and 963 cancer deaths. Low and high uric acid levels were associated with increased all-cause, CVD, and cancer mortality. The multivariable-adjusted HRs for all-cause mortality in the lowest uric acid categories (<3.5 mg/dl for men and <2.5 mg/dl for women) compared with the sex-specific reference category were 1.58 (95% CI 1.18-2.10) and 1.80 (95% CI 1.10-2.93), respectively. Corresponding HRs in the highest uric acid categories (≥9.5 mg/dl for men and ≥8.5 mg/dl for women) were 2.39 (95% CI 1.57-3.66) and 3.77 (95% CI 1.17-12.17), respectively. In this large cohort study of men and women, both low and high uric acid levels were predictive of increased mortality, supporting a U-shaped association between serum uric acid levels and adverse health outcomes. © 2018, American College of Rheumatology.

Neighbouring green space and mortality in community-dwelling elderly Hong Kong Chinese: a cohort study.

PubMed

Wang, Dan; Lau, Kevin Ka-Lun; Yu, Ruby; Wong, Samuel Y S; Kwok, Timothy T Y; Woo, Jean

2017-08-01

Green space has been shown to be beneficial for human wellness through multiple pathways. This study aimed to explore the contributions of neighbouring green space to cause-specific mortality. Data from 3544 Chinese men and women (aged ≥65 years at baseline) in a community-based cohort study were analysed. Outcome measures, identified from the death registry, were death from all-cause, respiratory system disease, circulatory system disease. The quantity of green space (%) within a 300 m radius buffer was calculated for each subject from a map created based on the Normalised Difference Vegetation Index. Cox proportional hazard models adjusted for demographics, socioeconomics, lifestyle, health conditions and housing type were used to estimate the HRs and 95% CIs. During a mean of 10.3 years of follow-up, 795 deaths were identified. Our findings showed that a 10% increase in coverage of green space was significantly associated with a reduction in all-cause mortality (HR 0.963, 95% CI 0.930 to 0.998), circulatory system-caused mortality (HR 0.887, 95% CI 0.817 to 0.963) and stroke-caused mortality (HR 0.661, 95% CI 0.524 to 0.835), independent of age, sex, marital status, years lived in Hong Kong, education level, socioeconomic ladder, smoking, alcohol intake, diet quality, self-rated health and housing type. The inverse associations between coverage of green space with all-cause mortality (HR 0.964, 95% CI 0.931 to 0.999) and circulatory system disease-caused mortality (HR 0.888, 95% CI 0.817 to 0.964) were attenuated when the models were further adjusted for physical activity and cognitive function. The effects of green space on all-cause and circulatory system-caused mortality tended to be stronger in females than in males. Higher coverage of green space was associated with reduced risks of all-cause mortality, circulatory system-caused mortality and stroke-caused mortality in Chinese older people living in a highly urbanised city. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Neighbouring green space and mortality in community-dwelling elderly Hong Kong Chinese: a cohort study

PubMed Central

Wang, Dan; Lau, Kevin Ka-Lun; Yu, Ruby; Wong, Samuel Y S; Kwok, Timothy T Y; Woo, Jean

2017-01-01

Objective Green space has been shown to be beneficial for human wellness through multiple pathways. This study aimed to explore the contributions of neighbouring green space to cause-specific mortality. Methods Data from 3544 Chinese men and women (aged ≥65 years at baseline) in a community-based cohort study were analysed. Outcome measures, identified from the death registry, were death from all-cause, respiratory system disease, circulatory system disease. The quantity of green space (%) within a 300 m radius buffer was calculated for each subject from a map created based on the Normalised Difference Vegetation Index. Cox proportional hazard models adjusted for demographics, socioeconomics, lifestyle, health conditions and housing type were used to estimate the HRs and 95% CIs. Results During a mean of 10.3 years of follow-up, 795 deaths were identified. Our findings showed that a 10% increase in coverage of green space was significantly associated with a reduction in all-cause mortality (HR 0.963, 95% CI 0.930 to 0.998), circulatory system-caused mortality (HR 0.887, 95% CI 0.817 to 0.963) and stroke-caused mortality (HR 0.661, 95% CI 0.524 to 0.835), independent of age, sex, marital status, years lived in Hong Kong, education level, socioeconomic ladder, smoking, alcohol intake, diet quality, self-rated health and housing type. The inverse associations between coverage of green space with all-cause mortality (HR 0.964, 95% CI 0.931 to 0.999) and circulatory system disease-caused mortality (HR 0.888, 95% CI 0.817 to 0.964) were attenuated when the models were further adjusted for physical activity and cognitive function. The effects of green space on all-cause and circulatory system-caused mortality tended to be stronger in females than in males. Conclusion Higher coverage of green space was associated with reduced risks of all-cause mortality, circulatory system-caused mortality and stroke-caused mortality in Chinese older people living in a highly urbanised city. PMID:28765127

Economic distress and cause-of-death patterns for black and non-black men in Chicago: reconsidering the relevance of classic epidemiological transition theory.

PubMed

Palazzo, Lorella; Guest, Avery; Almgren, Gunnar

2003-01-01

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

Effects of leisure-time and occupational physical activity on total mortality risk in NHANES III according to sex, ethnicity, central obesity, and age.

PubMed

Richard, Aline; Martin, Brian; Wanner, Miriam; Eichholzer, Monika; Rohrmann, Sabine

2015-02-01

Associations of physical activity with all-cause mortality seem to be quite strong, but little is known about potential effect modifiers as sex, race/ethnicity, age, and obesity. Data of the Third National Health and Nutrition Examination Survey (NHANES III), conducted 1988-1994 with mortality follow-up until 2006, were used to compare mortality risk between different levels of leisure-time physical activity (LTPA) and occupational physical activity (OPA). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). LTPA (n = 15,307) was inversely associated with all-cause mortality (HR 0.75, 95% CI 0.64-0.88 for regular vs. no LTPA). There was a statistically significant interaction with age (P = .03), with participants over 60 years of age benefitting more from regular or irregular LTPA. OPA was positively associated with all-cause mortality (HR 1.25, 95% CI 0.85-1.84 for high vs. low OPA), particularly among Mexican-Americans (HR 2.28, 95% CI 1.23-4.22); statistically significant interactions were observed for obesity and gender. LTPA clearly predicts all-cause mortality. However, associations between OPA and all-cause mortality are unclear and need further research with special regard to ethnic differences.

Higher carbohydrate intake is associated with increased risk of all-cause and disease-specific mortality in head and neck cancer patients: results from a prospective cohort study.

PubMed

Arthur, Anna E; Goss, Amy M; Demark-Wahnefried, Wendy; Mondul, Alison M; Fontaine, Kevin R; Chen, Yi Tang; Carroll, William R; Spencer, Sharon A; Rogers, Laura Q; Rozek, Laura S; Wolf, Gregory T; Gower, Barbara A

2018-03-31

No studies have evaluated associations between carbohydrate intake and head and neck squamous cell carcinoma (HNSCC) prognosis. We prospectively examined associations between pre- and post-treatment carbohydrate intake and recurrence, all-cause mortality, and HNSCC-specific mortality in a cohort of 414 newly diagnosed HNSCC patients. All participants completed pre- and post-treatment Food Frequency Questionnaires (FFQs) and epidemiologic surveys. Recurrence and mortality events were collected annually. Multivariable Cox Proportional Hazards models tested associations between carbohydrate intake (categorized into low, medium and high intake) and time to recurrence and mortality, adjusting for relevant covariates. During the study period, there were 70 deaths and 72 recurrences. In pretreatment analyses, high intakes of total carbohydrate (HR: 2.29; 95% CI: 1.23-4.25), total sugar (HR: 3.03; 95% CI: 1.12-3.68), glycemic load (HR: 2.10; 95% CI: 1.15-3.83) and simple carbohydrates (HR 2.26; 95% CI 1.19-4.32) were associated with significantly increased risk of all-cause mortality compared to low intake. High intakes of carbohydrate (HR 2.45; 95% CI: 1.23-4.25) and total sugar (HR 3.03; 95% CI 1.12-3.68) were associated with increased risk of HNSCC-specific mortality. In post-treatment analyses, medium fat intake was significantly associated with reduced risk of recurrence (HR 0.08; 95% CI 0.01-0.69) and all-cause mortality (HR 0.27; 95% CI 0.07-0.96). Stratification by tumor site and cancer stage in pretreatment analyses suggested effect modification by these factors. Our data suggest high pretreatment carbohydrate intake may be associated with adverse prognosis in HNSCC patients. Clinical intervention trials to further examine this hypothesis are warranted. © 2018 UICC.

Excess cause-specific mortality in in-patient-treated individuals with personality disorder: 25-year nationwide population-based study.

PubMed

Björkenstam, Emma; Björkenstam, Charlotte; Holm, Herman; Gerdin, Bengt; Ekselius, Lisa

2015-10-01

Although personality disorders are associated with increased overall mortality, less is known about cause of death and personality type. To determine causes of mortality in ICD personality disorders. Based on data from Swedish nationwide registers, individuals admitted to hospital with a primary diagnosis of personality disorder between 1987 and 2011 were followed with respect to mortality until 31 December 2011. Standardised mortality ratios (SMRs) with 95% confidence intervals and underlying causes of death were calculated. All-cause SMRs were increased, overall and in all clusters, for natural as well as unnatural causes of death. The overall SMR was 6.1 in women and 5.0 in men, as high as previously reported for anorexia nervosa, with higher rates in cluster B and mixed/other personality disorders. The SMR for suicide was 34.5 in women and 16.0 in men for cluster B disorders. Somatic and psychiatric comorbidity increased SMRs. The SMR was substantially increased for all personality disorder clusters. Thus, there was an increased premature mortality risk for all personality disorders, irrespective of category. © The Royal College of Psychiatrists 2015.

Mortality associated with phaeochromocytoma.

PubMed

Prejbisz, A; Lenders, J W M; Eisenhofer, G; Januszewicz, A

2013-02-01

Two major categories of mortality are distinguished in patients with phaeochromocytoma. First, the effects of excessive circulating catecholamines may result in lethal complications if the disease is not diagnosed and/or treated timely. The second category of mortality is related to development of metastatic disease or other neoplasms. Improvements in disease recognition and diagnosis over the past few decades have reduced mortality from undiagnosed tumours. Nevertheless, many tumours remain unrecognised until they cause severe complications. Death resulting from unrecognised or untreated tumour is caused by cardiovascular complications. There are also numerous drugs and diagnostic or therapeutic manipulations that can cause fatal complications in patients with phaeochromocytoma. Previously it has been reported that operative mortality was as high as 50% in unprepared patients with phaeochromocytoma who were operated and in whom the diagnosis was unsuspected. Today mortality during surgery in medically prepared patients with the tumour is minimal. Phaeochromocytomas may be malignant at presentation or metastases may develop later, but both scenarios are associated with a potentially lethal outcome. Patients with phaeochromocytoma run an increased risk to develop other tumours, resulting in an increased mortality risk compared to the general population. Phaeochromocytoma during pregnancy represents a condition with potentially high maternal and foetal mortality. However, today phaeochromocytoma in pregnancy is recognised earlier and in conjunction with improved medical management, maternal mortality has decreased to less than 5%. © Georg Thieme Verlag KG Stuttgart · New York.

Oral health in relation to all-cause mortality: the IPC cohort study.

PubMed

Adolph, Margaux; Darnaud, Christelle; Thomas, Frédérique; Pannier, Bruno; Danchin, Nicolas; Batty, G David; Bouchard, Philippe

2017-03-15

We evaluated the association between oral health and mortality. The study population comprised 76,188 subjects aged 16-89 years at recruitment. The mean follow-up time was 3.4 ± 2.4 years. Subjects with a personal medical history of cancer or cardiovascular disease and death by casualty were excluded from the analysis. A full-mouth clinical examination was performed in order to assess dental plaque, dental calculus and gingival inflammation. The number of teeth and functional masticatory units <5 were recorded. Causes of death were ascertained from death certificates. Mortality risk was evaluated using Cox regression model with propensity score calibrated for each oral exposure. All-cause mortality risk were raised with dental plaque, gingival inflammation, >10 missing teeth and functional masticatory units <5. All-cancer mortality was positively associated with dental plaque and gingival inflammation. Non-cardiovascular and non-cancer mortality were also positively associated with high dental plaque (HR = 3.30, [95% CI: 1.76-6.17]), high gingival inflammation (HR = 2.86, [95% CI: 1.71-4.79]), >10 missing teeth (HR = 2.31, [95% CI: 1.40-3.82]) and functional masticatory units <5 (HR = 2.40 [95% CI 1.55-3.73]). Moreover, when ≥3 oral diseases were cumulated in the model, the risk increased for all-cause mortality (HR = 3.39, [95% CI: 2.51-5.42]), all-cancer mortality (HR = 3.59, [95% CI: 1.23-10.05]) and non-cardiovascular and non-cancer mortality (HR = 4.71, [95% CI: 1.74-12.7]). The present study indicates a postive linear association between oral health and mortality.

Impact of persistence and non-persistence in leisure time physical activity on coronary heart disease and all-cause mortality: The Copenhagen City Heart Study.

PubMed

Schnohr, Peter; O'Keefe, James H; Lange, Peter; Jensen, Gorm Boje; Marott, Jacob Louis

2017-10-01

Aims The aim of this study was to investigate the impact of persistence and non-persistence in leisure time physical activity on coronary heart disease and all-cause mortality. Methods and results In the Copenhagen City Heart Study, we prospectively followed 12,314 healthy subjects for 33 years of maximum follow-up with at least two repeated measures of physical activity. The association between persistence and non-persistence in leisure time physical activity, coronary heart disease and all-cause mortality were assessed by multivariable Cox regression analyses. Coronary heart disease mortality for persistent physical activity in leisure compared to persistent sedentary activity were: light hazard ratio (HR) 0.76; 95% confidence interval (CI) 0.63-0.92, moderate HR 0.52; 95% CI 0.41-0.67, and high physical activity HR 0.51; 95% CI, 0.30-0.88. The differences in longevity were 2.8 years for light, 4.5 years for moderate and 5.5 years for high physical activity. A substantial increase in physical activity was associated with lower coronary heart disease mortality (HR 0.75; 95% CI 0.52-1.08) corresponding to 2.4 years longer life, whereas a substantial decrease in physical activity was associated with higher coronary heart disease mortality (HR 1.61; 95% CI 1.11-2.33) corresponding to 4.2 years shorter life than the unchanged group. A similar pattern was observed for all-cause mortality. Conclusion We found inverse dose-response relationships between persistent leisure time physical activity and both coronary heart disease and all-cause mortality. A substantial increase in physical activity was associated with a significant gain in longevity, whereas a decrease in physical activity was associated with even greater loss of longevity.

Part 2. Association of daily mortality with ambient air pollution, and effect modification by extremely high temperature in Wuhan, China.

PubMed

Qian, Zhengmin; He, Qingci; Lin, Hung-Mo; Kong, Lingli; Zhou, Dunjin; Liang, Shengwen; Zhu, Zhichao; Liao, Duanping; Liu, Wenshan; Bentley, Christy M; Dan, Jijun; Wang, Beiwei; Yang, Niannian; Xu, Shuangqing; Gong, Jie; Wei, Hongming; Sun, Huilin; Qin, Zudian

2010-11-01

Fewer studies have been published on the association between daily mortality and ambient air pollution in Asia than in the United States and Europe. This study was undertaken in Wuhan, China, to investigate the acute effects of air pollution on mortality with an emphasis on particulate matter (PM*). There were three primary aims: (1) to examine the associations of daily mortality due to all natural causes and daily cause-specific mortality (cardiovascular [CVD], stroke, cardiac [CARD], respiratory [RD], cardiopulmonary [CP], and non-cardiopulmonary [non-CP] causes) with daily mean concentrations (microg/m3) of PM with an aerodynamic diameter--10 pm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), or ozone (O3); (2) to investigate the effect modification of extremely high temperature on the association between air pollution and daily mortality due to all natural causes and daily cause-specific mortality; and (3) to assess the uncertainty of effect estimates caused by the change in International Classification of Disease (ICD) coding of mortality data from Revision 9 (ICD-9) to Revision 10 (ICD-10) code. Wuhan is called an "oven city" in China because of its extremely hot summers (the average daily temperature in July is 37.2 degrees C and maximum daily temperature often exceeds 40 degrees C). Approximately 4.5 million residents live in the core city area of 201 km2, where air pollution levels are higher and ranges are wider than the levels in most cities studied in the published literature. We obtained daily mean levels of PM10, SO2, and NO2 concentrations from five fixed-site air monitoring stations operated by the Wuhan Environmental Monitoring Center (WEMC). O3 data were obtained from two stations, and 8-hour averages, from 10:00 to 18:00, were used. Daily mortality data were obtained from the Wuhan Centres for Disease Prevention and Control (WCDC) during the study period of July 1, 2000, to June 30, 2004. To achieve the first aim, we used a regression of the logarithm of daily counts of mortality due to all natural causes and cause-specific mortality on the daily mean concentrations of the four pollutants while controlling for weather, temporal factors, and other important covariates with generalized additive models (GAMs). We derived pollutant effect estimations for 0-day, 1-day, 2-day, 3-day, and 4-day lagged exposure levels, and the averages of 0-day and 1-day lags (lag 0-1 day) and of 0-day, 1-day, 2-day, and 3-day lags (lag 0-3 days) before the event of death. In addition, we used individual-level data (e.g., age and sex) to classify subgroups in stratified analyses. Furthermore, we explored the nonlinear shapes ("thresholds") of the exposure-response relations. To achieve the second aim, we tested the hypothesis that extremely high temperature modifies the associations between air pollution and daily mortality. We developed three corresponding weather indicators: "extremely hot," "extremely cold," and "normal temperatures." The estimates were obtained from the models for the main effects and for the pollutant-temperature interaction for each pollutant and each cause of mortality. To achieve the third aim, we conducted an additional analysis. We examined the concordance rates and kappa statistics between the ICD-9-coded mortality data and the ICD-10-coded mortality data for the year 2002. We also compared the magnitudes of the estimated effects resulting from the use of the two types of ICD-coded mortality data. In general, the largest pollutant effects were observed at lag 0-1 day. Therefore, for this report, we focused on the results obtained from the lag 0-1 models. We observed consistent associations between PM10 and mortality: every 10-microg/m3 increase in PM10 daily concentration at lag 0-1 day produced a statistically significant association with an increase in mortality due to all natural causes (0.43%; 95% confidence interval [CI], 0.24 to 0.62), CVD (0.57%; 95% CI, 0.31 to 0.84), stroke (0.57%; 95% CI, 0.25 to 0.88), CARD (0.49%; 95% CI, 0.04 to 0.94), RD (0.87%; 95% CI, 0.34 to 1.41), CP (0.52%; 95% CI, 0.27 to 0.77), and non-CP (0.30%; 95% CI, 0.05 to 0.54). In general, these effects were stronger in females than in males and were also stronger among the elderly (> or = 65 years) than among the young. The results of sensitivity testing over the range of exposures from 24.8 to 477.8 microg/m3 also suggest the appropriateness of assuming a linear relation between daily mortality and PM10. Among the gaseous pollutants, we also observed statistically significant associations of mortality with NO, and SO2, and that the estimated effects of these two pollutants were stronger than the PM10 effects. The patterns of NO2 and SO2 associations were similar to those of PM10 in terms of sex, age, and linearity. O3 was not associated with mortality. In the analysis of the effect modification of extremely high temperature on the association between air pollution and daily mortality, only the interaction of PM10 with temperature was statistically significant. Specifically, the interaction terms were statistically significant for mortality due to all natural (P = 0.014), CVD (P = 0.007), and CP (P = 0.014) causes. Across the three temperature groups, the strongest PM10 effects occurred mainly on days with extremely high temperatures for mortality due to all natural (2.20%; 95% CI, 0.74 to 3.68), CVD (3.28%; 95% CI, 1.24 to 5.37), and CP (3.02%; 95% CI, 1.03 to 5.04) causes. The weakest effects occurred at normal temperature days, with the effects on days with low temperatures in the middle. To assess the uncertainty of the effect estimates caused by the change from ICD-9-coded mortality data to ICD-10-coded mortality data, we compared the two sets of data and found high concordance rates (> 99.3%) and kappa statistics close to 1.0 (> 0.98). All effect estimates showed very little change. All statistically significant levels of the estimated effects remained unchanged. In conclusion, the findings for the aims from the current study are consistent with those in most previous studies of air pollution and mortality. The small differences between mortality effects for deaths coded using ICD-9 and ICD-10 show that the change in coding had a minimal impact on our study. Few published papers have reported synergistic effects of extremely high temperatures and air pollution on mortality, and further studies are needed. Establishing causal links between heat, PM10, and mortality will require further toxicologic and cohort studies.

The Effects of Opioid Substitution Treatment and Highly Active Antiretroviral Therapy on the Cause-Specific Risk of Mortality Among HIV-Positive People Who Inject Drugs.

PubMed

Nosyk, Bohdan; Min, Jeong E; Evans, Elizabeth; Li, Libo; Liu, Lei; Lima, Viviane D; Wood, Evan; Montaner, Julio S G

2015-10-01

Prior studies indicated opioid substitution treatment (OST) reduces mortality risk and improves the odds of accessing highly active antiretroviral therapy (HAART); however, the relative effects of these treatments for human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) are unclear. We determine the independent and joint effects of OST and HAART on mortality, by cause, within a population of HIV-positive PWID initiating HAART. Using a linked population-level database for British Columbia, Canada, we used time-to-event analytic methods, including competing risks models, proportional hazards models with time-varying covariates, and marginal structural models, to identify the independent and joint effects of OST and HAART on all-cause as well as drug- and HIV-related mortality, controlling for covariates. Among 1727 HIV-positive PWID, 493 (28.5%) died during a median 5.1 years (interquartile range, 2.1-9.1) of follow-up: 18.7% due to drug-related causes, 55.8% due to HIV-related causes, and 25.6% due to other causes. Standardized mortality ratios were 12.2 (95% confidence interval [CI], 9.8, 15.0) during OST and 30.0 (27.1, 33.1) during periods out of OST. Both OST (adjusted hazard, 0.34; 95% CI, .23, .49) and HAART (0.39 [0.31, 0.48]) decreased the hazard of all-cause mortality; however, individuals were at lowest risk of death when these medications were used jointly (0.16 [0.10, 0.26]). Both OST and HAART independently protected against HIV-related death, drug-related death and death due to other causes. While both OST and HAART are life-saving treatments, joint administration is urgently needed to protect against both drug- and HIV-related mortality. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Socioeconomic status in relation to Parkinson's disease risk and mortality: A population-based prospective study.

PubMed

Yang, Fei; Johansson, Anna L V; Pedersen, Nancy L; Fang, Fang; Gatz, Margaret; Wirdefeldt, Karin

2016-07-01

Little is known about the role of socioeconomic status in relation to Parkinson's disease (PD) risk, and no study has investigated whether the impact of socioeconomic status on all-cause mortality differs between individuals with and without PD.In this population-based prospective study, over 4.6 million Swedish inhabitants who participated in the Swedish census in 1980 were followed from 1981 to 2010. The incidence rate of PD and incidence rate ratio were estimated for the association between socioeconomic status and PD risk. Age-standardized mortality rate and hazard ratio (HR) were estimated for the association between socioeconomic status and all-cause mortality for individuals with and without PD.During follow-up, 66,332 incident PD cases at a mean age of 76.0 years were recorded. Compared to individuals with the highest socioeconomic status (high nonmanual workers), all other socioeconomic groups (manual or nonmanual and self-employed workers) had a lower PD risk. All-cause mortality rates were higher in individuals with lower socioeconomic status compared with high nonmanual workers, but relative risks for all-cause mortality were lower in PD patients than in non-PD individuals (e.g., for low manual workers, HR: 1.12, 95% confidence interval [CI]: 1.09-1.15 for PD patients; HR: 1.36, 95% CI: 1.35-1.36 for non-PD individuals).Individuals with lower socioeconomic status had a lower PD incidence compared to the highest socioeconomic group. Lower socioeconomic status was associated with higher all-cause mortality among individuals with and without PD, but such impact was weaker among PD patients.

A Survey of Antiviral Drugs for Bioweapons: Review

DTIC Science & Technology

2005-01-01

person . An attack with these viruses would result in high morbidity and mortality and cause widespread panic. With the exception of smallpox and...infected cells and are not dependent upon the host cell nucleus. Possible targets for these viruses are the DNA polymerase, virus -encoded immune modulators... person to person . An attack with these viruses would result in high morbidity and mortality and cause widespread panic. With the

Precisely Tracking Childhood Death.

PubMed

Farag, Tamer H; Koplan, Jeffrey P; Breiman, Robert F; Madhi, Shabir A; Heaton, Penny M; Mundel, Trevor; Ordi, Jaume; Bassat, Quique; Menendez, Clara; Dowell, Scott F

2017-07-01

Little is known about the specific causes of neonatal and under-five childhood death in high-mortality geographic regions due to a lack of primary data and dependence on inaccurate tools, such as verbal autopsy. To meet the ambitious new Sustainable Development Goal 3.2 to eliminate preventable child mortality in every country, better approaches are needed to precisely determine specific causes of death so that prevention and treatment interventions can be strengthened and focused. Minimally invasive tissue sampling (MITS) is a technique that uses needle-based postmortem sampling, followed by advanced histopathology and microbiology to definitely determine cause of death. The Bill & Melinda Gates Foundation is supporting a new surveillance system called the Child Health and Mortality Prevention Surveillance network, which will determine cause of death using MITS in combination with other information, and yield cause-specific population-based mortality rates, eventually in up to 12-15 sites in sub-Saharan Africa and south Asia. However, the Gates Foundation funding alone is not enough. We call on governments, other funders, and international stakeholders to expand the use of pathology-based cause of death determination to provide the information needed to end preventable childhood mortality.

Different impacts of hypertension and diabetes mellitus on all-cause and cardiovascular mortality in community-dwelling older adults: the Rancho Bernardo Study.

PubMed

Oh, Jee-Young; Allison, Matthew A; Barrett-Connor, Elizabeth

2017-01-01

Although the prevalence rates of hypertension (HTN) and diabetes mellitus are slowing in some high-income countries, HTN and diabetes mellitus remain as the two major risk factors for atherosclerotic cardiovascular disease (CVD), the leading cause of death in the United States and worldwide. We aimed to observe the association of HTN and diabetes mellitus with all-cause and CVD mortality in older white adults. All community-dwelling Rancho Bernardo Study participants who were at least 55 years old and had carefully measured blood pressure and plasma glucose from 75-g oral glucose tolerance test at the baseline visit (1984-1987, n = 2186) were followed up until death or the last clinic visit in 2013 (median 14.3 years, interquartile range 8.4-21.3). In unadjusted analyses, diabetes mellitus was associated with all-cause mortality [hazard ratio 1.40, 95% confidence interval (CI) 1.23-1.60] and CVD mortality (hazard ratio 1.67, 95% CI 1.39-2.00); HTN with all-cause mortality [hazard ratio 1.93 (1.73-2.15)] and CVD mortality [hazard ratio 2.45 (2.10-2.93)]. After adjustment for cardiovascular risk factors, including age, BMI, triglycerides, HDL-cholesterol, smoking, exercise, and alcohol consumption, diabetes mellitus was associated with CVD mortality only (hazard ratio 1.25, P = 0.0213). Conversely, HTN was associated with both all-cause (hazard ratio 1.34, P < 0.0001) and CVD mortality (hazard ratio 1.40, P = 0.0003). Having both diabetes mellitus and HTN was associated with all-cause (hazard ratio 1.38, P = 0.0002) and CVD mortality (hazard ratio 1.70, P < 0.0001). We report the novel finding that HTN is more strongly associated with all-cause and CVD mortality than diabetes mellitus. Having both confers a modest increase in the hazards for these types of mortality.

Asymmetric and Symmetric Dimethylarginine as Risk Markers for Total Mortality and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Studies

PubMed Central

Schlesinger, Sabrina; Sonntag, Svenja R.

2016-01-01

Background A growing number of studies linked elevated concentrations of circulating asymmetric (ADMA) and symmetric (SDMA) dimethylarginine to mortality and cardiovascular disease (CVD) events. To summarize the evidence, we conducted a systematic review and quantified associations of ADMA and SDMA with the risks of all-cause mortality and incident CVD in meta-analyses accounting for different populations and methodological approaches of the studies. Methods Relevant studies were identified in PubMed until February 2015. We used random effect models to obtain summary relative risks (RR) and 95% confidence intervals (95%CIs), comparing top versus bottom tertiles. Dose-response relations were assessed by restricted cubic spline regression models and potential non-linearity was evaluated using a likelihood ratio test. Heterogeneity between subgroups was assessed by meta-regression analysis. Results For ADMA, 34 studies (total n = 32,428) investigating associations with all-cause mortality (events = 5,035) and 30 studies (total n = 30,624) investigating the association with incident CVD (events = 3,396) were included. The summary RRs (95%CI) for all-cause mortality were 1.52 (1.37–1.68) and for CVD 1.33 (1.22–1.45), comparing high versus low ADMA concentrations. Slight differences were observed across study populations and methodological approaches, with the strongest association of ADMA being reported with all-cause mortality in critically ill patients. For SDMA, 17 studies (total n = 18,163) were included for all-cause mortality (events = 2,903), and 13 studies (total n = 16,807) for CVD (events = 1,534). High vs. low levels of SDMA, were associated with increased risk of all-cause mortality [summary RR (95%CI): 1.31 (1.18–1.46)] and CVD [summary RR (95%CI): 1.36 (1.10–1.68) Strongest associations were observed in general population samples. Conclusions The dimethylarginines ADMA and SDMA are independent risk markers for all-cause mortality and CVD across different populations and methodological approaches. PMID:27812151

Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality.

PubMed

Song, Mingyang; Fung, Teresa T; Hu, Frank B; Willett, Walter C; Longo, Valter D; Chan, Andrew T; Giovannucci, Edward L

2016-10-01

Defining what represents a macronutritionally balanced diet remains an open question and a high priority in nutrition research. Although the amount of protein may have specific effects, from a broader dietary perspective, the choice of protein sources will inevitably influence other components of diet and may be a critical determinant for the health outcome. To examine the associations of animal and plant protein intake with the risk for mortality. This prospective cohort study of US health care professionals included 131 342 participants from the Nurses' Health Study (1980 to end of follow-up on June 1, 2012) and Health Professionals Follow-up Study (1986 to end of follow-up on January 31, 2012). Animal and plant protein intake was assessed by regularly updated validated food frequency questionnaires. Data were analyzed from June 20, 2014, to January 18, 2016. Hazard ratios (HRs) for all-cause and cause-specific mortality. Of the 131 342 participants, 85 013 were women (64.7%) and 46 329 were men (35.3%) (mean [SD] age, 49 [9] years). The median protein intake, as assessed by percentage of energy, was 14% for animal protein (5th-95th percentile, 9%-22%) and 4% for plant protein (5th-95th percentile, 2%-6%). After adjusting for major lifestyle and dietary risk factors, animal protein intake was not associated with all-cause mortality (HR, 1.02 per 10% energy increment; 95% CI, 0.98-1.05; P for trend = .33) but was associated with higher cardiovascular mortality (HR, 1.08 per 10% energy increment; 95% CI, 1.01-1.16; P for trend = .04). Plant protein was associated with lower all-cause mortality (HR, 0.90 per 3% energy increment; 95% CI, 0.86-0.95; P for trend < .001) and cardiovascular mortality (HR, 0.88 per 3% energy increment; 95% CI, 0.80-0.97; P for trend = .007). These associations were confined to participants with at least 1 unhealthy lifestyle factor based on smoking, heavy alcohol intake, overweight or obesity, and physical inactivity, but not evident among those without any of these risk factors. Replacing animal protein of various origins with plant protein was associated with lower mortality. In particular, the HRs for all-cause mortality were 0.66 (95% CI, 0.59-0.75) when 3% of energy from plant protein was substituted for an equivalent amount of protein from processed red meat, 0.88 (95% CI, 0.84-0.92) from unprocessed red meat, and 0.81 (95% CI, 0.75-0.88) from egg. High animal protein intake was positively associated with cardiovascular mortality and high plant protein intake was inversely associated with all-cause and cardiovascular mortality, especially among individuals with at least 1 lifestyle risk factor. Substitution of plant protein for animal protein, especially that from processed red meat, was associated with lower mortality, suggesting the importance of protein source.

Association between all-cause mortality and severity of depressive symptoms in patients with type 2 diabetes: Analysis from the Japan Diabetes Complications Study (JDCS).

PubMed

Matsunaga, Satoshi; Tanaka, Shiro; Fujihara, Kazuya; Horikawa, Chika; Iimuro, Satoshi; Kitaoka, Masafumi; Sato, Asako; Nakamura, Jiro; Haneda, Masakazu; Shimano, Hitoshi; Akanuma, Yasuo; Ohashi, Yasuo; Sone, Hirohito

2017-08-01

The aims of this study are to confirm whether the excess mortality caused by depressive symptoms is independent of severe hypoglycemia in patients with type 2 diabetes mellitus (T2DM) and to evaluate the association between all-cause mortality and degrees of severity of depressive symptoms in Japanese patients with T2DM. A total of 1160 Japanese patients with T2DM were eligible for this analysis. Participants were followed prospectively for 3years and their depressive states were evaluated at baseline by the Center for Epidemiologic Studies Depression Scale (CES-D). Cox proportional hazards model was used to evaluate the relative risk of all-cause mortality and was adjusted by possible confounding factors, including severe hypoglycemia, all of which are known as risk factors for both depression and mortality. After adjustment for severe hypoglycemia, each 5-point increase in the CES-D score was significantly associated with excess all-cause mortality (hazard ratio 1.69 [95% CI 1.26-2.17]). The spline curve of HRs for mortality according to total CES-D scores showed that mortality risk was slightly increased at lower scores but was sharply elevated at higher scores. A high score on the CES-D at baseline was significantly associated with all-cause mortality in patients with T2DM after adjusting for confounders including severe hypoglycemia. However, only a small effect on mortality risk was found at relatively lower levels of depressive symptoms in this population. Further research is needed to confirm this relationship between the severity of depressive symptoms and mortality in patients with T2DM. Copyright © 2017 Elsevier Inc. All rights reserved.

Remote Detection and Modeling of Abrupt and Gradual Tree Mortality in the Southwestern USA

NASA Astrophysics Data System (ADS)

Muss, J. D.; Xu, C.; McDowell, N. G.

2014-12-01

Current climate models predict a warming and drying trend that has a high probability of increasing the frequency and spatial extent of tree mortality events. Field surveys can be used to identify, date, and attribute a cause of mortality to specific trees, but monetary and time constraints prevent broad-scale surveys, which are necessary to establish regional or global trends in tree mortality. This is significant because widespread forest mortality will likely lead to radical changes in evapotranspiration and surface albedo, which could compound climate change. While understanding the causes and mechanisms of tree mortality events is crucial, it is equally important to be able to detect and monitor mortality and subsequent changes to the ecosystem at broad spatial- and temporal-scales. Over the past five years our ability to remotely detect abrupt forest mortality events has improved greatly, but gradual events—such as those caused by drought or certain types of insects—are still difficult to identify. Moreover, it is virtually impossible to quantify the amount of mortality that has occurred within a mixed pixel. We have developed a system that fuses climate and satellite-derived spectral data to identify both the date and the agent of forest mortality events. This system has been used with Landsat time series data to detect both abrupt and general trends in tree loss that have occurred during the past quarter-century in northern New Mexico. It has also been used with MODIS data to identify pixels with a high likelihood of drought-caused tree mortality in the Southwestern US. These candidate pixels were then fed to ED-FRT, a coupled forest dynamics-radiative transfer model, to generate estimates of drought-induced. We demonstrate a multi-scale approach that can produce results that will be instrumental in advancing our understanding of tree mortality-climate feedbacks, and improve our ability to predict what forests could look like in the future.

Spatial variation of multiple air pollutants and their potential contributions to all-cause, respiratory, and cardiovascular mortality across China in 2015-2016

NASA Astrophysics Data System (ADS)

Chen, Huan; Lin, Yun; Su, Qiong; Cheng, Liqiu

2017-11-01

Association of serious air pollution with adverse health effects in China has become a matter of public concern. However, many of studies that focused on a single air pollutant or a single city in China have rarely reflected the overall potential contribution of air pollution to unfavorable health outcomes. Therefore, our study estimated the spatial variation of particulate matter (PM2.5 and PM10) and gaseous pollutants (SO2, NO2, CO, and O3). Moreover, an additive approach was conducted to evaluate their overall potential contributions to mortality across China in 2015-2016 using the exposure-response coefficients. The results showed that cities with relatively high PM2.5 and PM10 concentrations were mainly distributed in the North China Plain (NCP). The average annual PM2.5 and PM10 concentrations in the NCP was 75.0 ± 14.7 and 131.2 ± 21.6 μg m-3. The potential contributions of six air pollutants ranged from 6.5% (95% confidence interval (CI): 5.4-7.5%) to 25.7% (95% CI: 22.2-28.9%) in all-cause mortality, from 6.5% (95% CI: 4.7-8.3%) to 24.9% (95% CI: 18.6-30.9%) in respiratory mortality, and from 7.0% (95% CI: 5.3-8.6%) to 29.5% (95% CI: 24.3-34.5%) in cardiovascular mortality. Many cities with high potential contributions of the multiple air pollutants were in the NCP. NCP had the average potential contribution of 20.0% (95% CI: 17.2-22.6%) in all-cause mortality, 19.5% (95% CI: 14.5-24.3%) in respiratory mortality, and 23.0% (95% CI: 18.8-27.0%) in cardiovascular mortality. Besides, the Taklimakan Desert (TD) also had high potential contribution of 19.9% (95% CI: 17.1-22.4%) in all-cause mortality, 19.5% (95% CI: 14.3-24.3%) in respiratory mortality, and 23.5% (95% CI: 19.2-27.5%) in cardiovascular mortality.

Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era.

PubMed

Howlader, Nadia; Mariotto, Angela B; Besson, Caroline; Suneja, Gita; Robien, Kim; Younes, Naji; Engels, Eric A

2017-09-01

Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown. Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs). Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years. Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017;123:3326-34. © 2017 American Cancer Society. © 2017 American Cancer Society.

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

Road traffic related mortality in Vietnam: Evidence for policy from a national sample mortality surveillance system

PubMed Central

2012-01-01

Background Road traffic injuries (RTIs) are among the leading causes of mortality in Vietnam. However, mortality data collection systems in Vietnam in general and for RTIs in particular, remain inconsistent and incomplete. Underlying distributions of external causes and body injuries are not available from routine data collection systems or from studies till date. This paper presents characteristics, user type pattern, seasonal distribution, and causes of 1,061 deaths attributable to road crashes ascertained from a national sample mortality surveillance system in Vietnam over a two-year period (2008 and 2009). Methods A sample mortality surveillance system was designed for Vietnam, comprising 192 communes in 16 provinces, accounting for approximately 3% of the Vietnamese population. Deaths were identified from commune level data sources, and followed up by verbal autopsy (VA) based ascertainment of cause of death. Age-standardised mortality rates from RTIs were computed. VA questionnaires were analysed in depth to derive descriptive characteristics of RTI deaths in the sample. Results The age-standardized mortality rates from RTIs were 33.5 and 8.5 per 100,000 for males and females respectively. Majority of deaths were males (79%). Seventy three percent of all deaths were aged from 15 to 49 years and 58% were motorcycle users. As high as 80% of deaths occurred on the day of injury, 42% occurred prior to arrival at hospital, and a further 29% occurred on-site. Direct causes of death were identified for 446 deaths (42%) with head injuries being the most common cause attributable to road traffic injuries overall (79%) and to motorcycle crashes in particular (78%). Conclusion The VA method can provide a useful data source to analyse RTI mortality. The observed considerable mortality from head injuries among motorcycle users highlights the need to evaluate current practice and effectiveness of motorcycle helmet use in Vietnam. The high number of deaths occurring on-site or prior to hospital admission indicates a need for effective pre-hospital first aid services and timely access to emergency facilities. In the absence of standardised death certification, sustained efforts are needed to strengthen mortality surveillance sites supplemented by VA to support evidence based monitoring and control of RTI mortality. PMID:22838959

Mortality due to noncommunicable diseases in Brazil, 1990 to 2015, according to estimates from the Global Burden of Disease study.

PubMed

Malta, Deborah Carvalho; França, Elisabeth; Abreu, Daisy Maria Xavier; Perillo, Rosângela Durso; Salmen, Maíra Coube; Teixeira, Renato Azeredo; Passos, Valeria; Souza, Maria de Fátima Marinho; Mooney, Meghan; Naghavi, Mohsen

2017-01-01

Noncommunicable diseases (NCDs) are the leading health problem globally and generate high numbers of premature deaths and loss of quality of life. The aim here was to describe the major groups of causes of death due to NCDs and the ranking of the leading causes of premature death between 1990 and 2015, according to the Global Burden of Disease (GBD) 2015 study estimates for Brazil. Cross-sectional study covering Brazil and its 27 federal states. This was a descriptive study on rates of mortality due to NCDs, with corrections for garbage codes and underreporting of deaths. This study shows the epidemiological transition in Brazil between 1990 and 2015, with increasing proportional mortality due to NCDs, followed by violence, and decreasing mortality due to communicable, maternal and neonatal causes within the global burden of diseases. NCDs had the highest mortality rates over the whole period, but with reductions in cardiovascular diseases, chronic respiratory diseases and cancer. Diabetes increased over this period. NCDs were the leading causes of premature death (30 to 69 years): ischemic heart diseases and cerebrovascular diseases, followed by interpersonal violence, traffic injuries and HIV/AIDS. The decline in mortality due to NCDs confirms that improvements in disease control have been achieved in Brazil. Nonetheless, the high mortality due to violence is a warning sign. Through maintaining the current decline in NCDs, Brazil should meet the target of 25% reduction proposed by the World Health Organization by 2025.

Has patient survival following renal transplantation improved in the era of modern immunosuppression?

PubMed

Hernández, Domingo; Moreso, Francesc

2013-01-01

Renal transplantation (TX) is the treatment of choice in the majority of patients with chronic kidney disease. But, these patients have a high mortality rate with respect to the general population despite new immunosuppression treatments and improved clinical management. This justifies that the excellent results obtained in the short terms do not have a parallel clinical benefit in the long term. This worrying situation is probably due to a high prevalence of cardiovascular conditions and infectious and neoplastic entities amongst this population against a backdrop of immunosuppression treatment. Furthermore, there is interaction between these processes, which share causal factors and common pathogenic mechanisms. Mortality thus increases. Therefore, identifying the causes of death and the risk factors, applying morbidity and mortality predictive models and intervening in causal factors could constitute some of the strategies for improving renal transplantation results in terms of survival. This review analyses some of the evidence conditioning this high mortality rate following TX, as well and the therapeutic and prognostic aspects associated with co-morbidity: 1) Magnitude of the problem and causes of death among sufferers; 2) Identification of mortality risk factors; 3) Therapeutic strategies for decrease post-TX mortality and; 4) Prediction of mortality and ischaemic heart disease.

Widening socioeconomic inequalities in mortality in six Western European countries.

PubMed

Mackenbach, Johan P; Bos, Vivian; Andersen, Otto; Cardano, Mario; Costa, Giuseppe; Harding, Seeromanie; Reid, Alison; Hemström, Orjan; Valkonen, Tapani; Kunst, Anton E

2003-10-01

During the past decades a widening of the relative gap in death rates between upper and lower socioeconomic groups has been reported for several European countries. Although differential mortality decline for cardiovascular diseases has been suggested as an important contributory factor, it is not known what its quantitative contribution was, and to what extent other causes of death have contributed to the widening gap in total mortality. We collected data on mortality by educational level and occupational class among men and women from national longitudinal studies in Finland, Sweden, Norway, Denmark, England/Wales, and Italy (Turin), and analysed age-standardized death rates in two recent time periods (1981-1985 and 1991-1995), both total mortality and by cause of death. For simplicity, we report on inequalities in mortality between two broad socioeconomic groups (high and low educational level, non-manual and manual occupations). Relative inequalities in total mortality have increased in all six countries, but absolute differences in total mortality were fairly stable, with the exception of Finland where an increase occurred. In most countries, mortality from cardiovascular diseases declined proportionally faster in the upper socioeconomic groups. The exception is Italy (Turin) where the reverse occurred. In all countries with the exception of Italy (Turin), changes in cardiovascular disease mortality contributed about half of the widening relative gap for total mortality. Other causes also made important contributions to the widening gap in total mortality. For these causes, widening inequalities were sometimes due to increasing mortality rates in the lower socioeconomic groups. We found rising rates of mortality from lung cancer, breast cancer, respiratory disease, gastrointestinal disease, and injuries among men and/or women in lower socioeconomic groups in several countries. Reducing socioeconomic inequalities in mortality in Western Europe critically depends upon speeding up mortality declines from cardiovascular diseases in lower socioeconomic groups, and countering mortality increases from several other causes of death in lower socioeconomic groups.

All-cause mortality and its risk factors among type 1 and type 2 diabetes mellitus in a country facing diabetes epidemic.

PubMed

Al-Rubeaan, Khalid; Youssef, Amira M; Ibrahim, Heba M; Al-Sharqawi, Ahmad H; AlQumaidi, Hamid; AlNaqeb, Dhekra; Aburisheh, Khaled H

2016-08-01

Diabetes mellitus is associated with an increased risk of premature death mainly secondary to macrovascular and microvascular complications. Mortality data from the Eastern Mediterranean region known for its high diabetes prevalence are lacking. We aimed to assess all-cause mortality and its predictors using large cohort from the Saudi National Diabetes Registry (SNDR). The study population comprised of 40,827 individuals with type 1 and type 2 diabetes mellitus aged ⩾25years registered in SNDR between January 2007 and December 2013. All patients were followed until death, according to the date of death or reaching 100years of age or end of the study. Death was verified from the national civil affairs database. The general population during the study period was used as a reference for standardized mortality ratio (SMR) calculation. With a total of 152,038 person-years of follow up, 2582 patients were deceased giving all-cause mortality rate of 16.98 per 1000 person-years and SMR (95% CI) of 1.93 (1.86-2.00). Mortality rates were higher among men and increased with age, while SMR attenuated with increasing age. The independent predictors for all-cause mortality were longer diabetes duration, presence of macrovascular complications, nephropathy, retinopathy, hypertension, male gender and older age, while morbid obesity and the presence of hyperlipidemia were associated with reduced risk. The unexpectedly low mortality rate in this population would be associated with higher number of deaths as a result of the high prevalence of diabetes and its complications. Reducing the prevalence of diabetes and its complications would reduce the risk of mortality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Trends in the leading causes of injury mortality, Australia, Canada, and the United States, 2000-2014.

PubMed

Mack, Karin; Clapperton, Angela; Macpherson, Alison; Sleet, David; Newton, Donovan; Murdoch, James; Mackay, J Morag; Berecki-Gisolf, Janneke; Wilkins, Natalie; Marr, Angela; Ballesteros, Michael; McClure, Roderick

2017-06-16

The aim of this study was to highlight the differences in injury rates between populations through a descriptive epidemiological study of population-level trends in injury mortality for the high-income countries of Australia, Canada and the United States. Mortality data were available for the US from 2000 to 2014, and for Canada and Australia from 2000 to 2012. Injury causes were defined using the International Classification of Diseases, Tenth Revision external cause codes, and were grouped into major causes. Rates were direct-method age-adjusted using the US 2000 projected population as the standard age distribution. US motor vehicle injury mortality rates declined from 2000 to 2014 but remained markedly higher than those of Australia or Canada. In all three countries, fall injury mortality rates increased from 2000 to 2014. US homicide mortality rates declined, but remained higher than those of Australia and Canada. While the US had the lowest suicide rate in 2000, it increased by 24% during 2000-2014, and by 2012 was about 14% higher than that in Australia and Canada. The poisoning mortality rate in the US increased dramatically from 2000 to 2014. Results show marked differences and striking similarities in injury mortality between the countries and within countries over time. The observed trends differed by injury cause category. The substantial differences in injury rates between similarly resourced populations raises important questions about the role of societal-level factors as underlying causes of the differential distribution of injury in our communities.

Hypothyroidism is associated with all-cause mortality in a national cohort of chronic haemodialysis patients.

PubMed

Lin, Hsuan-Jen; Lin, Chung-Chih; Lin, Hsuan Ming; Chen, Hsuan-Ju; Lin, Che-Chen; Chang, Chiz-Tzung; Chou, Che-Yi; Huang, Chiu-Ching

2018-06-01

The prevalence of hypothyroidism is high in haemodialysis (HD) patients and hypothyroidism increases all-cause mortality in HD patients. Comorbidities are common in HD patients and are associated with both mortality and hypothyroidism. The aim of the study is to explore the effect of the interactions of comorbidities and hypothyroidism on all-cause mortality in HD patients. Patients with hypothyroidism (ICD-9-CM 244.0, 244.1, and 244.9) and matched patients without hypothyroidism in the Registry for Catastrophic Illness Patient Database of Taiwan Health Insurance from 2000 to 2010 were analyzed. The association of hypothyroidism and risk of all-cause mortality was analyzed using Cox proportional hazard regression. Nine hundred and eight HD patients with hypothyroidism and 3632 sex-, age-, gender- matched HD patients without hypothyroidism were analyzed. Hypothyroidism was associated with increased all-cause mortality with an adjusted hazard ratio of 1.22 [95% confidence interval (CI): 1.10-1.36, P < 0.001]. TRT may decrease mortality associated with hypothyroidism (P < 0.001). There was a significant interaction (P = 0.04) between diabetes and hypothyroidism. There was no significant interaction found in hypothyroidism and the following comorbidities: hyperlipidaemia, hypertension, chronic obstructive pulmonary disease, coronary artery disease, stroke, peripheral arterial disease, asthma, congestive heart failure and cancer. Hypothyroidism is associated with increased all-cause mortality in chronic HD patients. The interaction of hypothyroidism and diabetes, but not other common comorbidities in HD patients, has an effect on mortality risks. © 2017 Asian Pacific Society of Nephrology.

The injury mortality burden in Guinea

PubMed Central

2012-01-01

Background The injury mortality burden of Guinea has been rarely addressed. The paper aimed to report patterns of injury mortality burden in Guinea. Methods We retrieved the mortality data from the Guinean Annual Health Statistics Report 2007. The information about underlying cause of deaths was collected based on Guinean hospital discharge data, Hospital Mortuary and City Council Mortuary data. The causes of death are coded in the 9th International Classification of Diseases (ICD-9). Multivariate Poisson regression was used to test the impacts of sex and age on mortality rates. The statistical analyses were performed using Statatm 10.0. Results In 2007, 7066 persons were reported dying of injuries in Guinea (mortality: 72.8 per 100,000 population). Transportation, fire/burn, falls, homicide and drowning were the five leading causes of fatal injuries for the whole population, accounting for 37%, 22%, 12%, 10% and 6% of total deaths, respectively. In general, age-specific injury causes displayed similar patterns of the whole population except that poisoning replaced falls as a leading cause among children under five years old. Males were at 30-50% more risk of dying from six commonest causes than females and old age groups had higher injury mortality rates than younger age groups. Conclusion Transportation, fire/burn, falls, homicide, and drowning accounted for the majority of total injury mortality burden in Guinea. Males and old adults were high-risk population of fatal injuries and should be targeted by injury prevention. Lots of work is needed to improve weak capacities for injury control in order to reduce the injury mortality burden. PMID:22937768

Cancer incidence and all-cause mortality in a cohort of 21,582 Norwegian military peacekeepers deployed to Lebanon during 1978-1998.

PubMed

Strand, Leif Aage; Martinsen, Jan Ivar; Borud, Einar Kristian

2015-08-01

We investigated cancer incidence and all-cause mortality among 21,582 Norwegian male military peacekeepers deployed to Lebanon during 1978-1998. We also looked at cancer risk according to duration of service in Lebanon, in the occupational groups of cooks and mechanics, and the risk of alcohol- and smoking-related cancers among those who served during high- or low-conflict periods. The cohort was followed for cancer incidence and all-cause mortality from 1978 through 2012. Standardised incidence ratios (SIR) for cancer and mortality ratios (SMR) were calculated from national rates for the total cohort. SIRs were calculated according to duration of service; among cooks and mechanics; and according to high- and low-conflict exposure. Poisson regression, expressed as rate ratio (RR), was used to see the effect of duration of service, and of conflict exposure. A decreased risk was found for cancer incidence overall (1050 cases, SIR=0.90, 95% confidence interval [CI] 0.84-0.95) and for cancers of the prostate (SIR=0.78) and skin (other than melanoma) (SIR=0.58). The incidence of rectal cancer was 73% higher in those who served for 1 year or more than in those with shorter-term service (RR=1.73, 95% CI 1.00-3.02). The cancer risk in cooks and mechanics was within expected values. The risk of lung cancer was higher in the high-conflict exposure group than in the low-conflict exposure group (RR=1.79; 95% CI 1.00-3.18). In the total cohort, all-cause mortality was lower than expected (SMR=0.83; 95% CI 0.78-0.88). We found a "healthy soldier effect" for overall cancer incidence and all-cause mortality. Service during high-conflict periods was associated with a higher risk of lung cancer than service during low-conflict periods, but this risk was in line with that of the reference population. Copyright © 2015. Published by Elsevier Ltd.

Demographic, social, and economic effects on Mexican causes of death in 1990.

PubMed

Pick, J B; Butler, E W

1998-01-01

This study examined spatial geographic patterns of cause of death and 28 demographic and socioeconomic influences on causes of death for 31 Mexican states plus the Federal District for 1990. Mortality data were obtained from the state death registration system and are age standardized. The 28 socioeconomic variables were obtained from Census records. Analysis included 2 submodels: one with all 28 socioeconomic variables in a stepwise regression, and one with each of the 4 groups of factors. The conceptual model is based on epidemiological transition theory and empirical findings. There are 4 stages in mortality decline. Effects are grouped as demographic, sociocultural, economic prosperity, and housing, health, and crime factors. Findings indicate that cancer and cardiovascular disease were strongly correlated and consistently high in border areas as well as the Federal District and Jalisco. Respiratory mortality had higher values in the Federal District, Puebla, and surrounding states, as well as Jalisco. The standardized total mortality rate was only in simple correlations associated inversely with underemployment. All cause specific mortality was associated with individual factors. Respiratory mortality was linked with manufacturing work force. Cardiovascular and cancer mortality were associated with socioeconomic factors. In submodel I, cause specific mortality was predicted by crowding, housing characteristics, marriage and divorce, and manufacturing work force. In submodel II, economic group factors had the strongest model fits explaining 33-60% of the "r" square. Hypothesized effects were only partially validated.

Substance use disorders, psychiatric disorders, and mortality after release from prison: a nationwide longitudinal cohort study

PubMed Central

Chang, Zheng; Lichtenstein, Paul; Larsson, Henrik; Fazel, Seena

2015-01-01

Summary Background High mortality rates have been reported in people released from prison compared with the general population. However, few studies have investigated potential risk factors associated with these high rates, especially psychiatric determinants. We aimed to investigate the association between psychiatric disorders and mortality in people released from prison in Sweden. Methods We studied all people who were imprisoned since Jan 1, 2000, and released before Dec 31, 2009, in Sweden for risks of all-cause and external-cause (accidents, suicide, homicide) mortality after prison release. We obtained data for substance use disorders and other psychiatric disorders, and criminological and sociodemographic factors from population-based registers. We calculated hazard ratios (HRs) by Cox regression, and then used them to calculate population attributable fractions for post-release mortality. To control for potential familial confounding, we compared individuals in the study with siblings who were also released from prison, but without psychiatric disorders. We tested whether any independent risk factors improved the prediction of mortality beyond age, sex, and criminal history. Findings We identified 47 326 individuals who were imprisoned. During a median follow-up time of 5·1 years (IQR 2·6–7·5), we recorded 2874 (6%) deaths after release from prison. The overall all-cause mortality rate was 1205 deaths per 100 000 person-years. Substance use disorders significantly increased the rate of all-cause mortality (alcohol use: adjusted HR 1·62, 95% CI 1·48–1·77; drug use: 1·67, 1·53–1·83), and the association was independent of sociodemographic, criminological, and familial factors. We identified no strong evidence that other psychiatric disorders increased mortality after we controlled for potential confounders. In people released from prison, 925 (34%) of all-cause deaths in men and 85 (50%) in women were potentially attributable to substance use disorders. Substance use disorders were also an independent determinant of external-cause mortality, with population attributable fraction estimates at 42% in men and 70% in women. Substance use disorders significantly improved the prediction of external-cause mortality, in addition to sociodemographic and criminological factors. Interpretation Interventions to address substance use disorders could substantially decrease the burden of excess mortality in people released from prison, but might need to be provided beyond the immediate period after release. Funding Wellcome Trust, Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare. PMID:26360286

The use of audit to identify maternal mortality in different settings: is it just a difference between the rich and the poor?

PubMed

van Dillen, Jeroen; Stekelenburg, Jelle; Schutte, Joke; Walraven, Gijs; van Roosmalen, Jos

2007-01-01

To illustrate how maternal mortality audit identifies different causes of and contributing factors to maternal deaths in different settings in low- and high-income countries and how this can lead to local solutions in reducing maternal deaths. Descriptive study of maternal mortality from different settings and review of data on the history of reducing maternal mortality in what are now high-income countries. Kalabo district in Zambia, Farafenni division in The Gambia, Onandjokwe district in Namibia, and the Netherlands. Population of rural areas in Zambia and The Gambia, peri-urban population in Namibia and nationwide data from the Netherlands. Data from facility-based maternal mortality audits from three African hospitals and data from the latest confidential enquiry in the Netherlands. Maternal mortality ratio (MMR), causes (direct and indirect) and characteristics. MMR ranged from 10 per 100,000 (the Netherlands) to 1,540 per 100,000 (The Gambia). Differences in causes of deaths were characterized by HIV/AIDS in Namibia, sepsis and HIV/AIDS in Zambia, (pre-)eclampsia in The Netherlands and obstructed labour in The Gambia. Differences in maternal mortality are more than just differences between the rich and poor. Acknowledging the magnitude of maternal mortality and harnessing a strong political will to tackle the issues are important factors. However, there is no single, general solution to reduce maternal mortality, and identification of problems needs to be promoted through audit, both national and local.

Evaluating the Effects of Temperature on Mortality in Manila City (Philippines) from 2006–2010 Using a Distributed Lag Nonlinear Model

PubMed Central

Seposo, Xerxes T.; Dang, Tran Ngoc; Honda, Yasushi

2015-01-01

The effect of temperature on the risk of mortality has been described in numerous studies of category-specific (e.g., cause-, sex-, age-, and season-specific) mortality in temperate and subtropical countries, with consistent findings of U-, V-, and J-shaped exposure-response functions. In this study, we analyzed the relationship between temperature and mortality in Manila City (Philippines), during 2006–2010 to identify the potential susceptible populations. We collected daily all-cause and cause-specific death counts from the Philippine Statistics Authority-National Statistics Office and the meteorological variables were collected from the Philippine Atmospheric Geophysical and Astronomical Services Administration. Temperature-mortality relationships were modeled using Poisson regression combined with distributed lag nonlinear models, and were used to perform cause-, sex-, age-, and season-specific analyses. The minimum mortality temperature was 30 °C, and increased risks of mortality were observed per 1 °C increase among elderly persons (RR: 1.53, 95% CI: 1.31–1.80), women (RR: 1.47, 95% CI: 1.27–1.69), and for respiratory causes of death (RR: 1.52, 95% CI: 1.23–1.88). Seasonal effect modification was found to greatly affect the risks in the lower temperature range. Thus, the temperature-mortality relationship in Manila City exhibited an increased risk of mortality among elderly persons, women, and for respiratory-causes, with inherent effect modification in the season-specific analysis. The findings of this study may facilitate the development of public health policies to reduce the effects of air temperature on mortality, especially for these high-risk groups. PMID:26086706

Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly

PubMed Central

Ju, Sang-Yhun; Lee, June-Young; Kim, Do-Hoon

2017-01-01

Abstract There is increasing evidence regarding the relationship between metabolic syndrome and mortality. However, previous research examining metabolic syndrome and mortality in older populations has produced mixed results. In addition, there is a clear need to identify and manage individual components of metabolic syndrome to decrease cardiovascular disease (CVD) mortality. In this meta-analysis, we searched the MEDLINE databases using PubMed, Cochrane Library, and EMBASE databases. Based on 20 prospective cohort studies, metabolic syndrome was associated with a higher risk of all-cause mortality [relative risk (RR), 1.23; 95% confidence interval (CI), 1.15–1.32; I2 = 55.9%] and CVD mortality (RR, 1.24; 95% CI, 1.11–1.39; I2 = 58.1%). The risk estimates of all-cause mortality for single components of metabolic syndrome were significant for higher values of waist circumference or body mass index (RR, 0.94; 95% CI, 0.88–1.00), higher values of blood glucose (RR, 1.19; 95% CI, 1.05–1.34), and lower values of high-density lipoprotein (HDL) cholesterol (RR, 1.11; 95% CI, 1.02–1.21). In the elderly population, metabolic syndrome was associated with an increased risk of all-cause and CVD mortality. Among the individual components of metabolic syndrome, increased blood glucose and HDL cholesterol levels were significantly associated with increased mortality. However, older obese or overweight individuals may have a decreased mortality risk. Thus, the findings of the current meta-analysis raise questions about the utility of the definition of metabolic syndrome in predicting all-cause mortality and CVD mortality in the elderly population. PMID:29137039

Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly: A meta-analysis of prospective cohort studies.

PubMed

Ju, Sang-Yhun; Lee, June-Young; Kim, Do-Hoon

2017-11-01

There is increasing evidence regarding the relationship between metabolic syndrome and mortality. However, previous research examining metabolic syndrome and mortality in older populations has produced mixed results. In addition, there is a clear need to identify and manage individual components of metabolic syndrome to decrease cardiovascular disease (CVD) mortality. In this meta-analysis, we searched the MEDLINE databases using PubMed, Cochrane Library, and EMBASE databases. Based on 20 prospective cohort studies, metabolic syndrome was associated with a higher risk of all-cause mortality [relative risk (RR), 1.23; 95% confidence interval (CI), 1.15-1.32; I = 55.9%] and CVD mortality (RR, 1.24; 95% CI, 1.11-1.39; I = 58.1%). The risk estimates of all-cause mortality for single components of metabolic syndrome were significant for higher values of waist circumference or body mass index (RR, 0.94; 95% CI, 0.88-1.00), higher values of blood glucose (RR, 1.19; 95% CI, 1.05-1.34), and lower values of high-density lipoprotein (HDL) cholesterol (RR, 1.11; 95% CI, 1.02-1.21). In the elderly population, metabolic syndrome was associated with an increased risk of all-cause and CVD mortality. Among the individual components of metabolic syndrome, increased blood glucose and HDL cholesterol levels were significantly associated with increased mortality. However, older obese or overweight individuals may have a decreased mortality risk. Thus, the findings of the current meta-analysis raise questions about the utility of the definition of metabolic syndrome in predicting all-cause mortality and CVD mortality in the elderly population.

Causes of mortality in an African city.

PubMed

Ayeni, O

1980-01-01

Registered deaths from the vital statistics registration system of Lagos City, a system that was judged to be 60% complete, were analysed for the year 1977. Nearly 40% of total registered deaths were from infections, parasitic diseases and motor vehicle accidents. Of the reported deaths, 17.3% were from ill-defined conditions. Deaths from neoplasms, diseases of the nervous and sense organs, diseases of the digestive and genitourinary systems as well as those from congenital anomalies are relatively less frequent. Maternal mortality appears to be very high. The age pattern of mortality is different from that in the developed countries, a high proportion of the deaths in Lagos City being those of children aged under 5 years. Infant mortality is dominated by perinatal causes which constituted a huge 38.4% of deaths of infants under 1 year, the other important causes being dysentery and diarrhoea, pneumonia and tetanus. Among adults, death from motor vehicles accidents is the most important cause accounting for more than 26% of deaths in the age group 15 years and above. Other important causes of adult deaths are cerebrovascular disease, hypertensive disease, heart disease, pneumonia, dysentery and diarrhoea and complications of pregnancy. Well organized health services stressing antenatal care, preventive and health education services are needed to effect a reduction in mortality and bring about a general improvement in the health of the people.

Availability and quality of cause-of-death data for estimating the global burden of injuries

PubMed Central

Harrison, James E; Shahraz, Saeid; Fingerhut, Lois A

2010-01-01

Abstract Objective To assess the availability and quality of global death registration data used for estimating injury mortality. Methods The completeness and coverage of recent national death registration data from the World Health Organization mortality database were assessed. The quality of data on a specific cause of injury death was judged high if fewer than 20% of deaths were attributed to any of several partially specified causes of injury, such as “unspecified unintentional injury”. Findings Recent death registration data were available for 83 countries, comprising 28% of the global population. They included most high-income countries, most countries in Latin America and several in central Asia and the Caribbean. Categories commonly used for partially specified external causes of injury resulting in death included “undetermined intent,” “unspecified mechanism of unintentional injury,” “unspecified road injury” and “unspecified mechanism of homicide”. Only 20 countries had high-quality data. Nevertheless, because the partially specified categories do contain some information about injury mechanisms, reliable estimates of deaths due to specific external causes of injury, such as road injury, suicide and homicide, could be derived for many more countries. Conclusion Only 20 countries had high-quality death registration data that could be used for estimating injury mortality because injury deaths were frequently classified using imprecise partially specified categories. Analytical methods that can derive national estimates of injury mortality from alternative data sources are needed for countries without reliable death registration systems. PMID:21076564

Weight Loss Surgery Reduces Healthcare Resource Utilization and All-Cause Inpatient Mortality in Morbid Obesity: a Propensity-Matched Analysis.

PubMed

Krishna, Somashekar G; Rawal, Varun; Durkin, Claire; Modi, Rohan M; Hinton, Alice; Cruz-Monserrate, Zobeida; Conwell, Darwin L; Hussan, Hisham

2018-06-21

There is a lack of population studies evaluating the impact of bariatric surgery (BRS) on all-cause inpatient mortality. We sought to determine the impact of prior BRS on all-cause mortality and healthcare utilization in hospitalized patients. We analyzed the National Inpatient Sample database from 2007 to 2013. Participants were adult (≥ 18 years) inpatients admitted with a diagnosis of morbid obesity or a history of BRS. Propensity score-matched analyses were performed to compare mortality and healthcare resource utilization (hospital length of stay and cost). There were 9,044,103 patient admissions with morbid obesity and 1,066,779 with prior BRS. A propensity score-matched cohort analysis demonstrated that prior BRS was associated with decreased mortality (OR = 0.58; 95% CI [0.54, 0.63]), shorter length of stay (0.59 days; P < 0.001), and lower hospital costs ($2152; P < 0.001) compared to morbid obesity. A subgroup of propensity score-matched analysis among patients with high-risk of mortality (leading ten causes of mortality in morbid obesity) revealed a consistently significant reduction in odds of mortality for patients with prior BRS (OR = 0.82; 95% CI [0.72, 0.92]). Hospitalized patients with a history of BRS have lower all-cause mortality and healthcare resource utilization compared to those who are morbidly obese. These observations support the continued application of BRS as an effective and resource-conscious treatment for morbid obesity.

Health transition in Brazil: regional variations and divergence/convergence in mortality.

PubMed

Borges, Gabriel Mendes

2017-08-21

This study analyzes the main characteristics of the health transition in Brazil and its five major regions, using a framework that accounts for regional inequalities in mortality trends. The regional mortality divergence/convergence process is described and discussed by considering the specific contributions of age groups and causes of death in life expectancy variations. Results show that mortality change in Brazil has follow the epidemiologic transition theory to some extent during the period under analysis - for instance, the sharp decline in infant mortality in all regions (first from infectious and parasitic diseases and then from causes associated with the perinatal period) and the increase in the participation of chronic and degenerative diseases as the main cause of death. However, some features of Brazilian transition have not followed the linear and unidirectional pattern proposed by the epidemiologic transition theory, which helps to understand the periods of regional divergence in life expectancy, despite the long-term trends showing reducing regional inequalities. The emergence of HIV/AIDS, the persistence of relatively high levels of other infections and parasitic diseases, the regional differences in the unexpected mortality improvements from cardiovascular diseases, and the rapid and strong variations in mortality from external causes are some of the examples.

Knowledge gaps in scientific literature on maternal mortality: a systematic review.

PubMed Central

Gil-González, Diana; Carrasco-Portiño, Mercedes; Ruiz, Maria Teresa

2006-01-01

Issues related to maternal mortality have generated a lot of empirical and theoretical information. However, despite the amount of work published on the topic, maternal mortality continues to occur at high rates and solutions to the problem are still not clear. Scientific research on maternal mortality is focused mainly on clinical factors. However, this approach may not be the most useful if we are to understand the problem of maternal mortality as a whole and appreciate the importance of economical, political and social macrostructural factors. In this paper, we report the number of scientific studies published between 2000 and 2004 about the main causes of maternal death, as identified by WHO, and compare the proportion of papers on each cause with the corresponding burden of each cause. Secondly, we systematically review the characteristics and quality of the papers on the macrostructural determinants of maternal mortality. In view of their burden, obstructed labour, unsafe abortion and haemorrhage are proportionally underrepresented in the scientific literature. In our review, most studies analysed were cross-sectional, and were carried out by developed countries without the participation of researchers in the developing countries where maternal mortality was studied. The main macrostructural factors mentioned were socioeconomic variables. Overall, there is a lack of published information about the cultural and political determinants of maternal mortality. We believe that a high-quality scientific approach must be taken in studies of maternal mortality in order to obtain robust comparative data and that study design should be improved to allow causality between macrostructural determinants and maternal mortality to be shown. PMID:17143465

Which Biomarker is the Best for Predicting Mortality in Incident Peritoneal Dialysis Patients: NT-ProBNP, Cardiac TnT, or hsCRP?

PubMed Central

Oh, Hyung Jung; Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

2015-01-01

Abstract Although numerous previous studies have explored various biomarkers for their ability to predict mortality in end-stage renal disease (ESRD) patients, these studies have been limited by retrospective analyses, mostly prevalent dialysis patients, and the measurement of only 1 or 2 biomarkers. This prospective study was aimed to evaluate the association between 3 biomarkers and mortality in incident 335 ESRD patients starting continuous ambulatory peritoneal dialysis (CAPD) in Korea. According to the baseline NT-proBNP, cTnT, and hsCRP levels, the patients were stratified into tertiles, and cardiovascular (CV) and all-cause mortalities were compared. Additionally, time-dependent ROC curves were constructed, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) of the models with various biomarkers were calculated. We found the upper tertile of NT-proBNP was significantly associated with increased risk of both CV and all-cause mortalities. However, the upper tertile of hsCRP was significantly related only to the high risk of all-cause mortality even after adjustment for age, sex, and white blood cell counts. Moreover, NT-proBNP had the highest predictive power for CV mortality, whereas hsCRP was the best prognostic marker for all-cause mortality among these biomarkers. In conclusions, NT-proBNP is a more significant prognostic factor for CV mortality than cTnT and hsCRP, whereas hsCRP is a more significant predictor than NT-proBNP and cTnT for all-cause mortality in incident peritoneal dialysis patients. PMID:26554763

Impact of public health strategies on reducing AIDS mortality in southern Brazil.

PubMed

Raboni, Sonia M; Ribeiro, Clea E; Almeida, Sergio M; Telles, João Paulo M; Azevedo, Marcos; Schaitza, Gustavo A

2017-01-01

In Brazil, all patients who fulfill the criteria for AIDS have had free access to antiretroviral therapy since 1996. We performed this cross-sectional study to evaluate the causes of death among 643 HIV-infected patients over three non-consecutive years (2000, 2006, and 2010), using their epidemiological, clinical, and laboratory data. The causes of death were classified as AIDS-defining or non-AIDS-defining conditions. We observed a progressive increase in the prevalence of HIV infection over the study period, although there was also a decrease in the mortality rate for various groups, and especially among pediatric patients. An AIDS-defining condition was recorded as the cause of death for approximately 30% of the patients. There was also a high frequency (>70%) of infectious and parasitic diseases, including opportunistic infections, and the most common diagnoses were septicemia, pneumonia, tuberculosis, and pneumocystosis. Acute respiratory failure was the underlying cause of death in 30% of these cases. Despite advances in HIV therapy, the mortality rate remains high in Brazil. As few Brazilian studies have investigated HIV/AIDS-related mortality, it is important to evaluate and improve the mortality notification databases, in order to provide information regarding the effects of HIV and to guide the implementation of appropriate healthcare measures.

Health effects of particulate air pollution and airborne desert dust

NASA Astrophysics Data System (ADS)

Lelieveld, J.; Pozzer, A.; Giannadaki, D.; Fnais, M.

2013-12-01

Air pollution by fine particulate matter (PM2.5) has increased strongly with industrialization and urbanization. In the past decades this increase has taken place at a particularly high pace in South and East Asia. We estimate the premature mortality and the years of human life lost (YLL) caused by anthropogenic PM2.5 and airborne desert dust (DU2.5) on regional and national scales (Giannadaki et al., 2013; Lelieveld et al., 2013). This is based on high-resolution global model calculations that resolve urban and industrial regions in relatively great detail. We apply an epidemiological health impact function and find that especially in large countries with extensive suburban and rural populations, air pollution-induced mortality rates have been underestimated given that previous studies largely focused on the urban environment. We calculate a global premature mortality by anthropogenic aerosols of 2.2 million/year (YLL ≈ 16 million/year) due to lung cancer and cardiopulmonary disease. High mortality rates by PM2.5 are found in China, India, Bangladesh, Pakistan and Indonesia. Desert dust DU2.5 aerosols add about 0.4 million/year (YLL ≈ 3.6 million/year). Particularly significant mortality rates by DU2.5 occur in Pakistan, China and India. The estimated global mean per capita mortality caused by airborne particulates is about 0.1%/year (about two thirds of that caused by tobacco smoking). We show that the highest premature mortality rates are found in the Southeast Asia and Western Pacific regions (about 25% and 46% of the global rate, respectively) where more than a dozen of the most highly polluted megacities are located. References: Giannadaki, D., A. Pozzer, and J. Lelieveld, Modeled global effects of airborne desert dust on air quality and premature mortality, Atmos. Chem. Phys. Discuss. (submitted), 2013. Lelieveld, J., C. Barlas, D. Giannadaki, and A. Pozzer, Model calculated global, regional and megacity premature mortality due to air pollution by ozone and fine particulate matter, Atmos. Chem. Phys., 13, 7023-7037, 2013.

Mortality and community changes drive sudden oak death impacts on litterfall and soil nitrogen cycling.

PubMed

Cobb, Richard C; Eviner, Valerie T; Rizzo, David M

2013-10-01

Few studies have quantified pathogen impacts to ecosystem processes, despite the fact that pathogens cause or contribute to regional-scale tree mortality. We measured litterfall mass, litterfall chemistry, and soil nitrogen (N) cycling associated with multiple hosts along a gradient of mortality caused by Phytophthora ramorum, the cause of sudden oak death. In redwood forests, the epidemiological and ecological characteristics of the major overstory species determine disease patterns and the magnitude and nature of ecosystem change. Bay laurel (Umbellularia californica) has high litterfall N (0.992%), greater soil extractable NO3 -N, and transmits infection without suffering mortality. Tanoak (Notholithocarpus densiflorus) has moderate litterfall N (0.723%) and transmits infection while suffering extensive mortality that leads to higher extractable soil NO3 -N. Redwood (Sequoia sempervirens) has relatively low litterfall N (0.519%), does not suffer mortality or transmit the pathogen, but dominates forest biomass. The strongest impact of pathogen-caused mortality was the potential shift in species composition, which will alter litterfall chemistry, patterns and dynamics of litterfall mass, and increase soil NO3 -N availability. Patterns of P. ramorum spread and consequent mortality are closely associated with bay laurel abundances, suggesting this species will drive both disease emergence and subsequent ecosystem function. © 2013 The Authors. New Phytologist © 2013 New Phytologist Trust.

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.

Causes of Mortality After Dose-Escalated Radiation Therapy and Androgen Deprivation for High-Risk Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tendulkar, Rahul D., E-mail: tendulr@ccf.org; Hunter, Grant K.; Reddy, Chandana A.

Purpose: Men with high-risk prostate cancer have other competing causes of mortality; however, current risk stratification schema do not account for comorbidities. We aim to identify the causes of death and factors predictive for mortality in this population. Methods and Materials: A total of 660 patients with high-risk prostate cancer were treated with definitive high-dose external beam radiation therapy (≥74 Gy) and androgen deprivation (AD) between 1996 and 2009 at a single institution. Cox proportional hazards regression analysis was conducted to determine factors predictive of survival. Results: The median radiation dose was 78 Gy, median duration of AD was 6more » months, and median follow-up was 74 months. The 10-year overall survival (OS) was 60.6%. Prostate cancer was the leading single cause of death, with 10-year mortality of 14.1% (95% CI 10.7-17.6), compared with other cancers (8.4%, 95% CI 5.7-11.1), cardiovascular disease (7.3%, 95% CI 4.7-9.9), and all other causes (10.4%, 95% CI 7.2-13.6). On multivariate analysis, older age (HR 1.55, P=.002) and Charlson comorbidity index score (CS) ≥1 (HR 2.20, P<.0001) were significant factors predictive of OS, whereas Gleason score, T stage, prostate-specific antigen, duration of AD, radiation dose, smoking history, and body mass index were not. Men younger than 70 years of age with CS = 0 were more likely to die of prostate cancer than any other cause, whereas older men or those with CS ≥1 more commonly suffered non-prostate cancer death. The cumulative incidences of prostate cancer-specific mortality were similar regardless of age or comorbidities (P=.60). Conclusions: Men with high-risk prostate cancer are more likely to die of causes other than prostate cancer, except for the subgroup of men younger than 70 years of age without comorbidities. Only older age and presence of comorbidities significantly predicted for OS, whereas prostate cancer- and treatment-related factors did not.« less

Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis.

PubMed

Pavasini, Rita; Guralnik, Jack; Brown, Justin C; di Bari, Mauro; Cesari, Matteo; Landi, Francesco; Vaes, Bert; Legrand, Delphine; Verghese, Joe; Wang, Cuiling; Stenholm, Sari; Ferrucci, Luigi; Lai, Jennifer C; Bartes, Anna Arnau; Espaulella, Joan; Ferrer, Montserrat; Lim, Jae-Young; Ensrud, Kristine E; Cawthon, Peggy; Turusheva, Anna; Frolova, Elena; Rolland, Yves; Lauwers, Valerie; Corsonello, Andrea; Kirk, Gregory D; Ferrari, Roberto; Volpato, Stefano; Campo, Gianluca

2016-12-22

The Short Physical Performance Battery (SPPB) is a well-established tool to assess lower extremity physical performance status. Its predictive ability for all-cause mortality has been sparsely reported, but with conflicting results in different subsets of participants. The aim of this study was to perform a meta-analysis investigating the relationship between SPPB score and all-cause mortality. Articles were searched in MEDLINE, the Cochrane Library, Google Scholar, and BioMed Central between July and September 2015 and updated in January 2016. Inclusion criteria were observational studies; >50 participants; stratification of population according to SPPB value; data on all-cause mortality; English language publications. Twenty-four articles were selected from available evidence. Data of interest (i.e., clinical characteristics, information after stratification of the sample into four SPPB groups [0-3, 4-6, 7-9, 10-12]) were retrieved from the articles and/or obtained by the study authors. The odds ratio (OR) and/or hazard ratio (HR) was obtained for all-cause mortality according to SPPB category (with SPPB scores 10-12 considered as reference) with adjustment for age, sex, and body mass index. Standardized data were obtained for 17 studies (n = 16,534, mean age 76 ± 3 years). As compared to SPPB scores 10-12, values of 0-3 (OR 3.25, 95%CI 2.86-3.79), 4-6 (OR 2.14, 95%CI 1.92-2.39), and 7-9 (OR 1.50, 95%CI 1.32-1.71) were each associated with an increased risk of all-cause mortality. The association between poor performance on SPPB and all-cause mortality remained highly consistent independent of follow-up length, subsets of participants, geographic area, and age of the population. Random effects meta-regression showed that OR for all-cause mortality with SPPB values 7-9 was higher in the younger population, diabetics, and men. An SPPB score lower than 10 is predictive of all-cause mortality. The systematic implementation of the SPPB in clinical practice settings may provide useful prognostic information about the risk of all-cause mortality. Moreover, the SPPB could be used as a surrogate endpoint of all-cause mortality in trials needing to quantify benefit and health improvements of specific treatments or rehabilitation programs. The study protocol was published on PROSPERO (CRD42015024916).

Mortality Trends from 2003 to 2009 among Adolescents and Young Adults in Rural Western Kenya Using a Health and Demographic Surveillance System

PubMed Central

Phillips-Howard, Penelope A.; Odhiambo, Frank O.; Hamel, Mary; Ackers, Marta; van Eijk, Anne M.; Orimba, Vincent; Hoog, Anja van’t; Beynon, Caryl; Vulule, John; Bellis, Mark A.; Slutsker, Laurence; deCock, Kevin; Breiman, Robert; Laserson, Kayla F.

2012-01-01

Background Targeted global efforts to improve survival of young adults need information on mortality trends; contributions from health and demographic surveillance system (HDSS) are required. Methods and Findings This study aimed to explore changing trends in deaths among adolescents (15–19 years) and young adults (20–24 years), using census and verbal autopsy data in rural western Kenya using a HDSS. Mid-year population estimates were used to generate all-cause mortality rates per 100,000 population by age and gender, by communicable (CD) and non-communicable disease (NCD) causes. Linear trends from 2003 to 2009 were examined. In 2003, all-cause mortality rates of adolescents and young adults were 403 and 1,613 per 100,000 population, respectively, among females; and 217 and 716 per 100,000, respectively, among males. CD mortality rates among females and males 15–24 years were 500 and 191 per 100,000 (relative risk [RR] 2.6; 95% confidence intervals [CI] 1.7–4.0; p<0.001). NCD mortality rates in same aged females and males were similar (141 and 128 per 100,000, respectively; p = 0.76). By 2009, young adult female all-cause mortality rates fell 53% (χ2 for linear trend 30.4; p<0.001) and 61.5% among adolescent females (χ2 for linear trend 11.9; p<0.001). No significant CD mortality reductions occurred among males or for NCD mortality in either gender. By 2009, all-cause, CD, and NCD mortality rates were not significantly different between males and females, and among males, injuries equalled HIV as the top cause of death. Conclusions This study found significant reductions in adolescent and young adult female mortality rates, evidencing the effects of targeted public health programmes, however, all-cause and CD mortality rates among females remain alarmingly high. These data underscore the need to strengthen programmes and target strategies to reach both males and females, and to promote NCD as well as CD initiatives to reduce the mortality burden amongst both gender. PMID:23144796

Premature mortality of epilepsy in low- and middle-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy.

PubMed

Levira, Francis; Thurman, David J; Sander, Josemir W; Hauser, W Allen; Hesdorffer, Dale C; Masanja, Honorati; Odermatt, Peter; Logroscino, Giancarlo; Newton, Charles R

2017-01-01

To determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low- and middle-income countries (LMICs). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMICs. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios (SMRs) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higher-quality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1,000 people. The weighted median SMRs were 5.0 in male and 4.5 in female patients; relatively higher SMRs within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio (PMR) of 27.3% (range 5-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMRs ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMICs has a significantly greater premature mortality, as in high-income countries, but in LMICs the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs. © 2016 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

Baseline fatty acids, food groups, a diet score and 50-year all-cause mortality rates. An ecological analysis of the Seven Countries Study.

PubMed

Menotti, Alessandro; Kromhout, Daan; Puddu, Paolo Emilio; Alberti-Fidanza, Adalberta; Hollman, Peter; Kafatos, Anthony; Tolonen, Hanna; Adachi, Hisashi; Jacobs, David R

2017-12-01

This analysis deals with the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in 16 cohorts of the Seven Countries Study. A dietary survey was conducted at baseline in cohorts subsamples including chemical analysis of food samples representing average consumptions. Ecologic correlations of dietary variables were computed across cohorts with 50-year all-cause mortality rates, where 97% of men had died. There was a 12-year average age at death population difference between extreme cohorts. In the 1960s the average population intake of saturated (S) and trans (T) fatty acids and hard fats was high in the northern European cohorts while monounsaturated (M), polyunsaturated (P) fatty acids and vegetable oils were high in the Mediterranean areas and total fat was low in Japan. The 50-year all-cause mortality rates correlated (r= -0.51 to -0.64) ecologically inversely with the ratios M/S, (M + P)/(S + T) and vegetable foods and the ratio hard fats/vegetable oils. Adjustment for high socio-economic status strengthened (r= -0.62 to -0.77) these associations including MAI diet score. The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets. KEY MESSAGES We aimed at studying the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in the Seven Countries Study. The 50-year all-cause mortality rates correlated (r = -0.51 to -0.64) ecologically inversely with the ratios M/S [monounsaturated (M) + polyunsaturated (P)]/[saturated (S) + trans (T)] fatty acids and vegetable foods and the ratio hard fats/vegetable oils. After adjustment for high socio-economic status, associations with the ratios strengthened (r = -0.62 to -0.77) including also the MAI diet score. The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets.

Precisely Tracking Childhood Death

PubMed Central

Farag, Tamer H.; Koplan, Jeffrey P.; Breiman, Robert F.; Madhi, Shabir A.; Heaton, Penny M.; Mundel, Trevor; Ordi, Jaume; Bassat, Quique; Menendez, Clara; Dowell, Scott F.

2017-01-01

Abstract. Little is known about the specific causes of neonatal and under-five childhood death in high-mortality geographic regions due to a lack of primary data and dependence on inaccurate tools, such as verbal autopsy. To meet the ambitious new Sustainable Development Goal 3.2 to eliminate preventable child mortality in every country, better approaches are needed to precisely determine specific causes of death so that prevention and treatment interventions can be strengthened and focused. Minimally invasive tissue sampling (MITS) is a technique that uses needle-based postmortem sampling, followed by advanced histopathology and microbiology to definitely determine cause of death. The Bill & Melinda Gates Foundation is supporting a new surveillance system called the Child Health and Mortality Prevention Surveillance network, which will determine cause of death using MITS in combination with other information, and yield cause-specific population-based mortality rates, eventually in up to 12–15 sites in sub-Saharan Africa and south Asia. However, the Gates Foundation funding alone is not enough. We call on governments, other funders, and international stakeholders to expand the use of pathology-based cause of death determination to provide the information needed to end preventable childhood mortality. PMID:28719334

Aspects of nestling growth in Abert's Towhee

Treesearch

Deborah M. Finch

1984-01-01

Among factors selecting for rapid growth rates in avian young are those that cause mortality of whole broods (e.g., predation, weather) (Ricklefs, Ecology 50:1031-1039, 1969). Abert's Towhee (Pipilo aberti) endures a high rate of nesting mortality caused by predation and brood parasitism (Finch, Condor 83:389, 1981; Condor 85:355-359, 1983). Predation is the...

Nonmelanoma skin cancer and risk of all-cause and cancer-related mortality: a systematic review.

PubMed

Barton, Virginia; Armeson, Kent; Hampras, Shalaka; Ferris, Laura K; Visvanathan, Kala; Rollison, Dana; Alberg, Anthony J

2017-05-01

Some reports suggest that a history of nonmelanoma skin cancer (NMSC) may be associated with increased mortality. NMSCs have very low fatality rates, but the high prevalence of NMSC elevates the importance of the possibility of associated subsequent mortality from other causes. The variable methods and findings of existing studies leave the significance of these results uncertain. To provide clarity, we conducted a systematic review to characterize the evidence on the associations of NMSC with: (1) all-cause mortality, (2) cancer-specific mortality, and (3) cancer survival. Bibliographic databases were searched through February 2016. Cohort studies published in English were included if adequate data were provided to estimate mortality ratios in patients with-versus-without NMSC. Data were abstracted from the total of eight studies from independent data sources that met inclusion criteria (n = 3 for all-cause mortality, n = 2 for cancer-specific mortality, and n = 5 for cancer survival). For all-cause mortality, a significant increased risk was observed for patients with a history of squamous cell carcinoma (SCC) (mortality ratio estimates (MR) 1.25 and 1.30), whereas no increased risk was observed for patients with a history of basal cell carcinoma (BCC) (MRs 0.96 and 0.97). Based on one study, the association with cancer-specific mortality was stronger for SCC (MR 2.17) than BCC (MR 1.15). Across multiple types of cancer both SCC and BCC tended to be associated with poorer survival from second primary malignancies. Multiple studies support an association between NMSC and fatal outcomes; the associations tend to be more potent for SCC than BCC. Additional investigation is needed to more precisely characterize these associations and elucidate potential underlying mechanisms.

New Insight into the Management of the Tomato Leaf Miner, Tuta absoluta (Lepidoptera: Gelechiidae) with Entomopathogenic Nematodes.

PubMed

Kamali, Shokoofeh; Karimi, Javad; Koppenhöfer, Albrecht M

2018-02-09

The tomato leaf miner, Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae), is a serious threat to tomato production in the world. Due to serious issues with insecticide resistance, there is a dire need for alternative control methods. Entomopathogenic nematodes (EPN) have potential for the biological control of T. absoluta. In the laboratory, we examined the effect of temperature, soil type, and exposure time on the efficacy of the EPN species Steinernema carpocapsae (Nematoda: Steinernematidae) and Heterorhabditis bacteriophora (Nematoda: Heterorhabditidae) against last-instar T. absoluta larvae. Both species caused high mortality in loamy sand (89%) and coco peat (93%) but not in sandy loam (17%). H. bacteriophora caused 92-96% mortality at 19, 25, and 31°C; S. carpocapsae caused 89-91% mortality at 25 and 31°C but only 76% at 19°C. Both species caused similar mortality levels after 65-min exposure; thereafter, mortality increased only with S. carpocapsae reaching high levels even at a low concentration. Both species infected larvae within leaf galleries. When applied to whole large tomato plants in the greenhouse, both species provided similar control levels (48-51%) at high pest densities. Both species could be incorporated as an effective alternative to synthetic insecticides into T. absoluta management programs in greenhouse tomato production. © The Author(s) 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old.

PubMed

Legrand, Delphine; Vaes, Bert; Matheï, Catharina; Adriaensen, Wim; Van Pottelbergh, Gijs; Degryse, Jean-Marie

2014-06-01

To evaluate the predictive value of muscle strength and physical performance in the oldest old for all-cause mortality; hospitalization; and the onset of disability, defined as a decline in activities of daily living (ADLs), independent of muscle mass, inflammatory markers, and comorbidities. A prospective, observational, population-based follow-up study. Three well-circumscribed areas of Belgium. Five hundred sixty participants aged 80 and older were followed for 33.5 months (interquartile range 31.1-35.6 months). Grip strength, Short Physical Performance Battery (SPPB) score, and muscle mass were measured at baseline; ADLs at baseline and after 20 months; and all-cause mortality and time to first hospitalization from inclusion onward. Kaplan-Meier curves and Cox proportional hazards models were calculated for all-cause mortality and hospitalization. Logistic regression analysis was used to determine predictors of decline in ADLs. Kaplan-Meier curves showed significantly higher all-cause mortality and hospitalization in subjects in the lowest tertile of grip strength and SPPB score. The adjusted Cox proportional hazards model showed that participants with high grip strength or a high SPPB score had a lower risk of mortality and hospitalization, independent of muscle mass, inflammatory markers, and comorbidity. A relationship was found between SPPB score and decline in ADLs, independent of muscle mass, inflammation, and comorbidity. In people aged 80 and older, physical performance is a strong predictor of mortality, hospitalization, and disability, and muscle strength is a strong predictor of mortality and hospitalization. All of these relationships were independent of muscle mass, inflammatory markers, and comorbidity. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Variations in the relation between education and cause-specific mortality in 19 European populations: a test of the "fundamental causes" theory of social inequalities in health.

PubMed

Mackenbach, Johan P; Kulhánová, Ivana; Bopp, Matthias; Deboosere, Patrick; Eikemo, Terje A; Hoffmann, Rasmus; Kulik, Margarete C; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Regidor, Enrique; Wojtyniak, Bogdan; Östergren, Olof; Lundberg, Olle

2015-02-01

Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a "fundamental cause" which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities. We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century. We calculated age-adjusted Relative Risks of mortality among men and women aged 30-79 for 24 causes of death, which were classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to injury prevention, and non-preventable. Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower educated, the strength of the education-mortality relation is highly variable between causes of death and populations. Inequalities in mortality are generally larger for causes amenable to behavior change, medical intervention and injury prevention than for non-preventable causes. The contrast between preventable and non-preventable causes is large for causes amenable to behavior change, but absent for causes amenable to injury prevention among women. The contrast between preventable and non-preventable causes is larger in Central & Eastern Europe, where resource inequalities are substantial, than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but they are absent or small in Southern Europe, where resource inequalities are also large. In conclusion, our results provide some further support for the theory of "fundamental causes". However, the absence of larger inequalities for preventable causes in Southern Europe and for injury mortality among women indicate that further empirical and theoretical analysis is necessary to understand when and why the additional resources that a higher socioeconomic status provides, do and do not protect against prevailing health risks. Copyright © 2014 Elsevier Ltd. All rights reserved.

Estimating Pneumonia Deaths of Post-Neonatal Children in Countries of Low or No Death Certification in 2008

PubMed Central

Theodoratou, Evropi; Zhang, Jian Shayne F.; Kolcic, Ivana; Davis, Andrew M.; Bhopal, Sunil; Nair, Harish; Chan, Kit Yee; Liu, Li; Johnson, Hope; Rudan, Igor; Campbell, Harry

2011-01-01

Background Pneumonia is the leading cause of child deaths globally. The aims of this study were to: a) estimate the number and global distribution of pneumonia deaths for children 1–59 months for 2008 for countries with low (<85%) or no coverage of death certification using single-cause regression models and b) compare these country estimates with recently published ones based on multi-cause regression models. Methods and Findings For 35 low child-mortality countries with <85% coverage of death certification, a regression model based on vital registration data of low child-mortality and >85% coverage of death certification countries was used. For 87 high child-mortality countries pneumonia death estimates were obtained by applying a regression model developed from published and unpublished verbal autopsy data from high child-mortality settings. The total number of 1–59 months pneumonia deaths for the year 2008 for these 122 countries was estimated to be 1.18 M (95% CI 0.77 M–1.80 M), which represented 23.27% (95% CI 17.15%–32.75%) of all 1–59 month child deaths. The country level estimation correlation coefficient between these two methods was 0.40. Interpretation Although the overall number of post-neonatal pneumonia deaths was similar irrespective to the method of estimation used, the country estimate correlation coefficient was low, and therefore country-specific estimates should be interpreted with caution. Pneumonia remains the leading cause of child deaths and is greatest in regions of poverty and high child-mortality. Despite the concerns about gender inequity linked with childhood mortality we could not estimate sex-specific pneumonia mortality rates due to the inadequate data. Life-saving interventions effective in preventing and treating pneumonia mortality exist but few children in high pneumonia disease burden regions are able to access them. To achieve the United Nations Millennium Development Goal 4 target to reduce child deaths by two-thirds in year 2015 will require the scale-up of access to these effective pneumonia interventions. PMID:21966425

Tiotropium might improve survival in subjects with COPD at high risk of mortality

PubMed Central

2014-01-01

Background Inhaled therapies reduce risk of chronic obstructive pulmonary disease (COPD) exacerbations, but their effect on mortality is less well established. We hypothesized that heterogeneity in baseline mortality risk influenced the results of drug trials assessing mortality in COPD. Methods The 5706 patients with COPD from the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®) study that had complete clinical information for variables associated with mortality (age, forced expiratory volume in 1 s, St George’s Respiratory Questionnaire, pack-years and body mass index) were classified by cluster analysis. Baseline risk of mortality between clusters, and impact of tiotropium were evaluated during the 4-yr follow up. Results Four clusters were identified, including low-risk (low mortality rate) patients (n = 2339; 41%; cluster 2), and high-risk patients (n = 1022; 18%; cluster 3), who had a 2.6- and a six-fold increase in all-cause and respiratory mortality compared with cluster 2, respectively. Tiotropium reduced exacerbations in all clusters, and reduced hospitalizations in high-risk patients (p < 0.05). The beneficial effect of tiotropium on all-cause mortality in the overall population (hazard ratio, 0.87; 95% confidence interval, 0.75–1.00, p = 0.054) was explained by a 21% reduction in cluster 3 (p = 0.07), with no effect in other clusters. Conclusions Large variations in baseline risks of mortality existed among patients in the UPLIFT® study. Inclusion of numerous low-risk patients may have reduced the ability to show beneficial effect on mortality. Future clinical trials should consider selective inclusion of high-risk patients. PMID:24913266

Sarcopenia as a predictor of all-cause mortality among community-dwelling older people: A systematic review and meta-analysis.

PubMed

Liu, Ping; Hao, Qiukui; Hai, Shan; Wang, Hui; Cao, Li; Dong, Birong

2017-09-01

The aim of this systematic review and meta-analysis was to examine the association between sarcopenia and all-cause mortality among community-dwelling older people. A systematic review was performed using three electronic databases (EMBASE, MEDLINE and the Cochrane Library) to identify prospective cohort studies from January 2009 to February 2017 examining sarcopenia as a predictor of all-cause mortality among community-dwelling older people. We conducted a pooled analysis of mortality associated with sarcopenia, and subgroup analyses based on measurements of muscle mass and length of follow-up by employing a random-effects model. Sensitivity analyses were performed evaluate the cause of high heterogeneity. In addition, methodological quality, heterogeneity and publication bias were evaluated. Of 1703 studies identified, 6 studies incorporating 7367 individuals were included in the meta-analysis for all-cause mortality. The pooled hazard ratios (HRs) of all-cause mortality from the combination of included studies suggested participants with sarcopenia had a significantly higher rate of mortality (pooled HR 1.60, 95%CI 1.24-2.06, I 2 =27.8%, p=0.216) than participants without sarcopenia. The subgroup analysis for length of follow-up suggested studies with a follow-up period of less than 5 years found a higher risk of all-cause mortality (pooled HR 2.09, 95%CI 1.21-3.60) than studies with a follow-up period of 5 years or more (pooled HR 1.52, 95%CI 1.14-2.01). A subgroup of anthropometric measures was found to identify higher mortality risks (pooled HR 2.26, 95%CI 1.30-3.92) than a subgroup of dual-energy x-ray (DXA) absorptiometry (pooled HR 1.82, 95%CI 1.04-3.18) factors or a subgroup of bioelectrical impedance analysis (BIA) factors (pooled HR 1.31, 95%CI 1.15-1.49). Sarcopenia is a predictor of all-cause mortality among community-dwelling older people. Therefore, it is important to diagnose sarcopenia and to intervene, in order to reduce mortality rates in the elderly. Copyright © 2017. Published by Elsevier B.V.

Trends in the leading causes of injury mortality, Australia, Canada and the United States, 2000–2014

PubMed Central

Mack, Karin A.; Clapperton, Angela J.; Macpherson, Alison; Sleet, David; Newton, Donovan; Murdoch, James; Mackay, J. Morag; Berecki-Gisolf, Janneke; Wilkins, Wilkins; Marr, Angela; Ballesteros, Michael F.; McClure, Roderick

2018-01-01

OBJECTIVES The aim of this study was to highlight the differences in injury rates between populations through a descriptive epidemiological study of population-level trends in injury mortality for the high-income countries of Australia, Canada and the United States. METHODS Mortality data were available for the US from 2000 to 2014, and for Canada and Australia from 2000 to 2012. Injury causes were defined using the International Classification of Diseases, Tenth Revision external cause codes, and were grouped into major causes. Rates were direct-method age-adjusted using the US 2000 projected population as the standard age distribution. RESULTS US motor vehicle injury mortality rates declined from 2000 to 2014 but remained markedly higher than those of Australia or Canada. In all three countries, fall injury mortality rates increased from 2000 to 2014. US homicide mortality rates declined, but remained higher than those of Australia and Canada. While the US had the lowest suicide rate in 2000, it increased by 24% during 2000–2014, and by 2012 was about 14% higher than that in Australia and Canada. The poisoning mortality rate in the US increased dramatically from 2000 to 2014. CONCLUSION Results show marked differences and striking similarities in injury mortality between the countries and within countries over time. The observed trends differed by injury cause category. The substantial differences in injury rates between similarly resourced populations raises important questions about the role of societal-level factors as underlying causes of the differential distribution of injury in our communities. PMID:28621655

Does personality predict mortality? Results from the GAZEL French prospective cohort study.

PubMed

Nabi, Hermann; Kivimäki, Mika; Zins, Marie; Elovainio, Marko; Consoli, Silla M; Cordier, Sylvaine; Ducimetière, Pierre; Goldberg, Marcel; Singh-Manoux, Archana

2008-04-01

Majority of studies on personality and physical health have focused on one or two isolated personality traits. We aim to test the independent association of 10 personality traits, from three major conceptual models, with all-cause and cause-specific mortality in the French GAZEL cohort. A total of 14,445 participants, aged 39-54 in 1993, completed the personality questionnaires composed of the Bortner Type-A scale, the Buss-Durkee Hostility Inventory (for total, neurotic and reactive hostility) and the Grossarth-Maticek-Eysenck Personality Stress Inventory that assesses six personality types [cancer-prone, coronary heart disease (CHD)-prone, ambivalent, healthy, rational, anti-social]. The association between personality traits and mortality, during a mean follow-up of 12.7 years, was assessed using the Relative Index of Inequality (RII) in Cox regression. In models adjusted for age, sex, marital status and education, all-cause and cause-specific mortality were predicted by 'total hostility', its 'neurotic hostility' component as well as by 'CHD-prone', 'ambivalent' 'antisocial', and 'healthy' personality types. After mutually adjusting personality traits for each other, only high 'neurotic hostility' remained a robust predictor of excess mortality from all causes [RII = 2.62; 95% confidence interval (CI) = 1.68-4.09] and external causes (RII = 3.24; 95% CI = 1.03-10.18). 'CHD-prone' (RII = 2.23; 95% CI = 0.72-6.95) and 'anti-social' (RII = 2.13; 95% CI 0.61-6.58) personality types were associated with cardiovascular mortality and with mortality from external causes, respectively, but CIs were wider. Adjustment for potential behavioural mediators had only a modest effect on these associations. Neurotic hostility, CHD-prone personality and anti-social personality were all predictive of mortality outcomes. Further research is required to determine the precise mechanisms that contribute to these associations.

Drought induced tree mortality and ensuing bark beetle outbreaks in southwestern pinyon-juniper woodlands

Treesearch

Michael J. Clifford; Monique E. Rocca; Robert Delph; Paulette L. Ford; Neil S. Cobb

2008-01-01

The current drought and ensuing bark beetle outbreaks during 2002 to 2004 in the Southwest have greatly increased tree mortality in pinyon-juniper woodlands. We studied causes and consequences of the drought-induced mortality. First, we tested the paradigm that high stand densities in pinyon-juniper woodlands would increase tree mortality. Stand densities did not...

Dietary α-Linolenic Acid, Marine ω-3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study.

PubMed

Sala-Vila, Aleix; Guasch-Ferré, Marta; Hu, Frank B; Sánchez-Tainta, Ana; Bulló, Mònica; Serra-Mir, Mercè; López-Sabater, Carmen; Sorlí, Jose V; Arós, Fernando; Fiol, Miquel; Muñoz, Miguel A; Serra-Majem, Luis; Martínez, J Alfredo; Corella, Dolores; Fitó, Montserrat; Salas-Salvadó, Jordi; Martínez-González, Miguel A; Estruch, Ramón; Ros, Emilio; B

2016-01-26

Epidemiological evidence suggests a cardioprotective role of α-linolenic acid (ALA), a plant-derived ω-3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω-3 fatty acids (long-chain n-3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all-cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long-chain n-3 polyunsaturated fatty acids (≥500 mg/day). We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable-adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9-y follow-up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56-0.92) for all-cause mortality and 0.95 (95% CI 0.58-1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long-chain n-3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67-1.05) for all-cause mortality, 0.61 (95% CI 0.39-0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29-0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22-1.01) for sudden cardiac death. The highest reduction in all-cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45-0.87]). In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all-cause mortality, whereas protection from cardiac mortality is limited to fish-derived long-chain n-3 polyunsaturated fatty acids. URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Self-Care and All-Cause Mortality in Patients With Chronic Heart Failure.

PubMed

Kessing, Dionne; Denollet, Johan; Widdershoven, Jos; Kupper, Nina

2016-03-01

This study examined the association of self-care with all-cause mortality in a cohort of patients with chronic heart failure (HF). Although self-care is crucial to maintain health in patients with chronic HF, studies examining an association with clinical outcomes are scarce. Consecutive patients with chronic HF (n = 559, mean age 66.3 ± 9.5 years, 78% men) completed the 9-item European Heart Failure Self-care Behaviour scale. Our endpoint was all-cause mortality. Associations between self-care and all-cause mortality were assessed with Kaplan-Meier analyses and multivariable Cox regression accounting for standard sociodemographic and clinical covariates, psychological distress, and self-rated health. After a median follow-up of 5.5 ± 2.4 years (range 16 weeks to 9.9 years), 221 deaths (40%) from any cause were recorded. There was no evidence of a mortality benefit in patients high over those low in global self-care (p = 0.71). In post hoc analyses, low self-reported sodium intake was associated with increased mortality (adjusted hazard ratio: 1.47; 95% confidence interval: 1.10 to 1.96; p = 0.01). Other significant predictors of mortality were: male sex, lack of a partner, New York Heart Association functional class III to IV, and increasing comorbid conditions. Global self-care was not associated with long-term mortality whereas low self-reported sodium intake independently predicted increased all-cause mortality beyond parameters of disease severity. Replication of findings is needed as well as studies examining the correspondence of subjectively and objectively measured sodium intake and its effects on long-term prognosis in patients with chronic HF. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Suicide, fatal injuries, and other causes of premature mortality in patients with traumatic brain injury: a 41-year Swedish population study.

PubMed

Fazel, Seena; Wolf, Achim; Pillas, Demetris; Lichtenstein, Paul; Långström, Niklas

2014-03-01

: Longer-term mortality in individuals who have survived a traumatic brain injury (TBI) is not known. To examine the relationship between TBI and premature mortality, particularly by external causes, and determine the role of psychiatric comorbidity. We studied all persons born in 1954 or later in Sweden who received inpatient and outpatient International Classification of Diseases-based diagnoses of TBI from 1969 to 2009 (n = 218,300). We compared mortality rates 6 months or more after TBI to general population controls matched on age and sex (n = 2,163,190) and to unaffected siblings of patients with TBI (n = 150,513). Furthermore, we specifically examined external causes of death (suicide, injury, or assault). We conducted sensitivity analyses to investigate whether mortality rates differed by sex, age at death, severity (including concussion), and different follow-up times after diagnosis. Adjusted odds ratios (AORs) of premature death by external causes in patients with TBI compared with general population controls. Among those who survived 6 months after TBI, we found a 3-fold increased odds of mortality (AOR, 3.2; 95% CI, 3.0-3.4) compared with general population controls and an adjusted increased odds of mortality of 2.6 (95% CI, 2.3-2.8) compared with unaffected siblings. Risks of mortality from external causes were elevated, including for suicide (AOR, 3.3; 95% CI, 2.9-3.7), injuries (AOR, 4.3; 95% CI, 3.8-4.8), and assault (AOR, 3.9; 95% CI, 2.7-5.7). Among those with TBI, absolute rates of death were high in those with any psychiatric or substance abuse comorbidity (3.8% died prematurely) and those with solely substance abuse (6.2%) compared with those without comorbidity (0.5%). Traumatic brain injury is associated with substantially elevated risks of premature mortality, particularly for suicide, injuries, and assaults, even after adjustment for sociodemographic and familial factors. Current clinical guidelines may need revision to reduce mortality risks beyond the first few months after injury and address high rates of psychiatric comorbidity and substance abuse.

Global Incidence and Mortality Rates of Stomach Cancer and the Human Development Index: an Ecological Study.

PubMed

Khazaei, Salman; Rezaeian, Shahab; Soheylizad, Mokhtar; Khazaei, Somayeh; Biderafsh, Azam

2016-01-01

Stomach cancer (SC) is the second leading cause of cancer death with the rate of 10.4% in the world. The correlation between the incidence and mortality rates of SC and human development index (HDI) has not been globally determined. Therefore, this study aimed to determine the association between the incidence and mortality rates of SC and HDI in various regions. In this global ecological study, we used the data about the incidence and mortality rate of SC and HDI from the global cancer project and the United Nations Development Programme database, respectively. In 2012, SCs were estimated to have affected a total of 951,594 individuals (crude rate: 13.5 per 100,000 individuals) with a male/female ratio of 1.97, and caused 723,073 deaths worldwide (crude rate: 10.2 per 100,000 individuals). There was a positive correlation between the HDI and both incidence (r=0.28, <0.05) and mortality rates of SC (r=0.13, P = 0.1) in the world in 2012. The high incidence and mortality rates of SC in countries with high and very high HDI is remarkable which should be the top priority of interventions for global health policymakers. In addition, health programs should be provided to reduce the burden of this disease in the regions with high incidence and mortality rates of SC.

The burden of premature mortality of epilepsy in high-income countries: A systematic review from the Mortality Task Force of the International League Against Epilepsy.

PubMed

Thurman, David J; Logroscino, Giancarlo; Beghi, Ettore; Hauser, W Allen; Hesdorffer, Dale C; Newton, Charles R; Scorza, Fulvio Alexandre; Sander, Josemir W; Tomson, Torbjörn

2017-01-01

Since previous reviews of epidemiologic studies of premature mortality among people with epilepsy were completed several years ago, a large body of new evidence about this subject has been published. We aim to update prior reviews of mortality in epilepsy and to reevaluate and quantify the risks, potential risk factors, and causes of these deaths. We systematically searched the Medline and Embase databases to identify published reports describing mortality risks in cohorts and populations of people with epilepsy. We reviewed relevant reports and applied criteria to identify those studies likely to accurately quantify these risks in representative populations. From these we extracted and summarized the reported data. All population-based studies reported an increased risk of premature mortality among people with epilepsy compared to general populations. Standard mortality ratios are especially high among people with epilepsy aged <50 years, among those whose epilepsy is categorized as structural/metabolic, those whose seizures do not fully remit under treatment, and those with convulsive seizures. Among deaths directly attributable to epilepsy or seizures, important immediate causes include sudden unexpected death in epilepsy (SUDEP), status epilepticus, unintentional injuries, and suicide. Epilepsy-associated premature mortality imposes a significant public health burden, and many of the specific causes of death are potentially preventable. These require increased attention from healthcare providers, researchers, and public health professionals. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

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

PubMed Central

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

2016-01-01

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

Smoking increases risks of all-cause and breast cancer specific mortality in breast cancer individuals: a dose-response meta-analysis of prospective cohort studies involving 39725 breast cancer cases

PubMed Central

Wang, Kang; Li, Feng; Zhang, Xiang; Li, Zhuyue; Li, Hongyuan

2016-01-01

Smoking is associated with the risks of mortality from breast cancer (BC) or all causes in BC survivors. Two-stage dose-response meta-analysis was conducted. A search of PubMed and Embase was performed, and a random-effect model was used to yield summary hazard ratios (HRs). Eleven prospective cohort studies were included. The summary HR per 10 cigarettes/day, 10 pack-years, 10 years increase were 1.10 (95% confidence interval (CI) = 1.04–1.16), 1.09 (95% CI = 1.06–1.12), 1.10 (95% CI = 1.06–1.14) for BC specific mortality, and 1.15 (95% CI = 1.10–1.19), 1.15 (95% CI = 1.10–1.20), 1.17 (95% CI = 1.11–1.23) for all-cause mortality, respectively. The linear or non-linear associations between smoking and risks of mortality from BC or all causes were revealed. Subgroup analyses suggested a positive association between ever or former smoking and the risk of all-cause mortality in BC patients, especially in high doses consumption. In conclusion, higher smoking intensity, more cumulative amount of cigarettes consumption and longer time for smoking is associated with elevated risk of mortality from BC and all causes in BC individuals. The results regarding smoking cessation and “ever or former” smokers should be treated with caution due to limited studies. PMID:27863414

Leading causes of death and all-cause mortality in American Indians and Alaska Natives.

PubMed

Espey, David K; Jim, Melissa A; Cobb, Nathaniel; Bartholomew, Michael; Becker, Tom; Haverkamp, Don; Plescia, Marcus

2014-06-01

We present regional patterns and trends in all-cause mortality and leading causes of death in American Indians and Alaska Natives (AI/ANs). US National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We analyzed temporal trends for 1990 to 2009 and comparisons between non-Hispanic AI/AN and non-Hispanic White persons by geographic region for 1999 to 2009. Results focus on IHS Contract Health Service Delivery Area counties in which less race misclassification occurs. From 1990 to 2009 AI/AN persons did not experience the significant decreases in all-cause mortality seen for Whites. For 1999 to 2009 the all-cause death rate in CHSDA counties for AI/AN persons was 46% more than that for Whites. Death rates for AI/AN persons varied as much as 50% among regions. Except for heart disease and cancer, subsequent ranking of specific causes of death differed considerably between AI/AN and White persons. AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions.

Excess black mortality in the United States and in selected black and white high-poverty areas, 1980-2000.

PubMed

Geronimus, Arline T; Bound, John; Colen, Cynthia G

2011-04-01

Black working-aged residents of urban high-poverty areas suffered severe excess mortality in 1980 and 1990. Our goal in this study was to determine whether this trend persisted in 2000. We analyzed death certificate and census data to estimate age-standardized all-cause and cause-specific mortality among 16- to 64-year-old Blacks and Whites nationwide and in selected urban and rural high-poverty areas. Urban men's mortality rate estimates peaked in 1990 and declined between 1990 and 2000 back to or below 1980 levels. Evidence of excess mortality declines among urban or rural women and among rural men was modest, with some increases. Between 1980 and 2000, there was little decline in chronic disease mortality among men and women in most areas, and in some instances there were increases. In 2000, despite improved economic conditions, working-age residents of the study areas still died disproportionately of early onset of chronic disease, suggesting an entrenched burden of disease and unmet health care needs. The lack of consistent improvement in death rates among working-age residents of high-poverty areas since 1980 necessitates reflection and concerted action given that sustainable progress has been elusive for this age group.

Trends in cardiovascular diseases and cancer mortality in 45 countries from five continents (1980-2010).

PubMed

Araújo, Fábio; Gouvinhas, Cláudia; Fontes, Filipa; La Vecchia, Carlo; Azevedo, Ana; Lunet, Nuno

2014-08-01

Cardiovascular diseases (CVD) and cancer are worldwide main causes of death with mortality trends varying across countries with different levels of economic development. We analysed trends in CVD and cancer mortality for 37 European countries, five high-income non-European countries and four leading emerging economies (BRICS) using data from the World Health Organization database for the period 1980-2010. In high-income countries, CVD mortality trends are characterized by steep declines over the last decades, while a downward trend in cancer mortality started more recently and was less pronounced. This resulted in the gradual convergence of the CVD and cancer mortality rates, and the latter are already higher in some countries. The absolute number of CVD deaths decreased in most settings, while cancer deaths increased in nearly all countries. Among the BRICS, China and South Africa share a similar pattern of no meaningful variation in both CVD and cancer age-standardized mortality rates and an increase in the overall number of deaths by these causes. Brazil presents trends similar to those of high-income countries, except for the still increasing number of CVD deaths. The substantial decreases in CVD mortality over the last decades have overcome the impact of the growth and ageing of populations in the overall number of deaths, while stabilization in the number of cancer deaths was observed only in some of the high-income countries. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

[Loss of labour productivity caused by premature mortality in Spain in 2005].

PubMed

Oliva, Juan

2009-01-01

Jointly with deaths, loss of quality of life and pain of patients and families, there are complementary indicators that help to reveal the social impact caused by illnesses and accidents. In the analysis, loss of labour productivity due to premature mortality in 2005 is estimated. The aim of this work is to estimate a part of the non health care costs caused by illnesses and accidents in the economy. A simulation model based in the human capital approach is developed using several available Spanish data bases (Death Registry According to Cause of Death, Structural Wage Survey, Labour Force Survey). A loss of production up to 9,100 millions of Euros due to premature mortality is estimated in Spain for the base year. This figure is equivalent to a 1.01% of the Spanish Gross Domestic Product, or to an 18.25% of the Public Health Care Expenditure of 2005. Premature mortality caused a very high labour cost.

Liver cancer mortality rate model in Thailand

NASA Astrophysics Data System (ADS)

Sriwattanapongse, Wattanavadee; Prasitwattanaseree, Sukon

2013-09-01

Liver Cancer has been a leading cause of death in Thailand. The purpose of this study was to model and forecast liver cancer mortality rate in Thailand using death certificate reports. A retrospective analysis of the liver cancer mortality rate was conducted. Numbering of 123,280 liver cancer causes of death cases were obtained from the national vital registration database for the 10-year period from 2000 to 2009, provided by the Ministry of Interior and coded as cause-of-death using ICD-10 by the Ministry of Public Health. Multivariate regression model was used for modeling and forecasting age-specific liver cancer mortality rates in Thailand. Liver cancer mortality increased with increasing age for each sex and was also higher in the North East provinces. The trends of liver cancer mortality remained stable in most age groups with increases during ten-year period (2000 to 2009) in the Northern and Southern. Liver cancer mortality was higher in males and increase with increasing age. There is need of liver cancer control measures to remain on a sustained and long-term basis for the high liver cancer burden rate of Thailand.

Scoring life insurance applicants' laboratory results, blood pressure and build to predict all-cause mortality risk.

PubMed

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

2012-01-01

Evaluate the degree of medium to longer term mortality prediction possible from a scoring system covering all laboratory testing used for life insurance applicants, as well as blood pressure and build measurements. Using the results of testing for life insurance applicants who reported a Social Security number in conjunction with the Social Security Death Master File, the mortality associated with each test result was defined by age and sex. The individual mortality scores for each test were combined for each individual and a composite mortality risk score was developed. This score was then tested against the insurance applicant dataset to evaluate its ability to discriminate risk across age and sex. The composite risk score was highly predictive of all-cause mortality risk in a linear manner from the best to worst quintile of scores in a nearly identical fashion for each sex and decade of age. Laboratory studies, blood pressure and build from life insurance applicants can be used to create scoring that predicts all-cause mortality across age and sex. Such an approach may hold promise for preventative health screening as well.

Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy.

PubMed

Marmo, Riccardo; Del Piano, Mario; Rotondano, Gianluca; Koch, Maurizio; Bianco, Maria Antonia; Zambelli, Alessandro; Di Matteo, Giovanni; Grossi, Enzo; Cipolletta, Livio; Prometeo Investigators

2012-02-01

Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). Secondary analysis of prospectively collected data from 3 national databases. Community and teaching hospitals. Consecutive patients admitted for acute nonvariceal UGIB. Early endoscopy, medical and endoscopic treatment as appropriate. Thirty-day mortality, recurrent bleeding, and need for surgery. A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P < .0001). Gastric or duodenal ulcer significantly increased the risk of death, but this was not related to the presence of high-risk stigmata (P = .368). The strongest predictor of mortality for all causes of nonvariceal UGIB was the overall physical status of the patient measured with the American Society of Anesthesiologists score (1-2 vs 3-4, P < .001). No data on the American Society of Anesthesiologists class score in the Prometeo study. Nonulcer causes of nonvariceal UGIB have a risk of death, similar to bleeding peptic ulcers in the clinical context of a high-risk patient. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

The impact of increasing income inequalities on educational inequalities in mortality - An analysis of six European countries.

PubMed

Hoffmann, Rasmus; Hu, Yannan; de Gelder, Rianne; Menvielle, Gwenn; Bopp, Matthias; Mackenbach, Johan P

2016-07-08

Over the past decades, both health inequalities and income inequalities have been increasing in many European countries, but it is unknown whether and how these trends are related. We test the hypothesis that trends in health inequalities and trends in income inequalities are related, i.e. that countries with a stronger increase in income inequalities have also experienced a stronger increase in health inequalities. We collected trend data on all-cause and cause-specific mortality, as well as on the household income of people aged 35-79, for Belgium, Denmark, England & Wales, France, Slovenia, and Switzerland. We calculated absolute and relative differences in mortality and income between low- and high-educated people for several time points in the 1990s and 2000s. We used fixed-effects panel regression models to see if changes in income inequality predicted changes in mortality inequality. The general trend in income inequality between high- and low-educated people in the six countries is increasing, while the mortality differences between educational groups show diverse trends, with absolute differences mostly decreasing and relative differences increasing in some countries but not in others. We found no association between trends in income inequalities and trends in inequalities in all-cause mortality, and trends in mortality inequalities did not improve when adjusted for rising income inequalities. This result held for absolute as well as for relative inequalities. A cause-specific analysis revealed some association between income inequality and mortality inequality for deaths from external causes, and to some extent also from cardiovascular diseases, but without statistical significance. We find no support for the hypothesis that increasing income inequality explains increasing health inequalities. Possible explanations are that other factors are more important mediators of the effect of education on health, or more simply that income is not an important determinant of mortality in this European context of high-income countries. This study contributes to the discussion on income inequality as entry point to tackle health inequalities. More research is needed to test the common and plausible assumption that increasing income inequality leads to more health inequality, and that one needs to act against the former to avoid the latter.

Potential for Low-Pathogenic Avian H7 Influenza A Viruses To Replicate and Cause Disease in a Mammalian Model

PubMed Central

Zanin, Mark; Koçer, Zeynep A.; Poulson, Rebecca L.; Gabbard, Jon D.; Howerth, Elizabeth W.; Jones, Cheryl A.; Friedman, Kimberly; Seiler, Jon; Danner, Angela; Kercher, Lisa; McBride, Ryan; Paulson, James C.; Wentworth, David E.; Krauss, Scott; Tompkins, Stephen M.; Stallknecht, David E.

2016-01-01

ABSTRACT H7 subtype influenza A viruses are widely distributed and have been responsible for human infections and numerous outbreaks in poultry with significant impact. Despite this, the disease-causing potential of the precursor low-pathogenic (LP) H7 viruses from the wild bird reservoir has not been investigated. Our objective was to assess the disease-causing potential of 30 LP H7 viruses isolated from wild avian species in the United States and Canada using the DBA/2J mouse model. Without prior mammalian adaptation, the majority of viruses, 27 (90%), caused mortality in mice. Of these, 17 (56.7%) caused 100% mortality and 24 were of pathogenicity similar to that of A/Anhui/1/2013 (H7N9), which is highly pathogenic in mice. Viruses of duck origin were more pathogenic than those of shorebird origin, as 13 of 18 (72.2%) duck origin viruses caused 100% mortality while 4 of 12 (33.3%) shorebird origin viruses caused 100% mortality, despite there being no difference in mean lung viral titers between the groups. Replication beyond the respiratory tract was also evident, particularly in the heart and brain. Of the 16 viruses studied for fecal shedding, 11 were detected in fecal samples. These viruses exhibited a strong preference for avian-type α2,3-linked sialic acids; however, binding to mammalian-type α2,6-linked sialic acids was also detected. These findings indicate that LP avian H7 influenza A viruses are able to infect and cause disease in mammals without prior adaptation and therefore pose a potential public health risk. IMPORTANCE Low-pathogenic (LP) avian H7 influenza A viruses are widely distributed in the avian reservoir and are the precursors of numerous outbreaks of highly pathogenic avian influenza viruses in commercial poultry farms. However, unlike highly pathogenic H7 viruses, the disease-causing potential of LP H7 viruses from the wild bird reservoir has not been investigated. To address this, we studied 30 LP avian H7 viruses isolated from wild avian species in the United States and Canada using the DBA/2J mouse model. Surprisingly, the majority of these viruses, 90%, caused mortality in mice without prior mammalian adaptation, and 56.7% caused 100% mortality. There was also evidence of spread beyond the respiratory tract and fecal shedding. Therefore, the disease-causing potential of LP avian H7 influenza A viruses in mammals may be underestimated, and these viruses therefore pose a potential public health risk. PMID:27852855

Association of coffee consumption with all-cause and cardiovascular disease mortality.

PubMed

Liu, Junxiu; Sui, Xuemei; Lavie, Carl J; Hebert, James R; Earnest, Conrad P; Zhang, Jiajia; Blair, Steven N

2013-10-01

To evaluate the association between coffee consumption and mortality from all causes and from cardiovascular disease. Data from the Aerobics Center Longitudinal Study representing 43,727 participants with 699,632 person-years of follow-up were included. Baseline data were collected by an in-person interview on the basis of standardized questionnaires and a medical examination, including fasting blood chemistry analysis, anthropometry, blood pressure, electrocardiography, and a maximal graded exercise test, between February 3, 1971, and December 30, 2002. Cox regression analysis was used to quantify the association between coffee consumption and all-cause and cause-specific mortality. During the 17-year median follow-up, 2512 deaths occurred (804 [32%] due to cardiovascular disease). In multivariate analyses, coffee intake was positively associated with all-cause mortality in men. Men who drank more than 28 cups of coffee per week had higher all-cause mortality (hazard ratio [HR], 1.21; 95% CI, 1.04-1.40). However, after stratification based on age, younger (<55 years old) men and women showed a significant association between high coffee consumption (>28 cups per week) and all-cause mortality after adjusting for potential confounders and fitness level (HR, 1.56; 95% CI, 1.30-1.87 for men; and HR, 2.13; 95% CI, 1.26-3.59 for women). In this large cohort, a positive association between coffee consumption and all-cause mortality was observed in men and in men and women younger than 55 years. On the basis of these findings, it seems appropriate to suggest that younger people avoid heavy coffee consumption (ie, averaging >4 cups per day). However, this finding should be assessed in future studies of other populations. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Association of coffee consumption with all-cause and cardiovascular disease mortality

PubMed Central

Liu, Junxiu; Sui, Xuemei; Lavie, Carl J.; Hebert, James R.; Earnest, Conrad; Zhang, Jiajia; Blair, Steven N.

2013-01-01

Objective To evaluate the association between coffee consumption and mortality from all causes and cardiovascular disease (CVD). Patients and Methods Data from the Aerobics Center Longitudinal Study (ACLS) representing a total of 43,727 participants contributing to 699,632 person-years of follow-up time, were included. Baseline data were collected by an in-person interview based on standardized questionnaires and a medical examination, including fasting blood chemistry analysis, anthropometry, blood pressure, electrocardiography, and a maximal graded exercise test, between February 3, 1971 and December 30, 2002. Cox regression analysis was used to quantify the association between coffee consumption and all-cause and cause-specific mortality. Results During the 17-year median follow-up period, 2512 deaths occurred (32% due to CVD). In multivariate analyses, coffee intake was positively associated with all-cause mortality in men. Men who drank >28 cups coffee per week had higher all-cause mortality (hazard ratio (HR): 1.21; 95% confidence interval (CI): 1.04–1.40). However, after stratification based on age, both younger (<55 years) men and women showed a statistically significant association between high coffee consumption (>28 cups/week) and all-cause mortality, after adjusting for potential confounders and fitness level (HR: 1.56; 95% CI: 1.30–1.87 for men and HR: 2.13; 95% CI: 1.26–3.59 for women, respectively). Conclusion In this large cohort, a positive association between coffee consumption and all-cause mortality was observed among men and both men and women <55 years of age. Based on our findings, it seems appropriate to suggest that younger people avoid heavy coffee consumption (ie, averaging >4 cups/day). However, this finding should be assessed in future studies from other populations. PMID:23953850

Leading causes of death from injury and poisoning by age, sex and urban/rural areas in Tianjin, China 1999-2006.

PubMed

Jiang, Guohong; Choi, Bernard C K; Wang, Dezheng; Zhang, Hui; Zheng, Wenlong; Wu, Tongyu; Chang, Gai

2011-05-01

Injury and poisoning are a growing public health concern in China due to rapid economic growth, which has resulted in many cases with an injury-prone environment, such as overcrowded traffic, booming construction, and work-related stress. This study investigates the distribution and trends of deaths from injury and poisoning in Tianjin, China, by age, sex and urban/rural status, from 1999 to 2006. The study used data from the all-cause mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC). Each death certificate recorded 53 variables. Cause of death was coded using the International Classification of Diseases (ICD). Standardized mortality rates and proportions of deaths were analyzed. Traffic accidents, suicide, poisoning, drowning and fall were the leading causes of fatal injuries in Tianjin from 1999 to 2006. Injury mortality rates were high in males, in rural areas, and in the older age groups. Despite low injury mortality rates, injury accounted for close to 50% of all deaths amongst the 5-29 year age group. Traffic accident mortality rates increased, although not significantly so, during the period from 1999 to 2006. Injury prevention and control is a high public health priority in Tianjin. Our detailed table on the number of deaths by causes of fatal injuries and by age group provides important information to set prevention strategies in the nurseries, schools, workplace and seniors homes. 2009 Elsevier Ltd. All rights reserved.

How will aspen respond to mountain pine beetle? A review of literature and discussion of knowledge gaps

Treesearch

Kristen A. Pelz; Frederick W. Smith

2013-01-01

There has been speculation that quaking aspen (Populus tremuloides) dominance of forests will increase due to mortality caused by mountain pine beetle (Dendroctonus ponderosae) (MPB). High aspen sucker densities have been observed inthe years following MPB-caused pine mortality, but it remains unclear if this disturbance will result in a pulse of aspen...

Improving life expectancy: how many years behind has the USA fallen? A cross-national comparison among high-income countries from 1958 to 2007.

PubMed

Verguet, Stéphane; Jamison, Dean T

2013-01-01

Many studies have documented higher mortality levels in the USA compared to other high-income nations. We add to this discussion by quantifying how many years behind comparison countries the USA has fallen and by identifying when US mortality rates began to diverge. We use full life tables, for men and women, for 17 high-income countries including the USA. We extract the life expectancy at birth and compute the mortality rates for each 5-year age group from birth up to age 80. Using the metric of how many 'years behind' a country has fallen, we compare US mortality levels with those in other high-income countries ('comparators'). We report life expectancy for 17 high-income countries, for the period 1958-2007. Up to the late 1970s, US men and especially women closely tracked comparators in life expectancy. In the late 1970s in the USA, most strikingly women began to diverge from comparators so that the US female life expectancy in 2007 corresponded to that of the comparators' average 10 years earlier. Mortality rates also began to diverge from the late 1970s, and the largest mortality gap was in the 15-49 age group, for both men and women, where the USA had fallen about 40 years behind the comparators by 2007. Some causes proposed for the relatively high US mortality today-racial differences, lack of universal health insurance, US exceptionalism-changed little while the mortality gap emerged and grew. This suggests that explanations for the growing gap lie elsewhere. Quantification of how many years behind the USA has fallen can help provide clues about where to look for potential causes and remedies.

Resistance and Protective Immunity in Redfish Lake Sockeye Salmon Exposed to M Type Infectious Hematopoietic Necrosis Virus (IHNV)

USGS Publications Warehouse

Kurath, Gael; Garver, Kyle; Purcell, Maureen K.; LaPatra, Scott E.

2010-01-01

Differential virulence of infectious hematopoietic necrosis virus (IHNV) isolates from the U and M phylogenetic subgroups is clearly evident in the Redfish Lake (RFL) strain of sockeye salmon Oncorhynchus nerka. In these fish, experimental immersion challenges with U isolates cause extremely high mortality and M isolates cause low or no mortality. When survivors of M virus immersion challenges were exposed to a secondary challenge with virulent U type virus they experienced high mortality, indicating that the primary M challenge did not elicit protective immunity. Delivery of a moderate dose (2 × 104 plaque-forming units [PFU]/fish) of virus by intraperitoneal injection challenge did not overcome RFL sockeye salmon resistance to M type IHNV. Injection challenge with a high dose (5 × 106 PFU/fish) of M type virus caused 10% mortality, and in this case survivors did develop protective immunity against a secondary U type virus challenge. Thus, although it is possible for M type IHNV to elicit cross-protective immunity in this disease model, it does not develop after immersion challenge despite entry, transient replication of M virus to low levels, stimulation of innate immune genes, and development of neutralizing antibodies in some fish.

Fine Particulate Air Pollution and Mortality in Nine California Counties: Results from CALFINE

PubMed Central

Ostro, Bart; Broadwin, Rachel; Green, Shelley; Feng, Wen-Ying; Lipsett, Michael

2006-01-01

Many epidemiologic studies provide evidence of an association between daily counts of mortality and ambient particulate matter < 10 μm in diameter (PM10). Relatively few studies, however, have investigated the relationship of mortality with fine particles [PM < 2.5 μm in diameter (PM2.5)], especially in a multicity setting. We examined associations between PM2.5 and daily mortality in nine heavily populated California counties using data from 1999 through 2002. We considered daily counts of all-cause mortality and several cause-specific subcategories (respiratory, cardiovascular, ischemic heart disease, and diabetes). We also examined these associations among several subpopulations, including the elderly (> 65 years of age), males, females, non-high school graduates, whites, and Hispanics. We used Poisson multiple regression models incorporating natural or penalized splines to control for covariates that could affect daily counts of mortality, including time, seasonality, temperature, humidity, and day of the week. We used meta-analyses using random-effects models to pool the observations in all nine counties. The analysis revealed associations of PM2.5 levels with several mortality categories. Specifically, a 10-μg/m3 change in 2-day average PM2.5 concentration corresponded to a 0.6% (95% confidence interval, 0.2–1.0%) increase in all-cause mortality, with similar or greater effect estimates for several other subpopulations and mortality subcategories, including respiratory disease, cardiovascular disease, diabetes, age > 65 years, females, deaths out of the hospital, and non-high school graduates. Results were generally insensitive to model specification and the type of spline model used. This analysis adds to the growing body of evidence linking PM2.5 with daily mortality. PMID:16393654

Use of Age and Medical Comorbidity to Assess Long-term Other-cause Mortality Risk in a Cohort of Men Undergoing Prostate Biopsy at an Academic Medical Center.

PubMed

Kominsky, Hal D; Bashline, Michael; Eun, Daniel; Pontari, Michel A; Mydlo, Jack H; Reese, Adam C

2017-02-01

To assess life expectancy and biopsy outcomes in men undergoing prostate biopsy at an academic medical center. We analyzed men who underwent prostate biopsy at our medical center between July 2012 and June 2014. Long-term other-cause mortality risk was determined using survival tables. Indications for biopsy and biopsy outcomes were assessed, and compared among men with varying mortality risks. A total of 417 men underwent prostate biopsy, in whom 14-year other-cause mortality risk ranged from 9% to 74%. One hundred ninety-three men (46.3%) were considered low-mortality risk (<40% risk of 14-year mortality), 131 (31.4%) intermediate risk (41%-55% 14-year mortality), and 93 (22.3%) high risk (>55% 14-year mortality). Of the 417 patients who underwent biopsy, 149 (35.7%) were found to have prostate cancer. There was no significant difference in the rate of positive biopsies (P = .72), distribution of Gleason scores (P = .60), or percentage of positive biopsy cores (P = .74) between mortality risk groups. However, by UCSF Cancer of the Prostate Risk Assessment score, there was significant trend toward higher-risk prostate cancer in men with intermediate and high-mortality risk (P = .04). In this analysis, a large number of men with limited life expectancies underwent prostate biopsy. The majority of these men had negative biopsies or low-risk cancers, suggesting that they were unlikely to benefit from biopsy. To avoid potentially unnecessary prostate biopsies, the practitioner must give serious consideration to a patient's age and medical comorbidities before making a recommendation as to whether biopsy should be performed. Copyright © 2016 Elsevier Inc. All rights reserved.

Docosahexaenoic acid is an independent predictor of all-cause mortality in hemodialysis patients.

PubMed

Hamazaki, Kei; Terashima, Yoshihiro; Itomura, Miho; Sawazaki, Shigeki; Inagaki, Hitoshi; Kuroda, Masahiro; Tomita, Shin; Hirata, Hitoshi; Inadera, Hidekuni; Hamazaki, Tomohito

2011-01-01

Dietary n-3 polyunsaturated fatty acids (PUFAs), docosahexaenoic acid (DHA) and eicosapentaenoic acid have been shown to reduce cardiovascular mortality. Patients on hemodialysis (HD) have a very high mortality from cardiovascular disease. Fish consumption reduces all-cause mortality in patients on HD. Moreover, n-3 PUFAs, especially DHA levels in red blood cells (RBCs), are associated with arteriosclerosis in patients on HD. The aim of this study was to determine whether DHA levels in RBCs predict the mortality of patients on HD in a prospective cohort study. A cohort of 176 patients (64.1 ± 12.0 (mean ± SD) years of age, 96 men and 80 women) under HD treatment was studied. The fatty acid composition of their RBCs was analyzed by gas chromatography. During the study period of 5 years, 54 deaths occurred. After adjustment for 10 confounding factors, the Cox hazard ratio of all-cause mortality of the patients on HD in the highest DHA tertile (>8.1%, 15 deaths) was 0.43 (95% CI 0.21-0.88) compared with those patients in the lowest DHA tertile (<7.2%, 21 deaths). The findings suggest that the level of DHA in RBCs could be an independent predictor of all-cause mortality in patients on HD. Copyright © 2010 S. Karger AG, Basel.

Mortality among rescue and recovery workers and community members exposed to the September 11, 2001 World Trade Center terrorist attacks, 2003-2014.

PubMed

Jordan, Hannah T; Stein, Cheryl R; Li, Jiehui; Cone, James E; Stayner, Leslie; Hadler, James L; Brackbill, Robert M; Farfel, Mark R

2018-05-01

Multiple chronic health conditions have been associated with exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We assessed whether excess deaths occurred during 2003-2014 among persons directly exposed to 9/11, and examined associations of 9/11-related exposures with mortality risk. Deaths occurring in 2003-2014 among members of the World Trade Center Health Registry, a cohort of rescue/recovery workers and lower Manhattan community members who were exposed to 9/11, were identified via linkage to the National Death Index. Participants' overall levels of 9/11-related exposure were categorized as high, intermediate, or low. We calculated standardized mortality ratios (SMR) using New York City reference rates from 2003 to 2012. Proportional hazards were used to assess associations of 9/11-related exposures with mortality, accounting for age, sex, race/ethnicity and other potential confounders. We identified 877 deaths among 29,280 rescue/recovery workers (3.0%) and 1694 deaths among 39,643 community members (4.3%) during 308,340 and 416,448 person-years of observation, respectively. The SMR for all causes of death was 0.69 [95% confidence interval (CI) 0.65-0.74] for rescue/recovery workers and 0.86 (95% CI 0.82-0.90) for community members. SMRs for diseases of the cardiovascular and respiratory systems were significantly lower than expected in both groups. SMRs for several other causes of death were significantly elevated, including suicide among rescue recovery workers (SMR 1.82, 95% CI 1.35-2.39), and brain malignancies (SMR 2.25, 95% CI 1.48-3.28) and non-Hodgkin's lymphoma (SMR 1.79, 95% CI 1.24-2.50) among community members. Compared to low exposure, both intermediate [adjusted hazard ratio (AHR) 1.36, 95% CI 1.10-1.67] and high (AHR 1.41, 95% CI 1.06-1.88) levels of 9/11-related exposure were significantly associated with all-cause mortality among rescue/recovery workers (p-value for trend 0.01). For community members, intermediate (AHR 1.13, 95% CI 1.01-1.27), but not high (AHR 1.14, 95% CI 0.94-1.39) exposure was significantly associated with all-cause mortality (p-value for trend 0.03). AHRs for associations of overall 9/11-related exposure with heart disease- and cancer-related mortality were similar in magnitude to those for all-cause mortality, but with 95% CIs crossing the null value. Overall mortality was not elevated. Among specific causes of death that were significantly elevated, suicide among rescue/recovery workers is a plausible long-term consequence of 9/11 exposure, and is potentially preventable. Elevated mortality due to other causes, including non-Hodgkin's lymphoma and brain cancer, and small but statistically significant associations of 9/11-related exposures with all-cause mortality hazard warrant additional surveillance. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Epidemiology of injuries in Singapore.

PubMed

Emmanuel, S

1991-03-01

Injuries are a major public health problem in developed industrialised countries and are the leading cause of premature mortality. This study has shown the same picture for Singapore. Injuries are the fifth leading cause of crude death but the most important cause of premature mortality being responsible for 23,800 potential years of life lost before the age of 65 years. The most vulnerable ages are from the preschool to the economically active age groups. Singapore males have twice the death rate of females (52 vs 20 per 100,000 population) because of the relatively higher proportion of males (78.5% among males vs 48% among females) who work and are therefore at higher risk. Indian males have the highest ethnic-and-sex-specific mortality rates (107 vs 48 among Chinese males and 39 among Malay males per 1000 population). Road traffic accidents were the leading cause of mortality from injuries but this has been over taken by suicides. Information on the specific causes and specific high risk behaviour and factors for injuries in Singapore is weak. This needs to be strengthened to enable more effective cause-specific control programmes to be drawn up.

Development of a Risk Score Based on Aortic Calcification to Predict 1-year Mortality After Transcatheter Aortic Valve Replacement.

PubMed

Lantelme, Pierre; Eltchaninoff, Hélène; Rabilloud, Muriel; Souteyrand, Géraud; Dupré, Marion; Spaziano, Marco; Bonnet, Marc; Becle, Clément; Riche, Benjamin; Durand, Eric; Bouvier, Erik; Dacher, Jean-Nicolas; Courand, Pierre-Yves; Cassagnes, Lucie; Dávila Serrano, Eduardo E; Motreff, Pascal; Boussel, Loic; Lefèvre, Thierry; Harbaoui, Brahim

2018-05-11

The aim of this study was to develop a new scoring system based on thoracic aortic calcification (TAC) to predict 1-year cardiovascular and all-cause mortality. A calcified aorta is often associated with poor prognosis after transcatheter aortic valve replacement (TAVR). A risk score encompassing aortic calcification may be valuable in identifying poor TAVR responders. The C 4 CAPRI (4 Cities for Assessing CAlcification PRognostic Impact) multicenter study included a training cohort (1,425 patients treated using TAVR between 2010 and 2014) and a contemporary test cohort (311 patients treated in 2015). TAC was measured by computed tomography pre-TAVR. CAPRI risk scores were based on the linear predictors of Cox models including TAC in addition to comorbidities and demographic, atherosclerotic disease and cardiac function factors. CAPRI scores were constructed and tested in 2 independent cohorts. Cardiovascular and all-cause mortality at 1 year was 13.0% and 17.9%, respectively, in the training cohort and 8.2% and 11.8% in the test cohort. The inclusion of TAC in the model improved prediction: 1-cm 3 increase in TAC was associated with a 6% increase in cardiovascular mortality and a 4% increase in all-cause mortality. The predicted and observed survival probabilities were highly correlated (slopes >0.9 for both cardiovascular and all-cause mortality). The model's predictive power was fair (AUC 68% [95% confidence interval [CI]: 64-72]) for both cardiovascular and all-cause mortality. The model performed similarly in the training and test cohorts. The CAPRI score, which combines the TAC variable with classical prognostic factors, is predictive of 1-year cardiovascular and all-cause mortality. Its predictive performance was confirmed in an independent contemporary cohort. CAPRI scores are highly relevant to current practice and strengthen the evidence base for decision making in valvular interventions. Its routine use may help prevent futile procedures. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Does equal socioeconomic status in black and white men mean equal risk of mortality?

PubMed Central

Keil, J E; Sutherland, S E; Knapp, R G; Tyroler, H A

1992-01-01

Although concerns have been expressed that mortality from coronary disease and all other causes is greater among Blacks than Whites, we hypothesized that, when socioeconomic status is adequately considered, mortality inequalities between Blacks and Whites are insignificant. The study population was a random sampling of Black and White men who were 35 years of age or older when recruited into the Charleston Heart Study in 1960. Education level and occupational status at baseline were used to compare mortality over the ensuing 28 years between Black and White men, who were classified as low or high socioeconomic status. In no instance were Black-White differences in all-cause or coronary disease mortality rates significantly different when socioeconomic status was controlled. We conclude that socioeconomic status is an important predictor of mortality and that, when socioeconomic status is considered, differences in Black-White mortality rates may be small. PMID:1636835

Temporal Patterns of Oak Mortality in a Southern Appalachian Forest (1991-2006).

Treesearch

Cathryn Greenberg; Tara L. Keyser; James Speer

2011-01-01

The sustainability of eastern oak-dominated forests is threatened by high oak mortality rates and widespread oak regeneration failure, and presents a challenge to natural area managers. We tracked the rate and cause of mortality of 287 mature oak trees of five species for 15 years to determine the temporal patterns and sources of mortality. We observed a 15.3% total...

Predicting risk of coronary events and all-cause mortality: role of B-type natriuretic peptide above traditional risk factors and coronary artery calcium scoring in the general population: the Heinz Nixdorf Recall Study.

PubMed

Kara, Kaffer; Mahabadi, Amir A; Berg, Marie H; Lehmann, Nils; Möhlenkamp, Stefan; Kälsch, Hagen; Bauer, Marcus; Moebus, Susanne; Dragano, Nico; Jöckel, Karl-Heinz; Neumann, Till; Erbel, Raimund

2014-09-01

Several biomarkers including B-type natriuretic peptide (BNP) have been suggested to improve prediction of coronary events and all-cause mortality. Moreover, coronary artery calcium (CAC) as marker of subclinical atherosclerosis is a strong predictor for cardiovascular mortality and morbidity. We aimed to evaluate the predictive ability of BNP and CAC for all-cause mortality and coronary events above traditional cardiovascular risk factors (TRF) in the general population. We followed 3782 participants of the population-based Heinz Nixdorf Recall cohort study without coronary artery disease at baseline for 7.3 ± 1.3 years. Associations of BNP and CAC with incident coronary events and all-cause mortality were assessed using Cox regression, Harrell's c, and time-dependent integrated discrimination improvement (IDI(t), increase in explained variance). Subjects with high BNP levels had increased frequency of coronary events and death (coronary events/mortality: 14.1/28.2% for BNP ≥100 pg/ml vs. 2.7/5.5% for BNP < 100 pg/ml, respectively). Subjects with a BNP ≥100 pg/ml had increased incidence of hard endpoints sustaining adjustment for CAC and TRF (for coronary events: hazard ratio (HR) (95% confidence interval (CI)) 3.41(1.78-6.53); for all-cause mortality: HR 3.35(2.15-5.23)). Adding BNP to TRF and CAC increased measures of predictive ability: coronary events (Harrell's c, for coronary events, 0.775-0.784, p = 0.09; for all-cause mortality 0.733-0.740, p = 0.04; and IDI(t) (95% CI), for coronary events: 2.79% (0.33-5.65%) and for all-cause mortality 1.78% (0.73-3.10%). Elevated levels of BNP are associated with excess incident coronary events and all-cause mortality rates, with BNP and CAC significantly and complementary improving prediction of risk in the general population above TRF. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review.

PubMed

Higgins, Julian P T; Soares-Weiser, Karla; López-López, José A; Kakourou, Artemisia; Chaplin, Katherine; Christensen, Hannah; Martin, Natasha K; Sterne, Jonathan A C; Reingold, Arthur L

2016-10-13

 To evaluate the effects on non-specific and all cause mortality, in children under 5, of Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), and standard titre measles containing vaccines (MCV); to examine internal validity of the studies; and to examine any modifying effects of sex, age, vaccine sequence, and co-administration of vitamin A.  Systematic review, including assessment of risk of bias, and meta-analyses of similar studies.  Clinical trials, cohort studies, and case-control studies of the effects on mortality of BCG, whole cell DTP, and standard titre MCV in children under 5.  Searches of Medline, Embase, Global Index Medicus, and the WHO International Clinical Trials Registry Platform, supplemented by contact with experts in the field. To avoid overlap in children studied across the included articles, findings from non-overlapping birth cohorts were identified.  Results from 34 birth cohorts were identified. Most evidence was from observational studies, with some from short term clinical trials. Most studies reported on all cause (rather than non-specific) mortality. Receipt of BCG vaccine was associated with a reduction in all cause mortality: the average relative risks were 0.70 (95% confidence interval 0.49 to 1.01) from five clinical trials and 0.47 (0.32 to 0.69) from nine observational studies at high risk of bias. Receipt of DTP (almost always with oral polio vaccine) was associated with a possible increase in all cause mortality on average (relative risk 1.38, 0.92 to 2.08) from 10 studies at high risk of bias; this effect seemed stronger in girls than in boys. Receipt of standard titre MCV was associated with a reduction in all cause mortality (relative risks 0.74 (0.51 to 1.07) from four clinical trials and 0.51 (0.42 to 0.63) from 18 observational studies at high risk of bias); this effect seemed stronger in girls than in boys. Seven observational studies, assessed as being at high risk of bias, have compared sequences of vaccines; results of a subset of these suggest that administering DTP with or after MCV may be associated with higher mortality than administering it before MCV.  Evidence suggests that receipt of BCG and MCV reduce overall mortality by more than would be expected through their effects on the diseases they prevent, and receipt of DTP may be associated with an increase in all cause mortality. Although efforts should be made to ensure that all children are immunised on schedule with BCG, DTP, and MCV, randomised trials are needed to compare the effects of different sequences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Characterizing the relationship between temperature and mortality in tropical and subtropical cities: a distributed lag non-linear model analysis in Hue, Viet Nam, 2009-2013.

PubMed

Dang, Tran Ngoc; Seposo, Xerxes T; Duc, Nguyen Huu Chau; Thang, Tran Binh; An, Do Dang; Hang, Lai Thi Minh; Long, Tran Thanh; Loan, Bui Thi Hong; Honda, Yasushi

2016-01-01

The relationship between temperature and mortality has been found to be U-, V-, or J-shaped in developed temperate countries; however, in developing tropical/subtropical cities, it remains unclear. Our goal was to investigate the relationship between temperature and mortality in Hue, a subtropical city in Viet Nam. We collected daily mortality data from the Vietnamese A6 mortality reporting system for 6,214 deceased persons between 2009 and 2013. A distributed lag non-linear model was used to examine the temperature effects on all-cause and cause-specific mortality by assuming negative binomial distribution for count data. We developed an objective-oriented model selection with four steps following the Akaike information criterion (AIC) rule (i.e. a smaller AIC value indicates a better model). High temperature-related mortality was more strongly associated with short lags, whereas low temperature-related mortality was more strongly associated with long lags. The low temperatures increased risk in all-category mortality compared to high temperatures. We observed elevated temperature-mortality risk in vulnerable groups: elderly people (high temperature effect, relative risk [RR]=1.42, 95% confidence interval [CI]=1.11-1.83; low temperature effect, RR=2.0, 95% CI=1.13-3.52), females (low temperature effect, RR=2.19, 95% CI=1.14-4.21), people with respiratory disease (high temperature effect, RR=2.45, 95% CI=0.91-6.63), and those with cardiovascular disease (high temperature effect, RR=1.6, 95% CI=1.15-2.22; low temperature effect, RR=1.99, 95% CI=0.92-4.28). In Hue, the temperature significantly increased the risk of mortality, especially in vulnerable groups (i.e. elderly, female, people with respiratory and cardiovascular diseases). These findings may provide a foundation for developing adequate policies to address the effects of temperature on health in Hue City.

Characterizing the relationship between temperature and mortality in tropical and subtropical cities: a distributed lag non-linear model analysis in Hue, Viet Nam, 2009–2013

PubMed Central

Dang, Tran Ngoc; Seposo, Xerxes T.; Duc, Nguyen Huu Chau; Thang, Tran Binh; An, Do Dang; Hang, Lai Thi Minh; Long, Tran Thanh; Loan, Bui Thi Hong; Honda, Yasushi

2016-01-01

Background The relationship between temperature and mortality has been found to be U-, V-, or J-shaped in developed temperate countries; however, in developing tropical/subtropical cities, it remains unclear. Objectives Our goal was to investigate the relationship between temperature and mortality in Hue, a subtropical city in Viet Nam. Design We collected daily mortality data from the Vietnamese A6 mortality reporting system for 6,214 deceased persons between 2009 and 2013. A distributed lag non-linear model was used to examine the temperature effects on all-cause and cause-specific mortality by assuming negative binomial distribution for count data. We developed an objective-oriented model selection with four steps following the Akaike information criterion (AIC) rule (i.e. a smaller AIC value indicates a better model). Results High temperature-related mortality was more strongly associated with short lags, whereas low temperature-related mortality was more strongly associated with long lags. The low temperatures increased risk in all-category mortality compared to high temperatures. We observed elevated temperature-mortality risk in vulnerable groups: elderly people (high temperature effect, relative risk [RR]=1.42, 95% confidence interval [CI]=1.11–1.83; low temperature effect, RR=2.0, 95% CI=1.13–3.52), females (low temperature effect, RR=2.19, 95% CI=1.14–4.21), people with respiratory disease (high temperature effect, RR=2.45, 95% CI=0.91–6.63), and those with cardiovascular disease (high temperature effect, RR=1.6, 95% CI=1.15–2.22; low temperature effect, RR=1.99, 95% CI=0.92–4.28). Conclusions In Hue, the temperature significantly increased the risk of mortality, especially in vulnerable groups (i.e. elderly, female, people with respiratory and cardiovascular diseases). These findings may provide a foundation for developing adequate policies to address the effects of temperature on health in Hue City. PMID:26781954

Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden.

PubMed

Åhman, Ada; Jerkeman, Anna; Blomé, Marianne Alanko; Björkman, Per; Håkansson, Anders

2018-07-01

Abuse of amphetamines is a worldwide problem with around 34 million users, and amphetamine is commonly used by people who inject drugs (PWID). Despite this, there is relatively little research on mortality and cause of death among people who use amphetamines primarily. The present study aimed to examine mortality and causes of death among people who inject amphetamine, and compare these results to the general population. This retrospective cohort study was based on data from The Malmö Needle Exchange Program in Sweden (MNEP) and on data from The Swedish National Cause of Death Register. Participants in the MNEP, between 1987 and 2011, with registered national identity number and amphetamine as their primary drug of injection use, were included in the study. Standardized mortality ratios (SMR) was calculated for overall mortality and categories of causes of death. 2019 individuals were included (mean follow-up-time 13.7 years [range 0.02-24.2 years], a total of 27,698 person-years). Of the 448 deceased, 428 had a registered cause of death. The most common causes of death were external causes (n = 162, 38%), followed by diseases of the circulatory system (n = 67, 16%). SMR were significantly elevated (8.3, 95% CI [7.5-9.1]) for the entire study population, and for every category of causes of death respectively. People injecting amphetamine as a primary drug were found to have significantly elevated mortality compared with the general population, with high rates of both external and somatic causes of death. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology

PubMed Central

Cicero, Arrigo F.

2013-01-01

Cardiovascular complications are important in hyperthyroidism because of their high frequency in clinical presentation and increased mortality and morbidity risk. The cause of hyperthyroidism, factors related to the patient, and the genetic basis for complications are associated with risk and the basic underlying mechanisms are important for treatment and management of the disease. Besides cellular effects, hyperthyroidism also causes hemodynamic changes, such as increased preload and contractility and decreased systemic vascular resistance causes increased cardiac output. Besides tachyarrythmias, impaired systolic ventricular dysfunction and diastolic dysfunction may cause thyrotoxic cardiomyopathy in a small percentage of the patients, as another high mortality complication. Although the medical literature has some conflicting data about benefits of treatment of subclinical hyperthyroidism, even high-normal thyroid function may cause cardiovascular problems and it should be treated. This review summarizes the cardiovascular consequences of hyperthyroidism with underlying mechanisms. PMID:24273583

Forest thinning and subsequent bark beetle-caused mortality in Northeastern California

Treesearch

Joel M. Egan; William R. Jacobi; Jose F. Negron; Sheri L. Smith; Daniel R. Cluck

2010-01-01

The Warner Mountains of northeastern California on the Modoc National Forest experienced a high incidence of tree mortality (2001-2007) that was associated with drought and bark beetle (Coleoptera: Curculionidae, Scolytinae) attack. Various silvicultural thinning treatments were implemented prior to this period of tree mortality to reduce stand density and increase...

Mortality Among Homeless Adults in Boston: Shifts in Causes of Death Over a 15-year Period

PubMed Central

Baggett, Travis P.; Hwang, Stephen W.; O'Connell, James J.; Porneala, Bianca C.; Stringfellow, Erin J.; Orav, E. John; Singer, Daniel E.; Rigotti, Nancy A.

2013-01-01

Background Homeless persons experience excess mortality, but U.S.-based studies on this topic are outdated or lack information about causes of death. No studies have examined shifts in causes of death for this population over time. Methods We assessed all-cause and cause-specific mortality rates in a cohort of 28,033 adults aged 18 years or older who were seen at Boston Health Care for the Homeless Program between January 1, 2003, and December 31, 2008. Deaths were identified through probabilistic linkage to the Massachusetts death occurrence files. We compared mortality rates in this cohort to rates in the 2003–08 Massachusetts population and a 1988–93 cohort of homeless adults in Boston using standardized rate ratios with 95% confidence intervals. Results 1,302 deaths occurred during 90,450 person-years of observation. Drug overdose (n=219), cancer (n=206), and heart disease (n=203) were the major causes of death. Drug overdose accounted for one-third of deaths among adults <45 years old. Opioids were implicated in 81% of overdose deaths. Mortality rates were higher among whites than non-whites. Compared to Massachusetts adults, mortality disparities were most pronounced among younger individuals, with rates about 9-fold higher in 25–44 year olds and 4.5-fold higher in 45–64 year olds. In comparison to 1988–93, reductions in HIV deaths were offset by 3- and 2-fold increases in deaths due to drug overdose and psychoactive substance use disorders, resulting in no significant difference in overall mortality. Conclusions The all-cause mortality rate among homeless adults in Boston remains high and unchanged since 1988–93 despite a major interim expansion in clinical services. Drug overdose has replaced HIV as the emerging epidemic. Interventions to reduce mortality in this population should include behavioral health integration into primary medical care, public health initiatives to prevent and reverse drug overdose, and social policy measures to end homelessness. PMID:23318302

A pilot study testing a natural and a synthetic Molluscicide for controlling invasive apple snails (Pomacea maculata)

USGS Publications Warehouse

Olivier, Heather M.; Jenkins, Jill A.; Berhow, Mark; Carter, Jacoby

2016-01-01

Pomacea maculata (formerly P. insularum), an apple snail native to South America, was discovered in Louisiana in 2008. These snails strip vegetation, reproduce at tremendous rates, and have reduced rice production and caused ecosystem changes in Asia. In this pilot study snails were exposed to two molluscicides, a tea (Camellia sinensis) seed derivative (TSD) or niclosamide monohydrate (Pestanal®, 2′,5-dichloro-4′-nitrosalicylanilide, CAS #73360-56-2). Mortality was recorded after exposure to high or low concentrations (0.03 and 0.015 g/L for TSD, 1.3 and 0.13 mg/L for niclosamide). The TSD induced 100 % mortality at both concentrations. Niclosamide caused 100 % and 17 % mortality at high and low concentrations respectively. These molluscicides were also tested on potential biocontrol agents, the red swamp crayfish (Procambarus clarkii) and redear sunfish (Lepomis microlophus). No crayfish mortalities occurred at either concentration for either chemical, but sunfish experienced 100 % mortality with TSD (0.03 g/L), and 21 % mortality with niclosamide (0.13 mg/L).

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: the double burden of non-communicable diseases and injuries.

PubMed

Arroyave, Ivan; Burdorf, Alex; Cardona, Doris; Avendano, Mauricio

2014-07-01

Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality. Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities. Copyright © 2014 Elsevier Inc. All rights reserved.

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: The double burden of non-communicable diseases and injuries

PubMed Central

Arroyave, Ivan; Burdorf, Alex; Cardona, Doris; Avendano, Mauricio

2014-01-01

Objectives Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. Methods Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. Results Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2·60, 95% confidence interval [CI]:2·56, 2·64; RRwomen=2·36, CI:2·31, 2·42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55·1% of male inequalities while non-communicable diseases explained 62·5% of female inequalities and 27·1% of male inequalities. Infections explained a small proportion of inequalities in mortality. Conclusion Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities. PMID:24674854

Perceived Social Support Trajectories and the All-Cause Mortality Risk of Older Mexican American Women and Men

PubMed Central

Hill, Terrence D.; Uchino, Bert N.; Eckhardt, Jessica L.; Angel, Jacqueline L.

2016-01-01

Although numerous studies of non-Hispanic whites and blacks show that social integration and social support tend to favor longevity, it is unclear whether this general pattern extends to the Mexican American population. Building on previous research, we employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the association between perceived social support trajectories and the all-cause mortality risk of older Mexican Americans. Growth mixture estimates revealed three latent classes of support trajectories: high, moderate, and low. Cox regression estimates indicated that older Mexican American men in the low support trajectory tend to exhibit a higher mortality risk than their counterparts in the high support trajectory. Social support trajectories were unrelated to the mortality risk of older Mexican American women. A statistically significant interaction term confirmed that social support was more strongly associated with the mortality risk of men. PMID:26966256

Perceived Social Support Trajectories and the All-Cause Mortality Risk of Older Mexican American Women and Men.

PubMed

Hill, Terrence D; Uchino, Bert N; Eckhardt, Jessica L; Angel, Jacqueline L

2016-04-01

Although numerous studies of non-Hispanic Whites and Blacks show that social integration and social support tend to favor longevity, it is unclear whether this general pattern extends to the Mexican American population. Building on previous research, we employed seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the association between perceived social support trajectories and the all-cause mortality risk of older Mexican Americans. Growth mixture estimates revealed three latent classes of support trajectories: high, moderate, and low. Cox regression estimates indicated that older Mexican American men in the low support trajectory tend to exhibit a higher mortality risk than their counterparts in the high support trajectory. Social support trajectories were unrelated to the mortality risk of older Mexican American women. A statistically significant interaction term confirmed that social support was more strongly associated with the mortality risk of men. © The Author(s) 2015.

A provegetarian food pattern and reduction in total mortality in the Prevención con Dieta Mediterránea (PREDIMED) study.

PubMed

Martínez-González, Miguel A; Sánchez-Tainta, Ana; Corella, Dolores; Salas-Salvadó, Jordi; Ros, Emilio; Arós, Fernando; Gómez-Gracia, Enrique; Fiol, Miquel; Lamuela-Raventós, Rosa M; Schröder, Helmut; Lapetra, Jose; Serra-Majem, Lluis; Pinto, Xavier; Ruiz-Gutierrez, Valentina; Estruch, Ramon

2014-07-01

Vegetarian diets have been associated with reduced mortality. Because a pure vegetarian diet might not easily be embraced by many individuals, consuming preferentially plant-derived foods would be a more easily understood message. A provegetarian food pattern (FP) emphasizing preference for plant-derived foods might reduce all-cause mortality. The objective was to identify the association between an a priori-defined provegetarian FP and all-cause mortality. We followed 7216 participants (57% women; mean age: 67 y) at high cardiovascular risk for a median of 4.8 y. A validated 137-item semiquantitative food-frequency questionnaire was administered at baseline and yearly thereafter. Fruit, vegetables, nuts, cereals, legumes, olive oil, and potatoes were positively weighted. Added animal fats, eggs, fish, dairy products, and meats or meat products were negatively weighted. Energy-adjusted quintiles were used to assign points to build the provegetarian FP (range: 12-60 points). Deaths were confirmed by review of medical records and the National Death Index. There were 323 deaths during the follow-up period (76 from cardiovascular causes, 130 from cancer, 117 for noncancer, noncardiovascular causes). Higher baseline conformity with the provegetarian FP was associated with lower mortality (multivariable-adjusted HR for ≥ 40 compared with <30 points: 0.59; 95% CI: 0.40, 0.88). Similar results were found with the use of updated information on diet (RR: 0.59; 95% CI: 0.39, 0.89). Among omnivorous subjects at high cardiovascular risk, better conformity with an FP that emphasized plant-derived foods was associated with a reduced risk of all-cause mortality. This trial was registered at www.controlled-trials.com as ISRCTN35739639. © 2014 American Society for Nutrition.

Epidemiological study of mortality in epilepsy in a Spanish population.

PubMed

Chamorro-Muñoz, María Isabel; García-Martín, Guillermina; Pérez-Errazquin, Francisco; Romero-Acebal, Manuel; García-Rodríguez, Antonio; Gutiérrez-Bedmar, Mario

2017-03-01

Studies concerning mortality in epilepsy have been performed primarily in Northern-Central Europe and US. The aim of this study was to provide information about mortality in people with epilepsy in Southern European countries. We studied a Spanish prevalence and incidence cohort of 2309 patients aged ≥14 years with epilepsy who were treated in an outpatient epilepsy clinic between 2000 and 2013. The deceased were identified through Civil Registries. Causes of death were determined using death certificates, forensic autopsies, hospital reports, family practitioners, and care-givers' records. Standardised mortality ratios (SMRs) were calculated. In a total of 15,865 person-years of follow-up, 152 patients died, resulting in an SMR of 2.11 (95% CI 1.79-2.47), which was higher for those aged 14-24. There was also a high rate of death for symptomatic epilepsies, progressive causes (SMR=6.12, CI 3.50-9.94), and remote causes (SMR=2.62, CI 2.12-3.21). High SMRs were found for all kinds of epilepsy and for respiratory and tumoural causes. Patients who died of epilepsy itself were 12.5%. Sudden unexpected death in epilepsy incidence was 0.44:1000. Death from status epilepticus incidence was 20:100,000. SMRs for external causes were of no statistical significance. This is the first epidemiological study to examine rate of mortality in epilepsy in a Southern European country. The identified mortality pattern is similar to the one provided by researchers from developed countries. The similarities between our results concerning epilepsy-related deaths and those provided by population-based studies are the result of the scarcely selected character of our study cohort. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Causes and predictors of mortality in hospitalized lupus patient in Sarawak General Hospital, Malaysia.

PubMed

Teh, C L; Ling, G R

2013-01-01

Systemic lupus erythematosus (SLE) is a serious autoimmune disease that can be life threatening and fatal if left untreated. Causes and prognostic indicators of death in SLE have been well studied in developed countries but lacking in developing countries. We aimed to investigate the causes of mortality in hospitalized patients with SLE and determine the prognostic indicators of mortality during hospitalization in our center. All SLE patients who were admitted to Sarawak General Hospital from January 1, 2006 to December 31, 2010, were followed up in a prospective study using a standard protocol. Demographic data, clinical features, disease activities and damage indices were collected. Logistic regression and Cox regression analysis were used to determine the prognostic indicators of mortality in our patients. There were a total of 251 patients in our study, with the female to male ratio 10 to 1. Our study patients were of multiethnic origins. They had a mean age of 30.5 ± 12.2 years and a mean duration of illness of 36.5 ± 51.6 months. The main involvements were hematologic (73.3%), renal (70.9%) and mucocutaneous (67.3%). There were 26 deaths (10.4%), with the main causes being: infection and flare (50%), infection alone (19%), flare alone (19%) and others (12%). Independent predictors of mortality in our cohort of SLE patients were the presence of both infection and flare of disease (hazard ratio (HR) 5.56) and high damage indices at the time of admission (HR 1.91). Infection and flare were the main causes of death in hospitalized Asian patients with SLE. The presence of infection with flare and high damage indices at the time of admission were independent prognostic indicators of mortality.

Seafarer deaths at sea: a German mortality study.

PubMed

Oldenburg, M; Herzog, J; Harth, V

2016-03-01

Seafarers face numerous hazards during their work at sea. To demonstrate the frequency and causes of mortality in German seafarers. The deaths of all German seafarers from 1998 to 2008 were counted and evaluated using the German central civil register in Berlin. The study cohort comprised a total of 159588 seafarer-years. During the 11 year period, 68 male seafarers died on board. The average age was 48.5 years (SD 12.7 years) and comprised 35 deck officers, 16 engine officers and 17 general crew members (i.e. non-officers from the deck and engine room crew and galley staff). Cause of death was documented in 45 cases (66%): 26 were due to unnatural causes (occupational accidents, suicides) and 19 due to natural causes (particularly, ischaemic heart disease). The crude annual mortality rate for German seamen was 65 per 100000 seafarer-years. For cardiac causes, this rate was significantly higher among deck and engine officers (24 and 38) than among crew ranks (7 per 100000 seafarer-years) (P < 0.05). Deck and engine offi-cers also showed a higher mortality rate for accidents (28 and 22) than crew ranks (15) (P < 0.05). The age-stratified fatal accident rate of German seafarers aboard was 10 times higher than the mortality of the German general population on shore. Seafaring constitutes an occupation with a high risk for serious accidents. Due to the unexpectedly high mortality rate among officers associated with work-related accidents, this occupational group should receive more effective education on safety behaviour on board. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Child Deaths Due to Injury in the Four UK Countries: A Time Trends Study from 1980 to 2010

PubMed Central

Hardelid, Pia; Davey, Jonathan; Dattani, Nirupa; Gilbert, Ruth

2013-01-01

Background Injuries are an increasingly important cause of death in children worldwide, yet injury mortality is highly preventable. Determining patterns and trends in child injury mortality can identify groups at particularly high risk. We compare trends in child deaths due to injury in four UK countries, between 1980 and 2010. Methods We obtained information from death certificates on all deaths occurring between 1980 and 2010 in children aged 28 days to 18 years and resident in England, Scotland, Wales or Northern Ireland. Injury deaths were defined by an external cause code recorded as the underlying cause of death. Injury mortality rates were analysed by type of injury, country of residence, age group, sex and time period. Results Child mortality due to injury has declined in all countries of the UK. England consistently experienced the lowest mortality rate throughout the study period. For children aged 10 to 18 years, differences between countries in mortality rates increased during the study period. Inter-country differences were largest for boys aged 10 to 18 years with mortality rate ratios of 1.38 (95% confidence interval 1.16, 1.64) for Wales, 1.68 (1.48, 1.91) for Scotland and 1.81 (1.50, 2.18) for Northern Ireland compared with England (the baseline) in 2006–10. The decline in mortality due to injury was accounted for by a decline in unintentional injuries. For older children, no declines were observed for deaths caused by self-harm, by assault or from undetermined intent in any UK country. Conclusion Whilst child deaths from injury have declined in all four UK countries, substantial differences in mortality rates remain between countries, particularly for older boys. This group stands to gain most from policy interventions to reduce deaths from injury in children. PMID:23874585

Mortality After Elective and Ruptured Abdominal Aortic Aneurysm Surgical Repair: 12-Year Single-Center Experience of Estonia.

PubMed

Lieberg, J; Pruks, L-L; Kals, M; Paapstel, K; Aavik, A; Kals, J

2018-06-01

Abdominal aortic aneurysm is a degenerative vascular pathology with high mortality due to its rupture, which is why timely treatment is crucial. The current single-center retrospective study was undertaken to analyze short- and long-term all-cause mortality after operative treatment of abdominal aortic aneurysm and to examine the factors that influence outcome. The data of all abdominal aortic aneurysm patients treated with open repair or endovascular aneurysm repair in 2004-2015 were retrospectively retrieved from the clinical database of Tartu University Hospital. The primary endpoint was 30-day, 90-day, and 5-year all-cause mortality. The secondary endpoint was determination of the risk factors for mortality. Elective abdominal aortic aneurysm repair was performed on 228 patients (mean age 71.8 years), of whom 178 (78%) were treated with open repair and 50 (22%) with endovascular aneurysm repair. A total of 48 patients with ruptured abdominal aortic aneurysm were treated with open repair (mean age 73.8 years) at the Department of Vascular Surgery, Tartu University Hospital, Estonia. Mean follow-up period was 4.2 ± 3.3 years. In patients with elective abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 0.9%, 2.6%, and 32%, respectively. In multivariate analysis, the main predictors for 5-year mortality were preoperative creatinine value and age (p < 0.05). In patients with ruptured abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 22.9%, 33.3%, and 55.1%, respectively. In multivariate analysis, the risk factors for 30-day mortality in ruptured abdominal aortic aneurysm were perioperative hemoglobin and lactate levels (p < 0.05). According to this study, the all-cause mortality rates of elective abdominal aortic aneurysm and ruptured abdominal aortic aneurysm at our hospital were comparable to those at other centers worldwide. Even though some variables were identified as potential predictors of survival, the mortality rates after ruptured abdominal aortic aneurysm remain high. Early diagnosis, timely treatment, and detection of the risk factors for abdominal aortic aneurysm progression would improve survival in patients with abdominal aortic aneurysm.

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

PubMed

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

2014-02-01

Elevated serum phosphorus is associated with all-cause mortality, but little is known about risk associated with dietary phosphorus intake. We investigated the association between phosphorus intake and mortality in a prospective cohort of healthy US adults (NHANES III; 1998-1994). 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. 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 diet quality and in analyses adjusted for sodium and saturated fat intakes. High phosphorus intake is associated with increased mortality in a healthy US population. Because of current patterns in phosphorus consumption in US adults, these findings may have important public health implications.

Physical activity and mortality: is the association explained by genetic selection?

PubMed

Carlsson, Sofia; Andersson, Tomas; Lichtenstein, Paul; Michaëlsson, Karl; Ahlbom, Anders

2007-08-01

Public health recommendations promote physical activity to improve health and longevity. Recent data suggest that the association between physical activity and mortality may be due to genetic selection. Using data on twins, the authors investigated whether genetic selection explains the association between physical activity and mortality. Data were based on a postal questionnaire answered by 13,109 Swedish twin pairs in 1972. The national Cause of Death Register was used for information about all-cause mortality (n=1,800) and cardiovascular disease mortality (n=638) during 1975-2004. The risk of death was reduced by 34% for men (relative risk=0.64, 95% confidence interval: 0.50, 0.83) and by 25% for women (relative risk=0.75, 95% confidence interval: 0.50, 1.14) reporting high physical activity levels. Within-pair comparisons of monozygotic twins showed that, compared with their less active co-twin, the more active twin had a 20% (odds ratio=0.80, 95% confidence interval: 0.65, 0.99) reduced risk of all-cause mortality and a 32% (odds ratio=0.68, 95% confidence interval: 0.49, 0.95) reduced risk of cardiovascular disease mortality. Results indicate that physical activity is associated with a reduced risk of mortality not due to genetic selection. This finding supports a causal link between physical activity and mortality.

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

Are sitting occupations associated with increased all-cause, cancer, and cardiovascular disease mortality risk? A pooled analysis of seven British population cohorts.

PubMed

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

2013-01-01

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. 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. 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. 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.

Dose-response association of moderate-to-vigorous physical activity with cardiovascular biomarkers and all-cause mortality: Considerations by individual sports, exercise and recreational physical activities.

PubMed

Loprinzi, Paul D

2015-12-01

Previous research demonstrates that moderate-to-vigorous physical activity (MVPA) is associated with reduced all-cause mortality risk. Our understanding of whether individual physical activities are associated with all-cause mortality is less understood. Data from the 1999-2006 NHANES were employed, with follow-up through 2011. 48 different individual physical activities (e.g., swimming, running, bicycling) were assessed, and total MVPA MET-min-month was calculated based on their responses to these 48 individual physical activities. Greater engagement in MVPA was associated with more favorable cardiovascular biomarkers, particularly for men. Even after adjustment for total MVPA, different individual physical activities were associated with cardiovascular biomarkers across gender. When compared to those not meeting guidelines (0-1999 MVPA MET-min-month), a dose-response association between MVPA and mortality was observed, with those engaging in 5 times the guideline level having the lowest risk of all-cause mortality (45% reduced risk). There was no evidence of a harmful effect of very high MVPA (e.g., 20,000+ MVPA MET-min-month). Engaging in MVPA even below the minimum recommendation was associated with survival benefits, and the greatest survival effects occurred at a dose of approximately 5 times the minimum recommendation. Although very high levels (e.g., 10 times the minimum recommendation) of self-reported MVPA did not demonstrate the greatest survival effects, high levels of physical activity did not appear to have harmful effects. Copyright © 2015 Elsevier Inc. All rights reserved.

Season of death and birth predict patterns of mortality in Burkina Faso.

PubMed

Kynast-Wolf, Gisela; Hammer, Gaël P; Müller, Olaf; Kouyaté, Bocar; Becher, Heiko

2006-04-01

Mortality in developing countries has multiple causes. Some of these causes are linked to climatic conditions that differ over the year. Data on season-specific mortality are sparse. We analysed longitudinal data from a population of approximately 35,000 individuals in Burkina Faso. During the observation period 1993-2001, a total number of 4,098 deaths were recorded. The effect of season on mortality was investigated separately by age group as (i) date of death and (ii) date of birth. For (i), age-specific death rates by month of death were calculated. The relative effect of each month was assessed using the floating relative risk method and modelled continuously. For (ii), age-specific death rates by month of birth were calculated and the mean date of birth among deaths and survivors was compared. Overall mortality was found to be consistently higher during the dry season (November to May). The pattern was seen in all age groups except in infants where a peak was seen around the end of the rainy season. In infants we found a strong association between high mortality and being born during the time period September to February. No effect was seen for the other age groups. The observed excess mortality in young children at or around the end of the rainy season can be explained by the effects of infectious diseases and, in particular, malaria during this time period. In contrast, the excess mortality seen in older children and adults during the early dry season remains largely unexplained although specific infectious diseases such as meningitis and pneumonia are possible main causes. The association between high infant mortality and being born at around the end of the rainy season is probably explained by most of the malaria deaths in areas of high transmission intensity occurring in the second half of infancy.

Association of socioeconomic status with overall and cause specific mortality in the Republic of Seychelles: results from a cohort study in the African region.

PubMed

Stringhini, Silvia; Rousson, Valentin; Viswanathan, Bharathi; Gedeon, Jude; Paccaud, Fred; Bovet, Pascal

2014-01-01

Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region. All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys. During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24-2.62), CVD (HR = 1.95; 1.04-3.65) and non-cancer/non-CVD (HR = 2.14; 1.10-4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76-2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality. In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.

Association of Socioeconomic Status with Overall and Cause Specific Mortality in the Republic of Seychelles: Results from a Cohort Study in the African Region

PubMed Central

Stringhini, Silvia; Rousson, Valentin; Viswanathan, Bharathi; Gedeon, Jude; Paccaud, Fred; Bovet, Pascal

2014-01-01

Background Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region. Methods All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys. Results During a mean follow-up of 15.0 years (range 0–23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24–2.62), CVD (HR = 1.95; 1.04–3.65) and non-cancer/non-CVD (HR = 2.14; 1.10–4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76–2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality. Conclusions In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries. PMID:25057938

Risk factors for all-cause, overdose and early deaths after release from prison in Washington state.

PubMed

Binswanger, Ingrid A; Blatchford, Patrick J; Lindsay, Rebecca G; Stern, Marc F

2011-08-01

High mortality rates after release from prison have been well-documented, particularly from overdose. However, little is known about the risk factors for death after release from prison. Therefore, the objective of this study was to determine the demographic and incarceration-related risk factors for all-cause, overdose and early mortality after release from prison. We conducted a retrospective cohort study of inmates released from a state prison system from 1999 through 2003. The cohort included 30,237 who had a total of 38,809 releases from prison. Potential risk factors included gender, race/ethnicity, age, length of incarceration, and community supervision. Cox proportional hazards regression was used to determine risk factors for all-cause, overdose and early (within 30 days of release) death after release from prison. Age over 50 was associated with an increased risk for all-cause mortality (hazard ratio [HR] 2.67 for each decade increase, 95% confidence interval [CI] 2.23, 3.20) but not for overdose deaths or early deaths. Latinos were at decreased risk of death compared to Whites only for all-cause mortality (HR 0.61, 95% CI 0.42, 0.87). Increasing years of incarceration were associated with a decreased risk of all-cause mortality (HR 0.95, 95% CI 0.91, 0.99) and overdose deaths (HR 0.80, 95% CI 0.68, 0.95), but not early deaths. Gender and type of release were not significantly associated with all-cause, overdose or early deaths. Age, ethnicity and length of incarceration were associated with mortality after release from prison. Interventions to reduce mortality among former inmates are needed. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Mortality in the endangered Laysan teal, Anas laysanensis: conservation implications

USGS Publications Warehouse

Reynolds, M.H.; Work, Thierry M.

2005-01-01

The Laysan Teal Anas laysanensis is an endangered anatid of the Hawaiian Islands, currently restricted to an emergent atoll, Laysan Island. Laysan Island lacks terrestrial mammalian predators, which permits the examination of mortality rates and causes without the anthropogenic effects of introduced predators. Mass and morophometrics were measured during the colour-marking of 297 Laysan Teal between 1998 and 2001. Intensive mark-resighting and recovery methods were used to estimate adult and juvenile mortality. One hundred and nineteen carcasses were collected on Laysan between 1998 and 2003, and systematic gross and microscopic examinations were undertaken on 63 of these. Causes of mortality were categorised as trauma, emaciation, miscellaneous or undetermined. Annual adult mortality rates were low, 0.05-0.10 (s.e. <0.01), but duckling mortality was much higher, varying from approximately 0.7-0.9 during 1998-2000 and 2003. Body condition of both sexes deteriorates during the breeding season, and most adult mortality (88%) occurred during or post-breeding (May-October). Cause of mortality was determined via necropsy in 22 ducks. Of three adults, one died from bacterial infections, one was egg bound, and one died from botulism concomitant with nematode infestation. Fourteen ducklings died from acute trauma, four from emaciation sometimes associated with nematode infection, and one from bacterial pneumonia Trauma is a significant factor in Laysan duckling mortalities, and elucidating the cause of and preventing such trauma may allow for management measures to enhance duckling survivability. High duckling mortality rates and emaciation also indicate that habitat on Laysan Island may have limited capacity to support broods.

The impact of income inequality and national wealth on child and adolescent mortality in low and middle-income countries.

PubMed

Ward, Joseph L; Viner, Russell M

2017-05-11

Income inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, particularly outside the high-income world. We performed cross-sectional regression analyses of the relationship between income inequality (national Gini coefficient) and national wealth (Gross Domestic Product (GDP) averaged over previous decade), and all-cause and grouped cause national mortality rate amongst infants, 1-4, 5-9, 10-14, 15-19 and 20-24 year olds in low and middle-income countries (LMIC) in 2012. Gini models were adjusted for GDP. Data were available for 103 (79%) countries. Gini was positively associated with increased all-cause and communicable disease mortality in both sexes across all age groups, after adjusting for national wealth. Gini was only positively associated with increased injury mortality amongst infants and 20-24 year olds, and increased non-communicable disease mortality amongst 20-24 year old females. The strength of these associations tended to increase during adolescence. Increasing GDP was negatively associated with all-cause, communicable and non-communicable disease mortality in males and females across all age groups. GDP was also associated with decreased injury mortality in all age groups except 15-19 year old females, and 15-24 year old males. GDP became a weaker predictor of mortality during adolescence. Policies to reduce income inequality, rather than prioritising economic growth at all costs, may be needed to improve adolescent mortality in low and middle-income countries, a key development priority.

High parasite burden increases the surfacing and mortality of the manila clam (Ruditapes philippinarum) in intertidal sandy mudflats on the west coast of Korea during hot summer.

PubMed

Nam, Ki-Woong; Jeung, Hee-Do; Song, Jae-Hee; Park, Kwan-Ha; Choi, Kwang-Sik; Park, Kyung-Il

2018-01-18

Over the past few decades, mass mortality events of Manila clams have been reported from several tidal flats on the west coast of Korea during hot summers. During such mortality events, once clams simultaneously surface, they fail to re-burrow, perishing within a week. The present study aimed to identify the possible causes of the mass mortality of this clam species by investigating the Perkinsus olseni parasite burden and immune parameters of surfaced clams (SC) and normal buried clams (NBCs) when sea water or sediment temperature in the study area varied from 25 °C to 34 °C from late July through mid-August 2015. We collected 2 groups of clams distributed within a 10-m 2 area when a summer clam mortality event occurred around Seonyu-do Island on the west coast of Korea in 2015. The clams were collected 2 days after they surfaced on the sediment and still looked healthy without any gaping. The clams were transported to the laboratory, and we compared P. olseni infection intensity and cell-mediated hemocyte parameters between the NBCs and SCs. SCs showed significantly higher levels of P. olseni burden, lower condition index, and lower levels of cell-mediated immune functions than those of NBCs. Our study suggests that high P. olseni infection weakens Manila clams' resistance against thermal stress, causing them to surface. We surmise that the summer mass mortality of Manila clams on the west coast of Korea is caused by the combined effects of high P. olseni infection levels and abnormally high water temperature stress.

A cross-sectional ecological analysis of international and sub-national health inequalities in commercial geospatial resource availability.

PubMed

Dotse-Gborgbortsi, Winfred; Wardrop, Nicola; Adewole, Ademola; Thomas, Mair L H; Wright, Jim

2018-05-23

Commercial geospatial data resources are frequently used to understand healthcare utilisation. Although there is widespread evidence of a digital divide for other digital resources and infra-structure, it is unclear how commercial geospatial data resources are distributed relative to health need. To examine the distribution of commercial geospatial data resources relative to health needs, we assembled coverage and quality metrics for commercial geocoding, neighbourhood characterisation, and travel time calculation resources for 183 countries. We developed a country-level, composite index of commercial geospatial data quality/availability and examined its distribution relative to age-standardised all-cause and cause specific (for three main causes of death) mortality using two inequality metrics, the slope index of inequality and relative concentration index. In two sub-national case studies, we also examined geocoding success rates versus area deprivation by district in Eastern Region, Ghana and Lagos State, Nigeria. Internationally, commercial geospatial data resources were inversely related to all-cause mortality. This relationship was more pronounced when examining mortality due to communicable diseases. Commercial geospatial data resources for calculating patient travel times were more equitably distributed relative to health need than resources for characterising neighbourhoods or geocoding patient addresses. Countries such as South Africa have comparatively high commercial geospatial data availability despite high mortality, whilst countries such as South Korea have comparatively low data availability and low mortality. Sub-nationally, evidence was mixed as to whether geocoding success was lowest in more deprived districts. To our knowledge, this is the first global analysis of commercial geospatial data resources in relation to health outcomes. In countries such as South Africa where there is high mortality but also comparatively rich commercial geospatial data, these data resources are a potential resource for examining healthcare utilisation that requires further evaluation. In countries such as Sierra Leone where there is high mortality but minimal commercial geospatial data, alternative approaches such as open data use are needed in quantifying patient travel times, geocoding patient addresses, and characterising patients' neighbourhoods.

Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis.

PubMed

Kim, In-Soo; Kim, Hyun-Jung; Kim, Tae-Hoon; Uhm, Jae-Sun; Joung, Boyoung; Lee, Moon-Hyoung; Pak, Hui-Nam

2018-04-26

We evaluated the dose-dependent efficacy, safety, and all-cause mortality of non-vitamin K antagonist oral anticoagulants (NOACs) in "atrial fibrillation (AF) patients who were OAC-naïve," or "AF patients with prior-stroke history" with those who were known to be high-risk subgroups under OAC. After a systematic database search (Medline, EMBASE, CENTRAL, SCOPUS, and Web of Science), five phase-III randomized trials comparing NOACs and warfarin in "OAC-naïve/OAC-experienced," or "with/without prior-stroke history" subgroups were included. The outcomes were pooled using a random-effects model to determine the relative risk (RR) for stroke/systemic thromboembolism (SSTE), major bleeding, intracranial hemorrhage, and all-cause mortality. 1. In OAC-naïve patients, standard-dose NOACs showed superior efficacy and safety with lower mortality [RR 0.90 (0.84-0.97), p=0.008, I 2 =0%] compared to warfarin. 2. For OAC-experienced patients, low-dose NOACs showed equivalent efficacy but reduced risk of major bleeding [RR 0.61 (0.40-0.91), p=0.02, I 2 =89%], and had lower all-cause mortality [RR 0.86 (0.75-0.99), p=0.04, I 2 =38%] compared to warfarin. 3. For patients with prior-stroke history, low-dose NOACs showed equivalent efficacy, but reduced risk of major bleeding [RR 0.58 (0.48-0.70), p<0.001, I 2 =0%] and all-cause mortality [RR 0.76 (0.66-0.88), p<0.001, I 2 =0%] compared to warfarin. 4. Among patients without prior-stroke history, standard-dose NOAC was superior to warfarin for both SSTE prevention [RR 0.78 (0.66-0.91), p=0.002, I 2 =43%] and all-cause mortality [RR 0.91 (0.85-0.97), p=0.004, I 2 =0%]. In conclusion, standard-dose NOAC showed lower all-cause mortality than warfarin in OAC-naïve patients with AF, and low-dose NOAC was better than warfarin among the patients with prior-stroke history in terms of all-cause mortality. Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis.

PubMed

Nitsch, Dorothea; Grams, Morgan; Sang, Yingying; Black, Corri; Cirillo, Massimo; Djurdjev, Ognjenka; Iseki, Kunitoshi; Jassal, Simerjot K; Kimm, Heejin; Kronenberg, Florian; Oien, Cecilia M; Levey, Andrew S; Levin, Adeera; Woodward, Mark; Hemmelgarn, Brenda R

2013-01-29

To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. Random effects meta-analysis using pooled individual participant data. 46 cohorts from Europe, North and South America, Asia, and Australasia. 2,051,158 participants (54% women) from general population cohorts (n=1,861,052), high risk cohorts (n=151,494), and chronic kidney disease cohorts (n=38,612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥ 50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m(2)) and urinary albumin-creatinine ratio (mg/g). Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (P(interaction)<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (P(interaction)<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk. Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium.

Educational inequalities in mortality over four decades in Norway: prospective study of middle aged men and women followed for cause specific mortality, 1960-2000.

PubMed

Strand, Bjørn Heine; Grøholt, Else-Karin; Steingrímsdóttir, Olöf Anna; Blakely, Tony; Graff-Iversen, Sidsel; Naess, Øyvind

2010-02-23

To determine the extent to which educational inequalities in relation to mortality widened in Norway during 1960-2000 and which causes of death were the main drivers of this disparity. Nationally representative prospective study. Four cohorts of the Norwegian population aged 45-64 years in 1960, 1970, 1980, and 1990 and followed up for mortality over 10 years. 359 547 deaths and 32 904 589 person years. All cause mortality and deaths due to cancer of lung, trachea, or bronchus; other cancer; cardiovascular diseases; suicide; external causes; chronic lower respiratory tract diseases; or other causes. Absolute and relative indices of inequality were used to present differences in mortality by educational level (basic, secondary, and tertiary). Mortality fell from the 1960s to the 1990s in all educational groups. At the same time the proportion of adults in the basic education group, with the highest mortality, decreased substantially. As mortality dropped more among those with the highest level of education, inequalities widened. Absolute inequalities in mortality denoting deaths among the basic education groups minus deaths among the high education groups doubled in men and increased by a third in women. This is equivalent to an increase in the slope index of inequality of 105% in men and 32% in women. Inequalities on a relative scale widened more, from 1.33 to 2.24 among men (P=0.01) and from 1.52 to 2.19 among women (P=0.05). Among men, absolute inequalities mainly increased as a result of cardiovascular diseases, lung cancer, and chronic lower respiratory tract diseases. Among women this was mainly due to lung cancer and chronic lower respiratory tract diseases. Unlike the situation in men, absolute inequalities in deaths due to cardiovascular causes narrowed among women. Chronic lower respiratory tract diseases contributed more to the disparities in inequalities among women than among men. All educational groups showed a decline in mortality. Nevertheless, and despite the fact that the Norwegian welfare model is based on an egalitarian ideology, educational inequalities in mortality among middle aged people in Norway are substantial and increased during 1960-2000.

Household Fuel Use and Cardiovascular Disease Mortality: Golestan Cohort Study

PubMed Central

Mitter, Sumeet S.; Vedanthan, Rajesh; Islami, Farhad; Pourshams, Akram; Khademi, Hooman; Kamangar, Farin; Abnet, Christian C.; Dawsey, Sanford M.; Pharoah, Paul D.; Brennan, Paul; Fuster, Valentin; Boffetta, Paolo; Malekzadeh, Reza

2016-01-01

Background Household air pollution is the third largest risk factor for global disease burden, but direct links with cardiovascular disease mortality are limited. This study aimed to evaluate the relationship between household fuel use and cardiovascular disease mortality. Methods and Results The Golestan Cohort Study in northeastern Iran enrolled 50045 individuals aged 40 to 75 years between 2004 and 2008, and collected data on lifetime household fuel use and other baseline exposures. Participants were followed through 2012 with a 99% successful follow-up rate. Cox proportional hazards models were fitted to calculate hazard ratios (HRs) for associations between pehen (local dung), wood, kerosene/diesel, or natural gas burning for cooking and heating and all-cause and cause-specific mortality, adjusting for lifetime exposure to each of these fuels and potential confounders. 3073 participants (6%) died during follow-up, 78% of which were attributable to non-communicable diseases, including cardiovascular, oncologic and respiratory illnesses. Adjusted 10-year HRs from kerosene/diesel burning were 1.06 (95% CI 1.02-1.10), and 1.11 (1.06-1.17), respectively, for all-cause and cardiovascular mortality. Subtype-specific analyses revealed a significant increase in ischemic heart disease (10-year HR 1.14 (1.06-1.21)) and a trend toward cerebrovascular accident (10-year HR 1.08 (0.99-1.17)) mortality. Stratification by sex revealed a potential signal for increased risk for all-cause and cardiovascular disease mortality among women versus men, with similar risk for ischemic heart disease mortality. Conclusions Household exposure to high-pollution fuels was associated with increased risk for all-cause and cardiovascular disease mortality. Replicating these results worldwide would support efforts to reduce such exposures. PMID:27297340

Decoy receptor 3, a novel inflammatory marker, and mortality in hemodialysis patients.

PubMed

Hung, Szu-Chun; Hsu, Ta-Wei; Lin, Yao-Ping; Tarng, Der-Cherng

2012-08-01

Inflammation is closely associated with cardiovascular disease, the leading cause of mortality in patients with CKD. Serum decoy receptor 3 (DcR3) is a member of the TNF receptor superfamily. CKD patients have higher levels of DcR3 than the general population, but whether DcR3 predicts mortality in CKD patients on hemodialysis has not been explored. DcR3 levels were measured in 316 prevalent hemodialysis patients who were followed up from November 1, 2004, to June 30, 2009, for cardiovascular and all-cause mortality. The baseline DcR3 concentration showed a strong positive correlation with inflammatory markers including high-sensitivity C-reactive protein, IL-6, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1). During a follow-up period of 54 months, 90 patients died (34 cardiovascular deaths). Kaplan-Meier survival analysis showed higher cardiovascular and all-cause mortality in patients with higher DcR3 levels. The hazard ratios (95% confidence intervals) of the highest versus lowest tertiles of DcR3 were 2.8 (1.1-7.3; P for trend=0.04) for cardiovascular mortality and 2.1 (1.1-3.7; P for trend=0.02) for all-cause mortality, respectively. Based on the minimal increase in the area under the receiver operating characteristic curve from 0.79 to 0.80, the addition of DcR3 to established risk factors including VCAM-1, albumin, and IL-6 does not improve the prediction of mortality. Higher DcR3 levels strongly correlate with inflammation and independently predict cardiovascular and all-cause mortality in CKD patients on hemodialysis.

Timing and proximate causes of mortality in wild bird populations: testing Ashmole’s hypothesis

USGS Publications Warehouse

Barton, Daniel C.; Martin, Thomas E.

2012-01-01

Fecundity in birds is widely recognized to increase with latitude across diverse phylogenetic groups and regions, yet the causes of this variation remain enigmatic. Ashmole’s hypothesis is one of the most broadly accepted explanations for this pattern. This hypothesis suggests that increasing seasonality leads to increasing overwinter mortality due to resource scarcity during the lean season (e.g., winter) in higher latitude climates. This mortality is then thought to yield increased per-capita resources for breeding that allow larger clutch sizes at high latitudes. Support for this hypothesis has been based on indirect tests, whereas the underlying mechanisms and assumptions remain poorly explored. We used a meta-analysis of over 150 published studies to test two underlying and critical assumptions of Ashmole’s hypothesis: first, that ad ult mortality is greatest during the season of greatest resource scarcity, and second, t hat most mortality is caused by starvation. We found that the lean season (winter) was generally not the season of greatest mortality. Instead, spring or summer was most frequently the season of greatest mortality. Moreover, monthly survival rates were not explained by monthly productivity, again opposing predictions from Ashmole’s hypothesis. Finally, predation, rather than starvation, was the most frequent proximate cause o f mortality. Our results do not support the mechanistic predictions of Ashmole‘s hypothesis, and suggest alternative explanations of latitudinal variation in clutch size should remain under consideration. Our meta-analysis also highlights a paucity of data available on the timing and causes of mortality in many bird populations, particularly tropical bird populations, despite the clear theoretical and empirical importance of such data.

Mortality Among a Cohort of U.S. Commercial Airline Cockpit Crew

PubMed Central

Yong, Lee C.; Pinkerton, Lynne E.; Yiin, James H.; Anderson, Jeri L.; Deddens, James A.

2015-01-01

Background We evaluated mortality among 5,964 former U.S. commercial cockpit crew (pilots and flight engineers). The outcomes of a priori interest were non-chronic lymphocytic leukemia, central nervous system (CNS) cancer (including brain), and malignant melanoma. Methods Vital status was ascertained through 2008. Life table and Cox regression analyses were conducted. Cumulative exposure to cosmic radiation was estimated from work history data. Results Compared to the U.S. general population, mortality from all causes, all cancer, and cardiovascular diseases was decreased, but mortality from aircraft accidents was highly elevated. Mortality was elevated for malignant melanoma but not for non-chronic lymphocytic leukemia. CNS cancer mortality increased with an increase in cumulative radiation dose. Conclusions Cockpit crew had a low all-cause, all-cancer, and cardiovascular disease mortality but elevated aircraft accident mortality. Further studies are needed to clarify the risk of CNS and other radiation-associated cancers in relation to cosmic radiation and other workplace exposures. PMID:24700478

Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives

PubMed Central

Jim, Melissa A.; Cobb, Nathaniel; Bartholomew, Michael; Becker, Tom; Haverkamp, Don; Plescia, Marcus

2014-01-01

Objectives. We present regional patterns and trends in all-cause mortality and leading causes of death in American Indians and Alaska Natives (AI/ANs). Methods. US National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We analyzed temporal trends for 1990 to 2009 and comparisons between non-Hispanic AI/AN and non-Hispanic White persons by geographic region for 1999 to 2009. Results focus on IHS Contract Health Service Delivery Area counties in which less race misclassification occurs. Results. From 1990 to 2009 AI/AN persons did not experience the significant decreases in all-cause mortality seen for Whites. For 1999 to 2009 the all-cause death rate in CHSDA counties for AI/AN persons was 46% more than that for Whites. Death rates for AI/AN persons varied as much as 50% among regions. Except for heart disease and cancer, subsequent ranking of specific causes of death differed considerably between AI/AN and White persons. Conclusions. AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions. PMID:24754554

The association between diabetes, comorbidities, body mass index and all-cause and cause-specific mortality among women with endometrial cancer.

PubMed

Nagle, C M; Crosbie, E J; Brand, A; Obermair, A; Oehler, M K; Quinn, M; Leung, Y; Spurdle, A B; Webb, P M

2018-04-26

Although endometrial cancer (EC) is associated with relatively good survival rates overall, women diagnosed with high-risk subtypes have poor outcomes. We examined the relationship between lifestyle factors and subsequent all-cause, cancer-specific and non-cancer related survival. In a cohort of 1359 Australian women diagnosed with incident EC between 2005 and 2007 pre-diagnostic information was collected by interview at recruitment. Clinical and survival information was abstracted from women's medical records, supplemented by linkage to the Australian National Death Index. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific survival (EC death vs. non-EC death) associated with each exposure, overall and by risk group (low-grade endometrioid vs. high-grade endometrioid and non-endometrioid). After a median follow-up of 7.1 years, 179 (13%) women had died, with 123 (69%) deaths from EC. As expected, elevated body mass index (BMI), diabetes and the presence of other co-morbidities were associated with a significantly increased risk of all-cause and non-cancer related death. Women with diabetes had higher cancer-specific mortality rates (HR 2.09, 95% CI 1.31-3.35), particularly those who had were not obese (HR 4.13, 95% CI 2.20-7.76). The presence of ≥2 other co-morbidities (excluding diabetes) was also associated with increased risk of cancer-specific mortality (HR 3.09, 95% CI 1.21-7.89). The patterns were generally similar for women with low-grade and high-grade endometrioid/non-endometrioid EC. Our findings demonstrate the importance of diabetes, other co-morbidities and obesity as negative predictors of mortality among women with EC but that the risks differ for cancer-specific and non-cancer related mortality. Copyright © 2018 Elsevier Inc. All rights reserved.

The association between plasma big endothelin-1 levels at admission and long-term outcomes in patients with atrial fibrillation.

PubMed

Wu, Shuang; Yang, Yan-Min; Zhu, Jun; Ren, Jia-Meng; Wang, Juan; Zhang, Han; Shao, Xing-Hui

2018-05-01

The prognostic role of big endothelin-1 (ET-1) in atrial fibrillation (AF) is unclear. We aimed to assess its predictive value in patients with AF. A total of 716 AF patients were enrolled and divided into two groups based on the optimal cut-off value of big ET-1 in predicting all-cause mortality. The primary outcomes were all-cause mortality and major adverse events (MAEs). Cox regression analysis and net reclassification improvement (NRI) analysis were performed to assess the predictive value of big ET-1 on outcomes. With the optimal cut-off value of 0.55 pmol/L, 326 patients were classified into the high big ET-1 levels group. Cardiac dysfunction and left atrial dilation were factors related to high big ET-1 levels. During a median follow-up of 3 years, patients with big ET-1 ≥ 0.55 pmol/L had notably higher risk of all-cause death (44.8% vs. 11.5%, p < 0.001), MAEs (51.8% vs. 17.4%, p < 0.001), cardiovascular death, major bleeding, and tended to have higher thromboembolic risk. After adjusting for confounding factors, high big ET-1 level was an independent predictor of all-cause mortality (hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.46-3.05; p < 0.001), MAEs (HR 2.05, 95% CI 1.50-2.80; p = 0.001), and cardiovascular death (HR 2.44, 95% CI 1.52-3.93; p < 0.001). NRI analysis showed that big ET-1 allowed a significant improvement of 0.32 in the accuracy of predicting the risk of both all-cause mortality and MAEs. Elevated big ET-1 levels is an independent predictor of long-term all-cause mortality, MAEs, and cardiovascular death in patients with AF. Copyright © 2018 Elsevier B.V. All rights reserved.

Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients.

PubMed

Noon, A P; Albertsen, P C; Thomas, F; Rosario, D J; Catto, J W F

2013-04-16

Bladder cancer (BC) predominantly affects the elderly and is often the cause of death among patients with muscle-invasive disease. Clinicians lack quantitative estimates of competing mortality risks when considering treatments for BC. Our aim was to determine the bladder cancer-specific mortality (CSM) rate and other-cause mortality (OCM) rate for patients with newly diagnosed BC. Patients (n=3281) identified from a population-based cancer registry diagnosed between 1994 and 2009. Median follow-up was 48.15 months (IQ range 18.1-98.7). Competing risk analysis was performed within patient groups and outcomes compared using Gray's test. At 5 years after diagnosis, 1246 (40%) patients were dead: 617 (19%) from BC and 629 (19%) from other causes. The 5-year BC mortality rate varied between 1 and 59%, and OCM rate between 6 and 90%, depending primarily on the tumour type and patient age. Cancer-specific mortality was highest in the oldest patient groups. Few elderly patients received radical treatment for invasive cancer (52% vs 12% for patients <60 vs >80 years, respectively). Female patients with high-risk non-muscle-invasive BC had worse CSM than equivalent males (Gray's P<0.01). Bladder CSM is highest among the elderly. Female patients with high-risk tumours are more likely to die of their disease compared with male patients. Clinicians should consider offering more aggressive treatment interventions among older patients.

Comparison of the Impact of High-Flux Dialysis on Mortality in Hemodialysis Patients with and without Residual Renal Function

PubMed Central

Kim, Hyung Wook; Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong-Lim; Kim, Yon-Su; Kang, Shin-Wook; Kim, Nam-Ho; Yang, Chul Woo; Kim, Yong Kyun

2014-01-01

Background The effect of flux membranes on mortality in hemodialysis (HD) patients is controversial. Residual renal function (RRF) has shown to not only be as a predictor of mortality but also a contributor to β2-microglobulin clearance in HD patients. Our study aimed to determine the interaction of residual renal function with dialyzer membrane flux on mortality in HD patients. Methods HD Patients were included from the Clinical Research Center registry for End Stage Renal Disease, a prospective observational cohort study in Korea. Cox proportional hazards regression models were used to study the association between use of high-flux dialysis membranes and all-cause mortality with RRF and without RRF. The primary outcome was all-cause mortality. Results This study included 893 patients with 24 h-residual urine volume ≥100 ml (569 and 324 dialyzed using low-flux and high-flux dialysis membranes, respectively) and 913 patients with 24 h-residual urine volume <100 ml (570 and 343 dialyzed using low-flux and high-flux dialysis membranes, respectively). After a median follow-up period of 31 months, mortality was not significantly different between the high and low-flux groups in patients with 24 h-residual urine volume ≥100 ml (HR 0.86, 95% CI, 0.38–1.95, P = 0.723). In patients with 24 h-residual urine volume <100 ml, HD using high-flux dialysis membrane was associated with decreased mortality compared to HD using low-flux dialysis membrane in multivariate analysis (HR 0.40, 95% CI, 0.21–0.78, P = 0.007). Conclusions Our data showed that HD using high-flux dialysis membranes had a survival benefit in patients with 24 h-residual urine volume <100 ml, but not in patients with 24 h-residual urine volume ≥100 ml. These findings suggest that high-flux dialysis rather than low-flux dialysis might be considered in HD patients without RRF. PMID:24906205

Iron loading, alcohol and mortality: A prospective study.

PubMed

Schutte, Rudolph; Huisman, Hugo; Mels, Catharina M C; Botha, Shani; Kruger, Ruan; Smith, Wayne; Kruger, Iolanthé M; Hawkins, Michelle; Smith, Lee; Breet, Yolandi; Schutte, Aletta E

2018-05-16

The relationship between total body iron and cardiovascular disease remains controversial and information absent in black sub-Saharan Africans in whom alcohol consumption tends to be high. The level of total body iron is tightly regulated, however this regulation is compromised by high alcohol intake causing iron loading. The aim of this study is to investigate total body iron, as represented by serum ferritin, and its interaction with measures of alcohol intake in predicting all-cause and cardiovascular mortality. We followed health outcomes for a median of 9.22 years in 877 randomly selected HIV negative African women (mean age: 50.4 years). One hundred and five deaths occurred of which 40 were cardiovascular related. Ferritin averaged 84.0 (5th to 95th percentile interval, 7.5-533.3) ng/ml and due to the augmenting effect of inflammation, lowered to 75.3 (6.9-523.2) ng/ml after excluding 271 participants with high-sensitivity C-reactive protein (CRP) levels (above 8 mg/l). CRP increased by quartiles of ferritin in the total group (P trend = 0.002), but this relationship was absent after excluding the 271 participants with high CRP values (P trend = 0.10). Ferritin, gamma-glutamyl transferase and carbohydrate deficient transferrin (all P < 0.0001) were higher in drinkers compared to non-drinkers, but CRP was similar (P = 0.77). In multivariable-adjusted analyses, ferritin predicted both all-cause (hazard ratio, 2.08; 95% confidence interval, 1.62-2.68; P < 0.0001) and cardiovascular (1.94; 1.29-2.92; P = 0.002) mortality. In participants with CRP levels below or equal to 8 mg/l, the significant relationship remained between ferritin and all-cause (2.51; 1.81-3.49; P < 0.0001) and cardiovascular mortality (2.34; 1.45-3.76; P = 0.0005). In fully adjusted models, interactions existed between ferritin and gamma-glutamyl transferase, self-reported alcohol use and carbohydrate deficient transferrin in predicting all-cause (P ≤ 0.012) and cardiovascular mortality (P ≤ 0.003). Iron loading in African women predicted all-cause and cardiovascular mortality and the intake of alcohol seems mechanistically implicated. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Polyphenol intake and mortality risk: a re-analysis of the PREDIMED trial

PubMed Central

2014-01-01

Background Polyphenols may lower the risk of cardiovascular disease (CVD) and other chronic diseases due to their antioxidant and anti-inflammatory properties, as well as their beneficial effects on blood pressure, lipids and insulin resistance. However, no previous epidemiological studies have evaluated the relationship between the intake of total polyphenols intake and polyphenol subclasses with overall mortality. Our aim was to evaluate whether polyphenol intake is associated with all-cause mortality in subjects at high cardiovascular risk. Methods We used data from the PREDIMED study, a 7,447-participant, parallel-group, randomized, multicenter, controlled five-year feeding trial aimed at assessing the effects of the Mediterranean Diet in primary prevention of cardiovascular disease. Polyphenol intake was calculated by matching food consumption data from repeated food frequency questionnaires (FFQ) with the Phenol-Explorer database on the polyphenol content of each reported food. Hazard ratios (HR) and 95% confidence intervals (CI) between polyphenol intake and mortality were estimated using time-dependent Cox proportional hazard models. Results Over an average of 4.8 years of follow-up, we observed 327 deaths. After multivariate adjustment, we found a 37% relative reduction in all-cause mortality comparing the highest versus the lowest quintiles of total polyphenol intake (hazard ratio (HR) = 0.63; 95% CI 0.41 to 0.97; P for trend = 0.12). Among the polyphenol subclasses, stilbenes and lignans were significantly associated with reduced all-cause mortality (HR =0.48; 95% CI 0.25 to 0.91; P for trend = 0.04 and HR = 0.60; 95% CI 0.37 to 0.97; P for trend = 0.03, respectively), with no significant associations apparent in the rest (flavonoids or phenolic acids). Conclusions Among high-risk subjects, those who reported a high polyphenol intake, especially of stilbenes and lignans, showed a reduced risk of overall mortality compared to those with lower intakes. These results may be useful to determine optimal polyphenol intake or specific food sources of polyphenols that may reduce the risk of all-cause mortality. Clinical trial registration ISRCTN35739639. PMID:24886552

“Without a mother”: caregivers and community members’ views about the impacts of maternal mortality on families in KwaZulu-Natal, South Africa

PubMed Central

2015-01-01

Background Maternal mortality in South Africa is high and a cause for concern especially because the bulk of deaths from maternal causes are preventable. One of the proposed reasons for persistently high maternal mortality is HIV which causes death both indirectly and directly. While there is some evidence for the impact of maternal death on children and families in South Africa, few studies have explored the impacts of maternal mortality on the well-being of the surviving infants, older children and family. This study provides qualitative insight into the consequences of maternal mortality for child and family well-being throughout the life-course. Methods This qualitative study was conducted in rural and peri-urban communities in Vulindlela, KwaZulu-Natal. The sample included 22 families directly affected by maternal mortality, 15 community stakeholders and 7 community focus group discussions. These provided unique and diverse perspectives about the causes, experiences and impacts of maternal mortality. Results and discussion Children left behind were primarily cared for by female family members, even where a father was alive and involved. The financial burden for care and children’s basic needs were largely met through government grants (direct and indirectly targeted at children) and/or through an obligation for the father or his family to assist. The repercussions of losing a mother were felt more by older children for whom it was harder for caregivers to provide educational supervision and emotional or psychological support. Respondents expressed concerns about adolescent’s educational attainment, general behaviour and particularly girl’s sexual risk. Conclusion These results illuminate the high costs to surviving children and their families of failing to reduce maternal mortality in South Africa. Ensuring social protection and community support is important for remaining children and families. Additional qualitative evidence is needed to explore differential effects for children by gender and to guide future research and inform policies and programs aimed at supporting maternal orphans and other vulnerable children throughout their development. PMID:26001160

Mortality of captive black-footed ferrets (Mustela nigripes) at Smithsonian's National Zoological Park, 1989-2004.

PubMed

Bronson, Ellen; Bush, Mitchell; Viner, Tabitha; Murray, Suzan; Wisely, Samantha M; Deem, Sharon L

2007-06-01

Black-footed ferret (Mustela nigripes) mortality was investigated retrospectively based on the pathology records of 107 captive animals held at Smithsonian's National Zoological Park from 1989 to 2004. The majority of deaths in neonates were due to cannibalism (n = 42; 64.6%) and maternal trauma (n = 11; 16.9%); both of these causes of mortality decreased during the study period. Prior to 2001, juvenile mortality was most often caused by gastrointestinal disease (n = 11; 52.4%), including coccidiosis, salmonellosis, and clostridium infection. In 2001, improvements in husbandry, hygiene, and medical treatment led to decreases in juvenile mortality associated with gastrointestinal disease. The most common causes of death in adult ferrets were renal or neoplastic disease. The etiology of the high prevalence of renal disease in the last 4 yr of the study is unknown; it was not associated with increasing age or inbreeding. Improved hygiene and vigilant monitoring for signs of gastrointestinal and renal disease will continue to improve the success of the captive propagation of this species.

Global burden of disease of chronic kidney disease in Mexico

PubMed

Torres-Toledano, Marisol; Granados-García, Víctor; López-Ocaña, Luis Rafael

2017-01-01

The Global Burden of Disease (GBD) is a methodology that evaluates risks to the population risks when confronted with a disease or injury, such as the entirety of the effects of mortality and disability that these represent for health systems. The chronic kidney disease (CKD) is an entity with high mortality, high disability, and high health-intervention costs. The review of the data generated by the Institute for Health Metrics and Evaluation (IHME), the headquarters of the GBD Study Group, show that at worldwide level, CKD-associated mortality has increased 108% since 1990 to 2015. The main cause that generates death by CKD in Mexico is diabetes mellitus, whose impact on mortality has progressed, being found in 19th place for diabetic nephropathy in 1990 to the 3rd cause of death in 2015, representing a 670% increase. Ages with greatest mortality are situated between 45 and 75 years, generating a greater impact on disability-adjusted death in women. Mexico City has the greatest CKD-related mortality and a greatest number of DALY (Disability-Adjusted Life Years): 1,559.71 per 100 000 inhabitants. The Mexican state with the lower number of deaths is Baja California, and Quintana Roo is the state with the lower number of DALY (766.32 per 100 000 inhabitants).

Homoarginine and all-cause mortality: A systematic review and meta-analysis.

PubMed

Zinellu, Angelo; Paliogiannis, Panagiotis; Carru, Ciriaco; Mangoni, Arduino A

2018-05-28

Homoarginine, a basic amino acid and analogue of L-arginine, has been shown to exert salutary effects on vascular homoeostasis, possibly through interaction with the enzymes nitric oxide synthase and arginase. This might translate into improved survival outcomes, particularly in subjects with moderate-high cardiovascular risk. We conducted a systematic review and meta-analysis to investigate the association between circulating homoarginine concentrations and all-cause mortality in observational studies of human cohorts. Studies reporting baseline circulating homoarginine concentrations and all-cause mortality as outcome were searched using the MEDLINE, Scopus and Cochrane databases until January 2018. Hazard ratios (HRs) with 95% confidence intervals (CIs) derived from multivariate Cox's proportional-hazards analysis were extracted from individual studies. A total of 13 studies in 11 964 participants were included in the final analysis. Homoarginine concentrations were inversely associated with all-cause mortality (HR 0.64, 95% CI 0.57-0.73). This association remained significant in participant sub-groups with predominant cardiovascular disease (HR 0.64, 95% CI 0.55-0.76) and renal disease (HR 0.60, 95% CI 0.46-0.68). This meta-analysis of observational studies showed an inverse association between circulating homoarginine concentrations and all-cause mortality. Further research is warranted to investigate the direct effects of homoarginine on cardiovascular homoeostasis, the associations between homoarginine and all-cause mortality in other population groups, and the effects of interventions on homoarginine concentrations on clinical outcomes. © 2018 Stichting European Society for Clinical Investigation Journal Foundation.

Mortality atlas of the main causes of death in Switzerland, 2008-2012.

PubMed

Chammartin, Frédérique; Probst-Hensch, Nicole; Utzinger, Jürg; Vounatsou, Penelope

2016-01-01

Analysis of the spatial distribution of mortality data is important for identification of high-risk areas, which in turn might guide prevention, and modify behaviour and health resources allocation. This study aimed to update the Swiss mortality atlas by analysing recent data using Bayesian statistical methods. We present average pattern for the major causes of death in Switzerland. We analysed Swiss mortality data from death certificates for the period 2008-2012. Bayesian conditional autoregressive models were employed to smooth the standardised mortality rates and assess average patterns. Additionally, we developed models for age- and gender-specific sub-groups that account for urbanisation and linguistic areas in order to assess their effects on the different sub-groups. We describe the spatial pattern of the major causes of death that occurred in Switzerland between 2008 and 2012, namely 4 cardiovascular diseases, 10 different kinds of cancer, 2 external causes of death, as well as chronic respiratory diseases, Alzheimer's disease, diabetes, influenza and pneumonia, and liver diseases. In-depth analysis of age- and gender-specific mortality rates revealed significant disparities between urbanisation and linguistic areas. We provide a contemporary overview of the spatial distribution of the main causes of death in Switzerland. Our estimates and maps can help future research to deepen our understanding of the spatial variation of major causes of death in Switzerland, which in turn is crucial for targeting preventive measures, changing behaviours and a more cost-effective allocation of health resources.

Effects of implantation method and temperature on mortality and loss of simulated transmitters in hybrid striped bass

USGS Publications Warehouse

Walsh, M.G.; Bjorgo, K.A.; Isely, J.J.

2000-01-01

To determine the effects of surgical implantation method and temperature on mortality and transmitter loss, we compared two antenna placements (trailing antenna versus shielded needle) and two suture materials (absorbable versus nonabsorbable) in hybrid striped bass Morone saxitilis x Morone chrysops (227-410 mm total length) that had been surgically implanted with simulated transmitters and held at high (22-29??C) and low (12-18??C) temperatures for 120 d. Fish were individually examined after 7, 30, 60. 90. and 120 d to evaluate suture and wound condition as well as transmitter loss. Neither suture material nor antenna placement affected transmitter loss, mortality, or growth at either high or low temperatures. Absorbable sutures were lost more quickly than were nonabsorbable sutures, but they persisted beyond incision closure at both high and low temperatures. At high temperatures, 50% suture loss occurred by 30 d for absorbable sutures and by 60 d for nonabsorbable sutures. Mortality occurred only at high temperatures but was delayed and was likely caused by peritoneal infection. Transmitter loss was not significant; it occurred only in the low-temperature trial and was caused by pressure necrosis at the incision rather than by suture failure. Temperature significantly affected all responses examined in this study. Significant irritation, infection, and mortality occurred in all treatment groups at high temperatures.

Mortality in adult immigrants in the 2000s in Belgium: a test of the 'healthy-migrant' and the 'migration-as-rapid-health-transition' hypotheses.

PubMed

Vandenheede, Hadewijch; Willaert, Didier; De Grande, Hannelore; Simoens, Steven; Vanroelen, Christophe

2015-12-01

Firstly, to map out and compare all-cause and cause-specific mortality patterns by migrant background in Belgium; and secondly, to probe into explanations for the observed patterns, more specifically into the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories. Data comprise individually linked Belgian census-mortality follow-up data for the period 2001-2011. All official inhabitants aged 25-54 at time of the census were included. To delve into the different explanations, differences in all-cause and chronic- and infectious-disease mortality were estimated using Poisson regression models, adjusted for age, socioeconomic position and urbanicity. First-generation immigrants have lower all-cause and chronic-disease mortality than the host population. This mortality advantage wears off with length of stay and is more marked among non-Western than Western first-generation immigrants. For example, Western and non-Western male immigrants residing 10 years or more in Belgium have a mortality rate ratio for cardiovascular disease of 0.72 (95% CI 0.66-0.78) and 0.59 (95% CI 0.53-0.66), respectively (vs host population). The pattern of infectious-disease mortality in migrants is slightly different, with rather high mortality rates in first-generation sub-Saharan Africans and rather low rates in all other immigrant groups. As for second-generation immigrants, the picture is gloomier, with a mortality disadvantage that disappears after control for socioeconomic position. Findings are largely consistent with the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories. The convergence of the mortality profile of second-generation immigrants towards that of the host population with similar socioeconomic position indicates the need for policies simultaneously addressing different areas of deprivation. © 2015 John Wiley & Sons Ltd.

Postpartum acute kidney injury: a review of 99 cases.

PubMed

Eswarappa, Mahesh; Madhyastha, P Rakesh; Puri, Sonika; Varma, Vijay; Bhandari, Aneesh; Chennabassappa, Gurudev

2016-07-01

Postpartum acute kidney injury (PPAKI) constitutes an important cause of obstetric AKI. It is associated with high maternal and fetal mortality in developing nations. The aim of this study is to survey the etiology and outcomes of PPAKI in a tertiary care Indian hospital. Ninety-nine patients, without prior comorbidities, treated for PPAKI, between 2005-2014 at M.S. Ramaiah Medical College, were included for analysis in this retrospective, observational study. AKI was analyzed in terms of maximal stage of renal injury attained as per RIFLE criteria. Outcomes included requirement for renal replacement therapy (RRT), maternal and fetal outcomes. PPAKI constituted 60% of all obstetric AKI cases. Median maternal age was 23 years and 52% of patients were primigravidas. Mean serum creatinine was 4.1 mg/dL. Failure (33%) and injury (31%) were the major categories as per RIFLE criteria. Thirty-nine percent of cases required RRT. Sepsis, particularly puerperal sepsis, was the leading causes of PPAKI (75% of cases) and maternal mortality (94% of deaths). Maternal and fetal mortality were 19% and 22% respectively. The incidence of cortical necrosis was 10.3%. Three patients required long-term RRT. In conclusion, consistent with other Indian literature, we report a high incidence of PPAKI. We found incremental mortality on moving from "Risk" to "Failure" category of RIFLE. PPAKI was associated with high maternal and fetal mortality with sepsis being the leading cause. Our study highlights the need for provision of better quality of maternal care and fetal monitoring to decrease mortality associated with PPAKI in developing countries.

Effect of prescribed burning on mortality of resettlement ponderosa pines in Grand Canyon National Park

Treesearch

G. Alan Kaufmann; W. Wallace Covington

2001-01-01

Ponderosa pine (Pinus ponderosa) trees established before Euro-American settlement are becoming rare on the landscape. Prescribed fire is the prime tool used to restore ponderosa pine ecosystems, but can cause high mortality in presettlement ponderosa pines. This study uses retrospective techniques to estimate mortality from prescribed burns within Grand Canyon...

The Effect of Cardiorespiratory Fitness and Obesity on Cancer Mortality in Women and Men.

ERIC Educational Resources Information Center

Evenson, Kelly R.; Stevens, June; Cai, Jianwen; Thomas, Ratna; Thomas, Olivia

2003-01-01

Investigated the independent and combined effects of cardiorespiratory fitness and obesity on all-cause cancer mortality for women and men. Data from the Lipids Research Clinics Prevalence Study indicated that higher fitness level was a stronger predictor of reduced cancer mortality among men, while high body mass index was a stronger predictor of…

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

PubMed Central

Streatfield, P. Kim; Khan, Wasif A.; Bhuiya, Abbas; Hanifi, Syed M.A.; Alam, Nurul; Bagagnan, Cheik H.; Sié, Ali; Zabré, Pascal; Lankoandé, Bruno; Rossier, Clementine; Soura, Abdramane B.; Bonfoh, Bassirou; Kone, Siaka; Ngoran, Eliezer K.; Utzinger, Juerg; Haile, Fisaha; Melaku, Yohannes A.; Weldearegawi, Berhe; Gomez, Pierre; Jasseh, Momodou; Ansah, Patrick; Debpuur, Cornelius; Oduro, Abraham; Wak, George; Adjei, Alexander; Gyapong, Margaret; Sarpong, Doris; Kant, Shashi; Misra, Puneet; Rai, Sanjay K.; Juvekar, Sanjay; Lele, Pallavi; Bauni, Evasius; Mochamah, George; Ndila, Carolyne; Williams, Thomas N.; Laserson, Kayla F.; Nyaguara, Amek; Odhiambo, Frank O.; Phillips-Howard, Penelope; Ezeh, Alex; Kyobutungi, Catherine; Oti, Samuel; Crampin, Amelia; Nyirenda, Moffat; Price, Alison; Delaunay, Valérie; Diallo, Aldiouma; Douillot, Laetitia; Sokhna, Cheikh; Gómez-Olivé, F. Xavier; Kahn, Kathleen; Tollman, Stephen M.; Herbst, Kobus; Mossong, Joël; Chuc, Nguyen T.K.; Bangha, Martin; Sankoh, Osman A.; Byass, Peter

2014-01-01

Background Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work. PMID:25377326

Nonfermented milk and other dairy products: associations with all-cause mortality.

PubMed

Tognon, Gianluca; Nilsson, Lena M; Shungin, Dmitry; Lissner, Lauren; Jansson, Jan-Håkan; Renström, Frida; Wennberg, Maria; Winkvist, Anna; Johansson, Ingegerd

2017-06-01

Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive. Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content. Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index, smoking status, education, energy intake, examination year, and physical activity. To circumvent confounding, Mendelian randomization was applied in a subsample via the lactase LCT - 13910 C/T single nucleotide polymorphism that is associated with lactose tolerance and milk intake. Results: High consumers of nonfermented milk (≥2.5 times/d) had a 32% increased hazard (HR: 1.32; 95% CI: 1.18, 1.48) for all-cause mortality compared with that of subjects who consumed milk ≤1 time/wk. The corresponding value for butter was 11% (HR: 1.11; 95% CI: 1.07, 1.21). All nonfermented milk-fat types were independently associated with increased HRs, but compared with full-fat milk, HRs were lower in consumers of medium- and low-fat milk. Fermented milk intake (HR: 0.90; 95% CI: 0.86, 0.94) and cheese intake (HR: 0.93; 95% CI: 0.91, 0.96) were negatively associated with mortality. Results were slightly attenuated by lifestyle adjustments but were robust in sensitivity analyses. Mortality was not significantly associated with the LCT -13910 C/T genotype in the smaller subsample. The amount and type of milk intake was associated with lifestyle variables. Conclusions: In the present Swedish cohort study, intakes of nonfermented milk and butter are associated with higher all-cause mortality, and fermented milk and cheese intakes are associated with lower all-cause mortality. Residual confounding by lifestyle cannot be excluded, and Mendelian randomization needs to be examined in a larger sample. © 2017 American Society for Nutrition.

Invasive infection caused by Klebsiella pneumoniae is a disease affecting patients with high comorbidity and associated with high long-term mortality

PubMed Central

Nauclér, P.; Kalin, M.; Giske, C. G.

2018-01-01

Klebsiella pneumoniae (KP) is after Escherichia coli (EC) the most common gram-negative species causing invasive infections. Herein, we analyzed risk factors and prognosis in invasive infections caused by KP versus EC, in an area with low antimicrobial resistance. Moreover, we compared antimicrobial resistance and relative prevalence of KP and EC (KP/EC-ratio) in different European countries, using EARS-Net data. Adult patients admitted to Karolinska University Hospital 2006–2012 with invasive infection caused by KP (n = 599) were matched regarding sex and age with patients infected by EC. The medical records were retrospectively reviewed. Comorbidity was adjusted for with multivariable analysis. European data were retrieved from the EARS-Net database. No differences were observed in 7- and 30-day mortality between the groups. The 90-day mortality was significantly higher in the KP cohort (26% versus 17%, p<0.001), but not after adjusting for comorbidity. Malignancy was seen in 53% of the patients with KP versus 38% with EC, OR 1.86 (1.34–2.58). A significant increase in the rate of ESBL-production was observed in EC, but not in KP. The KP/EC-ratio remained stable. In contrast, European data showed increasing percentages of isolates non-susceptible to third-generation cephalosporins in EC and KP, and increasing KP/EC-ratio. Invasive infection caused by KP is a disease affecting patients with high comorbidity and associated with high 90-d mortality. The stable KP/EC-ratio and low occurrence of antimicrobial resistance in data from Karolinska University Hospital compared to aggregate data from 20 EARS-Net countries could be related to absence of clonal spread of multidrug-resistant KP. PMID:29624618

Causes of death from the randomized CoreValve US Pivotal High-Risk Trial.

PubMed

Gaudiani, Vincent; Deeb, G Michael; Popma, Jeffrey J; Adams, David H; Gleason, Thomas G; Conte, John V; Zorn, George L; Hermiller, James B; Chetcuti, Stan; Mumtaz, Mubashir; Yakubov, Steven J; Kleiman, Neal S; Huang, Jian; Reardon, Michael J

2017-06-01

Explore causes and timing of death from the CoreValve US Pivotal High-Risk Trial. An independent clinical events committee adjudicated causes of death, followed by post hoc hierarchical classification. Baseline characteristics, early outcomes, and causes of death were evaluated for 3 time periods (selected based on threshold of surgical 30-day mortality and on the differences in the continuous hazard between the 2 groups): early (0-30 days), recovery (31-120 days), and late (121-365 days). Differences in the rate of death were evident only during the recovery period (31-120 days), whereas 15 patients undergoing transcatheter aortic valve replacement (TAVR) (4.0%) and 27 surgical aortic valve replacement (SAVR) patients (7.9%) died (P = .025). This mortality difference was largely driven by higher rates of technical failure, surgical complications, and lack of recovery following surgery. From 0 to 30 days, the causes of death were more technical failures in the TAVR group and lack of recovery in the SAVR group. Mortality in the late period (121-365 days) in both arms was most commonly ascribed to other circumstances, comprising death from medical complications from comorbid disease. Mortality at 1 year in the CoreValve US Pivotal High-Risk Trial favored TAVR over SAVR. The major contributor was that more SAVR patients died during the recovery period (31-121 days), likely affected by the overall influence of physical stress associated with surgery. Similar rates of technical failure and complications were observed between the 2 groups. This suggests that early TAVR results can improve with technical refinements and that high-risk surgical patients will benefit from reducing complications. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Tuberculin status, socioeconomic differences and differences in all-cause mortality: experience from Norwegian cohorts born 1910-49.

PubMed

Liestøl, Knut; Tretli, Steinar; Tverdal, Aage; Maehlen, Jan

2009-04-01

From 1948 to 1975, Norway had a mandatory tuberculosis (TB) screening programme with Pirquet testing, X-ray examinations and BCG vaccination. Electronic data registration in 1963-75 enabled the current study aimed at revealing (i) the relations between socioeconomic factors and tuberculosis infection and (ii) differences in later all-cause mortality according to TB infection status. TB screening data were linked to information from the Norwegian Cause of Death Registry (1975-98) and the National Population and Housing Censuses (1960, 1970 and 1980). Analyses were done for 10 years cohorts born 1910-49, separately for men (approximately 534,000 individuals) and women (608,000), using logistic and Cox regressions. TB infection and X-ray data confirmed the strong regional pattern seen for TB mortality, with the highest rates in the three northernmost counties and higher rates in urban than rural areas. High socioeconomic status relates to lower odds both for TB infection and TB-related chest X-ray findings (odds ratios 0.6-0.7 for highest vs lowest educational groups). Those infected by TB, and especially those with chest X-ray findings, have increased all-cause mortality in at least a 20 years period following determination of tuberculin status (hazard ratios approximately 1.15 and 1.30, respectively, higher for late than early cohorts). TB particularly affected lower socioeconomic strata, but even those in higher strata were at high risk. The differences in all-cause mortality could partly be attributed to socioeconomic factors, but we hypothesize that developing TB infection may also indicate biological frailness.

Cause of death in patients with poststroke epilepsy: Results from a nationwide cohort study.

PubMed

Hansen, Julia; Åsberg, Signild; Kumlien, Eva; Zelano, Johan

2017-01-01

The risk of death is increased for persons with epilepsy. The literature on causes of death in epilepsy is based mainly on cohorts with epilepsy of mixed aetiologies. For clinical purposes and improved understanding of mortality in different epilepsies, more information is needed on mortality in epilepsies of specific causes. In poststroke epilepsy (PSE), seizures occur in a setting of vascular disease and high mortality rates. The extent to which epilepsy contributes to mortality in this patient group is poorly understood. We therefore aimed to describe causes of death (COD) in PSE on a national scale. A previously identified cohort of 7740 patients with epilepsy or seizures after a stroke in 2005-2010 was investigated. A total of 4167 deaths occurred before the end of 2014. The standardized mortality ratio for the study cohort was 3.56 (95% CI: 3.45-3.67). The main underlying causes of death were disorders of the circulatory system (60%) followed by neoplasms (12%). Diseases of the nervous system were the sixth leading underlying COD (3%), and epilepsy or status epilepticus was considered the underlying COD in approximately a similar proportion of cases as neurodegenerative disorders (0.9% and 1.1%, respectively). Epilepsy was considered a contributing COD in 14% of cases. Our findings highlight the importance of optimal management of vascular morbidity in patients with PSE. The large proportion of patients with epilepsy as a contributing COD indicate the need of high ambitions also regarding the management of seizures in patients with PSE.

Combined associations of body weight and lifestyle factors with all cause and cause specific mortality in men and women: prospective cohort study.

PubMed

Veronese, Nicola; Li, Yanping; Manson, JoAnn E; Willett, Walter C; Fontana, Luigi; Hu, Frank B

2016-11-24

 To evaluate the combined associations of diet, physical activity, moderate alcohol consumption, and smoking with body weight on risk of all cause and cause specific mortality.  Longitudinal study with up to 32 years of follow-up.  Nurses' Health Study (1980-2012) and Health Professionals Follow-up Study (1986-2012).  74 582 women from the Nurses' Health Study and 39 284 men from the Health Professionals Follow-up Study who were free from cardiovascular disease and cancer at baseline.  Exposures included body mass index (BMI), score on the alternate healthy eating index, level of physical activity, smoking habits, and alcohol drinking while outcome was mortality (all cause, cardiovascular, cancer). Cox proportional hazard models were used to calculate the adjusted hazard ratios of all cause, cancer, and cardiovascular mortality with their 95% confidence intervals across categories of BMI, with 22.5-24.9 as the reference.  During up to 32 years of follow-up, there were 30 013 deaths (including 10 808 from cancer and 7189 from cardiovascular disease). In each of the four categories of BMI studied (18.5-22.4, 22.5-24.9, 25-29.9, ≥30), people with one or more healthy lifestyle factors had a significantly lower risk of total, cardiovascular, and cancer mortality than individuals with no low risk lifestyle factors. A combination of at least three low risk lifestyle factors and BMI between 18.5-22.4 was associated with the lowest risk of all cause (hazard ratio 0.39, 95% confidence interval 0.35 to 0.43), cancer (0.40, 0.34 to 0.47), and cardiovascular (0.37, 0.29 to 0.46) mortality, compared with those with BMI between 22.5-24.9 and none of the four low risk lifestyle factors.  Although people with a higher BMI can have lower risk of premature mortality if they also have at least one low risk lifestyle factor, the lowest risk of premature mortality is in people in the 18.5-22.4 BMI range with high score on the alternate healthy eating index, high level of physical activity, moderate alcohol drinking, and who do not smoke. It is important to consider diet and lifestyle factors in the evaluation of the association between BMI and mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Higher serum triglyceride to high-density lipoprotein cholesterol ratio was associated with increased cardiovascular mortality in female patients on peritoneal dialysis.

PubMed

Wu, H; Xiong, L; Xu, Q; Wu, J; Huang, R; Guo, Q; Mao, H; Yu, X; Yang, X

2015-08-01

High serum triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been found to be an independent predictor for cardiovascular events in the general population. We aimed to evaluate whether a high TG/HDL-C ratio was associated with an increased risk of mortality in patients on continuous ambulatory peritoneal dialysis (CAPD). In this single-center retrospective cohort study, 1170 incident patients on peritoneal dialysis (PD) from 1 January 2007 to 31 December 2011 were recruited and followed up until 31 December 31 2013. The mean age was 47.4 ± 15.2 years, and 24.7% were diabetic. During a median of the 34.5-month follow-up period, 213 (18.2%) deaths occurred, 121 of which (56.8%) were caused by cardiovascular disease (CVD). The serum median TG/HDL-C ratio at baseline was 2.57 (range: 0.06-39.39). On multivariate Cox regression analysis, the highest quartile of the TG/HDL-C ratio (≥4.19) was associated with increased risk of all-cause mortality (hazard ratio (HR) 1.98, 95% confidence interval (CI), 1.17-3.36; P = 0.011) and CVD mortality (HR 2.28, 95% CI, 1.16-4.47; P = 0.017). For female patients, each one-unit higher baseline TG/HDL-C was associated with 13% (95% CI 1.06-1.22; P = 0.001) increased risk of CVD mortality, whereas such an association was not observed for male patients, (HR 1.00, 95% CI 0.92-1.08; P = 0.977). A higher serum TG/HDL-C ratio was associated with an increased risk of all-cause and CVD mortality in PD patients. Moreover, the increased risk of CVD mortality was significantly higher in female than male PD patients. Copyright © 2015 Elsevier B.V. All rights reserved.

The PPARγ2 P12A polymorphism is not associated with all-cause mortality in patients with type 2 diabetes mellitus.

PubMed

Pacilli, Antonio; Prudente, Sabrina; Copetti, Massimiliano; Fontana, Andrea; Mercuri, Luana; Bacci, Simonetta; Marucci, Antonella; Alberico, Federica; Viti, Raffaella; Palena, Antonio; Lamacchia, Olga; Cignarelli, Mauro; De Cosmo, Salvatore; Trischitta, Vincenzo

2016-10-01

The high mortality risk of patients with type 2 diabetes mellitus may well be explained by the several comorbidities and/or complications. Also the intrinsic genetic component predisposing to diabetes might have a role in shaping the risk of diabetes-related mortality. Among type 2 diabetes mellitus SNPs, rs1801282 is of particular interest because (i) it is harbored by peroxisome proliferator-activated receptor-γ2 (PPARγ2), which is the target for thiazolidinediones which are used as antidiabetic drugs, decreasing all-cause mortality in type 2 diabetes mellitus, and (ii) it is associated with insulin resistance and related traits, risk factors for overall mortality in type 2 diabetes mellitus. We investigated the role of PPARγ2 P12A, according to a dominant model (PA + AA vs. PP individuals) on incident all-cause mortality in three cohorts of type 2 diabetes mellitus, comprising a total of 1672 patients (462 deaths) and then performed a meta-analysis of ours and all available published data. In the three cohorts pooled and analyzed together, no association between PPARγ2 P12A and all-cause mortality was observed (HR 1.02, 95 % CI 0.79-1.33). Similar results were observed after adjusting for age, sex, smoking habits, and BMI (HR 1.09, 95 % CI 0.83-1.43). In a meta-analysis of ours and all studies previously published (n = 3241 individuals; 666 events), no association was observed between PPARγ2 P12A and all-cause mortality (HR 1.07, 95 % CI 0.85-1.33). Results from our individual samples as well as from our meta-analysis suggest that the PPARγ2 P12A does not significantly affect all-cause mortality in patients with type 2 diabetes mellitus.

Circulating Omega-6 Polyunsaturated Fatty Acids and Total and Cause-Specific Mortality: The Cardiovascular Health Study

PubMed Central

Wu, Jason HY; Lemaitre, Rozenn N; King, Irena B; Song, Xiaoling; Psaty, Bruce M; Siscovick, David S; Mozaffarian, Dariush

2014-01-01

Background While omega-6 polyunsaturated fatty acids(n-6 PUFA) have been recommended to reduce CHD, controversy remains about benefits vs. harms, including concerns over theorized pro-inflammatory effects of n-6 PUFA. We investigated associations of circulating n-6 PUFA including linoleic acid(LA, the major dietary PUFA), γ-linolenic acid(GLA), dihomo-γ-linolenic acid(DGLA), and arachidonic acid(AA),with total and cause-specific mortality in the Cardiovascular Health Study, a community-based US cohort. Methods and Results Among 2,792 participants(age≥65y) free of CVD at baseline, plasma phospholipid n-6 PUFAwere measured at baseline using standardized methods. All-cause and cause-specific mortality, and total incident CHD and stroke, were assessed and adjudicated centrally. Associations of PUFA with risk were assessed by Cox regression. During 34,291 person-years of follow-up(1992–2010), 1,994 deaths occurred(678 cardiovascular deaths), with 427 fatal and 418 nonfatal CHD, and 154 fatal and 399 nonfatal strokes. In multivariable models, higher LA was associated with lower total mortality, with extreme-quintile HR=0.87(P-trend=0.005). Lower death was largely attributable to CVD causes, especially nonarrhythmic CHD mortality(HR=0.51, 95%CI=0.32–0.82, P-trend=0.001). Circulating GLA, DGLA, and AA were not significantly associated with total or cause-specific mortality; e.g., for AA and CHD death, the extreme-quintile HR was 0.97 (95%CI=0.70–1.34, P-trend=0.87). Evaluated semi-parametrically, LA showed graded inverse associations with total mortality(P=0.005). There was little evidence that associations of n-6 PUFA with total mortality varied by age, sex, race, or plasma n-3 PUFA. Evaluating both n-6 and n-3 PUFA, lowest risk was evident with highest levels of both. Conclusions High circulating LA, but not other n-6 PUFA, was inversely associated with total and CHD mortality in older adults. PMID:25124495

Characterizing prolonged heat effects on mortality in a sub-tropical high-density city, Hong Kong

NASA Astrophysics Data System (ADS)

Ho, Hung Chak; Lau, Kevin Ka-Lun; Ren, Chao; Ng, Edward

2017-11-01

Extreme hot weather events are likely to increase under future climate change, and it is exacerbated in urban areas due to the complex urban settings. It causes excess mortality due to prolonged exposure to such extreme heat. However, there is lack of universal definition of prolonged heat or heat wave, which leads to inadequacies of associated risk preparedness. Previous studies focused on estimating temperature-mortality relationship based on temperature thresholds for assessing heat-related health risks but only several studies investigated the association between types of prolonged heat and excess mortality. However, most studies focused on one or a few isolated heat waves, which cannot demonstrate typical scenarios that population has experienced. In addition, there are limited studies on the difference between daytime and nighttime temperature, resulting in insufficiency to conclude the effect of prolonged heat. In sub-tropical high-density cities where prolonged heat is common in summer, it is important to obtain a comprehensive understanding of prolonged heat for a complete assessment of heat-related health risks. In this study, six types of prolonged heat were examined by using a time-stratified analysis. We found that more consecutive hot nights contribute to higher mortality risk while the number of consecutive hot days does not have significant association with excess mortality. For a day after five consecutive hot nights, there were 7.99% [7.64%, 8.35%], 7.74% [6.93%, 8.55%], and 8.14% [7.38%, 8.88%] increases in all-cause, cardiovascular, and respiratory mortality, respectively. Non-consecutive hot days or nights are also found to contribute to short-term mortality risk. For a 7-day-period with at least five non-consecutive hot days and nights, there was 15.61% [14.52%, 16.70%] increase in all-cause mortality at lag 0-1, but only -2.00% [-2.83%, -1.17%] at lag 2-3. Differences in the temperature-mortality relationship caused by hot days and hot nights imply the need to categorize prolonged heat for public health surveillance. Findings also contribute to potential improvement to existing heat-health warning system.

Characterizing prolonged heat effects on mortality in a sub-tropical high-density city, Hong Kong.

PubMed

Ho, Hung Chak; Lau, Kevin Ka-Lun; Ren, Chao; Ng, Edward

2017-11-01

Extreme hot weather events are likely to increase under future climate change, and it is exacerbated in urban areas due to the complex urban settings. It causes excess mortality due to prolonged exposure to such extreme heat. However, there is lack of universal definition of prolonged heat or heat wave, which leads to inadequacies of associated risk preparedness. Previous studies focused on estimating temperature-mortality relationship based on temperature thresholds for assessing heat-related health risks but only several studies investigated the association between types of prolonged heat and excess mortality. However, most studies focused on one or a few isolated heat waves, which cannot demonstrate typical scenarios that population has experienced. In addition, there are limited studies on the difference between daytime and nighttime temperature, resulting in insufficiency to conclude the effect of prolonged heat. In sub-tropical high-density cities where prolonged heat is common in summer, it is important to obtain a comprehensive understanding of prolonged heat for a complete assessment of heat-related health risks. In this study, six types of prolonged heat were examined by using a time-stratified analysis. We found that more consecutive hot nights contribute to higher mortality risk while the number of consecutive hot days does not have significant association with excess mortality. For a day after five consecutive hot nights, there were 7.99% [7.64%, 8.35%], 7.74% [6.93%, 8.55%], and 8.14% [7.38%, 8.88%] increases in all-cause, cardiovascular, and respiratory mortality, respectively. Non-consecutive hot days or nights are also found to contribute to short-term mortality risk. For a 7-day-period with at least five non-consecutive hot days and nights, there was 15.61% [14.52%, 16.70%] increase in all-cause mortality at lag 0-1, but only -2.00% [-2.83%, -1.17%] at lag 2-3. Differences in the temperature-mortality relationship caused by hot days and hot nights imply the need to categorize prolonged heat for public health surveillance. Findings also contribute to potential improvement to existing heat-health warning system.

Did the Great Recession affect mortality rates in the metropolitan United States? Effects on mortality by age, gender and cause of death.

PubMed

Strumpf, Erin C; Charters, Thomas J; Harper, Sam; Nandi, Arijit

2017-09-01

Mortality rates generally decline during economic recessions in high-income countries, however gaps remain in our understanding of the underlying mechanisms. This study estimates the impacts of increases in unemployment rates on both all-cause and cause-specific mortality across U.S. metropolitan regions during the Great Recession. We estimate the effects of economic conditions during the recent and severe recessionary period on mortality, including differences by age and gender subgroups, using fixed effects regression models. We identify a plausibly causal effect by isolating the impacts of within-metropolitan area changes in unemployment rates and controlling for common temporal trends. We aggregated vital statistics, population, and unemployment data at the area-month-year-age-gender-race level, yielding 527,040 observations across 366 metropolitan areas, 2005-2010. We estimate that a one percentage point increase in the metropolitan area unemployment rate was associated with a decrease in all-cause mortality of 3.95 deaths per 100,000 person years (95%CI -6.80 to -1.10), or 0.5%. Estimated reductions in cardiovascular disease mortality contributed 60% of the overall effect and were more pronounced among women. Motor vehicle accident mortality declined with unemployment increases, especially for men and those under age 65, as did legal intervention and homicide mortality, particularly for men and adults ages 25-64. We find suggestive evidence that increases in metropolitan area unemployment increased accidental drug poisoning deaths for both men and women ages 25-64. Our finding that all-cause mortality decreased during the Great Recession is consistent with previous studies. Some categories of cause-specific mortality, notably cardiovascular disease, also follow this pattern, and are more pronounced for certain gender and age groups. Our study also suggests that the recent recession contributed to the growth in deaths from overdoses of prescription drugs in working-age adults in metropolitan areas. Additional research investigating the mechanisms underlying the health consequences of macroeconomic conditions is warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association between domains of physical activity and all-cause, cardiovascular and cancer mortality.

PubMed

Autenrieth, Christine S; Baumert, Jens; Baumeister, Sebastian E; Fischer, Beate; Peters, Annette; Döring, Angela; Thorand, Barbara

2011-02-01

Few studies have investigated the independent effects of domain-specific physical activity on mortality. We sought to investigate the association of physical activity performed in different domains of daily living on all-cause, cardiovascular (CVD) and cancer mortality. Using a prospective cohort design, 4,672 men and women, aged 25-74 years, who participated in the baseline examination of the MONICA/KORA Augsburg Survey 1989/1990 were classified according to their activity level (no, light, moderate, vigorous). Domains of self-reported physical activity (work, transportation, household, leisure time) and total activity were assessed by the validated MOSPA (MONICA Optional Study on Physical Activity) questionnaire. After a median follow-up of 17.8 years, a total of 995 deaths occurred, with 452 from CVD and 326 from cancer. For all-cause mortality, hazard ratios and 95% confidence interval (HR, 95% CI) of the highly active versus the inactive reference group were 0.69 (0.48-1.00) for work, 0.48 (0.36-0.65) for leisure time, and 0.73 (0.59-0.90) for total activity after multivariable adjustments. Reduced risks of CVD mortality were observed for high levels of work (0.54, 0.31-0.93), household (0.80, 0.54-1.19), leisure time (0.50, 0.31-0.79) and total activity (0.75, 0.55-1.03). Leisure time (0.36, 0.23-0.59) and total activity (0.62, 0.43-0.88) were associated with reduced risks of cancer mortality. Light household activity was related to lower all-cause (0.82, 0.71-0.95) and CVD (0.72, 0.58-0.89) mortality. No clear effects were found for transportation activities. Our findings suggest that work, household, leisure time and total physical activity, but not transportation activity, may protect from premature mortality.

[Clinical features and outcome of community-acquired methicillin-resistant Staphylococcus aureus pneumonia].

PubMed

Obed, Mora; García-Vidal, Carolina; Pessacq, Pedro; Mykietiuk, Analia; Viasus, Diego; Cazzola, Laura; Domínguez, M Angeles; Calmaggi, Anibal; Carratalà, Jordi

2014-01-01

The aim of this study is to describe the epidemiological and clinical features, treatment and prognosis of community-acquired pneumonia (CAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in two different geographic regions where community-acquired MRSA (CA-MRSA) infections have different frequencies. Observational study of patients admitted to two hospitals (one in Argentina, the other in Spain) between March 2008 and June 2012. We documented 16 cases of CAP caused by MRSA. MRSA accounted for 15 of 547 (2.7%) cases of CAP in Hospital Rodolfo Rossi and 1 of 1258 (0,08%) cases at the Hospital Universitari de Bellvitge (P ≤ .001). Most patients were young and previously healthy. Multilobar infiltrates, cavitation and skin and soft tissue involvement were frequent. All patients had positive blood cultures. Five patients required admission to the intensive care unit. Early mortality (≤ 48 hours) was 19%, and overall mortality (≤ 30 days) was 25%. CAP caused by MRSA causes high morbidity and mortality rates. It should be suspected in areas with a high prevalence of CA-MRSA infections, and especially in young and healthy patients who present with multilobar pneumonia with cavitation. Mortality is mainly related to septic shock and respiratory failure and occurs early in most cases. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals.

PubMed

Liu, Li; Oza, Shefali; Hogan, Dan; Chu, Yue; Perin, Jamie; Zhu, Jun; Lawn, Joy E; Cousens, Simon; Mathers, Colin; Black, Robert E

2016-12-17

Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000-15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival. We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1-59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation. In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935-1·179]), pneumonia (0·921 million [0·812 -1·117]), and intrapartum-related events (0·691 million [0·598 -0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000-15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR. In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target. Bill & Melinda Gates Foundation, WHO. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project.

PubMed

Harmon, Brook E; Boushey, Carol J; Shvetsov, Yurii B; Ettienne, Reynolette; Reedy, Jill; Wilkens, Lynne R; Le Marchand, Loic; Henderson, Brian E; Kolonel, Laurence N

2015-03-01

Healthy dietary patterns have been linked positively with health and longevity. However, prospective studies in diverse populations in the United States addressing dietary patterns and mortality are limited. We assessed the ability of the following 4 diet-quality indexes [the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension (DASH)] to predict the reduction in risk of mortality from all causes, cardiovascular disease (CVD), and cancer. White, African American, Native Hawaiian, Japanese American, and Latino adults (n = 215,782) from the Multiethnic Cohort completed a quantitative food-frequency questionnaire. Scores for each dietary index were computed and divided into quintiles for men and women. Mortality was documented over 13-18 y of follow-up. HRs and 95% CIs were computed by using adjusted Cox models. High HEI-2010, AHEI-2010, aMED, and DASH scores were all inversely associated with risk of mortality from all causes, CVD, and cancer in both men and women (P-trend < 0.0001 for all models). For men, the HEI-2010 was consistently associated with a reduction in risk of mortality for all causes (HR: 0.75; 95% CI: 0.71, 0.79), CVD (HR: 0.74; 95% CI: 0.69, 0.81), and cancer (HR: 0.76; 95% CI: 0.70, 0.83) when lowest and highest quintiles were compared. In women, the AHEI and aMED showed large reductions for all-cause mortality (HR: 0.78; 95% CI: 0.74, 0.82), the AHEI showed large reductions for CVD (HR: 0.76; 95% CI: 0.69, 0.83), and the aMED showed large reductions for cancer (HR: 0.84; 95% CI: 0.76, 0. 92). These results, in a US multiethnic population, suggest that consuming a dietary pattern that achieves a high diet-quality index score is associated with lower risk of mortality from all causes, CVD, and cancer in adult men and women. © 2015 American Society for Nutrition.

Social networks, social support, and burden in relationships, and mortality after breast cancer diagnosis in the Life After Breast Cancer Epidemiology (LACE) study.

PubMed

Kroenke, Candyce H; Quesenberry, Charles; Kwan, Marilyn L; Sweeney, Carol; Castillo, Adrienne; Caan, Bette J

2013-01-01

Larger social networks have been associated with lower breast cancer mortality. The authors evaluated how levels of social support and burden influenced this association. We included 2,264 women from the Life After Cancer Epidemiology study who were diagnosed with early-stage, invasive breast cancer between 1997 and 2000, and provided data on social networks (spouse or intimate partner, religious/social ties, volunteering, time socializing with friends, and number of first-degree female relatives), social support, and caregiving. 401 died during a median follow-up of 10.8 years follow-up with 215 from breast cancer. We used delayed entry Cox proportional hazards regression to evaluate associations. In multivariate-adjusted analyses, social isolation was unrelated to recurrence or breast cancer-specific mortality. However, socially isolated women had higher all-cause mortality (HR = 1.34, 95 % CI: 1.03-1.73) and mortality from other causes (HR = 1.79, 95 % CI: 1.19-2.68). Levels of social support and burden modified associations. Among those with low, but not high, levels of social support from friends and family, lack of religious/social participation (HR = 1.58, 95 % CI: 1.07-2.36, p = 0.02, p interaction = 0.01) and lack of volunteering (HR = 1.78, 95 % CI: 1.15-2.77, p = 0.01, p interaction = 0.01) predicted higher all-cause mortality. In cross-classification analyses, only women with both small networks and low levels of support (HR = 1.61, 95 % CI: 1.10-2.38) had a significantly higher risk of mortality than women with large networks and high levels of support; women with small networks and high levels of support had no higher risk of mortality (HR = 1.13, 95 % CI: 0.74-1.72). Social networks were also more important for caregivers versus noncaregivers. Larger social networks predicted better prognosis after breast cancer, but associations depended on the quality and burden of family relationships.

Further follow up of mortality in a United Kingdom oil distribution centre cohort.

PubMed Central

Rushton, L

1993-01-01

Results of an extension of follow up (1976 to 1989) of a cohort of workers employed for at least one year between 1 January 1950 and 31 December 1975 at oil distribution centres in Britain are presented. Over 99% of the workers were successfully traced to determine their vital status at 31 December 1989. The mortality observed was compared with that expected from the death rates of all the male population of England and Wales. The mortality from all causes of death for the total study population was less than that of the comparison population, and reduced mortality was also found for many of the major non-malignant causes of death. No healthy worker effect was found for ischaemic heart disease, and raised mortality from this disease was found in particular for one company and in several job groups. Raised mortality was also found for aortic aneurysm. Mortality from all neoplasms was lower than expected overall, largely due to a deficit of deaths from malignant neoplasm of the lung. Raised mortality patterns from all neoplasms, malignant neoplasm of the lung, and several non-malignant disease groups were found for general manual workers although the mortality from many of these diseases for all men in this social class in the national population is also high. There was increased mortality from malignant neoplasms of the larynx and prostate but these tended to be in isolated subgroups. Mortality from malignant neoplasm of the kidney was raised overall and in drivers in particular. Mortality from leukaemia was high at one company and in drivers overall. PMID:8329322

Incidence and predictors of 6 months mortality after an acute heart failure event in rural Uganda: The Mbarara Heart Failure Registry (MAHFER).

PubMed

Abeya, Fardous Charles; Lumori, Boniface Amanee Elias; Akello, Suzan Joan; Annex, Brian H; Buda, Andrew J; Okello, Samson

2018-03-29

We sought to estimate the incidence and predictors of all-cause mortality 6 months after heart failure hospitalization in Uganda. Mbarara Heart Failure Registry is a cohort of patients hospitalized with a clinical diagnosis of heart failure at Mbarara Regional Referral Hospital, Uganda. We measured serum electrolytes, cardiac markers, and echocardiograms. All participants were followed until death or end of 6 months. We used Fine and Gray models to estimate the incidence and predictors all-cause mortality. A total of 215 participants were enrolled, 141 (66%) were women, and mean age 53 (standard deviation 22) years. Nineteen (9%) had diabetes, 40 (19%) had HIV, and 119 (55%) had hypertension. The overall incidence of all-cause mortality was 3.58 (95% CI 2.92, 4.38) per 1000 person-days. Men had higher incidence of death compared to women (4.02 vs 3.37 per 1000 person-days). The incidence of all-cause mortality during hospitalization was almost twice that of in the community (27.5 vs 14.77 per 1000 person-days). In adjusted analysis, increasing age, NYHA class IV, decreasing renal function, smoking, each unit increase in serum levels of Potassium, BNP, and Creatine kinase-MB predicted increased incidence of 6 months all-cause death whereas taking beta-blockers and having an index admission on a weekend compared to a week day predicted survival. There is a high incidence of all-cause mortality occurring in-hospital among patients hospitalized with heart failure in rural Uganda. Heart failure directed therapies should be instituted to curb heart failure-related mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

Maternal mortality in Vietnam in 1994-95.

PubMed

Hieu, D T; Hanenberg, R; Vach, T H; Vinh, D Q; Sokal, D

1999-12-01

This report presents the first population-based estimates of maternal mortality in Vietnam. All the deaths of women aged 15-49 in 1994-95 in three provinces of Vietnam were identified and classified by cause. Maternal mortality was the fifth most frequent cause of death. The maternal mortality ratio was 155 deaths per 100,000 live births. This ratio compares with the World Health Organization's estimates of 430 such deaths globally and 390 for Asia. The maternal mortality ratio in the delta regions of these provinces was half that of the mountainous and semimountainous regions. Because a larger proportion of the Vietnamese population live in delta regions than elsewhere, the maternal mortality ratio for Vietnam as a whole may be lower than that of the three provinces studied. Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries take place in clinics and hospitals, where few women die in childbirth. Also, few women die of the consequences of induced abortion in Vietnam because the procedure is legal and easily available.

The Association between Triglyceride/High-Density Lipoprotein Cholesterol Ratio and All-Cause Mortality in Acute Coronary Syndrome after Coronary Revascularization

PubMed Central

Wan, Ke; Zhao, Jianxun; Huang, Hao; Zhang, Qing; Chen, Xi; Zeng, Zhi; Zhang, Li; Chen, Yucheng

2015-01-01

Aims High triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) are cardiovascular risk factors. A positive correlation between elevated TG/HDL-C ratio and all-cause mortality and cardiovascular events exists in women. However, utility of TG to HDL-C ratio for prediction is unknown among acute coronary syndrome (ACS). Methods Fasting lipid profiles, detailed demographic data, and clinical data were obtained at baseline from 416 patients with ACS after coronary revascularization. Subjects were stratified into three levels of TG/HDL-C. We constructed multivariate Cox-proportional hazard models for all-cause mortality over a median follow-up of 3 years using log TG to HDL-C ratio as a predictor variable and analyzing traditional cardiovascular risk factors. We constructed a logistic regression model for major adverse cardiovascular events (MACEs) to prove that the TG/HDL-C ratio is a risk factor. Results The subject’s mean age was 64 ± 11 years; 54.5% were hypertensive, 21.8% diabetic, and 61.0% current or prior smokers. TG/HDL-C ratio ranged from 0.27 to 14.33. During the follow-up period, there were 43 deaths. In multivariate Cox models after adjusting for age, smoking, hypertension, diabetes, and severity of angiographic coronary disease, patients in the highest tertile of ACS had a 5.32-fold increased risk of mortality compared with the lowest tertile. After adjusting for conventional coronary heart disease risk factors by the logistic regression model, the TG/HDL-C ratio was associated with MACEs. Conclusion The TG to HDL-C ratio is a powerful independent predictor of all-cause mortality and is a risk factor of cardiovascular events. PMID:25880982

Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients.

PubMed

Kask, J; Ramklint, M; Kolia, N; Panagiotakos, D; Ekbom, A; Ekselius, L; Papadopoulos, F C

2017-06-01

Anorexia nervosa (AN) is a psychiatric disorder with high mortality. A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses. The SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1-5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6-12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9-2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0-22.7), and that for unnatural causes was 35.5 (95% CI 17.7-63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality. Mortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.

Cause-specific mortality according to urine albumin creatinine ratio in the general population.

PubMed

Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Ahluwalia, Tarunveer Singh; Rossing, Peter; Jørgensen, Torben; Thuesen, Betina Heinsbæk; Pisinger, Charlotta; Rasmussen, Knud; Linneberg, Allan

2014-01-01

Urine albumin creatinine ratio, UACR, is positively associated with all-cause mortality, cardiovascular disease and diabetes in observational studies. Whether a high UACR is also associated with other causes of death is unclear. We investigated the association between UACR and cause-specific mortality. We included a total of 9,125 individuals from two population-based studies, Monica10 and Inter99, conducted in 1993-94 and 1999-2001, respectively. Urine albumin creatinine ratio was measured from spot urine samples by standard methods. Information on causes of death was obtained from The Danish Register of Causes of Death until 31 December 2010. There were a total of 920 deaths, and the median follow-up was 11.3 years. Multivariable Cox regression analyses with age as underlying time axis showed statistically significant positive associations between UACR status and risk of all-cause mortality, endocrine nutritional and metabolic diseases, mental and behavioural disorders, diseases of the circulatory system, and diseases of the respiratory system with hazard ratios 1.56, 6.98, 2.34, 2.03, and 1.91, for the fourth UACR compared with the first, respectively. Using UACR as a continuous variable, we also found a statistically significant positive association with risk of death caused by diseases of the digestive system with a hazard ratio of 1.02 per 10 mg/g higher UACR. We found statistically significant positive associations between baseline UACR and death from all-cause mortality, endocrine nutritional and metabolic diseases, and diseases of the circulatory system and possibly mental and behavioural disorders, and diseases of the respiratory and digestive system.

Geographical variations in seasonal mortality across the United States: A bioclimatological approach

NASA Astrophysics Data System (ADS)

Kalkstein, Adam

2008-10-01

Human mortality exhibits a strong seasonal pattern with deaths in winter far exceeding those in the summer. Surprisingly, this seasonal trend is evident in all major cities across the United States, seemingly independent of climate. While the pattern itself is clear, its magnitude varies considerably across space, and it is not known if there is regional homogeneity among cities. Additionally, the causal mechanisms relating to pattern variability are not clearly understood. The goal of this study is to conduct a comprehensive geographic analysis of seasonal mortality across the United States, to uncover systematic regional differences in such mortality, and to determine what role weather plays in impacting seasonal mortality rates. Unique seasonal mortality curves were created for 28 Metropolitan Statistical Areas across the United States, and the amplitude and timing of mortality peaks were determined. In addition, seasonality was calculated for different demographic groups and causes of death. Meteorological factors were also evaluated as possible causal mechanisms. The findings here indicate that the seasonality of mortality exhibits strong spatial variation with the largest seasonal mortality amplitudes found in the southwestern United States and the smallest in the North, along with South Florida. In addition, there have been changes in the timing of seasonal mortality; the date of maximum mortality is occurring increasingly early in the year. Demographics also play an important role with women, Whites, and the elderly exhibiting the strongest seasonality in mortality. There is a strong connection between respiratory disease and other causes of death, implying a cause-effect relationship. Meteorology also plays an important role in seasonal mortality; variations in the frequency of certain air masses were associated with changes in the timing and amplitude of seasonal mortality. Finally, there were strong intra-regional similarities that exist among the examined cities, implying that environmental factors are more important than social factors in determining seasonal mortality response. This work begins to fill a large gap within the scientific literature concerning the causes, geographic variation, and meteorological influences on seasonal mortality. Additionally, these results will increase the forecasting capabilities of determining when and where winter mortality will reach unusually high levels.

[Hospital mortality associated with upper gastrointestinal hemorrhage due to ruptured esophageal varices at the Lomé Campus Hospital in Togo].

PubMed

Bouglouga, O; Bagny, A; Lawson-Ananissoh, L; Djibril, M

2014-01-01

To study hospital mortality associated with upper gastrointestinal hemorrhages due to variceal bleeding in the department of hepatology and gastroenterology at the Lome Campus University Hospital. This retrospective cross-sectional and analytic study examined the 55 patients admitted for variceal bleeding on upper endoscopies during the 3-year period from January 1, 2008, through December 31, 2010. These patients accounted for 4.1% of all hospitalizations during the study period in the department. Their average age was 35 years, and their sex-ratio 4. A history of chronic liver disease was found in 65.5%. Liver cirrhosis was the principal cause of the esophageal varices, complicated by hepatocellular carcinoma in 30.9% of them. The mortality rate was 25.5% and was not related to the cause of portal hypertension. All the patients with a recurrence of bleeding died. Mortality was associated with jaundice. Blood transfusion did not significantly improve the prognosis. the mortality rate among patients with upper gastrointestinal hemorrhage linked to variceal bleeding is high in our unit. The prevention of hepatitis virus B is important because it is the main cause of chronic liver disease causing portal hypertension in our department.

The Impact of Educational Status on 10-Year (2004-2014) Cardiovascular Disease Prognosis and All-cause Mortality Among Acute Coronary Syndrome Patients in the Greek Acute Coronary Syndrome (GREECS) Longitudinal Study.

PubMed

Notara, Venetia; Panagiotakos, Demosthenes B; Kogias, Yannis; Stravopodis, Petros; Antonoulas, Antonis; Zombolos, Spyros; Mantas, Yannis; Pitsavos, Christos

2016-07-01

The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated. From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient's educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years). Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed. A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity.

Educational differences in all-cause mortality by marital status - Evidence from Bulgaria, Finland and the United States

PubMed Central

Kohler, Iliana V.; Martikainen, Pekka; Smith, Kirsten P.; Elo, Irma T.

2008-01-01

Using life table measures, we compare educational differentials in all-cause mortality at ages 40 to 70 in Bulgaria to those in Finland and the United States. Specifically, we assess whether the relationship between education and mortality is modified by marital status. Although high education and being married are associated with lower mortality in all three countries, absolute educational differences tend to be smaller among married than unmarried individuals. Absolute differentials by education are largest for Bulgarian men, but in relative terms educational differences are smaller among Bulgarian men than in Finland and the U.S. Among women, Americans experience the largest education-mortality gradients in both relative and absolute terms. Our results indicate a particular need to tackle health hazards among poorly educated men in countries in transition. PMID:19165349

Does high intelligence improve prognosis? The association of intelligence with recurrence and mortality among Swedish men with coronary heart disease.

PubMed

Sörberg Wallin, Alma; Falkstedt, Daniel; Allebeck, Peter; Melin, Bo; Janszky, Imre; Hemmingsson, Tomas

2015-04-01

Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown. A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969-1970 at age 18-20, who were diagnosed with CHD 1991-2007, were followed to the end of 2008. recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors. The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively). Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Social isolation, health literacy, and mortality risk: Findings from the English Longitudinal Study of Ageing.

PubMed

Smith, Samuel G; Jackson, Sarah E; Kobayashi, Lindsay C; Steptoe, Andrew

2018-02-01

To investigate the relationships between social isolation, health literacy, and all-cause mortality, and the modifying effect of social isolation on the latter relationship. Data were from 7731 adults aged ≥50 years participating in Wave 2 (2004/2005) of the English Longitudinal Study of Ageing. Social isolation was defined according to marital/cohabiting status and contact with children, relatives, and friends, and participation in social organizations. Scores were split at the median to indicate social isolation (yes vs. no). Health literacy was assessed as comprehension of a medicine label and classified as "high" (≥75% correct) or "low" (<75% correct). The outcome was all-cause mortality up to February 2013. Cox proportional hazards models were adjusted for sociodemographic factors, health status, health behaviors, and cognitive function. Mortality rates were 30.3% versus 14.3% in the low versus high health literacy groups, and 23.5% versus 13.7% in the socially isolated versus nonisolated groups. Low health literacy (adj. HR = 1.22, 95% CI 1.02-1.45 vs. high) and social isolation (adj. HR = 1.28, 95% CI 1.10-1.50) were independently associated with increased mortality risk. The multiplicative interaction term for health literacy and social isolation was not statistically significant (p = .81). Low health literacy and high social isolation are risk factors for mortality. Social isolation does not modify the relationship between health literacy and mortality. Clinicians should be aware of the health risks faced by socially isolated adults and those with low health literacy. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Ethnic and racial differences in prostate cancer incidence and mortality.

PubMed

Farkas, A; Marcella, S; Rhoads, G G

2000-01-01

Prostate cancer (CaP) incidence and mortality vary strikingly among ethnic, racial, and national groups. There is evidence that genetic, environmental, and social factors jointly-and often in combination-contribute to the observed differences in various populations. Noteworthy is the high rate of both CaP incidence and mortality among African Americans. Changes in the epidemiology of CaP since the advent of prostate specific antigen testing suggest that improved access to screening and treatment may serve to reduce somewhat the differences between the white and African-American populations. However, because the causes of these differences are likely to be multifactorial, a variety of strategies addressing the range of causes will be necessary to reduce the excess African-American mortality from this disease.

Carbon Impacts of Fire- and Bark Beetle-Caused Tree Mortality across the Western US using the Community Land Model (Invited)

NASA Astrophysics Data System (ADS)

Meddens, A. J.; Hicke, J. A.; Edburg, S. L.; Lawrence, D. M.

2013-12-01

Wildfires and bark beetle outbreaks cause major forest disturbances in the western US, affecting ecosystem productivity and thereby impacting forest carbon cycling and future climate. Despite the large spatial extent of tree mortality, quantifying carbon flux dynamics following fires and bark beetles over larger areas is challenging because of forest heterogeneity, varying disturbance severities, and field observation limitations. The objective of our study is to estimate these dynamics across the western US using the Community Land Model (version CLM4.5-BGC). CLM4.5-BGC is a land ecosystem model that mechanistically represents the exchanges of energy, water, carbon, and nitrogen with the atmosphere. The most recent iteration of the model has been expanded to include vertically resolved soil biogeochemistry and includes improved nitrogen cycle representations including nitrification and denitrification and biological fixation as well as improved canopy processes including photosynthesis. Prior to conducting simulations, we modified CLM4.5-BGC to include the effects of bark beetle-caused tree mortality on carbon and nitrogen stocks and fluxes. Once modified, we conducted paired simulations (with and without) fire- and bark beetle-caused tree mortality by using regional data sets of observed mortality as inputs. Bark beetle-caused tree mortality was prescribed from a data set derived from US Forest Service aerial surveys from 1997 to 2010. Annual tree mortality area was produced from observed tree mortality caused by bark beetles and was adjusted for underestimation. Fires were prescribed using the Monitoring Trends in Burn Severity (MTBS) database from 1984 to 2010. Annual tree mortality area was produced from forest cover maps and inclusion of moderate- and high-severity burned areas. Simulations show that maximum yearly reduction of net ecosystem productivity (NEP) caused by bark beetles is approximately 20 Tg C for the western US. Fires cause similar reductions in NEP, although the temporal pattern is different. The reductions in NEP from these major disturbances are similar to the variation in NEP caused by climatic conditions. When less favorable climatic conditions and these disturbances are co-occurring, forests switch from a carbon sink to a carbon source across the western US. This work increases understanding of the role of natural disturbances in the forest carbon budget of the western US.

Urinary arsenic profiles and the risks of cancer mortality: A population-based 20-year follow-up study in arseniasis-endemic areas in Taiwan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, Chi-Jung; Department of Medical Research, China Medical Hospital, Taichung, Taiwan; Huang, Ya-Li

2013-04-15

Few studies investigated the association between chronic arsenic exposure and the mortality of cancers by estimating individual urinary arsenic methylation profiles. Therefore, we compared with the general population in Taiwan to calculate the standardized mortality ratio (SMR) in arseniasis-endemic area of Taiwan from 1996 to 2010 and evaluated the dose-response relationships between environmental arsenic exposure indices or urinary arsenic profiles and the mortality of cause-specific cancer. A cohort of 1563 residents was conducted and collected their urine sample and information regarding arsenic exposure from a questionnaire. All-cause death was identified using the National Death Registry of Taiwan. Urinary arsenic profilesmore » were measured using high performance liquid chromatography–hydride generator–atomic absorption spectrometry. We used Cox proportional hazard models to evaluate the mortality risks. In results, 193 all-site cancer deaths, and 29, 71, 43 deaths respectively for liver, lung and bladder cancers were ascertained. The SMRs were significantly high in arseniasis-endemic areas for liver, lung, and bladder cancers. People with high urinary InAs% or low DMA% or low secondary methylation index (SMI) were the most likely to suffer bladder cancer after adjusting other risk factors. Even stopping exposure to arsenic from the artesian well water, the mortality rates of the residents were higher than general population. Finally, urinary InAs%, DMA% and SMI could be the potential biomarkers to predict the mortality risk of bladder cancer. -- Highlights: ► The SMRs were significantly high in arseniasis-endemic areas for liver, lung, and bladder cancers. ► People with high urinary InAs% were the most likely to suffer bladder cancer. ► People with low DMA% or low SMI were the most likely to suffer bladder cancer.« less

Baseline glycemic status and mortality in 241,499 Korean metropolitan subjects: A Kangbuk Samsung Health Study.

PubMed

Rhee, Eun-Jung; Park, Se Eun; Chang, Yoosoo; Ryu, Seungho; Lee, Won-Young

2016-02-01

Diabetes and prediabetes subjects have increased risk for mortality. We analyzed the mortality risk due to all causes, cardiovascular disease (CVD) and cancer in Korean subjects participating in a health-screening program according to baseline glycemic status and HbA1c levels. Among 241,499 participants of a health-screening program between 2005 and 2012, the risk of death from all causes, CVD, and cancer was calculated based on the baseline glycemic status (normoglycemia, prediabetes, and diabetes) and HbA1c levels. Uncontrolled diabetes was defined as HbA1c≥7.0%. Vital status and confirmation of the cause of death were based on the analysis of death certificate records from the National Death Index. During 923,343.1 person-years of follow-up, 877 participants died. The multivariable-adjusted hazard ratios (HR) of subjects with controlled and uncontrolled diabetes to normoglycemic subjects for all-cause mortality were 1.58 (95% CI 1.24-2.03) and 2.26 (95% CI 1.78-2.86), respectively. The HRs of subjects with controlled and uncontrolled diabetes to normoglycemic subjects for mortality due to cancer were 1.75 (95% CI 1.23-2.48) and 1.67 (95% CI 1.13-2.45). However, glycemic status was not significantly associated with the risk of mortality due to CVD. The subjects with HbA1c higher than 6.5% showed more than 2-fold increased risk for all-cause mortality and the subjects with HbA1c lower than 5.2% showed increased HR (1.45, 95% CI 1.06-1.97) compared with those with HbA1c of 5.5% in subjects not taking anti-diabetic medications. Mortality risk from all causes and cancer significantly increased in diabetes subjects regardless of the glucose control status. In subjects not taking anti-diabetic medications, both high and low HbA1c resulted in increased risk for all-cause mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

Causes of death and infant mortality rates among full-term births in the United States between 2010 and 2012: An observational study.

PubMed

Bairoliya, Neha; Fink, Günther

2018-03-01

While the high prevalence of preterm births and its impact on infant mortality in the US have been widely acknowledged, recent data suggest that even full-term births in the US face substantially higher mortality risks compared to European countries with low infant mortality rates. In this paper, we use the most recent birth records in the US to more closely analyze the primary causes underlying mortality rates among full-term births. Linked birth and death records for the period 2010-2012 were used to identify the state- and cause-specific burden of infant mortality among full-term infants (born at 37-42 weeks of gestation). Multivariable logistic models were used to assess the extent to which state-level differences in full-term infant mortality (FTIM) were attributable to observed differences in maternal and birth characteristics. Random effects models were used to assess the relative contribution of state-level variation to FTIM. Hypothetical mortality outcomes were computed under the assumption that all states could achieve the survival rates of the best-performing states. A total of 10,175,481 infants born full-term in the US between January 1, 2010, and December 31, 2012, were analyzed. FTIM rate (FTIMR) was 2.2 per 1,000 live births overall, and ranged between 1.29 (Connecticut, 95% CI 1.08, 1.53) and 3.77 (Mississippi, 95% CI 3.39, 4.19) at the state level. Zero states reached the rates reported in the 6 low-mortality European countries analyzed (FTIMR < 1.25), and 13 states had FTIMR > 2.75. Sudden unexpected death in infancy (SUDI) accounted for 43% of FTIM; congenital malformations and perinatal conditions accounted for 31% and 11.3% of FTIM, respectively. The largest mortality differentials between states with good and states with poor FTIMR were found for SUDI, with particularly large risk differentials for deaths due to sudden infant death syndrome (SIDS) (odds ratio [OR] 2.52, 95% CI 1.86, 3.42) and suffocation (OR 4.40, 95% CI 3.71, 5.21). Even though these mortality differences were partially explained by state-level differences in maternal education, race, and maternal health, substantial state-level variation in infant mortality remained in fully adjusted models (SIDS OR 1.45, suffocation OR 2.92). The extent to which these state differentials are due to differential antenatal care standards as well as differential access to health services could not be determined due to data limitations. Overall, our estimates suggest that infant mortality could be reduced by 4,003 deaths (95% CI 2,284, 5,587) annually if all states were to achieve the mortality levels of the best-performing state in each cause-of-death category. Key limitations of the analysis are that information on termination rates at the state level was not available, and that causes of deaths may have been coded differentially across states. More than 7,000 full-term infants die in the US each year. The results presented in this paper suggest that a substantial share of these deaths may be preventable. Potential improvements seem particularly large for SUDI, where very low rates have been achieved in a few states while average mortality rates remain high in most other areas. Given the high mortality burden due to SIDS and suffocation, policy efforts to promote compliance with recommended sleeping arrangements could be an effective first step in this direction.

Insights into mortality patterns and causes of death through a process point of view model.

PubMed

Anderson, James J; Li, Ting; Sharrow, David J

2017-02-01

Process point of view (POV) models of mortality, such as the Strehler-Mildvan and stochastic vitality models, represent death in terms of the loss of survival capacity through challenges and dissipation. Drawing on hallmarks of aging, we link these concepts to candidate biological mechanisms through a framework that defines death as challenges to vitality where distal factors defined the age-evolution of vitality and proximal factors define the probability distribution of challenges. To illustrate the process POV, we hypothesize that the immune system is a mortality nexus, characterized by two vitality streams: increasing vitality representing immune system development and immunosenescence representing vitality dissipation. Proximal challenges define three mortality partitions: juvenile and adult extrinsic mortalities and intrinsic adult mortality. Model parameters, generated from Swedish mortality data (1751-2010), exhibit biologically meaningful correspondences to economic, health and cause-of-death patterns. The model characterizes the twentieth century epidemiological transition mainly as a reduction in extrinsic mortality resulting from a shift from high magnitude disease challenges on individuals at all vitality levels to low magnitude stress challenges on low vitality individuals. Of secondary importance, intrinsic mortality was described by a gradual reduction in the rate of loss of vitality presumably resulting from reduction in the rate of immunosenescence. Extensions and limitations of a distal/proximal framework for characterizing more explicit causes of death, e.g. the young adult mortality hump or cancer in old age are discussed.

Insights into mortality patterns and causes of death through a process point of view model

PubMed Central

Anderson, James J.; Li, Ting; Sharrow, David J.

2016-01-01

Process point of view models of mortality, such as the Strehler-Mildvan and stochastic vitality models, represent death in terms of the loss of survival capacity through challenges and dissipation. Drawing on hallmarks of aging, we link these concepts to candidate biological mechanisms through a framework that defines death as challenges to vitality where distal factors defined the age-evolution of vitality and proximal factors define the probability distribution of challenges. To illustrate the process point of view, we hypothesize that the immune system is a mortality nexus, characterized by two vitality streams: increasing vitality representing immune system development and immunosenescence representing vitality dissipation. Proximal challenges define three mortality partitions: juvenile and adult extrinsic mortalities and intrinsic adult mortality. Model parameters, generated from Swedish mortality data (1751-2010), exhibit biologically meaningful correspondences to economic, health and cause-of-death patterns. The model characterizes the 20th century epidemiological transition mainly as a reduction in extrinsic mortality resulting from a shift from high magnitude disease challenges on individuals at all vitality levels to low magnitude stress challenges on low vitality individuals. Of secondary importance, intrinsic mortality was described by a gradual reduction in the rate of loss of vitality presumably resulting from reduction in the rate of immunosenescence. Extensions and limitations of a distal/proximal framework for characterizing more explicit causes of death, e.g. the young adult mortality hump or cancer in old age are discussed. PMID:27885527

Improving life expectancy: how many years behind has the USA fallen? A cross-national comparison among high-income countries from 1958 to 2007

PubMed Central

Verguet, Stéphane; Jamison, Dean T

2013-01-01

Objective Many studies have documented higher mortality levels in the USA compared to other high-income nations. We add to this discussion by quantifying how many years behind comparison countries the USA has fallen and by identifying when US mortality rates began to diverge. Design We use full life tables, for men and women, for 17 high-income countries including the USA. We extract the life expectancy at birth and compute the mortality rates for each 5-year age group from birth up to age 80. Using the metric of how many ‘years behind’ a country has fallen, we compare US mortality levels with those in other high-income countries (‘comparators’). Results We report life expectancy for 17 high-income countries, for the period 1958–2007. Up to the late 1970s, US men and especially women closely tracked comparators in life expectancy. In the late 1970s in the USA, most strikingly women began to diverge from comparators so that the US female life expectancy in 2007 corresponded to that of the comparators’ average 10 years earlier. Mortality rates also began to diverge from the late 1970s, and the largest mortality gap was in the 15–49 age group, for both men and women, where the USA had fallen about 40 years behind the comparators by 2007. Conclusions Some causes proposed for the relatively high US mortality today—racial differences, lack of universal health insurance, US exceptionalism—changed little while the mortality gap emerged and grew. This suggests that explanations for the growing gap lie elsewhere. Quantification of how many years behind the USA has fallen can help provide clues about where to look for potential causes and remedies. PMID:23833143

High Israeli mortality rates from diabetes and renal failure - Can international comparison of multiple causes of death reflect differences in choice of underlying cause?

PubMed

Goldberger, Nehama; Applbaum, Yael; Meron, Jill; Haklai, Ziona

2015-01-01

The age-adjusted mortality rate in Israel is low compared to most Western countries although mortality rates from diabetes and renal failure in Israel are amongst the highest, while those from cardiovascular diseases (CVD) are amongst the lowest. This study aims to assess validity of choice of underlying causes (UC) in Israel by analyzing Israeli and international data on the prevalence of these diseases as multiple causes of death (MCOD) compared to UC, and data on comorbidity (MCOD based). Age-adjusted death rates were calculated for UC and MCOD and the corresponding ratio of multiple to underlying cause of death (SRMU) for available years between 1999 and 2012. Comorbidity was explored by calculating cause of death association indicators (CDAI) and frequency of comorbid disease. These results were compared to data from USA, France, Italy, Australia and the Czech Republic for 2009 or other available year. Mortality rates for all these diseases except renal failure have decreased in Israel between 1999 and 2012 as UC and MCOD. In 2009, the SRMU for diabetes was 2.7, slightly lower than other Western countries (3.0-3.5) showing more frequent choice as UC. Similar results were found for renal failure. In contrast, the SRMU for ischemic heart disease (IHD) and cerebrovascular disease were 2.0 and 2.6, respectively, higher than other countries (1.4-1.6 and 1.7-1.9, respectively), showing less frequent choice as UC. CDAI data showed a strong association between heart and cerebrovascular disease, and diabetes in all countries. In Israel, 40 % of deaths with UC diabetes had IHD and 24 % had cerebrovascular disease. Renal disease was less strongly associated with IHD. This international comparison suggests that diabetes and renal failure may be coded more frequently in Israel as UC, sometimes instead of heart and cerebrovascular disease. Even with some changes in coding, mortality rates would be high compared to other countries, similar to the comparatively high diabetes prevalence in Israel at older ages and high rate of end-stage renal failure. This study highlights the importance of physician training on death certification practice and need for further progress towards automation in recording and coding death causes.

Female white-tailed deer survival across ecoregions in Minnesota and South Dakota

USGS Publications Warehouse

Grovenburg, T.W.; Swanson, C.C.; Jacques, C.N.; Deperno, C.S.; Klaver, R.W.; Jenks, J.A.

2011-01-01

Survival and cause-specific mortality of female white-tailed deer (Odocoileus virginianus) have been well documented in forested and agricultural landscapes, but limited information has been collected in grassland habitats typical of the Northern Great Plains. Our objectives were to document and compare survival and cause-specific mortality of adult female white-tailed deer in four distinct ecoregions. We captured and radiocollared 190 (159 adult, 31 yearling) female white-tailed deer and monitored (including deer from a previous study) a total of 246 (215 adult, 31 yearling) deer from Jan. 2000 to Dec. 2007. We documented 113 mortalities; hunting (including wounding loss) accounted for 69.9% of all mortalities and vehicle collisions accounted for an additional 15.0%. Natural causes (e.g., disease, predation) of mortality were minor compared to human-related causes (e.g., hunting, vehicle collisions). We used known fate modeling in program MARK to estimate survival rates and compare ecoregions and seasons. Model {Sseason (winter = summer)} had the lowest AICc value suggesting that survival differed only between seasons where winter and summer survival was equal and differed with fall season. Annual and seasonal (summer, fall, winter) survival rates using the top model {Sseason (summer = winter)} were 0.76 (95% ci  =  0.70–0.80), 0.97 (95% ci  =  0.96–0.98), 0.80 (95% ci  =  0.76–0.83) and 0.97 (95% ci  =  0.96–0.98), respectively. High human-related mortality was likely associated with limited permanent cover, extensive road networks and high hunter density. Deer management in four distinct ecoregions relies on hunter harvest to maintain deer populations within state management goals.

Leisure-time physical activity and all-cause mortality.

PubMed

Lahti, Jouni; Holstila, Ansku; Lahelma, Eero; Rahkonen, Ossi

2014-01-01

Physical inactivity is a major public health problem associated with increased mortality risk. It is, however, poorly understood whether vigorous physical activity is more beneficial for reducing mortality risk than activities of lower intensity. The aim of this study was to examine associations of the intensity and volume of leisure-time physical activity with all-cause mortality among middle-aged women and men while considering sociodemographic and health related factors as covariates. Questionnaire survey data collected in 2000-02 among 40-60-year-old employees of the City of Helsinki (N = 8960) were linked with register data on mortality (74% gave permission to the linkage) providing a mean follow-up time of 12-years. The analysis included 6429 respondents (79% women). The participants were classified into three groups according to intensity of physical activity: low moderate, high moderate and vigorous. The volume of physical activity was classified into three groups according to tertiles. Cox regression analysis was used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for all-cause mortality. During the follow up 205 participants died. Leisure-time physical activity was associated with reduced risk of mortality. After adjusting for covariates the vigorous group (HR = 0.54, 95% CI 0.34-0.86) showed a reduced risk of mortality compared with the low moderate group whereas for the high moderate group the reductions in mortality risk (HR = 0.72, 95% CI 0.48-1.08) were less clear. Adjusting for the volume of physical activity did not affect the point estimates. Higher volume of leisure-time physical activity was also associated with reduced mortality risk; however, adjusting for the covariates and the intensity of physical activity explained the differences. For healthy middle-aged women and men who engage in some physical activity vigorous exercise may provide further health benefits preventing premature deaths.

Current situation on highly pathogenic avian influenza

USDA-ARS?s Scientific Manuscript database

Avian influenza is one of the most important diseases affecting the poultry industry worldwide. Avian influenza viruses can cause a range of clinical disease in poultry. Viruses that cause severe disease and mortality are referred to as highly pathogenic avian influenza (HPAI) viruses. The Asian ...

Causes of mortality and temporal patterns in breeding season survival of lesser prairie-chickens in shinnery oak prairies

USGS Publications Warehouse

Grisham, Blake A.; Boal, Clint W.

2015-01-01

Baseline survival and mortality data for lesser prairie-chickens (Tympanuchus pallidicinctus) are lacking for shinnery oak (Quercus havardii) prairies. An understanding of the causes and timing of mortalities and breeding season survival in this ecoregion is important because shinnery oak prairies have hotter and drier environmental conditions, as well as different predator communities compared with the northern distribution of the species. The need for this information has become more pressing given the recent listing of the species as threatened under the U.S. Endangered Species Act. We investigated causes of mortality and survival of lesser prairie-chickens during the 6-month breeding season (1 Mar–31 Aug) of 2008–2011 on the Texas Southern High Plains, USA. We recorded 42 deaths of radiotagged individuals, and our results indicated female mortalities were proportionate among avian and mammalian predation and other causes of mortality but survival was constant throughout the 6-month breeding season. Male mortalities were constant across avian and mammalian predation and other causes, but more mortalities occurred in June compared with other months. Male survival also varied by month, and survival probabilities were lower in June–August. We found predation on leks was rare, mortalities from fence collisions were rare, female survival did not decrease during incubation or brood-rearing, and survival was influenced by drought. Our study corroborated recent studies that suggested lesser prairie-chickens are living at the edge of their physiological tolerances to environmental conditions in shinnery oak prairies. As such, lesser prairie-chickens in our study experienced different patterns of mortality and survival that we attributed to hot, dry conditions during the breeding season. Specifically, and converse to other studies on lesser prairie-chicken survival and mortality, drought positively influenced female survival because females did not incubate eggs during drought conditions; the incubation period is when females are most vulnerable to predation. Male mortalities and survival were negatively influenced by drought later in the breeding season, which we attributed to rigorous lekking activities through late May combined with lack of food and cover as the breeding season progressed into summer.

Association of the Aspartate Aminotransferase to Alanine Aminotransferase Ratio with BNP Level and Cardiovascular Mortality in the General Population: The Yamagata Study 10-Year Follow-Up

PubMed Central

Yokoyama, Miyuki; Otaki, Yoichiro; Takahashi, Hiroki; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Konta, Tsuneo; Shibata, Yoko; Daimon, Makoto; Kayama, Takamasa; Kubota, Isao

2016-01-01

Background. Early identification of high risk subjects for cardiovascular disease in health check-up is still unmet medical need. Cardiovascular disease is characterized by the superior increase in aspartate aminotransferase (AST) to alanine aminotransferase (ALT). However, the association of AST/ALT ratio with brain natriuretic peptide (BNP) levels and cardiovascular mortality remains unclear in the general population. Methods and Results. This longitudinal cohort study included 3,494 Japanese subjects who participated in a community-based health check-up, with a 10-year follow-up. The AST/ALT ratio increased with increasing BNP levels. And multivariate logistic analysis showed that the AST/ALT ratio was significantly associated with a high BNP (≥100 pg/mL). There were 250 all-cause deaths including 79 cardiovascular deaths. Multivariate Cox proportional hazard regression analysis revealed that a high AST/ALT ratio (>90 percentile) was an independent predictor of all-cause and cardiovascular mortality after adjustment for confounding factors. Kaplan-Meier analysis demonstrated that cardiovascular mortality was higher in subjects with a high AST/ALT ratio than in those without. Conclusions. The AST/ALT ratio was associated with an increase in BNP and was predictive of cardiovascular mortality in a general population. Measuring the AST/ALT ratio during routine health check-ups may be a simple and cost-effective marker for cardiovascular mortality. PMID:27872510

Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings

PubMed Central

Pane, Masdalina; Imari, Sholah; Alwi, Qomariah; Nyoman Kandun, I; Cook, Alex R.; Samaan, Gina

2013-01-01

Background Indonesia provides the largest single source of pilgrims for the Hajj (10%). In the last two decades, mortality rates for Indonesian pilgrims ranged between 200–380 deaths per 100,000 pilgrims over the 10-week Hajj period. Reasons for high mortality are not well understood. In 2008, verbal autopsy was introduced to complement routine death certificates to explore cause of death diagnoses. This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings. Methods Public health surveillance was conducted by Indonesian public health authorities accompanying pilgrims to Saudi Arabia, with daily reporting of hospitalizations and deaths. Surveillance data from 2008 were analyzed for timing, geographic location and site of death. Percentages for each cause of death category from death certificates were compared to that from verbal autopsy. Results In 2008, 206,831 Indonesian undertook the Hajj. There were 446 deaths, equivalent to 1,968 deaths per 100,000 pilgrim years. Most pilgrims died in Mecca (68%) and Medinah (24%). There was no statistically discernible difference in the total mortality risk for the two pilgrimage routes (Mecca or Medinah first), but the number of deaths peaked earlier for those traveling to Mecca first (p=0.002). Most deaths were due to cardiovascular (66%) and respiratory (28%) diseases. A greater proportion of deaths were attributed to cardiovascular disease by death certificate compared to the verbal autopsy method (p<0.001). Significantly more deaths had ill-defined cause based on verbal autopsy method (p<0.001). Conclusions Despite pre-departure health screening and other medical services, Indonesian pilgrim mortality rates were very high. Correct classification of cause of death is critical for the development of risk mitigation strategies. Since verbal autopsy classified causes of death differently to death certificates, further studies are needed to assess the method’s utility in this setting. PMID:23991182

US Mortality: Influence of Race, Geography and Cardiovascular Risk Among Participants in the Population-Based REGARDS Cohort.

PubMed

Limdi, Nita A; Howard, Virginia J; Higginbotham, John; Parton, Jason; Safford, Monika M; Howard, George

2016-12-01

We evaluated whether differences in cardiovascular risk factors, as assessed by the Framingham risk scores for stroke and cardiovascular disease (FSRS and FCRS), contributed to disparities in all-cause mortality across race and regional strata of USA. Race-region-specific FSRS and FCRS scores were computed for 30,086 REGARDS participants who were recruited between January 2003 and October 2007. They were divided across six regions of the "Eight Americas" and then compared after adjusting for race and sex. Kaplan-Meier curves and hazard ratios for all-cause mortality were estimated between regions, first adjusted for age and sex, and then for the risk scores. After adjustment for age, sex, FCRS, and FSRS, there was no difference in mortality among Middle-America Whites versus Low-Income White. However, mortality was lower among Middle-America Blacks (-23 %; p = 0.06) and High-Risk Urban Blacks (-24 %; p = 0.01) compared to Southern Low-Income Rural Blacks. Compared to Middle-American Whites, mortality was higher among Middle-America Blacks (+39 %; p < 0.001), High-Risk Urban Blacks (+35 %; p < 0.001) and Southern Low-Income Rural Blacks (+85 %; p < 0.001). Accounting for cardiovascular risk unmasked a greater disparity in mortality between Blacks and Whites and among Southern Rural Blacks compared to Middle-America Blacks and High-Risk Urban Blacks.

Multicity study of air pollution and mortality in Latin America (the ESCALA study).

PubMed

Romieu, Isabelle; Gouveia, Nelson; Cifuentes, Luis A; de Leon, Antonio Ponce; Junger, Washington; Vera, Jeanette; Strappa, Valentina; Hurtado-Díaz, Magali; Miranda-Soberanis, Victor; Rojas-Bracho, Leonora; Carbajal-Arroyo, Luz; Tzintzun-Cervantes, Guadalupe

2012-10-01

The ESCALA* project (Estudio de Salud y Contaminación del Aire en Latinoamérica) is an HEI-funded study that aims to examine the association between exposure to outdoor air pollution and mortality in nine Latin American cities, using a common analytic framework to obtain comparable and updated information on the effects of air pollution on several causes of death in different age groups. This report summarizes the work conducted between 2006 and 2009, describes the methodologic issues addressed during project development, and presents city-specific results of meta-analyses and meta-regression analyses. The ESCALA project involved three teams of investigators responsible for collection and analysis of city-specific air pollution and mortality data from three different countries. The teams designed five different protocols to standardize the methods of data collection and analysis that would be used to evaluate the effects of air pollution on mortality (see Appendices B-F). By following the same protocols, the investigators could directly compare the results among cities. The analysis was conducted in two stages. The first stage included analyses of all-natural-cause and cause-specific mortality related to particulate matter < or = 10 pm in aerodynamic diameter (PM10) and to ozone (O3) in cities of Brazil, Chile, and México. Analyses for PM10 and O3 were also stratified by age group and O3 analyses were stratified by season. Generalized linear models (GLM) in Poisson regression were used to fit the time-series data. Time trends and seasonality were modeled using natural splines with 3, 6, 9, or 12 degrees of freedom (df) per year. Temperature and humidity were also modeled using natural splines, initially with 3 or 6 df, and then with degrees of freedom chosen on the basis of residual diagnostics (i.e., partial autocorrelation function [PACF], periodograms, and a Q-Q plot) (Appendix H, available on the HEI Web site). Indicator variables for day-of-week and holidays were used to account for short-term cyclic fluctuations. To assess the association between exposure to air pollution and risk of death, the PM10 and O3 data were fit using distributed lag models (DLMs). These models are based on findings indicating that the health effects associated with air pollutant concentrations on a given day may accumulate over several subsequent days. Each DLM measured the cumulative effect of a pollutant concentration on a given day (day 0) and that day's contribution to the effect of that pollutant on multiple subsequent (lagged) days. For this study, exposure lags of up to 3, 5, and 10 days were explored. However, only the results of the DLMs using a 3-day lag (DLM 0-3) are presented in this report because we found a decreasing association with mortality in various age-cause groups for increasing lag effects from 3 to 5 days for both PM10 and O3. The potential modifying effect of socioeconomic status (SES) on the association of PM10 or O3 concentration and mortality was also explored in four cities: Mexico City, Rio de Janeiro, São Paulo, and Santiago. The methodology for developing a common SES index is presented in the report. The second stage included meta-analyses and metaregression. During this stage, the associations between mortality and air pollution were compared among cities to evaluate the presence of heterogeneity and to explore city-level variables that might explain this heterogeneity. Meta-analyses were conducted to combine mortality effect estimates across cities and to evaluate the presence of heterogeneity among city results, whereas meta-regression models were used to explore variables that might explain the heterogeneity among cities in mortality risks associated with exposures to PM10 (but not to O3). The results of the mortality analyses are presented as risk percent changes (RPC) with a 95% confidence interval (CI). RPC is the increase in mortality risk associated with an increase of 10 microg/m3 in the 24-hour average concentration of PM10 or in the daily maximum 8-hour moving average concentration of O3. Most of the results for PM10 were positive and statistically significant, showing an increased risk of mortality with increased ambient concentrations. Results for O3 also showed a statistically significant increase in mortality in the cities with available data. With the distributed lag model, DLM 0-3, PM10 ambient concentrations were associated with an increased risk of mortality in all cities except Concepci6n and Temuco. In Mexico City and Santiago the RPC and 95% CIs were 1.02% (0.87 to 1.17) and 0.48% (0.35 to 0.61), respectively. PM10 was also significantly associated with increased mortality from cardiopulmonary, respiratory, cardiovascular, cerebrovascular-stroke, and chronic obstructive lung diseases (COPD) in most cities. The few nonsignificant effects generally were observed in the smallest cities (Concepción, Temuco, and Toluca). The percentage increases in mortality associated with ambient O3 concentrations were smaller than for those associated with PM10. All-natural-cause mortality was significantly related to O3 in Mexico City, Monterrey, São Paulo and Rio de Janeiro. Increased mortality risks for some specific causes were also observed in these cities and in Santiago. In the analyses stratified by season, different patterns in mortality and O3 were observed for cold and warm seasons. Risk estimates for the warm season were larger and significant for several causes of death in São Paulo and Rio de Janeiro. Risk estimates for the cold season were larger and significant for some causes of death in Mexico City, Monterrey, and Toluca. In an analysis stratified by SES, the all-natural-cause mortality risk in Mexico City was larger for people with a medium SES; however we observed that the risk of mortality related to respiratory causes was larger among people with a low SES, while the risk of mortality related to cardiovascular and cerebrovascular-stroke causes was larger among people with medium or high SES. In São Paulo, the all-natural-cause mortality risk was larger in people with a high SES, while in Rio de Janeiro the all-natural-cause mortality risk was larger in people with a low SES. In both Brazilian cities, the risks of mortality were larger for respiratory causes, especially for the low- and high-SES groups. In Santiago, all-natural-cause mortality risk did not vary with level of SES; however, people with a low SES had a higher respiratory mortality risk, particularly for COPD. People with a medium SES had larger risks of mortality from cardiovascular and cerebrovascular-stroke disease. The effect of ambient PM10 concentrations on infant and child mortality from respiratory causes and lower respiratory infection (LRI) was studied only for Mexico City, Santiago, and São Paulo. Significant increased mortality risk from these causes was observed in both Santiago (in infants and older children) and Mexico City (only in infants). For O3, an increased mortality risk was observed in Mexico City (in infants and older children) and in São Paulo (only in infants during the warm season). The results of the meta-analyses confirmed the positive and statistically significant association between PM10 and all-natural-cause mortality (RPC = 0.77% [95% CI: 0.60 to 1.00]) using the random-effects model. For mortality from specific causes, the percentage increase in mortality ranged from 0.72% (0.54 to 0.89) for cardiovascular disease to 2.44% (1.36 to 3.59) for COPD, also using the random-effects model. For O3, significant positive associations were observed using the random-effects model for some causes, but not for all natural causes or for respiratory diseases in people 65 years or older (> or = 65 years), and not for COPD and cerebrovascular-stroke in the all-age and the > or = 65 age groups. The percentage increase in all-natural-cause mortality was 0.16% (-0.02 to 0.33). In the meta-regression analyses, variables that best explained heterogeneity in mortality risks among cities were the mean average of temperature in the warm season, population percentage of infants (< 1 year), population percentage of children at least 1 year old but < 5 years (i.e., 1-4 years), population percentage of people > or = 65 years, geographic density of PM10 monitors, annual average concentrations of PM10, and mortality rates for lung cancer. The ESCALA project was undertaken to obtain information for assessing the effects of air pollutants on mortality in Latin America, where large populations are exposed to relatively high levels of ambient air pollution. An important goal was to provide evidence that could inform policies for controlling air pollution in Latin America. This project included the development of standardized protocols for data collection and for statistical analyses as well as statistical analytic programs (routines developed in R by the ESCALA team) to insure comparability of results. The analytic approach and statistical programming developed within this project should be of value for researchers carrying out single-city analyses and should facilitate the inclusion of additional Latin American cities within the ESCALA multicity project. Our analyses confirm what has been observed in other parts of the world regarding the effects of ambient PM10 and 03 concentrations on daily mortality. They also suggest that SES plays a role in the susceptibility of a population to air pollution; people with a lower SES appeared to have an increased risk of death from respiratory causes, particularly COPD. Compared with the general population, infants and young children appeared to be more susceptible to both PM10 and O3, although an increased risk of mortality was not observed in these age groups in all cities. (ABSTRACT TRUNCATED)

Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends from 1999 to 2009.

PubMed

Binswanger, Ingrid A; Blatchford, Patrick J; Mueller, Shane R; Stern, Marc F

2013-11-05

Among former prisoners, a high rate of death has been documented in the early postrelease period, particularly from drug-related causes. Little is known about risk factors and trends in postrelease mortality in the past decade, especially given general population increases in overdose deaths from pharmaceutical opioids. To determine postrelease mortality between 1999 and 2009; cause-specific mortality rates; and whether sex, calendar year, and custody factors were risk factors for all-cause, overdose, and opioid-related deaths. Cohort study. Prison system of the Washington State Department of Corrections. 76 208 persons released from prison. Identities were linked probabilistically to the National Death Index to identify deaths and causes of death, and mortality rates were calculated. Cox proportional hazards regression estimated the effect of age, sex, race or ethnicity, whether the incarceration resulted from a violation of terms of the person's community supervision, length of incarceration, release type, and calendar year on the hazard ratio (HR) for death. The all-cause mortality rate was 737 per 100 000 person-years (95% CI, 708 to 766) (n = 2462 deaths). Opioids were involved in 14.8% of all deaths. Overdose was the leading cause of death (167 per 100 000 person-years [CI, 153 to 181]), and overdose deaths in former prisoners accounted for 8.3% of the overdose deaths among persons aged 15 to 84 years in Washington from 2000 to 2009. Women were at increased risk for overdose (HR, 1.38 [CI, 1.12 to 1.69]) and opioid-related deaths (HR, 1.39 [CI, 1.09 to 1.79]). The study was done in only 1 state. Innovation is needed to reduce the risk for overdose among former prisoners. National Institute on Drug Abuse and the Robert Wood Johnson Foundation.

Sunlight Has Cardiovascular Benefits Independently of Vitamin D.

PubMed

Weller, Richard B

2016-01-01

High blood pressure (BP) is the leading risk factor for disability adjusted life years lost globally. Epidemiological data show a correlation between increased sun exposure and reduced population BP and cardiovascular mortality. Individuals with high serum vitamin D levels are at reduced risk of hypertension, cardiovascular disease and metabolic syndrome, yet multiple trial data show that oral vitamin D supplementation has no effect on these endpoints. Sunlight is a risk factor for skin cancers, but no link has been shown with increased all-cause mortality. Cohort studies from Scandinavia show a dose-dependent fall in mortality with increased sun-seeking behaviour. Skin contains significant stores of nitrogen oxides, which can be converted to NO by UV radiation and exported to the systemic circulation. Human studies show that this pathway can cause arterial vasodilatation and reduced BP. Murine studies suggest the same mechanism may reduce metabolic syndrome. Sunlight has beneficial effects on cardiovascular risk factors independently of vitamin D. All-cause mortality should be the primary determinant of public health messages. Sunlight is a risk factor for skin cancer, but sun avoidance may carry more of a cost than benefit for overall good health. © 2016 S. Karger AG, Basel.

Temporal changes in occupational sitting time in the Danish workforce and associations with all-cause mortality: results from the Danish work environment cohort study.

PubMed

van der Ploeg, Hidde P; Møller, Simone Visbjerg; Hannerz, Harald; van der Beek, Allard J; Holtermann, Andreas

2015-06-02

Prolonged sitting has been negatively associated with a range of non-communicably diseases. However, the role of occupational sitting is less clear, and little is known on the changes of occupational sitting in a working population over time. The present study aimed to determine 1) temporal changes in occupational sitting time between 1990 and 2010 in the Danish workforce; 2) the association and possible dose-response relationship between occupational sitting time and all-cause mortality. This study analysed data from the Danish Work Environment Cohort Study (DWECS), which is a cohort study of the Danish working population conducted in five yearly intervals between 1990 and 2010. Occupational sitting time is self-reported in the DWECS. To determine the association with all-cause mortality, the DWECS was linked to the Danish Register of Causes of Death via the Central Person Register. Between 1990 and 2010 the proportion of the Danish workforce who sat for at least three quarters of their work time gradually increased from 33.1 to 39.1%. All-cause mortality analyses were performed with 149,773 person-years of observation and an average follow-up of 12.61 years, during which 533 deaths were registered. None of the presented analyses found a statistically significant association between occupational sitting time and all-cause mortality. The hazard ratio for all-cause mortality was 0.97 (95% CI: 0.79; 1.18) when ≥24 hr/wk occupational sitting time was compared to <24 hr/wk for the 1990-2005 waves. Occupational sitting time increased by 18% in the Danish workforce, which seemed to be limited to people with high socio-economic status. If this increase is accompanied by increases in total sitting time, this development has serious public health implications, given the detrimental associations between total sitting time and mortality. The current study was inconclusive on the specific role that occupational sitting might play in the increased all-cause mortality risk associated with the total volume of sitting.

Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events: A Meta-Analysis.

PubMed

Cohen, Randy; Bavishi, Chirag; Rozanski, Alan

2016-01-01

To assess the net impact of purpose in life on all-cause mortality and cardiovascular events. The electronic databases PubMed, Embase, and PsycINFO were systematically searched through June 2015 to identify all studies investigating the relationship between purpose in life, mortality, and cardiovascular events. Articles were selected for inclusion if, a) they were prospective, b) evaluated the association between some measure of purpose in life and all-cause mortality and/or cardiovascular events, and c) unadjusted and/or adjusted risk estimates and confidence intervals (CIs) were reported. Ten prospective studies with a total of 136,265 participants were included in the analysis. A significant association was observed between having a higher purpose in life and reduced all-cause mortality (adjusted pooled relative risk = 0.83 [CI = 0.75-0.91], p < .001) and cardiovascular events (adjusted pooled relative risk = 0.83 [CI = 0.75-0.92], p = .001). Subgroup analyses by study country of origin, questionnaire used to measure purpose in life, age, and whether or not participants with baseline cardiovascular disease were included in the study all yielded similar results. Possessing a high sense of purpose in life is associated with a reduced risk for all-cause mortality and cardiovascular events. Future research should focus on mechanisms linking purpose in life to health outcomes, as well as interventions to assist individuals identified as having a low sense of purpose in life.

Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding.

PubMed

Elsebaey, Mohamed A; Elashry, Heba; Elbedewy, Tamer A; Elhadidy, Ahmed A; Esheba, Noha E; Ezat, Sherif; Negm, Manal Saad; Abo-Amer, Yousry Esam-Eldin; Abgeegy, Mohamed El; Elsergany, Heba Fadl; Mansour, Loai; Abd-Elsalam, Sherief

2018-04-01

Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly.Variceal bleeding was the most common cause of acute UGIB in elderly Egyptian patients. In-hospital mortality rate was 8.74%. Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding were the predictors of in-hospital mortality.Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding should be considered when triaging those patients for immediate resuscitation, close observation, and early treatment.

Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe

PubMed Central

Walker, A. Sarah; Prendergast, Andrew J.; Mugyenyi, Peter; Munderi, Paula; Hakim, James; Kekitiinwa, Addy; Katabira, Elly; Gilks, Charles F.; Kityo, Cissy; Nahirya-Ntege, Patricia; Nathoo, Kusum; Gibb, Diana M.

2012-01-01

Background. Adult mortality in the first 3 months on antiretroviral therapy (ART) is higher in low-income than in high-income countries, with more similar mortality after 6 months. However, the specific patterns of changing risk and causes of death have rarely been investigated in adults, nor compared with children in low-income countries. Methods. We used flexible parametric hazard models to investigate how mortality risks varied over the first year on ART in human immunodeficiency virus–infected adults (aged 18–73 years) and children (aged 4 months to 15 years) in 2 trials in Zimbabwe and Uganda. Results. One hundred seventy-nine of 3316 (5.4%) adults and 39 of 1199 (3.3%) children died; half of adult/pediatric deaths occurred in the first 3 months. Mortality variation over year 1 was similar; at all CD4 counts/CD4%, mortality risk was greatest between days 30 and 50, declined rapidly to day 180, then declined more slowly. One-year mortality after initiating ART with 0–49, 50–99 or ≥100 CD4 cells/μL was 9.4%, 4.5%, and 2.9%, respectively, in adults, and 10.1%, 4.4%, and 1.3%, respectively, in children aged 4–15 years. Mortality in children aged 4 months to 3 years initiating ART in equivalent CD4% strata was also similar (0%–4%: 9.1%; 5%–9%: 4.5%; ≥10%: 2.8%). Only 10 of 179 (6%) adult deaths and 1 of 39 (3%) child deaths were probably medication-related. The most common cause of death was septicemia/meningitis in adults (20%, median 76 days) and children (36%, median 79 days); pneumonia also commonly caused child deaths (28%, median 41 days). Conclusions. Children ≥4 years and adults with low CD4 values have remarkably similar, and high, mortality risks in the first 3 months after ART initiation in low-income countries, similar to cohorts of untreated individuals. Bacterial infections are a major cause of death in both adults and children; targeted interventions could have important benefits. PMID:22972859

Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis

PubMed Central

Nitsch, Dorothea; Grams, Morgan; Sang, Yingying; Black, Corri; Cirillo, Massimo; Djurdjev, Ognjenka; Iseki, Kunitoshi; Jassal, Simerjot K; Kimm, Heejin; Kronenberg, Florian; Øien, Cecilia M; Levin, Adeera; Woodward, Mark; Hemmelgarn, Brenda R

2013-01-01

Objective To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. Design Random effects meta-analysis using pooled individual participant data. Setting 46 cohorts from Europe, North and South America, Asia, and Australasia. Participants 2 051 158 participants (54% women) from general population cohorts (n=1 861 052), high risk cohorts (n=151 494), and chronic kidney disease cohorts (n=38 612). Eligible cohorts (except chronic kidney disease cohorts) had at least 1000 participants, outcomes of either mortality or end stage renal disease of ≥50 events, and baseline measurements of estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (mL/min/1.73 m2) and urinary albumin-creatinine ratio (mg/g). Results Risks of all-cause mortality and cardiovascular mortality were higher in men at all levels of estimated glomerular filtration rate and albumin-creatinine ratio. While higher risk was associated with lower estimated glomerular filtration rate and higher albumin-creatinine ratio in both sexes, the slope of the risk relationship for all-cause mortality and for cardiovascular mortality were steeper in women than in men. Compared with an estimated glomerular filtration rate of 95, the adjusted hazard ratio for all-cause mortality at estimated glomerular filtration rate 45 was 1.32 (95% CI 1.08 to 1.61) in women and 1.22 (1.00 to 1.48) in men (Pinteraction<0.01). Compared with a urinary albumin-creatinine ratio of 5, the adjusted hazard ratio for all-cause mortality at urinary albumin-creatinine ratio 30 was 1.69 (1.54 to 1.84) in women and 1.43 (1.31 to 1.57) in men (Pinteraction<0.01). Conversely, there was no evidence of a sex difference in associations of estimated glomerular filtration rate and urinary albumin-creatinine ratio with end stage renal disease risk. Conclusions Both sexes face increased risk of all-cause mortality, cardiovascular mortality, and end stage renal disease with lower estimated glomerular filtration rates and higher albuminuria. These findings were robust across a large global consortium. PMID:23360717

Interaction between acyl-ghrelin and BMI predicts clinical outcomes in hemodialysis patients.

PubMed

Beberashvili, Ilia; Sinuani, Inna; Azar, Ada; Shapiro, Gregory; Feldman, Leonid; Doenyas-Barak, Keren; Stav, Kobi; Efrati, Shai

2017-01-18

Ghrelin, a gastric orexigenic peptide, and body mass index (BMI) are known as inversely associated to each other and are both linked to cardiovascular (CV) risk and mortality in maintenance hemodialysis (MHD) patients. However, it is unclear whether the interaction between ghrelin and BMI is associated with a risk of all-cause and CV death in this population. A prospective observational study was performed on 261 MHD outpatients (39% women, mean age 68.6 ± 13.6 years) recruited from October 2010 through April 2012, and were followed until November 2014 (median follow-up-28 months, interquartile range-19-34 months). We measured acyl-ghrelin (AG) levels, appetite, nutritional and inflammatory markers, prospective all-cause and cardiovascular (CV) mortality. During follow-up, 109 patients died, 51 due to CV causes. A significant interaction effect of high BMI and high AG (defined as levels higher than median) on all-cause mortality was found. Crude Cox HR for the product termed BMI x AG was 0.52, with a 95% confidence interval (CI): 0.29 to 0.95 (P = 0.03). Evaluating the interaction on an additive scale revealed that the combined predictive value of BMI and AG is larger than the sum of their individual predictive values (synergy index was 1.1). Across the four BMI-AG categories, the group with high BMI and high AG exhibited better all-cause and cardiovascular mortality irrespective of appetite and nutritional status (multivariable adjusted hazard ratios were 0.31, 95% CI 0.16 to 0.62, P = 0.001, and 0.35, 95% CI 0.13 to 0.91, P = 0.03, respectively). Data analyses made by dividing patients according to fat mass-AG, but not to lean body mass-AG categories, provided similar results. Higher AG levels enhance the favourable association between high BMI and survival in MHD patients irrespective of appetite, nutritional status and inflammation.

Excess mortality in women of reproductive age from low-income countries: a Swedish national register study.

PubMed

Esscher, Annika; Haglund, Bengt; Högberg, Ulf; Essén, Birgitta

2013-04-01

Cause-of-death statistics is widely used to monitor the health of a population. African immigrants have, in several European studies, shown to be at an increased risk of maternal death, but few studies have investigated cause-specific mortality rates in female immigrants. In this national study, based on the Swedish Cause of Death Register, we studied 27,957 women of reproductive age (aged 15-49 years) who died between 1988 and 2007. Age-standardized mortality rates per 100,000 person years and relative risks for death and underlying causes of death, grouped according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, were calculated and compared between women born in Sweden and in low-, middle- and high-income countries. The total age-standardized mortality rate per 100,000 person years was significantly higher for women born in low-income (84.4) and high-income countries (83.7), but lower for women born in middle-income countries (57.5), as compared with Swedish-born women (68.1). The relative risk of dying from infectious disease was 15.0 (95% confidence interval 10.8-20.7) and diseases related to pregnancy was 6.6 (95% confidence interval 2.6-16.5) for women born in low-income countries, as compared to Swedish-born women. Women born in low-income countries are at the highest risk of dying during reproductive age in Sweden, with the largest discrepancy in mortality rates seen for infectious diseases and diseases related to pregnancy, a cause of death pattern similar to the one in their countries of birth. The World Bank classification of economies may be a useful tool in migration research.

Excess mortality in women of reproductive age from low-income countries: a Swedish national register study

PubMed Central

Haglund, Bengt; Högberg, Ulf; Essén, Birgitta

2013-01-01

Background: Cause-of-death statistics is widely used to monitor the health of a population. African immigrants have, in several European studies, shown to be at an increased risk of maternal death, but few studies have investigated cause-specific mortality rates in female immigrants. Methods: In this national study, based on the Swedish Cause of Death Register, we studied 27 957 women of reproductive age (aged 15–49 years) who died between 1988 and 2007. Age-standardized mortality rates per 100 000 person years and relative risks for death and underlying causes of death, grouped according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, were calculated and compared between women born in Sweden and in low-, middle- and high-income countries. Results: The total age-standardized mortality rate per 100 000 person years was significantly higher for women born in low-income (84.4) and high-income countries (83.7), but lower for women born in middle-income countries (57.5), as compared with Swedish-born women (68.1). The relative risk of dying from infectious disease was 15.0 (95% confidence interval 10.8–20.7) and diseases related to pregnancy was 6.6 (95% confidence interval 2.6–16.5) for women born in low-income countries, as compared to Swedish-born women. Conclusions: Women born in low-income countries are at the highest risk of dying during reproductive age in Sweden, with the largest discrepancy in mortality rates seen for infectious diseases and diseases related to pregnancy, a cause of death pattern similar to the one in their countries of birth. The World Bank classification of economies may be a useful tool in migration research. PMID:22850186

Blood Pressure Mobile Monitoring for Pregnant Woman Based Android System

NASA Astrophysics Data System (ADS)

Supriyanti, Retno; Erfayanto, Uji; Ramadani, Yogi; Murdyantoro, Eko; Widodo, Haris B.

2016-01-01

Currently, at least 18,000 women die every year in Indonesia due to pregnancy or childbirth. It means that every half hour a woman dies due to pregnancy or childbirth. As a result, every year 36,000 children became orphans. The high maternal mortality rate was put Indonesia on top in ASEAN. The main causes of maternal mortality are high-risk pregnancy. Mothers who have diseases like high blood pressure, pre-eclampsia, diabetes, hyperthyroidism, and already over 40 years old and infectious diseases such as rubella, hepatitis and HIV can be factors that lead to high-risk pregnancy. This paper will discuss the development of a blood pressure monitoring device that is suitable for pregnant women. It is based on convenience for pregnant women to get the equipment that is flexible with her presence. Results indicate that the equipment is in use daily support for pregnant women therefore, one of the causes of maternal mortality can be detected earlier.

Multiple approaches to associations of physical activity and adherence to the Mediterranean diet with all-cause mortality in older adults: the PREvención con DIeta MEDiterránea study.

PubMed

Cárdenas-Fuentes, Gabriela; Subirana, Isaac; Martinez-Gonzalez, Miguel A; Salas-Salvadó, Jordi; Corella, Dolores; Estruch, Ramon; Fíto, Montserrat; Muñoz-Bravo, Carlos; Fiol, Miguel; Lapetra, José; Aros, Fernando; Serra-Majem, Luis; Tur, Josep A; Pinto, Xavier; Ros, Emilio; Coltell, Oscar; Díaz-López, Andres; Ruiz-Canela, Miguel; Schröder, Helmut

2018-04-25

Although evidence indicates that both physical activity and adherence to the Mediterranean diet (MedDiet) reduce the risk of all-cause mortality, a little is known about optimal intensities of physical activity and their combined effect with MedDiet in older adults. We assessed the separate and combined associations of leisure-time physical activity (LTPA) and MedDiet adherence with all-cause mortality. We prospectively studied 7356 older adults (67 ± 6.2 years) at high vascular risk from the PREvención con DIeta MEDiterránea study. At baseline and yearly thereafter, adherence to the MedDiet and LTPA were measured using validated questionnaires. After 6.8 years of follow-up, we documented 498 deaths. Adherence to the MedDiet and total, light, and moderate-to-vigorous LTPA were inversely associated with all-cause mortality (p < 0.01 for all) in multiple adjusted Cox regression models. The adjusted hazard of all-cause mortality was 73% lower (hazard ratio 0.27, 95% confidence interval 0.19-0.38, p < 0.001) for the combined category of highest adherence to the MedDiet (3rd tertile) and highest total LTPA (3rd tertile) compared to lowest adherence to the MedDiet (1st tertile) and lowest total LTPA (1st tertile). Reductions in mortality risk did not meaningfully differ between total, light intensity, and moderate-to-vigorous LTPA. We found that higher levels of LTPA, regardless of intensity (total, light and moderate-to-vigorous), and greater adherence to the MedDiet were associated separately and jointly with lower all-cause mortality. The finding that light LTPA was inversely associated with mortality is relevant because this level of intensity is a feasible option for older adults.

Long-term mortality and causes of death associated with Staphylococcus aureus bacteremia. A matched cohort study.

PubMed

Gotland, N; Uhre, M L; Mejer, N; Skov, R; Petersen, A; Larsen, A R; Benfield, T

2016-10-01

Data describing long-term mortality in patients with Staphylococcus aureus bacteremia (SAB) is scarce. This study investigated risk factors, causes of death and temporal trends in long-term mortality associated with SAB. Nationwide population-based matched cohort study. Mortality rates and ratios for 25,855 cases and 258,547 controls were analyzed by Poisson regression. Hazard ratio of death was computed by Cox proportional hazards regression analysis. The majority of deaths occurred within the first year of SAB (44.6%) and a further 15% occurred within the following 2-5 years. The mortality rate was 14-fold higher in the first year after SAB and 4.5-fold higher overall for cases compared to controls. Increasing age, comorbidity and hospital contact within 90 days of SAB was associated with an increased risk of death. The overall relative risk of death decreased gradually by 38% from 1992-1995 to 2012-2014. Compared to controls, SAB patients were more likely to die from congenital malformation, musculoskeletal/skin disease, digestive system disease, genitourinary disease, infectious disease, endocrine disease, injury and cancer and less likely to die from respiratory disease, nervous system disease, unknown causes, psychiatric disorders, cardiovascular disease and senility. Over time, rates of death decreased or were stable for all disease categories except for musculoskeletal and skin disease where a trend towards an increase was seen. Long-term mortality after SAB was high but decreased over time. SAB cases were more likely to die of eight specific causes of death and less likely to die of five other causes of death compared to controls. Causes of death decreased for most disease categories. Risk factors associated with long-term mortality were similar to those found for short-term mortality. To improve long-term survival after SAB, patients should be screened for comorbidity associated with SAB. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Does personality predict mortality? Results from the GAZEL French prospective cohort study

PubMed Central

Nabi, Hermann; Kivimäki, Mika; Zins, Marie; Elovainio, Marko; Consoli, Silla M.; Cordier, Sylvaine; Ducimetière, Pierre; Goldberg, Marcel; Singh-Manoux, Archana

2008-01-01

Background Majority of studies on personality and physical health have focused on one or two isolated personality traits. We aim to test the independent association of 10 personality traits, from three major conceptual models, with all-cause and cause-specific mortality in the French GAZEL cohort. Methods A total of 14,445 participants, aged 39–54 in 1993, completed the personality questionnaires composed of the Bortner Type-A scale, the Buss-Durkee-Hostility-Inventory (for total, neurotic and reactive hostility), and the Grossarth-Maticek-Eysenck-Personality- Stress-Inventory that assesses six personality types (cancer-prone, coronary heart disease (CHD)-prone, ambivalent, healthy, rational, anti-social). The association between personality traits and mortality, during a mean follow-up of 12.7 years, was assessed using the Relative Index of Inequality (RII) in Cox regression. Results In models adjusted for age, sex, marital status and education, all-cause and causespecific mortality were predicted by “total hostility”, its “neurotic hostility” component as well as by “CHD-prone”, “ambivalent” “antisocial”, and “healthy” personality types. After mutually adjusting personality traits for each other, only high “neurotic hostility” remained a robust predictor of excess mortality from all causes (RII=2.62; 95% CI=1.68–4.09) and external causes (RII=3.24; 95% CI=1.03–10.18). “CHD-prone” (RII=2.23; 95% CI=0.72– 6.95) and “anti-social” (RII=2.13; 95% CI 0.61–6.58) personality types were associated with cardiovascular mortality and with mortality from external causes, respectively, but confidence intervals were wider. Adjustment for potential behavioural mediators had only a modest effect on these associations. Conclusions Neurotic hostility, CHD-prone personality and antisocial personality were all predictive of mortality outcomes. Further research is required to determine the precise mechanisms that contribute to these associations. PMID:18263645

The standard deviation of extracellular water/intracellular water is associated with all-cause mortality and technique failure in peritoneal dialysis patients.

PubMed

Tian, Jun-Ping; Wang, Hong; Du, Feng-He; Wang, Tao

2016-09-01

The mortality rate of peritoneal dialysis (PD) patients is still high, and the predicting factors for PD patient mortality remain to be determined. This study aimed to explore the relationship between the standard deviation (SD) of extracellular water/intracellular water (E/I) and all-cause mortality and technique failure in continuous ambulatory PD (CAPD) patients. All 152 patients came from the PD Center between January 1st 2006 and December 31st 2007. Clinical data and at least five-visit E/I ratio defined by bioelectrical impedance analysis were collected. The patients were followed up till December 31st 2010. The primary outcomes were death from any cause and technique failure. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors for mortality and technique failure in CAPD patients. All patients were followed up for 59.6 ± 23.0 months. The patients were divided into two groups according to their SD of E/I values: lower SD of E/I group (≤0.126) and higher SD of E/I group (>0.126). The patients with higher SD of E/I showed a higher all-cause mortality (log-rank χ (2) = 10.719, P = 0.001) and technique failure (log-rank χ (2) = 9.724, P = 0.002) than those with lower SD of E/I. Cox regression analysis found that SD of E/I independently predicted all-cause mortality (HR  3.551, 95 % CI 1.442-8.746, P = 0.006) and technique failure (HR  2.487, 95 % CI 1.093-5.659, P = 0.030) in CAPD patients after adjustment for confounders except when sensitive C-reactive protein was added into the model. The SD of E/I was a strong independent predictor of all-cause mortality and technique failure in CAPD patients.

Urinary cadmium and mortality among inhabitants of a cadmium-polluted area in Japan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nakagawa, Hideaki; Nishijo, Muneko; Morikawa, Yuko

The influence of cadmium (Cd) body burden on mortality remains controversial. Excess mortality and the dose-response relationship between mortality and urinary cadmium excretion were investigated in this study among environmentally exposed subjects. A 15-year follow-up study was carried out on 3119 inhabitants (1403 men and 1716 women) of the Cd-polluted Kakehashi River basin, whose urinary Cd concentration was examined in a 1981-1982 health impact survey. The mortality risk of high urinary Cd ({>=}10 {mu}g/g Cr) subjects after adjustment for age using Cox's proportional hazard model was higher than that of moderate urinary Cd (<10 {mu}g/g Cr) subjects in both sexes.more » When the subjects were divided into five groups according to the amount of urinary Cd (<3, 3-5, 5-10, 10-20, {>=}20 {mu}g/g Cr), the mortality risk was significantly increased among the subjects with urinary Cd{>=}3 {mu}g/g Cr in proportion to the increases in the amount of urinary Cd concentration after adjustment for age, especially in women. Furthermore, special causes of death among high and moderate urinary Cd were investigated, and mortality risk ratio for heart failure, which is a cause of death often diagnosed in cases with a gradual deterioration culminating in death, was significantly increased in both sexes, compared with the moderate urinary Cd subjects. Also, in women the mortality risk for renal diseases in the high urinary Cd subjects was significantly higher than that in the moderate urinary Cd subjects. These results suggest that a causal association between Cd body burden and mortality exists among inhabitants environmentally exposed to Cd but that no special disease may be induced except renal diseases.« less

Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty--a BOLD analysis.

PubMed

Burney, Peter; Jithoo, Anamika; Kato, Bernet; Janson, Christer; Mannino, David; Nizankowska-Mogilnicka, Ewa; Studnicka, Michael; Tan, Wan; Bateman, Eric; Koçabas, Ali; Vollmer, William M; Gislason, Thorarrin; Marks, Guy; Koul, Parvaiz A; Harrabi, Imed; Gnatiuc, Louisa; Buist, Sonia

2014-05-01

Chronic obstructive pulmonary disease (COPD) is a commonly reported cause of death and associated with smoking. However, COPD mortality is high in poor countries with low smoking rates. Spirometric restriction predicts mortality better than airflow obstruction, suggesting that the prevalence of restriction could explain mortality rates attributed to COPD. We have studied associations between mortality from COPD and low lung function, and between both lung function and death rates and cigarette consumption and gross national income per capita (GNI). National COPD mortality rates were regressed against the prevalence of airflow obstruction and spirometric restriction in 22 Burden of Obstructive Lung Disease (BOLD) study sites and against GNI, and national smoking prevalence. The prevalence of airflow obstruction and spirometric restriction in the BOLD sites were regressed against GNI and mean pack years smoked. National COPD mortality rates were more strongly associated with spirometric restriction in the BOLD sites (<60 years: men rs=0.73, p=0.0001; women rs=0.90, p<0.0001; 60+ years: men rs=0.63, p=0.0022; women rs=0.37, p=0.1) than obstruction (<60 years: men rs=0.28, p=0.20; women rs=0.17, p<0.46; 60+ years: men rs=0.28, p=0.23; women rs=0.22, p=0.33). Obstruction increased with mean pack years smoked, but COPD mortality fell with increased cigarette consumption and rose rapidly as GNI fell below US$15 000. Prevalence of restriction was not associated with smoking but also increased rapidly as GNI fell below US$15 000. Smoking remains the single most important cause of obstruction but a high prevalence of restriction associated with poverty could explain the high 'COPD' mortality in poor countries.

Diet Quality as Assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies.

PubMed

Schwingshackl, Lukas; Bogensberger, Berit; Hoffmann, Georg

2018-01-01

Diets of the highest quality have been associated with a significantly lower risk of noncommunicable diseases. It was the aim of this study to update a previous systematic review investigating the associations of diet quality as assessed by the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), and Dietary Approaches to Stop Hypertension (DASH) score and multiple health outcomes. As an additional topic, the associations of these diet quality indices with all-cause mortality and cancer mortality among cancer survivors were also investigated. A literature search for prospective cohort studies that were published up to May 15, 2017 was performed using the electronic databases PubMed, Scopus, and Embase. Summary risk ratios (RRs) and 95% CIs were estimated using a random effects model for high vs low adherence categories. The updated review process showed 34 new reports (total number of reports evaluated=68; including 1,670,179 participants). Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction for all-cause mortality (RR 0.78, 95% CI 0.77 to 0.80; I 2 =59%; n=13), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.76 to 0.80; I 2 =49%; n=28), cancer (incidence or mortality) (RR 0.84, 95% CI 0.82 to 0.87; I 2 =66%; n=31), type 2 diabetes (RR 0.82, 95% CI 0.78 to 0.85; I 2 =72%; n=10), and neurodegenerative diseases (RR 0.85, 95% CI 0.74 to 0.98; I 2 =51%; n=5). Among cancer survivors, the association between diets for the highest quality resulted in a significant reduction in all-cause mortality (RR 0.88, 95% CI 0.81 to 0.95; I 2 =38%; n=7) and cancer mortality (RR 0.90, 95% CI 0.83 to 0.98; I 2 =0%; n=7). In the updated meta-analyses, diets that score highly on the HEI, AHEI, and DASH were associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative disease by 22%, 22%, 16%, 18%, and 15%, respectively. Moreover, high-quality diets were inversely associated with overall mortality and cancer mortality among cancer survivors. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Attribution of Disturbances Causing Tree Mortality for the Continental U.S.

NASA Astrophysics Data System (ADS)

Wang, M.; Xu, C.; Allen, C. D.; McDowell, N. G.

2016-12-01

Broad-scale tree mortality has been frequently reported and documented to increase with warming climate and human activities. However, there is so far no general method to quantify the relative contributions of different disturbances on observed broad-scale tree mortality. In this study, we presented a framework to investigate the contribution of various disturbances causing tree mortality for 2000-2014 in the continental US. Our work is based on the high-resolution forest-loss data developed by Hansen et al. (2013). Firstly, fire-driven mortality was determined using the data from Monitoring Trends in Burn Severity (MTBS) project. Secondly, a landscape-pattern-recognition approach focusing on the differences of boundary complexity caused by natural and anthropogenic disturbances was developed to attribute harvest-driven mortality patches. Then, a drought threshold was determined through conducting an intensive literature survey for attribution of drought-driven mortality. Our results showed that we can correctly attribute 85% harvest-driven mortality as compared to Forest Inventory and Analysis (FIA) data. Based on Evaporative Stress Index (ESI), our literature survey suggests that most mortality events happened at extreme drought (37.7%), then severe (31.4%) and moderate (23.4%) drought. In total, 92.6% of drought-induced mortality events observed during 2000-2014 occurred at drought conditions of moderate or worse with corresponding ESI values ranging from -0.9 -2.49. Therefore, -0.9 will be used as the threshold to attribute drought-driven tree mortality. Overall, these results imply a great potential for using these methods to identify and attribute disturbances driving tree death at broad spatial scales.

Socioeconomic Status, Structural and Functional Measures of Social Support, and Mortality

PubMed Central

Stringhini, Silvia; Berkman, Lisa; Dugravot, Aline; Ferrie, Jane E.; Marmot, Michael; Kivimaki, Mika; Singh-Manoux, Archana

2012-01-01

The authors examined the associations of social support with socioeconomic status (SES) and with mortality, as well as how SES differences in social support might account for SES differences in mortality. Analyses were based on 9,333 participants from the British Whitehall II Study cohort, a longitudinal cohort established in 1985 among London-based civil servants who were 35–55 years of age at baseline. SES was assessed using participant's employment grades at baseline. Social support was assessed 3 times in the 24.4-year period during which participants were monitored for death. In men, marital status, and to a lesser extent network score (but not low perceived support or high negative aspects of close relationships), predicted both all-cause and cardiovascular mortality. Measures of social support were not associated with cancer mortality. Men in the lowest SES category had an increased risk of death compared with those in the highest category (for all-cause mortality, hazard ratio = 1.59, 95% confidence interval: 1.21, 2.08; for cardiovascular mortality, hazard ratio = 2.48, 95% confidence interval: 1.55, 3.92). Network score and marital status combined explained 27% (95% confidence interval: 14, 43) and 29% (95% confidence interval: 17, 52) of the associations between SES and all-cause and cardiovascular mortality, respectively. In women, there was no consistent association between social support indicators and mortality. The present study suggests that in men, social isolation is not only an important risk factor for mortality but is also likely to contribute to differences in mortality by SES. PMID:22534202

Trajectory of cause of death among brought dead neonates in tertiary care public facilities of Pakistan: A multicenter study.

PubMed

Mustufa, Muhammad Ayaz; Sheikh, Munir Ahmed; Taseer, Ijaz-Ul-Haque; Raza, Syed Jamal; Arshad, Muhammad Sohail; Akhter, Tasleem; Arain, Ghazala Mohyuddin; Habibullah, Sultana; Safdar, Sohail; Firdous, Rukhsana; Adnan, Muhammad

2017-02-01

Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies. A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality. We identified 431 neonates presenting dead to the emergency department (238 males and 193 females). Sepsis (26.7%), birth asphyxia (18.8%) and persistent pulmonary arrest (17.2%) were main primary causes of brought death. Around 72% brought dead neonates were referred from doctors/health care facilities and more than 28% caregivers mentioned that they were not informed about the diagnosis/ailment of their deceased newborn. Findings of our study suggest that infectious disease remains the main primary cause of neonatal mortality. Underweight in newborns (64%) was estimated as a leading associated risk. Delays in referrals to respective health care facility enlightened the concern of sub-standard prerequisites of neonatal care that could be one of the major contributing risk factor of high mortality rates.

Increased short- and long-term mortality in 8146 hospitalised peptic ulcer patients.

PubMed

Malmi, H; Kautiainen, H; Virta, L J; Färkkilä, M A

2016-08-01

Incidence and complications of peptic ulcer disease (PUD) have declined, but mortality from peptic ulcer bleeding has remained unchanged. The few recent studies on mortality associated with both uncomplicated and complicated patients with peptic ulcer disease provide contradictory results. To evaluate short- and long-term mortality, and the main causes of death in peptic ulcer disease. In this retrospective epidemiologic cohort study, register data on 8146 adult patients hospitalised with peptic ulcer disease during 2000-2008 were collected in the capital region of Finland. All were followed in the National Cause of Death Register until the end of 2009. The data were linked with the nationwide Drug Purchase Register of the Finnish Social Insurance Institution. Mean follow-up time was 4.9 years. Overall mortality was substantially increased, standardised mortality ratio 2.53 (95% CI: 2.44-2.63); 3.7% died within 30 days, and 11.8% within 1 year. At 6 months, the survival of patients with perforated or bleeding ulcer was lower compared to those with uncomplicated ulcer; hazard ratios were 2.06 (1.68-2.04) and 1.32 (1.11-1.58), respectively. For perforated duodenal ulcers, both the short- and long-term survival was significantly impaired in women. The main causes of mortality at 1 year were malignancies and cardiovascular diseases. Previous use of statins was associated with significant reduction in all-cause mortality. One-year mortality in patients hospitalised with peptic ulcer disease remained high with no change. This peptic ulcer disease cohort had a clearly decreased survival rate up to 10 years, especially among women with a perforated duodenal ulcer, most likely explained by poorer survival due to underlying comorbidity. © 2016 John Wiley & Sons Ltd.

[Pregnancy and delivery in western Africa. High risk motherhood].

PubMed

Prual, A

1999-06-01

According to the World Health Organization, 585,000 women die each year from a pregnancy-related cause, 99% of whom are from developing countries. The first International Conference on Safe Motherhood in 1987 sensitized the world community to this drama. Ever since, maternal mortality and its medical causes are better known. The maternal mortality ratio is highest in West Africa (1,020 maternal deaths per 100,000 live borns) when it is 27/100,000 in industrialized countries. Direct obstetric causes account for 80% of the deaths: hemorrhage, infection, dystocia, hypertension and abortion. Indirect causes are essentially anemia, malaria, hepatitis C and AIDS. Severe maternal morbidity is 6 to 10 times more frequent than maternal mortality but it also leads to handicaps which end up often in women's social rejection. However, WHO estimates that 95% of these deaths and handicaps are avoidable, and at a low cost.

Mortality burden of the 2009 A/H1N1 influenza pandemic in France: comparison to seasonal influenza and the A/H3N2 pandemic.

PubMed

Lemaitre, Magali; Carrat, Fabrice; Rey, Grégoire; Miller, Mark; Simonsen, Lone; Viboud, Cécile

2012-01-01

The mortality burden of the 2009 A/H1N1 pandemic remains unclear in many countries due to delays in reporting of death statistics. We estimate the age- and cause-specific excess mortality impact of the pandemic in France, relative to that of other countries and past epidemic and pandemic seasons. We applied Serfling and Poisson excess mortality approaches to model weekly age- and cause-specific mortality rates from June 1969 through May 2010 in France. Indicators of influenza activity, time trends, and seasonal terms were included in the models. We also reviewed the literature for country-specific estimates of 2009 pandemic excess mortality rates to characterize geographical differences in the burden of this pandemic. The 2009 A/H1N1 pandemic was associated with 1.0 (95% Confidence Intervals (CI) 0.2-1.9) excess respiratory deaths per 100,000 population in France, compared to rates per 100,000 of 44 (95% CI 43-45) for the A/H3N2 pandemic and 2.9 (95% CI 2.3-3.7) for average inter-pandemic seasons. The 2009 A/H1N1 pandemic had a 10.6-fold higher impact than inter-pandemic seasons in people aged 5-24 years and 3.8-fold lower impact among people over 65 years. The 2009 pandemic in France had low mortality impact in most age groups, relative to past influenza seasons, except in school-age children and young adults. The historical A/H3N2 pandemic was associated with much larger mortality impact than the 2009 pandemic, across all age groups and outcomes. Our 2009 pandemic excess mortality estimates for France fall within the range of previous estimates for high-income regions. Based on the analysis of several mortality outcomes and comparison with laboratory-confirmed 2009/H1N1 deaths, we conclude that cardio-respiratory and all-cause mortality lack precision to accurately measure the impact of this pandemic in high-income settings and that use of more specific mortality outcomes is important to obtain reliable age-specific estimates.

Effect of loading density of sockeye salmon, Oncorhynchus nerka (Walbaum), eggs in incubation boxes on mortality caused by infectious haematopoietic necrosis

USGS Publications Warehouse

Mulcahy, D.; Bauersfeld, K.

1983-01-01

Infectious haematopoietic necrosis (IHN) can cause massive mortalities of sockeye salmon, Oncorhynchus nerka (Walbaum), cultured in hatcheries. One method of enhancing sockeye salmon populations is to use a streamside egg incubation box from which the fry are automatically released into the stream as they emerge from the gravel. In this system, however, IHN epizootics occur as the fry emerge and continue for up to two months after the fry leave the box (Mulcahy, unpublished data). In as much as the high density of eggs and alevins in incubation boxes might be conducive to the fulmination of an IHN epizootic, we varied the egg density in incubation boxes and studied the cffect on mortality caused by IHN.

Infant mortality in Novo Hamburgo: associated factors and cardiovascular causes.

PubMed

Brum, Camila de Andrade; Stein, Airton Tetelbom; Pellanda, Lucia Campos

2015-04-01

Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%), which was significantly associated with the variables 'age at death', 'gestational age' and 'birth weight'. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality.

Nine years of a single referral center management of Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome).

PubMed

Monteiro, Diana; Egipto, Paula; Barbosa, Julia; Horta, Ricardo; Amarante, Jose; Silva, Pedro; Silva, Alvaro

2017-06-01

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) corresponds to a rare and acute life-threatening mucocutaneous reactions characterized by extensive necrosis and epidermal detachment. There are no efficacious pharmaceutical interventions proven through large clinical trials. We sought to study clinical cases admitted in our institution in order to determine which drugs and medical comorbidities or treatments impacted the mortality. In a retrospective study over 9 years we evaluated all patients presenting biopsy-proven SJS or TEN for age, gender, total body surface area involved, causing agents, SCORTEN score, blood transfusion, steroid administration, intubation, length of intensive care stay and death rate. Statistical analysis was done using SPSS statistical software. The highest incidence of SJS and TEN was in age group of 71-80 years. Of the 30 patients, 30% died from SJS/TEN, mainly due sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality was from antibiotic treatment as causing agent. Step-wise regression analysis identified mechanical ventilation requirement and age over 65 years as mortality high-risk factors. The most crucial interventions are discontinuation of the offending drug and prompt referral to a burn unit, which helps in early diagnosis and decrease mortality in these diseases. When SJS/TEN is caused by antibiotics suspicion of developing fatal sepsis should be high, independently of patients' medical condition.

Emotional disturbance assessed by the Self-Rating Depression Scale test is associated with mortality among Japanese Hemodialysis patients.

PubMed

Kazama, Sakumi; Kazama, Junichiro James; Wakasugi, Minako; Ito, Yumi; Narita, Ichiei; Tanaka, Motoko; Horiguchi, Fumi; Tanigawa, Koichi

2018-04-17

Emotional disturbance including depression is associated with increased mortality among dialysis patients. The Self-Rating Depression Scale (SDS) is a simple tool for assessing emotional disturbance. This study investigated the relationship between emotional conditions as assessed with the SDS test and mortality among 491 hemodialysis patients. At baseline, 183 (37.3%), 180 (36.7%), 108 (22.0%), and 20 (4.1%) were classified as normal, borderline depression, depression, and severe depression, respectively. During the two years of observation period, 57 of 491 (11.6%) died. The SDS scores in the non-survivors were significantly higher than those in the survivors (p<0.0001). Logistic analyses showed that the diagnoses made by the SDS test were associated with significantly greater risks for all-cause mortality (99%CI: 1.905-3.698 for that without adjustment, 1.999-4.382 for that with full adjustment). When the SDS score = 50 was selected as the cut off value, the test screened two-year all cause death with sensitivity = 57.9% and the specificity = 78.1%. In conclusion, hemodialysis patients had high prevalence of emotional disturbance assessed by the SDS test, and high SDS score was significantly associated with all-cause mortality. These findings underscore the importance of screening for emotional conditions using the SDS test among hemodialysis patients.

Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients

PubMed Central

Kim, Eun-Jung; Choi, Myung-Jin; Lee, Jeoung-Hwan; Oh, Ji-Eun; Seo, Jang-Won; Lee, Young-Ki; Yoon, Jong-Woo; Kim, Hyung-Jik; Noh, Jung-Woo

2017-01-01

Background In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex. Methods Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively. Results The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01–1.25) and 1.09 (1.01–1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio. Conclusions Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD. PMID:28099511

Educational Inequalities in the Transition to Adulthood in Belgium: The Impact of Intergenerational Mobility on Young-Adult Mortality in 2001-2009

PubMed Central

2015-01-01

Several studies have focused on the association between parental and personal socioeconomic position (SEP) and health, with mixed results depending on the specific health outcome, research methodology and population under study. In the last decades, a growing interest is given to the influence of intergenerational mobility on several health outcomes at young ages. This study addresses the following research question: Is educational intergenerational mobility associated with all-cause and cause-specific mortality in young adulthood? To this end, the Belgian 1991 and 2001 censuses are used, providing characteristics of young persons at two time points (T1 = 01/03/91;T2 = 01/10/01) and follow-up information on mortality and emigration between T2 and 31/12/09 (T3). The study population consists of all official inhabitants of Flanders and the Brussels-Capital Region at T2, born between 1972 and 1982 and alive at T2. Parental and personal education are divided into primary (PE), lower secondary (LSE), higher secondary (HSE) and higher education (HE). We analyse mortality between T2 and T3 calculating age-standardised mortality rates (ASMRs) and using Cox regression (hazard ratios = HR). Personal rather than parental education determines the observed mortality rates, with high all-cause mortality rates among those with PE, irrespective of parental education (e.g., among men ASMRPE-PE = 200.0 [95% CI 158.0–241.9]; ASMRHE-PE = 319.7 [183.2–456.3]) and low all-cause mortality among those in higher education, regardless of parental education (ASMRPE-HE = 41.7 [30.8–52.6]; ASMRHE-HE = 38.0 [33.2–42.8]). There is some variation by gender and according to cause of death. This study shows the strong association between personal education and young-adult mortality. PMID:26657691

Mortality from violent causes in the Americas.

PubMed

Yunes, J

1993-01-01

This article provides an assessment of 1986 mortality from violent causes in the Americas. Directed at assisting with development of preventive public health measures, it employs data available in the PAHO data base to focus on the under-25 year age group, compare mortality from violent causes with mortality from infectious and parasitic diseases, and evaluate the relative role of motor vehicle traffic accidents, other accidents, suicide, homicide, and deaths from unknown causes in mortality from violent causes. The study uses the classification of causes presented in the International Classification of Diseases, Ninth Revision. The results show that 517,465 deaths from violent causes were registered in 28 countries and political units of the Americas in 1986, mortality from these causes ranging from 19.3 deaths per 100,000 inhabitants in Jamaica to 125 in El Salvador. Examination of available 1980-1986 data from five countries points to steady increases in mortality from violent causes in Brazil and Cuba that began respectively in 1983 and 1984. Assessment of male and female 1986 mortality from these causes in nine countries showed male mortality to be substantially higher, the lowest male:female ratio (in Cuba) being 1.9:1. Among infants, infectious and parasitic disease mortality was greater than mortality from violent causes in most countries. However, from age 1 to the study's 25-year cutoff, mortality from violent causes was found to exceed infectious and parasitic disease mortality in most countries and to play an especially large role in deaths among those 19-24 years old. Data from eight countries suggested that accidents other than motor vehicle traffic accidents were accounting for much of the mortality from violent causes among infants and the 1-4 year age group in 1986, while motor vehicle traffic accidents rivaled other accidents in importance among the older (5-9, 10-14, 15-19, and 19-24) age groups. It appears that the information presented could prove of considerable use in developing policies designed to reduce morbidity and mortality from violent causes (1).

Distinct mortality profile in systemic sclerosis: a death certificate study in Rio de Janeiro, Brazil (2006-2015) using a multiple causes of death analysis.

PubMed

de Rezende, Rodrigo Poubel Vieira; Gismondi, Ronaldo Altenburg; Maleh, Haim Cesar; de Miranda Coelho, Elisa Mendes; Vieira, Carol Sartori; Rosa, Maria Luiza Garcia; Mocarzel, Luis Otavio

2017-12-16

The objective of this study was to assess the mortality profile related to SSc in the state of Rio de Janeiro, Brazil. We retrospectively examined all registered deaths in the region (2006-2015 period) in which the diagnosis of SSc was mentioned on any line of the death certificates (underlying cause of death [UCD], n = 223; non-UCD, n = 151). Besides the analysis of gender, age, and the causes of death, we also compared the mortality from UCDs between individuals whose death causes included SSc (cases) and those whose death causes did not include SSc (deceased controls). For the latter comparison, we used the mortality odds ratio to approximate the cause-specific standardized mortality ratio. We identified 1495 death causes among the 374 SSc cases. The mean age at death of the SSc cases (85% women) was significantly lower than that of the controls (n = 1,294,117) (58.7 vs. 65.5 years, respectively). The main death causes were circulatory system diseases, infections, and respiratory diseases (36%, 34%, and 21% of SSc cases, respectively). Compared to the deceased controls, there were proportionally more deaths among the SSc cases from pulmonary arterial hypertension, lung fibrosis, septicemia, gastrointestinal hemorrhage, other systemic connective tissue diseases, and heart failure (for death age < 50 years). We confirmed the high burden of cardiovascular, respiratory, and infectious causes in this predominantly non-Caucasian sample of SSc patients. Of interest, the percentage of infection-related deaths in our report was about three times higher than that in SSc studies with predominantly Caucasian populations.

Risk of mortality, cancer incidence, and stroke in a population potentially exposed to cadmium.

PubMed

Elliott, P; Arnold, R; Cockings, S; Eaton, N; Järup, L; Jones, J; Quinn, M; Rosato, M; Thornton, I; Toledano, M; Tristan, E; Wakefield, J

2000-02-01

To follow up mortality and cancer incidence in a cohort potentially exposed to cadmium and to perform a geographical (ecological) analysis to further assess the health effects of potential exposure to cadmium. The English village of Shipham has very high concentrations of cadmium in the soil. A previous cohort study of residents of Shipham in 1939 showed overall mortality below that expected, but a 40% excess of mortality from stroke. This study extends the follow up of the cohort for mortality to 1997, and includes an analysis of cancer incidence from 1971 to 1992, and a geographical study of mortality and cancer incidence. Standardised mortality and incidence ratios (SMRs and SIRs) were estimated with regional reference rates. Comparisons were made with the nearby village of Hutton. All cause cohort mortality was lower than expected in both villages, although there was excess cancer incidence in both Shipham (SIR 167, 95% confidence interval (95% CI) 106 to 250) and Hutton (SIR 167, 95% CI 105 to 253). There was an excess of mortality from hypertension, cerebrovascular disease, and nephritis and nephrosis, of borderline significance, in Shipham (SMR 128, 95% CI 99 to 162). In the geographical study, all cause mortality in Shipham was also lower than expected (SMR 84, 95% CI 71 to 100). There was an excess in genitourinary cancers in both Shipham (SIR 160, 95% CI 107 to 239) and Hutton (SIR 153, 95% CI 122 to 192). No clear evidence of health effects from possible exposure to cadmium in Shipham was found despite the extremely high concentrations of cadmium in the soil.

Mortality trajectory analysis reveals the drivers of sex-specific epidemiology in natural wildlife–disease interactions

PubMed Central

McDonald, Jennifer L.; Smith, Graham C.; McDonald, Robbie A.; Delahay, Richard J.; Hodgson, Dave

2014-01-01

In animal populations, males are commonly more susceptible to disease-induced mortality than females. However, three competing mechanisms can cause this sex bias: weak males may simultaneously be more prone to exposure to infection and mortality; being ‘male’ may be an imperfect proxy for the underlying driver of disease-induced mortality; or males may experience increased severity of disease-induced effects compared with females. Here, we infer the drivers of sex-specific epidemiology by decomposing fixed mortality rates into mortality trajectories and comparing their parameters. We applied Bayesian survival trajectory analysis to a 22-year longitudinal study of a population of badgers (Meles meles) naturally infected with bovine tuberculosis (bTB). At the point of infection, infected male and female badgers had equal mortality risk, refuting the hypothesis that acquisition of infection occurs in males with coincidentally high mortality. Males and females exhibited similar levels of heterogeneity in mortality risk, refuting the hypothesis that maleness is only a proxy for disease susceptibility. Instead, sex differences were caused by a more rapid increase in male mortality rates following infection. Males are indeed more susceptible to bTB, probably due to immunological differences between the sexes. We recommend this mortality trajectory approach for the study of infection in animal populations. PMID:25056621

Tree mortality predicted from drought-induced vascular damage

USGS Publications Warehouse

Anderegg, William R.L.; Flint, Alan L.; Huang, Cho-ying; Flint, Lorraine E.; Berry, Joseph A.; Davis, Frank W.; Sperry, John S.; Field, Christopher B.

2015-01-01

The projected responses of forest ecosystems to warming and drying associated with twenty-first-century climate change vary widely from resiliency to widespread tree mortality1, 2, 3. Current vegetation models lack the ability to account for mortality of overstorey trees during extreme drought owing to uncertainties in mechanisms and thresholds causing mortality4, 5. Here we assess the causes of tree mortality, using field measurements of branch hydraulic conductivity during ongoing mortality in Populus tremuloides in the southwestern United States and a detailed plant hydraulics model. We identify a lethal plant water stress threshold that corresponds with a loss of vascular transport capacity from air entry into the xylem. We then use this hydraulic-based threshold to simulate forest dieback during historical drought, and compare predictions against three independent mortality data sets. The hydraulic threshold predicted with 75% accuracy regional patterns of tree mortality as found in field plots and mortality maps derived from Landsat imagery. In a high-emissions scenario, climate models project that drought stress will exceed the observed mortality threshold in the southwestern United States by the 2050s. Our approach provides a powerful and tractable way of incorporating tree mortality into vegetation models to resolve uncertainty over the fate of forest ecosystems in a changing climate.

The effect of atmospheric thermal conditions and urban thermal pollution on all-cause and cardiovascular mortality in Bangladesh.

PubMed

Burkart, Katrin; Schneider, Alexandra; Breitner, Susanne; Khan, Mobarak Hossain; Krämer, Alexander; Endlicher, Wilfried

2011-01-01

This study assessed the effect of temperature and thermal atmospheric conditions on all-cause and cardiovascular mortality in Bangladesh. In particular, differences in the response to elevated temperatures between urban and rural areas were investigated. Generalized additive models (GAMs) for daily death counts, adjusted for trend, season, day of the month and age were separately fitted for urban and rural areas. Breakpoint models were applied for determining the increase in mortality above and below a threshold (equivalent) temperature. Generally, a 'V'-shaped (equivalent) temperature-mortality curve with increasing mortality at low and high temperatures was observed. Particularly, urban areas suffered from heat-related mortality with a steep increase above a specific threshold. This adverse heat effect may well increase with ongoing urbanization and the intensification of the urban heat island due to the densification of building structures. Moreover, rising temperatures due to climate change could aggravate thermal stress. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: Analysis From the 2010 Global Burden of Disease Study.

PubMed

Yakoob, Mohammad Y; Micha, Renata; Khatibzadeh, Shahab; Singh, Gitanjali M; Shi, Peilin; Ahsan, Habibul; Balakrishna, Nagalla; Brahmam, Ginnela N V; Chen, Yu; Afshin, Ashkan; Fahimi, Saman; Danaei, Goodarz; Powles, John W; Ezzati, Majid; Mozaffarian, Dariush

2016-12-01

To quantify cardiovascular disease and diabetes deaths attributable to dietary and metabolic risks by country, age, sex, and time in South Asian countries. We used the 2010 Global Burden of Disease national surveys to characterize risk factor levels by age and sex. We derived etiological effects of risk factors-disease endpoints, by age, from meta-analyses. We defined optimal levels. We combined these inputs with cause-specific mortality rates to compute population-attributable fractions as a percentage of total cardiometabolic deaths. Suboptimal diet was the leading cause of cardiometabolic mortality in 4 of 5 countries, with population-attributable fractions from 40.7% (95% uncertainty interval = 37.4, 44.1) in Bangladesh to 56.9% (95% uncertainty interval = 52.4, 61.5) in Pakistan. High systolic blood pressure was the second leading cause, except in Bangladesh, where it superseded suboptimal diet. This was followed in all nations by high fasting plasma glucose, low fruit intake, and low whole grain intake. Other prominent burdens were more variable, such as low intake of vegetables, low omega-3 fats, and high sodium intake in India, Nepal, and Pakistan. Important similarities and differences are evident in cardiometabolic mortality burdens of modifiable dietary and metabolic risks across these countries, informing health policy and program priorities.

Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial

PubMed Central

2013-01-01

Background Prospective studies in non-Mediterranean populations have consistently related increasing nut consumption to lower coronary heart disease mortality. A small protective effect on all-cause and cancer mortality has also been suggested. To examine the association between frequency of nut consumption and mortality in individuals at high cardiovascular risk from Spain, a Mediterranean country with a relatively high average nut intake per person. Methods We evaluated 7,216 men and women aged 55 to 80 years randomized to 1 of 3 interventions (Mediterranean diets supplemented with nuts or olive oil and control diet) in the PREDIMED (‘PREvención con DIeta MEDiterránea’) study. Nut consumption was assessed at baseline and mortality was ascertained by medical records and linkage to the National Death Index. Multivariable-adjusted Cox regression and multivariable analyses with generalized estimating equation models were used to assess the association between yearly repeated measurements of nut consumption and mortality. Results During a median follow-up of 4.8 years, 323 total deaths, 81 cardiovascular deaths and 130 cancer deaths occurred. Nut consumption was associated with a significantly reduced risk of all-cause mortality (P for trend <0.05, all). Compared to non-consumers, subjects consuming nuts >3 servings/week (32% of the cohort) had a 39% lower mortality risk (hazard ratio (HR) 0.61; 95% CI 0.45 to 0.83). A similar protective effect against cardiovascular and cancer mortality was observed. Participants allocated to the Mediterranean diet with nuts group who consumed nuts >3 servings/week at baseline had the lowest total mortality risk (HR 0.37; 95% CI 0.22 to 0.66). Conclusions Increased frequency of nut consumption was associated with a significantly reduced risk of mortality in a Mediterranean population at high cardiovascular risk. Please see related commentary: http://www.biomedcentral.com/1741-7015/11/165. Trial registration Clinicaltrials.gov. International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005. PMID:23866098

An Overview of Infant Mortality Trends in Qatar from 2004 to 2014

PubMed Central

Al-Thani, Mohammed; Al-Thani, Al-Anoud; Toumi, Amine; Khalifa, Shams Eldin

2017-01-01

Background Infant mortality is an important health indicator that estimates population well-being. Infant mortality has declined globally but is still a major public health challenge. This article provides the characteristics, causes, burden, and trends of infant mortality in Qatar. Methods Frequencies, percentages, and rates were calculated using data from birth-death registries over 2004–2014 to describe infant mortality by nationality, gender, and age group. We calculated the relative risks of the top causes of infant mortality among subgroups according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10, Version 2016). Results During 2004–2014, 204,224 live births and 1,505 infant deaths were recorded. The infant mortality rate (IMR) averaged 7.4/1000 live births (males 8.1, females 6.6, non-Qataris 7.7, and Qataris 6.8). IMR declined 20% from 2004 to 2014. The decline in IMR was significant for the overall population of infants (p=0.006), male infants (p=0.04), females (p=0.006), and for non-Qatari males (p=0.007) and non-Qatari females (p=0.007). The leading causes of infant mortality were congenital malformations (all types) (34.5%), low birth weight (LBW) (27%), and respiratory distress of newborns (2.8%). Male infants had a higher risk of mortality than female infants due to a congenital malformation of lungs (p=0.02), other congenital malformations, not elsewhere classified (p=0.01), and cardiovascular disorders (p=0.05). Conclusion The study shows that infant mortality among male infants is high due to the top infant mortality-related disorders, and male infants have a higher risk of mortality than female infants. PMID:29152426

An Overview of Infant Mortality Trends in Qatar from 2004 to 2014.

PubMed

Al-Thani, Mohammed; Al-Thani, Al-Anoud; Toumi, Amine; Khalifa, Shams Eldin; Akram, Hammad

2017-09-09

Background Infant mortality is an important health indicator that estimates population well-being. Infant mortality has declined globally but is still a major public health challenge. This article provides the characteristics, causes, burden, and trends of infant mortality in Qatar. Methods Frequencies, percentages, and rates were calculated using data from birth-death registries over 2004-2014 to describe infant mortality by nationality, gender, and age group. We calculated the relative risks of the top causes of infant mortality among subgroups according to the 10 th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10, Version 2016). Results During 2004-2014, 204,224 live births and 1,505 infant deaths were recorded. The infant mortality rate (IMR) averaged 7.4/1000 live births (males 8.1, females 6.6, non-Qataris 7.7, and Qataris 6.8). IMR declined 20% from 2004 to 2014. The decline in IMR was significant for the overall population of infants (p=0.006), male infants (p=0.04), females (p=0.006), and for non-Qatari males (p=0.007) and non-Qatari females (p=0.007). The leading causes of infant mortality were congenital malformations (all types) (34.5%), low birth weight (LBW) (27%), and respiratory distress of newborns (2.8%). Male infants had a higher risk of mortality than female infants due to a congenital malformation of lungs (p=0.02), other congenital malformations, not elsewhere classified (p=0.01), and cardiovascular disorders (p=0.05). Conclusion The study shows that infant mortality among male infants is high due to the top infant mortality-related disorders, and male infants have a higher risk of mortality than female infants.

Cancer as a cause of death among people with AIDS in the United States

PubMed Central

Simard, Edgar P.; Engels, Eric A.

2010-01-01

Background People with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), are at increased risk for cancer. Highly active antiretroviral therapy [(HAART), widely available since 1996] has resulted in dramatic declines in AIDS-related deaths. Methods We evaluated cancer as a cause of death in a U.S. registry-based cohort of 83,282 people with AIDS (1980–2006). Causes of death due to AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs) were assessed. We evaluated mortality rates and the fraction of deaths due to cancer. Poisson regression assessed rates according to calendar year of AIDS onset. Results Overall mortality declined from 302 (1980–1989), to 140 (1990–1995), to 29 per 1,000 person-years (1996–2006). ADC mortality declined from 2.95 (1980–1989) to 0.65 per 1,000 person-years (1996–2006) (P<0.01), but the fraction of ADC-deaths increased from 1.05% to 2.47%, due to declines in other AIDS-related deaths. Non-Hodgkin lymphoma was the commonest cancer-related cause of death (36% during 1996–2006). Likewise, NADC mortality declined from 2.21 to 0.84 per 1,000 person-years (1980–1989 vs. 1996–2006, P<0.05), but the fraction of NADC-deaths increased to 3.16% during 1996–2006. Lung cancer was the most common NADC cause of death (21% of cancer-related deaths in 1996–2006). Conclusions Cancer mortality declined in the HAART era, but due to declining mortality from AIDS, cancers account for a growing fraction of deaths. Improved cancer prevention and treatment, particularly for non-Hodgkin lymphoma and lung cancer, would reduce mortality among people with AIDS. PMID:20825305

Prospective cohort studies of dietary vitamin B6 intake and risk of cause-specific mortality.

PubMed

Zhao, Long-Gang; Shu, Xiao-Ou; Li, Hong-Lan; Gao, Jing; Han, Li-Hua; Wang, Jing; Fang, Jie; Gao, Yu-Tang; Zheng, Wei; Xiang, Yong-Bing

2018-05-04

Vitamin B6 has been postulated to play an important role in determining chronic diseases. However, few studies have evaluated associations between dietary vitamin B6 and cause-specific mortality comprehensively. We investigated the associations between vitamin B6 from diet and risk of all-cause, and cause-specific mortality in 134,480 participants from the Shanghai Men's Health Study (2002-2014) and Shanghai Women's Health Study (1997-2014). The median follow-up periods for men and women were 10.3 and 16.2 years, respectively. We estimated hazard ratio (HR) and 95% confidence interval (CI) using Cox proportional hazards models. After adjustment for suspected confounders, the multivariable-adjusted HRs for the highest versus lowest quintiles for total, CVD, stroke and CHD mortality among men were 0.83 (95%CI = 0.76, 0.90), 0.73 (95%CI = 0.63, 0.85), 0.71 (95%CI = 0.58, 0.88), 0.66 (95%CI = 0.47, 0.91), accordingly. Women with the highest intake had significantly 17% (HR = 0.83; 95% CI = 0.77, 0.90), 20% (HR = 0.80; 95% CI = 0.70, 0.92), and 28% (HR = 0.72; 95% CI = 0.59, 0.86) lower risks of total, CVD and stroke mortality compared with those of women with lowest vitamin B6 intake. No significant association was observed between dietary vitamin B6 and cancer mortality both among men and women. In the current study with two prospective Chinese cohorts, high dietary vitamin B6 consumption was inversely associated with risk of all-cause and CVD mortality. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Symptoms of depression and anxiety predict mortality in patients undergoing oral anticoagulation: Results from the thrombEVAL study program.

PubMed

Michal, Matthias; Prochaska, Jürgen H; Keller, Karsten; Göbel, Sebastian; Coldewey, Meike; Ullmann, Alexander; Schulz, Andreas; Lamparter, Heidrun; Münzel, Thomas; Reiner, Iris; Beutel, Manfred E; Wild, Philipp S

2015-01-01

Depression and anxiety are highly prevalent in cardiovascular patients. Therefore, we examined whether the 4-item Patient Health Questionnaire (PHQ-4, measuring symptoms of depression and anxiety) predicts all-cause mortality in outpatients with long-term oral anticoagulation (OAC). The sample comprised n=1384 outpatients from a regular medical care setting receiving long-term OAC with vitamin K antagonists. At baseline, symptoms of anxiety and depression were assessed with the PHQ-4 and the past medical history was taken. The outcome was all-cause mortality in the 24 month observation period. The median follow-up time was 13.3 months. N=191 patients from n=1384 died (death rate 13.8%). Each point increase in the PHQ-4 score was associated with a 10% increase in mortality (hazard ratio [HR] 1.10, 95% confidence interval [95% CI] 1.05-1.16) after adjustment for age, sex, high school graduation, partnership, smoking, obesity, frailty according to the Barthel Index, Charlson Comorbidity Index and CHA2DS2-VASc score. The depression component (PHQ-2) increased mortality by 22% and anxiety (GAD-2) by 11% respectively. Neither medical history of any mental disorder, nor intake of antidepressants, anxiolytics or hypnotics predicted excess mortality. Elevated symptoms of depression and, to a lesser degree, symptoms of anxiety are independently associated with all-cause mortality in OAC outpatients. The PHQ-4 questionnaire provides valuable prognostic information. These findings emphasize the need for implementing regular screening procedures and the development and evaluation of appropriate psychosocial treatment approaches for OAC patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Cardiorespiratory Fitness Change and Mortality Risk Among Black and White Patients: Henry Ford Exercise Testing (FIT) Project.

PubMed

Ehrman, Jonathan K; Brawner, Clinton A; Al-Mallah, Mouaz H; Qureshi, Waqas T; Blaha, Michael J; Keteyian, Steven J

2017-10-01

Little is known about the relationship of change in cardiorespiratory fitness and mortality risk in Black patients. This study assessed change in cardiorespiratory fitness and its association with all-cause mortality risk in Black and White patients. This is a retrospective, longitudinal, observational cohort study of 13,345 patients (age = 55 ± 11 years; 39% women; 26% black) who completed 2 exercise tests, at least 12 months apart at Henry Ford Hospital, Detroit, Mich. All-cause mortality was identified through April 2013. Data were analyzed in 2015-2016 using Cox regression to calculate hazard ratios (HR) for risk of mortality associated with change in sex-specific cardiorespiratory fitness. Mean time between the tests was 3.4 years (interquartile range 1.9-5.6 years). During 9.1 years (interquartile range 6.3-11.6 years) of follow-up, there were 1931 (14%) deaths (16.5% black, 13.7% white). For both races, change in fitness from Low to the Intermediate/High category resulted in a significant reduction of death risk (HR 0.65 [95% confidence interval (CI), 0.49-0.87] for Black; HR 0.41 [95% CI, 0.34-0.51] for White). Each 1-metabolic-equivalent-of-task increase was associated with a reduced mortality risk in black (HR 0.84 [95% CI, 0.81-0.89]) and white (HR 0.87 [95% CI, 0.82-0.86]) patients. There was no interaction by race. Among black and white patients, change in cardiorespiratory fitness from Low to Intermediate/High fitness was associated with a 35% and 59% lower risk of all-cause mortality, respectively. Copyright © 2017 Elsevier Inc. All rights reserved.

Interaction between geriatric nutritional risk index and decoy receptor 3 predicts mortality in chronic hemodialysis patients.

PubMed

Tsai, Ming-Tsun; Hu, Fen-Hsiang; Lien, Tse-Jen; Chen, Ping-Jen; Huang, Tung-Po; Tarng, Der-Cherng

2014-01-01

Protein-energy wasting (PEW) is common and associated with poor outcome in hemodialysis patients. In hemodialysis patients, geriatric nutritional risk index (GNRI) and decoy receptor 3 (DcR3) have been shown as the nutritional and inflammatory markers, respectively. The present study aimed to assess the predictive ability of GNRI and DcR3 for PEW status and long-term outcomes in chronic hemodialysis patients. A prospective cohort of 318 hemodialysis patients was conducted with a median follow-up of 54 months. Malnutrition-inflammation score (MIS) was used as the reference standard for the presence of PEW. Endpoints were cardiovascular and all-cause mortality. Baseline GNRI had a strong negative correlation with DcR3 and MIS score. For patients with age < or ≥60, high DcR3 and low GNRI were independent predictors for the presence of PEW at baseline. At the end of the study, 81 patients died (27 cardiovascular deaths). The adjusted hazard ratios (95% confidence intervals) of low GNRI and high DcR3 were 1.93 (1.1-4.8) and 2.53 (1.2-5.5) for cardiovascular mortality and 1.85 (1.1-3.2) and 2.37 (1.5-3.7) for all-cause mortality, respectively. While integrated into a model of conventional risk factors, GNRI together with DcR3 further significantly improved the predictability for overall mortality (c statistic, 0.823). Low GNRI and high DcR3 were the alternatives for identifying hemodialysis patients at risk of PEW and overall mortality. Further studies are needed to verify whether timely recognition of hemodialysis patients with a high malnutrition-inflammation risk could reduce their mortality by appropriate interventional strategies.

Fiber Intake and Survival After Colorectal Cancer Diagnosis.

PubMed

Song, Mingyang; Wu, Kana; Meyerhardt, Jeffrey A; Ogino, Shuji; Wang, Molin; Fuchs, Charles S; Giovannucci, Edward L; Chan, Andrew T

2018-01-01

Although high dietary fiber intake has been associated with a lower risk of colorectal cancer (CRC), it remains unknown whether fiber benefits CRC survivors. To assess the association of postdiagnostic fiber intake with mortality. A total of 1575 health care professionals with stage I to III CRC were evaluated in 2 prospective cohorts, Nurses' Health Study and Health Professionals Follow-up Study. Colorectal cancer-specific and overall mortality were determined after adjusting for other potential predictors for cancer survival. The study was conducted from December 23, 2016, to August 23, 2017. Consumption of total fiber and different sources of fiber and whole grains assessed by a validated food frequency questionnaire between 6 months and 4 years after CRC diagnosis. Hazard ratios (HRs) and 95% CIs of CRC-specific and overall mortality after adjusting for other potential predictors for cancer survival. Of the 1575 participants, 963 (61.1%) were women; mean (SD) age was 68.6 (8.9) years. During a median of 8 years of follow-up, 773 deaths were documented, including 174 from CRC. High intake of total fiber after diagnosis was associated with lower mortality. The multivariable HR per each 5-g increment in intake per day was 0.78 (95% CI, 0.65-0.93; P = .006) for CRC-specific mortality and 0.86 (95% CI, 0.79-0.93; P < .001) for all-cause mortality. Patients who increased their fiber intake after diagnosis from levels before diagnosis had a lower mortality, and each 5-g/d increase in intake was associated with 18% lower CRC-specific mortality (95% CI, 7%-28%; P = .002) and 14% lower all-cause mortality (95% CI, 8%-19%; P < .001). According to the source of fiber, cereal fiber was associated with lower CRC-specific mortality (HR per 5-g/d increment, 0.67; 95% CI, 0.50-0.90; P = .007) and all-cause mortality (HR, 0.78; 95% CI, 0.68-0.90; P < .001); vegetable fiber was associated with lower all-cause mortality (HR, 0.83; 95% CI, 0.72-0.96; P = .009) but not CRC-specific mortality (HR, 0.82; 95% CI, 0.60-1.13; P = .22); no association was found for fruit fiber. Whole grain intake was associated with lower CRC-specific mortality (HR per 20-g/d increment, 0.72; 95% CI, 0.59-0.88; P = .002), and this beneficial association was attenuated after adjusting for fiber intake (HR, 0.77; 95% CI, 0.62-0.96; P = .02). Higher fiber intake after the diagnosis of nonmetastatic CRC is associated with lower CRC-specific and overall mortality. Increasing fiber consumption after diagnosis may confer additional benefits to patients with CRC.

Educational gains in cause-specific mortality: Accounting for cognitive ability and family-level confounders using propensity score weighting.

PubMed

Bijwaard, Govert E; Myrskylä, Mikko; Tynelius, Per; Rasmussen, Finn

2017-07-01

A negative educational gradient has been found for many causes of death. This association may be partly explained by confounding factors that affect both educational attainment and mortality. We correct the cause-specific educational gradient for observed individual background and unobserved family factors using an innovative method based on months lost due to a specific cause of death re-weighted by the probability of attaining a higher educational level. We use data on men with brothers from the Swedish Military Conscription Registry (1951-1983), linked to administrative registers. This dataset of some 700,000 men allows us to distinguish between five education levels and many causes of death. The empirical results reveal that raising the educational level from primary to tertiary would result in an additional 20 months of survival between ages 18 and 63. This improvement in mortality is mainly attributable to fewer deaths from external causes. The highly educated gain more than nine months due to the reduction in deaths from external causes, but gain only two months due to the reduction in cancer mortality and four months due to the reduction in cardiovascular mortality. Ignoring confounding would lead to an underestimation of the gains by educational attainment, especially for the less educated. Our results imply that if the education distribution of 50,000 Swedish men from the 1951 cohort were replaced with that of the corresponding 1983 cohort, 22% of the person-years that were lost to death between ages 18 and 63 would have been saved for this cohort. Copyright © 2017 Elsevier Ltd. All rights reserved.

All-cause and cause-specific mortality of social assistance recipients in Norway: a register-based follow-up study.

PubMed

Naper, Sille Ohrem

2009-11-01

To investigate the mortality among social assistance recipients, who are among the most marginalized people in Norway. Cause-specific mortality was analysed in an attempt to explain the excess mortality. Previous research has suggested that social disadvantage leads to higher mortality from all causes, whereas others have found substantial variation when studying separate causes. The impact of the various causes will influence policy recommendations. Data were compiled through linking between Norwegian administrative records. The entire population born between 1935 and 1974 (2,297,621 people) was followed with respect to social assistance and death from 1993 to 2003. Cause-specific, age-standardized mortality rates for social assistance recipients and the rest of the population were calculated, and both the absolute (rate difference) and relative (rate ratio) rates were measured. The rate ratio for total mortality was 3.1 for men and 2.5 for women for the comparison between social assistance recipients and the general population. The mortality among social assistance recipients was higher for all causes, but the magnitude differed considerably, depending on the cause. The rate ratio for men ranged from 1.2 for non-smoking-related cancer to 18.8 for alcohol- and drug-related causes. Alcohol-and drug-related and violent causes together contributed to half of the excess mortality for men and one-third for women. The mortality of this socially disadvantaged group was considerably higher than that of the general population, and this difference reflected mainly drug-related causes.

Quantifying cause-related mortality by weighting multiple causes of death

PubMed Central

Moreno-Betancur, Margarita; Lamarche-Vadel, Agathe; Rey, Grégoire

2016-01-01

Abstract Objective To investigate a new approach to calculating cause-related standardized mortality rates that involves assigning weights to each cause of death reported on death certificates. Methods We derived cause-related standardized mortality rates from death certificate data for France in 2010 using: (i) the classic method, which considered only the underlying cause of death; and (ii) three novel multiple-cause-of-death weighting methods, which assigned weights to multiple causes of death mentioned on death certificates: the first two multiple-cause-of-death methods assigned non-zero weights to all causes mentioned and the third assigned non-zero weights to only the underlying cause and other contributing causes that were not part of the main morbid process. As the sum of the weights for each death certificate was 1, each death had an equal influence on mortality estimates and the total number of deaths was unchanged. Mortality rates derived using the different methods were compared. Findings On average, 3.4 causes per death were listed on each certificate. The standardized mortality rate calculated using the third multiple-cause-of-death weighting method was more than 20% higher than that calculated using the classic method for five disease categories: skin diseases, mental disorders, endocrine and nutritional diseases, blood diseases and genitourinary diseases. Moreover, this method highlighted the mortality burden associated with certain diseases in specific age groups. Conclusion A multiple-cause-of-death weighting approach to calculating cause-related standardized mortality rates from death certificate data identified conditions that contributed more to mortality than indicated by the classic method. This new approach holds promise for identifying underrecognized contributors to mortality. PMID:27994280

Work-based predictors of mortality: a 20-year follow-up of healthy employees.

PubMed

Shirom, Arie; Toker, Sharon; Alkaly, Yasmin; Jacobson, Orit; Balicer, Ran

2011-05-01

This study investigated the effects of the Job-Demand-Control-Support (JDC-S) model's components, workload, control, peer and supervisor social support, on the risk of all-cause mortality. Also examined was the expectation that the above work-based components interact in predicting all-cause mortality. The study's hypotheses were tested after controlling for physiological variables and health behaviors known to be risk factors for mortality. The design used was prospective. Baseline data were obtained from healthy employees (N = 820) who underwent periodic health examinations in 1988. Follow-up data on all-cause mortality were obtained from the participants' computerized medical file, kept by their HMO, in 2008. The baseline data covered socioeconomic, behavioral, and biological risk factors in addition to the components of the JDC-S model. During the period of follow-up, 53 deaths were recorded. Data were analyzed using Cox regressions. Only one main effect was found: the risk of mortality was significantly lower for those reporting high levels of peer social support. The study found two significant interactions. Higher levels of control reduced the risk of mortality for the men and increased it for the women. The main effect of peer social support on mortality risk was significantly higher for those whose baseline age ranged from 38 to 43 but not for the older than 43 or the younger than 38 participants. Peer social support is a protective factor, reducing the risk of mortality, while perceived control reduces the risk of mortality among men but increases it among women. (c) 2011 APA, all rights reserved.

Infant mortality trend in the city of Rio Branco, AC, 1999 to 2015

PubMed Central

Ramalho, Alanderson Alves; de Andrade, Andréia Moreira; Martins, Fernanda Andrade; Koifman, Rosalina Jorge

2018-01-01

ABSTRACT OBJECTIVE Analyze the trend of infant mortality in Rio Branco, state of Acre, from 1999 to 2015. METHODS An ecological observational study of a time series, in which data from deaths from the Information System on Mortality and Births of the Information System on Live Births were used. The annual percentage change was estimated using the Joinpoint software. RESULTS The infant mortality rate decreased from 26.99 in 1999 to 14.50 in 2015 per 1,000 live births, with an annual percentage change of -4.37 (95%CI -5.4– -3.4). When stratified by age components, the neonatal period presented an annual percentage change of -4.73 (95%CI -5.7– -3.7), and the post-neonatal period was -3.7 (95%CI -5.4– -2.0). Avoidability, avoidable causes and poorly defined causes showed a downward trend throughout the period and causes not clearly preventable showed an upward trend until 2008. The group of causes that contributed most to the infant deaths during the period studied was perinatal diseases, followed by malformations, infectious and parasitic diseases, and respiratory diseases. CONCLUSIONS Despite the decreasing trend in infant mortality rates in the capital compared to developed countries, it is relatively high. PMID:29641657

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.

PubMed

2016-10-08

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Determinants of all cause mortality in Poland.

PubMed

Genowska, Agnieszka; Jamiołkowski, Jacek; Szpak, Andrzej; Pajak, Andrzej

2012-01-01

The study objective was to evaluate quantitatively the relationship between demographic characteristics, socio-economic status and medical care resources with all cause mortality in Poland. Ecological study was performed using data for the population of 66 subregions of Poland, obtained from the Central Statistical Office of Poland. The information on the determinants of health and all cause mortality covered the period from 1st January 2005 to 31st December 2010. Results for the repeated measures were analyzed using Generalized Estimating Equations GEE model. In the model 16 independent variables describing health determinants were used, including 6 demographic variables, 6 socio-economic variables, 4 medical care variables. The dependent variable, was age standardized all cause mortality rate. There was a large variation in all cause mortality, demographic features, socio-economic characteristics, and medical care resources by subregion. All cause mortality showed weak associations with demographic features, among which only the increased divorce rate was associated with higher mortality rate. Increased education level, salaries, gross domestic product (GDP) per capita, local government expenditures per capita and the number of non-governmental organizations per 10 thousand population was associated with decrease in all cause mortality. The increase of unemployment rate was related with a decrease of all cause mortality. Beneficial relationship between employment of medical staff and mortality was observed. Variation in mortality from all causes in Poland was explained partly by variation in socio-economic determinants and health care resources.

Mortality in Patients with Endogenous Cushing's Syndrome.

PubMed

Javanmard, Pedram; Duan, Daisy; Geer, Eliza B

2018-06-01

Cushing's syndrome is associated with increased morbidity and mortality. Cardiovascular events, sepsis, and thromboembolism are the leading causes of mortality. Patient's with Cushing's due to a pituitary adenoma and those with Cushing's due to benign adrenal adenoma have relatively good survival outcomes often mirroring that of the general population. Persistent or recurrent disease is associated with high mortality risk. Ectopic Cushing's syndrome and Cushing's due to adrenocortical carcinoma confer the highest mortality risk among Cushing's etiologies. Prompt diagnosis and treatment, and specific monitoring for and treatment of associated comorbidities are essential to decrease the burden of mortality from Cushing's. Copyright © 2018 Elsevier Inc. All rights reserved.

Causes of Death after a Hospitalization with AKI.

PubMed

Silver, Samuel A; Harel, Ziv; McArthur, Eric; Nash, Danielle M; Acedillo, Rey; Kitchlu, Abhijat; Garg, Amit X; Chertow, Glenn M; Bell, Chaim M; Wald, Ron

2018-03-01

Mortality after AKI is high, but the causes of death are not well described. To better understand causes of death in patients after a hospitalization with AKI and to determine patient and hospital factors associated with mortality, we conducted a population-based study of residents in Ontario, Canada, who survived a hospitalization with AKI from 2003 to 2013. Using linked administrative databases, we categorized cause of death in the year after hospital discharge as cardiovascular, cancer, infection-related, or other. We calculated standardized mortality ratios to compare the causes of death in survivors of AKI with those in the general adult population and used Cox proportional hazards modeling to estimate determinants of death. Of the 156,690 patients included, 43,422 (28%) died in the subsequent year. The most common causes of death were cardiovascular disease (28%) and cancer (28%), with respective standardized mortality ratios nearly six-fold (5.81; 95% confidence interval [95% CI], 5.70 to 5.92) and eight-fold (7.87; 95% CI, 7.72 to 8.02) higher than those in the general population. The highest standardized mortality ratios were for bladder cancer (18.24; 95% CI, 17.10 to 19.41), gynecologic cancer (16.83; 95% CI, 15.63 to 18.07), and leukemia (14.99; 95% CI, 14.16 to 15.85). Along with older age and nursing home residence, cancer and chemotherapy strongly associated with 1-year mortality. In conclusion, cancer-related death was as common as cardiovascular death in these patients; moreover, cancer-related deaths occurred at substantially higher rates than in the general population. Strategies are needed to care for and counsel patients with cancer who experience AKI. Copyright © 2018 by the American Society of Nephrology.

High-Amplitude Atlantic Hurricanes Produce Disparate Mortality in Small, Low-Income Countries.

PubMed

Dresser, Caleb; Allison, Jeroan; Broach, John; Smith, Mary-Elise; Milsten, Andrew

2016-12-01

Hurricanes cause substantial mortality, especially in developing nations, and climate science predicts that powerful hurricanes will increase in frequency during the coming decades. This study examined the association of wind speed and national economic conditions with mortality in a large sample of hurricane events in small countries. Economic, meteorological, and fatality data for 149 hurricane events in 16 nations between 1958 and 2011 were analyzed. Mortality rate was modeled with negative binomial regression implemented by generalized estimating equations to account for variable population exposure, sequence of storm events, exposure of multiple islands to the same storm, and nonlinear associations. Low-amplitude storms caused little mortality regardless of economic status. Among high-amplitude storms (Saffir-Simpson category 4 or 5), expected mortality rate was 0.72 deaths per 100,000 people (95% confidence interval [CI]: 0.16-1.28) for nations in the highest tertile of per capita gross domestic product (GDP) compared with 25.93 deaths per 100,000 people (95% CI: 13.30-38.55) for nations with low per capita GDP. Lower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations. (Disaster Med Public Health Preparedness. 2016;10:832-837).

Development of a waterborne challenge model for Flavobacterium psychrophilum.

PubMed

Long, Amy; Fehringer, Tyson R; LaFrentz, Benjamin R; Call, Douglas R; Cain, Kenneth D

2014-10-01

Flavobacterium psychrophilum is the causative agent of bacterial coldwater disease and can cause significant mortality in salmonid aquaculture. To better evaluate disease prevention or treatment methods for F. psychrophilum in the laboratory, a waterborne challenge model that mimics a natural outbreak is needed. Here we report on the development of a waterborne challenge model for F. psychrophilum in which we incorporated variables that may influence challenge success: specifically, scarification prior to bacterial exposure and culture of F. psychrophilum under iron-limited culture conditions to potentially increase the probability of establishing disease. Additionally, two F. psychrophilum strains, CSF 259-93 and THC 02-90, were used in this model to test whether there were virulence differences between strains. Mortality was significantly higher in scarred fish than unscarred fish (81.5 vs. 19.4%), supporting the hypothesis that disruptions in the dermal layer enhance mortality in F. psychrophilum waterborne challenges. Although mortality differences were not significant between iron-replete and iron-limited treatments, mortality was high overall (> 30%). There was a significant difference in mortality between CSF 259-93 and THC 02-90 treatments, although both strains caused high mortality in injection challenges. In conclusion, this waterborne challenge model can be used to evaluate potential disease prevention and treatment methods. © 2014 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

Model calculated global, regional and megacity premature mortality due to air pollution

NASA Astrophysics Data System (ADS)

Lelieveld, J.; Barlas, C.; Giannadaki, D.; Pozzer, A.

2013-03-01

Air pollution by fine particulate matter (PM2.5) and ozone (O3) has increased strongly with industrialization and urbanization. We estimated the premature mortality rates and the years of human life lost (YLL) caused by anthropogenic PM2.5 and O3 in 2005 for epidemiological regions defined by the World Health Organization. We carried out high-resolution global model calculations to resolve urban and industrial regions in greater detail compared to previous work. We applied a health impact function to estimate premature mortality for people of 30 yr and older, using parameters derived from epidemiological cohort studies. Our results suggest that especially in large countries with extensive suburban and rural populations, air pollution-induced mortality rates have previously been underestimated. We calculate a global respiratory mortality of about 773 thousand yr-1 (YLL ≈ 5.2 million yr-1), 186 thousand yr-1 by lung cancer (YLL ≈ 1.7 million yr-1) and 2.0 million yr-1 by cardiovascular disease (YLL ≈ 14.3 million yr-1). The global mean per capita mortality caused by air pollution is about 0.1 % yr-1. The highest premature mortality rates are found in the Southeast Asia and Western Pacific regions (about 25% and 46% of the global rate, respectively) where more than a dozen of the most highly polluted megacities are located.

Causes of child mortality (1 to 4 years of age) from 1983 to 2012 in the Republic of Korea: national vital data.

PubMed

Choe, Seung Ah; Cho, Sung-Il

2014-11-01

Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea. Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012. The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012). In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.

Screen-based entertainment time, all-cause mortality, and cardiovascular events: population-based study with ongoing mortality and hospital events follow-up.

PubMed

Stamatakis, Emmanuel; Hamer, Mark; Dunstan, David W

2011-01-18

The aim of this study was to examine the independent relationships of television viewing or other screen-based entertainment ("screen time") with all-cause mortality and clinically confirmed cardiovascular disease (CVD) events. A secondary objective was to examine the extent to which metabolic (body mass index, high-density lipoprotein and total cholesterol) and inflammatory (C-reactive protein) markers mediate the relationship between screen time and CVD events. Although some evidence suggests that prolonged sitting is linked to CVD risk factor development regardless of physical activity participation, studies with hard outcomes are scarce. A population sample of 4,512 (1,945 men) Scottish Health Survey 2003 respondents (≥35 years) were followed up to 2007 for all-cause mortality and CVD events (fatal and nonfatal combined). Main exposures were interviewer-assessed screen time (<2 h/day; 2 to <4 h/day; and ≥4 h/day) and moderate to vigorous intensity physical activity. Two hundred fifteen CVD events and 325 any-cause deaths occurred during 19,364 follow-up person-years. The covariable (age, sex, ethnicity, obesity, smoking, social class, long-standing illness, marital status, diabetes, hypertension)-adjusted hazard ratio (HR) for all-cause mortality was 1.52 (95% confidence interval [CI]: 1.06 to 2.16) and for CVD events was 2.30 (95% CI: 1.33 to 3.96) for participants engaging in ≥4 h/day of screen time relative to <2 h/day. Adjusting for physical activity attenuated these associations only slightly (all-cause mortality: HR: 1.48, 95% CI: 1.04 to 2.13; CVD events: HR: 2.25, 95% CI: 1.30 to 3.89). Exclusion of participants with CVD events in the first 2 years of follow-up and previous cancer registrations did not change these results appreciably. Approximately 25% of the association between screen time and CVD events was explained collectively by C-reactive protein, body mass index, and high-density lipoprotein cholesterol. Recreational sitting, as reflected by television/screen viewing time, is related to raised mortality and CVD risk regardless of physical activity participation. Inflammatory and metabolic risk factors partly explain this relationship. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Widening rural-urban disparities in all-cause mortality and mortality from major causes of death in the USA, 1969-2009.

PubMed

Singh, Gopal K; Siahpush, Mohammad

2014-04-01

This study examined trends in rural-urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural-urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural-urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005-2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005-2009 than in 1990-1992. Causes of death contributing most to the increasing rural-urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer's disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.

Influence of disease on population model of mid-continent mallards

USGS Publications Warehouse

Samuel, Michael D.

1992-01-01

On numerous occasions, waterfowl deaths caused by disease were highly visible to wildlife managers and to the general public. Thousands of birds died during duck plague, avian botulism and avian cholera outbreaks. Undoubtedly, some disease occurred in waterfowl populations throughout their evolution; however, knowledge of disease epizootiology primarily developed during the past 40-50 years (Wobeser 1981) for diseases that cause massive die-offs (e.g., avian cholera, avian botulism and duck plague). Other diseases, such as avian tuberculosis, aspergillosis, parasite infection and lead poisoning, also occur at chronic levels, but the data remain meager on many of these less spectacular causes of mortality and sublethal forms of disease. However, because chronic losses occur throughout the year, their cumulative effect, as well as the large die-offs, are a potential threat to waterfowl populations (Bellrose 1976, Wobeser 1981). Previous studies (Anderson 1975) demonstrated that 50 percent of the annual mortality in mallard (Anas platyrhynchos) populations is from nonhunting causes. In addition to disease, these causes include predation, accidental deaths, inclement weather and other factors (Stout and Cornwell 1976), which can be confounded by disease. Determination of mortality rates from diseases has been difficult because many biases and inconsistencies are associated with the available data. Assessment of disease prevalence and magnitude of losses is complicated by the spatial and temporal variability of many diseases, the logistic difficulty of studying highly mobile waterfowl populations, and the potentially confounding influences of predation and scavenging on detecting disease-related mortality;. Unless losses are so extensive that they direct attention to a particular area, mortality from disease is easily overlooked (see Zwank et al. 1985). Even when die-offs are evident, mortality from disease may be underestimated because sick waterfowl become debilitated, seek seclusion in dense cover and are removed by efficient predators or scavengers prior to human detection. Our objective was to evaluate the possible effects of three of the most common diseases (friend 1985), avian cholera, avian botulism and lead poisoning, on the population dynamics of mid-continental mallards. We used data from disease outbreaks to develop preliminary estimates of mortality rates and their temporal pattern. A computer model was used to integrate these mortality estimate with other mallard life history characteristics, evaluate the potential effects of these diseases on mallard demographics and assess the need for better information on the effects of disease on mallards.

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia

PubMed Central

Almashouq, Mohammad K.; Youssef, Amira M.; Al-Qumaidi, Hamid; Al Derwish, Mohammad; Ouizi, Samir; Al-Shehri, Khalid; Masoodi, Saba N.

2017-01-01

Background Although Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications. Methods Using data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients’ files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013. Results The all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55–5.23) and 7.21 (5.70–8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate. Conclusions Diabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered. PMID:29176889

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia.

PubMed

Al-Rubeaan, Khalid; Almashouq, Mohammad K; Youssef, Amira M; Al-Qumaidi, Hamid; Al Derwish, Mohammad; Ouizi, Samir; Al-Shehri, Khalid; Masoodi, Saba N

2017-01-01

Although Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications. Using data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients' files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013. The all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55-5.23) and 7.21 (5.70-8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate. Diabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered.

Social inequalities in mortality by cause among men and women in France.

PubMed

Saurel-Cubizolles, M-J; Chastang, J-F; Menvielle, G; Leclerc, A; Luce, D

2009-03-01

The aim of this study was to compare inequalities in mortality (all causes and by cause) by occupational group and educational level between men and women living in France in the 1990s. Data were analysed from a permanent demographic sample currently including about one million people. The French Institute of Statistics (INSEE) follows the subjects and collects demographic, social and occupational information from the census schedules and vital status forms. Causes of death were obtained from the national file of the French Institute of Health and Medical Research (INSERM). A relative index of inequality (RII) was calculated to quantify inequalities as a function of educational level and occupational group. Overall all-cause mortality, mortality due to cancer, mortality due to cardiovascular disease and mortality due to external causes (accident, suicide, violence) were considered. Overall, social inequalities were found to be wider among men than among women, for all-cause mortality, cancer mortality and external-cause mortality. However, this trend was not observed for cardiovascular mortality, for which the social inequalities were greater for women than for men, particularly for mortality due to ischaemic cardiac diseases. This study provides evidence for persistent social inequalities in mortality in France, in both men and women. These findings highlight the need for greater attention to social determinants of health. The reduction of cardiovascular disease mortality in low educational level groups should be treated as a major public health priority.

An inert pesticide adjuvant synergizes viral pathogenicity and mortality in honey bee larvae

USDA-ARS?s Scientific Manuscript database

Honey bees are highly valued for their pollination services in agricultural settings, and recent declines in managed populations have caused concern. Colony losses following a major pollination event in the United States, almond pollination, have been characterized by brood mortality with specific s...

Causes of mortality after haploidentical hematopoietic stem cell transplantation and the comparison with HLA-identical sibling hematopoietic stem cell transplantation.

PubMed

Yan, C H; Xu, L P; Wang, F R; Chen, H; Han, W; Wang, Yu; Wang, J Z; Liu, K Y; Huang, X J

2016-03-01

This study was performed to investigate incidence, causes and factors influencing mortality after haploidentical hematopoietic stem cell transplantation (HSCT) and to compare differences between haploidentical HSCT and HLA-identical sibling HSCT. From January 2000 to June 2011, 1411 patients with acute leukemia or myelodysplastic syndrome were included in this study. Of these patients, 571 received HLA-identical sibling HSCT and 840 received haploidentical HSCT. The cumulative incidence of overall mortality and transplant-related mortality (TRM) after haploidentical HSCT was higher than those after HLA-identical sibling HSCT (38.7% vs. 33.3%, P=0.012 and 27.5% vs. 19.9%, P=0.002), but the incidence of relapse-related mortality (RRM) did not differ between the two groups (15.6% vs. 16.7%, P=0.943). A multivariate analysis suggested that high-risk disease status and haploidentical HSCT correlated with a higher incidence of overall mortality (P<0.0001, hazard ratio=1.911 and P=0.019, hazard ratio=1.249); in addition, in haploidentical HSCT, only high-risk disease status correlated with a higher incidence of overall mortality (P<0.0001, hazard ratio=1.845). Our study suggested that haploidentical HSCT provided a higher incidence of overall mortality and TRM but the same incidence of RRM compared with HLA-identical sibling HSCT. Therefore, HLA-identical sibling HSCT remains the first choice, but haploidentical HSCT is available for patients without an HLA-identical sibling donor.

Association of BMI with risk of CVD mortality and all-cause mortality.

PubMed

Kee, Chee Cheong; Sumarni, Mohd Ghazali; Lim, Kuang Hock; Selvarajah, Sharmini; Haniff, Jamaiyah; Tee, Guat Hiong Helen; Gurpreet, Kaur; Faudzi, Yusoff Ahmad; Amal, Nasir Mustafa

2017-05-01

To determine the relationship between BMI and risk of CVD mortality and all-cause mortality among Malaysian adults. Population-based, retrospective cohort study. Participants were followed up for 5 years from 2006 to 2010. Mortality data were obtained via record linkages with the Malaysian National Registration Department. Multiple Cox regression was applied to compare risk of CVD and all-cause mortality between BMI categories adjusting for age, gender and ethnicity. Models were generated for all participants, all participants the first 2 years of follow-up, healthy participants, healthy never smokers, never smokers, current smokers and former smokers. All fourteen states in Malaysia. Malaysian adults (n 32 839) aged 18 years or above from the third National Health and Morbidity Survey. Total follow-up time was 153 814 person-years with 1035 deaths from all causes and 225 deaths from CVD. Underweight (BMI<18·5 kg/m2) was associated with a significantly increased risk of all-cause mortality, while obesity (BMI ≥30·0 kg/m2) was associated with a heightened risk of CVD mortality. Overweight (BMI=25·0-29·9 kg/m2) was inversely associated with risk of all-cause mortality. Underweight was significantly associated with all-cause mortality in all models except for current smokers. Overweight was inversely associated with all-cause mortality in all participants. Although a positive trend was observed between BMI and CVD mortality in all participants, a significant association was observed only for severe obesity (BMI≥35·0 kg/m2). Underweight was associated with increased risk of all-cause mortality and obesity with increased risk of CVD mortality. Therefore, maintaining a normal BMI through leading an active lifestyle and healthy dietary habits should continue to be promoted.

Dietary Flavonoid and Lignan Intake and Mortality in Prospective Cohort Studies: Systematic Review and Dose-Response Meta-Analysis.

PubMed

Grosso, Giuseppe; Micek, Agnieszka; Godos, Justyna; Pajak, Andrzej; Sciacca, Salvatore; Galvano, Fabio; Giovannucci, Edward L

2017-06-15

Recent evidence has suggested that flavonoid and lignan intake may be associated with decreased risk of chronic and degenerative diseases. The aim of this meta-analysis was to assess the association between dietary flavonoid and lignan intake and all-cause and cardiovascular disease (CVD) mortality in prospective cohort studies. A systematic search was conducted in electronic databases to identify studies published from January 1996 to December 2015 that satisfied inclusion/exclusion criteria. Risk ratios and 95% confidence intervals were extracted and analyzed using a random-effects model. Nonlinear dose-response analysis was modeled by using restricted cubic splines. The inclusion criteria were met by 22 prospective studies exploring various flavonoid and lignan classes. Compared with lower intake, high consumption of total flavonoids was associated with decreased risk of all-cause mortality (risk ratio = 0.74, 95% confidence intervals: 0.55, 0.99), while a 100-mg/day increment in intake led to a (linear) decreased risk of 6% and 4% of all-cause and CVD mortality, respectively. Among flavonoid classes, significant results were obtained for intakes of flavonols, flavones, flavanones, anthocyanidins, and proanthocyanidins. Only limited evidence was available on flavonoid classes and lignans and all-cause mortality. Findings from this meta-analysis indicated that dietary flavonoids are associated with decreased risk of all-cause and CVD mortality. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The impact of blood type O on mortality of severe trauma patients: a retrospective observational study.

PubMed

Takayama, Wataru; Endo, Akira; Koguchi, Hazuki; Sugimoto, Momoko; Murata, Kiyoshi; Otomo, Yasuhiro

2018-05-02

Recent studies have implicated the differences in the ABO blood system as a potential risk for various diseases, including hemostatic disorders and hemorrhage. In this study, we evaluated the impact of the difference in the ABO blood type on mortality in patients with severe trauma. A retrospective observational study was conducted in two tertiary emergency critical care medical centers in Japan. Patients with trauma with an Injury Severity Score (ISS) > 15 were included. The association between the different blood types (type O versus other blood types) and the outcomes of all-cause mortality, cause-specific mortalities (exsanguination, traumatic brain injury, and others), ventilator-free days (VFD), and total transfusion volume were evaluated using univariate and multivariate competing-risk regression models. Moreover, the impact of blood type O on the outcomes was assessed using regression coefficients in the multivariate analysis adjusted for age, ISS, and the Revised Trauma Score (RTS). A total of 901 patients were included in this study. The study population was divided based on the ABO blood type: type O, 284 (32%); type A, 285 (32%); type B, 209 (23%); and type AB, 123 (13%). Blood type O was associated with high mortality (28% in patients with blood type O versus 11% in patients with other blood types; p <  0.001). Moreover, this association was observed in a multivariate model (adjusted odds ratio = 2.86, 95% confidence interval 1.84-4.46; p <  0.001). The impact of blood type O on all-cause in-hospital mortality was comparable to 12 increases in the ISS, 1.5 decreases in the RTS, and 26 increases in age. Furthermore, blood type O was significantly associated with higher cause-specific mortalities and shorter VFD compared with the other blood types; however, a significant difference was not observed in the transfusion volume between the two groups. Blood type O was significantly associated with high mortality in severe trauma patients and might have a great impact on outcomes. Further studies elucidating the mechanism underlying this association are warranted to develop the appropriate intervention.

Food Sources of Saturated Fat and the Association With Mortality: A Meta-Analysis

PubMed Central

O’Sullivan, Therese A.; Mitrou, Francis; Lawrence, David

2013-01-01

We summarized the data related to foods high in saturated fat and risk of mortality. We searched Cochrane Library, MEDLINE, EMBASE, and ProQuest for studies from January 1952 to May 2012. We identified 26 publications with individual dietary data and all-cause, total cancer, or cardiovascular mortality as endpoints. Pooled relative risk estimates demonstrated that high intakes of milk, cheese, yogurt, and butter were not associated with a significantly increased risk of mortality compared with low intakes. High intakes of meat and processed meat were significantly associated with an increased risk of mortality but were associated with a decreased risk in a subanalysis of Asian studies. The overall quality of studies was variable. Associations varied by food group and population. This may be because of factors outside saturated fat content of individual foods. There is an ongoing need for improvement in assessment tools and methods that investigate food sources of saturated fat and mortality to inform dietary guidelines. PMID:23865702

Activity of Selected Formulated Biorational and Synthetic Insecticides Against Larvae of Helicoverpa armigera (Lepidoptera: Noctuidae).

PubMed

Vivan, L M; Torres, J B; Fernandes, P L S

2017-02-01

This work studied 17 insecticides belonging to nucleopolyhedrovirus (NPV), Bacillus thuringiensis (Bt kurstaki and Bt aizawai), benzoylureas (insect growth regulators [IGRs]), carbamates, organophosphates, spinosyns, and diamides against larvae of Helicoverpa armigera (Hübner), invasive species in the South American continent. Larvae of different instars were fed for 7 d with untreated or insecticide-treated diets. Mortality was recorded daily for 7 d, and surviving larvae were individually weighed on the seventh day. The NPV and Bt insecticides caused 100% mortality of first-instar larvae and first-instar and second-instar larvae, respectively. However, both NPV and Bt-based products caused low mortality of third-instar larvae and did not kill older larvae. The IGR lufenuron was highly effective against all three ages of larvae tested, whereas teflubenzuron and triflumuron produced maximum 60% mortality of second-instar larvae and lower than 50% to older larvae. Thiodicarb, chlorantraniliprole, indoxacarb, chlorpyrifos, and chlorfenapyr, irrespective of tested age, caused 100% mortality of larvae, with the last two insecticides reaching 100% mortality within 2 d of feeding on the treated diet. Flubendiamide caused lower mortality but significantly affected the weight of surviving larvae, whereas neither spinosad nor methomyl produced significant mortality or affected the weight of larvae. Based on the results, the age of H. armigera larvae plays an important role in the recommendation of NPV and Bt insecticides. Furthermore, there are potential options between biological and synthetic insecticides tested against H. armigera, and recording larval size during monitoring, in addition to the infestation level, should be considered when recommending biological-based insecticides to control this pest. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Alcohol consumption and all-cause mortality.

PubMed

Duffy, J C

1995-02-01

Prospective studies of alcohol and mortality in middle-aged men almost universally find a U-shaped relationship between alcohol consumption and risk of mortality. This review demonstrates the extent to which different studies lead to different risk estimates, analyses the putative influence of abstention as a risk factor and uses available data to produce point and interval estimates of the consumption level apparently associated with minimum risk from two studies in the UK. Data from a number of studies are analysed by means of logistic-linear modelling, taking account of the possible influence of abstention as a special risk factor. Separate analysis of British data is performed. Logistic-linear modelling demonstrates large and highly significant differences between the studies considered in the relationship between alcohol consumption and all-cause mortality. The results support the identification of abstention as a special risk factor for mortality, but do not indicate that this alone explains the apparent U-shaped relationship. Separate analysis of two British studies indicates minimum risk of mortality in this population at a consumption level of about 26 (8.5 g) units of alcohol per week. The analysis supports the view that abstention may be a specific risk factor for all-cause mortality, but is not an adequate explanation of the apparent protective effect of alcohol consumption against all-cause mortality. Future analyses might better be performed on a case-by-case basis, using a change-point model to estimate the parameters of the relationship. The current misinterpretation of the sensible drinking level of 21 units per week for men in the UK as a limit is not justified, and the data suggest that alcohol consumption is a net preventive factor against premature death in this population.

The association between A Body Shape Index and mortality: Results from an Australian cohort.

PubMed

Grant, Janet F; Chittleborough, Catherine R; Shi, Zumin; Taylor, Anne W

2017-01-01

It is well recognised that obesity increases the risk of premature death. A Body Shape Index (ABSI) is a formula that uses waist circumference (WC), body mass index (BMI) and height to predict risk of premature mortality, where a high score (Quartile 4) indicates that a person's WC is more than expected given their height and weight. Our study examines the association between ABSI quartiles and all-cause-, cardiovascular- and cancer-related mortality, and primary cause of death. Self-reported demographic and biomedically measured health-related risk factor and weight data was from the baseline stage of the North West Adelaide Health Study (1999-2003, n = 4056), a longitudinal cohort of Australian adults. Death-related information was obtained from the National Death Index. Primary cause of death across ABSI quartiles was examined. The association between mortality and ABSI (quartile and continuous scores) was investigated using a Cox proportional hazards survival model and adjusting for socioeconomic, and self-reported and biomedical risk factors. The proportion of all three types of mortality steadily increased from ABSI Quartile 1 through to Quartile 4. After adjusting for demographic and health-related risk factors, the risk of all-cause mortality was higher for people in ABSI Quartile 4 (HR 2.64, 95% CI 01.56-4.47), and ABSI Quartile 3 (HR 1.95, 95% CI 1.15-3.33), with a moderate association for the continuous ABSI score (HR 1.32, 95% CI 1.18-1.48). ABSI is therefore positively associated with mortality in Australian adults. Different combined measures of obesity such as the ABSI are useful in examining mortality risk.

Youth mortality due to HIV/AIDS in South Africa, 2001-2009: an analysis of the levels of mortality using life table techniques.

PubMed

De Wet, Nicole; Oluwaseyi, Somefun; Odimegwu, Clifford

2014-01-01

South Africa has one of the highest HIV/AIDS prevalence rates in the world. It is estimated that 5.38 million South Africans are living with HIV/AIDS. In addition, new infections among adults aged 15+ were reportedly 316 900 in 2011. New infections among children (0-14 years old) was also high in 2011 at 63 600. This paper examines South Africa's mortality due to HIV/AIDS among the youth (15-34 years old). This age group is of fundamental importance to the economic and social development of the country. However, the challenges of youth development remain vast and incomparable. One of these challenges is the impact of HIV/AIDS on mortality. Life table techniques are used to estimate among others, sex differentials in death rates for the youth population, probability of dying from HIV/AIDS before the age of 35 and life expectancy should HIV/AIDS be eradicated from the population. The study used data from the National Registry of Deaths, as collated by Statistics South Africa from 2001 to 2009. Results show that youth mortality due to HIV/AIDS has remained consistently higher among older youths than in younger ones. By sex, mortality due to this cause has also remained consistent over the period, with mortality due to HIV/AIDS being higher among females than males. Cause-specific mortality rates and proportional mortality ratios reflect the increased mortality of older youth (especially 30-34 years old) and females within the South African population. Probability of dying from HIV/AIDS shows that over the period, fluctuations in likelihood of mortality have occurred, but for both males and females (of all age groups) the chances of dying from this cause decreased in 2007-2009.

Single Marital Status and Infectious Mortality in Women With Cervical Cancer in the United States.

PubMed

Machida, Hiroko; Eckhardt, Sarah E; Castaneda, Antonio V; Blake, Erin A; Pham, Huyen Q; Roman, Lynda D; Matsuo, Koji

2017-10-01

Unmarried status including single marital status is associated with increased mortality in women bearing malignancy. Infectious disease weights a significant proportion of mortality in patients with malignancy. Here, we examined an association of single marital status and infectious mortality in cervical cancer. This is a retrospective observational study examining 86,555 women with invasive cervical cancer identified in the Surveillance, Epidemiology, and End Results Program between 1973 and 2013. Characteristics of 18,324 single women were compared with 38,713 married women in multivariable binary logistic regression models. Propensity score matching was performed to examine cumulative risk of all-cause and infectious mortality between the 2 groups. Single marital status was significantly associated with young age, black/Hispanic ethnicity, Western US residents, uninsured status, high-grade tumor, squamous histology, and advanced-stage disease on multivariable analysis (all, P < 0.05). In a prematched model, single marital status was significantly associated with increased cumulative risk of all-cause mortality (5-year rate: 32.9% vs 29.7%, P < 0.001) and infectious mortality (0.5% vs 0.3%, P < 0.001) compared with the married status. After propensity score matching, single marital status remained an independent prognostic factor for increased cumulative risk of all-cause mortality (adjusted hazards ratio [HR], 1.15; 95% confidence interval [CI], 1.11-1.20; P < 0.001) and those of infectious mortality on multivariable analysis (adjusted HR, 1.71; 95% CI, 1.27-2.32; P < 0.001). In a sensitivity analysis for stage I disease, single marital status remained significantly increased risk of infectious mortality after propensity score matching (adjusted HR, 2.24; 95% CI, 1.34-3.73; P = 0.002). Single marital status was associated with increased infectious mortality in women with invasive cervical cancer.

[Dynamics and spatial differentiation of premature mortality in the productive age group of the population--premise for in depth studies of causes and conditions of this phenomenon].

PubMed

Andryszek, C; Indulski, J A; Worach-Kardas, H

1996-01-01

The increased mortality in Poland compared to that observed just after the war was mainly caused by the elevated frequency of premature deaths (under 65 years of age). The aim of the work was to assess: the premature mortality in the population of the productive age in Poland in comparison with other countries of Central and Eastern Europe, Scandinavian and Western European countries as well as with other developed countries in the world; the dynamics of premature mortality; the spatial differentiation of premature mortality in our country. Two age phases: I = 20 - 44 years, and II = 45 - 64 years were identified in premature mortality. A considerable increase in male premature mortality in phase II of the productive age which began in the second half of the sixties and had continued until 1991 doubled the mortality ratio in Poland when compared with the average ratio observed in all Scandinavian and Western European countries. The analysis of spatial differentiation of premature mortality indicates clearly the relationship between mortality and environmental conditions: the highest ratios are noted in highly urbanized and industrialized voivodships (provinces). It accounts for possible reasons of shortened by 7-8 years period of men's life in Poland as compared to Western countries or even by 10 year in comparison with Japan, for example. The situation among women is more favorable. These alarming data on premature mortality, especially among men in phase II of the productive age emphasize the urgent need for in-depth studies of causes, circumstances and factors contributing to deaths at the most active productive age.

Secondary Bacterial Infections Associated with Influenza Pandemics

PubMed Central

Morris, Denise E.; Cleary, David W.; Clarke, Stuart C.

2017-01-01

Lower and upper respiratory infections are the fourth highest cause of global mortality (Lozano et al., 2012). Epidemic and pandemic outbreaks of respiratory infection are a major medical concern, often causing considerable disease and a high death toll, typically over a relatively short period of time. Influenza is a major cause of epidemic and pandemic infection. Bacterial co/secondary infection further increases morbidity and mortality of influenza infection, with Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus reported as the most common causes. With increased antibiotic resistance and vaccine evasion it is important to monitor the epidemiology of pathogens in circulation to inform clinical treatment and development, particularly in the setting of an influenza epidemic/pandemic. PMID:28690590

Global Impact of Rotavirus Vaccination on Childhood Hospitalizations and Mortality From Diarrhea.

PubMed

Burnett, Eleanor; Jonesteller, Christine L; Tate, Jacqueline E; Yen, Catherine; Parashar, Umesh D

2017-06-01

In 2006, 2 rotavirus vaccines were licensed. We summarize the impact of rotavirus vaccination on hospitalizations and deaths from rotavirus and all-cause acute gastroenteritis (AGE) during the first 10 years since vaccine licensure, including recent evidence from countries with high child mortality. We used standardized guidelines (PRISMA) to identify observational evaluations of rotavirus vaccine impact among children <5 years of age that presented at least 12 months of pre- and post-vaccine introduction surveillance data. We identified 57 articles from 27 countries. Among children <5 years of age, the median percentage reduction in AGE hospitalizations was 38% overall and 41%, 30%, and 46% in countries with low, medium, and high child mortality, respectively. Hospitalizations and emergency department visits due to rotavirus AGE were reduced by a median of 67% overall and 71%, 59%, and 60% in countries with low, medium, and high child mortality, respectively. Implementation of rotavirus vaccines has substantially decreased hospitalizations from rotavirus and all-cause AGE. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Sleep duration and all-cause mortality: a critical review of measurement and associations

PubMed Central

Kurina, Lianne M.; McClintock, Martha K.; Chen, Jen-Hao; Waite, Linda J.; Thisted, Ronald A.; Lauderdale, Diane S.

2013-01-01

Purpose Variation in sleep duration has been linked with mortality risk. The purpose of this review is to provide an updated evaluation of the literature on sleep duration and mortality, including a critical examination of sleep duration measurement and an examination of correlates of self-reported sleep duration. Methods We did a systematic search of studies reporting associations between sleep duration and all-cause mortality and extracted the sleep duration measure and the measure(s) of association. Results We identified 42 prospective studies of sleep duration and mortality drawing on 35 distinct study populations across the globe. Unlike previous reviews, we find that the published literature does not support a consistent finding of an association between self-reported sleep duration and mortality. Most studies have employed survey measures of sleep duration, which are not highly correlated with estimates based on physiologic measures. Conclusions Despite a large body of literature, it is premature to conclude, as previous reviews have, that a robust, U-shaped association between sleep duration and mortality risk exists across populations. Careful attention must be paid to measurement, response bias, confounding, and reverse causation in the interpretation of associations between sleep duration and mortality. PMID:23622956

Meat consumption and mortality--results from the European Prospective Investigation into Cancer and Nutrition.

PubMed

Rohrmann, Sabine; Overvad, Kim; Bueno-de-Mesquita, H Bas; Jakobsen, Marianne U; Egeberg, Rikke; Tjønneland, Anne; Nailler, Laura; Boutron-Ruault, Marie-Christine; Clavel-Chapelon, Françoise; Krogh, Vittorio; Palli, Domenico; Panico, Salvatore; Tumino, Rosario; Ricceri, Fulvio; Bergmann, Manuela M; Boeing, Heiner; Li, Kuanrong; Kaaks, Rudolf; Khaw, Kay-Tee; Wareham, Nicholas J; Crowe, Francesca L; Key, Timothy J; Naska, Androniki; Trichopoulou, Antonia; Trichopoulos, Dimitirios; Leenders, Max; Peeters, Petra H M; Engeset, Dagrun; Parr, Christine L; Skeie, Guri; Jakszyn, Paula; Sánchez, María-José; Huerta, José M; Redondo, M Luisa; Barricarte, Aurelio; Amiano, Pilar; Drake, Isabel; Sonestedt, Emily; Hallmans, Göran; Johansson, Ingegerd; Fedirko, Veronika; Romieux, Isabelle; Ferrari, Pietro; Norat, Teresa; Vergnaud, Anne C; Riboli, Elio; Linseisen, Jakob

2013-03-07

Recently, some US cohorts have shown a moderate association between red and processed meat consumption and mortality supporting the results of previous studies among vegetarians. The aim of this study was to examine the association of red meat, processed meat, and poultry consumption with the risk of early death in the European Prospective Investigation into Cancer and Nutrition (EPIC). Included in the analysis were 448,568 men and women without prevalent cancer, stroke, or myocardial infarction, and with complete information on diet, smoking, physical activity and body mass index, who were between 35 and 69 years old at baseline. Cox proportional hazards regression was used to examine the association of meat consumption with all-cause and cause-specific mortality. As of June 2009, 26,344 deaths were observed. After multivariate adjustment, a high consumption of red meat was related to higher all-cause mortality (hazard ratio (HR) = 1.14, 95% confidence interval (CI) 1.01 to 1.28, 160+ versus 10 to 19.9 g/day), and the association was stronger for processed meat (HR = 1.44, 95% CI 1.24 to 1.66, 160+ versus 10 to 19.9 g/day). After correction for measurement error, higher all-cause mortality remained significant only for processed meat (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d). We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day. Significant associations with processed meat intake were observed for cardiovascular diseases, cancer, and 'other causes of death'. The consumption of poultry was not related to all-cause mortality. The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer.

Meat consumption and mortality - results from the European Prospective Investigation into Cancer and Nutrition

PubMed Central

2013-01-01

Background Recently, some US cohorts have shown a moderate association between red and processed meat consumption and mortality supporting the results of previous studies among vegetarians. The aim of this study was to examine the association of red meat, processed meat, and poultry consumption with the risk of early death in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods Included in the analysis were 448,568 men and women without prevalent cancer, stroke, or myocardial infarction, and with complete information on diet, smoking, physical activity and body mass index, who were between 35 and 69 years old at baseline. Cox proportional hazards regression was used to examine the association of meat consumption with all-cause and cause-specific mortality. Results As of June 2009, 26,344 deaths were observed. After multivariate adjustment, a high consumption of red meat was related to higher all-cause mortality (hazard ratio (HR) = 1.14, 95% confidence interval (CI) 1.01 to 1.28, 160+ versus 10 to 19.9 g/day), and the association was stronger for processed meat (HR = 1.44, 95% CI 1.24 to 1.66, 160+ versus 10 to 19.9 g/day). After correction for measurement error, higher all-cause mortality remained significant only for processed meat (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d). We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day. Significant associations with processed meat intake were observed for cardiovascular diseases, cancer, and 'other causes of death'. The consumption of poultry was not related to all-cause mortality. Conclusions The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer. PMID:23497300

Diarrhoeal problems in Southeast Asia.

PubMed

Sunoto

1982-09-01

Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.

Crohn's disease and ulcerative colitis are associated with elevated standardized mortality ratios: a meta-analysis.

PubMed

Bewtra, Meenakshi; Kaiser, Lisa M; TenHave, Tom; Lewis, James D

2013-03-01

Evidence regarding all-cause and cause-specific mortality in inflammatory bowel disease (IBD) is conflicting, and debate exists over appropriate study design to examine these important outcomes. We conducted a comprehensive meta-analysis of all-cause and cause-specific mortality in both Crohn's disease (CD) and ulcerative colitis (UC), and additionally examined various effects of study design on this outcome. A systematic search of PubMed and EMBASE was conducted to identify studies examining mortality rates relative to the general population. Pooled summary standardized mortality ratios (SMR) were calculated using random effect models. Overall, 35 original articles fulfilled the inclusion and exclusion criteria, reporting all-cause mortality SMRs varying from 0.44 to 7.14 for UC and 0.71 to 3.20 for CD. The all-cause mortality summary SMR for inception cohort and population cohort UC studies was 1.19 (95% confidence interval, 1.06-1.35). The all-cause mortality summary SMR for inception cohort and population cohort CD studies was 1.38 (95% confidence interval, 1.23-1.55). Mortality from colorectal cancer, pulmonary disease, and nonalcoholic liver disease was increased, whereas mortality from cardiovascular disease was decreased. Patients with UC and CD have higher rates of death from all causes, colorectal-cancer, pulmonary disease, and nonalcoholic liver disease.

Severe 2010 Cold-Water Event Caused Unprecedented Mortality to Corals of the Florida Reef Tract and Reversed Previous Survivorship Patterns

PubMed Central

Lirman, Diego; Schopmeyer, Stephanie; Manzello, Derek; Gramer, Lewis J.; Precht, William F.; Muller-Karger, Frank; Banks, Kenneth; Barnes, Brian; Bartels, Erich; Bourque, Amanda; Byrne, James; Donahue, Scott; Duquesnel, Janice; Fisher, Louis; Gilliam, David; Hendee, James; Johnson, Meaghan; Maxwell, Kerry; McDevitt, Erin; Monty, Jamie; Rueda, Digna; Ruzicka, Rob; Thanner, Sara

2011-01-01

Background Coral reefs are facing increasing pressure from natural and anthropogenic stressors that have already caused significant worldwide declines. In January 2010, coral reefs of Florida, United States, were impacted by an extreme cold-water anomaly that exposed corals to temperatures well below their reported thresholds (16°C), causing rapid coral mortality unprecedented in spatial extent and severity. Methodology/Principal Findings Reef surveys were conducted from Martin County to the Lower Florida Keys within weeks of the anomaly. The impacts recorded were catastrophic and exceeded those of any previous disturbances in the region. Coral mortality patterns were directly correlated to in-situ and satellite-derived cold-temperature metrics. These impacts rival, in spatial extent and intensity, the impacts of the well-publicized warm-water bleaching events around the globe. The mean percent coral mortality recorded for all species and subregions was 11.5% in the 2010 winter, compared to 0.5% recorded in the previous five summers, including years like 2005 where warm-water bleaching was prevalent. Highest mean mortality (15%–39%) was documented for inshore habitats where temperatures were <11°C for prolonged periods. Increases in mortality from previous years were significant for 21 of 25 coral species, and were 1–2 orders of magnitude higher for most species. Conclusions/Significance The cold-water anomaly of January 2010 caused the worst coral mortality on record for the Florida Reef Tract, highlighting the potential catastrophic impacts that unusual but extreme climatic events can have on the persistence of coral reefs. Moreover, habitats and species most severely affected were those found in high-coral cover, inshore, shallow reef habitats previously considered the “oases” of the region, having escaped declining patterns observed for more offshore habitats. Thus, the 2010 cold-water anomaly not only caused widespread coral mortality but also reversed prior resistance and resilience patterns that will take decades to recover. PMID:21853066

High levels of cynical distrust partly predict premature mortality in middle-aged to ageing men.

PubMed

Šmigelskas, Kastytis; Joffė, Roza; Jonynienė, Jolita; Julkunen, Juhani; Kauhanen, Jussi

2017-08-01

The aim of this study was to evaluate the effect of cynical distrust on mortality in middle-aged and aging men. The analysis is based on Kuopio Ischemic Heart Disease study, follow-up from 1984 to 2011. Sample consisted of 2682 men, aged 42-61 years at baseline. Data on mortality was provided by the National Death Registry, causes of death were classified by the National Center of Statistics of Finland. Cynical distrust was measured at baseline using Cynical Distrust Scale. Survival analyses were conducted using Cox regression models. In crude estimates after 28 years of follow-up, high cynical distrust was associated with 1.5-1.7 higher hazards for earlier death compared to low cynical distrust. Adjusted for conventional risk factors, high cynical distrust was significantly associated regarding CVD-free men and CVD mortality, while non-CVD mortality in study sample was consistently but not significantly associated. The risk effects were more expressed after 12-20 years rather than in earlier or later follow-up. To conclude, high cynical distrust associates with increased risk of CVD mortality in CVD-free men. The associations with non-CVD mortality are weaker and not reach statistical significance.

Increased mortality risk in women with depression and diabetes mellitus

PubMed Central

Pan, An; Lucas, Michel; Sun, Qi; van Dam, Rob M.; Franco, Oscar H.; Willett, Walter C.; Manson, JoAnn E.; Rexrode, Kathryn M.; Ascherio, Alberto; Hu, Frank B.

2011-01-01

Context Both depression and diabetes have been associated with an increased risk of all-cause and cardiovascular diseases (CVD) mortality. However, data evaluating the joint effects of these two conditions on mortality are sparse. Objectives To evaluate the individual and joint effects of depression and diabetes on all-cause and CVD mortality in a prospective cohort study. Design, Settings and Participants A total of 78282 female participants in the Nurses' Health Study aged 54-79 years at baseline in 2000 were followed until 2006. Depression was defined as having self-reported diagnosed depression, treatment with antidepressant medications, or a score indicating severe depressive symptomatology, i.e., a five-item Mental Health Index score ≤52. Self-reported type 2 diabetes was confirmed using a supplementary questionnaire. Main outcome measures All-cause and CVD-specific mortality. Results During 6 years of follow-up (433066 person-years), 4654 deaths were documented, including 979 deaths from CVD. Compared to participants without either condition, the age-adjusted relative risks (95% confidence interval, CI) for all-cause mortality were 1.76 (1.64-1.89) for women with depression only, 1.71 (1.54-1.89) for individuals with diabetes only, and 3.11 (2.70-3.58) for those with both conditions. The corresponding age-adjusted relative risks of CVD mortality were 1.81 (1.54-2.13), 2.67 (2.20-3.23), and 5.38 (4.19-6.91), respectively. These associations were attenuated after multivariate adjustment for other demographic variables, body mass index, smoking status, alcohol intake, physical activity, and major comorbidities (including hypertension, hypercholesterolemia, heart diseases, stroke and cancer) but remained significant, with the highest relative risks for all-cause and CVD mortality found in those with both conditions (2.07 [95% CI, 1.79-2.40] and 2.72 [95% CI, 2.09-3.54], respectively). Furthermore, the combination of depression with a long duration of diabetes (i.e., >10 years) or insulin therapy was associated with particularly higher risk of CVD mortality after multivariate adjustment (relative risk=3.22 and 4.90, respectively). Conclusions Depression and diabetes are associated with significantly increased risk of all-cause and CVD mortality. The coexistence of both conditions identifies particularly high-risk women. PMID:21199964

Socioeconomic differentials in cause-specific mortality among South Korean adolescents.

PubMed

Cho, Hong-Jun; Khang, Young-Ho; Yang, Seungmi; Harper, Sam; Lynch, John W

2007-02-01

There is inconsistent evidence regarding the presence of a socioeconomic differential in adolescent all-cause and cause-specific mortality. This study examines possible socioeconomic mortality differentials in Korean adolescents. Method A total of 330 321 boys and 311 830 girls aged 10-19, who are health insurance beneficiaries for civil servants and private school teachers of Korean Health Insurance Cooperation, were followed for 9 years (1995-2003). Parental income information was linked to national death certificate data. For boys, all-cause mortality showed a graded inverse relationship with income level in both 10-14 year olds (RR = 1.64, 95% CI: 1.40-1.91) and 15-19 year olds (RR = 1.68, 95% CI: 1.40-1.91). The major contributor was mortality differentials from external causes, with differentials of transport accident death the most important. Mortality from circulatory disease was higher in the lowest income groups in 15-19 year olds (RR = 2.21, 95% CI: 1.09-4.50). A significant socioeconomic gradient of non-external cause mortality was found in 15-19 year olds. For girls, socioeconomic differentials were less evident than boys. The all-cause mortality gradient for girls was smaller than for boys and only significant between the lowest and the highest tertile in both 10-14 year olds and 15-19 year olds (RR = 1.33, 95% CI: 1.02-1.72, RR = 1.38, 95% CI: 1.11-1.72, respectively). There were significant socioeconomic mortality differentials in all external causes and transport accidents and a marginally significant difference in suicide mortality for 10-19 year olds. Mortality from non-external causes showed no social gradient in girls. Socioeconomic differentials in all-cause mortality were observed in adolescents, even in early youth. This pattern might also apply to mortality from non-external causes, especially cardiovascular disease in 15-19 year old males.

Impact of lifestyle-related factors on all-cause and cause-specific mortality in patients with type 2 diabetes: the Taichung Diabetes Study.

PubMed

Lin, Cheng-Chieh; Li, Chia-Ing; Liu, Chiu-Shong; Lin, Wen-Yuan; Fuh, Martin Mao-Tsu; Yang, Sing-Yu; Lee, Cheng-Chun; Li, Tsai-Chung

2012-01-01

To examine whether combined lifestyle behaviors have an impact on all-cause and cause-specific mortality in patients aged 30-94 years with type 2 diabetes (T2DM). Participants included 5,686 patients >30 years old with T2DM who were enrolled in a Diabetes Care Management Program at a medical center in central Taiwan before 2007. Lifestyle behaviors consisted of smoking, alcohol drinking, physical inactivity, and carbohydrate intake. The main outcomes were all-cause and cause-specific mortality. Cox proportional hazards models were used to examine the association between combined lifestyle behaviors and mortality. The mortality rate among men was 24.10 per 1,000 person-years, and that among women was 17.25 per 1,000 person-years. After adjusting for the traditional risk factors, we found that combined lifestyle behavior was independently associated with all-cause mortality and mortality due to diabetes, cardiovascular disease, and cancer. Patients with three or more points were at a 3.50-fold greater risk of all-cause mortality (95% CI 2.06-5.96) and a 4.94-fold (1.62-15.06), 4.24-fold (1.20-14.95), and 1.31-fold (0.39-4.41) greater risk of diabetes-specific, CVD-specific, and cancer-specific mortality, respectively, compared with patients with zero points. Among these associations, the combined lifestyle behavior was not significantly associated with cancer mortality. Combined lifestyle behavior is a strong predictor of all-cause and cause-specific mortality in patients with T2DM.

Age-specific excess mortality patterns and transmissibility during the 1889-1890 influenza pandemic in Madrid, Spain.

PubMed

Ramiro, Diego; Garcia, Sara; Casado, Yolanda; Cilek, Laura; Chowell, Gerardo

2018-05-01

Although the 1889-1890 influenza pandemic was one of the most important epidemic events of the 19th century, little is known about the mortality impact of this pandemic based on detailed respiratory mortality data sets. We estimated excess mortality rates for the 1889-1890 pandemic in Madrid from high-resolution respiratory and all-cause individual-level mortality data retrieved from the Gazeta de Madrid, the Official Bulletin of the Spanish government. We also generated estimates of the reproduction number from the early growth phase of the pandemic. The main pandemic wave in Madrid was evident from respiratory and all-cause mortality rates during the winter of 1889-1890. Our estimates of excess mortality for this pandemic were 58.3 per 10,000 for all-cause mortality and 44.5 per 10,000 for respiratory mortality. Age-specific excess mortality rates displayed a J-shape pattern, with school children aged 5-14 years experiencing the lowest respiratory excess death rates (8.8 excess respiratory deaths per 10,000), whereas older populations aged greater than or equal to 70 years had the highest rates (367.9 per 10,000). Although seniors experienced the highest absolute excess death rates, the standardized mortality ratio was highest among young adults aged 15-24 years. The early growth phase of the pandemic displayed dynamics consistent with an exponentially growing transmission process. Using the generalized-growth method, we estimated the reproduction number in the range of 1.2-1.3 assuming a 3-day mean generation interval and of 1.3-1.5 assuming a 4-day mean generation interval. Our study adds to our understanding of the mortality impact and transmissibility of the 1889-1890 influenza pandemic using detailed individual-level mortality data sets. More quantitative studies are needed to quantify the variability of the mortality impact of this understudied pandemic at regional and global scales. Copyright © 2017 Elsevier Inc. All rights reserved.

Grilled, Barbecued, and Smoked Meat Intake and Survival Following Breast Cancer.

PubMed

Parada, Humberto; Steck, Susan E; Bradshaw, Patrick T; Engel, Lawrence S; Conway, Kathleen; Teitelbaum, Susan L; Neugut, Alfred I; Santella, Regina M; Gammon, Marilie D

2017-06-01

Grilled, barbecued, and smoked meat intake, a prevalent dietary source of polycyclic aromatic hydrocarbon (PAH) carcinogens, may increase the risk of incident breast cancer. However, no studies have examined whether intake of this PAH source influences survival after breast cancer. We interviewed a population-based cohort of 1508 women diagnosed with first primary invasive or in situ breast cancer in 1996 and 1997 at baseline and again approximately five years later to assess grilled/barbecued and smoked meat intake. After a median of 17.6 years of follow-up, 597 deaths, of which 237 were breast cancer related, were identified. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality as related to prediagnosis intake, comparing high (above the median) to low intake, as well as postdiagnosis changes in intake, comparing every combination of pre-/postdiagnosis intake to low pre-/postdiagnosis intake. All statistical tests were two-sided. High prediagnosis grilled/barbecued and smoked meat intake was associated with increased risk of all-cause mortality (HR = 1.23, 95% CI = 1.03 to 1.46). Other associations were noted, but estimates were not statistically significant. These include high prediagnosis smoked beef/lamb/pork intake and increased all-cause (HR = 1.17, 95% CI = 0.99 to 1.38, P trend = .10) and breast cancer-specific (HR = 1.23, 95% CI = 0.95 to 1.60, P trend = .09) mortality. Also, among women with continued high grilled/barbecued and smoked meat intake after diagnosis, all-cause mortality risk was elevated 31% (HR = 1.31, 95% CI = 0.96 to 1.78). Further, breast cancer-specific mortality was decreased among women with any pre- and postdiagnosis intake of smoked poultry/fish (HR = 0.55, 95% CI = 0.31 to 0.97). High intake of grilled/barbecued and smoked meat may increase mortality after breast cancer. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cause-specific mortality in Finnish forensic psychiatric patients.

PubMed

Ojansuu, Ilkka; Putkonen, Hanna; Tiihonen, Jari

2018-05-02

To analyze the causes of mortality among patients committed to compulsory forensic psychiatric hospital treatment in Finland during 1980-2009 by categorizing the causes of mortality into somatic diseases, suicides and other unnatural deaths. The causes of mortality were analyzed among 351 patients who died during the follow-up. Standardized mortality ratio (SMR) was calculated as the ratio of observed and expected number of deaths by using the subject-years methods with 95% confidence intervals, assuming a Poisson distribution. The expected number of deaths was calculated on the basis of sex-, age- and calendar-period-specific mortality rates for the Finnish population. The vast majority (249/351) of deaths were due to a somatic disease with SMR of 2.6 (mean age at death 61 years). Fifty nine patients committed suicide with a SMR of 7.1 (mean age at death 40 years). Four patients were homicide victims (mean age at death 40 years) and 32 deaths were accidental (mean age at death 52 years). The combined homicides and accidental deaths resulted in a SMR of 1.7. The results of this study point out that the high risk for suicide should receive attention when the hospital treatment and the outpatient care is being organized for forensic psychiatric patients. In addition, the risk of accidents should be evaluated and it should be assured that the patients receive proper somatic healthcare during the forensic psychiatric treatment and that it continues also in the outpatient setting.

Compensatory mortality in a recovering top carnivore: wolves in Wisconsin, USA (1979-2013).

PubMed

Stenglein, Jennifer L; Wydeven, Adrian P; Van Deelen, Timothy R

2018-05-01

Populations of large terrestrial carnivores are in various stages of recovery worldwide and the question of whether there is compensation in mortality sources is relevant to conservation. Here, we show variation in Wisconsin wolf survival from 1979 to 2013 by jointly estimating the hazard of wolves' radio-telemetry ending (endpoint) and endpoint cause. In previous analyses, wolves lost to radio-telemetry follow-up (collar loss) were censored from analysis, thereby assuming collar loss was unconfounded with mortality. Our approach allowed us to explicitly estimate hazard due to collar loss and did not require censoring these records from analysis. We found mean annual survival was 76% and mean annual causes of mortality were illegal killing (9.4%), natural and unknown causes (9.5%), and other human-caused mortality such as hunting, vehicle collisions and lethal control (5.1%). Illegal killing and natural mortality were highest during winter, causing wolf survival to decrease relative to summer. Mortality was highest during early recovery and lowest during a period of sustained population growth. Wolves again experienced higher risk of human-caused mortality relative to natural mortality as wolves expanded into areas with more human activity. We detected partial compensation in human- and natural-caused mortality since 2004 as the population saturated more available habitat. Prior to 2004, we detected additivity in mortality sources. Assessments of wolf survival and cause of mortality rates and the finding of partial compensation in mortality sources will inform wolf conservation and management efforts by identifying sources and sinks, finding areas of conservation need, and assessing management zone delineation.

US County-Level Trends in Mortality Rates for Major Causes of Death, 1980-2014.

PubMed

Dwyer-Lindgren, Laura; Bertozzi-Villa, Amelia; Stubbs, Rebecca W; Morozoff, Chloe; Kutz, Michael J; Huynh, Chantal; Barber, Ryan M; Shackelford, Katya A; Mackenbach, Johan P; van Lenthe, Frank J; Flaxman, Abraham D; Naghavi, Mohsen; Mokdad, Ali H; Murray, Christopher J L

2016-12-13

County-level patterns in mortality rates by cause have not been systematically described but are potentially useful for public health officials, clinicians, and researchers seeking to improve health and reduce geographic disparities. To demonstrate the use of a novel method for county-level estimation and to estimate annual mortality rates by US county for 21 mutually exclusive causes of death from 1980 through 2014. Redistribution methods for garbage codes (implausible or insufficiently specific cause of death codes) and small area estimation methods (statistical methods for estimating rates in small subpopulations) were applied to death registration data from the National Vital Statistics System to estimate annual county-level mortality rates for 21 causes of death. These estimates were raked (scaled along multiple dimensions) to ensure consistency between causes and with existing national-level estimates. Geographic patterns in the age-standardized mortality rates in 2014 and in the change in the age-standardized mortality rates between 1980 and 2014 for the 10 highest-burden causes were determined. County of residence. Cause-specific age-standardized mortality rates. A total of 80 412 524 deaths were recorded from January 1, 1980, through December 31, 2014, in the United States. Of these, 19.4 million deaths were assigned garbage codes. Mortality rates were analyzed for 3110 counties or groups of counties. Large between-county disparities were evident for every cause, with the gap in age-standardized mortality rates between counties in the 90th and 10th percentiles varying from 14.0 deaths per 100 000 population (cirrhosis and chronic liver diseases) to 147.0 deaths per 100 000 population (cardiovascular diseases). Geographic regions with elevated mortality rates differed among causes: for example, cardiovascular disease mortality tended to be highest along the southern half of the Mississippi River, while mortality rates from self-harm and interpersonal violence were elevated in southwestern counties, and mortality rates from chronic respiratory disease were highest in counties in eastern Kentucky and western West Virginia. Counties also varied widely in terms of the change in cause-specific mortality rates between 1980 and 2014. For most causes (eg, neoplasms, neurological disorders, and self-harm and interpersonal violence), both increases and decreases in county-level mortality rates were observed. In this analysis of US cause-specific county-level mortality rates from 1980 through 2014, there were large between-county differences for every cause of death, although geographic patterns varied substantially by cause of death. The approach to county-level analyses with small area models used in this study has the potential to provide novel insights into US disease-specific mortality time trends and their differences across geographic regions.

Lifetime Smoking History and Cause-Specific Mortality in a Cohort Study with 43 Years of Follow-Up

PubMed Central

Taghizadeh, Niloofar; Vonk, Judith M.; Boezen, H. Marike

2016-01-01

Background In general, smoking increases the risk of mortality. However, it is less clear how the relative risk varies by cause of death. The exact impact of changes in smoking habits throughout life on different mortality risks is less studied. Methods We studied the impact of baseline and lifetime smoking habits, and duration of smoking on the risk of all-cause mortality, mortality of cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), any cancer and of the four most common types of cancer (lung, colorectal, prostate, and breast cancer) in a cohort study (Vlagtwedde-Vlaardingen 1965–1990, with a follow-up on mortality status until 2009, n = 8,645). We used Cox regression models adjusted for age, BMI, sex, and place of residence. Since previous studies suggested a potential effect modification of sex, we additionally stratified by sex and tested for interactions. In addition, to determine which cause of death carried the highest risk we performed competing-risk analyses on mortality due to CVD, cancer, COPD and other causes. Results Current smoking (light, moderate, and heavy cigarette smoking) and lifetime persistent smoking were associated with an increased risk of all-cause, CVD, COPD, any cancer, and lung cancer mortality. Higher numbers of pack years at baseline were associated with an increased risk of all-cause, CVD, COPD, any cancer, lung, colorectal, and prostate cancer mortality. Males who were lifetime persistent pipe/cigar smokers had a higher risk of lung cancer [HR (95% CI) = 7.72 (1.72–34.75)] as well as all-cause and any cancer mortality. A longer duration of smoking was associated with a higher risk of COPD, any and lung cancer [HR (95% CI) = 1.06 (1.00–1.12), 1.03 (1.00–1.06) and 1.10 (1.03–1.17) respectively], but not with other mortality causes. The competing risk analyses showed that ex- and current smokers had a higher risk of cancer, CVD, and COPD mortality compared to all other mortality causes. In addition, heavy smokers had a higher risk for COPD mortality compared to cancer, and CVD mortality. Conclusion Our study indicates that lifetime numbers of cigarettes smoked and the duration of smoking have different impacts for different causes of mortality. Moreover, our findings emphasize the importance of smoking-related competing risks when studying the smoking-related cancer mortality in a general population and that smoking cessation immediately effectively reduces the risk of all-cause and any cancer mortality. PMID:27055053

Vitamin K intake and all-cause and cause specific mortality.

PubMed

Zwakenberg, Sabine R; den Braver, Nicole R; Engelen, Anouk I P; Feskens, Edith J M; Vermeer, Cees; Boer, Jolanda M A; Verschuren, W M Monique; van der Schouw, Yvonne T; Beulens, Joline W J

2017-10-01

Vitamin K has been associated with various health outcomes, including non-fatal cardiovascular diseases (CVD) and cancer. However, little is known about the association between vitamin K intake and all-cause and cause specific mortality. This study aims to investigate the association between vitamin K intake and all-cause and cause-specific mortality. This prospective cohort study included 33,289 participants from the EPIC-NL cohort, aged 20-70 years at baseline and recruited between 1993 and 1997. Dietary intake was assessed at baseline with a validated food frequency questionnaire and intakes of phylloquinone, and total, short chain and long chain menaquinones were calculated. Information on vital status and causes of death was obtained through linkage to several registries. The association between the different forms of vitamin K intake and mortality was assessed with Cox proportional hazards, adjusted for risk factors for chronic diseases and nutrient intake. During a mean follow-up of 16.8 years, 2863 deaths occurred, including 625 from CVD (256 from coronary heart disease (CHD)), 1346 from cancer and 892 from other causes. After multivariable adjustment, phylloquinone and menaquinones were not associated with all-cause mortality with hazard ratios for the upper vs. the lowest quartile of intake of 1.04 (0.92;1.17) and 0.94 (0.82;1.07) respectively. Neither phylloquinone intake nor menaquinone intake was associated with risk of CVD mortality. Higher intake of long chain menaquinones was borderline significantly associated (p trend  = 0.06) with lower CHD mortality with a HR 10μg of 0.86 (0.74;1.00). None of the forms of vitamin K intake were associated with cancer mortality or mortality from other causes. Vitamin K intake was not associated with all-cause mortality, cancer mortality and mortality from other causes. Copyright © 2016. Published by Elsevier Ltd.

Global and regional causes of death.

PubMed

Mathers, Colin D; Boerma, Ties; Ma Fat, Doris

2009-01-01

Assessing the causes of death across all regions of the world requires a framework for integrating, and analysing, the fragmentary information that is available on numbers of deaths and their cause distributions. This paper provides an overview of the met and methods used by the World Health Organization to develop global-, regional- and country-level estimates of mortality for a comprehensive set of causes, and provides an overview of global and regional levels and patterns of causes of death for the year 2004. The paper also examines some of the data gaps, uncertainties and limitations in the resulting mortality estimates. Deaths for 136 disease and injury causes were estimated from available death registration data (111 countries), sample death registration data (India and China), and for the remaining countries from census and survey information, and cause-of-death models. Population-based epidemiological studies and notifications systems also contributed to estimating mortality for 21 of these causes (representing 28% of deaths globally, 58% in Africa). Ischaemic heart disease and cerebrovascular disease are the leading causes of death, followed by lower respiratory infections, chronic obstructive pulmonary disease and diarrhoeal diseases. AIDS and TB are the sixth and seventh most common causes of death, respectively, lower than in previous estimates. One-half of all child deaths are from four preventable and treatable communicable diseases. Globally, around 6 in 10 deaths are from non-communicable diseases, 3 from communicable diseases and 1 from injuries. Injury mortality is highest in South-East Asia, Latin America and the Eastern Mediterranean region. These results illustrate continuing huge disparities in risks and causes of death across the world. Global mortality analyses of the type reported here have been criticized for making estimates of mortality for regions with limited, incomplete and uncertain data. Estimates presented here use a range of techniques depending on the type and quality of evidence. Better evidence on levels of adult mortality is needed for African countries. Considerable gaps and deficiencies remain in the information available on causes of death. Nine of 10 deaths in 2004 occurred in low- and middle-income countries, reinforcing the fundamental importance of improving mortality statistics as a measure of health status in the developing world. Acknowledging the controversies around use of incomplete and uncertain data, systematic assessments and synthesis of the available evidence will continue to provide important inputs for global health planning. Innovative methods involving sample registration, and the use of verbal autopsy questionnaires in surveys, are needed to address these gaps. Research on strategies to improve comparability of cause-of-death certification and coding practices across countries is also a high priority.

Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial.

PubMed

Olds, David L; Kitzman, Harriet; Knudtson, Michael D; Anson, Elizabeth; Smith, Joyce A; Cole, Robert

2014-09-01

Mothers and children living in adverse contexts are at risk of premature death. To determine the effect of prenatal and infant/toddler nurse home visiting on maternal and child mortality during a 2-decade period (1990-2011). A randomized clinical trial was designed originally to assess the home visiting program's effect on pregnancy outcomes and maternal and child health through child age 2 years. The study was conducted in a public system of obstetric and pediatric care in Memphis, Tennessee. Participants included primarily African American women and their first live-born children living in highly disadvantaged urban neighborhoods, who were assigned to 1 of 4 treatment groups: treatment 1 (transportation for prenatal care [n = 166]), treatment 2 (transportation plus developmental screening for infants and toddlers [n = 514]), treatment 3 (transportation plus prenatal/postpartum home visiting [n = 230]), and treatment 4 (transportation, screening, and prenatal, postpartum, and infant/toddler home visiting [n = 228]). Treatments 1 and 3 were included originally to increase statistical power for testing pregnancy outcomes. For determining mortality, background information was available for all 1138 mothers assigned to all 4 treatments and all but 2 live-born children in treatments 2 and 4 (n = 704). Inclusion of children in treatments 1 and 3 was not possible because background information was missing on too many children. Nurses sought to improve the outcomes of pregnancy, children's health and development, and mothers' health and life-course with home visits beginning during pregnancy and continuing through child age 2 years. All-cause mortality in mothers and preventable-cause mortality in children (sudden infant death syndrome, unintentional injury, and homicide) derived from the National Death Index. The mean (SE) 21-year maternal all-cause mortality rate was 3.7% (0.74%) in the combined control group (treatments 1 and 2), 0.4% (0.43%) in treatment 3, and 2.2% (0.97%) in treatment 4. The survival contrast of treatments 1 and 2 combined with treatment 3 was significant (P = .007); the contrast of treatments 1 and 2 combined with treatment 4 was not significant (P = .19), and the contrast of treatments 1 and 2 combined with treatments 3 and 4 combined was significant (post hoc P = .008). At child age 20 years, the preventable-cause child mortality rate was 1.6% (0.57%) in treatment 2 and 0.0% (SE not calculable) in treatment 4; the survival contrast was significant (P = .04). Prenatal and infant/toddler home visitation by nurses is a promising means of reducing all-cause mortality among mothers and preventable-cause mortality in their first-born children living in highly disadvantaged settings. clinicaltrials.gov Identifier: NCT00708695.

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

PubMed

Misganaw, Awoke; Haregu, Tilahun N; Deribe, Kebede; Tessema, Gizachew Assefa; Deribew, Amare; Melaku, Yohannes Adama; Amare, Azmeraw T; Abera, Semaw Ferede; Gedefaw, Molla; Dessalegn, Muluken; Lakew, Yihunie; Bekele, Tolesa; Mohammed, Mesoud; Yirsaw, Biruck Desalegn; Damtew, Solomon Abrha; Krohn, Kristopher J; Achoki, Tom; Blore, Jed; Assefa, Yibeltal; Naghavi, Mohsen

2017-01-01

Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015. Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country's performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

PubMed

Misganaw, Awoke; Haregu, Tilahun N; Deribe, Kebede; Tessema, Gizachew Assefa; Deribew, Amare; Melaku, Yohannes Adama; Amare, Azmeraw T; Abera, Semaw Ferede; Gedefaw, Molla; Dessalegn, Muluken; Lakew, Yihunie; Bekele, Tolesa; Mohammed, Mesoud; Yirsaw, Biruck Desalegn; Damtew, Solomon Abrha; Krohn, Kristopher J; Achoki, Tom; Blore, Jed; Assefa, Yibeltal; Naghavi, Mohsen

2017-07-21

Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015. Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country's performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.

NT-proBNP Predicts All-Cause Mortality in a Population of Insurance Applicants, Follow-up Analysis and Further Observations.

PubMed

Fulks, Michael; Kaufman, Valerie; Clark, Michael; Stout, Robert L

2017-01-01

- Further refine the independent value of NT-proBNP, accounting for the impact of other test results, in predicting all-cause mortality for individual life insurance applicants with and without heart disease. - Using the Social Security Death Master File and multivariate analysis, relative mortality was determined for 245,322 life insurance applicants ages 50 to 89 tested for NT-proBNP (almost all based on age and policy amount) along with other laboratory tests and measurement of blood pressure and BMI. - NT-proBNP values ≤75 pg/mL included the majority of applicants denying heart disease and had the lowest risk, while values >500 pg/mL for females and >300 pg/mL for males had very high relative risk. Those admitting to heart disease had a higher mortality risk for each band of NT-proBNP relative to those denying heart disease but had a similar and equally predictive risk curve. - NT-proBNP is a strong independent predictor of all-cause mortality in the absence or presence of known heart disease but the range of values associated with increased risk varies by sex.

Testing the Predictive Validity of the Healthy Eating Index-2015 in the Multiethnic Cohort: Is the Score Associated with a Reduced Risk of All-Cause and Cause-Specific Mortality?

PubMed

Panizza, Chloe E; Shvetsov, Yurii B; Harmon, Brook E; Wilkens, Lynne R; Le Marchand, Loic; Haiman, Christopher; Reedy, Jill; Boushey, Carol J

2018-04-05

The Healthy Eating Index-2015 (HEI-2015) was created to assess conformance of dietary intake with the Dietary Guidelines for Americans (DGA) 2015-2020. We assessed the association between the HEI-2015 and mortality from all-cause, cardiovascular disease (CVD), and cancer in the Multiethnic Cohort (MEC). White, African American, Native Hawaiian, Japanese American, and Latino adults ( n > 215,000) from Hawaii and California completed a quantitative food-frequency questionnaire at study enrollment. HEI-2015 scores were divided into quintiles for men and women. Radar graphs were used to demonstrate how dietary components contributed to HEI-2015 scores. Mortality was documented over 17-22 years of follow-up. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox proportional hazards models. High HEI-2015 scores were inversely associated with risk of mortality from all-cause, CVD, and cancer for men and women ( p -trend <0.0001 for all models). For men, the HRs (CIs) for all-cause, CVD, and cancer comparing the highest to the lowest quintile were 0.79 (0.76, 0.82), 0.76 (0.71, 0.82), and 0.80 (0.75, 0.87), respectively. For women, the HRs were 0.79 (0.76, 0.82), 0.75 (0.70, 0.81), and 0.84 (0.78, 0.91), respectively. These results, in a multiethnic population, demonstrate that following a diet aligned with the DGAs 2015-2020 recommendations is associated with lower risk of mortality from all-cause, CVD, and cancer.

Adolescent conduct problems and premature mortality: follow-up to age 65 years in a national birth cohort.

PubMed

Maughan, B; Stafford, M; Shah, I; Kuh, D

2014-04-01

Severe youth antisocial behaviour has been associated with increased risk of premature mortality in high-risk samples for many years, and some evidence now points to similar effects in representative samples. We set out to assess the prospective association between adolescent conduct problems and premature mortality in a population-based sample of men and women followed to the age of 65 years. A total of 4158 members of the Medical Research Council National Survey of Health and Development (the British 1946 birth cohort) were assessed for conduct problems at the ages of 13 and 15 years. Follow-up to the age of 65 years via the UK National Health Service Central Register provided data on date and cause of death. Dimensional measures of teacher-rated adolescent conduct problems were associated with increased hazards of death from cardiovascular disease by the age of 65 years in men [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.04-1.32], and of all-cause and cancer mortality by the age of 65 years in women (all-cause HR 1.16, 95% CI 1.07-1.25). Adjustment for childhood cognition and family social class did little to attenuate these risks. Adolescent conduct problems were not associated with increased risks of unnatural/substance-related deaths in men or women in this representative sample. Whereas previous studies of high-risk delinquent or offender samples have highlighted increased risks of unnatural and alcohol- or substance abuse-related deaths in early adulthood, we found marked differences in mortality risk from other causes emerging later in the life course among women as well as men.

The Adoption of Smoking and Its Effect on the Mortality Gender Gap in Netherlands: A Historical Perspective

PubMed Central

Janssen, Fanny; van Poppel, Frans

2015-01-01

We examine in depth the effect of differences in the smoking adoption patterns of men and women on the mortality gender gap in Netherlands, employing a historical perspective. Using an indirect estimation technique based on observed lung cancer mortality from 1931 to 2012, we estimated lifetime smoking prevalence and smoking-attributable mortality. We decomposed the sex difference in life expectancy at birth into smoking-related and nonsmoking-related overall and cause-specific mortality. The smoking epidemic in Netherlands, which started among men born around 1850 and among women from birth cohort 1900 onwards, contributed substantially to the increasing sex difference in life expectancy at birth from 1931 (1.3 years) to 1982 (6.7 years), the subsequent decline to 3.7 years in 2012, and the high excess mortality among Dutch men born between 1895 and 1910. Smoking-related cancer mortality contributed most to the increase in the sex difference, whereas smoking-related cardiovascular disease mortality was mainly responsible for the decline from 1983 onwards. Examining nonsmoking-related (cause-specific) mortality shed new light on the mortality gender gap and revealed the important role of smoking-related cancers, the continuation of excess mortality among women aged 40–50, and a smaller role of biological factors in the sex difference than was previously estimated. PMID:26273613

Mapping and detecting bark beetle-caused tree mortality in the western United States

NASA Astrophysics Data System (ADS)

Meddens, Arjan J. H.

Recently, insect outbreaks across North America have dramatically increased and the forest area affected by bark beetles is similar to that affected by fire. Remote sensing offers the potential to detect insect outbreaks with high accuracy. Chapter one involved detection of insect-caused tree mortality on the tree level for a 90km2 area in northcentral Colorado. Classes of interest included green trees, multiple stages of post-insect attack tree mortality including dead trees with red needles ("red-attack") and dead trees without needles ("gray-attack"), and non-forest. The results illustrated that classification of an image with a spatial resolution similar to the area of a tree crown outperformed that from finer and coarser resolution imagery for mapping tree mortality and non-forest classes. I also demonstrated that multispectral imagery could be used to separate multiple postoutbreak attack stages (i.e., red-attack and gray-attack) from other classes in the image. In Chapter 2, I compared and improved methods for detecting bark beetle-caused tree mortality using medium-resolution satellite data. I found that overall classification accuracy was similar between single-date and multi-date classification methods. I developed regression models to predict percent red attack within a 30-m grid cell and these models explained >75% of the variance using three Landsat spectral explanatory variables. Results of the final product showed that approximately 24% of the forest within the Landsat scene was comprised of tree mortality caused by bark beetles. In Chapter 3, I developed a gridded data set with 1-km2 resolution using aerial survey data and improved estimates of tree mortality across the western US and British Columbia. In the US, I also produced an upper estimate by forcing the mortality area to match that from high-resolution imagery in Idaho, Colorado, and New Mexico. Cumulative mortality area from all bark beetles was 5.46 Mha in British Columbia in 2001-2010 and 0.47-5.37 Mha (lower and upper estimate) in the western conterminous US during 1997-2010. Improved methods for detection and mapping of insect outbreak areas will lead to improved assessments of the effects of these forest disturbances on the economy, carbon cycle (and feedback to climate change), fuel loads, hydrology and forest ecology.

The Impact of Educational Status on 10-Year (2004-2014) Cardiovascular Disease Prognosis and All-cause Mortality Among Acute Coronary Syndrome Patients in the Greek Acute Coronary Syndrome (GREECS) Longitudinal Study

PubMed Central

Notara, Venetia; Kogias, Yannis; Stravopodis, Petros; Antonoulas, Antonis; Zombolos, Spyros; Mantas, Yannis; Pitsavos, Christos

2016-01-01

Objectives: The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated. Methods: From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient’s educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years). Results: Overall all-cause mortality was almost twofold higher in the low-education group than in the intermediate-education and high-education groups (40% vs. 22% and 19%, respectively, p<0.001). Additionally, 10-year recurrent ACS events (fatal and non-fatal) were more common in the low-education group than in the intermediate-education and high-education groups (42% vs. 30% and 35%, p<0.001), and no interactions between sex and education on the investigated outcomes were observed. Moreover, patients in the high-education group were more physically active, had a better financial status, and were less likely to have hypertension, diabetes, or ACS than the participants with the least education (p<0.001); however, when those characteristics and lifestyle habits were accounted for, no moderating effects regarding the relationship of educational status with all-cause mortality and ACS events were observed. Conclusions: A U-shaped association may be proposed for the relationship between ACS prognosis and educational status, with participants in the low-education and high-education groups being negatively affected by other factors (e.g., job stress, depression, or loneliness). Public health policies should be aimed at specific social groups to reduce the overall burden of cardiovascular disease morbidity. PMID:27499164

Physical work demands and physical fitness in low social classes--30-year ischemic heart disease and all-cause mortality in the Copenhagen Male Study.

PubMed

Holtermann, Andreas; Mortensen, Ole Steen; Burr, Hermann; Søgaard, Karen; Gyntelberg, Finn; Suadicani, Poul

2011-11-01

Investigate whether high physical work demands increase risk of ischemic heart disease (IHD) mortality among men of low social class with low physical fitness. Thirty-year follow-up in the Copenhagen Male Study of 5249 men aged 40 to 59 years without cardiovascular disease. Physical fitness was estimated using the Åstrand cycling test, and physical work demands determined by two self-reported questions. Among 2707 low social class men, multiple-adjusted Cox proportional hazard ratios showed an almost threefold increased risk of IHD mortality among men with high physical work demands and low physical fitness, but not among men with a high physical fitness, referencing men with low physical work demands. These findings among low social class men support that high physical work demands increases the risk of IHD mortality among those with low physical fitness.

Relationships of suicide ideation with cause-specific mortality in a longitudinal study of South Koreans.

PubMed

Khang, Young-Ho; Kim, Hye-Ryun; Cho, Seong-Jin

2010-10-01

Using 7-year mortality follow-up data (n = 341) from the 1998 National Health and Nutrition Examination Surveys of South Korean individuals (N = 5,414), the authors found that survey participants with suicide ideation were at increased risk of suicide mortality during the follow-up period compared with those without suicide ideation. The cause-specific analyses showed that, in men, suicide ideation was significantly associated with mortality due to cardiovascular disease, external causes, and other causes. However, there was no significant association between suicide ideation and cause-specific mortality in women. The relationship between suicide ideation and cause-specific mortality in men was not fully explained by baseline health status, socioeconomic status, health behavior, or psychosocial factors.

Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease.

PubMed

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

2009-04-14

The aim of this study was to investigate the predictive value for all-cause and cardiovascular (CV) death of anthropometric measurements of abdominal obesity in patients with end-stage renal disease (ESRD). Surrogate measures of abdominal obesity and segmental fat distribution (waist circumference and waist/hip ratio [WHR]) are stronger predictors of all-cause and CV death than body mass index (BMI) in the general population, but the issue has never been investigated in patients with ESRD. We performed a prospective cohort study in 537 patients with ESRD (age 63 +/- 15 years). In BMI-adjusted Cox models, waist circumference was a direct predictor of all-cause and CV mortality (p < 0.001), whereas BMI showed an inverse relationship (p < 0.001) with these outcomes. The incidence rates of overall and CV death were maximal in patients with relatively lower BMI scores (below the median) and higher waist circumferences (at least the median) and minimal in patients with higher BMI scores (at least the median) and small waist circumferences (below the median). The prognostic power of waist circumference for all-cause (hazard ratio [HR] [10-cm increase]: 1.23; 95% confidence interval [CI]: 1.02 to 1.47; p = 0.03) and CV mortality (HR: 1.37; 95% CI: 1.09 to 1.73; p = 0.006) remained significant after adjustment for CV comorbidities and traditional and emerging risk factors. WHR was found to be related to all-cause (p = 0.009) and CV mortality (p = 0.07). Abdominal obesity underlies a high risk of all-cause and CV mortality in patients with ESRD. Redefinition of nutritional status by combining the metrics of abdominal obesity and BMI may refine prognosis in the ESRD population.

Increased risk of death immediately after losing a spouse: Cause-specific mortality following widowhood in Norway.

PubMed

Brenn, Tormod; Ytterstad, Elinor

2016-08-01

This paper examines the short-term risk of cause-specific death following widowhood. We followed all individuals registered as married in Norway in 1975 for marital status and mortality until 2006. Widowed individuals were followed for mortality for 7years following widowhood. Causes of death were categorized into five cause-groups. Life tables were used in survival analyses. Deaths among the widowed were most frequent in the week following widowhood. In this week and compared to married individuals, there were more deaths including those from malignant cancer in men (hazard ratio (HR) of 1.51; 95% CI: 1.12, 1.89), from external causes in men (HR=3.64; 95% CI: 2.01, 5.28), and from respiratory diseases (HR=2.18; 95% CI: 1.52, 2.84 in men and HR=3.18; 95% CI: 2.26, 4.09 in women). A majority of respiratory deaths were from pneumonia. Thereafter excess mortality among the widowed dropped gradually. Although these numbers stabilized, they were still elevated in year 7. Excess mortality was particularly high in the youngest age group considered (55-64years) and decreased with age, though more so in men than in women. Only a few more widowed individuals than expected died of a condition in the same cause-group as their spouses. A novel finding was that excess deaths in the week following widowhood also were from cancer and respiratory diseases. Men in the youngest age group seemed most vulnerable. Prevention should be considered directly after the death of a spouse, and measures should be aimed at virtually all causes of death. Copyright © 2016 Elsevier Inc. All rights reserved.

Beyond the five-year horizon: long-term outcome of high-risk and inoperable patients undergoing TAVR with first-generation devices.

PubMed

Deutsch, Marcus-André; Erlebach, Magdalena; Burri, Melchior; Hapfelmeier, Alexander; Witt, Olivia Ganga; Ziegelmueller, Johannes Amadeus; Wottke, Michael; Ruge, Hendrik; Krane, Markus; Piazza, Nicolo; Bleiziffer, Sabine; Lange, Rüdiger

2018-05-20

We sought to determine the long-term outcome of high-risk patients who underwent transcatheter aortic valve replacement (TAVR) with first-generation devices with a focus on the identification of predictors for mortality and valve durability. Consecutive patients in our prospective single-centre registry undergoing TAVR with first-generation devices (n=214 CoreValve; n=86 SAPIEN) between 06/2007 and 07/2009 were retrospectively analysed (n=300, mean age 81.43±6.55 years, mean STS score 6.5±4.5%). Kaplan-Meier estimates of survival and the Cox proportional hazards model were used to identify independent predictors of all-cause-mortality. At 1, 5, and 7 years, estimated survival rates were 76.0%, 40.2%, and 23.2%, respectively. Age-adjusted baseline predictors of mortality included atrial fibrillation, impaired kidney function, peripheral artery disease, and mitral regurgitation (≥moderate). Baseline risk-adjusted procedure-related predictors for all-cause mortality included acute kidney injury, neurological events, major vascular complications, and major/life-threatening bleeding. At both five and six years, 78.2% of surviving patients were in NYHA Class I or II. PVL was ≤mild in the majority of patients at discharge and throughout follow-up. At seven years, the overall crude cumulative incidence of structural valve deterioration according to the 2017 EAPCI/ESC/EACTS definition was 14.9% (CoreValve 11.8% vs. SAPIEN 22.6%; p=0.01). Seven years after TAVR, 23.2% of high-risk patients were still alive. Independent predictors of all-cause mortality included both patient- and procedure-related factors. With a cumulative incidence of 14.9% at seven years, there is some suggestion that SVD post TAVR may become increasingly relevant during longer-term follow-up.

Challenging the FDA black box warning for high aspirin dose with ticagrelor in patients with diabetes.

PubMed

DiNicolantonio, James J; Serebruany, Victor L

2013-03-01

Ticagrelor, a novel reversible antiplatelet agent, has a Food and Drug Administration (FDA) black box warning to avoid maintenance doses of aspirin (ASA) >100 mg/daily. This restriction is based on the hypothesis that ASA doses >100 mg somehow decreased ticagrelor's benefit in the Platelet Inhibition and Patient Outcomes (PLATO) U.S. cohort. However, these data are highly postrandomized, come from a very small subgroup in PLATO (57% of patients in the U.S. site), and make no biological sense. Moreover, the ticagrelor-ASA interaction was not significant by any multivariate Cox regression analyses. The Complete Response Review for ticagrelor indicates that for U.S. PLATO patients, an ASA dose >300 mg was not a significant interaction for vascular outcomes. In the ticagrelor-ASA >300 mg cohort, all-cause and vascular mortality were not significantly increased (hazard ratio [HR] 1.27 [95% CI 0.84-1.93], P = 0.262 and 1.39 [0.87-2.2], P = 0.170), respectively. Furthermore, for major adverse cardiovascular events (MACEs), 30-day all-cause mortality, and 30-day vascular mortality, the strongest interaction is the diabetes-ASA interaction. That is, patients who had diabetes had significantly fewer MACEs through study end (0.49 [0.34-0.63], P < 0.0001), significantly less 30-day all-cause mortality (0.33 [0.20-0.56], P < 0.0001), and significantly less 30-day vascular mortality (0.35 [0.22-0.55], P < 0.0001), respectively, when given high-dose (300-325 mg) ASA, regardless of treatment (clopidogrel or ticagrelor) assignment. The black box warning for the use of maintenance ASA doses >100 mg with ticagrelor is inappropriate for patients with diabetes and not evidence based.

Associations of Walking Speed, Grip Strength, and Standing Balance With Total and Cause-Specific Mortality in a General Population of Japanese Elders.

PubMed

Nofuji, Yu; Shinkai, Shoji; Taniguchi, Yu; Amano, Hidenori; Nishi, Mariko; Murayama, Hiroshi; Fujiwara, Yoshinori; Suzuki, Takao

2016-02-01

Walking speed, grip strength, and standing balance are key components of physical performance in older people. The present study aimed to evaluate (1) associations of these physical performance measures with cause-specific mortality, (2) independent associations of individual physical performance measures with mortality, and (3) the added value of combined use of the 3 physical performance measures in predicting all-cause and cause-specific mortality. Prospective cohort study with a follow-up of 10.5 years. Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (TMIG-LISA), Japan. A total of 1085 initially nondisabled older Japanese aged 65 to 89 years. Usual walking speed, grip strength, and standing balance were measured at baseline survey. During follow-up, 324 deaths occurred (122 of cardiovascular disease, 75 of cancer, 115 of other causes, and 12 of unknown causes). All 3 physical performance measures were significantly associated with all-cause, cardiovascular, and other-cause mortality, but not with cancer mortality, independent of potential confounders. When all 3 physical performance measures were simultaneously entered into the model, each was significantly independently associated with all-cause and cardiovascular mortality. The C statistics for all-cause and cardiovascular mortality were significantly increased by adding grip strength and standing balance to walking speed (P < .01), and the net reclassification improvement for them was estimated at 18.7% and 7.5%, respectively. Slow walking speed, weak grip strength, and poor standing balance predicted all-cause, cardiovascular, and other-cause mortality, but not cancer mortality, independent of covariates. Moreover, these 3 components of physical performance were independently associated with all-cause and cardiovascular mortality and their combined use increased prognostic power. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Differential host mortality explains the effect of high temperature on the prevalence of a marine pathogen

PubMed Central

Neigel, Joseph E.

2017-01-01

Infectious diseases threaten marine populations, and the extent of their impacts is often assessed by prevalence of infection (the proportion of infected individuals). Changes in prevalence are often attributed to altered rates of transmission, although the rates of birth, recovery, and mortality also determine prevalence. The parasitic dinoflagellate Hematodinium perezi causes a severe, often fatal disease in blue crabs. It has been speculated that decreases in prevalence associated with high temperatures result from lower rates of infection. We used field collections, environmental sensor data, and high-temperature exposure experiments to investigate the factors that change prevalence of infections in blue crab megalopae (post-larvae). These megalopae migrate from offshore waters, where temperatures are moderate, to marshes where temperatures may be extremely high. Within a few days of arriving in the marsh, the megalopae metamorphose into juvenile crabs. We found a strong negative association between prevalence of Hematodinium infection in megalopae and the cumulative time water temperatures in the marsh exceeded 34°C over the preceding two days. Temperatures this high are known to be lethal for blue crabs, suggesting that higher mortality of infected megalopae could be the cause of reduced prevalence. Experimental exposure of megalopae from the marsh to a temperature of 34°C resulted in higher mortality for infected than uninfected individuals, and decreased the prevalence of infection among survivors from 18% to 3%. PMID:29084257

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

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. Copyright © 2013 Elsevier Ltd. All rights reserved.

Competing risks to breast cancer mortality in Catalonia

PubMed Central

Vilaprinyo, Ester; Gispert, Rosa; Martínez-Alonso, Montserrat; Carles, Misericòrdia; Pla, Roger; Espinàs, Josep-Alfons; Rué, Montserrat

2008-01-01

Background Breast cancer mortality has experienced important changes over the last century. Breast cancer occurs in the presence of other competing risks which can influence breast cancer incidence and mortality trends. The aim of the present work is: 1) to assess the impact of breast cancer deaths among mortality from all causes in Catalonia (Spain), by age and birth cohort and 2) to estimate the risk of death from other causes than breast cancer, one of the inputs needed to model breast cancer mortality reduction due to screening or therapeutic interventions. Methods The multi-decrement life table methodology was used. First, all-cause mortality probabilities were obtained by age and cohort. Then mortality probability for breast cancer was subtracted from the all-cause mortality probabilities to obtain cohort life tables for causes other than breast cancer. These life tables, on one hand, provide an estimate of the risk of dying from competing risks, and on the other hand, permit to assess the impact of breast cancer deaths on all-cause mortality using the ratio of the probability of death for causes other than breast cancer by the all-cause probability of death. Results There was an increasing impact of breast cancer on mortality in the first part of the 20th century, with a peak for cohorts born in 1945–54 in the 40–49 age groups (for which approximately 24% of mortality was due to breast cancer). Even though for cohorts born after 1955 there was only information for women under 50, it is also important to note that the impact of breast cancer on all-cause mortality decreased for those cohorts. Conclusion We have quantified the effect of removing breast cancer mortality in different age groups and birth cohorts. Our results are consistent with US findings. We also have obtained an estimate of the risk of dying from competing-causes mortality, which will be used in the assessment of the effect of mammography screening on breast cancer mortality in Catalonia. PMID:19014473

The Enduring Association between Education and Mortality: The Role of Widening and Narrowing Disparities

PubMed Central

Miech, Richard; Pampel, Fred; Kim, Jinyoung; Rogers, Richard G.

2015-01-01

This paper examines how educational disparities in mortality emerge, grow, decline, and disappear across causes of death in the United States and how these change contribute to the enduring association of education and mortality over time. Focusing on adults age 40–64, we first examine the extent to which disparities in all-cause mortality by education persisted from 1989–2007. We then test the “fundamental cause” prediction that mortality disparities persist, in part, by shifting to new health outcomes over time, most importantly for those causes of death that have increasing mortality rates. To test this hypothesis, we focus in depth on the period from 1999–2007, when all causes of death were coded to the same classification system. The results indicate (a) both substantial widening and narrowing of mortality disparities across causes of death, (b) almost all causes of death that had increasing mortality rates also had widening disparities by education, and (c) the total disparity by education in all-cause mortality would be about 25% smaller today were it not for newly widened or emergent disparities since 1999. These results point to the theoretical and policy importance of identifying the social forces that cause health disparities to widen over time. PMID:26937041

Associations of Grip Strength and Change in Grip Strength With All-Cause and Cardiovascular Mortality in a European Older Population

PubMed Central

Prasitsiriphon, Orawan; Pothisiri, Wiraporn

2018-01-01

Objective: (1) To examine the associations between 3 measures of grip strength: static grip strength, change in grip strength, and the combination of grip strength and its change, with all-cause and cardiovascular mortality, and (2) to determine which measure is the most powerful predictor of all-cause and cardiovascular mortality among the European older population. Method: Data come from the first 4 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). A Cox proportional hazard model and a competing risk regression model were used to assess the associations. To determine the best predictor, Akaike information criterion was applied. Results: Grip strength and the combination of grip strength and its change were associated with all-cause and cardiovascular mortality. Change in grip strength was correlated with only all-cause mortality. Among the 3 measures, the static measure of grip strength was the best predictor of cardiovascular mortality whereas the combined measure is that of all-cause mortality. Discussion: Grip strength is a significant indicator of all-cause and cardiovascular mortality. The combination of grip strength and its change can be used to increase the accuracy for prediction of all-cause mortality among older persons.

Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people.

PubMed

Regidor, Enrique; Vallejo, Fernando; Granados, José A Tapia; Viciana-Fernández, Francisco J; de la Fuente, Luis; Barrio, Gregorio

2016-11-26

Studies of the effect of macroeconomic fluctuations on mortality in different socioeconomic groups are scarce and have yielded mixed findings. We analyse mortality trends in Spain before and during the Great Recession in different socioeconomic groups, quantifying the change within each group. We did a nationwide prospective study, in which we took data from the 2001 Census. All people living in Spain on Nov 1, 2001, were followed up until Dec 31, 2011. We included 35 951 354 people alive in 2001 who were aged between 10 and 74 years in each one of the four calendar years before the economic crisis (from 2004 to 2007) and in each one of the first four calendar years of the crisis (from 2008 to 2011), and analysed all-cause and cause-specific mortality in those people. We classified individuals by socioeconomic status (low, medium, or high) using two indicators of household wealth: household floor space (<72 m 2 , 72-104 m 2 , and >104 m 2 ) and number of cars owned by the residents of the household (none, one, and two or more). We used Poisson regression to calculate the annual percentage reduction (APR) in mortality rates during 2004-07 (pre-crisis) and 2008-11 (crisis) in each socioeconomic group, as well as the effect size, measured by the APR difference between the pre-crisis and crisis period. The annual decline in all-cause mortality in the three socioeconomic groups was 1·7% (95% CI 1·2 to 2·1) for the low group, 1·7% (1·3 to 2·1) for the medium group, and 2·0% (1·4 to 2·5) for the high group in 2004-07, and 3·0% (2·5 to 3·5) for the low group, 2·8% (2·5 to 3·2) for the medium group, and 2·1% (1·6 to 2·7) for the high group in 2008-11 when individuals were classified by household floor space. The annual decline in all-cause mortality when people were classified by number of cars owned by the household was 0·3% (-0·1 to 0·8) for the low group, 1·6% (1·2 to 2·0) for the medium group, and 2·2% (1·6 to 2·8) for the high group in 2004-07, and 2·3% (1·8 to 2·8) for the low group, 2·4% (2·0 to 2·7) for the medium group and 2·5% (1·9 to 3·0) for the high group in 2008-11. The low socioeconomic group showed the largest effect size for both wealth indicators. In Spain, probably due to the decrease in exposure to risk factors, all-cause mortality decreased more during the economic crisis than before the economic crisis, especially in low socioeconomic groups. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

Relationships between exercise, smoking habit and mortality in more than 100,000 adults.

PubMed

O'Donovan, Gary; Hamer, Mark; Stamatakis, Emmanuel

2017-04-15

Exercise is associated with reduced risks of all-cause, cardiovascular disease (CVD) and cancer mortality; however, the benefits in smokers and ex-smokers are unclear. The aim of this study was to investigate associations between exercise, smoking habit and mortality. Self-reported exercise and smoking, and all-cause, CVD and cancer mortality were assessed in 106,341 adults in the Health Survey for England and the Scottish Health Survey. There were 9149 deaths from all causes, 2839 from CVD and 2634 from cancer during 999,948 person-years of follow-up. Greater amounts of exercise were associated with decreases and greater amounts of smoking were associated with increases in the risks of mortality from all causes, CVD and cancer. There was no statistically significant evidence of biological interaction; rather, the relative risks of all-cause mortality were additive. In the subgroup of 26,768 ex-smokers, the all-cause mortality hazard ratio was 0.70 (95% CI 0.60, 0.80), the CVD mortality hazard ratio was 0.71 (0.55, 092) and the cancer mortality hazard ratio was 0.66 (0.52, 0.84) in those who exercised compared to those who did not. In the subgroup of 28,440 smokers, the all-cause mortality hazard ratio was 0.69 (0.57, 0.83), the CVD mortality hazard ratio was 0.66 (0.45, 0.96) and the cancer mortality hazard ratio was 0.69 (0.51, 0.94) in those who exercised compared to those who did not. Given that an outright ban is unlikely, this study is important because it suggests exercise reduces the risks of all-cause, CVD and cancer mortality by around 30% in smokers and ex-smokers. © 2017 UICC.

The evolution of senescence through decelerating selection for system reliability.

PubMed

Laird, R A; Sherratt, T N

2009-05-01

Senescence is a universal phenomenon in organisms, characterized by increasing mortality and decreasing fecundity with advancing chronological age. Most proximate agents of senescence, such as reactive oxygen species and UV radiation, are thought to operate by causing a gradual build-up of bodily damage. Yet most current evolutionary theories of senescence emphasize the deleterious effects of functioning genes in late life, leaving a gap between proximate and ultimate explanations. Here, we present an evolutionary model of senescence based on reliability theory, in which beneficial genes or gene products gradually get damaged and thereby fail, rather than actively cause harm. Specifically, the model allows organisms to evolve multiple redundant copies of a gene product (or gene) that performs a vital function, assuming that organisms can avoid condition-dependent death so long as at least one copy remains undamaged. We show that organisms with low levels of extrinsic mortality, and high levels of genetic damage, tend to evolve high levels of redundancy, and that mutation-selection balance results in a stable population distribution of the number of redundant elements. In contrast to previous evolutionary models of senescence, the mortality curves that emerge from such populations match empirical senescence patterns in three key respects: they exhibit: (1) an initially low, but rapidly increasing mortality rate at young ages, (2) a plateau in mortality at advanced ages and (3) 'mortality compensation', whereby the height of the mortality plateau is independent of the environmental conditions under which different populations evolved.

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

Exploring the association between heat and mortality in Switzerland between 1995 and 2013.

PubMed

Ragettli, Martina S; Vicedo-Cabrera, Ana M; Schindler, Christian; Röösli, Martin

2017-10-01

Designing effective public health strategies to prevent adverse health effect of hot weather is crucial in the context of global warming. In Switzerland, the 2003 heat have caused an estimated 7% increase in all-cause mortality. As a consequence, the Swiss Federal Office of Public Health developed an information campaign to raise public awareness on heat threats. For a better understanding on how hot weather affects daily mortality in Switzerland, we assessed the effect of heat on daily mortality in eight Swiss cities and population subgroups from 1995 to 2013 using different temperature metrics (daily mean (Tmean), maximum (Tmax), minimum (Tmin) and maximum apparent temperature (Tappmax)), and aimed to evaluate variations of the heat effect after 2003 (1995-2002 versus 2004-2013). We applied conditional quasi-Poisson regression models with non-linear distributed lag functions to estimate temperature-mortality associations over all cities (1995-2013) and separately for two time periods (1995-2002, 2004-2013). Relative risks (RR) of daily mortality were estimated for increases in temperature from the median to the 98th percentile of the warm season temperature distribution. Over the whole time period, significant temperature-mortality relationships were found for all temperature indicators (RR (95% confidence interval): Tappmax: 1.12 (1.05; 1.18); Tmax: 1.15 (1.08-1.22); Tmean: 1.16 (1.09-1.23); Tmin 1.23 (1.15-1.32)). Mortality risks were higher at the beginning of the summer, especially for Tmin. In the more recent time period, we observed a non-significant reduction in the effect of high temperatures on mortality, with the age group > 74 years remaining the population at highest risk. High temperatures continue to be a considerable risk factor for human health in Switzerland after 2003. More effective public health measures targeting the elderly should be promoted with increased attention to the first heat events in summer and considering both high day-time and night-time temperatures. Copyright © 2017 Elsevier Inc. All rights reserved.

Socioeconomic position, health behaviors, and racial disparities in cause-specific infant mortality in Michigan, USA

PubMed Central

El-Sayed, Abdulrahman M.; Finkton, Darryl W.; Paczkowski, Magdalena; Keyes, Katherine M.; Galea, Sandro

2015-01-01

Objectives Studies about racial disparities in infant mortality suggest that racial differences in socioeconomic position (SEP) and maternal risk behaviors explain some, but not all, excess infant mortality among Blacks relative to non-Hispanic Whites. We examined the contribution of these to disparities in specific causes of infant mortality. Methods We analyzed data about 2,087,191 mother–child dyads in Michigan between 1989 and 2005. First, we calculated crude Black–White infant mortality ratios independently and by specific cause of death. Second, we fit multivariable Poisson regression models of infant mortality, overall and by cause, adjusting for SEP and maternal risk behaviors. Third, Crude Black–White mortality ratios were compared to adjusted predicted probability ratios, overall and by specific cause. Results SEP and maternal risk behaviors explained nearly a third of the disparity in infant mortality overall, and over 25% of disparities in several specific causes including homicide, accident, sudden infant death syndrome, and respiratory distress syndrome. However, SEP and maternal risk behaviors had little influence on disparities in other specific causes, such as septicemia and congenital anomalies. Conclusions These findings help focus policy attention toward disparities in those specific causes of infant mortality most amenable to social and behavioral intervention, as well as research attention to disparities in specific causes unexplained by SEP and behavioral differences. PMID:25849882

Socioeconomic position, health behaviors, and racial disparities in cause-specific infant mortality in Michigan, USA.

PubMed

El-Sayed, Abdulrahman M; Finkton, Darryl W; Paczkowski, Magdalena; Keyes, Katherine M; Galea, Sandro

2015-07-01

Studies about racial disparities in infant mortality suggest that racial differences in socioeconomic position (SEP) and maternal risk behaviors explain some, but not all, excess infant mortality among Blacks relative to non-Hispanic Whites. We examined the contribution of these to disparities in specific causes of infant mortality. We analyzed data about 2,087,191 mother-child dyads in Michigan between 1989 and 2005. First, we calculated crude Black-White infant mortality ratios independently and by specific cause of death. Second, we fit multivariable Poisson regression models of infant mortality, overall and by cause, adjusting for SEP and maternal risk behaviors. Third, Crude Black-White mortality ratios were compared to adjusted predicted probability ratios, overall and by specific cause. SEP and maternal risk behaviors explained nearly a third of the disparity in infant mortality overall, and over 25% of disparities in several specific causes including homicide, accident, sudden infant death syndrome, and respiratory distress syndrome. However, SEP and maternal risk behaviors had little influence on disparities in other specific causes, such as septicemia and congenital anomalies. These findings help focus policy attention toward disparities in those specific causes of infant mortality most amenable to social and behavioral intervention, as well as research attention to disparities in specific causes unexplained by SEP and behavioral differences. Copyright © 2015. Published by Elsevier Inc.

Epidemiology of under-five mortality in İstanbul: changes from 1988 to 2011.

PubMed

Buzcu, Aysun Fahriye; Yetim Şahin, Aylin; Karapinar, Esra; Erol, Özge; Gökçay, Emine Gülbin

2017-06-12

Understanding the causes of under-five deaths is key to realizing sustainable developmental goals. The aim of this descriptive study was to investigate the causes of under-five mortality in İstanbul during 2011 and compare the findings to those of 1988 and 2000. All burial records of İstanbul were evaluated, and cemetery records of 1494 children, who died at under five years of age and were buried in İstanbul Metropolitan Municipality Cemeteries between 1 January and 31 December 2011, were analyzed. Several sociodemographic characteristics and causes of death were compared with the results of studies carried out in 1988 and 2000 in İstanbul with similar methods. Under-five mortality rate was lower in 2011 than in 1988 and 2000. Of all deaths, 58.8% had occurred in the neonatal period and most were in the first day of life, similarly to those of 1988 and 2000. The proportion of deaths in the age group of 1-4 years was found to be increasing. Prematurity and perinatal causes remained the main cause of death under five years of age in İstanbul during the 23-year period. Unknown causes, due to misclassification, were still seen in a relatively high proportion. Under-five mortality rate and death due to infectious diseases decreased in İstanbul from 1988 to 2011. Our findings showed a need for more emphasis on perinatal events and better evaluation of causes of death in clinical practice.

Fiber intake and all-cause mortality in the Prevención con Dieta Mediterránea (PREDIMED) study.

PubMed

Buil-Cosiales, Pilar; Zazpe, Itziar; Toledo, Estefanía; Corella, Dolores; Salas-Salvadó, Jordi; Diez-Espino, Javier; Ros, Emilio; Fernandez-Creuet Navajas, Joaquin; Santos-Lozano, José Manuel; Arós, Fernando; Fiol, Miquel; Castañer, Olga; Serra-Majem, Lluis; Pintó, Xavier; Lamuela-Raventós, Rosa M; Marti, Amelia; Basterra-Gortari, F Javier; Sorlí, José V; Verdú-Rotellar, Jose M; Basora, Josep; Ruiz-Gutierrez, Valentina; Estruch, Ramón; Martínez-González, Miguel Á

2014-12-01

Few observational studies have examined the effect of dietary fiber intake and fruit and vegetable consumption on total mortality and have reported inconsistent results. All of the studies have been conducted in the general population and typically used only a single assessment of diet. We investigated the association of fiber intake and whole-grain, fruit, and vegetable consumption with all-cause mortality in a Mediterranean cohort of elderly adults at high cardiovascular disease (CVD) risk by using repeated measurements of dietary information and taking into account the effect of a dietary intervention. We followed up 7216 men (55-75 y old) and women (60-75 y old) at high CVD risk in the Prevención con Dieta Mediterránea (PREDIMED) trial for a mean of 5.9 y. Data were analyzed as an observational cohort. Participants were initially free of CVD. A 137-item validated food-frequency questionnaire administered by dietitians was repeated annually to assess dietary exposures (fiber, fruit, vegetable, and whole-grain intakes). Deaths were identified through the continuing medical care of participants and the National Death Index. An independent, blinded Event Adjudication Committee adjudicated causes of death. Cox regression models were used to estimate HRs of death during follow-up according to baseline dietary exposures and their yearly updated changes. In up to 8.7 y of follow-up, 425 participants died. Baseline fiber intake and fruit consumption were significantly associated with lower risk of death [HRs for the fifth compared with the first quintile: 0.63 (95% CI: 0.46, 0.86; P = 0.015) and 0.59 (95% CI: 0.42, 0.82; P = 0.004), respectively]. When the updated dietary information was considered, participants with fruit consumption >210 g/d had 41% lower risk of all-cause mortality (HR: 0.59; 95% CI: 0.44, 0.78). Associations were strongest for CVD mortality than other causes of death. Fiber and fruit intakes are associated with a reduction in total mortality. PREDIMED was registered at controlled-trials.com as ISRCTN35739639. © 2014 American Society for Nutrition.

Variation in and risk factors for paediatric inpatient all-cause mortality in a low income setting: data from an emerging clinical information network.

PubMed

Gathara, David; Malla, Lucas; Ayieko, Philip; Karuri, Stella; Nyamai, Rachel; Irimu, Grace; van Hensbroek, Michael Boele; Allen, Elizabeth; English, Mike

2017-04-05

Hospital mortality data can inform planning for health interventions and may help optimize resource allocation if they are reliable and appropriately interpreted. However such data are often not available in low income countries including Kenya. Data from the Clinical Information Network covering 12 county hospitals' paediatric admissions aged 2-59 months for the periods September 2013 to March 2015 were used to describe mortality across differing contexts and to explore whether simple clinical characteristics used to classify severity of illness in common treatment guidelines are consistently associated with inpatient mortality. Regression models accounting for hospital identity and malaria prevalence (low or high) were used. Multiple imputation for missing data was based on a missing at random assumption with sensitivity analyses based on pattern mixture missing not at random assumptions. The overall cluster adjusted crude mortality rate across hospitals was 6 · 2% with an almost 5 fold variation across sites (95% CI 4 · 9 to 7 · 8; range 2 · 1% - 11 · 0%). Hospital identity was significantly associated with mortality. Clinical features included in guidelines for common diseases to assess severity of illness were consistently associated with mortality in multivariable analyses (AROC =0 · 86). All-cause mortality is highly variable across hospitals and associated with clinical risk factors identified in disease specific guidelines. A panel of these clinical features may provide a basic common data framework as part of improved health information systems to support evaluations of quality and outcomes of care at scale and inform health system strengthening efforts.

Does transport time help explain the high trauma mortality rates in rural areas? New and traditional predictors assessed by new and traditional statistical methods

PubMed Central

Røislien, Jo; Lossius, Hans Morten; Kristiansen, Thomas

2015-01-01

Background Trauma is a leading global cause of death. Trauma mortality rates are higher in rural areas, constituting a challenge for quality and equality in trauma care. The aim of the study was to explore population density and transport time to hospital care as possible predictors of geographical differences in mortality rates, and to what extent choice of statistical method might affect the analytical results and accompanying clinical conclusions. Methods Using data from the Norwegian Cause of Death registry, deaths from external causes 1998–2007 were analysed. Norway consists of 434 municipalities, and municipality population density and travel time to hospital care were entered as predictors of municipality mortality rates in univariate and multiple regression models of increasing model complexity. We fitted linear regression models with continuous and categorised predictors, as well as piecewise linear and generalised additive models (GAMs). Models were compared using Akaike's information criterion (AIC). Results Population density was an independent predictor of trauma mortality rates, while the contribution of transport time to hospital care was highly dependent on choice of statistical model. A multiple GAM or piecewise linear model was superior, and similar, in terms of AIC. However, while transport time was statistically significant in multiple models with piecewise linear or categorised predictors, it was not in GAM or standard linear regression. Conclusions Population density is an independent predictor of trauma mortality rates. The added explanatory value of transport time to hospital care is marginal and model-dependent, highlighting the importance of exploring several statistical models when studying complex associations in observational data. PMID:25972600

[Regional distribution of all-cause mortality and coronary disease incidence in Turkey: findings of Turkish Adult Risk Factor survey 2010].

PubMed

Onat, Altan; Murat, Sani Namık; Ciçek, Gökhan; Ayhan, Erkan; Ornek, Ender; Kaya, Hasan; Gümrükçüoğlu, Hasan Ali; Doğan, Yüksel; Can, Günay

2011-06-01

We analyzed the distribution of cumulative all-cause and cardiovascular mortality and incident coronary heart disease (CHD) across the seven geographic regions of Turkey and presented overall and coronary mortality findings of the 2010 survey of the Turkish Adult Risk Factor Study. A total of 1406 participants were surveyed. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local heath offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiography. Of the surveyed participants, 686 were examined; information on health status was obtained in 577 subjects, and 32 participants (14 women, 18 men; mean age 72.3±15.6 years) were ascertained to have died. The total duration of follow-up was 2,520 person-years. Nineteen deaths were of coronary (n=16) or cerebrovascular (n=3) origin. Cumulative 20-year assessment of the entire cohort for the age bracket of 45-74 years disclosed a high coronary mortality rate, being 7.4 and 4.1 per 1000 person-years in men and women, respectively, and representing a limited decline after year 2000. Age-adjusted Cox regression analysis comprising 433 deaths and 506 incident CHD cases over a 7.3-year follow-up showed similar mortality rates across the regions, and a significantly high CHD incidence in males of the Black Sea and Marmara regions and in females of the Southeast Anatolia. Currently, 480,000 incident CHD cases are estimated yearly in Turkey. The high age-adjusted overall mortality in Turkey shows nonsignificant differences across geographic regions, whereas the age-adjusted CHD incidence is high in the Black Sea and Marmara regions.

Complete Genome Sequence of the Neonatal Meningitis-Causing Escherichia coli Strain NMEC O18

PubMed Central

Nicholson, Bryon A.; Wannemuehler, Yvonne M.; Logue, Catherine M.; Li, Ganwu

2016-01-01

Neonatal meningitis Escherichia coli (NMEC) is a common agent of neonatal bacterial meningitis, causing high neonatal mortality and neurologic sequelae in its victims. Here, we present the complete genome sequence of NMEC O18 (also known as NMEC 58), a highly virulent (O18ac:K1, ST416) strain. PMID:27811114

Perinatal mortality in caribou from the Porcupine herd, Alaska

USGS Publications Warehouse

Roffe, T.J.

1993-01-01

During the 1989 caribou (Rangifer tarandus) calving season on the Arctic National Wildlife Refuge, Alaska (USA), 61 calf carcasses were examined for cause of death and associated pathology. Dead calves were located by low-level aerial searches with two fixed-wing aircraft and a helicopter over high density calving areas between the Hulahula and Aichilik rivers. Primary diagnoses included emaciation (39%), malnutrition (8%), stillbirth (21%), trauma (16%), other primary causes (7%), and undetermined causes (8%). Twenty calves had contributory renal tubular degeneration. The findings indicate that factors contributing to nutritional deprivation in calves were the major cause of neonatal mortality; however, factors affecting stillbirth, abortion, or the urogenital system may have major effects on neonatal caribou and warrant further investigation.

Perinatal mortality in caribou from the Porcupine herd, Alaska.

PubMed

Roffe, T J

1993-04-01

During the 1989 caribou (Rangifer tarandus) calving season on the Arctic National Wildlife Refuge, Alaska (USA), 61 calf carcasses were examined for cause of death and associated pathology. Dead calves were located by low-level aerial searches with two fixed-wing aircraft and a helicopter over high density calving areas between the Hulahula and Aichilik rivers. Primary diagnoses included emaciation (39%), malnutrition (8%), stillbirth (21%), trauma (16%), other primary causes (7%), and undetermined causes (8%). Twenty calves had contributory renal tubular degeneration. The findings indicate that factors contributing to nutritional deprivation in calves were the major cause of neonatal mortality; however, factors affecting stillbirth, abortion, or the urogenital system may have major effects on neonatal caribou and warrant further investigation.

Leptin, adiposity, and mortality: results from the National Health and Nutrition Examination Survey III, 1988 to 1994.

PubMed

Batsis, John A; Sahakyan, Karine R; Singh, Prachi; Bartels, Stephen J; Somers, Virend K; Lopez-Jimenez, Francisco

2015-04-01

To determine whether leptin is related to all-cause and cardiovascular (CV) mortality in older adults. Participants 60 years and older with plasma leptin level measurements from the National Health and Nutrition Examination Survey III (1988-1994) and mortality data linked to the National Death Index were included. We created sex-specific tertiles of leptin (men: 4.2-7.7 μg/L; women: 11.5-21.4 μg/L) to identify the effect of leptin on all-cause and CV mortality. We also determined whether leptin predicted mortality in patients with obesity. We classified obesity using 4 possible definitions: body mass index 30 kg/m(2) or greater; body fat 25% or more in men and 35% or more in women; waist circumference 102 cm or greater in men and 88 cm or greater in women; and waist-hip ratio 0.85 or higher in women and 0.95 or higher in men. Sex-specific proportional hazard models were used to assess the effect of leptin on all-cause and CV mortality. Of 1794 participants, 51.6% were women; the mean age was 70.3±0.4 years, and the follow-up period was 12.5 years with 994 deaths (469 were CV deaths). All-cause mortality in the highest leptin tertile was significant neither in men (hazard ratio [HR], 1.23; 95% CI, 0.93-1.63) nor in women (HR, 0.97; 95% CI, 0.68-1.40). CV mortality was the highest in the highest leptin tertile in men (HR, 1.69; 95% CI, 1.06-2.70) but not in women (HR, 1.21; 95% CI, 0.73-1.98). Evaluating the effect of leptin in subgroups of different obesity definitions, we found that high leptin levels as predict CV mortality in men as measured by waist circumference or body fat. Elevated leptin level is predictive of CV mortality only in men. Leptin may provide additional mortality discrimination in obese men. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Longitudinal study on morbidity and mortality in white veal calves in Belgium

PubMed Central

2012-01-01

Background Mortality and morbidity are hardly documented in the white veal industry, despite high levels of antimicrobial drug use and resistance. The objective of the present study was to determine the causes and epidemiology of morbidity and mortality in dairy, beef and crossbred white veal production. A total of 5853 calves, housed in 15 production cohorts, were followed during one production cycle. Causes of mortality were determined by necropsy. Morbidity was daily recorded by the producers. Results The total mortality risk was 5,3% and was significantly higher in beef veal production compared to dairy or crossbreds. The main causes of mortality were pneumonia (1.3% of the calves at risk), ruminal disorders (0.7%), idiopathic peritonitis (0.5%), enterotoxaemia (0.5%) and enteritis (0.4%). Belgian Blue beef calves were more likely to die from pneumonia, enterotoxaemia and arthritis. Detection of bovine viral diarrhea virus at necropsy was associated with chronic pneumonia and pleuritis. Of the calves, 25.4% was treated individually and the morbidity rate was 1.66 cases per 1000 calf days at risk. The incidence rate of respiratory disease, diarrhea, arthritis and otitis was 0.95, 0.30, 0.11 and 0.07 cases per 1000 calf days at risk respectively. Morbidity peaked in the first three weeks after arrival and gradually declined towards the end of the production cycle. Conclusions The present study provided insights into the causes and epidemiology of morbidity and mortality in white veal calves in Belgium, housed in the most frequent housing system in Europe. The necropsy findings, identified risk periods and differences between production systems can guide both veterinarians and producers towards the most profitable and ethical preventive and therapeutic protocols. PMID:22414223

Mortality profiles in a country facing epidemiological transition: An analysis of registered data

PubMed Central

Huicho, Luis; Trelles, Miguel; Gonzales, Fernando; Mendoza, Walter; Miranda, Jaime

2009-01-01

Background Sub-national analyses of causes of death and time-trends help to define public health policy priorities. They are particularly important in countries undergoing epidemiological transition like Peru. There are no studies exploring Peruvian national and regional characteristics of such epidemiological transition. We aimed to describe Peru's national and regional mortality profiles between 1996 and 2000. Methods Registered mortality data for the study period were corrected for under-registration following standardized methods. Main causes of death by age group and by geographical region were determined. Departmental mortality profiles were constructed to evaluate mortality transition, using 1996 data as baseline. Annual cumulative slopes for the period 1996–2000 were estimated for each department and region. Results For the study period non-communicable diseases explained more than half of all causes of death, communicable diseases more than one third, and injuries 10.8% of all deaths. Lima accounted for 32% of total population and 20% of total deaths. The Andean region, with 38% of Peru's population, accounted for half of all country deaths. Departmental mortality predominance shifted from communicable diseases in 1996 towards non-communicable diseases and injuries in 2000. Maternal and perinatal conditions, and nutritional deficiencies and nutritional anaemia declined markedly in all departments and regions. Infectious diseases decreased in all regions except Lima. In all regions acute respiratory infections are a leading cause of death, but their proportion ranged from 9.3% in Lima and Callao to 15.3% in the Andean region. Tuberculosis and injuries ranked high in Lima and the Andean region. Conclusion Peruvian mortality shows a double burden of communicable and non-communicable, with increasing importance of non-communicable diseases and injuries. This challenges national and sub-national health system performance and policy making. PMID:19187553

Cytokine activation is predictive of mortality in Zambian patients with AIDS-related diarrhoea.

PubMed

Zulu, Isaac; Hassan, Ghaniah; Njobvu R N, Lungowe; Dhaliwal, Winnie; Sianongo, Sandie; Kelly, Paul

2008-11-13

Mortality in Zambian AIDS patients is high, especially in patients with diarrhoea, and there is still unacceptably high mortality in Zambian patients just starting anti-retroviral therapy. We set out to determine if high concentrations of serum cytokines correlate with mortality. Serum samples from 30 healthy controls (HIV seropositive and seronegative) and 50 patients with diarrhoea (20 of whom died within 6 weeks) were analysed. Concentrations of tumour necrosis factor receptor p55 (TNFR p55), macrophage migration inhibitory factor (MIF), interleukin (IL)-6, IL-12, interferon (IFN)-gamma and C-reactive protein (CRP) were measured by ELISA, and correlated with mortality after 6 weeks follow-up. Apart from IL-12, concentrations of all cytokines, TNFR p55 and CRP increased with worsening severity of disease, showing highly statistically significant trends. In a multivariable analysis high TNFR p55, IFN-gamma, CRP and low CD4 count (CD4 count <100) were predictive of mortality. Although nutritional status (assessed by body mass index, BMI) was predictive in univariate analysis, it was not an independent predictor in multivariate analysis. High serum concentrations of TNFR p55, IFN-gamma, CRP and low CD4 count correlated with disease severity and short-term mortality in HIV-infected Zambian adults with diarrhoea. These factors were better predictors of survival than BMI. Understanding the cause of TNFR p55, IFN-gamma and CRP elevation may be useful in development of interventions to reduce mortality in AIDS patients with chronic diarrhoea in Africa.

Premature Mortality In Poor Health And Low Income Adults With Epilepsy

PubMed Central

Kaiboriboon, Kitti; Schiltz, Nicholas K.; Bakaki, Paul M.; Lhatoo, Samden D.; Koroukian, Siran M.

2014-01-01

SUMMARY Objective To examine mortality and causes of death (COD) in socioeconomically disadvantaged persons with epilepsy (PWE) in the US. Methods We performed a retrospective open cohort analysis using Ohio Medicaid claims data between 1992 and 2008 to assess mortality and COD in 68,785 adult Medicaid beneficiaries with epilepsy. Case fatality (CF), mortality rates (MRs), standardized mortality ratios (SMRs), and years of potential life lost (YPLL) were calculated. The SMRs were estimated to compare risk of death in PWE with that in the general Medicaid population with and without disabilities. Proportionate mortality ratios (PMRs), YPLLs, and SMRs for specific COD were also obtained. Results There were 12,630 deaths in PWE. CF was 18.4%, the age-race-sex adjusted MR was 18.6/1,000 person-years (95% CI, 18.3–18.9). The SMR was 1.8 (95% CI, 1.8 – 1.9) when compared to the general Medicaid population, and was 1.4 (95% CI, 1.3–1.6) when compared to those with disabilities. The average YPLL was 16.9 years (range, 1–47 years). Both epilepsy and comorbid conditions significantly contributed to premature mortality in PWE. Cardiovascular diseases, cancer, and unintentional injuries were the most common COD and account for a large proportion of YPLL. Deaths from epilepsy-related causes occurred in about 10% of the cases. Significance Socioeconomically deprived PWE, especially young adults, experience high mortality and die 17 years prematurely. The high mortality in Medicaid beneficiaries with epilepsy affirms that comorbid conditions and epilepsy play a crucial role in premature death. Management of comorbid conditions is, at a minimum, as important as epilepsy management, and therefore deserves more attention from physicians, particularly those who care for Medicaid individuals with epilepsy. PMID:25244361

[Infantile meningitis caused by respiratory syncytial virus].

PubMed

Shirota, Go; Morozumi, Miyuki; Ubukata, Kimiko; Shiro, Hiroyuki

2011-11-01

Respiratory syncytial (RS) virus commonly causes infantile respiratory tract infection causing significant morbidity and mortality, but rarely meningitis. We report a case of meningitis caused by RS virus subgroup B in a 56-day-old boy admitted for high fever who underwent blood examination and lumbar puncture. Empirical chemotherapy was started with intravenous ampicillin, gentamicin, and cefotaxime based on laboratory data on CSF cells (84/microL) and serum CRP (13.8mg/dL) data. RS virus subgroup B was only detected using real-time PCR comprehensive reverse transcription from the first CSF, but no bacterial gene was detected. No bacteria grew from his CSF, urine, or blood. Fever and serum CRP dropped in a few days. He had neither seizures nor disturbance of consciousness and was discharged on day 11 after admission. No evidence of encephalopathy was detected in brain MRI or electroencephalography. RS virus rarely causes meningitis, but a percentage of RS-virus-infected infants exhibit symptoms such as seizure and disturbance of consciousness. We should recognize that the RS virus may cause neurological complications associated with high morbidity and mortality.

Can we use plasma hyperosmolality as a predictor of mortality for ST-segment elevation myocardial infarction?

PubMed

Tatlisu, Mustafa A; Kaya, Adnan; Keskin, Muhammed; Uzman, Osman; Borklu, Edibe B; Cinier, Goksel; Hayiroglu, Mert I; Tatlisu, Kiymet; Eren, Mehmet

2017-01-01

The aim of this study was to investigate the association of plasma osmolality with all-cause mortality in ST-segment elevation myocardial infarction (STEMI) patients treated with a primary percutaneous coronary intervention. This study included 3748 patients (mean age 58.3±11.8 years, men 81%) with STEMI treated with primary percutaneous coronary intervention. The following formula was used to measure the plasma osmolality at admission: osmolality=1.86×sodium (mmol/l)+glucose (mg/dl)/18+BUN (mg/dl)/2.8+9. The patients were followed up for a mean period of 22±10 months. Patients with higher plasma osmolality had 3.7 times higher in-hospital (95% confidence interval: 2.7-5.1) and 3.2 times higher long-term (95% confidence interval: 2.5-4.1) all-cause mortality rates than patients with lower plasma osmolality. Plasma osmolality was found to be a predictor of both in-hospital and long-term all-cause mortality. Hence, plasma osmolality can be used to detect high-risk patients in STEMI.

Biogeochemistry of beetle-killed forests: Explaining a weak nitrate response

PubMed Central

Rhoades, Charles C.; McCutchan, James H.; Cooper, Leigh A.; Clow, David; Detmer, Thomas M.; Briggs, Jennifer S.; Stednick, John D.; Veblen, Thomas T.; Ertz, Rachel M.; Likens, Gene E.; Lewis, William M.

2013-01-01

A current pine beetle infestation has caused extensive mortality of lodgepole pine (Pinus contorta) in forests of Colorado and Wyoming; it is part of an unprecedented multispecies beetle outbreak extending from Mexico to Canada. In United States and European watersheds, where atmospheric deposition of inorganic N is moderate to low (<10 kg⋅ha⋅y), disturbance of forests by timber harvest or violent storms causes an increase in stream nitrate concentration that typically is close to 400% of predisturbance concentrations. In contrast, no significant increase in streamwater nitrate concentrations has occurred following extensive tree mortality caused by the mountain pine beetle in Colorado. A model of nitrate release from Colorado watersheds calibrated with field data indicates that stimulation of nitrate uptake by vegetation components unaffected by beetles accounts for significant nitrate retention in beetle-infested watersheds. The combination of low atmospheric N deposition (<10 kg⋅ha⋅y), tree mortality spread over multiple years, and high compensatory capacity associated with undisturbed residual vegetation and soils explains the ability of these beetle-infested watersheds to retain nitrate despite catastrophic mortality of the dominant canopy tree species. PMID:23319612

Persistent reduced ecosystem respiration after insect disturbance in high elevation forests

PubMed Central

Moore, David J P; Trahan, Nicole A; Wilkes, Phil; Quaife, Tristan; Stephens, Britton B; Elder, Kelly; Desai, Ankur R; Negron, Jose; Monson, Russell K

2013-01-01

Amid a worldwide increase in tree mortality, mountain pine beetles (Dendroctonus ponderosae Hopkins) have led to the death of billions of trees from Mexico to Alaska since 2000. This is predicted to have important carbon, water and energy balance feedbacks on the Earth system. Counter to current projections, we show that on a decadal scale, tree mortality causes no increase in ecosystem respiration from scales of several square metres up to an 84 km2 valley. Rather, we found comparable declines in both gross primary productivity and respiration suggesting little change in net flux, with a transitory recovery of respiration 6–7 years after mortality associated with increased incorporation of leaf litter C into soil organic matter, followed by further decline in years 8–10. The mechanism of the impact of tree mortality caused by these biotic disturbances is consistent with reduced input rather than increased output of carbon. PMID:23496289

Saigas on the brink: Multidisciplinary analysis of the factors influencing mass mortality events

PubMed Central

Kock, Richard A.; Orynbayev, Mukhit; Robinson, Sarah; Zuther, Steffen; Singh, Navinder J.; Beauvais, Wendy; Morgan, Eric R.; Kerimbayev, Aslan; Khomenko, Sergei; Martineau, Henny M.; Rystaeva, Rashida; Omarova, Zamira; Wolfs, Sara; Hawotte, Florent; Radoux, Julien; Milner-Gulland, Eleanor J.

2018-01-01

In 2015, more than 200,000 saiga antelopes died in 3 weeks in central Kazakhstan. The proximate cause of death is confirmed as hemorrhagic septicemia caused by the bacterium Pasteurella multocida type B, based on multiple strands of evidence. Statistical modeling suggests that there was unusually high relative humidity and temperature in the days leading up to the mortality event; temperature and humidity anomalies were also observed in two previous similar events in the same region. The modeled influence of environmental covariates is consistent with known drivers of hemorrhagic septicemia. Given the saiga population’s vulnerability to mass mortality and the likely exacerbation of climate-related and environmental stressors in the future, management of risks to population viability such as poaching and viral livestock disease is urgently needed, as well as robust ongoing veterinary surveillance. A multidisciplinary approach is needed to research mass mortality events under rapid environmental change. PMID:29376120

[Current trends in the depopulation process in the northwestern economic region of Russia].

PubMed

Semenov, S P; Dobroskok, V A

1996-01-01

Current demographic trends in the northwestern region of Russia, one of the regions most affected by depopulation, are analyzed. The author discusses the general decline in the standard of living and the decrease in the funding available for providing social services, as well as unemployment in the local military industry, as the main causes of the deterioration of the demographic situation. Data are presented by sex. Fertility seems to have reached its lowest level and mortality its highest in 1994, with a modest improvement in both indicators since then. The author compares trends among various ethnic groups and geographic regions. High levels of mortality among the young, and the contribution of alcoholism to mortality rates, continue to give cause for concern.

Effect of Serum C-Reactive Protein Level on Admission to Predict Mortality After Transcatheter Aortic Valve Implantation.

PubMed

Hioki, Hirofumi; Watanabe, Yusuke; Kozuma, Ken; Yamamoto, Masanori; Naganuma, Toru; Araki, Motoharu; Tada, Norio; Shirai, Shinichi; Yamanaka, Futoshi; Higashimori, Akihiro; Mizutani, Kazuki; Tabata, Minoru; Takagi, Kensuke; Ueno, Hiroshi; Hayashida, Kentaro

2018-04-12

The relation between C-reactive protein (CRP) level on admission and mortality after transcatheter aortic valve implantation (TAVI) remains unclear. To evaluate the impact of serum CRP level on mortality after TAVI, we assessed 1,016 patients with CRP who underwent TAVI and 538 patients with high-sensitive CRP (hs-CRP) level who underwent TAVI on admission in the OCEAN (Optimized Transcatheter Valvular Intervention)-TAVI registry. Study population was stratified into 2 groups (high/low), according to the median of CRP and hs-CRP on admission. We assessed the impact of high CRP and hs-CRP level on all-cause death after TAVI. During 2-year follow-up, all-cause death after TAVI was 9.4% in patients with CRP and 11.9% in patients with hs-CRP. Median value of serum CRP was 0.10 mg/dl in both CRP and hs-CRP. Patients with high CRP (>0.10 mg/dl) had significantly higher incidence of all-cause death compared with those with low CRP (11.5% vs 7.6%, log-rank p = 0.015). Multivariate Cox regression analysis with a time-varying covariate demonstrated that high CRP was an independent predictor of all-cause death within the first 3 months (hazard ratio 2.78, 95% CI 1.30 to 5.95) compared with from 3 months to 2 years (hazard ratio 0.80, 95% CI 0.47 to 1.36) (P for interaction = 0.008). Inversely, these results were not observed in the stratification using hs-CRP on admission. In conclusion, high CRP on admission was significantly associated with an increased risk of all-cause death after TAVI, particularly within the first 3 months after TAVI. Risk stratification using CRP may be a simple and useful strategy to identify high-risk patients who undergo TAVI. Copyright © 2018 Elsevier Inc. All rights reserved.

Epidemiology of soil-transmitted helminthiases-related mortality in Brazil.

PubMed

Martins-Melo, Francisco R; Ramos, Alberto N; Alencar, Carlos H; Lima, Mauricélia S; Heukelbach, Jorg

2017-04-01

Soil-transmitted helminth (STH) infections are widely distributed in tropical and subtropical areas, including Brazil. We performed a nationwide population-based study including all deaths in Brazil from 2000 to 2011, in which STHs (ascariasis, trichuriasis and/or hookworm infection) were mentioned on death certificates, either as underlying or as associated causes of death. Epidemiological characteristics, time trends and spatial analysis of STH-related mortality were analysed. STHs was identified on 853/12 491 280 death certificates: 827 (97·0%) deaths related to ascariasis, 25 (2·9%) to hookworm infections, and 1 (0·1%) to trichuriasis. The average annual age-adjusted mortality rate was 0·34/1 000 000 inhabitants (95% confidence interval: 0·27-0·44). Females, children <10 years of age, indigenous ethnic groups and residents in the Northeast region had highest STH-related mortality rates. Nationwide mortality decreased significantly over time (annual percent change: -5·7%; 95% CI: -6·9 to -4·4), with regional differences. We identified spatial high-risk clusters for STH-related mortality mainly in the North, Northeast and South regions. Diseases of the digestive system and infectious/parasitic diseases were the most commonly associated causes of death mentioned in the STH-related deaths. Despite decreasing mortality in Brazil, a considerable number of deaths is caused by STHs, with ascariasis responsible for the vast majority. There were marked regional differences, affecting mainly children and vulnerable populations.

Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.

PubMed

Kimura, Hiroshi; Tanaka, Kenichi; Kanno, Makoto; Watanabe, Kimio; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Hodaka; Sato, Keiji; Sakaue, Michiaki; Terawaki, Hiroyuki; Nakayama, Masaaki; Miyata, Toshio; Watanabe, Tsuyoshi

2014-10-01

Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. © 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.

Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure: HF-ACTION Randomized Controlled Trial

PubMed Central

O’Connor, Christopher M.; Whellan, David J.; Lee, Kerry L.; Keteyian, Steven J.; Cooper, Lawton S.; Ellis, Stephen J.; Leifer, Eric S.; Kraus, William E.; Kitzman, Dalane W.; Blumenthal, James A.; Rendall, David S.; Miller, Nancy Houston; Fleg, Jerome L.; Schulman, Kevin A.; McKelvie, Robert S.; Zannad, Faiez; Piña, Ileana L.

2010-01-01

Context Guidelines recommend that exercise training be considered for medically stable outpatients with heart failure. Previous studies have not had adequate statistical power to measure the effects of exercise training on clinical outcomes. Objective To test the efficacy and safety of exercise training among patients with heart failure. Design, Setting, and Patients Multicenter, randomized controlled trial among 2331 medically stable outpatients with heart failure and reduced ejection fraction. Participants in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) were randomized from April 2003 through February 2007 at 82 centers within the United States, Canada, and France; median follow-up was 30 months. Interventions Usual care plus aerobic exercise training, consisting of 36 supervised sessions followed by home-based training, or usual care alone. Main Outcome Measures Composite primary end point of all-cause mortality or hospitalization and prespecified secondary end points of all-cause mortality, cardiovascular mortality or cardiovascular hospitalization, and cardiovascular mortality or heart failure hospitalization. Results The median age was 59 years, 28% were women, and 37% had New York Heart Association class III or IV symptoms. Etiology was ischemic in 51%. Median left ventricular ejection fraction was 25%. Exercise adherence decreased from a median of 95 minutes per week during months 4 through 6 of follow-up to 74 minutes per week during months 10 through 12. A total of 759 (65%) patients in the exercise group died or were hospitalized, compared with 796 (68%) in the usual care group (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.84–1.02; P = .13). There were nonsignificant reductions in the exercise training group for mortality (189 [16%] in the exercise group vs 198 [17%] in the usual care group; HR, 0.96; 95% CI, 0.79–1.17; P = .70), cardiovascular mortality or cardiovascular hospitalization (632 [55%] in the exercise group vs 677 [58%] in the usual care group; HR, 0.92; 95% CI, 0.83–1.03; P = .14), and cardiovascular mortality or heart failure hospitalization (344 [30%] in the exercise group vs 393 [34%] in the usual care group; HR, 0.87; 95% CI, 0.75–1.00; P = .06). In prespecified supplementary analyses adjusting for highly prognostic baseline characteristics, the HRs were 0.89 (95% CI, 0.81–0.99; P = .03) for all-cause mortality or hospitalization, 0.91 (95% CI, 0.82–1.01; P = .09) for cardiovascular mortality or cardiovascular hospitalization, and 0.85 (95% CI, 0.74–0.99; P = .03) for cardiovascular mortality or heart failure hospitalization. Other adverse events were similar between the groups. Conclusions In the protocol-specified primary analysis, exercise training resulted in nonsignificant reductions in the primary end point of all-cause mortality or hospitalization and in key secondary clinical end points. After adjustment for highly prognostic predictors of the primary end point, exercise training was associated with modest significant reductions for both all-cause mortality or hospitalization and cardiovascular mortality or heart failure hospitalization. Trial Registration clinicaltrials.gov Identifier: NCT00047437 PMID:19351941

Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study.

PubMed

Sone, Toshimasa; Nakaya, Naoki; Ohmori, Kaori; Shimazu, Taichi; Higashiguchi, Mizuka; Kakizaki, Masako; Kikuchi, Nobutaka; Kuriyama, Shinichi; Tsuji, Ichiro

2008-07-01

To investigate the association between the sense of "life worth living (ikigai)" and the cause-specific mortality risk. The psychological factors play important roles in morbidity and mortality risks. However, the association between the negative psychological factors and the risk of mortality is inconclusive. The Ohsaki Study, a prospective cohort study, was initiated on 43,391 Japanese adults. To assess if the subjects found a sense of ikigai, they were asked the question, "Do you have ikigai in your life?" We used Cox regression analysis to calculate the hazard ratio of the all-cause and cause-specific mortality according to the sense of ikigai categories. Over 7 years' follow-up, 3048 of the subjects died. The risk of all-cause mortality was significantly higher among the subjects who did not find a sense of ikigai as compared with that in the subjects who found a sense of ikigai; the multivariate adjusted hazard ratio (95% confidence interval) was 1.5 (1.3-1.7). As for the cause-specific mortality, subjects who did not find a sense of ikigai were significantly associated with an increased risk of cardiovascular disease (1.6; 1.3-2.0) and external cause mortality (1.9; 1.1-3.3), but not of the cancer mortality (1.3; 1.0-1.6). In this prospective cohort study, subjects who did not find a sense of ikigai were associated with an increased risk of all-cause mortality. The increase in mortality risk was attributable to cardiovascular disease and external causes, but not cancer.

Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases

PubMed Central

Iflazoglu, Nidal; Ureyen, Orhan; Oner, Osman Z; Tusat, Mustafa; Akcal, Mehmet A

2015-01-01

Due to the high kinetic energy, of bullets and explosive gun particles, their paths through the abdomen (permanent cavity effect), and the blast effect (temporary cavity effect), firearm injuries (FAI) can produce damage not only in the organ they enter, but in the surrounding tissues as well. Since they change route after entering the body they may cause organ damage in locations other than those at the path of entry. For example, as a result of the crushing onto bone tissues, bullet particles or broken bone fragments may cause further damage outside of the path of travel, For these reasons it is very difficult to predict the possible complications from the size of the actual injury in patients with penetrating abdominal firearm injuries. The factors affecting the mortality and morbidity from firearm injuries have been evaluated in various studies. Insufficient blood transfusion, long duration of time until presenting to a hospital and the presence of colon injuries are common factors that cause the high complication rates and mortality. A total of 120 cases injured in the civil war at Turkey’s southern neighbouring countries were admitted to our hospital and evaluated in terms of: development of complications and factors affecting mortality; age, gender, time of presentation to the hospital, number of injured organs, the type of injuring weapon, the entrance site of the bullet, the presence of accompanying chest trauma, the amount of administered blood, the penetrating abdominal trauma index (PATI) and the injury severity score (ISS) scores were determined and evaluated retrospectively. The most significant factors for the development of complications and mortality include: accompanying clinical shock, high number of injured organs, numerous blood transfusions administered and accompanying thoracic trauma. It has also been observed that the PATI and ISS scoring systems can be used in predicting the complication and mortality rates in firearm injuries. Consequently, reducing the mortality and complication rates from firearm injuries is still a serious problem. Despite all of these efforts, there is still a need to determine the optimum treatment strategy to achieve this end goal. PMID:26131219

[The short-term effects of air pollution on mortality: the results of the EMECAM project in greater Bilbao. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad].

PubMed

Cambra Contín, K; Alonso Fustel, E

1999-01-01

The objective of this study was to assess the short-term impact of air pollution with sulfur dioxide (SO2), total suspended particles (TSP), nitrogen dioxide (NO2) and black smoke (BS) on the daily number of deaths in the metropolitan area of Bilbao. The EMECAM project protocol was followed. Increases in TSP, in both maximum hourly figures and daily averages, are significantly associated with increases in the daily number of deaths from all causes, from circulatory causes and from all causes among those older than 70. No differences between six-month periods were found. NO2 average levels were associated with daily mortality from respiratory causes in the entire period and during the warm season, and from all causes among those older than 70 in the cool months. TSP levels are associated with daily mortality in the metropolitan area of Bilbao. The relationship between NO2 and the number of deaths from respiratory causes, very high in the warm season, needs further research to assess its independence.

Effect of membrane flux and dialyzer biocompatibility on survival in end-stage diabetic nephropathy.

PubMed

Götz, Angela K; Böger, Carsten A; Popal, Massoud; Banas, Bernhard; Krämer, Bernhard K

2008-01-01

We examined the effects of dialyzer membrane flux and biocompatibility on mortality in diabetic dialysis patients. We enrolled 402 prevalent chronic hemodialysis patients from 30 centers in Germany in 1999 for a prospective observational study until 2003. We compared 2 groups in post hoc analysis: high-flux (HF, n = 166) versus low-flux (LF, n = 236) membrane, and high biocompatibility (HB, n = 300) versus low biocompatibility (LB, n = 102). All-cause mortality (ACM) was the primary endpoint. Death causes were the secondary endpoints. Multivariate Cox regression analysis showed no significant difference in risk for ACM with respect to flux (hazard ratio, HR, 0.79; p = 0.08; ACM 63% in HF vs. 70% in LF dialysis) and biocompatibility level (HR 1.00; p = 0.98; ACM 67% for HB vs. 66% for LB). The multivariate analysis of different causes of death did not reveal any outcome differences dependent on flux and biocompatibility level apart from a slightly better cumulative survival regarding the death cause 'infectious' in our HF dialysis group (HR 0.48; p = 0.07, Kaplan-Meier analysis p = 0.03). Our data indicate that mortality of hemodialysis patients with type-2 diabetic nephropathy is influenced neither by dialyzer flux level nor by biocompatibility. Copyright 2008 S. Karger AG, Basel.

[Inhibitory effect of turpentine oil on Aedes aegypti (Diptera:Culicidae) larvae growth].

PubMed

Leyva Silva, Maureen; Marquetti Fernández, Maria del Carmen; Tacoronte González, Juan E; Tiomno Tiomnovay, Olinka; Montada Dorta, Domingo

2010-01-01

in the fight for environmental protection, finding out alternative ways to control vectors that are important from the medical viewpoint is a must. Those plants having potent active principles and high chemical stability to act as pesticides can contribute to this end. to evaluate the possible inhibitory effect of photochemically-modified turpentine oil on Aedes aegypti larvae growth. Aedes aegypti larvae of an insecticide-sensitive strain from the insect breeding site located in the Institute of Tropical Medicine were used. During a week after the exposure to the lethal dose causing 90% mortality, the mortality indexes of larvae and pupas were recorded as well as the number of emerged adults and their sex in addition to adults stuck to the exuvias. high larval and pupal mortality was observed in the survivors to the lethal dose causing 90% mortality after one week of the exposure; mortality index was 39.46%. Larvae which managed to grow to become adults amounted to 60.54% of the surviving larvae. Female to male ratio was very similar in the control whereas the exposed group showed a higher number of male adults. On estimating the hatching inhibition percentage, it got 36.47%. the activity of turpentine oil as larvicide and Ae. aegypti growth inhibitor was demonstrated.

Influenza vaccine coverage, influenza-associated morbidity and all-cause mortality in Catalonia (Spain).

PubMed

Muñoz, M Pilar; Soldevila, Núria; Martínez, Anna; Carmona, Glòria; Batalla, Joan; Acosta, Lesly M; Domínguez, Angela

2011-07-12

The objective of this work was to study the behaviour of influenza with respect to morbidity and all-cause mortality in Catalonia, and their association with influenza vaccination coverage. The study was carried out over 13 influenza seasons, from epidemiological week 40 of 1994 to week 20 of 2007, and included confirmed cases of influenza and all-cause mortality. Two generalized linear models were fitted: influenza-associated morbidity was modelled by Poisson regression and all-cause mortality by negative binomial regression. The seasonal component was modelled with the periodic function formed by the sum of the sinus and cosines. Expected influenza mortality during periods of influenza virus circulation was estimated by Poisson regression and its confidence intervals using the Bootstrap approach. Vaccination coverage was associated with a reduction in influenza-associated morbidity (p<0.001), but not with a reduction in all-cause mortality (p=0.149). In the case of influenza-associated morbidity, an increase of 5% in vaccination coverage represented a reduction of 3% in the incidence rate of influenza. There was a positive association between influenza-associated morbidity and all-cause mortality. Excess mortality attributable to influenza epidemics was estimated as 34.4 (95% CI: 28.4-40.8) weekly deaths. In conclusion, all-cause mortality is a good indicator of influenza surveillance and vaccination coverage is associated with a reduction in influenza-associated morbidity but not with all-cause mortality. Copyright © 2011 Elsevier Ltd. All rights reserved.

Early mortality of alcoholic hepatitis: a review of data from placebo-controlled clinical trials.

PubMed

Yu, Chao-Hui; Xu, Cheng-Fu; Ye, Hua; Li, Lan; Li, You-Ming

2010-05-21

To investigate the early mortality of placebo-treated alcoholic hepatitis patients. Mortality data about alcoholic hepatitis patients who participated in randomized placebo-controlled trials were searched from PubMed, EMBASE, and Cochrane Library, extracted and analyzed. A total of 661 placebo-treated patients in 19 trials were included. The overall mortality rate was 34.19% with a median observation time of 160 d (range 21-720 d). Hepatic failure, gastrointestinal bleeding and infection were the three main causes of death, accounting for 55.47%, 21.17% and 7.30% of all deaths, respectively. One-month mortality data about 324 placebo-treated alcoholic hepatitis patients in 10 trials were reported with a pooled mortality rate of 20.37%. The one-month mortality rate of patients with moderate to severe alcoholic hepatitis tended to be higher than that of general patients (22.69% vs 10.93%, P < 0.05), whereas no significant difference was observed between the patients from North America or Europe (22.43% vs 18.45%, P > 0.05), neither any difference was found between the studies published before and after 1990 (18.18% vs 21.88%, P > 0.05). Alcoholic hepatitis is a severe liver disease with a high mortality rate, and hepatic failure, gastrointestinal bleeding and infection are the three main causes of death.

Motile Salmonella serotypes causing high mortality in poultry farms in three South-Western States of Nigeria

PubMed Central

Ibrahim, Najume Doguwar-Giginya; Saidu, Shehu NaAllah; Azeez, Aminullah Ajiyobiojo; Akinduti, Paul Akinniyi; Kwanashie, Clara Nna; Fakilahyel Kadiri, Amina Kinta; Muhammed, Maryam; Fagbamila, Idowu Oluwabunmi; Luka, Pam Dachung

2017-01-01

This study was carried out to identify the Salmonella serotypes causing high mortality in chickens in Lagos, Ogun and Oyo states, Nigeria. Chickens presented for postmortem examination during disease outbreaks that were characterised by high mortality (40 per cent to 80 per cent) in poultry farms in the study area were examined from January to December, 2013. Samples of the lungs, heart, liver, spleen, kidneys, proventriculus, intestine and caecum were collected from suspected cases of salmonellosis, for bacterial culture and identification. Salmonella isolates were confirmed using PCR and serotyped using the Kauffman-White scheme. Twenty-six day-old pullets were raised to two weeks and inoculated orally with 0.2 mL of 1×108 colony forming units of Salmonella Zega identified in the present study to determine their pathogenicity, while another 26 served as control. The Salmonella serotypes were S Zega (n=13; 35.14 per cent), Salmonella Kentucky (n=9; 24.32 per cent), Salmonella Herston (n=6; 16.22 per cent), Salmonella Nima (n=4; 10.81 per cent), Salmonella Telelkebir (n=3; 8.11 per cent), Salmonella Colindale (n=1; 2.70 per cent) and Salmonella Tshiongwe (n=1; 2.70 per cent). Clinical signs in both natural and experimental infections were acute (70 per cent) and chronic (30 per cent), and included weakness, anorexia, yellowish diarrhoea, pasted vents, somnolescence and mortality, while gross lesions showed marked pulmonary congestion and oedema, necrotic foci in the myocardium; the liver, spleen and kidneys were markedly enlarged and had subcapsular multifocal necrosis. There were catarrhal proventriculitis and enteritis, and haemorrhagic typhlitis. While most of the serotypes identified in the present study have been isolated from poultry sources from commercial farms in Nigeria, to the best of the authors' knowledge, they have not been previously reported to cause high mortality in chickens in the study area. PMID:29344363

Opposite associations between alanine aminotransferase and γ-glutamyl transferase levels and all-cause mortality in type 2 diabetes: Analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

PubMed

Williams, Kathryn H; Sullivan, David R; Nicholson, Geoffrey C; George, Jacob; Jenkins, Alicia J; Januszewski, Andrzej S; Gebski, Val J; Manning, Patrick; Tan, Yong Mong; Donoghoe, Mark W; Ehnholm, Christian; Young, Simon; O'Brien, Richard; Buizen, Luke; Twigg, Stephen M; Keech, Anthony C

2016-05-01

Reported associations between liver enzymes and mortality may not hold true in type 2 diabetes, owing to a high prevalence of non-alcoholic fatty liver disease, which has been linked to cardiovascular disease and mortality in its own right. Our study aimed to determine whether alanine aminotransferase (ALT) or γ-glutamyl transferase (GGT) levels predict mortality in type 2 diabetes, and to examine possible mechanisms. Data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were analyzed to examine the relationship between liver enzymes and all-cause and cause-specific mortality over 5years. Over 5years, 679 (6.9%) individuals died. After adjustment, for every standard deviation increase in ALT (13.2U/L), the HR for death on study was 0.85 (95% CI 0.78-0.93), p<0.001. Conversely, GGT >70U/L, compared with GGT ≤70U/L, had HR 1.82 (1.48-2.24), p<0.001. For cause-specific mortality, lower ALT was associated with a higher risk of cardiovascular death only, whereas GGT >70U/L was associated with higher risks of death due to cardiovascular disease, cancer and non-cancer/non-cardiovascular causes. The relationship for ALT persisted after adjustment for indirect measures of frailty but was attenuated by elevated hsCRP. As in the general population, ALT has a negative, and GGT a positive, correlation with mortality in type 2 diabetes when ALT is less than two times the upper limit of normal. The relationship for ALT appears specific for death due to cardiovascular disease. Links of low ALT with frailty, as a potential mechanism for relationships seen, were neither supported nor conclusively refuted by our analysis and other factors are also likely to be important in those with type 2 diabetes. Copyright © 2016 Elsevier Inc. All rights reserved.

The morbidity, mortality, and costs associated with Clostridium difficile infection.

PubMed

Kwon, Jennie H; Olsen, Margaret A; Dubberke, Erik R

2015-03-01

Clostridium difficile infection (CDI) is the most common cause of infectious health care-associated diarrhea and is a major burden to patients and the health care system. The incidence and severity of CDI remain at historically high levels. This article reviews the morbidity, mortality, and costs associated with CDI. Copyright © 2015 Elsevier Inc. All rights reserved.

Trapping Douglas-fir beetle (Dendroctonus pseudotsugae) with pheromone baited multiple-funnel traps does not reduce Douglas-fir (Pseudotsuga menziesii) mortality

Treesearch

R.A. Progar; N. Sturdevant; M.J. Rinella

2010-01-01

Douglas-fir beetle (Dendroctonus pseudotsugae Hopkins) (DFB) causes considerable mortality to Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) in western North American forests. We evaluated the use of semiochemical-baited multiple-funnel traps for the protection of small, high-value stands of trees, such as those occurring...

Climatic stress increases forest fire severity across the western United States

Treesearch

Phillip J. van Mantgem; Jonathan C.B. Nesmith; MaryBeth Keifer; Eric E. Knapp; Alan Flint; Lorriane Flint

2013-01-01

Pervasive warming can lead to chronic stress on forest trees, which may contribute to mortality resulting from fire-caused injuries. Longitudinal analyses of forest plots from across the western US show that high pre-fire climatic water deficit was related to increased post-fire tree mortality probabilities. This relationship between climate and fire was present after...

ECOLOGIC DRIVERS AND POPULATION IMPACTS OF AVIAN TRICHOMONOSIS MORTALITY EVENTS IN BAND-TAILED PIGEONS (PATAGIOENAS FASCIATA) IN CALIFORNIA, USA.

PubMed

Rogers, Krysta H; Girard, Yvette A; Koenig, Walter D; Johnson, Christine K

2016-07-01

:   Avian trichomonosis, a disease typically caused by the protozoan parasite Trichomonas gallinae , is a well recognized cause of death in many avian species. In California, US, trichomonosis has caused periodic epidemics in Pacific Coast Band-tailed Pigeons ( Patagioenas fasciata monilis). We summarize reported mortality events and investigate ecologic drivers and population impacts associated with epidemic mortality due to trichomonosis in Band-tailed Pigeons. Between 1945 and 2014, 59 mortality events involving Band-tailed Pigeons were reported in California with the number of reported events increasing over time. Estimated mortality for these events was variable, ranging between 10 and 10,000 pigeons. Events were most-frequently reported in Monterey (19%; 11/59) and San Luis Obispo (8%; 5/59) counties. Events often started in January (32%; 9/28) and February (50%; 14/28) and lasted 5-68 d. Impacts of mortality events on pigeon populations were indicated by Breeding Bird Survey and Christmas Bird Count abundance indices, which showed a decline in outbreak years compared to nonoutbreak years. Environmental conditions most associated with outbreak years included higher average temperatures between January and March, the period most associated with mortality events, and lower average precipitation in December just prior to mortality events. In Monterey County, events tended to occur in winters following higher acorn production of coast live oaks ( Quercus agrifolia ) in the fall. Weather and food abundance could be related to increased transmission or enhanced viability of Trichomonas spp. Although estimated mortality due to avian trichomonosis was highly variable across years, cumulative losses were substantial and likely to have a negative impact on population size.

Impact of Renal Impairment on Cardiovascular Disease Mortality After Liver Transplantation for Nonalcoholic Steatohepatitis Cirrhosis

PubMed Central

VanWagner, Lisa B.; Lapin, Brittany; Skaro, Anton I.; Lloyd-Jones, Donald M.; Rinella, Mary E.

2016-01-01

BACKGROUND & AIMS Non-alcoholic steatohepatitis (NASH) is an independent risk factor for cardiovascular disease (CVD) morbidity after liver transplantation, but its impact on CVD mortality is unknown. We sought to assess the impact of NASH on CVD mortality after liver transplantation and to predict which NASH recipients are at highest risk of a CVD-related death following a liver transplant. METHODS Using the Organ Procurement and Transplantation Network database we examined associations between NASH and post liver transplant CVD mortality, defined as primary cause of death from thromboembolism, arrhythmia, heart failure, myocardial infarction, or stroke. A physician panel reviewed cause of death. RESULTS Of 48,360 liver transplants (2/2002–12/2011), 5,057 (10.5%) were performed for NASH cirrhosis. NASH recipients were more likely to be older, female, obese, diabetic, and have history of renal failure or prior CVD versus non-NASH (p<0.001 for all). Although there was no difference in overall all-cause mortality (log-rank p=0.96), both early (30-day) and long-term CVD-specific mortality was increased among NASH recipients (Odds ratio=1.30, 95% Confidence interval (CI): 1.02–1.66; Hazard ratio=1.42, 95% CI: 1.07–1.41, respectively). These associations were no longer significant after adjustment for pre-transplant diabetes, renal impairment or CVD. A risk score comprising age ≥ 55, male sex, diabetes and renal impairment was developed for prediction of post liver transplant CVD mortality (c-statistic 0.60). CONCLUSION NASH recipients have an increased risk of CVD mortality after liver transplantation explained by a high prevalence of co-morbid cardiometabolic risk factors that in aggregate identify those at highest risk of post-transplant CVD mortality. PMID:25977117

Orthostatic changes in blood pressure and mortality in a nursing home population.

PubMed

Hartog, Laura C; Hendriks, Steven H; Cimzar-Sweelssen, Mateja; Knipscheer, Astrid; Groenier, Klaas H; Kleefstra, Nanne; Bilo, Henk J G; van Hateren, Kornelis J J

2016-06-01

Hypertension, orthostatic hypotension and orthostatic hypertension (OHT) are highly prevalent in old age. The associations in the very elderly and frail patients between blood pressure, and especially orthostatic changes in blood pressure, and mortality are unclear. We aimed to investigate the relationships between orthostatic changes in blood pressure, blood pressure and mortality in nursing home residents. A prospective observational cohort study. Cox proportional hazard modelling was used to investigate the relation between orthostatic hypotension, OHT, the various blood pressure variables and mortality with adjustment for confounders. In the case of significant associations in the models, risk prediction capabilities were assessed with Harrell's C statistics and the proportion of explained variance (R). Two hundred and ninety patients with a mean age of 80.8 (SD 9.9) years participated in this study. The overall mortality risk increased by 17% [95% confidence interval (CI): 2-34%] for every 10-mmHg increase in DBP. Adding DBP did not change Harrell's C values and increased R with 0.03 or less. Only in patients at the psychogeriatric department, orthostatic hypotension was associated with an increased all-cause mortality risk [hazard ratio (HR) 1.71 (95% CI: 1.08-2.71%)]. The HR of OHT in this patient group was 0.61 (95% CI: 0.32-1.19%). DBP was related to all-cause mortality in a nursing home population. Orthostatic hypotension was related to all-cause mortality in the most frail group of nursing home patients. The predictive capabilities of both DBP and orthostatic hypotension are rather small with respect to mortality. A beneficial effect of OHT could not be excluded on the basis of the width of the CI.

Inhibitor development and mortality in non-severe hemophilia A.

PubMed

Eckhardt, C L; Loomans, J I; van Velzen, A S; Peters, M; Mauser-Bunschoten, E P; Schwaab, R; Mazzucconi, M G; Tagliaferri, A; Siegmund, B; Reitter-Pfoertner, S E; van der Bom, J G; Fijnvandraat, K

2015-07-01

The life expectancy of non-severe hemophilia A (HA) patients equals the life expectancy of the non-hemophilic population. However, data on the effect of inhibitor development on mortality and on hemophilia-related causes of death are scarce. The development of neutralizing factor VIII antibodies in non-severe HA patients may dramatically change their clinical outcome due to severe bleeding complications. We assessed the association between the occurrence of inhibitors and mortality in patients with non-severe HA. In this retrospective cohort study, clinical data and vital status were collected for 2709 non-severe HA patients (107 with inhibitors) who were treated between 1980 and 2011 in 34 European and Australian centers. Mortality rates for patients with and without inhibitors were compared. During 64,200 patient-years of follow-up, 148 patients died (mortality rate, 2.30 per 1000 person-years; 95% confidence interval (CI), 1.96-2.70) at a median age of 64 years (interquartile range [IQR], 49-76). In 62 patients (42%) the cause of death was hemophilia related. Sixteen inhibitor patients died at a median age of 71 years (IQR, 60-81). In ten patients the inhibitor was present at time of death; seven of them died of severe bleeding complications. The all-cause mortality rate in inhibitor patients was > 5 times increased compared with that for those without inhibitors (age-adjusted mortality rate ratio, 5.6). Inhibitor development in non-severe hemophilia is associated with increased mortality. High rates of hemophilia-related mortality in this study indicate that non-severe hemophilia is not mild at all and stress the importance of close follow-up for these patients. © 2015 International Society on Thrombosis and Haemostasis.

Type A personality and mortality: Competitiveness but not speed is associated with increased risk.

PubMed

Lohse, Tina; Rohrmann, Sabine; Richard, Aline; Bopp, Matthias; Faeh, David

2017-07-01

Type A behavior pattern (TABP) is a possible risk factor for cardiovascular disease (CVD). However, existing evidence is conflicting, also because studies did not examine underlying traits separately. In this study, we investigated whether all-cause and CVD mortality were associated with the Bortner Scale, a measure of TABP, in particular with its subscales competitiveness and speed. Information on Bortner Scale and covariates of 9921 participants was collected at baseline in two cross-sectional studies that were linked with mortality information, yielding a follow-up of up to 37 years. We analyzed the Bortner Scale and its two subscales competitiveness and speed. Applying Cox regression models, we investigated the association with all-cause, CVD, and specific CVD type mortality. During follow-up, 3469 deaths were observed (1118 CVD deaths). The total Bortner Scale was not associated with mortality, only its subscales. In women, competitiveness was positively associated with all-cause mortality (highest category vs. the lowest, HR 1.25 [95% CI 1.08,1.44]), CVD mortality (1.39 [1.07,1.81]), and ischemic heart disease mortality (intermediate category vs. the lowest, 1.46 [1.02,2.10]). In men, CVD mortality was inversely associated with speed (highest category vs. the lowest, 0.74 [0.59,0.93]). The subscales of the Bortner Scale may be associated with CVD in an opposed manner and may therefore have to be analyzed separately. More studies are needed to further investigate this association, also considering differences by sex. Persons scoring high in the competitiveness subscale ought to be screened and counselled in order to reduce their CVD risk. Copyright © 2017 Elsevier B.V. All rights reserved.

Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis.

PubMed

Bogdanowicz, Karolina Magda; Stewart, Robert; Chang, Chin-Kuo; Downs, Johnny; Khondoker, Mizanur; Shetty, Hitesh; Strang, John; Hayes, Richard Derek

2016-07-01

Risk assessments are widely used, but their ability to predict outcomes in opioid use disorder (OUD) treatment remains unclear. Therefore, the aim was to investigate if addiction-specific brief risk screening is effective in identifying high mortality risk groups and if subsequent clinical actions following risk assessment impacts on mortality levels. Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Cox and competing-risk regression were used to model associations between brief risk assessment domains and all-cause and overdose mortality in 4488 OUD patients, with up-to 6-year follow-up time where 227 deaths were registered. Data were stratified by admission to general mental health services. All-cause mortality was significantly associated with unsafe injecting (HR 1.53, 95% CI 1.10-2.11) and clinically appraised likelihood of accidental overdose (HR 1.48, 95% CI 1.00-2.19). Overdose-mortality was significantly associated with unsafe injecting (SHR 2.52, 95% CI 1.11-5.70) and clinically appraised suicidality (SHR 2.89, 95% CI 1.38-6.03). Suicidality was associated with a twofold increase in mortality risk among OUD patients who were not admitted to mental health services within 2 months of their risk assessment (HR 2.03, 95% CI 1.67-3.24). Diagnosis-specific brief risk screening can identify OUD patient subgroups at increased risk of all-cause and overdose mortality. OUD patients, where suicidality is evident, who are not admitted into services are particularly vulnerable. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

Effects of leisure and non-leisure physical activity on mortality in U.S. adults over two decades.

PubMed

Arrieta, Alejandro; Russell, Louise B

2008-12-01

To estimate the effects of the components of total physical activity, leisure-time and non-leisure activity, on all-cause mortality over two decades in a large, nationally representative sample of U.S. adults. We used the first National Health and Nutrition Examination Survey (NHANES I, 1971-1975) and its Epidemiologic Followup Study (NHEFS), which tracked deaths of NHANES I participants through 1992. Using multivariable Cox regression, and multiple imputation for missing values of control variables, we related baseline leisure-time and non-leisure physical activity to all-cause mortality during follow-up, controlling for other risk factors. Adults 35 through 59 years of age (N = 5884) and 60 through 74 years of age (N = 4590) were analyzed separately. For persons aged 35-59, moderate non-leisure activity at baseline significantly reduced mortality risk over the next two decades by about 26%, high non-leisure activity by about 37%, compared with low non-leisure activity. For persons 60-74, risk reductions were 34% and 38%, respectively. Leisure-time activity was associated with lower mortality, but was not consistently significant when both types of activity were entered in the regressions. Over two decades, non-leisure physical activity was associated with a substantial reduction in all-cause mortality. These results contribute to a growing number of studies that support the importance of measuring all physical activity.

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 mortality. Limitations of the study include self-reported and under-specified measures, dichotomized risk scores, lack of long-term patterns of lifestyle behaviors, and lack of cause-specific mortality data. Conclusions Adherence to healthy lifestyle behaviors could reduce the risk for death from all causes. Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors. PMID:26645683

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

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

2015-12-01

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. 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 mortality. Limitations of the study include self-reported and under-specified measures, dichotomized risk scores, lack of long-term patterns of lifestyle behaviors, and lack of cause-specific mortality data. Adherence to healthy lifestyle behaviors could reduce the risk for death from all causes. Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors.

Child and Adolescent Mortality Across Malaysia's Epidemiological Transition: A Systematic Analysis of Global Burden of Disease Data.

PubMed

Abdul-Razak, Suraya; Azzopardi, Peter S; Patton, George C; Mokdad, Ali H; Sawyer, Susan M

2017-10-01

A rapid epidemiological transition in developing countries in Southeast Asia has been accompanied by major shifts in the health status of children and adolescents. In this article, mortality estimates in Malaysian children and adolescents from 1990 to 2013 are used to illustrate these changes. All-cause and cause-specific mortality estimates were obtained from the 2013 Global Burden of Disease Study. Data were extracted from 1990 to 2013 for the developmental age range from 1 to 24 years, for both sexes. Trends in all-cause and cause-specific mortality for the major epidemiological causes were estimated. From 1990 to 2013, all-cause mortality decreased in all age groups. Reduction of all-cause mortality was greatest in 1- to 4-year-olds (2.4% per year reduction) and least in 20- to 24-year-olds (.9% per year reduction). Accordingly, in 2013, all-cause mortality was highest in 20- to 24-year-old males (129 per 100,000 per year). In 1990, the principal cause of death for 1- to 9-year boys and girls was vaccine preventable diseases. By 2013, neoplasms had become the major cause of death in 1-9 year olds of both sexes. The major cause of death in 10- to 24-year-old females was typhoid in 1990 and neoplasms in 2013, whereas the major cause of death in 10- to 24-year-old males remained road traffic injuries. The reduction in mortality across the epidemiological transition in Malaysia has been much less pronounced for adolescents than younger children. The contribution of injuries and noncommunicable diseases to adolescent mortality suggests where public health strategies should focus. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Changes in cause-specific mortality during heat waves in central Spain, 1975-2008

NASA Astrophysics Data System (ADS)

Miron, Isidro Juan; Linares, Cristina; Montero, Juan Carlos; Criado-Alvarez, Juan Jose; Díaz, Julio

2015-09-01

The relationship between heat waves and mortality has been widely described, but there are few studies using long daily data on specific-cause mortality. This study is undertaken in central Spain and analysing natural causes, circulatory and respiratory causes of mortality from 1975 to 2008. Time-series analysis was performed using ARIMA models, including data on specific-cause mortality and maximum and mean daily temperature and mean daily air pressure. The length of heat waves and their chronological number were analysed. Data were stratified in three decadal stages: 1975-1985, 1986-1996 and 1997-2008. Heat-related mortality was triggered by a threshold temperature of 37 °C. For each degree that the daily maximum temperature exceeded 37 °C, the percentage increase in mortality due to circulatory causes was 19.3 % (17.3-21.3) in 1975-1985, 30.3 % (28.3-32.3) in 1986-1996 and 7.3 % (6.2-8.4) in 1997-2008. The increase in respiratory cause ranged from 12.4 % (7.8-17.0) in the first period, to 16.3 % (14.1-18.4) in the second and 13.7 % (11.5-15.9) in the last. Each day of heat-wave duration explained 5.3 % (2.6-8.0) increase in respiratory mortality in the first period and 2.3 % (1.6-3.0) in the last. Decadal scale differences exist for specific-causes mortality induced by extreme heat. The impact on heat-related mortality by natural and circulatory causes increases between the first and the second period and falls significantly in the last. For respiratory causes, the increase is no reduced in the last period. These results are of particular importance for the estimation of future impacts of climate change on health.

Beverage habits and mortality in Chinese adults.

PubMed

Odegaard, Andrew O; Koh, Woon-Puay; Yuan, Jian-Min; Pereira, Mark A

2015-03-01

There is limited research examining beverage habits, one of the most habitual dietary behaviors, with mortality risk. 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. 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. 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. Higher coffee and black tea intake was inversely associated with mortality in never-smokers, light to moderate alcohol intake was inversely associated with mortality regardless of smoking status, heavy alcohol intake was positively associated with mortality in ever-smokers, and there was no association between sugar-sweetened beverages and green tea and mortality. © 2015 American Society for Nutrition.

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 inversely associated with mortality in never-smokers, light to moderate alcohol intake was inversely associated with mortality regardless of smoking status, heavy alcohol intake was positively associated with mortality in ever-smokers, and there was no association between sugar-sweetened beverages and green tea and mortality. PMID:25733477

Recent trends in mortality in Australia--an analysis of the causes of death through the application of life table techniques.

PubMed

Jain, S K

1992-05-01

"The paper examines the post-1971 reduction in Australian mortality in light of data on causes of death. Multiple-decrement life tables for eleven leading causes of death by sex are calculated and the incidence of each cause of death is presented in terms of the values of the life table functions. The study found that in the overall decline in mortality over the last 20 years significant changes occurred in the contribution of the various causes to total mortality.... The sex-age-cause-specific incidence of mortality changed and the median age at death increased for all causes except for deaths due to motor-vehicle accidents for both sexes and suicide for males. The paper also deciphers the gains in the expectation of life at birth over various time periods and the sex-differentials in the expectation of life at birth at a point in time in terms of the contributions made by the various sex-age-cause-specific mortality rates." excerpt

Testing the Predictive Validity of the Healthy Eating Index-2015 in the Multiethnic Cohort: Is the Score Associated with a Reduced Risk of All-Cause and Cause-Specific Mortality?

PubMed Central

Panizza, Chloe E.; Shvetsov, Yurii B.; Harmon, Brook E.; Wilkens, Lynne R.; Le Marchand, Loic; Haiman, Christopher; Reedy, Jill

2018-01-01

The Healthy Eating Index-2015 (HEI-2015) was created to assess conformance of dietary intake with the Dietary Guidelines for Americans (DGA) 2015–2020. We assessed the association between the HEI-2015 and mortality from all-cause, cardiovascular disease (CVD), and cancer in the Multiethnic Cohort (MEC). White, African American, Native Hawaiian, Japanese American, and Latino adults (n > 215,000) from Hawaii and California completed a quantitative food-frequency questionnaire at study enrollment. HEI-2015 scores were divided into quintiles for men and women. Radar graphs were used to demonstrate how dietary components contributed to HEI-2015 scores. Mortality was documented over 17–22 years of follow-up. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox proportional hazards models. High HEI-2015 scores were inversely associated with risk of mortality from all-cause, CVD, and cancer for men and women (p-trend <0.0001 for all models). For men, the HRs (CIs) for all-cause, CVD, and cancer comparing the highest to the lowest quintile were 0.79 (0.76, 0.82), 0.76 (0.71, 0.82), and 0.80 (0.75, 0.87), respectively. For women, the HRs were 0.79 (0.76, 0.82), 0.75 (0.70, 0.81), and 0.84 (0.78, 0.91), respectively. These results, in a multiethnic population, demonstrate that following a diet aligned with the DGAs 2015–2020 recommendations is associated with lower risk of mortality from all-cause, CVD, and cancer. PMID:29621192

Analysis of underlying and multiple-cause mortality data.

PubMed

Moussa, M A; El Sayed, A M; Sugathan, T N; Khogali, M M; Verma, D

1992-01-01

"A variety of life table models were used for the analysis of the (1984-86) Kuwaiti cause-specific mortality data. These models comprised total mortality, multiple-decrement, cause-elimination, cause-delay and disease dependency. The models were illustrated by application to a set of four chronic diseases: hypertensive, ischaemic heart, cerebrovascular and diabetes mellitus. The life table methods quantify the relative weights of different diseases as hazards to mortality after adjustment for other causes. They can also evaluate the extent of dependency between underlying cause of death and other causes mentioned on [the] death certificate using an extended underlying-cause model." (SUMMARY IN FRE AND ITA) excerpt

[Analysis of the trend and impact of mortality due to external causes: Mexico, 2000-2013].

PubMed

Dávila Cervantes, Claudio Alberto; Pardo Montaño, Ana Melisa

2016-01-01

The objective of this study was to analyze mortality due to the main external causes of death (traffic accidents, other accidents, homicides and suicides) in Mexico, calculating the years of life lost between 0 and 100 years of age and their contribution to the change in life expectancy between 2000 and 2013, at the national level, by sex and age group. Data came from mortality vital statistics of the Instituto Nacional de Estadística y Geografía (INEGI) [National Institute of Statistics and Geography]. The biggest impact in mortality due to external causes occurred in adolescent and adult males 15-49 years of age; mortality due to these causes remained constant in males and slightly decreased in females. Mortality due to traffic accidents and other accidents decreased, with a positive contribution to life expectancy, but this effect was canceled out by the increase in mortality due to homicides and suicides. Mortality due to external causes can be avoided through interventions, programs and prevention strategies as well as timely treatment. It is necessary to develop multidisciplinary studies on the dynamics of the factors associated with mortality due to these causes.

Prisoner Survival Inside and Outside of the Institution: Implications for Health-Care Planning

PubMed Central

Spaulding, Anne C.; Seals, Ryan M.; McCallum, Victoria A.; Perez, Sebastian D.; Brzozowski, Amanda K.; Steenland, N. Kyle

2011-01-01

The life expectancy of persons cycling through the prison system is unknown. The authors sought to determine the 15.5-year survival of 23,510 persons imprisoned in the state of Georgia on June 30, 1991. After linking prison and mortality records, they calculated standardized mortality ratios (SMRs). The cohort experienced 2,650 deaths during follow-up, which were 799 more than expected (SMR = 1.43, 95% confidence interval (CI): 1.38, 1.49). Mortality during incarceration was low (SMR = 0.85, 95% CI: 0.77, 0.94), while postrelease mortality was high (SMR = 1.54, 95% CI: 1.48, 1.61). SMRs varied by race, with black men exhibiting lower relative mortality than white men. Black men were the only demographic subgroup to experience significantly lower mortality while incarcerated (SMR = 0.66, 95% CI: 0.58, 0.76), while white men experienced elevated mortality while incarcerated (SMR = 1.28, 95% CI: 1.10, 1.48). Four causes of death (homicide, transportation, accidental poisoning, and suicide) accounted for 74% of the decreased mortality during incarceration, while 6 causes (human immunodeficiency virus infection, cancer, cirrhosis, homicide, transportation, and accidental poisoning) accounted for 62% of the excess mortality following release. Adjustment for compassionate releases eliminated the protective effect of incarceration on mortality. These results suggest that the low mortality inside prisons can be explained by the rarity of deaths unlikely to occur in the context of incarceration and compassionate releases of moribund patients. PMID:21239522

Mortality risks in alcoholism and effects of abstinence and addiction treatment.

PubMed

Miller, N S

1999-06-01

The mortality rate from alcoholism and related comorbidities is high. Studies show multiple causes of premature death from alcoholism. Several studies showed that abstinence had a positive effective on the overall survival of alcoholics. Alcoholics who abstained from alcohol, particularly continuously, showed reduced mortality rates and increased years of longevity than alcoholics who relapsed to alcohol consumption. The sources of the findings tend to be derived from treatment populations, in which abstinence is expected to occur in higher rates than in the general population.

The influence of baseline risk on the relation between HbA1c and risk for new cardiovascular events and mortality in patients with type 2 diabetes and symptomatic cardiovascular disease.

PubMed

Bots, Sophie H; van der Graaf, Yolanda; Nathoe, Hendrik M W; de Borst, Gert Jan; Kappelle, Jaap L; Visseren, Frank L J; Westerink, Jan

2016-07-19

Strict glycaemic control in patients with type 2 diabetes has proven to have microvascular benefits while the effects on CVD and mortality are less clear, especially in high risk patients. Whether strict glycaemic control would reduce the risk of future CVD or mortality in patients with type 2 diabetes and pre-existing CVD, is unknown. This study aims to evaluate whether the relation between baseline HbA1c and new cardiovascular events or mortality in patients with type 2 diabetes and pre-existing cardiovascular disease (CVD) is modified by baseline vascular risk. A cohort of 1096 patients with type 2 diabetes and CVD from the Second Manifestations of ARTerial Disease (SMART) study was followed. The relation between HbA1c at baseline and future vascular events (composite of myocardial infarction, stroke and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses in a population that was stratified for baseline risk for vascular events as calculated with the SMART risk score. The mean follow-up duration was 6.9 years for all-cause mortality and 6.4 years for vascular events, in which period 243 and 223 cases were reported, respectively. A 1 % increase in HbA1c was associated with a higher risk for all-cause mortality (HR 1.18, 95 % CI 1.06-1.31). This association was also found in the highest SMART risk quartile (HR 1.33, 95 % CI 1.11-1.60). There was no relation between HbA1c and the occurrence of cardiovascular events during follow-up (HR 1.03, 95 % CI 0.91-1.16). The interaction term between HbA1c and SMART risk score was not significantly related to any of the outcomes. In patients with type 2 diabetes and CVD, HbA1c is related to the risk of all-cause mortality, but not to the risk of cardiovascular events. The relation between HbA1c and all-cause mortality in patients with type 2 diabetes and vascular disease is not dependent on baseline vascular risk.

Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?

PubMed Central

2012-01-01

Background Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Methods Cause-specific mortality data for people aged 30–74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30–74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients. Results In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. Conclusions We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies. PMID:22578154

Involvement of two specific causes of cell mortality in freeze-thaw cycles with freezing to -196 degrees C.

PubMed

Dumont, Frédéric; Marechal, Pierre-André; Gervais, Patrick

2006-02-01

The purpose of this study was to examine cell viability after freezing. Two distinct ranges of temperature were identified as corresponding to stages at which yeast cell mortality occurred during freezing to -196 degrees C. The upper temperature range was related to the temperature of crystallization of the medium, which was dependent on the solute concentration; in this range mortality was prevented by high solute concentrations, and the proportion of the medium in the vitreous state was greater than the proportion in the crystallized state. The lower temperature range was related to recrystallization that occurred during thawing. Mortality in this temperature range was increased by a high cooling rate and/or high solute concentration in the freezing medium and a low temperature (less than -70 degrees C). However, a high rate of thawing prevented yeast mortality in this lower temperature range. Overall, it was found that cell viability could be conserved better under freezing conditions by increasing the osmotic pressure of the medium and by using an increased warming rate.

Involvement of Two Specific Causes of Cell Mortality in Freeze-Thaw Cycles with Freezing to −196°C

PubMed Central

Dumont, Frédéric; Marechal, Pierre-André; Gervais, Patrick

2006-01-01

The purpose of this study was to examine cell viability after freezing. Two distinct ranges of temperature were identified as corresponding to stages at which yeast cell mortality occurred during freezing to −196°C. The upper temperature range was related to the temperature of crystallization of the medium, which was dependent on the solute concentration; in this range mortality was prevented by high solute concentrations, and the proportion of the medium in the vitreous state was greater than the proportion in the crystallized state. The lower temperature range was related to recrystallization that occurred during thawing. Mortality in this temperature range was increased by a high cooling rate and/or high solute concentration in the freezing medium and a low temperature (less than −70°C). However, a high rate of thawing prevented yeast mortality in this lower temperature range. Overall, it was found that cell viability could be conserved better under freezing conditions by increasing the osmotic pressure of the medium and by using an increased warming rate. PMID:16461684

Assessing the causes of under-five mortality in the Albert Schweitzer Hospital service area of rural Haiti.

PubMed

Perry, Henry B; Ross, Allen G; Fernand, Facile

2005-09-01

Limited information is available regarding the causes of under-five mortality in nearly all of the countries in which mortality is the highest. The purpose of this study was to use a standard computerized protocol for defining the leading causes of death among children in a high-mortality rural population of Haiti and to highlight the need for similar studies else-where in Haiti and throughout the high-mortality areas of Latin America and the Caribbean. In 2001 a standardized, closed-ended verbal autopsy questionnaire endorsed by the World Health Organization was administered to a representative, population-based sample of the mothers or other caregivers of 97 children who had died before reaching 5 years of age between 1995 and 1999 in the service area of the Albert Schweitzer Hospital, which is located in the rural Artibonite Valley of Haiti. With the data from the questionnaires we used a computerized algorithm to generate diagnoses of the cause of death; the algorithm made it possible to have more than one cause of death. Acute lower respiratory infection (ALRI) was the leading diagnosis, present in 45% of all under-five deaths, followed by enteric diseases, present in 21% of deaths. Neonatal tetanus, preterm birth, and other early neonatal causes unassociated with ALRI or diarrhea were present in 41% of the neonatal deaths. Among children 1-59 months of age, ALRI was present in 51% of the deaths, and enteric diseases in 30%. Deaths were concentrated during the first few months of life, with 35% occurring during the first month. Among the neonatal deaths, 27% occurred on the first day of life, and 80% occurred during the first 10 days of life. In the Albert Schweitzer Hospital program area--and presumably in other areas of Haiti as well--priority needs to be given to the prevention of and the early, effective treatment of ALRI, diarrhea, and early neonatal conditions. This study points to the need for more, similar standardized assessments to guide local, regional, and national programs.

Severe Blunt Hepatic Trauma in Polytrauma Patient - Management and Outcome.

PubMed

Doklestić, Krstina; Djukić, Vladimir; Ivančević, Nenad; Gregorić, Pavle; Lončar, Zlatibor; Stefanović, Branislava; Jovanović, Dušan; Karamarković, Aleksandar

2015-01-01

Despite the fact that treatment of liver injuries has dramatically evolved, severe liver traumas in polytraumatic patients still have a significant morbidity and mortality. The purpose of this study was to determine the options for surgical management of severe liver trauma as well as the outcome. In this retrospective study 70 polytraumatic patients with severe (American Association for the Surgery of Trauma [AAST] grade III-V) blunt liver injuries were operated on at the Clinic for Emergency Surgery. Mean age of patients was 48.26±16.80 years; 82.8% of patients were male. Road traffic accident was the leading cause of trauma, seen in 63 patients (90.0%). Primary repair was performed in 36 patients (51.4%), while damage control with perihepatic packing was done in 34 (48.6%). Complications related to the liver occurred in 14 patients (20.0%). Liver related mortality was 17.1%. Non-survivors had a significantly higher AAST grade (p=0.0001), higher aspartate aminotransferase level (p=0.01), lower hemoglobin level (p=0.0001), associated brain injury (p=0.0001), perioperative complications (p=0.001) and higher transfusion score (p=0.0001). The most common cause of mortality in the "early period" was uncontrolled bleeding, in the "late period" mortality was caused by sepsis and acute respiratory distress syndrome. Patients with high-grade liver trauma who present with hemorrhagic shock and associated severe injury should be managed operatively. Mortality from liver trauma is high for patients with higher AAST grade of injury, associated brain injury and massive transfusion score.

Acute-On-Chronic Liver Failure: Causes, Clinical Characteristics and Predictors of Mortality.

PubMed

Tasneem, Abbas Ali; Luck, Nasir Hassan

2017-01-01

To determine the causes, characteristics and predictors of mortality in patients with acute-on-chronic liver failure (ACLF). Cross-sectional study. Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from July 2014 to June 2016. All patients with acute-on-chronic liver disease (ACLD) with ages > 12 were included. Patients with ACLF, as defined by the Asian Pacific Association for the Study of Liver (APASL, 2014) were identified. Predictors of mortality were identified using chi-square or Fisher's exact test. Included in the study were 72 patients with mean age of 36.71 years, 46 (63.9%) being males. Among them, 61 developed ACLF. Commonest causes of chronic liver disease (CLD) were chronic viral hepatitis (37, 51.4%) and autoimmune hepatitis (14, 19.4%). Commonest causes of acute liver injury (ALI) were acute viral hepatitis (24, 33.3%) and drug induced liver injury (DILI) (17, 23.6%). Among those with ACLF, 24 (39.3%) patients died with median survival of 17.1 ±13.5 days. Mortality was significantly associated with Child Turcotte Pugh (CTP) score ≥13 (p=0.010), model for end-stage liver disease (MELD) score ≥30 (p=0.001), age >40 years (p=0.036), organ failures (OF) ≥3 (p <0.0001), portosystemic encephalopathy (PSE) (p <0.0001), renal failure (p <0.0001) and urosepsis (p <0.0001). Acute viral hepatitis and DILI are commonest causes of ACLF. Mortality is high in ACLF patients having OF ≥3, CTP ≥13, MELD ≥30, age >40 years, PSE, renal failure and urosepsis.

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.

A review of methods to estimate cause-specific mortality in presence of competing risks

USGS Publications Warehouse

Heisey, Dennis M.; Patterson, Brent R.

2006-01-01

Estimating cause-specific mortality is often of central importance for understanding the dynamics of wildlife populations. Despite such importance, methodology for estimating and analyzing cause-specific mortality has received little attention in wildlife ecology during the past 20 years. The issue of analyzing cause-specific, mutually exclusive events in time is not unique to wildlife. In fact, this general problem has received substantial attention in human biomedical applications within the context of biostatistical survival analysis. Here, we consider cause-specific mortality from a modern biostatistical perspective. This requires carefully defining what we mean by cause-specific mortality and then providing an appropriate hazard-based representation as a competing risks problem. This leads to the general solution of cause-specific mortality as the cumulative incidence function (CIF). We describe the appropriate generalization of the fully nonparametric staggered-entry Kaplan–Meier survival estimator to cause-specific mortality via the nonparametric CIF estimator (NPCIFE), which in many situations offers an attractive alternative to the Heisey–Fuller estimator. An advantage of the NPCIFE is that it lends itself readily to risk factors analysis with standard software for Cox proportional hazards model. The competing risks–based approach also clarifies issues regarding another intuitive but erroneous "cause-specific mortality" estimator based on the Kaplan–Meier survival estimator and commonly seen in the life sciences literature.

FEV1 is a better predictor of mortality than FVC: the PLATINO cohort study.

PubMed

Menezes, Ana Maria B; Pérez-Padilla, Rogelio; Wehrmeister, Fernando César; Lopez-Varela, Maria Victorina; Muiño, Adriana; Valdivia, Gonzalo; Lisboa, Carmen; Jardim, José Roberto B; de Oca, Maria Montes; Talamo, Carlos; Bielemann, Renata; Gazzotti, Mariana; Laurenti, Ruy; Celli, Bartolomé; Victora, Cesar G

2014-01-01

To determine whether the presence of chronic obstructive lung disease (COPD) and reduction of lung function parameters were predictors of mortality in a cohort. Population based cohorts were followed in Montevideo, Santiago and Sao Paulo during 5, 6 and 9 years, respectively. Outcomes included all-cause, cardiovascular, respiratory and cancer mortality; exposures were COPD, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Cox regression was used for analyses. Sensitivity, specificity, positive and negative predictive values, receiver operator characteristics curves and Youden's index were calculated. Main causes of death were cardiovascular, respiratory and cancer. Baseline COPD was associated with overall mortality (HR = 1.43 for FEV1/FVC

Changes in contribution of causes of death to socioeconomic mortality inequalities in Korean adults.

PubMed

Jung-Choi, Kyunghee; Khang, Young Ho; Cho, Hong Jun

2011-11-01

This study aimed to analyze long-term trends in the contribution of each cause of death to socioeconomic inequalities in all-cause mortality among Korean adults. Data were collected from death certificates between 1990 and 2004 and from censuses in 1990, 1995, and 2000. Age-standardized death rates by gender were produced according to education as the socioeconomic position indicator, and the slope index of inequality was calculated to evaluate the contribution of each cause of death to socioeconomic inequalities in all-cause mortality. Among adults aged 25-44, accidental injuries with transport accidents, suicide, liver disease and cerebrovascular disease made relatively large contributions to socioeconomic inequalities in all-cause mortality, while, among adults aged 45-64, liver disease, cerebrovascular disease, transport accidents, liver cancer, and lung cancer did so. Ischemic heart disease, a very important contributor to socioeconomic mortality inequality in North America and Western Europe, showed a very low contribution (less than 3%) in both genders of Koreans. Considering the contributions of different causes of death to absolute mortality inequalities, establishing effective strategies to reduce socioeconomic inequalities in mortality is warranted.

Mortality rates among Arab Americans in Michigan.

PubMed

Dallo, Florence J; Schwartz, Kendra; Ruterbusch, Julie J; Booza, Jason; Williams, David R

2012-04-01

The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population.

Mortality Rates Among Arab Americans in Michigan

PubMed Central

Schwartz, Kendra; Ruterbusch, Julie J.; Booza, Jason; Williams, David R.

2014-01-01

The objectives of this study were to: (1) calculate age-specific and age-adjusted cause-specific mortality rates for Arab Americans; and (2) compare these rates with those for blacks and whites. Mortality rates were estimated using Michigan death certificate data, an Arab surname and first name list, and 2000 U.S. Census data. Age-specific rates, age-adjusted all-cause and cause-specific rates were calculated. Arab Americans (75+) had higher mortality rates than whites and blacks. Among men, all-cause and cause-specific mortality rates for Arab Americans were in the range of whites and blacks. However, Arab American men had lower mortality rates from cancer and chronic lower respiratory disease compared to both whites and blacks. Among women, Arab Americans had lower mortality rates from heart disease, cancer, stroke, and diabetes than whites and blacks. Arab Americans are growing in number. Future study should focus on designing rigorous separate analyses for this population. PMID:21318619

DNA methylation-based measures of biological age: meta-analysis predicting time to death.

PubMed

Chen, Brian H; Marioni, Riccardo E; Colicino, Elena; Peters, Marjolein J; Ward-Caviness, Cavin K; Tsai, Pei-Chien; Roetker, Nicholas S; Just, Allan C; Demerath, Ellen W; Guan, Weihua; Bressler, Jan; Fornage, Myriam; Studenski, Stephanie; Vandiver, Amy R; Moore, Ann Zenobia; Tanaka, Toshiko; Kiel, Douglas P; Liang, Liming; Vokonas, Pantel; Schwartz, Joel; Lunetta, Kathryn L; Murabito, Joanne M; Bandinelli, Stefania; Hernandez, Dena G; Melzer, David; Nalls, Michael; Pilling, Luke C; Price, Timothy R; Singleton, Andrew B; Gieger, Christian; Holle, Rolf; Kretschmer, Anja; Kronenberg, Florian; Kunze, Sonja; Linseisen, Jakob; Meisinger, Christine; Rathmann, Wolfgang; Waldenberger, Melanie; Visscher, Peter M; Shah, Sonia; Wray, Naomi R; McRae, Allan F; Franco, Oscar H; Hofman, Albert; Uitterlinden, André G; Absher, Devin; Assimes, Themistocles; Levine, Morgan E; Lu, Ake T; Tsao, Philip S; Hou, Lifang; Manson, JoAnn E; Carty, Cara L; LaCroix, Andrea Z; Reiner, Alexander P; Spector, Tim D; Feinberg, Andrew P; Levy, Daniel; Baccarelli, Andrea; van Meurs, Joyce; Bell, Jordana T; Peters, Annette; Deary, Ian J; Pankow, James S; Ferrucci, Luigi; Horvath, Steve

2016-09-28

Estimates of biological age based on DNA methylation patterns, often referred to as "epigenetic age", "DNAm age", have been shown to be robust biomarkers of age in humans. We previously demonstrated that independent of chronological age, epigenetic age assessed in blood predicted all-cause mortality in four human cohorts. Here, we expanded our original observation to 13 different cohorts for a total sample size of 13,089 individuals, including three racial/ethnic groups. In addition, we examined whether incorporating information on blood cell composition into the epigenetic age metrics improves their predictive power for mortality. All considered measures of epigenetic age acceleration were predictive of mortality (p≤8.2x10 -9 ) , independent of chronological age, even after adjusting for additional risk factors (p<5.4x10 -4 ) , and within the racial/ethnic groups that we examined (non-Hispanic whites, Hispanics, African Americans). Epigenetic age estimates that incorporated information on blood cell composition led to the smallest p-values for time to death (p=7.5x10 -43 ). Overall, this study a) strengthens the evidence that epigenetic age predicts all-cause mortality above and beyond chronological age and traditional risk factors, and b) demonstrates that epigenetic age estimates that incorporate information on blood cell counts lead to highly significant associations with all-cause mortality.

Unusual mortality pattern among short term workers in the perfumery industry in Geneva.

PubMed Central

Gubéran, E; Usel, M

1987-01-01

A cohort of 537 workers employed for less than one year between 1900 and 1964 in the Geneva perfumery industry was followed up from entry to the end of 1983. During the period of study, 251 workers died and 41 (8%) were lost to follow up. The standardised mortality ratio (SMR) was significantly above 100 for all causes (SMR = 120), all cancers (SMR = 127), lung cancer (SMR = 186), and violent death (SMR = 179). The highest SMR from all causes was associated with the shortest period of employment (less than two months) and it decreased significantly with longer duration. Such mortality excesses had not been recorded among the 1168 workers of the same industry employed one year or more, previously studied in similar fashion. Interviews among a random sample of 52 workers employed for less than two months seem to indicate that the prevalence of smoking, exposures to asbestos, and occupational accidents in other hazardous industries were higher for these workers than for the reference population. Furthermore, unmarried men were overrepresented among the study cohort. These findings support previous observations indicating that short term workers share atypical features related to high mortality from various causes. It is suggested that mortality in this subgroup should be analysed separately in occupational studies. PMID:3663526

Association of cholesterol, LDL, HDL, cholesterol/ HDL and triglyceride with all-cause mortality in life insurance applicants.

PubMed

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

2009-01-01

Determine the relationship between various lipid tests and all-cause mortality in life insurance applicants stratified by age and sex. By use of the Social Security Death Master File, mortality was determined in 1,488,572 life insurance applicants from whom blood samples were submitted to Clinical Reference Laboratory. There were 41,020 deaths observed in this healthy adult population during a median follow-up of 12 years (range 10 to 14 years). Results were stratified by 4 age-sex subpopulations: females, ages 20 to 59 or 60+; and males, ages 20 to 59 or 60+. Those with serum albumin < 3.6 mg/dL or fructosamine > or = 2.1 mmol/L were excluded. The middle 50% of lipid values specific to each of these 4 age-sex subpopulations was used as the reference band. The mortality rates in bands representing other percentiles of lipid values were compared with the mortality rate in the reference band within each age-sex subpopulation. In contrast to some published findings from general populations, lipid test results are only moderately predictive of all-cause mortality risk in a life insurance applicant population and that risk is dependent on age and sex. At ages below 60, HDL values are associated with a "J" shaped mortality curve and at ages 60+, total cholesterol is associated with a "U" shaped curve. The total cholesterol/HDL ratio may serve as a useful single measure to predict mortality risk, but only if stratified by age and sex, and only if high HDL values at younger ages and lower total cholesterol values at ages 60+ are recognized as being associated with increased risk as well. Using LDL or non-HDL cholesterol instead of total cholesterol does not improve mortality risk discrimination; neither does using total cholesterol or triglyceride values in addition to the total cholesterol/HDL ratio. The total cholesterol/HDL ratio is the best single measure of all-cause mortality risk among the various lipid tests but is useful only if viewed on an age- and sex-specific basis and is only a modest risk predictor.

Not just smoking and high-tech medicine: socioeconomic inequities in US mortality rates, overall and by race/ethnicity, 1960–2006

PubMed Central

Krieger, Nancy; Chen, Jarvis T.; Kosheleva, Anna; Waterman, Pamela D.

2011-01-01

Recent research on the post-1980 widening of US socioeconomic mortality inequalities has emphasized the contribution of smoking and high-tech medicine, with some studies treating the growing inequalities as effectively inevitable. No studies, however, have analyzed long-term trends in US mortality rates and inequities unrelated to smoking or due to lack of basic medical care, even as a handful have shown that US socioeconomic inequalities in overall mortality shrank between the mid-1960s and 1980. We accordingly analyzed US mortality data for 1960–2006, stratified by county income quintile and race/ethnicity, for mortality unrelated to smoking and preventable by 1960s standards of medical care. Key findings were that relative and absolute socioeconomic inequalities in US mortality unrelated to smoking and preventable by 1960s medical care standards shrank between the 1960s and 1980 and then increased and stagnated, with absolute rates on par with several leading causes of death, and with the burden worst for US populations of color. None of these findings can be attributed to trends in smoking-related deaths and access to high-tech medicine, and they also demonstrate that socioeconomic inequities in mortality can shrink and need not inevitably rise. PMID:22611656

All-cause and cause-specific mortality among US youth: socioeconomic and rural-urban disparities and international patterns.

PubMed

Singh, Gopal K; Azuine, Romuladus E; Siahpush, Mohammad; Kogan, Michael D

2013-06-01

We analyzed international patterns and socioeconomic and rural-urban disparities in all-cause mortality and mortality from homicide, suicide, unintentional injuries, and HIV/AIDS among US youth aged 15-24 years. A county-level socioeconomic deprivation index and rural-urban continuum measure were linked to the 1999-2007 US mortality data. Mortality rates were calculated for each socioeconomic and rural-urban group. Poisson regression was used to derive adjusted relative risks of youth mortality by deprivation level and rural-urban residence. The USA has the highest youth homicide rate and 6th highest overall youth mortality rate in the industrialized world. Substantial socioeconomic and rural-urban gradients in youth mortality were observed within the USA. Compared to their most affluent counterparts, youth in the most deprived group had 1.9 times higher all-cause mortality, 8.0 times higher homicide mortality, 1.5 times higher unintentional-injury mortality, and 8.8 times higher HIV/AIDS mortality. Youth in rural areas had significantly higher mortality rates than their urban counterparts regardless of deprivation levels, with suicide and unintentional-injury mortality risks being 1.8 and 2.3 times larger in rural than in urban areas. However, youth in the most urbanized areas had at least 5.6 times higher risks of homicide and HIV/AIDS mortality than their rural counterparts. Disparities in mortality differed by race and sex. Socioeconomic deprivation and rural-urban continuum were independently related to disparities in youth mortality among all sex and racial/ethnic groups, although the impact of deprivation was considerably greater. The USA ranks poorly in all-cause mortality, youth homicide, and unintentional-injury mortality rates when compared with other industrialized countries.

Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort.

PubMed

Nilsson, L M; Winkvist, A; Eliasson, M; Jansson, J-H; Hallmans, G; Johansson, I; Lindahl, B; Lenner, P; Van Guelpen, B

2012-06-01

Long-term effects of carbohydrate-restricted diets are unclear. We examined a low-carbohydrate, high-protein (LCHP) score in relation to mortality. This is a population-based cohort study on adults in the northern Swedish county of Västerbotten. In 37,639 men (1460 deaths) and 39,680 women (923 deaths) from the population-based Västerbotten Intervention Program, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create an LCHP score (2-20 points). Sex-specific hazard ratios (HR) were calculated by Cox regression. Median intakes of carbohydrates, protein and fat in subjects with LCHP scores 2-20 ranged from 61.0% to 38.6%, 11.3% to 19.2% and 26.6% to 41.5% of total energy intake, respectively. High LCHP score (14-20 points) did not predict all-cause mortality compared with low LCHP score (2-8 points), after accounting for saturated fat intake and established risk factors (men: HR for high vs low 1.03 (95% confidence interval (CI) 0.88-1.20), P for continuous = 0.721; women: HR for high vs low 1.10 (95% CI 0.91-1.32), P for continuous = 0.229). For cancer and cardiovascular disease, no clear associations were found. Carbohydrate intake was inversely associated with all-cause mortality, though only statistically significant in women (multivariate HR per decile increase 0.95 (95% CI 0.91-0.99), P = 0.010). Our results do not support a clear, general association between LCHP score and mortality. Studies encompassing a wider range of macronutrient consumption may be necessary to detect such an association.

Recreational Waterborne Illnesses: Recognition, Treatment, and Prevention.

PubMed

Perkins, Allen; Trimmier, Marirose

2017-05-01

Illness after recreational water activities can be caused by a variety of agents, including bacteria, viruses, parasites, algae, and even chlorine gas. These illnesses are more common in summer. Waterborne illnesses are underreported because most recreational activity occurs in unsupervised venues or on private property, and participants tend to disperse before illness occurs. Symptoms of waterborne illness are primarily gastrointestinal, but upper respiratory and skin manifestations also occur. Gastrointestinal symptoms are usually self-limited, and supportive treatment may be all that is necessary. However, some infections can cause significant morbidity and mortality. Cryptosporidium and Giardia intestinalis are the most common cause of gastrointestinal illness and have partial chlorine resistance. Respiratory infections are typically mild and self-limited. However, if legionnaires' disease develops and is unrecognized, mortality may be as high as 10%. Cellulitis caused by Vibrio vulnificus can result in serious illness, amputation, and death. Early and appropriate antibiotic treatment is important. Chronically ill and immunocompromised persons are at high risk of infection and should be counseled accordingly.

Associations of Serum Ferritin and Transferrin % Saturation With All-cause, Cancer, and Cardiovascular Disease Mortality: Third National Health and Nutrition Examination Survey Follow-up Study

PubMed Central

Kim, Ki-Su; Son, Hye-Gyeong; Hong, Nam-Soo

2012-01-01

Objectives Even though experimental studies have suggested that iron can be involved in generating oxidative stress, epidemiologic studies on the association of markers of body iron stores with cardiovascular disease or cancer remain controversial. This study was performed to examine the association of serum ferritin and transferrin saturation (%TS) with all-cause, cancer, and cardiovascular mortality. Methods The study subjects were men aged 50 years or older and postmenopausal women of the Third National Health and Nutrition Examination Survey 1988-1994. Participants were followed-up for mortality through December 31, 2006. Results Serum ferritin was not associated with all-cause, cancer, or cardiovascular mortality for either men or postmenopausal women. However, all-cause, cancer, and cardiovascular mortality were inversely associated with %TS in men. Compared with men in the lowest quintile, adjusted hazard ratios for all-cause, cancer, and cardiovascular mortality were 0.85, 0.86, 0.76, and 0.74 (p for trend < 0.01), 0.82, 0.73, 0.75, and 0.63 (p for trend < 0.01), and 0.86, 0.81, 0.72, and 0.76 (p for trend < 0.01), respectively. For postmenopausal women, inverse associations were also observed for all-cause and cardiovascular mortality, but cancer mortality showed the significantly lower mortality only in the 2nd quintile of %TS compared with that of the 1st quintile. Conclusions Unlike speculation on the role of iron from experimental studies, %TS was inversely associated with all-cause, cancer and cardiovascular mortality in men and postmenopausal women. On the other hand, serum ferritin was not associated with all-cause, cancer, or cardiovascular mortality. PMID:22712047

Short-term effects of air temperature on mortality and effect modification by air pollution in three cities of Bavaria, Germany: a time-series analysis.

PubMed

Breitner, Susanne; Wolf, Kathrin; Devlin, Robert B; Diaz-Sanchez, David; Peters, Annette; Schneider, Alexandra

2014-07-01

Air temperature has been shown to be associated with mortality; however, only very few studies have been conducted in Germany. This study examined the association between daily air temperature and cause-specific mortality in Bavaria, Southern Germany. Moreover, we investigated effect modification by age and ambient air pollution. We obtained data from Munich, Nuremberg as well as Augsburg, Germany, for the period 1990 to 2006. Data included daily cause-specific death counts, mean daily meteorology and air pollution concentrations (particulate matter with a diameter<10 μm [PM10] and maximum 8-h ozone). We used Poisson regression models combined with distributed lag non-linear models adjusting for long-term trend, calendar effects, and meteorological factors. Air pollutant concentrations were categorized into three levels, and an interaction term was included to quantify potential effect modification of the air temperature effects. The temperature-mortality relationships were non-linear for all cause-specific mortality categories showing U- or J-shaped curves. An increase from the 90th (20.0 °C) to the 99th percentile (24.8 °C) of 2-day average temperature led to an increase in non-accidental mortality by 11.4% (95% CI: 7.6%-15.3%), whereas a decrease from the 10th (-1.0 °C) to the 1st percentile (-7.5 °C) in the 15-day average temperature resulted in an increase of 6.2% (95% CI: 1.8%-10.8%). The very old were found to be most susceptible to heat effects. Results also suggested some effect modification by ozone, but not for PM10. Results indicate that both very low and very high air temperature increase cause-specific mortality in Bavaria. Results also pointed to the importance of considering effect modification by age and ozone in assessing temperature effects on mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

Pentraxin-3 Predicts Short- and Mid-term Mortality in Patients with Sepsis and Septic Shock During Intensive Care Treatment.

PubMed

Hamed, Sonja; Behnes, Michael; Pauly, Dominic; Lepiorz, Dominic; Barre, Max; Becher, Tobias; Lang, Siegfried; Akin, Ibrahim; Borggrefe, Martin; Bertsch, Thomas; Hoffmann, Ursula

2018-06-01

The prognostic value of the acute phase protein Pentraxin 3 (PTX-3) is not well evaluated in patients with septic shock, which reveal an unacceptably high short- and long-term mortality. New Sepsis-3 definitions are not yet implemented in most biomarker studies. Therefore, this study assesses the prognostic value of PTX-3 for short- and mid-term mortality in patients with sepsis or septic shock, as defined by the latest definitions, treated at a medical intensive care unit (ICU). The study includes 213 ICU patients with clinical criteria of sepsis and septic shock. Plasma levels of PTX-3, procalcitonin (PCT) and interleukin-6 were measured on day 1, 3, and 8. All-cause mortality was followed up to 30 days and at 6 months. On all three days, PTX-3 levels were able to discriminate non-survivors from survivors at 30 days and 6 months (AUC range: 0.59 - 0.70; 95% CI: 0.52 - 0.79; p ≤ 0.02). Highest PTX-3 levels within the fourth quartiles during the first week of ICU treatment were associated with an increased mortality rate at 30 days (OR = 7; 95% CI: 2.0 - 23.5; p ≤ 0.002) and at 6 months (OR = 5; 95% CI: 2.1 - 11.4; p ≤ 0.006). Additionally, the prognostic value of PTX-3 was proven for all patients as well as in subcohorts of patients with sepsis and septic shock, according to Sepsis-3 criteria, both in univariate and multivariate analyses for 30-day and 6-months all-cause mortality, especially predicting all-cause mortality in septic shock (HRs range: 1.0 - 2.9; 95% CI: 0.3 - 5.1; p ≤ 0.03). PTX-3 offers prognostic value for the prediction of short- and mid-term all-cause mortality in patients suffering from sepsis and septic shock according to the latest Sepsis-3 criteria.

Colonic volvulus in the United States: trends, outcomes, and predictors of mortality.

PubMed

Halabi, Wissam J; Jafari, Mehraneh D; Kang, Celeste Y; Nguyen, Vinh Q; Carmichael, Joseph C; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J

2014-02-01

Colonic volvulus is a rare entity associated with high mortality rates. Most studies come from areas of high endemicity and are limited by small numbers. No studies have investigated trends, outcomes, and predictors of mortality at the national level. The Nationwide Inpatient Sample 2002-2010 was retrospectively reviewed for colonic volvulus cases admitted emergently. Patients' demographics, hospital factors, and outcomes of the different procedures were analyzed. The LASSO algorithm for logistic regression was used to build a predictive model for mortality in cases of sigmoid (SV) and cecal volvulus (CV) taking into account preoperative and operative variables. An estimated 3,351,152 cases of bowel obstruction were admitted in the United States over the study period. Colonic volvulus was found to be the cause in 63,749 cases (1.90%). The incidence of CV increased by 5.53% per year whereas the incidence of SV remained stable. SV was more common in elderly males (aged 70 years), African Americans, and patients with diabetes and neuropsychiatric disorders. In contrast, CV was more common in younger females. Nonsurgical decompression alone was used in 17% of cases. Among cases managed surgically, resective procedures were performed in 89% of cases, whereas operative detorsion with or without fixation procedures remained uncommon. Mortality rates were 9.44% for SV, 6.64% for CV, 17% for synchronous CV and SV, and 18% for transverse colon volvulus. The LASSO algorithm identified bowel gangrene and peritonitis, coagulopathy, age, the use of stoma, and chronic kidney disease as strong predictors of mortality. Colonic volvulus is a rare cause of bowel obstruction in the United States and is associated with high mortality rates. CV and SV affect different populations and the incidence of CV is on the rise. The presence of bowel gangrene and coagulopathy strongly predicts mortality, suggesting that prompt diagnosis and management are essential.

Profile of mortality from external causes among Seventh-day Adventists and the general populations.

PubMed

Velten, Ana Paula Costa; Cade, Nágela Valadão; Silva, Gulnar Azevedo E; Oliveira, Elizabete Regina Araújo de

2017-07-01

This paper aimed to compare the profile of mortality from external causes among Seventh-day Adventists and the general population of Espírito Santo from 2003 to 2009. A search of Adventists was performed in the nominal database of the Mortality Information System containing data on Adventists provided by the administrative offices of the institution. Deaths from external causes occurred during the study period were then divided into two groups: Adventists and the general population. Adventists had lower proportional mortality from external causes (10%) than the general population (19%), and males were the main reason for this difference. In both groups, deaths prevailed in the 20-29 years age group. Deaths from accidental causes were most significant among Adventists (68.08%), while deaths from intentional causes related to assault and self-inflicted injuries were more significant in the general population (53.67% of all deaths). The standardized mortality ratio for external causes was 41.3, thus, being Adventist reduced mortality by 58.7%. It is believed that the benefit of Adventists observed for mortality from external causes is related to this group's abstinence from alcohol consumption.

The extent and distribution of inequalities in childhood mortality by cause of death according to parental socioeconomic positions: a birth cohort study in South Korea.

PubMed

Kim, Jongoh; Son, Mia; Kawachi, Ichiro; Oh, Juhwan

2009-10-01

It has been shown that childhood mortality is affected by parental socioeconomic positions; in this article, we investigate the extent and distribution of inequalities across major causes of childhood death. We built a retrospective birth cohort using individually linked national birth and death records in South Korea. 1,329,540 children were followed up to exact age eight from 1995 to 1996 and total observed person-years were 10,594,168.18. Causes of death were identified from death records while parental education, occupation and birth characteristics were identified from birth records. Survival analysis was performed according to parental socioeconomic positions. Cox proportional hazard analysis was done according to parental education and occupation with adjustment of birth characteristics such as sex, parental age, gestational age, birth weight, multiple birth, the number of total births, and previous death of children. Cumulative incidence of mortality by age was obtained through a competing-risk method in each cause according to maternal education. From these results, distribution of inequalities across major causes of death was calculated. In total, 7018 deaths occurred during the eight years and mortality rate was 66.24 per 100,000 person-years. External cause was the most common cause of death followed by congenital malformations, nervous system diseases, perinatal diseases, cancer, respiratory, cardiovascular, infectious and gastrointestinal diseases. For all-cause mortality, hazard ratios (HR) were 1.98 (95% CI: 1.83-2.13) for paternal education, 1.90 (1.75-2.07) for maternal education, 1.40 (1.33-1.47) for paternal occupation and 2.33(1.98-2.73) for maternal occupation (between middle school graduation or lower and university or more for education, between manual and non-manual for occupation). Mortality differentials were found in every cause of death. External cause, respiratory, cardiovascular and infectious diseases showed larger HR than all-cause mortality: 2.20 (1.90-2.56), 2.87 (2.02-4.08), 2.50 (1.67-3.75) and 2.12 (1.43-3.15) respectively according to maternal education. On the contrary, congenital malformations and cancer had smaller HR than all-cause mortality: 1.49 (1.22-1.82) and 1.43 (1.00-2.05) respectively according to maternal education. In all-cause mortality and most of the causes, cumulative incidence of mortality increased rapidly until one or two years after birth and then slowed down. But in external cause and cancer, cumulative incidence of mortality accumulated at a constant pace. Thus, inequalities in these causes of death consistently widened. External cause was the leading cause of overall inequalities and its proportion was 36-42% followed by congenital malformations, respiratory diseases etc. We conclude that there were inequalities of childhood mortality in every major cause of death. External cause was the leading cause of both all-cause mortality and overall inequalities. Public health interventions to reduce inequalities are necessary and external cause should be primarily considered.

Prognostic value of low and high ankle-brachial index in hospitalized medical patients.

PubMed

Pasqualini, Leonella; Schillaci, Giuseppe; Pirro, Matteo; Vaudo, Gaetano; Leli, Christian; Colella, Renato; Innocente, Salvatore; Ciuffetti, Giovanni; Mannarino, Elmo

2012-04-01

Peripheral arterial disease (PAD) is frequently underdiagnosed in the clinical practice, leading to a lack of opportunity to detect subjects at a high risk for cardiovascular (CV) death. The ankle-brachial pressure index (ABI) represents a noninvasive, objective tool to diagnose PAD and to predict adverse outcome. ABI was determined by means of Doppler velocimetry, in 707 patients, aged 50 years or older, consecutively hospitalized in an internal medicine ward, who were followed-up for at least 12 months in order to assess all-cause and CV mortality. Symptomatic PAD affected 8% of the population while the prevalence of PAD, defined as ABI <0.90, was 29%; high ABI (>1.40) was found in 8% of the patients. After a mean follow-up period of 1.6 years, both low and high ABI were independently associated with CV mortality with a hazard ratio of 1.99 (p=0.016) for low and 2.13 (p=0.04) for high ABI, compared with normal ABI (0.90-1.40). High ABI also independently predicted all-cause mortality with a hazard ratio of 1.77 (p=0.04). ABI measurement reveals a large number of individuals with asymptomatic PAD among those hospitalized in an internal medicine department. An increased mortality was observed in patients with both low and high ABI. Hospital admission for any reason may serve as an opportunity to detect PAD and start appropriate preventive actions. Copyright © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Signaling, Gene Regulation and Cancer | Center for Cancer Research

Cancer.gov

Although there have been tremendous progress in cancer research and treatment, the mortality caused by this disease is still very high. Cancer is the leading cause of death worldwide and second leading cause of death in the United States of America. Signaling, Gene Regulation and Cancer covers topics including the role of various signaling pathways in development, regulation

Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women.

PubMed

Ekelund, Ulf; Steene-Johannessen, Jostein; Brown, Wendy J; Fagerland, Morten Wang; Owen, Neville; Powell, Kenneth E; Bauman, Adrian; Lee, I-Min

2016-09-24

High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality. We did a systematic review, searching six databases (PubMed, PsycINFO, Embase, Web of Science, Sport Discus, and Scopus) from database inception until October, 2015, for prospective cohort studies that had individual level exposure and outcome data, provided data on both daily sitting or TV-viewing time and physical activity, and reported effect estimates for all-cause mortality, cardiovascular disease mortality, or breast, colon, and colorectal cancer mortality. We included data from 16 studies, of which 14 were identified through a systematic review and two were additional unpublished studies where pertinent data were available. All study data were analysed according to a harmonised protocol, which categorised reported daily sitting time and TV-viewing time into four standardised groups each, and physical activity into quartiles (in metabolic equivalent of task [MET]-hours per week). We then combined data across all studies to analyse the association of daily sitting time and physical activity with all-cause mortality, and estimated summary hazard ratios using Cox regression. We repeated these analyses using TV-viewing time instead of daily sitting time. Of the 16 studies included in the meta-analysis, 13 studies provided data on sitting time and all-cause mortality. These studies included 1 005 791 individuals who were followed up for 2-18·1 years, during which 84 609 (8·4%) died. Compared with the referent group (ie, those sitting <4 h/day and in the most active quartile [>35·5 MET-h per week]), mortality rates during follow-up were 12-59% higher in the two lowest quartiles of physical activity (from HR=1·12, 95% CI 1·08-1·16, for the second lowest quartile of physical activity [<16 MET-h per week] and sitting <4 h/day; to HR=1·59, 1·52-1·66, for the lowest quartile of physical activity [<2·5 MET-h per week] and sitting >8 h/day). Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35·5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for more than 8 h/day but who also reported >35·5 MET-h per week of activity (HR=1·04; 95% CI 0·99-1·10). By contrast, those who sat the least (<4 h/day) and were in the lowest activity quartile (<2·5 MET-h per week) had a significantly increased risk of dying during follow-up (HR=1·27, 95% CI 1·22-1·31). Six studies had data on TV-viewing time (N=465 450; 43 740 deaths). Watching TV for 3 h or more per day was associated with increased mortality regardless of physical activity, except in the most active quartile, where mortality was significantly increased only in people who watched TV for 5 h/day or more (HR=1·16, 1·05-1·28). High levels of moderate intensity physical activity (ie, about 60-75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of Lives Saved Tool model child mortality estimates against measured data from vector control studies in sub-Saharan Africa

PubMed Central

2011-01-01

Background Insecticide-treated mosquito nets (ITNs) and indoor-residual spraying have been scaled-up across sub-Saharan Africa as part of international efforts to control malaria. These interventions have the potential to significantly impact child survival. The Lives Saved Tool (LiST) was developed to provide national and regional estimates of cause-specific mortality based on the extent of intervention coverage scale-up. We compared the percent reduction in all-cause child mortality estimated by LiST against measured reductions in all-cause child mortality from studies assessing the impact of vector control interventions in Africa. Methods We performed a literature search for appropriate studies and compared reductions in all-cause child mortality estimated by LiST to 4 studies that estimated changes in all-cause child mortality following the scale-up of vector control interventions. The following key parameters measured by each study were applied to available country projections: baseline all-cause child mortality rate, proportion of mortality due to malaria, and population coverage of vector control interventions at baseline and follow-up years. Results The percent reduction in all-cause child mortality estimated by the LiST model fell within the confidence intervals around the measured mortality reductions for all 4 studies. Two of the LiST estimates overestimated the mortality reductions by 6.1 and 4.2 percentage points (33% and 35% relative to the measured estimates), while two underestimated the mortality reductions by 4.7 and 6.2 percentage points (22% and 25% relative to the measured estimates). Conclusions The LiST model did not systematically under- or overestimate the impact of ITNs on all-cause child mortality. These results show the LiST model to perform reasonably well at estimating the effect of vector control scale-up on child mortality when compared against measured data from studies across a range of malaria transmission settings. The LiST model appears to be a useful tool in estimating the potential mortality reduction achieved from scaling-up malaria control interventions. PMID:21501453

Causes of mortality of red-cockaded woodpecker cavity trees

Treesearch

Richard N. Conner; D. Craig Rudolph; David L. Kulhavy; Ann E. Snow

1991-01-01

Over a 13-year period we examined the mortality of cavity trees (n = 453) used by red-cockaded woodpeckers (Picoides borealis) on national forests in eastern Texas. Bark beetles (53%), wind snap (30%), and fire (7%) were the major causes of cavity tree mortality. Bark beetles were the major cause of mortality in loblolly (Pinus taeda...

Mortality under age 50 accounts for much of the fact that US life expectancy lags that of other high-income countries.

PubMed

Ho, Jessica Y

2013-03-01

Life expectancy at birth in the United States is among the lowest of all high-income countries. Most recent studies have concentrated on older ages, finding that Americans have a lower life expectancy at age fifty and experience higher levels of disease and disability than do their counterparts in other industrialized nations. Using cross-national mortality data to identify the key age groups and causes of death responsible for these shortfalls, I found that mortality differences below age fifty account for two-thirds of the gap in life expectancy at birth between American males and their counterparts in sixteen comparison countries. Among females, the figure is two-fifths. The major causes of death responsible for the below-fifty trends are unintentional injuries, including drug overdose--a fact that constitutes the most striking finding from this study; noncommunicable diseases; perinatal conditions, such as pregnancy complications and birth trauma; and homicide. In all, this study highlights the importance of focusing on younger ages and on policies both to prevent the major causes of death below age fifty and to reduce social inequalities.

Killer Whale (Orcinus orca) Deaths in Prince William Sound, Alaska, 1985-1990.

PubMed

Fraker, Mark A

2013-01-01

During 1985-1990, two groups of killer whales in Prince William Sound, Alaska, experienced unusually high rates of mortality, while seven others did not. Those affected were AB pod, part of the southern Alaska population of resident (fish-eating) killer whales, and the AT1 transient (marine mammal-eating) group, a very small, reproductively isolated population that last reproduced in 1984. In 1985-1986, several AB pod members were shot by fishermen defending their catch from depredation, which explains some of the deaths. Understanding the other deaths is complicated by the Exxon Valdez oil spill (March 1989) and uncertainties about the causes and times of the deaths. For AB pod, possible factors involved in the post-spill mortalities are delayed effects of bullet wounds, continued shooting, oil exposure, and consequences of being orphaned. For the AT1 group, possible factors are oil exposure, small population size, old age, and high-contaminant burdens. An analysis of possible effects of inhalation of volatile organic compounds, contact with the oil slick, and ingestion of oil with water or prey did not reveal route(s) of exposure that could explain the mortalities. The cause(s) of the killer whale deaths recorded following the oil spill remain uncertain.

[Causes and management of severe acute liver damage during pregnancy].

PubMed

Sepulveda-Martinez, Alvaro; Romero, Carlos; Juarez, Guido; Hasbun, Jorge; Parra-Cordero, Mauro

2015-05-01

Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial.

Consumption of berries, fruits and vegetables and mortality among 10,000 Norwegian men followed for four decades.

PubMed

Hjartåker, Anette; Knudsen, Markus Dines; Tretli, Steinar; Weiderpass, Elisabete

2015-06-01

The association between vegetable and fruit consumption and risk of cancer and cardiovascular disease (CVD) has been investigated by several studies, whereas fewer studies have examined consumption of vegetables and fruits in relation to all-cause mortality. Studies on berries, a rich source of antioxidants, are rare. The purpose of the current study was to examine the association between intake of vegetables, fruits and berries (together and separately) and the risk of all-cause mortality and cause-specific mortality due to cancer and CVD and subtypes of these, in a cohort with very long follow-up. We used data from a population-based prospective Norwegian cohort study of 10,000 men followed from 1968 through 2008. Information on vegetable, fruit and berry consumption was available from a food frequency questionnaire. Association between these and all-cause mortality, cause-specific mortality due to cancers and CVDs were investigated using Cox proportional hazard regression models. Men who in total consumed vegetables, fruit and berries more than 27 times per month had an 8-10% reduced risk of all-cause mortality compared with men with a lower consumption. They also had a 20% reduced risk of stroke mortality. Consumption of fruit was inversely related to overall cancer mortality, with hazard rate ratios of 0.94, 0.84 and 0.79 in the second, third and firth quartile, respectively, compared with the first quartile. Increased consumption of vegetables, fruits and berries was associated with a delayed risk of all-cause mortality and of mortality due to cancer and stroke.

Association of Hypothyroidism with All-cause Mortality: A Cohort Study in an Older Adult Population.

PubMed

Huang, Huei-Kai; Wang, Jen-Hung; Kao, Sheng-Lun

2018-06-26

Although hypothyroidism is associated with many comorbidities, the evidence for its association with all-cause mortality in older adults is limited. To evaluate the association between hypothyroidism and all-cause mortality in older adults. Population-based retrospective cohort study. National Health Insurance Research Database in Taiwan. After 1:10 age/sex/index year matching, 2029 patients aged ≥65 years who received a new diagnosis of hypothyroidism between 2001 and 2011, and 20290 patients without hypothyroidism or other thyroid diseases, were included in the hypothyroidism and non-hypothyroidism cohorts respectively. All-cause mortality was defined as the primary outcome. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of mortality. To further evaluate the effect of thyroxine replacement therapy (TRT) on mortality, we divided patients with hypothyroidism into two groups: patients who received TRT and those who did not. Hypothyroidism was associated with an increased risk of all-cause mortality (adjusted HR [aHR] = 1.82, 95% confidence interval [CI] = 1.68-1.98, p < 0.001). Patients with hypothyroidism who received TRT had a lower risk of mortality than patients who did not receive TRT (aHR = 0.57, 95% CI = 0.49-0.66, p < 0.001). Similar results were obtained after further propensity score matching, in age-, sex-, and comorbidity-stratified analyses. Hypothyroidism was independently associated with increased all-cause mortality in older adults. In patients with hypothyroidism, TRT was associated with a lower risk of all-cause mortality.

Chronic and catastrophic natural mortality of three common Caribbean reef corals

NASA Astrophysics Data System (ADS)

Bythell, J. C.; Gladfelter, E. H.; Bythell, M.

1993-11-01

Compared to catastrophic impacts from storms, disease epidemics and bleaching events, little is known about the effects of more routine chronic mortality in reef corals. To monitor this ongoing mortality, monthly visual assessments of the cause of tissue damage were related to mortality rates (changes in planar surface area) of tagged colonies of three common reef corals: Montastrea annularis, Porites astreoides and Diploria strigosa at Buck Island Reef National Monument, St. Croix, US Virgin Islands. During the study Hurricane Hugo, the most powerful cyclone to affect the area in at least 60 y, made a direct impact on the site. Effects of the hurricane were extremely localized, with certain exposed sites being almost completely razed while others showed no detectable changes in community structure. Mortality caused both by the hurricane and by other factors during the 26 month study varied between species and also between site locations around the island. Differences in susceptibility were not dependent solely on gross morphology, because two robust, massive species showed opposite responses to hurricane damage and chronic mortality. Diploria strigosa was virtually unaffected by chronic factors, but was heavily damaged at exposed sites during the hurricane. In contrast, mortality from predation and tissue necrosis was high in Montastrea annularis, but it largely escaped damage from the hurricane because it was absent from the most severely scoured locations. Porites astreoides, with populations dominated by much smaller colonies, was affected by both chronic and hurricanerelated mortality. Differences in susceptibility to the various types of natural disturbance among species, coupled with high spatial and temporal variability in the effects of such disturbances, may be critical to the maintenance of species diversity on the reef.

Iron deficiency, anemia, and mortality in renal transplant recipients.

PubMed

Eisenga, Michele F; Minović, Isidor; Berger, Stefan P; Kootstra-Ros, Jenny E; van den Berg, Else; Riphagen, Ineke J; Navis, Gerjan; van der Meer, Peter; Bakker, Stephan J L; Gaillard, Carlo A J M

2016-11-01

Anemia, iron deficiency anemia (IDA), and iron deficiency (ID) are highly prevalent in renal transplant recipients (RTR). Anemia is associated with poor outcome, but the role of ID is unknown. Therefore, we aimed to investigate the association of ID, irrespective of anemia, with all-cause mortality in RTR. Cox regression analyses were used to investigate prospective associations. In 700 RTR, prevalences of anemia, IDA, and ID were 34%, 13%, and 30%, respectively. During follow-up for 3.1 (2.7-3.9) years, 81 (12%) RTR died. In univariable analysis, anemia [HR, 1.72 (95%CI: 1.11-2.66), P = 0.02], IDA [2.44 (1.48-4.01), P < 0.001], and ID [2.04 (1.31-3.16), P = 0.001] were all associated with all-cause mortality. In multivariable analysis, the association of anemia with mortality became weaker after adjustment for ID [1.52 (0.97-2.39), P = 0.07] and disappeared after adjustment for proteinuria and eGFR [1.09 (0.67-1.78), P = 0.73]. The association of IDA with mortality attenuated after adjustment for potential confounders. In contrast, the association of ID with mortality remained independent of potential confounders, including anemia [1.77 (1.13-2.78), P = 0.01]. In conclusion, ID is highly prevalent among RTR and is associated with an increased risk of mortality, independent of anemia. As ID is a modifiable factor, correction of ID could be a target to improve survival. © 2016 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT.

Sickle cell disease in Africa: an overview of the integrated approach to health, research, education and advocacy in Tanzania, 2004–2016

PubMed Central

Tluway, Furahini; Makani, Julie

2017-01-01

Summary Sickle cell disease (SCD) is the single most important genetic cause of childhood mortality globally. Tanzania has one of the highest annual births of SCD individuals in the world, estimated to reach 11 000 births a year. Without intervention, 50–90% of children will die in childhood. However, cost-effective interventions have the potential to reduce childhood mortality by up to 70%. The effects of SCD are multi-dimensional, ranging from causing high morbidity and mortality, and reducing the quality of life, to imposing a high socio-economic burden on individuals, families and health systems. In the past 12 years, the SCD programme in Tanzania has developed, with local and global partnerships, a systematic framework for comprehensive research that is integrated into providing healthcare, training and advocacy in SCD. This report outlines the approach and achievements of collective initiatives for management and control of SCD in Tanzania. PMID:28295224

Leisure-Time Physical Activity Reduces Total and Cardiovascular Mortality and Cardiovascular Disease Incidence in Older Adults.

PubMed

Barengo, Noël C; Antikainen, Riitta; Borodulin, Katja; Harald, Kennet; Jousilahti, Pekka

2017-03-01

To determine whether leisure-time physical activity (LTPA) is independently associated with all-cause and cardiovascular mortality and with incidence of cardiovascular disease (CVD) and stroke in older adults. Population-based cohort study (median follow-up 11.8 years). Community, five Finnish provinces. Men and women aged 65 to 74 who participated in a baseline risk factor survey between 1997 and 2007 in Finland (N = 2,456). The study protocol included a self-administered questionnaire, health examination at the study site, and blood sample for laboratory analysis. LTPA was classified into three levels: low, moderate, high. Mortality data were obtained from the National Causes of Death Register and data on incident CVD (coronary heart disease, stroke) events from the National Hospital Discharge Register. Multifactorial-adjusted (age, area, study year, sex, smoking, body mass index, systolic blood pressure, serum cholesterol, education, marital status) risks of total mortality (moderate: hazard ratio (HR) = 0.61, 95% confidence interval (CI) = 0.50-0.74; high: HR = 0.47, 95% CI = 0.34-0.63, P for trend <.001), CVD mortality (moderate: HR = 0.46, 95% CI = 0.33-0.64; high: HR = 0.34, 95% CI = 0.20-0.59, P for trend <.001), and an incident CVD event (moderate HR = 0.69, 95% CI = 0.54-0.88; high: HR = 0.55, 95% CI = 0.38-0.79, P for trend <.001) were lower for those with moderate or high LTPA levels than for those with low LTPA levels. Further adjustment for self-reported inability to perform LTPA did not change the associations remarkably. Baseline LTPA reduces the risk of total and CVD mortality and incident CVD events in older adults independently of the major known CVD risk factors. The protective effect of LTPA is dose dependent. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.