A never-ending succession of epidemics? Mortality in early-modern York.

PubMed

Galley, C

1994-04-01

Early-modern cities are often perceived to be centres of high mortality and under constant siege from a barrage of epidemics. However, few urban mortality rates have been calculated and by employing parish register evidence from the regional capital of York, the thesis that the city was subjected to continual sudden increases in mortality can be firmly rejected. Infant mortality was high but remained virtually constant between 1561 and 1700. About a quarter of all infants did not survive to reach their first birthday and neonatal mortality was especially severe. From the mid-seventeenth century a series of epidemics increased child mortality although overall levels of mortality were not significantly affected. Relatively little can be said about adult mortality and apart from two periods of 'crisis' mortality there is little to suggest that adults were greatly affected by epidemics. Indeed, for many adults the urban environment appears to have posed no great threat to health and most could look forward to a relatively long life in the city. York's mortality regime was very similar to that of the smaller market town of Gainsborough where high levels of mortality remained stable throughout much of the early-modern period.

Identifying and Targeting Mortality Disparities: A Framework for Sub-Saharan Africa Using Adult Mortality Data from South Africa

PubMed Central

Sartorius, Benn; Sartorius, Kurt

2013-01-01

Background Health inequities in developing countries are difficult to eradicate because of limited resources. The neglect of adult mortality in Sub-Saharan Africa (SSA) is a particular concern. Advances in data availability, software and analytic methods have created opportunities to address this challenge and tailor interventions to small areas. This study demonstrates how a generic framework can be applied to guide policy interventions to reduce adult mortality in high risk areas. The framework, therefore, incorporates the spatial clustering of adult mortality, estimates the impact of a range of determinants and quantifies the impact of their removal to ensure optimal returns on scarce resources. Methods Data from a national cross-sectional survey in 2007 were used to illustrate the use of the generic framework for SSA and elsewhere. Adult mortality proportions were analyzed at four administrative levels and spatial analyses were used to identify areas with significant excess mortality. An ecological approach was then used to assess the relationship between mortality “hotspots” and various determinants. Population attributable fractions were calculated to quantify the reduction in mortality as a result of targeted removal of high-impact determinants. Results Overall adult mortality rate was 145 per 10,000. Spatial disaggregation identified a highly non-random pattern and 67 significant high risk local municipalities were identified. The most prominent determinants of adult mortality included HIV antenatal sero-prevalence, low SES and lack of formal marital union status. The removal of the most attributable factors, based on local area prevalence, suggest that overall adult mortality could be potentially reduced by ∼90 deaths per 10,000. Conclusions The innovative use of secondary data and advanced epidemiological techniques can be combined in a generic framework to identify and map mortality to the lowest administration level. The identification of high risk mortality determinants allows health authorities to tailor interventions at local level. This approach can be replicated elsewhere. PMID:23967209

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.

THE CAUSAL RELATIONSHIP BETWEEN CONSANGUINEOUS MARRIAGES AND INFANT MORTALITY IN TURKEY.

PubMed

Koç, İsmet; Eryurt, Mehmet Alİ

2017-07-01

Turkey has high levels of infant mortality and consanguineous marriages. It has had a high level of infant mortality for its economic level for many years. Over recent decades, although adult mortality rates have not been very different from those of other countries with similar socioeconomic structures, its life expectancy at birth has remained low due to its high infant mortality rate. This has been called the Turkish Puzzle. According to the Turkey Family Structure and Population Issues Survey, 27% of women had a consanguineous marriage in 1968. Subsequent Turkish Demographic and Health Surveys (TDHSs) found the rate of consanguineous marriages to be stagnated at 22-24%, with a resistance to reduction. According to the TDHS-2008, 24% of women had a consanguineous marriage. Numerous studies in various countries of the world have indicated that consanguineous marriages, particularly of first-degree, have the effect of increasing infant mortality. The main aim of this study was to assess the causal impact of consanguineous, particularly first-degree consanguineous, marriages on infant mortality, controlling for individual, cultural, bio-demographic and environmental factors. Data were merged from four Turkish DHS data sets (1993, 1998, 2003 and 2008). Multivariate analysis revealed that first-degree consanguineous marriages have increased infant mortality by 45% in Turkey: 57% in urban areas and 39% in rural areas. The results indicate that there is a causal relationship between consanguineous marriages and infant mortality. This finding should be taken into account when planning policies to reduce infant mortality in Turkey, and in other countries with high rates of consanguineous marriage and infant mortality.

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

Alligator diet in relation to alligator mortality on Lake Griffin, FL

USGS Publications Warehouse

Rice, A.N.; Ross, J.P.; Woodward, A.R.; Carbonneau, D.A.; Percival, H.F.

2007-01-01

Alligator mississippiensis (American Alligators) demonstrated low hatch-rate success and increased adult mortality on Lake Griffin, FL, between 1998 and 2003. Dying Lake Griffin alligators with symptoms of poor motor coordination were reported to show specific neurological impairment and brain lesions. Similar lesions were documented in salmonines that consumed clupeids with high thiaminase levels. Therefore, we investigated the diet of Lake Griffin alligators and compared it with alligator diets from two lakes that exhibited relatively low levels of unexplained alligator mortality to see if consumption of Dorosoma cepedianum (gizzard shad) could be correlated with patterns of mortality. Shad in both lakes Griffin and Apopka had high levels of thiaminase and Lake Apopka alligators were consuming greater amounts of shad relative to Lake Griffin without showing mortality rates similar to Lake Griffin alligators. Therefore, a relationship between shad consumption alone and alligator mortality is not supported.

Drinking Level, Drinking Pattern, and Twenty-Year Total Mortality Among Late-Life Drinkers.

PubMed

Holahan, Charles J; Schutte, Kathleen K; Brennan, Penny L; Holahan, Carole K; Moos, Rudolf H

2015-07-01

Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. heavy episodic) in 20-year total mortality among late-life drinkers. The sample comprised 1,121 adults ages 55-65 years. Alcohol consumption was assessed at baseline, and total mortality was indexed across 20 years. We used multiple logistic regression analyses controlling for a broad set of sociodemographic, behavioral, and health status covariates. Among individuals whose high level of drinking placed them at risk, a heavy episodic drinking pattern did not increase mortality odds compared with a regular drinking pattern. Conversely, among individuals who engage in a moderate level of drinking, prior findings showed that a heavy episodic drinking pattern did increase mortality risk compared with a regular drinking pattern. Correspondingly, a high compared with a moderate drinking level increased mortality risk among individuals maintaining a regular drinking pattern, but not among individuals engaging in a heavy episodic drinking pattern, whose pattern of consumption had already placed them at risk. Findings highlight that low-risk drinking requires that older adults drink low to moderate average levels of alcohol and avoid heavy episodic drinking. Heavy episodic drinking is frequent among late-middle-aged and older adults and needs to be addressed along with average consumption in understanding the health risks of late-life drinkers.

Use of admission serum lactate and sodium levels to predict mortality in necrotizing soft-tissue infections.

PubMed

Yaghoubian, Arezou; de Virgilio, Christian; Dauphine, Christine; Lewis, Roger J; Lin, Matthew

2007-09-01

Simple admission laboratory values can be used to classify patients with necrotizing soft-tissue infection (NSTI) into high and low mortality risk groups. Chart review. Public teaching hospital. All patients with NSTI from 1997 through 2006. Variables analyzed included medical history, admission vital signs, laboratory values, and microbiologic findings. Data analyses included univariate and classification and regression tree analyses. Mortality. One hundred twenty-four patients were identified with NSTI. The overall mortality rate was 21 of 124 (17%). On univariate analysis, factors associated with mortality included a history of cancer (P = .03), intravenous drug abuse (P < .001), low systolic blood pressure on admission (P = .03), base deficit (P = .009), and elevated white blood cell count (P = .06). On exploratory classification and regression tree analysis, admission serum lactate and sodium levels were predictors of mortality, with a sensitivity of 100%, specificity of 28%, positive predictive value of 23%, and negative predictive value of 100%. A serum lactate level greater than or equal to 54.1 mg/dL (6 mmol/L) alone was associated with a 32% mortality, whereas a serum sodium level greater than or equal to 135 mEq/L combined with a lactate level less than 54.1 mg/dL was associated with a mortality of 0%. Mortality for NSTIs remains high. A simple model, using admission serum lactate and serum sodium levels, may help identify patients at greatest risk for death.

Adaptation of the Long-Lived Monocarpic Perennial Saxifraga longifolia to High Altitude1[OPEN

PubMed Central

Morales, Melanie; Fleta-Soriano, Eva; Garcia, Maria B.

2016-01-01

Global change is exerting a major effect on plant communities, altering their potential capacity for adaptation. Here, we aimed at unveiling mechanisms of adaptation to high altitude in an endemic long-lived monocarpic, Saxifraga longifolia, by combining demographic and physiological approaches. Plants from three altitudes (570, 1100, and 2100 m above sea level [a.s.l.]) were investigated in terms of leaf water and pigment contents, and activation of stress defense mechanisms. The influence of plant size on physiological performance and mortality was also investigated. Levels of photoprotective molecules (α-tocopherol, carotenoids, and anthocyanins) increased in response to high altitude (1100 relative to 570 m a.s.l.), which was paralleled by reduced soil and leaf water contents and increased ABA levels. The more demanding effect of high altitude on photoprotection was, however, partly abolished at very high altitudes (2100 m a.s.l.) due to improved soil water contents, with the exception of α-tocopherol accumulation. α-Tocopherol levels increased progressively at increasing altitudes, which paralleled with reductions in lipid peroxidation, thus suggesting plants from the highest altitude effectively withstood high light stress. Furthermore, mortality of juveniles was highest at the intermediate population, suggesting that drought stress was the main environmental driver of mortality of juveniles in this rocky plant species. Population structure and vital rates in the high population evidenced lower recruitment and mortality in juveniles, activation of clonal growth, and absence of plant size-dependent mortality. We conclude that, despite S. longifolia has evolved complex mechanisms of adaptation to altitude at the cellular, whole-plant and population levels, drought events may drive increased mortality in the framework of global change. PMID:27440756

Adaptation of the Long-Lived Monocarpic Perennial Saxifraga longifolia to High Altitude.

PubMed

Munné-Bosch, Sergi; Cotado, Alba; Morales, Melanie; Fleta-Soriano, Eva; Villellas, Jesús; Garcia, Maria B

2016-10-01

Global change is exerting a major effect on plant communities, altering their potential capacity for adaptation. Here, we aimed at unveiling mechanisms of adaptation to high altitude in an endemic long-lived monocarpic, Saxifraga longifolia, by combining demographic and physiological approaches. Plants from three altitudes (570, 1100, and 2100 m above sea level [a.s.l.]) were investigated in terms of leaf water and pigment contents, and activation of stress defense mechanisms. The influence of plant size on physiological performance and mortality was also investigated. Levels of photoprotective molecules (α-tocopherol, carotenoids, and anthocyanins) increased in response to high altitude (1100 relative to 570 m a.s.l.), which was paralleled by reduced soil and leaf water contents and increased ABA levels. The more demanding effect of high altitude on photoprotection was, however, partly abolished at very high altitudes (2100 m a.s.l.) due to improved soil water contents, with the exception of α-tocopherol accumulation. α-Tocopherol levels increased progressively at increasing altitudes, which paralleled with reductions in lipid peroxidation, thus suggesting plants from the highest altitude effectively withstood high light stress. Furthermore, mortality of juveniles was highest at the intermediate population, suggesting that drought stress was the main environmental driver of mortality of juveniles in this rocky plant species. Population structure and vital rates in the high population evidenced lower recruitment and mortality in juveniles, activation of clonal growth, and absence of plant size-dependent mortality. We conclude that, despite S. longifolia has evolved complex mechanisms of adaptation to altitude at the cellular, whole-plant and population levels, drought events may drive increased mortality in the framework of global change. © 2016 American Society of Plant Biologists. All Rights Reserved.

Gene expression regulation of the TLR9 and MyD88-dependent pathways in rock bream against rock bream iridovirus (RBIV) infection.

PubMed

Jung, Myung-Hwa; Jung, Sung-Ju

2017-11-01

Rock bream iridovirus (RBIV), which is a member of the Megalocytivirus genus, causes severe mass mortalities in rock bream in Korea. To date, the innate immune defense mechanisms of rock bream against RBIV is unclear. In this study, we assessed the expression levels of genes related to TLR9 and MyD88-dependent pathways in RBIV-infected rock bream in high, low or no mortality conditions. In the high mortality group (100% mortality at 15 days post infection (dpi)), high levels of TLR9 and MyD88 expressions (6.4- and 2.4-fold, respectively) were observed at 8 d and then reduced (0.6- and 0.1-fold, respectively) with heavy viral loads at 10 dpi (2.21 × 10 7 /μl). Moreover, TRAF6, IRF5, IL1β, IL8, IL12 and TNFα expression levels showed no statistical significance until 10 dpi. Conversely, in the low mortality group (28% expected mortality at 35 dpi), TLR9, MyD88 and TRAF6 expression levels were significantly higher than those in the control group at several sampling points until 30 dpi. Higher levels of IRF5, IL1β, IL8, IL12 and TNFα expression were also observed, however, these were not significantly different from those of the control group. In the no mortality group (0% mortality at 40 dpi), significantly higher levels of MyD88 (2 d, 4 d and 40 dpi), TRAF6 (2 dpi), IL1β (4 dpi) and IL8 (2 d and 4 dpi) expression were observed. In summary, RBIV-infected rock bream induces innate immune response, which could be a major contributing factor to effective fish control over viral transcription. MyD88, TRAF6, IL1β and IL8-related immune responses were activated in fish survivor condition (low or no mortality group). This is a critical factor for RBIV disease recovery; however, these immune responses did not efficiently respond in fish dead condition (high mortality group). Copyright © 2017 Elsevier Ltd. All rights reserved.

Association of Hemoglobin Concentration With Total and Cause-Specific Mortality in a Cohort of Postmenopausal Women.

PubMed

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

2016-05-15

Anemia and low and high levels of hemoglobin have been associated with increased mortality and morbidity. However, most studies have measured hemoglobin at only 1 time point, and few studies have considered possible reverse causation. We used data from the Women's Health Initiative, in which baseline hemoglobin was measured in 160,081 postmenopausal women and year 3 hemoglobin was measured in 75,658 participants, to examine the associations of hemoglobin concentration with total mortality, coronary heart disease mortality, and cancer mortality. Women were enrolled from 1993 to 1998 and followed for a median of 16 years. Cox proportional hazards models were used to estimate the relative mortality hazards associated with deciles of baseline hemoglobin and the mean of baseline + year 3 hemoglobin. Both low and high deciles of baseline hemoglobin were positively associated with all 3 outcomes in the total cohort. In analyses restricted to women with 2 measurements, a low mean hemoglobin level was robustly and positively associated with all 3 outcomes, after exclusion of the early years of follow-up. High mean hemoglobin was also associated with increased risk of total mortality, whereas associations with heart disease mortality and cancer mortality were weaker and inconsistent. Our results provide evidence that low and high levels of hemoglobin are associated with increased risk of mortality in otherwise healthy women. © The Author 2016. 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.

Impact of multisectoral health determinants on child mortality 1980-2010: An analysis by country baseline mortality.

PubMed

Cohen, Robert L; Murray, John; Jack, Susan; Arscott-Mills, Sharon; Verardi, Vincenzo

2017-01-01

Some health determinants require relatively stronger health system capacity and socioeconomic development than others to impact child mortality. Few quantitative analyses have analyzed how the impact of health determinants varies by mortality level. 149 low- and middle-income countries were stratified into high, moderate, low, and very low baseline levels of child mortality in 1990. Data for 52 health determinants were collected for these countries for 1980-2010. To quantify how changes in health determinants were associated with mortality decline, univariable and multivariable regression models were constructed. An advanced statistical technique that is new for child mortality analyses-MM-estimation with first differences and country clustering-controlled for outliers, fixed effects, and variation across decades. Some health determinants (immunizations, education) were consistently associated with child mortality reduction across all mortality levels. Others (staff availability, skilled birth attendance, fertility, water and sanitation) were associated with child mortality reduction mainly in low or very low mortality settings. The findings indicate that the impact of some health determinants on child mortality was only apparent with stronger health systems, public infrastructure and levels of socioeconomic development, whereas the impact of other determinants was apparent at all stages of development. Multisectoral progress was essential to mortality reduction at all baseline mortality levels. Policy-makers can use such analyses to direct investments in health and non-health sectors and to set five-year child mortality targets appropriate for their baseline mortality levels and local context.

[Temperature modifies the acute effect of particulate air pollution on mortality in Jiang'an district of Wuhan].

PubMed

Zhu, Y H; Wu, R; Zhong, P R; Zhu, C H; Ma, L

2016-06-01

To analyze the temperature modification effect on acute mortality due to particulate air pollution. Daily non-accidental mortality, cardiovascular mortality, and respiratory mortality data were obtained from Jiang'an District Center for Disease Control and Prevention. Daily meteorological data on mean temperature and relative humidity were collected from China Meteorological Data Sharing Service System. The daily concentration of particulate matter was collected from Wuhan Environmental Monitoring center. By using the stratified time-series models, we analyzed effects of particulate air pollution on mortality under different temperature zone from 2002 to 2010, meanwhile comparing the difference of age, gender and educational level, in Wuhan city of China. High temperature (daily average temperature > 33.4 ℃) obviously enhanced the effect of PM10 on mortality. With 10 μg/m(3) increase in PM10 concentrations, non-accidental, cardiovascular, and respiratory mortality increased 2.95% (95%CI: 1.68%-4.24%), 3.58% (95%CI: 1.72%-5.49%), and 5.07% (95%CI: 2.03%-9.51%) respectively. However, low temperature (daily average temperature <-0.21 ℃) enhanced PM10 effect on respiratory mortality with 3.31% (95% CI: 0.07%-6.64%) increase. At high temperature, PM10 had significantly stronger effect on non-accidental mortality of female aged over 65 and people with high educational level groups. With an increase of 10 μg/m(3), daily non-accidental mortality increased 4.27% (95% CI:2.45%-6.12%), 3.38% (95% CI:1.93%-4.86%) and 3.47% (95% CI:1.79%-5.18%), respectively. Whereas people with low educational level were more susceptible to low temperature. A 10 μg/m(3) increase in PM10 was associated with 2.11% (95% CI: 0.20%-4.04%) for non-accidental mortality. Temperature factor can modify the association between the PM10 level and cause-specific mortality. Moreover, the differences were apparent after considering the age, gender and education groups.

Geographical trends in infant mortality: England and Wales, 1970-2006.

PubMed

Norman, Paul; Gregory, Ian; Dorling, Danny; Baker, Allan

2008-01-01

At national level in England and Wales, infant mortality rates fell rapidly from the early 1970s and into the 1980s. Subnational areas have also experienced a reduction in levels of infant mortality. While rates continued to fall to 2006, the rate of reduction has slowed. Although the Government Office Regions Yorkshire and The Humber, the North West and the West Midlands and the Office for National Statistics local authority types Cities and Services and London Cosmopolitan have experienced relatively large absolute reductions in infant mortality, their rates remained high compared with the national average. Within all regions and local authority types, a strong relationship was found between ward level deprivation and infant mortality rates. Nevertheless, levels of infant mortality declined over time even in the most deprived areas with a narrowing of absolute differences in rates between areas. Areas in which the level of deprivation eased have experienced greater than average reductions in levels of infant mortality.

Biomarkers in critically ill patients with systemic inflammatory response syndrome or sepsis supplemented with high-dose selenium.

PubMed

Brodska, Helena; Valenta, Jiri; Malickova, Karin; Kohout, Pavel; Kazda, Antonin; Drabek, Tomas

2015-01-01

Low levels of selenium (Se) and glutathione peroxidase (GSHPx), a key selenoenzyme, were documented in systemic inflammatory response syndrome (SIRS) and sepsis, both associated with high mortality. Se supplementation had mixed effects on outcome. We hypothesized that Se supplementation could have a different impact on biomarkers and 28-day mortality in patients with SIRS vs. sepsis. Adult patients with SIRS or sepsis were randomized to either high-dose (Se+, n = 75) or standard-dose (Se-, n = 75) Se supplementation. Plasma Se, whole blood GSHPx activity, C-reactive protein (CRP), procalcitonin (PCT), prealbumin, albumin and cholesterol levels were measured serially up to day 14. There was no difference in mortality between Se- (24/75) vs. Se+ group (19/75; p = 0.367) or between SIRS and septic patients (8/26 vs. 35/124; p = 0.794). There was a trend to reduced mortality in SIRS patients in the Se+ vs. Se- group (p = 0.084). Plasma Se levels increased in the Se+ group only in patients with sepsis but not in patients with SIRS. Plasma Se levels correlated with GSHPx. In SIRS/Se+ group, Se correlated only with GSHPx. In SIRS/Se- group, Se correlated with cholesterol but not with other biomarkers. In sepsis patients, Se levels correlated with cholesterol, GSHPx and prealbumin. Cholesterol levels were higher in survivors in the Se- group. Se levels correlated with GSHPx activity and other nutritional biomarkers with significant differences between SIRS and sepsis groups. High-dose Se supplementation did not affect mortality but a strong trend to decreased mortality in SIRS patients warrants further studies in this population. Copyright © 2015 Elsevier GmbH. All rights reserved.

Level of dependency: a simple marker associated with mortality during the 2003 heatwave among French dependent elderly people living in the community or in institutions.

PubMed

Belmin, Joël; Auffray, Jean-Christian; Berbezier, Christine; Boirin, Pascal; Mercier, Sophie; de Reviers, Béatrice; Golmard, Jean-Louis

2007-05-01

In France, the August 2003 heat wave was responsible for considerable excess mortality among the elderly. We wonder whether the dependency level could be a marker of the risk for mortality during this heat wave. Retrospective cohort study of deaths that occurred between 1 and 20 August 2003, conducted in five departments in the Paris area (Ile-de-France) among the beneficiaries of the Allocation personnalisée d'autonomie (APA), a stipend specifically allocated to dependent subjects > or =60 years of age. Their dependency level was determined by the GIR group (defined by the French law) used to fix the APA amount. Subjects' GIR group classification and demographic variables were obtained from departmental administrative files. Among the 31,603 APA beneficiaries alive on 31 July 2003, 16,779 were community dwellers and 14,824 lived in institutions. Between 1 and 20 August 2003, 858 subjects died: 300 community dwellers and 558 institutionalised (mortality rates of 2.7, 1.8 and 3.8 per cent, respectively). Independent risk factors for mortality were: age, sex and GIR group in community dwellers; age, GIR group and living in a region highly exposed to heatwave mortality for institutionalised elderly; independent factors for mortality were age, sex, GIR group, type of residence (institution/community), living in a region highly exposed to heatwave mortality and income for the overall population. The dependency level was associated with mortality during the 2003 heatwave in France, especially for elderly community dwellers. Dependency might help identify high-risk subjects and guide targeted prevention measures against heatwave-associated mortality.

High mortality of Red Sea zooplankton under ambient solar radiation.

PubMed

Al-Aidaroos, Ali M; El-Sherbiny, Mohsen M O; Satheesh, Sathianeson; Mantha, Gopikrishna; Agustī, Susana; Carreja, Beatriz; Duarte, Carlos M

2014-01-01

High solar radiation along with extreme transparency leads to high penetration of solar radiation in the Red Sea, potentially harmful to biota inhabiting the upper water column, including zooplankton. Here we show, based on experimental assessments of solar radiation dose-mortality curves on eight common taxa, the mortality of zooplankton in the oligotrophic waters of the Red Sea to increase steeply with ambient levels of solar radiation in the Red Sea. Responses curves linking solar radiation doses with zooplankton mortality were evaluated by exposing organisms, enclosed in quartz bottles, allowing all the wavelengths of solar radiation to penetrate, to five different levels of ambient solar radiation (100%, 21.6%, 7.2%, 3.2% and 0% of solar radiation). The maximum mortality rates under ambient solar radiation levels averaged (±standard error of the mean, SEM) 18.4±5.8% h(-1), five-fold greater than the average mortality in the dark for the eight taxa tested. The UV-B radiation required for mortality rates to reach ½ of maximum values averaged (±SEM) 12±5.6 h(-1)% of incident UVB radiation, equivalent to the UV-B dose at 19.2±2.7 m depth in open coastal Red Sea waters. These results confirm that Red Sea zooplankton are highly vulnerable to ambient solar radiation, as a consequence of the combination of high incident radiation and high water transparency allowing deep penetration of damaging UV-B radiation. These results provide evidence of the significance of ambient solar radiation levels as a stressor of marine zooplankton communities in tropical, oligotrophic waters. Because the oligotrophic ocean extends across 70% of the ocean surface, solar radiation can be a globally-significant stressor for the ocean ecosystem, by constraining zooplankton use of the upper levels of the water column and, therefore, the efficiency of food transfer up the food web in the oligotrophic ocean.

Trends in under-5 mortality rates and the HIV/AIDS epidemic.

PubMed Central

Adetunji, J.

2000-01-01

INTRODUCTION: The prevalence of human immunodeficiency virus (HIV) among adults and mortality rates among under-5-year-olds have increased or stagnated in many countries. The objective of this study was to investigate whether there is a link between under-5 mortality trends and the prevalence of HIV among adults and, if so, to assess the magnitude of the effect of adult HIV prevalence on under-5 mortality rates. METHOD: Data from Demographic and Health Surveys were used to establish the trends in under-5 mortality rates for 25 countries for which there are data for at least two points in time. Countries were ranked according to the most recent adult HIV prevalence data and grouped in three categories: those with very high HIV prevalence (> or = 5%); those with moderately high prevalence (1-4.9%); and those with low prevalence (< 1%). A mathematical model was fitted to obtain an estimate of the contribution of HIV/AIDS to the level of under-5 mortality in each country. RESULTS: Under-5 mortality rates showed an increase in most countries with high adult HIV prevalence, but a decrease in almost every country with moderately high or low prevalence. The estimated contribution of adult HIV prevalence to the observed level of under-5 mortality was highest (up to 61%) in Zimbabwe (where HIV prevalence was highest) and tended to decrease with the level of HIV prevalence. DISCUSSION: The contribution of HIV/AIDS to childhood mortality therefore appears to be most noticeable in settings where the epidemic is most severe. PMID:11100615

Ecological study of road traffic injuries in the eastern Mediterranean region: country economic level, road user category and gender perspectives.

PubMed

Sengoelge, Mathilde; Laflamme, Lucie; El-Khatib, Ziad

2018-02-13

The Eastern Mediterranean region has the second highest number of road traffic injury mortality rates after the African region based on 2013 data, with road traffic injuries accounting for 27% of the total injury mortality in the region. Globally the number of road traffic deaths has plateaued despite an increase in motorization, but it is uncertain whether this applies to the Region. This study investigated the regional trends in both road traffic injury mortality and morbidity and examined country-based differences considering on income level, categories of road users, and gender distribution. Register-based ecological study linking data from Global Burden of Disease Study with the United Nations Statistics Division for population and World Bank definition for country income level. Road traffic injury mortality rates and disability-adjusted life years were compiled for all ages at country level in 1995, 2005, 2015 and combined for a regional average (n = 22) and a global average (n = 122). The data were stratified by country economic level, road user category and gender. Road traffic injury mortality rates in the Region were higher than the global average for all three reference years but suggest a downward trend. In 2015 mortality rates were more than twice as high in low and high income countries compared to global income averages and motor vehicle occupants had a 3-fold greater mortality than the global average. Severe injuries decreased by more than half for high/middle income countries but remained high for low income countries; three times higher for males than females. Despite a potential downward trend, inequalities in road traffic injury mortality and morbidity burden remain high in the Eastern Mediterranean region. Action needs to be intensified and targeted to implement and enforce safety measures that prevent and mitigate severe motor vehicle crashes in high income countries especially and invest in efforts to promote public, active transport for vulnerable road users in the resource poor countries of the Region.

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.

Observed to expected or logistic regression to identify hospitals with high or low 30-day mortality?

PubMed Central

Helgeland, Jon; Clench-Aas, Jocelyne; Laake, Petter; Veierød, Marit B.

2018-01-01

Introduction A common quality indicator for monitoring and comparing hospitals is based on death within 30 days of admission. An important use is to determine whether a hospital has higher or lower mortality than other hospitals. Thus, the ability to identify such outliers correctly is essential. Two approaches for detection are: 1) calculating the ratio of observed to expected number of deaths (OE) per hospital and 2) including all hospitals in a logistic regression (LR) comparing each hospital to a form of average over all hospitals. The aim of this study was to compare OE and LR with respect to correctly identifying 30-day mortality outliers. Modifications of the methods, i.e., variance corrected approach of OE (OE-Faris), bias corrected LR (LR-Firth), and trimmed mean variants of LR and LR-Firth were also studied. Materials and methods To study the properties of OE and LR and their variants, we performed a simulation study by generating patient data from hospitals with known outlier status (low mortality, high mortality, non-outlier). Data from simulated scenarios with varying number of hospitals, hospital volume, and mortality outlier status, were analysed by the different methods and compared by level of significance (ability to falsely claim an outlier) and power (ability to reveal an outlier). Moreover, administrative data for patients with acute myocardial infarction (AMI), stroke, and hip fracture from Norwegian hospitals for 2012–2014 were analysed. Results None of the methods achieved the nominal (test) level of significance for both low and high mortality outliers. For low mortality outliers, the levels of significance were increased four- to fivefold for OE and OE-Faris. For high mortality outliers, OE and OE-Faris, LR 25% trimmed and LR-Firth 10% and 25% trimmed maintained approximately the nominal level. The methods agreed with respect to outlier status for 94.1% of the AMI hospitals, 98.0% of the stroke, and 97.8% of the hip fracture hospitals. Conclusion We recommend, on the balance, LR-Firth 10% or 25% trimmed for detection of both low and high mortality outliers. PMID:29652941

Do heart failure status and psychosocial variables moderate the relationship between leisure time physical activity and mortality risk among patients with a history of myocardial infarction?

PubMed

Oosterom-Calo, Rony; Te Velde, Saskia J; Stut, Wim; Drory, Yaacov; Brug, Johannes; Gerber, Yariv

2016-10-12

Leisure time physical activity (LTPA) is inversely related to mortality risk among patients with a history of myocardial infarction (MI). The aims were to explore if heart failure (HF) status and psychosocial variables moderate the association. Participants (n = 1169) were from a multi-center prospective cohort study. Information on LTPA (none, irregular,1-150, 151-300 and >300 weekly minutes), depression, social support and other prognostic indicators were collected 10-13 years after index MI. Cox regressions were conducted, adjusting for potential confounders. In case of significant moderation by HF-status or psychosocial variables, stratified analyses were performed. During follow-up (M = 8.4 years), 25.6 % of the sample had died. LTPA was inversely associated with mortality (p for trend < 0.01 in all models). HF did not, but psychosocial variables did, moderate the association. In the LTPA category 1-150 weekly minutes, patients with a high level of depression had a lower mortality risk in comparison to those with a low level (hazard ratios (95 % confidence intervals) were 0.43 (0.25, 0.75) versus 0.69 (0.36, 1.32)), and patients with a low level of social support had a lower mortality risk in comparison to those with a high level (0.40 (0.21, 0.77) versus 0.71 (0.39, 1.27)). In the category >300 min, patients with a high level of social support had a lower mortality risk than those with a low level (0.38 (0.19, 0.79) versus 0.51 (0.30, 0.87)). LTPA was inversely related to mortality risk of post-MI patients. HF did not moderate the relationship; depression and social support partially did.

The Folate-Vitamin B12 Interaction, Low Hemoglobin, and the Mortality Risk from Alzheimer's Disease.

PubMed

Min, Jin-Young; Min, Kyoung-Bok

2016-03-21

Abnormal hemoglobin levels are a risk factor for Alzheimer's disease (AD). Although the mechanism underlying these associations is elusive, inadequate micronutrients, particularly folate and vitamin B12, may increase the risk for anemia, cognitive impairment, and AD. In this study, we investigated whether the nutritional status of folate and vitamin B12 is involved in the association between low hemoglobin levels and the risk of AD mortality. Data were obtained from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) and the NHANES (1999-2006) Linked Mortality File. A total of 4,688 participants aged ≥60 years with available baseline data were included in this study. We categorized three groups based on the quartiles of folate and vitamin B12 as follows: Group I (low folate and vitamin B12); Group II (high folate and low vitamin B12 or low folate and high vitamin B12); and Group III (high folate and vitamin B12). Of 4,688 participants, 49 subjects died due to AD. After adjusting for age, sex, ethnicity, education, smoking history, body mass index, the presence of diabetes or hypertension, and dietary intake of iron, significant increases in the AD mortality were observed in Quartile1 for hemoglobin (HR: 8.4, 95% CI: 1.4-50.8), and the overall risk of AD mortality was significantly reduced with increases in the quartile of hemoglobin (p for trend = 0.0200), in subjects with low levels of both folate and vitamin B12 at baseline. This association did not exist in subjects with at least one high level of folate and vitamin B12. Our finding shows the relationship between folate and vitamin B12 levels with respect to the association between hemoglobin levels and AD mortality.

The effects of unemployment on mortality following workplace downsizing and workplace closure: a register-based follow-up study of Finnish men and women during economic boom and recession.

PubMed

Martikainen, Pekka; Mäki, Netta; Jäntti, Markus

2007-05-01

Unemployment is strongly associated with mortality on the individual level. The reasons for this association are not fully established. The authors estimated the effects of unemployment and workplace downsizing on mortality during periods of low (1989) and high (1994) unemployment in Finland. They used prospective population registration data containing detailed socioeconomic and demographic information on two cohorts aged 35-64 years at the beginning of 1989 (N = 87,317) and 1994 (N = 72,419) followed up for mortality in 1990-1997 and 1995-2002, respectively. Unemployment was found to be associated with a 2.38-fold increase in the hazard of mortality after 1989 and with a 1.25-fold increase after 1994. No excess mortality was observed among those who, at baseline, were employed at workplaces that had experienced large reductions in employment. Furthermore, the association between unemployment and mortality was weaker among those working in establishments that had been strongly downsized. By showing that, in the context of either a high level of unemployment or rapid downsizing, the effects of unemployment on mortality are modest, this study provides strong evidence of unaccounted confounding. Individual-level studies may thus overestimate the causal effects of unemployment on mortality.

Regional Inequalities in Lung Cancer Mortality in Belgium at the Beginning of the 21st Century: The Contribution of Individual and Area-Level Socioeconomic Status and Industrial Exposure.

PubMed

Hagedoorn, Paulien; Vandenheede, Hadewijch; Willaert, Didier; Vanthomme, Katrien; Gadeyne, Sylvie

2016-01-01

Being a highly industrialized country with one of the highest male lung cancer mortality rates in Europe, Belgium is an interesting study area for lung cancer research. This study investigates geographical patterns in lung cancer mortality in Belgium. More specifically it probes into the contribution of individual as well as area-level characteristics to (sub-district patterns in) lung cancer mortality. Data from the 2001 census linked to register data from 2001-2011 are used, selecting all Belgian inhabitants aged 65+ at time of the census. Individual characteristics include education, housing status and home ownership. Urbanicity, unemployment rate, the percentage employed in mining and the percentage employed in other high-risk industries are included as sub-district characteristics. Regional variation in lung cancer mortality at sub-district level is estimated using directly age-standardized mortality rates. The association between lung cancer mortality and individual and area characteristics, and their impact on the variation of sub-district level is estimated using multilevel Poisson models. Significant sub-district variations in lung cancer mortality are observed. Individual characteristics explain a small share of this variation, while a large share is explained by sub-district characteristics. Individuals with a low socioeconomic status experience a higher lung cancer mortality risk. Among women, an association with lung cancer mortality is found for the sub-district characteristics urbanicity and unemployment rate, while for men lung cancer mortality was associated with the percentage employed in mining. Not just individual characteristics, but also area characteristics are thus important determinants of (regional differences in) lung cancer mortality.

Spatial Analysis of China Province-level Perinatal Mortality

PubMed Central

XIANG, Kun; SONG, Deyong

2016-01-01

Background: Using spatial analysis tools to determine the spatial patterns of China province-level perinatal mortality and using spatial econometric model to examine the impacts of health care resources and different socio-economic factors on perinatal mortality. Methods: The Global Moran’s I index is used to examine whether the spatial autocorrelation exists in selected regions and Moran’s I scatter plot to examine the spatial clustering among regions. Spatial econometric models are used to investigate the spatial relationships between perinatal mortality and contributing factors. Results: The overall Moran’s I index indicates that perinatal mortality displays positive spatial autocorrelation. Moran’s I scatter plot analysis implies that there is a significant clustering of mortality in both high-rate regions and low-rate regions. The spatial econometric models analyses confirm the existence of a direct link between perinatal mortality and health care resources, socio-economic factors. Conclusions: Since a positive spatial autocorrelation has been detected in China province-level perinatal mortality, the upgrading of regional economic development and medical service level will affect the mortality not only in region itself but also its adjacent regions. PMID:27398334

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.

Infant mortality in South Africa - distribution, associations and policy implications, 2007: an ecological spatial analysis

PubMed Central

2011-01-01

Background Many sub-Saharan countries are confronted with persistently high levels of infant mortality because of the impact of a range of biological and social determinants. In particular, infant mortality has increased in sub-Saharan Africa in recent decades due to the HIV/AIDS epidemic. The geographic distribution of health problems and their relationship to potential risk factors can be invaluable for cost effective intervention planning. The objective of this paper is to determine and map the spatial nature of infant mortality in South Africa at a sub district level in order to inform policy intervention. In particular, the paper identifies and maps high risk clusters of infant mortality, as well as examines the impact of a range of determinants on infant mortality. A Bayesian approach is used to quantify the spatial risk of infant mortality, as well as significant associations (given spatial correlation between neighbouring areas) between infant mortality and a range of determinants. The most attributable determinants in each sub-district are calculated based on a combination of prevalence and model risk factor coefficient estimates. This integrated small area approach can be adapted and applied in other high burden settings to assist intervention planning and targeting. Results Infant mortality remains high in South Africa with seemingly little reduction since previous estimates in the early 2000's. Results showed marked geographical differences in infant mortality risk between provinces as well as within provinces as well as significantly higher risk in specific sub-districts and provinces. A number of determinants were found to have a significant adverse influence on infant mortality at the sub-district level. Following multivariable adjustment increasing maternal mortality, antenatal HIV prevalence, previous sibling mortality and male infant gender remained significantly associated with increased infant mortality risk. Of these antenatal HIV sero-prevalence, previous sibling mortality and maternal mortality were found to be the most attributable respectively. Conclusions This study demonstrates the usefulness of advanced spatial analysis to both quantify excess infant mortality risk at the lowest administrative unit, as well as the use of Bayesian modelling to quantify determinant significance given spatial correlation. The "novel" integration of determinant prevalence at the sub-district and coefficient estimates to estimate attributable fractions further elucidates the "high impact" factors in particular areas and has considerable potential to be applied in other locations. The usefulness of the paper, therefore, not only suggests where to intervene geographically, but also what specific interventions policy makers should prioritize in order to reduce the infant mortality burden in specific administration areas. PMID:22093084

[The theory of the demographic transition as a reference for demo-economic models].

PubMed

Genne, M

1981-01-01

The aim of the theory of demographic transition (TTD) is to better understand the behavior and interrelationship of economic and demographic variables. There are 2 types of demo-economic models: 1) the malthusian models, which consider demographic variables as pure exogenous variables, and 2) the neoclassical models, which consider demographic variables as strictly endogenous. If TTD can explore the behavior of exogenous and endogenous demographic variables, it cannot demonstrate neither the relation nor the order of causality among the various demographic and economic variables, but it is simply the theoretical framework of a complex social and economic phenomenon which started in Europe in the 19th Century, and which today can be extended to developing countries. There are 4 stages in the TTD; the 1st stage is characterized by high levels of fecundity and mortality; the 2nd stage is characterized by high fecundity levels and declining mortality levels; the 3rd stage is characterized by declining fecundity levels and low mortality levels; the 4th stage is characterized by low fertility and mortality levels. The impact of economic variables over mortality and birth rates is evident for mortality rates, which decline earlier and at a greater speed than birth rates. According to reliable mathematical predictions, around the year 1987 mortality rates in developing countries will have reached the low level of European countries, and growth rate will be only 1.5%. If the validity of demo-economic models has not yet been established, TTD has clearly shown that social and economic development is the factor which influences demographic expansion.

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.

Agents affecting health of mother and child in a rural area of Kenya. XVIII. Fertility, mortality and migration in 1975-1978.

PubMed

Van Ginneken, J K; Voorhoeve, A M; Omondi-Odhiambo; Muller, A S; Blok, P G; W'Oigo, H O

1980-06-01

The results reported here are based on age-specific rates and are, therefore, more sensitive and meaningful as indicators of fertility and mortality than the crude rates mentioned in the previous article. The results confirm that, compared to world standards, the study area is characterized by a high level of fertility and a fairly low level of mortality. Fertility and mortality are, however, lower in the study area in comparison to Kenya as a whole. Another characteristic is high population mobility which is of two types: temporary migration of absent members of the population, and permanent in- and out-migration.

Role of TRPA1 in acute cardiopulmonary toxicity of inhaled acrolein

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

Conklin, Daniel J., E-mail: dj.conklin@louisville.

Acrolein is a highly toxic, volatile, unsaturated aldehyde generated during incomplete combustion as in tobacco smoke and indoor fires. Because the transient receptor potential ankyrin 1 (TRPA1) channel mediates tobacco smoke-induced lung injury, we assessed its role in high-level acrolein-induced toxicity in mice. Acrolein (100–275 ppm, 10–30 min) caused upper airway epithelial sloughing, bradypnea and oral gasping, hypothermia, cardiac depression and mortality. Male wild-type mice (WT, C57BL/6; 5–52 weeks) were significantly more sensitive to high-level acrolein than age-matched, female WT mice. Both male and female TRPA1-null mice were more sensitive to acrolein-induced mortality than age- and sex-matched WT mice. Acroleinmore » exposure increased lung weight:body weight ratios and lung albumin and decreased plasma albumin to a greater extent in TRPA1-null than in WT mice. Lung and plasma protein-acrolein adducts were not increased in acrolein-exposed TRPA1-null mice compared with WT mice. To assess TRPA1-dependent protective mechanisms, respiratory parameters were monitored by telemetry. TRPA1-null mice had a slower onset of breathing rate suppression (‘respiratory braking’) than WT mice suggesting TRPA1 mediates this protective response. Surprisingly, WT male mice treated either with a TRPA1 antagonist (HC030031; 200 mg/kg) alone or with combined TRPA1 (100 mg/kg) and TRPV1 (capsazepine, 10 mg/kg) antagonists at 30 min post-acrolein exposure (i.e., “real world” delay in treatment) were significantly protected from acrolein-induced mortality. These data show TRPA1 protects against high-level acrolein-induced toxicity in a sex-dependent manner. Post-exposure TRPA1 antagonism also protected against acrolein-induced mortality attesting to a complex role of TRPA1 in cardiopulmonary injury. - Highlights: • TRPA1 protects mice against toxicity and mortality of inhaled high-level acrolein. • TRPA1 protection against inhaled high-level acrolein is sex-dependent in mice. • Age (5–52 weeks old) was not a determinant of acrolein-induced mortality in mice. • TRPA1 antagonist is protective after inhaled high-level acrolein in male mice.« less

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa

PubMed Central

2013-01-01

Background Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. Results The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa’s 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. Conclusion The results indicate that the model can accurately plot mortality and service delivery “hotspots’ at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems. PMID:23425437

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa.

PubMed

Sartorius, Kurt; Sartorius, Benn K D

2013-02-20

Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa's 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. The results indicate that the model can accurately plot mortality and service delivery "hotspots' at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems.

A new multidimensional population health indicator for policy makers: absolute level, inequality and spatial clustering - an empirical application using global sub-national infant mortality data.

PubMed

Sartorius, Benn K D; Sartorius, Kurt

2014-11-01

The need for a multidimensional measure of population health that accounts for its distribution remains a central problem to guide the allocation of limited resources. Absolute proxy measures, like the infant mortality rate (IMR), are limited because they ignore inequality and spatial clustering. We propose a novel, three-part, multidimensional mortality indicator that can be used as the first step to differentiate interventions in a region or country. The three-part indicator (MortalityABC index) combines absolute mortality rate, the Theil Index to calculate mortality inequality and the Getis-Ord G statistic to determine the degree of spatial clustering. The analysis utilises global sub-national IMR data to empirically illustrate the proposed indicator. The three-part indicator is mapped globally to display regional/country variation and further highlight its potential application. Developing countries (e.g. in sub-Saharan Africa) display high levels of absolute mortality as well as variable mortality inequality with evidence of spatial clustering within certain sub-national units ("hotspots"). Although greater inequality is observed outside developed regions, high mortality inequality and spatial clustering are common in both developed and developing countries. Significant positive correlation was observed between the degree of spatial clustering and absolute mortality. The proposed multidimensional indicator should prove useful for spatial allocation of healthcare resources within a country, because it can prompt a wide range of policy options and prioritise high-risk areas. The new indicator demonstrates the inadequacy of IMR as a single measure of population health, and it can also be adapted to lower administrative levels within a country and other population health measures.

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013

PubMed Central

Yang, Zhixun; Zheng, Rongshou; Zhang, Siwei; Zeng, Hongmei; Xia, Changfa; Li, He; Wang, Li; Wang, Yanhong; Chen, Wanqing

2017-01-01

Objective In this research, the patterns of cancer incidence and mortality in areas with different gross domestic product per capita (GDPPC) levels in China were explored, using data from population-based cancer registries in 2013, collected by the National Central Cancer Registry (NCCR). Methods Data from 255 cancer registries were qualified and included in this analysis. Based on the GDPPC data of 2014, cities/counties were divided into 3 levels: high-, middle- and low-GDPPC areas, with 40,000 and 80,000 RMB per year as cut points. We calculated cancer incidences and mortalities in these three levels, stratified by gender and age group. The national population of the Fifth Census in 2000 and Segi’s population were applied for age-standardized rates. Results The crude incidence and mortality rates as well as age-standardized incidence rate (ASIR) showed positive associations with GDPPC level. The age-standardized mortality rate (ASMR) nevertheless showed a negative association with GDPPC level. The ASMR in high-, middle- and low-GDPPC areas was 103.12/100,000, 112.49/100,000 and 117.43/100,000, respectively. Lung cancer was by far the most common cancer in all three GDPPC levels. It was also the leading cause of cancer death, regardless of gender and GDPPC level. Negative associations with GDPPC level were found for the ASIRs of lung, stomach, esophageal and liver cancer, whereas colorectal and breast cancer showed positive associations. Except for breast cancer, the ASMRs of the other five cancers were always higher in middle- and low-GDPPC areas than in high-GDPPC areas. Conclusions The economic development is one of the main factors of the heavy cancer burden on Chinese population. It would be reasonable to implement cancer control strategies referring to the local GDPPC level. PMID:29142457

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013.

PubMed

Yang, Zhixun; Zheng, Rongshou; Zhang, Siwei; Zeng, Hongmei; Xia, Changfa; Li, He; Wang, Li; Wang, Yanhong; Chen, Wanqing

2017-10-01

In this research, the patterns of cancer incidence and mortality in areas with different gross domestic product per capita (GDPPC) levels in China were explored, using data from population-based cancer registries in 2013, collected by the National Central Cancer Registry (NCCR). Data from 255 cancer registries were qualified and included in this analysis. Based on the GDPPC data of 2014, cities/counties were divided into 3 levels: high-, middle- and low-GDPPC areas, with 40,000 and 80,000 RMB per year as cut points. We calculated cancer incidences and mortalities in these three levels, stratified by gender and age group. The national population of the Fifth Census in 2000 and Segi's population were applied for age-standardized rates. The crude incidence and mortality rates as well as age-standardized incidence rate (ASIR) showed positive associations with GDPPC level. The age-standardized mortality rate (ASMR) nevertheless showed a negative association with GDPPC level. The ASMR in high-, middle- and low-GDPPC areas was 103.12/100,000, 112.49/100,000 and 117.43/100,000, respectively. Lung cancer was by far the most common cancer in all three GDPPC levels. It was also the leading cause of cancer death, regardless of gender and GDPPC level. Negative associations with GDPPC level were found for the ASIRs of lung, stomach, esophageal and liver cancer, whereas colorectal and breast cancer showed positive associations. Except for breast cancer, the ASMRs of the other five cancers were always higher in middle- and low-GDPPC areas than in high-GDPPC areas. The economic development is one of the main factors of the heavy cancer burden on Chinese population. It would be reasonable to implement cancer control strategies referring to the local GDPPC level.

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.

Childhood cancer mortality and radon concentration in drinking water in North Carolina.

PubMed Central

Collman, G. W.; Loomis, D. P.; Sandler, D. P.

1991-01-01

We explored the association between groundwater radon levels and childhood cancer mortality in North Carolina. Using data from two state-wide surveys of public drinking water supplies, counties were ranked according to average groundwater radon concentration. Age and sex-adjusted 1950-79 cancer death rates among children under age 15 were calculated for counties with high, medium, and low radon levels. Overall cancer mortality was increased in counties with medium and high radon levels. The strongest association was for the leukaemias, but risks were also suggested for other sites. These associations could be due to confounding or other biases, but the findings are consistent with other recent reports. PMID:2021549

Childhood cancer mortality and radon concentration in drinking water in North Carolina.

PubMed

Collman, G W; Loomis, D P; Sandler, D P

1991-04-01

We explored the association between groundwater radon levels and childhood cancer mortality in North Carolina. Using data from two state-wide surveys of public drinking water supplies, counties were ranked according to average groundwater radon concentration. Age and sex-adjusted 1950-79 cancer death rates among children under age 15 were calculated for counties with high, medium, and low radon levels. Overall cancer mortality was increased in counties with medium and high radon levels. The strongest association was for the leukaemias, but risks were also suggested for other sites. These associations could be due to confounding or other biases, but the findings are consistent with other recent reports.

Ecological context of infant mortality in high-focus states of India

PubMed Central

2016-01-01

OBJECTIVES: This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India. METHODS: Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres. RESULTS: A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate. CONCLUSIONS: Interventions at the community level can reduce district infant mortality rates. PMID:26971696

Ecological context of infant mortality in high-focus states of India.

PubMed

Ladusingh, Laishram; Gupta, Ashish Kumar; Yadav, Awdhesh

2016-01-01

This goal of this study was to shed light on the ecological context as a potential determinant of the infant mortality rate in nine high-focus states in India. Data from the Annual Health Survey (2010-2011), the Census of India (2011), and the District Level Household and Facility Survey 3 (2007-08) were used in this study. In multiple regression analysis explanatory variable such as underdevelopment is measured by the non-working population, and income inequality, quantified as the proportion of households in the bottom wealth quintile. While, the trickle-down effect of education is measured by female literacy, and investment in health, as reflected by neonatal care facilities in primary health centres. A high spatial autocorrelation of district infant mortality rates was observed, and ecological factors were found to have a significant impact on district infant mortality rates. The result also revealed that non-working population and income inequality were found to have a negative effect on the district infant mortality rate. Additionally, female literacy and new-born care facilities were found to have an inverse association with the infant mortality rate. Interventions at the community level can reduce district infant mortality rates.

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.

Spatial Patterns of Heat-Related Cardiovascular Mortality in the Czech Republic

PubMed Central

Urban, Aleš; Burkart, Katrin; Kyselý, Jan; Schuster, Christian; Plavcová, Eva; Hanzlíková, Hana; Štěpánek, Petr; Lakes, Tobia

2016-01-01

The study examines spatial patterns of effects of high temperature extremes on cardiovascular mortality in the Czech Republic at a district level during 1994–2009. Daily baseline mortality for each district was determined using a single location-stratified generalized additive model. Mean relative deviations of mortality from the baseline were calculated on days exceeding the 90th percentile of mean daily temperature in summer, and they were correlated with selected demographic, socioeconomic, and physical-environmental variables for the districts. Groups of districts with similar characteristics were identified according to socioeconomic status and urbanization level in order to provide a more general picture than possible on the district level. We evaluated lagged patterns of excess mortality after hot spell occurrences in: (i) urban areas vs. predominantly rural areas; and (ii) regions with different overall socioeconomic level. Our findings suggest that climatic conditions, altitude, and urbanization generally affect the spatial distribution of districts with the highest excess cardiovascular mortality, while socioeconomic status did not show a significant effect in the analysis across the Czech Republic as a whole. Only within deprived populations, socioeconomic status played a relevant role as well. After taking into account lagged effects of temperature on excess mortality, we found that the effect of hot spells was significant in highly urbanized regions, while most excess deaths in rural districts may be attributed to harvesting effects. PMID:26959044

Educational inequalities in mortality are larger at low levels of income: A register-based study on premature mortality among 2.3 million Swedes, 2006-2009.

PubMed

Östergren, Olof

2018-08-01

Education develops skills that help individuals use available material resources more efficiently. When material resources are scarce, each decision becomes comparatively more important. Education may also protect from health-related income decline, since the highly educated tend to work in occupations with lower physical demands. Educational inequalities in health may, therefore, be more pronounced at lower levels of income. The aim of this study is to assess whether the shape of the income gradient in premature mortality depends on the level of education. Total population data on education, income and mortality was obtained by linking several Swedish registers. Income was defined as five-year average disposable household income for ages 35-64 and mortality follow-up covered the period 2006-2009. The final population comprised 2.3 million individuals, 6.2 million person-years and 14,362 deaths. Income was modeled using splines in order to allow variation in the functional form of the association across educational categories. Poisson regression with robust standard errors was used. The curvilinear shape of the association between income and mortality was more pronounced among those with a low education. Both absolute and relative educational inequalities in premature mortality tended to be larger at low levels of income. The greatest income differences in mortality were observed for those with a low education and the smallest for the highly educated. Education and income interact as predictors of mortality. Education is a more important factor for health when access to material resources is limited.

The impact of high serum bicarbonate levels on mortality in hemodialysis patients.

PubMed

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

2017-01-01

The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO 2 ) levels: quartile 1, a tCO 2 of < 19.4 mEq/L; quartile 2, a tCO 2 of 19.4 to 21.5 mEq/L; quartile 3, a tCO 2 of 21.6 to 23.9 mEq/L; and quartile 4, a tCO 2 of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles ( p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). Our data indicate that high serum bicarbonate levels (a tCO2 of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.

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 Prevalence and Clinical Significance of Low Procalcitonin Levels Among Patients With Severe Sepsis or Septic Shock in the Emergency Department.

PubMed

Choe, Eun A; Shin, Tae Gun; Jo, Ik Joon; Hwang, Sung Yeon; Lee, Tae Rim; Cha, Won Chul; Sim, Min Seob

2016-07-01

The aims of this study were to evaluate the prevalence of low procalcitonin (PCT) levels among patients with severe sepsis or septic shock, and to investigate clinical characteristics and outcomes associated with low PCT levels. We analyzed data from the sepsis registry for patients with severe sepsis or septic shock in the emergency department. Based on a specific PCT cutoff value, patients were classified into two groups: a low PCT group, PCT <0.25 ng/mL; and a high PCT group, PCT ≥0.25 ng/mL. The primary endpoint was 28-day mortality. A multivariable logistic regression model was used to evaluate independent factors associated with low PCT and 28-day mortality. A total of 1,212 patients were included. Of the eligible patients, 154 (12.7%) were assigned to the low PCT group, and 1,058 (87.3%) to the high PCT group. The 28-day mortality was 4.6% in the low PCT group and 13.5% in the high PCT group (P < 0.01). The adjusted odds ratio of the low PCT group for 28-day mortality was 0.43 (95% CI 0.19-0.98; P = 0.04). There was no trend of increasing mortality among higher PCT level patients. In a logistic regression model, factors associated with low PCT were pneumonia, lower C-reactive protein levels, lower lactate levels, the absence of bacteremia, and the absence of organ failure. Intra-abdominal infection and obesity were associated with high PCT. Initial low PCT levels were common among patients diagnosed with severe sepsis or septic shock in the emergency department, suggesting favorable outcomes. The prevalence of low PCT levels was significantly different according to obesity, the source of infection, C-reactive protein levels, lactate levels, bacteremia, and organ failure.

Fibroblast growth factor-23 levels in maintenance hemodialysis patients in India.

PubMed

Anandh, U; Mandavkar, P; Das, B; Rao, S

2017-01-01

Fibroblast growth factor-23 (FGF-23) levels start rising early in patients with chronic kidney disease and is implicated in cardiovascular and overall mortality of hemodialysis patients. We conducted a prospective observational cohort study in stable dialysis patients looking into the levels of FGF-23 in hemodialysis patients and its association with various demographic and biochemical variables and mortality. A total of 91 patients were enrolled in the study. The mean FGF-23 levels were very high (1152.7 pg/ml). FGF-23 levels were significantly associated with serum phosphorus and parathyroid hormone (PTH) levels in univariate and multivariate analysis. No significant association between FGF-23 and cardiovascular comorbidities and overall mortality was seen. FGF-23 levels rise exponentially in maintenance hemodialysis patients. There is a strong association between FGF-23 and phosphorus and PTH levels. No association between FGF-23 and mortality was noted in our patients.

The value of time-averaged serum high-sensitivity C-reactive protein in prediction of mortality and dropout in peritoneal dialysis patients.

PubMed

Liu, Shou-Hsuan; Chen, Chao-Yu; Li, Yi-Jung; Wu, Hsin-Hsu; Lin, Chan-Yu; Chen, Yung-Chang; Chang, Ming-Yang; Hsu, Hsiang-Hao; Ku, Cheng-Lung; Tian, Ya-Chung

2017-01-01

C-reactive protein (CRP) is a useful biomarker for prediction of long-term outcomes in patients undergoing chronic dialysis. This observational cohort study evaluated whether the time-averaged serum high-sensitivity CRP (HS-CRP) level was a better predictor of clinical outcomes than a single HS-CRP level in patients undergoing peritoneal dialysis (PD). We classified 335 patients into three tertiles according to the time-averaged serum HS-CRP level and followed up regularly from January 2010 to December 2014. Clinical outcomes such as cardiovascular events, infection episodes, newly developed malignancy, encapsulating peritoneal sclerosis (EPS), dropout (death plus conversion to hemodialysis), and mortality were assessed. During a 5-year follow-up, 164 patients (49.0%) ceased PD; this included 52 patient deaths (15.5%), 100 patients (29.9%) who converted to hemodialysis, and 12 patients (3.6%) who received a kidney transplantation. The Kaplan-Meier survival analysis and log-rank test revealed a significantly worse survival accumulation in patients with high time-average HS-CRP levels. A multivariate Cox regression analysis revealed that a higher time-averaged serum HS-CRP level, older age, and the occurrence of cardiovascular events were independent mortality predictors. A higher time-averaged serum HS-CRP level, the occurrence of cardiovascular events, infection episodes, and EPS were important predictors of dropout. The receiver operating characteristic analysis verified that the value of the time-average HS-CRP level in predicting the 5-year mortality and dropout was superior to a single serum baseline HS-CRP level. This study shows that the time-averaged serum HS-CRP level is a better marker than a single baseline measurement in predicting the 5-year mortality and dropout in PD patients.

Providing instrumental social support is more beneficial to reduce mortality risk among the elderly with low educational level in Taiwan: a 12-year follow-up national longitudinal study.

PubMed

Liao, C C; Yeh, C J; Lee, S H; Liao, W C; Liao, M Y; Lee, M C

2015-04-01

To evaluate whether the effects of providing or receiving social support are more beneficial to reduce mortality risk among the elderly with different educational levels. In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was initiated from 1996 until 2007. The complete data from 1492 males and 1177 females aged ≥67 years were retrieved. Participants received financial, instrumental, and emotional support, and they actively provided instrumental and emotional support to others and involved in social engagement. Education attainment was divided into two levels: high and low. The low education level included illiterate and elementary school. The high education level included junior high school to senior high school and above college. Cox regression analysis was used to examine the association between providing or receiving social support on mortality with different educational levels. The average age of the participants in 1996 was 73.0 (IQR=8.0) years, and the median survival following years (1996-2007) of participants was 10.3 (IQR=6.7) years. Most participants were low educational level including illiterate (39.3%) and elementary school (41.2%). Participants with high educational level tend to be younger and more male significantly. On the contrary, participants with low educational level tend to have significant more poor income, more depression, more cognition impairment, more with IADL and ADL disability than high educational level. Most participants received instrumental support from others (95.5%) and also provided emotional support to others (97.7%). Providing instrumental support can reduce 17% of mortality risk among the elderly with a low level of education after adjusting several covariates [Hazard ratio (HR) = 0.83; 95% confidence interval (CI) = 0.70-0.99; p = 0.036]. Providing instrumental social support to others confer benefits to the giver and prolong life expectancy among the elderly with low educational levels.

Under-Five Mortality in High Focus States in India: A District Level Geospatial Analysis

PubMed Central

Kumar, Chandan; Singh, Prashant Kumar; Rai, Rajesh Kumar

2012-01-01

Background This paper examines if, when controlling for biophysical and geographical variables (including rainfall, productivity of agricultural lands, topography/temperature, and market access through road networks), socioeconomic and health care indicators help to explain variations in the under-five mortality rate across districts from nine high focus states in India. The literature on this subject is inconclusive because the survey data, upon which most studies of child mortality rely, rarely include variables that measure these factors. This paper introduces these variables into an analysis of 284 districts from nine high focus states in India. Methodology/Principal Findings Information on the mortality indicator was accessed from the recently conducted Annual Health Survey of 2011 and other socioeconomic and geographic variables from Census 2011, District Level Household and Facility Survey (2007–08), Department of Economics and Statistics Divisions of the concerned states. Displaying high spatial dependence (spatial autocorrelation) in the mortality indicator (outcome variable) and its possible predictors used in the analysis, the paper uses the Spatial-Error Model in an effort to negate or reduce the spatial dependence in model parameters. The results evince that the coverage gap index (a mixed indicator of district wise coverage of reproductive and child health services), female literacy, urbanization, economic status, the number of newborn care provided in Primary Health Centers in the district transpired as significant correlates of under-five mortality in the nine high focus states in India. The study identifies three clusters with high under-five mortality rate including 30 districts, and advocates urgent attention. Conclusion Even after controlling the possible biophysical and geographical variables, the study reveals that the health program initiatives have a major role to play in reducing under-five mortality rate in the high focus states in India. PMID:22629412

Unintended pregnancy and abortion in Uganda.

PubMed

Hussain, Rubina

2013-01-01

Unintended pregnancy is common in Uganda, leading to high levels of unplanned births, unsafe abortions, and maternal injury and death. Because most pregnancies that end in abortion are unwanted, nearly all ill health and mortality resulting from unsafe abortion is preventable. This report summarizes evidence on the context and consequences of unintended pregnancy and unsafe abortion in Uganda, points out gaps in knowledge, and highlights steps that can be taken to reduce levels of unintended pregnancy and unsafe abortion, and, in turn, the high level of maternal mortality.

Relationship of metabolic alkalosis, azotemia and morbidity in patients with chronic obstructive pulmonary disease and hypercapnia.

PubMed

Ucgun, Irfan; Oztuna, Funda; Dagli, Canan Eren; Yildirim, Huseyin; Bal, Cengiz

2008-01-01

Exacerbation of chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality, but the effect of metabolic compensation of respiratory acidosis (RA) on mortality is not fully understood. To investigate the relationship between metabolic compensation and mortality in COPD patients with RA. We prospectively investigated all COPD patients with RA admitted to the respiratory intensive care unit between February 2001 and March 2007. Two hundred and thirteen patients (159 male, 54 female; mean age 65 +/- 10.8 years) were divided into three groups (71 patients each) according to base excess (BE) levels: (1) low BE, (2) medium BE, and (3) high BE. H(+) concentration was calculated according to their standard formula and BE was calculated according to the Van Slyke equation. The overall mortality rate was 24.9%. The group mortality rates were 32, 17 and 25% in the low, medium and high BE groups, respectively (p = 0.001). When patients were divided into three groups according to the HCO(3)(-) levels, the group mortality rate was 59.1% in the low HCO(3)(-) group and 19.8% in the high HCO(3)(-) group. Based on univariate analysis, six factors affecting mortality were identified. However, multivariate analysis showed that the levels of serum HCO(3)(-) (p = 0.013; OR: 0.552; CI: 0.345-0.882) and creatinine (p = 0.019; OR: 2.114; CI: 1.132-3.949) had an independent effect. In patients with COPD exacerbation and hypercapnia, the development of sufficient metabolic compensation and adequate renal function significantly decreases mortality. Copyright 2008 S. Karger AG, Basel.

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

Examining Road Traffic Mortality Status in China: A Simulation Study

PubMed Central

Schwebel, David C.; Li, Li; Hu, Guoqing

2016-01-01

Background Data from the Chinese police service suggest substantial reductions in road traffic injuries since 2002, but critics have questioned the accuracy of those data, especially considering conflicting data reported by the health department. Methods To address the gap between police and health department data and to determine which may be more accurate, we conducted a simulation study based on the modified Smeed equation, which delineates a non-linear relation between road traffic mortality and the level of motorization in a country or region. Our goal was to simulate trends in road traffic mortality in China and compare performances in road traffic safety management between China and 13 other countries. Results Chinese police data indicate a peak in road traffic mortalities in 2002 and a significant and a gradual decrease in population-based road traffic mortality since 2002. Health department data show the road traffic mortality peaked in 2012. In addition, police data suggest China’s road traffic mortality peaked at a much lower motorization level (0.061 motor vehicles per person) in 2002, followed by a reduction in mortality to a level comparable to that of developed countries. Simulation results based on health department data suggest high road traffic mortality, with a mortality peak in 2012 at a moderate motorization level (0.174 motor vehicles per person). Comparisons to the other 13 countries suggest the health data from China may be more valid than the police data. Conclusion Our simulation data indicate China is still at a stage of high road traffic mortality, as suggested by health data, rather than a stage of low road traffic mortality, as suggested by police data. More efforts are needed to integrate safety into road design, improve road traffic management, improve data quality, and alter unsafe behaviors of pedestrians, drivers and passengers in China. PMID:27071008

Relation between serum creatinine and postoperative results of open-heart surgery.

PubMed

Ezeldin, Tamer H

2013-10-01

To determine the impact of preoperative serum creatinine level in non-dialyzable patients on postoperative morbidity and mortality. This is a prospective study, where serum creatinine was used to give primary assessment on renal function status preoperatively. This study includes 1,033 patients, who underwent coronary artery bypass grafting, or valve(s) operations. The study took place at Al-Hada Military Hospital, Taif, Kingdom of Saudi between May 2008 and January 2012. Data were statistically analyzed using Chi square (x2) test and multivariable logistic regression, to evaluate the postoperative morbidity and mortality risks associated with low serum creatinine levels. Postoperative mortality increased with high serum creatinine level >1.8 mg/dL (p

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.

Changes in mortality rates and humanitarian conditions in Darfur, Sudan 2003-2007.

PubMed

Garfield, Richard; Polonsky, Jonny

2010-01-01

The Darfur region of Sudan has been an intense focus of humanitarian concern since rebellions began there early in 2003. In 2004, the US Secretary of State declared that conflict in Darfur represented genocide. Since 2003, many sample surveys and various mortality estimates for Darfur have been made. Nonetheless, confusion and controversy surrounding mortality levels and trends have continued. For this project, results were reviewed from the highest quality field surveys on mortality in Darfur conducted between 2003 and 2008. Trend analysis demonstrated a dramatic decline in mortality over time in Darfur. By 2005, mortality levels had fallen below emergency levels and have continued to decline. Deaths directly due violence have declined as a proportion of all of the deaths in Darfur. Declining mortality in Darfur was not associated with other proximate improvements in well-being, such as improved nutrition. Without large-scale, humanitarian intervention, continuing high rates of mortality due to violence likely would have occurred. If mortality had continued at the high rate documented in 2004, by January 2009, there would have been 330,000 additional deaths. With the humanitarian assistance provided through the United Nations and non-governmental organizations, these people are alive today. A focus on excess deaths among noncombatants may draw attention away from other needs, such as establishing better security, improving service delivery to the displaced, and advocating for internally displaced persons to be reached today and to re-establish their lives and livelihoods tomorrow.

Increased Mortality Exposure within the Family Rather than Individual Mortality Experiences Triggers Faster Life-History Strategies in Historic Human Populations

PubMed Central

Störmer, Charlotte; Lummaa, Virpi

2014-01-01

Life History Theory predicts that extrinsic mortality risk is one of the most important factors shaping (human) life histories. Evidence from contemporary populations suggests that individuals confronted with high mortality environments show characteristic traits of fast life-history strategies: they marry and reproduce earlier, have shorter birth intervals and invest less in their offspring. However, little is known of the impact of mortality experiences on the speed of life histories in historical human populations with generally higher mortality risk, and on male life histories in particular. Furthermore, it remains unknown whether individual-level mortality experiences within the family have a greater effect on life-history decisions or family membership explains life-history variation. In a comparative approach using event history analyses, we study the impact of family versus individual-level effects of mortality exposure on two central life-history parameters, ages at first marriage and first birth, in three historical human populations (Germany, Finland, Canada). Mortality experience is measured as the confrontation with sibling deaths within the natal family up to an individual's age of 15. Results show that the speed of life histories is not adjusted according to individual-level mortality experiences but is due to family-level effects. The general finding of lower ages at marriage/reproduction after exposure to higher mortality in the family holds for both females and males. This study provides evidence for the importance of the family environment for reproductive timing while individual-level mortality experiences seem to play only a minor role in reproductive life history decisions in humans. PMID:24421897

Increased mortality exposure within the family rather than individual mortality experiences triggers faster life-history strategies in historic human populations.

PubMed

Störmer, Charlotte; Lummaa, Virpi

2014-01-01

Life History Theory predicts that extrinsic mortality risk is one of the most important factors shaping (human) life histories. Evidence from contemporary populations suggests that individuals confronted with high mortality environments show characteristic traits of fast life-history strategies: they marry and reproduce earlier, have shorter birth intervals and invest less in their offspring. However, little is known of the impact of mortality experiences on the speed of life histories in historical human populations with generally higher mortality risk, and on male life histories in particular. Furthermore, it remains unknown whether individual-level mortality experiences within the family have a greater effect on life-history decisions or family membership explains life-history variation. In a comparative approach using event history analyses, we study the impact of family versus individual-level effects of mortality exposure on two central life-history parameters, ages at first marriage and first birth, in three historical human populations (Germany, Finland, Canada). Mortality experience is measured as the confrontation with sibling deaths within the natal family up to an individual's age of 15. Results show that the speed of life histories is not adjusted according to individual-level mortality experiences but is due to family-level effects. The general finding of lower ages at marriage/reproduction after exposure to higher mortality in the family holds for both females and males. This study provides evidence for the importance of the family environment for reproductive timing while individual-level mortality experiences seem to play only a minor role in reproductive life history decisions in humans.

Democracy and growth in divided societies: A health-inequality trap?

PubMed

Powell-Jackson, Timothy; Basu, Sanjay; Balabanova, Dina; McKee, Martin; Stuckler, David

2011-07-01

Despite a tremendous increase in financial resources, many countries are not on track to achieve the child and maternal mortality targets set out in the Millennium Development Goals 4 and 5. It is commonly argued that two main social factors - improved democratic governance and aggregate income - will ultimately lead to progress in reducing child and maternal mortality. However, these two factors alone may be insufficient to achieve progress in settings where there is a high level of social division. To test the effects of growth and democratisation, and their interaction with social inequalities, we regressed data on child and maternal mortality rates for 192 countries against internationally used indexes of income, democracy, and population inequality (including income, ethnic, linguistic, and religious divisions) covering the period 1970-2007. We found that a higher degree of social division, especially ethnic and linguistic fractionalisation, was significantly associated with greater child and maternal mortality rates. We further found that, even in democratic states, greater social division was associated with lower overall population access to healthcare and lesser expansion of health system infrastructure. Perversely, while greater democratisation and aggregate income were associated with reduced maternal and child mortality overall, in regions with high levels of ethnic fragmentation the health benefits of democratisation and rising income were undermined and, at high levels of inequality reversed, so that democracy and growth were adversely related to child and maternal mortality. These findings are consistent with literature suggesting that high degrees of social division in the context of democratisation can strengthen the power of dominant elite and ethnic groups in political decision-making, resulting in health and welfare policies that deprive minority groups (a health-inequality trap). Thus, we show that improving economic growth and democratic governance are insufficient to achieve child and maternal health targets in communities with high levels of persistent social inequality. To reduce child and maternal mortality in highly divided societies, it will be necessary not only to increase growth and promote democratic elections, but also empower disenfranchised communities. Copyright © 2011 Elsevier Ltd. All rights reserved.

Long-term exposure to ambient air pollution and respiratory disease mortality in Shenyang, China: a 12-year population-based retrospective cohort study.

PubMed

Dong, Guang-Hui; Zhang, Pengfei; Sun, Baijun; Zhang, Liwen; Chen, Xi; Ma, Nannan; Yu, Fei; Guo, Huimin; Huang, Hui; Lee, Yungling Leo; Tang, Naijun; Chen, Jie

2012-01-01

In China, both the levels and patterns of outdoor air pollution have altered dramatically with the rapid economic development and urbanization over the past two decades. However, few studies have investigated the association of outdoor air pollution with respiratory mortality, especially in the high pollution range. We conducted a retrospective cohort study of 9,941 residents aged ≥35 years old in Shenyang, China, to examine the association between outdoor air pollutants [particulate matter <10 µm in aerodynamic diameter (PM(10)), sulfur dioxide (SO(2)) and nitrogen dioxide (NO(2))] and mortality using 12 years of data. We applied extended Cox proportional hazards modeling with time-dependent covariates to respiratory mortality. Analyses were also stratified by age, sex, educational level, smoking status, personal income, occupational exposure and body mass index (BMI) to examine the association of air pollution with mortality. We found significant associations between PM(10) and NO(2) levels and respiratory disease mortality. Our analysis found a relative risk of 1.67 [95% confidence interval (CI) 1.60-1.74] and 2.97 (95% CI 2.69-3.27) for respiratory mortality per 10 µg/m(3) increase in PM(10) and NO(2), respectively. The effects of air pollution were more apparent in women than in men. Age, sex, educational level, smoking status, personal income, occupational exposure, BMI and exercise frequency influenced the relationship between outdoor PM(10) and NO(2) and mortality. For SO(2), only smoking, little regular exercise and BMI above 18.5 influenced the relationship with mortality. These data contribute to the scientific literature on the long-term effects of air pollution for the high-exposure settings typical in developing countries. Copyright © 2011 S. Karger AG, Basel.

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.

Densities of breeding birds and changes in vegetation in an alaskan boreal forest following a massive disturbance by spruce beetles

USGS Publications Warehouse

Matsuoka, S.M.; Handel, C.M.; Ruthrauff, D.R.

2001-01-01

We examined bird and plant communities among forest stands with different levels of spruce mortality following a large outbreak of spruce beetles (Dendroctonus rufipennis (Kirby)) in the Copper River Basin, Alaska. Spruce beetles avoided stands with black spruce (Picea mariana) and selectively killed larger diameter white spruce (Picea glauca), thereby altering forest structure and increasing the dominance of black spruce in the region. Alders (Alnus sp.) and crowberry (Empetrum nigrum) were more abundant in areas with heavy spruce mortality, possibly a response to the death of overstory spruce. Grasses and herbaceous plants did not proliferate as has been recorded following outbreaks in more coastal Alaskan forests. Two species closely tied to coniferous habitats, the tree-nesting Ruby-crowned Kinglet (Regulus calendula) and the red squirrel (Tamiasciurus hudsonicus), a major nest predator, were less abundant in forest stands with high spruce mortality than in low-mortality stands. Understory-nesting birds as a group were more abundant in forest stands with high levels of spruce mortality, although the response of individual bird species to tree mortality was variable. Birds breeding in stands with high spruce mortality likely benefited reproductively from lower squirrel densities and a greater abundance of shrubs to conceal nests from predators.

Patterns of bleaching and mortality following widespread warming events in 2014 and 2015 at the Hanauma Bay Nature Preserve, Hawai'i.

PubMed

Rodgers, Ku'ulei S; Bahr, Keisha D; Jokiel, Paul L; Richards Donà, Angela

2017-01-01

Drastic increases in global carbon emissions in the past century have led to elevated sea surface temperatures that negatively affect coral reef organisms. Worldwide coral bleaching-related mortality is increasing and data has shown even isolated and protected reefs are vulnerable to the effects of global climate change. In 2014 and 2015, coral reefs in the main Hawaiian Islands (MHI) suffered up to 90% bleaching, with higher than 50% subsequent mortality in some areas. The location and severity of bleaching and mortality was strongly influenced by the spatial and temporal patterns of elevated seawater temperatures. The main objective of this research was to understand the spatial extent of bleaching mortality in Hanauma Bay Nature Preserve (HBNP), O'ahu, Hawai'i to gain a baseline understanding of the physical processes that influence localized bleaching dynamics. Surveys at HBNP in October 2015 and January 2016 revealed extensive bleaching (47%) and high levels of coral mortality (9.8%). Bleaching was highly variable among the four HBNP sectors and ranged from a low of ∼31% in the central bay at Channel (CH) to a high of 57% in the area most frequented by visitors (Keyhole; KH). The highest levels of bleaching occurred in two sectors with different circulation patterns: KH experienced comparatively low circulation velocity and a low temperature increase while Witches Brew (WB) and Backdoors (BD) experienced higher circulation velocity and higher temperature increase. Cumulative mortality was highest at WB (5.0%) and at BD (2.9%) although WB circulation velocity is significantly higher. HBNP is minimally impacted by local factors that can lead to decline such as high fishing pressure or sedimentation although human use is high. Despite the lack of these influences, high coral mortality occurred. Visitor impacts are strikingly different in the two sectors that experienced the highest mortality evidenced by the differences in coral cover associated with visitor use however, coral mortality was similar. These results suggest that elevated temperature was more influential in coral bleaching and the associated mortality than high circulation or visitor use.

Patterns of bleaching and mortality following widespread warming events in 2014 and 2015 at the Hanauma Bay Nature Preserve, Hawai‘i

PubMed Central

2017-01-01

Drastic increases in global carbon emissions in the past century have led to elevated sea surface temperatures that negatively affect coral reef organisms. Worldwide coral bleaching-related mortality is increasing and data has shown even isolated and protected reefs are vulnerable to the effects of global climate change. In 2014 and 2015, coral reefs in the main Hawaiian Islands (MHI) suffered up to 90% bleaching, with higher than 50% subsequent mortality in some areas. The location and severity of bleaching and mortality was strongly influenced by the spatial and temporal patterns of elevated seawater temperatures. The main objective of this research was to understand the spatial extent of bleaching mortality in Hanauma Bay Nature Preserve (HBNP), O‘ahu, Hawai‘i to gain a baseline understanding of the physical processes that influence localized bleaching dynamics. Surveys at HBNP in October 2015 and January 2016 revealed extensive bleaching (47%) and high levels of coral mortality (9.8%). Bleaching was highly variable among the four HBNP sectors and ranged from a low of ∼31% in the central bay at Channel (CH) to a high of 57% in the area most frequented by visitors (Keyhole; KH). The highest levels of bleaching occurred in two sectors with different circulation patterns: KH experienced comparatively low circulation velocity and a low temperature increase while Witches Brew (WB) and Backdoors (BD) experienced higher circulation velocity and higher temperature increase. Cumulative mortality was highest at WB (5.0%) and at BD (2.9%) although WB circulation velocity is significantly higher. HBNP is minimally impacted by local factors that can lead to decline such as high fishing pressure or sedimentation although human use is high. Despite the lack of these influences, high coral mortality occurred. Visitor impacts are strikingly different in the two sectors that experienced the highest mortality evidenced by the differences in coral cover associated with visitor use however, coral mortality was similar. These results suggest that elevated temperature was more influential in coral bleaching and the associated mortality than high circulation or visitor use. PMID:28584703

The U-shaped association of body mass index with mortality: Influence of the traits height, intelligence, and education.

PubMed

Jørgensen, Terese Sara Høj; Osler, Merete; Ängquist, Lars Henrik; Zimmermann, Esther; Christensen, Gunhild Tidemann; Sørensen, Thorkild I A

2016-10-01

The U-shaped association between body mass index (BMI) and mortality may depend on other traits with permanent health effects. Whether the association between BMI and mortality depends on levels of health-related traits known to be inversely associated with mortality throughout adult life such as height, intelligence, and education was investigated. The study was based on a cohort of young men with data on weight, height, intelligence test score, and education from the Danish Conscription Database. In total, 346,500 men born 1939 to 1959 were followed until December 2013. The association between BMI and mortality was analyzed using Cox-regression models including interactions between BMI and height, intelligence, and education, respectively. BMI and mortality showed the U-shaped association from the start of the follow-up period, and it persisted through the subsequent 56 years. As expected, the mortality was inversely associated with height, intelligence, and education, but the U shape of the association between BMI and mortality was unaffected by the levels of these traits except at higher BMI values, where the slopes were steeper for men with higher levels of height, intelligence, and education. High and low BMI was associated with higher mortality throughout life regardless of the levels of height, intelligence, and education. © 2016 The Obesity Society.

Estimation of high risk pregnancy contributing to perinatal morbidity and mortality from a birth population-based regional survey in 2010 in China.

PubMed

Sun, Libo; Yue, Hongni; Sun, Bo; Han, Liangrong; Tian, Zhaofang; Qi, Meihua; Lu, Shuyan; Shan, Chunming; Luo, Jianxin; Fan, Yujing; Li, Shouzhong; Dong, Maotian; Zuo, Xiaofeng; Zhang, Yixing; Lin, Wenlong; Xu, Jinzhong; Heng, Yongbo

2014-09-30

Neonatal mortality reduction in China over past two decades was reported from nationwide sampling surveys, however, how high risk pregnancy affected neonatal outcome is unknown. The objective of this study was to explore relations of pregnancy complications and neonatal outcomes from a regional birth population. In a prospective, cross-sectional survey of complete birth population-based data file from 151 level I-III hospitals in Huai'an region in 2010, pregnancy complications were analyzed for perinatal morbidity and mortality in association with maternal and perinatal characteristics, hospital levels, mode of delivery, newborn birth weight and gestational age, using international definition for birth registry and morbidities. Pregnancy complications were found in 10% of all births, in which more than 70% were delivered at level II and III hospitals associated with higher proportions of fetal and neonatal death, preterm birth, death at delivery and congenital anomalies. High Cesarean section delivery was associated with higher pregnancy complications, and more neonatal critical illnesses. The pregnancy complications related perinatal morbidity and mortality in level III were 2-4 times as high as in level I and II hospitals. By uni- and multi-variate regression analysis, impact of pregnancy complications was along with congenital anomalies and preterm birth, and maternal child-bearing age and school education years contributing to the prevalence. This survey revealed variable links of pregnancy complications to perinatal outcome in association with very high Cesarean section deliveries, which warrants investigation for causal relations between high risk pregnancy and neonatal outcome in this emerging region.

Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke.

PubMed

Nam, Ki-Woong; Kim, Chi Kyung; Kim, Tae Jung; An, Sang Joon; Oh, Kyungmi; Mo, Heejung; Kang, Min Kyoung; Han, Moon-Ku; Demchuk, Andrew M; Ko, Sang-Bae; Yoon, Byung-Woo

2017-01-01

Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46-3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke

PubMed Central

Kim, Tae Jung; An, Sang Joon; Oh, Kyungmi; Mo, Heejung; Kang, Min Kyoung; Han, Moon-Ku; Demchuk, Andrew M.; Ko, Sang-Bae; Yoon, Byung-Woo

2017-01-01

Background Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. Aim In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. Methods We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Results Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46–3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00–1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10–8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. Conclusions D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer. PMID:28282388

Association of Women’s Reproductive History With Long-Term Mortality and Effect of Socioeconomic Factors

PubMed Central

Halland, Frode; Morken, Nils-Halvdan; DeRoo, Lisa A; Klungsøyr, Kari; Wilcox, Allen J; Skjærven, Rolv

2017-01-01

Objective To assess the effects of socioeconomic factors on the association between parity and long-term maternal mortality. Methods This was a population-based cohort study of mothers with births registered in the Medical Birth Registry of Norway (MBRN) during the period 1967 to 2009. We estimated age-specific (40 to 69 years) cardiovascular and non-cardiovascular mortality ratios by number of births using Cox proportional-hazard models. To assess effect modification by mothers’ attained education we stratified on low (<11 years) and high (≥11 years) educational level. We further evaluated fathers’ mortality by number of births using the same analytical approach. Results Mothers with low education had higher mortality (cardiovascular: hazard ratio (HR) 2.62, 95% confidence interval (CI) 2.34–2.93, non-cardiovascular: HR 1.67, 95% CI 1.62–1.73). Among mothers with low education, cardiovascular mortality increased linearly with each additional birth above one, (p-trend=0.02). In contrast, among mothers with high education, cardiovascular mortality declined with added births, (p-trend=0.045). For non-cardiovascular mortality there was no association among mothers with low education, while mortality declined with increasing number of births among mothers with high education, (p-trend<0.01). Father’s mortality showed similar associations with number of births when stratified on maternal education. Conclusions Women’s long-term mortality rose with number of births only for cardiovascular causes of death, and only among mothers with low education. Partners of women with low education had similar increasing risk with increasing number of births. Maternal educational level is a strong modifier of the association between parity and long-term mortality. PMID:26551179

Projected trends in high-mortality heatwaves under different scenarios of climate, population, and adaptation in 82 US communities.

PubMed

Anderson, G Brooke; Oleson, Keith W; Jones, Bryan; Peng, Roger D

2018-02-01

Some rare heatwaves have extreme daily mortality impacts; moderate heatwaves have lower daily impacts but occur much more frequently at present and so account for large aggregated impacts. We applied health-based models to project trends in high-mortality heatwaves, including proportion of all heatwaves expected to be high-mortality, using the definition that a high-mortality heatwave increases mortality risk by ≥20 %. We projected these trends in 82 US communities in 2061-2080 under two scenarios of climate change (RCP4.5, RCP8.5), two scenarios of population change (SSP3, SSP5), and three scenarios of community adaptation to heat (none, lagged, on-pace) for large- and medium-ensemble versions of the National Center for Atmospheric Research's Community Earth System Model. More high-mortality heatwaves were expected compared to present under all scenarios except on-pace adaptation, and population exposure was expected to increase under all scenarios. At least seven more high-mortality heatwaves were expected in a twenty-year period in the 82 study communities under RCP8.5 than RCP4.5 when assuming no adaptation. However, high-mortality heatwaves were expected to remain <1 % of all heatwaves and heatwave exposure under all scenarios. Projections were most strongly influenced by the adaptation scenario- going from a scenario of on-pace to lagged adaptation or from lagged to no adaptation more than doubled the projected number of and exposure to high-mortality heatwaves. Based on our results, fewer high-mortality heatwaves are expected when following RCP4.5 versus RCP8.5 and under higher levels of adaptation, but high-mortality heatwaves are expected to remain a very small proportion of total heatwave exposure.

Total insulinlike growth factor 1 and insulinlike growth factor binding protein levels, functional status, and mortality in older adults.

PubMed

Kaplan, Robert C; McGinn, Aileen P; Pollak, Michael N; Kuller, Lewis; Strickler, Howard D; Rohan, Thomas E; Xue, XiaoNan; Kritchevsky, Stephen B; Newman, Anne B; Psaty, Bruce M

2008-04-01

To assess the association between total insulinlike growth factor (IGF)-1, IGF binding protein-1 (IGFBP-1), and IGFBP-3 levels and functioning and mortality in older adults. Cohort study. One thousand one hundred twenty-two individuals aged 65 and older without prior cardiovascular disease events participating in the Cardiovascular Health Study. Baseline fasting plasma levels of IGF-1, IGFBP-1, and IGFBP-3 (defined as tertiles, T1-T3) were examined in relationship to handgrip strength, time to walk 15 feet, development of new difficulties with activities of daily living (ADLs), and mortality. Higher IGFBP-1 predicted worse handgrip strength (P-trend(T1-T3)<.01) and slower walking speed (P-trend(T1-T3)=.03), lower IGF-1 had a borderline significant association with worse handgrip strength (P-trend(T1-T3)=.06), and better grip strength was observed in the middle IGFBP-3 tertile than in the low or high tertiles (P=.03). Adjusted for age, sex, and race, high IGFBP-1 predicted greater mortality (P-trend(T1-T3)<.001, hazard ratio (HR)(T3vsT1)=1.48, 95% confidence interval (CI)=1.15-1.90); this association was borderline significant after additional confounder adjustment (P-trend(T1-T3)=.05, HR(T3vsT1)=1.35, 95% CI=0.98-1.87). High IGFBP-1 was associated with greater risk of incident ADL difficulties after adjustment for age, sex, race, and other confounders (P-trend(T1-T3)=.04, HR(T3vsT1)=1.40, CI=1.01-1.94). Neither IGF-1 nor IGFBP-3 level predicted mortality or incident ADL difficulties. In adults aged 65 and older, high IGFBP-1 levels were associated with greater risk of mortality and poorer functional ability, whereas IGF-1 and IGFBP-3 had little association with these outcomes.

Impact of extreme high temperature on mortality and regional level definition of heat wave: a multi-city study in China.

PubMed

Gao, Jinghong; Sun, Yunzong; Liu, Qiyong; Zhou, Maigeng; Lu, Yaogui; Li, Liping

2015-02-01

Few multi-city studies have been conducted to explore the regional level definition of heat wave and examine the association between extreme high temperature and mortality in developing countries. The purpose of the present study was to investigate the impact of extreme high temperature on mortality and to explore the local definition of heat wave in five Chinese cities. We first used a distributed lag non-linear model to characterize the effects of daily mean temperature on non-accidental mortality. We then employed a generalized additive model to explore the city-specific definition of heat wave. Finally, we performed a comparative analysis to evaluate the effectiveness of the definition. For each city, we found a positive non-linear association between extreme high temperature and mortality, with the highest effects appearing within 3 days of extreme heat event onset. Specifically, we defined individual heat waves of Beijing and Tianjin as being two or more consecutive days with daily mean temperatures exceeding 30.2 °C and 29.5 °C, respectively, and Nanjing, Shanghai and Changsha heat waves as ≥3 consecutive days with daily mean temperatures higher than 32.9 °C, 32.3 °C and 34.5 °C, respectively. Comparative analysis generally supported the definition. We found extreme high temperatures were associated with increased mortality, after a short lag period, when temperatures exceeded obvious threshold levels. The city-specific definition of heat wave developed in our study may provide guidance for the establishment and implementation of early heat-health response systems for local government to deal with the projected negative health outcomes due to heat waves. Copyright © 2014 Elsevier B.V. All rights reserved.

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

PubMed

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

2015-03-01

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

Association of Elevated High Sensitivity Cardiac Troponin T(hs-cTnT) Levels with Hemorrhagic Transformation and 3-Month Mortality in Acute Ischemic Stroke Patients with Rheumatic Heart Disease in China

PubMed Central

Xiong, Yao; Liu, Bian; Hao, Zilong; Tao, Wendan; Liu, Ming

2016-01-01

Background and Objective Elevated levels of high sensitivity cardiac troponin T (hs-cTnT) occur in a substantial proportion of patients with acute ischemic stroke (AIS) and can predict poor outcome and mortality after stroke. Whether elevated hs-cTnT levels can also predict hemorrhagic transformation (HT) or prognosis in AIS patients with rheumatic heart disease (RHD) remains unclear. Methods Data from the Chengdu Stroke Registry on consecutive AIS patients with RHD admitted to West China Hospital within1 month of stroke onset from October 2011 to February 2014 were examined. Clinico-demographic characteristics, HT, functional outcomes and stroke recurrence were compared between patients with elevated hs-cTnT levels(≥14ng/L) and patients with normal hs-cTnT levels (<14ng/L). Results The final analysis involved 84 patients (31 males; mean age, 61.6±12.2years), of whom serum hs-cTnT levels were elevated in 58.3%. Renal impairment was independently associated with elevated hs-cTnT levels (OR 4.184, 95%CI 1.17 to 15.01, P = 0.028), and patients with elevated hs-cTnT levels were at significantly higher risk of HT, 3-month mortality and 3-month disability/mortality (all P≤0.029). After controlling for age, sex, hypertension, renal impairment and National Institutes of Health Stroke Scale score on admission, the risk of HT and 3-month mortality was, respectively, 4.0- and 5.5-fold higher in patients with elevated hs-cTnT levels than in patients with normal hs-cTnT levels. Conclusion Elevated hs-cTnT levels are independently associated with HT and 3-month mortality in AIS patients with RHD. These results with a small cohort should be verified and extended in large studies. PMID:26849554

Association of Elevated High Sensitivity Cardiac Troponin T(hs-cTnT) Levels with Hemorrhagic Transformation and 3-Month Mortality in Acute Ischemic Stroke Patients with Rheumatic Heart Disease in China.

PubMed

Liu, Junfeng; Wang, Deren; Xiong, Yao; Liu, Bian; Hao, Zilong; Tao, Wendan; Liu, Ming

2016-01-01

Elevated levels of high sensitivity cardiac troponin T (hs-cTnT) occur in a substantial proportion of patients with acute ischemic stroke (AIS) and can predict poor outcome and mortality after stroke. Whether elevated hs-cTnT levels can also predict hemorrhagic transformation (HT) or prognosis in AIS patients with rheumatic heart disease (RHD) remains unclear. Data from the Chengdu Stroke Registry on consecutive AIS patients with RHD admitted to West China Hospital within 1 month of stroke onset from October 2011 to February 2014 were examined. Clinico-demographic characteristics, HT, functional outcomes and stroke recurrence were compared between patients with elevated hs-cTnT levels (≥14 ng/L) and patients with normal hs-cTnT levels (<14 ng/L). The final analysis involved 84 patients (31 males; mean age, 61.6±12.2 years), of whom serum hs-cTnT levels were elevated in 58.3%. Renal impairment was independently associated with elevated hs-cTnT levels (OR 4.184, 95%CI 1.17 to 15.01, P = 0.028), and patients with elevated hs-cTnT levels were at significantly higher risk of HT, 3-month mortality and 3-month disability/mortality (all P≤0.029). After controlling for age, sex, hypertension, renal impairment and National Institutes of Health Stroke Scale score on admission, the risk of HT and 3-month mortality was, respectively, 4.0- and 5.5-fold higher in patients with elevated hs-cTnT levels than in patients with normal hs-cTnT levels. Elevated hs-cTnT levels are independently associated with HT and 3-month mortality in AIS patients with RHD. These results with a small cohort should be verified and extended in large studies.

The historical development of suicide mortality in Russia, 1870-2007.

PubMed

Jukkala, Tanya; Mäkinen, Ilkka Henrik; Stickley, Andrew

2015-01-01

Russia has one of the highest suicide mortality rates in the world. This study investigates the development of Russian suicide mortality over a longer time period in order to provide a context within which the contemporary high level might be better understood. Annual sex- and age-specific suicide-mortality data for Russia for the period 1870-2007 were studied, where available. Russian suicide mortality increased 11-fold over the period. Trends in male and female suicide developed similarly, although male suicide rates were consistently much higher. From the 1990s suicide has increased in a relative sense among the young (15-34), while the high suicide mortality among middle-aged males has reduced. Changes in Russian suicide mortality over the study period may be attributable to modernization processes.

High serum levels of caspase-cleaved cytokeratin-18 are associated with malignant middle cerebral artery infarction patient mortality.

PubMed

Lorente, Leonardo; Martín, María M; Pérez-Cejas, Antonia; Ramos, Luis; Argueso, Mónica; Solé-Violán, Jordi; Cáceres, Juan J; Jiménez, Alejandro; García-Marín, Victor

2018-03-24

There have been found apoptotic changes in brain tissue samples from humans after cerebral ischemia. Caspase-cleaved cytokeratin (CCCK)-18 could appears in blood during apoptosis. High circulating levels of CCCK-18 have been associated with a poor prognosis in patients with cerebral process, such as traumatic brain injury and spontaneous cerebral hemorrhage. However, they have not been explored in patients with ischemic stroke. Thus, the aim of this study was to determine whether there is an association between serum CCCK-18 levels and mortality in patients with severe malignant middle cerebral artery infarction (MMCAI). This was an observational, prospective and multicentre study. We included patients with severe MMCAI. We considered MMCAI as severe when Glasgow Coma Scale (GCS) was lower than 9. We measured serum CCCK-18 levels at the diagnosis moment of the severe MMCAI. We found that non-surviving severe MMCAI patients (n = 33) showed lower GCS and platelet count, and higher serum CCCK-18 levels than survivor ones (n = 33). We found an area under the curve (AUC) of serum CCCK-18 levels to predict 30-day mortality of 82% (95% CI = 71%-91%; p < 0.001). In the multiple logistic regression analysis was found that serum CCCK-18 levels were associated with 30-day mortality (OR = 1.023; 95% CI = 1.010-1.037; p = 0.001) after to control for platelet count and GCS. To our knowledge, this is the first series reporting data on serum CCCK-18 levels in ischemic stroke patients. The novel findings of our study were that non-surviving severe MMCAI patients had higher serum CCCK-18 levels than surviving patients, and that there is an association between high serum CCCK-18 levels and MMCAI patients mortality.

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.

Role of hormonal levels on hospital mortality for male patients with severe traumatic brain injury.

PubMed

Hohl, Alexandre; Ronsoni, Marcelo Fernando; Debona, Rodrigo; Ben, Juliana; Schwarzbold, Marcelo Liborio; Diaz, Alexandre Paim; Thais, Maria Emília Rodrigues de Oliveira; Linhares, Marcelo Neves; Latini, Alexandra; Prediger, Rui Daniel; Pizzol, Felipe Dal; Walz, Roger

2014-01-01

Changes in hormone blood levels during the acute phase of traumatic brain injury (TBI) have been described in the literature. The objective was to investigate the association among several hormones plasma levels in the acute phase of severe TBI and the hospital mortality rate of male patients. The independent association among plasma levels of TSH, LH, FSH, GH, free T4, cortisol, IGF-1 and total testosterone was measured 10 hours and 30 hours after severe TBI and the hospital mortality of 60 consecutive male patients was evaluated. At least one hormonal level abnormality was demonstrated in 3.6-73.1% of patients. The multiple logistic regressions showed a trend for an independent association among hospital mortality and normal or elevated LH levels measured at 10 hours (OR = 3.7, 95% CI = 0.8-16.3, p = 0.08) and 30 hours (OR = 3.9, 95% CI = 0.9-16.7, p = 0.06). Admission with abnormal pupils and a lower Glasgow Coma Score also were independently associated with hospital mortality. The hormonal changes are frequent in the acute phase of severe TBI. The hormones plasma levels, excepting the LH, are not highly consistent with the hospital mortality of male patients.

Prevalence of preoperative anemia, abnormal mean corpuscular volume and red cell distribution width among surgical patients in Singapore, and their influence on one year mortality

PubMed Central

Wee, Hide Elfrida; Ang, Ai Leen; Ranjakunalan, Niresh; Ong, Biauw Chi; Abdullah, Hairil Rizal

2017-01-01

Introduction Preoperative anemia and high red cell distribution width (RDW) are associated with higher perioperative mortality. Conditions with high RDW levels can be categorized by mean corpuscular volume (MCV). The relationship between RDW, anemia and MCV may explain causality between high RDW levels and outcomes. We aim to establish the prevalence of preoperative anemia and distribution of RDW and MCV among pre-surgical patients in Singapore. In addition, we aim to investigate the association between preoperative anemia, RDW and MCV levels with one-year mortality after surgery. Methods Retrospective review of 97,443 patients aged > = 18 years who underwent cardiac and non-cardiac surgeries under anesthesia between January 2012 and October 2016. Patient demographics, comorbidities, priority of surgery, surgical risk classification, perioperative transfusion, preoperative hemoglobin, RDW, MCV were collected. WHO anemia classification was used. High RDW was defined as >15.7%. Multivariate regression analyses were done to identify independent risk factors for mild or moderate/severe anemia and high RDW (>15.7). Multivariate cox regression analysis was done to determine the effect of preoperative anemia, abnormal RDW and MCV values on 1-year mortality. Results Our cohort comprised of 94.7% non-cardiac and 5.3% cardiac surgeries. 88.7% of patients achieved 1 year follow-up. Anemia prevalence was 27.8%—mild anemia 15.3%, moderate anemia 12.0% and severe anemia 0.5%. One-year mortality was 3.5%. Anemia increased with age in males, while in females, anemia was more prevalent between 18–49 years and > = 70 years. Most anemics were normocytic. Normocytosis and macrocytosis increased with age, while microcytosis decreased with age. Older age, male gender, higher ASA-PS score, anemia (mild- aHR 1.98; moderate/severe aHR 2.86), macrocytosis (aHR 1.47), high RDW (aHR 2.34), moderate-high risk surgery and emergency surgery were associated with higher hazard ratios of one-year mortality. Discussion Preoperative anemia is common. Anemia, macrocytosis and high RDW increases one year mortality. PMID:28777814

The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates.

PubMed

Masters, Ryan K; Reither, Eric N; Powers, Daniel A; Yang, Y Claire; Burger, Andrew E; Link, Bruce G

2013-10-01

To estimate the percentage of excess death for US Black and White men and women associated with high body mass, we examined the combined effects of age variation in the obesity-mortality relationship and cohort variation in age-specific obesity prevalence. We examined 19 National Health Interview Survey waves linked to individual National Death Index mortality records, 1986-2006, for age and cohort patterns in the population-level association between obesity and US adult mortality. The estimated percentage of adult deaths between 1986 and 2006 associated with overweight and obesity was 5.0% and 15.6% for Black and White men, and 26.8% and 21.7% for Black and White women, respectively. We found a substantially stronger association than previous research between obesity and mortality risk at older ages, and an increasing percentage of mortality attributable to obesity across birth cohorts. Previous research has likely underestimated obesity's impact on US mortality. Methods attentive to cohort variation in obesity prevalence and age variation in obesity's effect on mortality risk suggest that obesity significantly shapes US mortality levels, placing it at the forefront of concern for public health action.

Outlier identification in colorectal surgery should separate elective and nonelective service components.

PubMed

Byrne, Ben E; Mamidanna, Ravikrishna; Vincent, Charles A; Faiz, Omar D

2014-09-01

The identification of health care institutions with outlying outcomes is of great importance for reporting health care results and for quality improvement. Historically, elective surgical outcomes have received greater attention than nonelective results, although some studies have examined both. Differences in outlier identification between these patient groups have not been adequately explored. The aim of this study was to compare the identification of institutional outliers for mortality after elective and nonelective colorectal resection in England. This was a cohort study using routine administrative data. Ninety-day mortality was determined by using statutory records of death. Adjusted Trust-level mortality rates were calculated by using multiple logistic regression. High and low mortality outliers were identified and compared across funnel plots for elective and nonelective surgery. All English National Health Service Trusts providing colorectal surgery to an unrestricted patient population were studied. Adults admitted for colorectal surgery between April 2006 and March 2012 were included. Segmental colonic or rectal resection was performed. The primary outcome measured was 90-day mortality. Included were 195,118 patients, treated at 147 Trusts. Ninety-day mortality rates after elective and nonelective surgery were 4% and 18%. No unit with high outlying mortality for elective surgery was a high outlier for nonelective mortality and vice versa. Trust level, observed-to-expected mortality for elective and nonelective surgery, was moderately correlated (Spearman ρ = 0.50, p< 0.001). This study relied on administrative data and may be limited by potential flaws in the quality of coding of clinical information. Status as an institutional mortality outlier after elective and nonelective colorectal surgery was not closely related. Therefore, mortality rates should be reported for both patient cohorts separately. This would provide a broad picture of the state of colorectal services and help direct research and quality improvement activities.

Inequalities in mortality by socioeconomic factors and Roma ethnicity in the two biggest cities in Slovakia: a multilevel analysis.

PubMed

Rosicova, Katarina; Reijneveld, Sijmen A; Madarasova Geckova, Andrea; Stewart, Roy E; Rosic, Martin; Groothoff, Johan W; van Dijk, Jitse P

2015-11-05

The socioeconomic and ethnic composition of urban neighbourhoods may affect mortality, but evidence on Central European cities is lacking. The aim of this study was to assess the associations between socioeconomic and ethnic neighbourhood indicators and the mortality of individuals aged 20-64 years old in the two biggest cities of the Slovak Republic. We obtained data on the characteristics of neighbourhoods and districts (educational level, unemployment, income and share of Roma) and on individual mortality of residents aged 20-64 years old, for the two largest cities in the Slovak Republic (Bratislava and Kosice) in the period 2003-2005. We performed multilevel Poisson regression analyses adjusted for age and gender on the individual (mortality), neighbourhood (education level and share of Roma in population) and district levels (unemployment and income). The proportions of Roma and of low-educated residents were associated with mortality at the neighbourhood level in both cities. Mutually adjusted, only the association with the proportion of Roma remained in the model (risk ratio 1.02; 95 % confidence interval 1.01-1.04). The area indicators - high education, income and unemployment - were not associated with mortality. The proportion of Roma is associated with early mortality in the two biggest cities in the Slovak Republic.

Mortality of resprouting chaparral shrubs after a fire and during a record drought: physiological mechanisms and demographic consequences.

PubMed

Pratt, R Brandon; Jacobsen, Anna L; Ramirez, Aaron R; Helms, Anjel M; Traugh, Courtney A; Tobin, Michael F; Heffner, Marcus S; Davis, Stephen D

2014-03-01

We examined postfire regeneration of chaparral shrubs during an intense drought. This study focused on the demography and physiology of shrub species that resprout from a basal lignotuber following fire. We found significant levels of resprout mortality when intense drought occurred in the year following fire during the period of shrub recovery. Three of the seven sampled resprouting species had the greatest or near greatest levels of mortality ever recorded when compared to previous studies. Most shrub mortality occurred during the drought after individuals had resprouted (i.e. individuals survived fire, resprouted and then subsequently died). Physiological measurements of species with high mortality suggested that resprout stems were highly embolized and xylem hydraulic conductivities were close to zero during the peak of the drought. In addition, lignotubers of two of the three species experiencing high mortality were depleted of starch. Population densities of most shrub species declined after the drought compared with their prefire levels, with the exception of one drought tolerant obligate seeding species. Resprouting shrub species may deplete their carbohydrate reserves during the resprouting process, making them particularly vulnerable to drought because of the need to transpire water to acquire the CO2 that is used to supply energy to a large respiring root system. Drought appears to interact with fire by altering postfire shrub recovery and altering species abundances and composition of chaparral communities. © 2013 John Wiley & Sons Ltd.

High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in Individuals Without Previous Cardiovascular Conditions: The CANHEART Study.

PubMed

Ko, Dennis T; Alter, David A; Guo, Helen; Koh, Maria; Lau, Geoffrey; Austin, Peter C; Booth, Gillian L; Hogg, William; Jackevicius, Cynthia A; Lee, Douglas S; Wijeysundera, Harindra C; Wilkins, John T; Tu, Jack V

2016-11-08

The prognostic importance of high-density lipoprotein cholesterol (HDL-C) as a specific risk factor for cardiovascular (CV) disease has been challenged by recent clinical trials and genetic studies. This study sought to reappraise the association of HDL-C level with CV and non-CV mortality using a "big data" approach. An observational cohort study was conducted using the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) dataset, which was created by linking together 17 different individual-level data sources. People were included if they were between 40 and 105 years old on January 1, 2008, living in Ontario, Canada, without previous CV conditions or severe comorbidities, and had an outpatient fasting cholesterol measurement in the year prior to the inception date. The primary outcome was cause-specific mortality. A total of 631,762 individuals were included. The mean age of our cohort was 57.2 years, 55.4% were women, and mean HDL-C level was 55.2 mg/dl. There were 17,952 deaths during a mean follow-up of 4.9 ± 0.4 years. The overall all-cause mortality rate was 8.1 per 1,000 person-years for men and 6.6 per 1,000 person-years for women. Individuals with lower HDL-C levels were more likely to have low incomes, unhealthy lifestyle, higher triglycerides levels, other cardiac risk factors, and medical comorbidities. Individuals with lower HDL-C levels were independently associated with higher risk of CV, cancer, and other mortality compared with individuals in the reference ranges of HDL-C levels. In addition, individuals with higher HDL levels (>70 mg/dl in men, >90 mg/dl in women) had increased hazard of non-CV mortality. Complex associations exist between HDL-C levels and sociodemographic, lifestyle, comorbidity factors, and mortality. HDL-C level is unlikely to represent a CV-specific risk factor given similarities in its associations with non-CV outcomes. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Blood Pressure Levels and Mortality Risk among Hemodialysis Patients: Results from the Dialysis Outcomes and Practice Patterns Study

PubMed Central

Robinson, Bruce M.; Tong, Lin; Zhang, Jinyao; Wolfe, Robert A.; Goodkin, David A.; Greenwood, Roger N.; Kerr, Peter G.; Morgenstern, Hal; Li, Yun; Pisoni, Ronald L.; Saran, Rajiv; Tentori, Francesca; Akizawa, Tadao; Fukuhara, Shunichi; Port, Friedrich K.

2014-01-01

KDOQI practice guidelines recommend pre-dialysis blood pressure (BP) <140/90 mm Hg. However, most prior hemodialysis studies found elevated mortality with low, not high, systolic blood pressure (SBP), possibly due to unmeasured confounders affecting BP and mortality such as severity of comorbidities. To lessen this bias, we analyzed facility-level BP practices, relating patient-level survival to the fraction of patients in BP categories at each dialysis facility in Cox regression models adjusted for patient and facility characteristics. Analyses included 24,525 patients in the Dialysis Outcomes and Practice Patterns Study. Compared with pre-dialysis SBP 130–159 mm Hg, mortality was 13% higher in facilities with 20% more patients at SBP 110–129 mm Hg and 16% higher in facilities with 20% more patients at SBP ≥160 mm Hg. For patient-level SBP, mortality was elevated at low (<130 mm Hg), not high (up to ≥180 mm Hg) SBP. For pre-dialysis diastolic BP, mortality was lowest at 60–99 mm Hg, a wide range suggesting less chance to improve outcomes. Higher mortality at SBP <130 mm Hg is consistent with prior studies and may be due to excessive BP-lowering during dialysis. The lowest risk facility SBP range of 130–159 mm Hg indicates this range may be optimal, but may have been influenced by unmeasured facility practices. While additional study is needed, the findings contrast with KDOQI BP targets, and provide guidance on optimal BP range in absence of definitive clinical trial data. PMID:22718187

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.

Association between serum levels of caspase-cleaved cytokeratin-18 and early mortality in patients with severe spontaneous intracerebral hemorrhage.

PubMed

Lorente, Leonardo; Martín, María M; Pérez-Cejas, Antonia; Ramos, Luis; Argueso, Mónica; Solé-Violán, Jordi; Cáceres, Juan J; Jiménez, Alejandro; García-Marín, Victor

2018-04-16

Apoptotic changes after cerebral hemorrhage in brain samples of humans have been found. Caspase-cleaved cytokeratin (CCCK)-18 could be detected in the bloodstream during apoptosis. Higher circulating CCCK-18 levels have been associated with 6-month mortality in patients with basal ganglia hemorrhage. The aim of our study was to determine whether there is an association between serum CCCK-18 levels and early mortality of spontaneous intracerebral hemorrhage (SIH) patients. We performed an observational, prospective and multicentre study. There were included patients with severe SIH defined as Glasgow Coma Scale (GCS) lower than 9. We determined serum CCCK-18 levels at the severe SIH diagnosis moment. We found that non-surviving SIH patients (n = 46) showed lower GCS, and higher serum CCCK-18 levels and APACHE-II score than survivor ones (n = 54). In ROC analysis was found that the area under the curve of serum CCCK-18 levels for 30-day mortality prediction was 90% (95% CI 82-95%; p < 0.001). In the multiple logistic regression analysis, we found an association between serum CCCK-18 levels and 30-day mortality (OR 1.034; 95% CI 1.013-1.055; p = 0.002). The novel finding of our study was that there is an association between high serum CCCK-18 levels and 30-day mortality in severe SIH patients.

Effect of cross-level interaction between individual and neighborhood socioeconomic status on adult mortality rates.

PubMed

Winkleby, Marilyn; Cubbin, Catherine; Ahn, David

2006-12-01

We examined whether the influence of neighborhood-level socioeconomic status (SES) on mortality differed by individual-level SES. We used a population-based, mortality follow-up study of 4476 women and 3721 men, who were predominately non-HIspanic White and aged 25-74 years at baseline, from 82 neighborhoods in 4 California cities. Participants were surveyed between 1979 and 1990, and were followed until December 31, 2002 (1148 deaths; mean follow-up time 17.4 years). Neighborhood SES was defined by 5 census variables and was divided into 3 levels. Individual SES was defined by a composite of educational level and household income and was divided into tertiles. Death rates among women of low SES were highest in high-SES neighborhoods (1907/100000 person-years), lower in moderate-SES neighborhoods (1323), and lowest in low-SES neighborhoods (1128). Similar to women, rates among men of low SES were 1928, 1646, and 1590 in high-, moderate-, and low-SES neighborhoods, respectively. Differences were not explained by individual-level baseline risk factors. The disparities in mortality by neighborhood of residence among women and men of low SES demonstrate that they do not benefit from the higher quality of resources and knowledge generally associated with neighborhoods that have higher SES.

Small apolipoprotein(a) size predicts mortality in end-stage renal disease: The CHOICE study.

PubMed

Longenecker, J Craig; Klag, Michael J; Marcovina, Santica M; Powe, Neil R; Fink, Nancy E; Giaculli, Federico; Coresh, Josef

2002-11-26

The high mortality rate in end-stage renal disease has engendered interest in nontraditional atherosclerotic cardiovascular disease (ASCVD) risk factors that are more prevalent in end-stage renal disease, such as elevated lipoprotein(a) [Lp(a)] levels. Previous studies suggest that high Lp(a) levels and small apolipoprotein(a) [apo(a)] isoform size are associated with ASCVD, but none have investigated the relationship between Lp(a) level, apo(a) size, and mortality. An inception cohort of 864 incident dialysis patients was followed prospectively. Lp(a) was measured by an apo(a) size-independent ELISA and apo(a) size by Western blot after SDS-agarose gel electrophoresis. Comorbid conditions were determined by medical record review. Time to death was ascertained through dialysis clinic and Health Care Financing Administration follow-up. Survival analyses were performed with adjustment for baseline demographic, comorbid conditions, albumin, and lipids. Median follow-up was 33.7 months, with 346 deaths, 162 transplantations, and 10 losses to follow-up during 1999 person-years of follow-up. Cox regression analysis showed no association between Lp(a) level and mortality. However, an association between small apo(a) isoform size and mortality was found (hazard ratio, 1.36; P=0.004) after adjusting for age, race, sex, comorbidity score, cause of renal disease, and congestive heart failure. The association was somewhat lower in white patients (hazard ratio 1.34; P=0.019) than in black patients (1.69; P=0.04). No interaction by age, race, sex, diabetes, ASCVD, or Lp(a) level was present. Small apo(a) size, but not Lp(a) level, independently predicts total mortality risk in dialysis patients.

Alarmins and Clinical Outcomes After Major Abdominal Surgery-A Prospective Study.

PubMed

Máca, Jan; Burša, Filip; Ševčík, Pavel; Sklienka, Peter; Burda, Michal; Holub, Michal

2017-06-01

Tissue injury causing immune response is an integral part of surgical procedure. Evaluation of the degree of surgical trauma could help to improve postoperative management and determine the clinical outcomes. We analyzed serum levels of alarmins, including S100A5, S100A6, S100A8, S100A9, S100A11, and S100A12; high-mobility group box 1; and heat-shock protein 70, after elective major abdominal surgery (n = 82). Blood samples were collected for three consecutive days after surgery. The goals were to evaluate the relationships among the serum levels of alarmins and selected surgical characteristics and to test potential of alarmins to predict the clinical outcomes. Significant, positive correlations were found for high-mobility group box 1 with the length of surgery, blood loss, and intraoperative fluid intake for all three days of blood sampling. The protein S100A8 serum levels showed positive correlations with intensive care unit length of stay, 28-day and in-hospital mortality. The protein S100A12 serum levels had significant, positive correlations with intensive care unit length of stay, 28-day mortality, and in-hospital mortality. We did not find significant differences in alarmin levels between cancer and noncancer subjects. The high-mobility group box 1 serum levels reflect the degree of surgical injury, whereas proteins S100A8 and S100A12 might be considered good predictors of major abdominal surgery morbidity and mortality.

Serum creatinine and bilirubin predict renal failure and mortality in patients with spontaneous bacterial peritonitis: a retrospective study.

PubMed

Terg, Rubén; Gadano, Adrian; Cartier, Mariano; Casciato, Paola; Lucero, Romina; Muñoz, Alberto; Romero, Gustavo; Levi, Diana; Terg, Gonzalo; Miguez, Carlos; Abecasis, Raquel

2009-03-01

Patients with spontaneous bacterial peritonitis (SBP) are at a high risk for renal failure and death despite successful treatment of infection. Intravenous (IV) albumin administration combined with antibiotic treatment has been shown to significantly decrease these risks. Clinical evidence is lacking on which patients are appropriate candidates for albumin treatment. To retrospectively analyse the usefulness of serum creatinine and bilirubin levels in predicting renal failure and mortality of patients hospitalized for SBP. Between March 1995 and September 1998, 127 cirrhotic patients with SBP who had not received plasma expansion were evaluated. Eighty-one patients (64%) were classified as having a high risk for renal failure and mortality (serum bilirubin >4 mg/dl or serum creatinine >1 mg/dl) and 46 (36%) as having a low risk. At admission, 36.3% of all patients presented renal failure. Mortality during their hospitalization was 23% among those with a high risk and 6.5% among those with a low risk (P=0.01). Renal failure occurred in 23% of the high-risk patients, compared with 2.6% of the low-risk patients (P=0.006). The presence of hyponatraemia was significantly associated with higher mortality and renal failure in the high-risk group. Our retrospective review of patients with SBP suggests that serum bilirubin levels >4 mg and serum creatinine levels >1 mg/dl at the time of diagnosis represent significant risk factors for the clinical outcomes of patients with SBP. Patients without these risk factors may have a very low likelihood of death or renal failure.

Long-term mortality patterns in a residential cohort exposed to inorganic selenium in drinking water.

PubMed

Vinceti, Marco; Ballotari, Paola; Steinmaus, Craig; Malagoli, Carlotta; Luberto, Ferdinando; Malavolti, Marcella; Giorgi Rossi, Paolo

2016-10-01

Selenium (Se) is a metalloid of considerable nutritional and toxicological importance in humans. To date, limited epidemiologic evidence exists about the health effects of exposure to this trace element in drinking water. We investigated the relationship between Se levels in water and mortality in the municipality of Reggio Emilia, Italy, where high levels of Se were previously observed in drinking water. From 1974 to 1985, 2065 residents consumed drinking water with Se levels close to the European standard of 10μg/l, in its inorganic hexavalent form (selenate). Follow-up was conducted for the years 1986-2012 in Reggio Emilia and a lesser exposed comparison group of around 100,000 municipal residents, with comparable socio-demographic characteristics. Overall mortality from all causes, cardiovascular disease and cancer showed little evidence of differences. However, excess rate ratios were seen for some site specific cancers such as neoplasms of buccal cavity and pharynx, urinary tract, lymphohematopoietic tissue, melanoma, and two neurodegenerative diseases, Parkinson's disease and amyotrophic lateral sclerosis. Excess mortality in the exposed cohort for specific outcomes was concentrated in the first period of follow-up (1986-1997), and waned starting 10 years after the high exposure ended. We also found lower mortality from breast cancer in females during the first period of follow-up. When we extended the analysis to include residents who had been consuming the high-selenium drinking water for a shorter period, mortality rate ratios were also increased, but to a lesser extent. Overall, we found that the mortality patterns related to long-term exposure to inorganic hexavalent selenium through drinking water were elevated for several site-specific cancers and neurodegenerative disease. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Systemic inflammatory response and serum lipopolysaccharide levels predict multiple organ failure and death in alcoholic hepatitis.

PubMed

Michelena, Javier; Altamirano, José; Abraldes, Juan G; Affò, Silvia; Morales-Ibanez, Oriol; Sancho-Bru, Pau; Dominguez, Marlene; García-Pagán, Juan Carlos; Fernández, Javier; Arroyo, Vicente; Ginès, Pere; Louvet, Alexandre; Mathurin, Philippe; Mehal, Wajahat Z; Caballería, Juan; Bataller, Ramón

2015-09-01

Alcoholic hepatitis (AH) frequently progresses to multiple organ failure (MOF) and death. However, the driving factors are largely unknown. At admission, patients with AH often show criteria of systemic inflammatory response syndrome (SIRS) even in the absence of an infection. We hypothesize that the presence of SIRS may predispose to MOF and death. To test this hypothesis, we studied a cohort including 162 patients with biopsy-proven AH. The presence of SIRS and infections was assessed in all patients, and multivariate analyses identified variables independently associated with MOF and 90-day mortality. At admission, 32 (19.8%) patients were diagnosed with a bacterial infection, while 75 (46.3%) fulfilled SIRS criteria; 58 patients (35.8%) developed MOF during hospitalization. Short-term mortality was significantly higher among patients who developed MOF (62.1% versus 3.8%, P < 0.001). The presence of SIRS was a major predictor of MOF (odds ratio = 2.69, P = 0.025) and strongly correlated with mortality. Importantly, the course of patients with SIRS with and without infection was similar in terms of MOF development and short-term mortality. Finally, we sought to identify serum markers that differentiate SIRS with and without infection. We studied serum levels of high-sensitivity C-reactive protein, procalcitonin, and lipopolysaccharide at admission. All of them predicted mortality. Procalcitonin, but not high-sensitivity C-reactive protein, serum levels identified those patients with SIRS and infection. Lipopolysaccharide serum levels predicted MOF and the response to prednisolone. In the presence or absence of infections, SIRS is a major determinant of MOF and mortality in AH, and the mechanisms involved in the development of SIRS should be investigated; procalcitonin serum levels can help to identify patients with infection, and lipopolysaccharide levels may help to predict mortality and the response to steroids. © 2015 by the American Association for the Study of Liver Diseases.

Why Have Educational Disparities in Mortality Increased among White Women in the United States?

ERIC Educational Resources Information Center

Montez, Jennifer Karas; Zajacova, Anna

2013-01-01

Since the mid-1980s differences in mortality risk across education levels have widened considerably among non-Hispanic white women. For example, while mortality has "declined" among college-educated women, it has remained fairly "stable" among women with a high school credential or some college education and "increased" among women without a high…

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…

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

[Trends of cancer mortality rates in children and adolescents by level of marginalization in Mexico (1990-2009)].

PubMed

Escamilla-Santiago, Ricardo Antonio; Narro-Robles, José; Fajardo-Gutiérrez, Arturo; Rascón-Pacheco, Ramón Alberto; López-Cervantes, Malaquías

2012-01-01

To determine childhood and adolescent cancer mortality by the level of marginalization in Mexico. We used 1990-2009 death certificates estimating age-standardized rates. We calculated the Average Annual Percent Change (AAPC) using the Joinpoint Regression program available at the National Cancer Institute to assess tendency. Cancer mortality rates increased. AAPC were 0.87% male and 0.96% female children, and for adolescents were: males 1.22% and females 0.63%. The neoplasm pattern in infants was leukemia -central nervous system- lymphomas; and in adolescents it was leukemia -bone and articulation- lymphomas. The increase in cancer mortality corresponded to the high and highest marginated areas of each state. The increase in highly marginated areas may be partly explained by well-documented local registration of deaths. Further studies focusing on survival are required in order to better assess the effectiveness of cancer detection and medical treatment in our country.

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

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.

Effects of Racial Prejudice on the Health of Communities: A Multilevel Survival Analysis.

PubMed

Lee, Yeonjin; Muennig, Peter; Kawachi, Ichiro; Hatzenbuehler, Mark L

2015-11-01

We examined whether and how racial prejudice at both the individual and community levels contributes to mortality risk among majority as well as minority group members. We used data on racial attitudes from the General Social Survey (1993-2002) prospectively linked to mortality data from the National Death Index through 2008. Whites and Blacks living in communities with higher levels of racial prejudice were at an elevated risk of mortality, independent of individual and community sociodemographic characteristics and individually held racist beliefs (odds ratio = 1.24; 95% confidence interval = 1.04, 1.49). Living in a highly prejudiced community had similar harmful effects among both Blacks and Whites. Furthermore, the interaction observed between individual- and community-level racial prejudice indicated that respondents with higher levels of racial prejudice had lower survival rates if they lived in communities with low degrees of racial prejudice. Community-level social capital explained the relationship between community racial prejudice and mortality. Community-level racial prejudice may disrupt social capital, and reduced social capital is associated with increased mortality risk among both Whites and Blacks. Our results contribute to an emerging body of literature documenting the negative consequences of prejudice for population health.

Mortality in a complete 4-year follow up of 85-year-old residents of Leiden, classified by serum level of thyrotropin and thyroxine.

PubMed

Singer, Richard B

2006-01-01

The authors of the source article emphasize the clinical tendency to screen for, detect and treat for thyroid dysfunction in very elderly patients, in which it is a fairly common disorder, often with occult or no symptoms. Published evidence is conflicting on the benefit, if any, of such a program. Accordingly, they devised a prospective, population-based study to determine outcomes, including survival outcome, based on serum levels of thyroid-stimulating hormone (TSH) and thyroxine. A cohort of 558 subjects who had their 85th birthday between September 1997 and September 1999 was enrolled after consent of the subject and screening examination that included serum TSH and thyroxine levels. This represented a 79% sample of all 85-year-old residents of Leiden, the Netherlands. Follow up was complete for survival 4 years to the subject's 89th birthday or prior death, although 70 subjects refused the annual re-examination. Thyroid function, disability, cognitive function and number of chronic diseases were analyzed, in addition to mortality, through Cox regression and other statistical methods. In 67 subjects with abnormally high TSH (>4.8 mIU/ L), the mean annual mortality rate was derived as 64 deaths per 1000 per year. In the 491 subjects with normal TSH or low TSH (<0.3 mIU/L), the mean annual mortality rate was derived at 114 per 1000 per year. Laboratory evidence of hypothyroidism (initially low serum thyroxine) was found in only 37 of the 67 subjects. In the 13% of elderly subjects in Leiden with abnormally high serum TSH levels, the mean annual mortality rate was significantly lower than the mortality rate in the 87% of the elderly patients with normal or low serum TSH. The significance is based on 95% confidence levels of the Poisson distribution. The rate in the group with high TSH levels had 16 deaths in 264 person-years of follow up (FU). The majority with normal or low TSH levels had 193 deaths in 1698 person-years of FU.

Patients with high serum substance P levels previously to liver transplantation for hepatocellular carcinoma have higher risk of one-year liver transplantation mortality.

PubMed

Lorente, Leonardo; Rodriguez, Sergio T; Sanz, Pablo; Pérez-Cejas, Antonia; Padilla, Javier; Díaz, Dácil; González, Antonio; Martín, María M; Jiménez, Alejandro; Cerro, Purificación; Barrera, Manuel A

2018-04-20

Substance P is a tachykinins family member with inflammatory effects. Higher circulating levels of substance P have been found in patients with liver diseases and in patients with higher severity of liver diseases. The objective of this study was to determine whether serum levels of substance P levels, prior to liver transplantation (LT) for hepatocellular carcinoma (HCC) are associated with one-year LT mortality. In this observational retrospective unicenter study were included patients with LT for HCC. Serum levels of substance P were measured before LT. The end-point of the study was one-year mortality after LT. We found that one-year survivor patients ( n = 127) showed a lower age in liver donors ( p = 0.03) and lower levels of serum substance P levels ( p = 0.003) than non-survivor patients ( n = 15). Logistic regression analysis showed that serum levels of substance P (levels) were associated with one-year mortality (Odds Ratio = 1.011; 95% CI = 1.004-1.018; p = 0.002) controlling for the age of the LT donor. We believe that our study is the first study reporting data on circulating levels of substance P previously to LT for HCC, and an association between elevated levels of serum substance P before LT and mortality during the first year of LT.

Patients with high serum substance P levels previously to liver transplantation for hepatocellular carcinoma have higher risk of one-year liver transplantation mortality

PubMed Central

Lorente, Leonardo; Rodriguez, Sergio T.; Sanz, Pablo; Pérez-Cejas, Antonia; Padilla, Javier; Díaz, Dácil; González, Antonio; Martín, María M.; Jiménez, Alejandro; Cerro, Purificación; Barrera, Manuel A.

2018-01-01

Purpose Substance P is a tachykinins family member with inflammatory effects. Higher circulating levels of substance P have been found in patients with liver diseases and in patients with higher severity of liver diseases. The objective of this study was to determine whether serum levels of substance P levels, prior to liver transplantation (LT) for hepatocellular carcinoma (HCC) are associated with one-year LT mortality. Material and Methods In this observational retrospective unicenter study were included patients with LT for HCC. Serum levels of substance P were measured before LT. The end-point of the study was one-year mortality after LT. Results We found that one-year survivor patients (n = 127) showed a lower age in liver donors (p = 0.03) and lower levels of serum substance P levels (p = 0.003) than non-survivor patients (n = 15). Logistic regression analysis showed that serum levels of substance P (levels) were associated with one-year mortality (Odds Ratio = 1.011; 95% CI = 1.004–1.018; p = 0.002) controlling for the age of the LT donor. Conclusions We believe that our study is the first study reporting data on circulating levels of substance P previously to LT for HCC, and an association between elevated levels of serum substance P before LT and mortality during the first year of LT. PMID:29765559

The impact of development and population policies on fertility in India.

PubMed

Jain, A K

1985-01-01

This article examines the impact of development and population policies on fertility decline and regional variations in India during the 1970s. Indicators of development at the household level include female literacy and education, infant mortality, and poverty; at the village level they include availability of such social services as schools, medical facilities, and transportation and communication facilities. Multiple regression analysis of data aggregated at the state level demonstrates that conditions conducive to fertility decline include high adult female literacy and low infant mortality as indicators of social development, and high contraceptive use and, to a lesser extent, high female age at marriage as proximate determinants of fertility. There are reasons to believe that India's national family planning program contributed to the decline in fertility observed since the 1960s. The pace of fertility decline in the future will depend upon the pace of infant mortality decline, enhancement in female education, and improvements in family planning programs.

Changes in serum phosphate and potassium and their effects on mortality in malnourished African HIV-infected adults starting antiretroviral therapy and given vitamins and minerals in lipid-based nutritional supplements: secondary analysis from the Nutritional Support for African Adults Starting Antiretroviral Therapy (NUSTART) trial.

PubMed

Rehman, Andrea Mary; Woodd, Susannah Louise; Heimburger, Douglas Corbett; Koethe, John Robert; Friis, Henrik; PrayGod, George; Kasonka, Lackson; Kelly, Paul; Filteau, Suzanne

2017-03-01

Malnourished HIV-infected patients starting antiretroviral therapy (ART) are at high risk of early mortality, some of which may be attributed to altered electrolyte metabolism. We used data from a randomised controlled trial of electrolyte-enriched lipid-based nutritional supplements to assess the association of baseline and time-varying serum phosphate and K concentrations with mortality within the first 12 weeks after starting ART. Baseline phosphate results were available from 1764 patients and there were 9096 subsequent serum phosphate measurements, a median of 6 per patient. For serum K there were 1701 baseline and 8773 subsequent measures, a median of 6 per patient. Abnormally high or low serum phosphate was more common than high or low serum K. Controlling for other factors found to affect mortality in this cohort, low phosphate which had not changed from the previous time interval was associated with increased mortality; the same was not true for high phosphate or for high or low K. Both increases and decreases in serum electrolytes from the previous time interval were generally associated with increased mortality, particularly in the electrolyte-supplemented group. The results suggest that changes in serum electrolytes, largely irrespective of the starting point and the direction of change, were more strongly associated with mortality than were absolute electrolyte levels. Although K and phosphate are required for tissue deposition during recovery from malnutrition, further studies are needed to determine whether specific supplements exacerbate physiologically adverse shifts in electrolyte levels during nutritional rehabilitation of ill malnourished HIV patients.

Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran.

PubMed

Ahmadi, Ali; Khaledifar, Arsalan; Sajjadi, Homeira; Soori, Hamid

2014-11-27

Since no hospital-based, nationwide study has been yet conducted on the association between risk factors and in-hospital mortality due to myocardial infarction (MI) by educational level in Iran, the present study was conducted to investigate relationship between risk factors and in-hospital mortality due to MI by educational level. In this nationwide hospital-based, prospective analysis, follow-up duration was from definite diagnosis of MI to death. The cohort of the patients was defined in view of the date at diagnosis, hospitalization and the date at discharge (recovery or in-hospital death due to MI). 20750 patients hospitalized for newly diagnosed MI between April, 2012 and March, 2013 comprised sample size. Totally, 2511 deaths due to MI were obtained. The data on education level (four-level) were collected based on years of schooling. To determine in-hospital mortality rate and the associated factors with mortality, seven statistical models were developed using Cox proportional hazards models. Of the studied patients, 9611 (6.1%) had no education. in-hospital mortality rate was 8.36 (95% CI: 7.81-8.9) in women and 6.12 (95% CI: 5.83-6.43) in men per 100 person-years. This rate was 5.56 in under 65-year-old patients and 8.37 in over 65-year-old patients. This rate in the patients with no, primary, high school, and academic education was respectively 8.11, 6.11, 4.85 and 5.81 per 100 person-years. Being woman, chest pain prior to arriving in hospital, lack of thrombolytic therapy, right bundle branch block, ventricular tachycardia, smoking and ST-segment elevation myocardial infarction were significantly associated with increased hazard ratio (HR) of death. The adjusted HR of mortality was 1.27 (95% CI: 1.06-1.52), 0.93 (95% CI: 0.77-1.13), 0.72 (95% CI: 0.57-0.91) and 0.82 (95% CI: 0.66-1.01) in the patients with respectively illiterate, primary, secondary and high school education compared to academic education. A disparity was noted in post-MI mortality incidence in different educational levels in Iran. HR of death was higher in illiterate patients than in the patients with academic education. Identifying disparities per educational level could contribute to detecting the individuals at high risk, health promotion and care improvement by relevant planning and interventions in clinics and communities.

Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke: A Population-Based Nationwide Cohort Study From 2002 to 2013.

PubMed

Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In

2016-03-01

We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox proportional hazard models to test our hypothesis. A total of 798 subjects were included in our study. After adjusting for hospital volume of cerebrovascular surgical procedures as well as all for other potential confounders, the hazard ratio (HR) of 30-day mortality in low healthcare technology hospitals as compared to high healthcare technology hospitals was 2.583 (P < 0.001). We also found that, although the HR of 30-day mortality in low healthcare technology hospitals with high volume as compared to high healthcare technology hospitals with high volume was the highest (10.014, P < 0.0001), cerebrovascular surgical procedure patients treated in low healthcare technology hospitals had the highest 30-day mortality rate, irrespective of hospital volume. Although results of our study provide scientific evidence for a hospital volume/30-day mortality rate relationship in ischemic stroke patients who underwent cerebrovascular surgical procedures, our results also suggest that the level of hospital-based healthcare technology is associated with mortality rates independent of hospital volume. Given these results, further research into what components of hospital-based healthcare technology significantly impact mortality is warranted.

Community Characteristics and Mortality: The Relative Strength of Association of Different Community Characteristics

PubMed Central

Roberts, Eric; McCleary, Rachael; Buttorff, Christine; Gaskin, Darrell J.

2014-01-01

Objectives. We compared the strength of association between average 5-year county-level mortality rates and area-level measures, including air quality, sociodemographic characteristics, violence, and economic distress. Methods. We obtained mortality data from the National Vital Statistics System and linked it to socioeconomic and demographic data from the Census Bureau, air quality data, violent crime statistics, and loan delinquency data. We modeled 5-year average mortality rates (1998–2002) for all-cause, cancer, heart disease, stroke, and respiratory diseases as a function of county-level characteristics using ordinary least squares regression models. We limited analyses to counties with population of 100 000 or greater (n = 458). Results. Demographic and socioeconomic characteristics, particularly the percentage older than 65 years and near poor, were top predictors of all-cause and condition-specific mortality, as were a high concentration of construction and service workers. We found weaker associations for air quality, mortgage delinquencies, and violent crimes. Protective characteristics included the percentage of Hispanics, Asians, and married residents. Conclusions. Multiple factors influence county-level mortality. Although county demographic and socioeconomic characteristics are important, there are independent, although weaker, associations of other environmental characteristics. Future studies should investigate these factors to better understand community mortality risk. PMID:25033152

A study of the combined effects of physical activity and air pollution on mortality in elderly urban residents: the Danish Diet, Cancer, and Health Cohort.

PubMed

Andersen, Zorana Jovanovic; de Nazelle, Audrey; Mendez, Michelle Ann; Garcia-Aymerich, Judith; Hertel, Ole; Tjønneland, Anne; Overvad, Kim; Raaschou-Nielsen, Ole; Nieuwenhuijsen, Mark J

2015-06-01

Physical activity reduces, whereas exposure to air pollution increases, the risk of premature mortality. Physical activity amplifies respiratory uptake and deposition of air pollutants in the lung, which may augment acute harmful effects of air pollution during exercise. We aimed to examine whether benefits of physical activity on mortality are moderated by long-term exposure to high air pollution levels in an urban setting. A total of 52,061 subjects (50-65 years of age) from the Danish Diet, Cancer, and Health cohort, living in Aarhus and Copenhagen, reported data on physical activity in 1993-1997 and were followed until 2010. High exposure to air pollution was defined as the upper 25th percentile of modeled nitrogen dioxide (NO2) levels at residential addresses. We associated participation in sports, cycling, gardening, and walking with total and cause-specific mortality by Cox regression, and introduced NO2 as an interaction term. In total, 5,534 subjects died: 2,864 from cancer, 1,285 from cardiovascular disease, 354 from respiratory disease, and 122 from diabetes. Significant inverse associations of participation in sports, cycling, and gardening with total, cardiovascular, and diabetes mortality were not modified by NO2. Reductions in respiratory mortality associated with cycling and gardening were more pronounced among participants with moderate/low NO2 [hazard ratio (HR) = 0.55; 95% CI: 0.42, 0.72 and 0.55; 95% CI: 0.41, 0.73, respectively] than with high NO2 exposure (HR = 0.77; 95% CI: 0.54, 1.11 and HR = 0.81; 95% CI: 0.55, 1.18, p-interaction = 0.09 and 0.02, respectively). In general, exposure to high levels of traffic-related air pollution did not modify associations, indicating beneficial effects of physical activity on mortality. These novel findings require replication in other study populations.

Housing, income inequality and child injury mortality in Europe: a cross-sectional study.

PubMed

Sengoelge, M; Hasselberg, M; Ormandy, D; Laflamme, L

2014-03-01

Child poverty rates are compared throughout Europe to monitor how countries are caring for their children. Child poverty reduction measures need to consider the importance of safe living environments for all children. In this study we investigate how European country-level economic disparity and housing conditions relate to one another, and whether they differentially correlate with child injury mortality. We used an ecological, cross-sectional study design of 26 European countries of which 20 high-income and 6 upper-middle-income. Compositional characteristics of the home and its surroundings were extracted from the 2006 European Union Income Social Inclusion and Living Conditions Database (n = 203,000). Mortality data of children aged 1-14 years were derived from the World Health Organization Mortality Database. The main outcome measure was age standardized cause-specific injury mortality rates analysed by income inequality and housing and neighbourhood conditions. Nine measures of housing and neighbourhood conditions highly differentiating European households at country level were clustered into three dimensions, labelled respectively housing, neighbourhood and economic household strain. Income inequality significantly and positively correlated with housing strain (r = 0.62, P = 0.001) and household economic strain (r = 0.42, P = 0.009) but not significantly with neighbourhood strain (r = 0.34, P = 0.087). Child injury mortality rates correlated strongly with both country-level income inequality and housing strain, with very small age-specific differences. In the European context housing, neighbourhood and household economic strains worsened with increasing levels of income inequality. Child injury mortality rates are strongly and positively associated with both income inequality and housing strain, suggesting that housing material conditions could play a role in the association between income inequality and child health. © 2013 John Wiley & Sons Ltd.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey.

PubMed

Fledderjohann, Jasmine; Vellakkal, Sukumar; Khan, Zaky; Ebrahim, Shah; Stuckler, David

2016-04-01

Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India's slow progress in improving childhood survival. Using rounds 2 and 3 (2002-08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states ('Empowered Action Groups'). Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories. Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states. © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey

PubMed Central

Fledderjohann, Jasmine; Vellakkal, Sukumar; Khan, Zaky; Ebrahim, Shah; Stuckler, David

2016-01-01

Abstract Background: Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India’s slow progress in improving childhood survival. Methods : Using rounds 2 and 3 (2002—08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states (‘Empowered Action Groups’). Results : Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories. Conclusions: Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states. PMID:27063607

Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis: A nationwide cohort study.

PubMed

Su, Hui-Hsien; Kao, Chia-Man; Lin, Yi-Chun; Lin, Yen-Chung; Kao, Chih-Chin; Chen, Hsi-Hsien; Hsu, Chih-Cheng; Chen, Kuan-Chou; Peng, Chiung-Chi; Wu, Mai-Szu

2017-10-01

Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1-0.3, 0.3-0.7, 0.7-1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50% were male, 13% were hepatitis B carriers, and 20% were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7-1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95% 1.07-1.20, p < 0.01), and adjusted HR was 1.18 (model 1, 95% CI 1.11-1.25), 1.21 (model 2, 95% CI 1.14-1.29, p < 0.01), 1.44 (model 3, 95% CI 1.06-1.96, p < 0.01), respectively. Sensitivity test showed that after excluding 14,899 patients with hepatitis B or C, or abnormal liver function, the highest level of TB associated with higher significant mortality was still robust. In our study, high TB level is associated with mortality in uremia patients undergoing long-term hemodialysis, but further studies of the different effects of unconjugated or conjugated bilirubin on hemodialysis patients are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

A study of the mortality of Cornish tin miners.

PubMed Central

Fox, A J; Goldlbatt, P; Kinlen, L J

1981-01-01

Increased mortality from cancer of the lung has been found in several studies of miners exposed to high levels of radioactivity in underground air. In view of their exposure to raised levels of radiation, we have studied the mortality of a group of men recorded as Cornish tin miners in 1939. Using occupational description, a crude classification of exposure was derived for these miners. The meaningfulness of this classification was supported by differences in mortality from silicosis and silicotuberculosis. A twofold excess of cancer of the lung was found for underground miners, while for other categories mortality from this cause was less than expected. This supports the findings of previous studies on exposure to radon and its daughters. An excess of cancer of the stomach was also observed among underground miners. PMID:7317301

Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data.

PubMed

Robinson, Mark; Shipton, Deborah; Walsh, David; Whyte, Bruce; McCartney, Gerry

2015-01-07

Regional differences in population levels of alcohol-related harm exist across Great Britain, but these are not entirely consistent with differences in population levels of alcohol consumption. This incongruence may be due to the use of self-report surveys to estimate consumption. Survey data are subject to various biases and typically produce consumption estimates much lower than those based on objective alcohol sales data. However, sales data have never been used to estimate regional consumption within Great Britain (GB). This ecological study uses alcohol retail sales data to provide novel insights into regional alcohol consumption in GB, and to explore the relationship between alcohol consumption and alcohol-related mortality. Alcohol sales estimates derived from electronic sales, delivery records and retail outlet sampling were obtained. The volume of pure alcohol sold was used to estimate per adult consumption, by market sector and drink type, across eleven GB regions in 2010-11. Alcohol-related mortality rates were calculated for the same regions and a cross-sectional correlation analysis between consumption and mortality was performed. Per adult consumption in northern England was above the GB average and characterised by high beer sales. A high level of consumption in South West England was driven by on-trade sales of cider and spirits and off-trade wine sales. Scottish regions had substantially higher spirits sales than elsewhere in GB, particularly through the off-trade. London had the lowest per adult consumption, attributable to lower off-trade sales across most drink types. Alcohol-related mortality was generally higher in regions with higher per adult consumption. The relationship was weakened by the South West and Central Scotland regions, which had the highest consumption levels, but discordantly low and very high alcohol-related mortality rates, respectively. This study provides support for the ecological relationship between alcohol-related mortality and alcohol consumption. The synthesis of knowledge from a combination of sales, survey and mortality data, as well as primary research studies, is key to ensuring that regional alcohol consumption, and its relationship with alcohol-related harms, is better understood.

Mortality in Asia.

PubMed

1981-01-01

Although the general trend in mortality between 1950 and 1975 in South and East Asia has been downward, there is considerable country-to-country variation in the rate of decline. In countries where combined economic, social, and political circumstances resulted in controlling the disease spectrum (e.g., China, Malaysia, Sri Lanka), mortality levels declined to those seen in low-mortality countries. In most of the large countries of the region however, mortality declined at a slower rate, even slowing down considerably in the 1970's while the death rates remained high (e.g., India, Bangladesh, Thailand, Philippines); this slowing down of mortality level is attributed essentially to the poverty-stricken masses of society which were not able to take advantage of social, technological, and health-promoting behavioral changes conducive to mortality decline. Infant mortality levels, although declining since 1950, followed the same dismal pattern of the general mortality level. The rate varies from less than 10/1000 live births (Japan) to more than 140/1000 (Bangladesh, Laos, Nepal). Generally, rural areas exhibited higher infant mortality than urban areas. The level of child mortality declines with increases in the mother's educational level in Bangladesh, India, Indonesia, Sri Lanka, and Thailand. The largest decline in child mortality occurs when at least 1 parent has secondary education. The premature retardation of mortality decline is caused by several factors: economic development, nutrition and food supply, provision and adequacy of health services, and demographic trends. The outlook for the year 2000 for most of Asia's countries will depend heavily on significant population increases. In most countries, particularly in South Asia, population is expected to increase by 75%, much of it in rural areas and among poorer socioeconomic groups. In view of this, Asia's health planners and policymakers will have to develop health policies which will strike a balance between costs and returns of curative vs. preventive strategies. Health services will have to continue dealing with infectious diseases and will have to be redistributed geographically. Investments in health programs will produce clear economic benefits and returns for society.

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.

Tree regeneration following drought- and insect-induced mortality in piñon-juniper woodlands.

PubMed

Redmond, Miranda D; Barger, Nichole N

2013-10-01

Widespread piñon (Pinus edulis) mortality occurred across the southwestern USA during 2002-2003 in response to drought and bark beetle infestations. Given the recent mortality and changes in regional climate over the past several decades, there is a keen interest in post-mortality regeneration dynamics in piñon-juniper woodlands. Here, we examined piñon and Utah juniper (Juniperus osteosperma) recruitment at 30 sites across southwestern Colorado, USA that spanned a gradient of adult piñon mortality levels (10-100%) to understand current regeneration dynamics. Piñon and juniper recruitment was greater at sites with more tree and shrub cover. Piñon recruitment was more strongly facilitated than juniper recruitment by trees and shrubs. New (post-mortality) piñon recruitment was negatively affected by recent mortality. However, mortality had no effect on piñon advanced regeneration (juveniles established pre-mortality) and did not shift juvenile piñon dominance. Our results highlight the importance of shrubs and juniper trees for the facilitation of piñon establishment and survival. Regardless of adult piñon mortality levels, areas with low tree and shrub cover may become increasingly juniper dominated as a result of the few suitable microsites for piñon establishment and survival. In areas with high piñon mortality and high tree and shrub cover, our results suggest that piñon is regenerating via advanced regeneration. © 2013 The Authors. New Phytologist © 2013 New Phytologist Trust.

Multiple resistance to acaricides in field populations of Rhipicephalus microplus from Rio Grande do Sul state, Southern Brazil.

PubMed

Klafke, Guilherme; Webster, Anelise; Dall Agnol, Bruno; Pradel, Endrigo; Silva, Jeniffer; de La Canal, Luiz Henrique; Becker, Marcelo; Osório, Mateus Felipe; Mansson, Melanie; Barreto, Rafael; Scheffer, Ramon; Souza, Ugo Araújo; Corassini, Vivian Bamberg; Dos Santos, Julsan; Reck, José; Martins, João Ricardo

2017-01-01

Acaricide resistance is a major obstacle to the control of Rhipicephalus microplus. Historically, the indiscriminate use of chemical compounds has contributed to the selection of populations resistant to different classes of acaricides. Therefore, multiple acaricide resistance is an important threat to the chemical control of the cattle tick. To investigate the occurrence and extent of multiple resistance to acaricides in Southern Brazil we performed larval tests with cypermethrin, chlorpyriphos, amitraz, fipronil and ivermectin on 104 cattle tick field samples from different ranches in Rio Grande do Sul, between the years 2013 and 2015. Adult immersion tests with a commercial formulation mixture of chlorpyriphos and cypermethrin were performed on 75 samples. Four levels of resistance were established according to the mortality of larvae: Level I: mortality between 82% and 95%; Level II: mortality between 57% and 82%; Level III: mortality between 25% and 57%; and Level IV: mortality lower than 25%. Resistance to cypermethrin was detected in 98.08% of the samples evaluated, mostly at resistance level IV. The frequency of samples resistant to amitraz, chlorpyriphos, ivermectin and fipronil was 76.92%, 60.58%, 60.58% and 53.85% respectively. Multiple resistance to three or more compounds was found in 78.85% of the samples. The results obtained in this study are alarming and reveal a new scenario for the challenge of tick control using chemicals. This is an issue of high importance to cattle production systems where this tick is responsible for a high economic impact. Copyright © 2016 Elsevier GmbH. All rights reserved.

Reduced marine survival of hatchery-reared Atlantic salmon post-smolts exposed to aluminium and moderate acidification in freshwater

NASA Astrophysics Data System (ADS)

Thorstad, Eva B.; Uglem, Ingebrigt; Finstad, Bengt; Kroglund, Frode; Einarsdottir, Ingibjörg Eir; Kristensen, Torstein; Diserud, Ola; Arechavala-Lopez, Pablo; Mayer, Ian; Moore, Andy; Nilsen, Rune; Björnsson, Björn Thrandur; Økland, Finn

2013-06-01

Short-term Al-exposure and moderate acidification increased initial marine mortality in migrating post-smolts, and can thereby reduce viability of Atlantic salmon stocks. The delayed impact of short-term aluminium (Al) exposure on hatchery-reared Atlantic salmon smolt in moderately acidified freshwater (pH 5.88-5.98) was investigated during the first 37 km of the marine migration. Smolts were tagged with acoustic tags and exposed to low (28.3 ± 4.6 μg l-1 labile Al, 90 h) or high (48.5 ± 6.4 μg l-1 labile Al, 90 or 48 h) Al concentrations within the hatchery. Thereafter their movements, together with a control group, were monitored throughout the marine fjord. Al-exposure resulted in increased gill-Al and compromised hypoosmoregulatory capacity, as shown by elevated mortality in laboratory seawater challenge tests and reduced Na+, K+-ATPase activity levels. Further, Al-exposure resulted in decreased plasma concentrations of growth hormone (GH), while the insulin-like growth factor (IGF-I) was unaffected. There was a significant mortality in the 90 h high-Al group during exposure, and those surviving until release died during the first 3.6 km of the marine migration. Physiological stress and mortality were not only a result of the Al-concentrations, but also dependent on exposure duration, as shown by results from the 48 h high-Al group. Elevated mortality was not recorded in freshwater or after entering the sea for this group, which highly contrasts to the 100% mortality in the 90 h high-Al group, despite both groups having similarly high gill-Al levels. The low-Al group showed a 20% higher mortality compared to the control group during the first 10 km of the marine migration, but during the next 28 km, mortality rates did not differ. Hence, post-smolts surviving the first 10 km subsequently showed no differences in mortality compared to controls. At least one third of the mortality in both the low-Al and control groups were due to predation by marine fishes, indicating that the proximate cause for elevated mortality due to Al-exposure may have been predation. Migration speeds over 3.6, 9.6 or 37.1 km from the release site was not affected by Al-exposure.

Determinants of child nutrition and mortality in north-west Uganda.

PubMed

Vella, V; Tomkins, A; Borghesi, A; Migliori, G B; Adriko, B C; Crevatin, E

1992-01-01

An anthropometric survey of children aged 0-59 months in north-west Uganda in February-March 1987 indicated a high prevalence of stunting but little wasting. Use of unprotected water supplies in the dry season, prolonged breast-feeding, and age negatively affected nutrition; in contrast, parental education level improved nutrition. Mortality during the 12 months following the survey was higher among those who had low weight-for-age and weight-for-height, but children who had low height-for-age did not have higher mortality. Weight-for-age was the most sensitive predictor of mortality at specificities > 88%, while at lower specificity levels weight-for-height was the most sensitive. Children whose fathers' work was associated with the distillation of alcohol had a higher risk of mortality than other children. The lowest mortality was among children whose fathers were businessmen or who grew tobacco.

Plasma Levels of Fatty Acid-Binding Protein 4, Retinol-Binding Protein 4, High-Molecular Weight Adiponectin, and Cardiovascular Mortality among Men with Type 2 Diabetes: A 22-Year Prospective Study

PubMed Central

Liu, Gang; Ding, Ming; Chiuve, Stephanie E.; Rimm, Eric B.; Franks, Paul W.; Meigs, James B.; Hu, Frank B.; Sun, Qi

2016-01-01

Objective To examine select adipokines, including fatty acid-binding protein 4 (FABP4), retinol-binding protein 4 (RBP4), and high-molecular weight (HMW) adiponectin in relation to cardiovascular disease (CVD) mortality among patients with type 2 diabetes (T2D). Approach and Results Plasma levels of FABP4, RBP4, and HMW adiponectin were measured in 950 men with T2D in the Health Professionals Follow-up Study. After an average of 22 years of follow up (1993–2015), 580 deaths occurred, of whom 220 died of CVD. After multivariate adjustment for covariates, higher levels of FABP4 were significantly associated with a higher CVD mortality: comparing extreme tertiles, the hazard ratio (HR) and 95% confidence interval (CI) of CVD mortality was 1.78 (1.22, 2.59; P trend=0.001). A positive association was also observed for HMW adiponectin: the HR (95% CI) was 2.07 (1.42, 3.06; P trend=0.0002), comparing extreme tertiles, whereas higher RBP4 levels were non-significantly associated with a decreased CVD mortality with an HR (95% CI) of 0.73 (0.50, 1.07; P trend=0.09). A Mendelian randomization (MR) analysis suggested that the causal relationships of HMW adiponectin and RBP4 would be directionally opposite to those observed based on the biomarkers, although none of the MR associations achieved statistical significance. Conclusions These data suggest that higher levels of FABP4 and HMW adiponectin are associated with elevated CVD mortality among men with T2D. Biological mechanisms underlying these observations deserve elucidation, but the associations of HMW adiponectin may partially reflect altered adipose tissue functionality among T2D patients. PMID:27609367

Determinants of acute mortality of Hippodamia convergens (Coleoptera: Coccinellidae) to ultra-low volume permethrin used for mosquito management

PubMed Central

Preftakes, Collin J.; Bodin, Jennifer L.; Brown, Christopher R.; Piccolomini, Alyssa M.; Schleier, Jerome J.

2016-01-01

There are relatively few experimental studies and risk assessments of the effects on non-target insects from ultra-low volume (ULV) insecticides used for management of adult mosquitoes. Therefore, we evaluated factors that may influence the ability of an insect to intercept the insecticide at the time of application by using Hippodamia convergens (Coleoptera: Coccinellidae) in field bioassay experiments in 2011 and 2015. Treatment factors included different distances, two cage heights (ground-level and 1.5 m above ground) to the point of the application, and covered vs. uncovered cage faces (2015 only). Insecticides used included a water-based formulation (Aqua-Reslin®) and an oil-based formulation (Permanone® 30-30) of permethrin. Cage height was highly significant both years, with much less acute (i.e., short-term exposure) mortality at ground-level compared with 1.5 m. In 2011, acute mortality was less at ground-level (mean = 3.2%, median = 0%) compared to 1.5 m (mean = 85.2%, median = 100%). Cage type also was highly significant, with less mortality in covered cages compared to uncovered cages. Mortality by cage height and cage type was as follows: ground level, covered cage (mean = 2.8%, median = 0.1%); ground level, uncovered cage (mean = 41.9%, median = 9.6%); 1.5 m, covered cage (mean = 6.8%, median = 0%); 1.5 m, uncovered cage (mean = 83.7%, median = 100%). Results suggest that acute mortality to non-target insects may vary considerably based on their height and their ability to directly intercept the insecticide as the aerosol passes through the area being sprayed. PMID:27366655

Red oak decline and mortality by ecological land type in the Missouri ozarks

Treesearch

John M. Fan Kabrick; Stephen R. Shifley

2007-01-01

Oak decline, the precipitous mortality of mature oak trees, has been a chronic problem in xeric oak ecosystems and is reaching unprecedented levels in red oak group (Quercus section Lobatae) species in the Ozark Highlands. The high rates of mortality are leading to rapid changes in species composition, forest structure, and related changes in fire...

SOLAR ULTRAVIOLET EXPOSURE AND MORTALITY FROM SKIN TUMORS

PubMed Central

Berwick, Marianne; Pestak, Claire; Thomas, Nancy

2015-01-01

Solar UV radiation (UVR) exposure is clearly associated with increased mortality from nonmelanoma skin cancer—usually squamous cell carcinoma. However, the association with cutaneous melanoma is unclear from the evidence in ecologic studies and several analytic studies have conflicting results regarding the effect of high levels of intermittent UV exposure prior to diagnosis on mortality. Understanding this conundrum is critical to present coherent public health messages and to improve the mortality rates from melanoma. PMID:18348452

SOLAR ULTRAVIOLET EXPOSURE AND MORTALITY FROM SKIN TUMORS

PubMed Central

Berwick, Marianne; Pestak, Claire; Thomas, Nancy

2015-01-01

Solar UV radiation (UVR) exposure is clearly associated with increased mortality from nonmelanoma skin cancer—usually squamous cell carcinoma. However, the association with cutaneous melanoma is unclear from the evidence in ecologic studies and several analytic studies have conflicting results regarding the effect of high levels of intermittent UV exposure prior to diagnosis on mortality. Understanding this conundrum is critical to present coherent public health messages and to improve the mortality rates from melanoma. PMID:25207375

High levels of serum fibroblast growth factor (FGF)-23 are associated with increased mortality in long haemodialysis patients.

PubMed

Jean, Guillaume; Terrat, Jean-Claude; Vanel, Thierry; Hurot, Jean-Marc; Lorriaux, Christie; Mayor, Brice; Chazot, Charles

2009-09-01

Fibroblast growth factor (FGF)-23, a novel bone-derived phosphaturic factor involved in mineral metabolism, is increased in chronic kidney disease (CKD); in dialysis patients, it has been linked to increased mortality rates and vascular calcification (VC). The present investigation aimed to study the factors associated with elevated serum FGF-23 levels in patients treated with long haemodialysis (LHD) sessions and to determine whether a relationship exists between serum FGF-23 levels and patient survival. All patients treated in one haemodialysis centre from September 2006 were included in the study. Standard laboratory values, medical history, cardiovascular events and risk factors, medication and FGF-23 levels [ELISA (C-Term) Immutopics] were recorded. Patients received haemodialysis three times a week, on a 5- to 8-h schedule. Patient data were analysed according to FGF-23 quartiles. The effect of FGF-23 on the 2-year survival rate was assessed using the Cox proportional hazard model, adjusted for confounding variables and according to the serum phosphate tertiles. The study included 219 patients. Serum FGF-23 levels were high: 7060 +/- 13 500 RU/mL (median, 2740 RU/mL). In logistical regressions, only calcaemia (P = 0.002), phosphataemia (P = 0.008) and warfarin use (P = 0.04) were associated with the highest FGF-23 quartile. In the subgroup of patients with an estimated VC score, the third and fourth quartiles of the FGF-23 levels were associated with more severe VC. In multivariate linear regressions, only phosphataemia remained significantly correlated with FGF-23 (P = 0.04). The 2-year mortality rate was significantly higher for haemodialysis patients with serum FGF-23 levels in the higher quartile [P = 0.007; hazard ratio, 2.5 (1.3-5)] than in the first quartile, whereas within the phosphataemia tertiles, the lowest serum FGF-23 quartile was associated with lowered mortality. This study demonstrated a high level of circulating FGF-23 in LHD patients, despite infrequent hyperphosphataemia. However, phosphataemia is still the main factor correlating with serum FGF-23. The association of higher serum FGF-23 levels with mortality and VC, regardless of the serum phosphate levels, has thus been confirmed.

Effect of Socioeconomic Status on Mortality after Bacteremia in Working-Age Patients. A Danish Population-Based Cohort Study

PubMed Central

Koch, Kristoffer; Nørgaard, Mette; Schønheyder, Henrik Carl; Thomsen, Reimar Wernich; Søgaard, Mette

2013-01-01

Objectives To examine the effect of socioeconomic status (SES) on mortality in patients with bacteremia and the underlying factors that may mediate differences in mortality. Methods We conducted a population-based cohort study in two Danish regions. All patients 30 to 65 years of age with first time bacteremia from 2000 through 2008 were identified in a population-based microbiological bacteremia database (n = 8,653). Individual-level data on patients’ SES (educational level and personal income) and comorbid conditions were obtained from public and medical registries. We used Cox regression to examine mortality within 30 days after bacteremia with and without cumulative adjustment for potential mediators. Results Bacteremia patients of low SES were more likely to live alone and be unmarried than patients of high SES. They also had more pre-existing comorbidity, more substance abuse, more Staphylococcus aureus and nosocomial infections, and more admissions to small nonteaching hospitals. Overall, 1,374 patients (15.9%) died within 30 days of follow-up. Patients of low SES had consistently higher mortality after bacteremia than those of high SES crude hazard ratio for low vs. high education, 1.38 [95% confidence interval (CI), 1.18–1.61]; crude hazard ratio for low-income vs. high-income tertile, 1.58 [CI, 1.39–1.80]. Adjustment for differences in social support, pre-existing comorbidity, substance abuse, place of acquisition of the infection, and microbial agent substantially attenuated the effect of SES on mortality (adjusted hazard ratio for low vs. high education, 1.15 [95% CI, 0.98–1.36]; adjusted hazard ratio for low-income vs. high-income tertile, 1.29 [CI, 1.12–1.49]). Further adjustment for characteristics of the admitting hospital had minimal effect on observed mortality differences. Conclusions Low SES was strongly associated with increased 30-day mortality after bacteremia. Less social support, more pre-existing comorbidity, more substance abuse, and differences in place of acquisition and agent of infection appeared to mediate much of the observed disparities in mortality. PMID:23936145

Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study.

PubMed

Koch, Kristoffer; Nørgaard, Mette; Schønheyder, Henrik Carl; Thomsen, Reimar Wernich; Søgaard, Mette

2013-01-01

To examine the effect of socioeconomic status (SES) on mortality in patients with bacteremia and the underlying factors that may mediate differences in mortality. We conducted a population-based cohort study in two Danish regions. All patients 30 to 65 years of age with first time bacteremia from 2000 through 2008 were identified in a population-based microbiological bacteremia database (n = 8,653). Individual-level data on patients' SES (educational level and personal income) and comorbid conditions were obtained from public and medical registries. We used Cox regression to examine mortality within 30 days after bacteremia with and without cumulative adjustment for potential mediators. Bacteremia patients of low SES were more likely to live alone and be unmarried than patients of high SES. They also had more pre-existing comorbidity, more substance abuse, more Staphylococcus aureus and nosocomial infections, and more admissions to small nonteaching hospitals. Overall, 1,374 patients (15.9%) died within 30 days of follow-up. Patients of low SES had consistently higher mortality after bacteremia than those of high SES crude hazard ratio for low vs. high education, 1.38 [95% confidence interval (CI), 1.18-1.61]; crude hazard ratio for low-income vs. high-income tertile, 1.58 [CI, 1.39-1.80]. Adjustment for differences in social support, pre-existing comorbidity, substance abuse, place of acquisition of the infection, and microbial agent substantially attenuated the effect of SES on mortality (adjusted hazard ratio for low vs. high education, 1.15 [95% CI, 0.98-1.36]; adjusted hazard ratio for low-income vs. high-income tertile, 1.29 [CI, 1.12-1.49]). Further adjustment for characteristics of the admitting hospital had minimal effect on observed mortality differences. Low SES was strongly associated with increased 30-day mortality after bacteremia. Less social support, more pre-existing comorbidity, more substance abuse, and differences in place of acquisition and agent of infection appeared to mediate much of the observed disparities in mortality.

Effects of storage time on the motility, mortality and calcium levels of Atlantic salmon Salmo salar spermatozoa.

PubMed

Parodi, J; Guerra, G; Cuevas, M; Ramírez-Reveco, A; Romero, F

2017-04-01

This study estimates spermatozoa mortality, morphology, motility and intracellular calcium levels in Atlantic salmon Salmo salar milt after prolonged storage. Milt samples were preserved at 4° C for 25 days and then evaluated for mortality. Motility remained high for the first 3 days and the mortality was low during the first 5 days of storage. A decrease of >50% in calcium content was observed after 5 days of storage. When spermatozoa were activated, calcium levels increased >200% in relative fluorescence units (RFU); this rate of increase was lost when the samples were stored for extended periods of time and was only partially manifested in a zero calcium solution. The results suggest that in vitro storage of S. salar spermatozoa at 4° C for a period of 3 days preserves motility and limits mortality to levels similar to those of fresh spermatozoa. This method also maintains intracellular calcium storage critical for spermatozoa performance. © 2017 The Fisheries Society of the British Isles.

Modeling the Effects of Mortality on Sea Otter Populations

USGS Publications Warehouse

Bodkin, James L.; Ballachey, Brenda E.

2010-01-01

Conservation and management of sea otters can benefit from managing the magnitude and sex composition of human related mortality, including harvesting within sustainable levels. Using age and sex-specific reproduction and survival rates from field studies, we created matrix population models representing sea otter populations with growth rates of 1.005, 1.072, and 1.145, corresponding to stable, moderate, and rapid rates of change. In each modeled population, we incrementally imposed additional annual mortality over a 20-year period and calculated average annual rates of change (lambda). Additional mortality was applied to (1) males only, (2) at a 1:1 ratio of male to female, and (3) at a 3:1 ratio of male to female. Dependent pups (age 0-0.5) were excluded from the mortality. Maintaining a stable or slightly increasing population was largely dependent on (1) the magnitude of additional mortality, (2) the underlying rate of change in the population during the period of additional mortality, and (3) the extent that females were included in the additional mortality (due to a polygnous reproductive system where one male may breed with more than one female). In stable populations, additional mortality as high as 2.4 percent was sustainable if limited to males only, but was reduced to 1.2 percent when males and females were removed at ratios of 3:1 or 0.5 percent at ratios of 1:1. In moderate growth populations, additional mortality of 9.8 percent (male-only) and 15.0 percent (3:1 male to female) maximized the sustainable mortality about 3-10 ten-fold over the stable population levels. However, if additional mortality consists of males and females at equal proportions, the sustainable rate is 7.7 percent. In rapid growth populations, maximum sustainable levels of mortality as high as 27.3 percent were achieved when the ratio of additional mortality was 3:1 male to female. Although male-only mortality maximized annual harvest in stable populations, high male biased mortality in all simulations eventually led to low proportions of males, leading to instability in projected populations over time. Our findings identify the critical need to understand underlying rates of change that can be acquired only through frequent monitoring of managed populations. Models could be improved through better understanding of the effects of density and demographic and environmental stochasticity on sea otter vital rates. Although our primary objective was to provide information useful in managing harvests of sea otters, our findings have implications for the conservation and management of sea otter populations subjected to other sources of mortality that can be quantified, such as incidental, accidental, or illegal.

Modeling total cholesterol as predictor of mortality: the low-cholesterol paradox.

PubMed

Wesley, David; Cox, Hugh F

2011-01-01

Elevated total cholesterol is well-established as a risk factor for coronary artery disease and cardiovascular mortality. However, less attention is paid to the association between low cholesterol levels and mortality--the low cholesterol paradox. In this paper, restricted cubic splines (RCS) and complex survey methodology are used to show the low-cholesterol paradox is present in the laboratory, examination, and mortality follow-up data from the Third National Health and Nutrition Examination Survey (NHANES III). A series of Cox proportional hazard models, demonstrate that RCS are necessary to incorporate desired covariates while avoiding the use of categorical variables. Valid concerns regarding the accuracy of such predictive models are discussed. The one certain conclusion is that low cholesterol levels are markers for excess mortality, just as are high levels. Restricted cubic splines provide the necessary flexibility to demonstrate the U-shaped relationship between cholesterol and mortality without resorting to binning results. Cox PH models perform well at identifying associations between risk factors and outcomes of interest such as mortality. However, the predictions from such a model may not be as accurate as common statistics suggest and predictive models should be used with caution.

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.

Sphingolipids in Congenital Diaphragmatic Hernia; Results from an International Multicenter Study

PubMed Central

Snoek, Kitty G.; Reiss, Irwin K. M.; Tibboel, Jeroen; van Rosmalen, Joost; Capolupo, Irma; van Heijst, Arno; Schaible, Thomas; Post, Martin; Tibboel, Dick

2016-01-01

Background Congenital diaphragmatic hernia is a severe congenital anomaly with significant mortality and morbidity, for instance chronic lung disease. Sphingolipids have shown to be involved in lung injury, but their role in the pathophysiology of chronic lung disease has not been explored. We hypothesized that sphingolipid profiles in tracheal aspirates could play a role in predicting the mortality/ development of chronic lung disease in congenital diaphragmatic hernia patients. Furthermore, we hypothesized that sphingolipid profiles differ between ventilation modes; conventional mechanical ventilation versus high-frequency oscillation. Methods Sphingolipid levels in tracheal aspirates were determined at days 1, 3, 7 and 14 in 72 neonates with congenital diaphragmatic hernia, born after > 34 weeks gestation at four high-volume congenital diaphragmatic hernia centers. Data were collected within a multicenter trial of initial ventilation strategy (NTR 1310). Results 36 patients (50.0%) died or developed chronic lung disease, 34 patients (47.2%) by stratification were initially ventilated by conventional mechanical ventilation and 38 patients (52.8%) by high-frequency oscillation. Multivariable logistic regression analysis with correction for side of the defect, liver position and observed-to-expected lung-to-head ratio, showed that none of the changes in sphingolipid levels were significantly associated with mortality /development of chronic lung disease. At day 14, long-chain ceramides 18:1 and 24:0 were significantly elevated in patients initially ventilated by conventional mechanical ventilation compared to high-frequency oscillation. Conclusions We could not detect significant differences in temporal sphingolipid levels in congenital diaphragmatic hernia infants with mortality/development of chronic lung disease versus survivors without development of CLD. Elevated levels of ceramides 18:1 and 24:0 in the conventional mechanical ventilation group when compared to high-frequency oscillation could probably be explained by high peak inspiratory pressures and remodeling of the alveolar membrane. PMID:27159222

Patterns of coordination and clinical outcomes: a study of surgical services.

PubMed Central

Young, G J; Charns, M P; Desai, K; Khuri, S F; Forbes, M G; Henderson, W; Daley, J

1998-01-01

OBJECTIVE: To test the hypothesis that surgical services combining relatively high levels of feedback and programming approaches to the coordination of surgical staff would have better quality of care than surgical services using low levels of both coordination approaches as well as those surgical service using low levels of either coordination approach. STUDY SETTING: A study sample of 44 academically affiliated surgical services that are part of the Department of Veterans Affairs. STUDY DESIGN: In a cross-sectional analysis, surgical services were assigned to one of three groups based on their scores on feedback and programming coordination measures: high on both measures; high on one measure, low on the other; and low on both. Univariate and multivariate analyses were used to assess differences among these groups with respect to three quality indicators: risk-adjusted mortality, risk-adjusted morbidity, and staff perceptions of quality. DATA COLLECTION/EXTRACTION METHODS: Risk-adjusted mortality and morbidity came from an outcomes reporting program within the Department of Veterans Affairs that entails the prospective collection of clinical data from patient charts. Data on coordination practices and perceived quality came from a survey of surgical staff at each of the 44 participating surgical services. PRINCIPAL FINDINGS: The group of surgical services using high feedback and high programming had the best perceived quality. This group also had the lowest morbidity, but the difference was statistically significant with respect to only one of the two other groups: the group with low feedback and low programming. No significant group differences were found for mortality. CONCLUSIONS: Study results provide partial support for the hypothesis that high levels of feedback and programming should be combined for optimal quality of care. Study results also suggest that staff coordination is more important for improving morbidity than mortality in surgical services. PMID:9865218

Interaction of maternal protein and carbon monoxide on pup mortality in mice: implications for global infant mortality.

PubMed

Singh, Jarnail

2006-06-01

The United States Surgeon General declared 2005 as the "Year of Healthy Child." To improve the health of all children, we need to start before pregnancy, with their mothers. Unfortunately, protein deficiency in the diets of poor pregnant mothers in developing countries is widespread. Carbon monoxide (CO) pollution is serious public health problem in developed and developing countries. A two-way factorial experimental design was used. Mice were maintained on 27%, 16%, 8%, or 4% protein diets. Dams were exposed to 0 ppm (control), 65 ppm, or 125 ppm CO in air, in environmental chambers for 6 hr/day during the first 2 weeks of pregnancy. Controls were also subjected to environmental chamber conditions. Food and water were available at all times. Animals were allowed to deliver, and data on pup mortality was recorded. Litter size was not affected by CO exposure, but was directly related to the dietary protein levels. Pup weight was inversely related to the CO exposure level, and directly related to the dietary protein levels. Pup mortality on date of birth was increased by CO exposure and was inversely related to the dietary protein levels. Pup mortality at 1 week of age was increased by CO exposure and 55% of all pups died in 125 ppm CO exposed group. Pup mortality at 1 week of age was inversely related to dietary protein levels. All pups in the 4% dietary protein and in all concentrations of CO died. All pups in the 8% protein group and in all CO concentrations died except in 125 ppm CO group. Pup mortality in the 16% dietary protein group ranged from 14.8% in 0 ppm to 36.8% in 65 ppm CO groups. Pup mortality in the 27% dietary protein group ranged from 14.3% in the 0 ppm to 41.1% in the 125 ppm CO groups. DATA suggest that protein deficiency and CO exposure enhance pup mortality. The protein and CO also interact to increase pup mortality in 16% and 27% protein groups. Carbon monoxide exposure, along with protein deficiency during gestation, may be contributing factors for high rates of infant mortality in developing countries. The results of the study also suggest that un-vented combustion for heating and cooking, ambient pollution, and biomass smoke may have a major impact on the health of children worldwide; and may explain the causes of high infant mortality in poor countries and some sections of the United States population.

A Two-Center Randomized Trial of an Additional Early Dose of Measles Vaccine: Effects on Mortality and Measles Antibody Levels.

PubMed

Fisker, Ane B; Nebie, Eric; Schoeps, Anja; Martins, Cesario; Rodrigues, Amabelia; Zakane, Alphonse; Kagone, Moubassira; Byberg, Stine; Thysen, Sanne M; Tiendrebeogo, Justin; Coulibaly, Boubacar; Sankoh, Osman; Becher, Heiko; Whittle, Hilton C; van der Klis, Fiona R M; Benn, Christine S; Sie, Ali; Müller, Olaf; Aaby, Peter

2018-05-02

In addition to protecting against measles, measles vaccine (MV) may have beneficial nonspecific effects. We tested the effect of an additional early MV on mortality and measles antibody levels. Children aged 4-7 months at rural health and demographic surveillance sites in Burkina Faso and Guinea-Bissau were randomized 1:1 to an extra early standard dose of MV (Edmonston-Zagreb strain) or no extra MV 4 weeks after the third diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine. All children received routine MV at 9 months. We assessed mortality through home visits and compared mortality from enrollment to age 3 years using Cox proportional hazards models, censoring for subsequent nontrial MV. Subgroups of participants had blood sampled to assess measles antibody levels. Among 8309 children enrolled from 18 July 2012 to 3 December 2015, we registered 145 deaths (mortality rate: 16/1000 person-years). The mortality was lower than anticipated and did not differ by randomization group (hazard ratio, 1.05; 95% confidence interval, 0.75-1.46). At enrollment, 4% (16/447) of children in Burkina Faso and 21% (90/422) in Guinea-Bissau had protective measles antibody levels. By age 9 months, no measles-unvaccinated/-unexposed child had protective levels, while 92% (306/333) of early MV recipients had protective levels. At final follow-up, 98% (186/189) in the early MV group and 97% (196/202) in the control group had protective levels. Early MV did not reduce all-cause mortality. Most children were susceptible to measles infection at age 4-7 months and responded with high antibody levels to early MV. NCT01644721.

Relationship between fasting glucose levels and in-hospital mortality in Chinese patients with acute myocardial infarction and diabetes mellitus: a retrospective cohort study.

PubMed

Liang, Hao; Guo, Yi Chen; Chen, Li Ming; Li, Min; Han, Wei Zhong; Zhang, Xu; Jiang, Shi Liang

2016-08-02

Previous studies have demonstrated that elevated admission and fasting glucose (FG) is associated with worse outcomes in patients with acute myocardial infarction (AMI). However, the quantitative relationship between FG levels and in-hospital mortality in patients with AMI remains unknown. The aim of the study is to assess the prevalence of elevated FG levels in hospitalized Chinese patients with AMI and diabetes mellitus and to determine the quantitative relationship between FG levels and the in-hospital mortality as well as the optimal level of FG in patients with AMI and diabetes mellitus. A retrospective study was carried out in 1856 consecutive patients admitted for AMI and diabetes mellitus from 2002 to 2013. Clinical variables of baseline characteristics, in-hospital management and in-hospital adverse outcomes were recorded and compared among patients with different FG levels. Among all patients recruited, 993 patients (53.5 %) were found to have FG ≥100 mg/dL who exhibited a higher in-hospital mortality than those with FG < 100 mg/dL (P < 0.001). Although there was a high correlation between FG levels and in-hospital mortality in all patients (r = 0.830, P < 0.001), the relationship showed a J-curve configuration with an elevated mortality when FG was less than 80 mg/dL. Using multivariate logistic regression models, we identified that age, FG levels and Killip class of cardiac function were independent predictors of in-hospital mortality in AMI patients with diabetes mellitus. More than half of patients with AMI and diabetes mellitus have FG ≥100 mg/dL and the relationship between in-hospital mortality and FG level was a J-curve configuration. Both FG ≥ 100 mg/dL and FG <80 mg/dL were identified to be independent predictors of in-hospital mortality and thus the optimal FG level in AMI patients with diabetes mellitus appears to be 80-100 mg/dL.

Myeloperoxidase can differentiate between sepsis and non-infectious SIRS and predicts mortality in intensive care patients with SIRS.

PubMed

Schrijver, Irene T; Kemperman, Hans; Roest, Mark; Kesecioglu, Jozef; de Lange, Dylan W

2017-09-15

Systemic inflammatory response syndrome (SIRS) is a clinical syndrome following inflammation. Clinically, it is difficult to distinguish SIRS following an infection, i.e., sepsis, from non-infectious SIRS. Myeloperoxidase is a hemeprotein stored in the neutrophil azurophilic granules and is one of the main pillars of neutrophil attack. Therefore, we hypothesized that myeloperoxidase can differentiate between sepsis and non-infectious SIRS in patients with systemic inflammatory response syndrome in the intensive care unit (ICU). An observational single-center cohort study was conducted measuring myeloperoxidase in patients with SIRS in the first 48 h after admission. The outcomes were established using predefined definitions. Thirty-day mortality was retrospectively assessed. We found significantly higher levels of myeloperoxidase in patients with sepsis and septic shock compared to patients without sepsis (60 ng/ml versus 43 ng/ml, P = 0.002). Myeloperoxidase levels were related to 30-day mortality (P = 0.032), and high MPO levels on top of a high APACHE IV score further increased mortality risk. We show that myeloperoxidase is a potentially novel biomarker for sepsis in the ICU. Myeloperoxidase could eventually help in diagnosing sepsis and predicting mortality. However, more research is necessary to confirm our results.

Climate extremes promote fatal co-infections during canine distemper epidemics in African lions.

PubMed

Munson, Linda; Terio, Karen A; Kock, Richard; Mlengeya, Titus; Roelke, Melody E; Dubovi, Edward; Summers, Brian; Sinclair, Anthony R E; Packer, Craig

2008-06-25

Extreme climatic conditions may alter historic host-pathogen relationships and synchronize the temporal and spatial convergence of multiple infectious agents, triggering epidemics with far greater mortality than those due to single pathogens. Here we present the first data to clearly illustrate how climate extremes can promote a complex interplay between epidemic and endemic pathogens that are normally tolerated in isolation, but with co-infection, result in catastrophic mortality. A 1994 canine distemper virus (CDV) epidemic in Serengeti lions (Panthera leo) coincided with the death of a third of the population, and a second high-mortality CDV epidemic struck the nearby Ngorongoro Crater lion population in 2001. The extent of adult mortalities was unusual for CDV and prompted an investigation into contributing factors. Serological analyses indicated that at least five "silent" CDV epidemics swept through the same two lion populations between 1976 and 2006 without clinical signs or measurable mortality, indicating that CDV was not necessarily fatal. Clinical and pathology findings suggested that hemoparsitism was a major contributing factor during fatal epidemics. Using quantitative real-time PCR, we measured the magnitude of hemoparasite infections in these populations over 22 years and demonstrated significantly higher levels of Babesia during the 1994 and 2001 epidemics. Babesia levels correlated with mortalities and extent of CDV exposure within prides. The common event preceding the two high mortality CDV outbreaks was extreme drought conditions with wide-spread herbivore die-offs, most notably of Cape buffalo (Syncerus caffer). As a consequence of high tick numbers after the resumption of rains and heavy tick infestations of starving buffalo, the lions were infected by unusually high numbers of Babesia, infections that were magnified by the immunosuppressive effects of coincident CDV, leading to unprecedented mortality. Such mass mortality events may become increasingly common if climate extremes disrupt historic stable relationships between co-existing pathogens and their susceptible hosts.

Climate Extremes Promote Fatal Co-Infections during Canine Distemper Epidemics in African Lions

PubMed Central

Munson, Linda; Terio, Karen A.; Kock, Richard; Mlengeya, Titus; Roelke, Melody E.; Dubovi, Edward; Summers, Brian; Sinclair, Anthony R. E.; Packer, Craig

2008-01-01

Extreme climatic conditions may alter historic host-pathogen relationships and synchronize the temporal and spatial convergence of multiple infectious agents, triggering epidemics with far greater mortality than those due to single pathogens. Here we present the first data to clearly illustrate how climate extremes can promote a complex interplay between epidemic and endemic pathogens that are normally tolerated in isolation, but with co-infection, result in catastrophic mortality. A 1994 canine distemper virus (CDV) epidemic in Serengeti lions (Panthera leo) coincided with the death of a third of the population, and a second high-mortality CDV epidemic struck the nearby Ngorongoro Crater lion population in 2001. The extent of adult mortalities was unusual for CDV and prompted an investigation into contributing factors. Serological analyses indicated that at least five “silent” CDV epidemics swept through the same two lion populations between 1976 and 2006 without clinical signs or measurable mortality, indicating that CDV was not necessarily fatal. Clinical and pathology findings suggested that hemoparsitism was a major contributing factor during fatal epidemics. Using quantitative real-time PCR, we measured the magnitude of hemoparasite infections in these populations over 22 years and demonstrated significantly higher levels of Babesia during the 1994 and 2001 epidemics. Babesia levels correlated with mortalities and extent of CDV exposure within prides. The common event preceding the two high mortality CDV outbreaks was extreme drought conditions with wide-spread herbivore die-offs, most notably of Cape buffalo (Syncerus caffer). As a consequence of high tick numbers after the resumption of rains and heavy tick infestations of starving buffalo, the lions were infected by unusually high numbers of Babesia, infections that were magnified by the immunosuppressive effects of coincident CDV, leading to unprecedented mortality. Such mass mortality events may become increasingly common if climate extremes disrupt historic stable relationships between co-existing pathogens and their susceptible hosts. PMID:18575601

Educational inequalities in mortality of patients with atrial fibrillation in Norway.

PubMed

Akerkar, Rupali; Ebbing, Marta; Sulo, Gerhard; Ariansen, Inger; Igland, Jannicke; Tell, Grethe S; Egeland, Grace M

2017-04-01

We explored the educational gradient in mortality in atrial fibrillation (AF) patients. We prospectively followed patients hospitalized with AF as primary discharge diagnosis in the Cardiovascular Disease in Norway 2008-2012 project. The average length of follow-up was 2.4 years. Mortality by educational level was assessed by Cox proportional hazard models. Population attributable fractions (PAF) were calculated. Analyses stratified by age (≤75 and >75 years of age), and adjusted for age, gender, medical intervention, and Charlson Comorbidity Index. Of 42,138 AF patients, 16% died by end of 2012. Among younger patients, those with low education (≤10 years) had a HR of 2.3 (95% confidence interval 2.0, 2.6) for all-cause mortality relative to those with any college or university education. Similar results were observed for cardiovascular mortality. Disparities in mortality were greater among younger than older patients. A PAF of 35.9% (95% confidence interval 27.9, 43.1) was observed for an educational level of high school/vocational school or less versus higher education in younger patients. Increasing educational level associated with better prognosis suggesting underlying education-related behavioral and medical determinants of mortality. A considerable proportion of mortality within 5 years following hospital discharge could be prevented.

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.

Variation in intensive care unit utilization and mortality after blunt splenic injury.

PubMed

Kaufman, Elinore J; Wiebe, Douglas J; Martin, Niels D; Pascual, Jose L; Reilly, Patrick M; Holena, Daniel N

2016-06-15

Although trauma patients are frequently cared for in the intensive care unit (ICU), admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. We conducted a retrospective cohort study of patients treated for blunt splenic injuries from 2011-2014 at 30 level I and II Pennsylvania trauma centers. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman's rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement between high and low-ICU-utilization centers. Of 2587 patients with blunt splenic injuries, 63.9% (1654) were admitted to the ICU. Median injury severity score was 17 overall, 13 for non-ICU patients and 17 for ICU patients (P < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9%-87.3%. Risk-adjusted mortality rates ranged from 1.2%-9.6%. There was no correlation between observed-to-expected ratios for ICU utilization and mortality (Spearman's rho = -0.2595, P = 0.2103). Proportionately fewer ICU patients received critical care procedures at high-utilization centers than at low-utilization centers. Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Variation in ICU Utilization and Mortality After Blunt Splenic Injury

PubMed Central

Kaufman, Elinore J.; Wiebe, Douglas J.; Martin, Niels D.; Pascual, Jose L.; Reilly, Patrick M.; Holena, Daniel N.

2016-01-01

Background While trauma patients are frequently cared for in the ICU, admission triage criteria are unclear and may vary among providers and institutions. The benefits of close monitoring must be weighed against the economic and opportunity costs of an ICU admission. Materials and Methods We conducted a retrospective cohort study of patients treated for blunt splenic injuries at 30 level I and II Pennsylvania trauma centers, 2011–2014. We used multivariable logistic regression to assess the relationship between ICU admission and mortality, adjusting for patient characteristics, injury characteristics, and physiology. We calculated center-level observed-to-expected ratios for ICU utilization and mortality and evaluated correlations with Spearman’s rho. We compared the proportion of patients receiving critical care procedures, such as mechanical ventilation or central line placement, between high- and low-ICU-utilization centers. Results Of 2,587 patients with blunt splenic injuries, 63.9% (1,654) were admitted to the ICU. Median injury severity score (ISS) was 17 overall, 13 for non-ICU patients and 17 for ICU patients (p < 0.001). In multivariable logistic regression, ICU admission was not significantly associated with mortality. Center-level risk-adjusted ICU admission rates ranged from 17.9% to 87.3%. Risk-adjusted mortality rates ranged from 1.2% to 9.6%. There was no correlation between O:E ratios for ICU utilization and mortality (rs = −0.2595, p=0.2103). Proportionately fewer ICU patients at high-utilization centers received critical care procedures than at low-utilization centers. Conclusions Risk-adjusted ICU utilization rates for splenic trauma varied widely among trauma centers, with no clear relationship to mortality. Standardizing ICU admission criteria could improve resource utilization without increasing mortality. PMID:27363642

Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia.

PubMed

Andersen, Stine Bang; Baunbæk Egelund, Gertrud; Jensen, Andreas Vestergaard; Petersen, Pelle Trier; Rohde, Gernot; Ravn, Pernille

2017-04-01

C-reactive protein (CRP) is a well-known acute phase protein used to monitor the patient's response during treatment in infectious diseases. Mortality from Community-acquired Pneumonia (CAP) remains high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality levels. The aim of this study was to evaluate CRP on the 3rd day (CRP3) of hospitalization as a predictor for 30 days mortality. A retrospective multicentre cohort study of adult patients admitted with CAP at three Danish hospitals. Predictive associations of CRP3 (absolute levels and relative decline) and 30 days mortality were analysed using receiver operating characteristics and logistic regression. Eight hundred and fourteen patients were included and 90 (11%) died within 30 days. The area under the curve for CRP3 level and decline for predicting 30 days mortality were 0.64 (0.57-0.70) and 0.71 (0.65-0.76). Risk of death was increased in patients with CRP3 level >75 mg/l (OR 2.44; 95%CI 1.36-4.37) and in patients with a CRP3 decline <50% (OR 4.25; 95%CI 2.30-7.83). In the multivariate analysis, the highest mortality risk was seen in patients who failed to decline by 50%, irrespective of the actual level of CRP (OR 7.8; 95%CI 3.2-19.3). Mortality risk increased significantly according to CRP decline for all strata of CURB-65 score. CRP responses day 3 is a valuable predictor of 30 days mortality in hospitalized CAP patients. Failure to decline in CRP was associated with a poor prognosis irrespective of the actual level of CRP or CURB-65.

Health and wealth in Uzbekistan and sub-Saharan Africa in comparative perspective.

PubMed

Hohmann, Sophie; Garenne, Michel

2010-12-01

The study investigates the magnitude of differences in child and adult mortality by wealth in Uzbekistan, a former soviet country of Central Asia, and compares it with similar indicators from sub-Saharan Africa. Data were derived from Demographic and Health Surveys. An "Absolute Wealth Index" was built from data on goods owned by households and quality of housing, and scaled from 0 to 12. Wealth was distributed evenly in Uzbekistan, with a symmetric distribution around a mean of 5.5 modern goods. In sub-Saharan Africa, on the contrary, the wealth distribution had a lower mean (2.5) and was highly skewed towards the left, revealing a high proportion of very poor people. Adult and child mortality levels were lower in Uzbekistan. Despite these major differences, the relationships between mortality indicators and the wealth index were similar in the two cases. The magnitude of mortality differentials by wealth was of the same order in both cases, with gradients ranging from 2.5 to 1 for child mortality and 1.5 to 1 for adult mortality (poorest versus richest). However, mortality levels remained lower in Uzbekistan than in sub-Saharan Africa at the same level of wealth for both children and adults. A similar relationship was found between nutritional status and wealth index in both cases. On the contrary, there were no differences by wealth in use of health services and level of education in Uzbekistan, whereas wealth gradients were steep for the same variables in sub-Saharan Africa. The study suggests that mortality differentials were primarily due to nutritional status, and not to access and use of health services or to education. The discussion focuses on health and social policies during the colonial and post-colonial period that have produced these patterns. Copyright © 2010 Elsevier B.V. All rights reserved.

Clinical and demographic risk factors associated with mortality during early adulthood in a population-based cohort of childhood-onset type 1 diabetes.

PubMed

Cooper, M N; de Klerk, N H; Jones, T W; Davis, E A

2014-12-01

To calculate standardized mortality ratios and to assess the association between paediatric clinical factors and higher risk of mortality during early adulthood in a population-based cohort of subjects with Type 1 diabetes. Subjects with Type 1 diabetes were identified through the Western Australian Children's Diabetes Database and clinical data for those who reached 18 years of age (n = 1309) were extracted. An age- and sex-matched (without diabetes) comparison cohort (n = 6451) was obtained from the birth registry. Mortality records were obtained from the death registry. Participants were followed up until 31 January 2012. Associations of clinical factors (from clinic visits before 18 years of age) with mortality were assessed using Cox proportional hazard models. The standardized mortality ratio for all-cause mortality was 1.7 (95% CI 0.7-3.3) for male and 10.1 (95% CI 5.2-17.7) for female subjects with Type 1 diabetes (median age at end of study 25.6 years). The adjusted hazard ratio was 1.5 (95% CI 1.1-2.1) for a 1% increase in mean paediatric HbA1c level, 3.8 (95% CI 0.9-15.3) for four episodes of severe hypoglycaemia relative to zero episodes, and 6.21 (95% CI 1.4-28.4) for a low-level socio-economic background relative to a high-level background. People with childhood-onset Type 1 diabetes have higher mortality rates in early adulthood. At particularly high risk are women, those with a history of poor HbA1c levels, those with recurrent severe hypoglycaemia during paediatric management, and those from a low socio-economic background. These groups may benefit from intensified management during transition from paediatric to adult care facilities. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

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.

Serum levels of marine-derived n-3 fatty acids in Icelanders, Japanese, Koreans, and Americans - A descriptive epidemiologic study

PubMed Central

Sekikawa, Akira; Steingrimsdottir, Laufey; Ueshima, Hirotsugu; Shin, Chol; Curb, J. David; Evans, Rhobert W.; Hauksdottir, Alda M.; Kadota, Aya; Choo, Jina; Masaki, Kamal; Thorsson, Bolli; Launer, Lenore J.; Garcia, Melisa E.; Maegawa, Hiroshi; Willcox, Bradley J.; Eiriksdottir, Gudny; Fujiyoshi, Akira; Miura, Katsuyuki; Harris, Tamara B.; Kuller, Lewis H.; Gudnason, Vilmundur

2012-01-01

Summary In the 1990’s Iceland and Japan were known as countries with high fish consumption whereas coronary heart disease (CHD) mortality in Iceland was high and that in Japan was low among developed countries. We described recent data fish consumption and CHD mortality from publicly available data. We also measured CHD risk factors and serum levels of marine-derived n-3 and other fatty acids from population-based samples of 1,324 men in Iceland, Japan, South Korea, and the US. CHD mortality in men in Iceland was almost 3 times as high as that in Japan and South Korea. Generally a profile of CHD risk factors in Icelanders compared to Japanese was more favorable. Serum marine-derived n-3 fatty acids in Iceland were significantly lower than in Japan and South Korea but significantly higher than in the US. PMID:22658580

Cancer mortality rates in Appalachia: descriptive epidemiology and an approach to explaining differences in outcomes.

PubMed

Blackley, David; Behringer, Bruce; Zheng, Shimin

2012-08-01

Cancer is a leading cause of death in the Appalachian region of the United States. Existing studies compare regional mortality rates to those of the entire nation. We compare cancer mortality rates in Appalachia to those of the nation, with additional comparisons of Appalachian and non-Appalachian counties within the 13 states that contain the Appalachian region. Lung/bronchus, colorectal, female breast and cervical cancers, as well as all cancers combined, are included in analysis. Linear regression is used to identify independent associations between ecological socioeconomic and demographic variables and county-level cancer mortality outcomes. There is a pattern of high cancer mortality rates in the 13 states containing Appalachia compared to the rest of the United States. Mortality rate differences exist between Appalachian and non-Appalachian counties within the 13 states, but these are not consistent. Lung cancer is a major problem in Appalachia; most Appalachian counties within the 13 states have significantly higher mortality rates than in-state, non-Appalachian counterparts. Mortality rates from all cancers combined also appear to be worse overall within Appalachia, but part of this disparity is likely driven by lung cancer. Education and income are generally associated with cancer mortality, but differences in the strength and direction of these associations exist depending on location and cancer type. Improving high school graduation rates in Appalachia could result in a meaningful long term reduction in lung cancer mortality. The relative importance of household income level to cancer outcomes may be greater outside the Appalachian regions within these states.

Predicting Honeybee Colony Failure: Using the BEEHAVE Model to Simulate Colony Responses to Pesticides

PubMed Central

2015-01-01

To simulate effects of pesticides on different honeybee (Apis mellifera L.) life stages, we used the BEEHAVE model to explore how increased mortalities of larvae, in-hive workers, and foragers, as well as reduced egg-laying rate, could impact colony dynamics over multiple years. Stresses were applied for 30 days, both as multiples of the modeled control mortality and as set percentage daily mortalities to assess the sensitivity of the modeled colony both to small fluctuations in mortality and periods of low to very high daily mortality. These stresses simulate stylized exposure of the different life stages to nectar and pollen contaminated with pesticide for 30 days. Increasing adult bee mortality had a much greater impact on colony survival than mortality of bee larvae or reduction in egg laying rate. Importantly, the seasonal timing of the imposed mortality affected the magnitude of the impact at colony level. In line with the LD50, we propose a new index of “lethal imposed stress”: the LIS50 which indicates the level of stress on individuals that results in 50% colony mortality. This (or any LISx) is a comparative index for exploring the effects of different stressors at colony level in model simulations. While colony failure is not an acceptable protection goal, this index could be used to inform the setting of future regulatory protection goals. PMID:26444386

Effects of parasite pressure on parasite mortality and reproductive output in a rodent-flea system: inferring host defense trade-offs.

PubMed

Warburton, Elizabeth M; Kam, Michael; Bar-Shira, Enav; Friedman, Aharon; Khokhlova, Irina S; Koren, Lee; Asfur, Mustafa; Geffen, Eli; Kiefer, Daniel; Krasnov, Boris R; Degen, A Allan

2016-09-01

Evaluating host resistance via parasite fitness helps place host-parasite relationships within evolutionary and ecological contexts; however, few studies consider both these processes simultaneously. We investigated how different levels of parasite pressure affect parasite mortality and reproductive success in relationship to host defense efforts, using the rodent Gerbillus nanus and the flea Xenopsylla conformis as a host-parasite system. Fifteen immune-naïve male rodents were infested with 20, 50, or 100 fleas for four weeks. During this time number of new imagoes produced per adult flea (our flea reproductive output metric), flea mortality, and change in circulating anti-flea immunoglobulin G (our measure of adaptive immune defense) were monitored. Three hypotheses guided this work: (1) increasing parasite pressure would heighten host defenses; (2) parasite mortality would increase and parasite reproductive output would decrease with increasing investment in host defense; and (3) hosts under high parasite pressure could invest in behavioral and/or immune responses. We predicted that at high infestation levels (a) parasite mortality would increase; (b) flea reproductive output per individual would decrease; and (c) host circulating anti-flea antibody levels would increase. The hypotheses were partially supported. Flea mortality significantly increased and flea reproductive output significantly decreased as flea pressure increased. Host adaptive immune defense did not significantly change with increasing flea pressure. Therefore, we inferred that investment in host behavioral defense, either alone or in combination with density-dependent effects, may be more efficient at increasing flea mortality and decreasing flea reproductive output than antibody production during initial infestation in this system.

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

Maternal mortality in developing countries: challenges in scaling-up priority interventions.

PubMed

Prata, Ndola; Passano, Paige; Sreenivas, Amita; Gerdts, Caitlin Elisabeth

2010-03-01

Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when appropriate strategies are in place. Such achievable strategies need to include redoubled commitments on the part of local, national and global political bodies, concrete investments in high-yield and cost-effective interventions and the delegation of some clinical tasks from higher-level healthcare providers to mid- or lower-level healthcare providers, as well as improved health-management information systems.

Contextual socioeconomic factors associated with childhood mortality in Nigeria: a multilevel analysis.

PubMed

Adekanmbi, Victor T; Kandala, Ngianga-Bakwin; Stranges, Saverio; Uthman, Olalekan A

2015-11-01

Childhood mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is associated with childhood mortality beyond individual-level measures of socioeconomic status in Nigeria. Multilevel logistic regression models were applied to data on 31 482 under-five children whether alive or dead (level 1) nested within 896 neighbourhoods (level 2) from the 37 states in Nigeria (level 3) using the most recent 2013 Nigeria Demographic and Health Survey (DHS). More than 1 of every 10 children studied had died before reaching the age of 5 years (130/1000 live births). The following factors independently increased the odds of childhood mortality: male sex, mother's age at 15-24 years, uneducated mother or low maternal education attainment, decreasing household wealth index at individual level (level 1), residing in rural area and neighbourhoods with high poverty rate at level 2. There were significant neighbourhoods and states clustering in childhood mortality in Nigeria. The study provides evidence that individual-level and neighbourhood-level socioeconomic conditions are important correlates of childhood mortality in Nigeria. The findings of this study also highlight the need to implement public health prevention strategies at the individual level, as well as at the area/neighbourhood level. These strategies include the establishment of an effective publicly funded healthcare system, as well as health education and poverty alleviation programmes. 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.

Effects of Racial Prejudice on the Health of Communities: A Multilevel Survival Analysis

PubMed Central

Muennig, Peter; Kawachi, Ichiro; Hatzenbuehler, Mark L.

2015-01-01

Objectives. We examined whether and how racial prejudice at both the individual and community levels contributes to mortality risk among majority as well as minority group members. Methods. We used data on racial attitudes from the General Social Survey (1993–2002) prospectively linked to mortality data from the National Death Index through 2008. Results. Whites and Blacks living in communities with higher levels of racial prejudice were at an elevated risk of mortality, independent of individual and community sociodemographic characteristics and individually held racist beliefs (odds ratio = 1.24; 95% confidence interval = 1.04, 1.49). Living in a highly prejudiced community had similar harmful effects among both Blacks and Whites. Furthermore, the interaction observed between individual- and community-level racial prejudice indicated that respondents with higher levels of racial prejudice had lower survival rates if they lived in communities with low degrees of racial prejudice. Community-level social capital explained the relationship between community racial prejudice and mortality. Conclusions. Community-level racial prejudice may disrupt social capital, and reduced social capital is associated with increased mortality risk among both Whites and Blacks. Our results contribute to an emerging body of literature documenting the negative consequences of prejudice for population health. PMID:26378850

Social differentials in the decline of infant mortality in Sweden in the twentieth century: the impact of politics and policy.

PubMed

Burström, Bo

2003-01-01

This article describes some of the policies behind the decline of infant mortality in Sweden during the 20th century, from very high levels and large social differentials at the turn of the 19th century to one of the lowest levels in the world by 1950. Political commitment to reducing infant mortality and disparities between groups, a more equitable distribution of economic resources, and a successful combination of universal social and health policies most benefiting the least advantaged families and their children contributed to this favorable development.

Predictors of short-term mortality, cognitive and physical decline in older adults in northwest Russia: a population-based prospective cohort study.

PubMed

Turusheva, Anna; Frolova, Elena; Hegendoerfer, Eralda; Degryse, Jean-Marie

2017-08-01

The classical phenotype, accumulated deficit model and self-report approach of frailty were found not useful in older adults in northwest Russia. More research is needed to identify predictors of adverse outcomes in this population. The aim of this study is to identify predictors of mortality, autonomy and cognitive decline in a population that is characterized by a high cardiovascular morbidity and mortality rate. A population-based prospective cohort study of 611 community-dwelling individuals 65+. Anthropometry, medical history nutritional status were recorded. An evaluation of cognitive, physical and autonomy function, spirometry, and laboratory tests were performed. The total follow-up was 5 years. Multiple imputation, backward stepwise Cox regression analysis, C-statistic, risk reclassification analysis and the bootstrapping techniques were used to analyze the data. We found that the combination of increasing age, male sex, low physical function, low mid-arm muscle area, low forced expiratory volume in 1 s and anemia was associated with mortality for people 65+. The substitution of anemia with anemia + high level of C-reactive protein (hCRP) and the addition of high brain natriuretic peptide (hBNP) levels improved the classification of older persons at risk for mortality. The combination of low physical function, low mid-arm muscle area, low forced expiratory volume in 1 s, anemia with hCRP levels and hBNP identified older persons at a higher risk for mortality. These predictors may be used for the development of a prediction model to detect older people who are at risk for adverse health outcomes in northwest Russia.

Beverage-specific alcohol sales and violent mortality in Russia.

PubMed

Razvodovsky, Yury Evgeny

2010-01-01

High violent mortality rate in Russia and its profound fluctuation over recent decades have attracted considerable interest. A mounting body of evidence points to the binge drinking pattern as a potentially important contributor to the violent mortality crisis in Russia. In line with this evidence, we assume that higher level of vodka consumption in conjunction with binge drinking pattern results in close aggregate-level association between vodka sales and violent mortality rates in Russia. To test this hypothesis, trends in beverage-specific alcohol sales per capita and mortality rates from external causes in Russia between 1980 and 2005 were analyzed by means of ARIMA time-series analysis. Results of the analysis indicate that violent mortality rates tend to be more responsive to change in vodka sales per capita than to change in total level of alcohol sales. The analysis suggests that a 1-litre increase in vodka sales per capita would result in a 5% increase in violent mortality rate, an 11.3% increase in accidents and injuries mortality rate, a 9.2% increase in suicide rate, a 12.5% increase in homicide rate, and a 21.9% increase in fatal alcohol poisoning rate. The outcomes of this study provide support for the hypothesis that alcohol played a crucial role in the fluctuation in violent mortality rate in Russia in recent decades. Assuming that drinking vodka is usually associated with intoxication episodes, these findings provide additional evidence that the binge drinking pattern is an important determinant of the violent mortality crisis in Russia.

The role of red cell distribution width in the prognosis of patients with gastric cancer.

PubMed

Yazici, Pinar; Demir, Uygar; Bozkurt, Emre; Isil, Gurhan R; Mihmanli, Mehmet

2017-01-01

Although the red cell distribution width (RDW) has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge the prognostic value of RDW in gastric carcinoma has not been studied, so far. We aimed to investigate the role of red cell distribution width (RDW) in predicting prognosis in gastric cancer patients. All gastric cancer patients who underwent curative surgery (n= 172, 110M/62F) over a five-year study period were evaluated. Data on demographics, preoperative RDW levels, tumor characteristics (early stage: I and II, advanced stage: IIIA-B-C), disease-free (DFS) and overall survival (OS) were retrospectively reviewed. Patients were classified as high RDW group (RDW ≥ 16, n= 62) or low RDW group (RDW < 16, n= 110). Overall mortality and postoperative 60-day mortality in both groups were 55% and 14%, respectively. A borderline significant association between RDW (0.063) and mortality was noted. Preoperative RDW levels were significantly higher in patients with short-term mortality (17.9 ± 4.3 vs. 16 ± 3.2, p= 0.015). In high RDW group, the incidence of advanced gastric cancer was significantly higher (75 vs. 51%, p= 0.002), whereas DFS (0.035) and OS (p= 0.04) were lower. The frequency of advanced cancer was high in patients with high RDWvalues. High RDW values were strongly associated with short-term mortality although only a borderline relationship with overall survival was observed.

Maternal education and age: inequalities in neonatal death.

PubMed

Fonseca, Sandra Costa; Flores, Patricia Viana Guimarães; Camargo, Kenneth Rochel; Pinheiro, Rejane Sobrino; Coeli, Claudia Medina

2017-11-17

Evaluate the interaction between maternal age and education level in neonatal mortality, as well as investigate the temporal evolution of neonatal mortality in each stratum formed by the combination of these two risk factors. A nonconcurrent cohort study, resulting from a probabilistic relationship between the Mortality Information System and the Live Birth Information System. To investigate the risk of neonatal death we performed a logistic regression, with an odds ratio estimate for the combined variable of maternal education and age, as well as the evaluation of additive and multiplicative interaction. The neonatal mortality rate time series, according to maternal education and age, was estimated by the Joinpoint Regression program. The neonatal mortality rate in the period was 8.09‰ and it was higher in newborns of mothers with low education levels: 12.7‰ (adolescent mothers) and 12.4‰ (mother 35 years old or older). Low level of education, without the age effect, increased the chance of neonatal death by 25% (OR = 1.25, 95%CI 1.14-1.36). The isolated effect of age on neonatal death was higher for adolescent mothers (OR = 1.39, 95%CI 1.33-1.46) than for mothers aged ≥ 35 years (OR = 1.16, 95%CI 1.09-1.23). In the time-trend analysis, no age group of women with low education levels presented a reduction in the neonatal mortality rate for the period, as opposed to women with intermediate or high levels of education, where the reduction was significant, around 4% annually. Two more vulnerable groups - adolescents with low levels of education and older women with low levels of education - were identified in relation to the risk of neonatal death and inequality in reducing the mortality rate.

Maternal education and age: inequalities in neonatal death

PubMed Central

Fonseca, Sandra Costa; Flores, Patricia Viana Guimarães; Camargo, Kenneth Rochel; Pinheiro, Rejane Sobrino; Coeli, Claudia Medina

2017-01-01

ABSTRACT OBJECTIVE Evaluate the interaction between maternal age and education level in neonatal mortality, as well as investigate the temporal evolution of neonatal mortality in each stratum formed by the combination of these two risk factors. METHODS A nonconcurrent cohort study, resulting from a probabilistic relationship between the Mortality Information System and the Live Birth Information System. To investigate the risk of neonatal death we performed a logistic regression, with an odds ratio estimate for the combined variable of maternal education and age, as well as the evaluation of additive and multiplicative interaction. The neonatal mortality rate time series, according to maternal education and age, was estimated by the Joinpoint Regression program. RESULTS The neonatal mortality rate in the period was 8.09‰ and it was higher in newborns of mothers with low education levels: 12.7‰ (adolescent mothers) and 12.4‰ (mother 35 years old or older). Low level of education, without the age effect, increased the chance of neonatal death by 25% (OR = 1.25, 95%CI 1.14–1.36). The isolated effect of age on neonatal death was higher for adolescent mothers (OR = 1.39, 95%CI 1.33–1.46) than for mothers aged ≥ 35 years (OR = 1.16, 95%CI 1.09–1.23). In the time-trend analysis, no age group of women with low education levels presented a reduction in the neonatal mortality rate for the period, as opposed to women with intermediate or high levels of education, where the reduction was significant, around 4% annually. CONCLUSIONS Two more vulnerable groups – adolescents with low levels of education and older women with low levels of education – were identified in relation to the risk of neonatal death and inequality in reducing the mortality rate. PMID:29166446

Cancer incidence and mortality of Surinamese migrants in the Netherlands: in-between Surinamese and Dutch levels?

PubMed

Williams, Graciëlle; Mans, Dennis R A; Garssen, Joop; Visser, Otto; Kramer, Daniëlle; Kunst, Anton E

2013-07-01

It has been suggested that the cancer risk of migrants from low-income to high-income countries will converge toward the levels of their host country. However, comparisons with country of origin are mostly lacking. We compared cancer incidence and mortality rates of Surinamese migrants in the Netherlands to both native Dutch and Surinamese levels. Data covering the period 1995-2008 were obtained from Surinamese and Dutch national cancer registries and national cause-of-death registries. Cancer incidence was studied for 21 types of cancer and cancer mortality for nine types. We calculated age-standardized incidence/mortality ratios (SIR/SMR) for the Surinamese migrants and for Suriname, using the native Dutch population as reference. Significantly lower overall cancer incidence (SIR = 0.77, 95% CI = 0.69-0.84) and mortality rates (SMR = 0.63, 95% CI = 0.55-0.72) were found for Surinamese migrants compared to native Dutch. Generally, cancer risk was lower for most cancers (e.g., cancer of the breast, colon and rectum, lung), but higher for other cancers (e.g., cancer of the uterine cervix, liver). For most cancers, cancer risk of the Surinamese migrants was in-between Surinamese and native Dutch levels. Importantly, for many cancers, migrants' incidence and mortality rates had not closely approached native Dutch rates. For skin cancer, incidence levels for Surinamese migrants were lower than both Surinamese and native Dutch levels. The results suggest that cancer incidence and mortality rates of Surinamese migrants generally converge from Surinamese toward Dutch levels, though not for all cancer types. Overall, Surinamese migrants still had a much more favorable cancer profile than the native Dutch population.

Urbanization Level and Vulnerability to Heat-Related Mortality in Jiangsu Province, China

PubMed Central

Chen, Kai; Zhou, Lian; Chen, Xiaodong; Ma, Zongwei; Liu, Yang; Huang, Lei; Bi, Jun; Kinney, Patrick L.

2016-01-01

Background: Although adverse effects of high temperature on mortality have been studied extensively in urban areas, little is known of the heat–mortality associations outside of cities. Objective: We investigated whether heat–mortality associations differed between urban and nonurban areas and how urbanicity affected the vulnerability to heat-related mortality. Methods: We first analyzed heat-related mortality risk in each of 102 counties in Jiangsu Province, China, during 2009–2013 using a distributed-lag nonlinear model. The county-specific estimates were then pooled for more urban (percentage of urban population ≥ 57.11%) and less urban (percentage of urban population < 57.11%) counties using a Bayesian hierarchical model. To explain the spatial variation in associations by county, county-level characteristics affecting heat vulnerability were also examined. Results: We found that the overall mortality risk comparing the 99th vs. 75th percentiles of temperature was 1.43 [95% posterior intervals (PI): 1.36, 1.50] in less urban counties and 1.26 (95% PI: 1.23, 1.30) in more urban counties. The heat effects on cardiorespiratory mortality followed a similar pattern. Higher education level and prevalence of air conditioning were significantly associated with counties having lower risks, whereas percentage of elderly people was significantly associated with increased risks. Conclusion: Our findings reveal that nonurban areas have significant heat-related mortality risks in Jiangsu, China. These results suggest the need for enhanced adaptation planning in Chinese nonurban areas under a changing climate. Citation: Chen K, Zhou L, Chen X, Ma Z, Liu Y, Huang L, Bi J, Kinney PL. 2016. Urbanization level and vulnerability to heat-related mortality in Jiangsu Province, China. Environ Health Perspect 124:1863–1869; http://dx.doi.org/10.1289/EHP204 PMID:27152420

Urbanization Level and Vulnerability to Heat-Related Mortality in Jiangsu Province, China.

PubMed

Chen, Kai; Zhou, Lian; Chen, Xiaodong; Ma, Zongwei; Liu, Yang; Huang, Lei; Bi, Jun; Kinney, Patrick L

2016-12-01

Although adverse effects of high temperature on mortality have been studied extensively in urban areas, little is known of the heat-mortality associations outside of cities. We investigated whether heat-mortality associations differed between urban and nonurban areas and how urbanicity affected the vulnerability to heat-related mortality. We first analyzed heat-related mortality risk in each of 102 counties in Jiangsu Province, China, during 2009-2013 using a distributed-lag nonlinear model. The county-specific estimates were then pooled for more urban (percentage of urban population ≥ 57.11%) and less urban (percentage of urban population < 57.11%) counties using a Bayesian hierarchical model. To explain the spatial variation in associations by county, county-level characteristics affecting heat vulnerability were also examined. We found that the overall mortality risk comparing the 99th vs. 75th percentiles of temperature was 1.43 [95% posterior intervals (PI): 1.36, 1.50] in less urban counties and 1.26 (95% PI: 1.23, 1.30) in more urban counties. The heat effects on cardiorespiratory mortality followed a similar pattern. Higher education level and prevalence of air conditioning were significantly associated with counties having lower risks, whereas percentage of elderly people was significantly associated with increased risks. Our findings reveal that nonurban areas have significant heat-related mortality risks in Jiangsu, China. These results suggest the need for enhanced adaptation planning in Chinese nonurban areas under a changing climate. Citation: Chen K, Zhou L, Chen X, Ma Z, Liu Y, Huang L, Bi J, Kinney PL. 2016. Urbanization level and vulnerability to heat-related mortality in Jiangsu Province, China. Environ Health Perspect 124:1863-1869; http://dx.doi.org/10.1289/EHP204.

A geographical information system-based analysis of cancer mortality and population exposure to coal mining activities in West Virginia, United States of America.

PubMed

Hendryx, Michael; Fedorko, Evan; Anesetti-Rothermel, Andrew

2010-05-01

Cancer incidence and mortality rates are high in West Virginia compared to the rest of the United States of America. Previous research has suggested that exposure to activities of the coal mining industry may contribute to elevated cancer mortality, although exposure measures have been limited. This study tests alternative specifications of exposure to mining activity to determine whether a measure based on location of mines, processing plants, coal slurry impoundments and underground slurry injection sites relative to population levels is superior to a previously-reported measure of exposure based on tons mined at the county level, in the prediction of age-adjusted cancer mortality rates. To this end, we utilize two geographical information system (GIS) techniques--exploratory spatial data analysis and inverse distance mapping--to construct new statistical analyses. Total, respiratory and "other" age-adjusted cancer mortality rates in West Virginia were found to be more highly associated with the GIS-exposure measure than the tonnage measure, before and after statistical control for smoking rates. The superior performance of the GIS measure, based on where people in the state live relative to mining activity, suggests that activities of the industry contribute to cancer mortality. Further confirmation of observed phenomena is necessary with person-level studies, but the results add to the body of evidence that coal mining poses environmental risks to population health in West Virginia.

Changes in physical activity and all-cause mortality in COPD.

PubMed

Vaes, Anouk W; Garcia-Aymerich, Judith; Marott, Jacob L; Benet, Marta; Groenen, Miriam T J; Schnohr, Peter; Franssen, Frits M E; Vestbo, Jørgen; Wouters, Emiel F M; Lange, Peter; Spruit, Martijn A

2014-11-01

Little is known about changes in physical activity in subjects with chronic obstructive pulmonary disease (COPD) and its impact on mortality. Therefore, we aimed to study changes in physical activity in subjects with and without COPD and the impact of physical activity on mortality risk. Subjects from the Copenhagen City Heart Study with at least two consecutive examinations were selected. Each examination included a self-administered questionnaire and clinical examination. 1270 COPD subjects and 8734 subjects without COPD (forced expiratory volume in 1 s 67±18 and 91±15% predicted, respectively) were included. COPD subjects with moderate or high baseline physical activity who reported low physical activity level at follow-up had the highest hazard ratios of mortality (1.73 and 2.35, respectively; both p<0.001). In COPD subjects with low baseline physical activity, no differences were found in survival between unchanged or increased physical activity at follow-up. In addition, subjects without COPD with low physical activity at follow-up had the highest hazard ratio of mortality, irrespective of baseline physical activity level (p≤0.05). A decline to low physical activity at follow-up was associated with an increased mortality risk in subjects with and without COPD. These observational data suggest that it is important to assess and encourage physical activity in the earliest stages of COPD in order to maintain a physical activity level that is as high as possible, as this is associated with better prognosis. ©ERS 2014.

Cardiovascular Disease, Mortality Risk and Healthcare Costs by Lipoprotein(a) Levels According to Low Density Lipoprotein-Cholesterol Levels in Older High Risk Adults

PubMed Central

Zhao, Yanglu; Delaney, Joseph A; Quek, Ruben G.W.; Gardin, Julius M.; Hirsch, Calvin; Gandra, Shravanthi R.; Wong, Nathan D.

2017-01-01

Background The value of lipoprotein(a) [Lp(a)] for predicting cardiovascular disease (CVD) across low density lipoprotein-cholesterol (LDL-C) is uncertain. We examined in older high risk adults these associations with CVD events, mortality, and healthcare costs. Methods We included 3,251 high risk subjects (prior CVD, diabetes or 10-year Framingham CVD risk > 20%) aged ≥ 65 years from the Cardiovascular Health Study with LDL-C and Lp(a). We examined the relation of Lp(a) tertiles with incident CVD, coronary heart disease (CHD) and all-cause mortality within LDL-C strata (< 70 mg/dL, 70–99 mg/dL, 100–129 mg/dL, 130–159 mg/dL and ≥ 160 mg/dL). We also examined 1-year all-cause and CVD healthcare costs from Medicare claims. Results Over up a 22.5-year follow-up, higher Lp(a) levels predicted CVD and total mortality [both standardized hazard ratio (HR) =1.06, p<0.01] while higher LDL-C levels predicted higher CHD (standardized HR =1.09, p<0.01) but lower total mortality (standardized HR =0.94, p< 0.001). Adjusted HRs in the highest (vs. lowest) tertile of Lp(a) level were 1.95 (p=0.06) for CVD events and 2.68 (p=0.03) for CHD events when LDL-C was < 70 mg/dL. One year all-cause healthcare costs were increased for Lp(a) [$771 per SD of 56 ug/mL (p=0.03), $1,976 for Lp(a) 25–64 ug/mL vs. < 25 ug/mL (p=0.02) and $1648 for Lp(a) ≥ 65 ug/mL vs. < 25 ug/mL (p=0.054)], but not LDL-C. Conclusion In older high risk adults, increased Lp(a) levels were associated with higher CVD risk especially in those with LDL-C < 70 mg/dL and with higher healthcare costs. PMID:27177347

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.

Predictive Value of IL-8 for Sepsis and Severe Infections after Burn Injury - A Clinical Study

PubMed Central

Kraft, Robert; Herndon, David N; Finnerty, Celeste C; Cox, Robert A; Song, Juquan; Jeschke, Marc G

2014-01-01

The inflammatory response induced by burn injury contributes to increased incidence of infections, sepsis, organ failure, and mortality. Thus, monitoring post-burn inflammation is of paramount importance but so far there are no reliable biomarkers available to monitor and/or predict infectious complications after burn. As IL-8 is a major mediator for inflammatory responses, the aim of our study was to determine whether IL-8 expression can be used to predict post-burn sepsis, infections, and mortality other outcomes post-burn. Plasma cytokines, acute phase proteins, constitutive proteins, and hormones were analyzed during the first 60 days post injury from 468 pediatric burn patients. Demographics and clinical outcome variables (length of stay, infection, sepsis, multiorgan failure (MOF), and mortality were recorded. A cut-off level for IL-8 was determined using receiver operating characteristic (ROC) analysis. Statistical significance is set at (p<0.05). ROC analysis identified a cut-off level of 234 pg/ml for IL-8 for survival. Patients were grouped according to their average IL-8 levels relative to this cut off and stratified into high (H) (n=133) and low (L) (n=335) groups. In the L group, regression analysis revealed a significant predictive value of IL-8 to percent of total body surface area (TBSA) burned and incidence of MOF (p<0.001). In the H group IL-8 levels were able to predict sepsis (p<0.002). In the H group, elevated IL-8 was associated with increased inflammatory and acute phase responses compared to the L group (p<0.05). High levels of IL-8 correlated with increased MOF, sepsis, and mortality. These data suggest that serum levels of IL-8 may be a valid biomarker for monitoring sepsis, infections, and mortality in burn patients. PMID:25514427

Plasma concentration of diamine oxidase (DAO) predicts 1-month mortality of acute-on-chronic hepatitis B liver failure.

PubMed

Li, Feng-Cai; Li, Yue-Kai; Fan, Yu-Chen; Wang, Kai

2018-05-26

Acute-on-chronic hepatitis B liver failure (ACHBLF) has high 1-month mortality but it is difficult to predict. This present study was aimed to determine the diagnostic value of plasma diamine oxidase (DAO) in predicting the 1-month mortality of ACHBLF. A total of 106 consecutive newly diagnosed ACHBLF patients were retrospectively collected. The plasma expression of DAO was determined using enzyme-linked immunosorbent assay (ELISA). The plasma DAO level of survivals [14.0 (7.1; 26.5) ng/mL] was significantly lower than the nonsurvivals [58.6 (32.5; 121.3) ng/mL, P < .001]. The plasma DAO level, hepatic encephalopathy, spontaneous bacterial peritonitis and model for end-stage liver disease (MELD) score were independent factors associated with the 1-month mortality for ACHBLF. The cut-off point of 15.2 ng/mL for plasma DAO level with sensitivity of 95.45%, specificity of 62.5%, 22.6 for MELD score with sensitivity of 90.91%, specificity of 67.5%, 0.07 for DAO plus MELD with sensitivity of 87.88%, specificity of 80% were selected to discriminate 1-month morality of ACHBLF. Furthermore, DAO plus MELD score showed high AUROC than MELD score for predicting 1-month (0.916 vs. 0.843, P < .01). The plasma DAO level plus MELD > 0.07 predicts poor 1-month mortality of ACHBLF. Copyright © 2018 Elsevier B.V. All rights reserved.

The absence of birthweight paradox as a marker of disadvantages faced by low maternal education children.

PubMed

Guimarães, P V; Fonseca, S C; Pinheiro, R S; Aguiar, F P; Camargo, K R; Coeli, C M

2017-12-01

This study tested the hypothesis that the birthweight paradox would not be observed when assessing the effect of maternal education on neonatal mortality in the presence of socioeconomic inequality in access to health care. Non-concurrent cohort study. Passive follow-up of live-born infants using probabilistic record linkage of birth and death records for Rio de Janeiro (2004-2010; n = 1 445 367). Maternal age, birthweight and neonatal death were evaluated according to maternal educational level strata (<4, 4-11 and ≥12 years of study). We estimated the association between maternal educational level and neonatal mortality using logistical regression models adjusted for maternal age and birthweight (<2500 g and ≥2500 g). Neonatal mortality was 1.8 times higher in low educational level group compared with high educational level. We did not find birthweight-specific mortality curves crossing over in the stratum under 2500 g (birthweight paradox). The odds of a low birthweight child being born in facilities without neonatal intensive care units was about 70% higher in the group of low education when compared with mothers with high education. The absence of crossing birthweight-specific mortality curves may be a reason for concern about the severity of the disadvantages faced by low maternal education women. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Employment status and mortality in the context of high and low regional unemployment levels in Belgium (2001-2011): A test of the social norm hypothesis across educational levels.

PubMed

De Moortel, Deborah; Hagedoorn, Paulien; Vanroelen, Christophe; Gadeyne, Sylvie

2018-01-01

Because of compositional effects (more highly educated unemployed) and differences in the vulnerability towards the health consequences of unemployment (i.e. disappointment paradox hypothesis and/or status inconsistency for highly educated unemployed), it is argued that indicators of educational attainment need to be included when investigating the social norm of unemployment. Data from the 2001 census linked to register data from 2001-2011 are used, selecting all Belgian employed and unemployed between 30 and 59-year-old at time of the census. Poisson multilevel modelling was used to account for clustering of respondents within sub-districts. For individuals with low education levels, the relative difference in mortality rate ratios between the unemployed and employed is smallest in those regions where aggregate unemployment levels are high. For highly educated, this social norm effect was not found. This study suggest that the social norm effect is stronger for workers with low education levels, while highly educated workers suffer from disappointment and status inconsistency.

Employment status and mortality in the context of high and low regional unemployment levels in Belgium (2001–2011): A test of the social norm hypothesis across educational levels

PubMed Central

Hagedoorn, Paulien; Vanroelen, Christophe; Gadeyne, Sylvie

2018-01-01

Because of compositional effects (more highly educated unemployed) and differences in the vulnerability towards the health consequences of unemployment (i.e. disappointment paradox hypothesis and/or status inconsistency for highly educated unemployed), it is argued that indicators of educational attainment need to be included when investigating the social norm of unemployment. Data from the 2001 census linked to register data from 2001–2011 are used, selecting all Belgian employed and unemployed between 30 and 59-year-old at time of the census. Poisson multilevel modelling was used to account for clustering of respondents within sub-districts. For individuals with low education levels, the relative difference in mortality rate ratios between the unemployed and employed is smallest in those regions where aggregate unemployment levels are high. For highly educated, this social norm effect was not found. This study suggest that the social norm effect is stronger for workers with low education levels, while highly educated workers suffer from disappointment and status inconsistency. PMID:29420646

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.

Why do people need self-esteem? A theoretical and empirical review.

PubMed

Pyszczynski, Tom; Greenberg, Jeff; Solomon, Sheldon; Arndt, Jamie; Schimel, Jeff

2004-05-01

Terror management theory (TMT; J. Greenberg, T. Pyszczynski, & S. Solomon, 1986) posits that people are motivated to pursue positive self-evaluations because self-esteem provides a buffer against the omnipresent potential for anxiety engendered by the uniquely human awareness of mortality. Empirical evidence relevant to the theory is reviewed showing that high levels of self-esteem reduce anxiety and anxiety-related defensive behavior, reminders of one's mortality increase self-esteem striving and defense of self-esteem against threats in a variety of domains, high levels of self-esteem eliminate the effect of reminders of mortality on both self-esteem striving and the accessibility of death-related thoughts, and convincing people of the existence of an afterlife eliminates the effect of mortality salience on self-esteem striving. TMT is compared with other explanations for why people need self-esteem, and a critique of the most prominent of these, sociometer theory, is provided. ((c) 2004 APA, all rights reserved)

Neighborhood socio-environmental vulnerability and infant mortality in Hermosillo, Sonora.

PubMed

Lara-Valencia, Francisco; Álvarez-Hernández, Gerardo; Harlow, Siobán D; Denman, Catalina; García-Pérez, Hilda

2012-01-01

This paper explores the impact of contextual variables at the neighborhood level on a health marker in the city of Hermosillo, Mexico and discusses the importance of collaboration between planners and health professional to minimize the negative effect of contextual factors on urban health. Few studies in Mexico have assessed health outcomes at the intra-urban scale and their interaction with neighborhood-level contextual variables. Using spatial analysis and geographical information systems, the paper explores the association between infant mortality and an index of socio-environmental vulnerability used to measure urban contextual factors. Two high infant mortality clusters were detected within neighborhoods characterized by relatively good environmental conditions and one in a neighborhood with a poor environment. Our results show the clustering of high infant mortality areas and some association with built environment factors in Hermosillo. The results support the need to reconnect public health and urban planning as a way to create healthier environments in Mexican cities.

High blood glucose independent of pre-existing diabetic status predicts mortality in patients initiating peritoneal dialysis therapy.

PubMed

Chung, Sung Hee; Han, Dong Cheol; Noh, Hyunjin; Jeon, Jin Seok; Kwon, Soon Hyo; Lindholm, Bengt; Lee, Hi Bahl

2015-06-01

Poor glycemic control associates with increased mortality in diabetic (DM) dialysis patients, but it is less well established whether high blood glucose (BG) independent of pre-existing diabetic status associates with mortality in dialysis patients. We assessed factors affecting BG at the start of peritoneal dialysis (PD) and its mortality-predictive impact in Korean PD patients. In 174 PD patients (55 % males, 56 % DM), BG, nutritional status, comorbidity (CMD), and residual renal function (RRF) were assessed in conjunction with dialysis initiation. Determinants of BG and its association with mortality after a mean follow-up period of 30 ± 24 months were analyzed. On Cox proportional hazards analysis comprising all patients, old age, high CMD score, presence of protein energy wasting, and low serum albumin (Salb) concentration were independent predictors of mortality but not a high-BG level, while in patients without pre-existing diabetic status, high BG, together with old age and high CMD score, was an independent predictor of mortality. After adjustment for age, CMD score, and Salb, the risk ratio for mortality increased by 12 % per 1 mg/dL increase in BG in the non-DM patients. Patient survival in patients without pre-existing diabetic status with high BG did not differ from DM patients, but the survival of patients with high BG was significantly lower than in patients with low BG. In patients without pre-existing diabetic status, in multiple regression analysis, high BG at initiation of PD associated with high age, high body mass index, and low RRF. High blood glucose at initiation of PD associated with an increased mortality risk in PD patients without pre-existing diabetic status suggesting that blood glucose monitoring and surveillance of factors contributing to poor glycemic control are warranted in patients initiating PD therapy.

Mortality Attributable to Low Levels of Education in the United States.

PubMed

Krueger, Patrick M; Tran, Melanie K; Hummer, Robert A; Chang, Virginia W

2015-01-01

Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. We use the National Health Interview Survey data (1986-2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. If adults aged 25-85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality.

Mortality Attributable to Low Levels of Education in the United States

PubMed Central

Krueger, Patrick M.; Tran, Melanie K.; Hummer, Robert A.; Chang, Virginia W.

2015-01-01

Background Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. Methods We use the National Health Interview Survey data (1986–2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. Results If adults aged 25–85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Conclusions Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality. PMID:26153885

Elvis to Eminem: quantifying the price of fame through early mortality of European and North American rock and pop stars.

PubMed

Bellis, Mark A; Hennell, Tom; Lushey, Clare; Hughes, Karen; Tocque, Karen; Ashton, John R

2007-10-01

Rock and pop stars are frequently characterised as indulging in high-risk behaviours, with high-profile deaths amongst such musicians creating an impression of premature mortality. However, studies to date have not quantified differences between mortality experienced by such stars and general populations. This study measures survival rates of famous musicians (n = 1064) from their point of fame and compares them to matched general populations in North America and Europe. We describe and utilise a novel actuarial survival methodology which allows quantification of excess post-fame mortality in pop stars. Individuals from North America and Europe performing on any album in the All-Time Top 1000 albums from the music genres rock, punk, rap, R&B, electronica and new age. From 3 to 25 years post fame, both North American and European pop stars experience significantly higher mortality (more than 1.7 times) than demographically matched populations in the USA and UK, respectively. After 25 years of fame, relative mortality in European (but not North American) pop stars begins to return to population levels. Five-year post-fame survival rates suggest differential mortality between stars and general populations was greater in those reaching fame before 1980. Pop stars can suffer high levels of stress in environments where alcohol and drugs are widely available, leading to health-damaging risk behaviour. However, their behaviour can also influence would-be stars and devoted fans. Collaborations between health and music industries should focus on improving both pop star health and their image as role models to wider populations.

The joint contribution of neighborhood poverty and social integration to mortality risk in the United States.

PubMed

Marcus, Andrea Fleisch; Echeverria, Sandra E; Holland, Bart K; Abraido-Lanza, Ana F; Passannante, Marian R

2016-04-01

A well-established literature has shown that social integration strongly patterns health, including mortality risk. However, the extent to which living in high-poverty neighborhoods and having few social ties jointly pattern survival in the United States has not been examined. We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to mortality follow-up through 2006 and census-based neighborhood poverty. We fit Cox proportional hazards models to estimate associations between social integration and neighborhood poverty on all-cause mortality as independent predictors and in joint-effects models using the relative excess risk due to interaction to test for interaction on an additive scale. In the joint-effects model adjusting for age, gender, race/ ethnicity, and individual-level socioeconomic status, exposure to low social integration alone was associated with increased mortality risk (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.59) while living in an area of high poverty alone did not have a significant effect (HR: 1.10; 95% CI: 0.95-1.28) when compared with being jointly unexposed. Individuals simultaneously living in neighborhoods characterized by high poverty and having low levels of social integration had an increased risk of mortality (HR: 1.63; 95% CI: 1.35-1.96). However, relative excess risk due to interaction results were not statistically significant. Social integration remains an important determinant of mortality risk in the United States independent of neighborhood poverty. Copyright © 2016 Elsevier Inc. All rights reserved.

Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: results from the Euro-Peristat project

PubMed Central

Zeitlin, Jennifer; Mortensen, Laust; Cuttini, Marina; Lack, Nicholas; Nijhuis, Jan; Haidinger, Gerald; Blondel, Béatrice; Hindori-Mohangoo, Ashna D

2016-01-01

Background Stillbirth and neonatal mortality rates declined in Europe between 2004 and 2010. We hypothesised that declines might be greater for countries with higher mortality in 2004 and disproportionally affect very preterm infants at highest risk. Methods Data about live births, stillbirths and neonatal deaths by gestational age (GA) were collected using a common protocol by the Euro-Peristat project in 2004 and 2010. We analysed stillbirths at ≥28 weeks GA in 22 countries and live births ≥24 weeks GA for neonatal mortality in 18 countries. Per cent changes over time were assessed by calculating risk ratios (RR) for stillbirth, neonatal mortality and preterm birth rates in 2010 vs 2004. We used meta-analysis techniques to derive pooled RR using random-effects models overall, by GA subgroups and by mortality level in 2004. Results Between 2004 and 2010, stillbirths declined by 17% (95% CI 10% to 23%), with a range from 1% to 39% by country. Neonatal mortality declined by 29% (95% CI 23% to 35%) with a range from 9% to 67%. Preterm birth rates did not change: 0% (95% CI −3% to 3%). Mortality declines were of a similar magnitude at all GA; mortality levels in 2004 were not associated with RRs. Conclusions Stillbirths and neonatal deaths declined at all gestational ages in countries with both high and low levels of mortality in 2004. These results raise questions about how low-mortality countries achieve continued declines and highlight the importance of improving care across the GA spectrum. PMID:26719590

Socioeconomic status and survival among older adults with dementia and depression.

PubMed

Chen, Ruoling; Hu, Zhi; Wei, Li; Wilson, Kenneth

2014-06-01

People from lower socioeconomic groups have a higher risk of mortality. The impact of low socioeconomic status on survival among older adults with dementia and depression remains unclear. To investigate the association between socioeconomic status and mortality in people with dementia and late-life depression in China. Using Geriatric Mental Status - Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) we interviewed 2978 people aged ⩾60 years in Anhui, China. We characterised baseline socioeconomic status and risk factors and diagnosed 223 people with dementia and 128 with depression. All-cause mortality was followed up over 5.6 years. Individuals with dementia living in rural areas had a three times greater risk of mortality (multivariate adjusted hazard ratio (HR) = 2.96, 95% CI 1.45-6.04) than those in urban areas, and for those with depression the HR was 4.15 (95% CI 1.59-10.83). There were similar mortality rates when comparing people with dementia with low v. high levels of education, occupation and income, but individuals with depression with low v. high levels had non-significant increases in mortality of 11%, 50% and 55% respectively Older adults with dementia and depression living in rural China had a significantly higher risk of mortality than urban counterparts. Interventions should be implemented in rural areas to tackle survival inequality in dementia and depression. Royal College of Psychiatrists.

Litter Decomposition in Low and High Mortality Northern Red Oak Stands on Extremely Acidic Southwestern Pennsylvania Soils

Treesearch

Michael C. Demchik; William E. Sharpe

2004-01-01

Previous research has shown that decomposition of organic matter is slower in soils with high levels of soil acidity and available aluminum (Al). The objective of this experiment was to determine if differences in decomposition rates of northern red oak leaves occurred between extremely acidic and less acidic sites that also differed in oak mortality. Leaf litter from...

Long-Term Mortality Consequences of Childhood Family Context in Liaoning, China, 1749-1909

PubMed Central

Campbell, Cameron Dougall; Lee, James Z

2009-01-01

We examine the effects on adult and old age mortality of childhood living arrangements and other aspects of family context in early life. We focus on features of family context that have already been shown to be associated with infant or child mortality in historical and developing country populations. We apply discrete-time event-history analysis to longitudinal, individual-level household register data for a rural population in northeast China from the eighteenth and nineteenth centuries. Loss of a mother in childhood, a short preceding birth interval, and high maternal age were all associated with elevated mortality risks later in life. Such effects persist in a model with fixed effects that account for unobserved characteristics of the community and household. An important implication of these results is that in high mortality populations, features of early life family context that are associated with elevated infant and child mortality may also predict adverse mortality outcomes in adulthood. PMID:19278765

Rheumatoid factor and anti-citrullinated protein antibody positivity, but not level, are associated with increased mortality in patients with rheumatoid arthritis: results from two large independent cohorts.

PubMed

Humphreys, Jennifer H; van Nies, Jessica A B; Chipping, Jackie; Marshall, Tarnya; van der Helm-van Mil, Annette H M; Symmons, Deborah P M; Verstappen, Suzanne M M

2014-12-04

This study aimed to investigate rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) status and levels as predictors of mortality in two large cohorts of patients with early inflammatory arthritis (EIA). Data from the Norfolk Arthritis Register (NOAR) and Leiden Early Arthritis Clinic (EAC) cohorts were used. At baseline, patients had demographic data and smoking status recorded; RF, ACPA and inflammatory markers were measured in the local laboratories. Patients were flagged with national death registers until death or censor date. Antibody status was stratified as negative, low or high positive by RF and ACPA levels individually. In addition, patients were grouped as seronegative, RF positive, ACPA positive or double antibody (RF and ACPA) positive. Cox regression models explored associations between antibody status and mortality adjusting for age, sex, smoking status, inflammatory markers and year of enrolment. A total of 4962 patients were included, 64% were female. Median age at onset was 56 (NOAR) and 54 (EAC) years. In NOAR and EAC respectively, 35% and 42% of patients were ACPA/RF positive. When antibody status was stratified as negative, low or high positive, there were no consistent findings between the two cohorts. Double antibody positivity was associated with excess mortality in both cohorts compared to seronegative patients: NOAR and EAC respective adjusted HR (95% confidence interval) 1.35 (1.09 to 1.68) and 1.58 (1.16 to 2.15). Patients with EIA who are seropositive for both RF and ACPA have increased mortality compared to those who are single positive or seronegative. Antibody level in seropositive patients was not consistently associated with excess mortality.

Does the socioeconomic context explain both mortality and income inequality? Prospective register-based study of Norwegian regions

PubMed Central

2011-01-01

Background Studies from various countries have observed worse population health in geographical areas with more income inequality. The psychosocial interpretation of this association is that large income disparities are harmful to health because they generate relative deprivation and undermine social cohesion. An alternative explanation contends that the association between income inequality and ill health arises because the underlying social and economic structures will influence both the level of illness and disease and the size of income differences. This paper examines whether the observed association between mortality and income inequality in Norwegian regions can be accounted for by the socioeconomic characteristics of the regions. Methods Norwegian register data covering the entire population were utilised. An extensive set of contextual and individual predictors were included in multilevel Poisson regression analyses of mortality 1994-2003 among 1.6 millions individuals born 1929-63, distributed across 35 residential regions. Results Mean income, composition of economic branches, and percentage highly educated in the regions were clearly connected to the level of income inequality. These social and economic characteristics of the regions were also markedly related to regional mortality levels, after adjustment for population composition, i.e., the individual-level variables. Moreover, regional mortality was significantly higher in regions with larger income disparities. The regions' social and economic structure did not, however, account for the association between regional income inequality and mortality. A distinct independent effect of income inequality on mortality remained after adjustment for regional-level social and economic characteristics. Conclusions The results indicate that the broader socioeconomic context in Norwegian regions has a substantial impact both on mortality and on the level of income disparities. However, the results also suggest, in a way compatible with the psychosocial interpretation, that on top of the general socioeconomic influences, a higher level of income inequality adds independently to higher mortality levels. Previous publication This article is a reworked version of the study 'Er inntektsforskjeller dødelige?' [Are income inequalities lethal?] which was published in Norwegian in Tidsskrift for velferdsforskning [Journal for welfare research], Vol. 13 (4), 2010. PMID:21291530

Reasons and risk factors for beef calf and youngstock on-farm mortality in extensive cow-calf herds.

PubMed

Mõtus, K; Viltrop, A; Emanuelson, U

2017-12-26

Raising calves and youngstock is an essential part of beef production. High on-farm mortality (unassisted death and euthanasia) is a consequence of poor animal health and welfare, and is economically unfavourable. The present study aimed to identify the reasons and risk factors for beef calf and youngstock on-farm mortality, using registry data for the years 2013 to 2015. Cox regression models were applied for the data of four age groups: calves up to 30 days (n=21 075), calves 1 to 5 months (n=21 116), youngstock 6 to 19 months (n=22 637) and youngstock ⩾20 months of age (n=9582). We found that dystocia, small birth weight and older parity of the mother increased the mortality hazard in calves up to 30 days of age. A summer birth was a common protective factor against mortality for calves up to 30 days and calves 1 to 5 months of age, compared with birth in other seasons. Among calves 1 to 5 months old, being the offspring of a first-parity cow was associated with significantly higher risk of death compared with calves who were the offspring of third- or higher-parity cows. A high herd-level stillbirth rate was associated with higher mortality hazard. The most commonly reported reasons for calf mortality were digestive disorders and respiratory disease. According to the models of youngstock from 6 months of age, male sex was a risk factor for mortality. Cattle having more than 10% dairy breed experienced a higher mortality risk in the ⩾20 months age group. No significant differences were found across regions, herd size or different breeds in any of the calf or youngstock groups. Metabolic and digestive disorders, as well as traumas and accidents, were the most common causes of mortality in beef youngstock older than 6 months. We can conclude that in young calves, animal-level factors associated with calving had a high impact on mortality. Further, timing calving for the warmer spring months would benefit calf survivability. Further studies including complementary information about farm factors adapted across the whole youngstock period is highly needed to provide sound recommendations in reducing on-farm mortality.

Humidity May Modify the Relationship between Temperature and Cardiovascular Mortality in Zhejiang Province, China

PubMed Central

Zeng, Jie; Zhang, Xuehai; Yang, Jun; Bao, Junzhe; Dear, Keith; Liu, Qiyong; Lin, Shao; Lin, Aihua; Huang, Cunrui

2017-01-01

Background: The evidence of increased mortality attributable to extreme temperatures is widely characterized in climate-health studies. However, few of these studies have examined the role of humidity on temperature-mortality association. We investigated the joint effect between temperature and humidity on cardiovascular disease (CVD) mortality in Zhejiang Province, China. Methods: We collected data on daily meteorological and CVD mortality from 11 cities in Zhejiang Province during 2010–2013. We first applied time-series Poisson regression analysis within the framework of distributed lag non-linear models to estimate the city-specific effect of temperature and humidity on CVD mortality, after controlling for temporal trends and potential confounding variables. We then applied a multivariate meta-analytical model to pool the effect estimates in the 11 cities to generate an overall provincial estimate. The joint effects between them were calculated by the attributable fraction (AF). The analyses were further stratified by gender, age group, education level, and location of cities. Results: In total, 120,544 CVD deaths were recorded in this study. The mean values of temperature and humidity were 17.6 °C and 72.3%. The joint effect between low temperature and high humidity had the greatest impact on the CVD death burden over a lag of 0–21 days with a significant AF of 31.36% (95% eCI: 14.79–38.41%), while in a condition of low temperature and low humidity with a significant AF of 16.74% (95% eCI: 0.89, 24.44). The AFs were higher at low temperature and high humidity in different subgroups. When considering the levels of humidity, the AFs were significant at low temperature and high humidity for males, youth, those with a low level of education, and coastal area people. Conclusions: The combination of low temperature and high humidity had the greatest impact on the CVD death burden in Zhejiang Province. This evidence has important implications for developing CVD interventions. PMID:29135955

Humidity May Modify the Relationship between Temperature and Cardiovascular Mortality in Zhejiang Province, China.

PubMed

Zeng, Jie; Zhang, Xuehai; Yang, Jun; Bao, Junzhe; Xiang, Hao; Dear, Keith; Liu, Qiyong; Lin, Shao; Lawrence, Wayne R; Lin, Aihua; Huang, Cunrui

2017-11-14

Background : The evidence of increased mortality attributable to extreme temperatures is widely characterized in climate-health studies. However, few of these studies have examined the role of humidity on temperature-mortality association. We investigated the joint effect between temperature and humidity on cardiovascular disease (CVD) mortality in Zhejiang Province, China. Methods : We collected data on daily meteorological and CVD mortality from 11 cities in Zhejiang Province during 2010-2013. We first applied time-series Poisson regression analysis within the framework of distributed lag non-linear models to estimate the city-specific effect of temperature and humidity on CVD mortality, after controlling for temporal trends and potential confounding variables. We then applied a multivariate meta-analytical model to pool the effect estimates in the 11 cities to generate an overall provincial estimate. The joint effects between them were calculated by the attributable fraction (AF). The analyses were further stratified by gender, age group, education level, and location of cities. Results : In total, 120,544 CVD deaths were recorded in this study. The mean values of temperature and humidity were 17.6 °C and 72.3%. The joint effect between low temperature and high humidity had the greatest impact on the CVD death burden over a lag of 0-21 days with a significant AF of 31.36% (95% eCI: 14.79-38.41%), while in a condition of low temperature and low humidity with a significant AF of 16.74% (95% eCI: 0.89, 24.44). The AFs were higher at low temperature and high humidity in different subgroups. When considering the levels of humidity, the AFs were significant at low temperature and high humidity for males, youth, those with a low level of education, and coastal area people. Conclusions : The combination of low temperature and high humidity had the greatest impact on the CVD death burden in Zhejiang Province. This evidence has important implications for developing CVD interventions.

Risk factors predicting mortality in patients with lung abscess in a public tertiary care center in Karachi, Pakistan.

PubMed

Ghazal, Shaista; Kumar, Ashok; Shrestha, Binav; Sajid, Sana; Malik, Maria; Rizvi, Nadeen

2013-01-01

Lung abscess is a commonly encountered entity in South-East Asia but not much data regarding its outcome is available. The objective of this study was to identify the factors associated with increased mortality in patients diagnosed with lung abscess in a tertiary care center of Karachi, Pakistan. A retrospective case analysis was performed via hospital records, on patients admitted with lung abscess between January 2009 and January 2011 at the largest state-owned tertiary care centre in Karachi, Pakistan. Out of the 41 patients hospitalized, 17 could not survive and were evaluated for clinical, radiological and microbiological factors to determine association with heightened mortality. Mortality due to lung abscess stood at 41.4% (17 of 41 cases). Adult male patients were found to have higher mortality with 13 out of 17 (43%) dead patients being male. A majority (21/41, 51.2%) of the cases belonged to the 41-60 year old age group. Highest mortality was seen in patients<20 years of age (3/4, 75%). Patients with blood sugar levels of >200 mg/dL (56%) succumb to disease. Patients with a positive history of smoking, diabetes mellitus, and alcohol intake expressed mortality rates of 44%, 56%, and 50% respectively; while 29.4% of the mortalities were positive for Pseudomonas aeruginosa on sputum culture. A significant association was found with elevated mortality and low haemoglobin levels at time of admission; mortality was 58% (p=0.005) in patients with Hb less than or equal to 10 mg/dL. The risk factors involved with heightened mortality included male gender and history of smoking, diabetes and alcohol intake. High blood sugar levels and detection of Pseudomonas aeruginosa on sputum cultures were also implicated. Anemia (Hb level less than or equal to 10 mg/dl) was statistically significant predictive factor for increased mortality.

Obesity and excess mortality among the elderly in the United States and Mexico.

PubMed

Monteverde, Malena; Noronha, Kenya; Palloni, Alberto; Novak, Beatriz

2010-02-01

Increasing levels of obesity could compromise future gains in life expectancy in low- and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BAI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U.S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.

Effects of consanguineous marriage on reproductive behaviour, adverse pregnancy outcomes and offspring mortality in Oman.

PubMed

Islam, M Mazharul

2013-05-01

The long tradition of high prevalence of consanguineous marriages in Omani society may have ramifications for reproductive behaviour and health of offspring. To examine the relevance of consanguinity to reproductive behaviour, adverse pregnancy outcome and offspring mortality in Oman. The data analysed came from the 2000 Oman National Health Survey. Selected indicators that are related to reproductive behaviour, adverse pregnancy outcome and offspring mortality were considered as explanatory variables. Various statistical methods and tests were used for data analysis. Consanguineous marriage was found to be associated with lower age at first birth, higher preference for larger family size, lower level of husband-wife communication about use of family planning methods and lower rate of contraceptive use. Although bivariate analysis showed elevated fertility and childhood mortality among the women with consanguineous marriage, after controlling for relevant socio-demographic factors in multivariate analysis, fertility, childhood mortality and foetal loss showed no significant association with consanguinity in Oman. Consanguinity plays an important role in determining some of the aspects of reproduction and health of newborns, but did not show any detrimental effects on fertility and offspring mortality. The high level of consanguinity and its relevance to reproduction in Oman need to be considered in its public health strategy in a culturally acceptable manner.

Education of adult children and mortality of their elderly parents in Taiwan.

PubMed

Zimmer, Zachary; Martin, Linda G; Ofstedal, Mary Beth; Chuang, Yi-Li

2007-05-01

In societies in which families are highly integrated, the education of family members may be linked to survival. Such may be the case in Taiwan, where there are large gaps in levels of education across generations and high levels of resource transfers between family members. This study employs 14 years of longitudinal data from Taiwan to examine the combined effects of the education of older adults and their adult children on the mortality outcomes of older adults. We use nested Gompertz hazard models to evaluate the importance of the education of an older adult and his or her highest-educated child after controlling for socioeconomic, demographic, and health characteristics at baseline. To gain further insight, we fit additional models based on the sample stratified by whether older adults report serious diseases at baseline. The results indicate that the educational levels of both older adults and children are associated with older adult mortality, but children's education appears more important when we examine the mortality of only those older adults who already report a serious disease. This finding suggests that there may be different roles for education in the onset versus the progression of a health problem that may lead to death.

Anti-Gay Prejudice and All-Cause Mortality Among Heterosexuals in the United States

PubMed Central

Bellatorre, Anna; Muennig, Peter

2014-01-01

Objectives. We determined whether individuals who harbor antigay prejudice experience elevated mortality risk. Methods. Data on heterosexual sexual orientation (n = 20 226, aged 18–89 years), antigay attitudes, and mortality risk factors came from the General Social Survey, which was linked to mortality data from the National Death Index (1988–2008). We used Cox proportional hazard models to examine whether antigay prejudice was associated with mortality risk among heterosexuals. Results. Heterosexuals who reported higher levels of antigay prejudice had higher mortality risk than those who reported lower levels (hazard ratio [HR] = 1.25; 95% confidence interval [CI] = 1.09, 1.42), with control for multiple risk factors for mortality, including demographics, socioeconomic status, and fair or poor self-rated health. This result translates into a life expectancy difference of approximately 2.5 years (95% CI = 1.0, 4.0 years) between individuals with high versus low levels of antigay prejudice. Furthermore, in sensitivity analyses, antigay prejudice was specifically associated with increased risk of cardiovascular-related causes of death in fully adjusted models (HR = 1.29; 95% CI = 1.04, 1.60). Conclusions. The findings contribute to a growing body of research suggesting that reducing prejudice may improve the health of both minority and majority populations. PMID:24328664

Anti-gay prejudice and all-cause mortality among heterosexuals in the United States.

PubMed

Hatzenbuehler, Mark L; Bellatorre, Anna; Muennig, Peter

2014-02-01

We determined whether individuals who harbor antigay prejudice experience elevated mortality risk. Data on heterosexual sexual orientation (n = 20,226, aged 18-89 years), antigay attitudes, and mortality risk factors came from the General Social Survey, which was linked to mortality data from the National Death Index (1988-2008). We used Cox proportional hazard models to examine whether antigay prejudice was associated with mortality risk among heterosexuals. Heterosexuals who reported higher levels of antigay prejudice had higher mortality risk than those who reported lower levels (hazard ratio [HR] = 1.25; 95% confidence interval [CI] = 1.09, 1.42), with control for multiple risk factors for mortality, including demographics, socioeconomic status, and fair or poor self-rated health. This result translates into a life expectancy difference of approximately 2.5 years (95% CI = 1.0, 4.0 years) between individuals with high versus low levels of antigay prejudice. Furthermore, in sensitivity analyses, antigay prejudice was specifically associated with increased risk of cardiovascular-related causes of death in fully adjusted models (HR = 1.29; 95% CI = 1.04, 1.60). The findings contribute to a growing body of research suggesting that reducing prejudice may improve the health of both minority and majority populations.

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.

Brood stock segregation for the control of bacterial kidney disease can affect mortality of progeny chinook salmon (Oncorhynchus tshawytscha) in seawater

USGS Publications Warehouse

Elliott, Diane G.; Pascho, Ronald J.; Palmisano, Aldo N.

1995-01-01

Segregation of spring chinook salmon (Oncorhynchus tshawytscha) brood stock based on the measurement of maternal Renibacterium salmoninarum infection levels by the enzyme-linked immunosorbent assay (ELISA) and the fluorescent antibody technique (FAT) was previously shown to affect the prevalence and levels of bacterial kidney disease (BKD) in progeny fish during hatchery rearing. Smolts from that study were subjected to standardized fish health and condition evaluation procedures 2 weeks before the conclusion of hatchery rearing and release of the fish for migration to the Pacific Ocean. The results suggested that the general health of the smolts in the progeny group from parents that had low R. salmoninarum infection levels or tested negative for R. salmoninarum (low-BKD group) was better than that of the smolts in the progeny group from female parents with high R. salmoninarum infection levels (high-BKD group). Testing by the ELISA showed that the overall severity of R. salmoninarum infection also was lower in the smolts from the low-BKD group. Subgroups of smolts from the study were acclimated to tanks of seawater for extended holding. After a 22-day acclimation period and 98 days in full-strength (29 ppt salinity) seawater, total mortality was 12% in the low-BKD group and 44% in the high-BKD group. All of the mortality in the low-BKD group and 85% of the mortality in the high-BKD group occurred after the fish were transferred to full-strength seawater. Testing of kidney tissues from all dead fish by the FAT revealed that 85% of the fish that died in the high-BKD group had high R. salmoninarum numbers, indicating that BKD was the cause of death. In contrast, none of the fish that died in the low-BKD group had detectable numbers of R. salmoninarum. We concluded that brood stock segregation by use of the ELISA and the FAT can affect mortality and the R. salmoninarum status of progeny chinook salmon for as long as 21 months after hatching, even after the fish have been transferred to seawater.

Variability modifies life satisfaction's association with mortality risk in older adults

PubMed Central

Boehm, Julia K.; Winning, Ashley; Segerstrom, Suzanne; Kubzansky, Laura D.

2015-01-01

Life satisfaction is associated with greater longevity, but its variability across time has not been examined relative to longevity. We investigated whether mean levels of life satisfaction across time, variability in life satisfaction across time, and their interaction were associated with mortality over 9 years of follow-up. Participants were 4,458 Australians initially ≥50 years old. During the follow-up, 546 people died. Adjusting for age, greater mean life satisfaction was associated with reduced risk and greater variability in life satisfaction was associated with increased risk of mortality. These findings were qualified by a significant interaction such that individuals with low mean satisfaction and high variability in satisfaction had the greatest risk of mortality over the follow-up period. In combination with mean levels of life satisfaction, variability in life satisfaction is relevant for mortality risk among older adults. Considering intraindividual variability provides additional insight into associations between psychological characteristics and health. PMID:26048888

Analysing child mortality in Nigeria with geoadditive discrete-time survival models.

PubMed

Adebayo, Samson B; Fahrmeir, Ludwig

2005-03-15

Child mortality reflects a country's level of socio-economic development and quality of life. In developing countries, mortality rates are not only influenced by socio-economic, demographic and health variables but they also vary considerably across regions and districts. In this paper, we analysed child mortality in Nigeria with flexible geoadditive discrete-time survival models. This class of models allows us to measure small-area district-specific spatial effects simultaneously with possibly non-linear or time-varying effects of other factors. Inference is fully Bayesian and uses computationally efficient Markov chain Monte Carlo (MCMC) simulation techniques. The application is based on the 1999 Nigeria Demographic and Health Survey. Our method assesses effects at a high level of temporal and spatial resolution not available with traditional parametric models, and the results provide some evidence on how to reduce child mortality by improving socio-economic and public health conditions. Copyright (c) 2004 John Wiley & Sons, Ltd.

Explanations for high levels of infant mortality in Pakistan--a dissenting view.

PubMed

Zaidi, A

1989-01-01

The author critiques a paper by Zeba A. Sathar concerning the relationship between poverty and the infant mortality rate in Pakistan. The focus is on the socioeconomic determinants of fertility decline and policy implications. A reply by Sathar is included (pp. 258-9).

Admission Low Magnesium Level Is Associated with In-Hospital Mortality in Acute Ischemic Stroke Patients.

PubMed

You, Shoujiang; Zhong, Chongke; Du, Huaping; Zhang, Yu; Zheng, Danni; Wang, Xia; Qiu, Chenhong; Zhao, Hongru; Cao, Yongjun; Liu, Chun-Feng

2017-01-01

Low magnesium levels are associated with an elevated risk of stroke. In this study, we investigated the association between magnesium levels on hospital admission and in-hospital mortality in acute ischemic stroke (AIS) patients. A total of 2,485 AIS patients, enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city, were included in this study. The patients were divided into 4 groups according to their level of admission magnesium: Q1 (<0.82 mmol/L), Q2 (0.82-0.89 mmol/L), Q3 (0.89-0.98 mmol/L), and Q4 (≥0.98 mmol/L). Cox proportional hazard model was used to estimate the effect of magnesium on all-cause in-hospital mortality in AIS patients. During hospitalization, 92 patients (3.7%) died from all causes. The lowest serum magnesium level (Q1) was associated with a 2.66-fold increase in the risk of in-hospital mortality in comparison to Q4 (hazard ratio [HR] 2.66; 95% CI 1.55-4.56; p-trend < 0.001). After adjusting for age, sex, time from onset to hospital admission, baseline National Institutes of Health Stroke Scale score, and other potential covariates, HR for Q1 was 2.03 (95% CI 1.11-3.70; p-trend = 0.014). Sensitivity and subgroup analyses further confirmed a significant association between lower magnesium levels and a high risk of in-hospital mortality. Decreased serum magnesium levels at admission were independently associated with in-hospital mortality in AIS patients. © 2017 S. Karger AG, Basel.

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006-2010.

PubMed

Florey, Lia S; Bennett, Adam; Hershey, Christine L; Bhattarai, Achuyt; Nielsen, Carrie F; Ali, Doreen; Luhanga, Misheck; Taylor, Cameron; Eisele, Thomas P; Yé, Yazoume

2017-09-01

Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62-90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60-0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006-2010 in Malawi and represent a novel use of district-level data from nationally representative surveys.

Is there a 'Scottish effect' for mortality? Prospective observational study of census linkage studies.

PubMed

Popham, Frank; Boyle, Paul J

2011-09-01

Scotland's mortality rate is higher than England and Wales' and this difference cannot be explained by differences in area-level socio-economic deprivation. However, studies of this 'Scottish effect' have not adjusted for individual-level measures of socio-economic position nor accounted for country of birth; important as Scottish born living in England and Wales also have high mortality risk. Data sets (1991-2001 and 2001-2007) were obtained from the Scottish Longitudinal Study and the Office for National Statistics England and Wales Longitudinal Study that both link census records to subsequent mortality. Analysis was limited to those aged 35-74 at baseline with people followed to emigration, death or end of follow-up. Those born in Scotland living in either England and Wales or Scotland had a higher mortality rate than the English born living in England and Wales that was not fully attenuated by adjustment for car access and housing tenure. Adjusting for household-level differences in socio-economic deprivation does not fully explain the Scottish excess mortality that is seen for those born in Scotland whether living in England and Wales or Scotland. Taking a life course approach may reveal the cause of the 'Scottish effect'.

Impact of elevated cardiac biomarkers on mortality after vascular surgery procedures.

PubMed

Buckley, Ryan; Stevens, Scott L

2014-12-01

Concurrent cardiac disease is an important cause of morbidity and mortality in vascular surgical patients. Increasingly, cardiac biomarkers are used to identify cardiac injury in these high-risk patients. This review provides data demonstrating that perioperative troponin elevation correlates with poor short- and long-term outcomes for vascular surgical patients. In addition, the data demonstrate that patients with high circulating troponin levels fair worse than those with lower levels. Early identification of patients with cardiac injury using biomarkers allows timely diagnosis, risk stratification, and aggressive medical therapy for vascular surgical patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Trends and patterns of modern contraceptive use and relationships with high-risk births and child mortality in Burkina Faso.

PubMed

Maïga, Abdoulaye; Hounton, Sennen; Amouzou, Agbessi; Akinyemi, Akanni; Shiferaw, Solomon; Baya, Banza; Bahan, Dalomi; Barros, Aluisio J D; Walker, Neff; Friedman, Howard

2015-01-01

In sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births. This paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso. The last three Demographic and Health Surveys - conducted in Burkina Faso in 1998, 2003, and 2010 - enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR). Overall, Burkina Faso's modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women's fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children. Programmes that target sub-national differentials and leverage women's health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied for modern contraception may result in a reduction in the percentage of women experiencing high-risk births and may also reduce child mortality.

Trends and patterns of modern contraceptive use and relationships with high-risk births and child mortality in Burkina Faso

PubMed Central

Maïga, Abdoulaye; Hounton, Sennen; Amouzou, Agbessi; Akinyemi, Akanni; Shiferaw, Solomon; Baya, Banza; Bahan, Dalomi; Barros, Aluisio J. D.; Walker, Neff; Friedman, Howard

2015-01-01

Background In sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births. Objective This paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso. Design The last three Demographic and Health Surveys – conducted in Burkina Faso in 1998, 2003, and 2010 – enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR). Results Overall, Burkina Faso's modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women's fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children. Conclusions Programmes that target sub-national differentials and leverage women's health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied for modern contraception may result in a reduction in the percentage of women experiencing high-risk births and may also reduce child mortality. PMID:26562142

Contrasts between whole-plant and local nutrient levels determine root growth and death in Ailanthus altissima (Simaroubaceae).

PubMed

Hu, Fengqin; Mou, Paul P; Weiner, Jacob; Li, Shuo

2014-05-01

• There is an ongoing debate about the importance of whole-plant control vs. local modular mechanisms for root growth. We conducted a split-root experiment with different patch/background levels of nitrogen to examine whether local root growth and death are controlled by local resource levels or at the whole-plant level.• Three microrhizotrons with 0, 10, and 100 µg N/g growth medium levels (74 g growth medium each) were attached to pots of high or low soil N in which one Ailanthus altissima individual was growing. One fine root was guided into each of the microrhizotrons and photographed every 4 d. Plants were harvested after 28 d; root growth and mortality in the microrhizotrons were recorded. Changes in root length, number of laterals, and interlateral length were determined from the photos and analyzed.• While overall plant growth was influenced by background N level, both patch and background N levels influenced root growth and mortality in patches. Local roots proliferated most when the patch N level was high and background level low, and they proliferated least and showed highest mortality when patch N was low and the background level high.• The fate of roots growing in a patch is influenced by the resource environment of the plant's other roots as well as the resource levels in the patch itself. Thus, the growth and death of roots in patches is determined by both modular and whole-plant mechanisms. © 2014 Botanical Society of America, Inc.

Mortality of Rocky Mountain elk in Michigan due to meningeal worm.

PubMed

Bender, Louis C; Schmitt, Stephen M; Carlson, Elaine; Haufler, Jonathan B; Beyer, Dean E

2005-01-01

Mortality from cerebrospinal parelaphostrongylosis caused by the meningeal worm (Parelaphostrongylus tenuis) has been hypothesized to limit elk (Cervus elaphus nelsoni) populations in areas where elk are conspecific with white-tailed deer (Odocoileus virginianus). Elk were reintroduced into Michigan (USA) in the early 1900s and subsequently greatly increased population size and distribution despite sympatric high-density (>or=12/km2) white-tailed deer populations. We monitored 100 radio-collared elk of all age and sex classes from 1981-94, during which time we documented 76 mortalities. Meningeal worm was a minor mortality factor for elk in Michigan and accounted for only 3% of mortalities, fewer than legal harvest (58%), illegal kills (22%), other diseases (7%), and malnutrition (4%). Across years, annual cause-specific mortality rates due to cerebrospinal parelaphostrongylosis were 0.033 (SE=0.006), 0.029 (SE=0.005), 0.000 (SE=0.000), and 0.000 (SE=0.000) for calves, 1-yr-old, 2-yr-old, and >or=3-yr-old, respectively. The overall population-level mortality rate due to cerebrospinal parelaphostrongylosis was 0.009 (SE=0.001). Thus, meningeal worm had little impact on elk in Michigan during our study despite greater than normal precipitation (favoring gastropods) and record (>or=14 km2) deer densities. Further, elk in Michigan have shown sustained population rates-of-increase of >or=18%/yr and among the highest levels of juvenile production and survival recorded for elk in North America, indicating that elk can persist in areas with meningeal worm at high levels of population productivity. It is likely that local ecologic characteristics among elk, white-tailed deer, and gastropods, and degree of exposure, age of elk, individual and population experience with meningeal worm, overall population vigor, and moisture determine the effects of meningeal worm on elk populations.

Mortality of rocky mountain elk in Michigan due to meningeal worm

USGS Publications Warehouse

Bender, L.C.; Schmitt, S.M.; Carlson, E.; Haufler, J.B.; Beyer, D.E.

2005-01-01

Mortality from cerebrospinal parelaphostrongylosis caused by the meningeal worm (Parelaphostrongylus tenuis) has been hypothesized to limit elk (Cervus elaphus nelsoni) populations in areas where elk are conspecific with white-tailed deer (Odocoileus virginianus). Elk were reintroduced into Michigan (USA) in the early 1900s and subsequently greatly increased population size and distribution despite sympatric high-density (???12/km2) white-tailed deer populations. We monitored 100 radio-collared elk of all age and sex classes from 1981-94, during which time we documented 76 mortalities. Meningeal worm was a minor mortality factor for elk in Michigan and accounted for only 3% of mortalities, fewer than legal harvest (58%), illegal kills (22%), other diseases (7%), and malnutrition (4%). Across years, annual cause-specific mortality rates due to cerebrospinal parelaphostrongylosis were 0.033 (SE=0.006), 0.029 (SE=0.005), 0.000 (SE=0.001), and 0.000 (SE=0.000) for calves, 1-yr-old, 2-yr-old, and ???3-yr-old, respectively. The overall population-level mortality rate due to cerebrospinal parelaphostrongylosis was 0.009 (SE=0.001). Thus, meningeal worm had little impact on elk in Michigan during our study despite greater than normal precipitation (favoring gastropods) and record (???14 km2) deer densities. Further, elk in Michigan have shown sustained population rates-of-increase of ???18%/yr and among the highest levels of juvenile production and survival recorded for elk in North America, indicating that elk can persist in areas with meningeal worm at high levels of population productivity. it is likely that local ecologic characteristics among elk, white-tailed deer, and gastropods, and degree of exposure, age of elk, individual and population experience with meningeal worm, overall population vigor, and moisture determine the effects of meningeal worm on elk populations. ?? Wildlife Disease Association 2005.

Short-term exposure to air pollutants increases the risk of ST elevation myocardial infarction and of infarct-related ventricular arrhythmias and mortality.

PubMed

Bañeras, Jordi; Ferreira-González, Ignacio; Marsal, Josep Ramon; Barrabés, José A; Ribera, Aida; Lidón, Rosa Maria; Domingo, Enric; Martí, Gerard; García-Dorado, David

2018-01-01

The relation between STEMI and air pollution (AP) is scant. We aimed to investigate the short term association between AP and the incidence of STEMI, and STEMI-related ventricular arrhythmias (VA) and mortality. The study was carried out in the area of Barcelona from January 2010 to December 2011. Daily STEMI rates and incidence of STEMI-related VA and mortality were obtained prospectively. The corresponding daily levels of the main pollutants were recorded as well as the atmospheric variables. Three cohorts were defined in order to minimize exposure bias. The magnitude of association was estimated using a time-series design and was adjusted according to atmospheric variables. The daily rate of hospital admissions for STEMI was associated with increases in PM 2.5, PM 10, lead and NO2 concentrations. VA incidence and mortality were associated with increases in PM 2.5 and PM 10 concentrations. In the most specific cohort, BCN (Barcelona) Attended & Resident, STEMI incidence was associated with increases in PM 2.5 (1.009% per 10μg/m 3 ) and PM 10 concentrations (1.005% per 10μg/m 3 ). VA was associated with increases in PM 2.5 (1.021%) and PM 10 (1.015%) and mortality was associated with increases in PM 2.5 (1.083%) and PM 10 (1.045%). Short-term exposure to high levels of PM 2.5 and PM 10 is associated with increased daily STEMI admissions and STEMI-related VA and mortality. Exposure to high levels of lead and NO2 is associated with increased daily STEMI admissions, and NO2 with higher mortality in STEMI patients. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Cow- and herd-level risk factors for on-farm mortality in Midwest US dairy herds.

PubMed

Shahid, M Q; Reneau, J K; Chester-Jones, H; Chebel, R C; Endres, M I

2015-07-01

The objectives of this study were to describe on-farm mortality and to investigate cow- and herd-level risk factors associated with on-farm mortality in Midwest US dairy herds using lactation survival analysis. We analyzed a total of approximately 5.9 million DHIA lactation records from 10 Midwest US states from January 2006 to December 2010. The cow-level independent variables used in the models were first test-day milk yield, milk fat percent, milk protein percent, fat-to-protein ratio, milk urea nitrogen, somatic cell score, previous dry period, previous calving interval, stillbirth, calf sex, twinning, calving difficulty, season of calving, parity, and breed. The herd-level variables included herd size, calving interval, somatic cell score, 305-d mature-equivalent milk yield, and herd stillbirth percentage. Descriptive analysis showed that overall cow-level mortality rate was 6.4 per 100 cow-years and it increased from 5.9 in 2006 to 6.8 in 2010. Mortality was the primary reason of leaving the herd (19.4% of total culls) followed by reproduction (14.6%), injuries and other (14.0%), low production (12.3%), and mastitis (10.5%). Risk factor analysis showed that increased hazard for mortality was associated with higher fat-to-protein ratio (>1.6 vs. 1 to 1.6), higher milk fat percent, lower milk protein percent, cows with male calves, cows carrying multiple calves, higher milk urea nitrogen, increasing parity, longer previous calving interval, higher first test-day somatic cell score, increased calving difficulty score, and breed (Holstein vs. others). Decreased hazard for mortality was associated with higher first test-day milk yield, higher milk protein, and shorter dry period. For herd-level factors, increased hazard for mortality was associated with increased herd size, increased percentage of stillbirths, higher somatic cell score, and increased herd calving interval. Cows in herds with higher milk yield had lower mortality hazard. Results of the study indicated that first test-day records, especially those indicative of negative energy balance in cows, could be helpful to identify animals at high risk for mortality. Higher milk yield per cow did not have a negative association with mortality. In addition, the association between herd-level factors and mortality indicated that management quality could be an important factor in lowering on-farm mortality, thereby improving cow welfare. Copyright © 2015 American Dairy Science Association. Published by 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.

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.

Lethal and sub-lethal responses of the biogenic reef forming polychaete Sabellaria alveolata to aqueous chlorine and temperature.

PubMed

Last, K S; Hendrick, V J; Beveridge, C M; Roberts, D A; Wilding, T A

2016-06-01

Sabellaria alveolata, a reef-forming marine polychaete, was exposed to aqueous chlorine which is routinely used as an anti-fouling agent in power station cooling water. Worms were treated to a range of chlorination levels (0, 0.02, 0.1 and 0.5 mg l(-1) Total Residual Oxidant referred to as control, low, intermediate and high TRO) at mean and maximum summer temperatures (18 and 23 °C respectively). Overall mortality was relatively low, however a combination of high temperature and intermediate and high TRO resulted in a significant increase in mortality compared to the control and low TRO treatments. In contrast the extension of dwelling tubes was reduced at high TRO, but increased at low and intermediate TRO levels relative to the controls independent of temperature. Finally, tube strength was found to decrease with increasing TRO, again independent of temperature. On the basis of these findings, S. alveolata can be considered tolerant of one month exposures to low TRO at water temperatures up to and including the summer maxima for southern UK waters. However, at higher TRO levels and during warm weather, high mortality would be predicted. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Heat and mortality for ischemic and hemorrhagic stroke in 12 cities of Jiangsu Province, China.

PubMed

Zhou, Lian; Chen, Kai; Chen, Xiaodong; Jing, Yuanshu; Ma, Zongwei; Bi, Jun; Kinney, Patrick L

2017-12-01

Little evidence exists on the relationship between heat and subtypes of stroke mortality, especially in China. Moreover, few studies have reported the effect modification by individual characteristics on heat-related stroke mortality. In this study, we aimed to evaluate the effect of heat exposure on total, ischemic, and hemorrhagic stroke mortality and its individual modifiers in 12 cities in Jiangsu Province, China during 2009 to 2013. We first used a distributed lag non-linear model with quasi-Poisson regression to examine the city-specific heat-related total, ischemic, and hemorrhagic stroke mortality risks at 99th percentile vs. 75th percentile of daily mean temperature in the whole year for each city, while adjusting for long-term trend, season, relative humidity, and day of the week. Then, we used a random-effects meta-analysis to pool the city-specific risk estimates. We also considered confounding by air pollution and effect modification by gender, age, education level, and death location. Overall, the heat-related mortality risk in 12 Jiangsu cities was 1.54 (95%CI: 1.44 to 1.65) for total stroke, 1.63 (95%CI: 1.48 to 1.80) for ischemic stroke, and 1.36 (95%CI: 1.26 to 1.48) for hemorrhagic stroke, respectively. Estimated total, ischemic, and hemorrhagic stroke mortality risks were higher for women versus men, older people versus younger people, those with low education levels versus high education levels, and deaths that occurred outside of hospital. Air pollutants did not significantly influence the heat-related stroke mortality risk. Heat exposure significantly increased both ischemic and hemorrhagic stroke mortality risks in Jiangsu Province, China. Females, the elderly, and those with low education levels are particularly vulnerable to this effect. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

Association of troponin T detected with a highly sensitive assay and cardiac structure and mortality risk in the general population.

PubMed

de Lemos, James A; Drazner, Mark H; Omland, Torbjorn; Ayers, Colby R; Khera, Amit; Rohatgi, Anand; Hashim, Ibrahim; Berry, Jarett D; Das, Sandeep R; Morrow, David A; McGuire, Darren K

2010-12-08

Detectable levels of cardiac troponin T (cTnT) are strongly associated with structural heart disease and increased risk of death and adverse cardiovascular events; however, cTnT is rarely detectable in the general population using standard assays. To determine the prevalence and determinants of detectable cTnT in the population using a new highly sensitive assay and to assess whether cTnT levels measured with the new assay associate with pathological cardiac phenotypes and subsequent mortality. Cardiac troponin T levels were measured using both the standard and the highly sensitive assays in 3546 individuals aged 30 to 65 years enrolled between 2000 and 2002 in the Dallas Heart Study, a multiethnic, population-based cohort study. Mortality follow-up was complete through 2007. Participants were placed into 5 categories based on cTnT levels. Magnetic resonance imaging measurements of cardiac structure and function and mortality through a median of 6.4 (interquartile range, 6.0-6.8) years of follow-up. In Dallas County, the prevalence of detectable cTnT (≥0.003 ng/mL) was 25.0% (95% confidence interval [CI], 22.7%-27.4%) with the highly sensitive assay vs 0.7% (95% CI, 0.3%-1.1%) with the standard assay. Prevalence was 37.1% (95% CI, 33.3%-41.0%) in men vs 12.9% (95% CI, 10.6%-15.2%) in women and 14.0% (95% CI, 11.2%-16.9%) in participants younger than 40 years vs 57.6% (95% CI, 47.0%-68.2%) in those 60 years and older. Prevalence of left ventricular hypertrophy increased from 7.5% (95% CI, 6.4%-8.8%) in the lowest cTnT category (<0.003 ng/mL) to 48.1% (95% CI, 36.7%-59.6%) in the highest (≥0.014 ng/mL) (P < .001); prevalence of left ventricular systolic dysfunction and chronic kidney disease also increased across categories (P < .001 for each). During a median follow-up of 6.4 years, there were 151 total deaths, including 62 cardiovascular disease deaths. All-cause mortality increased from 1.9% (95% CI, 1.5%-2.6%) to 28.4% (95% CI, 21.0%-37.8%) across higher cTnT categories (P < .001). After adjustment for traditional risk factors, C-reactive protein level, chronic kidney disease, and N-terminal pro-brain-type natriuretic peptide level, cTnT category remained independently associated with all-cause mortality (adjusted hazard ratio, 2.8 [95% CI, 1.4-5.2] in the highest category). Adding cTnT categories to the fully adjusted mortality model modestly improved model fit (P = .02) and the integrated discrimination index (0.010 [95% CI, 0.002-0.018]; P = .01). In this population-based cohort, cTnT detected with a highly sensitive assay was associated with structural heart disease and subsequent risk for all-cause mortality.

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy.

PubMed

Cafagna, Gianluca; Seghieri, Chiara

2017-01-09

There is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy). A retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years). Mortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47-0.94; OR age > 75 years 0.72, 95% CI:0.54-0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58-0.93). Among patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

State of newborn health in India.

PubMed

Sankar, M J; Neogi, S B; Sharma, J; Chauhan, M; Srivastava, R; Prabhakar, P K; Khera, A; Kumar, R; Zodpey, S; Paul, V K

2016-12-01

About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal mortality rate (NMR) declined from 52 per 1000 live births in 1990 to 28 per 1000 live births in 2013, but the rate of decline has been slow and lags behind that of infant and under-five child mortality rates. The slower decline has led to increasing contribution of neonatal mortality to infant and under-five mortality. Among neonatal deaths, the rate of decline in early neonatal mortality rate (ENMR) is much lower than that of late NMR. The high level and slow decline in early NMR are also reflected in a high and stagnant perinatal mortality rate. The rate of decline in NMR, and to an extent ENMR, has accelerated with the introduction of National Rural Health Mission in mid-2005. Almost all states have witnessed this phenomenon, but there is still a huge disparity in NMR between and even within the states. The disparity is further compounded by rural-urban, poor-rich and gender differentials. There is an interplay of different demographic, educational, socioeconomic, biological and care-seeking factors, which are responsible for the differentials and the high burden of neonatal mortality. Addressing inequity in India is an important cross-cutting action that will reduce newborn mortality.

State of newborn health in India

PubMed Central

Sankar, M J; Neogi, S B; Sharma, J; Chauhan, M; Srivastava, R; Prabhakar, P K; Khera, A; Kumar, R; Zodpey, S; Paul, V K

2016-01-01

About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal mortality rate (NMR) declined from 52 per 1000 live births in 1990 to 28 per 1000 live births in 2013, but the rate of decline has been slow and lags behind that of infant and under-five child mortality rates. The slower decline has led to increasing contribution of neonatal mortality to infant and under-five mortality. Among neonatal deaths, the rate of decline in early neonatal mortality rate (ENMR) is much lower than that of late NMR. The high level and slow decline in early NMR are also reflected in a high and stagnant perinatal mortality rate. The rate of decline in NMR, and to an extent ENMR, has accelerated with the introduction of National Rural Health Mission in mid-2005. Almost all states have witnessed this phenomenon, but there is still a huge disparity in NMR between and even within the states. The disparity is further compounded by rural–urban, poor–rich and gender differentials. There is an interplay of different demographic, educational, socioeconomic, biological and care-seeking factors, which are responsible for the differentials and the high burden of neonatal mortality. Addressing inequity in India is an important cross-cutting action that will reduce newborn mortality. PMID:27924104

A Study of the Combined Effects of Physical Activity and Air Pollution on Mortality in Elderly Urban Residents: The Danish Diet, Cancer, and Health Cohort

PubMed Central

de Nazelle, Audrey; Mendez, Michelle Ann; Garcia-Aymerich, Judith; Hertel, Ole; Tjønneland, Anne; Overvad, Kim; Raaschou-Nielsen, Ole; Nieuwenhuijsen, Mark J.

2015-01-01

Background Physical activity reduces, whereas exposure to air pollution increases, the risk of premature mortality. Physical activity amplifies respiratory uptake and deposition of air pollutants in the lung, which may augment acute harmful effects of air pollution during exercise. Objectives We aimed to examine whether benefits of physical activity on mortality are moderated by long-term exposure to high air pollution levels in an urban setting. Methods A total of 52,061 subjects (50–65 years of age) from the Danish Diet, Cancer, and Health cohort, living in Aarhus and Copenhagen, reported data on physical activity in 1993–1997 and were followed until 2010. High exposure to air pollution was defined as the upper 25th percentile of modeled nitrogen dioxide (NO2) levels at residential addresses. We associated participation in sports, cycling, gardening, and walking with total and cause-specific mortality by Cox regression, and introduced NO2 as an interaction term. Results In total, 5,534 subjects died: 2,864 from cancer, 1,285 from cardiovascular disease, 354 from respiratory disease, and 122 from diabetes. Significant inverse associations of participation in sports, cycling, and gardening with total, cardiovascular, and diabetes mortality were not modified by NO2. Reductions in respiratory mortality associated with cycling and gardening were more pronounced among participants with moderate/low NO2 [hazard ratio (HR) = 0.55; 95% CI: 0.42, 0.72 and 0.55; 95% CI: 0.41, 0.73, respectively] than with high NO2 exposure (HR = 0.77; 95% CI: 0.54, 1.11 and HR = 0.81; 95% CI: 0.55, 1.18, p-interaction = 0.09 and 0.02, respectively). Conclusions In general, exposure to high levels of traffic-related air pollution did not modify associations, indicating beneficial effects of physical activity on mortality. These novel findings require replication in other study populations. Citation Andersen ZJ, de Nazelle A, Mendez MA, Garcia-Aymerich J, Hertel O, Tjønneland A, Overvad K, Raaschou-Nielsen O, Nieuwenhuijsen MJ. 2015. A study of the combined effects of physical activity and air pollution on mortality in elderly urban residents: the Danish Diet, Cancer, and Health cohort. Environ Health Perspect 123:557–563; http://dx.doi.org/10.1289/ehp.1408698 PMID:25625237

Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan.

PubMed

Fikree, F F; Gray, R H

1996-01-01

A demographic survey was used to estimate the level and determinants of perinatal mortality in eight lower socio-economic squatter settlements of Karachi, Pakistan. The perinatal mortality rate was 54.1 per 1000 births, with a stillbirth to early neonatal mortality ratio of 1:1. About 65% of neonatal deaths occurred in the early neonatal period, and early neonatal mortality contributed 32% of all infant deaths. Risk factor assessment was conducted on 375 perinatal deaths and 6070 current survivors. Poorer socio-economic status variables such as maternal and paternal illiteracy, maternal work outside the home and fewer household assets were significantly associated with perinatal mortality as were biological factors of higher parental age, short birth intervals and poor obstetric history. Multivariable logistic analysis indicated that some socio-economic factors retained their significance after adjusting for the more proximate biological factors. Population attributable risk estimates suggest that public health measures for screening of high-risk women and use of family planning to space births will not improve perinatal mortality substantially without improvement of socio-economic conditions, particularly maternal education. The results of this study indicate that an evaluation of perinatal mortality can be conducted using pregnancy histories derived from demographic surveys.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-05-01

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

Detecting early warning signals of tree mortality using multi-scale satellite data: a case study in boreal North Americ

NASA Astrophysics Data System (ADS)

Rogers, B. M.; Hogg, E. H.; Solvik, K.; Ju, J.; Masek, J. G.; Michaelian, M.; Berner, L. T.; Goetz, S. J.

2017-12-01

Tree mortality from drought and biotic infestations represents a fundamental transition for forests at the level of an individual tree, forest stand, and even landscape. Tree mortality precipitates a cascade of ecosystem impacts and has been increasing across the continents, including in the boreal zone where climate changes and feedbacks to the Earth system are relatively large. Despite the importance for science and management communities, our ability to forecast tree mortality at landscape to continental scales is limited. However, two independent information streams have the potential to inform and significantly improve mortality forecasts. Tree-level productivity dynamics are known to precede mortality in predictable ways years to decades before death. Plot-level productivity, in turn, has been related to satellite-based indices such as the Normalized Difference Vegetation Index (NDVI). Here we link these two data sources to show that early warning signals of mortality are evident in several NDVI-based metrics up to 20 years before death. We focus on two repeat forest inventories and three NDVI products across western boreal North America where productivity and mortality dynamics are influenced by periodic drought. These data sources capture a range in forest conditions and spatial resolution to highlight the sensitivity and limitations of our approach. Overall, results indicate potential to use satellite NDVI for early warning signals of mortality. Relationships are broadly consistent across inventories, species, and spatial resolutions, although coarse-scale imagery in the heterogeneous aspen parkland was of limited utility. Longer-term NDVI data and annually re-measured sites with high mortality levels generate the strongest signals, although we still found robust relationships at sites re-measured at a typical five-year frequency. The approach and relationships developed here can be used as a basis for improving forest mortality models and monitoring systems.

Long-term exposure to crystalline silica and risk of heart disease mortality.

PubMed

Liu, Yuewei; Rong, Yi; Steenland, Kyle; Christiani, David C; Huang, Xiji; Wu, Tangchun; Chen, Weihong

2014-09-01

The association between crystalline silica exposure and risk of heart disease mortality remains less clear. We investigated a cohort of 42,572 Chinese workers who were potentially exposed to crystalline silica and followed from 1960 to 2003. Cumulative silica exposure was estimated by linking a job-exposure matrix to each person's work history. Low-level silica exposure was defined as never having held a job with an exposure higher than 0.1 mg/m. We estimated hazard ratios (HRs) in exposure-response analyses using Cox proportional hazards model. We identified 2846 deaths from heart disease during an average of 35 years follow-up. Positive exposure-response trends were observed for cumulative silica exposure associated with mortality from total heart disease (HRs for increasing quartiles of cumulative silica exposure compared with the unexposed group = 0.89, 1.09, 1.32, 2.10; P for linear trend < 0.001) and pulmonary heart disease (0.92, 1.39, 2.47, 5.46; P for linear trend < 0.001). These positive trends remained among workers with both high- and low-level silica exposure. There was also a positive trend for ischemic heart disease among workers with low-level exposure, with quartile HRs of 1.04, 1.13, 1.52, and 1.60 (P for linear trend < 0.001). Low-level crystalline silica exposure was associated with increased mortality from heart disease, including pulmonary heart disease and ischemic heart disease, whereas high-level exposure mainly increased mortality from pulmonary heart disease. Current permissible exposure limits for crystalline silica in many countries may be insufficient to protect people from deaths due to heart disease.

Plasma Levels of Fatty Acid-Binding Protein 4, Retinol-Binding Protein 4, High-Molecular-Weight Adiponectin, and Cardiovascular Mortality Among Men With Type 2 Diabetes: A 22-Year Prospective Study.

PubMed

Liu, Gang; Ding, Ming; Chiuve, Stephanie E; Rimm, Eric B; Franks, Paul W; Meigs, James B; Hu, Frank B; Sun, Qi

2016-11-01

To examine select adipokines, including fatty acid-binding protein 4, retinol-binding protein 4, and high-molecular-weight (HMW) adiponectin in relation to cardiovascular disease (CVD) mortality among patients with type 2 diabetes mellitus. Plasma levels of fatty acid-binding protein 4, retinol-binding protein 4, and HMW adiponectin were measured in 950 men with type 2 diabetes mellitus in the Health Professionals Follow-up Study. After an average of 22 years of follow-up (1993-2015), 580 deaths occurred, of whom 220 died of CVD. After multivariate adjustment for covariates, higher levels of fatty acid-binding protein 4 were significantly associated with a higher CVD mortality: comparing extreme tertiles, the hazard ratio and 95% confidence interval of CVD mortality was 1.78 (1.22-2.59; P trend=0.001). A positive association was also observed for HMW adiponectin: the hazard ratio (95% confidence interval) was 2.07 (1.42-3.06; P trend=0.0002), comparing extreme tertiles, whereas higher retinol-binding protein 4 levels were nonsignificantly associated with a decreased CVD mortality with an hazard ratio (95% confidence interval) of 0.73 (0.50-1.07; P trend=0.09). A Mendelian randomization analysis suggested that the causal relationships of HMW adiponectin and retinol-binding protein 4 would be directionally opposite to those observed based on the biomarkers, although none of the Mendelian randomization associations achieved statistical significance. These data suggest that higher levels of fatty acid-binding protein 4 and HMW adiponectin are associated with elevated CVD mortality among men with type 2 diabetes mellitus. Biological mechanisms underlying these observations deserve elucidation, but the associations of HMW adiponectin may partially reflect altered adipose tissue functionality among patients with type 2 diabetes mellitus. © 2016 American Heart Association, Inc.

Mountain pine beetle host selection behavior confirms high resistance in Great Basin bristlecone pine

Treesearch

Erika L. Eidson; Karen E. Mock; Barbara J. Bentz

2017-01-01

Over the last two decades, mountain pine beetle (Dendroctonus ponderosae) populations reached epidemic levels across much of western North America, including high elevations where cool temperatures previously limited mountain pine beetle persistence. Many high-elevation pine species are susceptible hosts and experienced high levels of mortality in recent outbreaks, but...

Impact of uric acid levels on the risk of long-term cardiovascular mortality in patients with type 2 diabetes mellitus.

PubMed

Ilundain-González, Ana Isabel; Gimeno-Orna, José Antonio; Sáenz-Abad, Daniel; Pons-Dolset, Jordi; Cebollada-Del Hoyo, Jesús; Lahoza-Pérez, María Del Carmen

Hyperuricemia is associated to cardiovascular disease. However, the contribution of uric acid (UA) to cardiovascular mortality in diabetic patients is controversial. To assess the impact of UA levels on the risk of cardiovascular mortality risk in a cohort of patients with type 2 diabetes mellitus (T2DM). A prospective cohort study on outpatients with T2DM. The clinical endpoint was cardiovascular death. Anthropometric, demographic, clinical, and biochemical variables were collected, including UA levels, urinary albumin excretion and estimated glomerular filtration rate. The independent contribution of UA levels to cardiovascular mortality was assessed using multivariate Cox regression models, progressively adjusted for potential confounders. A total of 452 patients with a mean age of 65.9 (SD 9.5) years were enrolled. Mean UA level was 4.2mg/dL. Quartiles of UA levels were Q1 < 3.3; Q2: 3.3-4.2; Q3: 4.3-5.1; Q4 > 5.1mg/dL. UA levels significantly correlated with estimated glomerular filtration rate (Rho=-0.227; p<0.001). During a median follow-up time of 13 years, cardiovascular mortality rates were higher in Q4 of the UA distribution (Q1: 10.7; Q2: 11.7; Q3: 10.7; Q4: 21.6 per 1000 patient-years; p = 0.027). UA was a predictor of cardiovascular mortality in the univariate analysis (HR1mg/dL = 1.30; p=0.002), but not in a multivariate analysis adjusted for urinary albumin excretion and eGFR (HR1mg/dL=1.20; p=0.12). High UA levels are associated to cardiovascular mortality in patients with T2DM. However, the role of UA may be mediated by impaired kidney function in patients with hyperuricemia. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Prospective register-based study of the impact of immigration on educational inequalities in mortality in Norway.

PubMed

Elstad, Jon Ivar; Øverbye, Einar; Dahl, Espen

2015-04-11

Differences in mortality with regard to socioeconomic status have widened in recent decades in many European countries, including Norway. A rapid upsurge of immigration to Norway has occurred since the 1990s. The article investigates the impact of immigration on educational mortality differences among adults in Norway. Two linked register-based data sets are analyzed; the first consists of all registered inhabitants aged 20-69 in Norway January 1, 1993 (2.6 millions), and the second of all registered inhabitants aged 20-69 as of January 1, 2008 (2.8 millions). Deaths 1993-1996 and 2008-2011, respectively, immigrant status, and other background information are available in the data. Mortality is examined by Cox regression analyses and by estimations of age-adjusted deaths per 100,000 personyears. Both relative and absolute educational inequality in mortality increased from the 1993-1996 period to 2008-2011, but overall mortality levels went down during these years. Immigrants in general, and almost all the analyzed immigrant subcategories, had lower mortality than the native majority. This was due to comparatively low mortality among lower educated immigrants, while mortality among higher educated immigrants was similar to the mortality level of highly educated natives. The widening of educational inequality in mortality during the 1990s and 2000s in Norway was not due to immigration. Immigration rather contributed to slightly lower overall mortality in the population and a less steep educational gradient in mortality.

Some aspects of socio-economic determinants of mortality in tropical Africa.

PubMed

Gaisie, S K

1980-01-01

Measurements of mortality levels and trends continue to be inadequate in Africa, largely because of the lack of reliable and adequate information on deaths. A series of estimates depicting mortality levels and trends has been prepared by demographers, different kinds of data and employing different estimation procedures, but knowledge of the "true" structure of mortality in tropical Africa is virtually nonexistent. Because of these problems only a "bird's eye view" of the prevailing situation in tropical Africa is presented. The discussion -- directed to mortality by sex and age, by residence, and by cause -- is based on secondary and fragmentary data. Socioeconomic and cultural determinants of mortality are also examined. Available information on male and female mortality indicates that the death rates for males are higher than they are for females. Early childhood mortality (1-4 years) in tropical Africa is relatively high compared with the other age groups, including infants. Mortality differentials have been noted among geographical and administrative units and subdivisions of populations within the various countries of tropical Africa. Also, urban dwellers enjoy a higher expectation of life at birth than do rural dwellers. Communicable diseases are the main killers in tropical Africa. Persistent poverty and malnutrition, poor housing, unhealthy conditions in the growing cities, nonexistence of health facilities in the rural areas, rapid population expansion, and low levels of education are among the factors impeding progress in reducing mortality in tropical Africa. The need exists to express development goals in terms of the progressive reduction and eventual elimination of malnutrition, disease, illiteracy, squalor, and inequalities. Future trends in mortality in tropical Africa may depend more than they have in the recent past on economic and social development.

Declines in stillbirth and neonatal mortality rates in Europe between 2004 and 2010: results from the Euro-Peristat project.

PubMed

Zeitlin, Jennifer; Mortensen, Laust; Cuttini, Marina; Lack, Nicholas; Nijhuis, Jan; Haidinger, Gerald; Blondel, Béatrice; Hindori-Mohangoo, Ashna D

2016-06-01

Stillbirth and neonatal mortality rates declined in Europe between 2004 and 2010. We hypothesised that declines might be greater for countries with higher mortality in 2004 and disproportionally affect very preterm infants at highest risk. Data about live births, stillbirths and neonatal deaths by gestational age (GA) were collected using a common protocol by the Euro-Peristat project in 2004 and 2010. We analysed stillbirths at ≥28 weeks GA in 22 countries and live births ≥24 weeks GA for neonatal mortality in 18 countries. Per cent changes over time were assessed by calculating risk ratios (RR) for stillbirth, neonatal mortality and preterm birth rates in 2010 vs 2004. We used meta-analysis techniques to derive pooled RR using random-effects models overall, by GA subgroups and by mortality level in 2004. Between 2004 and 2010, stillbirths declined by 17% (95% CI 10% to 23%), with a range from 1% to 39% by country. Neonatal mortality declined by 29% (95% CI 23% to 35%) with a range from 9% to 67%. Preterm birth rates did not change: 0% (95% CI -3% to 3%). Mortality declines were of a similar magnitude at all GA; mortality levels in 2004 were not associated with RRs. Stillbirths and neonatal deaths declined at all gestational ages in countries with both high and low levels of mortality in 2004. These results raise questions about how low-mortality countries achieve continued declines and highlight the importance of improving care across the GA spectrum. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Evidence for the free radical/oxidative stress theory of ageing from the CHANCES consortium: a meta-analysis of individual participant data.

PubMed

Schöttker, Ben; Brenner, Hermann; Jansen, Eugène H J M; Gardiner, Julian; Peasey, Anne; Kubínová, Růžena; Pająk, Andrzej; Topor-Madry, Roman; Tamosiunas, Abdonas; Saum, Kai-Uwe; Holleczek, Bernd; Pikhart, Hynek; Bobak, Martin

2015-12-15

The free radical/oxidative stress theory of ageing has received considerable attention, but the evidence on the association of oxidative stress markers with mortality is sparse. We measured derivatives of reactive oxygen metabolite (D-ROM) levels as a proxy for the reactive oxygen species concentration and total thiol levels (TTL) as a proxy for the redox control status in 10,622 men and women (age range, 45-85 years), from population-based cohorts from Germany, Poland, Czech Republic, and Lithuania, of whom 1,702 died during follow-up. Both oxidative stress markers were significantly associated with all-cause mortality independently from established risk factors (including inflammation) and from each other in all cohorts. Regarding cause-specific mortality, compared to low D-ROM levels (≤ 340 Carr U), very high D-ROM levels (>500 Carr U) were strongly associated with both cardiovascular (relative risk (RR), 5.09; 95 % CI, 2.67-9.69) and cancer mortality (RR, 4.34; 95 % CI, 2.31-8.16). TTL was only associated with CVD mortality (RR, 1.30; 95 % CI, 1.15-1.48, for one-standard-deviation-decrease). The strength of the association of TTL with CVD mortality increased with age of the participants (RR for one-standard-deviation-decrease in those aged 70-85 years was 1.65; 95 % CI, 1.22-2.24). In these four population-based cohort studies from Central and Eastern Europe, the oxidative stress serum markers D-ROM and TTL were independently and strongly associated with all-cause and CVD mortality. In addition, D-ROM levels were also strongly associated with cancer mortality. This study provides epidemiological evidence supporting the free radical/oxidative stress theory of ageing and suggests that d-ROMs and TTL are useful oxidative stress markers associated with premature mortality.

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease.

PubMed

Gaglioti, Anne H; Xu, Junjun; Rollins, Latrice; Baltrus, Peter; O'Connell, Laura Kathryn; Cooper, Dexter L; Hopkins, Jammie; Botchwey, Nisha D; Akintobi, Tabia Henry

2018-02-01

Cardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD. We examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city. We found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality. This study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes.

Neighborhood Environmental Health and Premature Death From Cardiovascular Disease

PubMed Central

Xu, Junjun; Rollins, Latrice; Baltrus, Peter; O’Connell, Laura Kathryn; Cooper, Dexter L.; Hopkins, Jammie; Botchwey, Nisha D.; Akintobi, Tabia Henry

2018-01-01

Introduction Cardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD. Methods We examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city. Results We found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality. Conclusion This study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes. PMID:29389312

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.

Attenuating the mortality risk of high serum uric acid: the role of physical activity underused.

PubMed

Chen, Jiunn-Horng; Wen, Chi Pang; Wu, Shiuan Bei; Lan, Joung-Liang; Tsai, Min Kuang; Tai, Ya-Ping; Lee, June Han; Hsu, Chih Cheng; Tsao, Chwen Keng; Wai, Jackson Pui Man; Chiang, Po Huang; Pan, Wen Han; Hsiung, Chao Agnes

2015-11-01

High serum uric acid (sUA) has been associated with increased mortality risks, but its clinical treatment varied with potential side effects. The role of physical activity has received limited attention. A cohort, consisting of 467 976 adults, who went through a standard health screening programme, with questionnaire and fasting blood samples, was successively recruited between 1996 and 2008. High sUA is defined as uric acid above 7.0 mg/dL. Leisure time physical activity level was self-reported, with fully active defined as those with 30 min per day for at least 5 days a week. National death file identified 12 228 deaths with a median follow-up of 8.5 years. Cox proportional model was used to analyse HRs, and 12 variables were controlled, including medical history, life style and risk factors. High sUA constituted one quarter of the cohort (25.6%). Their all-cause mortality was significantly increased [HR: 1.22 (1.15-1.29)], with much of the increase contributed to by the inactive (HR: 1.27 (1.17-1.37)), relative to the reference group with sUA level of 5-6 mg/dL. When they were fully active, mortality risks did not increase, but decreased by 11% (HR: 0.89 (0.82-0.97)), reflecting the benefits of being active was able to overcome the adverse effects of high sUA. Given the same high sUA, a 4-6 years difference in life expectancy was found between the active and the inactive. Physical activity is a valuable alternative to pharmacotherapy in its ability to reduce the increases in mortality risks from high sUA. By being fully active, exercise can extend life span by 4-6 years, a level greater than the 1-4 years of life-shortening effect from high sUA. 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.

Nationwide In-hospital Mortality Following Pancreatic Surgery in Germany is Higher than Anticipated.

PubMed

Nimptsch, Ulrike; Krautz, Christian; Weber, Georg F; Mansky, Thomas; Grützmann, Robert

2016-12-01

We aimed to determine the unbiased mortality rates for pancreatic surgery procedures at the national level through a comprehensive analysis of every inpatient case in Germany. Several studies have proclaimed a general improvement of perioperative outcomes following pancreatic surgery. These results are challenged by recent analyses of large US databases that found strong volume-outcome relationships, with high mortality in low-volume facilities. All inpatient cases with a pancreatic surgery procedure code in Germany from 2009 to 2013 were identified from nationwide administrative hospital data. We determined the absolute number of patients and the in-hospital death rate for crucial subcategories such as medical indications and types of surgical procedure. A total of 58,003 inpatient episodes of pancreatic surgery were identified between 2009 and 2013. Annual case numbers increased significantly, which was primarily attributed to patients aged 70 years and older. The overall in-hospital mortality rate (10.1%) did not significantly change during the study period. Major pancreatic resections were associated with mortality ranging from 7.3% (distal pancreatectomy) to 22.9% (total pancreatectomy). Postoperative interventions indicative of severe complications were documented frequently (eg, more than 6 blood transfusions in 20% of all patients and relaparotomy in 16%). Their occurrence was associated with a dramatic increase in mortality. At the national level in Germany, perioperative mortality is higher than anticipated from previous studies. The absence of a significant reduction in overall mortality challenges current health policies that aim to improve the outcomes of high-risk surgical procedures in Germany.

Interest in health screening as a predictor of long-term overall mortality: multilevel analysis of a Japanese national cohort study.

PubMed

Fujino, Yoshihisa; Tanabe, Naohito; Honjo, Kaori; Suzuki, Sadao; Iso, Hiroyasu; Tamakoshi, Akiko

2011-01-01

In Japan, screening programmes have been widely implemented as a public health practice. We investigated the effect of the area-level interest in health screening on mortality using data from a large cohort in Japan. A baseline survey was conducted between 1988 and 1990 among 110,792 residents of 45 areas, aged 40-79 years. Area-level interest in health screening was defined as the proportion of people with high and moderate interest in health screening in an area. Multilevel Poisson regression was employed in a two-level structure of individuals nested within the areas. During 15 years of follow-up (1,035,617 person-years), 13,184 deaths were observed. The reduction in mortality rate was (a) 2% in both men (p=0.009) and women (p=0.038) for each percent increase in area-level interest in screening, and (b) 10% in men (p=0.001) and 9% in women (p=0.001) for individual attendance to screening in the year before follow-up. There was no interaction between area-level interest in screening, individual-level attendance at screening and overall mortality. Area-level and individual interest for health screening appear to be independent predictor of 15-year mortality in this national Japanese study. The present findings may support public health practices to promote knowledge and participation in screening programmes. Copyright © 2010 Elsevier Inc. All rights reserved.

Asthma and Hispanic Americans

MedlinePlus

... as bronchitis. Children living below or near the poverty level are more likely to have high levels ... www.cdc.gov/nchs/hdi.htm The proportional impact of asthma prevalence, health care use and mortality ...

Shifting visions: "delegation" policies and the building of a "rights-based" approach to maternal mortality.

PubMed

Freedman, Lynn P

2002-01-01

"Rights-based" approaches fold human rights principles into the ongoing work of health policy making and programming. The example of delegation of anesthesia provision for emergency obstetric care is used to demonstrate how a rights-based approach, applied to this problem in the context of high-mortality countries, requires decision makers to shift from an individual, ethics-based, clinical perspective to a structural, rights-based, public health perspective. This fluid and context-sensitive approach to human rights also applies at the international level, where the direction of overall maternal mortality reduction strategy is set. By contrasting family planning programs and maternal mortality programs, this commentary argues for choosing the human rights approach that speaks most effectively to the power dynamics underlying the particular health problem being addressed. In the case of maternal death in high-mortality countries, this means a strategic focus on the health care system itself.

Spatial variability of excess mortality during prolonged dust events in a high-density city: a time-stratified spatial regression approach.

PubMed

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

2017-07-24

Dust events have long been recognized to be associated with a higher mortality risk. However, no study has investigated how prolonged dust events affect the spatial variability of mortality across districts in a downwind city. In this study, we applied a spatial regression approach to estimate the district-level mortality during two extreme dust events in Hong Kong. We compared spatial and non-spatial models to evaluate the ability of each regression to estimate mortality. We also compared prolonged dust events with non-dust events to determine the influences of community factors on mortality across the city. The density of a built environment (estimated by the sky view factor) had positive association with excess mortality in each district, while socioeconomic deprivation contributed by lower income and lower education induced higher mortality impact in each territory planning unit during a prolonged dust event. Based on the model comparison, spatial error modelling with the 1st order of queen contiguity consistently outperformed other models. The high-risk areas with higher increase in mortality were located in an urban high-density environment with higher socioeconomic deprivation. Our model design shows the ability to predict spatial variability of mortality risk during an extreme weather event that is not able to be estimated based on traditional time-series analysis or ecological studies. Our spatial protocol can be used for public health surveillance, sustainable planning and disaster preparation when relevant data are available.

Lipid-lowering therapy in older persons

PubMed Central

2015-01-01

Numerous randomized, double-blind, placebo-controlled studies and observational studies have shown that statins reduce mortality and major cardiovascular events in older high-risk persons with hypercholesterolemia. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in high-risk persons regardless of the initial level of serum lipids, age, or gender. The updated National Cholesterol Education Program III guidelines state that in very high-risk persons, a serum low-density lipoprotein (LDL) cholesterol level of < 70 mg/dl (1.8 mmol/l) is a reasonable clinical strategy for moderately high-risk persons (2 or more risk factors and a 10-year risk for coronary artery disease of 10% to 20%), and the serum LDL cholesterol should be reduced to < 100 mg/dl (2.6 mmol/l). When LDL cholesterol-lowering drug therapy is used to treat high-risk persons or moderately high-risk persons, the serum LDL cholesterol should be reduced by at least 30% to 40%. The serum LDL cholesterol should be decreased to less than 160 mg/dl in persons at low risk for cardiovascular disease. Addition of other lipid-lowering drugs to statin therapy has not been demonstrated to further reduce cardiovascular events and mortality. PMID:25861289

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006–2010

PubMed Central

Florey, Lia S.; Bennett, Adam; Hershey, Christine L.; Bhattarai, Achuyt; Nielsen, Carrie F.; Ali, Doreen; Luhanga, Misheck; Taylor, Cameron; Eisele, Thomas P.; Yé, Yazoume

2017-01-01

Abstract. Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62–90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60–0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006–2010 in Malawi and represent a novel use of district-level data from nationally representative surveys. PMID:28990922

Economic status and temperature-related mortality in Asia

NASA Astrophysics Data System (ADS)

Lim, Youn-Hee; Bell, Michelle L.; Kan, Haidong; Honda, Yasushi; Guo, Yue-Liang Leon; Kim, Ho

2015-10-01

In developed countries, low latitude and high temperature are positively associated with the population's ability to adapt to heat. However, few studies have examined the effect of economic status on the relationship between long-term exposure to high temperature and health. We compared heterogeneous temperature-related mortality effects relative to the average summer temperature in high-socioeconomic-status (SES) cities to temperature-related effects in low-SES cities. In the first stage of the research, we conducted a linear regression analysis to quantify the mortality effects of high temperature (at or above the 95th percentile) in 32 cities in Taiwan, China, Japan, and Korea. In the second stage, we used a meta-regression to examine the association between mortality risk with average summer temperature and gross domestic product (GDP) per capita. In cities with a low GDP per capita (less than 20,000 USD), the effects of temperature were detrimental to the population if the long-term average summer temperature was high. In contrast, in cities with a high GDP per capita, temperature-related mortality risk was not significantly related to average summer temperature. The relationship between long-term average summer temperature and the short-term effects of high temperatures differed based on the city-level economic status.

Mortality and morbidity in the 21st century.

PubMed

Case, Anne; Deaton, Angus

2017-01-01

We build on and extend the findings in Case and Deaton (2015) on increases in mortality and morbidity among white non-Hispanic Americans in midlife since the turn of the century. Increases in all-cause mortality continued unabated to 2015, with additional increases in drug overdoses, suicides, and alcohol-related liver mortality, particularly among those with a high-school degree or less. The decline in mortality from heart disease has slowed and, most recently, stopped, and this combined with the three other causes is responsible for the increase in all-cause mortality. Not only are educational differences in mortality among whites increasing, but from 1998 to 2015 mortality rose for those without, and fell for those with, a college degree. This is true for non-Hispanic white men and women in all five year age groups from 35-39 through 55-59. Mortality rates among blacks and Hispanics continued to fall; in 1999, the mortality rate of white non-Hispanics aged 50-54 with only a high-school degree was 30 percent lower than the mortality rate of blacks in the same age group but irrespective of education; by 2015, it was 30 percent higher . There are similar crossovers in all age groups from 25-29 to 60-64. Mortality rates in comparable rich countries have continued their pre-millennial fall at the rates that used to characterize the US. In contrast to the US, mortality rates in Europe are falling for those with low levels of educational attainment, and have fallen further over this period than mortality rates for those with higher levels of education. Many commentators have suggested that poor mortality outcomes can be attributed to contemporaneous levels of resources, particularly to slowly growing, stagnant, and even declining incomes; we evaluate this possibility, but find that it cannot provide a comprehensive explanation. In particular, the income profiles for blacks and Hispanics, whose mortality rates have fallen, are no better than those for whites. Nor is there any evidence in the European data that mortality trends match income trends, in spite of sharply different patterns of median income across countries after the Great Recession. We propose a preliminary but plausible story in which cumulative disadvantage from one birth cohort to the next, in the labor market, in marriage and child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65. This is in contrast to an account in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this implies that there are no policy levers to be pulled; preventing the over-prescription of opioids is an obvious target that would clearly be helpful.

Mediational pathways connecting secondary education and age at marriage to maternal mortality: A comparison between developing and developed countries.

PubMed

Hagues, Rachel Joy; Bae, DaYoung; Wickrama, Kandauda K A S

2017-02-01

While studies have shown that maternal mortality rates have been improving worldwide, rates are still high across developing nations. In general, poor health of women is associated with higher maternal mortality rates in developing countries. Understanding country-level risk factors can inform intervention and prevention efforts that could bring high maternal mortality rates down. Specifically, the authors were interested in investigating whether: (1) secondary education participation (SEP) or age at marriage (AM) of women were related to maternal mortality rates, and (2) adolescent birth rate and contraceptive use (CU) acted as mediators of this association. The authors add to the literature with this current article by showing the relation of SEP and AM to maternal mortality rates globally (both directly and indirectly through mediators) and then by comparing differences between developed and developing/least developed countries. Path analysis was used to test the hypothesized model using country level longitudinal data from 2000 to 2010 obtained from United Nations publications, World Health Organization materials, and World Bank development reports. Findings include a significant correlation between SEP and AM for developing countries; for developed countries the relation was not significant. As well, SEP in developing countries was associated with increased CU. Women in developing countries who finish school before marriage may have important social capital gains.

Mortality analysis by neighbourhood in a city with high levels of industrial air pollution.

PubMed

Vigotti, Maria Angela; Mataloni, Francesca; Bruni, Antonella; Minniti, Caterina; Gianicolo, Emilio A L

2014-08-01

Taranto, a city in south-eastern Italy, suffers serious environmental pollution from industrial sources. A previous cohort analysis found mortality excesses among neighbourhoods closest to industrial areas. Aim of this study was to investigate whether mortality also increased in other neighbourhoods compared to Apulia region. Standardized mortality ratios were computed. Number of deaths and of person-years at risk by neighbourhood came from the previous cohort study for 1998-2008 period. Reference population was Apulia region excluding Taranto province. A meta-analysis was conducted across less close neighbourhoods computing summary SMR estimates and evaluating heterogeneity. For the entire city higher mortality values are confirmed for all causes, all malignant neoplasms and several specific sites, neurological, cardiac, respiratory and digestive diseases. High mortality values are not confined to neighbourhoods closest to industrial areas for lung cancer, cardiac, respiratory and digestive diseases, in both sexes, and among women for all malignant neoplasms and pancreatic cancer. Increased mortality risks can also be observed in Taranto neighbourhoods not directly adjacent to industrial areas. Spatial trend, impact of socio-economic factors and duration of residence should be further explored.

The contribution of hospital nursing leadership styles to 30-day patient mortality.

PubMed

Cummings, Greta G; Midodzi, William K; Wong, Carol A; Estabrooks, Carole A

2010-01-01

Nursing work environment characteristics, in particular nurse and physician staffing, have been linked to patient outcomes (adverse events and patient mortality). Researchers have stressed the need for nursing leadership to advance change in healthcare organizations to create safer practice environments for patients. The relationship between styles of nursing leadership in hospitals and patient outcomes has not been well examined. The purpose of this study was to examine the contribution of hospital nursing leadership styles to 30-day mortality after controlling for patient demographics, comorbidities, and hospital factors. Ninety acute care hospitals in Alberta, Canada, were categorized into five styles of nursing leadership: high resonant, moderately resonant, mixed, moderately dissonant, and high dissonant. In the secondary analysis, existing data from three sources (nurses, patients, and institutions) were used to test a hypothesis that the styles of nursing leadership at the hospital level contribute to patient mortality rates. Thirty-day mortality was 7.8% in the study sample of 21,570 medical patients; rates varied across hospital categories: high resonant (5.2%), moderately resonant (7.4%), mixed (8.1%), moderately dissonant (8.8%), and high dissonant (4.3%). After controlling for patient demographics, comorbidities, and institutional and hospital nursing characteristics, nursing leadership styles explained 5.1% of 72.2% of total variance in mortality across hospitals, and high-resonant leadership was related significantly to lower mortality. Hospital nursing leadership styles may contribute to 30-day mortality of patients. This relationship may be moderated by homogeneity of leadership styles, clarity of communication among leaders and healthcare providers, and work environment characteristics.

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.

Ambient temperature enhanced acute cardiovascular-respiratory mortality effects of PM2.5 in Beijing, China.

PubMed

Li, Yi; Ma, Zhiqiang; Zheng, Canjun; Shang, Yu

2015-12-01

Studies have shown that temperature could modify the effect of ambient fine particles on mortality risk. In assessing air pollution effects, temperature is usually considered as a confounder. However, ambient temperature can alter people's physiological response to air pollution and might "modify" the impact of air pollution on health outcomes. This study investigated the interaction between daily PM2.5 and daily mean temperature in Beijing, China, using data for the period 2005-2009. Bivariate PM2.5-temperature response surfaces and temperature-stratified generalized additive model (GAM) were applied to study the effect of PM2.5 on cardiovascular, respiratory mortality, and total non-accidental mortality across different temperature levels. We found that low temperature could significantly enhance the effect of PM2.5 on cardiovascular mortality. For an increase of 10 μg/m(3) in PM2.5 concentration in the lowest temperature range (-9.7∼2.6 °C), the relative risk (RR) of cardiovascular mortality increased 1.27 % (95 % CI 0.38∼2.17 %), which was higher than that of the whole temperature range (0.59 %, 95 % CI 0.22-1.16 %). The largest effect of PM2.5 on respiratory mortality appeared in the high temperature range. For an increase of 10 μg/m(3) in PM2.5 concentration, RR of respiratory mortality increased 1.70 % (95 % CI 0.92∼3.33 %) in the highest level (23.50∼31.80 °C). For the total non-accidental mortality, significant associations appeared only in low temperature levels (-9.7∼2.6 °C): for an increase of 10 μg/m(3) in current day PM2.5 concentration, RR increased 1.27 % (95 % CI 0.46∼2.00 %) in the lowest temperature level. No lag effect was observed. The results suggest that in air pollution mortality time series studies, the possibility of an interaction between air pollution and temperature should be considered.

Ambient temperature enhanced acute cardiovascular-respiratory mortality effects of PM2.5 in Beijing, China

NASA Astrophysics Data System (ADS)

Li, Yi; Ma, Zhiqiang; Zheng, Canjun; Shang, Yu

2015-12-01

Studies have shown that temperature could modify the effect of ambient fine particles on mortality risk. In assessing air pollution effects, temperature is usually considered as a confounder. However, ambient temperature can alter people's physiological response to air pollution and might "modify" the impact of air pollution on health outcomes. This study investigated the interaction between daily PM2.5 and daily mean temperature in Beijing, China, using data for the period 2005-2009. Bivariate PM2.5-temperature response surfaces and temperature-stratified generalized additive model (GAM) were applied to study the effect of PM2.5 on cardiovascular, respiratory mortality, and total non-accidental mortality across different temperature levels. We found that low temperature could significantly enhance the effect of PM2.5 on cardiovascular mortality. For an increase of 10 μg/m3 in PM2.5 concentration in the lowest temperature range (-9.7˜2.6 °C), the relative risk (RR) of cardiovascular mortality increased 1.27 % (95 % CI 0.38˜2.17 %), which was higher than that of the whole temperature range (0.59 %, 95 % CI 0.22-1.16 %). The largest effect of PM2.5 on respiratory mortality appeared in the high temperature range. For an increase of 10 μg/m3 in PM2.5 concentration, RR of respiratory mortality increased 1.70 % (95 % CI 0.92˜3.33 %) in the highest level (23.50˜31.80 °C). For the total non-accidental mortality, significant associations appeared only in low temperature levels (-9.7˜2.6 °C): for an increase of 10 μg/m3 in current day PM2.5 concentration, RR increased 1.27 % (95 % CI 0.46˜2.00 %) in the lowest temperature level. No lag effect was observed. The results suggest that in air pollution mortality time series studies, the possibility of an interaction between air pollution and temperature should be considered.

Making sense of differing overdose mortality: contributions to improved understanding of European patterns.

PubMed

Waal, Helge; Gossop, Michael

2014-01-01

The European Monitoring Centre for Drugs and Drug Addiction, EMCDDA, publishes statistics for overdose deaths giving a European mean number, and ranking nations in a national 'league table' for overdose deaths. The interpretation of differing national levels of mortality is more problematic and more complex than is usually recognised. Different systems are used to compile mortality data and this causes problems for cross-national comparisons. Addiction behaviour can only be properly understood within its specific social and environmental ecology. Risk factors for overdose, such as the type of drug consumed, and the route of administration, are known to differ across countries. This paper describes problems associated with ranking and suggests how mortality data might be used in high-level countries aiming at reduction in the number of overdose deaths. Copyright © 2013 S. Karger AG, Basel.

Associations of marital status with mortality from all causes and mortality from cardiovascular disease in Japanese haemodialysis patients.

PubMed

Tanno, Kozo; Ohsawa, Masaki; Itai, Kazuyoshi; Kato, Karen; Turin, Tanvir Chowdhury; Onoda, Toshiyuki; Sakata, Kiyomi; Okayama, Akira; Fujioka, Tomoaki

2013-04-01

Marital status is an important social factor associated with increased mortality from cardiovascular disease (CVD) and all causes. However, there has been no study on the association of marital status with mortality in haemodialysis patients. We analysed data from a 5-year prospective cohort study of 1064 Japanese haemodialysis patients aged 30 years or older. Marital status was classified into three groups: married, single and divorced/widowed. Cox's regression was used to estimate multivariate hazard ratios (HRs) [95% confidence intervals (CIs)] for all-cause mortality and CVD mortality according to marital status after adjusting for age, sex, duration of haemodialysis, cause of renal failure, body mass index, systolic blood pressure, total cholesterol, high density lipoprotein-cholesterol, albumin, high-sensitivity C-reactive protein, co-morbid conditions, smoking, alcohol consumption, education levels and job status. Single patients had higher risks than married patients for mortality from all causes (HR = 1.51, 95% CI: 1.06-2.16) and mortality from CVD (HR = 1.68, 95% CI: 1.03-2.76), and divorced/widowed patients had a higher risk than married patients for mortality from CVD (HR = 1.73, 95% CI: 1.15-2.60). After stratification by age, single patients aged 30-59 years had significantly higher risks for all-cause mortality and CVD mortality. The findings suggest that single status is a significant predictor for all-cause mortality and CVD mortality and that divorced/widowed status is a significant predictor for CVD mortality in haemodialysis patients.

The short-term association of temperature and rainfall with mortality in Vadu Health and Demographic Surveillance System: a population level time series analysis

PubMed Central

Ingole, Vijendra; Juvekar, Sanjay; Muralidharan, Veena; Sambhudas, Somnath; Rocklöv, Joacim

2012-01-01

Background Research in mainly developed countries has shown that some changes in weather are associated with increased mortality. However, due to the lack of accessible data, few studies have examined such effects of weather on mortality, particularly in rural regions in developing countries. Objective In this study, we aimed to investigate the relationship between temperature and rainfall with daily mortality in rural India. Design Daily mortality data were obtained from the Health and Demographic Surveillance System (HDSS) in Vadu, India. Daily mean temperature and rainfall data were obtained from a regional meteorological center, India Meteorological Department (IMD), Pune. A Poisson regression model was established over the study period (January 2003–May 2010) to assess the short-term relationship between weather variables and total mortality, adjusting for time trends and stratifying by both age and sex. Result Mortality was found to be significantly associated with daily ambient temperatures and rainfall, after controlling for seasonality and long-term time trends. Children aged 5 years or below appear particularly susceptible to the effects of warm and cold temperatures and heavy rainfall. The population aged 20–59 years appeared to face increased mortality on hot days. Most age groups were found to have increased mortality rates 7–13 days after rainfall events. This association was particularly evident in women. Conclusion We found the level of mortality in Vadu HDSS in rural India to be highly affected by both high and low temperatures and rainfall events, with time lags of up to 2 weeks. These results suggest that weather-related mortality may be a public health problem in rural India today. Furthermore, as changes in local climate occur, adaptation measures should be considered to mitigate the potentially negative impacts on public health in these rural communities. PMID:23195513

Hospital Spending and Inpatient Mortality: Evidence from California

PubMed Central

Romley, John A.; Jena, Anupam B.; Goldman, Dana P.

2013-01-01

Background Evidence shows that high Medicare spending is not associated with better health outcomes at a regional level, and that high spending in hospitals is not associated with better process quality. But the relationship between hospital spending and inpatient mortality is less well understood. Objective To determine the association between hospital spending and risk-adjusted inpatient mortality. Design Retrospective cohort study. Setting Database of discharge records from 1999–2008 for 208 California hospitals included in the Dartmouth Atlas of Health Care Patients 2,545,352 patients hospitalized during 1999–2008 with one of six major medical conditions. Measurements Inpatient mortality rates among patients admitted to hospitals with varying levels of end-of-life hospital spending. Results For each of six admitting diagnoses – acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia – patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality. During 1999–2003, for example, patients admitted with acute myocardial infarction to California hospitals in the highest quintile of hospital spending had lower inpatient mortality than those admitted to hospitals in the lowest quintile (odds ratio of mortality 0.862, 95% confidence interval 0.742–0.983). Predicted inpatient deaths would increase by 1,831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. The association between hospital spending and inpatient mortality did not vary by geographic region or hospital size. Limitations Unobserved predictors of mortality create uncertainty about whether greater inpatient hospital spending leads to lower inpatient mortality. Conclusion Hospitals that spend more at the end of life have lower inpatient mortality for a variety of major admitting medical conditions. Primary funding source National Institute on Aging, RAND Bing Center for Health Economics PMID:21282695

Arsenic levels in drinking water and mortality of liver cancer in Taiwan.

PubMed

Lin, Hung-Jung; Sung, Tzu-I; Chen, Chi-Yi; Guo, How-Ran

2013-11-15

The carcinogenic effect of arsenic is well documented, but epidemiologic data on liver cancer were limited. To evaluate the dose-response relationship between arsenic in drinking water and mortality of liver cancer, we conducted a study in 138 villages in the southwest coast area of Taiwan. We assessed arsenic levels in drinking water using data from a survey conducted by the government and reviewed death certificates from 1971 to 1990 to identify liver cancer cases. Using village as the unit, we conducted multi-variate regression analyses and then performed post hoc analyses to validate the findings. During the 20-year period, 802 male and 301 female mortality cases of liver cancer were identified. After adjusting for age, arsenic levels above 0.64 mg/L were associated with an increase in the liver cancer mortality in both genders, but no significant effect was observed for lower exposure categories. Post hoc analyses and a review of literature supported these findings. We concluded that exposures to high arsenic levels in drinking water are associated with the occurrence of liver cancer, but such an effect is not prominent at exposure levels lower than 0.64 mg/L. Copyright © 2013 Elsevier B.V. All rights reserved.

The entropy of the life table: A reappraisal.

PubMed

Fernandez, Oscar E; Beltrán-Sánchez, Hiram

2015-09-01

The life table entropy provides useful information for understanding improvements in mortality and survival in a population. In this paper we take a closer look at the life table entropy and use advanced mathematical methods to provide additional insights for understanding how it relates to changes in mortality and survival. By studying the entropy (H) as a functional, we show that changes in the entropy depend on both the relative change in life expectancy lost due to death (e(†)) and in life expectancy at birth (e0). We also show that changes in the entropy can be further linked to improvements in premature and older deaths. We illustrate our methods with empirical data from Latin American countries, which suggests that at high mortality levels declines in H (which are associated with survival increases) linked with larger improvements in e0, whereas at low mortality levels e(†) made larger contributions to H. We additionally show that among countries with low mortality level, contributions of e(†) to changes in the life table entropy resulted from averting early deaths. These findings indicate that future increases in overall survival in low mortality countries will likely result from improvements in e(†). Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of Extrinsic Mortality on the Evolution of Aging: A Stochastic Modeling Approach

PubMed Central

Shokhirev, Maxim Nikolaievich; Johnson, Adiv Adam

2014-01-01

The evolutionary theories of aging are useful for gaining insights into the complex mechanisms underlying senescence. Classical theories argue that high levels of extrinsic mortality should select for the evolution of shorter lifespans and earlier peak fertility. Non-classical theories, in contrast, posit that an increase in extrinsic mortality could select for the evolution of longer lifespans. Although numerous studies support the classical paradigm, recent data challenge classical predictions, finding that high extrinsic mortality can select for the evolution of longer lifespans. To further elucidate the role of extrinsic mortality in the evolution of aging, we implemented a stochastic, agent-based, computational model. We used a simulated annealing optimization approach to predict which model parameters predispose populations to evolve longer or shorter lifespans in response to increased levels of predation. We report that longer lifespans evolved in the presence of rising predation if the cost of mating is relatively high and if energy is available in excess. Conversely, we found that dramatically shorter lifespans evolved when mating costs were relatively low and food was relatively scarce. We also analyzed the effects of increased predation on various parameters related to density dependence and energy allocation. Longer and shorter lifespans were accompanied by increased and decreased investments of energy into somatic maintenance, respectively. Similarly, earlier and later maturation ages were accompanied by increased and decreased energetic investments into early fecundity, respectively. Higher predation significantly decreased the total population size, enlarged the shared resource pool, and redistributed energy reserves for mature individuals. These results both corroborate and refine classical predictions, demonstrating a population-level trade-off between longevity and fecundity and identifying conditions that produce both classical and non-classical lifespan effects. PMID:24466165

Detecting early warning signals of tree mortality in boreal North America using multiscale satellite data.

PubMed

Rogers, Brendan M; Solvik, Kylen; Hogg, Edward H; Ju, Junchang; Masek, Jeffrey G; Michaelian, Michael; Berner, Logan T; Goetz, Scott J

2018-06-01

Increasing tree mortality from global change drivers such as drought and biotic infestations is a widespread phenomenon, including in the boreal zone where climate changes and feedbacks to the Earth system are relatively large. Despite the importance for science and management communities, our ability to forecast tree mortality at landscape to continental scales is limited. However, two independent information streams have the potential to inform and improve mortality forecasts: repeat forest inventories and satellite remote sensing. Time series of tree-level growth patterns indicate that productivity declines and related temporal dynamics often precede mortality years to decades before death. Plot-level productivity, in turn, has been related to satellite-based indices such as the Normalized difference vegetation index (NDVI). Here we link these two data sources to show that early warning signals of mortality are evident in several NDVI-based metrics up to 24 years before death. We focus on two repeat forest inventories and three NDVI products across western boreal North America where productivity and mortality dynamics are influenced by periodic drought. These data sources capture a range of forest conditions and spatial resolution to highlight the sensitivity and limitations of our approach. Overall, results indicate potential to use satellite NDVI for early warning signals of mortality. Relationships are broadly consistent across inventories, species, and spatial resolutions, although the utility of coarse-scale imagery in the heterogeneous aspen parkland was limited. Longer-term NDVI data and annually remeasured sites with high mortality levels generate the strongest signals, although we still found robust relationships at sites remeasured at a typical 5 year frequency. The approach and relationships developed here can be used as a basis for improving forest mortality models and monitoring systems. © 2018 John Wiley & Sons Ltd.

Simulated leakage of high pCO2 water negatively impacts bivalve dominated infaunal communities from the Western Baltic Sea

NASA Astrophysics Data System (ADS)

Schade, Hanna; Mevenkamp, Lisa; Guilini, Katja; Meyer, Stefanie; Gorb, Stanislav N.; Abele, Doris; Vanreusel, Ann; Melzner, Frank

2016-08-01

Carbon capture and storage is promoted as a mitigation method counteracting the increase of atmospheric CO2 levels. However, at this stage, environmental consequences of potential CO2 leakage from sub-seabed storage sites are still largely unknown. In a 3-month-long mesocosm experiment, this study assessed the impact of elevated pCO2 levels (1,500 to 24,400 μatm) on Cerastoderma edule dominated benthic communities from the Baltic Sea. Mortality of C. edule was significantly increased in the highest treatment (24,400 μatm) and exceeded 50%. Furthermore, mortality of small size classes (0-1 cm) was significantly increased in treatment levels ≥6,600 μatm. First signs of external shell dissolution became visible at ≥1,500 μatm, holes were observed at >6,600 μatm. C. edule body condition decreased significantly at all treatment levels (1,500-24,400 μatm). Dominant meiofauna taxa remained unaffected in abundance. Densities of calcifying meiofauna taxa (i.e. Gastropoda and Ostracoda) decreased in high CO2 treatments (>6,600 μatm), while the non - calcifying Gastrotricha significantly increased in abundance at 24,400 μatm. In addition, microbial community composition was altered at the highest pCO2 level. We conclude that strong CO2 leakage can alter benthic infauna community composition at multiple trophic levels, likely due to high mortality of the dominant macrofauna species C. edule.

Simulated leakage of high pCO2 water negatively impacts bivalve dominated infaunal communities from the Western Baltic Sea.

PubMed

Schade, Hanna; Mevenkamp, Lisa; Guilini, Katja; Meyer, Stefanie; Gorb, Stanislav N; Abele, Doris; Vanreusel, Ann; Melzner, Frank

2016-08-19

Carbon capture and storage is promoted as a mitigation method counteracting the increase of atmospheric CO2 levels. However, at this stage, environmental consequences of potential CO2 leakage from sub-seabed storage sites are still largely unknown. In a 3-month-long mesocosm experiment, this study assessed the impact of elevated pCO2 levels (1,500 to 24,400 μatm) on Cerastoderma edule dominated benthic communities from the Baltic Sea. Mortality of C. edule was significantly increased in the highest treatment (24,400 μatm) and exceeded 50%. Furthermore, mortality of small size classes (0-1 cm) was significantly increased in treatment levels ≥6,600 μatm. First signs of external shell dissolution became visible at ≥1,500 μatm, holes were observed at >6,600 μatm. C. edule body condition decreased significantly at all treatment levels (1,500-24,400 μatm). Dominant meiofauna taxa remained unaffected in abundance. Densities of calcifying meiofauna taxa (i.e. Gastropoda and Ostracoda) decreased in high CO2 treatments (>6,600 μatm), while the non - calcifying Gastrotricha significantly increased in abundance at 24,400 μatm. In addition, microbial community composition was altered at the highest pCO2 level. We conclude that strong CO2 leakage can alter benthic infauna community composition at multiple trophic levels, likely due to high mortality of the dominant macrofauna species C. edule.

Increased Tuberculosis Patient Mortality Associated with Mycobacterium tuberculosis Mutations Conferring Resistance to Second-Line Antituberculous Drugs

PubMed Central

Seifert, Marva; Garfein, Richard S.; Rodwell, Timothy C.

2017-01-01

ABSTRACT Rapid molecular diagnostics have great potential to limit the spread of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) (M/XDR-TB). These technologies detect mutations in the Mycobacterium tuberculosis genome that confer phenotypic drug resistance. However, there have been few data published regarding the relationships between the detected M. tuberculosis resistance mutations and M/XDR-TB treatment outcomes, limiting our current ability to exploit the full potential of molecular diagnostics. We analyzed clinical, microbiological, and sequencing data for 451 patients and their clinical isolates collected in a multinational, observational cohort study to determine if there was an association between M. tuberculosis resistance mutations and patient mortality. The presence of an rrs 1401G mutation was associated with significantly higher odds of patient mortality (adjusted odds ratio [OR] = 5.72; 95% confidence interval [CI], 1.65 to 19.84]) after adjusting for relevant patient clinical characteristics and all other resistance mutations. Further analysis of mutations, categorized by the associated resistance level, indicated that the detection of mutations associated with high-level fluoroquinolone (OR, 3.99 [95% CI, 1.10 to 14.40]) and kanamycin (OR, 5.47 [95% CI, 1.64 to 18.24]) resistance was also significantly associated with higher odds of patient mortality, even after accounting for clinical site, patient age, reported smoking history, body mass index (BMI), diabetes, HIV, and all other resistance mutations. Specific gyrA and rrs resistance mutations, associated with high-level resistance, were associated with patient mortality as identified in clinical M. tuberculosis isolates from a diverse M/XDR-TB patient population at three high-burden clinical sites. These results have important implications for the interpretation of molecular diagnostics, including identifying patients at increased risk for mortality during treatment. (This study has been registered at ClinicalTrials.gov under registration no. NCT02170441.) PMID:28404672

Increased Tuberculosis Patient Mortality Associated with Mycobacterium tuberculosis Mutations Conferring Resistance to Second-Line Antituberculous Drugs.

PubMed

Georghiou, Sophia B; Seifert, Marva; Catanzaro, Donald G; Garfein, Richard S; Rodwell, Timothy C

2017-06-01

Rapid molecular diagnostics have great potential to limit the spread of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) (M/XDR-TB). These technologies detect mutations in the Mycobacterium tuberculosis genome that confer phenotypic drug resistance. However, there have been few data published regarding the relationships between the detected M. tuberculosis resistance mutations and M/XDR-TB treatment outcomes, limiting our current ability to exploit the full potential of molecular diagnostics. We analyzed clinical, microbiological, and sequencing data for 451 patients and their clinical isolates collected in a multinational, observational cohort study to determine if there was an association between M. tuberculosis resistance mutations and patient mortality. The presence of an rrs 1401G mutation was associated with significantly higher odds of patient mortality (adjusted odds ratio [OR] = 5.72; 95% confidence interval [CI], 1.65 to 19.84]) after adjusting for relevant patient clinical characteristics and all other resistance mutations. Further analysis of mutations, categorized by the associated resistance level, indicated that the detection of mutations associated with high-level fluoroquinolone (OR, 3.99 [95% CI, 1.10 to 14.40]) and kanamycin (OR, 5.47 [95% CI, 1.64 to 18.24]) resistance was also significantly associated with higher odds of patient mortality, even after accounting for clinical site, patient age, reported smoking history, body mass index (BMI), diabetes, HIV, and all other resistance mutations. Specific gyrA and rrs resistance mutations, associated with high-level resistance, were associated with patient mortality as identified in clinical M. tuberculosis isolates from a diverse M/XDR-TB patient population at three high-burden clinical sites. These results have important implications for the interpretation of molecular diagnostics, including identifying patients at increased risk for mortality during treatment. (This study has been registered at ClinicalTrials.gov under registration no. NCT02170441.). Copyright © 2017 American Society for Microbiology.

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.

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.

The impact of socioeconomic status and multimorbidity on mortality: a population-based cohort study.

PubMed

Lund Jensen, Nikoline; Pedersen, Henrik Søndergaard; Vestergaard, Mogens; Mercer, Stewart W; Glümer, Charlotte; Prior, Anders

2017-01-01

Multimorbidity (MM) is more prevalent among people of lower socioeconomic status (SES), and both MM and SES are associated with higher mortality rates. However, little is known about the relationship between SES, MM, and mortality. This study investigates the association between educational level and mortality, and to what extent MM modifies this association. We followed 239,547 individuals invited to participate in the Danish National Health Survey 2010 (mean follow-up time: 3.8 years). MM was assessed by using information on drug prescriptions and diagnoses for 39 long-term conditions. Data on educational level were provided by Statistics Denmark. Date of death was obtained from the Civil Registration System. Information on lifestyle factors and quality of life was collected from the survey. The main outcomes were overall and premature mortality (death before the age of 75). Of a total of 12,480 deaths, 6,607 (9.5%) were of people with low educational level (LEL) and 1,272 (2.3%) were of people with high educational level (HEL). The mortality rate was higher among people with LEL compared with HEL in groups of people with 0-1 disease (hazard ratio: 2.26, 95% confidence interval: 2.00-2.55) and ≥4 diseases (hazard ratio: 1.14, 95% confidence interval: 1.04-1.24), respectively (adjusted model). The absolute number of deaths was six times higher among people with LEL than those with HEL in those with ≥4 diseases. The 1-year cumulative mortality proportions for overall death in those with ≥4 diseases was 5.59% for people with HEL versus 7.27% for people with LEL, and 1-year cumulative mortality proportions for premature death was 2.93% for people with HEL versus 4.04% for people with LEL. Adjusting for potential mediating factors such as lifestyle and quality of life eliminated the statistical association between educational level and mortality in people with MM. Our study suggests that LEL is associated with higher overall and premature mortality and that the association is affected by MM, lifestyle factors, and quality of life.

HLA-inferred extended haplotype disparity level is more relevant than the level of HLA mismatch alone for the patients survival and GvHD in T cell-replate hematopoietic stem cell transplantation from unrelated donor.

PubMed

Nowak, Jacek; Nestorowicz, Klaudia; Graczyk-Pol, Elzbieta; Mika-Witkowska, Renata; Rogatko-Koros, Marta; Jaskula, Emilia; Koscinska, Katarzyna; Madej, Sylwia; Tomaszewska, Agnieszka; Nasilowska-Adamska, Barbara; Szczepinski, Andrzej; Halaburda, Kazimierz; Dybko, Jaroslaw; Kuliczkowski, Kazimierz; Czerw, Tomasz; Giebel, Sebastian; Holowiecki, Jerzy; Baranska, Malgorzata; Pieczonka, Anna; Wachowiak, Jacek; Czyz, Anna; Gil, Lidia; Lojko-Dankowska, Anna; Komarnicki, Mieczyslaw; Bieniaszewska, Maria; Kucharska, Agnieszka; Hellmann, Andrzej; Gronkowska, Anna; Jedrzejczak, Wieslaw W; Markiewicz, Miroslaw; Koclega, Anna; Kyrcz-Krzemien, Slawomira; Mielcarek, Monika; Kalwak, Krzysztof; Styczynski, Jan; Wysocki, Mariusz; Drabko, Katarzyna; Wojcik, Beata; Kowalczyk, Jerzy; Gozdzik, Jolanta; Pawliczak, Daria; Gwozdowicz, Slawomir; Dziopa, Joanna; Szlendak, Urszula; Witkowska, Agnieszka; Zubala, Marta; Gawron, Agnieszka; Warzocha, Krzysztof; Lange, Andrzej

2018-06-01

Serious risks in unrelated hematopoietic stem cell transplantation (HSCT) including graft versus host disease (GvHD) and mortality are associated with HLA disparity between donor and recipient. The increased risks might be dependent on disparity in not-routinely-tested multiple polymorphisms in genetically dense MHC region, being organized in combinations of two extended MHC haplotypes (Ehp). We assessed the clinical role of donor-recipient Ehp disparity levels in N = 889 patients by the population-based detection of HLA allele phase mismatch. We found increased GvHD incidences and mortality rates with increasing Ehp mismatch level even with the same HLA mismatch level. In multivariate analysis HLA mismatch levels were excluded from models and Ehp disparity level remained independent prognostic factor for high grade acute GvHD (p = 0.000037, HR = 10.68, 95%CI 5.50-32.5) and extended chronic GvHD (p < 0.000001, HR = 15.51, CI95% 5.36-44.8). In group with single HLA mismatch, patients with double Ehp disparity had worse 5-year overall survival (45% vs. 56%, p = 0.00065, HR = 4.05, CI95% 1.69-9.71) and non-relapse mortality (40% vs. 31%, p = 0.00037, HR = 5.63, CI95% 2.04-15.5) than patients with single Ehp disparity. We conclude that Ehp-linked factors contribute to the high morbidity and mortality in recipients given HLA-mismatched unrelated transplant and Ehp matching should be considered in clinical HSCT. Copyright © 2018. Published by Elsevier Inc.

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

PubMed Central

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

2016-01-01

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

Risk of death from cardiovascular disease associated with low-level arsenic exposure among long-term smokers in a US population-based study

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

Farzan, Shohreh F.; Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY; Chen, Yu

High levels of arsenic exposure have been associated with increases in cardiovascular disease risk. However, studies of arsenic's effects at lower exposure levels are limited and few prospective studies exist in the United States using long-term arsenic exposure biomarkers. We conducted a prospective analysis of the association between toenail arsenic and cardiovascular disease mortality using longitudinal data collected on 3939 participants in the New Hampshire Skin Cancer Study. Using Cox proportional hazard models adjusted for potential confounders, we estimated hazard ratios and 95% confidence intervals associated with the risk of death from any cardiovascular disease, ischemic heart disease, and stroke,more » in relation to natural-log transformed toenail arsenic concentrations. In this US population, although we observed no overall association, arsenic exposure measured from toenail clipping samples was related to an increased risk of ischemic heart disease mortality among long-term smokers (as reported at baseline), with increased hazard ratios among individuals with ≥ 31 total smoking years (HR: 1.52, 95% CI: 1.02, 2.27), ≥ 30 pack-years (HR: 1.66, 95% CI: 1.12, 2.45), and among current smokers (HR: 1.69, 95% CI: 1.04, 2.75). These results are consistent with evidence from more highly exposed populations suggesting a synergistic relationship between arsenic exposure and smoking on health outcomes and support a role for lower-level arsenic exposure in ischemic heart disease mortality. - Highlights: • Arsenic (As) has been associated with increased cardiovascular disease (CVD) risk. • Little is known about CVD effects at lower levels of As exposure common in the US. • Few have investigated the joint effects of As and smoking on CVD in US adults. • We examine chronic low-level As exposure and smoking in relation to CVD mortality. • Arsenic exposure may increase ischemic heart disease mortality among smokers in US.« less

An ecologic analysis of county-level PM2.5 concentrations and lung cancer incidence and mortality.

PubMed

Vinikoor-Imler, Lisa C; Davis, J Allen; Luben, Thomas J

2011-06-01

Few studies have explored the relationship between PM2.5 and lung cancer incidence. Although results are mixed, some studies have demonstrated a positive relationship between PM2.5 and lung cancer mortality. Using an ecologic study design, we examined the county-level associations between PM2.5 concentrations (2002-2005) and lung cancer incidence and mortality in North Carolina (2002-2006). Positive trends were observed between PM2.5 concentrations and lung cancer incidence and mortality; however, the R2 for both were <0.10. The slopes for the relationship between PM2.5 and lung cancer incidence and mortality were 1.26 (95% CI 0.31, 2.21, p-value 0.01) and 0.73 (95% CI 0.09, 1.36, p-value 0.03) per 1 μg/m3 PM2.5, respectively. These associations were slightly strengthened with the inclusion of variables representing socioeconomic status and smoking. Although variability is high, thus reflecting the importance of tobacco smoking and other etiologic agents that influence lung cancer incidence and mortality besides PM2.5, a positive trend is observed between PM2.5 and lung cancer incidence and mortality. This suggests the possibility of an association between PM2.5 concentrations and lung cancer incidence and mortality.

An Ecologic Analysis of County-Level PM2.5 Concentrations and Lung Cancer Incidence and Mortality

PubMed Central

Vinikoor-Imler, Lisa C.; Davis, J. Allen; Luben, Thomas J.

2011-01-01

Few studies have explored the relationship between PM2.5 and lung cancer incidence. Although results are mixed, some studies have demonstrated a positive relationship between PM2.5 and lung cancer mortality. Using an ecologic study design, we examined the county-level associations between PM2.5 concentrations (2002–2005) and lung cancer incidence and mortality in North Carolina (2002–2006). Positive trends were observed between PM2.5 concentrations and lung cancer incidence and mortality; however, the R2 for both were <0.10. The slopes for the relationship between PM2.5 and lung cancer incidence and mortality were 1.26 (95% CI 0.31, 2.21, p-value 0.01) and 0.73 (95% CI 0.09, 1.36, p-value 0.03) per 1 μg/m3 PM2.5, respectively. These associations were slightly strengthened with the inclusion of variables representing socioeconomic status and smoking. Although variability is high, thus reflecting the importance of tobacco smoking and other etiologic agents that influence lung cancer incidence and mortality besides PM2.5, a positive trend is observed between PM2.5 and lung cancer incidence and mortality. This suggests the possibility of an association between PM2.5 concentrations and lung cancer incidence and mortality. PMID:21776206

Innate immune function and mortality in critically ill children with influenza: a multicenter study.

PubMed

Hall, Mark W; Geyer, Susan M; Guo, Chao-Yu; Panoskaltsis-Mortari, Angela; Jouvet, Philippe; Ferdinands, Jill; Shay, David K; Nateri, Jyotsna; Greathouse, Kristin; Sullivan, Ryan; Tran, Tram; Keisling, Shannon; Randolph, Adrienne G

2013-01-01

To prospectively evaluate relationships among serum cytokine levels, innate immune responsiveness, and mortality in a multicenter cohort of critically ill children with influenza infection. Prospective, multicenter, observational study. Fifteen pediatric ICUs among members of the Pediatric Acute Lung Injury and Sepsis Investigators network. Patients ≤18 yrs old admitted to a PICU with community-acquired influenza infection. A control group of outpatient children was also evaluated. ICU patients underwent sampling within 72 hrs of ICU admission for measurement of a panel of 31 serum cytokine levels and quantification of whole blood ex vivo lipopolysaccharide-stimulated tumor necrosis factor-α production capacity using a standardized stimulation protocol. Outpatient control subjects also underwent measurement of tumor necrosis factor-α production capacity. Fifty-two patients (44 survivors, eight deaths) were sampled. High levels of serum cytokines (granulocyte macrophage colony-stimulating factor, interleukin-6, interleukin-8, interferon-inducible protein-10, monocyte chemotactic protein-1, and macrophage inflammatory protein-1α) were associated with mortality (p < 0.0016 for each comparison) as was the presence of secondary infection with Staphylococcus aureus (p = 0.007), particularly methicillin-resistant S. aureus (p < 0.0001). Nonsurvivors were immunosuppressed with leukopenia and markedly reduced tumor necrosis factor-α production capacity compared with outpatient control subjects (n = 21, p < 0.0001) and to ICU survivors (p < 0.0001). This association remained after controlling for multiple covariables. A tumor necrosis factor-α response <250 pg/mL was highly predictive of death and longer duration of ICU stay (p < 0.0001). Patients with S. aureus coinfection demonstrated the greatest degree of immunosuppression (p < 0.0001). High serum levels of cytokines can coexist with marked innate immune suppression in children with critical influenza. Severe, early innate immune suppression is highly associated with both S. aureus coinfection and mortality in this population. Multicenter innate immune function testing is feasible and can identify these high-risk children.

Implementation strategy for achieving replacement level fertility.

PubMed

1993-01-01

The recommendation of the Bali Declaration on Population and Sustainable Development at the ESCAP regional conference was to adopt strategies for attaining replacement-level fertility of 2.1 or 2.2 children by 2010. East Asian countries, except Mongolia and the Democratic People's Republic of Korea, and the Southeast Asian countries Singapore and Thailand have already reached replacement-level fertility. Most larger Oceanic countries have also done so. Only South Asian Sri Lanka and southern India have attained replacement level. The following conditions slow or hinder the goal, but they do not provide an "absolute" barrier to fertility decline: social welfare schemes and old age security, son preference, lack of government family planning, poverty, relatively high mortality, low status of women, and education status. Theories of demographic transition have postulated that economic and social development initially brings a decline in mortality, and later brings a decline in fertility; and high fertility was an adaptation to high mortality. Policy gets caught in the lag between mortality and fertility decline. Eventually the cultural motives for high fertility are undercut by social and economic development. Although the generalization that economic growth slows fertility is true for South Asia, the correlation is uneven. Forceful government-sponsored family planning programs in Bangladesh and China may lead the way to strategies for decline in ESCAP region. A Thailand study suggested important factors were fundamental social change, the increased cost of children, cultural acceptance of birth control, a latent demand for fertility control, and government efforts in family planning. ESCAP countries have in common relatively high morality and inadequate public health programs, patriarchal structures, and limited female autonomy, poverty and landlessness, lack of community cohesiveness, and inadequate family planning programs. Weaknesses in programs are attributed to failure to recognize policies that affect reproduction and the difference between male power and female responsibility. Direct strategies should involve strong government support for male and female contraception, government promotion of delayed marriage, and an emphasis on reproductive health in female family planning programs.

Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

PubMed Central

Wang, Yanping; Li, Xiaohong; Zhou, Maigeng; Luo, Shusheng; Liang, Juan; Liddell, Chelsea A; Coates, Matthew M; Gao, Yanqiu; Wang, Linhong; He, Chunhua; Kang, Chuyun; Liu, Shiwei; Dai, Li; Schumacher, Austin E; Fraser, Maya S; Wolock, Timothy M; Pain, Amanda; Levitz, Carly E; Singh, Lavanya; Coggeshall, Megan; Lind, Margaret; Li, Yichong; Li, Qi; Deng, Kui; Mu, Yi; Deng, Changfei; Yi, Ling; Liu, Zheng; Ma, Xia; Li, Hongtian; Mu, Dezhi; Zhu, Jun; Murray, Christopher J L; Wang, Haidong

2017-01-01

Summary Background In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. Methods We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. Findings In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4·4%. Interpretation The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8·8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates. Funding National “Twelfth Five-Year” Plan for Science and Technology Support, National Health and Family Planning Commission of The People’s Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation. PMID:26510780

Landscape-scale consequences of differential tree mortality from catastrophic wind disturbance in the Amazon.

PubMed

Rifai, Sami W; Urquiza Muñoz, José D; Negrón-Juárez, Robinson I; Ramírez Arévalo, Fredy R; Tello-Espinoza, Rodil; Vanderwel, Mark C; Lichstein, Jeremy W; Chambers, Jeffrey Q; Bohlman, Stephanie A

2016-10-01

Wind disturbance can create large forest blowdowns, which greatly reduces live biomass and adds uncertainty to the strength of the Amazon carbon sink. Observational studies from within the central Amazon have quantified blowdown size and estimated total mortality but have not determined which trees are most likely to die from a catastrophic wind disturbance. Also, the impact of spatial dependence upon tree mortality from wind disturbance has seldom been quantified, which is important because wind disturbance often kills clusters of trees due to large treefalls killing surrounding neighbors. We examine (1) the causes of differential mortality between adult trees from a 300-ha blowdown event in the Peruvian region of the northwestern Amazon, (2) how accounting for spatial dependence affects mortality predictions, and (3) how incorporating both differential mortality and spatial dependence affect the landscape level estimation of necromass produced from the blowdown. Standard regression and spatial regression models were used to estimate how stem diameter, wood density, elevation, and a satellite-derived disturbance metric influenced the probability of tree death from the blowdown event. The model parameters regarding tree characteristics, topography, and spatial autocorrelation of the field data were then used to determine the consequences of non-random mortality for landscape production of necromass through a simulation model. Tree mortality was highly non-random within the blowdown, where tree mortality rates were highest for trees that were large, had low wood density, and were located at high elevation. Of the differential mortality models, the non-spatial models overpredicted necromass, whereas the spatial model slightly underpredicted necromass. When parameterized from the same field data, the spatial regression model with differential mortality estimated only 7.5% more dead trees across the entire blowdown than the random mortality model, yet it estimated 51% greater necromass. We suggest that predictions of forest carbon loss from wind disturbance are sensitive to not only the underlying spatial dependence of observations, but also the biological differences between individuals that promote differential levels of mortality. © 2016 by the Ecological Society of America.

Natural mortality estimation and rational exploitation of purpleback flying squid Sthenoteuthis oualaniensis in the southern South China Sea

NASA Astrophysics Data System (ADS)

Wang, Xuehui; Qiu, Yongsong; Zhang, Peng; Du, Feiyan

2017-07-01

Based on the biological data of purpleback flying squid ( Sthenoteuthis oualaniensis) collected by light falling-net in the southern South China Sea (SCS) during September to October 2012 and March to April 2013, growth and mortality of `Medium' and `Dwarf' forms of squid are derived using the Powell-Wetherall, ELEFAN methods and length-converted catch curves (FiSAT package). Given a lack of commercial exploitation, we assume total mortality to be due entirely to natural mortality. We estimate these squid have fast growth, with growth coefficients ( k) ranging from 1.42 to 2.39, and high natural mortality ( M), with estimates ranging from 1.61 to 2.92. To sustainably exploit these squid stocks, yield per recruitment based on growth and natural mortality was determined using the Beverton-Holt dynamic pool model. We demonstrate squid stocks could sustain high fishing mortality and low ages at first capture, with an optimal fishing mortality >3.0, with the optimal age at first capture increased to 0.4-0.6 years when fishing mortality approached optimal levels. On the basis of our analyses and estimates of stock biomass, we believe considerable potential exists to expand the squid fishery into the open SCS, relieving fishing pressure on coastal waters.

Thirteen-year nationwide trends in use of implantable cardioverter-defibrillators and subsequent long-term survival.

PubMed

Schmidt, Morten; Pedersen, Susanne Bendesgaard; Farkas, Dóra Körmendiné; Hjortshøj, Søren Pihlkjær; Bøtker, Hans Erik; Nielsen, Jens Cosedis; Sørensen, Henrik Toft

2015-09-01

Long-term trends in use of implantable cardioverter-defibrillators (ICDs) and outcomes are rare. We examined 13-year nationwide trends in ICD implantation and survival rates in Denmark. Using medical databases, we identified all first time ICD recipients in Denmark during 2000-2012 (N = 8460) and ascertained all-cause mortality. We computed standardized annual implantation rates and mortality rate ratios according to age, sex, comorbidity level, indication, and device type. The standardized annual implantation rate increased from 42 per million persons in 2000 to 213 per million persons in 2012 (from 34 to 174 for men and from 8 to 39 for women). The increase was driven by secondary prophylactic ICDs until 2006 and primary prophylactic ICDs thereafter. The increase occurred particularly in older patients and those with a high level of comorbidity. Independent of indication, 76% of all patients with ICD were alive after 5 years. Men had a higher mortality rate compared with women (mortality rate ratio 1.28; 95% confidence interval 1.10-1.49). Compared with low comorbidity level, moderate, severe, and very severe comorbidity levels were associated with 1.6-, 2.5-, and 4.9-fold increased mortality rates, respectively. The most influential individual comorbidities were heart failure, diabetes, liver disease, and renal disease. The annual implantation rate of ICDs increased 5-fold in Denmark between 2000 and 2012. The rate increase occurred for both men and women, but particularly in the elderly and patients with severe comorbidity. Five-year survival probability was high, but severe comorbidity and male sex were associated with shorter survival. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Mortality among survivors of the Sept 11, 2001, World Trade Center disaster: results from the World Trade Center Health Registry cohort.

PubMed

Jordan, Hannah T; Brackbill, Robert M; Cone, James E; Debchoudhury, Indira; Farfel, Mark R; Greene, Carolyn M; Hadler, James L; Kennedy, Joseph; Li, Jiehui; Liff, Jonathan; Stayner, Leslie; Stellman, Steven D

2011-09-03

The Sept 11, 2001 (9/11) World Trade Center (WTC) disaster has been associated with several subacute and chronic health effects, but whether excess mortality after 9/11 has occurred is unknown. We tested whether excess mortality has occurred in people exposed to the WTC disaster. In this observational cohort study, deaths occurring in 2003-09 in WTC Health Registry participants residing in New York City were identified through linkage to New York City vital records and the National Death Index. Eligible participants were rescue and recovery workers and volunteers; lower Manhattan area residents, workers, school staff and students; and commuters and passers-by on 9/11. Study participants were categorised as rescue and recovery workers (including volunteers), or non-rescue and non-recovery participants. Standardised mortality ratios (SMR) were calculated with New York City rates from 2000-09 as the reference. Within the cohort, proportional hazards were used to examine the relation between a three-tiered WTC-related exposure level (high, intermediate, or low) and total mortality. We identified 156 deaths in 13,337 rescue and recovery workers and 634 deaths in 28,593 non-rescue and non-recovery participants. All-cause SMRs were significantly lower than that expected for rescue and recovery participants (SMR 0·45, 95% CI 0·38-0·53) and non-rescue and non-recovery participants (0·61, 0·56-0·66). No significantly increased SMRs for diseases of the respiratory system or heart, or for haematological malignancies were found. In non-rescue and non-recovery participants, both intermediate and high levels of WTC-related exposure were significantly associated with mortality when compared with low exposure (adjusted hazard ratio 1·22, 95% CI 1·01-1·48, for intermediate exposure and 1·56, 1·15-2·12, for high exposure). High levels of exposure in non-rescue and non-recovery individuals, when compared with low exposed non-rescue and non-recovery individuals, were associated with heart-disease-related mortality (adjusted hazard ratio 2·06, 1·10-3·86). In rescue and recovery participants, level of WTC-related exposure was not significantly associated with all-cause mortality (adjusted hazard ratio 1·25, 95% CI 0·56-2·78, for high exposure and 1·03, 0·52-2·06, for intermediate exposure when compared with low exposure). This exploratory study of mortality in a well defined cohort of 9/11 survivors provides a baseline for continued surveillance. Additional follow-up is needed to establish whether these associations persist and whether a similar association over time will occur in rescue and recovery participants. US Centers for Disease Control and Prevention (National Institute for Occupational Safety and Health, Agency for Toxic Substances and Disease Registry, and National Center for Environmental Health); New York City Department of Health and Mental Hygiene. Copyright © 2011 Elsevier Ltd. All rights reserved.

Global cardiovascular mortality risk in the adult Polish population: prospective assessment of the cohorts studied in multicentre national WOBASZ and WOBASZ Senior studies.

PubMed

Piotrowski, Walerian; Waśkiewicz, Anna; Cicha-Mikołajczyk, Alicja

2016-01-01

To develop a global cardiovascular disease (CVD) mortality risk model for the Polish population and to verify these data in the context of the SCORE risk algorithm. We analysed data obtained in two multicentre national population studies, the WOBASZ study which was conducted in 2003-2005 and included 14,769 subjects aged 20-74 years, and the WOBASZ Senior study which was conducted in 2007 and included 1096 subjects above 74 years of age. All these subjects were followed for survival status until 2012 and the cause of death was determined. The mean duration of follow-up was 8.2 years for WOBASZ study participants and about 5 years for WOBASZ Senior study participants. Overall, 1436 subjects died, including 568 due to CVD. For the purpose of our analysis of overall and CVD mortality, 15 established risk factors were selected. Survival was analysed separately in WOBASZ and WOBASZ Senior study participants. Statistical methods included descriptive statistics, Kaplan-Meier curves, Cox proportional hazard models, and the SCORE risk algorithm. Measure of incompatibility of the SCORE risk model to the Polish population was determined as the difference between mortality rates by the SCORE risk quartiles and the Cox approach. During the 8-year follow-up of the WOBASZ study population, mortality due to CVD was 38% among men and 31% among women. The most common causes of CVD mortality were ischaemic heart disease (IHD, 33%) followed by cerebro-vascular disease (17%) in men, and cerebrovascular disease (31%) followed by IHD (23%) in women. We found significant differences between men and women in regard to survival curves for both overall mortality and CVD mortality (p < 0.0001). For overall mortality among men and women, nearly all selected risk factors were shown to be significant in univariate analyses, except for high density lipoprotein cholesterol (HDL-C) level and the total cholesterol/HDL-C ratio in men, and smoking status in women. In multivariate analysis, independent predictors in men included age, glucose level, systolic blood pressure, and smoking status. In women, independent predictors were age, smoking status, and diabetes. During the 5-year follow-up of the WOBASZ Senior study population, mortality due to CVD was 48% among men and 58% among women. The most common cause of CVD mortality in both men and women was IHD (29% and 24%, respectively), followed by cerebrovascular disease (16% and 21%, respectively). We found significant differences between men and women in regard to survival curves for overall mortality (p < 0.0001) but not for CVD mortality (p = 0.0755). Due to the fact that survival curves for CVD mortality did not differ between men and women, we estimated the cut-off age for no survival difference in the WOBASZ study. By selecting the oldest patients and adding them to the WOBASZ Senior cohort, we obtained the cut-off age of 70 years above which the survival curves were not significantly different between men and women. In univariate analyses, independent predictors in men were age and creatinine level. These factors remained significant in multivariate analysis. In women above 74 years of age, independent predictors in univariate analyses included age, HDL-C level, creatinine level, total cholesterol/HDL-C ratio, and smoking status. Age, HDL-C level, creatinine level, and smoking status remained independent predictors of overall mortality in multivariate analysis. For CVD mortality, significant predictors were the same as for overall mortality. In women, significant predictors in uni- and multivariate analyses were age and smoking status. Overall disagreement between CVD mortality rates by the SCORE risk model and the Cox model was 5.7% in men and 2% in women. 1. Long-term follow-up of WOBASZ and WOBASZ Senior study participants allowed assessment of the inde-pendent association of the evaluated cardiovascular risk factors with CVD mortality in the Polish population. 2. Validation of the SCORE risk algorithm to estimate individual global CVD risk in the Polish population showed a high predictive value of this algorithm.

Prospective association between phobic anxiety and cardiac mortality in individuals with coronary heart disease

PubMed Central

Watkins, Lana L.; Blumenthal, James A.; Babyak, Michael A.; Davidson, Jonathan R.T.; McCants, Charles B.; O’Connor, Christopher; Sketch, Michael H.

2010-01-01

Objective Previous findings suggest that phobic anxiety may pose increased risk of cardiac mortality in medically healthy cohorts. The present study evaluated whether phobic anxiety is associated with increased risk of cardiac mortality in individuals with established coronary heart disease (CHD) and examined the role of reduced heart rate variability (HRV) in mediating this risk. Methods We performed a prospective cohort study in 947 CHD patients recruited during hospitalization for coronary angiography. At baseline, supine recordings of heart rate for HRV were collected, and participants completed the Crown-Crisp phobic anxiety scale. Fatal cardiac events were identified over an average period of 3 years. Results Female CHD patients reported significantly elevated levels of phobic anxiety when compared with male patients (p <.001) and survival analysis showed an interaction between gender and phobic anxiety in the prediction of cardiac mortality (p =.058) and sudden cardiac death (SCD) (p=.03). In women, phobic anxiety was associated with a 1.6-fold increased risk of cardiac mortality (HR, 1.56; 95% CI, 1.15–2.11; p=.004) and a 2.0-fold increased risk of SCD (HR, 2.02; 95% CI, 1.16–3.52; p=.01) and was unassociated with increased mortality risk in men (p=.56). Phobic anxiety was weakly associated with reduced high frequency HRV in female patients (r=−.14, p=.02), but reduced HRV did not alter the association between phobic anxiety on mortality. Conclusions Phobic anxiety levels are high in women with CHD and may be a risk factor for cardiac-related mortality in women diagnosed with CHD. Reduced HRV measured during rest does not appear to mediate phobic anxiety-related risk. PMID:20639390

Phobic anxiety and increased risk of mortality in coronary heart disease.

PubMed

Watkins, Lana L; Blumenthal, James A; Babyak, Michael A; Davidson, Jonathan R T; McCants, Charles B; O'Connor, Christopher; Sketch, Michael H

2010-09-01

To evaluate whether phobic anxiety is associated with increased risk of cardiac mortality in individuals with established coronary heart disease (CHD) and to examine the role of reduced heart rate variability (HRV) in mediating this risk. Previous findings suggest that phobic anxiety may pose increased risk of cardiac mortality in medically healthy cohorts. We performed a prospective cohort study in 947 CHD patients recruited during hospitalization for coronary angiography. At baseline, supine recordings of heart rate for HRV were collected, and participants completed the Crown-Crisp phobic anxiety scale. Fatal cardiac events were identified over an average period of 3 years. Female CHD patients reported significantly elevated levels of phobic anxiety when compared with male patients (p < .001), and survival analysis showed an interaction between gender and phobic anxiety in the prediction of cardiac mortality (p = .058) and sudden cardiac death (p = .03). In women, phobic anxiety was associated with a 1.6-fold increased risk of cardiac mortality (hazard ratio, 1.56; 95% confidence interval, 1.15-2.11; p = .004) and a 2.0-fold increased risk of sudden cardiac death (hazard ratio, 2.02; 95% confidence interval, 1.16-3.52; p = .01) and was unassociated with increased mortality risk in men (p = .56). Phobic anxiety was weakly associated with reduced high-frequency HRV in female patients (r = -.14, p = .02), but reduced HRV did not alter the association between phobic anxiety on mortality. Phobic anxiety levels are high in women with CHD and may be a risk factor for cardiac-related mortality in women diagnosed with CHD. Reduced HRV measured during rest does not seem to mediate phobic anxiety-related risk.

The decline in child mortality: a reappraisal.

PubMed Central

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

2000-01-01

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

Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines.

PubMed

Kraft, Aleli D; Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Hodge, Andrew

2013-01-01

The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country's socioeconomic-related child health inequality. Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality--that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system--to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.

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.

Seeking explanations for high levels of infant mortality in Pakistan.

PubMed

Sathar, Z A

1987-01-01

Data from the Fertility Module of the 1979 Population, Labour Force and Migration (PLM) Survey of Pakistan were analyzed to determine which of 4 factors were primarily responsible for the high infant mortality rate. The factors examined were poverty, childbearing and childrearing practices, distribution of health care and lack of individual attention given to children due to ignorance. These items were presented in a discussion format. Infant mortality in Pakistan is high at about 125-140/1000, for a country with mid-level per capita income. Income was not a good indicator of child mortality, primarily because it was difficult to determine, particularly in rural areas where non-cash income predominates. Wealth and status were good indicators of child survival. Child-rearing practices were somewhat important, as judged by birth order, breastfeeding duration and gender. Childbearing practices as shown by spacing were important determinants of survival. Health care facilities were somewhat important, indicated by higher mortality in rural areas. Rural neonates die from tetanus due to lack of immunization, or later from diarrheal disease due to lack of potable water or poor weaning practices. Maternal education was a strong indicator of survival, much more so than paternal education. Similarly, female heads of households increased survival, probably because they control financial allocations. The study suggested that rather than attempting to eliminate poverty overall, improvements in maternal education, nutrition, health care facilities and their use, and childbearing and child-rearing methods would do more to improve child survival in Pakistan.

Plasma lipid profiles and epidemiology of atherosclerotic diseases in Taiwan--a unique experience.

PubMed

Pan, W H; Chiang, B N

1995-12-01

Rapid economic growth in Taiwan is accompanied by changing lifestyles, and the mortality pattern has switched from predominantly infectious diseases to chronic diseases. Age-adjusted mortality from heart disease has increased slowly but steadily. However, mortality from heart disease in Taiwan remains low compared with many other countries. Mortality from the cerebrovascular diseases has decreased gradually. Current age- and sex-specific values of blood cholesterol low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) are, in general, higher than values in mainland China, but lower than those in the NHANES III and PROCAM studies. From 1950 to 1987, percent dietary fat increased from 16% to 36% in Taiwan. However, a high polyunsaturated fat/saturated fat (P/S) ratio (1.3) maintained during this period may in part explain the favorable blood lipid status and low mortality from heart disease. Data from prospective studies are scarce. In case-control studies carried out in Chinese, significantly higher values of TG, CHOL LDL-C, but lower high density lipoprotein cholesterol (HDL-C) levels have often been found in coronary artery disease (CAD) patients than in controls. The percent differences in TG and HDL-C values (20%) were much greater than those of CHOL and LDL-C (3%). A few studies have identified the TG level as an independent risk factor for stroke and CAD in Taiwan, where a moderate to high fat diet with an advantageous P/S ratio is consumed.

Fluid overload correction and cardiac history influence brain natriuretic peptide evolution in incident haemodialysis patients.

PubMed

Chazot, Charles; Vo-Van, Cyril; Zaoui, Eric; Vanel, Thierry; Hurot, Jean Marc; Lorriaux, Christie; Mayor, Brice; Deleaval, Patrick; Jean, Guillaume

2011-08-01

Brain natriuretic peptide (BNP) is a cardiac peptide secreted by ventricle myocardial cells under stretch constraint. Increased BNP has been shown associated with increased mortality in end-stage renal disease patients. In patients starting haemodialysis (HD), both fluid overload and cardiac history are frequently present and may be responsible for a high BNP plasma level. We report in this study the evolution of BNP levels in incident HD patients, its relationship with fluid removal and cardiac history as well as its prognostic value. Forty-six patients (female/male: 21/25; 68.6 ± 14.5 years old) surviving at least 6 months after HD treatment onset were retrospectively analysed. Plasma BNP (Chemoluminescent Microparticule ImmunoAssay on i8200 Architect Abbott, Paris, France; normal value < 100 pg/mL) was assessed at HD start and during the second quarter of HD treatment (Q2). At dialysis start, the plasma BNP level was 1041 ± 1178 pg/mL (range: 14-4181 pg/mL). It was correlated with age (P = 0.0017) and was significantly higher in males (P = 0.0017) and in patients with cardiac disease history (P = 0.001). The plasma BNP level at baseline was not related to the mortality risk. At Q2, predialysis systolic blood pressure (BP) decreased from 140.5 ± 24.5 to 129.4 ± 20.6 mmHg (P = 0.0001) and the postdialysis body weight by 7.6 ± 8.4% (P < 0.0001). The BNP level decreased to 631 ± 707 pg/mL (P = 0.01) at Q2. Its variation was significantly correlated with systolic BP decrease (P = 0.006). A high BNP level was found associated with an increased risk of mortality. Hence, plasma BNP levels decreased during the first months of HD treatment during the dry weight quest. Whereas initial BNP values were not associated with increased mortality risk, the BNP level at Q2 was independently predictive of mortality. Hence, BNP is a useful tool to follow patient dehydration after dialysis start. Initial fluid overload may act as a confounding factor for its value as a prognostic marker because of cardiac disease.

Midregional Proadrenomedullin as a Prognostic Tool in Community-Acquired Pneumonia

PubMed Central

Huang, David T.; Angus, Derek C.; Kellum, John A.; Pugh, Nathan A.; Weissfeld, Lisa A.; Struck, Joachim; Delude, Russell L.; Rosengart, Matthew R.; Yealy, Donald M.

2009-01-01

Background: Midregional proadrenomedullin (MR-proADM) is a potential prognostic biomarker in patients with community-acquired pneumonia (CAP). Previous work has been hampered by sample size and illness spectrum limits. We sought to describe the pattern of MR-proADM in a broad CAP cohort, confirm its prognostic role, and compare its performance to procalcitonin, a novel biomarker of infection. Methods: We conducted a multicenter prospective cohort study in 28 community and teaching EDs. Patients with a clinical and radiographic diagnosis of CAP were enrolled. We stratified MR-proADM levels a priori into quartiles and quantified severity of illness using the pneumonia severity index (PSI); and confusion (abbreviated mental test score of ≤ 8), urea ≥ 7 mmol/L, respiratory rate ≥ 30 breaths/min, BP < 90 mm Hg systolic or < 60 mm Hg diastolic, age ≥ 65 years (CURB-65). The primary outcome was 30-day mortality. Results: A total of 1,653 patients formed the study cohort. MR-proADM levels consistently rose with PSI class and 30-day mortality (p < 0.001). MR-proADM had a higher area under the curve for 30-day mortality than procalcitonin (0.76 vs 0.65, respectively; p < 0.001), but adding MR-proADM to the PSI in all subjects minimally improved performance. Among low-risk subjects (PSI classes I to III), mortality was low and did not differ by MR-proADM quartile. However, among high-risk subjects (PSI class IV/V; n = 546), subjects in the highest MR-proADM quartile (n = 232; 42%) had higher 30-day mortality than those in MR-proADM quartiles 1 to 3 (23% vs 9%, respectively; p < 0.0001). Similar results were seen with CURB-65. MR-proADM and procalcitonin levels were generally concordant; only 6% of PSI class IV/V subjects in the highest MR-proADM quartile had very low procalcitonin levels (< 0.1 ng/mL). Conclusions: In our multicenter CAP cohort, MR-proADM levels correlate with increasing severity of illness and death. High MR-proADM levels offer additional risk stratification in high-risk CAP patients, but otherwise MR-proADM levels do not alter PSI-based risk assessment in most CAP patients. PMID:19363212

The role of canine distemper virus and persistent organic pollutants in mortality patterns of Caspian seals (Pusa caspica).

PubMed

Wilson, Susan C; Eybatov, Tariel M; Amano, Masao; Jepson, Paul D; Goodman, Simon J

2014-01-01

Persistent organic pollutants are a concern for species occupying high trophic levels since they can cause immunosuppression and impair reproduction. Mass mortalities due to canine distemper virus (CDV) occurred in Caspian seals (Pusa caspica), in spring of 1997, 2000 and 2001, but the potential role of organochlorine exposure in these epizootics remains undetermined. Here we integrate Caspian seal mortality data spanning 1971-2008, with data on age, body condition, pathology and blubber organochlorine concentration for carcases stranded between 1997 and 2002. We test the hypothesis that summed PCB and DDT concentrations contributed to CDV associated mortality during epizootics. We show that age is the primary factor explaining variation in blubber organochlorine concentrations, and that organochlorine burden, age, sex, and body condition do not account for CDV infection status (positive/negative) of animals dying in epizootics. Most animals (57%, n = 67) had PCB concentrations below proposed thresholds for toxic effects in marine mammals (17 µg/g lipid weight), and only 3 of 67 animals had predicted TEQ values exceeding levels seen to be associated with immune suppression in harbour seals (200 pg/g lipid weight). Mean organonchlorine levels were higher in CDV-negative animals indicating that organochlorines did not contribute significantly to CDV mortality in epizootics. Mortality monitoring in Azerbaijan 1971-2008 revealed bi-annual stranding peaks in late spring, following the annual moult and during autumn migrations northwards. Mortality peaks comparable to epizootic years were also recorded in the 1970s-1980s, consistent with previous undocumented CDV outbreaks. Gompertz growth curves show that Caspian seals achieve an asymptotic standard body length of 126-129 cm (n = 111). Males may continue to grow slowly throughout life. Mortality during epizootics may exceed the potential biological removal level (PBR) for the population, but the low frequency of epizootics suggest they are of secondary importance compared to anthropogenic sources of mortality such as fishing by-catch.

Multi-Country analysis of palm oil consumption and cardiovascular disease mortality for countries at different stages of economic development: 1980-1997.

PubMed

Chen, Brian K; Seligman, Benjamin; Farquhar, John W; Goldhaber-Fiebert, Jeremy D

2011-12-16

Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat. The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat. In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries. Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.

REGIONAL TRENDS IN THE WORKING-AGE POPULATION MORTALITY RATE IN THE REPUBLIC OF SAKHA (YAKUTIA) IN 1990-2012.

PubMed

Ivanova, A A; Kakorina, E P; Timofeev, L F; Potapov, A F; Aprosimov, L A

2015-01-01

Regions of the Russian Federation differ in climatic-geographic, medical-demographic and social-economic situations. One of the regions with distinct peculiarities is the Republic of Sakha (Yakutia). Ranking first by the territory (3,103.2 thousand sq x km), Yakutia is on the 81th place by the population density among regions of the Russian Federation (0.3 people per 1 km2).Yakutia is one of the most isolated and inaccessible regions of the world: 90% of the territory lacks all-the-year-round transportation. Regions of the republic, as well, differ significantly in the climatic conditions and the levels of social-economic development, which influences the population health indicators, including mortality. This survey aimed to study the trends of mortality in the working-age population in different groups of regions. To do this, basing on the statistical data, we compared the levels, trends and structure of mortality in 1990-2012. It was established that the different groups of regions show a significant variation in the working-age population mortality, depending on the social-economic conditions. Since 2000, the Arctic group of regions has demonstrated higher mortality in working-age men and women, especially of cardiovascular and digestive system diseases, and external causes. Lying beyond the Arctic Circle, these regions have severe conditions and a relatively low level of social-economic development. As for the rural regions, despite the relatively favourabe situation, they also show a high level of mortality of external causes. The industrial regions are characterized by higher social-economic development, better transport infrastructure, a satisfactory material base of medical institutions. They also have sufficient resources of health institutions, including the staff and modern equipment for treatment and diagnostics, as well as, which is critical, the full range of medical specialists. Thus, these regions demonstrate lower population mortality; however, there is still mortality of infectious diseases, neoplasms, and respiratory diseases.

The interactive effects between high temperature and air pollution on mortality: A time-series analysis in Hefei, China.

PubMed

Qin, Rennie Xinrui; Xiao, Changchun; Zhu, Yibin; Li, Jing; Yang, Jun; Gu, Shaohua; Xia, Junrui; Su, Bin; Liu, Qiyong; Woodward, Alistair

2017-01-01

Recent evidence suggests that there may be an interaction between air pollution and heat on mortality, which is pertinent in the context of global climate change. We sought to examine this interaction in Hefei, a hot and polluted Chinese city. We conducted time-series analyses using daily mortality, air pollutant concentration (including particulate matter with aerodynamic diameter <10μm (PM 10 ), sulphur dioxide (SO 2 ) and nitrogen dioxide (NO 2 )), and temperature data from 2008 to 2014. We applied quasi-Poisson regression models with natural cubic splines and examined the interactive effects using temperature-stratified models. Subgroup analyses were conducted by age, gender, and educational levels. We observed consistently stronger associations between air pollutants and mortality at high temperatures than at medium temperatures. These differences were statistically significant for the associations between PM 10 and non-accidental mortality and between all pollutants studied and respiratory mortality. Mean percentage increases in non-accidental mortality per 10μg/m 3 at high temperatures were 2.40% (95% confidence interval: 0.64 to 4.20) for PM 10 , 7.77% (0.60 to 15.00) for SO 2 , and 6.83% (-1.37 to 15.08) for NO 2 . The estimates for PM 10 were 3.40% (0.96 to 5.90) in females and 4.21% (1.44 to 7.05) in the illiterate, marking them as more vulnerable. No clear trend was identified by age. We observed an interaction between air pollutants and high temperature on mortality in Hefei, which was stronger in females and the illiterate. This may be due to differences in behaviours affecting personal exposure to high temperatures and has potential policy implications. Copyright © 2016 Elsevier B.V. All rights reserved.

Will metformin postpone high-fat diet promotion of TRAMP mouse prostate cancer development and progression?

PubMed

Xu, Hua; Hu, Meng-Bo; Bai, Pei-de; Zhu, Wen-Hui; Ding, Qiang; Jiang, Hao-Wen

2014-12-01

We aimed to examine the effect of high-fat diet (HFD) on prostate cancer (PCa) development and progression and to investigate whether metformin would postpone PCa development and progression promoted by HFD. TRAMP mice were randomly divided into three groups: normal diet group, HFD group and metformin-HFD (Met-HFD) group. Mortality rate and tumor formation rate were examined. TRAMP mice were sacrificed and sampled on the 20th, 24(th), and 28th week, respectively. Serum levels of insulin and IGF-1 were tested by ELISA. Prostate tissue of TRAMP mice was used for HE staining. A total of 17 deaths of TRAMP mice were observed, including 3 (10 %) from the normal diet group, 10 (33.33 %) from the HFD group, and 4 (13.33 %) from Met-HFD group. The mortality rate of TRAMP mice from HFD group was significantly higher than that of normal diet group (P = 0.028), and metformin could moderately decrease the mortality rate by 60.01 % (P = 0.067). Tumor formation rates were not significantly different among the three groups. Levels of glucose, insulin, and IGF-1 tended to increase with TRAMP mice's age in HFD group. TRAMP mice from HFD group had higher serum insulin and IGF-1 levels. A moderate decrease in IGF-1 was also seen in Met-HFD group. HFD could promote TRAMP mouse PCa development and progression and metformin had moderate effect of reducing PCa mortality rate with a decrease in serum IGF-1 level.

Understanding the determinants of under-five child mortality in Uganda including the estimation of unobserved household and community effects using both frequentist and Bayesian survival analysis approaches.

PubMed

Nasejje, Justine B; Mwambi, Henry G; Achia, Thomas N O

2015-10-01

Infant and child mortality rates are among the health indicators of importance in a given community or country. It is the fourth millennium development goal that by 2015, all the United Nations member countries are expected to have reduced their infant and child mortality rates by two-thirds. Uganda is one of those countries in Sub-Saharan Africa with high infant and child mortality rates, therefore it is important to use sound statistical methods to determine which factors are strongly associated with child mortality which in turn will help inform the design of intervention strategies The Uganda Demographic Health Survey (UDHS) funded by USAID, UNFPA, UNICEF, Irish Aid and the United Kingdom government provides a data set which is rich in information on child mortality or survival. Survival analysis techniques are among the well-developed methods in Statistics for analysing time to event data. These methods were adopted in this paper to examine factors affecting under-five child mortality rates (UMR) in Uganda using the UDHS data for 2011 in R and STATA software. Results obtained by fitting the Cox-proportional hazard model with frailty effects and drawing inference using both the frequentists and Bayesian approaches at 5 % significance level, show evidence of the existence of unobserved heterogeneity at the household level but there was not enough evidence to conclude the existence of unobserved heterogeneity at the community level. Sex of the household head, sex of the child and number of births in the past one year were found to be significant. The results further suggest that over the period of 1990-2015, Uganda reduced its UMR by 52 % . Uganda has not achieved the MDG4 target but the 52 % reduction in the UMR is a move in the positive direction. Demographic factors (sex of the household head) and Biological determinants (sex of the child and number of births in the past one year) are strongly associated with high UMR. Heterogeneity or unobserved covariates were found to be significant at the household but insignificant at the community level.

Impact of differing glucose-lowering regimens on the pattern of association between glucose control and survival.

PubMed

Currie, Craig J; Holden, Sarah E; Jenkins-Jones, Sara; Morgan, Christopher Ll; Voss, Bernd; Rajpathak, Swapnil N; Alemayehu, Berhanu; Peters, John R; Engel, Samuel S

2018-04-01

To characterize survival in relation to achieved glycated haemoglobin (HbA1c) level within alternative glucose-lowering regimens with differing risks of hypoglycaemia. Data were extracted from the UK Clinical Practice Research Datalink and the corresponding Hospital Episode Statistics. Patients with type 2 diabetes prescribed glucose-lowering therapy in monotherapy or dual therapy with metformin between 2004 and 2013 were identified. Risk of all-cause mortality within treatment cohorts was evaluated using the Cox proportional hazards model, introducing mean HbA1c as a quarterly updated, time-dependent covariable. There were 6646 deaths in a total follow-up period of 374 591 years. Survival for lower (<7%) vs moderate HbA1c levels (≥7%, <8.5%) differed by cohort: metformin, adjusted hazard ratio (aHR) 1.03 (95% confidence interval [CI] 0.95-1.12); sulphonylurea, aHR 1.11 (95% CI 0.99-1.25); insulin, aHR 1.47 (95% CI 1.25-1.72); combined regimens with low hypoglycaemia risk, aHR 1.02 (95% CI 0.94-1.10); and combined regimens with higher hypoglycaemia risk excluding insulin, aHR 1.24 (95% CI 1.13-1.35) and including insulin, aHR 1.28 (95% CI 1.18-1.37). Higher HbA1c levels were associated with increased mortality in regimens with low hypoglycaemia risk. Post hoc analysis by HbA1c deciles revealed an elevated risk of all-cause mortality for the lowest deciles across all cohorts, but particularly in those regimens associated with hypoglycaemia. High HbA1c was associated with no difference, or a small increase in mortality risk in regimens with increased risk of hypoglycaemia. The pattern of mortality risk across the range of HbA1c differed by glucose-lowering regimen. Lower HbA1c was associated with increased mortality risk compared with moderate control, especially in those regimens associated with hypoglycaemia. High levels of HbA1c were associated with the expected elevated mortality risk in regimens with low hypoglycaemia risk. © 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

The correlation between burn mortality rates from fire and flame and economic status of countries.

PubMed

Peck, Michael; Pressman, Melissa A

2013-09-01

Over 95% of burn deaths occur in low- and middle-income countries globally. However, the association between burn mortality rates and economic health has not been evaluated for individual countries. This study seeks to answer the question, how strong is the correlation between burn mortality and national indices of economic strength? A retrospective review was performed for 189 countries during 2008-2010 using economic data from the World Bank as well as mortality data from the World Health Organization (WHO). Countries were categorized into four groups based on income level according to stratification by the World Bank: low income, lower middle income, upper middle income, and high income. The Pearson correlation coefficient was used to estimate presence and strength of association among death rates, Gini coefficient (measure of inequality of distribution of wealth), gross domestic product (GDP) per capita, and gross national index (GNI) per capita. Statistically significant associations (p<0.05) were found between burn mortality and GDP per capita (r=-0.26), GNI per capita (r=-0.36), and Gini (r=+0.17). A nation's income level is negatively correlated with burn mortality; the lower the income level, the higher the burn mortality rates. The degree to which income within a country is equitably or inequitably distributed also correlates with burn mortality. Both governmental and non-governmental organizations need to focus on preventing burns in low-income countries, as well as in other countries in which there is marked disparity of income. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Educational inequality in cancer mortality: a record linkage study of over 35 million Italians.

PubMed

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

2017-09-01

Large studies are needed to evaluate socioeconomic inequality for site-specific cancer mortality. We conducted a longitudinal census-based national study to quantify the relative inequality in cancer mortality among educational levels in Italy. We linked the 2011 Italian census with the 2012 and 2013 death registries. Educational inequality in overall cancer and site-specific cancer mortality were evaluated by computing the mortality rate ratio (MRR). A total of 35,708,445 subjects aged 30-74 years and 147,981 cancer deaths were registered. Compared to the lowest level of education (none or primary school), the MRR for all cancers in the highest level (university) was 0.57 (95% CI 0.55; 0.58) in men and 0.84 (95% CI 0.81; 0.87) in women. Higher education was associated with reduced risk of mortality from lip, oral cavity, pharynx, oesophagus, stomach, colon and liver in both sexes. Higher education (university) was associated with decreased risk of lung cancer in men (MRR: 0.43, 95% CI 0.41; 0.46), but not in women (MRR: 1.00, 95% CI 0.92; 1.10). Highly educated women had a reduced risk of mortality from cervical cancer than lower educated women (MRR: 0.39, 95% CI 0.27; 0.56), but they had a similar risk for breast cancer (MRR: 1.01, 95% CI 0.94; 1.09). Education is inversely associated with total cancer mortality, and the association was stronger in men. Different patterns and trends in tobacco smoking in men and women account for at least most of the gender differences.

Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study

PubMed Central

Timæus, Ian M; Banda, Richard; Thankian, Kusanthan; Banda, Andrew; Lemba, Musonda; Stringer, Jeffrey S A; Chi, Benjamin H

2016-01-01

Objectives To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head. Setting Households in Lusaka District, Zambia, 2004–2011. Participants 43 064 household heads (88% female) who enumerated 123 807 adult household members aged between 15 and 60 years. Primary outcome Premature adult mortality. Results The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing. Conclusions To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services. PMID:26940113

Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database.

PubMed

Lingsma, Hester F; Bottle, Alex; Middleton, Steve; Kievit, Job; Steyerberg, Ewout W; Marang-van de Mheen, Perla J

2018-02-14

Hospital mortality, readmission and length of stay (LOS) are commonly used measures for quality of care. We aimed to disentangle the correlations between these interrelated measures and propose a new way of combining them to evaluate the quality of hospital care. We analyzed administrative data from the Global Comparators Project from 26 hospitals on patients discharged between 2007 and 2012. We correlated standardized and risk-adjusted hospital outcomes on mortality, readmission and long LOS. We constructed a composite measure with 5 levels, based on literature review and expert advice, from survival without readmission and normal LOS (best) to mortality (worst outcome). This composite measure was analyzed using ordinal regression, to obtain a standardized outcome measure to compare hospitals. Overall, we observed a 3.1% mortality rate, 7.8% readmission rate (in survivors) and 20.8% long LOS rate among 4,327,105 admissions. Mortality and LOS were correlated at the patient and the hospital level. A patient in the upper quartile LOS had higher odds of mortality (odds ratio = 1.45, 95% confidence interval 1.43-1.47) than those in the lowest quartile. Hospitals with a high standardized mortality had higher proportions of long LOS (r = 0.79, p < 0.01). Readmission rates did not correlate with either mortality or long LOS rates. The interquartile range of the standardized ordinal composite outcome was 74-117. The composite outcome had similar or better reliability in ranking hospitals than individual outcomes. Correlations between different outcome measures are complex and differ between hospital- and patient-level. The proposed composite measure combines three outcomes in an ordinal fashion for a more comprehensive and reliable view of hospital performance than its component indicators.

Small-area spatiotemporal analysis of heatwave impacts on elderly mortality in Paris: A cluster analysis approach.

PubMed

Benmarhnia, Tarik; Kihal-Talantikite, Wahida; Ragettli, Martina S; Deguen, Séverine

2017-08-15

Heat-waves have a substantial public health burden. Understanding spatial heterogeneity at a fine spatial scale in relation to heat and related mortality is central to target interventions towards vulnerable communities. To determine the spatial variability of heat-wave-related mortality risk among elderly in Paris, France at the census block level. We also aimed to assess area-level social and environmental determinants of high mortality risk within Paris. We used daily mortality data from 2004 to 2009 among people aged >65 at the French census block level within Paris. We used two heat wave days' definitions that were compared to non-heat wave days. A Bernoulli cluster analysis method was applied to identify high risk clusters of mortality during heat waves. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the mortality risk. The spatial approach revealed a spatial aggregation of death cases during heat wave days. We found that small scale chronic PM 10 exposure was associated with a 0.02 (95% CI: 0.001; 0.045) increase of the risk of dying during a heat wave episode. We also found a positive association with the percentage of foreigners and the percentage of labor force, while the proportion of elderly people living in the neighborhood was negatively associated. We also found that green space density had a protective effect and inversely that the density of constructed feature increased the risk of dying during a heat wave episode. We showed that a spatial variation in terms of heat-related vulnerability exists within Paris and that it can be explained by some contextual factors. This study can be useful for designing interventions targeting more vulnerable areas and reduce the burden of heat waves. Copyright © 2017 Elsevier B.V. All rights reserved.

Isolated and synergistic effects of PM10 and average temperature on cardiovascular and respiratory mortality.

PubMed

Pinheiro, Samya de Lara Lins de Araujo; Saldiva, Paulo Hilário Nascimento; Schwartz, Joel; Zanobetti, Antonella

2014-12-01

OBJECTIVE To analyze the effect of air pollution and temperature on mortality due to cardiovascular and respiratory diseases. METHODS We evaluated the isolated and synergistic effects of temperature and particulate matter with aerodynamic diameter < 10 µm (PM10) on the mortality of individuals > 40 years old due to cardiovascular disease and that of individuals > 60 years old due to respiratory diseases in Sao Paulo, SP, Southeastern Brazil, between 1998 and 2008. Three methodologies were used to evaluate the isolated association: time-series analysis using Poisson regression model, bidirectional case-crossover analysis matched by period, and case-crossover analysis matched by the confounding factor, i.e., average temperature or pollutant concentration. The graphical representation of the response surface, generated by the interaction term between these factors added to the Poisson regression model, was interpreted to evaluate the synergistic effect of the risk factors. RESULTS No differences were observed between the results of the case-crossover and time-series analyses. The percentage change in the relative risk of cardiovascular and respiratory mortality was 0.85% (0.45;1.25) and 1.60% (0.74;2.46), respectively, due to an increase of 10 μg/m3 in the PM10 concentration. The pattern of correlation of the temperature with cardiovascular mortality was U-shaped and that with respiratory mortality was J-shaped, indicating an increased relative risk at high temperatures. The values for the interaction term indicated a higher relative risk for cardiovascular and respiratory mortalities at low temperatures and high temperatures, respectively, when the pollution levels reached approximately 60 μg/m3. CONCLUSIONS The positive association standardized in the Poisson regression model for pollutant concentration is not confounded by temperature, and the effect of temperature is not confounded by the pollutant levels in the time-series analysis. The simultaneous exposure to different levels of environmental factors can create synergistic effects that are as disturbing as those caused by extreme concentrations.

Mortality and morbidity in the 21st century

PubMed Central

Case, Anne; Deaton, Angus

2017-01-01

SUMMARY We build on and extend the findings in Case and Deaton (2015) on increases in mortality and morbidity among white non-Hispanic Americans in midlife since the turn of the century. Increases in all-cause mortality continued unabated to 2015, with additional increases in drug overdoses, suicides, and alcohol-related liver mortality, particularly among those with a high-school degree or less. The decline in mortality from heart disease has slowed and, most recently, stopped, and this combined with the three other causes is responsible for the increase in all-cause mortality. Not only are educational differences in mortality among whites increasing, but from 1998 to 2015 mortality rose for those without, and fell for those with, a college degree. This is true for non-Hispanic white men and women in all five year age groups from 35–39 through 55–59. Mortality rates among blacks and Hispanics continued to fall; in 1999, the mortality rate of white non-Hispanics aged 50–54 with only a high-school degree was 30 percent lower than the mortality rate of blacks in the same age group but irrespective of education; by 2015, it was 30 percent higher. There are similar crossovers in all age groups from 25–29 to 60–64. Mortality rates in comparable rich countries have continued their pre-millennial fall at the rates that used to characterize the US. In contrast to the US, mortality rates in Europe are falling for those with low levels of educational attainment, and have fallen further over this period than mortality rates for those with higher levels of education. Many commentators have suggested that poor mortality outcomes can be attributed to contemporaneous levels of resources, particularly to slowly growing, stagnant, and even declining incomes; we evaluate this possibility, but find that it cannot provide a comprehensive explanation. In particular, the income profiles for blacks and Hispanics, whose mortality rates have fallen, are no better than those for whites. Nor is there any evidence in the European data that mortality trends match income trends, in spite of sharply different patterns of median income across countries after the Great Recession. We propose a preliminary but plausible story in which cumulative disadvantage from one birth cohort to the next, in the labor market, in marriage and child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65. This is in contrast to an account in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this implies that there are no policy levers to be pulled; preventing the over-prescription of opioids is an obvious target that would clearly be helpful. PMID:29033460

Cancer incidence and mortality in the province of Ferrara 1989-1990.

PubMed

Ferretti, S; Tassinari, D; Albonico, G; Nenci, I

1995-01-01

Mortality data have clearly highlighted the province of Ferrara as an area with a particular distribution of tumors strictly related with environmental factors. The project of a tumor registry has been planned for a better description of cancer incidence and for a deeper insight into etiologic factors, considering the typical features of the province from geographic and occupational points of view. This study presents the registration results of the first 2 years, in order to verify the quality level of data recruitment and to confirm that observed in previous studies. The population covered by the registry was 151,968 males and 165,835 females, with high representation of the elderly. In this period 2,087 tumors in men and 1,778 in women were observed. Lung cancer reaches one of the highest levels in Italy, according to that observed in Lombardy and Veneto regions and the northern Adriatic coast. Incidence and mortality are, however, significantly higher than in other Emilia-Romagna areas, as pointed out by the registries of Parma, Modena and Forii. Colon cancer also presents high frequencies in comparison with neighboring areas, whereas non-Hodgkin lymphomas reach the highest level in Italy. Gastric tumors, although well represented in males and females, show lower levels than the high-risk neighboring Romagna region. In women, a low incidence of cervix uteri-tumors and high levels of breast cancer have also been observed. The distribution of such neoplasms and the differences observed among neighboring areas deserve further analytical studies, with the aim of a better reading of cancer onset and diffusion. The quality of data obtained (about 70% of histocytologic confirmations, and 5% of "final" death-certificate-only cases), appears to reach satisfying levels, considering the starting phase of the registry.

Association of Trajectories of Higher-Level Functional Capacity with Mortality and Medical and Long-Term Care Costs Among Community-Dwelling Older Japanese.

PubMed

Taniguchi, Yu; Kitamura, Akihiko; Nofuji, Yu; Ishizaki, Tatsuro; Seino, Satoshi; Yokoyama, Yuri; Shinozaki, Tomohiro; Murayama, Hiroshi; Mitsutake, Seigo; Amano, Hidenori; Nishi, Mariko; Matsuyama, Yutaka; Fujiwara, Yoshinori; Shinkai, Shoji

2018-03-26

Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.

Hyperglycaemic crisis in the Eastern Cape province of South Africa: high mortality and association of hyperosmolar ketoacidosis with a new diagnosis of diabetes.

PubMed

Ekpebegh, C O; Longo-Mbenza, B; Akinrinmade, A; Blanco-Blanco, E; Badri, M; Levitt, N S

2010-12-01

To describe the frequencies, presenting characteristics (demographic, clinical and biochemical) and outcomes (duration of admission and mortality rates) for various types of hyperglycaemic crisis. Retrospective review of medical records of patients with hyperglycaemic crisis admitted to Nelson Mandela Academic Hospital, Mthatha, E Cape, from 1 January 2008 to 31 December 2009. Outcome measures were duration of admission and mortality. Data were available for 269 admissions (response rate 81.0%), 169 females and 100 males. Admissions for hyperglycaemia (HG, N=119), and non-hyperosmolar diabetic ketoacidosis (NHDKA, N=97) were more frequent than those for hyperosmolar hyperglycaemic state (HHS, N=29) and hyperosmolar diabetic ketoacidosis (HDKA, N=24). Duration of admission was similar in all groups. Mortality was high in all groups, but was higher in patients with HDKA (37.5%, risk ratio (RR) 3.88, 95% confidence interval (CI) 1.41 - 10.67, p=0.009), HHS (31.0%, RR 2.91, 95% CI 1.09 - 7.75, p=0.033) and HG (19.5%, RR 1.56, 95% CI 0.75 - 3.21, p=0.236) than in those with NHDKA (13.4%). HDKA (62.5%) was associated with new-onset diabetes more often than NHDKA (27.8%), HHS (44.8%) or HG (17.6%) (p<0.0001). An altered level of consciousness was more frequent in HDKA than NHDKA admissions (RR 5.71, 95% CI 1.90 - 17.17, p=0.002). Duration of hospital stay was similar across groups. Mortality rates were high in all groups. New-onset diabetes, altered level of consciousness and mortality were more characteristically associated with HDKA than any of the other types of hyperglycaemic crisis. Optimal glycaemic control in known diabetic patients will reduce rates of hyperglycaemic crisis admissions.

Pollution and regional variations of lung cancer mortality in the United States.

PubMed

Moore, Justin Xavier; Akinyemiju, Tomi; Wang, Henry E

2017-08-01

The aims of this study were to identify counties in the United States (US) with high rates of lung cancer mortality, and to characterize the associated community-level factors while focusing on particulate-matter pollution. We performed a descriptive analysis of lung cancer deaths in the US from 2004 through 2014. We categorized counties as "clustered" or "non-clustered" - based on whether or not they had high lung cancer mortality rates - using novel geospatial autocorrelation methods. We contrasted community characteristics between cluster categories. We performed logistic regression for the association between cluster category and particulate-matter pollution. Among 362 counties (11.6%) categorized as clustered, the age-adjusted lung cancer mortality rate was 99.70 deaths per 100,000 persons (95%CI: 99.1-100.3). Compared with non-clustered counties, clustered counties were more likely in the south (72.9% versus 42.1%, P<0.01) and in non-urban communities (73.2% versus 57.4, P<0.01). Clustered counties had greater particulate-matter pollution, lower education and income, higher rates of obesity and physical inactivity, less access to healthcare, and greater unemployment rates (P<0.01). Higher levels of particulate-matter pollution (4th quartile versus 1st quartile) were associated with two-fold greater odds of being a clustered county (adjusted OR: 2.10; 95%CI: 1.23-3.59). We observed a belt of counties with high lung mortality ranging from eastern Oklahoma through central Appalachia; these counties were characterized by higher pollution, a more rural population, lower socioeconomic status and poorer access to healthcare. To mitigate the burden of lung cancer mortality in the US, both urban and rural areas should consider minimizing air pollution. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Fraction of stroke mortality attributable to alcohol consumption in Russia.

PubMed

Y E, Razvodovsky

2014-01-01

Stroke is an international health problem with high associated human and economic costs. The mortality rate from stroke in Russia is one of the highest in the world. Risk factors identification is therefore a high priority from the public health perspective. Epidemiological evidence suggests that binge drinking is an important determinant of high stroke mortality rate in Russia. The aim of the present study was to estimate the premature stroke mortality attributable to alcohol abuse in Russia on the basis of aggregate-level data of stroke mortality and alcohol consumption. Age-standardized sex-specific male and female stroke mortality data for the period 1980-2005 and data on overall alcohol consumption were analyzed by means ARIMA time series analysis. The results of the analysis suggest that 26.8% of all male stroke deaths and 18.4% female stroke deaths in Russia could be attributed to alcohol. The estimated alcohol-attributable fraction for men ranged from 16.2% (75+ age group) to 57,5% (30-44 age group) and for women from 21.7% (60-74 age group) and 43.5% (30- 44 age group). The outcomes of this study provide support for the hypothesis that alcohol is an important contributor to the high stroke mortality rate in Russian Federation. Therefore prevention of alcohol-attributable harm should be a major public health priority in Russia. Given the distribution of alcohol-related stroke deaths, interventions should be focused on the young and middle-aged men and women.

Income differentials in functional disability in old age: relative risks of onset, recovery, decline, attrition and mortality.

PubMed

Broese van Groenou, Marjolein I; Deeg, Dorly J H; Penninx, Brenda W J H

2003-04-01

Socioeconomic status (SES) differences in health decline in late life may be underestimated, because the relatively higher risks of attrition of lower-SES persons are seldom taken into account. This longitudinal study aimed at comparing income differences in the course of disability, non-mortality attrition and mortality in older adults. A sample population of 3107 older adults who participated in the 1992/1993 baseline of the Longitudinal Aging Study Amsterdam was examined regarding changes in functional disability in 1998/1999. SES was indicated by household income. Multinomial regression analyses revealed that, for men without disability at baseline, the relative rate for attrition was four times higher and the mortality rate was twice as high for low-income vs high-income persons. For non-disabled women, the relative risk for the onset of disability was nearly twice as high for low-income vs high-income persons. For both men and women, these risks decreased only slightly when behavioral and psychosocial risk factors were taken into account. Among persons with disability at baseline, the relative risks for attrition (for women) and mortality (for men) were twice as high for low-income persons, but no income differences were found with respect to recovery and decline. Adjustment for risk factors decreased the relative risks for attrition and mortality to a non-significant level. Income inequality in health in late life is to a large degree explained by the higher incidence of disability among lower-status women and by the higher attrition and mortality risks among lower-status men.

Effects of food price inflation on infant and child mortality in developing countries.

PubMed

Lee, Hyun-Hoon; Lee, Suejin A; Lim, Jae-Young; Park, Cyn-Young

2016-06-01

After a historic low level in the early 2000s, global food prices surged upwards to bring about the global food crisis of 2008. High and increasing food prices can generate an immediate threat to the security of a household's food supply, thereby undermining population health. This paper aims to assess the precise effects of food price inflation on child health in developing countries. This paper employs a panel dataset covering 95 developing countries for the period 2001-2011 to make a comprehensive assessment of the effects of food price inflation on child health as measured in terms of infant mortality rate and child mortality rate. Focusing on any departure of health indicators from their respective trends, we find that rising food prices have a significant detrimental effect on nourishment and consequently lead to higher levels of both infant and child mortality in developing countries, and especially in least developed countries (LDCs). High food price inflation rates are also found to cause an increase in undernourishment only in LDCs and thus leading to an increase in infant and child mortality in these poorest countries. This result is consistent with the observation that, in lower-income countries, food has a higher share in household expenditures and LDCs are likely to be net food importing countries. Hence, there should be increased efforts by both LDC governments and the international community to alleviate the detrimental link between food price inflation and undernourishment and also the link between undernourishment and infant mortality.

A better indicator to measure the effects of meteorological factors on cardiovascular mortality: heat index.

PubMed

Yin, Qian; Wang, Jinfeng

2018-05-31

Although many studies have examined the correlation between temperature and mortality from cardiovascular diseases (CVD), other meteorological factors, such as relative humidity, may modify the relationship. Yet the studies on this aspect are relatively few. We chose a heat index (HI, which is an index that combines air temperature and relative humidity) as an alternative indicator of temperature, and used a distributed lag nonlinear model (DLNM) to analyze the combined effects of temperature and relative humidity on CVD mortality among all of the Beijing residents and subsociodemographic groups by age, sex, and occupation. The heat index can better reflect the human-perceived temperature when relative humidity is combined with air temperature. The results show that females, elderly people, and outdoor workers have higher vulnerability levels in regard to a high heat index. The strongest effect of heat index was found among females, for which the highest mortality risk was about 2.4 (95% CI 1.8-3) times greater than the lowest mortality risk. In addition, we found that there is a significant interaction effect of temperature and relative humidity on CVD mortality. The impact of extreme high temperature may be exacerbated by increases in humidity. Based on these results, we draw the risk level map of CVD death under different temperatures and grades of relative humidity. These findings may aid governments in the development of more accurate heat alerts and the provision of measures to prevent or reduce temperature-related deaths.

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.

[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.

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.

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

Increased Level of Interleukin 6 Associates With Increased 90-Day and 1-Year Mortality in Patients With End-Stage Liver Disease.

PubMed

Remmler, Johannes; Schneider, Christoph; Treuner-Kaueroff, Theresa; Bartels, Michael; Seehofer, Daniel; Scholz, Markus; Berg, Thomas; Kaiser, Thorsten

2018-05-01

Organ allocation for liver transplantation is based on prognosis, using the model for end-stage liver disease (MELD) or MELD including serum sodium (MELD-Na) score. These scores do not consider systemic inflammation and septic complications. Blood level of C-reactive protein (CRP), in addition to the MELD score, associates with mortality in patients with end-stage liver disease, whereas levels of interleukin 6 (IL6) have not been systematically studied. We performed a retrospective observational cohort study of 474 patients with end-stage liver disease (63.5% male; median age, 56.9 years), evaluated for liver transplantation in Germany, with at least 1 year of follow up. Data were collected on blood levels of CRP, IL6, and white blood cell count (WBC). Findings were analyzed in relation to mortality and compared with patients' MELD scores and MELD-Na scores. For survival analysis, the cohort was divided into quartiles of IL6, CRP, and WBC levels, as well as MELD scores. Log-rank test and the Cox proportional hazards regression model were used to compare the groups, and area under the receiver operating characteristic (AUROC) values were calculated. Blood levels of IL6 and MELD scores associated with mortality: none of the patients with levels of IL6 below the first quartile (below 5.3 pg/mL) died within 1 year. In contrast, 67.7% of the patients in the highest quartile of IL6 level (37.0 pg/mL or more) died within 1 year. MELD score also correlated with mortality: among patients with MELD scores below 8.7, 0.9% died within 1 year, whereas in patients with MELD scores of 18.0 or more, 67.4% died within 1 year. The predictive value of level of IL6 (AUROC, 0.940) was higher than level of CRP (AUROC, 0.866) (P = .009) or WBC (AUROC, 0.773) (P < .001) for 90-day mortality. MELD scores associated with 90-day mortality (AUROC, 0.933) (P = .756) as did MELD-Na score (AUROC, 0.946) (P = .771). Level of IL6 associated with 1-year mortality (AUROC, 0.916) to a greater extent than liver synthesis or detoxification markers international normalized ratio (AUROC, 0.839) (P = .007) or bilirubin (AUROC 0.846) (P = .007). Level of IL6 was an independent, significant risk factor for mortality after adjustment for MELD score, MELD-Na score, level of CRP, or WBC. In a retrospective analysis, we found high blood levels of IL6 to associate with 90-day and 1-year mortality in patients with end-stage liver disease; its predictive value was comparable to that of MELD or MELD-Na score, and was higher than that of level of CRP or WBC. Further studies should be performed to confirm the results in different cohorts. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study.

PubMed

Abramowitz, Matthew K; Hall, Charles B; Amodu, Afolarin; Sharma, Deep; Androga, Lagu; Hawkins, Meredith

2018-01-01

The level of body-mass index (BMI) associated with the lowest risk of death remains unclear. Although differences in muscle mass limit the utility of BMI as a measure of adiposity, no study has directly examined the effect of muscle mass on the BMI-mortality relationship. Body composition was measured by dual-energy x-ray absorptiometry in 11,687 participants of the National Health and Nutrition Examination Survey 1999-2004. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). Proportional hazards models were created to model associations with all-cause mortality. At any level of BMI ≥22, participants with low muscle mass had higher body fat percentage (%TBF), an increased likelihood of diabetes, and higher adjusted mortality than other participants. Increases in %TBF manifested as 30-40% smaller changes in BMI than were observed in participants with preserved muscle mass. Excluding participants with low muscle mass or adjustment for ASMI attenuated the risk associated with low BMI, magnified the risk associated with high BMI, and shifted downward the level of BMI associated with the lowest risk of death. Higher ASMI was independently associated with lower mortality. Effects were similar in never-smokers and ever-smokers. Additional adjustment for waist circumference eliminated the risk associated with higher BMI. Results were unchanged after excluding unintentional weight loss, chronic illness, early mortality, and participants performing muscle-strengthening exercises or recommended levels of physical activity. Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox.

Muscle mass, BMI, and mortality among adults in the United States: A population-based cohort study

PubMed Central

Hall, Charles B.; Amodu, Afolarin; Sharma, Deep; Androga, Lagu; Hawkins, Meredith

2018-01-01

Background The level of body-mass index (BMI) associated with the lowest risk of death remains unclear. Although differences in muscle mass limit the utility of BMI as a measure of adiposity, no study has directly examined the effect of muscle mass on the BMI-mortality relationship. Methods Body composition was measured by dual-energy x-ray absorptiometry in 11,687 participants of the National Health and Nutrition Examination Survey 1999–2004. Low muscle mass was defined using sex-specific thresholds of the appendicular skeletal muscle mass index (ASMI). Proportional hazards models were created to model associations with all-cause mortality. Results At any level of BMI ≥22, participants with low muscle mass had higher body fat percentage (%TBF), an increased likelihood of diabetes, and higher adjusted mortality than other participants. Increases in %TBF manifested as 30–40% smaller changes in BMI than were observed in participants with preserved muscle mass. Excluding participants with low muscle mass or adjustment for ASMI attenuated the risk associated with low BMI, magnified the risk associated with high BMI, and shifted downward the level of BMI associated with the lowest risk of death. Higher ASMI was independently associated with lower mortality. Effects were similar in never-smokers and ever-smokers. Additional adjustment for waist circumference eliminated the risk associated with higher BMI. Results were unchanged after excluding unintentional weight loss, chronic illness, early mortality, and participants performing muscle-strengthening exercises or recommended levels of physical activity. Conclusions Muscle mass mediates associations of BMI with adiposity and mortality and is inversely associated with the risk of death. After accounting for muscle mass, the BMI associated with the greatest survival shifts downward toward the normal range. These results provide a concrete explanation for the obesity paradox. PMID:29641540

The Comparison of Gemfibrozil and Lovastatin Therapy in Patients with High LDL and Low HDL Cholesterol Levels

DTIC Science & Technology

1990-08-01

cholesterol with same method as for TC; however, precision of the HDL measurements were (±SD) ±1.5 mg/dl. Triglycerides ( TG ) were...placebo lipid levels (TC and TG levels), lipoprotein cholesterol levels (LDL, VLDL, and HDL cholesterol levels), and the cholesterol ratios between... high density lipoprotein cholesterol in the serum and risk of mortality: evidence of a threshold effect. Br Med J. 1985; 290:1239-43. 7. Gordon

Is elevated Red cell distribution width a prognostic predictor in adult patients with community acquired Pneumonia?

PubMed Central

2014-01-01

Background Community acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (<60 years old) with CAP, elevated red blood cell distribution width (RDW) level on admission was associated with significant higher rates of mortality and severe morbidity. We aimed to investigate the prognostic predictive value of RDW among CAP patients in general population of internal wards. Methods The cohort included patients of 18 years old or older who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between January 1, 2005 and December 31, 2010. Patients were retrospectively analyzed for risk factors for a primary endpoint of 90-day mortality. Secondary endpoint was defined as complicated hospitalization (defined as at least one of the following: In- hospital mortality, length of stay of at least 10 days or ICU admission). Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in univariate and multivariate analysis to identify association between patient characteristic, 90-day mortality and complicated hospitalization. Results The cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb < 10 mg/dl, Na <130 meq/l, blood urea nitrogen (BUN) >30 mg/dl, systolic blood pressure < 90 mmHg and elevated RDW >15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin < 10 g/dl, heart rate >124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels. Conclusions Elevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score. PMID:24597687

Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation.

PubMed

Pavliša, Gordana; Labor, Marina; Puretić, Hrvoje; Hećimović, Ana; Jakopović, Marko; Samaržija, Miroslav

2017-12-31

To determine in-hospital and post-discharge mortality, readmission rates, and predictors of invasive mechanical ventilation (IMV) in patients treated at intensive care unit (ICU) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). A retrospective observational cohort study included all patients treated at a respiratory ICU for AECOPD during one year. A total of 62 patients (41 men) with mean age 68.4±10.4 years were analyzed for outcomes including in-hospital and post-discharge mortality, readmission rates, and IMV. Patients' demographic, hematologic, biochemical data and arterial blood gas (ABG) values were recorded on admission to hospital. Mean duration of follow-up time was 2.4 years. Of 62 patients, 7 (11.3%) died during incident hospitalization and 21 (33.9%) died during the follow-up. The overall 2.4-year mortality was 45.2%. Twenty nine (46.8%) patients were readmitted due to AECOPD. The average number of readmissions was 1.2. Multivariate analysis showed that blood pH, bicarbonate levels, low albumin, low serum chloride, and low hemoglobin were significant predictors of IMV during incident hospitalization (P<0.001 for the overall model fit). High in-hospital and post-discharge mortality and high readmission rates in our patients treated due to AECOPD at ICU indicate that these patients represent a high risk group in need of close monitoring. Our results suggested that anemia, hypoalbuminemia, and elevated troponin levels were risk factors for the need of IMV in severe AECOPD. Identification of such high-risk patients could provide the opportunity for administration of an appropriate and timely treatment.

Role of TRPA1 in acute cardiopulmonary toxicity of inhaled acrolein.

PubMed

Conklin, Daniel J; Haberzettl, Petra; Jagatheesan, Ganapathy; Kong, Maiying; Hoyle, Gary W

2017-06-01

Acrolein is a highly toxic, volatile, unsaturated aldehyde generated during incomplete combustion as in tobacco smoke and indoor fires. Because the transient receptor potential ankyrin 1 (TRPA1) channel mediates tobacco smoke-induced lung injury, we assessed its role in high-level acrolein-induced toxicity in mice. Acrolein (100-275ppm, 10-30min) caused upper airway epithelial sloughing, bradypnea and oral gasping, hypothermia, cardiac depression and mortality. Male wild-type mice (WT, C57BL/6; 5-52weeks) were significantly more sensitive to high-level acrolein than age-matched, female WT mice. Both male and female TRPA1-null mice were more sensitive to acrolein-induced mortality than age- and sex-matched WT mice. Acrolein exposure increased lung weight:body weight ratios and lung albumin and decreased plasma albumin to a greater extent in TRPA1-null than in WT mice. Lung and plasma protein-acrolein adducts were not increased in acrolein-exposed TRPA1-null mice compared with WT mice. To assess TRPA1-dependent protective mechanisms, respiratory parameters were monitored by telemetry. TRPA1-null mice had a slower onset of breathing rate suppression ('respiratory braking') than WT mice suggesting TRPA1 mediates this protective response. Surprisingly, WT male mice treated either with a TRPA1 antagonist (HC030031; 200mg/kg) alone or with combined TRPA1 (100mg/kg) and TRPV1 (capsazepine, 10mg/kg) antagonists at 30min post-acrolein exposure (i.e., "real world" delay in treatment) were significantly protected from acrolein-induced mortality. These data show TRPA1 protects against high-level acrolein-induced toxicity in a sex-dependent manner. Post-exposure TRPA1 antagonism also protected against acrolein-induced mortality attesting to a complex role of TRPA1 in cardiopulmonary injury. Copyright © 2016 Elsevier Inc. All rights reserved.

Intra-dialytic hypertension is associated with high mortality in hemodialysis patients

PubMed Central

Yoon, Kyu Tae; Gil, Hyo Wook; Hong, Sae Yong

2017-01-01

Background Intra-dialytic hypertension (IDH) is emerging as an important issue in hemodialysis patients. Its risk factors and clinical outcomes are unclear. Methods A total of 73 prevalent hemodialysis patients were enrolled. They included 14 (19.2%) patients with baseline IDH and 59 patients without IDH. Their clinical parameters, laboratory parameters, and mortality were investigated over 78 months. Results The risks factor of IDH included low serum potassium levels, low ultrafiltration, and low arm muscle area. Lower median survival was evident in the IDH group compared to the non-IDH group, but was not significantly different. After adjusting for relevant confounders for age, the IDH group displayed 2.846 times higher mortality rate than the non-IDH Group (adjusted hazard ratio: 2.846; 95% confidence interval: 1.081–7.490; P = 0.034). Conclusion IDH is associated with high mortality in hemodialysis patients. Clinicians should be aware of the risk factors. Future research studies are needed to explore the mechanisms involved in the association between IDH and mortality. PMID:28742805

Relative Impact of Surgeon and Hospital Volume on Operative Mortality and Complications Following Pancreatic Resection in Medicare Patients

PubMed Central

Mehta, Hemalkumar B.; Parmar, Abhishek D.; Adhikari, Deepak; Tamirisa, Nina P.; Dimou, Francesca; Jupiter, Daniel; Riall, Taylor S.

2016-01-01

Background Surgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-day mortality and 30-day complications after pancreatic resection among older patients. Materials and Methods The study used Texas Medicare data (2000–2012), identifying high-volume surgeons as those performing ≥4 pancreatic resections/year, and high-volume hospitals as those performing ≥11 pancreatic resections/year, on Medicare patients. Three-level hierarchical logistic regression models were used to evaluate the relative effects of surgeon and hospital volumes on mortality and complications, after adjusting for case mix differences. Results There were 2,453 pancreatic resections performed by 490 surgeons operating in 138 hospitals. 4.5% of surgeons and 6.5% of hospitals were high-volume. The overall 30-day mortality was 9.0%, and the 30-day complication rate was 40.6%. Overall, 8.9% of the variance in 30-day mortality was attributed to surgeon factors and 9.8% to hospital factors. For 30-day complications, 4.7% of the variance was attributed to surgeon factors and 1.2% to hospital factors. After adjusting for patient, surgeon and hospital characteristics, high surgeon volume (OR 0.54, 95% CI 0.33–0.87) and high hospital volume (OR, 0.52; 95% CI, 0.30–0.92) were associated with lower risk of mortality; high surgeon volume (OR 0.71, 95% CI 0.55–0.93) was also associated lower risk of 30-day complications. Conclusions Both hospital and surgeon factors contributed significantly to the observed variance in mortality, but only surgeon factors impacted complications. PMID:27565068

Increased serum bicarbonate in critically ill patients: a retrospective analysis.

PubMed

Libório, Alexandre Braga; Noritomi, Danilo Teixeira; Leite, Tacyano Tavares; de Melo Bezerra, Candice Torres; de Faria, Evandro Rodrigues; Kellum, John A

2015-03-01

Although metabolic alkalosis is a common occurrence, no study has evaluated its prevalence, associated factors or outcomes in critically ill patients. This is a retrospective study from the Multiparameter Intelligent Monitoring in Intensive Care II database. From 23,529 adult patient records, 18,982 patients met the inclusion criteria. Serum bicarbonate levels demonstrated a U-shaped association with mortality with knots at 25 and 30 mEq/l. Of the total included patients, 5,565 (29.3 %) had at least one serum bicarbonate level measurement >30 mEq/l. The majority were exposed to multiple factors that are classically associated with metabolic alkalosis (mainly diuretic use, hypernatremia, hypokalemia and high gastric output). Patients with increased serum bicarbonate exhibited increased ICU LOS, more days on mechanical ventilation and higher hospital mortality. After multivariate adjustment, each 5-mEq/l increment in the serum bicarbonate level above 30 mEq/l was associated with an odds ratio of 1.21 for hospital mortality. The association between increased serum bicarbonate levels and mortality occurs independently of its possible etiologies. An increased serum bicarbonate level is common in critically ill patients; this can be attributed to multiple factors in the majority of cases, and its presence and duration negatively influence patient outcomes.

Misery Loves Company? A Meta-Regression Examining Aggregate Unemployment Rates and the Unemployment-Mortality Association

PubMed Central

Roelfs, David J.; Shor, Eran; Blank, Aharon; Schwartz, Joseph E.

2015-01-01

PURPOSE Individual-level unemployment has been consistently linked to poor health and higher mortality, but some scholars have suggested that the negative effect of job loss may be lower during times and in places where aggregate unemployment rates are high. We review three logics associated with this moderation hypothesis: health selection, social isolation, and unemployment stigma. We then test whether aggregate unemployment rates moderate the individual-level association between unemployment and all-cause mortality. METHODS We use 6 meta-regression models (each utilizing a different measure of the aggregate unemployment rate) based on 62 relative all-cause mortality risk estimates from 36 studies (from 15 nations). RESULTS We find that the magnitude of the individual-level unemployment-mortality association is approximately the same during periods of high and low aggregate-level unemployment. Model coefficients (exponentiated) were 1.01 for the crude unemployment rate (p = 0.27), 0.94 for the change in unemployment rate from the previous year (p = 0.46), 1.01 for the deviation of the unemployment rate from the 5-year running average (p = 0.87), 1.01 for the deviation of the unemployment rate from the 10-year running average (p = 0.73), 1.01 for the deviation of the unemployment rate from the overall average (measured as a continuous variable; p = 0.61), and showed no variation across unemployment levels when the deviation of the unemployment rate from the overall average was measured categorically. Heterogeneity between studies was significant (p < .001), supporting the use of the random effects model. CONCLUSIONS We found no strong evidence to suggest that unemployment experiences change when macro-economic conditions change. Efforts to ameliorate the negative social and economic consequences of unemployment should continue to focus on the individual and should be maintained regardless of periodic changes in macro-economic conditions. PMID:25795225

Misery loves company? A meta-regression examining aggregate unemployment rates and the unemployment-mortality association.

PubMed

Roelfs, David J; Shor, Eran; Blank, Aharon; Schwartz, Joseph E

2015-05-01

Individual-level unemployment has been consistently linked to poor health and higher mortality, but some scholars have suggested that the negative effect of job loss may be lower during times and in places where aggregate unemployment rates are high. We review three logics associated with this moderation hypothesis: health selection, social isolation, and unemployment stigma. We then test whether aggregate unemployment rates moderate the individual-level association between unemployment and all-cause mortality. We use six meta-regression models (each using a different measure of the aggregate unemployment rate) based on 62 relative all-cause mortality risk estimates from 36 studies (from 15 nations). We find that the magnitude of the individual-level unemployment-mortality association is approximately the same during periods of high and low aggregate-level unemployment. Model coefficients (exponentiated) were 1.01 for the crude unemployment rate (P = .27), 0.94 for the change in unemployment rate from the previous year (P = .46), 1.01 for the deviation of the unemployment rate from the 5-year running average (P = .87), 1.01 for the deviation of the unemployment rate from the 10-year running average (P = .73), 1.01 for the deviation of the unemployment rate from the overall average (measured as a continuous variable; P = .61), and showed no variation across unemployment levels when the deviation of the unemployment rate from the overall average was measured categorically. Heterogeneity between studies was significant (P < .001), supporting the use of the random effects model. We found no strong evidence to suggest that unemployment experiences change when macroeconomic conditions change. Efforts to ameliorate the negative social and economic consequences of unemployment should continue to focus on the individual and should be maintained regardless of periodic changes in macroeconomic conditions. Copyright © 2015 Elsevier Inc. All rights reserved.

The use of plastic debris as nesting material by a colonial seabird and associated entanglement mortality.

PubMed

Votier, Stephen C; Archibald, Kirsten; Morgan, Greg; Morgan, Lisa

2011-01-01

Entanglement with plastic debris is a major cause of mortality in marine taxa, but the population-level consequences are unknown. Some seabirds collect marine debris for nesting material, which may lead to entanglement. Here we investigate the use of plastics as nesting material by northern gannets Morus bassanus and assess the associated levels of mortality. On average gannet nests contained 469.91 g (range 0-1293 g) of plastic, equating to an estimated colony total of 18.46 tones (range 4.47-42.34 tones). The majority of nesting material was synthetic rope, which appears to be used preferentially. On average 62.85 ± 26.84 (range minima 33-109) birds were entangled each year, totalling 525 individuals over eight years, the majority of which were nestlings. Although mortality rates are high, they are unlikely to have population-level effects. The use of synthetic fibres as nesting material is a common strategy among seabirds, but the impacts of entanglement warrants further investigation. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Infant Mortality in Washington, D.C.: A Study of Risk Factors among Black Residents.

ERIC Educational Resources Information Center

Ahmed, Feroz

This report examines the determinants of the high level of infant mortality in Washington, D.C. Data were analyzed for 36,872 black resident single-delivery births occurring in the years 1980 through 1984, and 762 infant deaths occurring to these birth cohorts from 1980 to 1985. Findings were the following: (1) poor birthweight distribution among…

Recent Trends in Fertility and Mortality in Hungary: A Curriculum Unit. Fulbright-Hays Summer Seminars Abroad Program, 1998 (Hungary/Poland).

ERIC Educational Resources Information Center

Behr, Michelle

This curriculum unit, suitable for advanced placement high school courses or introductory level college courses, explores Hungarian fertility and mortality rates and their social and economic consequences. Students are required to map, graph, analyze, and summarize demographic data to examine population trends in Hungary in the post-World War 2…

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.

Death on a strange isle: the mortality of the stone workers of Purbeck in the nineteenth century.

PubMed

Hinde, Andrew; Edgar, Michael

2010-01-01

This paper analyses the mortality of a group of rural workers in an extractive industry, the stone quarriers of the Isle of Purbeck in the southern English county of Dorset. The analysis uses a database created by nominal record linkage of the census enumerators' books and the Church of England baptism and burial registers to estimate age-specific death rates at all ages for males and females, and hence statistics such as the expectation of life at birth. The results are compared with mortality statistics published by the Registrar General of England and Wales (on the basis of the civil registers of deaths) for the registration district of Wareham, in which Purbeck is situated. The stone quarriers had heavier mortality levels than the rest of the population of Purbeck. Closer inspection, however, reveals that their high mortality was confined to males, and was almost entirely due to especially high mortality among boys aged less than five years. In contrast to the experience of coal and metal ore miners, adult male mortality among stone workers was no higher than that among the general population. The final section of the paper considers possible explanations for these results, and suggests that excess mortality among boys in Purbeck from lung diseases might have been responsible.

Mortality, readmission and length of stay have different relationships using hospital-level versus patient-level data: an example of the ecological fallacy affecting hospital performance indicators.

PubMed

Hofstede, Stefanie N; van Bodegom-Vos, Leti; Kringos, Dionne S; Steyerberg, Ewout; Marang-van de Mheen, Perla J

2018-06-01

Ecological fallacy refers to an erroneous inference about individuals on the basis of findings for the group to which those individuals belong. Suppose analysis of a large database shows that hospitals with a high proportion of long length of stay (LOS) patients also have higher than average in-hospital mortality. This may prompt efforts to reduce mortality among patients with long LOS. But patients with long LOS may not be the ones at higher risk of death. It may be that hospitals with higher mortality (regardless of LOS) also have more long LOS patients-either because of quality problems on both counts or because of unaccounted differences in case mix. To provide more insight how the ecological fallacy influences the evaluation of hospital performance indicators, we assessed whether hospital-level associations between in-hospital mortality, readmission and long LOS reflect patient-level associations. Patient admissions from the Dutch National Medical Registration (2007-2012) for specific diseases (stroke, colorectal carcinoma, heart failure, acute myocardial infarction and hip/knee replacements in patients with osteoarthritis) were analysed, as well as all admissions. Logistic regression analysis was used to assess patient-level associations. Pearson correlation coefficients were used to quantify hospital-level associations. Overall, we observed 2.2% in-hospital mortality, 8.1% readmissions and a mean LOS of 5.9 days among 8 478 884 admissions in 95 hospitals. Of the 10 disease-specific associations tested, 2 were reversed at hospital-level, 3 were consistent and 5 were only significant at either hospital-level or patient-level. A reversed association was found for stroke: patients with long LOS had 58% lower in-hospital mortality (OR 0.42 (95% CI 0.40 to 0.44)), whereas the hospital-level association was reversed (r=0.30, p<0.01). Similar negative patient-level associations were found for each hospital, but LOS varied across hospitals, thereby resulting in a positive hospital-level association. A similar effect was found for long LOS and readmission in patients with heart failure. Hospital-level associations did not reflect the same patient-level associations in 7 of 10 associations, and were even reversed in 2 associations. Ecological fallacy thus potentially influences interpretation of hospital performance when patient-level associations are not taken into account. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Alcohol consumption and pancreatitis mortality in Russia.

PubMed

Razvodovsky, Yury E

2014-07-28

Pancreatitis is a major public health problem with high associated economic costs. The incidence of pancreatitis has increased in many European countries in recent decade. Accumulated research and empirical evidence suggests that excessive alcohol consumption is a major risk factor for both acute and chronic pancreatitis. The aim of this study was to examine the aggregate-level relation between the alcohol consumption and pancreatitis mortality rates in Russia. Age-standardized sex-specific male and female pancreatitis mortality data for the period 1970-2005 and data on overall alcohol consumption were analyzed by means ARIMA (autoregressive integrated moving average) time series analysis. Alcohol consumption was significantly associated with both male and female pancreatitis mortality rates: a 1 liter increase in overall alcohol consumption would result in a 7.0% increase in the male pancreatitis mortality rate and in 2.3% increase in the female mortality rate. The results of the analysis suggest that 63.1% of all male pancreatitis deaths and 26.8% female deaths in Russia could be attributed to alcohol. Conclusions The outcomes of this study provide indirect support for the hypothesis that unfavorable mixture of higher overall level of alcohol consumption and binge drinking pattern is an important contributor to the pancreatitis mortality rate in Russian Federation.

Residual confounding explains the association between high parity and child mortality.

PubMed

Kozuki, Naoko; Sonneveldt, Emily; Walker, Neff

2013-01-01

This study used data from recent Demographic and Health Surveys (DHS) to examine the impact of high parity on under-five and neonatal mortality. The analyses used various techniques to attempt eliminating selection issues, including stratification of analyses by mothers' completed fertility. We analyzed DHS datasets from 47 low- and middle-income countries. We only used data from women who were age 35 or older at the time of survey to have a measure of their completed fertility. We ran log-binominal regression by country to calculate relative risk between parity and both under-five and neonatal mortality, controlled for wealth quintile, maternal education, urban versus rural residence, maternal age at first birth, calendar year (to control for possible time trends), and birth interval. We then controlled for maternal background characteristics even further by using mothers' completed fertility as a proxy measure. We found a statistically significant association between high parity and child mortality. However, this association is most likely not physiological, and can be largely attributed to the difference in background characteristics of mothers who complete reproduction with high fertility versus low fertility. Children of high completed fertility mothers have statistically significantly increased risk of death compared to children of low completed fertility mothers at every birth order, even after controlling for available confounders (i.e. among children of birth order 1, adjusted RR of under-five mortality 1.58, 95% CI: 1.42, 1.76). There appears to be residual confounders that put children of high completed fertility mothers at higher risk, regardless of birth order. When we examined the association between parity and under-five mortality among mothers with high completed fertility, it remained statistically significant, but negligible in magnitude (i.e. adjusted RR of under-five mortality 1.03, 95% CI: 1.02-1.05). Our analyses strongly suggest that the observed increased risk of mortality associated with high parity births is not driven by a physiological link between parity and mortality. We found that at each birth order, children born to women who have high fertility at the end of their reproductive period are at significantly higher mortality risk than children of mothers who have low fertility, even after adjusting for available confounders. With each unit increase in birth order, a larger proportion of births at the population level belongs to mothers with these adverse characteristics correlated with high fertility. Hence it appears as if mortality rates go up with increasing parity, but not for physiological reasons.

Population-Level Density Dependence Influences the Origin and Maintenance of Parental Care

PubMed Central

Reyes, Elijah; Thrasher, Patsy; Bonsall, Michael B.; Klug, Hope

2016-01-01

Parental care is a defining feature of animal breeding systems. We now know that both basic life-history characteristics and ecological factors influence the evolution of care. However, relatively little is known about how these factors interact to influence the origin and maintenance of care. Here, we expand upon previous work and explore the relationship between basic life-history characteristics (stage-specific rates of mortality and maturation) and the fitness benefits associated with the origin and the maintenance of parental care for two broad ecological scenarios: the scenario in which egg survival is density dependent and the case in which adult survival is density dependent. Our findings suggest that high offspring need is likely critical in driving the origin, but not the maintenance, of parental care regardless of whether density dependence acts on egg or adult survival. In general, parental care is more likely to result in greater fitness benefits when baseline adult mortality is low if 1) egg survival is density dependent or 2) adult mortality is density dependent and mutant density is relatively high. When density dependence acts on egg mortality, low rates of egg maturation and high egg densities are less likely to lead to strong fitness benefits of care. However, when density dependence acts on adult mortality, high levels of egg maturation and increasing adult densities are less likely to maintain care. Juvenile survival has relatively little, if any, effect on the origin and maintenance of egg-only care. More generally, our results suggest that the evolution of parental care will be influenced by an organism’s entire life history characteristics, the stage at which density dependence acts, and whether care is originating or being maintained. PMID:27093056

Surveillance of Pediatric Cardiac Surgical Outcome Using Risk Stratifications at a Tertiary Care Center in Thailand

PubMed Central

Vijarnsorn, Chodchanok; Laohaprasitiporn, Duangmanee; Durongpisitkul, Kritvikrom; Chantong, Prakul; Soongswang, Jarupim; Cheungsomprasong, Paweena; Nana, Apichart; Sriyoschati, Somchai; Subtaweesin, Thawon; Thongcharoen, Punnarerk; Prakanrattana, Ungkab; Krobprachya, Jiraporn; Pooliam, Julaporn

2011-01-01

Objectives. To determine in-hospital mortality and complications of cardiac surgery in pediatric patients and identify predictors of hospital mortality. Methods. Records of pediatric patients who had undergone cardiac surgery in 2005 were reviewed retrospectively. The risk adjustment for congenital heart surgery (RACHS-1) method, the Aristotle basic complexity score (ABC score), and the Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery Mortality score (STS-EACTS score) were used as measures. Potential predictors were analyzed by risk analysis. Results. 230 pediatric patients had undergone congenital cardiac surgery. Overall, the mortality discharge was 6.1%. From the ROC curve of the RACHS-1, the ABC level, and the STS-EACTS categories, the validities were determined to be 0.78, 0.74, and 0.67, respectively. Mortality risks were found at the high complexity levels of the three tools, bypass time >85 min, and cross clamp time >60 min. Common morbidities were postoperative pyrexia, bleeding, and pleural effusion. Conclusions. Overall mortality and morbidities were 6.1%. The RACHS-1 method, ABC score, and STS-EACTS score were helpful for risk stratification. PMID:21738856

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).

The association of admission blood glucose level with the clinical picture and prognosis in cardiogenic shock - Results from the CardShock Study.

PubMed

Kataja, Anu; Tarvasmäki, Tuukka; Lassus, Johan; Cardoso, Jose; Mebazaa, Alexandre; Køber, Lars; Sionis, Alessandro; Spinar, Jindrich; Carubelli, Valentina; Banaszewski, Marek; Marino, Rossella; Parissis, John; Nieminen, Markku S; Harjola, Veli-Pekka

2017-01-01

Critically ill patients often present with hyperglycemia, regardless of previous history of diabetes mellitus (DM). Hyperglycemia has been associated with adverse outcome in acute myocardial infarction and acute heart failure. We investigated the association of admission blood glucose level with the clinical picture and short-term mortality in cardiogenic shock (CS). Consecutively enrolled CS patients were divided into five categories according to plasma glucose level at the time of enrolment: hypoglycemia (glucose <4.0mmol/L), normoglycemia (4.0-7.9mmol/L), mild (8.0-11.9mmol/L), moderate (12.0-15.9mmol/L), and severe (≥16.0mmol/L) hyperglycemia. Clinical presentation, biochemistry, and short-term mortality were compared between the groups. Plasma glucose level of 211 CS patients was recorded. Glucose levels were distributed equally between normoglycemia (26% of patients), mild (27%), moderate (19%) and severe (25%) hyperglycemia, while hypoglycemia (2%) was rare. Severe hyperglycemia was associated with higher blood leukocyte count (17.3 (5.8) E9/L), higher lactate level (4.4 (3.3-8.4) mmol/L) and lower arterial pH (7.23 (0.14)) compared with normoglycemia or mild to moderate hyperglycemia (p<0.001 for all). In-hospital mortality was highest among hypoglycemic (60%) and severely hyperglycemic (56%) patients, compared with 22% in normoglycemic group (p<0.01). Severe hyperglycemia was an independent predictor of in-hospital mortality (OR 3.7, 95% CI 1.19-11.7, p=0.02), when adjusted for age, gender, LVEF, lactate, and DM. Admission blood glucose level has prognostic significance in CS. Mortality is highest among patients with severe hyperglycemia or hypoglycemia. Severe hyperglycemia is independently associated with high in-hospital mortality in CS. It is also associated with biomarkers of systemic hypoperfusion and stress response. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Associations between Soluble Receptor for Advanced Glycation End Products (sRAGE) and S100A12 (EN-RAGE) with Mortality in Long-term Hemodialysis Patients.

PubMed

Jung, Eul Sik; Chung, Wookyung; Kim, Ae Jin; Ro, Han; Chang, Jae Hyun; Lee, Hyun Hee; Jung, Ji Yong

2017-01-01

Hemodialysis (HD) patients experience vascular calcification, ultimately leading to high mortality rates. Previously, we reported associations between soluble receptor for advanced glycation end products (sRAGEs) and extracellular newly identified RAGE-binding protein S100A12 (EN-RAGE) and vascular calcification. Here, we extended our observations, investigating whether these biomarkers may be useful for predicting cardiovascular morbidity and mortality in these subjects. Thus, we evaluated the relationship between sRAGE and S100A12 and mortality in long-term HD patients. This was a prospective observational cohort study in 199 HD patients from an extended analysis of our previous study. Plasma sRAGE, S100A12, comorbidities, and other traditional risk factors were investigated. The cumulative incidences for death using Cox proportional hazards regression were evaluated in multivariable analyses. The observation period was 44 months. During the observation period, 27 (13.6%) patients died. Univariate analysis demonstrated that S100A12 was correlated with diabetes (P = 0.040) and high-sensitivity C-reactive protein (hsCRP) (P = 0.006). In multivariable analyses, plasma sRAGE (hazard ratio [HR] = 1.155; 95% confidence interval [CI] = 0.612-2.183; P = 0.656) and S100A12 (HR = 0.960; 95% CI = 0.566-1.630; P = 0.881) were not associated with mortality in HD patients, although traditional predictors of mortality, including age, history of cardiovascular diseases (CVDs), and serum levels of albumin and hsCRP were related to mortality. Powerful predictors of mortality were age, CVD, and albumin levels. Plasma sRAGE and S100A12 may be weak surrogate markers for predicting all-cause mortality in patients undergoing HD, although S100A12 was partly related to diabetes and inflammation.

High fibrin/fibrinogen degradation product to fibrinogen ratio is associated with 28-day mortality and massive transfusion in severe trauma.

PubMed

Lee, D H; Lee, B K; Noh, S M; Cho, Y S

2018-04-01

There is a lack of association between coagulation biomarkers and long-term mortality in severe trauma. We aimed to investigate the association between coagulation biomarkers on admission and outcome of late stage of trauma. This retrospective observational study included patients admitted with severe trauma between 2012 and 2015. We used the area under the receiver operating characteristic curve (AUROC) of coagulation biomarkers to determine 28-day mortality. Head Abbreviated Injury Scale scores greater than 3 were defined as traumatic brain injury (TBI). The primary outcome was 28-day mortality and the secondary outcome was massive transfusion. Of the 1266 patients included in the study, 28-day mortality rate was 19.7% (n = 249) and 7.9% (n = 100) of patients received massive transfusion. The AUROC of fibrin/fibrinogen degradation product (FDP) to fibrinogen ratio had a significantly higher prognostic performance than other markers. Multivariate analysis revealed that D-dimer level [odds ratio (OR) 1.033; 95% confidence interval (CI) 1.016-1.051] and FDP/fibrinogen ratio (OR 1.007; 95% CI 1.001-1.013) were independently associated with 28-day mortality. D-dimer (OR 1.028; 95% CI 1.003-1.055) and FDP/fibrinogen ratio (OR 1.035; 95% CI 1.012-1.058) were associated with 28-day mortality in the TBI group. In the non-TBI group, D-dimer was associated with 28-day mortality (OR 1.033; 95% CI 1.008-1.059), but the FDP/fibrinogen ratio was not. FDP/fibrinogen ratio, not D-dimer level, was an independent predictor for massive transfusion (OR 1.005; 95% CI 1.001-1.010). High FDP/fibrinogen ratio on arrival is a predictor of 28-day mortality and the requirement for massive transfusion in severe trauma.

Effects of oil on avian reproduction: A review and discussion

USGS Publications Warehouse

Albers, P.H.; Rosie, Don; Barnes, Stephen N.

1983-01-01

Oil pollution is a highly visible form of environmental contamination that affects avian reproduction in a variety of ways. Plumage oiling causes widespread and locally severe mortality of adult birds. Egg oiling can be a serious hazard for bird embryos but only a few field observationons of this have been reported. Oil ingestion seldom kills birds directly but it causes sublethal change~ in the bodily functions and behavior of adults and nestlings. Studies of the effects of oil on avian reproduction have produced varied and, in ingestion studies, sometimes conflicting results because of inconsistent experimental design and the use of different test species and types of oil. Field experimentation with the sublethal effects of ingested oil on avian reproduction has been limited. Simulation modelling of seabird populations has shown that (l) an occasional decrease in survival of breeding adults will have a greater impact on seabird populations than an occasional decrease in reproductive success, and (2) populations of long-lived seabirds with low reproductive potential have great difficulty recovering from high one-time mortality when experiencing even small sustained annual decreases in either natality or breeding adult survival. The impact of oil-related decreases in survival or reproduction will be more noticeable at the local or colony level than at the regional or species level. Immigration, surplus breeders, and possible compensatory changes in natality and mortality resulting from population reductions usually prevent local population reductions from lasting very long (unless the species is rare or at the edge of its range). A study of west European seabird populations indicates that the natural annual mortality of the region greatly exceeds the annual mortality due to plumage oiling; effects of oil ingestion and egg oiling were not measured but were thought to be less than the mortality from plu~age oiling. Oil-related mortality, even if in addition to expected mortality, would not have a detectable impact on regional populations if environmental conditions were favorable (increased natality, decreased mortality) for the birds.

Trends in geographical disparities for cervical cancer mortality in China from 1973 to 2013: a subnational spatio-temporal study

PubMed Central

Xia, Changfa; Ding, Chao; Zheng, Rongshou; Zhang, Siwei; Zeng, Hongmei; Wang, Jinfeng; Liao, Yilan; Zhang, Ningxu; Yang, Zhixun; Chen, Wanqing

2017-01-01

Objective This study was designed to explore the time trends in geographical variations of cervical cancer mortality in mainland China over the period 1973 to 2013, to provide subnational spatio-temporal patterns for targeted promotion of human papillomavirus vaccine in China. Methods Data were extracted from three national retrospective death surveys and cancer registry. The rate ratio (RR) was estimated for the aggregated data for seven geographical regions using generalized linear models to evaluate time trends in geographical disparities of cervical cancer mortality. Results There was a significant decrease in cervical cancer mortality in China from 1973–1975 to 2004–2005, but leveled off thereafter to 2011–2013. Compared to the period 1973–1975 the RR for the three last time periods were 0.33 [95% confidence interval (95% CI): 0.30–0.37] for 1990–1992, 0.21 (95% CI: 0.19–0.24) for 2004–2005 and 0.24 (95% CI: 0.22–0.26) for 2011–2013. Females living in the Northwest China and Central China have a high risk of mortality from cervical cancer compared to the nationwide, with the RR being 2.09 (95% CI: 1.83–2.38) and 1.26 (95% CI: 1.11–1.44) respectively, while the RRs for South China, Northeast China and Southwest China were below 1.00, indicating the lower death risk. Despite the mortality rate had increased slightly from 2004 to 2013, there was an encouraging sign that the geographical disparities in cervical cancer mortality had gradually narrowed over time across China. Conclusions Although cervical cancer mortality in China has reduced to very low levels, the high risk of cervical cancer in Northwest China and Central China is still noteworthy. Public health policies including the promotion of vaccine should be targeted to further reduction of geographical disparities in cervical cancer mortality. PMID:29353971

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.

Two-way effect modifications of air pollution and air temperature on total natural and cardiovascular mortality in eight European urban areas.

PubMed

Chen, Kai; Wolf, Kathrin; Breitner, Susanne; Gasparrini, Antonio; Stafoggia, Massimo; Samoli, Evangelia; Andersen, Zorana Jovanovic; Bero-Bedada, Getahun; Bellander, Tom; Hennig, Frauke; Jacquemin, Bénédicte; Pekkanen, Juha; Hampel, Regina; Cyrys, Josef; Peters, Annette; Schneider, Alexandra

2018-07-01

Although epidemiological studies have reported associations between mortality and both ambient air pollution and air temperature, it remains uncertain whether the mortality effects of air pollution are modified by temperature and vice versa. Moreover, little is known on the interactions between ultrafine particles (diameter ≤ 100 nm, UFP) and temperature. We investigated whether the short-term associations of particle number concentration (PNC in the ultrafine range (≤100 nm) or total PNC ≤ 3000 nm, as a proxy for UFP), particulate matter ≤ 2.5 μm (PM 2.5 ) and ≤ 10 μm (PM 10 ), and ozone with daily total natural and cardiovascular mortality were modified by air temperature and whether air pollution levels affected the temperature-mortality associations in eight European urban areas during 1999-2013. We first analyzed air temperature-stratified associations between air pollution and total natural (nonaccidental) and cardiovascular mortality as well as air pollution-stratified temperature-mortality associations using city-specific over-dispersed Poisson additive models with a distributed lag nonlinear temperature term in each city. All models were adjusted for long-term and seasonal trend, day of the week, influenza epidemics, and population dynamics due to summer vacation and holidays. City-specific effect estimates were then pooled using random-effects meta-analysis. Pooled associations between air pollutants and total and cardiovascular mortality were overall positive and generally stronger at high relatively compared to low air temperatures. For example, on days with high air temperatures (>75th percentile), an increase of 10,000 particles/cm 3 in PNC corresponded to a 2.51% (95% CI: 0.39%, 4.67%) increase in cardiovascular mortality, which was significantly higher than that on days with low air temperatures (<25th percentile) [-0.18% (95% CI: -0.97%, 0.62%)]. On days with high air pollution (>50th percentile), both heat- and cold-related mortality risks increased. Our findings showed that high temperature could modify the effects of air pollution on daily mortality and high air pollution might enhance the air temperature effects. Copyright © 2018 Elsevier Ltd. All rights reserved.

Drought characteristics' role in widespread aspen forest mortality across Colorado, USA.

PubMed

Anderegg, Leander D L; Anderegg, William R L; Abatzoglou, John; Hausladen, Alexandra M; Berry, Joseph A

2013-05-01

Globally documented widespread drought-induced forest mortality has important ramifications for plant community structure, ecosystem function, and the ecosystem services provided by forests. Yet the characteristics of drought seasonality, severity, and duration that trigger mortality events have received little attention despite evidence of changing precipitation regimes, shifting snow melt timing, and increasing temperature stress. This study draws upon stand level ecohydrology and statewide climate and spatial analysis to examine the drought characteristics implicated in the recent widespread mortality of trembling aspen (Populus tremuloides Michx.). We used isotopic observations of aspen xylem sap to determine water source use during natural and experimental drought in a region that experienced high tree mortality. We then drew upon multiple sources of climate data to characterize the drought that triggered aspen mortality. Finally, regression analysis was used to examine the drought characteristics most associated with the spatial patterns of aspen mortality across Colorado. Isotopic analysis indicated that aspens generally utilize shallow soil moisture with little plasticity during drought stress. Climate analysis showed that the mortality-inciting drought was unprecedented in the observational record, especially in 2002 growing season temperature and evaporative deficit, resulting in record low shallow soil moisture reserves. High 2002 summer temperature and low shallow soil moisture were most associated with the spatial patterns of aspen mortality. These results suggest that the 2002 drought subjected Colorado aspens to the most extreme growing season water stress of the past century by creating high atmospheric moisture demand and depleting the shallow soil moisture upon which aspens rely. Our findings highlight the important role of drought characteristics in mediating widespread aspen forest mortality, link this aspen die-off to regional climate change trends, and provide insight into future climate vulnerability of these forests. © 2013 Blackwell Publishing Ltd.

Infant mortality in India: use of maternal and child health services in relation to literacy status.

PubMed

Gokhale, Medha K; Rao, Shobha S; Garole, Varsha R

2002-06-01

Slow reduction in infant mortality rate in the last couple of decades is a major concern in India. State-level aggregate data from the National Family Health Survey 1992 and micro-level data on rural mothers (n=317) were used for examining the influence of female literacy on reduction of infant mortality through increased use of maternal and child health (MCH) services. Illiteracy of females was strongly associated with all variables relating to maternal care and also with infant mortality rate. States were grouped into best, medium, and worst on the basis of female illiteracy (about 11%, 48.5%, and 75% respectively). Infant mortality rate (per 1,000 livebirths) was significantly (p<0.01) higher among the worst group (90.99) than that among the medium (64.2) and the best (24.0) groups. Use of maternal health services increased in the worst to become the best groups for tetanus toxoid (from 48.0% to 84.4%), iron and folic acid tablets (36.6% to 76.2%), hospitalized deliveries (14.2% to 69.7%), and childcare services, such as vaccination (23.8% to 64.9%). Illiteracy of females had a more detrimental impact on rural than on urban areas. In the event of high female illiteracy, male literacy was beneficial for improving the use of services for reducing infant mortality rate. The micro-level study supported all major findings obtained for the national-level aggregate data. Programmes, like providing free education to girls, will yield long-term health benefits.

Women's status and child well-being: a state-level analysis.

PubMed

Koenen, Karestan C; Lincoln, Alisa; Appleton, Allison

2006-12-01

We conducted an ecologic analysis of the relation between women's status and child well-being in the 50 United States. State-level women's status was assessed via four composite indices: women's political participation, economic autonomy, employment and earnings, and reproductive rights. Child well-being was measured via five outcomes: percentage of low birthweight babies, infant mortality, teen mortality, high school dropout rate, and teen birth rate. Higher state-level women's status on all indicators was associated with significantly better state-level child well-being in unadjusted analyses. Several associations remained significant after adjusting for income inequality and state racial composition. Women's political participation was associated with a significantly lower percentage of low birthweight babies (p<.001) and lower teen birth rates (p<.05). Women's employment and earnings was associated with lower infant mortality (p<.05) and teen birth rates (p<.05). More economic and social autonomy for women was associated with better child outcomes on all measures (p<.01 all). Greater reproductive rights were associated with significantly lower infant mortality (p<.01). We conclude that child well-being is worse in states where women have lower political, economic, and social status. Women's status is an important aspect of children's social context which may impact their well-being. Multi-level analyses of the association between state-level women's status and child well-being are needed.

The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health.

PubMed

Karlsen, Saffron; Say, Lale; Souza, João-Paulo; Hogue, Carol J; Calles, Dinorah L; Gülmezoglu, A Metin; Raine, Rosalind

2011-07-29

Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships. Cross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America) and 2007-2008 (in Asia) as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths. In the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years), those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects relating to country of residence which were not explained in the model. Lower levels of maternal education were associated with higher maternal mortality even amongst women able to access facilities providing intrapartum care. More attention should be given to the wider social determinants of health when devising strategies to reduce maternal mortality and to achieve the increasingly elusive MDG for maternal mortality.

Persistence of Pneumolysin in the Cerebrospinal Fluid of Patients With Pneumococcal Meningitis Is Associated With Mortality

PubMed Central

Wall, Emma C.; Hussain, Samia; Goonetilleke, Upali R. S.; Gritzfeld, Jenna; Scarborough, Matthew; Kadioglu, Aras

2012-01-01

Poor prognosis in Pneumococcal meningitis may be associated with high pneumolysin levels in cerebrospinal fluid (CSF). In patient samples we showed that pneumolysin levels in CSF remained high after 48 hours in nonsurvivors of meningitis compared with survivors. Selective antipneumolysin treatment may present a novel therapeutic option. PMID:22238165

Relationship between field resistance to Phytophthora ramorum and constitutive phenolic chemistry of coast live oak

Treesearch

A.M. Nagle; B.A. McPherson; D.L. Wood; M. Garbelotto; A.O. Conrad; S. Opiyo; P. Bonello

2012-01-01

Sudden oak death, caused by Phytophthora ramorum, has resulted in high levels of coast live oak (Quercus agrifolia Nee (CLO) mortality. However, some CLO survive in areas with high disease pressure and may thus be resistant. We tested the hypothesis that such field resistant trees contain constitutively higher levels of...

Estimation and Uncertainty Analysis of Impacts of Future Heat Waves on Mortality in the Eastern United States

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

Wu, Jianyong; Zhou, Ying; Gao, Yang

Background: It is anticipated that climate change will influence heat-related mortality in the future. However, the estimation of excess mortality attributable to future heat waves is subject to large uncertainties, which have not been examined under the latest greenhouse gas emission scenarios. Objectives: We estimated the future heat wave impact on mortality in the eastern United States (~ 1,700 counties) under two Representative Concentration Pathways (RCPs) and analyzed the sources of uncertainties. Methods Using dynamically downscaled hourly temperature projections in 2057-2059, we calculated heat wave days and episodes based on four heat wave metrics, and estimated the excess mortality attributablemore » to them. The sources of uncertainty in estimated excess mortality were apportioned using a variance-decomposition method. Results: In the eastern U.S., the excess mortality attributable to heat waves could range from 200-7,807 with the mean of 2,379 persons/year in 2057-2059. The projected average excess mortality in RCP 4.5 and 8.5 scenarios was 1,403 and 3,556 persons/year, respectively. Excess mortality would be relatively high in the southern and eastern coastal areas. The major sources of uncertainty in the estimates are relative risk of heat wave mortality, the RCP scenarios, and the heat wave definitions. Conclusions: The estimated mortality risks from future heat waves are likely an order of magnitude higher than its current level and lead to thousands of deaths each year under the RCP8.5 scenario. The substantial spatial variability in estimated county-level heat mortality suggests that effective mitigation and adaptation measures should be developed based on spatially resolved data.« less

Interaction of infection with Renibacterium salmoninarum and physical stress in juvenile chinook salmon: Physiological responses, disease progression, and mortality

USGS Publications Warehouse

Mesa, M.G.; Maule, A.G.; Schreck, C.B.

2000-01-01

We experimentally infected juvenile spring chinook salmon Oncorhynchus tshawytscha with Renibacterium salmoninarum (Rs), the causative agent of bacterial kidney disease (BKD), in order to compare the physiological responses of Rs-infected and Rs-noninfected fish to a series of multiple, acute stressors and to determine whether exposure to these stressors worsens the infection and leads to increased mortality. After subjecting groups of fish to a waterborne challenge of Rs, we sampled them biweekly to monitor infection levels, mortality, and some stress-related physiological changes. As infections worsened, fish developed decreased hematocrits and blood glucose levels and increased levels of cortisol and lactate, indicating that BKD is stressful, particularly during the later stages. Eight weeks after the challenge, when fish had moderate to high infection levels, we subjected them, along with unchallenged control fish, to three 60-s bouts of hypoxia, struggling, and mild agitation that were separated by 48-72 h. Our results indicate that the imposition of these stressors on Rs-infected fish did not lead to higher infection levels or increased mortality when compared with diseased fish that did not receive the stressors. Furthermore, the kinetics of plasma cortisol, glucose, and lactate over a 24-h period following each application of the stressor were similar between fish with moderate to high Rs infections and those that had low or no detectable infection. Some differences in the stress responses of these two groups did exist, however. Most notably, fish with moderate to high Rs infections had higher titers of cortisol and lactate prior to each application of the stressor and also were unable to consistently elicit a significant hyperglycemia in response to the stressors. Collectively, our results should be important in understanding the impact that BKD has on the survival of juvenile salmonids, but we caution that our results represent the combined effects of one type of stressor and one disease only and probably cannot be applied to other scenarios.

Effects on mortality, treatment, and time management as a result of routine use of total body computed tomography in blunt high-energy trauma patients.

PubMed

van Vugt, Raoul; Kool, Digna R; Deunk, Jaap; Edwards, Michael J R

2012-03-01

Currently, total body computed tomography (TBCT) is rapidly implemented in the evaluation of trauma patients. With this review, we aim to evaluate the clinical implications-mortality, change in treatment, and time management-of the routine use of TBCT in adult blunt high-energy trauma patients compared with a conservative approach with the use of conventional radiography, ultrasound, and selective computed tomography. A literature search for original studies on TBCT in blunt high-energy trauma patients was performed. Two independent observers included studies concerning mortality, change of treatment, and/or time management as outcome measures. For each article, relevant data were extracted and analyzed. In addition, the quality according to the Oxford levels of evidence was assessed. From 183 articles initially identified, the observers included nine original studies in consensus. One of three studies described a significant difference in mortality; four described a change of treatment in 2% to 27% of patients because of the use of TBCT. Five studies found a gain in time with the use of immediate routine TBCT. Eight studies scored a level of evidence of 2b and one of 3b. Current literature has predominantly suboptimal design to prove terminally that the routine use of TBCT results in improved survival of blunt high-energy trauma patients. TBCT can give a change of treatment and improves time intervals in the emergency department as compared with its selective use.

Police transport versus ground EMS: A trauma system-level evaluation of prehospital care policies and their effect on clinical outcomes.

PubMed

Wandling, Michael W; Nathens, Avery B; Shapiro, Michael B; Haut, Elliott R

2016-11-01

Rapid transport to definitive care ("scoop and run") versus field stabilization in trauma remains a topic of debate and has resulted in variability in prehospital policy. We aimed to identify trauma systems frequently using a true "scoop and run" police transport approach and to compare mortality rates between police and ground emergency medical services (EMS) transport. Using the National Trauma Databank (NTDB), we identified adult gunshot and stab wound patients presenting to Level 1 or 2 trauma centers from 2010 to 2012. Hospitals were grouped into their respective cities and regional trauma systems. Patients directly transported by police or ground EMS to trauma centers in the 100 most populous US trauma systems were included. Frequency of police transport was evaluated, identifying trauma systems with high utilization. Mortality rates and risk-adjusted odds ratio for mortality for police versus EMS transport were derived. Of 88,564 total patients, 86,097 (97.2%) were transported by EMS and 2,467 (2.8%) by police. Unadjusted mortality was 17.7% for police transport and 11.6% for ground EMS. After risk adjustment, patients transported by police were no more likely to die than those transported by EMS (OR = 1.00, 95% CI: 0.69-1.45). Among all police transports, 87.8% occurred in three locations (Philadelphia, Sacramento, and Detroit). Within these trauma systems, unadjusted mortality was 19.9% for police transport and 13.5% for ground EMS. Risk-adjusted mortality was no different (OR = 1.01, 95% CI: 0.68-1.50). Using trauma system-level analyses, patients with penetrating injuries in urban trauma systems were found to have similar mortality for police and EMS transport. The majority of prehospital police transport in penetrating trauma occurs in three trauma systems. These cities represent ideal sites for additional system-level evaluation of prehospital transport policies. Prognostic/epidemiologic study, level III.

The Moderating Role of Executive Functioning in Older Adults' Responses to a Reminder of Mortality

PubMed Central

Maxfield, Molly; Pyszczynski, Tom; Greenberg, Jeff; Pepin, Renee; Davis, Hasker P.

2011-01-01

In previous research, older adults responded to mortality salience (MS) with increased tolerance, whereas younger persons responded with increased punitiveness. One possible explanation for this is that many older adults adapt to challenges of later life, such as the prospect of mortality, by becoming more flexible. Recent studies suggest that positively-oriented adaptation is more likely for older adults with high levels of executive functioning. We thus hypothesized that the better an older adult's executive functioning, the more likely MS would result in increased tolerance. Older and younger adults were randomly assigned to MS or control conditions, and then evaluated moral transgressors. As in previous research, younger adults were more punitive following reminders of mortality; executive functioning did not affect their responses. Among older adults, high functioning individuals responded to MS with increased tolerance rather than intolerance, whereas those low in functioning became more punitive. PMID:21728445

Predicting Early Mortality After Hip Fracture Surgery: The Hip Fracture Estimator of Mortality Amsterdam.

PubMed

Karres, Julian; Kieviet, Noera; Eerenberg, Jan-Peter; Vrouenraets, Bart C

2018-01-01

Early mortality after hip fracture surgery is high and preoperative risk assessment for the individual patient is challenging. A risk model could identify patients in need of more intensive perioperative care, provide insight in the prognosis, and allow for risk adjustment in audits. This study aimed to develop and validate a risk prediction model for 30-day mortality after hip fracture surgery: the Hip fracture Estimator of Mortality Amsterdam (HEMA). Data on 1050 consecutive patients undergoing hip fracture surgery between 2004 and 2010 were retrospectively collected and randomly split into a development cohort (746 patients) and validation cohort (304 patients). Logistic regression analysis was performed in the development cohort to determine risk factors for the HEMA. Discrimination and calibration were assessed in both cohorts using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow goodness-of-fit test, and by stratification into low-, medium- and high-risk groups. Nine predictors for 30-day mortality were identified and used in the final model: age ≥85 years, in-hospital fracture, signs of malnutrition, myocardial infarction, congestive heart failure, current pneumonia, renal failure, malignancy, and serum urea >9 mmol/L. The HEMA showed good discrimination in the development cohort (AUC = 0.81) and the validation cohort (AUC = 0.79). The Hosmer-Lemeshow test indicated no lack of fit in either cohort (P > 0.05). The HEMA is based on preoperative variables and can be used to predict the risk of 30-day mortality after hip fracture surgery for the individual patient. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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.

Recurrence of Seagrass Mortality in Florida Bay: The Role of Climate Change and Implications for Carbon Sequestration

NASA Astrophysics Data System (ADS)

Yarbro, L.; Carlson, P. R., Jr.

2016-02-01

Catastrophic mortality of seagrass in Florida Bay (USA) from 1987 to 1991 resulted in the complete loss of thousands of hectares of dense Thalassia testudinum beds. At that time, acutely toxic levels of dissolved sulfide in sediments were determined to be the proximal cause of seagrass mortality, but the mechanisms responsible for sulfide accumulation in sediments were not demonstrated. With the recurrence of seagrass mortality in Florida Bay in summer 2015, we show that several processes create the conditions that lead to sulfide toxicity and catastrophic mortality of Thalassia. Regional drought and elevated water temperature lead to hypersalinity, particularly in the northern Bay. In addition, evaporation of seawater on mudbanks and microtidal flow patterns create stratified brine layers in basins adjacent to mudbanks. Because of very high seagrass shoot densities and limited tidal exchange, brine layers limit oxygen diffusion and prevent oxidation of sulfide in sediments and bottom water, exposing roots, rhizomes and lateral meristems of Thalassia to acutely toxic levels of sulfide, causing extensive mortality. Dead belowground tissues provide labile carbon sources to sulfate-reducing bacteria enhancing sulfide production and creating a positive feedback loop of increasing sulfide toxicity leading to further seagrass death. The carbon sequestration capacity of these dense seagrass communities is diminished three ways: 1) export of dead seagrass shoots and leaves as floating wrack, 2) in situ decomposition of roots, rhizomes, and some leaf material, and 3) reduced areal productivity of surviving seagrasses. Climate analyses show that, in the short term ( 50 years), higher water temperatures and evaporation rates might result in recurring seagrass mortality events. However, in the long term, sea level rise will increase tidal exchange and flushing in Florida Bay reducing the likelihood of seagrass mortality.

Predicting mortality with biomarkers: a population-based prospective cohort study for elderly Costa Ricans

PubMed Central

2012-01-01

Background Little is known about adult health and mortality relationships outside high-income nations, partly because few datasets have contained biomarker data in representative populations. Our objective is to determine the prognostic value of biomarkers with respect to total and cardiovascular mortality in an elderly population of a middle-income country, as well as the extent to which they mediate the effects of age and sex on mortality. Methods This is a prospective population-based study in a nationally representative sample of elderly Costa Ricans. Baseline interviews occurred mostly in 2005 and mortality follow-up went through December 2010. Sample size after excluding observations with missing values: 2,313 individuals and 564 deaths. Main outcome: prospective death rate ratios for 22 baseline biomarkers, which were estimated with hazard regression models. Results Biomarkers significantly predict future death above and beyond demographic and self-reported health conditions. The studied biomarkers account for almost half of the effect of age on mortality. However, the sex gap in mortality became several times wider after controlling for biomarkers. The most powerful predictors were simple physical tests: handgrip strength, pulmonary peak flow, and walking speed. Three blood tests also predicted prospective mortality: C-reactive protein (CRP), glycated hemoglobin (HbA1c), and dehydroepiandrosterone sulfate (DHEAS). Strikingly, high blood pressure (BP) and high total cholesterol showed little or no predictive power. Anthropometric measures also failed to show significant mortality effects. Conclusions This study adds to the growing evidence that blood markers for CRP, HbA1c, and DHEAS, along with organ-specific functional reserve indicators (handgrip, walking speed, and pulmonary peak flow), are valuable tools for identifying vulnerable elderly. The results also highlight the need to better understand an anomaly noted previously in other settings: despite the continued medical focus on drugs for BP and cholesterol, high levels of BP and cholesterol have little predictive value of mortality in this elderly population. PMID:22694922

Socioeconomic disparities in lung cancer mortality in Belgian men and women (2001-2011): does it matter who you live with?

PubMed

Vanthomme, Katrien; Vandenheede, Hadewijch; Hagedoorn, Paulien; Gadeyne, Sylvie

2016-06-10

Ample studies have observed an adverse association between individual socioeconomic position (SEP) and lung cancer mortality. Moreover, the presence of a partner has shown to be a crucial determinant of health. Yet, few studies have assessed whether partner's SEP affects health in addition to individual SEP. This paper will study whether own SEP (education), partner's SEP (partner's education) and own and partner's SEP combined (housing conditions), are associated with lung cancer mortality in Belgium. Data consist of the Belgian 2001 census linked to register data on cause-specific mortality for 2001-2011. The study population includes all married or cohabiting Belgian inhabitants aged 40-84 years. Age-standardized lung cancer mortality rates (direct standardization) and mortality rate ratios (Poisson regression) were computed for the different SEP groups. In men, we observed a clear inverse association between all SEP indicators (own and partner's education, and housing conditions) and lung cancer mortality. Men benefit from having a higher educated partner in terms of lower lung cancer mortality rates. These observations hold for both middle-aged and older men. For women, the picture is less uniform. In middle-aged and older women, housing conditions is inversely associated with lung cancer mortality. As for partner's education, for middle-aged women, the association is rather weak whereas for older women, there is no such association. Whereas the educational level of middle-aged women is inversely associated with lung cancer mortality, in older women this association disappears in the fully adjusted model. Both men and women benefit from being in a relationship with a high-educated partner. It seems that for men, the educational level of their partner is of great importance while for women the housing conditions is more substantial. Both research and policy interventions should allow for the family level as well.

Social sector expenditure and child mortality in India: a state-level analysis from 1997 to 2009.

PubMed

Makela, Susanna M; Dandona, Rakhi; Dilip, T R; Dandona, Lalit

2013-01-01

India is unlikely to meet the Millennium Development Goal for child mortality. As public policy impacts child mortality, we assessed the association of social sector expenditure with child mortality in India. Mixed-effects regression models were used to assess the relationship of state-level overall social sector expenditure and its major components (health, health-related, education, and other) with mortality by sex among infants and children aged 1-4 years from 1997 to 2009, adjusting for potential confounders. Counterfactual models were constructed to estimate deaths averted due to overall social sector increases since 1997. Increases in per capita overall social sector expenditure were slightly higher in less developed than in more developed states from 1997 to 2009 (2.4-fold versus 2-fold), but the level of expenditure remained 36% lower in the former in 2009. Increase in public expenditure on health was not significantly associated with mortality reduction in infants or at ages 1-4 years, but a 10% increase in health-related public expenditure was associated with a 3.6% mortality reduction (95% confidence interval 0.2-6.9%) in 1-4 years old boys. A 10% increase in overall social sector expenditure was associated with a mortality reduction in both boys (6.8%, 3.5-10.0%) and girls (4.1%, 0.8-7.5%) aged 1-4 years. We estimated 119,807 (95% uncertainty interval 53,409-214,662) averted deaths in boys aged 1-4 years and 94,037 (14,725-206,684) in girls in India in 2009 that could be attributed to increases in overall social sector expenditure since 1997. Further reduction in child mortality in India would be facilitated if policymakers give high priority to the social sector as a whole for resource allocation in the country's 5-year plan for 2012-2017, as public expenditure on health alone has not had major impact on reducing child mortality.

The Effect of Cuts in Medicare Reimbursement on Hospital Mortality

PubMed Central

Seshamani, Meena; Schwartz, J Sanford; Volpp, Kevin G

2006-01-01

Objective To determine if patients treated at hospitals under different levels of financial strain from the Balanced Budget Act (BBA) of 1997 had differential changes in 30-day mortality, and whether vulnerable patient populations such as the uninsured were disproportionately affected. Data Source Hospital discharge data from all general acute care hospitals in Pennsylvania from 1997 to 2001. Study Design A multivariate regression analysis was performed retrospectively on 30-day mortality rates, using hospital discharge data, hospital financial data, and death certificate information from Pennsylvania. Data Collection We used 370,017 hospital episodes with one of four conditions identified by the Agency for Healthcare Research and Quality as inpatient quality indicators were extracted. Principal Findings The average magnitude of Medicare payment reduction on overall net revenues was estimated at 1.8 percent for hospitals with low BBA impact and 3.6 percent for hospitals with a high impact in 1998, worsening to 2 and 4.8 percent, respectively, by 2001. Operating margins decreased significantly over the time period for all hospitals (p<.05). While unadjusted mortality rates demonstrated a disproportionate rise in mortality for patients from high impact hospitals from 1997 to 2000, adjusted analyses show no consistent, significant difference in the rate of change in mortality between high-impact and low-impact hospitals (p = .04–.94). Similarly, uninsured patients did not experience greater increases in mortality in high-impact hospitals relative to low-impact hospitals. Conclusions An analysis of hospitalizations in the Commonwealth of Pennsylvania did not find an adverse impact of increased financial strain from the BBA on patient mortality either among all patients or among the uninsured. PMID:16704507

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.

Benchmarking life expectancy and cancer mortality: global comparison with cardiovascular disease 1981-2010

PubMed Central

Bray, Freddie; Beltrán-Sánchez, Hiram; Ginsburg, Ophira; Soneji, Samir; Soerjomataram, Isabelle

2017-01-01

Objective To quantify the impact of cancer (all cancers combined and major sites) compared with cardiovascular disease (CVD) on longevity worldwide during 1981-2010. Design Retrospective demographic analysis using aggregated data. Setting National civil registration systems in member states of the World Health Organization. Participants 52 populations with moderate to high quality data on cause specific mortality. Main outcome measures Disease specific contributions to changes in life expectancy in ages 40-84 (LE40-84) over time in populations grouped by two levels of Human Development Index (HDI) values. Results Declining CVD mortality rates during 1981-2010 contributed to, on average, over half of the gains in LE40-84; the corresponding gains were 2.3 (men) and 1.7 (women) years, and 0.5 (men) and 0.8 (women) years in very high and medium and high HDI populations, respectively. Declines in cancer mortality rates contributed to, on average, 20% of the gains in LE40-84, or 0.8 (men) and 0.5 (women) years in very high HDI populations, and to over 10% or 0.2 years (both sexes) in medium and high HDI populations. Declining lung cancer mortality rates brought about the largest LE40-84 gain in men in very high HDI populations (up to 0.7 years in the Netherlands), whereas in medium and high HDI populations its contribution was smaller yet still positive. Among women, declines in breast cancer mortality rates were largely responsible for the improvement in longevity, particularly among very high HDI populations (up to 0.3 years in the United Kingdom). In contrast, losses in LE40-84 were observed in many medium and high HDI populations as a result of increasing breast cancer mortality rates. Conclusions The control of CVD has led to substantial gains in LE40-84 worldwide. The inequality in improvement in longevity attributed to declining cancer mortality rates reflects inequities in implementation of cancer control, particularly in less resourced populations and in women. Global actions are needed to revitalize efforts for cancer control, with a specific focus on less resourced countries. PMID:28637656

Reduced high-density lipoprotein cholesterol: A valuable, independent prognostic marker in peripheral arterial disease.

PubMed

Martinez-Aguilar, Esther; Orbe, Josune; Fernández-Montero, Alejandro; Fernández-Alonso, Sebastián; Rodríguez, Jose A; Fernández-Alonso, Leopoldo; Páramo, Jose A; Roncal, Carmen

2017-11-01

The prognosis of patients with peripheral arterial disease (PAD) is characterized by an exceptionally high risk for myocardial infarction, ischemic stroke, and death; however, studies in search of new prognostic biomarkers in PAD are scarce. Even though low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with higher risk of cardiovascular (CV) complications and death in different atherosclerotic diseases, recent epidemiologic studies have challenged its prognostic utility. The aim of this study was to test the predictive value of HDL-C as a risk factor for ischemic events or death in symptomatic PAD patients. Clinical and demographic parameters of 254 symptomatic PAD patients were recorded. Amputation, ischemic coronary disease, cerebrovascular disease, and all-cause mortality were recorded during a mean follow-up of 2.7 years. Multivariate analyses showed that disease severity (critical limb ischemia) was significantly reduced in patients with normal HDL-C levels compared with the group with low HDL-C levels (multivariate analysis odds ratio, 0.09; 95% confidence interval [CI], 0.03-0.24). A decreased risk for mortality (hazard ratio, 0.46; 95% CI, 0.21-0.99) and major adverse CV events (hazard ratio, 0.38; 95% CI, 0.16-0.86) was also found in patients with normal vs reduced levels of HDL-C in both Cox proportional hazards models and Kaplan-Meier estimates, after adjustment for confounding factors. Reduced HDL-C levels were significantly associated with higher risk for development of CV complications as well as with mortality in PAD patients. These findings highlight the usefulness of this simple test for early identification of PAD patients at high risk for development of major CV events. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2016-01-01

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

Characteristics of ACS-verified Level I and Level II trauma centers: A study linking trauma center verification review data and the National Trauma Data Bank of the American College of Surgeons Committee on Trauma.

PubMed

Shafi, Shahid; Barnes, Sunni; Ahn, Chul; Hemilla, Mark R; Cryer, H Gill; Nathens, Avery; Neal, Melanie; Fildes, John

2016-10-01

The Trauma Quality Improvement Project of the American College of Surgeons (ACS) has demonstrated variations in trauma center outcomes despite similar verification status. The purpose of this study was to identify structural characteristics of trauma centers that affect patient outcomes. Trauma registry data on 361,187 patients treated at 222 ACS-verified Level I and Level II trauma centers were obtained from the National Trauma Data Bank of ACS. These data were used to estimate each center's observed-to-expected (O-E) mortality ratio with 95% confidence intervals using multivariate logistic regression analysis. De-identified data on structural characteristics of these trauma centers were obtained from the ACS Verification Review Committee. Centers in the lowest quartile of mortality based on O-E ratio (n = 56) were compared to the rest (n = 166) using Classification and Regression Tree (CART) analysis to identify institutional characteristics independently associated with high-performing centers. Of the 72 structural characteristics explored, only 3 were independently associated with high-performing centers: annual patient visits to the emergency department of fewer than 61,000; proportion of patients on Medicare greater than 20%; and continuing medical education for emergency department physician liaison to the trauma program ranging from 55 and 113 hours annually. Each 5% increase in O-E mortality ratio was associated with an increase in total length of stay of one day (r = 0.25; p < 0.001). Very few structural characteristics of ACS-verified trauma centers are associated with risk-adjusted mortality. Thus, variations in patient outcomes across trauma centers are likely related to variations in clinical practices. Therapeutic study, level III.

Chronic cardiovascular disease mortality in mountaintop mining areas of central Appalachian states.

PubMed

Esch, Laura; Hendryx, Michael

2011-01-01

To determine if chronic cardiovascular disease (CVD) mortality rates are higher among residents of mountaintop mining (MTM) areas compared to mining and nonmining areas, and to examine the association between greater levels of MTM surface mining and CVD mortality. Age-adjusted chronic CVD mortality rates from 1999 to 2006 for counties in 4 Appalachian states where MTM occurs (N = 404) were linked with county coal mining data. Three groups of counties were compared: MTM, coal mining but not MTM, and nonmining. Covariates included smoking rate, rural-urban status, percent male population, primary care physician supply, obesity rate, diabetes rate, poverty rate, race/ethnicity rates, high school and college education rates, and Appalachian county. Linear regression analyses examined the association of mortality rates with mining in MTM areas and non-MTM areas and the association of mortality with quantity of surface coal mined in MTM areas. Prior to covariate adjustment, chronic CVD mortality rates were significantly higher in both mining areas compared to nonmining areas and significantly highest in MTM areas. After adjustment, mortality rates in MTM areas remained significantly higher and increased as a function of greater levels of surface mining. Higher obesity and poverty rates and lower college education rates also significantly predicted CVD mortality overall and in rural counties. MTM activity is significantly associated with elevated chronic CVD mortality rates. Future research is necessary to examine the socioeconomic and environmental impacts of MTM on health to reduce health disparities in rural coal mining areas. © 2011 National Rural Health Association.

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.

Development of a Middle-Age and Geriatric Trauma Mortality Risk Score A Tool to Guide Palliative Care Consultations.

PubMed

Konda, Sanjit R; Seymour, Rachel; Manoli, Arthur; Gales, Jordan; Karunakar, Madhav A

2016-11-01

This study aimed to develop a tool to quantify risk of inpatient mortality among geriatric and middleaged trauma patients. This study sought to demonstrate the ability of the novel risk score in the early identification of high risk trauma patients for resource-sparing interventions, including referral to palliative medicine. This retrospective cohort study utilized data from a single level 1 trauma center. Regression analysis was used to create a novel risk of inpatient mortality score. A total of 2,387 low energy and 1,201 high-energy middle-aged (range: 55 to 64 years of age) and geriatric (65 years of age or odler) trauma patients comprised the study cohort. Model validation was performed using 37,474 lowenergy and 97,034 high-energy patients from the National Trauma Databank (NTDB). Potential hospital cost reduction was calculated for early referral of high risk trauma patients to palliative medicine services in comparison to no palliative medicine referral. Factors predictive of inpatient mortality among the study and validation patient cohorts included; age, Glasgow Coma Scale, and Abbreviated Injury Scale for the head and neck and chest. Within the validation cohort, the novel mortality risk score demonstrated greater predictive capacity than existing trauma scores [STTGMALE-AUROC: 0.83 vs. TRISS 0.80, (p < 0.01), STTGMAHE-AUROC: 0.86 vs. TRISS 0.85, (p < 0.01)]. Our model demonstrated early palliative medicine evaluation could produce $1,083,082 in net hospital savings per year. This novel risk score for older trauma patients has shown fidelity in prediction of inpatient mortality; in the study and validation cohorts. This tool may be used for early intervention in the care of patients at high risk of mortality and resource expenditure.

Modelling determinants, impact, and space-time risk of age-specific mortality in rural South Africa: integrating methods to enhance policy relevance.

PubMed

Sartorius, Benn

2013-01-24

There is a lack of reliable data in developing countries to inform policy and optimise resource allocation. Health and socio-demographic surveillance sites (HDSS) have the potential to address this gap. Mortality levels and trends have previously been documented in rural South Africa. However, complex space-time clustering of mortality, determinants, and their impact has not been fully examined. To integrate advanced methods enhance the understanding of the dynamics of mortality in space-time, to identify mortality risk factors and population attributable impact, to relate disparities in risk factor distributions to spatial mortality risk, and thus, to improve policy planning and resource allocation. Agincourt HDSS supplied data for the period 1992-2008. Advanced spatial techniques were used to identify significant age-specific mortality 'hotspots' in space-time. Multivariable Bayesian models were used to assess the effects of the most significant covariates on mortality. Disparities in risk factor profiles in identified hotspots were assessed. Increasing HIV-related mortality and a subsequent decrease possibly attributable to antiretroviral therapy introduction are evident in this rural population. Distinct space-time clustering and variation (even in a small geographic area) of mortality were observed. Several known and novel risk factors were identified, and population impact was quantified. Significant differences in the risk factor profiles of the identified 'hotspots' included ethnicity; maternal, partner, and household deaths; household head demographics; migrancy; education; and poverty. A complex interaction of highly attributable multilevel factors continues to demonstrate differential space-time influences on mortality risk (especially for HIV). High-risk households and villages displayed differential risk factor profiles. This integrated approach could prove valuable to decision makers. Tailored interventions for specific child and adult high-risk mortality areas are needed, such as preventing vertical transmission, ensuring maternal survival, and improving water and sanitation infrastructure. This framework can be applied in other settings within the region.

AIDS-related and non-AIDS-related mortality in the Asia-Pacific region in the era of combination antiretroviral treatment.

PubMed

Falster, Kathleen; Choi, Jun Yong; Donovan, Basil; Duncombe, Chris; Mulhall, Brian; Sowden, David; Zhou, Jialun; Law, Matthew G

2009-11-13

Although studies have shown reductions in mortality from AIDS after the introduction of combination antiretroviral treatment (cART), little is known about cause-specific mortality in low-income settings in the cART era. We explored predictors of AIDS and non-AIDS mortality and compared cause-specific mortality across high-income and low-income settings in the Asia-Pacific region. We followed patients in the Asia Pacific HIV Observational Database from the date they started cART (or cohort enrolment if cART initiation was identified retrospectively), until the date of death or last follow-up visit. Competing risks methods were used to estimate the cumulative incidence, and to investigate predictors, of AIDS and non-AIDS mortality. Of 4252 patients, 215 died; 89 from AIDS, 97 from non-AIDS causes and 29 from unknown causes. Age more than 50 years [hazard ratio 4.29; 95% confidence interval (CI) 2.10-8.79] and CD4 cell counts less than or equal to 100 cells/microl (hazard ratio 8.59; 95% CI 5.66-13.03) were associated with an increased risk of non-AIDS mortality. Risk factors for AIDS mortality included CD4 cell counts less than or equal to 100 cells/microl (hazard ratio 34.97; 95% CI 18.01-67.90) and HIV RNA 10 001 or more (hazard ratio 4.21; 95% CI 2.07-8.55). There was some indication of a lower risk of non-AIDS mortality in Asian high-income, and possibly low-income, countries compared to Australia. Immune deficiency is associated with an increased risk of AIDS and non-AIDS mortality. Older age predicts non-AIDS mortality in the cART era. Less conclusive was the association between country-income level and cause-specific mortality because of the relatively high proportion of unknown causes of death in low-income settings.

Wine Consumption and 20-Year Mortality Among Late-Life Moderate Drinkers

PubMed Central

Holahan, Charles J.; Schutte, Kathleen K.; Brennan, Penny L.; North, Rebecca J.; Holahan, Carole K.; Moos, Bernice S.; Moos, Rudolf H.

2012-01-01

Objective: This study examined level of wine consumption and total mortality among 802 older adults ages 55–65 at baseline, controlling for key sociodemographic, behavioral, and health status factors. Despite a growing consensus that moderate alcohol consumption is associated with reduced total mortality, whether wine consumption provides an additional, unique protective effect is unresolved. Method: Participants were categorized in three subsamples: abstainers, high-wine-consumption moderate drinkers, and low-wine-consumption moderate drinkers. Alcohol consumption, sociodemographic factors, health behavior, and health problems were assessed at baseline; total mortality was indexed across an ensuing 20-year period. Results: After adjusting for all covariates, both high-wine-consumption and low-wine-consumption moderate drinkers showed reduced mortality risks compared with abstainers. Further, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine were older, were more likely to be male, reported more health problems, were more likely to be tobacco smokers, scored lower on socioeconomic status, and (statistical trend) reported engaging in less physical activity. Controlling only for overall ethanol consumption, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine showed a substantially increased 20-year mortality risk of 85%. However, after controlling for all covariates, the initial mortality difference associated with wine consumption was no longer significant. Conclusions: Among older adults who are moderate drinkers, the apparent unique effects of wine on longevity may be explained by confounding factors correlated with wine consumption. PMID:22152665

Characteristics and Mortality of Pneumocystis Pneumonia in Patients With Cushing’s Syndrome: A Plea for Timely Initiation of Chemoprophylaxis

PubMed Central

van Halem, Karlijn; Vrolijk, Lucia; Pereira, Alberto Martin

2017-01-01

Abstract In patients with Cushing’s syndrome, development of Pneumocystis pneumonia (PCP) is associated with extreme cortisol production levels. In this setting, immune reconstitution after abrogation of cortisol excess appears to induce development of symptomatic PCP. The high mortality rate warrants timely initiation of chemoprophylaxis or even preemptive treatment of PCP. PMID:28480275

Proposal of global flood vulnerability scenarios for evaluating future potential flood losses

NASA Astrophysics Data System (ADS)

Kinoshita, Y.; Tanoue, M.; Watanabe, S.; Hirabayashi, Y.

2015-12-01

Flooding is one of the most hazardous and damaging natural disasters causing serious economic loss and casualties across the world (Jongman et al., 2015). Previous studies showed that the global temperature increase affects regional weather pattern, and several general circulation model (GCM) simulations suggest the increase of flood events in both frequency and magnitude in many parts of the world (Hirabayashi et al., 2013). Effective adaptation to potential flood risks under the warming climate requires an in-depth understanding of both the physical and socioeconomic contributors of the flood risk. To assess the realistic future potential flood risk, future sophisticated vulnerability scenarios associated with the shared socioeconomic pathways (SSPs) are necessary. In this study we propose a new future vulnerability scenarios in mortality. Our vulnerability scenarios are constructed based on the modeled flood exposure (population potentially suffered by flooding) and a past from 1980 to 2005. All the flood fatality data were classified according to four income levels (high, mid-high, mid-low and low). Our proposed scenarios have three pathways regarding to SSPs; High efficiency (HE) scenario (SSP1, SSP4 (rich country) and SSP5), Medium efficiency (ME) scenario (SSP2), and Low efficiency (LE) scenario (SSP3 and SSP4 (poor country)). The maximum mortality protection level on each category was detected by applying exponential curve fitting with offset term. Slopes in the HE scenario are assumed to be equal to slopes estimated by regression analysis in each category. The slope in the HE scenario is defined by the mean value of all countries' slope value that is approximately -0.33 mortality decreases per year. The EM-DAT mortality data shows a decreasing trend in time in almost all of the countries. Although mortalities in some countries show an increasing trend, this is because these countries were affected by once-in-hundred-years floods after 1990's. The slope in the ME scenario are half of that in the HE scenario, and a quarter in the LE scenario. In addition, we set three categories depending on mortality level. Our proposed vulnerability scenarios would enable us to reasonably replicate self-sustained vulnerability change against flood hazard associated with the SSPs.

Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

PubMed Central

Ekmekci, Ahmet; Uluganyan, Mahmut; Tufan, Fatif; Uyarel, Huseyin; Karaca, Gurkan; Kul, Seref; Gungor, Barış; Ertas, Gokhan; Erer, Betul; Sayar, Nurten; Gul, Mehmet; Eren, Mehmet

2013-01-01

Objective Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events. We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients (> 65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction. Methods We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ± 5.4). Patients were divided into two groups according to admission blood glucose levels. Group 1: low glucose group (LLG), glucose < 168 mg/dL; and Group 2: high glucose group (HGG), glucose > 168 mg/dL. Results In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P < 0.001). Multivariate regression analysis showed: Killip > 1, post-thrombolysis in MI < 3 and admission blood glucose levels were independent predictors of in-hospital adverse cardiac events (P < 0.001). Conclusions Admission hyperglycemia in elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality. PMID:24454322

Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery.

PubMed

Lazzeroni, Davide; Bini, Matteo; Camaiora, Umberto; Castiglioni, Paolo; Moderato, Luca; Bosi, Davide; Geroldi, Simone; Ugolotti, Pietro T; Brambilla, Lorenzo; Brambilla, Valerio; Coruzzi, Paolo

2018-01-01

Background High levels of serum uric acid have been associated with adverse outcomes in cardiovascular diseases such as myocardial infarction and heart failure. The aim of the current study was to evaluate the prognostic role of serum uric acid levels in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. Design We performed an observational prospective cohort study. Methods The study included 1440 patients with available serum uric acid levels, prospectively followed for 50 ± 17 months. Mean age was 67 ± 11 years; 781 patients (54%) underwent myocardial revascularization, 474 (33%) cardiac valve surgery and 185 (13%) valve-plus-coronary artery by-pass graft surgery. The primary endpoints were overall and cardiovascular mortality while secondary end-points were combined major adverse cardiac and cerebrovascular events. Results Serum uric acid level mean values were 286 ± 95 µmol/l and elevated serum uric acid levels (≥360 µmol/l or 6 mg/dl) were found in 275 patients (19%). Overall mortality (hazard ratio = 2.1; 95% confidence interval: 1.5-3.0; p < 0.001), cardiovascular mortality (hazard ratio = 2.0; 95% confidence interval: 1.2-3.2; p = 0.004) and major adverse cardiac and cerebrovascular events rate (hazard ratio = 1.5; 95% confidence interval: 1.0-2.0; p = 0.019) were significantly higher in patients with elevated serum uric acid levels, even after adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate, atrial fibrillation and medical therapy. Moreover, strong positive correlations between serum uric acid level and probability of overall mortality ( p < 0.001), cardiovascular mortality ( p < 0.001) and major adverse cardiac and cerebrovascular events ( p = 0.003) were found. Conclusions Serum uric acid levels predict mortality and adverse cardiovascular outcome in patients undergoing myocardial revascularization and/or cardiac valve surgery even after the adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate and medical therapy.

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study

PubMed Central

Corrigan, Neil; Sebag-Montefiore, David; Finan, Paul J; Thomas, James D; Chapman, Michael; Hamilton, Russell; Campbell, Helen; Cameron, David; Kaplan, Richard; Parmar, Mahesh; Stephens, Richard; Seymour, Matt; Gregory, Walter; Selby, Peter

2017-01-01

Objective In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Design Data for patients diagnosed with CRC in England in 2001–2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Results Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer ‘centres of excellence’, although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%–5%, p<2.2×10−6) and an improvement in survival (p<10−19; 5-year difference: 3.8% (41.0%–44.8%)) comparing high participation for ≥4 years with 0 years. Conclusions There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation. PMID:27797935

Identifying humanitarian crises in population surveillance field sites: simple procedures and ethical imperatives.

PubMed

Fottrell, E; Byass, P

2009-02-01

Effective early warning systems of humanitarian crises may help to avert substantial increases in mortality and morbidity, and prevent major population movements. The Butajira Rural Health Programme (BRHP) in Ethiopia has maintained a programme of epidemiological surveillance since 1987. Inspection of the BRHP data revealed large peaks of mortality in 1998 and 1999, well in excess of the normally observed year-to-year variation. Further investigation and enquiry revealed that these peaks related to a measles epidemic, and a serious episode of drought and consequent food insecurity that went undetected by the BRHP. This paper applies international humanitarian crisis threshold definitions to the BRHP data in an attempt to identify suitable mortality thresholds that may be used for the prospective detection of humanitarian crises in population surveillance sites in developing countries. Empirical investigation using secondary analysis of longitudinal population-based cohort data. The daily, weekly and monthly thresholds for crises in Butajira were applied to mortality data for the 5-year period incorporating the crisis periods of 1998-1999. Days, weeks and months in which mortality exceeded each threshold level were identified. Each threshold level was assessed in terms of prospectively identifying the true crisis periods in a timely manner whilst avoiding false alarms. The daily threshold definition is too sensitive to accurately detect impending or real crises in the population surveillance setting of the BRHP. However, the weekly threshold level is useful in identifying important increases in mortality in a timely manner without the excessive sensitivity of the daily threshold. The weekly threshold level detects the crisis periods approximately 2 weeks before the monthly threshold level. Mortality measures are highly specific indicators of the health status of populations, and simple procedures can be used to apply international crisis threshold definitions in population surveillance settings for the prospective detection of important changes in mortality rate. Standards for the timely use of surveillance data and ethical responsibilities of those responsible for the data should be made explicit to improve the public health functioning of current sentinel surveillance methodologies.

Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure.

PubMed

Heidenreich, Paul A; Lewis, William R; LaBresh, Kenneth A; Schwamm, Lee H; Fonarow, Gregg C

2009-10-01

Many hospitals enrolled in the American Heart Association's Get With The Guidelines (GWTG) Program achieve high levels of recommended care for heart failure, acute myocardial infarction (MI) and stroke. However, it is unclear if outcomes are better in those hospitals recognized by the GWTG program for their processes of care. We compared hospitals enrolled in GWTG and receiving achievement awards for high levels of recommended processes of care with other hospitals using data on risk-adjusted 30-day survival for heart failure and acute MI reported by the Center for Medicare and Medicaid Services. Among the 3,909 hospitals with 30-day data reported by Center for Medicare and Medicaid Services 355 (9%) received GWTG achievement awards. Risk-adjusted mortality for hospitals receiving awards was lower for both heart failure (11.0% vs 11.2%, P = .0005) and acute MI (16.1% vs 16.5%, P < .0001) compared to those not receiving awards. After additional adjustment for hospital characteristics and noncardiac performance measures, the reduction in mortality remained significantly lower for GWTG award hospitals for acute myocardial infraction (-0.19%, 95% CI -0.33 to -0.05), but not for heart failure (-0.11%, 95% CI -0.25 to 0.02). Additional adjustment for cardiac processes of care reduced the benefit of award hospitals by 28% for heart failure mortality and 43% for acute MI mortality. Hospitals receiving achievement awards from the GWTG program have modestly lower risk adjusted mortality for acute MI and to a lesser extent, heart failure, explained in part by better process of care.

Explaining the Widening Education Gap in Mortality among U.S. White Women

PubMed Central

Montez, Jennifer Karas; Zajacova, Anna

2013-01-01

Over the last half century the gap in mortality across education levels grew in the United States, and since the mid-1980s the growth was especially pronounced among white women. The reasons for the growth among white women are unclear. We investigated three explanations—social-psychological factors, economic circumstances, and health behaviors—for the widening education gap in mortality across 1997-2006 among white women 45-84 years of age. We used data from the National Health Interview Survey Linked Mortality File (N=46,744; deaths=4,053). We found little support for social-psychological factors; however, economic circumstances and health behaviors jointly explained the growing education gap in mortality to statistical nonsignificance. Employment and smoking were the most important individual components. Increasing high school graduation rates, reducing smoking prevalence, and designing work-family policies that help women find and maintain desirable employment may reduce mortality inequalities among women. PMID:23723344

Explaining the widening education gap in mortality among U.S. white women.

PubMed

Montez, Jennifer Karas; Zajacova, Anna

2013-06-01

Over the past half century the gap in mortality across education levels has grown in the United States, and since the mid-1980s, the growth has been especially pronounced among white women. The reasons for the growth among white women are unclear. We investigated three explanations-social-psychological factors, economic circumstances, and health behaviors-for the widening education gap in mortality from 1997 to 2006 among white women aged 45 to 84 years using data from the National Health Interview Survey Linked Mortality File (N = 46,744; 4,053 deaths). Little support was found for social-psychological factors, but economic circumstances and health behaviors jointly explained the growing education gap in mortality to statistical nonsignificance. Employment and smoking were the most important individual components. Increasing high school graduation rates, reducing smoking prevalence, and designing work-family policies that help women find and maintain desirable employment may reduce mortality inequalities among women.

Differences in the association of cardiovascular risk factors with education: a comparison of Costa Rica (CRELES) and the USA (NHANES).

PubMed

Rehkopf, David H; Dow, William H; Rosero-Bixby, Luis

2010-09-01

Despite different levels of economic development, Costa Rica and the USA have similar mortalities among adults. However, in the USA there are substantial differences in mortality by educational attainment, and in Costa Rica there are only minor differences. This contrast motivates an examination of behavioural and biological correlates underlying this difference. The authors used data on adults aged 60 and above from the Costa Rican Longevity and Healthy Ageing Study (CRELES) (n=2827) and from the US National Health and Nutrition Examination Survey (NHANES) (n=5607) to analyse the cross-sectional association between educational level and the following risk factors for cardiovascular disease (CVD): ever smoked, current smoker, sedentary, high saturated fat, high carbohydrates, high calorie diet, obesity, severe obesity, large waist circumference, HDL cholesterol, LDL cholesterol, triglycerides, hemoglobin A1c, fasting glucose, C-reactive protein, systolic blood pressure and BMI. There were significantly fewer hazardous levels of risk biomarkers at higher levels of education for more than half (10 out of 17) of the risk factors in the USA, but for less than a third of the outcomes in Costa Rica (five out of 17). These results are consistent with the context-specific nature of educational differences in risk factors for CVD and with a non-uniform nature of association of CVD risk factors with education within countries. Our results also demonstrate that social equity in mortality is achieved without uniform equity in all risk factors.

Creatinine kinase isoenzyme-MB: A simple prognostic biomarker in patients with pulmonary embolism treated with thrombolytic therapy.

PubMed

Bozbay, Mehmet; Uyarel, Huseyin; Avsar, Sahin; Oz, Ahmet; Keskin, Muhammed; Tanik, Veysel Ozan; Bakhshaliyev, Nijat; Ugur, Murat; Pehlivanoglu, Seckin; Eren, Mehmet

2015-12-01

Creatinine kinase isoenzyme-MB (CK-MB) is a biomarker for detecting myocardial injury. The aim of this study was to evaluate the association between admission CK-MB levels and in-hospital and long-term clinical outcomes in pulmonary embolism (PE) patients treated with thrombolytic tissue-plasminogen activator. A total of 148 acute PE patients treated with tissue-plasminogen activator enrolled in the study. The study population was divided into 2 tertiles, based on admission CK-MB levels. The high CK-MB group (n=35) was defined as having a CK-MB level in the third tertile (>31.5 U/L), and the low group (n=113) was defined as having a level in the lower 2 tertiles (≤31.5 U/L). High CK-MB group had a higher incidence of in-hospital mortality (37.1% vs 1.7%, P<.001). Admission systolic blood pressure and tricuspid annular plane systolic excursion were lower in the high CK-MB group. In the receiver-operating characteristic curve analysis, a CK-MB value of more than 31.5 U/L yielded a sensitivity of 86.7% and specificity of 83.5% for predicting in-hospital mortality. During long-term follow-up, recurrent PE, major and minor bleeding, and mortality rates were similar in both groups. Creatinine kinase isoenzyme-MB is a simple, widely available, and useful biomarker for predicting adverse in-hospital clinical outcomes in PE. Copyright © 2015 Elsevier Inc. All rights reserved.

School Health Guidelines to Promote Healthy Eating and Physical Activity. Morbidity and Mortality Weekly Report. Recommendations and Reports. Volume 60, Number 5

ERIC Educational Resources Information Center

Rutledge, Teresa F., Ed.

2011-01-01

During the last 3 decades, the prevalence of obesity has tripled among persons aged 6-19 years. Multiple chronic disease risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose levels are related to obesity. Schools have a responsibility to help prevent obesity and promote physical activity and healthy eating…

Socioeconomic and geographical disparities in under-five and neonatal mortality in Uttar Pradesh, India.

PubMed

Dettrick, Zoe; Jimenez-Soto, Eliana; Hodge, Andrew

2014-05-01

As a part of the Millennium Development Goals, India seeks to substantially reduce its burden of childhood mortality. The success or failure of this goal may depend on outcomes within India's most populous state, Uttar Pradesh. This study examines the level of disparities in under-five and neonatal mortality across a range of equity markers within the state. Estimates of under-five and neonatal mortality rates were computed using five datasets, from three available sources: sample registration system, summary birth histories in surveys, and complete birth histories. Disparities were evaluated via comparisons of mortality rates by rural-urban location, ethnicity, wealth, and districts. While Uttar Pradesh has experienced declines in both rates of under-five (162-108 per 1,000 live births) and neonatal (76-49 per 1,000 live births) mortality, the rate of decline has been slow (averaging 2 % per annum). Mortality trends in rural and urban areas are showing signs of convergence, largely due to the much slower rate of change in urban areas. While the gap between rich and poor households has decreased in both urban and rural areas, trends suggest that differences in mortality will remain. Caste-related disparities remain high and show no signs of diminishing. Of concern are also the signs of stagnation in mortality amongst groups with greater ability to access services, such as the urban middle class. Notwithstanding the slow but steady reduction of absolute levels of childhood mortality within Uttar Pradesh, the distribution of the mortality by sub-state populations remains unequal. Future progress may require significant investment in quality of care provided to all sections of the community.

Time trends in cardiovascular disease mortality in Russia and Germany from 1980 to 2007 - are there migration effects?

PubMed

Deckert, Andreas; Winkler, Volker; Paltiel, Ari; Razum, Oliver; Becher, Heiko

2010-08-17

Cardiovascular disease (CVD) is the leading cause of death in the industrialized world. Large variations in CVD mortality between countries and also between population subgroups within countries have been observed. Previous studies showed significantly lower risks in German repatriates and Jews emigrating from Russia than in the general Russian population. We examined to what degree the migration of large subgroups influenced national CVD mortality rates. We used WHO data to map the CVD mortality distribution in Europe in 2005. Supplemented by data of the Statistisches Bundesamt, the mortality trends in three major CVD groups between 1980 and 2007 in Russia and Germany are displayed, as well as demographic information. The effects of migration on demography were estimated and percentage changes in CVD mortality trends were calculated under the assumption that migration had not occurred. Cardiovascular disease mortality patterns within Europe showed a strong west-east gradient with ratios up to sixfold. In Germany, the CVD mortality levels were low and steadily decreasing, whereas in Russia they fluctuated at high levels with substantial differences between the sexes and strong correlations with political changes and health campaigns. The trends in both Russia and Germany were affected by the migration that occurred in both countries over recent decades. However, our restricted focus in only adjusting for the migration of German repatriates and Jews had moderate effects on the national CVD mortality statistics in Germany (+1.0%) and Russia (-0.6%). The effects on CVD mortality rates due to migration in Germany and Russia were smaller than those due to secular economical changes. However, migration should still be considered as a factor influencing national mortality trends.

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.

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.

Increased endothelial and macrophage markers are associated with disease severity and mortality in scrub typhus.

PubMed

Otterdal, Kari; Janardhanan, Jeshina; Astrup, Elisabeth; Ueland, Thor; Prakash, John A J; Lekva, Tove; Abraham, O C; Thomas, Kurien; Damås, Jan Kristian; Mathews, Prasad; Mathai, Dilip; Aukrust, Pål; Varghese, George M

2014-11-01

Scrub typhus is endemic in the Asia-Pacific region. Mortality is high even with treatment, and further knowledge of the immune response during this infection is needed. This study was aimed at comparing plasma levels of monocyte/macrophage and endothelial related inflammatory markers in patients and controls in South India and to explore a possible correlation to disease severity and clinical outcome. Plasma levels of ALCAM, VCAM-1, sCD163, sCD14, YKL-40 and MIF were measured in scrub typhus patients (n = 129), healthy controls (n = 31) and in infectious disease controls (n = 31), both in the acute phase and after recovery, by enzyme immunoassays. Patients had markedly elevated levels of all mediators in the acute phase, differing from both healthy and infectious disease controls. During follow-up levels of ALCAM, VCAM-1, sCD14 and YKL-40 remained elevated compared to levels in healthy controls. High plasma ALCAM, VCAM-1, sCD163, sCD14, and MIF, and in particular YKL-40 were all associated with disease severity and ALCAM, sCD163, MIF and especially YKL-40, were associated with mortality. Our findings show that scrub typhus is characterized by elevated levels of monocyte/macrophage and endothelial related markers. These inflammatory markers, and in particular YKL-40, may contribute to disease severity and clinical outcome. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Hypophosphatemia during continuous veno-venous hemofiltration is associated with mortality in critically ill patients with acute kidney injury.

PubMed

Yang, Yi; Zhang, Ping; Cui, Yu; Lang, Xia; Yuan, Jing; Jiang, Hua; Lei, Wen; Lv, Rong; Zhu, Yi; Lai, En; Chen, Jiang

2013-09-19

The primary aim of this study was to determine whether hypophosphatemia during continuous veno-venous hemofiltration (CVVH) is associated with the global outcome of critically ill patients with acute kidney injury (AKI). 760 patients diagnosed with AKI and had received CVVH therapy were retrospectively recruited. Death during the 28-day period and survival at 28 days after initiation of CVVH were used as endpoints. Demographic and clinical data including serum phosphorus levels were recorded along with clinical outcome. Hypophosphatemia was defined according to the colorimetric method as serum phosphorus levels < 0.81 mmol/L (2.5 mg/dL), and severe hypophosphatemia was defined as serum phosphorus levels < 0.32 mmol/L (1 mg/dL). The ratio of CVVH therapy days with hypophosphatemia over total CVVH therapy days was calculated to reflect the persistence of hypophosphatemia. The Cox proportional hazard survival model analysis indicated that the incidence of hypophosphatemia or even severe hypophosphatemia was not associated with 28-day mortality independently (p = 0.700). Further analysis with the sub-cohort of patients who had developed hypophosphatemia during the CVVH therapy period indicated that the mean ratio of CVVH therapy days with hypophosphatemia over total CVVH therapy days was 0.58, and the ratio independently associated with the global outcome. Compared with the patients with low ratio (< 0.58), those with high ratio (≥ 0.58) conferred a 1.451-fold increase in 28-day mortality rate (95% CI 1.103-1.910, p = 0.008). Hypophosphatemia during CVVH associated with the global clinical outcome of critically ill patients with AKI. The ratio of CVVH therapy days with hypophosphatemia over total CVVH therapy days was independently associated with the 28-day mortality, and high ratio conferred higher mortality rate.

Geographic disparity in chronic obstructive pulmonary disease (COPD) mortality rates among the Taiwan population.

PubMed

Chan, Ta-Chien; Chiang, Po-Huang; Su, Ming-Daw; Wang, Hsuan-Wen; Liu, Michael Shi-yung

2014-01-01

Chronic obstructive pulmonary disease (COPD) causes a high disease burden among the elderly worldwide. In Taiwan, the long-term temporal trend of COPD mortality is declining, but the geographical disparity of the disease is not yet known. Nationwide COPD age-adjusted mortality at the township level during 1999-2007 is used for elucidating the geographical distribution of the disease. With an ordinary least squares (OLS) model and geographically weighted regression (GWR), the ecologic risk factors such as smoking rate, area deprivation index, tuberculosis exposure, percentage of aborigines, density of health care facilities, air pollution and altitude are all considered in both models to evaluate their effects on mortality. Global and local Moran's I are used for examining their spatial autocorrelation and identifying clusters. During the study period, the COPD age-adjusted mortality rates in males declined from 26.83 to 19.67 per 100,000 population, and those in females declined from 8.98 to 5.70 per 100,000 population. Overall, males' COPD mortality rate was around three times higher than females'. In the results of GWR, the median coefficients of smoking rate, the percentage of aborigines, PM10 and the altitude are positively correlated with COPD mortality in males and females. The median value of density of health care facilities is negatively correlated with COPD mortality. The overall adjusted R-squares are about 20% higher in the GWR model than in the OLS model. The local Moran's I of the GWR's residuals reflected the consistent high-high cluster in southern Taiwan. The findings indicate that geographical disparities in COPD mortality exist. Future epidemiological investigation is required to understand the specific risk factors within the clustering areas.

Mortality prediction in patients with severe septic shock: a pilot study using a target metabolomics approach.

PubMed

Ferrario, Manuela; Cambiaghi, Alice; Brunelli, Laura; Giordano, Silvia; Caironi, Pietro; Guatteri, Luca; Raimondi, Ferdinando; Gattinoni, Luciano; Latini, Roberto; Masson, Serge; Ristagno, Giuseppe; Pastorelli, Roberta

2016-02-05

Septic shock remains a major problem in Intensive Care Unit, with high lethality and high-risk second lines treatments. In this preliminary retrospective investigation we examined plasma metabolome and clinical features in a subset of 20 patients with severe septic shock (SOFA score >8), enrolled in the multicenter Albumin Italian Outcome Sepsis study (ALBIOS, NCT00707122). Our purpose was to evaluate the changes of circulating metabolites in relation to mortality as a pilot study to be extended in a larger cohort. Patients were analyzed according to their 28-days and 90-days mortality. Metabolites were measured using a targeted mass spectrometry-based quantitative metabolomic approach that included acylcarnitines, aminoacids, biogenic amines, glycerophospholipids, sphingolipids, and sugars. Data-mining techniques were applied to evaluate the association of metabolites with mortality. Low unsaturated long-chain phosphatidylcholines and lysophosphatidylcholines species were associated with long-term survival (90-days) together with circulating kynurenine. Moreover, a decrease of these glycerophospholipids was associated to the event at 28-days and 90-days in combination with clinical variables such as cardiovascular SOFA score (28-day mortality model) or renal replacement therapy (90-day mortality model). Early changes in the plasma levels of both lipid species and kynurenine associated with mortality have potential implications for early intervention and discovering new target therapy.

Mortality prediction in patients with severe septic shock: a pilot study using a target metabolomics approach

PubMed Central

Ferrario, Manuela; Cambiaghi, Alice; Brunelli, Laura; Giordano, Silvia; Caironi, Pietro; Guatteri, Luca; Raimondi, Ferdinando; Gattinoni, Luciano; Latini, Roberto; Masson, Serge; Ristagno, Giuseppe; Pastorelli, Roberta

2016-01-01

Septic shock remains a major problem in Intensive Care Unit, with high lethality and high-risk second lines treatments. In this preliminary retrospective investigation we examined plasma metabolome and clinical features in a subset of 20 patients with severe septic shock (SOFA score >8), enrolled in the multicenter Albumin Italian Outcome Sepsis study (ALBIOS, NCT00707122). Our purpose was to evaluate the changes of circulating metabolites in relation to mortality as a pilot study to be extended in a larger cohort. Patients were analyzed according to their 28-days and 90-days mortality. Metabolites were measured using a targeted mass spectrometry-based quantitative metabolomic approach that included acylcarnitines, aminoacids, biogenic amines, glycerophospholipids, sphingolipids, and sugars. Data-mining techniques were applied to evaluate the association of metabolites with mortality. Low unsaturated long-chain phosphatidylcholines and lysophosphatidylcholines species were associated with long-term survival (90-days) together with circulating kynurenine. Moreover, a decrease of these glycerophospholipids was associated to the event at 28-days and 90-days in combination with clinical variables such as cardiovascular SOFA score (28-day mortality model) or renal replacement therapy (90-day mortality model). Early changes in the plasma levels of both lipid species and kynurenine associated with mortality have potential implications for early intervention and discovering new target therapy. PMID:26847922

Intra-demographic birth risk assessment scheme and infant mortality in Nigeria

PubMed Central

Adebowale, Ayo S.

2017-01-01

ABSTRACT Background: Infant mortality (IM) is high in Nigeria. High-risk birth can limit a newborn’s survival chances to the first year of life. The approach used in investigating the relationship between high-risk birth and IM in this study is yet to be documented in Nigeria. Objectives: The Intra-Demographic Birth Risk Assessment Scheme (IDBRAS) was generated and its relationship with IM was examined. Methods: 2013 Nigeria demographic and health survey data were used. Mothers who gave birth in the 5 years before the survey were investigated (n = 31,155). IDBRAS was generated from information on maternal age at childbirth, parity and preceding birth interval and was disaggregated into low, medium and high. Data were analysed using the Cox proportional hazard and Brass 1-parameter models (α = 0.05). Results: Infant mortality rate was 88.4, 104.7 and 211.6 per 1000 live births among women with low, medium and high level of IDBRAS respectively. The rate of increase of reported infant deaths between low and high IDBRAS was 0.1932 (R 2 = 0.5326; p < 0.001). The prevalence of medium- and high-risk birth was 24.6 and 4.2% respectively. The identified predictors of IM were place of residence, marital status and size of the child at birth. The hazard ratio of IM was higher among women with medium (HR = 1.35; 95% CI = 1.22–1.48, p < 0.001) and high IDBRAS (HR = 1.73; 95% CI = 1.48–2.02, p < 0.001) than among those with low IDBRAS. Controlling for other correlates barely changed this pattern. Conclusions: The risk and level of IM increased as the level of IDBRAS increases in Nigeria. IDBRAS was an important predictor of IM. Maintaining a low level of IDBRAS will facilitate a reduction in IM rate in Nigeria. PMID:28882095

Intra-demographic birth risk assessment scheme and infant mortality in Nigeria.

PubMed

Adebowale, Ayo S

2017-01-01

Infant mortality (IM) is high in Nigeria. High-risk birth can limit a newborn's survival chances to the first year of life. The approach used in investigating the relationship between high-risk birth and IM in this study is yet to be documented in Nigeria. The Intra-Demographic Birth Risk Assessment Scheme (IDBRAS) was generated and its relationship with IM was examined. 2013 Nigeria demographic and health survey data were used. Mothers who gave birth in the 5 years before the survey were investigated (n = 31,155). IDBRAS was generated from information on maternal age at childbirth, parity and preceding birth interval and was disaggregated into low, medium and high. Data were analysed using the Cox proportional hazard and Brass 1-parameter models (α = 0.05). Infant mortality rate was 88.4, 104.7 and 211.6 per 1000 live births among women with low, medium and high level of IDBRAS respectively. The rate of increase of reported infant deaths between low and high IDBRAS was 0.1932 (R 2  = 0.5326; p < 0.001). The prevalence of medium- and high-risk birth was 24.6 and 4.2% respectively. The identified predictors of IM were place of residence, marital status and size of the child at birth. The hazard ratio of IM was higher among women with medium (HR = 1.35; 95% CI = 1.22-1.48, p < 0.001) and high IDBRAS (HR = 1.73; 95% CI = 1.48-2.02, p < 0.001) than among those with low IDBRAS. Controlling for other correlates barely changed this pattern. The risk and level of IM increased as the level of IDBRAS increases in Nigeria. IDBRAS was an important predictor of IM. Maintaining a low level of IDBRAS will facilitate a reduction in IM rate in Nigeria.

Implementing the US air quality standard for PM2.5 worldwide can prevent millions of premature deaths per year.

PubMed

Giannadaki, Despina; Lelieveld, Jos; Pozzer, Andrea

2016-08-23

Air pollution by fine aerosol particles is among the leading causes of poor health and premature mortality worldwide. The growing awareness of this issue has led several countries to implement air pollution legislation. However, populations in large parts of the world are still exposed to high levels of ambient particulate pollution. The main aim of this work is to evaluate the potential impact of implementing current air quality standards for fine particulate matter (PM2.5) in the European Union (EU), United States (US) and other countries where PM2.5 levels are high. We use a high-resolution global atmospheric chemistry model combined with epidemiological concentration response functions to investigate premature mortality attributable to PM2.5 in adults ≥30 years and children <5 years. We perform sensitivity studies to estimate the reductions in mortality that could be achieved if the PM2.5 air quality standards of the EU and US and other national standards would be implemented worldwide. We estimate the global premature mortality by PM2.5 at 3.15 million/year in 2010. China is the leading country with about 1.33 million, followed by India with 575 thousand and Pakistan with 105 thousand per year. For the 28 EU member states we estimate 173 thousand and for the United States 52 thousand premature deaths in 2010. Based on sensitivity analysis, applying worldwide the EU annual mean standard of 25 μg/m(3) for PM2.5 could reduce global premature mortality due to PM2.5 exposure by 17 %; while within the EU the effect is negligible. With the 2012 revised US standard of 12 μg/m(3) premature mortality by PM2.5 could drop by 46 % worldwide; 4 % in the US and 20 % in the EU, 69 % in China, 49 % in India and 36 % in Pakistan. These estimates take into consideration that about 22 % of the global PM2.5 related mortality cannot be avoided due to the contribution of natural PM2.5 sources, mainly airborne desert dust and PM2.5 from wild fires. Our results reflect the need to adopt stricter limits for annual mean PM2.5 levels globally, like the US standard of 12 μg/m(3) or an even lower limit to substantially reduce premature mortality in most of the world.

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.

Factors affecting in-hospital heat-related mortality: a multi-city case-crossover analysis.

PubMed

Stafoggia, M; Forastiere, F; Agostini, D; Caranci, N; de'Donato, F; Demaria, M; Michelozzi, P; Miglio, R; Rognoni, M; Russo, A; Perucci, C A

2008-03-01

Several studies have identified strong effects of high temperatures on mortality at population level; however, individual vulnerability factors associated with heat-related in-hospital mortality are largely unknown. The objective of the study was to evaluate heat-related in-hospital mortality using a multi-city case-crossover analysis. We studied residents of four Italian cities, aged 65+ years, who died during 1997-2004. For 94,944 individuals who died in hospital and were hospitalised two or more days before death, demographics, chronic conditions, primary diagnoses of last event and hospital wards were considered. A city-specific case-crossover analysis was performed to evaluate the association between apparent temperature and mortality. Pooled odds ratios (OR) of dying on a day with a temperature of 30 degrees C compared to a day with a temperature of 20 degrees C were estimated with a random-effects meta-analysis. We estimated an overall OR of 1.32 (95% confidence interval: 1.25, 1.39). Age, marital status and hospital ward were important risk indicators. Patients in general medicine were at higher risk than those in high and intensive care units. A history of psychiatric disorders and cerebrovascular diseases gave a higher vulnerability. Mortality was greater among patients hospitalised for heart failure, stroke and chronic pulmonary diseases. In-hospital mortality is strongly associated with high temperatures. A comfortable temperature in hospitals and increased attention to vulnerable patients during heatwaves, especially in general medicine, are necessary preventive measures.

Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines.

PubMed

Shield, Kevin D; Gmel, Gerrit; Gmel, Gerhard; Mäkelä, Pia; Probst, Charlotte; Room, Robin; Rehm, Jürgen

2017-09-01

Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men. If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision. © 2017 Society for the Study of Addiction.

Predicting Mortality in African Americans With Type 2 Diabetes Mellitus: Soluble Urokinase Plasminogen Activator Receptor, Coronary Artery Calcium, and High-Sensitivity C-Reactive Protein.

PubMed

Hayek, Salim S; Divers, Jasmin; Raad, Mohamad; Xu, Jianzhao; Bowden, Donald W; Tracy, Melissa; Reiser, Jochen; Freedman, Barry I

2018-05-01

Type 2 diabetes mellitus is a major risk factor for cardiovascular disease; however, outcomes in individual patients vary. Soluble urokinase plasminogen activator receptor (suPAR) is a bone marrow-derived signaling molecule associated with adverse cardiovascular and renal outcomes in many populations. We characterized the determinants of suPAR in African Americans with type 2 diabetes mellitus and assessed whether levels were useful for predicting mortality beyond clinical characteristics, coronary artery calcium (CAC), and high-sensitivity C-reactive protein (hs-CRP). We measured plasma suPAR levels in 500 African Americans with type 2 diabetes mellitus enrolled in the African American-Diabetes Heart Study. We used Kaplan-Meier curves and Cox proportional hazards models adjusting for clinical characteristics, CAC, and hs-CRP to examine the association between suPAR and all-cause mortality. Last, we report the change in C-statistics comparing the additive values of suPAR, hs-CRP, and CAC to clinical models for prediction of mortality. The suPAR levels were independently associated with female sex, smoking, insulin use, decreased kidney function, albuminuria, and CAC. After a median 6.8-year follow-up, a total of 68 deaths (13.6%) were recorded. In a model incorporating suPAR, CAC, and hs-CRP, only suPAR was significantly associated with mortality (hazard ratio 2.66, 95% confidence interval 1.63-4.34). Addition of suPAR to a baseline clinical model significantly improved the C-statistic for all-cause death (Δ0.05, 95% confidence interval 0.01-0.10), whereas addition of CAC or hs-CRP did not. In African Americans with type 2 diabetes mellitus, suPAR was strongly associated with mortality and improved risk discrimination metrics beyond traditional risk factors, CAC and hs-CRP. Studies addressing the clinical usefulness of measuring suPAR concentrations are warranted. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Effect of vitamin D on all-cause mortality in heart failure (EVITA): a 3-year randomized clinical trial with 4000 IU vitamin D daily.

PubMed

Zittermann, Armin; Ernst, Jana B; Prokop, Sylvana; Fuchs, Uwe; Dreier, Jens; Kuhn, Joachim; Knabbe, Cornelius; Birschmann, Ingvild; Schulz, Uwe; Berthold, Heiner K; Pilz, Stefan; Gouni-Berthold, Ioanna; Gummert, Jan F; Dittrich, Marcus; Börgermann, Jochen

2017-08-01

Circulating 25-hydroxyvitamin D (25OHD) levels <75 nmol/L are associated with a nonlinear increase in mortality risk. Such 25OHD levels are common in heart failure (HF). We therefore examined whether oral vitamin D supplementation reduces mortality in patients with advanced HF. Four hundred HF patients with 25OHD levels <75 nmol/L were randomized to receive 4000 IU vitamin D daily or matching placebo for 3 years. Primary endpoint was all-cause mortality. Key secondary outcome measures included hospitalization, resuscitation, mechanical circulatory support (MCS) implant, high urgent listing for heart transplantation, heart transplantation, and hypercalcaemia. Initial 25OHD levels were on average <40 nmol/L, remained around 40 nmol/L in patients assigned to placebo and plateaued around 100 nmol/L in patients assigned to vitamin D. Mortality was not different in patients receiving vitamin D (19.6%; n = 39) or placebo (17.9%; n = 36) with a hazard ratio (HR) of 1.09 [95% confidence interval (CI): 0.69-1.71; P = 0.726]. The need for MCS implant was however greater in patients assigned to vitamin D (15.4%, n = 28) vs. placebo [9.0%, n = 15; HR: 1.96 (95% CI: 1.04-3.66); P = 0.031]. Other secondary clinical endpoints were similar between groups. The incidence of hypercalcaemia was 6.2% (n = 10) and 3.1% (n = 5) in patients receiving vitamin D or placebo (P = 0.192). A daily vitamin D dose of 4000 IU did not reduce mortality in patients with advanced HF but was associated with a greater need for MCS implants. Data indicate caution regarding long-term supplementation with moderately high vitamin D doses. clinicaltrials.gov Idenitfier: NCT01326650. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

[Estimation of the excess of lung cancer mortality risk associated to environmental tobacco smoke exposure of hospitality workers].

PubMed

López, M José; Nebot, Manel; Juárez, Olga; Ariza, Carles; Salles, Joan; Serrahima, Eulàlia

2006-01-14

To estimate the excess lung cancer mortality risk associated with environmental tobacco (ETS) smoke exposure among hospitality workers. The estimation was done using objective measures in several hospitality settings in Barcelona. Vapour phase nicotine was measured in several hospitality settings. These measurements were used to estimate the excess lung cancer mortality risk associated with ETS exposure for a 40 year working life, using the formula developed by Repace and Lowrey. Excess lung cancer mortality risk associated with ETS exposure was higher than 145 deaths per 100,000 workers in all places studied, except for cafeterias in hospitals, where excess lung cancer mortality risk was 22 per 100,000. In discoteques, for comparison, excess lung cancer mortality risk is 1,733 deaths per 100,000 workers. Hospitality workers are exposed to ETS levels related to a very high excess lung cancer mortality risk. These data confirm that ETS control measures are needed to protect hospital workers.

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.

Population causes and consequences of leading chronic diseases: a comparative analysis of prevailing explanations.

PubMed

Stuckler, David

2008-06-01

The mortality numbers and rates of chronic disease are rising faster in developing than in developed countries. This article compares prevailing explanations of population chronic disease trends with theoretical and empirical models of population chronic disease epidemiology and assesses some economic consequences of the growth of chronic diseases in developing countries based on the experiences of developed countries. Four decades of male mortality rates of cardiovascular and chronic noncommunicable diseases were regressed on changes in and levels of country income per capita, market integration, foreign direct investment, urbanization rates, and population aging in fifty-six countries for which comparative data were available. Neoclassical economic growth models were used to estimate the effect of the mortality rates of chronic noncommunicable diseases on economic growth in high-income OECD countries. Processes of economic growth, market integration, foreign direct investment, and urbanization were significant determinants of long-term changes in mortality rates of heart disease and chronic noncommunicable disease, and the observed relationships with these social and economic factors were roughly three times stronger than the relationships with the population's aging. In low-income countries, higher levels of country income per capita, population urbanization, foreign direct investment, and market integration were associated with greater mortality rates of heart disease and chronic noncommunicable disease, less increased or sometimes reduced rates in middle-income countries, and decreased rates in high-income countries. Each 10 percent increase in the working-age mortality rates of chronic noncommunicable disease decreased economic growth rates by close to a half percent. Macrosocial and macroeconomic forces are major determinants of population rises in chronic disease mortality, and some prevailing demographic explanations, such as population aging, are incomplete on methodological, empirical, and policy grounds. Rising chronic disease mortality rates will significantly reduce economic growth in developing countries and further widen the health and economic gap between the developed and developing world.

Population Causes and Consequences of Leading Chronic Diseases: A Comparative Analysis of Prevailing Explanations

PubMed Central

Stuckler, David

2008-01-01

Context The mortality numbers and rates of chronic disease are rising faster in developing than in developed countries. This article compares prevailing explanations of population chronic disease trends with theoretical and empirical models of population chronic disease epidemiology and assesses some economic consequences of the growth of chronic diseases in developing countries based on the experiences of developed countries. Methods Four decades of male mortality rates of cardiovascular and chronic noncommunicable diseases were regressed on changes in and levels of country income per capita, market integration, foreign direct investment, urbanization rates, and population aging in fifty-six countries for which comparative data were available. Neoclassical economic growth models were used to estimate the effect of the mortality rates of chronic noncommunicable diseases on economic growth in high-income OECD countries. Findings Processes of economic growth, market integration, foreign direct investment, and urbanization were significant determinants of long-term changes in mortality rates of heart disease and chronic noncommunicable disease, and the observed relationships with these social and economic factors were roughly three times stronger than the relationships with the population's aging. In low-income countries, higher levels of country income per capita, population urbanization, foreign direct investment, and market integration were associated with greater mortality rates of heart disease and chronic noncommunicable disease, less increased or sometimes reduced rates in middle-income countries, and decreased rates in high-income countries. Each 10 percent increase in the working-age mortality rates of chronic noncommunicable disease decreased economic growth rates by close to a half percent. Conclusions Macrosocial and macroeconomic forces are major determinants of population rises in chronic disease mortality, and some prevailing demographic explanations, such as population aging, are incomplete on methodological, empirical, and policy grounds. Rising chronic disease mortality rates will significantly reduce economic growth in developing countries and further widen the health and economic gap between the developed and developing world. PMID:18522614

Stagnant Neonatal Mortality and Persistent Health Inequality in Middle-Income Countries: A Case Study of the Philippines

PubMed Central

Kraft, Aleli D.; Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Hodge, Andrew

2013-01-01

Background The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality. Methodology Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Findings Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. Conclusion The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health. PMID:23308278

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

Ramifications of the Children's Surgery Verification Program for Patients and Hospitals.

PubMed

Baxter, Katherine J; Gale, Bonnie F; Travers, Curtis D; Heiss, Kurt F; Raval, Mehul V

2018-05-01

The American College of Surgeons in 2015 instituted the Children's Surgery Verification program delineating requirements for hospitals providing pediatric surgical care. Our purpose was to examine possible effects of the Children's Surgery Verification program by evaluating neonates undergoing high-risk operations. Using the Kid's Inpatient Database 2009, we identified infants undergoing operations for 5 high-risk neonatal conditions. We considered all children's hospitals and children's units Level I centers and considered all others Level II/III. We estimated the number of neonates requiring relocation and the additional distance traveled. We used propensity score adjusted logistic regression to model mortality at Level I vs Level II/III hospitals. Overall, 7,938 neonates were identified across 21 states at 91 Level I and 459 Level II/III hospitals. Based on our classifications, 2,744 (34.6%) patients would need to relocate to Level I centers. The median additional distance traveled was 6.6 miles. The maximum distance traveled varied by state, from <55 miles (New Jersey and Rhode Island) to >200 miles (Montana, Oregon, Colorado, and California). The adjusted odds of mortality at Level II/III vs Level I centers was 1.67 (95% CI 1.44 to 1.93). We estimate 1 life would be saved for every 32 neonates moved. Although this conservative estimate demonstrates that more than one-third of complex surgical neonates in 2009 would have needed to relocate under the Children's Surgery Verification program, the additional distance traveled is relatively short for most but not all, and this program might improve mortality. Local level ramifications of this novel national program require additional investigation. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The population attributable fraction of low education for mortality in South Korea with improvement in educational attainment and no improvement in mortality inequalities.

PubMed

Lim, Dohee; Kong, Kyoung Ae; Lee, Hye Ah; Lee, Won Kyung; Park, Su Hyun; Baik, Sun Jung; Park, Hyesook; Jung-Choi, Kyunghee

2015-03-31

The educational attainment of Koreans has greatly increased, which was expected to reduce the magnitude of the population attributable fraction (PAF) of mortality associated with low education levels. However, increase in the relative risk (RR) of mortality among those with lower educational levels actually increased the PAF. The purpose of this study was to examine the change in the PAF of lower educational levels for mortality in Korea, where educational attainment has improved and is associated with the exacerbation of inequalities in mortality levels. National census data were used to derive educational levels. The mortality-associated RR of lower educational levels was calculated by reference to national census and death certificate data from 1995, 2000, 2005, and 2010. PAFs were calculated for all-cause mortality, malignant neoplasms, cerebrovascular disease, heart disease, and suicide by gender and age group (30-44 and 45-59 years). The PAF of low educational level in terms of total mortality has decreased since 1995 in both genders. This trend was more prominent among those aged 30-44 years. However, the PAFs of suicide in younger females (30-44 years) and of cerebrovascular disease in older males (45-59 years) have increased. The RRs of all-cause mortality and those of the four leading causes of death in those with the lowest educational levels have increased, especially in females aged 30-44 years. The consistent and sharp increase in the attainment of education has contributed to the reduction in the PAFs of lower education for mortality, despite the fact that mortality inequalities have not improved. Efforts to reduce health inequalities must promote healthy public policy and address public health policies.

Local variability but landscape stability in coral reef communities following repeated hurricane impacts

USGS Publications Warehouse

Bythell, John C.; Hillis-Star, Zandy M; Rogers, Caroline S.

2000-01-01

Coral reef community structure has remained remarkably stable over a 10 yr period within a small protected marine area despite repeated hurricane impacts. Local community dynamics have been highly variable, however. Sites that were destroyed by disease in the 1970s are showing little or no recovery, while sites less than a kilometre away that were devastated by Hurricane Hugo in 1989 are recovering well. Strong coral recruitment has occurred in shallow, exposed areas that showed the greatest hurricane impacts, and these areas are now more species rich than in 1988, although coral cover has not reached pre-hurricane levels. Coral colony survivorship has been high throughout most of the study area. Partial mortality rates were elevated for several years following Hurricane Hugo, but significant whole coral-head mortality only occurred during periods with hurricane impacts and only at the most exposed sites. Overall, the coral community has proved resilient to closely repeated major hurricane impacts. From a single case study we cannot attribute this resilience to the relatively low level of human impacts, but grazing fish populations have apparently remained high enough to keep macroalgae in check despite the mass mortality of the herbivore Diadema antillarum in the 1980s.

Health and productivity of traditionally managed Djallonke sheep and West African dwarf goats under high and moderate trypanosomosis risk.

PubMed

Osaer, S; Goossens, B; Kora, S; Gaye, M; Darboe, L

1999-03-31

Trypanosome infections, packed red cell volume levels (PCV), body weight and nematode faecal egg counts of village-based small ruminants were monitored in two areas in The Gambia with either moderate or high trypanosomosis risk for 24 and 30 months respectively. Outflows from the flock and new-born animals were recorded and data on housing and management were compiled. Reported mortality rates were higher in goats than in sheep, but for both species highest in the moderate risk area. The peak of trypanosome infections lagged the peak of tsetse densities by 1-3 months in both areas. Trypanosoma vivax was the predominant species found in the infected animals, followed by T. congolense. Trypanosome prevalence was, in general, higher in sheep than in goats but only significantly higher during Year 1 in the moderate risk area. Trypanosome infection reduced the PCV level significantly and seasonal effects indicated significantly lower PCV levels during the rains. Trypanosome infection significantly depressed weight gain in both species at periods where infection rates were highest. In both species considerably lower weight gains were observed during the rainy season. Abortion rates were higher in goats than in sheep in both study sites, and highest in the high-risk site. Trypanosome infection in ewes in the high risk area increased lamb mortality significantly but had no effect on birth weights, nor on growth rates up to 4 months. Offspring mortality up to 4 months was generally high at both sites. Trypanosome infection in the dam between 3.5 to 7 months post parturition significantly increased parturition interval in both species. Peak faecal egg output occurred at the end of the rainy season and was highest for both species in the moderate risk site. Poor grazing management was found responsible for a seasonal nutritional constraint. Based on these results, these breeds of sheep and goats can be considered as trypanotolerant since they are able to remain productive under high and moderate levels of trypanosome challenge. Nevertheless, trypanosomosis affected their health and production level as shown by reduced PCV levels, depressed weight gains, longer parturition intervals and higher lamb mortality. In addition, during the rains, helminth infections and poor management leading to nutritional constraints had also a negative impact on health and production and therefore influenced the innate resilience to trypanosomosis in those indigenous breeds. Adaptations in management may have an equal impact as certain disease control measures to improve biological and economical returns from small ruminants in tsetse infested rural areas.

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.

Is patriarchy the source of men's higher mortality?

PubMed Central

Stanistreet, D; Bambra, C; Scott-Samuel, A

2005-01-01

Objective: To examine the relation between levels of patriarchy and male health by comparing female homicide rates with male mortality within countries. Hypothesis: High levels of patriarchy in a society are associated with increased mortality among men. Design: Cross sectional ecological study design. Setting: 51 countries from four continents were represented in the data—America, Europe, Australasia, and Asia. No data were available for Africa. Results: A multivariate stepwise linear regression model was used. Main outcome measure was age standardised male mortality rates for 51 countries for the year 1995. Age standardised female homicide rates and GDP per capita ranking were the explanatory variables in the model. Results were also adjusted for the effects of general rates of homicide. Age standardised female homicide rates and ranking of GDP were strongly correlated with age standardised male mortality rates (Pearson's r = 0.699 and Spearman's 0.744 respectively) and both correlations achieved significance (p<0.005). Both factors were subsequently included in the stepwise regression model. Female homicide rates explained 48.8% of the variance in male mortality, and GDP a further 13.6% showing that the higher the rate of female homicide, and hence the greater the indicator of patriarchy, the higher is the rate of mortality among men. Conclusion: These data suggest that oppression and exploitation harm the oppressors as well as those they oppress, and that men's higher mortality is a preventable social condition, which could be tackled through global social policy measures. PMID:16166362

Heat Wave and Mortality: A Multicountry, Multicommunity Study

PubMed Central

Gasparrini, Antonio; Armstrong, Ben G.; Tawatsupa, Benjawan; Tobias, Aurelio; Lavigne, Eric; Coelho, Micheline de Sousa Zanotti Stagliorio; Pan, Xiaochuan; Kim, Ho; Hashizume, Masahiro; Honda, Yasushi; Guo, Yue-Liang Leon; Wu, Chang-Fu; Zanobetti, Antonella; Schwartz, Joel D.; Bell, Michelle L.; Scortichini, Matteo; Michelozzi, Paola; Punnasiri, Kornwipa; Li, Shanshan; Tian, Linwei; Garcia, Samuel David Osorio; Seposo, Xerxes; Overcenco, Ala; Zeka, Ariana; Goodman, Patrick; Dang, Tran Ngoc; Dung, Do Van; Mayvaneh, Fatemeh; Saldiva, Paulo Hilario Nascimento; Williams, Gail; Tong, Shilu

2017-01-01

Background: Few studies have examined variation in the associations between heat waves and mortality in an international context. Objectives: We aimed to systematically examine the impacts of heat waves on mortality with lag effects internationally. Methods: We collected daily data of temperature and mortality from 400 communities in 18 countries/regions and defined 12 types of heat waves by combining community-specific daily mean temperature ≥90th, 92.5th, 95th, and 97.5th percentiles of temperature with duration ≥2, 3, and 4 d. We used time-series analyses to estimate the community-specific heat wave–mortality relation over lags of 0–10 d. Then, we applied meta-analysis to pool heat wave effects at the country level for cumulative and lag effects for each type of heat wave definition. Results: Heat waves of all definitions had significant cumulative associations with mortality in all countries, but varied by community. The higher the temperature threshold used to define heat waves, the higher heat wave associations on mortality. However, heat wave duration did not modify the impacts. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 d. Heat waves had higher associations with mortality in moderate cold and moderate hot areas than cold and hot areas. There were no added effects of heat waves on mortality in all countries/regions, except for Brazil, Moldova, and Taiwan. Heat waves defined by daily mean and maximum temperatures produced similar heat wave–mortality associations, but not daily minimum temperature. Conclusions: Results indicate that high temperatures create a substantial health burden, and effects of high temperatures over consecutive days are similar to what would be experienced if high temperature days occurred independently. People living in moderate cold and moderate hot areas are more sensitive to heat waves than those living in cold and hot areas. Daily mean and maximum temperatures had similar ability to define heat waves rather than minimum temperature. https://doi.org/10.1289/EHP1026 PMID:28886602

Reasons for Persistently High Maternal and Perinatal Mortalities in Ethiopia: Part II-Socio-Economic and Cultural Factors

PubMed Central

Berhan, Yifru; Berhan, Asres

2014-01-01

Background The major causes of maternal and perinatal deaths are mostly pregnancy related. However, there are several predisposing factors for the increased risk of pregnancy related complications and deaths in developing countries. The objective of this review was to grossly estimate the effect of selected socioeconomic and cultural factors on maternal mortality, stillbirths and neonatal mortality in Ethiopia. Methods A comprehensive literature review was conducted focusing on the effect of total fertility rate (TFR), modern contraceptive use, harmful traditional practice, adult literacy rate and level of income on maternal and perinatal mortalities. For the majority of the data, regression analysis and Pearson correlation coefficient were used as a proxy indicator for the association of variables with maternal, fetal and neonatal mortality. Results Although there were variations in the methods for estimation, the TFR of women in Ethiopia declined from 5.9 to 4.8 in the last fifteen years, which was in the middle as compared with that of other African countries. The preference of injectable contraceptive method has increased by 7-fold, but the unmet contraceptive need was among the highest in Africa. About 50% reduction in female genital cutting (FGC) was reported although some women's attitude was positive towards the practice of FGC. The regression analysis demonstrated increased risk of stillbirths, neonatal and maternal mortality with increased TFR. The increased adult literacy rate was associated with increased antenatal care and skilled person attended delivery. Low adult literacy was also found to have a negative association with stillbirths and neonatal and maternal mortality. A similar trend was also observed with income. Conclusion Maternal mortality ratio, stillbirth rate and neonatal mortality rate had inverse relations with income and adult education. In Ethiopia, the high total fertility rate, low utilization of contraceptive methods, low adult literacy rate, low income and prevalent harmful traditional practices have probably contributed to the high maternal mortality ratio, stillbirth and neonatal mortality rates. PMID:25489187

Country-level economic disparity and child mortality related to housing and injuries: a study in 26 European countries.

PubMed

Sengoelge, Mathilde; Elling, Berty; Laflamme, Lucie; Hasselberg, Marie

2013-10-01

Adverse living standards are associated with poorer child health and safety. This study investigates whether adverse housing and neighbourhood conditions contribute to explain country-level associations between a country's economic level and income inequality and child mortality, specifically injury mortality. Ecological, cross-sectional study. Twenty-six European countries were grouped according to two country-level economic measures from Eurostat: gross domestic product (GDP) and income inequality. Adverse country-level housing and neighbourhood conditions were assessed using data from the 2006 European Union Income Social Inclusion and Living Conditions Database (n=203 000). Child mortality incidence rates were derived for children aged 1-14 years for all causes, all injuries, road traffic injuries and unintentional injuries excluding road traffic. Linear regression analysis was applied to measure whether housing or neighbourhood conditions have a significant association with child mortality and whether a strain modified the association between GDP/income inequality and mortality. Country-level income inequality and GDP demonstrated a significant association with child mortality for all outcomes. A significant association was also found between housing strain and all child mortality outcomes, but not for neighbourhood strain. Housing strain partially modified the relationship between income inequality and GDP and all child mortality outcomes, with the exception of income inequality and road traffic injury mortality showing full mediation by housing strain. Adverse housing conditions are a likely pathway in the country-level association between income inequality and economic GDP and child injury mortality.

Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue.

PubMed

Rao, Aditi D; Kumar, Aparna; McHugh, Matthew

2017-01-01

Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006-2007. Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p < .001) and 17% lower odds of failure to rescue (p < .01). Hospitals with lower levels of nurse autonomy place their surgical patients at an increased risk for mortality and FTR. Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes. © 2016 Sigma Theta Tau International.

Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue

PubMed Central

Rao, Aditi D.; Kumar, Aparna; McHugh, Matthew

2017-01-01

Research Purpose Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. Study Design This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006–2007. Methods Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. Findings Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p < .001) and 17% lower odds of failure to rescue (p < .01). Conclusions Hospitals with lower levels of nurse autonomy place their surgical patients at an increased risk for mortality and FTR. Clinical Relevance Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes. PMID:28094907

Association between protein C levels and mortality in patients with advanced prostate, lung and pancreatic cancer.

PubMed

Wilts, I T; Hutten, B A; Meijers, J C M; Spek, C A; Büller, H R; Kamphuisen, P W

2017-06-01

Procoagulant factors promote cancer progression and metastasis. Protein C is involved in hemostasis, inflammation and signal transduction, and has a protective effect on the endothelial barrier. In mice, administration of activated protein C reduced experimental metastasis. We assessed the association between protein C and mortality in patients with three types of cancer. The study population consisted of patients with advanced prostate, non-small cell lung or pancreatic cancer, who participated in the INPACT trial (NCT00312013). The trial evaluated the addition of nadroparin to chemotherapy in patients with advanced malignancy. Patients were divided into tertiles based on protein C at baseline. The association between protein C levels and mortality was evaluated with Cox proportional hazard models. We analysed 477 patients (protein C tertiles: <97, 97-121 and ≥121%). Mean age was 65±9years; 390 (82%) were male; 191 patients (40%) had prostate cancer, 161 (34%) had lung cancer, and 125 (26%) pancreatic cancer. During a median follow-up of 10.4months, 291 patients (61%) died. Median protein C level was 107% (IQR 92-129). In the lowest tertile, 75 patients per 100 patient-years died, as compared to 60 and 54 in the middle and high tertile, respectively. Lower levels of protein C were associated with increased mortality (in tertiles: HR for trend 1.18, 95%CI 1.02-1.36, adjusted for age, sex and nadroparin use; as a continuous variable: HR 1.004, 95%CI 1.00-1.008, p=0.07). Protein C seems inversely associated with mortality in patients with advanced prostate, lung and pancreatic cancer. Further research should validate protein C as a biomarker for mortality, and explore the effects of protein C on progression of cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prevention, screening and treatment of colorectal cancer: a global and regional generalized cost effectiveness analysis

PubMed Central

2010-01-01

Background Regional generalized cost-effectiveness estimates of prevention, screening and treatment interventions for colorectal cancer are presented. Methods Standardised WHO-CHOICE methodology was used. A colorectal cancer model was employed to provide estimates of screening and treatment effectiveness. Intervention effectiveness was determined via a population state-transition model (PopMod) that simulates the evolution of a sub-regional population accounting for births, deaths and disease epidemiology. Economic costs of procedures and treatment were estimated, including programme overhead and training costs. Results In regions characterised by high income, low mortality and high existing treatment coverage, the addition of screening to the current high treatment levels is very cost-effective, although no particular intervention stands out in cost-effectiveness terms relative to the others. In regions characterised by low income, low mortality with existing treatment coverage around 50%, expanding treatment with or without screening is cost-effective or very cost-effective. Abandoning treatment in favour of screening (no treatment scenario) would not be cost effective. In regions characterised by low income, high mortality and low treatment levels, the most cost-effective intervention is expanding treatment. Conclusions From a cost-effectiveness standpoint, screening programmes should be expanded in developed regions and treatment programmes should be established for colorectal cancer in regions with low treatment coverage. PMID:20236531

Level, trends and differentials of infant and child mortality in Yemen.

PubMed

Suchindran, C M; Adlakha, A L

1985-12-01

This study investigates the levels, trends and differentials of infant and child mortality in Yemen. The data used are from the 1979 Yemen Fertility Survey, part of the World Fertility Survey. Mortality rates for 4 age intervals of life are presented: neonatal, postnatal, infant and child. For the birth cohort immediately preceding the survey (1976 1978), the level of infant mortality was estimated as 157/1000 for both sexes and 163 for males and 145 for females. For the birth cohort 1971 1975, the level of child mortality was 95/1000 for both sexes, 78 for males and 112 for females. Analysis of time trends in mortality for the years from 1961 to 1978 indicated substantial declines in neonatal, postneonatal, infant and child mortality. Neonatal mortality declined by almost 33%, and postneonatal mortality by almost 43%. During 1961-1975, child mortality declined by about 39%. A persistent pattern of mortality differentials by sex was found in the data. For all birth cohorts between 1961 and 1978, male neonatal and postneonatal mortality exceeded female neonatal mortality, but male childhood mortality was less than corresponding female mortality. This pattern suggests preferential care and treatment of male offspring. Estimates of infant and child mortality showed considerable regional differences. The eastern region experienced considerably lower risk of infant and childhood mortality than other regions. Breastfeeders aged 1-5 experienced lower mortality rates than nonbreastfeeders. Multivariate analysis with a logistic regression model show the net effect of demographic and socioeconomic factors on mortality.

Species biogeography predicts drought responses in a seasonally dry tropical forest

NASA Astrophysics Data System (ADS)

Schwartz, N.; Powers, J. S.; Vargas, G.; Xu, X.; Smith, C. M.; Brodribb, T.; Werden, L. K.; Becknell, J.; Medvigy, D.

2017-12-01

The timing, distribution, and amount of rainfall in the seasonal tropics have shifted in recent years, with consequences for seasonally dry tropical forests (SDTF). SDTF are sensitive to changing rainfall regimes and drought conditions, but sensitivity to drought varies substantially across species. One potential explanation of species differences is that species that experience dry conditions more frequently throughout their range will be better able to cope with drought than species from wetter climates, because species from drier climates will be better adapted to drought. An El-Niño induced drought in 2015 presented an opportunity to assess species-level differences in mortality in SDTF, and to ask whether the ranges of rainfall conditions species experience and the average rainfall regimes in species' ranges predict differences in mortality rates in Costa Rican SDTF. We used field plot data from northwest Costa Rica to determine species' level mortality rates. Mortality rates ranged substantially across species, with some species having no dead individuals to as high as 50% mortality. To quantify rainfall conditions across species' ranges, we used species occurrence data from the Global Biodiversity Information Facility, and rainfall data from the Chelsa climate dataset. We found that while the average and range of mean annual rainfall across species ranges did not predict drought-induced mortality in the field plots, across-range averages of the seasonality index, a measure of rainfall seasonality, was strongly correlated with species-level drought mortality (r = -0.62, p < 0.05), with species from more strongly seasonal climates experiencing less severe drought mortality. Furthermore, we found that the seasonality index was a stronger predictor of mortality than any individual functional trait we considered. This result shows that species' biogeography may be an important factor for how species will respond to future drought, and may be a more integrative predictor than individual functional traits.

Excess under-5 female mortality across India: a spatial analysis using 2011 census data.

PubMed

Guilmoto, Christophe Z; Saikia, Nandita; Tamrakar, Vandana; Bora, Jayanta Kumar

2018-06-01

Excess female mortality causes half of the missing women (estimated deficit of women in countries with suspiciously low proportion of females in their population) today. Globally, most of these avoidable deaths of women occur during childhood in China and India. We aimed to estimate excess female under-5 mortality rate (U5MR) for India's 35 states and union territories and 640 districts. Using the summary birth history method (or Brass method), we derived district-level estimates of U5MR by sex from 2011 census data. We used data from 46 countries with no evidence of gender bias for mortality to estimate the effects and intensity of excess female mortality at district level. We used a detailed spatial and statistical analysis to highlight the correlates of excess mortality at district level. Excess female U5MR was 18·5 per 1000 livebirths (95% CI 13·1-22·6) in India 2000-2005, which corresponds to an estimated 239 000 excess deaths (169 000-293 000) per year. More than 90% of districts had excess female mortality, but the four largest states in northern India (Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh) accounted for two-thirds of India's total number. Low economic development, gender inequity, and high fertility were the main predictors of excess female mortality. Spatial analysis confirmed the strong spatial clustering of postnatal discrimination against girls in India. The considerable effect of gender bias on mortality in India highlights the need for more proactive engagement with the issue of postnatal sex discrimination and a focus on the northern districts. Notably, these regions are not the same as those most affected by skewed sex ratio at birth. None. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Cognitive decline and survival in Alzheimer's disease according to education level.

PubMed

Bruandet, A; Richard, F; Bombois, S; Maurage, C A; Masse, I; Amouyel, P; Pasquier, F

2008-01-01

We tested the hypothesis that a higher education level is associated with faster cognitive decline and lower survival in a cohort of 670 Alzheimer's disease patients, followed for 3.5 years at the Lille-Bailleul memory centre. The patients were categorized in 3 groups according to educational levels: low (12 years). Cognitive function was measured with the Mini Mental State Examination (MMSE) and the Mattis Dementia Rating Scale (DRS). Survival was analyzed with a Cox model. Analyses were adjusted for age, sex, cholinesterase inhibitor treatment, diabetes, hypertension, visible vascular lesions on MRI, baseline DRS and MMSE. The adjusted mixed random model showed that MMSE declined faster for patients with high and intermediate educational levels compared with those with a low educational level (p < 0.0001). The mean annually adjusted DRS decline was highest for the groups with the most education (p = 0.05). The mortality risk was not higher in the better-educated groups (high vs. low: RR = 0.84; 95% CI = 0.35-1.99, intermediate vs. low: RR = 0.82; 95% CI = 0.41-1.63). In our cohort, highly educated patients had a faster cognitive decline than less educated patients but similar mortality rates. Our findings support the cognitive reserve hypothesis. (c) 2007 S. Karger AG, Basel.

Resistance Risk Assessment of Spodoptera frugiperda (Lepidoptera: Noctuidae) and Diatraea saccharalis (Lepidoptera: Crambidae) to Vip3Aa20 Insecticidal Protein Expressed in Corn.

PubMed

Bernardi, Oderlei; Bernardi, Daniel; Amado, Douglas; Sousa, Renan S; Fatoretto, Julio; Medeiros, Fernanda C L; Conville, Jared; Burd, Tony; Omoto, Celso

2015-12-01

Transgenic Agrisure Viptera 3 corn that expresses Cry1Ab, Vip3Aa20, and EPSPS proteins and Agrisure Viptera expressing Vip3Aa20 are used for control of Spodoptera frugiperda (J.E. Smith) and Diatraea saccharalis (F.) in Brazil. To support a resistance management program, resistance risk assessment studies were conducted to characterize the dose expression of Vip3Aa20 protein and level of control against these species. The Vip3Aa20 expression in Agrisure Viptera 3 and Agrisure Viptera decreased from V6 to V10 stage of growth. However, Vip3Aa20 expression in Agrisure Viptera 3 at V6 and V10 stages was 13- and 16-fold greater than Cry1Ab, respectively. The Vip3Aa20 expression in lyophilized tissue of Agrisure Viptera 3 and Agrisure Viptera diluted 25-fold in an artificial diet caused complete larval mortality of S. frugiperda and D. saccharalis. In contrast, lyophilized tissue of Bt11 at the same dilution does not provide complete mortality of these species. Agrisure Viptera 3 and Agrisure Viptera also caused a high level of mortality against S. frugiperda and D. saccharalis. Moreover, 100% mortality was observed for S. frugiperda larvae (neonates through fifth-instar larvae) when fed in corn with the Vip trait technology. Viptera corn achieves a high level of control against S. frugiperda and D. saccharalis providing a high dose, which is an important determination to support the refuge strategy for an effective resistance management program. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Mortality-related Factors in Patients with Malignant Obstructive Jaundice.

PubMed

Kurniawan, Juferdy; Hasan, Irsan; Gani, Rino Alvani; Simadibrata, Marcellus

2016-10-01

to obtain survival rate and mortality-related factors of malignant obstructive jaundice patients. all medical records of obstructive jaundice inpatient at Cipto Mangunkusumo Hospital, Jakarta from January 2010 to December 2013 were reviewed retrospectively. The following factors were analyzed in terms of mortality: age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid factors. total 181 out of 402 patients were enrolled in this study with male proportion was 58.6%, and patients aged 50 years or above was 57.5%. Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and Charlson comorbid score ≥4 were independent predictors of mortality. Patients with significant prognostic factors had median survival 14 days compared with overall median survival 26 days. Score ≥2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. sepsis, unsuccessful or no prior bilirary drainage, and Charlson comorbid score ≥4 are factors significantly associated with shortened survival in malignant obstructive jaundice patients. Prognostic score  ≥2 was determined to classify patients into high risk mortality group. Mortality of patients with those significant prognostic factors can be predicted in 76.9%.

Mortality Rate and Predictors in Children Under 15 Years Old Who Acquired HIV from Mother to Child Transmission in Paraguay.

PubMed

Aguilar, Gloria; Miranda, Angélica Espinosa; Rutherford, George W; Munoz, Sergio; Hills, Nancy; Samudio, Tania; Galeano, Fernando; Kawabata, Anibal; González, Carlos Miguel Rios

2018-02-17

We estimated mortality rate and predictors of death in children and adolescents who acquired HIV through mother-to-child transmission in Paraguay. In 2000-2014, we conducted a cohort study among children and adolescents aged < 15 years. We abstracted data from medical records and death certificates. We used the Cox proportional hazards model for the multivariable analysis of mortality predictors. A total of 302 subjects were included in the survey; 216 (71.5%) were younger than 5 years, 148 (51.0%) were male, and 214 (70.9%) resided in the Asunción metropolitan area. There were 52 (17.2%) deaths, resulting in an overall mortality rate of 2.06 deaths per 100 person-years. The children and adolescents with hemoglobin levels ≤ 9 g/dL at baseline had a 2-times higher hazard of death compared with those who had levels > 9 g/dL (HR 2.27, 95% CI 1.01-5.10). The mortality of HIV-infected children and adolescents in Paraguay is high, and anemia is associated with mortality. Improving prenatal screening to find cases earlier and improving pediatric follow-up are needed.

Maternal education, birth weight, and infant mortality in the United States.

PubMed

Gage, Timothy B; Fang, Fu; O'Neill, Erin; Dirienzo, Greg

2013-04-01

This research determines whether the observed decline in infant mortality with socioeconomic level, operationalized as maternal education (dichotomized as college or more, versus high school or less), is due to its "indirect" effect (operating through birth weight) and/or to its "direct" effect (independent of birth weight). The data used are the 2001 U.S. national African American, Mexican American, and European American birth cohorts by sex. The analysis explores the birth outcomes of infants undergoing normal and compromised fetal development separately by using covariate density defined mixture of logistic regressions (CDDmlr). Among normal births, mean birth weight increases significantly (by 27-108 g) with higher maternal education. Mortality declines significantly (by a factor of 0.40-0.96) through the direct effect of education. The indirect effect of education among normal births is small but significant in three cohorts. Furthermore, the indirect effect of maternal education tends to increase mortality despite improved birth weight. Among compromised births, education has small and inconsistent effects on birth weight and infant mortality. Overall, our results are consistent with the view that the decrease in infant death by socioeconomic level is not mediated by improved birth weight. Interventions targeting birth weight may not result in lower infant mortality.

Modeling historical tuberculosis epidemics among Canadian First Nations: effects of malnutrition and genetic variation

PubMed Central

Ackley, Sarah F.; Liu, Fengchen; Porco, Travis C.

2015-01-01

Late 19th century epidemics of tuberculosis (TB) in Western Canadian First Nations resulted in peak TB mortality rates more than six times the highest rates recorded in Europe. Using a mathematical modeling approach and historical TB mortality time series, we investigate potential causes of high TB mortality and rapid epidemic decline in First Nations from 1885 to 1940. We explore two potential causes of dramatic epidemic dynamics observed in this setting: first, we explore effects of famine prior to 1900 on both TB and population dynamics. Malnutrition is recognized as an individual-level risk factor for TB progression and mortality; its population-level effects on TB epidemics have not been explored previously. Second, we explore effects of heterogeneity in susceptibility to TB in two ways: modeling heterogeneity in susceptibility to infection, and heterogeneity in risk of developing disease once infected. Our results indicate that models lacking famine-related changes in TB parameters or heterogeneity result in an implausibly poor fit to both the TB mortality time series and census data; the inclusion of these features allows for the characteristic decline and rise in population observed in First Nations during this time period and confers improved fits to TB mortality data. PMID:26421237

Spatial patterns of natural hazards mortality in the United States

PubMed Central

Borden, Kevin A; Cutter, Susan L

2008-01-01

Background Studies on natural hazard mortality are most often hazard-specific (e.g. floods, earthquakes, heat), event specific (e.g. Hurricane Katrina), or lack adequate temporal or geographic coverage. This makes it difficult to assess mortality from natural hazards in any systematic way. This paper examines the spatial patterns of natural hazard mortality at the county-level for the U.S. from 1970–2004 using a combination of geographical and epidemiological methods. Results Chronic everyday hazards such as severe weather (summer and winter) and heat account for the majority of natural hazard fatalities. The regions most prone to deaths from natural hazards are the South and intermountain west, but sub-regional county-level mortality patterns show more variability. There is a distinct urban/rural component to the county patterns as well as a coastal trend. Significant clusters of high mortality are in the lower Mississippi Valley, upper Great Plains, and Mountain West, with additional areas in west Texas, and the panhandle of Florida, Significant clusters of low mortality are in the Midwest and urbanized Northeast. Conclusion There is no consistent source of hazard mortality data, yet improvements in existing databases can produce quality data that can be incorporated into spatial epidemiological studies as demonstrated in this paper. It is important to view natural hazard mortality through a geographic lens so as to better inform the public living in such hazard prone areas, but more importantly to inform local emergency practitioners who must plan for and respond to disasters in their community. PMID:19091058

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.

Making abortions safe: a matter of good public health policy and practice.

PubMed Central

Berer, M.

2000-01-01

Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally. PMID:10859852

Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes

PubMed Central

Waterman, Pamela D.; Spasojevic, Jasmina; Li, Wenhui; Maduro, Gil; Van Wye, Gretchen

2016-01-01

Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. Results. Point estimates for rate ratios were consistently greatest for the novel ICE that jointly measured extreme concentrations of income and race/ethnicity. For example, the census tract–level rate ratio for infant mortality comparing the bottom versus top quintile for an ICE contrasting low-income Black versus high-income White equaled 2.93 (95% confidence interval [CI] = 2.11, 4.09), but was 2.19 (95% CI = 1.59, 3.02) for low versus high income, 2.77 (95% CI = 2.02, 3.81) for Black versus White, and 1.56 (95% CI = 1.19, 2.04) for census tracts with greater than or equal to 30% versus less than 10% below poverty. Conclusions. The ICE may be a useful metric for public health monitoring, as it simultaneously captures extremes of privilege and deprivation and can jointly measure economic and racial/ethnic segregation. PMID:26691119

Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage.

PubMed Central

Silverstein, M; Maizlish, N; Park, R; Mirer, F

1985-01-01

The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected (95% Confidence Limits 1.36, 2.62). Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant (odds ratios greater than 10). High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy. PMID:4051064

Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study.

PubMed

Schmidt, Matthieu; Stewart, Claire; Bailey, Michael; Nieszkowska, Ania; Kelly, Joshua; Murphy, Lorna; Pilcher, David; Cooper, D James; Scheinkestel, Carlos; Pellegrino, Vincent; Forrest, Paul; Combes, Alain; Hodgson, Carol

2015-03-01

To describe mechanical ventilation settings in adult patients treated for an acute respiratory distress syndrome with extracorporeal membrane oxygenation and assess the potential impact of mechanical ventilation settings on ICU mortality. Retrospective observational study. Three international high-volume extracorporeal membrane oxygenation centers. A total of 168 patients treated with extracorporeal membrane oxygenation for severe acute respiratory distress syndrome from January 2007 to January 2013. We analyzed the association between mechanical ventilation settings (i.e. plateau pressure, tidal volume, and positive end-expiratory pressure) on ICU mortality using multivariable logistic regression model and Cox-proportional hazards model. We obtained detailed demographic, clinical, daily mechanical ventilation settings and ICU outcome data. One hundred sixty-eight patients (41 ± 14 years old; PaO2/FIO2 67 ± 19 mm Hg) fulfilled our inclusion criteria. Median duration of extracorporeal membrane oxygenation and ICU stay were 10 days (6-18 d) and 28 days (16-42 d), respectively. Lower positive end-expiratory pressure levels and significantly lower plateau pressures during extracorporeal membrane oxygenation were used in the French center than in both Australian centers (23.9 ± 1.4 vs 27.6 ± 3.7 and 27.8 ± 3.6; p < 0.0001). Overall ICU mortality was 29%. Lower positive end-expiratory pressure levels (until day 7) and lower delivered tidal volume after 3 days on extracorporeal membrane oxygenation were associated with significantly higher mortality (p < 0.05). In multivariate analysis, higher positive end-expiratory pressure levels during the first 3 days of extracorporeal membrane oxygenation support were associated with lower mortality (odds ratio, 0.75; 95% CI, 0.64-0.88; p = 0.0006). Other independent predictors of ICU mortality included time between ICU admission and extracorporeal membrane oxygenation initiation, plateau pressure greater than 30 cm H2O before extracorporeal membrane oxygenation initiation, and lactate level on day 3 of extracorporeal membrane oxygenation support. Protective mechanical ventilation strategies were routinely used in high-volume extracorporeal membrane oxygenation centers. However, higher positive end-expiratory pressure levels during the first 3 days on extracorporeal membrane oxygenation support were independently associated with improved survival. Further prospective trials on the optimal mechanical ventilation strategy during extracorporeal membrane oxygenation support are warranted.

[Association of lipid metabolism disorder with peritoneum transport ability and mortality in peritoneal dialysis patients].

PubMed

Fang, Yan-hui; Jiang, Lan-ping; Zhou, Zi-juan; Wang, Hai-yun; Xu, Hong; Li, Xue-mei; Chen, Li-meng; Li, Xue-wang

2013-06-01

To observe the features of lipid metabolism disorders of peritoneal dialysis(PD)patients and hemodialysis(HD)patients and explore the association of lipid metabolism disorder with peritoneum transport ability and mortality. The clinical data of 127 PD patients and 95 HD patients who had received regular dialysis for more than 3 months in Peking Union Medical College Hospital since March 2009 were retrospectively analyzed.Serum lipid profiles were tested.Serum hypersensitive C reactive protein(hsCRP)was examined by immune turbidimetric method.Serum carbohydrate antigen 125(CA125)and iPTH were detected by electrochemical luminescence method.Peritoneum transport ability was evaluated through peritoneal equilibration test(PET).After a 2-year follow-up,the levels of CA125 and the peritoneum transport abilities were compared between the baseline data and the end point,and the relationship between lipid disorder and the mortality was analyzed. After the 2-year follow-up,25(19.7%)PD patients died.The leading cause of death was congestive heart failure(56.0%),followed by myocardial infarction(12.0%),septic shock(12.0%),respiratory failure(8.0%),asphyxiation(8.0%),and gastrointestinal bleeding(4.0%).Compared with the survivors,the death patients were older(P=0.005),with significant lower albumin level(P=0.000)and pre-albumin level(P=0.001).However,there was no significant difference in other clinical features including body mass index(BMI),blood pressure,dialysis time,nPCR,iPTH,hemoglobin,hsCRP,and serum lipid level(all P>0.05).COX regression analysis showed that diabetes mellitus(P=0.030)and mean SBP(P=0.048)were significantly associated with the mortality of PD patients.At the baseline,the CA125 level in patients with high,high average,and low average transport status of peritoneum was(38.02±64.37),(21.21±19.41),and(17.55±23.2)U/ml,respectively(P=0.09).There was no association between the transport status and lipid(TC,TG and LDL). Congestive heart failure is the leading cause of death among PD patients.Diabetes and blood pressure are the dependent risk factors of mortality.Lipid disorder is associated with CA125,while its association with peritoneum transport ability or mortality was not found.

Brood stock segregation of spring chinook salmon Oncorhynchus tshawytscha by use of the enzyme-linked immunosorbent assay (ELISA) and the fluorescent antibody technique (FAT) affects the prevalence and levels of Renibacterium salmoninarum infection in progeny

USGS Publications Warehouse

Pascho, Ronald J.; Elliott, Diane G.; Streufert, Jonathan M.

1991-01-01

A study of the effect of maternal Renibacterium salmoninarum infection levels on the prevalence and levels of bacterial kidney disease (BKD) in progeny fish was conducted at a production salmon hatchery. A total of 302 mating pairs of spring chinook salmon Oncorhynchus tshawytscha was screened in August 1988 for R. salmoninarum by an enzyme-linked immunosorbent assay (ELISA). On the basis of ELISA testing of kidney tissues from all fish and the testing of ovarian fluid samples from a subsample of the females by a direct membrane filtration fluorescent antibody technique (MF-FAT), selected egg lots were segregated into 2 groups of 30 egg lots or about 135 000 eggs each. One group contained egg lots from male and female parents that had low R. salmoninarum infection levels or tested negative for R. salmoninarum (low-BKD group), and the other group contained egg lots from female parents with relatively high R. salmoninarum infection levels and male parents with various infection levels (high-BKD group). The progeny groups were maintained in separate rearing units supplied with untreated river water, and were monitored for R. salmoninarum by the ELISA until they were released from the hatchery in April 1990. Total mortality of the juvenile fish was higher (p = 0.0001) in the high-BKD group (20%) than in the low-BKD group (10 %). Mortality in the high-BKD group was highest after the fish were moved from nursery tanks to raceways, and clinical BKD became evident in this group. During the 11 mo of raceway rearing, mortality in the high-BKD group was 17 % compared with 5 % for the low-BKD group. An ELISA analysis of smolts just before release showed an R. salmoninarum infection rate of 85 % in the high-BKD group and 62 % in the low-BKD group. Of the positive fish, 98 % in the low-BKD group and 55 % in the high-BKD group had low infection levels, whereas 36 % in the high-BKD group and only 1 % in the low-BKD group had high infection levels. The results of this research suggest that segregation of brood stock by the ELISA and the MF-FAT can be used to reduce the prevalence and levels of BKD in hatchery-reared spring chinook salmon, even in locations with open water supplies.

Education level and mortality in systemic lupus erythematosus (SLE): evidence of underascertainment of deaths due to SLE in ethnic minorities with low education levels.

PubMed

Ward, Michael M

2004-08-15

To determine if socioeconomic status, as measured by education level, is associated with mortality due to systemic lupus erythematosus (SLE), and to determine if these associations differ among ethnic groups. Sex- and race-specific mortality rates due to SLE by education level were computed for persons age 25-64 years using US Multiple Causes of Death data from 1994 to 1997. SLE-specific mortality rates were compared with all-cause mortality rates in 1997 to determine if the association between education level and mortality in SLE was similar to that in other causes of death. Among whites, the risk of death due to SLE was significantly higher among those with lower levels of education, and the risk gradient closely paralleled the 1997 all-cause mortality risks by education level. However, in African American women and men and Asian/Pacific Islander women, the risk of death due to SLE was lower among those with lower education levels, contrary to the associations between education level and all-cause mortality in these groups. Comparing the distribution of education levels among deaths due to SLE and all deaths in 1997, persons with lower education levels were underrepresented among deaths due to SLE in African Americans and Asian/Pacific Islanders. Among whites, higher education levels are associated with lower mortality due to SLE. These associations were not present in ethnic minorities, likely due to underascertainment of deaths due to SLE in less-well educated persons. This underascertainment may be due to underreporting of SLE on death certificates, but may also represent underdiagnosis of SLE in ethnic minorities with low education levels.

Quality of colon cancer outcomes in hospitals with a high percentage of Medicaid patients.

PubMed

Rhoads, Kim F; Ackerson, Leland K; Jha, Ashish K; Dudley, R Adams

2008-08-01

There is evidence that patients with Medicaid insurance suffer worse outcomes from surgical conditions; but there is little research about whether this reflects clustering of such patients at hospitals with worse outcomes. We assess the outcomes of patients with colon and rectal cancers at hospitals with a high proportion of Medicaid patients. California Cancer Registry patient-level records were linked to discharge abstracts from California's Office of Statewide Health Planning and Development. All operative California Cancer Registry patients from 1998 and 1999 were included. Hospitals with > 40% Medicaid patients were labeled high Medicaid hospitals (HMH). We analyzed the odds of mortality at 30 days, 1, and 5 years for colon cancer and rectal cancer separately. Multilevel logistic regression models were constructed, using MLwiN 2.0, to include patient and hospital-level characteristics. Thirty-day mortality after colon operation was worse in HMH (1% versus 0.6%; p = 0.04); as was 1-year mortality (3.4% versus 2.4%; p = 0.001). There was no substantial difference in rates of 5-year mortality. Individuals who were insured by Medicaid had worse outcomes at 5 years. Adjustment for surgical volume eliminated the effect of HMH at 30 days (1% versus 0.7%; p = 0.45) but not at 1 year (3.4% versus 2.5%; p = 0.01). Adjustment for academic affiliation did not alter these results. There were an insufficient number of rectal cancer patients to detect any differences by hospital type. HMH have higher postoperative colon cancer mortality rates at 30 days and 1 year but not at 5 years. The early effect can be explained by surgical volume, but additional research is needed to determine which factors contribute to differences in intermediate outcomes after operations in HMH settings.

The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s.

PubMed

Gadeyne, S; Menvielle, G; Kulhanova, I; Bopp, M; Deboosere, P; Eikemo, T A; Hoffmann, R; Kovács, K; Leinsalu, M; Martikainen, P; Regidor, E; Rychtarikova, J; Spadea, T; Strand, B H; Trewin, C; Wojtyniak, B; Mackenbach, J P

2017-07-01

This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors. © 2017 UICC.

Hourly peak concentration measuring the PM2.5-mortality association: Results from six cities in the Pearl River Delta study

NASA Astrophysics Data System (ADS)

Lin, Hualiang; Ratnapradipa, Kendra; Wang, Xiaojie; Zhang, Yonghui; Xu, Yanjun; Yao, Zhenjiang; Dong, Guanghui; Liu, Tao; Clark, Jessica; Dick, Rebecca; Xiao, Jianpeng; Zeng, Weilin; Li, Xing; Qian, Zhengmin (Min); Ma, Wenjun

2017-07-01

Compared with daily mean concentration of air pollution, hourly peak concentration may be more directly relevant to the acute health effects due to the high concentration levels, however, few have analyzed the acute mortality effects of hourly peak levels of air pollution. We examined the associations of hourly peak concentration of fine particulate matter air pollution (PM2.5) with mortality in six cities in Pearl River Delta, China. We used generalized additive Poisson models to examine the associations with adjustment for potential confounders in each city. We further applied random-effects meta-analyses to estimate the regional overall effects. We further estimated the mortality burden attributable to hourly peak and daily mean PM2.5. We observed significant associations between hourly peak PM2.5 and mortality. Each 10 μg/m3 increase in 4-day averaged (lag03) hourly peak PM2.5 corresponded to a 0.9% [95% confidence interval (CI): 0.7%, 1.1%] increase in total mortality, 1.2% (95% CI: 1.0%, 1.5%) in cardiovascular mortality, and 0.7% (95% CI: 0.2%, 1.1%) in respiratory mortality. We observed a greater mortality burden using hourly peak PM2.5 than daily mean PM2.5, with an estimated 12915 (95% CI: 9922, 15949) premature deaths attributable to hourly peak PM2.5, and 7951 (95% CI: 5067, 10890) to daily mean PM2.5 in the Pearl River Delta (PRD) region during the study period. This study suggests that hourly peak PM2.5 might be one important risk factor of mortality in PRD region of China; the finding provides important information for future air pollution management and epidemiological studies.

Government health care spending and child mortality.

PubMed

Maruthappu, Mahiben; Ng, Ka Ying Bonnie; Williams, Callum; Atun, Rifat; Zeltner, Thomas

2015-04-01

Government health care spending (GHS) is of increasing importance to child health. Our study determined the relationship between reductions in GHS and child mortality rates in high- and low-income countries. The authors used comparative country-level data for 176 countries covering the years 1981 to 2010, obtained from the World Bank and the Institute for Health Metrics and Evaluation. Multivariate regression analysis was used to determine the association between changes in GHS and child mortality, controlling for differences in infrastructure and demographics. Data were available for 176 countries, equating to a population of ∼ 5.8 billion as of 2010. A 1% decrease in GHS was associated with a significant increase in 4 child mortality measures: neonatal (regression coefficient [R] 0.0899, P = .0001, 95% confidence interval [CI] 0.0440-0.1358), postneonatal (R = 0.1354, P = .0001, 95% CI 0.0678-0.2030), 1- to 5-year (R = 0.3501, P < .0001, 95% CI 0.2318-0.4685), and under 5-year (R = 0.5207, P < .0001, 95% CI 0.3168-0.7247) mortality rates. The effect was evident up to 5 years after the reduction in GHS (P < .0001). Compared with high-income countries, low-income countries experienced greater deteriorations of ∼ 1.31 times neonatal mortality, 2.81 times postneonatal mortality, 8.08 times 1- to 5-year child mortality, and 2.85 times under 5-year mortality. Reductions in GHS are associated with significant increases in child mortality, with the largest increases occurring in low-income countries. Copyright © 2015 by the American Academy of Pediatrics.

Changes in the Geographic Patterns of Heart Disease Mortality in the United States

PubMed Central

Casper, Michele; Kramer, Michael R.; Quick, Harrison; Schieb, Linda J.; Vaughan, Adam S.; Greer, Sophia

2016-01-01

Background Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. Methods and Results Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. Conclusions The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality. PMID:27002081

Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010.

PubMed

Casper, Michele; Kramer, Michael R; Quick, Harrison; Schieb, Linda J; Vaughan, Adam S; Greer, Sophia

2016-03-22

Although many studies have documented the dramatic declines in heart disease mortality in the United States at the national level, little attention has been given to the temporal changes in the geographic patterns of heart disease mortality. Age-adjusted and spatially smoothed county-level heart disease death rates were calculated for 2-year intervals from 1973 to 1974 to 2009 to 2010 for those aged ≥35 years. Heart disease deaths were defined according to the International Classification of Diseases codes for diseases of the heart in the eighth, ninth, and tenth revisions of the International Classification of Diseases. A fully Bayesian spatiotemporal model was used to produce precise rate estimates, even in counties with small populations. A substantial shift in the concentration of high-rate counties from the Northeast to the Deep South was observed, along with a concentration of slow-decline counties in the South and a nearly 2-fold increase in the geographic inequality among counties. The dramatic change in the geographic patterns of heart disease mortality during 40 years highlights the importance of small-area surveillance to reveal patterns that are hidden at the national level, gives communities the historical context for understanding their current burden of heart disease, and provides important clues for understanding the determinants of the geographic disparities in heart disease mortality. © 2016 American Heart Association, Inc.

The association between air pollution and mortality in Thailand

PubMed Central

Guo, Yuming; Li, Shanshan; Tawatsupa, Benjawan; Punnasiri, Kornwipa; Jaakkola, Jouni J. K.; Williams, Gail

2014-01-01

Bayesian statistical inference with a case-crossover design was used to examine the effects of air pollutants {Particulate matter <10 μm in aerodynamic diameter (PM10), sulphur dioxide (SO2), and ozone (O3)} on mortality. We found that all air pollutants had significant short-term impacts on non-accidental mortality. An increase of 10 μg/m3 in PM10, 10 ppb in O3, 1 ppb in SO2 were associated with a 0.40% (95% posterior interval (PI): 0.22, 0.59%), 0.78% (95% PI: 0.20, 1.35%) and 0.34% (95% PI: 0.17, 0.50%) increase of non-accidental mortality, respectively. O3 air pollution is significantly associated with cardiovascular mortality, while PM10 is significantly related to respiratory mortality. In general, the effects of all pollutants on all mortality types were higher in summer and winter than those in the rainy season. This study highlights the effects of exposure to air pollution on mortality risks in Thailand. Our findings support the Thailand government in aiming to reduce high levels of air pollution. PMID:24981315

The association between air pollution and mortality in Thailand.

PubMed

Guo, Yuming; Li, Shanshan; Tawatsupa, Benjawan; Punnasiri, Kornwipa; Jaakkola, Jouni J K; Williams, Gail

2014-07-01

Bayesian statistical inference with a case-crossover design was used to examine the effects of air pollutants {Particulate matter <10 μm in aerodynamic diameter (PM10), sulphur dioxide (SO₂), and ozone (O₃)} on mortality. We found that all air pollutants had significant short-term impacts on non-accidental mortality. An increase of 10 μg/m(3) in PM10, 10 ppb in O₃, 1 ppb in SO₂ were associated with a 0.40% (95% posterior interval (PI): 0.22, 0.59%), 0.78% (95% PI: 0.20, 1.35%) and 0.34% (95% PI: 0.17, 0.50%) increase of non-accidental mortality, respectively. O₃ air pollution is significantly associated with cardiovascular mortality, while PM10 is significantly related to respiratory mortality. In general, the effects of all pollutants on all mortality types were higher in summer and winter than those in the rainy season. This study highlights the effects of exposure to air pollution on mortality risks in Thailand. Our findings support the Thailand government in aiming to reduce high levels of air pollution.

Serum Chloride and Sodium Interplay in Patients With Acute Myocardial Infarction and Heart Failure With Reduced Ejection Fraction: An Analysis From the High-Risk Myocardial Infarction Database Initiative.

PubMed

Ferreira, João Pedro; Girerd, Nicolas; Duarte, Kevin; Coiro, Stefano; McMurray, John J V; Dargie, Henry J; Pitt, Bertram; Dickstein, Kenneth; Testani, Jeffrey M; Zannad, Faiez; Rossignol, Patrick

2017-02-01

Serum chloride levels were recently found to be independently associated with mortality in heart failure (HF). We investigated the relationship between serum chloride and clinical outcomes in 7195 subjects with acute myocardial infarction complicated by reduced left ventricular function and HF. The studied outcomes were all-cause mortality, cardiovascular mortality, and hospitalization for HF. Both chloride and sodium had a nonlinear association with the studied outcomes (P<0.05 for linearity). Patients in the lowest chloride tertile (chloride ≤100) were older, had more comorbidities, and had lower sodium levels (P<0.05 for all). Serum chloride showed a significant interaction with sodium with regard to all studied outcomes (P for interaction <0.05 for all). The lowest chloride tertile (≤100 mmol/L) was associated with increased mortality rates in the context of lower sodium (≤138 mmol/L; adjusted hazard ratio [95% confidence interval] for all-cause mortality=1.42 (1.14-1.77); P=0.002), whereas in the context of higher sodium levels (>141 mmol/L), the association with mortality was lost. Spline-transformed chloride and its interaction with sodium did not add significant prognostic information on top of other well-established prognostic variables (P>0.05 for all outcomes). In post-myocardial infarction with systolic dysfunction and HF, low serum chloride was associated with mortality (but not hospitalization for HF) in the setting of lower sodium. Overall, chloride and its interaction with sodium did not add clinically relevant prognostic information on top of other well-established prognostic variables. Taken together, these data support an integrated and critical consideration of chloride and sodium interplay. © 2017 American Heart Association, Inc.

Warm weather transport of broiler chickens in Manitoba. II. Truck management factors associated with death loss in transit to slaughter.

PubMed

Whiting, Terry L; Drain, Mairead E; Rasali, Drona P

2007-02-01

This observational study was conducted to identify the cause of death and load level factors associated with mortality in 1 090 733 Manitoba broiler chickens transported to slaughter in spring and early summer. Death loss in transit was 0.346% and accounted for 19% of the total carcass condemnation. The death loss pattern was clearly bimodal, with a low death loss in 180 of 198 shipments. Cumulative death loss during the growing phase of production was consistently associated with increased transport mortalities in load level models and when comparing high death loss with low death loss truckloads. High ambient temperature at the time of slaughter and loading density of the truck were the major factors associated with exceptional death loss.

Lower Education Level Is a Risk Factor for Peritonitis and Technique Failure but Not a Risk for Overall Mortality in Peritoneal Dialysis under Comprehensive Training System

PubMed Central

Kim, Hyo Jin; Lee, Joongyub; Park, Miseon; Kim, Yuri; Lee, Hajeong; Kim, Dong Ki; Joo, Kwon Wook; Kim, Yon Su; Cho, Eun Jin; Ahn, Curie

2017-01-01

Background Lower education level could be a risk factor for higher peritoneal dialysis (PD)-associated peritonitis, potentially resulting in technique failure. This study evaluated the influence of lower education level on the development of peritonitis, technique failure, and overall mortality. Methods Patients over 18 years of age who started PD at Seoul National University Hospital between 2000 and 2012 with information on the academic background were enrolled. Patients were divided into three groups: middle school or lower (academic year≤9, n = 102), high school (912, n = 324). Outcomes were analyzed using Cox proportional hazards models and competing risk regression. Results A total of 655 incident PD patients (60.9% male, age 48.4±14.1 years) were analyzed. During follow-up for 41 (interquartile range, 20–65) months, 255 patients (38.9%) experienced more than one episode of peritonitis, 138 patients (21.1%) underwent technique failure, and 78 patients (11.9%) died. After adjustment, middle school or lower education group was an independent risk factor for peritonitis (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10–2.36; P = 0.015) and technique failure (adjusted HR, 1.87; 95% CI, 1.10–3.18; P = 0.038), compared with higher than high school education group. However, lower education was not associated with increased mortality either by as-treated (adjusted HR, 1.11; 95% CI, 0.53–2.33; P = 0.788) or intent-to-treat analysis (P = 0.726). Conclusions Although lower education was a significant risk factor for peritonitis and technique failure, it was not associated with increased mortality in PD patients. Comprehensive training and multidisciplinary education may overcome the lower education level in PD. PMID:28056058

Lower Education Level Is a Risk Factor for Peritonitis and Technique Failure but Not a Risk for Overall Mortality in Peritoneal Dialysis under Comprehensive Training System.

PubMed

Kim, Hyo Jin; Lee, Joongyub; Park, Miseon; Kim, Yuri; Lee, Hajeong; Kim, Dong Ki; Joo, Kwon Wook; Kim, Yon Su; Cho, Eun Jin; Ahn, Curie; Oh, Kook-Hwan

2017-01-01

Lower education level could be a risk factor for higher peritoneal dialysis (PD)-associated peritonitis, potentially resulting in technique failure. This study evaluated the influence of lower education level on the development of peritonitis, technique failure, and overall mortality. Patients over 18 years of age who started PD at Seoul National University Hospital between 2000 and 2012 with information on the academic background were enrolled. Patients were divided into three groups: middle school or lower (academic year≤9, n = 102), high school (912, n = 324). Outcomes were analyzed using Cox proportional hazards models and competing risk regression. A total of 655 incident PD patients (60.9% male, age 48.4±14.1 years) were analyzed. During follow-up for 41 (interquartile range, 20-65) months, 255 patients (38.9%) experienced more than one episode of peritonitis, 138 patients (21.1%) underwent technique failure, and 78 patients (11.9%) died. After adjustment, middle school or lower education group was an independent risk factor for peritonitis (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10-2.36; P = 0.015) and technique failure (adjusted HR, 1.87; 95% CI, 1.10-3.18; P = 0.038), compared with higher than high school education group. However, lower education was not associated with increased mortality either by as-treated (adjusted HR, 1.11; 95% CI, 0.53-2.33; P = 0.788) or intent-to-treat analysis (P = 0.726). Although lower education was a significant risk factor for peritonitis and technique failure, it was not associated with increased mortality in PD patients. Comprehensive training and multidisciplinary education may overcome the lower education level in PD.

Predictors of poor outcome in gastrointestinal bleeding in emergency department.

PubMed

Kaya, Ender; Karaca, Mehmet Ali; Aldemir, Deniz; Ozmen, M Mahir

2016-04-28

To determine the prognostic risk factors of gastrointestinal bleeding in emergency department cases. The trial was a retrospective single-center study involving 600 patients over 18-years-old and carried out with approval by the Institutional Ethics Committee. Patient data included demographic characteristics, symptoms at admission, past medical history, vital signs, laboratory results, endoscopy and colonoscopy results, length of hospital stay, need of intensive care unit (ICU) admission, and mortality. Mortality rate was the principal endpoint of the study, while duration of hospital stay, required interventional treatment, and admission to the ICU were secondary endpoints. The mean age of patients was 61.92-years-old. Among the 600 total patients, 363 (60.5%) underwent upper gastrointestinal endoscopy and the most frequent diagnoses were duodenal ulcer (19.2%) and gastric ulcer (12.8%). One-hundred-and-fifteen (19.2%) patients required endoscopic treatment, 20 (3.3%) required surgical treatment, and 5 (0.8%) required angiographic embolization. The mean length of hospital stay was 5.21 ± 5.85 d. The mortality rate was 6.3%. The ICU admission rate was 5.3%. Patients with syncope, higher blood glucose levels, and coronary artery disease had significantly higher ICU admission rates (P = 0.029, P = 0.043, and P = 0.002, respectively). Patients with low thrombocyte levels, high creatinine, high international normalized ratio, and high serum transaminase levels had significantly longer hospital stay (P = 0.02, P = 0.001, P = 0.019, and P = 0.005, respectively). Patients who died had significantly higher serum blood urea nitrogen and creatinine levels (P = 0.016 and P = 0.038), and significantly lower mean blood pressure and oxygen saturation (P = 0.004 and P = 0.049). Malignancy and low Glasgow coma scale (GCS) were independent predictive factors of mortality. Prognostic factors for gastrointestinal bleeding in emergency room cases are malignancy, hypotension on admission, low GCS, and impaired kidney function.

[Treatment of acute colonic pseudo-obstruction (Ogilvie's Syndrome). Systematic review].

PubMed

Ben Ameur, Hazem; Boujelbene, Salah; Beyrouti, Mohamed Issam

2013-10-01

Ogilvie's syndrome is acute colonic dilatation without organic obstacle in a previously healthy colon. Surgery is the only treatment of cases complicated by necrosis or perforation. In contrast, treatment of uncomplicated forms is not unanimous, and is the subject of this literature review. Determine the results of different therapeutic methods of uncomplicated forms of Ogilvie's syndrome in terms of efficiency of removal of colonic distension, recurrence, morbidity and mortality. Clarify their respective indications. An electronic literature search in the "MEDLINE" database, supplemented by hand searching on the reference lists of articles, was conducted for the period between 1980 and 2012. Conservative treatment is effective in 53 to 96% of cases with a risk of colonic perforation less than 2.5% and a mortality of 0 to 14% % (level of evidence 4, recommendation grade C). Neostigmine is effective in 64 to 91% of cases after a first dose, with a risk of recurrence of 0 to 38%. It remains effective in 40 to 100% of cases after a second dose (evidence level 2, grade recommendation B). Endoscopic decompression is a safe and effective technique with a success rate of 61 to 100% at the first attempt , a recurrence rate of 0 to 50%, a rate of colonic perforation less than 5% and a mortality less than 5% (level evidence 4, recommendation grade C). PEG may be recommended for the prevention of recurrence of the ACPO after successful treatment with neostigmine or endoscopic decompression (evidence level 2, recommendation grade B). The cecostomy is more effective and safer than conventional colostomy (level of evidence 4, recommendation grade C). The cecostomy is highly effective in colonic decompression but associated with a high mortality (level of evidence 4, recommendation grade C). Conservative treatment is recommended in first intention. In case of failure, neostigmine should be tried. If unsuccessful, the endoscopic decompression is proposed. The cecostomy is indicated as a last resort after failure of endoscopic decompression.

Inflammation and elevated levels of fibroblast growth factor 23 are independent risk factors for death in chronic kidney disease.

PubMed

Munoz Mendoza, Jair; Isakova, Tamara; Cai, Xuan; Bayes, Liz Y; Faul, Christian; Scialla, Julia J; Lash, James P; Chen, Jing; He, Jiang; Navaneethan, Sankar; Negrea, Lavinia; Rosas, Sylvia E; Kretzler, Matthias; Nessel, Lisa; Xie, Dawei; Anderson, Amanda Hyre; Raj, Dominic S; Wolf, Myles

2017-03-01

Inflammation is a consequence of chronic kidney disease (CKD) and is associated with adverse outcomes in many clinical settings. Inflammation stimulates production of fibroblast growth factor 23 (FGF23), high levels of which are independently associated with mortality in CKD. Few large-scale prospective studies have examined inflammation and mortality in patients with CKD, and none tested the interrelationships among inflammation, FGF23, and risk of death. Therefore, we conducted a prospective investigation of 3875 participants in the Chronic Renal Insufficiency Cohort (CRIC) study with CKD stages 2 to 4 to test the associations of baseline plasma interleukin-6, high-sensitivity C-reactive protein, and FGF23 levels with all-cause mortality, censoring at the onset of end-stage renal disease. During a median follow-up of 6.9 years, 550 participants died (20.5/1000 person-years) prior to end-stage renal disease. In separate multivariable-adjusted analyses, higher levels of interleukin-6 (hazard ratio per one standard deviation increase of natural log-transformed levels) 1.35 (95% confidence interval, 1.25-1.46), C-reactive protein 1.28 (1.16-1.40), and FGF23 1.45 (1.32-1.60) were each independently associated with increased risk of death. With further adjustment for FGF23, the risks of death associated with interleukin-6 and C-reactive protein were minimally attenuated. Compared to participants in the lowest quartiles of inflammation and FGF23, the multivariable-adjusted hazard ratio of death among those in the highest quartiles of both biomarkers was 4.38 (2.65-7.23) for interleukin-6 and FGF23, and 5.54 (3.04-10.09) for C-reactive protein and FGF23. Thus, elevated levels of interleukin-6, C-reactive protein, and FGF23 are independent risk factors for mortality in CKD. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Comparison and relationship of thyroid hormones, IL-6, IL-10 and albumin as mortality predictors in case-mix critically ill patients.

PubMed

Quispe E, Álvaro; Li, Xiang-Min; Yi, Hong

2016-05-01

To compare the ability of thyroid hormones, IL-6, IL-10, and albumin to predict mortality, and to assess their relationship in case-mix acute critically ill patients. APACHE II scores and serum thyroid hormones (FT3, FT4, and TSH), IL-6, IL-10, and albumin were obtained at EICU admission for 79 cases of mix acute critically ill patients without previous history of thyroid disease. Patients were followed for 28 days with patient's death as the primary outcome. All mean values were compared, correlations assessed with Pearson' test, and mortality prediction assessed by multivariate logistic regression and ROC. Non survivors were older, with higher APACHE II score (p=0.000), IL-6 (p<0.05), IL-10 (p=0.000) levels, and lower albumin (p=0.000) levels compared to survivors at 28 days. IL-6 and IL-10 had significant negative correlation with albumin (p=0.001) and FT3 (p ⩽ 0.05) respectively, while low albumin had a direct correlation with FT3 (p<0.05). In the mortality prediction assessment, IL-10, albumin and APACHE II were independent morality predictors and showed to have a good (0.70-0.79) AUC-ROC (p<0.05). Despite that the entire cohort showed low FT3 serum levels (p=0.000), there was not statistical difference between survivors and non-survivors; neither showed any significance as mortality predictor. IL-6 and IL-10 are correlated with Low FT3 and hypoalbuminemia. Thyroid hormones assessed at EICU admission did not have any predictive value in our study. And finally, high levels of IL-6 and IL-10 in conjunction with albumin could improve our ability to evaluate disease's severity and predict mortality in the critically ill patients. When use in combination with APACHE II scores, our model showed improved mortality prediction. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Influence of admission plasma glucose level on short- and long-term prognosis in patients with ST-segment elevation myocardial infarction.

PubMed

Mladenović, Violeta; Zdravković, Vladimir; Jović, Marina; Vucić, Rada; Irić-Cupić, Violeta; Rosić, Mirko

2010-04-01

Hyperglicemia is common in patients with ST-elevation myocardial infarction (STEMI) and is associated with high risk of mortality and morbidity. Relationship between admission plasma glucose (APG) levels and mortality in diabetic and nondiabetic patients with STEMI needs further investigation. The aim of this study was to analyse the short- and long-term prognostic significance of APG levels in patients with STEMI with and without diabetes. This study included 115 patients with STEMI, 86 (74.8%) nondiabetic and 29 (25.2%) dibaetic patients, in which we performed a prospective analysis of the relationship between APG levels and short- and long-term mortality. Comparison of APG levels between nondiabetic (8.32 +/- 2.4 mmol/L) and diabetic (10.09 +/- 2.5 mmol/L) patients showed statistically significantly higher average APG levels in diabetic patients (p = 0.001). In all patients observed who died either after one month or one year after STEMI, average APG values were significantly higher in comparison with those in survived patients. There was no statistical significance in average APG levels in the diabetic patients with STEMI who died after one month and those who survived (10.09 +/- 2.68 vs 10.0 +/- 2.51 mmol/L, respectively; p = 0.657), as well as those who died after one year and those who survived (10.1 +/- 1.92 vs 10.09 +/- 2.8 mmol/L, respectively; p = 0.996). There was, however, statistical significance in average APG levels in the nondiabetic patients with STEMI who died after one month and those who survived (9.97 +/- 2.97 vs 7.91 +/- 2.08 mmol/L, respectively; p = 0.001), as well as those who died after one year and those who survived (9.17 +/- 2.49 vs 7.84 +/- 2.24 mmol/L, respectively; p = 0.013). Acute hyperglicemia in the settings of STEMI worsenes the prognosis in patients with and without diabetes. Our study showed that nondiabetic patients with high APG levels are at higher risk of mortality than patients with a known history of diabetes.

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.

PubMed

2016-10-08

Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. 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.

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

PubMed Central

2017-01-01

Summary Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1–4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980–2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age–sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95% uncertainty interval [UI] 5·7–6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7–53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3–43·6) to 2·6 million (2·6–2·7) neonatal deaths and 47·0% (35·1–57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6–3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. PMID:27733285

Does the Slow-Growth, High-Mortality Hypothesis Apply Below Ground?

PubMed

Hourston, James E; Bennett, Alison E; Johnson, Scott N; Gange, Alan C

2016-01-01

Belowground tri-trophic study systems present a challenging environment in which to study plant-herbivore-natural enemy interactions. For this reason, belowground examples are rarely available for testing general ecological theories. To redress this imbalance, we present, for the first time, data on a belowground tri-trophic system to test the slow growth, high mortality hypothesis. We investigated whether the differing performance of entomopathogenic nematodes (EPNs) in controlling the common pest black vine weevil Otiorhynchus sulcatus could be linked to differently resistant cultivars of the red raspberry Rubus idaeus. The O. sulcatus larvae recovered from R. idaeus plants showed significantly slower growth and higher mortality on the Glen Rosa cultivar, relative to the more commercially favored Glen Ample cultivar creating a convenient system for testing this hypothesis. Heterorhabditis megidis was found to be less effective at controlling O. sulcatus than Steinernema kraussei, but conformed to the hypothesis. However, S. kraussei maintained high levels of O. sulcatus mortality regardless of how larval growth was influenced by R. idaeus cultivar. We link this to direct effects that S. kraussei had on reducing O. sulcatus larval mass, indicating potential sub-lethal effects of S. kraussei, which the slow-growth, high-mortality hypothesis does not account for. Possible origins of these sub-lethal effects of EPN infection and how they may impact on a hypothesis designed and tested with aboveground predator and parasitoid systems are discussed.

Development assistance for health in central and eastern European Region.

PubMed

Suhrcke, Marc; Rechel, Bernd; Michaud, Catherine

2005-12-01

We aimed to quantify development assistance for health to countries of central and eastern Europe and the Commonwealth of Independent States (CEE-CIS). We used the International Development Statistics database of the Organisation for Economic Co-operation and Development and the database on development assistance for health compiled for the Commission on Macroeconomics and Health to quantify health development assistance to the region, compared to global and overall development assistance. We based our analysis on standard health indicators, including child mortality, life expectancy at birth and health expenditures. Although total development assistance per capita to CEE-CIS was higher than that for most other regions of the world, development assistance for health was very low compared to other countries with similar levels of child mortality, life expectancy at birth and national expenditures on health. The allocation of development assistance for health on a global scale seems to be related far more to child mortality rather than adult mortality. Countries of CEE-CIS have a high burden of adult morbidity and mortality from non-communicable diseases, which does not appear to attract proportionate development assistance. Levels of development assistance for health should be determined in consideration of the region's particular burden of disease.

The influence of hypophosphatemia on outcomes of low- and high-intensity continuous renal replacement therapy in critically ill patients with acute kidney injury

PubMed Central

Kim, Soo Young; Kim, Ye Na; Shin, Ho Sik; Jung, Yeonsoon; Rim, Hark

2017-01-01

Background The purpose of this study was to assess the role of hypophosphatemia in major clinical outcomes of patients treated with low- or high-intensity continuous renal replacement therapy (CRRT). Methods We performed a retrospective analysis of data collected from 492 patients. We divided patients into two CRRT groups based on treatment intensity (greater than or equal to or less than 40 mL/kg/hour of effluent generation) and measured serum phosphate level daily during CRRT. Results We obtained a total of 1,440 phosphate measurements on days 0, 1, and 2 and identified 39 patients (7.9%), 74 patients (15.0%), and 114 patients (23.1%) with hypophosphatemia on each of these respective days. In patients treated with low-intensity CRRT, there were 23 episodes of hypophosphatemia/1,000 patient days, compared with 83 episodes/1,000 patient days in patients who received high-intensity CRRT (P < 0.01). Multiple Cox proportional hazards analysis showed that Acute Physiology and Chronic Health Evaluation (APACHE) III score, utilization of vasoactive drugs, and arterial pH on the second day of CRRT were significant predictors of mortality, while serum phosphate level was not a significant contributor to mortality. Conclusion APACHE score, use of vasoactive drugs, and arterial pH on the second CRRT day were identified as significant predictors of mortality. Hypophosphatemia might not be a major risk factor of increased mortality in patients treated with CRRT. PMID:28904875

Novel Biomarker of Oxidative Stress Is Associated With Risk of Death in Patients With Coronary Artery Disease.

PubMed

Patel, Riyaz S; Ghasemzadeh, Nima; Eapen, Danny J; Sher, Salman; Arshad, Shawn; Ko, Yi-an; Veledar, Emir; Samady, Habib; Zafari, A Maziar; Sperling, Laurence; Vaccarino, Viola; Jones, Dean P; Quyyumi, Arshed A

2016-01-26

Free radical scavengers have failed to improve patient outcomes, promoting the concept that clinically important oxidative stress may be mediated by alternative mechanisms. We sought to examine the association of emerging aminothiol markers of nonfree radical mediated oxidative stress with clinical outcomes. Plasma levels of reduced (cysteine and glutathione) and oxidized (cystine and glutathione disulphide) aminothiols were quantified by high performance liquid chromatography in 1411 patients undergoing coronary angiography (mean age 63 years, male 66%). All patients were followed for a mean of 4.7 ± 2.1 years for the primary outcome of all-cause death (n=247). Levels of cystine (oxidized) and glutathione (reduced) were associated with risk of death (P<0.001 both) before and after adjustment for covariates. High cystine and low glutathione levels (>+1 SD and <-1 SD, respectively) were associated with higher mortality (adjusted hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.19-2.21; HR, 2.19; 95% CI, 1.50-3.19; respectively) compared with those outside these thresholds. Furthermore, the ratio of cystine/glutathione was also significantly associated with mortality (adjusted HR, 1.92; 95% CI, 1.39-2.64) and was independent of and additive to high-sensitivity C-reactive protein level. Similar associations were found for other outcomes of cardiovascular death and combined death and myocardial infarction. A high burden of oxidative stress, quantified by the plasma aminothiols, cystine, glutathione, and their ratio, is associated with mortality in patients with coronary artery disease, a finding that is independent of and additive to the inflammatory burden. Importantly, these data support the emerging role of nonfree radical biology in driving clinically important oxidative stress. © 2015 The Authors.

N-terminal pro-brain natriuretic peptide and high-sensitivity troponin T exhibit additive prognostic value for the outcome of critically ill patients.

PubMed

Lenz, Max; Krychtiuk, Konstantin A; Goliasch, Georg; Distelmaier, Klaus; Wojta, Johann; Heinz, Gottfried; Speidl, Walter S

2018-04-01

Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter. Of the included 148 patients, 52% were male, mean age was of 64.2 ± 16.8 years and 30-day mortality was 33.2%. Non-survivors showed significantly higher NT-proBNP and TnT plasma levels as compared with survivors ( p<0.01). An elevation of both markers exhibited an additive effect on mortality, as those with both NT-proBNP and TnT levels above the median had a 30-day mortality rate of 51.0%, while those with both markers below the median had a 16.7% mortality rate (hazard ratio 3.7). These findings were independent of demographic and clinical parameters ( p<0.05). Our findings regarding the individual predictive properties of NT-proBNP and TnT are in line with literature. However, we were able to highlight that they exhibit additive prognostic potential which exceeds their individual value. This might be attributed to a difference in underlying pathomechanisms and an assessment of synergistic risk factors.

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries.

PubMed

Kahan, Brennan C; Koulenti, Desponia; Arvaniti, Kostoula; Beavis, Vanessa; Campbell, Douglas; Chan, Matthew; Moreno, Rui; Pearse, Rupert M

2017-07-01

As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. We did not identify any survival benefit from critical care admission following surgery.

Does respiratory health contribute to the effects of long-term air pollution exposure on cardiovascular mortality?

PubMed

Schikowski, Tamara; Sugiri, Dorothea; Ranft, Ulrich; Gehring, Ulrike; Heinrich, Joachim; Wichmann, H-Erich; Krämer, Ursula

2007-03-07

There is growing epidemiological evidence that short-term and long-term exposure to high levels of air pollution may increase cardiovascular morbidity and mortality. In addition, epidemiological studies have shown an association between air pollution exposure and respiratory health. To what extent the association between cardiovascular mortality and air pollution is driven by the impact of air pollution on respiratory health is unknown. The aim of this study was to investigate whether respiratory health at baseline contributes to the effects of long-term exposure to high levels of air pollution on cardiovascular mortality in a cohort of elderly women. We analyzed data from 4750 women, aged 55 at the baseline investigation in the years 1985-1994. 2593 of these women had their lung function tested by spirometry. Respiratory diseases and symptoms were asked by questionnaire. Ambient air pollution exposure was assessed by the concentrations of NO2 and total suspended particles at fixed monitoring sites and by the distance of residency to a major road. A mortality follow-up of these women was conducted between 2001 and 2003. For the statistical analysis, Cox' regression was used. Women with impaired lung function or pre-existing respiratory diseases had a higher risk of dying from cardiovascular causes. The impact of impaired lung function declined over time. The risk ratio (RR) of women with forced expiratory volume in one second (FEV1) of less than 80% predicted to die from cardiovascular causes was RR = 3.79 (95%CI: 1.64-8.74) at 5 years survival time and RR = 1.35 (95%CI: 0.66-2.77) at 12 years. The association between air pollution levels and cardiovascular death rate was strong and statistically significant. However, this association did only change marginally when including indicators of respiratory health into the regression analysis. Furthermore, no interaction between air pollution and respiratory health on cardiovascular mortality indicating a higher risk of those with impaired respiratory health could be detected. Respiratory health is a predictor for cardiovascular mortality. In women followed about 15 years after the baseline investigation at age 55 years long-term air pollution exposure and impaired respiratory health were independently associated with increased cardiovascular mortality.

The influence of sex, race/ethnicity, and educational attainment on human immunodeficiency virus death rates among adults, 1993-2007.

PubMed

Simard, Edgar P; Fransua, Mesfin; Naishadham, Deepa; Jemal, Ahmedin

2012-11-12

Overall declines in human immunodeficiency virus (HIV) mortality may mask patterns for subgroups, and prior studies of disparities in mortality have used area-level vs individual-level socioeconomic status measures. The aim of this study was to examine temporal trends in HIV mortality by sex, race/ethnicity, and individual level of education (as a proxy for socioeconomic status). We examined HIV deaths among non-Hispanic white, non-Hispanic black, and Hispanic men and women aged 25 to 64 years in 26 states (1993-2007; N=91 307) reported to the National Vital Statistics System. The main outcome measures were age-standardized HIV death rates, rate differences, and rate ratios by educational attainment and between the least- and the most-educated (≤12 vs ≥16 years) individuals. Between 1993-1995 and 2005-2007, mortality declined for most men and women by race/ethnicity and educational levels, with the greatest absolute decreases for nonwhites owing to their higher baseline rates. Among men with the most education, rates per 100 000 population decreased from 117.89 (95% CI, 101.08-134.70) to 15.35 (12.08-18.62) in blacks vs from 26.42 (24.93-27.92) to 1.79 (1.50-2.08) in whites. Rates were unchanged for the least-educated black women (26.76; 95% CI, 24.30-29.23; during 2005-2007) and remained high for similarly educated black men (52.71; 48.96-56.45). Relative declines were greater with increasing levels of education (P < .001), resulting in widening disparities. Among men, the disparity rate ratio (comparing the least and the most educated) increased from 1.04 (95% CI, 0.89-1.21) during 1993-1995 to 3.43 (2.74-4.30) during 2005-2007 for blacks and from 0.98 (0.91-1.05) to 2.82 (2.34-3.40) for whites. Although absolute declines in HIV mortality were greatest for nonwhites, rates remain high among blacks, especially in the lowest educated groups, underscoring the need for additional interventions.

Terror Management in a Multicultural Society: Effects of Mortality Salience on Attitudes to Multiculturalism Are Moderated by National Identification and Self-Esteem Among Native Dutch People

PubMed Central

Tjew-A-Sin, Mandy; Koole, Sander Leon

2018-01-01

Terror Management Theory (TMT; Greenberg et al., 1997) proposes that mortality concerns may lead people to reject other cultures than their own. Although highly relevant to multiculturalism, TMT has been rarely tested in a European multicultural society. To fill this void, two studies examined the effects of mortality salience (MS) among native Dutch people with varying levels of national identification and self-esteem. Consistent with TMT, MS led to less favorable attitudes about Muslims and multiculturalism among participants with high (rather than low) national identification and low (rather than high) self-esteem (Study 1). Likewise, MS led participants with high national identification and low self-esteem to increase their support of Sinterklaas, a traditional Dutch festivity with purported racist elements (Study 2). Together, these findings indicate that existential concerns may fuel resistance against multiculturalism, especially among people with low self-esteem who strongly identify with their nationality. PMID:29867681

Terror Management in a Multicultural Society: Effects of Mortality Salience on Attitudes to Multiculturalism Are Moderated by National Identification and Self-Esteem Among Native Dutch People.

PubMed

Tjew-A-Sin, Mandy; Koole, Sander Leon

2018-01-01

Terror Management Theory (TMT; Greenberg et al., 1997) proposes that mortality concerns may lead people to reject other cultures than their own. Although highly relevant to multiculturalism, TMT has been rarely tested in a European multicultural society. To fill this void, two studies examined the effects of mortality salience (MS) among native Dutch people with varying levels of national identification and self-esteem. Consistent with TMT, MS led to less favorable attitudes about Muslims and multiculturalism among participants with high (rather than low) national identification and low (rather than high) self-esteem (Study 1). Likewise, MS led participants with high national identification and low self-esteem to increase their support of Sinterklaas, a traditional Dutch festivity with purported racist elements (Study 2). Together, these findings indicate that existential concerns may fuel resistance against multiculturalism, especially among people with low self-esteem who strongly identify with their nationality.