The Rural Inpatient Mortality Study: Does Urban-Rural County Classification Predict Hospital Mortality in California?

PubMed

Linnen, Daniel T; Kornak, John; Stephens, Caroline

2018-03-28

Evidence suggests an association between rurality and decreased life expectancy. To determine whether rural hospitals have higher hospital mortality, given that very sick patients may be transferred to regional hospitals. In this ecologic study, we combined Medicare hospital mortality ratings (N = 1267) with US census data, critical access hospital classification, and National Center for Health Statistics urban-rural county classifications. Ratings included mortality for coronary artery bypass grafting, stroke, chronic obstructive pulmonary disease, heart attack, heart failure, and pneumonia across 277 California hospitals between July 2011 and June 2014. We used generalized estimating equations to evaluate the association of urban-rural county classifications on mortality ratings. Unfavorable Medicare hospital mortality rating "worse than the national rate" compared with "better" or "same." Compared with large central "metro" (metropolitan) counties, hospitals in medium-sized metro counties had 6.4 times the odds of rating "worse than the national rate" for hospital mortality (95% confidence interval = 2.8-14.8, p < 0.001). For hospitals in small metro counties, the odds of having such a rating were 3.7 times greater (95% confidence interval = 0.7-23.4, p = 0.12), although not statistically significant. Few ratings were provided for rural counties, and analysis of rural counties was underpowered. Hospitals in medium-sized metro counties are associated with unfavorable Medicare mortality ratings, but current methods to assign mortality ratings may hinder fair comparisons. Patient transfers from rural locations to regional medical centers may contribute to these results, a potential factor that future research should examine.

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

PubMed

de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

2013-08-01

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs.

PubMed

Mackenzie, George; Barnhart, Mathew; Kennedy, Shawn; DeHoff, William; Schertel, Eric

2010-01-01

Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs that has been associated with high mortality rates in previous studies. Factors were evaluated in this study for their influence on overall and postoperative mortality in 306 confirmed cases of GDV between 2000 and 2004. The overall mortality rate was 10%, and the postoperative mortality rate was 6.1%. The factor that was associated with a significant increase in overall mortality was the presence of preoperative cardiac arrhythmias. Factors that were associated with a significant increase in postoperative mortality were postoperative cardiac arrhythmias, splenectomy, or splenectomy with partial gastric resection. The factor that was associated with a significant decrease in the overall mortality rate was time from presentation to surgery. This study documents that certain factors continue to affect the overall and postoperative mortality rates associated with GDV, but these mortality rates have decreased compared to previously reported rates.

Inequalities in health: living conditions and infant mortality in Northeastern Brazil

PubMed Central

Carvalho, Renata Alves da Silva; Santos, Victor Santana; de Melo, Cláudia Moura; Gurgel, Ricardo Queiroz; Oliveira, Cristiane Costa da Cunha

2015-01-01

OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting. METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test. RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions. CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue. PMID:25741650

Anesthesia-related mortality in pediatric patients: a systematic review.

PubMed

Gonzalez, Leopoldo Palheta; Pignaton, Wangles; Kusano, Priscila Sayuri; Módolo, Norma Sueli Pinheiro; Braz, José Reinaldo Cerqueira; Braz, Leandro Gobbo

2012-01-01

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

Racial disparities in stage-specific colorectal cancer mortality rates from 1985 to 2008.

PubMed

Robbins, Anthony S; Siegel, Rebecca L; Jemal, Ahmedin

2012-02-01

Since the early 1980s, colorectal cancer (CRC) mortality rates for whites and blacks in the United States have been diverging as a result of earlier and larger reductions in death rates for whites. We examined whether this mortality pattern varies by stage at diagnosis. The Incidence-Based Mortality database of the Surveillance, Epidemiology, and End Results (SEER) Program was used to examine data from the nine original SEER regions. Our main outcome measures were changes in stage-specific mortality rates by race. From 1985 to 1987 to 2006 to 2008, CRC mortality rates decreased for each stage in both blacks and whites, but for every stage, the decreases were smaller for blacks, particularly for distant-stage disease. For localized stage, mortality rates decreased 30.3% in whites compared with 13.2% in blacks; for regional stage, declines were 48.5% in whites compared with 34.0% in blacks; and for distant stage, declines were 32.6% in whites compared with 4.6% in blacks. As a result, the black-white rate ratios increased from 1.17 (95% CI, 0.98 to 1.39) to 1.41 (95% CI, 1.21 to 1.63) for localized disease, from 1.03 (95% CI, 0.93 to 1.14) to 1.30 (95% CI, 1.17 to 1.44) for regional disease, and from 1.21 (95% CI, 1.10 to 1.34) to 1.72 (95% CI, 1.58 to 1.86) for distant-stage disease. In absolute terms, the disparity in distant-stage mortality rates accounted for approximately 60% of the overall black-white mortality disparity. The black-white disparities in CRC mortality increased for each stage of the disease, but the overall disparity in overall mortality was largely driven by trends for late-stage disease. Concerted efforts to prevent or detect CRC at earlier stages in blacks could improve the worsening black- white disparities.

Comparative study on mortality due to cardiovascular diseases in São Caetano do Sul, São Paulo, Brazil, between 1980 and 2010.

PubMed

Luz, Fernanda Eugenio da; Santos, Brigitte Rieckmann Martins Dos; Sabino, Wilson

2017-01-01

Analysis of the mortality due to cardiovascular diseases (CVD) can provide subsidies for preventive and control measures. The goal of this article is to compare CVD mortality rates in São Caetano do Sul, the state of São Paulo and the country as a whole. Standardized mortality and mortality due to CVD were calculated for the 1980-2010 period. We found a significant reduction in cardiovascular mortality in all three study units during this period, with the largest reduction in CVD in São Caetano do Sul. The largest mortality rate was found in the state of São Paulo. In adults 30 to 59, the CVD mortality rate in São Caetano do Sul was three times as high in men as in women, yet among adults 60 and older, CVD mortality was higher in women than in men. The lower rate is the result of implementing different healthcare policies. However, specific interventions are required that focus on changes in lifestyle, especially among adult men and the elderly.

Self-rated function, self-rated health, and postmortem evidence of brain infarcts: findings from the Nun Study.

PubMed

Greiner, P A; Snowdon, D A; Greiner, L H

1999-07-01

Self-rated function is a new global measure. Previous findings suggest that self-rated function predicts future functional decline and is strongly associated with all-cause mortality. We hypothesized that the strength of the relationship of self-rated function to all-cause mortality was in part due to functional decline, such as would occur with brain infarcts. Self-ratings of function and health (on a 5-point scale, ranging from excellent to poor) were assessed annually on 630 participants in the Nun Study. Mortality surveillance extended from October 31, 1991 to March 1, 1998, and, among those who died, neuropathological examination determined postmortem evidence of brain infarcts. Cox regression modeling with self-rated function and health as time-dependent covariates and stratification by assessment period were used in these analyses. Self-rated function and health ratings of good, fair, and poor were significantly associated with doubling of the risk of mortality, compared with ratings of very good and excellent. Self-rated function ratings of fair or poor were associated with a threefold increase in the risk of mortality with brain infarcts, but self-rated function and health ratings of fair and poor were comparable in their association with all-cause mortality and mortality without brain infarcts. Self-rated function was significantly associated with mortality with brain infarcts, suggesting that brain infarcts may be experienced as functional loss but not recognized or labeled as disease. Our results suggest that self-rated function and health should be explored simultaneously in future research.

The relationship between social stratification and all-cause mortality among children in the United States: 1968-1992.

PubMed

DiLiberti, J H

2000-01-01

US childhood poverty rates have increased for most of the past 2 decades. Although overall mortality among children has apparently fallen during this interval, these aggregate mortality rates may hide a disproportionate burden imposed on the least advantaged. This study assessed the impact of social stratification on long-term US childhood mortality rates and examined the temporal relationship between mortality attributable to social stratification and childhood poverty rates. Using US childhood mortality data obtained from the Compressed Mortality File (National Center for Health Statistics) and a county-level measure of social stratification (residential telephone availability), I evaluated the impact of social stratification on long-term trends (1968-1992) in age-adjusted mortality and compared the resulting attributable proportions to trends in childhood poverty rates. Between 1968 and 1987 the proportion of US childhood deaths attributable to social stratification decreased from.22 to.17. Subsequently, it increased to.24 in 1992, despite continuous declines in overall childhood mortality rates. These proportions correlated strongly with earlier childhood poverty rates, taking into account an apparent 9-year lag. Among black children comparable trends were not observed, although throughout this time period their mortality rates were far higher than among the rest of the population and declined more slowly. Despite declining childhood mortality rates between 1968 and 1992, children living in the least advantaged counties continued to die at higher rates than those living in the most advantaged counties. This differential worsened considerably after 1987, and by 1992 had a substantive impact on US life expectancy at birth, resulting in perhaps the most significant (in terms of years of life lost) reversal in the health of the US public in the 20th century.

Parliamentary privilege--mortality in members of the Houses of Parliament compared with the UK general population: retrospective cohort analysis, 1945-2011.

PubMed

Dennis, John; Crayford, Tim

2015-12-14

To examine mortality in members of the two UK Houses of Parliament compared with the general population, 1945-2011. Retrospective cohort analysis of death rates and predictors of mortality in Members of Parliament (MPs) and members of the House of Lords (Lords). UK. 4950 MPs and Lords first joining the UK parliament in 1945-2011. Standardised mortality ratios, comparing all cause death rates of MPs and Lords from first election or appointment with those in the age, sex, and calendar year matched general population. Between 1945 and 2011, mortality was lower in MPs (standardised mortality ratio 0.72, 95% confidence interval 0.67 to 0.76) and Lords (0.63, 0.60 to 0.67) than in the general population. Over the same period, death rates among MPs also improved more quickly than in the general population. For every 100 expected deaths, 22 fewer deaths occurred among MPs first elected in 1990-99 compared with MPs first elected in 1945-49. Labour party MPs had 19% higher death rates compared with the general population than did Conservative MPs (relative mortality ratio 1.19, 95% confidence interval 1.01 to 1.40). The effect of political party on mortality disappeared when controlling for education level. From 1945 to 2011, MPs and Lords experienced lower mortality than the UK general population, and, at least until 1999, the mortality gap between newly elected MPs and the general population widened. Even among MPs, educational background was an important predictor of mortality, and education possibly explains much of the mortality difference between Labour and Conservative MPs. Social inequalities are alive and well in UK parliamentarians, and at least in terms of mortality, MPs are likely to have never had it so good. 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.

Assessment of the perioperative period in civilians injured in the Syrian Civil War.

PubMed

Hakimoglu, Sedat; Karcıoglu, Murat; Tuzcu, Kasım; Davarcı, Isıl; Koyuncu, Onur; Dikey, İsmail; Turhanoglu, Selim; Sarı, Ali; Acıpayam, Mehmet; Karatepe, Celalettin

2015-01-01

wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. the study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. the mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Assessment of the perioperative period in civilians injured in the Syrian Civil War].

PubMed

Hakimoglu, Sedat; Karcıoglu, Murat; Tuzcu, Kasım; Davarcı, Isıl; Koyuncu, Onur; Dikey, İsmail; Turhanoglu, Selim; Sarı, Ali; Acıpayam, Mehmet; Karatepe, Celalettin

2015-01-01

Wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. The study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. The mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. Among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Transnational Mortality Comparisons Between Archipelago and Mainland Puerto Ricans.

PubMed

Colón-Ramos, Uriyoán; Rodríguez-Ayuso, Idania; Gebrekristos, Hirut T; Roess, Amira; Pérez, Cynthia M; Simonsen, Lone

2017-10-01

Puerto Ricans in the US experience higher deaths from diabetes and other causes compared to non-Hispanic Whites and other Hispanic groups. We compared mortality in Puerto Rico to that of Puerto Ricans in the US as a first step to investigate if similar or worse mortality patterns originate from the sending country (Puerto Rico). Age-adjusted death rates were generated using national vital statistics databases in the US and territories for all-cause and the top ten causes of death among Hispanics in 2009. Mortality ratios in the archipelago of Puerto Rico (APR) were compared to mainland US Puerto Ricans (MPR). Rates for other ethnic/racial groups (Mexican Americans, Cubans, and non-Hispanic Whites, Blacks, American Indians, and Asians) were calculated to provide a context. APR had significantly higher all-cause mortality and death rates for diabetes, nephritis, pneumonia/influenza, and homicide/assault compared to MPR (APR/MPR ratio for all-cause: 1.08, diabetes: 2.04, nephritis: 1.84, pneumonia/influenza: 1.33, homicide/assault: 3.15). Death rates for diabetes and homicide/assault (particularly among men) were higher among APR compared to any other racial/ethnic groups in the US. In contrast, deaths from heart disease, cancer, and chronic liver disease were significantly lower for APR compared to MPR (MPR/APR ratio 0.72, 0.91, 0.41, respectively). Among APR women, death rates for these causes were also lower compared to any other group in the US. Substantial mortality variability exists between Puerto Ricans in Puerto Rico and those in the US, re-emphasizing the need to study of how socio-environmental determinants of health differ in sending and receiving countries. Explanations for disparate rates include access to and availability of healthcare and unique factors related to the migration experience of this group.

Disparities in Cancer Mortality and Incidence Among American Indians and Alaska Natives in the United States

PubMed Central

Espey, David K.; Swan, Judith; Wiggins, Charles L.; Eheman, Christie; Kaur, Judith S.

2014-01-01

Objectives. We used improved data on American Indian and Alaska Native (AI/AN) ancestry to provide an updated and comprehensive description of cancer mortality and incidence among AI/AN populations from 1990 to 2009. Methods. We linked the National Death Index and central cancer registry records independently to the Indian Health Service (IHS) patient registration database to improve identification of AI/AN persons in cancer mortality and incidence data, respectively. Analyses were restricted to non-Hispanic persons residing in Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted mortality and incidence rates for AI/AN populations with White populations using rate ratios and mortality-to-incidence ratios. Trends were described using joinpoint analysis. Results. Cancer mortality and incidence rates for AI/AN persons compared with Whites varied by region and type of cancer. Trends in death rates showed that greater progress in cancer control was achieved for White populations compared with AI/AN populations over the last 2 decades. Conclusions. Spatial variations in mortality and incidence by type of cancer demonstrated both persistent and emerging challenges for cancer control in AI/AN populations. PMID:24754660

Surgical Mortality Audit-lessons Learned in a Developing Nation.

PubMed

Bindroo, Sandiya; Saraf, Rakesh

2015-06-01

Surgical audit is a systematic, critical analysis of the quality of surgical care that is reviewed by peers against explicit criteria or recognized standards. It is used to improve surgical practice with the ultimate goal of improving patient care. As the pattern of surgical care is different in the developing world, we analyzed mortalities in a referral medical institute of India to suggest interventions for improvement. An analysis of total admissions, different surgeries, and mortalities over 1 year in an urban referral medical institute of northern India was performed, followed by "peer review" of the mortalities. Mortality rates as outcomes and classification was done to provide comparative results. Of 10,005 surgical patients, 337 (male = 221, female = 116) deaths were reported over 1 year. The overall mortality rate was 3.36%, while mortality in operative cases was 1.76%. Total deaths were classified into (1) Viable: 153 (45%), (2) Nonviable: 174 (52%), and (3) Indeterminate: 10 (3%). Exclusion of the nonviable group reduced the mortality rate from 3.36% to 1.62%. Trauma was the major cause of mortality (n = 235; 70%) as compared to other surgical patients (n = 102; 30%). Increased mortality was also associated with emergency procedures (3.66%) as compared to elective surgeries (0.34%). In conclusion, audit of mortality and morbidity helps in initiating and implementing preventive strategies to improve surgical practice and patient care, and to reduce mortality rates. The mortality and morbidity forum is an important educational activity. It should be considered a mandatory activity in all postgraduate training programs.

All-cause and cause-specific mortality among US youth: socioeconomic and rural-urban disparities and international patterns.

PubMed

Singh, Gopal K; Azuine, Romuladus E; Siahpush, Mohammad; Kogan, Michael D

2013-06-01

We analyzed international patterns and socioeconomic and rural-urban disparities in all-cause mortality and mortality from homicide, suicide, unintentional injuries, and HIV/AIDS among US youth aged 15-24 years. A county-level socioeconomic deprivation index and rural-urban continuum measure were linked to the 1999-2007 US mortality data. Mortality rates were calculated for each socioeconomic and rural-urban group. Poisson regression was used to derive adjusted relative risks of youth mortality by deprivation level and rural-urban residence. The USA has the highest youth homicide rate and 6th highest overall youth mortality rate in the industrialized world. Substantial socioeconomic and rural-urban gradients in youth mortality were observed within the USA. Compared to their most affluent counterparts, youth in the most deprived group had 1.9 times higher all-cause mortality, 8.0 times higher homicide mortality, 1.5 times higher unintentional-injury mortality, and 8.8 times higher HIV/AIDS mortality. Youth in rural areas had significantly higher mortality rates than their urban counterparts regardless of deprivation levels, with suicide and unintentional-injury mortality risks being 1.8 and 2.3 times larger in rural than in urban areas. However, youth in the most urbanized areas had at least 5.6 times higher risks of homicide and HIV/AIDS mortality than their rural counterparts. Disparities in mortality differed by race and sex. Socioeconomic deprivation and rural-urban continuum were independently related to disparities in youth mortality among all sex and racial/ethnic groups, although the impact of deprivation was considerably greater. The USA ranks poorly in all-cause mortality, youth homicide, and unintentional-injury mortality rates when compared with other industrialized countries.

White Infant Mortality in Appalachian States, 1976-1980 and 1996-2000: Changing Patterns and Persistent Disparities

ERIC Educational Resources Information Center

Yao, Nengliang; Matthews, Stephen A.; Hillemeier, Marianne M.

2012-01-01

Purpose: Appalachian counties have historically had elevated infant mortality rates. Changes in infant mortality disparities over time in Appalachia are not well-understood. This study explores spatial inequalities in white infant mortality rates over time in the 13 Appalachian states, comparing counties in Appalachia with non-Appalachian…

Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality.

PubMed

Pezzi, Christopher M; Mallin, Katherine; Mendez, Andres Samayoa; Greer Gay, Emmelle; Putnam, Joe B

2014-11-01

To evaluate 30-day and 90-day mortality after major pulmonary resection for lung cancer including the relationship to hospital volume. Major lung resections from 2007 to 2011 were identified in the National Cancer Data Base. Mortality was compared according to annual volume and demographic and clinical covariates using univariate and multivariable analyses, and included information on comorbidity. Statistical significance (P<.05) and 95% confidence intervals were assessed. There were 124,418 major pulmonary resections identified in 1233 facilities. The 30-day mortality rate was 2.8%. The 90-day mortality rate was 5.4%. Hospital volume was significantly associated with 30-day mortality, with a mortality rate of 3.7% for volumes less than 10, and 1.7% for volumes of 90 or more. Other variables significantly associated with 30-day mortality include older age, male sex, higher stage, pneumonectomy, a previous primary cancer, and multiple comorbidities. Similar results were found for 90-day mortality rates. In the multivariate analysis, hospital volume remained significant with adjusted odds ratios of 2.1 (95% confidence interval [CI], 1.7-2.6) for 30-day mortality and 1.3 (95% CI, 1.1-1.6) for conditional 90-day mortality for the hospitals with the lowest volume (<10) compared with those with the highest volume (>90). Hospitals with a volume less than 30 had an adjusted odds ratio for 30-day mortality of 1.3 (95% CI, 1.2-1.5) compared with those with a volume greater than 30. Mortality at 30 and 90 days and hospital volume should be monitored by institutions performing major pulmonary resection and benchmarked against hospitals performing at least 30 resections per year. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Cross-National Systematic Review of Neonatal Mortality and Postnatal Newborn Care: Special Focus on Pakistan.

PubMed

Ahmed, Mansoor; Won, Youngjoon

2017-11-23

The latest nationwide survey of Pakistan showed that considerable progress has been made toward reducing all child mortality indicators except neonatal mortality. The aim of this study is to compare Pakistan's under-five mortality, neonatal mortality, and postnatal newborn care rates with those of other countries. Neonatal mortality rates and postnatal newborn care rates from the Demographic and Health Surveys (DHSs) of nine low- and middle-income countries (LMIC) from Asia and Africa were analyzed. Pakistan's maternal, newborn, and child health (MNCH) policies and programs, which have been implemented in the country since 1990, were also analyzed. The results highlighted that postnatal newborn care in Pakistan was higher compared with the rest of countries, yet its neonatal mortality remained the worst. In Zimbabwe, both mortality rates have been increasing, whereas the neonatal mortality rates in Nepal and Afghanistan remained unchanged. An analysis of Pakistan's MNCH programs showed that there is no nationwide policy on neonatal health. There were only a few programs concerning the health of newborns, and those were limited in scale. Pakistan's example shows that increased coverage of neonatal care without ensuring quality is unlikely to improve neonatal survival rates. It is suggested that Pakistan needs a comprehensive policy on neonatal health similar to other countries, and its effective programs need to be scaled up, in order to obtain better neonatal health outcomes.

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

Cancer mortality in central Serbia.

PubMed

Markovic-Denic, Ljiljana; Cirkovic, Andia; Zivkovic, Snezana; Stanic, Danica; Skodric-Trifunovic, Vesna

2014-01-01

Cancer is the one of the leading cause of death worldwide. The aim of this study was to examine cancer mortality trends in the population of central Serbia in the period from 2002 to 2011. The descriptive epidemiological method was used. The mortality from all malignant tumors (code C00-C96 of the International Disease Classification) was registered. The source of mortality data was the published material of the Cancer Registry of Serbia. The source of population data was the census of 2002 and 2011 and the estimates for inter-census years. Non-standardized, age-adjusted and age-specific mortality rates were calculated. Age adjustment of mortality rates was performed by the direct method of standardization. Trend lines were estimated using linear regression. During 2002-2011, cancer caused about 20% of all deaths each year in central Serbia. More men (56.9%) than women (43.1%) died of cancer. The average mortality rate for men was 1.3 times higher compared to women. A significant trend of increase of the age-adjusted mortality rates was recorded both for males (p<0.001) and for females (p=0.02). Except gastric cancer, the age-adjusted mortality rates in men were significantly increased for lung cancer (p=0.02), colorectal cancer (p<0.05), prostate cancer (p=0.01) and pancreatic cancer (p=0.01). Age-adjusted mortality rates for breast cancer in females were remarkably increased (p=0.01), especially after 2007. In central Serbia during the period from 2002 to 2011, there was an increasing trend in mortality rates due to cancers in both sexes. Cancer mortality in males was 1.3-fold higher compared to females.

Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011.

PubMed

Hastings, Katherine G; Eggleston, Karen; Boothroyd, Derek; Kapphahn, Kristopher I; Cullen, Mark R; Barry, Michele; Palaniappan, Latha P

2016-10-28

With immigration and minority populations rapidly growing in the USA, it is critical to assess how these populations fare after immigration, and in subsequent generations. Our aim is to compare death rates and cause of death across foreign-born, US-born and country of origin Chinese and Japanese populations. We analysed all-cause and cause-specific age-standardised mortality rates and trends using 2003-2011 US death record data for Chinese and Japanese decedents aged 25 or older by nativity status and sex, and used the WHO Mortality Database for Hong Kong and Japan decedents in the same years. Characteristics such as age at death, absolute number of deaths by cause and educational attainment were also reported. We examined a total of 10 458 849 deaths. All-cause mortality was highest in Hong Kong and Japan, intermediate for foreign-born, and lowest for US-born decedents. Improved mortality outcomes and higher educational attainment among foreign-born were observed compared with developed Asia counterparts. Lower rates in US-born decedents were due to decreased cancer and communicable disease mortality rates in the US heart disease mortality was either similar or slightly higher among Chinese-Americans and Japanese-Americans compared with those in developed Asia counterparts. Mortality advantages in the USA were largely due to improvements in cancer and communicable disease mortality outcomes. Mortality advantages and higher educational attainments for foreign-born populations compared with developed Asia counterparts may suggest selective migration. Findings add to our limited understanding of the racial and environmental contributions to immigrant health disparities. 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/.

Widening social inequalities in mortality: the case of Barcelona, a southern European city.

PubMed Central

Borrell, C; Plasència, A; Pasarin, I; Ortún, V

1997-01-01

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas. PMID:9519129

All-cancers mortality rates approaching diseases of the heart mortality rates as leading cause of death in Texas.

PubMed

Wyatt, Stephen W; Maynard, William Ryan; Risser, David R; Hakenewerth, Anne M; Williams, Melanie A; Garcia, Rebecca

2014-01-01

Diseases of the heart and malignant neoplasms (all-cancers) are the leading causes of death in the United States. The gap between the two has been closing in recent years. To assess the gap status in Texas and to establish a baseline to support evaluation efforts for the Cancer Prevention Research Institute of Texas, mortality data from 2006 to 2009 were analyzed. Immediate cause of death data in Texas for the years 2006-2009 were analyzed and rates developed by sex, race/ethnicity, and four metropolitan counties. Overall, for the years 2006-2009, the age-adjusted mortality rates (AARs) among Texas residents for both diseases of the heart and all-cancers decreased; however, during this time frame, there was greater improvement in diseases of the heart AARs as compared with all-cancers AARs. For the four large metropolitan counties of Bexar, Dallas, Harris, and Travis, data were analyzed by sex and race/ethnicity, and 11 of the 12 largest percent mortality rate decreases were for diseases of the heart. Age-adjusted mortality rates among Texas residents from diseases of the heart are showing improvement as compared with the rates for all-cancers.

Mortality Rates among Substance Use Disorder Participants in Clinical Trials: Pooled Analysis of Twenty-two Clinical Trials within the National Drug Abuse Treatment Clinical Trials Network

PubMed Central

Lindblad, Robert; Hu, Lian; Oden, Neal; Wakim, Paul; Rosa, Carmen; VanVeldhuisen, Paul

2016-01-01

Background Most substance use disorders (SUD) treatment clinical trials are too short and small to reliably estimate the incidence of rare events like death. Objective The aim of this study is to estimate the overall mortality rates among a SUD treatment-seeking population by pooling participants from multiple clinical trials conducted through the National Institute on Drug Abuse (NIDA)-sponsored National Drug Abuse Treatment Clinical Trials Network (CTN). Participants Drug and or alcohol users (N=9,866) who sought treatment and participated in one of the twenty-two CTN trials. Measurements Data were collected through randomized clinical trials in national community treatment programs (CTPs) for SUD. Pooled analysis was performed to assess age- and gender-standardized mortality rate(s) (SM rate(s)), and mortality ratio(s) (SM ratio(s)) of CTN trial participants compared to the U.S. general population. We also assessed if there were differences in mortality rates across different types of substance of abuse. Results The age- and gender-SM rate among CTN trials participants was 1403 (95% CI: 862-2074) per 100,000 person years (PY) compared to 542 (95% CI: 541-543) per 100,000 PY among the U.S. general population in 2005. By gender, age-adjusted SM ratio for female CTN trial participants was over five times (SM ratio=5.35, 95% CI: 3.31-8.19)), and for male CTN trial participants was over three times (SM ratio=3.39, 95% CI: 2.25-4.90) higher than their gender comparable peers in the U.S. general population. Conclusions Age and gender-standardized mortality rates and ratios among NIDA CTN SUD treatment-seeking clinical trial participants are higher than the age and gender comparable U.S. general population. The overall mortality rates of CTN trial participants are similar to in-treatment mortality reported in large U.S. and non-U.S. cohorts of opioid users. Future analysis with additional CTN trial participants and risk times will improve the stability of estimates, especially within subgroups based on primary substance of abuse. These SUD mortality rates can be used to facilitate safety monitoring within SUD clinical trials. PMID:27692192

Mortality Rates Among Substance Use Disorder Participants in Clinical Trials: Pooled Analysis of Twenty-Two Clinical Trials Within the National Drug Abuse Treatment Clinical Trials Network.

PubMed

Lindblad, Robert; Hu, Lian; Oden, Neal; Wakim, Paul; Rosa, Carmen; VanVeldhuisen, Paul

2016-11-01

Most substance use disorders (SUD) treatment clinical trials are too short and small to reliably estimate the incidence of rare events like death. The aim of this study is to estimate the overall mortality rates among a SUD treatment-seeking population by pooling participants from multiple clinical trials conducted through the National Institute on Drug Abuse (NIDA)-sponsored National Drug Abuse Treatment Clinical Trials Network (CTN). Drug and or alcohol users (N=9866) who sought treatment and participated in one of the twenty-two CTN trials. Data were collected through randomized clinical trials in national community treatment programs for SUD. Pooled analysis was performed to assess age- and gender-standardized mortality rate(s) (SM rate(s)), and mortality ratio(s) (SM ratio(s)) of CTN trial participants compared to the U.S. general population. The age- and gender-SM rate among CTN trials participants was 1403 (95% CI: 862-2074) per 100,000 person years (PY) compared to 542 (95% CI: 541-543) per 100,000 PY among the U.S. general population in 2005. By gender, age-adjusted SM ratio for female CTN trial participants was over five times (SM ratio=5.35, 95% CI: 3.31-8.19)), and for male CTN trial participants, it was over three times (SM ratio=3.39, 95% CI: 2.25-4.90) higher than their gender comparable peers in the U.S. general population. Age and gender-standardized mortality rates and ratios among NIDA CTN SUD treatment-seeking clinical trial participants are higher than the age and gender comparable U.S. general population. The overall mortality rates of CTN trial participants are similar to in-treatment mortality reported in large U.S. and non-U.S. cohorts of opioid users. Future analysis with additional CTN trial participants and risk times will improve the stability of estimates, especially within subgroups based on primary substance of abuse. These SUD mortality rates can be used to facilitate safety monitoring within SUD clinical trials. Copyright © 2016 Elsevier Inc. All rights reserved.

Chronic Cardiovascular Disease Mortality in Mountaintop Mining Areas of Central Appalachian States

ERIC Educational Resources Information Center

Esch, Laura; Hendryx, Michael

2011-01-01

Purpose: 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. Methods: Age-adjusted chronic CVD mortality rates from 1999 to 2006 for…

Child mortality after Hurricane Katrina.

PubMed

Kanter, Robert K

2010-03-01

Age-specific pediatric health consequences of community disruption after Hurricane Katrina have not been analyzed. Post-Katrina vital statistics are unavailable. The objectives of this study were to validate an alternative method to estimate child mortality rates in the greater New Orleans area and compare pre-Katrina and post-Katrina mortality rates. Pre-Katrina 2004 child mortality was estimated from death reports in the local daily newspaper and validated by comparison with pre-Katrina data from the Louisiana Department of Health. Post-Katrina child mortality rates were analyzed as a measure of health consequences. Newspaper-derived estimates of mortality rates appear to be valid except for possible underreporting of neonatal rates. Pre-Katrina and post-Katrina mortality rates were similar for all age groups except infants. Post-Katrina, a 92% decline in mortality rate occurred for neonates (<28 days), and a 57% decline in mortality rate occurred for postneonatal infants (28 days-1 year). The post-Katrina decline in infant mortality rate exceeds the pre-Katrina discrepancy between newspaper-derived and Department of Health-reported rates. A declining infant mortality rate raises questions about persistent displacement of high-risk infants out of the region. Otherwise, there is no evidence of long-lasting post-Katrina excess child mortality. Further investigation of demographic changes would be of interest to local decision makers and planners for recovery after public health emergencies in other regions.

Trends in brain cancer mortality among U.S. Gulf War veterans: 21 year follow-up.

PubMed

Barth, Shannon K; Dursa, Erin K; Bossarte, Robert M; Schneiderman, Aaron I

2017-10-01

Previous mortality studies of U.S. Gulf War veterans through 2000 and 2004 have shown an increased risk of brain cancer mortality among some deployed individuals. When veterans possibly exposed to environmental contaminants associated with demolition of the Khamisiyah Ammunition Storage Facility at Khamisiyah, Iraq, have been compared to contemporaneously deployed unexposed veterans, the results have suggested increased risk for mortality from brain cancer among the exposed. Brain cancer mortality risk in this cohort has not been updated since 2004. This study analyzes the risk for brain cancer mortality between 1991-2011 through two series of comparisons: U.S. Gulf War deployed and non-deployed veterans from the same era; and veterans possibly exposed to environmental contaminants at Khamisiyah compared to contemporaneously deployed but unexposed U.S. Gulf War veterans. Risk of brain cancer mortality was determined using logistic regression. Life test hazard models were created to plot comparisons of annual hazard rates. Joinpoint regression models were applied to assess trends in hazard rates for brain cancer mortality. U.S. Army veterans possibly exposed at Khamisiyah had similar rates of brain cancer mortality compared to those not possibly exposed; however, veterans possibly exposed had a higher risk of brain cancer in the time period immediately following the Gulf War. Results from these analyses suggest that veterans possibly exposed at Khamisiyah experienced different patterns of brain cancer mortality risk compared to the other groups. Published by Elsevier Ltd.

Mortality in the 2011 Tsunami in Japan

PubMed Central

Nakahara, Shinji; Ichikawa, Masao

2013-01-01

Introduction On 11 March 2011, a magnitude 9.0 earthquake caused a huge tsunami that struck Northeast Japan, resulting in nearly 20 000 deaths. We investigated mortality patterns by age, sex, and region in the 3 most severely affected prefectures. Methods Using police data on earthquake victims in Iwate, Miyagi, and Fukushima prefectures, mortality rates by sex, age group, and region were calculated, and regional variability in mortality rates across age groups was compared using rate ratios (RRs), with the rates in Iwate as the reference. Results In all regions, age-specific mortality showed a tendency to increase with age; there were no sex differences. Among residents of Iwate, mortality was markedly lower among school-aged children as compared with other age groups. In northern Miyagi and the southern part of the study area, RRs were higher among school-aged children than among other age groups. Conclusions The present study could not address the reasons for the observed mortality patterns and regional differences. To improve preparedness policies, future research should investigate the reasons for regional differences. PMID:23089585

Mortality risk in a nationwide cohort of individuals with tic disorders and with tourette syndrome.

PubMed

Meier, Sandra M; Dalsgaard, Søren; Mortensen, Preben B; Leckman, James F; Plessen, Kerstin J

2017-04-01

Few studies have investigated mortality risk in individuals with tic disorders. We thus measured the risk of premature death in individuals with tic disorders and with Tourette syndrome in a prospective cohort study with 80 million person-years of follow-up. We estimated mortality rate ratios and adjusted for calendar year, age, sex, urbanicity, maternal and paternal age, and psychiatric disorders to compare individuals with and without tic disorders. The risk of premature death was higher among individuals with tic disorders (mortality rate ratio, 2.02; 95% CI, 1.49-2.66) and with Tourette syndrome (mortality rate ratio, 1.63; 95% CI, 1.11-2.28) compared with controls. After the exclusion of individuals with comorbid attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, and substance abuse, tic disorder remained associated with increased mortality risk (mortality rate ratio, 2.30; 95% CI, 1.57-3.23), as did also Tourette Syndrome (mortality rate ratio, 1.81; 95% CI, 1.11-2.75). These results are of clinical significance for clinicians and advocacy organizations. Several factors may contribute to this increased risk of premature death, and more research mapping out these factors is needed. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics.

PubMed

May, Margaret T; Hogg, Robert S; Justice, Amy C; Shepherd, Bryan E; Costagliola, Dominique; Ledergerber, Bruno; Thiébaut, Rodolphe; Gill, M John; Kirk, Ole; van Sighem, Ard; Saag, Michael S; Navarro, Gemma; Sobrino-Vegas, Paz; Lampe, Fiona; Ingle, Suzanne; Guest, Jodie L; Crane, Heidi M; D'Arminio Monforte, Antonella; Vehreschild, Jörg J; Sterne, Jonathan A C

2012-12-01

HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.

Comparison of pediatric cardiac surgical mortality rates from national administrative data to contemporary clinical standards.

PubMed

Welke, Karl F; Diggs, Brian S; Karamlou, Tara; Ungerleider, Ross M

2009-01-01

Despite the superior coding and risk adjustment of clinical data, the ready availability, national scope, and perceived unbiased nature of administrative data make it the choice of governmental agencies and insurance companies for evaluating quality and outcomes. We calculated pediatric cardiac surgery mortality rates from administrative data and compared them with widely quoted standards from clinical databases. Pediatric cardiac surgical operations were retrospectively identified by ICD-9-CM diagnosis and procedure codes from the Nationwide Inpatient Sample (NIS) 1988-2005 and the Kids' Inpatient Database (KID) 2003. Cases were grouped into Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) categories. In-hospital mortality rates and 95% confidence intervals were calculated. A total of 55,164 operations from the NIS and 10,945 operations from the KID were placed into RACHS-1 categories. During the 18-year period, the overall NIS mortality rate for pediatric cardiac surgery decreased from 8.7% (95% confidence interval, 8.0% to 9.3%) to 4.6% (95% confidence interval, 4.3% to 5.0%). Mortality rates by RACHS-1 category decreased significantly as well. The KID and NIS mortality rates from comparable years were similar. Overall mortality rates derived from administrative data were higher than those from contemporary national clinical data, The Society of Thoracic Surgeons Congenital Heart Surgery Database, or published data from pediatric cardiac specialty centers. Although category-specific mortality rates were higher in administrative data than in clinical data, a minority of the relationships reached statistical significance. Despite substantial improvement, mortality rates from administrative data remain higher than those from clinical data. The discrepancy may be attributable to several factors: differences in database design and composition, differences in data collection and reporting structures, and variation in data quality.

Unintentional falls mortality among elderly in the United States: time for action.

PubMed

Alamgir, Hasanat; Muazzam, Sana; Nasrullah, Muazzam

2012-12-01

Fall injury is a leading cause of death and disability among older adults. The objective of this study is to identify the groups among the ≥ 65 population by age, gender, race, ethnicity and state of residence which are most vulnerable to unintentional fall mortality and report the trends in falls mortality in the United States. Using mortality data from the Centers for Disease Control and Prevention, the age specific and age-adjusted fall mortality rates were calculated by gender, age, race, ethnicity and state of residence for a five year period (2003-2007). Annual percentage changes in rates were calculated and linear regression using natural logged rates were used for time-trend analysis. There were 79,386 fall fatalities (rate: 40.77 per 100,000 population) reported. The annual mortality rate varied from a low of 36.76 in 2003 to a high of 44.89 in 2007 with a 22.14% increase (p=0.002 for time-related trend) during 2003-2007. The rates among whites were higher compared to blacks (43.04 vs. 18.83; p=0.01). While comparing falls mortality rate for race by gender, white males had the highest mortality rate followed by white females. The rate was as low as 20.19 for Alabama and as high as 97.63 for New Mexico. The relative attribution of falls mortality among all unintentional injury mortality increased with age (23.19% for 65-69 years and 53.53% for 85+ years), and the proportion of falls mortality was significantly higher among females than males (46.9% vs. 40.7%: p<0.001) and among whites than blacks (45.3% vs. 24.7%: p<0.001). The burden of fall related mortality is very high and the rate is on the rise; however, the burden and trend varied by gender, age, race and ethnicity and also by state of residence. Strategies will be more effective in reducing fall-related mortality when high risk population groups are targeted. Copyright © 2011 Elsevier Ltd. All rights reserved.

Mortality from Cardiovascular Diseases in the Elderly: Comparative Analysis of Two Five-year Periods

PubMed Central

Piuvezam, Grasiela; Medeiros, Wilton Rodrigues; Costa, Andressa Vellasco; Emerenciano, Felipe Fonseca; Santos, Renata Cristina; Seabra, Danilo Silveira

2015-01-01

Background Cardiovascular diseases are the leading cause of death in Brazil. The better understanding of the spatial and temporal distribution of mortality from cardiovascular diseases in the Brazilian elderly population is essential to support more appropriate health actions for each region of the country. Objective To describe and to compare geospatially the rates of mortality from cardiovascular disease in elderly individuals living in Brazil by gender in two 5-year periods: 1996 to 2000 and 2006 to 2010. Methods This is an ecological study, for which rates of mortality were obtained from DATASUS and the population rates from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística). An average mortality rate for cardiovascular disease in elderly by gender was calculated for each period. The spatial autocorrelation was evaluated by TerraView 4.2.0 through global Moran index and the formation of clusters by the index of local Moran-LISA. Results There was an increase, in the second 5-year period, in the mortality rates in the Northeast and North regions, parallel to a decrease in the South, South-East and Midwest regions. Moreover, there was the formation of clusters with high mortality rates in the second period in Roraima among females, and in Ceará, Pernambuco and Roraima among males. Conclusion The increase in mortality rates in the North and Northeast regions is probably related to the changing profile of mortality and improvement in the quality of information, a result of the increase in surveillance and health care measures in these regions. PMID:26559984

The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil.

PubMed

Algranti, Eduardo; Saito, Cézar Akiyoshi; Carneiro, Ana Paula Scalia; Moreira, Bruno; Mendonça, Elizabete Medina Coeli; Bussacos, Marco Antonio

2015-10-01

There are limited data on mesothelioma mortality in industrializing countries, where, at present, most of the asbestos consumption occurs. To analyze temporal trends and to calculate mortality rates from mesothelioma and cancer of the pleura in Brazil from 2000 to 2012 and to estimate future mortality rates. We retrieved records of deaths from mesothelioma (ICD-10C45) and cancer of the pleura (ICD-10C38.4) from 2000 to 2012 in adults aged 30 years and over. Crude and age-standardized mortality rates (ASMR) were calculated. Rate ratios of mean crude mortality for selected municipalities were compared to the Brazilian rate. A regression was carried out of the annual number of deaths against asbestos consumption using a Generalized Additive Model (GAM). The best model was chosen to estimate the future burden and peak period of deaths. There were 929C45 and 1379 C38.4 deaths. The ratio of men to women for C45 was 1.4. A positive trend in C45 numbers was observed in Brazil (p=0.0012), particularly in São Paulo (p=0.0004) where ASMRs presented an increasing linear trend (p=0.0344). Selected municipalities harboring asbestos manipulation presented 3.7-11 fold rate ratios of C45 compared to Brazil. GAM presented best fits for latencies of 34 years or more. It is estimated that the peak incidence of C45 mortality will occur between 2021 and 2026. The observed ASMRs and the gender ratio close to 1 suggest underreporting. Even so, deaths are increasing and mesothelioma clusters were identified. Compared to industrialized countries Brazil displays a 15-20 year lag in estimated peak mesothelioma mortality which is consistent with the lag of asbestos peak consumption in the country. Copyright © 2015 Elsevier Ltd. All rights reserved.

Comparison of Data on Serious Adverse Events and Mortality in ClinicalTrials.gov, Corresponding Journal Articles, and FDA Medical Reviews: Cross-Sectional Analysis.

PubMed

Pradhan, Richeek; Singh, Sonal

2018-04-11

Inconsistencies in data on serious adverse events (SAEs) and mortality in ClinicalTrials.gov and corresponding journal articles pose a challenge to research transparency. The objective of this study was to compare data on SAEs and mortality from clinical trials reported in ClinicalTrials.gov and corresponding journal articles with US Food and Drug Administration (FDA) medical reviews. We conducted a cross-sectional study of a randomly selected sample of new molecular entities approved during the study period 1 January 2013 to 31 December 2015. We extracted data on SAEs and mortality from 15 pivotal trials from ClinicalTrials.gov and corresponding journal articles (the two index resources), and FDA medical reviews (reference standard). We estimated the magnitude of deviations in rates of SAEs and mortality between the index resources and the reference standard. We found deviations in rates of SAEs (30% in ClinicalTrials.gov and 30% in corresponding journal articles) and mortality (72% in ClinicalTrials.gov and 53% in corresponding journal articles) when compared with the reference standard. The intra-class correlation coefficient between the three resources was 0.99 (95% confidence interval [CI] 0.98-0.99) for SAE rates and 0.99 (95% CI 0.97-0.99) for mortality rates. There are differences in data on rates of SAEs and mortality in randomized clinical trials in both ClinicalTrials.gov and journal articles compared with FDA reviews. Further efforts should focus on decreasing existing discrepancies to enhance the transparency and reproducibility of data reporting in clinical trials.

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.

Does Mortality Vary between Asian Subgroups in New Zealand: An Application of Hierarchical Bayesian Modelling

PubMed Central

Jatrana, Santosh; Richardson, Ken; Blakely, Tony; Dayal, Saira

2014-01-01

The aim of this paper was to see whether all-cause and cause-specific mortality rates vary between Asian ethnic subgroups, and whether overseas born Asian subgroup mortality rate ratios varied by nativity and duration of residence. We used hierarchical Bayesian methods to allow for sparse data in the analysis of linked census-mortality data for 25–75 year old New Zealanders. We found directly standardised posterior all-cause and cardiovascular mortality rates were highest for the Indian ethnic group, significantly so when compared with those of Chinese ethnicity. In contrast, cancer mortality rates were lowest for ethnic Indians. Asian overseas born subgroups have about 70% of the mortality rate of their New Zealand born Asian counterparts, a result that showed little variation by Asian subgroup or cause of death. Within the overseas born population, all-cause mortality rates for migrants living 0–9 years in New Zealand were about 60% of the mortality rate of those living more than 25 years in New Zealand regardless of ethnicity. The corresponding figure for cardiovascular mortality rates was 50%. However, while Chinese cancer mortality rates increased with duration of residence, Indian and Other Asian cancer mortality rates did not. Future research on the mechanisms of worsening of health with increased time spent in the host country is required to improve the understanding of the process, and would assist the policy-makers and health planners. PMID:25140523

A comparison of foetal and infant mortality in the United States and Canada.

PubMed

Ananth, Cande V; Liu, Shiliang; Joseph, K S; Kramer, Michael S

2009-04-01

Infant mortality rates are higher in the United States than in Canada. We explored this difference by comparing gestational age distributions and gestational age-specific mortality rates in the two countries. Stillbirth and infant mortality rates were compared for singleton births at >or=22 weeks and newborns weighing>or=500 g in the United States and Canada (1996-2000). Since menstrual-based gestational age appears to misclassify gestational duration and overestimate both preterm and postterm birth rates, and because a clinical estimate of gestation is the only available measure of gestational age in Canada, all comparisons were based on the clinical estimate. Data for California were excluded because they lacked a clinical estimate. Gestational age-specific comparisons were based on the foetuses-at-risk approach. The overall stillbirth rate in the United States (37.9 per 10,000 births) was similar to that in Canada (38.2 per 10,000 births), while the overall infant mortality rate was 23% (95% CI 19-26%) higher (50.8 vs 41.4 per 10,000 births, respectively). The gestational age distribution was left-shifted in the United States relative to Canada; consequently, preterm birth rates were 8.0 and 6.0%, respectively. Stillbirth and early neonatal mortality rates in the United States were lower at term gestation only. However, gestational age-specific late neonatal, post-neonatal and infant mortality rates were higher in the United States at virtually every gestation. The overall stillbirth rates (per 10,000 foetuses at risk) among Blacks and Whites in the United States, and in Canada were 59.6, 35.0 and 38.3, respectively, whereas the corresponding infant mortality rates were 85.6, 49.7 and 42.2, respectively. Differences in gestational age distributions and in gestational age-specific stillbirth and infant mortality in the United States and Canada underscore substantial differences in healthcare services, population health status and health policy between the two neighbouring countries.

[Mortality rate of acute heart attack in Zalaegerszeg micro-region. Results of the first Hungarian 24-hour acute ST-elevation myocardial infarction intervention care unit].

PubMed

Lupkovics, Géza; Motyovszki, Akos; Németh, Zoltán; Takács, István; Kenéz, András; Burkali, Bernadett; Menyhárt, Ildikó

2010-04-04

Morbidity and mortality rates of acute heart attack emphasize the significance of this patient group worldwide. The prompt and exact diagnosis and the timing of adequate therapy is crucial for this patients. Modern supply of acute heart attack includes invasive cardiology intervention, primer percutaneous coronary intervention. In year 1999, American and European recommendations suggested primer percutaneous coronary intervention only as an alternative possibility instead of thrombolysis, or in case of cardiogenic shock. 24 hour intervention unit for patients with acute heart attack was first organized in Hungary in Zala County Hospital's Cardiology Department, in year 1998. Our present study confirms, that since the intervention treatment has been introduced, average mortality rate has been reduced considerably in our area comparing to the national average. Mortality rates in West Transdanubian region and in Zalaegerszeg's micro-region were studied and compared for the period between 1997-2004, according to the data of National Public Health and Medical Officer Service. These data were then compared with the national average mortality data of Hungarian Central Statistical Office. With the help of our own computerized database we examined this period and compared the number of the completed invasive interventions to the mortality statistics. In the first full year, in 1998, we completed 82 primer and 283 elective PCIs; these number increased to 318 and 1265 by year 2005. At the same time, significant decrease of acute infarction related mortality was detectable among men of the Zalaegerszeg micro-region, comparing to the national average (p<0.001). The first Hungarian 24 hour acute heart attack intervention care improved the area's mortality statistics significantly, comparing to the national average. The skilled work of the experienced team means an important advantage to the patients in Zalaegerszeg micro-region.

Alzheimer's Disease in Down Syndrome: Neurobiology and Risk

ERIC Educational Resources Information Center

Zigman, Warren B.; Lott, Ira T.

2007-01-01

Down syndrome (DS) is characterized by increased mortality rates, both during early and later stages of life, and age-specific mortality risk remains higher in adults with DS compared with the overall population of people with mental retardation and with typically developing populations. Causes of increased mortality rates early in life are…

Alternative Measures of Self-Rated Health for Predicting Mortality Among Older People: Is Past or Future Orientation More Important?

PubMed

Ferraro, Kenneth F; Wilkinson, Lindsay R

2015-10-01

The purpose of this study was to compare the prognostic validity of alternative measures of health ratings, including those that tap temporal reflections, on adult mortality. The study uses a national sample of 1,266 Americans 50-74 years old in 1995, with vital status tracked through 2005, to compare the effect of 3 types of health ratings on mortality: conventional indicator of self-rated health (SRH), age comparison form of SRH, and health ratings that incorporate temporal dimensions. Logistic regression was used to estimate the odds of mortality associated with alternative health ratings while adjusting for health conditions, lifestyle factors, and status characteristics and resources. Self-rated health was a consistent predictor of mortality, but the respondent's expected health rating-10 years in the future-was an independent predictor. Future health expectations were more important than past (recalled change) in predicting mortality risk: People with more negative expectations of future health were less likely to survive. The findings reveal the importance of future time perspective for older people and suggest that it is more useful to query older people about their future health expectations than about how their health has changed. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

Risk-adjusted performance evaluation in three academic thoracic surgery units using the Eurolung risk models.

PubMed

Pompili, Cecilia; Shargall, Yaron; Decaluwe, Herbert; Moons, Johnny; Chari, Madhu; Brunelli, Alessandro

2018-01-03

The objective of this study was to evaluate the performance of 3 thoracic surgery centres using the Eurolung risk models for morbidity and mortality. This was a retrospective analysis performed on data collected from 3 academic centres (2014-2016). Seven hundred and twenty-one patients in Centre 1, 857 patients in Centre 2 and 433 patients in Centre 3 who underwent anatomical lung resections were analysed. The Eurolung1 and Eurolung2 models were used to predict risk-adjusted cardiopulmonary morbidity and 30-day mortality rates. Observed and risk-adjusted outcomes were compared within each centre. The observed morbidity of Centre 1 was in line with the predicted morbidity (observed 21.1% vs predicted 22.7%, P = 0.31). Centre 2 performed better than expected (observed morbidity 20.2% vs predicted 26.7%, P < 0.001), whereas the observed morbidity of Centre 3 was higher than the predicted morbidity (observed 41.1% vs predicted 24.3%, P < 0.001). Centre 1 had higher observed mortality when compared with the predicted mortality (3.6% vs 2.1%, P = 0.005), whereas Centre 2 had an observed mortality rate significantly lower than the predicted mortality rate (1.2% vs 2.5%, P = 0.013). Centre 3 had an observed mortality rate in line with the predicted mortality rate (observed 1.4% vs predicted 2.4%, P = 0.17). The observed mortality rates in the patients with major complications were 30.8% in Centre 1 (versus predicted mortality rate 3.8%, P < 0.001), 8.2% in Centre 2 (versus predicted mortality rate 4.1%, P = 0.030) and 9.0% in Centre 3 (versus predicted mortality rate 3.5%, P = 0.014). The Eurolung models were successfully used as risk-adjusting instruments to internally audit the outcomes of 3 different centres, showing their applicability for future quality improvement initiatives. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

PubMed

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

2013-01-29

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

Socioeconomic gradients in all-cause, premature and avoidable mortality among immigrants and long-term residents using linked death records in Ontario, Canada

PubMed Central

Khan, Anam M; Urquia, Marcelo; Kornas, Kathy; Henry, David; Cheng, Stephanie Y; Bornbaum, Catherine

2017-01-01

Background Immigrants have been shown to possess a health advantage, yet are also more likely to reside in arduous economic conditions. Little is known about if and how the socioeconomic gradient for all-cause, premature and avoidable mortality differs according to immigration status. Methods Using several linked population-based vital and demographic databases from Ontario, we examined a cohort of all deaths in the province between 2002 and 2012. We constructed count models, adjusted for relevant covariates, to attain age-adjusted mortality rates and rate ratios for all-cause, premature and avoidable mortality across income quintile in immigrants and long-term residents, stratified by sex. Results A downward gradient in age-adjusted all-cause mortality was observed with increasing income quintile, in immigrants (males: Q5: 13.32, Q1: 20.18; females: Q5: 9.88, Q1: 12.51) and long-term residents (males: Q5: 33.25, Q1: 57.67; females: Q5: 22.31, Q1: 36.76). Comparing the lowest and highest income quintiles, male and female immigrants had a 56% and 28% lower all-cause mortality rate, respectively. Similar trends were observed for premature and avoidable mortality. Although immigrants had consistently lower mortality rates compared with long-term residents, trends only differed statistically across immigration status for females (p<0.05). Conclusions This study illustrated the presence of income disparities as it pertains to all-cause, premature, and avoidable mortality, irrespective of immigration status. Additionally, the immigrant health advantage was observed and income disparities were less pronounced in immigrants compared with long-term residents. These findings support the need to examine the factors that drive inequalities in mortality within and across immigration status. PMID:28289039

Mortality among subjects with chronic obstructive pulmonary disease or asthma at two respiratory disease clinics in Ontario

PubMed Central

Finkelstein, Murray M; Chapman, Kenneth R; McIvor, R Andrew; Sears, Malcolm R

2011-01-01

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma are common; however, mortality rates among individuals with these diseases are not well studied in North America. OBJECTIVE: To investigate mortality rates and risk factors for premature death among subjects with COPD. METHODS: Subjects were identified from the lung function testing databases of two academic respiratory disease clinics in Hamilton and Toronto, Ontario. Mortality was ascertained by linkage to the Ontario mortality registry between 1992 and 2002, inclusive. Standardized mortality ratios were computed. Poisson regression of standardized mortality ratios and proportional hazards regression were performed to examine the multivariate effect of risk factors on the standardized mortality ratios and mortality hazards. RESULTS: Compared with the Ontario population, all-cause mortality was approximately doubled among subjects with COPD, but was lower than expected among subjects with asthma. The risk of mortality in patients with COPD was related to cigarette smoking, to the presence of comorbid conditons of ischemic heart disease and diabetes, and to Global initiative for chronic Obstructive Lung Disease severity scores. Individuals living closer to traffic sources showed an elevated risk of death compared with those who lived further away from traffic sources. CONCLUSIONS: Mortality rates among subjects diagnosed with COPD were substantially elevated. There were several deaths attributed to asthma among subjects in the present study; however, overall, patients with asthma demonstrated lower mortality rates than the general population. Subjects with COPD need to be managed with attention devoted to both their respiratory disorders and related comorbidities. PMID:22187688

Visualising and quantifying 'excess deaths' in Scotland compared with the rest of the UK and the rest of Western Europe.

PubMed

Minton, Jon; Shaw, Richard; Green, Mark A; Vanderbloemen, Laura; Popham, Frank; McCartney, Gerry

2017-05-01

Scotland has higher mortality rates than the rest of Western Europe (rWE), with more cardiovascular disease and cancer among older adults; and alcohol-related and drug-related deaths, suicide and violence among younger adults. We obtained sex, age-specific and year-specific all-cause mortality rates for Scotland and other populations, and explored differences in mortality both visually and numerically. Scotland's age-specific mortality was higher than the rest of the UK (rUK) since 1950, and has increased. Between the 1950s and 2000s, 'excess deaths' by age 80 per 100 000 population associated with living in Scotland grew from 4341 to 7203 compared with rUK, and from 4132 to 8828 compared with rWE. UK-wide mortality risk compared with rWE also increased, from 240 'excess deaths' in the 1950s to 2320 in the 2000s. Cohorts born in the 1940s and 1950s throughout the UK including Scotland had lower mortality risk than comparable rWE populations, especially for males. Mortality rates were higher in Scotland than rUK and rWE among younger adults from the 1990s onwards suggesting an age-period interaction. Worsening mortality among young adults in the past 30 years reversed a relative advantage evident for those born between 1950 and 1960. Compared with rWE, Scotland and rUK have followed similar trends but Scotland has started from a worse position and had worse working age-period effects in the 1990s and 2000s. 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/.

Increased inequality in mortality from road crashes among Arabs and Jews in Israel.

PubMed

Magid, Avi; Leibovitch-Zur, Shalhevet; Baron-Epel, Orna

2015-01-01

Previous studies in several countries have shown that the economically disadvantaged seem to have a greater risk of being involved in a car crash. The aim of the present study was to compare rates and trends in mortality and injury from road crashes by age among the Arab and Jewish populations in Israel. Data on road crashes with casualties (2003-2011) from the Israeli Central Bureau of Statistics were analyzed. Age-adjusted road crash injury rates and mortality rates for 2003 to 2011 were calculated and time trends for each age group and population group are presented. Time trend significance was evaluated by linear regression models. Arabs in Israel are at increased risk of injury and mortality from road crashes compared to Jews. Road crash injury rates have significantly decreased in both populations over the last decade, although the rates have been persistently higher among Arabs. Road crash mortality rates have also decreased significantly in the Jewish population but not in the Arab population. This implies an increase in the disparity in mortality between Jews and Arabs. The most prominent differences in road crash injury and mortality rates between Arabs and Jews can be observed in young adults and young children. The reduction in road crashes in the last decade is a positive achievement. However, the reductions are not equal among Arabs and Jews in Israel. Therefore, an increase in the disparities in mortality from road crashes is apparent. Public health efforts need to focus specifically on decreasing road crashes in the Arab community.

Mortality rates among children and teenagers living in Inuit Nunangat, 1994 to 2008.

PubMed

Oliver, Lisa N; Peters, Paul A; Kohen, Dafna E

2012-09-01

Because Vital Statistics data do not include information on Inuit identity in all jurisdictions, mortality rates cannot be calculated specifically for Inuit. However, Inuit in Canada are geographically concentrated--78% live in Inuit Nunangat, and 82% of the area's total population identify as Inuit. While there are limitations, geographic approaches can be employed to calculate mortality for the population of that area. The Vital Statistics Database (1994 to 2008) and population estimates were used to calculate age-standardized mortality rates (ASMRs) in five-year intervals around the 1996 and 2006 Census years. Mortality rates were calculated for 1- to 19-year-olds living in Inuit Nunangat and those living elsewhere in Canada. The ASMR in 2004-2008 for 1- to 19-year-olds in Inuit Nunangat was 188.0 deaths per 100,000 person-years at risk, five times the rate (35.3) elsewhere in Canada. The disparity had not narrowed over the previous decade. In Inuit Nunangat, injuries were responsible for 64% of deaths of children and teenagers, compared with 36% in the rest of Canada. The persistently high mortality rates for children and teenagers living in Inuit Nunangat, compared with the rest of Canada, are important in understanding the health and socio-economic situation of residents of this region.

Comparison of physician referral and insurance claims data-based risk prediction as approaches to identify patients for care management in primary care: an observational study.

PubMed

Freund, Tobias; Gondan, Matthias; Rochon, Justine; Peters-Klimm, Frank; Campbell, Stephen; Wensing, Michel; Szecsenyi, Joachim

2013-10-20

Primary care-based care management (CM) could reduce hospital admissions in high-risk patients. Identification of patients most likely to benefit is needed as resources for CM are limited. This study aimed to compare hospitalization and mortality rates of patients identified for CM either by treating primary care physicians (PCPs) or predictive modelling software for hospitalization risk (PM). In 2009, a cohort of 6,026 beneficiaries of a German statutory health insurance served as a sample for patient identification for CM by PCPs or commercial PM (CSSG 0.8, Verisk Health). The resulting samples were compared regarding hospitalization and mortality rates in 2010 and in the two year period before patient selection. No CM-intervention was delivered until the end of 2010 and PCPs were blinded for the assessment of hospitalization rates. In 2010, hospitalization rates of PM-identified patients were 80% higher compared to PCP-identified patients. Mortality rates were also 8% higher in PM-identified patients if compared to PCP-identified patients (10% vs. 2%). The hospitalization rate of patients independently identified by both PM and PCPs was numerically between PM- and PCP-identified patients. Time trend between 2007 and 2010 showed decreasing hospitalization rates in PM-identified patients (-15% per year) compared to increasing rates in PCP-identified patients (+34% per year). PM identified patients with higher hospitalization and mortality rates compared to PCP-referred patients. But the latter showed increasing hospitalization rates over time thereby suggesting that PCPs may be able to predict future deterioration in patients with relatively good current health status. These patients may most likely benefit from preventive services like CM.

Estimating In Situ Zooplankton Non-Predation Mortality in an Oligo-Mesotrophic Lake from Sediment Trap Data: Caveats and Reality Check

PubMed Central

Dubovskaya, Olga P.; Tang, Kam W.; Gladyshev, Michail I.; Kirillin, Georgiy; Buseva, Zhanna; Kasprzak, Peter; Tolomeev, Aleksandr P.; Grossart, Hans-Peter

2015-01-01

Background Mortality is a main driver in zooplankton population biology but it is poorly constrained in models that describe zooplankton population dynamics, food web interactions and nutrient dynamics. Mortality due to non-predation factors is often ignored even though anecdotal evidence of non-predation mass mortality of zooplankton has been reported repeatedly. One way to estimate non-predation mortality rate is to measure the removal rate of carcasses, for which sinking is the primary removal mechanism especially in quiescent shallow water bodies. Objectives and Results We used sediment traps to quantify in situ carcass sinking velocity and non-predation mortality rate on eight consecutive days in 2013 for the cladoceran Bosmina longirostris in the oligo-mesotrophic Lake Stechlin; the outcomes were compared against estimates derived from in vitro carcass sinking velocity measurements and an empirical model correcting in vitro sinking velocity for turbulence resuspension and microbial decomposition of carcasses. Our results show that the latter two approaches produced unrealistically high mortality rates of 0.58-1.04 d-1, whereas the sediment trap approach, when used properly, yielded a mortality rate estimate of 0.015 d-1, which is more consistent with concurrent population abundance data and comparable to physiological death rate from the literature. Ecological implications Zooplankton carcasses may be exposed to water column microbes for days before entering the benthos; therefore, non-predation mortality affects not only zooplankton population dynamics but also microbial and benthic food webs. This would be particularly important for carbon and nitrogen cycles in systems where recurring mid-summer decline of zooplankton population due to non-predation mortality is observed. PMID:26146995

Trends in mortality in older women: findings from the Nun Study.

PubMed

Butler, S M; Snowdon, D A

1996-07-01

During this century, Catholic sisters have remained constant in many life-style characteristics such as smoking and reproduction (Catholic sisters are nonsmoking and nulliparous). It is therefore of interest to compare trends in the health of elderly Catholic sisters to those in the general population. In this study, mortality rates at ages 50 to 84 years in a population of 2,573 Catholic sisters were compared to those in the general population during the years 1965 to 1989. The Catholic sisters had a mortality advantage that increased dramatically over calendar time, and from early to more recent birth cohorts. This coincided with increases in smoking by U.S. women, while during the same time period the Catholic sisters had very low rates of mortality from smoking-related diseases. The Catholic sisters had high rates of mortality from cancers of the breast and reproductive organs, suggesting an effect of nulliparity manifested in older women.

Factors related to mortality after osteoporotic hip fracture treatment at Chiang Mai University Hospital, Thailand, during 2006 and 2007.

PubMed

Chaysri, Rathasart; Leerapun, Taninnit; Klunklin, Kasisin; Chiewchantanakit, Siripong; Luevitoonvechkij, Sirichai; Rojanasthien, Sattaya

2015-01-01

To investigate the one-year mortality rate after osteoporotic hip fracture and to identify factors associated with that mortality rate. A retrospective review of 275 osteoporotic patients who sustained a low-trauma hip fracture and were admitted in Chiang Mai University Hospital during January 1, 2006 to December 31, 2007 was accomplished. Eligibility criteria were defined as age over 50 years, fracture caused by a simple fall and not apathologicalfracture caused by cancer or infection. Results of this one-year mortality rate study were compared to studies of hip fracture patient mortality in 1997 and the period 1998-2003. The average one-year mortality rate in 2006-2007 was 21.1%. Factors correlated with higher mortality were non-operative treatment, delayed surgical treatment, and absence of medical treatment for osteoporosis. The 2006-2007 mortality rate was slightly higher than for the 1997 and 1998-2003 periods. The one-year mortality rate after osteoporotic hip fracture of 21.1% was approximately 9.3 times the mortality rate for the same age group in the general population, indicating that treatment of osteoporosis as a means of helping prevent hip fracture is very important for the individual, the family, and society as a whole.

Mortality and comorbidities in patients with multiple sclerosis compared with a population without multiple sclerosis: An observational study using the US Department of Defense administrative claims database.

PubMed

Capkun, Gorana; Dahlke, Frank; Lahoz, Raquel; Nordstrom, Beth; Tilson, Hugh H; Cutter, Gary; Bischof, Dorina; Moore, Alan; Simeone, Jason; Fraeman, Kathy; Bancken, Fabrice; Geissbühler, Yvonne; Wagner, Michael; Cohan, Stanley

2015-11-01

Data are limited for mortality and comorbidities in patients with multiple sclerosis (MS). Compare mortality rates and event rates for comorbidities in MS (n=15,684) and non-MS (n=78,420) cohorts from the US Department of Defense (DoD) database. Comorbidities and all-cause mortality were assessed using the database. Causes of death (CoDs) were assessed through linkage with the National Death Index. Cohorts were compared using mortality (MRR) and event (ERR) rate ratios. All-cause mortality was 2.9-fold higher in the MS versus non-MS cohort (MRR, 95% confidence interval [CI]: 2.9, 2.7-3.2). Frequent CoDs in the MS versus non-MS cohort were infectious diseases (6.2, 4.2-9.4), diseases of the nervous (5.8, 3.7-9.0), respiratory (5.0, 3.9-6.4) and circulatory (2.1, 1.7-2.7) systems and suicide (2.6, 1.3-5.2). Comorbidities including sepsis (ERR, 95% CI: 5.7, 5.1-6.3), ischemic stroke (3.8, 3.5-4.2), attempted suicide (2.4, 1.3-4.5) and ulcerative colitis (2.0, 1.7-2.3), were higher in the MS versus non-MS cohort. The rate of cancers was also higher in the MS versus the non-MS cohort, including lymphoproliferative disorders (2.2, 1.9-2.6) and melanoma (1.7, 1.4-2.0). Rates of mortality and several comorbidities are higher in the MS versus non-MS cohort. Early recognition and management of comorbidities may reduce premature mortality and improve quality of life in patients with MS. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Cervical cancer incidence and mortality among American Indian and Alaska Native women, 1999-2009.

PubMed

Watson, Meg; Benard, Vicki; Thomas, Cheryll; Brayboy, Annie; Paisano, Roberta; Becker, Thomas

2014-06-01

We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races. We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009. AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (-25.8%/year) and remained stable thereafter. Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions.

The northern population development; colonization and mortality in Swedish Sápmi, 1776-1895.

PubMed

Sköld, Peter; Axelsson, Per

2008-02-01

The aim of the Consequence of Colonization project is to study population development and mortality in Swedish Sápmi. This article, the first to be drawn from our research, compares these changes between Sami and non-Sami, South and North Sami. Study design. Longitudinal individual based data from computerized records ofthe Glillivare, Undersåker and Frostviken parishes, divided into 2 40-year periods: 1776-1815 and 1856-1895. The main source material used for the present study was a set of data files from the Demographic Data Base (DDB) at Umeå University, the largest historical database in Europe. A Sami cohort was created by indicators of ethnicity in the parish registers, and was later extended with automatic linkages to children and parents. Sami mortality rates show great fluctuations during the period 1776-1815, almost always peaking at a higher rate than in the rest of Sweden. The non-Sami group had lower mortality rates compared with both Sweden as a whole and the Sami in the parish. Between 1856 and 1895, the non-Sami experienced a very small reduction in their mortality rates and the Sami experienced overall improvement in their health status. Significant differences in age-specific mortality appear when the South and North Sami are compared, showing that the South Sami had far lower child mortality rates. The Sami population's health status improved during the nineteenth century. This indicates that they had advanced in the epidemiologic transition model. A corresponding change is not found for the non-Sami group.

The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

PubMed

Quercioli, Cecilia; Messina, Gabriele; Basu, Sanjay; McKee, Martin; Nante, Nicola; Stuckler, David

2013-02-01

During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

Tissue mortality by Caribbean ciliate infection and white band disease in three reef-building coral species

PubMed Central

Bastidas, Carolina; Croquer, Aldo

2016-01-01

Caribbean ciliate infection (CCI) and white band disease (WBD) are diseases that affect a multitude of coral hosts and are associated with rapid rates of tissue losses, thus contributing to declining coral cover in Caribbean reefs. In this study we compared tissue mortality rates associated to CCI in three species of corals with different growth forms: Orbicella faveolata (massive-boulder), O. annularis (massive-columnar) and Acropora cervicornis (branching). We also compared mortality rates in colonies of A. cervicornis bearing WBD and CCI. The study was conducted at two locations in Los Roques Archipelago National Park between April 2012 and March 2013. In A. cervicornis, the rate of tissue loss was similar between WBD (0.8 ± 1 mm/day, mean ± SD) and CCI (0.7 ± 0.9 mm/day). However, mortality rate by CCI in A. cervicornis was faster than in the massive species O. faveolata (0.5 ± 0.6 mm/day) and O. annularis (0.3 ± 0.3 mm/day). Tissue regeneration was at least fifteen times slower than the mortality rates for both diseases regardless of coral species. This is the first study providing coral tissue mortality and regeneration rates associated to CCI in colonies with massive morphologies, and it highlights the risks of further cover losses of the three most important reef-building species in the Caribbean. PMID:27547525

Countries with women inequalities have higher stroke mortality.

PubMed

Kim, Young Dae; Jung, Yo Han; Caso, Valeria; Bushnell, Cheryl D; Saposnik, Gustavo

2017-10-01

Background Stroke outcomes can differ by women's legal or socioeconomic status. Aim We investigated whether differences in women's rights or gender inequalities were associated with stroke mortality at the country-level. Methods We used age-standardized stroke mortality data from 2008 obtained from the World Health Organization. We compared female-to-male stroke mortality ratio and stroke mortality rates in women and men between countries according to 50 indices of women's rights from Women, Business and the Law 2016 and Gender Inequality Index from the Human Development Report by the United Nations Development Programme. We also compared stroke mortality rate and income at the country-level. Results In our study, 176 countries with data available on stroke mortality rate in 2008 and indices of women's rights were included. There were 46 (26.1%) countries where stroke mortality in women was higher than stroke mortality in men. Among them, 29 (63%) countries were located in Sub-Saharan African region. After adjusting by country income level, higher female-to-male stroke mortality ratio was associated with 14 indices of women's rights, including differences in getting a job or opening a bank account, existence of domestic violence legislation, and inequalities in ownership right to property. Moreover, there was a higher female-to-male stroke mortality ratio among countries with higher Gender Inequality Index (r = 0.397, p < 0.001). Gender Inequality Index was more likely to be associated with stroke mortality rate in women than that in men (p < 0.001). Conclusions Our study suggested that the gender inequality status is associated with women's stroke outcomes.

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

PubMed

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

2014-03-01

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

Burden of cancer mortality and differences attributable to demographic aging and risk factors in Argentina, 1986-2011.

PubMed

Pou, Sonia Alejandra; Tumas, Natalia; Coquet, Julia Becaria; Niclis, Camila; Román, María Dolores; Díaz, María Del Pilar

2017-03-09

The world faces an aging population that implies a large number of people affected with chronic diseases. Argentina has reached an advanced stage of demographic transition and presents a comparatively high rate of cancer mortality within Latin America. The objectives of this study were to examine cancer mortality trends in the province of Córdoba, Argentina, between 1986 and 2011, and to analyze the differences attributable to risk variations and demographic changes. Longitudinal series of age-standardized mortality rates for overall, breast and prostate cancers were modeled by Joinpoint regression to estimate the annual percent change. The Bashir & Estève method was used to split crude mortality rate variation into three components: mortality risk, population age structure and population size. A decreasing cancer age-standardized mortality rates trend was observed (1986-2011 annual percent change: -1.4, 95%CI: -1.6, -1.2 in men; -0.8, 95%CI: -1.0, -0.6 in women), with a significant shift in 1996. There were positive crude mortality rate net changes for overall female cancer, breast and prostate cancers, which were primarily attributable to demographic changes. Inversely, overall male cancer crude mortality rate showed a 9.15% decrease, mostly due to mortality risk. Despite favorable age-standardized mortality rates trends, the influence of population aging reinforces the challenge to control cancer in populations with an increasingly aged demographic structure.

Update of a cohort mortality study of workers exposed to methylene chloride employed at a plant producing cellulose triacetate film base.

PubMed

Tomenson, John A

2011-12-01

To update the mortality experience of employees of a factory that produced cellulose triacetate film base at Brantham in the United Kingdom and generate information on the effects of exposure to methylene chloride, in particular, mortality from cardiovascular disease and cancers of the lung, liver and biliary tract, pancreas and brain. All 1,785 male employees with a record of employment at the film factory in 1946-1988 were followed through 2006, including 1,473 subjects exposed to methylene chloride on average for 9 years at a concentration of 19 ppm (8 h time-weighted average). A total of 559 deaths occurred during the follow-up period. In the subcohort of workers exposed to methylene chloride, substantially reduced mortalities compared with national and local rates were found for all causes, all cancers, and all the principal cancer sites of interest except for brain cancer. There was a small excess of brain cancer deaths (8 observed and 4.4 expected), but no evidence of an association with exposure to methylene chloride. Lung cancer mortality was significantly reduced in exposed workers, even compared to the low mortality rate in the local population (SMR 55). In contrast, mortality from ischaemic heart disease in exposed workers was slightly increased compared with local rates (SMR 102), but was lower in active employees (SMR 94; local rates), where a direct effect of exposure to methylene chloride should be concentrated. The study provided no indication that employment at the plant, or exposure to methylene chloride, had adversely affected the mortalities of workers.

Comparative mortality among US military personnel in the Persian Gulf region and worldwide during Operations Desert Shield and Desert Storm.

PubMed

Writer, J V; DeFraites, R F; Brundage, J F

1996-01-10

To determine cause-specific mortality rates among US troops stationed in the Persian Gulf region and compare them with those of US troops serving elsewhere during Operations Desert Shield and Desert Storm. Retrospective cohort. US men and women on active duty from August 1, 1990, through July 31, 1991. Deaths occurring among all active-duty US military persons during the 1-year study period. Age-adjusted mortality rates among US troops stationed in the Persian Gulf region were compared with rates projected from mortality rates among troops on active duty elsewhere. A total of 1769 active-duty persons died during the study period, 372 in the Persian Gulf region and 1397 elsewhere. Of the 372 deaths in the Persian Gulf region, 147 (39.5%) occurred as a direct result of combat during the war, 194 (52.2%) resulted from injuries not incurred in battle, and 30 (8%) resulted from illness. Twenty-three of the deaths due to illness were considered unexpected or cardiovascular deaths. Based on age-adjusted mortality rates observed among US troops on active duty outside the Persian Gulf region, 165 deaths from unintentional injury and 32 deaths from illness (20 of which were unexpected or cardiovascular) would have been anticipated among Persian Gulf troops. Except for deaths from unintentional injury, US troops in the Persian Gulf region did not experience significantly higher mortality rates than US troops serving elsewhere. There were no clusters of unexplained deaths. The number and circumstances of nonbattle deaths among Persian Gulf troops were typical for the US military population.

Slowdown in the decline of stroke mortality in the United States, 1978-1986.

PubMed

Cooper, R; Sempos, C; Hsieh, S C; Kovar, M G

1990-09-01

The gradual decline in stroke mortality rates observed in the United States since 1900 accelerated markedly around 1973 for whites and around 1968 for blacks. During the next decade stroke mortality rates decreased by almost 50% so that the United States now experiences one of the lowest stroke mortality rates in the world. Beginning in 1979, however the annual rate of decline in stroke mortality began to slow considerably. Comparing the period 1979-1986 with the previous decade, a 57% slowing in the absolute rate of decline (as estimated by the slope of the linear portion of the mortality curve) was observed for white men; the corresponding slowdowns in the rate of decline were 58% for white women, 44% for black men, and 62% for black women. If the decline during the 1980s had continued at the rate observed for the period 1968/73-1978, there would have been 131,000 fewer stroke deaths during the period 1979-1986, 28,000 fewer in 1986 alone. This slowdown in the rate of decline in stroke mortality is occurring while mortality rates for both coronary heart disease and all causes are leveling off. The reasons for this change in the mortality trend remain unknown, and corresponding trends in the treatment and control of hypertension do not provide an entirely satisfactory explanation.

Regional differences of standardised mortality rates for ischemic heart diseases in the Slovak Republic for the period 1996-2013 in the context of income inequality.

PubMed

Gavurová, Beáta; Vagašová, Tatiana

2016-12-01

The aim of paper is to analyse the development of standardised mortality rates for ischemic heart diseases in relation to the income inequality in the regions of Slovakia. This paper assesses different types of income indicators, such as mean equivalised net income per household, Gini coefficient, unemployment rate, at risk of poverty threshold (60 % of national median), S80/S20 and their effect on mortality. Using data from the Slovak mortality database 1996-2013, the method of direct standardisation was applied to eliminate variances resulted from differences in age structures of the population across regions and over time. To examine the relationships between income indicators and standardised mortality rates, we used the tools of descriptive statistics and methods of correlation and regression analysis. At first, we show that Slovakia has the worst values of standardised mortality rates for ischemic heart diseases in EU countries. Secondly, mortality rates are significantly higher for males compared with females. Thirdly, mortality rates are improving from Eastern Slovakia to Western Slovakia; additionally, high differences in the results of variability are seen among Slovak regions. Finally, the unemployment rate, the poverty rate and equivalent disposable income were statistically significant income indicators. Main contribution of paper is to demonstrate regional differences between mortality and income inequality, and to point out the long-term unsatisfactory health outcomes.

Racial and Residential Differences in U.S. Infant Death Rates: A Temporal Analysis.

ERIC Educational Resources Information Center

Johnson, Nan E.; Zaki, Khalida P.

1988-01-01

Compares annual rates of neonatal, postneonatal mortality to annual rates of low birth weight, 1963-1982. Shows that same level of decline in incidence of low birth weight is associated with greater decline in mortality rates of non-White than White infants and for nonmetro than metro infants. Contains 15 references. (Author/DHP)

Unintentional injury mortality among indigenous communities of Taiwan: trends from 2002 to 2013 and evaluation of a community-based intervention.

PubMed

Pan, Stephen W; Chong, Hiu Ha; Kao, Hui-Chuan

2017-11-27

Indigenous communities in Taiwan shoulder a disproportionate burden of unintentional injury fatalities. We compare unintentional injury mortality rate trends among Taiwan's indigenous communities and the general population from 2002 to 2013, and evaluate potential impact of a community-based injury prevention programme on indigenous unintentional injury death rates. Standardised and crude unintentional injury mortality rates were obtained from Taiwan government reports. Segmented linear regression was used to estimate and compare unintentional injury mortality rate trends before and after the intervention. Between 2002 and 2013, unintentional injury mortality rates among Taiwan's indigenous population significantly declined by about 4.5 deaths per 100 000 each year (p<0.0001). During that time, the unintentional injury mortality rate ratio between indigenous Taiwanese and the general population significantly decreased by approximately 1% each successive year (p=0.02). However, we were unable to detect evidence that the 'Healthy and Safe Tribe' programme was associated with a statistically significant decrease in the unintentional injury mortality rate trend among indigenous persons (p=0.81). Taiwanese indigenous communities remain at significantly higher risk of unintentional injury death, though the gap may be slowly narrowing. We found no evidence that the 'Healthy and Safe Tribe' indigenous injury-prevention programme significantly contributed to the nationwide decline in unintentional injury mortality among indigenous Taiwanese communities from 2009 to 2013. Future interventions to address the disproportionate burden of unintentional injury fatalities among indigenous Taiwanese should consider interventions with wider coverage of the indigenous population, and complementing grass roots led community-based interventions with structural policy interventions as well. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

How have changes in air bag designs affected frontal crash mortality?

PubMed

Braver, Elisa R; Shardell, Michelle; Teoh, Eric R

2010-07-01

To determine whether front air bag changes have affected occupant protection, frontal crash mortality rates were compared among front outboard occupants in vehicles having certified-advanced air bags (latest generation of air bags) or sled-certified air bags with and without advanced features. Poisson marginal structural models were used to calculate standardized mortality rate ratios (MRRs) for front occupants per registered vehicle. Vehicle age-corrected mortality rates were lower for drivers of vehicles having sled-certified air bags with advanced features than for drivers having sled-certified air bags without advanced features (MRR = 0.88; 95% confidence interval [CI]: 0.81-0.95), including unbelted men and drivers younger than 60. The mortality rate was higher, though not statistically significant, for drivers having certified-advanced air bags compared with sled-certified air bags with advanced features (vehicle age-corrected MRR = 1.13; 95% CI: 0.97-1.32) and significantly higher for belted drivers (MRR = 1.21; 95% CI: 1.04-1.39). Advanced air bag features appeared protective for some occupants. However, increased mortality rates among belted drivers of vehicles having certified-advanced air bags relative to those having sled-certified air bags with advanced features suggest that further study is needed to identify any potential problems with requirements for certification. 2010 Elsevier Inc. All rights reserved.

Cancer in Korean war navy technicians: mortality survey after 40 years.

PubMed

Groves, Frank D; Page, William F; Gridley, Gloria; Lisimaque, Laure; Stewart, Patricia A; Tarone, Robert E; Gail, Mitchell H; Boice, John D; Beebe, Gilbert W

2002-05-01

This study reports on over 40 years of mortality follow-up of 40,581 Navy veterans of the Korean War with potential exposure to high-intensity radar. The cohort death rates were compared with mortality rates for White US men using standardized mortality ratios, and the death rates for men in occupations considered a priori to have high radar exposure were compared with the rates for men in low-exposure occupations using Poisson regression. Deaths from all diseases and all cancers were significantly below expectation overall and for the 20,021 sailors with high radar exposure potential. There was no evidence of increased brain cancer in the entire cohort (standardized mortality ratio (SMR) = 0.9, 95% confidence interval (CI): 0.7, 1.1) or in high-exposure occupations (SMR = 0.7, 95% CI: 0.5, 1.0). Testicular cancer deaths also occurred less frequently than expected in the entire cohort and high-exposure occupations. Death rates for several smoking-related diseases were significantly lower in the high-exposure occupations. Nonlymphocytic leukemia was significantly elevated among men in high-exposure occupations but in only one of the three high-exposure occupations, namely, electronics technicians in aviation squadrons (SMR = 2.2, 95% CI: 1.3, 3.7). Radar exposure had little effect on mortality in this cohort of US Navy veterans.

Meta-analysis of treatment with rabbit and horse antithymocyte globulin for aplastic anemia.

PubMed

Hayakawa, Jin; Kanda, Junya; Akahoshi, Yu; Harada, Naonori; Kameda, Kazuaki; Ugai, Tomotaka; Wada, Hidenori; Ishihara, Yuko; Kawamura, Koji; Sakamoto, Kana; Ashizawa, Masahiro; Sato, Miki; Terasako-Saito, Kiriko; Kimura, Shun-Ichi; Kikuchi, Misato; Yamazaki, Rie; Kako, Shinichi; Kanda, Yoshinobu

2017-05-01

Aplastic anemia patients who received rabbit antithymocyte globulin exhibited response and survival rates inferior to those who received horse antithymocyte globulin in several studies. Therefore, we conducted a meta-analysis to compare rabbit and horse antithymocyte globulin as immunosuppressive therapy for aplastic anemia. We searched online databases for studies that compared antithymocyte globulin regimens as first-line treatment for aplastic anemia, including both randomized and non-randomized controlled trials. The early mortality rate at 3 months and overall response rate at 6 months were evaluated. Thirteen studies were included in the analysis. The risk ratio (RR) of early mortality for rabbit vs. horse antithymocyte globulin was 1.33 [95% confidence interval (CI) 0.69-2.57; P = 0.39], with significant heterogeneity. A sensitivity analysis suggested higher early mortality rate in patients who received rabbit antithymocyte globulin. The overall response rate was significantly higher in patients who received horse antithymocyte globulin (RR 1.27; 95% CI 1.05-1.54; P = 0.015). In conclusion, in aplastic anemia patients treated with ATG, early mortality rate was not significantly different in patients receiving horse or rabbit ATG, although a sensitivity analysis showed higher early mortality in the rabbit ATG group. Horse ATG was associated with significantly higher response rate than rabbit ATG.

NT-proBNP: Is It a More Significant Risk Factor for Mortality Than Troponin T in Incident Hemodialysis Patients?

PubMed Central

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

2014-01-01

Abstract Numerous studies have demonstrated that cardiac biomarkers are significant predictors of cardiovascular (CV) and all-cause mortality in ESRD patients, but most of the studies were retrospective or included small numbers of patients, only prevalent dialysis patients, or measured 1 or 2 biomarkers. This study was to analyze the association between 3 cardiac biomarkers and mortality in incident HD patients. A prospective cohort of 864 incident HD patients was followed for 30 months. Based on the median values of baseline NT-proBNP, cTnT, and hsCRP, the patients were divided into “high” and “low” groups, and CV and all-cause mortality were compared between each group. Additionally, time-dependent ROC curves were constructed, and the NRI and IDI of the models with various biomarkers were calculated. The CV survival rates were significantly lower in the “high” NT-proBNP and cTnT groups compared to the corresponding “low” groups, while there was no significant difference in CV survival rate between the 2 hsCRP groups. However, all-cause mortality rates were significantly higher in all 3 “high” groups compared to each lower group. In multivariate analyses, only Ln NT-proBNP was found to be an independent predictor of mortality. Moreover, NT-proBNP was a more prognostic marker for mortality compared to cTnT. In conclusion, NT-proBNP is the biomarker that results in the most added prognostic value on top of traditional risk factors for CV and all-cause mortality in incident HD patients. PMID:25501091

Mortality throughout early childhood for Michigan children born with congenital anomalies, 1992-1998.

PubMed

Berger, Katherine H; Zhu, Bao-Ping; Copeland, Glenn

2003-09-01

Congenital anomalies are a leading cause of infant deaths, accounting for almost a fifth of all infant deaths. Few studies have researched the survival experience of infants born with congenital anomalies past the infant stage. Using birth and death files routinely linked to the Michigan Birth Defects Registry, we identified all singleton infants during calendar years 1992 through 1998 with reportable congenital anomalies for our study. A comparative file of children born without congenital anomalies during the same time period was developed using linked birth and death files. The mortality data were assessed by age at death (through age six) and race to determine mortality rates, relative risks, hazard ratios, and survival trends. Throughout early childhood, children born with congenital anomalies had a high risk of mortality compared with all other children. The overall 7-year hazard ratio comparing children with congenital anomalies with all other children was 7.2. Overall mortality rates for black children were significantly higher than white children through the age of seven, irrespective of whether they had congenital anomalies. Among children with congenital anomalies, this disparity disappeared after adjusting for birth weight, sex, mother's age, mother's education, and number of organ systems affected. Compared with children without congenital anomalies, children born with congenital anomalies had a higher risk of mortality well beyond the infant period. Racial disparities in mortality rates among children with congenital anomalies were due to confounding factors.

Income inequality and socioeconomic gradients in mortality.

PubMed

Wilkinson, Richard G; Pickett, Kate E

2008-04-01

We investigated whether the processes underlying the association between income inequality and population health are related to those responsible for the socioeconomic gradient in health and whether health disparities are smaller when income differences are narrower. We used multilevel models in a regression analysis of 10 age- and cause-specific US county mortality rates on county median household incomes and on state income inequality. We assessed whether mortality rates more closely related to county income were also more closely related to state income inequality. We also compared mortality gradients in more- and less-equal states. Mortality rates more strongly associated with county income were more strongly associated with state income inequality: across all mortality rates, r= -0.81; P=.004. The effect of state income inequality on the socioeconomic gradient in health varied by cause of death, but greater equality usually benefited both wealthier and poorer counties. Although mortality rates with steep socioeconomic gradients were more sensitive to income distribution than were rates with flatter gradients, narrower income differences benefit people in both wealthy and poor areas and may, paradoxically, do little to reduce health disparities.

Increased mortality rate and suicide in Swedish former elite male athletes in power sports.

PubMed

Lindqvist, A-S; Moberg, T; Ehrnborg, C; Eriksson, B O; Fahlke, C; Rosén, T

2014-12-01

Physical training has been shown to reduce mortality in normal subjects, and athletes have a healthier lifestyle after their active career as compared with normal subjects. Since the 1950s, the use of anabolic androgenic steroids (AAS) has been frequent, especially in power sports. The aim of the present study was to investigate mortality, including causes of death, in former Swedish male elite athletes, active 1960-1979, in wrestling, powerlifting, Olympic lifting, and the throwing events in track and field when the suspicion of former AAS use was high. Results indicate that, during the age period of 20-50 years, there was an excess mortality of around 45%. However, when analyzing the total study period, the mortality was not increased. Mortality from suicide was increased 2-4 times among the former athletes during the period of 30-50 years of age compared with the general population of men. Mortality rate from malignancy was lower among the athletes. As the use of AAS was marked between 1960 and 1979 and was not doping-listed until 1975, it seems probable that the effect of AAS use might play a part in the observed increased mortality and suicide rate. The otherwise healthy lifestyle among the athletes might explain the low malignancy rates. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Does early functional outcome predict 1-year mortality in elderly patients with hip fracture?

PubMed

Dubljanin-Raspopović, Emilija; Marković-Denić, Ljiljana; Marinković, Jelena; Nedeljković, Una; Bumbaširević, Marko

2013-08-01

Hip fractures in the elderly are followed by considerable risk of functional decline and mortality. The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures. A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables. Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture. Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.

Increased Incidence of Critical Illness in Psoriasis.

PubMed

Marrie, Ruth Ann; Bernstein, Charles N; Peschken, Christine A; Hitchon, Carol A; Chen, Hui; Garland, Allan

Psoriasis is associated with an increased risk of comorbid disease. Despite the recognition of increased morbidity in psoriasis, the effects on health care utilisation remain incompletely understood. Little is known about the risk of intensive care unit (ICU) admission in persons with psoriasis. To compare the incidence of ICU admission and post-ICU mortality rates in a psoriasis population compared with a matched population without psoriasis. Using population-based administrative data from Manitoba, Canada, we identified 40 930 prevalent cases of psoriasis and an age-, sex-, and geographically matched cohort from the general population (n = 150 210). We compared the incidence of ICU admission between populations using incidence rates and Cox regression models adjusted for age, sex, socioeconomic status, and comorbidity and compared mortality after ICU admission. Among incident psoriasis cases (n = 30 150), the cumulative 10-year incidence of ICU admission was 5.6% (95% confidence interval [CI], 5.3%-5.8%), 21% higher than in the matched cohort (incidence rate ratio, 1.21; 95% CI, 1.15-1.27). In the prevalent psoriasis cohort, crude mortality in the ICU was 11.5% (95% CI, 9.9%-13.0%), 32% higher than observed in the matched population admitted to the ICU (8.7%; 95% CI, 8.3%-9.1%). Mortality rates after ICU admission remained elevated at all time points in the psoriasis cohort compared with the matched cohort. Psoriasis is associated with an increased risk for ICU admission and with an increased risk of mortality post-ICU admission.

Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study.

PubMed

Chen, Chien-Min; Yang, Yao-Hsu; Chang, Chia-Hao; Chen, Pau-Chung

2017-12-01

To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. Retrospective cohort study. Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR, 1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity (Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted HR, 4.23). First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Birth rates among male cancer survivors and mortality rates among their offspring: a population-based study from Sweden.

PubMed

Tang, Siau-Wei; Liu, Jenny; Juay, Lester; Czene, Kamila; Miao, Hui; Salim, Agus; Verkooijen, Helena M; Hartman, Mikael

2016-03-08

With improvements in treatment of cancer, more men of fertile age are survivors of cancer. This study evaluates trends in birth rates among male cancer survivors and mortality rates of their offspring. From the Swedish Multi-generation Register and Cancer Register, we identified 84,752 men ≤70 years with a history of cancer, for which we calculated relative birth rates as compared to the background population(Standardized Birth Ratios, SBRs). We also identified 126,696 offspring of men who had cancer, and compared their risks of death to the background population(Standardized Mortality Ratio, SMRs). Independent factors associated with reduced birth rates and mortality rates were estimated with Poisson modelling. Men with a history of cancer were 23 % less likely to father a child compared to the background population(SBR 0.77, 95 % Confidence Interval[CI] 0.75-0.79). Nulliparous men were significantly more likely to father a child after diagnosis (SBR 0.81, 95 % CI 0.79-0.83) compared to parous men (SBR 0.68, 95 % CI 0.66-0.74). Cancer site(prostate), onset of cancer during childhood or adolescence, parity status at diagnosis(parous), current age(>40 years) and a recent diagnosis were significant and independent predictors of a reduced probability of fathering a child after diagnosis. Of the 126,696 children born to men who have had a diagnosis of cancer, 2604(2.06 %) died during follow up. The overall mortality rate was similar to the background population(SMR of 1.00, 95 %CI 0.96-1.04) and was not affected by the timing of their birth in relation to father's cancer diagnosis. Male cancer survivors are less likely to father a child compared to the background population. This is influenced by cancer site, age of onset and parity status at diagnosis. However, their offspring are not at an increased risk of death.

Gestational age specific neonatal survival in the State of Qatar (2003-2008) - a comparative study with international benchmarks.

PubMed

Rahman, Sajjad; Salameh, Khalil; Al-Rifai, Hilal; Masoud, Ahmed; Lutfi, Samawal; Salama, Husam; Abdoh, Ghassan; Omar, Fahmi; Bener, Abdulbari

2011-09-01

To analyze and compare the current gestational age specific neonatal survival rates between Qatar and international benchmarks. An analytical comparative study. Women's Hospital, Hamad Medical Corporation, Doha, Qatar, from 2003-2008. Six year's (2003-2008) gestational age specific neonatal mortality data was stratified for each completed week of gestation at birth from 24 weeks till term. The data from World Health Statistics by WHO (2010), Vermont Oxford Network (VON, 2007) and National Statistics United Kingdom (2006) were used as international benchmarks for comparative analysis. A total of 82,002 babies were born during the study period. Qatar's neonatal mortality rate (NMR) dropped from 6/1000 in 2003 to 4.3/1000 in 2008 (p < 0.05). The overall and gestational age specific neonatal mortality rates of Qatar were comparable with international benchmarks. The survival of < 27 weeks and term babies was better in Qatar (p=0.01 and p < 0.001 respectively) as compared to VON. The survival of > 32 weeks babies was better in UK (p=0.01) as compared to Qatar. The relative risk (RR) of death decreased with increasing gestational age (p < 0.0001). Preterm babies (45%) followed by lethal chromosomal and congenital anomalies (26.5%) were the two leading causes of neonatal deaths in Qatar. The current total and gestational age specific neonatal survival rates in the State of Qatar are comparable with international benchmarks. In Qatar, persistently high rates of low birth weight and lethal chromosomal and congenital anomalies significantly contribute towards neonatal mortality.

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

PubMed Central

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

2013-01-01

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

Revisiting the effect of colonial institutions on comparative economic development

PubMed Central

Regele, Matthew

2017-01-01

European settler mortality has been proposed as an instrument to predict the causal effect of colonial institutions on differences in economic development. We examine the relationship between mortality, temperature, and economic development in former European colonies in Asia, Africa, and the Americas. We find that (i) European settler mortality rates increased with regional temperatures and (ii) economic output decreased with regional temperatures. Conditioning on the continent of settlement and accounting for colonies that were not independent as of 1900 undermines the causal effect of colonial institutions on comparative economic development. Our findings run counter to the institutions hypothesis of economic development, showing instead that geography affected both historic mortality rates and present-day economic output. PMID:28481920

Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population.

PubMed

Rodger, Alison J; Lodwick, Rebecca; Schechter, Mauro; Deeks, Steven; Amin, Janaki; Gilson, Richard; Paredes, Roger; Bakowska, Elzbieta; Engsig, Frederik N; Phillips, Andrew

2013-03-27

Due to the success of antiretroviral therapy (ART), it is relevant to ask whether death rates in optimally treated HIV are higher than the general population. The objective was to compare mortality rates in well controlled HIV-infected adults in the SMART and ESPRIT clinical trials with the general population. Non-IDUs aged 20-70 years from the continuous ART control arms of ESPRIT and SMART were included if the person had both low HIV plasma viral loads (≤400 copies/ml SMART, ≤500 copies/ml ESPRIT) and high CD4(+) T-cell counts (≥350 cells/μl) at any time in the past 6 months. Standardized mortality ratios (SMRs) were calculated by comparing death rates with the Human Mortality Database. Three thousand, two hundred and eighty individuals [665 (20%) women], median age 43 years, contributed 12,357 person-years of follow-up. Sixty-two deaths occurred during follow up. Commonest cause of death was cardiovascular disease (CVD) or sudden death (19, 31%), followed by non-AIDS malignancy (12, 19%). Only two deaths (3%) were AIDS-related. Mortality rate was increased compared with the general population with a CD4(+) cell count between 350 and 499 cells/μl [SMR 1.77, 95% confidence interval (CI) 1.17-2.55]. No evidence for increased mortality was seen with CD4(+) cell counts greater than 500 cells/μl (SMR 1.00, 95% CI 0.69-1.40). In HIV-infected individuals on ART, with a recent undetectable viral load, who maintained or had recovery of CD4(+) cell counts to at least 500 cells/μl, we identified no evidence for a raised risk of death compared with the general population.

Motor neuron disease mortality rates in New Zealand 1992-2013.

PubMed

Cao, Maize C; Chancellor, Andrew; Charleston, Alison; Dragunow, Mike; Scotter, Emma L

2018-05-01

We determined the mortality rates of motor neuron disease (MND) in New Zealand over 22 years from 1992 to 2013. Previous studies have found an unusually high and/or increasing incidence of MND in certain regions of New Zealand; however, no studies have examined MND rates nationwide to corroborate this. Death certificate data coded G12.2 by International Classification of Diseases (ICD)-10 coding, or 335.2 by ICD-9 coding were obtained. These codes specify amyotrophic lateral sclerosis, progressive bulbar palsy, or other motor neuron diseases as the underlying cause of death. Mortality rates for MND deaths in New Zealand were age-standardized to the European Standard Population and compared with rates from international studies that also examined death certificate data and were age-standardized to the same standard population. The age-standardized mortality from MND in New Zealand was 2.3 per 100,000 per year from 1992-2007 and 2.8 per 100,000 per year from 2008-2013. These rates were 3.3 and 4.0 per 100,000 per year, respectively, for the population 20 years and older. The increase in rate between these two time periods was likely due to changes in MND death coding from 2008. Contrary to a previous regional study of MND incidence, nationwide mortality rates did not increase steadily over this time period once aging was accounted for. However, New Zealand MND mortality rate was higher than comparable studies we examined internationally (mean 1.67 per 100,000 per year), suggesting that further analysis of MND burden in New Zealand is warranted.

Cervical Cancer Incidence and Mortality Among American Indian and Alaska Native Women, 1999–2009

PubMed Central

Benard, Vicki; Thomas, Cheryll; Brayboy, Annie; Paisano, Roberta; Becker, Thomas

2014-01-01

Objectives. We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races. Methods. We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009. Results. AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (−25.8%/year) and remained stable thereafter. Conclusions. Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions. PMID:24754650

Weight-elimination neural networks applied to coronary surgery mortality prediction.

PubMed

Ennett, Colleen M; Frize, Monique

2003-06-01

The objective was to assess the effectiveness of the weight-elimination cost function in improving classification performance of artificial neural networks (ANNs) and to observe how changing the a priori distribution of the training set affects network performance. Backpropagation feedforward ANNs with and without weight-elimination estimated mortality for coronary artery surgery patients. The ANNs were trained and tested on cases with 32 input variables describing the patient's medical history; the output variable was in-hospital mortality (mortality rates: training 3.7%, test 3.8%). Artificial training sets with mortality rates of 20%, 50%, and 80% were created to observe the impact of training with a higher-than-normal prevalence. When the results were averaged, weight-elimination networks achieved higher sensitivity rates than those without weight-elimination. Networks trained on higher-than-normal prevalence achieved higher sensitivity rates at the cost of lower specificity and correct classification. The weight-elimination cost function can improve the classification performance when the network is trained with a higher-than-normal prevalence. A network trained with a moderately high artificial mortality rate (artificial mortality rate of 20%) can improve the sensitivity of the model without significantly affecting other aspects of the model's performance. The ANN mortality model achieved comparable performance as additive and statistical models for coronary surgery mortality estimation in the literature.

Mortality patterns among residents in Louisiana's industrial corridor, USA, 1970–99

PubMed Central

Tsai, S; Cardarelli, K; Wendt, J; Fraser, A

2004-01-01

Background: Because of the high concentration of oil refining and petrochemical facilities, the industrial area of the lower Mississippi River of South Louisiana has been termed the Industrial Corridor and has frequently been referred to as the "Cancer Corridor". Aims: To quantitatively assess the "Cancer Corridor" controversy based on mortality data available in the public domain, and to identify potential contributing factors to the observed differences in mortality. Methods: Age adjusted mortality rates were calculated for white and non-white males and females in the Industrial Corridor, Louisiana, and the United States for the time periods 1970–79, 1980–89, and 1990–99. Results: All-cause mortality and all cancer combined for white males in the Industrial Corridor were significantly lower than the corresponding Louisiana population while Louisiana had significantly higher rates than the US population for all three time periods. Cancer of the lung was consistently higher in the Industrial Corridor region relative to national rates but lower than or similar to Louisiana. Non-respiratory disease and cerebrovascular disease mortality for white males in the Industrial Corridor were consistently lower than either Louisiana or the USA. However, mortality due to diabetes and heart disease, particularly during the 1990s, was significantly higher in the Industrial Corridor and Louisiana when compared to the USA. Similar mortality patterns were observed for white females. The mortality for non-white males and females in the Industrial Corridor was generally similar to the corresponding populations in Louisiana. There were no consistent patterns for all cancer mortality combined. Stomach cancer was increased among non-whites in both the Industrial Corridor and Louisiana when compared to the corresponding US data. Mortality from diabetes and heart disease among non-whites was significantly higher in the Industrial Corridor and Louisiana than in the USA. Conclusions: Mortality rates in the Industrial Corridor area were generally similar to or lower than the State of Louisiana, which were increased compared to the United States. Contrary to prior public perceptions, mortality due to cancer in the Industrial Corridor does not exceed that for the State of Louisiana. PMID:15031386

Avoidable mortality among First Nations adults in Canada: A cohort analysis.

PubMed

Park, Jungwee; Tjepkema, Michael; Goedhuis, Neil; Pennock, Jennifer

2015-08-01

Avoidable mortality is a measure of deaths that potentially could have been averted through effective prevention practices, public health policies, and/or provision of timely and adequate health care. This longitudinal analysis compares avoidable mortality among First Nations and non-Aboriginal adults. Data are from the 1991-to-2006 Canadian Census Mortality and Cancer Follow-up Study. A 15% sample of 1991 Census respondents aged 25 or older was linked to 16 years of mortality data. This study examines avoidable mortality among 61,220 First Nations and 2,510,285 non-Aboriginal people aged 25 to 74. During the 1991-to-2006 period, First Nations adults had more than twice the risk of dying from avoidable causes compared with non-Aboriginal adults. The age-standardized avoidable mortality rate (ASMR) per 100,000 person-years at risk for First Nations men was 679.2 versus 337.6 for non-Aboriginal men (rate ratio = 2.01). For women, ASMRs were lower, but the gap was wider. The ASMR for First Nations women was 453.2, compared with 183.5 for non-Aboriginal women (rate ratio = 2.47). Disparities were greater at younger ages. Diabetes, alcohol and drug use disorders, and unintentional injuries were the main contributors to excess avoidable deaths among First Nations adults. Education and income accounted for a substantial share of the disparities. The results highlight the gap in avoidable mortality between First Nations and non-Aboriginal adults due to specific causes of death and the association with socioeconomic factors.

Variability in the measurement of hospital-wide mortality rates.

PubMed

Shahian, David M; Wolf, Robert E; Iezzoni, Lisa I; Kirle, Leslie; Normand, Sharon-Lise T

2010-12-23

Several countries use hospital-wide mortality rates to evaluate the quality of hospital care, although the usefulness of this metric has been questioned. Massachusetts policymakers recently requested an assessment of methods to calculate this aggregate mortality metric for use as a measure of hospital quality. The Massachusetts Division of Health Care Finance and Policy provided four vendors with identical information on 2,528,624 discharges from Massachusetts acute care hospitals from October 1, 2004, through September 30, 2007. Vendors applied their risk-adjustment algorithms and provided predicted probabilities of in-hospital death for each discharge and for hospital-level observed and expected mortality rates. We compared the numbers and characteristics of discharges and hospitals included by each of the four methods. We also compared hospitals' standardized mortality ratios and classification of hospitals with mortality rates that were higher or lower than expected, according to each method. The proportions of discharges that were included by each method ranged from 28% to 95%, and the severity of patients' diagnoses varied widely. Because of their discharge-selection criteria, two methods calculated in-hospital mortality rates (4.0% and 5.9%) that were twice the state average (2.1%). Pairwise associations (Pearson correlation coefficients) of discharge-level predicted mortality probabilities ranged from 0.46 to 0.70. Hospital-performance categorizations varied substantially and were sometimes completely discordant. In 2006, a total of 12 of 28 hospitals that had higher-than-expected hospital-wide mortality when classified by one method had lower-than-expected mortality when classified by one or more of the other methods. Four common methods for calculating hospital-wide mortality produced substantially different results. This may have resulted from a lack of standardized national eligibility and exclusion criteria, different statistical methods, or fundamental flaws in the hypothesized association between hospital-wide mortality and quality of care. (Funded by the Massachusetts Division of Health Care Finance and Policy.).

Cervical cancer, a disease of poverty: mortality differences between urban and rural areas in Mexico.

PubMed

Palacio-Mejía, Lina Sofía; Rangel-Gómez, Gudelia; Hernández-Avila, Mauricio; Lazcano-Ponce, Eduardo

2003-01-01

To examine cervical cancer mortality rates in Mexican urban and rural communities, and their association with poverty-related factors, during 1990-2000. We analyzed data from national databases to obtain mortality trends and regional variations using a Poisson regression model based on location (urban-rural). During 1990-2000 a total of 48,761 cervical cancer (CC) deaths were reported in Mexico (1990 = 4,280 deaths/year; 2000 = 4,620 deaths/year). On average, 12 women died every 24 hours, with 0.76% yearly annual growth in CC deaths. Women living in rural areas had 3.07 higher CC mortality risks compared to women with urban residence. Comparison of state CC mortality rates (reference = Mexico City) found higher risk in states with lower socio-economic development (Chiapas, relative risk [RR] = 10.99; Nayarit, RR = 10.5). Predominantly rural states had higher CC mortality rates compared to Mexico City (lowest rural population). CC mortality is associated with poverty-related factors, including lack of formal education, unemployment, low socio-economic level, rural residence and insufficient access to healthcare. This indicates the need for eradication of regional differences in cancer detection. This paper is available too at: http://www.insp.mx/salud/index.html.

Secular Changes in Postfracture Outcomes Over 2 Decades in Australia: A Time-Trend Comparison of Excess Postfracture Mortality in Two Birth Controls Over Two Decades.

PubMed

Bliuc, Dana; Tran, Thach; Alarkawi, Dunia; Nguyen, Tuan V; Eisman, John A; Center, Jacqueline R

2016-06-01

Hip fracture incidence has been declining and life expectancy improving. However, trends of postfracture outcomes are unknown. The objective of the study was to compare the refracture risk and excess mortality after osteoporotic fracture between two birth cohorts, over 2 decades. Prospective birth cohorts were followed up over 2 decades (1989-2004 and 2000-2014). The study was conducted in community-dwelling participants in Dubbo, Australia. Women and men aged 60-80 years, participating in Dubbo Osteoporosis Epidemiology Study 1 (DOES 1; born before 1930) and Dubbo Osteoporosis Epidemiology Study 2 (DOES 2; born after 1930) participated in the study. Age-standardized fracture and mortality over two time intervals: (1989-2004 [DOES 1] and 2000-2014 [DOES 2]) were measured. The DOES 2 cohort had higher body mass index and bone mineral density and lower initial fracture rate than DOES 1, but similar refracture rates [age-standardized refracture rates per 1000 person-years: women: 53 (95% confidence interval [CI] 42-63) and 51 (95% CI 41-60) and men: 53 (95% CI 38-69) and 55 (95% CI 40-71) for DOES 2 and DOES 1, respectively). Absolute postfracture mortality rates declined in DOES 2 compared with DOES 1, mirroring the improvement in general-population life expectancy. However, when compared with period-specific general-population mortality, there was a similar 2.1- to 2.6-fold increased mortality risk after a fracture in both cohorts (age-adjusted standardized mortality ratio, women: 2.05 [95% CI 1.43-2.83] and 2.43 [95% CI 1.95-2.99] and men: 2.56 [95% CI 1.78-3.58] and 2.48 [95% CI 1.87-3.22] for DOES 2 and DOES 1, respectively). Over the 2 decades, despite the decline in the prevalence of fracture risk factors, general-population mortality, and initial fracture incidence, there was no improvement in postfracture outcomes. Refracture rates were similar and fracture-associated mortality was 2-fold higher than expected. These data indicate that the low postfracture treatment rates are still a major problem.

Comparing alcohol mortality in Tsarist and contemporary Russia: is the current situation historically unique?

PubMed

Andreev, Evgeny; Bogoyavlensky, Dmitri; Stickley, Andrew

2013-01-01

This study compared the level of alcohol mortality in tsarist and contemporary Russia. Cross-sectional and annual time-series data from 1870 to 1894, 2008 and 2009 on the mortality rate from deaths due to 'drunkenness' were compared for men in the 50 provinces of tsarist 'European Russia': an area that today corresponds with the territory occupied by the Baltic countries, Belarus, Moldova, Ukraine and the Russian provinces to the west of the Ural Mountains. In 1870-1894, the male death rate from 'drunkenness' in the Russian provinces (15.9 per 100,000) was much higher than in the non-Russian provinces. However, the rate recorded in Russia in the contemporary period was even higher--23.3. Russia has had high levels of alcohol mortality from at least the late 19th century onwards. While a dangerous drinking pattern and spirits consumption may underpin high alcohol mortality across time, the seemingly much higher levels in the contemporary period seem to be also driven by an unprecedented level of consumption, and also possibly, surrogate alcohol use. This study highlights the urgent need to reduce the level of alcohol consumption among the population in order to reduce high levels of alcohol mortality in contemporary Russia.

Determinants of self-rated health: could health status explain the association between self-rated health and mortality?

PubMed

Murata, Chiyoe; Kondo, Takaaki; Tamakoshi, Koji; Yatsuya, Hiroshi; Toyoshima, Hideaki

2006-01-01

The purpose of this study was to investigate factors related to self-rated health and to mortality among 2490 community-living elderly. Respondents were followed for 7.3 years for all-cause mortality. To compare the relative impact of each variable, we employed logistic regression analysis for self-rated health and Cox hazard analysis for mortality. Cox analysis stratified by gender, follow-up periods, age group, and functional status was also employed. Series of analysis found that factors associated with self-rated health and with mortality were not identical. Psychological factors such as perceived isolation at home or 'ikigai (one aspect of psychological well-being)' were associated with self-rated health only. Age, functional status, and social relations were associated both with self-rated health and mortality after controlling for possible confounders. Illnesses and functional status accounted for 35-40% of variances in the fair/poor self-rated health. Differences by gender and functional status were observed in the factors related to self-rated health. Overall, self-rated health effect on mortality was stronger for people with no functional impairment, for shorter follow-up period, and for young-old age group. Although, illnesses and functional status were major determinants of self-rated health, economical, psychological, and social factors were also related to self-rated health.

Do burns increase the severity of terror injuries?

PubMed

Peleg, Kobi; Liran, Alon; Tessone, Ariel; Givon, Adi; Orenstein, Arie; Haik, Josef

2008-01-01

The use of explosives and suicide bombings has become more frequent since October 2000. This change in the nature of terror attacks has marked a new era in the Israeli-Palestinian conflict. We previously reported that the incidence of thermal injuries has since risen. However, the rise in the incidence of burns among victims of terror was proportionate to the rise in the incidence of burns among all trauma victims. This paper presents data from the Israeli National Trauma Registry during the years 1997--2003, to compare the severity of injuries and outcome (mortality rates) in terror victims with and without burn injuries. We also compare the severity of injuries and outcome (mortality rates) for patients with terror-attack related burns to non terror-attack related burns during the same period. Data was obtained from the Israeli National Trauma Registry for all patients admitted to 8 to 10 hospitals in Israel between 1997 and 2003. We analyzed and compared demographic and clinical characteristics of 219 terror-related burn patients (terror/burn), 2228 terror patients with no associated burns (Terror/no-burn) and 6546 non terror related burn patients (burn/no-terror). Severity of injuries was measured using the injury severity score, and burn severity by total body surface percentage indices. Admission rates to Intensive Care Units (ICU) and total length of hospitalization were also used to measure severity of injuries. In-hospital mortality rates were used to indicate outcome. Of burn/terror patients, 87.2% suffered other accompanying injuries, compared with 10.4% of burn/no-terror patients. Of burn/terror patients, 49.8% were admitted to ICU compared with only 11.9% of burn/no-terror patients and 23.8% of no-burn/terror patients. Mean length of hospital stay was 18.5 days for the terror/burn group compared with 11.1 days for the burn/no-terror group and 9.5 days for the terror/no-burn group. Burn/terror patients had a significantly higher injury severity score compared with the other groups. In-hospital mortality rate for the burn/no-terror group was 3.4%. The burn/terror group had a mortality rate of 6.4% which was similar to the no-burn/terror group (6.6%). Terror-attack injuries with accompanying burns have a more complex presentation, are of higher severity, and are associated with increased length of hospital stay and a higher ICU admissions rate, compared with terror-attack injuries without burns and non terror-attack related burns. However, mortality rates in terror-attack injuries are not affected by burns.

Mortality after hip fracture: regional variations in New Zealand.

PubMed

Walker, N; Norton, R; Vander Hoorn, S; Rodgers, A; MacMahon, S; Clark, T; Gray, H

1999-07-23

To determine the 35-day and one-year mortality rates following a hospital admission for hip fracture, among individuals aged 60 years or older in New Zealand. New Zealand Health Information Service mortality data for the years 1988 to 1992 were examined to determine the case fatality rate among individuals aged 60 years or older admitted to hospital for fractures of the neck of femur (ICD-9 N-code 820). Case fatality rates assessed at 35 days and one year after admission to hospital were examined by age, gender, year of admission, place of residence, area health board region and cause of death. Between 1988 and 1992, the case fatality rate was 8% within 35 days of admission to hospital and 24% within one year of admission. Case fatality rates were found to be twice as high in men compared to women and four to five times higher in individuals aged 85 years and older, compared to people aged between 60 and 64 years. The only regional difference in hip fracture mortality was found in the Canterbury area health board region, which had a 30% higher rate of hip fracture mortality compared to all regions combined. The two main cited underlying causes of death after hip fracture were accidental falls (ICD E880-E888) and ischaemic heart disease (ICD 410-414). Over three-quarters of individuals aged 60 years or older who are hospitalised with a hip fracture in New Zealand survive for at least one year after admission. However, significant variations in mortality exist with age and gender. These data highlight the importance of preventive strategies for hip fracture in older people and the need to identify ways of improving post-admission care.

What Is the Best Way to Measure Surgical Quality? Comparing the American College of Surgeons National Surgical Quality Improvement Program versus Traditional Morbidity and Mortality Conferences.

PubMed

Zhang, Jacques X; Song, Diana; Bedford, Julie; Bucevska, Marija; Courtemanche, Douglas J; Arneja, Jugpal S

2016-04-01

Morbidity and mortality conferences have played a traditional role in tracking complications. Recently, the American College of Surgeons National Surgical Quality Improvement Program Pediatrics (ACS NSQIP-P) has gained popularity as a risk-adjusted means of addressing quality assurance. The purpose of this article is to report an analysis of the two methodologies used within pediatric plastic surgery to determine the best way to manage quality. ACS NSQIP-P and morbidity and mortality data were extracted for 2012 and 2013 at a quaternary care institution. Overall complication rates were compared statistically, segregated by type and severity, followed by a subset comparison of ACS NSQIP-P-eligible cases only. Concordance and discordance rates between the two methodologies were determined. One thousand two hundred sixty-one operations were performed in the study period. Only 51.4 percent of cases were ACS NSQIP-P eligible. The overall complication rates of ACS NSQIP-P (6.62 percent) and morbidity and mortality conferences (6.11 percent) were similar (p = 0.662). Comparing for only ACS NSQIP-P-eligible cases also yielded a similar rate (6.62 percent versus 5.71 percent; p = 0.503). Although different complications are tracked, the concordance rate for morbidity and mortality and ACS NSQIP-P was 35.1 percent and 32.5 percent, respectively. The ACS NSQIP-P database is able to accurately track complication rates similarly to morbidity and mortality conferences, although it samples only half of all procedures. Although both systems offer value, limitations exist, such as differences in definitions and purpose. Because of the rigor of the ACS NSQIP-P, we recommend that it be expanded to include currently excluded cases and an extension of the study interval.

Socioeconomic gradients in all-cause, premature and avoidable mortality among immigrants and long-term residents using linked death records in Ontario, Canada.

PubMed

Khan, Anam M; Urquia, Marcelo; Kornas, Kathy; Henry, David; Cheng, Stephanie Y; Bornbaum, Catherine; Rosella, Laura C

2017-07-01

Immigrants have been shown to possess a health advantage, yet are also more likely to reside in arduous economic conditions. Little is known about if and how the socioeconomic gradient for all-cause, premature and avoidable mortality differs according to immigration status. Using several linked population-based vital and demographic databases from Ontario, we examined a cohort of all deaths in the province between 2002 and 2012. We constructed count models, adjusted for relevant covariates, to attain age-adjusted mortality rates and rate ratios for all-cause, premature and avoidable mortality across income quintile in immigrants and long-term residents, stratified by sex. A downward gradient in age-adjusted all-cause mortality was observed with increasing income quintile, in immigrants (males: Q5: 13.32, Q1: 20.18; females: Q5: 9.88, Q1: 12.51) and long-term residents (males: Q5: 33.25, Q1: 57.67; females: Q5: 22.31, Q1: 36.76). Comparing the lowest and highest income quintiles, male and female immigrants had a 56% and 28% lower all-cause mortality rate, respectively. Similar trends were observed for premature and avoidable mortality. Although immigrants had consistently lower mortality rates compared with long-term residents, trends only differed statistically across immigration status for females (p<0.05). This study illustrated the presence of income disparities as it pertains to all-cause, premature, and avoidable mortality, irrespective of immigration status. Additionally, the immigrant health advantage was observed and income disparities were less pronounced in immigrants compared with long-term residents. These findings support the need to examine the factors that drive inequalities in mortality within and across immigration status. 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/.

Mortality causes and outcomes in Indigenous populations of Canada, the United States, and Australia with rheumatic disease: A systematic review.

PubMed

Hurd, Kelle; Barnabe, Cheryl

2018-02-01

Indigenous populations of Canada, America, Australia, and New Zealand have increased rates and severity of rheumatic disease. Our objective was to summarize mortality outcomes and explore disease and social factors related to mortality. A systematic search was performed in medical (Medline, EMBASE, and CINAHL), Indigenous and conference abstract databases (to June 2015) combining search terms for Indigenous populations and rheumatic diseases. Studies were included if they reported measures of mortality (crude frequency, mortality rate, survival, and potential years of life lost (PYLL)) in Indigenous populations from the four countries. Of 5269 titles and abstracts identified, 504 underwent full-text review and 12 were included. No studies from New Zealand were found. In five Canadian studies of systemic lupus erythematosus (SLE) patients, First Nations ethnicity was associated with lower survival after adjusting for disease and social factors, and an increased frequency of death from lupus and its complications compared to Caucasians was found. All-cause mortality was higher in Native Americans (n = 2 studies) relative to Whites with SLE after adjusting for disease and social factors, but not in those with lupus nephritis alone. Australian Aborigines with SLE frequently developed infection and lupus complications leading to death (n = 3 studies). Mortality rates were increased in Pima Indians in the United States with rheumatoid arthritis (RA) compared to those without RA. One study in Native Americans with scleroderma found nearly all deaths were related to progressive disease. Canadian and American Indigenous populations with SLE have increased mortality rates compared to Caucasian populations. Mortality in Canadian and Australian Indigenous populations with SLE, and in Native American populations with RA and scleroderma, is frequently attributed to disease progression or complications. The proportional attribution of rheumatic disease severity and social factors to mortality and complications leading to death between Indigenous and non-Indigenous populations has not been fully evaluated. Copyright © 2018 Elsevier Inc. All rights reserved.

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

PubMed

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

2016-07-01

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

Application of a global reference for fetal-weight and birthweight percentiles in predicting infant mortality.

PubMed

Ding, G; Tian, Y; Zhang, Y; Pang, Y; Zhang, J S; Zhang, J

2013-12-01

To determine whether the recently published A global reference for fetal-weight and birthweight percentiles (Global Reference) improves small- (SGA), appropriate- (AGA), and large-for-gestational-age (LGA) definitions in predicting infant mortality. Population-based cohort study. The US Linked Livebirth and Infant Death records between 1995 and 2004. Singleton births with birthweight >500 g born at 24-41 weeks of gestation. We compared infant mortality rates of SGA, AGA, and LGA infants classified by three different references: the Global Reference; a commonly used birthweight reference; and Hadlock's ultrasound reference. Infant mortality rates. Among 33 997 719 eligible liveborn singleton births, 25% of preterm and 9% of term infants were classified differently for SGA, AGA, and LGA by the Global Reference and the birthweight reference. The Global Reference indicated higher mortality rates in preterm SGA and preterm LGA infants than the birthweight reference. The mortality rate was considerably higher in infants classified as preterm SGA by the Global Reference but not by the birthweight reference, compared with the corresponding infants classified by the birthweight reference but not by the Global Reference (105.7 versus 12.9 per 1000, RR 8.17, 95% CI 7.38-9.06). Yet, the differences in mortality rates were much smaller in term infants than in preterm infants. Black infants had a particularly higher mortality rate than other races in AGA and LGA preterm and term infants. In respect to the commonly used birthweight reference, the Global Reference increases the identification of infant deaths by improved classification of abnormal newborn size at birth, and these advantages were more obvious in preterm than in term infants. © 2013 RCOG.

South African child deaths 1990–2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?

PubMed Central

Kerber, Kate J.; Lawn, Joy E.; Johnson, Leigh F.; Mahy, Mary; Dorrington, Rob E.; Phillips, Heston; Bradshaw, Debbie; Nannan, Nadine; Msemburi, William; Oestergaard, Mikkel Z.; Walker, Neff P.; Sanders, David; Jackson, Debra

2013-01-01

Objective: To analyse trends in under-five mortality rate in South Africa (1990–2011), particularly the contribution of AIDS deaths. Methods: Three nationally used models for estimating AIDS deaths in children were systematically reviewed. The model outputs were compared with under-five mortality rate estimates for South Africa from two global estimation models. All estimates were compared with available empirical data. Results: Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005. The three models showing the contribution of AIDS suggest a maximum of 37–39% of child deaths were due to AIDS in 2004–2005 which has since declined. Although the rate of progress from 1990 is not the 4.4% needed to meet Millennium Development Goal 4 for child survival, South Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%. Conclusion: In 2005, South Africa was one of only four countries globally with an under-five mortality rate higher than the 1990 Millennium Development Goal baseline. Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries. This rapid turnaround is likely due to scale-up of prevention of mother-to-child transmission of HIV, and to a lesser degree, the expanded roll-out of antiretroviral therapy. Emphasis on these programmes must continue, but failure to address other aspects of care including integrated high-quality maternal and neonatal care means that the decline in child mortality could stall. PMID:23863402

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

PubMed Central

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

2013-01-01

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

Age, period, and birth cohort-specific effects on cervical cancer mortality rates in Japanese women and projections for mortality rates over 20-year period (2012-2031).

PubMed

Uchida, Hiroyuki; Kobayashi, Mizuki; Hosobuchi, Ami; Ohta, Ayano; Ohtake, Kazuo; Yamaki, Tutomu; Uchida, Masaki; Odagiri, Youichi; Natsume, Hideshi; Kobayashi, Jun

2014-01-01

We aimed to determine the effects of age, period, and birth cohort on cervical cancer mortality rate trends in Japanese women, by age-period-cohort (APC) analysis. Additionally, we analyzed projected mortality rates. We obtained data on the number of cervical cancer deaths in Japanese women from 1975-2011 from the national vital statistics and census population data. A cohort table of mortality rate data was analyzed on the basis of a Bayesian APC model. We also projected the mortality rates for the 2012-2031 period. The period effect was relatively limited, compared with the age and cohort effects. The age effect increased suddenly from 25-29 to 45-49 years of age and gently increased thereafter. An analysis of the cohort effect on mortality rate trends revealed a steep decreasing slope for birth cohorts born from 1908-1940 and a subsequent sudden increase after 1945. The mortality rate projections indicated increasing trends from 40 to 74 years of age until the year 2031. The age effect increased from 25-29 years of age. This could be attributable to the high human papilloma virus (HPV) infection risk and the low cervical cancer screening rate. The cohort effect changed from decreasing to increasing after the early 1940s. This might be attributable to the spread of cervical cancer screening and treatment before 1940 and the high HPV infection risk and reduced cervical cancer screening rate after 1945. The projected mortality rate indicated an increasing trend until the year 2031.

Inhibitor development and mortality in non-severe hemophilia A.

PubMed

Eckhardt, C L; Loomans, J I; van Velzen, A S; Peters, M; Mauser-Bunschoten, E P; Schwaab, R; Mazzucconi, M G; Tagliaferri, A; Siegmund, B; Reitter-Pfoertner, S E; van der Bom, J G; Fijnvandraat, K

2015-07-01

The life expectancy of non-severe hemophilia A (HA) patients equals the life expectancy of the non-hemophilic population. However, data on the effect of inhibitor development on mortality and on hemophilia-related causes of death are scarce. The development of neutralizing factor VIII antibodies in non-severe HA patients may dramatically change their clinical outcome due to severe bleeding complications. We assessed the association between the occurrence of inhibitors and mortality in patients with non-severe HA. In this retrospective cohort study, clinical data and vital status were collected for 2709 non-severe HA patients (107 with inhibitors) who were treated between 1980 and 2011 in 34 European and Australian centers. Mortality rates for patients with and without inhibitors were compared. During 64,200 patient-years of follow-up, 148 patients died (mortality rate, 2.30 per 1000 person-years; 95% confidence interval (CI), 1.96-2.70) at a median age of 64 years (interquartile range [IQR], 49-76). In 62 patients (42%) the cause of death was hemophilia related. Sixteen inhibitor patients died at a median age of 71 years (IQR, 60-81). In ten patients the inhibitor was present at time of death; seven of them died of severe bleeding complications. The all-cause mortality rate in inhibitor patients was > 5 times increased compared with that for those without inhibitors (age-adjusted mortality rate ratio, 5.6). Inhibitor development in non-severe hemophilia is associated with increased mortality. High rates of hemophilia-related mortality in this study indicate that non-severe hemophilia is not mild at all and stress the importance of close follow-up for these patients. © 2015 International Society on Thrombosis and Haemostasis.

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.

Perinatal mortality in twin pregnancy: an analysis of birth weight-specific mortality rates and adjusted mortality rates for birth weight distributions.

PubMed

Fabre, E; González de Agüero, R; de Agustin, J L; Pérez-Hiraldo, M P; Bescos, J L

1988-01-01

The objective of this study is to compare the fetal mortality rate (FMR), early neonatal mortality rate (ENMR) and perinatal mortality rate (PMR) of twin and single births. It is based on a survey which was carried out in 22 Hospital Centers in Spain in 1980, and covered 1,956 twins born and 110,734 singletons born. The FMR in twins was 36.3/1000 and 8.8/1000 for singletons. The ENMR in twins was 36.1/1000 and 5.7/1000 for singletons. The PMR in twins was 71.1/1000 and 14.4/1000 for singletons. When birthweight-specific PMR in twin and singletons births are compared, there were no differences between the rates for groups 500-999 g and 1000-1499 g. For birthweight groups of 1500-1999 g (124.4 vs 283.8/1000) and 2000-2999 g (29.6 vs 73.2/1000) the rates for twins were about twice lower than those for single births. The PMR for 2500 g and over birthweight was about twice higher in twins than in singletons (12.5 vs 5.5/1000). After we adjusted for birthweight there was a difference in the FMR (12.6 vs 9.8/1000) and the PMR (19.1 vs 16.0/1000, and no difference in the ENMR between twins and singletons (5.9 vs 6.4/1000), indicating that most of the differences among crude rates are due to differences in distribution of birthweight.

[Mobility Exposure Measures in Serious Road Traffic Injuries in Madrid, Spain].

PubMed

Velázquez Buendía, Luis; Domínguez-Berjón, María Felicitas; Esteban-Vasallo, María D; Gènova Maleras, Ricard; Zoni, Ana Clara

2015-01-01

The search of suitable indicators for estimating the risk of road traffic injuries is nowadays a relevant topic. The objective of this study was to carry out a comparative description of mortality and inhospital morbidity by age and sex, using population rates and mobility exposure related indicators. Cross sectional study in the Community of Madrid, 2003-2005. Population rates and mortality and morbidity rates per billion of persons-kilometers travelled and per million of persons-hours travelled were estimated and compared by age and sex. The Minimum Basic Hospital Discharge Data Set, the 2004 Mobility House Survey of the Community of Madrid and the mortality register of the Statistic Institute of the Community of Madrid were used as information sources. 7,413 hospital discharges and 1,046 deaths were identified. Morbidity and mortality population rates in men were 62.24 and 9.20 respectively, and in women 23.80 and 2.97 per 100,000 inhabitants, being the highest rates those for men aged 16-24 years (119.27 hospital discharges and 12.00 deaths per 100,000 inhabitants). Women of 65 years and older showed the highest mobility related rates: 649.78 hospital discharges and 96.72 deaths per 10(9) km, and 13.11 hospital discharges and 1.95 deaths per 10(6) travelled hours. Morbidity and mortality were higher in men for the three indicators. Rates referred to mobility exposure, faced to population rates, decrease mortality and morbidity due to road traffic injuries in men and young ages and increase both in advanced ages.

Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database

PubMed Central

Cornish, Rosie; Macleod, John; Strang, John; Vickerman, Peter

2010-01-01

Objective To investigate the effect of opiate substitution treatment at the beginning and end of treatment and according to duration of treatment. Design Prospective cohort study. Setting UK General Practice Research Database Participants Primary care patients with a diagnosis of substance misuse prescribed methadone or buprenorphine during 1990-2005. 5577 patients with 267 003 prescriptions for opiate substitution treatment followed-up (17 732 years) until one year after the expiry of their last prescription, the date of death before this time had elapsed, or the date of transfer away from the practice. Main outcome measures Mortality rates and rate ratios comparing periods in and out of treatment adjusted for sex, age, calendar year, and comorbidity; standardised mortality ratios comparing opiate users’ mortality with general population mortality rates. Results Crude mortality rates were 0.7 per 100 person years on opiate substitution treatment and 1.3 per 100 person years off treatment; standardised mortality ratios were 5.3 (95% confidence interval 4.0 to 6.8) on treatment and 10.9 (9.0 to 13.1) off treatment. Men using opiates had approximately twice the risk of death of women (morality rate ratio 2.0, 1.4 to 2.9). In the first two weeks of opiate substitution treatment the crude mortality rate was 1.7 per 100 person years: 3.1 (1.5 to 6.6) times higher (after adjustment for sex, age group, calendar period, and comorbidity) than the rate during the rest of time on treatment. The crude mortality rate was 4.8 per 100 person years in weeks 1-2 after treatment stopped, 4.3 in weeks 3-4, and 0.95 during the rest of time off treatment: 9 (5.4 to 14.9), 8 (4.7 to 13.7), and 1.9 (1.3 to 2.8) times higher than the baseline risk of mortality during treatment. Opiate substitution treatment has a greater than 85% chance of reducing overall mortality among opiate users if the average duration approaches or exceeds 12 months. Conclusions Clinicians and patients should be aware of the increased mortality risk at the start of opiate substitution treatment and immediately after stopping treatment. Further research is needed to investigate the effect of average duration of opiate substitution treatment on drug related mortality. PMID:20978062

Is 30-day Posthospitalization Mortality Lower Among Racial/Ethnic Minorities?: A Reexamination.

PubMed

Lin, Meng-Yun; Kressin, Nancy R; Paasche-Orlow, Michael K; Kim, Eun Ji; López, Lenny; Rosen, Jennifer E; Hanchate, Amresh D

2018-06-05

Multiple studies have reported that risk-adjusted rates of 30-day mortality after hospitalization for an acute condition are lower among blacks compared with whites. To examine if previously reported lower mortality for minorities, relative to whites, is accounted for by adjustment for do-not-resuscitate status, potentially unconfirmed admission diagnosis, and differential risk of hospitalization. Using inpatient discharge and vital status data for patients aged 18 and older in California, we examined all admissions from January 1, 2010 to June 30, 2011 for acute myocardial infarction, heart failure, pneumonia, acute stroke, gastrointestinal bleed, and hip fracture and estimated relative risk of mortality for Hispanics, non-Hispanic blacks, non-Hispanic Asians, and non-Hispanic whites. Multiple mortality measures were examined: inpatient, 30-, 90-, and 180 day. Adding census data we estimated population risks of hospitalization and hospitalization with inpatient death. Across all mortality outcomes, blacks had lower mortality rate, relative to whites even after exclusion of patients with do-not-resuscitate status and potentially unconfirmed diagnosis. Compared with whites, the population risk of hospitalization was 80% higher and risk of hospitalization with inpatient mortality was 30% higher among blacks. Among Hispanics and Asians, disparities varied with mortality measure. Lower risk of posthospitalization mortality among blacks, relative to whites, may be associated with higher rate of hospitalizations and differences in unobserved patient acuity. Disparities for Hispanics and Asians, relative to whites, vary with the mortality measure used.

Effect of More vs Less Frequent Follow-up Testing on Overall and Colorectal Cancer-Specific Mortality in Patients With Stage II or III Colorectal Cancer: The COLOFOL Randomized Clinical Trial.

PubMed

Wille-Jørgensen, Peer; Syk, Ingvar; Smedh, Kenneth; Laurberg, Søren; Nielsen, Dennis T; Petersen, Sune H; Renehan, Andrew G; Horváth-Puhó, Erzsébet; Påhlman, Lars; Sørensen, Henrik T

2018-05-22

Intensive follow-up of patients after curative surgery for colorectal cancer is common in clinical practice, but evidence of a survival benefit is limited. To examine overall mortality, colorectal cancer-specific mortality, and colorectal cancer-specific recurrence rates among patients with stage II or III colorectal cancer who were randomized after curative surgery to 2 alternative schedules for follow-up testing with computed tomography and carcinoembryonic antigen. Unblinded randomized trial including 2509 patients with stage II or III colorectal cancer treated at 24 centers in Sweden, Denmark, and Uruguay from January 2006 through December 2010 and followed up for 5 years; follow-up ended on December 31, 2015. Patients were randomized either to follow-up testing with computed tomography of the thorax and abdomen and serum carcinoembryonic antigen at 6, 12, 18, 24, and 36 months after surgery (high-frequency group; n = 1253 patients) or at 12 and 36 months after surgery (low-frequency group; n = 1256 patients). The primary outcomes were 5-year overall mortality and colorectal cancer-specific mortality rates. The secondary outcome was the colorectal cancer-specific recurrence rate. Both intention-to-treat and per-protocol analyses were performed. Among 2555 patients who were randomized, 2509 were included in the intention-to-treat analysis (mean age, 63.5 years; 1128 women [45%]) and 2365 (94.3%) completed the trial. The 5-year overall patient mortality rate in the high-frequency group was 13.0% (161/1253) compared with 14.1% (174/1256) in the low-frequency group (risk difference, 1.1% [95% CI, -1.6% to 3.8%]; P = .43). The 5-year colorectal cancer-specific mortality rate in the high-frequency group was 10.6% (128/1248) compared with 11.4% (137/1250) in the low-frequency group (risk difference, 0.8% [95% CI, -1.7% to 3.3%]; P = .52). The colorectal cancer-specific recurrence rate was 21.6% (265/1248) in the high-frequency group compared with 19.4% (238/1250) in the low-frequency group (risk difference, 2.2% [95% CI, -1.0% to 5.4%]; P = .15). Among patients with stage II or III colorectal cancer, follow-up testing with computed tomography and carcinoembryonic antigen more frequently compared with less frequently did not result in a significant rate reduction in 5-year overall mortality or colorectal cancer-specific mortality. clinicaltrials.gov Identifier: NCT00225641.

Mortality in children with early detected congenital central hypothyroidism.

PubMed

Zwaveling-Soonawala, Nitash; Naafs, Jolanda C; Verkerk, Paul H; van Trotsenburg, A S Paul

2018-06-07

Approximately 60-80% of patients with congenital central hypothyroidism (CH-C) have multiple pituitary hormone deficiencies (MPHD), making CH-C a potentially life-threatening disease. Data on mortality in CH-C patients, however, are lacking. To study mortality rate in early detected and treated pediatric CH-C patients in the Netherlands and to investigate whether causes of death were related to pituitary hormone deficiencies. Overall mortality rate, infant mortality rate and under-5 mortality rate were calculated in all children with CH-C detected by neonatal screening between 1-1-1995 and 1-1-2013. Medical charts were reviewed to establish causes of death. 139 children with CH-C were identified, of which 138 could be traced (82 MPHD/56 isolated CHC). Total observation time was 1414 years with a median follow up duration of 10.2 years. The overall mortality rate was 10.9% (15/138). Infant mortality rate (IMR) and under-5 mortality rate were 65.2/1000 (9/138) and 101.4/1000 (14/138), respectively, compared to an IMR of 4.7/1000 and under-5 mortality of 5.4/1000 live born children in the Netherlands during the same time period (p<0.0001). Main causes of death were severe congenital malformations in six patients, asphyxia in two patients, and congenital or early neonatal infection in two patients. Pituitary hormone deficiency was noted as cause of death in only one infant. We report an increased mortality rate in early detected CH-C patients which does not seem to be related to endocrine disease. This suggests that mortality due to pituitary insufficiency is low in an early detected and treated CH-C population.

Mortality from treatable illnesses in marginally housed adults: a prospective cohort study

PubMed Central

Jones, Andrea A; Vila-Rodriguez, Fidel; Leonova, Olga; Langheimer, Verena; Lang, Donna J; Barr, Alasdair M; Procyshyn, Ric M; Smith, Geoffrey N; Schultz, Krista; Buchanan, Tari; Krausz, Michael; Montaner, Julio S; MacEwan, G William; Rauscher, Alexander; Panenka, William J; Thornton, Allen E; Honer, William G

2015-01-01

Objectives Socially disadvantaged people experience greater risk for illnesses that may contribute to premature death. This study aimed to evaluate the impact of treatable illnesses on mortality among adults living in precarious housing. Design A prospective cohort based in a community sample. Setting A socially disadvantaged neighbourhood in Vancouver, Canada. Participants Adults (N=371) living in single room occupancy hotels or recruited from the Downtown Community Court and followed for median 3.8 years. Main outcome measures Participants were assessed for physical and mental illnesses for which treatment is currently available. We compared cohort mortality rates with 2009 Canadian rates. Left-truncated Cox proportional hazards modelling with age as the time scale was used to assess risk factors for earlier mortality. Results During 1269 person-years of observation, 31/371 (8%) of participants died. Compared with age-matched and sex-matched Canadians, the standardised mortality ratio was 8.29 (95% CI 5.83 to 11.79). Compared with those that had cleared the virus, active hepatitis C infection was a significant predictor for hepatic fibrosis adjusting for alcohol dependence and age (OR=2.96, CI 1.37 to 7.08). Among participants <55 years of age, psychosis (HR=8.12, CI 1.55 to 42.47) and hepatic fibrosis (HR=13.01, CI 3.56 to 47.57) were associated with earlier mortality. Treatment rates for these illnesses were low (psychosis: 32%, hepatitis C virus: 0%) compared with other common disorders (HIV: 57%, opioid dependence: 61%) in this population. Conclusions Hepatic fibrosis and psychosis are associated with increased mortality in people living in marginal conditions. Timely diagnosis and intervention could reduce the high mortality in marginalised inner city populations. PMID:26297373

Perinatal statistics of a 15-year period in the Central Region of Saudi Arabia.

PubMed

Sobaih, Badr H; Al-Shebly, Mashael M

2013-01-01

Perinatal statistics are one of the most essential outcome indicators used by many developed countries in order to evaluate perinatal services provided to newborns. In this retrospective study, we collected 15 years of perinatal data at King Khalid University Hospital in Riyadh, Saudi Arabia in order to determine stillbirth and other mortality rates in our institute and compare them with international figures. A total of 58,073 babies were evaluated. Data were collected from maternal and neonatal registry books and from perinatal mortality and morbidity meeting reports between 1994 and 2008. Data were entered and analyzed using Microsoft Office Excel 2007. The stillbirth rate was 11.7/1000, early neonatal death rate was 3.4/1000, perinatal mortality rate (PMR) was 14.9/1000, and corrected PMR was 11.9/1000. Our rates were not significantly different from those of North American and European ones. We noticed a dramatic reduction in the corrected PMR in the last 3 years of the study because of greater advancement in perinatal and neonatal care. Our mortality rates were comparable to the North American and European rates which may reflect the quality of perinatal care provided in our institute.

Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012.

PubMed

Eyawo, Oghenowede; Franco-Villalobos, Conrado; Hull, Mark W; Nohpal, Adriana; Samji, Hasina; Sereda, Paul; Lima, Viviane D; Shoveller, Jeannie; Moore, David; Montaner, Julio S G; Hogg, Robert S

2017-02-27

Non-HIV/AIDS-related diseases are gaining prominence as important causes of morbidity and mortality among people living with HIV. The purpose of this study was to characterize and compare changes over time in mortality rates and causes of death among a population-based cohort of persons living with and without HIV in British Columbia (BC), Canada. We analysed data from the Comparative Outcomes And Service Utilization Trends (COAST) study; a retrospective population-based study created via linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC, and containing data for HIV-infected individuals and the general population of BC, respectively. Our analysis included all known HIV-infected adults (≥ 20 years) in BC and a random 10% sample of uninfected BC adults followed from 1996 to 2012. Deaths were identified through Population Data BC - which contains information on all registered deaths in BC (BC Vital Statistics Agency dataset) and classified into cause of death categories using International Classification of Diseases (ICD) 9/10 codes. Age-standardized mortality rates (ASMR) and mortality rate ratios were calculated. Trend test were performed. 3401 (25%), and 47,647 (9%) individuals died during the 5,620,150 person-years of follow-up among 13,729 HIV-infected and 510,313 uninfected individuals, respectively. All-cause and cause-specific mortality rates were consistently higher among HIV-infected compared to HIV-negative individuals, except for neurological disorders. All-cause ASMR decreased from 126.75 (95% CI: 84.92-168.57) per 1000 population in 1996 to 21.29 (95% CI: 17.79-24.79) in 2011-2012 (83% decline; p < 0.001 for trend), compared to a change from 7.97 (95% CI: 7.61-8.33) to 6.87 (95% CI: 6.70-7.04) among uninfected individuals (14% decline; p < 0.001). Mortality rates from HIV/AIDS-related causes decreased by 94% from 103.85 per 1000 population in 1996 to 6.72 by the 2011-2012 era (p < 0.001). Significant ASMR reductions were also observed for hepatic/liver disease and drug abuse/overdose deaths. ASMRs for neurological disorders increased significantly over time. Non-AIDS-defining cancers are currently the leading non-HIV/AIDS-related cause of death in both HIV-infected and uninfected individuals. Despite the significant mortality rate reductions observed among HIV-infected individuals from 1996 to 2012, they still have excess mortality risk compared to uninfected individuals. Additional efforts are needed to promote effective risk factor management and appropriate screening measures among people living with HIV.

Variation in hospital mortality rates with inpatient cancer surgery.

PubMed

Wong, Sandra L; Revels, ShaʼShonda L; Yin, Huiying; Stewart, Andrew K; McVeigh, Andrea; Banerjee, Mousumi; Birkmeyer, John D

2015-04-01

To elucidate clinical mechanisms underlying variation in hospital mortality after cancer surgery : Thousands of Americans die every year undergoing elective cancer surgery. Wide variation in hospital mortality rates suggest opportunities for improvement, but these efforts are limited by uncertainty about why some hospitals have poorer outcomes than others. Using data from the 2006-2007 National Cancer Data Base, we ranked 1279 hospitals according to a composite measure of perioperative mortality after operations for bladder, esophagus, colon, lung, pancreas, and stomach cancers. We then conducted detailed medical record review of 5632 patients at 1 of 19 hospitals with low mortality rates (2.1%) or 30 hospitals with high mortality rates (9.1%). Hierarchical logistic regression analyses were used to compare risk-adjusted complication incidence and case-fatality rates among patients experiencing serious complications. The 7.0% absolute mortality difference between the 2 hospital groups could be attributed to higher mortality from surgical site, pulmonary, thromboembolic, and other complications. The overall incidence of complications was not different between hospital groups [21.2% vs 17.8%; adjusted odds ratio (OR) = 1.34, 95% confidence interval (CI): 0.93-1.94]. In contrast, case-fatality after complications was more than threefold higher at high mortality hospitals than at low mortality hospitals (25.9% vs 13.6%; adjusted OR = 3.23, 95% CI: 1.56-6.69). Low mortality and high mortality hospitals are distinguished less by their complication rates than by how frequently patients die after a complication. Strategies for ensuring the timely recognition and effective management of postoperative complications will be essential in reducing mortality after cancer surgery.

Hospitalization and mortality in Mexico due to breast cancer since its inclusion in the catastrophic expenditures scheme.

PubMed

Ventura-Alfaro, Carmelita Elizabeth; Torres-Mejía, Gabriela; Ávila-Burgos, Leticia Del Socorro

2016-04-01

To compare trends in hospital discharges and mortality due to breast cancer (BC) in Mexico from 2004 to 2012 by insurance condition before and after incorporating BC comprehensive treatment into the System of Social Protection in Health (Sistema de Protrección Social en Salud, SPSS) in 2007. Data on BC hospital discharges and mortality reported in women aged 25 years and over were obtained from the National Health Information System. Mortality rates were adjusted by age and state. At the national level, a growing tendency in hospital discharges was observed, mainly for women without social security, while mortality rate remained constant. Mortality rates by state show that lower marginalization index corresponded to higher mortality. A differential behavior was observed among women according to insurance condition, partly due to the inclusion of BC treatment in the SPSS.

Mortality in the Vertebroplasty Population

PubMed Central

McDonald, Robert J.; Achenbach, Sara; Atkinson, Elizabeth; Gray, Leigh A.; Cloft, Harry J.; Melton, L. Joseph; Kallmes, David F.

2011-01-01

Purpose Vertebroplasty is an effective treatment for painful compression fractures refractory to conservative management. Since there are limited data regarding the survival characteristics of this patient population, we compared the survival of a treated to an untreated vertebral fracture cohort to determine if vertebroplasty affects mortality rates. Materials and Methods The survival of a treated cohort, comprising 524 vertebroplasty recipients with refractory osteoporotic vertebral compression fractures, was compared to a separate, historical cohort of 589 subjects with fractures not treated by vertebroplasty who were identified from the Rochester Epidemiology Project. Mortality was compared between cohorts using Cox proportional hazard models adjusting for age, gender, and Charlson indices of co-morbidity. Mortality was also correlated with pre-, peri-, and post-procedural clinical metrics (e.g., cement volume utilization, Roland-Morris Disability Questionnaire score, analog pain scales, frequency of narcotic use, and improvements in mobility) within the treated cohort. Results Vertebroplasty recipients demonstrated 77% of the survival expected for individuals of similar age, ethnicity, and gender within the US population. When compared to individuals with both symptomatic and asymptomatic untreated vertebral fractures, vertebroplasty recipients retained a 17% greater mortality risk. However, when compared to symptomatic untreated vertebral fractures, vertebroplasty recipients had no increased mortality following adjustment for differences in age, sex and co-morbidity (HR 1.02; CI 0.82–1.25). In addition, no clinical metrics used to assess the efficacy of vertebroplasty were predictive of survival. Conclusion Vertebroplasty recipients have mortality rates similar to individuals with untreated symptomatic fractures but worse mortality compared to those with asymptomatic vertebral fractures. PMID:21998109

Educational inequality in adult mortality: an assessment with death certificate data from Michigan.

PubMed

Christenson, B A; Johnson, N E

1995-05-01

Education was added to the U.S. Standard Certificate of Death in 1989. The current study uses Michigan's 1989-1991 death certificates, together with the 1990 Census, to evaluate the quality of data on education from death certificates and to examine educational differences in mortality rates. With log-rates modeling, we systematically analyze the variability in educational differences in mortality by race and sex across the adult life cycle. The relative differences in mortality rates between educational levels decline with age at the same pace for all sex and race categories. Women gain a slightly greater reduction in mortality than men by reaching the secondary-education level, but a modestly smaller reduction by advancing beyond it. Blacks show a reduction in predicted mortality rates comparable to whites' by moving from the secondary to the postsecondary level of education but experience less reduction than whites by moving from the primary to the secondary level. Thus, the secular decline in mortality rates that generally accompanies historical improvements in education might actually be associated with an increase in the relative differences between blacks' and whites' mortality. We discuss limitations of the data and directions for future research.

Trends in penile cancer: a comparative study between Australia, England and Wales, and the US.

PubMed

Sewell, James; Ranasinghe, Weranja; De Silva, Daswin; Ayres, Ben; Ranasinghe, Tamra; Hounsome, Luke; Verne, Julia; Persad, Raj

2015-01-01

To investigate and compare the trends in incidence and mortality of penile cancer between Australia, England and Wales, and the US, and provide hypotheses for these trends. Cancer registry data from 1982 to 2005 inclusive were obtained from Australia, England and Wales, and the United States. From these data, age-specific, -standardised and mortality:incidence ratios were calculated, and compared. The overall incidence of penile cancer in England and Wales (1.44 per 100,000 man-years) was higher than in Australia (0.80 per 100,000), and the US (0.66 per 100,000). Incidence of penile cancer in all three countries has remained relatively stable over time. Similarly, although the mortality rates were also higher in England and Wales (0.37 per 100,000 man-years) compared to Australia (0.18 per 100,000) and the US (0.15 per 100,000), the mortality/incidence ratios were similar for all three countries. Penile cancer incidence is low, affecting mainly older men. Rates differ between the three countries, being twice as common in England and Wales as in the other studied regions. Circumcision rates have a potential influence on these rates but are not the sole explanation for the variation.

International variations and trends in renal cell carcinoma incidence and mortality.

PubMed

Znaor, Ariana; Lortet-Tieulent, Joannie; Laversanne, Mathieu; Jemal, Ahmedin; Bray, Freddie

2015-03-01

Renal cell carcinoma (RCC) incidence rates are higher in developed countries, where up to half of the cases are discovered incidentally. Declining mortality trends have been reported in highly developed countries since the 1990s. To compare and interpret geographic variations and trends in the incidence and mortality of RCC worldwide in the context of controlling the future disease burden. We used data from GLOBOCAN, the Cancer Incidence in Five Continents series, and the World Health Organisation mortality database to compare incidence and mortality rates in more than 40 countries worldwide. We analysed incidence and mortality trends in the last 10 yr using joinpoint analyses of the age-standardised rates (ASRs). RCC incidence in men varied in ASRs (World standard population) from approximately 1/100,000 in African countries to >15/100,000 in several Northern and Eastern European countries and among US blacks. Similar patterns were observed for women, although incidence rates were commonly half of those for men. Incidence rates are increasing in most countries, most prominently in Latin America. Although recent mortality trends are stable in many countries, significant declines were observed in Western and Northern Europe, the USA, and Australia. Southern European men appear to have the least favourable RCC mortality trends. Although RCC incidence is still increasing in most countries, stabilisation of mortality trends has been achieved in many highly developed countries. There are marked absolute differences and opposing RCC mortality trends in countries categorised as areas of higher versus lower human development, and these gaps appear to be widening. Renal cell cancer is becoming more commonly diagnosed worldwide in both men and women. Mortality is decreasing in the most developed settings, but not in low- and middle-income countries, where access to and the availability of optimal therapies are likely to be limited. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Potential Conflicting Interests for Surgeons in End-of-Life Care.

PubMed

Golden, Adam G; Silverman, Michael A; Heller, Andrew; Loyal, Michael; Cendan, Juan

2015-11-01

Thirty-day mortality represents a variable that is commonly used to measure the quality of surgical care. The definition of 30-day mortality and the application of a risk adjustment to its measurement may vary among different organizations comparing physician quality. In the midst of this confusion, conflicting interests arise for surgeons who must weigh the potential benefit of surgical interventions to individual patients versus the potential loss of access by future patients should 30-day mortality ratings be adversely affected. Similarly, surgeons may become adversely impacted by the lack of compensation from avoiding "high-risk" cases, but might face a more severe financial impact if they have a higher mortality rating compared to their peers. © The Author(s) 2014.

Early mortality experience in a large military cohort and a comparison of mortality data sources

PubMed Central

2010-01-01

Background Complete and accurate ascertainment of mortality is critically important in any longitudinal study. Tracking of mortality is particularly essential among US military members because of unique occupational exposures (e.g., worldwide deployments as well as combat experiences). Our study objectives were to describe the early mortality experience of Panel 1 of the Millennium Cohort, consisting of participants in a 21-year prospective study of US military service members, and to assess data sources used to ascertain mortality. Methods A population-based random sample (n = 256,400) of all US military service members on service rosters as of October 1, 2000, was selected for study recruitment. Among this original sample, 214,388 had valid mailing addresses, were not in the pilot study, and comprised the group referred to in this study as the invited sample. Panel 1 participants were enrolled from 2001 to 2003, represented all armed service branches, and included active-duty, Reserve, and National Guard members. Crude death rates, as well as age- and sex-adjusted overall and age-adjusted, category-specific death rates were calculated and compared for participants (n = 77,047) and non-participants (n = 137,341) based on data from the Social Security Administration Death Master File, Department of Veterans Affairs (VA) files, and the Department of Defense Medical Mortality Registry, 2001-2006. Numbers of deaths identified by these three data sources, as well as the National Death Index, were compared for 2001-2004. Results There were 341 deaths among the participants for a crude death rate of 80.7 per 100,000 person-years (95% confidence interval [CI]: 72.2,89.3) compared to 820 deaths and a crude death rate of 113.2 per 100,000 person-years (95% CI: 105.4, 120.9) for non-participants. Age-adjusted, category-specific death rates highlighted consistently higher rates among study non-participants. Although there were advantages and disadvantages for each data source, the VA mortality files identified the largest number of deaths (97%). Conclusions The difference in crude and adjusted death rates between Panel 1 participants and non-participants may reflect healthier segments of the military having the opportunity and choosing to participate. In our study population, mortality information was best captured using multiple data sources. PMID:20492737

Gender bias in under-five mortality in low/middle-income countries.

PubMed

Costa, Janaína Calu; da Silva, Inacio Crochemore Mohnsam; Victora, Cesar Gomes

2017-01-01

Due to biological reasons, boys are more likely to die than girls. The detection of gender bias requires knowing the expected relation between male and female mortality rates at different levels of overall mortality, in the absence of discrimination. Our objective was to compare two approaches aimed at assessing excess female under-five mortality rate (U5MR) in low/middle-income countries. We compared the two approaches using data from 60 Demographic and Health Surveys (2005-2014). The prescriptive approach compares observed mortality rates with historical patterns in Western societies where gender discrimination was assumed to be low or absent. The descriptive approach is derived from global estimates of all countries with available data, including those affected by gender bias. The prescriptive approach showed significant excess female U5MR in 20 countries, compared with only one country according to the descriptive approach. Nevertheless, both models showed similar country rankings. The 13 countries with the highest and the 10 countries with the lowest rankings were the same according to both approaches. Differences in excess female mortality among world regions were significant, but not among country income groups. Both methods are useful for monitoring time trends, detecting gender-based inequalities and identifying and addressing its causes. The prescriptive approach seems to be more sensitive in the identification of gender bias, but needs to be updated using data from populations with current-day structures of causes of death.

Effect of prenatal care on infant mortality rates according to birth-death certificate files.

PubMed

Poma, P A

1999-09-01

Infant mortality has decreased nationwide; however, our national rates still log behind those of other industrialized countries, especially the rates for minority groups. This study evaluates the effect of prenatal care and risk factors on infant mortality rates in Chicago. Using linked infant birth and death certificates of Chicago residents for 1989-1995, a total of 5838 deaths occurring during the first year of life were identified. Birth certificate variables, especially prenatal care, were reviewed. Variables were compared by stratified analysis. Pearson chi 2 analysis and odd ratios (ORs) were computed. Infant mortality rate (IMR) in Chicago decreased from 17 in 1989 to 12.6 in 1995 (P < .0001). Some factors increased IMR several fold: prematurity (OR 17.43), no prenatal care (OR 4.07), inadequate weight gain (OR 2.95), African-American ethnicity (OR 2.55), and inadequate prenatal care (OR 2.03). Compared with no care, prenatal care was associated with lower IMR; however, early care was associated with higher IMR and ORs than later care. These results demonstrate prenatal care is associated with lower IMR; however, compared with late prenatal care, early care does not improve IMR. Further studies should evaluate whether improving the quality of care improves IMRs.

Forecasting Spanish natural life expectancy.

PubMed

Guillen, Montserrat; Vidiella-i-Anguera, Antoni

2005-10-01

Knowledge of trends in life expectancy is of major importance for policy planning. It is also a key indicator for assessing future development of life insurance products, substantiality of existing retirement schemes, and long-term care for the elderly. This article examines the feasibility of decomposing age-gender-specific accidental and natural mortality rates. We study this decomposition by using the Lee and Carter model. In particular, we fit the Poisson log-bilinear version of this model proposed by Wilmoth and Brouhns et al. to historical (1975-1998) Spanish mortality rates. In addition, by using the model introduced by Wilmoth and Valkonen we analyze mortality-gender differentials for accidental and natural rates. We present aggregated life expectancy forecasts compared with those constructed using nondecomposed mortality rates.

Tobacco-, Alcohol-, and Drug-Attributable Deaths and Their Contribution to Mortality Disparities in a Cohort of Homeless Adults in Boston

PubMed Central

Chang, Yuchiao; Singer, Daniel E.; Porneala, Bianca C.; Gaeta, Jessie M.; O’Connell, James J.; Rigotti, Nancy A.

2015-01-01

Objectives. We quantified tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities among homeless adults. Methods. We ascertained causes of death among 28 033 adults seen at the Boston Health Care for the Homeless Program in 2003 to 2008. We calculated population-attributable fractions to estimate the proportion of deaths attributable to tobacco, alcohol, or drug use. We compared attributable mortality rates with those for Massachusetts adults using rate ratios and differences. Results. Of 1302 deaths, 236 were tobacco-attributable, 215 were alcohol-attributable, and 286 were drug-attributable. Fifty-two percent of deaths were attributable to any of these substances. In comparison with Massachusetts adults, tobacco-attributable mortality rates were 3 to 5 times higher, alcohol-attributable mortality rates were 6 to 10 times higher, and drug-attributable mortality rates were 8 to 17 times higher. Disparities in substance-attributable deaths accounted for 57% of the all-cause mortality gap between the homeless cohort and Massachusetts adults. Conclusions. In this clinic-based cohort of homeless adults, over half of all deaths were substance-attributable, but this did not fully explain the mortality disparity with the general population. Interventions should address both addiction and non-addiction sources of excess mortality. PMID:25521869

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

American-Indian diabetes mortality in the Great Plains Region 2002–2010

PubMed Central

Kelley, Allyson; Giroux, Jennifer; Schulz, Mark; Aronson, Bob; Wallace, Debra; Bell, Ronny; Morrison, Sharon

2015-01-01

Objective To compare American-Indian and Caucasian mortality rates from diabetes among tribal Contract Health Service Delivery Areas (CHSDAs) in the Great Plains Region (GPR) and describe the disparities observed. Research design and methods Mortality data from the National Center for Vital Statistics and Seer*STAT were used to identify diabetes as the underlying cause of death for each decedent in the GPR from 2002 to 2010. Mortality data were abstracted and aggregated for American-Indians and Caucasians for 25 reservation CHSDAs in the GPR. Rate ratios (RR) with 95% CIs were used and SEER*Stat V.8.0.4 software calculated age-adjusted diabetes mortality rates. Results Age-adjusted mortality rates for American-Indians were significantly higher than those for Caucasians during the 8-year period. In the GPR, American-Indians were 3.44 times more likely to die from diabetes than Caucasians. South Dakota had the highest RR (5.47 times that of Caucasians), and Iowa had the lowest RR, (1.1). Reservation CHSDA RR ranged from 1.78 to 10.25. Conclusions American-Indians in the GPR have higher diabetes mortality rates than Caucasians in the GPR. Mortality rates among American-Indians persist despite special programs and initiatives aimed at reducing diabetes in these populations. Effective and immediate efforts are needed to address premature diabetes mortality among American-Indians in the GPR. PMID:25926992

Geographic distribution of dementia mortality: elevated mortality rates for black and white Americans by place of birth.

PubMed

Glymour, M Maria; Kosheleva, Anna; Wadley, Virginia G; Weiss, Christopher; Manly, Jennifer J

2011-01-01

We hypothesized that patterns of elevated stroke mortality among those born in the United States Stroke Belt (SB) states also prevailed for mortality related to all-cause dementia or Alzheimer Disease. Cause-specific mortality (contributing cause of death, including underlying cause cases) rates in 2000 for United States-born African Americans and whites aged 65 to 89 years were calculated by linking national mortality records with population data based on race, sex, age, and birth state or state of residence in 2000. Birth in a SB state (NC, SC, GA, TN, AR, MS, or AL) was cross-classified against SB residence at the 2000 Census. Compared with those who were not born in the SB, odds of all-cause dementia mortality were significantly elevated by 29% for African Americans and 19% for whites born in the SB. These patterns prevailed among individuals who no longer lived in the SB at death. Patterns were similar for Alzheimer Disease-related mortality. Some non-SB states were also associated with significant elevations in dementia-related mortality. Dementia mortality rates follow geographic patterns similar to stroke mortality, with elevated rates among those born in the SB. This suggests important roles for geographically patterned childhood exposures in establishing cognitive reserve.

Excess mortality rate associated with hepatitis C virus infection: A community-based cohort study in rural Egypt.

PubMed

Mostafa, Aya; Shimakawa, Yusuke; Medhat, Ahmed; Mikhail, Nabiel N; Chesnais, Cédric B; Arafa, Naglaa; Bakr, Iman; El Hoseiny, Mostafa; El-Daly, Mai; Esmat, Gamal; Abdel-Hamid, Mohamed; Mohamed, Mostafa K; Fontanet, Arnaud

2016-06-01

>80% of people chronically infected with hepatitis C virus (HCV) live in resource-limited countries, yet the excess mortality associated with HCV infection in these settings is poorly documented. Individuals were recruited from three villages in rural Egypt in 1997-2003 and their vital status was determined in 2008-2009. Mortality rates across the cohorts were compared according to HCV status: chronic HCV infection (anti-HCV antibody positive and HCV RNA positive), cleared HCV infection (anti-HCV antibody positive and HCV RNA negative) and never infected (anti-HCV antibody negative). Data related to cause of death was collected from a death registry in one village. Among 18,111 survey participants enrolled in 1997-2003, 9.1% had chronic HCV infection, 5.5% had cleared HCV infection, and 85.4% had never been infected. After a mean time to follow-up of 8.6years, vital status was obtained for 16,282 (89.9%) participants. When compared to those who had never been infected with HCV in the same age groups, mortality rate ratios (MRR) of males with chronic HCV infection aged <35, 35-44, and 45-54years were 2.35 (95% CI 1.00-5.49), 2.87 (1.46-5.63), and 2.22 (1.29-3.81), respectively. No difference in mortality rate was seen in older males or in females. The all-cause mortality rate attributable to chronic HCV infection was 5.7% (95% CI: 1.0-10.1%), while liver-related mortality was 45.5% (11.3-66.4%). Use of a highly potent new antiviral agent to treat all villagers with positive HCV RNA may reduce all-cause mortality rate by up to 5% and hepatic mortality by up to 40% in rural Egypt. Copyright © 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Effect of Dietary Supplements in Reducing Probability of Death for Uremic Crises in Dogs Affected by Chronic Kidney Disease (Masked RCCT)

PubMed Central

Zatelli, Andrea; Pierantozzi, Marco; D'Ippolito, Paola; Bigliati, Mauro; Zini, Eric

2012-01-01

Chitosan and alkalinizing agents can decrease morbidity and mortality in humans with chronic kidney disease (CKD). Whether this holds true in dog is not known. Objective of the study was to determine whether a commercial dietary supplement containing chitosan, phosphate binders, and alkalinizing agents (Renal), compared to placebo, reduces mortality rate due to uremic crises in dogs with spontaneous CKD, fed a renal diet (RD). A masked RCCT was performed including 31 azotemic dogs with spontaneous CKD. Dogs enrolled in the study were randomly allocated to receive RD plus placebo (group A; 15 dogs) or RD plus Renal (group B; 16 dogs). During a first 4-week period, all dogs were fed an RD and then randomized and clinically evaluated up to 44 weeks. The effects of dietary supplements on mortality rate due to uremic crises were assessed. At 44 weeks, compared to group A, dogs in group B had approximately 50% lower mortality rate due to uremic crises (P = 0.015). Dietary supplementation with chitosan, phosphate binders, and alkalinizing agents, along with an RD, is beneficial in reducing mortality rate in dogs with spontaneous CKD. PMID:22593665

Comparative Longterm Mortality Trends in Cancer vs. Ischemic Heart Disease in Puerto Rico.

PubMed

Torres, David; Pericchi, Luis R; Mattei, Hernando; Zevallos, Juan C

2017-06-01

Although contemporary mortality data are important for health assessment and planning purposes, their availability lag several years. Statistical projection techniques can be employed to obtain current estimates. This study aimed to assess annual trends of mortality in Puerto Rico due to cancer and Ischemic Heart Disease (IHD), and to predict shorterm and longterm cancer and IHD mortality figures. Age-adjusted mortality per 100,000 population projections with a 50% interval probability were calculated utilizing a Bayesian statistical approach of Age-Period-Cohort dynamic model. Multiple cause-of-death annual files for years 1994-2010 for Puerto Rico were used to calculate shortterm (2011-2012) predictions. Longterm (2013-2022) predictions were based on quinquennial data. We also calculated gender differences in rates (men-women) for each study period. Mortality rates for women were similar for cancer and IHD in the 1994-1998 period, but changed substantially in the projected 2018-2022 period. Cancer mortality rates declined gradually overtime, and the gender difference remained constant throughout the historical and projected trends. A consistent declining trend for IHD historical annual mortality rate was observed for both genders, with a substantial changepoint around 2004-2005 for men. The initial gender difference of 33% (80/100,00 vs. 60/100,000) in mortality rates observed between cancer and IHD in the 1994-1998 period increased to 300% (60/100,000 vs. 20/100,000) for the 2018-2022 period. The APC projection model accurately projects shortterm and longterm mortality trends for cancer and IHD in this population: The steady historical and projected cancer mortality rates contrasts with the substantial decline in IHD mortality rates, especially in men.

Disparities in the surgical treatment of colorectal liver metastases.

PubMed

Munene, Gitonga; Parker, Robyn D; Shaheen, Abdel Aziz; Myers, Robert P; Quan, May Lynn; Ball, Chad G; Dixon, Elijah

2013-01-01

Hepatectomy is an accepted standard of care for patients with resectable colorectal liver metastases (CLM). Given that it is unclear whether disparities exist between different patient populations, a population-based analysis was performed to analyze this issue with regards to resection rates and surgical mortality in patients with CLM. Using the Nationwide Inpatient Sample, characteristics and outcomes of adult patients with a diagnosis of colorectal cancer and colorectal metastases that subsequently underwent a liver resection during the years 1993-2007 were identified. Multivariate analysis was used to determine the effects of demographic and clinical covariables on resection rates and in-hospital mortality. Incident colorectal and liver metastases were identified in 138,565 patients; 3,528 patients (2.6%) underwent subsequent resection. African American and Hispanic race were associated with lower resection rates compared to Caucasian patients (adjusted OR 0.61 (0.52 - 0.71) and 0.81 (0.68 - 0.96) respectively). Medicaid insurance was associated with decreased resection rates compared to private insurance (AOR 0.47 (0.40 - 0.56)). The overall inpatient mortality rate was 3.1%. Multivariate analysis determined that mortality rate was correlated to both insurance status and geographic region. The national resection rate is significantly lower than has been reported by most case series. Race and insurance status appear to be correlated to the likelihood of surgical resection. In-hospital mortality is equivalent to the rates reported elsewhere, but is correlated to insurance status and region.

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

PubMed

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

2017-08-14

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

Changes in U.S. Hospitalization and Mortality Rates following Smoking Bans

ERIC Educational Resources Information Center

Shetty, Kanaka D.; DeLeire, Thomas; White, Chapin; Bhattacharya, Jayanta

2011-01-01

U.S. state and local governments have increasingly adopted restrictions on smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller…

Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder.

PubMed

Laursen, Thomas Munk; Munk-Olsen, Trine; Agerbo, Esben; Gasse, Christiane; Mortensen, Preben Bo

2009-07-01

Excess mortality from heart disease is observed in patients with severe mental disorder. This excess mortality may be rooted in adverse effects of pharmacological or psychotropic treatment, lifestyle factors, or inadequate somatic care. To examine whether persons with severe mental disorder, defined as persons admitted to a psychiatric hospital with bipolar affective disorder, schizoaffective disorder, or schizophrenia, are in contact with hospitals and undergoing invasive procedures for heart disease to the same degree as the nonpsychiatric general population, and to determine whether they have higher mortality rates of heart disease. A population-based cohort of 4.6 million persons born in Denmark was followed up from 1994 to 2007. Rates of mortality, somatic contacts, and invasive procedures were estimated by survival analysis. Incidence rate ratios of heart disease admissions and heart disease mortality as well as probability of invasive cardiac procedures. The incidence rate ratio of heart disease contacts in persons with severe mental disorder compared with the rate for the nonpsychiatric general population was only slightly increased, at 1.11 (95% confidence interval, 1.08-1.14). In contrast, their excess mortality rate ratio from heart disease was 2.90 (95% confidence interval, 2.71-3.10). Five years after the first contact for somatic heart disease, the risk of dying of heart disease was 8.26% for persons with severe mental disorder (aged <70 years) but only 2.86% in patients with heart disease who had never been admitted to a psychiatric hospital. The fraction undergoing invasive procedures within 5 years was reduced among patients with severe mental disorder as compared with the nonpsychiatric general population (7.04% vs 12.27%, respectively). Individuals with severe mental disorder had only negligible excess rates of contact for heart disease. Given their excess mortality from heart disease and lower rates of invasive procedures after first contact, it would seem that the treatment for heart disease offered to these individuals in Denmark is neither sufficiently efficient nor sufficiently intensive. This undertreatment may explain part of their excess mortality.

Lamb and kid mortality in village flocks in the coastal savanna zone of Ghana.

PubMed

Turkson, P K

2003-12-01

A cohort study was designed to observe and follow up mortality in lambs and kids in 88 flocks of sheep and goats under the traditional production system in five villages within the coastal savanna zone of Ghana over a 2-year period. The overall mortality rates for kids and lambs were 30.8% and 33.5%, respectively. Significantly higher proportions of kids (80.2%) and lambs (75.6%) up to 3 months of age died compared to kids and lambs from 4 to 12 months of age. The differences in mortality rates, either between male and female kids and lambs or between single-born and multiple-birth kids and lambs, were not significant. The odds ratio (OR) and relative risks (RR) for lambs and kids, on the basis of sex and birth types, were not significant; neither were the values obtained for attributable risk, attributable fraction, population attributable risk and population attributable fraction. The overall mortality rate on the basis of species of animal was not significant. At the village level, significant differences in the proportions of mortality on the basis of sex were seen in two villages. At Akotokyir, more male lambs (54.2%) died compared to females (27.6%), while at Apewosika more female lambs (42.2%) died compared to males (16.7%). The only significant difference in mortality proportions on the basis of birth type at the village level was seen at Apewosika, where more single-born kids died (52.8%) compared to kids born with sibling(s) (28.4%). The significant ORs for mortalities were 3.10 for male lambs at Akotokyir, 3.35 for female lambs at Apewosika and 2.82 for single-born kids at Apewosika. The corresponding RRs were equally significant. On the basis of species, significantly more lambs died at Akotokyir (44.2%) and Kwesimprah (44.7%) compared to kids. The implications of these findings are discussed.

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

Analysis and Long-Term Follow-Up of the Surgical Treatment of Children With Craniopharyngioma.

PubMed

Cheng, Jing; Shao, Qiang; Pan, Zhiyong; You, Jin

2016-11-01

To investigate the relationship between the operative approach, clinical pathological factors, and curative effect of the surgical treatment in the patients with craniopharyngioma; to provide a theoretical basis for determining the prognosis and reducing the recurrence rate during the long-term postoperative follow-up in children. This was a retrospective analysis of the clinical data of 92 children who underwent surgical treatment in our department from May 2011 to January 2005. Long-term follow-up was performed from 12 months to 8 years. The pterional approach was used in 49 patients, the interhemispheric approach in 20 patients, the corpus callosum approach in 16 patients, and the butterfly approach in 7 patients. Pathological classification was performed by hematoxylin and eosin stain staining of the pathological tissues and evaluated according to the different surgical approaches, MRI calcification status, calcification type, pathological type, whether radiotherapy was performed, postoperative recurrence, and death. For the pterion approach resection, there was near total resection in 46 patients (93.9%) with the lowest recurrence rate. The operative approach and postoperative recurrence rates were compared; the difference was statistically significant (P <0.05). For comparison of the operative approach and postoperative mortality, the difference was not statistically significant (P >0.05). There was not a significant difference between the MRI classification and postoperative recurrence rate (P >0.05). Comparing the degree of tumor calcification with the recurrence rate after operation and the mortality rate, the difference was statistically significant (P <0.05). The recurrence rate and mortality rate of adamantimous craniopharyngioma and squamous papillary craniopharyngioma in 2 groups following operation were compared, and the differences were statistically significant (P <0.05). Postoperative adjuvant radiotherapy was compared with the postoperative recurrence rate and mortality; the differences were statistically significant (P <0.05). The main effects on tumor recurrence include the choice of surgical approach and degree of calcification. The adamantimous craniopharyngioma relapse rate is higher, which could be because invasion of craniopharyngioma only occurs with adamantimous craniopharyngioma. Postoperative radiotherapy can significantly prolong the recurrence time and reduce the mortality rate of patients with craniopharyngioma.

Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study.

PubMed

Hwang, Stephen W; Wilkins, Russell; Tjepkema, Michael; O'Campo, Patricia J; Dunn, James R

2009-10-26

To examine mortality in a representative nationwide sample of homeless and marginally housed people living in shelters, rooming houses, and hotels. Follow-up study. Canada 1991-2001. 15 100 homeless and marginally housed people enumerated in 1991 census. Age specific and age standardised mortality rates, remaining life expectancies at age 25, and probabilities of survival from age 25 to 75. Data were compared with data from the poorest and richest income fifths as well as with data for the entire cohort Of the homeless and marginally housed people, 3280 died. Mortality rates among these people were substantially higher than rates in the poorest income fifth, with the highest rate ratios seen at younger ages. Among those who were homeless or marginally housed, the probability of survival to age 75 was 32% (95% confidence interval 30% to 34%) in men and 60% (56% to 63%) in women. Remaining life expectancy at age 25 was 42 years (42 to 43) and 52 years (50 to 53), respectively. Compared with the entire cohort, mortality rate ratios for men and women, respectively, were 11.5 (8.8 to 15.0) and 9.2 (5.5 to 15.2) for drug related deaths, 6.4 (5.3 to 7.7) and 8.2 (5.0 to 13.4) for alcohol related deaths, 4.8 (3.9 to 5.9) and 3.8 (2.7 to 5.4) for mental disorders, and 2.3 (1.8 to 3.1) and 5.6 (3.2 to 9.6) for suicide. For both sexes, the largest differences in mortality rates were for smoking related diseases, ischaemic heart disease, and respiratory diseases. Living in shelters, rooming houses, and hotels is associated with much higher mortality than expected on the basis of low income alone. Reducing the excessively high rates of premature mortality in this population would require interventions to address deaths related to smoking, alcohol, and drugs, and mental disorders and suicide, among other causes.

Emergency Heart Failure Mortality Risk Grade score performance for 7-day mortality prediction in patients with heart failure attended at the emergency department: validation in a Spanish cohort.

PubMed

Gil, Víctor; Miró, Òscar; Schull, Michael J; Llorens, Pere; Herrero-Puente, Pablo; Jacob, Javier; Ríos, José; Lee, Douglas S; Martín-Sánchez, Francisco J

2018-06-01

The Emergency Heart Failure Mortality Risk Grade (EHMRG) scale, derived in 86 Canadian emergency departments (EDs), stratifies patients with acute-decompensated heart failure (ADHF) according to their 7-day mortality risk. We evaluated its external validity in a Spanish cohort. We applied the EHMRG scale to ADHF patients consecutively included in the Epidemiology of Acute Heart Failure in Emergency departments (EAHFE) registry (29 Spanish EDs) and measured its performance. Patients were distributed into quintiles according to the original and their self-defined score cutoffs. The 7-day mortality rates were compared internally among different categories and with categories of Canadian cohorts. The EAHFE group [n: 1553 patients; 80 (10) years; 55.6% women] had a 5.5% 7-day mortality rate and the EHMRG scale c-statistic was 0.741 (95% confidence interval: 0.688-0.793) compared with 0.807 (0.761-0.842) and 0.804 (0.763-0.840) obtained in the Canadian derivation and validation cohorts. The mortality rate of the EAHFE group mortality increased progressively as the quintile categories increased using intervals defined by either the Canadian or the Spanish EHMRG score cutoffs, although with more regular increments with the EAHFE-defined intervals; using the latter, patients at quintiles 2, 3, 4, 5a and 5b had (compared with quintile 1) odds ratios of 1.77, 3.36, 4.44, 9.39 and 16.19, respectively. The EHMRG scale stratified risk in an ADHF cohort that included both palliative and nonpalliative patients in Spanish EDs, showing an extrapolation to a higher mortality risk cohort than the original derivation sample. Stratification improved when the score was recalibrated in the Spanish cohort.

Preadmission Use of Glucocorticoids and 30-Day Mortality After Stroke.

PubMed

Sundbøll, Jens; Horváth-Puhó, Erzsébet; Schmidt, Morten; Dekkers, Olaf M; Christiansen, Christian F; Pedersen, Lars; Bøtker, Hans Erik; Sørensen, Henrik T

2016-03-01

The prognostic impact of glucocorticoids on stroke mortality remains uncertain. We, therefore, examined whether preadmission use of glucocorticoids is associated with short-term mortality after ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012. We categorized glucocorticoid use as current use (last prescription redemption ≤90 days before admission), former use, and nonuse. Current use was further classified as new or long-term use. We used Cox regression to compute 30-day mortality rate ratios with 95% confidence intervals (CIs), controlling for confounders. We identified 100 042 patients with a first-time stroke. Of these, 83 735 patients had ischemic stroke, 11 779 had ICH, and 4528 had SAH. Absolute mortality risk was higher for current users compared with nonusers for ischemic stroke (19.5% versus 10.2%), ICH (46.5% versus 34.4%), and SAH (35.0% versus 23.2%). For ischemic stroke, the adjusted 30-day mortality rate ratio was increased among current users compared with nonusers (1.58, 95% CI: 1.46-1.71), driven by the effect of glucocorticoids among new users (1.80, 95% CI: 1.62-1.99). Current users had a more modest increase in the adjusted 30-day mortality rate ratio for hemorrhagic stroke (1.26, 95% CI: 1.09-1.45 for ICH and 1.40, 95% CI: 1.01-1.93 for SAH) compared with nonusers. Former use was not substantially associated with mortality. Preadmission use of glucocorticoids was associated with increased 30-day mortality among patients with ischemic stroke, ICH, and SAH. © 2016 American Heart Association, Inc.

Mortality in Patients with HIV-1 Infection Starting Antiretroviral Therapy in South Africa, Europe, or North America: A Collaborative Analysis of Prospective Studies

PubMed Central

Boulle, Andrew; Schomaker, Michael; May, Margaret T.; Hogg, Robert S.; Shepherd, Bryan E.; Monge, Susana; Keiser, Olivia; Lampe, Fiona C.; Giddy, Janet; Ndirangu, James; Garone, Daniela; Fox, Matthew; Ingle, Suzanne M.; Reiss, Peter; Dabis, Francois; Costagliola, Dominique; Castagna, Antonella; Ehren, Kathrin; Campbell, Colin; Gill, M. John; Saag, Michael; Justice, Amy C.; Guest, Jodie; Crane, Heidi M.; Egger, Matthias; Sterne, Jonathan A. C.

2014-01-01

Background High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America. Methods and Findings Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0–3, 3–6, 6–12, 12–24, and 24–48 months on ART for the period 2001–2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count <50 cells/µl. Cumulative mortality at 4 years was 16.6%, 4.7%, and 15.3% in South Africa, Europe, and North America, respectively. Mortality was initially much lower in Europe and North America than South Africa, but the differences were reduced or reversed (North America) at longer durations on ART (adjusted rate ratios 0.46, 95% CI 0.37–0.58, and 1.62, 95% CI 1.27–2.05 between 24 and 48 months on ART comparing Europe and North America to South Africa). While bias due to under-ascertainment of mortality was minimised through death registry linkage, residual bias could still be present due to differing approaches to and frequency of linkage. Conclusions After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts. Please see later in the article for the Editors' Summary PMID:25203931

Racial disparities in diabetes mortality in the 50 most populous US cities.

PubMed

Rosenstock, Summer; Whitman, Steve; West, Joseph F; Balkin, Michael

2014-10-01

While studies have consistently shown that in the USA, non-Hispanic Blacks (Blacks) have higher diabetes prevalence, complication and death rates than non-Hispanic Whites (Whites), there are no studies that compare disparities in diabetes mortality across the largest US cities. This study presents and compares Black/White age-adjusted diabetes mortality rate ratios (RRs), calculated using national death files and census data, for the 50 most populous US cities. Relationships between city-level diabetes mortality RRs and 12 ecological variables were explored using bivariate correlation analyses. Multivariate analyses were conducted using negative binomial regression to examine how much of the disparity could be explained by these variables. Blacks had statistically significantly higher mortality rates compared to Whites in 39 of the 41 cities included in analyses, with statistically significant rate ratios ranging from 1.57 (95 % CI: 1.33-1.86) in Baltimore to 3.78 (95 % CI: 2.84-5.02) in Washington, DC. Analyses showed that economic inequality was strongly correlated with the diabetes mortality disparity, driven by differences in White poverty levels. This was followed by segregation. Multivariate analyses showed that adjusting for Black/White poverty alone explained 58.5 % of the disparity. Adjusting for Black/White poverty and segregation explained 72.6 % of the disparity. This study emphasizes the role that inequalities in social and economic determinants, rather than for example poverty on its own, play in Black/White diabetes mortality disparities. It also highlights how the magnitude of the disparity and the factors that influence it can vary greatly across cities, underscoring the importance of using local data to identify context specific barriers and develop effective interventions to eliminate health disparities.

Renal cell cancer in Israel: sex and ethnic differences in incidence and mortality, 1980-2004.

PubMed

Tarabeia, Jalal; Kaluski, Dorit Nitzan; Barchana, Micha; Dichtiar, Rita; Green, Manfred S

2010-06-01

The causes of renal cell cancer (RCC) remain largely unexplained. While the incidence is generally higher in men than in women, little has been reported on ethnic differences. We examine trends in RCC incidence and mortality rates among Israeli Arab and Jewish populations and compared with the rates in other countries. Age-adjusted RCC incidence and mortality rates in Israel, during 1980-2004, were calculated by sex and population group, using the National Cancer Registry. They were compared with the United States based on the Surveillance Epidemiology and End Results [SEER] program and the IARC database for international comparisons. While RCC incidence rates in Israel are similar to the United States and the European average, the rates are significantly higher among Israeli Jews than Arabs. Men are affected more than women. Incidence rates over the last 24 years have increased among all men and Jewish women, but not among Arab women. Among men, the incidence rate ratio for Jews to Arabs declined from 3.96 in 1980-1982 to 2.34 in 2001-2004, whereas for women there was no change. The mortality rates were higher among Jews than Arab and among men than women. There were no significant change in the mortality rates and rate ratios. Our findings demonstrate marked ethnic differences in RCC in Israel. The lower incidence among Arabs stands in contrast to the higher prevalence of potential risk factors for RCC in this population group. Genetic factors, diet and other lifestyle factors could play protective roles. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States.

PubMed

Raymond, Elizabeth G; Grossman, Daniel; Weaver, Mark A; Toti, Stephanie; Winikoff, Beverly

2014-11-01

The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities. We calculated the abortion-related mortality rate during 2000-2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving. The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health. Copyright © 2014 Elsevier Inc. All rights reserved.

Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh: an analysis over a 24-year period

PubMed Central

Khan, Jahangir AM; Trujillo, Antonio J; Ahmed, Sayem; Siddiquee, Ali Tanweer; Alam, Nurul; Mirelman, Andrew J; Koehlmoos, Tracey Perez; Niessen, Louis Wilhelmus; Peters, David H

2015-01-01

Background: Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty. Methods: Age-sex standardized chronic diseases mortality rates were estimated across socioeconomic groups in 1982, 1996 and 2005, using data from the health and demographic surveillance system in Matlab, Bangladesh. Changes in households falling below a poverty threshold after a chronic disease death were estimated between 1982–96 and 1996–2005. Results: Age-sex standardized chronic disease mortality rates rose from 646 per 100 000 population in 1982 to 670 in 2005. Mortality rates were higher in wealthier compared with poorer households in 1982 [Concentration Index = 0.037; 95% confidence interval (CI): 0.002, 0.072], but switched direction in 1996 (Concentration Index = −0.007; 95% CI: −0.023, 0.009), with an even higher concentration in the poor by 2005 (Concentration Index = −0.047; 95% CI: −0.061, −0.033). Between 1982–96 and 1996–2005, the highest chronic disease mortality rates were found among those households that fell below the poverty line. Households that had a chronic disease death in 1982 were 1.33 (95% CI: 1.03, 1.70) times more likely to fall below the poverty line in 1996 compared with households that did not. Conclusions: Chronic disease mortality is a growing proportion of the disease burden in Bangladesh, with poorer households being more affected over time periods, leading to future household poverty. PMID:26467760

Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh: an analysis over a 24-year period.

PubMed

Khan, Jahangir Am; Trujillo, Antonio J; Ahmed, Sayem; Siddiquee, Ali Tanweer; Alam, Nurul; Mirelman, Andrew J; Koehlmoos, Tracey Perez; Niessen, Louis Wilhelmus; Peters, David H

2015-12-01

Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty. Age-sex standardized chronic diseases mortality rates were estimated across socioeconomic groups in 1982, 1996 and 2005, using data from the health and demographic surveillance system in Matlab, Bangladesh. Changes in households falling below a poverty threshold after a chronic disease death were estimated between 1982-96 and 1996-2005. Age-sex standardized chronic disease mortality rates rose from 646 per 100 000 population in 1982 to 670 in 2005. Mortality rates were higher in wealthier compared with poorer households in 1982 [Concentration Index = 0.037; 95% confidence interval (CI): 0.002, 0.072], but switched direction in 1996 (Concentration Index = -0.007; 95% CI: -0.023, 0.009), with an even higher concentration in the poor by 2005 (Concentration Index = -0.047; 95% CI: -0.061, -0.033). Between 1982-96 and 1996-2005, the highest chronic disease mortality rates were found among those households that fell below the poverty line. Households that had a chronic disease death in 1982 were 1.33 (95% CI: 1.03, 1.70) times more likely to fall below the poverty line in 1996 compared with households that did not. Chronic disease mortality is a growing proportion of the disease burden in Bangladesh, with poorer households being more affected over time periods, leading to future household poverty. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Mortality of spruce and fir in Maine in 1976-78 due to the spruce budworm outbreak

Treesearch

Donald W. Seegrist; Stanford L. Arner

1982-01-01

The spruce budworm population in Maine's spruce-fir forests has been at epidemic levels since the early 1970's. Spruce-fir mortality in 1976-78 is compared with predictions of what mortality would have been had the natural mortality rates remained at the levels experienced before the budworm outbreak. It appears that mortality of spruce and fir has increased...

Intermittent aortic cross-clamping for isolated CABG can save lives and money: experience with 15307 patients.

PubMed

Boethig, D; Minami, K; Lueth, J-U; El-Banayosy, A; Breymann, T; Koerfer, R

2004-06-01

The ideal myocardial protection during isolated CABG is still a matter of debate. Cardioplegia versus intermittent aortic cross-clamping (IACC) are the main opponents; the following article shows that IACC can be safe, efficient and might be cheaper than cardioplegia. Demographics and co-morbidities of 15307 CABG only patients consecutively operated on between January 1993 and October 2001 in the Heart Center in Bad Oeynhausen were assessed by the German Quality Assurance data set and risk-stratified using the EuroSCORE. Outcome (30-day or in-hospital mortality) was compared to the expected EuroSCORE estimation. Expected mortality was 3.25 %, observed mortality was 1.3 %, being significantly lower in the low, medium as well as high risk patients subgroup. Complication rates increased steadily with expected mortality rates. Stroke and myocardial infarction rates for patients with peripheral vessel disease were not higher than in comparable studies. More than 1000000 EUR were saved by lower cardioplegia bills. Myocardial protection with intermittent aortic cross-clamping for isolated CABG can be safe, effective, and economically advantageous when compared to cardioplegic solutions.

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

PubMed Central

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

2014-01-01

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

Association of long-term PM2.5 exposure with mortality using different air pollution exposure models: impacts in rural and urban California.

PubMed

Garcia, Cynthia A; Yap, Poh-Sin; Park, Hye-Youn; Weller, Barbara L

2016-01-01

Most PM2.5-associated mortality studies are not conducted in rural areas where mortality rates may differ when population characteristics, health care access, and PM2.5 composition differ. PM2.5-associated mortality was investigated in the elderly residing in rural-urban zip codes. Exposure (2000-2006) was estimated using different models and Poisson regression was performed using 2006 mortality data. PM2.5 models estimated comparable exposures, although subtle differences were observed in rate ratios (RR) within areas by health outcomes. Cardiovascular disease (CVD), ischemic heart disease (IHD), and cardiopulmonary disease (CPD), mortality was significantly associated with rural, urban, and statewide chronic PM2.5 exposures. We observed larger effect sizes in RRs for CVD, CPD, and all-cause (AC) with similar sizes for IHD mortality in rural areas compared to urban areas. PM2.5 was significantly associated with AC mortality in rural areas and statewide; however, in urban areas, only the most restrictive exposure model showed an association. Given the results seen, future mortality studies should consider adjusting for differences with rural-urban variables.

Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality.

PubMed

Lohsiriwat, Varut; Prapasrivorakul, Siriluck; Lohsiriwat, Darin

2009-01-01

The purposes of this study were to determine clinical presentations and surgical outcomes of perforated peptic ulcer (PPU), and to evaluate the accuracy of the Boey scoring system in predicting mortality and morbidity. We carried out a retrospective study of patients undergoing emergency surgery for PPU between 2001 and 2006 in a university hospital. Clinical presentations and surgical outcomes were analyzed. Adjusted odds ratio (OR) of each Boey score on morbidity and mortality rate was compared with zero risk score. Receiver-operating characteristic curve analysis was used to compare the predictive ability between Boey score, American Society of Anesthesiologists (ASA) classification, and Mannheim Peritonitis Index (MPI). The study included 152 patients with average age of 52 years (range: 15-88 years), and 78% were male. The most common site of PPU was the prepyloric region (74%). Primary closure and omental graft was the most common procedure performed. Overall mortality rate was 9% and the complication rate was 30%. The mortality rate increased progressively with increasing numbers of the Boey score: 1%, 8% (OR=2.4), 33% (OR=3.5), and 38% (OR=7.7) for 0, 1, 2, and 3 scores, respectively (p<0.001). The morbidity rates for 0, 1, 2, and 3 Boey scores were 11%, 47% (OR=2.9), 75% (OR=4.3), and 77% (OR=4.9), respectively (p<0.001). Boey score and ASA classification appeared to be better than MPI for predicting the poor surgical outcomes. Perforated peptic ulcer is associated with high rates of mortality and morbidity. The Boey risk score serves as a simple and precise predictor for postoperative mortality and morbidity.

Tuberculosis mortality trends in cuba, 1998 to 2007.

PubMed

González, Edilberto; Risco, Grisel E; Borroto, Susana; Perna, Abel; Armas, Luisa

2009-01-01

Introduction Tuberculosis (TB) is a major cause of illness and death throughout the world. The World Health Organization's Global Plan to Stop TB 2006-2015 proposes that countries cut TB mortality by half compared to 1990 rates. In Cuba, TB mortality declined steadily throughout the 20th century, particularly after 1960. Objective Describe TB mortality distribution and trends in Cuba from January 1998 to December 2007 by infection site, sex, age and province, and determine progress towards the WHO's 2015 target for TB mortality reduction. Methods A time series ecological study was conducted. Death certificates stating TB as cause of death were obtained from the Ministry of Public Health's National Statistics Division, and population data by age group, sex, and province were obtained from the National Statistics Bureau. Crude and specific death rate trends and variation were analyzed. Results TB mortality declined from 0.4 per 100,000 population in 1998 to 0.2 (under half the 1990 rate) in 2007. Clinical forms of the disease, both pulmonary and extrapulmonary, also declined. The highest mortality rates were found in males and in the group aged ≥ 65 years. Rates were also highest in the capital, Havana, with extreme values of 0.73 and 0.39 per 100,000 population at the beginning and end of the period, respectively. Conclusions Deaths from TB declined steadily compared to total deaths and deaths caused by infectious diseases. The Global Plan to Stop TB target was met well ahead of 2015. If this trend continues, TB is likely to become an exceptional cause of death in Cuba.

Cause-specific mortality by occupational skill level in Canada: a 16-year follow-up study.

PubMed

Tjepkema, M; Wilkins, R; Long, A

2013-09-01

Mortality data by occupation are not routinely available in Canada, so we analyzed census-linked data to examine cause-specific mortality rates across groups of occupations ranked by skill level. A 15% sample of 1991 Canadian Census respondents aged 25 years or older was previously linked to 16 years of mortality data (1991-2006). The current analysis is based on 2.3 million people aged 25 to 64 years at cohort inception, among whom there were 164 332 deaths during the follow-up period. Occupations coded according to the National Occupation Classification were grouped into five skill levels. Age-standardized mortality rates (ASMRs), rate ratios (RRs), rate differences (RDs) and excess mortality were calculated by occupational skill level for various causes of death. ASMRs were clearly graded by skill level: they were highest among those employed in unskilled jobs (and those without an occupation) and lowest for those in professional occupations. All-cause RRs for men were 1.16, 1.40, 1.63 and 1.83 with decreasing occupational skill level compared with professionals. For women the gradient was less steep: 1.23, 1.24, 1.32 and 1.53. This gradient was present for most causes of death. Rate ratios comparing lowest to highest skill levels were greater than 2 for HIV/AIDS, diabetes mellitus, suicide and cancer of the cervix as well as for causes of death associated with tobacco use and excessive alcohol consumption. Mortality gradients by occupational skill level were evident for most causes of death. These results provide detailed cause-specific baseline indicators not previously available for Canada.

Racial Difference in Sarcoidosis Mortality in the United States

PubMed Central

Machado, Roberto F.; Schraufnagel, Dean; Sweiss, Nadera J.; Baughman, Robert P.

2015-01-01

BACKGROUND: The clinical presentation and outcome of sarcoidosis varies by race. However, the race difference in mortality outcome remains largely unknown. METHODS: We studied mortality related to sarcoidosis from 1999 through 2010 by examining data on multiple causes of death from the National Center for Health Statistics. We compared the comorbid conditions between sarcoidosis-related deaths with deaths caused by car accidents (previously healthy control subjects) and rheumatoid arthritis (chronic disease control subjects) in both African Americans and Caucasians. RESULTS: From 1999 through 2010, sarcoidosis was reported as an immediate cause of death in 10,348 people in the United States with a combined overall mean age-adjusted mortality rate of 2.8 per 1 million person-years. Of these, 6,285 were African American and 3,984 Caucasian. The age-adjusted mortality rate for African Americans was 12 times higher than for Caucasians. African Americans died at an earlier age than Caucasians. African Americans living in the District of Columbia and North Carolina and Caucasians living in Vermont had higher mortality rates. Although the total sarcoidosis age-adjusted mortality rate had not changed over the 12 year period studied, this rate increased for Caucasians (R = 0.747, P = .005) but not for African Americans. Compared with the control groups, pulmonary hypertension was significantly more common in individuals with sarcoidosis. CONCLUSIONS: This nationwide population-based study exposes a significant difference in ethnicity and sex among people dying of sarcoidosis in the United States. Pulmonary hypertension investigation should be considered in all patients with sarcoidosis, especially African Americans. PMID:25188873

Association between an Internet-Based Measure of Area Racism and Black Mortality.

PubMed

Chae, David H; Clouston, Sean; Hatzenbuehler, Mark L; Kramer, Michael R; Cooper, Hannah L F; Wilson, Sacoby M; Stephens-Davidowitz, Seth I; Gold, Robert S; Link, Bruce G

2015-01-01

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the "N-word" in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004-2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health.

Association between an Internet-Based Measure of Area Racism and Black Mortality

PubMed Central

Chae, David H.; Clouston, Sean; Hatzenbuehler, Mark L.; Kramer, Michael R.; Cooper, Hannah L. F.; Wilson, Sacoby M.; Stephens-Davidowitz, Seth I.; Gold, Robert S.; Link, Bruce G.

2015-01-01

Racial disparities in health are well-documented and represent a significant public health concern in the US. Racism-related factors contribute to poorer health and higher mortality rates among Blacks compared to other racial groups. However, methods to measure racism and monitor its associations with health at the population-level have remained elusive. In this study, we investigated the utility of a previously developed Internet search-based proxy of area racism as a predictor of Black mortality rates. Area racism was the proportion of Google searches containing the “N-word” in 196 designated market areas (DMAs). Negative binomial regression models were specified taking into account individual age, sex, year of death, and Census region and adjusted to the 2000 US standard population to examine the association between area racism and Black mortality rates, which were derived from death certificates and mid-year population counts collated by the National Center for Health Statistics (2004–2009). DMAs characterized by a one standard deviation greater level of area racism were associated with an 8.2% increase in the all-cause Black mortality rate, equivalent to over 30,000 deaths annually. The magnitude of this effect was attenuated to 5.7% after adjustment for DMA-level demographic and Black socioeconomic covariates. A model controlling for the White mortality rate was used to further adjust for unmeasured confounders that influence mortality overall in a geographic area, and to examine Black-White disparities in the mortality rate. Area racism remained significantly associated with the all-cause Black mortality rate (mortality rate ratio = 1.036; 95% confidence interval = 1.015, 1.057; p = 0.001). Models further examining cause-specific Black mortality rates revealed significant associations with heart disease, cancer, and stroke. These findings are congruent with studies documenting the deleterious impact of racism on health among Blacks. Our study contributes to evidence that racism shapes patterns in mortality and generates racial disparities in health. PMID:25909964

Comparing trends in cancer rates across overlapping regions.

PubMed

Li, Yi; Tiwari, Ram C

2008-12-01

Monitoring and comparing trends in cancer rates across geographic regions or over different time periods have been major tasks of the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program as it profiles healthcare quality as well as decides healthcare resource allocations within a spatial-temporal framework. A fundamental difficulty, however, arises when such comparisons have to be made for regions or time intervals that overlap, for example, comparing the change in trends of mortality rates in a local area (e.g., the mortality rate of breast cancer in California) with a more global level (i.e., the national mortality rate of breast cancer). In view of sparsity of available methodologies, this article develops a simple corrected Z-test that accounts for such overlapping. The performance of the proposed test over the two-sample "pooled"t-test that assumes independence across comparison groups is assessed via the Pitman asymptotic relative efficiency as well as Monte Carlo simulations and applications to the SEER cancer data. The proposed test will be important for the SEER * STAT software, maintained by the NCI, for the analysis of the SEER data.

A comparative population-based study of prostate cancer incidence and mortality rates in Singapore, Sweden and Geneva, Switzerland from 1973 to 2006.

PubMed

Chen, Cynthia; Naidoo, Nasheen; Yang, Qian; Hartman, Mikael; Verkooijen, Helena M; Loy, En Yun; Bouchardy, Christine; Chia, Kee Seng; Chia, Sin Eng

2012-06-06

Prostate cancer is the most commonly diagnosed malignancy in men in Sweden and Geneva, and the third most common in men in Singapore. This population-based study describes trends in the incidence and mortality rates of prostate cancer in Singapore, Sweden and Geneva (Switzerland) from 1973 to 2006 and explores possible explanations for these different trends. Data from patients diagnosed with prostate cancer were extracted from national cancer registries in Singapore (n = 5,172), Sweden (n = 188,783) and Geneva (n = 5,755) from 1973 to 2006. Trends of incidence and mortality were reported using the Poisson and negative binomial regression models. The age, period and birth-cohort were tested as predictors of incidence and mortality rates of prostate cancer. Incidence rates of prostate cancer increased over all time periods for all three populations. Based on the age-period-cohort analysis, older age and later period of diagnosis were associated with a higher incidence of prostate cancer, whereas older age and earlier period were associated with higher mortality rates for prostate cancer in all three countries. This study demonstrated an overall increase in incidence rates and decrease in mortality rates in Singapore, Sweden and Geneva. Both incidence and mortality rates were much lower in Singapore. The period effect is a stronger predictor of incidence and mortality of prostate cancer than the birth-cohort effect.

The Hispanic mortality advantage and ethnic misclassification on US death certificates.

PubMed

Arias, Elizabeth; Eschbach, Karl; Schauman, William S; Backlund, Eric L; Sorlie, Paul D

2010-04-01

We tested the data artifact hypothesis regarding the Hispanic mortality advantage by investigating whether and to what degree this advantage is explained by Hispanic origin misclassification on US death certificates. We used the National Longitudinal Mortality Study, which links Current Population Survey records to death certificates for 1979 through 1998, to estimate the sensitivity, specificity, and net ascertainment of Hispanic ethnicity on death certificates compared with survey classifications. Using national vital statistics mortality data, we estimated Hispanic age-specific and age-adjusted death rates, which were uncorrected and corrected for death certificate misclassification, and produced death rate ratios comparing the Hispanic with the non-Hispanic White population. Hispanic origin reporting on death certificates in the United States is reasonably good. The net ascertainment of Hispanic origin is just 5% higher on survey records than on death certificates. Corrected age-adjusted death rates for Hispanics are lower than those for the non-Hispanic White population by close to 20%. The Hispanic mortality paradox is not explained by an incongruence between ethnic classification in vital registration and population data systems.

Age-Specific Malaria Mortality Rates in the KEMRI/CDC Health and Demographic Surveillance System in Western Kenya, 2003–2010

PubMed Central

Desai, Meghna; Buff, Ann M.; Khagayi, Sammy; Byass, Peter; Amek, Nyaguara; van Eijk, Annemieke; Slutsker, Laurence; Vulule, John; Odhiambo, Frank O.; Phillips-Howard, Penelope A.; Lindblade, Kimberly A.; Laserson, Kayla F.; Hamel, Mary J.

2014-01-01

Recent global malaria burden modeling efforts have produced significantly different estimates, particularly in adult malaria mortality. To measure malaria control progress, accurate malaria burden estimates across age groups are necessary. We determined age-specific malaria mortality rates in western Kenya to compare with recent global estimates. We collected data from 148,000 persons in a health and demographic surveillance system from 2003–2010. Standardized verbal autopsies were conducted for all deaths; probable cause of death was assigned using the InterVA-4 model. Annual malaria mortality rates per 1,000 person-years were generated by age group. Trends were analyzed using Poisson regression. From 2003–2010, in children <5 years the malaria mortality rate decreased from 13.2 to 3.7 per 1,000 person-years; the declines were greatest in the first three years of life. In children 5–14 years, the malaria mortality rate remained stable at 0.5 per 1,000 person-years. In persons ≥15 years, the malaria mortality rate decreased from 1.5 to 0.4 per 1,000 person-years. The malaria mortality rates in young children and persons aged ≥15 years decreased dramatically from 2003–2010 in western Kenya, but rates in older children have not declined. Sharp declines in some age groups likely reflect the national scale up of malaria control interventions and rapid expansion of HIV prevention services. These data highlight the importance of age-specific malaria mortality ascertainment and support current strategies to include all age groups in malaria control interventions. PMID:25180495

Cancer mortality by country of birth, sex, and socioeconomic position in Sweden, 1961-2009.

PubMed

Abdoli, Gholamreza; Bottai, Matteo; Moradi, Tahereh

2014-01-01

In 2010, cancer deaths accounted for more than 15% of all deaths worldwide, and this fraction is estimated to rise in the coming years. Increased cancer mortality has been observed in immigrant populations, but a comprehensive analysis by country of birth has not been conducted. We followed all individuals living in Sweden between 1961 and 2009 (7,109,327 men and 6,958,714 women), and calculated crude cancer mortality rates and age-standardized rates (ASRs) using the world population for standardization. We observed a downward trend in all-site ASRs over the past two decades in men regardless of country of birth but no such trend was found in women. All-site cancer mortality increased with decreasing levels of education regardless of sex and country of birth (p for trend <0.001). We also compared cancer mortality rates among foreign-born (13.9%) and Sweden-born (86.1%) individuals and determined the effect of education level and sex estimated by mortality rate ratios (MRRs) using multivariable Poisson regression. All-site cancer mortality was slightly higher among foreign-born than Sweden-born men (MRR = 1.05, 95% confidence interval 1.04-1.07), but similar mortality risks was found among foreign-born and Sweden-born women. Men born in Angola, Laos, and Cambodia had the highest cancer mortality risk. Women born in all countries except Iceland, Denmark, and Mexico had a similar or smaller risk than women born in Sweden. Cancer-specific mortality analysis showed an increased risk for cervical and lung cancer in both sexes but a decreased risk for colon, breast, and prostate cancer mortality among foreign-born compared with Sweden-born individuals. Further studies are required to fully understand the causes of the observed inequalities in mortality across levels of education and countries of birth.

Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study.

PubMed

Sharma, Praveen; Dietrich, Thomas; Ferro, Charles J; Cockwell, Paul; Chapple, Iain L C

2016-02-01

Periodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all-cause and cardiovascular disease-related) in individuals with stage 3-5 CKD, hitherto referred to as "CKD". Survival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking). Of the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow-up for this cohort was 14.3 years. Adjusting for confounders, the 10-year all-cause mortality rate for individuals with CKD increased from 32% (95% CI: 29-35%) to 41% (36-47%) with the addition of periodontitis. For diabetes, the 10-year all-cause mortality rate increased to 43% (38-49%). There is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Early-Stage Estimated Value of Blend Sign on the Prognosis of Patients with Intracerebral Hemorrhage

PubMed Central

Zhou, Ningquan; Wang, Chao

2018-01-01

Background and Purpose This study aimed to explore the relationship between blend sign and prognosis of patients with intracerebral hemorrhage (ICH). Methods Between January 2014 and December 2016, the results of cranial computed tomography imaging within 24 h after the onset of symptoms from 275 patients with ICH were retrospectively analyzed. The patients with or without blend sign were compared to observe and analyze the difference in coagulation function abnormality, rebleeding, mortality, and bad prognosis rates in the early stages. Results Of the 275 patients with ICH, 47 patients had Blend Sign I (17.09%) and 17 patients had Blend Sign II (6.18%). The coagulation function abnormality rate had no statistical difference among Blend Sign I, Blend Sign II, and conventional groups (P > 0.05). In the Blend Sign I group, the rebleeding rate was 4.26%, bad prognosis rate was 25.53%, and mortality rate was 6.38%, which were not statistically significantly different compared with those in the conventional group (P > 0.05). The rebleeding rate in the Blend Sign II group was 47.06%, bad prognosis rate was 82.35%, and mortality rate was 47.06%, which were statistically significantly different compared with those in the conventional and Blend Sign I groups (P < 0.05). Conclusions For the patients associated with Blend Sign I, the prognosis was equivalent to that in the conventional group, with no statistically significant difference. The rebleeding, bad prognosis, and mortality rates were higher in the Blend Sign II group than in the conventional group and deserved more attention.

Pesticide mortality. A Jordanian experience.

PubMed

Abu al-Ragheb, S Y; Salhab, A S

1989-09-01

During the 13-year period of 1973-1985, at least 329 deaths in Jordan resulted from poisoning by pesticides. Organophosphates were the major compounds incriminated in 93.6% of the cases. The annual mortality rate compared with that of other countries is relatively high, and was 5.97%, 17.35%, and 2.6% per 1 million people in 1973, 1979, and 1985, respectively. The annual mortality rates due to suicidal and accidental poisoning are 61% and 35.3%, respectively: 74% of the accidentally poisoned group are children less than 10 years, while 60.7% of the suicides are 15-24 years of age. To minimize such high mortality rates from pesticide poisoning, Jordan needs to adopt more protective measures by rigorous regulation.

First do no harm: the impact of recent armed conflict on maternal and child health in Sub-Saharan Africa

PubMed Central

O'Hare, Bernadette A M; Southall, David P

2007-01-01

Objectives To compare the rates of under-5 mortality, malnutrition, maternal mortality and other factors which influence health in countries with and without recent conflict. To compare central government expenditure on defence, education and health in countries with and without recent conflict. To summarize the amount spent on SALW and the main legal suppliers to countries in Sub-Saharan African countries (SSA), and to summarize licensed production of Small Arms and Light Weapons (SALW) in these countries. Design We compared the under-5 mortality rate in 2004 and the adjusted maternal mortality ratio in SSA which have and have not experienced recent armed conflict (post-1990). We also compared the percentage of children who are underweight in both sets of countries, and expenditure on defence, health and education. Setting Demographic data and central government expenditure details (1994-2004) were taken from UNICEF's The State of the World's Children 2006 report. Main outcome measures Under-5 mortality, adjusted maternal mortality, and government expenditure. Results 21 countries have and 21 countries have not experienced recent conflict in this dataset of 42 countries in SSA. Median under-5 mortality in countries with recent conflict is 197/1000 live births, versus 137/1000 live births in countries without recent conflict. In countries which have experienced recent conflict, a median of 27% of under-5s were moderately underweight, versus 22% in countries without recent conflict. The median adjusted maternal mortality in countries with recent conflict was 1000/100,000 births versus 690/100,000 births in countries without recent conflict. Median reported maternal mortality ratio is also significantly higher in countries with recent conflict. Expenditure on health and education is significantly lower and expenditure on defence significantly higher if there has been recent conflict. Conclusions There appears to be an association between recent conflict and higher rates of under-5 mortality, malnutrition and maternal mortality. Governments spend more on defence and less on health and education if there has been a recent conflict. SALW are the main weapon used and France and the UK appear to be the two main suppliers of SALW to SSA. PMID:18065709

Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.

PubMed

Chughtai, Abrar A; Wang, Alex Y; Hilder, Lisa; Li, Zhuoyang; Lui, Kei; Farquhar, Cindy; Sullivan, Elizabeth A

2018-02-01

Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births? Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births. Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births. This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples. All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death. Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group. Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian definition of perinatal period commences at 20 completed weeks (140 days) of gestation and ends 27 completed days after birth which is different from the definition by World Health Organisation (commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth) and by Centers for Disease Control and Prevention (includes infant deaths under age 7 days and fetal deaths at 28 weeks of gestation or more). Preterm birth is the single most important contributing factor to increased risk of perinatal mortality among ART singletons compared to non-ART singletons. Further research on reducing early preterm delivery, with the aim of reducing the perinatal mortality among ART births is needed. Couples who access ART treatment should be fully informed regarding the risk of preterm birth and subsequent risk of perinatal death. There was no funding associated with this study. No conflict of interest was declared. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Inpatient mortality after elective primary total hip and knee joint arthroplasty in Botswana.

PubMed

Lisenda, Laughter; Mokete, Lipalo; Mkubwa, Joseph; Lukhele, Mkhululi

2016-12-01

Total hip and knee joint arthroplasty (TJA) rank among the most successful orthopaedic operations. Several developing countries in Africa have started to perform these procedures that are routine in developed countries. The aims of this study were to measure the incidence and assess the determinants of in-hospital mortality after elective primary TJA in our unit and compare it with published data. This was a retrospective study of the first consecutive cohort of patients who underwent elective primary TJA in Princess Marina Hospital, Botswana between March 2009 and October 2015 (6.5 years). 346 elective joint replacements were performed comprising 153 total hip arthroplasties (THA) and 193 total knee arthroplasties (TKA); 36 % of the THA were in female patients and 82 % of TKA were in females. The mean age was 64.5 years (range 26-86). Three patients died giving an inpatient mortality rate of 0.86 %. These three mortalities represent 1.55 % (three out of 193) of all the TKA. There were no deaths after THA. The cause of mortality in two patients was an adverse cardiac event while the third mortality was due to pulmonary embolism. The inpatient mortality rate of 0.86 % following TJA is higher than the reported rates in the developed countries but comparable with data from other developing countries. The inpatient mortality rate following TKA was higher than that following THA and cardiovascular events proved to be the main cause of death. We recommend formal cardiology assessment and close peri-operative monitoring of all patients with a history of cardiovascular disease undergoing TJA.

Mortality from accidents, disease, suicide and homicide in the British fishing industry from 1900 to 2010.

PubMed

Roberts, Stephen E; Carter, Tim

2015-01-01

To establish the causes of mortality in the British fishing industry from 1900 up to 2010, to investigate long term trends in mortality and to identify causal factors in the mortality patterns and rates. A longitudinal study, based on examinations of official death inquiry files, marine accident investigation files and reports, death registers and annual death returns. Mortality rates from accidents while working at sea remain high in the British fishing industry. Over the twentieth century there has been a progressive fall in the numbers of deaths, much of this relates to changes in fishing methods and in the types of vessels used. However in recent years, and with a fleet of smaller vessels, the mortality rates from accidents have shown little change and a larger proportion of deaths than in the past have arisen from personal injuries and drowning as compared to vessel losses. Disease makes a relatively small contribution to mortality at sea and this has dwindled with the decline in distant water fishing. Suicide and homicide both feature in a small way, but rates cannot readily be compared with those ashore. The pattern of change in vessels, fisheries and fishing techniques over the study period are complex. However, improved injury and drowning prevention is the most important way to reduce deaths, coupled with attention to vessel stability and maintenance. The social, economic and organisational features of the fishing industry mean that securing improvements in these areas is a major challenge.

Longitudinal Predictors of Self-Rated Health and Mortality in Older Adults

PubMed Central

Short, Jerome L.

2014-01-01

Introduction Few studies have compared the effects of demographic, cognitive, and behavioral factors of health and mortality longitudinally. We examined predictors of self-rated health and mortality at 3 points, each 2 years apart, over 4 years. Methods We used data from the 2006 wave of the Health and Retirement Study and health and mortality indicators from 2006, 2008, and 2010. We analyzed data from 17,930 adults (aged 50–104 y) to examine predictors of self-rated health and data from a subgroup of 1,171 adults who died from 2006 through 2010 to examine predictors of mortality. Results Time 1 depression was the strongest predictor of self-rated health at all points, independent of age and education. Education, mild activities, body mass index, delayed word recall, and smoking were all associated with self-rated health at each point and predicted mortality. Delayed word recall mediated the relationships of mild activity with health and mortality. Bidirectional mediation was found for the effects of mild activity and depression on health. Conclusion Medical professionals should consider screening for depression and memory difficulties in addition to conducting medical assessments. These assessments could lead to more effective biopsychosocial interventions to help older adults manage risks for mortality. PMID:24901793

Mortality in babies with achondroplasia: revisited.

PubMed

Simmons, Kristen; Hashmi, S Shahrukh; Scheuerle, Angela; Canfield, Mark; Hecht, Jacqueline T

2014-04-01

Natural history studies performed 30 years ago identifying higher mortality among children born with achondroplasia, a genetic dwarfing condition, resulted in clinical recommendations aimed at improving mortality in childhood. The objective of this study was to determine if mortality rates have changed over the past few decades. Children born with achondroplasia during 1996 to 2003 were ascertained from the Texas Birth Defects Registry and matched with death certificate data from the Bureau of Vital Statistics through 2007. Infant and overall mortality rates, both crude and standardized to the 2005 (SMR2005 ) and 1975 (SMR1975 ) U.S. populations, were calculated. 106 children born with achondroplasia were identified. Four deaths were reported, with all occurring in the first year of life (mortality rate: 41.4 /1000 live-births). Infant mortality was higher when standardized to the 2005 U.S. population (SMR2005 :6.02, 95% CI:1.64-15.42) than the 1975 population (SMR1975 :2.58, 95% CI:0.70-6.61). The higher SMR2005 compared with SMR1975 , along with the fact that SMR1975 was nearly half that of a previous cohort reported 25 years ago (rate ratio: 0.53, 95% CI: 0.11-2.25), reflect a discrepancy in the changes in mortality in the overall population and in our cohort. Although an overall improvement in mortality, especially after the first year of life, is observed in our cohort, children with achondroplasia are still at a much higher risk of death compared with the general population. A longer follow-up is needed to elucidate whether evaluation/intervention changes have resulted in significant improvement in long-term survival among these patients. Copyright © 2014 Wiley Periodicals, Inc.

Global mortality from conditions with skin manifestations.

PubMed

Boyers, Lindsay N; Karimkhani, Chante; Naghavi, Mohsen; Sherwood, David; Margolis, David J; Hay, Roderick J; Williams, Hywel C; Naldi, Luigi; Coffeng, Luc E; Weinstock, Martin A; Dunnick, Cory A; Pederson, Hannah; Vos, Theo; Dellavalle, Robert P

2014-12-01

Global Burden of Disease Study is a research database containing systematically compiled information from vital statistics and epidemiologic literature to inform research, public policy, and resource allocation. We sought to compare mortality among conditions with skin manifestations in 50 developed and 137 developing countries from 1990 to 2010. This was a cross-sectional study to calculate mean age-standardized mortality (per 100,000 persons) across countries for 10 disease categories with skin manifestations. We compared differences in mortality from these disorders by time period (year 1990 vs year 2010) and by developing versus developed country status. Melanoma death rates were 5.6 and 4.7 times greater in developed compared with developing countries in 1990 and 2010, respectively. Measles death rates in 1990 and 2010 were 345 and 197 times greater in developing countries, and corresponding syphilis death rates were 33 and 45 times greater. Inability to adjust for patient-, provider-, and geographic-level confounders may limit the accuracy and generalizability of these results. The mortality burden from skin-related conditions differs between developing and developed countries, with the greatest differences observed for melanoma, measles, and syphilis. These results may help prioritize and optimize efforts to prevent and treat these disorders. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Maryland's high cancer mortality rate: a review of contributing demographic factors.

PubMed

Freedman, D M

1999-01-01

For many years, Maryland has ranked among the top states in cancer mortality. This study analyzed mortality data from the National Center for Health Statistics (CDC-Wonder) to help explain Maryland's cancer rate and rank. Age-adjusted rates are based on deaths per 100,000 population from 1991 through 1995. Rates and ranks overall, and stratified by age, are calculated for total cancer mortality, as well as for four major sites: lung, breast, prostate, and colorectal. Because states differ in their racial/gender mix, race/gender rates among states are also compared. Although Maryland ranks seventh in overall cancer mortality, its rates and rank by race and gender subpopulation are less high. For those under 75, white men ranked 26th, black men ranked 20th, and black and white women ranked 12th and 10th, respectively. Maryland's overall rank, as with any state, is a function of the rates of its racial and gender subpopulations and the relative size of these groups in the state. Many of the disparities between Maryland's overall high cancer rank and its lower rank by subpopulation also characterize the major cancer sites. Although a stratified presentation of cancer rates and ranks may be more favorable to Maryland, it should not be used to downplay the attention cancer mortality in Maryland deserves.

Geographical and Temporal Variations in Female Breast Cancer Mortality in the Municipalities of Andalusia (Southern Spain).

PubMed

Ocaña-Riola, Ricardo; Montaño-Remacha, Carmen; Mayoral-Cortés, José María

2016-11-22

The last published figures have shown geographical variations in mortality with respect to female breast cancer in European countries. However, national health policies need a dynamic image of the geographical variations within the country. The aim of this paper was to describe the spatial distribution of age-specific mortality rates from female breast cancer in the municipalities of Andalusia (southern Spain) and to analyze its evolution over time from 1981 to 2012. An ecological study was devised. Two spatio-temporal hierarchical Bayesian models were estimated. One of these was used to estimate the age-specific mortality rate for each municipality, together with its time trends, and the other was used to estimate the age-specific rate ratio compared with Spain as a whole. The results showed that 98% of the municipalities exhibited a decreasing or a flat mortality trend for all the age groups. In 2012, the geographical variability of the age-specific mortality rates was small, especially for population groups below 65. In addition, more than 96.6% of the municipalities showed an age-specific mortality rate similar to the corresponding rate for Spain, and there were no identified significant clusters. This information will contribute towards a reflection on the past, present and future of breast cancer outcomes in Andalusia.

Geographical and Temporal Variations in Female Breast Cancer Mortality in the Municipalities of Andalusia (Southern Spain)

PubMed Central

Ocaña-Riola, Ricardo; Montaño-Remacha, Carmen; Mayoral-Cortés, José María

2016-01-01

The last published figures have shown geographical variations in mortality with respect to female breast cancer in European countries. However, national health policies need a dynamic image of the geographical variations within the country. The aim of this paper was to describe the spatial distribution of age-specific mortality rates from female breast cancer in the municipalities of Andalusia (southern Spain) and to analyze its evolution over time from 1981 to 2012. An ecological study was devised. Two spatio-temporal hierarchical Bayesian models were estimated. One of these was used to estimate the age-specific mortality rate for each municipality, together with its time trends, and the other was used to estimate the age-specific rate ratio compared with Spain as a whole. The results showed that 98% of the municipalities exhibited a decreasing or a flat mortality trend for all the age groups. In 2012, the geographical variability of the age-specific mortality rates was small, especially for population groups below 65. In addition, more than 96.6% of the municipalities showed an age-specific mortality rate similar to the corresponding rate for Spain, and there were no identified significant clusters. This information will contribute towards a reflection on the past, present and future of breast cancer outcomes in Andalusia. PMID:27879690

Effects of travel distance and season of the year on transport-related mortality in cattle.

PubMed

Simova, Veronika; Voslarova, Eva; Vecerek, Vladimir; Passantino, Annamaria; Bedanova, Iveta

2017-03-01

The number of animals that die during transport to a slaughterhouse or shortly after being delivered to a slaughterhouse may serve as an indicator of animal welfare during transport. The aim of this study was to determine the mortality rate in cattle resulting from transport to slaughter in the Czech Republic in the period from 2009 to 2014, and to investigate the effect of travel distance and season of the year. Transport-related mortality rates were recorded for all categories of cattle for the following travel distances: up to 50 km, 51-100 km, 101-200 km and over 200 km. Higher mortality rates occurred with shorter travel distances (<50 km and 51-100 km) when compared to longer travel distances (101-200 km and > 200 km), with a significant difference (P < 0.01) between short and long travel distances being found in feeders and dairy cows. Also, the season of the year had a significant impact on the mortality rate among transported cattle. The highest mortality rate in all categories was observed in spring months. The lowest mortality rate was found in autumn months for fat cattle and dairy cows and in winter months for feeders and calves. © 2016 Japanese Society of Animal Science.

Frequency of breast cancer, lung cancer, and tobacco use articles in women's magazines from 1987 to 2003.

PubMed

Tobler, Kyle J; Wilson, Philip K; Napolitano, Peter G

2009-01-01

The objective of this study was to compare the frequency of articles in women's magazines that address breast cancer, lung cancer, and tobacco use from 1987-2003 and to ascertain whether the annual number of articles reflected corresponding cancer mortality rates from breast cancer and lung cancer and the number of female smokers throughout this time period. We reviewed 13 women's magazines published in the United States from 1987-2003 using the search terms breast cancer, lung cancer, smoking, and tobacco. We reviewed the abstracts or entire articles to determine relevance. A total of 1044 articles addressed breast cancer, lung cancer, or tobacco use: 681 articles related to breast cancer, 47 related to lung cancer, and 316 related to tobacco use. The greater number of breast cancer articles compared to lung cancer articles was statistically significant (P value < .0001). The greater number of breast cancer articles compared to lung cancer articles combined with tobacco use articles was also statistically significant (P = .0012). The annual number breast cancer articles compared to the breast cancer mortality rate demonstrated a negative relationship. The annual number of lung cancer articles compared to the lung cancer mortality rate demonstrated no relationship. The annual number of tobacco use articles compared to the annual number of female smokers demonstrated no relationship. Breast cancer was more frequently represented than lung cancer or tobacco use in women's magazines from 1987-2003 despite the increase in lung cancer mortality, a decrease in breast cancer mortality, and an insignificant change in the number of female smokers.

Urbanisation and coronary heart disease mortality among African Americans in the US South.

PubMed Central

Barnett, E; Strogatz, D; Armstrong, D; Wing, S

1996-01-01

STUDY OBJECTIVE: Despite significant declines since the late 1960s, coronary mortality remains the leading cause of death for African Americans. African Americans in the US South suffer higher rates of cardiovascular disease than African Americans in other regions; yet the mortality experiences of rural-dwelling African Americans, most of whom live in the South, have not been described in detail. This study examined urban-rural differentials in coronary mortality trends among African Americans for the period 1968-86. SETTING: The United States South, comprising 16 states and the District of Columbia. STUDY POPULATION: African American men and women aged 35-74 years. DESIGN: Analysis of urban-rural differentials in temporal trends in coronary mortality for a 19 year study period. All counties in the US South were grouped into five categories: greater metropolitan, lesser metropolitan, adjacent to metropolitan, semirural, and isolated rural. Annual age adjusted mortality rates were calculated for each urban status group. In 1968, observed excesses in coronary mortality were 29% for men and 45% for women, compared with isolated rural areas. Metropolitan areas experienced greater declines in mortality than rural areas, so by 1986 the urban-rural differentials in coronary mortality were 3% for men and 11% for women. CONCLUSIONS: Harsh living conditions in rural areas of the South precluded important coronary risk factors and contributed to lower mortality rates compared with urban areas during the 1960s. The dramatic transformation from an agriculturally based economy to manufacturing and services employment over the course of the study period contributed to improved living conditions which promoted coronary mortality declines in all areas of the South; however, the most favourable economic and mortality trends occurred in metropolitan areas. Images PMID:8935454

Comparison of ventilator-associated pneumonia (VAP) rates between different ICUs: Implications of a zero VAP rate.

PubMed

Sundar, Krishna M; Nielsen, David; Sperry, Paul

2012-02-01

Ventilator-associated pneumonia (VAP) is associated with significant morbidity and mortality. Measures to reduce the incidence of VAP have resulted in institutions reporting a zero or near-zero VAP rates. The implications of zero VAP rates are unclear. This study was done to compare outcomes between two intensive care units (ICU) with one of them reporting a zero VAP rate. This study retrospectively compared VAP rates between two ICUs: Utah Valley Regional Medical Center (UVRMC) with 25 ICU beds and American Fork Hospital (AFH) with 9 ICU beds. Both facilities are under the same management and attended by a single group of intensivists. Both ICUs have similar nursing and respiratory staffing patterns. Both ICUs use the same intensive care program for reduction of VAP rates. ICU outcomes between AFH (reporting zero VAP rate) and UVRMC (VAP rate of 2.41/1000 ventilator days) were compared for the years 2007-2008. UVRMC VAP rates during 2007 and 2008 were 2.31/1000 ventilator days and 2.5/1000 ventilator days respectively compared to a zero VAP rate at AFH. The total days of ventilation, mean days of ventilation per patient and mean duration of ICU stay per patient was higher in the UVRMC group as compared to AFH ICU group. There was no significant difference in mean age and APACHE II score between ICU patients at UVRMC and AFH. There was no statistical difference in rates of VAP and mortality between UVRMC and AFH. During comparisons of VAP rate between institutions, a zero VAP rate needs to be considered in the context of overall ventilator days, mean durations of ventilator stay and ICU mortality. Copyright © 2012 Elsevier Inc. All rights reserved.

Early Mortality Experience in a Large Military Cohort and a Comparison of Mortality Data Sources

DTIC Science & Technology

2010-05-24

were enrolled from 2001 to 2003, represented all armed service branches, and included active-duty, Reserve, and National Guard members. Crude death rates , as...well as age- and sex-adjusted overall and age-adjusted, category specific death rates were calculated and compared for participants (n = 77,047

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

PubMed

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

2013-04-16

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

Mortality Associated With Seasonal and Pandemic Influenza Among Pregnant and Nonpregnant Women of Childbearing Age in a High-HIV-Prevalence Setting-South Africa, 1999-2009.

PubMed

Tempia, Stefano; Walaza, Sibongile; Cohen, Adam L; von Mollendorf, Claire; Moyes, Jocelyn; McAnerney, Johanna M; Cohen, Cheryl

2015-10-01

Information on the mortality burden associated with seasonal and pandemic influenza virus infection among pregnant women is scarce in most settings, particularly in sub-Saharan Africa where pregnancy and maternal mortality rates as well as human immunodeficiency virus (HIV) prevalence are elevated. We used an ecological study design to estimate the seasonal and A(H1N1)pdm09 influenza-associated mortality among pregnant and nonpregnant women of childbearing age (15-49 years) by HIV serostatus during 1999-2009 in South Africa. Mortality rates were expressed per 100 000 person-years. During 1999-2009, the estimated mean annual seasonal influenza-associated mortality rates were 12.6 (123 deaths) and 7.3 (914 deaths) among pregnant and nonpregnant women, respectively. Among pregnant women, the estimated mean annual seasonal influenza-associated mortality rates were 74.9 (109 deaths) among HIV-infected and 1.5 (14 deaths) among HIV-uninfected individuals. Among nonpregnant women, the estimated mean annual seasonal influenza-associated mortality rate was 41.2 (824 deaths) among HIV-infected and 0.9 (90 deaths) among HIV-uninfected individuals. Pregnant women experienced an increased risk of seasonal influenza-associated mortality compared with nonpregnant women (relative risk [RR], 2.8; 95% confidence interval [CI], 1.7-3.9). In 2009, the estimated influenza A(H1N1)pdm09-associated mortality rates were 19.3 (181 deaths) and 9.4 (1189 deaths) among pregnant and nonpregnant women, respectively (RR, 3.2; 95% CI, 2.3-4.1). Among women of childbearing age, the majority of estimated seasonal influenza-associated deaths occurred in HIV-infected individuals. Pregnant women experienced an increased risk of death associated with seasonal and A(H1N1)pdm09 influenza infection compared with nonpregnant women. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

[Mortality rates of circulatory system diseases and malignant neoplasms in Zagreb population younger than sixty-five--call for alarm].

PubMed

Vizintin, Marina Polić; Mrcela, Nada Tomasović; Kovacić, Luka

2012-12-01

The aim of this work was to analyze the public health indicators for circulatory heart diseases and malignant neoplasms in the population younger than 65 in the City of Zagreb, Croatia, and compare them with the European Union (EU) countries. The purpose was to evaluate the situation and propose the public health preventive measures. The study population were Zagreb citizens aged 0-64 according to the 2001 census. Total Zagreb population was 779145, making 17.6% of total Croatian population. Data from the Croatian Bureau of Statistics and Dr Andrija Stampar Institute of Public Health were used. The standardized 0-64 mortality rates of the selected diseases 2006-2010 were used in the analysis. In 2010, the standardized mortality rates of all analyzed diseases were significantly higher in Zagreb population aged 0-64 than the EU averages except for cervical cancer. In 2010, the mortality rates in Zagreb population aged 0-64 were as follows: circulatory system diseases 61.22, ischemic heart disease 28.99, cerebrovascular diseases 12.51, malignant neoplasms 94.69, tracheal and lung cancer 24.92, breast cancer 21.08 and cervical cancer 2.05. Standardized mortality rates in Zagreb population aged 0-64 for circulatory system were lower than for Croatia (61.22 vs. 63.25), but higher for malignant neoplasms (94.69 vs. 91.2), except for cervical cancer (2.05 vs. 3.14). High standardized mortality rates for the selected diseases in the City of Zagreb, Croatia, were observed. The rates were higher in Zagreb population compared to EU averages except for cervical cancer. This situation urges revision of the public health strategy and implementation of more intensive preventive and screening measures to reduce the risk factors.

Trends in systemic lupus erythematosus mortality rates in the state of Sao Paulo, Brazil from 1985 to 2004.

PubMed

Souza, D C C; Santo, A H; Sato, E I

2010-01-01

To estimate mortality rates and mortality trends from SLE in the state of São Paulo, Brazil. The official data bank was used to study all deaths occurred from 1985 to 2004 in which SLE was mentioned as the underlying cause of death. Besides the overall mortality rate, the annual gender- and age-specific mortality rates were estimated for each calendar year by age bracket (0-19 years, 20-39 years, 40-59 years and over 60 years) and for the sub-periods 1985-1995 (first) and 1996-2004 (second), by decades. Chi-square test was used to compare the mortality rates between the two periods, as well the mortality rates according to educational level considering years of study. Pearson correlation coefficient test was used to analyse mortality trends. The crude rates were adjusted for age by the direct method, using the standard Brazilian population in 2000. A total of 2,601 deaths (90% female) attributed to SLE were analysed. The mean age at death was significantly higher in the second than in the first sub-period (36.6+/-15.6 years vs. 33.9+/-14.0 years; p<0.001). The overall adjusted mortality rate was 3.8 deaths/million habitants/year for the entire period and 3.4 deaths/million inhabitants/year for the first and 4.0 deaths/million inhabitants/year for the second sub-period (p<0.001). In each calendar year, the mortality rate was significantly lower for the better educated group. Throughout the period, there was a significant increase in mortality rates only among women over 40. SLE patients living in the state of São Paulo still die at younger ages than those living in developed countries. Our data do not support the theory that there was an improvement in the SLE mortality rate in the last 20 years in the state of Sao Paulo. Socio-economic factors, such as the difficulty to get medical care and adequate treatment, may be the main factors to explain the worst prognosis for our patients.

Changes in water, nitrogen and carbon cycling in loblolly pine (Pinus taeda L.) during a mortality event

NASA Astrophysics Data System (ADS)

Renninger, H. J.; Hornslein, N.; Siegert, C. M.

2017-12-01

Depending on the type of disturbance, the mortality process of an individual tree may occur over an extended period leading to changes in tree and ecosystem functioning throughout this time period and before ultimate tree death is evident. Therefore, the goals of this research were to quantify physiological changes occurring in loblolly pine (Pinus taeda L.) during an extended mortality event. In July 2015, ten trees were girdled to simulate a Southern pine beetle disturbance and trees were monitored until their eventual mortality which occurred from Aug. to Dec. of 2016. Sapflow rates and litterfall were monitored throughout the mortality process and photosynthetic rates and leaf nitrogen concentrations were measured at the height of the 2016 growing season. Girdled pines had significantly higher sapflow compared with control pines in the first month following girdling, then sapflow did not differ significantly for the remainder of the 2015 growing season. From Dec. 2015 to Dec. 2016, control trees had about 25% higher sapflow compared with girdled pines, but both groups maintained a similar relationship between sapflow and soil moisture. Extensive litterfall occurred throughout the 2016 growing season and litter had 50% higher N concentration than the prior growing season. N concentration of fresh leaves collected in 2016 did not differ in girdled vs. control pines but control pines had 64% higher maximum Rubisco-limited carboxylation rates (Vcmax) and 68% higher electron transport-limited carboxylation rates (Jmax) compared to girdled pines. Control pines also had 66% higher foliage densities and 44% larger growth ring widths than girdled pines at the end of the 2016 growing season. Taken together, these results highlight the physiological changes that occur in pines undergoing mortality before needles completely discolor and drop. Compared with control pines, girdled pines exhibited greater changes in carbon and nitrogen compared with water use suggesting that sapflow per unit leaf area was increased to compensate for the losses in total leaf area. These data highlight the importance of physiological measurements taken throughout a mortality event to more accurately quantify the changes in ecosystem-scale water, nitrogen and carbon balance occurring during disturbance episodes.

Mortality reductions for older adults differ by race/ethnicity and gender since the introduction of adult and pediatric pneumococcal vaccines.

PubMed

Soneji, Samir; Metlay, Joshua

2011-01-01

We determined the effectiveness of a 23-valent-polysaccharide pneumococcal vaccine (PPV-23) and pneumococcal conjugate vaccine (PCV-7) in reducing adult pneumococcal mortality by comparing historically predicted declines in pneumococcal disease mortality with observed patterns since the introduction of PPV-23 and PCV-7, including analyses of age, gender, and racial/ethnic subgroups. We analyzed all deaths registered on U.S. death certificates reporting any site of pneumococcal infection (e.g., meningitis, sepsis, pneumonia, bacteremia, and peritonitis) from 1968 to 2006. We used time-series dynamic linear regression on annual pneumococcal mortality rates to determine the percentage reduction in post-1983 mortality rates for a given increase in PPV-23 vaccination rates and post-2000 mortality rates for a given increase in PCV-7 vaccination rates. Pneumococcal mortality decreased well before the introduction of PPV-23 in 1983 and again before the introduction of PCV-7 in 2000. The level of PPV-23 vaccination was associated with a direct and significant reduction in adult mortality, especially white female adults > or = 65 years of age. In contrast, the level of PCV-7 vaccination in the population was not associated with an indirect and significant reduction in pneumococcal mortality beyond the historical pace of decline. PPV-23 introduction was associated with a reduction in pneumococcal mortality among older adults > or = 65 years of age beyond levels predicted by secular trends, whereas PCV-7 introduction was not. Mortality reduction was not uniformly experienced across the population, revealing the need for additional strategies to reduce pneumococcal mortality in older adults.

Site Productivity and Tree Mortality on New Frontiers of Gypsy Moth Infestation

Treesearch

David A. Gansner; David A. Gansner

1987-01-01

Recent analysis of forest stand losses to gypsy moth has provided basic information for analyzing the relationship between forest site productivity and tree mortality on new frontiers of infestation. Poor timber-growing sites had the lowest rates of mortality. Oak mortality (number of trees) amounted to 18 percent on poor sites compared with 26 percent on medium and 28...

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

PubMed

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

2016-10-01

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

To live and die in L.A. County: neighborhood economic and social context and premature age-specific mortality rates among Latinos.

PubMed

Bjornstrom, Eileen

2011-01-01

This ecological study compares the utility of neighborhood economic, social, and co-ethnic concentration characteristics in explaining mortality among Latinos aged 25-64 due to all causes and heart disease in Los Angeles County from 2000 to 2004. Results indicate that local economic well-being and social resources are beneficial for both outcomes to varying degrees. Economic well-being is the strongest predictor of all-cause mortality rates among Latinos aged 25-64 and was the only characteristic that significantly predicted heart disease mortality among those aged 45-64. Among social resources, results indicate collective efficacy is comparatively more important for mortality in younger adults. Social interaction was associated with lower mortality but the effect was not significant for any outcome. Co-ethnic concentration was consistently associated with increased mortality, but only achieved significance for all-cause mortality in younger adults. This effect was mediated by neighborhood income. Though social resources appear to be beneficial to a lesser extent, results suggest policy should first aim to address income disparities across local communities. Copyright © 2010 Elsevier Ltd. All rights reserved.

Health Improvements Have Been More Rapid and Widespread in China than in India: A Comparative Analysis of Health and Socioeconomic Trends from 1960 to 2011

PubMed Central

Singh, Gopal K.; Liu, Jihong

2012-01-01

Objectives We examined differences between China and India in key health and socioeconomic indicators, including life expectancy, infant and child mortality, non-communicable disease mortality from cancer, cardiovascular diseases (CVD), and diabetes, Human Development Index, Gender Inequality Index, material living conditions, and health expenditure. Methods Data on health and social indicators came from various World Health Organization and United Nations databases on global health and development statistics, including the GLOBOCAN cancer database. Mortality trends were modeled by log-linear regression, and differences in rates and relative risks were tested for statistical significance. Results Although both countries have made marked improvements, India lags behind China on several key health indicators. Differential rates of mortality decline during 1960-2009 have led to a widening health gap between China and India. In 2009 the infant mortality rate in India was 50 deaths per 1,000 live births, 3 times greater than the rate for China. Sixty-six out of 1,000 Indian children died before reaching their 5th birthday, compared with 19 children in China. China’s life expectancy is 9 years longer than India’s. Life expectancy at birth in India increased from 42 years in 1960 to 65 years in 2009, while life expectancy in China increased from 47 years in 1960 to 74 years in 2009. Major health concerns for China include high rates of stomach, liver, and lung cancer, CVD, and smoking prevalence. Globally, India ranked 90th and China 102nd in life satisfaction. Conclusions and Public Health Implications India’s less favorable health profile compared to China is largely attributable to its higher rates of mortality from communicable diseases and maternal and perinatal conditions. Further health gains can be achieved by reducing social inequality, greater investments in human development and health services, and by prevention and control of chronic-disease risks such as hypertension, smoking, obesity, and physical inactivity. PMID:27621957

Recent fertility and mortality trends among aboriginal and nonaboriginal populations of central Siberia.

PubMed

Leonard, W R; Keenleyside, A; Ivakine, E

1997-06-01

We examine mortality and fertility patterns of aboriginal (primarily Evenki and Keto) and Russian (i.e., nonaboriginal) populations from the Baykit District of Central Siberia for the period 1982-1994. Mortality rates in the aboriginal population of Baykit are substantially greater than those observed in the Russians and are comparable to levels recently reported for other indigenous Siberian groups. Infant mortality rates average 48 per 1000 live births among Baykit aboriginals, three times greater than the Russians of the district (15 per 1000 births) and more than double the rates for Inuit and Indian populations of Canada. Similarly, crude death rates of the Baykit aboriginals are twice as high as those observed in either the Baykit Russians or the Canadian aboriginal populations (13 vs 6-7 deaths per 1000 individuals). Birth rates of the indigenous population of Baykit are higher than those of the Russians (33 vs. 15 births per 1000 individuals) but are comparable to those of Canadian aboriginal groups. Violence and accidents are the leading causes of adult male mortality in both ethnic groups, whereas circulatory diseases have emerged as the prime cause of death in women. The greater male mortality resulting from violence and accidents is a widely observed cross-cultural phenomenon. The emergence of circulatory diseases as a major mortality risk for women, however, appears to be linked to specific lifestyle changes associated with Soviet reorganization of indigenous Siberian societies. Marked declines in mortality and increases in fertility were observed in the Baykit aboriginal population during the mid to late 1980s with the government's implementation of anti-alcohol policies. The decline in mortality, however, was largely erased during the early 1990s, as the region became increasingly isolated and marginalized following the collapse of the Soviet Union. Demographic trends in the Baykit District suggest that because the indigenous groups have become more isolated, many are returning to a more traditional subsistence lifestyle.

Changing ethnic inequalities in mortality in New Zealand over 30 years: linked cohort studies with 68.9 million person-years of follow-up.

PubMed

Disney, George; Teng, Andrea; Atkinson, June; Wilson, Nick; Blakely, Tony

2017-01-01

Internationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods. Cohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1-74-year-olds, for Māori and Pacific peoples in comparison to European/Other. All-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls - resulting in widening relative inequalities. Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling. Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females. We found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.

Changing ethnic inequalities in mortality in New Zealand over 30 years: linked cohort studies with 68.9 million person-years of follow-up.

PubMed

Disney, George; Teng, Andrea; Atkinson, June; Wilson, Nick; Blakely, Tony

2017-04-26

Internationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods. Cohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1-74-year-olds, for Māori and Pacific peoples in comparison to European/Other. All-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls - resulting in widening relative inequalities. Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling. Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females. We found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.

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

PubMed Central

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

2013-01-01

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

The Importance of Rockall Scoring System for Upper Gastrointestinal Bleeding in Long-Term Follow-Up.

PubMed

Bozkurt, Mehmet Abdussamet; Peker, Kıvanç Derya; Unsal, Mustafa Gökhan; Yırgın, Hakan; Kahraman, İzzettin; Alış, Halil

2017-06-01

The aim of the study is to examine the importance of Rockall scoring system in long-term setting to estimate re-bleeding and mortality rate due to upper gastrointestinal bleeding. A total of 321 patients who had been treated for upper gastrointestinal bleeding were recruited to the study. Patients' demographic and clinical data, the amount of blood transfusion, endoscopy results, and Rockall scores were retrieved from patients' charts. The re-bleeding, morbidity, and mortality rates were noted after 3 years of follow-up with telephone. Re-bleeding rate was statistically significantly higher in Rockall 4 group compared to Rockall 0 group. Mortality rate was also statistically significantly higher in Rockall 4 group. Rockall risk scoring system is a valuable tool to predict re-bleeding and mortality rates for patients with upper gastrointestinal bleeding in long-term setting.

Impact of vaccination on influenza mortality in children <5years old in Mexico.

PubMed

Sánchez-Ramos, Evelyn L; Monárrez-Espino, Joel; Noyola, Daniel E

2017-03-01

Influenza is a leading cause of respiratory tract infections among children. In Mexico, influenza vaccination was included in the National Immunization Program since 2004. However, the population health effects of the vaccine on children have not been fully described. Thus, we estimated the impact of influenza immunization in terms of mortality associated with this virus among children younger than 5years of age in Mexico. Mortality rates and years of life lost associated with influenza were estimated using national mortality register data for the period 1998-2012. Age-stratified and cause-specific mortality rates were estimated for all-cause, respiratory and cardiovascular events. Influenza-associated mortality was compared between the period prior to introduction of the influenza vaccine as part of the National Immunization Program (1998-2004) and the period thereafter (2004-2012). During the 1998-2012 winter seasons, the average number of all-cause, respiratory and cardiovascular deaths attributable to influenza were 1186, 794 and 21, respectively. Influenza-associated mortality was higher prior to the vaccination period than after influenza was included in the immunization program for all-cause (mean 1660 vs. 780) and respiratory (mean 1063 vs. 563) mortality, but no reduction was seen for cardiovascular mortality. The proportion of all-cause and respiratory deaths attributable to influenza was significantly lower in the post-vaccine period compared with the pre-vaccine period (P<0.001), but no reduction was seen in the proportion of cardiovascular deaths. There was an average annual reduction of 66,558years of life lost in the post-vaccine compared with the pre-vaccine period. The introduction of influenza vaccination within the Mexican Immunization Program was associated with a reduction in mortality rates attributable to this virus among children younger than 5years of age. Copyright © 2017 Elsevier Ltd. All rights reserved.

All Rural Places Are Not Created Equal: Revisiting the Rural Mortality Penalty in the United States

PubMed Central

2014-01-01

Objectives. I investigated mortality disparities between urban and rural areas by measuring disparities in urban US areas compared with 6 rural classifications, ranging from suburban to remote locales. Methods. Data from the Compressed Mortality File, National Center for Health Statistics, from 1968 to 2007, was used to calculate age-adjusted mortality rates for all rural and urban regions by year. Criteria measuring disparity between regions included excess deaths, annual rate of change in mortality, and proportion of excess deaths by population size. I used multivariable analysis to test for differences in determinants across regions. Results. The rural mortality penalty existed in all rural classifications, but the degree of disparity varied considerably. Rural–urban continuum code 6 was highly disadvantaged, and rural–urban continuum code 9 displayed a favorable mortality profile. Population, socioeconomic, and health care determinants of mortality varied across regions. Conclusions. A 2-decade long trend in mortality disparities existed in all rural classifications, but the penalty was not distributed evenly. This constitutes an important public health problem. Research should target the slow rates of improvement in mortality in the rural United States as an area of concern. PMID:25211763

[BIPOLAR DISORDER AS A MULTI-SYSTEM ILLNESS].

PubMed

Fenchel, Daphna; Levkovitz, Yechiel; Kotler, Moshe

2017-12-01

Bipolar disorder is a chronic condition, characterized by high distress in patients and high suicide rates (30%). Most patients suffer from medical and other psychiatric comorbidities, which worsen the psychiatric symptoms and decrease the likelihood of remission. More than 70% of bipolar patients have cardio-metabolic symptoms, with higher rates compared to other psychiatric disorders. Cardiovascular disease is the major cause of high mortality rates in these patients, with 1.5-2 fold increased risk of mortality, compared to the general population without psychiatric symptoms. The rates of cardiovascular risk factors and their resulting increased mortality rates are similar to those found in schizophrenia. In addition to cardio-metabolic conditions, 50% of patients with bipolar disorder suffer from other medical symptoms, which are also associated with worse outcomes. Therefore, the current perspective is that bipolar disorder is not only a psychiatric disorder, but rather a multi-system illness, affecting the entire body. The optimal treatment for these patients should include diagnosis, monitoring and treatment of both psychiatric and physical symptoms, which would improve their prognosis.

Perinatal mortality and adverse pregnancy outcomes in a low-income rural population of women who smoke.

PubMed

McElroy, Jane A; Bloom, Tina; Moore, Kelly; Geden, Beth; Everett, Kevin; Bullock, Linda F

2012-04-01

We describe adverse pregnancy outcomes, including congenital anomalies, fetal, neonatal, and infant mortality among a Missouri population of low-income, rural mothers who participated in two randomized smoking cessation trials. In the Baby BEEP (BB) trial, 695 rural women were recruited from 21 WIC clinics with 650 women's pregnancy outcomes known (93.5% retention rate). Following the BB trial, 298 women who had a live infant after November 2004 were recruited again into and completed the Baby Beep for Kids (BBK) trial. Simple statistics describing the population and perinatal and postneonatal mortality rates were calculated. Of the adverse pregnancy outcomes (n = 79), 29% were spontaneous abortions of less than 20 weeks' gestation, 23% were premature births, and 49% were identified birth defects. The perinatal mortality rate was 15.9 per 1000 births (BB study) compared with 8.6 per 1000 births (state of Missouri) and 8.5 per 1000 births (United States). The postneonatal infant mortality rate was 13.4 per 1000 live births (BBK) compared with 2.1 per 1000 live births (United States). The health disparity in this population of impoverished, rural, pregnant women who smoke, particularly in regard to perinatal and infant deaths, warrants attention. Copyright © 2012 Wiley Periodicals, Inc.

Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006: findings from the National Health Interview Survey.

PubMed

Gregg, Edward W; Cheng, Yiling J; Saydah, Sharon; Cowie, Catherine; Garfield, Sanford; Geiss, Linda; Barker, Lawrence

2012-06-01

To determine whether all-cause and cardiovascular disease (CVD) death rates declined between 1997 and 2006, a period of continued advances in treatment approaches and risk factor control, among U.S. adults with and without diabetes. We compared 3-year death rates of four consecutive nationally representative samples (1997-1998, 1999-2000, 2001-2002, and 2003-2004) of U.S. adults aged 18 years and older using data from the National Health Interview Surveys linked to National Death Index. Among diabetic adults, the CVD death rate declined by 40% (95% CI 23-54) and all-cause mortality declined by 23% (10-35) between the earliest and latest samples. There was no difference in the rates of decline in mortality between diabetic men and women. The excess CVD mortality rate associated with diabetes (i.e., compared with nondiabetic adults) decreased by 60% (from 5.8 to 2.3 CVD deaths per 1,000) while the excess all-cause mortality rate declined by 44% (from 10.8 to 6.1 deaths per 1,000). Death rates among both U.S. men and women with diabetes declined substantially between 1997 and 2006, reducing the absolute difference between adults with and without diabetes. These encouraging findings, however, suggest that diabetes prevalence is likely to rise in the future if diabetes incidence is not curtailed.

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

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

PubMed Central

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

2005-01-01

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

Does equality legislation reduce intergroup differences? Religious affiliation, socio-economic status and mortality in Scotland and Northern Ireland: A cohort study of 400,000 people.

PubMed

Wright, David M; Rosato, Michael; Raab, Gillian; Dibben, Chris; Boyle, Paul; O'Reilly, Dermot

2017-05-01

Religion frequently indicates membership of socio-ethnic groups with distinct health behaviours and mortality risk. Determining the extent to which interactions between groups contribute to variation in mortality is often challenging. We compared socio-economic status (SES) and mortality rates of Protestants and Catholics in Scotland and Northern Ireland, regions in which interactions between groups are profoundly different. Crucially, strong equality legislation has been in place for much longer and Catholics form a larger minority in Northern Ireland. Drawing linked Census returns and mortality records of 404,703 people from the Scottish and Northern Ireland Longitudinal Studies, we used Poisson regression to compare religious groups, estimating mortality rates and incidence rate ratios. We fitted age-adjusted and fully adjusted (for education, housing tenure, car access and social class) models. Catholics had lower SES than Protestants in both countries; the differential was larger in Scotland for education, housing tenure and car access but not social class. In Scotland, Catholics had increased age-adjusted mortality risk relative to Protestants but variation among groups was attenuated following adjustment for SES. Those reporting no religious affiliation were at similar mortality risk to Protestants. In Northern Ireland, there was no mortality differential between Catholics and Protestants either before or after adjustment. Men reporting no religious affiliation were at increased mortality risk but this differential was not evident among women. In Scotland, Catholics remained at greater socio-economic disadvantage relative to Protestants than in Northern Ireland and were also at a mortality disadvantage. This may be due to a lack of explicit equality legislation that has decreased inequality by religion in Northern Ireland during recent decades. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

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.

Penetrating abdominal injuries during the Syrian war: Patterns and factors affecting mortality rates.

PubMed

Arafat, Shawqi; Alsabek, Mhd Belal; Ahmad, Mousa; Hamo, Iman; Munder, Eskander

2017-05-01

A large number of innocent Syrians were injured or killed during the years of war. This retrospective study investigates the differences in patterns of injury and factors affecting the mortality rate in 324 patients coming to Damascus Hospital with penetrating abdominal trauma, and illustrates the difficulties of diagnosis and decision making in crisis situations. A retrospective study was registered from patient's records between October 2012 and June 2013 in Damascus Hospital. All victims were injured either by explosions or gunshots. A total of 325 patients: 183 by explosion; 56.3%, 141 by gunshot; 43.3%, and one patient by other means; 0.3% were reviewed. The study focused on the two large groups with a total of 324 patients. Males were predominant (82.1%; n=266) and the majority of patients were between 19 and 35 years old. Patients suffering from multi abdominal organ injury were more common in gunshot group (n=72, 51.1%) compared to the explosion group (n=83, 45.3%). 264 patients (81.5%) underwent surgical operations and only 22 (8.3%) had normal laparotomy. The inpatient mortality rate was (17.0%; n=55), and there was no difference in mortality rate between the two groups. More than the half of deaths (n=42; 76.4%) had a P.A.T.I score≥25 where the death rate was 35.6% which is higher compared to 6.3% in those with a P.A.T.I<25. In the ICU 33 patients died, of these (87.9%; n=29) died after immediate admission to the ICU which is higher compared with a later admission (12.1%; n=4). The need for massive blood transfusion affected the mortality rate. Efforts must be directed toward training of medical staff to deal with crisis incidents. The need for massive blood transfusion and ICU admissions can affects mortality. P.A.T.I was found to be an effective predictor of mortality. Clinical experience in this field can produce better health care and faster judgments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Black/white differences in very low birth weight neonatal mortality rates among New York City hospitals.

PubMed

Howell, Elizabeth A; Hebert, Paul; Chatterjee, Samprit; Kleinman, Lawrence C; Chassin, Mark R

2008-03-01

We sought to determine whether differences in the hospitals at which black and white infants are born contribute to black/white disparities in very low birth weight neonatal mortality rates in New York City. We performed a population-based cohort study using New York City vital statistics records on all live births and deaths of infants weighing 500 to 1499 g who were born in 45 hospitals between January 1, 1996, and December 31, 2001 (N = 11 781). We measured very low birth weight risk-adjusted neonatal mortality rates for each New York City hospital and assessed differences in the distributions of non-Hispanic black and non-Hispanic white very low birth weight births among these hospitals. Risk-adjusted neonatal mortality rates for very low birth weight infants in New York City hospitals ranged from 9.6 to 27.2 deaths per 1000 births. White very low birth weight infants were more likely to be born in the lowest mortality tertile of hospitals (49%), compared with black very low birth weight infants (29%). We estimated that, if black women delivered in the same hospitals as white women, then black very low birth weight mortality rates would be reduced by 6.7 deaths per 1000 very low birth weight births, removing 34.5% of the black/white disparity in very low birth weight neonatal mortality rates in New York City. Volume of very low birth weight deliveries was modestly associated with very low birth weight mortality rates but explained little of the racial disparity. Black very low birth weight infants more likely to be born in New York City hospitals with higher risk-adjusted neonatal mortality rates than were very low birth weight infants, contributing substantially to black-white disparities.

The predictive value of resting heart rate following osmotherapy in brain injury: back to basics.

PubMed

Hasanpour Mir, Mahsa; Yousefshahi, Fardin; Abdollahi, Mohammad; Ahmadi, Arezoo; Nadjafi, Atabak; Mojtahedzadeh, Mojtaba

2012-12-30

The importance of resting heart rate as a prognostic factor was described in several studies. An elevated heart rate is an independent risk factor for adverse cardiovascular events and total mortality in patients with coronary artery disease, chronic heart failure, and the general population. Also heart rate is elevated in the Multi Organ Dysfunction Syndrome (MODS) and the mortality due to MODS is highly correlated with inadequate sinus tachycardia.To evaluate the value of resting heart rate in predicting mortality in patients with traumatic brain injury along scoring systems like Acute Physiology and Chronic Health Evaluation(APACHE II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Score (GCS). By analyzing data which was collected from an open labeled randomized clinical trial that compared the different means of osmotherapy (mannitol vs bolus or infusion hypertonic saline), heart rate, GCS, APACHE II and SOFA score were measured at baseline and daily for 7 days up to 60 days and the relationship between elevated heart rate and mortality during the first 7 days and 60th day were assessed. After adjustments for confounding factors, although there was no difference in mean heart rate between either groups of alive and expired patients, however, we have found a relative correlation between 60th day mortality rate and resting heart rate (P=0.07). Heart rate can be a prognostic factor for estimating mortality rate in brain injury patients along with APACHE II and SOFA scores in patients with brain injury.

Historical Mortality of Valley Oak (Quercus lobata, Nee) in the Santa Ynez Valley, Santa Barbara County, 1938-1989

Treesearch

Rodney W. Brown; Frank W. Davis

1991-01-01

The range and abundance of valley oak (Quercus lobata, Nee) have steadily decreased in the last 100 years due to low rates of regeneration during this period. Documented low rates of sapling recruitment must be compared to adult mortality rates in order to evaluate the severity of this decline. The purpose of this research is to measure and analyze...

A comparison of operation, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography in biliary complications after hepatic transplantation.

PubMed

Kuo, P C; Lewis, W D; Stokes, K; Pleskow, D; Simpson, M A; Jenkins, R L

1994-08-01

Biliary complications (BC) remain a significant cause of morbidity and mortality after orthotopic liver transplantation (OLT). In an effort to determine the incidence of BC after OLT and the success of management options, 157 hepatic transplants performed from January 1987 to July 1991 were reviewed. The incidence of BC was 25 percent, with a one year mortality rate of 43.5 percent compared with 23.4 percent for patients in a control group (p < 0.05). Most BC occurring before postoperative day 30 presented as leaks, with a one year mortality rate of 50 percent (p < 0.03 versus control group). Biliary complications presenting after postoperative day 30 presented as strictures, with a one year mortality rate of 36.8 percent (p = NS versus control group). Endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTHC), and operative treatment were analyzed to determine relative patency rates after intervention for BC. The analysis showed that ERCP and PTHC were equivalent, with a one year patency rate of 45 percent. Operative treatment had a patency rate of 89 percent (p < 0.05 compared to ERCP and PTHC). The results from ERCP and PTHC may be useful for delineation of rejection versus BC after OLT. However, operative treatment is significantly more effective for definitive treatment of BC after OLT.

Trends in socioeconomic disparities in stroke mortality in six european countries between 1981-1985 and 1991-1995.

PubMed

Avendaño, M; Kunst, A E; van Lenthe, F; Bos, V; Costa, G; Valkonen, T; Cardano, M; Harding, S; Borgan, J-K; Glickman, M; Reid, A; Mackenbach, J P

2005-01-01

This study assesses whether stroke mortality trends have been less favorable among lower than among higher socioeconomic groups. Longitudinal data on mortality by socioeconomic status were obtained for Finland, Norway, Denmark, Sweden, England/Wales, and Turin, Italy. Data covered the entire population or a representative sample. Stroke mortality rates were calculated for the period 1981-1995. Changes in stroke mortality rate ratios were analyzed using Poisson regression and compared with rate ratios in ischemic heat disease mortality. Trends in stroke mortality were generally as favorable among lower as among higher socioeconomic groups, such that socioeconomic disparities in stroke mortality persisted and remained of a similar magnitude in the 1990s as in the 1980s. In Norway, however, occupational disparities in stroke mortality significantly widened, and a nonsignificant increase was observed in some countries. In contrast, disparities in ischemic heart disease mortality widened throughout this period in most populations. Improvements in hypertension prevalence and treatment may have contributed to similar stroke mortality declines in all socioeconomic groups in most countries. Socioeconomic disparities in stroke mortality generally persisted and may have widened in some populations, which fact underlines the need to improve preventive and secondary care for stroke among the lower socioeconomic groups.

Trends in Cardiovascular Risk Factor Levels in the Minnesota Heart Survey (1980–2002) as Compared With the National Health and Nutrition Examination Survey (1976–2002): A Partial Explanation for Minnesota's Low Cardiovascular Disease Mortality?

PubMed Central

Wang, Huifen; Steffen, Lyn M.; Jacobs, David R.; Zhou, Xia; Blackburn, Henry; Berger, Alan K.; Filion, Kristian B.; Luepker, Russell V.

2011-01-01

The authors compared trends in and levels of coronary heart disease (CHD) risk factors between the Minneapolis-St. Paul, Minnesota, metropolitan area (Twin Cities) and the entire US population to help explain the ongoing decline in US CHD mortality rates. The study populations for risk factors were adults aged 25–74 years enrolled in 2 population-based surveillance studies: the Minnesota Heart Survey (MHS) in 1980–1982, 1985–1987, 1990–1992, 1995–1997, and 2000–2002 and the National Health and Nutrition Examination Survey (NHANES) in 1976–1980, 1988–1994, 1999–2000, and 2001–2002. The authors found a continuous decline in CHD mortality rates in the Twin Cities and nationally between 1980 and 2000. Similar decreasing rates of change in risk factors across survey years, parallel to the CHD mortality rate decline, were observed in MHS and in NHANES. Adults in MHS had generally lower levels of CHD risk factors than NHANES adults, consistent with the CHD mortality rate difference. Approximately 47% of women and 44% of men in MHS had no elevated CHD risk factors, including smoking, hypertension, high cholesterol, and obesity, versus 36% of women and 34% of men in NHANES. The better CHD risk factor profile in the Twin Cities may partly explain the lower CHD death rate there. PMID:21273396

Mortality from Parkinson's disease and other causes among a workforce manufacturing paraquat: a retrospective cohort study

PubMed Central

Campbell, Clive

2011-01-01

Objective To assess the risk of Parkinson's disease (PD) and update information on mortality from major causes of death among a UK workforce who manufactured paraquat (PQ) between 1961 and 1995. There have been no previous studies of the incidence of PD among PQ production workers, although much epidemiological literature exists concerning the relationship between pesticides and PD, and interest has focused on PQ and its users. Methods The cohort included all employees who had ever worked on any of the four plants at Widnes where PQ was manufactured between 1961 and 1995, and 926 male and 42 female workers were followed through 30 June 2009. Mortalities for males were compared with national and local rates, including rates for PD as a mentioned cause of death. Results Overall, 307 workers had died by 30 June 2009. One male death was due to PD, and no other death certificate mentioned PD. At least 3.3 death certificates of male employees would have been expected to have mentioned PD (standardised mortality ratio=31; 95% CI 1 to 171). Personal monitoring results were indicative that the exposure of a PQ production worker on a daily basis was at least comparable with that of a PQ sprayer or mixer/loader. Reduced mortalities compared with local rates were found for major causes of death. Conclusions The study provided no evidence of an increased risk of PD, or increased mortalities from other causes. PMID:22080539

Noncommunicable disease mortality and life expectancy in immigrants to Israel from the former Soviet Union: country of origin compared with host country.

PubMed

Ott, Jördis Jennifer; Paltiel, Ari M; Becher, Heiko

2009-01-01

To assess the influence of country of origin effects and of adjustment and selection processes by comparing noncommunicable disease mortality and life expectancy among migrants to Israel from the former Soviet Union (FSU) with noncommunicable disease mortality and life expectancy among Israelis and the population of the Russian Federation. Data from 926,870 FSU-immigrants who migrated to Israel between 1990 and 2003 (study cohort) were analysed. Life expectancy was calculated for the study cohort, all Israelis, and the population of the Russian Federation. Age-standardized death rates were calculated for grouped causes of death. FSU immigrants were additionally compared with other Israelis and with inhabitants of the Russian Federation using cause-specific standardized mortality ratios (SMRs). Life expectancy at age 15 years in 2000-2003 was 61.0 years for male and 67.0 years for female FSU immigrants to Israel. Age-standardized death rates for FSU immigrants in Israel were similar to those of other Israelis and much lower than those of inhabitants of the Russian Federation. Relative to Israelis, the study cohort had a higher SMR for neoplasms, and particularly for stomach cancer. Mortality from brain cancer was higher when immigrants were compared to the Russian Federation (SMR: 1.71, 95% confidence interval, CI: 1.50-1.94 for males; SMR: 1.77, 95% CI: 1.56-2.02 for females), whereas mortality from stomach cancer was lower among immigrants relative to the Russian Federation (SMR: 0.43, 95% CI: 0.40-0.47 for males; SMR: 0.56, 95% CI: 0.52-0.61 for females). Mortality from external causes was lower among immigrants relative to the population of the Russian Federation (SMR: 0.20, 95% CI: 0.19-0.21 for males; SMR: 0.35, 95% CI: 0.33-0.37 for females) but significantly higher relative to other Israelis (SMR: 1.41, 95% CI: 1.35-1.47 for males; SMR: 1.08, 95% CI: 1.02-1.15). Noncommunicable disease mortality among FSU immigrants to Israel is lower than in the population of the Russian Federation. Mortality rates in FSU immigrants, particularly from circulatory diseases, have rapidly adjusted and have become similar to those of the destination country. However, immigrants from the FSU have considerably higher mortality than other Israelis from external causes and some noncommunicable diseases such as cancer. Mortality rates in these diaspora migrants show a mixed picture of rapid assimilation together with persistent country of origin effects, as well as the effects of adjustment hardships.

Breech delivery in very preterm and very low birthweight infants in The Netherlands.

PubMed

Gravenhorst, J B; Schreuder, A M; Veen, S; Brand, R; Verloove-Vanhorick, S P; Verweij, R A; van Zeben-van der Aa, D M; Ens-Dokkum, M H

1993-05-01

To study the relation between various perinatal factors and the sequelae of very preterm birth, applying logistic regression analysis. In a nationwide collaborative study in the Netherlands, perinatal and follow up data were collected on 899 liveborn singleton nonmalformed infants with gestational age less than 32 weeks or birthweight less than 1500 g born in 1983. Neonatal mortality rate and total handicap rates (minor and major) in surviving children at two years and five years of age. Comparing breech with vertex presentation, the odds ratio for neonatal mortality (adjusted for duration of pregnancy, birthweight, maternal hypertension and prolonged rupture of membranes) is 1.6 (P < 0.05). Comparing abdominal versus vaginal delivery, the odds ratio indicates equal risks. When breech and vertex presentation are analysed separately it appears that breech presenting infants have a significantly lower mortality risk when born by caesarean section compared with vaginal delivery. However, comparing abdominal versus vaginal delivery in breech presentation, the odds ratio for handicap at five years (0.9) is not significantly different from 1. The data presented suggest a reduced neonatal mortality rate in breech presenting infants born by caesarean section but because of the observational design of the study the statistical analysis described only identifies a possible trend and cannot prove the issue.

Risk factors for mortality during the 2002 landslides in Chuuk, Federated States of Micronesia.

PubMed

Sanchez, Carlos; Lee, Tze-San; Young, Stacy; Batts, Dahna; Benjamin, Jefferson; Malilay, Josephine

2009-10-01

This study examines health effects resulting from landslides in Chuuk during Tropical Storm Chata'an in July 2002, and suggests strategies to prevent future mortality. In August 2002, we conducted a cross-sectional survey to identify risk factors for mortality during landslides, which included 52 survivors and 40 surrogates for 43 decedents to identify risk factors for death. Findings suggest that 1) females had a higher mortality rate from this event than males, and 2) children aged 5-14 years had a 10-fold increase in mortality when compared with annual mortality rates from all causes. Awareness of landslides occurring elsewhere and knowledge of natural warning signs were significantly associated with lower risks of death; being outside during landslides was not associated with reduced mortality. In Chuuk, improving communication systems during tropical storms and increasing knowledge of natural warnings can reduce the risk for mortality during landslides.

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

Mortality Rates and Cause of Death Among Former Prison Inmates in North Carolina.

PubMed

Jones, Mark; Kearney, Gregory D; Xu, Xiaohui; Norwood, Tammy; Proescholdbell, Scott K

2017-01-01

BACKGROUND Inmates face challenges upon release from prison, including increased risk of death. We examine mortality among former inmates in North Carolina, including both violent and nonviolent deaths. METHODS A retrospective cohort study among former North Carolina inmates released between 2008 and 2010 were linked with North Carolina mortality data to determine cause of death. Inmates were followed through December 31, 2012. Mortality rates among former inmates were compared with deaths among North Carolina residents using standardized mortality ratios (SMRs). RESULTS Among former inmates (N = 41,495), there were 926 deaths during the study period. Compared to the North Carolina general population, SMRs were higher for all-cause mortality for total deaths (SMR = 2.10, 95% CI: 1.97-2.24), heart disease (SMR = 4.45, 95% CI: 3.64-5.34), cancer (SMR = 3.92, 95% CI: 3.34-4.62), suicide (SMR = 14.46, 95% CI: 10.28-19.76), and homicide (SMR = 7.98, 95% CI: 6.34-10.03). DISCUSSION The death rate among former North Carolina inmates is significantly higher than that of other North Carolina residents. Although more research is needed, identifying areas for interventions is essential for reducing the risk of death among this population. ©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

All-cause and cause-specific mortality among Black and White North Carolina state prisoners, 1995-2005

PubMed Central

Wohl, David A.; Schoenbach, Victor J.

2011-01-01

Purpose We compared mortality rates among state prisoners and other state residents to identify prisoners’ healthcare needs Methods We linked North Carolina prison records with state death records for 1995-2005 to estimate all-cause and cause-specific death rates among Black and White male prisoners aged 20-79 years, and used standardized mortality ratios (SMRs) to compare these observed deaths with the expected number based on death rates among state residents Results The all-cause SMR of Black prisoners was 0.52 (95%CI: 0.48 0.57), with fewer deaths than expected from accidents, homicides, cardiovascular disease and cancer. The all-cause SMR of White prisoners was 1.12 (95%CI: 1.01, 1.25) with fewer deaths than expected for accidents, but more deaths than expected from viral hepatitis, liver disease, cancer, chronic lower respiratory disease, and HIV. Conclusions Mortality of Black prisoners was lower than that of Black state residents for both traumatic and chronic causes of death. Mortality of White prisoners was lower than that of White state residents for accidents, but higher for several chronic causes of death. Future studies should investigate the effect of prisoners’ pre-incarceration and in-prison morbidity, the prison environment, and prison healthcare on prisoners’ patterns of mortality. PMID:21737304

Cancer Mortality in Rural Appalachian Kentucky. Appalachian Data Bank Report #6.

ERIC Educational Resources Information Center

Tucker, Thomas C.; And Others

This report compares cancer mortality rates in rural Appalachian Kentucky with rates for rural non-Appalachian Kentucky and the U.S. white population. Rural Appalachian Kentucky differs from the rest of rural Kentucky in having a younger, poorer, less educated population with greater employment in mining as opposed to agriculture, and with less…

Effects of Paraquat Ban on Herbicide Poisoning-Related Mortality.

PubMed

Ko, Dong Ryul; Chung, Sung Phil; You, Je Sung; Cho, Soohyung; Park, Yongjin; Chun, Byeongjo; Moon, Jeongmi; Kim, Hyun; Kim, Yong Hwan; Kim, Hyun Jin; Lee, Kyung Woo; Choi, SangChun; Park, Junseok; Park, Jung Soo; Kim, Seung Whan; Seo, Jeong Yeol; Park, Ha Young; Kim, Su Jin; Kang, Hyunggoo; Hong, Dae Young; Hong, Jung Hwa

2017-07-01

In Korea, registration of paraquat-containing herbicides was canceled in November 2011, and sales thereof were completely banned in November 2012. We evaluated the effect of the paraquat ban on the epidemiology and mortality of herbicide-induced poisoning. This retrospective study analyzed patients treated for herbicide poisoning at 17 emergency departments in South Korea between January 2010 and December 2014. The overall and paraquat mortality rates were compared pre- and post-ban. Factors associated with herbicide mortality were evaluated using logistic analysis. To determine if there were any changes in the mortality rates before and after the paraquat sales ban and the time point of any such significant changes in mortality, R software, version 3.0.3 (package, bcp) was used to perform a Bayesian change point analysis. We enrolled 2257 patients treated for herbicide poisoning (paraquat=46.8%). The overall and paraquat poisoning mortality rates were 40.6% and 73.0%, respectively. The decreased paraquat poisoning mortality rate (before, 75% vs. after, 67%, p=0.014) might be associated with increased intentionality. The multivariable logistic analysis revealed the paraquat ban as an independent predictor that decreased herbicide poisoning mortality (p=0.035). There were two major change points in herbicide mortality rates, approximately 3 months after the initial paraquat ban and 1 year after complete sales ban. This study suggests that the paraquat ban decreased intentional herbicide ingestion and contributed to lowering herbicide poisoning-associated mortality. The change point analysis suggests a certain timeframe was required for the manifestation of regulatory measures outcomes. © Copyright: Yonsei University College of Medicine 2017

Birthweight, preterm birth and perinatal mortality: a comparison of black babies in Tanzania and the USA.

PubMed

Abu Habib, Ndema; Wilcox, Allen J; Daltveit, Anne Kjersti; Basso, Olga; Shao, John; Oneko, Olola; Lie, Rolv Terje

2011-10-01

Adverse conditions in Africa produce some of the highest rates of infant mortality in the world. Fetal growth restriction and preterm delivery are commonly regarded as major pathways through which conditions in the developing world affect infant survival. The aim of this article was to compare patterns of birthweight, preterm delivery, and perinatal mortality between black people in Tanzania and the USA. Registry-based study. Referral hospital data from North Eastern Tanzania and US Vital Statistics. 14 444 singleton babies from a hospital-based registry (1999-2006) and 3 530 335 black singletons from US vital statistics (1995-2000). Birthweight, gestational age and perinatal mortality. Restricting our study to babies born at least 500g, we compared birthweight, gestational age, and perinatal mortality (stillbirths and deaths in the first week) in the two study populations. Perinatal mortality in the Tanzanian sample was 41/1 000, compared with 10/1 000 among USA blacks. Tanzanian babies were slightly smaller on average (43g), but fewer were preterm (<37 weeks) (10.0 vs. 16.2%). Applying the USA weight-specific mortality rates to Tanzanian babies born at term suggested that birthweight does not play a role in their increased mortality relative to USA blacks. Higher mortality independent of birthweight and preterm delivery for Tanzanian babies suggests the need to address the contribution of other pathways to further reduce the excess perinatal mortality. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Mortality rates and cause-of-death patterns in a vaccinated population.

PubMed

McCarthy, Natalie L; Weintraub, Eric; Vellozzi, Claudia; Duffy, Jonathan; Gee, Julianne; Donahue, James G; Jackson, Michael L; Lee, Grace M; Glanz, Jason; Baxter, Roger; Lugg, Marlene M; Naleway, Allison; Omer, Saad B; Nakasato, Cynthia; Vazquez-Benitez, Gabriela; DeStefano, Frank

2013-07-01

Determining the baseline mortality rate in a vaccinated population is necessary to be able to identify any unusual increases in deaths following vaccine administration. Background rates are particularly useful during mass immunization campaigns and in the evaluation of new vaccines. Provide background mortality rates and describe causes of death following vaccination in the Vaccine Safety Datalink (VSD). Analyses were conducted in 2012. Mortality rates were calculated at 0-1 day, 0-7 days, 0-30 days, and 0-60 days following vaccination for deaths occurring between January 1, 2005, and December 31, 2008. Analyses were stratified by age and gender. Causes of death were examined, and findings were compared to National Center for Health Statistics (NCHS) data. Among 13,033,274 vaccinated people, 15,455 deaths occurred between 0 and 60 days following vaccination. The mortality rate within 60 days of a vaccination visit was 442.5 deaths per 100,000 person-years. Rates were highest in the group aged ≥85 years, and increased from the 0-1-day to the 0-60-day interval following vaccination. Eleven of the 15 leading causes of death in the VSD and NCHS overlap in both systems, and the top four causes of death were the same in both systems. VSD mortality rates demonstrate a healthy vaccinee effect, with rates lowest in the days immediately following vaccination, most apparent in the older age groups. The VSD mortality rate is lower than that in the general U.S. population, and the causes of death are similar. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine

Inequality in mortality by occupation related to economic crisis from 1980 to 2010 among working-age Japanese males.

PubMed

Wada, Koji; Gilmour, Stuart

2016-03-03

The mortality rate for Japanese males aged 30-59 years in managerial and professional spiked in 2000 and remains worse than that of other occupations possibly associated with the economic downturn of the 1990s and the global economic stagnation after 2008. The present study aimed to assess temporal occupation-specific mortality trends from 1980 to 2010 for Japanese males aged 30-59 years for major causes of death. We obtained data from the Occupation-specific Vital Statistics. We calculated age-standardized mortality rates for the four leading causes of death (all cancers, suicide, ischaemic heart disease, and cerebrovascular disease). We used a generalized estimating equation model to determine specific effects of the economic downturn after 2000. The age-standardized mortality rate for the total working-age population steadily declined up to 2010 in all major causes of death except suicide. Managers had a higher risk of mortality in all leading causes of death compared with before 1995. Mortality rates among unemployed people steadily decreased for all cancers and ischaemic heart disease. Economic downturn may have caused the prolonged increase in suicide mortality. Unemployed people did not experience any change in mortality due to suicide and cerebrovascular disease and saw a decline in cancer and ischemic heart disease mortality, perhaps because the basic properties of Japan's social welfare system were maintained even during economic recession.

POSSUM--a model for surgical outcome audit in quality care.

PubMed

Ng, K J; Yii, M K

2003-10-01

Comparative surgical audit to monitor quality of care should be performed with a risk-adjusted scoring system rather than using crude morbidity and mortality rates. A validated and widely applied risk adjusted scoring system, P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality) methodology, was applied to a prospective series of predominantly general surgical patients at the Sarawak General Hospital, Kuching over a six months period. The patients were grouped into four risk groups. The observed mortality rates were not significantly different from predicted rates, showing that the quality of surgical care was at par with typical western series. The simplicity and advantages of this scoring system over other auditing tools are discussed. The P-POSSUM methodology could form the basis of local comparative surgical audit for assessment and maintenance of quality care.

Epidemiology, disease burden and outcomes of cirrhosis in a large secondary care hospital in South Auckland, New Zealand.

PubMed

Hsiang, J C; Bai, W W; Raos, Z; Stableforth, W; Upton, A; Selvaratnam, S; Gane, E J; Gerred, S J

2015-02-01

Liver cirrhosis is an important cause of morbidity and mortality; however, little is known about its impact in New Zealand. We aim to determine the disease burden, epidemiology and outcomes of cirrhotic patients. This is a retrospective study of cirrhosis patients under secondary public hospital care in a geographically defined region, between the years 2000 and 2011. Cirrhosis complications and mortality was recorded. Poisson log-linear regression analysis was performed for incidence rate ratio (IRR) and Cox regression analysis was used to analyse time-related events. Seven hundred and forty-six cirrhotic patients were analysed; most were European/Other (39.9%), Pacific islanders (21.6%), Southeast Asian/Chinese (17.8%) and Maori (12.3%). 68.4% were male. The common primary aetiologies for cirrhosis were chronic hepatitis B (CHB) cirrhosis (37.3%), alcoholic liver disease (ALD) cirrhosis (24.1%), chronic hepatitis C (CHC) cirrhosis (22.3%) and non-alcoholic fatty liver disease (NAFLD) cirrhosis (16.4%). The hepatocellular carcinoma (HCC) mortality rates were highest in NAFLD and CHB cirrhosis groups (3.0 and 3.1 per 100 patient-year respectively), compared with ALD and CHC groups (2.2 and 1.4 per 100 patient-year, all P < 0.05 respectively). Patients with ALD and NAFLD cirrhosis had the highest all-cause and non-HCC mortality rate compared with viral hepatitis cirrhosis groups. The IRR for HCC incidence, liver-related mortality and HCC mortality were 1.087, 1.098 and 1.114, respectively (all P < 0.001), suggesting increasing incidence and disease burden over the study period. The number of cirrhotic patients in secondary care is increasing steadily. Cirrhosis complications and mortality rates are also rising, particularly the incidence and mortality of HCC. © 2014 Royal Australasian College of Physicians.

Cause-specific mortality in the unionized U.S. trucking industry.

PubMed

Laden, Francine; Hart, Jaime E; Smith, Thomas J; Davis, Mary E; Garshick, Eric

2007-08-01

Occupational and population-based studies have related exposure to fine particulate air pollution, and specifically particulate matter from vehicle exhausts, to cardiovascular diseases and lung cancer. We have established a large retrospective cohort to assess mortality in the unionized U.S. trucking industry. To provide insight into mortality patterns associated with job-specific exposures, we examined rates of cause-specific mortality compared with the general U.S. population. We used records from four national trucking companies to identify 54,319 male employees employed in 1985. Cause-specific mortality was assessed through 2000 using the National Death Index. Expected numbers of all and cause-specific deaths were calculated stratifying by race, 10-year age group, and calendar period using U.S. national reference rates. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated for the entire cohort and by job title. As expected in a working population, we found a deficit in overall and all-cancer mortality, likely due to the healthy worker effect. In contrast, compared with the general U.S. population, we observed elevated rates for lung cancer, ischemic heart disease, and transport-related accidents. Lung cancer rates were elevated among all drivers (SMR = 1.10; 95% CI, 1.02-1.19) and dockworkers (SMR = 1.10; 95% CI, 0.94-1.30); ischemic heart disease was also elevated among these groups of workers [drivers, SMR = 1.49 (95% CI, 1.40-1.59); dockworkers, SMR = 1.32 (95% CI, 1.15-1.52)], as well as among shop workers (SMR = 1.34; 95% CI, 1.05-1.72). In this detailed assessment of specific job categories in the U.S. trucking industry, we found an excess of mortality due to lung cancer and ischemic heart disease, particularly among drivers.

The role of gender in the association between self-rated health and mortality among older adults in Santiago, Chile: A cohort study

PubMed Central

Moreno, Ximena; Albala, Cecilia; Lera, Lydia; Sánchez, Hugo; Fuentes-García, Alejandra; Dangour, Alan D.

2017-01-01

Background Previous studies on the role of gender in the association between self-rated health and mortality have shown contrasting results. This study was aimed to determine the importance of gender in the association between self-rated health and mortality among older people in Santiago, Chile. Methods A 10 year follow-up of 1066 people aged 60 or more, from the Chilean cohort of the Study of Health, Ageing and Well-Being. Self-rated health was assessed in face to face interviews through a single general question, along with socio-demographic and health status information. Cox proportional hazards and flexible parametric models for survival analyses were employed. Results By the end of follow-up, 30.7% of women and 39.4% of men died. Adjusted hazard ratio of poor self-rated health, compared to good self-rated health, was 1.92(95% CI 1.29–2.86). In models stratified by gender, an increased risk of mortality was observed among women who rated their health as poor (HR = 2.21, 95% CI 1.43–3.40), but not among men (HR = 1.04, 95% CI 0.58–1.86). Age was associated with mortality in both groups; for men, functional limitation and underweight were also risk factors and obesity was a protective factor. Conclusions Compared to older women who rated their health as good, older women who rated their health as poor had a 2 fold increased risk of mortality over the subsequent 10 years. These findings stress the importance of considering a gender perspective into health programmes, including those focused on older people, in order to address the different elements that increase, on the long run, the risk of dying among older women and men. PMID:28719627

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.

Burden of invasive squamous cell carcinoma of the penis in the United States, 1998-2003.

PubMed

Hernandez, Brenda Y; Barnholtz-Sloan, Jill; German, Robert R; Giuliano, Anna; Goodman, Marc T; King, Jessica B; Negoita, Serban; Villalon-Gomez, Jose M

2008-11-15

Invasive squamous cell carcinoma (SCC) of the penis is rare in the United States. Although human papillomavirus (HPV) infection is an established etiologic agent in at least 40% of penile SCCs, relatively little is known about the epidemiology of this malignancy. Population-based data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, the Centers for Disease Control and Prevention's National Program for Cancer Registries, and the National Center for Health Statistics were used to examine invasive penile SCC incidence and mortality in the United States. SEER data were used to examine treatment of penile SCC. From 1998 to 2003, 4967 men were diagnosed with histologically confirmed invasive penile SCC in the United States, representing less than 1% of new cancers in men. The annual, average age-adjusted incidence rate was 0.81 cases per 100,000 men, and rates increased steadily with age. Overall, penile SCC incidence was comparable in whites and blacks, but approximately 2-fold lower in Asians/Pacific Islanders. Rates among Hispanics were 72% higher compared with non-Hispanics. Blacks compared with whites and Asians/Pacific Islanders and Hispanics compared with non-Hispanics were diagnosed at significantly younger ages. Higher rates of mortality were also observed among blacks compared with whites and Hispanics compared with non-Hispanics. Penile SCC incidence and mortality were elevated in Southern states and in regions of low socioeconomic status (SES). Some histologic and anatomic site differences were observed by race and ethnicity. Treatment of penile SCC varied with age, stage, and other tumor characteristics. There are considerable disparities in invasive penile cancer incidence and mortality in the United States. Key risk factors for excess incidence include Hispanic ethnicity and residence in the South and in low SES regions. Risks for excess mortality include these factors in addition to black race. Decreases in penile cancer incidence and mortality in the United States may be realized in the future as the indirect result of prophylactic HPV vaccination of females. Further research is needed to better understand the epidemiology of penile cancer including the role of HPV.

Burden of Invasive Squamous Cell Carcinoma of the Penis in the United States, 1998–2003

PubMed Central

Hernandez, Brenda Y.; Barnholtz-Sloan, Jill; German, Robert R.; Giuliano, Anna; Goodman, Marc T.; King, Jessica B.; Negoita, Serban; Villalon-Gomez, Jose M.

2009-01-01

BACKGROUND Invasive squamous cell carcinoma (SCC) of the penis is rare in the United States. Although human papillomavirus (HPV) infection is an established etiologic agent in at least 40% of penile SCCs, relatively little is known about the epidemiology of this malignancy. METHODS Population-based data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, the Centers for Disease Control and Prevention's National Program for Cancer Registries, and the National Center for Health Statistics were used to examine invasive penile SCC incidence and mortality in the United States. SEER data were used to examine treatment of penile SCC. RESULTS From 1998 to 2003, 4967 men were diagnosed with histologically confirmed invasive penile SCC in the United States, representing less than 1% of new cancers in men. The annual, average age-adjusted incidence rate was 0.81 cases per 100,000 men, and rates increased steadily with age. Overall, penile SCC incidence was comparable in whites and blacks, but approximately 2-fold lower in Asians/Pacific Islanders. Rates among Hispanics were 72% higher compared with non-Hispanics. Blacks compared with whites and Asians/Pacific Islanders and Hispanics compared with non-Hispanics were diagnosed at significantly younger ages. Higher rates of mortality were also observed among blacks compared with whites and Hispanics compared with non-Hispanics. Penile SCC incidence and mortality were elevated in Southern states and in regions of low socioeconomic status (SES). Some histologic and anatomic site differences were observed by race and ethnicity. Treatment of penile SCC varied with age, stage, and other tumor characteristics. CONCLUSIONS There are considerable disparities in invasive penile cancer incidence and mortality in the United States. Key risk factors for excess incidence include Hispanic ethnicity and residence in the South and in low SES regions. Risks for excess mortality include these factors in addition to black race. Decreases in penile cancer incidence and mortality in the United States may be realized in the future as the indirect result of prophylactic HPV vaccination of females. Further research is needed to better understand the epidemiology of penile cancer including the role of HPV. PMID:18980292

Outcomes of laparoscopic and open appendectomy for acute appendicitis in patients with acquired immunodeficiency syndrome.

PubMed

Masoomi, Hossein; Mills, Steven D; Dolich, Matthew O; Dang, Phat; Carmichael, Joseph C; Nguyen, Ninh T; Stamos, Michael J

2011-10-01

The aims of this study were to compare outcomes of appendectomy between acquired immunodeficiency syndrome (AIDS) and nonAIDS patients and laparoscopic appendectomy (LA) versus open appendectomy (OA) in AIDS patients. Using the Nationwide Inpatient Sample database, from 2006 to 2008, clinical data of patients with AIDS who underwent LA and OA were evaluated. A total of 800 patients with AIDS underwent appendectomy during these years. Patients with AIDS had a significantly higher postoperative complication rate (22.56% vs 10.36%), longer length of stay [(LOS) 4.9 vs 2.9 days], and higher mortality (0.61% vs 0.16%) compared with non-AIDS patients. In nonperforated cases in patients with AIDS, LA was associated with a significantly lower complication rate (11.25% vs 21.61%), lower mortality (0.0% vs 2.78%), and shorter mean LOS (3.22 days vs 4.82 days) compared with OA. In perforated cases in patients with AIDS, LA had a significantly lower complication rate (27.52% vs 57.50%), and shorter mean LOS (5.92 days vs 9.67 days) compared with OA. No mortality was reported in either group. In patients with AIDS, LA has a lower morbidity, lower mortality, and shorter LOS compared with OA. Laparoscopic appendectomy should be considered as a preferred operative option for acute appendicitis in patients with AIDS.

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.

Colorectal cancer epidemiology in minorities: a review.

PubMed

Baquet, C R; Commiskey, P

1999-01-01

Colorectal cancer is the second leading cause of cancer death in the United States. In 1997, more than 131,000 new cases and more than 54,000 deaths were estimated. Racial and ethnic disparities in incidence, mortality and survival rates, and trends exist for this disease. Differences in colorectal cancer screening, early detection, and treatment in minority communities are related to therapeutic outcomes. Age-adjusted incidence rates for men with colorectal cancer are highest for Alaskan native men, followed by Japanese, then African-American men. For women, the incidence is highest for Alaskan native women, followed by African-American, then Japanese women. Mortality rates in men are highest for African Americans, followed by Alaskan natives and then Hawaiians. In women, mortality rates are highest for Alaskan natives, then African Americans and whites. Colorectal cancer screening rates vary by race, income, and education. It is interesting that, when compared with whites, African-American men demonstrate the higher reported rate of screening for this disease. In addition, site specificity is different for African Americans compared with whites. Findings also reveal that stage at diagnosis is an influential factor with regard to mortality and survival. This may be related in part to socioeconomic factors, differences in anatomic site, and treatment differences in African Americans. Risk factor data for this disease are scarce for minority populations. Documented differences in colorectal cancer incidence, mortality, and survival rates exist between minorities and whites. Additional research is needed on risk factors specific to African Americans and other minorities, differences in treatment, and the role of socioeconomic status.

Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality.

PubMed

Walrath, Christine; Garraza, Lucas Godoy; Reid, Hailey; Goldston, David B; McKeon, Richard

2015-05-01

We examined whether a reduction in youth suicide mortality occurred between 2007 and 2010 that could reasonably be attributed to Garrett Lee Smith (GLS) program efforts. We compared youth mortality rates across time between counties that implemented GLS-funded gatekeeper training sessions (the most frequently implemented suicide prevention strategy among grantees) and a set of matched counties in which no GLS-funded training occurred. A rich set of background characteristics, including preintervention mortality rates, was accounted for with a combination of propensity score-based techniques. We also analyzed closely related outcomes that we did not expect to be affected by GLS as control outcomes. Counties implementing GLS training had significantly lower suicide rates among the population aged 10 to 24 years the year after GLS training than similar counties that did not implement GLS training (1.33 fewer deaths per 100 000; P = .02). Simultaneously, we found no significant difference in terms of adult suicide mortality rates or nonsuicide youth mortality the year after the implementation. These results support the existence of an important reduction in youth suicide rates resulting from the implementation of GLS suicide prevention programming.

The impact of drug-related deaths on mortality among young adults in Madrid.

PubMed

de la Fuente, L; Barrio, G; Vicente, J; Bravo, M J; Santacreu, J

1995-01-01

The trend from 1983 to 1990 of drug-related mortality (defined as the sum of deaths from acute drug reactions and the acquired immuno-deficiency syndrome [AIDS] in drug users) among the population 15 to 39 years of age in Madrid, Spain, was studied and compared with mortality from all causes. All of the mortality rates increased from 1983 to 1990: all causes, from 101/100,000 to 148/100,000; acute drug reactions, from 3/100,000 to 15/100,000; and AIDS, from 0 to 20/100,000. Drug-related mortality represented 60% of the increase in the rate from all causes in males and 170% of the increase in females. The increases in drug-related mortality are likely to continue in the future.

The impact of drug-related deaths on mortality among young adults in Madrid.

PubMed Central

de la Fuente, L; Barrio, G; Vicente, J; Bravo, M J; Santacreu, J

1995-01-01

The trend from 1983 to 1990 of drug-related mortality (defined as the sum of deaths from acute drug reactions and the acquired immuno-deficiency syndrome [AIDS] in drug users) among the population 15 to 39 years of age in Madrid, Spain, was studied and compared with mortality from all causes. All of the mortality rates increased from 1983 to 1990: all causes, from 101/100,000 to 148/100,000; acute drug reactions, from 3/100,000 to 15/100,000; and AIDS, from 0 to 20/100,000. Drug-related mortality represented 60% of the increase in the rate from all causes in males and 170% of the increase in females. The increases in drug-related mortality are likely to continue in the future. PMID:7832243

Long-term reductions in mortality among children under age 5 in rural Haiti: effects of a comprehensive health system in an impoverished setting.

PubMed

Perry, Henry; Berggren, Warren; Berggren, Gretchen; Dowell, Duane; Menager, Henri; Bottex, Erve; Dortonne, Jean Richard; Philippe, Francois; Cayemittes, Michel

2007-02-01

Evidence regarding the long-term impact of health and other community development programs on under-5 mortality (the risk of death from birth until the fifth birthday) is limited. We compared mortality in a population served by health and other community development programs at the Hôpital Albert Schweitzer (HAS) with national mortality rates among children younger than 5 years for Haiti between 1958 and 1999. We collected information on births and deaths in the HAS service area between 1995 and 1999 and assembled previously published under-5 mortality rates at HAS. Published national rates for Haiti served as a comparison. In the early 1970s, the under-5 mortality rate at HAS declined to a level three fourths lower than that in Haiti nationwide. More recently, HAS rates have remained at one half those for Haiti nationwide. Child survival interventions in the HAS service area were substantially higher than in Haiti nationwide although socioeconomic characteristics and levels of childhood malnutrition were similar in both areas. HAS's programs have been responsible for long-term sustained reduction in mortality among children aged less than 5 years. Integrated systems for health and other community development programs could be an effective strategy for achieving the United Nations Millennium Goal to reduce under-5 mortality two thirds by 2015.

Hyperbaric Oxygen Therapy Is Associated With Lower Short- and Long-Term Mortality in Patients With Carbon Monoxide Poisoning.

PubMed

Huang, Chien-Cheng; Ho, Chung-Han; Chen, Yi-Chen; Lin, Hung-Jung; Hsu, Chien-Chin; Wang, Jhi-Joung; Su, Shih-Bin; Guo, How-Ran

2017-11-01

To date, there has been no consensus about the effect of hyperbaric oxygen therapy (HBOT) on the mortality of patients with carbon monoxide poisoning (COP). This retrospective nationwide population-based cohort study from Taiwan was conducted to clarify this issue. Using the Nationwide Poisoning Database, we identified 25,737 patients with COP diagnosed between 1999 and 2012, including 7,278 patients who received HBOT and 18,459 patients who did not. The mortality risks of the two cohorts were compared, including overall mortality, and stratified analyses by age, sex, underlying comorbidities, monthly income, suicide attempt, drug poisoning, acute respiratory failure, and follow-up until 2013 were conducted. We also tried to identify independent mortality predictors and evaluated their effects. Patients who received HBOT had a lower mortality rate compared with patients who did not (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.67-0.81) after adjusting for age, sex, underlying comorbidities, monthly income, and concomitant conditions, especially in patients younger than 20 years (AHR, 0.45; 95% CI, 0.26-0.80) and those with acute respiratory failure (AHR, 0.43; 95% CI, 0.35-0.53). The lower mortality rate was noted for a period of 4 years after treatment of the COP. Patients who received two or more sessions of HBOT had a lower mortality rate than did those who received HBOT only once. Older age, male sex, low monthly income, diabetes, malignancy, stroke, alcoholism, mental disorders, suicide attempts, and acute respiratory failure were also independent mortality predictors. HBOT was associated with a lower mortality rate in patients with COP, especially in those who were younger than 20 years and those with acute respiratory failure. The results provide important references for decision-making in the treatment of COP. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Sex-Based Differences in Rates, Causes, and Predictors of Death Among Injection Drug Users in Vancouver, Canada

PubMed Central

Hayashi, Kanna; Dong, Huiru; Marshall, Brandon D. L.; Milloy, Michael-John; Montaner, Julio S. G.; Wood, Evan; Kerr, Thomas

2016-01-01

In the present study, we sought to identify rates, causes, and predictors of death among male and female injection drug users (IDUs) in Vancouver, British Columbia, Canada, during a period of expanded public health interventions. Data from prospective cohorts of IDUs in Vancouver were linked to the provincial database of vital statistics to ascertain rates and causes of death between 1996 and 2011. Mortality rates were analyzed using Poisson regression and indirect standardization. Predictors of mortality were identified using multivariable Cox regression models stratified by sex. Among the 2,317 participants, 794 (34.3%) of whom were women, there were 483 deaths during follow-up, with a rate of 32.1 (95% confidence interval (CI): 29.3, 35.0) deaths per 1,000 person-years. Standardized mortality ratios were 7.28 (95% CI: 6.50, 8.14) for men and 15.56 (95% CI: 13.31, 18.07) for women. During the study period, mortality rates related to infection with human immunodeficiency virus (HIV) declined among men but remained stable among women. In multivariable analyses, HIV seropositivity was independently associated with mortality in both sexes (all P < 0.05). The excess mortality burden among IDUs in our cohorts was primarily attributable to HIV infection; compared with men, women remained at higher risk of HIV-related mortality, indicating a need for sex-specific interventions to reduce mortality among female IDUs in this setting. PMID:26865265

[Huntington's Disease in Balearic Islands Population-Based Registry of Rare Diseases: Prevalence and Mortality during the Period 2010-2013. Spain].

PubMed

Cáffaro Rovira, Mercedes; Salom Castell, M Magdalena

2017-02-16

Huntington's disease is a hereditary disease with low prevalence. The low frequency of Huntington's disease leads to its inclusion as one of the pathologies in the Registry of Rare Diseases. The Balearic Islands Population-based Registry of Rare Diseases began in 2010. Previously, there had been no prevalence or mortality data for Huntington's disease in the Balearic Islands. The aim of this study was to determine the prevalence and mortality of Huntington's disease in the Balearic Islands between 2010 and 2013. The data sources were the Balearic Islands Population-based Registry of Rare Diseases, from which the diagnosed cases were obtained; the Balearic Islands Mortality Register, from which the deceased cases were obtained; the Balearic Islands Health Service, from which the number of Health Cards was obtained; and the National Institute for Statistics, from which population data were obtained. Prevalence and mortality rates were calculated. The Balearic Islands Population-based Registry of Rare Diseases registered 27 cases of Huntington's disease between 2010-2013. 63% of these were women. The period prevalence rate was 2.6 per 100,000 and the period mortality rate was 1.1 per 100,000. Menorca was the island with the highest rates, the prevalence rate was 5,9 per 100,000 and the mortality rate was 2,1 per 100,000. Prevalence and mortality of Huntington's disease in the Balearic Islands are low compared to similar areas.

Forecasting the mortality rates using Lee-Carter model and Heligman-Pollard model

NASA Astrophysics Data System (ADS)

Ibrahim, R. I.; Ngataman, N.; Abrisam, W. N. A. Wan Mohd

2017-09-01

Improvement in life expectancies has driven further declines in mortality. The sustained reduction in mortality rates and its systematic underestimation has been attracting the significant interest of researchers in recent years because of its potential impact on population size and structure, social security systems, and (from an actuarial perspective) the life insurance and pensions industry worldwide. Among all forecasting methods, the Lee-Carter model has been widely accepted by the actuarial community and Heligman-Pollard model has been widely used by researchers in modelling and forecasting future mortality. Therefore, this paper only focuses on Lee-Carter model and Heligman-Pollard model. The main objective of this paper is to investigate how accurately these two models will perform using Malaysian data. Since these models involves nonlinear equations that are explicitly difficult to solve, the Matrix Laboratory Version 8.0 (MATLAB 8.0) software will be used to estimate the parameters of the models. Autoregressive Integrated Moving Average (ARIMA) procedure is applied to acquire the forecasted parameters for both models as the forecasted mortality rates are obtained by using all the values of forecasted parameters. To investigate the accuracy of the estimation, the forecasted results will be compared against actual data of mortality rates. The results indicate that both models provide better results for male population. However, for the elderly female population, Heligman-Pollard model seems to underestimate to the mortality rates while Lee-Carter model seems to overestimate to the mortality rates.

The suitability of using death certificates as a data source for cancer mortality assessment in Turkey

PubMed Central

Ulus, Tumer; Yurtseven, Eray; Cavdar, Sabanur; Erginoz, Ethem; Erdogan, M. Sarper

2012-01-01

Aim To compare the quality of the 2008 cancer mortality data of the Istanbul Directorate of Cemeteries (IDC) with the 2008 data of International Agency for Research on Cancer (IARC) and Turkish Statistical Institute (TUIK), and discuss the suitability of using this databank for estimations of cancer mortality in the future. Methods We used 2008 and 2010 death records of the IDC and compared it to TUIK and IARC data. Results According to the WHO statistics, in Turkey in 2008 there were 67 255 estimated cancer deaths. As the population of Turkey was 71 517 100, the cancer mortality rate was 9.4 per 10 000. According to the IDC statistics, the cancer mortality rate in Istanbul in 2008 was 5.97 per 10 000. Conclusion IDC estimates were higher than WHO estimates probably because WHO bases its estimates on a sample group and because of the restrictions of IDC data collection method. Death certificates could be a reliable and accurate data source for mortality statistics if the problems of data collection are solved. PMID:23100210

New equations for predicting postoperative risk in patients with hip fracture.

PubMed

Hirose, Jun; Ide, Junji; Irie, Hiroki; Kikukawa, Kenshi; Mizuta, Hiroshi

2009-12-01

Predicting the postoperative course of patients with hip fractures would be helpful for surgical planning and risk management. We therefore established equations to predict the morbidity and mortality rates in candidates for hip fracture surgery using the Estimation of Physiologic Ability and Surgical Stress (E-PASS) risk-scoring system. First we evaluated the correlation between the E-PASS scores and postoperative morbidity and mortality rates in all 722 patients surgically treated for hip fractures during the study period (Group A). Next we established equations to predict morbidity and mortality rates. We then applied these equations to all 633 patients with hip fractures treated at seven other hospitals (Group B) and compared the predicted and actual morbidity and mortality rates to assess the predictive ability of the E-PASS and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems. The ratio of actual to predicted morbidity and mortality rates was closer to 1.0 with the E-PASS than the POSSUM system. Our data suggest the E-PASS scoring system is useful for defining postoperative risk and its underlying algorithm accurately predicts morbidity and mortality rates in patients with hip fractures before surgery. This information then can be used to manage their condition and potentially improve treatment outcomes. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study

PubMed Central

Wilkins, Russell; Tjepkema, Michael; O’Campo, Patricia J; Dunn, James R

2009-01-01

Objective To examine mortality in a representative nationwide sample of homeless and marginally housed people living in shelters, rooming houses, and hotels. Design Follow-up study. Setting Canada 1991-2001. Participants 15 100 homeless and marginally housed people enumerated in 1991 census. Main outcome measures Age specific and age standardised mortality rates, remaining life expectancies at age 25, and probabilities of survival from age 25 to 75. Data were compared with data from the poorest and richest income fifths as well as with data for the entire cohort Results Of the homeless and marginally housed people, 3280 died. Mortality rates among these people were substantially higher than rates in the poorest income fifth, with the highest rate ratios seen at younger ages. Among those who were homeless or marginally housed, the probability of survival to age 75 was 32% (95% confidence interval 30% to 34%) in men and 60% (56% to 63%) in women. Remaining life expectancy at age 25 was 42 years (42 to 43) and 52 years (50 to 53), respectively. Compared with the entire cohort, mortality rate ratios for men and women, respectively, were 11.5 (8.8 to 15.0) and 9.2 (5.5 to 15.2) for drug related deaths, 6.4 (5.3 to 7.7) and 8.2 (5.0 to 13.4) for alcohol related deaths, 4.8 (3.9 to 5.9) and 3.8 (2.7 to 5.4) for mental disorders, and 2.3 (1.8 to 3.1) and 5.6 (3.2 to 9.6) for suicide. For both sexes, the largest differences in mortality rates were for smoking related diseases, ischaemic heart disease, and respiratory diseases. Conclusions Living in shelters, rooming houses, and hotels is associated with much higher mortality than expected on the basis of low income alone. Reducing the excessively high rates of premature mortality in this population would require interventions to address deaths related to smoking, alcohol, and drugs, and mental disorders and suicide, among other causes. PMID:19858533

Risk adjusted surgical audit in gynaecological oncology: P-POSSUM does not predict outcome.

PubMed

Das, N; Talaat, A S; Naik, R; Lopes, A D; Godfrey, K A; Hatem, M H; Edmondson, R J

2006-12-01

To assess the Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and its validity for use in gynaecological oncology surgery. All patients undergoing gynaecological oncology surgery at the Northern Gynaecological Oncology Centre (NGOC) Gateshead, UK over a period of 12months (2002-2003) were assessed prospectively. Mortality and morbidity predictions using the Portsmouth modification of the POSSUM algorithm (P-POSSUM) were compared to the actual outcomes. Performance of the model was also evaluated using the Hosmer and Lemeshow Chi square statistic (testing the goodness of fit). During this period 468 patients were assessed. The P-POSSUM appeared to over predict mortality rates for our patients. It predicted a 7% mortality rate for our patients compared to an observed rate of 2% (35 predicted deaths in comparison to 10 observed deaths), a difference that was statistically significant (H&L chi(2)=542.9, d.f. 8, p<0.05). The P-POSSUM algorithm overestimates the risk of mortality for gynaecological oncology patients undergoing surgery. The P-POSSUM algorithm will require further adjustments prior to adoption for gynaecological cancer surgery as a risk adjusted surgical audit tool.

Epidemiological isolation causing variable mortality in Island populations during the 1918-1920 influenza pandemic.

PubMed

Shanks, G Dennis; Hussell, Tracy; Brundage, John F

2012-11-01

During the 1918 pandemic period, influenza-related mortality increased worldwide; however, mortality rates varied widely across locations and demographic subgroups. Islands are isolated epidemiological situations that may elucidate why influenza pandemic mortality rates were so variable in apparently similar populations. Our objectives were to determine and compare the patterns of pandemic influenza mortality on islands. We reviewed historical records of mortality associated with the 1918-1920 influenza pandemic in various military and civilian groups on islands. Mortality differed more than 50-fold during pandemic-related epidemics on Pacific islands [range: 0.4% (Hawaii) to 22% (Samoa)], and on some islands, mortality sharply varied among demographic subgroups of island residents such as Saipan: Chamorros [12%] and Caroline Islanders [0.4%]. Among soldiers from island populations who had completed initial military training, influenza-related mortality rates were generally low, for example, Puerto Rico (0.7%) and French Polynesia (0.13%). The findings suggest that among island residents, those who had been exposed to multiple, antigenically diverse respiratory pathogens prior to infection with the 1918 pandemic strain (e.g., less isolated) experienced lower mortality. The continuous circulation of antigenically diverse influenza viruses and other respiratory infectious agents makes widespread high mortality during future influenza pandemics unlikely. © 2012 Blackwell Publishing Ltd.

Suicide Rates in Aboriginal Communities in Labrador, Canada

PubMed Central

Pollock, Nathaniel J.; Mulay, Shree; Valcour, James

2016-01-01

Objectives. To compare suicide rates in Aboriginal communities in Labrador, including Innu, Inuit, and Southern Inuit, with the general population of Newfoundland, Canada. Methods. In partnership with Aboriginal governments, we conducted a population-based study to understand patterns of suicide mortality in Labrador. We analyzed suicide mortality data from 1993 to 2009 from the Vital Statistics Death Database. We combined this with community-based methods, including consultations with Elders, youths, mental health and community workers, primary care clinicians, and government decision-makers. Results. The suicide rate was higher in Labrador than in Newfoundland. This trend persisted across all age groups; however, the disparity was greatest among those aged 10 to 19 years. Males accounted for the majority of deaths, although suicide rates were elevated among females in the Inuit communities. When comparing Aboriginal subregions, the Innu and Inuit communities had the highest age-standardized mortality rates of, respectively, 165.6 and 114.0 suicides per 100 000 person-years. Conclusions. Suicide disproportionately affects Innu and Inuit populations in Labrador. Suicide rates were high among male youths and Inuit females. PMID:27196659

Race and insurance status as risk factors for trauma mortality.

PubMed

Haider, Adil H; Chang, David C; Efron, David T; Haut, Elliott R; Crandall, Marie; Cornwell, Edward E

2008-10-01

To determine the effect of race and insurance status on trauma mortality. Review of patients (aged 18-64 years; Injury Severity Score > or = 9) included in the National Trauma Data Bank (2001-2005). African American and Hispanic patients were each compared with white patients and insured patients were compared with uninsured patients. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, injury severity (Injury Severity Score and revised Trauma Score), severity of head and/or extremity injury, and injury mechanism. A total of 429 751 patients met inclusion criteria. African American (n = 72,249) and Hispanic (n = 41,770) patients were less likely to be insured and more likely to sustain penetrating trauma than white patients (n = 262,878). African American and Hispanic patients had higher unadjusted mortality rates (white, 5.7%; African American, 8.2%; Hispanic, 9.1%; P = .05 for African American and Hispanic patients) and an increased adjusted odds ratio (OR) of death compared with white patients (African American OR, 1.17; 95% confidence interval [CI], 1.10-1.23; Hispanic OR, 1.47; 95% CI, 1.39-1.57). Insured patients (47%) had lower crude mortality rates than uninsured patients (4.4% vs 8.6%; P = .05). Insured African American and Hispanic patients had increased mortality rates compared with insured white patients. This effect worsened for uninsured patients across groups (insured African American OR, 1.2; 95% CI, 1.08-1.33; insured Hispanic OR, 1.51; 95% CI, 1.36-1.64; uninsured white OR, 1.55; 95% CI, 1.46-1.64; uninsured African American OR, 1.78; 95% CI, 1.65-1.90; uninsured Hispanic OR, 2.30; 95% CI, 2.13-2.49). The reference group was insured white patients. Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma.

[A rank-order method for the integrated assessment of trends in all-cause and cardiovascular mortality rates in the subjects of the Russian Federation in 2006-2012].

PubMed

Artamonova, G V; Maksimov, S A; Tabakaev, M V; Barbarash, L S

2016-01-01

To rank the subjects of the Russian Federation by the trend direction in all-cause and cardiovascular mortality (including mortality from coronary heart disease and cerebrovascular diseases) as a whole and at able-bodied age. The investigation used mortality rates from to the 2006 and 2012 data available in the Federal State Statistics Service on 81 subjects of the Russian Federation. According to mortality rates, each region was assigned a rank in 2006 and 2012. Trends in rank changes in the Russian Federation's regions were analyzed. A cluster analysis was used to group the subjects of the Russian Federation by trends in rank changes. The cluster analysis of rank changes from 2006 to 2012 could combine the Russian Federation's regions into 10 groups showing the similar trends in all-cause and circulatory disease mortality rates. Overall, the results of the ranking and further clusterization of the regions of the Russian Federation correspond to the trends in all-cause and cardiovascular mortality rates according to the data of other Russian investigations, by qualitatively complementing them. The trend rank-order method permits a comprehensive comparative analysis of changes in all-cause and cardiovascular mortality in the subjects of the Russian Federation both as a whole and at able-bodied age, which provides qualitatively new information complementing the universally accepted approaches to studying the population's mortality.

Association of Admission to Veterans Affairs Hospitals Versus non-Veterans Affairs Hospitals with Mortality and Readmission Rates Among Older Men Hospitalized with Acute Myocardial Infarction, Heart Failure, and Pneumonia

PubMed Central

Nuti, Sudhakar V.; Qin, Li; Rumsfeld, John S.; Ross, Joseph S.; Masoudi, Frederick A.; Normand, Sharon-Lise T.; Murugiah, Karthik; Bernheim, Susannah M.; Suter, Lisa G.; Krumholz, Harlan M.

2017-01-01

Importance Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. Objective To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Design Cross-sectional analysis between 2010 and 2013 Setting Medicare Standard Analytic Files and Enrollment Database Participants Male Medicare Fee-for-Service beneficiaries aged 65 or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia. Exposures Hospitalization in a VA or non-VA hospital in urban MSAs that contained at least 1 VA and non-VA hospital Main Outcomes and Measures For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean-aggregated within-MSA differences in mortality and readmission rates were also assessed. Results We studied 104 VA and 1,513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7,900 patients, in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs. 13.7%, p=0.02; −0.2 percentage point difference) and HF (11.4% vs. 11.9%, p=0.008; −0.5 percentage point difference), but higher for pneumonia (12.6% vs. 12.2%, p<0.05; 0.4 percentage point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI: 17.8% vs. 17.2%, 0.6 percentage point difference; HF: 24.7% vs. 23.5%, 1.2 percentage point difference; pneumonia: 19.4% vs. 18.7%, 0.7 percentage point difference, all p<0.001). In within-MSA comparisons, VA hospitals had lower mortality rates for AMI (percentage point difference: −0.22, 95% CI: −0.40 to −0.04) and HF (−0.63, 95% CI: −0.95 to −0.31), and mortality rates for pneumonia were not significantly different (−0.03, 95% CI: −0.46 to 0.40); however, VA hospitals had higher readmission rates (AMI: 0.62, 95% CI: 0.48 to 0.75; HF: 0.97, 95% CI: 0.59 to 1.34; pneumonia: 0.66, 95% CI: 0.41 to 0.91). Conclusion and Relevance Among older men with AMI, HF, and pneumonia, hospitalization at VA hospitals, compared with hospitalization at non-VA hospitals, was associated with lower risk-standardized 30-day all-cause mortality rates for AMI and HF, and higher risk-standardized 30 day all-cause readmission rates for all 3 conditions, both nationally and within similar geographic areas, although absolute differences between these outcomes at VA and non-VA hospitals were small. PMID:26864412

Patterns and trends in accidental poisoning death rates in the US, 1979-2014.

PubMed

Buchanich, Jeanine M; Balmert, Lauren C; Pringle, Janice L; Williams, Karl E; Burke, Donald S; Marsh, Gary M

2016-08-01

The purpose of this study was to examine US accidental poisoning death rates by demographic and geographic factors from 1979 to 2014, including High Intensity Drug Trafficking Areas. Crude and age-adjusted death rates were formed for age group, race, sex, and county for accidental poisonings (ICD 9th revision: E850-E869; ICD 10th revision: X40-X49) from 1979 to 2014 using the Mortality and Population Data System housed at the University of Pittsburgh. Rate ratios were calculated comparing rates from 2014 to 1979, overall, by sex, age group, race, and county. Joinpoint regression detected changes in trends and calculated the average annual percentage change (AAPC) as a summary measure of trend. Drug poisoning mortality rates have risen an average of 6% per year since 1979. Increases are occurring in all ages 15+, and in all race-sex groups. HIDTA counties with the highest mortality rates were in Appalachia and New Mexico. Many of the HIDTA border counties had lower rates of mortality. The drug poisoning mortality epidemic is continuing to grow. While HIDTA resources are appropriately targeted at many areas in the US most affected, rates are also rapidly rising in some non-HIDTA areas. Copyright © 2016 Elsevier Inc. All rights reserved.

The relationship between heart rate and mortality of patients with acute coronary syndromes in the coronary intervention era: Meta-analysis.

PubMed

Xu, Tan; Zhan, Youqin; Xiong, Jianping; Lu, Nan; He, Zhuoqiao; Su, Xi; Tan, Xuerui

2016-11-01

Most of acute coronary syndromes (ACS) were receiving intervention treatment a high overall rate of coronary angiography in the modern medical practice.Consequently, we conduct a review to determine the heart rate (HR) on the prognosis of ACS in the coronary intervention era. PubMed, EMBASE, MEDLINE, and the Cochrane Library was systematically searched up to May 2016 using the search terms "heart rate," "acute coronary syndrome," "acute myocardial infarction," "ST elevation myocardial infarction," "non-ST-segment elevation." The outcome of interest was all-cause mortality. All analyses were performed using Review Manager. Database searches retrieved 2324 citations. Eleven studies enrolling 156,374 patients were included. In-hospital mortality was significantly higher in the elevated HR group compared to the lower HR group (pooled RR 2.04, 95%CI 1.80-2.30, P < 0.0001). Individuals with elevated admission HR had increased risk of long-term mortality (Pooled RR = 1.63, 95%CI 1.27-2.10, P = 0.008) compared to lower admission HR. The pooled results showed elevated discharge and resting HR were related to increased mortality of patients with ACS (pooled RR 1.88, 95% CI 1.02-3.47, P = 0.04; pooled RR 2.14, 95%CI 1.37-3.33, P < 0.0001, respectively). Elevated HR may increase the mortality of ACS patients in the percutaneous coronary intervention era.

Movement behavior preceding autumn mortality for white-tailed deer in central New York

USGS Publications Warehouse

Whitman, Brigham J.; Porter, W. F.; Dechen Quinn, Amy C.; Williams, David M.; Frair, Jacqueline L.; Underwood, Harold; Crawford, Joanne C.

2018-01-01

A common yet largely untested assumption in the theory of animal movements is that increased rates and a wider range of movements, such as occurs during breeding, make animals more vulnerable to mortality. We examined mortality among 34 white-tailed deer (Odocoileus virginianus) wearing GPS collars during the autumn breeding season of 2006 and 2007 in a heavily hunted, forest-agricultural landscape of central New York state. We evaluated whether individuals having higher rates of movement incurred higher rates of mortality and whether mortality risk was higher when deer were in less familiar areas. We used a Cox proportional hazards model to analyze how mortality risk changes with movement rates measured over 3 time periods: < 1 day, up to 2 weeks prior to death, and 3–4 weeks prior to death. Overall, deer increased their movement rates as autumn progressed, males more so than females. However, deer that died moved at a slower rate relative to surviving deer up to 2 weeks prior to death (ß = -2.22 ± 0.81; 95% confidence interval [CI] = -3.91 to -0.51) and a slower rate on their day of death compared to deer that survived (ß = -1.77 ± 0.73; 95% CI = -3.19 to -0.33). Site familiarity was not significantly related to mortality risk. Deer were equally likely to die within their 50% core use area as elsewhere within their autumn home range. We hypothesize that increased sociality associated with breeding may make animals more vulnerable to harvest mortality. Our findings contradict general assumptions about the influences of movement behavior on mortality risk, suggesting that patterns may be sensitive to the spatiotemporal context of the movement analysis.

Bladder cancer mortality of workers exposed to aromatic amines: a 58-year follow-up.

PubMed

Pira, Enrico; Piolatto, Giorgio; Negri, Eva; Romano, Canzio; Boffetta, Paolo; Lipworth, Loren; McLaughlin, Joseph K; La Vecchia, Carlo

2010-07-21

We previously investigated bladder cancer risk in a cohort of dyestuff workers who were heavily exposed to aromatic amines from 1922 through 1972. We updated the follow-up by 14 years (through 2003) for 590 exposed workers to include more than 30 years of follow-up since last exposure to aromatic amines. Expected numbers of deaths from bladder cancer and other causes were computed by use of national mortality rates from 1951 to 1980 and regional mortality rates subsequently. There were 394 deaths, compared with 262.7 expected (standardized mortality ratio = 1.50, 95% confidence interval = 1.36 to 1.66). Overall, 56 deaths from bladder cancer were observed, compared with 3.4 expected (standardized mortality ratio = 16.5, 95% confidence interval = 12.4 to 21.4). The standardized mortality ratio for bladder cancer increased with younger age at first exposure and increasing duration of exposure. Although the standardized mortality ratio for bladder cancer steadily decreased with time since exposure stopped, the absolute risk remained approximately constant at 3.5 deaths per 1000 man-years up to 29 years after exposure stopped. Excess risk was apparent 30 years or more after last exposure.

Is outdoor work associated with elevated rates of cerebrovascular disease mortality? A cohort study based on iron-ore mining.

PubMed

Björ, Ove; Jonsson, Håkan; Damber, Lena; Burström, Lage; Nilsson, Tohr

2016-01-01

A cohort study that examined iron ore mining found negative associations between cumulative working time employed underground and several outcomes, including mortality of cerebrovascular diseases. In this cohort study, and using the same group of miners, we examined whether work in an outdoor environment could explain elevated cerebrovascular disease rates. This study was based on a Swedish iron ore mining cohort consisting of 13,000 workers. Poisson regression models were used to generate smoothed estimates of standardized mortality ratios and adjusted rate ratios, both models by cumulative exposure time in outdoor work. The adjusted rate ratio between employment classified as outdoor work ≥25 years and outdoor work 0-4 years was 1.62 (95 % CI 1.07-2.42). The subgroup underground work ≥15 years deviated most in occurrence of cerebrovascular disease mortality compared with the external reference population: SMR (0.70 (95 % CI 0.56-0.85)). Employment in outdoor environments was associated with elevated rates of cerebrovascular disease mortality. In contrast, work in tempered underground employment was associated with a protecting effect.

Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans - United States, 1999-2015.

PubMed

Cunningham, Timothy J; Croft, Janet B; Liu, Yong; Lu, Hua; Eke, Paul I; Giles, Wayne H

2017-05-05

Although the overall life expectancy at birth has increased for both blacks and whites and the gap between these populations has narrowed, disparities in life expectancy and the leading causes of death for blacks compared with whites in the United States remain substantial. Understanding how factors that influence these disparities vary across the life span might enhance the targeting of appropriate interventions. Trends during 1999-2015 in mortality rates for the leading causes of death were examined by black and white race and age group. Multiple 2014 and 2015 national data sources were analyzed to compare blacks with whites in selected age groups by sociodemographic characteristics, self-reported health behaviors, health-related quality of life indicators, use of health services, and chronic conditions. During 1999-2015, age-adjusted death rates decreased significantly in both populations, with rates declining more sharply among blacks for most leading causes of death. Thus, the disparity gap in all-cause mortality rates narrowed from 33% in 1999 to 16% in 2015. However, during 2015, blacks still had higher death rates than whites for all-cause mortality in all groups aged <65 years. Compared with whites, blacks in age groups <65 years had higher levels of some self-reported risk factors and chronic diseases and mortality from cardiovascular diseases and cancer, diseases that are most common among persons aged ≥65 years. To continue to reduce the gap in health disparities, these findings suggest an ongoing need for universal and targeted interventions that address the leading causes of deaths among blacks (especially cardiovascular disease and cancer and their risk factors) across the life span and create equal opportunities for health.

Site-specific cancer mortality inequalities by employment and occupational groups: a cohort study among Belgian adults, 2001-2011.

PubMed

Vanthomme, Katrien; Van den Borre, Laura; Vandenheede, Hadewijch; Hagedoorn, Paulien; Gadeyne, Sylvie

2017-11-12

This study probes into site-specific cancer mortality inequalities by employment and occupational group among Belgians, adjusted for other indicators of socioeconomic (SE) position. This cohort study is based on record linkage between the Belgian censuses of 1991 and 2001 and register data on emigration and mortality for 01/10/2001 to 31/12/2011. Belgium. The study population contains all Belgians within the economically active age (25-65 years) at the census of 1991. Both absolute and relative measures were calculated. First, age-standardised mortality rates have been calculated, directly standardised to the Belgian population. Second, mortality rate ratios were calculated using Poisson's regression, adjusted for education, housing conditions, attained age, region and migrant background. This study highlights inequalities in site-specific cancer mortality, both related to being employed or not and to the occupational group of the employed population. Unemployed men and women show consistently higher overall and site-specific cancer mortality compared with the employed group. Also within the employed group, inequalities are observed by occupational group. Generally manual workers and service and sales workers have higher site-specific cancer mortality rates compared with white-collar workers and agricultural and fishery workers. These inequalities are manifest for almost all preventable cancer sites, especially those cancer sites related to alcohol and smoking such as cancers of the lung, oesophagus and head and neck. Overall, occupational inequalities were less pronounced among women compared with men. Important SE inequalities in site-specific cancer mortality were observed by employment and occupational group. Ensuring financial security for the unemployed is a key issue in this regard. Future studies could also take a look at other working regimes, for instance temporary employment or part-time employment and their relation to health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study.

PubMed

Ferri, Cleusa P; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Llibre-Rodriguez, Juan J; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Gaona, Ciro; Liu, Zhaorui; Noriega-Fernandez, Lisseth; Jotheeswaran, A T; Prince, Martin J

2012-02-01

Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking. The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development.

Seatbelt compliance and mortality in the Gulf Cooperation Council countries in comparison with other high-income countries.

PubMed

Abbas, Alaa K; Hefny, Ashraf F; Abu-Zidan, Fikri M

2011-01-01

Mortality from road traffic collisions (RTC) is a major problem in the Gulf Cooperation Council (GCC) countries. Low compliance with seatbelt usage can be a contributing factor for increased mortality. The present study aimed to ascertain the presence of a relationship between seatbelt non-compliance of vehicle occupants and mortality rates in the GCC countries versus other high-income countries. Observational and descriptive study using information published by the World Health Organization. Data for all GCC countries (n=6) and other high-income countries (n=37) were retrieved and compared with regard to population, gross national income, number of vehicles, seatbelt non-compliance and road traffic death rates. Univariate and multivariate analysis were used to define factors affecting the mortality rates. The median road traffic death rates, occupant death rates, and the percentage of seatbelt non-compliance were significantly higher in the GCC countries (P<.0001, P=.02, P<.001, respectively). There was a strong correlation between occupant death rates and seatbelt non-compliance (R=.52, P=.008). Seatbelt non-compliance percentage was the only significant factor predicting mortality in the multiple linear regression model (P=.015). Seatbelt non-compliance percentages in the GCC countries are significantly higher than in other high-income countries. This is a contributing factor in the increased road traffic collision mortality rate in these countries. Enforcement of seatbelt usage by law should be mandatory so as to reduce the toll of death of RTC in the GCC countries.

Mortality and economic instability: detailed analyses for Britain and comparative analyses for selected industrialized countries.

PubMed

Brenner, M H

1983-01-01

This paper discusses a first-stage analysis of the link of unemployment rates, as well as other economic, social and environmental health risk factors, to mortality rates in postwar Britain. The results presented represent part of an international study of the impact of economic change on mortality patterns in industrialized countries. The mortality patterns examined include total and infant mortality and (by cause) cardiovascular (total), cerebrovascular and heart disease, cirrhosis of the liver, and suicide, homicide and motor vehicle accidents. Among the most prominent factors that beneficially influence postwar mortality patterns in England/Wales and Scotland are economic growth and stability and health service availability. A principal detrimental factor to health is a high rate of unemployment. Additional factors that have an adverse influence on mortality rates are cigarette consumption and heavy alcohol use and unusually cold winter temperatures (especially in Scotland). The model of mortality that includes both economic changes and behavioral and environmental risk factors was successfully applied to infant mortality rates in the interwar period. In addition, the "simple" economic change model of mortality (using only economic indicators) was applied to other industrialized countries. In Canada, the United States, the United Kingdom, and Sweden, the simple version of the economic change model could be successfully applied only if the analysis was begun before World War II; for analysis beginning in the postwar era, the more sophisticated economic change model, including behavioral and environmental risk factors, was required. In France, West Germany, Italy, and Spain, by contrast, some success was achieved using the simple economic change model.

Associations among ancestry, geography and breast cancer incidence, mortality, and survival in Trinidad and Tobago.

PubMed

Warner, Wayne A; Morrison, Robert L; Lee, Tammy Y; Williams, Tanisha M; Ramnarine, Shelina; Roach, Veronica; Slovacek, Simeon; Maharaj, Ravi; Bascombe, Nigel; Bondy, Melissa L; Ellis, Matthew J; Toriola, Adetunji T; Roach, Allana; Llanos, Adana A M

2015-11-01

Breast cancer (BC) is the most common newly diagnosed cancer among women in Trinidad and Tobago (TT) and BC mortality rates are among the highest in the world. Globally, racial/ethnic trends in BC incidence, mortality and survival have been reported. However, such investigations have not been conducted in TT, which has been noted for its rich diversity. In this study, we investigated associations among ancestry, geography and BC incidence, mortality and survival in TT. Data on 3767 incident BC cases, reported to the National Cancer Registry of TT, from 1995 to 2007, were analyzed in this study. Women of African ancestry had significantly higher BC incidence and mortality rates ( 66.96; 30.82 per 100,000) compared to women of East Indian ( 41.04, MORTALITY: 14.19 per 100,000) or mixed ancestry ( 36.72, MORTALITY: 13.80 per 100,000). Geographically, women residing in the North West Regional Health Authority (RHA) catchment area followed by the North Central RHA exhibited the highest incidence and mortality rates. Notable ancestral differences in survival were also observed. Women of East Indian and mixed ancestry experienced significantly longer survival than those of African ancestry. Differences in survival by geography were not observed. In TT, ancestry and geographical residence seem to be strong predictors of BC incidence and mortality rates. Additionally, disparities in survival by ancestry were found. These data should be considered in the design and implementation of strategies to reduce BC incidence and mortality rates in TT. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Study of colorectal mortality in the Andalusian population.

PubMed

Cayuela, A; Rodríguez-Domínguez, S; Garzón-Benavides, M; Pizarro-Moreno, A; Giráldez-Gallego, A; Cordero-Fernández, C

2011-06-01

to provide up-to-date information and to analyze recent changes in colorectal cancer mortality trends in Andalusia during the period of 1980-2008 using joinpoint regression models. age- and sex-specific colorectal cancer deaths were taken from the official vital statistics published by the Instituto de Estadística de Andalucía for the years 1980 to 2008. We computed age-specific rates for each 5-year age group and calendar year and age-standardized mortality rates per 100,000 men and women. A joinpoint regression analysis was used for trend analysis of standardized rates. Joinpoint regression analysis was used to identify the years when a significant change in the linear slope of the temporal trend occurred. The best fitting points (the "join-points") are chosen where the rate significantly changes. mortality from colorectal cancer in Andalusia during the period studied has increased, from 277 deaths in 1980 to 1,227 in 2008 in men, and from 333 to 805 deaths in women. Adjusted overall colorectal cancer mortality rates increased from 7.7 to 17.0 deaths per 100,000 person-years in men and from 6.6 to 9.0 per 100,000 person-years in women Changes in mortality did not evolve similarly for men and women. Age-specific CRC mortality rates are lower in women than in men, which imply that women reach comparable levels of colorectal cancer mortality at higher ages than men. sex differences for colorectal cancer mortality have been widening in the last decade in Andalusia. In spite of the decreasing trends in age-adjusted mortality rates in women, incidence rates and the absolute numbers of deaths are still increasing, largely because of the aging of the population. Consequently, colorectal cancer still has a large impact on health care services, and this impact will continue to increase for many more years.

Premature mortality in Belgium in 1993-2009: leading causes, regional disparities and 15 years change.

PubMed

Renard, Françoise; Tafforeau, Jean; Deboosere, Patrick

2014-01-01

Reducing premature mortality is a crucial public health objective. After a long gap in the publication of Belgian mortality statistics, this paper presents the leading causes and the regional disparities in premature mortality in 2008-2009 and the changes since 1993. All deaths occurring in the periods 1993-1999 and 2003-2009, in people aged 1-74 residing in Belgium were included. The cause of death and population data for Belgium were provided by Statistics Belgium , while data for international comparisons were extracted from the WHO mortality database. Age-adjusted mortality rates and Person Year of Life Lost (PYLL) were calculated. The Rate Ratios were computed for regional and international comparisons, using the region or country with the lowest rate as reference; statistical significance was tested assuming a Poisson distribution of the number of deaths. The burden of premature mortality is much higher in men than in women (respectively 42% and 24% of the total number of deaths). The 2008-9 burden of premature mortality in Belgium reaches 6410 and 3440 PYLL per 100,000, respectively in males and females, ranking 4th and 3rd worst within the EU15. The disparities between Belgian regions are substantial: for overall premature mortality, respective excess of 40% and 20% among males, 30% and 20% among females are observed in Wallonia and Brussels as compared to Flanders. Also in cause specific mortality, Wallonia experiences a clear disadvantage compared to Flanders. Brussels shows an intermediate level for natural causes, but ranks differently for external causes, with less road accidents and suicide and more non-transport accidents than in the other regions. Age-adjusted premature mortality rates decreased by 29% among men and by 22% among women over a period of 15 years. Among men, circulatory diseases death rates decreased the fastest (-43.4%), followed by the neoplasms (-26.6%), the other natural causes (-21.0%) and the external causes (-20.8%). The larger decrease in single cause is observed for stomach cancer (-48.4%), road accident (-44%), genital organs (-40.4%) and lung (-34.6%) cancers. On the opposite, liver cancer death rate increased by 16%. Among female, the most remarkable feature is the 50.2% increase in the lung cancer death rate. For most other causes, the decline is slightly weaker than in men. Despite a steady decrease over time, international comparisons of the premature mortality burden highlight the room for improvement in Belgium. The disadvantage in Wallonia and to some extent in Brussels suggest the role of socio-economic factors; well- designed health policies could contribute to reduce the regional disparities. The increase in female lung cancer mortality is worrying.

Impact of carbapenem resistance on the outcome of patients' hospital-acquired bacteraemia caused by Klebsiella pneumoniae.

PubMed

Hussein, K; Raz-Pasteur, A; Finkelstein, R; Neuberger, A; Shachor-Meyouhas, Y; Oren, I; Kassis, I

2013-04-01

Carbapenem-resistant Enterobacteriaceae, especially Klebsiella spp., have become a major health problem recently worldwide. Since 2006 the incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections has increased substantially in Israel. Bloodstream infections (BSIs) caused by these strains have been associated with high rates of treatment failure and mortality. This study was designed to identify risk factors for carbapenem resistance among patients with healthcare-related (HCR) K. pneumoniae bacteraemia and predictors of mortality associated with HCR-CRKP bacteraemia compared with carbapenem-susceptible K. pneumoniae (CSKP). In this retrospective case-control study, all cases of K. pneumoniae bacteraemia during 2006-2008 were identified. Resistance patterns, underlying morbidities, risk factors for drug resistance and mortality rates were compared for patients with CRKP and CSKP bacteraemia. Two hundred and fourteen patients with CSKP bacteraemia were compared with 103 patients with CRKP bacteraemia. Severe, chronic comorbidities and prior antibiotic use were more frequent among patients with CRKP bacteraemia. On multivariate analysis prior use of macrolides and antibiotic exposure for ≥14 days remained the only independent factors associated with CRKP bacteraemia. Mortality rates of CRKP patients were significantly higher than those of CSKP patients. On multivariate analyses: bedridden status, chronic liver disease, Charlson comorbidity index ≥5, mechanical ventilation, and haemodialysis remained independently associated with mortality among patients with K. pneumoniae bacteraemia. Carbapenem resistance was not a risk factor for mortality. Previous antibiotic exposure is a risk factor for CRKP-BSI. Mortality among patients with K. pneumoniae bacteraemia is associated with serious comorbidities, but not with carbapenem resistance. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The predictive value of resting heart rate following osmotherapy in brain injury: back to basics

PubMed Central

2012-01-01

Background The importance of resting heart rate as a prognostic factor was described in several studies. An elevated heart rate is an independent risk factor for adverse cardiovascular events and total mortality in patients with coronary artery disease, chronic heart failure, and the general population. Also heart rate is elevated in the Multi Organ Dysfunction Syndrome (MODS) and the mortality due to MODS is highly correlated with inadequate sinus tachycardia. To evaluate the value of resting heart rate in predicting mortality in patients with traumatic brain injury along scoring systems like Acute Physiology and Chronic Health Evaluation(APACHE II), Sequential Organ Failure Assessment (SOFA) and Glasgow Coma Score (GCS). Method By analyzing data which was collected from an open labeled randomized clinical trial that compared the different means of osmotherapy (mannitol vs bolus or infusion hypertonic saline), heart rate, GCS, APACHE II and SOFA score were measured at baseline and daily for 7 days up to 60 days and the relationship between elevated heart rate and mortality during the first 7 days and 60th day were assessed. Results After adjustments for confounding factors, although there was no difference in mean heart rate between either groups of alive and expired patients, however, we have found a relative correlation between 60th day mortality rate and resting heart rate (P=0.07). Conclusion Heart rate can be a prognostic factor for estimating mortality rate in brain injury patients along with APACHE II and SOFA scores in patients with brain injury. PMID:23351393

Sex Differences in Diabetes Mellitus Mortality Trends in Brazil, 1980-2012.

PubMed

Malhão, Thainá Alves; Brito, Alexandre Dos Santos; Pinheiro, Rejane Sobrino; Cabral, Cristiane da Silva; Camargo, Thais Medina Coeli Rochel de; Coeli, Claudia Medina

2016-01-01

To investigate the hypothesis that the change from the female predominance of diabetes mellitus to a standard of equality or even male preponderance can already be observed in Brazilian mortality statistics. Data on deaths for which diabetes mellitus was listed as the underlying cause were obtained from the Brazilian Mortality Information System for the years 1980 to 2012. The mortality data were also analyzed according to the multiple causes of death approach from 2001 to 2012. The population data came from the Brazilian Institute of Geography and Statistics. The mortality rates were standardized to the world population. We used a log-linear joinpoint regression to evaluate trends in age-standardized mortality rates (ASMR). From 1980 to 2012, we found a marked increment in the diabetes ASMR among Brazilian men and a less sharp increase in the rate among women, with the latter period (2003-2012) showing a slight decrease among women, though it was not statistically significant. The results of this study suggest that diabetes mellitus in Brazil has changed from a pattern of higher mortality among women compared to men to equality or even male predominance.

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

Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013-2015.

PubMed

Ely, Danielle M; Hoyert, Donna L

2018-02-01

The leading causes of infant death vary by age at death but were consistent from 2005 to 2015 (1-6). Previous research shows higher infant mortality rates in rural counties compared with urban counties and differences in cause of death for individuals aged 1 year and over by urbanization level (4,5,7,8). No research, however, has examined if mortality rates from the leading causes of infant death differ by urbanization level. This report describes the mortality rates for the five leading causes of infant, neonatal, and postneonatal death in the United States across rural, small and medium urban, and large urban counties defined by maternal residence, as reported on the birth certificate for combined years 2013-2015. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial--SCORE.

PubMed

Segnan, Nereo; Armaroli, Paola; Bonelli, Luigina; Risio, Mauro; Sciallero, Stefania; Zappa, Marco; Andreoni, Bruno; Arrigoni, Arrigo; Bisanti, Luigi; Casella, Claudia; Crosta, Cristiano; Falcini, Fabio; Ferrero, Franco; Giacomin, Adriano; Giuliani, Orietta; Santarelli, Alessandra; Visioli, Carmen Beatriz; Zanetti, Roberto; Atkin, Wendy S; Senore, Carlo

2011-09-07

A single flexible sigmoidoscopy at around the age of 60 years has been proposed as an effective strategy for colorectal cancer (CRC) screening. We conducted a randomized controlled trial to evaluate the effect of flexible sigmoidoscopy screening on CRC incidence and mortality. A questionnaire to assess the eligibility and interest in screening was mailed to 236,568 men and women, aged 55-64 years, who were randomly selected from six trial centers in Italy. Of the 56,532 respondents, interested and eligible subjects were randomly assigned to the intervention group (invitation for flexible sigmoidoscopy; n = 17,148) or the control group (no further contact; n = 17,144), between June 14, 1995, and May 10, 1999. Flexible sigmoidoscopy was performed on 9911 subjects. Intention-to-treat and per-protocol analyses were performed to compare the CRC incidence and mortality rates in the intervention and control groups. Per-protocol analysis was adjusted for noncompliance. A total of 34,272 subjects (17,136 in each group) were included in the follow-up analysis. The median follow-up period was 10.5 years for incidence and 11.4 years for mortality; 251 subjects were diagnosed with CRC in the intervention group and 306 in the control group. Overall incidence rates in the intervention and control groups were 144.11 and 176.43, respectively, per 100,000 person-years. CRC-related death was noted in 65 subjects in the intervention group and 83 subjects in the control group. Mortality rates in the intervention and control groups were 34.66 and 44.45, respectively, per 100,000 person-years. In the intention-to-treat analysis, the rate of CRC incidence was statistically significantly reduced in the intervention group by 18% (rate ratio [RR] = 0.82, 95% confidence interval [CI] = 0.69 to 0.96), and the mortality rate was non-statistically significantly reduced by 22% (RR = 0.78; 95% CI = 0.56 to 1.08) compared with the control group. In the per-protocol analysis, both CRC incidence and mortality rates were statistically significantly reduced among the screened subjects; CRC incidence was reduced by 31% (RR = 0.69; 95% CI = 0.56 to 0.86) and mortality was reduced by 38% (RR = 0.62; 95% CI = 0.40 to 0.96) compared with the control group. A single flexible sigmoidoscopy screening between ages 55 and 64 years was associated with a substantial reduction of CRC incidence and mortality.

Comparative efficacy of tilmicosin versus tulathromycin as a metaphylactic antimicrobial in feedlot calves at moderate risk for respiratory disease.

PubMed

Van Donkersgoed, Joyce; Merrill, John; Hendrick, Steven

2008-01-01

The purpose of this study was to compare the efficacy and cost-effectiveness of tilmicosin (MIC) versus tulathromycin (DRAX) as a metaphylactic antimicrobial in feedlot calves at moderate risk for bovine respiratory disease (BRD). Calves that received DRAX had significantly (P < or = .05) lower initial BRD treatment rates compared with calves that received MIC. However, there were no significant differences in the BRD relapse rate, railer rate, total mortality rate, BRD mortality rate, average daily gain, and dry matter conversion between the two groups. The economic advantage of the MIC group was Can$8.29/animal. Based on these results, while DRAX was more efficacious in reducing initial treatments for BRD in feedlot calves at moderate risk for disease, MIC was more cost-effective. The lower initial BRD treatment costs in the DRAX group did not offset the higher metaphylactic cost of DRAX.

Do Mothers with Lower Socioeconomic Status Contribute to the Rate of All-Cause Child Mortality in Kazakhstan?

PubMed

Yu, Fei; Yan, Ziqi; Pu, Run; Tang, Shangfeng; Ghose, Bishwajit; Huang, Rui

2018-01-01

This study aimed to explore whether or not mothers with higher educational and wealth status report lower rate of child mortality compared to those with less advantageous socioeconomic situation. Data used were cross-sectional and collected from Multiple Indicator Cluster Survey in Kazakhstan conducted in 2015. Subjects experiencing childbirth were 9278 women aging between 15 and 49 years. The associations between maternal education and household wealth status with child mortality were examined by multivariate analytical methods. The overall prevalence of child mortality was 6.7%, with noticeable variations across the different regions. Compared with women who had the highest educational status, those with upper and lower secondary were 1.47 and 1.89 times more likely to experience child death. Women in the lowest and second lowest wealth quintile had 2.74 and 2.68 times higher odds of experiencing child death compared with those in the richest wealth status households. Policy makers pay special attention to improving socioeconomic status of the mothers in an effort to reduce child mortality in the country. Women living in the disadvantaged regions with poor access to quality health care services should be regarded as a top priority.

Evaluation of mortality rate and predictors of outcome in dogs receiving outpatient treatment for parvoviral enteritis.

PubMed

Sarpong, Kathryn J; Lukowski, Jennifer M; Knapp, Cassandra G

2017-11-01

OBJECTIVE To determine mortality rates and prognostic factors for dogs with parvoviral enteritis receiving outpatient treatment. DESIGN Retrospective case series and case-control study. ANIMALS 130 client-owned dogs with a diagnosis of parvoviral enteritis between August 1, 2012, and January 31, 2015, that were treated with outpatient care. PROCEDURES Medical records were reviewed and data extracted regarding dog age, body weight, breed, and vaccination history; treatments administered; and short-term (≥ 3 day) outcome (determined via telephone call with owner). Treatments were administered according to clinician preference. Mortality rates were calculated overall and for various signalment and treatment groupings and compared. RESULTS 97 (75%) dogs survived and 33 (25%) dogs failed to survive for ≥ 3 days after initial diagnosis of parvoviral enteritis. Compared with distributions in the general hospital population, Chihuahuas, German Shepherd Dogs, pit bull-type dogs, and males were overrepresented. No significant difference was identified between survivors and nonsurvivors regarding age, body weight, or sex. Dogs prescribed a caloric supplement fed every 2 to 4 hours had a mortality rate of 19% (16/85). Most of these dogs had also received fluids administered SC, an antiemetic, and antimicrobials. CONCLUSIONS AND CLINICAL RELEVANCE Clinicians should note the 25% mortality rate of the dogs with parvoviral enteritis that received outpatient care in this study setting when discussing treatment options with owners of affected dogs who are financially unable to pursue hospitalization.

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.

The Relationship Between Child Mortality Rates and Prevalence of Celiac Disease.

PubMed

Biagi, Federico; Raiteri, Alberto; Schiepatti, Annalisa; Klersy, Catherine; Corazza, Gino R

2018-02-01

Some evidence suggests that prevalence of celiac disease in the general population is increasing over time. Because the prognosis of celiac disease was a dismal one before discovering the role of gluten, our aim was to investigate a possible relationship between children under-5 mortality rates and prevalence rates of celiac disease. Thanks to a literature review, we found 27 studies performed in 17 different countries describing the prevalence of celiac disease in schoolchildren; between 1995 and 2011, 4 studies were performed in Italy. A meta-analysis of prevalence rates was performed. Prevalence was compared between specific country under-5 mortality groups, publication year, and age. In the last decades, under-5 mortality rates have been decreasing all over the world. This reduction is paralleled by an increase of the prevalence of celiac disease. The Spearman correlation coefficient was -63%, 95% confidence interval -82% to -33% (P < 0.001). So, the higher the mortality rate, the lower the prevalence of CD. This finding is confirmed by the meta-analysis of the 4 studies conducted in Italy over time. The under-5 mortality rate seems to influence the prevalence of celiac disease in the general population. In the near future, the number of patients with celiac disease will increase, thanks to the better environmental conditions that nowadays allow a better survival of children with celiac disease.

Outcome of severe infections in afebrile neutropenic cancer patients

PubMed Central

Mahkovic-Hergouth, Ksenija; Novakovic, Barbara Jezersek; Seruga, Bostjan

2016-01-01

Abstract Background In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test. Results We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). Conclusions Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy. PMID:27904453

Dying for a smoke: how much does differential mortality of smokers affect estimated life-course smoking prevalence?

PubMed

Christopoulou, Rebekka; Han, Jeffrey; Jaber, Ahmed; Lillard, Dean R

2011-01-01

An extensive literature uses reconstructed historical smoking rates by birth-cohort to inform anti-smoking policies. This paper examines whether and how these rates change when one adjusts for differential mortality of smokers and non-smokers. Using retrospectively reported data from the US (Panel Study of Income Dynamics, 1986, 1999, 2001, 2003, 2005), the UK (British Household Panel Survey, 1999, 2002), and Russia (Russian Longitudinal Monitoring Study, 2000), we generate life-course smoking prevalence rates by age-cohort. With cause-specific death rates from secondary sources and an improved method, we correct for differential mortality, and we test whether adjusted and unadjusted rates statistically differ. With US data (National Health Interview Survey, 1967-2004), we also compare contemporaneously measured smoking prevalence rates with the equivalent rates from retrospective data. We find that differential mortality matters only for men. For Russian men over age 70 and US and UK men over age 80 unadjusted smoking prevalence understates the true prevalence. The results using retrospective and contemporaneous data are similar. Differential mortality bias affects our understanding of smoking habits of old cohorts and, therefore, of inter-generational patterns of smoking. Unless one focuses on the young, policy recommendations based on unadjusted smoking rates may be misleading. Copyright © 2010 Elsevier Inc. All rights reserved.

Age structure and mortality of walleyes in Kansas reservoirs: Use of mortality caps to establish realistic management objectives

USGS Publications Warehouse

Quist, M.C.; Stephen, J.L.; Guy, C.S.; Schultz, R.D.

2004-01-01

Age structure, total annual mortality, and mortality caps (maximum mortality thresholds established by managers) were investigated for walleye Sander vitreus (formerly Stizostedion vitreum) populations sampled from eight Kansas reservoirs during 1991-1999. We assessed age structure by examining the relative frequency of different ages in the population; total annual mortality of age-2 and older walleyes was estimated by use of a weighted catch curve. To evaluate the utility of mortality caps, we modeled threshold values of mortality by varying growth rates and management objectives. Estimated mortality thresholds were then compared with observed growth and mortality rates. The maximum age of walleyes varied from 5 to 11 years across reservoirs. Age structure was dominated (???72%) by walleyes age 3 and younger in all reservoirs, corresponding to ages that were not yet vulnerable to harvest. Total annual mortality rates varied from 40.7% to 59.5% across reservoirs and averaged 51.1% overall (SE = 2.3). Analysis of mortality caps indicated that a management objective of 500 mm for the mean length of walleyes harvested by anglers was realistic for all reservoirs with a 457-mm minimum length limit but not for those with a 381-mm minimum length limit. For a 500-mm mean length objective to be realized for reservoirs with a 381-mm length limit, managers must either reduce mortality rates (e.g., through restrictive harvest regulations) or increase growth of walleyes. When the assumed objective was to maintain the mean length of harvested walleyes at current levels, the observed annual mortality rates were below the mortality cap for all reservoirs except one. Mortality caps also provided insight on management objectives expressed in terms of proportional stock density (PSD). Results indicated that a PSD objective of 20-40 was realistic for most reservoirs. This study provides important walleye mortality information that can be used for monitoring or for inclusion into population models; these results can also be combined with those of other studies to investigate large-scale differences in walleye mortality. Our analysis illustrates the utility of mortality caps for monitoring walleye populations and for establishing realistic management goals.

Levels and trends of child and adult mortality rates in the Islamic Republic of Iran, 1990-2013; protocol of the NASBOD study.

PubMed

Mohammadi, Younes; Parsaeian, Mahboubeh; Farzadfar, Farshad; Kasaeian, Amir; Mehdipour, Parinaz; Sheidaei, Ali; Mansouri, Anita; Saeedi Moghaddam, Sahar; Djalalinia, Shirin; Mahmoudi, Mahmood; Khosravi, Ardeshir; Yazdani, Kamran

2014-03-01

Calculation of burden of diseases and risk factors is crucial to set priorities in the health care systems. Nevertheless, the reliable measurement of mortality rates is the main barrier to reach this goal. Unfortunately, in many developing countries the vital registration system (VRS) is either defective or does not exist at all. Consequently, alternative methods have been developed to measure mortality. This study is a subcomponent of NASBOD project, which is currently conducting in Iran. In this study, we aim to calculate incompleteness of the Death Registration System (DRS) and then to estimate levels and trends of child and adult mortality using reliable methods. In order to estimate mortality rates, first, we identify all possible data sources. Then, we calculate incompleteness of child and adult morality separately. For incompleteness of child mortality, we analyze summary birth history data using maternal age cohort and maternal age period methods. Then, we combine these two methods using LOESS regression. However, these estimates are not plausible for some provinces. We use additional information of covariates such as wealth index and years of schooling to make predictions for these provinces using spatio-temporal model. We generate yearly estimates of mortality using Gaussian process regression that covers both sampling and non-sampling errors within uncertainty intervals. By comparing the resulted estimates with mortality rates from DRS, we calculate child mortality incompleteness. For incompleteness of adult mortality, Generalized Growth Balance, Synthetic Extinct Generation and a hybrid of two mentioned methods are used. Afterwards, we combine incompleteness of three methods using GPR, and apply it to correct and adjust the number of deaths. In this study, we develop a conceptual framework to overcome the existing challenges for accurate measuring of mortality rates. The resulting estimates can be used to inform policy-makers about past, current and future mortality rates as a major indicator of health status of a population.

Marital status and living condition as predictors of mortality and readmissions among African Americans with heart failure.

PubMed

Lu, Marvin Louis Roy; Davila, Carlos D; Shah, Mahek; Wheeler, David S; Ziccardi, Mary Rodriguez; Banerji, Sourin; Figueredo, Vincent M

2016-11-01

Socioeconomic factors, including social support, may partially explain why African Americans (AA) have the highest prevalence of heart failure and with worse outcomes compared to other races. AA are more likely to be hospitalized and readmitted for heart failure and have higher mortality. The purpose of this study is to determine whether the social factors of marital status and living condition affect readmission rates and all-cause mortality following hospitalization for acute decompensated heart failure (ADHF) in AA patients. Medical records from 611 AA admitted to Einstein Medical Center Philadelphia from January, 2011 to February, 2013 for ADHF were reviewed. Patient demographics including living condition (nursing home residents, living with family or living alone) and marital status (married or non-married -including single, divorced, separated and widowed) were correlated with all-cause mortality and readmission rates. In this cohort (53% male, mean age 65±15, mean ejection fraction 32±16%) 25% (n=152) of subjects were unmarried. Unmarried patients had significantly higher 30-day readmission rates (16% vs. 6% p=0.0002) and higher 1-year mortality (17% vs. 11% p=0.047) compared with married patients. Fifty percent (n=303) of subjects were living with family members, while 40% (n=242) and 11% (n=66) were living alone or in a nursing facility, respectively. Patients living with family members had significantly lower 30-day readmission rates when compared with those living alone or in a nursing facility (7% vs 21% vs. 18% p=<0.0001). Furthermore, they had the lowest 1-year mortality (14% vs 32% for nursing facility patients and 17% for those living alone (p=0.0007). After controlling for traditional risk factors (age, gender, body mass index, peak troponin I, left ventricular ejection fraction, B-type natriuretic peptide, hypertension, diabetes mellitus, hyperlipidemia, and coronary artery disease), being married was an indpendent predictor of 1-year mortality (OR 0.50 p=0.019) and living alone for 30-day readmission (OR 2.86 p=<0.001). The socioeconomic factors of marital status and living condition significantly correlated with mortality and 30-day readmission rate in AA heart failure patients. Specifically, being married and living with family independently predict lower mortality and fewer readmissions. Surprisingly, living in a nursing facility was associated with significantly higher mortality than living alone or with family. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Endovascular abdominal aortic aneurysm repair (EVAR) procedures: counterbalancing the benefits with the costs.

PubMed

Paraskevas, Kosmas I; Bessias, Nikolaos; Giannoukas, Athanasios D; Mikhailidis, Dimitri P

2010-05-01

Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is associated with lower 30-day mortality rates compared with open repair. Despite that, there are no significant differences in mortality rates between the two procedures at 2 years. On the other hand, EVAR is associated with considerably higher costs compared with open repair. The lack of significant long-term differences between the two procedures together with the substantially higher cost of EVAR may question the appropriateness of EVAR as an alternative to open surgical repair in patients fit for surgery. With several thousands of AAA procedures performed worldwide, the employment of EVAR for the management of all AAAs irrespective of the patient's surgical risk may hold implications for several national health economies. The lower perioperative mortality and morbidity rates associated with EVAR should thus be counterbalanced against the considerable costs of these procedures.

Cystatin C-based glomerular filtration rate associates more closely with mortality than creatinine-based or combined glomerular filtration rate equations in unselected patients.

PubMed

Helmersson-Karlqvist, Johanna; Ärnlöv, Johan; Larsson, Anders

2016-10-01

Decreased glomerular filtration rate (GFR) is an important cardiovascular risk factor, but estimated GFR (eGFR) may differ depending on whether it is based on creatinine or cystatin C. A combined creatinine/cystatin C equation has recently been shown to best estimate GFR; however, the benefits of using the combined equation for risk prediction in routine clinical care have been less studied. This study compares mortality risk prediction by eGFR using the combined creatinine/cystatin C equation (CKD-EPI), a sole creatinine equation (CKD-EPI) and a sole cystatin C equation (CAPA), respectively, using assays that are traceable to international calibrators. All patients analysed for both creatinine and cystatin C from the same blood sample tube (n = 13,054) during 2005-2007 in Uppsala University Hospital Laboratory were divided into eGFR risk categories>60, 30-60 and <30 mL/min/1.73 m(2) by each eGFR equation. During follow-up (median 4.6 years), 4398 participants died, of which 1396 deaths were due to cardiovascular causes. Reduced eGFR was significantly associated with death as assessed by all eGFR equations. The net reclassification improvement (NRI) for the combination equation compared with the sole creatinine equation was 0.10 (p < 0.001) for all-cause mortality and 0.08 (p < 0.001) for cardiovascular mortality, indicating improved reclassification. In contrast, NRI for the combination equation, compared with the sole cystatin C equation, was -0.06 (p < 0.001) for all-cause mortality and -0.02 (p = 0.032) for cardiovascular mortality, indicating a worsened reclassification. In routine clinical care, cystatin C-based eGFR was more closely associated with mortality compared with both creatinine-based eGFR and creatinine/cystatin C-based eGFR. © The European Society of Cardiology 2016.

Loss to follow-up and mortality amongst pregnant women referred to a community clinic for antiretroviral treatment

PubMed Central

Orrell, Catherine; Zwane, Eugene; Bekker, Linda-Gail; Wood, Robin

2009-01-01

Summary In a retrospective cohort analysis, loss to follow-up (LTFU) and mortality rates were compared between pregnant and non-pregnant women referred to a community-based antiretroviral treatment (ART) program in South Africa. While there was no significant difference in adjusted mortality rates between the two groups, the pregnant women had a substantially higher risk of LTFU both pre and on-treatment. This finding highlights the need for programmatic interventions to address retention in care for this patient population. PMID:18670232

[Estimation of infant and child mortality in the eastern provinces of Cuba].

PubMed

Gonzalez, G; Herrera, L

1986-01-01

An estimate of infant and child mortality in the eastern provinces of Cuba is presented using the Brass method as adapted by Trussell. "Estimations by urban and rural zones are also performed within the provinces studied, and results are compared with those possible to obtain by continuous statistics. Results obtained show that in the eastern [part] of the country Holguin and Guantanamo are the provinces with highest infantile mortality rates, and the lowest rates correspond to Granma, followed by Santiago de Cuba." (SUMMARY IN ENG AND FRE) excerpt

[Mortality of working age population in Russia and indusrial countries in Europe: trends of the last two decades].

PubMed

Izmerov, N F; Tikhonova, G I; Gorchakova, T Iu

2014-01-01

The purpose of the study was to carry out comparative analysis of the status and trends in mortality of male and female population of working age (15-59 (54) years) in Russia and the EU-27. Based on official Russian (Rosstat) data, on the global database of the World Health Organization's cause of death (The WHO Mortality Database, WHOMD) and databases The Human Mortality Database (HMD) of the sex-age composition of the population and the number of deaths from certain causes of death by age and sex standardized (direct method) mortality rates of working age population from selected causes of death for 1990 and 2011 in Russia and the average for the EU-27 were calculated. Analysis of trends in mortality of male and female population of working age in Russia over the past two decades shows that, despite the positive changes in during last six years, in 2011, age-standardized mortality rates remained above the 1990 level for most causes of death. During the same period in the EU-27 mortality in men (15-59 years) and women (15-54 years) increased from almost all causes ofdeath, which led to an even greatergap between Russia and developed countries on this indicator: standardized mortality rate of the male population of Russia in 1990 was higher than in the EU-27 by 2.1 times, and by 2011 the gap had increased to 3.5 times. The women in the 1990 had 1.5 times higher standardized mortality rates, and by 2011 the gap had increased to 2.7 times. Despite a steady decline in the mortality rates of working age population after 2005, its level in 2012 was still higher than the one of 1990 for both men and women, which led to a further increase in the gap between the age-standardized coefficients of mortality rate of working age population in Russia and the countries of European Community-27 (15-59 (54)). Faster reduction of mortality rate in the working age population will preserve Russian population and its labor potential.

Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

PubMed

Yoo, Ri Na; Kye, Bong-Hyeon; Kim, Gun; Kim, Hyung Jin; Cho, Hyeon-Min

2017-10-01

Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

Inequality in mortality by occupation related to economic crisis from 1980 to 2010 among working-age Japanese males

PubMed Central

Wada, Koji; Gilmour, Stuart

2016-01-01

The mortality rate for Japanese males aged 30–59 years in managerial and professional spiked in 2000 and remains worse than that of other occupations possibly associated with the economic downturn of the 1990s and the global economic stagnation after 2008. The present study aimed to assess temporal occupation-specific mortality trends from 1980 to 2010 for Japanese males aged 30–59 years for major causes of death. We obtained data from the Occupation-specific Vital Statistics. We calculated age-standardized mortality rates for the four leading causes of death (all cancers, suicide, ischaemic heart disease, and cerebrovascular disease). We used a generalized estimating equation model to determine specific effects of the economic downturn after 2000. The age-standardized mortality rate for the total working-age population steadily declined up to 2010 in all major causes of death except suicide. Managers had a higher risk of mortality in all leading causes of death compared with before 1995. Mortality rates among unemployed people steadily decreased for all cancers and ischaemic heart disease. Economic downturn may have caused the prolonged increase in suicide mortality. Unemployed people did not experience any change in mortality due to suicide and cerebrovascular disease and saw a decline in cancer and ischemic heart disease mortality, perhaps because the basic properties of Japan’s social welfare system were maintained even during economic recession. PMID:26936097

Spatiotemporal Variations in Chronic Obstructive Pulmonary Disease Mortality in China: Multilevel Evidence from 2006 to 2012.

PubMed

Yin, Peng; Feng, Xiaoqi; Astell-Burt, Thomas; Qi, Fei; Liu, Yunning; Liu, Jiangmei; Page, Andrew; Wang, Limin; Liu, Shiwei; Wang, Lijun; Zhou, Maigeng

2016-06-01

Mortality of Chronic Obstructive Pulmonary Disease (COPD) is on the decline in China. It is not known if this trend occurs across all areas or whether spatiotemporal variations manifest. We used data from the nationally representative China Mortality Surveillance System to calculate annual COPD mortality counts (2006-2012) stratified by 5-year age groups (aged > 20), gender and time for 161 counties and districts (Disease Surveillance Points, or DSP). These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in COPD mortality adjusting for age, gender and area-level risk factors. COPD mortality rate decreased markedly from 105.1 to 73.7 per 100,000 during 2006 to 2012 and varied over two-fold between DSPs across China. Mortality rates were higher in the west compared with the east (Rate ratio (RR) 2.15, 95% confidence intervals (CI) 1.73, 2.68) and in rural compared with the urban (RR 1.87, 95% CI 1.55, 2.25). Adjustment for age, gender, urban/rural, region, smoking prevalence, indoor air pollution, mean body mass index and socioeconomic circumstances accounted for 67% of the geographical variation. Urban/rural differences in COPD mortality narrowed over time, but the magnitude of the east-west inequality persisted without change. Immediate action via large-scale interventions to enhance the prevention and management of COPD are needed specifically within China's western region in order to tackle this crucial health inequality and leading preventable cause of death.

The effects of price competition and reduced subsidies for uncompensated care on hospital mortality.

PubMed

Volpp, Kevin G M; Ketcham, Jonathan D; Epstein, Andrew J; Williams, Sankey V

2005-08-01

To determine whether hospital mortality rates changed in New Jersey after implementation of a law that changed hospital payment from a regulated system based on hospital cost to price competition with reduced subsidies for uncompensated care and whether changes in mortality rates were affected by hospital market conditions. State discharge data for New Jersey and New York from 1990 to 1996. Study Design. We used an interrupted time series design to compare risk-adjusted in-hospital mortality rates between states over time. We compared the effect sizes in markets with different levels of health maintenance organization penetration and hospital market concentration and tested the sensitivity of our results to different approaches to defining hospital markets. The study sample included all patients under age 65 admitted to New Jersey or New York hospitals with stroke, hip fracture, pneumonia, pulmonary embolism, congestive heart failure, hip fracture, or acute myocardial infarction (AMI). Mortality among patients in New Jersey improved less than in New York by 0.4 percentage points among the insured (p=.07) and 0.5 percentage points among the uninsured (p=.37). There was a relative increase in mortality for patients with AMI, congestive heart failure, and stroke, especially for uninsured patients with these conditions, but not for patients with the other four conditions we studied. Less competitive hospital markets were significantly associated with a relative decrease in mortality among insured patients. Market-based reforms may adversely affect mortality for some conditions but it appears the effects are not universal. Insured patients in less competitive markets fared better in the transition to price competition.

Cancer morbidity and mortality in USA Mormons and Seventh-day Adventists.

PubMed

Grundmann, E

1992-01-01

Comparison of cancer morbidity and mortality rates between Mormons and Seventh-day-Adventists and the corresponding rates in the Federal Republic of Germany and the United States, reveals that mortality from malignant neoplasms in general is much lower in Mormons and Seventh-day Adventists than in the Federal Republic of Germany. The difference concerns in particular the tobacco-dependent tumors: compared to the rate of affected males in the Federal Republic of Germany, only some 25% of Mormon males are getting lung cancer. Similar patterns are found in laryngeal carcinoma. Tumors that are related to both alcohol and tobacco, such as carcinomas of tongue, pharynx and esophagus, are also significantly less frequent in Mormons. Malignant neoplasms of the female genital tract show distinct analogies: cervical carcinoma has a morbidity rate of only 26.7% of affected women in Germany. Accordingly, mortality rates of Mormons and Seventh-day Adventists show a significant lower level when compared with cancer data of lung, colon and rectum, and prostate from the best German cancer registry (Saarland). Some tumor rates are higher in Mormons, e.g. malignant melanoma, also all types of malignant lymphoma and myeloma. The life expectancy is generally elevated by 2-4 years in Mormons and Seventh-day Adventists. The association with the particular life style of both religious groups, especially the strict reduction of tobacco consumption, and factors of dietary and other habits is discussed.

Los Años de la Crisis: an examination of change in differential infant mortality risk within Mexico.

PubMed

Frank, R; Finch, Brian Karl

2004-08-01

The main aim of the present analysis is to test the possibility that the period of economic hardship characterizing Mexico over the decade 1986-1996 has negatively influenced infant health outcomes. Data on births from two installments of the Encuesta Nacional de la Dinámica Demográfica, a nationally representative demographic survey, are used to determine whether a reduction in mortality differentials has paralleled the overall drop in the national infant mortality rate. The findings indicate that the decrease observed in the overall infant mortality rate has been matched by decreases in several disparities at the same time that it has been marred by increases in others. The data support the possibility that where you live has become an increasingly salient factor in determining the odds of infant mortality. High parity, low education and unemployment status have also become more salient factors in predicting post neonatal infant mortality risk in the more recent period as compared to the earlier period. As Mexico's infant mortality rate begins to stabilize in the near future, this research highlights the need to re-focus our research efforts on the causes and consequences of differential mortality trends.

Colorectal cancer among Koreans living in South Korea versus California: incidence, mortality, and screening rates.

PubMed

Ryu, So Yeon; Crespi, Catherine M; Maxwell, Annette E

2014-08-01

This study compared trends in colorectal cancer (CRC) incidence and mortality rates among Koreans in South Korea and Korean Americans and non-Hispanic whites in California between 1999 and 2009, and examined CRC screening rates and socio-demographic correlates of CRC screening in the two Korean populations. Age-standardized CRC incidence and mortality rates of Koreans in South Korea and Korean Americans and non-Hispanic whites in California for the years 1999-2009 were obtained from annual reports of cancer statistics and modeled using joinpoint regression. Using 2009 data from the Korean National Health and Nutrition Examination Survey and the California Health Interview Survey, we estimated and compared CRC screening rates and test modalities. We used multiple logistic regression to examine socio-demographic correlates of completion of CRC screening according to the guidelines among the two Korean populations. CRC incidence and mortality rates among South Koreans increased during 1999-2009 but more slowly during the late 2000s. In California, CRC incidence increased among Korean American females but decreased among non-Hispanic whites. About 37% of South Koreans and 60% of Korean Americans reported completion of CRC screening according to guidelines in 2009. Among South Koreans, married status, higher income, and private health insurance were associated with CRC screening, adjusting for other factors. Among Korean Americans, having health insurance was associated with CRC screening. Despite almost identical CRC screening guidelines in South Korea and the USA and substantially higher screening rates among Korean Americans as compared to South Koreans, disparities remain in both populations with respect to CRC statistics. Thus, efforts to promote primary and secondary prevention of CRC in both Korean populations are critically important in both countries.

Gender-related differences in clinical characteristics and outcomes in patients with diabetic ketoacidosis.

PubMed

Barski, Leonid; Harman-Boehm, Ilana; Nevzorov, Roman; Rabaev, Elena; Zektser, Miri; Jotkowitz, Alan B; Zeller, Lior; Shleyfer, Elena; Almog, Yaniv

2011-12-01

Diabetic ketoacidosis (DKA) is 1 of the most common and serious complications of diabetes, and is a significant cause of morbidity and mortality. There is a paucity of data regarding gender-related differences in clinical characteristics and outcomes of patients hospitalized for DKA. The purpose of this study was to assess whether gender plays a role in clinical characteristics and outcome of DKA. We performed a retrospective cohort study of patients hospitalized with DKA between January 1, 2003 and January 1, 2010. The outcomes of male and female patients were compared. The primary outcome was in-hospital all-cause mortality. The secondary outcomes were 30-day all-cause mortality and rate of complications: sepsis, respiratory failure, multiple organ failure, stroke, and myocardial infarction. Eighty-nine men and 131 women with DKA were included in the study. Male patients had higher rates of chronic renal failure compared with women (16.9% vs 3.1%; P = 0.001), whereas more women than men received oral hypoglycemic therapy (19.8% vs 9.0%; P = 0.046); women also had higher glycosated hemoglobin levels before admission (11.9% [1.7%] vs 9.9% [2.2%]; P = 0.025). The in-hospital mortality rate was not significantly different for both genders (4.5% in the male group vs 3.8% in the female group; P = 1.0). We did not find significant differences between the 2 groups in the 30-day mortality rate (4.5% vs 6.1%; P = 0.7) or the rate of complications (5.6% vs 6.9%; P = 0.9). Advanced age, mechanical ventilation, and bedridden state were independent predictors of 30-day mortality. In our study we did not find statistically significant differences in the in-hospital mortality, 30-day all-cause mortality, or rate of complications between men and women hospitalized with DKA. However, women with poorly controlled type 2 diabetes mellitus receiving oral hypoglycemic therapy required particular attention and might benefit from earlier introduction and intensification of insulin therapy to avoid DKA. Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.

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.

Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford).

PubMed

Key, Timothy J; Appleby, Paul N; Spencer, Elizabeth A; Travis, Ruth C; Roddam, Andrew W; Allen, Naomi E

2009-05-01

Few prospective studies have examined the mortality of vegetarians. We present results on mortality among vegetarians and nonvegetarians in the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). We used a prospective study of men and women recruited throughout the United Kingdom in the 1990s. Among 64,234 participants aged 20-89 y for whom diet group was known, 2965 had died before age 90 by 30 June 2007. The death rates of participants are much lower than average for the United Kingdom. The standardized mortality ratio for all causes of death was 52% (95% CI: 50%, 54%) and was identical in vegetarians and in nonvegetarians. Comparing vegetarians with meat eaters among the 47,254 participants who had no prevalent cardiovascular disease or malignant cancer at recruitment, the death rate ratios adjusted for age, sex, smoking, and alcohol consumption were 0.81 (95% CI: 0.57, 1.16) for ischemic heart disease and 1.03 (95% CI: 0.90, 1.16) for all causes of death. The mortality of both the vegetarians and the nonvegetarians in this study is low compared with national rates. Within the study, mortality from circulatory diseases and all causes is not significantly different between vegetarians and meat eaters, but the study is not large enough to exclude small or moderate differences for specific causes of death, and more research on this topic is required.

An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients.

PubMed

Bratzler, Dale W; Normand, Sharon-Lise T; Wang, Yun; O'Donnell, Walter J; Metersky, Mark; Han, Lein F; Rapp, Michael T; Krumholz, Harlan M

2011-04-12

Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998-2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998-2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25(th), 50(th), and 75(th) percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.

An Administrative Claims Model for Profiling Hospital 30-Day Mortality Rates for Pneumonia Patients

PubMed Central

Bratzler, Dale W.; Normand, Sharon-Lise T.; Wang, Yun; O'Donnell, Walter J.; Metersky, Mark; Han, Lein F.; Rapp, Michael T.; Krumholz, Harlan M.

2011-01-01

Background Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. PMID:21532758

Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit.

PubMed

van Rijssen, Lennart B; Zwart, Maurice J; van Dieren, Susan; de Rooij, Thijs; Bonsing, Bert A; Bosscha, Koop; van Dam, Ronald M; van Eijck, Casper H; Gerhards, Michael F; Gerritsen, Josephus J; van der Harst, Erwin; de Hingh, Ignace H; de Jong, Koert P; Kazemier, Geert; Klaase, Joost; van der Kolk, Berendina M; van Laarhoven, Cornelis J; Luyer, Misha D; Molenaar, Isaac Q; Patijn, Gijs A; Rupert, Coen G; Scheepers, Joris J; van der Schelling, George P; Vahrmeijer, Alexander L; Busch, Olivier R C; van Santvoort, Hjalmar C; Groot Koerkamp, Bas; Besselink, Marc G

2018-03-20

In the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complications and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hospitals are compared, and independent predictors for FTR investigated. Patients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo ≥3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis. Out of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2-3.9), age >75 years (OR = 4.3, 1.8-10.2), BMI ≥30 (OR = 2.9, 1.3-6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1-3.7), and hospital volume <30 (OR = 3.9, 1.6-9.6). Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications. Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Mortality and cardiovascular diseases risk in patients with Barrett's oesophagus: a population-based nationwide cohort study.

PubMed

Erichsen, R; Horvath-Puho, E; Lund, J L; Dellon, E S; Shaheen, N J; Pedersen, L; Davey Smith, G; Sørensen, H T

2017-04-01

Patients with Barrett's oesophagus may be at increased risk of mortality overall, and cardiovascular disease has been suggested as the main underlying cause of death. To examine cause-specific mortality and risk of cardiovascular events among patients with Barrett's oesophagus. Utilising existing Danish data sources (1997-2011), we identified all patients with histologically verified Barrett's oesophagus (n = 13 435) and 123 526 members of the general population matched by age, sex and individual comorbidities. We calculated cause-specific mortality rates and incidence rates of cardiovascular diseases. We then compared rates between patients with Barrett's oesophagus and the general population comparison cohort, using stratified Cox proportional hazard regression. Patients with Barrett's oesophagus had a 71% increased risk of overall mortality. The cause-specific mortality rate per 1000 person-years for patients with Barrett's oesophagus was 8.5 for cardiovascular diseases, 14.7 for non-oesophageal cancers, and 5.4 for oesophageal cancer. Compared to the general population cohort, corresponding hazard ratios were 1.26 (95% confidence interval (CI): 1.15-1.38), 1.77 (95% CI: 1.65-1.90), and 19.4 (95% CI: 16.1-23.4), respectively. The incidence rates of cardiovascular diseases per 1000 person-years for Barrett's oesophagus patients and for persons from the general population cohort, respectively, varied from 0.4 and 0.2 for subarachnoid bleeding (hazard ratio 1.10, 95% CI: 0.87-1.39) to 8.1 and 5.9 for congestive heart failure (hazard ratio 1.33, 95% CI: 1.21-1.46). Prophylactic measures targeted at cardiovascular diseases and non-oesophageal cancers potentially could be more important than measures against oesophageal cancer, for improving prognosis among patients with Barrett's oesophagus. © 2017 John Wiley & Sons Ltd.

Neurodegenerative causes of death among retired National Football League players.

PubMed

Lehman, Everett J; Hein, Misty J; Baron, Sherry L; Gersic, Christine M

2012-11-06

To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players. This was a cohort mortality study of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988. Vital status was ascertained through 2007. For analysis purposes, players were placed into 2 strata based on characteristics of position played: nonspeed players (linemen) and speed players (all other positions except punter/kicker). External comparisons with the US population used standardized mortality ratios (SMRs); internal comparisons between speed and nonspeed player positions used standardized rate ratios (SRRs). Overall player mortality compared with that of the US population was reduced (SMR 0.53, 95% confidence interval [CI] 0.48-0.59). Neurodegenerative mortality was increased using both underlying cause of death rate files (SMR 2.83, 95% CI 1.36-5.21) and multiple cause of death (MCOD) rate files (SMR 3.26, 95% CI 1.90-5.22). Of the neurodegenerative causes, results were elevated (using MCOD rates) for both ALS (SMR 4.31, 95% CI 1.73-8.87) and AD (SMR 3.86, 95% CI 1.55-7.95). In internal analysis (using MCOD rates), higher neurodegenerative mortality was observed among players in speed positions compared with players in nonspeed positions (SRR 3.29, 95% CI 0.92-11.7). The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players.

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

PubMed

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

2015-01-01

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

[The disease burden of cardiovascular and circulatory diseases in China, 1990 and 2010].

PubMed

Liu, Jiangmei; Liu, Yunning; Wang, Lijun; Yin, Peng; Liu, Shiwei; You, Jinling; Zeng, Xinying; Zhou, Maigeng

2015-04-01

To analyze the death status of disease burden of cardiovascular and circulatory diseases in 1990 and 2010 in China, and to provide the basic information for cardiovascular and circulatory disease prevention and control. Using the results of the Global Burden of Diseases Study 2010 (GBD 2010) to describe the cardiovascular and circulatory diseases deaths status and disease burden in China. The measurement index included the mortality, years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). At the same time, we used the population from 2010 national census as standard population to calculate the age-standardized mortality rate and DALY rate, YLL rate and YLD rates which will describe the mortality status and disease burden of total and different types of cardiovascular disease. We also calculated the change in 1990 and 2010 for all indexes, to describe the change of the burden of disease in the 20 years. In 2010, the total deaths of cardiovascular and circulatory diseases reached 3.136 2 million, the mortality rate reached 233.70 per 100 000 people and the age-standardized mortality rate was 256.90 per 100 000 people. The total DALYs, YLLs, and YLDs of cardiovascular and circulatory diseases reached 58.2055, 54.0488, and 4.1568 million person-years, respectively, and the age-standardized DALY rate, YLL rate and YLD rate were 4 639.04, 4 313.13, 325.91 per 100 000. In 1990, the deaths only 2.1675 million and the DALYs, YLLs and YLDs were 45.2679, 42.2922, and 2.9757 million person-years. The age-standardized mortality rate was 300.30 per 100 000 people. And the age-standardized DALY rate, YLL rate and YLD rate were 5 872.58, 5 523.42 and 349.16 per 100 000. Compared with the result in 1990, the total deaths, DALYs, YLLs, and YLDs were increased 44.72%, 28.58%, 27.80%, and 39.68%, respectively, while the age-standardized mortality rate, age-standardized DALY rate, age-standardized YLL rate, and age-standardized YLD rate were decreased 14.45%, 21.01%, 21.91%, and 6.66%, respectively. In 1990 and 2010, cerebrovascular disease caused the most DALYs (24.8768 and 30.1389 million person-years, respectively) compared with other types of cardiovascular and circulatory diseases, and followed by ischemic heart disease (10.1270 and 17.8858 million person-years). And the YLLs of cerebrovascular disease (24.3436 and 29.1726 million person-years) also the highest in different type of cardiovascular and circulatory diseases, ischemic heart disease (8.9919 and 16.0839 million person-years) was the second highest. The deaths of cerebrovascular disease and cerebrovascular disease increased from 1 340.6 and 450.3 thousands in 1990 to 1 726.7 and 948.7 thousands in 2010, respectively. The age-standardized mortality rate and DALY rate of cerebrovascular disease were decreased from 187.19 and 3 335.37 per 100 000 people in 1990 to 141.43 and 2 409.09 per 100 000 people. While in the ischemic heart disease, the age-standardized mortality rate, and DALY rate were increased form 62.53 and 1 318.38 per 100 000 people in 1990 to 77.89 and 1 428.31 per 100 000 people. Burden of cardiovascular and circulatory disease became more and more serious in China, of which the cerebrovascular disease and ischemic heart disease were most serious.

Mortality from idiopathic pulmonary fibrosis: a temporal trend analysis in Brazil, 1979-2014

PubMed Central

Algranti, Eduardo; Saito, Cézar Akiyoshi; Silva, Diego Rodrigues Mendonça e; Carneiro, Ana Paula Scalia; Bussacos, Marco Antonio

2017-01-01

ABSTRACT Objective: To analyze mortality from idiopathic pulmonary fibrosis (IPF) in Brazil over the period 1979-2014. Methods: Microdata were extracted from the Brazilian National Ministry of Health Mortality Database. Only deaths for which the underlying cause was coded as International Classification of Diseases version 9 (ICD-9) 515 or 516.3 (until 1995) or as ICD version 10 (ICD-10) J84.1 (from 1996 onward) were included in our analysis. Standardized mortality rates were calculated for the 2010 Brazilian population. The annual trend in mortality rates was analyzed by joinpoint regression. We calculated risk ratios (RRs) by age group, time period of death, and gender, using a person-years denominator. Results: A total of 32,092 deaths were recorded in the study period. Standardized mortality rates trended upward, rising from 0.24/100,000 population in 1979 to 1.10/100,000 population in 2014. The annual upward trend in mortality rates had two inflection points, in 1992 and 2008, separating three distinct time segments with an annual growth of 2.2%, 6.8%, and 2.4%, respectively. The comparison of RRs for the age groups, using the 50- to 54-year age group as a reference, and for the study period, using 1979-1984 as a reference, were 16.14 (14.44-16.36) and 6.71 (6.34-7.12), respectively. Men compared with women had higher standardized mortality rates (per 100,000 person-years) in all age groups. Conclusion: Brazilian IPF mortality rates are lower than those of other countries, suggesting underdiagnosis or underreporting. The temporal trend is similar to those reported in the literature and is not explained solely by population aging. PMID:29340493

Examining trends in type 2 diabetes incidence, prevalence and mortality in the UK between 2004 and 2014.

PubMed

Zghebi, Salwa S; Steinke, Douglas T; Carr, Matthew J; Rutter, Martin K; Emsley, Richard A; Ashcroft, Darren M

2017-11-01

Contemporary data describing type 2 diabetes prevalence, incidence and mortality are limited. We aimed to (1) estimate annual incidence and prevalence rates of type 2 diabetes in the UK between 2004 and 2014, (2) examine relationships between observed rates with age, gender, socio-economic status and geographic region, and (3) assess how temporal changes in incidence and all-cause mortality rates influence changes in prevalence. Type 2 diabetes patients aged ≥16 years between January 2004 and December 2014 were identified using the Clinical Practice Research Datalink (CPRD). Up to 5 individuals without diabetes were matched to diabetes patients based on age, gender and the general practice. Annual incidence, prevalence and mortality rates were calculated per 10 000 person-years at risk (95% CI). Survival models compared mortality rates in patients with and without type 2 diabetes. Prevalence rates of type 2 diabetes increased from 3.21% (3.19; 3.22) in 2004 to 5.26% (5.24; 5.29) in 2014. Incidence rates remained stable, overall, throughout the study period. Higher incidence and prevalence rates were related to male gender and deprivation. Individuals with type 2 diabetes were associated with higher risk of mortality (Hazard ratio 1.26 [1.20; 1.32]). Mortality rates declined in patients with and without diabetes throughout the study period. The incidence and prevalence of type 2 diabetes in patients aged 16 to 34 years increased over time. The rising prevalence of type 2 diabetes in the UK over the last decade is probably explained by patients living longer rather than by increasing incidence of type 2 diabetes. © 2017 John Wiley & Sons Ltd.

Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review.

PubMed

Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Alodat, Tareq; Memon, Breda; Memon, Muhammed Ashraf

2016-10-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this meta-analysis and systematic review was to compare the "early postoperative complication rate i.e. within 30-days" reported from randomized control trials (RCTs) comparing these two procedures. RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures. Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications. A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05). Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications. A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4). However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures. This meta-analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30-day mortality for either procedure.

Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality.

PubMed

Phillips, Elyse; Gazmararian, Julie

To determine whether specific state legislation has an effect on opioid overdose mortality rates compared to states without those types of legislation. Ecological study estimating opioid-related mortality in states with and without a prescription drug monitoring program (PDMP) and/or medical cannabis legislation. Opioid-related mortality rates for 50 states and Washington DC from 2011 to 2014 were obtained from CDC WONDER. PDMP data were obtained from the National Alliance for Model State Drug Laws, and data on medical cannabis legislation from the National Organization for the Reform of Marijuana Laws. The relationship between PDMPs with mandatory access provisions, medical cannabis legislation, and opioid-related mortality rates. Multivariate repeated measures analysis performed with software and services. Medical cannabis laws were associated with an increase of 21.7 percent in mean age-adjusted opioid-related mortality (p < 0.0001). PDMPs were associated with an increase of 11.4 percent in mean age-adjusted opioid-related mortality (p = 0.005). For every additional year since enactment, mean age-adjusted opioid-related mortality rate increased by 1.7 percent in states with medical cannabis (p = 0.049) and 5.8 percent for states with a PDMP (p = 0.005). Interaction between both types of legislation produced a borderline significant decrease of 10.1 percent (p = 0.055). For every year states had both types of legislation, interaction resulted in a 0.6 percent decrease in rate (p = 0.013). When combined with the availability of medical cannabis as an alternative analgesic therapy, PDMPs may be more effective at decreasing opioid-related mortality.

Lead Water Pipes and Infant Mortality at the Turn of the Twentieth Century

ERIC Educational Resources Information Center

Troesken, Werner

2008-01-01

In 1897, about half of all American municipalities used lead pipes to distribute water. Employing data from Massachusetts, this paper compares infant death rates in cities that used lead water pipes to rates in cities that used nonlead pipes. In the average town in 1900, the use of lead pipes increased infant mortality by 25 to 50 percent.…

Poverty and child (0-14 years) mortality in the USA and other Western countries as an indicator of "how well a country meets the needs of its children" (UNICEF).

PubMed

Pritchard, Colin; Williams, Richard

2011-01-01

Children's (0-14 years) mortality rates in the USA and 19 Western countries (WCs) were examined in the context of a nation-specific measure of relative poverty and the Gross Domestic Product Health Expenditure (GDPHE) of countries to compare the effectiveness and efficiency of health care systems "to meet the needs of its children" (UNICEF). World Health Organisation child mortality rates per million were analysed for 1979-1981 and 2003-2005 to determine any significant differences between the USA and the other WCs over these periods. Child mortality rates are correlated with all countries GDPHE and 'relative poverty', defined by 'Income Inequalities', i.e., the gap between top and bottom 20% of incomes. Outputs: The mortality rate of every country fell substantially ranging from falls of 46% in the USA to 78% in Portugal. The highest current mortality rates are: USA, 2436 per million (pm), New Zealand 2105 pm, Portugal 1929 pm, Canada 1877 pm and the UK 1834 pm; the lowest are: Japan 1073 pm and Sweden 1075 pm, Finland 1193 pm and Norway 1200 pm. A total of 16 countries rates fell significantly more than the USA over these periods. Inputs: The USA had the greatest GDPHE and widest Income Inequality gap. There was no significant correlation between GDPHE and mortality but highly significant correlations with children's deaths and income inequalities. The five widest income inequality countries had the six worst rates, the narrowest four had the lowest. Despite major improvements in every WC, based upon financial inputs and child mortality outputs, the USA health care system appears the least efficient and effective in "meeting the needs of its children".

The associations between nationality, fertility history and diabetes-related mortality: a retrospective cohort study in the Brussels-Capital Region (2001-2005).

PubMed

Vandenheede, Hadewijch; Deboosere, Patrick; Gadeyne, Sylvie; De Spiegelaere, Myriam

2012-03-01

The relationship between women's parity and diabetes mortality has been investigated in several studies, with mixed results. This study aims to establish if parity and age at first birth are associated with diabetes-related mortality and if these factors contribute to variations in diabetes-related mortality among women with different nationalities. Data of the 2001 census are linked to registration records of all deaths and emigrations (period 2001-2005). The study population comprises all female inhabitants of the Brussels-Capital Region aged 45-74 of either Belgian or North African nationality (n = 108 296). Age-standardized mortality rates (direct standardization) and mortality rate ratios (Poisson's regression) are computed. Both parity and age at first birth are associated with diabetes-related mortality. Highest risks of dying from diabetes are observed among grandmultiparous women and teenage mothers. Differences in diabetes-related mortality according to nationality are observed. Age-standardized diabetes mortality rates are higher in North African [ASMR = 417.4/100,000; 95% confidence interval (CI) 227.2-607.7] than in Belgian women (ASMR = 184.0/100,000; 95% CI 157.3-210.8). Taking parity, age at first birth and education into account, these differences largely disappear. Reproductive factors are associated with diabetes-related mortality and play an important part in the higher diabetes-related mortality of North African compared with Belgian women.

Estimation of peacock bass (Cichla spp.) mortality rate during catch-release fishing employing different post-capture procedures.

PubMed

Barroco, L S A; Freitas, C E C; Lima, Á C

2018-05-01

The effect of catch-and-release fishing on the survival of peacock bass (Cichla spp.) was evaluated by comparing two types of artificial bait (jig and shallow-diver plugs) and two types of post-catch confinement. Two experiments were conducted during the periods January-February and October-November 2012 in the Unini River, a right-bank tributary of the Negro River. In total, 191 peacock bass were captured. Both groups of fish were subjected to experimental confinement (collective and individual) for three days. Additionally, 11 fish were tagged with radio transmitters for telemetry monitoring. Mortality rate was estimated as the percentage of dead individuals for each type of bait and confinement. For peacock bass caught with jig baits, mortality was zero. The corresponding figure for shallow-diver bait was 1.66% for fish in collective containment, 18.18% for fish monitored by telemetry and 0% for individuals confined individually. Our results show low post-release mortality rates for peacock bass. Furthermore, neither the type of confinement nor the type of bait had a statistically significant influence on mortality rates. While future studies could include other factors in the analysis, our results show that catch-and-release fishing results in low mortality rates.

Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out.

PubMed

Kimani-Murage, E W; Fotso, J C; Egondi, T; Abuya, B; Elungata, P; Ziraba, A K; Kabiru, C W; Madise, N

2014-09-01

We describe trends in childhood mortality in Kenya, paying attention to the urban-rural and intra-urban differentials. We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban-rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out

PubMed Central

Kimani-Murage, E.W.; Fotso, J.C.; Egondi, T.; Abuya, B.; Elungata, P.; Ziraba, A.K.; Kabiru, C.W.; Madise, N.

2014-01-01

Background We describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials. Methods We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Results Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. Conclusions The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums. PMID:25024120

Balanced management of hepatic trauma is associated with low liver-related mortality.

PubMed

Benckert, Christoph; Thelen, Armin; Gaebelein, Gereon; Hepp, Pierre; Josten, Christoph; Bartels, Michael; Jonas, Sven

2010-04-01

Hepatic trauma is a rare surgical emergency with significant morbidity and mortality. Therapeutic strategies have been controversially discussed during the last decades. The medical records of 47 consecutive patients with hepatic trauma treated at the University Hospital of Leipzig between 2004 and 2008 were retrospectively reviewed for the severity of liver injury, management, morbidity, and mortality and compared to a preceding cohort. Logistic regression analysis was performed to identify risk factors influencing mortality. Compared to 63 patients treated between 1993 and 2003, moderate liver injuries (grades I-III) occurred more frequently (p = 0.0006), and the proportion of patients that were managed operatively decreased from 68.9% to 37.5%. Twenty patients (42.6%) were treated conservatively (all grades I to III) and 27 surgically (47.4%). In detail, five patients were treated by hepatic packing alone, 13 by suture or coagulation, five by atypical resection, and four by hemihepatectomy. The overall mortality was 8.5% with a liver-related mortality rate of 2.1%. According to severity grades I-III, IV, and V, mortality rates were 0%, 18.2%, and 50.0%, respectively. Univariate analysis identified Injury Severity Score (ISS) >30, Moore grades IV and V, hemoglobin at admission <6.0 mmol/L, and need for transfusion of >12 erythrocyte concentrates to be significant risk factors for early posttraumatic death, while multivariate analysis only ISS >30 revealed to be of prognostic significance for early postoperative survival. Compared to a previous cohort in the same hospital, more patients were treated conservatively. Management of liver injuries presented with a low liver-related mortality rate. Grades I-III injuries can safely be treated by conservative means with excellent results. However, complex hepatic injuries may often require surgical treatment ranging from packing to complex hemihepatectomy. Hence, for selection of appropriate therapeutic options, patients with hepatic injuries should be treated in a specialized institution.

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

PubMed

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

2016-10-01

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

Cancer and noncancer mortality in populations living near uranium and vanadium mining and milling operations in Montrose County, Colorado, 1950-2000.

PubMed

Boice, John D; Mumma, Michael T; Blot, William J

2007-06-01

Mining and milling of uranium in Montrose County on the Western Slope of Colorado began in the early 1900s and continued until the early 1980s. To evaluate the possible impact of these activities on the health of communities living on the Colorado Plateau, mortality rates between 1950 and 2000 among Montrose County residents were compared to rates among residents in five similar counties in Colorado. Standardized mortality ratios (SMRs) were computed as the ratio of observed numbers of deaths in Montrose County to the expected numbers of deaths based on mortality rates in the general populations of Colorado and the United States. Relative risks (RRs) were computed as the ratio of the SMRs for Montrose County to the SMRs for the five comparison counties. Between 1950 and 2000, a total of 1,877 cancer deaths occurred in the population residing in Montrose County, compared with 1,903 expected based on general population rates for Colorado (SMR(CO) 0.99). There were 11,837 cancer deaths in the five comparison counties during the same 51-year period compared with 12,135 expected (SMR(CO) 0.98). There was no difference between the total cancer mortality rates in Montrose County and those in the comparison counties (RR = 1.01; 95% CI 0.96-1.06). Except for lung cancer among males (RR = 1.19; 95% CI 1.06-1.33), no statistically significant excesses were seen for any causes of death of a priori interest: cancers of the breast, kidney, liver, bone, or childhood cancer, leukemia, non-Hodgkin lymphoma, renal disease or nonmalignant respiratory disease. Lung cancer among females was decreased (RR = 0.83; 95% CI 0.67-1.02). The absence of elevated mortality rates of cancer in Montrose County over a period of 51 years suggests that the historical milling and mining operations did not adversely affect the health of Montrose County residents. Although descriptive correlation analyses such as this preclude definitive causal inferences, the increased lung cancer mortality seen among males but not females is most likely due to prior occupational exposure to radon and cigarette smoking among underground miners residing in Montrose County, consistent with previous cohort studies of Colorado miners and of residents of the town of Uravan in Montrose County.

Cancer mortality in the West Bank, Occupied Palestinian Territory.

PubMed

Abu-Rmeileh, Niveen M E; Gianicolo, Emilio Antonio Luca; Bruni, Antonella; Mitwali, Suzan; Portaluri, Maurizio; Bitar, Jawad; Hamad, Mutaem; Giacaman, Rita; Vigotti, Maria Angela

2016-01-26

The burden of cancer is difficult to study in the context of the occupied Palestinian territory because of the limited data available. This study aims to evaluate the quality of mortality data and to investigate cancer mortality patterns in the occupied Palestinian territory's West Bank governorates from 1999 to 2009. Death certificates collected by the Palestinian Ministry of Health for Palestinians living in the West Bank were used. Direct and indirect age-standardised mortality rates were computed and used to compare different governorates according to total and specific cancer mortality. Furthermore, standardised proportional mortality ratios were calculated to compare mortality by urban, rural and camp locales. The most common cause of death out of all cancer types was lung cancer among males (22.8 %) and breast cancer among females (21.5 %) followed by prostate cancer for males (9.5 %) and by colon cancer for females (11.4 %). Regional variations in cancer-specific causes of death were observed. The central- West Bank governorates had the lowest mortality for most cancer types among men and women. Mortality for lung cancer was highest in the north among men (SMR 109.6; 95%CI 99.5-120.4). For prostate cancer, mortality was highest in the north (SMR 103.6; 95%CI 88.5-120.5) and in the south (SMR 118.6; 95%CI 98.9-141.0). Breast cancer mortality was highest in the south (SMR 119.3; 95%CI 103.9-136.2). Similar mortality rate patterns were found in urban, rural and camp locales. The quality of the Palestinian mortality registry has improved over time. Results in the West Bank governorates present different mortality patterns. The differences might be explained by personal, contextual and environmental factors that need future in-depth investigations.

Inequality and mortality: demographic hypotheses regarding advanced and peripheral capitalism.

PubMed

Gregory, J W; Piché, V

1983-01-01

This paper analyzes mortality differences between social classes and between advanced and peripheral regions of the world economy. The demographic analysis of mortality is integrated with the study of political economy, which emphasizes the entire process of social reproduction. As part of this dialectic model, both the struggle of the working class to improve health and the interest of capital in maximizing profits are examined. Data from Québec and Upper Volta are used to illustrate the hypothesis that substantially higher mortality rates exist for the working class compared with the bourgeoisie and in the less developed peripheral regions compared with the more developed regions.

Quantifying cause-related mortality by weighting multiple causes of death

PubMed Central

Moreno-Betancur, Margarita; Lamarche-Vadel, Agathe; Rey, Grégoire

2016-01-01

Abstract Objective To investigate a new approach to calculating cause-related standardized mortality rates that involves assigning weights to each cause of death reported on death certificates. Methods We derived cause-related standardized mortality rates from death certificate data for France in 2010 using: (i) the classic method, which considered only the underlying cause of death; and (ii) three novel multiple-cause-of-death weighting methods, which assigned weights to multiple causes of death mentioned on death certificates: the first two multiple-cause-of-death methods assigned non-zero weights to all causes mentioned and the third assigned non-zero weights to only the underlying cause and other contributing causes that were not part of the main morbid process. As the sum of the weights for each death certificate was 1, each death had an equal influence on mortality estimates and the total number of deaths was unchanged. Mortality rates derived using the different methods were compared. Findings On average, 3.4 causes per death were listed on each certificate. The standardized mortality rate calculated using the third multiple-cause-of-death weighting method was more than 20% higher than that calculated using the classic method for five disease categories: skin diseases, mental disorders, endocrine and nutritional diseases, blood diseases and genitourinary diseases. Moreover, this method highlighted the mortality burden associated with certain diseases in specific age groups. Conclusion A multiple-cause-of-death weighting approach to calculating cause-related standardized mortality rates from death certificate data identified conditions that contributed more to mortality than indicated by the classic method. This new approach holds promise for identifying underrecognized contributors to mortality. PMID:27994280

Observed effects of an exceptional drought on tree mortality in a tropical dry forest

NASA Astrophysics Data System (ADS)

Medvigy, D.; Vargas, G.; Xu, X.; Smith, C. M.; Becknell, J.; Brodribb, T.; Powers, J. S.

2016-12-01

Climate models predict that the coming century will bring reduced rainfall to Neotropical dry forests. It is unknown how tropical dry forest trees will respond to such rainfall reductions. Will there be increased mortality? If so, what will be the dominant mechanism of mortality? Will certain functional groups or size classes be more susceptible to unusually dry conditions and do functional traits underlie these patterns? With these questions in mind, we analyzed the response of trees from 18 Costa Rican tropical dry forest inventory plots and from additional transects to the exceptional 2015 drought that coincided with a strong ENSO event. We compared stand-level mortality rates observed during pre-drought years (2008-2014) and during the drought year of 2015 in the inventory plots. For both inventory plots and transects, we analyzed whether particular functional groups or size classes experienced exceptional mortality after the drought. We found that mortality rates were two to three times higher during the drought than before the drought. In contrast to observations at moist tropical forests, tree size had little influence on mortality. In terms of functional groups, mortality rates of evergreen oaks growing on nutrient-poor soils particularly increased during drought. Legumes seemed less affected by the drought than non-legumes. However, elevated mortality rates were not clearly correlated with commonly-measured traits like wood density or specific leaf area. Instead, hydraulic traits like P50 or turgor loss point may be better predictors of drought-driven mortality. In addition, trees that died during the drought tended to have smaller relative growth rate prior to the drought than trees that survived the drought.

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.

Mortality Rates in the General Irish Population Compared to Those with an Intellectual Disability from 2003 to 2012

ERIC Educational Resources Information Center

McCarron, Mary; Carroll, Rachael; Kelly, Caraiosa; McCallion, Philip

2015-01-01

Background:Historically, there has been higher and earlier mortality among people with intellectual disability as compared to the general population, but there have also been methodological problems and differences in the available studies. Method: Data were drawn from the 2012 National Intellectual Disability Database and the Census in Ireland. A…

Climate Classification is an Important Factor in ­Assessing Hospital Performance Metrics

NASA Astrophysics Data System (ADS)

Boland, M. R.; Parhi, P.; Gentine, P.; Tatonetti, N. P.

2017-12-01

Context/Purpose: Climate is a known modulator of disease, but its impact on hospital performance metrics remains unstudied. Methods: We assess the relationship between Köppen-Geiger climate classification and hospital performance metrics, specifically 30-day mortality, as reported in Hospital Compare, and collected for the period July 2013 through June 2014 (7/1/2013 - 06/30/2014). A hospital-level multivariate linear regression analysis was performed while controlling for known socioeconomic factors to explore the relationship between all-cause mortality and climate. Hospital performance scores were obtained from 4,524 hospitals belonging to 15 distinct Köppen-Geiger climates and 2,373 unique counties. Results: Model results revealed that hospital performance metrics for mortality showed significant climate dependence (p<0.001) after adjusting for socioeconomic factors. Interpretation: Currently, hospitals are reimbursed by Governmental agencies using 30-day mortality rates along with 30-day readmission rates. These metrics allow Government agencies to rank hospitals according to their `performance' along these metrics. Various socioeconomic factors are taken into consideration when determining individual hospitals performance. However, no climate-based adjustment is made within the existing framework. Our results indicate that climate-based variability in 30-day mortality rates does exist even after socioeconomic confounder adjustment. Use of standardized high-level climate classification systems (such as Koppen-Geiger) would be useful to incorporate in future metrics. Conclusion: Climate is a significant factor in evaluating hospital 30-day mortality rates. These results demonstrate that climate classification is an important factor when comparing hospital performance across the United States.

Comparison of crude and adjusted mortality rates from leading causes of death in northeastern Brazil.

PubMed

França, Elisabeth; Rao, Chalapati; Abreu, Daisy Maria Xavier de; Souza, Maria de Fátima Marinho de; Lopez, Alan D

2012-04-01

To present how the adjustment of incompleteness and misclassification of causes of death in the vital registration (VR) system can contribute to more accurate estimates of the risk of mortality from leading causes of death in northeastern Brazil. After estimating the total numbers of deaths by age and sex in Brazil's Northeast region in 2002-2004 by correcting for undercount in the VR data, adjustment algorithms were applied to the reported cause-of-death structure. Average annual age-standardized mortality rates were computed by cause, with and without the corrections, and compared to death rates for Brazil's South region after adjustments for potential misdiagnosis. Death rates from ischemic heart disease, lower respiratory infections, chronic obstructive pulmonary disease, and perinatal conditions were more than 100% higher for both sexes than what was suggested by the routine VR data. Corrected cause-specific mortality rates were higher in the Northeast region versus the South region for the majority of causes of death, including several noncommunicable conditions. Failure to adjust VR data for undercount of cases reported and misdiagnoses will cause underestimation of mortality risks for the populations of the Northeast region, which are more vulnerable than those in other regions of the country. In order to more reliably understand the pattern of disease, all cause-specific mortality rates in poor populations should be adjusted.

Epidemiology of Parkinson disease in the city of Kolkata, India

PubMed Central

Das, S.K.; Misra, A.K.; Ray, B.K.; Hazra, A.; Ghosal, M.K.; Chaudhuri, A.; Roy, T.; Banerjee, T.K.; Raut, D.K.

2010-01-01

Objective: No well-designed longitudinal study on Parkinson disease (PD) has been conducted in India. Therefore, we planned to determine the prevalence, incidence, and mortality rates of PD in the city of Kolkata, India, on a stratified random sample through a door-to-door survey. Method: This study was undertaken between 2003 to 2007 with a validated questionnaire by a team consisting of 4 trained field workers in 3 stages. Field workers screened the cases, later confirmed by a specialist doctor. In the third stage, a movement disorders specialist undertook home visits and reviewed all surviving cases after 1 year from last screening. Information on death was collected through verbal autopsy. A nested case-control study (1:3) was also undertaken to determine putative risk factors. The rates were age adjusted to the World Standard Population. Result: A total population of 100,802 was screened. The age-adjusted prevalence rate (PR) and average annual incidence rate were 52.85/100,000 and 5.71/100,000 per year, respectively. The slum population showed significantly decreased PR with age compared with the nonslum population. The adjusted average annual mortality rate was 2.89/100,000 per year. The relative risk of death was 8.98. The case-control study showed that tobacco chewing protected and hypertension increased PD occurrence. Conclusion: This study documented lower prevalence and incidence of PD as compared with Caucasian and a few Oriental populations. The mortality rates were comparable. The decreased age-specific PR among slum populations and higher relative risk of death need further probing. GLOSSARY AAIR = average annual incidence rate; AAMR = average annual mortality rate; CI = confidence interval; FSQ = family screening questionnaire; ICC = intraclass correlation coefficient; IR = incidence rate; MD = movement disorder; NSSO = National Sample Survey Organization; OR = odds ratio; PD = Parkinson disease; PPS = parkinsonism plus syndrome; PR = prevalence rate; PRM = Poisson regression modeling; RR = relative risk; SP = secondary parkinsonism; VA = verbal autopsy. PMID:20938028

An analysis of variations of indications and maternal-fetal prognosis for caesarean section in a tertiary hospital of Beijing: A population-based retrospective cohort study.

PubMed

Liu, Yajun; Wang, Xin; Zou, Liying; Ruan, Yan; Zhang, Weiyuan

2017-02-01

In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in China. According to the World Health Organization (WHO) systematic review, if the increase in CS rate was between 10% and 15%, the maternal and neonatal mortality was decreased. However, above this level, increasing the rate of CS is no longer associated with reduced mortality. To date, no consensus has been reached on the main factors driving the cesarean epidemic. To reduce the progressively increasing rate of CS, we should find indications for the increasing CS rate. The aim of our study was to estimate the change of CS rate of Beijing Obstetrics and Gynecology Hospital and to find the variation of the indications.From January 1995 to December 2014, the CS rate of Beijing Obstetrics and Gynecology Hospital was analyzed. For our analysis, we selected 14,642 and 16,335 deliveries respectively that occurred during the year 2011 and 2014, to analyze the difference of indications, excluding incomplete data and miscarriages or termination of pregnancy before 28 weeks of gestation because of fatal malformations, intrauterine death, or other reasons.The average CS rate during the past 20 years was 51.15%. The highest caesarean delivery rate was 60.69% in 2002; however, the caesarean delivery rate declined to 34.53% in 2014. The obviously different indications were caesarean delivery on maternal request and previous CS delivery. The rate of CS due to maternal request in 2014 was decreased by 8.16% compared with the year 2011. However, the percentage of pregnancy women with a previous CS delivery increased from 9.61% to 20.42% in 3 years. Along with the decline of CS rate, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014 compared with that in 2011.After a series of measures, the CS rate declined indeed. Compared with 2011, the perinatal mortality and the rate of neonatal asphyxia decreased in 2014. Caesarean delivery on maternal request (CDMR) cannot improve the maternal-fetal prognosis compared with the spontaneous vaginal delivery. With the releasing of China's 2 children policy, more CS will be implemented due to previous CS. There is a need for further research that evaluates interventions for increasing VBAC rates that target clinicians.

Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates.

PubMed

Kim, Do Hyun; Jeon, Jihyun; Park, Chang Gi; Sriram, Sudhir; Lee, Kwang Sun

2016-09-01

Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (< 1,500 g) rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions.

Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates

PubMed Central

2016-01-01

Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (< 1,500 g) rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions. PMID:27510390

Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment.

PubMed

Folbert, E C; Hegeman, J H; Vermeer, M; Regtuijt, E M; van der Velde, D; Ten Duis, H J; Slaets, J P

2017-01-01

To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care. The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors. This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008. The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4-5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1-2 OR 1.46, CCI 3-4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96). After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that affect the 1-year mortality can be useful in optimizing care and outcomes. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.

Cross-temporal and cross-national poverty and mortality rates among developed countries.

PubMed

Fritzell, Johan; Kangas, Olli; Bacchus Hertzman, Jennie; Blomgren, Jenni; Hiilamo, Heikki

2013-01-01

A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship between relative poverty rates and population health indicators is less self-evident, notwithstanding the obvious similarity to the debated topic of the relationship between population health and income inequality. In this study we undertake a comparative analysis of the relationship between relative poverty and mortality across 26 countries over time, with pooled cross-sectional time series analysis. We utilize data from the Luxembourg Income Study to construct age-specific poverty rates across countries and time covering the period from around 1980 to 2005, merged with data on age- and gender-specific mortality data from the Human Mortality Database. Our results suggest not only an impact of relative poverty but also clear differences by welfare regime that partly goes beyond the well-known differences in poverty rates between welfare regimes.

Cross-Temporal and Cross-National Poverty and Mortality Rates among Developed Countries

PubMed Central

Fritzell, Johan; Kangas, Olli; Bacchus Hertzman, Jennie; Blomgren, Jenni; Hiilamo, Heikki

2013-01-01

A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship between relative poverty rates and population health indicators is less self-evident, notwithstanding the obvious similarity to the debated topic of the relationship between population health and income inequality. In this study we undertake a comparative analysis of the relationship between relative poverty and mortality across 26 countries over time, with pooled cross-sectional time series analysis. We utilize data from the Luxembourg Income Study to construct age-specific poverty rates across countries and time covering the period from around 1980 to 2005, merged with data on age- and gender-specific mortality data from the Human Mortality Database. Our results suggest not only an impact of relative poverty but also clear differences by welfare regime that partly goes beyond the well-known differences in poverty rates between welfare regimes. PMID:23840235

Timing and location of mortality of fledgling, subadult, and adult California Gulls

USGS Publications Warehouse

Pugesek, B.H.; Diem, K.L.

2008-01-01

We investigated patterns of mortality during post-breeding migrations of California Gulls (Larus californicus) nesting near Laramie, Wyoming, USA. We used 151 recoveries and 647 sightings of banded and patagially-marked gulls to compare ratios of mortalities to observations of live birds (1) during four time periods (early and late fall migration, winter, and spring migration), (2) at two locations (Pacific coast and inland), and (3) among three age-classes of gulls (fledglings, 1- and 2-year-olds, and breeding-age adults). Mortality rates were higher in inland areas (35%) than in coastal areas (15%) and were dependent on season within inland areas, but not in coastal areas. Mortality in inland areas during early fall (21%) was comparable with that in coastal areas (13%) but was higher during late fall (68 vs. 13%) and spring migration (46 vs. 17%). Both fledgling (71%) and adult (64%) gulls experienced high mortality rates during late fall migration, possibly because some gulls were too weak to make their way to the Pacific coast and became trapped by poor weather conditions. Adult gulls also experienced high mortality inland during spring migration; few subadults made the costly migration to and from the breeding area. Some adults also skipped breeding and remained in coastal areas during the breeding season.

Early and mid-term clinical outcome in younger and elderly patients undergoing mitral valve repair with or without tricuspid valve repair.

PubMed

Renner, André; Zittermann, Armin; Aboud, Anas; Hakim-Meibodi, Kavous; Börgermann, Jochen; Gummert, Jan F

2015-01-01

Data regarding durability and midterm benefits of mitral valve (MV) repair in elderly patients are scarce. To evaluate the feasibility and safety of MV repair in elderly patients, we performed a retrospective data analysis. We compared clinical outcomes in younger patients (<75 years: n = 462) and older patients (≥75 years: n = 100) undergoing MV repair with or without tricuspid valve (TV) repair. The primary end-point was 30-day mortality. The preoperative risk profile (EuroSCORE, NYHA class, percentage pulmonary hypertension, percentage diabetes) was higher in older patients compared with younger patients. Nevertheless, operative complications such as low cardiac output syndrome, stroke, infections, the need of haemofiltration and IABP use did not differ significantly between the two groups. The thirty-day mortality rate was 0% in older patients and 1% in younger patients (P = 0.30). In the subgroup of patients with double valve repair, the 30-day mortality rate in older patients (n = 28) and younger patients (n = 46) was 0 and 4%, respectively (P = 0.27). In older and younger patients, the 6-month mortality rate was 4 and 2%, respectively (P = 0.16), and the 1-year mortality rate was 10 and 3%, respectively (P = 0.001). The propensity score-adjusted odds ratio of 1-year mortality with the group of younger patients as a reference was 2.04 (95% confidence interval: 0.77-5.40; P = 0.15) for older patients. Freedom from 1-year reoperation did not differ significantly between age groups. Data demonstrate excellent postoperative mortality rates in older patients undergoing MV repair with or without TV repair. Consequently, even in older patients with numerous comorbidities, MV repair should be considered a suitable surgical method. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis: A Multicenter Cohort Study.

PubMed

De Soyza, Anthony; McDonnell, Melissa J; Goeminne, Pieter C; Aliberti, Stefano; Lonni, Sara; Davison, John; Dupont, Lieven J; Fardon, Thomas C; Rutherford, Robert M; Hill, Adam T; Chalmers, James D

2017-06-01

This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI). Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and "other" BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded. A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%). Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality. Copyright © 2017 American College of Chest Physicians. All rights reserved.

Fever Is Associated with Reduced, Hypothermia with Increased Mortality in Septic Patients: A Meta-Analysis of Clinical Trials

PubMed Central

Rumbus, Zoltan; Matics, Robert; Hegyi, Peter; Zsiboras, Csaba; Szabo, Imre; Illes, Anita; Petervari, Erika; Balasko, Marta; Marta, Katalin; Miko, Alexandra; Parniczky, Andrea; Tenk, Judit; Rostas, Ildiko; Solymar, Margit

2017-01-01

Background Sepsis is usually accompanied by changes of body temperature (Tb), but whether fever and hypothermia predict mortality equally or differently is not fully clarified. We aimed to find an association between Tb and mortality in septic patients with meta-analysis of clinical trials. Methods We searched the PubMed, EMBASE, and Cochrane Controlled Trials Registry databases (from inception to February 2016). Human studies reporting Tb and mortality of patients with sepsis were included in the analyses. Average Tb with SEM and mortality rate of septic patient groups were extracted by two authors independently. Results Forty-two studies reported Tb and mortality ratios in septic patients (n = 10,834). Pearson correlation analysis revealed weak negative linear correlation (R2 = 0.2794) between Tb and mortality. With forest plot analysis, we found a 22.2% (CI, 19.2–25.5) mortality rate in septic patients with fever (Tb > 38.0°C), which was higher, 31.2% (CI, 25.7–37.3), in normothermic patients, and it was the highest, 47.3% (CI, 38.9–55.7), in hypothermic patients (Tb < 36.0°C). Meta-regression analysis showed strong negative linear correlation between Tb and mortality rate (regression coefficient: -0.4318; P < 0.001). Mean Tb of the patients was higher in the lowest mortality quartile than in the highest: 38.1°C (CI, 37.9–38.4) vs 37.1°C (CI, 36.7–37.4). Conclusions Deep Tb shows negative correlation with the clinical outcome in sepsis. Fever predicts lower, while hypothermia higher mortality rates compared with normal Tb. Septic patients with the lowest (< 25%) chance of mortality have higher Tb than those with the highest chance (> 75%). PMID:28081244

Fever Is Associated with Reduced, Hypothermia with Increased Mortality in Septic Patients: A Meta-Analysis of Clinical Trials.

PubMed

Rumbus, Zoltan; Matics, Robert; Hegyi, Peter; Zsiboras, Csaba; Szabo, Imre; Illes, Anita; Petervari, Erika; Balasko, Marta; Marta, Katalin; Miko, Alexandra; Parniczky, Andrea; Tenk, Judit; Rostas, Ildiko; Solymar, Margit; Garami, Andras

2017-01-01

Sepsis is usually accompanied by changes of body temperature (Tb), but whether fever and hypothermia predict mortality equally or differently is not fully clarified. We aimed to find an association between Tb and mortality in septic patients with meta-analysis of clinical trials. We searched the PubMed, EMBASE, and Cochrane Controlled Trials Registry databases (from inception to February 2016). Human studies reporting Tb and mortality of patients with sepsis were included in the analyses. Average Tb with SEM and mortality rate of septic patient groups were extracted by two authors independently. Forty-two studies reported Tb and mortality ratios in septic patients (n = 10,834). Pearson correlation analysis revealed weak negative linear correlation (R2 = 0.2794) between Tb and mortality. With forest plot analysis, we found a 22.2% (CI, 19.2-25.5) mortality rate in septic patients with fever (Tb > 38.0°C), which was higher, 31.2% (CI, 25.7-37.3), in normothermic patients, and it was the highest, 47.3% (CI, 38.9-55.7), in hypothermic patients (Tb < 36.0°C). Meta-regression analysis showed strong negative linear correlation between Tb and mortality rate (regression coefficient: -0.4318; P < 0.001). Mean Tb of the patients was higher in the lowest mortality quartile than in the highest: 38.1°C (CI, 37.9-38.4) vs 37.1°C (CI, 36.7-37.4). Deep Tb shows negative correlation with the clinical outcome in sepsis. Fever predicts lower, while hypothermia higher mortality rates compared with normal Tb. Septic patients with the lowest (< 25%) chance of mortality have higher Tb than those with the highest chance (> 75%).

Changing patterns of breast cancer incidence and mortality by education level over four decades in Norway, 1971-2009.

PubMed

Trewin, Cassia B; Strand, Bjørn Heine; Weedon-Fekjær, Harald; Ursin, Giske

2017-02-01

In the last century, breast cancer incidence and mortality was higher among higher versus lower educated women in developed countries. Post-millennium, incidence rates have flattened off and mortality declined. We examined breast cancer trends by education level, to see whether recent improvements in incidence and mortality rates have occurred in all education groups. We linked individual registry data on female Norwegian inhabitants aged 35 years and over during 1971–2009. Using Poisson models, we calculated absolute and relative educational differences in age-standardised breast cancer incidence and mortality over four decades. We estimated educational differences by Slope and Relative Index of Inequality, which correspond to rate difference and rate ratio, comparing the highest to lowest educated women. Pre-millennium, incidence and mortality of breast cancer were significantly higher in higher versus lower educated women. Post-millennium, educational differences in breast cancer incidence and mortality attenuated. During 2000–2009, breast cancer incidence was still 38% higher for higher versus lower educated women (Relative Index of Inequality: 1.38, 95% confidence interval: 1.31–1.44), but mortality no longer varied significantly by education level (Relative Index of Inequality: 1.09, 95% confidence interval: 0.99–1.19). Among women below 50 years, however, the education gradient for mortality reversed, and mortality was 28% lower for the highest versus lowest educated women during 2000–2009 (Relative Index of Inequality: 0.72, 95% confidence interval: 0.51–0.93). Post-millennium improvements in breast cancer incidence and mortality have primarily benefited higher educated women. Breast cancer mortality is now highest among the lowest educated women below 50 years. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.

PubMed

Haynes, Alex B; Edmondson, Lizabeth; Lipsitz, Stuart R; Molina, George; Neville, Bridget A; Singer, Sara J; Moonan, Aunyika T; Childers, Ashley Kay; Foster, Richard; Gibbons, Lorri R; Gawande, Atul A; Berry, William R

2017-12-01

To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program. We compared postoperative mortality rates after inpatient surgery in South Carolina utilizing state-wide all-payer discharge claims from 2008 to 2013, linked with state vital statistics, stratifying hospitals on the basis of completion of the checklist program. Changes in risk-adjusted 30-day mortality were compared between hospitals, using propensity score-adjusted difference-in-differences analysis. Fourteen hospitals completed the program by December 2013. Before program launch, there was no difference in mortality trends between the completion cohort and all others (P = 0.33), but postoperative mortality diverged thereafter (P = 0.021). Risk-adjusted 30-day mortality among completers was 3.38% in 2010 and 2.84% in 2013 (P < 0.00001), whereas mortality among other hospitals (n = 44) was 3.50% in 2010 and 3.71% in 2013 (P = 0.3281), reflecting a 22% difference between the groups on difference-in-differences analysis (P = 0.0021). Despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state. This may indicate that effective large-scale implementation of a team-based surgical safety checklist is feasible.

High cancer mortality for US-born Latinos: evidence from California and Texas.

PubMed

Pinheiro, Paulo S; Callahan, Karen E; Gomez, Scarlett Lin; Marcos-Gragera, Rafael; Cobb, Taylor R; Roca-Barcelo, Aina; Ramirez, Amelie G

2017-07-11

Latinos born in the US, 36 million, comprise 65% of all US Latinos. Yet their cancer experience is nearly always analyzed together with their foreign-born counterparts, 19 million, who constitute a steady influx of truly lower-risk populations from abroad. To highlight specific cancer vulnerabilities for US-born Latinos, we compare their cancer mortality to the majority non-Latino white (NLW) population, foreign-born Latinos, and non-Latino blacks. We analyzed 465,751 cancer deaths from 2008 to 2012 occurring among residents of California and Texas, the two most populous states, accounting for 47% of US Latinos. This cross-sectional analysis, based on granular data obtained from death certificates on cause of death, age, race, ethnicity and birthplace, makes use of normal standardization techniques and negative binomial regression models. While Latinos overall have lower all-cancers-combined mortality rates than NLWs, these numbers were largely driven by low rates among the foreign born while mortality rates for US-born Latinos approach those of NLWs. Among Texas males, rates were 210 per 100,000 for NLWs and 166 for Latinos combined, but 201 per 100,000 for US-born Latinos and 125 for foreign-born Latinos. Compared to NLWs, US-born Latino males in California had mortality rate ratios of 2.83 (95% CI: 2.52-3.18) for liver cancer, 1.44 (95% CI: 1.30-1.61) for kidney cancer, and 1.25 (95% CI: 1.17-1.34) for colorectal cancer (CRC). Texas results showed a similar site-specific pattern. Specific cancer patterns for US-born Latinos, who have relatively high cancer mortality, similar overall to NLWs, are masked by aggregation of all Latinos, US-born and foreign-born. While NLWs had high mortality for lung cancer, US-born Latinos had high mortality for liver, kidney and male colorectal cancers. HCV testing and reinforcement of the need for CRC screening should be a priority in this specific and understudied population. The unprecedented proximity of overall rates between NLWs and US-born Latino populations runs counter to the prevailing narrative of Latinos having significantly lower cancer risk and mortality. Birthplace data are critical in detecting meaningful differences among Latinos; these findings merit not only clinical but also public health attention.

Growth, productivity, and relative extinction risk of a data-sparse devil ray

PubMed Central

Pardo, Sebastián A.; Kindsvater, Holly K.; Cuevas-Zimbrón, Elizabeth; Sosa-Nishizaki, Oscar; Pérez-Jiménez, Juan Carlos; Dulvy, Nicholas K.

2016-01-01

Devil rays (Mobula spp.) face intensifying fishing pressure to meet the ongoing international demand for gill plates. The paucity of information on growth, mortality, and fishing effort for devil rays make quantifying population growth rates and extinction risk challenging. Furthermore, unlike manta rays (Manta spp.), devil rays have not been listed on CITES. Here, we use a published size-at-age dataset for the Spinetail Devil Ray (Mobula japanica), to estimate somatic growth rates, age at maturity, maximum age, and natural and fishing mortality. We then estimate a plausible distribution of the maximum intrinsic population growth rate (rmax) and compare it to 95 other chondrichthyans. We find evidence that larger devil ray species have low somatic growth rate, low annual reproductive output, and low maximum population growth rates, suggesting they have low productivity. Fishing rates of a small-scale artisanal Mexican fishery were comparable to our estimate of rmax, and therefore probably unsustainable. Devil ray rmax is very similar to that of manta rays, indicating devil rays can potentially be driven to local extinction at low levels of fishing mortality and that a similar degree of protection for both groups is warranted. PMID:27658342

Lethal and sublethal endpoints observed for Artemia exposed to two reference toxicants and an ecotoxicological concern organic compound.

PubMed

Manfra, Loredana; Canepa, Sara; Piazza, Veronica; Faimali, Marco

2016-01-01

Swimming speed alteration and mortality assays with the marine crustacean Artemia franciscana were carried out. EC50 and LC50 values after 24-48h exposures were calculated for two reference toxicants, copper sulphate pentahydrate (CuSO4·5H2O) and Sodium Dodecyl Sulphate (SDS), and an ecotoxicological concern organic compound, Diethylene Glycol (DEG). Different end-points have been evaluated, in order to point out their sensitivity levels. The swimming speed alteration (SSA) was compared to mortality values and also to the hatching rate inhibition (literature data). SSA resulted to be more sensitive than the mortality and with a sensitivity comparable to (or even higher than) the hatching rate endpoint. Copyright © 2015 Elsevier Inc. All rights reserved.

Opportunistic testing versus organized prostate-specific antigen screening: outcome after 18 years in the Göteborg randomized population-based prostate cancer screening trial.

PubMed

Arnsrud Godtman, Rebecka; Holmberg, Erik; Lilja, Hans; Stranne, Johan; Hugosson, Jonas

2015-09-01

It has been shown that organized screening decreases prostate cancer (PC) mortality, but the effect of opportunistic screening is largely unknown. To compare the ability to reduce PC mortality and the risk of overdiagnosis between organized and opportunistic screening. The Göteborg screening study invited 10 000 randomly selected men for prostate-specific antigen (PSA) testing every 2 yr since 1995, with a prostate biopsy recommended for men with PSA ≥2.5 ng/ml. The control group of 10 000 men not invited has been exposed to a previously reported increased rate of opportunistic PSA testing. Both groups were followed until December 31, 2012. Observed cumulative PC incidence and mortality rates in both groups were calculated using the actuarial method. Using historical data from 1990-1994 (pre-PSA era), we calculated expected PC incidence and mortality rates in the absence of any PSA testing. The number needed to invite (NNI) and the number needed to diagnose (NND) were calculated by comparing the expected versus observed incidence and mortality rates. At 18 yr, 1396 men were diagnosed with PC and 79 men died of PC in the screening group, compared to 962 and 122, respectively, in the control group. In the screening group, the observed cumulative PC incidence/mortality was 16%/0.98% compared to expected values of 6.8%/1.7%. The corresponding values for the control group were 11%/1.5% and 6.9%/1.7%. Organized screening was associated with an absolute PC-specific mortality reduction of 0.72% (95% confidence interval [CI] 0.50-0.94%) and relative risk reduction of 42% (95% CI 28-54%). There was an absolute reduction in PC deaths of 0.20% (95% CI -0.06% to 0.47%) and a relative risk reduction of 12% (95% CI -5 to 26%) associated with opportunistic PSA testing. NNI and NND were 139 (95% CI 107-200) and 13 for organized biennial screening and 493 (95% CI 213- -1563) and 23 for opportunistic screening. The extent of opportunistic screening could not be measured; incidence trends were used as a proxy. Organized screening reduces PC mortality but is associated with overdiagnosis. Opportunistic PSA testing had little if any effect on PC mortality and resulted in more overdiagnosis, with almost twice the number of men needed to be diagnosed to save one man from dying from PC compared to men offered an organized biennial screening program. Prostate-specific antigen (PSA) screening within the framework of an organized program seems more effective than unorganized screening. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Life expectancy and cardiovascular mortality in persons with schizophrenia.

PubMed

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

2012-03-01

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

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.

Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis.

PubMed

Mohammed, Sara Elfadil Abbas; Abdo, Abdelmunem Eltayeb; Mudawi, Hatim Mohamed Yousif

2016-11-08

To investigate mortality and rebleeding rate and identify associated risk factors at 6 wk and 5 d following acute variceal haemorrhage in patients with liver cirrhosis and schistosomal periportal fibrosis. This is a prospective study conducted during the period from March to December 2014. Patients with portal hypertension presenting with acute variceal haemorrhage secondary to either liver cirrhosis (group A) or schistosomal periportal fibroses (group B) presenting within 24 h of the onset of the bleeding were enrolled in the study and followed for a period of 6 wk. Analysis of data was done by Microsoft Excel and comparison between groups was done by Statistical Package of Social Sciences version 20 to calculate means and find the levels of statistical differences and define the mortality rates, the P value of < 0.05 was considered to be significant. A total of 94 patients were enrolled in the study. Thirty-two patients (34%) had liver cirrhosis (group A) and 62 (66%) patients had periportal fibrosis (group B). Mortality: The 6-wk and 5-d mortality were 53% and 16% respectively in group A compared to 10% and 0% in group B ( P value < 0.000 and < 0.004). In group A; a Child-Turcotte-Pugh class C and rebleeding within 5 d were significantly associated with 5-d mortality ( P value < 0.029 and < 0.049 respectively) and Child- Turcotte-Pugh class C was also a significant risk factor for 6-wk mortality ( P value < 0.018). In group B; mortality was significantly associated with rebleeding within the 6-wk follow-up period and requirement for blood transfusion on admission ( P value < 0.005 and < 0.049). Rebleeding: The 6-wk and 5-d rebleeding rate in group A were 56% and 25% respectively compared to 32% and 3% in group B ( P value < 0.015 and < 0.002). Clinical presentation with encephalopathy was a significant risk factor for 5 d rebleeding in group A ( P value < 0.005) while grade III periportal fibrosis and requirement for blood transfusion on admission were significant risk factors for 6-wk rebleeding in group B ( P value < 0.004 and < 0.02). The 6-wk and 5-d mortality and rebleeding rate were significantly higher in patients with liver cirrhosis compared to patients with schistosomal periportal fibrosis.

Modeling ecological traps for the control of feral pigs

PubMed Central

Dexter, Nick; McLeod, Steven R

2015-01-01

Ecological traps are habitat sinks that are preferred by dispersing animals but have higher mortality or reduced fecundity compared to source habitats. Theory suggests that if mortality rates are sufficiently high, then ecological traps can result in extinction. An ecological trap may be created when pest animals are controlled in one area, but not in another area of equal habitat quality, and when there is density-dependent immigration from the high-density uncontrolled area to the low-density controlled area. We used a logistic population model to explore how varying the proportion of habitat controlled, control mortality rate, and strength of density-dependent immigration for feral pigs could affect the long-term population abundance and time to extinction. Increasing control mortality, the proportion of habitat controlled and the strength of density-dependent immigration decreased abundance both within and outside the area controlled. At higher levels of these parameters, extinction was achieved for feral pigs. We extended the analysis with a more complex stochastic, interactive model of feral pig dynamics in the Australian rangelands to examine how the same variables as the logistic model affected long-term abundance in the controlled and uncontrolled area and time to extinction. Compared to the logistic model of feral pig dynamics, the stochastic interactive model predicted lower abundances and extinction at lower control mortalities and proportions of habitat controlled. To improve the realism of the stochastic interactive model, we substituted fixed mortality rates with a density-dependent control mortality function, empirically derived from helicopter shooting exercises in Australia. Compared to the stochastic interactive model with fixed mortality rates, the model with the density-dependent control mortality function did not predict as substantial decline in abundance in controlled or uncontrolled areas or extinction for any combination of variables. These models demonstrate that pest eradication is theoretically possible without the pest being controlled throughout its range because of density-dependent immigration into the area controlled. The stronger the density-dependent immigration, the better the overall control in controlled and uncontrolled habitat combined. However, the stronger the density-dependent immigration, the poorer the control in the area controlled. For feral pigs, incorporating environmental stochasticity improves the prospects for eradication, but adding a realistic density-dependent control function eliminates these prospects. PMID:26045954

[Trend on mortality changes for lung cancer during 1972 - 2011 in Qidong, Jiangsu].

PubMed

Zhu, Jian; Chen, Jian-guo; Zhang, Yong-hui; Chen, Yong-sheng; Ding, Lu-lu

2012-09-01

To study the trend of mortality changes on lung cancer during the period 1972 to 2011 in Qidong. Cancer registration data from 1972 - 2011 in Qidong was used to analyze the following information as: crude mortality rate (CR) of lung cancer, the age-standardized rates by China population (CASR) and the World population (WASR), the truncated mortality rate of 35 - 64, the accumulative rate of age from 0 to 74 years old, the accumulative risk, and the total percentage over all sites of cancers. The changes on the trend of mortality by gender, age and period were analyzed. The CR of lung cancer was 31.15 per 100 000 (males: 45.68, females: 16.95). While CASR and WASR were 14.04, and 22.95 per 100 000, respectively. The truncated rate was 31.82 per 100 000. Accumulative rate, accumulative risk, and total percentage were 2.93%, 2.89%, and 20.50% respectively. The mortality rate of lung cancer in males was significantly higher than that in females, with a sex ratio of 2.69:1. CRs increased remarkably with age among those 30-year-olds, with P value being 0.000. When compared with 9 periods of 1972, 1973 - 1977, 1978 - 1982, 1983 - 1987, 1988 - 1992, 1993 - 1997, 1998 - 2002, 2003 - 2007, and 2008 - 2011, the CRs, CASRs and WASRs increased 6.78-folds, 1.60-folds and 1.92-folds, respectively, with the average annual percentage changes (APC) as 4.78%, 1.86% and 2.04%, respectively. The mortality rate of lung cancer among residents during the last four decades in Qidong had been increasing remarkably, suggesting that special attention on lung cancer trend should be highly paid.

Horizontal and trophic transfer of diflubenzuron and fipronil among grasshoppers (Melanoplus sanguinipes) and between grasshoppers and darkling beetles (Tenebrionidae).

PubMed

Smith, D I; Lockwood, J A

2003-04-01

The possibility of horizontal transmission of diflubenzuron and fipronil was assessed in rangeland grasshoppers. Laboratory studies of Melanoplus sanguinipes demonstrated that fipronil was horizontally transferred at lethal levels (p < 0.05) via cannibalism through four passages when the initial dose applied to a food source was 250 times the label rate for rangeland grasshopper and locust control (label rate is 4 g AI/ha). Mortality was 100% on the first three passages through cannibalism. At 25 and 1 times the label rate, fipronil was lethal (p < 0.05) only on the first cannibalistic passage. Diflubenzuron generated significant (p < 0.05) mortality via horizontal transmission through two passages when the initial dose applied to a food source was 2,000 times the label rate for rangeland grasshopper control (label rate is 8.71 g AI/ha). There was 100% mortality in the first passage via cannibalism. At 250 and 25 times the label rate, diflubenzuron was lethal only on the first cannibalistic passage. Field applications of these two acridicides followed by collection of cadavers (Amphitornus coloradus and Ageneotettix deorum) that were fed to M. sanguinipes in the laboratory revealed that fipronil (25 times the label rate) generated significant (p < 0.05) mortality through two passages and diflubenzuron (label rate) caused no mortality via necrophagy. Tenebrionid beetles fed grasshopper cadavers collected from the field application of fipronil yielded 45% mortality, compared with 25% mortality in the controls. These findings suggest that horizontal and trophic transfer probably play a nominal ecotoxicological role in rangeland grasshopper control programs with diflubenzuron, but the transfer of fipronil to grasshoppers, scavengers, and natural enemies via necrophagy may increase both the efficacy of control programs and their environmental affects.

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

PubMed

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

2013-04-01

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

Firearm Homicide and Other Causes of Death in Delinquents: A 16-Year Prospective Study

PubMed Central

Jakubowski, Jessica A.; Abram, Karen M.; Olson, Nichole D.; Stokes, Marquita L.; Welty, Leah J.

2014-01-01

BACKGROUND: Delinquent youth are at risk for early violent death after release from detention. However, few studies have examined risk factors for mortality. Previous investigations studied only serious offenders (a fraction of the juvenile justice population) and provided little data on females. METHODS: The Northwestern Juvenile Project is a prospective longitudinal study of health needs and outcomes of a stratified random sample of 1829 youth (657 females, 1172 males; 524 Hispanic, 1005 African American, 296 non-Hispanic white, 4 other race/ethnicity) detained between 1995 and 1998. Data on risk factors were drawn from interviews; death records were obtained up to 16 years after detention. We compared all-cause mortality rates and causes of death with those of the general population. Survival analyses were used to examine risk factors for mortality after youth leave detention. RESULTS: Delinquent youth have higher mortality rates than the general population to age 29 years (P < .05), irrespective of gender or race/ethnicity. Females died at nearly 5 times the general population rate (P < .05); Hispanic males and females died at 5 and 9 times the general population rates, respectively (P < .05). Compared with the general population, significantly more delinquent youth died of homicide and its subcategory, homicide by firearm (P < .05). Among delinquent youth, racial/ethnic minorities were at increased risk of homicide compared with non-Hispanic whites (P < .05). Significant risk factors for external-cause mortality and homicide included drug dealing (up to 9 years later), alcohol use disorder, and gang membership (up to a decade later). CONCLUSIONS: Delinquent youth are an identifiable target population to reduce disparities in early violent death. PMID:24936005

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

PubMed Central

Haglund, Bengt; Högberg, Ulf; Essén, Birgitta

2013-01-01

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

An experimental evaluation of potential scavenger effects on snake road mortality detections

USGS Publications Warehouse

Hubbard, Kaylan A.; Chalfoun, Anna D.

2012-01-01

As road networks expand and collisions between vehicles and wildlife become more common, accurately quantifying mortality rates for the taxa that are most impacted will be critical. Snakes are especially vulnerable to collisions with vehicles because of their physiology and behavior. Reptile road mortality is typically quantified using driving or walking surveys; however, scavengers can rapidly remove carcasses from the road and cause underestimation of mortality. Our objective was to determine the effect that scavengers might have had on our ability to accurately detect reptile road mortality during over 150 h and 4,000 km of driving surveys through arid shrublands in southwest Wyoming, which resulted in only two observations of mortality. We developed unique simulated snake carcasses out of Burbot (Lota lota), a locally invasive fish species, and examined removal rates across three different road types at three study sites. Carcass size was not a significant predictor of time of removal, and carcass removal was comparable during the daytime and nighttime hours. However, removal of simulated carcasses was higher on paved roads than unpaved or two-track roads at all study sites, with an average of 75% of the carcasses missing within 60 h compared to 34% and 31%, respectively. Scavengers may therefore negatively impact the ability of researchers to accurately detect herpetofaunal road mortality, especially for paved roads where road mortality is likely the most prevalent.

Early loss to follow-up and mortality of HIV-infected patients diagnosed after the era of antiretroviral treatment scale up: a call for re-invigorating the response in Iran.

PubMed

Badie, Banafsheh Moradmand; Nabaei, Ghaemeh; Rasoolinejad, Mehrnaz; Mirzazadeh, Ali; McFarland, Willi

2013-12-01

In Iran, the HIV/AIDS epidemic is growing during an era of scaling up the national surveillance system and antiretroviral therapy programs. We examined the early loss to follow-up and mortality rates in a retrospective cohort of 1495 HIV-infected patients by survival proportional hazard Cox model. We also conducted a data abstraction sub-study in a systematic random sample of 147 patients to assess the association between mortality and predictor factors. Overall, 17.3% patients were not seen after their first visit and 17.4% more were lost by 6 months. The overall mortality rate was 7.0 (95% CI 6.1-8.1) per 100 person-years. Moreover, crude mortality rate was higher in men (8.6) than in women (1.7), with an age-adjusted hazard ratio for men compared to women of 4.55 (95% CI 2.31-8.93). Lastly, history of tuberculosis and not being on antiretroviral therapy were significantly associated with higher mortality in the patient sub-sample.

Patterns in mortality among people with severe mental disorders across birth cohorts: a register-based study of Denmark and Finland in 1982-2006.

PubMed

Gissler, Mika; Laursen, Thomas Munk; Ösby, Urban; Nordentoft, Merete; Wahlbeck, Kristian

2013-09-11

Mortality among patients with mental disorders is higher than in general population. By using national longitudinal registers, we studied mortality changes and excess mortality across birth cohorts among people with severe mental disorders in Denmark and Finland. A cohort of all patients admitted with a psychiatric disorder in 1982-2006 was followed until death or 31 December 2006. Total mortality rates were calculated for five-year birth cohorts from 1918-1922 until 1983-1987 for people with mental disorder and compared to the mortality rates among the general population. Mortality among patients with severe mental disorders declined, but patients with mental disorders had a higher mortality than general population in all birth cohorts in both countries. We observed two exceptions to the declining mortality differences. First, the excess mortality stagnated among Finnish men born in 1963-1987, and remained five to six times higher than at ages 15-24 years in general. Second, the excess mortality stagnated for Danish and Finnish women born in 1933-1957, and remained six-fold in Denmark and Finland at ages 45-49 years and seven-fold in Denmark at ages 40-44 years compared to general population. The mortality gap between people with severe mental disorders and the general population decreased, but there was no improvement for young Finnish men with mental disorders. The Finnish recession in the early 1990s may have adversely affected mortality of adolescent and young adult men with mental disorders. Among women born 1933-1957, the lack of improvement may reflect adverse effects of the era of extensive hospitalisation of people with mental disorders in both countries.

Advancing the Hypothesis that Geographic Variations in Risk Factors Contribute Relatively Little to Observed Geographic Variations in Heart Disease and Stroke Mortality

PubMed Central

Howard, George; Cushman, Mary; Prineas, Ronald J.; Howard, Virginia J.; Moy, Claudia S.; Sullivan, Lisa M.; D’Agostino, Ralph B.; McClure, Leslie A.; Pulley, Lea Vonne; Safford, Monika M.

2009-01-01

Purpose Geographic variation in risk factors may underlie geographic disparities in coronary heart disease (CHD) and stroke mortality. Methods Framingham CHD Risk Score (FCRS) and Stroke Risk Score (FSRS) were calculated for 25,770 stroke-free and 22,247 CHD-free participants from the REasons for Geographic And Racial Differences in Stroke cohort. Vital statistics provided age-adjusted CHD and stroke mortality rates. In an ecologic analysis, the age-adjusted, race-sex weighted, average state-level risk factor levels were compared to state-level mortality rates. Results There was no relationship between CHD and stroke mortality rates (r = 0.04; p = 0.78), but there was between CHD and stroke risk scores at the individual (r = 0.68; p < 0.0001) and state (r = 0.64, p < 0.0001) level. There was a stronger (p < 0.0001) association between state-level FCRS and state-level CHD mortality (r = 0.28, p = 0.18), than between FSRS and stroke mortality (r = 0.12, p = 0.56). Conclusions Weak associations between CHD and stroke mortality and strong associations between CHD and stroke risk scores suggest geographic variation in risk factors may not underlie geographic variations in stroke and CHD mortality. The relationship between risk factor scores and mortality was stronger for CHD than stroke. PMID:19285103

A Population-Based Assessment of the Health of Homeless Families in New York City, 2001–2003

PubMed Central

Bainbridge, Jay; Kennedy, Joseph; Bennani, Yussef; Agerton, Tracy; Marder, Dova; Forgione, Lisa; Faciano, Andrew; Thorpe, Lorna E.

2011-01-01

Objectives. We compared estimated population-based health outcomes for New York City (NYC) homeless families with NYC residents overall and in low-income neighborhoods. Methods. We matched a NYC family shelter user registry to mortality, tuberculosis, HIV/AIDS, and blood lead test registries maintained by the NYC Department of Health and Mental Hygiene (2001–2003). Results. Overall adult age-adjusted death rates were similar among the 3 populations. HIV/AIDS and substance-use deaths were 3 and 5 times higher for homeless adults than for the general population; only substance-use deaths were higher than for low-income adults. Children who experienced homelessness appeared to be at an elevated risk of mortality (41.3 vs 22.5 per 100 000; P < .05). Seven in 10 adult and child deaths occurred outside shelter. Adult HIV/AIDS diagnosis rates were more than twice citywide rates but comparable with low-income rates, whereas tuberculosis rates were 3 times higher than in both populations. Homeless children had lower blood lead testing rates and a higher proportion of lead levels over 10 micrograms per deciliter than did both comparison populations. Conclusions. Morbidity and mortality levels were comparable between homeless and low-income adults; homeless children's slightly higher risk on some measures possibly reflects the impact of poverty and poor-quality, unstable housing. PMID:21233439

Evaluating the Brazilian zero tolerance drinking and driving law: Time series analyses of traffic-related mortality in three major cities.

PubMed

Volpe, Fernando Madalena; Ladeira, Roberto Marini; Fantoni, Rosely

2017-05-19

A zero tolerance alcohol restriction law was adopted in Brazil in 2008. In order to assess the effectiveness of this intervention, the present study compares specific mortality in 2 time series: 1980-2007 and 2008-2013. Data on mortality and population were gathered from official Brazilian Ministry of Health information systems. Segmented regression analyses were carried out separately for 3 major Brazilian capitals: Belo Horizonte, Rio de Janeiro, and São Paulo. In 2 cities (Belo Horizonte and Rio de Janeiro) there were no significant changes in mortality rate trends in 2 periods, 1980 to 2007 and 2008 to 2013, where the observed rates did not differ significantly from predicted rates. In São Paulo, a decreasing trend until 2007 unexpectedly assumed higher levels after implementation of the law. There is no evidence of reduced traffic-related mortality in the 3 major Brazilian capitals 5.5 years after the zero tolerance drinking and driving law was adopted.

Reduction of maternal mortality due to preeclampsia in Colombia-an interrupted time-series analysis

PubMed Central

Herrera-Medina, Rodolfo; Herrera-Escobar, Juan Pablo; Nieto-Díaz, Aníbal

2014-01-01

Introduction: Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002 - 2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR=0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR=0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations. PMID:24970956

Perioperative mortality after hemiarthroplasty related to fixation method.

PubMed

Costain, Darren J; Whitehouse, Sarah L; Pratt, Nicole L; Graves, Stephen E; Ryan, Philip; Crawford, Ross W

2011-06-01

The appropriate fixation method for hemiarthroplasty of the hip as it relates to implant survivorship and patient mortality is a matter of ongoing debate. We examined the influence of fixation method on revision rate and mortality. We analyzed approximately 25,000 hemiarthroplasty cases from the AOA National Joint Replacement Registry. Deaths at 1 day, 1 week, 1 month, and 1 year were compared for all patients and among subgroups based on implant type. Patients treated with cemented monoblock hemiarthroplasty had a 1.7-times higher day-1 mortality compared to uncemented monoblock components (p < 0.001). This finding was reversed by 1 week, 1 month, and 1 year after surgery (p < 0.001). Modular hemiarthroplasties did not reveal a difference in mortality between fixation methods at any time point. This study shows lower (or similar) overall mortality with cemented hemiarthroplasty of the hip.

Can rheumatoid arthritis (RA) registries provide contextual safety data for modern RA clinical trials? The case for mortality and cardiovascular disease.

PubMed

Michaud, Kaleb; Berglind, Niklas; Franzén, Stefan; Frisell, Thomas; Garwood, Christopher; Greenberg, Jeffrey D; Ho, Meilien; Holmqvist, Marie; Horne, Laura; Inoue, Eisuke; Nyberg, Fredrik; Pappas, Dimitrios A; Reed, George; Symmons, Deborah; Tanaka, Eiichi; Tran, Trung N; Verstappen, Suzanne M M; Wesby-van Swaay, Eveline; Yamanaka, Hisashi; Askling, Johan

2016-10-01

We implemented a novel method for providing contextual adverse event rates for a randomised controlled trial (RCT) programme through coordinated analyses of five RA registries, focusing here on cardiovascular disease (CVD) and mortality. Each participating registry (Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (East Europe, Latin America, India) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan)) defined a main cohort from January 2000 onwards. To address comparability and potential bias, we harmonised event definitions and defined several subcohorts for sensitivity analyses based on disease activity, treatment, calendar time, duration of follow-up and RCT exclusions. Rates were standardised for age, sex and, in one sensitivity analysis, also HAQ. The combined registry cohorts included 57 251 patients with RA (234 089 person-years)-24.5% men, mean (SD) baseline age 58.2 (13.8) and RA duration 8.2 (11.7) years. Standardised registry mortality rates (per 100 person-years) varied from 0.42 (CORRONA) to 0.80 (NOAR), with 0.60 for RCT patients. Myocardial infarction and major adverse cardiovascular events (MACE) rates ranged from 0.09 and 0.31 (IORRA) to 0.39 and 0.77 (SRR), with RCT rates intermediate (0.18 and 0.42), respectively. Additional subcohort analyses showed small and mostly consistent changes across registries, retaining reasonable consistency in rates across the Western registries. Additional standardisation for HAQ returned higher mortality and MACE registry rates. This coordinated approach to contextualising RA RCT safety data demonstrated reasonable differences and consistency in rates for mortality and CVD across registries, and comparable RCT rates, and may serve as a model method to supplement clinical trial analyses for drug development programmes. 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/

Latitudinal variation in virus-induced mortality of phytoplankton across the North Atlantic Ocean

PubMed Central

Mojica, Kristina D A; Huisman, Jef; Wilhelm, Steven W; Brussaard, Corina P D

2016-01-01

Viral lysis of phytoplankton constrains marine primary production, food web dynamics and biogeochemical cycles in the ocean. Yet, little is known about the biogeographical distribution of viral lysis rates across the global ocean. To address this, we investigated phytoplankton group-specific viral lysis rates along a latitudinal gradient within the North Atlantic Ocean. The data show large-scale distribution patterns of different virus groups across the North Atlantic that are associated with the biogeographical distributions of their potential microbial hosts. Average virus-mediated lysis rates of the picocyanobacteria Prochlorococcus and Synechococcus were lower than those of the picoeukaryotic and nanoeukaryotic phytoplankton (that is, 0.14 per day compared with 0.19 and 0.23 per day, respectively). Total phytoplankton mortality (virus plus grazer-mediated) was comparable to the gross growth rate, demonstrating high turnover rates of phytoplankton populations. Virus-induced mortality was an important loss process at low and mid latitudes, whereas phytoplankton mortality was dominated by microzooplankton grazing at higher latitudes (>56°N). This shift from a viral-lysis-dominated to a grazing-dominated phytoplankton community was associated with a decrease in temperature and salinity, and the decrease in viral lysis rates was also associated with increased vertical mixing at higher latitudes. Ocean-climate models predict that surface warming will lead to an expansion of the stratified and oligotrophic regions of the world's oceans. Our findings suggest that these future shifts in the regional climate of the ocean surface layer are likely to increase the contribution of viral lysis to phytoplankton mortality in the higher-latitude waters of the North Atlantic, which may potentially reduce transfer of matter and energy up the food chain and thus affect the capacity of the northern North Atlantic to act as a long-term sink for CO2. PMID:26262815

Latitudinal variation in virus-induced mortality of phytoplankton across the North Atlantic Ocean.

PubMed

Mojica, Kristina D A; Huisman, Jef; Wilhelm, Steven W; Brussaard, Corina P D

2016-02-01

Viral lysis of phytoplankton constrains marine primary production, food web dynamics and biogeochemical cycles in the ocean. Yet, little is known about the biogeographical distribution of viral lysis rates across the global ocean. To address this, we investigated phytoplankton group-specific viral lysis rates along a latitudinal gradient within the North Atlantic Ocean. The data show large-scale distribution patterns of different virus groups across the North Atlantic that are associated with the biogeographical distributions of their potential microbial hosts. Average virus-mediated lysis rates of the picocyanobacteria Prochlorococcus and Synechococcus were lower than those of the picoeukaryotic and nanoeukaryotic phytoplankton (that is, 0.14 per day compared with 0.19 and 0.23 per day, respectively). Total phytoplankton mortality (virus plus grazer-mediated) was comparable to the gross growth rate, demonstrating high turnover rates of phytoplankton populations. Virus-induced mortality was an important loss process at low and mid latitudes, whereas phytoplankton mortality was dominated by microzooplankton grazing at higher latitudes (>56°N). This shift from a viral-lysis-dominated to a grazing-dominated phytoplankton community was associated with a decrease in temperature and salinity, and the decrease in viral lysis rates was also associated with increased vertical mixing at higher latitudes. Ocean-climate models predict that surface warming will lead to an expansion of the stratified and oligotrophic regions of the world's oceans. Our findings suggest that these future shifts in the regional climate of the ocean surface layer are likely to increase the contribution of viral lysis to phytoplankton mortality in the higher-latitude waters of the North Atlantic, which may potentially reduce transfer of matter and energy up the food chain and thus affect the capacity of the northern North Atlantic to act as a long-term sink for CO2.

Was the economic crisis 1997-1998 responsible for rising suicide rates in East/Southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand.

PubMed

Chang, Shu-Sen; Gunnell, David; Sterne, Jonathan A C; Lu, Tsung-Hsueh; Cheng, Andrew T A

2009-04-01

In 1997-1998 a widespread economic crisis hit the economies of many East/Southeast Asian countries; its impact on suicide rates across the region has not been systematically documented. We investigated the impact of the Asian economic crisis (1997-1998) on suicide in Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Suicide and population data for the period 1985-2006 were extracted from the World Health Organisation's mortality database and Taiwanese mortality statistics. Sex-specific age-standardised suicide rates for people aged 15years or above were analysed using joinpoint regression. Trends in divorce, marriage, unemployment, gross domestic product (GDP) per capita and alcohol consumption were compared with trends in suicide rates graphically and using time-series analysis. Suicide mortality decreased in the late 1980s and early 1990s but subsequently increased markedly in all countries except Singapore, which had steadily declining suicide rates throughout the study period. Compared to 1997, male rates in 1998 rose by 39% in Japan, 44% in Hong Kong and 45% in Korea; rises in female rates were less marked. Male rates also rose in Thailand, but accurate data were incomplete. The economic crisis was associated with 10,400 more suicides in 1998 compared to 1997 in Japan, Hong Kong and Korea. Similar increases in suicide rates were not seen in Taiwan and Singapore, the two countries where the economic crisis had a smaller impact on GDP and unemployment. Time-series analyses indicated that some of the crisis's impact on male suicides was attributable to increases in unemployment. These findings suggest an association of the Asian economic crisis with a sharp increase in suicide mortality in some, but not all, East/Southeast Asian countries, and that these increases were most closely associated with rises in unemployment.

Education and mortality in Spain: a national study supports local findings.

PubMed

Regidor, Enrique; Reques, Laura; Belza, María J; Kunst, Anton E; Mackenbach, Johan P; de la Fuente, Luis

2016-01-01

To estimate educational inequalities in mortality in Spain and in three Spanish areas: Madrid, Barcelona, and the Basque country. A national prospective study was carried out including all persons aged 25-74 years living in Spain in 2001 and followed up for mortality over 7 years. The mortality rate ratio and difference from all causes and from leading causes of death were estimated for the entire Spanish population and for the above three geographical areas. With respect to people with the highest education, the mortality rate ratios in the entire population of Spain in people with the second highest, second lowest and lowest education were, respectively, 1.09, 1.10, 1.39 in women and 1.19, 1.27 and 1.54 in men. The mortality rate differences per 100,000 person-years were, respectively, 24.8, 28.3, 108.2 in women and 116.7, 162.5 and 319.1 in men. These estimates were intermediate in magnitude compared to those seen in the three geographical areas. The results provide further evidence that educational inequalities in mortality are smaller in the south of Europe than in other European countries.

Mortality in Digestive Cancers, 2012: International Data and Data from Romania.

PubMed

Valean, Simona; Acalovschi, Monica; Diculescu, Mircea; Manuc, Mircea; Goldis, Adrian; Sfarti, Catalin; Trifan, Anca

2015-12-01

We aimed to compare the difference in case fatality rate between more developed and very high Human Development Index (HDI) regions, less developed and low HDI regions, and Romania. The incidence and mortality rates for digestive cancers were obtained from the IARC/WHO 2012 database. World mean mortality-to-incidence ratios registered the highest values in pancreatic cancer (0.97/0.94), and liver cancer (0.93/0.96) in males/females, respectively. The lowest values were recorded in colorectal cancer (0.48 in both sexes). Mortality-to-incidence ratios were generally higher in less developed areas, low HDI populations, and in Romania. The difference in case fatality rate between different areas showed higher variations for colorectal, gastric and gallbladder cancers, and smaller variations for esophageal, liver, and pancreatic cancers. In summary, mortality-to-incidence ratios of digestive cancers were high in 2012; higher values were registered in less developed and low HDI regions, and in Romania. Mortality-to-incidence ratios were similar in both sexes, even though the incidence was generally higher in men. Digestive cancer mortality variation suggests the necessity of finding better strategies for prevention, early diagnosis and treatment of digestive cancers.

Sex Differences in Diabetes Mellitus Mortality Trends in Brazil, 1980-2012

PubMed Central

Brito, Alexandre dos Santos; Pinheiro, Rejane Sobrino; Cabral, Cristiane da Silva; de Camargo, Thais Medina Coeli Rochel

2016-01-01

Aims To investigate the hypothesis that the change from the female predominance of diabetes mellitus to a standard of equality or even male preponderance can already be observed in Brazilian mortality statistics. Methods Data on deaths for which diabetes mellitus was listed as the underlying cause were obtained from the Brazilian Mortality Information System for the years 1980 to 2012. The mortality data were also analyzed according to the multiple causes of death approach from 2001 to 2012. The population data came from the Brazilian Institute of Geography and Statistics. The mortality rates were standardized to the world population. We used a log-linear joinpoint regression to evaluate trends in age-standardized mortality rates (ASMR). Results From 1980 to 2012, we found a marked increment in the diabetes ASMR among Brazilian men and a less sharp increase in the rate among women, with the latter period (2003–2012) showing a slight decrease among women, though it was not statistically significant. Conclusions The results of this study suggest that diabetes mellitus in Brazil has changed from a pattern of higher mortality among women compared to men to equality or even male predominance. PMID:27275600

Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions.

PubMed

Borzecki, Ann M; Christiansen, Cindy L; Chew, Priscilla; Loveland, Susan; Rosen, Amy K

2010-12-01

In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities.

Bacterial Sepsis in Brazilian Children: A Trend Analysis from 1992 to 2006

PubMed Central

Mangia, Cristina Malzoni Ferreira; Kissoon, Niranjan; Branchini, Otavio Augusto; Andrade, Maria Cristina; Kopelman, Benjamin Israel; Carcillo, Joe

2011-01-01

Background The objective of this study was to determine the epidemiology of hospitalized pediatric sepsis in Brazil (1992–2006) and to compare mortality caused by sepsis to that caused by other major childhood diseases. Methods and Findings We performed a retrospective descriptive study of hospital admissions using a government database of all hospital affiliated with the Brazilian health system. We studied all hospitalizations in children from 28 days through 19 years with diagnosis of bacterial sepsis defined by the criteria of the International Classification of Diseases (ICD), (Appendix S1). Based on the data studied from 1992 through 2006, the pediatric hospital mortality rate was 1.23% and there were 556,073 pediatric admissions with bacterial sepsis with a mean mortality rate of 19.9%. There was a case reduction of 67% over.1992–2006 (p<0.001); however, the mortality rate remained unchanged (from 1992–1996, 20.5%; and from 2002–2006, 19.7%). Sepsis-hospital mortality rate was substantially higher than pneumonia (0.5%), HIV (3.3%), diarrhea (0.3%), undernutrition (2.3%), malaria (0.2%) and measles (0.7%). The human development index (HDI) and mortality rates (MR) by region were: North region 0.76 and 21.7%; Northeast region 0.72 and 27.1%; Central-West 0.81 and 23.5%; South region 0.83 and 12.2% and Southeast region 0.82 and 14.8%, respectively. Conclusions We concluded that sepsis remains an important health problem in children in Brazil. The institution of universal primary care programs has been associated with substantially reduced sepsis incidence and therefore deaths; however, hospital mortality rates in children with sepsis remain unchanged. Implementation of additional health initiatives to reduce sepsis mortality in hospitalized patients could have great impact on childhood mortality rates in Brazil. PMID:21674036

The obesity-associated risk of cardiovascular disease and all-cause mortality is not lower in Inuit compared to Europeans: A cohort study of Greenlandic Inuit, Nunavik Inuit and Danes.

PubMed

Rønn, Pernille Falberg; Lucas, Michel; Laouan Sidi, Elhadji A; Tvermosegaard, Maria; Andersen, Gregers Stig; Lauritzen, Torsten; Toft, Ulla; Carstensen, Bendix; Christensen, Dirk Lund; Jørgensen, Marit Eika

2017-10-01

Inuit populations have lower levels of cardiometabolic risk factors for the same level of body mass index (BMI) or waist circumference (WC) compared to Europeans in cross-sectional studies. We aimed to compare the longitudinal associations of anthropometric measures with cardiovascular disease (CVD) and all-cause mortality in Inuit and Europeans. Using pooled data from three population-based studies in Canada, Greenland and Denmark, we conducted a cohort study of 10,033 adult participants (765 Nunavik Inuit, 2960 Greenlandic Inuit and 6308 Europeans). Anthropometric measures collected at baseline included: BMI, WC, waist-to-hip-ratio (WHR), waist-to-height-ratio (WHtR) and a body shape index (ABSI). Information on CVD and death was retrieved from national registers or medical files. Poisson regression analyses were used to calculate incidence rates for CVD and all-cause mortality. During a median follow-up of 10.5 years, there were 642 CVD events and 594 deaths. Slightly higher absolute incidence rates of CVD for a given anthropometric measure were found in Nunavik Inuit compared with Greenlandic Inuit and the Europeans; however, no cohort interactions were observed. For all-cause mortality, all anthropometric measures were positively associated in the Europeans, but only ABSI in the two Inuit populations. In contrast, BMI and WC were inversely associated with mortality in the two Inuit populations. Inuit and Europeans have different absolute incidences of CVD and all-cause mortality, but the trends in the associations with the anthropometric measures only differ for all-cause mortality. Previous findings of a lower obesity-associated cardiometabolic risk among Inuit were not confirmed. Copyright © 2017 Elsevier B.V. All rights reserved.

Speed of Heart Rate Recovery in Response to Orthostatic Challenge.

PubMed

McCrory, Cathal; Berkman, Lisa F; Nolan, Hugh; O'Leary, Neil; Foley, Margaret; Kenny, Rose Anne

2016-08-19

Speed of heart rate recovery (HRR) may serve as an important biomarker of aging and mortality. To examine whether the speed of HRR after an orthostatic maneuver (ie, active stand from supine position) predicts mortality. A longitudinal cohort study involving a nationally representative sample of community-dwelling older individuals aged ≥50 years. A total of 4475 participants completed an active stand at baseline as part of a detailed clinic-based cardiovascular assessment. Beat-to-beat heart rate and blood pressure responses to standing were measured during a 2-minute window using a finometer and binned in 10-s intervals. We modeled HRR to the stand by age group, cardiovascular disease burden, and mortality status using a random effects model. Mortality status during a mean follow-up duration of 4.3 years served as the primary end point (n=138). Speed of HRR in the immediate 20 s after standing was a strong predictor of mortality. A 1-bpm slower HRR between 10 and 20 s after standing increased the hazard of mortality by 6% controlling for established risk factors. A clear dose-response relationship was evident. Sixty-nine participants in the slowest HRR quartile died during the observation period compared with 14 participants in the fastest HRR quartile. Participants in the slowest recovery quartile were 2.3× more likely to die compared with those in the fastest recovery quartile. Speed of orthostatic HRR predicts mortality and may aid clinical decision making. Attenuated orthostatic HRR may reflect dysregulation of the parasympathetic branch of the autonomic nervous system. © 2016 American Heart Association, Inc.

Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines-Stroke Hospitals.

PubMed

Thompson, Michael P; Zhao, Xin; Bekelis, Kimon; Gottlieb, Daniel J; Fonarow, Gregg C; Schulte, Phillip J; Xian, Ying; Lytle, Barbara L; Schwamm, Lee H; Smith, Eric E; Reeves, Mathew J

2017-08-01

We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation. This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level. We used linear regression to estimate adjusted HRR-level 30-day outcomes, to identify HRR-level characteristics associated with 30-day outcomes, and to describe which characteristics explained variation in 30-day outcomes. The mean adjusted HRR-level 30-day mortality and readmission rates were 10.3% (SD=1.1%) and 13.1% (SD=1.1%), respectively; a modest, negative correlation ( r =-0.17; P =0.003) was found between one another. Demographics explained more variation in readmissions than mortality (25% versus 6%), but after accounting for demographics, comorbidities accounted for more variation in mortality compared with readmission rates (17% versus 7%). The combination of hospital characteristics and healthcare resources explained 11% and 16% of the variance in mortality and readmission rates, beyond patient characteristics. Most of the regional variation in mortality (65%) and readmission (50%) rates remained unexplained. Thirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained. © 2017 American Heart Association, Inc.

Variation in hospital mortality in an Australian neonatal intensive care unit network.

PubMed

Abdel-Latif, Mohamed E; Nowak, Gen; Bajuk, Barbara; Glass, Kathryn; Harley, David

2018-07-01

Studying centre-to-centre (CTC) variation in mortality rates is important because inferences about quality of care can be made permitting changes in practice to improve outcomes. However, comparisons between hospitals can be misleading unless there is adjustment for population characteristics and severity of illness. We sought to report the risk-adjusted CTC variation in mortality among preterm infants born <32 weeks and admitted to all eight tertiary neonatal intensive care units (NICUs) in the New South Wales and the Australian Capital Territory Neonatal Network (NICUS), Australia. We analysed routinely collected prospective data for births between 2007 and 2014. Adjusted mortality rates for each NICU were produced using a multiple logistic regression model. Output from this model was used to construct funnel plots. A total of 7212 live born infants <32 weeks gestation were admitted consecutively to network NICUs during the study period. NICUs differed in their patient populations and severity of illness.The overall unadjusted hospital mortality rate for the network was 7.9% (n=572 deaths). This varied from 5.3% in hospital E to 10.4% in hospital C. Adjusted mortality rates showed little CTC variation. No hospital reached the +99.8% control limit level on adjusted funnel plots. Characteristics of infants admitted to NICUs differ, and comparing unadjusted mortality rates should be avoided. Logistic regression-derived risk-adjusted mortality rates plotted on funnel plots provide a powerful visual graphical tool for presenting quality performance data. CTC variation is readily identified, permitting hospitals to appraise their practices and start timely intervention. © 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.

Mortality Rates After Emergent Posterior Fossa Decompression for Ischemic or Hemorrhagic Stroke in Older Patients.

PubMed

Puffer, Ross C; Graffeo, Christopher; Rabinstein, Alejandro; Van Gompel, Jamie J

2016-08-01

Cerebellar stroke causes major morbidity in the aging population. Guidelines from the American Stroke Association recommend emergent decompression in patients who have brainstem compression, hydrocephalus, or clinical deterioration. The objective of this study was to determine 30-day and 1-year mortality rates in patients >60 years old undergoing emergent posterior fossa decompression. Surgical records identified all patients >60 years old who underwent emergent posterior fossa decompression. Mortality rates were calculated at 30 days and 1 year postoperatively, and these rates were compared with patient and procedure characteristics. During 2000-2014, 34 emergent posterior fossa decompressions were performed in patients >60 years old. Mortality rates at 30 days were 0%, 33%, and 25% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age (alive at 30 days 75.2 years ± 1.7 vs. deceased 81.1 years ± 1.7, P = 0.01) and smaller craniectomy dimensions were associated with 30-day mortality. Mortality rates at 1 year were 0%, 50%, and 67% for age deciles 60-69 years, 70-79 years, and ≥80 years. Increasing age was significantly associated with mortality at 1 year (alive at 1 year 72.3 years ± 2.0 vs. deceased 81.1 years ± 1.2, P < 0.01). Type of pathology, side of pathology, volume of bleed/infarct, and placement of an external ventricular drain were not associated with mortality. Age was independent of admission Glasgow Coma Scale score as a predictor of mortality at 30 days, 90 days, and 1 year postoperatively. Increasing age and smaller craniectomy size were significantly associated with mortality in patients undergoing emergent posterior fossa decompression. Among patients ≥80 years old, one-quarter were dead within 1 month of the operation, and more than two-thirds were dead within 1 year. Copyright © 2016 Elsevier Inc. All rights reserved.

Do Mothers with Lower Socioeconomic Status Contribute to the Rate of All-Cause Child Mortality in Kazakhstan?

PubMed Central

Yu, Fei; Yan, Ziqi; Pu, Run

2018-01-01

Background This study aimed to explore whether or not mothers with higher educational and wealth status report lower rate of child mortality compared to those with less advantageous socioeconomic situation. Methods Data used were cross-sectional and collected from Multiple Indicator Cluster Survey in Kazakhstan conducted in 2015. Subjects experiencing childbirth were 9278 women aging between 15 and 49 years. The associations between maternal education and household wealth status with child mortality were examined by multivariate analytical methods. Results The overall prevalence of child mortality was 6.7%, with noticeable variations across the different regions. Compared with women who had the highest educational status, those with upper and lower secondary were 1.47 and 1.89 times more likely to experience child death. Women in the lowest and second lowest wealth quintile had 2.74 and 2.68 times higher odds of experiencing child death compared with those in the richest wealth status households. Conclusions Policy makers pay special attention to improving socioeconomic status of the mothers in an effort to reduce child mortality in the country. Women living in the disadvantaged regions with poor access to quality health care services should be regarded as a top priority. PMID:29651427

Ascertainment of Hispanic ethnicity on California death certificates: implications for the explanation of the Hispanic mortality advantage.

PubMed

Eschbach, Karl; Kuo, Yong-Fang; Goodwin, James S

2006-12-01

We determined the size and correlates of underascertainment of Hispanic ethnicity on California death certificates. We used 1999 to 2000 vital registration data. We compared Hispanic ethnicity reported on the death certificate to Hispanic ethnicity derived from birthplace for the foreign-born and an algorithm that used first and last name and percentage of Hispanics in the county of residence for the US-born. We validated death certificate nativity by comparing data with that in linked Social Security Administration records. Ethnicity and birthplace information was concordant for foreign-born Hispanics, who have mortality rates that are 25% to 30% lower than those of non-Hispanic Whites. Death certificates likely underascertain deaths of US-born Hispanics, particularly at older ages, for persons with more education, and in census tracts with lower percentages of Hispanics. Conservative correction for under-ascertainment eliminates the Hispanic mortality advantage for US-born men. Hispanic ethnicity is accurately ascertained on the California death certificate for immigrants. Immigrant Hispanics have lower age-adjusted mortality rates than do non-Hispanic Whites. For US-born Hispanics, the mortality advantage compared with non-Hispanic Whites is smaller and may be explained by underreporting of Hispanic ethnicity on the death certificate.

The Diabetic Foot as a Proxy for Cardiovascular Events and Mortality Review.

PubMed

Dietrich, Isa; Braga, Gustavo Arruda; de Melo, Fernanda Gomes; da Costa Silva Silva, Ana Carolina Calmon

2017-10-02

This article reviewed very recent papers (2016) discussing or bringing clinical evidences of the possible common pathways leading to diabetic foot syndrome (DFS) and increased mortality rates. Diabetic patients with diabetic foot syndrome have a mortality rate greater than twofold when compared with non-ulcerated diabetics. In addition, the 5-year mortality rate following amputation is estimated at 39-68%, a life expectancy comparable to aggressive types of cancer or advanced congestive heart failure. The majority of patients with diabetic foot ulcer also present insulin resistance, central obesity, dyslipidemia, and hypertension that characterize the metabolic syndrome that, in turn, is associated with an elevated risk of major cardiovascular events. Sensory neuropathy is the primary cause of more the 60% of diabetic foot ulcer. Diabetic peripheral neuropathy is a microvascular complication of diabetes mellitus and in type 2 diabetes, not only hyperglycemia but also other metabolic alterations and persistent inflammatory status due to adiposity play a major role in axon injury. Elevated triglycerides have been showed to be an independent risk factor for lower extremity amputation in diabetic patients. Also, toxic adiposity, oxidative stress, mitochondrial dysfunction, activation of the polyol pathway, accumulation of advanced glycation end products (AGEs), and elevation of inflammatory markers are also implicated in diabetic vascular disease and neuropathy. The hypotheses that the association between DFS and increased rates of mortality reflects the progression of micro- and macrovascular complications are reinforced by the additional association of DFU to renal failure and retinopathy.

Six-fold difference in the stomach cancer mortality rate between northern and southern Iran.

PubMed

Zendehdel, Kazem; Marzban, Maryam; Nahvijou, Azin; Jafari, Nahid

2012-12-01

Stomach cancer is the most common cancer in Iran. A multi-ethnic population and wide variation in the environmental risk factors may lead to variations in cancer risk within this country. We have designed an ecological study and evaluated geographical variation regarding mortality from stomach cancer and its established risk factors in Iran.  We used the Iranian National Causes of Death Registry and estimated the age-standardized mortality rates (ASMR) of stomach cancer in 29 Iranian provinces, stratified by sex and area of residence (rural/urban).  The average ASMR of stomach cancer among Iranian males was 15 per 100,000 and for females it was 8.1 per 100,000. The highest and lowest mortality rates were observed in Kurdistan with an ASMR of 29.1 per 100,000 in northwestern Iran and Hormozgan that had an ASMR of 5.0 per 100,000 in southern Iran. Males had approximately a two-fold higher ASMR compared to females, as did rural residents when compared with urban residents. The prevalence of H. pylori infection was about 90% in the province of Ardabil (a high-risk area) and 27% in the province of Sistan-Baluchistan (a low-risk area).  The wide geographical variation and high mortality rate of stomach cancer in Iran is likely due to differences in the exposure to the environmental risk factors among people living in the high- and low-risk areas, particularly H. pylori infection, a well-established risk factor of stomach cancer.

Comparative life tables of leek moth, Acrolepiopsis assectella (Zeller) (Lepidoptera: Acrolepiidae), in its native range.

PubMed

Jenner, W H; Kuhlmann, U; Mason, P G; Cappuccino, N

2010-02-01

Leek moth, Acrolepiopsis assectella (Zeller) (Lepidoptera: Acrolepiidae), is an invasive alien species in eastern Canada, the larvae of which mine the green tissues of Allium spp. This study was designed to construct and analyse life tables for leek moth within its native range. Stage-specific mortality rates were estimated for the third leek moth generation at three sites in Switzerland from 2004 to 2006 to identify some of the principle factors that inhibit leek moth population growth in areas of low pest density. The contribution of natural enemies to leek moth mortality was measured by comparing mortality on caged and uncaged leeks. Total pre-imaginal mortality on uncaged plants was 99.6%, 99.1% and 96.4% in 2004, 2005 and 2006, respectively. Variation in mortality was greater among years than among sites. Total larval mortality was greater than that in the eggs and pupae. This was due largely to the high mortality (up to 83.3%) of neonates during the brief period between egg hatch and establishment of the feeding mine. Leek moth pupal mortality was significantly greater on uncaged than on caged leeks, indicating an impact by natural enemies, and this pattern was consistent over all three years of study. In contrast, the other life stages did not show consistently higher mortality rates on uncaged plants. This observation suggests that the pupal stage may be particularly vulnerable to natural enemies and, therefore, may be the best target for classical biological control in Canada.

Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study

PubMed Central

Ferri, Cleusa P.; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Llibre-Rodriguez, Juan J.; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D.; Gaona, Ciro; Liu, Zhaorui; Noriega-Fernandez, Lisseth; Jotheeswaran, A. T.; Prince, Martin J.

2012-01-01

Background Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking. Methods and Findings The vital status of 12,373 people aged 65 y and over was determined 3–5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89–0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. Conclusions Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development. Please see later in the article for the Editors' Summary PMID:22389633

Socioeconomic disparities in colorectal cancer mortality in the United States, 1990-2007.

PubMed

Enewold, Lindsey; Horner, Marie-Josèphe; Shriver, Craig D; Zhu, Kangmin

2014-08-01

United States colorectal cancer mortality rates have declined; however, disparities by socioeconomic status and race/ethnicity persist. The objective of this study was to describe the temporal association between colorectal cancer mortality and socioeconomic status by sex and race/ethnicity. Cancer mortality rates in the United States from 1990 to 2007, which were generated by the National Center for Health Statistics, and county-level socioeconomic status, which was estimated as the proportion of county residents living below the national poverty line based on 1990 US Census Bureau data, were obtained from the Surveillance, Epidemiology, and End Results program. The Kunst-Mackenbach relative index of inequality, which considers data across all poverty levels when comparing risks in the poorest (≥ 20%) and richest counties (<10%), was calculated as the measure of association. The study found that colorectal cancer mortality rates were significantly lower in the poorest counties than the richest counties during 1990-1992 among non-Hispanic whites, non-Hispanic black women and non-Hispanic API men. Over time though the tendency was for the poorest counties to have higher mortality rates. By 2003-2007 colorectal cancer mortality rates were significantly higher in the poorest than the richest counties among all sex-race/ethnicity groups. This disparity was most noticeable and appeared to be increasing most among Hispanic men. This suggests that socioeconomic disparities in colorectal cancer mortality were apparent after stratifying by sex and race/ethnicity and reversed over time. Further studies into the causes of these disparities would provide a basis for targeted cancer control interventions and allocation of public health resources.

Trends in Mortality of Tuberculosis Patients in the United States: The Long-term Perspective

PubMed Central

Barnes, Richard F.W.; Moore, Maria Luisa; Garfein, Richard S.; Brodine, Stephanie; Strathdee, Steffanie A.; Rodwell, Timothy C.

2011-01-01

PURPOSE To describe long-term trends in TB mortality and to compare trends estimated from two different sources of public health surveillance data. METHODS Trends and changes in trend were estimated by joinpoint regression. Comparisons between datasets were made by fitting a Poisson regression model. RESULTS Since 1900, TB mortality rates estimated from death certificates have declined steeply, except for a period of no change in the 1980s. This decade had long-term consequences resulting in more TB deaths in later years than would have occurred had there been no flattening of the trend. Recent trends in TB mortality estimated from National Tuberculosis Surveillance System (NTSS) data, which record all-cause mortality, differed from trends based on death certificates. In particular, NTSS data showed TB mortality rates flattening since 2002. CONCLUSIONS Estimates of trends in TB mortality vary by data source, and therefore interpretation of the success of control efforts will depend upon the surveillance dataset used. The datasets may be subject to different biases that vary with time. One dataset showed a sustained improvement in the control of TB since the early 1990s while the other indicated that the rate of TB mortality was no longer declining. PMID:21820320

Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France.

PubMed

Pilkington, Hugo; Blondel, Béatrice; Drewniak, Nicolas; Zeitlin, Jennifer

2014-12-01

The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001-08 by distance from mother's municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5-45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

Interactions between hatch dates, growth rates, and mortality of Age-0 native Rainbow Smelt and nonnative Alewife in Lake Champlain

USGS Publications Warehouse

Parrish, Donna; Simonin, Paul W.; Rudstam, Lars G.; Pientka, Bernard; Sullivan, Patrick J.

2016-01-01

Timing of hatch in fish populations can be critical for first-year survival and, therefore, year-class strength and subsequent species interactions. We compared hatch timing, growth rates, and subsequent mortality of age-0 Rainbow Smelt Osmerus mordax and Alewife Alosa pseudoharengus, two common open-water fish species of northern North America. In our study site, Lake Champlain, Rainbow Smelt hatched (beginning May 26) almost a month earlier than Alewives (June 20). Abundance in the sampling area was highest in July for age-0 Rainbow Smelt and August for age-0 Alewives. Late-hatching individuals of both species grew faster than those hatching earlier (0.6 mm/d versus 0.4 for Rainbow Smelt; 0.7 mm/d versus 0.6 for Alewives). Mean mortality rate during the first 45 d of life was 3.4%/d for age-0 Rainbow Smelt and was 5.5%/d for age-0 Alewives. Alewife mortality rates did not differ with hatch timing but daily mortality rates of Rainbow Smelt were highest for early-hatching fish. Cannibalism is probably the primary mortality source for age-0 Rainbow Smelt in this lake. Therefore, hatching earlier may not be advantageous because the overlap of adult and age-0 Rainbow Smelt is highest earlier in the season. However, Alewives, first documented in Lake Champlain in 2003, may increase the mortality of age-0 Rainbow Smelt in the summer, which should favor selection for earlier hatching.

Breast Cancer Biology and Ethnic Disparities in Breast Cancer Mortality in New Zealand: A Cohort Study

PubMed Central

Seneviratne, Sanjeewa; Lawrenson, Ross; Scott, Nina; Kim, Boa; Shirley, Rachel; Campbell, Ian

2015-01-01

Introduction Indigenous Māori women have a 60% higher breast cancer mortality rate compared with European women in New Zealand. We investigated differences in cancer biological characteristics and their impact on breast cancer mortality disparity between Māori and NZ European women. Materials and Methods Data on 2849 women with primary invasive breast cancers diagnosed between 1999 and 2012 were extracted from the Waikato Breast Cancer Register. Differences in distribution of cancer biological characteristics between Māori and NZ European women were explored adjusting for age and socioeconomic deprivation in logistic regression models. Impacts of socioeconomic deprivation, stage and cancer biological characteristics on breast cancer mortality disparity between Māori and NZ European women were explored in Cox regression models. Results Compared with NZ European women (n=2304), Māori women (n=429) had significantly higher rates of advanced and higher grade cancers. Māori women also had non-significantly higher rates of ER/PR negative and HER-2 positive breast cancers. Higher odds of advanced stage and higher grade remained significant for Māori after adjusting for age and deprivation. Māori women had almost a 100% higher age and deprivation adjusted breast cancer mortality hazard compared with NZ European women (HR=1.98, 1.55-2.54). Advanced stage and lower proportion of screen detected cancer in Māori explained a greater portion of the excess breast cancer mortality (HR reduction from 1.98 to 1.38), while the additional contribution through biological differences were minimal (HR reduction from 1.38 to 1.35). Conclusions More advanced cancer stage at diagnosis has the greatest impact while differences in biological characteristics appear to be a minor contributor for inequities in breast cancer mortality between Māori and NZ European women. Strategies aimed at reducing breast cancer mortality in Māori should focus on earlier diagnosis, which will likely have a greater impact on reducing breast cancer mortality inequity between Māori and NZ European women. PMID:25849101

Association of Visual Impairment and All-Cause 10-Year Mortality Among Indigenous Australian Individuals Within Central Australia: The Central Australian Ocular Health Study.

PubMed

Ng, Soo Khai; Kahawita, Shyalle; Andrew, Nicholas Howard; Henderson, Tim; Craig, Jamie Evan; Landers, John

2018-05-01

It is well established from different population-based studies that visual impairment is associated with increased mortality rate. However, to our knowledge, the association of visual impairment with increased mortality rate has not been reported among indigenous Australian individuals. To assess the association between visual impairment and 10-year mortality risk among the remote indigenous Australian population. Prospective cohort study recruiting indigenous Australian individuals from 30 remote communities located within the central Australian statistical local area over a 36-month period between July 2005 and June 2008. The data were analyzed in January 2017. Visual acuity, slitlamp biomicroscopy, and fundus examination were performed on all patients at recruitment. Visual impairment was defined as a visual acuity of less than 6/12 in the better eye. Mortality rate and mortality cause were obtained at 10 years, and statistical analyses were performed. Hazard ratios for 10-year mortality with 95% confidence intervals are presented. One thousand three hundred forty-seven patients were recruited from a total target population number of 2014. The mean (SD) age was 56 (11) years, and 62% were women. The total all-cause mortality was found to be 29.3% at 10 years. This varied from 21.1% among those without visual impairment to 48.5% among those with visual impairment. After adjustment for age, sex, and the presence of diabetes and hypertension, those with visual impairment were 40% more likely to die (hazard ratio, 1.40; 95% CI, 1.16-1.70; P = .001) during the 10-year follow-up period compared with those with normal vision. Bilateral visual impairment among remote indigenous Australian individuals was associated with 40% higher 10-year mortality risk compared with those who were not visually impaired. Resource allocation toward improving visual acuity may therefore aid in closing the gap in mortality outcomes between indigenous and nonindigenous Australian individuals.

Mortality in children, adolescents and adults with sickle cell anemia in Rio de Janeiro, Brazil.

PubMed

Lobo, Clarisse Lopes de Castro; Nascimento, Emilia Matos do; Jesus, Leonardo José Carvalho de; Freitas, Thiago Gotelip de; Lugon, Jocemir Ronaldo; Ballas, Samir K

To determine the mortality rate of children, adolescents and adults with sickle cell anemia in Rio de Janeiro, Brazil. The number of deaths, the mortality rate and the causes of deaths in patients with sickle cell anemia who were treated and followed up at our institution for 15 years were determined and compared to data available for the Brazilian population. The overall number of deaths was 281 patients with a mortality rate of 16.77%. Survival probability was significantly higher in females. The number of deaths and the mortality rate were age-specific with a significant increase in the 19- to 29-year-old age group. The remaining life expectancy of the patients with sickle cell anemia was less than that of Brazilians at large. The gap between the two was about 20 years for ages between one and five years with this gap decreasing to ten years after the age of 65 years. The most common causes of death were infection, acute chest syndrome, overt stroke, organ damage and sudden death during painful crises. To the best of our knowledge, this is the first Brazilian study in a single institution in Rio de Janeiro; the mortality rate was 18.87% among adult patients with sickle cell anemia. The mortality rates in children and adults are higher than those reported in developed countries of the northern hemisphere. Copyright © 2017 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.

Trends in Hospitalization Rates and Outcomes of Endocarditis among Medicare Beneficiaries

PubMed Central

Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Desai, Mayur M.; Quagliarello, Vincent; Krumholz, Harlan M.

2015-01-01

Objectives To determine the hospitalization rates and outcomes of endocarditis among older adults. Background Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. Methods Using Medicare inpatient Standard Analytic Files, we identified all Fee-For-Service beneficiaries aged ≥65 years with a principal or secondary diagnosis of endocarditis from 1999-2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised recommendations for endocarditis prophylaxis. Results Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999-2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006-2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with principal diagnosis of endocarditis. Conclusions Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines. PMID:23994421

Trends in hospitalization rates and outcomes of endocarditis among Medicare beneficiaries.

PubMed

Bikdeli, Behnood; Wang, Yun; Kim, Nancy; Desai, Mayur M; Quagliarello, Vincent; Krumholz, Harlan M

2013-12-10

The aim of this study was to determine the hospitalization rates and outcomes of endocarditis among older adults. Endocarditis is the most serious cardiovascular infection and is especially common among older adults. Little is known about recent trends for endocarditis hospitalizations and outcomes. Using Medicare inpatient Standard Analytic Files, we identified all fee-for-service beneficiaries age ≥65 years with a principal or secondary diagnosis of endocarditis from 1999 to 2010. We used Medicare Denominator Files to report hospitalizations per 100,000 person-years. Rates of 30-day and 1-year mortality were calculated using Vital Status Files. We used mixed-effects models to calculate adjusted rates of hospitalization and mortality and to compare the results before and after 2007, when the American Heart Association revised their recommendations for endocarditis prophylaxis. Overall, 262,658 beneficiaries were hospitalized with endocarditis. The adjusted hospitalization rate increased from 1999 to 2005, reaching 83.5 per 100,000 person-years in 2005, and declined during 2006 to 2007. After 2007, the decline continued, reaching 70.6 per 100,000 person-years in 2010. Adjusted 30-day and 1-year mortality rates ranged from 14.2% to 16.5% and from 32.6% to 36.2%, respectively. There were no consistent changes in adjusted rates of 30-day and 1-year mortality after 2007. Trends in rates of hospitalization and outcomes were consistent across demographic subgroups. Adjusted rates of hospitalization and mortality declined consistently in the subgroup with a principal diagnosis of endocarditis. Our study highlights the high burden of endocarditis among older adults. We did not observe an increase in adjusted rates of hospitalization or mortality associated with endocarditis after publication of the 2007 guidelines. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Diabetes increases mortality after myocardial infarction by oxidizing CaMKII

PubMed Central

Luo, Min; Guan, Xiaoqun; Luczak, Elizabeth D.; Lang, Di; Kutschke, William; Gao, Zhan; Yang, Jinying; Glynn, Patric; Sossalla, Samuel; Swaminathan, Paari D.; Weiss, Robert M.; Yang, Baoli; Rokita, Adam G.; Maier, Lars S.; Efimov, Igor R.; Hund, Thomas J.; Anderson, Mark E.

2013-01-01

Diabetes increases oxidant stress and doubles the risk of dying after myocardial infarction, but the mechanisms underlying increased mortality are unknown. Mice with streptozotocin-induced diabetes developed profound heart rate slowing and doubled mortality compared with controls after myocardial infarction. Oxidized Ca2+/calmodulin-dependent protein kinase II (ox-CaMKII) was significantly increased in pacemaker tissues from diabetic patients compared with that in nondiabetic patients after myocardial infarction. Streptozotocin-treated mice had increased pacemaker cell ox-CaMKII and apoptosis, which were further enhanced by myocardial infarction. We developed a knockin mouse model of oxidation-resistant CaMKIIδ (MM-VV), the isoform associated with cardiovascular disease. Streptozotocin-treated MM-VV mice and WT mice infused with MitoTEMPO, a mitochondrial targeted antioxidant, expressed significantly less ox-CaMKII, exhibited increased pacemaker cell survival, maintained normal heart rates, and were resistant to diabetes-attributable mortality after myocardial infarction. Our findings suggest that activation of a mitochondrial/ox-CaMKII pathway contributes to increased sudden death in diabetic patients after myocardial infarction. PMID:23426181

Cardiovascular Disease Mortality in Asian Americans (2003–2010)

PubMed Central

Jose, Powell O.; Frank, Ariel TH; Kapphahn, Kristopher I.; Goldstein, Benjamin A.; Eggleston, Karen; Hastings, Katherine G.; Cullen, Mark R.; Palaniappan, Latha P

2014-01-01

Background Asian Americans are a rapidly growing racial/ethnic group in the United States. Our current understanding of Asian-American cardiovascular disease mortality patterns is distorted by the aggregation of distinct subgroups. Objectives To examine heart disease and stroke mortality rates in Asian-American subgroups to determine racial/ethnic differences in cardiovascular disease mortality within the United States. Methods We examined heart disease and stroke mortality rates for the 6 largest Asian-American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) from 2003–2010. U.S. death records were used to identify race/ethnicity and cause of death by ICD-10 coding. Using both U.S. Census and death record data, standardized mortality ratios (SMR), relative SMRs (rSMR), and proportional mortality ratios (PMR) were calculated for each sex and ethnic group relative to Non-Hispanic Whites (NHW). Results 10,442,034 death records were examined. While NHW men and women had the highest overall mortality rates, Asian Indian men and women and Filipino men had greater proportionate mortality burden from ischemic heart disease. The proportionate mortality burden of hypertensive heart disease and cerebrovascular disease, especially hemorrhagic stroke, was higher in every Asian-American subgroup compared to NHWs. Conclusions The heterogeneity in cardiovascular disease mortality patterns among diverse Asian-American subgroups calls attention to the need for more research to help direct more specific treatment and prevention efforts, in particular with hypertension and stroke, to reduce health disparities for this growing population. PMID:25500233

Population density and mortality among individuals in motor vehicle crashes.

PubMed

Gedeborg, Rolf; Thiblin, Ingemar; Byberg, Liisa; Melhus, Håkan; Lindbäck, Johan; Michaelsson, Karl

2010-10-01

To assess whether higher mortality rates among individuals in motor vehicle crashes in areas with low population density depend on injury type and severity or are related to the performance of emergency medical services (EMS). Prehospital and hospital deaths were studied in a population-based cohort of 41,243 motor vehicle crashes that occurred in Sweden between 1998 and 2004. The final multivariable analysis was restricted to 6884 individuals in motor vehicle crashes, to minimise the effects of confounding factors. Crude mortality rates following motor vehicle crashes were inversely related to regional population density. In regions with low population density, the unadjusted rate ratio for prehospital death was 2.2 (95% CI 1.9 to 2.5) and for hospital death 1.5 (95% CI 1.1 to 1.9), compared with a high-density population. However, after controlling for regional differences in age, gender and the type/severity of injuries among 6884 individuals in motor vehicle crashes, low population density was no longer associated with increased mortality. At 25 years of age, predicted prehospital mortality was 9% lower (95% CI 5% to 12%) in regions with low population density compared with high population density. This difference decreased with increasing age, but was still 3% lower (95% CI 0.5% to 5%) at 65 years of age. The inverse relationship between population density and mortality among individuals in motor vehicle crashes is related to pre-crash factors that influence the type and severity of injuries and not to differences in EMS.

Characteristics and Long-Term Prognosis of Holocaust Survivors Presenting with Acute Myocardial Infarction.

PubMed

Shiyovich, Arthur; Plakht, Ygal; Belinski, Katya; Gilutz, Harel

2016-05-01

Catastrophic life events are associated with the occurrence of cardiovascular incidents and worsening of the clinical course followirg-such events. To evaluate the characteristics and long-term prognosis of Holocaust survivors presenting with acute myocardial infarction (AMI) compared to non-Holocaust survivors. Israeli Jews who were born before 1941 and had been admitted to a tertiary medical center due to AMI during the period 2002-2012 were studied. Holocaust survivors were compared with non-Holocaust survivor controls using individual age matching. Overall 305 age-matched pairs were followed for up to 10 years after AMI. We found a higher prevalence of depression (5.9% vs. 3.3%, P = 0.045) yet a similar rate of cardiovascular risk factors, non-cardiovascular co-morbidity, severity of coronary artery disease, and in-hospital complications in survivors compared to controls. Throughout the follow-up period, similar mortality rates (62.95% vs. 63.9%, P = 0.801) and reduced cumulative mortality (0.9 vs. 0.96, HR = 0.780, 95% CI 0.636-0.956, P = 0.016) were found among survivors compared to age-matched controls, respectively. However, in a multivariate analysis survival was not found to be an independent predictor of mortality, although some tendency towards reduced mortality was seen (AdjHR = 0.84, 95% CI 0.68-1.03, P = 0.094). Depression disorder was associated with a 77.9% increase in the risk for mortality. Holocaust survivors presenting with AMI were older and had a higher prevalence of depression than controls. No. excessive, and possibly even mildly improved, risk of mortality.was observed in survivors compared with controls presenting with AMI. Possibly, specific traits that are associated with surviving catastrophic events counter the excess risk of such events following AMI.

Variation in stem mortality rates determines patterns of above-ground biomass in Amazonian forests: implications for dynamic global vegetation models.

PubMed

Johnson, Michelle O; Galbraith, David; Gloor, Manuel; De Deurwaerder, Hannes; Guimberteau, Matthieu; Rammig, Anja; Thonicke, Kirsten; Verbeeck, Hans; von Randow, Celso; Monteagudo, Abel; Phillips, Oliver L; Brienen, Roel J W; Feldpausch, Ted R; Lopez Gonzalez, Gabriela; Fauset, Sophie; Quesada, Carlos A; Christoffersen, Bradley; Ciais, Philippe; Sampaio, Gilvan; Kruijt, Bart; Meir, Patrick; Moorcroft, Paul; Zhang, Ke; Alvarez-Davila, Esteban; Alves de Oliveira, Atila; Amaral, Ieda; Andrade, Ana; Aragao, Luiz E O C; Araujo-Murakami, Alejandro; Arets, Eric J M M; Arroyo, Luzmila; Aymard, Gerardo A; Baraloto, Christopher; Barroso, Jocely; Bonal, Damien; Boot, Rene; Camargo, Jose; Chave, Jerome; Cogollo, Alvaro; Cornejo Valverde, Fernando; Lola da Costa, Antonio C; Di Fiore, Anthony; Ferreira, Leandro; Higuchi, Niro; Honorio, Euridice N; Killeen, Tim J; Laurance, Susan G; Laurance, William F; Licona, Juan; Lovejoy, Thomas; Malhi, Yadvinder; Marimon, Bia; Marimon, Ben Hur; Matos, Darley C L; Mendoza, Casimiro; Neill, David A; Pardo, Guido; Peña-Claros, Marielos; Pitman, Nigel C A; Poorter, Lourens; Prieto, Adriana; Ramirez-Angulo, Hirma; Roopsind, Anand; Rudas, Agustin; Salomao, Rafael P; Silveira, Marcos; Stropp, Juliana; Ter Steege, Hans; Terborgh, John; Thomas, Raquel; Toledo, Marisol; Torres-Lezama, Armando; van der Heijden, Geertje M F; Vasquez, Rodolfo; Guimarães Vieira, Ima Cèlia; Vilanova, Emilio; Vos, Vincent A; Baker, Timothy R

2016-12-01

Understanding the processes that determine above-ground biomass (AGB) in Amazonian forests is important for predicting the sensitivity of these ecosystems to environmental change and for designing and evaluating dynamic global vegetation models (DGVMs). AGB is determined by inputs from woody productivity [woody net primary productivity (NPP)] and the rate at which carbon is lost through tree mortality. Here, we test whether two direct metrics of tree mortality (the absolute rate of woody biomass loss and the rate of stem mortality) and/or woody NPP, control variation in AGB among 167 plots in intact forest across Amazonia. We then compare these relationships and the observed variation in AGB and woody NPP with the predictions of four DGVMs. The observations show that stem mortality rates, rather than absolute rates of woody biomass loss, are the most important predictor of AGB, which is consistent with the importance of stand size structure for determining spatial variation in AGB. The relationship between stem mortality rates and AGB varies among different regions of Amazonia, indicating that variation in wood density and height/diameter relationships also influences AGB. In contrast to previous findings, we find that woody NPP is not correlated with stem mortality rates and is weakly positively correlated with AGB. Across the four models, basin-wide average AGB is similar to the mean of the observations. However, the models consistently overestimate woody NPP and poorly represent the spatial patterns of both AGB and woody NPP estimated using plot data. In marked contrast to the observations, DGVMs typically show strong positive relationships between woody NPP and AGB. Resolving these differences will require incorporating forest size structure, mechanistic models of stem mortality and variation in functional composition in DGVMs. © 2016 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

Mortality Rates Following Posterior C1-2 Fusion for Displaced Type II Odontoid Fractures in Octogenarians.

PubMed

Clark, Stephen; Nash, Alysa; Shasti, Mark; Brown, Luke; Jauregui, Julio J; Mistretta, Katherine; Koh, Eugene; Banagan, Kelley; Ludwig, Steven; Gelb, Daniel

2018-03-13

Retrospective cohort study OBJECTIVE.: To assess 30-day and one-year mortality rates as well as the most common complications associated with posterior C1-2 fusion in an octogenarian cohort. Treatment of unstable type II odontoid fractures in elderly patients can present challenges. Recent evidence indicates in patients older than 80 years, posterior C1-2 fusion results in improved survival as compared to other modes of treatment. Retrospective analysis of 43 consecutive patients (25 F and 18 M; mean age 84.3y, range 80-89y; mean Charlson Comorbidities Index 1.4, (range 1-6); mean BMI 24.8 ± 4.2 kg/m2, who underwent posterior C1-C2 fusion for management of unstable type II odontoid fracture by 4 fellowship trained spine surgeons at a single institution between January 2006-June 2016. Mean fracture displacement was 5.1 ± 3.6 mm and mean absolute value of angulation was 19.93 ± 12.93°. The most common complications were altered mental status (41.9%, n = 18), dysphagia (27.9%, n = 12) with 50% of those patients (6 of 12) requiring a feeding tube, and emergency reintubation (9.3%, n = 4). To the date of review completion, 25 of 43 patients expired (58.1%), median survival of 1.76 years from the date of surgery. Thirty-day and one-year mortality rates were 2.3% and 18.6%, respectively. Patients who developed dysphagia were 14.5 times more likely to have expired at 1 year; dysphagia was also found to be significantly associated with degree of displacement. Fracture displacement was found to be associated with increased odds for 1-year mortality when accounting for age and requirement of a feeding tube. Posterior C1-2 fusion results in acceptably low mortality rates in octogenarians with unstable type II odontoid fractures when compared to non-operative management mortality rates in current literature. Initial fracture displacement is associated with higher mortality rate in this patient population. 4.

Examining mortality among formerly homeless adults enrolled in Housing First: An observational study.

PubMed

Henwood, Benjamin F; Byrne, Thomas; Scriber, Brynn

2015-12-04

Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population. Housing First (HF) is an evidence-based practice that effectively ends chronic homelessness, yet there has been virtually no research on premature mortality among HF enrollees. In the United States, this gap in the literature exists despite research that has suggested chronically homeless adults constitute an aging cohort, with nearly half aged 50 years old or older. This observational study examined mortality among formerly homeless adults in an HF program. We examined death rates and causes of death among HF participants and assessed the timing and predictors of death among HF participants following entry into housing. We also compared mortality rates between HF participants and (a) members of the general population and (b) individuals experiencing homelessness. We supplemented these analyses with a comparison of the causes of death and characteristics of decedents in the HF program with a sample of adults identified as homeless in the same city at the time of death through a formal review process. The majority of decedents in both groups were between the ages of 45 and 64 at their time of death; the average age at death for HF participants was 57, compared to 53 for individuals in the homeless sample. Among those in the HF group, 72% died from natural causes, compared to 49% from the homeless group. This included 21% of HF participants and 7% from the homeless group who died from cancer. Among homeless adults, 40% died from an accident, which was significantly more than the 14% of HF participants who died from an accident. HIV or other infectious diseases contributed to 13% of homeless deaths compared to only 2% of HF participants. Hypothermia contributed to 6% of homeless deaths, which was not a cause of death for HF participants. Results suggest HF participants face excess mortality in comparison to members of the general population and that mortality rates among HF participants are higher than among those reported among members of the general homeless population in prior studies. However, findings also suggest that causes of death may differ between HF participants and their homeless counterparts. Specifically, chronic diseases appear to be more prominent causes of death among HF participants, indicating the potential need for integrating medical support and end-of-life care in HF.

Projected temperature-related deaths in ten large U.S. metropolitan areas under different climate change scenarios.

PubMed

Weinberger, Kate R; Haykin, Leah; Eliot, Melissa N; Schwartz, Joel D; Gasparrini, Antonio; Wellenius, Gregory A

2017-10-01

There is an established U-shaped association between daily temperature and mortality. Temperature changes projected through the end of century are expected to lead to higher rates of heat-related mortality but also lower rates of cold-related mortality, such that the net change in temperature-related mortality will depend on location. We quantified the change in heat-, cold-, and temperature-related mortality rates through the end of the century across 10 large US metropolitan areas. We applied location-specific projections of future temperature from over 40 downscaled climate models to exposure-response functions relating daily temperature and mortality in 10 US metropolitan areas to estimate the change in temperature-related mortality rates in 2045-2055 and 2085-2095 compared to 1992-2002, under two greenhouse gas emissions scenarios (RCP 4.5 and 8.5). We further calculated the total number of deaths attributable to temperature in 1997, 2050, and 2090 in each metropolitan area, either assuming constant population or accounting for projected population growth. In each of the 10 metropolitan areas, projected future temperatures were associated with lower rates of cold-related deaths and higher rates of heat-related deaths. Under the higher-emission RCP 8.5 scenario, 8 of the 10 metropolitan areas are projected to experience a net increase in annual temperature-related deaths per million people by 2086-2095, ranging from a net increase of 627 (95% empirical confidence interval [eCI]: 239, 1018) deaths per million in Los Angeles to a net decrease of 59 (95% eCI: -485, 314) deaths per million in Boston. Applying these projected temperature-related mortality rates to projected population size underscores the large public health burden of temperature. Increases in the heat-related death rate are projected to outweigh decreases in the cold-related death rate in 8 out of 10 cities studied under a high emissions scenario. Adhering to a lower greenhouse gas emissions scenario has the potential to substantially reduce future temperature-related mortality. Copyright © 2017 Elsevier Ltd. All rights reserved.

Mortality in patients with psoriasis. A retrospective cohort study.

PubMed

Masson, Walter; Rossi, Emiliano; Galimberti, María Laura; Krauss, Juan; Navarro Estrada, José; Galimberti, Ricardo; Cagide, Arturo

2017-06-07

The immune and inflammatory pathways involved in psoriasis could favor the development of atherosclerosis, consequently increasing mortality. The objectives of this study were: 1) to assess the mortality of a population with psoriasis compared to a control group, and 2) to assess the prevalence of cardiovascular risk factors. A retrospective cohort was analyzed from a secondary database (electronic medical record). All patients with a diagnosis of psoriasis at 1-01-2010 were included in the study and compared to a control group of the same health system, selected randomly (1:1). Subjects with a history of cardiovascular disease were excluded from the study. A survival analysis was performed considering death from any cause as an event. Follow-up was extended until 30-06-2015. We included 1,481 subjects with psoriasis and 1,500 controls. Prevalence of cardiovascular risk factors was higher in the group with psoriasis. The average follow-up time was 4.6±1.7 years. Mortality was higher in psoriasis patients compared to controls (15.1 vs. 9.6 events per 1,000 person-year, P<.005). Psoriasis was seen to be significantly associated with increased mortality rates compared to the control group in the univariate analysis (HR 1.58, 95% CI 1.16-2.15, P=.004) and after adjusting for cardiovascular risk factors (HR 1.48, 95% CI 1.08-2.3, P=.014). In this population, patients with psoriasis showed a higher prevalence for the onset of cardiovascular risk factors as well as higher mortality rates during follow-up. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003-15.

PubMed

Gesesew, Hailay Abrha; Ward, Paul; Woldemichael, Kifle; Mwanri, Lillian

2018-01-01

Several studies reported that the majority of deaths in HIV-infected people are documented in their early antiretroviral therapy (ART) follow-ups. Early mortality refers to death of people on ART for follow up period of below 24 months due to any cause. The current study assessed predictors of early HIV mortality in Southwest Ethiopia. We have conducted a retrospective analysis of 5299 patient records dating from June 2003- March 2015. To estimate survival time and compare the time to event among the different groups of patients, we used a Kaplan Meir curve and log-rank test. To identify mortality predictors, we used a cox regression analysis. We used SPSS-20 for all analyses. A total of 326 patients died in the 12 years follow-up period contributing to 6.2% cumulative incidence and 21.7 deaths per 1000 person-year observations incidence rate. Eighty-nine percent of the total deaths were documented in the first two years follow up-an early-term ART follow up. Early HIV mortality rates among adults were 50% less in separated, divorced or widowed patients compared with never married patients, 1.6 times higher in patients with baseline CD4 count <200 cells/μL compared to baseline CD4 count ≥200 cells/μL, 1.5 times higher in patients with baseline WHO clinical stage 3 or 4 compared to baseline WHO clinical stage 1 or 2, 2.1 times higher in patients with immunologic failure compared with no immunologic failure, 60% less in patients with fair or poor compared with good adherence, 2.9 times higher in patients with bedridden functional status compared to working functional status, and 2.7 times higher with patients who had no history of HIV testing before diagnosis compared to those who had history of HIV testing. Most predictors of early mortality remained the same to the predictors of an overall HIV mortality. When discontinuation was assumed as an event, the predictors of an overall HIV mortality included age between 25-50 years, base line CD4 count, developing immunologic failure, bedridden functional status, and no history of HIV testing before diagnosis. The great majority of deaths were documented in the first two years of ART, and several predictors of early HIV mortality were also for the overall mortality when discontinuation was assumed as event or censored. Considering the above population, interventions to improve HIV program in the first two years of ART follow up should be improved.

Self-Rated Health Changes and Oldest-Old Mortality

PubMed Central

2014-01-01

Objectives. This study explores how 2 measures of self-rated health (SRH) change are related to mortality among oldest-old adults. In doing so, it also considers how associations between SRH and mortality may depend on prior SRH. Method. Data come from the Asset and Health Dynamics survey—the oldest-old portion of the Health and Retirement Study—and follow 6,233 individuals across 13 years. I use parametric hazard models to examine relationships between death and 2 measures of short-term SRH change—a computed measure comparing SRH at time t–1 and t, and a respondent-provided retrospectively reported change. Results. Respondents who demonstrate or report any SRH change between survey waves died at a greater rate than those with consistent SRH. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death, when compared with those with no change. Discussion. These findings suggest that the well-established associations between SRH status and mortality may understate the risk of death for oldest-old individuals with recent subjective health improvements. PMID:24589929

Comparative analyses of longevity and senescence reveal variable survival benefits of living in zoos across mammals.

PubMed

Tidière, Morgane; Gaillard, Jean-Michel; Berger, Vérane; Müller, Dennis W H; Bingaman Lackey, Laurie; Gimenez, Olivier; Clauss, Marcus; Lemaître, Jean-François

2016-11-07

While it is commonly believed that animals live longer in zoos than in the wild, this assumption has rarely been tested. We compared four survival metrics (longevity, baseline mortality, onset of senescence and rate of senescence) between both sexes of free-ranging and zoo populations of more than 50 mammal species. We found that mammals from zoo populations generally lived longer than their wild counterparts (84% of species). The effect was most notable in species with a faster pace of life (i.e. a short life span, high reproductive rate and high mortality in the wild) because zoos evidently offer protection against a number of relevant conditions like predation, intraspecific competition and diseases. Species with a slower pace of life (i.e. a long life span, low reproduction rate and low mortality in the wild) benefit less from captivity in terms of longevity; in such species, there is probably less potential for a reduction in mortality. These findings provide a first general explanation about the different magnitude of zoo environment benefits among mammalian species, and thereby highlight the effort that is needed to improve captive conditions for slow-living species that are particularly susceptible to extinction in the wild.

Pretreatment with intravenous lipid emulsion reduces mortality from cocaine toxicity in a rat model.

PubMed

Carreiro, Stephanie; Blum, Jared; Hack, Jason B

2014-07-01

We compare the effects of intravenous lipid emulsion and normal saline solution pretreatment on mortality and hemodynamic changes in a rat model of cocaine toxicity. We hypothesize that intravenous lipid emulsion will decrease mortality and hemodynamic changes caused by cocaine administration compared with saline solution. Twenty male Sprague-Dawley rats were sedated and randomized to receive intravenous lipid emulsion or normal saline solution, followed by a 10 mg/kg bolus of intravenous cocaine. Continuous monitoring included intra-arterial blood pressure, pulse rate and ECG tracing. Endpoints included a sustained undetectable mean arterial pressure (MAP) or return to baseline MAP for 5 minutes. The log-rank test was used to compare mortality. A mixed-effect repeated-measures ANOVA was used to estimate the effects of group (intravenous lipid emulsion versus saline solution), time, and survival on change in MAP, pulse rate, or pulse pressure. In the normal saline solution group, 7 of 10 animals died compared with 2 of 10 in the intravenous lipid emulsion group. The survival rate of 80% (95% confidence interval 55% to 100%) for the intravenous lipid emulsion rats and 30% (95% confidence interval 0.2% to 58%) for the normal saline solution group was statistically significant (P=.045). Intravenous lipid emulsion pretreatment decreased cocaine-induced cardiovascular collapse and blunted hypotensive effects compared with normal saline solution in this rat model of acute lethal cocaine intoxication. Intravenous lipid emulsion should be investigated further as a potential adjunct in the treatment of severe cocaine toxicity. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Gender-specific mortality in DTP-IPV- and MMR±MenC-eligible age groups to determine possible sex-differential effects of vaccination: an observational study.

PubMed

Schurink-van't Klooster, Tessa M; Knol, Mirjam J; de Melker, Hester E; van der Sande, Marianne A B

2015-03-24

Several studies suggested that vaccines could have non-specific effects on mortality depending on the type of vaccine. Non-specific effects seem to be different in boys and girls. In this study we want to investigate whether there are differences in gender-specific mortality among Dutch children according to the last vaccination received. We tested the hypothesis that the mortality rate ratio for girls versus boys is more favourable for girls following MMR±MenC vaccination (from 14 months of age) compared with the ratio following DTP-IPV vaccination (2-13 months of age). Secondarily, we investigated whether there were gender-specific changes in mortality following booster vaccination at 4 years of age. This observational study included all Dutch children aged 0-11 years from 2000 until 2011. Age groups were classified according to the last vaccination offered. The mortality rates for all natural causes of death were calculated by gender and age group. Incidence rate ratios (IRRs) were computed using a multivariable Poisson analysis to compare mortality in boys and girls across different age groups. The study population consisted of 6,261,472 children. During the study period, 14,038 children (0.22%) died, 91% of which were attributed to a known natural cause of death. The mortality rate for natural causes was higher among boys than girls in all age groups. Adjusted IRRs for girls compared with boys ranged between 0.81 (95% CI 0.74-0.89) and 0.91 (95% CI 0.77-1.07) over the age groups. The IRR did not significantly differ between all vaccine-related age groups (p=0.723), between children 2-13 months (following DTP-IPV vaccination) and 14 months-3 years (following MMR±MenC vaccination) (p=0.493) and between children 14 months-3 years and 4-8 years old (following DTP-IPV vaccination) (p=0.868). In the Netherlands, a high income country, no differences in gender-specific mortality related to the type of last vaccination received were observed in DTP-IPV- and MMR ± MenC eligible age groups. The inability to detect this effect indicates that when non-specific effects were present the effects were not reflected in changes in the differences in mortality between boys and girls. The findings in this large population-based study are reassuring for the continued trust in the safety of the national vaccination programme.

High rates of death and hospitalization follow bone fracture among hemodialysis patients.

PubMed

Tentori, Francesca; McCullough, Keith; Kilpatrick, Ryan D; Bradbury, Brian D; Robinson, Bruce M; Kerr, Peter G; Pisoni, Ronald L

2014-01-01

Altered bone structure and function contribute to the high rates of fractures in dialysis patients compared to the general population. Fracture events may increase the risk of subsequent adverse clinical outcomes. Here we assessed the incidence of post-fracture morbidity and mortality in an international cohort of 34,579 in-center hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). We estimated country-specific rates of fractures requiring a hospital admission and associated length of stay in the hospital. Incidence rates of death and of a composite event of death/rehospitalization were estimated for 1 year after fracture. Overall, 3% of participants experienced a fracture. Fracture incidence varied across countries, from 12 events/1000 patient-years (PY) in Japan to 45/1000 PY in Belgium. In all countries, fracture rates were higher in the hemodialysis group compared to those reported for the general population. Median length of stay ranged from 7 to 37 days in the United States and Japan, respectively. In most countries, postfracture mortality rates exceeded 500/1000 PY and death/rehospitalization rates exceeded 1500/1000 PY. Fracture patients had higher unadjusted rates of death (3.7-fold) and death/rehospitalization (4.0-fold) compared to the overall DOPPS population. Mortality and hospitalization rates were highest in the first month after the fracture and declined thereafter. Thus, the high frequency of fractures and increased adverse outcomes following a fracture pose a significant health burden for dialysis patients. Fracture prevention strategies should be identified and applied broadly in nephrology practices.

High rates of death and hospitalization follow bone fracture among hemodialysis patients

PubMed Central

Tentori, Francesca; McCullough, Keith; Kilpatrick, Ryan D.; Bradbury, Brian D.; Robinson, Bruce M.; Kerr, Peter G.; Pisoni, Ronald L.

2013-01-01

Altered bone structure and function contribute to the high rates of fractures in dialysis patients compared to the general population. Fracture events may increase the risk of subsequent adverse clinical outcomes. Here we assessed incidence of post-fracture morbidity and mortality in an international cohort of 34, 579 in-center hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). We estimated country-specific rates of fractures requiring a hospital admission and associated length of stay in the hospital. Incidence rates of death and of a composite event of death/re-hospitalization were estimated for the 1-year post-fracture. Overall, 3% of participants experienced a fracture. Fracture incidence varied across countries, from 12 events/1000 patient year (p-y) in Japan to 45/1000 p-y in Belgium. In all countries, fracture rates were higher in the hemodialysis group compared to those reported for the general population. Median length of stay ranged from 7 to 37 days in the United States and Japan, respectively. In most countries, post-fracture mortality rates exceeded 500/1000 p-y and death/re-hospitalization rates exceeded 1500/1000 p-y. Fracture patients had higher unadjusted rates of death (3.7- fold) and death/re-hospitalization (4.0-fold) compared to the overall DOPPS population. Mortality and hospitalization rates were highest in the first month after the fracture and declined thereafter. Thus, the high frequency of fractures and increased adverse outcomes following a fracture pose a significant health burden for dialysis patients. Fracture prevention strategies should be identified and applied broadly in nephrology practices. PMID:23903367

Contextual determinants of neonatal mortality using two analysis methods, Rio Grande do Sul, Brazil.

PubMed

Zanini, Roselaine Ruviaro; Moraes, Anaelena Bragança de; Giugliani, Elsa Regina Justo; Riboldi, João

2011-02-01

To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models. Cohort study including 138,407 live births with birth certificates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis. The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1- and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain significant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions. The use of multilevel models showed a small effect of contextual determinants on the neonatal mortality rate. There was found a positive association with the poverty rate in the general model, and the proportion of households with water supply among preterm newborns.

Trends in Breast Cancer Stage and Mortality in Michigan (1992–2009) by Race, Socioeconomic Status, and Area Healthcare Resources

PubMed Central

Akinyemiju, Tomi F.; Soliman, Amr S.; Copeland, Glenn; Banerjee, Mousumi; Schwartz, Kendra; Merajver, Sofia D.

2013-01-01

The long-term effect of socioeconomic status (SES) and healthcare resources availability (HCA) on breast cancer stage of presentation and mortality rates among patients in Michigan is unclear. Using data from the Michigan Department of Community Health (MDCH) between 1992 and 2009, we calculated annual proportions of late-stage diagnosis and age-adjusted breast cancer mortality rates by race and zip code in Michigan. SES and HCA were defined at the zip-code level. Joinpoint regression was used to compare the Average Annual Percent Change (AAPC) in the median zip-code level percent late stage diagnosis and mortality rate for blacks and whites and for each level of SES and HCA. Between 1992 and 2009, the proportion of late stage diagnosis increased among white women [AAPC = 1.0 (0.4, 1.6)], but was statistically unchanged among black women [AAPC = −0.5 (−1.9, 0.8)]. The breast cancer mortality rate declined among whites [AAPC = −1.3% (−1.8,−0.8)], but remained statistically unchanged among blacks [AAPC = −0.3% (−0.3, 1.0)]. In all SES and HCA area types, disparities in percent late stage between blacks and whites appeared to narrow over time, while the differences in breast cancer mortality rates between blacks and whites appeared to increase over time. PMID:23637921

Assessment of the Effects of Severe Winter Disasters (Dzud) on Public Health in Mongolia on the Basis of Loss of Livestock.

PubMed

Otani, Shinji; Onishi, Kazunari; Kurozawa, Youichi; Kurosaki, Yasunori; Bat-Oyun, Tserenpurev; Shinoda, Masato; Mu, Haosheng

2016-08-01

Mongolia experienced one of its most severe natural winter disasters (dzud) in 2009-2010. It is difficult to accurately assess the risk of the effects of dzud on human lives and public health. This study aimed to evaluate the Mongolian public health risks of dzud by assessing livestock loss. We analyzed data from all 21 provinces and Ulaanbaatar in Mongolia and compared the changes in infant mortality (2009-2010) and the decline in the numbers of livestock (percentage change from the previous year), which included horses, cattle, camels, sheep, and goats (2009-2010) and/or meteorological data. We also evaluated the association among the trends in the infant mortality rate, the number of livestock, and foodstuff consumption throughout Mongolia (2001-2012). The change in the infant mortality rate was positively correlated with the rate of decreasing numbers of each type of livestock in 2010. Average temperature and total precipitation were not related to the change in the infant mortality rate. In the trend from 2001 to 2012, there was a significant positive correlation between the infant mortality rate and the number of livestock and the consumption of milk products. Loss of livestock and shortage of milk products leading to malnutrition might have affected public health as typified by infant mortality in Mongolia. (Disaster Med Public Health Preparedness. 2016;10:549-552).

Mortality rates and risk factors for emergent open repair of abdominal aortic aneurysms in the endovascular era.

PubMed

Pecoraro, Felice; Gloekler, Steffen; Mader, Caecilia E; Roos, Malgorzata; Chaykovska, Lyubov; Veith, Frank J; Cayne, Neal S; Mangialardi, Nicola; Neff, Thomas; Lachat, Mario

2018-03-01

The background of this paper is to report the mortality at 30 and 90 days and at mean follow-up after open abdominal aortic aneurysms (AAA) emergent repair and to identify predictive risk factors for 30- and 90-day mortality. Between 1997 and 2002, 104 patients underwent emergent AAA open surgery. Symptomatic and ruptured AAAs were observed, respectively, in 21 and 79% of cases. Mean patient age was 70 (SD 9.2) years. Mean aneurysm maximal diameter was 7.4 (SD 1.6) cm. Primary endpoints were 30- and 90-day mortality. Significant mortality-related risk factor identification was the secondary endpoint. Open repair trend and its related perioperative mortality with a per-year analysis and a correlation subanalysis to identify predictive mortality factor were performed. Mean follow-up time was 23 (SD 23) months. Overall, 30-day mortality was 30%. Significant mortality-related risk factors were the use of computed tomography (CT) as a preoperative diagnostic tool, AAA rupture, preoperative shock, intraoperative cardiopulmonary resuscitation (CPR), use of aortic balloon occlusion, intraoperative massive blood transfusion (MBT), and development of abdominal compartment syndrome (ACS). Previous abdominal surgery was identified as a protective risk factor. The mortality rate at 90 days was 44%. Significant mortality-related risk factors were AAA rupture, aortocaval fistula, peripheral artery disease (PAD), preoperative shock, CPR, MBT, and ACS. The mortality rate at follow-up was 45%. Correlation analysis showed that MBT, shock, and ACS are the most relevant predictive mortality factor at 30 and 90 days. During the transition period from open to endovascular repair, open repair mortality outcomes remained comparable with other contemporary data despite a selection bias for higher risk patients. MBT, shock, and ACS are the most pronounced predictive mortality risk factors.

High-Amplitude Atlantic Hurricanes Produce Disparate Mortality in Small, Low-Income Countries.

PubMed

Dresser, Caleb; Allison, Jeroan; Broach, John; Smith, Mary-Elise; Milsten, Andrew

2016-12-01

Hurricanes cause substantial mortality, especially in developing nations, and climate science predicts that powerful hurricanes will increase in frequency during the coming decades. This study examined the association of wind speed and national economic conditions with mortality in a large sample of hurricane events in small countries. Economic, meteorological, and fatality data for 149 hurricane events in 16 nations between 1958 and 2011 were analyzed. Mortality rate was modeled with negative binomial regression implemented by generalized estimating equations to account for variable population exposure, sequence of storm events, exposure of multiple islands to the same storm, and nonlinear associations. Low-amplitude storms caused little mortality regardless of economic status. Among high-amplitude storms (Saffir-Simpson category 4 or 5), expected mortality rate was 0.72 deaths per 100,000 people (95% confidence interval [CI]: 0.16-1.28) for nations in the highest tertile of per capita gross domestic product (GDP) compared with 25.93 deaths per 100,000 people (95% CI: 13.30-38.55) for nations with low per capita GDP. Lower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations. (Disaster Med Public Health Preparedness. 2016;10:832-837).

Model calculated global, regional and megacity premature mortality due to air pollution

NASA Astrophysics Data System (ADS)

Lelieveld, J.; Barlas, C.; Giannadaki, D.; Pozzer, A.

2013-03-01

Air pollution by fine particulate matter (PM2.5) and ozone (O3) has increased strongly with industrialization and urbanization. We estimated the premature mortality rates and the years of human life lost (YLL) caused by anthropogenic PM2.5 and O3 in 2005 for epidemiological regions defined by the World Health Organization. We carried out high-resolution global model calculations to resolve urban and industrial regions in greater detail compared to previous work. We applied a health impact function to estimate premature mortality for people of 30 yr and older, using parameters derived from epidemiological cohort studies. Our results suggest that especially in large countries with extensive suburban and rural populations, air pollution-induced mortality rates have previously been underestimated. We calculate a global respiratory mortality of about 773 thousand yr-1 (YLL ≈ 5.2 million yr-1), 186 thousand yr-1 by lung cancer (YLL ≈ 1.7 million yr-1) and 2.0 million yr-1 by cardiovascular disease (YLL ≈ 14.3 million yr-1). The global mean per capita mortality caused by air pollution is about 0.1 % yr-1. The highest premature mortality rates are found in the Southeast Asia and Western Pacific regions (about 25% and 46% of the global rate, respectively) where more than a dozen of the most highly polluted megacities are located.

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.

[Trends in the mortality of liver cancer in Qidong, China: an analysis of fifty years].

PubMed

Chen, Jian-guo; Zhu, Jian; Zhang, Yong-hui; Chen, Yong-sheng; Ding, Lu-lu; Lu, Jian-hua; Zhu, Yuan-rong

2012-07-01

To describe and analyze the charecteristics and trends of liver cancer mortality during the past fifty years in Qidong, China. Retrospective mortality survey was conducted to get the data on liver cancer death in the period of 1958-1971, and the data from 1972 to 2007 were obtained from the records of cancer registration in Qidong. The crude mortality rate (CR) of liver cancer, and age-standardized rate by Chinese population (CASR) and by world population (WASR) were calculated and analyzed. The total percent changes (PC) and annual percent changes (APC) were used for evaluating the increasing trends of the mortality. The sex-specific rate, age-specific rate, truncated rate of the age group 35 - 64, cumulative rate of the age group 0-74, cumulative risk, period-rate, and the rate for age-birth cohort were compared. The natural death rate in Qidong residents for the past five-decade period experienced a wave interval of 8.62‰ in 1958 down to 5.37‰ in 1979, and up to 7.75‰ in 2007. The mortality rate for all-site cancers was increased from 56.69 per 100, 000 to 234.97 per 100, 000. The mortality rate of liver cancer, being 20.45 per 100, 100 in 1958 was increased to 49.04 per 100, 000 in 1972, and up to 69.29 per 100, 000 in 2007. According to the registration data of 1972 - 2007, the death from liver cancer was accounted for 34.88% of all deaths due to cancers, with a CR of 58.86 per 100, 000, CASR of 38.36 per 100, 000, and WASR, 49.37 Per 100, 000 in Qidong. The truncated rate for the age group 35 - 64 was 117.08 per 100, 000, and the cumulative rate for the age group 0-74 and the cumulative risk were 5.15% and 5.02%, respectively. The CRs for males was 90.52 per 100, 000 and for females was 27.93 per 100, 000, with a sex ratio of 3.24:1. For the period of 1972 - 2007, the PC for CR was 49.71%, and APC was +1.41%, showing an increasing variation tendency. The APCs for CASR and WASR, however, were decreasing, with a percentage of -1.11%, and -0.84%, respectively. The age-specific mortality rates by period showed a decreasing trend for those under age of 44. Moreover, age-birth cohort analysis showed a more rapid lowering mortality in the age groups 35-, 30-, 25-, and 15-, that is, those born after 1950's. Liver cancer remains the leading death cause due to cancers in Qidong, with a continuing higher crude mortality rate. Yet the age-standardized mortality rate has presented a declining posture. The liver cancer mortality in young people in Qidong demonstrates a continuously falling trend. The campaign for the control of liver cancer in Qidong has achieved initial success.

Contribution of Early Detection and Adjuvant Treatments to Breast Cancer Mortality Reduction in Catalonia, Spain

PubMed Central

Vilaprinyo, Ester; Puig, Teresa; Rue, Montserrat

2012-01-01

Background Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975–2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30–69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods. PMID:22272292

All‐cause and cause‐specific mortality in rheumatoid arthritis are not greater than expected when treated with tumour necrosis factor antagonists

PubMed Central

Carmona, Loreto; Descalzo, Miguel Ángel; Perez‐Pampin, Eva; Ruiz‐Montesinos, Dolores; Erra, Alba; Cobo, Tatiana; Gómez‐Reino, Juan J

2007-01-01

Background Mortality is increased in rheumatoid arthritis (RA), mainly because of cardiovascular (CV) events, cancer and infections. Recent data suggest that treatment with tumour necrosis factor (TNF) antagonists may affect this trend. Objective To assess whether treatment with TNF antagonists is associated with reduction in CV events, cancer and infection rates, and in mortality in patients with RA treated and not treated with TNF antagonists. Methods BIOBADASER is a registry for active long‐term follow‐up of safety of biological treatments in patients with RA. It includes 4459 patients with RA treated with TNF antagonists. EMECAR is an external RA cohort (n = 789) established to define the characteristics of the disease in Spain and to assess comorbidity. The incidence density (ischaemic heart disease) of CV events, cancer and infections was estimated and compared. The standardised mortality ratio was compared with the rate in the general population. A propensity score was used to match cohorts by the probability of being treated. Results Rates of CV and cancer events are significantly higher in EMECAR than in BIOBADASER (RR 5–7 for different CV events, and RR 2.9 for cancer), whereas the rate of serious infections is significantly higher in BIOBADASER (RR 1.6). Mortality ratio of BIOBADASER by EMECAR is 0.32 (0.20–0.53) for all causes of death, 0.58 (0.24–1.41) for CV events, 0.52 (0.21–1.29) for infection and 0.36 (0.10–1.30) for cancer‐related deaths. Conclusion Morbidity, other than infection, and mortality are not higher than expected in patients with RA treated with TNF antagonists. PMID:17324968

Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure.

PubMed

Habal, Marlena V; Liu, Peter P; Austin, Peter C; Ross, Heather J; Newton, Gary E; Wang, Xuesong; Tu, Jack V; Lee, Douglas S

2014-01-01

Heart failure (HF) is associated with a high burden of morbidity and mortality. Hospital discharge is an opportunity for identification of modifiable prognostic factors in the transition to chronic HF. We examined the association of discharge heart rate with 30-day and 1-year mortality and hospitalization outcomes in a cohort of 9097 patients with HF discharged from hospital. Discharge heart rate was categorized into predefined groups: 40 to 60 (n=1333), 61 to 70 (n=2170), 71 to 80 (n=2631), 81 to 90 (n=1700), and >90 bpm (n=1263). There was a significant increase in all-cause 30-day mortality with adjusted odds ratios of 1.59 (95% confidence interval [CI], 1.18-2.14; P=0.003) for discharge heart rates 81 to 90 bpm and 1.56 (95% CI, 1.13-2.16; P=0.007) for heart rates>90 bpm when compared with the reference group (heart rates, 61-70 bpm). Cardiovascular death risk at 30 days was also higher with adjusted odds ratio 1.59 (discharge heart rates, 81-90 bpm; 95% CI, 1.09-2.33; P=0.017) and 1.65 (discharge heart rates, >90 bpm; 95% CI, 1.09-2.48; P=0.017). One-year all-cause mortality (adjusted odds ratio, 1.41; 95% CI, 1.16-1.72; P<0.001) and cardiovascular death (adjusted odds ratio, 1.47; 95% CI, 1.12-1.92; P=0.005) were higher with discharge heart rates>90 bpm when compared with the reference group (heart rates, 40-60 bpm). Readmissions for HF (adjusted hazard ratio, 1.26; 95% CI, 1.04-1.54; P=0.021) and cardiovascular disease (adjusted hazard ratio, 1.29; 95% CI, 1.08-1.54; P=0.004) within 30 days were also higher with discharge heart rates>90 bpm. Higher discharge heart rates were associated with greater risk of all-cause and cardiovascular mortality≤1-year follow-up and an elevated risk of 30-day readmission for HF and cardiovascular disease.

The mortality and hospitalization rates associated with the long interdialytic gap in thrice-weekly hemodialysis patients.

PubMed

Fotheringham, James; Fogarty, Damian G; El Nahas, Meguid; Campbell, Michael J; Farrington, Ken

2015-09-01

Excess mortality and hospitalization have been identified after the 2-day gap in thrice-weekly hemodialysis patients compared with 1-day intervals, although findings vary internationally. Here we aimed to identify factors associated with mortality and hospitalization events in England using an incident cohort of 5864 hemodialysis patients from years 2002 to 2006 inclusive in the UK Renal Registry linked to hospitalization data. Higher admission rates were seen after the 2-day gap irrespective of whether thrice-weekly dialysis sequence commenced on a Monday or Tuesday (2.4 per year after the 2-day gap vs. 1.4 for the rest of the week, rate ratio 1.7). The greatest differences in admission rates were seen in patients admitted with fluid overload or with conditions associated with a high risk of fluid overload. Increased mortality following the 2-day gap was similarly independent of session pattern (20.5 vs. 16.7 per 100 patient years, rate ratio 1.22), with these increases being driven by out-of-hospital death (rate ratio 1.59 vs. 1.06 for in-hospital death). Non-white patients had an overall survival advantage, with the increased mortality after the 2-day gap being found only in whites. Thus, fluid overload may increase the risk of hospital admission after the 2-day gap and that the increased out-of-hospital mortality may relate to a higher incidence of sudden death. Future work should focus on exploring interventions in these subgroups.

Survival and harvest-related mortality of white-tailed deer in Massachusetts

USGS Publications Warehouse

Mcdonald, John E.; DeStefano, Stephen; Gaughan, Christopher; Mayer, Michael; Woytek, William A.; Christensen, Sonja; Fuller, Todd K.

2011-01-01

We monitored 142 radiocollared adult (≥1.0 yr old) white-tailed deer (Odocoileus virginianus) in 3 study areas of Massachusetts, USA, to estimate annual survival and mortality due to legal hunting. We then applied these rates to deer harvest information to estimate deer population trends over time, and compared these to trends derived solely from harvest data estimates. Estimated adult female survival rates were similar (0.82–0.86), and uniformly high, across 3 management zones in Massachusetts that differed in landscape composition, human density, and harvest regulations. Legal hunting accounted for 16–29% of all adult female mortality. Estimated adult male survival rates varied from 0.55 to 0.79, and legal hunting accounted for 40–75% of all mortality. Use of composite hunting mortality rates produced realistic estimates for adult deer populations in 2 zones, but not for the third, where estimation was hindered by regulatory restrictions on antlerless deer harvest. In addition, the population estimates we calculated were generally higher than those derived from population reconstruction, likely due to relatively low harvest pressure. Legal harvest may not be the dominant form of deer mortality in developed landscapes; thus, estimates of populations or trends that rely solely on harvest data will likely be underestimates.

Human actuarial aging increases faster when back ground death rates are lower: a consequence of differential heterogeneity?

PubMed Central

Hawkes, Kristen; Smith, Ken R.; Blevins, James K.

2014-01-01

Many analyses of human populations have found that age-specific mortality rates increase faster across most of adulthood when overall mortality levels decline. This contradicts the relationship often expected from Williams′ classic hypothesis about the effects of natural selection on the evolution of senescence. More likely, much of the within-species difference in actuarial aging is not due to variation in senescence, but to the strength of filters on the heterogeneity of frailty in older survivors. A challenge to this differential frailty hypothesis was recently posed by an analysis of life tables from historical European populations and traditional societies that reported variation in actuarial aging consistent with Williams′ hypothesis after all. To investigate the challenge, we reconsidered those cases and aging measures. Here we show that the discrepancy depends on Ricklefs′ aging rate measure,ω, which decreases as mortality levels drop because it is an index of mortality level itself, not the rate of increase in mortality with age. We also show unappreciated correspondence among the parameters of Gompertz–Makeham and Weibull survival models. Finally, we compare the relationships among mortality parameters of the traditional societies and the historical series, providing further suggestive evidence that differential heterogeneity has strong effects on actuarial aging. PMID:22220868

Some aspects of social exclusion: do they influence suicide mortality?

PubMed

Yur'yev, Andriy; Värnik, Peeter; Sisask, Merike; Leppik, Lauri; Lumiste, Kaur; Värnik, Airi

2013-05-01

The current study is aimed to assess the relationship between the 'economic/employment' and 'social/welfare' dimensions of social exclusion and suicide mortality in Europe. Suicide rates for 26 countries were obtained from the WHO. Data on social expenditure were obtained from the OECD database. Employment rates and GDP were obtained from the Total Economy Database. Questions about citizens' attitudes towards different aspects of social exclusion were taken from the European Social Survey. Structural equation modelling was applied to research the theoretical structure of the variables. All variables are statistically significant in male and female models except of the relationships between 'economic/employment' and 'social/welfare' dimensions and female suicides; and the relationship between 'employment rates' and 'economic/employment' dimension. Suicide mortality rates among both males and females are influenced negatively by 'economic/employment' and 'social/welfare' dimensions. Among females, the influence of 'social/welfare' dimension is stronger compared to the 'economic/employment' dimension. The remaining influence of GDP is positive in both models. Both 'economic/employment' and 'social/welfare' dimensions of social exclusion significantly influence suicide mortality among males. The influence of 'economic/employment' and 'social/welfare' dimensions of social exclusion on female suicide mortality is controversial. Social exclusion might be considered as a risk factor for suicide mortality in Europe.

Prognostic performance of Emergency Severity Index (ESI) combined with qSOFA score.

PubMed

Kwak, Hyeongkyu; Suh, Gil Joon; Kim, Taegyun; Kwon, Woon Yong; Kim, Kyung Su; Jung, Yoon Sun; Ko, Jung-In; Shin, So Mi

2018-01-31

We conducted this study to investigate whether ESI combined with qSOFA score (ESI+qSOFA) predicts hospital outcome better than ESI alone in the emergency department (ED). This was a retrospective study for patients aged over 15years who visited an ED of a tertiary referral hospital from January 1st, 2015 to December 31st, 2015. We calculated and compared predictive performances of ESI alone and ESI+qSOFA for prespecified outcomes. The primary outcome was hospital mortality, and the secondary outcome was composite outcome of in-hospital mortality and ICU admission. We calculated in-hospital mortality rates by positive qSOFA in each subgroup divided according to ESI levels (1, 2, 3, 4+5). 43,748 patients were enrolled. The area under receiver-operating characteristics curves were higher in ESI+qSOFA than in ESI alone for both mortality and composite outcome (0.786 vs. 0.777, P<.001 for mortality; 0.778 vs. 0.774, P<.001 for composite outcome). In each subgroup divided by ESI levels, patients with positive qSOFA had significantly higher in-hospital mortality rate compared to those with negative qSOFA (20.4% vs. 14.7%, P=.117 in ESI level 1 subgroup; 11.3% vs. 2.7%, P=.001 in ESI level 2 subgroup; 2.3% vs. 0.4%, P<.001 in ESI level 3 subgroup; 0.0% vs. 0.0% in ESI level 4 or 5 subgroup). The prognostic performance of ESI+qSOFA for in-hospital mortality was significantly higher than that of ESI alone. Within each subgroup, patients with positive qSOFA had higher in-hospital mortality compared to those with negative qSOFA. Copyright © 2018 Elsevier Inc. All rights reserved.

Male breast cancer: a nation-wide population-based comparison with female breast cancer.

PubMed

Lautrup, Marianne D; Thorup, Signe S; Jensen, Vibeke; Bokmand, Susanne; Haugaard, Karen; Hoejris, Inger; Jylling, Anne-Marie B; Joernsgaard, Hjoerdis; Lelkaitis, Giedrius; Oldenburg, Mette H; Qvamme, Gro M; Soee, Katrine; Christiansen, Peer

2018-05-01

Describe prognostic parameters of Danish male breast cancer patients (MBCP) diagnosed from 1980-2009. Determine all-cause mortality compared to the general male population and analyze survival/mortality compared with Danish female breast cancer patients (FBCP) in the same period. The MBCP cohort was defined from three national registers. Data was extracted from medical journals. Data for FBCP is from the DBCG database. Overall survival (OS) was quantified by Kaplan-Meier estimates. Standardized mortality ratios (SMRs) were calculated based on mortality rate among patients relative to the mortality rate in the general population. The association between SMR and risk factors were analyzed in univariate and multivariable Poisson regression models. Separate models for each gender were used for the analyses. We found a marked difference in OS for the two genders. For the total population of MBCP, 5- and 10-year survivals were 55.1% and 31.7%, respectively. For FBCP, the corresponding figures were 76.8% and 59.3%. Median age at diagnosis for FBCP was 61 years and 70 years for MBCP. By applying SMR, the difference in mortality between genders equalized and showed pronounced age-dependency. For males <40 years, SMR was 9.43 and for females 19.56 compared to SMR for males 80 + years (0.95) and females 80 + years (0.89). During the period 1980-2009, the risk of dying gradually decreased for FBCP (p < .0001). The risk 1980-1984 was 35% higher than 2005-2009 (RR 1.35). Although the risk of dying for MBCP was also lowest in 2005-2009, there was no clear tendency (p = .1439). The risk was highest in 1990-1994 (RR =2.48). We found better OS for FBCP than for MBCP. But SMR showed similar mortality rate for the two genders, except for very young FBCP, who had higher SMR. Furthermore, significantly improved survival over time for FBCP was observed, with no clear tendency for MBCP.

ICU Multipoint Military Pacific Consultation using Telehealth (IMMPACT)

DTIC Science & Technology

2010-05-01

the Leapfrog Group has found that mortality rates are up to 30 percent lower and lengths of stay ( LOS ) up to three days shorter in ICUs managed by...length of stay ( LOS ), the two key outcome measures for ICUs. Some hospitals report clinical improvements such as higher rates of survival from...compares patient outcomes before and after the installation of the Tele-ICU.5 Sentara found that mortality, LOS , and financial measures all improved

Predicting mortality rates: Comparison of an administrative predictive model (hospital standardized mortality ratio) with a physiological predictive model (Acute Physiology and Chronic Health Evaluation IV)--A cross-sectional study.

PubMed

Toua, Rene Elaine; de Kock, Jacques Erasmus; Welzel, Tyson

2016-02-01

Direct comparison of mortality rates has limited value because most deaths are due to the disease process. Predicting the risk of death accurately remains a challenge. A cross-sectional study compared the expected mortality rate as calculated with an administrative model to a physiological model, Acute Physiology and Chronic Health Evaluation IV. The combined cohort and stratified samples (<0.1, 0.1-0.5, or >0.5 predicted mortality) were considered. A total of 47,982 patients were scored from 1 July 2013 to 30 June 2014, and 46,061 records were included in the analysis. A moderate correlation was shown for the combined cohort (Pearson correlation index, 0.618; 95% confidence interval [CI], 0.380-0.779; R(2) = 0.38). A very good correlation for the less than 10% stratum (Pearson correlation index, 0.884; R(2) = 0.78; 95% CI, 0.79-0.937) and a moderate correlation for 0.1 to 0.5 predicted mortality rates (Pearson correlation index, 0.782; R(2) = 0.61; 95% CI, 0.623-0.879). There was no significant positive correlation for the greater than 50% predicted mortality stratum (Pearson correlation index, 0.087; R(2) = 0.007; 95% CI, -0.23 to 0.387). At less than 0.1, the models are interchangeable, but in spite of a moderate correlation, greater than 0.1 hospital standardized mortality ratio cannot be used to predict mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

The influence of interpregnancy interval on infant mortality.

PubMed

McKinney, David; House, Melissa; Chen, Aimin; Muglia, Louis; DeFranco, Emily

2017-03-01

In Ohio, the infant mortality rate is above the national average and the black infant mortality rate is more than twice the white infant mortality rate. Having a short interpregnancy interval has been shown to correlate with preterm birth and low birthweight, but the effect of short interpregnancy interval on infant mortality is less well established. We sought to quantify the population impact of interpregnancy interval on the risk of infant mortality. This was a statewide population-based retrospective cohort study of all births (n = 1,131,070) and infant mortalities (n = 8152) using linked Ohio birth and infant death records from January 2007 through September 2014. For this study we analyzed 5 interpregnancy interval categories: 0-<6, 6-<12, 12-<24, 24-<60, and ≥60 months. The primary outcome for this study was infant mortality. During the study period, 3701 infant mortalities were linked to a live birth certificate with an interpregnancy interval available. We calculated the frequency and relative risk of infant mortality for each interval compared to a referent interval of 12-<24 months. Stratified analyses by maternal race were also performed. Adjusted risks were estimated after accounting for statistically significant and biologically plausible confounding variables. Adjusted relative risk was utilized to calculate the attributable risk percent of short interpregnancy intervals on infant mortality. Short interpregnancy intervals were common in Ohio during the study period. Of all multiparous births, 20.5% followed an interval of <12 months. The overall infant mortality rate during this time was 7.2 per 1000 live births (6.0 for white mothers and 13.1 for black mothers). Infant mortalities occurred more frequently for births following short intervals of 0-<6 months (9.2 per 1000) and 6-<12 months (7.1 per 1000) compared to 12-<24 months (5.6 per 1000) (P < .001 and <.001). The highest risk for infant mortality followed interpregnancy intervals of 0-<6 months (adjusted relative risk, 1.32; 95% confidence interval, 1.17-1.49) followed by interpregnancy intervals of 6-<12 months (adjusted relative risk, 1.16; 95% confidence interval, 1.04-1.30). Analysis stratified by maternal race revealed similar findings. Attributable risk calculation showed that 24.2% of infant mortalities following intervals of 0-<6 months and 14.1% with intervals of 6-<12 months are attributable to the short interpregnancy interval. By avoiding short interpregnancy intervals of ≤12 months we estimate that in the state of Ohio 31 infant mortalities (20 white and 8 black) per year could have been prevented and the infant mortality rate could have been reduced from 7.2-7.0 during this time frame. An interpregnancy interval of 12-60 months (1-5 years) between birth and conception of next pregnancy is associated with lowest risk of infant mortality. Public health initiatives and provider counseling to optimize birth spacing has the potential to significantly reduce infant mortality for both white and black mothers. Copyright © 2017 Elsevier Inc. All rights reserved.

The Influence of Interpregnancy Interval on Infant Mortality

PubMed Central

MCKINNEY, David; HOUSE, Melissa; CHEN, Aimin; MUGLIA, Louis; DEFRANCO, Emily

2017-01-01

Background In Ohio the infant mortality rate is above the national average and the black infant mortality rate is more than twice the white infant mortality rate. Having a short interpregnancy interval has been shown to correlate with preterm birth and low birth weight, but the effect of short interpregnancy interval on infant mortality is less well established. Objective To quantify the population impact of interpregnancy interval on the risk of infant mortality. Study Design This was a statewide population-based retrospective cohort study of all births (n=1,131,070) and infant mortalities (n=8,152) using linked Ohio birth and infant death records from 1/2007 through 9/2014. For this study we analyzed 5 interpregnancy interval categories: 0 to < 6 months, 6 to < 12 months, 12 to < 24 months, 24 to < 60 months, and ≥ 60 months. The primary outcome for this study was infant mortality. During the study period, 3701 infant mortalities were linked to a live birth certificate with an interpregnancy interval available. We calculated the frequency and relative risk (RR) of infant mortality for each interval compared to a referent interval of 12 to < 24 months. Stratified analyses by maternal race were also performed. Adjusted risks were estimated after accounting for statistically significant and biologically plausible confounding variables. Adjusted relative risk was utilized to calculate the attributable risk percent of short interpregnancy intervals on infant mortality. Results Short interpregnancy intervals were common in Ohio during the study period. 20.5% of all multiparous births followed an interval of < 12 months. The overall infant mortality rate during this time was 7.2 per 1000 live births (6.0 for white mothers and 13.1 for black mothers). Infant mortalities occurred more frequently for births that occurred following short intervals of 0 to < 6 months (9.2 per 1000) and 6 to < 12 months (7.1 per 1000) compared to 12 to < 24 months (5.6 per 1000), (p= <0.001 and <0.001). The highest risk for infant mortality followed interpregnancy intervals of 0 to < 6 months, adjRR 1.32 (95% CI 1.17–1.49) followed by interpregnancy intervals of 6 to < 12 months, adjRR 1.16 (95% CI 1.04–1.30). Analysis stratified by maternal race revealed similar findings. Attributable risk calculation showed that 24.2% of infant mortalities following intervals of 0 to < 6 months and 14.1% with intervals of 6 to < 12 months are attributable to the short interpregnancy interval. By avoiding short interpregnancy intervals of 12 months or less we estimate that in the state of Ohio 31 infant mortalities (20 white and 8 black) per year could have been prevented and the infant mortality rate could have been reduced from 7.2 to 7.0 during this time frame. Conclusion An interpregnancy interval of 12–60 months (1–5 years) between birth and conception of next pregnancy is associated with lowest risk of infant mortality. Public health initiatives and provider counseling to optimize birth spacing has the potential to significantly reduce infant mortality for both white and black mothers. PMID:28034653

Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

PubMed

Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

2015-08-01

When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

What is the cause of the decline in maternal mortality in India? Evidence from time series and cross-sectional analyses.

PubMed

Goli, Srinivas; Jaleel, Abdul C P

2014-05-01

Summary Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (-1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (-0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) show statistically significant association with the decline in the maternal mortality ratio in India. The Barro-regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305). The negative β-coefficient (β=-0.69578, p<0.05), showing the effect of the initial maternal mortality ratio on change in maternal mortality ratio in the Barro-regression model, indicates a greater decline in maternal mortality ratio in laggard states compared with advanced states. Overall, comparing the estimates of relative effects, the socioeconomic and demographic factors have a stronger statistically significant association with the maternal mortality ratio than institutional deliveries. Interestingly, the weak association between 'increase in institutional deliveries' and 'decline in maternal mortality ratio' suggests that merely increasing deliveries alone will not help in ensuring maternal survival in India. Quality of services provided by the health facility, birth preparedness and avoiding delay in reaching health facility are also important. Deliveries in health facilities will not necessarily translate into increased survival chances of mothers unless women receive full antenatal care services and delays in reaching health facility are avoided.

Women's Education and Health Inequalities in Under-Five Mortality in Selected Sub-Saharan African Countries, 1990–2015

PubMed Central

Bado, Aristide Romaric; Sathiya Susuman, A.

2016-01-01

Background The aim of the study was to analyse trends in the relationship between mother’s educational level and mortality of children under the year of five in Sub-Saharan Africa, from 1990 to 2015. Data and Methods Data used in this study came from different waves of Demographic and Health Surveys (DHS) of Sub-Saharan countries. Logistic regression and Buis’s decomposition method were used to explore the effect of mother’s educational level on the mortality of children under five years. Results Although the results of our study in the selected countries show that under-five mortality rates of children born to mothers without formal education are higher than the mortality rates of children of educated mothers, it appears that differences in mortality were reduced over the past two decades. In selected countries for our study, we noticed a significant decline in mortality among children of non-educated mothers compared to the decrease in mortality rates among children of educated mothers during the period of 1990–2010. The results show that the decline in mortality of children under five years was much higher among the children born to mothers who have never received formal education—112 points drop in Malawi, over 80 in Zambia and Zimbabwe, 65 points in Burkina Faso, 56 in Congo, 43 in Namibia, 27 in Guinea, Cameroon, and 22 to 15 in Niger. However, we noted a variation in results among the countries selected for the study—in Burkina Faso (OR = 0.7), in Cameroon (OR = 0.8), in Guinea (OR = 0.8) and Niger (OR = 0.8). It is normally observed that children of mothers with 0–6 years of education are about 20% more likely to survive until their fifth year compared to children of mothers who have not been to school. Conversely, the results did not reveal significant differences between the under-five deaths of children born to non-educated mothers and children of low-level educated mothers in Congo, Malawi and Namibia. Conclusion The decline in under-five mortality rates, during last two decades, can be partly due to the government policies on women’s education. It is evident that women’s educational level has resulted in increased maternal awareness about infant health and hygiene, thereby bringing about a decline in the under-five mortality rates. This reduction is due to improved supply of health care programmes and health policies in reducing economic inequalities and increasing access to health care. PMID:27442118

Isoflurane: An Ideal Anesthetic for Rodent Orthotopic Liver Transplantation Surgery?

PubMed

Cao, D; Liu, Y; Li, J; Gong, J

2016-10-01

Because the choice of anesthetic affects the rodent orthotopic liver transplantation (OLT) model, we compared the effects of isoflurane, ketamine, chloral hydrate, and pentobarbital on the OLT model. OLT was performed using the two-cuff technique. Two hundred male rats were randomly divided into five groups: control, isoflurane, ketamine, chloral hydrate, and pentobarbital groups. Rectal temperatures, respiratory rates, arterial blood values (pH, PaCO 2 , PaO 2 , and SatO 2 ), liver function tests and histopathology, recovery times, and anhepatic stage mortality rates were assessed. Compared with controls, respiratory rates decreased by 20% in the isoflurane group, and decreased by 40%-50% in the ketamine, chloral hydrate, and pentobarbital groups. The PaO 2 , SatO 2 , and pH levels in the ketamine, chloral hydrate, and pentobarbital groups were significantly lower than those in the isoflurane and control groups (P < .05). Only the pentobarbital group displayed significant liver histopathologic changes along with significantly higher levels of serum alanine aminotransferase and total bilirubin, but a significantly lower level of serum albumin, compared with the control group (P < .05). The isoflurane group had a 0% anhepatic stage mortality rate compared with rates of 30%-40% in the other anesthetic groups. Isoflurane should be the preferred anesthetic for rodent OLT surgery due to its minimal respiratory and hepatic physiological effects as well as its low anhepatic phase mortality rate. Secondary to isoflurane, ketamine and chloral hydrate may be administered as donor anesthetics. Pentobarbital use should be avoided entirely in rodent OLT surgery due to its significant hepatotoxic effects. Copyright © 2016 Elsevier Inc. All rights reserved.

Homicide, suicide, motor vehicle crash, and fall mortality: United States' experience in comparative perspective.

PubMed Central

Rockett, I R; Smith, G S

1989-01-01

US mortality data on motor vehicle crashes, falls, suicide, and homicide for 1980 are compared with corresponding data for France, Japan, West Germany, and the United Kingdom. Unadjusted and age-specific death rates are presented, together with age-adjusted rates of years of life lost (YLL). A large male excess in rates is typical outside the fall category. Motor vehicle crashes are the predominant cause of YLL, and the United States manifests the highest YLL rates for each sex. US fall death rates at the older ages are exceeded by those of France and West Germany. The elderly generally manifest the greatest risk of suicide; American females exhibit a unique rate decline after ages 45-54 years, however. Beyond early adulthood, US suicide rates are lower than those of France, Japan, and West Germany. US homicide rates dwarf those of the comparison countries with 16- to 29-fold differentials separating prime-risk American males aged 25-34 years from their foreign counterparts. PMID:2782511

Umbilical hernia repair in patients with signs of portal hypertension: surgical outcome and predictors of mortality.

PubMed

Cho, Sung W; Bhayani, Neil; Newell, Pippa; Cassera, Maria A; Hammill, Chet W; Wolf, Ronald F; Hansen, Paul D

2012-09-01

To compare the outcomes of umbilical hernia repair in patients with and without signs of portal hypertension, such as esophageal varices or ascites; to assess the effect of emergency surgery on complication rates; and to identify predictors of postoperative mortality. Database search from January 1, 2005, through December 31, 2009. North American hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program initiative. We studied patients who underwent umbilical hernia repair. Those with congestive heart failure, disseminated malignant tumor, or chronic renal failure while undergoing dialysis were excluded. Preoperative variables and perioperative course were analyzed. Main outcome measures were morbidity and mortality after umbilical hernia repair. A total of 390 patients with ascites and/or esophageal varices formed the study group, and the remaining 22 952 patients formed the control group. The overall morbidity and mortality rates for the study group were 13.1% and 5.1%, whereas these rates were 3.9% and 0.1% for the control group, respectively (P < .001). For the study group, the mortality after elective repair among patients with a model for end-stage liver disease (MELD) score greater than 15 was 11.1% compared with 1.3% in patients with a MELD score of 15 or less. The patients with ascites and/or esophageal varices underwent emergency surgery more frequently than the control group (37.7% vs 4.9%; P < .001). Emergency surgery for the study group was associated with a higher morbidity than elective surgery (20.8% vs 8.3%; P < .001) but not a significantly higher mortality (7.4% vs 3.7%; P = .11). However, logistic regression analysis showed that age older than 65 years, MELD score higher than 15, albumin level less than 3.0 g/dL (to convert to grams per liter, multiply by 10), and sepsis at presentation were more predictive of postoperative mortality. Umbilical hernia repair in the presence of ascites and/or esophageal varices is associated with significant postoperative complication rates. Emergency surgery is associated with higher morbidity rates but not significantly higher mortality rates. Elective repair of umbilical hernia should be avoided for those with adverse predictors, such as age older than 65 years, MELD score higher than 15, and albumin level less than 3.0 g/dL.

Epidemiological isolation causing variable mortality in Island populations during the 1918–1920 influenza pandemic

PubMed Central

Shanks, G. Dennis; Hussell, Tracy; Brundage, John F.

2012-01-01

Please cite this paper as: Shanks et al. (2012) Epidemiological isolation causing variable mortality in Island populations during the 1918–1920 influenza pandemic. Influenza and Other Respiratory Viruses 6(6), 417–423. Background  During the 1918 pandemic period, influenza‐related mortality increased worldwide; however, mortality rates varied widely across locations and demographic subgroups. Islands are isolated epidemiological situations that may elucidate why influenza pandemic mortality rates were so variable in apparently similar populations. Objectives  Our objectives were to determine and compare the patterns of pandemic influenza mortality on islands. Methods  We reviewed historical records of mortality associated with the 1918–1920 influenza pandemic in various military and civilian groups on islands. Results and Conclusions  Mortality differed more than 50‐fold during pandemic‐related epidemics on Pacific islands [range: 0·4% (Hawaii) to 22% (Samoa)], and on some islands, mortality sharply varied among demographic subgroups of island residents such as Saipan: Chamorros [12%] and Caroline Islanders [0·4%]. Among soldiers from island populations who had completed initial military training, influenza‐related mortality rates were generally low, for example, Puerto Rico (0·7%) and French Polynesia (0·13%). The findings suggest that among island residents, those who had been exposed to multiple, antigenically diverse respiratory pathogens prior to infection with the 1918 pandemic strain (e.g., less isolated) experienced lower mortality. The continuous circulation of antigenically diverse influenza viruses and other respiratory infectious agents makes widespread high mortality during future influenza pandemics unlikely. PMID:22226378

Adolescence BMI and trends in adulthood mortality: a study of 2.16 million adolescents.

PubMed

Twig, Gilad; Afek, Arnon; Shamiss, Ari; Derazne, Estela; Landau Rabbi, Moran; Tzur, Dorit; Gordon, Barak; Tirosh, Amir

2014-06-01

The consequence of elevated body mass index (BMI) at adolescence on early adulthood mortality rate and on predicted life expectancy is unclear. The objective of the investigation was to study the relationship between BMI at adolescence and mortality rate as well as the mortality trend over the past 4 decades across the entire BMI range. The study included a nationwide longitudinal cohort. A total of 2 159 327 adolescents (59.1% males) born between 1950 and 1993, who were medically evaluated for compulsory military service in Israel, participated in the study. Height and weight were measured at age 17 years, and BMI was stratified based on the Centers for Disease Control and Prevention-established percentiles for age and sex. Incident cases of all-cause mortality before age 50 years were recorded. Cox-proportional hazard models were used to assess mortality rates and its trend overtime. During 43 126 211 person-years of follow-up, 18 530 deaths were recorded. As compared with rates observed in the 25th to 50th BMI percentiles, all-cause mortality continuously increased across BMI range, reaching rates of 8.90/10(4) and 2.90/10(4) person-years for men and women with BMI greater than the 97th percentile, respectively. A multivariate analysis adjusted for age, socioeconomic status, education, and ethnicity demonstrated a significant increase in mortality at BMI greater than the 50th percentile (BMI > 20.55 kg/m(2)) for men and the 85th percentile or greater in women (BMI > 24.78 kg/m(2)). During the last 4 decades, a significant decrease in mortality rates was documented in normal-weight participants born between 1970 and 1980 vs those born between 1950 and 1960 (3.60/104 vs 4.99/10(4) person-years, P < .001). However, no improvement in the survival rate was observed among overweight and obese adolescents during the same time interval. Significant interaction between BMI and birth year was observed (P = .007). BMI at adolescence, within the normal range, is associated with all-cause mortality in adulthood. Mortality rates among overweight and obese adolescents did not improve in the last 40 years, suggesting that preadulthood obesity may attenuate the progressive increase in life expectancy.

Liver cirrhosis in England-an observational study: are we measuring its burden occurrence correctly?

PubMed

Ratib, Sonia; West, Joe; Fleming, Kate M

2017-07-13

Mortality due to liver disease (of which cirrhosis is the end stage) is increasing more than any other chronic condition in the UK. This study aims to demonstrate that (1) exclusive reliance on mortality rates may not reveal the true burden of liver cirrhosis, and (2) diverse use of diagnostic coding may produce misleading estimates. Observational study. The Office for National Statistics death registry was interrogated to investigate liver cirrhosis mortality trends in England and Wales from 1968 to 2011. Standardised mortality trends according to three different definitions of liver cirrhosis based on the specificity of diagnostic codes were calculated: 1 (chronic liver diseases), 2 (alcoholic and unspecified cirrhosis only) and 3 (cirrhosis as end-stage liver disease). The mortality trends were compared with incidence rates established in a previous population-based study (based on definition 3), from 1998 to 2009, to investigate discrepancies between these two measures. Over the study period, the overall standardised liver cirrhosis mortality rates were 8.8, 5,1 and 5.4 per 100 000 person-years for definitions 1, 2 and 3, respectively. The mortality rates for definition 3 in 1998 and 2009 were 6.2 and 5.9 per 100 000 person-years, respectively; while the equivalent incidence rates were at least threefold and sixfold higher: 23.4 and 35.9 per 100 000 person-years, respectively. This discrepancy between incidence and mortality rates was also at least threefold in men and women separately and across age groups. Mortality rates underestimated the incidence of liver cirrhosis by at least threefold between 1998 and 2009 and varied with differing definitions of disease. Mortality data should not be used exclusively as an indicator for the occurrence of liver cirrhosis in the population. Routinely collected healthcare data are available to measure occurrence of this disease. Careful consideration should be taken when selecting diagnostic codes for cirrhosis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Differences in colorectal carcinoma stage and survival by race and ethnicity.

PubMed

Chien, Chloe; Morimoto, Libby M; Tom, Jamie; Li, Christopher I

2005-08-01

In the United States, blacks with colorectal carcinoma (CRC) presented with more advanced-stage disease and had higher mortality rates compared with non-Hispanic whites. Data regarding other races/ethnicities were limited, especially for Asian/Pacific Islander and Hispanic white subgroups. Using data from 11 population-based cancer registries that participate in the Surveillance, Epidemiology and End Results program, the authors evaluated the relation among 18 different races/ethnicities and disease stage and mortality rates among 154,103 subjects diagnosed with CRC from 1988 to 2000. Compared with non-Hispanic whites, blacks, American Indians, Chinese, Filipinos, Koreans, Hawaiians, Mexicans, South/Central Americans, and Puerto Ricans were 10-60% more likely to be diagnosed with Stage III or IV CRC. Alternatively, Japanese had a 20% lower risk of advanced-stage CRC. With respect to mortality rates, blacks, American Indians, Hawaiians, and Mexicans had a 20-30% greater risk of mortality, whereas Chinese, Japanese, and Indians/Pakistanis had a 10-40 % lower risk. The authors observed numerous racial/ethnic disparities in the risks of advanced-stage cancer and mortality among patients with CRC, and there was considerable variation in these risks across Asian/Pacific Islander and Hispanic white subgroups. Although the etiology of these disparities was multifactorial, developing screening and treatment programs that target racial/ethnic populations with elevated risks of poor CRC outcomes may be an important means of reducing these disparities. (c) 2005 American Cancer Society.

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia

PubMed Central

Almashouq, Mohammad K.; Youssef, Amira M.; Al-Qumaidi, Hamid; Al Derwish, Mohammad; Ouizi, Samir; Al-Shehri, Khalid; Masoodi, Saba N.

2017-01-01

Background Although Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications. Methods Using data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients’ files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013. Results The all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55–5.23) and 7.21 (5.70–8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate. Conclusions Diabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered. PMID:29176889

All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia.

PubMed

Al-Rubeaan, Khalid; Almashouq, Mohammad K; Youssef, Amira M; Al-Qumaidi, Hamid; Al Derwish, Mohammad; Ouizi, Samir; Al-Shehri, Khalid; Masoodi, Saba N

2017-01-01

Although Diabetes mellitus is a major public health problem in the Middle East and North Africa (MENA) region with high rates of diabetic foot complications, there are only limited data concerning mortality among such a high risk group. Therefore, the main aim of the current study was to assess all-cause mortality and its related predictors among diabetic patients with and without diabetic foot complications. Using data from the Saudi National Diabetes Registry (SNDR), a total of 840 patients with type 1 or type 2 diabetes aged ≥25 years with current or past history of diabetic foot ulcer (DFU) or diabetes related lower extremity amputation (LEA) were recruited in 2007 from active patients' files and followed up to 2013. These patients were compared with an equal number of age and gender matched diabetic patients without foot complication recruited at the same period. All patients were subjected to living status verification at 31st December 2013. The all-cause mortality rate among patients with DFU was 42.54 per 1000 person-years and among LEA patients was 86.80 per 1000 person-years among LEA patients for a total of 2280 and 1129 person-years of follow up respectively. The standardized mortality ratio (SMR) (95% CI) was 4.39 (3.55-5.23) and 7.21 (5.70-8.72) for cases with foot ulcer and LEA respectively. The percentage of deceased patients increased by almost twofold (18.5%) among patients with diabetic foot ulcer and more than threefold (32.2%) among patients with LEA compared with patients without diabetic foot complications (10.7%). The worst survival was among patients with LEA at 0.679 and the presence of diabetic nephropathy was the only significant independent risk factor for all-cause mortality among patients with diabetic foot complications. On the other hand, obese patients have demonstrated significantly reduced all-cause mortality rate. Diabetic patients with diabetic foot complications have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. Early interventions to prevent foot ulceration and consequent LEA as well as all the measurements for reducing the prevalence of microvascular and macrovascular complications should be considered.

Association of disease-specific causes of visual impairment and 10-year mortality amongst Indigenous Australians: the Central Australian Ocular Health Study.

PubMed

Estevez, José; Kaidonis, Georgia; Henderson, Tim; Craig, Jamie E; Landers, John

2018-01-01

Visual impairment significantly impairs the length and quality of life, but little is known of its impact in Indigenous Australians. To investigate the association of disease-specific causes of visual impairment with all-cause mortality. A retrospective cohort analysis. A total of 1347 Indigenous Australians aged over 40 years. Participants visiting remote medical clinics underwent clinical examinations including visual acuity, subjective refraction and slit-lamp examination of the anterior and posterior segments. The major ocular cause of visual impairment was determined. Patients were assessed periodically in these remote clinics for the succeeding 10 years after recruitment. Mortality rates were obtained from relevant departments. All-cause 10-year mortality and its association with disease-specific causes of visual impairment. The all-cause mortality rate for the entire cohort was 29.3% at the 10-year completion of follow-up. Of those with visual impairment, the overall mortality rate was 44.9%. The mortality rates differed for those with visual impairment due to cataract (59.8%), diabetic retinopathy (48.4%), trachoma (46.6%), 'other' (36.2%) and refractive error (33.4%) (P < 0.0001). Only those with visual impairment from diabetic retinopathy were any more likely to die during the 10 years of follow-up when compared with those without visual impairment (HR 1.70; 95% CI, 1.00-2.87; P = 0.049). Visual impairment was associated with all-cause mortality in a cohort of Indigenous Australians. However, diabetic retinopathy was the only ocular disease that significantly increased the risk of mortality. Visual impairment secondary to diabetic retinopathy may be an important predictor of mortality. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Mortality trend by dengue in Mexico 1980 to 2009.

PubMed

Gaxiola-Robles, Ramón; Celis, Alfredo; Serrano-Pinto, Vania; Orozco-Valerio, María de Jesús; Zenteno-Savín, Tania

2012-01-01

To describe the mortality of dengue in Mexico during 1980 to 2009. Dengue mortality data for Mexico were obtained from Instituto Nacional de Estadistica, Geografía e Informática. We used standardized and non-standardized dengue mortality rates per 1,000,000 people and determined the mortality trend. The groups were based on International Classification of Diseases coding criteria (ICD-9 E061 and ICD-10 A91X). The results were stratified by age groups and the frequencies of dengue deaths were compared using relative risk (RR) with its 95% confidence interval. During 1980 to 2009 in Mexico, 549 deaths due to dengue were reported. We found an important variation in the mortality rates during the years studied. We were able to identify three periods: 1980 to 1992, 1994 to 2000, and 2001 to 2009. The mortality rates found are from 0.88/1,000,000 through 0.00/1,000,000. The average mortality rates by decade: 1980 to 1989: 0.53/1,000,000; 1990 to 1999: 0.06/1,000,000; 2000 to 2009: 0.12/1,000,000. In the analysis of mortality by community size during 2000 to 2009, we observed in the small communities with < 2,499 people, the risk is 1.25 times higher than in those with more than 20,000 people. We found, in general, a sustained decline in the number of deaths by dengue over the last 30 years in Mexico. However, a slow increase was observed since 1994, which may be related to the circulation of DENV2 and DENV3, among other factors. We need to strengthen prevention programs in smaller communities (< 2,499) where we found a higher risk of mortality due to dengue.

Mortality of New York children with sickle cell disease identified through newborn screening.

PubMed

Wang, Ying; Liu, Gang; Caggana, Michele; Kennedy, Joseph; Zimmerman, Regina; Oyeku, Suzette O; Werner, Ellen M; Grant, Althea M; Green, Nancy S; Grosse, Scott D

2015-06-01

Long-term follow-up of newborn screening for conditions such as sickle cell disease can be conducted using linkages to population-based data. We sought to estimate childhood sickle cell disease mortality and risk factors among a statewide birth cohort with sickle cell disease identified through newborn screening. Children with sickle cell disease identified by newborn screening and born to New York residents in 2000-2008 were matched to birth and death certificates. Mortality rates were calculated (using numbers of deaths and observed person-years at risk) and compared with mortality rates for all New York children by maternal race/ethnicity. Stratified analyses were conducted to examine associations between selected factors and mortality. Among 1,911 infants with sickle cell disease matched to birth certificates, 21 deaths were identified. All-cause mortality following diagnosis was 3.8 per 1,000 person-years in the first 2 years of life and 1.0 per 1,000 person-years at ages 2-9 years. The mortality rate was significantly lower among children of foreign-born mothers and was significantly higher among preterm infants with low birth weight. The mortality rates were not significantly higher for infants after 28 days with sickle cell disease than for all New York births, but they were 2.7-8.4 times higher for children 1 through 9 years old with homozygous sickle cell disease than for those of all non-Hispanic black or Hispanic children born to New York residents. Estimated mortality risk in children with homozygous sickle cell disease remains elevated even after adjustment for maternal race/ethnicity. These results provide evidence regarding the current burden of child mortality among children with sickle cell disease despite newborn screening.Genet Med 17 6, 452-459.

Old age mortality and macroeconomic cycles.

PubMed

Rolden, Herbert J A; van Bodegom, David; van den Hout, Wilbert B; Westendorp, Rudi G J

2014-01-01

As mortality is more and more concentrated at old age, it becomes critical to identify the determinants of old age mortality. It has counter-intuitively been found that mortality rates at all ages are higher during short-term increases in economic growth. Work-stress is found to be a contributing factor to this association, but cannot explain the association for the older, retired population. Historical figures of gross domestic product (Angus Maddison) were compared with mortality rates (Human Mortality Database) of middle aged (40-44 years) and older people (70-74 years) in 19 developed countries for the period 1950-2008. Regressions were performed on the de-trended data, accounting for autocorrelation and aggregated using random effects models. Most countries show pro-cyclical associations between the economy and mortality, especially with regard to male mortality rates. On average, for every 1% increase in gross domestic product, mortality increases with 0.36% for 70-year-old to 74-year-old men (p<0.001) and 0.38% for 40-year-old to 44-year-old men (p<0.001). The effect for women is 0.18% for 70-year-olds to 74-year-olds (p=0.012) and 0.15% for 40-year-olds to 44-year-olds (p=0.118). In developed countries, mortality rates increase during upward cycles in the economy, and decrease during downward cycles. This effect is similar for the older and middle-aged population. Traditional explanations as work-stress and traffic accidents cannot explain our findings. Lower levels of social support and informal care by the working population during good economic times can play an important role, but this remains to be formally investigated.

Mortality Among Very Low-Birthweight Infants in Hospitals Serving Minority Populations

PubMed Central

Morales, Leo S.; Staiger, Douglas; Horbar, Jeffrey D.; Carpenter, Joseph; Kenny, Michael; Geppert, Jeffrey; Rogowski, Jeannette

2005-01-01

Objective. We investigated whether the proportion of Black very low-birth-weight (VLBW) infants treated by hospitals is associated with neonatal mortality for Black and White VLBW infants. Methods. We analyzed medical records linked to secondary data sources for 74050 Black and White VLBW infants (501 g to 1500 g) treated by 332 hospitals participating in the Vermont Oxford Network from 1995 to 2000. Hospitals where more than 35% of VLBW infants treated were Black were defined as “minority-serving.” Results. Compared with hospitals where less than 15% of the VLBW infants were Black, minority-serving hospitals had significantly higher risk-adjusted neonatal mortality rates (White infants: odds ratio [OR]=1.30, 95% confidence interval [CI] = 1.09, 1.56; Black infants: OR = 1.29, 95% CI = 1.01, 1.64; Pooled: OR = 1.28, 95% CI=1.10, 1.50). Higher neonatal mortality in minority-serving hospitals was not explained by either hospital or treatment variables. Conclusions. Minority-serving hospitals may provide lower quality of care to VLBW infants compared with other hospitals. Because VLBW Black infants are disproportionately treated by minority-serving hospitals, higher neonatal mortality rates at these hospitals may contribute to racial disparities in infant mortality in the United States. PMID:16304133

Cancer mortality disparities among New York City's Upper Manhattan neighborhoods.

PubMed

Hashim, Dana; Manczuk, Marta; Holcombe, Randall; Lucchini, Roberto; Boffetta, Paolo

2017-11-01

The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.

Time trends and epidemiological patterns of perinatal lamb mortality in Norway.

PubMed

Holmøy, Ingrid Hunter; Waage, Steinar

2015-09-30

Perinatal mortality is a major cause of loss in the sheep industry. Our aim was to explore time trends in crude population stillbirth and neonatal mortality rates in Norway. We used data on 6,435,715 lambs from flocks enrolled in the Norwegian Sheep Recording System (NSRS) from 2000 through 2010 for descriptive analysis of trends. Longitudinal patterns of mortality rates were compared for lambs within different levels of variables suspected to be associated with perinatal loss. There was an approximately linear increase in the annual proportion of stillborn lambs during the study period, from 3.3 % in 2000 to 4.7 % in 2010. In the same time period, average litter size of ewes in NSRS flocks increased from 2.00 to 2.19. However, a steady rise in stillbirth rate was observed within each litter size group, suggesting a gradually increasing impact on stillbirth risk of other, yet unidentified, factors. Average flock size increased during the study period. The highest stillbirth rates were found in the largest and smallest flocks. Early neonatal mortality rates (0-5 days of life) varied from year to year (minimum 2.2 %, maximum 3.2 %) and were invariably higher among triplets and quadruplets than among singletons and twins. Annual fluctuations were parallel within the various litter sizes. A significant overall decreasing trend was present within all litter sizes with the exception of singletons. Weather data for the prime lambing months (April and May) 2000-2010 indicated a relationship between low temperatures and high neonatal mortality rates. At the flock level, there was a significant positive correlation between stillbirths and early neonatal mortality rates (r = 0.13), between stillbirth rates in two consecutive years (r = 0.43) and between early neonatal mortality rates in two consecutive years (r = 0.40). The substantial increase in ovine stillbirth rate in recent years in Norway was to some extent related to a corresponding increase in the proportion of lambs in triplet or larger litters; however, other factors apparently have contributed. Early neonatal mortality rate exhibited year-to-year variations, partly following temperature fluctuations, which is somewhat unexpected, considering that lambing mainly occurs indoors in Norway.

Patterns of Mortality in Patients Treated with Dental Implants: A Comparison of Patient Age Groups and Corresponding Reference Populations.

PubMed

Jemt, Torsten; Kowar, Jan; Nilsson, Mats; Stenport, Victoria

2015-01-01

Little is known about the relationship between implant patient mortality compared to reference populations. The aim of this study was to report the mortality pattern in patients treated with dental implants up to a 15-year period, and to compare this to mortality in reference populations with regard to age at surgery, sex, and degree of tooth loss. Patient cumulative survival rate (CSR) was calculated for a total of 4,231 treated implant patients from a single clinic. Information was based on surgical registers in the clinic and the National Population Register in Sweden. Patients were arranged into age groups of 10 years, and CSR was compared to that of the reference population of comparable age and reported in relation to age at surgery, sex, and type of jaw/dentition. A similar, consistent, general relationship between CSR of different age groups of implant patients and reference populations could be observed for all parameters studied. Completely edentulous patients presented higher mortality than partially edentulous patients (P < .05). Furthermore, implant patients in younger age groups showed mortality similar to or higher than reference populations, while older patient age groups showed increasingly lower mortality than comparable reference populations for edentulous and partially edentulous patients (P < .05). A consistent pattern of mortality in different age groups of patients compared to reference populations was observed, indicating higher patient mortality in younger age groups and lower in older groups. The reported pattern is not assumed to be related to implant treatment per se, but is assumed to reflect the variation in general health of a selected subgroup of treated implant patients compared to the reference population in different age groups.

Thrombolytic therapy use for acute myocardial infarction and outcome in Qatar.

PubMed

Hadi, Hadi A R; Al Suwaidi, J; Bener, A; Khinji, A; Al Binali, H A

2005-07-10

Data on the outcome of patients treated with thrombolytic therapy in the Arab world is scarce. The main objective of this study is to study the 7-day morbidity and mortality rate and the rate of use of thrombolytic therapy in patients presenting with acute myocardial infarction treated with thrombolytic therapy in the Middle East. We conducted a retrospective analysis of prospectively collected data for all patients who were admitted to Coronary Care Unit in Cardiology Department in Hamad Medical during the period (1991-2001). Patients were divided into two groups in relation to ethnicity whether they received thrombolysis or not. In each group, the number of patients, age at the time of admission, gender, cardiovascular risk profile, therapy and outcome in regard of in-hospital complication and 7-day death as primary end point were analyzed. Of the total 5388 patients admitted with acute myocardial infarction during the 10-year period, 66.3% (3567) with STE MI were found, 61.4% (2190) of them received thrombolytic therapy while 38.6% (1377) were not eligible for thrombolytic therapy. The remaining 33.7% (1821) were admitted with non-STE MI. In consideration of ethnic variation, patients with STE MI eligible for thrombolytic therapy, 29.6% (1598) were Qataris and 70.4% (3792) were non-Qataris. Thrombolytic therapy was administered to 25.9% (414) of Qatari patients and 51.3% (1947) of non-Qataris. The mortality rate of Qatari patients who received thrombolytic therapy was 9.2% (38) vs. 19.5% (231) who did not receive thrombolytic therapy (p<0.001). In non-Qatari patients, the mortality rate was 5.2% (102) for those who received thrombolytic therapy, while it was 8.6% (159) for those with no thrombolytic therapy (p<0.001). When compared to male patients, female patients with thrombolytic therapy had higher mortality rates (in both Qataris and non-Qataris) (20.5% vs. 6.1%; p value<0.001 and 16.1% vs. 9.4%; p<0.001, respectively), there were no significant differences between the ethnic groups in regard to in-hospital complications. Patients treated with thrombolytic therapy had lower incidence of in-hospital complication regarding acute heart failure, post-myocardial angina, heart block and arrhythmia. Thrombolytic therapy reduced mortality rate in acute myocardial infarction by 69%. Logistic regression analysis had shown that arrhythmia, acute heart failure, heart block, cardiogenic shock, diabetes mellitus and stroke were independent predictors of increased mortality. Thrombolysis was used in 61.4%, which is still underutilized when compared to a few available studies in the Gulf area, and to other studies in the developed world. In the current study, use of thrombolysis in acute myocardial infarction was associated with significant decrease in in-hospital mortality and morbidity. Mortality rate was higher in the Qatari nationals when compared to non-Qataris. Reperfusion therapy may be underutilized in the developing world. Increased use of reperfusion therapy would result in reduced mortality rate. Global measures to encourage the use of reperfusion therapy including patients' education, and strategies to improve the health care system are needed.

Mortality from road traffic accidents in a rapidly urbanizing Chinese city: A 20-year analysis in Shenzhen, 1994-2013.

PubMed

Xie, Shao-Hua; Wu, Yong-Sheng; Liu, Xiao-Jian; Fu, Ying-Bin; Li, Shan-Shan; Ma, Han-Wu; Zou, Fei; Cheng, Jin-Quan

2016-01-01

This study aimed to describe the trends of motorization and mortality rates from road traffic accidents and examine their associations in a rapidly urbanizing city in China, Shenzhen. Using data from the Shenzhen Deaths Registry between 1994 and 2013, we calculated the annual mortality rates of road traffic accidents, in addition to the age- and sex-specific mortality rates and their annual percentage changes (APCs) for the period of 2000-2013. We also examined the associations between mortality rate of road traffic accidents and traffic growth with Spearman's rank correlation analysis and a log-linear model derived from Smeed's law. A total of 20,196 deaths due to road traffic accidents, including 14,391 (71.3%) male deaths and 5,805 (28.7%) female deaths, were recorded in Shenzhen from 1994 to 2013. The annual mortality rates in terms of deaths per population and deaths per vehicle changed in similar patterns, demonstrating an increase since 1994 and peaking in 1997, followed by a steady decrease thereafter. The decrease in mortality was faster in individuals aged 20 year or older compared to those younger than 20 years. The mortality rates in term of deaths per population were positively correlated with the total number of vehicles per kilometer of road but negatively correlated with the motorization rate in term of vehicles per population. The estimated model for deaths due to road traffic accidents in relation to the total population and the number of registered vehicles was ln (deaths/10,000 vehicles) = -1.902 × ln (vehicles/population) - 1.961. The coefficient was statistically significant (P < .001) and the coefficient of determination was 0.966, indicating a good model fit. We described a generally decreasing trend in the mortality rates of road traffic accidents in a rapidly urbanizing Chinese city based observations in the 20-year period from 1994 to 2013. The decreased mortality rate may be explained by the expansion of road network construction, improved road safety regulations and management, as well as more accessible ambulance services in recent years. Nevertheless, road traffic accidents remain a universal problem of great public health concern in the whole population.

Characteristics and outcome of unplanned out-of-institution births in Norway from 1999 to 2013: a cross-sectional study.

PubMed

Gunnarsson, Björn; Smárason, Alexander K; Skogvoll, Eirik; Fasting, Sigurd

2014-10-01

To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. Register-based cross-sectional study. All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital. © 2014 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Safety and efficacy of flow diverter treatment for blood blister-like aneurysm: A systematic review and meta-analysis.

PubMed

Zhu, Deyuan; Yan, Yazhou; Zhao, Puyuan; Duan, Guoli; Zhao, Rui; Liu, Jianmin; Huang, Qinghai

2018-06-23

To clarify the safety and efficacy of flow diverter (FD) treatment for blood blister-like aneurysm (BBA), we conducted a systematic review and literature analyzing perioperative and long-term clinical and angiographic outcomes. A comprehensive review of the up-to-date literature for studies with >2 patients related to FD treatment of BBAs published was performed. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, aneurysm recurrence, rebleeding, perioperative mortality, perioperative stroke, procedure-related morbidity and mortality, long-term neurological morbidity and mortality, and overall good neurological outcome. We included 15 non-comparative studies with 165 target BBAs. Complete occlusion rates were 72% (95%CI= 0.59-0.85). Recurrence occurred in 13% (95%CI= -0.04-0.29) and rebleeding in 3% (95%CI = -0.02-0.07) of patients. Procedure-related morbidity and mortality were 26% (95%CI =0.19-0.33) and 3% (95%CI= -0.01-0.07), respectively. Long-term good outcome was 83% (95% CI = 0.77-0.89). Subgroup analysis indicated that single FD strategy for BBA seemed to have a higher good outcome rate compared to overlapped FD strategy (89.9% versus 61.9%, OR=1.42, 95%CI=1.25-14.98, P=0.02). Complete occlusion rate and procedure-related morbidity rate did not see any significant difference between these two strategies. Our meta-analysis suggests that in select cases, FD can be safe and effective. Single FD strategy may result in a higher good outcome rate compared to overlapped FD strategy. Ultimately, treatment of BBA should be considered on a case-by-case basis to maximize patient benefits and limit the risk of perioperative complications. Copyright © 2018. Published by Elsevier Inc.

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries.

PubMed

Hagen, Terje P; Häkkinen, Unto; Belicza, Eva; Fatore, Giovanni; Goude, Fanny

2015-12-01

Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary. Copyright © 2015 John Wiley & Sons, Ltd.

Reduced mortality rates in a cohort of long-term underground iron-ore miners.

PubMed

Björ, Ove; Jonsson, Håkan; Damber, Lena; Wahlström, Jens; Nilsson, Tohr

2013-05-01

Historically, working in iron-ore mines has been associated with an increased risk of lung cancer and silicosis. However, studies on other causes of mortality are inconsistent and in the case of cancer incidence, sparse. The aim of this study was to examine the association between iron-ore mining, mortality and cancer incidence. A 54-year cohort study on iron-ore miners from mines in northern Sweden was carried out comprising 13,000 workers. Standardized rate ratios were calculated comparing the disease frequency, mortality, and cancer incidence with that of the general population of northern Sweden. Poisson regression was used to evaluate the association between the durations of employment and underground work, and outcome. Underground mining was associated with a significant decrease in adjusted mortality rate ratios for cerebrovascular and digestive system diseases, and stroke. For several outcomes, elevated standardized rate ratios were observed among blue-collar workers relative to the reference population. However, only the incidence of lung cancer increased with employment time underground (P < 0.001). Long-term iron-ore mining underground was associated with lower rates regarding several health outcomes. This is possibly explained by factors related to actual job activities, environmental exposure, or the selection of healthier workers for long-term underground employment. Copyright © 2013 Wiley Periodicals, Inc.

All-Cause Mortality Risk in Australian Women with Impaired Fasting Glucose and Diabetes

PubMed Central

Mohebbi, Mohammadreza; Sajjad, Muhammad A.

2017-01-01

Aims Impaired fasting glucose (IFG) and diabetes are increasing in prevalence worldwide and lead to serious health problems. The aim of this longitudinal study was to investigate the association between impaired fasting glucose or diabetes and mortality over a 10-year period in Australian women. Methods This study included 1167 women (ages 20–94 yr) enrolled in the Geelong Osteoporosis Study. Hazard ratios for all-cause mortality in diabetes, IFG, and normoglycaemia were calculated using a Cox proportional hazards model. Results Women with diabetes were older and had higher measures of adiposity, LDL cholesterol, and triglycerides compared to the IFG and normoglycaemia groups (all p < 0.001). Mortality rate was greater in women with diabetes compared to both the IFG and normoglycaemia groups (HR 1.8; 95% CI 1.3–2.7). Mortality was not different in women with IFG compared to those with normoglycaemia (HR 1.0; 95% CI 0.7–1.4). Conclusions This study reports an association between diabetes and all-cause mortality. However, no association was detected between IFG and all-cause mortality. We also showed that mortality in Australian women with diabetes continues to be elevated and women with IFG are a valuable target for prevention of premature mortality associated with diabetes. PMID:28698884

Surgical volume and postoperative mortality rate at a referral hospital in Western Uganda: Measuring the Lancet Commission on Global Surgery indicators in low-resource settings.

PubMed

Anderson, Geoffrey A; Ilcisin, Lenka; Abesiga, Lenard; Mayanja, Ronald; Portal Benetiz, Noralis; Ngonzi, Joseph; Kayima, Peter; Shrime, Mark G

2017-06-01

The Lancet Commission on Global Surgery recommends that every country report its surgical volume and postoperative mortality rate. Little is known, however, about the numbers of operations performed and the associated postoperative mortality rate in low-income countries or how to best collect these data. For one month, every patient who underwent an operation at a referral hospital in western Uganda was observed. These patients and their outcomes were followed until discharge. Prospective data were compared with data obtained from logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics. Surgical volume at this regional hospital in Uganda is 8,515 operations/y, compared to 4,000 operations/y reported in the only other published data. The postoperative mortality rate at this hospital is 2.4%, similar to other hospitals in low-income countries. Finding patient files in the medical records department was time consuming and yielded only 62% of the files. Furthermore, a comparison of missing versus found charts revealed that the missing charts were significantly different from the found charts. Logbooks, on the other hand, captured 99% of the operations and 94% of the deaths. Our results describe a simple, reproducible, accurate, and inexpensive method for collection of the Lancet Commission on Global Surgery variables using logbooks that already exist in most hospitals in low-income countries. While some have suggested using risk-adjusted postoperative mortality rate as a more equitable variable, our data suggest that only a limited amount of risk adjustment is possible given the limited available data. Copyright © 2017 Elsevier Inc. All rights reserved.

Ischaemic heart disease in the former Soviet Union 1990–2015 according to the Global Burden of Disease 2015 Study

PubMed Central

Murphy, Adrianna; Johnson, Catherine O; Roth, Gregory A; Forouzanfar, Mohammad H; Naghavi, Mohsen; Ng, Marie; Pogosova, Nana; Vos, Theo; Murray, Christopher J L; Moran, Andrew E

2018-01-01

Objective The objective of this study was to compare ischaemic heart disease (IHD) mortality and risk factor burden across former Soviet Union (fSU) and satellite countries and regions in 1990 and 2015. Methods The fSU and satellite countries were grouped into Central Asian, Central European and Eastern European regions. IHD mortality data for men and women of any age were gathered from national vital registration, and age, sex, country, year-specific IHD mortality rates were estimated in an ensemble model. IHD morbidity and mortality burden attributable to risk factors was estimated by comparative risk assessment using population attributable fractions. Results In 2015, age-standardised IHD death rates in Eastern European and Central Asian fSU countries were almost two times that of satellite states of Central Europe. Between 1990 and 2015, rates decreased substantially in Central Europe (men −43.5% (95% uncertainty interval −45.0%, −42.0%); women −42.9% (−44.0%, −41.0%)) but less in Eastern Europe (men −5.6% (−9.0, –3.0); women −12.2% (−15.5%, −9.0%)). Age-standardised IHD death rates also varied within regions: within Eastern Europe, rates decreased −51.7% in Estonian men (−54.0, −47.0) but increased +19.4% in Belarusian men (+12.0, +27.0). High blood pressure and cholesterol were leading risk factors for IHD burden, with smoking, body mass index, dietary factors and ambient air pollution also ranking high. Conclusions Some fSU countries continue to experience a high IHD burden, while others have achieved remarkable reductions in IHD mortality. Control of blood pressure, cholesterol and smoking are IHD prevention priorities. PMID:28883037

Suicide mortality rates in Louisiana, 1999-2010.

PubMed

Straif-Bourgeois, Susanne; Ratard, Raoult

2012-01-01

This report is a descriptive study on suicide deaths in Louisiana occurring in the years 1999 to 2010. Mortality data was collected from death certificates from this 12-year period to describe suicide mortality by year, race, sex, age group, and methods of suicide. Data were also compared to national data. Rates and methods used to commit suicide vary greatly according to sex, race, and age. The highest rates were observed in white males, followed by black males, white females, and black females. Older white males had the highest suicide rates. The influence of age was modulated by the sex and race categories. Firearm was the most common method used in all four categories. Other less common methods were hanging/strangulation/suffocation (HSS) and drugs/alcohol. Although no parish-level data were systematically analyzed, a comparison of suicide rates post-Katrina versus pre-Katrina was done for Orleans Parish, the rest of the Greater New Orleans area, and a comparison group. It appears that rates observed among whites, particularly males, were higher after Katrina. Data based on mortality do not give a comprehensive picture of the burden of suicide, and their interpretation should be done with caution.

A 2-fold higher rate of intraventricular hemorrhage-related mortality in African American neonates and infants.

PubMed

Qureshi, Adnan I; Adil, Malik M; Shafizadeh, Negin; Majidi, Shahram

2013-07-01

Despite the recognition of racial or ethnic differences in preterm gestation, such differences in the rate of intraventricular hemorrhage (IVH), frequently associated with preterm gestation, are not well studied. The authors performed the current study to identify racial or ethnic differences in the incidence of IVH-related mortality within the national population of the US. Using the ICD-10 codes P52.0, P52.1, P52.2, P52.3, and P10.2 and the Multiple Cause of Death data from 2000 to 2009, the authors identified all IVH-related mortalities that occurred in neonates and infants aged less than 1 year. The live births for whites and African Americans from the census for 2000-2009 were used to derive the incidence of IVH-related mortality for whites and African Americans per 100,000 live births. The IVH rate ratio (RR, 95% confidence interval [CI]) and annual percent change (APC) in the incidence rates from 2000 to 2009 were also calculated. A total of 3249 IVH-related mortality cases were reported from 2000 to 2009. The incidence rates of IVH were higher among African American infants (16 per 100,000 live births) than among whites (7.8 per 100,000 live births). African American infants had a 2-fold higher risk of IVH-related mortality compared with whites (RR 2.0, 95% CI 1.2-3.2). The rate of increase over the last 10 years was less in African American infants (APC 1.6%) than in white infants (APC 4.3%). The rate of IVH-related mortality is 2-fold higher among African American than white neonates and infants. Further studies are required to understand the underlying reasons for this prominent disparity in one of the most significant causes of infant mortality.

Trends and Patterns of Differences in Infectious Disease Mortality Among US Counties, 1980-2014.

PubMed

El Bcheraoui, Charbel; Mokdad, Ali H; Dwyer-Lindgren, Laura; Bertozzi-Villa, Amelia; Stubbs, Rebecca W; Morozoff, Chloe; Shirude, Shreya; Naghavi, Mohsen; Murray, Christopher J L

2018-03-27

Infectious diseases are mostly preventable but still pose a public health threat in the United States, where estimates of infectious diseases mortality are not available at the county level. To estimate age-standardized mortality rates and trends by county from 1980 to 2014 from lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis. This study used deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database. Validated small-area estimation models were applied to these data to estimate county-level infectious disease mortality rates. County of residence. Age-standardized mortality rates of lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis by county, year, and sex. Between 1980 and 2014, there were 4 081 546 deaths due to infectious diseases recorded in the United States. In 2014, a total of 113 650 (95% uncertainty interval [UI], 108 764-117 942) deaths or a rate of 34.10 (95% UI, 32.63-35.38) deaths per 100 000 persons were due to infectious diseases in the United States compared to a total of 72 220 (95% UI, 69 887-74 712) deaths or a rate of 41.95 (95% UI, 40.52-43.42) deaths per 100 000 persons in 1980, an overall decrease of 18.73% (95% UI, 14.95%-23.33%). Lower respiratory infections were the leading cause of infectious diseases mortality in 2014 accounting for 26.87 (95% UI, 25.79-28.05) deaths per 100 000 persons (78.80% of total infectious diseases deaths). There were substantial differences among counties in death rates from all infectious diseases. Lower respiratory infection had the largest absolute mortality inequality among counties (difference between the 10th and 90th percentile of the distribution, 24.5 deaths per 100 000 persons). However, HIV/AIDS had the highest relative mortality inequality between counties (10.0 as the ratio of mortality rate in the 90th and 10th percentile of the distribution). Mortality from meningitis and tuberculosis decreased over the study period in all US counties. However, diarrheal diseases were the only cause of infectious diseases mortality to increase from 2000 to 2014, reaching a rate of 2.41 (95% UI, 0.86-2.67) deaths per 100 000 persons, with many counties of high mortality extending from Missouri to the northeastern region of the United States. Between 1980 and 2014, there were declines in mortality from most categories of infectious diseases, with large differences among US counties. However, over this time there was an increase in mortality for diarrheal diseases.

Buprenorphine physician supply: Relationship with state-level prescription opioid mortality

PubMed Central

Havens, Jennifer R.; Lofwall, Michelle R.; Studts, Jamie L.; Walsh, Sharon L.

2017-01-01

Background Buprenorphine is an effective treatment for opioid use disorder but the supply of buprenorphine physicians is currently inadequate to address the nation’s prescription opioid crisis. Perception of need due to rising opioid overdose rates is one possible reason for physicians to adopt buprenorphine. This study examined associations between rates of growth in buprenorphine physicians and prescription opioid overdose mortality rates in US states. Methods The total buprenorphine physician supply and number of physicians approved to treat 100 patients (per 100,000 population) were measured from June, 2013 to January, 2016. States were divided into two groups: those with rates of prescription opioid overdose mortality in 2013 at or above the median (>5.5 deaths per 100,000 population) and those with rates below the median. State-level growth curves were estimated using mixed-effects regression to compare rates of growth between high and low overdose states. Results The total supply and the supply of 100-patient buprenorphine physicians grew significantly (total supply from 7.7 to 9.9 per 100,000 population, p<.001; 100-patient supply from 2.2 to 3.4 per 100,000 population, p<.001). Rates of growth were significantly greater in high overdose states when compared to low overdose states (total supply b=.033, p<.01; 100-patient b=.022, p<.01). Conclusions The magnitude of the US prescription opioid crisis, as measured by the rate of prescription opioid overdose mortality, is associated with growth in the number of buprenorphine physicians. Because this observational design cannot establish causality, further research is needed to elucidate the factors influencing physicians’ decisions to begin prescribing buprenorphine. PMID:28363321

Buprenorphine physician supply: Relationship with state-level prescription opioid mortality.

PubMed

Knudsen, Hannah K; Havens, Jennifer R; Lofwall, Michelle R; Studts, Jamie L; Walsh, Sharon L

2017-04-01

Buprenorphine is an effective treatment for opioid use disorder but the supply of buprenorphine physicians is currently inadequate to address the nation's prescription opioid crisis. Perception of need due to rising opioid overdose rates is one possible reason for physicians to adopt buprenorphine. This study examined associations between rates of growth in buprenorphine physicians and prescription opioid overdose mortality rates in US states. The total buprenorphine physician supply and number of physicians approved to treat 100 patients (per 100,000 population) were measured from June 2013 to January 2016. States were divided into two groups: those with rates of prescription opioid overdose mortality in 2013 at or above the median (>5.5 deaths per 100,000 population) and those with rates below the median. State-level growth curves were estimated using mixed-effects regression to compare rates of growth between high and low overdose states. The total supply and the supply of 100-patient buprenorphine physicians grew significantly (total supply from 7.7 to 9.9 per 100,000 population, p<0.001; 100-patient supply from 2.2 to 3.4 per 100,000 population, p<0.001). Rates of growth were significantly greater in high overdose states when compared to low overdose states (total supply b=0.033, p<0.01; 100-patient b=0.022, p<0.01). The magnitude of the US prescription opioid crisis, as measured by the rate of prescription opioid overdose mortality, is associated with growth in the number of buprenorphine physicians. Because this observational design cannot establish causality, further research is needed to elucidate the factors influencing physicians' decisions to begin prescribing buprenorphine. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Mortality for chronic-degenerative diseases in Tuscany: Ecological study comparing neighboring areas with substantial differences in environmental pollution.

PubMed

Marabotti, Claudio; Piaggi, Paolo; Scarsi, Paolo; Venturini, Elio; Cecchi, Romina; Pingitore, Alessandro

2017-06-19

Environmental pollution is associated with morbidity and mortality for chronic-degenerative diseases. Recent data points out a relationship between proximity to industrial plants and mortality due to neoplasms. The aim of this study has been to compare mortality due to chronic-degenerative diseases in the area of Tuscany (Bassa Val di Cecina), Italy, characterized by the presence of 2 neighboring municipalities similar in terms of size but with substantial differences in industrial activities: Rosignano (the site of chemical, energy production and waste processing industries) and Cecina (with no polluting activity). Standardized mortality rates for the 2001-2010 decade were calculated; the data of the whole Tuscany was assumed as reference. Environmental levels of pollutants were obtained by databases of the Environmental Protection Agency of Tuscany Region (Agenzia Regionale per la Protezione Ambientale della Toscana - ARPAT). Maximum tolerated pollutant levels set by national laws were assumed as reference. In the whole Bassa Val di Cecina, significantly elevated standardized mortality rates due to mesothelioma, ischemic heart diseases, cerebrovascular diseases and Alzheimer and other degenerative diseases of nervous system were observed. In the municipality of Rosignano, a significant excess of mortality for all these groups of diseases was confirmed. On the contrary, the municipality of Cecina showed only significantly higher mortality rates for ischemic heart diseases. Elevated levels of heavy metals in sea water and of particulate matter which contains particles of diameter ≤ 10 mm (PM₁₀) and ozone in air were detected in Rosignano. This study shows an excess of mortality for chronic-degenerative diseases in the area with elevated concentration of polluting factories. Proximity to industrial plants seems to represent a risk factor for those diseases. Int J Occup Med Environ Health 2017;30(4):641-653. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Historical cancer incidence and mortality assessment in an Illinois community proximal to a former manufactured gas plant

PubMed Central

Alexander, Dominik D; Jiang, Xiaohui; Bylsma, Lauren C; Garabrant, David H; Irvin, Sarah R; Fryzek, Jon P

2014-01-01

Objectives Concern has been raised that the occurrence of cancer may be increased in neighbourhoods around a former manufactured gas plant in Champaign, Illinois, USA. Thus, we compared historical rates of cancer in this area to comparison communities as well as with nationally standardised rates. Design Retrospective population-based community cancer assessment during 1990–2010. Setting Champaign County, Illinois, USA, and zip codes encompassing the location of the former manufactured gas plant to counties that were similar demographically. Participants Residents of the counties and zip codes studied between 1990 and 2010. Main outcome measures The relative risk (RR) and 95% CI were used to compare cancer incidence and mortality in the areas near the gas compression site to the comparison counties. Standardised incidence ratios (SIRs) were calculated to compare rates in the areas near the gas compression site to expected rates based on overall US cancer rates. Results Total cancer mortality (RR=0.91, 95% CI 0.88 to 0.94) and incidence (RR=0.95, 95% CI 0.94 to 0.97) were reduced significantly in Champaign County versus the comparison counties. Similarly, a reduced rate of total cancer was observed in analyses by zip code (proximal to the former gas plant) when compared with either similar counties (RR=0.89, 95% CI 0.86 to 0.93) or national standardised rates of cancer (SIR=0.88, 95% CI 0.85 to 0.91). Conclusions This historical cancer assessment did not find an increased risk of total cancer or specific cancer types in communities near a former manufactured gas plant site. PMID:25534215

Death rates from human immunodeficiency virus and tuberculosis among American Indians/Alaska Natives in the United States, 1990-2009.

PubMed

Reilley, Brigg; Bloss, Emily; Byrd, Kathy K; Iralu, Jonathan; Neel, Lisa; Cheek, James

2014-06-01

We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100,000 people) for AI/AN persons with those for Whites; Hispanics were excluded. Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations.

Death Rates From Human Immunodeficiency Virus and Tuberculosis Among American Indians/Alaska Natives in the United States, 1990–2009

PubMed Central

Bloss, Emily; Byrd, Kathy K.; Iralu, Jonathan; Neel, Lisa; Cheek, James

2014-01-01

Objectives. We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. Methods. National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100 000 people) for AI/AN persons with those for Whites; Hispanics were excluded. Results. Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). Conclusions. The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations. PMID:24754664

Fine-particulate Air Pollution from Diesel Emission Control and Mortality Rates in Tokyo: A Quasi-experimental Study.

PubMed

Yorifuji, Takashi; Kashima, Saori; Doi, Hiroyuki

2016-11-01

Evidence linking air pollution with adverse health outcomes is accumulating. However, few studies have adopted a quasi-experimental design to evaluate whether decline in air pollution from regulatory action improves public health. We evaluated the effect of a diesel emission control ordinance introduced in 2003 on mortality rates in 23 wards of the Tokyo metropolitan area, Japan, from October 2000 to September 2012, taking into account change in mortality rates in a reference population (Osaka) with a introduction of such a regulation in 2009. We obtained daily counts of all-cause and cause-specific mortality and concentrations of nitrogen dioxide (NO2) and particulate matter less than 2.5 μm in diameter (PM2.5) during the study period. We employed interrupted time-series analysis to analyze the data. Decline in NO2 during the study period was similar in the two areas, while decline in PM2.5 and the improvement in age-standardized mortality rates were greater in Tokyo's 23 wards compared with Osaka. Even after adjusting for age-standardized mortality rates in Osaka, percent changes in mortality between the first 3-year interval (October 2000 to September 2003) and the last 3-year interval (October 2009 to September 2012) were -6.0% for all causes, -11% for cardiovascular disease, -10% for ischemic heart disease, -6.2% for cerebrovascular disease, -22% for pulmonary disease, and -4.9% for lung cancer. We did not observe a decline in mortality from other causes. This quasi-experimental study in Tokyo suggests that emission control was associated with improvements in both air quality and health outcomes.

Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990-2011.

PubMed

Ong, Paulina; Lovasi, Gina S; Madsen, Ann; Van Wye, Gretchen; Demmer, Ryan T

2017-09-01

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

High mortality due to sepsis in Native Hawaiians and African Americans: The Multiethnic Cohort.

PubMed

Matter, Michelle L; Shvetsov, Yurii B; Dugay, Chase; Haiman, Christopher A; Le Marchand, Loic; Wilkens, Lynne R; Maskarinec, Gertraud

2017-01-01

Sepsis is a severe systemic response to infection with a high mortality rate. A higher incidence has been reported for older people, in persons with a compromised immune system including cancer patients, and in ethnic minorities. We analyzed sepsis mortality and its predictors by ethnicity in the Multiethnic Cohort (MEC). Among 191,561 white, African American, Native Hawaiian, Japanese American, and Latino cohort members, 49,347 deaths due to all causes and 345 deaths due to sepsis were recorded during follow-up from 1993-96 until 2010. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated and adjusted for relevant confounders. In addition, national death rates were analyzed to compare mortality by state. Age-adjusted rates of sepsis death were 5-times higher for Hawaii than Los Angeles (14.4 vs. 2.7 per 100,000). By ethnicity, Native Hawaiians had the highest rate in Hawaii (29.0 per 100,000) and African Americans in Los Angeles (5.2 per 100,000). In fully adjusted models, place of residence was the most important predictor of sepsis mortality (HR = 7.18; 95%CI: 4.37-11.81 Hawaii vs. Los Angeles). African Americans showed the highest risk (HR = 2.08; 95% CI: 1.16-3.75) followed by Native Hawaiians (HR = 1.88; 95% CI: 1.34-2.65) as compared to whites. Among cohort members with cancer (N = 49,794), the 2-fold higher sepsis mortality remained significant in Native Hawaiians only. The geographic and ethnic differences in the MEC agreed with results for national death data. The finding that African Americans and Native Hawaiians experience a higher mortality risk due to sepsis than other ethnic groups suggest ethnicity-related biological factors in the predisposition of cancer patients and other immune-compromising conditions to develop sepsis, but regional differences in health care access and death coding may also be important.

High mortality due to sepsis in Native Hawaiians and African Americans: The Multiethnic Cohort

PubMed Central

Shvetsov, Yurii B.; Dugay, Chase; Haiman, Christopher A.; Le Marchand, Loic; Wilkens, Lynne R.; Maskarinec, Gertraud

2017-01-01

Background/Objectives Sepsis is a severe systemic response to infection with a high mortality rate. A higher incidence has been reported for older people, in persons with a compromised immune system including cancer patients, and in ethnic minorities. We analyzed sepsis mortality and its predictors by ethnicity in the Multiethnic Cohort (MEC). Subjects/Methods Among 191,561 white, African American, Native Hawaiian, Japanese American, and Latino cohort members, 49,347 deaths due to all causes and 345 deaths due to sepsis were recorded during follow-up from 1993–96 until 2010. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated and adjusted for relevant confounders. In addition, national death rates were analyzed to compare mortality by state. Results Age-adjusted rates of sepsis death were 5-times higher for Hawaii than Los Angeles (14.4 vs. 2.7 per 100,000). By ethnicity, Native Hawaiians had the highest rate in Hawaii (29.0 per 100,000) and African Americans in Los Angeles (5.2 per 100,000). In fully adjusted models, place of residence was the most important predictor of sepsis mortality (HR = 7.18; 95%CI: 4.37–11.81 Hawaii vs. Los Angeles). African Americans showed the highest risk (HR = 2.08; 95% CI: 1.16–3.75) followed by Native Hawaiians (HR = 1.88; 95% CI: 1.34–2.65) as compared to whites. Among cohort members with cancer (N = 49,794), the 2-fold higher sepsis mortality remained significant in Native Hawaiians only. The geographic and ethnic differences in the MEC agreed with results for national death data. Conclusions The finding that African Americans and Native Hawaiians experience a higher mortality risk due to sepsis than other ethnic groups suggest ethnicity-related biological factors in the predisposition of cancer patients and other immune-compromising conditions to develop sepsis, but regional differences in health care access and death coding may also be important. PMID:28558016

[The safety of biologics : a risk-benefit assessment of treating rheumatoid arthritis with biologics based on registry data on mortality].

PubMed

Sander, O

2010-11-01

The aim of this study is a risk-benefit assessment of treating rheumatoid arthritis with biologics based on registry data on mortality.UK, Sweden and Spain have published evaluable data on mortality. A parallel control group was conducted in the UK. Sweden and Spain used an historical cohort for comparison.Central registries supported British and Swedish research by sending details on all deaths. The variety of possible confounders prevents direct comparisons of the registers and safe predictions for individual patients.The death rate in TNF-inhibitor-treated patients is higher than in the general population but lower than in the control groups with RA. Thus comorbidities are not balanced, the weighted mortality rate scaled down the difference between exposed patients and controls. When TNF-inhibitors are given for the usual indication, mortality is reduced compared to conventional therapy.

The High Burden of Cancer Among American Indians/Alaska Natives in Wisconsin.

PubMed

Foote, Mary; Strickland, Rick; Lucas-Pipkorn, Samantha; Williamson, Amy; Lamers, Lauren

2016-02-01

American Indians/Alaska Natives (AI/AN) who live in the Northern Plains, includingt Wisconsin, face disproportionate cancer disparities. This report examines cancer incidence and mortality based on residence in Contract Health Service Delivery Areas (CHSDA) to assess disparities between AIs/ANs and other racial populations in Wisconsin. To improve identification of the AI/AN race, incidence data were linked with Indian Health Service (IHS) patient records. Analysis further focused on residents of IHS CHSDA counties. Age-adjusted cancer incidence and mortality rates (2007-2011) were calculated by sex and major cancer sites. AI/AN rates were.analyzed for both statewide and CHSDA residency in comparison to statewide white rates and comparable national rates. In comparison with whites, AI/ANs in CHSDA counties had higher incidence rates of cervical (3.5 times), liver (3.2), lung (2.3), and kidney cancers (2.1), and higher mortality rates for liver (2.7), kidney (2.2) and lung (1.9) cancers. Although there were similar rates of prostate cancer incidence between the 2 populations, AI/ANs were 1.9 times more likely to die from the disease. AI/AN individuals in Wisconsin CHDSA counties experience the highest cancer incidence rate of any racial group for both genders combined and for females. This population also has the highest mortality rate among all racial groups for both males and females. To meet the Wisconsin Comprehensive Cancer Control Plan 2015-2020 and Healthy People 2020 goals of lowering cancer incidence and mortality rates, the disproportionate cancer burden among AIs.

Impact of Community-Based Approach as Policy Tool: World Health Organization-Designated Safe Communities of Korea and Health Action Zones of the United Kingdom.

PubMed

Kang, Changhyun; Shin, Jihyung; Matthews, Bob

2016-02-01

The aim of this study is to ascertain and identify the effectiveness of area-based initiatives as a policy tool mediated by societal and individual factors in the five World Health Organization (WHO)-designated Safe Communities of Korea and the Health Action Zones of the United Kingdom (UK). The Korean National Hospital discharge in-depth injury survey from the Korea Centers for Disease Control and Prevention and causes of death statistics by the Statistics Korea were used for all analyses. The trend and changes in injury rate and mortality by external causes were compared among the five WHO-designated Safe Communities in Korea. The injury incident rates decreased at a greater level in the Safe Communities compared with the national average. Similar results were shown for the changes in unintentional injury incident rates. In comparison of changes in mortality rate by external causes between 2005 and 2011, the rate increase in Safe Communities was higher than the national average except for Jeju, where the mortality rate by external causes decreased. When the Healthy Action Zones of the UK and the WHO Safe Communities of Korea were examined, the outcomes were interpreted differently among the compared index, regions, and time periods. Therefore, qualitative outcomes, such as bringing the residents' attention to the safety of the communities and promoting participation and coordination of stakeholders, should also be considered as important impacts of the community-based initiatives.

Joint effects of social class and community occupational structure on coronary mortality among black men and white men, upstate New York, 1988–92

PubMed Central

Armstrong, D; Strogatz, D; Barnett, E; Wang, R

2003-01-01

Study objective: Occupational structure represents the unequal geographical distribution of more desirable jobs among communities (for example, white collar jobs). This study examines joint effects of social class, race, and county occupational structure on coronary mortality rates for men, ages 35–64 years, 1988–92, in upstate New York. Design: Upstate New York's 57 counties were classified into three occupational structure categories; counties with the lowest percentages of the labour force in managerial, professional, and technical occupations were classified in category I, counties with the highest percentages were in category III. Age adjusted coronary heart disease (CHD) mortality rates, 35–64 years, (from vital statistics and census data) were calculated for each occupational structure category. Main results: An inverse association between CHD mortality and occupational structure was observed among blue collar and white collar workers, among black men and white men, with the lowest CHD mortality observed among white collar, white men in category III (135/100 000). About two times higher mortality was observed among blue collar than white collar workers. Among blue collar workers, mortality was 1.3–1.8 times higher among black compared with white workers, and the highest rates were observed among black, blue collar workers (689/100 000). Also, high residential race segregation was shown in all areas. Conclusions: Results suggest the importance of community conditions in coronary health of local populations; however, differential impact on subpopulations was shown. Blue collar and black workers may especially lack economic and other resources to use available community services and/or may experience worse working and living conditions compared with white collar and white workers in the same communities. PMID:12700223

A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: the EURHOBOP project.

PubMed

Dégano, Irene R; Subirana, Isaac; Torre, Marina; Grau, María; Vila, Joan; Fusco, Danilo; Kirchberger, Inge; Ferrières, Jean; Malmivaara, Antti; Azevedo, Ana; Meisinger, Christa; Bongard, Vanina; Farmakis, Dimitros; Davoli, Marina; Häkkinen, Unto; Araújo, Carla; Lekakis, John; Elosua, Roberto; Marrugat, Jaume

2015-03-01

Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Economic development and family size.

PubMed

Rios, R J

1991-01-01

The demographic transition in Latin America has resulted in increased family size rather than the Western European model of reduced family size. In 1905, both fertility and mortality were high in Latin America, but mortality declined more rapidly in Latin America than in Europe. In 1905, the crude birth rate for 15 selected countries averaged 44/1000 population. Western fertility at a comparable transition point was much lower at 30/1000. Between 1905 and 1960, fertility declines were evident in Uruguay, Argentina, Cuba, and Chile. Between 1960 and 1985, fertility declines appeared in Costa Rica, Panama, Brazil, and Colombia. Fertility declines were smaller in the other Latin American countries. Crude birth rates declined markedly by 1985 but may overestimate fertility decline, which is more accurately measured by standardized birth rates. Fertility decline was evident in Argentina, Chile, and Costa Rica for standardized birth rates, survivorship ratio, and births surviving past the age of 15 years. Theoretically, families are expected to reduce family size when survivorship is assured; when mortality is 25%, only four children need be planned instead of six when mortality is 50%. A result of falling mortality is a cheaper cost of producing children, which may stimulate parents to raise bigger families. Western fertility decline has been attributed to mortality decline, urbanization, increased female labor force participation, rising wages, and more efficient contraception. Comparable economic development in Latin America has not resulted in large enough changes to encourage family size limitation. A table of fertility and economic indicators for selected countries in Latin America and Europe reflects the inverse relationship between income growth, urban growth, and growth in female educational status and fertility. The regression equation explains 60% of the variation in fertility rates among Latin American countries. Explanatory power increases to 75% when female high school enrollment is added to per capita gross national product. Fertility declines in Latin America in the future will be dependent on economic development, educational advancement for women, and a reduction in rural population.

Landscape‐level patterns in fawn survival across North America

USGS Publications Warehouse

Gingery, Tess M.; Diefenbach, Duane R.; Wallingford, Bret D.; Rosenberry, Christopher S.

2018-01-01

A landscape‐level meta‐analysis approach to examining early survival of ungulates may elucidate patterns in survival not evident from individual studies. Despite numerous efforts, the relationship between fawn survival and habitat characteristics remains unclear and there has been no attempt to examine trends in survival across landscape types with adequate replication. In 2015–2016, we radiomarked 98 white‐tailed deer (Odocoileus virginianus) fawns in 2 study areas in Pennsylvania. By using a meta‐analysis approach, we compared fawn survival estimates from across North America using published data from 29 populations in 16 states to identify patterns in survival and cause‐specific mortality related to landscape characteristics, predator communities, and deer population density. We modeled fawn survival relative to percentage of agricultural land cover and deer density. Estimated average survival to 3–6 months of age was 0.414 ± 0.062 (SE) in contiguous forest landscapes (no agriculture) and for every 10% increase in land area in agriculture, fawn survival increased 0.049 ± 0.014. We classified cause‐specific mortality as human‐caused, natural (excluding predation), and predation according to agriculturally dominated, forested, and mixed (i.e., both agricultural and forest cover) landscapes. Predation was the greatest source of mortality in all landscapes. Landscapes with mixed forest and agricultural cover had greater proportions and rates of human‐caused mortalities, and lower proportions and rates of mortality due to predators, when compared to forested landscapes. Proportion and rate of natural deaths did not differ among landscapes. We failed to detect any relationship between fawn survival and deer density. The results highlight the need to consider multiple spatial scales when accounting for factors that influence fawn survival. Furthermore, variation in mortality sources and rates among landscapes indicate the potential for altered landscape mosaics to influence fawn survival rates. Wildlife managers can use the meta‐analysis to identify factors that will facilitate comparisons of results among studies and advance a better understanding of patterns in fawn survival.

Comparing two survey methods for estimating maternal and perinatal mortality in rural Cambodia.

PubMed

Chandy, Hoeuy; Heng, Yang Van; Samol, Ha; Husum, Hans

2008-03-01

We need solid estimates of maternal mortality rates (MMR) to monitor the impact of maternal care programs. Cambodian health authorities and WHO report the MMR in Cambodia at 450 per 100,000 live births. The figure is drawn from surveys where information is obtained by interviewing respondents about the survival of all their adult sisters (sisterhood method). The estimate is statistically imprecise, 95% confidence intervals ranging from 260 to 620/100,000. The MMR estimate is also uncertain due to under-reporting; where 80-90% of women deliver at home maternal fatalities may go undetected especially where mortality is highest, in remote rural areas. The aim of this study was to attain more reliable MMR estimates by using survey methods other than the sisterhood method prior to an intervention targeting obstetric rural emergencies. The study was carried out in rural Northwestern Cambodia where access to health services is poor and poverty, endemic diseases, and land mines are endemic. Two survey methods were applied in two separate sectors: a community-based survey gathering data from public sources and a household survey gathering data direct from primary sources. There was no statistically significant difference between the two survey results for maternal deaths, both types of survey reported mortality rates around the public figure. The household survey reported a significantly higher perinatal mortality rate as compared to the community-based survey, 8.6% versus 5.0%. Also the household survey gave qualitative data important for a better understanding of the many problems faced by mothers giving birth in the remote villages. There are detection failures in both surveys; the failure rate may be as high as 30-40%. PRINCIPLE CONCLUSION: Both survey methods are inaccurate, therefore inappropriate for evaluation of short-term changes of mortality rates. Surveys based on primary informants yield qualitative information about mothers' hardships important for the design of future maternal care interventions.

Interactive Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers or Their Combination on Survival of Hemodialysis Patients

PubMed Central

Kido, Ryo; Akizawa, Tadao; Fukagawa, Masafumi; Onishi, Yoshihiro; Yamaguchi, Takuhiro; Fukuhara, Shunichi

2018-01-01

Background Does the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers individually or as a combination confer a survival benefit in hemodialysis patients? The answer to this question is yet unclear. Methods We performed a case-cohort study using data from the Mineral and Bone Disorder Outcomes Study for Japanese CKD stage 5D patients (MBD-5D), a 3-year multicenter prospective case-cohort study, including 8,229 hemodialysis patients registered from 86 facilities in Japan. All patients had secondary hyperparathyroidism, a condition defined as a parathyroid hormone level ≥180 pg/mL and/or receiving vitamin D receptor activators. We compared all-cause mortality rates between those receiving ACEI, ARB, and their combination and non-users with interaction testing. We used marginal structural Poisson regression (causal model) to estimate the causal effect and interaction adjusted for possible time-dependent confounding. Cardiovascular mortality was also evaluated. Results Among 3,762 randomly sampled subcohort patients, those taking ACEI, ARB, and their combination at baseline accounted for 4.0, 31.6, and 3.8%, respectively. Over 3 years, 1,226 all-cause and 462 cardiovascular deaths occurred. Compared to non-users, ARB-alone users had a lower all-cause mortality rate (adjusted incident rate ratio [aIRR] 0.62, 95% CI 0.50–0.76), whereas ACEI-alone users showed a statistically similar rate (aIRR 1.01, 95% CI 0.57–1.77). On the contrary, combination users had a greater mortality rate (aIRR 2.56, 95% CI 1.22–5.37), showing significant interaction (p = 0.03). Analysis for cardiovascular mortality showed similar results. Conclusion Among hemodialysis patients with secondary hyperparathyroidism, unlike ACEI use, ARB use was associated with greater survival than non-use. Conversely, combination use was associated with greater mortality. Controlled trials are warranted to verify the causality factors of these associations. PMID:29161689

Sex differences in cardiovascular mortality in diabetics and nondiabetic subjects: a population-based study (Italy).

PubMed

Ballotari, Paola; Ranieri, Sofia Chiatamone; Luberto, Ferdinando; Caroli, Stefania; Greci, Marina; Giorgi Rossi, Paolo; Manicardi, Valeria

2015-01-01

The objective of this study is to assess the impact of diabetes on cardiovascular mortality, focusing on sex differences. The inhabitants of Reggio Emilia province on December 31, 2009, aged 20-84 were followed up for three years for mortality. The exposure was determined using Reggio Emilia diabetes register. The age-adjusted death rates were estimated as well as the incidence rate ratios using Poisson regression model. Interaction terms for diabetes and sex were tested by the Wald test. People with diabetes had an excess of mortality, compared with nondiabetic subjects (all cause: IRR = 1.68; 95%CI 1.60-1.78; CVD: IRR = 1.61; 95%CI 1.47-1.76; AMI: IRR = 1.59; 95%CI 1.27-1.99; renal causes: IRR = 1.71; 95%CI 1.22-2.38). The impact of diabetes is greater in females than males for all causes (P = 0.0321) and for CVD, IMA, and renal causes. Further studies are needed to investigate whether the difference in cardiovascular risk profile or in the quality of care delivered justifies the higher excess of mortality in females with diabetes compared to males.

Sex Differences in Cardiovascular Mortality in Diabetics and Nondiabetic Subjects: A Population-Based Study (Italy)

PubMed Central

Ballotari, Paola; Ranieri, Sofia Chiatamone; Luberto, Ferdinando; Caroli, Stefania; Greci, Marina; Manicardi, Valeria

2015-01-01

The objective of this study is to assess the impact of diabetes on cardiovascular mortality, focusing on sex differences. The inhabitants of Reggio Emilia province on December 31, 2009, aged 20–84 were followed up for three years for mortality. The exposure was determined using Reggio Emilia diabetes register. The age-adjusted death rates were estimated as well as the incidence rate ratios using Poisson regression model. Interaction terms for diabetes and sex were tested by the Wald test. People with diabetes had an excess of mortality, compared with nondiabetic subjects (all cause: IRR = 1.68; 95%CI 1.60–1.78; CVD: IRR = 1.61; 95%CI 1.47–1.76; AMI: IRR = 1.59; 95%CI 1.27–1.99; renal causes: IRR = 1.71; 95%CI 1.22–2.38). The impact of diabetes is greater in females than males for all causes (P = 0.0321) and for CVD, IMA, and renal causes. Further studies are needed to investigate whether the difference in cardiovascular risk profile or in the quality of care delivered justifies the higher excess of mortality in females with diabetes compared to males. PMID:25873959