Cause-specific Mortality In Relation Research Articles

Effect of mortality in cost-effectiveness modeling of disease-modifying treatment for Alzheimer's disease.

We examined (1) the magnitude of mortality attributed to Alzheimer's disease (AD), and (2) the effect of mortality in cost-effectiveness modeling of hypothetical disease-modifying treatment (DMT) in AD. Data were derived from Swedish Dementia Registry (N=39,308). Mortality was analyzed with survival analysis and multinomial logistic regression. A Markov microsimulation model was used to model the cost effectiveness of DMT using routine care as a comparator. Three scenarios were simulated: (1) indirect effect, (2) no effect on overall mortality, (3) indirect effect on AD-related mortality. Overall mortality increased with cognitive decline, age, male sex, number of medications used, and lower body mass index. Nearly all cause-specific mortality was associated with cognitive decline. DMT increased survival by 0.35 years in scenario 1 and 0.14 years in scenario 3. DMT with no mortality effect is the least cost effective. The results provide key mortality estimates and demonstrate influences on the cost effectiveness of DMT. We describe cause-specific mortality in relation to disease severity in Alzheimer's disease (AD).We model different assumptions of disease-modifying treatment (DMT) on AD survival.DMT was the least cost effective when assuming no effect on AD survival.Cost effectiveness is mainly influenced by the relative cost of staying in each disease state.

Associations of Dietary Cholesterol, Serum Cholesterol, and Egg Consumption With Overall and Cause-Specific Mortality: Systematic Review and Updated Meta-Analysis.

Despite substantial research highlighting the importance of exogenous dietary cholesterol intake and endogenous serum cholesterol level in human health, a thorough evaluation of the associations is lacking. Our study objective was to examine overall and cause-specific mortality in relation to dietary and serum cholesterol, as well as egg consumption, and conduct an updated meta-regression analysis of cohort studies. We conducted a prospective analysis of 27 078 men in the ATBC Study (Alpha-Tocopherol, Beta-Carotene Cancer Prevention). Multivariable-controlled cause-specific Cox proportional hazards regression models were used to calculate hazard ratios and 31-year absolute mortality risk differences. A systematic review and meta-analysis of cohort studies was also performed (PROSPERO [URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021272756]). Based on 482 316 person-years of follow-up, we identified 22 035 deaths, including 9110 deaths from cardiovascular disease (CVD). Greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD-related mortality. Hazard ratios for each additional 300 mg cholesterol intake per day were 1.10 and 1.13 for overall and CVD-related mortality, respectively; for each additional 50-g egg consumed daily, hazard ratios were 1.06 and 1.09, respectively, for overall and CVD-related mortality (all P values<0.0001). After multivariable adjustment, higher serum total cholesterol concentrations were associated with increased risk of CVD-related mortality (hazard ratios per 1 SD increment, 1.14; P<0.0001). The observed associations were generally similar across cohort subgroups. The updated meta-analysis of cohort studies on the basis of 49 risk estimates, 3 601 401 participants, and 255 479 events showed consumption of 1 additional 50-g egg daily was associated with significantly increased CVD risk (pooled relative risk, 1.04 [95% CI, 1.00-1.08]; I2=80.1%). In the subgroup analysis of geographic regions (Pinteraction=0.02), an increase of 50-g egg consumed daily was associated with a higher risk of CVD in US cohorts (pooled relative risk, 1.08 [95% CI, 1.02-1.14]) and appeared related to a higher CVD risk in European cohorts with borderline significance (pooled relative risk, 1.05), but was not associated with CVD risk in Asian cohorts. In this prospective cohort study and updated meta-analysis, greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD-related mortality. Our findings support restricted consumption of dietary cholesterol as a means to improve long-term health and longevity.

Mortality among persons experiencing musculoskeletal pain: a prospective study among Danish men and women

BackgroundMusculoskeletal (MSK) pain affects many people worldwide and has a great impact on general health and quality of life. However, the relationship between MSK pain and mortality is not clear. This study aimed to investigate all-cause and cause-specific mortality in relation to self-reported MSK pain within the last 14 days, including spread of pain and pain intensity.MethodsThis prospective cohort study included a representative cohort of 4806 men and women aged 16+ years, who participated in a Danish MSK survey 1990–1991. The survey comprised questions on MSK pain, including spread of pain and pain intensity. These data were linked with the Danish Register of Causes of Death to obtain information on cause of death. Mean follow-up was 19.1 years. Cox regression analyses were performed with adjustment for potential confounders.ResultsIn the study population (mean age 44.5 years; 47.9% men), 41.0% had experienced MSK pain within the last 14 days and 1372 persons died during follow-up. For both sexes, increased all-cause mortality with higher spread and intensity of MSK pain was observed; a high risk was observed especially for men with strong pain (HR = 1.66; 95% CI:1.09–2.53) and women with widespread pain (HR = 1.49; 95% CI:1.16–1.92). MSK pain within last 14 days yielded c-statistics of 0.544 and 0.887 with age added. Moreover, persons with strong MSK pain had an increased cardiovascular mortality, persons with moderate pain and pain in two areas had an increased risk of cancer mortality, and persons with widespread pain had an increased risk of respiratory mortality.ConclusionsOverall, persons experiencing MSK pain had a higher risk of mortality. The increased mortality was not accounted for by potential confounders. However, when evaluating these results, it is important to take the possibility of unmeasured confounders into account as we had no information on e.g. BMI etc.SignificanceThe present study provides new insights into the long-term consequences of MSK pain. However, the discriminatory accuracy of MSK pain was low, which indicates that this information cannot stand alone when predicting mortality risk.

Cause-Specific Mortality Following Initial Chemotherapy in a Population-Based Cohort of Patients With Classical Hodgkin Lymphoma, 2000-2016.

Mortality for patients with classical Hodgkin lymphoma (cHL) treated during an era characterized in the United States by widespread use of doxorubicin, bleomycin, vinblastine, and dacarbazine and diminishing use of radiotherapy is not well understood. We identified 20,007 individuals diagnosed with stage I/II (early) or III/IV (advanced) cHL between age 20 and 74 years treated with initial chemotherapy in US population-based cancer registries during 2000-2015 (follow-up through 2016). We used standardized mortality ratios (SMRs) to compare cause-specific relative mortality risk following cHL to that expected in the general population and estimated excess absolute risks (EARs; per 10,000 patient-years) to quantify disease-specific death burden. We identified 3,380 deaths in the cHL cohort, including 1,321 (39%) not attributed to lymphoma. Overall, noncancer SMRs were increased 2.4-fold (95% CI, 2.2 to 2.6; observed, 559; EAR, 61.6) and 1.6-fold (95% CI, 1.4 to 1.7; observed, 473; EAR, 18.2) for advanced- and early-stage cHL, respectively, compared with the general US population. SMRs and EARs differed substantially by cause of death and cHL stage. Among the highest EARs for noncancer causes of death were those for heart disease (EAR, 15.1; SMR, 2.1), infections (EAR, 10.6; SMR, 3.9), interstitial lung disease (ILD; EAR, 9.7; SMR, 22.1), and adverse events (AEs) related to medications/drugs (EAR, 7.4; SMR, 5.0) after advanced-stage cHL and heart disease (EAR, 6.6; SMR, 1.7), ILD (EAR, 3.7; SMR, 13.1), and infections (EAR, 3.1; SMR, 2.2) after early-stage cHL. Strikingly elevated SMRs for ILD, infections, and AEs were observed < 1 year after cHL. Individuals age 60-74 years with advanced-stage cHL experienced a disproportionate excess of deaths as a result of heart disease, ILD, infections, AEs, and solid tumors. Despite evolving cHL treatment approaches, patients continue to face increased nonlymphoma mortality risks from multiple, potentially preventable causes. Surveillance, early interventions, and cHL treatment refinements may favorably affect patient longevity, particularly among high-risk subgroups.

Circulating 25-hydroxyvitamin D concentration and cause-specific mortality in the Melbourne Collaborative Cohort Study

Vitamin D deficiency is associated with higher all-cause mortality, but associations with specific causes of death are unclear. We investigated the association between circulating 25-hydroxyvitamin D (25(OH)D) concentration and cause-specific mortality using a case-cohort study within the Melbourne Collaborative Cohort Study (MCCS). Eligibility for the case-cohort study was restricted to participants with baseline dried blood spot samples and no pre-baseline diagnosis of cancer. These analyses included participants who died (n = 2307) during a mean follow-up of 14 years and a sex-stratified random sample of eligible cohort participants (‘subcohort’, n = 2923). Concentration of 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. Cox regression, with Barlow weights and robust standard errors to account for the case-cohort design, was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for cause-specific mortality in relation to 25(OH)D concentration with adjustment for confounders.Circulating 25(OH)D concentration was inversely associated with risk of death due to cancer (HR per 25 nmol/L increment = 0.88, 95 % CI 0.78–0.99), particularly colorectal cancer (HR = 0.75, 95 % CI 0.57–0.99). Higher 25(OH)D concentrations were also associated with a lower risk of death due to diseases of the respiratory system (HR = 0.62, 95 % CI 0.43–0.88), particularly chronic obstructive pulmonary disease (HR = 0.53, 95 % CI 0.30–0.94), and diseases of the digestive system (HR = 0.44, 95 % CI 0.26–0.76). Estimates for diabetes mortality (HR = 0.64, 95 % CI 0.33–1.26) and cardiovascular disease mortality (HR = 0.90, 95 % CI 0.76–1.07) lacked precision.The findings suggest that vitamin D might be important for preventing death due to some cancers, respiratory diseases, and digestive diseases.

Causes that Contribute to the Excess Mortality Risk in Multiple Sclerosis: A Population-Based Study

Background: Lifespan is 6–10 years shorter in multiple sclerosis (MS), but the reasons remain unclear. Using linked clinical- and population-based administrative health databases, we compared cause-specific mortality in an MS cohort to the general population. Methods: MS patients in British Columbia (BC), Canada, were followed from the later of first MS clinic visit or January 1, 1986, to the earlier of death, emigration, or December 31, 2013. Comprehensive mortality information was obtained by linkage to BC’s multiple-cause-of-death mortality data. Causes were grouped using International Classification of Disease codes. Standardized mortality ratios (SMRs) were calculated for underlying cause, and relative mortality ratios (RMRs) for any mention cause, by comparison to mortality rates in the age-, sex-, and calendar year-matched general population. Cause-specific relative mortality was explored by sex and disease course (relapsing onset and primary progressive). Results: Among 6,629 MS patients with 104,236 patient-years of follow-up, 1,416 died. The all-cause mortality risk was increased relative to the general population (SMR 2.71; 95% CI 2.55–2.87). MS was the underlying cause in 50.4%, and a mentioned cause in 77.9%, of deaths. Mortality by underlying cause was higher than expected for genitourinary disorders/infections (SMR 3.55; 95% CI 2.25–5.32), respiratory diseases/infections (SMR 2.69; 95% CI 2.17–3.28), suicide (SMR 2.40; 95% CI 1.61–3.45), cardiovascular disease (SMR 1.57; 95% CI 1.36–1.81), and other infections/septicemia (SMR 1.83; 95% CI 1.15–2.78). Risks of death due to overall cancer, accidents, digestive system disorders, and endocrine/nutritional diseases as underlying causes were similar to the general population. However, mortality with any mention of accidents (RMR 2.71; 95% CI 2.22–3.29) or endocrine/nutritional diseases (RMR 1.75; 95% CI 1.46–2.09) was greater. Bladder cancer mortality was increased in women (SMR 3.87; 95% CI 1.42–8.42) but not men. No notable differences were observed by disease course. Conclusions: MS itself was the most frequent underlying cause of death. Infections (genitourinary, respiratory, and septicemia), suicides, cardiovascular disease, and accidents contributed significantly to the increased risk of death. Some findings differed by sex, but not disease course. Multiple-cause death data offer advantages over “traditional” use of underlying cause only.

Abstract 3238: Annual coal use and stove improvement in relation to cause-specific mortality in a 36-year cohort analysis among anthracite coal users in Xuanwei, China

Abstract Emissions from burning solid fuels contribute substantially to the global disease burden. Xuanwei (XW), China, has among the highest lung cancer rates in the world, which has been attributed to the use of bituminous (“smoky”) coal for cooking and heating. Anthracite (“smokeless”) coal is also used in XW and is considered a “cleaner” fuel source compared to bituminous coal, but it emits high-levels of certain indoor pollutants (e.g. nitrogen dioxide and sulfur dioxide) and the disease burden associated with its use has not been well characterized. To evaluate the impact of anthracite coal use and stove improvement on all- and cause-specific mortality, we conducted a cohort study in which 42,400 XW residents were followed from 1976-2011. We ascertained information on fuel use, stove improvement, and lifestyle factors using questionnaires, and mortality data were obtained from hospital records and death certificates. Sex-specific multivariable Cox regression models were used to estimate the hazard ratio (HR) of all- and cause-specific mortality in relation to time-dependent annual coal tonnage use (median: 2 tons/year; 25th and 75th percentile = 1 and 3 tons/year, respectively) and stove improvement among 4,486 lifetime anthracite coal users. Compared to subjects who used &amp;lt;2 tons of anthracite coal/year, higher annual tonnage was associated with increased total mortality (HR=1.16, 95% CI =1.03-1.30 in men; HR=1.18, 95% CI =1.02-1.37 in women), total respiratory disease mortality (HR=1.52, 95% CI =1.16-1.99 in men; HR=1.74, 95% CI=1.28-2.36 in women), which was driven by pneumonia, and total cancer mortality in men (HR=1.66, 95% CI=1.09-2.51) but not women. Lung cancer mortality was non-significantly increased and liver cancer mortality was significantly increased in both men and women for use of ≥2 tons of anthracite coal/year. Suggestive positive associations in relation to higher tonnage were also observed for ischemic heart disease. Changing from the traditional use of an unvented firepit to a portable or vented stove was associated with a reduction in overall mortality (HR=0.70, 95% CI=0.61-0.80 in men; HR=0.72, 95% CI=0.61-0.85 in women). Consistent sex-specific reductions in risk were observed for pneumonia and ischemic heart disease mortality, and a non-significant reduction in total cancer mortality was also observed for those who changed to using a portable or vented stove. Our findings suggest that anthracite coal use contributes to the burden of mortality in XW. This study emphasizes the importance of reducing the use of anthracite coal, which is still widely used in China for indoor cooking and heating, in favor of alternative fuel sources such as gas/electricity where possible. Citation Format: Bryan Bassig, Bingshu E. Chen, Wei Jie Seow, Roel Vermeulen, Jinming Zhang, Wei Hu, Jason Wong, Bofu Ning, H.Dean Hosgood, Yunchao Huang, Kaiyun Yang, George S. Downward, Lützen Portengen, Nathaniel Rothman, Qing Lan. Annual coal use and stove improvement in relation to cause-specific mortality in a 36-year cohort analysis among anthracite coal users in Xuanwei, China [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3238.

Education and Mortality in the Rome Longitudinal Study.

BackgroundA large body of evidence supports an inverse association between socioeconomic status and mortality. We analysed data from a large cohort of residents in Rome followed-up between 2001 and 2012 to assess the relationship between individual education and mortality. We distinguished five causes of death and investigated the role of age, gender, and birthplace.MethodsFrom the Municipal Register we enrolled residents of Rome on October 21st 2001 and collected information on educational level attained from the 2001 Census. We selected Italian citizens aged 30–74 years and followed-up their vital status until 2012 (n = 1,283,767), identifying the cause of death from the Regional Mortality Registry. We calculated hazard ratios (HRs) for overall and cause-specific mortality in relation to education. We used age, gender, and birthplace for adjusted or stratified analyses. We used the inverse probability weighting approach to account for right censoring due to emigration.ResultsWe observed an inverse association between education (none vs. post-secondary+ level) and overall mortality (HRs(95%CIs): 2.1(1.98–2.17), males; 1.5(1.46–1.59), females) varying according to demographic characteristics. Cause-specific analysis also indicated an inverse association with education, in particular for respiratory, digestive or circulatory system related-mortality, and the youngest people seemed to be more vulnerable to low education.ConclusionOur results confirm the inverse association between education and overall or cause-specific mortality and show differentials particularly marked among young people compared to the elderly. The findings provide further evidence from the Mediterranean area, and may contribute to national and cross-country comparisons in Europe to understand the mechanisms generating socioeconomic differentials especially during the current recession period.

Socioeconomic inequalities in cause-specific mortality in 15 European cities

BackgroundSocioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated....

Mortality follow-up of the German Health Interview and Examination Survey for Adults (DEGS) : methods and first results

Within the framework of the German Health Interview and Examination Survey for Adults (DEGS), the Robert Koch Institute (RKI) conducted a nationwide mortality follow-up study. As there is no national mortality register in Germany, mortality and causes of death were investigated individually and under observance of state-specific data protection conditions. The German Health Interview and Examination Survey 1998 (GNHIES98) provided the database including 7,124 participants aged 18-79 years. A total of 6,979 participantsof GNHIES98 (98 %) who consented to be re-contacted were invited between October 2008 and October 2011 to also participate in the first data collection wave of DEGS (DEGS1). In this context, the vital status and the causes of death for deceased participants were assessed. Age- and sex-specific probabilities of survival and death rates were calculated and grouped by main causes of death according to ICD-10 groups. A total of 671 individuals (285 women, 386 men) died between the two survey contacts. For all deceased persons the date of death and for 539 (80.3 %) the causes of death could be determined. With a median follow-up time of 12.0years, 8,0742.5 person years were available for survival analysis. The crude overall death rate amounted to 8.3 per 1,000 persons-years (women: 7.2; men: 9.5). Among 539 persons with available information on causes of death, 209 (38.8 %) were attributable to cardiovascular diseases, 188 (34.9 %) to cancer, 135 (25.0 %) to other causes, and seven (1.3 %) could not be unambiguously assigned. A mortality follow-up was successfully integrated in the longitudinal component of DEGS as part of the national health monitoring at the RKI. Death rates and cause-specific mortality in relation to highly prevalent chronic diseases and risk factors provide essential information for assessing the potential of prevention and quality of care among adults in Germany. This requires a regular and complete conduction of mortality follow-ups.

Treatment with curative intent and survival in men with high‐risk prostate cancer. A population‐based study of 11 380 men with serum PSA level 20–100 ng/mL

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There are two randomized controlled trials showing that radiotherapy can be beneficial for men with locally advanced prostate cancer. The present study confirms the importance of curative treatment for men with high-risk prostate cancer. To investigate the influence of curative treatment on cause-specific mortality in men diagnosed with prostate cancer (PCa) with serum prostate-specific antigen (PSA) levels between 20 and 100 ng/mL. Patients with PCa (T1-4, N0/N1/NX, M0/MX), PSA 20-100 ng/mL and age ≤75 years were identified in the National Prostate Cancer Register of Sweden. Data on co-morbidity diagnoses were obtained from the National Patient Register and cause of death from the Cause of Death Register. Following adjustment for age at diagnosis, co-morbidity burden, Gleason score, T-category, PSA level and cause-specific mortality in relation to treatment were estimated using Cox regression analysis. A total of 11 380 men were diagnosed with PCa between 1996 and 2008 and fulfilled the inclusion criteria. The cumulative 10-year PCa-specific mortality was 36% for patients receiving only palliative treatment and 13% for those treated with curative intent. For the 8462 (74%) patients with PSA levels from 20 to 50 ng/mL at diagnosis, the hazard ratio for death from PCa was 0.23 (95% confidence interval 0.19-0.27) for those treated with curative intent compared with those given palliative treatment after adjusting for age, co-morbidity, T category, PSA level and Gleason score. The corresponding hazard ratio was 0.22 (95% confidence interval 0.17-0.30) for patients with PSA levels from 51 to 100 ng/mL. Treatment with curative intent for men with high-risk PCa was associated with reduced cause-specific mortality and should be considered even when serum PSA exceeds 20 ng/mL.

Cause-Specific Mortality in Relation to Chrysotile-Asbestos Exposure in a Chinese Cohort

The carcinogenic potency of chrysotile asbestos remains a contentious topic, and more data are needed to address this issue. We examine cause-specific mortality, especially lung cancer, and its association with chrysotile-asbestos exposure in a Chinese cohort. A cohort of 577 workers from a chrysotile-textile plant was followed prospectively from 1972 to 2008. Occupational history, exposure information, and smoking data were obtained from company records and personal interviews; vital status and causes of death were ascertained from death registries and hospitals. Workers were classified into three exposure levels on the basis of exposure assessments of different workshops. Standardized Mortality Ratios (SMRs) were calculated in terms of exposure levels and other indices. Among 259 identified deaths, 53 died from lung cancer, with an SMR of 4.08 (95% confidence interval 3.12, 5.33), and 96 from all cancers with an SMR of 2.09 (1.71, 2.55). In addition, two deaths from mesothelioma were observed. Increased mortality from respiratory diseases was also observed (SMR 3.38, 95% confidence interval 2.72, 4.21). Asbestos-exposure levels, exposure years, and birth cohorts showed a clear trend of risk for lung cancer and respiratory diseases. The current analysis indicated that exposure to chrysotile asbestos was closely associated with excess mortality from lung cancer and respiratory diseases.

Cause-specific Mortality after Stroke: Relation to Age, Sex, Stroke Severity, and Risk Factors in a 10-Year Follow-up Study

We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n = 988) were registered on admission. Evaluation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate information was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were performed by cause-specific Cox regression after multiple imputation of missing data, assuming that values were missing at random. Death was due to stroke in 310 patients (31%), to heart/arterial disease in 209 patients (21%), and to nonvascular diseases in 289 patients (29%); 180 patients were still alive after 10 years (18%). Stroke was the dominant cause of death during first year, with an absolute risk of 20.2% versus 5.2% for heart/arterial disease and 6.5% for nonvascular disease. The subsequent absolute risk of death per year was 2.8% for stroke, 4.5% for heart/arterial disease, and 5.2% for nonvascular disease. Death after stroke was associated with older age, male sex, greater stroke severity, and diabetes regardless of the cause of death. Previous stroke and hemorrhagic stroke were associated with death by stroke, ischemic heart disease was associated with death by heart/arterial disease and atrial fibrillation was associated with death by cardiovascular disease (stroke or heart/arterial disease). Hypertension, smoking, and alcohol consumption were not associated with cause-specific death.

Early postural blood pressure response and cause-specific mortality among middle-aged adults: what is the role of diastolic blood pressure?

Dear Editor, With interest we have read the article by Fedorowski et al. [1], which provides valuable information about cause-specific mortality in middle-aged subjects with orthostatic hypotension. In their study orthostatic hypotension (defined as a decrease in systolic blood pressure ≥20 mmHg and/or decrease in diastolic blood pressure ≥10 mmHg within 3 min of standing) was associated with mortality through injuries and neurologic diseases. Our major comment is that the article lacks data on the postural diastolic pressure response, both in describing the whole group with orthostatic hypotension, and the analyses of all cause and cause-specific mortality. Surprisingly, orthostatic hypotension and postural systolic blood pressure decline was not associated with cardiovascular mortality, although there was such an association in a smaller rescreened subsample. In other studies orthostatic hypotension was associated with myocardial infarction in middle-aged adults [2] and home dwelling elderly [3]. Unfortunately Fedorowski et al. [1] did not study the influence of postural diastolic blood pressure decline on cause-specific mortality. There might be a crucial role of diastolic blood flow on myocardial perfusion and subsequently myocardial infarction and cardiovascular mortality [3]. Postural diastolic, but not systolic blood pressure decline, seems to be associated with an increased risk of myocardial infarction [3]. Moreover in the same study population of the Malmo Preventive Project already the association was found that postural diastolic, but not systolic blood pressure decline predicts coronary events [4]. In conclusion, Fedorowski et al. [1] added very valuable information to the current knowledge of orthostatic hypotension through information on cause-specific mortality. However we miss in their study specific data on cause-specific mortality in relation to postural diastolic blood pressure decline and especially regarding cardiovascular mortality. References Fedorowski A, Hedblad B, Melander O. Early postural blood pressure response and cause-specific mortality among middle-aged adults. Eur J Epidemiol 2011. Rose KM, Tyroler HA, Nardo CJ, Arnett DK, Light KC, Rosamond W et al. Orthostatic hypotension and the incidence of coronary heart disease: the Atherosclerosis Risk in Communities study. Am J Hypertens 2000; 13(6 Pt 1): 571–8. Luukinen H, Koski K, Laippala P, Airaksinen KE. Orthostatic hypotension and the risk of myocardial infarction in the home-dwelling elderly. J Intern Med 2004; 255(4): 486–93. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). Eur Heart J 2010; 31(1): 85–91.

Age at Retirement and Mortality in a General Population Sample: The Greek EPIC Study

Investigation of the health effects of retirement and age at retirement is limited, but the issue is particularly important given the pressure for an increase in the retirement age in Europe. In the Greek segment of the European Investigation into Cancer and Nutrition study, 16,827 men and women enrolled from 1994 to 1999 were either gainfully employed or had retired from such employment at enrollment; had not previously been diagnosed with stroke, cancer, coronary heart disease, or diabetes mellitus; and had complete information on important covariates and documented survival status as of July 2006. All-cause and cause-specific mortality in relation to employment status and age at retirement (among retirees) was analyzed through Cox regression models, controlling for potential confounders. In comparison to subjects still employed, retirees had a 51% increase in all-cause mortality (95% confidence interval: 16, 98). Among retirees, a 5-year increase in age at retirement was associated with a 10% decrease in mortality (95% confidence interval: 4, 15). Findings were more evident for cardiovascular than for cancer mortality, whereas, for injury mortality, there was no evidence of association. Results indicate that early retirement may be a risk factor for all-cause and cardiovascular mortality in apparently healthy persons.

Sequential Comparison of the Proportionate Mortality Ratio for an Ongoing Study of Mortality in an Occupational Cohort

Potential adverse health effects associated with occupational exposure to acrylonitrile have been studied since a report of increased lung cancer incidence among DuPont fiber production workers in 1980. Six investigations have been conducted for the cohort through 2002. At each iteration, standardized mortality ratios (SMR) taking into account age and period characteristics have been reported. The objective of this study is to apply the proportionate mortality ratio (PMR) and the proportionate cancer mortality ratio (PCMR) to compare serial estimates of respiratory and all malignant cancer mortality risks in a closed cohort. The cohort includes 2,548 male employees from two fiber production facilities operating from 1947 through 1991. Sequential mortality risks have been assessed through the years 1976, 1981, 1991, 1997, and 2002. We calculated the PMR and PCMR from estimates of the SMR for respiratory cancer, malignant cancer, and overall mortality based on two referent populations, the U.S. general population and a regional population of workers from the same company. Compared to the company reference rates, respiratory cancer, malignant cancer, and overall SMR were increased in early analyses (SMR > 1.1 for each mortality category) but decreased over time (SMR < 1.0 for each). PMR and PCMR estimates for cancer mortality were consistent (PMR = 0.98 to 1.05) indicating a non-varying mortality pattern over time. Bias in the overall SMR due to the healthy worker effect resulted in notable upward bias for PMR calculated from SMR based on the U.S. population. We find the PMR to be a useful indicator of temporal variation in mortality patterns for ongoing occupational cohort studies. As the number of deaths increases for an aging cohort, the magnitude and direction of the PMR may be used to compare serial estimates of cause-specific relative mortality risks. SMR estimates can vary within a closed cohort over time and may not be a suitable longitudinal risk indicator. The PMR can be applied to evaluate internal consistency of results as well as the strength of association for sequential investigations of closed cohorts.

Racial differences in survival among men with prostate cancer and comorbidity at time of diagnosis.

This study evaluated the effect of comorbidity at diagnosis on racial differences in survival among men with prostate cancer. Clinical and demographic data were abstracted from records of 864 patients diagnosed at 4 Chicago area hospitals between 1986 and 1990. Comorbidity was scored on the basis of clinical information in the Charlson index. Cause-specific relative mortality adjusted for age, stage, differentiation, and treatment was compared across Charlson scores with Cox proportional hazards functions. Blacks had significantly greater mortality from prostate cancer and other causes (vs Whites, relative risk [95% confidence interval] = 1.84 [1.22, 2.79] and 1.69 [1.33, 2.29], respectively; P <.001). However, differences disappeared as initial comorbidity increased (1.75 [1.33, 2.31] vs 0.90 [0.59, 1.29] for scores = 0 and > or =5, respectively). Absence of a significant preexisting medical diagnosis is associated with a higher risk for excess mortality among Black men diagnosed with prostate cancer.

Temporal and age variation of United States black/white cause-specific mortality differentials: a study of the recent changes in the relative health status of the United States black population.

The relative age-specific medical progress of United States blacks and whites is examined by studying detailed age variation in their cause-specific relative mortality risks for the period 1962 through 1975. The results show considerable variation in both the change and absolute level of sex- and age-specific relative mortality risks for major causes of death during the period. Interesting observations about the relative mortality risks are the tendency for black females to have decreasing relative risks at early ages, the relative increases in cancer risks for black males, and the decrease in the relative risks of stroke for both sexes.