Circulatory Disease Mortality Research Articles

Sizable variations in circulatory disease mortality by region and country of birth in six European countries

Circulatory disease mortality inequalities by country of birth (COB) have been demonstrated for some EU countries but pan-European analyses are lacking. We examine inequalities in circulatory mortality by geographical region/COB for six EU countries. We obtained national death and population data from Denmark, England and Wales, France, the Netherlands, Scotland and Sweden. Mortality rate ratios (MRRs) were constructed to examine differences in circulatory, ischaemic heart disease (IHD) and cerebrovascular disease mortality by geographical region/COB in 35-74 years old men and women. South Asians in Denmark, England and Wales and France experienced excess circulatory disease mortality (MRRs 1.37-1.91). Similar results were seen for Eastern Europeans in these countries as well as in Sweden (MRRs 1.05-1.51), for those of Middle Eastern origin in Denmark (MRR = 1.49) and France (MRR = 1.15), and for East and West sub-Saharan Africans in England and Wales (MRRs 1.28 and 1.39) and France (MRRs 1.24 and 1.22). Low ratios were observed for East Asians in France, Scotland and Sweden (MRRs 0.64-0.50). Sex-specific analyses showed results of similar direction but different effect sizes. The pattern for IHD mortality was similar to that for circulatory disease mortality. Two- to three-fold excess cerebrovascular disease mortality was found for several foreign-born groups compared with the local-born populations in some countries. Circulatory disease mortality varies by geographical region/COB within six EU countries. Excess mortality was observed for some migrant populations, less for others. Reliable pan-European data are needed for monitoring and understanding mortality inequalities in Europe's multiethnic populations.

Circulatory disease mortality rates in the elderly and exposure to PM2.5 generated by biomass burning in the Brazilian Amazon in 2005

The aim of this study was to analyze the association between the exposure to fine particulate matter and circulatory disease mortality rates in the elderly living in the Brazilian Amazon. An ecological study of circulatory disease, acute myocardial infarction and cerebrovascular disease mortality rates in micro areas of the Brazilian Amazon was carried out. The environmental exposure indicator used was percentage hours of PM2.5 concentrations > 25µg/m³ divided by the total number of estimated hours of PM2.5 in 2005. The association between exposure and circulatory disease mortality rates was strongest in the oldest age group. No significant statistical association was found between cerebrovascular disease mortality rates and exposure. Circulatory disease mortality rates in the elderly living in the Amazon have been influenced by atmospheric pollution from emissions caused by forest fires.

Socio-economic position over the life course and all-cause, and circulatory diseases mortality at age 50–87 years: results from a Swedish birth cohort

Both child and adult socio-economic position (SEP) predict adult mortality, but little is known about the variation in the impact of SEP across the life course. The Uppsala Birth Cohort Study is a representative birth cohort born 1915-1929 in Uppsala, Sweden. For the 5,138 males and 5,069 females alive in 1980, SEP was available at birth; in adulthood (age 31-45); and in later life (age 51-65). Follow-up for mortality (all-cause, and circulatory disease) was from 1980 to 2002. To test which life course model best described the association between SEP and mortality, we compared the fit of a series of nested Cox proportional hazards regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. For all-cause mortality in both genders, the sensitive period model best described the influence of SEP across the life course with a heightened effect in later adult life (males: Hazard Ratio (95% CI) for advantaged SEP: 0.89 (0.81-0.97) at birth, 0.90 (0.81-0.98) in adulthood, 0.74 (0.67-0.82) in later life; females: 0.87 (0.78-0.98), 0.95 (0.86-1.06), 0.73 (0.64-0.83)). The effect of SEP on circulatory diseases mortality in males was cumulative (HR: 0.84 (0.80-0.87) per unit time in advantaged SEP). For circulatory disease mortality among females, a sensitive period model was selected due to SEP in later adult life (HR: 0.64 (0.52-0.80)). These findings suggest that reducing inequality throughout the life course might reduce all-cause and circulatory disease mortality.

Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973–2008

BackgroundGender differences in mortality vary widely between countries and over time, but few studies have examined predictors of these variations, apart from smoking. The aim of this study is to investigate the link between gender policy and the gender gap in cause-specific mortality, adjusted for economic factors and health behaviours.Methods22 OECD countries were followed 1973–2008 and the outcomes were gender gaps in external cause and circulatory disease mortality. A previously found country cluster solution was used, which includes indicators on taxes, parental leave, pensions, social insurances and social services in kind. Male breadwinner countries were made reference group and compared to earner-carer, compensatory breadwinner, and universal citizen countries. Specific policies were also analysed. Mixed effect models were used, where years were the level 1-units, and countries were the level 2-units.ResultsBoth the earner-carer cluster (ns after adjustment for GDP) and policies characteristic of that cluster are associated with smaller gender differences in external causes, particularly due to an association with increased female mortality. Cluster differences in the gender gap in circulatory disease mortality are the result of a larger relative decrease of male mortality in the compensatory breadwinner cluster and the earner-carer cluster. Policies characteristic of those clusters were however generally related to increased mortality.ConclusionResults for external cause mortality are in concordance with the hypothesis that women become more exposed to risks of accident and violence when they are economically more active. For circulatory disease mortality, results differ depending on approach – cluster or indicator. Whether cluster differences not explained by specific policies reflect other welfare policies or unrelated societal trends is an open question. Recommendations for further studies are made.

Ability of a biomarker-based score to predict death from circulatory disease and cancer in NHANES III

BackgroundA score based on serum concentrations of C-reactive protein (CRP), albumin, gamma-glutamyl transferase (GGT), and HDL cholesterol was positively associated with death from cancer, circulatory disease, and all-cause mortality. We replicated this in the third National Health and Nutrition Examination Survey (NHANES III), a US nationally representative survey conducted between 1988–1994.MethodsBaseline measurements of CRP, albumin, GGT, and HDL were available for participants with mortality follow-up (n=13,056). A biomarker score, ranging 0–4, was created by adding number of markers with abnormal values (cut-off: CRP>10mg/L, albumin<35mg/L, GGT>36U/L, HDL<1.04mmol/L). Its association with mortality was analyzed with multivariate Cox proportional hazards models.ResultsThe score was positively associated with death from all causes, cancer and circulatory disease [e.g. HR all-cause mortality: 1.21 (95% CI: 1.09, 1.35), 1.92 (1.67, 2.20), 3.38 (2.62, 4.36), and 7.93 (5.77, 10.89), for score 1, 2, 3, 4 vs.0]. These patterns were found across the Charlson Comorbidity Index (CCI). Where CCI =3, risk of cancer death was 1.09 (0.93, 1.28), 1.81 (1.43, 2.29), 4.67 (3.05, 7.14), and 6.97 (5.32, 9.14) for score 1, 2, 3, 4 vs. 0. No effect-modification by sex or race/ethnicity was observed.ConclusionsThese findings correlate with results from a Swedish study. This biomarker-based score could help clinicians make decisions in prevention and disease management.

Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks.

Background: Although high doses of ionizing radiation have long been linked to circulatory disease, evidence for an association at lower exposures remains controversial. However, recent analyses suggest excess relative risks at occupational exposure levels.Objectives: We performed a systematic review and meta-analysis to summarize information on circulatory disease risks associated with moderate- and low-level whole-body ionizing radiation exposures.Methods: We conducted PubMed/ISI Thomson searches of peer-reviewed papers published since 1990 using the terms “radiation” AND “heart” AND “disease,” OR “radiation” AND “stroke,” OR “radiation” AND “circulatory” AND “disease.” Radiation exposures had to be whole-body, with a cumulative mean dose of < 0.5 Sv, or at a low dose rate (< 10 mSv/day). We estimated population risks of circulatory disease from low-level radiation exposure using excess relative risk estimates from this meta-analysis and current mortality rates for nine major developed countries.Results: Estimated excess population risks for all circulatory diseases combined ranged from 2.5%/Sv [95% confidence interval (CI): 0.8, 4.2] for France to 8.5%/Sv (95% CI: 4.0, 13.0) for Russia.Conclusions: Our review supports an association between circulatory disease mortality and low and moderate doses of ionizing radiation. Our analysis was limited by heterogeneity among studies (particularly for noncardiac end points), the possibility of uncontrolled confounding in some occupational groups by lifestyle factors, and higher dose groups (> 0.5 Sv) generally driving the observed trends. If confirmed, our findings suggest that overall radiation-related mortality is about twice that currently estimated based on estimates for cancer end points alone (which range from 4.2% to 5.6%/Sv for these populations).

Mortality among adults: gender and socioeconomic differences in a Brazilian city

BackgroundPopulation groups living in deprived areas are more exposed to several risk factors for diseases and injuries and die prematurely when compared with their better-off counterparts. The strength and patterning of the relationships between socioeconomic status and mortality differ depending on age, gender, and diseases or injuries. The objective of this study was to identify the magnitude of social differences in mortality among adult residents in a city of one million people in Southeastern Brazil in 2004-2008.MethodsForty-nine health care unit areas were classified into three homogeneous strata using 2000 Census small-area socioeconomic indicators. Mortality rates by age group, sex, and cause of death were calculated for each socioeconomic stratum. Mortality rate ratios (RR) and 95% confidence intervals were estimated for the low and middle socioeconomic strata compared with the high stratum.ResultsIn general, age-specific mortality rates showed a social gradient of increasing risks of death with decreasing socioeconomic status. The highest mortality rate ratios between low and high strata were observed in the 30-39 age group for males (RR = 1.74, 95% CI 1.59-1.89), and females (RR = 1.90, 95% CI 1.65-2.15). Concerning specific diseases and injuries, the greatest inequalities between low and high strata were found for homicides (RR = 2.44, 95% CI 2.27-2.61) and traffic accidents (RR = 1.64, 95% CI 1.45-1.83) among males. For women, the highest inequalities between the low and high strata were for chronic respiratory diseases (RR = 2.19, 95% CI 1.94-2.45) and acute myocardial infarction (RR = 1.93, 95% CI 1.79-2.07). Only breast cancer showed a reversed social gradient (RR = 0.70, 95% CI 0.48-0.92). Inequalities in circulatory and respiratory diseases mortality were greater among females than among males.ConclusionsSubstandard living conditions are related to unhealthy behaviors, as well as difficulties in accessing health care. Therefore, the Brazilian Health System (SUS) must ensure greater access to primary and hospital care, and develop programs that promote healthier lifestyles among vulnerable groups to reduce social inequalities in mortality. Moreover, because deaths from external causes are concentrated in poor areas, cooperative and coordinated intersectoral actions should be taken to combat the deadly violence cycle.

Socio-economic position over the life course and all-cause, circulatory diseases, and neoplasms mortality in adulthood and old age: Results from a Swedish birth cohort

ObjectiveTo compare alternative lifecourse models in predicting the effects of child and adult socio-economic position (SEP) upon adult mortality.DesignLife-long follow-up of a representative, population-based birth cohort (Uppsala Birth Cohort Study),...

Associations of mortality rates with height using son's height as an instrumental variable

ObjectivesHeight has been negatively associated with mortality from circulatory disease, but positively associated with mortality from most forms of cancer. These results are vulnerable to confounding, including the confounding effect...

O1-4.6 Alcohol-induced damage to heart muscle rather than atherosclerosis may drive the association of circulatory disease with hazardous drinking in Russia

<h3>Background</h3> Circulatory disease mortality in Russia is associated with hazardous drinking. Over the past 40 years there have been major fluctuations in mortality from circulatory disease that are closely correlated with deaths from acute alcohol poisoning (r=0.8 among working-age men). In a case-control study (2003–2005) hazardous drinking was associated with deaths attributed to ischaemic heart disease. However, rather than hazardous alcohol consumption increasing risk of atherosclerotic disease and subsequent myocardial infarction, these effects could be due to misclassified non-atherosclerotic damage to the heart induced by heavy drinking as occurs in extreme form in alcoholic cardiomyopathy. <h3>Methods</h3> A population-based sample of 1052 men aged 30–60 years living in Izhevsk (a medium-sized Russian city) were examined (2008–2009). Information about drinking was obtained by interview of proxy informants (mainly spouses or partners). Levels of B-type natriuretic peptide (BNP—a sensitive and highly specific marker of heart muscle stress) and an atherogenic index (ApoB to ApoA1 ratio) were measured in blood. <h3>Results</h3> Compared to abstainers, men who drank hazardously had an increased risk of being in the top 20% of BNP (OR 4.80, 95% CI 2.29 to 10.1) adjusted for age and BMI, with non-hazardous drinkers being intermediate in risk. The equivalent association for the ApoB/ApoA1 ratio was in the opposite direction (OR 0.31, 0.16 to 0.61). <h3>Conclusion</h3> Hazardous drinkers show a lipoprotein profile associated with a reduced risk of atherosclerotic disease. However, they have raised levels of BNP. Taken together these results support the hypothesis that hazardous drinking among Russian men may induce non-atherosclerotic heart muscle damage.

Diesel vehicle emission and death rates in Tokyo, Japan: A natural experiment

Evidence linking air pollution with adverse cardiopulmonary outcomes is accumulating. However, few studies have been conducted to evaluate whether vehicle emission control improves public health. We thus evaluated the effect of a diesel emission control law on mortality rates in 23 wards of Tokyo metropolitan area, Japan. We obtained daily counts of mortality and concentrations of nitrogen dioxide (NO 2) and particulate matter less than 2.5 μm in diameter (PM 2.5) from April 2003 to December 2008. Time-series and interrupted time-series analysis were employed to analyze the data in two periods: prior to the introduction of tighter restrictions (April 2003 to March 2006) and after the enforcement (April 2006 to December 2008). Concentrations of air pollutants gradually decreased during the study period: from 36.3 ppb (NO 2) and 22.8 μg/m 3 (PM 2.5) to 32.1 ppb and 20.3 μg/m 3, respectively. Air pollutants were positively associated with circulatory and pulmonary disease mortality, especially cerebrovascular disease. Each same-day PM 2.5 increase of 10 μg/m 3 was associated with a 1.3% increase in cerebrovascular mortality rate (95% confidence interval: 0.2–2.4). Rate ratios were attenuated after the enforcement in most of the outcomes, probably due to reduced toxicity of the pollutants. In the crude interrupted time-series analysis, reductions of standardized mortality rates after the enforcement were the greatest in high traffic areas. Even after adjustment of longer-time trend, mortality rate from cerebrovascular disease was reduced by 8.50% (p < .001) with dose–response relationship. However, the declines in other cause-specific mortality became equivocal. This natural experiment in Tokyo suggests that emission controls improved air quality. Although suggestive, further data are needed to conclusively demonstrate an impact on mortality rates.

Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment

Perceptions that rural populations are inevitably healthier and live longer than urban populations are increasingly being challenged. But very few publications have investigated the extent to which these putative differences can be explained by variation in area composition. Existing publications have tended to use conventional deprivation measures, often thought to mask rural deprivation by favourable averages. Further, they have typically been based on large and variably-sized geographical units, or confined to studies of a single region or cause of death. This study examines differences in mortality between rural and urban areas in the entire population of England and Wales for 2002–2004. It uses the most up-to-date small geographical units of similar size and homogeneity of population together with the recently-introduced Rural and Urban Area Classification, and adjusts for five different deprivation measures (including modern composite indices). The causes of death investigated were all-cause mortality, cancer, lung cancer, respiratory disease, circulatory disease, suicide and accidents. Particular points of focus for the study were the potential for interaction between deprivation and rurality, and the importance of choice of deprivation measure in quantifying the relationships between mortality, rurality and deprivation. Choice of deprivation measure was not found to alter the substantive conclusions of any analysis, and little evidence for differential effects of deprivation in rural and urban areas was uncovered. Differences between rural and urban areas in all-cause, circulatory disease and cancer mortality could largely be accounted for by adjusting for deprivation. For these causes of death, therefore, rural populations were not found to be inherently healthier than their urban counterparts. However, substantial residual differences between rural and urban areas were found in comparisons of mortality from lung cancer and respiratory disease, mortality being lower in rural areas. Stronger relationships between rurality and mortality were found in ‘village and dispersed’ settlements.

Mortality Among U.S. Astronauts: 1980–2009

It has been nearly 20 yr since the first published astronaut mortality analysis. Using astronaut vital data and general population mortality rates, we calculate Standardized Mortality Ratios (SMR) for both total and specific causes of death among astronauts between January 1980 and June 2009 to look for changes in mortality patterns over time. Astronaut vital data were derived from the Johnson Space Center website and the Astronaut Fact Book. General population mortality rates were taken from the Human Mortality Database and the Centers for Disease Control. SMR were computed as the ratio of observed deaths to expected deaths using indirect standardization to several comparison populations. All SMR declined from the 1980s to the 2000s, though astronauts are still at increased risk of accidental death (SMR = 574, 95% C.I. 335-919). Astronauts are at greatly reduced risk of death by cardiovascular disease (SMR = 27, 95% C.I. 9-63) and cancer (SMR = 47, 95% C.I. 19-97), and astronauts are now at decreased risk of all-cause mortality compared with the general population. The SMR show that mortality from circulatory disease, cancer, and accidents have all declined from previous estimates, though astronauts are still at increased risk of accidental death. Improvements in circulatory disease mortality are likely due to intensive health screening and physical fitness within the Astronaut Corps. Similarly, physical fitness may be contributing to the reduction in cancer mortality. Fewer airplane crashes have contributed to the decreased risk of fatal accidents, which in turn is driving the reduction in all-cause mortality risk.

Alcohol increases circulatory disease mortality in Russia: acute and chronic effects or misattribution of cause?

Background There is a consensus that the large fluctuations in mortality seen in Russia in the past two decades can be attributed to trends in alcohol consumption. However, the precise mechanisms linking alcohol to mortality from circulatory disease remain unclear. It has recently been argued that a substantial number of such deaths currently ascribed to cardiovascular disorders are misclassified cases of acute alcohol poisoning.Methods Analysis of routine mortality data and of a case–control study of mortality among working-age (25–54 years) men occurring in the Russian city of Izhevsk, west of the Ural mountains, 2003–05. Interviews were carried out with proxy informants for both the dead cases (N = 1750) and the controls (N = 1750) selected at random from a population register. Mortality was analysed according to indicators of alcohol problems.Results Hazardous drinking was associated with an increased risk of death from circulatory diseases as a whole [odds ratio (OR) = 4.14, 95% confidence interval (CI) 3.23, 5.31] adjusted for age, smoking and education. The association with alcoholic cardiomyopathy was particularly strong (OR = 15.7, 95% CI 9.5, 25.9). Although there was no association with deaths from myocardial infarction (MI; OR = 1.17, 95% CI 0.59, 2.32), there was a strong association with the aggregate of all other ischaemic heart disease (IHD; OR = 4.04, 95% CI 2.79, 5.84). Stronger associations for each of these causes (other than MI) were seen with whether or not the man had drunk very heavily in the previous week. However, associations also remained when analyses were restricted to subjects with no evidence of recent heavy drinking, suggesting that misclassification of acute alcohol poisonings is unlikely to explain these overall associations.Conclusion Taken as a whole, the available evidence suggests that the positive association of alcohol with increased cardiovascular disease mortality may be best explained as being the result of a combination of chronic and acute alcohol consumption resulting in alcohol-related cardiac disorders, especially cardiomyopathy, rather than being due to misclassification of acute alcohol poisoning. Further work is required to understand the mechanisms underlying the link between heavy alcohol consumption and deaths classified as being due to IHD (other than MI).

Regional differences in body fat distributions among people with comparable body mass index: a comparison across six German population-based surveys

The mortality of circulatory diseases of the German population varies considerably across regions. The comparison of the regional distributions of cardiovascular risk factors can provide clues to the reasons for cardiovascular mortality differences. The aim of this study was to determine whether indirect measures of fat distribution within subgroups of comparable body mass indices (BMIs) differ by region in Germany. We included six German population-based epidemiological studies conducted between 1997 and 2006 that included a detailed assessment of anthropometric measures including overall 15 215 people aged 45–74 years. We calculated mean values of BMI, waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). We estimated mean regional differences of WC, HC, and WHR within narrow ranges of BMI. BMI distributions across the study populations were very similar. However, body fat distributions as measured by WC within subgroups of similar BMIs differed considerably across regions. For example, among people with a BMI of 24.0–25.9, estimated WCs were on average 3.4 and 6.7 cm higher among men and women in Saxony-Anhalt than among men and women in Bavaria, respectively. We provide evidence that the BMI distributions across six population-based surveys in Germany are very similar and that body fat distributions among people with comparable BMIs show relevant regional differences. Our observed WC differences might contribute to regional cardiovascular disease risk differences in Germany. Our findings may trigger further similar analyses across European populations to explain large area variations of cardiovascular disease burden.

Factors affecting mortality in a large cohort study with special reference to oral contraceptive use

Background This analysis updates mortality in the Oxford-Family Planning Association (Oxford-FPA) contraceptive study, with emphasis on oral contraceptive (OC) use. Study design The Oxford-FPA study includes 17,032 women recruited from 1968–1974 at contraceptive clinics, aged 25–39 years, using OCs a diaphragm or an intrauterine device. Follow-up has been to March 2009; by then, 1715 women had died. Results The rate ratio (RR) for overall mortality was 0.87 (CI 0.79–0.96), comparing ever-users of OCs with never-users. The RR for fatal cervical cancer was increased (7.3), but the CIs were very wide (1.2–305). There was no association between ever-use of OCs and mortality from breast cancer (RR 1.0, CI 0.8–1.2), nor was fatal breast cancer related to duration of OC use. OC use strongly protected against death from other uterine cancer and ovarian cancer; RRs for ever-use of OCs were 0.3 (CI 0.1–0.8) and 0.4 (CI 0.3–0.6), respectively. Protection increased with duration of OC use and persisted more than 20 years after cessation. Circulatory disease mortality was not increased, the RR for ever-use of OCs being 0.9 (CI 0.7–1.1). The overall mortality RR for all women smoking 15+ cigarettes daily was 2.25 (CI 1.99–2.53) and, for all women with a body mass index of 28+ kg/m 2, was 1.33 (CI 1.07–1.64). Conclusions Long-term follow-up strongly suggests that OC use slightly reduces all cause mortality.

Birth weight of infants and mortality in their parents and grandparents: the Uppsala Birth Cohort Study

Individuals who are small at birth are at increased risk of cardiovascular disease later in life. To enhance understanding of the mechanisms underlying this association we examined the link between infants' birth weight and mortality in their parents and grandparents. We used the Uppsala birth cohort to examine all-cause and circulatory disease mortality among 14,129 mothers, 13,863 fathers, 3992 maternal and 3910 paternal grandmothers and 3896 maternal and 3798 paternal grandfathers. Follow-up time lasted up to 2002 with median of 21.6 years for parents and 47.8 years for grandparents. Hazard models controlling for socio-demographic characteristics indicated an inverse linear association between offspring's birth weight and maternal circulatory disease mortality [hazards ratio (HR) = 0.74; 95% confidence interval (CI): 0.56-0.99]. No association was observed for fathers. The association between birth weight of grandchildren and grandparental mortality varied. No association was detected for maternal grandmothers for the whole period examined; only among grandmothers whose grandchild was born prior to 1977 was a U-shaped association observed for circulatory disease mortality. There was a U-shaped association between birth weight of grandchildren and maternal grandfather's overall and circulatory disease mortality (quadratic term: HR = 1.05; 95% CI: 1.01-1.09). An inverse linear relationship was found for circulatory disease mortality in paternal grandmothers (HR = 0.93; 95% CI: 0.85-1.00). For paternal grandfathers there was an inverse association between grandchildren's birth weight and overall mortality; for circulatory disease mortality an effect was found only for grandfathers whose grandchild was born prior to 1977. We showed, for the first time, associations between fetal growth in one generation and mortality in the previous two generations. Genetic and/or environmental pathways accounting for these associations should be further explored.

Temperature and Mortality in Taiwan, a Subtropical Country

ISEE-0125 Background and Objective: Ambient temperature, especially extreme weather, has been found to influence mortality in human beings. Taiwan is a subtropical country where heat waves and cold storms rarely occur. This study aims to assess whether there is still a significant association of mortality with temperature in Taiwan, where extreme weather is generally lacking. Methods: Daily mortality data during the period from 2001 to 2003 were obtained from the Taiwan Death Registry. Daily temperature (3.3°C–31.0°C) for the study period was averaged from 33 monitoring stations nationwide. Daily mortality rates of all-causes (excluding accidents, suicide, and homicide), respiratory and circulatory diseases were investigated for the associations with temperature. Generalized least square model was constructed to assess the relation between two time-series trends (i.e., temperature and mortality). Additionally, the cross-correlation function was used to determine the possible time lag for the influence of temperature on mortality. Results: As the temperature increased, the daily mortality rates of all-causes (b = −0.006) and respiratory disease (b = −0.012) decreased. On the other hand, the apparently inverse relationship (b = −0.028) between daily temperature and circulatory disease mortality rate was observed only for days with temperature of 26.36°C or lower. The circulatory disease mortality rate increased (b = 0.011) with rising temperature in warm and hot days (>26.36°C). The study also demonstrated a lag effect between two time trends. The time lag for all-causes and circulatory disease mortality was similar at 4–6 days, while the lag for respiratory disease was longer at 13–16 days. Conclusion: Data from the subtropic area still showed an apparent inverse relationship between temperature and all-causes mortality, and the increased temperature posed a greater beneficial effect on mortality of circulatory disease than on that of respiratory disease. Additionally, lower temperature in sub-tropic area didn't increase the risk of mortality.

Green space, psychological restoration, and health inequality

In today's Lancet, Richard Mitchell and Frank Popham1 report on health inequality as moderated by the degree of access to parks and other green spaces near the home. They divide people in England who were younger than retirement age into four income deprivation groups, and five groups according to their access to green space. Looking at mortality data for 2001–05, these researchers found that the populations with the most access to green space had the weakest associations between income-related deprivation and both all-cause and circulatory disease mortality.

A case–control study relating railroad worker mortality to diesel exhaust exposure using a threshold regression model

A case–control study of lung cancer mortality in U.S. railroad workers in jobs with and without diesel exhaust exposure is reanalyzed using a new threshold regression methodology. The study included 1256 workers who died of lung cancer and 2385 controls who died primarily of circulatory system diseases. Diesel exhaust exposure was assessed using railroad job history from the US Railroad Retirement Board and an industrial hygiene survey. Smoking habits were available from next-of-kin and potential asbestos exposure was assessed by job history review. The new analysis reassesses lung cancer mortality and examines circulatory system disease mortality. Jobs with regular exposure to diesel exhaust had a survival pattern characterized by an initial delay in mortality, followed by a rapid deterioration of health prior to death. The pattern is seen in subjects dying of lung cancer, circulatory system diseases, and other causes. The unique pattern is illustrated using a new type of Kaplan–Meier survival plot in which the time scale represents a measure of disease progression rather than calendar time. The disease progression scale accounts for a healthy-worker effect when describing the effects of cumulative exposures on mortality.