Decline In Mortality Risk Research Articles

Rising testicular cancer incidence in Spain despite declining mortality: an age-period-cohort analysis

BackgroundTesticular cancer, primarily affecting young men, has seen an alarming rise globally. This study delves into incidence and mortality trends in Spain from 1990 to 2019 using the Global Burden of Disease (GBD) database and the Age-Period-Cohort (A-P-C) model. MethodsWe analyzed GBD data on testicular cancer cases and deaths in Spain, calculating age-standardized rates (ASIR and ASMR) and employing Joinpoint regression to identify significant shifts. The A-P-C model further dissected the effects of age, period, and birth cohort on these trends. ResultsA striking doubling in testicular cancer incidence was observed, from 3.09 to 5.40 per 100,000 men (1.9% annual increase), while mortality rates remained stable and even decreased in younger age groups (0.34 to 0.26 per 100,000, 0.8% annual decrease). Joinpoint analysis revealed four distinct periods of increasing incidence, with a recent slowdown. The A-P-C model highlighted a consistent rise in incidence risk with each successive generation born after 1935, contrasting with a progressive decline in mortality risk across cohorts, particularly marked for those born since the 1960s. ConclusionWhile mortality rates are encouraging, Spain reflects the global trend of escalating testicular cancer incidence. The A-P-C analysis suggests a generational influence, but the underlying causes remain elusive. Further research is crucial to understand these trends and implement effective prevention strategies to combat this growing health concern.

Aumento de la incidencia del cáncer testicular en España a pesar del descenso de la mortalidad: un análisis edad-periodo-cohorte

BackgroundTesticular cancer, primarily affecting young men, has seen an alarming rise globally. This study delves into incidence and mortality trends in Spain from 1990 to 2019 using the Global Burden of Disease (GBD) database and the Age-Period-Cohort (A-P-C) model. MethodsWe analyzed GBD data on testicular cancer cases and deaths in Spain, calculating age-standardized rates (ASIR and ASMR) and employing Joinpoint regression to identify significant shifts. The A-P-C model further dissected the effects of age, period, and birth cohort on these trends. ResultsA striking doubling in testicular cancer incidence was observed, from 3.09 to 5.40 per 100,000 men (1.9% annual increase), while mortality rates remained stable and even decreased in younger age groups (0.34 to 0.26 per 100,000, 0.8% annual decrease). Joinpoint analysis revealed four distinct periods of increasing incidence, with a recent slowdown. The A-P-C model highlighted a consistent rise in incidence risk with each successive generation born after 1935, contrasting with a progressive decline in mortality risk across cohorts, particularly marked for those born since the 1960s. ConclusionWhile mortality rates are encouraging, Spain reflects the global trend of escalating testicular cancer incidence. The A-P-C analysis suggests a generational influence, but the underlying causes remain elusive. Further research is crucial to understand these trends and implement effective prevention strategies to combat this growing health concern.

Direct and Spillover Effects of Quality Disclosure Regulation: Evidence from California Hospitals

Quality disclosures regarding medical outcomes such as patient mortality are common healthcare policy instruments. Mixed evidence exists on whether quality disclosures improve outcomes for disclosed ailments. Moreover, disclosure policies can generate spillovers and impact ailments not targeted by the policy. We examine the effects of quality disclosure regulation on mortality improvements in disclosed and nondisclosed ailments. We use patient records for California hospitals for 1995–2014 and construct three groups of ailments: those that were the target of disclosure regulation, complementary ailments that were not the target of disclosure regulation but are medically related to the disclosed ailments, and medically unrelated ailments. Using a difference-in-differences design, we find that quality disclosure regulation is associated with declines in mortality risk of disclosed ailments ranging from 11.5% to 23%. Quality disclosure regulation is also associated with improvements for complementary ailments that are not the target of the disclosure policy. Such positive spillover effects yield an estimated 15.2% decline in mortality risk. Consistent with demand-side pressures driving improvements, market shares become sensitive to disclosed quality measures after disclosure regulation. Our findings of direct and spillover effects have implications for disclosure regulation. This paper was accepted by David Simchi-Levi, accounting. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4817 .

Association of childhood out-of-home care status with all-cause mortality up to 42-years later: Office of National Statistics Longitudinal Study

BackgroundThe adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples.MethodsData on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971–2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age2, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings.ResultsAdults who had been in care at any census (maximum of two) had an adjusted all-cause mortality hazard ratio 1.62 (95% CI 1.43, 1.86) times higher than adults who had never been in care. The excess mortality was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes. Mortality risk was elevated if the LS member was initially assessed in 1981 or 2001, compared to 1971. There was no significant variation in mortality risk for those in care by age or gender. The main findings were consistent irrespective of choice of comparison group (whole population, disadvantaged population), care placement (residential, non-residential) and age at death (all ages, adulthood only).ConclusionsIn this large, nationally representative study of dependent children resident in England and Wales, those who had been in care during childhood had a higher risk of mortality long after they had left care on average, mainly from unnatural causes. No differences by age or gender were found. Children in care have not benefitted from the general decline in mortality risk over time.

Mortality risk over time after early fluid resuscitation in African children

BackgroundAfrican children hospitalised with severe febrile illness have a high risk of mortality. The Fluid Expansion As Supportive Therapy (FEAST) trial (ISCRTN 69856593) demonstrated increased mortality risk associated with fluid boluses, but the temporal relationship to bolus therapy and underlying mechanism remains unclear.MethodsIn a post hoc retrospective analysis, flexible parametric models were used to compare change in mortality risk post-randomisation in children allocated to bolus therapy with 20–40 ml/kg 5% albumin or 0.9% saline over 1–2 h or no bolus (control, 4 ml/kg/hour maintenance), overall and for different terminal clinical events (cardiogenic, neurological, respiratory, or unknown/other).ResultsTwo thousand ninety-seven and 1041 children were randomised to bolus vs no bolus, of whom 254 (12%) and 91 (9%) respectively died within 28 days. Median (IQR) bolus fluid in the bolus groups received by 4 h was 20 (20, 40) ml/kg and was the same at 8 h; total fluids received in bolus groups at 4 h and 8 h were 38 (28, 43) ml/kg and 40 (30, 50) ml/kg, respectively. Total fluid volumes received in the control group by 4 h and 8 h were median (IQR) 10 (6, 15) ml/kg and 10 (10, 26) ml/kg, respectively. Mortality risk was greatest 30 min post-randomisation in both groups, declining sharply to 4 h and then more slowly to 28 days. Maximum mortality risk was similar in bolus and no bolus groups; however, the risk declined more slowly in the bolus group, with significantly higher mortality risk compared to the no bolus group from 1.6 to 101 h (4 days) post-randomisation. The delay in decline in mortality risk in the bolus groups was most pronounced for cardiogenic modes of death.ConclusionsThe increased risk from bolus therapy was not due to a mechanism occurring immediately after bolus administration. Excess mortality risk in the bolus group resulted from slower decrease in mortality risk over the ensuing 4 days. Thus, administration of modest bolus volumes appeared to prevent mortality risk declining at the same rate that it would have done without a bolus, rather than harm associated with bolus resulting from a concurrent increased risk of death peri-bolus administration.Trial registrationISRCTN69856593. Date of registration 15 December 2008.

Unequal Gain of Equal Resources across Racial Groups.

The health effects of economic resources (eg, education, employment, and living place) and psychological assets (eg, self-efficacy, perceived control over life, anger control, and emotions) are well-known. This article summarizes the results of a growing body of evidence documenting Blacks’ diminished return, defined as a systematically smaller health gain from economic resources and psychological assets for Blacks in comparison to Whites. Due to structural barriers that Blacks face in their daily lives, the very same resources and assets generate smaller health gain for Blacks compared to Whites. Even in the presence of equal access to resources and assets, such unequal health gain constantly generates a racial health gap between Blacks and Whites in the United States. In this paper, a number of public policies are recommended based on these findings. First and foremost, public policies should not merely focus on equalizing access to resources and assets, but also reduce the societal and structural barriers that hinder Blacks. Policy solutions should aim to reduce various manifestations of structural racism including but not limited to differential pay, residential segregation, lower quality of education, and crime in Black and urban communities. As income was not found to follow the same pattern demonstrated for other resources and assets (ie, income generated similar decline in risk of mortality for Whites and Blacks), policies that enforce equal income and increase minimum wage for marginalized populations are essential. Improving quality of education of youth and employability of young adults will enable Blacks to compete for high paying jobs. Policies that reduce racism and discrimination in the labor market are also needed. Without such policies, it will be very difficult, if not impossible, to eliminate the sustained racial health gap in the United States.

Cancer mortality of residents near a steel factory in Udine (Friuli Venezia Giulia Region, Northern Italy)

to evaluate the association between distance of residence from a steel factory, a point source of air pollution within an industrial area in Udine (Friuli Venezia Giulia Region, Northern Italy), and cancer mortality. retrospective study. To evaluate the association between mortality rates and distance from the source, a Stone test analysis for all cases occurred in the entire area was conducted. The significance level was determined using Monte Carlo simulations. a GIS mapped residential history of Friuli Venezia Giulia population was completed. Among residents within 5 km from the principal industrial plant of the area from 1989 to 2012, deaths caused by cancer were selected. Furthermore, according to the prevalent wind direction, an analysis was conducted also in a subgroup of residents located into the South-Western quadrant. A set of 8 bands with increasing distance from the point-source was defined. The total population was 37,473 inhabitants. in each band, observed and expected cancer-related deaths (calculated on the basis of mortality rates in the entire area) and standardized mortality ratios (SMRs) were computed to test for decline in risk of mortality at different distances from the main chimney. Stone test, in which a decline in risk of disease with an increase in distance from the source of pollution is tested, was used. the risk for all cancers and lung cancer was higher than expected. For male residents located within 2 km into the South-Western quarter there were 21 observed deaths from lung cancer vs. 13 expected (SMR: 1.62; p-value=0.02). despite the fact that in the whole area cancer mortality is not increased, this study seems to support evidence of an excess of cancer deaths, especially lung cancer among males, near a steel factory. However, the study has limitations because of the small number of cases and the lack of individual exposure data and information about confounders (e.g., smoke habits and professional exposure). Therefore, a possible cause-effect interpretation of this association should be considered with caution.

Upper Gastrointestinal Bleeding Mortality Risk Changes in Patients With Comorbidities Over Three Decades

Purpose: Our objective was to show the changes in the mortality risk of each comorbidity used in the Rockall score in patients with upper GI bleeding (UGIB) during three decades, using a nationwide representative data. Methods: We analyzed the National Hospital Discharge Sample (NHDS) for UGIB outcomes through the last three decades from 1979 to 2009. We identified the patients with the primary ICD-9 codes representing a diagnosis of UGIB and then calculated the mortality risk, crude odds ratio and adjusted odds ratio of each comorbidity used in the Rockall score in each decade. Results: There is a dramatic decline in mortality risk of patients with renal failure, starting from 50% in the first decade and ending up 4.0% in the third decade. Mortality risk of patients with CHF also had a substantial decrease from 17.9% to 5.2% in the first and third decades, respectively. Patients with IHD, cancer, and liver failure all showed decrease in the mortality risk too. Overall adjusted odds ratio of UGIB mortality indicates that liver failure, CHF, renal failure and cancer are significant risk factors for UGIB. The decreasing trend of odds ratio for patients with CHF (P<0.001), IHD (P<0.02) and renal failure (P<0.001) were statistically significant in this period. In esophageal bleedings, there was an increase in the mortality risk for patients with renal failure, while other comorbidities had a decreased risk from the second to third decade. Mortality risk of gastric bleeding for patients with renal failure has had a dramatic change, starting with 37.5% in the first decade, and ending up 3.7% in the third decade. Mortality risk of patients with CHF had a significant decline from 15% in the first decade to 4.1% in the third decade. Other comorbidities did not show such significant changes in their mortality risk in this period. Duodenal bleeding mortality risk in patients with renal failure plummeted from 47.4% in the first decade to 3.4% in the third decade. CHF patients showed a significant decline in this period, with 20.7% to 8.4% in the first and third decades, respectively. Patients with liver failure, IHD and cancer did not show significant changes in the mortality risk in this period. Conclusion: Critical care improvements in patients with comorbidities may have reduced mortality risks, particularly in renal and heart failure cases. These reductions are less in other studied comorbidities, which might be related to the pharmaceutical and procedural risks for causing UGIB. Despite reduction in the mortality risk, extra caution should be taken in the management of UGIB cases with the studied comorbidities due to higher risk of mortality in them.Table: Table. UGIB mortality risk and adjusted odds ratio for different Rockall score comorbidities

Smoking Status on Outcomes After Percutaneous Coronary Intervention

The effect of smoking on prognosis among patients undergoing percutaneous coronary intervention (PCI) is controversial, and data on the importance of smoking cessation or reductions were lacking. Smoking cessation or reductions could reduce the risk of adverse outcomes in patient after PCI. There were 19 506 consecutive patients who had undergone successful PCI between April 2004 and January 2010 followed. Extensive data, including self-reported smoking habits, were obtained at baseline and during follow-up. Compared with post-PCI quitters and persistent smokers, the nonsmokers and pre-PCI quitters were older and had a higher prevalence of comorbid factors such as hypertension and impaired left ventricle function. The adjusted hazard ratios for mortality were 2.52 (95% confidence interval [CI]: 1.92-3.30) for nonsmokers, 0.52 (95% CI: 0.32-0.84) for pre-PCI quitters, and 0.11 (95% CI: 0.06-0.22) for post-PCI quitters, compared to persistent smokers. With respect to additional revascularizations, a higher risk was observed among the quitters (1.70 [95% CI: 1.40-2.08] for pre-PCI quitters and 1.59 [95% CI: 1.36-1.85] for post-PCI quitters) as well as the nonsmokers (1.40 [95% CI: 1.20-1.64]). Among persistent smokers, each reduction of 5 cigarettes/day was associated with a 72% decline in mortality risk (P < 0.001) but did not reach statistical significant for repeated revascularizations (0.80 [95% CI: 0.46-1.37], P = 0.4132). Despite a higher risk of revascularization, the cessation of smoking either before or after PCI is beneficial in all-cause mortality. The apparent smoker's paradox may be explained by the differences in baseline risk or the reduced sensitivity to adverse outcomes as well as the reluctance to seek medical help among smokers.

Educational attainment and adult mortality in the United States: a systematic analysis of functional form.

A vast literature has documented the inverse association between educational attainment and U.S. adult mortality risk but given little attention to identifying the optimal functional form of the association. A theoretical explanation of the association hinges on our ability to describe it empirically. Using the 1979-1998 National Longitudinal Mortality Study for non-Hispanic white and black adults aged 25-100 years during the mortality follow-up period (N = 1,008,215), we evaluated 13 functional forms across race-gender-age subgroups to determine which form(s) best captured the association. Results revealed that the preferred functional form includes a linear decline in mortality risk from 0 to 11 years of education, followed by a step-change reduction in mortality risk upon attainment of a high school diploma, at which point mortality risk resumes a linear decline but with a steeper slope than that prior to a high school diploma. The findings provide important clues for theoretical development of explanatory mechanisms: an explanation for the selected functional form may require integrating a credentialist perspective to explain the step-change reduction in mortality risk upon attainment of a high school diploma, with a human capital perspective to explain the linear declines before and after a high school diploma.

Decreasing systolic blood pressure and declining mortality rates in an untreated population: results from the Copenhagen City Heart Study

The aim of the present study was to evaluate developments in 30 years mortality risk that may be associated with developments in population systolic blood pressure (SBP) and to evaluate possible secular trends in BP-associated mortality risk in the untreated population. The Copenhagen City Heart Study is a prospective longitudinal epidemiological study. The present analysis comprised participants from survey 1 (1976-78) and 3 (1991-94). BP measurements and other methods were fully standardized and unchanged throughout the observation period. Questionnaires were completed by the participants and double checked by the technicians while they were interviewing the participants. 18 077 persons participated. Age, systolic BP, diastolic BP, cholesterol, BMI, diabetes, gender and habitual physical activity were significant predictors of all-cause death in all age groups. Risk factor adjusted risk for all-cause death was significantly lower in survey 3 compared with survey 1. Among elderly people, there was no development in mortality risk. In the age groups 40-49 years and 50-59 years there were survey differences indicating a significant trend towards longer life expectancy compared with their age-matched counterparts in survey 1. The association between BP and mortality remained unchanged. A declining risk of all-cause death was observed in the younger and middle-aged cohorts of the population. The decrease in systolic BP and decline in mortality risk in the same age groups points to a role of systolic BP in age-cohort differentiated improvements of life expectancy. The effect of systolic BP on mortality did not change during follow-up.

Smoking Status and Long-Term Survival After First Acute Myocardial Infarction: A Population-Based Cohort Study

We compared long-term survival after acute myocardial infarction (AMI) of never-smokers, pre-AMI quitters, post-AMI quitters, and persistent smokers and assessed whether cigarette reduction among persistent smokers is associated with lower mortality. Quitting smoking has been shown to improve outcome after AMI. However, longitudinal cohort data with repeated assessments of smoking and information on multiple confounders are lacking. Moreover, little is known about the importance, if any, of reductions in the amount smoked. Consecutive patients < or = 65 years of age, discharged from 8 hospitals in central Israel after first AMI in 1992 to 1993, were followed through 2005. Extensive data, including self-reported smoking habits, were obtained at baseline and 4 times during follow-up. Cox proportional hazards regressions were used to assess the hazard ratios (HRs) for death associated with smoking categories modeled as time-dependent variables. At baseline, smokers were younger, more likely to be male, and had a lower prevalence of hypertension and diabetes than nonsmokers. Over a median follow-up of 13.2 years, 427 deaths occurred in 1,521 patients. The multivariable-adjusted HRs for mortality were 0.57 (95% confidence interval [CI]: 0.43 to 0.76) for never-smokers, 0.50 (95% CI: 0.36 to 0.68) for pre-AMI quitters, and 0.63 (95% CI: 0.48 to 0.82) for post-AMI quitters, compared with persistent smokers. Among persistent smokers, upon multivariable adjustment including pre-AMI intensity, each reduction of 5 cigarettes smoked daily after AMI was associated with an 18% decline in mortality risk (p < 0.001). Smoking cessation either before or after AMI is associated with improved survival. Among persistent smokers, reducing intensity after AMI appears to be beneficial.

Statistical Methods for Individual-Level Data in Cohort Mortality Studies of Rheumatic Diseases

In the field of rheumatic diseases, prospective individual-level data on (prevalent) cohorts of patients over a long period of time are collected. One of the many uses of such data is to investigate mortality. Excess mortality, time trends (temporal variation) in mortality rates, life expectancy and life years lost of patients, and risk factors for mortality may all be of interest. In this article, we show how careful application of Poisson and Cox relative risk regression models can be used to tackle these questions, illustrating the methods with cohort data from patients with systemic lupus erythematosus and psoriatic arthritis. For external comparisons of a cohort with a standard (or reference) population, Poisson regression can be used to generalize the usual standardized mortality ratio (SMR) analyses. For assessing the pattern of (excess) mortality over time, unadjusted and adjusted “rolling average” SMRs are developed and shown to provide further insight concerning an observed decline in SMR over time for psoriatic arthritis patients. An extension of the traditional life expectancy and years of life lost calculations is also derived. For comparisons within a cohort, we demonstrate how Cox regression models can incorporate time measured on a variety of scales to allow the identification of a calendar time decline in mortality risk for lupus patients which is demonstrably independent of possible declines with disease duration and/or time in clinic and of other disease related explanatory variables.

Decline in mortality risk following HIV seroconversion

Decline in mortality risk following HIV seroconversion

New venture survival: Ignorance, external shocks, and risk reduction strategies

Although scholars have long recognized the increased mortality risk that new ventures face in terms of a “liability of newness,” most of the discussion around this risk has been in terms of the contextual constraints that new ventures face and the difficulties that managers have in overcoming them. This emphasis is in part a reflection of the perils of newness but also stems from the retrospective and aggregate perspective taken by researchers. Although the macro-level perspective of new venture mortality has made a significant contribution to our knowledge of mortality risk patterns, there has been little interest in identifying how venture managers can address the risks that all new organizations face. We argue that in order to make progress in explaining new venture survival, a theoretical model is required that uses a more micro-level perspective to explain new venture failure (and the flip side, new venture survival). In this paper we develop such a model. We establish a definition of mortality risk and argue that the liability of newness is largely dependent on the degree of novelty (ignorance) associated with a new venture. Novelty is viewed in three different dimensions, viz.: to the market, to the technology of production and to management. Novelty to the market concerns the degree to which the customers are uncertain about the new venture. Novelty in production concerns the extent to which the production technology used by the new venture is similar to the technologies in which the production team has experience and knowledge. Novelty to management concerns the entrepreneurial team's lack of business skills, industry specific information and start-up experience. We argue that mortality risk increases with the degree of novelty in each dimension and with the number of dimensions in which the new venture is novel. We propose that the decline in mortality risk occurs as the venture's novelty in each of the three dimensions is eroded by information search and dissemination processes. This allows the new firm to become an established business and explains what we term the “evolutionary” path of mortality—novelty and risk decline monotonically, after a period of adolescence, as ignorance decays over time due to `passive learning'. We also propose that there is a “strategic” mortality risk path that reflects the impact of positive and negative shocks (shocks are exogenous events that alter the overall degree of novelty at a point in time— positive shocks decrease overall novelty, while negative shocks increase overall novelty) and reversals (endogenous actions that increase the overall novelty of the new venture at a point in time) on the mortality risk of a new venture. If the incidence and effects of these disruptions can be managed, then venture managers may be able to mitigate the mortality risk for their venture. We argue that risk reduction strategies can be employed, most of which impact on one or more of the dimensions of mortality risk in order to increase the firm's chances of survival. A series of risk reduction strategies are proposed and their impact on the determinants of mortality risk is considered.

Physical Activity, Physical Fitness, and Risk of Dying

We examined the relation between physical activity, physical fitness, and all-cause mortality in a national population-based study of Canadians. We followed men and women ages 20-69 years who had participated in the Canada Fitness Survey between 1981 and 1988. We assessed risk factors for 6,246 men and 8,196 women using multivariate Poisson regression analysis. At baseline, all subjects were asymptomatic according to self-reported screening questions for cardiovascular disease. Men who expended > or =0.5 kilocalories per kilogram of body weight per day (KKD) experienced a 20% decline in risk of mortality [rate ratio (RR) = 0.82; 95% confidence interval (CI) = 0.65-1.04] when compared with subjects expending <0.5 KKD. We observed a 30% decline in risk of mortality among women expending > or =3.0 KKD relative to those expending <0.5 KKD (RR = 0.71; 95% CI = 0.45-1.11). Similar patterns of risk were evident for both men and women when analyses were restricted to participation in nonvigorous activities. Those who perceived themselves to be of less than average fitness were at increased risk of mortality (male RR = 1.64, 95% CI = 1.21-2.22; female RR = 1.66, 95% CI = 1.21-2.26). Subjects with undesirable cardiorespiratory fitness levels were more likely to die, compared with those having recommended fitness levels (RR = 1.52; 95% CI = 0.72-3.18). Fifty-three per cent of men and 35% of women reported participating in a vigorous activity. The relation between daily energy expenditure and risk of mortality in these subjects could not be evaluated, as there were few deaths. Nonetheless, our results among participants reporting no vigorous activities support the hypothesis that there is a reduction in mortality risk associated with even modest participation in activities of low intensity.

The Temporal Pattern of Reduction of Mortality Risk After Smoking Cessation

We investigated the excess mortality risks of former smokers according to the number of years since they quit smoking in a cohort of 21,112 men and women evaluated with coronary angiography and included in the Coronary Artery Surgery Study registry. There is a prompt decline in mortality risk within the first year of quitting. Thereafter, former smokers have a sustained, modestly elevated mortality risk for at least 20 years compared with people who never smoked. The pattern is similar in men and women, in 35-54, 55-64, and greater than or equal to 65 age groups, and in subcohorts of those with coronary artery disease and those without coronary artery disease.