Differences In Excess Mortality Research Articles

Visualising variation in mortality rates across the life course and by sex, USA and comparator states, 1933–2010

BackgroundPrevious research showed that younger adult males in the USA have, since the 1950s, died at a faster rate than females of the same age. In this paper, we quantify...

Risk of Death among HIV Co-Infected Multidrug Resistant Tuberculosis Patients, Compared To Mortality in the General Population of South Africa.

Even though highly effective drugs are available in South Africa, multidrug resistant tuberculosis (MDR-TB) patients with HIV infection have higher mortality compared to HIV-uninfected MDR-TB patients. This trend has been observed in similar countries with high HIV prevalence. This study sought to determine excess mortality attributable to HIV among MDR-TB patients in South Africa using relative survival methods. Data available were from a cohort of 2079 MDR-TB patients enrolled in a Standardized Programmatic Management of MDR-TB from 2000 to 2004 in South Africa. A Poisson-based model adjusted for age, gender, year of diagnosis, TB history, and resistance to ethambutol, anti-TB injectable drugs and fluoroquinolones antibiotics was constructed to assess the excess mortality among HIV co-infected MDR-TB patients. Excess hazard ratios (EHRs) were used to describe the effect of the predictors on net mortality, controlling for the general mortality in the South African population. Death was recorded on 1619 patients, of whom 367 (22.7%) had died within 2 years. Out of the 1413 patients that tested for HIV infection, 554 (39.2%) tested positive. Excess mortality was higher in HIV infected, compared to HIV uninfected, MDR-TB patients (adjusted excess hazard ratio, 5.6 [95% CI, 3.2-9.7]); in patients whose TB isolates' resistance to ethambutol and kanamycin was unknown (3.7 [2.1-6.2] and 4.87 [1.9-13.3], respectively) vs. known. There were no differences in excess mortality between age and gender of the patient, year of diagnosis and TB history. Adjusting for some important predictors, MDR-TB patients with HIV infection experienced higher excess mortality compared to HIV-uninfected MDR-TB patients, after accounting for the general mortality in South Africa. An appropriate, though complex method has produced predictor effect estimates similar to those obtained from classical methods. Thus, the use of relative survival methods should be encouraged in the analysis of causespecific mortality, when ascertainment of cause of death is inaccurate or unknown.

Differences in prostate cancer survival between Denmark, Iceland, and Sweden: A high-resolution study.

159 Background: Register-based studies have demonstrated large differences in relative survival and excess mortality following the diagnosis of PC in the Nordic countries. These differences may reflect differences in patient characteristics, diagnostics (PSA-use) and treatment strategies. This high-resolution study explores the background for the differences in PC survival between Denmark, Iceland and Sweden. Methods: Patients with newly diagnosed PC in 1997 were identified through population-based national cancer registers in Denmark and Iceland. Information on clinical findings was retrieved by reviewing hospital files. In Sweden information was gathered from two regional population-based prostate cancer registers providing both time of diagnosis and clinical information. Country specific excess mortality rates were compared adjusting for available information on known prognostic factors. Results: The overall relative survival in the cohorts was comparable to population-based results previously published. Across countries significant differences in excess mortality rates were seen. These differences were largely explained by differences in patient characteristics at diagnosis, and when adjusting for differences in patient characteristics i.e. metastatic / non-metastatic disease, clinical T-stage, and PSA level at diagnosis, the differences in excess mortality diminished or disappeared. The difference in percentage of patients with metastatic disease at diagnosis was the one factor responsible for the major differences in mortality-rates across countries. Conclusions: Register-based studies on relative survival and excess mortality following a PC diagnosis may be influenced by national differences in clinical presentation at diagnosis. Differences between countries in the proportion of patients with metastatic spread at diagnosis apparently explains most of the difference in relative survival previously reported. Further studies and cross country comparisons of survival and excess mortality for PC should adjust for differences in patient characteristics, mainly TNM.

Urban-Rural Differences in Excess Mortality among High-Poverty Populations: Evidence from the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health

Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.

Heat wave 2003 and mortality in Switzerland.

During June to August 2003, high temperatures were reported across Europe including Switzerland. In many European countries, particularly in France the heat wave was associated with an increase in mortality. This is the first analysis investigating whether the high temperatures during summer 2003 in Switzerland had a measurable impact on mortality. Daily data on all-cause mortality for the period January 1990 to December 2003, and meteorological data from 20 different stations for the same period were analysed. Excess mortality for different age groups, gender and geographic regions was calculated. Daily mortality and temperature in 2003 was correlated with lags of temperature up to 7 days. An estimated 7% increase in all cause mortality occurred during June to August 2003. Excess mortality was limited to the region north of the Alps, to inhabitants of cities and suburban areas and was more pronounced among the elderly and the inhabitants of Basel, Geneva and Lausanne. North of the Alps, deviations in daily mortality were significantly correlated with deviations in maximum daily temperatures and night temperatures. The combination of day temperature above 35 degrees C and night temperatures above 20 degrees C predominantly occurred in Basel and Geneva and might in part explain the regional differences in excess mortality. As the number of elderly people in Switzerland continues to rise and the occurrence of heat waves is predicted to increase as a consequence of global warming, preventive programmes targeting susceptible populations during heat waves are warranted.

Long term prognosis of women with breast cancer in New Zealand: study of survival to 30 years.

The long term prognosis of women with breast cancer was studied by analysing retrospectively the 30 year survival of 2019 women with histologically proved breast cancer recorded at the National Cancer Registry in New Zealand between 1950 and 1954. Excess mortality rates for successive five year survival cohorts were calculated from the survival data. From the total cohort the excess mortality rate fell rapidly during the first 10 years and then became low after 20 years. There were no significant differences in excess mortality for the age cohorts. Most of the excess mortality for 20 years was due to deaths from breast cancer. In this study the prognosis for women with breast cancer approached normal after 20 years and the improvement in prognosis resulted from decreasing death rates from breast cancer.

Mortality among male and female alcoholic patients treated in a psychiatric unit.

A series of patients consisting of 139 men and 118 women had themselves sought treatment and were admitted to a psychiatric unit under a diagnosis of alcohol abuse. Prior to admission, they had not been registered for drinking offences. The series was studied with regard to mortality during an observation period from 5 to 10 years.Compared to the general population the mortality was high for both sexes, and this was more pronounced for women than for men. However, since alcoholism is much more widespread among men, mortality in the male population is affected by alcoholism to a greater extent than mortality in the female population. Differences in excess mortality between the sexes in this study disappear if death‐risks applying to men are also applied to women.The specific causes of death broadly follow the same pattern as in earlier studies. The excess mortality from accidents was, however, remarkably low. An explanation for this may be that accidental deaths, more than deaths from other causes, are correlated to the social effects of abuse. Suicide through drug intoxication was more common among women than among men; this corresponds to the situation in the general population.