Differences In Premature Mortality Research Articles

Disparities in air pollution attributable mortality in the US population by race/ethnicity and sociodemographic factors.

There are large differences in premature mortality in the USA by race/ethnicity, education, rurality and social vulnerability index groups. Using existing concentration-response functions, published particulate matter (PM2.5) air pollution estimates, population estimates at the census tract level and county-level mortality data from the US National Vital Statistics System, we estimated the degree to which these mortality discrepancies can be attributed to differences in exposure and susceptibility to PM2.5. We show that differences in PM2.5-attributable mortality were consistently more pronounced by race/ethnicity than by education, rurality or social vulnerability index, with the Black American population having the highest proportion of deaths attributable to PM2.5 in all years from 1990 to 2016. Our model estimates that over half of the difference in age-adjusted all-cause mortality between the Black American and non-Hispanic white population was attributable to PM2.5 in the years 2000 to 2011. This difference decreased only marginally between 2000 and 2015, from 53.4% (95% confidence interval 51.2-55.9%) to 49.9% (95% confidence interval 47.8-52.2%), respectively. Our findings underscore the need for targeted air quality interventions to address environmental health disparities.

Sociodemographic features of COVID-19 premature mortality: Serbian individual-level data evidence

Abstract Background In Serbia, premature mortality due to COVID-19 usually has been assessed using aggregated mortality data, thus overlooking the impact of sociodemographic factors. Within the European Burden of Disease Network (COST Action CA18218), we examined the association between several sociodemographic factors and COVID-19 years of life lost (YLL) to reveal potential social inequalities. Methods The Statistical Office of the Republic of Serbia (SORS) has provided disaggregated, anonymized, and individual data on COVID-19 deaths in 2020 and 2021 from death certificates having U07.1 and U07.2 ICD codes as the main cause of death. Additionally, SORS remaining life expectancy and population size estimates were used along with sociodemographic data for each YLL case (sex, time and place of death, type of residential settlement, educational attainment, marital status, and economic activity). Results In the observed two-year period, 38,098 COVID-19 death cases were assessed, of which 72.8% were registered in 2021. The average YLL per death case was 12.51±7.62, and the median YLL was 11.50 (12.60±7.44 for men and 12.39±7.85 for women, p < 0.006). The multivariate linear regression indicated a significant association between the number of YLL and sex (B = 1.02, p < 0.01), residential area (B = 0.21, p < 0.01), educational attainment (B = 0.84, p < 0.01), marital status (B = 1.65, p < 0.01), employment (B=-7.02, p < 0.01) and place of death (B=-1.76, p < 0.01). Conclusions This study demonstrates social inequalities in COVID-19 premature mortality associated with the highest YLL among men, single persons, retired persons, and those with higher education status. We identify significant differences in YLL when comparing different regions. Key messages • Individual-level data reveals differences in premature mortality aggravated by social disparities. • Policymakers should consider sociodemographic factors when designing COVID-19 prevention measures.

Sex differences in disease burden in Norway: an analysis of the Global Burden of Disease Study 2019

Abstract Background Sex differences in premature mortality is well documented, but we have less knowledge about sex differences in disability, how this varies across the life course, and what risk factors attribute to these differences. Using data from the Global Burden of Disease Study (GBD) 2019, we examined sex differences in diseases burden in Norway. Methods Data for years of life lost (YLLs), years lived with disability (YLDs) and the sum of these two; disability-adjusted life-years (DALYs), were extracted from GBD 2019 by sex and age groups, in addition to data on risk factors (data will be updated upon the release of GBD 2021). Results In 2019, the age-standardized DALY rate was similar in males (18 901, 95% CI 16 338-21 823) and females (18 165, 95% CI 14 875 - 21 791) in Norway. However, in women, a larger proportion of the disease burden was due to causes leading to years lived with disability (YLD), compared to in men. This was found across all age groups, starting in adolescence. A larger proportion of the disease burden among males could be attributed to known and preventable risk factors (41.0%, 95% CI 38.3-43.7) compared to in females (32.4%, 95% CI 29.3-35.6%). Conclusions The total burden of disease is equally shared by men and women in Norway. However, women have a larger share of the total burden of years lived with disability. As we know much less about what contributes to disability compared to premature mortality, we also have less knowledge about the causes of disease burden in women. This in turn, affects our ability to develop targeted and effective health policies to address sex differences in disease burden. Key messages • Women carry a larger share of the total number of years lived with disability, while men have higher premature mortality. • We know less about how to prevent disease burden in women than in men.

Gender differences in premature mortality for cardiovascular disease in India, 2017–18

BackgroundThe present study tries to provide a comprehensive estimate of gender differences in the years of life lost due to CVD across the major states of India during 2017–18.MethodsThe information on the CVD related data were collected from medical certification of causes of death (MCCD reports, 2018). Apart from this, information from census of India (2001, 2011), SRS (2018) were also used to estimate YLL. To understand the variation in YLL due to CVD at the state level, nine sets of covariates were chosen: share of elderly population, percentage of urban population, literacy rate, health expenditure, social sector expenditure, labour force participation, HDI Score and co-existence of other NCDs such as diabetes, & obesity. The absolute number of YLL and YLL rates were calculated. Further, Pearson’s correlation had been calculated and to understand the effect of explanatory variables on YLL due to CVD, multiple linear regression analysis had been applied.ResultsMen have a higher burden of premature mortality in terms of Years of life lost (YLL) due to CVD than women in India, with pronounced differences at adult ages of 50–54 years and over. The age pattern of YLL rate suggests that the age group 85 + makes the highest contribution to the overall YLL rate due to CVD. YLL rate showed a J-shaped relationship with age, starting high at ages below 1 years, dropping to their lowest among children aged 1–4 years, and rising again to highest levels at 85 + years among both men and women. In all the states except Bihar men had higher estimated YLL due to CVD for all ages than women. Among men the YLL due to CVD was higher in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. On the other hand, the YLL due to CVD among men was lowest in Jharkhand followed by Assam. Similarly, among women the YLL due to CVD was highest in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. While, the YLL due to CVD among women was lowest in Jharkhand. Irrespective of gender, all factors except state health expenditure were positively linked with YLL due to CVD, i.e., as state health expenditure increases, the years of life lost (YLL) due to CVDs falls. Among all the covariates, the proportion of a state's elderly population emerges as the most significant predictor variable for YLL for CVDs (r = 0.42 for men and r = 0.50 for women).ConclusionYLL due to cardiovascular disease varies among men and women across the states of India. The state-specific findings of gender differences in years of life lost due to CVD may be used to improve policies and programmes in India.

Specific differences and responses to reductions for premature mortality attributable to ambient PM2.5 in China

Although recent assessments have quantified the impact of ambient PM2.5 on public health in China, air quality managers would benefit from assessing specific differences in premature mortality and its responses to air quality improvement. Using PM2.5 data simulated by an observation-fused air quality model and an integrated exposure-response model for the full range of PM2.5, we determined the premature mortality attributable to ambient PM2.5 across mainland China in 2016. Overall, the total number of PM2.5-related deaths nationwide was 1.31 million, of which lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, and stroke represented 0.13, 0.13, 0.42, and 0.62 million, respectively. Per capita PM2.5-related mortality in China was 95 per 100,000 person-years, and that of elderly people aged ≥75 years (1166 deaths per 100,000) was much higher than that of young people aged 25–44 years (11 deaths per 100,000). Additionally, there were significant spatial differences in premature deaths, which mainly occurred in regions with high PM2.5 levels or/and population density. Halving deaths across mainland China required an average of 63% reduction of PM2.5 nationwide and a decrease by 73% in high concentration regions exceeding 70 μg/m3 and 19% in low concentration locales below 10 μg/m3. Moreover, reducing PM2.5 to the WHO interim target I (IT-1) of 35 μg/m3 would only result in a 12.6% reduction in premature mortality, while a more exacting standard (reducing PM2.5 to 10 μg/m3) would avoid 73.0% of mortality. In particular, there is a large potential for reducing the high PM2.5-related mortality in heavily polluted locales. In conclusion, to further reduce premature mortality across mainland China, targets stricter than the IT-1 and tight policies to improve air quality and protect public health are necessary, especially for vulnerable groups such as the elderly and patients with cardio-cerebrovascular diseases, particularly in areas with high premature mortality.

Association between the regional variation in premature mortality and immigration in Ontario, Canada

ObjectivesHealth region differences in immigration patterns and premature mortality rates exist in Ontario, Canada. This study used linked population-based databases to describe the regional proportion of immigrants in the context of provincial health region variation in premature mortality.MethodsWe analyzed all adult premature deaths in Ontario from 1992 to 2012 using linked population files, Canadian census, and death registry databases. Geographic boundaries were analyzed according to 14 health service regions, known as Local Health Integration Networks (LHINs). We assessed the role of immigrant status and regional proportion of immigrants in the context of these health region variations and assessed the contribution using sex-specific multilevel negative binomial models, accounting for age, individual- and area-level immigration, and area-level material deprivation.ResultsWe observed significant premature mortality variation among health service regions in Ontario between 1992 and 2012. Average annual rates ranged across LHINs from 3.03 to 6.40 per 1000 among males and 2.04 to 3.98 per 1000 among females. The median rate ratio (RR) decreased for men from 1.14 (95% CI 1.06, 1.19) to 1.07 (95% CI 1.00, 1.11) after adjusting for year, age, area-based material deprivation, and individual- and area-level immigration, and among females reduced from 1.13 (95% CI 1.05, 1.18) to 1.04 (95% CI 1.00, 1.05). These adjustments explained 84.1% and 94.4% of the LHIN-level variation in males and females respectively. Reduced premature mortality rates were associated with immigrants compared with those for long-term residents in the fully adjusted models for both males 0.43 (95% CI 0.42, 0.44) and females 0.45 (0.44, 0.46).ConclusionThe findings demonstrate that health region differences in premature mortality in Ontario are in part explained by individual-level effects associated with the health advantage of immigrants, as well as contextual area-level effects that are associated with regional differences in the immigrant population. These factors should be considered in addition to health system factors when looking at health region variation in premature deaths.

Premature mortality in adult survivors of child abuse and neglect: a nationwide birth cohort study

BackgroundChild neglect and abuse are not uncommon. Both are associated with deleterious outcomes in adulthood, but there is sparse evidence on the association between such trauma and premature adult mortality. We aimed to establish whether different types of child maltreatments were associated with all-cause mortality in mid-adulthood and examined potential intermediaries of this association. MethodsUsing the 1958 British birth cohort (n=9310), we examined associations between child neglect (prospectively recorded at years 7 and 11 of age) and abuse (physical, psychological, witnessing and sexual; self-reported at years 44–45 of age) with all-cause mortality, using Cox proportional hazard models adjusted for early-life covariates and other maltreatment types. We tested interactions between each maltreatment type and sex; there was little evidence of effect modification (pinteraction>0·001), hence models also adjust for sex. Mortality follow-up was between 2002–03 and December 2016 (participants aged 44–45 to 58 years). Death was ascertained from the National Health Service Central Register (n=296) or from survey updates (n=16). Potential intermediaries included: adult social factors, health behaviours, adiposity, mental health, cardiometabolic markers, and growth (height) at years 7 to 45 of age. Missing data were imputed via multiple imputation. FindingsChild maltreatment prevalence varied from 1·6% (n=149; sexual abuse) to 11% (n=1000; physiological abuse); 77% (n=6536) reported no maltreatment. Neglect and abuse (physical and sexual) were associated with increased risk of premature death, independent of covariates and other maltreatment types; adjusted hazard ratios (HRs) were 1·47 (95% CI 1·05–2·05) for neglect, 1·73 (1·10–2 ·71) for physical abuse, and 2·60 (1·49–4·52) for sexual abuse. Associations for neglect and physical abuse disappeared after adjustment for adult health behaviours, and, for neglect only, social factors; other intermediaries had little effect on these associations. Sexual abuse associations were largely unexplained by examined intermediaries. Risk of all-cause mortality increased with the number of maltreatments (versus none): adjusted HRs were 1·44 (1·07–1·93) for one maltreatment and 2·04 (1·45–2·87) for at least two maltreatments. InterpretationChild neglect and physical and sexual abuse are associated with increased risk of premature mortality in mid-adulthood. Our findings highlight the importance of preventing specific child maltreatments and of supporting survivors to potentially mitigate differences in premature mortality. Child abuse was reported retrospectively and estimated associations for sexual abuse might be imprecise due to low prevalence. However, child neglect, potential confounders, and mediators were ascertained prospectively. FundingUS National Institute on Aging, the UK Economic and Social Research Council, the UK Biotechnology and Biological Sciences Research Council, and the UK National Institute for Health Research Biomedical Research Centre.

Geodemographic Area Classification and Association with Mortality: An Ecological Study of Small Areas of Cyprus.

Geographical investigations are a core function of public health monitoring, providing the foundation for resource allocation and policies for reducing health inequalities. The aim of this study was to develop geodemographic area classification based on several area-level indicators and to explore the extent of geographical inequalities in mortality. A series of 19 area-level socioeconomic indicators were used from the 2011 national population census. After normalization and standardization of the geographically smoothed indicators, the k-means cluster algorithm was implemented to classify communities into groups based on similar characteristics. The association between geodemographic area classification and the spatial distribution of mortality was estimated in Poisson log-linear spatial models. The k-means algorithm resulted in four distinct clusters of areas. The most characteristic distinction was between the ageing, socially isolated, and resource-scarce rural communities versus metropolitan areas with younger population, higher educational attainment, and professional occupations. By comparison to metropolitan areas, premature mortality appeared to be 44% (95% Credible Intervals [CrI] of Rate Ratio (RR): 1.06–1.91) higher in traditional rural areas and 36% (95% CrI of RR: 1.13–1.62) higher in young semi-rural areas. These findings warrant future epidemiological studies investigating various causes of the urban-rural differences in premature mortality and implementation policies to reduce the mortality gap between urban and rural areas.

Burden, pattern, and causes of road traffic accidents in South India: Estimate of years of life lost

Context: Road traffic accident (RTA) is one of the major preventable public health problems and is on the rise. Aims: The aims of this study were to estimate the burden of RTA in Andhra Pradesh calculating years of life lost (YLL) and age-standardized YLL rates and to evaluate sex- and age-related differences in premature mortality. Subjects and Materials: The data were obtained from State Crime Record Bureau of Andhra Pradesh and Census of India 2011 for age-specific population to calculate YLL and mortality rates were calculated based on the age of the person involved in the accident. Results: A total of 24,258 RTA cases were reported from January 2015 to December 2015. Most of the cases 16,995 reported RTA are from rural areas. The time slot with the highest rate of road accidents in the morning was 09:00 am–12:00 am and in the evening was 06:00 pm–09:00 pm. The age group 25–34 years were the most vulnerable toward road accidental death of which male and female died in RTA were 929 (26.57%) and 101 (28.06%), respectively. Most of the RTA occurred at T-Junctions causing 5548 accidents with a share of 31.52% the total RTA on Junctions, the total YLL was 89,557, and highest YLL was 25,486 in 25–34 years of age group. Conclusions: We conclude that there is high fatal mortality and YLL in young age group in Andhra Pradesh. These are preventable events, and efforts to reduce the associated economic and social burden must be made.

Avoidable Mortality in the German Baltic Sea Region Since Reunification: Convergence or Persistent Disparities?

The consequences of political reunification for health and mortality have the unique character of a 'natural experiment'. This is particularly true for the formerly divided German Baltic Sea region due to its cultural and geographic commonalities. This paper ascertains the changes and differences in premature mortality at ages 0-74 in urban and rural areas of the German states of Mecklenburg-Vorpommern (MV) and Schleswig-Holstein (SH) since reunification and the contribution made by 'avoidable' mortality. Using official cause-of-death data, the effectiveness of health care and health policies was measured based on the concept of avoidable mortality in terms of both amenable and preventable conditions. Methods of decomposition and standardisation were employed in order to erase the compositional effect from the mortality trend. As a result, mortality differences relate primarily to men and the rural areas of the German Baltic Sea region. Whereas the mortality levels in the urban areas of MV and SH have converged, the rural areas of MV still show higher levels of preventable and amenable mortality. The results show that the accessibility and quality of medical care in the thinly populated areas of MV and the effectiveness of inter-sectoral health policies through primary prevention, particularly with regard to men, have room for improvement.

Spatial epidemiology of premature mortality in Ontario, Canada

IntroductionGeographic disparities in health indicators, such as premature mortality, may reveal area-level weaknesses in health system performance. Monitoring geographic trends can therefore have powerful implications for system evaluation and planning. However, attempts to understand patterns of population health can be complicated by underlying regional differences in demographics and behaviours.
 Objectives and ApproachThis study aimed to identify regional disparities in premature mortality (defined as death before age 75), and to investigate how fully these disparities can be explained by population-level characteristics. Ontario’s 76 administrative Local Health Integration Network (LHIN) sub-regions, which vary in geographic and population size, were analyzed using linked population-level data from the Institute for Clinical Evaluative Sciences and Cancer Care Ontario.
 Spatially structured, sex-stratified Bayesian hierarchical models were used to estimate standardized mortality ratios (SMRs) for each LHIN sub-region in the 2011-2015 period. Models were adjusted for key population-level demographic and behavioural risk factors.
 ResultsLarge disparities in premature mortality presented at the sub-region level in males and females. Low premature mortality clustered around large, urban population centers in Ottawa and Toronto. Premature mortality was comparatively higher throughout the rest of the province, particularly in northern and southeast Ontario.
 Higher prevalence of material deprivation, overweight and obesity, sedentary behaviour, and smoking were all significantly (α=0.05) associated with elevated premature mortality risk, while increased alcohol consumption and immigrant population were associated with decreased risk.
 Adjusting for model covariates reduced variance of sub-region SMR estimates by 87% in males and 89% in females. Population-level characteristics thus explain a large proportion of geographic inequality in premature mortality. However, residual spatial variation suggests that systematic regional differences in premature mortality extend beyond population-level traits.
 Conclusion/Implications
 This study represents a novel application of small-area analytic techniques to Ontario mortality data, made possible by comprehensive linkage of vital statistics. The findings highlight the importance of population composition to geographic disparities in health. Future work should investigate the influence of system-level factors in areas with elevated premature mortality.

Divergence and convergence in cause-specific premature adult mortality in Mexico and US Mexican Hispanics from 1995 to 2015: analyses of 4.9 million individual deaths

BackgroundMexicans and US Mexican Hispanics share modifiable determinants of premature mortality. We compared trends in mortality at ages 30–69 in Mexico and among US Mexican Hispanics from 1995 to 2015.MethodsWe examined nationally representative statistics on 4.2 million Mexican and 0.7 million US deaths to examine cause-specific mortality. We used lung cancer indexed methods to estimate smoking-attributable deaths stratified by high and lower burden Mexican states.ResultsIn 1995–99, Mexican men had about 30% higher relative risk of death from all causes than US Mexican Hispanic men, and this difference nearly doubled to 58% by 2010–15. The divergence between Mexican and US Mexican Hispanic women over this time period was less marked. Among US Mexican Hispanics, declines in the risk of smoking-attributable death constituted about 25–30% of the declines in the overall risk of death. However, among Mexican men the declines in the risk of smoking-attributable deaths were offset by increases in causes of death not due to smoking. Homicide rates (mostly from guns) rose among men in Mexico from 2005 to 2010, but not among Mexican women or US Mexican Hispanic men or women. The probability at 30–69 years of death from cardiac disease diverged significantly between Mexicans and US Mexican Hispanics, reaching 10% and 5% for men, and 7% and 2% for women, respectively.ConclusionsLarge differences in premature mortality between otherwise genetically and culturally similar groups arise from a few modifiable factors, most notably smoking, untreated diabetes and homicide.

Educational inequalities in premature mortality in Poland, 2002-2011: a population-based cross-sectional study.

BackgroundThe aim of the study is to evaluate the differences in premature mortality between educational groups of Polish inhabitants in 2002 and 2011.MethodsThe analysis included all deaths among inhabitants of Poland, aged 25–64 years, which occurred in 2002 (N=97 004) and 2011 (N=104 598). We calculated age-standardised death rates (SDRs) and summary measures on inequalities. The relative index of inequality (RII) was calculated with Poisson regression.ResultsThe SDR for Poland decreased from 285.7 per 100 000 in 2002 to 246.0 in 2011 among males with higher education and increased from 1141.0 in 2002 to 1183.0 in 2011 among males with lower secondary or less education (the rate ratio increased from 4.0 to 4.8). With regard to females with higher education, the SDR decreased from 127.2 per 100 000 in 2002 to 115.6 in 2011. Among females with lower secondary or less education, the SDR increased from 375.8 per 100 000 in 2002 to 423.1 in 2011 (the rate ratio increased from 3.0 to 3.7). The RII increased from 5.8 to 9.7 in the male group and from 4.4 to 8.3 in the female group. The greatest educational inequalities in 2011 were observed in females who died of cardiovascular diseases (RII=14.9) and lung cancer (RII=6.6) and in males who died of suicides (RII=19.3) and lung cancer (RII=11.9).ConclusionsEducational inequalities in premature mortality in Poland are growing. There is a need to implement health education programmes targeted at groups of the most poorly educated Polish inhabitants, especially for diseases resulting from smoking and excessive alcohol consumption.

Trends of potential years of life lost due to main causes of deaths in urban and rural population in Poland, 2002-2011.

The aim of the study was to analyse the level and the trends of Potential Years of Life Lost due to main causes of deaths in Poland in 2002-2011, with consideration of place of residence, urban-rural. The material for the study was the number of deaths due to main causes in Poland in years 2002-2011, based on data from the Central Statistical Office. Premature mortality analysis was conducted with the use of PYLL indicator (PYLL - Potential Years of Life Lost). PYLL rate was calculated according to the method proposed by J. Romeder, according to which the premature mortality was defined as death before the age of 70. Time trends of PYLL rate and the annual percent change (APC) were assessed using the Joinpoint Regression Programme. Rural/urban ratio was used to presented the differences in premature mortality between rural and urban areas . In years2002-2011, the PYLL rate for all-cause deaths decreased by 13.2% among men and 16.0% among women in rural areas, whereas in urban decreased it decreased by 15.7% among men and 14.9% among women. In 2011, the main causes of PYLL among men in rural areas were: external causes (32.3%), cardiovascular diseases (23.5%) and cancers (19.4%); in urban areas: cardiovascular diseases (24.7%), external causes (24.3%) and cancers (20.9%). Among women in rural areas, the leading causes were: cancers (39.9%), cardiovascular diseases (20.1%) and external causes (15.1%). The main causes of premature mortality among women in urban areas were: cancers (41.7%), cardiovascular diseases (19.6%) and external causes (11.1%). Premature mortality among men in rural areas was significantly higher than in urban for all analysed causes of death, with the exception of ischaemic heart diseases and colorectal cancer. Premature mortality among women in rural areas was significantly lower than in urban for all analysed cause of deaths, except of cerebrovascular diseases, external causes, suicides and traffic accidents. The presented epidemiological situation for premature mortality indicate differences in the state of health of the inhabitants in urban and rural areas in Poland. The leading causes of premature mortality are caused by preventable deaths, which leads to a need to intensify measures in primary and secondary prevention.

Sex and Racial/Ethnic Differences in Premature Mortality Due to HIV: Florida, 2000-2009.

This study aimed to characterize premature mortality among people diagnosed with HIV infection from 2000 to 2009 in Florida, by sex and race/ethnicity, to estimate differences in premature mortality that could be prevented by linkage to HIV care and treatment. Florida surveillance data for HIV diagnoses (excluding concurrent AIDS diagnoses) were linked with vital records data to ascertain deaths through 2011. Years of potential life lost (YPLL) were obtained from the expected number of remaining years of life at a given age from the U.S. sex-specific period life tables. Among 41,565 people diagnosed with HIV infection during the study period, 5,249 died, and 2,563 (48.8%) deaths were due to HIV/AIDS. Age-standardized YPLL (aYPLL) due to HIV/AIDS per 1,000 person-years was significantly higher for females than males (372.6, 95% confidence interval [CI] 349.8, 396.2 vs. 295.2, 95% CI 278.4, 312.5); for non-Hispanic black (NHB) females than non-Hispanic white (NHW) and Hispanic females (388.2, 95% CI 360.7, 416.9; 294.3, 95% CI 239.8, 354.9; and 295.0, 95% CI 242.9, 352.5, respectively); and for NHB males compared with NHW and Hispanic males (378.7, 95% CI 353.7, 404.7; 210.6, 95% CI 174.3, 250.8; and 240.9, 95% CI 204.8, 280.2, respectively). In multilevel modeling controlling for individual factors, NHB race was associated with YPLL due to HIV/AIDS for women (p=0.04) and men (p<0.001). Among people diagnosed with HIV infection, females and NHB people had a disproportionately high premature mortality from HIV/AIDS, suggesting the need for enhanced efforts to improve linkage to and retention in care and medication adherence for these groups.

Race, Mental Illness, and Premature Mortality: Double Jeopardy?

Back to table of contents Previous article Next article LettersFull AccessRace, Mental Illness, and Premature Mortality: Double Jeopardy?Elizabeth E. Piatt, Ph.D.Elizabeth E. PiattSearch for more papers by this author, Ph.D.Published Online:1 Feb 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Racial-ethnic disparities in mortality have been extensively noted in the literature (1). A number of studies have also established that a diagnosis of a mental disorder increases a person's risk of premature death (2). However, research has not focused on the issue of “double jeopardy,” as postulated by Dowd and Bengtson (3). If race-ethnicity and a mental illness diagnosis lead to a double disadvantage in regard to health, then racial-ethnic health disparities should be greater among persons with mental illness than among those who do not have mental illness.To address this issue, I compared racial-ethnic differences in premature mortality among decedents with severe mental illness and decedents in the general population without mental illness. Death records for the City of Akron, Ohio, were matched with clinical case management files from Community Support Services (CSS), a community mental health center in Akron. The sample consisted of 16,164 individuals who died between January 1998 and December 2004; 647 of these individuals also had CSS records and 15, 517 did not. The mean±SD age of decedents in the sample was 79.4±11.4 years. Fifty-six percent (N=9,052) of the decedents were female, 20% (N=3,233) were African American, and 80% (N=12,931) were white. The sample and methods have been described extensively elsewhere (2). Analysis was limited to African Americans and whites because reporting of race on death certificates for these groups has been shown to be accurate (4).I used multivariate ordinary least-squares regression to estimate premature mortality, adjusting for gender, marital status, education, mental illness diagnosis, race, and cause of death. After the analysis controlled for the other factors, race (b=2.5, p≤.001) and a mental illness diagnosis (b=4.5, p≤.001) were significantly related to premature mortality. The regression coefficients were used to calculate the predicted values of years of potential life lost (YPLL) for CSS and non-CSS decedents by race. The difference in YPLL between African Americans and whites was smaller among CSS decedents than among non-CSS decedents (2.1 years and 2.5 years, respectively). CSS decedents who were African American lost 15.8 years of life, compared with 13.7 years for white CSS decedents. Among non-CSS decedents, the YPLL for African Americans was 11.7 years, compared with 9.2 years for whites, for whom YPLL was lowest. [A table summarizing these results is available as an online supplement to this letter at ps.psychiatryonline.org.] As a final step, an interaction term was entered in the regression model to assess whether a mental illness diagnosis had a differential effect on YPLL by race. This interaction was not significant.Although both racial minority status and a mental illness diagnosis contributed independently to premature mortality, African-American decedents with severe mental illness in this study did not have a differential vulnerability to premature mortality compared with white decedents with severe mental illness. Although premature mortality was higher among CSS decedents overall (2), racial differences in YPLL among CSS decedents were smaller than racial differences in YPLL in the non-CSS sample. This appears to be because YPLL was so much higher among the white CSS decedents. These findings provide further support for the addition of primary health care services to mental health treatment.Dr. Piatt is affiliated with the Department of Sociology, Hiram College, Hiram, Ohio.Acknowledgments and disclosuresThe author thanks Christian Ritter, Ph.D., Robin Shura, Ph.D., and Erica Hill, M.A., for helpful comments on drafts of this letter.The author reports no competing interests.References1 Williams DR : The health of US racial and ethnic populations. Journals of Gerontology Series B 60:53–62, 2005 Crossref, Medline, Google Scholar2 Piatt E , Munetz M , Ritter C : An examination of premature mortality among decedents with serious mental illness and those in the general population. Psychiatric Services 61:663–668, 2010 Link, Google Scholar3 Dowd JJ , Bengtson VL : Aging in minority populations: an examination of the double jeopardy hypothesis. Journal of Gerontology 33:427–436, 1978 Crossref, Medline, Google Scholar4 Arias E , Schauman WS , Eschbach K , et al.: The validity of race and Hispanic origin reporting on death certificates in the United States. Vital Health Statistics 148:1–23, 2008 Google Scholar FiguresReferencesCited byDetailsCited ByThe physical health of Māori with bipolar disorder15 September 2020 | Australian & New Zealand Journal of Psychiatry, Vol. 54, No. 11Drug and Alcohol Dependence, Vol. 151 Volume 62Issue 2 February 2011Pages 223-224 Metrics Acknowledgments and disclosuresThe author thanks Christian Ritter, Ph.D., Robin Shura, Ph.D., and Erica Hill, M.A., for helpful comments on drafts of this letter.The author reports no competing interests.PDF download History Published online 1 February 2011 Published in print 1 February 2011

Gender Patterns of Socioeconomic Differences in Premature Mortality: Follow-up of the Hungarian Epidemiological Panel

Gender differences in premature mortality rates and in the size of socioeconomic inequalities in mortality vary across countries. We aimed to quantify the gender differences in the association between socioeconomic status (SES) and premature all-cause mortality and to analyse whether psychosocial factors might associate between SES and mortality among men and women separately in the middle-aged Hungarian population. Men (n = 1130) and women (n = 1529), aged 40-69years, participants in the Hungarian Epidemiological Panel (2002) were followed up for 3.5years for total mortality. Cox proportional hazard models were used to evaluate the association between several socioeconomic measures and total death. During the follow-up, 99 men (8.8%) and 53 women (3.5%) died. The age-adjusted hazard ratios and the Rothman's synergy indexes showed that each measure of socioeconomic position was more deleterious in men compared with women. When investigating potential explanatory factors for the SES-mortality association, we found that adjustment for severe depression resulted in the most pronounced reduction in the regression coefficients for the association between most socioeconomic factors and male premature death. There was no indication that depression would mediate between SES and mortality in women. Work stress factors, poor lifestyle and low social support also contributed to the explanation of the link between socioeconomic disadvantage and premature death in men. Middle-aged Hungarian men seem to be considerably more vulnerable to the chronic stress of material disadvantage than women. This effect modification by gender might partly be explained by a stronger connection between low SES and depressive symptoms in men.

Serbia within the European context: An analysis of premature mortality

BackgroundBased on the global predictions majority of deaths will be collectively caused by cancer, cardiovascular diseases, and traffic accidents over the coming 25 years. In planning future national health policy actions, inter – regional assessments play an important role. The purpose of the study was to analyze similarities and differences in premature mortality between Serbia, EURO A, EURO B, and EURO C regions in 2000.MethodsMortality and premature mortality patterns were analysed according to cause of death, by gender and seven age intervals. The study results are presented in relative (%) and absolute terms (age-specific and age-standardized death rates per 100,000 population, and age-standardized rates of years of life lost – YLL per 1,000). Direct standardization of rates was undertaken using the standard population of Europe. The inter-regional comparison was based on a calculation of differences in YLL structures and with a ratio of age-standardized YLL rates per 1,000. A multivariate generalized linear model was used to explore mortality of Serbia and Europe sub-regions with ln age-specific death rates. The dissimilarity was achieved with a p ≤ 0.05.ResultsAccording to the mortality pattern, Serbia was similar to EURO B, but with a lower average YLL per death case. YLL patterns indicated similarities between Serbia and EURO A, while SRR YLL had similarities between Serbia and EURO B. Compared to all Europe sub-regions, Serbia had a major excess of premature mortality in neoplasms and diabetes mellitus. Serbia had lost more years of life than EURO A due to cardiovascular, genitourinary diseases, and intentional injuries. Yet, Serbia was not as burdened with communicable diseases and injuries as were EURO B and EURO C.ConclusionWith a premature mortality pattern, Serbia is placed in the middle position of the Europe triangle. The main excess of YLL in Serbia was due to cardiovascular, malignant diseases, and diabetes mellitus. The results may be used for assessment of unacceptable social risks resulting from health inequalities. Within intentions to reduce an unfavourable premature mortality gap, it is necessary to reconsider certain local polices and practices as well as financial and human resources incorporated in the prevention of disease and injury burden.

Increase in differences in survival according to income per capita in Spain in the last quarter of the twentieth century

OBJECTIVE To estimate probability of survival in Spain from 1975 to 1995 according to income per capita quintiles. METHODS The 50 provinces in Spain were ordered by income per capita in 1975, 1981, 1985, 1990 and 1995. For each quintile and year we estimated the probability of surviving 75 years from birth and the probability of survival in several age intervals in men and women. Probability was estimated by percentages. Subsequently, we calculated differences in the probability of survival between the highest and the lowest income per capita quintiles. RESULTS Differences in the probability of surviving from birth to the age of 75 years increased from 1.3 in 1975 to 3.1 in 1995 in women, whereas in men the increase was from 0.1 in 1975 to 3.7 in 1995. CONCLUSIONS In Spain, as in other developed countries, socioeconomic differences in premature mortality increased in the latter decades of the twentieth century.

Incremento de la diferencia en la supervivencia según la renta per cápita en España en los últimos años del siglo XX

ObjectiveTo estimate probability of survival in Spain from 1975 to 1995 according to income per capita quintiles. MethodsThe 50 provinces in Spain were ordered by income per capita in 1975, 1981, 1985, 1990 and 1995. For each quintile and year we estimated the probability of surviving 75 years from birth and the probability of survival in several age intervals in men and women. Probability was estimated by percentages. Subsequently, we calculated differences in the probability of survival between the highest and the lowest income per capita quintiles. ResultsDifferences in the probability of surviving from birth to the age of 75 years increased from 1.3 in 1975 to 3.1 in 1995 in women, whereas in men the increase was from 0.1 in 1975 to 3.7 in 1995. ConclusionsIn Spain, as in other developed countries, socioeconomic differences in premature mortality increased in the latter decades of the twentieth century.