Premature Adult Mortality Research Articles

Estimación de la fracción de la mortalidad en Rusia atribuible al alcohol

Accumulated research evidence suggests that alcohol is a major contributor to premature deaths toll in Russia. The aim of the present study was to estimate the premature adult mortality attributable to alcohol abuse in Russia on the basis of aggregate-level data of all-cause mortality and alcohol consumption. With this purpose age-standardized sex-specific male and female all-cause mortality data for the period 1980-2005 and data on overall alcohol consumption were analyzed by means ARIMA time series analysis. As a result alcohol consumption was significantly associated with both male and female all-cause mortality rates: a 1 liter increase in overall alcohol consumption would result in a 3.9% increase in the male mortality rate and in 2.4% increase in female mortality rate. The results of the analysis also suggest that 41.1% of all male deaths and 27.8% female deaths in Russia could be attributed to alcohol. We can conclude that alcohol is a major contributor to the high mortality rate in Russian Federation. Therefore prevention of alcohol-attributable harm should be a major public health priority in Russia.

Geographic Inequalities in All-Cause Mortality in Japan: Compositional or Contextual?

BackgroundA recent study from Japan suggested that geographic inequalities in all-cause premature adult mortality have increased since 1995 in both sexes even after adjusting for individual age and occupation in 47 prefectures. Such variations can arise from compositional effects as well as contextual effects. In this study, we sought to further examine the emerging geographic inequalities in all-cause mortality, by exploring the relative contribution of composition and context in each prefecture.MethodsWe used the 2005 vital statistics and census data among those aged 25 or older. The total number of decedents was 524,785 men and 455,863 women. We estimated gender-specific two-level logistic regression to model mortality risk as a function of age, occupation, and residence in 47 prefectures. Prefecture-level variance was used as an estimate of geographic inequalities in mortality, and prefectures were ranked by odds ratios (ORs), with the reference being the grand mean of all prefectures (value = 1).ResultsOverall, the degree of geographic inequalities was more pronounced when we did not account for the composition (i.e., age and occupation) in each prefecture. Even after adjusting for the composition, however, substantial differences remained in mortality risk across prefectures with ORs ranging from 0.870 (Okinawa) to 1.190 (Aomori) for men and from 0.864 (Shimane) to 1.132 (Aichi) for women. In some prefectures (e.g., Aomori), adjustment for composition showed little change in ORs, while we observed substantial attenuation in ORs in other prefectures (e.g., Akita). We also observed qualitative changes in some prefectures (e.g., Tokyo). No clear associations were observed between prefecture-level socioeconomic status variables and the risk of mortality in either sex.ConclusionsGeographic disparities in mortality across prefectures are quite substantial and cannot be fully explained by differences in population composition. The relative contribution of composition and context to health inequalities considerably vary across prefectures.

Mortality and cause-of-death reporting and analysis systems in seven pacific island countries

BackgroundMortality statistics are essential for population health assessment. Despite limitations in data availability, Pacific Island Countries are considered to be in epidemiological transition, with non-communicable diseases increasingly contributing to premature adult mortality. To address rapidly changing health profiles, countries would require mortality statistics from routine death registration given their relatively small population sizes.MethodsThis paper uses a standard analytical framework to examine death registration systems in Fiji, Kiribati, Nauru, Palau, Solomon Islands, Tonga and Vanuatu.ResultsIn all countries, legislation on death registration exists but does not necessarily reflect current practices. Health departments carry the bulk of responsibility for civil registration functions. Medical cause-of-death certificates are completed for at least hospital deaths in all countries. Overall, significantly more information is available than perceived or used. Use is primarily limited by poor understanding, lack of coordination, limited analytical skills, and insufficient technical resources.ConclusionAcross the region, both registration and statistics systems need strengthening to improve the availability, completeness, and quality of data. Close interaction between health staff and local communities provides a good foundation for further improvements in death reporting. System strengthening activities must include a focus on clear assignment of responsibility, provision of appropriate authority to perform assigned tasks, and fostering ownership of processes and data to ensure sustained improvements. These human elements need to be embedded in a culture of data sharing and use. Lessons from this multi-country exercise would be applicable in other regions afflicted with similar issues of availability and quality of vital statistics.

Perceived Parenting Style and the Eating Practices of College Freshmen

Background: Unhealthy eating contributes to morbidity in adolescents and college students and is an antecedent of premature mortality in adulthood. It has been suggested that the increase in independence (i.e., living away from parents) of adolescents contributes to their poor eating behaviors. Some literature reports that specific parenting styles may reduce the probability of engaging in poor eating practices. Purpose: We investigated the association between college freshmen's eating practices and their perceptions of parenting style. Methods: An Internet-based survey was used to sample 264 college freshmen between the ages of 18 and 20 years from a large southeastern university. Data analysis used univariate and bivariate statistics along with multiple regression analysis. Results: Student eating practices fell short of optimal dietary recommendations. Whereas the literature suggests that parenting style predicts healthy eating during early adolescence, it did not predict healthy eating in this sample of college freshmen, accounting for less than 1% of the variance in eating practices. Nevertheless, responses to an open-ended question suggested that some students believed that parents had influenced their current eating behaviors. Discussion: We found little evidence of any latent effects of parenting style on eating behaviors among college freshmen. Translation to Health Education Practice: Despite positive parental influences, as it relates to health eating, continued reinforcement at the individual (e.g., skill enhancement with regard to meal preparation), interpersonal (e.g., role modeling healthy eating practices among peers), community (e.g., establishing famers' markets) and organizational (e.g., increased access to healthy food options in cafeterias) levels is needed.

Social and geographic inequalities in premature adult mortality in Japan: a multilevel observational study from 1970 to 2005

ObjectivesTo examine trends in social and geographic inequalities in all-cause premature adult mortality in Japan.DesignObservational study of the vital statistics and the census data.SettingJapan.ParticipantsEntire population aged 25 years or older...

Premature adult mortality from non-communicable diseases (NCD) in three middle-income countries: do NCD programmes matter?

BACKGROUND In many middle-income countries, there is limited data available to evaluate the effectiveness of non-communicable disease (NCD) programmes. Since 1970, three neighbouring middle-income countries-Argentina, Chile and Uruguay-have undergone health sector reforms and reorganized their NCD programmes. In this paper, we explore whether data on premature adult mortality can be used to gauge the effectiveness of these programmes. METHODS We describe NCD programmes and examine mortality trends for the years 1970-2005 among adults aged 15-59 years. We contrast mortality trends from all-NCD to mortality trends from NCD that are avoidable through timely and effective medical care. The assumption is that if NCD programmes exert no effect, then all-NCD mortality and avoidable-NCD mortality will follow the same trend and avoidable-NCD mortality will not change at a faster pace. We used joinpoint regression analysis to describe the pace of change, measured as the geometric weighted average of the annual percentage change (AAPC). RESULTS Since the 1980s, all three countries have implemented NCD programmes delivered through health care, but only after the year 2000 did these countries begin to scale-up population-based NCD prevention programmes. In Argentina, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality, while the contrary is occurring in Chile. In Uruguay, all-NCD mortality is declining at a faster pace than avoidable-NCD mortality among males, whereas among females, all-NCD mortality has stagnated while avoidable-NCD mortality continues to decline. CONCLUSION NCD interventions through health care have likely contributed to the reduction of premature NCD mortality in Chile and among women in Uruguay. In Argentina and among men in Uruguay, factors outside the health sector seem to have had a greater impact. This approach could be used in other countries to assess the effect of NCD interventions and raise key questions on programme effectiveness.

Following cancer prevention guidelines may lower risk of death from all causes

Nonsmokers who followed cancer prevention guidelines lowered their risk of death from cancer, cardiovascular disease, and all causes, according to a study of more than 100,000 men and women that was conducted over 14 years. The study, led by Marjorie McCullough, ScD, of the ACS, was published in Cancer Epidemiology, Biomarkers & Prevention.1 Few studies to date have examined the impact of following prevention guidelines on all 3 causes of death, and the majority of those previously conducted used tobacco avoidance as one of the recommendations; however, because 8 in 10 Americans are never or former smokers, investigators wanted to better understand the effect of following other recommendations. McCullough and colleagues used results from diet and lifestyle questionnaires completed in 1992 and 1993 by 111,966 nonsmoking men and women in the Cancer Prevention Study II Nutrition Cohort. They were scored on a scale ranging from 0 to 8 in terms of adherence to all recommendations. After 14 years, men with high compliance scores (7 or 8) had a 42% lower risk of death compared with those with low scores (0-2). The risk of death from cardiovascular disease was 48% lower among men and 58% lower among women in the high-compliance group, whereas the risk of cancer death was 30% lower in high-compliance men and 24% lower in high-compliance women. Similar, although not statistically significant, associations were observed for never and former smokers. As a result, researchers summarized that adhering to cancer prevention guidelines for obesity, diet, physical activity, and alcohol consumption is associated with a lower risk of death from cancer, cardiovascular disease, and all causes in nonsmokers and may substantially lower the risk of premature mortality in older adults. Correction In the August 1, 2011 issue of “CancerScope,” Jill O'Donnell- Tormey, PhD, was incorrectly identified as the executive director of the Cancer Vaccine Acceleration Fund. She is the executive director of the Cancer Research Institute

P2-304 Childhood infectious diseases and premature adult mortality: results from the Newcastle Thousand Families Study

IntroductionEarly life infections may negatively influence health in later life, but there have been few studies of the association, due to the difficulty of obtaining adequate information from throughout life....

Following Cancer Prevention Guidelines Reduces Risk of Cancer, Cardiovascular Disease, and All-Cause Mortality

Few studies have evaluated the combined impact of following recommended lifestyle behaviors on cancer, cardiovascular disease (CVD) and all-cause mortality, and most included tobacco avoidance. Because 80% of Americans are never or former smokers, it is important to consider the impact of other recommended behaviors. In 1992 and 1993, 111,966 nonsmoking men and women in the Cancer Prevention Study-II Nutrition Cohort completed diet and lifestyle questionnaires. A score ranging from 0 to 8 points was computed to reflect adherence to the American Cancer Society cancer prevention guidelines on body mass index, physical activity, diet, and alcohol consumption, with 8 points representing optimal adherence. Multivariable-adjusted relative risks (RR) of death and 95% CI were computed by Cox proportional hazard regression. During 14 years of follow-up, 10,369 men and 6,613 women died. The RR of all-cause mortality was lower for participants with high (7, 8) versus low (0-2) scores (men, RR = 0.58, 95% CI: 0.53-0.62; women, RR = 0.58, 95% CI: 0.52-0.64). Inverse associations were found with CVD mortality (men, RR = 0.52, 95% CI: 0.45-0.59; women, RR = 0.42, 95% CI: 0.35-0.51) and cancer mortality (men, RR = 0.70, 95% CI: 0.61-0.80; women, RR = 0.76, 95% CI: 0.65-0.89). Similar associations, albeit not all statistically significant, were observed for never and former smokers. Adherence to cancer prevention guidelines for obesity, diet, physical activity, and alcohol consumption is associated with lower risk of death from cancer, CVD, and all causes in nonsmokers. Beyond tobacco avoidance, following other cancer prevention guidelines may substantially lower risk of premature mortality in older adults.

Selective deletion of long but not short Cypher isoforms leads to late-onset dilated cardiomyopathy

Cypher long (CypherL) and short (CypherS) isoforms are distinguished from each other by the presence and absence of three C-terminal LIM domains, respectively. Cypher isoforms are developmentally regulated, and mutations affecting both long and short isoforms are linked to muscle disease in humans. Given these data, we hypothesized that various Cypher isoforms play overlapping and unique roles in striated muscle. To determine the specific role of Cypher isoforms in striated muscle, we generated two mouse lines in which either CypherS or CypherL isoforms were specifically deleted. Mice specifically, deficient in CypherS isoforms had no detectable muscle phenotype. In contrast, selective loss of CypherL isoforms resulted in partial neonatal lethality. Surviving mutants exhibited growth retardation and late-onset dilated cardiomyopathy, which was associated with cardiac fibrosis and calcification, leading to premature adult mortality. At a young age, preceding development of cardiomyopathy, hearts from these mutants exhibited defects in both Z-line ultrastructure and specific aberrations in calcineurin-NFAT and protein kinase C pathways. Earlier onset of cardiac dilation relative to control wild-type mice was observed in young CypherL isoform knockout mice consequent to pressure overload, suggesting a greater susceptibility to the disease. In summary, we have identified unique roles for CypherL isoforms in maintaining Z-line ultrastructure and signaling that are distinct from the roles of CypherS isoforms, while highlighting the contribution of mutations in the long isoforms to the development of dilated cardiomyopathy.

Obesity in Children and Future Cardiometabolic Risk

Rates of pediatric obesity have increased substantially in recent years (1) and now pose a major risk for increased morbidity and premature mortality in adulthood for those affected, with cardiovascular disease (CVD) being a major contributor. In the current issue, Libman et al. (2) examine the relationship between glucose and insulin in overweight children and adolescents and a range of biomarkers for cardiovascular disease. They report that increased fasting and postprandial insulin are related to CVD risk factors, including systolic blood pressure and triglycerides, whereas glucose is not. These results are perhaps not surprising given what we already know about glucose homeostasis in obese children and adolescents (3) and recent evidence supporting a relatively weak relationship between elevations in fasting glucose within the normal range and incident CVD events in adults (4). Hyperinsulinemia is the hallmark of metabolic dysfunction in children and adolescents, with hyperglycemia not manifesting until a very late stage of β-cell failure (3), making the process far lengthier than in adults and reflecting the ability of the young pancreas to better compensate. Given the epidemic of childhood …

Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review

The last systematic review on the health consequences of child and adolescent obesity found little evidence on consequences for adult health. The present study aimed to summarize evidence on the long-term impact of child and adolescent obesity for premature mortality and physical morbidity in adulthood. Systematic review with evidence searched from January 2002 to June 2010. Studies were included if they contained a measure of overweight and/or obesity between birth and 18 years (exposure measure) and premature mortality and physical morbidity (outcome) in adulthood. Five eligible studies examined associations between overweight and/or obesity, and premature mortality: 4/5 found significantly increased risk of premature mortality with child and adolescent overweight or obesity. All 11 studies with cardiometabolic morbidity as outcomes reported that overweight and obesity were associated with significantly increased risk of later cardiometabolic morbidity (diabetes, hypertension, ischaemic heart disease, and stroke) in adult life, with hazard ratios ranging from 1.1-5.1. Nine studies examined associations of child or adolescent overweight and obesity with other adult morbidity: studies of cancer morbidity were inconsistent; child and adolescent overweight and obesity were associated with significantly increased risk of later disability pension, asthma, and polycystic ovary syndrome symptoms. A relatively large and fairly consistent body of evidence now demonstrates that overweight and obesity in childhood and adolescence have adverse consequences on premature mortality and physical morbidity in adulthood.

Impact of Chronic Alcohol Ingestion on Cardiac Muscle Protein Expression

Chronic alcohol abuse contributes not only to an increased risk of health-related complications, but also to a premature mortality in adults. Myocardial dysfunction, including the development of a syndrome referred to as alcoholic cardiomyopathy, appears to be a major contributing factor. One mechanism to account for the pathogenesis of alcoholic cardiomyopathy involves alterations in protein expression secondary to an inhibition of protein synthesis. However, the full extent to which myocardial proteins are affected by chronic alcohol consumption remains unresolved. The purpose of this study was to examine the effect of chronic alcohol consumption on the expression of cardiac proteins. Male rats were maintained for 16 weeks on a 40% ethanol-containing diet in which alcohol was provided both in drinking water and agar blocks. Control animals were pair-fed to consume the same caloric intake. Heart homogenates from control- and ethanol-fed rats were labeled with the cleavable isotope coded affinity tags (ICAT). Following the reaction with the ICAT reagent, we applied one-dimensional gel electrophoresis with in-gel trypsin digestion of proteins and subsequent MALDI-TOF-TOF mass spectrometric techniques for identification of peptides. Differences in the expression of cardiac proteins from control- and ethanol-fed rats were determined by mass spectrometry approaches. Initial proteomic analysis identified and quantified hundreds of cardiac proteins. Major decreases in the expression of specific myocardial proteins were observed. Proteins were grouped depending on their contribution to multiple activities of cardiac function and metabolism, including mitochondrial-, glycolytic-, myofibrillar-, membrane-associated, and plasma proteins. Another group contained identified proteins that could not be properly categorized under the aforementioned classification system. Based on the changes in proteins, we speculate modulation of cardiac muscle protein expression represents a fundamental alteration induced by chronic alcohol consumption, consistent with changes in myocardial wall thickness measured under the same conditions.

Childhood Obesity, Glucose Intolerance, and Hypertension Increase Risk for Premature Adult Mortality

Whether childhood obesity, hypertension, glucose intolerance, and hypercholesterolemia are associated with premature adult mortality has not been

Body mass index through life and adult mortality: results from the British 1946 birth cohort

Adult body mass index (BMI) has been consistently related to mortality, but little is known about the impact of earlier life BMI on adult mortality. Investigate the impact of childhood,...

Do childhood cognitive ability or smoking behaviour explain the influence of lifetime socio-economic conditions on premature adult mortality in a British post war birth cohort?

Poor childhood and adult socio-economic conditions, lower childhood cognitive ability and cigarette smoking are all associated with adult mortality risk. Using data on 4458 men and women aged 60 years from a British birth cohort study, we investigated the extent to which these risk factors are part of the same pathway linking childhood experience to adult survival. Compared with women from non-manual origins, men from non-manual origins, women and men from manual origins, and those with missing data on father's social class had about double the risk of mortality between 26 and 60 years. Cox proportional hazards models showed that these differences were reduced but remained significant after adjusting for childhood cognitive ability, adult socio-economic conditions and smoking. Higher childhood ability increased survival chances by securing better adult socio-economic conditions, such as home ownership, which was strongly associated with survival. These findings were similar for cardiovascular and cancer mortality.

Congenital Cardiovascular Disease in Turner Syndrome

Turner syndrome (TS), or monosomy X, occurs in approximately 1/2000 live born females. Intelligence is normal and short stature is the most obvious and consistent feature of the syndrome. Congenital cardiovascular disease affects approximately 50% of individuals and is the major cause of premature mortality in adults. Unfortunately, this most important aspect of the syndrome has received little attention outside of pediatric medicine, and adult cardiological follow-up is seriously lacking. This review describes the spectrum of cardiovascular defects with particular attention to identifying risk factors for aortic dissection/rupture. X-chromosome genetic pathways implicated in Turner cardiovascular disease, including premature coronary artery disease, are discussed. Recent guidelines for diagnosis and treatment of girls and women with TS are reviewed.

The economic impacts of premature adult mortality: panel data evidence from KwaZulu-Natal, South Africa

Measuring the household level economic impacts of AIDS-related deaths is of particular salience in South Africa, a country struggling with a legacy of poverty and economic inequality in the midst of an HIV epidemic. Household panel data that span more than a decade permit us to resolve many of the statistical problems that make it difficult to determine these impacts. After allowing for the impact of demographic adjustments and other coping strategies, we found evidence that these impacts are quite different across different types of households, and that the largest and most persistent effects were in the middle ranges of the South African income distribution, that is, households just above the poverty line. Households below that level seem less severely affected, whereas those above it seem to recover more quickly. All these results need to be treated with caution because their statistical precision is weak.

Alcohol accounts for a high proportion of premature mortality in central and eastern Europe

There is a west-east mortality gradient in Europe, more pronounced in men. The objective of this article was to quantify the contribution of alcohol use to the gap in premature adult mortality between three old (France, Sweden and United Kingdom) and four new (Czech Republic, Hungary, Lithuania and Poland) European Union (EU) member states for the year 2002. Russia was added as an external comparator. Exposure data were taken from surveys and per capita consumption records from the World Health Organization (WHO) Global Alcohol Database. Mortality data were taken from the WHO databank. The risk relationships were taken from published meta-analyses and from the WHO Comparative Risk Assessment project. Alcohol exposure and relative risk information was combined to derive alcohol-attributable fractions for relevant causes of premature mortality. Alcohol consumption was responsible for 14.6% of all premature adult mortality in the eight countries, 17.3% in men and 8.0% in women. This proportion was clearly higher in the new EU member states and Russia compared with the comparison countries from the old EU. For men, Russia with 29.0 alcohol-attributable premature deaths per 10,000 population had a more than 10-fold higher rate compared with Sweden (2.7 deaths/10,000). For women, the ratio between Hungary (5.0 alcohol-attributable deaths/10,000) and Russia (4.7 deaths/10,000) compared with Sweden (0.5 deaths/10,000) was almost as high, but the rates were much lower. The Czech Republic and Poland showed proportionally less alcohol-attributable premature mortality than the other new EU member states or Russia for both genders, which, however, was still higher than in any of the old EU member states. Alcohol is a strong contributor to the health gap between western and central and eastern Europe, with both average volume of consumption and patterns of drinking contributing to burden of disease and injury. Alcohol also contributes substantially to male-female differences in mortality and life expectancy. However, there are feasible and cost-effective measures to reduce alcohol-related burden that should be implemented in central and eastern Europe.

The Long-Run Effects of HIV/AIDS in Kenya

This essay analyzes the long-run economic effects of HIV/AIDS in Kenya, with emphasis on fertility, education and child labor. Human capital, which is built up through formal education and parental child-rearing, is the only input in production. Two aspects are central to the analysis: First, a mature AIDS epidemic causes massive premature adult mortality, thereby destroying existing human capital and reducing the labor force on a large scale. Second, the transmission of human capital to future generations is weakened, as children are left orphaned and surviving adults are correspondingly burdened. As a consequence, per capita income decreases and communities can less afford to raise and educate children as they did before the outbreak of the disease. The underlying theoretical model, in which it is assumed that parents raise and educate children for both financial and altruistic reasons, is calibrated using data for the period 1920 to 2000. The long-run effects of the disease, which depend heavily on parents' expectations about future mortality rates, are estimated for the years 2000-2040. Both human capital and per capita income grow significantly more slowly after the outbreak of the epidemic, while the incidence of child labor doubles for some periods. The level of fertility falls in the immediate aftermath of the outbreak, but can be significantly higher when the epidemic has reached a mature phase, depending on parents' expectations. Governmental interventions in the health sector in the early phase of the epidemic can strongly mitigate its adverse effects.