Premature Adult Mortality Research Articles

Growth and Enduring Epidemic Diseases

This paper studies the formation of human capital and its transmission across generations when premature adult mortality is a salient feature of the demographic landscape, either permanently or in the form of a long-period wave that follows the outbreak of an epidemic. We establish several threshold properties of the model, for such a shock can severely retard economic growth, even to the point of leading to an economic collapse. Premature adult mortality may exacerbate inequality under nuclear family arrangements. Pooling mortality risks with equal treatment of all children may fend off, or even induce, a collapse, depending on the initial conditions and the size and duration of the shock. Awareness campaigns may also trigger a collapse by introducing undesirable expectational feedbacks.

The Long-Run Economic Costs of aids: A Model with an Application to South Africa

Primarily a disease of young adults, aids imposes economic costs that could be devastatingly high in the long run by undermining the transmission of human capital—the main driver of long-run economic growth—across generations. aids makes it harder for victims’ children to obtain an education and deprives them of the love, nurturing, and life skills that parents provide. These children will in turn find it difficult to educate their children, and so on. An overlapping generations model is used to show that an otherwise growing economy could decline to a low-level subsistence equilibrium if hit with an aids-type increase in premature adult mortality. Calibrating the model for South Africa, where the hiv prevalence rate is over 20 percent, simulations reveal that the economy could shrink to half its current size in about four generations in the absence of intervention. Programs to combat the disease and to support needy families could avert such a collapse, but they imply a fiscal burden of about 4 percent of gdp.

Atherosclerosis in childhood and adolescent type 1 diabetes: early disease, early treatment?

Autopsy studies have shown that atherosclerosis begins in adolescence in otherwise healthy individuals, and imaging techniques have shown that atherosclerosis develops earlier and is more prevalent in children with diabetes than in age-matched healthy controls. Cardiovascular disease has now overtaken diabetic nephropathy as the leading cause of premature mortality in young adults with diabetes, and the emphasis on disease prevention has accordingly shifted to a younger age group. The majority of children and adolescents with diabetes have suboptimal blood glucose control, and this contributes to accelerated arterial disease in this age group. Other conventional risk factors for coronary heart disease also need to be considered and treated aggressively. Effective early prevention of cardiovascular disease will involve lifestyle modification and full implementation of existing treatment guidelines, and large-scale prospective studies will be needed to establish the risks and benefits of early pharmacological intervention in children and adolescents.

Wealth, Race, and Mortality*

Objective. We explore, first, whether wealth relates to mortality risk independent of income and education, and second, whether wealth closes the black‐white gap in U.S. adult mortality while controlling for other socioeconomic and sociodemographic factors.Methods. We employ the Cox proportional hazards models on data from the 1992 wave of the Health and Retirement Study linked to deaths through 1998, to analyze pre‐retirement adult mortality in the United States.Results. The findings suggest that broader measures of SES, including wealth, are significant for understanding adult mortality. Further, vastly lower asset holdings among blacks, compared to whites, not only affects their financial well‐being but also their survival prospects.Conclusions. Research and social policies that aim to understand and close health disparities in the United States may be poorly conceived if they ignore the impact of wealth on premature adult mortality.

Circunstancias socioeconómicas y mortalidad prematura por enfermedades crónicas

Our aim was to investigate the association between socioeconomic factors in childhood or adolescence and adulthood and premature mortality from various causes of death. Men and women aged 25-74 years residing on May 1, 1996, in the Autonomous Community of Madrid. For the next 19 months, information on individuals who died and the cause of death were obtained from the Mortality Register. We estimated the mortality from 5 types of cancer and from 4 chronic diseases by the educational level--as an indicator of the socioeconomic circumstances in childhood or adolescence--and by income--as an indicator of the socioeconomic circumstances in adulthood. When both variables were included in the analysis simultaneously, the relative mortality ratio for men with second grade first phase and lower educational level versus those with second grade, second phase and higher educational level and the relative mortality ratio for men belonging to income quartiles 3 and 4 (lowest) versus those belonging to quartiles 1 and 2 were, respectively: 1.15 (95% confidence interval 1.01-1.31) and 1.22 (1.09-1.36) for lung cancer; 1.46 (1.19-1,93) and 1.13 (0.90-1.41) for gastric cancer; 1.80 (1.32-2.44) and 1.46 (1.18-1.80) for chronic obstructive pulmonary disease; and 1.18 (0.77-1.81) and 0.68 (0.47-0.98) for diabetes mellitus. For women the relative mortality ratios were, respectively: 0.63 (0.43-0.92) and 0.72 (0.52-0.99) for lung cancer; 1.68 (0.99-2.83) and 1.17 (0.86-1.60) for gastric cancer; 0.76 (0.61-0.94) and 0.98 (0.82-1.16) for breast cancer; 1.36 (0.95-1.95) and 1.20 (0.97-1.48) for ischemic heart disease; 1.72 (1.19-2.50) and 0.93 (0.75-1.16) for stroke; and 2.23 (0.94-5.27) and 1.51 (1.02-2.25) for diabetes mellitus. Premature mortality in adulthood is associated with several socioeconomic factors acting across the whole course of life. The contribution of these socioeconomic circumstances to mortality varies regarding the cause of death and gender.

Mortality in adults aged 26-54 years related to socioeconomic conditions in childhood and adulthood: post war birth cohort study

Objective: To examine premature mortality in adults in relation to socioeconomic conditions in childhood and adulthood.Design: Nationally representative birth cohort study with prospective information on socioeconomic conditions.Setting: England, Scotland, and...

Resource requirements to develop a large, remote aboriginal health service: whose responsibility?

In 1994 the Commonwealth funded studies to establish and develop Aboriginal health services. One such study was undertaken in 1995 at Maningrida, Northern Territory: to identify the health-service needs of the population and consider community management structures; to identify Northern Territory expenditure for primary health care; and to provide a three- to five-year development budget. Approximately 2100 Aboriginal residents in the region used the service, including 750 living on 24 outstations within 75 km. Nearly 40 per cent were aged under 15 years. Childhood morbidity was high, with children under two averaging 1.4 hospital admissions per year. The age pyramid reflected premature adult mortality from the third decade of life. Service providers identified inadequate staffing and infrastructure as barriers to service development. Community consultations emphasised the need for resident doctors, improved outstation services and aged and respite care, local training for Aboriginal health workers and housing for staff. These developments would require per capita primary health care expenditure ($872) to be doubled. Aboriginal people in remote areas are disadvantaged through Commonwealth Grants Commission funding formulae and lack of Medicare access. As the sole funding source, the Northern Territory spends over $1.83 million per year providing health services at Maningrida. Additionally, the study proposed that the Commonwealth spend $1.96 million a year over five years on staffing and infrastructure. Local Aboriginal organisations also agreed to allocate resources for health service development. Ineffective implementation, lack of clarification of government responsibilities and funding shortfalls remain barriers to developing remote Aboriginal health services.

A medical cause of death validation study of adult Aboriginal deaths in the Northern Territory of Australia in 1992

Judged on the criterion of equity, premature adult Aboriginal mortality is the most serious public health problem faced in Australia today. There have been a number of published epidemiological studies that have analysed Aboriginal cause of death data, but this is the first study to formally validate such data. The study sample included all adult Aboriginal people who lived and died in the Northern Territory in 1992, excluding residents of the Alice Springs region. The appropriateness of underlying cause of death codes was assessed by a single reviewer in light of death certificates, medical records, postmortem records and interviews with key health professional informants. Data were collected on 220 deaths. 8% (17 out of 220) of deaths were classified erroneously at the ICD-9 chapter level. Errors in death certification accounted for 64% (11 out of 17) of the chapter errors and diagnostic and coding errors for 18% (3 out of 17) each. The overall impact on mortality statistics was less severe because some cross-chapter classification errors cancelled each other out. Misclassification errors aggregated mainly in chapter VII (circulatory diseases) of the ICD-9 classification which was overcounted by 3.2%, and chapter VIII (respiratory diseases) which was overcounted by 1.3%. Before correction for misclassification error, circulatory diseases were judged to cause the highest proportion of deaths, whereas after correction, respiratory diseases accounted for the highest proportion. Despite this, the overall quality of the medical cause of death statistics was of a sufficiently good standard from a public health perspective to broadly inform health policy. Future attempts to improve the validity of medical cause of death statistics for Australian Aboriginal people should focus on the education of medical practitioners about the purpose and process of death certification.

Premature mortality in Aboriginal adults in the Northern Territory, 1979–1991: In reply

Premature mortality in Aboriginal adults in the Northern Territory, 1979–1991: In reply

Premature mortality in aboriginal adults in the Northern Territory, 1979-1991.

To identify important causes of premature mortality among Aboriginal adults in the Northern Territory (NT), 1979-1991. All deaths of NT Aboriginal residents aged 15-64 years which occurred in the NT between 1979 and 1991 and which were recorded by the Registry of Births, Deaths and Marriages were included. Standardised mortality ratios (SMRs) were used to compare the number of deaths observed among Aboriginals in the NT to those expected, based on overall Australian rates. Years of potential life lost before age 65 (YPLL65) were estimated for specific causes of death. Aboriginal women (overall SMR, 5.5) and Aboriginal men (SMR, 4.7) experienced a high burden of excess mortality from almost every cause of death. This excess increased over time, especially for Aboriginal women. Among Aboriginal men, the most important causes of premature death were motor vehicle accidents (11% of excess deaths and 17% of YPLL65), ischaemic heart disease (10% of excess deaths and 10% of YPLL65), pneumonia and influenza (8% of excess deaths and 6% of YPLL65), and homicide (7% of excess deaths and 8% of YPLL65). For Aboriginal women, the most important causes included homicide (7% of excess deaths and 11% of YPLL65), chronic obstructive pulmonary disease (10% of excess deaths and 5% of YPLL65), rheumatic heart disease (7% of excess deaths and 8% of YPLL65), and ischaemic heart disease (6% of excess deaths and 5% of YPLL65). The wide variety of causes of excess mortality will require an equally wide variety of solutions, both medical and non-medical, and a long term commitment will be necessary to achieve reductions in premature mortality among NT Aboriginal adults.

Adult mortality in the light of criminality, substance abuse, and behavioural and family‐risk factors in adolescence

In their general theory of crime, Gottfredson and Hirschi (1990) advanced the argument that different aspects of antisocial behaviour and health‐endangering forms of behaviour are derived from the same personality characteristic, namely low self‐control. This raises expectations of high intercorrelations between antisocial behaviour, criminality and health‐compromising activities. The objective of the present study was to examine mortality risk at an adult age (including sudden violent death and death due to accidents) as a consequence of adolescent behavioural problems and adverse home‐upbringing conditions, and further to examine whether subjects who had a criminal conviction as an adult were over‐represented among those who died prematurely. An alternative hypothesis was that disproportionately high future premature mortality among males with a record of early antisocial behaviour (and many family risk factors) is largely accounted for by a subgroup of antisocial subjects with strong alcohol and/or drug problems. In total, 7577 persons about to undertake compulsory military service, 18 years old in 1969–70, responded to questions about their family background and antisocial behaviour, and were followed up in registers of mortality, criminality and alcohol or drug abuse up to the age of 33. The results revealed that early contact with the police, truancy and school misconduct, and also the home‐upbringing variables, divorce and parents' nervous disorders, were significant predictors of later premature mortality. When future registered abusers were excluded, the prognostic power of these variables was reduced; despite this, the same indicated risk factors still had a general impact on premature adult mortality. However, adolescent risk had less impact on deaths from accidents than on other types of death. It was also found that males had criminal convictions were over‐represented among those who died prematurely. Excluding known cases of alcohol and drug abuse, there was a slight, almost negligible, increased risk of motality among males with criminal records. It is concluded that the higher likelihood of mortality among offenders can be attributed largely to the existence of a small group of alcohol and/or drug abusers who run a hight risk of dying prematurely. The generality of Gottfredson and Hirschi's theory with respect to mortality is called into question.

Smoking-Attributable Mortality—Mexico, 1992

This report summarizes trends in the occurrence of smoking-related diseases in Mexico and estimates smoking-attributable mortality and years of potential life lost before age 65 years (YPLL-65) in 1992....The findings in this report document the substantial impact of cigarette smoking on premature mortality in adults in Mexico. Death rates from the leading causes of smoking-related deaths have nearly tripled since 1970 in Mexico. (EXCERPT)

Regional mortality differences in Britain, 1931-87: a two dimensional analysis.

In a recent analysis, Illsley, Le Grand & Mullings argued that, over the years 1931-87, regional inequalities in mortality in Britain effectively disappeared for most age groups. The present study reanalyses their data, breaking regional life tables down into their two major components, the level of survivorship, and the shape of the mortality curve. It is shown that whereas there has been a consistent decline in regional inequalities in the level of mortality, there has not been a comparable convergence in the shape of the mortality curves. These shape differences, implying premature adult mortality, are now the major source of variation among the regions.

Premature adult mortality and short‐stay hospitalization in Western Australia attributable to the smoking of tobacco, 1979‐1983

The proportions of total deaths and premature adult mortality in 1979-1983, and of short-stay hospital admissions and bed-days in 1983, that were attributable to the smoking of tobacco were estimated in Western Australia by the use of aetiological fractions that had been derived from the published literature. Premature adult mortality was measured by the person-years of life that were lost from ages 15 to 69 years (PYLL 15-69). In men it was estimated that 25% of all deaths and 14% of PYLL 15-69 were attributable to smoking. In women the corresponding proportions were 15% of deaths and 8% of PYLL 15-69. The proportions of short-stay hospital bed-days that were attributable to smoking were estimated at 7% in men and 3% in women; for hospital admissions the estimates were 4% and 1% in men and women, respectively. In all, tobacco-related disease and injury accounted for around 1700 deaths and 7500 short-stay hospitalizations each year in a population of 1.4 million persons.