Standardized Mortality Odds Ratios Research Articles

Causes of death among United States decedents with ALS: An eye toward delaying mortality

To report multiple cause of death (MCOD) occurrence among patients in the United States with amyotrophic lateral sclerosis (ALS). Using death certificate data for all ALS deaths from 50 U.S. states and the District of Columbia, 2011-2014, we tabulated MCOD, used association rules mining (ARM) to determine if MCOD occurred together, and calculated standardized mortality odds ratios (SMOR) for select causes, comparing ALS with other U.S. decedents. Among 24,328 death certificates, there were 25,704 MCOD, excluding ALS. ALS was listed as the sole cause of death in n=11,263 (46%). The most frequent causes of death co-occurring with ALS were respiratory failure (n=6503; 25.3%), cardiovascular disease (n=6077; 12.6%), pneumonia (n=1345; 5.2%), and pneumonitis (n=856; 3.3%). The SMORs among ALS decedents compared with non-ALS decedents for falls and accidents were 3.4 (95% CI 2.6, 4.3) and 3.0 (95% CI 2.2, 4.2), respectively. From ARM analysis, falls and accidents were both associated with injuries. The most common causes identified were weakly to very strongly associated with being an ALS decedent compared with other U.S. deaths, with SMOR point estimates ranging from 1.3 to 51.1. This study provides information about the natural history of ALS. With knowledge that some causes of death may be preventable, healthcare providers may be able to optimize patient care and possibly postpone mortality and reduce morbidity. Moreover, this study located gaps in data; medical certifiers completing death certificates for ALS decedents should ensure all MCOD data are recorded.

Causes of death in patients with Down syndrome in 2014-2016: A population study in Japan.

Despite the higher mortality rates in patients with Down syndrome compared with the general Japanese population, the life span has dramatically increased in Japan and other countries. We aimed to clarify recent causes of death in patients with Down syndrome in Japan. We calculated proportionate mortality and standardized mortality odds ratios (SMORs) among all deaths registered with Down syndrome as the cause of death (ICD‐10 code, Q90) in the Japanese National Death Registry Database in 2014–2016. In the study period, 762 in patients with Down syndrome died. The main causes of death were pneumonia/respiratory infections (20.5%), congenital malformations of the circulatory system (11.2%), other diseases of the circulatory system (9.2%), and aspiration pneumonia (8.4%). The SMORs (95% confidence intervals) were higher for natural death, defined as death of an elderly person with no other cause of death to be mentioned (55.73 [36.92–84.12]), early‐onset Alzheimer's disease, defined as Alzheimer's disease with onset <65 years of age (29.36 [16.44–52.44]), aspiration pneumonia (18.33 [14.03–23.96]), pneumonia/respiratory infections (8.11 [6.76–9.73]), congenital malformations of the circulatory system (8.07 [5.98–10.88]), and leukemia/lymphoma (2.16 [1.55–2.99]) but lower for malignant solid tumors (0.04 [0.02–0.06]) in patients with Down syndrome. Patients with Down syndrome had the greatest relative risk of dying from natural death, early‐onset Alzheimer's disease, and respiratory illnesses, highlighting the need for appropriate medical, health, and welfare services.

COMPARISON OF AGE AND BIOLOGICAL SEX MORTALITY TRENDS BETWEEN ADULTS WITH AND WITHOUT DOWN SYNDROME

Age at death and cause of death comparisons between adults with and without Down syndrome reveal distinct mortality trends that can be utilized to inform preventive care efforts to reduce premature mortality in this population. We compare mean and median age at death, and standardized mortality odds ratios (SMORs) for 20 leading causes of death for 9,564 decedents with and 13,050,319 without Down syndrome in the U.S. between 2012 and 2016. Decedents with Down syndrome, on average, were substantially younger than those without Down syndrome, and were more likely to die from Alzheimer disease and dementia at younger ages. In addition, adults with Down syndrome also had higher risk of choking related deaths. Efforts to reduce premature mortality through public health and preventive care interventions for this population should be cognizant of these increased risk factors, as well as variation in age and biological sex mortality trends.

COMPARISON OF AGE AND BIOLOGICAL SEX MORTALITY TRENDS BETWEEN ADULTS WITH AND WITHOUT DOWN SYNDROME

Distinct mortality trends emerge from comparisons of mean and median age at death and specific causes of death between adults with and without cerebral palsy. We compare standardized mortality odds ratios (SMORs) for 20 leading causes of death for 11,895 adults with cerebral palsy and 13,047,988 without cerebral palsy in the US between 2012 and 2016. Male and female decadents with cerebral palsy died significantly younger than male and female decadents without cerebral palsy, and were more likely to die from respiratory diseases, choking, and unknown causes. Public health and preventive care efforts should account for respiratory, swallowing, and nutrition risks, as well as mortality trends’ variation across age and biological sex. The CDC and WHO could better surveil this population’s health and mortality by disallowing certifiers from using cerebral palsy as the underlying cause of death as the practice leads to high rates of unknown causes of death.

Mortality causes and trends associated with giant cell arteritis: analysis of the French national death certificate database (1980-2011).

Comprehensive analyses of cause-specific death patterns in GCA are sparse. We studied the patterns and time trends in GCA-related mortality using a large death certificate database. We obtained multiple-cause-of-death data from the French national death certificate database for 1980-2011. GCA-associated deaths were defined as decedents ⩾55 years old with GCA listed as an underlying or non-underlying cause of death. Time trends of death rates were analysed and the mean age at death with GCA and in the general population ⩾55 years old were calculated. Standardized mortality odds ratios (SMORs) were calculated for 17 selected causes of death (based on 2000-11 data). The analyses pertained to approximately 15 000 death certificates listing GCA (including approximately 6300 for 2000-11). Annual standardized death rates for GCA increased to a peak in 1997 and then decreased (Spearman's correlation test, both P < 0.0001). Mean age at death was higher for GCA than for general population decedents (Student's t-test, P < 0.0001). GCA deaths were frequently or strongly associated with aortic aneurysm and dissection (1.85% of death certificates, SMOR: 3.09, 95% CI: 2.48, 3.82), hypertensive disease (20.78%, SMOR: 2.22, 95% CI: 1.97, 2.50), diabetes mellitus (11.27%, SMOR: 1.96, 95% CI: 1.72, 2.23), certain infectious and parasitic diseases (12.12%, SMOR: 1.76, 95% CI: 1.55, 2.00) and ischaemic heart disease (16.54%, SMOR: 1.45, 95% CI: 1.35, 1.64). GCA is associated with increased risk of dying from large-vessel disease, other cardiovascular diseases and potentially treatment-related co-morbidities. These findings help provide better insights into the outcomes of GCA.

Mesothelioma among Motor Vehicle Mechanics: An Updated Review and Meta-analysis.

We published a meta-analysis of the association between work as a motor vehicle mechanic and mesothelioma in 2004. Since then, several relevant studies on this topic have been published. Thus, to update the state-of-the-science on this issue, we conducted a new systematic review and meta-analysis. A comprehensive PubMed literature search through May 2014 was conducted to identify studies that reported relative risk estimates for mesothelioma among motor vehicle mechanics (in general), and those who were engaged in brake repair (specifically). Studies were scored and classified based on study characteristics. Random-effects meta-analyses generated summary relative risk estimates (SRREs) and corresponding 95% confidence intervals (CI). Heterogeneity of results was examined by calculating Q-test P-values (P-H) and I (2) estimates. Sub-group and sensitivity analyses were conducted for relevant study characteristics and quality measures. Ten case-control studies, one cohort study, and five proportionate mortality ratio (PMR)/standardized mortality odds ratio (SMOR) studies were identified and included in the quantitative assessment. Most meta-analysis models produced SRREs below 1.0, and no statistically significant increases in mesothelioma were observed. The SRRE for all studies was 0.80 (95% CI: 0.61-1.05) with significant heterogeneity (P-H <0.001, I (2) = 62.90). A similar SRRE was observed among the five Tier 1 studies with the highest quality ratings (SRRE = 0.76, 95% CI: 0.46-1.25), with no heterogeneity among studies (P-H = 0.912, I (2) = 0.00). Meta-analysis of the Tier 2 (n = 5) and Tier 3 (n = 6) studies resulted in SRREs of 1.09 (95% CI: 0.76-1.58) and 0.73 (95% CI: 0.49-1.08), respectively. Restricting the analysis to Tiers 1 and 2 combined resulted in an SRRE of 0.92 (95% CI: 0.72-1.29). The SRRE specific to brake work (n = 4) was 0.64 (95% CI: 0.38-1.09). This meta-analysis of the epidemiologic studies provides evidence that motor vehicle mechanics, including workers who were engaged in brake repair, are not at an increased risk of mesothelioma.

Trends in non-AIDS-related causes of death among adults with HIV/AIDS, Brazil, 1999 to 2010

The aim of this study was to analyze trends in the listing of non-AIDS-related causes of death on the death certificates of adults with HIV/AIDS in Brazil. The study analyzed mortality data for persons 15 to 69 years of age from 1999 to 2010. Standardized mortality odds ratios were used to compare mortality from non-AIDS-related causes in the group with HIV/AIDS listed on the death certificate and in the group without HIV/ AIDS. From 1999 to 2010, there were 6,120,670 deaths among adults in Brazil. Deaths in the HIV group represented 2.2% of the total. NonAIDS-related causes, and more specifically cardiovascular diseases, diseases of the genitourinary system, and non-AIDS-related malignant neoplasms increased at higher rates in the group with HIV/AIDS listed on the death certificate. The results point to a greater increase in mortality from non-AIDS-related diseases among persons with HIV/AIDS. This finding suggests that long contact with HIV and antiretroviral therapy play an important role in the occurrence of these diseases.

Trends in non-AIDS-related causes of death among adults with HIV/AIDS, Brazil, 1999 to 2010

The aim of this study was to analyze trends in the listing of non-AIDS-related causes of death on the death certificates of adults with HIV/AIDS in Brazil. The study analyzed mortality data for persons 15 to 69 years of age from 1999 to 2010. Standardized mortality odds ratios were used to compare mortality from non-AIDS-related causes in the group with HIV/AIDS listed on the death certificate and in the group without HIV/ AIDS. From 1999 to 2010, there were 6,120,670 deaths among adults in Brazil. Deaths in the HIV group represented 2.2% of the total. Non- AIDS-related causes, and more specifically cardiovascular diseases, diseases of the genitourinary system, and non-AIDS-related malignant neoplasms increased at higher rates in the group with HIV/AIDS listed on the death certificate. The results point to a greater increase in mortality from non-AIDS-related diseases among persons with HIV/AIDS. This finding suggests that long contact with HIV and antiretroviral therapy play an important role in the occurrence of these diseases.

Mortality in fibromyalgia: A study of 8,186 patients over thirty‐five years

To determine if mortality is increased among patients diagnosed as having fibromyalgia. We studied 8,186 fibromyalgia patients seen between 1974 and 2009 in 3 settings: all fibromyalgia patients in a clinical practice, patients participating in the US National Data Bank for Rheumatic Diseases (NDB), and patients invited to participate in the NDB who refused participation. Internal controls included 10,087 patients with osteoarthritis. Deaths were determined by multiple source communication, and all patients were also screened in the US National Death Index (NDI). We calculated standardized mortality ratios (SMRs) based on age- and sex-stratified US population data, after adjustment for NDI nonresponse. There were 539 deaths, and the overall SMR was 0.90 (95% confidence interval [95% CI] 0.61-1.26). Among 1,665 clinic patients, the SMR was 0.92 (95% CI 0.81-1.05). Sensitivity analyses varying the rate of NDI nonidentification did not alter the nonassociation. Adjusted for age and sex, the hazard ratio for fibromyalgia compared with osteoarthritis was 1.05 (95% CI 0.94-1.17). The standardized mortality odds ratio (OR) compared with the US general population was increased for suicide (OR 3.31, 95% CI 2.15-5.11) and for accidental deaths (OR 1.45, 95% CI 1.02- 2.06), but not for malignancy. Mortality does not appear to be increased in patients diagnosed with fibromyalgia, but the risk of death from suicide and accidents was increased.

Standardized Mortality Odds Ratios

Michigan Health and Social Security Research Institute, Health and Safety Department, International Union, UAW, 8000 East Jefferson Avenue, Detroit, MI 48214 Department of Family and Consumer Studies, 228 AEB, University of Utah, Salt Lake City, UT 84112 National Centre for Epidemiology and Public Health, Australian National University, Canberra A.C.T., 2601 Australia

Standardized Mortality Odds Ratios

Standardized Mortality Odds Ratios

ESTIMATING STANDARDIZED MORTALITY ODDS RATIOS WITH NATIONAL MORTALITY FOLLOWBACK DATA

Proportionate mortality analyses are often used to study cause-specific mortality when population denominators are not available. The purpose of this paper is to present an extension of published proportionate mortality ratio logistic regression methods used to analyze such data. This paper describes methods used to estimate standardized mortality odds ratios (SMORs) with numerator data and the problems encountered when external standard rates are not available for all strata of interest. This paper focuses on the case where one has representative mortality followback data. These data are based on a large, representative sample of deaths from a defined population for whom numerous covariates about the decedents are collected from surviving family members. With these data, one may use logistic regression methods to generate fully standardized estimates of risk, SMORs, with numerator data. It is also possible to generate SMORs that allow for effect modification. Mortality followback data are also a more flexible data source from which one may generate substitutes for external standard mortality rate ratios to be used with previously developed SMOR methods. An application of the methods is provided using logistic regression.

Ischemic heart disease mortality of firemen and policemen.

Ischemic heart disease (IHD) mortality of Connecticut firemen and policemen is studied for the years 1960-78, using death certificate data. The mortality of these two occupations is expected to be greater than that of other workers. Standardized Mortality Odds Ratios for firemen and policemen are greater than 1.00. Although some increased IHD risk for firemen and policemen is suggested, the exact role of occupational risk factors remains to be determined.