Standardized Mortality Ratios For Causes Of Death Research Articles

Short-term mortality risks among patients with non-metastatic bladder cancer

BackgroundPopulation-based analysis for the short-term non-bladder cancer related mortality among patients with non-metastatic bladder cancer is currently lacking. The objective of the current study was to assess and quantify cause of death after bladder cancer diagnosis.MethodsThe custom Surveillance, Epidemiology, and End Results (SEER) dataset for standardized mortality ratios (SMRs) was utilized to identify 24,074 patients who were diagnosed with nonmetastatic (M0) bladder cancer from 2014 to 2015. SMRs for causes of death were calculated. Risk factors for bladder cancer-specific mortality, competing mortality, second-cancer mortality, and noncancer mortality were determined using either multivariable Cox or competing risk regression models.ResultsAmong all the 4179 (17.4%) deaths occurred during the follow-up period, almost half of them (44.2%) were attributed to non-bladder cancer cause, including second non-bladder cancer (10%) and other non-cancer causes (34.2%). The most common noncancer causes of death were heart diseases followed by chronic obstructive pulmonary disease. Patients had a higher risk of death from second malignancies (SMR, 1.59; 95% CI, 1.47–1.74) compared with death from first malignancies in the US general population, and also had higher risks of death from heart diseases (SMR, 1.29; 95% CI, 1.18–1.40) and chronic obstructive pulmonary disease (SMR, 1.52; 95% CI, 1.29–1.79) compared with the US general population. Additionally, some risk factors for competing second malignancies or noncancer mortality were determined, such as age, gender, marital status and treatment modalities.ConclusionsDeath from non-bladder cancer cause contributed to almost half of all deaths in bladder cancer survivors during the short-term follow-up period. These findings can inform medical management and assist clinicians in counseling those survivors regarding their short-term health risks.

Mortality among rescue and recovery workers and community members exposed to the September 11, 2001 World Trade Center terrorist attacks, 2003–2014

BackgroundMultiple chronic health conditions have been associated with exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We assessed whether excess deaths occurred during 2003–2014 among persons directly exposed to 9/11, and examined associations of 9/11-related exposures with mortality risk. Materials and methodsDeaths occurring in 2003–2014 among members of the World Trade Center Health Registry, a cohort of rescue/recovery workers and lower Manhattan community members who were exposed to 9/11, were identified via linkage to the National Death Index. Participants’ overall levels of 9/11-related exposure were categorized as high, intermediate, or low. We calculated standardized mortality ratios (SMR) using New York City reference rates from 2003 to 2012. Proportional hazards were used to assess associations of 9/11-related exposures with mortality, accounting for age, sex, race/ethnicity and other potential confounders. ResultsWe identified 877 deaths among 29,280 rescue/recovery workers (3.0%) and 1694 deaths among 39,643 community members (4.3%) during 308,340 and 416,448 person-years of observation, respectively. The SMR for all causes of death was 0.69 [95% confidence interval (CI) 0.65–0.74] for rescue/recovery workers and 0.86 (95% CI 0.82–0.90) for community members. SMRs for diseases of the cardiovascular and respiratory systems were significantly lower than expected in both groups. SMRs for several other causes of death were significantly elevated, including suicide among rescue recovery workers (SMR 1.82, 95% CI 1.35–2.39), and brain malignancies (SMR 2.25, 95% CI 1.48–3.28) and non-Hodgkin's lymphoma (SMR 1.79, 95% CI 1.24–2.50) among community members. Compared to low exposure, both intermediate [adjusted hazard ratio (AHR) 1.36, 95% CI 1.10–1.67] and high (AHR 1.41, 95% CI 1.06–1.88) levels of 9/11-related exposure were significantly associated with all-cause mortality among rescue/recovery workers (p-value for trend 0.01). For community members, intermediate (AHR 1.13, 95% CI 1.01–1.27), but not high (AHR 1.14, 95% CI 0.94–1.39) exposure was significantly associated with all-cause mortality (p-value for trend 0.03). AHRs for associations of overall 9/11-related exposure with heart disease- and cancer-related mortality were similar in magnitude to those for all-cause mortality, but with 95% CIs crossing the null value. ConclusionsOverall mortality was not elevated. Among specific causes of death that were significantly elevated, suicide among rescue/recovery workers is a plausible long-term consequence of 9/11 exposure, and is potentially preventable. Elevated mortality due to other causes, including non-Hodgkin's lymphoma and brain cancer, and small but statistically significant associations of 9/11-related exposures with all-cause mortality hazard warrant additional surveillance.

Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients.

Anorexia nervosa (AN) is a psychiatric disorder with high mortality. A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses. The SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1-5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6-12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9-2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0-22.7), and that for unnatural causes was 35.5 (95% CI 17.7-63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality. Mortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.

Environment/occupation

Abstract PURPOSE: In the Agricultural Health Study we evaluated the mortality experience of 52,395 farmers and 32,347 of their spouses in Iowa and North Carolina obtain information on cancer and other chronic disease risks from agricultural exposures and other factors associated with rural lifestyle. METHODS: Standardized mortality ratios (SMRs) adjusted for race, gender, age, and calendar time were computed for the prospective cohort, using the general population in each state as the referent. RESULTS: After an average follow-up of 3.7 years, the SMRs for most causes of death were significantly less than 1.0. Significant deficits were observed for all causes (SMR = 0.5), all cancers combined (SMR = 0.5), and for cancers of the lung (SMR = 0.3), female genital organs (SMR = 0.4), prostate (SMR = 0.6) and bladder (SMR = 0.6), as well as diabetes (SMR = 0.3), cardiovascular disease (SMR = 0.5), and chronic obstructive pulmonary disease (SMR = 0.2). Non-significant excesses involving at least 3 deaths occurred for liver cancer (SMR = 2.1), multiple myeloma (SMR = 1.6), leukemia (SMR = 1.4), and Parkinson's disease among spouses (SMR = 2.7. Among farmers elevated SMRs were noted for Hodgkin's disease (SMR = 2.9) and cancer of the thyroid gland (SMR = 2.9), and non-motor vehicle accidents (SMR = 1.1). Soft tissue sarcoma (SMR = 1.1 for spouses; SMR = 1.6 for applicators) was elevated in both groups. NHL had an SMR of 1.0 among applicators and spouses. Stratification by presence of livestock or corn on the farm, farm size, and duration of handling pesticides revealed no obvious mortality differences. CONCLUSION: Despite a very low initial mortality experience compared to the general population, Agricultural Health Study farmers and their spouses appear to have rates for some cancers and chronic diseases that deserve continued monitoring and further scrutiny.