Times Higher Risk Of Mortality Research Articles

Association of alcohol, alcohol and tobacco with mortality: findings from a prospective cohort study in Mumbai (Bombay), India

The aim of the present study was to examine the association between alcohol, alcohol and tobacco, and mortality in a large adult population in the city of Mumbai. A total of 35,102 men aged 45 years and older were surveyed about their alcohol drinking as part of a cohort study. These respondents were followed up over time, and all deaths were recorded. Compared with those who never drank alcohol, alcohol drinkers had 1.22 times higher risk of mortality, with the highest risk observed for liver disease (hazard ratio [HR]=3.19). Among ever drinkers, risk of mortality varied according to types (country/desi), frequency (four or less times a week, HR=1.39), and quantity of alcohol consumed (>100mL) per day. In addition, country/desi drinkers (HR=1.34) had the highest mortality risk compared with all other types of alcohol (HR=0.97). Alcohol drinkers had increased risk of mortality for tuberculosis (HR=2.53), cerebrovascular disease (HR=1.83), and liver disease (HR=3.19). Synergistic joint effect of tobacco and alcohol on mortality was also observed, with lowest risk in never tobacco user drinkers (HR=1.02) and highest in mixed tobacco user drinkers (HR=1.79). The results of this study show a direct association between greater consumption of alcohol and increased risk of mortality from alcohol-specific causes. In addition to individual effect, this study demonstrates the synergistic interaction between alcohol and tobacco use in various forms on mortality.

Body Mass Index, Waist Circumference, and Waist-to-Hip Ratio as Predictors of Mortality in Nonagenarians: The Vitality 90+ Study

The associations of body mass index (BMI) and abdominal obesity with mortality among very old people are poorly known. The purpose of this study was to investigate the association of BMI, waist circumference (WC), and waist-to-hip ratio with mortality in nonagenarians. This study is part of a prospective population-based study, Vitality 90+, including both community-dwelling and institutionalized persons from Tampere, Finland. Altogether 192 women and 65 men aged 90 years were subjected to anthropometric measurements, a baseline interview, and a 4-year mortality follow-up. Cox proportional hazards models were used in the statistical analyses. In men, normal weight indicated a three times higher mortality risk (hazard ratio [HR] 3.09, 95% confidence interval [CI] 1.35-7.06) compared with overweight, and WC was inversely associated with mortality (HR 0.96, 95% CI 0.93-1.00) after adjustment for covariates. In women, the univariate waist-to-hip ratio (HR 1.43, 95% CI 1.06-1.92) and BMI-adjusted waist-to-hip ratio (HR 1.45, 95% CI 1.07-1.97) were positively associated with mortality. Also, overweight women whose WC was <86 cm had lower mortality than normal weight women with similar WC (HR 0.34, 95% CI 0.12-0.97). In nonagenarian men, low BMI and low WC predict increased mortality. In nonagenarian women, waist-to-hip ratio alone and adjusted for BMI is positively associated with mortality. The potential positive effects of overweight combined with WC warrant more detailed analyses in larger data. In all, future studies are needed to better understand the health and functional consequences of body composition among the oldest old.

The impact of combined pulmonary fibrosis and emphysema on mortality

The impact on patient mortality of combined pulmonary fibrosis and emphysema (CPFE) compared with emphysema alone has never been investigated. To elucidate whether CPFE has an impact on overall mortality over that of emphysema alone. We screened patients who underwent chest computed tomography (CT) scans during the period from 1 January 2001 to 31 December 2005 in a tertiary referral hospital. Patients who had both emphysema and pulmonary fibrosis, thus meeting the inclusion criteria, were defined as CPFE. Controls with emphysema alone who were matched for age, sex and the date of CT scan were randomly selected. Cox proportional regression analysis was performed to verify whether CPFE is associated with increased overall mortality. We found 135 CPFE cases. In the multivariable Cox regression stratified by the presence of comorbid malignancy, CPFE had five times higher mortality risk (adjusted HR 5.10, 95%CI 1.75-14.9) in non-malignant cases, and showed a statistically insignificant trend for higher mortality risk (adjusted HR 1.70, 95%CI 0.94-2.51) in the malignant cases after adjusting for forced vital capacity, height and hypertension. CPFE is not rare and CPFE patients had a higher overall mortality risk than emphysema-only patients.

Coagulation Status and Platelet Functions in Children with Severe Falciparum Malaria and their Correlation of Outcome

This study was undertaken to observe the changes in coagulation and platelet profile, and findings were correlated with their outcome. Forty consecutive children with severe falciparum malaria were studied for their coagulation status, i.e. prothrombin time (PT), activated thromboplastin time (APTT), thrombin time (TT) and anti-thrombin-III (AT-III), platelet profile (platelet count, platelet aggregation with adenine diphosphate (ADP) and ADR and PF3 availability). Derangements in the coagulation profile in the form of increased PT, APTT and/or TT were seen in 47.5, 35 and 62.5% cases, respectively, but bleeding was seen in only six cases. Thrombocytopenia was found in 34 patients. Platelet aggregation with ADP and ADR revealed hypoaggregation in 95.3 and 97.5% cases, respectively, and were statistically significant. Platelet factor-3 availability was also significantly prolonged. Patients with prolonged PT, PF-3 and hypoaggregation with adrenaline had 1.4, 1.7 and 1.45 times higher risk of mortality.

IGF-I gene promoter polymorphism is a predictor of survival after myocardial infarction in patients with type 2 diabetes

Previously we observed that non-carriers of the most common alleles of an IGF-I promoter polymorphism have low circulating IGF-I levels and an increased risk of developing myocardial infarction (MI), particularly in patients with type 2 diabetes. We investigated whether this IGF-I promoter polymorphism is associated with survival of type 2 diabetes in a Caucasian population aged 55 years and older. The study was embedded in the Rotterdam Study, a prospective population-based cohort study. At baseline, 668 patients with type 2 diabetes were diagnosed, among which, 55 incident MI were ascertained during follow-up. For the present study, we used two genotype groups: non-variant carriers (homozygous for 192, 194, or 192/194 bp genotypes), and variant carriers. During a median follow-up of 8.8 years, 396 out of the 668 patients with type 2 diabetes (59.3%) died of various causes. The frequency of type 2 diabetes variant carrier and non-variant carriers was 28.7 and 71.3% respectively. The survival in patients with type 2 diabetes without an MI did not differ between the IGF-I genotype groups (hazard ratio (HR) = 0.8, 95% confidence interval (CI): 0.7-1.1, P = 0.1). In contrast, in those who developed an MI, variant carriers had a 2.4 times higher risk of mortality than non-variant carriers (95% CI: 1.2-4.8, P = 0.01). Our study suggests that genetically determined low IGF-I activity is an important determinant of survival in patients with type 2 diabetes who developed an MI. The IGF-I promoter polymorphism, therefore, may help to predict the future mortality risk in this group of patients.

The Burden of Congenital Heart Disease in Libya

Congenital Heart Disease (CHD) is defined as a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. It is the most common congenital problem that accounts for up to 25% of all congenital malformations presenting in the neonatal period [1]. The cause of CHD is multifactorial. Early diagnosis and proper and early medical or surgical intervention for most of the CHD could provide anatomical correction and a normal life expectancy. Patients born with severe forms of CHD are at approximately 12 times higher risk of mortality in the first year of life, particularly if they are missed in the neonatal period. Mortality in the first year of life was 18% for all CHD that are diagnosed in infancy [2]. Cardiac surgery with poor setup could have a higher mortality than not performing surgery. Hoffman et al reported that, given the causes of variation, there is no evidence for differences in incidence between different countries or times. The general worldwide incidence of CHD is 12–15/1000 live births [3]. Due to lack of reported national epidemiological studies in Libya, it is wise to make some statistical calculations for the incidence and prevalence of CHD. The birth rate in Libya is 27.6 live births/1000 populations [4]. The total estimated number of live births with CHD is about 2000 per year, which is added every year to the already existing pool. For the details of the different types, incidence and the mathematically calculated actual number of CHD in Libyan population, see table 1. The incidence of moderate to severe forms of CHD, which require urgent cardiac management, is about 4–5/1,000 live births [3]. In Libya there is a total number of at least 400 – 600 live births/year with moderate to severe forms of CHD, who need surgical or medical intervention in the first year of life. Table 1 Types, incidence and number of newly diagnosed CHDs per vearin Libya* Surgery is the treatment of choice for most of CHD, but cardiac catheterization and intervention are becoming a routine treatment for many of CHD such as closure of patent ductus arteriosus, atrial septal defect and ventricular septal defect and balloon dilatation of pulmonary and aortic valve stenosis. Centralization of the paediatric cardiac service improves the results of the treatment of CHD. Sweden and the United Kingdom have turned towards centralization of paediatric cardiac surgery to achieve the best results. In Sweden, the overall 30-days mortality for open-heart surgery was reduced from 9.5% before centralization (1988–1991) to 1.9% (1995–1997) after centralization [5]. In 2002 the total mortality for both closed and open heart surgery was 0.0% (personal communication).

Cause‐Specific Mortality in Epilepsy

Epilepsy is associated with a two- to three-fold increase in mortality. Studies of cause-specific mortality show that deaths may be classified into those that are directly or indirectly related to epilepsy, those that are related to the underlying pathology giving rise to epilepsy, and those that are unrelated to both epilepsy and its causes. Overall, direct epilepsy related deaths are infrequent. Pneumonia, especially in the elderly, central nervous system (CNS) and non-CNS neoplasias, and cerebrovascular disease are frequent causes of death. Suicides, accidental deaths, and ischemic heart disease do not appear to be significant contributors to mortality in community-based studies. In hospital/institution-based analyses, epilepsy-related deaths are common and sudden unexpected death in epilepsy (SUDEP) may account for up to 17% of all deaths in epilepsy. A small proportion of these deaths may be witnessed and most such witnessed deaths occur in relation to convulsive seizures. The exact pathogenetic mechanisms are unknown although it is very probable that lack of seizure control is an important risk factor. Patients who continue to suffer seizures appear to have an almost 40 times higher risk of mortality than those in remission.

Is Depression in Old Age Fatal Only When People Feel Lonely?

The impact of depression and perceived loneliness in the oldest old is largely unknown. The authors studied the relationship between the presence of depressive symptoms and all-cause mortality in old age, especially the potential distorting effect of perceived loneliness. Within a prospective population-based study of 85-year-olds, the 15-item Geriatric Depression Scale and the Loneliness Scale were annually applied in all 476 participants with a Mini-Mental State Examination score of 18 points or more. Depression was present in 23% and associated with marital state, institutionalization, and perceived loneliness. When depression and perceived loneliness were assessed during follow-up, neither depression nor perceived loneliness had a significant effect on mortality. However, those who suffered from both depression and feelings of loneliness had a 2.1 times higher mortality risk. The data suggest that the increased mortality risk attributable to depression in the presence of perceived loneliness may result from motivational depletion.

The Impact of a Ventilator Associated Pneumonia Protocol (VAP) on Health Care Utilization

PURPOSE: VAP is the most common acquired infection in mechanically ventilated patients. It occurs more than 48 hours after intubation with a 2-10 times higher mortality risk. There is no gold standard for diagnosis and therapy is usually empiric. A number of studies have demonstrated the appropriateness of the initial antibiotic regimen as a vital factor in determining outcome. Therefore, the correct choice of the empiric regimen is crucial. A VAP protocol was introduced at our institution in October 2001 which included cefepime and gentamicin as the empiric antibiotics of choice (alternative: cefepime and levofloxacin in patients with acute renal failure).

Anaemia prior to operation is related with poorer long-term survival in patients with operable rectal cancer

Purpose. Local hypoxia has been linked to a higher risk of metastasis in patients with cancer of the uterine cervix and a haemoglobin concentration of 7.45 mmol/l or less. It is unknown whether the same holds true for rectal cancer. We evaluated the independent impact of pre-operative anaemia on survival in patients with rectal cancer.Patients and methods. A random set of 144 patients diagnosed with Dukes' A, B or C rectal cancer in the period 1995–1999 and registered in the database of the Eindhoven Cancer Registry was included in a survival analysis. Parameters tested were gender, age, pre-operative haemoglobin concentration, tumour stage and therapy. The ones that showed a relation with survival (log-rank test, p<0.1) were entered in a multivariate analysis.Results. For patients without pre-operative anaemia, the hazard ratio of death was 0.35 (95% confidence interval 0.19–0.65, p=0.001), which indicates a three times higher mortality risk. For patients with a higher tumour stage (Dukes' B vs. Dukes' A or Dukes' C vs. Dukes' B) the hazard ratio of death was 1.52 (95% CI 1.04–2.23, p=0.03). For older patients (64–73 years vs. <64 years or >73 years vs. 64–73 years) the hazard ratio of death was 1.85 (95% CI 1.29–2.63, p=0.001).Conclusion. Long-term survival was significantly affected in rectal cancer patients with pre-operative anaemia. Further study on the relation between anaemia, tumour oxygenation and prognosis is needed, as it may have implications for future therapy.

Does gender influence outcome in pediatric trauma?

Introduction: Recent experimental data suggests that sex hormones play an important role in host response to injury. Studies on the influence of gender on outcome in adult trauma populations have yielded mixed results, with some demonstrating no difference between men and women and others showing a slight advantage to female gender. To date, there have been no studies evaluating the role of gender in pediatric trauma patients. We hypothesize that since the hormonal milieu in pre-pubertal children is the same in both boys and girls, there should be no gender-related differences in outcome between them. Furthermore, as children progress through puberty, any role that sex-hormones play in outcome should become apparent. Methods: A five-year (1994–1999) retrospective review of the Pennsylvania Trauma Outcome Study database was performed and information regarding all children ≤16 years was abstracted. We evaluated the effects of age (≤10 years and 11–16 years), gender, injury severity (measured by Injury Severity Score, ISS), and type of injury on mortality. Statistical analysis was performed using chi-square and multivariate logistic regression (Stata, College Station, Texas). P < 0.05 was considered statistically significant. Results: 17,690 children were admitted to Pennsylvania trauma centers during the study period; 67% were male and the overall mortality was 3.8%. There was no gender-related difference in mortality in children ≤ 10 years of age with mild (ISS ≤ 15; p = .4), moderate (ISS 16–24; p = .9), or severe (ISS > 25; p = .5) injuries, head injuries (p = .5), or injury to the trunk (p = .6) or extremities (p = .4). In contrast, girls 11–16 years of age with a head injury had a 3 times higher risk of mortality than boys (OR 3.09, 95% CI 2.63–3.64) despite equivalent admission GCS and ISS. Conclusion: As expected, gender does not influence mortality in children ≤ 10 years of age. On the other hand, adolescent girls appear to have a higher than expected mortality from head injuries. Whether this is a result of hormonal influences or other factors have yet to be determined. TABLE—ABSTRACT P115Head injuryMale (died/total)Female (died/total)P-value≤10 years151/259396/13850.4>10 years118/184762/7120.04