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1.
Because of women's survival advantage, the impact of myocardial infarction (MI) on long-term mortality in women compared with men may be underestimated. The authors examined this issue in a community sample of 2,462 persons aged > or = 65 years living in New Haven, Connecticut, who were free of MI at baseline and were followed for 10 years (1982-1992). By using proportional hazards models with MI hospitalizations and the sex-MI interaction as time-dependent covariables, survival for the MI cases from the date of MI was compared with survival of persons who, at the same follow-up time, were still alive and free of MI. Women survived longer than men mainly in the absence of MI. The multivariable-adjusted hazard ratios of death were 0.53 in the absence and 0.87 in the presence of MI, and MI was associated with a greater risk of death in women (adjusted hazard ratio = 5.9) than in men (adjusted hazard ratio = 3.6) (p = 0.01 for the sex-MI interaction). When out-of-hospital fatal infarctions were considered, the impact of MI on survival in women compared with men increased. In conclusion, in this elderly cohort, when viewed from a population perspective, MI had a greater impact on mortality in women and significantly narrowed women's typical survival advantage over men.  相似文献   

2.
AIMS: A study was undertaken to investigate whether cohort or period effects could explain the varying and generally increasing incidence of disability pension in Norway between 1970 and 1999. METHODS: The study used data from a complete national register of new disability cases in Norway, including all cases of disability pension in the 16-60 age group categorized according to age and gender for each year from 1970 to 1999. The population at risk was defined for each year from census data and number of individuals already receiving disability pension. Data were organized in five-year age groups, five-year time periods and corresponding overlapping nine-year birth cohorts. Age- and gender-specific rates were displayed graphically for periods and cohorts. Separate Poisson regression models were fitted for age periods and age cohorts. Finally a combined age, period, and cohort model was applied. RESULTS: The overall incidence was 7.4/1,000 non-disabled persons per year for women and 6.0/1,000 for men. For women 52.1% of the cases were in the 51-60 age group, whereas the corresponding figure for men was 57.6%. Statistical analysis showed an increasing trend for both genders, more pronounced for women than men. All time periods deviated significantly from the trend, either upwards or downwards. Age-cohort models showed less variation, but recent cohorts had higher than expected rates, especially for men. CONCLUSIONS: Further studies should investigate why Norwegian women were more affected by the period effects than men. An increasing incidence of disability pension among recent cohorts is a major challenge for the Norwegian welfare system.  相似文献   

3.
This study investigates incidence of first acute myocardial infarction (MI) among foreign born persons in Sweden using case control methods, taking into consideration country of birth, gender, socio-economic group and time since immigration and evaluates if the decreasing incidence of MI in Sweden during the study period was also present in immigrants. The study base consisted of persons 30–74 years of age in Stockholm County 1977–96. All incident cases of first acute MI in the study population were identified using registers of hospital discharges and deaths. Controls were selected randomly from the study base and the sampling fractions were known, enabling estimates of person time at risk. Foreign born subjects had a higher incidence of MI than subjects born in Sweden (men RR[Relative risk]=1,17; 95% CI 1,13–1,21; women RR = 1,15; 95% CI 1,09–1,21) after adjustment for calendar year, age and socio-economic group. An increased incidence was present primarily in subjects born in Finland, other Nordic countries, Poland, Turkey, Syria and South Asia in both genders, from the Netherlands among men and from Iraq among women and was still present after more than 20 years in Sweden. The incidence rate of MI 1977–96 among foreign born persons followed the general decline in the Swedish population. We conclude that foreign born persons in Sweden have an increased incidence of first MI which persists several years after immigration and is not explained by socio-economic differences. It is likely that this to an important extent has a background in factors in the country of origin.  相似文献   

4.
OBJECTIVE: To examine socioeconomic differences in case fatality and prognosis of myocardial infarction (MI) events, and to estimate the contributions of incidence and case fatality to socioeconomic differences in coronary heart disease (CHD) mortality. DESIGN: A population-based MI register study. METHODS: The FINMONICA MI Register recorded all MI events among persons aged 35-64 years in three areas of Finland during 1983-1992. A record linkage of the MI Register data with the files of Statistics Finland was performed to obtain information on socioeconomic indicators for each individual registered. First MI events (n=8427) were included in the analyses. MAIN RESULTS: The adjusted risk ratio of prehospital coronary death was 2.11 (95% CI 1.82, 2.46) among men and 1.68 (1.14, 2.48) among women with low income compared with those with high income. Even among persons hospitalised alive the risk of death during the next 12 months was markedly higher in the low income group than in the high income group. Case fatality explained 51% of the CHD mortality difference between the low and the high income groups among men and 38% among women. Incidence contributed 49% and 62%, respectively. CONCLUSIONS: Considerable socioeconomic differences were observed in the case fatality of first coronary events both before hospitalisation and among patients hospitalised alive. Case fatality explained a half of the CHD mortality difference between the low and the high income groups among men and more than a third among women.  相似文献   

5.
We compared the diagnoses obtained from the routine mortality statistics with the standardized World Health Organization (WHO) MONICA (multinational MONItoring of trends and determinants in CArdiovascular disease) classification in suspect coronary heart disease (CHD) deaths registered in the FINMONICA myocardial infarction (MI) register during 1983-1992. All CHD deaths from routine mortality statistics (International Classification of Diseases codes 410-414) were registered in the MI register. Of the CHD deaths in routine mortality statistics 1.7% in men and 4.8% in women did not fulfill the MONICA criteria for CHD death (P<0.001 for the difference between the sexes). In men 4.7% and in women 7.3% (P=0.004) of the deaths registered in the MI Register and classified as CHD deaths by MONICA criteria had another underlying cause of death than CHD in routine mortality statistics; this proportion increased over time in both sexes (P=0.002 in men and P=0.77 in women). The CHD mortality trends obtained separately from the routine mortality statistics and from the FINMONICA MI Register were very similar. In conclusion, the high CHD mortality in Finland reported by the routine mortality statistics is real. It is possible that some CHD deaths have escaped registration, but the decline seen in the CHD mortality is also real.  相似文献   

6.
OBJECTIVE: To detect possible sex differences in risk factors, referrals and prognosis after angina pectoris (AP) and myocardial infarction (MI). DESIGN: Retrospective. METHOD: From 4 general practices in/around Nijmegen, the Netherlands, patients were selected who in 1985-1989 had a first episode of AP or a first MI. Sex differences regarding risk factors, referrals and prognosis were studied by means of patients' files. RESULTS: There were 71 men and 55 women with AP and 97 men and 58 women with MI. Mean age in AP was 69.6 year in women and 63.6 year in men, mean ages in MI were 74.9 and 64.4 year, respectively. Women with MI more frequently suffered from hypertension, AP or CVA/transient ischaemic attack (TIA). Men with MI were referred more often to a specialist than women, but not sooner. Development of cardiovascular co-morbidity after AP and after recovery from a MI were the same for both sexes. Of all patients with a MI 36% suffered a sudden unexpected death, mostly women. CONCLUSION: Women with a first episode of AP and a MI were 6-10 years older than men. Women with a MI suffered more frequently from hypertension, AP and CVA/TIA. The prognosis after angina pectoris showed no sex differences. The prognosis after MI was worse in women than in men.  相似文献   

7.
OBJECTIVE: We validated the diagnoses of self-reported acute myocardial infarction (AMI) treated in hospital. STUDY DESIGN AND SETTING: The agreement between myocardial infarction reported in a postal questionnaire in 1998 and data from the Augsburg Coronary Event Register were assessed in a representative sample of German men and women (n = 9,176) aged 25 to 74 years at baseline examination. RESULTS: Of the 9,176 persons, 207 men and women reported an incident AMI treated in hospital during the follow-up period. Of these, 148 persons fulfilled the criteria for verified AMI (positive predictive value 71.5%). Among the 8,969 respondents who reported no AMI, three persons had an AMI (negative predictive value 100%). The sensitivity was 98.0%, and the specificity 99.3%. Much of the false-positive reporting was related to cardiac hospitalizations, predominantly for coronary heart disease (42%). CONCLUSION: A postal questionnaire seems to be a useful method to identify hospitalizations for incident nonfatal AMI cases in epidemiologic cohort studies. Because the proportion of false negatives is low, medical record reviews for case ascertainment can be limited to the group of positive responders.  相似文献   

8.
An attempt is made here to quantify occupational disability at the age of 30 years. The term disability is used in a broader sense than defined in the National Insurance Scheme, and covers all permanent occupational disability irrespective of cause. Disability is evaluated in terms of earned income and in accordance with the definition used under the National Insurance Scheme. The study is based on a cohort of 1570 persons, all live births in 1940 of mothers then residing in Bergen. Relevant information on earned incomes and on disability pensions was extracted from the files of the National Insurance Institution for 1331 persons of the cohort residing in Norway on 1st June 1971. Among the 30-year-old men residing in Norway the frequency of disability irrespective of cause was 3.1%, whereas the proportion receiving disability pension was 1.8%. The difference of 1.3% is explained mainly by the fact that alcoholism in itself is not accepted as grounds for a disability pension. Of the women, 88.3% were married. Among these, 0.7% were receiving disability pension. Of the unmarried women in the cohort, 20% (10 persons) were found to be disabled, irrespective of cause. They were all receiving disability pension.  相似文献   

9.
OBJECTIVE: We examined socioeconomic disparities in coronary procedure rates after first events among hospitalized myocardial infarction (MI) patients. STUDY DESIGN AND SETTING: Information on MI patients in 1995 in Finland was obtained from the Finnish Cardiovascular Disease Register Project. Data on comorbidity, invasive treatments, hospitalizations, mortality, and socioeconomic status were obtained by linking data from the Finnish Hospital Discharge Register, cause of death register, population census, and the health insurance register using personal identity numbers. RESULTS: In 1995, 5172 patients aged 40 to 74 years were hospitalized for first MI. This corresponds to age-standardized event rates of 354/100,000 for men and 152/100,000 for women. Within 2 years, 33% of men and 21% of women underwent an invasive coronary procedure. Men in the lowest income third underwent 25% (95% confidence interval [CI] 12-36) fewer procedures than men in the highest third. Among women, the corresponding difference was 43% (95% CI 24-57). These disparities persisted throughout the 2-year follow-up, and they were not reduced by adjustment for comorbidity or hospital district. CONCLUSION: Socioeconomic disparities were observed in receipt of invasive cardiac procedures. More attention should be paid to equitable distribution of scarce health care resources.  相似文献   

10.
BACKGROUND: Knowledge on predictors of disability pension is very limited. The aim was to assess the importance of sick-leave diagnosis and socio-demographic variables as risk factors for disability pension among individuals on long-term sickness absence and to compare these factors by gender and over time. METHODS: A prospective population-based cohort study in Osterg?tland County, Sweden, included 19,379 individuals who, in 1985-87, were aged 16-60 years and had a new spell of long-term sickness absence lasting > or =56 days. Follow-up was done in two time frames: 0-5 and 6-10 years after inclusion. The risk of disability pension in relation to sick-leave diagnosis and socio-demographic factors was assessed by Cox proportional hazard regression analysis. RESULTS: In 5 years, after inclusion, 28% of the cohort had been granted disability pension. Those with higher age, low income, previous sick leave, no employment and non-Swedish origin had higher risk of disability pension, while those with young children had lower risk. Considering the inclusion diagnosis, the pattern differed between men and women (P < 0.001). Among men, those with mental disorders had the highest risk and among women those with musculoskeletal disorders. Except for income, the effect of which was reversed over time, the overall pattern of disability pension predictors remained 6-10 years after inclusion but was attenuated. CONCLUSION: Besides socio-demographic risk factors, the sick-leave diagnoses constitute an important both medium and long-term predictor of disability pension among both men and women on long-term sickness absence.  相似文献   

11.
BACKGROUND: The aim of the study was to identify predictors for the transition from long-term sickness absence into disability pension with a special focus on gender. METHODS: The study used data from a national database containing a 10% random sample of the Norwegian adult population (The KIRUT database). The study population were all individuals in the database who on 1 January 1990 were eligible for sick pay from the Norwegian National Insurance System: 83,398 men and 75,586 women. Individuals below 60 years with long-term sickness absence starting in 1990 and 1991 were identified, 6,434 men and 8,233 women, and followed up for three years. Background data were used as independent variables in a logistic regression of the probability for receiving disability pension during follow-up. RESULTS: Annual cumulative incidence of long-term sickness absence was 6.5% for women and 4.9% for men. During follow-up, 12.4% of the women and 12.6% of the men received disability pension. Among full-time employed women only 10.3% had become disability pensioners, while the corresponding proportion for women working part-time was 15.5%. For men the figures were 12.1% (full-time) and 18.1% (part-time). In the logistic regression of the whole sample the female odds ratio was insignificant. The dominant predictive factors for disability pension were age and duration of the sickness spells. Working part-time also increased the risk. Higher levels of education and having children below 7 years reduced the probability for disability pension. Separate regressions for men and women showed that the 'protective' effect of having small children only remained for women.  相似文献   

12.
AIMS: The number of people leaving the labour market with a disability pension is high and knowledge regarding risk factors is limited. The aim of this study was to explore work- and non-work-related predictors of disability pension among men and women and to estimate to what extent the gender difference in retirement rate could be explained by factors in and outside work. METHODS: A random sample of 5,940 employees registered in the Danish National Work Environment Cohort Study in 1995 was followed up with regard to labour market status in 2005 using the DREAM register, which contains data on all social transfer payments in the Danish population. Associations between disability pension and measures of ergonomic and psychosocial work environment, public employment, family status, and lifestyle were analysed by Cox regression and the difference in retirement rates adjusted separately for each group of variables. RESULTS: The results showed (a) that both men and women had a higher risk of disability pension when they had work that involved standing or if they smoked; (b) that women in addition had a higher likelihood if they were public employees, had low job security, or low social support at work; (c) that the higher rate of disability pension among women compared with men could not be explained by work environmental factors, lifestyle, or family situation. Public employment was the single factor that explained most of the difference. CONCLUSIONS: Gender differences in exposures and predictors of disability pension were found, but few explanations of the higher rate of disability pension among women.  相似文献   

13.
The objective of the study was to determine which component of an anger-prone personality more strongly predicts coronary heart disease (CHD) risk. Proneness to anger, as assessed by the Spielberger Trait Anger Scale, is composed of two distinct subcomponents-anger-temperament and anger-reaction. Participants were 12,990 middle-aged Black men and women and White men and women from the Atherosclerosis Risk in Communities Study who were followed for the occurrence of acute myocardial infarction (MI)/fatal CHD, silent MI, or cardiac revascularization procedures (average = 53 months; maximum = 72 months) through December 31, 1995. Among normotensive persons, a strong, angry temperament (tendency toward quick, minimally provoked, or unprovoked anger) was associated with combined CHD (acute MI/fatal CHD, silent MI, or cardiac revascularization procedures) (multivariate-adjusted hazard ratio = 2.10, 95% confidence interval: 1.34, 3.29) and with 'hard" events (acute MI/fatal CHD) (multivariate adjusted hazard ratio = 2.28, 95% confidence interval: 1.29, 4.02). CHD event-free survival among normotensives who had a strong, angry temperament was not significantly different from that of hypertensives at either level of anger. These data suggest that a strong, angry temperament rather than anger in reaction to criticism, frustration, or unfair treatment places normotensive, middle-aged persons at increased risk for cardiac events and may confer a CHD risk similar to that of hypertension.  相似文献   

14.
The purpose of this research was to study the occurrence of extradyadic sexual relationships among Norwegians. We examined what background factors were associated with this type of relationship, and to what extent condoms were used. In 2002, a random sample of 9,852 Norwegians between the ages of 18 and 49 were asked to participate in an anonymous self-administered questionnaire survey on sexual behavior. A total of 3387 persons responded (1386 men, 1993 women, and 8 who did not indicate their gender), yielding a response rate of 34%. Of the 2807 participants who had ever been married or cohabited, 29% of the men and 23% of the women reported experience with extradyadic sexual relationships at some point during their lives. Sixteen percent of the men and 11% of the women reported extradyadic sex during their current marriage/cohabiting relationship. Women were more emotionally attached to the extradyadic partner than men. Factors that predicted occurrence of extradyadic sexual relationships were age, number of years married/cohabiting, number of sex partners, and sexual orientation. In addition, there was a correlation between low self-esteem and extradyadic sexual experience. About 50% of the participants reported no use of contraception during the most recent intercourse with an extradyadic partner. In conclusion, men's extradyadic partner seems most often to be a casual partner, whereas women prefer someone they already know. The choice of extradyadic partner is most likely associated with use of STI protection.  相似文献   

15.
BACKGROUND: Myocardial infarction (MI) incidence and mortality display a high geographic variation. AIMS: The objective of the present study was to analyze MI mortality, cumulative incidence rate variability in seven regions of Spain from 1997 to 1998. METHODS AND RESULTS: Standardized methods were used to identify, find, register, and classify MI cases that were classified as definite, possible, insufficient-data MI, and non-MI. The total population of the seven monitored regions was 7,364,682 inhabitants. Of the 11,256 cases fulfilling eligibility criteria to investigate, 10,660 were selected to calculate MI rates: 6554 (61.5%) non-fatal definite MI, 1179 (11.1%) fatal definite MI, 1859 (17.4%) fatal possible MI, 1068 (10.0%) fatal cases with insufficient data. The IBERICA 25-74 years age-standardized cumulative incidence rates for men and women, were 207 (range: 175-252) and 45 (range: 36-65) per 100,000, respectively. The age-standardized mortality rates for men and women, were 73 (range: 62-94) and 20 (range: 13-29) per 100,000, respectively. Age-standardized case-fatality was 31.4 and 24.2% in men aged 25-74 and 35-64 years, respectively, and 32.7 and 27.0%, respectively, in women. CONCLUSIONS: MI cumulative incidence and mortality rates are low compared with other industrialized countries but, vary considerably among regions in a Mediterranean country like Spain.  相似文献   

16.
STUDY OBJECTIVE: The validity of self reported smoking in population surveys remains an important question. An associated question is what would be the value of measuring serum cotinine concentrations in such surveys to obtain validated smoking data. DESIGN: Cross sectional analysis of data on self reported smoking and serum cotinine among a random population sample of 5846 persons aged 25 to 64 years, who participated in the FINRISK-92 survey. MAIN RESULTS: Among self reported regular smokers, 97.2% of men and 94.9% of women had a cotinine concentration of 10 ng/ml or higher in serum. Of those participants who reported to have smoked at any time during their life but not during the previous month, 6.3% of men and 5.2% of women had a serum cotinine concentration of at least 10 ng/ml. Among never smokers 2.5% of men and 2.7% of women had detectable level of cotinine in their serum. The validity of self reporting was similar among subjects from different areas, ages, and socioeconomic groups. CONCLUSIONS: In a sample of the general population in Finland the validity of self reported smoking is high, and most of the few self reported non-smokers who had cotinine in their serum had only low or moderate levels.  相似文献   

17.
OBJECTIVE: Body image measures were assessed among the Old Order Amish, a Protestant religious community living separate from Western industrialized society. METHOD: One hundred six Old Order Amish men (n = 50) and women (n = 56), aged 14-67 years, were studied by two measures of body image: (1) body dissatisfaction as assessed by the difference between subjects' body mass index (BMI, kg/m(2)) and the BMI that they chose as their ideal and (2) the relative accuracy of perception of body size assessed by comparing subjects' choice of body size on a Figure Rating Scale with the choice of a relative. RESULTS: Young persons and persons of normal weight of both genders showed no body dissatisfaction or inaccuracy in their perception of their body size. Older persons of both genders, on the other hand, manifested body dissatisfaction (actual BMI greater than ideal BMI). Older women also overestimated their body size. Obese persons of both genders manifested body dissatisfaction (actual BMI greater than ideal BMI) and obese men overestimated their body size. DISCUSSION: Young Amish people do not show the body image problems characteristic of young persons in Western industrial society. Their elders and obese persons may have some such problems. 2000 by John Wiley & Sons, Inc.  相似文献   

18.
AIMS: To explore psychotropic drug use in the general population and in particular among non-institutionalized persons with mental distress symptoms. METHODS: A total of 14,139 women and 11,665 men participating in the Oslo Health Study or the Oppland/Hedmark Study 2000-2001 submitted a self-administered questionnaire on health status and drug use, lifestyle, and socioeconomic factors. Respondents using antidepressants, hypnotics, and/or anxiolytics during the last four weeks were defined as users. A high Hopkins Symptoms Checklist-10 score indicated mental distress. The 15% with the highest score in each gender and age group (adults: 30/40/45 years; elderly: 60 years) were studied. RESULTS: The prevalence of antidepressant use among those with mental distress was, for women: adults 21%; elderly 30%; and for men, adults 15%; elderly 15%. These figures were nearly four times higher than in the general population. Not participating in the labour market was the main factor associated with use of antidepressants for subjects with mental distress: adult women (odds ratio (OR) 3.5; 95% confidence interval (CI) 2.5-5.0); elderly women (OR 5.2; CI 2.7-10.2); adult men (OR 4.7; CI 3.0-7.3); and elderly men (OR 2.9; CI 1.4-6.0). Use of analgesics was the main factor associated with use of anxiolytics/hypnotics: adult women (OR 2.4; CI 1.7-3.4); elderly women (OR 2.3; CI 1.4-3.8); adult men (OR 2.1; CI 1.3-3.3); and elderly men (OR 3.4; CI 1.9-6.0). CONCLUSIONS: Among individuals with mental distress, not participating in the labour market and regular use of analgesics were the main factors associated with use of psychotropics in both genders regardless of age.  相似文献   

19.
AIMS: To investigate time trends in first acute myocardial infarction (MI) incidence in male and female dominated occupations in Stockholm during 1977-1996. METHODS: Population-based case-control study, where all first events of acute MI among participants aged 40-69 in Stockholm 1977-1996 were identified, using registers of hospital discharges and deaths. Controls were selected randomly using national population registers. There were 16,531 male and 4382 female cases and 117,015 male and 102,083 female controls. In all, 222 female cases worked in male dominated occupations and 844 male cases worked in female dominated occupations. RESULTS: Both women and men in male dominated occupations showed an elevated relative risk of first MI compared to other employees during the study period. Between 1985-1996, when there was a general decline in MI incidence in Sweden, women in male dominated occupations tended to show an increasing trend. Women in female dominated high and intermediate occupations had a lower relative risk of MI compared to other women in the same socioeconomic group. In male dominated and non-manual female dominated occupations a decline in the incidence of MI was seen during 1985-1996 in men but not in women. CONCLUSIONS: Work in male dominated occupations appears to be associated with an increased risk of MI in both genders. There is a need to investigate possible work related or other factors that may be driving this elevated risk.  相似文献   

20.
BACKGROUND: As the relation between socioeconomic status (SES) and obesity may depend on the stage of development of a country, this relation is assessed in adults from urban Cameroon. METHODS: A sample comprising 1530 women and 1301 men aged 25 years and above, from 1897 households in the Biyem-Assi health area in the capital of Cameroon, Yaoundé, were interviewed about their household amenities, occupation, and education. Weight, height, and waist circumference were measured and subjects were classified as obese if their BMI>or=30 kg/m2 or overweight if BMI was between 25.0 and 29.9 kg/m2. Abdominal obesity was defined by a waist circumference>or=80 cm in women and>or=94 cm in men. RESULTS: Of the sample studied 33% of women and 30% of men were overweight (P<0.08), whereas 22% of women and 7% of men were obese (P<0.001). Abdominal obesity was present in 67% of women and 18% of men (P<0.001). After adjusting for age, leisure time physical activity, alcohol consumption, and tobacco smoking, the prevalence of overweight+obesity, obesity, and abdominal obesity increased with quartiles of household amenities in both genders and with occupational level in men. CONCLUSION: SES is positively associated with adiposity in urban Cameroon after adjusting for confounding factors.  相似文献   

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