Changes in alcohol intake and mortality: a longitudinal population-based study

BACKGROUND: Using alcohol intake at one point in time, numerous studies have shown a J- or U-shaped relation with all-cause mortality. Mortality is lowest among the light to moderate drinkers, with the risk of dying from coronary heart disease higher among nondrinkers and the risk of dying from cancer higher among heavy drinkers. We studied whether changes in individual alcohol intake result in corresponding changes in mortality. METHODS: In a longitudinal study of 6644 men and 8010 women, age 25 to 98 years, who had attended at least 2 health surveys with a 5-year interval between them, we addressed the risk of death after combinations of changes in alcohol intake. RESULTS: Mortality after changes in alcohol intake was consistent with the mortality observed among those who reported stable drinking. Stable drinkers showed a U-shaped all-cause mortality, with relative risks of 1.29 (95% confidence interval [CI] = 1.13-1.48) for nondrinkers (< 1 drink per week) and 1.32 (1.15-1.53) for heavy drinkers (> 13 drinks per week) compared with light drinkers (1 to 6 drinks per week). For coronary heart disease mortality, stable nondrinkers had a relative risk of 1.32 (0.97-1.79) compared with stable light drinkers and those who had reduced their drinking from light to none increased their risk (1.40; 1.00-1.95), and those who had increased from nondrinking to light drinking reduced their relative risk ratio (0.71; 0.44-1.14). Cancer mortality was increased in all groups of heavy drinkers. CONCLUSION: Persons with stable patterns of light and moderate alcohol intake had the lowest all-cause mortality. Individual changes in alcohol intake were followed by corresponding changes in mortality.     

Self-esteem and mortality: prospective evidence from a population-based study

PURPOSE: Self-esteem is considered to be importantly associated with both psychosocial states such as depression as well as physical health. There are no population-based studies that examine the association between self-esteem and mortality. The objective of this study was to assess whether low self-esteem was prospectively associated with increased risk of death in a population-based sample of Finnish men. METHODS: A sample of 2682 male residents of Kuopio, Finland were interviewed and followed prospectively as part of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Characteristics of the KIHD sample at baseline included self-esteem, measured by the Rosenberg ten-item scale, socioeconomic factors, behavioral risk factors, other psychosocial characteristics, and prevalent diseases. Mortality was ascertained through linkage to the Finnish national death registry. We assessed the relationship between self-esteem and all-cause mortality using Cox proportional hazards models. RESULTS: Low self-esteem was associated with a two-fold [hazard ratio (HR)=2.0, 95% confidence interval (CI)=1.3-3.2] increase in age-adjusted mortality. This relationship was partially explained by behavioral and socioeconomic factors, and prevalent diseases, and fully explained by other psychosocial characteristics (hopelessness, depression, cynical hostility, and sullenness). When adjusted for hopelessness alone there was no increased risk associated with low self-esteem (HR=1.3, 95% CI=0.8-2.2). CONCLUSIONS: This study found no association between self-esteem and all-cause mortality after adjustment for other psychosocial characteristics, primarily hopelessness. Our understanding of the observed relationships between some psychosocial factors and mortality may be improved by simultaneous measurement of multiple psychosocial domains, thus diminishing the potential for residual confounding.     

Injury mortality among American Indian and Alaska Native children and youth--United States, 1989-1998

Injuries account for 75% of all deaths among American Indian and Alaska Native (AI/AN) children and youth, and AI/ANs have an overall injury-related death rate that is twice the U.S. rate for all racial/ethnic populations. However, rate disparities vary by area and by cause. To help focus prevention efforts, CDC analyzed injury mortality data by Indian Health Service (IHS) administrative area and by race/ethnicity. This report summarizes the results of these analyses, which indicate that although death rates for some causes (e.g. drowning and fire) have shown substantial improvement over time, rates for other causes have increased or remained unchanged (e.g., homicide and suicide, respectively). Prevention strategies should focus on the leading causes of injury-related death in each AI/AN community, such as motor-vehicle crashes, suicides, and violence.     

Cause-specific mortality in a population-based study of diabetes.

BACKGROUND. Mortality from vascular diseases has been reported to be high in diabetic persons. METHODS. To evaluate mortality from these and other specific causes, we examined cause-specific age-sex standardized mortality ratios in a geographically defined population of younger onset (diagnosed before age 30 and taking insulin, n = 1200) and older onset (diagnosed after age 30, n = 1772) diabetic persons followed for 8.5 years. Cause of death was determined from death certificates. RESULTS. In younger onset persons, age-sex standardized mortality ratios were significantly high (P less than .05) for all causes of death (7.5) as well as for diabetes (191), all heart disease (9.1), ischemic heart disease (10.1), other heart disease (6.3), nephritis and nephrosis (41.2), accidents (2.9), and all other causes (3.2). In older onset persons, age-sex standardized mortality ratios were significantly high for all causes of death (2.0) as well as for diabetes (16.8), all heart disease (2.3), ischemic heart disease (2.3), other heart disease (2.1), stroke (2.0), and pneumonia and influenza (1.7). CONCLUSIONS. Diabetic persons experience very high mortality, especially from vascular diseases, compared to the general population.     

Perinatal mortality in southern Brazil: a population-based study of 7392 births

Perinatal, fetal and early neonatal mortality rates were determined in a population of 7392 babies born in hospitals in Pelotas (total population, 260 000) during 1982. These babies represented over 99% of all births in the city in that year. The perinatal mortality rate for singletons was 31.9 per 1000 total births, the fetal mortality rate being 16.2 and the early neonatal mortality rate 15.9 per 1000 total births.     

Perceived discrimination and mortality in a population-based study of older adults

Objectives. We examined the relation of individual-level perceived discrimination to mortality in a biracial, population-based sample.Methods. Participants were 4154 older adults from the Chicago Health and Aging Project who underwent up to 2 interviews over 4.5 years. Perceived discrimination was measured at baseline, and vital status was obtained at each follow-up and verified through the National Death Index.Results. During follow-up, 1166 deaths occurred. Participants reporting more perceived discrimination had a higher relative risk of death (hazard ratio [HR]= 1.05; 95% confidence interval [CI]=1.01, 1.09). This association was independent of differences in negative affect or chronic illness and appeared to be stronger among Whites than among Blacks (Whites: HR=1.12; 95% CI=1.04, 1.20; Blacks: HR=1.03; 95% CI=0.99, 1.07). Secondary analyses revealed that the relation to mortality was related to discriminatory experiences of a more demeaning nature and that racial differences were no longer significant when the sample was restricted to respondents interviewed by someone of the same race.Conclusions. Perceived discrimination was associated with increased mortality risk in a general population of older adults. The results suggest that subjective experience of interpersonal mistreatment is toxic in old age. This study adds to a growing literature documenting discrimination as an important social determinant of health.There is growing interest in the health effects of perceived discrimination.1^,2 Although evidence has been mixed, several studies have demonstrated that discrimination is related to poor physical and mental health, including blood pressure,3^,4 breast cancer,5 self-rated health,4^,6^–8 psychological distress,7^–10 well-being10^,11 and depressive symptoms.8^,12 Several studies have reported no or conditional associations as well.13^–18 Inconsistency in results may be because, at least in part, of the variation in the measurement of discrimination, differences in study methodologies and populations, and the variety of outcomes that have been considered.1^,2 Overall, however, it appears that the results have been stronger for mental health than for physical health outcomes. Although the mechanisms are not clear, hypotheses include restricted access to socioeconomic resources, poor health behaviors, and stress responses.6^,19^–22Few studies have focused on well-established clinical outcomes, such as hypertension. Although some studies have reported that discrimination increases the risk for hypertension,23^,24 others have not found an association.13^,14 Discrimination has also been linked with subclinical cardiovascular disease, including carotid intima-media thickness25 and coronary artery calcification.26We examined perceived discrimination in relation to all-cause mortality for 2 reasons. First, this end point has rarely been considered in relation to discrimination.27^,28 Second, mortality serves as the common end point of many disease processes that affect adult populations. Because the negative health effects of discrimination are thought to be nonspecific—that is, they are not restricted to a particular disease process—this end point may be particularly suitable to capture much of the spectrum of adverse outcomes associated with this risk factor.Racism, racial discrimination, and perceived discrimination have been used interchangeably in the research literature. We focused on perceived discrimination, defined as the subjective experience of common forms of unfair treatment,10 and its relation to mortality in a population-based study of older Blacks and Whites. Because the weight of the current evidence shows that discrimination is associated with poorer health among minorities, we hypothesize that perceived discrimination is related to an increased risk for mortality and that this risk is stronger among Blacks than among Whites.     

Cardiovascular disease mortality and serum carotenoid levels: a Japanese population-based follow-up study

BACKGROUND: Some observational epidemiologic studies suggest that dietary and serum carotenoids are associated with reduced cardiovascular disease mortality. METHODS: Three thousand and sixty-one subjects (1,190 males and 1,871 females), aged 39 to 80 years, were recruited from residents of Hokkaido, Japan who had attended comprehensive health check-up programs from 1988 through 1995. Serum levels of alpha-carotene, beta-carotene, and lycopene were separately determined by high-performance liquid chromatography. Serum levels of total carotene consisted of the sum of alpha-carotene, beta-carotene, and lycopene levels. Each serum level of alpha-carotene, beta-carotene, lycopene, total carotene, triglyceride, and alanine transaminase (ALT) activity was transformed logarithmically. The hazard ratios of serum alpha- and beta-carotenes, lycopene, and total carotene values were estimated by the Cox proportional hazard model after adjusting for sex, age, and other potential confounding factors. RESULTS: During the 11.9-year follow-up period, 80 deaths (49 males and 31 females) from cardiovascular disease, 40 deaths from heart disease, and 37 deaths from stroke were identified among the cohort subjects. High serum values of carotenoids such as alpha- and beta-carotenes, and lycopene were found to be significantly associated with low hazard ratios for cardiovascular disease mortality. However, a significant inverse association between high serum lycopene value and the risk for stroke mortality was not always observed. CONCLUSIONS: High serum levels of total carotene, comprising alpha- and beta-carotenes and lycopene, may reduce the risk for cardiovascular disease mortality among the Japanese population.     

Hearing, mobility, and pain predict mortality: a longitudinal population-based study

ObjectiveMeasures of health-related quality of life (HRQL), including the Health Utilities Index Mark 3 (HUI3) are predictive of mortality. HUI3 includes eight attributes, vision, hearing, speech, ambulation, dexterity, cognition, emotion, and pain and discomfort, with five or six levels per attribute that vary from no to severe disability. This study examined associations between individual HUI3 attributes and mortality.Study Design and SettingBaseline data and 12 years of follow-up data from a closed longitudinal cohort study, the 1994/95 Canadian National Population Health Survey, consisting of 12,375 women and men aged 18 and older. A priori hypotheses were that ambulation, cognition, emotion, and pain would predict mortality. Cox proportional hazards regression models were applied controlling for standard determinants of health and risk factors.ResultsSingle-attribute utility scores for ambulation (hazard ratio [HR] = 0.10; 0.04–0.22), hearing (HR = 0.18; 0.06–0.57), and pain (HR = 0.53; 0.29–0.96) were statistically significantly associated with an increased risk of mortality; ambulation and hearing were predictive for the 60+ cohort.ConclusionFew studies have identified hearing or pain as risk factors for mortality. This study is innovative because it identifies specific components of HRQL that predict mortality. Further research is needed to understand better the mechanisms through which deficits in hearing and pain affect mortality risks.     

New moccasins: articulating research approaches through interviews with faculty and staff at Native and non-Native academic institutions

OBJECTIVE: The goals of this study were to explore the perceptions of professionals concerning research, its different approaches, and appropriate future directions with Native American communities, particularly in relation to nutrition issues. DESIGN: Semistructured qualitative interviews. setting: Interviews were conducted at Native and non-Native academic institutions, at other relevant locations, and over the telephone. PARTICIPANTS: Participants (N = 20) were from Native and non-Native academic institutions and had experience working with research in Native American communities. PHENOMENA OF INTEREST: Relationships between Native and non-Native academic institutions, worldviews regarding research and American Indian communities, and beneficial research within American Indian communities. ANALYSIS: Interviews were audiotaped, transcribed verbatim, and returned to the participants for review. Analysis of interview material involved eliciting themes. RESULTS: Some participants acknowledged different cultural worldviews in relation to research. Many participants provided insight on how to define beneficial research. Most said building trust between Native and non-Native academic institutions is an important step in developing effective research relationships. CONCLUSIONS AND IMPLICATIONS: These findings are a first step toward creating a more equitable process of research that acknowledges different cultural worldviews and values community involvement within Native American communities.     

Parental reported bullying among Nordic children: a population-based study

BACKGROUND: Bullying has been shown to be a serious problem amongst school children, but few studies have been population-based and included pre-school children. METHODS: The study is part of a cross-sectional comparative study in 1984 and 1996, focusing on children's and their families' health and welfare in the Nordic countries. At each point of time parents of 3000 randomly selected children aged 2-17 years in each of five Nordic countries received a postal questionnaire. Altogether approximately 20,000 questionnaires were completed. The prevalence of bullying, risk factors for bullying and possible effect factors were analysed. RESULTS: Parents reported bullying of their child in 15.1% of the cases. Bullying varied from 7.2% in Sweden to about 20% in Denmark and Finland. There was a small increase in bullying from 13.7% in 1984 to 16.4% in 1996. Bullying was most frequent in boys (OR: 1.4) and in children 2-6 and 7-12 years old (OR: 2.0 and 2.2 compared with older children). Children of single parents and of parents with low education had increased risks (OR: 1.4 and 1.4). Children with chronic conditions had higher risks for being bullied (OR: 2.3). In 1996 children with psychiatric/nervous problems and hyperactivity had high risks for being bullied (OR: 8.8 and 10.5) and for bullying others (3.9 and 3.5). Being bullied was associated with poor thriving and psychosomatic and psychological problems. No countries had national interventions before 1984, but Sweden had early focused on the problem and implemented a strong national policy before 1996. After 1996 national anti-bullying policies were strengthened in the Nordic countries, most in Sweden and Norway. CONCLUSION: Bullying is common among Nordic children, including pre-school children. Bullying is a threat to children's health, and augments problems in children with chronic conditions. The low prevalence of bullying in Sweden may be a result from sustained, strong anti-bullying policies. There is still a need for continuing interventions.     

Socioeconomic inequalities in homicide mortality: a population-based comparative study of 12 European countries

Recent research has suggested that violent mortality may be socially patterned and a potentially important source of health inequalities within and between countries. Against this background the current study assessed socioeconomic inequalities in homicide mortality across Europe. To do this, longitudinal and cross-sectional data were obtained from mortality registers and population censuses in 12 European countries. Educational level was used to indicate socioeconomic position. Age-standardized mortality rates were calculated for post, upper and lower secondary or less educational groups. The magnitude of inequalities was assessed using the relative and slope index of inequality. The analysis focused on the 35–64 age group. Educational inequalities in homicide mortality were present in all countries. Absolute inequalities in homicide mortality were larger in the eastern part of Europe and in Finland, consistent with their higher overall homicide rates. They contributed 2.5?% at most (in Estonia) to the inequalities in total mortality. Relative inequalities were high in the northern and eastern part of Europe, but were low in Belgium, Switzerland and Slovenia. Patterns were less consistent among women. Socioeconomic inequalities in homicide are thus a universal phenomenon in Europe. Wide-ranging social and inter-sectoral health policies are now needed to address the risk of violent victimization that target both potential offenders and victims.     

Long-term mortality among older adults with burn injury: a population-based study in Australia

Objective

To assess if burn injury in older adults is associated with changes in long-term all-cause mortality and to estimate the increased risk of death attributable to burn injury.

Methods

We conducted a population-based matched longitudinal study – based on administrative data from Western Australia’s hospital morbidity data system and death register. A cohort of 6014 individuals who were aged at least 45 years when hospitalized for a first burn injury in 1980–2012 was identified. A non-injury comparison cohort, randomly selected from Western Australia’s electoral roll (n = 25 759), was matched to the patients. We used Kaplan–Meier plots and Cox proportional hazards regression to analyse the data and generated mortality rate ratios and attributable risk percentages.

Findings

For those hospitalized with burns, 180 (3%) died in hospital and 2498 (42%) died after discharge. Individuals with burn injury had a 1.4-fold greater mortality rate than those with no injury (95% confidence interval, CI: 1.3–1.5). In this cohort, the long-term mortality attributable to burn injury was 29%. Mortality risk was increased by both severe and minor burns, with adjusted mortality rate ratios of 1.3 (95% CI: 1.1–1.9) and 2.1 (95% CI: 1.9–2.3), respectively.

Conclusion

Burn injury is associated with increased long-term mortality. In our study population, sole reliance on data on in-hospital deaths would lead to an underestimate of the true mortality burden associated with burn injury.     

Cause-specific mortality in a cohort of patients with diabetes mellitus: a population-based study in Sweden

A cohort of patients with diabetes mellitus hospitalised in Sweden from 1965 to 1983 was followed up until 1989, by linkages of population-based registers. Standardised mortality ratios (SMR), adjusted for confounding variables, and 95% confidence intervals (CIs) were calculated. After exclusion of the first year of follow-up (to reduce the effect of selection bias), the cohort consisted of 144,427 patients, of whom 92,248 patients died during follow-up. The SMR for all causes of death combined was 2.62 (95% CI 2.58-2.67) among men and 3.23 (95% CI 3.18-3.28) among women. The excess mortality was still evident 20 years after first hospitalisation, but became less marked with longer follow-up time. Patients with presumably insulin-dependent diabetes mellitus (IDDM) had the highest SMRs (10.2; CI 9.5-11.0); however, there was a significant (34%) improvement over time in their mortality risk. We conclude that excess mortality persisted throughout all calendar periods and at all ages, indicating the need for health care prevention measures.     

Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study

Introduction: Mortality rates after hip fracture have not declined in 20 years. We assessed the impact of chronic obstructive pulmonary disease (COPD) on mortality after hip fracture, and compared mortality in this cohort to persons without hip fracture in a population-based prospective cohort study. Methods: Using Danish health care registries, we identified persons ≥40 years old with first-time hospitalization for hip fracture between 1/1/1998 and 1/31/2003. Hospitalization for COPD was assessed from hospital discharge registries. Using Cox regression, we computed relative risks (RR) and 95% confidence intervals (CI) for mortality endpoints among persons with COPD compared to persons without COPD. Mortality following hip fracture was also compared to age and gender matched controls without hip fracture. Results: We identified 11, 985 persons with first-time hospitalization for hip fracture; 771 (6.4%) had a diagnosis of COPD. Average follow up was 22 months. Compared to persons without COPD, mortality following hip fracture in persons with COPD was RR = 1.58 (95% CI 1.30–1.90) at 30 days, RR = 1.52 (95% CI 1.30–1.77) at 90–days, RR = 1.58 (95% CI 1.40–1.78) at 1 year, and RR = 1.71 (95% CI 1.55–1.88) overall. The 1-year mortality in persons with hip fracture and COPD was approximately 3–5 times greater than in controls without hip fracture. Conclusions: In this cohort, persons with COPD have a 60–70% higher risk of death following hip fracture than those without COPD. In addition, hip fracture and COPD increased 1-year mortality 3–5 times that of persons without hip fracture. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Cooking fuel and risk of under-five mortality in 23 Sub-Saharan African countries: a population-based study

Relationship between cooking fuel and under-five mortality has not been adequately established in Sub-Saharan Africa (SSA). We therefore investigated the association between cooking fuel and risk of under-five mortality in SSA, and further investigated its interaction with smoking. Using the most recent Demographic Health Survey data of 23 SSA countries (n = 783,691), Cox proportional hazard was employed to determine the association between cooking fuel and risk of under-five deaths. The adjusted hazard ratios were 1.21 (95 % CI, 1.10–1.34) and 1.20 (95 % CI, 1.08–1.32) for charcoal and biomass cooking fuel, respectively, compared to clean fuels. There was no positive interaction between biomass cooking fuel and smoking. Use of charcoal and biomass were associated with the risk of under-five mortality in SSA. Disseminating public health information on health risks of cooking fuel and development of relevant public health policies are likely to have a positive impact on a child’s survival.     

Infant mortality among the Canadian-born offspring of immigrants and non-immigrants in Canada: a population-based study

Background

Adult immigrants in Canada have a survival advantage over their Canadian-born counterparts. It is unknown whether migrants are able to transmit their survival advantage to their Canadian-born children.

Methods

Neonatal and postneonatal mortality between the Canadian-born population and 12 immigrant subgroups were compared using 1990–2005 linked birth-infant death records. Age-at-death specific mortality rates and rate differences were calculated by nativity status and maternal birthplace. A chi-square statistic was used to compare group differences in maternal sociodemographic characteristics. Multivariate survival analysis was used to estimate the effect of maternal birthplace on neonatal and postneonatal mortality, net of maternal sociodemographic and infant characteristics.

Results

Overall, immigrants had lower rates of neonatal and postneonatal mortality than the Canadian-born population. But the adjusted risk of neonatal mortality was higher for Sub-Saharan African (hazard ratio [HR]?=?1.32; 95 % confidence interval [CI]?=?1.05, 1.66), Haitian (HR?=?2.29, 95 % CI?=?1.90, 2.76), non-Spanish Caribbean (HR?=?1.38; 95 % CI?=?1.01, 1.89), and Pakistani (HR?=?1.87; 95 % CI?=?1.31, 2.68) migrants relative to Canadian-born women. There were fewer significant disparities in postneonatal death, with higher adjusted risks of mortality observed for Pakistani (HR?=?2.67, 95 % CI?=?1.77, 4.02) and Haitian (HR?=?1.41, 95 % CI?=?1.02, 1.97) migrants only.

Conclusion

Inequalities in infant mortality are more concentrated in the neonatal period. Contingent on surviving the first 27 days after birth, the infants of most immigrants (except those from Haiti and Pakistan) have the same chances of survival as the infants of Canadian-born women. Improvements in prenatal care and access to postpartum care may reduce disparities in infant mortality.

     

Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan

Objective

To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care.

Methods

Study area women were enrolled at 20–26 weeks’ gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios.

Findings

Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital.

Conclusion

In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial.