Psychological distress and premature mortality in the general population: a prospective study

PURPOSE: To determine whether higher rates of mortality are observed in people reporting psychological distress, to establish the nature of any excess, and to examine the possible existence of a dose response relationship. METHODS: We conducted a prospective follow-up study of mortality over an eight-year period in the North West of England. A total of 4,501 adults were recruited from two general practices during a population-based survey conducted at the start of 1992. At baseline psychological distress was assessed using the General Health Questionnaire (12-item version, GHQ-12). The relationship between levels of distress and subsequent mortality was examined using Cox proportional hazard models. RESULTS: Risk of all-cause mortality was greatest in subjects reporting the highest levels of distress (hazard ratio (HR) 1.71, 95% CI 1.32-2.23) but was also raised in subjects reporting intermediate distress (HR 1.38 95% CI 1.06-1.79) when compared to those reporting no distress. Increased risk of mortality in subjects reporting distress appeared to be due largely to an excess of deaths from ischaemic heart disease (high distress, HR 1.90, 95% CI 1.08-3.35; intermediate distress, HR 1.58, 95% CI 0.90-2.76) and respiratory diseases (high distress, HR 5.39, 95% CI 2.70-10.78; intermediate distress, HR 2.33, 95% CI 1.12-4.22). CONCLUSIONS: The association between mortality and psychological distress observed in this study seems to arise largely because of premature deaths from ischaemic heart disease and respiratory diseases. The existence of a dose-response effect between distress and mortality provides further evidence to support the existence of a casual relationship.     

Socioeconomic and behavioral determinants of mortality in posttransition Russia: a prospective population study

PURPOSE: To study different socioeconomic determinants of mortality in posttransition Russia and propose potential explanations. Previous research has demonstrated a widening educational mortality gradient, widespread deprivation, and harmful health behaviors. METHODS: Data were from seven rounds (1994-2002) of the 38-center Russia Longitudinal Monitoring Survey. We measured associations among education, income, consumer goods, smoking, alcohol consumption, and subsequent death (reported by another household member), using univariate and multivariate Cox proportional hazards analysis. RESULTS: There were 11,482 adults older than 18 years, 782 deaths, and a mean follow-up of 4.2 years. Study and national mortality rates were comparable (standardized mortality ratio of 0.96 in men and 0.78 in women). Education predicted mortality strongly: the fully adjusted hazard ratios for less than secondary compared with higher education were 1.68 (1.26-2.23) in men and 3.08 (2.25-4.21) in women. Income and material measures did not predict mortality strongly. Smoking and weekly drinking independently doubled the mortality risk; however, like income, they did not explain the educational mortality gradient, of which material measures accounted for one-third in men only. CONCLUSIONS: Education, unlike material advantage, protected strongly against mortality. Education may better reflect lifetime health-related exposures, although other explanations (e.g., psychosocial, cardiovascular risk) deserve further research. Health behaviors exhibited strong, separate effects on mortality.     

Hyperglycemia as a risk factor of mortality in a middle-aged Finnish population

In 1990-1992, a population-based study was carried out in the city of Oulu in northern Finland, to assess the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a middle-aged population. We report the mortality of the study population until 31 December 1998. Altogether 831 subjects (82%) (369 men) participated in the baseline examinations, in which the prognostic risk factors were determined. Special attention was given to the effect of hyperglycemia on mortality. The WHO 1985, ADA 1997 and WHO 1999 criteria for diabetes, IGT and impaired fasting glucose (IFG) were used. Forty-one subjects (32 men) died during the average follow-up of 6.7 years, and the mortality rate was hence 7.7/1000 person-years. The results suggest that both fasting and post-load hyperglycemia are important predictors of mortality. Estimated by the Cox proportional hazards regression, the unadjusted hazard ratio (HR) for death was 2.5 (95% CI 0.9-6.6) in the subjects classified as diabetic according to the WHO 1999 criteria compared to normoglycemic subjects. The corresponding HR of the subjects with IFG was 2.5 (95% CI 0.7-8.8) and that of the subjects with IGT 1.5 (0.6-3.7). In addition, a high mortality was predicted by smoking (HR 4.2, 95% CI 2.0-8.8), male gender (HR 3.5, 95% CI 1.6-7.9) and hypertension (HR 2.3, 95% CI 1.1-5.1).     

A prospective study of variability in systolic blood pressure and mortality in a rural Bangladeshi population cohort

Objective

Limited studies suggest that blood pressure variability over time is a risk factor of long-term cardiovascular outcomes. However, most of these were in populations with pre-existing cardiovascular diseases (CVD) and studies in general population are lacking.

Methods

The study included 11,153 participants in a population-based, prospective cohort study in Araihazar, Bangladesh. Resting blood pressure was measured at baseline and every two years thereafter. Participants were followed up for an average of 6.5 years (2002–2009).

Results

Male gender, older age, baseline systolic blood pressure (SBP), and absence of betel leaf use were independently positively associated with greater SBP variability over time. There was a significant association between SBP variability and the risk of death from overall CVD, especially from major CVD events. The positive association with the risk of death from any cause and stroke in age- and sex-adjusted models was attenuated in fully-adjusted models. In addition, the hazard ratio (HR) of stroke mortality was greater for individuals with both high baseline and high SBP variability. Similar patterns of HRs were observed for all-cause and CVD mortalities.

Conclusion

In this rural Bangladeshi population, variability in SBP contributes to the risk of death from CVD and may further potentiate the increased mortality risk associated with high SBP.     

Multivitamin use and mortality in a large prospective study

To determine the relation between multivitamin use and death from heart disease, cerebrovascular disease, and cancer, the authors examined a prospective cohort of 1,063,023 adult Americans in 1982-1989 and compared the mortality of users of multivitamins alone; vitamin A, C, or E alone; and multivitamin and vitamin A, C, or E in combination with that of vitamin nonusers by using multivariate Cox proportional hazard models. Multivitamin users had heart disease and cerebrovascular disease mortality risks similar to those of nonusers, whereas combination users had mortality risks that were 15% lower than those of nonusers. Multivitamin and combination use had minimal effect on cancer mortality overall, although mortality from all cancers combined was increased among male current smokers who used multivitamins alone (relative risk (RR) = 1.13, 95% confidence interval (CI): 1.05, 1.23) or in combination with vitamin A, C, or E (RR = 1.16, 95% CI: 1.06, 1.26), but decreased in male combination users who had never (RR = 0.86, 95% CI: 0.74, 0.99) or had formerly (RR = 0.90, 95% CI: 0.82, 0.98) smoked. No such associations were seen in women. These observational data provide limited support for the hypothesis that multivitamin use in combination with vitamin A, C, or E may reduce heart disease and cardiovascular disease mortality, but add to concerns raised by randomized studies that some vitamin supplements may adversely affect male smokers.     

代谢综合征对中国中老年人日常生活活动能力影响的前瞻性队列研究

目的:探讨我国中老年人代谢综合征（MS）与日常生活活动能力（ADL）受损的关联,为提高人口健康预期寿命提供依据。方法:采用前瞻性队列研究设计,利用2011-2018年中国健康与养老追踪调查数据,以2011年数据为基线,分别在2013、2015和2018年随访ADL结局,且以2013年和2015年新进入队列的人群作为基线...     

Relation of adult height to cause-specific and total mortality: a prospective follow-up study of 31,199 middle-aged men and women in Finland

The purpose of this study was to analyze the association of adult height with cause-specific and total mortality. The study included 31,199 men and women aged 25-64 years who participated in a risk factor survey in 1972, 1977, 1982, or 1987 in eastern Finland. The cohorts were followed until the end of 1994. The relation between height and mortality was assessed by using Cox proportional hazard models. The authors found that height was associated inversely with most of the measured risk factors and directly with socioeconomic status. For both genders, height was inversely associated with cardiovascular and total mortality; the age- and birth-cohort-adjusted risk ratios per 5 cm increase in height were 0.89 and 0.91 for men and 0.86 and 0.90 for women, respectively. The inverse association also remained after adjustment for the other known risk factors. For men, an independent inverse association also was found between height and mortality from chronic obstructive pulmonary disease and from violence and accidents. Cancer mortality was not associated with height. Thus, genetic factors, and environmental factors during the fetal period, childhood, and adolescence, which determine adult height, appear to be related to a person's health later in life.     

Weight cycling and mortality in a large prospective US study

Weight cycling has been associated with an increased risk of death in some studies, but few studies differentiated weight cycling initiated by intentional weight loss from that initiated by illness. The association of weight cycling with death was examined among 55,983 men and 66,655 women in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2008. A weight cycle was defined as an intentional loss of 10 or more pounds (≥4.5 kg) followed by regain of that weight, and the lifetime number of weight cycles was reported on a questionnaire administered at enrollment in 1992. A total of 15,138 men and 10,087 women died during follow-up, which ended in 2008. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression models. When the models were adjusted for age only, weight cycling was positively associated with mortality (P for trend < 0.0001). However, after adjustment for body mass index and other risk factors, low numbers of weight cycles (1-4 cycles) were associated with slightly lower mortality rates (hazard ratio (HR) = 0.93, 95% confidence interval (CI): 0.89, 0.97 in men and HR = 0.93, 95% CI: 0.89, 0.98 in women), whereas high numbers of weight cycles (≥20 cycles) were not associated with mortality (HR = 1.03, 95% CI: 0.89, 1.19 in men and HR = 0.99, 95% CI: 0.88, 1.12 in women). These results do not support an increased risk of mortality associated with weight cycling.     

Non-participation and mortality in a prospective study of cardiovascular disease.

Men who did not participate in a prospective study of cardiovascular disease (The British Regional Heart Study) were younger than the participants, more likely to be unmarried, and more likely to be less skilled workers. In the first three years of follow-up, their total mortality rate was significantly higher than that of the participants; thereafter it declined to levels not significantly different from those of the participants. This excess of early deaths could not be attributed to age. There was a small but non significant excess mortality in non-participants due to neoplasms and cardiovascular disease and a somewhat greater excess from all other causes combined. The social characteristics of the non-participant population appear to contribute to their significantly higher total mortality rate, and allowance needs to be made for this in interpreting the study findings. However the death rate from cardiovascular disease was similar in participants and non-participants, suggesting that any analysis related to this particular cause of death should not be biased by non-participation.     

Trends in mortality from major non-communicable diseases in the middle-aged population of Malta

Trends in life expectancy and mortality from major non-communicable diseases in Malta were analyzed from the national vital statistics available. Most of the increased life expectancy during the 20th century in Malta took place between 1930 and 1960 and since then only a minor increase was observed. The peak in age standardized total mortality in men and women aged 40-69 years was during 1974-76. Total mortality in men was about 40% higher than that of women. The proportion of deaths from major non-communicable diseases (cardiovascular diseases, cancer and diabetes) of all deaths increased during 1968-82. In 1983-84 in the age group 45-64 cardiovascular diseases accounted for 54% of deaths in men and 43% in women, cancer 27% and 34%, and diabetes 3% and 11% in men and women, respectively. The international comparison of mortality data showed that mortality from both cardiovascular diseases, cancer and diabetes was clearly higher than in other European Mediterranean countries ranking among the highest in the whole Europe. Public health intervention programmes have initiated in Malta to reduce these high death rates in the future.     

Obesity and cardiovascular disease risk factors in firefighters: a prospective cohort study

OBJECTIVE: Obesity, despite being a significant determinant of fitness for duty, is reaching epidemic levels in the workplace. Firefighters' fitness is important to their health and to public safety. RESEARCH METHODS AND PROCEDURES: We examined the distribution of BMI and its association with major cardiovascular disease (CVD) risk factors in Massachusetts firefighters who underwent baseline (1996) and annual medical examinations through a statewide medical surveillance program over 5 years of follow-up. We also evaluated firefighters' weight change over time. RESULTS: The mean BMI among 332 firefighters increased from 29 at baseline to 30 at the follow-up examination (2001), and the prevalence of obesity increased from 35% to 40%, respectively (p < 0.0001). In addition, the proportion of firefighters with extreme obesity increased 4-fold at follow-up (from 0.6% to 2.4%, p < 0.0001). Obese firefighters were more likely to have hypertension (p = 0.03) and low high-density lipoprotein-cholesterol (p = 0.01) at follow-up. Firefighters with extreme obesity had an average of 2.1 CVD risk factors (excluding obesity) in contrast to 1.5 CVD risk factors for normal-weight firefighters (p = 0.02). Finally, on average, normal-weight firefighters gained 1.1 pounds, whereas firefighters with BMI > or = 35 gained 1.9 pounds per year of active duty over 5 years of follow-up. DISCUSSION: Obesity is a major concern among firefighters and shows worsening trends over time. Periodic medical evaluations coupled with exercise and dietary guidelines are needed to address this problem, which threatens firefighters' health and may jeopardize public safety.     

Physical activity and mortality: a prospective study among women

OBJECTIVES: This study examined the association between recreational physical activity and mortality in middle-aged and older women and the possibility that physical activity serves as an important marker of health. METHODS: Analyses were conducted among participants in the Nurses' Health Study. Levels of physical activity were assessed by questionnaire in 1980 and updated every 2 to 4 years. RESULTS: Levels of physical activity were inversely associated with mortality risk; however, each activity level above the reference level had approximately the same level of risk reduction (20%-30%). The inverse association was stronger for cardiovascular deaths than for cancer deaths and was strongest for respiratory deaths. Women who died of noncardiovascular, noncancer causes were more likely to have reported that poor health limited their physical activity than were women who died of other causes or who remained alive. CONCLUSIONS: Part of the link between physical activity and mortality risk is probably spurious and difficult to remove analytically; however, on the basis of epidemiologic evidence, much of the health benefit of activity is real.     

Correlation of cerebro-cardiovascular findings to mortality of middle-aged and elderly in a population from a fishing village in Shizuoka Prefecture

Six hundred and eighteen men and 993 women ranging in age from 30-69, living in Kamo Village, Shizuoka Prefecture, underwent baseline health examinations in 1964-1966. During the follow-up period of 20-years, 175 men and 170 women died. The most frequent cause of death was malignant neoplasms (57 men and 45 women), followed by stroke (47 men and 44 women) and heart disease (29 men and 37 women). The relationship of 22 cerebro-cardiovascular disease variables investigated in the baseline examination to stroke and heart disease mortalities, and, in addition, to cancer and all-cause mortalities were analyzed using Cox's proportional hazard model. In univariate analysis controlled for age and sex, systolic and diastolic blood pressures, albuminuria, hypertensive and sclerotic changes in fundus oculi, body mass index, atrial fibrillation, and use of antihypertensive drugs had significant positive relationships to stroke mortality. As for heart disease mortality, albuminuria, glucosuria, high R wave, and ST and/or T changes in ECG were positively and significantly related. Only Q.QS in ECG significantly correlated with cancer mortality. Variables showing significant relationship to all-cause mortality were systolic and diastolic blood pressures, albuminuria, glucosuria, hypertensive changes in fundus oculi, Q.QS, high R wave, ST and/or T changes, atrial fibrillation, use of antihypertensive drugs, and history of stroke. In multivariate analysis (step-wise) of all examination variables including age and sex, stroke mortality was significantly related to age, atrial fibrillation, use of antihypertensive drugs, and hypertensive changes in fundus oculi. Age, albuminuira, and ST changes in ECG were significantly related to heart disease mortality. Age, sex, and Q.QS in ECG were significantly related to cancer mortality. The relationship of age, sex, albuminuria, Q.QS, and ST changes in ECG to all-cause mortality was significant.     

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.     

Stress and dysmenorrhoea: a population based prospective study

Background: Dysmenorrhoea is the most common gynaecological disorder in women of reproductive age. Despite the association between stress and pregnancy outcomes, few studies have examined the possible link between stress and dysmenorrhoea.     

Diet and 20-y mortality in two rural population groups of middle-aged men in Italy

The relationships between individual diet, measured in 1965 on the two Italian rural cohorts of the Seven Countries Study on Cardiovascular Disease, and subsequent mortality from all and specific causes of death in 20 y are studied. The analysis covers 1536 men aged 45-64 y at entry to the study. By using a cluster analysis technique, individuals are aggregated into four groups so that the elements within a group have a higher degree of similarity in dietary nutrients than between groups. Impressive differences in death rates between groups are found especially at the 10- and 15-y anniversaries. The relative risk between the least and the most favored group in 15-y mortality from coronary heart disease is 4.7; in 10 y the relative risk for cancer mortality is 2.9 and for liver cirrhosis approximately 4.     

Obesity and mortality in Africans-Americans

The Cancer Prevention Study II indicated that obesity might be associated with a smaller increase in the relative rate of mortality in African-Americans compared with whites. The absolute death rate in obese whites, however, was not higher than in obese African-Americans. Avoidance of obesity remains sound advice.