Body mass index, smoking, and risk of death between 40 and 70 years of age in a Norwegian cohort of 32,727 women and 33,475 men

Overweight-obesity and smoking are two main preventable causes of premature death. Because the relationship between smoking and body mass index (BMI) complicates the interpretation of associations between BMI and death risks, direct estimates of risks associated with joint exposures are helpful. We have studied the relationships of BMI and smoking to middle age (40–69 years) death risk—overall and by causes—in a Norwegian cohort of 32,727 women and 33,475 men who were 35–49 years old when baseline measurements and lifestyle information were collected in 1974–1988. Individuals with a history of cancer, cardiovascular disease or diabetes at baseline were excluded. Mortality follow-up was through 2009. The relationship between BMI and middle age death risk was U-shaped. Overall middle age death risks were 11 % in women and 21 % in men. The combination of obesity and heavy smoking resulted in fivefold increase in middle age death risks in both women and men: For women middle age death risk ranged from 6 % among never smokers in the 22.5–24.9 BMI group to 31 % (adjusted 28 %) in obese (BMI > 30 kg/m²) heavy smokers (≥20 cigarettes/day). The corresponding figures in men were 10 % and 53 % (adjusted 45 %). Obese never smokers and light (1–9 cigarettes/day) smokers in the 22.5–24.9 BMI groups both experienced a twofold increase in middle age risks of death. For women, cancer (56 %) was the most common cause of death followed by cardiovascular disease (22 %). In men, cardiovascular disease was most common (41 %) followed by cancer (34 %). Cardiovascular disease deaths were more strongly related to BMI than were cancer deaths.     

Seroprevalence of rubella antibodies and determinants of susceptibility to rubella in a cohort of pregnant women in Canada, 2008–2011

Long term control of rubella and congenital rubella syndrome relies on high population-level immunity against rubella, particularly among women of childbearing age. In Canada, all pregnant women should be screened so that susceptible new mothers can be offered vaccination for rubella before discharge. This study was undertaken to estimate rubella susceptibility in a cohort of pregnant women in Canada and to identify associated socio-economic and demographic factors. Biobanked plasma samples were obtained from the Maternal-Infant Research on Environmental Chemicals (MIREC) study, in which pregnant women were recruited between 2008 and 2011. Socio-demographic characteristics and obstetric histories were collected. Second trimester plasma samples (n = 1,752) were tested for rubella-specific IgG using an in-house enzyme-linked immunosorbent assay. The percentage of women with IgG titers <5 IU/mL, 5–10 IU/mL, and ≥10 IU/mL were 2.3%, 10.1%, and 87.6%, respectively. Rates of seronegativity, defined as <5 IU/mL, were 3.1% in women who had no previous live birth and 1.6% in women who had given birth previously. Among the latter group, seronegativity was higher in women with high school education or less (adjusted OR (aOR) 5.93, 95% CI 2.08–16.96) or with a college or trade school diploma (aOR 3.82, 95% CI 1.45–10.12), compared to university graduates, and those born outside Canada (aOR 2.60, 95% CI 1.07–6.31). In conclusion, a large majority of pregnant women were found to be immune to rubella. Further research is needed to understand inequalities in vaccine uptake or access, and more effort is needed to promote catch-up measles-mumps-rubella vaccination among socioeconomically disadvantaged and immigrant women of childbearing age.     

Hypertension and risk of death from external causes in the Physicians’ Health Study enrollment cohort

Objectives  

To address the recent hypothesis that hypertension increases the risk of death from external causes.     

The effect of sociodemographic factors on infant mortality according to cause of death: a birth cohort in Seoul,Korea, 1999–2003

Objectives  

The aim of this study was to examine the effect of socioeconomic status and demographic factors on infant mortality, classified by cause of death, in a group of children born in Seoul, Korea during 1999–2003.     

Predictors of reported influenza vaccination in HIV-infected women in the United States, 2006–2007 and 2007–2008 seasons

ObjectiveTo estimate the cumulative incidence of self-reported influenza vaccination (“vaccination coverage”) and investigate predictors in HIV-infected women.MethodsIn an ongoing cohort study of HIV-infected women in five US cities, data from two influenza seasons (2006–2007 n = 1209 and 2007–2008 n = 1161) were used to estimate crude and adjusted prevalence ratios (aPR) and 95% confidence intervals ([,]) from Poisson regression with robust variance models using generalized estimating equations (GEE).ResultsIn our study, 55% and 57% of HIV-infected women reported vaccination during the 2006–2007 and 2007–2008 seasons, respectively. Using data from both seasons, older age, non-smoking status, CD4 T-lymphocyte (CD4) count ≥ 200 cells/mm³, and reporting at least one recent healthcare visit was associated with increased vaccination coverage. In the 2007–2008 season, a belief in the protection of the vaccine (aPR = 1.38 [1.18, 1.61]) and influenza vaccination in the previous season (aPR = 1.66 [1.44, 1.91]) most strongly predicted vaccination status.ConclusionInterventions to reach unvaccinated HIV-infected women should focus on changing beliefs about the effectiveness of influenza vaccination and target younger women, current smokers, those without recent healthcare visits, or a CD4 count < 200 cells/mm³.     

Patterns and trends in accidental poisoning death rates in the US, 1979–2014

ObjectivesThe purpose of this study was to examine US accidental poisoning death rates by demographic and geographic factors from 1979 to 2014, including High Intensity Drug Trafficking Areas.MethodsCrude and age-adjusted death rates were formed for age group, race, sex, and county for accidental poisonings (ICD 9th revision: E850–E869; ICD 10th revision: X40–X49) from 1979 to 2014 using the Mortality and Population Data System housed at the University of Pittsburgh. Rate ratios were calculated comparing rates from 2014 to 1979, overall, by sex, age group, race, and county. Joinpoint regression detected changes in trends and calculated the average annual percentage change (AAPC) as a summary measure of trend.ResultsDrug poisoning mortality rates have risen an average of 6% per year since 1979. Increases are occurring in all ages 15 +, and in all race–sex groups. HIDTA counties with the highest mortality rates were in Appalachia and New Mexico. Many of the HIDTA border counties had lower rates of mortality.ConclusionsThe drug poisoning mortality epidemic is continuing to grow. While HIDTA resources are appropriately targeted at many areas in the US most affected, rates are also rapidly rising in some non-HIDTA areas.     

Drowning Mortality in the United States, 1999–2006

Drowning is the fifth leading cause of unintentional fatalities in the US. Our study described demographics and trend analysis of unintentional drowning mortality in the US from 1999 to 2006, and identifies the changes in deaths for specific population subgroups. Mortality data came from the CDC’s Web-based Injury Statistics Query and Reporting System. Trends during 1999–2006 were analyzed by gender, age group and race. Annual percentage change in deaths/rates and simple linear regression was used for time-trend analysis from 1999 to 2006, and examines its significance. During 1999–2006, there were 27,514 deaths; 21,668 (78.8%) males, 21,380 (77.7%) whites, and 4,241 (15.4%) aged 00–04 years. The annual number of drowning mortality varied from a high of 3,529 in 1999 to a low of 3,281 in 2001. Overall, deaths were increased 1.4% from 3,529 during 1999 to 3,579 deaths during 2006 however, the overall mortality rate decreased by 5%. The proportion of deaths was significantly greater among males than females (27.4 vs. 13.7%: p < 0.001) and blacks than among all other races combined (32.5 vs. 21.3%: p < 0.001). Fatalities reported from California (n = 3,234; 11.75%), Florida (n = 2,852; 10.37%) and Texas (n = 2,395; 8.70%) accounted for 30.82% of all such deaths in the US. Sub-group analyses showed that drowning mortality decreased 0.72% for males but increased 9.52% for females, the trend differ significantly among males and females (p < 0.001). Males, American Indians, and blacks appear to have higher risk of drowning mortality. The trend varied among sexes, age and racial groups from 1999 to 2006. Preventive measures and continuous surveillance is warranted to further decrease these drowning mortalities.     

Trends and determinants of mortality in women of reproductive age in rural Guinea-Bissau,West Africa – a cohort study

Background

There are few studies reporting mortality of women of reproductive age (WRA) in developing countries. The trend and patterns of their mortality may be important for documenting the health status of the population in general.

Methods

We used a prospective open cohort of women aged 12 to 49 years living in the Bandim Health Project’s rural Health and Demographic Surveillance System (HDSS) in 5 regions of Guinea-Bissau from 1996 to 2007. Information on in- and out-migration and deaths were collected through the HDSS routine procedures. We assessed the trends in mortality and the associated determinants using Cox regression models.

Results

We followed 27,185 WRA for 141,693 person-years-at-risk (PYO) among whom 9,093 moved out and 1,006 died. Overall standardized mortality rate was 759 per 100,000 PYO. WRA mortality did not decline, but three periods could be distinguished: a stable mortality between 1996–2000 followed by 14% increase in mortality [Hazard rate ratio (HRR)?=?1.14; 95% confidence interval (CI): 0.98-1.32; p?=?0.08] between 2001–2003, and then in the last period from 2004–2007 a 25% decline (HRR?=?0.75; 95% CI: 0.64-0.87; p?<?0.001) in relation to the first period. Compared with the years 1990–1996 mortality increased in the first two periods until 2003; only in the last period did mortality reach the same level as in 1990–1996 (HRR?=?0.96; 95% CI: 0.82-1.13; p?=?0.62). The level of mortality differed between regions. In the adjusted analysis the eastern regions Bafata (HRR?=?1.79; 95% CI: 1.38-2.32; p?<?0.001) and Gabu (HRR?=?1.70; 95% CI: 1.28-2.26; p?<?0.001) had significantly higher mortality, but the hazard rate did not differ by ethnic group. As expected the rate increased with increasing age.

Conclusions

Over the twelve-year period mortality of WRA did not decline. A stable mortality in the beginning was followed by an increase and then a return to the previous levels. Further monitoring of mortality is needed to identify the risk factors for the striking regional differences. Advantage should be taken of the HDSS to monitor progress towards the MDGs and beyond.

     

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999–2008

Spain’s immigrant population has increased 380 % in the last decade, accounting for 13.1 % of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999–2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (?17.8 % for men and ?16.6 % for women) as well as in the foreign-born one (?45.9 % for men and ?35.7 % for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.     

Dietary and cancer–related behaviors of vitamin/mineral dietary supplement users in a large cohort of French women

Summary Background Several epidemiological studies suggested an association between vitamin/mineral dietary supplement use and cancer risk. However, characteristics of supplement users may themselves be related to cancer risk, and therefore could confound such etiological studies. Very little is known about the characteristics of French supplement users. Aim of the study To identify cancer–related behaviors and dietary characteristics of vitamin/mineral supplement users in the E3N cohort of French women. Methods Data on supplement use and cancer–related and socio–demographic characteristics were collected by self–administered questionnaires completed by 83,058 women, 67,229 of whom also completed a food frequency questionnaire. Supplement users were compared to non–users by unconditional logistic regression. Results Vitamin/mineral supplement users were significantly older and leaner (odds ratio [OR] for BMI ≥ 30 vs. <18.5 kg/m² = 0.35, 95% confidence interval [CI] 0.31–0.39), were less often current smokers, had a higher level of education and had more leisure physical activity. They used more phytooestrogen supplements (OR=3.95, 95 % CI 3.69–4.23), had more often a family history of breast cancer and had more often undergone cancer–screening. Users tended to have a healthier diet: less alcohol, more vegetables, fruit, dairy products, fish and soups. They had higher dietary intakes for most micro–nutrients, fiber and ω3 fatty acids, lower fat intake and either similar or lower prevalence of inadequate dietary intake for all relevant nutrients except magnesium. Conclusions To avoid major confounding, the lifestyle characteristics of supplement users should be considered in studies investigating the association between supplement use and cancer risk.     

Comparison of Stroke Mortality in Finnish-Born Migrants Living in Sweden 1970–1999 and in Swedish-Born Individuals

A limited number of studies have been found on stroke mortality in migrants showing higher mortality for some groups. Influence of time of residence has been studied by one research group. An earlier study showed a significantly higher number of deaths in Diseases of the circulatory system in Finnish migrants compared with native Swedes. To test the hypothesis of a higher mortality in and a decrease in mortality over time in stroke among Finnish migrants in Sweden. The study was based on National Population data, the study population included 321,407 Swedish and 307,174 foreign born persons living in Sweden 1987–1999. Mean age was lower at time for death for Finnish migrants than native Swedes, men 5.1 years difference and women 2.3 years. The difference decreased over time. The risk of death by stroke was higher for migrants with short time of residence than with long time (≤10 years, OR 1.61–1.36 vs ≥11 year, OR 1.18). Migrants with short time of residence died 9.8–5.3 years earlier than native Swedes. The hypothesis was confirmed and an indication of adjustment to life in the new country was found. International studies show similar results for other migrant groups but further studies are needed to verify if the same pattern can be found in other migrants groups in Sweden and to generalise the findings.     

Mortality in First Generation White Immigrants in California, 1989–1999

Objective To identify mortality differentials in the first generation non-Hispanic White (NHW) immigrants in California for 1989 through 1999. Methods First generation NHW immigrants (107,432) were identified in California Death Certificate files by place of birth outside the US and were grouped into Anglo-Saxon dominant, Northern, Western, Eastern, and Southern Europe, former USSR, Arabs and non-Arab Middle Eastern areas. US-born NHW (1,480,347) were used as standard to determine proportional mortality ratios (PMR) for major causes of death including: cancers, coronary heart disease, cerebrovascular accidents, chronic obstructive pulmonary disease (COPD), HIV/AIDS, accidents, diabetes, pneumonia, suicide, and homicide. Results All immigrants had significantly higher PMR for suicide and with few exceptions for cardiovascular diseases. Lower PMR was recorded for COPD and homicide. No difference was noticed for pneumonia and accidents. Cancer deaths were generally higher in European immigrants. Conclusions Mortality patterns of NHW immigrants reflect the mixed impacts of acculturation, ethnic-specific characteristics, and psychological well being.     

HRQoL in HIV-infected children using PedsQL™ 4.0 and comparison with uninfected children

Purpose  

To assess the reliability and validity of Pediatric Quality of Life Inventory 4.0 (PedsQL^TM 4.0) in children living with HIV. Also to determine the association of HIV infection, treatment regimens, and type of care received on quality of life (QoL) in pediatric patients.     

Age-period cohort analysis of AIDS incidence rates in Rio de Janeiro,Brazil, 1985–2009

Introduction

The long average incubation time from HIV infection to AIDS makes it difficult to estimate the recent tendencies of HIV from AIDS incidence data. The objective of this study was to investigate the effects of three temporal components in AIDS incidence in the state of Rio de Janeiro, Brazil - age, period, and cohort.

Methods

Age-specific AIDS incidence rates per 100,000 from Rio de Janeiro (Brazil) were calculated for both sexes using five-year age classes from 1985 to 2009 based on reported data from the Notifiable Disease Information System of the Brazilian Ministry of Health and from census population counts. Multivariate negative binomial models were used to analyze the risk of AIDS by age, period, and birth cohort.

Results

From 1985 to 2009, AIDS incidence initially increased with age in each birth cohort and then decreased (except for individuals born from 1971–1979 to 1986–1994). High peaks in the rates in each birth cohort were detected in 1995–1999 for males and in 2000–2004 for females. Multivariate analysis showed the maximum risk of AIDS in the 30–34 age group and 1958–1962 birth cohort.

Conclusion

Age, birth cohort, and period effects all may have influenced the AIDS incidence rates over the period investigated. From 1985 to 1999, comparison of the tendencies (by age) of the period with the birth cohort revealed opposing tendencies in individuals older than 29 years and in the youngest age groups (0 to 14 years). From 2000 to 2009, a strong age effect can be observed in both sexes. Consistent changes in period tendency curves suggest the occurrence of period effects. A reduction in the intensity of the risk of AIDS can be observed after 2000–2004.

     

Trends in predictors of death due to HIV-related causes among persons living with AIDS in New York City: 1993–2001

To examine trends in predictors of HIV-related mortality among cohorts of persons living with AIDS (PLWA) in New York City (NYC), nine calendar year-specific cohorts of PLWA were created from 1993 to 2001. Cohorts were defined as persons who had been alive at any time during that year and had been diagnosed with AIDS before the end of that year. Predictors of death because of HIV-related causes of death were assessed by examinnng year-specific, stratified death rates per 1,000 PLWA and adjusted relative risks (RRs) from proportional hazards models. We conducted an analysis of AIDS surveillance data PLWA in NYC between 1993 and 2001. Univariate and multivariate Cox proportional hazards models were constructed for each calendar year cohort to evaluate trends in the RR of HIV-related death over the subsequent 5 years, adjusting for sex, reace/ethnicity, age, transmission risk borough of residence, category of AIDS diagnosis [opportunistic illness (OI) or CD4 count <200 cells/μL], time since AIDS diagnosis, and CD4 count at time of AIDS diagnosis. Death rates due to all causes and HIV-related causes declined substantially during 1993–1997 and then stabilized in all subgroups of PLWA between 1998 and 2001. Beginning in 1995, differences in survival emerged in some subgroups, such that by 2001 (1) injecting drug users (IDUs) had poorer survival compared with men who have sex with men (MSM) [RR₂₀₀₁=2.1, 95% confidence intervals (95% CI)=1.8–2.4]; (2) black and Hispanic PLWA had a significantly higher risk of death than white PLWA (RR₂₀₀₁=1.4, 95% CI=1.2–1.6, RR₂₀₀₁=1.2, 95% CI=1.1–1.4, respectively, and (3) PLWA aged 60 and above had poorer survival compared with younger persons (RR₂₀₀₁=2.4, 95% CI=1.9–3.0), after adjustment for other factors. The observed disparities that began to emerge in 1995 may be attributable to differential effects of, access to, or usage of highly active antiretroviral therapy (HAART). More targeted studies are needed to determine why such disparities have emerged.     

Mortality and cancer incidence in a Swedish art glassworks—an updated cohort study

Aim: To study mortality and cancer incidence, in a Swedish art glassworks producing both heavy and semi-crystal glassware, in an extended cohort of workers over a long time period during which some preventive actions had taken place.Methods: In the updated study, 1,229 men and women were eligible as cohort members during the period 1964–1997. The observed number of cases was compared with expected numbers, as calculated from cause-, age-, gender- and calendar year-specific national rates for mortality and cancer incidence.Results: Among men only, a significant risk was seen for cancer incidence in the colon and rectum [standardised incidence ratio (SIR) 1.92, 95% confidence interval (CI) 1.05–3.23; 14 cases] and increased, but statistically non-significant, risks were also seen for male cases of tumours in the liver/bile ducts and brain. Among women, statistically non-significant risks were seen for tumours in the liver/bile ducts and in the lymphatic and haematopoietic systems. No increased risk for cancer of the lung was found in this updated study. The risk for cancer in the colon/rectum was slightly increased in all work categories, and the increase was statistically significant among male and female unspecified glassworkers (SIR 3.13, 95% CI 1.35–6.16; five male and three female cases). A statistically significantly increased risk for cancer in the liver/bile ducts was seen among refinement workers (SIR 3.96, 95% CI 1.07–10.14; two male and two female cases).Conclusion: Most of the causes of death associated with an elevated standardised mortality ratio (SMR) in the 1985 cohort resulted in lower SMRs in this updated cohort, maybe as a consequence of preventive actions taken at the glassworks. On the other hand, the risk for cancers in the digestive system seems to remain, perhaps due to past asbestos exposure or inhalation/digestion of larger particles in the ambient air.     

Widening Rural–Urban Disparities in All-Cause Mortality and Mortality from Major Causes of Death in the USA, 1969–2009

This study examined trends in rural–urban disparities in all-cause and cause-specific mortality in the USA between 1969 and 2009. A rural–urban continuum measure was linked to county-level mortality data. Age-adjusted death rates were calculated by sex, race, cause-of-death, area-poverty, and urbanization level for 13 time periods between 1969 and 2009. Cause-of-death decomposition and log-linear and Poisson regression were used to analyze rural–urban differentials. Mortality rates increased with increasing levels of rurality overall and for non-Hispanic whites, blacks, and American Indians/Alaska Natives. Despite the declining mortality trends, mortality risks for both males and females and for blacks and whites have been increasingly higher in non-metropolitan than metropolitan areas, particularly since 1990. In 2005–2009, mortality rates varied from 391.9 per 100,000 population for Asians/Pacific Islanders in rural areas to 1,063.2 for blacks in small-urban towns. Poverty gradients were steeper in rural areas, which maintained higher mortality than urban areas after adjustment for poverty level. Poor blacks in non-metropolitan areas experienced two to three times higher all-cause and premature mortality risks than affluent blacks and whites in metropolitan areas. Disparities widened over time; excess mortality from all causes combined and from several major causes of death in non-metropolitan areas was greater in 2005–2009 than in 1990–1992. Causes of death contributing most to the increasing rural–urban disparity and higher rural mortality include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, diabetes, nephritis, pneumonia/influenza, cirrhosis, and Alzheimer’s disease. Residents in metropolitan areas experienced larger mortality reductions during the past four decades than non-metropolitan residents, contributing to the widening gap.