Recent trends in cancer mortality in the Slovak Republic and in Europe

During the last 30 years the trends in cancer mortality in Europe significantly changed. In 1970 the male and female cancer mortality (all ages) was higher in the Western Europe than in the "socialist" Central and Eastern Europe. After 1970 in most Western countries decrease or no change of male premature (0-64 years) cancer mortality was observed. The decrease was deepest in Finland and in United Kingdom. In the most of the former communist countries an increase of both total and premature male cancer mortality was observed, especially in Hungary, Poland, Roumania, Bulgaria and in some regions of the former Soviet Union. Present male premature cancer mortality in Hungary is two-times higher than the average of European Union. Male cancer mortality in the Slovak Republic is at least two-times higher than in United Kingdom, Switzerland or Sweden. These differences are partially explainable by the higher prevalence of smoking in the East. The further risk factor could be oxidative stress, caused by low intake of antioxidants and high intake of spirits. In female populations, the differences between East and West are not so dramatic, with the exception of extremely high mortality in Hungarian females. Parallel increase of female lung cancer mortality both in the West and East is caused probably by the continually increasing smoking prevalence in females almost in the whole Europe. Further local risk factors in Eastern Europe (e.g. pollution) need to be identified with more specificity for preventive programs in Eastern Europe. This region is a prospective area for the research on lesser known cancer risk factors, e.g., chronic deficiency of antioxidants, natural anticarcinogens and psychosocial disorders.     

Decreasing child mortality,spatial clustering and decreasing disparity in North‐Western Burkina Faso

Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village‐specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990–2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two‐thirds reduction.     

Fasting Serum Cholesterol and Triglycerides in a Ten-Year Prospective Study in Old Age

ABSTRACT. In a ten-year prospective study of a population of men and women aged exactly 70 at entry and otherwise selected only according to geography, the predictive values of serum cholesterol and serum triglycerides were evaluated concerning total mortality and cardiovascular disease (CVD) and cancer manifestations in the eighth decade. Both high and low cholesterol values at 70 were associated with excess total mortality in men, the former showing excess CVD mortality, the latter excess cancer mortality. In men, high values of triglycerides at 70 were associated with increased CVD mortality as well as CVD development. In women, high values of triglycerides at 70 were associated with excess hospitalization for cerebrovascular incidence alone.     

Geographic variation in the incidence of and mortality from inflammatory bowel disease

The geographic and temporal variations in mortality from Crohn's disease and ulcerative colitis were investigated. The validity of mortality data as indicators of morbidity was tested by comparing the death rates and incidences among different countries. Death rates from Crohn's disease and ulcerative colitis were high in England, Germany, and the Scandinavian countries, and low in the Mediterranean countries. There was a significant correlation between the incidence and mortality of both diseases among different countries. In addition, the incidence and mortality of Crohn's disease were correlated with those of ulcerative colitis. In countries with a low mortality rate from Crohn's disease, the death rates in men tended to be higher than those in women. In contrast, countries with high death rates from Crohn's disease showed female predominance. No such relationship existed for ulcerative colitis. The overall change in mortality rates during the last 20 to 30 years was characterized by a rise of Crohn's disease and a marked fall of ulcerative colitis. In countries with a high mortality rate from Crohn's disease, the death rates started to fall in recent times. The significant correlations between incidence and mortality show that the death rates from both diseases represent reliable indicators of the morbidity and that the severity of the two diseases is similar in different countries. The marked temporal and geographic variations in both incidence and mortality suggest that environmental factors play an important role in the etiology of both diseases. Supported by grant number So 172/1-1 from the Deutsche Forschungsgemeinschaft.     

Sleep apnea in female patients in a nursing home. Increased risk of mortality

There has been much speculation on the risk of mortality associated with sleep apnea. We followed-up 233 elderly patients in nursing homes, 70 percent of whom had five or more respiratory disturbances per hour of sleep, to determine if sleep apnea is a predictor of mortality. Cox proportional hazards survival analyses indicated a gender effect, with women having a much better survival rate than men. In women, but not in men, there was a strong association between mortality and the RDI. In addition, patients with obstructive sleep apnea had a greater tendency to die in their sleep. These results show that respiratory disturbances in sleep are an extremely significant risk factor for mortality in elderly women who are in poor health.     

Queen Margrethe II and mortality in Danish women

All-cause mortality in women is declining in all western European countries, apart from in Danish women. All-cause mortality in Danish women, age-adjusted to 45-74 years was compared with all-cause mortality in women in Scotland and with the mean of the other countries of the European Union for 1970-96. The decline of all-cause mortality in Danish women stopped in 1978 whereas the decline continued in Scotland. In 1996, all-cause mortality was 48% higher in Denmark than that of the mean for the European Union countries. Many Danish women are smokers. Halting of the decline in mortality occurred about 5 years after the ascension to the throne of Denmark by Queen Margrethe II. The queen is very popular in Denmark and a known cigarette smoker. As a role model for women, the Queen's example could offer an explanation for the unusual mortality in Danish women.     

Insulintherapie in der Schwangerschaft

Pregnancy in women with diabetes mellitus represents a high risk for both mother and child. Before the introduction of insulin, pregnancy in diabetic women was an extremely rare occurrence. With the availability of insulin, women with insulin-dependent diabetes could also risk becoming pregnant, although maternal mortality was still around 10% and fetal mortality 45–50%. During the 1960s perinatal mortality remained at approximately 20%. In recent decades, however, mortality and morbidity of both mother and child have been drastically reduced by improved therapeutic options and close interdisciplinary care by specialized teams. However, in comparison to non-diabetic pregnant women there is still a 3–5 times higher risk of congenital malformation, and perinatal mortality is also still higher than in children of healthy mothers.     

Risk of Mortality with Paclitaxel Drug-Coated Balloon in De Novo Coronary Artery Disease

A recent meta-analysis showed increased mortality with paclitaxel drug-coated balloons (PCB) in peripheral arterial disease. With the absence of a definitive study evaluating the risk of mortality with PCB in de novo coronary artery disease, we performed a systematic review and critical appraisal of the literature analyzing this risk. In this review, we included 17 trials with a total of 1573 patients. Cardiac mortality was reported in 16 studies and all-cause mortality in 14 studies. Eleven studies had <12 months' follow-up; 6 had ≥12 months' follow-up. None of the studies was powered to evaluate any differences in mortality. The majority of the included studies have a Jadad scale ≤2. Ten of 17 studies had no mortality, 4 had numerically higher mortality with PCB, and 3 had lower or same mortality with PCB, when compared to drug-eluting stents. A standard meta-analysis cannot be performed, as most studies did not report hazard ratios or Kaplan-Meier survival plots on mortality. With the available literature, conclusions cannot be made in identifying the association of mortality with PCB in de novo coronary artery disease. There is an urgent need for well-designed studies with long-term follow-up for PCB in de novo coronary artery disease.A recent meta-analysis showed increased mortality with paclitaxel drug-coated balloon (PCB) in peripheries. No studies to date evaluate the risk of mortality with PCB in de novo coronary artery disease. In this systematic review and critical appraisal of literature, we outline why the risk cannot be elucidated from the available literature. A standard meta-analysis using inverse variance method would be incorrect to use, as mortality is a time-to-event data point, and only 1 out of 17 studies reported a Kaplan-Meier survival plot.     

Mortality in acromegaly: a metaanalysis

CONTEXT: Several studies have assessed mortality risk in patients treated for acromegaly. All studies found a mortality that was higher than expected for the general population, but most of these increases were not statistically significant. For this reason, it is not formally established whether mortality in acromegaly is different from the general population. OBJECTIVE: The objective of the study was to address the all-cause mortality risk in patients with acromegaly. DESIGN: The study was a metaanalysis. METHODS: Sixteen studies on mortality in patients with acromegaly were included. The principal outcome of the metaanalysis was the weighted average of the standardized mortality ratio (SMR) of all studies. In addition, we performed a subgroup analysis of studies in which more than 80% of the patients were treated by transsphenoidal approach. RESULTS: The weighted mean of the SMR from all 16 studies was 1.72 (95% confidence interval 1.62-1.83). In studies with transsphenoidal surgery as the primary therapy, the weighted mean of the SMR was 1.32 (95% confidence interval 1.12-1.56). CONCLUSIONS: This metaanalysis shows increased all-cause mortality in acromegalic patients, compared with the general population, even after transsphenoidal surgery.     

Age-specific demographic profiles of longevity mutants in Caenorhabditis elegans show segmental effects

Demographic profiles of several single-gene longevity mutants of the nematode Caenorhabditis elegans reveal segmental (age-specific) effects on mortality. The mortality profiles of wild-type worms were examined across multiple replicate cultures containing 100,000 or more nematodes and found to be quite replicable, although clear environmental effects are routinely found. The combined profile of wild type was compared with those of three long-lived mutants to determine how age-specific mortality is altered by mutations in age-1, clk-1, or spe-26. In all four genotypes, death rates fit a two-stage Gompertz model better than a one-stage Gompertz; that is, mortality levels off at later ages. The largest genetic effect on mortality was that of an age-1 mutation, which lowered mortality more than fivefold at most later ages. In contrast, a spe-26 mutant had a tenfold lower mortality until approximately 2 weeks of age but ultimately achieved a higher mortality, whereas clk-1 mutants show slightly higher mortality than wild type during the fertile period, early in life, but ultimately level off at lower mortality. Each mutant thus has a distinctive profile of age-specific mortalities that could suggest the time of action of each gene.     

Decrease in mortality in patients with a hospital diagnosis of atrial fibrillation in Denmark during the period 1980-1993.

BACKGROUND: Atrial fibrillation is associated with increased mortality. We hypothesized that the death rate in atrial fibrillation patients in Denmark has diminished during the period 1980-1993. METHODS: In a random sample of half of the Danish population, 30 330 patients were found to have a diagnosis of incident atrial fibrillation in the Danish National Hospital Discharge Register 1980-1993. Information on previous and concomitant cardiovascular and metabolic diseases during the period 1977-1993 was sought in the register. The temporal trend in total and cardiovascular mortality in the cohort of atrial fibrillation patients was analysed. RESULTS: A significant decrease in total and cardiovascular mortality was seen, 12-13% for total mortality and 17-18% for cardiovascular mortality. By adjusting for the decreasing cardiovascular mortality rate in the general population, a decrease in the relative risk of total mortality of 8-13% with time was seen for the atrial fibrillation cohort, compared with the population risk, while no reduction in the relative risk of cardiovascular death was seen. CONCLUSION: A significant decrease in mortality with calendar period occurred in the cohort of atrial fibrillation patients.     

Lipids and coronary heart disease in Asia

In Western countries, it has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countries. With growing urbanization and industrialization in Asia, it has been shown that there is a concomitant rise in the level of serum TC and with it a rise in CHD. In all the Asian countries, serum TC levels are also higher in the urban compared with the rural population. Singapore, the only Asian country which is 100% urbanized since 1980, showed a rise of serum TC similar to that seen in the US and UK from the 1950s to the 1980s followed thereafter by a fall. This is reflected in the trend (rise followed by a fall) of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high in Singapore and comparable to the Western countries. The rest of the Asian countries show a different pattern from Singapore. In general, there is still a rising trend in serum TC level and in CHD mortality in most Asian countries. However, Japan is considered an exception in having a decreasing CHD mortality in spite of an increasing trend in serum TC. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.     

High Mortality Rate of Infectious Diseases in Dialysis Patients: A Comparison With the General Population in Japan

Infectious disease is the second leading cause of death among dialysis patients, and it is generally assumed that the mortality rate of infectious disease is considerably higher in dialysis patients than in the general population. There are no comprehensive studies on this issue and on the contribution of each category of infectious disease to excess mortality in dialysis patients in Japan. We used mortality data reported to the Japanese Society for Dialysis Therapy and national Vital Statistics data for 2008 and 2009. We calculated standardized mortality ratios and compared the mortality rates for each category of infectious disease. During the 2‐year study period, 274 683 and 10 435 deaths from infectious diseases were recorded in 126 million people and 273 237 dialysis patients, respectively. The standardized mortality ratio for all infectious diseases was 7.5 (95% confidence interval, 7.3–7.6) in dialysis patients with respect to the general population in Japan. The categories of infectious disease with a significantly higher standardized mortality ratio among the dialysis patients were sepsis, peritonitis, influenza, tuberculosis, and pneumonia and in that order. In particular, the mortality rate of sepsis contributed to 69.5% of the difference in infectious disease mortality between dialysis patients and the general population. This study underlines markedly increased mortality from infectious diseases, particularly from sepsis, in dialysis patients compared with the general population.     

Impact of atrial fibrillation on mortality in patients with chronic heart failure

Chronic heart failure and atrial fibrillation often occur together. The aim of the study is to review the available literature on the impact of atrial fibrillation on mortality in patients with heart failure. Using MEDLINE six full papers were identified. In the studies with severe heart failure atrial fibrillation did not emerge as an independent predictor of mortality beyond standard clinical variables. In contrast, atrial fibrillation was associated with increased mortality in case of mild-to-moderate heart failure.     

Diabetes and cancer (2): evaluating the impact of diabetes on mortality in patients with cancer

In this paper we address methodological aspects of aetiological importance in the link between diabetes and mortality in patients with cancer. We identified nine key points on the cancer pathway at which confounding may arise-cancer screening use, stage at diagnosis, cancer treatment selection, cancer treatment complications and failures, peri-treatment mortality, competing risks for long-term mortality, effects of type 2 diabetes on anti-cancer therapies, effects of glucose-lowering treatments on cancer outcome and differences in tumour biology. Two types of mortality studies were identified: (1) inception cohort studies that evaluate the effect of baseline diabetes on cancer-related mortality in general populations, and (2) cohorts of patients with a cancer diagnosis and pre-existing type 2 diabetes. We demonstrate, with multiple examples from the literature, that pre-existing diabetes affects presentation, cancer treatment, and outcome of several common cancer types, often to varying extents. Diabetes is associated with increased all-cause mortality in cancer patients, but the evidence that it influences cancer-specific mortality is inconsistent. In the absence of data that address the potential biases and confounders outlined in the above framework, we caution against the reporting of cancer-related mortality as a main endpoint in analyses determining the impact of diabetes and glucose-lowering medications on risk of cancer.     

Low pulse pressure is independently related to elevated natriuretic peptides and increased mortality in advanced chronic heart failure.

AIMS: An increased pulse pressure (PP) has consistently predicted increased cardiovascular morbidity and mortality in cardiovascular risk patients and mild chronic heart failure (CHF). In contrast, a decreased PP was related to increased mortality in patients with acute decompensated heart failure. However, the predictive value of PP in patients with advanced CHF is not known. METHODS AND RESULTS: PP was analysed for its effect on mortality, adjusting for other modifiers of risk, using Cox proportional hazards regression analysis of data collected from 1901 patients with New York Heart Association Class III or IV CHF (mean age 65 and mean ejection fraction 0.26). Natriuretic peptides were measured in a subgroup. Multivariable Cox-regression analysis demonstrated that lower PP was associated with an increased mortality [hazard ratio (HR) 0.91 per 10 mmHg; 0.93-0.99], independent of mean arterial pressure (MAP) and other well known prognostic markers. In patients with a PP below the median value of 45 mmHg, PP was a stronger predictor of mortality than MAP (HR for PP 0.80 per 10 mmHg; 0.64-0.99). In patients with a PP above the median value of 45 mmHg, MAP was a stronger predictor of mortality than PP (HR for MAP 0.83 per 10 mmHg increase; 0.72-0.95). In addition, lower PP was independently related to increased atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP). CONCLUSION: In patients with advanced CHF, low PP is an independent predictor of mortality. In addition, low PP was related to increased levels of ANP and BNP.     

Impact of multivessel coronary disease on long-term mortality in patients with ST-elevation myocardial infarction is due to the presence of a chronic total occlusion

In acute ST-elevation myocardial infarction (STEMI), patients with multivessel disease (MVD) are considered to be a subgroup with an increased risk of mortality compared with patients with single-vessel disease (SVD). To evaluate the effect of MVD on 1-year mortality in patients with STEMI, we studied 1,417 consecutive patients with STEMI who were admitted between 1997 and 2002 and treated with primary percutaneous coronary intervention. Further, we hypothesized that the effect of MVD on mortality is due to the presence of a chronic total occlusion in a noninfarct-related artery. Patients with MVD and/or a chronic total occlusion had multiple differences in baseline and angiographic characteristics that were associated with worse outcome. Mortalities in patients with SVD, MVD, and a chronic total occlusion were 8%, 16%, and 35%, respectively. After correction for the baseline differences, MVD was an independent predictor of mortality (odds ratio 1.5, 95% confidence interval 1.1 to 2.1). However, when chronic total occlusion was included in the model, MVD was no longer an independent predictor for mortality, whereas chronic total occlusion was a strong and independent predictor for 1-year mortality in patients with STEMI treated with percutaneous coronary intervention (odds ratio 3.8, 95% confidence interval 2.5 to 5.8). In conclusion, patients with STEMI and MVD have a higher 1-year mortality rate compared with patients with SVD, which is mainly determined by the presence of a chronic total occlusion in a noninfarct-related artery. In the setting of primary percutaneous coronary intervention, the presence of a chronic total occlusion, and not the mere presence of MVD, is an independent predictor of mortality.     

Evolution of all-causes and cardiovascular mortality in the age-group 75-84 years in Europe during the period 1970-1996; a comparison with worldwide changes.

BACKGROUND: In spite of the increase in longevity in the past century, studies of mortality patterns in elderly populations are scarce. We investigated cardiovascular and all-cause mortality patterns in age-group 75-84 years in Europe in the period 1970-1996. Methods Mortality data for the age-group 75-84 years were obtained from WHO and standardized according to the old European population standard. Tables were produced showing mortality rates per country around the year 1995 and trends were calculated over the period 1970-1996 using linear regression analysis. Results In both men and women aged 75-84 all-cause and cardiovascular mortality rates were higher in Central and Eastern Europe compared with Western Europe. For the last 3 available years, all-cause mortality rates differed by a factor 2/2.5 (men, women) when comparing the country with the highest with that of the lowest rate. For total cardiovascular mortality this factor was about 4/5 (men, women). During the period 1970-1996, all-cause and total cardiovascular mortality rates declined in most European countries. The decline in all causes of mortality was almost exclusively due to a decline in total cardiovascular disease mortality, especially stroke. Increases in total cardiovascular mortality were observed in some central European countries and Greece. CONCLUSION: Major changes, mainly a decline, occurred in all-cause and cardiovascular mortality in subjects aged 75-84 in Europe. Therefore a passive attitude to health problems in the elderly is not warranted.     

Cancer mortality in Württemberg, 1910 and 1970.

The results of a special survey of cancer mortality statistics in selected areas of the Ober- and Unterland of Württemberg in the period 1908--1912 were compared with the official mortality statistics of the same region for 1969--1972. In the Oberland, formerly part of an area of high cancer mortality comprising the adjacent regions of Bavaria, Austria, Switzerland, and Baden, the overall cancer mortality showed a marked fall in both sexes. In the Unterland, where cancer mortality was previously low, the overall death rate increased in men and did not change in women. These variations are largely accounted for by changes in mortality from cancer of the stomach and bronchus. The death rates from gastric cancer observed around 1900 in the Oberland of Württemberg and adjacent regions of the neighbouring countries are among the highest recorded even in the world. Since the fall of gastric cancer noted is very marked and this disease is still the leading cause of death from cancer today, the Oberland of Württemberg seems to be uniquely suited for the search of environmental factors which associate with this decline. In theremainder of cancer sites changes over time were less striking and/or observed already in other countries.     

Factors predicting mortality in invasive pneumococcal disease in adults in Alberta

To define the factors associated with 30-day mortality among adult patients with invasive pneumococcal disease (IPD), we conducted a retrospective review of all cases of IPD in Alberta from 2000 to 2004. We hypothesized that multiple factors would be predictive of such mortality. We also examined the factors predictive of early (within 5 days of admission) mortality. We identified 1154 patients who met our inclusion criteria, 163 (14.1%) of whom died within 30 days. Over half (62.6%) of the deaths occurred within 5 days of admission. Ten factors were independently associated with increased 30-day mortality: 3 comorbidity factors-cancer within 5 years of diagnosis of IPD, diabetes, and cirrhosis; 4 complications-requirement for supplemental oxygen, mechanical ventilation, alteration of mental status, and cardiac arrest; 2 microorganism-related factors-infection with high- or infection with intermediate-mortality serotypes; and 1 treatment-related factor-treatment with a single antibiotic. Age 18-40 years and treatment with 2 antibiotics concurrently were associated with lower 30-day mortality. Comorbid illnesses were not contributory to early mortality (within 5 days of admission); instead, complications (alteration of mental status, requirement for supplemental oxygen, mechanical ventilation, and cardiac arrest) as well as infection with high-mortality serotypes and treatment with a single antibiotic were important. Age 18-40 years, infection with serotypes in the polysaccharide vaccine, and treatment with 2 or more than 2 antibiotics were associated with decreased early mortality. Early mortality accounted for 62.6% of the deaths. In conclusion, we found that mortality in IPD is multifactorial, the factors differ for 5- and 30-day mortality, and mortality is associated with host (age and complications), microorganism (pneumococcal serotypes), and therapeutic factors. Our data indicate that treatment with 2 or more antibiotics effective against Streptococcus pneumoniae should be used to treat IPD.