Is patriarchy the source of men's higher mortality?

OBJECTIVE: To examine the relation between levels of patriarchy and male health by comparing female homicide rates with male mortality within countries. HYPOTHESIS: High levels of patriarchy in a society are associated with increased mortality among men. DESIGN: Cross sectional ecological study design. SETTING: 51 countries from four continents were represented in the data-America, Europe, Australasia, and Asia. No data were available for Africa. RESULTS: A multivariate stepwise linear regression model was used. Main outcome measure was age standardised male mortality rates for 51 countries for the year 1995. Age standardised female homicide rates and GDP per capita ranking were the explanatory variables in the model. Results were also adjusted for the effects of general rates of homicide. Age standardised female homicide rates and ranking of GDP were strongly correlated with age standardised male mortality rates (Pearson's r=0.699 and Spearman's 0.744 respectively) and both correlations achieved significance (p<0.005). Both factors were subsequently included in the stepwise regression model. Female homicide rates explained 48.8% of the variance in male mortality, and GDP a further 13.6% showing that the higher the rate of female homicide, and hence the greater the indicator of patriarchy, the higher is the rate of mortality among men. CONCLUSION: These data suggest that oppression and exploitation harm the oppressors as well as those they oppress, and that men's higher mortality is a preventable social condition, which could be tackled through global social policy measures.     

Avoidable mortality. Changes in the new century?

OBJECTIVES: To analyze time trends and the geographical distribution of avoidable mortality in the autonomous community of Valencia and its health departments by sex in the periods 1990-1994, 1995-1999, and 2000-2004. MATERIAL AND METHOD: Twenty-one causes of avoidable mortality were analyzed. The deaths analyzed corresponded to residents in the autonomous community of Valencia between 1990 and 2004. Age-standardized mortality rates were calculated using the direct method. To study time trends in the geographical area of interest for each period and sex, comparative mortality ratios were calculated. To analyze geographical distribution, standardized mortality rates were calculated by the indirect method. RESULTS: The total number of avoidable deaths was 38,061 (7.1% of overall deaths). Men accounted for 76.2% and women for 23.8%. By groups, 82.4% were preventable and 17.6% were treatable. Preventable deaths represented 86.5% of deaths in men and 69.4% of those in women. Avoidable mortality in Valencia significantly decreased in both sexes, this decrease being more marked in the group of treatable deaths and in men. Mortality from lung cancer in women significantly increased. Between 2000 and 2004, none of the health departments showed a significant excess of treatable mortality. CONCLUSIONS: In the autonomous community of Valencia, there was a greater decrease in avoidable mortality than in general mortality. The increase in lung cancer in women was notable.     

Education, gender, and mortality: does schooling have the same effect on mortality for men and women in the US?

In this paper I examine whether the effect of education on mortality for US adults differs by gender. Discrete time logit models were used to analyze a nationally representative dataset (NHANES I) with 12,036 adults who were 25-74-years-old at the baseline survey in 1971-1975, and then re-interviewed three times through 1992. Demographic characteristics, health behaviors and economic status were controlled as potential confounding or mediating factors in the education-mortality relationship. The results showed that education had a comparable effect on mortality for men and women. No statistically significant gender difference was found in all-cause mortality, or mortality by cause of death, among younger persons, and among the elderly. Analysis by marital status, however, suggested that these findings apply only to married men and women. Among the divorced, there was a statistically significant gender difference whereby education had no effect on mortality for men while divorced women evidenced a strong education gradient (seven percent lower odds of dying for each year of schooling). Possible explanations for these patterns are discussed.     

Does volunteering moderate the relation between functional limitations and mortality?

Previous studies have demonstrated that functional limitations increase, and organizational volunteering decreases, the risk of mortality in later life. However, scant attention has been paid to investigating the joint effect of functional limitations and organizational volunteering on mortality. Accordingly, we tested the hypothesis that volunteering moderates the relation between functional limitations and risk of mortality. This prospective study used baseline survey data from a representative sample of 916 non-institutionalized adults 65 years old and older who lived in the continental United States. Data on mortality were extracted six years later from the National Death Index. Survival analyses revealed that functional limitations were associated with an increased risk of dying only among participants who never or almost never volunteered, suggesting that volunteering buffers the association between functional limitations and mortality. We conclude that although it may be more difficult for older adults with functional limitations to volunteer, they may receive important benefits from doing so.     

Why did postperinatal mortality rates fall in the 1970s?

Postperinatal mortality rates have shown two phases of decline since 1947 which are traditionally ascribed to social and medical improvements. These factors cannot, however, explain the arrest of decline during the 1960s. There appears to be a biological effect on child mortality rates, manifesting as a generation effect. This is due partly to continuing changes in the structure of the child population, itself a consequence of social and biological changes among the parent generation when they were children. In this study national and selected urban postperinatal deaths have been divided into two categories: "probably inevitable" and "possibly preventable". The continuing prevalence of "possibly preventable" deaths gives cause for concern. If the number of these deaths is to be further reduced, reconsideration and redeployment of community child health staff may be necessary.     

Cardiovascular mortality patterns in Turkey: what is the evidence?

In Turkey, reliable cause-specific mortality data are not available. It is thus unknown whether ischaemic heart disease (as in western Europe and the US) or stroke (as in the Far East) is the prevailing cause of cardiovascular death. This information, however, is required for planning cardiovascular prevention programmes. We analyse available Turkish national cause-of-death data as well as patterns of cardiovascular mortality in a hospital in Ankara and among Turkish migrants in Germany. According to national statistics, the ischaemic heart disease-to-stroke ratio would be 0.3 among men aged 45-64 years, lower than that in Japan. Hospital and migrant data show this ratio to be 2-4. We demonstrate the implausibility of the national data by assessing the precision of cause-of-death assignment. We then discuss to what degree mortality experience among migrants is representative for their country of origin. Our findings suggest that the pattern of cardiovascular mortality in Turkey is closer to that in western Europe and the US than to that in the Far East. Finally, we discuss options for improving cardiovascular surveillance in Turkey.     

Self-assessed health and mortality: could psychosocial factors explain the association?

BACKGROUND: The single-item question of self-assessed health has consistently been reported to be associated with mortality, even after controlling for a wide range of health measurements and known risk factors for mortality. It has been suggested that this association is due to psychosocial factors which are both related to self-assessed health and to mortality. We tested this hypothesis. METHODS: The study was carried out in a subsample (n = 5667) of the GLOBE-population, a prospective cohort study conducted in the southeastern part of the Netherlands. Data on self-assessed health, sociodemographic variables, various aspects of health status, behavioural risk factors, and a number of psychosocial factors (social support, psychosocial stressors, personality traits, and coping styles) were collected by postal survey and structured interview in 1991, and mortality data were collected between 1991 and 1998. Cox proportional hazards analyses were used to calculate the association between self-assessed health and mortality, before and after controlling for the psychosocial variables. RESULTS: After controlling for sociodemographic variables, various aspects of health status, and behavioural risk factors, self-assessed health is still strongly associated with mortality in our dataset (Relative Risk [RR] of dying for 'poor' versus 'very good' self-assessed health = 3.98; 95% CI: 1.65-9.61). After controlling for the same set of confounders, many of the psychosocial variables are statistically significantly associated with a 'less-than-good' self-assessed health, particularly instrumental social support, long-lasting difficulties, neuroticism, and locus of control. However, only 'disclosure of emotions'-coping style has a statistically significant relationship with mortality. Adding the psychosocial variables to a model already containing self-assessed health does not attenuate the association between self-assessed health and mortality. CONCLUSIONS: We did not find indications that the association between self-assessed health and mortality is due to the psychosocial factors included in this analysis. It seems likely that the unexplained mortality effects of self-assessed health are due to the fact that self-assessed health is a very inclusive measure of health reflecting health aspects relevant to survival which are not covered by other health indicators.     

Female mortality in Brazil: the weaker sex or stronger sex?

Population ageing in Brazil has been more rapid and more intense among women. This phenomenon is well described in developed countries where mortality rates are higher for men than women. In this regard, the analysis of mortality patterns by cause contributes to elucidate the determinant factors of the present situation in Brazil and provides indications of some future trends in female mortality. This is especially important due to the fact that in Brazil the social role of women has experienced great changes. This study presents data on mortality from ten capital cities in 1985, showing age-standardized overall and cause-specific mortality rates for five of the main groups of causes by sex. Ratios and differences effect estimators were used. The results revealed that regional patterns are associated with the urban and industrial processes with greater differences by sex in more developed regions. External causes and cardiovascular diseases are the main factors responsible for higher mortality among men with special emphasis on violent deaths. It is inferred that the present trend will be maintained, though it is possible that mortality differences by sex could decrease in the near future. The authors discuss that longer survival among women in Brazil does not reveal better life conditions.     

Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool?

OBJECTIVE: To determine if a widely used proprietary risk-adjustment system, APR-DRGs, misadjusts for severity of illness and misclassifies provider performance. DATA SOURCES: (1) Discharge abstracts for 116,174 noninstitutionalized adults with acute myocardial infarction (AMI) admitted to nonfederal California hospitals in 1991-1993; (2) inpatient medical records for a stratified probability sample of 974 patients with AMIs admitted to 30 California hospitals between July 31, 1990 and May 31, 1991. STUDY DESIGN: Using the 1991-1993 data set, we evaluated the predictive performance of APR-DRGs Version 12. Using the 1990/1991 validation sample, we assessed the effect of assigning APR-DRGs based on different sources of ICD-9-CM data. DATA COLLECTION/EXTRACTION METHODS: Trained, blinded coders reabstracted all ICD-9-CM diagnoses and procedures, and established the timing of each diagnosis. APR-DRG Risk of Mortality and Severity of Illness classes were assigned based on (1) all hospital-reported diagnoses, (2) all reabstracted diagnoses, and (3) reabstracted diagnoses present at admission. The outcome variables were 30-day mortality in the 1991-1993 data set and 30-day inpatient mortality in the 1990/1991 validation sample. PRINCIPAL FINDINGS: The APR-DRG Risk of Mortality class was a strong predictor of death (c = .831-.847), but was further enhanced by adding age and sex. Reabstracting diagnoses improved the apparent performance of APR-DRGs (c = .93 versus c = .87), while using only the diagnoses present at admission decreased apparent performance (c = .74). Reabstracting diagnoses had less effect on hospitals' expected mortality rates (r = .83-.85) than using diagnoses present at admission instead of all reabstracted diagnoses (r = .72-.77). There was fair agreement in classifying hospital performance based on these three sets of diagnostic data (K = 0.35-0.38). CONCUSIONS: The APR-DRG Risk of Mortality system is a powerful risk-adjustment tool, largely because it includes all relevant diagnoses, regardless of timing. Although some late diagnoses may not be preventable, APR-DRGs appear suitable only if one assumes that none is preventable.     

What is the association between sickness absence, mortality and morbidity?

This paper examines the area-level relationships in England and Wales between sickness absence ('incapacity benefit'), mortality and morbidity. It uses a random sample of incapacity benefit claims, and population counts of mortality and Census morbidity for local government districts. Although there is little correspondence between sickness absence claims by specific cause and mortality, all cause sickness absence has a strong relationship with all cause mortality (male r 0.74, p=0.00; female r 0.64, p=0.00) and it also has a very strong relationship with the Census measures of morbidity: LLTI (male r 0.98, p=0.00; female r 0.97, p=0.00) and 'not good health' (male r 0.99, p=0.00; female r 0.96, p=0.00). Incapacity benefit claims by all causes has the potential to provide an ongoing measure of area-level health in England and Wales.     

Mid-upper-arm-circumference and mid-upper-arm circumference z-score: the best predictor of mortality?

Background/Objective:Mid-upper-arm circumference (MUAC) is a simple method of assessing nutritional status in children above 6 months of age. In 2007 World Health Organization (WHO) introduced a MUAC z-score for children above 3 months of age. We evaluated whether MUAC or MUAC z-score had the best ability to identify children with high short-term mortality risk in Guinea-Bissau.Subjects/Methods:The Bandim Health Project visits children 3-monthly until 3 years of age. MUAC is measured and deaths are registered. We studied a high-mortality cohort of children born in 1995-96 and a lower mortality cohort of children born in 2005-06. The prognostic ability of MUAC and MUAC z-score to predict mortality within 1 and 3 months after the MUAC assessment were compared by area under the receiver operating characteristic curve, sensitivity and positive predictive value.Results:Compared with MUAC z-score, MUAC identified as malnourished more girls than boys (prevalence ratio (PR)=1.74 (1.52;2.01)) and more children aged 6-11 months than children aged 12-35 months (1.59 (1.38;1.82)). There was no difference in the prognostic ability of MUAC and MUAC z-score to predict mortality for children aged 6-35 months. The prognostic ability was higher when mortality was lower. MUAC performed well in the youngest infants.Conclusion:In the age group 6-35 months, MUAC and MUAC z-score had the same prognostic ability to predict short-term mortality. As MUAC is easier to use in field settings, there is no need to use MUAC z-score to identify children with a high-mortality risk.     

Does the association between smoking and mortality differ by educational level?

Some researchers suggest that the effect of smoking on health depends on socioeconomic status; while others purport that the effect of smoking on health is similar across all social groups. This question of the interaction between smoking and socioeconomic status is important to an improved understanding of the role of smoking in the social gradient in mortality and morbidity. For this purpose, we examined whether educational level modifies the association between smoking and mortality. Information on smoking by age, gender and educational level was extracted from the Belgian Health Interview Surveys of 1997 and 2001. The mortality follow up of the survey respondents was reported until December 2010. A Poisson regression was used to estimate the hazard ratio of mortality for heavy smokers, light smokers, and former smokers compared with never smokers by educational level controlling for age and other confounders. Among men, we found lower hazard ratios in the lowest educational category compared with the intermediate and high-educated categories. For instance, for heavy smokers, the hazard ratios were 2.59 (1.18-5.70) for those with low levels of education, 4.03 (2.59-6.26) for those with intermediate levels of education and 3.78 (1.52-9.43) for the highly educated. However, the interaction between smoking and education was not statistically significant. For women, the hazard ratios were not significant for any educational category except for heavy smokers with intermediate levels of education. Also here the interaction was not statistically significant. Our results support the hypothesis that educational attainment does not substantially influence the association between smoking and mortality.     

Asthma mortality in the city of São Paulo,Brazil

OBJECTIVE: To quantify and compare asthma mortality rates as the main cause of death, taking into consideration the following variables: sex, age and seasonality. METHODS: Data was collected from all death certificates coded 493 of people aged 5 to 34 years in the periods of 1983-5 and 1993-5 in the city of S?o Paulo, SP, Brazil. Data analysis was performed by directly comparing death rates and identifying the odds ratio trend and directly comparing the numbers of asthma deaths. RESULTS: There was no increase in asthma mortality rates for the study periods. There was no difference between men and women. A greater number of deaths in the age group 20 to 34 years were observed. Seasonality was more evident in the first period studied. CONCLUSIONS: Differing from reports in other countries, the results did not show any increase in asthma mortality rates, The variable sex didn't seem to interfere with mortality. Deaths are more frequent among young adults, and their risk may be 9 times greater than that of young children. Deterioration of social and economic issues and health care services and even climatic changes may have been implicated in the absence of seasonality as a risk factor for asthma mortality. The disease by itself is not considered by many health professionals as critical in order to explain the chain of events that lead to death.     

Do subject characteristics modify the effects of particulate air pollution on daily mortality among the elderly?

OBJECTIVE: Studies have reported associations between mortality and air pollution, but questions subsist on the identification of susceptible subgroups in the population. We studied individual characteristics that modify the relationship between particulate air pollution and mortality among elderly. METHOD: We examined 527 nonaccidental deaths (197 cardiorespiratory deaths) among the 1469 subjects from the Personnes Agees QUID cohort in Bordeaux between 1988 and 1997. Air pollution was measured as black smoke by urban monitoring background stations. We used a case crossover approach and calculated odds ratio by conditional logistic regression models. RESULTS: We observed associations between the third lag day and cardiorespiratory mortality for an increase of 10 microg/m3 of black smoke (odds ratio = 1.30, 95% confidence interval: 1.01-1.68). CONCLUSIONS: Our results provide insight into factors possibly conferring susceptibility to the acute effect of urban air pollution.     

Maternal mortality in Brazil: what has the scientific literature shown in the last 30 years?

The aim of this study was to analyze maternal mortality in Brazil in the last 30 years, by means of a literature review. The authors performed an electronic search of scientific articles from 1980 to 2010 in LILACS and MEDLINE and found 486 abstracts, of which 50 articles were selected. Studies showed a decrease in the maternal mortality ratio (MMR), although varying across regions of the country. A few articles evaluated maternal mortality factors, identifying social inequalities associated with skin color and schooling. There was persistent underreporting of maternal deaths and inadequate completion of death certificates. Direct obstetric causes were the most frequent, mainly hypertensive diseases of pregnancy. Analysis of avoidability revealed deficiencies in prenatal and childbirth care. Despite the relevance of maternal mortality in Brazil, there are few studies on the subject. Although MMR has decreased, it is still above the desired levels. Improvements are thus needed in the quality of prenatal and perinatal care.