Long-Term Prospective Study of 6104 Survivors of Arsenic Poisoning During Infancy Due to Contaminated Milk Powder in 1955

Background

In 1955, an outbreak of arsenic poisoning caused by ingestion of arsenic-contaminated dry milk occurred in western Japan. We assessed the excess mortality among Japanese who were poisoned during this episode as infants.

Methods

We identified and enrolled 6104 survivors (mean age at enrollment, 27.4 years) who had ingested contaminated milk when they were age 2 years or younger; they were followed until 2006 (mean duration of follow-up, 24.3 years). Death certificates of subjects who died between 1982 and 2006 were examined to calculate cause-specific standardized mortality ratios (SMRs) using the mortality rate among Osaka residents as the standard.

Results

There was no significant excess overall mortality (SMR: 1.1, 95% confidence interval: 1.0–1.2). However, significant excess mortality in both sexes was observed from diseases of the nervous system (3.7, 1.9–6.2). Excess mortality from all causes of death decreased to unity beyond 10 years after study enrollment. The 408 men who were unemployed at the time of enrollment in the study had a significantly elevated risk of death from diseases of the nervous system (25.3, 10.8–58.8), respiratory diseases (8.6, 3.1–16.8), circulatory diseases (3.2, 1.6–5.2), and external causes (2.6, 1.4–4.1).

Conclusions

As compared with the general population, survivors of arsenic poisoning during infancy had a significantly higher mortality risk from diseases of the nervous system.Key words: arsenic poisoning, mortality, prospective study, food poisoning, standardized mortality ratio     

2002—2014年上海市浦东新区居民大肠癌死亡及减寿率分析

目的了解2008—2017年上海市浦东新区高东社区居民的死亡水平、主要死因及其对居民寿命损失和期望寿命的影响,进一步为相关疾病防控提供依据。方法采用死亡率、潜在减寿年数、期望寿命、去死因期望寿命及疾病对期望寿命的归因等指标,对2008—2017年的人口资料及死亡资料进行回顾性分析。结果该社区户籍居民≥65岁人口构成比从2008年的14.99%上升至2017年的22.59%;2008—2017年该社区户籍居民的平均粗死亡率为810.06/10万,平均标化死亡率为356.03/10万,男性粗死亡率高于女性(P＜0.05),2013—2017年的总体和男性粗死亡率均高于2008—2012年(均P＜0.05)。死因顺位前5位占全死因的80.11%,分别是循环系统疾病、肿瘤、呼吸系统疾病、损伤和中毒及内分泌、营养和代谢疾病。全死因潜在减寿年数为8 662.00人年,平均减寿年数为2.93人年,潜在减寿率为23.73‰,标化潜在减寿年数为8 053.26人年,标化潜在减寿率为22.06‰。潜在减寿年数(PYLL)最大的死因为肿瘤,平均减寿年数值最大的死因为损伤和中毒。该社区户籍居民2008—2017年的平均期望寿命为83.34岁,去除循环系统及肿瘤2大死因后,期望寿命分别提高5.27和4.11岁,寿命增长率分别为6.32%和4.93%。2008—2017年间对该社区户籍居民期望寿命变化呈负归因的慢性病有糖尿病、心脏病、脑血管病、大肠癌、呼吸系统疾病、食管癌和高血压。结论高东社区人口老龄化严重,期望寿命已达发达国家水平,慢性非传染性疾病及伤害是高东社区户籍居民的主要致死原因,也是对寿命损失及期望寿命影响最大的疾病。     

广东省四会市2004-2010年居民死因监测结果分析

目的 分析广东四会市2004-2010年居民死亡趋势、死因谱,掌握四会市居民主要疾病谱和变化趋势,为卫生政策制定和资源配置提供科学依据.方法 收集2004-2005年四会市第3次死因回顾调查资料以及2006-2010年居民常规死因监测资料,采用国际疾病分类ICD - 10进行编码,运用Excel和SPSS 13.0进行...     

Excess mortality among 5,064 victims of arsenic poisoning from ingestion of arsenic-contaminated "Morinaga dry-milk" in 1955: a prospective study from 1982 to 2004

OBJECTIVES: A prospective cohort study was conducted to assess the excess mortality among victims of arsenic poisoning who had ingested "Morinaga dry-milk" that was contaminated with arsenic compounds in 1955. METHODS: We identified and enrolled 5,064 individuals who had ingested contaminated Morinaga dry-milk when they were aged two years or younger, in 1982 (mean age: 27.4 years) and they were followed until 2004 (mean length of follow-up: 22.3 years). The death certificates of subjects who died between 1982 and 2004 were examined. The risk of death was assessed by the ratio of the observed number (O) to the expected number of deaths (E), calculated from the mortality rate among Osaka residents. RESULTS: The O/E ratio for all causes of death was 1.3 (O = 211, P < 0.01). Significant excess mortality was observed for diseases of the central nervous system (O/E = 5.4) or circulatory system (O/E = 1.4), external causes (O/E = 1.4) and traffic accidents (O/E = 2.0). Excess mortality from all causes appeared 0 to 4 years after study enrollment (O/E = 2.1, P < 0.01), and then the O/E ratio decreased to unity (O/E = 1.2) beyond 10 years after study enrollment. The 352 males who were unemployed at the time of enrollment in the study showed significantly elevated risk of death from all causes (O/E = 3.3), death from disease of the central nervous system (O/E = 36.7), circulatory system (O/E = 3.7) or respiratory system (O/E = 5.7), and death from external causes (O/E = 3.4). CONCLUSION: This prospective cohort study showed that excess mortality from all causes among the victims of arsenic poisoning from ingestion of arsenic-contaminated "Morinaga dry-milk" in 1955 decreased to unity when they reached middle age.     

广东省四会市2004-2010年居民死因监测结果分析

目的分析广东四会市2004-2010年居民死亡趋势、死因谱，掌握四会市居民主要疾病谱和变化趋势，为卫生政策制定和资源配置提供科学依据。方法收集2004-2005年四会市第3次死因回顾调查资料以及2006-2010年居民常规死因监测资料，采用国际疾病分类ICD-10进行编码，运用Excel和SPSS13．0进行统计分析，计算人群粗死亡率、标化死亡率、死因构成、平均期望寿命等指标。结果2004-2010年四会市居民年平均死亡率为581．51／10万（标化死亡率为470．80／10万），其中男性平均死亡率为610．28／10万（标化死亡率为667．89／10万），女性平均死亡率为550．93／10万（标化死亡率为321．72／10万），两者差异有统计学意义（P〈0．05）。前5位死因依次为呼吸系统疾病、循环系统疾病、肿瘤、损伤和中毒、消化系统疾病，前5位死因合计占全死因构成的89．78％。起源于围生期的某些疾病是0—4岁组居民的首位死因，损伤和中毒是5～19岁组居民的首位死因，肿瘤是20-59岁组居民的首位死因，呼吸系统疾病、循环系统疾病、肿瘤是60岁及以上居民的前3位死因。结论起源于围生期的某些疾病、损伤和中毒、慢性病是四会市居民的主要死亡原因，育龄妇女应加强产检，预防婴幼儿围生期疾病，儿童青年应着重加强损伤和中毒的预防，中老年人应加强呼吸系统疾病、循环系统疾病、肿瘤等慢性病的防治。     

An analysis of excess mortality rates for persons with non-insulin-dependent diabetes mellitus in Western Australia using the Cox proportional hazards regression model.

A cohort of 888 rural, nonaboriginal persons with non-insulin-dependent diabetes mellitus identified in Western Australia through surveys in 1978-1982 were followed for death until the end of 1986. A total of 257 deaths were observed. Excess mortality in this cohort as compared with the general Australian population was investigated by calculating standardized mortality ratios and using the Cox proportional hazards regression model with hazard rates for the general population as the baseline. The overall standardized mortality ratio was 1.83 (95% confidence interval 1.51-2.16) for women and 1.43 (95% confidence interval 1.18-1.67) for men. Cause-specific comparisons with the general population showed that the majority of excess deaths could be attributed to diseases of the circulatory system. Factors assessed at the baseline survey that were independently prognostic of shorter survival were early onset of diabetes (for females only), high plasma glucose level, retinopathy, macrovascular disease, albuminuria (for females only), and elevated plasma creatinine level. Reductions in life expectancy at 60 years of age as compared with the general population averaged about 5 years but could be as much as 16 years for female diabetics with early onset of diabetes, high plasma glucose levels, and several complications.     

The burden of diabetes-related mortality in France in 2002: an analysis using both underlying and multiple causes of death

Aim To describe the burden of diabetes-related mortality in France. Methods Underlying and multiple causes (all causes listed) of death were extracted from the 2002 French national mortality registry. Death rates were standardized on the age structure of the European population. Results Diabetes was reported as the underlying cause of death in 11,177 certificates (2.1%), and as multiple causes in 29,357 certificates (5.3%), giving a ratio (multiple/underlying causes) of 2.6. When diabetes was a multiple cause, the mean age at death was 75 years in men, 81 years in women. The age-standardized mortality rates were 41.0/100,000 in men, 24.6/100,000 in women. The excess mortality observed in men (men/women ratio = 1.7) decreased with age. Geographic differences were observed: higher rates in the North-East, lower rates in the West of the country. In certificates mentioning diabetes, the most frequent cause of death was diseases of the circulatory system (76%). Coronary heart diseases, foot ulcers and renal diseases were more likely to be mentioned in certificates referring to diabetes than in those that did not. Discussion The use of multiple rather than underlying causes of death more than doubled diabetes-related mortality rates. While probably still under-estimated, the burden of diabetes-related mortality corresponds to a high proportion of the total mortality, especially in men. Geographic differences partially reflect disparities in diabetes prevalence. Causes more frequently associated with diabetes include coronary heart disease and complications related to neuropathy and nephropathy.     

循环系疾病已经成为上海地区60岁以上老人首位死因

[目的 ]　分析上海地区 6 0岁以上老年人循环系病死亡情况。 [方法 ]　利用上海市 2 0 0 0年死亡个案记录 ,按国际疾病分类 (ICD— 9)进行分类。用DIS居民死亡分析软件处理。 [结果 ]　 6 0岁以上老年人循环系病死亡占 6 0岁以上死亡总数的 36 .2 9% ,男性死亡率大于女性 ,各年龄组死亡率上升幅度呈几何级数增加 ,高血压、糖尿病、脑血管病的晚期(残留 )效应是主要的危险因素。 [结论 ]　循环系病是 6 0岁以上老人的首位死因 ,同时也构成了当前上海地区人群的主要死亡原因     

新疆生产建设兵团2008-2012年居民死因分析

目的 了解新疆生产建设兵团(兵团)居民死因状况及主要死因造成的寿命损失情况,为制定有效的预防干预措施提供科学依据.方法 利用兵团2008-2012年8个师部死因监测系统上报的数据和公安部门提供的人口资料,采用ICD-10进行死因分类,使用Excel 2010和SAS 9.2软件进行数据整理和统计分析,计算死亡率、潜在寿命损失年(potential years of life lost,PYLL)和减寿率等指标.结果 兵团2008-2012年居民粗死亡率为508.67/10万,男性624.01/10万,女性383.14/10万,男性粗死亡率高于女性;0～岁组和15～岁组的5年标化死亡率呈下降趋势,45～岁组和≥65岁组的标化死亡率呈上升趋势;损伤与中毒占0～岁组和15～岁组死亡人数的构成比为24.19％和30.48％,循环系统疾病占45～岁组和≥65岁组死亡人数的构成比为36.68％和47.20％;按标化潜在寿命损失年(standard potential years of life lost,SPYLL)排序前5位死因依次是损伤与中毒、循环系统疾病、恶性肿瘤、呼吸系统疾病和消化系统疾病.结论 损伤与中毒和慢性非传染性疾病已经成为严重威胁兵团居民健康的公共卫生问题,应有针对性的开展健康教育与健康促进等措施,降低损伤与中毒和慢性非传染性疾病对居民健康的威胁.     

Geographic disparity in premature mortality in Ontario, 1992-1996

BACKGROUND: Standardized mortality ratios are used to identify geographic areas with higher or lower mortality than expected. This article examines geographic disparity in premature mortality in Ontario, Canada, at three geographic levels of population and considers factors that may underlie variations in premature mortality across geographic areas. All-cause, sex and disease chapter specific premature mortality were analyzed at the regional, district and public health unit level to determine the extent of geographic variation. Standardized mortality ratios for persons aged 0-74 years were calculated to identify geographic areas with significantly higher or lower premature mortality than expected, using Ontario death rates as the basis for the calculation of expected deaths in the local population. Data are also presented from the household component of the 1996/97 National Population Health Survey and from the 1996 Statistics Canada Census. RESULTS: Results showed approximately 20% higher than expected all-cause premature mortality for males and females in the North region. However, disparity in all-cause premature mortality in Ontario was most pronounced at the public health unit level, ranging from 20% lower than expected to 30% higher than expected. Premature mortality disparities were largely influenced by neoplasms, circulatory diseases, injuries and poisoning, respiratory diseases and digestive diseases, which accounted for more than 80% of all premature deaths. Premature mortality disparities were also more pronounced for disease chapter specific mortality. CONCLUSION: Geographic disparities in premature mortality are clearly greater at the small area level. Geographic disparities in premature mortality undoubtedly reflect the underlying distribution of population health determinants such as health related behaviours, social, economic and environmental influences.     

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

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

2015-2018年乌海市市区居民死因分析

目的 了解2015-2018年乌海市市区居民主要死因及寿命损失，为提出有针对性的疾病预防控制策略提供依据。 方法 整理2015-2018年乌海市市区居民全死因数据，分析死亡率、死因顺位、期望寿命等指标。结果 2015-2018年乌海市市区居民粗死亡率为533.59/10万，标化死亡率为531.61/10万，男性高于女性，随年龄增长死亡率呈升高趋势（〖XC小五号.EPS;P〗=30785.35，P<0.001）。全人群死因前5位依次为循环系统疾病、肿瘤、呼吸系统疾病、损伤和中毒及其他，占全部死亡人数的90.34%；其中循环系统疾病和肿瘤占全部死亡人数的69.33%。2015-2018年乌海市市区居民期望寿命为77.20岁，去循环系统疾病和去肿瘤后期望寿命可分别增加5.44岁和3.33岁。结论 循环系统疾病和肿瘤是乌海市市区居民的两大死因，也是造成居民期望寿命损失最主要的两大疾病，尤其要重点关注肿瘤。     

厦门市2002-2009年老年人口死因分析

目的了解厦门市老年人口死亡特征,评价老年人口主要死因的影响程度及变化趋势。方法应用死亡率、标化死亡率、死因构成及死因顺位、老年保健效益指数（GEI）等统计指标,对2002-2009年厦门市60岁以上老年人口死因资料进行分析。结果 2002-2009年间老年人口死亡总数为42 435人,占全部死亡人数的72.43%,平均死亡率为31.11‰。死亡率男性高于女性,城乡差异无统计学意义。主要死因为恶性肿瘤、脑血管病、心脏病、呼吸系统疾病、损伤与中毒等,前五位死因占总死亡的84.68%,全死因中慢性非传染性疾病的死亡占总死亡的90.59%。主要疾病的GEI顺位为恶性肿瘤、意外伤害、传染病、呼吸系统疾病和心脑血管疾病,大多数死因的GEI高于0.5,女性普遍高于男性。与1987-1997年统计结果比较,死亡率呈下降趋势,各主要疾病的GEI也有所下降。结论厦门市老年人口主要死因是恶性肿瘤、心脑血管疾病和呼吸系统疾病等慢性疾病,是影响老年人寿命的最主要原因,应当作为老年医疗卫生工作的重点,并引起全社会的关注。     

常德市鼎城区2013-2015年居民心脑血管疾病死亡状况及疾病负担分析

目的 了解常德市鼎城区居民2013-2015年心脑血管疾病死亡情况及疾病负担的影响,为有针对性的开展预防和干预措施提供科学依据。方法 本文利用鼎城区2013-2015年各年度死因登记资料及人口资料进行统计分析,计算粗死亡率、标化死亡率、健康寿命年损失年等指标。结果 2013-2015年常德市鼎城区居民因心脑血管疾病死亡6 207人,粗死亡率为257.54/10万,标化死亡率为252.27/10万,死亡率随着年龄的增加而增加。男女标化死亡率分别为275.69/10万和233.20/10万,男性高于女性。按各主要心脑血管疾病死亡数进行排序如下:脑血管病、高血压性心脏病、循环系统其他疾病、缺血性心脏病、风湿性心脏病、炎症性心脏病。心脑血管疾病造成的平均每千人健康寿命年损失(YLL率‰)为20.77人年,标化后YLL率‰为18.57人年,平均每位因心脑血管疾病死者健康寿命年损失(YLLd) 8.07人年。结论 心脑血管疾病严重危害鼎城区居民的生命健康,已成为鼎城区居民疾病负担的主要原因,应针对目标人群制定有效的控制策略和干预措施,以降低居民心脑血管疾病的死亡率。     

2006-2009年大连市金州区居民死因分析

目的了解金州区居民的健康水平及其影响因素,为针对影响居民健康状况的主要死因进行干预提供科学依据。方法使用卫生部指定的死因专用软件"DeathReg2005"对"中国疾病预防控制系统"的"死因登记报告信息系统"中的数据进行统计分析,按照国际疾病分类ICD-10进行分类统计。结果 2006-2009年金州区居民年均死亡率为749.92/10万,标化死亡率为406.17/10万;前5位死因依次是循环系统疾病、肿瘤、损伤中毒、呼吸系统疾病、内分泌系统疾病;各年龄组主要死因婴儿组为围生期疾病、少儿组为损伤中毒、青中年为肿瘤、老年人为循环系统疾病;对寿命损失影响最大的前3位死因是肿瘤、损伤中毒、循环系统疾病。结论循环系统疾病、肿瘤等慢性非传染性疾病和伤害已成为金州区居民的主要死因。     

Mortality among individuals diagnosed with glucose intolerance by the 75 g oral glucose tolerance test in rural Japanese communities

OBJECTIVE: To examine mortality among individuals confirmed to have glucose intolerance by the 75 g oral glucose tolerance test (OGTT) in rural communities. METHODS: Subjects were 1,639 residents of seven rural communities in Japan (total population size = 54,000) who underwent an OGTT as a secondary screening test for diabetes during 1987-95 and had received no medication for diabetes at baseline. OGTT results were classified as diabetes (n = 471), impaired glucose tolerance (IGT) (n = 408), or normal glucose tolerance (NGT) (n = 760), according to the recommendations of the American Diabetes Association. Indirect age-adjusted mortality rates and standardized mortality ratios (SMRs) for diabetes and IGT groups were calculated using age-stratified mortality rates for people aged 40-89 in the communities as the standard population. Relative risks of death and 95% confidence intervals (CI) for diabetes and IGT were calculated using Cox's proportional models, adjusted for age and baseline factors such as body mass index (BMI), total cholesterol, hypertension, smoking, alcohol drinking, history of diabetes, and family history of diabetes. RESULTS: During 9.4 years of follow-up, we recorded 70 deaths for the NGT, 46 for the IGT, and 71 for the diabetes group. The SMRs for IGT and diabetic men and women were not significantly increased in comparison with the standard population values. However, when analyzed in our cohort, age-adjusted relative risks of death for IGT and diabetes versus NGT men were 1.10 (9.5% CI: 0.72-1.67) and 1.54 (95% CI: 1.05-2.24), respectively, whereas, the risks among women did not significantly vary. Finally, multivariate analysis, further adjusted for the baseline factors, indicated the relative risk of mortality with diabetes in men to be significantly increased (relative risk = 1.74, 95% CI: 1.11-2.75). CONCLUSION: During follow-up, mortality rates among screened IGT and diabetes were not significantly higher than those in general. Nonetheless, we found that diabetes elevated the risk of death in our cohort, primarily in men.     

Mortality and educational level among diabetic and non-diabetic population in the Turin Longitudinal Study: a 9-year follow-up

BACKGROUND: People in a lower social position have a higher prevalence of unhealthy behaviour, more difficult access to healthcare, and lower compliance with drug treatment; as a consequence, social differences in mortality are likely to be higher in people with diabetes compared with the non-diabetic population. We compared diabetics with non-diabetics in terms of mortality and social differences in mortality. METHODS: In all, 31 264 residents in Turin (northern Italy), who were > or =20 years old, registered in the local diabetes register between 1991 and 1999. They were followed up from recruitment to December 1999, and their cause-specific mortality by educational level was analysed. This was compared with that of the local non-diabetic population. Diabetes was classified as type 1 (< or =35 years at diagnosis) or type 2 (>35 years). RESULTS: For type 1 diabetes, the all-cause standardized mortality ratio (SMR) was 197.6 (95% CI:155.7, 247.4) in men and 336.0 (95% CI:259.3, 428.2) in women; for type 2 diabetes, the all-cause SMR was 142.8 (95% CI:138, 147.6) in men and 143.4 (95% CI:138.5, 148.5) in women. Whereas social differences in mortality were evident among non-diabetic men and women for all causes of death considered, no significant differences were found among diabetic women. Mortality was slightly increased among less educated diabetic men, particularly for neoplasms, although this gradient was less steep than that among non-diabetics. CONCLUSIONS: These results suggest that the regular clinical follow-up and health education provided by the local network of diabetic centres might play an important role in confronting the adverse effects of diabetes and in reducing social differences in health.     

The high risk of death by alcohol related diseases in subjects diagnosed as diabetic and impaired glucose tolerant: the Paris Prospective Study after 15 years of follow-up

The 15 year mortality rates and causes of death are reported for the Paris Prospective Study cohort of 7180 working men, aged between 44 and 55 years who attended the first follow-up examination. All subjects were classified as normoglycaemic, impaired glucose tolerant or diabetic according to the WHO criteria, following an oral glucose tolerance test. The relative risks of death in comparison to the normoglycaemic group were 1.6 for impaired glucose tolerant and 2.3 for diabetic subjects; for death due to coronary heart disease: 1.7 and 2.3 respectively; for death due to alcohol and cirrhosis: 7.0 and 13.3 respectively. It appears that in this cohort a proportion of subjects screened as diabetic have impaired liver function and disturbed carbohydrate metabolism, due to excessive alcohol consumption. Alcohol should be investigated as a possible risk factor for diabetes, particularly in epidemiological studies where diabetes is diagnosed by the oral glucose tolerance test and the population has a high consumption of alcohol.     

Widening socioeconomic mortality disparity among diabetic people in Finland

BACKGROUND: A clear social class gradient in mortality has been consistently reported among western populations. However, in the early 1980s in Finland, no major socioeconomic differences in mortality were found among people with diabetes. The present study examines whether this exceptional finding persisted in the 1990s. METHODS: All residents of Finland aged 30 to 74 in the 1980 and 1990 population censuses were classified as diabetic or non-diabetic according to entitlement to reimbursement for diabetes medication. The patient's age at onset of the disease was used as a proxy for diabetes type. All diabetic and non-diabetic persons were followed up for mortality in 1981-1985 and 1991-1996. Age-adjusted relative death rates were obtained from Poisson regression models. RESULTS: From the early 1980s to the early 1990s marked socioeconomic mortality disparities favouring the better-off emerged among diabetic people. The increase in socioeconomic mortality differences from 1981-1985 to 1991-1996 was mainly due to divergence in deaths from diabetes, which contributed 52% of the increase in mortality disparity among women and 35% among men, and from cardiovascular diseases, whose contribution was 21% for women and 25% for men. CONCLUSIONS: From the early 1980s to the 1990s in Finland a clear socioeconomic gradient in mortality emerged in every age group of diabetic people. This was largely due to a much worse development among blue-collar than white-collar workers in deaths from diabetes and cardiovascular diseases.