Avoidable mortality in Europe 1955-1994: a plea for prevention.
OBJECTIVE: To analyse trends of avoidable mortality in Europe, emphasising causes of death amenable to primary prevention through reduction of exposures, secondary prevention through early detection and treatment, and tertiary prevention through improved treatment and medical care. DESIGN: Descriptive study of mortality from avoidable causes for the years 1955 through 1994, for ages 5-64 at time of death. Using the World Health Organisation Mortality Database, five year death rates were standardised to the world population. SETTING: 21 countries of Europe in four regions (northern, central, and southern Europe, Nordic countries). PARTICIPANTS: All causes of deaths for men and women, aged 5-64, at time of death. MAIN RESULTS: Between 1955-59 and 1990-94, the reduction in mortality was somewhat greater for avoidable causes than for all causes: 45.8% v 45.1% (women) and 39.3% v 32.6% among men. Reductions in mortality were greater for causes amenable to improved medical care: 77.9% among women and 76.3% among men. The smallest reduction in mortality was seen in women for causes amenable to secondary prevention (11.0%), and in men for causes amendable to primary prevention including tobacco related conditions (16.6%). From a geographical point of view, there were slight differences in trends between European regions, but overall the patterns were similar. CONCLUSIONS: The greatest reduction of avoidable mortality in Europe from 1955-94 came from causes amenable to improved treatment and medical care for both sexes. Further reductions of avoidable mortality can be achieved through implementation of primary and secondary prevention activities, such as tobacco control, reduction of occupational exposures, and universal access to breast and cervical cancer screening programmes. (+info)
Comparative total mortality in 25 years in Italian and Greek middle aged rural men.
STUDY OBJECTIVE: Mortality over 25 years has been low in the Italian and very low in the Greek cohorts of the Seven Countries Study; factors responsible for this particularity were studied in detail. PARTICIPANTS AND SETTINGS: 1712 Italian and 1215 Greek men, aged 40-59 years, cohorts of the Seven Countries Study, representing over 95% of the populations in designated rural areas. DESIGN: Entry (1960-61) data included age, systolic blood pressure (SBP), smoking habits, total serum cholesterol, body mass index (BMI), arm circumference, vital capacity (VC), and forced expiratory volume in 3/4 seconds (FEV); the same data were obtained 10 years later. Multivariate Cox analysis was performed with all causes death in 25 years as end point. MAIN RESULTS: Italian men had higher entry levels of SBP, arm circumference, BMI, and VC; Greek men had higher cholesterol levels, smoking habits, and FEV. Mortality of Italian men was higher throughout; at 25 years cumulative mortality was 48.3% and 35.3% respectively. Coronary heart disease and stroke mortality increased fivefold in Italy and 10-fold in Greece between years 10 and 25. The only risk factor with a significantly higher contribution to mortality in Italian men was cholesterol. However, differences in entry SBP (higher in Italy) and FEV (higher in Greece) accounted for, according to the Lee method, 75% of the differential mortality between the two populations. At 10 years increases in SBP, cholesterol, BMI, and decreases in smoking habits, VC, FEV, and arm circumference had occurred (deltas). SBP increased more and FEV and VC decreased more in Italy than in Greece. Deltas, fed stepwise in the original model for the prediction of 10 to 25 years mortality, were significant for SBP, smoking, arm circumference, and VC in Greece, and for SBP and VC in Italy. CONCLUSION: Higher mortality in Italian men is related to stronger positive effects of entry SBP and weaker negative (protective) effects of FEV; in addition 10 year increases in SBP are higher and 10 year decreases in FEV are larger in Italy. Unaccounted factors, however, related to, for example, differences in the diet, may also have contributed to the differential mortality of these two Mediterranean populations. (+info)
Respiratory symptoms and long-term risk of death from cardiovascular disease, cancer and other causes in Swedish men.
BACKGROUND: Depressed respiratory function and respiratory symptoms are associated with impaired survival. The present study was undertaken to assess the relation between respiratory symptoms and mortality from cardiovascular causes, cancer and all causes in a large population of middle-aged men. METHODS: Prospective population study of 6442 men aged 51-59 at baseline, free of clinical angina pectoris and prior myocardial infarction. RESULTS: During 16 years there were 1804 deaths (786 from cardiovascular disease, 608 from cancer, 103 from pulmonary disease and 307 from any other cause). Men with effort-related breathlessness had increased risk of dying from all of the examined diseases. After adjustment for age, smoking habit and other risk factors, the relative risk (RR) associated with breathlessness of dying from coronary disease was 1.43 (95% CI : 1.16-1.77), from stroke 1.77 (95% CI: 1.07-2.93), from any cardiovascular disease 1.48 (95% CI : 1.24-1.76), cancer 1.36 (95% CI : 1.11-1.67) and from any cause 1.62 (95% CI: 1.44-1.81). An independent effect of breathlessness on cardiovascular death, cancer death and mortality from all causes was found in life-time non-smokers, and also if men with chest pain not considered to be angina were excluded. An independent effect was also found if all deaths during the first half of the follow-up were excluded. Men with cough and phlegm, without breathlessness, also had an elevated risk of dying from cardiovascular disease and cancer, but after adjustment for smoking and other risk factors this was no longer significant. However, a slightly elevated independent risk of dying from any cause was found (RR = 1.18 [95% CI: 1.02-1.36]). CONCLUSION: A positive response to a simple question about effort related breathlessness predicted subsequent mortality from several causes during a follow-up period of 16 years, independently of smoking and other risk factors. (+info)
Water traffic accidents, drowning and alcohol in Finland, 1969-1995.
OBJECTIVE: To examine age- and sex-specific mortality rates and trends in water traffic accidents (WTA), and their association with alcohol, in Finland. MATERIALS AND METHODS: National mortality and population data from Finland, 1969-1995, are used to analyse rates and trends. The mortality rates are calculated on the basis of population, per 100000 inhabitants in each age group (<1, 1-4, 5-14, 15-24, 25-44, 45-64, > or = 65), and analysed by sex and age. The Poisson regression model and chi2 test for trend (EGRET and StatXact softwares) are used to analyse time trends. RESULTS: From 1969 through 1995 there were 3473 (2.7/100000/year; M:F= 20.4:1) WTA-related deaths among Finns of all ages. In 94.7% of the cases the cause of death was drowning. Alcohol intoxication was a contributing cause of death in 63.0% of the fatalities. During the study period the overall WTA mortality rates declined significantly (-4% per year; P < 0.001). This decline was observed in all age groups except > or = 65 year olds. The overall mortality rates in WTA associated with alcohol intoxication (1987-1995) also declined significantly (-6%; P = 0.01). CONCLUSIONS: In Finland, mortality rates in WTA are exceptionally high. Despite a marked decline in most age groups, the high mortality in WTA nevertheless remains a preventable cause of death. Preventive countermeasures targeted specifically to adult males, to the reduction of alcohol consumption in aquatic settings and to the use of personal safety devices should receive priority. (+info)
A method for calculating age-weighted death proportions for comparison purposes.
OBJECTIVE: To introduce a method for calculating age-weighted death proportions (wDP) for comparison purposes. MATERIALS AND METHODS: A methodological study using secondary data from the municipality of Sao Paulo, Brazil (1980-1994) was carried out. First, deaths are weighted in terms of years of potential life lost before the age of 100 years. Then, in order to eliminate distortion of comparisons among proportions of years of potential life lost before the age of 100 years (pYPLL-100), the denominator is set to that of a standard age distribution of deaths for all causes. Conventional death proportions (DP), pYPLL-100, and wDP were calculated. RESULTS: Populations in which deaths from a particular cause occur at older ages exhibit lower wDP than those in which deaths occur at younger ages. The sum of all cause-specific wDP equals one only when the test population has exactly the same age distribution of deaths for all causes as that of the standard population. CONCLUSION: Age-weighted death proportions improve the information given by conventional DP, and are strongly recommended for comparison purposes. (+info)
The meaning and use of the cumulative rate of potential life lost.
BACKGROUND: The 'years of potential life lost' (YPLL) is a public health measure in widespread use. However, the index does not apply to the comparisons between different populations or across different time periods. It also has the limit of being cross-sectional in nature, quantifying current burden but not future impact on society. METHODS: A new years-lost index is proposed-the 'cumulative rate of potential life lost' (CRPLL). It is a simple combination of the 'cumulative rate' (CR) and the YPLL. Vital statistics in Taiwan are used for demonstration and comparison of the new index with existing health-status measures. RESULTS: The CRPLL serves the purpose of between-group comparison. It can also be considered a projection of future impact, under the assumption that the age-specific mortality rates in the current year prevail. For a rare cause of death, it can be interpreted as the expected years (days) of potential life lost during a subject's lifetime. CONCLUSIONS: The CRPLL has several desirable properties, rendering it a promising alternative for quantifying health status. (+info)
Toxic oil syndrome mortality: the first 13 years.
BACKGROUND: The toxic oil syndrome (TOS) epidemic that occurred in Spain in the spring of 1981 caused approximately 20000 cases of a new illness. Overall mortality and mortality by cause in this cohort through 1994 are described for the first time in this report. METHODS: We contacted, via mail or telephone, almost every living member of the cohort and family members of those who were known to have died in order to identify all deaths from 1 May 1981 through 31 December 1994. Cause of death data were collected from death certificates and underlying causes of death were coded using the International Classification of Diseases, 9th Revision. RESULTS: We identified 1663 deaths between 1 May 1981 and 31 December 1994 among 19 754 TOS cohort members, for a crude mortality rate of 8.4%. Mortality was highest during 1981, with a standardized mortality ratio (SMR) of 4.92 (95% confidence interval [CI]: 4.39-5.50) compared with the Spanish population as a whole. The highest SMR, (20.41, 95% CI: 15.97-25.71) was seen among women aged 20-39 years during the period from 1 May 1981 through 31 December 1982. Women <40 years old, who were affected by TOS , were at greater risk for death in most time periods than their unaffected peers, while older women and men were not. Over the follow-up period, mortality of the cohort was less than expected when compared with mortality of the general Spanish population, or with mortality of the population of the 14 provinces where the epidemic occurred. We also found that, except for deaths attributed to external causes including TOS and deaths due to pulmonary hypertension, all causes of death were decreased in TOS patients compared to the Spanish population. The most frequent underlying causes of death were TOS, 350 (21.1%); circulatory disorders, 536 (32.3%); and malignancies, 310 (18.7%). CONCLUSIONS: We conclude that while on average people affected by toxic oil syndrome are not at greater risk for death over the 13-year study period than any of the comparison groups, women <40 years old were at greater risk of death. (+info)
Failing firefighters: a survey of causes of death and ill-health retirement in serving firefighters in Strathclyde, Scotland from 1985-94.
During the decade beginning 1 January 1985, 887 full-time firefighters, all male, left the service of Strathclyde Fire Brigade (SFB). There were 17 deaths--compared to 64.4 expected in the Scottish male population aged 15-54 years--giving a standardized mortality ratio (SMR) of 26, and 488 ill-health retirements (IHR). None of the deaths was attributable to service, the major causes being: myocardial infarction--five, (expected = 17.3; SMR = 29); cancers--three (colon, kidney and lung) (expected = 13.6; SMR = 22); road traffic accidents--two (expected = 4.17; SMR = 48) and suicide--two (expected = 4.9; SMR = 41). Amalgamating the deaths and IHRs showed that the six most common reasons for IHR were musculoskeletal (n = 202, 40%), ocular (n = 61, 12.1%), 'others' (n = 58, 11.5%), injuries (n = 50, 9.9%), heart disease (n = 48, 9.5%) and mental disorders (n = 45, 8.9%). Over 300 IHRs (over 60%) occurred after 20 or more years service. When the IHRs were subdivided into two quinquennia, there were 203 and 302 in each period. Mean length of service during each quinquennium was 19.4 vs. 21.3 years (p = 0.003) and median length was 21 years in both periods; interquartile range was 12-26 years in the first and 17-27 years in the second period (p = 0.002), but when further broken down into diagnostic categories, the differences were not statistically significant, with the exception of means of IHRs attributed to mental disorders (14.5 vs. 19 years, p = 0.03). (+info)