The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally. This article first considers whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases) has already taken place in Sweden during an equivalent 15-year period. Secondly, it assesses which population sub-groups have been more or less successful in contributing to overall changes in premature NCD mortality in Sweden.
A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30 to 69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality using a life table method as specified by the WHO. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality.
A total of 292,320 deaths occurred in the 30 to 69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by the WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002, and 2003-2006.
Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25?×?25 target, particularly where substantial premature mortality reductions have already been achieved.
Cites: J Epidemiol Community Health. 2015 Mar;69(3):207-17; discussion 205-624964740
Mortality parameters among able-bodied individuals engaged into nonferrous metallurgy due to cardiovascular, respiratory diseases and malignancies several times exceed the analogous parameters among general population residing in the same climate (5.4, 4.9 and 3.6 times respectively). High mortality due to malignancies among the workers exposed to nonferrous metals does not match the data by official statistics declaring the occupational malignancies rate over 400 times lower than the mortality parameter. Such gap between actual and official statistics could result from inadequate occupational medical service for these workers.
INTRODUCTION: Analysis of deaths during and up to one month after discharge from hospital. MATERIALS AND METHODS: For 2006, all deaths during and up to one month after discharge were identified for patients admitted to hospital in Roskilde or Køge. Age, acute or planned hospitalisation, duration of in-hospital stay, department of discharge and main diagnose were registered. RESULTS: Out of 50,302 hospitalisations, 2.2% had a fatal outcome during hospitalisation, whereas 2.1% died within the following month. During hospitalisation, the proportion of deaths among patients with either planned or acute admission was 1.1% and 2.6%, respectively. For several diagnose groups the risk of death during the first month after discharge was higher than that of fatal outcome during hospitalisation. The diagnose groups most frequently related to fatal outcome were cancers, infectious diseases, cardiovascular diseases and respiratory diseases. Pneumonia was the most prevalent benign diagnosis for fatal cases during hospitalisation. Data are provided for mortality related to diagnose and age group. The incidence of fatal outcome increased with the length of in-patient stay. CONCLUSION: Analysis of fatality rates also during planned hospitalisations and within the first month after acute as well as planned hospitalisations should be in focus when planning quality improvement projects.
Temperature, a key climate change indicator, is expected to increase substantially in the Northern Hemisphere, with potentially grave implications for human health. This study is the first to investigate the association between the daily 3-hour maximum apparent temperature (Tapp(max)), and respiratory, cardiovascular and cerebrovascular mortality in Copenhagen (1999-2006) using a case-crossover design. Susceptibility was investigated for age, sex, socio-economic status and place of death. For an inter-quartile range (7 °C) increase in Tapp(max), an inverse association was found with cardiovascular mortality (-7% 95% CI -13%; -1%) and none with respiratory and cerebrovascular mortality. In the cold period all associations were inverse, although insignificant.
Cites: Epidemiology. 2008 Sep;19(5):711-918520615
Cites: Scand J Public Health. 2008 Jul;36(5):516-2318567653
Cites: J Occup Environ Med. 2009 Jan;51(1):13-2519136869
Cites: Am J Respir Crit Care Med. 2009 Mar 1;179(5):383-919060232
Celiac disease may be associated with a modest but persistent increased long-term mortality risk. It is uncertain whether this risk has changed in the era of wider diagnosis rates, less severe clinical disease, and more widespread availability of gluten-free food.
To evaluate the association between celiac disease and mortality risk in a population-based cohort in Sweden.
All individuals in Sweden with celiac disease diagnosed between 1969 and 2017 were identified through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) cohort. Participants (n?=?49?829) were observed starting on the day of the biopsy. The final date of follow-up was December 31, 2017.
Celiac disease was defined by the presence of small intestinal villus atrophy on histopathology specimens during the years 1969-2017 from Sweden's 28 pathology departments. Each individual was matched with as many as 5 control participants in the general population by age, sex, county, and calendar period.
The primary outcome was all-cause mortality, and the secondary outcome was cause-specific mortality. Patients with celiac disease were compared with controls using stratified Cox proportional modeling, stratifying by year of diagnosis.
There were 49?829 patients with celiac disease, including 24% who were diagnosed between the years 2010 and 2017. The mean (SD) age at diagnosis was 32.2 (25.2) years and 62.4% were women. During a median follow-up time of 12.5 years, 13.2% (n?=?6596) died. Compared with controls (n?=?246?426), overall mortality was increased in those with celiac disease (9.7 vs 8.6 deaths per 1000 person-years; absolute difference, 1.2 per 1000 person-years; hazard ratio [HR], 1.21 [95% CI, 1.17-1.25]). The relative increase in mortality risk was present in all age groups and was greatest in those diagnosed in the age range of 18 to 39 years (1.9 vs 1.1 per 1000 person-years; HR, 1.69 [95% CI, 1.47-1.94]; P values for heterogeneity comparing 18-39 years with 40-59 years and with =60 years were both
This study was undertaken to determine whether variations in concentrations of particulates in the ambient air of Montreal, Quebec, during the period 1984 to 1993, were associated with daily variations in cause-specific daily mortality. Fixed-site air pollution monitors in Montreal provided daily mean levels of various measures of particles and gaseous pollutants. Total sulfate was also measured daily (1986-1993) at a monitoring station 150 km southeast of the city (Sutton, Quebec). We used coefficient of haze (COH), extinction coefficient, and sulfate from the Sutton station to predict fine particles and sulfate from fine particles for days that were missing. We estimated associations between cause-specific mortality and PM(2.5), PM(10), predicted fine particles and fine sulfate particles, total suspended particles, coefficient of haze, extinction coefficient, and total sulfate measured at the Sutton station. We selected a set of underlying causes of death, as recorded on the death certificates, as the endpoint and then regressed the logarithm of daily counts of cause-specific mortality on the daily mean levels for the above measures of particulates, after accounting for seasonal and subseasonal fluctuations in the mortality time series, non-Poisson dispersion, weather variables, and gaseous pollutants. We found positive and statistically significant associations between the daily measures of ambient particle mass and sulfate mass and the deaths from respiratory diseases and diabetes. The mean percentage change in daily mortality (MPC), evaluated at the interquartile range for pollutants averaged over the day of death and the preceding 2 days, for deaths from respiratory diseases was MPC(COH)=6.90% (95% CI: 3.69-10.21%), MPC(Predicted PM2.5)= 9.03% (95% CI: 5.83- 12.33%), and MPC(Sutton sulfate)=4.64% (95% CI: 2.46-6.86%). For diabetes, the corresponding estimates were MPC(COH)=7.50% (95% CI: 1.96-13.34%), MPC(Predicted PM2.5)=7.59% (95% CI: 2.36-13.09%), and MPC(Sutton sulfate)=4.48% (95% CI: 1.08-7.99%). Among individuals older than 65 years at time of death, we found consistent associations across our metrics of particles for neoplasms and coronary artery diseases. Associations with sulfate mass were also found among elderly persons who died of cardiovascular diseases and of lung cancer. These associations were consistent with linear relationships. The associations found for respiratory diseases and for cardiovascular diseases, especially in the elderly, are in line with some of the current hypotheses regarding mechanisms by which ambient particles may increase daily mortality. The positive associations found for cancer and for diabetes may be understood through a general hypothesis proposed by Frank and Tankersley, who suggested that persons in failing health may be at higher risk for external insults through the failure of regulating physiological set points. The association with diabetes may be interpreted in light of recent toxicological findings that inhalation of urban particles in animals increases blood pressure and plasmatic levels of endothelins that enhance vasoconstriction and alter electrophysiology. Further research to confirm these findings and to determine whether they are causal is warranted.
The role of the autopsy is discussed in the study of the etiology of the current major causes of death (cardiovascular and neoplastic diseases) in developed countries. Evidence is accumulating for the importance of environmental factors in the etiology of these diseases. The study of regional differences in occurrence is described as a method of identifying specific factors. Maps are shown of mortality rates for all causes of death in Ontario counties for males aged 65-74 and 95+ during 1964-68. Some of the difficulties in obtaining data in this form, and in their analysis, are indicated. Regional mortality patterns can be interpreted by the use of associations with available regional socioeconomic measures, or by the use of regional data on trace-metal levels in autopsy samples of human lung, rib, vertebra, kidney and liver. The methodology and the difficulties involved in the determination of trace-metal levels in these tissues are discussed, as is the possible relevance of these levels to the study of degenerative diseases. All these considerations emphasize the valuable contributions of autopsy studies.
Cohorts of Finnish asbestos sprayers and of asbestosis and silicosis patients were followed for cancer with the aid of the Finnish Cancer Registry in the period 1967-1994. Compared with the cancer incidence of the total Finnish population, asbestos sprayers had an increased risk for total cancer (standardized incidence ratio [SIR] 6.7, 95% confidence interval [95% CI] 4.2-10); lung cancer (SIR 17.95% CI 8.2-31); and mesothelioma (SIR 263, 95% CI 85-614). The SIR of the asbestosis patients was 3.7 (95% CI 2.8-5.0) for all sites, 10 (95% CI 6.9-14) for lung cancer, and 65 (95% CI 13-188) for mesothelioma. The silicosis patients also had significantly high SIR values for all sites (1.5, 95% CI 1.0-2.1) and lung cancer (2.7, 95% CI 1.5-4.5). The values for the SIR and the standardized mortality ratio for all sites and lung cancer were very similar, and therefore it seems that both are reliable indicators of the occurrence of occupational cancer. It was concluded that pneumoconioses patients and asbestos-exposed workers have a markedly elevated risk for cancer. Asbestos-induced occupational cancers are not only diseases of the elderly, since the relative risk is high also for middle-aged people.
Mortality rates for coronary heart disease (CHD), chronic non-specific lung disease (CNSLD), and lung cancer for ages 45-74 years were studied for British and Norwegian migrants to the U.S. and for sample of U.S. native-born. The observed order for CHD and lung cancer was as anticipated, with native-born experiencing the highest CHD rate, British migrants the highest lung cancer rate, and, in each instance, Norwegian migrants experiencing the lowest rates. For CNSLD, contrary to national comparisons, the British migrant rates were about equal to the U.S. native-born although Norwegian migrant rates were lowest, as expected. Migrants who were younger than 15 years of age at migration experienced the highest CHD mortality levels, but a decreasing gradient in mortality level with increasing age at migration did not materialize. Due to inherent limitations in the data, results for CNSLD and lung cancer mortality levels with respect to age at migration remain uncertain. Data on cigarette smoking status indicated substantial excess mortality for cigarette smokers compared to non-smokers and occasional smokers for all groups studied.