BACKGROUND: To study mortality rate and causes of death among all hospitalized opioid addicts treated for self-poisoning or admitted for voluntary detoxification in Oslo between 1980 and 1981, and to compare their mortality to that of the general population. METHODS: A prospective cohort study was conducted on 185 opioid addicts from all medical departments in Oslo who were treated for either self-poisoning (n = 93, 1980), voluntary detoxification (n = 75, 1980/1981) or both (n = 17). Their median age was 24 years; with a range from 16 to 41, and 53% were males. All deaths that had occurred by the end of 2000 were identified from the Central Population Register. Causes of death were obtained from Statistics Norway. Standardized mortality ratios (SMRs) were computed for mortality, in general, and in particular, for different causes of death. RESULTS: During a period of 20 years, 70 opioid addicts died (37.8%), with a standardized mortality ratio (SMR) equal to 23.6 (95% CI, 18.7-29.9). The SMR remained high during the whole period, ranging from 32.4 in the first five-year period, to 13.4 in the last five-year period. There were no significant differences in SMR between self-poisonings and those admitted for voluntarily detoxification. The registered causes of death were accidents (11.4%), suicide (7.1%), cancer (4.3%), cardiovascular disease (2.9%), other violent deaths (2.9%), other diseases (71.4%). Among the 50 deaths classified as other diseases, the category "drug dependence" was listed in the vast majority of cases (37 deaths, 52.9% of the total). SMRs increased significantly for all causes of death, with the other diseases group having the highest SMR; 65.8 (95% CI, 49.9-86.9). The SMR was 5.4 (95% CI, 1.3-21.5) for cardiovascular diseases, and 4.3 (95% CI, 1.4-13.5) for cancer. The SMR was 13.2 (95% CI, 6.6-26.4) for accidents, 10.7 (95% CI, 4.5-25.8) for suicides, and 28.6 (95% CI, 7.1-114.4) for other violent deaths. CONCLUSION: The risk of death among opioid addicts was significantly higher for all causes of death compared with the general population, implying a poor prognosis over a 20-year period for this young patient group.
A 22- to 25-year follow-up study of former child psychiatric patients: a register-based investigation of the course of psychiatric disorder and mortality in 546 Danish child psychiatric patients.
A total of 546 children and adolescents, aged 5 to 15 years, who were admitted as in-patients to psychiatric hospitals throughout Denmark between 1970 and 1973, were followed up with regard to later readmissions and mortality. Approximately one-third of the sample had at least one readmission after the age of 18 years; there was no significant difference between male and female subjects. Probands with three selected diagnoses, namely childhood neurosis, conduct disorder and maladjustment reactions, did have a significantly greater general risk of readmission to psychiatric hospital in adulthood than the background population. In total, 24 probands (22 male, and 2 female subjects) died during the study period. Eight subjects had committed suicide. The standard mortality rate was significantly increased.
The 15-year follow-up of mortality and the factors associated with death from various causes were studied in an unselected group of patients surviving deliberate self-poisoning in 1978. The cohort included 152 females and 101 males. By the end of 1993 a total of 37 (24%) of the females and 33 (33%) of the males admitted in 1978 had died. The total follow-up mortality was 4.5 times greater than expected for the female group (95% confidence interval: 3.1-6.1) and 3.6 times greater than expected (2.5-5.1) for the male group. It was highest in the first 5-year period. With regard to specific causes the mortality ratio was highest for deaths from suicide. For females it was 61.1 (30.5-109.4) and for males: 38.8 (20.4-65.4) times the expected ratio. It was also significantly raised for deaths from cardiovascular diseases in females: SMR = 3.7 (2.0-6.4) and from respiratory diseases in males: SMR = 3.3 (1.2-7.1). Significant predictors for death from all causes were age > or = 30 years: RR = 4.4 (2.3-8.5) and male sex: RR = 2.1 (1.2-3.5). Imprisonment was found to be a protective factor: RR = 0.2 (0.1-0.5). Predictors for death from suicide were age > or = 30: RR = 3.1 (1.2-8.1), male sex: RR = 3.3 (1.4-7.9) and a serious suicidal attempt, as evaluated by a psychiatrist: RR = 3.4 (1.4-7.9). It is concluded that patients who survive parasuicide by deliberate self-poisoning are at increased risk of death. The predictors for death are not very specific and are difficult to apply in clinical work with these patients.
OBJECTIVE: To inform health care workers about the health status of Canada's native people. DATA SOURCES: A MEDLINE search for articles published from Jan. 1, 1989, to Nov. 31, 1995, with the use of subject headings "Eskimos" and "Indians, North American," excluding specific subject headings related to genetics and history. Case reports were excluded. Material was also identified from a review of standard references and bibliographies and from consultation with experts. STUDY SELECTION: Review and research articles containing original data concerning epidemiologic aspects of native health. Studies of Canadian populations were preferred, but population-based studies of US native peoples were included if limited Canadian information was available. DATA EXTRACTION: Information about target population, methods and conclusions was extracted from each study. RESULTS: Mortality and morbidity rates are higher in the native population than in the general Canadian population. The infant mortality rates averaged for the years 1986 to 1990 were 13.8 per 1000 live births among Indian infants, 16.3 per 1000 among Inuit infants, and only 7.3 per 1000 among all Canadian infants. Age-standardized all-cause mortality rates among residents of reserves averaged for the years 1979 to 1983 were 561.0 per 100,000 population among men and 334.6 per 100,000 among women, compared with 340.2 per 100,000 among all Canadian men and 173.4 per 100,000 among all Canadian women. Compared with the general Canadian population, specific native populations have an increased risk of death from alcoholism, homicide, suicide and pneumonia. Of the aboriginal population of Canada 15 years of age and older, 31% have been informed that they have a chronic health problem. Diabetes mellitus affects 6% of aboriginal adults, compared with 2% of all Canadian adults. Social problems identified by aboriginal people as a concern in their community include substance abuse, suicide, unemployment and family violence. Subgroups of aboriginal people are at a greater-than-normal risk of infectious diseases, injuries, respiratory diseases, nutritional problems (including obesity) and substance abuse. Initial data suggest that, compared with the general population, some subgroups of the native population have a lower incidence of heart disease and certain types of cancer. However, knowledge about contributing factors to the health status of aboriginal people is limited, since the literature generally does not assess confounding factors such as poverty. CONCLUSIONS: Canadian aboriginal people die earlier than their fellow Canadians, on average, and sustain a disproportionate share of the burden of physical disease and mental illness. However, few studies have assessed poverty as a confounding factor. Future research priorities in native health are best determined by native people themselves.
Notes
Comment In: CMAJ. 1996 Dec 1;155(11):1581-38956835
Alcoholism is known to be greatly underdiagnosed in death certificates, a fact that biases in estimates of alcohol-related mortality. An autopsy series of 1658 cases (920 with natural cause of death and 738 nonnatural) was reviewed to evaluate the extent of this bias, and also to see how well different sources of information served as indicators of alcoholism when alcohol-related disease diagnosed at autopsy was considered as a gold standard. A stepwise logistic regression model adjusted by age and sex showed police reports of individual's alcohol usage and blood alcohol concentration (BAC) of > 2.9/1000 at autopsy to be the two most significant predictors of chronic alcohol abuse (p 2.9/1000), due to its high specificity, as particularly suggestive of chronic heavy drinking. However, it is wise to use these parameters only as an aid in decision-making, not as sole indicators of alcoholism. Deaths associated with chronic heavy drinking were frequent, 50.5% of the total series (male 56.4%, female 37.1%). For all but one age-group (male 45-64 years), however, death certificates mentioned alcohol-related diseases in less than half of these cases. Especially evident underdiagnosis was found for female and males 65 years and older. These results indicate that alcoholism is frequent in such a highly selected population as a series of forensic autopsies and suggest that estimates of prevalence of alcoholism based only on review of death certificates are to be considered with great caution.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Seasonal variation in suicides has been shown in many countries. We assessed the seasonality and the variation with latitude in suicides and homicides, and the impact of alcohol on the seasonality in suicides. METHODS: Official computerized registers on causes of death in all Greenland during 1968-2002 were used. Sales data on beer from one of the major food store chains for July 2005-June 2006 were examined. Seasonal variation was assessed by Rayleigh's test for circular distributions. RESULTS: There were a total of 1351 suicides and 308 homicides. The suicides rate varied from 4.2/100 000 person-years in 1971 to 128.4/100 000 person-years in 1987. The homicide rate varied from 2.1/100000 person-years in 1969-1970 to 34.8/100 000 person-years in 1988. Out of the 1351 suicides, 80.5% were committed by men and 19.5% by women. Median age was 25 years (n = 1351; Range 11-84 years). Violent methods of suicide were used in 95% of all cases (n = 1286). Out of the 308 homicide victims, 61% were men and 39% were women, and 13% were killed in multiple homicide events.There was a significant seasonal variation with peaks in June and troughs in the winter in all suicide cases (n = 1351, r = 0.07; Z = 7.58, p
BACKGROUND: Deliberate self-poisoning is a big health problem. We wanted to study if there had been changes in drug use, morbidity and mortality in this group over the last 25 years in our hospital's catchment area. MATERIAL AND METHODS: In this study, 924 patients admitted to our hospital after deliberate self-poisoning in 1978, 1987 and 2002 were studied prospectively. RESULTS: From 1978 to 1987, there was a significant increase in the incidence of self-poisoning followed by a decline from 1987 to 2002 among both men and women. The age distribution remained the same. Benzodiazepines were the most commonly used drugs during the whole period (20% of patients in 1978, 39% in 1987, and 30% in 2002). There has been a significant reduction in the use of acetylsalicylic acid, tricyclic antidepressants and a significant increase in paracetamol and selective serotonin reuptake inhibitor poisonings. The use of gastric lavage and activated charcoal declined. The main antidote in 1978 was physostigmine, in 1987 and 2002 n-acetyl cysteine. During the whole period, complications (usually minor) were recorded in approximately 10% of cases. In 1978, mortality was 1.3%, in 1987 0.9%; no patient died in 2002. INTERPRETATION: The incidence of deliberate self-poisoning has fallen over the last 25 years. Selective serotonin reuptake inhibitors have to a large extent replaced tricyclic antidepressants and paracetamol has replaced acetylsalicylic acid.
In spite of persistent criticisms regarding their validity, official suicide statistics continue to be used in epidemiologic studies that have substantial public health implications. We ask which epidemiologic findings might be affected by underreporting in the suicide rate. We estimate the extent of potential underreporting by comparing Canadian suicide rates with and without deaths of undetermined origin (UDs) added. Our results tend to confirm findings from other jurisdictions, specifically that underreporting is probably higher among females and cases of poisoning and drowning. The highest underreporting in the 1950-82 period was in 1977-1978. Overall, the average potential underreporting was found to be 17.5% for females and 12% for males. Still, underreporting is not sufficiently large that reasonable reformulations of the suicide rate substantially alter findings, suggesting that most epidemiologic conclusions based on official rates are essentially correct.
The suicide rate in Alberta is consistently above the Canadian average. Health care use profiles of those who die by suicide in Alberta are currently unknown.
Death records were selected for people aged 25 to 64 with suicide coded as the underlying cause of death from April 1, 2003 to March 31, 2006. The death records were linked to administrative records pertaining to physician visits, emergency department visits, inpatient hospital separations, and community mental health visits. The control group was the Alberta population aged 25 to 64 who did not die by suicide. Frequency estimates were produced to determine the characteristics of the study population. Odds ratios relating to demographics, exposure to health care services, and case-control status were estimated with logistic regression.
Almost 90% of suicides had a health service in the year before their death. Suicides averaged 16.6 visits per person, compared with 7.7 visits for non-suicides. Much of the health service use among people who died by suicide appears to have been driven by mental disorders.
Information about health service delivery to those who die by suicide can guide prevention and intervention efforts.
Advanced paternal age is a risk factor for adverse health outcomes in the offspring. In a population-based birth cohort from Finland, 10,965 singleton offspring born in 1966 and alive at age 1 were followed to age 39. Hazard ratios were calculated, adjusting for maternal age, gender, paternal social class, and maternal parity. In females but not in males, increasing paternal age was associated with a linear increased risk of suicide (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.04-1.24, p /=30, the population attributable risk percentage was 13.7% for all deaths and 7.5% for suicides. Parental age at birth may affect suicide and all-causes mortality risk in the offspring in the general population. The causal pathways and specific disorders associated with this increased mortality are largely unknown.
