Impact of human immunodeficiency virus infection on mortality among young men and women in Spain

BACKGROUND: This paper describes the impact of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality among young adults in Spain with specific reference to other causes of death. METHODS: Based on death registration data for the period 1980-1993, HIV/AIDS was compared against all other causes of death by gender, using specific rates in the 25-44 age group and standardized rates for potential years of life lost (PYLL). RESULTS: In 1993, HIV/AIDS was the leading cause of death among men aged 25-44 years (21.8% of all deaths) and the second leading cause of death among women (14.9%), exceeded only by cancer. Since 1982, the trend in the overall standardized mortality rate for men in the 25-44 age group has been reversed, showing a progressive increase. Similarly, since 1984 there has been a halt in the decline in female mortality. For both sexes, maintenance of these trends in mortality was largely ascribable to the effect of HIV/AIDS deaths which registered a marked rise, a rise far sharper than that witnessed for variations in all other causes studied. In 1993, the adjusted PYLL rate for HIV/AIDS for ages 1-70 rose to 615 per 100,000 population in men and 156 in women. These values accounted for 9.2% and 5.8% of PYLL for all causes, thereby ranking HIV/AIDS behind motor vehicle accidents as the second leading cause of premature death in men, and behind motor vehicle accidents and breast cancer as the third leading cause in women. For both sexes, the rise in the PYLL rate for HIV/AIDS from 1992 to 1993 proved far greater than that for all other causes of death. CONCLUSION: In Spain, HIV/AIDS has become the leading cause of death among young adults and is counteracting improvements in mortality due to other causes. It should therefore be regarded as a priority public health problem.     

Body mass index and mortality in a general population sample of men and women. The Buffalo Health Study

The objective of this research was to investigate the long-term relation between body mass index (BMI) and mortality from all causes and from specific causes in the general population. A 29-year follow-up study was conducted in a random sample of white men (n = 611) and women (n = 697) aged 20-96 years who were residents of Buffalo, New York, in 1960. At baseline, height and weight were determined by self-report. BMI was calculated as weight (kg)/height (m2). During the follow-up period, 295 (48.3 percent) men and 281 (40.3 percent) women died. With the Cox proportional hazards model and adjustment for age, education, and cigarette smoking, a significant linear association was found between BMI and all-cause mortality in men less than age 65 years at baseline (relative risk (RR) = 1.06, 95 percent confidence interval 1.02-1.09), but not in women (RR = 1.02, 95 percent confidence interval 0.99-1.05). In men age 65 years and older, the relation was quadratic in form (p = 0.02), with the lowest risks appearing in the BMI range of 23-27. BMI was most strongly related to cardiovascular disease (CVD) and coronary heart disease mortality in women and younger men. No such associations were observed in older men. BMI was not related to an increased risk of death from non-CVD or cancer in either sex. These findings illustrate the importance of BMI as a risk factor for CVD and coronary heart disease mortality in certain gender-age groups and indicate that the majority of the impact of BMI on overall mortality is due to the strong relation between relative weight and these specific causes of death.     

Depression among cancer patients

OBJECTIVE: To identify important causes of premature mortality among Aboriginal adults in the Northern Territory (NT), 1979-1991. METHODS: All deaths of NT Aboriginal residents aged 15-64 years which occurred in the NT between 1979 and 1991 and which were recorded by the Registry of Births, Deaths and Marriages were included. Standardised mortality ratios (SMRs) were used to compare the number of deaths observed among Aboriginals in the NT to those expected, based on overall Australian rates. Years of potential life lost before age 65 (YPLL65) were estimated for specific causes of death. RESULTS: Aboriginal women (overall SMR, 5.5) and Aboriginal men (SMR, 4.7) experienced a high burden of excess mortality from almost every cause of death. This excess increased over time, especially for Aboriginal women. Among Aboriginal men, the most important causes of premature death were motor vehicle accidents (11% of excess deaths and 17% of YPLL65), ischaemic heart disease (10% of excess deaths and 10% of YPLL65), pneumonia and influenza (8% of excess deaths and 6% of YPLL65), and homicide (7% of excess deaths and 8% of YPLL65). For Aboriginal women, the most important causes included homicide (7% of excess deaths and 11% of YPLL65), chronic obstructive pulmonary disease (10% of excess deaths and 5% of YPLL65), rheumatic heart disease (7% of excess deaths and 8% of YPLL65), and ischaemic heart disease (6% of excess deaths and 5% of YPLL65). CONCLUSIONS: The wide variety of causes of excess mortality will require an equally wide variety of solutions, both medical and non-medical, and a long term commitment will be necessary to achieve reductions in premature mortality among NT Aboriginal adults.     

Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women

We studied physical fitness and physical activity in relation to all-cause and cancer mortality in a cohort of 7080 women and 25,341 men examined at the Cooper Clinic in Dallas, Texas, during 1970 to 1989. Physical fitness was assessed at baseline by a maximal treadmill exercise test, while physical activity was self-reported on the attendant health habits questionnaire. Both men and women averaged about 43 years of age at baseline (range, 20 to 88 years), and they were followed for approximately 8 years on average. Through the end of 1989, the women contributed 52,982 person-years of observation and incurred 89 deaths, including 44 deaths due to cancer. The men contributed 211,996 person-years and incurred 601 deaths, with 179 due to cancer. After adjustment for baseline differences in age, examination year, cigarette habit, chronic illnesses, and electrocardiogram abnormalities, we found a strong inverse association between risk of all-cause mortality and level of physical fitness in both men and women (P for trend < 0.001). Physically active men also were at lower risk of all-cause mortality than were sedentary ones (P for trend = 0.01). Among women, however, self-reported physical activity was not significantly related to risk of death from all causes. The risk of mortality from cancer declined sharply across increasing levels of fitness among men (P for trend < 0.001), whereas among women the gradient was suggestive but not significant (P for trend = 0.07). Physically active men also were at lower risk of death from cancer than were sedentary men (P for trend = 0.002), but among women physical activity was unrelated to cancer mortality.     

Mortality from major causes of death and its risk factors in the elderly--26-year follow-up study in Hisayama

The authors studied mortality from major causes of death and risk factors in the elderly in a long-term prospective survey conducted in a Japanese suburban community, Hisayama. In the baseline survey in 1961, we scrutinized 1658 residents of the town aged 40 years or older accounting for 92% of the total population in this age range. Of those, 591 residents (245 men and 346 women) aged 60 years or older, who were free from major cardiovascular disease, were selected for the present study. They were followed-up for 26 years from 1961 to 1987. The average age was 67 years for men and 70 years for women, being significantly higher for women than for men. During the follow-up period, 529 subjects (89.5%) died, and 448 were autopsied (autopsy rate 84.7%). The all-cause mortality (per 1,000 person-years) after adjustment for age was 89.9 for men and 56.7 for women, the former being significantly higher than the latter (p < 0.01). The age-adjusted mortality from cerebrovascular disease was estimated to be 21.4 for men and 9.9 for women, i.e. 8.9 and 8.8 from heart disease, and 19.9 and 10.6 from neoplasm, and 18.1 and 12.2 from-pneumonia, respectively. There was significant sex difference in mortality from cerebrovascular disease, neoplasm and pneumonia (p < 0.01) but not from heart disease (p > 0.1). Multiple Cox's proportional hazards regression analysis showed systolic blood pressure and male sex to be significant risk factors for death by cerebrovascular disease. Systolic blood pressure was also a predictor for death by heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical features, molecular genetics, and pathophysiology of dominant optic atrophy

CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.     

Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology

OBJECTIVE: To compare patterns of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality in 11 selected industrialized countries with highly developed death registration systems and a broad range of cumulative AIDS incidence rates. METHODS: Data on HIV/AIDS mortality were obtained from the World Health Organization (WHO) and Statistics Canada for the years 1987-1991. We obtained data for Australia, Canada, Denmark, France, the former Federal Republic of Germany, Italy, the Netherlands, New Zealand, Spain, Switzerland, and the US, stratified by sex and 5-year age groups. Population figures were obtained from national censal, post-censal or interpolated annual estimates compiled by WHO and from Statistics Canada. RESULTS: A total of 141534 deaths were attributed to HIV/AIDS (126224 in men and 15310 in women) in the 11 countries from 1987 to 1991. The majority of deaths (73.7%) occurred in the US. Other countries contributing substantially to the number of deaths were France (7.1%), Italy (4.9%), Spain (4.9%), former West Germany (3.5%), and Canada (3.0%). Age-specific death rates for men aged 25-44 years in 1991 were highest in the USA at 47.1 per 100000 population and highest for women in Switzerland at 7.7 per 100000 population. Potential years of life lost (PYLL) before age 75 years were highest for males in the US (2388 per 100000 population) and for females in Switzerland (373 per 100000 population). The lowest rates were in New Zealand (339 per 100000 population in men and 6.5 per 100000 population in women). CONCLUSIONS: This historical demographic analysis indicates that mortality resulting from HIV infection and AIDS among men and women varies considerable by country. Rates of death were highest in the US and lowest in Australia, the Netherlands, and New Zealand.     

Women's health status and gender inequality in China

This paper examines the health status of women in China by reviewing levels and trends of female mortality at several phases of a woman's life cycle focusing on infancy girlhood, childbearing and old age. The mortality rates of Chinese women and men are compared for the period 1950-1990 as are comparisons with women in selected countries. The cause-specific death rate, expressed as a percentage of all deaths, and the burden of disease, measured in terms of the disability-adjusted life years (DALYs), are used to reflect the changing patterns of female diseases and causes of deaths. Significant improvement in the health status of Chinese women since 1950 is widely acknowledged as a major achievement for a developing country with the largest population in the world, but the differentials in women's health by region and urban/rural areas are considerable. The Physical Quality of Life Index (PQLI) indicates that the overall level of physical well-being of Chinese women has increased in recent decades, but disparity in health between men and women still exists. The Gender-Related Development Index (GDI) further reveals that China has achieved significant progress in women's health during the past four decades, but far less has been achieved with respect to gender equality overall. The final sections of the paper focus on the discussion of some health problems faced by the female population during the process of economic reform since the 1980 s. In order to promote gender equality between women and men, concerns on women's health care needs are highlighted.     

Widening social inequalities in mortality: the case of Barcelona, a southern European city

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas.     

Iowa record-linkage study: death rates in psychiatric patients

The Iowa record-linkage study was developed to investigate death rates in psychiatric patients, and involved computer matching of death certificates with a roster of patients. A list of all patients admitted to our hospital from 1972 through 1981 was obtained and after removing duplicate entries the list was pared to 5412 names. The record included multiple identifiers (e.g., name, gender, date-of-birth, hospital number). This information was then linked by computer with all Iowa death certificates for the same period; a total of 331 deaths were identified. Patients were assigned to a single psychiatric diagnostic category based on a computer program that reviewed each patient's clinical diagnoses and picked the one with the highest priority in a hierarchy we had created. Age and sex adjusted mortality tables were constructed, allowing us to compute expected numbers of deaths. Relative risk for premature death was greatest among women, and those under 20 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either gender with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psychophysiological disorders; and men with neuroses. Death from natural causes, especially from heart disease, was significantly excessive among women, while death from accidents and suicides was excessive for both men and women. The overall SMR was 1.65 (P < 0.001). Most importantly, we found that the greatest excess of mortality occurred within the first 2 years following hospital discharge. Thus, we were able to demonstrate that risk of mortality in general, and of suicide specifically, differed according to age, gender, diagnosis, and portion of the follow-up. We have subsequently used this method to investigate specific risk factors associated with mortality in mood disorders, schizophrenia, and antisocial personality disorder. Findings from these studies are reported.     

The main causes of death in Spain, 1992; comment

BACKGROUND: To study the mortality from the leading causes of death in Spain in 1992 and trends since 1980. POPULATION AND METHOD: The number of deaths was obtained from mortality statistics. We included the 12 causes with the highest mortality rates in 1992 and calculated for each cause of death the age adjusted mortality rates for each year in the study period, the percent change from 1990 to 1992 and from 1980 to 1992, and the adjusted ratio of rates between men and women in 1992. RESULTS: The leading causes of death in 1992 were malignant neoplasms, with 24.3% of deaths and a mortality rate of 205.6 per 100,000 population; diseases of the heart, with 22.6% and a rate of 191.8 per 100,000; and cerebrovascular disease, with 12.7% and a rate of 107.6 per 100,000 population. Between 1980 and 1992 the adjusted mortality rate increased for four causes of death: malignant neoplasms; chronic obstructive pulmonary disease and similar diseases; nephritis, nephrotic syndrome and nephrosis; and suicide. From 1990 to 1992, the adjusted mortality rate declined for all other causes of death. From 1990 to 1992, the adjusted mortality rate declined for all causes of death except for malignant neoplasms and human immunodeficiency virus (HIV) infection, which rose 0.4% and 69%, respectively. The adjusted mortality rate was higher in men than in women for all causes of death except for diabetes mellitus and atherosclerosis. CONCLUSIONS: Except for malignant neoplasms and HIV infection, mortality from all other leading causes of death declined in 1992 with respect to 1990, independently of the trend experienced by each cause of death in the eighties.     

The Bedford survey: ten year mortality rates in newly diagnosed diabetics, borderline diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics

Mortality rates from coronary heart disease and from all causes have been ascertained over ten years in three groups of people participating in the Bedford Survey--newly-diagnosed diabetics, borderline diabetics and control subjects with normal glucose tolerance. Age corrected mortality rates, from all causes and coronary heart disease, were highest in the diabetics and intermediate in the borderline diabetics and in both groups were similar in men and women. When statistical allowance was made for baseline differences in age, blood pressure and obesity, female borderline diabetics still had a significantly increased risk over their controls of death from 'all causes'. Much of the difference appeared to be due to a relative excess of deaths due to coronary heart disease. It is concluded that borderline diabetes (or impaired glucose tolerance) is associated with a relatively greater increase in mortality risk in women than men. During the 10-year follow-up of the Bedford borderline diabetics, coronary heart disease morbidity and mortality rates were similar in men and women. Age at entry to the study was the major independent and significant predictor of mortality from all causes. The level of systolic blood pressure and current cigarette smoking at baseline were statistically significant predictors only of mortality due to coronary heart disease.     

The impact of AIDS in the global mortality in Catalonia, 1981-1993

OBJECTIVES: To compare the evolution of the principal causes of death in Catalonia, Spain and to assess the impact of AIDS as a contributing factor to the increase of mortality in young people in Catalonia. METHODS: Data from the mortality register of Department of Health in Catalonia has been used. We have compared the principal causes of death in Catalonia for the global population and for the group of 20 to 39 year olds. We have calculated the potential years of life lost (PYLL) between the ages of 13 to 65. RESULTS: Since the first case of AIDS in 1981, AIDS has been the cause of death with the most important increase for the global population in Catalonia. AIDS is the sixth cause of death and the first cause of PYLL. For the young population in Catalonia (aged 20-39) AIDS became, in 1993, the first cause of death. From 1992 to 1993 the PYLL due to AIDS increased 5% in men and 51% in women. CONCLUSIONS: The present situation has led AIDS being the first cause of death among young population. The collaboration between mortality registers and AIDS registers is absolutely essential to assess more accurately the impact of AIDS on the mortality of population.     

Use of leukocyte depletion to decrease injury after lung preservation and rewarming ischemia: an experimental model

The New York City neighborhood of Harlem has mortality rates that are among the highest in the United States. In absolute numbers, cardiovascular disease and cancer account for the overwhelming majority of deaths, especially among men, and these deaths occur at relatively young ages. The aim of this research was to examine self-reported smoking habits according to measures of socioeconomic status among Harlem men and women, in order to estimate the contribution of tobacco consumption to Harlem's remarkably high excess mortality. During 1992-1994, in-person interviews were conducted among 695 Harlem adults aged 18-65 years who were randomly selected from dwelling unit enumeration lists. The self-reported prevalence of current smoking was strikingly high among both men (48%) and women (41%), even among highly educated men (38%). The 21% of respondents without working telephones reported an even higher prevalence of current smoking (61%), indicating that national and state-based estimates which rely on telephone surveys may seriously underestimate the prevalence of smoking in poor urban communities. Among persons aged 35-64 years, the smoking attributable fractions for selected causes of death were larger in Harlem than in either New York City as a whole or the entire United States for both men and women. Tobacco consumption is likely to be one of several important mediators of the high numbers of premature deaths in Harlem.     

Forty years of evolution of mortality in Belgium and The Netherlands

Age adjusted mortality in Belgium (B) and The Netherlands (NL) was calculated from 5 yearly age-specific death rates between the ages 45-74 and 75-85+ years. Mortality was available in Belgium from 1954 to 1991 or 1994 (depending on the cause of death) and from 1950 to 1993 in The Netherlands. In the 45-74 years age class all-cause mortality decreased in B between 1955 and 1992 with 33% in men and 48% in women. In NL this was 11% and 40%, respectively. In the age class 75-85+ it was 21% and 37% in B, and 4% and 36% in NL, respectively. Since 1980 to the last available year there was a marked decrease in mortality in the age class 75-85+ years in men and women from B and no change in NL. Wallonia always had the highest mortality, followed by B, Flanders and NL. However, recently the observed mortality in Flanders was the lowest. Mortality trends, in both age classes and sexes, were obtained between 1980 to the last available year for 11 causes of death in men and 13 in women. Among 48 possible comparisons, 38 (79%) were in favor of B, 9 in favor of NL and 1 ex aequo. Life expectancy in 1992 was compared in the 15 EU countries. For both sexes together B ranked 8th, NL 3rd. The difference in life expectancy between the two countries was 3 year in 1967 and 1 year in 1992. Flanders ranked 5th (0.3 year lower than NL) and Wallonia 14th (2.2 years lower) when substituted for B in the EU. Portugal had the best and Denmark had the worst results between 1967 and 1992). Changes in life style-fat, salt, fruit and vegetable intake and smoking habits -which occurred since 1960 in B, its regions and in NI are consistent with the changes in mortality and life expectancy. Curative medicine and medical technology cannot explain the observed differences and trends.     

Syndrome X and mortality: a population-based study. Risk Factor and Life Expectancy Research Group

The present report analyzes the prevalence of the cluster of metabolic abnormalities defined as syndrome X (high blood glucose, high blood pressure, low high density lipoprotein (HDL) cholesterol, and high triglycerides) and its impact on cardiovascular disease mortality in a large cohort of men and women (22,561 men and 18,495 women). These individuals were participants in a series of epidemiologic investigations of cardiovascular disease conducted in Italy between 1978 and 1987. They were followed for an average of 7 years, during which time a total of 1,218 deaths occurred (1,003 in men and 215 in women). Deaths were coded according to the International Classification of Diseases, 9th Revision (ICD-9). The prevalence of the full cluster of metabolic abnormalities (syndrome X) was low in the population as a whole, with only 3.0 percent of men and 3.4 percent of women exhibiting the full cluster of abnormalities that comprise syndrome X. The risk of death from all causes and cardiovascular disease increased with increased numbers of metabolic abnormalities in both men and women. Mortality from cancer was significantly increased in women (but not in men) with syndrome X, compared with women with no metabolic abnormalities. Population attributable risks for all cause mortality and cardiovascular disease mortality were 0.06 and 0.09 in men and 0.04 and 0.48 in women when assessed by population cutpoints. These data from a large population-based epidemiologic investigation indicate that the presence of a full cluster of metabolic abnormalities from syndrome X is an important risk factor for cardiovascular disease and all-cause mortality in both men and women, but that the low prevalence of such a cluster in the population reduces the public health impact of syndrome X. The majority of individuals who die from cardiovascular disease present elevations in any one, two, or three of the metabolic abnormalities. The notion of the cluster of metabolic abnormalities (syndrome X) should not distract our attention from established individual risk factors that have been proven to be major causes of cardiovascular disease death and disability in our society.     

Impact of atrial fibrillation on the risk of death: the Framingham Heart Study

BACKGROUND: Atrial fibrillation (AF) causes substantial morbidity. It is uncertain whether AF is associated with excess mortality independent of associated cardiac conditions and risk factors. METHODS AND RESULTS: We examined the mortality of subjects 55 to 94 years of age who developed AF during 40 years of follow-up of the original Framingham Heart Study cohort. Of the original 5209 subjects, 296 men and 325 women (mean ages, 74 and 76 years, respectively) developed AF and met eligibility criteria. By pooled logistic regression, after adjustment for age, hypertension, smoking, diabetes, left ventricular hypertrophy, myocardial infarction, congestive heart failure, valvular heart disease, and stroke or transient ischemic attack, AF was associated with an OR for death of 1.5 (95% CI, 1.2 to 1.8) in men and 1.9 (95% CI, 1.5 to 2.2) in women. The risk of mortality conferred by AF did not significantly vary by age. However, there was a significant AF-sex interaction: AF diminished the female advantage in survival. In secondary multivariate analyses, in subjects free of valvular heart disease and preexisting cardiovascular disease, AF remained significantly associated with excess mortality, with about a doubling of mortality in both sexes. CONCLUSIONS: In subjects from the original cohort of the Framingham Heart Study, AF was associated with a 1.5- to 1.9-fold mortality risk after adjustment for the preexisting cardiovascular conditions with which AF was related. The decreased survival seen with AF was present in men and women and across a wide range of ages.     

Laboratory animal allergy

Since the second World War, excess mortality of males has been steadily growing in Poland. The aim of this paper was to analyze the basic relationships between excess male mortality and some social and economic factors, with special reference to both age and place of residence. Data published in Demographic Yearbooks and included in reports produced by the Government Population Council were used in the analysis. The excess male mortality is expressed in terms of male/female mortality ratio, and also in terms of the difference between the average female and male life expectancy. In the early 1990s the general male mortality rate in Poland was by 23% higher than the general female mortality rate, whereas in males at younger working age (20-44 years) mortality was three times higher, and in the older age (45-64 years) groups 2.7 times higher than the female mortality. Compared with the majority of European countries, Poland is characterised by high rates of excess male mortality, which points to a deteriorated health status of the population. At present, excess mortality of the working age males is much higher than in the 1960s and 1970s. Our analysis of the 1960-1994 trends revealed that the highest excess male mortality occurs in the 20-24 age group. Although recently a falling trend has been observed in the infant, juvenile and post working age groups, a continuous increase is noted in the working age population of Poland. Causes of death were also included in our analysis. Among circulatory diseases, the highest excess mortality was due to acute myocardial infarction (the risk of death from this disease was 8 times higher for males than for females). Accidents, injuries and poisoning constitute another leading group of causes responsible for excess mortality (6/1 male/female death risk ratio). The excess male mortality rates are higher in the rural than in the urban areas. The excess male mortality was also reflected in the indices of average life expectancy. In 1995, the average life expectancy was 67.6 years for males and 76.4 years for females. Thus, in Poland males live 8.6 years shorter than females on average. Increased excess mortality among the working age males, a considerable difference between male and female average life expectancy, disturbed demographic male/female balance, these are at least some of the reasons why further in depth studies of excess male mortality in Poland should continue.     

Cholesterolemia and total, cardiovascular and cancer mortality. Study of a cohort of 220,000 people]

The distribution of cholesterolemia and their relationship to total mortality, cardiovascular mortality, and cancer mortality were studied in a population of 125,513 men and 96,301 women, aged 16-90. Cholesterolemia in the population increases with age, up to age 50-60 for men and 60-70 for women. Beyond these ages, cholesterolemia decreases very significantly for men and moderately for women. Upon global examination of the entire population, the relationship between cholesterolemia and total mortality is observed as a U-shaped curve. The relationship with cancer mortality is slightly negative in men and appears as a U-shaped curve in women. The relationship with cardiovascular mortality in men is strongly positively correlated when adjusted for body mass index, blood pressure, tobacco consumption, gamma GT, and age. This relationship is not significant in women. There is a significant interaction in the relationship between cholesterolemia and mortality in men for weight, body mass index, vital capacity, maximum expiration volume per second, tobacco consumption, urea, serum albumin, hematocrit, hemoglobin, alkaline phosphatases, gamma GT, red cell volume, and sedimentation rate. Age is a fundamental variable to take into account. Thus, in men under 50 years of age at the time of inclusion, the relationship between cholesterolemia and total mortality shows a positive tendency, and the relationship with cardiovascular mortality is strongly positive. In men over 65 years of age, these relationships are negative. The same tendencies exist for cancer mortality. The reasons for these negative relationships may be related to the decreased cholesterol levels in subjects with malnutrition or diseases (essentially hepatic diseases); this is especially true in older subjects. These data push for additional in-depth analysis of these relationships and interactions, according to age categories and detailed causes of mortality. They also reinforce the idea that, in some patients, low cholesterolemia appears to be a marker for predisposition or the result, but not a cause, of cancer.