The mortality rate from anorexia nervosa
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We determined the standardized mortality ratio (SMR) in our anorexia nervosa (AN) patient population.We used a cross-sectional design to study an inception cohort (1981-2000) drawn from the provincial tertiary care eating disorders program at St. Paul's Hospital (British Columbia, Canada). All patients who completed their initial assessment for an eating disorder were included in the study. Vital status, date and cause of death from British Columbia Vital Statistics Agency, date of assessment, date of birth, and diagnosis at the time of assessment were collected for each patient.Of 954 patients, 326 diagnosed with AN completed an assessment over the 20 years. The SMR was 10.5 (95% confidence interval [CI] = 5.5-15.5) for AN.Some studies in the literature report that AN has the highest mortality rate of any psychiatric disorder in young females. However, others dispute this fact and report an SMR lower than the normal population mortality (SMR = 0.71). Contrary to some reports in the literature, our study confirms a high mortality rate within the AN population.Keywords:
Anorexia nervosa
Standardized mortality ratio
Excess mortality
In this study, standardized mortality ratios (SMR - observed deaths/expected deaths) were calculated among a cohort of psychiatric patients hospitalized in Livorno (Italy) in the years 1990-2003. Findings show an excess of deaths due to both natural (SMR=2.37) and non natural (SMR=2.37) causes, with a higher rate of excess mortality in younger patients and in the first years after discharge. A slightly decreasing trend in excess deaths was found from 1990-2003. Better and more timely access to healthcare, aimed at improving physical as well as well as mental health, is warranted in this population.
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Differential All-Cause Excess Mortality of the 1918 Influenza Pandemic in the U.S. Registration Area
The 1918 influenza pandemic is one of the deadliest events to have occurred in recorded history. This pandemic remains significant to public health due to the potential of a 1918-like pandemic occurring today. The implications of a future influenza similar to that of 1918 necessitate investigation into the mortality of this pandemic. Previous studies examining mortality records in the U.S. during the pandemic found that mortality varied by city and state, and was associated with factors such as sex, age, urbanization, and population density and growth.
The purpose of this study is to evaluate the age- and sex-specific all-cause excess mortality during the 1918 pandemic in the U.S. among twenty-four states with registered mortality data. A secondary objective of the study is to examine the correlations between all-cause excess mortality and suspected determinants of mortality during the pandemic.
This study used mortality data from Vital Statistics reports of the U.S. Census Bureau for states that registered by 1915. Excess mortality was determined by age and sex as the deviation of mortality in 1918-20 from the average mortality rate in 1915-17 and 1921-23.
Overall, the excess mortality rate was the highest in 1918, while in 1919 and 1920 the mortality rates were similar to the non-pandemic rates. With few state exceptions, excess mortality decreased substantially in 1919 and increased in 1920. Younger age groups had higher excess mortality in every year. In 1918, male excess mortality exceeded female excess mortality; however in 1919 and 1920 this was reversed. While some states demonstrated consistent age-specific and sex-specific patterns of excess mortality compared to the average rates, overall, the excess mortality varied greatly across all states. Population density, urbanization, and male to female ratios were moderately correlated with overall excess mortality, while military enlistment and influenza and pneumonia mortality were weakly correlated with excess mortality rates. These correlations varied by age and sex. The variation in excess mortality and the weak to moderate correlations with suspected determinants of mortality during the 1918 pandemic suggest further investigation of these determinants with regards to predicting excess mortality.
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Influenza pandemic
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A study was undertaken to determine the excess risk of death following primary total hip replacement (THR). All patients who underwent THR or were placed on the waiting list for THR during an 18-month period were studied as to their mortality. The dates of all deaths among both of these populations, and age- and sex-specific mortality rates for the Scottish population, were obtained from the Registrar General for Scotland. It was possible to determine a mortality rate for those patients operated upon and those patients who waited 1 year for their operation. The crude mortality rate, standardized mortality ratio (SMR) and excess risk of death were calculated for the patients operated upon. The crude mortality rate was 1.8% and the SMR was 45.5 for the operated-upon group. The excess risk of death associated with THR within the first 3 post-operative months was calculated in two ways. The relative mortality ratio was determined to be 2.37, and the comparative mortality ratio was calculated to be 1.6 for the operated-upon population. Patients selected for THR are in general fitter than average, and the excess risk of death in the first 3 post-operative months after THR is of the order of 1.6.
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Abstract Background The aim was to identify specific manual occupations with high mortality and to examine whether there are differences in the role of alcohol in explaining the excess mortality among manual occupations with high all-cause mortality. Methods A register-based study of employees aged 30–64 years, followed for mortality 2001–15. Age standardized mortality ratios (SMRs) were calculated to compare the mortality rates of manual occupations. The contribution of alcohol-related mortality to excess mortality was obtained by comparing the excess mortality in all deaths and deaths not related to alcohol. Results Men had 31 and women 11 manual occupations with SMR statistically significantly over 120 compared with all employees. Mortality rates were highest among building construction labourers (SMR 180) among men and building caretakers (SMR 155) among women. With few exceptions, high mortality was a combination of high alcohol-related and high non-alcohol-related mortality. Among men, the contribution of alcohol-related mortality to the excess all-cause mortality compared with all employees was over 10% in half of the high-mortality occupations. The contribution was highest among welders and flame cutters (50%) and lowest among farmer’s locums (−50%). Among women the contribution was highest among building caretakers (15%). Conclusions High-mortality occupations had high mortality even without alcohol-related deaths. However, alcohol-related mortality was generally higher than mortality for other causes; therefore, alcohol-related mortality increased further the excess mortality. Diminishing the alcohol-related mortality would level excess mortality of these occupations but not eliminate it.
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Objectives: The purpose of this study was to assess the effects of recent influenza epidemics on mortality in Japan.Methods: We applied a new definition of excess mortality associated with influenza epidemics and a new estimation method (new method) proposed in our previous paper to the national vital statistics for 1975-1999 (ICD8- ICD10 had been adopted) in Japan. This new method has the advantages of removing a source of random variations in excess mortality and of being applicable to shifting trends in mortality rates from different causes of death in response to the revision of ICD. The monthly rates of death from all causes other than accidents (all causes) and some cause-specific deaths such as pneumonia, malignant neoplasm, heart disease, cerebrovascular disease (C. V. D) and diabetes (D. M.) were analyzed by total and by five age groups: 0-4 years, 5-24 years, 25-44 years, 45-64 years, and 65 years old or older.Results: The following findings were noted:1. For each epidemic in every other year since 1993, large-scale excess mortality of over 10, 000 deaths was observed and the effect of those epidemics could be frequently detected in mortality even among young persons, i. e., 0-4 years or 5-25 years.2. Excess mortality associated with influenza epidemics influenced mortality by some chronic diseases such as pneumonia, heart disease, C. V. D., D. M., etc. For some epidemic years since 1978, excess mortality rates were detected even in mortality by malignant neoplasm.Conclusions: It has been definitely shown by applying the new method to the national vital statistics for 1975-1999 in Japan that influenza epidemics in recent years exerted an influence on overall mortality, increasing the number of deaths among the elderly and the younger generation. Monitoring of the trends in excess mortality associated with influenza epidemics should be continued.
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Background To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. Methods Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method. Results COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17–1.42) and women (SMR 1.2, 95% CI 1.06–1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67–2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years. Conclusion There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.
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Ecological study
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This study examines the Standardized Mortality Ratio (SMR) by age, sex and cause of death among psychiatric inpatients in Singapore. Mortality in mentally ill inpatients was found to be 2.79 times that of the general population. The SMR decreased with age and the SMR for those 70 years and above was lower than that reported in the literature. The mortality ratio was most accentuated in the younger patients, especially in the female. Excess mortality was observed in both the natural as well as the unnatural causes of death. Among the natural causes of death, infection and pneumonia showed high excess in mortality. In the unnatural causes of death, suicide was predominant.
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Abstract The aim of preventive medicine is to stop the cause of illness as soon as possible. So, if the study group itself is to benefit from the results, the disease state should be in an early phase. Many published reports in occupational medicine concern mortality studies. In a follow-up study, the mortality due to a specific disease can be studied. If mortality rates among the exposed are compared with (divided by) the mortality rate for non-exposed, relative mortality rates are calculated (instead of relative morbidity rates). Often you find the term SMR (standardized mortality ratio) used in these studies, meaning that the rates are adjusted (standardized) for age-differences in the two groups compared. The SMR value gives the excess mortality in percentages. An SMR value of 130 means an excess mortality rate among the exposed of 30 percent.
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Flora's Z statistic and standardized mortality ratios (SMRs) as indicators of excess mortality were calculated for a sample of 355 patients with major trauma. A statistically significant overall excess mortality was observed in this sample (Z = 6.77, SMR = 1.81, p < 0.05). Advanced life support provided by physicians at the scene (MD-ALS) was not associated with reduced excess mortality. A significant trend toward lower excess mortality was associated with a higher level of trauma care at the receiving hospital (p < 0.05). Total prehospital time over 60 minutes was associated with a significant increase in excess mortality (p < 0.001). These results support regionalization of trauma care and failed to show any benefit associated with MD-ALS.
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Trauma care
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