Prognostic indicators in multiple sclerosis
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Abstract The influence of sex, age at onset, course of the disease and initial symptomatology on the mortality of patients with multiple sclerosis is analysed. A sample of 1926 patients was followed up prospectively over 4.9 years. Both, the mortality ratio (number of observed to expected deaths) and the excess death rate are calculated. Whereas the mortality ratio as a parameter of overall mortality is influenced by a variety of factors, such as age and sex; the excess death rate represents the number of extra deaths per 1000 exposed to risk in an indicated year and is, therefore, a parameter of the mortality which is attributed to MS. The excess death rate was comparable for the sexes, it was slightly higher for patients with a higher age at onset and it was clearly higher for the progressive course. Patients with initial diplopia and sensory signs and symptoms had the lowest excess death rate, whereas patients with pareses, cerebral and sphincter disturbances at onset showed the highest excess death rate.Keywords:
Excess mortality
Standardized mortality ratio
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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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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This study updates the mortality experience of over 25,000 workers in a large Canadian petroleum company through December 31, 2006.Standardized mortality ratios were generated for all-cause and specific cause mortality.All cause and all cancer mortality were favorable compared with the general Canadian population. Cancers of previous interest were largely consistent with expectation. There is a continuing excess of mesothelioma, which is of similar magnitude as the previous update, although based on larger numbers. This excess is mostly attributable to men who died in their 50s and 60s and who worked in the refining sector.Most causes of death show mortality rates lower than the Canadian general population. Given the excess of mesothelioma observed, this study supports ongoing vigilance in asbestos exposure control programs, as refineries continue to remove asbestos from their facilities.
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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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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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To describe the mortality of Paris sewage workers.A cohort of all Paris sewage workers since 1970 was established and followed up in mortality until 1999. The causes of death were determined by matching with a national database. The mortality rates were compared to the rates of a local reference population.A large excess in mortality (standardised mortality ratio (SMR) = 1.25; 530 cases, 95% CI 1.15 to 1.36) and in particular mortality from cancer (SMR = 1.37, 235 cases) was detected which was particularly important in the subgroup of subjects who had left employment because they resigned or were laid off (SMR = 1.77; 50 cases). The excess mortality is to a large extent due to alcohol related diseases (SMR = 1.65, 122 cases) especially malignant (SMR = 1.85, 16 cases) and non-malignant (SMR = 1.68, 38 cases) liver diseases, lung cancer (SMR = 1.47, 68 cases), and infectious diseases (SMR = 1.86, 25 cases). The SMRs for some diseases (all cancers, cancers of the oesophagus and lung, all alcohol related diseases) seem to increase with duration of employment as a sewage worker. Other than lung cancer, smoking related diseases were not in excess.The increased mortality by both malignant and non-malignant liver diseases is probably due to excessive alcohol consumption, but could be partially the result of occupational exposure to chemical and infectious agents and interactions of these factors. The excess lung cancer is unlikely to be due to an increased smoking prevalence.
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This paper describes a cohort study of the mortality among workers employed in one of Polish tyre plants. The scope of the study was limited to the analysis of mortality from main disease categories. Mortality from particular cancer sites will be discussed in a separate publication. The cohort comprised 17,747 workers (11,660 men and 6,087 women) employed during the years 1950-95 for at least three months in the tyre plant. As of 31 December 1995, the follow-up of the cohort was completed. A detailed analysis of mortality by causes was carried out using standardised mortality ratio (SMR) calculated by the person-years method. The general population of Poland was used as the reference. The results indicated general mortality significantly lower in the cohort (men: SMR = 72; women: SMR = 62), than in the reference population. The number of observed deaths from main disease categories was also lower than those expected. The analysis by specific causes revealed significant excess of deaths, due to hypertensive disease among men (36 deaths, SMR = 142; 95% CI: 99-197). SMRs were also calculated in sub-cohorts identified by activities performed (preparatory works: production of tyres and inner tubes; maintenance; storage; others). General mortality in sub-cohorts was similar to that in the total cohort. After analysis by causes of death, some non-significant excess mortality could be observed. It was very small or it applied only to single cases of death. Excess mortality from hypertensive disease in male maintenance workers (21 deaths, SMR = 262; 95% CI: 162-400) was the only exception. The absence of adverse health effects pronounced by significant excess mortality should be attributed to a relatively short period of exposure among the majority of the followed-up workers (over 58% of workers in the cohort employed in the plant for a period shorter than five years) and to their young age. Almost 56% of workers in the cohort were born in the 1950s or later which means that at the end of the follow-up they were not older than 45 years. In order to complete the final mortality assessment the follow-up should continue.
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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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An historical cohort study was conducted among salaried pensioners alive and receiving benefits on Dec 31, 1974, and followed for vital status through Dec 31, 1980. For all causes combined, this cohort experienced mortality levels at or below that of the US population. For all malignant neoplasms combined, workers with plant experience only showed a statistically significant excess (standardized mortality ratio [SMR] = 1.34). This may have been largely due to a significant excess of lung cancer in the same group (SMR = 1.90). Individuals with some plant experience exhibited a significant excess of lung cancer (SMR = 1.48). These findings were not detected among active workers in the same company. There were no causes of death for which the SMR deviated significantly from unity among individuals with research experience.
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