Category Archive for: ‘All-cause mortality’
Chronic diseases associated with all-cause mortality
In middle-aged men from the Seven Countries Study the additional relative risk of death within 15 years varied for seven chronic diseases from 47% for ‘other’ heart disease to 81% for heart attacks.
In older men the additional risk of death for any chronic disease was 95% in Finland, 88% in The Netherlands and 27% in Italy.
The risk of death with an entry class of 3 or more chronic diseases compared to their absence was more than 3 times greater in elderly men from Finland and The Netherlands and 2 times greater in Italy.
These results indicate that the presence of clinically manifest major chronic diseases predicts all-cause mortality and the relation is stronger in northern than in southern Europe.
The scrutinized diseases were heart attack, heart failure, stroke, peripheral arterial disease, other heart disease, diabetes and chronic obstructive pulmonary disease.
Telomere length not related to all-cause mortality
Longer telomeres at baseline did not predict all-cause and cause specific mortality after 7 years of follow-up in the elderly men cohort from Zutphen. The cross-sectional mean telomere length decreased from 5.03 kbp in the 1993 survey to 4.76 kbp in 2000. Telomere shortening is a marker of ageing that might be related to oxidative stress.
Repeated measures of telomere length
Telomeres are nucleoprotein structures at the end of chromosomes. They prevent chromosomal ends from being recognized as double strand breaks and thus apparently protect them from end to end fusion and degradation.
In elderly, smoking and heart rate predict all-cause mortality
In elderly men from Finland, The Netherlands and Italy, age, smoking and heart rate were positively associated with excess 10-year all-cause mortality. The association of systolic blood pressure with all-cause mortality was marginally significant at 10 years. HDL-cholesterol and body mass index were significantly inversely related to all-cause mortality after 10 years of follow-up but these associations were no longer significant after excluding early deaths (during the first 5 years of follow-up).
These results suggest that smoking and heart rate (an indicator of physical activity and fitness) remain useful risk factors in prediction of all-cause mortality up to old age.
Many cardiovascular risk factors related to all-cause mortality
In the Seven Countries Study age, systolic blood pressure, smoking and serum cholesterol predicted 25-year all-cause mortality in most cohorts. These risk factors were also predictive of 40-year all-cause mortality in the US railroad and the Cretan cohort.
An analysis of the European cohorts showed that systolic blood pressure remained a strong predictor of excess relative risk of all-cause mortality during 35 years of follow-up. The strength of the association declined with increasing follow-up years (ageing) while absolute risk increased greatly with age.
In the rural Italian cohorts other risk factors were also related to 40-year all-cause mortality, namely: mortality of father and mother before age 60, job-related physical activity (inversely related), body mass index (inverse J-shaped), mid-arm circumference (inversely related), lung function (inversely related) and the presence of corneal arcus, xanthalasmata and of any catagory of clinical CVD, diabetes or cancer at entry.
- Menotti et al. Eur J Epidemiol 2001;17:337-46
- Menotti et al. Eur J Epidemiol 2004;19:417-24,
- Menotti et al. J Hypertension 2004;22:1683-90
- Moschandreas et al. Int J Cardiol 2005;100:85-91
- Menotti et al. Aging Clin Exp Res 2005;18:394-406
Cognitive decline associated with mortality
Elderly men from Finland, The Netherlands and Italy (the FINE study) whose cognition declined in the preceding 5 years, had a 2-fold greater risk of dying in the subsequent 5 years. The mortality risk of the men whose cognition improved between 1990 and 1995 was not different from those whose cognition remained stable.
Many factors predict survival
At the start of the mortality follow-up in 1995, the survivors in 2000 were younger, had a better cognitive function, were more physically active and were less disabled. They also had a lower prevalence of heart attacks and cancer than those who died during the 5-year mortality follow-up period.
Disability and depressive symptoms related to all-cause mortality
Self-rated health, disability and depressive symptoms were independent from each other, and were associated with all-cause mortality in elderly men from Finland, The Netherlands and Italy (the FINE study). After adjustment for the prevalence of chronic diseases severity of disability and depressive symptoms remained related to all-cause mortality.
Combinations of measures also associated with all-cause mortality
For the combination of disability and self-rated health a 3-fold greater mortality risk was observed for men who had severe disability and a poor self-rated health compared to the reference group. Men with severe disability in the two highest categories of depressive symptoms had also a 3-fold higher mortality risk.
These results suggest that for adequate prognosis of mortality and for developing intervention strategies information is needed on other and different health outcomes.
Self-rated and physician-rated health associated with mortality
Self-rated health was strongly related to all-cause mortality after 5 and 15 years of follow-up. Physician-rated health was an independent predictor of 15-year all-cause mortality. Self-rated health predicted cancer mortality and physician-rated health predicted cardiovascular mortality. Self-rated health provided information beyond physican-rated health and may help clinicians to optimize the decision-making surrounding treatment, hospital referral and follow-up visits to achieve “patient-centered care”.
Measuring self-rated and physician-rated health
Self-rated health has been identified by the American Institute of Medicine as one of the 20 key indicators valuable in measuring health of populations. In 1985, self-rated health was measured on a four-point scale in the Zutphen Elderly Study. Physician-rated health was evaluated with a five-point scale.
Low alcohol intake associated with low all-cause mortality and better survival
Among regular consumers of alcoholic beverages in the Zutphen Study, average alcohol intake increased from 8 g/d in 1960 to 18 g/d in 1985 and then decreased to 13 g/d in 2000. All-cause mortality during 40 years of follow-up was 25% lower in men who drank less than 20 g alcohol per day and on average 6 g/d compared to non-drinkers. Men average aged 50 with a long-term regular alcohol intake of 20 g/d or less, had a 2.3 years longer life expectancy than those who did not use alcohol.
Wine drinkers had the best life expectancy
The life expectancy of wine drinkers (average age 50, average alcohol intake 2 g/d) was 4.7 years longer compared to those who did not use alcohol. For those who consumed on average 8 g/d alcohol as beer or spirits the difference in life expectancy from non-alcohol drinkers was 2.2 years.
Strong relationship of smoking with all-cause mortality
Smoking was associated with all-cause mortality after 10-years of follow-up in all cohorts of the Seven Countries Study except the Japanese, apparently due to the small number of events in Japan in the early follow-up. The strength of this association was stronger in the cohorts from the US and northern Europe than in the eastern and southern European cohorts. After 25 years of follow-up, in contrast, smoking was associated with a higher all-cause mortality in all 16 cohorts. For example, the 40-year follow-up data from the Zutphen Study showed that smokers had a 60% higher all-cause mortality compared to non-smokers. In the elderly men of Finland, the Netherlands and Italy, the 10-year all-cause mortality was 67% higher in smokers than in non-smokers.
Apparent large health gain from stopping smoking
Men who stopped smoking at age 40 had 4.6 year greater life expectancy, while men who stopped smoking at age 70 had an addes 2.5 years. Life expectancy at age 40 was 6.8 years shorter for cigarette smokers compared to non-smokers and 8.8 years for men who smoked more than 30 cigarettes per day. Exclusively cigar or pipe smokers had a 4.7 year lower life expectancy.
- Keys et al. Harvard University Press. ISBN 0-674-80273-3, 1980: 136-60
- Jacobs et al. Arch Intern Med 1999;159:733-40
- Menotti et al. Eur Heart J 2001;22:573-9
- Streppel et al. Tob Control 2007;16:107-13
Activity inversely related to all-cause mortality
Elderly men in Zutphen with a high level of leasure physical activity (mean 1217 min/week) had a 23% lower all-cause mortality after 10 years of follow-up compared to those with a low level (mean 122 min/week). Men who walked or cycled at least 3 times per week for 20 min or more per day were called active and those who did not meet the criterion were considered sedentary. All-cause mortality was 29% lower in the active compared to the sedentary men.
Reducing activity was associated with greater all-cause mortality
Changes in physical activity over the period of study were also related to all-cause mortality rate. Men who were sedentary in both 1985 and 1990 surveys had a 2 times greater risk of death from all-causes by 1995 compared to those who were classed as active in both surveys. A gradient of decreasing risk of death was observed among those who became active compared to those who became or remained sedentary.
Measuring physical activity
In the Zutphen Elderly Study physical activity was assessed with a questionnaire among these retired men, which queried about frequency and duration of walking, cycling, sports, gardening, hobbies and odd jobs. The questionnaire was validated against measures of total energy expenditure.
- Caspersen et al. Am J Epidemiol 1991;133:1078-92
- Bijnen et al Arch Intern Med 1998;158:1499-1505
- Bijnen et al. Am J Epidemiol 1999;150:1289-96