Psychological distress and premature mortality in the general population: a prospective study

PURPOSE: To determine whether higher rates of mortality are observed in people reporting psychological distress, to establish the nature of any excess, and to examine the possible existence of a dose response relationship. METHODS: We conducted a prospective follow-up study of mortality over an eight-year period in the North West of England. A total of 4,501 adults were recruited from two general practices during a population-based survey conducted at the start of 1992. At baseline psychological distress was assessed using the General Health Questionnaire (12-item version, GHQ-12). The relationship between levels of distress and subsequent mortality was examined using Cox proportional hazard models. RESULTS: Risk of all-cause mortality was greatest in subjects reporting the highest levels of distress (hazard ratio (HR) 1.71, 95% CI 1.32-2.23) but was also raised in subjects reporting intermediate distress (HR 1.38 95% CI 1.06-1.79) when compared to those reporting no distress. Increased risk of mortality in subjects reporting distress appeared to be due largely to an excess of deaths from ischaemic heart disease (high distress, HR 1.90, 95% CI 1.08-3.35; intermediate distress, HR 1.58, 95% CI 0.90-2.76) and respiratory diseases (high distress, HR 5.39, 95% CI 2.70-10.78; intermediate distress, HR 2.33, 95% CI 1.12-4.22). CONCLUSIONS: The association between mortality and psychological distress observed in this study seems to arise largely because of premature deaths from ischaemic heart disease and respiratory diseases. The existence of a dose-response effect between distress and mortality provides further evidence to support the existence of a casual relationship.     

Lactase persistence,milk intake,and mortality in the Danish general population: a Mendelian randomization study

Meta-analyses have suggested no association between milk intake and mortality. Since only few studies have been conducted, we investigated the association between the lactase persistent genetic variant LCT-13910 C/T (rs4988235), a proxy for long-term low and high intake of milk, and mortality. We used two Danish population-based studies with self-reported intake of milk and genotyping for LCT-13910 C/T. We obtained information on all-cause and cause-specific mortality (cardiovascular and cancer) from the national Danish registries. We used multivariable adjusted Cox regression to assess the association between milk intake and mortality in 74,241 individuals, and both logistic and Cox-regression to assess the association between genetic lactase persistence and mortality in 82,964 individuals using a Mendelian randomization design. We applied per T-allele, co-dominant and dominant models. During a mean follow-up of 7 years, 9759 individuals died, 2166 from cardiovascular disease, and 2822 from cancer. Observationally, there was no association between intake of skimmed milk and all-cause or cardiovascular mortality, and we did not find any associations between intake of semi-skimmed or whole milk with all-cause or cause-specific mortality. Intake of skimmed milk was associated with lower cancer mortality with a hazard ratio of 0.97 (95% CI 0.96–1.00) per doubling in milk intake. Per T-allele, milk intake increased with 0.58 (0.50–0.68) glasses/week. Genetically, we found no associations between the lactase persistent LCT-13910 C/T genotype and all-cause or cause-specific mortality; per T-allele OR (95% CI) for all-cause mortality was 1.02 (0.97–1.06). Our study did not provide strong evidence of observational or genetic associations between milk intake and all-cause or cause-specific mortality.     

Age at retirement and mortality in a general population sample: the Greek EPIC study

Investigation of the health effects of retirement and age at retirement is limited, but the issue is particularly important given the pressure for an increase in the retirement age in Europe. In the Greek segment of the European Investigation into Cancer and Nutrition study, 16,827 men and women enrolled from 1994 to 1999 were either gainfully employed or had retired from such employment at enrollment; had not previously been diagnosed with stroke, cancer, coronary heart disease, or diabetes mellitus; and had complete information on important covariates and documented survival status as of July 2006. All-cause and cause-specific mortality in relation to employment status and age at retirement (among retirees) was analyzed through Cox regression models, controlling for potential confounders. In comparison to subjects still employed, retirees had a 51% increase in all-cause mortality (95% confidence interval: 16, 98). Among retirees, a 5-year increase in age at retirement was associated with a 10% decrease in mortality (95% confidence interval: 4, 15). Findings were more evident for cardiovascular than for cancer mortality, whereas, for injury mortality, there was no evidence of association. Results indicate that early retirement may be a risk factor for all-cause and cardiovascular mortality in apparently healthy persons.     

Marital status and mortality: the national longitudinal mortality study

PURPOSE: To examine the effect of marital status (married, widowed, divorced/separated, and never-married) on mortality in a cohort of 281,460 men and women, ages 45 years and older, of black and white races, who were part of the National Longitudinal Mortality Study (NLMS). METHODS: Major findings are based on assessments of estimated relative risk (RR) from Cox proportional hazards models. Duration of bereavement for the widowed is also estimated using the Cox model. RESULTS: For persons aged 45-64, each of the non-married groups generally showed statistically significant increased risk compared to their married counterparts (RR for white males, 1.24-1.39; white females, 1.46-1.49; black males, 1.27-1.57; and black females, 1. 10-1.36). Older age groups tended to have smaller RRs than their younger counterparts. Elevated risk for non-married females was comparable to that of non-married males. For cardiovascular disease mortality, widowed and never-married white males ages 45-64 showed statistically significant increased RRs of 1.25 and 1.32, respectively, whereas each non-married group of white females showed statistically significant increased RRs from 1.50 to 1.60. RRs for causes other than cardiovascular diseases or cancers were high (for white males ages 45-64: widowed, 1.85; divorced/separated, 2.15; and never-married, 1.48). The importance of labor force status in determining the elevated risk of non-married males compared to non-married females by race is shown. CONCLUSIONS: Each of the non-married categories show elevated RR of death compared to married persons, and these effects continue to be strong after adjustment for other socioeconomic factors.     

Social class, smoking and the severity of respiratory symptoms in the general population

STUDY OBJECTIVE: The prevalence of respiratory symptoms has been found in some studies to vary with social class. One explanation of this link may be the effect of exposure to cigarette smoke. To investigate this, the relation between social class, smoking and respiratory symptoms was explored in a population based survey. DESIGN: A cross sectional survey using a validated questionnaire. SETTING: Two general practices in Staffordshire, United Kingdom. PATIENTS: A random sample of 4237 patients aged 16 and over from two general practices in Staffordshire were mailed a questionnaire enquiring about respiratory symptoms and their severity. MAIN RESULTS: The severity of respiratory symptoms increased with increasing exposure to cigarette smoke and was greater among manual social classes. Current smokers (odds ratio (OR) = 2.9, 95% confidence limits (CI) 2.3, 3.6), past smokers (OR = 1.5, 95% CI 1.2, 1.8) and passive smokers (OR = 1.4, 95% CI 1.0, 1.8) were more likely to report the more severe respiratory symptoms compared with non-smokers. Responders from social class V (OR = 2.4, 95% CI 1.3, 4. 4) were more likely to report the more severe respiratory symptoms compared with social class I, as were responders from social classes IIIM (OR = 1.3, 95% CI 0.9, 1.9) and IV (OR = 1.4, 95% CI 0.9, 2.1). These effects were independent of each other. CONCLUSIONS: This study has shown that social class is linked to the severity of respiratory symptoms, independently of smoking. Although the need to reduce and quit smoking in manual class households remains a crucial preventive issue, other mechanisms by which social class differences may influence symptom occurrence and severity need to be explored.     

Heart rate and mortality in a Japanese general population: an 18-year follow-up study

The predictive power of elevated heart rate for total mortality was evaluated in a Japanese general population. A total of 573 male participants, aged 40 to 64, who underwent a health examination in 1977, were followed until 1994. Heart rate (beats per minute; bpm) was measured using an electrocardiogram. During the 18 years, 82 subjects died; 18 from cerebro-cardiovascular diseases and 36 from cancer. In a multivariate proportional hazards regression model, age, elevated systolic and diastolic blood pressures, antihypertensive medication, heart rate, uric acid, vital capacity (inversely), and serum cholesterol (inversely) were significantly associated with all-cause death. Of these variables, elevated heart rate was the strongest predictor of all-cause death after adjustment for age. Resting heart rate levels were classified into five groups: < 60 (G1), 60-69 (G2), 70-79 (G3), 80-89 (G4), and > or = 90 (G5) bpm. Heart rates of 60-69 (G2) bpm showed the lowest death rate (14.3%) and heart rate > or = 90 (G5) bpm showed the highest death rate (38.2%) after adjustments for age and other confounding factors. The relative risk of G2 versus G5 was 2.68. An increased mortality risk was shown in men whose heart rate was > or = 90 bpm. Moreover, a continuous model suggested a graded increase in risk, so that risk is likely elevated even for heart rates less than 90 bpm, and lowest risk may be around 60 bpm.     

Symptom prevalence and severity in a general practice population

The prevalence of symptoms in the community is sometimes used as an index of untreated morbidity. However, such an index can be very misleading unless it makes allowance for differences in symptom severity between declared and undeclared patients. Recent attenders at one health centre were compared with controls who had not seen their GPs for at least three months. Comparisons of symptom severity were made between attenders who had reported one or more of seven selected symptoms and non-attenders who said they were troubled by the same symptoms. For the symptoms selected, it was found that a high proportion of sufferers in both groups were of at least two months' chronicity. Prevalence rates of up to 33% for backache and tiredness in older women were found in non-attending controls, but symptom severity was significantly less than in patients who had recently consulted their doctors with the same symptom. Symptoms were both more prevalent and more severe among women than among men. It seemed unlikely, however, that this difference could explain the higher consultation rates for women, because the same excess of women over men persisted among consulters. It seems that for these symptoms increasing severity is associated with an increasing probability of attending the surgery but that the symptoms functions more often as a background factor than as a precipitant.     

Right bundle branch block: Prevalence,incidence, and cardiovascular morbidity and mortality in the general population

Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities.

Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG).

Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB.

Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR?=?3.8; 95%CI: 2.4–6.1) and age (HR?=?1.05 per year; 95%CI: 1.03–1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease.

Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.     

Dyspnea in elderly family practice patients. Occurrence, severity, quality of life and mortality over an 8-year period

BACKGROUND AND OBJECTIVES: This study examined the prevalence and severity of dyspnea in patients >/=70 years of age and its impact on the quality of life. We also examined the prognostic significance of dyspnea for mortality. METHODS: The cohort study started with a mailed questionnaire, supplemented with an interview. From the population of elderly patients in a family practice health center, a one in five sample (n = 124) was randomly selected, similar in age and sex distribution to those not in the sample. Demographic and other relevant variables were examined for their association with dyspnea. Cox proportional hazards ratio analysis was done with dyspnea (MRC, BDI scores) as independent and mortality as dependent variable. RESULTS: Baseline data indicated that 23% (MRC) to 37% (BDI) of the patients had moderate to severe dyspnea. Shortness of breath was associated with older age, poor perceived health, more anxiety and depressive symptoms, impaired daily functioning, and lower happiness. Moderate and severe dyspnea measured with BDI and MRC was a significant predictor of death within eight years due to cardiovascular or lung disease. Selective participation did not appear to have biased this outcome. CONCLUSIONS: Dyspnea occurs frequently in the elderly, is associated with poor health, and interferes with daily functioning. Results suggest that dyspnea contributes to mortality. Development and implementation of guidelines would be highly desirable. Early diagnosis is valuable because this provides opportunities to positively influence the patient's functional condition.     

Increased mortality in the slim elderly: a 42 years follow-up study in a general population

The Bergen Clinical Blood Pressure Study in Norway was used to examine the relationship between body mass index (BMI (kg/m²)) and total mortality in different age segments. Of 6,811 invited subjects, 5,653 (84%) participated in the study (1965–1971) and 4,520 (66%) died during 182,798 person-years of follow-up (1965–2007). Mean age at baseline was 47.5 years; range 22–75 years. BMI (kg/m²) was calculated from standardized measurements of body height and weight and divided into four groups (<22.0, 22.0–24.9, 25.0–27.9, ≥28.0). The 20 years cumulative risk of death related to baseline BMI was U-shaped in the elderly (aged 65–75 years), whereas the pattern was more linear in the youngest age group (20–44 years). In contrast to the younger age groups, the highest mortality in the elderly was in the lower BMI range (<22.0 kg/m²) (adjusted Cox proportional Hazard Ratio 1.39, 95% Confidence Interval 1.10, 1.75) compared to the BMI reference group (22.0–24.9 kg/m²). This pattern persisted after 72 months of early follow-up exclusion and it was robust to adjustments for a wide range of possible confounders including gender, history of cardiovascular disease, respiratory disease or hypertension, smoking habits, physical activity, socioeconomic status, physical appearance and other anthropometric measures. The study shows that a low BMI is an appreciable independent risk factor of total mortality in the elderly, and not a result of subclinical disease or confounding factors such as current or previous smoking. Awareness of this issue ought to be emphasized in advice, care and treatment of elderly subjects.     

Cerebral microbleeds and the risk of mortality in the general population

Presence of cerebral microbleeds indicates underlying vascular brain disease and has been implicated in lobar hemorrhages and dementia. However, it remains unknown whether microbleeds also reflect more systemic vascular burden. We investigated the association of microbleeds with all-cause and cardiovascular related mortality in the general population. We rated the brain magnetic resonance imaging scans of 3979 Rotterdam Scan Study participants to determine presence, number, and location of microbleeds. Cox proportional hazards models, adjusted for age, sex, subcohort, vascular risk factors, and other MRI markers of cerebral vascular disease, were applied to quantify the association of microbleeds with mortality. After a mean follow up of 5.2 (±1.1) years, 172 (4.3 %) people had died. Presence of microbleeds, and particularly deep or infratentorial microbleeds, was significantly associated with an increased risk of all-cause mortality [sex-, age-, subcohort adjusted hazard ratio (HR) 2.27; CI 1.50–3.45], independent of vascular risk factors (HR 1.87; 95 % CI 1.20–2.92). The presence of deep or infratentorial microbleeds strongly associated with the risk of cardiovascular related mortality (HR 4.08; CI 1.78–9.39). Mortality risk increased with increasing number of microbleeds. The presence of microbleeds, particularly multiple microbleeds and those in deep or infratentorial regions, indicates an increased risk of mortality, independent of other MRI markers of cerebral vascular disease. Our data suggest that microbleeds may mark severe underlying vascular pathology associated with poorer survival.     

Dyspnea and 8-year mortality among elderly men and women: The PAQUID cohort study

PAQUID is an epidemiological cohort which aims to study cerebral and functional factors of ageing. We have examined the relationship between dyspnea level at entrance into this cohort and mortality occurring during the subsequent 8 years. Dyspnea was evaluated by a questionnaire derived from a Fletcher's five-degree scale. Mortality was recorded during follow-up according to its date and cause. Of 2762 subjects (98.9%) initially giving their dyspnea level, 935 (33.5%) had died 8 years later including 444 (40%) men and 491 (29.4%) women. Mortality was closely related to dyspnea level (p < 0.0001) both in men and women, especially for grade 3 and over, even after adjusting on age, sex, smoking history and former occupation. These results show that dyspnea grade 3 or higher is an important predictive symptom of mortality, thus suggesting that this is a threshold defining the dyspneic subject.     

A follow-up study of tuberculosis incidence and general mortality in various occupational-social groups of the Danish population

The aim of this study (which was prospective, as opposed to retrospective) was to determine, for the tuberculosis case-finding programme in Denmark, whether grouping the population in eight broad occupational-social classes would reveal groups with a high tuberculosis incidence. The procedure was to examine the incidence of respiratory tuberculosis in the various groups during a 6-year follow-up period. The study comprises the total male population outside the metropolitan area and aged 15-34 years in 1950-52.     

Subjective health status and health values in the general population.

OBJECTIVE: To explore the relationship between rating-scale evaluation of health-related quality of life ("health value") and two subjective evaluations of health: the SF-36 profile and the five-category perception of general health (excellent, very good, good, fair, and poor). METHODS: This relationship was explored by linear and nonlinear regression analysis of data obtained through face-to-face interviews with a sample of 2,030 persons aged 45-75 years representing the Israeli Jewish urban population in that age group. RESULTS: The main outcome is a mapping assigning health values to the subjective health-status scores, e.g., "good" general health is equivalent to a health value of 76-81, depending on the functional form of the relation. "Poor" health is equivalent to a value of 45-61. The R2 is about 0.3. While the eight scales of the SF-36 were found to be linearly related to health value (R2=0.51), the two summary measures-physical component scale (PCS) and mental component scale (MCS)-were not. The scales measuring general health, vitality, and physical functioning were the main determinants of health value, while the role-performance scales were insignificant. The PCS had a larger effect than the MCS. DISCUSSION: These relationships provide deeper insight into the structure and meaning of the two health-status measures in the general population. They also place earlier determinations of these relationships among sick persons in a broader context and raise several further questions regarding the relationship between health values and health status.     

Predicting all causes mortality in the general population as a function of blood pressure and smoking habits measured in population samples: A pilot study

Nine population samples of mean aged 40–59, for a total of 1777 individuals drawn from nine health units, were examined in 1978–79 for the measurement of some risk factors possibly related to total mortality. The analysis evaluated the possible relationship between blood pressure levels and smoking habits measured in the population samples and the official death rates covering the period 1980–82 in the health units from which the samples were drawn. The analysis was conducted in a direct way but also by the help of a risk function linking blood pressure and smoking habits as obtained from another Italian population sample. The cograduation test between mean blood pressure in the nine areas and total mortality was 0.58 (linear correlation 0.57); the cograduation test was-0.70 for non-smokers, 0.62 for ex-smokers, 0.50 for present smokers (linear correlation of-0.27, 0.29, and 0.14 respectively). The death rates estimated by the risk function (Cox model) tended to overestimate the death rates from 5 to 64% (average 36.3%). The cograduation test between expected and observed death rates was 0.56 (linear correlation coefficient 0.66). Some limitations of this pilot study are largely explained by the small size of the sample and by the need to use a risk function provided by another population sample. see appendix Research partly developed within the Targeted Project FATMA (Prevention and Control of Risk Factors), Sub Project Community Medicine, of the CNR (Italian National Research Council) Contract CNR. 91. 00289. PF41     

Dyspnea: A strong independent factor for long-term mortality in the elderly

Objective

To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors.

Methods: Design

Longitudinal study.

Setting

In Dordogne and Gironde, South Western France.

Subjects

A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included. Main outcome measures: dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m²), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes.

Results

The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects, 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P<10^?4). The median survival was at 13.26 (SD 0.20) years for level-0 of dyspnea, 12.33 (SD 0.31) years for level-1 of dyspnea, 9.28 (SD 0.44) years for level-2 and 6.43 (SD 0.45) years for level-3 and 4 (P=10^?3). In the multivariate analysis, the risk of mortality for level1 compared to level-0 was HR=1.13 (CI95%=[1.01–1.26]); this risk increases to HR=1.42 (CI95%=[1.25–1.63]) for level-2 and to HR=1.90 (CI95%=[1.61–2.25]) for level-3 and 4.

Conclusion

These findings suggest that the relationship between long-term mortality and dyspnea is strong, consistent and independent of other covariates in the elderly.     

Epidemiology of bulimia and symptoms in a general population: Sex,age, race,and socioeconomic status

The prevalence of bulimia (as defined by DSM-/I/ [American Psychiatric Association 1980. Diagnostic and statistical manual of mental disorders (3rd ed.). Washing- ton, D.C.: Author]) was estimated by structured interview in a random sample of 2,715 adults in the general population, aged 18-96. Prevalence was 1.1% for the total sample, and among women aged 18-30, 4.1%. Bulimic behaviors and symptoms were more common among women than men, younger than older respondents, and, on some items, lower socioeconomic status (SES) than higher SES respondents. There was no difference in prevalence of bulimia between women students and same-aged non-students. No racial differences were found. There were more cases of bulimia in the older population than expected.     

Correlates of markers of oxidative status in the general population

Oxidative stress has been implicated in the etiology of many chronic diseases, including cardiovascular disease. However, limited information exists on the factors that may influence oxidative status in the general population. In a random sample of the population of two counties in western New York, levels of several markers of oxidative status (i.e., thiobarbituric acid-reactive substances, erythrocyte glutathione, and glutathione peroxidase) were determined. A total of 894 men and 903 women aged 35-79 years were included in the study (1996-1999). In addition, a number of sociodemographic and lifestyle characteristics and cardiovascular disease risk factors were measured. Age, markers of glucose metabolism (e.g., plasma glucose level) and insulin resistance (e.g., serum triglycerides, high density lipoprotein cholesterol, body mass index), and postmenopausal status in women were associated with increased oxidative stress and reduced antioxidant potentials. Oxidative status and antioxidant potentials appear to be significantly associated with a number of major cardiovascular disease risk factors; most of them are linked to abnormalities in glucose and insulin metabolism.