Respiratory symptoms in older people and their association with mortality.

BACKGROUND: A study was undertaken to assess the prevalence of reported respiratory symptoms in a population aged over 75 years and their association with mortality. METHODS: A total of 14 458 people aged 75 years and over participating in a trial of health screening of older people in general practice answered questions on three respiratory symptoms: cough, sputum production, and wheeze. The association of symptoms with mortality was examined for all cause and respiratory causes of death taking account of potential confounders. RESULTS: Coughing up phlegm in winter mornings had a prevalence of 27.0% (95% confidence interval (CI) 26.8 to 27.2). Those with this symptom had an adjusted hazard ratio for all cause mortality of 1.35 (95% CI 1.21 to 1.50), p<0.001 and for respiratory specific mortality of 2.01 (95% CI 1.66 to 2.41), p<0.001. Phlegm at any time of the day in winter had a prevalence of 16.5% (95% CI 16.3 to 16.7) with hazard ratios for all cause and respiratory specific mortality of 1.28 (95% CI 1.15 to 1.42) and 2.28 (95% CI 1.92 to 2.70), p<0.001. Wheeze or whistling from the chest had a prevalence of 14.3% (95% CI 14.1 to 14.5) with hazard ratios of 1.45 (95% CI 1.31 to 1.61) and 2.86 (95% CI 2.45 to 3.35), p<0.001. CONCLUSIONS: The prevalence of respiratory symptoms is widespread among elderly people and their presence is a strong predictor of mortality

The impact of heat waves and cold spells on mortality rates in the Dutch population.

We conducted the study described in this paper to investigate the impact of ambient temperature on mortality in the Netherlands during 1979-1997, the impact of heat waves and cold spells on mortality in particular, and the possibility of any heat wave- or cold spell-induced forward displacement of mortality. We found a V-like relationship between mortality and temperature, with an optimum temperature value (e.g., average temperature with lowest mortality rate) of 16.5 degrees C for total mortality, cardiovascular mortality, respiratory mortality, and mortality among those [Greater and equal to] 65 year of age. For mortality due to malignant neoplasms and mortality in the youngest age group, the optimum temperatures were 15.5 degrees C and 14.5 degrees C, respectively. For temperatures above the optimum, mortality increased by 0.47, 1.86, 12.82, and 2.72% for malignant neoplasms, cardiovascular disease, respiratory diseases, and total mortality, respectively, for each degree Celsius increase above the optimum in the preceding month. For temperatures below the optimum, mortality increased 0.22, 1.69, 5.15, and 1.37%, respectively, for each degree Celsius decrease below the optimum in the preceding month. Mortality increased significantly during all of the heat waves studied, and the elderly were most effected by extreme heat. The heat waves led to increases in mortality due to all of the selected causes, especially respiratory mortality. Average total excess mortality during the heat waves studied was 12.1%, or 39.8 deaths/day. The average excess mortality during the cold spells was 12.8% or 46.6 deaths/day, which was mostly attributable to the increase in cardiovascular mortality and mortality among the elderly. The results concerning the forward displacement of deaths due to heat waves were not conclusive. We found no cold-induced forward displacement of deaths

Associations between fine and coarse particles and mortality in Mediterranean cities: results from the MED-PARTICLES project

Few studies have investigated the independent health effects of different size fractions of particulate matter (PM) in multiple locations, especially in Europe. We estimated the short-term effects of PM with aerodynamic diameter = 10 µm (PM10), = 2.5 µm (PM2.5), and between 2.5 and 10 µm (PM2.5–10) on all-cause, cardiovascular, and respiratory mortality in 10 European Mediterranean metropolitan areas within the MEDPARTICLES project. We analyzed data from each city using Poisson regression models, and combined cityspecific estimates to derive overall effect estimates. We evaluated the sensitivity of our estimates to co-pollutant exposures and city-specific model choice, and investigated effect modification by age, sex, and season. We applied distributed lag and threshold models to investigate temporal patterns of associations. A 10-µg/m3 increase in PM2.5 was associated with a 0.55% (95% CI: 0.27, 0.84%) increase in all-cause mortality (0–1 day cumulative lag), and a 1.91% increase (95% CI: 0.71, 3.12%) in respiratory mortality (0–5 day lag). In general, associations were stronger for cardiovascular and respiratory mortality than all-cause mortality, during warm versus cold months, and among those = 75 versus < 75 years of age. Associations with PM2.5–10 were positive but not statistically significant in most analyses, whereas associations with PM10 seemed to be driven by PM2.5. We found evidence of adverse effects of PM2.5 on mortality outcomes in the European Mediterranean region. Associations with PM2.5–10 were positive but smaller in magnitude. Associations were stronger for respiratory mortality when cumulative exposures were lagged over 0–5 days, and were modified by season and age.Peer ReviewedPostprint (published version

Summertime, and the livin is easy: Winter and summer pseudoseasonal life expectancy in the United States

In temperate climates, mortality is seasonal with a winter-dominant pattern, due in part to pneumonia and influenza. Cardiac causes, which are the leading cause of death in the United States, are also winter-seasonal although it is not clear why. Interactions between circulating respiratory viruses (f.e., influenza) and cardiac conditions have been suggested as a cause of winter-dominant mortality patterns. We propose and implement a way to estimate an upper bound on mortality attributable to winter-dominant viruses like influenza. We calculate 'pseudo-seasonal' life expectancy, dividing the year into two six-month spans, one encompassing winter the other summer. During the summer when the circulation of respiratory viruses is drastically reduced, life expectancy is about one year longer. We also quantify the seasonal mortality difference in terms of seasonal "equivalent ages" (defined herein) and proportional hazards. We suggest that even if viruses cause excess winter cardiac mortality, the population-level mortality reduction of a perfect influenza vaccine would be much more modest than is often recognized

The Impact of HAART on the Respiratory Complications of HIV Infection: Longitudinal Trends in the MACS and WIHS Cohorts

Objective: To review the incidence of respiratory conditions and their effect on mortality in HIV-infected and uninfected individuals prior to and during the era of highly active antiretroviral therapy (HAART). Design: Two large observational cohorts of HIV-infected and HIV-uninfected men (Multicenter AIDS Cohort Study [MACS]) and women (Women's Interagency HIV Study [WIHS]), followed since 1984 and 1994, respectively. Methods: Adjusted odds or hazards ratios for incident respiratory infections or non-infectious respiratory diagnoses, respectively, in HIV-infected compared to HIV-uninfected individuals in both the pre-HAART (MACS only) and HAART eras; and adjusted Cox proportional hazard ratios for mortality in HIV-infected persons with lung disease during the HAART era. Results: Compared to HIV-uninfected participants, HIV-infected individuals had more incident respiratory infections both pre-HAART (MACS, odds ratio [adjusted-OR], 2.4; 95% confidence interval [CI], 2.2-2.7; p<0.001) and after HAART availability (MACS, adjusted-OR, 1.5; 95%CI 1.3-1.7; p<0.001; WIHS adjusted-OR, 2.2; 95%CI 1.8-2.7; p<0.001). Chronic obstructive pulmonary disease was more common in MACS HIV-infected vs. HIV-uninfected participants pre-HAART (hazard ratio [adjusted-HR] 2.9; 95%CI, 1.02-8.4; p = 0.046). After HAART availability, non-infectious lung diseases were not significantly more common in HIV-infected participants in either MACS or WIHS participants. HIV-infected participants in the HAART era with respiratory infections had an increased risk of death compared to those without infections (MACS adjusted-HR, 1.5; 95%CI, 1.3-1.7; p<0.001; WIHS adjusted-HR, 1.9; 95%CI, 1.5-2.4; p<0.001). Conclusion: HIV infection remained a significant risk for infectious respiratory diseases after the introduction of HAART, and infectious respiratory diseases were associated with an increased risk of mortality. © 2013 Gingo et al

Mortality among Lifelong Nonsmokers Exposed to Secondhand Smoke at Home: Cohort Data and Sensitivity Analyses

Evidence is growing that secondhand smoke can cause death from several diseases. The association between household exposure to secondhand smoke and disease-specific mortality was examined in two New Zealand cohorts of lifelong nonsmokers (‘‘never smokers’’) aged 45–77 years. Individual census records from 1981 and 1996 were anonymously and probabilistically linked with mortality records from the 3 years that followed each census. Age- and ethnicity-standardized mortality rates were compared for never smokers with and without home exposure to secondhand smoke (based on the reported smoking behavior of other household members). Relative risk estimates adjusted for age, ethnicity, marital status, and socioeconomic position showed a significantly greater mortality risk for never smokers living in households with smokers, with excess mortality attributed to tobacco-related diseases, particularly ischemic heart disease and cerebrovascular disease, but not lung cancer. Adjusted relative risk estimates for all cardiovascular diseases were 1.19 (95 % confidence interval: 1.04, 1.38) for men and 1.01 (95 % confidence interval: 0.88, 1.16) for women from the 1981–1984 cohort, and 1.25 (95 % confidence interval: 1.06, 1.47) for men and 1.35 (95 % confidence interval: 1.11, 1.64) for women from the 1996–1999 cohort. Passive smokers also had nonsignificantly increased mortality from respiratory disease. Sensitivity analyses in-dicate that these findings are not due to misclassification bias. cohort studies; mortality; myocardial ischemia; neoplasms; New Zealand; respiratory tract diseases; tobacc

Excess mortality during heat waves in Ireland

Ireland is not known for having extreme high temperatures, with values above 30C uncommon. Ireland has significant excess winter mortality compared to summer. The objective of this study is to estimate the impact of nation-wide heat waves on the total, cardiovascular and respiratory relationship, for the period 1981–2003, to determine if there are any periods of excess summer mortality

Exposure-Lag-Response in Longitudinal Studies: Application of Distributed-Lag Nonlinear Models in an Occupational Cohort.

Prolonged exposures can have complex relationships with health outcomes, as timing, duration, and intensity of exposure are all potentially relevant. Summary measures such as cumulative exposure or average intensity of exposure may not fully capture these relationships. We applied penalized and unpenalized distributed-lag nonlinear models (DLNMs) with flexible exposure-response and lag-response functions in order to examine the association between crystalline silica exposure and mortality from lung cancer and nonmalignant respiratory disease in a cohort study of 2,342 California diatomaceous earth workers followed during 1942-2011. We also assessed associations using simple measures of cumulative exposure assuming linear exposure-response and constant lag-response. Measures of association from DLNMs were generally higher than those from simpler models. Rate ratios from penalized DLNMs corresponding to average daily exposures of 0.4 mg/m3 during lag years 31-50 prior to the age of observed cases were 1.47 (95% confidence interval (CI): 0.92, 2.35) for lung cancer mortality and 1.80 (95% CI: 1.14, 2.85) for nonmalignant respiratory disease mortality. Rate ratios from the simpler models for the same exposure scenario were 1.15 (95% CI: 0.89, 1.48) and 1.23 (95% CI: 1.03, 1.46), respectively. Longitudinal cohort studies of prolonged exposures and chronic health outcomes should explore methods allowing for flexibility and nonlinearities in the exposure-lag-response