mortality

Introduction

Susceptibility to death. Also see longevity

Etiology

• see death for causes of mortality
• risk factors
  • also see cardiovascular risk factors
  • 6 risk factors for premature mortality from chronic disease
    • tobacco use
    • alcoholism
    • excessive salt intake
    • hypertension
    • obesity
    • hyperglycemia & diabetes mellitus
  • low socioeconomic status
  • manifestations of increased mortality in the elderly
    • weaker grip strength
    • slower walking speed
      • 400 meter walk predicts mortality
        • lowest quartile, mean time 4.5 minutes
      • gait speed is best predictor of mortality
    • slower chair rise time
    • self reported exhaustion is not strongly associated with mortality
  • low muscle strength in adolescent males (knee extension, hand grip) associated with higher early death due to cardiovascular disease or suicide
    • no effect on early cancers
    • alpha male effect ?
  • body composition predicts mortality
    • predicted fat mass & all-cause death is linear
    • predicted lean mass & death is U-shaped
  • 10-year mortality higher in adolescents presenting to an emergency department with injuries from self-harm, drugs, alcohol, or violence versus accidents
  • anosmia increases 5-year risk of mortality in the elderly 5-fold
  • telomer length
    • shorter leukocyte telomere length associated with increased mortality risk
    • shortening of telomeres does not play a causative role in aging
    • leukocyte telomere length of 5 kb defined as telomeric brink
      • a subset of adults may reach the telomeric brink within 100 years
  • attending religious services may be a negative risk factor
  • online calculator for prediction score based on questionnaire

* self-rated health best predictor of mortality

* ePrognosis calculator estimates mortality in elderly without terminal illness

Epidemiology

• mortality increases exponentially with age
  • clinical significance of predicting mortality in elderly > 80 years of age less important than quality of life & maintaining independence
• infant mortality 0.582 % of live births
  • infant mortality in the U.S. is declining
• from 2013 to 2014, deaths in the U.S from Alzheimer disease increased 8.1% to 25.4 per 100,000 population
  • in 2013 Alzheimer disease was the 6th leading cause of death
• adults without health insurance with 40% higher relative risk for death than insured adults
• mortality from causes amenable to healthcare intervention are higher in the U.S. than in France, Germany, & the U.K.
  • regional variations in U.S. mortality rates
    • mortality rate in Mississippi, Washington DC twice that in Minnesota
• since 1980, U.S. mortality has been higher than that in other affluent nations
  • 1980-2019, 335 million fewer years of life in U.S. than in other affluent nations
• economic hardship is associated with higher levels of physical activity, lower body mass index (BMI), & probably better dietary habits in Cuba
  • the reduction in BMI is associated with reduced mortality from diabetes & cardiovascular disease
• increase in economic prosperity in U.S. associated with small decrease in cardiovascular mortality
• all-cause mortality is 24% lower for Hispanics than non-Hispanic whites living in the U.S. despite Hispanics lesser access to healthcare
  • hispanics have lower mortality from heart disease & cancer than whites
  • deaths due to diabetes mellitus & chronic liver disease are ~ 50% higher in hispanics than whites
  • deaths due to homicide are ~100% higher in hispanics than whites
  • less smoking & more family support among Hispanics may be factors
• increasing mortality among middle-age white men with at most a high school degree; suicide & chronic liver disease contribute
• cardiovascular mortality declining, but less so after 2011
• mortality decreases as aerobic fitness improves with no upper limit of benefit at any age
• baseline poverty or loss of wealth over 2 years in US adults > 50 years is associated with an increased risk of all-cause mortality (RR=1.5-1.7)
• mortality due to Alzheimer's disease has increased in elderly (> 65 years) from 129 per 100,000 to 200 per 100,000 in 2014

Additional terms

• death
• life expectancy
• longevity
• morbidity