Mortality

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Surgical Complications and Mortality Rates

December 16, 2009 in Hospitals, Medical Studies, Surgery | No comments

Mortality during surgery is dependent on two factors.  The first is the probability of having complications during surgery.  The second is the probability of dying conditional on having a complication.  One would expect that hospitals with low mortality rates would have both fewer complications and lower probability of death conditional on a complication.  

A paper by Gheferi, Birkmeyer, and Dimick (NEJM 2009) shows that this may not be the case.  After risk adjustment complication rates were not significantly higher in high mortality hospitals.  However, conditional on there being a complication, mortality rates were much higher in high mortality hospitals than low mortality hospitals.  

 

In Hospital Mortality (Gheferi et al. NEJM 2009)

How can doctors decrease mortality due to complications?  Gheferi, Birkmeyer, and Dimick recommend “timely administration of antibiotics in patients with sepsis, the rapid transfer of a patient to an intensive care unit (ICU), and the availability of interventional cardiologists during an acute myocardial infarction.”

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Winning the Nobel Prize gives you fame, fortune…and 1-2 years of added longevity

December 3, 2008 in Miscellaneous | No comments

From Rabien and Oswald (2008) in the latest edition of the Journal of Health Economics:

“It has been known for centuries that the rich and famous have longer lives than the poor and ordinary. Causality, however, remains trenchantly debated. The ideal experiment would be one in which extra status could somehow be dropped upon a sub-sample of individuals while those in a control group of comparable individuals received none. This paper attempts to formulate a test in that spirit. It collects 19th-century birth data on science Nobel Prize winners. Correcting for potential biases, we estimate that winning the Prize, compared to merely being nominated, is associated with between 1 and 2 years of extra longevity.“

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Evidence that Women are the stronger sex: Mortality after the death of a spouse

September 30, 2008 in Academic Articles | Permalink

A few papers have found that mortality rises after the death of the spouse.  Some researchers have inferred that this is due to a causal effect of this emotionally traumatic event.  Further, married individuals generally live longer, so the loss of this “marriage protection” could be the cause of increased mortality.  On the other hand, it could be the case that spouses “select” to partner with each other and engage in similar eating and exercise habits and thus have similar mortality.  Further, spouses often partner on the basis of income-generating capacity and education which are also correlated with mortality.  So does the death of a spouse cause an increase in mortality or is this just a case of marriage selection?

This question is what a paper by Espinosa and Evens (JHE 2008) tries to uncover.  This authors look at informative deaths–deaths due to health an individual’s health condition–compared with uninformative deaths (e.g., motor vehicle accident, homicide).  The authors find that men have a significant increase in mortality after the death of their spouse even when the death is “uninformative.”  This authors conclude that for males, this bereavement effect of losing a wife is causing increased mortality.

For women, “The bereavement effect for surviving wives when their husband dies of an uninformative cause is small but with a large standard error, making it statistically indistinguishable from the effect for informative causes.” Thus, there seems that the death of a woman’s husband does not cause increased mortality.

Here is some scientific evidence that women are the stronger sex.

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Aviodable Mortality in 3 world cities: London vs. New York vs. Paris

June 13, 2008 in International Health Care Systems | Permalink

A recent paper by Wesiz et al. (Eur J Pub Health 2008) attempts to compare mortality rates and avoidable mortality rates in the urban core of 3 world cities: London (Inner London); New York (Manhattan) and Paris. Mortality

The authors find that Paris has the lowest mortality rates and New York has the highest mortality rates with London in between.

Avoidable Mortality

Avoidable mortality is death from diseases such as tuberculosis, septicemia, hypertension, influenza, peptic ulcer, appendicitis, etc. Paris also has the lowest avoidable mortality rates while London has the highest and New York in between. The authors also find that the difference between Paris and New York is higher when measuring avoidable mortality than total mortality. Avoidable mortality rates are higher within poor areas of each city.

Interpretation

The authors interpret these findings as avoidable mortality is due to a lack of access to care, especially for the poor. Government provided health insurance is far less prevalent in the U.S. than in the other countries so this access to care in the U.S. may be lower than in other countries. However, it could also be the case the physician practices are better in Paris than in the New York or London. Further, Great Britain also has a national health insurance system yet avoidable mortality is higher in London than in New York. It is possible that the frequency with which the population visits a doctor is culturally different in the three cities in a way that is unrelated to insurance coverage. Thus, while Paris should be celebrated for having the lowest avoidable mortality rate, the cause of their success is unclear from this study and what steps New York or London could take to decrease avoidable mortality are also unclear.

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