The causes of premature death and the associated risk factors were analysed in a cohort of 7935 middle aged men participating in a preventive population programme in Malm8. They were screened when aged 46-48 and then followed up for 31-8 years. Two hundred and eighteen died, of whom 181 (83%) underwent necropsy. Three major causes of death were established: cancer in 61 (28%), deaths related to consumption of alcohol in 55 (25%), and coronary heart disease in 50 (23%).Distinctly different patterns of risk factors were found to be associated with each of the three main causes of premature death. In death due to coronary heart disease smoking (p= 0-0062), serum cholesterol concentration (p = 0 00014), serum triglyceride concentration (p=0 00013), systolic blood pressure (p= 0000012), and diastolic blood pressure (p=00021) were the strongest single determinants but diastolic blood pressure ceased to be a predictive factor in a multivariate analysis whereas all the other variables could be combined in a highly predictive logistic model. In death related to consumption of alcohol equal or even stronger associations were found for serum y glutamyltransferase activity (p <0 0001), points scored in a questionnaire screening for alcoholism (p <0 0001), and, inversely, serum cholesterol (p= 00046) and serum creatinine (p <0 0001) concentrations both when applied independently and when combined in a logistic model. In death due to cancer significant associations were found for serum urate concentration (p=0 023) and, inversely, serum cholesterol concentration (p= 0056-0-031).Malignant diseases and diseases related to consumption of alcohol were at least as prominent as cardiovascular disorders in causing premature death in the cohort of men studied. All three types of conditions are potentially avoidable and seem to be associated with significant and distinctive patterns of risk factors. These patterns should be used, as blood pressure and serum lipid concentrations already are, to predict the risk of premature death and indicate preventive measures.
Low serum cholesterol concentrations are associated with deaths from cancer. This association was found in a prospective study of middle aged men in Malmo and consideration of possible explanations for the lowering of serum cholesterol prompted an analysis of serum urate in relation to deaths from cancer. A total of 127 of the 7725 participants in the Malmo study had died since screening. A weakly positive but significant correlation between raised serum urate concentration and total mortality was found. This correlation was wholly explained by neoplastic deaths (p < 0 01), while there were no associations with alcohol related deaths or with deaths from coronary heart disease. When the deaths from cancer were classified as "early" or "late"-that is, occurring less than or more than 2 5 years after the screeningthe correlation between raised urate concentrations and cancer mortality was confined to the "early" deaths (p < 0001). Further studies are needed to substantiate the relation between raised serum urate concentrations and fatal neoplasia. Nevertheless, these findings weigh against recent suggestions that uric acid has an antioxidant protective effect against cancer.
The total, consecutive mortality in a population of 10,353 middle-aged males invited to participate in a preventive medical population program in Malmö was followed up 1.5-6.5 years, mean 4.5 years, after the time of invitation and analyzed in relation to participation or nonparticipation, forensic or in-hospital autopsy and possible intervention effects. The total mortality was twice as high in the nonparticipants as in the participants, and the death rate due to alcohol-related diseases was five times higher. There were no significant differences in other causes of death, including cancer and cardiovascular diseases. In the nonparticipants autopsied at the Forensic Department the proportion of alcohol-related deaths was 60.5%, compared with 10.0% in participants autopsied in hospital. A history of alcohol abuse was present in 45.2% of the total sample, and in 61.0% of the group autopsied at the Forensic Department. In participants with increased screening gamma-glutamyltransferase, mortality at 48-72 months' follow-up was lower in an intervention group in comparison with a control group matched for sex, age and gamma-glutamyltransferase. The results support findings that alcohol-related deaths, nonparticipation in a preventive population program, and intervention effects in a public health strategy against alcohol and its complications are major determinants of premature mortality in middle-aged urban males.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.