Characteristics of males with myocardial infarction below age 40

Indicators of health and well-being in Iceland and Sweden. A comparative study of various indicators concerning standards of living and mortality

OBJECTIVE

To study various indicators concerning health and well-being in two Nordic countries with special attention to standards of living and mortality.

DESIGN

Comparative study of the mortality rates from various causes of death during the years 1983-1992 and some indicators of standard of living derived from official reports and registers in Iceland and Sweden. SETTING, SUBJECTS: The total populations of Iceland and Sweden.

MAIN OUTCOME MEASURES

Mortality rates, indicators of living standard, gross domestic product and demographic variables such as divorces and unemployment.

RESULTS

The mortality rates for all causes of death were similar for women in Iceland and Sweden during 1983-1992 but were lower for men in Iceland than in Sweden. The mortality rates from cardiovascular diseases decreased during the study period. The rates for malignant disease were higher in Iceland for both men and women. Iceland has a larger population growth but a much lower population density. Most of the demographic variables were similar in the two countries. Unemployment rates were higher in Sweden.

CONCLUSION

In spite of large similarities between Iceland and Sweden in socio-demographic variables there are substantial differences in mortality rates between the countries. The causes for these mortality differences are obscure and should be further investigated.

Increased mortality among sleepy snorers: a prospective population based study

BACKGROUND

The long term health consequences of snoring and sleep apnoea syndrome are still uncertain. This study was conducted to assess the mortality risk associated with snoring and excessive daytime sleepiness (EDS), the two main symptoms of sleep apnoea syndrome, in men.

METHODS

In 1984 a sample of 3100 men aged 30-69 responded to a postal questionnaire including questions about snoring, EDS, and the prevalence of various diseases (response rate 77.1%). Mortality data for the period 1985-1995 were collected for the complete sample.

RESULTS

During the 10 year follow up period 213 men died, 88 of cardiovascular diseases. Compared with subjects with no snoring or EDS in 1984, men with isolated snoring or EDS displayed no significantly increased mortality. The combination of snoring and EDS was associated with a significant increase in mortality. However, the relative rates decreased with increasing age, and in men aged 60 and above no effect on mortality was found. Men below the age of 60 with both snoring and EDS had an age adjusted total death rate which was 2.7 times higher than men with no snoring or EDS (95% CI 1.6 to 4.5). The corresponding age adjusted hazard ratio for cardiovascular mortality was 2.9 (95% CI 1.3 to 6.7) for subjects with both snoring and EDS. Further adjustment for body mass index and reported hypertension, cardiac disease, and diabetes reduced the relative mortality risk associated with the combination of snoring and EDS to 2.2 (95% CI 1.3 to 3.8) and the relative risk of cardiovascular mortality to 2.0 (95% CI 0.8 to 4.7).

CONCLUSION

Snoring without EDS does not appear to carry an increased risk of mortality. The combination of snoring and EDS appears to be associated with an increased mortality rate, but the effects seems to be age dependent. The increased mortality is partly explained by an association between "snoring and EDS" and cardiovascular disease.

Comparison of participants and non-participants in a population study of injuries. The study of men born in 1913 and 1923

In a population study of injuries in two samples from the general population of Göteborg, Sweden, of altogether about 1200 50- and 60-year-old men, the non-participation rates were 25% and 19% respectively. The aim of this report was to estimate the size of the bias caused by non-participation. Besides comparing official register data, e.g., marital status, dwelling conditions and mortality between non-participants and participants, it was also possible to measure certain morbidity variables by using the register of an emergency department over a 7-year period. The non-participants had less stable dwelling conditions and were more often unmarried, divorced or widowed than the participants. They also had more accidents per person and more head injuries, were more often transported to the emergency department by ambulance, tended to have more serious injuries and had a higher mortality rate during follow-up. The non-participants were about six times more often inebriated at the attendance and the differences seemed to be associated mainly with the alcohol factor and less with the participation factor. In conclusion, the bias in incidence estimates caused by non-participation appears to be small to moderate in this type of study as long as the non-participation rate can be kept on the same level as in this study or lower.

Bias due to non-participation and heterogenous sub-groups in population surveys

A random sample of men in the age-group 30-39 years from the general population in Göteborg, Sweden, has been investigated with respect to socioeconomic factors and risk factors for coronary artery disease. The total sample could well be characterized with socioeconomic variables obtained from public registers. All the individuals of the sample were invited to an examination which 68% attended (participants). It was found that those not attending the examination (non-participants) greatly differed from the participants. The non-participants were more often unmarried, and had lower annual incomes and more sickness benefit days. There were more foreigners and more individuals registered for intemperance among the non-participants than the participants. Among the participants the foreigners reported lower physical activity and had higher serum cholesterol than the participating Swedes and individuals registered for intemperance stated a higher tobacco consumption and had higher systolic and diastolic blood pressures than those not registered. This highlights that consideration of factors discriminating participants and non-participants is important for proper estimation of population parameters. The same is true for comparisons between cases and controls recruited from cross-sectional population surveys.