Standardized Mortality Ratio

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Raymond C. L. Kwok - One of the best experts on this subject based on the ideXlab platform.

  • THU0301 Effect of Renal Disease on Standardized Mortality Ratio and Life Expectancy of Patients with Systemic Lupus Erythematosus
    Annals of the Rheumatic Diseases, 2020
    Co-Authors: Raymond C. L. Kwok
    Abstract:

    Objectives To study the effect of renal disease on Standardized Mortality Ratio (SMR) and life expectancy (LE) of patients with systemic lupus erythematosus (SLE). Methods Patients who fulfilled ³4 ACR criteria for SLE who were prospectively followed in our unit from 1995 to 2011 were studied. The cumulative survival rate (by Kaplan Meier’s method), and age and sex adjusted Standardized Mortality Ratio (SMR) was calculated. Life expectancy (LE) was studied by single decrement life table analysis. The effect of renal involvement, histological classes, renal damage and end stage renal disease (ESRD) on these parameters was evaluated. Results 694 patients were studied (92%). The mean age of onset of SLE was 32.9±13.4 years (range 6-78). 368 (53%) had evidence of renal disease according to the ACR definition of renal involvement (persistent proteinuria of >0.5g/day; cellular casts or histological evidence). 285 (77%) patients had undergone renal biopsy for at least once. The distribution of histological classes (ISN/RPS) was as follows: class I (1%), class II (6%), class III (19%), class III+V (10%), class IV (47%), class V (16%) and others (1%). At the time of analysis, the mean observation of our patients since SLEonset was 9.6±7.3 years. Thirty-four (4.9%) patients were lost to follow-up. Among patients with lupus renal disease, 79 (11%) patients had renal damage as assessed by the SLE damage index (SDI) and 24 (3%) patients developed ESRD. The cumulative 5, 10 and 15 year survival of patients with renal involvement was 92.3%, 88.8% and 84.3%, respectively, which was significantly lower than that of patients without renal involvement (97.0%, 93.7% and 91.6%, respectively; p=0.004). Cox regression demonstrated that the age and sex adjusted hazard Ratio (HR) of Mortality in patients with renal disease and renal damage compared with those without renal involvement was 2.23 \[1.29-3.85\] (p=0.004) and 3.59 \[2.20-5.87\] (p

  • effect of renal disease on the Standardized Mortality Ratio and life expectancy of patients with systemic lupus erythematosus
    Arthritis & Rheumatism, 2013
    Co-Authors: Raymond C. L. Kwok
    Abstract:

    OBJECTIVE: To study the effect of renal disease on the Standardized Mortality Ratio (SMR) and life expectancy of patients with systemic lupus erythematosus (SLE). METHODS: Patients whose diagnosis met ≥4 American College of Rheumatology criteria for SLE were longitudinally followed up from 1995 to 2011. The cumulative survival rate, SMR, and life expectancy were calculated, and the effect of renal involvement, histologic class of lupus nephritis, renal damage, and end-stage renal disease (ESRD) on these parameters was evaluated. RESULTS: Of the 694 SLE patients studied, 368 (53%) had renal disease, and the distribution of histologic classes (among 285 patients) was class I (1%), class II (6%), class III (19%), class IV (47%), class III/IV + class V (10%), and class V (16%). Renal damage was present in 79 patients (11%), and 24 (3%) developed ESRD. The age- and sex-adjusted hazard Ratios (HRs) of Mortality in SLE patients with renal disease, those with renal damage, and those with ESRD, as compared to those without, were 2.23 (95% confidence interval [95% CI] 1.29-3.85), 3.59 (95% CI 2.20-5.87), and 9.20 (95% CI 4.92-17.2), respectively. Proliferative lupus nephritis (adjusted HR 2.28, 95% CI 1.22-4.24), but not the pure membranous type (adjusted HR 1.09, 95% CI 0.38-3.14), was associated with a significant increase in Mortality. The age- and sex-adjusted SMRs of SLE patients without renal involvement, those with lupus nephritis, those with proliferative nephritis, those with pure membranous nephritis, those with renal damage, and those with ESRD were 4.8 (95% CI 2.8-7.5), 9.0 (95% CI 6.7-11.9), 9.8 (95% CI 6.5-14.1), 6.1 (95% CI 2.0-14.1), 14.0 (95% CI 9.1-20.5), and 63.1 (95% CI 33.6-108.0), respectively. The life expectancy of SLE patients with renal disease and those with renal damage was reduced by 15.1 years and 23.7 years, respectively, compared to the general population. CONCLUSION: The presence of renal disease, in particular proliferative nephritis causing renal insufficiency, significantly reduces the survival and life expectancy of SLE patients.

  • thu0301 effect of renal disease on Standardized Mortality Ratio and life expectancy of patients with systemic lupus erythematosus
    Annals of the Rheumatic Diseases, 2013
    Co-Authors: Raymond C. L. Kwok
    Abstract:

    Objectives To study the effect of renal disease on Standardized Mortality Ratio (SMR) and life expectancy (LE) of patients with systemic lupus erythematosus (SLE). Methods Patients who fulfilled ³4 ACR criteria for SLE who were prospectively followed in our unit from 1995 to 2011 were studied. The cumulative survival rate (by Kaplan Meier’s method), and age and sex adjusted Standardized Mortality Ratio (SMR) was calculated. Life expectancy (LE) was studied by single decrement life table analysis. The effect of renal involvement, histological classes, renal damage and end stage renal disease (ESRD) on these parameters was evaluated. Results 694 patients were studied (92%). The mean age of onset of SLE was 32.9±13.4 years (range 6-78). 368 (53%) had evidence of renal disease according to the ACR definition of renal involvement (persistent proteinuria of >0.5g/day; cellular casts or histological evidence). 285 (77%) patients had undergone renal biopsy for at least once. The distribution of histological classes (ISN/RPS) was as follows: class I (1%), class II (6%), class III (19%), class III+V (10%), class IV (47%), class V (16%) and others (1%). At the time of analysis, the mean observation of our patients since SLEonset was 9.6±7.3 years. Thirty-four (4.9%) patients were lost to follow-up. Among patients with lupus renal disease, 79 (11%) patients had renal damage as assessed by the SLE damage index (SDI) and 24 (3%) patients developed ESRD. The cumulative 5, 10 and 15 year survival of patients with renal involvement was 92.3%, 88.8% and 84.3%, respectively, which was significantly lower than that of patients without renal involvement (97.0%, 93.7% and 91.6%, respectively; p=0.004). Cox regression demonstrated that the age and sex adjusted hazard Ratio (HR) of Mortality in patients with renal disease and renal damage compared with those without renal involvement was 2.23 \[1.29-3.85\] (p=0.004) and 3.59 \[2.20-5.87\] (p<0.001), respectively (Table 1). The corresponding hazard Ratio for Mortality in patients who developed ESRD was 9.20 \[4.92-17.2\] (p<0.001). Patients with proliferative types of lupus nephritis (class III, IV and III/IV+V) had significantly increased Mortality compared to those without renal disease (adjusted HR 2.28 [1.22-4.24]; p=0.01). In contrast, pure membranous lupus nephropathy was not associated with increased Mortality (adjusted HR 1.09 [0.38-3.14]; p=0.88). Adjustment for the use of immunosuppressive regimens in the Cox regression models did not materially affect the overall hazard Ratios for Mortality. The age and sex adjusted SMRs of all SLE patients, SLE patients without renal disease, SLE patients with renal disease, proliferative nephritis, pure membranous nephropathy, renal damage and renal failure compared to the general population were 7.3 (95% confidence interval [CI] 5.7-9.3), 4.8 (CI 2.8-7.5), 9.0 (CI 6.7-11.9), 9.8 (CI 6.5-14.1), 6.1 (CI 2.0-14.1), 14.0 (CI 9.1-20.5) and 63.1 (CI 33.6-108), respectively. LE was reduced by 12.4, 15.1 and 23.7 years, respectively, in SLE patients, SLE patients with renal disease and SLE patients with renal damage as compared to the general population. Conclusions The presence of renal disease, in particular proliferative types of nephritis causing renal function impairment, significantly reduces survival and life expectancy of SLE patients. Disclosure of Interest None Declared

Toshiro Tango - One of the best experts on this subject based on the ideXlab platform.

  • health care resources and Mortality as assessed by the empirical bayes estimate of Standardized Mortality Ratio results for municipalities in japan
    Japanese journal of public health, 2009
    Co-Authors: Koichi Otsubo, Kazue Yamaoka, Tetsuji Yokoyama, Kunihiko Takahashi, Masako Nishikawa, Toshiro Tango
    Abstract:

    BACKGROUND AND OBJECTIVE: The Standardized Mortality Ratio (SMR) is frequently used to compare health status among different populations. However, SMR could be biased when based upon communities with small population size such as towns and wards and comparison of SMRs in such cases is not appropriate. The "empirical Bayes estimate of Standardized Mortality Ratio" (EBSMR) is a useful alternative index for comparing mortalities among small populations. The objective of the present study was to use the EBSMR to clarify the relationships between health care resources and mortalities in 3,360 municipalities in Japan. MATERIALS AND METHODS: Health care resource data (number of physicians, number of general clinics, number of general sickbeds, and number of emergency hospitals) and socioeconomic factors (population, birth rate, aged households, marital rate, divorce rate, taxable income per individual under taxes duty, unemployment, secondary, tertiary industrial employment and prefecture) were obtained from officially published reports. EBSMRs for all causes, cerebrovascular disease, heart disease, acute myocardial infarction, and malignant neoplasms were calculated from the 1997-2001 vital statistic records. Multiple regression analysis was used to examine the relationships between EBSMRs and the variables representing health care resources and socioeconomic factors as covariates. Some of the variables were log-transformed to normalize the distribution of variables. RESULTS: The correlation between number of physicians and general sickbeds was very high (Pearson's r = 0.776). So, we excluded the number of general sickbeds. Some of the EBSMRs were inversely associated with the number of physicians per person (all causes in males (beta = -0.042, P = 0.024) and females (beta = -0.150, P < 0.001), cerebrovascular disease in females (beta = -0.074, P < 0.001), heart disease in males (beta = -0.066, P < 0.001) and females (beta = - 0.087, P < 0.001), acute myocardial infarction in females (beta = -0.061, P = 0.003), and malignant neoplasms in females (beta = -0.064, P = 0.001)). In contrast, when there was a higher number of clinics per persons, the EBSMR was higher for all causes in males (beta = 0.053, P = 0.001) and females (beta = 0.115, P < 0.001), cerebrovascular disease in males (beta = 0.047, P = 0.002) and females (beta = 0.070, P < 0.001), heart disease in females (beta = 0.061, P < 0.001), acute myocardial infarction in females (beta = 0.048, P = 0.006), and malignant neoplasms in males (beta = 0.036, P = 0.018) and females (beta = 0.046, P = 0.005). Next, we selected the number of emergency hospitals as the variable representing health care resources. Some of the EBSMRs were inversely associated with the existence of emergency hospitals (all causes in females (beta = -0.085, P < 0.001), cerebrovascular disease in males (beta = -0.032, P = 0.031) and females (beta = -0.059, P = 0.001), and heart disease in females (beta = -0.052, P = 0.008)). CONCLUSION: The results suggested that an appropriate distribution of health care resources such as physicians and emergency hospitals is an important factor associated with Mortality in a community.

  • Health care resources and Mortality as assessed by the "empirical Bayes estimate of Standardized Mortality Ratio": results for Fukuoka Prefecture
    Japanese journal of public health, 2004
    Co-Authors: Koichi Otsubo, Kazue Yamaoka, Tetsuji Yokoyama, Kunihiko Takahashi, Toshiro Tango
    Abstract:

    BACKGROUND AND OBJECTIVE: The Standardized Mortality Ratio (SMR) is frequently used to compare health status among different populations. However, it may be biased when based upon communities with small population sizes such as towns, cities, and wards. Thus, comparison of SMRs among such small communities is not appropriate. But the "empirical Bayes estimate of Standardized Mortality Ratio" (EBSMR) is, in contrast, a useful index. The objective of the present study was to use the EBSMR to clarify the relationships between health care resources and mortalities in 109 communities in Fukuoka Prefecture. MATERIALS AND METHODS: Data for health care resources (number of physicians, number of general clinics, number of general sickbeds in hospitals, number of emergency hospitals, and proportion of elderly outpatients within their resident' community) and socioeconomic factors (birth rate, inflow or outflow population, aged households, marital status, taxable income per individual under taxes duty, unemployment, primary, secondary, tertiary industrial employment and criminal offense records) were obtained from officially published reports. EBSMRs for all causes, cerebrovascular disease, heart disease, malignant neoplasms, and acute myocardial infarction were calculated from the 1993-1997 vital statistic records. Multiple regression analysis with stepwise variable selection was used to examine the relationships between EBSMRs and the five variables representing health care resources, considering the eleven socioeconomic factors as covariates. Some of the variables were log-transformed to normalize the distribution. RESULTS: Some of the EBSMRs were inversely related to the numbers of physicians per person (acute myocardial infarction in males (P=0.047) and females (P=0.012)), emergency hospitals per person (acute myocardial infarction in females: P=0.001), and general sickbeds per person (all causes in females: P

  • health care resources and Mortality as assessed by the empirical bayes estimate of Standardized Mortality Ratio results for fukuoka prefecture
    Japanese journal of public health, 2004
    Co-Authors: Koichi Otsubo, Kazue Yamaoka, Tetsuji Yokoyama, Kunihiko Takahashi, Toshiro Tango
    Abstract:

    BACKGROUND AND OBJECTIVE: The Standardized Mortality Ratio (SMR) is frequently used to compare health status among different populations. However, it may be biased when based upon communities with small population sizes such as towns, cities, and wards. Thus, comparison of SMRs among such small communities is not appropriate. But the "empirical Bayes estimate of Standardized Mortality Ratio" (EBSMR) is, in contrast, a useful index. The objective of the present study was to use the EBSMR to clarify the relationships between health care resources and mortalities in 109 communities in Fukuoka Prefecture. MATERIALS AND METHODS: Data for health care resources (number of physicians, number of general clinics, number of general sickbeds in hospitals, number of emergency hospitals, and proportion of elderly outpatients within their resident' community) and socioeconomic factors (birth rate, inflow or outflow population, aged households, marital status, taxable income per individual under taxes duty, unemployment, primary, secondary, tertiary industrial employment and criminal offense records) were obtained from officially published reports. EBSMRs for all causes, cerebrovascular disease, heart disease, malignant neoplasms, and acute myocardial infarction were calculated from the 1993-1997 vital statistic records. Multiple regression analysis with stepwise variable selection was used to examine the relationships between EBSMRs and the five variables representing health care resources, considering the eleven socioeconomic factors as covariates. Some of the variables were log-transformed to normalize the distribution. RESULTS: Some of the EBSMRs were inversely related to the numbers of physicians per person (acute myocardial infarction in males (P=0.047) and females (P=0.012)), emergency hospitals per person (acute myocardial infarction in females: P=0.001), and general sickbeds per person (all causes in females: P<0.001, cerebrovascular disease in females: P=0.007, heart disease in females: P<0.001, malignant neoplasms in females: P=0.049). In contrast, when the higher the number of clinics per person, the higher the EBSMR in females for all causes (P=0.025), as well as acute myocardial infarction (P=0.006). CONCLUSION: The results suggest that an appropriate distribution of hospital care resources such as physicians, general sickbeds, and emergency hospitals is an important factor related to Mortality in a community.

Ognjen Gajic - One of the best experts on this subject based on the ideXlab platform.

Shan P Tsai - One of the best experts on this subject based on the ideXlab platform.

  • statistical analysis of the Standardized Mortality Ratio and life expectancy
    American Journal of Epidemiology, 1996
    Co-Authors: Robert J Hardy, Shan P Tsai
    Abstract:

    A new theoretical relation that does not require the constant age-specific Mortality Ratio assumption is established between the Standardized Mortality Ratio (SMR) and the life expectancy. A set of regression equations is developed from the theoretical relation to derive estimates of the future expectation of life from estimates of the SMR. Curves are presented showing the changes in life expectancy that are associated with a given SMR for individuals aged 25 45 and 65 years. These results will provide practical applications in estimating remaining life expectancy in epidemiologic studies in which the SMR is the summary statistic. An application is shown for studies in occupational health [in the United States] to develop and illustrate the method. (EXCERPT)

  • the Standardized Mortality Ratio and life expectancy
    American Journal of Epidemiology, 1992
    Co-Authors: Shan P Tsai, Robert J Hardy
    Abstract:

    This paper describes a theoretical relation between the Standardized Mortality Ratio (SMR) which is commonly used to ascertain the magnitude of risks experienced by a working population and life expectancy. The authors also attempt "to establish a statistical model for an easy method to convert the SMR of a study population to the corresponding life expectancy for that population." Data are from official sources for 1980 and concern the white population of the United States. (EXCERPT)

Koichi Otsubo - One of the best experts on this subject based on the ideXlab platform.

  • health care resources and Mortality as assessed by the empirical bayes estimate of Standardized Mortality Ratio results for municipalities in japan
    Japanese journal of public health, 2009
    Co-Authors: Koichi Otsubo, Kazue Yamaoka, Tetsuji Yokoyama, Kunihiko Takahashi, Masako Nishikawa, Toshiro Tango
    Abstract:

    BACKGROUND AND OBJECTIVE: The Standardized Mortality Ratio (SMR) is frequently used to compare health status among different populations. However, SMR could be biased when based upon communities with small population size such as towns and wards and comparison of SMRs in such cases is not appropriate. The "empirical Bayes estimate of Standardized Mortality Ratio" (EBSMR) is a useful alternative index for comparing mortalities among small populations. The objective of the present study was to use the EBSMR to clarify the relationships between health care resources and mortalities in 3,360 municipalities in Japan. MATERIALS AND METHODS: Health care resource data (number of physicians, number of general clinics, number of general sickbeds, and number of emergency hospitals) and socioeconomic factors (population, birth rate, aged households, marital rate, divorce rate, taxable income per individual under taxes duty, unemployment, secondary, tertiary industrial employment and prefecture) were obtained from officially published reports. EBSMRs for all causes, cerebrovascular disease, heart disease, acute myocardial infarction, and malignant neoplasms were calculated from the 1997-2001 vital statistic records. Multiple regression analysis was used to examine the relationships between EBSMRs and the variables representing health care resources and socioeconomic factors as covariates. Some of the variables were log-transformed to normalize the distribution of variables. RESULTS: The correlation between number of physicians and general sickbeds was very high (Pearson's r = 0.776). So, we excluded the number of general sickbeds. Some of the EBSMRs were inversely associated with the number of physicians per person (all causes in males (beta = -0.042, P = 0.024) and females (beta = -0.150, P < 0.001), cerebrovascular disease in females (beta = -0.074, P < 0.001), heart disease in males (beta = -0.066, P < 0.001) and females (beta = - 0.087, P < 0.001), acute myocardial infarction in females (beta = -0.061, P = 0.003), and malignant neoplasms in females (beta = -0.064, P = 0.001)). In contrast, when there was a higher number of clinics per persons, the EBSMR was higher for all causes in males (beta = 0.053, P = 0.001) and females (beta = 0.115, P < 0.001), cerebrovascular disease in males (beta = 0.047, P = 0.002) and females (beta = 0.070, P < 0.001), heart disease in females (beta = 0.061, P < 0.001), acute myocardial infarction in females (beta = 0.048, P = 0.006), and malignant neoplasms in males (beta = 0.036, P = 0.018) and females (beta = 0.046, P = 0.005). Next, we selected the number of emergency hospitals as the variable representing health care resources. Some of the EBSMRs were inversely associated with the existence of emergency hospitals (all causes in females (beta = -0.085, P < 0.001), cerebrovascular disease in males (beta = -0.032, P = 0.031) and females (beta = -0.059, P = 0.001), and heart disease in females (beta = -0.052, P = 0.008)). CONCLUSION: The results suggested that an appropriate distribution of health care resources such as physicians and emergency hospitals is an important factor associated with Mortality in a community.

  • Health care resources and Mortality as assessed by the "empirical Bayes estimate of Standardized Mortality Ratio": results for Fukuoka Prefecture
    Japanese journal of public health, 2004
    Co-Authors: Koichi Otsubo, Kazue Yamaoka, Tetsuji Yokoyama, Kunihiko Takahashi, Toshiro Tango
    Abstract:

    BACKGROUND AND OBJECTIVE: The Standardized Mortality Ratio (SMR) is frequently used to compare health status among different populations. However, it may be biased when based upon communities with small population sizes such as towns, cities, and wards. Thus, comparison of SMRs among such small communities is not appropriate. But the "empirical Bayes estimate of Standardized Mortality Ratio" (EBSMR) is, in contrast, a useful index. The objective of the present study was to use the EBSMR to clarify the relationships between health care resources and mortalities in 109 communities in Fukuoka Prefecture. MATERIALS AND METHODS: Data for health care resources (number of physicians, number of general clinics, number of general sickbeds in hospitals, number of emergency hospitals, and proportion of elderly outpatients within their resident' community) and socioeconomic factors (birth rate, inflow or outflow population, aged households, marital status, taxable income per individual under taxes duty, unemployment, primary, secondary, tertiary industrial employment and criminal offense records) were obtained from officially published reports. EBSMRs for all causes, cerebrovascular disease, heart disease, malignant neoplasms, and acute myocardial infarction were calculated from the 1993-1997 vital statistic records. Multiple regression analysis with stepwise variable selection was used to examine the relationships between EBSMRs and the five variables representing health care resources, considering the eleven socioeconomic factors as covariates. Some of the variables were log-transformed to normalize the distribution. RESULTS: Some of the EBSMRs were inversely related to the numbers of physicians per person (acute myocardial infarction in males (P=0.047) and females (P=0.012)), emergency hospitals per person (acute myocardial infarction in females: P=0.001), and general sickbeds per person (all causes in females: P

  • health care resources and Mortality as assessed by the empirical bayes estimate of Standardized Mortality Ratio results for fukuoka prefecture
    Japanese journal of public health, 2004
    Co-Authors: Koichi Otsubo, Kazue Yamaoka, Tetsuji Yokoyama, Kunihiko Takahashi, Toshiro Tango
    Abstract:

    BACKGROUND AND OBJECTIVE: The Standardized Mortality Ratio (SMR) is frequently used to compare health status among different populations. However, it may be biased when based upon communities with small population sizes such as towns, cities, and wards. Thus, comparison of SMRs among such small communities is not appropriate. But the "empirical Bayes estimate of Standardized Mortality Ratio" (EBSMR) is, in contrast, a useful index. The objective of the present study was to use the EBSMR to clarify the relationships between health care resources and mortalities in 109 communities in Fukuoka Prefecture. MATERIALS AND METHODS: Data for health care resources (number of physicians, number of general clinics, number of general sickbeds in hospitals, number of emergency hospitals, and proportion of elderly outpatients within their resident' community) and socioeconomic factors (birth rate, inflow or outflow population, aged households, marital status, taxable income per individual under taxes duty, unemployment, primary, secondary, tertiary industrial employment and criminal offense records) were obtained from officially published reports. EBSMRs for all causes, cerebrovascular disease, heart disease, malignant neoplasms, and acute myocardial infarction were calculated from the 1993-1997 vital statistic records. Multiple regression analysis with stepwise variable selection was used to examine the relationships between EBSMRs and the five variables representing health care resources, considering the eleven socioeconomic factors as covariates. Some of the variables were log-transformed to normalize the distribution. RESULTS: Some of the EBSMRs were inversely related to the numbers of physicians per person (acute myocardial infarction in males (P=0.047) and females (P=0.012)), emergency hospitals per person (acute myocardial infarction in females: P=0.001), and general sickbeds per person (all causes in females: P<0.001, cerebrovascular disease in females: P=0.007, heart disease in females: P<0.001, malignant neoplasms in females: P=0.049). In contrast, when the higher the number of clinics per person, the higher the EBSMR in females for all causes (P=0.025), as well as acute myocardial infarction (P=0.006). CONCLUSION: The results suggest that an appropriate distribution of hospital care resources such as physicians, general sickbeds, and emergency hospitals is an important factor related to Mortality in a community.