Determinants of premature mortality in a city population: An eight-year observational study concerning subjects aged 18–64

Background: Premature deaths constitute 31.1% of all deaths in Łódź. Analysis of the causes of premature deaths may be helpful in the evaluation of health risk factors. Moreover, findings of this study may enhance prophylactic measures. Material and Methods: In 2001, 1857 randomly selected citizens, aged 18-64, were included in the Countrywide Integrated Noncommunicable Diseases Intervention (CINDI) Programme. In 2009, a follow-up study was conducted and information on the subjects of the study was collected concerning their health status and if they continued to live in Łódź. The Cox proportional hazards model was used for evaluation of hazard coefficients. We adjusted our calculations for age and sex. The analysis revealed statistically significant associations between the number of premature deaths of the citizens of Łódź and the following variables: a negative self-evaluation of health - HR = 3.096 (95% CI: 1.729-5.543), poor financial situation - HR = 2.811 (95% CI: 1.183‑6.672), occurring in the year preceding the study: coronary pain - HR = 2.754 (95% CI: 1.167-6.494), depression - HR = 2.001 (95% CI: 1.222-3.277) and insomnia - HR = 1.660 (95% CI: 1.029-2.678). Our research study also found a negative influence of smoking on the health status - HR = 2.782 (95% CI: 1.581-4.891). Moreover, we conducted survival analyses according to sex and age with Kaplan-Meier curves. Conclusions: The risk factors leading to premature deaths were found to be highly significant but possible to reduce by modifying lifestyle-related health behaviours. The confirmed determinants of premature mortality indicate a need to spread and intensify prophylactic activities in Poland, which is a post-communist country, in particular, in the field of cardiovascular diseases

Own education, current conditions, parental material circumstances, and risk of myocardial infarction in a former communist country

OBJECTIVE—To study the association between own education, adult and parental circumstances and the risk of myocardial infarction in a former communist country.
DESIGN—Population based case-control study.
SETTING—General population of five districts of the Czech Republic in the age group 25-64 years.
PARTICIPANTS—Random sample of population (938 men and 1048 women, response rate 77%) served as controls to 282 male and 80 female cases of non-fatal first myocardial infarctions.
MAIN OUTCOME MEASURES—Myocardial infarction was defined by the WHO MONICA criteria based on ECG, enzymes and symptoms. The following socioeconomic indicators were studied: own education, crowded housing conditions (more than one person per room), car ownership, and education and occupation of mother and father.
RESULTS—There was a weak correlation between education and car ownership, and a strong association between own education and parental education and occupation. Crowding was not related to other socioeconomic factors. The risk of myocardial infarction was inversely related to education, and was unrelated to material conditions and parental education and occupation. The age-sex-district adjusted odds ratios for apprenticeship, secondary, and university education, compared with primary education, were 0.87, 0.74 and 0.46, respectively (p for trend 0.009); odds ratios for car ownership and crowding were 1.01 (95% confidence intervals 0.77, 1.34) and 0.92 (0.76,( )1.12), respectively. Further adjustment for parental circumstances and adult height did not change these estimates but adjustment for coronary risk factors reduced the gradient. Increased height seemed, anomalously, to confer a small increased risk.
CONCLUSIONS—In this population, the social gradient in non-fatal myocardial infarction is only apparent for own education. Materialist explanations for this gradient seem unlikely but behaviours seem responsible for a part of the gradient.


Keywords: myocardial infarction; ischaemic heart disease; socioeconomic factors; epidemiology; Eastern Europ