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      All-cause mortality in the Aberdeen 1921 birth cohort: Effects of socio-demographic, physical and cognitive factors

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      BMC Public Health
      BioMed Central

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          Abstract

          Background

          Childhood intelligence predicts mortality throughout most of the life span. However, it is unknown whether its effect persists into advanced old age.

          Methods

          The Aberdeen Birth Cohort born in 1921 (n = 354) and that had an IQ test as part of the national Scottish Mental Survey of 1932 were seen in 1997 at age 76 years when childhood and adult socio-environmental, medical and cognitive data were collected. Participants were followed until May 2007 and vital status determined from the General Register for Scotland records. Univariate associations between baseline variables and mortality were determined and multivariable survival analysis performed with Cox's proportional hazards modelling.

          Results

          One hundred and fifty-eight (44.6%) of the 354 cohort members had died by the census date. Significantly more men (n = 102) died during follow-up than women (n = 56, χ 2 = 5.27, p = .022). Lower scores on four of the six cognitive tests at age 76 years were associated with increased mortality, but not IQ age 11. Survival was associated with gender (H.R. 0.32, 95% C.I. 0.11–0.89 for women versus men), peak expiratory flow rate (H.R. 0.997, 95% C.I. 0.992–1.001 per l/min) and the Uses of Common Objects test (H.R. 0.91, 95% C.I. 0.82–1.01)

          Conclusion

          Both physical and psychological variables independently predicted survival in old age: respiratory function and executive function in particular. Male gender conferred increased risk of mortality and this was not explained by the broad range of socio-environmental, mental ability and health status variables examined in the study.

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          Most cited references19

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          Longitudinal cohort study of childhood IQ and survival up to age 76.

          To test the association between childhood IQ and mortality over the normal human lifespan. Longitudinal cohort study. Aberdeen. All 2792 children in Aberdeen born in 1921 and attending school on 1 June 1932 who sat a mental ability test as part of the Scottish mental survey 1932. Survival at 1 January 1997. 79.9% (2230) of the sample was traced. Childhood mental ability was positively related to survival to age 76 years in women (P<0.0001) and men (P<0.0001). A 15 point disadvantage in mental ability at age 11 conferred a relative risk of 0.79 of being alive 65 years later (95% confidence interval 0.75 to 0.84); a 30 point disadvantage reduced this to 0.63 (0.56 to 0.71). However, men who died during active service in the second world war had a relatively high IQ. Overcrowding in the school catchment area was weakly related to death. Controlling for this factor did not alter the association between mental ability and mortality. Childhood mental ability is a significant factor among the variables that predict age at death.
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            The exclusion of the elderly and women from clinical trials in acute myocardial infarction.

            To determine the extent to which the elderly have been excluded from trials of drug therapies used in the treatment of acute myocardial infarction, to identify factors associated with such exclusions, and to explore the relationship between the exclusion of elderly and the representation of women. We conducted a systematic search of the English-language literature from January 1960 through September 1991 to identify all relevant studies of specific pharmacotherapies employed in the treatment of acute myocardial infarction. To accomplish this, we searched MEDLINE, major cardiology textbooks, meta-analyses, reviews, editorials, and the bibliographies of all identified articles. Only trials in which patients were randomly allocated to receive a specific therapeutic regimen or a placebo or nonplacebo control regimen were included for review. Studies were abstracted for year of publication, source of support, performance location, drug therapies to which patients were randomized, use of invasive diagnostic tests or therapeutic procedures, exclusion criteria, size and demographic characteristics of the randomized study population, and principal outcome measures. A total of 214 trials met inclusion criteria, involving 150,920 study subjects. Over 60% of trials excluded persons over the age of 75 years. Studies published after 1980 were more likely to have age-based exclusions compared with studies published before 1980 (adjusted odds ratio, 4.92; 95% confidence interval, 2.33 to 10.54). Trials of thrombolytic therapy involving an invasive procedure were more likely to exclude elderly patients compared with other studies (adjusted odds ratio, 2.45; 95% confidence interval, 1.10 to 5.47). Studies with age-based exclusions had a smaller percentage of women compared with those without such exclusions (18% vs 23%; P = .0002), with the mean age of the study population significantly associated with the proportion of women participants (P = .0001, R2 = .29). Age-based exclusions are frequently used in clinical trials of medications used in the treatment of acute myocardial infarction. Such exclusions limit the ability to generalize study findings to the patient population that experiences the most morbidity and mortality from acute myocardial infarction.
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              Cognition and all-cause mortality across the entire adult age range: health and lifestyle survey.

              To investigate the association of reaction time and brief measures of memory and spatial ability with all-cause mortality. Participants were from the UK Health and Lifestyle Survey (HALS), a national sample survey of adults in England, Scotland, and Wales. In 1984/1985, data on lifestyle factors, socioeconomic status, and health were collected for 9,003 people. Cognitive data were collected for 7,414 individuals. All-cause mortality was investigated over 19 years of follow-up in relation to simple and choice reaction time, performance on a short-term verbal declarative memory test, and on a test of visual-spatial reasoning. Slower and more variable simple and choice reaction times were significantly related to increased risk of all-cause mortality over 19 years of follow-up. The increased risk of all-cause mortality was partly attenuated after adjustments for socioeconomic status, health behaviors, and health status. A novel finding was the existence of an effect of reaction time on all-cause mortality in young adults. Poorer verbal memory ability was also significantly related to an increased risk of dying in young adults independently of reaction time score. Slower and more variable reaction time was related to higher mortality risk in younger as well as older participants. Among younger adults, higher memory ability was also associated with lower risk of dying. The cognition-mortality relationship may be explained in part by the brain's efficiency of information processing and memory performance.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2008
                10 September 2008
                : 8
                : 307
                Affiliations
                [1 ]Geriatric Medicine Unit, University of Edinburgh, Edinburgh, UK
                [2 ]Psychology, University of Edinburgh, Edinburgh, UK
                [3 ]Department of Environmental and Occupational Medicine, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
                Article
                1471-2458-8-307
                10.1186/1471-2458-8-307
                2551612
                18783620
                7a3ba8dc-d30c-4e2e-b648-8e5008c3212a
                Copyright © 2008 Starr et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 November 2007
                : 10 September 2008
                Categories
                Research Article

                Public health
                Public health

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