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Background The effect of early hypertension on midlife cardiovascular (CV) mortality remains controversial. We assessed the association of established hypertension in late adolescence with subsequent CV mortality. Methods Of 2,298,130 Israeli adolescents (60 % males; age 17.4 ± 0.3 years) who underwent a compulsory medical examination prior to military service between 1967 and 2010, 8720 teenagers (0.4 %) were formally diagnosed with persistent hypertension. Using Cox proportional hazards modeling, we compared the hypertensive group to the large normotensive group with regard to time to event analysis of midlife mortality due to cerebrovascular accidents (CVA), coronary heart disease (CHD), sudden death (SD) and their summation as cardiovascular disease (CVD). Results During 45,729,521 person-years of follow-up, we identified 2918 CV deaths-2879 and 39 among the 2,289,410 normotensive and 8720 hypertensive adolescents, respectively. Hypertension at a young age was associated with a threefold elevation of stroke mortality compared to normotension when adjusted for sex, age at examination, birth year, country of origin, socioeconomic status, education, body mass index (BMI) and height [hazard ratio (HR) 3.12; 95 % confidence interval (CI) 1.76-5.54; p < 0.001]. There was no significant association of hypertension with CHD mortality or SD. An increased risk for overall CVD mortality among hypertensive youngsters (HR 1.51; 95 % CI 1.10-2.07) was attenuated after adjusting for BMI and other covariates (HR 1.24; 95 % CI 0.90-1.72). Conclusions Established hypertension at a young age was independently associated with elevated stroke mortality in midlife. This finding warrants confirmatory large-scale long-term follow-up studies to address the distant effects of adolescent hypertension., Author(s): Adi Leiba[sup.1] [sup.2] [sup.3] , Gilad Twig[sup.1] [sup.2] [sup.4] , Hagai Levine[sup.5] , Nehama Goldberger[sup.6] , Arnon Afek[sup.1] [sup.6] , Ari Shamiss[sup.1] , Estela Derazne[sup.2] , Dorit Tzur[sup.2] , [...]

An analysis of all emergency department admissions in Israel classified as an attempted suicide in the years 1996-2002 was done to examine attempted suicide rates by age and gender with particular attention to adolescents and young adults. Gender differences in attempted suicide rates were significant only during adolescence and young adulthood, ages 13 to 26. The highest rate for females was 3 years earlier than the highest rate for males. The results lead to the conclusion that women do not attempt suicide more than men, except for 13-26 year olds.

Previous findings regarding European Holocaust survivors' suicide risk are conflicting. North African survivors' suicide risk was not previously studied. In this study, we aimed to determine suicide risk among European and North African Holocaust survivors. The study was based on the Israeli population census from 1972, followed until 2015 for suicide. European survivors were grouped into survivors of severe Nazi persecution (HS) and early HS. North African survivors were grouped into those from Algeria, Libya and Tunisia who were likely to have suffered more severe persecution (group 1) and those from Morocco who apparently suffered less persecution (group 2). Comparison groups were chosen according to similar ethnic origins who were not under Nazi control. Age standardized suicide rates, Standard Mortality Ratios (SMR) were calculated. Cox regression analysis was used to assess suicide risk. The age adjusted suicide rates (per 100,000) among Europeans were: HS 17.8 (95%CI 16.9–18.6), early HS 28.6 (95%CI 24.9–32.2), comparison group 20.3 (95%CI 18.5–22.1). Among North Africans: group 1, 6.9 (95%CI 5.6–8.2), group 2, 4.8 (95%CI 4.0–5.5), comparison group, 8.5 (95% CI 6.4–11.0). The SMRs with European comparisons were 0.88 (95%CI 0.84–0.92) for HS and 1.41 (95%CI 1.20–1.65) for early HS. SMRs with North African comparisons were 0.81 (95%CI 0.67–0.97) for group 1 and 0.57 (95%CI 0.48–0.66) for group 2. Cox regression models showed significantly higher suicide risk for European early HS vs comparisons (Hazard Ratio (HR) = 1.31, 95% CI 1.12–1.52), and lower risk for HS (0.89, 95%CI 0.80–0.98). North African group 2 had significantly lower HR (0.58, 95%CI 0.43–0.79). To conclude, higher resilience was found among European survivors of severe adversity, compared to those who suffered lesser persecution. No elevated risk was found among North African survivors. [ABSTRACT FROM AUTHOR]

Background To compare the underlying cause of death reported by the Israeli Central Bureau of Statistics (CBS) with diagnoses in the electronic health records (EHR) of a fully integrated payer/provider healthcare system. Methods Underlying cause of death was obtained from the CBS for deaths occurring during 2009–2012 of all Clalit Health Service members in Israel. The final cohort consisted of members who had complete medical records. The frequency of a supportive diagnosis in the EHR was reported for 10 leading causes of death (malignancies, heart disease, cerebrovascular disease, diabetes, kidney disease, septicemia, accidents, chronic lower respiratory disease, dementia and pneumonia and influenza). Results Of the 45 680 members included in the study, the majority of deaths had at least one diagnosis in the EHR that could support the cause of death. The lowest frequency of supportive diagnosis was for septicemia (52.2%) and the highest was for malignancies (94.3%). Sensitivity analysis did not suggest an alternative explanation for the missing documentation. Conclusions The underlying cause of death coded by the CBS is often supported by diagnoses in Clalit's EHR. Exceptions are septicemia or accidents that cannot be anticipated from a patient's EHR, and dementia which may be under-reported. [ABSTRACT FROM AUTHOR]

Abstract Background Mortality from causes amenable to health care is a valuable indicator of quality of the health care system, which can be used to assess inter-regional differences and trends over time. This study investigates these mortality rates in Israel over time, and compares inter-regional and international rates in recent years. Results Age-adjusted amenable mortality rates have been decreasing steadily in Israel, by 31% for males and 28% for females between 1998–2000 and 2007–2009. Amenable mortality was lower in the center of the country than in the Northern, Southern, and Haifa districts. The proportion of mortality from circulatory diseases was highest in the North and Haifa districts and from cancer in the Tel-Aviv and Central districts. A higher proportion of infectious diseases was seen in the Southern district. In comparison with amenable mortality rates in 20 European countries, Israel ranked 8th lowest for males and 12th lowest for females, in 2008. The rate was lower than in Britain, Ireland, and Portugal; lower than in Germany, Spain, Austria, and Finland for males; and higher than France, Netherlands, Sweden, Norway, and Italy. But Israel ranked higher in the decrease in amenable mortality rates between 2001 and 2007 for females than males in a 19 country comparison. Genitourinary diseases were a larger component in Israel than other countries and circulatory diseases were smaller. Conclusion The indicator of amenable mortality shows improvement in health outcomes over the years, but continuing improvement is needed in health care and education, in particular in the periphery of Israel and for females.