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Epidemiology (Cambridge, Mass.) Jul 2017Holistic depiction of time-trends in average mortality rates, and absolute and relative inequalities, is challenging. (Comparative Study)
Comparative Study Review
BACKGROUND
Holistic depiction of time-trends in average mortality rates, and absolute and relative inequalities, is challenging.
METHODS
We outline a typology for situations with falling average mortality rates (m↓; e.g., cardiovascular disease), rates stable over time (m-; e.g., some cancers), and increasing average mortality rates (m↑; e.g., suicide in some contexts). If we consider inequality trends on both the absolute (a) and relative (r) scales, there are 13 possible combination of m, a, and r trends over time. They can be mapped to graphs with relative inequality (log relative index of inequality [RII]; r) on the y axis, log average mortality rate on the x axis (m), and absolute inequality (slope index of inequality; SII; a) as contour lines. We illustrate this by plotting adult mortality trends: (1) by household income from 1981 to 2011 for New Zealand, and (2) by education for European countries.
RESULTS
Types range from the "best" m↓a↓r↓ (average, absolute, and relative inequalities all decreasing; southwest movement in graphs) to the "worst" m↑a↑r↑ (northeast). Mortality typologies in New Zealand (all-cause, cardiovascular disease, nonlung cancer, and unintentional injury) were all m↓r↑ (northwest), but variable with respect to absolute inequality. Most European typologies were m↓r↑ types (northwest; e.g., Finland), but with notable exceptions of m-a↑r↑ (north; e.g., Hungary) and "best" or southwest m↓a↓r↓ for Spain (Barcelona) females.
CONCLUSIONS
Our typology and corresponding graphs provide a convenient way to summarize and understand past trends in inequalities in mortality, and hold potential for projecting future trends and target setting.
Topics: Adult; Age Factors; Aged; Cardiovascular Diseases; Cause of Death; Epidemiologic Methods; Female; Humans; Male; Middle Aged; Mortality; Neoplasms; New Zealand; Risk Assessment; Sex Factors; Socioeconomic Factors
PubMed: 28394874
DOI: 10.1097/EDE.0000000000000671 -
JAMA Psychiatry May 2020Extramedical opioid use has escalated in recent years. A better understanding of cause-specific mortality in this population is needed to inform comprehensive responses. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Extramedical opioid use has escalated in recent years. A better understanding of cause-specific mortality in this population is needed to inform comprehensive responses.
OBJECTIVE
To estimate all-cause and cause-specific crude mortality rates (CMRs) and standardized mortality ratios (SMRs) among people using extramedical opioids, including age- and sex-specific estimates when possible.
DATA SOURCES
For this systematic review and meta-analysis, MEDLINE, PsycINFO, and Embase were searched for studies published from January 1, 2009, to October 3, 2019, and an earlier systematic review on this topic published in 2011.
STUDY SELECTION
Cohort studies of people using extramedical opioids and reporting mortality outcomes were screened for inclusion independently by 2 team members.
DATA EXTRACTION AND SYNTHESIS
Data were extracted by a team member and checked by another team member. Study quality was assessed using a custom set of items that examined risk of bias and quality of reporting. Data were pooled using random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression.
MAIN OUTCOMES AND MEASURES
Outcome measures were all-cause and cause-specific CMRs and SMRs among people using extramedical opioids compared with the general population of the same age and sex.
RESULTS
Of 8683 identified studies, 124 were included in this analysis (100 primary studies and 24 studies providing additional data for primary studies). The pooled all-cause CMR, based on 99 cohorts of 1 262 592 people, was 1.6 per 100 person-years (95% CI, 1.4-1.8 per 100 person-years), with substantial heterogeneity (I2 = 99.7%). Heterogeneity was associated with the proportion of the study sample that injected opioids or was living with HIV infection or hepatitis C. The pooled all-cause SMR, based on 43 cohorts, was 10.0 (95% CI, 7.6-13.2). Excess mortality was observed across a range of causes, including overdose, injuries, and infectious and noncommunicable diseases.
CONCLUSIONS AND RELEVANCE
The findings suggest that people using extramedical opioids experience significant excess mortality, much of which is preventable. The range of causes for which excess mortality was observed highlights the multiplicity of risk exposures experienced by this population and the need for comprehensive responses to address these. Better data on cause-specific mortality in this population in several world regions appear to be needed.
Topics: Cause of Death; Humans; Mortality; Opioid-Related Disorders
PubMed: 31876906
DOI: 10.1001/jamapsychiatry.2019.4170 -
PloS One 2019To analyze the mortality trend in Spain before, during and after the economic crisis and austerity policies in the working-age population.
OBJECTIVE
To analyze the mortality trend in Spain before, during and after the economic crisis and austerity policies in the working-age population.
METHODS
From 2005 to 2016 we calculated the annual all-cause mortality rate and the annual mortality rate from the main causes of death in the population aged 15 to 64. We also estimated the linear trends in mortality rates during four time intervals-2005-2007 (before crisis), 2008-2010 (first part of the crisis), 2011-2013 (second part of the crisis and implementation of austerity policies) and 2014-2016 (after the crisis)- by the annual percentage change (APC).
RESULTS
The all-cause mortality rate in men and women showed the greatest decline in 2008-2010 and the smallest decline in 2014-2016. The decline in 2011-2013 was higher than in 2014-2016. The APCs in 2005-2007, 2008-2010, 2011-2013 and 2014-2016 were -2.8, -4.1, -3.0 and -1.5 in men and -1.0. -2.1, -1.1 and -0.6 in women, respectively, although the APC in 2014-2016 in women was not significant. In 2014-2016, cancer mortality showed the largest decrease, mortality from cardiovascular diseases (men), respiratory diseases and traffic accidents reversed and showed an upward trend, and the downward trend in mortality from infectious diseases and digestive diseases was equal to or greater than that observed before the crisis.
CONCLUSION
The decline in all-cause mortality in the working-age population during the economic crisis and the introduction of austerity measures was greater than that observed before and after the economic crisis. The slowing of the decline after the crisis was due to the reversal of the trend in mortality from cardiovascular and respiratory diseases.
Topics: Adolescent; Adult; Age Factors; Cause of Death; Economic Recession; Female; History, 21st Century; Humans; Male; Middle Aged; Mortality; Population Surveillance; Socioeconomic Factors; Spain; Young Adult
PubMed: 31247019
DOI: 10.1371/journal.pone.0218410 -
The Journal of Maternal-fetal &... Nov 2016The purpose of this study was to assess the variability in neonatal survival to discharge from the neonatal unit by using different inclusion criteria. (Observational Study)
Observational Study
OBJECTIVE
The purpose of this study was to assess the variability in neonatal survival to discharge from the neonatal unit by using different inclusion criteria.
METHODS
An observational and descriptive study was performed between January 2008 and December 2013 which included infants born between 22 weeks and 31 weeks and 6 d of gestation. The rate of survival was calculated using three different inclusion criteria: the total number of preterm births, the number of all preterm live births, and the number of preterm newborns admitted to the neonatal unit.
RESULTS
A total of 783 patients met the inclusion criteria. The survival rate for births between 22 and 31 weeks and 6 d of gestation was 72.8% of total births, 82.3% of live births, and 84.0% of all admissions to the neonatal unit. Therefore, we found a significant difference in survival rates according to whether or not foetal mortality (11.6%) and mortality in the delivery room (2.0%) were included. This variation increased with decreasing gestational age: 17,2%, 25%, and 38,4% at 23 weeks gestation.
CONCLUSIONS
Late foetal mortality and the mortality in the delivery room affect the survival rates of preterm infants significantly, especially the most immature newborns.
Topics: Fetal Mortality; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Spain; Survival Rate
PubMed: 26762756
DOI: 10.3109/14767058.2016.1140736 -
Journal of the American Academy of... Apr 2018There are varying reports of the association of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) with mortality. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are varying reports of the association of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) with mortality.
OBJECTIVE
To synthesize the available information on all-cause mortality after a diagnosis of BCC or SCC in the general population.
METHODS
We searched PubMed (1966-present), Web of Science (1898-present), and Embase (1947-present) and hand-searched to identify additional records. All English articles that reported all-cause mortality in patients with BCC or SCC were eligible. We excluded case reports, case series, and studies in subpopulations of patients. Random effects model meta-analyses were performed separately for BCC and SCC.
RESULTS
The searches yielded 6538 articles, and 156 were assessed in a full-text review. Twelve studies met the inclusion criteria, and 4 were included in the meta-analysis (encompassing 464,230 patients with BCC and with 175,849 SCC), yielding summary relative mortalities of 0.92 (95% confidence interval, 0.83-1.02) in BCC and 1.25 (95% confidence interval, 1.17-1.32) in SCC.
LIMITATIONS
Only a minority of studies controlled for comorbidities. There was significant heterogeneity in meta-analysis (χP < .001, I > 98%), but studies of SCC were qualitatively concordant: all showed statistically significant increased relative mortality.
CONCLUSIONS
We found that patients with SCC are at higher risk for death from any cause compared with the general population.
Topics: Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Cause of Death; Humans; Skin Neoplasms
PubMed: 29146125
DOI: 10.1016/j.jaad.2017.11.026 -
Cancer Epidemiology, Biomarkers &... Jul 2021This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and...
BACKGROUND
This study investigated socioeconomic inequalities in premature cancer mortality by cancer types, and evaluated the associations between socioeconomic status (SES) and premature cancer mortality by cancer types.
METHODS
Using multiple databases, cancer mortality was linked to SES and other county characteristics. The outcome measure was cancer mortality among adults ages 25-64 years in 3,028 U.S. counties, from 1999 to 2018. Socioeconomic inequalities in mortality were calculated as a concentration index (CI) by income (annual median household income), educational attainment (% with bachelor's degree or higher), and unemployment rate. A hierarchical linear mixed model and dominance analyses were used to investigate SES associated with county-level mortality. The analyses were also conducted by cancer types.
RESULTS
CIs of SES factors varied by cancer types. Low-SES counties showed increasing trends in mortality, while high-SES counties showed decreasing trends. Socioeconomic inequalities in mortality among high-SES counties were larger than those among low-SES counties. SES explained 25.73% of the mortality. County-level cancer mortality was associated with income, educational attainment, and unemployment rate, at -0.24 [95% (CI): -0.36 to -0.12], -0.68 (95% CI: -0.87 to -0.50), and 1.50 (95% CI: 0.92-2.07) deaths per 100,000 population with one-unit SES factors increase, respectively, after controlling for health care environment and population health.
CONCLUSIONS
SES acts as a key driver of premature cancer mortality, and socioeconomic inequalities differ by cancer types.
IMPACT
Focused efforts that target socioeconomic drivers of mortalities and inequalities are warranted for designing cancer-prevention implementation strategies and control programs and policies for socioeconomically underprivileged groups.
Topics: Adult; Aged; Female; Geography; Health Status Disparities; History, 20th Century; History, 21st Century; Humans; Male; Middle Aged; Mortality, Premature; Neoplasms; Social Determinants of Health; Socioeconomic Factors; United States
PubMed: 33947656
DOI: 10.1158/1055-9965.EPI-20-1534 -
Population Health Metrics Jan 2022The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without...
BACKGROUND
The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without high functioning vital registration systems could benefit from estimates of age- and cause-specific mortality to inform health programming, however, to date the causes of under-five death have only been described for broad age categories such as for neonates (0-27 days), infants (0-11 months), and children age 12-59 months.
METHODS
We adapt the log quadratic model to mortality patterns for children under five to all-cause child mortality and then to age- and cause-specific mortality (U5ACSM). We apply these methods to empirical sample registration system mortality data in China from 1996 to 2015. Based on these empirical data, we simulate probabilities of mortality in the case when the true relationships between age and mortality by cause are known.
RESULTS
We estimate U5ACSM within 0.1-0.7 deaths per 1000 livebirths in hold out strata for life tables constructed from the China sample registration system, representing considerable improvement compared to an error of 1.2 per 1000 livebirths using a standard approach. This improved prediction error for U5ACSM is consistently demonstrated for all-cause as well as pneumonia- and injury-specific mortality. We also consistently identified cause-specific mortality patterns in simulated mortality scenarios.
CONCLUSION
The log quadratic model is a significant improvement over the standard approach for deriving U5ACSM based on both simulation and empirical results.
Topics: Cause of Death; Child; Child Mortality; Child, Preschool; China; Humans; Infant; Infant Mortality; Infant, Newborn; Life Tables
PubMed: 35012587
DOI: 10.1186/s12963-021-00277-w -
Einstein (Sao Paulo, Brazil) 2015To identify, in national and international journals, the studies conducted in Brazil related to breast feeding and reducing cases of diarrhea in children under 2 years... (Review)
Review
OBJECTIVE
To identify, in national and international journals, the studies conducted in Brazil related to breast feeding and reducing cases of diarrhea in children under 2 years of age, featuring health interventions more used.
METHODS
Descriptive study, based on an integrative review of literature from PubMed and LILACS data published between January 1992 and August 2011. The keywords "breastfeeding AND diarrhea" was searched in Portuguese, English and Spanish in PubMed and LILACS. The guiding question was: "What was knowledge produced about breast feeding and prevention of diarrhea in children under 2 years between 1992 and 2011 in studies conducted in Brazil?"
RESULTS
We selected 11 studies that showed the importance of breast feeding in the prevention and protection against diarrhea in children under 6 months, especially among children in exclusive breastfeeding.
CONCLUSION
Public health policies should be directed to the context of each locality, in order to reduce the problems that involve the early weaning.
Topics: Brazil; Breast Feeding; Child Mortality; Child, Preschool; Diarrhea, Infantile; Female; Hospital Mortality; Humans; Infant; Infant Mortality; Infant, Newborn; Male; Retrospective Studies
PubMed: 26061078
DOI: 10.1590/S1679-45082015RW3107 -
Mid-term survival of patients with chronic kidney disease after extracorporeal membrane oxygenation.Interactive Cardiovascular and Thoracic... Nov 2020Chronic kidney disease (CKD) impairs the elimination of fluids, electrolytes and metabolic wastes, which can affect the outcomes of extracorporeal membrane oxygenation...
OBJECTIVES
Chronic kidney disease (CKD) impairs the elimination of fluids, electrolytes and metabolic wastes, which can affect the outcomes of extracorporeal membrane oxygenation (ECMO) treatment. This study aimed to elucidate the impact of CKD on in-hospital mortality and mid-term survival of adult patients who received ECMO treatment.
METHODS
Patients who received first-time ECMO treatment between 1 January 2003 and 31 December 2013 were included. Those with CKD were identified and matched to patients without CKD using a 1:2 ratio and were followed for 3 years. The study outcomes included in-hospital outcomes and the 3-year mortality rate. A subgroup analysis was conducted by comparing the dialytic patients with the non-dialytic CKD patients.
RESULTS
The study comprised 1008 CKD patients and 2016 non-CKD patients after propensity score matching. The CKD patients had higher in-hospital mortality rates [69.5% vs 62.2%; adjusted odds ratio 1.41; 95% confidence interval (CI) 1.15-1.72] than the non-CKD patients. The 3-year mortality rate was 80.4% in the CKD group and 68% in the non-CKD group (adjusted hazard ratio 1.17; 95% CI 1.06-1.28). The subgroup analysis showed that the 3-year mortality rates were 84.5% and 78.4% in the dialytic and non-dialytic patients, respectively. No difference in the 3-year mortality rate was noted between the 2 CKD subgroups (P = 0.111).
CONCLUSIONS
CKD was associated with increased risks of in-hospital and mid-term mortalities in patients who received ECMO treatment. Furthermore, no difference in survival was observed between the patients with end-stage renal disease and non-dialytic CKD patients.
Topics: Adult; Aged; Extracorporeal Membrane Oxygenation; Female; Hospital Mortality; Humans; Male; Middle Aged; Propensity Score; Renal Insufficiency, Chronic; Retrospective Studies; Survival Rate
PubMed: 33005952
DOI: 10.1093/icvts/ivaa168 -
Gaceta Sanitaria 2019To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends.
OBJECTIVE
To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends.
METHOD
We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein.
RESULTS
After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis.
CONCLUSIONS
Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.
Topics: Economic Recession; Female; Humans; Longitudinal Studies; Male; Mortality; Neoplasms; Spain; Time Factors
PubMed: 29452751
DOI: 10.1016/j.gaceta.2017.11.008