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European Journal of Obstetrics,... Oct 2018Maternal mortality is rare in high-resource settings. This hampers studies of the association between maternal mortality and mode of birth, although this topic remains...
OBJECTIVES
Maternal mortality is rare in high-resource settings. This hampers studies of the association between maternal mortality and mode of birth, although this topic remains of importance, given the changing patterns in mode of birth with increasing cesarean section rates in most countries. Purpose of this study was to examine incidence of cesarean section-related maternal mortality in the Netherlands and association of surgery with the chain of morbid events leading to death.
STUDY DESIGN
We performed a retrospective cohort study using the Confidential Enquiry into Maternal Deaths, including all 2,684,946 maternities in the Netherlands between January 1st, 1999, and December 31st, 2013, registered in the Dutch Perinatal Registry. All available medical records of cases reported to the Dutch Maternal Mortality and Severe Morbidity Audit Committee were assessed by two researchers, and one or two additional experts in case of contradicting opinions, based on a set of pre-identified clinical criteria. Main outcome measures were (1) incidence and relative risk of maternal death following cesarean section and vaginal birth and (2) incidence of death directly related to cesarean section and death in which cesarean section was one of the contributing factors.
RESULTS
Risk of death after cesarean section was 21.9 per 100.000 cesarean sections (86/393,443) versus 3.8 deaths per 100.000 vaginal births (88/2,291,503): Relative Risk (RR) 5.7 (95% Confidence Interval [CI] 4.2-7.7). Death directly related to complications of cesarean section occurred in 8/86 women: 2 per 100,000 cesarean sections. With addition of 43 women in which cesarean section did not initiate, but contributed to the chain of events leading to mortality, risk of death increased to 13 per 100,000 cesarean sections (51/393,443; RR 3.4; 95%CI 2.4-4.8). At the start of cesarean section, pre-existing morbidity was present in 70/86 women (81.4%).
CONCLUSIONS
Compared to vaginal birth, maternal mortality after cesarean section was three times higher following exclusion of deaths that had no association with surgery. In approximately one in ten deaths after cesarean section, surgery did in fact initiate the chain of morbid events.
Topics: Adult; Cause of Death; Cesarean Section; Female; Humans; Maternal Mortality; Netherlands; Pregnancy; Retrospective Studies; Young Adult
PubMed: 30195138
DOI: 10.1016/j.ejogrb.2018.08.586 -
Public Health Reports (Washington, D.C.... Jan 2020Male mortality fell substantially during the past century, and major causes of death changed. Building on our recent analysis of female mortality trends in the United...
OBJECTIVES
Male mortality fell substantially during the past century, and major causes of death changed. Building on our recent analysis of female mortality trends in the United States, we examined all-cause and cause-specific mortality trends at each decade from 1900 to 2010 among US males.
METHODS
We conducted a descriptive study of age-adjusted death rates (AADRs) for 11 categories of disease and injury stratified by race (white, nonwhite, and, when available, black), the excess of male mortality over female mortality ([male AADR - female AADR]/female AADR), and potential causes of persistent excess of male mortality. We used national mortality data for each decade.
RESULTS
From 1900 to 2010, the all-cause AADR declined 66.4% among white males and 74.5% among nonwhite males. Five major causes of death in 1900 were pneumonia and influenza, heart disease, stroke, tuberculosis, and unintentional nonmotor vehicle injuries; in 2010, infectious conditions were replaced by cancers and chronic lower respiratory diseases. The all-cause excess of male mortality rose from 9.1% in 1900 to 65.5% in 1980 among white males and a peak of 63.7% in 1990 among nonwhite males, subsequently falling among all groups.
CONCLUSION
During the last century, AADRs among males declined more slowly than among females. Although the gap diminished in recent decades, exploration of social and behavioral factors may inform interventions that could further reduce death rates among males.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cause of Death; Child; Child, Preschool; Communicable Diseases; History, 20th Century; History, 21st Century; Humans; Infant; Infant, Newborn; Male; Middle Aged; Mortality; Noncommunicable Diseases; United States; Young Adult
PubMed: 31804898
DOI: 10.1177/0033354919893029 -
Eastern Mediterranean Health Journal =... Jan 2021The Family Physician and Social Protection Scheme for Iranian rural inhabitants was launched in June 2005 to improve physician density. To our knowledge, a comprehensive...
BACKGROUND
The Family Physician and Social Protection Scheme for Iranian rural inhabitants was launched in June 2005 to improve physician density. To our knowledge, a comprehensive study of the impact of the Scheme on mortality-related health indicators has not been conducted.
AIMS
To investigate the effects of health workforce density on maternal, neonatal, infant and under-5 mortality rates in rural areas of the Islamic Republic of Iran between 2005 and 2011.
METHODS
We built mixed-effects Poisson regression models including mortality measures as response variables and physician and behvarz (community-based health worker) densities as independent variables, using data from the Iranian Vital Horoscope tool, annual Households Income and Expenditure Survey, and DTARH software. We also included population sizes, age of inhabitants, rate of urbanization, years of schooling, and wealth index in each district, as well as effect of time, as covariates.
RESULTS
Physician density was significantly associated with child mortality rates (1.5%, 1.1% and 63.5% decrease in neonatal, under-5 and maternal mortality with a 1-unit increase in physician density per 1000 individuals). In the model built for infant mortality rate, physician density and behvarz densities were not significantly associated with this measure.
CONCLUSIONS
Improving the distribution of family physicians was associated with lower child and maternal mortality. Improvements in behvarz densities were not associated with decrements in these rates, which probably calls for improvement in access to more professional health services and facilities.
Topics: Child; Child Mortality; Humans; Infant; Infant Mortality; Infant, Newborn; Iran; Maternal Mortality; Workforce; Female
PubMed: 33538315
DOI: 10.26719/2021.27.1.16 -
Journal of Internal Medicine Jul 2023Current evidence regarding the mortality outcomes associated with calcium supplementation with or without low-dose vitamin D is conflicting.
BACKGROUND
Current evidence regarding the mortality outcomes associated with calcium supplementation with or without low-dose vitamin D is conflicting.
OBJECTIVES
To investigate the effects of calcium supplementation with or without vitamin D on all-cause and cause-specific mortalities in a large-scale cohort.
METHODS
This study used data from the Korean National Health Insurance System database and National Death Registry. A total of 27,846 participants aged >55 years who had taken calcium supplements with or without vitamin D for at least 90 days (calcium supplementation only [CaO], n = 6256; calcium supplementation in combination with vitamin D [CaD], n = 21,590) were matched in a 1:1 ratio to those who did not take calcium or vitamin D supplements (control group) using propensity scores.
RESULTS
No difference in all-cause mortality risk was found between the CaO and control groups: (adjusted hazard ratio [HR] = 1.00; 95% confidence interval [CI]: 0.92-1.10). However, all-cause mortality was lower in the CaD group (HR = 0.85; 95% CI: 0.80-0.89) compared with that in the control group. Mortality risk associated with cardiovascular disease (CVD) was decreased in the CaD group when the daily vitamin D dose received was less than 1000 IU (HR = 0.72; 95% CI: 0.64-0.81). Subgroup analysis showed significant effect of vitamin D with calcium in individuals who were female, aged ≥65 years or had previous history of cancer or CVD.
CONCLUSION
In combination with calcium, vitamin D supplementation provides better outcomes for all-cause mortality, particularly CVD-associated mortality, in a duration-dependent manner.
Topics: Female; Humans; Male; Vitamin D; Calcium; Cause of Death; Vitamins; Dietary Supplements; Cardiovascular Diseases
PubMed: 37056045
DOI: 10.1111/joim.13643 -
Environmental Science and Pollution... Jun 2022To investigate the causative component for certain health outcomes, the associations between the properties of ambient particles and cause-specific mortality (all-cause,...
To investigate the causative component for certain health outcomes, the associations between the properties of ambient particles and cause-specific mortality (all-cause, cardiovascular, and respiratory-related mortality) measured in Seoul, Korea, from January 1, 2013, to December 31, 2016, were evaluated with a quasi-Poisson generalized additive model (GAM). The total mass of PM and PM moderately affected respiratory-related mortality but had almost no impact on all-cause and cardiovascular-related mortality. Among PM mass compositions, ammonium sulfate, which is in generally 300-500 nm as a secondary species, showed the most statistically significant effect on respiratory-related mortality at lag 4 (p < 0.1) but not for other mortalities. However, from the size-selective investigations, cardiovascular-related mortality was impacted by particle number concentrations (PNCs), particle surface concentrations (PSCs), and particle volume concentrations (PVCs) in the size range from 50 to 200 nm with a statistically significant association, particularly at lag 1, suggesting that mass is not the only way to examine mortality, which is likely because mass and chemical composition concentrations are generally controlled by larger-sized particles. Our study suggests that the size-specific mortality and/or impacts of size-resolved properties on mortalities need to be evaluated since smaller particles get into the body more efficiently, and therefore, more diverse size-dependent causes and effects can occur.
Topics: Air Pollutants; Air Pollution; Causality; Mortality; Particle Size; Particulate Matter; Republic of Korea; Seoul
PubMed: 35141828
DOI: 10.1007/s11356-022-19069-2 -
Social Science & Medicine (1982) Mar 2015Social contact frequency is a well-defined and relatively objective measure of social relationships, which according to many studies is closely associated with health... (Meta-Analysis)
Meta-Analysis
Social contact frequency is a well-defined and relatively objective measure of social relationships, which according to many studies is closely associated with health and longevity. However, no previous meta-analysis has isolated this measure; existing reviews instead aggregate social contact with other diverse measures of social support, leaving unexplored the unique contribution of social contact to mortality. Furthermore, no study has sufficiently explored the factors that may moderate the relationship between contact frequency and mortality. We conducted meta-analyses and meta-regressions to examine 187 all-cause mortality risk estimates from 91 publications, providing data on about 400,000 persons. The mean hazard ratio (HR) for mortality among those with lower levels of social contact frequency was 1.13 (p < 0.05) among multivariate-adjusted HRs. However, sub-group meta-analyses show that there is no significant relationship between contact and mortality for male individuals and that contact with family members does not have a significant effect. The moderate effect sizes and the lack of association for some subgroups suggest that mere social contact frequency may not be as beneficial to one's health as previously thought.
Topics: Cause of Death; Female; Humans; Male; Mortality; Risk Factors; Social Support
PubMed: 25594955
DOI: 10.1016/j.socscimed.2015.01.010 -
The Science of the Total Environment Jul 2018The short-term mortality effects of ambient fine particulate matter air pollution have been widely investigated in China. However, the associations between day-to-day...
The short-term mortality effects of ambient fine particulate matter air pollution have been widely investigated in China. However, the associations between day-to-day variation in ambient coarse particles pollution (PM) and mortality, as well as the corresponding mortality burden, remain understudied. We estimated the short-term PM-mortality association in three Chinese cities of the Pearl River Delta (PRD) region during the period of 2013-16. The city-specific association was first estimated using generalized additive models and then combined to obtain the overall effect estimates. We further estimated PM related attributable fraction and attributable mortality. Our study found a significant association between PM and mortality. Each 10μg/m increase of a current day's PM was associated with a 1.37% (95% CI: 0.55%, 2.22%) increase in total mortality, a 1.63% increase (95% CI: 0.31%, 2.98%) in cardiovascular mortality, and a 0.97% increase (95% CI: -0.17%, 2.13%) in respiratory mortality in the three cities. We estimated that 0.37% (95% CI: 0.14%, 0.61%) and 2.72% (95% CI: 1.03%, 4.50%) of total mortalities were attributable to PM by using China's standards and WHO's air quality guidelines as references-corresponding to 1394 (95% CI: 528, 2291) and 10,305 (95% CI: 3884, 17,000) attributable premature mortalities in the three cities, respectively. This study suggests that ambient coarse particulate pollution might be one important risk factor of total, cardiovascular, and respiratory mortality, as well as account for substantial mortality burdens in the three Chinese cities of the PRD.
Topics: Adult; Air Pollutants; Air Pollution; Cardiovascular Diseases; China; Cities; Environmental Exposure; Humans; Mortality; Ozone; Particulate Matter; Respiratory Tract Diseases
PubMed: 30045528
DOI: 10.1016/j.scitotenv.2018.02.100 -
Journal of Research in Health Sciences Mar 2023This study was conducted to determine the mortality rate and years of life lost (YLL) due to homicide in Fars province.
BACKGROUND
This study was conducted to determine the mortality rate and years of life lost (YLL) due to homicide in Fars province.
STUDY DESIGN
This was a cross-sectional study.
METHODS
All data related to deaths due to homicide in Fars province were obtained from the Populationbased Electronic Death Registration System. Crude and age-standardized mortality rate, YLL, and YLL rate data were calculated and joinpoint regression was used to examine the trend.
RESULTS
During 2004-2019, 2148 deaths due to homicide occurred in Fars province, and (1782 cases (83.0%) were men. The crude mortality rate in men decreased by 44.0% from 2004 to 2019, but a stable trend was observed in women. The total YLL due to homicide during these 16 years was 43230 (1.37 per 1000 people) in men and 8931 (0.29 per 1000 people) in women. According to the joinpoint regression analysis, the 16-year trend of the YLL rate due to premature mortality in men was decreasing, and the annual percent change (APC) was -4.00% (95% confidence interval [CI]: -6.60 to -1.20, =0.008). However, women demonstrated stable trends in this respect, and APC was -0.50% (95% CI: -3.10 to 2.20, =0.704).
CONCLUSION
The crude and standardized mortality rates and the number of YLL due to homicide in the study period had a significant decreasing trend in men but a stable trend in women. To control this issue, officials and policymakers should identify the areas of homicide and control its risk factors such as economic and social issues, drug addiction, and the state of violence.
Topics: Male; Humans; Female; Homicide; Cause of Death; Iran; Cross-Sectional Studies; Mortality, Premature; Mortality
PubMed: 37571944
DOI: 10.34172/jrhs.2023.108 -
Journal of Perinatal Medicine Feb 2023Maternal mortality represents a major issue for every health system, especially in developed countries that aim on creating protocols to retain a declining pattern. With... (Review)
Review
Maternal mortality represents a major issue for every health system, especially in developed countries that aim on creating protocols to retain a declining pattern. With the appropriate medical supplies and training, some of these countries have made a remarkable progress in preventing maternal morbidity and mortality. On the contrary, developing countries have still made little or even no progress. Identifying determinants and designing strategies is of great importance in order to overcome such difficulties. The aim of this study is to identify the main causes of maternal mortality in the different societies.
Topics: Humans; Maternal Mortality; Developing Countries; Mortality; Female
PubMed: 36318719
DOI: 10.1515/jpm-2022-0408 -
Ethiopian Journal of Health Sciences Sep 2014The major causes of maternal and perinatal deaths are mostly pregnancy related. However, there are several predisposing factors for the increased risk of pregnancy... (Review)
Review
BACKGROUND
The major causes of maternal and perinatal deaths are mostly pregnancy related. However, there are several predisposing factors for the increased risk of pregnancy related complications and deaths in developing countries. The objective of this review was to grossly estimate the effect of selected socioeconomic and cultural factors on maternal mortality, stillbirths and neonatal mortality in Ethiopia.
METHODS
A comprehensive literature review was conducted focusing on the effect of total fertility rate (TFR), modern contraceptive use, harmful traditional practice, adult literacy rate and level of income on maternal and perinatal mortalities. For the majority of the data, regression analysis and Pearson correlation coefficient were used as a proxy indicator for the association of variables with maternal, fetal and neonatal mortality.
RESULTS
Although there were variations in the methods for estimation, the TFR of women in Ethiopia declined from 5.9 to 4.8 in the last fifteen years, which was in the middle as compared with that of other African countries. The preference of injectable contraceptive method has increased by 7-fold, but the unmet contraceptive need was among the highest in Africa. About 50% reduction in female genital cutting (FGC) was reported although some women's attitude was positive towards the practice of FGC. The regression analysis demonstrated increased risk of stillbirths, neonatal and maternal mortality with increased TFR. The increased adult literacy rate was associated with increased antenatal care and skilled person attended delivery. Low adult literacy was also found to have a negative association with stillbirths and neonatal and maternal mortality. A similar trend was also observed with income.
CONCLUSION
Maternal mortality ratio, stillbirth rate and neonatal mortality rate had inverse relations with income and adult education. In Ethiopia, the high total fertility rate, low utilization of contraceptive methods, low adult literacy rate, low income and prevalent harmful traditional practices have probably contributed to the high maternal mortality ratio, stillbirth and neonatal mortality rates.
Topics: Birth Rate; Circumcision, Female; Culture; Ethiopia; Female; Fetal Death; Humans; Infant; Infant Mortality; Infant, Newborn; Maternal Death; Maternal Mortality; Perinatal Death; Perinatal Mortality; Pregnancy; Socioeconomic Factors; Stillbirth
PubMed: 25489187
DOI: 10.4314/ejhs.v24i0.11s