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JAMA Network Open Jun 2021Knowledge of the health challenges and mortality in people with intellectual disability (ID) should guide health policies and practices in contemporary society. (Comparative Study)
Comparative Study
IMPORTANCE
Knowledge of the health challenges and mortality in people with intellectual disability (ID) should guide health policies and practices in contemporary society.
OBJECTIVE
To examine premature mortality in individuals with ID.
DESIGN, SETTING, AND PARTICIPANTS
This population-based longitudinal cohort study obtained data from several national health care, education, and population registers in Sweden. Two registers were used to identify individuals with ID: the National Patient Register and the Halmstad University Register on Pupils With Intellectual Disability. Two cohorts were created: cohort 1 comprised young adults (born between 1980 and 1991) with mild ID, and cohort 2 comprised individuals (born between 1932 and 2013) with mild ID or moderate to profound ID; each cohort had matched reference cohorts. Data analyses were conducted between June 1, 2020, and March 31, 2021.
EXPOSURES
Mild or moderate to profound ID.
MAIN OUTCOMES AND MEASURES
The primary outcome was overall (all-cause) mortality, and the secondary outcomes were cause-specific mortality and potentially avoidable mortality.
RESULTS
Cohort 1 included 13 541 young adults with mild ID (mean [SD] age at death, 24.53 [3.66] years; 7826 men [57.8%]), and its matched reference cohort consisted of 135 410 individuals. Cohort 2 included 24 059 individuals with mild ID (mean [SD] age at death, 52.01 [16.88] years; 13 649 male individuals [56.7%]) and 26 602 individuals with moderate to profound ID (mean [SD] age at death, 42.16 [21.68] years; 15 338 male individuals [57.7%]); its matched reference cohorts consisted of 240 590 individuals with mild ID and 266 020 with moderate to profound ID. Young adults with mild ID had increased overall mortality risk compared with the matched reference cohort (odds ratio [OR], 2.86; 95% CI, 2.33-3.50), specifically excess mortality in neoplasms (OR, 3.58; 95% CI, 2.02-6.35), diseases of the nervous system (OR, 40.00; 95% CI, 18.43-86.80) and circulatory system (OR, 9.24; 95% CI, 4.76-17.95). Among deaths that were amenable to health care (OR, 7.75; 95% CI, 4.85-12.39), 55% were attributed to epilepsy. In cohort 2, increased risk of overall mortality was observed among both individuals with mild ID (OR, 6.21; 95% CI, 5.79-6.66) and moderate to profound ID (OR, 13.15; 95% CI, 12.52-13.81) compared with the matched reference cohorts. Those with moderate to profound ID had a higher risk in several cause-of-death categories compared with those with mild ID or the matched reference cohort. Adjustment for epilepsy and congenital malformations attenuated the associations. The relative risk of premature death was higher in women (OR, 6.23; 95% CI, 4.42-8.79) than in men (OR, 1.99; 95% CI, 1.53-2.60), but the absolute risk of mortality was similar (0.9% for women vs 0.9% for men).
CONCLUSIONS AND RELEVANCE
This study found excess premature mortality and high risk of deaths with causes that were potentially amenable to health care intervention among people with ID. This finding suggests that this patient population faces persistent health challenges and inequality in health care encounters.
Topics: Adolescent; Adult; Cause of Death; Cohort Studies; Female; Humans; Intellectual Disability; Life Expectancy; Longitudinal Studies; Male; Mortality; Mortality, Premature; Population Surveillance; Sweden; Young Adult
PubMed: 34156453
DOI: 10.1001/jamanetworkopen.2021.13014 -
NCHS Data Brief Jan 2016Data from the National Vital Statistics System, Mortality. Death rates for centenarians increased from 2000 through 2008 and then decreased through 2014 for both males...
Data from the National Vital Statistics System, Mortality. Death rates for centenarians increased from 2000 through 2008 and then decreased through 2014 for both males and females. Death rates for centenarians increased from 2000 through 2006 for the Hispanic population and from 2000 through 2008 for the non- Hispanic white and black populations, and subsequently decreased through 2014 for all racial and ethnic groups examined. The top five causes of death among centenarians in 2014 were heart disease, Alzheimer's disease, stroke, cancer, and influenza and pneumonia. Death rates for Alzheimer's disease increased 119% between 2000 and 2014 among centenarians.
Topics: Aged, 80 and over; Aging; Cause of Death; Ethnicity; Female; Humans; Life Expectancy; Male; Mortality; Racial Groups; Sex Distribution; United States
PubMed: 26828422
DOI: No ID Found -
International Journal of Environmental... Mar 2022Understanding and managing the impacts of population growth and densification are important steps for sustainable development. This study sought to evaluate the health...
BACKGROUND
Understanding and managing the impacts of population growth and densification are important steps for sustainable development. This study sought to evaluate the health trade-offs associated with increasing densification and to identify the optimal balance of neighbourhood densification for health.
METHODS
We linked population density with a 27-year mortality dataset in Metro Vancouver that includes census-tract levels of life expectancy (LE), cause-specific mortalities, and area-level deprivation. We applied two methods: (1) difference-in-differences (DID) models to study the impacts of densification changes from the early 1990s on changes in mortality over a 27-year period; and (2) smoothed cubic splines to identify thresholds of densification at which mortality rates accelerated.
RESULTS
At densities above ~9400 persons per km, LE began to decrease more rapidly. By cause, densification was linked to decreased mortality for major causes of mortality in the region, such as cardiovascular diseases, neoplasms, and diabetes. Greater inequality with increasing density was observed for causes such as human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS), sexually transmitted infections, and self-harm and interpersonal violence.
CONCLUSIONS
Areas with higher population densities generally have lower rates of mortality from the major causes, but these environments are also associated with higher relative inequality from largely preventable causes of death.
Topics: Acquired Immunodeficiency Syndrome; Canada; Cause of Death; Humans; Life Expectancy; Mortality; Residence Characteristics
PubMed: 35270597
DOI: 10.3390/ijerph19052900 -
BMC Public Health Jul 2016Sedentary behaviours (time spent sitting, with low energy expenditure) are associated with deleterious health outcomes, including all-cause mortality. Whether this...
BACKGROUND
Sedentary behaviours (time spent sitting, with low energy expenditure) are associated with deleterious health outcomes, including all-cause mortality. Whether this association can be considered causal has yet to be established. Using systematic reviews and primary studies from those reviews, we drew upon Bradford Hill's criteria to consider the likelihood that sedentary behaviour in epidemiological studies is likely to be causally related to all-cause (premature) mortality.
METHODS
Searches for systematic reviews on sedentary behaviours and all-cause mortality yielded 386 records which, when judged against eligibility criteria, left eight reviews (addressing 17 primary studies) for analysis. Exposure measures included self-reported total sitting time, TV viewing time, and screen time. Studies included comparisons of a low-sedentary reference group with several higher sedentary categories, or compared the highest versus lowest sedentary behaviour groups. We employed four Bradford Hill criteria: strength of association, consistency, temporality, and dose-response. Evidence supporting causality at the level of each systematic review and primary study was judged using a traffic light system depicting green for causal evidence, amber for mixed or inconclusive evidence, and red for no evidence for causality (either evidence of no effect or no evidence reported).
RESULTS
The eight systematic reviews showed evidence for consistency (7 green) and temporality (6 green), and some evidence for strength of association (4 green). There was no evidence for a dose-response relationship (5 red). Five reviews were rated green overall. Twelve (67 %) of the primary studies were rated green, with evidence for strength and temporality.
CONCLUSIONS
There is reasonable evidence for a likely causal relationship between sedentary behaviour and all-cause mortality based on the epidemiological criteria of strength of association, consistency of effect, and temporality.
Topics: Cause of Death; Humans; Mortality, Premature; Posture; Review Literature as Topic; Sedentary Behavior
PubMed: 27456959
DOI: 10.1186/s12889-016-3307-3 -
Nigerian Journal of Clinical Practice Jul 2022The perioperative mortality rate (POMR) has been recognized as a useful indicator to measure surgical safety at an institutional or national level. The POMR can thus be...
BACKGROUND
The perioperative mortality rate (POMR) has been recognized as a useful indicator to measure surgical safety at an institutional or national level. The POMR can thus be used as a tool to identify procedures that carry the highest mortality rates and provide hindsight based on past surgical experiences.
AIM
To document the pattern of perioperative mortality and the factors that influence it at district hospitals in southeast Nigeria.
PATIENTS AND METHODS
This was a retrospective study of cases of perioperative mortality at district hospitals in southeast Nigeria between January 2014 to December 2018. All perioperative mortalities from surgical admissions in both elective and emergency set-ups were included. During analysis, we computed P values for categorical variables using Chi-square and Fisher's exact test in accordance with the size of the dataset. Furthermore, we determined the association between some selected clinical variables and mortality using logistic regression analyses.
RESULTS
During the period under review, 254 perioperative deaths occurred from 2,369 surgical operations, giving a POMR of 10.7%. Of the 254 deaths, there were 180 (70.9%) males and 74 (29.1%) females. Nearly one-third (31.2%) were farmers and 64.2% of the deaths occurred in those 50 years and below. Delayed presentation was two-pronged: delay before presentation and in-hospital delay. The POMR was the highest among general surgery emergencies and least among those with plastic surgery conditions. The observed factors associated with mortality were time of presentation (early or late), type of surgery (emergency or elective), category of surgery (general surgery or others), American Society of Anesthesiologists (ASA) score (high or low), place of admission after surgery (intensive care unit or general ward), level of training of doctors who performed the surgery (specialist or general duty doctor) (P < 0.05).
CONCLUSION
The POMR was higher in male patients and in those with general surgery emergencies compared to other conditions. Delayed presentation, high ASA scores, and operations performed under emergency set-ups were associated with elevated POMRs.
Topics: Emergencies; Female; Hospital Mortality; Hospitals, District; Humans; Male; Nigeria; Perioperative Period; Retrospective Studies
PubMed: 35859458
DOI: 10.4103/njcp.njcp_1291_21 -
International Journal of Epidemiology Apr 2020Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear....
BACKGROUND
Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors.
METHODS
Data were from seven cohort studies participating in the LIFEPATH Consortium (total n = 179 090). Using both socio-economic position (SEP) (based on occupation) and education, we estimated the natural direct effect on all-cause mortality and the natural indirect effect via the joint mediating role of smoking, alcohol intake, dietary patterns, physical activity, body mass index, hypertension, diabetes and coronary artery disease. Hazard ratios (HRs) were estimated, using counterfactual natural effect models under different hypothetical actions of either lower or higher SEP or education.
RESULTS
Lower SEP and education were associated with an increase in all-cause mortality within an average follow-up time of 17.5 years. Mortality was reduced via modelled hypothetical actions of increasing SEP or education. Through higher education, the HR was 0.85 [95% confidence interval (CI) 0.84, 0.86] for women and 0.71 (95% CI 0.70, 0.74) for men, compared with lower education. In addition, 34% and 38% of the effect was jointly mediated for women and men, respectively. The benefits from altering SEP were slightly more modest.
CONCLUSIONS
These observational findings support policies to reduce mortality both through improving socio-economic circumstances and increasing education, and by altering intermediaries, such as lifestyle behaviours and morbidities.
Topics: Adult; Cause of Death; Cohort Studies; Female; Health Status Disparities; Humans; Male; Middle Aged; Mortality; Socioeconomic Factors
PubMed: 31855265
DOI: 10.1093/ije/dyz248 -
Diabetes Research and Clinical Practice Apr 2021Diabetes mellitus is a major health problem in Costa Rica. Its prevalence is increasing and represents a significant burden.
AIM
Diabetes mellitus is a major health problem in Costa Rica. Its prevalence is increasing and represents a significant burden.
OBJECTIVES
To determine specific diabetes mortality rates (SDMR) in Costa Rica from 2007 to 2017 and explore it's potential causes.
METHODS
Death certificates (classification CIE-10) were obtained from the Instituto Nacional de Estadística y Censos. All-cause mortality, SDMR, ischemic heart disease (IHD), cerebrovascular disease (CVD), and peripheral vascular disease mortality were assessed per year, sex, age and province. We evaluated relationships between SDMR and Index of Human Development (IHUD), performed a multivariate regression negative binomial model analysis and compared SDMR with goals of metabolic control in the primary care setting.
RESULTS
All-cause mortality and SDMR increased while IHD and CVD mortality rates remained invariable. SDMR was higher in females and in provinces with predominant rural areas. The years of observation, sex, age and province were significant predictors of death at a 5% level in people with diabetes. Reports from primary care setting showed inadequeate public health care coverage and insuficient metabolic control.
CONCLUSIONS
SDMR increased in elderly patients with specific complications. Age, place of residence and sex predicted SDMR. Unsatisfactory diabetes medical coverage and poorly diabetes management likely explain our findings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Costa Rica; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Mortality; Prevalence; Prognosis; Survival Rate; Time Factors; Young Adult
PubMed: 33713723
DOI: 10.1016/j.diabres.2021.108749 -
Frontiers in Public Health 2024It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic...
INTRODUCTION
It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases.
METHODS
Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality.
RESULTS
Out of the total 13,855 participants included, the median (1, 3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]).
CONCLUSION
Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.
Topics: Humans; Male; Female; China; Depression; Middle Aged; Chronic Disease; Longitudinal Studies; Aged; Cause of Death; Risk Factors; Mortality; Proportional Hazards Models
PubMed: 38841667
DOI: 10.3389/fpubh.2024.1381273 -
PloS One 2018Although research on the fertility response to childhood mortality is widespread in demographic literature, very few studies focused on the two-way causal relationships...
Although research on the fertility response to childhood mortality is widespread in demographic literature, very few studies focused on the two-way causal relationships between infant mortality and fertility. Understanding the nature of such relationships is important in order to design effective policies to reduce child mortality and improve family planning. In this study, we use dynamic panel data techniques to analyse the causal effects of infant mortality on birth intervals and fertility, as well as the causal effects of birth intervals on mortality in rural Bangladesh, accounting for unobserved heterogeneity and reverse causality. Simulations based upon the estimated model show whether (and to what extent) mortality and fertility can be reduced by breaking the causal links between short birth intervals and infant mortality. We find a replacement effect of infant mortality on total fertility of about 0.54 children for each infant death in the comparison area with standard health services. Eliminating the replacement effect would lengthen birth intervals and reduce the total number of births, resulting in a fall in mortality by 2.45 children per 1000 live births. These effects are much smaller in the treatment area with extensive health services and information on family planning, where infant mortality is smaller, birth intervals are longer, and total fertility is lower. In both areas, we find evidence of boy preference in family planning.
Topics: Artificial Intelligence; Bangladesh; Birth Intervals; Child; Child Mortality; Fertility; Humans; Infant; Infant Mortality
PubMed: 29702692
DOI: 10.1371/journal.pone.0195940 -
PloS One 2017To investigate the trends in mortality, as well as in the timing and cause of death, among extremely preterm infants at the limit of viability, and thus to identify the...
OBJECTIVE
To investigate the trends in mortality, as well as in the timing and cause of death, among extremely preterm infants at the limit of viability, and thus to identify the clinical factors that contribute to decreased mortality.
METHODS
We retrospectively reviewed the medical records of 382 infants born at 23-26 weeks' gestation; 124 of the infants were born between 2001 and 2005 (period I) and 258 were born between 2006 and 2011 (period II). We stratified the infants into two subgroups-"23-24 weeks" and "25-26 weeks"-and retrospectively analyzed the clinical characteristics and mortality in each group, as well as the timing and cause of death. Univariate and multivariate logistic regression analyses were done to identify the clinical factors associated with mortality.
RESULTS
The overall mortality rate in period II was 16.7% (43/258), which was significantly lower than that in period I (30.6%; 38/124). For overall cause of death, there were significantly fewer deaths due to sepsis (2.4% [6/258] vs. 8.1% [10/124], respectively) and air-leak syndrome (0.8% [2/258] vs. 4.8% (6/124), respectively) during period II than during period I. Among the clinical factors of time period, 1-and 5-min Apgar score, antenatal steroid identified significant by univariate analyses. 5-min Apgar score and antenatal steroid use were significantly associated with mortality in multivariate analyses.
CONCLUSION
Improved mortality rate attributable to fewer deaths due to sepsis and air leak syndrome in the infants with 23-26 weeks' gestation was associated with higher 5-minute Apgar score and more antenatal steroid use.
Topics: Cause of Death; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Premature; Retrospective Studies
PubMed: 28114330
DOI: 10.1371/journal.pone.0170220