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American Journal of Obstetrics and... Apr 2024National Vital Statistics System reports show that maternal mortality rates in the United States have nearly doubled, from 17.4 in 2018 to 32.9 per 100,000 live births...
Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance?
BACKGROUND
National Vital Statistics System reports show that maternal mortality rates in the United States have nearly doubled, from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. However, these high and rising rates could reflect issues unrelated to obstetrical factors, such as changes in maternal medical conditions or maternal mortality surveillance (eg, due to introduction of the pregnancy checkbox).
OBJECTIVE
This study aimed to assess if the high and rising rates of maternal mortality in the United States reflect changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance.
STUDY DESIGN
The study was based on all deaths in the United States from 1999 to 2021. Maternal deaths were identified using the following 2 approaches: (1) per National Vital Statistics System methodology, as deaths in pregnancy or in the postpartum period, including deaths identified solely because of a positive pregnancy checkbox, and (2) under an alternative formulation, as deaths in pregnancy or in the postpartum period, with at least 1 mention of pregnancy among the multiple causes of death on the death certificate. The frequencies of major cause-of-death categories among deaths of female patients aged 15 to 44 years, maternal deaths, deaths due to obstetrical causes (ie, direct obstetrical deaths), and deaths due to maternal medical conditions aggravated by pregnancy or its management (ie, indirect obstetrical deaths) were quantified.
RESULTS
Maternal deaths, per National Vital Statistics System methodology, increased by 144% (95% confidence interval, 130-159) from 9.65 in 1999-2002 (n=1550) to 23.6 per 100,000 live births in 2018-2021 (n=3489), with increases occurring among all race and ethnicity groups. Direct obstetrical deaths increased from 8.41 in 1999-2002 to 14.1 per 100,000 live births in 2018-2021, whereas indirect obstetrical deaths increased from 1.24 to 9.41 per 100,000 live births: 38% of direct obstetrical deaths and 87% of indirect obstetrical deaths in 2018-2021 were identified because of a positive pregnancy checkbox. The pregnancy checkbox was associated with increases in less specific and incidental causes of death. For example, maternal deaths with malignant neoplasms listed as a multiple cause of death increased 46-fold from 0.03 in 1999-2002 to 1.42 per 100,000 live births in 2018-2021. Under the alternative formulation, the maternal mortality rate was 10.2 in 1999-2002 and 10.4 per 100,000 live births in 2018-2021; deaths from direct obstetrical causes decreased from 7.05 to 5.82 per 100,000 live births. Deaths due to preeclampsia, eclampsia, postpartum hemorrhage, puerperal sepsis, venous complications, and embolism decreased, whereas deaths due to adherent placenta, renal and unspecified causes, cardiomyopathy, and preexisting hypertension increased. Maternal mortality increased among non-Hispanic White women and decreased among non-Hispanic Black and Hispanic women. However, rates were disproportionately higher among non-Hispanic Black women, with large disparities evident in several causes of death (eg, cardiomyopathy).
CONCLUSION
The high and rising rates of maternal mortality in the United States are a consequence of changes in maternal mortality surveillance, with reliance on the pregnancy checkbox leading to an increase in misclassified maternal deaths. Identifying maternal deaths by requiring mention of pregnancy among the multiple causes of death shows lower, stable maternal mortality rates and declines in maternal deaths from direct obstetrical causes.
Topics: Pregnancy; Female; Humans; United States; Maternal Mortality; Maternal Death; Cause of Death; Live Birth; Cardiomyopathies
PubMed: 38480029
DOI: 10.1016/j.ajog.2023.12.038 -
Biochemistry. Biokhimiia Feb 2024The most important manifestation of aging is an increased risk of death with advancing age, a mortality pattern characterized by empirical regularities known as... (Review)
Review
The most important manifestation of aging is an increased risk of death with advancing age, a mortality pattern characterized by empirical regularities known as mortality laws. We highlight three significant ones: the Gompertz law, compensation effect of mortality (CEM), and late-life mortality deceleration and describe new developments in this area. It is predicted that CEM should result in declining relative variability of mortality at older ages. The quiescent phase hypothesis of negligible actuarial aging at younger adult ages is tested and refuted by analyzing mortality of the most recent birth cohorts. To comprehend the aging mechanisms, it is crucial to explain the observed empirical mortality patterns. As an illustrative example of data-directed modeling and the insights it provides, we briefly describe two different reliability models applied to human mortality patterns. The explanation of aging using a reliability theory approach aligns with evolutionary theories of aging, including idea of chronic phenoptosis. This alignment stems from their focus on elucidating the process of organismal deterioration itself, rather than addressing the reasons why organisms are not designed for perpetual existence. This article is a part of a special issue of the journal that commemorates the legacy of the eminent Russian scientist Vladimir Petrovich Skulachev (1935-2023) and his bold ideas about evolution of biological aging and phenoptosis.
Topics: Adult; Humans; Longevity; Reproducibility of Results; Aging; Cell Division; Mortality
PubMed: 38622100
DOI: 10.1134/S0006297924020123 -
Food & Function Feb 2024: advanced glycation end-products (AGEs), formed through a series of non-enzymatic reactions, can promote inflammation and oxidative stress. Their accumulation in the...
: advanced glycation end-products (AGEs), formed through a series of non-enzymatic reactions, can promote inflammation and oxidative stress. Their accumulation in the body has been linked to cardiovascular disease (CVD) and cancer. However, the association of total AGEs and AGEs from different food sources with risks of all-cause, CVD, and cancer mortality is still unknown. : we conducted a prospective cohort study of a nationally representative sample of 22 124 participants from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES 2003-2006. A food frequency questionnaire (FFQ) was utilized to calculate total and different food-derived AGE intake. Associations between various dietary AGE scores and the risk of all-cause, CVD, and cancer mortality were assessed by weighted Cox proportional hazard regression models. : over a median follow-up period of 27.1 years, we found that in the general population, AGE scores of both baked foods and meat were risk factors for all-cause, CVD, and cancer mortality. Specially, higher AGE scores in total and those derived from 10 of the 13 food groups were statistically associated with an increased risk of CVD mortality. Egg-, fruit-, and vegetable-derived AGE scores were positively correlated with the risk of cancer mortality. Additionally, there were positive multiplicative and additive interactions between smoking and meat-derived AGE scores on all-cause mortality. : high amounts of AGE consumption is associated with an increased risk of CVD mortality, and meat and baked food-derived AGEs were positively linked to all-cause, CVD, and cancer mortalities. Adherence to unhealthy lifestyles, such as smoking, may increase mortality from leading causes in individuals with AGE-enriched diet habits.
Topics: Humans; Diet; Nutrition Surveys; Cause of Death; Prospective Studies; Maillard Reaction; Risk Factors; Vegetables; Cardiovascular Diseases; Neoplasms
PubMed: 38235609
DOI: 10.1039/d3fo03945e -
The Journal of Clinical Endocrinology... Mar 2024
Topics: Humans; Hospital Mortality; Hyperglycemia
PubMed: 38055957
DOI: 10.1210/clinem/dgad680 -
The Journal of Clinical Endocrinology... Mar 2024
Topics: Humans; Hospital Mortality; Hyperglycemia
PubMed: 37992182
DOI: 10.1210/clinem/dgad679 -
Journal of Clinical Gastroenterology Jul 2024Pancreatic cancer is the third leading cause of cancer deaths in the United States. Despite decreasing cancer mortality rates as a whole, pancreatic cancer death rates...
BACKGROUND
Pancreatic cancer is the third leading cause of cancer deaths in the United States. Despite decreasing cancer mortality rates as a whole, pancreatic cancer death rates in the United States remain steady and demonstrate racial/ethnic disparities. Divergent cancer mortality trends have also been observed between metro and nonmetro populations. We therefore aimed to compare metro and nonmetro trends in pancreatic cancer mortality rates in the United States from 1999 to 2020 and investigate potential sex and racial/ethnic differences.
METHODS
We analyzed National Center for Health Statistics data for all pancreatic cancer deaths among individuals aged 25 years or older in the United States. We estimated the average annual percent change (AAPC) in age-standardized pancreatic cancer mortality rates in metro versus nonmetro areas by sex and race/ethnicity.
RESULTS
Of the total 810,425 pancreatic cancer-related deaths identified from 1999 to 2020, 668,547 occurred in metro areas and 141,878 in nonmetro areas. Non-Hispanic Black individuals had the highest rates of pancreatic cancer mortality regardless of metropolitan status. In both metro and nonmetro areas, pancreatic cancer mortality rates among non-Hispanic White individuals increased over the study period (AAPC: metro, males, 0.32%; females, 0.27%; nonmetro, males, 0.77%; females, 0.62%). Non-Hispanic Black individuals in metro areas had a decrease in pancreatic cancer mortality (AAPC: males, -0.25%; females, -0.29%), but rates among non-Hispanic Black women in nonmetro areas increased (AAPC, 0.49%).
CONCLUSIONS
There are variations not only in pancreatic cancer mortality by metro and nonmetro status but also by sex and race/ethnicity within these areas. Individuals who live in nonmetro areas have higher pancreatic cancer mortality rates and increasing death rates compared with their metro counterparts. These findings highlight the need for targeted cancer prevention strategies that are specific to metro or nonmetro populations.
Topics: Humans; Pancreatic Neoplasms; Male; Female; United States; Middle Aged; Adult; Aged; Health Status Disparities; Mortality; Aged, 80 and over; Rural Population
PubMed: 37983816
DOI: 10.1097/MCG.0000000000001929 -
PloS One 2023Schizophrenia spectrum disorders (SSDs) are associated with significant functional impairments, disability, and low rates of personal recovery, along with tremendous...
Schizophrenia spectrum disorders (SSDs) are associated with significant functional impairments, disability, and low rates of personal recovery, along with tremendous economic costs linked primarily to lost productivity and premature mortality. Efforts to delineate the contributors to disability in SSDs have highlighted prominent roles for a diverse range of symptoms, physical health conditions, substance use disorders, neurobiological changes, and social factors. These findings have provided valuable advances in knowledge and helped define broad patterns of illness and outcomes across SSDs. Unsurprisingly, there have also been conflicting findings for many of these determinants that reflect the heterogeneous population of individuals with SSDs and the challenges of conceptualizing and treating SSDs as a unitary categorical construct. Presently it is not possible to identify the functional course on an individual level that would enable a personalized approach to treatment to alter the individual's functional trajectory and mitigate the ensuing disability they would otherwise experience. To address this ongoing challenge, this study aims to conduct a longitudinal multimodal investigation of a large cohort of individuals with SSDs in order to establish discrete trajectories of personal recovery, disability, and community functioning, as well as the antecedents and predictors of these trajectories. This investigation will also provide the foundation for the co-design and testing of personalized interventions that alter these functional trajectories and improve outcomes for people with SSDs.
Topics: Humans; Schizophrenia; Knowledge; Mortality, Premature; Neurobiology; Physical Examination
PubMed: 37733693
DOI: 10.1371/journal.pone.0288354 -
Thrombosis Research Aug 2023Population-based data on high-risk pulmonary embolism (PE) mortality trends in the United States (US) are scant.
BACKGROUND
Population-based data on high-risk pulmonary embolism (PE) mortality trends in the United States (US) are scant.
OBJECTIVES
To assess current trends in US mortality related to high-risk PE over the past 21 years and determine differences by sex, race, ethnicity, age and census region.
METHODS
Data were extracted from the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) to determine trends in age-adjusted mortality rates (AAMR) per 100,000 people, due to high-risk PE. To calculate nationwide annual trends, we assessed the average (AAPC) and annual percent change (APC) with relative 95 % confidence intervals (CIs) using Joinpoint regression.
RESULTS
Between 1999 and 2019, high-risk PE was listed as the underlying cause of death in 209,642 patients, corresponding to an AAMR of 3.01 per 100,000 people (95 % CI: 2.99 to 3.02). AAMR from high-risk PE remained stable from 1999 to 2007 [APC: -0.2 %, (95 % CI: -2.0 to 0.5, p = 0.22)] and then significantly increased [APC: 3.1 % (95 % CI: 2.6 to 3.6), p < 0.0001], especially in males [AAPC: 1.9 % (95 % CI: 1.4 to 2.4), p < 0.001 vs AAPC: 1.5 % (95 % CI: 1.1 to 2.2), p < 0.001]. AAMR increase was more pronounced in those <65 years, Black Americans, and residents of rural areas.
CONCLUSIONS
In an US population analysis, high-risk PE mortality rate increased, with racial, sex-based, and regional variations. Further studies are needed to understand root causes for these trends and to implement appropriate corrective strategies.
Topics: Humans; Male; Black or African American; Mortality; Pulmonary Embolism; United States; Racial Groups; Race Factors; Sex Factors; Rural Population; Age Factors
PubMed: 37295022
DOI: 10.1016/j.thromres.2023.05.028 -
Journal of the American Medical... Mar 2024To examine the dose-response relationship between physical activity (PA) and all-cause and cardiovascular disease (CVD) mortality, specifically among older adults. (Review)
Review
OBJECTIVES
To examine the dose-response relationship between physical activity (PA) and all-cause and cardiovascular disease (CVD) mortality, specifically among older adults.
DESIGN
Umbrella review.
SETTING AND PARTICIPANTS
Eligible studies included systematic reviews with meta-analyses that investigated the association of aerobic PA, muscle-strengthening activity, and multicomponent PA, including exercise programs (such as aerobic, muscle strengthening, and balance training), with all-cause and CVD mortality among older adults aged ≥60 years.
METHODS
We performed a literature search in PubMed, CINAHL, and the Cochrane Library for eligible studies published between January 2017 and March 2023 to update an umbrella review initially conducted by the United States 2018 PA Guidelines Advisory Committee. Studies included in the 2018 US PA and 2020 World Health Organization (WHO) Guidelines were also reviewed. In addition, meta-analyses that reported effect sizes stratified by age and recruiting older adults (aged ≥60 years) were included.
RESULTS
Overall, 16 relevant systematic reviews (10 from our review and 6 from the US and WHO guidelines) met the inclusion criteria. All these reviews showed that 7.5 to 15.0 metabolic equivalents (METs)-hours/week (around the recommended PA levels outlined in the US and WHO guidelines) substantially reduced mortality risks among older adults (approximately 19%-30% for all-cause mortality and 25%-34% for CVD mortality). Moreover, 15.0 to 22.5 MET-hours/week, exceeding the guideline-recommended PA levels, resulted in greater reductions in mortality risks by 35% to 37% and 38% to 40%, respectively.
CONCLUSIONS AND IMPLICATIONS
PA substantially reduced all-cause and CVD mortality risks among older adults. Larger risk reductions may be achieved by engaging in PA levels higher than those recommended by the current international PA guidelines. Our findings suggest that recommending higher PA levels beyond the current guidelines may benefit older adults when developing future international PA guidelines.
Topics: Aged; Humans; Cardiovascular Diseases; Exercise; Risk Reduction Behavior; Systematic Reviews as Topic; Meta-Analysis as Topic; Mortality
PubMed: 37925162
DOI: 10.1016/j.jamda.2023.09.028 -
Health Psychology : Official Journal of... Apr 2024Various literature are suggestive of a relation between lifetime trauma and mortality risk in adulthood, however, findings seem unclear and inconsistent. In our...
OBJECTIVE
Various literature are suggestive of a relation between lifetime trauma and mortality risk in adulthood, however, findings seem unclear and inconsistent. In our preregistered review, we conducted a systematic review to examine the association between lifetime trauma and mortality risk in adulthood.
METHOD
Six databases (Scopus, Web of Science, CINAHL [EBSCO], PsycInfo [EBSCO], Embase, and Medline [PubMed]); were searched up to April 2023 for studies reporting adult mortality outcomes associated with traumatic events accumulated across the lifespan. Five studies were found, and a narrative review of the literature was conducted.
RESULTS
Five studies met the inclusion criteria, including 5,506 individuals. Two studies with men/male-only samples reported no relation between lifetime trauma and mortality risk; however, three studies with a mixed-sex sample found a positive relation between lifetime trauma and mortality risk, indicating that the more traumatic events a person has across their lifespan, the greater their mortality risk.
CONCLUSION
Lifetime trauma appears to be associated with mortality risk during adulthood. The strongest evidence stems from larger samples. However, research is sparse and inconclusive. A plethora of additional research is needed to address several limitations within the current literature, which includes utilizing standardized measures of lifetime trauma, replication of effects, and the examination of vulnerable and underrepresented populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Topics: Adult; Humans; Male; Longevity; Wounds and Injuries; Mortality; Female
PubMed: 38190201
DOI: 10.1037/hea0001343